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I want to inform you that we are keeping you longer,’” Golomb, who was 33 at the time, recalled saying to the patient. “‘You will have the opportunity to meet with a judge on Monday.’”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The patient called her a thief and a liar, Golomb told KQED in a recent interview.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Chris Van Gorder, CEO, Scripps Health\"]‘Violence in emergency rooms is not exactly new. But it is worse than it’s ever been, by far.’[/pullquote]Golomb said she placed paperwork and the phone number for a patient advocacy line on the foot of the bed before slowly walking out of the room, closing the door behind her. She was seeing other patients when she heard someone yell “thief” and “liar.”\u003c/p>\n\u003cp>Suddenly, from behind, came a forceful shove and Golomb was on the ground being “punched in the head, neck and shoulders,” she said. The patient grabbed her metal clipboard, “smashing it repeatedly on my head, dragging me by my hair.”\u003c/p>\n\u003cp>Golomb suffered a concussion and a traumatic brain injury, but she wouldn’t find out about that until later.\u003c/p>\n\u003cp>“I came to, and there was one of our wonderful nurses kneeling before me,” she said. “I don’t know if he broke up what was happening or if another patient pulled [them off]. But I immediately ran off to go upstairs to collect myself and just cry.”\u003c/p>\n\u003cp>Health care workers suffer the highest rates of injury caused by violence on the job. They are five times as likely than workers overall to experience a violent injury, according to \u003ca href=\"https://www.bls.gov/iif/factsheets/workplace-violence-healthcare-2018.htm\">federal statistics\u003c/a>. California hospitals tallied roughly \u003ca href=\"https://www.dir.ca.gov/dosh/WPVIH_Annual_Reports.html\">10,000 incidents annually in recent years\u003c/a>.\u003c/p>\n\u003cp>In February, San Mateo County prosecutors charged an unhoused man with attempted murder after he \u003ca href=\"https://www.beckershospitalreview.com/legal-regulatory-issues/sutter-hospital-employee-stabbed-man-charged.html\">allegedly stabbed a health worker nine times with a pocket knife\u003c/a> at Sutter Health’s Mills-Peninsula Medical Center in Burlingame.\u003c/p>\n\u003cp>[aside postID=\"news_11955211,news_11944448\" label=\"Related Stories\"]Nurses in the Santa Clara County health system have authorized a strike over what they describe as violent work conditions. James Mount, who works in the intensive care unit at the St. Louise Regional Hospital in Gilroy, said the vast majority of his colleagues don’t feel safe.\u003c/p>\n\u003cp>“They have witnessed the escalation of violence within hospitals since COVID,” he said. “It’s disheartening. Our challenge is to try and feel secure in our job and take care of our patients. That’s why we are there. What we are asking for is for someone to protect those frontline workers who are treating the patients.”\u003c/p>\n\u003cfigure id=\"attachment_1991425\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991425\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED.jpg\" alt='The outside of a building and sign that reads \"Sutter Health.\"' width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Sutter Health CPMC Davies Campus in San Francisco on Feb. 8, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Staff inside the Sutter Health inpatient psych unit in San Francisco where Golomb was attacked said they are regularly threatened and assaulted, including being pushed, punched and pulled to the ground, according to interviews with Golomb and more than a half dozen of her resident colleagues and nurses and a KQED review of internal documents.\u003c/p>\n\u003cp>In a survey conducted by the psych residents, three-quarters of those who responded and work on that unit said they are in “an unsafe situation on a daily or weekly basis.” They all report they have experienced violence or harassment from a patient.\u003c/p>\n\u003cp>“Violence in emergency rooms is not exactly new. But it is worse than it’s ever been, by far,” said Chris Van Gorder, the CEO of Scripps Health in San Diego. He attributes the uptick in violence to a surge in homelessness, a drug crisis and a lack of available care for behavioral health patients.\u003c/p>\n\u003cp>“The hospital is the end of the food chain,” he said. “Nobody else knows what to do with you. They bring you to the hospital emergency room and assume that we’re going to somehow be able to take care of you.”\u003c/p>\n\u003cp>Golomb and her colleagues said the hospital is not doing enough to ensure their safety, as 91% of the residents responded to the survey saying the security presence was “not at all adequate.”\u003c/p>\n\u003cfigure id=\"attachment_1991428\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991428\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED.jpg\" alt=\"A person's hand holds up a cellphone with an image of people holding signs.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dani Golomb, psychiatry resident at CPMC Sutter Davies Campus, holds a photo of herself and fellow psych unit staff holding signs asking for more safety measures at their hospital at her home in San Francisco on Feb. 9, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s one of the reasons that Golomb and about 15 of her resident colleagues \u003ca href=\"https://sfstandard.com/2023/01/17/san-francisco-hospital-cpmc-residents-unionize/\">announced in January their plans to unionize\u003c/a> and join the Committee of Interns and Residents, which represents 30,000 resident and fellow physicians and is a local of the powerful Service Employees International Union.\u003c/p>\n\u003cp>As part of their bargaining with Sutter Health, residents demand round-the-clock security presence in the inpatient psych unit. At the time of Golomb’s attack, the unit was located in the Pacific Heights neighborhood across the street from the larger medical campus. Staff would call security, and they “would come running from a full city block away,” Golomb said.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Dani Golomb, psychiatry resident, California Pacific Medical Center\"]‘They see their doctor get pummeled, dragged and beat up. What must that feel like as a patient?’[/pullquote]In 2022, Sutter moved the inpatient psych unit to its California Pacific Medical Center Davies campus near the Duboce Triangle in San Francisco and, in a statement to KQED, Sutter said it had spent nearly $40 million to “enhance safety at the facility,” on things like cameras, panic buttons, duress alarms and secured doors. Staff can reach security by phone and a voice-operated device.\u003c/p>\n\u003cp>“Inpatient psychiatric units, in particular, are among the more challenging work environments to fully secure while providing therapeutic and compassionate care to the patients being served by them,” Sutter’s statement said.\u003c/p>\n\u003cp>But Golomb and other hospital staff said security officers at the new facility are often stationed on the lower floors of the hospital, on the other side of the building, which means they would have to run across the building and then ride an elevator up to the third-floor psych unit before badging through two sets of doors.\u003c/p>\n\u003cfigure id=\"attachment_1991429\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991429\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED.jpg\" alt=\"A man wearing glasses and a jacket over scrubs sits outside on a bench.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Eric Kalis, a residency doctor at CPMC Sutter Davies Campus, poses for a portrait at the hospital in San Francisco on Feb. 13, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“The security issue is particularly salient for us residents because we’re actively asking for [Sutter] to help us, and we’ve not been receiving that help,” said Eric Kalis, a second-year psychiatry resident with California Pacific Medical Center.\u003c/p>\n\u003cp>Sutter’s statement said the hospital had planned to staff the inpatient psych unit with a “dedicated in-unit security officer” from 11 a.m. to 7 p.m. when it moved into the Davies facility in 2022. However, that “proved challenging” and didn’t initially happen.\u003c/p>\n\u003cp>“Since late last year, this position has been consistently staffed,” the statement said.\u003c/p>\n\u003cp>The hospital said it recently extended the hours, beginning at 9 a.m.\u003c/p>\n\u003ch2>Fallout from the assault\u003c/h2>\n\u003cp>For days following her assault, Golomb “felt very surreal and odd and strange.” She had trouble with her vision, hearing, balance and sense of spatial relations. She had trouble multitasking and making decisions, and her mood was volatile.\u003c/p>\n\u003cp>A series of brain scans revealed that an abnormal cluster of blood vessels in her brain had bled either during or after the attack.\u003c/p>\n\u003cp>“And while all that was going on, I was desperately trying to find out what to do,” Golomb said. “What does a resident do when they are assaulted? And I couldn’t get any answers.”\u003c/p>\n\u003cp>After a week, Golomb returned to work and “white-knuckled it” for a while, powering through what she described as “excruciating headaches.” She felt embarrassed, having been “torn apart in front of my colleagues,” and worried about the attack’s impact on her patients.\u003c/p>\n\u003cp>“They see their doctor get pummeled, dragged and beat up,” she said. “What must that feel like as a patient?”\u003c/p>\n\u003ch2>California passes controversial plans to expand involuntary holds\u003c/h2>\n\u003cp>State lawmakers have passed a flurry of laws in recent years targeted at workplace violence in health care, including requiring \u003ca href=\"https://www.nationalnursesunited.org/press/california-senate-approves-rn-sponsored-bill-reduce-workplace-violence-hospitals\">hospitals to have a violence prevention plan\u003c/a> and \u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_1251-1300/sb_1299_cfa_20140609_152624_asm_comm.html\">report violent incidents to the state\u003c/a>. This year, an association of hospitals — including Sutter and Scripps — are pushing \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB977\">AB 977\u003c/a>, which would increase penalties on people who are violent toward patients or hospital staff.\u003c/p>\n\u003cp>Lawmakers have also thrown billions of dollars at trying to address the mental health issues at the root cause of some of that violence.\u003c/p>\n\u003cfigure id=\"attachment_1991430\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991430\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED.jpg\" alt='A purple button that says \"Doctors Uniting for Patient Care.\"' width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Eric Kalis, a residency doctor at CPMC Sutter Davies Campus, wears a pin that says, ‘Doctors Uniting for Patient Care’ at the hospital in San Francisco on Feb. 13, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This includes a new California civil CARE Court, which launched last fall in \u003ca href=\"https://www.kqed.org/news/11955211/californias-new-care-courts-prompt-orange-county-to-weigh-best-practices\">eight counties, including San Francisco\u003c/a>. It allows family members and first responders to ask judges to order people with psychotic illness into treatment.\u003c/p>\n\u003cp>Last year, California passed \u003ca href=\"https://www.kqed.org/news/11944448/a-war-of-compassion-debate-over-forced-treatment-of-mental-illness-splits-california-liberals\">SB 43\u003c/a>, a controversial update to its conservatorship law, which for decades has allowed involuntary holds and treatment for people who are a danger to themselves or others or if they are unable to seek food, clothing or shelter as a result of mental illness. With Gov. Gavin Newsom’s approval, it now covers people who cannot care for themselves because of a substance use disorder.\u003c/p>\n\u003cp>“We know, and as we see every single day, we have gaping holes in our safety net and it allows people to fall onto our sidewalks with a horrible splat,” said state Sen. Susan Talamantes Eggman, who authored the update.\u003c/p>\n\u003cp>\u003ca href=\"https://www.disabilityrightsca.org/\">Disability rights groups\u003c/a> pushed back, saying it deprived people of their liberty, privacy and civil rights.\u003c/p>\n\u003cp>Meanwhile, hospital officials said the efforts could create more problems for the facilities and health care workers who treat these individuals.\u003c/p>\n\u003cp>“Where are you going to take those patients? We’re not equipped to be a jail,” Van Gorder said. “They’re all going to go to the hospital, and I think we’ve got this looming crisis on our hands.”\u003c/p>\n\u003cp>Van Gorder pushed the San Diego County Board of Supervisors to delay the implementation of SB 43, which it did for a year. He also helped create a \u003ca href=\"https://www.scripps.org/news_items/7725-hospital-violence-task-force-makes-progress-on-protecting-health-care-workers\">hospital violence task force\u003c/a>, in partnership with San Diego County’s District Attorney, which allows police to make rounds through hospitals and improves training and tracking of violent cases.\u003c/p>\n\u003cp>San Francisco County, the first county in California to implement SB 43, began to submit people for conservatorship at the beginning of the year.\u003c/p>\n\u003ch2>‘I was not myself and spiraling’\u003c/h2>\n\u003cp>To hear Golomb tell it, the attack strained her relationship with her supervisors. She felt blamed for not de-escalating the situation before the attack and described her conversations with hospital officials about it as “volatile.”\u003c/p>\n\u003cfigure id=\"attachment_1991426\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991426\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED.jpg\" alt=\"A woman wearing a red shirt plays with an animal in a home.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dani Golomb, psychiatry resident at CPMC Sutter Davies Campus, repairs a quilt she made at her home, with her bunny Hanky nearby, in San Francisco on Feb. 9, 2024. Golomb makes art as a coping mechanism after experiencing workplace violence incidents where patients have attacked staff. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Golomb took a few more weeks off and then returned to work part time, leaving more work for her resident colleagues. “I felt very stressed, guilty, overwhelmed by that,” she said. “I was not myself and spiraling.”\u003c/p>\n\u003cp>Exhausted and suffering from head, neck and back pain, Golomb talked with her doctor and decided to take a second leave, this time for a full year. While she was out, Golomb said the hospital told her it couldn’t guarantee her position when she returned. She thought: “‘Oh my God, is my career jeopardized because of this?’”\u003c/p>\n\u003cp>Golomb tried all kinds of therapy: physical, occupational, speech, vestibular and neuromuscular. She unsuccessfully attempted to match with another residency program. Returning to work at Sutter “became my only option.”\u003c/p>\n\u003cp>“You have to fight tooth and nail to get here,” said Golomb, who is on course to graduate from her residency in June 2025 and plans to pursue a private psychiatry practice. “And that’s what I did, and that’s what I chose to do.”\u003c/p>\n\u003cp>When she returned to work at Sutter, two things helped her turn things around: art and labor organizing. She joined a support group for artists with head injuries and stitched quilts and hand-built ceramics.\u003c/p>\n\u003cp>“I’ve always been an artist way before I was interested in medicine,” she said. “It was just very tethering, making a blanket that’s going to keep you warm or a bowl that can hold your soup.”\u003c/p>\n\u003cp>Back at work, Golomb felt like she had something to prove and had to shake a reputation that she had dramatized the assault to get out of work. She dove into the effort to unionize residents at California Pacific Medical Center.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“It was a way to demonstrate my care for others,” she said. “Having shared goals and putting the work in was really what allowed me to survive. Because going back was absolutely terrifying.”\u003c/p>\n\n","blocks":[],"excerpt":"Residents of the California Pacific Medical Center are pushing the Sutter Health network for increased security in an inpatient psych unit after a horrific assault.","status":"publish","parent":0,"modified":1710790309,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":54,"wordCount":2441},"headData":{"title":"Bay Area Psychiatry Resident Pushes for Hospital Safety After Violent Attack | KQED","description":"Residents of the California Pacific Medical Center are pushing the Sutter Health network for increased security in an inpatient psych unit after a horrific assault.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Bay Area Psychiatry Resident Pushes for Hospital Safety After Violent Attack","datePublished":"2024-03-07T12:00:32.000Z","dateModified":"2024-03-18T19:31:49.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"audioUrl":"https://traffic.omny.fm/d/clips/0af137ef-751e-4b19-a055-aaef00d2d578/ffca7e9f-6831-4[…]f-aaef00f5a073/64caf7a4-0ff3-44e0-b72f-b1370105a410/audio.mp3","sticky":false,"excludeFromSiteSearch":"Include","articleAge":"0","path":"/science/1991739/bay-area-medical-psychiatry-pushes-for-hospital-safety-after-violent-attack","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Dani Golomb started her shift on Sept. 5, 2020, she had no idea that she’d be beaten, dragged and knocked unconscious.\u003c/p>\n\u003cp>Like usual, the psychiatry resident reported to an inpatient unit at California Pacific Medical Center at 8 a.m. The hospital was extending one patient’s legal hold, and it fell on Golomb to deliver the news.\u003c/p>\n\u003cp>“Most of the patients we’re seeing are San Francisco’s sickest,” Golomb said, referring to what health care workers call “5150s,” a California legal code that allows people experiencing a mental health crisis to be involuntarily committed for 72 hours if they are a danger to others or themselves.\u003c/p>\n\u003cp>The patient had been violent before and had a temper.\u003c/p>\n\u003cp>“‘I know this isn’t what you wanted to hear, and I know you want to go home. I want to inform you that we are keeping you longer,’” Golomb, who was 33 at the time, recalled saying to the patient. “‘You will have the opportunity to meet with a judge on Monday.’”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The patient called her a thief and a liar, Golomb told KQED in a recent interview.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘Violence in emergency rooms is not exactly new. But it is worse than it’s ever been, by far.’","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Chris Van Gorder, CEO, Scripps Health","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Golomb said she placed paperwork and the phone number for a patient advocacy line on the foot of the bed before slowly walking out of the room, closing the door behind her. She was seeing other patients when she heard someone yell “thief” and “liar.”\u003c/p>\n\u003cp>Suddenly, from behind, came a forceful shove and Golomb was on the ground being “punched in the head, neck and shoulders,” she said. The patient grabbed her metal clipboard, “smashing it repeatedly on my head, dragging me by my hair.”\u003c/p>\n\u003cp>Golomb suffered a concussion and a traumatic brain injury, but she wouldn’t find out about that until later.\u003c/p>\n\u003cp>“I came to, and there was one of our wonderful nurses kneeling before me,” she said. “I don’t know if he broke up what was happening or if another patient pulled [them off]. But I immediately ran off to go upstairs to collect myself and just cry.”\u003c/p>\n\u003cp>Health care workers suffer the highest rates of injury caused by violence on the job. They are five times as likely than workers overall to experience a violent injury, according to \u003ca href=\"https://www.bls.gov/iif/factsheets/workplace-violence-healthcare-2018.htm\">federal statistics\u003c/a>. California hospitals tallied roughly \u003ca href=\"https://www.dir.ca.gov/dosh/WPVIH_Annual_Reports.html\">10,000 incidents annually in recent years\u003c/a>.\u003c/p>\n\u003cp>In February, San Mateo County prosecutors charged an unhoused man with attempted murder after he \u003ca href=\"https://www.beckershospitalreview.com/legal-regulatory-issues/sutter-hospital-employee-stabbed-man-charged.html\">allegedly stabbed a health worker nine times with a pocket knife\u003c/a> at Sutter Health’s Mills-Peninsula Medical Center in Burlingame.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11955211,news_11944448","label":"Related Stories "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Nurses in the Santa Clara County health system have authorized a strike over what they describe as violent work conditions. James Mount, who works in the intensive care unit at the St. Louise Regional Hospital in Gilroy, said the vast majority of his colleagues don’t feel safe.\u003c/p>\n\u003cp>“They have witnessed the escalation of violence within hospitals since COVID,” he said. “It’s disheartening. Our challenge is to try and feel secure in our job and take care of our patients. That’s why we are there. What we are asking for is for someone to protect those frontline workers who are treating the patients.”\u003c/p>\n\u003cfigure id=\"attachment_1991425\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991425\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED.jpg\" alt='The outside of a building and sign that reads \"Sutter Health.\"' width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Sutter Health CPMC Davies Campus in San Francisco on Feb. 8, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Staff inside the Sutter Health inpatient psych unit in San Francisco where Golomb was attacked said they are regularly threatened and assaulted, including being pushed, punched and pulled to the ground, according to interviews with Golomb and more than a half dozen of her resident colleagues and nurses and a KQED review of internal documents.\u003c/p>\n\u003cp>In a survey conducted by the psych residents, three-quarters of those who responded and work on that unit said they are in “an unsafe situation on a daily or weekly basis.” They all report they have experienced violence or harassment from a patient.\u003c/p>\n\u003cp>“Violence in emergency rooms is not exactly new. But it is worse than it’s ever been, by far,” said Chris Van Gorder, the CEO of Scripps Health in San Diego. He attributes the uptick in violence to a surge in homelessness, a drug crisis and a lack of available care for behavioral health patients.\u003c/p>\n\u003cp>“The hospital is the end of the food chain,” he said. “Nobody else knows what to do with you. They bring you to the hospital emergency room and assume that we’re going to somehow be able to take care of you.”\u003c/p>\n\u003cp>Golomb and her colleagues said the hospital is not doing enough to ensure their safety, as 91% of the residents responded to the survey saying the security presence was “not at all adequate.”\u003c/p>\n\u003cfigure id=\"attachment_1991428\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991428\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED.jpg\" alt=\"A person's hand holds up a cellphone with an image of people holding signs.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dani Golomb, psychiatry resident at CPMC Sutter Davies Campus, holds a photo of herself and fellow psych unit staff holding signs asking for more safety measures at their hospital at her home in San Francisco on Feb. 9, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s one of the reasons that Golomb and about 15 of her resident colleagues \u003ca href=\"https://sfstandard.com/2023/01/17/san-francisco-hospital-cpmc-residents-unionize/\">announced in January their plans to unionize\u003c/a> and join the Committee of Interns and Residents, which represents 30,000 resident and fellow physicians and is a local of the powerful Service Employees International Union.\u003c/p>\n\u003cp>As part of their bargaining with Sutter Health, residents demand round-the-clock security presence in the inpatient psych unit. At the time of Golomb’s attack, the unit was located in the Pacific Heights neighborhood across the street from the larger medical campus. Staff would call security, and they “would come running from a full city block away,” Golomb said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘They see their doctor get pummeled, dragged and beat up. What must that feel like as a patient?’","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Dani Golomb, psychiatry resident, California Pacific Medical Center","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>In 2022, Sutter moved the inpatient psych unit to its California Pacific Medical Center Davies campus near the Duboce Triangle in San Francisco and, in a statement to KQED, Sutter said it had spent nearly $40 million to “enhance safety at the facility,” on things like cameras, panic buttons, duress alarms and secured doors. Staff can reach security by phone and a voice-operated device.\u003c/p>\n\u003cp>“Inpatient psychiatric units, in particular, are among the more challenging work environments to fully secure while providing therapeutic and compassionate care to the patients being served by them,” Sutter’s statement said.\u003c/p>\n\u003cp>But Golomb and other hospital staff said security officers at the new facility are often stationed on the lower floors of the hospital, on the other side of the building, which means they would have to run across the building and then ride an elevator up to the third-floor psych unit before badging through two sets of doors.\u003c/p>\n\u003cfigure id=\"attachment_1991429\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991429\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED.jpg\" alt=\"A man wearing glasses and a jacket over scrubs sits outside on a bench.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Eric Kalis, a residency doctor at CPMC Sutter Davies Campus, poses for a portrait at the hospital in San Francisco on Feb. 13, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“The security issue is particularly salient for us residents because we’re actively asking for [Sutter] to help us, and we’ve not been receiving that help,” said Eric Kalis, a second-year psychiatry resident with California Pacific Medical Center.\u003c/p>\n\u003cp>Sutter’s statement said the hospital had planned to staff the inpatient psych unit with a “dedicated in-unit security officer” from 11 a.m. to 7 p.m. when it moved into the Davies facility in 2022. However, that “proved challenging” and didn’t initially happen.\u003c/p>\n\u003cp>“Since late last year, this position has been consistently staffed,” the statement said.\u003c/p>\n\u003cp>The hospital said it recently extended the hours, beginning at 9 a.m.\u003c/p>\n\u003ch2>Fallout from the assault\u003c/h2>\n\u003cp>For days following her assault, Golomb “felt very surreal and odd and strange.” She had trouble with her vision, hearing, balance and sense of spatial relations. She had trouble multitasking and making decisions, and her mood was volatile.\u003c/p>\n\u003cp>A series of brain scans revealed that an abnormal cluster of blood vessels in her brain had bled either during or after the attack.\u003c/p>\n\u003cp>“And while all that was going on, I was desperately trying to find out what to do,” Golomb said. “What does a resident do when they are assaulted? And I couldn’t get any answers.”\u003c/p>\n\u003cp>After a week, Golomb returned to work and “white-knuckled it” for a while, powering through what she described as “excruciating headaches.” She felt embarrassed, having been “torn apart in front of my colleagues,” and worried about the attack’s impact on her patients.\u003c/p>\n\u003cp>“They see their doctor get pummeled, dragged and beat up,” she said. “What must that feel like as a patient?”\u003c/p>\n\u003ch2>California passes controversial plans to expand involuntary holds\u003c/h2>\n\u003cp>State lawmakers have passed a flurry of laws in recent years targeted at workplace violence in health care, including requiring \u003ca href=\"https://www.nationalnursesunited.org/press/california-senate-approves-rn-sponsored-bill-reduce-workplace-violence-hospitals\">hospitals to have a violence prevention plan\u003c/a> and \u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_1251-1300/sb_1299_cfa_20140609_152624_asm_comm.html\">report violent incidents to the state\u003c/a>. This year, an association of hospitals — including Sutter and Scripps — are pushing \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB977\">AB 977\u003c/a>, which would increase penalties on people who are violent toward patients or hospital staff.\u003c/p>\n\u003cp>Lawmakers have also thrown billions of dollars at trying to address the mental health issues at the root cause of some of that violence.\u003c/p>\n\u003cfigure id=\"attachment_1991430\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991430\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED.jpg\" alt='A purple button that says \"Doctors Uniting for Patient Care.\"' width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Eric Kalis, a residency doctor at CPMC Sutter Davies Campus, wears a pin that says, ‘Doctors Uniting for Patient Care’ at the hospital in San Francisco on Feb. 13, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This includes a new California civil CARE Court, which launched last fall in \u003ca href=\"https://www.kqed.org/news/11955211/californias-new-care-courts-prompt-orange-county-to-weigh-best-practices\">eight counties, including San Francisco\u003c/a>. It allows family members and first responders to ask judges to order people with psychotic illness into treatment.\u003c/p>\n\u003cp>Last year, California passed \u003ca href=\"https://www.kqed.org/news/11944448/a-war-of-compassion-debate-over-forced-treatment-of-mental-illness-splits-california-liberals\">SB 43\u003c/a>, a controversial update to its conservatorship law, which for decades has allowed involuntary holds and treatment for people who are a danger to themselves or others or if they are unable to seek food, clothing or shelter as a result of mental illness. With Gov. Gavin Newsom’s approval, it now covers people who cannot care for themselves because of a substance use disorder.\u003c/p>\n\u003cp>“We know, and as we see every single day, we have gaping holes in our safety net and it allows people to fall onto our sidewalks with a horrible splat,” said state Sen. Susan Talamantes Eggman, who authored the update.\u003c/p>\n\u003cp>\u003ca href=\"https://www.disabilityrightsca.org/\">Disability rights groups\u003c/a> pushed back, saying it deprived people of their liberty, privacy and civil rights.\u003c/p>\n\u003cp>Meanwhile, hospital officials said the efforts could create more problems for the facilities and health care workers who treat these individuals.\u003c/p>\n\u003cp>“Where are you going to take those patients? We’re not equipped to be a jail,” Van Gorder said. “They’re all going to go to the hospital, and I think we’ve got this looming crisis on our hands.”\u003c/p>\n\u003cp>Van Gorder pushed the San Diego County Board of Supervisors to delay the implementation of SB 43, which it did for a year. He also helped create a \u003ca href=\"https://www.scripps.org/news_items/7725-hospital-violence-task-force-makes-progress-on-protecting-health-care-workers\">hospital violence task force\u003c/a>, in partnership with San Diego County’s District Attorney, which allows police to make rounds through hospitals and improves training and tracking of violent cases.\u003c/p>\n\u003cp>San Francisco County, the first county in California to implement SB 43, began to submit people for conservatorship at the beginning of the year.\u003c/p>\n\u003ch2>‘I was not myself and spiraling’\u003c/h2>\n\u003cp>To hear Golomb tell it, the attack strained her relationship with her supervisors. She felt blamed for not de-escalating the situation before the attack and described her conversations with hospital officials about it as “volatile.”\u003c/p>\n\u003cfigure id=\"attachment_1991426\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991426\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED.jpg\" alt=\"A woman wearing a red shirt plays with an animal in a home.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dani Golomb, psychiatry resident at CPMC Sutter Davies Campus, repairs a quilt she made at her home, with her bunny Hanky nearby, in San Francisco on Feb. 9, 2024. Golomb makes art as a coping mechanism after experiencing workplace violence incidents where patients have attacked staff. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Golomb took a few more weeks off and then returned to work part time, leaving more work for her resident colleagues. “I felt very stressed, guilty, overwhelmed by that,” she said. “I was not myself and spiraling.”\u003c/p>\n\u003cp>Exhausted and suffering from head, neck and back pain, Golomb talked with her doctor and decided to take a second leave, this time for a full year. While she was out, Golomb said the hospital told her it couldn’t guarantee her position when she returned. She thought: “‘Oh my God, is my career jeopardized because of this?’”\u003c/p>\n\u003cp>Golomb tried all kinds of therapy: physical, occupational, speech, vestibular and neuromuscular. She unsuccessfully attempted to match with another residency program. Returning to work at Sutter “became my only option.”\u003c/p>\n\u003cp>“You have to fight tooth and nail to get here,” said Golomb, who is on course to graduate from her residency in June 2025 and plans to pursue a private psychiatry practice. “And that’s what I did, and that’s what I chose to do.”\u003c/p>\n\u003cp>When she returned to work at Sutter, two things helped her turn things around: art and labor organizing. She joined a support group for artists with head injuries and stitched quilts and hand-built ceramics.\u003c/p>\n\u003cp>“I’ve always been an artist way before I was interested in medicine,” she said. “It was just very tethering, making a blanket that’s going to keep you warm or a bowl that can hold your soup.”\u003c/p>\n\u003cp>Back at work, Golomb felt like she had something to prove and had to shake a reputation that she had dramatized the assault to get out of work. She dove into the effort to unionize residents at California Pacific Medical Center.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It was a way to demonstrate my care for others,” she said. “Having shared goals and putting the work in was really what allowed me to survive. Because going back was absolutely terrifying.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/1991739/bay-area-medical-psychiatry-pushes-for-hospital-safety-after-violent-attack","authors":["11608"],"categories":["science_39","science_40","science_4450"],"tags":["science_4417","science_4414","science_1648","science_249","science_5254"],"featImg":"science_1991427","label":"science"},"science_1985952":{"type":"posts","id":"science_1985952","meta":{"index":"posts_1591205157","site":"science","id":"1985952","score":null,"sort":[1704456004000]},"guestAuthors":[],"slug":"how-to-support-your-mental-health-amidst-vicarious-trauma-and-war","title":"How to Protect Your Mental Health When Viewing War on Social Media","publishDate":1704456004,"format":"audio","headTitle":"How to Protect Your Mental Health When Viewing War on Social Media | KQED","labelTerm":{"site":"science"},"content":"\u003cp>The moment Haleema Bharoocha wakes up in the morning, she scrolls through social media to find out what’s happening in Gaza. The 25-year-old Muslim UC Berkeley graduate student said the footage makes her want to vomit, scream and cry.\u003c/p>\n\u003cp>Bharoocha couldn’t eat after watching footage \u003ca href=\"https://www.cnn.com/2023/12/08/middleeast/babies-al-nasr-gaza-hospital-what-we-know-intl/index.html#:~:text=Infants%20found%20dead%20and%20decomposing%20in%20evacuated%20hospital%20ICU%20in,Here's%20what%20we%20know&text=The%20bodies%20of%20decomposing%20babies,Baalousha%2C%20reportedly%20on%20November%2027.\">of newborns found dead at a hospital in Gaza\u003c/a>. Nurses had fled during intense fighting.[pullquote size=\"medium\" align=\"right\" citation=\"Sara Ghalaini, a licensed psychotherapist in Berkeley\"]‘If you’re surrounded by it, or witnessing it, you yourself are also part of that even if you don’t realize you are.’[/pullquote]\u003c/p>\n\u003cp>“How could you have an appetite after you saw decomposing babies in a hospital?” she asked. “It really does feel like I’m kind of hanging on by the last thread that I have in myself.”\u003c/p>\n\u003cp>Recently, while studying at the library, she said she started to hallucinate.\u003c/p>\n\u003cp>“There was a plastic wrapper that fell. But in my mind, for like two seconds, I thought it was a rat crawling towards me, and I just jumped,” she said. “Or I thought the person sitting next to me was moving. But they weren’t.”\u003c/p>\n\u003cp>As the Israel-Hamas war stretches into its 12th week, videos from overseas continue to shock viewers and listeners in the Bay Area. Footage from war has never been palatable. But today, social media provides instantaneous images from the battleground; horrific and violent videos — both real and fake. Every day, social media platforms are rivers of atrocities, which can leave people emotionally triggered, overwhelmed and unstable.\u003c/p>\n\u003cp>Shoshanna Howard learned about the initial attacks by Hamas on Israel when she was scrolling through social media. In the days following the Oct. 7 offensive, she happened upon a video that went viral showing what appeared to be \u003ca href=\"https://www.cnn.com/videos/world/2023/10/07/gaza-hostages-jeep-woman-amanpour-israel-vpx.cnn\">Hamas fighters pulling a woman with blood seeping through her sweatpants out of a truck\u003c/a>. She was limping, handcuffed and blindfolded.\u003c/p>\n\u003cp>“That broke me,” Howard said. “I could not fathom what was happening. And then seeing friends calling it liberation.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Howard, who is Jewish and has cousins living in Israel, was mortified that people she cared about were responding to the horrific acts by making statements that, to her, felt anti-Jewish. As the days passed, it became harder and harder to focus on running her communications business in Oakland.\u003c/p>\n\u003cp>“That’s when I started to have night terrors,” Howard said. “I was ending my days going into my closet. I would just cry and turn off the lights. Close the door. It just felt like what I had to do.”\u003c/p>\n\u003cp>These symptoms reflect \u003ca href=\"https://compassionbehavioralhealth.com/blog/signs-and-symptoms-of-secondary-trauma/\">secondary trauma\u003c/a>, according to \u003ca href=\"https://www.yusracoachinganddevelopment.com/meet-sara\">Sara Ghalaini\u003c/a>, a licensed psychotherapist in Berkeley. She said an individual may experience symptoms of post-traumatic stress disorder if they are exposed to people who have been traumatized or hear descriptions of traumatic events.\u003c/p>\n\u003cp>“If you’re surrounded by it or witnessing it, you yourself are also part of that, even if you don’t realize you are,” Ghalaini said.\u003c/p>\n\u003cp>She recommended people who are suffering surround themselves with community. Some people may find relief praying at a mosque, temple or church. Others may feel better after hitting the gym. Ghalaini said we are experiencing a “collective grief” and advised people to be gentle on themselves as there is no quick fix.\u003c/p>\n\u003cp>Bharoocha said she feels less helpless when she is protesting. She volunteers for groups that have organized numerous rallies, including a \u003ca href=\"https://www.berkeleyside.org/2023/10/25/students-walk-out-class-demanding-uc-berkeley-support-palestine\">mass student walkout on Oct. 25\u003c/a>. “For me, those are spaces to grieve and process,” she said.\u003c/p>\n\u003cp>[aside tag=\"mental-health, war\" label=\"More Related Stories\"]Howard found relief in listening to sermons or Hebrew songs online. She said she has \u003ca href=\"https://www.songtell.com/karolina-israel/af-echad-lo-ba-li\">Karolina’s “Af Echad Lo Ba li”\u003c/a> on repeat. But Howard’s major lifeline is talking to her psychotherapist, who recommended taking a break from social media.\u003c/p>\n\u003cp>Howard said that has been “really, really significant” for her mental health. She also suggests people find somewhere safe to talk.\u003c/p>\n\u003cp>“A place that you can go, that you can let down your guard, that you can speak your truth, and even do the work of accessing deeper truths,” said Robyn Bloom, the director of adult services for Jewish Family and Children’s Services in San Francisco.\u003c/p>\n\u003cp>Many organizations in the Bay Area, like the \u003ca href=\"https://khalilcenter.com/\">Khalil Center\u003c/a> or \u003ca href=\"https://www.jfcs.org/about/resources-during-israel-hamas-war/\">Jewish Family and Children Services\u003c/a> offer mental health support. You can also join a sewing circle or take a walk in nature.\u003c/p>\n\u003cp>“What’s happening is not normal,” Ghalaini said. “What’s happening is awful, and it’s happening to a lot of people whether you’re there or not.”\u003c/p>\n\u003cp>Ghalaini’s best advice is to slow down. Give yourself and the people around you a lot of grace.\u003c/p>\n\u003cp>\u003c/p>\n","blocks":[],"excerpt":"As the Israel-Hamas war stretches on, videos from overseas continue to shock viewers and listeners in the Bay Area. Social media platforms are rivers of atrocities, which can leave people emotionally triggered and overwhelmed. Here's advice from mental health professionals on how to cope.","status":"publish","parent":0,"modified":1706641598,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":841},"headData":{"title":"How to Protect Your Mental Health When Viewing War on Social Media | KQED","description":"As the Israel-Hamas war stretches on, videos from overseas continue to shock viewers and listeners in the Bay Area. Social media platforms are rivers of atrocities, which can leave people emotionally triggered and overwhelmed. Here's advice from mental health professionals on how to cope.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"How to Protect Your Mental Health When Viewing War on Social Media","datePublished":"2024-01-05T12:00:04.000Z","dateModified":"2024-01-30T19:06:38.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"audioUrl":"https://traffic.omny.fm/d/clips/0af137ef-751e-4b19-a055-aaef00d2d578/ffca7e9f-6831-4[…]f-aaef00f5a073/b03c84bf-5738-4724-b23e-b0d901296f02/audio.mp3","sticky":false,"excludeFromSiteSearch":"Include","articleAge":"0","path":"/science/1985952/how-to-support-your-mental-health-amidst-vicarious-trauma-and-war","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The moment Haleema Bharoocha wakes up in the morning, she scrolls through social media to find out what’s happening in Gaza. The 25-year-old Muslim UC Berkeley graduate student said the footage makes her want to vomit, scream and cry.\u003c/p>\n\u003cp>Bharoocha couldn’t eat after watching footage \u003ca href=\"https://www.cnn.com/2023/12/08/middleeast/babies-al-nasr-gaza-hospital-what-we-know-intl/index.html#:~:text=Infants%20found%20dead%20and%20decomposing%20in%20evacuated%20hospital%20ICU%20in,Here's%20what%20we%20know&text=The%20bodies%20of%20decomposing%20babies,Baalousha%2C%20reportedly%20on%20November%2027.\">of newborns found dead at a hospital in Gaza\u003c/a>. Nurses had fled during intense fighting.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘If you’re surrounded by it, or witnessing it, you yourself are also part of that even if you don’t realize you are.’","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Sara Ghalaini, a licensed psychotherapist in Berkeley","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“How could you have an appetite after you saw decomposing babies in a hospital?” she asked. “It really does feel like I’m kind of hanging on by the last thread that I have in myself.”\u003c/p>\n\u003cp>Recently, while studying at the library, she said she started to hallucinate.\u003c/p>\n\u003cp>“There was a plastic wrapper that fell. But in my mind, for like two seconds, I thought it was a rat crawling towards me, and I just jumped,” she said. “Or I thought the person sitting next to me was moving. But they weren’t.”\u003c/p>\n\u003cp>As the Israel-Hamas war stretches into its 12th week, videos from overseas continue to shock viewers and listeners in the Bay Area. Footage from war has never been palatable. But today, social media provides instantaneous images from the battleground; horrific and violent videos — both real and fake. Every day, social media platforms are rivers of atrocities, which can leave people emotionally triggered, overwhelmed and unstable.\u003c/p>\n\u003cp>Shoshanna Howard learned about the initial attacks by Hamas on Israel when she was scrolling through social media. In the days following the Oct. 7 offensive, she happened upon a video that went viral showing what appeared to be \u003ca href=\"https://www.cnn.com/videos/world/2023/10/07/gaza-hostages-jeep-woman-amanpour-israel-vpx.cnn\">Hamas fighters pulling a woman with blood seeping through her sweatpants out of a truck\u003c/a>. She was limping, handcuffed and blindfolded.\u003c/p>\n\u003cp>“That broke me,” Howard said. “I could not fathom what was happening. And then seeing friends calling it liberation.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Howard, who is Jewish and has cousins living in Israel, was mortified that people she cared about were responding to the horrific acts by making statements that, to her, felt anti-Jewish. As the days passed, it became harder and harder to focus on running her communications business in Oakland.\u003c/p>\n\u003cp>“That’s when I started to have night terrors,” Howard said. “I was ending my days going into my closet. I would just cry and turn off the lights. Close the door. It just felt like what I had to do.”\u003c/p>\n\u003cp>These symptoms reflect \u003ca href=\"https://compassionbehavioralhealth.com/blog/signs-and-symptoms-of-secondary-trauma/\">secondary trauma\u003c/a>, according to \u003ca href=\"https://www.yusracoachinganddevelopment.com/meet-sara\">Sara Ghalaini\u003c/a>, a licensed psychotherapist in Berkeley. She said an individual may experience symptoms of post-traumatic stress disorder if they are exposed to people who have been traumatized or hear descriptions of traumatic events.\u003c/p>\n\u003cp>“If you’re surrounded by it or witnessing it, you yourself are also part of that, even if you don’t realize you are,” Ghalaini said.\u003c/p>\n\u003cp>She recommended people who are suffering surround themselves with community. Some people may find relief praying at a mosque, temple or church. Others may feel better after hitting the gym. Ghalaini said we are experiencing a “collective grief” and advised people to be gentle on themselves as there is no quick fix.\u003c/p>\n\u003cp>Bharoocha said she feels less helpless when she is protesting. She volunteers for groups that have organized numerous rallies, including a \u003ca href=\"https://www.berkeleyside.org/2023/10/25/students-walk-out-class-demanding-uc-berkeley-support-palestine\">mass student walkout on Oct. 25\u003c/a>. “For me, those are spaces to grieve and process,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"tag":"mental-health, war","label":"More Related Stories "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Howard found relief in listening to sermons or Hebrew songs online. She said she has \u003ca href=\"https://www.songtell.com/karolina-israel/af-echad-lo-ba-li\">Karolina’s “Af Echad Lo Ba li”\u003c/a> on repeat. But Howard’s major lifeline is talking to her psychotherapist, who recommended taking a break from social media.\u003c/p>\n\u003cp>Howard said that has been “really, really significant” for her mental health. She also suggests people find somewhere safe to talk.\u003c/p>\n\u003cp>“A place that you can go, that you can let down your guard, that you can speak your truth, and even do the work of accessing deeper truths,” said Robyn Bloom, the director of adult services for Jewish Family and Children’s Services in San Francisco.\u003c/p>\n\u003cp>Many organizations in the Bay Area, like the \u003ca href=\"https://khalilcenter.com/\">Khalil Center\u003c/a> or \u003ca href=\"https://www.jfcs.org/about/resources-during-israel-hamas-war/\">Jewish Family and Children Services\u003c/a> offer mental health support. You can also join a sewing circle or take a walk in nature.\u003c/p>\n\u003cp>“What’s happening is not normal,” Ghalaini said. “What’s happening is awful, and it’s happening to a lot of people whether you’re there or not.”\u003c/p>\n\u003cp>Ghalaini’s best advice is to slow down. Give yourself and the people around you a lot of grace.\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/1985952/how-to-support-your-mental-health-amidst-vicarious-trauma-and-war","authors":["11229"],"categories":["science_39","science_40","science_4450"],"tags":["science_4414","science_249","science_697"],"featImg":"science_1985978","label":"science"},"science_1985979":{"type":"posts","id":"science_1985979","meta":{"index":"posts_1591205157","site":"science","id":"1985979","score":null,"sort":[1704398406000]},"guestAuthors":[],"slug":"kaiser-eases-restrictions-on-postpartum-depression-care-after-investigations","title":"Kaiser Eases Restrictions on Postpartum Depression Care After Investigations","publishDate":1704398406,"format":"standard","headTitle":"Kaiser Eases Restrictions on Postpartum Depression Care After Investigations | KQED","labelTerm":{"term":4951,"site":"science"},"content":"\u003cp>A year after her son, Nico, was born and she still felt like an empty shell of herself despite multiple attempts to find treatment, Miriam McDonald “came out” as suffering from debilitating postpartum depression, a decision she now says was totally worth it.\u003c/p>\n\u003cp>For months, McDonald battled her health provider and insurer, Kaiser Permanente, which denied her the one and only FDA-approved medication for postpartum depression, brexanolone. [pullquote size=\"medium\" align=\"right\" citation=\"Miriam McDonald, mother\"]‘No woman should suffer like I did after having a child. The policy was completely unfair. I was in purgatory.’[/pullquote]But since she shared the details of her struggle in a\u003ca href=\"https://www.kqed.org/news/11879309/theres-only-1-drug-for-postpartum-depression-why-does-kaiser-permanente-make-it-so-hard-to-get\"> 2021 KQED investigation\u003c/a>, Kaiser has revamped its coverage guidelines twice, according to internal documents recently obtained by KQED, and federal regulators — citing KQED’s reporting — have launched an investigation into the insurer that is still ongoing.\u003c/p>\n\u003cp>“This will prevent other women from having to go through a year of depression to find something that works,” McDonald said after learning of Kaiser’s policy changes. “No woman should suffer like I did after having a child. The policy was completely unfair. I was in purgatory.”\u003c/p>\n\u003cp>When McDonald experienced her first symptoms of postpartum depression in 2019, including suicidal thoughts, Kaiser’s written guidelines required patients to try and fail four medications and electroconvulsive therapy before they would be eligible for brexanolone. But, because the drug was only approved for use up to six months postpartum, experts said this amounted to a blanket denial for all Kaiser patients, a potential violation of state and federal law.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One month after KQED published its investigation, Kaiser overhauled its guidelines, instead recommending women try just one medication before becoming eligible for brexanolone, and if that trial could not be completed before the six-month window expired, women could bypass it and go straight to brexanolone.\u003c/p>\n\u003cp>“Kaiser basically went from having the most restrictive policy to the most robust,” said Joy Burkhard, executive director of the nonprofit\u003ca href=\"https://www.2020mom.org/\"> Policy Center for Maternal Mental Health\u003c/a>. “It’s now a gold standard for the rest of the industry.”\u003c/p>\n\u003ch2>Next, a federal investigation\u003c/h2>\n\u003cp>But the scrutiny over Kaiser didn’t stop there. By late 2022, the federal Department of Labor had launched an investigation into the insurer, according to emails reviewed by KQED. Investigators called McDonald and contacted other patients to discuss the difficulty they had accessing postpartum mental health care, including brexanolone.\u003c/p>\n\u003cp>A few months later, in March 2023, Kaiser revised its brexanolone guidelines again, removing all fail-first recommendations. Patients need only decline a trial of another medication. [pullquote size=\"medium\" align=\"right\" citation=\"Kaiser Permanente statement\"]‘Kaiser Permanente is committed to ensuring brexanolone is available when physicians and patients determine it is an appropriate treatment.’[/pullquote]“Since brexanolone was first approved for use, more experience and research have added to information about its efficacy and safety,” Kaiser said in a statement. “Kaiser Permanente is committed to ensuring brexanolone is available when physicians and patients determine it is an appropriate treatment.”\u003c/p>\n\u003cp>The Department of Labor said in an email to KQED that it “will not confirm or deny the existence of an ongoing investigation” as a matter of policy but added the agency could sue a private insurer and force it to change its policies if they violate federal law. It can also force insurers to provide treatment or reimburse patients who paid out of pocket for treatments the department found improperly denied.\u003c/p>\n\u003ch2>A new era for postpartum therapies\u003c/h2>\n\u003cp>Brexanolone came on the market in 2019 with the hope of revolutionizing the treatment of postpartum depression by targeting hormone function instead of the brain’s serotonin system, as typical antidepressants do. \u003ca href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression\">In early trials,\u003c/a> women with moderate to severe depression reported relief immediately after the three-day treatment. But brexanolone is expensive, $34,000 per treatment, and must be delivered intravenously during an inpatient hospital stay where patients can be closely monitored for side effects like fainting.\u003c/p>\n\u003cp>Both the price and finding a hospital certified to administer the drug proved to be prohibitive barriers for new mothers pursuing the treatment. Until recently, Kaiser did not have its own certification and had to refer women to one of only three other approved hospitals in California. [aside label='More Stories on health' tag='health']A new, more accessible pill form of the medication, zuranolone, taken once a day at home over 14 days, \u003ca href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression\">was approved by the FDA in August\u003c/a>. In November, Sage Therapeutics, the company that makes both drugs, set the price for zuranolone at $15,900.\u003c/p>\n\u003cp>Since then, less than 1% of health plans have established criteria for when they will cover it, according to \u003ca href=\"https://www.2020mom.org/blog/2023/12/15/zurzuvae-the-new-postpartum-depression-drug-now-available-in-the-us-this-is-how-insurers-have-responded\">an analysis\u003c/a> using data from \u003ca href=\"https://www.policyreporter.com/\">Policy Reporter\u003c/a>, a website that tracks insurance policies. Regulators, lawyers, and advocates are watching closely to see how insurance companies will shape policies for the new drug.\u003c/p>\n\u003cp>“We’ll have to see if insurers cover this drug and what fail-first requirements they put in,” said \u003ca href=\"https://psych-appeal.com/meiram-bendat-attorney-founder/\">Meiram Bendat\u003c/a>, an attorney and licensed psychotherapist who represents patients.\u003c/p>\n\u003cp>These new policies will be written at a time when the regulatory environment around mental health treatment is shifting. The federal Department of Labor is now cracking down more on potential violations of the \u003ca href=\"https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity\">2008 Mental Health Parity and Addiction Equity Act\u003c/a>, which requires insurers to cover psychiatric treatments on par with physical treatments.\u003c/p>\n\u003cp>As of this summer, insurers must comply with new, stricter reporting and auditing requirements that are intended to increase patient access to mental health care and, advocates say, could compel them to be more careful about the policies they write in the first place. [pullquote size=\"medium\" align=\"right\" citation=\"Meiram Bendat, attorney and licensed psychotherapist, who represents patients\"]‘We’ll have to see if insurers cover this drug and what fail-first requirements they put in.’[/pullquote]In California, insurers must also comply with an even broader state mental health parity law from 2021, making sure their coverage policies are aligned with generally accepted standards of care. Highly awaited \u003ca href=\"https://www.kqed.org/science/1984855/is-californias-landmark-mental-health-law-working\">regulations for the law\u003c/a> are expected to be released this spring.\u003c/p>\n\u003cp>Many perinatal psychiatrists told KQED it is imperative to treat postpartum depression as quickly as possible to avoid negative impacts, including cognitive and social problems in the baby, anxiety or depression in the husband or partner, or the death of the mother to suicide, which accounts for \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/\">up to 20% of maternal deaths\u003c/a>.\u003c/p>\n\u003cp>It’s possible this reasoning is why Kaiser was quick to revise its guidelines for brexanolone for the first time in 2021, Burkhard said, who worked at an insurance company before becoming an advocate. But it is unclear what criteria Kaiser will set for the new pill zuranolone.\u003c/p>\n\u003cp>“We will apply the same evidence-based, expert review process to zuranolone as we do with all medications,” Kaiser said.\u003c/p>\n\u003cp>McDonald is hopeful that women will now have more choices for care in policy and practice, including treatments that work faster and they can access immediately. She doesn’t want them to be forced on a trial-and-error medication merry-go-round like she was and can choose the treatment that’s right for them.\u003c/p>\n\u003cp>“There has to be more options for women,” she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"California patients are waiting to see what coverage policies insurers will set for the new pill form of the drug, zuranolone.","status":"publish","parent":0,"modified":1705619333,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":1244},"headData":{"title":"Kaiser Eases Restrictions on Postpartum Depression Care After Investigations | KQED","description":"California patients are waiting to see what coverage policies insurers will set for the new pill form of the drug, zuranolone.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Kaiser Eases Restrictions on Postpartum Depression Care After Investigations","datePublished":"2024-01-04T20:00:06.000Z","dateModified":"2024-01-18T23:08:53.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"audioUrl":"https://traffic.omny.fm/d/clips/0af137ef-751e-4b19-a055-aaef00d2d578/ffca7e9f-6831-41c5-bcaf-aaef00f5a073/7b44e5c3-5f3a-4063-be7e-b0ec0114f3cc/audio.mp3","sticky":false,"excludeFromSiteSearch":"Include","articleAge":"0","path":"/science/1985979/kaiser-eases-restrictions-on-postpartum-depression-care-after-investigations","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>A year after her son, Nico, was born and she still felt like an empty shell of herself despite multiple attempts to find treatment, Miriam McDonald “came out” as suffering from debilitating postpartum depression, a decision she now says was totally worth it.\u003c/p>\n\u003cp>For months, McDonald battled her health provider and insurer, Kaiser Permanente, which denied her the one and only FDA-approved medication for postpartum depression, brexanolone. \u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘No woman should suffer like I did after having a child. The policy was completely unfair. I was in purgatory.’","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Miriam McDonald, mother","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>But since she shared the details of her struggle in a\u003ca href=\"https://www.kqed.org/news/11879309/theres-only-1-drug-for-postpartum-depression-why-does-kaiser-permanente-make-it-so-hard-to-get\"> 2021 KQED investigation\u003c/a>, Kaiser has revamped its coverage guidelines twice, according to internal documents recently obtained by KQED, and federal regulators — citing KQED’s reporting — have launched an investigation into the insurer that is still ongoing.\u003c/p>\n\u003cp>“This will prevent other women from having to go through a year of depression to find something that works,” McDonald said after learning of Kaiser’s policy changes. “No woman should suffer like I did after having a child. The policy was completely unfair. I was in purgatory.”\u003c/p>\n\u003cp>When McDonald experienced her first symptoms of postpartum depression in 2019, including suicidal thoughts, Kaiser’s written guidelines required patients to try and fail four medications and electroconvulsive therapy before they would be eligible for brexanolone. But, because the drug was only approved for use up to six months postpartum, experts said this amounted to a blanket denial for all Kaiser patients, a potential violation of state and federal law.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One month after KQED published its investigation, Kaiser overhauled its guidelines, instead recommending women try just one medication before becoming eligible for brexanolone, and if that trial could not be completed before the six-month window expired, women could bypass it and go straight to brexanolone.\u003c/p>\n\u003cp>“Kaiser basically went from having the most restrictive policy to the most robust,” said Joy Burkhard, executive director of the nonprofit\u003ca href=\"https://www.2020mom.org/\"> Policy Center for Maternal Mental Health\u003c/a>. “It’s now a gold standard for the rest of the industry.”\u003c/p>\n\u003ch2>Next, a federal investigation\u003c/h2>\n\u003cp>But the scrutiny over Kaiser didn’t stop there. By late 2022, the federal Department of Labor had launched an investigation into the insurer, according to emails reviewed by KQED. Investigators called McDonald and contacted other patients to discuss the difficulty they had accessing postpartum mental health care, including brexanolone.\u003c/p>\n\u003cp>A few months later, in March 2023, Kaiser revised its brexanolone guidelines again, removing all fail-first recommendations. Patients need only decline a trial of another medication. \u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘Kaiser Permanente is committed to ensuring brexanolone is available when physicians and patients determine it is an appropriate treatment.’","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Kaiser Permanente statement","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>“Since brexanolone was first approved for use, more experience and research have added to information about its efficacy and safety,” Kaiser said in a statement. “Kaiser Permanente is committed to ensuring brexanolone is available when physicians and patients determine it is an appropriate treatment.”\u003c/p>\n\u003cp>The Department of Labor said in an email to KQED that it “will not confirm or deny the existence of an ongoing investigation” as a matter of policy but added the agency could sue a private insurer and force it to change its policies if they violate federal law. It can also force insurers to provide treatment or reimburse patients who paid out of pocket for treatments the department found improperly denied.\u003c/p>\n\u003ch2>A new era for postpartum therapies\u003c/h2>\n\u003cp>Brexanolone came on the market in 2019 with the hope of revolutionizing the treatment of postpartum depression by targeting hormone function instead of the brain’s serotonin system, as typical antidepressants do. \u003ca href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression\">In early trials,\u003c/a> women with moderate to severe depression reported relief immediately after the three-day treatment. But brexanolone is expensive, $34,000 per treatment, and must be delivered intravenously during an inpatient hospital stay where patients can be closely monitored for side effects like fainting.\u003c/p>\n\u003cp>Both the price and finding a hospital certified to administer the drug proved to be prohibitive barriers for new mothers pursuing the treatment. Until recently, Kaiser did not have its own certification and had to refer women to one of only three other approved hospitals in California. \u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"label":"More Stories on health ","tag":"health"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>A new, more accessible pill form of the medication, zuranolone, taken once a day at home over 14 days, \u003ca href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression\">was approved by the FDA in August\u003c/a>. In November, Sage Therapeutics, the company that makes both drugs, set the price for zuranolone at $15,900.\u003c/p>\n\u003cp>Since then, less than 1% of health plans have established criteria for when they will cover it, according to \u003ca href=\"https://www.2020mom.org/blog/2023/12/15/zurzuvae-the-new-postpartum-depression-drug-now-available-in-the-us-this-is-how-insurers-have-responded\">an analysis\u003c/a> using data from \u003ca href=\"https://www.policyreporter.com/\">Policy Reporter\u003c/a>, a website that tracks insurance policies. Regulators, lawyers, and advocates are watching closely to see how insurance companies will shape policies for the new drug.\u003c/p>\n\u003cp>“We’ll have to see if insurers cover this drug and what fail-first requirements they put in,” said \u003ca href=\"https://psych-appeal.com/meiram-bendat-attorney-founder/\">Meiram Bendat\u003c/a>, an attorney and licensed psychotherapist who represents patients.\u003c/p>\n\u003cp>These new policies will be written at a time when the regulatory environment around mental health treatment is shifting. The federal Department of Labor is now cracking down more on potential violations of the \u003ca href=\"https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity\">2008 Mental Health Parity and Addiction Equity Act\u003c/a>, which requires insurers to cover psychiatric treatments on par with physical treatments.\u003c/p>\n\u003cp>As of this summer, insurers must comply with new, stricter reporting and auditing requirements that are intended to increase patient access to mental health care and, advocates say, could compel them to be more careful about the policies they write in the first place. \u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘We’ll have to see if insurers cover this drug and what fail-first requirements they put in.’","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Meiram Bendat, attorney and licensed psychotherapist, who represents patients","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>In California, insurers must also comply with an even broader state mental health parity law from 2021, making sure their coverage policies are aligned with generally accepted standards of care. Highly awaited \u003ca href=\"https://www.kqed.org/science/1984855/is-californias-landmark-mental-health-law-working\">regulations for the law\u003c/a> are expected to be released this spring.\u003c/p>\n\u003cp>Many perinatal psychiatrists told KQED it is imperative to treat postpartum depression as quickly as possible to avoid negative impacts, including cognitive and social problems in the baby, anxiety or depression in the husband or partner, or the death of the mother to suicide, which accounts for \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/\">up to 20% of maternal deaths\u003c/a>.\u003c/p>\n\u003cp>It’s possible this reasoning is why Kaiser was quick to revise its guidelines for brexanolone for the first time in 2021, Burkhard said, who worked at an insurance company before becoming an advocate. But it is unclear what criteria Kaiser will set for the new pill zuranolone.\u003c/p>\n\u003cp>“We will apply the same evidence-based, expert review process to zuranolone as we do with all medications,” Kaiser said.\u003c/p>\n\u003cp>McDonald is hopeful that women will now have more choices for care in policy and practice, including treatments that work faster and they can access immediately. She doesn’t want them to be forced on a trial-and-error medication merry-go-round like she was and can choose the treatment that’s right for them.\u003c/p>\n\u003cp>“There has to be more options for women,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/1985979/kaiser-eases-restrictions-on-postpartum-depression-care-after-investigations","authors":["3205"],"programs":["science_4951"],"categories":["science_39","science_40","science_4450"],"tags":["science_4417","science_4414","science_5181","science_249","science_4277"],"featImg":"science_1985871","label":"science_4951"},"science_1985148":{"type":"posts","id":"science_1985148","meta":{"index":"posts_1591205157","site":"science","id":"1985148","score":null,"sort":[1699560047000]},"guestAuthors":[],"slug":"affluent-parents-criticize-californias-mental-health-law-for-low-income-teens","title":"Affluent Parents Criticize California’s Mental Health Law for Low-Income Teens","publishDate":1699560047,"format":"standard","headTitle":"Affluent Parents Criticize California’s Mental Health Law for Low-Income Teens | KQED","labelTerm":{"site":"science"},"content":"\u003cp>When she was in ninth grade, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB665#99INT\">Fiona Lu\u003c/a> fell into a depression. She had trouble adjusting to her new high school in Orange County and felt so isolated and exhausted that she cried every morning.\u003c/p>\n\u003cp>Lu wanted to get help, but she needed a parent’s permission and her mother — a single mom and an immigrant from China — worked long hours to provide for Fiona, her brother and her grandmother. Finding time to explain to her what therapy was and why she needed it felt like too much of an obstacle.\u003c/p>\n\u003cp>“I wouldn’t want her to have to sign all these forms and go to therapy with me,” said Lu, now 18 and a freshman at UCLA. “There’s a lot of rhetoric in immigrant cultures that having mental health concerns and getting treatment for that is a Western phenomenon.”\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Fiona Lu, student\"]‘They don’t realize that this is a policy that will affect hundreds of thousands of other families.’[/pullquote]During her senior year of high school, Lu campaigned to change the state policy to allow low-income teens like her to get mental health counseling without their parents’ consent, and in October, Gov. Gavin Newsom signed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB665\">a new law\u003c/a> doing so. Teens covered by commercial insurance have had this right for more than a decade. But it was their parents who were among the most vocal in opposing the extension of that right to youth covered by Medicaid — seizing the opportunity to air their grievances about how much control the state has over their children, specifically related to gender identity and care.\u003c/p>\n\u003cp>One mother \u003ca href=\"https://www.foxnews.com/video/6323586560112\">went on Fox News\u003c/a> last April, calling school therapists “indoctrinators,” saying the bill allowed them to fill kids’ heads with ideas about “transgenderism” without their parents knowing. Those ideas were then repeated on social media and at protests held across the country in late October. Within the state Capitol, several Republican lawmakers voted against the bill, AB 665, including Assemblymember James Gallagher from Sutter County.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[aside postID=\"news_11964791,science_1984855,mindshift_62649\" label=\"Related Stories\"]“If my child is dealing with a mental health crisis, I want to know about it,” Gallagher said on the Assembly floor last spring. “This misguided and, I think, wrongful trend in our policy now, that is continuing to exclude parents from that equation and say they don’t need to be informed, is wrong.”\u003c/p>\n\u003cp>State lawmaker salaries are \u003ca href=\"https://www.calhr.ca.gov/cccc/pages/cccc-salaries.aspx\">set by statute\u003c/a> and are \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/DoYouQualifyForMedi-Cal.aspx\">too high\u003c/a> to qualify them or their families for Medicaid, called Medi-Cal in California. They are offered a choice of \u003ca href=\"https://www.calhr.ca.gov/cccc/Pages/cccc-2023-summary-of-constitutional-and-legislative-officer-benefits.aspx\">15 commercial health insurance plans\u003c/a> as part of their employment, so children like Gallagher’s already have the rights he objected to in his speech.\u003c/p>\n\u003cp>To Lu and other low-income youth, this was frustrating and hypocritical. It felt to them like the mostly white, mostly middle-class opponents were hijacking the narrative.\u003c/p>\n\u003cfigure id=\"attachment_1985164\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1985164\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED-800x534.jpg\" alt='Two young Asian women stand behind a digital display that reads \"SB 260 and SB 59.\"' width=\"800\" height=\"534\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED-1536x1025.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED.jpg 1970w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">During their last year of high school, Fiona Lu (left) and Esther Lau advocated for two bills on behalf of low-income youth, one expanding access to mental health care and the other, menstrual hygiene products. Gov. Gavin Newsom signed the mental health bill into law in October. \u003ccite>(Photo courtesy of Courtney Lindberg)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“It’s inauthentic that they were advocating against a policy that won’t directly affect them,” Lu said. “They don’t realize that this is a policy that will affect hundreds of thousands of other families.”\u003c/p>\n\u003cp>AB 665 was merely intended to make a common-sense update to an existing law, according to the bill’s sponsors. Back in 2010, California lawmakers made it easier for youth to access outpatient mental health treatment and emergency shelters without their parents’ consent by removing a requirement that they be in immediate crisis. But at the last minute, lawmakers cut out teens covered by Medi-Cal for cost reasons because of an ongoing recession. AB 665 was meant to close the disparity and level the playing field for all kids.\u003c/p>\n\u003cp>“This is about equity,” said Assemblywoman Wendy Carrillo, the bill’s author, a Democrat from Los Angeles.\u003c/p>\n\u003cp>The original law passed with bipartisan support, no opposition, she said, and was signed by a Republican governor, Arnold Schwarzenegger.\u003c/p>\n\u003cp>“Since then, the extremes on both sides have gotten so extreme that we have a hard time actually talking about the need for mental health,” she said.\u003c/p>\n\u003cp>After she introduced the bill this year, her office faced death threats. She said the goal of the law is not to divide families but to encourage dialogue between parents and children and to rely on counseling to facilitate that.\u003c/p>\n\u003cp>To opponents like San Francisco Bay Area attorney Erin Friday, AB 665 is an incremental piece of a broader campaign to take parents’ rights away in California, something she opposes regardless of what kind of health insurance kids have.\u003c/p>\n\u003cp>Friday is a self-described life-long Democrat who voted for same-sex marriage. But when she discovered her teenager had come out as transgender at school and was being referred to by a different name and pronouns by teachers for months without her knowledge, she devoted herself to fighting any and all bills that she saw as promoting “transgender ideology.”\u003c/p>\n\u003cp>“We’re giving children autonomy they should never have,” Friday said.\u003c/p>\n\u003cp>While youth will be able to talk to a therapist about gender identity without their parents’ consent under AB 665, they cannot get residential treatment, medication or gender-affirming surgery without their parents’ okay, as opponents have suggested. Youth cannot opt to run away from home or emancipate themselves under the law.\u003c/p>\n\u003cp>“This law is not about inpatient psychiatric facilities. This law is not about changing child custody laws,” said Rachel Velcoff Hults, an attorney with the \u003ca href=\"https://youthlaw.org/\">National Center for Youth Law\u003c/a>, which sponsored AB 665. “This law is about ensuring when a young person needs counseling or needs a temporary roof over their head to ensure their own safety and well-being, that we want to make sure they have a way to access it.”\u003c/p>\n\u003cp>For low-income teens from immigrant families, like Lu and Esther Lau, removing the parental consent barrier, above all else, is about making sure there is a robust network of mental health clinicians willing to treat youth on Medi-Cal. Without parental consent, clinicians can’t get paid for the counseling they provide, either in a private practice or a school counselor’s office.\u003c/p>\n\u003cp>Even with her parents’ support, Lau, now 18, couldn’t find a Medi-Cal provider to help with her mental health struggles when she was in high school in Fremont. As the only native English speaker in her family, she had to navigate the bureaucracy of the health system on her own. For her, AB 665 incentivizes more clinicians to accept more low-income youth into their practice.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“For the opposition, it’s just about political tactics and furthering their agenda,” she said. “The bill was designed to expand access to Medi-Cal youth, period.”\u003c/p>\n\n","blocks":[],"excerpt":"Parental rights’ groups are attacking AB 665, claiming it is part of California Democrats' “transgender agenda.”","status":"publish","parent":0,"modified":1704845839,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":1229},"headData":{"title":"Affluent Parents Criticize California’s Mental Health Law for Low-Income Teens | KQED","description":"Parental rights’ groups are attacking AB 665, claiming it is part of California Democrats' “transgender agenda.”","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Affluent Parents Criticize California’s Mental Health Law for Low-Income Teens","datePublished":"2023-11-09T20:00:47.000Z","dateModified":"2024-01-10T00:17:19.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"audioUrl":"https://traffic.omny.fm/d/clips/0af137ef-751e-4b19-a055-aaef00d2d578/ffca7e9f-6831-41c5-bcaf-aaef00f5a073/2779a4f2-7c58-4638-bf3b-b0bb0112103a/audio.mp3","sticky":false,"excludeFromSiteSearch":"Include","articleAge":"0","path":"/science/1985148/affluent-parents-criticize-californias-mental-health-law-for-low-income-teens","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>When she was in ninth grade, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB665#99INT\">Fiona Lu\u003c/a> fell into a depression. She had trouble adjusting to her new high school in Orange County and felt so isolated and exhausted that she cried every morning.\u003c/p>\n\u003cp>Lu wanted to get help, but she needed a parent’s permission and her mother — a single mom and an immigrant from China — worked long hours to provide for Fiona, her brother and her grandmother. Finding time to explain to her what therapy was and why she needed it felt like too much of an obstacle.\u003c/p>\n\u003cp>“I wouldn’t want her to have to sign all these forms and go to therapy with me,” said Lu, now 18 and a freshman at UCLA. “There’s a lot of rhetoric in immigrant cultures that having mental health concerns and getting treatment for that is a Western phenomenon.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘They don’t realize that this is a policy that will affect hundreds of thousands of other families.’","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Fiona Lu, student","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>During her senior year of high school, Lu campaigned to change the state policy to allow low-income teens like her to get mental health counseling without their parents’ consent, and in October, Gov. Gavin Newsom signed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB665\">a new law\u003c/a> doing so. Teens covered by commercial insurance have had this right for more than a decade. But it was their parents who were among the most vocal in opposing the extension of that right to youth covered by Medicaid — seizing the opportunity to air their grievances about how much control the state has over their children, specifically related to gender identity and care.\u003c/p>\n\u003cp>One mother \u003ca href=\"https://www.foxnews.com/video/6323586560112\">went on Fox News\u003c/a> last April, calling school therapists “indoctrinators,” saying the bill allowed them to fill kids’ heads with ideas about “transgenderism” without their parents knowing. Those ideas were then repeated on social media and at protests held across the country in late October. Within the state Capitol, several Republican lawmakers voted against the bill, AB 665, including Assemblymember James Gallagher from Sutter County.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11964791,science_1984855,mindshift_62649","label":"Related Stories "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>“If my child is dealing with a mental health crisis, I want to know about it,” Gallagher said on the Assembly floor last spring. “This misguided and, I think, wrongful trend in our policy now, that is continuing to exclude parents from that equation and say they don’t need to be informed, is wrong.”\u003c/p>\n\u003cp>State lawmaker salaries are \u003ca href=\"https://www.calhr.ca.gov/cccc/pages/cccc-salaries.aspx\">set by statute\u003c/a> and are \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/DoYouQualifyForMedi-Cal.aspx\">too high\u003c/a> to qualify them or their families for Medicaid, called Medi-Cal in California. They are offered a choice of \u003ca href=\"https://www.calhr.ca.gov/cccc/Pages/cccc-2023-summary-of-constitutional-and-legislative-officer-benefits.aspx\">15 commercial health insurance plans\u003c/a> as part of their employment, so children like Gallagher’s already have the rights he objected to in his speech.\u003c/p>\n\u003cp>To Lu and other low-income youth, this was frustrating and hypocritical. It felt to them like the mostly white, mostly middle-class opponents were hijacking the narrative.\u003c/p>\n\u003cfigure id=\"attachment_1985164\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1985164\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED-800x534.jpg\" alt='Two young Asian women stand behind a digital display that reads \"SB 260 and SB 59.\"' width=\"800\" height=\"534\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED-1536x1025.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/11/231108-Teens-Mental-Health-02-KQED.jpg 1970w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">During their last year of high school, Fiona Lu (left) and Esther Lau advocated for two bills on behalf of low-income youth, one expanding access to mental health care and the other, menstrual hygiene products. Gov. Gavin Newsom signed the mental health bill into law in October. \u003ccite>(Photo courtesy of Courtney Lindberg)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“It’s inauthentic that they were advocating against a policy that won’t directly affect them,” Lu said. “They don’t realize that this is a policy that will affect hundreds of thousands of other families.”\u003c/p>\n\u003cp>AB 665 was merely intended to make a common-sense update to an existing law, according to the bill’s sponsors. Back in 2010, California lawmakers made it easier for youth to access outpatient mental health treatment and emergency shelters without their parents’ consent by removing a requirement that they be in immediate crisis. But at the last minute, lawmakers cut out teens covered by Medi-Cal for cost reasons because of an ongoing recession. AB 665 was meant to close the disparity and level the playing field for all kids.\u003c/p>\n\u003cp>“This is about equity,” said Assemblywoman Wendy Carrillo, the bill’s author, a Democrat from Los Angeles.\u003c/p>\n\u003cp>The original law passed with bipartisan support, no opposition, she said, and was signed by a Republican governor, Arnold Schwarzenegger.\u003c/p>\n\u003cp>“Since then, the extremes on both sides have gotten so extreme that we have a hard time actually talking about the need for mental health,” she said.\u003c/p>\n\u003cp>After she introduced the bill this year, her office faced death threats. She said the goal of the law is not to divide families but to encourage dialogue between parents and children and to rely on counseling to facilitate that.\u003c/p>\n\u003cp>To opponents like San Francisco Bay Area attorney Erin Friday, AB 665 is an incremental piece of a broader campaign to take parents’ rights away in California, something she opposes regardless of what kind of health insurance kids have.\u003c/p>\n\u003cp>Friday is a self-described life-long Democrat who voted for same-sex marriage. But when she discovered her teenager had come out as transgender at school and was being referred to by a different name and pronouns by teachers for months without her knowledge, she devoted herself to fighting any and all bills that she saw as promoting “transgender ideology.”\u003c/p>\n\u003cp>“We’re giving children autonomy they should never have,” Friday said.\u003c/p>\n\u003cp>While youth will be able to talk to a therapist about gender identity without their parents’ consent under AB 665, they cannot get residential treatment, medication or gender-affirming surgery without their parents’ okay, as opponents have suggested. Youth cannot opt to run away from home or emancipate themselves under the law.\u003c/p>\n\u003cp>“This law is not about inpatient psychiatric facilities. This law is not about changing child custody laws,” said Rachel Velcoff Hults, an attorney with the \u003ca href=\"https://youthlaw.org/\">National Center for Youth Law\u003c/a>, which sponsored AB 665. “This law is about ensuring when a young person needs counseling or needs a temporary roof over their head to ensure their own safety and well-being, that we want to make sure they have a way to access it.”\u003c/p>\n\u003cp>For low-income teens from immigrant families, like Lu and Esther Lau, removing the parental consent barrier, above all else, is about making sure there is a robust network of mental health clinicians willing to treat youth on Medi-Cal. Without parental consent, clinicians can’t get paid for the counseling they provide, either in a private practice or a school counselor’s office.\u003c/p>\n\u003cp>Even with her parents’ support, Lau, now 18, couldn’t find a Medi-Cal provider to help with her mental health struggles when she was in high school in Fremont. As the only native English speaker in her family, she had to navigate the bureaucracy of the health system on her own. For her, AB 665 incentivizes more clinicians to accept more low-income youth into their practice.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“For the opposition, it’s just about political tactics and furthering their agenda,” she said. “The bill was designed to expand access to Medi-Cal youth, period.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/1985148/affluent-parents-criticize-californias-mental-health-law-for-low-income-teens","authors":["3205"],"categories":["science_40","science_4450"],"tags":["science_249"],"featImg":"science_1985163","label":"science"},"science_1984855":{"type":"posts","id":"science_1984855","meta":{"index":"posts_1591205157","site":"science","id":"1984855","score":null,"sort":[1698058827000]},"guestAuthors":[],"slug":"is-californias-landmark-mental-health-law-working","title":"Patients Demand California Enforce Its Landmark Mental Health Law","publishDate":1698058827,"format":"standard","headTitle":"Patients Demand California Enforce Its Landmark Mental Health Law | KQED","labelTerm":{},"content":"\u003cp>California’s top health insurance authority faces mounting criticism and impatience from lawmakers and advocates who accuse the regulator of going easy on health insurers and failing to ensure they abide by a three-year-old law to provide timely mental health care to their consumers.\u003c/p>\n\u003cp>A barrage of complaints was lodged at an oversight hearing in Sacramento on Wednesday, just days after the Department of Managed Health Care relied on the same law to \u003ca href=\"https://www.dmhc.ca.gov/AbouttheDMHC/Newsroom/October12,2023.aspx\" target=\"_blank\" rel=\"noopener\">levy a historic $50 million fine\u003c/a> against Kaiser Permanente for failing to provide timely mental health care.\u003c/p>\n\u003cfigure id=\"attachment_1984869\" class=\"wp-caption alignright\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1984869\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/10/Parity-screenshot.png\" alt=\"A woman holds her hands together emphasising a point, wearing a black blazer and a green shirt. \" width=\"1920\" height=\"1080\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/10/Parity-screenshot.png 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/10/Parity-screenshot-800x450.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/10/Parity-screenshot-1020x574.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/10/Parity-screenshot-160x90.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/10/Parity-screenshot-768x432.png 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/10/Parity-screenshot-1536x864.png 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Mary Watanabe, director of the Department of Managed Health Care, speaks to a Senate mental health oversight committee.\u003c/figcaption>\u003c/figure>\n\u003cp>“I know everybody’s framing this as ‘I’m in the hot seat,’” Mary Watanabe, director of the department, told the Senate mental health committee. “I’m happy to be here. This is an issue that is deeply important and personal to me.”\u003c/p>\n\u003cp>The Department of Managed Health Care oversees 96% of the state’s commercial and government health plans covering 30 million Californians. In 2021, a new state law took effect, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">SB 855\u003c/a>, which was designed to curb insurers’ ability to deny mental health and substance abuse treatments for arbitrary or cost reasons. Instead, the law requires them to use clinical guidelines established by nonprofit health associations.\u003c/p>\n\u003cp>However, clinicians and health administrators testified in the Senate that health plans continue to violate the law. They said Anthem and other insurers were relying on unqualified doctors who ignored the standards set by the American Society of Addiction Medicine when deciding how long a person could stay in residential treatment.\u003c/p>\n\u003cp>“You can’t send a podiatrist to determine whether a stage 4 liver cancer patient needs chemotherapy,” said Joan Borsten, executive director of Summit Estate Recovery Center, which runs rehabs in Saratoga and San Jose. “It’s essentially what they’re doing.”\u003c/p>\n\u003cp>She gave the example of a 40-year-old man, a father of two small children, who came to rehab when his wife kicked him out of the house because of his alcohol addiction. After two weeks, two doctors working for Anthem, including a geriatric psychiatrist, reviewed the man’s medical record and said he had to go home.\u003c/p>\n\u003cp>“If I had left residential treatment early, I probably would have relapsed, lost my job and my family,” the man told his clinicians.\u003c/p>\n\u003cp>[pullquote align='right' size='medium' citation='Kaiser Patient Rebecca Farmer']‘The recent settlement aside, the Department of Managed Health Care has been an absent regulator, allowing Kaiser and likely other health insurance companies to effectively withhold adequate and timely mental health care when we need it the most.’[/pullquote]Borsten’s team helped the patient appeal the decision to state regulators, who overturned the denial, saying he needed to stay in residential treatment and the insurer had to pay for it. Anthem declined to comment.\u003c/p>\n\u003cp>Since the new mental health parity law took affect, about two-thirds of addiction and mental health treatment appeals had the same outcome, with the insurer ordered to pay for treatment it initially denied, according to state data.\u003c/p>\n\u003cp>This is a backward system, patients argued. They shouldn’t be forced to wade through layers of bureaucratic red tape, when they’re at the most vulnerable time in their lives, to get the treatment insurers should have granted in the first place.\u003c/p>\n\u003cp>“No one should have to have specialized knowledge to get basic access to health care that we deserve, let alone that we also pay for,” said Rebecca Farmer, a Kaiser patient who said she faced weeks-long delays and “obstacle after obstacle” trying to get care for major depression, anxiety and ADHD.\u003c/p>\n\u003cp>She struggled through multiple attempts to get help from regulators and ultimately found a therapist on her own, whom she paid $4,000 per year, out of pocket, for treatment.\u003c/p>\n\u003cp>“The recent settlement aside, the Department of Managed Health Care has been an absent regulator,” she said, “allowing Kaiser and likely other health insurance companies to effectively withhold adequate and timely mental health care when we need it the most.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ca href=\"https://about.kaiserpermanente.org/news/our-commitment-to-transforming-mental-health-care-in-california\">In its defense,\u003c/a> Kaiser’s CEO Greg Adams pointed to the sharp increase in demand for mental health care during and after the pandemic, coupled with clinician burnout and turnover, but also acknowledged its “shortcomings” and said the regulatory action “provides an opportunity for Kaiser Permanente and all health plans to step up in a new way, to ensure that we are meeting the mental health care needs of our communities.”\u003c/p>\n\u003cp>Several advocates who track the regulatory department testified that enforcement staff worked too slowly, resolving patient complaints in twice the time allowed by law and taking three years and counting to issue rules and regulations for SB 855 that would give insurers more clarity on their responsibilities under the law.\u003c/p>\n\u003cp>When it was her turn at the microphone, Watanabe, the director of the Department of Managed Health Care, addressed the complaints outlined during the hearing one by one.\u003c/p>\n\u003cp>SB 855 regulations? She expects them to be finalized this fall and take effect next April, she said, having been through several drafts and public comment periods.\u003c/p>\n\u003cp>Slow appeals process? These take time, she said. The department has to determine jurisdiction, obtain medical records, review them and get more information from the health plan. Cases are getting more complex. “It’s very nuanced and case-specific, but I appreciate the urgency and the need to move this as quickly as possible,” she said.\u003c/p>\n\u003cp>Are unqualified doctors determining addiction coverage? Doctors need to be trained on the nonprofit clinical guidelines and follow them, but we will not require them to be certified in addiction medicine, Watanabe said. There aren’t enough addiction specialists, and we don’t want to pull them out of the workforce, seeing patients, to do administrative jobs.\u003c/p>\n\u003cp>Too cozy with insurers? The $50 million fine against Kaiser was the largest in the regulator’s history, and Kaiser agreed to invest another $150 million in additional behavioral health services. This was the result of an investigation the department initiated after noticing an uptick in complaints from Kaiser patients, Watanabe said. They plan to do more nonroutine audits like this on top of its regular investigations into five commercial plans every year, starting with the largest insurers in the state.\u003c/p>\n\u003cp>“I want to make sure that all health plan enrollees in our jurisdiction have access to appropriate behavioral health services when they need them,” Watanabe concluded. “This is one of my highest priorities.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"California’s top health insurance authority faces mounting criticism and impatience from lawmakers and advocates who accuse the regulator of going easy on health insurers.","status":"publish","parent":0,"modified":1704845859,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":1139},"headData":{"title":"Patients Demand California Enforce Its Landmark Mental Health Law | KQED","description":"California’s top health insurance authority faces mounting criticism and impatience from lawmakers and advocates who accuse the regulator of going easy on health insurers.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Patients Demand California Enforce Its Landmark Mental Health Law","datePublished":"2023-10-23T11:00:27.000Z","dateModified":"2024-01-10T00:17:39.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"source":"Mental Health","sticky":false,"excludeFromSiteSearch":"Include","articleAge":"0","path":"/science/1984855/is-californias-landmark-mental-health-law-working","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>California’s top health insurance authority faces mounting criticism and impatience from lawmakers and advocates who accuse the regulator of going easy on health insurers and failing to ensure they abide by a three-year-old law to provide timely mental health care to their consumers.\u003c/p>\n\u003cp>A barrage of complaints was lodged at an oversight hearing in Sacramento on Wednesday, just days after the Department of Managed Health Care relied on the same law to \u003ca href=\"https://www.dmhc.ca.gov/AbouttheDMHC/Newsroom/October12,2023.aspx\" target=\"_blank\" rel=\"noopener\">levy a historic $50 million fine\u003c/a> against Kaiser Permanente for failing to provide timely mental health care.\u003c/p>\n\u003cfigure id=\"attachment_1984869\" class=\"wp-caption alignright\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1984869\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/10/Parity-screenshot.png\" alt=\"A woman holds her hands together emphasising a point, wearing a black blazer and a green shirt. \" width=\"1920\" height=\"1080\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/10/Parity-screenshot.png 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/10/Parity-screenshot-800x450.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/10/Parity-screenshot-1020x574.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/10/Parity-screenshot-160x90.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/10/Parity-screenshot-768x432.png 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/10/Parity-screenshot-1536x864.png 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Mary Watanabe, director of the Department of Managed Health Care, speaks to a Senate mental health oversight committee.\u003c/figcaption>\u003c/figure>\n\u003cp>“I know everybody’s framing this as ‘I’m in the hot seat,’” Mary Watanabe, director of the department, told the Senate mental health committee. “I’m happy to be here. This is an issue that is deeply important and personal to me.”\u003c/p>\n\u003cp>The Department of Managed Health Care oversees 96% of the state’s commercial and government health plans covering 30 million Californians. In 2021, a new state law took effect, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">SB 855\u003c/a>, which was designed to curb insurers’ ability to deny mental health and substance abuse treatments for arbitrary or cost reasons. Instead, the law requires them to use clinical guidelines established by nonprofit health associations.\u003c/p>\n\u003cp>However, clinicians and health administrators testified in the Senate that health plans continue to violate the law. They said Anthem and other insurers were relying on unqualified doctors who ignored the standards set by the American Society of Addiction Medicine when deciding how long a person could stay in residential treatment.\u003c/p>\n\u003cp>“You can’t send a podiatrist to determine whether a stage 4 liver cancer patient needs chemotherapy,” said Joan Borsten, executive director of Summit Estate Recovery Center, which runs rehabs in Saratoga and San Jose. “It’s essentially what they’re doing.”\u003c/p>\n\u003cp>She gave the example of a 40-year-old man, a father of two small children, who came to rehab when his wife kicked him out of the house because of his alcohol addiction. After two weeks, two doctors working for Anthem, including a geriatric psychiatrist, reviewed the man’s medical record and said he had to go home.\u003c/p>\n\u003cp>“If I had left residential treatment early, I probably would have relapsed, lost my job and my family,” the man told his clinicians.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘The recent settlement aside, the Department of Managed Health Care has been an absent regulator, allowing Kaiser and likely other health insurance companies to effectively withhold adequate and timely mental health care when we need it the most.’","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Kaiser Patient Rebecca Farmer","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Borsten’s team helped the patient appeal the decision to state regulators, who overturned the denial, saying he needed to stay in residential treatment and the insurer had to pay for it. Anthem declined to comment.\u003c/p>\n\u003cp>Since the new mental health parity law took affect, about two-thirds of addiction and mental health treatment appeals had the same outcome, with the insurer ordered to pay for treatment it initially denied, according to state data.\u003c/p>\n\u003cp>This is a backward system, patients argued. They shouldn’t be forced to wade through layers of bureaucratic red tape, when they’re at the most vulnerable time in their lives, to get the treatment insurers should have granted in the first place.\u003c/p>\n\u003cp>“No one should have to have specialized knowledge to get basic access to health care that we deserve, let alone that we also pay for,” said Rebecca Farmer, a Kaiser patient who said she faced weeks-long delays and “obstacle after obstacle” trying to get care for major depression, anxiety and ADHD.\u003c/p>\n\u003cp>She struggled through multiple attempts to get help from regulators and ultimately found a therapist on her own, whom she paid $4,000 per year, out of pocket, for treatment.\u003c/p>\n\u003cp>“The recent settlement aside, the Department of Managed Health Care has been an absent regulator,” she said, “allowing Kaiser and likely other health insurance companies to effectively withhold adequate and timely mental health care when we need it the most.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://about.kaiserpermanente.org/news/our-commitment-to-transforming-mental-health-care-in-california\">In its defense,\u003c/a> Kaiser’s CEO Greg Adams pointed to the sharp increase in demand for mental health care during and after the pandemic, coupled with clinician burnout and turnover, but also acknowledged its “shortcomings” and said the regulatory action “provides an opportunity for Kaiser Permanente and all health plans to step up in a new way, to ensure that we are meeting the mental health care needs of our communities.”\u003c/p>\n\u003cp>Several advocates who track the regulatory department testified that enforcement staff worked too slowly, resolving patient complaints in twice the time allowed by law and taking three years and counting to issue rules and regulations for SB 855 that would give insurers more clarity on their responsibilities under the law.\u003c/p>\n\u003cp>When it was her turn at the microphone, Watanabe, the director of the Department of Managed Health Care, addressed the complaints outlined during the hearing one by one.\u003c/p>\n\u003cp>SB 855 regulations? She expects them to be finalized this fall and take effect next April, she said, having been through several drafts and public comment periods.\u003c/p>\n\u003cp>Slow appeals process? These take time, she said. The department has to determine jurisdiction, obtain medical records, review them and get more information from the health plan. Cases are getting more complex. “It’s very nuanced and case-specific, but I appreciate the urgency and the need to move this as quickly as possible,” she said.\u003c/p>\n\u003cp>Are unqualified doctors determining addiction coverage? Doctors need to be trained on the nonprofit clinical guidelines and follow them, but we will not require them to be certified in addiction medicine, Watanabe said. There aren’t enough addiction specialists, and we don’t want to pull them out of the workforce, seeing patients, to do administrative jobs.\u003c/p>\n\u003cp>Too cozy with insurers? The $50 million fine against Kaiser was the largest in the regulator’s history, and Kaiser agreed to invest another $150 million in additional behavioral health services. This was the result of an investigation the department initiated after noticing an uptick in complaints from Kaiser patients, Watanabe said. They plan to do more nonroutine audits like this on top of its regular investigations into five commercial plans every year, starting with the largest insurers in the state.\u003c/p>\n\u003cp>“I want to make sure that all health plan enrollees in our jurisdiction have access to appropriate behavioral health services when they need them,” Watanabe concluded. “This is one of my highest priorities.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/1984855/is-californias-landmark-mental-health-law-working","authors":["3205"],"categories":["science_39","science_40","science_4450"],"tags":["science_249"],"featImg":"science_1984856","label":"source_science_1984855"},"science_1984534":{"type":"posts","id":"science_1984534","meta":{"index":"posts_1591205157","site":"science","id":"1984534","score":null,"sort":[1696849228000]},"guestAuthors":[],"slug":"why-nature-is-great-for-your-mental-health","title":"4 Ways Nature Improves Your Mental Health","publishDate":1696849228,"format":"standard","headTitle":"4 Ways Nature Improves Your Mental Health | KQED","labelTerm":{"site":"science"},"content":"\u003cp>Nesrin Tarablosi is the founder of \u003ca href=\"https://www.instagram.com/adventuremamaof3/\">Adventure Mama of 3\u003c/a>, an Instagram page where she shares her tips for exploring the outdoors with her three kids. Tarablosi has always loved the outdoors, but previously felt like she needed someone with her for protection, a feeling that held her back for many years.\u003c/p>\n\u003cp>She cherishes her memories of spending time with her father watching a sunrise, or running on the beach. But a few years ago her father suffered a stroke, was in an induced coma for about a month, and never returned to his normal state. This was around the same time Tarablosi gave birth, and was experiencing postpartum depression alongside grief from her father’s condition.\u003c/p>\n\u003cp>During this period, at her lowest point, she thought to herself: “There’s no way I can heal from this.”\u003c/p>\n\u003cp>She got into her car and decided to embark on a solo hike. She drove from San José to Point Reyes National Seashore. When she arrived, it was close to sunset, and the doubts crept in.\u003c/p>\n\u003cp>“I remember seeing a ranger in the parking lot and I’m just like, ‘Oh my God, what am I doing?’” she said.\u003c/p>\n\u003cp>She decided to proceed and the ranger recommended the \u003ca href=\"https://www.nps.gov/thingstodo/hike-to-divide-meadow.htm\">Divide Meadows trail\u003c/a>, which meanders from the Bear Valley trailhead to Bear Valley Creek, toward a meadow.\u003c/p>\n\u003cp>Tarablosi recalls asking the ranger: “How do I know what the Divide Meadow trail is?” He said: “Trust me, you’re going to know.”\u003c/p>\n\u003cp>“Once we got there, I saw this big opening with the cloud[s] just coming in over the trees, and it just completely took my breath away,” Tarablosi said.\u003c/p>\n\u003cp>“I remember coming back from that hike, and I just felt completely uplifted,” she said.\u003c/p>\n\u003cp>https://www.instagram.com/p/CxDhmlNLfFt/\u003c/p>\n\u003cp>Whether it’s hiking a trail or simply sitting on the grass while enjoying a good book, we’ve all experienced that dose of happiness that comes from spending time in nature. What is it about immersing ourselves in nature that makes us feel so good? It turns out, there’s some fascinating science behind those feelings.\u003c/p>\n\u003ch2>What the research suggests: Just 20 minutes in blue spaces might do the trick\u003c/h2>\n\u003cp>Spending time in nature has positive effects on both short-term and long-term mental health outcomes and can improve the quality of life, according to \u003ca href=\"https://apps.who.int/iris/bitstream/handle/10665/342931/9789289055666-eng.pdf\">researchers at the World Health Organization (PDF)\u003c/a>.\u003c/p>\n\u003cp>[aside postID='mindshift_50949,science_1984306,news_11910495' label='Related coverage']In fact, spending time in forests, parks, gardens, or coastlines can even reduce climate anxiety, according to the research.\u003c/p>\n\u003cp>Other studies have demonstrated that \u003ca href=\"https://www.sciencedirect.com/science/article/abs/pii/S0013935120307076?via%3Dihub\">just 20 minutes in blue spaces\u003c/a>, near the water swimming in a lake, soaking in a river, or splashing in the ocean’s waves can positively impact our mental well-being and physical activity levels. Residents living in neighborhoods with parks and other green spaces or along the coast report \u003ca href=\"https://www.nature.com/articles/s41598-021-87675-0\">better overall health\u003c/a>.\u003c/p>\n\u003cp>You might have heard of nature rituals such as the Japanese practice known as shinrin-yoku or “\u003ca href=\"https://develop.kqed.org/mindshift/50949/suffering-from-nature-deficit-disorder-try-forest-bathing\">forest bathing\u003c/a>,” which involves spending extended periods of time with trees to reap their many health benefits. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589172/\">Research\u003c/a> has shown that this practice can reduce stress, anxiety, depression and anger.\u003c/p>\n\u003ch2>Nature helps your brain relax and restore\u003c/h2>\n\u003cp>Being out in nature has a restorative effect on individuals living in cities. Bustling urban life \u003ca href=\"https://doi.org/10.1016/0272-4944(95)90001-2\">can lead to mental fatigue\u003c/a>, consume our brain energy, and leave people stressed out, according to Dr. Nooshin Razani, a pediatrician, clinical scientist, and associate professor at UCSF, where she directs the Center for Nature and Health. The organization’s mission is to improve children’s health and well-being through connections with nature.\u003c/p>\n\u003cp>Nature captures our attention effortlessly, helping to relax our brains and, over time, enhance our creativity. Within just minutes of being immersed in a natural environment, many people \u003ca href=\"https://positivepsychology.com/attention-restoration-theory/\">can restore their attention\u003c/a> leading to an improved state of mind. Nature has also been proven to help improve working memory, which helps the brain with tasks like learning, problem-solving and reasoning, according to Razani.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Preethi Chandrasekhar, content creator and founder, Outdoorsy South Asians\"]‘It was magical. It didn’t feel judgmental. It felt very freeing.’[/pullquote]\u003ca href=\"https://www.instagram.com/eagertravele/\">Preethi Chandrasekhar\u003c/a>, a content creator and founder of \u003ca href=\"https://www.facebook.com/groups/658280768830411/\">Outdoorsy South Asians\u003c/a>, moved to the U.S. as a child and had to grapple with fitting into a new culture and navigating life in the Midwest as a pre-teen at an all-white school. “Because I had been made fun of so much in school for being a different color, I honestly didn’t want to be who I was,” she recalled.\u003c/p>\n\u003cp>Her passion for the outdoors began as an adult, as a way to “get out of my own head,” she said. It all started on a backpacking trip with friends one summer in the Inyo National Forest.\u003c/p>\n\u003cp>https://www.instagram.com/p/CsEYlmZRF3O/?img_index=2\u003c/p>\n\u003cp>While immersing herself in nature, she discovered solace, self-confidence and acceptance. “It was magical. It didn’t feel judgmental. It felt very freeing,” she said.\u003c/p>\n\u003cp>“It genuinely allowed me to meet myself for the first time and also learn to start liking myself and then accepting myself just the way that I was,” she said.\u003c/p>\n\u003cp>When people are in nature, they \u003ca href=\"https://www.frontiersin.org/articles/10.3389/fpsyg.2021.700709/full\">feel more connected to natural life cycles\u003c/a> and to animals and plants. “We are part of a larger family and plants and animals are a part of that family,” said Razani. People have reported feeling less lonely and more connected when they are in natural spaces according to Razani.\u003c/p>\n\u003cp>“It could even be a connection to yourself, like being more physically present in your body at that time,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003ch2>Happiness hormones are released when we’re in nature\u003c/h2>\n\u003cp>Being in a natural environment changes our brain chemistry, tweaking chemicals like dopamine and serotonin that affect how we feel, flooding our bodies with positive signals, according to Dr. Leticia Márquez-Magaña, a scientist and professor of biology at San Francisco State University.\u003c/p>\n\u003cp>Several other factors can also help make a person feel happy, including being with loved ones, or feeling a sense of service, said Márquez-Magaña.\u003c/p>\n\u003cp>Being in nature can also help people \u003ca href=\"https://ggsc.berkeley.edu/images/uploads/GGSC-JTF_White_Paper-Awe_FINAL.pdf\">experience awe (PDF)\u003c/a>. “Being in a state of awe triggers hormonal reactions that are important for well-being,” Márquez-Magaña said.\u003c/p>\n\u003cp>Deandre Latour felt that sense of awe as a child when he first experienced snow, hail and sunshine all in a single day during his visit to Yosemite National Park.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Leslie Hammer, clinical social worker and ecotherapist\"]‘When we are in a relationship with the land, water, sun and the plants we eat, it’s all in our nature. It’s all part of our human history to be that way and to be in those relationships.’[/pullquote]“Being so young and seeing that, not even knowing that those things could happen in one day, had a huge impact on me,” Latour said.\u003c/p>\n\u003cp>When he first started hiking, he mostly did it alone, which provided him with time to reflect. “When do you really have time to sit back, reflect on things, consider things, and see where you want to head? That’s what nature gave me, the opportunity to sit next to a waterfall or a flowing stream of water. You don’t realize how relaxing and calming that is,” he said.\u003c/p>\n\u003cp>He says hiking played a significant role in helping him overcome depression following the loss of his parents. “When I found hiking, it was like I had something to live for all over again,” Latour said.\u003c/p>\n\u003cp>When people spend a lot of time indoors or get sucked into social media, they can feel isolated and lonely.\u003c/p>\n\u003cp>This can increase feelings of depression, according to Bita Shooshani, a queer Iranian therapist based in Oakland. “Just being outside with others breaks that sense of isolation, and isolation is often associated with mental illness,” Shooshani said. “When we’re in nature, our senses are much more engaged.”\u003c/p>\n\u003cp>Today, Latour is the founder of the Bay Area hiking community, \u003ca href=\"https://www.instagram.com/melanatedadventures_/\">Melanated Adventures\u003c/a>, a group he started to encourage folks to “discover their capabilities in new and interesting ways.” It’s also a safe space for Black people and people of color looking for a hiking community in the Bay Area.\u003c/p>\n\u003cp>https://www.instagram.com/p/CsrDOMBJ-lI/\u003c/p>\n\u003cp>Latour started the group in 2021, aiming to share his hiking experiences with others in the community. He loves witnessing people’s reactions when they reach the summit of a hike for the first time. “It is uplifting. It keeps me going,” he said.\u003c/p>\n\u003cp>In his experience leading groups of new hikers, he emphasizes the importance of overcoming fear. “It’s not always how you perceive it to be. Yes, it looks impossible from ground zero, ‘we’ll never make it up there.’ And yet, here we are [at the top], standing up here,” he said.\u003c/p>\n\u003ch2>Being in a relationship with nature helps with mindfulness\u003c/h2>\n\u003cp>Mindfulness — an awareness of your body and connecting to your body and mind is enhanced through nature. It’s a sensory experience that allows you to connect with what you smell, see and hear.\u003c/p>\n\u003cp>“It helps alter our state of mind when we go outside and connect with the greater world around us,” said Leslie Hammer, a clinical social worker and ecotherapist.\u003c/p>\n\u003cp>[aside postID='science_1984360,news_11953853,news_11953794' label='Related coverage']For children, nature provides an excellent landscape for exploration and helps them become mindful when they are playing. It’s valuable for their development, said Razani.\u003c/p>\n\u003cp>The same can be said for how nature benefits adults. Adults need to adopt a child-centric view when they’re in nature, Razani said, adding “Adults need play too.”\u003c/p>\n\u003cp>Hammer emphasizes that having a relationship with nature is a two-way street; as much as we enjoy nature’s benefits, we should also take care of our environment in return.\u003c/p>\n\u003cp>“When we are in a relationship with the land, water, sun and the plants we eat — it’s all in our nature. It’s all part of our human history. … to be in those relationships,” Hammer said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"What is it about immersing ourselves in nature that makes us feel so good? It turns out, there's some fascinating science behind those feelings.","status":"publish","parent":0,"modified":1704845880,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":42,"wordCount":1802},"headData":{"title":"4 Ways Nature Improves Your Mental Health | KQED","description":"What is it about immersing ourselves in nature that makes us feel so good? It turns out, there's some fascinating science behind those feelings.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"4 Ways Nature Improves Your Mental Health","datePublished":"2023-10-09T11:00:28.000Z","dateModified":"2024-01-10T00:18:00.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"sticky":false,"excludeFromSiteSearch":"Include","articleAge":"0","path":"/science/1984534/why-nature-is-great-for-your-mental-health","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Nesrin Tarablosi is the founder of \u003ca href=\"https://www.instagram.com/adventuremamaof3/\">Adventure Mama of 3\u003c/a>, an Instagram page where she shares her tips for exploring the outdoors with her three kids. Tarablosi has always loved the outdoors, but previously felt like she needed someone with her for protection, a feeling that held her back for many years.\u003c/p>\n\u003cp>She cherishes her memories of spending time with her father watching a sunrise, or running on the beach. But a few years ago her father suffered a stroke, was in an induced coma for about a month, and never returned to his normal state. This was around the same time Tarablosi gave birth, and was experiencing postpartum depression alongside grief from her father’s condition.\u003c/p>\n\u003cp>During this period, at her lowest point, she thought to herself: “There’s no way I can heal from this.”\u003c/p>\n\u003cp>She got into her car and decided to embark on a solo hike. She drove from San José to Point Reyes National Seashore. When she arrived, it was close to sunset, and the doubts crept in.\u003c/p>\n\u003cp>“I remember seeing a ranger in the parking lot and I’m just like, ‘Oh my God, what am I doing?’” she said.\u003c/p>\n\u003cp>She decided to proceed and the ranger recommended the \u003ca href=\"https://www.nps.gov/thingstodo/hike-to-divide-meadow.htm\">Divide Meadows trail\u003c/a>, which meanders from the Bear Valley trailhead to Bear Valley Creek, toward a meadow.\u003c/p>\n\u003cp>Tarablosi recalls asking the ranger: “How do I know what the Divide Meadow trail is?” He said: “Trust me, you’re going to know.”\u003c/p>\n\u003cp>“Once we got there, I saw this big opening with the cloud[s] just coming in over the trees, and it just completely took my breath away,” Tarablosi said.\u003c/p>\n\u003cp>“I remember coming back from that hike, and I just felt completely uplifted,” she said.\u003c/p>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"instagramLink","attributes":{"named":{"instagramId":"CxDhmlNLfFt"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Whether it’s hiking a trail or simply sitting on the grass while enjoying a good book, we’ve all experienced that dose of happiness that comes from spending time in nature. What is it about immersing ourselves in nature that makes us feel so good? It turns out, there’s some fascinating science behind those feelings.\u003c/p>\n\u003ch2>What the research suggests: Just 20 minutes in blue spaces might do the trick\u003c/h2>\n\u003cp>Spending time in nature has positive effects on both short-term and long-term mental health outcomes and can improve the quality of life, according to \u003ca href=\"https://apps.who.int/iris/bitstream/handle/10665/342931/9789289055666-eng.pdf\">researchers at the World Health Organization (PDF)\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"mindshift_50949,science_1984306,news_11910495","label":"Related coverage "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>In fact, spending time in forests, parks, gardens, or coastlines can even reduce climate anxiety, according to the research.\u003c/p>\n\u003cp>Other studies have demonstrated that \u003ca href=\"https://www.sciencedirect.com/science/article/abs/pii/S0013935120307076?via%3Dihub\">just 20 minutes in blue spaces\u003c/a>, near the water swimming in a lake, soaking in a river, or splashing in the ocean’s waves can positively impact our mental well-being and physical activity levels. Residents living in neighborhoods with parks and other green spaces or along the coast report \u003ca href=\"https://www.nature.com/articles/s41598-021-87675-0\">better overall health\u003c/a>.\u003c/p>\n\u003cp>You might have heard of nature rituals such as the Japanese practice known as shinrin-yoku or “\u003ca href=\"https://develop.kqed.org/mindshift/50949/suffering-from-nature-deficit-disorder-try-forest-bathing\">forest bathing\u003c/a>,” which involves spending extended periods of time with trees to reap their many health benefits. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589172/\">Research\u003c/a> has shown that this practice can reduce stress, anxiety, depression and anger.\u003c/p>\n\u003ch2>Nature helps your brain relax and restore\u003c/h2>\n\u003cp>Being out in nature has a restorative effect on individuals living in cities. Bustling urban life \u003ca href=\"https://doi.org/10.1016/0272-4944(95)90001-2\">can lead to mental fatigue\u003c/a>, consume our brain energy, and leave people stressed out, according to Dr. Nooshin Razani, a pediatrician, clinical scientist, and associate professor at UCSF, where she directs the Center for Nature and Health. The organization’s mission is to improve children’s health and well-being through connections with nature.\u003c/p>\n\u003cp>Nature captures our attention effortlessly, helping to relax our brains and, over time, enhance our creativity. Within just minutes of being immersed in a natural environment, many people \u003ca href=\"https://positivepsychology.com/attention-restoration-theory/\">can restore their attention\u003c/a> leading to an improved state of mind. Nature has also been proven to help improve working memory, which helps the brain with tasks like learning, problem-solving and reasoning, according to Razani.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘It was magical. It didn’t feel judgmental. It felt very freeing.’","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Preethi Chandrasekhar, content creator and founder, Outdoorsy South Asians","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003ca href=\"https://www.instagram.com/eagertravele/\">Preethi Chandrasekhar\u003c/a>, a content creator and founder of \u003ca href=\"https://www.facebook.com/groups/658280768830411/\">Outdoorsy South Asians\u003c/a>, moved to the U.S. as a child and had to grapple with fitting into a new culture and navigating life in the Midwest as a pre-teen at an all-white school. “Because I had been made fun of so much in school for being a different color, I honestly didn’t want to be who I was,” she recalled.\u003c/p>\n\u003cp>Her passion for the outdoors began as an adult, as a way to “get out of my own head,” she said. It all started on a backpacking trip with friends one summer in the Inyo National Forest.\u003c/p>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"instagramLink","attributes":{"named":{"instagramId":"CsEYlmZRF3O"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>While immersing herself in nature, she discovered solace, self-confidence and acceptance. “It was magical. It didn’t feel judgmental. It felt very freeing,” she said.\u003c/p>\n\u003cp>“It genuinely allowed me to meet myself for the first time and also learn to start liking myself and then accepting myself just the way that I was,” she said.\u003c/p>\n\u003cp>When people are in nature, they \u003ca href=\"https://www.frontiersin.org/articles/10.3389/fpsyg.2021.700709/full\">feel more connected to natural life cycles\u003c/a> and to animals and plants. “We are part of a larger family and plants and animals are a part of that family,” said Razani. People have reported feeling less lonely and more connected when they are in natural spaces according to Razani.\u003c/p>\n\u003cp>“It could even be a connection to yourself, like being more physically present in your body at that time,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch2>Happiness hormones are released when we’re in nature\u003c/h2>\n\u003cp>Being in a natural environment changes our brain chemistry, tweaking chemicals like dopamine and serotonin that affect how we feel, flooding our bodies with positive signals, according to Dr. Leticia Márquez-Magaña, a scientist and professor of biology at San Francisco State University.\u003c/p>\n\u003cp>Several other factors can also help make a person feel happy, including being with loved ones, or feeling a sense of service, said Márquez-Magaña.\u003c/p>\n\u003cp>Being in nature can also help people \u003ca href=\"https://ggsc.berkeley.edu/images/uploads/GGSC-JTF_White_Paper-Awe_FINAL.pdf\">experience awe (PDF)\u003c/a>. “Being in a state of awe triggers hormonal reactions that are important for well-being,” Márquez-Magaña said.\u003c/p>\n\u003cp>Deandre Latour felt that sense of awe as a child when he first experienced snow, hail and sunshine all in a single day during his visit to Yosemite National Park.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘When we are in a relationship with the land, water, sun and the plants we eat, it’s all in our nature. It’s all part of our human history to be that way and to be in those relationships.’","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Leslie Hammer, clinical social worker and ecotherapist","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>“Being so young and seeing that, not even knowing that those things could happen in one day, had a huge impact on me,” Latour said.\u003c/p>\n\u003cp>When he first started hiking, he mostly did it alone, which provided him with time to reflect. “When do you really have time to sit back, reflect on things, consider things, and see where you want to head? That’s what nature gave me, the opportunity to sit next to a waterfall or a flowing stream of water. You don’t realize how relaxing and calming that is,” he said.\u003c/p>\n\u003cp>He says hiking played a significant role in helping him overcome depression following the loss of his parents. “When I found hiking, it was like I had something to live for all over again,” Latour said.\u003c/p>\n\u003cp>When people spend a lot of time indoors or get sucked into social media, they can feel isolated and lonely.\u003c/p>\n\u003cp>This can increase feelings of depression, according to Bita Shooshani, a queer Iranian therapist based in Oakland. “Just being outside with others breaks that sense of isolation, and isolation is often associated with mental illness,” Shooshani said. “When we’re in nature, our senses are much more engaged.”\u003c/p>\n\u003cp>Today, Latour is the founder of the Bay Area hiking community, \u003ca href=\"https://www.instagram.com/melanatedadventures_/\">Melanated Adventures\u003c/a>, a group he started to encourage folks to “discover their capabilities in new and interesting ways.” It’s also a safe space for Black people and people of color looking for a hiking community in the Bay Area.\u003c/p>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"instagramLink","attributes":{"named":{"instagramId":"CsrDOMBJ-lI"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Latour started the group in 2021, aiming to share his hiking experiences with others in the community. He loves witnessing people’s reactions when they reach the summit of a hike for the first time. “It is uplifting. It keeps me going,” he said.\u003c/p>\n\u003cp>In his experience leading groups of new hikers, he emphasizes the importance of overcoming fear. “It’s not always how you perceive it to be. Yes, it looks impossible from ground zero, ‘we’ll never make it up there.’ And yet, here we are [at the top], standing up here,” he said.\u003c/p>\n\u003ch2>Being in a relationship with nature helps with mindfulness\u003c/h2>\n\u003cp>Mindfulness — an awareness of your body and connecting to your body and mind is enhanced through nature. It’s a sensory experience that allows you to connect with what you smell, see and hear.\u003c/p>\n\u003cp>“It helps alter our state of mind when we go outside and connect with the greater world around us,” said Leslie Hammer, a clinical social worker and ecotherapist.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"science_1984360,news_11953853,news_11953794","label":"Related coverage "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>For children, nature provides an excellent landscape for exploration and helps them become mindful when they are playing. It’s valuable for their development, said Razani.\u003c/p>\n\u003cp>The same can be said for how nature benefits adults. Adults need to adopt a child-centric view when they’re in nature, Razani said, adding “Adults need play too.”\u003c/p>\n\u003cp>Hammer emphasizes that having a relationship with nature is a two-way street; as much as we enjoy nature’s benefits, we should also take care of our environment in return.\u003c/p>\n\u003cp>“When we are in a relationship with the land, water, sun and the plants we eat — it’s all in our nature. It’s all part of our human history. … to be in those relationships,” Hammer said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/1984534/why-nature-is-great-for-your-mental-health","authors":["11631"],"categories":["science_39","science_40","science_4450"],"tags":["science_4992","science_856","science_5196","science_254","science_249","science_179","science_4729"],"featImg":"science_1984535","label":"science"},"science_1982857":{"type":"posts","id":"science_1982857","meta":{"index":"posts_1591205157","site":"science","id":"1982857","score":null,"sort":[1686171083000]},"guestAuthors":[],"slug":"magic-mushrooms-may-treat-depression-but-hurdles-to-psilocybin-access-abound","title":"Magic Mushrooms May Treat Depression. But Hurdles to Psilocybin Access Abound","publishDate":1686171083,"format":"standard","headTitle":"Magic Mushrooms May Treat Depression. But Hurdles to Psilocybin Access Abound | KQED","labelTerm":{},"content":"\u003cp>Diamond was tripping on an August morning in Baltimore.\u003c/p>\n\u003cp>The mom and entrepreneur sat cozily under a weighted blanket at Sheppard Pratt Hospital. Little mushroom people jumped across imaginary flower petals behind her eye mask. A therapist monitored Diamond from close by, ready to serve her food and measure her \u003ca href=\"https://www.kqed.org/search?q=depression&site=all\">depression\u003c/a> symptoms.\u003c/p>\n\u003cp>In the weeks leading up to today, clinicians had asked Diamond, “Can you remember a time when you were happy for more than a month?” No, she thought.\u003c/p>\n\u003cp>Diamond told them she’d been having what psychologists call “passive” suicidal thoughts, like, “If this car ran into me and I died, things would be OK.”\u003c/p>\n\u003cp>Such thoughts weren’t new for Diamond; growing up, she had been hospitalized for wanting to kill herself. Over the years, she tried many medications for her depression, including Seroquel, Prozac, Trazodone and Risperidone.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“A lot of ‘dones,’ a lot of ‘ols,’” she said. Some of them helped her sleep, but left her feeling numb. She recalled thinking, “I still feel sad, so what are we doing here, antidepressants?”\u003c/p>\n\u003cp>Diamond was curious whether a clinically guided mushroom trip would help, and she enrolled in this clinical trial testing the safety and efficacy of psilocybin, the psychoactive ingredient in “magic mushrooms,” for her type of bipolar depression. KQED is only using Diamond’s first name because she uses psilocybin, which is illegal federally.\u003c/p>\n\u003cfigure id=\"attachment_1982859\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-1982859\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/06/005_KQEDScience_Edits_DSC_0033-1-1020x678.jpg\" alt=\"A woman stands with her back to the camera and a shirt that says "Don't Trip Drip" and has psychedelic colored mushrooms. \" width=\"640\" height=\"425\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/06/005_KQEDScience_Edits_DSC_0033-1-1020x678.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/06/005_KQEDScience_Edits_DSC_0033-1-800x532.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/06/005_KQEDScience_Edits_DSC_0033-1-160x106.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/06/005_KQEDScience_Edits_DSC_0033-1-768x511.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/06/005_KQEDScience_Edits_DSC_0033-1-1536x1022.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/06/005_KQEDScience_Edits_DSC_0033-1.jpg 1920w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Diamond wants to be an advocate for psilocybin treatments for depression. \u003ccite>(Anna Marie Yanny/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Diamond met with a therapist before and after a daylong psilocybin session, as part of the months-long trial. On her “dosing day” she grounded herself with an intention she set with her therapist earlier: self-grace.\u003c/p>\n\u003cp>While she was hallucinating, Diamond remembers feeling like someone buried her. She felt like she was losing air, light, everything.\u003c/p>\n\u003cp>“I was panicking,” Diamond said. “I was fearful.”\u003c/p>\n\u003cp>But then she remembered that “they tell you to, if anything comes up, just go with it. I settled in and I was like, OK, so this is death.”\u003c/p>\n\u003cp>The “go-with-the-flow” mantra Diamond adopted during the trial has stuck with her to this day.\u003c/p>\n\u003ch2>Psilocybin faces numerous barriers moving from trial to treatment\u003c/h2>\n\u003cp>Like Diamond, about \u003ca href=\"https://www.who.int/news-room/fact-sheets/detail/depression\">280 million people worldwide have depression\u003c/a>. For some, traditional medications don’t work. Researchers are studying whether psilocybin could help, and many of the \u003ca href=\"https://clinicaltrials.gov/ct2/results?cond=Depression&term=&type=Intr&rslt=&age_v=&gndr=&intr=Psilocybin&titles=&outc=&spons=&lead=&id=&cntry=&state=&city=&dist=&locn=&rsub=&strd_s=&strd_e=&prcd_s=&prcd_e=&sfpd_s=&sfpd_e=&rfpd_s=&rfpd_e=&lupd_s=&lupd_e=&sort=\">dozens of trials have had promising results\u003c/a>.\u003c/p>\n\u003cp>Neuroscientist Dennis Parker Kelley helps run \u003ca href=\"https://psychedelics.ucsf.edu/#Studies\">psilocybin trials at UCSF\u003c/a>, and thinks the drug has incredible potential.\u003c/p>\n\u003cp>“More potential than we have really seen with any other pharmacological treatments in the past several decades,” Kelley said.\u003c/p>\n\u003cp>It’s so promising that psilocybin treatment could get Food and Drug Administration approval for stubborn forms of depression within the year. Meanwhile, San Francisco state Sen. Scott Wiener’s \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202320240SB58\">bill decriminalizing drugs like these is pressing ahead in the state Legislature\u003c/a>.\u003c/p>\n\u003cp>But it could be tricky for clinicians to move psilocybin into mainstream treatment.\u003c/p>\n\u003cp>First, psychedelic-assisted therapy can be prohibitively expensive.\u003c/p>\n\u003cp>“People who don’t have health insurance, this could prevent them from being able to meaningfully experience these therapies” Kelley said.\u003c/p>\n\u003cp>Psilocybin sessions typically last six to eight hours and are accompanied by a handful of therapy meetings before and after. Many people might not have time for these treatments. Plus, most studies require participants to wean off their current antidepressants before trying the treatment. This might not be necessary for all medications, and researchers like Kelley are trying to understand whether some drugs may be safe to mix with psilocybin.\u003c/p>\n\u003cp>All told, “I don’t think people will be able to go home with psilocybin from their doctor anytime soon,” Kelley said.\u003c/p>\n\u003cp>Indigenous groups in Mexico were using psilocybin long before these trials, and advocates have raised concerns about appropriation with the mushrooms. Critics have also raised concerns about power dynamics in the treatment room with psychedelics like psilocybin, and point to a documented history of sexual violation within psychedelic therapy.\u003c/p>\n\u003ch2>‘With great hype needs to come great responsibility’\u003c/h2>\n\u003cp>Clinicians discourage people from taking psilocybin without a therapist or trained guide. Diamond heard author Michael Pollan, who has written extensively about psychedelic research, talk about the treatments. She went looking for a trial after learning there was a lack of Black guides and clinical trial participants in psilocybin research.\u003c/p>\n\u003cp>“We don’t see a lot of people who look like us talking about what [psilocybin has] done for us,” said Diamond, who is Black.\u003c/p>\n\u003cp>Before the trial, she tried to control her life by planning every minute of her day. She felt weak if she couldn’t accomplish everything.\u003c/p>\n\u003cp>Now, she gives herself grace if she doesn’t complete her to-do lists. Diamond wants to be an advocate for psilocybin, especially for Black people, through \u003ca href=\"https://www.diamonddripconsulting.com/about-faq\">her consulting and wellness business\u003c/a>.\u003c/p>\n\u003cp>Research psychologist Philip Corlett of Yale University says psychiatrists are desperate for new treatments, but the psilocybin data isn’t as miraculous as it sounds. After all, the trials have been small, and participants could be feeling a placebo effect.\u003c/p>\n\u003cp>“I think these are extremely promising new treatments. But I think with great hype needs to come great responsibility,” Corlett said.\u003c/p>\n\u003cp>Psilocybin may not help everyone whom antidepressants have failed. Trials generally don’t include patients who are actively suicidal or experiencing psychosis, for fear of making it worse. In a large, phase 2 clinical trial for treatment-resistant depression conducted by the company Compass Pathways and published in \u003cem>The New England Journal of Medicine\u003c/em>, \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa2206443\">some participants had worsening suicidal states — marked by suicidal ideation and self-injury — after taking psilocybin\u003c/a>.\u003c/p>\n\u003cp>The American Psychiatric Association states that there is not enough evidence to support the use of psychedelics outside of clinical trials.\u003c/p>\n\u003cp>Clinical psychologist Rosalind Watts was a lead for such trials at Imperial College London. After guiding patients through psilocybin treatment for years, she thinks of the drug as a catalyst for healing. But, she said, the treatment needs a “therapeutic container,” such as integration therapy or an Indigenous ceremony, to be effective.\u003c/p>\n\u003cp>“If it was just the drug, every time somebody went to Burning Man, they’d have their depression fixed. And that doesn’t happen,” Watts said.\u003c/p>\n\u003cp>People need community care to move through sometimes harrowing drug experiences, she said.\u003c/p>\n\u003cp>“My real feeling is that psilocybin is calling us to change our models of care,” Watts said. “Because if we fit it into the existing profit-making, private health care models of clinics, it’s going to be really, really ineffective.”\u003c/p>\n\u003cp>For Diamond, psilocybin was effective. After the trial, she woke up one morning, energized. She knocked out her to-do list, worked out and left early to pick up her daughter from school. Music drifted through her car speakers as she sat in the sunny school parking lot, waiting for the “school’s out” announcement.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I thought to myself for the first time in forever that it would really suck to die today,” Diamond recalled, tearing up. “And that was so profound because I had never felt that way in my whole entire life.”\u003c/p>\n\n","blocks":[],"excerpt":"Clinicians anticipate some key barriers as magic mushrooms move from trial studies to treatment for diseases like depression. \r\n","status":"publish","parent":0,"modified":1712959118,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":38,"wordCount":1253},"headData":{"title":"Magic Mushrooms May Treat Depression. But Hurdles to Psilocybin Access Abound | KQED","description":"Clinicians anticipate some key barriers as magic mushrooms move from trial studies to treatment for diseases like depression. \r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Magic Mushrooms May Treat Depression. But Hurdles to Psilocybin Access Abound","datePublished":"2023-06-07T20:51:23.000Z","dateModified":"2024-04-12T21:58:38.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"source":"Psilocybin","audioUrl":"https://traffic.omny.fm/d/clips/0af137ef-751e-4b19-a055-aaef00d2d578/ffca7e9f-6831-4[…]f-aaef00f5a073/5773af41-2c1e-480f-b5df-b00401106890/audio.mp3","sticky":false,"nprByline":"Anna Marie Yanny","excludeFromSiteSearch":"Include","showOnAuthorArchivePages":"No","articleAge":"0","path":"/science/1982857/magic-mushrooms-may-treat-depression-but-hurdles-to-psilocybin-access-abound","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Diamond was tripping on an August morning in Baltimore.\u003c/p>\n\u003cp>The mom and entrepreneur sat cozily under a weighted blanket at Sheppard Pratt Hospital. Little mushroom people jumped across imaginary flower petals behind her eye mask. A therapist monitored Diamond from close by, ready to serve her food and measure her \u003ca href=\"https://www.kqed.org/search?q=depression&site=all\">depression\u003c/a> symptoms.\u003c/p>\n\u003cp>In the weeks leading up to today, clinicians had asked Diamond, “Can you remember a time when you were happy for more than a month?” No, she thought.\u003c/p>\n\u003cp>Diamond told them she’d been having what psychologists call “passive” suicidal thoughts, like, “If this car ran into me and I died, things would be OK.”\u003c/p>\n\u003cp>Such thoughts weren’t new for Diamond; growing up, she had been hospitalized for wanting to kill herself. Over the years, she tried many medications for her depression, including Seroquel, Prozac, Trazodone and Risperidone.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“A lot of ‘dones,’ a lot of ‘ols,’” she said. Some of them helped her sleep, but left her feeling numb. She recalled thinking, “I still feel sad, so what are we doing here, antidepressants?”\u003c/p>\n\u003cp>Diamond was curious whether a clinically guided mushroom trip would help, and she enrolled in this clinical trial testing the safety and efficacy of psilocybin, the psychoactive ingredient in “magic mushrooms,” for her type of bipolar depression. KQED is only using Diamond’s first name because she uses psilocybin, which is illegal federally.\u003c/p>\n\u003cfigure id=\"attachment_1982859\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-1982859\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/06/005_KQEDScience_Edits_DSC_0033-1-1020x678.jpg\" alt=\"A woman stands with her back to the camera and a shirt that says "Don't Trip Drip" and has psychedelic colored mushrooms. \" width=\"640\" height=\"425\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/06/005_KQEDScience_Edits_DSC_0033-1-1020x678.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/06/005_KQEDScience_Edits_DSC_0033-1-800x532.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/06/005_KQEDScience_Edits_DSC_0033-1-160x106.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/06/005_KQEDScience_Edits_DSC_0033-1-768x511.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/06/005_KQEDScience_Edits_DSC_0033-1-1536x1022.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/06/005_KQEDScience_Edits_DSC_0033-1.jpg 1920w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Diamond wants to be an advocate for psilocybin treatments for depression. \u003ccite>(Anna Marie Yanny/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Diamond met with a therapist before and after a daylong psilocybin session, as part of the months-long trial. On her “dosing day” she grounded herself with an intention she set with her therapist earlier: self-grace.\u003c/p>\n\u003cp>While she was hallucinating, Diamond remembers feeling like someone buried her. She felt like she was losing air, light, everything.\u003c/p>\n\u003cp>“I was panicking,” Diamond said. “I was fearful.”\u003c/p>\n\u003cp>But then she remembered that “they tell you to, if anything comes up, just go with it. I settled in and I was like, OK, so this is death.”\u003c/p>\n\u003cp>The “go-with-the-flow” mantra Diamond adopted during the trial has stuck with her to this day.\u003c/p>\n\u003ch2>Psilocybin faces numerous barriers moving from trial to treatment\u003c/h2>\n\u003cp>Like Diamond, about \u003ca href=\"https://www.who.int/news-room/fact-sheets/detail/depression\">280 million people worldwide have depression\u003c/a>. For some, traditional medications don’t work. Researchers are studying whether psilocybin could help, and many of the \u003ca href=\"https://clinicaltrials.gov/ct2/results?cond=Depression&term=&type=Intr&rslt=&age_v=&gndr=&intr=Psilocybin&titles=&outc=&spons=&lead=&id=&cntry=&state=&city=&dist=&locn=&rsub=&strd_s=&strd_e=&prcd_s=&prcd_e=&sfpd_s=&sfpd_e=&rfpd_s=&rfpd_e=&lupd_s=&lupd_e=&sort=\">dozens of trials have had promising results\u003c/a>.\u003c/p>\n\u003cp>Neuroscientist Dennis Parker Kelley helps run \u003ca href=\"https://psychedelics.ucsf.edu/#Studies\">psilocybin trials at UCSF\u003c/a>, and thinks the drug has incredible potential.\u003c/p>\n\u003cp>“More potential than we have really seen with any other pharmacological treatments in the past several decades,” Kelley said.\u003c/p>\n\u003cp>It’s so promising that psilocybin treatment could get Food and Drug Administration approval for stubborn forms of depression within the year. Meanwhile, San Francisco state Sen. Scott Wiener’s \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202320240SB58\">bill decriminalizing drugs like these is pressing ahead in the state Legislature\u003c/a>.\u003c/p>\n\u003cp>But it could be tricky for clinicians to move psilocybin into mainstream treatment.\u003c/p>\n\u003cp>First, psychedelic-assisted therapy can be prohibitively expensive.\u003c/p>\n\u003cp>“People who don’t have health insurance, this could prevent them from being able to meaningfully experience these therapies” Kelley said.\u003c/p>\n\u003cp>Psilocybin sessions typically last six to eight hours and are accompanied by a handful of therapy meetings before and after. Many people might not have time for these treatments. Plus, most studies require participants to wean off their current antidepressants before trying the treatment. This might not be necessary for all medications, and researchers like Kelley are trying to understand whether some drugs may be safe to mix with psilocybin.\u003c/p>\n\u003cp>All told, “I don’t think people will be able to go home with psilocybin from their doctor anytime soon,” Kelley said.\u003c/p>\n\u003cp>Indigenous groups in Mexico were using psilocybin long before these trials, and advocates have raised concerns about appropriation with the mushrooms. Critics have also raised concerns about power dynamics in the treatment room with psychedelics like psilocybin, and point to a documented history of sexual violation within psychedelic therapy.\u003c/p>\n\u003ch2>‘With great hype needs to come great responsibility’\u003c/h2>\n\u003cp>Clinicians discourage people from taking psilocybin without a therapist or trained guide. Diamond heard author Michael Pollan, who has written extensively about psychedelic research, talk about the treatments. She went looking for a trial after learning there was a lack of Black guides and clinical trial participants in psilocybin research.\u003c/p>\n\u003cp>“We don’t see a lot of people who look like us talking about what [psilocybin has] done for us,” said Diamond, who is Black.\u003c/p>\n\u003cp>Before the trial, she tried to control her life by planning every minute of her day. She felt weak if she couldn’t accomplish everything.\u003c/p>\n\u003cp>Now, she gives herself grace if she doesn’t complete her to-do lists. Diamond wants to be an advocate for psilocybin, especially for Black people, through \u003ca href=\"https://www.diamonddripconsulting.com/about-faq\">her consulting and wellness business\u003c/a>.\u003c/p>\n\u003cp>Research psychologist Philip Corlett of Yale University says psychiatrists are desperate for new treatments, but the psilocybin data isn’t as miraculous as it sounds. After all, the trials have been small, and participants could be feeling a placebo effect.\u003c/p>\n\u003cp>“I think these are extremely promising new treatments. But I think with great hype needs to come great responsibility,” Corlett said.\u003c/p>\n\u003cp>Psilocybin may not help everyone whom antidepressants have failed. Trials generally don’t include patients who are actively suicidal or experiencing psychosis, for fear of making it worse. In a large, phase 2 clinical trial for treatment-resistant depression conducted by the company Compass Pathways and published in \u003cem>The New England Journal of Medicine\u003c/em>, \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa2206443\">some participants had worsening suicidal states — marked by suicidal ideation and self-injury — after taking psilocybin\u003c/a>.\u003c/p>\n\u003cp>The American Psychiatric Association states that there is not enough evidence to support the use of psychedelics outside of clinical trials.\u003c/p>\n\u003cp>Clinical psychologist Rosalind Watts was a lead for such trials at Imperial College London. After guiding patients through psilocybin treatment for years, she thinks of the drug as a catalyst for healing. But, she said, the treatment needs a “therapeutic container,” such as integration therapy or an Indigenous ceremony, to be effective.\u003c/p>\n\u003cp>“If it was just the drug, every time somebody went to Burning Man, they’d have their depression fixed. And that doesn’t happen,” Watts said.\u003c/p>\n\u003cp>People need community care to move through sometimes harrowing drug experiences, she said.\u003c/p>\n\u003cp>“My real feeling is that psilocybin is calling us to change our models of care,” Watts said. “Because if we fit it into the existing profit-making, private health care models of clinics, it’s going to be really, really ineffective.”\u003c/p>\n\u003cp>For Diamond, psilocybin was effective. After the trial, she woke up one morning, energized. She knocked out her to-do list, worked out and left early to pick up her daughter from school. Music drifted through her car speakers as she sat in the sunny school parking lot, waiting for the “school’s out” announcement.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I thought to myself for the first time in forever that it would really suck to die today,” Diamond recalled, tearing up. “And that was so profound because I had never felt that way in my whole entire life.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/1982857/magic-mushrooms-may-treat-depression-but-hurdles-to-psilocybin-access-abound","authors":["byline_science_1982857"],"categories":["science_39","science_3890","science_40","science_4450"],"tags":["science_4414","science_249","science_5155"],"featImg":"science_1992384","label":"source_science_1982857"},"science_1981630":{"type":"posts","id":"science_1981630","meta":{"index":"posts_1591205157","site":"science","id":"1981630","score":null,"sort":[1677672059000]},"guestAuthors":[],"slug":"proven-schizophrenia-treatments-keep-people-in-school-at-work-and-off-the-street-why-wont-insurance-companies-cover-them","title":"Proven Schizophrenia Treatments Keep People in School, at Work and off the Street. Why Won't Insurance Companies Cover Them?","publishDate":1677672059,"format":"standard","headTitle":"Proven Schizophrenia Treatments Keep People in School, at Work and off the Street. Why Won’t Insurance Companies Cover Them? | KQED","labelTerm":{},"content":"\u003ch2>\u003cem>What if, instead of telling patients with schizophrenia to prepare for a lifetime of disability, we asked them what they want and worked with them toward full recovery?\u003c/em>\u003c/h2>\n\u003cp>[dropcap]W[/dropcap]hen Yvonne was walking across campus and heard someone calling her name, she stopped and looked around, but the other students flowed around her, oblivious. She continued on, then heard it again.\u003c/p>\n\u003cp>\u003cem>Yvonne?\u003c/em> Stop. Look. Nothing.\u003c/p>\n\u003cp>She was confused, but like anyone else would, Yvonne brushed it off.\u003c/p>\n\u003cp>She sat down in her anatomy class, in the middle of a big lecture hall, and when the professor began his lesson on the renal system, Yvonne started to feel funny, like he was talking about \u003cem>her\u003c/em> body.\u003c/p>\n\u003cp>“I was like, ‘Why is he talking about \u003cem>my\u003c/em> kidneys? How dare he,’” she remembered. “I got really scared and I ran out of class.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She shook this off, too. As she crunched through the rust-colored leaves of an East Coast autumn, she started to hear chattering, like a radio was on in the background of her life. She ignored it as long as she could — until the voices started speaking to her in full sentences, telling her what to do: “You should jump off a bridge. Take that knife and cut yourself,” they said. “You’re worthless.”[pullquote citation='Yvonne, who has schizoaffective disorder']‘My life wasn’t my own. It was up to these voices because they told me what to do. They wouldn’t go away.’[/pullquote]Her doctor prescribed some medications, but Yvonne, 22 at the time, continued to lose perspective. Maybe the voices weren’t just her mind playing tricks on her? Maybe they were real? That’s when the aliens arrived. She heard the loud, screeching sound of their ship hovering outside her window at night.\u003c/p>\n\u003cp>“We need to remove you from this planet,” the aliens told Yvonne. Then they spoke to each other in their own gargled alien language that she couldn’t understand.\u003c/p>\n\u003cp>Yvonne had no doubt this was real. And when God started talking to her a few weeks later, that was real, too. He told her she was going to be the next Jesus and he was going to give her instructions on how to save the world. At first, this made Yvonne feel great. God had chosen her. But then she got scared, overwhelmed by the responsibility. What if she couldn’t fulfill what God wanted for her?\u003c/p>\n\u003cp>“He’s going to send me to hell and I’m a terrible person,” Yvonne said.\u003c/p>\n\u003cp>Yvonne’s mom convinced her to check herself into the hospital. But it was almost six months after she left the hospital that she got an accurate diagnosis: schizoaffective disorder — roughly, schizophrenia with bouts of mania or depression. And for another six months after that, she sat on her parents’ couch, unable to read, unable to go to school, waiting for a spot to open up in a treatment program.\u003c/p>\n\u003cp>“My life wasn’t my own,” said Yvonne, who asked that we use a family name to protect her mental health history. “It was up to these voices because they told me what to do. They wouldn’t go away and I couldn’t do anything with them. So they ruled my life.”\u003c/p>\n\u003cp>Yvonne is one of \u003ca href=\"https://portal.ct.gov/DMHAS/Initiatives/Evidence-Based/First-Episode-Psychosis#:~:text=Psychosis%20impacts%20approximately%20100%2C000%20youth,others%20may%20have%20ongoing%20symptoms.\">100,000 young adults or adolescents\u003c/a> who have a psychotic episode every year in the U.S. For most of them, it takes \u003ca href=\"https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201400124\">a year and a half to get into meaningful treatment\u003c/a>, if they ever do at all. Treatment programs\u003ca href=\"https://www.hhs.gov/guidance/document/coverage-early-intervention-services-first-episode-psychosis\"> recommended by the National Institute of Mental Health \u003c/a>as the gold standard of care for early psychosis rarely have enough slots available for the people who need them, and health insurance companies typically refuse to cover the full cost of these programs, even when they are available.\u003c/p>\n\u003cfigure id=\"attachment_1981638\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981638 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/Kaiser-clinician-800x600.jpeg\" alt=\"A woman with light skin, dark brown hair, glasses, and a purple knit hat holds a sign that says "Depressed? Suicidal? I'll see in you 6 weeks." She faces the camera and stands amid a crowd of people marching on a sidewalk, many of whom are, like the woman, wearing red T-shirts, and holding signs on wooden dowels that say "Kaiser Don't Deny."\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-800x600.jpeg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-1020x765.jpeg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-160x120.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-768x576.jpeg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-1536x1152.jpeg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician.jpeg 1832w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Mental health clinicians at Kaiser Permanente went on strike in December 2018 and 2019 over long patient wait times. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Instead, many young people like Yvonne inch through the country’s fragmented mental health care system, struggling to find a clinician with adequate training in psychosis. Yvonne waited \u003ca href=\"https://www.kqed.org/news/11791527/kaiser-therapists-strike-again-over-long-wait-times\">up to six weeks between therapy appointments\u003c/a> at Kaiser Permanente, and said she made little progress with a clinician who always seemed to change the subject when Yvonne wanted to talk about her voices. “She would skip over it and talk about my anxiety instead,” Yvonne said.\u003c/p>\n\u003cp>Eventually, Kaiser agreed to pay for Yvonne to go to the \u003ca href=\"https://pathprogram.ucsf.edu/\">UCSF Path Program for Early Psychosis\u003c/a>, a two-year outpatient treatment program designed specifically for young people in the earliest stages of psychotic illness. The clinic is one of about 50 in California and 340 across the country that began operating in the mid-2000s. Right away, Yvonne knew this would be different. In her first session, Yvonne’s therapist had her set goals for what she wanted to achieve.\u003c/p>\n\u003cp>“No one had ever asked me what my goals for treatment were,” Yvonne said.\u003c/p>\n\u003ch2>A revolutionary idea for treating schizophrenia\u003c/h2>\n\u003cp>Back in the ’80s and ’90s, doctors didn’t really know what to do with schizophrenia, and they \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8990328/#:~:text=The%20NIMH%20RAISE%20initiative%20aimed,costs%20associated%20with%20psychotic%20disorders.\">didn’t have many options\u003c/a>. They prescribed high doses of antipsychotic medications that sedated people into zombie-like depths. They advised patients to give up on any career ambitions and sign up for disability payments instead. Even today, some doctors still see schizophrenia as a lost cause.\u003c/p>\n\u003cp>“There’s a real failure to appreciate how much potential there is to manage the illness and symptoms,” said \u003ca href=\"https://www.ucsfhealth.org/providers/dr-daniel-mathalon\">Dr. Daniel Mathalon\u003c/a>, a psychiatrist at UCSF’s early psychosis program.\u003c/p>\n\u003cp>Around the turn of the century, a new generation of doctors started thinking, What if we ask patients what they want and actually work with them toward full recovery? “It’s not just about stabilizing you clinically. It’s about making sure we don’t lose track of your future,” said \u003ca href=\"https://health.ucdavis.edu/psychiatry/team/1290/tara-niendam---pediatric-and-transition-age-youth-mental-health-sacramento/\">Tara Niendam\u003c/a>, a child psychologist who runs \u003ca href=\"https://health.ucdavis.edu/psychiatry/specialties/edapt/\">the early psychosis clinic at UC Davis\u003c/a>. “You \u003cem>should\u003c/em> be in college. You \u003cem>should\u003c/em> be living on your own.”\u003c/p>\n\u003cp>With other conditions like diabetes or cancer, the sooner people get into care, the better they do. \u003ca href=\"https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise\">The same is true of psychotic illness.\u003c/a> Upwards of 80 studies from early psychosis clinics show that patients see \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/26481174/\">a greater reduction of symptoms\u003c/a>, like voices or delusions, and a greater improvement in functioning at school, at work and in their social lives, compared to people who get treatment as usual.\u003c/p>\n\u003cp>There are a few reasons why earlier treatment is more effective, Niendam said. People respond more quickly to medication and at a lower dose, so they have fewer side effects that make them want to stop taking them. Families are more involved and more supportive, and patients themselves are more curious about their psychotic experiences. “They come out of it and they’re like, ‘Whoa! What was that?’” Niendam said. “Folks are still in that questioning phase.”\u003c/p>\n\u003cp>When someone is deep in psychosis, their beliefs are rigid, intractable. They might not see themselves as being sick. But if they get help earlier, Niendam said, they’re more likely to engage in treatment.\u003c/p>\n\u003cfigure id=\"attachment_1981632\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981632 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-800x533.jpg\" alt=\"A woman with gray black, short cropped hair and a purple lanier around her neck speaks to a person with blond hair. \" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Clinical psychologist Tara Niendam speaks with a colleague at the UC Davis Behavioral Health Center in Sacramento on Feb. 7, 2023. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Yvonne, even though she believed the alien ship outside her window was real, her doctors at UCSF started her on a new medication that shook that belief loose. Her new therapist then used targeted cognitive behavioral techniques that helped Yvonne challenge those beliefs further.\u003c/p>\n\u003cp>“So for example, I’d have a thought: ‘Aliens are going to abduct me,’” she said. “So then we do ‘evidence for’ that thought and ‘evidence against’ that thought.”\u003c/p>\n\u003cp>First, she made a list of all the evidence she had that the alien abduction plan was real: I hear the aliens. They’re talking to me. I hear their ship.\u003c/p>\n\u003cp>Then she had to list the evidence that they weren’t real. For this, the therapist had Yvonne set up a jar in her bedroom. Every morning that she woke up and had not been abducted, she would put a blue marble in the jar. If she had been abducted, she was supposed to put a white marble in the jar.\u003c/p>\n\u003cp>“And I had all blue marbles,” Yvonne said. “So that’s evidence against ‘they’re going to get me,’ cause they haven’t yet.”\u003c/p>\n\u003cp>To get control over the voices in her head, Yvonne learned to talk back to them. She would sit in the therapist’s office, in the chair on the right side of the room, and pretend to be her voices, telling her to go back to bed or not to go outside. “It’s dangerous,” she’d say.\u003c/p>\n\u003cp>Then Yvonne would go sit in the chair on the left side of the room and practice her response.\u003c/p>\n\u003cp>“Thank you, voices, for wanting to protect me and watch out for me,” she’d say back. “But I’m going to get up and be brave and go out into the world today.”\u003c/p>\n\u003cp>It took a while to get the hang of it, maybe a year, but when she did, Yvonne was able to go back to school. When the voices would start yelling at her while she was in class, calling her dumb, she was ready.\u003c/p>\n\u003cfigure id=\"attachment_1981731\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-1981731\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/03/IMG_0142-e1677283844671-1020x765.jpg\" alt=\"A drawing of a clear jar filling with round, blue marbles.\" width=\"640\" height=\"480\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-768x576.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-1536x1152.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671.jpg 1920w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">(Illustration by Anna Vignet/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>“I’d be like, ‘You know what? I really don’t appreciate the way you talk to me. Let’s talk after class, let’s talk at 2 p.m.,’” she told them.\u003c/p>\n\u003cp>The voices wouldn’t go away completely, but they would fade into the background, enough where Yvonne could finish class or read a book or do her homework. “I just started to feel more in control,” said Yvonne, now 27.\u003c/p>\n\u003cp>She graduated college last spring, summa cum laude, and she’s now working a full-time job. She’s about to move into her own place. She keeps up with her broad circle of friends, going to shows in the city or having bonfires on the beach. If she thinks she hears a voice or an alien, she does a literal reality check. “Oh, did you hear that?” she’ll ask a friend or her mom. And if they don’t, she tells herself, “Okay, that’s just a voice.”\u003c/p>\n\u003cp>But mostly, Yvonne doesn’t like talking about her illness with her friends. She’d rather talk about the Kardashians instead.\u003c/p>\n\u003cp>“I just like to be normal when I’m with them,” she said.\u003c/p>\n\u003ch2>Independent, career-oriented people\u003c/h2>\n\u003cp>Even though the skills Yvonne learned from therapy at UCSF were a revelation, there was actually a whole other dimension of care that she never got. That’s because UCSF’s program only accepts private insurance, and private health insurers only cover about half of the services of early psychosis treatment.\u003c/p>\n\u003cp>People who get care under government health coverage, like Medi-Cal, can enroll in programs like the \u003ca href=\"https://felton.org/\">Felton Institute\u003c/a>‘s, which offer not just specialized therapy, like Yvonne got, but a full array of social support, as well. At Felton’s five clinic locations, they believe it takes a full team of specialists who all talk to each other, who are all looking out for every aspect of a young person’s life.\u003c/p>\n\u003cp>That includes specialists like Monet Burpee, an education and employment coach. On a typical workday, she’ll drive her clients to the local mall or downtown shopping district, charting their path according to the “Help Wanted” signs. Together, they’ll chat with store managers about open positions, then sit down and fill out the applications.\u003c/p>\n\u003cp>Burpee says helping her clients who have psychosis find work is about more than landing a job; it’s about helping them see themselves differently, as independent, career-oriented people, rather than permanent patients receiving government wage assistance.\u003c/p>\n\u003cp>“If you work, you’re going to notice a huge improvement in your self-esteem,” she tells them. “It has better long-term, positive results versus you just sitting around on SSI.”\u003c/p>\n\u003cfigure id=\"attachment_1981636\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981636 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/Monet-Burpee-2_edited-800x600.jpg\" alt=\"A Black woman with a green cutoff t-shirt and beige hat speaks through a black mask to a man in a blue surgical mask inside a bright space with tables and colorful art on the wall. \" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-768x576.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-1536x1152.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Monet Burpee (right) talks to the manager of a restaurant in Redwood City on one of her job-scouting expeditions in July 2022. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This is what she said to one of her clients, Sandy, after she had her first psychotic episode. Sandy was taking new medications that made her really sleepy, and she was struggling to get motivated.\u003c/p>\n\u003cp>“Since I didn’t really have anything to do, I would just take superlong naps during the day,” said Sandy, now 20, who asked that we call her by a family name so her health history doesn’t disrupt her career path.\u003c/p>\n\u003cp>For her, psychosis hit when she was working her first job after high school, at a fast-food restaurant making burgers. Her co-workers were chatting over the fryer one day when Sandy got this weird feeling, that somehow they knew what she was thinking. It was like her co-workers could read her mind and were discussing her thoughts with each other.\u003c/p>\n\u003cp>“I was like, are they talking about burgers or are they talking about me?” Sandy said.\u003c/p>\n\u003cp>There was one co-worker in particular, a guy she had a crush on, that she was pretty sure was watching her — even following her around. If she was walking down the street, or hanging out in the park, she saw him. Her mom remembers Sandy wanted to sleep with the lights on, repeatedly asking her, “Mom, is someone here?”[pullquote size='medium' citation='Sandy, who has schizophrenia']‘I was like, are they talking about burgers or are they talking about me?’[/pullquote]One day, her mom said Sandy got so scared, she locked herself in the bathroom and just screamed and screamed and screamed.\u003c/p>\n\u003cp>Her mom wanted to call for help. But she didn’t have a job at the time. This was about a year into the pandemic, and the hotel where Sandy’s mom worked had been closed since the first government lockdown. When she lost her job, her union helped her hold on to her health benefits for a while, but that extension was about to run out. “My husband was like, ‘What is that going to cost?’” her mom remembers.\u003c/p>\n\u003cp>Sandy’s mom called 911 anyway. In the hospital, Sandy was diagnosed with schizophrenia. From there, she was enrolled in the Felton Institute’s outpatient early psychosis treatment program. At this point, she and her family were covered by Medi-Cal, the state’s public insurance. They wouldn’t have to pay a dime.\u003c/p>\n\u003cp>Right away, Sandy was introduced to a team of providers who would be by her side for the next two years: a physician, a psychotherapist, an occupational therapist, an education and employment specialist, a peer specialist and a family support specialist for her mom.\u003c/p>\n\u003cp>Sandy’s mom found she needed almost as much support as her daughter did after the diagnosis. She blamed herself. She started meeting once a week with Mike Krechevsky, Felton’s family specialist. He walked her through what schizophrenia was, explained that it was no one’s fault, and helped her manage her own feelings about it so that she didn’t pass them on to Sandy. “When you express anxiety to your child, they don’t feel as though they have any capability of going out in the world, stumbling, falling, picking themselves up, learning from their mistakes and moving forward. You infantilize them,” Krechevsky said. “If you continue to do that, they’re never going to recover.”\u003c/p>\n\u003cp>When Sandy was ready to look for work, she and Burpee went to the mall on a job-scouting expedition. They filled out the applications together. “Next thing I know, I was being interviewed and I got hired,” Sandy said.\u003c/p>\n\u003cp>She started out as a cashier at a new fast-food restaurant and within three months she got promoted to a manager role. Now Burpee is coaching her on how to ask for a raise. “She has a brand-new car,” Burpee said, beaming with pride. “She’s meeting new friends.”\u003c/p>\n\u003cp>For Sandy, it was just one step in her long-term recovery plan.\u003c/p>\n\u003cp>“I want to focus on getting a degree, to get a better career,” she said.\u003c/p>\n\u003ch2>A reverse disparity\u003c/h2>\n\u003cp>In an unusual twist of the U.S.’ separate and unequal health system favoring the wealthy, the reason Sandy was able to get the best care after her psychotic episode was primarily because her mom had lost her job and her insurance.\u003c/p>\n\u003cp>[pullquote citation='Tara Niendam, UC Davis clinical psychologist']‘I can give the Rolls-Royce of care if you walk in and you have Medi-Cal. But 60% of Californians have commercial insurance. That’s 60% of kids who can’t get care, 60% of kids whose parents call me crying when I tell them they can’t access my clinic.’[/pullquote]This is because the state and federal government are the main funders of these early psychosis clinics, investing tens of millions of dollars into them every year. Officials believe it will save money in the long run, because \u003ca href=\"https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise\">without sufficient treatment, people with schizophrenia can deteriorate so much\u003c/a>, they end up on wage assistance, in a group home, on the street or in jail — all things the government pays for.\u003c/p>\n\u003cp>But commercial insurance companies, like Anthem or Blue Shield, don’t face those risks. They don’t have the incentive to cover full-scope psychosis treatment. For that reason, and others, they don’t.\u003c/p>\n\u003cp>This means lower-income families with public insurance like Medi-Cal can get the gold standard of care, while middle-class families with commercial plans cannot.\u003c/p>\n\u003cp>“It is a reverse disparity,” said UC Davis’ Niendam, testifying at a state Senate Committee on Health hearing last year, about the impact of this disparity at the early psychosis clinic she runs in Sacramento.\u003c/p>\n\u003cp>“I can give the Rolls-Royce of care if you walk in and you have Medi-Cal,” she said. But “60% of Californians have commercial insurance. That’s 60% of kids who can’t get care, 60% of kids whose parents call me crying when I tell them they can’t access my clinic.”\u003c/p>\n\u003cp>At the Felton Institute in the Bay Area, early psychosis director \u003ca href=\"https://felton.org/about-us/who-we-are/leadership/adriana-furuzawa/\">Adriana Furuzawa\u003c/a> said the same. For every one person who has Medi-Cal and is eligible for care at her Alameda clinic, there are another two with commercial insurance who are turned away. Last year, they turned about 100 people away.\u003c/p>\n\u003cp>“It was very difficult to think that behind each number, there is a young person, there is a family, that we’re saying no to, when we have the resources right here,” Furuzawa said.\u003c/p>\n\u003cfigure id=\"attachment_1981634\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981634 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-800x533.jpg\" alt='A woman with dark red hair and glass sits in a black office chair in a room with \"positive\" painted on the wall above a white lamp and alongside a brown door. ' width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Adriana Furuzawa, division director for early psychosis services at the Felton Institute, sits in her office in Alameda on Feb. 13, 2023. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>So what happens to these kids? Generally, they’re on their own to find a psychiatrist and therapist who accepts their insurance. Health plans will pay for these medical services. But they won’t cover anything else: the job and education support, the peer specialist, the family coach.\u003c/p>\n\u003cp>This is discrimination, health advocates argue. If someone has cancer, insurers would never just pay for surgery and radiation, but not chemotherapy.\u003c/p>\n\u003cp>“It’s a package of services,” said David Lloyd, chief of policy at the \u003ca href=\"https://www.thekennedyforum.org/\">Kennedy Forum\u003c/a>. “So the idea that you can split apart the package of services and only reimburse for little components of it really destroys the whole evidence base of what the service is.”\u003c/p>\n\u003cp>This almost happened to Sandy. A few months into her treatment, her mom got her job back at the hotel, and the family was back on her commercial insurance plan. In most counties, this would have meant Sandy got kicked out of the program. Her mom said there would have been no way she could afford to pay for a job coach, a family coach and a peer specialist on her own.\u003c/p>\n\u003cp>“I couldn’t do it. I would definitely stop all the help,” she said, even though it was keeping Sandy alive. Maybe she would have turned to Craigslist to find other parents to talk to, she said, or looked up mental health advice on YouTube to pass on to Sandy. “I just hope and pray for the best,” she said.\u003c/p>\n\u003cp>Last year, state lawmakers wanted to help families like Sandy’s, by forcing insurance companies to cover the full spectrum of early psychosis treatment. One state has done this already — \u003ca href=\"https://www.ilga.gov/legislation/publicacts/101/101-0461.htm\">Illinois\u003c/a> — while Massachusetts and Virginia are working on a similar effort. But the proposal in California, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB1337\">Senate Bill 1337\u003c/a>, died under pressure from the insurance lobby.\u003c/p>\n\u003cp>Historically, insurers have not covered the costs of services provided by non-licensed staff, like job or family coaches. More importantly, they do not like being cornered into covering specific treatments, according to Nick Louizos, a lobbyist with the \u003ca href=\"https://www.calhealthplans.org/\">California Association of Health Plans\u003c/a>, a trade group that represents companies like Anthem, Blue Shield and Kaiser.\u003c/p>\n\u003cp>“Science evolves. Research evolves. There could be evidence-based techniques that are better in the future,” he testified at the Senate health committee hearing last year.\u003c/p>\n\u003cp>While scores of studies show \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=202120220SB1337\">the treatment works in the short term\u003c/a> — people are more likely to stay in school, in jobs, in treatment and out of the hospital — the treatment hasn’t been around long enough for researchers to know how long the positive effects last.\u003c/p>\n\u003cp>“There is a lack of evidence of this model’s long-term effectiveness,” Louizos said.\u003c/p>\n\u003cp>Kaiser Permanente is currently running a pilot project, sending 30 of its patients to a full-scope early psychosis clinic based in Solano County. Louizos claims insurers want to see the results from that study — although they are short-term results — before the industry considers investing in the treatment as a whole.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" title=\"Early Psychosis Treatment By County\" aria-label=\"Map\" id=\"datawrapper-chart-GXdZu\" src=\"https://datawrapper.dwcdn.net/GXdZu/2/\" scrolling=\"no\" frameborder=\"0\" style=\"border: none;\" width=\"800\" height=\"845\" data-external=\"1\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003ch2>Perverse incentives\u003c/h2>\n\u003cp>The insurance restrictions create a perverse incentive for middle-income families who need help now. Some parents are so desperate to give their kids the best care, they actually drop them from their health plans and enroll them in Medi-Cal so they can access county-funded clinics like Felton.\u003c/p>\n\u003cp>Some counties, including Sacramento and San Mateo, have taken an even bolder step. Health officials there said denying young people the full suite of care is unethical, enough so that they decided to use taxpayer dollars from the county’s coffers to pay for the services that private insurers refuse to cover. In the end, this is what allowed Sandy to stay in the Felton program.\u003c/p>\n\u003cp>But all of these workarounds are problematic, said the Kennedy Forum’s Lloyd. For-profit insurance companies are essentially making more profits by allowing the public to pay their bills.\u003c/p>\n\u003cp>“That’s not an appropriate role for taxpayers, to be picking up that burden,” he said, adding that insurers’ lack of investment is stifling the growth that’s needed in these programs to provide care for all the young people who need it.\u003c/p>\n\u003cp>Formal consumer protections may ultimately come from a novel 2021 California law designed to expand the kinds of mental health care insurers are required to cover. Under \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">SB 855\u003c/a>, health plans must make mental health coverage decisions based on expert-recognized guidelines for treatment, rather than their own internal criteria, which are often \u003ca href=\"https://www.kqed.org/stateofhealth/series/state-of-mind\">arbitrary or cost-driven\u003c/a>.\u003c/p>\n\u003cp>Multiple agencies, including the \u003ca href=\"https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise\">National Institute of Mental Health\u003c/a>, the \u003ca href=\"https://www.hhs.gov/guidance/document/coverage-early-intervention-services-first-episode-psychosis\">Centers for Medicare and Medicaid Services\u003c/a> and the \u003ca href=\"https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.177901\">American Psychiatric Association\u003c/a>, all recommend full-scope early psychosis care for treatment of a first psychotic episode. State regulators are considering inscribing this guidance explicitly into the official rules they will use to enforce SB 855, with regulatory agencies planning to finalize draft rules this year.\u003c/p>\n\u003cp>Until that happens, psychosis patients with commercial insurance are stuck navigating the status quo of in-network providers. Finding one who understands psychosis, or \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614988/\">who can accurately identify it\u003c/a>, can be a serious challenge.\u003c/p>\n\u003cp>[pullquote citation='Marie, who has bipolar disorder with psychotic features']‘When I had my first episode of psychosis, my therapist thought I was on drugs. She had absolutely no clue what was going on.’[/pullquote]“When I had my first episode of psychosis, my therapist thought I was on drugs. She had absolutely no clue what was going on,” said Marie, 27, who asked us to refer to her by her middle name because of the stigma she’s experienced around her illness, bipolar disorder with psychotic features.\u003c/p>\n\u003cp>When Marie was in high school, her bedroom walls started talking to her. She read a book about Buddhism and it took over her thoughts completely. For three months, she skipped school and went to the beach to meditate instead. “Because I thought I was chosen and I needed to go meditate to attain nirvana,” she said. The entire time, she was seeing a therapist.\u003c/p>\n\u003cp>“Not even close to enough training to be able to say, ‘Oh, I think you’re having psychosis. Let’s go to the hospital,’” Marie remembers. “No. Instead it took months for me to end up in the hospital.”\u003c/p>\n\u003cp>But the hospital was also horrible. There was no empathy, no respect. Marie later researched this and found that mental health providers hold the same level of \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/21954319/\">stigmatizing beliefs about mental illness\u003c/a> as the general population.\u003c/p>\n\u003cp>“I think that has a lot to do with why people hate the hospital,” she said. “It’s because the people in the hospital hate them.”\u003c/p>\n\u003cp>Marie made her own way through college, and when she got a job at a residential treatment program for people with mental illness, she was horrified to discover this thinking was baked into the way staff got trained: Marie’s supervisors warned her to watch out for clients who lied, and constantly referred to the clients as “manipulative.”\u003c/p>\n\u003cp>Marie quit, and found a different approach at the early psychosis program at UC Davis. She got hired to be their peer specialist, drawing on her own experience to counsel young people after their first psychotic episode, when they’re the most scared and confused.\u003c/p>\n\u003cp>“The people around them don’t understand it at all,” Marie said. “But I totally get it. I think that’s the point of my existence — I get it.”\u003c/p>\n\u003cp>She talks to her clients about symptoms, about how to come out to their friends. She becomes a role model to them, a living example of someone who was able to manage her symptoms and get better. Marie is now in nursing school.\u003c/p>\n\u003cp>But for her, recovery was a long and very lonely road. She said she can hardly imagine what it would have meant to her, to her self-esteem, if her insurance had covered the kind of peer support that she provides to others.\u003c/p>\n\u003cp>“I believed I wouldn’t get better,” she said. “It would have been life changing to see someone who got better say that I could.”\u003c/p>\n\u003cp>For Sandy and her family, the full-scope early psychosis care has been life changing. Sandy has struggled with some of her symptoms recently at her fast-food job. The difference is, now she knows what’s happening. She has skills to quiet the voices. She knows her mom will understand. She knows there are half a dozen providers who will pick up if she calls for help.\u003c/p>\n\u003cp>When her mom thinks about the generosity, she thinks about her own father. He was a doctor in the Philippines, and none of his patients had insurance. If they didn’t have money, he treated them anyway. “I remember people paying him with chicken and rice,” she said.\u003c/p>\n\u003cp>She thinks, maybe all the help Sandy got was because of him. The luck of landing in a county that paid for all her care — maybe it was her dad’s karma paying off. \u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">KQED is part of the \u003c/span>\u003ca href=\"https://publicintegrity.org/health/health-parity/mental-health-parity-collaborative/\">\u003cspan style=\"font-weight: 400\">Mental Health Parity Collaborative\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a group of newsrooms that are covering the challenges and solutions to accessing mental health care in the U.S. in partnership with The Center for Public Integrity and The Carter Center.\u003c/span>\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"What if, instead of telling patients with schizophrenia to prepare for a lifetime of disability, we asked them what they want and worked with them toward full recovery?","status":"publish","parent":0,"modified":1704846081,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["https://datawrapper.dwcdn.net/GXdZu/2/"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":97,"wordCount":4969},"headData":{"title":"Proven Schizophrenia Treatments Keep People in School, at Work and off the Street. Why Won't Insurance Companies Cover Them? | KQED","description":"What if, instead of telling patients with schizophrenia to prepare for a lifetime of disability, we asked them what they want and worked with them toward full recovery?","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Proven Schizophrenia Treatments Keep People in School, at Work and off the Street. Why Won't Insurance Companies Cover Them?","datePublished":"2023-03-01T12:00:59.000Z","dateModified":"2024-01-10T00:21:21.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"source":"The California Report Magazine","sourceUrl":"/californiareportmagazine","audioUrl":"https://www.podtrac.com/pts/redirect.mp3/traffic.megaphone.fm/KQINC7482122370.mp3?updated=1677801512","sticky":false,"templateType":"standard","featuredImageType":"standard","excludeFromSiteSearch":"Include","articleAge":"0","path":"/science/1981630/proven-schizophrenia-treatments-keep-people-in-school-at-work-and-off-the-street-why-wont-insurance-companies-cover-them","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003ch2>\u003cem>What if, instead of telling patients with schizophrenia to prepare for a lifetime of disability, we asked them what they want and worked with them toward full recovery?\u003c/em>\u003c/h2>\n\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">W\u003c/span>\u003c/p>\u003cp>hen Yvonne was walking across campus and heard someone calling her name, she stopped and looked around, but the other students flowed around her, oblivious. She continued on, then heard it again.\u003c/p>\n\u003cp>\u003cem>Yvonne?\u003c/em> Stop. Look. Nothing.\u003c/p>\n\u003cp>She was confused, but like anyone else would, Yvonne brushed it off.\u003c/p>\n\u003cp>She sat down in her anatomy class, in the middle of a big lecture hall, and when the professor began his lesson on the renal system, Yvonne started to feel funny, like he was talking about \u003cem>her\u003c/em> body.\u003c/p>\n\u003cp>“I was like, ‘Why is he talking about \u003cem>my\u003c/em> kidneys? How dare he,’” she remembered. “I got really scared and I ran out of class.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She shook this off, too. As she crunched through the rust-colored leaves of an East Coast autumn, she started to hear chattering, like a radio was on in the background of her life. She ignored it as long as she could — until the voices started speaking to her in full sentences, telling her what to do: “You should jump off a bridge. Take that knife and cut yourself,” they said. “You’re worthless.”\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘My life wasn’t my own. It was up to these voices because they told me what to do. They wouldn’t go away.’","name":"pullquote","attributes":{"named":{"citation":"Yvonne, who has schizoaffective disorder","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Her doctor prescribed some medications, but Yvonne, 22 at the time, continued to lose perspective. Maybe the voices weren’t just her mind playing tricks on her? Maybe they were real? That’s when the aliens arrived. She heard the loud, screeching sound of their ship hovering outside her window at night.\u003c/p>\n\u003cp>“We need to remove you from this planet,” the aliens told Yvonne. Then they spoke to each other in their own gargled alien language that she couldn’t understand.\u003c/p>\n\u003cp>Yvonne had no doubt this was real. And when God started talking to her a few weeks later, that was real, too. He told her she was going to be the next Jesus and he was going to give her instructions on how to save the world. At first, this made Yvonne feel great. God had chosen her. But then she got scared, overwhelmed by the responsibility. What if she couldn’t fulfill what God wanted for her?\u003c/p>\n\u003cp>“He’s going to send me to hell and I’m a terrible person,” Yvonne said.\u003c/p>\n\u003cp>Yvonne’s mom convinced her to check herself into the hospital. But it was almost six months after she left the hospital that she got an accurate diagnosis: schizoaffective disorder — roughly, schizophrenia with bouts of mania or depression. And for another six months after that, she sat on her parents’ couch, unable to read, unable to go to school, waiting for a spot to open up in a treatment program.\u003c/p>\n\u003cp>“My life wasn’t my own,” said Yvonne, who asked that we use a family name to protect her mental health history. “It was up to these voices because they told me what to do. They wouldn’t go away and I couldn’t do anything with them. So they ruled my life.”\u003c/p>\n\u003cp>Yvonne is one of \u003ca href=\"https://portal.ct.gov/DMHAS/Initiatives/Evidence-Based/First-Episode-Psychosis#:~:text=Psychosis%20impacts%20approximately%20100%2C000%20youth,others%20may%20have%20ongoing%20symptoms.\">100,000 young adults or adolescents\u003c/a> who have a psychotic episode every year in the U.S. For most of them, it takes \u003ca href=\"https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201400124\">a year and a half to get into meaningful treatment\u003c/a>, if they ever do at all. Treatment programs\u003ca href=\"https://www.hhs.gov/guidance/document/coverage-early-intervention-services-first-episode-psychosis\"> recommended by the National Institute of Mental Health \u003c/a>as the gold standard of care for early psychosis rarely have enough slots available for the people who need them, and health insurance companies typically refuse to cover the full cost of these programs, even when they are available.\u003c/p>\n\u003cfigure id=\"attachment_1981638\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981638 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/Kaiser-clinician-800x600.jpeg\" alt=\"A woman with light skin, dark brown hair, glasses, and a purple knit hat holds a sign that says "Depressed? Suicidal? I'll see in you 6 weeks." She faces the camera and stands amid a crowd of people marching on a sidewalk, many of whom are, like the woman, wearing red T-shirts, and holding signs on wooden dowels that say "Kaiser Don't Deny."\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-800x600.jpeg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-1020x765.jpeg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-160x120.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-768x576.jpeg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-1536x1152.jpeg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician.jpeg 1832w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Mental health clinicians at Kaiser Permanente went on strike in December 2018 and 2019 over long patient wait times. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Instead, many young people like Yvonne inch through the country’s fragmented mental health care system, struggling to find a clinician with adequate training in psychosis. Yvonne waited \u003ca href=\"https://www.kqed.org/news/11791527/kaiser-therapists-strike-again-over-long-wait-times\">up to six weeks between therapy appointments\u003c/a> at Kaiser Permanente, and said she made little progress with a clinician who always seemed to change the subject when Yvonne wanted to talk about her voices. “She would skip over it and talk about my anxiety instead,” Yvonne said.\u003c/p>\n\u003cp>Eventually, Kaiser agreed to pay for Yvonne to go to the \u003ca href=\"https://pathprogram.ucsf.edu/\">UCSF Path Program for Early Psychosis\u003c/a>, a two-year outpatient treatment program designed specifically for young people in the earliest stages of psychotic illness. The clinic is one of about 50 in California and 340 across the country that began operating in the mid-2000s. Right away, Yvonne knew this would be different. In her first session, Yvonne’s therapist had her set goals for what she wanted to achieve.\u003c/p>\n\u003cp>“No one had ever asked me what my goals for treatment were,” Yvonne said.\u003c/p>\n\u003ch2>A revolutionary idea for treating schizophrenia\u003c/h2>\n\u003cp>Back in the ’80s and ’90s, doctors didn’t really know what to do with schizophrenia, and they \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8990328/#:~:text=The%20NIMH%20RAISE%20initiative%20aimed,costs%20associated%20with%20psychotic%20disorders.\">didn’t have many options\u003c/a>. They prescribed high doses of antipsychotic medications that sedated people into zombie-like depths. They advised patients to give up on any career ambitions and sign up for disability payments instead. Even today, some doctors still see schizophrenia as a lost cause.\u003c/p>\n\u003cp>“There’s a real failure to appreciate how much potential there is to manage the illness and symptoms,” said \u003ca href=\"https://www.ucsfhealth.org/providers/dr-daniel-mathalon\">Dr. Daniel Mathalon\u003c/a>, a psychiatrist at UCSF’s early psychosis program.\u003c/p>\n\u003cp>Around the turn of the century, a new generation of doctors started thinking, What if we ask patients what they want and actually work with them toward full recovery? “It’s not just about stabilizing you clinically. It’s about making sure we don’t lose track of your future,” said \u003ca href=\"https://health.ucdavis.edu/psychiatry/team/1290/tara-niendam---pediatric-and-transition-age-youth-mental-health-sacramento/\">Tara Niendam\u003c/a>, a child psychologist who runs \u003ca href=\"https://health.ucdavis.edu/psychiatry/specialties/edapt/\">the early psychosis clinic at UC Davis\u003c/a>. “You \u003cem>should\u003c/em> be in college. You \u003cem>should\u003c/em> be living on your own.”\u003c/p>\n\u003cp>With other conditions like diabetes or cancer, the sooner people get into care, the better they do. \u003ca href=\"https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise\">The same is true of psychotic illness.\u003c/a> Upwards of 80 studies from early psychosis clinics show that patients see \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/26481174/\">a greater reduction of symptoms\u003c/a>, like voices or delusions, and a greater improvement in functioning at school, at work and in their social lives, compared to people who get treatment as usual.\u003c/p>\n\u003cp>There are a few reasons why earlier treatment is more effective, Niendam said. People respond more quickly to medication and at a lower dose, so they have fewer side effects that make them want to stop taking them. Families are more involved and more supportive, and patients themselves are more curious about their psychotic experiences. “They come out of it and they’re like, ‘Whoa! What was that?’” Niendam said. “Folks are still in that questioning phase.”\u003c/p>\n\u003cp>When someone is deep in psychosis, their beliefs are rigid, intractable. They might not see themselves as being sick. But if they get help earlier, Niendam said, they’re more likely to engage in treatment.\u003c/p>\n\u003cfigure id=\"attachment_1981632\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981632 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-800x533.jpg\" alt=\"A woman with gray black, short cropped hair and a purple lanier around her neck speaks to a person with blond hair. \" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Clinical psychologist Tara Niendam speaks with a colleague at the UC Davis Behavioral Health Center in Sacramento on Feb. 7, 2023. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Yvonne, even though she believed the alien ship outside her window was real, her doctors at UCSF started her on a new medication that shook that belief loose. Her new therapist then used targeted cognitive behavioral techniques that helped Yvonne challenge those beliefs further.\u003c/p>\n\u003cp>“So for example, I’d have a thought: ‘Aliens are going to abduct me,’” she said. “So then we do ‘evidence for’ that thought and ‘evidence against’ that thought.”\u003c/p>\n\u003cp>First, she made a list of all the evidence she had that the alien abduction plan was real: I hear the aliens. They’re talking to me. I hear their ship.\u003c/p>\n\u003cp>Then she had to list the evidence that they weren’t real. For this, the therapist had Yvonne set up a jar in her bedroom. Every morning that she woke up and had not been abducted, she would put a blue marble in the jar. If she had been abducted, she was supposed to put a white marble in the jar.\u003c/p>\n\u003cp>“And I had all blue marbles,” Yvonne said. “So that’s evidence against ‘they’re going to get me,’ cause they haven’t yet.”\u003c/p>\n\u003cp>To get control over the voices in her head, Yvonne learned to talk back to them. She would sit in the therapist’s office, in the chair on the right side of the room, and pretend to be her voices, telling her to go back to bed or not to go outside. “It’s dangerous,” she’d say.\u003c/p>\n\u003cp>Then Yvonne would go sit in the chair on the left side of the room and practice her response.\u003c/p>\n\u003cp>“Thank you, voices, for wanting to protect me and watch out for me,” she’d say back. “But I’m going to get up and be brave and go out into the world today.”\u003c/p>\n\u003cp>It took a while to get the hang of it, maybe a year, but when she did, Yvonne was able to go back to school. When the voices would start yelling at her while she was in class, calling her dumb, she was ready.\u003c/p>\n\u003cfigure id=\"attachment_1981731\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-1981731\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/03/IMG_0142-e1677283844671-1020x765.jpg\" alt=\"A drawing of a clear jar filling with round, blue marbles.\" width=\"640\" height=\"480\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-768x576.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-1536x1152.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671.jpg 1920w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">(Illustration by Anna Vignet/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>“I’d be like, ‘You know what? I really don’t appreciate the way you talk to me. Let’s talk after class, let’s talk at 2 p.m.,’” she told them.\u003c/p>\n\u003cp>The voices wouldn’t go away completely, but they would fade into the background, enough where Yvonne could finish class or read a book or do her homework. “I just started to feel more in control,” said Yvonne, now 27.\u003c/p>\n\u003cp>She graduated college last spring, summa cum laude, and she’s now working a full-time job. She’s about to move into her own place. She keeps up with her broad circle of friends, going to shows in the city or having bonfires on the beach. If she thinks she hears a voice or an alien, she does a literal reality check. “Oh, did you hear that?” she’ll ask a friend or her mom. And if they don’t, she tells herself, “Okay, that’s just a voice.”\u003c/p>\n\u003cp>But mostly, Yvonne doesn’t like talking about her illness with her friends. She’d rather talk about the Kardashians instead.\u003c/p>\n\u003cp>“I just like to be normal when I’m with them,” she said.\u003c/p>\n\u003ch2>Independent, career-oriented people\u003c/h2>\n\u003cp>Even though the skills Yvonne learned from therapy at UCSF were a revelation, there was actually a whole other dimension of care that she never got. That’s because UCSF’s program only accepts private insurance, and private health insurers only cover about half of the services of early psychosis treatment.\u003c/p>\n\u003cp>People who get care under government health coverage, like Medi-Cal, can enroll in programs like the \u003ca href=\"https://felton.org/\">Felton Institute\u003c/a>‘s, which offer not just specialized therapy, like Yvonne got, but a full array of social support, as well. At Felton’s five clinic locations, they believe it takes a full team of specialists who all talk to each other, who are all looking out for every aspect of a young person’s life.\u003c/p>\n\u003cp>That includes specialists like Monet Burpee, an education and employment coach. On a typical workday, she’ll drive her clients to the local mall or downtown shopping district, charting their path according to the “Help Wanted” signs. Together, they’ll chat with store managers about open positions, then sit down and fill out the applications.\u003c/p>\n\u003cp>Burpee says helping her clients who have psychosis find work is about more than landing a job; it’s about helping them see themselves differently, as independent, career-oriented people, rather than permanent patients receiving government wage assistance.\u003c/p>\n\u003cp>“If you work, you’re going to notice a huge improvement in your self-esteem,” she tells them. “It has better long-term, positive results versus you just sitting around on SSI.”\u003c/p>\n\u003cfigure id=\"attachment_1981636\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981636 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/Monet-Burpee-2_edited-800x600.jpg\" alt=\"A Black woman with a green cutoff t-shirt and beige hat speaks through a black mask to a man in a blue surgical mask inside a bright space with tables and colorful art on the wall. \" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-768x576.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-1536x1152.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Monet Burpee (right) talks to the manager of a restaurant in Redwood City on one of her job-scouting expeditions in July 2022. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This is what she said to one of her clients, Sandy, after she had her first psychotic episode. Sandy was taking new medications that made her really sleepy, and she was struggling to get motivated.\u003c/p>\n\u003cp>“Since I didn’t really have anything to do, I would just take superlong naps during the day,” said Sandy, now 20, who asked that we call her by a family name so her health history doesn’t disrupt her career path.\u003c/p>\n\u003cp>For her, psychosis hit when she was working her first job after high school, at a fast-food restaurant making burgers. Her co-workers were chatting over the fryer one day when Sandy got this weird feeling, that somehow they knew what she was thinking. It was like her co-workers could read her mind and were discussing her thoughts with each other.\u003c/p>\n\u003cp>“I was like, are they talking about burgers or are they talking about me?” Sandy said.\u003c/p>\n\u003cp>There was one co-worker in particular, a guy she had a crush on, that she was pretty sure was watching her — even following her around. If she was walking down the street, or hanging out in the park, she saw him. Her mom remembers Sandy wanted to sleep with the lights on, repeatedly asking her, “Mom, is someone here?”\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘I was like, are they talking about burgers or are they talking about me?’","name":"pullquote","attributes":{"named":{"size":"medium","citation":"Sandy, who has schizophrenia","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>One day, her mom said Sandy got so scared, she locked herself in the bathroom and just screamed and screamed and screamed.\u003c/p>\n\u003cp>Her mom wanted to call for help. But she didn’t have a job at the time. This was about a year into the pandemic, and the hotel where Sandy’s mom worked had been closed since the first government lockdown. When she lost her job, her union helped her hold on to her health benefits for a while, but that extension was about to run out. “My husband was like, ‘What is that going to cost?’” her mom remembers.\u003c/p>\n\u003cp>Sandy’s mom called 911 anyway. In the hospital, Sandy was diagnosed with schizophrenia. From there, she was enrolled in the Felton Institute’s outpatient early psychosis treatment program. At this point, she and her family were covered by Medi-Cal, the state’s public insurance. They wouldn’t have to pay a dime.\u003c/p>\n\u003cp>Right away, Sandy was introduced to a team of providers who would be by her side for the next two years: a physician, a psychotherapist, an occupational therapist, an education and employment specialist, a peer specialist and a family support specialist for her mom.\u003c/p>\n\u003cp>Sandy’s mom found she needed almost as much support as her daughter did after the diagnosis. She blamed herself. She started meeting once a week with Mike Krechevsky, Felton’s family specialist. He walked her through what schizophrenia was, explained that it was no one’s fault, and helped her manage her own feelings about it so that she didn’t pass them on to Sandy. “When you express anxiety to your child, they don’t feel as though they have any capability of going out in the world, stumbling, falling, picking themselves up, learning from their mistakes and moving forward. You infantilize them,” Krechevsky said. “If you continue to do that, they’re never going to recover.”\u003c/p>\n\u003cp>When Sandy was ready to look for work, she and Burpee went to the mall on a job-scouting expedition. They filled out the applications together. “Next thing I know, I was being interviewed and I got hired,” Sandy said.\u003c/p>\n\u003cp>She started out as a cashier at a new fast-food restaurant and within three months she got promoted to a manager role. Now Burpee is coaching her on how to ask for a raise. “She has a brand-new car,” Burpee said, beaming with pride. “She’s meeting new friends.”\u003c/p>\n\u003cp>For Sandy, it was just one step in her long-term recovery plan.\u003c/p>\n\u003cp>“I want to focus on getting a degree, to get a better career,” she said.\u003c/p>\n\u003ch2>A reverse disparity\u003c/h2>\n\u003cp>In an unusual twist of the U.S.’ separate and unequal health system favoring the wealthy, the reason Sandy was able to get the best care after her psychotic episode was primarily because her mom had lost her job and her insurance.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘I can give the Rolls-Royce of care if you walk in and you have Medi-Cal. But 60% of Californians have commercial insurance. That’s 60% of kids who can’t get care, 60% of kids whose parents call me crying when I tell them they can’t access my clinic.’","name":"pullquote","attributes":{"named":{"citation":"Tara Niendam, UC Davis clinical psychologist","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>This is because the state and federal government are the main funders of these early psychosis clinics, investing tens of millions of dollars into them every year. Officials believe it will save money in the long run, because \u003ca href=\"https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise\">without sufficient treatment, people with schizophrenia can deteriorate so much\u003c/a>, they end up on wage assistance, in a group home, on the street or in jail — all things the government pays for.\u003c/p>\n\u003cp>But commercial insurance companies, like Anthem or Blue Shield, don’t face those risks. They don’t have the incentive to cover full-scope psychosis treatment. For that reason, and others, they don’t.\u003c/p>\n\u003cp>This means lower-income families with public insurance like Medi-Cal can get the gold standard of care, while middle-class families with commercial plans cannot.\u003c/p>\n\u003cp>“It is a reverse disparity,” said UC Davis’ Niendam, testifying at a state Senate Committee on Health hearing last year, about the impact of this disparity at the early psychosis clinic she runs in Sacramento.\u003c/p>\n\u003cp>“I can give the Rolls-Royce of care if you walk in and you have Medi-Cal,” she said. But “60% of Californians have commercial insurance. That’s 60% of kids who can’t get care, 60% of kids whose parents call me crying when I tell them they can’t access my clinic.”\u003c/p>\n\u003cp>At the Felton Institute in the Bay Area, early psychosis director \u003ca href=\"https://felton.org/about-us/who-we-are/leadership/adriana-furuzawa/\">Adriana Furuzawa\u003c/a> said the same. For every one person who has Medi-Cal and is eligible for care at her Alameda clinic, there are another two with commercial insurance who are turned away. Last year, they turned about 100 people away.\u003c/p>\n\u003cp>“It was very difficult to think that behind each number, there is a young person, there is a family, that we’re saying no to, when we have the resources right here,” Furuzawa said.\u003c/p>\n\u003cfigure id=\"attachment_1981634\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981634 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-800x533.jpg\" alt='A woman with dark red hair and glass sits in a black office chair in a room with \"positive\" painted on the wall above a white lamp and alongside a brown door. ' width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Adriana Furuzawa, division director for early psychosis services at the Felton Institute, sits in her office in Alameda on Feb. 13, 2023. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>So what happens to these kids? Generally, they’re on their own to find a psychiatrist and therapist who accepts their insurance. Health plans will pay for these medical services. But they won’t cover anything else: the job and education support, the peer specialist, the family coach.\u003c/p>\n\u003cp>This is discrimination, health advocates argue. If someone has cancer, insurers would never just pay for surgery and radiation, but not chemotherapy.\u003c/p>\n\u003cp>“It’s a package of services,” said David Lloyd, chief of policy at the \u003ca href=\"https://www.thekennedyforum.org/\">Kennedy Forum\u003c/a>. “So the idea that you can split apart the package of services and only reimburse for little components of it really destroys the whole evidence base of what the service is.”\u003c/p>\n\u003cp>This almost happened to Sandy. A few months into her treatment, her mom got her job back at the hotel, and the family was back on her commercial insurance plan. In most counties, this would have meant Sandy got kicked out of the program. Her mom said there would have been no way she could afford to pay for a job coach, a family coach and a peer specialist on her own.\u003c/p>\n\u003cp>“I couldn’t do it. I would definitely stop all the help,” she said, even though it was keeping Sandy alive. Maybe she would have turned to Craigslist to find other parents to talk to, she said, or looked up mental health advice on YouTube to pass on to Sandy. “I just hope and pray for the best,” she said.\u003c/p>\n\u003cp>Last year, state lawmakers wanted to help families like Sandy’s, by forcing insurance companies to cover the full spectrum of early psychosis treatment. One state has done this already — \u003ca href=\"https://www.ilga.gov/legislation/publicacts/101/101-0461.htm\">Illinois\u003c/a> — while Massachusetts and Virginia are working on a similar effort. But the proposal in California, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB1337\">Senate Bill 1337\u003c/a>, died under pressure from the insurance lobby.\u003c/p>\n\u003cp>Historically, insurers have not covered the costs of services provided by non-licensed staff, like job or family coaches. More importantly, they do not like being cornered into covering specific treatments, according to Nick Louizos, a lobbyist with the \u003ca href=\"https://www.calhealthplans.org/\">California Association of Health Plans\u003c/a>, a trade group that represents companies like Anthem, Blue Shield and Kaiser.\u003c/p>\n\u003cp>“Science evolves. Research evolves. There could be evidence-based techniques that are better in the future,” he testified at the Senate health committee hearing last year.\u003c/p>\n\u003cp>While scores of studies show \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=202120220SB1337\">the treatment works in the short term\u003c/a> — people are more likely to stay in school, in jobs, in treatment and out of the hospital — the treatment hasn’t been around long enough for researchers to know how long the positive effects last.\u003c/p>\n\u003cp>“There is a lack of evidence of this model’s long-term effectiveness,” Louizos said.\u003c/p>\n\u003cp>Kaiser Permanente is currently running a pilot project, sending 30 of its patients to a full-scope early psychosis clinic based in Solano County. Louizos claims insurers want to see the results from that study — although they are short-term results — before the industry considers investing in the treatment as a whole.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" title=\"Early Psychosis Treatment By County\" aria-label=\"Map\" id=\"datawrapper-chart-GXdZu\" src=\"https://datawrapper.dwcdn.net/GXdZu/2/\" scrolling=\"no\" frameborder=\"0\" style=\"border: none;\" width=\"800\" height=\"845\" data-external=\"1\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003ch2>Perverse incentives\u003c/h2>\n\u003cp>The insurance restrictions create a perverse incentive for middle-income families who need help now. Some parents are so desperate to give their kids the best care, they actually drop them from their health plans and enroll them in Medi-Cal so they can access county-funded clinics like Felton.\u003c/p>\n\u003cp>Some counties, including Sacramento and San Mateo, have taken an even bolder step. Health officials there said denying young people the full suite of care is unethical, enough so that they decided to use taxpayer dollars from the county’s coffers to pay for the services that private insurers refuse to cover. In the end, this is what allowed Sandy to stay in the Felton program.\u003c/p>\n\u003cp>But all of these workarounds are problematic, said the Kennedy Forum’s Lloyd. For-profit insurance companies are essentially making more profits by allowing the public to pay their bills.\u003c/p>\n\u003cp>“That’s not an appropriate role for taxpayers, to be picking up that burden,” he said, adding that insurers’ lack of investment is stifling the growth that’s needed in these programs to provide care for all the young people who need it.\u003c/p>\n\u003cp>Formal consumer protections may ultimately come from a novel 2021 California law designed to expand the kinds of mental health care insurers are required to cover. Under \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">SB 855\u003c/a>, health plans must make mental health coverage decisions based on expert-recognized guidelines for treatment, rather than their own internal criteria, which are often \u003ca href=\"https://www.kqed.org/stateofhealth/series/state-of-mind\">arbitrary or cost-driven\u003c/a>.\u003c/p>\n\u003cp>Multiple agencies, including the \u003ca href=\"https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise\">National Institute of Mental Health\u003c/a>, the \u003ca href=\"https://www.hhs.gov/guidance/document/coverage-early-intervention-services-first-episode-psychosis\">Centers for Medicare and Medicaid Services\u003c/a> and the \u003ca href=\"https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.177901\">American Psychiatric Association\u003c/a>, all recommend full-scope early psychosis care for treatment of a first psychotic episode. State regulators are considering inscribing this guidance explicitly into the official rules they will use to enforce SB 855, with regulatory agencies planning to finalize draft rules this year.\u003c/p>\n\u003cp>Until that happens, psychosis patients with commercial insurance are stuck navigating the status quo of in-network providers. Finding one who understands psychosis, or \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614988/\">who can accurately identify it\u003c/a>, can be a serious challenge.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘When I had my first episode of psychosis, my therapist thought I was on drugs. She had absolutely no clue what was going on.’","name":"pullquote","attributes":{"named":{"citation":"Marie, who has bipolar disorder with psychotic features","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>“When I had my first episode of psychosis, my therapist thought I was on drugs. She had absolutely no clue what was going on,” said Marie, 27, who asked us to refer to her by her middle name because of the stigma she’s experienced around her illness, bipolar disorder with psychotic features.\u003c/p>\n\u003cp>When Marie was in high school, her bedroom walls started talking to her. She read a book about Buddhism and it took over her thoughts completely. For three months, she skipped school and went to the beach to meditate instead. “Because I thought I was chosen and I needed to go meditate to attain nirvana,” she said. The entire time, she was seeing a therapist.\u003c/p>\n\u003cp>“Not even close to enough training to be able to say, ‘Oh, I think you’re having psychosis. Let’s go to the hospital,’” Marie remembers. “No. Instead it took months for me to end up in the hospital.”\u003c/p>\n\u003cp>But the hospital was also horrible. There was no empathy, no respect. Marie later researched this and found that mental health providers hold the same level of \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/21954319/\">stigmatizing beliefs about mental illness\u003c/a> as the general population.\u003c/p>\n\u003cp>“I think that has a lot to do with why people hate the hospital,” she said. “It’s because the people in the hospital hate them.”\u003c/p>\n\u003cp>Marie made her own way through college, and when she got a job at a residential treatment program for people with mental illness, she was horrified to discover this thinking was baked into the way staff got trained: Marie’s supervisors warned her to watch out for clients who lied, and constantly referred to the clients as “manipulative.”\u003c/p>\n\u003cp>Marie quit, and found a different approach at the early psychosis program at UC Davis. She got hired to be their peer specialist, drawing on her own experience to counsel young people after their first psychotic episode, when they’re the most scared and confused.\u003c/p>\n\u003cp>“The people around them don’t understand it at all,” Marie said. “But I totally get it. I think that’s the point of my existence — I get it.”\u003c/p>\n\u003cp>She talks to her clients about symptoms, about how to come out to their friends. She becomes a role model to them, a living example of someone who was able to manage her symptoms and get better. Marie is now in nursing school.\u003c/p>\n\u003cp>But for her, recovery was a long and very lonely road. She said she can hardly imagine what it would have meant to her, to her self-esteem, if her insurance had covered the kind of peer support that she provides to others.\u003c/p>\n\u003cp>“I believed I wouldn’t get better,” she said. “It would have been life changing to see someone who got better say that I could.”\u003c/p>\n\u003cp>For Sandy and her family, the full-scope early psychosis care has been life changing. Sandy has struggled with some of her symptoms recently at her fast-food job. The difference is, now she knows what’s happening. She has skills to quiet the voices. She knows her mom will understand. She knows there are half a dozen providers who will pick up if she calls for help.\u003c/p>\n\u003cp>When her mom thinks about the generosity, she thinks about her own father. He was a doctor in the Philippines, and none of his patients had insurance. If they didn’t have money, he treated them anyway. “I remember people paying him with chicken and rice,” she said.\u003c/p>\n\u003cp>She thinks, maybe all the help Sandy got was because of him. The luck of landing in a county that paid for all her care — maybe it was her dad’s karma paying off. \u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">KQED is part of the \u003c/span>\u003ca href=\"https://publicintegrity.org/health/health-parity/mental-health-parity-collaborative/\">\u003cspan style=\"font-weight: 400\">Mental Health Parity Collaborative\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a group of newsrooms that are covering the challenges and solutions to accessing mental health care in the U.S. in partnership with The Center for Public Integrity and The Carter Center.\u003c/span>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/1981630/proven-schizophrenia-treatments-keep-people-in-school-at-work-and-off-the-street-why-wont-insurance-companies-cover-them","authors":["3205"],"programs":["science_4714"],"categories":["science_39","science_40","science_4450"],"tags":["science_4417","science_4414","science_249"],"featImg":"science_1981753","label":"source_science_1981630"},"science_1956693":{"type":"posts","id":"science_1956693","meta":{"index":"posts_1591205157","site":"science","id":"1956693","score":null,"sort":[1581354143000]},"guestAuthors":[],"slug":"psychedelic-therapy-available-to-more-people-before-clinical-trials-end","title":"Psychedelic Therapy Available to More People During Clinical Trials","publishDate":1581354143,"format":"audio","headTitle":"Psychedelic Therapy Available to More People During Clinical Trials | KQED","labelTerm":{},"content":"\u003cp>When Army Sergeant Jonathan Lubecky returned to the U.S. from Iraq more than a decade ago, simple activities, like family trips to theme parks or the county fair, overwhelmed him.\u003c/p>\n\u003cp>He recalls “panic attacks, intrusive thoughts. I’d get auditory and olfactory flashbacks.” Along with an “intense fear that bad things were about to happen.”\u003c/p>\n\u003cp>He’d spent some of his deployment at a base in Iraq that caught mortar fire thousands of times, he says. One mortar even landed next to a porta-potty while he was inside.\u003c/p>\n\u003cp>After his return home, doctors diagnosed him with a traumatic brain injury and post-traumatic stress disorder, or PTSD.\u003c/p>\n\u003cp>Lubecky could not find mental and emotional relief. He tried all kinds of treatment: talk therapy, cognitive behavioral therapy, and multiple medications. None of them worked. Suicidal thoughts plagued him for eight years. He says he tried to kill himself five times.\u003c/p>\n\u003cp>Out of options, he enrolled in a clinical trial that used psychedelic-assisted therapy. The drug was MDMA — also known as Ecstasy or Molly. Lubecky says it worked.\u003c/p>\n\u003cp>“I literally went from being in a VA facility inpatient [program] to being Senator Rand Paul’s national veterans director in his presidential campaign in two years because of this therapy,” he says.\u003c/p>\n\u003cfigure id=\"attachment_1956707\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1956707 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2020/02/RS41243_alt_983-e1581109029589-800x636.jpg\" alt=\"Jonathan Lubecky and stepson Joey Monteleone in Washington, D.C. before visiting the White House in 2019.\" width=\"800\" height=\"636\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2020/02/RS41243_alt_983-e1581109029589-800x636.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/02/RS41243_alt_983-e1581109029589-160x127.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/02/RS41243_alt_983-e1581109029589-768x610.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/02/RS41243_alt_983-e1581109029589-1020x810.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/02/RS41243_alt_983-e1581109029589-1920x1525.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jonathan Lubecky and stepson Joey Monteleone in Washington, D.C. before visiting the White House in 2019. \u003ccite>(Courtesy of Jonathan Lubecky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Until recently, only participants in clinical trials could qualify for MDMA-assisted therapy. Now the federal Food and Drug Administration has granted researchers what it calls “expanded access.” That means people who can’t find relief other ways — who are “treatment-resistant” — can get this therapy before the FDA approves it.\u003c/p>\n\u003cp>Rick Doblin established and runs the \u003ca href=\"https://maps.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Multidisciplinary Associations for Psychedelic Studies (MAPS)\u003c/a>, the nonprofit conducting the MDMA-assisted therapy trials in the U.S., Canada, and Israel.\u003c/p>\n\u003cp>Doblin said the FDA’s move is “a sign that we’re getting over ‘the psychedelic 60s’ — that the FDA is really more science over politics now.\u003c/p>\n\u003cp>“The FDA is recognizing that there’s a humanitarian crisis with many, many millions of people that have treatment-resistant PTSD,” Doblin says. The U.S. Department of Veterans Affairs estimates that \u003ca href=\"https://www.ptsd.va.gov/understand/common/common_adults.asp\" target=\"_blank\" rel=\"noopener noreferrer\">8 million adults have PTSD\u003c/a>.\u003c/p>\n\u003cp>That disorder results from combat, Doblin says, but also from sexual assault and other trauma.\u003c/p>\n\u003cp>For those treated with MDMA, \u003ca href=\"https://link.springer.com/article/10.1007/s00213-019-05249-5\" target=\"_blank\" rel=\"noopener noreferrer\">54% no longer had PTSD symptoms\u003c/a> after therapy. Researchers found that number increased to 68% a year after treatment.\u003c/p>\n\u003cp>The federal Controlled Substances Act classifies MDMA as an illegal Schedule 1 drug. While the FDA is expanding access to just 50 people beyond the clinical trial, Doblin and his team hope to increase that number, and to see the FDA approve the treatment by 2022.\u003c/p>\n\u003cp>Lubecky, the Army veteran, now works for MAPS as its Veterans and Governmental Affairs Liaison. He says making this treatment available to even a small number of people could mean the difference between life and death.\u003c/p>\n\u003cp>“The MDMA-assisted therapy,” he says, “is the reason that my stepson Joey has a father instead of a folded flag.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n","blocks":[],"excerpt":"The FDA has granted researchers “expanded access” to help people with treatment-resistent PTSD.","status":"publish","parent":0,"modified":1704847793,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":551},"headData":{"title":"Psychedelic Therapy Available to More People During Clinical Trials | KQED","description":"The FDA has granted researchers “expanded access” to help people with treatment-resistent PTSD.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Psychedelic Therapy Available to More People During Clinical Trials","datePublished":"2020-02-10T17:02:23.000Z","dateModified":"2024-01-10T00:49:53.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"source":"Medical Science","audioUrl":"https://www.kqed.org/.stream/anon/radio/science/2020/02/KlivansMDMATherapy.mp3","sticky":false,"path":"/science/1956693/psychedelic-therapy-available-to-more-people-before-clinical-trials-end","audioDuration":165000,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Army Sergeant Jonathan Lubecky returned to the U.S. from Iraq more than a decade ago, simple activities, like family trips to theme parks or the county fair, overwhelmed him.\u003c/p>\n\u003cp>He recalls “panic attacks, intrusive thoughts. I’d get auditory and olfactory flashbacks.” Along with an “intense fear that bad things were about to happen.”\u003c/p>\n\u003cp>He’d spent some of his deployment at a base in Iraq that caught mortar fire thousands of times, he says. One mortar even landed next to a porta-potty while he was inside.\u003c/p>\n\u003cp>After his return home, doctors diagnosed him with a traumatic brain injury and post-traumatic stress disorder, or PTSD.\u003c/p>\n\u003cp>Lubecky could not find mental and emotional relief. He tried all kinds of treatment: talk therapy, cognitive behavioral therapy, and multiple medications. None of them worked. Suicidal thoughts plagued him for eight years. He says he tried to kill himself five times.\u003c/p>\n\u003cp>Out of options, he enrolled in a clinical trial that used psychedelic-assisted therapy. The drug was MDMA — also known as Ecstasy or Molly. Lubecky says it worked.\u003c/p>\n\u003cp>“I literally went from being in a VA facility inpatient [program] to being Senator Rand Paul’s national veterans director in his presidential campaign in two years because of this therapy,” he says.\u003c/p>\n\u003cfigure id=\"attachment_1956707\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1956707 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2020/02/RS41243_alt_983-e1581109029589-800x636.jpg\" alt=\"Jonathan Lubecky and stepson Joey Monteleone in Washington, D.C. before visiting the White House in 2019.\" width=\"800\" height=\"636\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2020/02/RS41243_alt_983-e1581109029589-800x636.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/02/RS41243_alt_983-e1581109029589-160x127.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/02/RS41243_alt_983-e1581109029589-768x610.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/02/RS41243_alt_983-e1581109029589-1020x810.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/02/RS41243_alt_983-e1581109029589-1920x1525.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jonathan Lubecky and stepson Joey Monteleone in Washington, D.C. before visiting the White House in 2019. \u003ccite>(Courtesy of Jonathan Lubecky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Until recently, only participants in clinical trials could qualify for MDMA-assisted therapy. Now the federal Food and Drug Administration has granted researchers what it calls “expanded access.” That means people who can’t find relief other ways — who are “treatment-resistant” — can get this therapy before the FDA approves it.\u003c/p>\n\u003cp>Rick Doblin established and runs the \u003ca href=\"https://maps.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Multidisciplinary Associations for Psychedelic Studies (MAPS)\u003c/a>, the nonprofit conducting the MDMA-assisted therapy trials in the U.S., Canada, and Israel.\u003c/p>\n\u003cp>Doblin said the FDA’s move is “a sign that we’re getting over ‘the psychedelic 60s’ — that the FDA is really more science over politics now.\u003c/p>\n\u003cp>“The FDA is recognizing that there’s a humanitarian crisis with many, many millions of people that have treatment-resistant PTSD,” Doblin says. The U.S. Department of Veterans Affairs estimates that \u003ca href=\"https://www.ptsd.va.gov/understand/common/common_adults.asp\" target=\"_blank\" rel=\"noopener noreferrer\">8 million adults have PTSD\u003c/a>.\u003c/p>\n\u003cp>That disorder results from combat, Doblin says, but also from sexual assault and other trauma.\u003c/p>\n\u003cp>For those treated with MDMA, \u003ca href=\"https://link.springer.com/article/10.1007/s00213-019-05249-5\" target=\"_blank\" rel=\"noopener noreferrer\">54% no longer had PTSD symptoms\u003c/a> after therapy. Researchers found that number increased to 68% a year after treatment.\u003c/p>\n\u003cp>The federal Controlled Substances Act classifies MDMA as an illegal Schedule 1 drug. While the FDA is expanding access to just 50 people beyond the clinical trial, Doblin and his team hope to increase that number, and to see the FDA approve the treatment by 2022.\u003c/p>\n\u003cp>Lubecky, the Army veteran, now works for MAPS as its Veterans and Governmental Affairs Liaison. He says making this treatment available to even a small number of people could mean the difference between life and death.\u003c/p>\n\u003cp>“The MDMA-assisted therapy,” he says, “is the reason that my stepson Joey has a father instead of a folded flag.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/1956693/psychedelic-therapy-available-to-more-people-before-clinical-trials-end","authors":["8648"],"categories":["science_39","science_3890","science_40","science_3423"],"tags":["science_3370","science_249"],"featImg":"science_1956721","label":"source_science_1956693"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. 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Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Consider-This-Podcast-Tile-703x703-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. 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