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You can follow her on Twitter: \u003ca title=\"https://twitter.com/laliferis\" href=\"https://twitter.com/laliferis\">@laliferis\u003c/a>","avatar":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twitter":"laliferis","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"futureofyou","roles":["subscriber"]},{"site":"stateofhealth","roles":["subscriber"]},{"site":"science","roles":["subscriber"]},{"site":"food","roles":["contributor"]}],"headData":{"title":"Lisa Aliferis | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lisaaliferis"},"state-of-health":{"type":"authors","id":"8344","meta":{"index":"authors_1591205172","id":"8344","found":true},"name":"State of Health","firstName":"State of 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FM","link":"/"}},"futureofyou_275033":{"type":"posts","id":"futureofyou_275033","meta":{"index":"posts_1591205157","site":"futureofyou","id":"275033","score":null,"sort":[1478105487000]},"guestAuthors":[],"slug":"evidence-piles-up-that-the-poor-are-high-risk-for-mental-illness","title":"Evidence Piles Up: The Poor Are High Risk for Mental Illness","publishDate":1478105487,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>After a mother killed her four young children and then herself last month in rural China, onlookers quickly pointed to life circumstances.\u003c/p>\n\u003cp>The family lived in extreme poverty, and bloggers speculated that her inability to escape adversity pushed her over the edge.\u003c/p>\n\u003cp>Can poverty really cause mental illness?\u003c/p>\n\u003caside class=\"pullquote alignright\">Studies show that all over the globe, there is a connection between poverty and mental illness.\u003c/aside>\n\u003cp>It's a complex question that is fairly new to science. Despite high rates of both poverty and mental disorders around the world, researchers only started probing the possible links about 25 years ago.\u003c/p>\n\u003cp>Since then, evidence has piled up to make the case that, at the very least, there is a connection. People who live in poverty appear to be at higher risk for mental illnesses. They also report lower levels of happiness.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That seems to be true all over the globe. In a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20621748\">2010 review\u003c/a> of 115 studies that spanned 33 countries across the developed and developing worlds, nearly 80 percent of the studies showed that poverty comes with higher rates of mental illness. Among people living in poverty, those studies also found, mental illnesses were more severe, lasted longer and had worse outcomes.\u003c/p>\n\u003cp>And there's growing \u003ca href=\"https://www.brookings.edu/research/subjective-well%e2%80%90being-and-income-is-there-any-evidence-of-satiation/;%20https://www.dartmouth.edu/~neudc2012/docs/paper_195.pdf\">evidence\u003c/a> that levels of depression are higher in poorer countries than in wealthier ones. Those kinds of findings challenge a long-held myth of the \"poor but happy African sitting under a palm tree,\" says \u003ca href=\"http://www.princeton.edu/haushofer/\">Johannes Haushofer\u003c/a>, an economist and neurobiologist who studies interactions between poverty and mental health at Princeton University.\u003c/p>\n\u003cp>As data builds to connect tough economic circumstances with mental struggles, scientists are still trying to answer a trickier question: Which causes which?\u003c/p>\n\u003cp>There is no easy answer, says psychologist \u003ca href=\"http://www.health.uct.ac.za/fhs/departments/psychiatry/staff/crick-lund\">Crick Lund \u003c/a>of the University of Capetown, who studies mental health policy. Mental illness is never caused by just one thing. Poverty can be one factor that interacts with genetics, adverse life events or substance abuse.\u003c/p>\n\u003cp>But so far, the strongest evidence suggests that poverty can lead to mental illness, especially in cases of disorders like depression.\u003c/p>\n\u003cp>Because scientists can't experimentally plunge people into poverty to see what happens to their mental health, natural experiments offer one kind of clue. When disasters or tough spells (like losing a job or enduring periods of drought for farmers) destroy financial circumstances, numerous studies show a rise in rates of depression, Haushofer says.\u003c/p>\n\u003cp>On the flip side, people often get happier after economic windfalls. In a \u003ca href=\"http://www.princeton.edu/haushofer/publications/Haushofer_Shapiro_UCT_2016.04.25.pdf\">new study\u003c/a>, Haushofer and a colleague found that when families in Kenya were given cash grants averaging $700 (nearly twice the amount typically spent per person per year), they reported higher levels of life satisfaction and lower levels of depression than they did before they got the money, which they could spend on anything. The larger the cash transfer, the bigger the mental boost. It didn't matter if the money came in monthly installments or all at once.\u003c/p>\n\u003cp>Despite the long-held belief that winning the lottery destroys lives as people make bad decisions about \u003ca href=\"http://qje.oxfordjournals.org/content/early/2016/02/17/qje.qjw001.full.pdf\">how to use the money\u003c/a>, Haushofer adds, newer evidence suggests the opposite. In study published this year, researchers in Sweden, reported that lottery winners used fewer anti-anxiety medications and sleeping pills after collecting their payout, suggesting that they became happier.\u003c/p>\n\u003cp>So how does poverty \"get under the skin\" or into the brain, Lund asks? Stress is a leading contender. \u003ca href=\"https://www.dartmouth.edu/~neudc2012/docs/paper_195.pdf\">Some studies\u003c/a> have found higher levels of the stress hormone cortisol in people living in poverty. In Mexican households that received cash grants, found a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768580/\">2009 study\u003c/a>, young children had lower cortisol levels compared to kids from families that didn't get extra money. Other studies, however, have failed to find any changes in cortisol.\u003c/p>\n\u003cp>Rates of violence are also higher among people who face economic tension. Living amid violence can exacerbate depression, Lund adds. And studies have found connections between mental illness and poverty-associated conditions, such as not having enough to eat, not making enough money to live on and having a greater chance of developing risks for physical illnesses.\u003c/p>\n\u003cp>Mental illness may, in some cases, lead people down a road to poverty, Lund says, because of disability, stigma or the need to spend extra money on health care. may play a role, with some evidence suggesting that poverty more often leads to depression while disorders like schizophrenia more often lead to poverty.\u003c/p>\n\u003cp>Still unclear is how best to break the cycle. Although cash-transfer programs have shown promising improvements to mental health, studies have yet to determine whether those improvements persist in the long-term.\u003c/p>\n\u003cp>\"I think the jury is still out on the extent to which poverty alleviation interventions actually lead to mental health improvements,\" Lund says. \"It hasn't been evaluated rigorously enough.\"\u003c/p>\n\u003cp>Data is also lacking on whether mental-health interventions can make a true dent in poverty rates or why some people remain resilient even in extremely challenging circumstances.\u003c/p>\n\u003cp>\"We don't know whether intervening in depression is also a good poverty intervention,\" Haushofer says. Because depression keeps people out of work, treating it should help, but evidence is still lacking.\u003c/p>\n\u003cp>Better data may be coming. Lund is in charge of an effort called \u003ca href=\"http://www.prime.uct.ac.za/background/about-prime\">PRIME\u003c/a>, a multinational consortium that aims to implement treatment programs for mental disorders in low-resource settings. One project involves tracking efforts to improve access to mental health services in five countries, including Ethiopia, South Africa and Uganda, with preliminary results expected within the next year.\u003c/p>\n\u003cp>\u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61139-3/fulltext\">In 2013\u003c/a>, the World Health Organization committed to a mental health action plan, with a goal of increasing access to services for severe mental health disorders by 20 percent and reducing the suicide rate by 10 percent in 135 member countries by 2020.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As for why the mother in China took the lives of her children, no one can say for sure. Similar tragedies happen in wealthy countries, too.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Can+Poverty+Lead+To+Mental+Illness%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The question is fairly new to science, but researchers are now exploring the possible links.","status":"publish","parent":0,"modified":1478213358,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":25,"wordCount":995},"headData":{"title":"Evidence Piles Up: The Poor Are High Risk for Mental Illness | KQED","description":"The question is fairly new to science, but researchers are now exploring the possible links.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Evidence Piles Up: The Poor Are High Risk for Mental Illness","datePublished":"2016-11-02T16:51:27.000Z","dateModified":"2016-11-03T22:49:18.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"275033 http://ww2.kqed.org/futureofyou/?p=275033","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/11/02/evidence-piles-up-that-the-poor-are-high-risk-for-mental-illness/","disqusTitle":"Evidence Piles Up: The Poor Are High Risk for Mental Illness","source":"NPR Goats and Soda","nprByline":"Emily Sohn\u003cbr />NPR Goats and Soda","nprImageAgency":"Lily Padula for NPR","nprStoryId":"499777541","nprApiLink":"http://api.npr.org/query?id=499777541&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/goatsandsoda/2016/10/30/499777541/can-poverty-lead-to-mental-illness?ft=nprml&f=499777541","nprRetrievedStory":"1","nprPubDate":"Mon, 31 Oct 2016 10:15:00 -0400","nprStoryDate":"Sun, 30 Oct 2016 05:06:00 -0400","nprLastModifiedDate":"Mon, 31 Oct 2016 10:21:20 -0400","path":"/futureofyou/275033/evidence-piles-up-that-the-poor-are-high-risk-for-mental-illness","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>After a mother killed her four young children and then herself last month in rural China, onlookers quickly pointed to life circumstances.\u003c/p>\n\u003cp>The family lived in extreme poverty, and bloggers speculated that her inability to escape adversity pushed her over the edge.\u003c/p>\n\u003cp>Can poverty really cause mental illness?\u003c/p>\n\u003caside class=\"pullquote alignright\">Studies show that all over the globe, there is a connection between poverty and mental illness.\u003c/aside>\n\u003cp>It's a complex question that is fairly new to science. Despite high rates of both poverty and mental disorders around the world, researchers only started probing the possible links about 25 years ago.\u003c/p>\n\u003cp>Since then, evidence has piled up to make the case that, at the very least, there is a connection. People who live in poverty appear to be at higher risk for mental illnesses. They also report lower levels of happiness.\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>That seems to be true all over the globe. In a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20621748\">2010 review\u003c/a> of 115 studies that spanned 33 countries across the developed and developing worlds, nearly 80 percent of the studies showed that poverty comes with higher rates of mental illness. Among people living in poverty, those studies also found, mental illnesses were more severe, lasted longer and had worse outcomes.\u003c/p>\n\u003cp>And there's growing \u003ca href=\"https://www.brookings.edu/research/subjective-well%e2%80%90being-and-income-is-there-any-evidence-of-satiation/;%20https://www.dartmouth.edu/~neudc2012/docs/paper_195.pdf\">evidence\u003c/a> that levels of depression are higher in poorer countries than in wealthier ones. Those kinds of findings challenge a long-held myth of the \"poor but happy African sitting under a palm tree,\" says \u003ca href=\"http://www.princeton.edu/haushofer/\">Johannes Haushofer\u003c/a>, an economist and neurobiologist who studies interactions between poverty and mental health at Princeton University.\u003c/p>\n\u003cp>As data builds to connect tough economic circumstances with mental struggles, scientists are still trying to answer a trickier question: Which causes which?\u003c/p>\n\u003cp>There is no easy answer, says psychologist \u003ca href=\"http://www.health.uct.ac.za/fhs/departments/psychiatry/staff/crick-lund\">Crick Lund \u003c/a>of the University of Capetown, who studies mental health policy. Mental illness is never caused by just one thing. Poverty can be one factor that interacts with genetics, adverse life events or substance abuse.\u003c/p>\n\u003cp>But so far, the strongest evidence suggests that poverty can lead to mental illness, especially in cases of disorders like depression.\u003c/p>\n\u003cp>Because scientists can't experimentally plunge people into poverty to see what happens to their mental health, natural experiments offer one kind of clue. When disasters or tough spells (like losing a job or enduring periods of drought for farmers) destroy financial circumstances, numerous studies show a rise in rates of depression, Haushofer says.\u003c/p>\n\u003cp>On the flip side, people often get happier after economic windfalls. In a \u003ca href=\"http://www.princeton.edu/haushofer/publications/Haushofer_Shapiro_UCT_2016.04.25.pdf\">new study\u003c/a>, Haushofer and a colleague found that when families in Kenya were given cash grants averaging $700 (nearly twice the amount typically spent per person per year), they reported higher levels of life satisfaction and lower levels of depression than they did before they got the money, which they could spend on anything. The larger the cash transfer, the bigger the mental boost. It didn't matter if the money came in monthly installments or all at once.\u003c/p>\n\u003cp>Despite the long-held belief that winning the lottery destroys lives as people make bad decisions about \u003ca href=\"http://qje.oxfordjournals.org/content/early/2016/02/17/qje.qjw001.full.pdf\">how to use the money\u003c/a>, Haushofer adds, newer evidence suggests the opposite. In study published this year, researchers in Sweden, reported that lottery winners used fewer anti-anxiety medications and sleeping pills after collecting their payout, suggesting that they became happier.\u003c/p>\n\u003cp>So how does poverty \"get under the skin\" or into the brain, Lund asks? Stress is a leading contender. \u003ca href=\"https://www.dartmouth.edu/~neudc2012/docs/paper_195.pdf\">Some studies\u003c/a> have found higher levels of the stress hormone cortisol in people living in poverty. In Mexican households that received cash grants, found a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768580/\">2009 study\u003c/a>, young children had lower cortisol levels compared to kids from families that didn't get extra money. Other studies, however, have failed to find any changes in cortisol.\u003c/p>\n\u003cp>Rates of violence are also higher among people who face economic tension. Living amid violence can exacerbate depression, Lund adds. And studies have found connections between mental illness and poverty-associated conditions, such as not having enough to eat, not making enough money to live on and having a greater chance of developing risks for physical illnesses.\u003c/p>\n\u003cp>Mental illness may, in some cases, lead people down a road to poverty, Lund says, because of disability, stigma or the need to spend extra money on health care. may play a role, with some evidence suggesting that poverty more often leads to depression while disorders like schizophrenia more often lead to poverty.\u003c/p>\n\u003cp>Still unclear is how best to break the cycle. Although cash-transfer programs have shown promising improvements to mental health, studies have yet to determine whether those improvements persist in the long-term.\u003c/p>\n\u003cp>\"I think the jury is still out on the extent to which poverty alleviation interventions actually lead to mental health improvements,\" Lund says. \"It hasn't been evaluated rigorously enough.\"\u003c/p>\n\u003cp>Data is also lacking on whether mental-health interventions can make a true dent in poverty rates or why some people remain resilient even in extremely challenging circumstances.\u003c/p>\n\u003cp>\"We don't know whether intervening in depression is also a good poverty intervention,\" Haushofer says. Because depression keeps people out of work, treating it should help, but evidence is still lacking.\u003c/p>\n\u003cp>Better data may be coming. Lund is in charge of an effort called \u003ca href=\"http://www.prime.uct.ac.za/background/about-prime\">PRIME\u003c/a>, a multinational consortium that aims to implement treatment programs for mental disorders in low-resource settings. One project involves tracking efforts to improve access to mental health services in five countries, including Ethiopia, South Africa and Uganda, with preliminary results expected within the next year.\u003c/p>\n\u003cp>\u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61139-3/fulltext\">In 2013\u003c/a>, the World Health Organization committed to a mental health action plan, with a goal of increasing access to services for severe mental health disorders by 20 percent and reducing the suicide rate by 10 percent in 135 member countries by 2020.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As for why the mother in China took the lives of her children, no one can say for sure. Similar tragedies happen in wealthy countries, too.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Can+Poverty+Lead+To+Mental+Illness%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/275033/evidence-piles-up-that-the-poor-are-high-risk-for-mental-illness","authors":["byline_futureofyou_275033"],"categories":["futureofyou_452","futureofyou_1","futureofyou_73"],"tags":["futureofyou_204","futureofyou_1120"],"featImg":"futureofyou_275034","label":"source_futureofyou_275033"},"stateofhealth_166706":{"type":"posts","id":"stateofhealth_166706","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"166706","score":null,"sort":[1459450014000]},"guestAuthors":[],"slug":"a-decade-later-obama-advances-mental-health-parity","title":"A Decade Later, Obama Advances 'Mental Health Parity'","publishDate":1459450014,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Tucked in \u003ca href=\"http://www.11alive.com/news/full-transcript-president-obama-at-atlanta-heroin-summit/108944462\" target=\"_blank\">remarks\u003c/a> the president made Tuesday on the opioid epidemic was his announcement of a new \u003ca href=\"https://www.whitehouse.gov/the-press-office/2016/03/29/presidential-memorandum-mental-health-and-substance-use-disorder-parity\" target=\"_blank\">task force on mental health parity\u003c/a> — aimed at ensuring that people with mental illnesses and substance abuse problems don’t face discrimination in the health care system.\u003c/p>\n\u003caside class=\"pullquote alignright\">Advocates say parity has long been an 'empty phrase' and it has taken the administration far too long to address the problem.\u003c/aside>\n\u003cp>Despite a landmark \u003ca href=\"https://www.cms.gov/Regulations-and-Guidance/Health-Insurance-Reform/HealthInsReformforConsume/downloads/MHPAEA.pdf\" target=\"_blank\">2008 law\u003c/a> intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.\u003c/p>\n\u003cp>“The goal of the task force is to essentially develop a set of tools, guidelines, mechanisms so that it’s actually enforced, that the concept is not just a phrase — an empty phrase,” President Obama said during a panel discussion at the National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia. “We’ve got to let the insurance carriers know that we’re serious about this.”\u003c/p>\n\u003cp>Advocates say parity has long been an “empty phrase” and it has taken the administration far too long to address the problem. They say insurers have been subverting the law in subtle ways, and the government has not aggressively acted to stop them.\u003c/p>\n\u003cp>“It’s better late than never, and you can’t not be grateful for the fact that we’re finally implementing a law that was passed nearly a decade ago,” said former congressman Patrick Kennedy, one of the authors of the parity law. “But it’s troubling that it’s occurring in the last year of the presidency, and that it took the administration this long to address a problem that’s been with us for many years.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In \u003ca href=\"http://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf\" target=\"_blank\">a 2015 survey\u003c/a> by the National Alliance on Mental Illness, an advocacy group for people with mental illness and their families, many patients said they were denied payment because treatment was deemed “not medically necessary” twice as often for mental health as for other medical conditions. Only \u003ca href=\"http://khn.org/news/achieving-mental-health-parity-slow-going-even-in-pace-car-state/\" target=\"_blank\">a handful of states, including California\u003c/a> and New York, have been investigating whether insurers are complying with the parity law. Meanwhile, the federal government has taken few if any public enforcement actions, as \u003ca href=\"http://khn.org/news/advocates-say-mental-health-parity-law-is-not-fulfilling-its-promise/\" target=\"_blank\">Kaiser Health News reported\u003c/a> last year.\u003c/p>\n\u003cp>For years, Kennedy has been traveling the country speaking about the lack of enforcement of the federal mental health parity law he helped create. One problem, he has said repeatedly, is that the administration has been hesitant to enforce a law against insurers, who were a key partner in implementing the Affordable Care Act.\u003c/p>\n\u003cp>“Even this administration, which is pro-consumer and liberal, has a tough time doing anything but dancing around issues of enforcing the law because they’re afraid to step on the insurers’ toes,” Kennedy said.\u003c/p>\n\u003cp>Tuesday’s announcement, he said, was also meager. “If the administration really wanted to be front and center on this they could have done it at the White House at a summit that would have gotten all kind of attention.”\u003c/p>\n\u003cp>Instead, he said, it was buried in an announcement of new programs and funding for opioid addiction. Also announced Tuesday were \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-03-29.html\" target=\"_blank\">the final parity rules\u003c/a> for patients with coverage under Medicaid and the Children’s Health Insurance Program (CHIP).\u003c/p>\n\u003cp>Despite the complaints of advocates and patients, insurers argue they have long been complying with parity.\u003c/p>\n\u003cp>“Our industry has long supported mental health parity and implementation of those requirements so that consumers have access to care when they need it,” Clare Krusing, a spokesperson for America’s Health Insurance Plans, the industry’s main trade group, said in a written statement. “Suggesting that coverage decisions drive the mental health challenges we face does a disservice to the ongoing efforts to improve the country’s health system for those who need behavioral health care.”\u003c/p>\n\u003cp>The interagency task force, which will be chaired by the White House’s \u003ca href=\"https://www.whitehouse.gov/administration/eop/dpc\" target=\"_blank\">Domestic Policy Council\u003c/a>, will aim to identify and promote best practices for state and federal agencies to ensure that insurers are complying with the parity law. It will consist of heads of the departments of Treasury, Justice, Labor and Health and Human Services, among others, and will be responsible for delivering a report to the President by October 31, 2016.\u003c/p>\n\u003cp>“I think anything the White House does to acknowledge the obstacles to treatment of mental illness is a step in the right direction. But frankly, another task force is a far cry from much-needed enforcement,” said Meiram Bendat, a Los Angeles-based lawyer who has filed several lawsuits against insurers alleging violations of the parity law.\u003c/p>\n\u003cp>People with mental illness and their advocates have long been aware of exactly what the problems are, he said. But rooting them out will require the task force to be “keenly attuned to social and institutional bias against patients with behavioral health problems. And that bias frequently takes the form of insurance companies effectively limiting care only to crisis and refusing to acknowledge the pervasive and long-term nature of these disorders.”\u003c/p>\n\u003cp>Provider groups widely applauded the creation of the task force.\u003c/p>\n\u003cp>“What we’re hoping is that the task force will increase the visibility of the issue and highlight its significance,” said Dr. Renée Binder, president of the American Psychiatric Association, which has identified wide variation in how well insurers are complying with the law.\u003c/p>\n\u003cp>“We would welcome the opportunity to meet with the task force as part of its outreach charge,” she said.\u003c/p>\n\u003cp>But even if parity is successfully implemented, Benjamin Miller, director of the health policy center at the University of Colorado School of Medicine, said it may be “too little, too late.”\u003c/p>\n\u003cp>“It’s simply not enough to have mental health parity – even with this change in law, there will still be access issues for patients.”\u003c/p>\n\u003cp>That’s because mental health providers often don’t have appointments readily available or won’t accept these patients’ insurance coverage, he said.\u003c/p>\n\u003cp>“While mental health parity rights a wrong, it does not change the fundamental delivery of care, which is sorely needed for increasing access to mental health,” Miller said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, an editorially independent project of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"A landmark 2008 law aimed at ensuring people with mental illnesses didn't face discrimination in health care, but enforcement has been paltry.","status":"publish","parent":0,"modified":1459450094,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":25,"wordCount":1105},"headData":{"title":"A Decade Later, Obama Advances 'Mental Health Parity' | KQED","description":"A landmark 2008 law aimed at ensuring people with mental illnesses didn't face discrimination in health care, but enforcement has been paltry.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"A Decade Later, Obama Advances 'Mental Health Parity'","datePublished":"2016-03-31T18:46:54.000Z","dateModified":"2016-03-31T18:48:14.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"166706 http://ww2.kqed.org/stateofhealth/?p=166706","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/03/31/a-decade-later-obama-advances-mental-health-parity/","disqusTitle":"A Decade Later, Obama Advances 'Mental Health Parity'","nprByline":"Jenny Gold\u003cbr />\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>","path":"/stateofhealth/166706/a-decade-later-obama-advances-mental-health-parity","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Tucked in \u003ca href=\"http://www.11alive.com/news/full-transcript-president-obama-at-atlanta-heroin-summit/108944462\" target=\"_blank\">remarks\u003c/a> the president made Tuesday on the opioid epidemic was his announcement of a new \u003ca href=\"https://www.whitehouse.gov/the-press-office/2016/03/29/presidential-memorandum-mental-health-and-substance-use-disorder-parity\" target=\"_blank\">task force on mental health parity\u003c/a> — aimed at ensuring that people with mental illnesses and substance abuse problems don’t face discrimination in the health care system.\u003c/p>\n\u003caside class=\"pullquote alignright\">Advocates say parity has long been an 'empty phrase' and it has taken the administration far too long to address the problem.\u003c/aside>\n\u003cp>Despite a landmark \u003ca href=\"https://www.cms.gov/Regulations-and-Guidance/Health-Insurance-Reform/HealthInsReformforConsume/downloads/MHPAEA.pdf\" target=\"_blank\">2008 law\u003c/a> intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.\u003c/p>\n\u003cp>“The goal of the task force is to essentially develop a set of tools, guidelines, mechanisms so that it’s actually enforced, that the concept is not just a phrase — an empty phrase,” President Obama said during a panel discussion at the National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia. “We’ve got to let the insurance carriers know that we’re serious about this.”\u003c/p>\n\u003cp>Advocates say parity has long been an “empty phrase” and it has taken the administration far too long to address the problem. They say insurers have been subverting the law in subtle ways, and the government has not aggressively acted to stop them.\u003c/p>\n\u003cp>“It’s better late than never, and you can’t not be grateful for the fact that we’re finally implementing a law that was passed nearly a decade ago,” said former congressman Patrick Kennedy, one of the authors of the parity law. “But it’s troubling that it’s occurring in the last year of the presidency, and that it took the administration this long to address a problem that’s been with us for many years.”\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>In \u003ca href=\"http://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf\" target=\"_blank\">a 2015 survey\u003c/a> by the National Alliance on Mental Illness, an advocacy group for people with mental illness and their families, many patients said they were denied payment because treatment was deemed “not medically necessary” twice as often for mental health as for other medical conditions. Only \u003ca href=\"http://khn.org/news/achieving-mental-health-parity-slow-going-even-in-pace-car-state/\" target=\"_blank\">a handful of states, including California\u003c/a> and New York, have been investigating whether insurers are complying with the parity law. Meanwhile, the federal government has taken few if any public enforcement actions, as \u003ca href=\"http://khn.org/news/advocates-say-mental-health-parity-law-is-not-fulfilling-its-promise/\" target=\"_blank\">Kaiser Health News reported\u003c/a> last year.\u003c/p>\n\u003cp>For years, Kennedy has been traveling the country speaking about the lack of enforcement of the federal mental health parity law he helped create. One problem, he has said repeatedly, is that the administration has been hesitant to enforce a law against insurers, who were a key partner in implementing the Affordable Care Act.\u003c/p>\n\u003cp>“Even this administration, which is pro-consumer and liberal, has a tough time doing anything but dancing around issues of enforcing the law because they’re afraid to step on the insurers’ toes,” Kennedy said.\u003c/p>\n\u003cp>Tuesday’s announcement, he said, was also meager. “If the administration really wanted to be front and center on this they could have done it at the White House at a summit that would have gotten all kind of attention.”\u003c/p>\n\u003cp>Instead, he said, it was buried in an announcement of new programs and funding for opioid addiction. Also announced Tuesday were \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-03-29.html\" target=\"_blank\">the final parity rules\u003c/a> for patients with coverage under Medicaid and the Children’s Health Insurance Program (CHIP).\u003c/p>\n\u003cp>Despite the complaints of advocates and patients, insurers argue they have long been complying with parity.\u003c/p>\n\u003cp>“Our industry has long supported mental health parity and implementation of those requirements so that consumers have access to care when they need it,” Clare Krusing, a spokesperson for America’s Health Insurance Plans, the industry’s main trade group, said in a written statement. “Suggesting that coverage decisions drive the mental health challenges we face does a disservice to the ongoing efforts to improve the country’s health system for those who need behavioral health care.”\u003c/p>\n\u003cp>The interagency task force, which will be chaired by the White House’s \u003ca href=\"https://www.whitehouse.gov/administration/eop/dpc\" target=\"_blank\">Domestic Policy Council\u003c/a>, will aim to identify and promote best practices for state and federal agencies to ensure that insurers are complying with the parity law. It will consist of heads of the departments of Treasury, Justice, Labor and Health and Human Services, among others, and will be responsible for delivering a report to the President by October 31, 2016.\u003c/p>\n\u003cp>“I think anything the White House does to acknowledge the obstacles to treatment of mental illness is a step in the right direction. But frankly, another task force is a far cry from much-needed enforcement,” said Meiram Bendat, a Los Angeles-based lawyer who has filed several lawsuits against insurers alleging violations of the parity law.\u003c/p>\n\u003cp>People with mental illness and their advocates have long been aware of exactly what the problems are, he said. But rooting them out will require the task force to be “keenly attuned to social and institutional bias against patients with behavioral health problems. And that bias frequently takes the form of insurance companies effectively limiting care only to crisis and refusing to acknowledge the pervasive and long-term nature of these disorders.”\u003c/p>\n\u003cp>Provider groups widely applauded the creation of the task force.\u003c/p>\n\u003cp>“What we’re hoping is that the task force will increase the visibility of the issue and highlight its significance,” said Dr. Renée Binder, president of the American Psychiatric Association, which has identified wide variation in how well insurers are complying with the law.\u003c/p>\n\u003cp>“We would welcome the opportunity to meet with the task force as part of its outreach charge,” she said.\u003c/p>\n\u003cp>But even if parity is successfully implemented, Benjamin Miller, director of the health policy center at the University of Colorado School of Medicine, said it may be “too little, too late.”\u003c/p>\n\u003cp>“It’s simply not enough to have mental health parity – even with this change in law, there will still be access issues for patients.”\u003c/p>\n\u003cp>That’s because mental health providers often don’t have appointments readily available or won’t accept these patients’ insurance coverage, he said.\u003c/p>\n\u003cp>“While mental health parity rights a wrong, it does not change the fundamental delivery of care, which is sorely needed for increasing access to mental health,” Miller 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\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, an editorially independent project of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/166706/a-decade-later-obama-advances-mental-health-parity","authors":["byline_stateofhealth_166706"],"categories":["stateofhealth_2442","stateofhealth_14"],"tags":["stateofhealth_2713","stateofhealth_274","stateofhealth_2519"],"featImg":"stateofhealth_166724","label":"stateofhealth"},"stateofhealth_159708":{"type":"posts","id":"stateofhealth_159708","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"159708","score":null,"sort":[1457973674000]},"guestAuthors":[],"slug":"with-help-scarce-and-expensive-family-struggles-with-daughters-mental-illness","title":"Help is Scarce, Expensive as Family Struggles With Daughter's Mental Illness","publishDate":1457973674,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>In March 2010, Pam Lipp received the call she’d been dreading for months. She figured it would come from one of three places: the police, the hospital or the morgue. Instead, it was her husband, Doug, saying that he’d just received word that their 18-year-old daughter, Amanda, a freshman at Chico State University in California, was being held at a psychiatric crisis center after trying to throw herself in front of a moving car. Amanda had lost her grip on reality and fallen into a state of psychosis. She’d started selling off her belongings and believed that cameras were following her everywhere.\u003c/p>\n\u003cp>Doug was away at a speaking engagement, so Pam jumped in the car with a friend and raced to the crisis center two hours away. When they arrived, they found Amanda, curled up in a ball on the floor in a fetal position, sobbing. “I was hallucinating. I thought I was a doctor. When my mom got there, I realized I was the one in trouble,” says Amanda. “Nothing prepares you for seeing your child in such turmoil. I felt helpless,” says Pam.\u003c/p>\n\u003caside class=\"alignright\">The mental health parity law helps guarantee consumers fair access to mental health care. If you believe you’ve been unfairly denied or charged for treatment, you can start by reaching out to a consumer advocacy organization. Two resources to try: \u003ca href=\"https://www.paritytrack.org/\" target=\"_blank\">ParityTrack\u003c/a> and \u003ca href=\"https://parityispersonal.org/\" target=\"_blank\">The Parity Implementation Coalition\u003c/a>.\u003c/aside>\n\u003cp>Amanda was soon diagnosed with bipolar disorder, a mental illness characterized by manic highs, depressive lows and possible periods of psychosis. Although the diagnosis provided a new direction to what had been an all-consuming journey for the Lipp family, it was just one stop on the bumpy road to navigating the mental health system. The Lipps are not alone: Nearly one in five Americans experiences a mental illness in any given year, but fewer than half of them receive treatment.\u003c/p>\n\u003cp>\u003cstrong>Early Signs\u003c/strong>\u003c/p>\n\u003cp>Amanda first started acting out when she was in middle school in Fair Oaks, California. She had extreme mood swings and explosive arguments with her parents. Pam and Doug, who run a small business together, hoped it was typical adolescent drama that would soon fade. “We never knew which Amanda we were going to get,” Pam recalls — the edgy Amanda looking for a heated debate, or the down, depressed Amanda who would retreat to her room. Eventually, the intensity and unpredictability of her moods made them realize she needed professional help.\u003c/p>\n\u003caside class=\"pullquote alignright\">When you break a leg, you get a cast and people sign it and put smiley faces on it. When you’re given a mental illness diagnosis, you’re cast out.”\u003c/aside>\n\u003cp>They took her to the family doctor, who agreed that Amanda required more help but said that she didn’t have anyone to refer her to. Instead, the doctor recommended that Pam request a copy of all the therapists in her zip code who worked with her insurance company and call down the list. Pam called dozens of practitioners, leaving message after message. Not only was the list outdated, but most were too busy to even see her daughter and the ones who were highly recommended didn’t accept her insurance anymore.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For her part, Amanda was reluctant about seeing a therapist. She worried about what other people might think, and that it would change the image she had of herself. “I was the popular kid who people looked up to,” says Amanda. “I thought that if my friends saw me as someone to be pitied, they wouldn’t lean on me anymore. Part of me wanted to get help, yet the other part of me didn’t want to admit I needed it.”\u003c/p>\n\u003cp>She agreed to give therapy a try and Pam found someone Amanda was comfortable with. Yet, at an out-of-pocket rate of $120 per hour, the Lipps just couldn’t afford the amount of care she needed, which was about three sessions per week. She visited a psychiatrist and was diagnosed with depression and put on an antidepressant. Despite the treatment, Amanda continued to spiral downward — staying out late, self-medicating with drugs and arguing with her family.\u003c/p>\n\u003cp>During those years, Pam says, she and Doug were living one exhausting day to the next. They had three children to raise, but taking care of Amanda consumed their lives. “We felt like we were in prison in our own home with all the hostility and upheaval.”\u003c/p>\n\u003cp>By the time Amanda headed to college, she was barely speaking to her parents.\u003c/p>\n\u003cp>\u003cstrong>Fighting For Care\u003c/strong>\u003c/p>\n\u003cp>Amanda’s bipolar diagnosis was a turning point — it meant that she could begin to receive the treatment she desperately needed. But it wasn’t easy to find at first.\u003c/p>\n\u003cp>The crisis center would only hold her for a maximum of 72 hours, and Amanda needed much more treatment than that. When Pam asked where her daughter would be sent next, the doctor told her Amanda would be discharged and likely end up back in the center.\u003c/p>\n\u003cp>So Pam spent the next day in the crisis center waiting room, desperately calling one psychiatric hospital after another to find a place to send Amanda. They were all full. She begged them to call her back when they had an opening, but they told her they couldn’t reserve a spot. Instead, they told her to call every half hour in the hope that she’d be able to grab the next available bed. Pam plugged her cellphone into the waiting room wall and repeatedly called each one on speed dial. “You go into mother-bear mode, where you dig in and do what you have to do to protect your cub. I knew I couldn’t stop until Amanda had the help she needed,” says Pam.\u003c/p>\n\u003cp>After eight hours of continuous dialing, Pam finally found Amanda an open bed at a hospital near their home. For Pam, it was a huge relief that her daughter was safe. “We felt like we were finally entering a new phase of tackling her condition. In the hospital, at least we knew where she was and that she was under a watchful eye. We felt safest knowing she didn’t have a choice to leave.”\u003c/p>\n\u003cp>But Amanda had a different perspective. She didn’t see her psychosis as a disease — she saw it as a transformation where she was finally able to face her vulnerability and deal with her issues.\u003c/p>\n\u003cp>“In the hospital, I felt like a prisoner,” she says. “I felt trapped in a space where people were always watching me and monitoring my behavior.” Amanda is an artist who finds solace in creativity, but she says the staff in the hospital was more focused on trying to treat her medically and didn’t seem to value what she was doing with her art. “Trying to express myself and heal felt impossible,” she says.\u003c/p>\n\u003cp>\u003cstrong>Figuring Out Finances\u003c/strong>\u003c/p>\n\u003cp>While Amanda was in the hospital, Pam was gripped with fear over the coverage of the treatment. “I was terrified that insurance would run out and we’d lose our savings and everything we’d worked for.”\u003c/p>\n\u003cp>Fortunately, a federal law passed in 2008 guarantees that mental illnesses be covered “at parity” with any other disease, without special limitations. Her insurer informed Pam that any care Amanda needed would be covered. “I was so relieved,” says Pam.\u003c/p>\n\u003cp>After a month in the hospital, two months of a full-time outpatient program, the temporary help of an antipsychotic medication and years of therapy with a new psychologist, Amanda made an impressive recovery, learning to manage her condition.\u003c/p>\n\u003cp>A key point for her was a change in perspective. She went from seeing her symptoms as evidence of illness to seeing them as strengths that she could use to her benefit. For example, she could turn a period of introspection that she might have previously seen as “depression” into a piece of art.\u003c/p>\n\u003cp>\u003cstrong>Living Out Loud\u003c/strong>\u003c/p>\n\u003cp>Many families end up running into similar obstacles — they don’t know where to go for proper care or they’re worried about the cost. But there’s also the stigma of mental illness that prevents people from reaching out because they fear judgment or worry that it might affect their jobs.\u003c/p>\n\u003cp>“When you break a leg, you get a cast and people sign it and put smiley faces on it. When you’re given a mental illness diagnosis, you’re cast out,” says Amanda, who is now a 24-year-old college graduate and member of the board of California’s National Alliance on Mental Illness, an advocacy group.\u003c/p>\n\u003cp>Fortunately, Pam wasn’t afraid of the stigma, having learned from her own family’s mistakes. “I grew up in an environment where everything was pushed under the rug,” she says. “People were suffering from mental illness, but they blamed it on other things like migraines. In reality, they needed therapy. I wasn’t going to let that happen with Amanda.”\u003c/p>\n\u003cp>Pam faced the stigma head-on and was completely open with her friends about what was happening. While this didn’t help the Lipps crack the code on their daughter’s illness earlier, it gave them strength when they needed it.\u003c/p>\n\u003cp>“Mental illness is not usually a casserole disease — when you tell your friends that a family member is suffering from a mental illness, they don’t deliver a lasagna. But in our case, our friends did because we were open about it,” says Pam.\u003c/p>\n\u003cp>People rallied around her. In particular, Pam was already part of a monthly mothers’ group that got together to make care packages for their children in college. The other women urged her to keep coming to the group and making care packages for Amanda throughout her illness. “They were my rock of friendship. It truly took a village and a community of friends to help Amanda heal,” says Pam.\u003c/p>\n\u003cp>\u003cstrong>Finding Hope\u003c/strong>\u003c/p>\n\u003cp>Hard-won strides in the area of mental illness like the parity law helped Pam and her family get through the crisis intact, but it was a difficult road.\u003c/p>\n\u003cp>“We’re so proud of Amanda and everything she’s overcome,” says Pam. That doesn’t mean she’s stopped worrying. “We experienced a mental health emergency, an illness and a recovery, and now we’re stable. But every day I wake up and worry, could she relapse?” For anyone with a history of psychosis, another breakdown is always a possibility.\u003c/p>\n\u003cp>Now armed with knowledge and experience, Pam feels more confident. And in the meantime, both mother and daughter are dedicated to raising awareness and helping other families find the hope and the care they need in a system that often seems to be working against them.\u003c/p>\n\u003cp>For women facing similar situations, Pam has this advice: “Treat mental health concerns like you would any condition. Don’t let the stigma be a roadblock to getting yourself and your family the care that’s needed. If your gut tells you there’s something going on with your child, look the issue in the face and get the help you need.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This article is part of an editorial partnership between Woman’s Day and Kaiser Health News and is the first in a series focusing on mental health.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"One Californian's struggle with bipolar disorder illustrates the difficulties families face when mental health care is needed.","status":"publish","parent":0,"modified":1458054921,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":37,"wordCount":1978},"headData":{"title":"Help is Scarce, Expensive as Family Struggles With Daughter's Mental Illness | KQED","description":"One Californian's struggle with bipolar disorder illustrates the difficulties families face when mental health care is needed.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Help is Scarce, Expensive as Family Struggles With Daughter's Mental Illness","datePublished":"2016-03-14T16:41:14.000Z","dateModified":"2016-03-15T15:15:21.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"159708 http://ww2.kqed.org/stateofhealth/?p=159708","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/03/14/with-help-scarce-and-expensive-family-struggles-with-daughters-mental-illness/","disqusTitle":"Help is Scarce, Expensive as Family Struggles With Daughter's Mental Illness","nprByline":"Jenny Gold\u003cbr />\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>","path":"/stateofhealth/159708/with-help-scarce-and-expensive-family-struggles-with-daughters-mental-illness","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In March 2010, Pam Lipp received the call she’d been dreading for months. She figured it would come from one of three places: the police, the hospital or the morgue. Instead, it was her husband, Doug, saying that he’d just received word that their 18-year-old daughter, Amanda, a freshman at Chico State University in California, was being held at a psychiatric crisis center after trying to throw herself in front of a moving car. Amanda had lost her grip on reality and fallen into a state of psychosis. She’d started selling off her belongings and believed that cameras were following her everywhere.\u003c/p>\n\u003cp>Doug was away at a speaking engagement, so Pam jumped in the car with a friend and raced to the crisis center two hours away. When they arrived, they found Amanda, curled up in a ball on the floor in a fetal position, sobbing. “I was hallucinating. I thought I was a doctor. When my mom got there, I realized I was the one in trouble,” says Amanda. “Nothing prepares you for seeing your child in such turmoil. I felt helpless,” says Pam.\u003c/p>\n\u003caside class=\"alignright\">The mental health parity law helps guarantee consumers fair access to mental health care. If you believe you’ve been unfairly denied or charged for treatment, you can start by reaching out to a consumer advocacy organization. Two resources to try: \u003ca href=\"https://www.paritytrack.org/\" target=\"_blank\">ParityTrack\u003c/a> and \u003ca href=\"https://parityispersonal.org/\" target=\"_blank\">The Parity Implementation Coalition\u003c/a>.\u003c/aside>\n\u003cp>Amanda was soon diagnosed with bipolar disorder, a mental illness characterized by manic highs, depressive lows and possible periods of psychosis. Although the diagnosis provided a new direction to what had been an all-consuming journey for the Lipp family, it was just one stop on the bumpy road to navigating the mental health system. The Lipps are not alone: Nearly one in five Americans experiences a mental illness in any given year, but fewer than half of them receive treatment.\u003c/p>\n\u003cp>\u003cstrong>Early Signs\u003c/strong>\u003c/p>\n\u003cp>Amanda first started acting out when she was in middle school in Fair Oaks, California. She had extreme mood swings and explosive arguments with her parents. Pam and Doug, who run a small business together, hoped it was typical adolescent drama that would soon fade. “We never knew which Amanda we were going to get,” Pam recalls — the edgy Amanda looking for a heated debate, or the down, depressed Amanda who would retreat to her room. Eventually, the intensity and unpredictability of her moods made them realize she needed professional help.\u003c/p>\n\u003caside class=\"pullquote alignright\">When you break a leg, you get a cast and people sign it and put smiley faces on it. When you’re given a mental illness diagnosis, you’re cast out.”\u003c/aside>\n\u003cp>They took her to the family doctor, who agreed that Amanda required more help but said that she didn’t have anyone to refer her to. Instead, the doctor recommended that Pam request a copy of all the therapists in her zip code who worked with her insurance company and call down the list. Pam called dozens of practitioners, leaving message after message. Not only was the list outdated, but most were too busy to even see her daughter and the ones who were highly recommended didn’t accept her insurance anymore.\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>For her part, Amanda was reluctant about seeing a therapist. She worried about what other people might think, and that it would change the image she had of herself. “I was the popular kid who people looked up to,” says Amanda. “I thought that if my friends saw me as someone to be pitied, they wouldn’t lean on me anymore. Part of me wanted to get help, yet the other part of me didn’t want to admit I needed it.”\u003c/p>\n\u003cp>She agreed to give therapy a try and Pam found someone Amanda was comfortable with. Yet, at an out-of-pocket rate of $120 per hour, the Lipps just couldn’t afford the amount of care she needed, which was about three sessions per week. She visited a psychiatrist and was diagnosed with depression and put on an antidepressant. Despite the treatment, Amanda continued to spiral downward — staying out late, self-medicating with drugs and arguing with her family.\u003c/p>\n\u003cp>During those years, Pam says, she and Doug were living one exhausting day to the next. They had three children to raise, but taking care of Amanda consumed their lives. “We felt like we were in prison in our own home with all the hostility and upheaval.”\u003c/p>\n\u003cp>By the time Amanda headed to college, she was barely speaking to her parents.\u003c/p>\n\u003cp>\u003cstrong>Fighting For Care\u003c/strong>\u003c/p>\n\u003cp>Amanda’s bipolar diagnosis was a turning point — it meant that she could begin to receive the treatment she desperately needed. But it wasn’t easy to find at first.\u003c/p>\n\u003cp>The crisis center would only hold her for a maximum of 72 hours, and Amanda needed much more treatment than that. When Pam asked where her daughter would be sent next, the doctor told her Amanda would be discharged and likely end up back in the center.\u003c/p>\n\u003cp>So Pam spent the next day in the crisis center waiting room, desperately calling one psychiatric hospital after another to find a place to send Amanda. They were all full. She begged them to call her back when they had an opening, but they told her they couldn’t reserve a spot. Instead, they told her to call every half hour in the hope that she’d be able to grab the next available bed. Pam plugged her cellphone into the waiting room wall and repeatedly called each one on speed dial. “You go into mother-bear mode, where you dig in and do what you have to do to protect your cub. I knew I couldn’t stop until Amanda had the help she needed,” says Pam.\u003c/p>\n\u003cp>After eight hours of continuous dialing, Pam finally found Amanda an open bed at a hospital near their home. For Pam, it was a huge relief that her daughter was safe. “We felt like we were finally entering a new phase of tackling her condition. In the hospital, at least we knew where she was and that she was under a watchful eye. We felt safest knowing she didn’t have a choice to leave.”\u003c/p>\n\u003cp>But Amanda had a different perspective. She didn’t see her psychosis as a disease — she saw it as a transformation where she was finally able to face her vulnerability and deal with her issues.\u003c/p>\n\u003cp>“In the hospital, I felt like a prisoner,” she says. “I felt trapped in a space where people were always watching me and monitoring my behavior.” Amanda is an artist who finds solace in creativity, but she says the staff in the hospital was more focused on trying to treat her medically and didn’t seem to value what she was doing with her art. “Trying to express myself and heal felt impossible,” she says.\u003c/p>\n\u003cp>\u003cstrong>Figuring Out Finances\u003c/strong>\u003c/p>\n\u003cp>While Amanda was in the hospital, Pam was gripped with fear over the coverage of the treatment. “I was terrified that insurance would run out and we’d lose our savings and everything we’d worked for.”\u003c/p>\n\u003cp>Fortunately, a federal law passed in 2008 guarantees that mental illnesses be covered “at parity” with any other disease, without special limitations. Her insurer informed Pam that any care Amanda needed would be covered. “I was so relieved,” says Pam.\u003c/p>\n\u003cp>After a month in the hospital, two months of a full-time outpatient program, the temporary help of an antipsychotic medication and years of therapy with a new psychologist, Amanda made an impressive recovery, learning to manage her condition.\u003c/p>\n\u003cp>A key point for her was a change in perspective. She went from seeing her symptoms as evidence of illness to seeing them as strengths that she could use to her benefit. For example, she could turn a period of introspection that she might have previously seen as “depression” into a piece of art.\u003c/p>\n\u003cp>\u003cstrong>Living Out Loud\u003c/strong>\u003c/p>\n\u003cp>Many families end up running into similar obstacles — they don’t know where to go for proper care or they’re worried about the cost. But there’s also the stigma of mental illness that prevents people from reaching out because they fear judgment or worry that it might affect their jobs.\u003c/p>\n\u003cp>“When you break a leg, you get a cast and people sign it and put smiley faces on it. When you’re given a mental illness diagnosis, you’re cast out,” says Amanda, who is now a 24-year-old college graduate and member of the board of California’s National Alliance on Mental Illness, an advocacy group.\u003c/p>\n\u003cp>Fortunately, Pam wasn’t afraid of the stigma, having learned from her own family’s mistakes. “I grew up in an environment where everything was pushed under the rug,” she says. “People were suffering from mental illness, but they blamed it on other things like migraines. In reality, they needed therapy. I wasn’t going to let that happen with Amanda.”\u003c/p>\n\u003cp>Pam faced the stigma head-on and was completely open with her friends about what was happening. While this didn’t help the Lipps crack the code on their daughter’s illness earlier, it gave them strength when they needed it.\u003c/p>\n\u003cp>“Mental illness is not usually a casserole disease — when you tell your friends that a family member is suffering from a mental illness, they don’t deliver a lasagna. But in our case, our friends did because we were open about it,” says Pam.\u003c/p>\n\u003cp>People rallied around her. In particular, Pam was already part of a monthly mothers’ group that got together to make care packages for their children in college. The other women urged her to keep coming to the group and making care packages for Amanda throughout her illness. “They were my rock of friendship. It truly took a village and a community of friends to help Amanda heal,” says Pam.\u003c/p>\n\u003cp>\u003cstrong>Finding Hope\u003c/strong>\u003c/p>\n\u003cp>Hard-won strides in the area of mental illness like the parity law helped Pam and her family get through the crisis intact, but it was a difficult road.\u003c/p>\n\u003cp>“We’re so proud of Amanda and everything she’s overcome,” says Pam. That doesn’t mean she’s stopped worrying. “We experienced a mental health emergency, an illness and a recovery, and now we’re stable. But every day I wake up and worry, could she relapse?” For anyone with a history of psychosis, another breakdown is always a possibility.\u003c/p>\n\u003cp>Now armed with knowledge and experience, Pam feels more confident. And in the meantime, both mother and daughter are dedicated to raising awareness and helping other families find the hope and the care they need in a system that often seems to be working against them.\u003c/p>\n\u003cp>For women facing similar situations, Pam has this advice: “Treat mental health concerns like you would any condition. Don’t let the stigma be a roadblock to getting yourself and your family the care that’s needed. If your gut tells you there’s something going on with your child, look the issue in the face and get the help you need.”\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>This article is part of an editorial partnership between Woman’s Day and Kaiser Health News and is the first in a series focusing on mental health.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/159708/with-help-scarce-and-expensive-family-struggles-with-daughters-mental-illness","authors":["byline_stateofhealth_159708"],"categories":["stateofhealth_11","stateofhealth_12"],"tags":["stateofhealth_68","stateofhealth_274","stateofhealth_2519"],"featImg":"stateofhealth_159714","label":"stateofhealth"},"stateofhealth_20841":{"type":"posts","id":"stateofhealth_20841","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"20841","score":null,"sort":[1408365055000]},"guestAuthors":[],"slug":"a-day-in-californias-psychiatric-prison-units","title":"A Day in California's Psychiatric Prison Units","publishDate":1408365055,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003c!--more-->\u003cbr>\n\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/163042061%3Fsecret_token%3Ds-z9Urx&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false&visual=true\" width=\"100%\" height=\"400\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>In California, prisoners who repeatedly violate rules or commit new crimes end up in segregation units. These are like prisons within the prison. A federal judge recently ruled that this kind of punishment might pose too great a risk for inmates with serious mental illness -- who often worsen in segregation and become suicidal.\u003c/p>\n\u003cp>Inmates in segregation spend more time in their cells; they’re often in handcuffs and leg chains, and they have to submit to frequent strip searches for weapons and drugs.\u003c/p>\n\u003cp>The California State Prison in Sacramento runs one segregation unit for inmates who committed a serious crime but also have a severe mental illness. KQED News got a rare tour of the facility.\u003c/p>\n\u003cp>\u003cem>Photos and audio by Julie Small, photos of weapons courtesy the California Department of Corrections and Rehabilitation, production by Lisa Pickoff-White\u003c/em>\u003c/p>\n\u003cstyle>\n.single-post #content {width: 100%; }\n.single-post #sidebar {display: none;}\n\u003c/style>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n","blocks":[],"excerpt":"Inmates who repeatedly violate rules or commit new crimes end up being segregated.","status":"publish","parent":0,"modified":1408390436,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["https://w.soundcloud.com/player/"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":7,"wordCount":151},"headData":{"title":"A Day in California's Psychiatric Prison Units | KQED","description":"Inmates who repeatedly violate rules or commit new crimes end up being segregated.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"A Day in California's Psychiatric Prison Units","datePublished":"2014-08-18T12:30:55.000Z","dateModified":"2014-08-18T19:33:56.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"20841 http://blogs.kqed.org/stateofhealth/?p=20841","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/08/18/a-day-in-californias-psychiatric-prison-units/","disqusTitle":"A Day in California's Psychiatric Prison Units","path":"/stateofhealth/20841/a-day-in-californias-psychiatric-prison-units","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c!--more-->\u003cbr>\n\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/163042061%3Fsecret_token%3Ds-z9Urx&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false&visual=true\" width=\"100%\" height=\"400\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>In California, prisoners who repeatedly violate rules or commit new crimes end up in segregation units. These are like prisons within the prison. A federal judge recently ruled that this kind of punishment might pose too great a risk for inmates with serious mental illness -- who often worsen in segregation and become suicidal.\u003c/p>\n\u003cp>Inmates in segregation spend more time in their cells; they’re often in handcuffs and leg chains, and they have to submit to frequent strip searches for weapons and drugs.\u003c/p>\n\u003cp>The California State Prison in Sacramento runs one segregation unit for inmates who committed a serious crime but also have a severe mental illness. KQED News got a rare tour of the facility.\u003c/p>\n\u003cp>\u003cem>Photos and audio by Julie Small, photos of weapons courtesy the California Department of Corrections and Rehabilitation, production by Lisa Pickoff-White\u003c/em>\u003c/p>\n\u003cstyle>\n.single-post #content {width: 100%; }\n.single-post #sidebar {display: none;}\n\u003c/style>\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>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/20841/a-day-in-californias-psychiatric-prison-units","authors":["8344"],"categories":["stateofhealth_14"],"tags":["stateofhealth_274","stateofhealth_599"],"featImg":"stateofhealth_20848","label":"stateofhealth"},"stateofhealth_19404":{"type":"posts","id":"stateofhealth_19404","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"19404","score":null,"sort":[1402007555000]},"guestAuthors":[],"slug":"privacy-law-hipaa-frustrates-parents-with-mentally-ill-adult-children","title":"Privacy Law Frustrates Parents with Mentally Ill Adult Children","publishDate":1402007555,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_19409\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/IMG_4052.jpg\">\u003cimg class=\"size-large wp-image-19409\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/IMG_4052-640x480.jpg\" alt=\"Mark, a minister who lives in the Bay Area, has not been able to communicate with doctors about his son, Scott, since Scott became an adult (Jenny Gold/ KHN).\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mark, a minister who lives in the Bay Area, has not been able to communicate with doctors about his son, Scott, since Scott became an adult (Jenny Gold/ KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Jenny Gold\u003c/strong>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/04/Parents-Of-Mentally-Ill-Adult-Children-Frustrated-By-Privacy-Law.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>The horrifying mass shooting in Isla Vista nearly two weeks ago brought up many questions: What -- if anything -- could parents have done to prevent the tragedy? And what did they actually know about their son's mental illness?\u003c/p>\n\u003caside class=\"pullquote alignleft\">'We were shut out of the conversation.' \u003c/aside>\n\u003cp>A privacy law called the \u003ca href=\"http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/mhguidance.html\" target=\"_blank\">Health Insurance Portability and Accountability Act\u003c/a> was created in part to protect patients' information. But the law, called HIPAA for short, also presents a dilemma for families of people with serious mental illnesses like schizophrenia. HIPAA restricts what family members can find out directly, leaving them to wonder how they can help a loved one who won't share treatment details.\u003c/p>\n\u003cp>Mark, an ordained minister in Moraga, about 20 miles east of San Francisco, struggles with the problem almost every day. His son Scott, 24, has \u003ca href=\"http://www.mayoclinic.org/diseases-conditions/schizoaffective-disorder/basics/definition/con-20029221\" target=\"_blank\">schizoaffective disorder\u003c/a> and has been hospitalized a dozen times for the hallucinations, mania and depression that it brings. (Kaiser Health News and KQED aren't publishing the family's last name to protect Scott's identity.)\u003c!--more-->\u003c/p>\n\u003cp>Mark first noticed a change in his son just before his high school graduation. \"There was a deep aggressiveness that started to emerge,\" he recalls. \"We just thought, well, it was frustration with life or circumstances, things weren't going well in school.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And it got worse. In the middle of a standoff one day, Scott threw a small table at his mother. Scott was taken to a psychiatric hospital by the police. He was 18. Because he was still in high school, he was treated as a minor by the hospital. Mark and his wife met with Scott's doctors and set up a treatment plan.\u003c/p>\n\u003cp>\"We saw, OK, this is kind of the way it works,\" says Mark, adding, \"That was pretty much the last time we had that opportunity\" to talk to any medical professionals about Scott.\u003c/p>\n\u003cp>The next time their son was hospitalized, he was out of high school. The doctors told the family that because of HIPAA, they couldn't be part of the treatment discussion unless Scott granted permission, which he refused to do.\u003c/p>\n\u003cp>\"We were shut out of the conversation,\" says Mark. \"And I think that was the first time we really started feeling hopeless. As long as we could feel we were in a conversation with them, we had a sense of hope. All of a sudden there was a wall that went up, and that was gone.\"\u003c/p>\n\u003cp>What little information Mark and his wife get about Scott's treatment comes from their insurance company, since Scott is still on their plan. The family hasn't spoken to any of Scott's doctors since that first hospitalization, even though one of their most pressing questions is whether it's even safe for Scott to come back home. Mark still has scars on his head from an altercation with Scott the last time he was home.\u003c/p>\n\u003cp>Mark is a gentle and deliberate man with round glasses and a rosy complexion. His tidy suburban home is filled with photos of his children and piles of books about faith. But, he wonders, \"Why am I, as the one who is a primary caregiver, protector, provider, whatever — I've watched this kid grow up — and yet I'm out of the circle?\"\u003c/p>\n\u003cp>That's something E. Fuller Torrey, a psychiatrist and founder of the Treatment Advocacy Center, a mental health advocacy group, hears all the time. He says the problem is that HIPAA wasn't written with mental illness in mind.\u003c/p>\n\u003cp>\"When someone has cancer, you can make the assumption that their brain is working normally so that they can make an informed decision as to whether or not they want their loved ones to know exactly what the details of the cancer is,\" he says. \"You can't make that assumption about people with schizophrenia or bipolar disorder.\"\u003c/p>\n\u003cp>Often, he says, sharing information with the family can be crucial to a patient's care, helping to ensure that they stick with a treatment plan, and can minimize the need for readmission to the hospital. Torrey supports\u003ca href=\"http://murphy.house.gov/helpingfamiliesinmentalhealthcrisisact\" target=\"_blank\"> a bill in Congress\u003c/a> that would alter HIPAA to make it easier for families to access information about patients with severe illness. That's particularly important for parents who \"still continue to provide the primary care for many, many of the people who are severely mentally ill,\" he says.\u003c/p>\n\u003cp>Opponents of \u003ca href=\"http://www.npr.org/2014/05/30/317274857/rep-murphy-aims-for-mental-health-bill-to-pass-before-next-shooting\" target=\"_blank\">the bill\u003c/a>, including Jennifer Mathis, director of programs at the Bazelon Center for Mental Health Law, says that weakening privacy protections would make patients less willing to seek treatment. \"They need to know that it's going to be kept confidential,\" Mathis says.\u003c/p>\n\u003cp>There are already exceptions in HIPAA that allow providers to talk to family or caregivers when the patient is a danger to themselves or others, she says. But those exceptions often are not used. Sometimes, Mathis says, providers may be \"hiding behind HIPAA,\" so that they don't have to deal with families, or because they are afraid of being sued.\u003c/p>\n\u003cp>Others problems include plain misunderstanding about what the law requires and allows.\u003c/p>\n\u003cp>But even for doctors who thoroughly understand HIPAA, the safety exemption can be too narrow. \"The vast majority of situations families find themselves in are not life and death,\" says Carolyn Wolf, who directs the mental health practice at New York law firm Abrams Fensterman.\u003c/p>\n\u003cp>The exemptions and possible changes to the law don't help Pastor Mark much. \"It has been a very arduous journey, and it continues,\" he says. \"It's had its moments of extreme anguish, a lot of tears shed, a lot of prayers prayed, a lot of just absolute puzzlement at life itself.\"\u003c/p>\n\u003cp>For now, as a father and as a minister, he's relying on faith.\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"fukx5RCuMuJHuX7DW0Vj3qKaf12HD0WS\"]\u003c/p>\n\n","blocks":[],"excerpt":"Even if parents are providing health insurance, they often can't get any information when their adult children suffer from severe mental illness.","status":"publish","parent":0,"modified":1402348706,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":1038},"headData":{"title":"Privacy Law Frustrates Parents with Mentally Ill Adult Children | KQED","description":"Even if parents are providing health insurance, they often can't get any information when their adult children suffer from severe mental illness.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Privacy Law Frustrates Parents with Mentally Ill Adult Children","datePublished":"2014-06-05T22:32:35.000Z","dateModified":"2014-06-09T21:18:26.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"19404 http://blogs.kqed.org/stateofhealth/?p=19404","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/06/05/privacy-law-hipaa-frustrates-parents-with-mentally-ill-adult-children/","disqusTitle":"Privacy Law Frustrates Parents with Mentally Ill Adult Children","path":"/stateofhealth/19404/privacy-law-hipaa-frustrates-parents-with-mentally-ill-adult-children","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19409\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/IMG_4052.jpg\">\u003cimg class=\"size-large wp-image-19409\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/IMG_4052-640x480.jpg\" alt=\"Mark, a minister who lives in the Bay Area, has not been able to communicate with doctors about his son, Scott, since Scott became an adult (Jenny Gold/ KHN).\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mark, a minister who lives in the Bay Area, has not been able to communicate with doctors about his son, Scott, since Scott became an adult (Jenny Gold/ KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Jenny Gold\u003c/strong>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/04/Parents-Of-Mentally-Ill-Adult-Children-Frustrated-By-Privacy-Law.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>The horrifying mass shooting in Isla Vista nearly two weeks ago brought up many questions: What -- if anything -- could parents have done to prevent the tragedy? And what did they actually know about their son's mental illness?\u003c/p>\n\u003caside class=\"pullquote alignleft\">'We were shut out of the conversation.' \u003c/aside>\n\u003cp>A privacy law called the \u003ca href=\"http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/mhguidance.html\" target=\"_blank\">Health Insurance Portability and Accountability Act\u003c/a> was created in part to protect patients' information. But the law, called HIPAA for short, also presents a dilemma for families of people with serious mental illnesses like schizophrenia. HIPAA restricts what family members can find out directly, leaving them to wonder how they can help a loved one who won't share treatment details.\u003c/p>\n\u003cp>Mark, an ordained minister in Moraga, about 20 miles east of San Francisco, struggles with the problem almost every day. His son Scott, 24, has \u003ca href=\"http://www.mayoclinic.org/diseases-conditions/schizoaffective-disorder/basics/definition/con-20029221\" target=\"_blank\">schizoaffective disorder\u003c/a> and has been hospitalized a dozen times for the hallucinations, mania and depression that it brings. (Kaiser Health News and KQED aren't publishing the family's last name to protect Scott's identity.)\u003c!--more-->\u003c/p>\n\u003cp>Mark first noticed a change in his son just before his high school graduation. \"There was a deep aggressiveness that started to emerge,\" he recalls. \"We just thought, well, it was frustration with life or circumstances, things weren't going well in school.\"\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>And it got worse. In the middle of a standoff one day, Scott threw a small table at his mother. Scott was taken to a psychiatric hospital by the police. He was 18. Because he was still in high school, he was treated as a minor by the hospital. Mark and his wife met with Scott's doctors and set up a treatment plan.\u003c/p>\n\u003cp>\"We saw, OK, this is kind of the way it works,\" says Mark, adding, \"That was pretty much the last time we had that opportunity\" to talk to any medical professionals about Scott.\u003c/p>\n\u003cp>The next time their son was hospitalized, he was out of high school. The doctors told the family that because of HIPAA, they couldn't be part of the treatment discussion unless Scott granted permission, which he refused to do.\u003c/p>\n\u003cp>\"We were shut out of the conversation,\" says Mark. \"And I think that was the first time we really started feeling hopeless. As long as we could feel we were in a conversation with them, we had a sense of hope. All of a sudden there was a wall that went up, and that was gone.\"\u003c/p>\n\u003cp>What little information Mark and his wife get about Scott's treatment comes from their insurance company, since Scott is still on their plan. The family hasn't spoken to any of Scott's doctors since that first hospitalization, even though one of their most pressing questions is whether it's even safe for Scott to come back home. Mark still has scars on his head from an altercation with Scott the last time he was home.\u003c/p>\n\u003cp>Mark is a gentle and deliberate man with round glasses and a rosy complexion. His tidy suburban home is filled with photos of his children and piles of books about faith. But, he wonders, \"Why am I, as the one who is a primary caregiver, protector, provider, whatever — I've watched this kid grow up — and yet I'm out of the circle?\"\u003c/p>\n\u003cp>That's something E. Fuller Torrey, a psychiatrist and founder of the Treatment Advocacy Center, a mental health advocacy group, hears all the time. He says the problem is that HIPAA wasn't written with mental illness in mind.\u003c/p>\n\u003cp>\"When someone has cancer, you can make the assumption that their brain is working normally so that they can make an informed decision as to whether or not they want their loved ones to know exactly what the details of the cancer is,\" he says. \"You can't make that assumption about people with schizophrenia or bipolar disorder.\"\u003c/p>\n\u003cp>Often, he says, sharing information with the family can be crucial to a patient's care, helping to ensure that they stick with a treatment plan, and can minimize the need for readmission to the hospital. Torrey supports\u003ca href=\"http://murphy.house.gov/helpingfamiliesinmentalhealthcrisisact\" target=\"_blank\"> a bill in Congress\u003c/a> that would alter HIPAA to make it easier for families to access information about patients with severe illness. That's particularly important for parents who \"still continue to provide the primary care for many, many of the people who are severely mentally ill,\" he says.\u003c/p>\n\u003cp>Opponents of \u003ca href=\"http://www.npr.org/2014/05/30/317274857/rep-murphy-aims-for-mental-health-bill-to-pass-before-next-shooting\" target=\"_blank\">the bill\u003c/a>, including Jennifer Mathis, director of programs at the Bazelon Center for Mental Health Law, says that weakening privacy protections would make patients less willing to seek treatment. \"They need to know that it's going to be kept confidential,\" Mathis says.\u003c/p>\n\u003cp>There are already exceptions in HIPAA that allow providers to talk to family or caregivers when the patient is a danger to themselves or others, she says. But those exceptions often are not used. Sometimes, Mathis says, providers may be \"hiding behind HIPAA,\" so that they don't have to deal with families, or because they are afraid of being sued.\u003c/p>\n\u003cp>Others problems include plain misunderstanding about what the law requires and allows.\u003c/p>\n\u003cp>But even for doctors who thoroughly understand HIPAA, the safety exemption can be too narrow. \"The vast majority of situations families find themselves in are not life and death,\" says Carolyn Wolf, who directs the mental health practice at New York law firm Abrams Fensterman.\u003c/p>\n\u003cp>The exemptions and possible changes to the law don't help Pastor Mark much. \"It has been a very arduous journey, and it continues,\" he says. \"It's had its moments of extreme anguish, a lot of tears shed, a lot of prayers prayed, a lot of just absolute puzzlement at life itself.\"\u003c/p>\n\u003cp>For now, as a father and as a minister, he's relying on faith.\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\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>[contextly_auto_sidebar id=\"fukx5RCuMuJHuX7DW0Vj3qKaf12HD0WS\"]\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/19404/privacy-law-hipaa-frustrates-parents-with-mentally-ill-adult-children","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_274"],"featImg":"stateofhealth_19409","label":"stateofhealth"},"stateofhealth_6410":{"type":"posts","id":"stateofhealth_6410","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"6410","score":null,"sort":[1339104937000]},"guestAuthors":[],"slug":"a-compelling-series-of-photographs-nearly-halted-before-it-happened","title":"Faces of Mental Illness: A Compelling Photo Project, Nearly Stopped Before It Started","publishDate":1339104937,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Lauren M. Whaley, \u003ca title=\"http://centerforhealthreporting.org/blog/what-mental-illness-looks917\" href=\"http://centerforhealthreporting.org/blog/what-mental-illness-looks917\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_6430\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Screen-Shot-2012-06-07-at-2.16.41-PM.png\">\u003cimg class=\"size-medium wp-image-6430 \" title='A Stanislaus County woman who volunteered to be photographed in a series \"Faces of Mental Illness.\" (Lauren M. Whaley/CHCF Center for Health Reporting)' src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Screen-Shot-2012-06-07-at-2.16.41-PM-300x199.png\" alt='A Stanislaus County woman who volunteered to be photographed in a series \"Faces of Mental Illness.\" (Lauren M. Whaley/CHCF Center for Health Reporting)' width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A Stanislaus County woman who volunteered to be photographed in a series \"Faces of Mental Illness.\" (Lauren M. Whaley/CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>I assembled my makeshift photo studio in a windowless office just big enough for a desk and two chairs. Wax paper covered the Home Depot work lights. Electrical tape held up the white sheet I had borrowed from my Modesto hotel room.\u003c/p>\n\u003cp>My subjects walked in one at a time and sat in the chair in front of the sheet, facing my camera and tripod.\u003c/p>\n\u003cp>Name. Age. Residence. Mental illness diagnosis. They rattled off their stats.\u003c/p>\n\u003cp>They sat for photographs and told me their stories. One lost a father when she was seven-years-old to a bullet from a bouncer at a bar. Another served five years in prison. Another met his girlfriend through his treatment and therapy.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Each had been diagnosed with a mental illness, ranging from mild depression to schizophrenia. And they each found community and help within the walls of the \u003ca title=\"http://www.namistanislaus.org/\" href=\"http://www.namistanislaus.org/\" target=\"_blank\">Stanislaus chapter of the National Alliance on Mental Illness\u003c/a> (NAMI).\u003c/p>\n\u003caside class=\"pullquote alignleft\">But before the shoot, a county nurse saw my makeshift studio setup and got suspicious.\u003c/aside>\n\u003cp>The \u003ca title=\"http://centerforhealthreporting.org/article/photography-gallery-faces-mental-illness886\" href=\"http://centerforhealthreporting.org/article/photography-gallery-faces-mental-illness886\" target=\"_blank\">12 black and white portraits\u003c/a> ended up being one of the most popular galleries ever on the Modesto Bee website. The pictures in the print edition spanned two pages.\u003c/p>\n\u003cp>And they almost didn’t happen.\u003c!--more-->\u003c/p>\n\u003cp>The participants were game. Eager. When I pitched my idea, they practically lined up to be photographed. They seemed enthused by the possibility of showing that mentally ill people were regular people, people who could hold jobs, go to school, parent and teach.\u003c/p>\n\u003cp>But before the shoot, a county nurse saw my makeshift studio setup and got suspicious. Was I coercing people into being photographed? Was I tricking them into participating? Were they even able to give consent?\u003c/p>\n\u003cp>I was equal parts perplexed and angry. These folks were not in a hospital. They were not in jail. They did not have a guardian to speak on their behalf. They were consenting adults.\u003c/p>\n\u003cfigure id=\"attachment_6416\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Screen-Shot-2012-06-07-at-1.39.19-PM.png\">\u003cimg class=\"size-medium wp-image-6416\" title=\"Richard M. Hamilton at the photo shoot. (Lauren M. Whaley/CHCF Center for Health Reporting)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Screen-Shot-2012-06-07-at-1.39.19-PM-300x204.png\" alt=\"Richard M. Hamilton at the photo shoot. (Lauren M. Whaley/CHCF Center for Health Reporting)\" width=\"300\" height=\"204\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Richard M. Hamilton at the photo shoot. (Lauren M. Whaley/CHCF Center for Health Reporting)(Lauren M. Whaley: CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>I felt certain I had explained everything clearly. Plus, we had been reporting \u003ca title=\"http://centerforhealthreporting.org/article/mental-health-care-breaking-down-stanislaus-county887\" href=\"http://centerforhealthreporting.org/article/mental-health-care-breaking-down-stanislaus-county887\" target=\"_blank\">the story\u003c/a> for months. I had been to the NAMI office numerous times shooting photos for the project, which was scheduled to be published about two weeks from then. And, the project, for the most part, was about the mentally ill and how cuts to services had forced so many of them to lean ever harder on NAMI.\u003c/p>\n\u003cp>No matter. The county nurse insisted that we call her higher-ups to get permission to take the portraits. She was nervous we were violating a confidentiality agreement that I didn’t know existed.\u003c/p>\n\u003cp>I needed to get permission to get the participants’ permission.\u003c/p>\n\u003cp>The implication: These people are incapable of consenting.\u003c/p>\n\u003cp>I talked to \u003ca title=\"http://www.nami.org/walkTemplate.cfm?section=NAMIWALKS&template=/customsource/namiwalks/walkerpage.cfm&walkerID=198295\" href=\"http://www.nami.org/walkTemplate.cfm?section=NAMIWALKS&template=/customsource/namiwalks/walkerpage.cfm&walkerID=198295\" target=\"_blank\">Joyce Plis\u003c/a>, NAMI Stanislaus’s executive director. She called the Consumer and Family Affairs Manager for Stanislaus County. He told her to call the Behavioral Health Director for the county.\u003c/p>\n\u003cp>I was starting to doubt myself. Even if we got permission, was I exploiting mental health patients by plastering these people’s faces across the newspaper pages? Or was I doing just the opposite, helping to demonstrate that these were ordinary people -- your friends, neighbors, co-workers -- who needed to be seen as just that?\u003c/p>\n\u003cp>Was I sensitive enough in trying to show who they are, that they look like anyone and everyone, that they’re not scary or deformed or dangerous?\u003c/p>\n\u003cp>My editor smoothed things over with the county. We typed up a permission form so each person I photographed put down in writing that they knew we would publish their portrait in the Modesto Bee and online. They were all perfectly comfortable with signing the form. They just wanted to know when the story would run. They wanted to know when their pictures would be in the paper, when their story would be told.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I want people to get help that need help,” said Michelle Gustafson of Modesto, one of the women I photographed. “When you suffer with something like depression, you have a hard time getting up in the morning. It’s even harder to get up and find help to make it go away.”\u003c/p>\n\n","blocks":[],"excerpt":"I assembled my makeshift photo studio in a windowless office just big enough for a desk and two chairs. Wax paper covered the Home Depot work lights. Electrical tape held up the white sheet I had borrowed from my Modesto hotel room.\r\n\r\nMy subjects walked in one at a time and sat in the chair in front of the sheet, facing my camera and tripod.\r\n\r\nName. Age. Residence. Mental illness diagnosis. They rattled off their stats.","status":"publish","parent":0,"modified":1339525644,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":750},"headData":{"title":"Faces of Mental Illness: A Compelling Photo Project, Nearly Stopped Before It Started | KQED","description":"I assembled my makeshift photo studio in a windowless office just big enough for a desk and two chairs. Wax paper covered the Home Depot work lights. Electrical tape held up the white sheet I had borrowed from my Modesto hotel room.\r\n\r\nMy subjects walked in one at a time and sat in the chair in front of the sheet, facing my camera and tripod.\r\n\r\nName. Age. Residence. Mental illness diagnosis. They rattled off their stats.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Faces of Mental Illness: A Compelling Photo Project, Nearly Stopped Before It Started","datePublished":"2012-06-07T21:35:37.000Z","dateModified":"2012-06-12T18:27:24.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"6410 http://blogs.kqed.org/stateofhealth/?p=6410","disqusUrl":"https://ww2.kqed.org/stateofhealth/2012/06/07/a-compelling-series-of-photographs-nearly-halted-before-it-happened/","disqusTitle":"Faces of Mental Illness: A Compelling Photo Project, Nearly Stopped Before It Started","path":"/stateofhealth/6410/a-compelling-series-of-photographs-nearly-halted-before-it-happened","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lauren M. Whaley, \u003ca title=\"http://centerforhealthreporting.org/blog/what-mental-illness-looks917\" href=\"http://centerforhealthreporting.org/blog/what-mental-illness-looks917\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_6430\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Screen-Shot-2012-06-07-at-2.16.41-PM.png\">\u003cimg class=\"size-medium wp-image-6430 \" title='A Stanislaus County woman who volunteered to be photographed in a series \"Faces of Mental Illness.\" (Lauren M. Whaley/CHCF Center for Health Reporting)' src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Screen-Shot-2012-06-07-at-2.16.41-PM-300x199.png\" alt='A Stanislaus County woman who volunteered to be photographed in a series \"Faces of Mental Illness.\" (Lauren M. Whaley/CHCF Center for Health Reporting)' width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A Stanislaus County woman who volunteered to be photographed in a series \"Faces of Mental Illness.\" (Lauren M. Whaley/CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>I assembled my makeshift photo studio in a windowless office just big enough for a desk and two chairs. Wax paper covered the Home Depot work lights. Electrical tape held up the white sheet I had borrowed from my Modesto hotel room.\u003c/p>\n\u003cp>My subjects walked in one at a time and sat in the chair in front of the sheet, facing my camera and tripod.\u003c/p>\n\u003cp>Name. Age. Residence. Mental illness diagnosis. They rattled off their stats.\u003c/p>\n\u003cp>They sat for photographs and told me their stories. One lost a father when she was seven-years-old to a bullet from a bouncer at a bar. Another served five years in prison. Another met his girlfriend through his treatment and therapy.\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>Each had been diagnosed with a mental illness, ranging from mild depression to schizophrenia. And they each found community and help within the walls of the \u003ca title=\"http://www.namistanislaus.org/\" href=\"http://www.namistanislaus.org/\" target=\"_blank\">Stanislaus chapter of the National Alliance on Mental Illness\u003c/a> (NAMI).\u003c/p>\n\u003caside class=\"pullquote alignleft\">But before the shoot, a county nurse saw my makeshift studio setup and got suspicious.\u003c/aside>\n\u003cp>The \u003ca title=\"http://centerforhealthreporting.org/article/photography-gallery-faces-mental-illness886\" href=\"http://centerforhealthreporting.org/article/photography-gallery-faces-mental-illness886\" target=\"_blank\">12 black and white portraits\u003c/a> ended up being one of the most popular galleries ever on the Modesto Bee website. The pictures in the print edition spanned two pages.\u003c/p>\n\u003cp>And they almost didn’t happen.\u003c!--more-->\u003c/p>\n\u003cp>The participants were game. Eager. When I pitched my idea, they practically lined up to be photographed. They seemed enthused by the possibility of showing that mentally ill people were regular people, people who could hold jobs, go to school, parent and teach.\u003c/p>\n\u003cp>But before the shoot, a county nurse saw my makeshift studio setup and got suspicious. Was I coercing people into being photographed? Was I tricking them into participating? Were they even able to give consent?\u003c/p>\n\u003cp>I was equal parts perplexed and angry. These folks were not in a hospital. They were not in jail. They did not have a guardian to speak on their behalf. They were consenting adults.\u003c/p>\n\u003cfigure id=\"attachment_6416\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Screen-Shot-2012-06-07-at-1.39.19-PM.png\">\u003cimg class=\"size-medium wp-image-6416\" title=\"Richard M. Hamilton at the photo shoot. (Lauren M. Whaley/CHCF Center for Health Reporting)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Screen-Shot-2012-06-07-at-1.39.19-PM-300x204.png\" alt=\"Richard M. Hamilton at the photo shoot. (Lauren M. Whaley/CHCF Center for Health Reporting)\" width=\"300\" height=\"204\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Richard M. Hamilton at the photo shoot. (Lauren M. Whaley/CHCF Center for Health Reporting)(Lauren M. Whaley: CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>I felt certain I had explained everything clearly. Plus, we had been reporting \u003ca title=\"http://centerforhealthreporting.org/article/mental-health-care-breaking-down-stanislaus-county887\" href=\"http://centerforhealthreporting.org/article/mental-health-care-breaking-down-stanislaus-county887\" target=\"_blank\">the story\u003c/a> for months. I had been to the NAMI office numerous times shooting photos for the project, which was scheduled to be published about two weeks from then. And, the project, for the most part, was about the mentally ill and how cuts to services had forced so many of them to lean ever harder on NAMI.\u003c/p>\n\u003cp>No matter. The county nurse insisted that we call her higher-ups to get permission to take the portraits. She was nervous we were violating a confidentiality agreement that I didn’t know existed.\u003c/p>\n\u003cp>I needed to get permission to get the participants’ permission.\u003c/p>\n\u003cp>The implication: These people are incapable of consenting.\u003c/p>\n\u003cp>I talked to \u003ca title=\"http://www.nami.org/walkTemplate.cfm?section=NAMIWALKS&template=/customsource/namiwalks/walkerpage.cfm&walkerID=198295\" href=\"http://www.nami.org/walkTemplate.cfm?section=NAMIWALKS&template=/customsource/namiwalks/walkerpage.cfm&walkerID=198295\" target=\"_blank\">Joyce Plis\u003c/a>, NAMI Stanislaus’s executive director. She called the Consumer and Family Affairs Manager for Stanislaus County. He told her to call the Behavioral Health Director for the county.\u003c/p>\n\u003cp>I was starting to doubt myself. Even if we got permission, was I exploiting mental health patients by plastering these people’s faces across the newspaper pages? Or was I doing just the opposite, helping to demonstrate that these were ordinary people -- your friends, neighbors, co-workers -- who needed to be seen as just that?\u003c/p>\n\u003cp>Was I sensitive enough in trying to show who they are, that they look like anyone and everyone, that they’re not scary or deformed or dangerous?\u003c/p>\n\u003cp>My editor smoothed things over with the county. We typed up a permission form so each person I photographed put down in writing that they knew we would publish their portrait in the Modesto Bee and online. They were all perfectly comfortable with signing the form. They just wanted to know when the story would run. They wanted to know when their pictures would be in the paper, when their story would be told.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I want people to get help that need help,” said Michelle Gustafson of Modesto, one of the women I photographed. “When you suffer with something like depression, you have a hard time getting up in the morning. It’s even harder to get up and find help to make it go away.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/6410/a-compelling-series-of-photographs-nearly-halted-before-it-happened","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_274"],"featImg":"stateofhealth_6430","label":"stateofhealth"},"stateofhealth_6065":{"type":"posts","id":"stateofhealth_6065","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"6065","score":null,"sort":[1337892354000]},"guestAuthors":[],"slug":"perhaps-the-most-vulnerable-budget-cuts-hit-mentally-ill-especially-hard","title":"Perhaps the Most Vulnerable ... Budget Cuts Hit Mentally Ill Especially Hard","publishDate":1337892354,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_6073\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/Screen-Shot-2012-05-24-at-1.44.14-PM.png\">\u003cimg class=\"size-medium wp-image-6073\" title=\"(Lauren Whaley: CHCF Center for Health Reporting)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/Screen-Shot-2012-05-24-at-1.44.14-PM-300x179.png\" alt=\"(Lauren Whaley: CHCF Center for Health Reporting)\" width=\"300\" height=\"179\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Lauren Whaley: CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>In a series they're calling \"Mental Breakdown\" the \u003ca title=\"http://localsearch.modbee.com/sp?aff=1100&keywords=mental+breakdown&x=0&y=0\" href=\"http://localsearch.modbee.com/sp?aff=1100&keywords=mental+breakdown&x=0&y=0\" target=\"_blank\">Modesto Bee\u003c/a> collaborated with the \u003ca title=\"http://centerforhealthreporting.org/project/mental-breakdown-state-county-cuts-devastate-mentally-ill\" href=\"http://centerforhealthreporting.org/project/mental-breakdown-state-county-cuts-devastate-mentally-ill\" target=\"_blank\">Center for Health Reporting\u003c/a> in a sobering look at how state and county cuts are devastating county mental health departments -- by focusing close to home in the Central Valley's Stanislaus County. Modesto is the county seat of Stanislaus.\u003c/p>\n\u003cp>Reporters describe people with mental illness who should be in state mental hospitals instead\u003ca title=\"http://centerforhealthreporting.org/article/mentally-ill-languish-jails-due-budget-cuts-lack-beds893\" href=\"http://centerforhealthreporting.org/article/mentally-ill-languish-jails-due-budget-cuts-lack-beds893\" target=\"_blank\"> spend weeks in local jails\u003c/a>, waiting for beds. \u003ca title=\"http://www.modbee.com/2012/05/19/2207051/hospital-emergency-feeling-the.html\" href=\"http://www.modbee.com/2012/05/19/2207051/hospital-emergency-feeling-the.html\" target=\"_blank\">Hospital emergency rooms\u003c/a> have seen a dramatic increase in mentally ill patients. In all likelihood, counties across California are feeling the same impact.\u003c/p>\n\u003cp>But the series also speaks of hope. With the right treatment, even people with the most serious mental illnesses can do well -- as this short video between father and daughter attests:\u003c/p>\n\u003cp>[youtube http://player.vimeo.com/video/42419594?title=0&byline=0&portrait=0&color=ffffff]\u003c/p>\n\u003cp>You can read more about Matt Freitas and the work he does in his clinic \u003ca title=\"http://centerforhealthreporting.org/article/shining-light-modesto899\" href=\"http://centerforhealthreporting.org/article/shining-light-modesto899\" target=\"_blank\">here\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n","blocks":[],"excerpt":"In a series they're calling \"Mental Breakdown\" the Modesto Bee has collaborated with the Center for Health Reporting in a sobering look at how state and county cuts are devastating county mental health departments. They zeroed in on the Central Valley's Stanislaus County.\r\n\r\nReporters describe people with mental illness who should be in state mental hospitals instead spend weeks in local jails, waiting for beds. Hospital emergency rooms have seen a dramatic increase in mentally ill patients. In all likelihood, counties across California are feeling the same impact.","status":"publish","parent":0,"modified":1337893647,"stats":{"hasAudio":false,"hasVideo":true,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":7,"wordCount":171},"headData":{"title":"Perhaps the Most Vulnerable ... Budget Cuts Hit Mentally Ill Especially Hard | KQED","description":"In a series they're calling "Mental Breakdown" the Modesto Bee has collaborated with the Center for Health Reporting in a sobering look at how state and county cuts are devastating county mental health departments. They zeroed in on the Central Valley's Stanislaus County.\r\n\r\nReporters describe people with mental illness who should be in state mental hospitals instead spend weeks in local jails, waiting for beds. Hospital emergency rooms have seen a dramatic increase in mentally ill patients. In all likelihood, counties across California are feeling the same impact.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Perhaps the Most Vulnerable ... Budget Cuts Hit Mentally Ill Especially Hard","datePublished":"2012-05-24T20:45:54.000Z","dateModified":"2012-05-24T21:07:27.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"6065 http://blogs.kqed.org/stateofhealth/?p=6065","disqusUrl":"https://ww2.kqed.org/stateofhealth/2012/05/24/perhaps-the-most-vulnerable-budget-cuts-hit-mentally-ill-especially-hard/","disqusTitle":"Perhaps the Most Vulnerable ... Budget Cuts Hit Mentally Ill Especially Hard","path":"/stateofhealth/6065/perhaps-the-most-vulnerable-budget-cuts-hit-mentally-ill-especially-hard","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_6073\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/Screen-Shot-2012-05-24-at-1.44.14-PM.png\">\u003cimg class=\"size-medium wp-image-6073\" title=\"(Lauren Whaley: CHCF Center for Health Reporting)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/Screen-Shot-2012-05-24-at-1.44.14-PM-300x179.png\" alt=\"(Lauren Whaley: CHCF Center for Health Reporting)\" width=\"300\" height=\"179\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Lauren Whaley: CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>In a series they're calling \"Mental Breakdown\" the \u003ca title=\"http://localsearch.modbee.com/sp?aff=1100&keywords=mental+breakdown&x=0&y=0\" href=\"http://localsearch.modbee.com/sp?aff=1100&keywords=mental+breakdown&x=0&y=0\" target=\"_blank\">Modesto Bee\u003c/a> collaborated with the \u003ca title=\"http://centerforhealthreporting.org/project/mental-breakdown-state-county-cuts-devastate-mentally-ill\" href=\"http://centerforhealthreporting.org/project/mental-breakdown-state-county-cuts-devastate-mentally-ill\" target=\"_blank\">Center for Health Reporting\u003c/a> in a sobering look at how state and county cuts are devastating county mental health departments -- by focusing close to home in the Central Valley's Stanislaus County. Modesto is the county seat of Stanislaus.\u003c/p>\n\u003cp>Reporters describe people with mental illness who should be in state mental hospitals instead\u003ca title=\"http://centerforhealthreporting.org/article/mentally-ill-languish-jails-due-budget-cuts-lack-beds893\" href=\"http://centerforhealthreporting.org/article/mentally-ill-languish-jails-due-budget-cuts-lack-beds893\" target=\"_blank\"> spend weeks in local jails\u003c/a>, waiting for beds. \u003ca title=\"http://www.modbee.com/2012/05/19/2207051/hospital-emergency-feeling-the.html\" href=\"http://www.modbee.com/2012/05/19/2207051/hospital-emergency-feeling-the.html\" target=\"_blank\">Hospital emergency rooms\u003c/a> have seen a dramatic increase in mentally ill patients. In all likelihood, counties across California are feeling the same impact.\u003c/p>\n\u003cp>But the series also speaks of hope. With the right treatment, even people with the most serious mental illnesses can do well -- as this short video between father and daughter attests:\u003c/p>\n\u003cp>\u003c/p>\u003cp>null\u003c/p>\u003cp>\u003c/p>\n\u003cp>You can read more about Matt Freitas and the work he does in his clinic \u003ca title=\"http://centerforhealthreporting.org/article/shining-light-modesto899\" href=\"http://centerforhealthreporting.org/article/shining-light-modesto899\" target=\"_blank\">here\u003c/a>.\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>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/6065/perhaps-the-most-vulnerable-budget-cuts-hit-mentally-ill-especially-hard","authors":["240"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_274"],"featImg":"stateofhealth_6073","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. 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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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. 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For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us","airtime":"SUN 2pm-3pm, MON 12am-1am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png","officialWebsiteLink":"https://www.wnycstudios.org/shows/otm","meta":{"site":"news","source":"wnyc"},"link":"/radio/program/on-the-media","subscribe":{"apple":"https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2","tuneIn":"https://tunein.com/radio/On-the-Media-p69/","rss":"http://feeds.wnyc.org/onthemedia"}},"our-body-politic":{"id":"our-body-politic","title":"Our Body Politic","info":"Presented by KQED, KCRW and KPCC, and created and hosted by award-winning journalist Farai Chideya, Our Body Politic is unapologetically centered on reporting on not just how women of color experience the major political events of today, but how they’re impacting those very issues.","airtime":"SAT 6pm-7pm, SUN 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Our-Body-Politic-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://our-body-politic.simplecast.com/","meta":{"site":"news","source":"kcrw"},"link":"/radio/program/our-body-politic","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/our-body-politic/id1533069868","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5zaW1wbGVjYXN0LmNvbS9feGFQaHMxcw","spotify":"https://open.spotify.com/show/4ApAiLT1kV153TttWAmqmc","rss":"https://feeds.simplecast.com/_xaPhs1s","tuneIn":"https://tunein.com/podcasts/News--Politics-Podcasts/Our-Body-Politic-p1369211/"}},"pbs-newshour":{"id":"pbs-newshour","title":"PBS NewsHour","info":"Analysis, background reports and updates from the PBS NewsHour putting today's news in context.","airtime":"MON-FRI 3pm-4pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.pbs.org/newshour/","meta":{"site":"news","source":"pbs"},"link":"/radio/program/pbs-newshour","subscribe":{"apple":"https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2","tuneIn":"https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/","rss":"https://www.pbs.org/newshour/feeds/rss/podcasts/show"}},"perspectives":{"id":"perspectives","title":"Perspectives","tagline":"KQED's series of of daily listener commentaries since 1991","info":"KQED's series of of daily listener commentaries since 1991.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Perspectives-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/perspectives/","meta":{"site":"radio","source":"kqed","order":"15"},"link":"/perspectives","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/id73801135","npr":"https://www.npr.org/podcasts/432309616/perspectives","rss":"https://ww2.kqed.org/perspectives/category/perspectives/feed/","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvcGVyc3BlY3RpdmVzL2NhdGVnb3J5L3BlcnNwZWN0aXZlcy9mZWVkLw"}},"planet-money":{"id":"planet-money","title":"Planet Money","info":"The economy explained. 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The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.","airtime":"SAT 4pm-5pm","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/reveal300px.png","officialWebsiteLink":"https://www.revealnews.org/episodes/","meta":{"site":"news","source":"npr"},"link":"/radio/program/reveal","subscribe":{"apple":"https://itunes.apple.com/us/podcast/reveal/id886009669","tuneIn":"https://tunein.com/radio/Reveal-p679597/","rss":"http://feeds.revealradio.org/revealpodcast"}},"says-you":{"id":"says-you","title":"Says You!","info":"Public radio's game show of bluff and bluster, words and whimsy. 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