Health insurance and mental health

One of the supposed hallmarks of the U.S. system of providing health care is choice. “Don’t let the socialist boogeyman come and force you to see a doctor trained in Guatemala!” You may not realize it, but that’s pretty funny (not the bit about Guatemala… the part about choice). Well, it doesn’t quite rise to the level of expelling fluids through your head’s secondary and tertiary access points, but it’s still funny.

Come on, ask me why it’s funny. You know you want to. You think you may know, but your dying to know if your right (yes, I’m nothing if not a little presumptuous).

My mother is on the verge of being sent back to the (medical) hospital again. She’s gone back to not eating, drinking, or taking her meds. One of the nurses says she’ll probably have to go back (possibly as soon as tonight or tomorrow). In the mean time, they’ve scheduled a hearing (again) to decide on long term commitment at one of the state psychiatric hospitals. A couple of the possible facilities (there are three where she might be sent) are the same place they send people who are unfit to stand trial (for all sorts of things). My dad asked the social worker if there were any choices.

“No, not if you don’t have insurance coverage.”

See, that’s when you were supposed to laugh. By U.S. standards, my father is not wealthy, but he’s well above average (in terms of salary). He’s highly paid, highly trained, and employed by a large company with loads of lucrative defense and aerospace contracts (among other things). If anyone was going to have good health insurance (besides a government worker), you’d think it was him – and it always seemed like he did – until now. My mother was in the hospital for just under two months earlier this year, in a locked-down psych ward… and that ate up all the benefits for the year. There’s no more coverage left until next February.

So here’s the choices, under the U.S. system of health care:
1. Accept a commitment to the state mental hospital.
2. Sell the house, cash in the retirement savings, borrow from the kids, sell some organs on the black market, and go to a private hospital.

I hate to be down on a state run operation, but experience tells me that facilities in this country which are operated for the benefit of those who can’t pay are rarely top notch, and have the reputation of being substandard. After all, politicians get elected in this country for cutting back on welfare, not for maintaining the status quo (or – gasp – expanding it).

I could be wrong. I pray I’m wrong. I fear I’m not.

You gotta love those choices.

Not so fast

On Friday I told a friend that last week was the first week I’d worked a full 40 hours since my diagnosis. As it turns out I was wrong. It was my second. I felt pretty good, a little tired maybe, but not exhausted. Or so I thought. I slept through most of the weekend. I hadn’t intended to… it just kind of happened.

Last night, after we finished eating pork chops in a ginger glaze (which my dad came over to help us eat – the smell of which remains in yesterday’s laundry), we found out mom had been transferred back to the psychiatric facitilty. I say “finally” like it was some triumph… an unambiguously good thing. Let me just say that I have mixed feelings at best. I’m of a mind that mom’s dehydration was a psychological/psychiatric problem first; which only became a medical problem when it wasn’t monitored closely enough by the facility she’s been transferred back to. Maybe that’s why they didn’t want her back. Maybe they are aware of their own limitations, and aren’t willing to take on the liability that an unmasking of their neglect would produce.

You just can’t make me happy, can you?

My mom needs psychiatric care, but if they aren’t making sure she’s eating, how likely is it that they are treating her other problems? With our options limited, it’s not like we can just go to another hospital. She was already “politely nudged” out of one, and this was the place that would take her without insurance.

What do I write now?

I’ve long ago run out of words. Everyone is in bed, it’s just me, and I want to feel better. A Mac keyboard has been my outlet for a long time… going back to the good old Mac Plus days after my high school graduation. Now? Nothing.

It seems like even these words have graced my screen before. Simply put, my mind is a hollow shell.

In this ongoing medical drama, I feel worst about my father. (I wrote about him once, though I never shared.) The depression, anxiety, and psychosis have been a life long horror for my mother, but I can’t help but wonder if nothing’s left at this point. On the other hand, my father’s all there… in far too many ways. Once you get beyond the bizarre nature of psychosis, in some ways its easier to see my mother like this. She’s been fighting psychological demons for most of her life. However, my father’s always been steady. He’s always been the rock. Now he’s unsettled. Now he’s shaken. Now he’s the one that doesn’t know what to do. Mind you, he’s just as sharp as he’s ever been – and that’s pretty sharp, but the situation he finds himself in is one that has few answers, and LOTS of societal indifference.

So here I am… nothing of substance to say, wanting terribly to say something, and putzing around after midnight when I should be sleeping.



There’s been good news and bad news this week, but I’ll start with the good. The tree scare is finally coming to an end. To date we’ve talked to five tree guys, four experts, and too many friends to count. Opinions have ranged from “cut it down,” to thirteen thousand dollars of pins, cables, fertilizers, and injected fungi, to trimming it up a bit. Depending on the person, we’ve been told our tree is two different species, with two very different lifespans.

This week we finally got an opinion from an expert (a certified arborist) which seconded a previous opinion, so we’re finally ready to proceed with a plan… a plan which thankfully doesn’t involve cutting it down or spending our computer budget.

The bad news it that my mother’s apparent recovery two weeks ago was just what it appeared to be: too good to be true. That day was the only good day she’s had. This week she’s been back in the medical hospital due to severe dehydration, which brings up concerns about the care she’s received at the psychiatric facility. Yesterday and last night we played the insurance game again… due to her psychiatric benefits long ago being used up, insurance not wanting to pay for anything which might have anything to do with her mental problems, the medical hospital wanting to shed a patient that might not be able to pay, and a psychiatric facility that doesn’t want a patient with medical problems they aren’t set up to treat. On top of that, it seems it’s only a matter of time before the county psychiatric facility decides to set a hearing (under the Baker Act) to have her committed long term, possibly to the state hospital… which is a nightmare beyond description.

If you’ll excuse me for a moment, I’d like to vent (cover the kids eyes).

I’M SO FUCKING FED UP WITH ALL OF IT. No, that doesn’t quite cover it. I’M SO SICK OF BEING FUCKING FED UP. My mother is being shuttled around like an unwanted vagrant, my father’s on the verge of another heart attack, and I’m more inept than the stupid tree I’ve been so worried about.

I’m not asking you, because I know you don’t know the answer… but I’d like to ask someone. When is it going to end? Doctors, psychiatrists, and nurses are seemingly incapable of speaking in anything but useless platitudes; and God doesn’t seem to be taking my calls lately.


This morning I got a troubling call… a hearing was going to be set to continue my mother’s involuntary commitment for another 30 days, because she wasn’t showing any improvement. There was panicked talk of lawyers, and… nothing for the rest of the day. It turned out half a day of hearings was all I could take (at work today). I went home and fell asleep; not having planned to, but sleeping through the afternoon and well into dinnertime.

The ringing of my phone woke me up this evening. I think the clock on the wall said 7:30 or so, and the light coming in through the window was impossible to discern between twilight and first light. I was completely out of sorts when the caller told me that my mother was alert. She was up, talking, smiling, reading magazines, and making plans. She was looking forward to going home, building her strength back up, driving the car again, and going shopping. It may not be quite as stunning, but I immediately thought of that Robin Williams movie, Awakenings.

I’m nearly speechless. I don’t know what to make of all this, without seeing it for myself. From the sound of things, she sounded better than I remember her being in at least a year. I don’t want to doubt this turn of events, but how often do things turn out to be “too good to be true?” Yesterday she wasn’t taking care of herself in the most basic ways, and today, seemingly like a switch was flipped, she’s all better? What happened? Was it just a new combination of drugs, pure chance, or a combination of the two? Will it last? Will she be home and talking to me like she hasn’t been in years?

Maybe I’m still not quite awake, but I can’t wrap my head around this yet.


The urge to purge

My area of relative academic expertise is psychology. I say “relative” because I haven’t put this expertise to actual use since I graduated from UF. I didn’t go on to earn any advanced degrees, and it seems like it’s been a really, really long freaking time since I graduated.

Living through my own psychological thriller (of sorts) has given me cause to look back on my psych classes and see them for what they were: a collosal waste of money. Notice I didn’t say my “education” was a waste; it was anything but. I learned so much about life, other cultures, and the world in school that its staggering vaule is impossible to calculate.

This morning I wasn’t feeling terribly well so I stayed home. At some point while I was sitting in my family room, my eyes wandered over to one of our many bookselves, and I caught sight of one of my old psychology text books. I thought of my mother, sitting in a hospital that I’ve been afraid to visit (lest my surpressed immune system betray me again), and I got angry.

I scowered the house. I left no shelf undisturbed, no cabinet unopened. I gathered up my books on personality, social psychology, behaviorism, Meyers, Skinner, abnormal pyschology, counseling. I almost tore up my book on the psychology of aging and gerontology. And while I was at it I grabbed my sociology books too. I stacked them all up by our garage door… the one that’s closest to our garbage cans outside… and I gave them a cathartic toss… one at a time. I put them right where they belong: with Adam’s dirty diapers and the rest of yesterday’s trash.

Tomorrow I may wish I hadn’t, but today I feel a little better.


Earlier this week my mother was hospitalized involuntarily under the provisions of a Florida Law known as the “Baker Act.” When the legal requirement for the hospital to hold her expired, and they determined that her benefits (through her health insurance) had been used up, she was shipped out to the first facility that would take her. It was an assisted living facility, which primarily deals with elderly adults who can – to some degree – care for themselves. My mother could not, but what choice did we have? The hospital staff advised us they called the non-profit, inpatient facility that is familiar to me because of my wife’s work in the criminal justice system, but they turned her down, allegedly because of her age (too old).

She was at the assisted living facility less than two days before my dad got the call this morning – the one where my mother was destroying property – the one that resulted in the police being called – the one that resulted in my mother sitting in the back seat of a police cruiser, handcuffed.

When my father arrived on the scene the police waived him over to let him know where they were taking her. The hospital – the place where all of this started earlier in the week – would not take her back, based on the health insurance situation. I’m not sure what was the deciding factor, but the non-profit that turned her down two days ago took her (perhaps due to a contract with the sheriff’s office for Baker Act cases?).

This episode rises to a level of obscenity that defies description. It is accepted as unquestioned truth that no American goes without necessary health care, even if he or she has no insurance. “No one dies on the hospital doorstep,” or so the saying goes. The trouble with our system is the lengths one must go before the care is given. In this case it took the destruction of private property, (essentially) an arrest by the local police, and an involuntary commitment under the least ideal circumstances.

Is this really how we want to take care of ourselves? Health care reform is low on many people’s list of priorities. The reason? Even though an estimated 40 million don’t have health insurance… approximately 260 million do. Of those that do have insurance, most of them (at any given point in time) are in relatively good health, and have no need to test the limits of their coverage.

In the mean time there is a silent, growing minority who are being failed by our health care system. The poor, the chronically ill, and the self employed are the most obvious victims of our system… the ones who can’t afford private coverage. What’s truly insidious about our system is that even those with coverage… and pretty good coverage, by most objective standards, are at risk. My mother’s coverage was pretty good, in that it has covered mental health at all (even when there weren’t laws mandating it). Still, she had to be put in FUCKING HAND CUFFS before we could get her placed in an appropriate inpatient, mental health facility. HAND CUFFS! This for a person who was too squeamish to kill bugs when I was growing up… for someone who didn’t believe in corporal punishment (for her kids)… for someone who didn’t have a violent bone in her body.

What is wrong with us as a society, that we would deny our own people basic care? Think of all the things government pays for… subsidies to grow four times as much corn as we can eat, and fuck all knows what else. I am sick with disappointment in my own country, with my own people. You may not have made my mother sick, but you put the cuffs on her. You gave my father an ulcer. You broke that furniture at the assisted living facility. You broke my heart, you stole my hope, and you took what remained of my mother’s sanity.

YOU can vote.

YOU are the “people,” in a country governed by “the people.”

YOU ultimately decide who gets health care, and who does not.

YOU have failed my mother.

YOU have failed me.

YOU may have ultimately failed yourself.

YOUR decision makes me sick with despair.

Bad to worse

The ill-conceived placement with the assisted living facility came to an abrupt end this morning. We got a call from the facility reporting that our family member was “out of control,” wandering the halls breaking lamps, overturning furniture, and upsetting the other residents. My dad left straight away, telling them he’d be there soon to pick her up, with no idea where we were going to take her next.

When he got there, a police car was waiting outside… with my mother in the back seat.

I am at once depressed, discouraged, tired, and enraged. What the F&%$ was the hospital thinking when they placed her at such a facility? Weren’t they listening when we brought her into the emergency room? Were they taking notes of ANY kind while she was there? And what the F&%$ was the ALF thinking taking a patient that so clearly needed more care than they could give? Didn’t they see from the first night that she was going to require too much care?

What the F&%$ are we going to do now? The psych ward beds are no less full than they were six days ago. She’s still too old for the major non-profit, inpatient psych facility in the area. Her F&%$ing psychiatrist is still not returning our calls. F&%$ing health insurance is still useless (until next year). My prescription for Xanax may need to be refilled… that or I may need to take up drinking.

I think a politician against universal heath coverage should be required to take her in for a week.

What a difference a day makes

Today’s events will be a boon to bank accounts, but it’s unclear wether medical outcomes will benefit or suffer. Yesterday, phone interviews with assisted living facilities produced the conclusion that my mother needed more care than they could provide. Today, with the Baker Act placement ending and my mother’s insurance coverage exhausted, the hospital has decided that an assisted living facility is ideal.

You know what I’m thinking? As it happens, I’m trying to do as little thinking as possible right now. It’s my defense mechanism du jour.


Coverage caps

There’s a law in Florida called the Baker Act; a law which gives law enforcement and medical professionals the authority to hold people with mental illness – specifically those who show signs of being a danger to others or themselves.

There are few (if any) public facilities to provide this emergency care, so patients are cared for in private facilities… usually a floor set aside at the local hospital (the so called “psych ward”).

Since these institutions often are not publicly funded, “Baker Acted” patients are expected to pay for their care. Since most health insurance policies in the U.S. have unconscionable caps on the number of days covered in a 12 month period, and because mental illness can require extended periods of hospitalization, patients usually pay through the nose.

Because patients without coverage can not easily bargain as a group for the prices paid, patients without coverage usually pay more than insurance companies (for the same services). In fact, hospitals have been known to make up financial losses from insurance contracts with the fees charged to the uninsured.

As it happens, someone close to me is in the hospital, and she used up her hospitalization coverage (which only covered a percentage of the cost anyway) earlier this year. If I’m not mistaken, the bill submitted to insurance earlier this year was in excess of $60,000.

Imagine you had a really good job, with what was considered above average health benefits. Imagine what your finances would look like after paying 20% of a 60k hospital bill, plus 100% of what ever happens from here on out (which looks to be worse this time). Then ask yourself if you still like our health care system as it is.

With all the stress that undoubtedly accumulates in direct proportion to the accumulation of medical bills, it’s a wonder anyone recovers from a hospital stay.