The "New Reality" is Cuts to Mental Health Care

Sad but true

Yesterday, an article in the Dayton Daily News discussed the closing of the inpatient psychiatric care facilities, as well as cutting back on some outpatient psychiatric services, at Greene Memorial Hospital, a member of the Kettering Health Network.  Patients formerly taken in by Greene Memorial will now be directed to Kettering Behavioral Health Center (the same facility that told me, when I was pregnant and walked in for an evaluation, they could "not ethically" let me leave because I was a threat to myself and my baby...and less than 20 minutes later dismissed me out of hand, because they could not admit me because I was pregnant and pregnancy was considered a medical condition they could not accommodate.  But that's a different story).

A spokesperson for the Kettering Health Network said that "'the new reality is that hospitals will be required to care for more patients with less reimbursement.'"  To get a general idea of how many mental health patients Greene Memorial usually services, the article mentions that they discharged 508 psychiatric patients in the "first 11 months of 2011."  According to US News and World Report, Greene Memorial Hospital has a total of 185 beds across all services, so it's a safe assumption that only a small percentage of these beds are in the psychiatric inpatient unit.  So the bottom line is that the area may be losing only a few total psychiatric inpatient spaces -- but when you've only got a few to start with, every space matters.

What's especially telling is that the amount of bad debt that Greene Memorial faced increased in the past few years, to a whopping 30% -- this while its patient volume actually decreased by 13% (these stats from the same article as I mentioned before).

Here's the naked truth:  mental health care is messy.  As I talked about when I discussed the closing of the Twin Valley Behavioral Health Center and replacement with the new Access Dayton mental health facility, many of the people in the mental health care system are also in some way involved in the courts/legal system -- meaning they have Medicare or Medicaid.  Thus we are right back around to the crux of the problem:  hospitals don't want to treat patients with Medicare, Medicaid, or other similar health insurance.  And it's no mystery why -- it's because the hospital very often doesn't get the reimbursement it needs to keep its services running, which then puts them at a deficit for other services, which messes with their financial solvency, etc. etc.   

I don't usually get real political on here, mainly because if I was pressed to profess an allegiance to any party, I'd say I'm in the Voter Apathy Party and I really just can't be bothered to sift through all the parties' crap to see what I really believe in.  But when I start talking about mental health care, it's a no-brainer.  Our health care system is broken.  It needs to be fixed.  I'm not exactly sure how to do that -- it's like moving a mountain with a teaspoon -- but just because it's a hard job isn't a good enough excuse to not do it.

Almost exactly a year ago, a state trooper  was responding to a disturbance at a trailer park near here (up towards Springfield), and was shot to death in a standoff-then-shootout.  There was much public outcry when it came to light that the shooter been in a shootout almost ten years before, then served two years in a mental institution after being found not guilty by reason of insanity.  Law enforcement called for a more accessible database of offenders found not guilty by reason of insanity, so the officers knew better what kind of situations they were walking in to.  Gee, I have an idea -- let's try to help these ill people so they aren't in another shootout.  I know, crazy -- but just crazy enough to work, maybe?

On a more national scale, one can point to the shooting of Arizona Congresswoman Gabrielle Giffords (and others) almost exactly a year ago, and all the discussion around the fact that the shooter, Jared Loughner, should have been receiving mental health care but wasn't, according to this NPR article, because of the stigma attached to mental illness.

Advocating for mental health care is not just about "taking care of our brothers and sisters," which clearly isn't a good enough reason for many people to take it seriously as a cause (though for those people who consider themselves Christians, it should be).  Mental illness, perhaps more than many other kinds of illness, has far-reaching tentacles that does not stop at the sufferer.  Failure to attain treatment for mental illness can reach far, affecting completely anonymous, innocent bystanders in the most horrific of ways. 

Unfortunately, with the constant closing of mental health facilities like Greene Memorial, Twin Valley Behavioral Health Center, and others all across the nation, I suspect it's going to get worse before it gets better.

Oh, Oh, Where'd You Go, Psychiatrist?

[Warning:  self-reflective diatribe ahead]

In looking back over previous posts, it occurs to me that way too many of my titles are in the form of a question.  Maybe I watch too much Jeopardy!, but I think the larger reason is that a lot of my posts are, indeed, questions.  When I teach Freshmen Composition, we learn that one way to "enter a conversation" about a specific topic is to raise questions about what has already been said in that conversation. For example, if you wanted to write a research paper on inane children's TV programs, you could say, "Experts believe that The Fresh Beat Band helps children learn about music and friendship.  But who are these experts?  And why isn't anyone beating them with a sock full of pennies?"

He he he -- guess someone else hates Twist too!

(Sorry, I hate The Fresh Beat Band.)

Anyhow, that's how I sort of view this blog:  an attempt to enter the conversation about mental health care and mental illness (and knitting) through question-raising and providing jumping off points for new conversations.  Of course, that's very ambitious, and I know that it takes a lot more than one loser posting random rants about Nick Jr. TV shows, but I'm trying.

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ANYHOW, on to the real topic of this post.  I got a letter in the mail this week informing me that my psychiatrist -- the one it took me months to find and get an appointment with this past winter -- is leaving private practice to work at a local University.

Well, shit.

Good for her and all, but what the hell do I do now?  This winter, when I needed a doctor, I honestly asked anyone that would listen who I should go to for psychiatric care, and nobody (read:  NOBODY) had any good suggestions.  I've been through several therapists and psychiatrists already, and have heard various negative things about more doctors in the area. Let me say, pickings are slim.  For heaven's sake, my OB-GYN's office was calling me to recommend a psychiatrist for a patient a month ago.  That should speak volumes about the number of doctors in the area.

I went through a lot of blood, sweat, and tears to try to find a doctor this past winter, and now it seems I have to start the whole process over again.  Not only am I unhappy about it, I'm a little overwhelmed.  And pissed.  I know there is no benefit to being angry and upset, but I can't help it.  I'll get myself together and try to start making calls in the next day or two, but right now, I'm just going to let myself wallow in the injustice of it all.

Okay, that's a little dramatic -- how about if I just let myself rant?  Damn you, doctor!  Damn you, mental health care system!  Damn you, Dayton, Ohio!

I feel a little better now.  On with the show.

Will another mental health facility help?

Last week, I wrote a post about the lack of mental health care both in Dayton, Ohio, and in general.  An article from the Dayton Daily News today discussed the grand opening of a new psychiatric hospital in the area, which sounds like a step in the right direction.

Or is it?

Access Hospital Dayton is a for-profit facility, opening where a state hospital (Twin Valley Behavioral Health Center, or TVBH) used to be, until it closed in 2008.  It is run by a private company, owned by two psychiatrists.  It will have 28 beds initially, and the director hopes to expand to over 100 when it's all said and done.  I can't find a website for it (which doesn't mean it doesn't exist, but it's not obvious), and all the information I'm getting is coming from the DDN and from the Dayton Business Journal.

The facility will not take anyone on Medicare or Medicaid; it will only take patients with private insurance that will cover the costs, or patients who are willing to pay for the care themselves. It sounds like, from the Dayton Business Journal article, the owner plans to expand to accept Medicare and Medicaid, but that's a future plan.

[Side note:  In my opinion, 28 beds sounds pretty paltry, so I tried to do a comparison.  I looked up the Linder Center of Hope, a facility down in Mason, Ohio, that I visited (ha, sounds so pleasant) this spring.  It has 48 acute inpatient rooms for adolescents through adults, and has capacity for 16 people to stay long-term in their Sibcy House.  They also have various outpatient programs.  And they take Medicare and Medicaid.]

Maybe this is good news for Dayton.  We need mental health care, and that's 28 beds that Dayton didn't have before, right?  Well, at least since 2008, when the TVBH closed down.

And that's where things get a little more grim.  TWBH was a state hospital, and had an over 100 bed capacity.  They were a state hospital, so they took Medicare and Medicaid.

What's also significant is that over half of their patients at the time of their closure were forensic patients -- that is, people who were in some phase of the criminal justice system.  Now, those patients will either be transferred for care out of the area -- if care can be found -- or shuffled back through the criminal justice system.  Or, worse yet, released without treatment back into society, sure to end up back in front of a judge at some point.  (Statistics come from an articled called "Reopening of Mental Hospital Won't Help Uninsured Patients" from the Dayton Daily News -- may not be available when you click on it).

According to the National Alliance on Mental Health, "64 percent of local jail inmates, 56 percent of state prisoners and 45 percent of federal prisoners have symptoms of serious mental illnesses" (From "Department of Justice Study:  Mental Illness of Prison Inmates Worse than Past Estimates").  

It's been proven, then, that there is a high percentage of mentally ill inmates, and it's no secret that Dayton's crime rate is pretty bad.  From neighborhoodscout.com:

• Dayton's "Crime Index," with 100 being the safest, is 5 -- this means that Dayton is safer than 5% of the cities in the country
• An individual's chance of being a victim of violent crime in Dayton is 1 in 98; in Ohio it is 1 in 287
• The murder rate per 1000 people is .21; the national average is .05
• Note:  all these stats are from neighborhoodscout.com:  click here to see how they got them) 

Is there a correlation here?  I have to think there is.

So, hip hip hooray that a new mental health facility is opening in town.  Obviously, Dayton (and the country in general) needs all the help it can get.  But, contrary to their name ("Access Hospital"), this facility won't serve the segments of the population most in need.

I guess we still have a ways to go in mental health care for the area, and the country.

Why can't we find mental health help??

A couple of weeks ago, the nurse from my OB-GYN's office called and left a message, asking me to call her because she had a question "not related" to me, but more of a general nature.

It turns out that there was a patient in the office who was in desperate need of psychiatric care and was having a problem getting an appointment to see any doctors or therapists.  The nurse wanted to know what psychiatrist I saw, if I liked her, and if it was easy to get an appointment in her office.


Now, I have a good relationship with everyone in my OB's office, mainly because when I was pregnant this past year I called them on average, oh, a million times a week.  Sadly, at one point, the nurses knew my phone number when it came up on caller ID and knew to answer if it was me.  They were aware of my mental health problems and my struggle to find help, so I'm not shocked they called me to see if I could recommend someone for their patient.

That being said, how sad is it that the doctor's office was calling me?  I'd like to think I'm something of an expert -- on pretty much everything, really -- but the reality is I'm just a girl (cue Gwen Stefani) who has had mental health problems.  What does it say about the state of our mental health care system when someone is calling me for guidance?  It's terrifying, frankly.

Doing a little research on psychiatric care in this country reveals some really scary statistics.  A 2006 study in North Carolina, conducted in part by Duke University, showed that there was 1 psychiatrist for every 10,000 people in the state.  It also found that many patients' insurance was lacking when it came to mental health care, which made it harder for them to find help.  (Source:  "Report Finds Limited Number of Psychiatrists Statewide")

A blog called "Health and Medical News and Resources" states that there is a shortage of 45,000 psychiatrists in the United States.  If I was teaching, I don't know if I'd let a student use this blog as a credible source, but I did find the statistic repeated on a page on medscape.com.  Apparently it comes from a study with...a lot of impressive looking references.  The medscape.com page also has an interesting interview with several psychiatrists about the state of the mental health system in the country.

Unfortunately, the lack of care isn't just frustrating -- it has serious ramifications.  For example, in the same interview, one of the psychiatrists state that studies show 16% of prisoners have some form of mental illness (you may have to have a medscape.com account to see this page).  These are people who, if given proper mental health care, would likely not be in prison, but in a psychiatric facility or treated to the point they can live productive lives.

I could go on and on -- I haven't even mentioned the epidemic of mental illness among the homeless -- but I'll leave it at that for now.  I also would be interested in looking up statistics on Ohio in particular, but I'll do that in another post. 

In summation, the statistics are staggering. 

It's actually pretty depressing. 

I think I'll go knit.

Routine, Interrupted

I'm not OCD; far from it.  I'm not particularly clean or organized or particular.  That being said, we are in the process of  remodeling our kitchen, and oh my, it is driving me nuts.

I should state upfront that I am really excited for the new kitchen.  It's going to be great.  I've worked hard putting it all together, and it's not going to take that long to do -- just a couple of weeks or so, then I'll have a beautiful new kitchen to enjoy.

However...there's something about my routine being disrupted that causes me to totally crash.  I've gone through two bathroom remodels and various other smaller projects, and it's always the same -- it get irritable, depressed, and anxious.  I can't cook anything, I can't really wash dishes, it's hard to get to my refrigerator (at least I still have one, though), and all the contents of my kitchen are strewn around my living room and dining room.  I found my two-year-old trying to eat a beef bullion cube she found yesterday because she assumed if it was in a shiny wrapper, it was candy.  She was disabused of that notion pretty quickly.

Out of curiosity, I did a little web searching on bipolar disorder and routine, and found quite a few articles that talk about how people with bipolar disorder may be helped by regular routines.  I'm not surprised, because a disruption to my routine certainly wreaks havoc with my mood, so it would stand to reason that the opposite is true.  Here are the articles:

From webmd.com:  Daily Routine May Help Bipolar Disorder
From the American Journal of Psychiatry:  The Importance of Routine for Preventing Recurrence in Bipolar Disorder
From healthyplace.com:  Stability in Bipolar Disorder Requires Routine

At least I feel a little justified that I'm not just making up an excuse for my bad mood.  Here's hoping the reno goes quickly.

Bipolar Knitter...back at it

Well, I kind of fell off the blogging wagon around March. I started having early labor symptoms and was in and out of the hospital pretty much until I gave birth in April. But, I had a healthy baby girl, Lydia, who is beautiful, sweet, and easy (thank God).

So, technically, I'm not Pregnant Bipolar Knitter anymore. I think I am going to keep this blog, though, and just rename it to Bipolar Knitter. Look for a new title/logo/etc. I still believe in the spirit of the blog -- bringing information and awareness about mental illness, specifically in women, to the public. This being said, I'm going to regroup and refocus my energies back to this blog and other outlets.

Also, my brain is rotting, so this is a way to try to prevent that from happening. With three kids 4 and under, it's probably a losing battle, but I gotta try!

Back to the point, part 2

In my last post I started detailing the issues I've had during pregnancy with getting mental health care, which is the whole reason I started this blog in the first place.  I will continue the story with this post.

In late October/early November, I went to my general practitioner because my mood had started getting really bad since going off my meds (Seroquel and Lamictal) in August.  After talking to me, -- which involved a lot of crying on my part-- looking at my medical history, and looking at the cuts I had made on my arms, he put me back on a low dose of Seroquel.  For about a week, I felt not great, but functional, but then things continued back on their downhill spiral.  I was crying all the time, just wanting to sleep, having anxiety attacks, and doing a lot of cutting.  I called my GP back and talked to a nurse, who in turn talked to the doctor, who increased my Seroquel dosage. 

The increase in Seroquel didn't seem to make much difference, other than to make me more tired (something not particularly desirable when you're trying to chase a four-year-old and a two-year-old).  I called my ob/gyn's office to see if she could help out at all.  She put me on Vistaril as needed, which is pretty much just an antihistamine but can kind of mellow you out at the same time. Both my ob/gyn and my GP suggested strongly that I see a psychiatrist, but not wanting to go back to my prior psychiatrist, and with nobody recommending a new one, I was sort of at a loss for who to see.  If you've ever tried to get psychiatric help in Dayton, Ohio, you understand what I'm talking about.  There aren't too many psychiatrists, and those that there are often have a 3-6 month waiting list just to schedule an initial appointment.

In early December, after a few more weeks of generally decreasing mood and functionality, I called my family doctor again and the nurse recommended I go to Kettering Behavioral Health Center, a facility located in Centerville (I think) that has both inpatient and outpatient care.  They also offer walk-in assessments.  I drove myself over there and talked to the admitting nurse for about a half hour.  I explained I was about 21 weeks pregnant (in case she couldn't tell), was cutting myself daily, crying all the time, and generally feeling like utter crap.  I was worried that my mood was hurting the baby, and I needed psychiatric help to look over and manage my medications. She asked the $64,000 question:  "Are you suicidal?  Do you have specific plans?"  I told her that I frequently thought about suicide, but didn't have a specific plan to follow.  I thought about taking pills or slitting my wrists, but hadn't written a suicide note or anything.

At this point she assured me that the facility had an ethical responsibility to help me out, since I was a danger to myself and my baby, based on my suicidal thoughts and cutting behavior.  They wouldn't just send me home and tell me good luck.  She asked me to step out while she called the psychiatrist on duty and talked to him about what to do next.  My sense of relief was tangible -- finally, someone was going to help me.

She came out to the waiting room a few minutes later and told me that the psychiatrist wanted to admit me to try to regulate my medications.  I didn't particularly want to be admitted -- it was close to Christmas, and I wanted to be home.  But, I knew I needed help, so I agreed.  She went back to her office to talk to the admissions people to get the process started.

About 15 minutes later, she called me back in to her office.  As it turns out, they couldn't admit me to their facility, because I was more than 20 weeks pregnant, and they didn't have the medical facilities to help me in out in case of a problem (they are not on the same grounds as the actual hospital).  What they could do is prescribe Klonopin for me, a powerful anti-anxiety drug, increase my Seroquel again, and suggest if I was still having problems to either call my old psychiatrist or go to Miami Valley Hospital's ER.

And with that, despite their "ethical obligations," they sent me on my way.

Next post:  a new psychiatrist and the ER.