Wednesday, December 26, 2012

Does Having a Mental Illness Equate to Violence?

In light of the events that have taken place over the past few weeks, as well as in the past, I’ve decided to blog regarding the discussion as to “the supposed correlation” as to guns and mental illness. Just because you have a mental illness, does this mean you are going to go on a shooting rampage, and denied a gun permit? Although not a gun owner, nor do I ever plan to be, nevertheless, why is the connection to having a “mental illness” and “going on a killing rampage” have to be used in the same sentence?

I agree there is a big gap between treatment needs for those with a mental illness, and the lack of available resources.

Pete Earley, in USA Today, says he worries that those with mental illness will be lumped together with the small group of people who have committed heinous acts of violence, who have also had their share of mental health issues.

Another assumption the news jumps to when a shooting occurs is the individual who just committed this horrible act of violence has a mental illness and I feel jumping to this conclusion is not fair.

Is treatment of an individual with a mental illness with medication, going to eliminate all these shootings? I really do not think so. I realize in certain circumstances this may be true, but I guarantee shootings still will occur from those individuals considered “mental illness free.”

Another thing I don’t understand, in many states that require people with a history of violently mental illness (from 72 hour or 96 hour holds) to be placed in the National Instant Criminal Background Check system.

I understand in some certain circumstances this may prevent violence….but it has been my understanding that those individuals on this (72/96 hour hold list) were not individuals involved in these recent and passed shootings!

In general though…is sending individuals who commit crimes, to jail appropriate. Many times those individuals sent to prison or jail has an increase in symptoms because the environment exacerbates symptoms. It is my opinion; the United States jumps right away to locking up individuals with mental illnesses not provide medication management, therapy, or an understanding of the diagnosed or specially undiagnosed mental disorder. The law should consider putting those mental ill into the state facilities specially designed for this.

According to Human Rights Watch, the number of mentally ill inmates in U.S. prisons quadrupled from 2000 to 2006, and it continues to rise -- in fact, the rate of inmate mental illness is five times greater (56 percent) than in the non-incarcerated population.

I would love to hear feedback on this topic, please provide comments, so that we can all figure out the best solution for preventing and understanding these folks.

Thanks everyone for reading!

Sunday, November 25, 2012

Help Me Help You

I've been in a depressive slump. I'm in the process (slowly) of writing a new blog. In order to get a general idea of the interests out there, please comment and respond to this as to suggestions of blog topics to come, and the blog itself!!!

Tuesday, October 9, 2012

Navigating the Medicare Nightmare

What is Medicare?

This is one of the hardest blog topics thus far. This topic of Medicare is so complicated and this topic could go on forever. I have summarized the information that I feel will help others understand the in’s and out’s of Medicare, which is very difficult for those in need of health care.

Many folks think Medicare is for those 65 or older. When in fact it also includes those deemed disabled, and includes individuals under 65 with certain disabilities. Additionally those people of any age with End-Stage Renal Disease (ESRD). It is based on Federal and state laws, and national coverage decisions are made by Medicare as to if something is covered or not. For me personally, I qualified, even though I am 37, for SSDI, which automatically provides me with Medicare.

When I went to sign up for Medicare two years ago I thought it would be a simple process! I was wrong. I actually spent about a month researching and figuring out what would be the best advantage plan (I will discuss this definition); including the costs of all 17 of my medications! Discussion of the basic definitions and parts of Medicare is provided below.

So let us start with the basic aspects of Medicare and the coverage’s included. Medicare consists of four parts, Medicare A, B, C, and D.

Medicare Part A: Hospital Insurance helps to cover:
Inpatient care in hospitals; Skilled nursing facility care; Hospice care; and Home health care

Medicare Part B: Medical Insurance helps to cover:
Services considered medically necessary to treat and diagnosis disease or illness. This could include lab tests, doctor’s visits, surgeries, and durable medical supplies such as a wheelchair.

Under this section of Medicare, preventative services are included. I have found that Medicare and Medicare Advantage plans encourage the use of these services, and many plans include these services at no cost as long as you find a health care provider who accepts costs. Some of the preventative services include (this list is brief): flu shots; breast cancer screening; cervical and vaginal cancer screening; colorectal screening; depression screening; and diabetes screening. Under Part B, diabetes self-management, and diabetes supplies are included.

Additionally Part B pays for inpatient hospital care; including mental health inpatient; outpatient and partial hospitalization. Limited outpatient prescription drugs are included as well.

Medicare Part C: Medicare Advantage Plans
This is the part, for me found very confusing, and what I referenced above as taking me a month to research. This is where Medicare Advantage Plans come into play. Medicare approved private insurance companies run these plans. The benefits of these companies include Part A and B, with the option to pick up Part D, which is the prescription drug coverage. With these plans, there are many different policies so this is where the dreaded decision comes as to whether one wants a supplemental plan such as a HMO, PPO, PFFS, Medigap, and others. If you are in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare.

Some services may only be covered in certain settings or for patients with certain conditions, and on top of the regular cost of Part A and B Medicare premiums, there is an extra cost. Medicare Advantage Plans are from some of the same companies that group employee and private individual plans pay for. Some of these are Humana; Care First; Anthem; Blue Cross Blue Shield, these are just some examples. Additionally plan coverage is based on place of residency. Companies in each state that process claims for Medicare make local coverage decisions.

Medicare Part D: Prescription Drug Coverage

The Medicare approved private insurance companies that include Part D, the prescription drug coverage, run similar to Part C. You can pick this Medicare part up by itself or most Advantage Plans include it when you pay out of pocket. Under this part additional drug coverage is provided, and aids to help lower prescription costs. I would like to note, Original Medicare only provides standard Medicare Part A and B, with limited prescription coverage. For me I’m on a Medicare Advantage Plan, which includes Part D, the prescription plan as well, and helps enormously with out of pocket prescription costs, being that I’m on 17 medications.

I know I know your heads are probably spinning. I do not understand how this country’s biggest health plan, is so confusing to understand and difficult with all its twists and turns. Luckily, for me I am “with it” enough to go online and research the Advantage Plans for extra help with my enormous medical and prescription costs. For those who are elderly and severely disabled, I have found that there is not a lot of local help to help navigate this steep path.

Lastly, the most important thing I will mention, upon deciding on a Medicare plan make sure the Medicare plan covers what you need. Talk to your doctor or health care provider to make sure your coverage includes their services. Also, discuss with them what services or supplies they will not cover. You can also call Medicare directly to ask about specific procedures and services. Below are some resources to help you getting started on your quest to navigate through the Medicare system, or prepare you for future use.

Resources to help get some additional information and questions answered

Direct Medicare Help
TTY 1-877-486-2048

Social Security Administration
TTY 1-800-325-0779

Friday, October 5, 2012

Relief Is On Its Way: Initial Diagnosis Part 1

On average, there is an eight-year lag between a first episode of depression or manic symptoms and the first time the disorder is diagnosed and treated (Goodwin & Jamison; Lewis 2000).

Usually individual’s first stop is to their primary care physician. While some physicians’ have a little experience treating psychological issues, their primary role is for regular medical issues that are not emotional in nature.  Psychiatrists really are the type of medical doctor that specifically and solely deal with mental and emotional issues.

It has been my experience from discussing this topic with others, that their primary care physicians more frequently prescribe Prozac whenever a patient complains of depression. Their repertoire usually does not include a supplementary understanding of additional medications like anti-depressants and especially mood stabilizers!

What happens upon making that initial appointment to see a psychiatrist? For me it was fear… a “what happens from here on?” kind of feeling. This is what I have found and still find the most important piece of the puzzle, of getting your life back on track. Something I will call “the discovery.”

Nobody jumps up and down when they are first diagnosed with a mental or psychiatric illness. Personally, for me I went through the, shock, blame, anger, and acceptance phases’ sort of equivalent to the stages of loss. I thought my life was over and I could see no light at the end of the tunnel. Even now after 15 years, that light comes and goes!

The average person diagnosed with bipolar disorder experiences four episodes per year during the first 10 years of the illness.  Like any mental illness, there are no limits to who will acquire a diagnosis. Old or young, female or male, rich or poor, etc.

One fact I found very fascinating is men tend to start in the mania phase while woman tend to start initial diagnosis in the depressed phase! Note to person’s with bipolar, woman are not the only dramatic ones!

For me, I feel the bipolar diagnosis is much more stigmatizing than depression. I cannot tell you how many folks, who do not know about my bipolar, will make comments like “that person is so wacko, she is bipolar,” or “you never can predict if he is going to be unstable”! It is easier I think to understand “being depressed,” that usually equates to a low or sad mood. However, for those who don’t understand it “bipolar” means folks are all over the place, up and down.

 So after you get the courage to make that initial appointment to see a psychiatrist, make sure you feel comfortable with him or her.  This is where the discussion regarding treatment and medication begins. From experience with various psychiatrist’s I have found that the same steps take place. Initially, the psychiatrist sits down to discuss what brought you to him or her. I have found as if this is almost like a job interview. Your road to recovery needs to happen in an environment that will help you progress further. I can vouch. I have had really great, intelligent, warm, and non-arrogant psychiatrists’, and I have had intelligent rude psychiatrists. It is hard sometimes to decided, do you want smart with no interpersonal skills, or a more caring one not as informed. It is your call. Yes, I know this does not make the choice easier.

The psychiatrist usually wants to get an idea of what brought you into the office. What symptoms have you been experiencing that is so difficult that you feel medication might be useful? In addition, the doctor probably will discuss your life from birth to present age. This takes place to see if there has been a pattern and/or how long your symptoms have been in existence.

So have your medical history available, with current and past doctor’s information in the case the psychiatrist needs to discuss other medical issues. As well as past medication use, for any other health reason.

This topic could go on and on. I have chosen to end it here and write a second part to this later. More along the lines of “what continuous care” looks like after the initial psychiatric visit. Please provide comments for those going through this difficult time in their lives!

Tuesday, August 21, 2012

On The Road to Treatment: Figuring Out As Quickly As Possible If One Is Bipolar

Bipolar disorder affects at least 1 in 70 people. Bipolar disorder can start as early as adolescence, or as late as the fifties.

One difficulty can be diagnosis of bipolar disorder in adolescence. What adolescent doesn’t have raging hormones? Looking back, of course I cried when the person I liked starting dating someone else, or broke up with me for no reason. On the other hand, the backstabbing friend that starts spreading rumors. I think as a girl, these can tend to be normal or common reactions.  Alternatively, what about about the moodiness, as a boy, and dealing with the raging hormones, resulting in anger.

The National Institute of Mental Health conducted studies on mental illness, and concluded that 48% of all adults in the United States will at some point in their life will have a diagnosis if a mental illness. Although this is only one study, it really surprised me how high this statistics is! Like me, many individuals will be diagnosed with multiple psychiatric disorders, which usually referred to as “co-morbidity or co-occurrence.”

It is not uncommon for those who eventually are diagnosed with a mental illness, to initially try to grin and bear it, and try to “deal” with it on their own. Sadly this rarely works. However, upon receiving treatment, the sense of relief is tremendous.

While it took my psychiatrist a few years to “officially” diagnosis me with bipolar disorder, statistically the onset age was accurate. Multiple research studies out there suggest the median age of onset is between 20 and 25 years. At the time of my first hospitalization, I was 23 years.

I have always wondered why it takes so long for the initial diagnosis of bipolar disorder. I think in my case it’s because my bipolar is mixed and rapid cycling, so if the doctor sees me depressed he or she would probably diagnosis me with major depression. Sometimes when I am so depressed, it is hard to see the ups at that point in time. In my opinion, diagnosing bipolar is becoming easier to spot and the gap between initial symptoms and diagnosis of bipolar is becoming smaller.

While receiving initial treatment is great, the next step is not so simple. It is at this point I find and continue to find the most difficult. Discussing the type of medication. When somebody is diagnosed with Bipolar or any other mood disorder, other issues concurrently might be diagnosed. There includes alcohol and substance abuse, ADHD, and an increased risk of suicide. These are the most common, but it is not unusual that there are also other co-morbid diseases.

Unfortunately, for me I have a SEVERE case of Bipolar I. My full diagnosis is Bipolar I, mixed state, ultra rapid cycling, with psychotic features. Yes, I know that is a mouthful. When psychiatrists look at mood disorders there are a number of “specific clusters” the doctor assess. This is just a brief description, but for me this was used to help aid in the diagnoses of my bipolar. I was not diagnosed with bipolar right away, which is not that uncommon. I presented initially with depression, than mania, and after 4 years of observation during hospitalization, my psychiatrist finally gave me the mood disorder diagnoses.

In a future blog, I will discuss in detail the more common symptoms that can lead to a diagnosis of bipolar disorder.

Monday, July 23, 2012

Staying Healthy and Avoiding Triggers

It is possible, other than medications, to aid in mood stability. In conjunction with taking your medication(s), psychotherapy, self-management techniques, which I will address later, and avoiding outside triggers, stabilizing your mood is possible. Fortunately coping in society is 100% possible. I personally have discovered and am still discovering healthy ways and self-management techniques to assist with my stability. Additionally, monitoring my sleep is SO important. I need to make sure every night I go to bed on time, and take my initial does of medication at 6:00pm; otherwise, I will sleep until 1:00pm. Clozaril makes me sleep 12-14 hours a night. It SUCKS!!! 

One factor for contributing to relapse is stress. This can be a huge trigger and destabilize. Reducing stress as much as possible really helps. Way in which I do this includes exercising, relaxing, and eating healthy. Some folks find meditation and yoga helps, but I have not tried this before. As I have experienced, there are ups and downs in my life, and I cannot say that it is also easy and that the road had no potholes. However, I do not feel doomed, and shackled for the rest of my life! 

As I have experienced now and in the past that there are “red” flags. For example, my psychiatrist put me on a stimulant for my ADHD. For those that do not know, if a person is Bipolar, prescribed a stimulant, such as Adderall, can cause manic and rapid cycling episodes to occur. Particularly if a person is not stabilized with a mood disorder. I am not a medical doctor, so everything I am saying is based on my experience and personal opinion. 

Some questions I constantly ask to myself: Is my mood stable right now, have I noticed any severe manic or depression symptoms? What trigger my moods, and have I been staying away from these triggers? Can I make sure I can diminish my chances for destabilization? For me personally I self manage by tracking my moods daily, by using a mood chart. This also proves beneficial when I meet with my psychiatrist so that she can see how stable or unstable I have been. Which in turn also helps with adjusts, if needed, with my medication. Another point I would like to make, is if you have a mood disorder, and do not track your mood, think make….do you clearly remember your mood yesterday, the day before, last week. Assessing my behavior and moods has become second nature to me. Sometimes I do get paranoid a little around folks who know I have bipolar disorder. I tend to ask myself when around them, how is my behavior and how am I being perceived. What if I am manic and don’t notice, what if I am depressed and not sociable? These questions are constantly in my head! 

For me, as well, there are questions I am constantly asking myself, to ensure that I am remaining stable. I also ask my friends and family to have these questions in the back of their mind when interacting with me. Some of this includes: Am I talking a lot? Jumping from topic to topic? Not sleeping as much? Sleeping too much? Keep to myself for more? This is only a summary of the questions that arise. Someone times it is harder for me to look in rather than look out at yourself. Thus, making it important those close to you are also monitoring your mood and actions as well. 

Another suggestion that I have found usual, and others too, is building a support network. This includes friends, family, and others diagnosed with a mental illness. For me personally for the first couple of years I found it difficult to rely on my friends and family for support. Not because they were not there for me but because they did not “get it.”  However, I too was just learning about it. 

**Additionally another suggestion is to contact your local Depressive Manic Depressive Association (DMDA) to identify local support groups.

If there is not one in your area, there is a link on this website that provides suggestions and help for starting your own support group. While at first the membership may be low, eventually folks will come out of the woodwork and reach out! Research has shown that individuals diagnosed with a mental illness who have some sort of support network stay healthy and do better. So if it's finding a support group, checking out resources online, as well as online blog or mental illness "talk" forums, there's help out there.

**Bipolar Support Group:
How do you avoid triggers, still healthy, or utilize outside resources?

Bipolar Betty

**These resources I have utilized....I don't have any connection to these websites, I've just suggested them because they have helped me.