Locked Behind Door #3

BrandyDistance-Related Challenges
In Tuesday’s Expert Perspective, Ron Manderscheid outlined three common kinds of challenges to accessing mental health care: insurance-related, provider-related, and distance-related challenges. We’ve heard first-hand from Jennifer and Doug how these barriers have impeded their access to mental health care.

Today we hear from Brandy, whose distance-related and other challenges are not uncommon for people who live in rural areas and elsewhere.


Brandy’s Story
I was diagnosed with bipolar disorder after having my second son. As a nurse, I know how critical care is for the mentally ill. Well, my experience has not been very positive.

When I was first diagnosed, it took a year to get in to a psychiatrist and I was treated by my nurse midwife until then. Finding a psychiatrist in a rural area that is covered by whatever insurance I had at the time was the problem. I once drove 2 hours for all my appointments because the only provider with an opening that carried my insurance was 2 hours away. That lasted a year and that wonderful psychiatrist retired.

My latest experience is with a provider 45 minutes away. First, let me explain that I have literally thousands of dollars in medical bills due to mental illness, even though I am normally covered by a healthcare insurance. That’s just in copays, out-of-pocket, and anything that goes over the mental health benefits coverage, which is minimal, I must say. I am a registered nurse—I should be able to pay my medical bills and feed my children!

Finally, when I recently had a two-month gap in coverage, my current psychiatrist refused to refill my medications without seeing me. (I couldn’t get in to see him because I have to pay $200 up front for an appointment because of past-due medical bills.) That didn’t matter to him. It seems to me that he had written me off as the stereotypical noncompliant bipolar.

When I finally got my tax returns and was able to go in, I was an emotional mess and I was angry. I clearly let him know the situation and that I felt he had let me down in our care partnership. I haven’t been back to see him, but I believe he now sees me in a different light. I work hard to take my medications, remain stable, and be a good nurse and mother to my children and I would just like it to be a LITTLE less hard to do that.

Your Turn
Have you had to wait a long time or drive a long distance to see a provider? Do other parts of Brandy’s story ring true? Comment below and let us know what you think!

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Recent stories posted on this blog emphasize access of mental health care issues faced by many people. In Maine, a recent state budget proposed to eliminate licensed clinical mental health counselors from being able to provide services to folks who are dually-eligible (i.e., who have medicare and medicaid). This was proposed as a cost-saving measure. It has been argued, however, that the proposal would simply shift costs to other providers not targeted by the legislation, as well as diminish access to quality mental health care in a State that is largely rural. After much grouynd work and lobbying, a comprise 5% reduction was proposed - but only for licensed mental health counselors.

When I testified at the State Capital on behalf of mental health counselors and the people who are served, I listened to the Commissioner of the Department of Health and Human Srevices make her case for this and other program cuts. Clearly, the States are facing budget challenges. But in this case, her argument before the committees was basically that licensed clinical counselors are not reimbursable under Medicare and are therefore the most reasonable group to cut. This position has impacted hiring practices in Maine as well as the aspiriations of those who wish to serve as LPC's in our State.

This access to care issue can be remided in Maine and across the country by the passage of the "Seniors Mental Health Access Improvement Act of 2013". This Senate bill, introduced by Senators Wyden and Barrasso, would establish Medicare coverage for both LPC's and Marriage and family counselors. With Medicare enrollent projected to grow in the next 20 years, this bill would significantly impact access to care issues as well as costs related to emergency room visits, chronic conditions, etc. It would also correct the tone on the State level where implementation of local practices is viewed in light of the Medicare guidelines.

This Senate bill needs co-sponsorship. Companion House legislation needs to be introduced. In Maine, members of the Maine Counseling Association (ACA Branch), and the Maine Mental Health Counselor Association (AMCHA State Branch) have been working to influence our Senators and Representatives. Recently, we are happy that Senator Susan Collins has signed on as a co-sponsor to this bill on the national level. On the State level, a ground-swell of activism from many places (professional, providers, consumer council representatives, university personnel and students, and concerned citizens!) has made an impact on many of our State representatives and Senators.

Access of care issues are not going to go away easily or soon. But advocacy can work. It is so important to give these concerns a public voice. Networking and "bending the ear" of State representatives and actively exhorting our Congressional Friends to pass legislation in support of mental health services is a part of the overall picture.

Working with these issues has underscored two beliefs of mine. First, if we don't speak up, we don;t exist. Secondly, mental health and social justice are one, inseperable process.

John Yasenchak, President Maine Counseling Association


Because of these unforeseen delays in healthcare, I have discovered firsthand the importance and efficacy of self-care. Management strategies in the short term - determining needs, establishing support and developing resilience, for example - and management over the long term, encompassing the quality of my entire life, until its end - are imperative for me to implement while we pioneer. 

We are a little bit more vulnerable. Taking responsibility for what we can, to create a buffer from undesirable outcomes of our vulnerability, is another direction to move from while coping with and recovering from gaps in the system.

I currently live in a county without a psychiatrist who will accept my insurance. While I wait for my appointment with County Mental Health Social Services and recover from my move here, I enjoy practicing Yoga in all its forms, including meditation, breathing practices and Ayurveda, which supports a harmonious lifestyle via diet and other daily practices. I call home and talk to friends and mentors, many of whom I sought out after years of depression. I exercise gently every day, I make sure that I get enough rest and sleep, I spend time in nature and with my pets... I basically live by the book. These practices have brought me to a way of living that helps carry me through challenges that affect any human, including those bipolar extras, with patience, grace, less anger and less indignation. Frustration with a faulty system will do my precious mental balance no good. I look for the bright side, and practice gratitude constantly.

This doesn't reverse my diagnosis, but it has consistently delayed most of my previous need for immediate healthcare. Serious wellness takes constant attention. It has been worth it. Taking as much of my health into my own hands has helped alleviate my reliance on an imperfect healthcare system, if only by providing a sense of self-empowerment. My lifestyle has done much more than just that, of course, but I have found that self-empowerment is achieved and maintained achieved, the rest comes more easily.


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