Saturday, April 5, 2008

Chemical Dependency Road Show: PTSD vrs. Addiction Round One

Mental illness is not a four letter word. But, those of us living with diagnosed mental illnesses are treated by everyone, except perhaps medical practitioners, as if we need to perk up, cheer up, get over it, get some fresh air, change jobs, or get a hobby. Even medical insurers treat mental illness as a second-rate physical ailment (for those that need it spelled out mental illnesses are permanent physical incapacitations of various brain functions that result in various outward behaviors that are described as mental illnesses).

Paul and Sheila Wellstone, may they rest in peace in their kibbutz in the sky, were champions of mental health. One of Senator Wellstone's as yet unfinished projects was a mental health bill of rights that would have, if passed, required that medical insurers treat mental illness in the same way they treat other illness and not as if mental illness were something that the American Medical Association made up to make sure that doctors specializing in psychiatry had something to do with their days.

Let's take this out of the abstract and into concrete examples. I have been diagnosed with severe PTSD, which mimics both depression and anxiety, and, in many cases, including my own, trigger another mental illness/brain dysfunction, which is chemical dependency. Even within mental illness there is a hierarchy to which the medical insurance establishment adheres. For example, PTSD (Post Traumatic Stress Disorder) is most commonly caused by direct or approximate exposure to various extremely violent events: war, rape, extreme physical and mental abuse, etc. versus chemical dependency—also classified by the medical establishment as a medical condition directly related to a malformation of the brain and atypical brain functioning, which is generally also triggered by traumatic life events. How these two mental illness are treated, though, by medical insurers (not to mention the general public) are criminally different.

Medical insurers treat folks with PTSD with pity and concern. Those suffering from PTSD are generally completely covered when seeking medical treatment. For PTSD and the various forms of behavior that are engendered by a person living with PTSD who has not received treatment or has stopped taking their medication, the answer is hospitalization. In general, most medical plans that both non-profit and for-profit workers possess are actually decent once you qualify for hospital treatment (they may still leave you with crippling medical bills later on, but once you have been admitted for psychiatric treatment and maintain your medical insurance, the burden of care is on the hospital and they are liable if they release you before you have satisfactorily completed a course of treatment, received the proper medications, and have an exit plan in place). Because mental illness such as PTSD are treated in a medical hospital setting they are covered under the hospitalization benefit of medical insurance plans which tend to max out at between $1 million and $5 million a year. You can receive a lot of in-patient treatment for a million dollars a year. As a matter of fact, at an average of $15,000 a week for in-patient mental health treatment at a hospital, you can, quite literally, live for an entire year at a hospital receiving treatment and still have funds left over at the end of the year for that special minor medical procedure you've always wanted to have. Merry Christmas.

Addicts and alcoholics are treated as morally perverse and suspect. Although the AMA has, for decades, recognized chemical dependency as a mental illness the same as depression, PTSD, bi-polar disorder, etc., the fact that the outward manifestation of this disease is the visible use of various intoxicating substances, addiction is viewed as a failure of character rather than as a medical condition deserving respect and treatment. This plays out in the insurance industry and in the courts very differently than PTSD and other mental illnesses. Beat up a nice old lady on the street and have it be proven that you you were reacting to external circumstances mis-processed by a PTSD brain that has gone off its medications, and you will be found not guilt or guilty of a lesser charge, court ordered to psychiatric treatment (and if you do not have medical insurance the state will gladly pay). Let it be discovered tough, that you beat up that nice old lady because you were drunk and she reminded you of your own grandmother that used to be the hell out of you with an extension chord and until you bled, then you obviously are a dangerous and violent drunk, you will most likely receive the harshest penalty that the district attorney is able to levy, and you will spend the next five to ten years in the county jail with untreated mental illness and a whole new set of experiences and triggers being built up around those that you had going in. In the insurance industry, chemical dependency is treated like a Jew in the Reichstag. The mental illness of chemical dependency is treated outside of the normal medical establishment in special “treatment facilities.” Since these facilities are not hospitals, they do not trigger the in-patient hospitalization insurance benefit, allowing the insurance companies to write their own chemical dependency treatment benefit, which, since there will be no CNN Headline special about the poor alcoholics and addicts left to suffer the ravages of their illness, and, even if there is, the public won't give a shit, so, therefore, the medical insurance companies---being about making the dollar and not making people well—writes off addicts and alcoholics providing minimal benefits, so minimal that they are virtually guaranteed to not cover the costs of even part of a basic course of treatment.

For example, let us look specifically at Group Health Cooperative of Wisconsin. For inpatient, in plan hospitalization for mental illness such as PTSD, I am eligible for 30 days of inpatient coverage full stop. For inpatient Alcohol and Drug Abuse services, I am also eligible for 30 days of inpatient coverage. But wait, there are two little asterisks following that plan benefit. The asterisks read, “The maximum alcohol or drug abuse benefit is $6,300 combined (including outpatient, transitional, and in patient).” Considering that the Pride Institute, the leading chemical dependency treatment facility for the queer community charges roughly $12,000 for 28 days of inpatient treatment and Hazelden, the treatment center that has set the standard of care for chemical dependency treatment and success for more than half a century, charges nearly $30,000 for a 28 day inpatient program, the result is that even with private insurance individuals living with the mental illness diagnosis of chemical dependency, unless they have significant private means or are able to secure private loans or qualify for public chemical dependency dollars, are looking at partial treatment only to be released, half-treated, back into the community where 90% of those that COMPLETE treatment relapse.

Three years ago I went through inpatient treatment. I made a commitment that before I would ever allow myself to fall back to the place I was when I checked myself in first to Fairview Riverside hospital and then to the Pride Institute, I would seek preventative help. Yesterday, I called the Pride Institute with my insurance information to seek admission to their outpatient treatment program. Pride called back and said that because of my insurance maximum benefit of $1,800 a year for outpatient chemical dependency services, I would be covered for 11 of 23 sessions and after the 11th session I would either have to leave the program or pay $2000 out of pocket to cover the remaining 12 sessions. Basically, this is the same as if I were to break my leg in several places and the doctor saying that it will take 23 days to heal, but my insurance will only cover the cast for 11 days and after that I either have to pay for the remaining 12 days of healing out of my pocket or they will gladly take off the cast, and I can take my chances that I have healed enough in that time that I won't simply shatter the leg again by attempting to walk on it. Of course, should I shatter my leg and require surgery, I will be welcomed at the hospital where the medical establishment will receive a greater payout, and, after which, I will require rehabilitative therapy if I ever want to walk again...and...oh yes...23 sessions of therapy will be required...but only 11 will be covered by my insurance.

1 comment:

  1. I want to address one element of difference between the stigma of "mental illness" (the way that different conditions that affect thinking and behavior and have a variety of causes are lumped under that ugly term is BS) and that of chemical addiction.
    From my personal experience, most "mental illness" treatment centers and wards are lockdowns, and the staff treat the patients in the most disrespectful and infantilizing way imaginable. They justify the imprisonment and treatment by saying that they can't risk a patient leaving the ward and possibly harming themselves or others.
    In contrast, most chemical dependency centers and wards are not lockdowns. Even people who are court-ordered to go to treatment get sent to places that they can literally walk out of. A patient at these places can leave and then relapse and die of a chemical overdose the same day, or use a chemical and get some else killed, but nobody who runs these places seem to worry about that.
    The criminalization and demonization of people who suffer from chemical addiction is, well, criminal. However, the treatment and image of people who have issues catagorized as "mental illness" still has remnants of the olden days when "crazy" people were treated as devil-possessed "maniacs" who needed to be locked away -- without even the due process that people involved with the criminal justice system gets -- tied up, tortured and treated as a subhuman untouchables.
    I'm not disagreeing with what you wrote. I just feel this point needs to be added.
    By the way, I've been diagnosed with PTSD and have suffered from depression and anxiety.



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