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"content": "\u003cp>The Senate is set to approve a bill intended to change the way police and health care workers treat people struggling with opioid addictions.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.congress.gov/bill/114th-congress/senate-bill/524/text\">bill\u003c/a> is an amalgam of \u003ca href=\"https://www.washingtonpost.com/news/powerpost/wp/2016/05/13/house-passes-opioid-bills-setting-up-negotiations-with-the-senate/\" target=\"_blank\">more than a dozen proposals\u003c/a> passed through the year in the House and Senate. And while it has lots of new policies and provisions — from creating a task force to study how best to treat pain, to encouraging states to create \u003ca href=\"http://www.cdc.gov/drugoverdose/pdmp/\">prescription drug monitoring programs \u003c/a>— it doesn't have much money to put them in place.\u003c/p>\n\u003cp>President Obama had requested $1.1 billion to help pay for more addiction treatment programs and other initiatives. But the version agreed to by House and Senate Republicans last week didn't include all that money. In the end, it will probably get about half that much.\u003c/p>\n\u003cp>\"It's clear that efforts to prevent and treat the opioid epidemic will fall short without additional investments,\" Sen. \u003ca href=\"http://www.murray.senate.gov/public/\">Patty Murray\u003c/a>, D-Washington, said in a statement after House and Senate negotiators hammered out the final bill.\u003c/p>\n\u003cp>But \u003ca href=\"http://www.alexander.senate.gov/public/\" target=\"_blank\">Sen. Lamar Alexander\u003c/a>, R-Tenn., argued that the money for treatment has been rising for three years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Our friends on the other side say, you have to fund it. We are funding it,\" he said in a statement on the Senate floor Friday. \"And they helped fund it. We've increased funding for opioids already by 542 percent.\"\u003c/p>\n\u003cp>Still, Democrats are expected to support the bill even without the additional money.\u003c/p>\n\u003cp>And that's a good thing, says \u003ca href=\"http://www.thenationalcouncil.org/about/national-mental-health-association/executives/\">Linda Rosenberg\u003c/a>, president of the National Council for Behavioral Health, because the bill helps expand treatment in significant ways.\u003c/p>\n\u003cp>For example, it allows nurses and physician assistants to treat people with addictions using medications, which is considered the evidence-based standard.\u003c/p>\n\u003cp>\"Treatment capacity is really a crisis. There just isn't enough,\" Rosenberg tells Shots. \"But what this bill does to address that — it expands the kinds of people who can prescribe medications for addictions. And that's a very big deal.\"\u003c/p>\n\u003cp>She says that provision alone can help because nonprofit treatment centers will be able to use nurse practitioners and physician assistants rather than trying to hire doctors, who are both scarce and expensive.\u003c/p>\n\u003cp>The bill also allows the Department of Health and Human Services to give grants to states and community organizations for improving or expanding treatment and recovery programs. It has several provisions that would allow police departments to send people with addiction problems to treatment rather than to jail.\u003c/p>\n\u003cp>In one of the few areas of the bill that includes funding, lawmakers authorized the Department of Justice to spend $100 million a year for five years to find alternatives to jail for opioid abusers, and to allow prisons to use methadone or buprenorphine to treat inmates with opioid addictions.\u003c/p>\n\u003cp>Rosenberg says these measures help change the definition of addiction from a crime to a health problem.\u003c/p>\n\u003cp>\"It's a health care issue and not a moral failing issue,\" she says. That's a big reversal from the \"war on drugs\" campaigns of a few decades ago.\u003c/p>\n\u003cp>And the legislation allows more people to have access to \u003ca href=\"https://medlineplus.gov/druginfo/meds/a612022.html\">naloxone,\u003c/a> the drug that can reverse an opioid overdose, reducing the risk of death. Access would be expanded for people working in schools and community centers.\u003c/p>\n\u003cp>The bill encourage pharmacies to fill standing orders for the drug so that those likely to come in contact with someone suffering an overdose will have the drug on hand, according to Mike Kelly. He is the U.S. president of \u003ca href=\"http://adaptpharma.com/\">Adapt Pharma\u003c/a>, which sells \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm473505.htm\">Narcan\u003c/a>, a nasal spray version of naloxone.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"This bill addresses getting Narcan out into the community, outside of emergency and first responders,\" Kelly says. \"The big thing here is this will fund recovery.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Opioid+Bill+Reframes+Addiction+As+A+Health+Problem%2C+Not+A+Crime&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate is set to approve a bill intended to change the way police and health care workers treat people struggling with opioid addictions.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.congress.gov/bill/114th-congress/senate-bill/524/text\">bill\u003c/a> is an amalgam of \u003ca href=\"https://www.washingtonpost.com/news/powerpost/wp/2016/05/13/house-passes-opioid-bills-setting-up-negotiations-with-the-senate/\" target=\"_blank\">more than a dozen proposals\u003c/a> passed through the year in the House and Senate. And while it has lots of new policies and provisions — from creating a task force to study how best to treat pain, to encouraging states to create \u003ca href=\"http://www.cdc.gov/drugoverdose/pdmp/\">prescription drug monitoring programs \u003c/a>— it doesn't have much money to put them in place.\u003c/p>\n\u003cp>President Obama had requested $1.1 billion to help pay for more addiction treatment programs and other initiatives. But the version agreed to by House and Senate Republicans last week didn't include all that money. In the end, it will probably get about half that much.\u003c/p>\n\u003cp>\"It's clear that efforts to prevent and treat the opioid epidemic will fall short without additional investments,\" Sen. \u003ca href=\"http://www.murray.senate.gov/public/\">Patty Murray\u003c/a>, D-Washington, said in a statement after House and Senate negotiators hammered out the final bill.\u003c/p>\n\u003cp>But \u003ca href=\"http://www.alexander.senate.gov/public/\" target=\"_blank\">Sen. Lamar Alexander\u003c/a>, R-Tenn., argued that the money for treatment has been rising for three years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Our friends on the other side say, you have to fund it. We are funding it,\" he said in a statement on the Senate floor Friday. \"And they helped fund it. We've increased funding for opioids already by 542 percent.\"\u003c/p>\n\u003cp>Still, Democrats are expected to support the bill even without the additional money.\u003c/p>\n\u003cp>And that's a good thing, says \u003ca href=\"http://www.thenationalcouncil.org/about/national-mental-health-association/executives/\">Linda Rosenberg\u003c/a>, president of the National Council for Behavioral Health, because the bill helps expand treatment in significant ways.\u003c/p>\n\u003cp>For example, it allows nurses and physician assistants to treat people with addictions using medications, which is considered the evidence-based standard.\u003c/p>\n\u003cp>\"Treatment capacity is really a crisis. There just isn't enough,\" Rosenberg tells Shots. \"But what this bill does to address that — it expands the kinds of people who can prescribe medications for addictions. And that's a very big deal.\"\u003c/p>\n\u003cp>She says that provision alone can help because nonprofit treatment centers will be able to use nurse practitioners and physician assistants rather than trying to hire doctors, who are both scarce and expensive.\u003c/p>\n\u003cp>The bill also allows the Department of Health and Human Services to give grants to states and community organizations for improving or expanding treatment and recovery programs. It has several provisions that would allow police departments to send people with addiction problems to treatment rather than to jail.\u003c/p>\n\u003cp>In one of the few areas of the bill that includes funding, lawmakers authorized the Department of Justice to spend $100 million a year for five years to find alternatives to jail for opioid abusers, and to allow prisons to use methadone or buprenorphine to treat inmates with opioid addictions.\u003c/p>\n\u003cp>Rosenberg says these measures help change the definition of addiction from a crime to a health problem.\u003c/p>\n\u003cp>\"It's a health care issue and not a moral failing issue,\" she says. That's a big reversal from the \"war on drugs\" campaigns of a few decades ago.\u003c/p>\n\u003cp>And the legislation allows more people to have access to \u003ca href=\"https://medlineplus.gov/druginfo/meds/a612022.html\">naloxone,\u003c/a> the drug that can reverse an opioid overdose, reducing the risk of death. Access would be expanded for people working in schools and community centers.\u003c/p>\n\u003cp>The bill encourage pharmacies to fill standing orders for the drug so that those likely to come in contact with someone suffering an overdose will have the drug on hand, according to Mike Kelly. He is the U.S. president of \u003ca href=\"http://adaptpharma.com/\">Adapt Pharma\u003c/a>, which sells \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm473505.htm\">Narcan\u003c/a>, a nasal spray version of naloxone.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"This bill addresses getting Narcan out into the community, outside of emergency and first responders,\" Kelly says. \"The big thing here is this will fund recovery.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Opioid+Bill+Reframes+Addiction+As+A+Health+Problem%2C+Not+A+Crime&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Tough love, interventions and \u003ca href=\"http://www.npr.org/tags/381641163/12-step-program\" target=\"_blank\">12-step programs\u003c/a> are some of the most common methods of treating drug addiction, but journalist Maia Szalavitz says they're often counterproductive.\u003c/p>\n\u003cp>\"We have this idea that if we are just cruel enough and mean enough and tough enough to people with addiction, that they will suddenly wake up and stop, and that is not the case,\" she tells \u003cem>Fresh Air\u003c/em>'s Terry Gross.\u003c/p>\n\u003cp>Szalavitz is the author of \u003cem>Unbroken Brain\u003c/em>, a book that challenges traditional notions of addiction and treatment. Her work is based on research and experience; she was addicted to cocaine and heroin from the age of 17 until she was 23.\u003c/p>\n\u003cp>Szalavitz is a proponent of \"harm reduction\" programs that take a nonpunitive approach to helping addicts and \"treat people with addiction like human beings.\" In her own case, she says that getting \"some kind of hope that I could change\" enabled her to get the help she needed.\u003c/p>\n\u003chr>\n\u003ch3>Interview Highlights\u003c/h3>\n\u003cp>\u003cstrong>On the limitations of \u003ca href=\"http://www.npr.org/tags/381641163/12-step-program\" target=\"_blank\">12-step\u003c/a> programs\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The data shows that \u003ca href=\"http://www.npr.org/tags/276505286/cognitive-behavioral-therapy\" target=\"_blank\">cognitive behavioral therapy\u003c/a> and motivational enhancement therapy are equally effective, and they have none of the issues around surrendering to a higher power, or prayer or confession.\u003c/p>\n\u003cp>I think that one of the problems with the primary 12-step approach that we've seen in addiction treatment is that because the 12 steps involve moral issues, it makes people think that addiction is a sin and not a disease. The only treatment in medicine that involves prayer, restitution and confession is for addiction. That fact makes people think that addiction is a sin, not a medical problem. I think that if we want to destigmatize addiction, we need to get the 12 steps out of professional treatment and put them where they belong — as self-help. ...\u003c/p>\n\u003cp>That doesn't mean that professional treatment can't refer people to AA as a support group, but professional treatment should consist of things that you cannot get for free elsewhere.\u003c/p>\n\u003cp>\u003cstrong>On the efficacy of maintenance treatment\u003c/strong>\u003c/p>\n\u003cp>Buprenorphine and \u003ca href=\"http://www.npr.org/tags/477525967/methadone\" target=\"_blank\">methadone\u003c/a> are the two most effective treatments that we have for opioid addiction, and that is when they are taken indefinitely and possibly for a lifetime. So these medications are opioids themselves. They each have slightly different properties ... but what they do is they allow you to function completely normally. You can drive. You can love. You can work. You can do everything that anybody else does. ...\u003c/p>\n\u003cp>The way they are able to do that is because if you take an opioid in a regular steady dose every day at the same time and the dose is adjusted right for you, you will not experience any intoxication. The way people with addiction experience intoxication is that they take more and more and more, they take it irregularly, the dosing pattern is completely different. But if you do take it in a steady-state way — which is what happens when you are given it at a clinic every day at the same time — you then have a tolerance to opioids which will protect you if you relapse, and will mean that the death rate from overdose in people who are in maintenance is 50 to 70 percent lower than the death rate for people who are using other methods of treatment, and that includes all of the abstinence treatments.\u003c/p>\n\u003cp>So maintenance is a really important treatment option for people with opioid addiction. It should be the standard of care. No one should ever be denied access to it. Unfortunately, we have this idea that if you take methadone or buprenorphine, you are just substituting one addiction for another.\u003c/p>\n\u003cp>\u003cstrong>On not serving any time in prison after being caught with 2.5 kilos of cocaine when she was 20 years old\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>I have to say that being white and being female and being a person who was at an Ivy League school and being privileged in many other ways had an enormous amount to do with ... why I was not incarcerated and why I'm not in prison now. I think our laws are completely and utterly racist. They were founded in racism, and they are enforced in a thoroughly biased manner. I was extraordinarily lucky to have an attorney and a judge that saw that I was getting better, and that allowed me to avoid that.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Fresh Air. To see more, or listen to the whole show, visit \u003ca href=\"http://www.npr.org/programs/fresh-air/\" target=\"_blank\">Fresh Air\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=%27Unbroken+Brain%27+Explains+Why+%27Tough%27+Treatment+Doesn%27t+Help+Drug+Addicts&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Tough love, interventions and \u003ca href=\"http://www.npr.org/tags/381641163/12-step-program\" target=\"_blank\">12-step programs\u003c/a> are some of the most common methods of treating drug addiction, but journalist Maia Szalavitz says they're often counterproductive.\u003c/p>\n\u003cp>\"We have this idea that if we are just cruel enough and mean enough and tough enough to people with addiction, that they will suddenly wake up and stop, and that is not the case,\" she tells \u003cem>Fresh Air\u003c/em>'s Terry Gross.\u003c/p>\n\u003cp>Szalavitz is the author of \u003cem>Unbroken Brain\u003c/em>, a book that challenges traditional notions of addiction and treatment. Her work is based on research and experience; she was addicted to cocaine and heroin from the age of 17 until she was 23.\u003c/p>\n\u003cp>Szalavitz is a proponent of \"harm reduction\" programs that take a nonpunitive approach to helping addicts and \"treat people with addiction like human beings.\" In her own case, she says that getting \"some kind of hope that I could change\" enabled her to get the help she needed.\u003c/p>\n\u003chr>\n\u003ch3>Interview Highlights\u003c/h3>\n\u003cp>\u003cstrong>On the limitations of \u003ca href=\"http://www.npr.org/tags/381641163/12-step-program\" target=\"_blank\">12-step\u003c/a> programs\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The data shows that \u003ca href=\"http://www.npr.org/tags/276505286/cognitive-behavioral-therapy\" target=\"_blank\">cognitive behavioral therapy\u003c/a> and motivational enhancement therapy are equally effective, and they have none of the issues around surrendering to a higher power, or prayer or confession.\u003c/p>\n\u003cp>I think that one of the problems with the primary 12-step approach that we've seen in addiction treatment is that because the 12 steps involve moral issues, it makes people think that addiction is a sin and not a disease. The only treatment in medicine that involves prayer, restitution and confession is for addiction. That fact makes people think that addiction is a sin, not a medical problem. I think that if we want to destigmatize addiction, we need to get the 12 steps out of professional treatment and put them where they belong — as self-help. ...\u003c/p>\n\u003cp>That doesn't mean that professional treatment can't refer people to AA as a support group, but professional treatment should consist of things that you cannot get for free elsewhere.\u003c/p>\n\u003cp>\u003cstrong>On the efficacy of maintenance treatment\u003c/strong>\u003c/p>\n\u003cp>Buprenorphine and \u003ca href=\"http://www.npr.org/tags/477525967/methadone\" target=\"_blank\">methadone\u003c/a> are the two most effective treatments that we have for opioid addiction, and that is when they are taken indefinitely and possibly for a lifetime. So these medications are opioids themselves. They each have slightly different properties ... but what they do is they allow you to function completely normally. You can drive. You can love. You can work. You can do everything that anybody else does. ...\u003c/p>\n\u003cp>The way they are able to do that is because if you take an opioid in a regular steady dose every day at the same time and the dose is adjusted right for you, you will not experience any intoxication. The way people with addiction experience intoxication is that they take more and more and more, they take it irregularly, the dosing pattern is completely different. But if you do take it in a steady-state way — which is what happens when you are given it at a clinic every day at the same time — you then have a tolerance to opioids which will protect you if you relapse, and will mean that the death rate from overdose in people who are in maintenance is 50 to 70 percent lower than the death rate for people who are using other methods of treatment, and that includes all of the abstinence treatments.\u003c/p>\n\u003cp>So maintenance is a really important treatment option for people with opioid addiction. It should be the standard of care. No one should ever be denied access to it. Unfortunately, we have this idea that if you take methadone or buprenorphine, you are just substituting one addiction for another.\u003c/p>\n\u003cp>\u003cstrong>On not serving any time in prison after being caught with 2.5 kilos of cocaine when she was 20 years old\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>I have to say that being white and being female and being a person who was at an Ivy League school and being privileged in many other ways had an enormous amount to do with ... why I was not incarcerated and why I'm not in prison now. I think our laws are completely and utterly racist. They were founded in racism, and they are enforced in a thoroughly biased manner. I was extraordinarily lucky to have an attorney and a judge that saw that I was getting better, and that allowed me to avoid that.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Fresh Air. To see more, or listen to the whole show, visit \u003ca href=\"http://www.npr.org/programs/fresh-air/\" target=\"_blank\">Fresh Air\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=%27Unbroken+Brain%27+Explains+Why+%27Tough%27+Treatment+Doesn%27t+Help+Drug+Addicts&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Finding a therapist who takes your insurance can already be hard. If you’re black, or if you’re working class, it’s even harder.\u003c/p>\n\u003cp>\u003ca href=\"http://www.asanet.org/journals/JHSB/Jun16JHSBFeature.pdf\" target=\"_blank\">A new study \u003c/a>found 28 percent of white middle class people who called a psychotherapist asking for an appointment, were offered one, while 17 percent of middle class black callers were offered an appointment. Only 8 percent of working class callers – black or white – were offered a slot.\u003c/p>\n\u003cp>“Broadly, it shows how deeply embedded discrimination against black and working class individuals continues to be in American society, even in realms where people might not expect it,” said Heather Kugelmass, a Princeton University graduate student who conducted the study, published this month in the \u003cem>Journal of Health and Social Behavior\u003c/em>.\u003c/p>\n\u003cp>In the study, she had voice actors call 320 psychotherapists in New York City.\u003c/p>\n\u003cp>All the callers expressed symptoms of depression or anxiety, like having trouble sleeping, or not wanting to see friends. All said they had the exact same kind of insurance: Empire Blue Cross Blue Shield.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But some went by names like Amy Roberts and Bobby Carpenter. And others went by Latoya Johnson and Darnell Thomas.\u003c/p>\n\u003cp>“Race was signaled through name and accent,” Kugelmass explained. “And then class was cued through vocabulary, grammar, and accent.”\u003c/p>\n\u003cp>For example, a middle class white caller said things like, “I’m becoming concerned because I can’t get going in the morning, and it takes a lot of effort to deal with people at work.”\u003c/p>\n\u003cp>While a working class black caller said, “I just be feeling down and annoyed at work all the time. Now I can’t even sleep right and that ain’t no good.”\u003c/p>\n\u003cp>Kugelmass said the overall response rate was low, which is similar to findings of a recent \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">KQED survey\u003c/a> of San Francisco psychologists.\u003c/p>\n\u003cp>But the disparities in who the therapists called back were “striking,” Kugelmass said. One out of two middle class white callers got a response, while one in three working class black callers did.\u003c/p>\n\u003cp>\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22121963\" target=\"_blank\">Previous research\u003c/a> has shown that psychotherapists have a preference to treat clients they perceive to be verbal, intelligent, and “psychologically minded,” in other words, people who are like them. \u003ca href=\"http://psycnet.apa.org/psycinfo/1988-97772-005\" target=\"_blank\">Another study\u003c/a> found that psychiatrists perceive black patients as “less articulate, competent, [and] introspective” compared to white patients.\u003c/p>\n\u003cp>Kugelmass says her results suggest the therapists contacted for her study – all of whom held doctoral degrees and operated a solo practice – could be turning down potential patients based on unconscious biases or stereotypes.\u003c/p>\n\u003cp>“These white middle class, or upper middle class, therapists are probably reluctant to embark on what can be an intimate, potentially long-term relationship with someone that they feel they can't relate to,” Kugelmass said.\u003c/p>\n\u003cp>The biggest disparity found in the study appeared with weekday evening appointment times – the most coveted slots in therapy.\u003c/p>\n\u003cp>Of all the calls placed by middle class white women asking for that slot, 20 percent resulted in an appointment offer for a weekday evening. That compares to just one percent of calls placed by working class black men resulting in an evening appointment offer.\u003c/p>\n\u003cp>“If the magnitude of discrimination against working class men in the study translates to what is happening in the real world,” Kugelmass said, “then they’re facing a virtually insurmountable barrier to getting care from the types of therapists who were investigated here.”\u003c/p>\n\u003cp>She said she hopes psychotherapy training programs, professional associations, and insurers will take her findings seriously and find a way to address them in practice.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>To read more about barriers to mental health care in California, check out KQED's series, \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/state-of-mind/\">State of Mind\u003c/a>. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Finding a therapist who takes your insurance can already be hard. If you’re black, or if you’re working class, it’s even harder.\u003c/p>\n\u003cp>\u003ca href=\"http://www.asanet.org/journals/JHSB/Jun16JHSBFeature.pdf\" target=\"_blank\">A new study \u003c/a>found 28 percent of white middle class people who called a psychotherapist asking for an appointment, were offered one, while 17 percent of middle class black callers were offered an appointment. Only 8 percent of working class callers – black or white – were offered a slot.\u003c/p>\n\u003cp>“Broadly, it shows how deeply embedded discrimination against black and working class individuals continues to be in American society, even in realms where people might not expect it,” said Heather Kugelmass, a Princeton University graduate student who conducted the study, published this month in the \u003cem>Journal of Health and Social Behavior\u003c/em>.\u003c/p>\n\u003cp>In the study, she had voice actors call 320 psychotherapists in New York City.\u003c/p>\n\u003cp>All the callers expressed symptoms of depression or anxiety, like having trouble sleeping, or not wanting to see friends. All said they had the exact same kind of insurance: Empire Blue Cross Blue Shield.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But some went by names like Amy Roberts and Bobby Carpenter. And others went by Latoya Johnson and Darnell Thomas.\u003c/p>\n\u003cp>“Race was signaled through name and accent,” Kugelmass explained. “And then class was cued through vocabulary, grammar, and accent.”\u003c/p>\n\u003cp>For example, a middle class white caller said things like, “I’m becoming concerned because I can’t get going in the morning, and it takes a lot of effort to deal with people at work.”\u003c/p>\n\u003cp>While a working class black caller said, “I just be feeling down and annoyed at work all the time. Now I can’t even sleep right and that ain’t no good.”\u003c/p>\n\u003cp>Kugelmass said the overall response rate was low, which is similar to findings of a recent \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">KQED survey\u003c/a> of San Francisco psychologists.\u003c/p>\n\u003cp>But the disparities in who the therapists called back were “striking,” Kugelmass said. One out of two middle class white callers got a response, while one in three working class black callers did.\u003c/p>\n\u003cp>\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22121963\" target=\"_blank\">Previous research\u003c/a> has shown that psychotherapists have a preference to treat clients they perceive to be verbal, intelligent, and “psychologically minded,” in other words, people who are like them. \u003ca href=\"http://psycnet.apa.org/psycinfo/1988-97772-005\" target=\"_blank\">Another study\u003c/a> found that psychiatrists perceive black patients as “less articulate, competent, [and] introspective” compared to white patients.\u003c/p>\n\u003cp>Kugelmass says her results suggest the therapists contacted for her study – all of whom held doctoral degrees and operated a solo practice – could be turning down potential patients based on unconscious biases or stereotypes.\u003c/p>\n\u003cp>“These white middle class, or upper middle class, therapists are probably reluctant to embark on what can be an intimate, potentially long-term relationship with someone that they feel they can't relate to,” Kugelmass said.\u003c/p>\n\u003cp>The biggest disparity found in the study appeared with weekday evening appointment times – the most coveted slots in therapy.\u003c/p>\n\u003cp>Of all the calls placed by middle class white women asking for that slot, 20 percent resulted in an appointment offer for a weekday evening. That compares to just one percent of calls placed by working class black men resulting in an evening appointment offer.\u003c/p>\n\u003cp>“If the magnitude of discrimination against working class men in the study translates to what is happening in the real world,” Kugelmass said, “then they’re facing a virtually insurmountable barrier to getting care from the types of therapists who were investigated here.”\u003c/p>\n\u003cp>She said she hopes psychotherapy training programs, professional associations, and insurers will take her findings seriously and find a way to address them in practice.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>To read more about barriers to mental health care in California, check out KQED's series, \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/state-of-mind/\">State of Mind\u003c/a>. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>There’s a hot pink suitcase on the floor of Shariah Vroman-Nagy’s bedroom. The 18-year-old is packing for a trip to Disneyland, one of several she takes with her family every year.\u003c/p>\n\u003cp>“Let’s see, I need a hairbrush,” she says, moving past the collection of Mickey Mouse ears on her dresser, glancing at the inspirational quotes from Marilyn Monroe on the wall.\u003c/p>\n\u003cp>The lyrics to a song called “\u003cem>Smile\u003c/em>” hang in a frame over her bed.\u003c/p>\n\u003cp>“My mom made me that when I was struggling,” says Vroman-Nagy, “because that’s the song that I would listen to. Michael Jackson did a version of it, which I love.”\u003c/p>\n\u003cp>When she feels her depression creeping in, she sings it to herself.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cem>Smile, though your heart is aching\u003c/em>\u003cbr>\n\u003cem>Smile, even though it’s breaking \u003c/em>\u003cbr>\n\u003cem>If you smile through your tears and sorrow\u003c/em>\u003cbr>\n\u003cem>Smile and maybe tomorrow \u003c/em>\u003cbr>\n\u003cem>You’ll see the sun come shining through, for you. \u003c/em>\u003c/p>\n\u003cp>Three years ago, it was in this room, lined with porcelain dolls and stuffed animals, where Vroman-Nagy tried to kill herself. She was 15, a freshman in high school.\u003c/p>\n\u003cp>“Everything piled up, piled up, piled up until I just couldn’t handle it anymore,” she says. “So I had my anti-depressants and I took a handful of those. But then I thought better of it, and I told my mom. She took me to the emergency room.”\u003c/p>\n\u003cfigure id=\"attachment_191785\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191785\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg\" alt=\"Shariah Vroman-Nagy in her bedroom in Redding, Calif. \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy in her bedroom in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>There’s no adolescent psychiatric hospital in Redding, the small city in far northern California where Vroman-Nagy lives. So she was taken from the local ER to a hospital in Sacramento, an hour and a half drive to the south. She was there for eight days.\u003c/p>\n\u003cp>The doctors diagnosed her with bipolar disorder. They wanted to keep her longer, but they told her the insurance company wouldn’t cover it.\u003c/p>\n\u003cp>“I didn’t feel like I was ready because I had just been put on new medications,” she says. “In the past I’ve had reactions to medications, and some have not worked. So I wanted to wait and stay for observation a little bit longer.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/266972349\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Vroman-Nagy wasn’t alone with feeling that she was sent home too soon. Since 2010, the state received almost 900 appeals from patients saying their insurer unfairly denied inpatient mental health treatment, according to data from the \u003ca href=\"http://www.dmhc.ca.gov/fileacomplaint.aspx#.V04DLPkrKUl\">Department of Managed Health Care\u003c/a>, the main health insurance regulator in the state. The department overturned 47 percent of those decisions.\u003c/p>\n\u003cp>Insurers are allowed to deny coverage for certain treatments, if they determine that the care is not “medically necessary.” This determination is based on evidence-based clinical standards in both mental and medical care, but it has become a key battleground for mental health advocates.\u003c/p>\n\u003cp>They say insurers are able to \u003ca href=\"https://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf\" target=\"_blank\">deny mental health treatments\u003c/a> more often than other medical treatments, because it’s harder to prove when mental health care is medically necessary.\u003c/p>\n\u003cp>Determining the best treatment for depression, bipolar disorder, or anxiety disorders relies heavily on the subjective report of the patient, so it can be difficult to demonstrate how ill a person is.\u003c/p>\n\u003cp>“There aren’t blood tests in mental health, there aren’t X-rays in mental health,” says Keith Humphreys, Stanford psychiatrist and former White House advisor on mental health policy. “So, it’s easier to deny care for mental health than it is for things we've got physical evidence for.”\u003c/p>\n\u003cp>\u003cstrong>Outside the Hospital, Care Still Difficult to Find\u003c/strong>\u003c/p>\n\u003cp>After Vroman-Nagy went home, the hospital helped her find a therapist to continue the work she had begun on the inpatient unit. But the insurance company, Anthem Blue Cross, said no to that, too. They said the therapist wasn’t part of its network.\u003c/p>\n\u003cp>“We spent quite a long time with the insurance company battling them trying to get them to cover visits,” Vroman-Nagy says.\u003c/p>\n\u003cp>Anthem wanted her to see someone on its list of approved in-network providers, Vroman-Nagy says. At the time, that list was just six people, a common scarcity in \u003ca href=\"http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsacriteria.html\" target=\"_blank\">rural parts\u003c/a> of the country. When Vroman-Nagy started calling them, they either told her their schedules were full or they were retired. So Vroman-Nagy decided to stick with the out-of-network therapist.\u003c/p>\n\u003cfigure id=\"attachment_191782\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191782\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg\" alt=\"Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Her father, Tom Nagy, supported the decision. “Because at that point, I’m mean you’re talking possible life and death issues,” he says. “That was my approach, to pay for it. Run up the charge cards.”\u003c/p>\n\u003cp>He ended up paying thousands of dollars out of pocket. Nagy is a teacher, and his wife is a nurse. They couldn’t afford to keep doing that.\u003c/p>\n\u003cp>By law in California, insurers are required to make special arrangements for patients to see an outside therapist if there are none in the plan, and they have to provide the care at the same copay or coinsurance as an in-network clinician. They can’t charge extra.\u003c/p>\n\u003cp>It’s unclear why Tom Nagy didn’t get that help. He had to fight and fight with the insurance company until he was finally reimbursed.\u003c/p>\n\u003cp>He went through \"two or three denials,\" then filed an appeal with Anthem. That was denied. So he filed a second appeal.\u003c/p>\n\u003cp>“It was literally a year-long process,” he says. \"As a parent, it’s hard enough to deal with these situations and be supportive, but then you get the whole financial thing, it just adds a whole other layer. It’s frustrating.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"X2OS9UvvrWrgYd3y51AcrwAvhclm8opt\"]Psychiatrist Keith Humphreys says it’s rare to see someone keep up a fight with an insurance company as long as Nagy did.\u003c/p>\n\u003cp>“It's the easiest fight in the world to win for an insurer,” Humphreys says.\u003c/p>\n\u003cp>Most people would have given up long before, he says. Take someone with depression who has trouble concentrating or can’t get out of bed.\u003c/p>\n\u003cp>“Now you're demanding that I fill out eight pages of forms?” Humphreys says. “It's canted heavily against the people wanting the services, by the nature of the condition.”\u003c/p>\n\u003cp>In a statement, Anthem Blue Cross said it is “committed to providing access to high quality and affordable health care, including mental healthcare.” It has a variety of resources to help people find the best provider for them, the statement continues, including an online listing of available mental health providers, and customer service staff who can help with a search.\u003c/p>\n\u003cp>The company also launched a new online psychology service earlier this year, called LiveHealth Online Psychology, so patients who live in rural areas where it can sometimes be hard to find a clinician, can “talk face-to-face with a licensed therapist or psychologist through high-definition video on your smartphone, tablet or computer with a webcam.\"\u003c/p>\n\u003cp>\u003cstrong>Looking Toward the Future\u003c/strong>\u003c/p>\n\u003cp>It’s Shariah Vroman-Nagy’s spring break from college, and the preparations for the family trip to Disneyland continue. She says she really needs the vacation.\u003c/p>\n\u003cp>“They call it the happiest place on earth, and I really do feel that it makes me happy when I go,” Vroman-Nagy says. “I’m glad we get to go this week because I have been having a little depression going on.”\u003c/p>\n\u003cp>She and her parents run some errands before they leave town, including a stop at Walmart to stock up on snacks for the nine-hour drive.\u003c/p>\n\u003cp>“I have a question,” Vroman-Nagy says to the cashier. “You used to have Mickey Mouse shaped cheese. Do you not carry it anymore?”\u003c/p>\n\u003cp>Instead, she got \u003cem>Frozen\u003c/em>-themed cheese sticks, with characters from the hit Disney film on the package. The radio in her car is primed with a series of Disney soundtracks, from \u003cem>Tarzan\u003c/em> to \u003cem>Beauty and the Beast\u003c/em>, songs which Vroman-Nagy knows well from her days singing with a show choir in high school.\u003c/p>\n\u003cp>Overall, Vroman-Nagy is doing much better. She works part time at the local In-N-Out Burger, and she’s training to volunteer for a suicide hotline. She’s also studying psychology and music at the local junior college.\u003c/p>\n\u003cp>She plans to become an adolescent therapist one day. But first, she’d like to be a character singer at Disneyland.\u003c/p>\n\u003cp>“I would love to be in their entertainment,” she says, and imagines herself in a princess costume singing and dancing in the park’s stage shows or parades. “That would be my dream.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Have a story about mental health that you think KQED should cover? Email reporter \u003ca href=\"mailto:adembosky@kqed.org\" target=\"_blank\">April Dembosky\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There’s a hot pink suitcase on the floor of Shariah Vroman-Nagy’s bedroom. The 18-year-old is packing for a trip to Disneyland, one of several she takes with her family every year.\u003c/p>\n\u003cp>“Let’s see, I need a hairbrush,” she says, moving past the collection of Mickey Mouse ears on her dresser, glancing at the inspirational quotes from Marilyn Monroe on the wall.\u003c/p>\n\u003cp>The lyrics to a song called “\u003cem>Smile\u003c/em>” hang in a frame over her bed.\u003c/p>\n\u003cp>“My mom made me that when I was struggling,” says Vroman-Nagy, “because that’s the song that I would listen to. Michael Jackson did a version of it, which I love.”\u003c/p>\n\u003cp>When she feels her depression creeping in, she sings it to herself.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Smile, though your heart is aching\u003c/em>\u003cbr>\n\u003cem>Smile, even though it’s breaking \u003c/em>\u003cbr>\n\u003cem>If you smile through your tears and sorrow\u003c/em>\u003cbr>\n\u003cem>Smile and maybe tomorrow \u003c/em>\u003cbr>\n\u003cem>You’ll see the sun come shining through, for you. \u003c/em>\u003c/p>\n\u003cp>Three years ago, it was in this room, lined with porcelain dolls and stuffed animals, where Vroman-Nagy tried to kill herself. She was 15, a freshman in high school.\u003c/p>\n\u003cp>“Everything piled up, piled up, piled up until I just couldn’t handle it anymore,” she says. “So I had my anti-depressants and I took a handful of those. But then I thought better of it, and I told my mom. She took me to the emergency room.”\u003c/p>\n\u003cfigure id=\"attachment_191785\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191785\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg\" alt=\"Shariah Vroman-Nagy in her bedroom in Redding, Calif. \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy in her bedroom in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>There’s no adolescent psychiatric hospital in Redding, the small city in far northern California where Vroman-Nagy lives. So she was taken from the local ER to a hospital in Sacramento, an hour and a half drive to the south. She was there for eight days.\u003c/p>\n\u003cp>The doctors diagnosed her with bipolar disorder. They wanted to keep her longer, but they told her the insurance company wouldn’t cover it.\u003c/p>\n\u003cp>“I didn’t feel like I was ready because I had just been put on new medications,” she says. “In the past I’ve had reactions to medications, and some have not worked. So I wanted to wait and stay for observation a little bit longer.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/266972349&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/266972349'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Vroman-Nagy wasn’t alone with feeling that she was sent home too soon. Since 2010, the state received almost 900 appeals from patients saying their insurer unfairly denied inpatient mental health treatment, according to data from the \u003ca href=\"http://www.dmhc.ca.gov/fileacomplaint.aspx#.V04DLPkrKUl\">Department of Managed Health Care\u003c/a>, the main health insurance regulator in the state. The department overturned 47 percent of those decisions.\u003c/p>\n\u003cp>Insurers are allowed to deny coverage for certain treatments, if they determine that the care is not “medically necessary.” This determination is based on evidence-based clinical standards in both mental and medical care, but it has become a key battleground for mental health advocates.\u003c/p>\n\u003cp>They say insurers are able to \u003ca href=\"https://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf\" target=\"_blank\">deny mental health treatments\u003c/a> more often than other medical treatments, because it’s harder to prove when mental health care is medically necessary.\u003c/p>\n\u003cp>Determining the best treatment for depression, bipolar disorder, or anxiety disorders relies heavily on the subjective report of the patient, so it can be difficult to demonstrate how ill a person is.\u003c/p>\n\u003cp>“There aren’t blood tests in mental health, there aren’t X-rays in mental health,” says Keith Humphreys, Stanford psychiatrist and former White House advisor on mental health policy. “So, it’s easier to deny care for mental health than it is for things we've got physical evidence for.”\u003c/p>\n\u003cp>\u003cstrong>Outside the Hospital, Care Still Difficult to Find\u003c/strong>\u003c/p>\n\u003cp>After Vroman-Nagy went home, the hospital helped her find a therapist to continue the work she had begun on the inpatient unit. But the insurance company, Anthem Blue Cross, said no to that, too. They said the therapist wasn’t part of its network.\u003c/p>\n\u003cp>“We spent quite a long time with the insurance company battling them trying to get them to cover visits,” Vroman-Nagy says.\u003c/p>\n\u003cp>Anthem wanted her to see someone on its list of approved in-network providers, Vroman-Nagy says. At the time, that list was just six people, a common scarcity in \u003ca href=\"http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsacriteria.html\" target=\"_blank\">rural parts\u003c/a> of the country. When Vroman-Nagy started calling them, they either told her their schedules were full or they were retired. So Vroman-Nagy decided to stick with the out-of-network therapist.\u003c/p>\n\u003cfigure id=\"attachment_191782\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191782\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg\" alt=\"Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Her father, Tom Nagy, supported the decision. “Because at that point, I’m mean you’re talking possible life and death issues,” he says. “That was my approach, to pay for it. Run up the charge cards.”\u003c/p>\n\u003cp>He ended up paying thousands of dollars out of pocket. Nagy is a teacher, and his wife is a nurse. They couldn’t afford to keep doing that.\u003c/p>\n\u003cp>By law in California, insurers are required to make special arrangements for patients to see an outside therapist if there are none in the plan, and they have to provide the care at the same copay or coinsurance as an in-network clinician. They can’t charge extra.\u003c/p>\n\u003cp>It’s unclear why Tom Nagy didn’t get that help. He had to fight and fight with the insurance company until he was finally reimbursed.\u003c/p>\n\u003cp>He went through \"two or three denials,\" then filed an appeal with Anthem. That was denied. So he filed a second appeal.\u003c/p>\n\u003cp>“It was literally a year-long process,” he says. \"As a parent, it’s hard enough to deal with these situations and be supportive, but then you get the whole financial thing, it just adds a whole other layer. It’s frustrating.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Psychiatrist Keith Humphreys says it’s rare to see someone keep up a fight with an insurance company as long as Nagy did.\u003c/p>\n\u003cp>“It's the easiest fight in the world to win for an insurer,” Humphreys says.\u003c/p>\n\u003cp>Most people would have given up long before, he says. Take someone with depression who has trouble concentrating or can’t get out of bed.\u003c/p>\n\u003cp>“Now you're demanding that I fill out eight pages of forms?” Humphreys says. “It's canted heavily against the people wanting the services, by the nature of the condition.”\u003c/p>\n\u003cp>In a statement, Anthem Blue Cross said it is “committed to providing access to high quality and affordable health care, including mental healthcare.” It has a variety of resources to help people find the best provider for them, the statement continues, including an online listing of available mental health providers, and customer service staff who can help with a search.\u003c/p>\n\u003cp>The company also launched a new online psychology service earlier this year, called LiveHealth Online Psychology, so patients who live in rural areas where it can sometimes be hard to find a clinician, can “talk face-to-face with a licensed therapist or psychologist through high-definition video on your smartphone, tablet or computer with a webcam.\"\u003c/p>\n\u003cp>\u003cstrong>Looking Toward the Future\u003c/strong>\u003c/p>\n\u003cp>It’s Shariah Vroman-Nagy’s spring break from college, and the preparations for the family trip to Disneyland continue. She says she really needs the vacation.\u003c/p>\n\u003cp>“They call it the happiest place on earth, and I really do feel that it makes me happy when I go,” Vroman-Nagy says. “I’m glad we get to go this week because I have been having a little depression going on.”\u003c/p>\n\u003cp>She and her parents run some errands before they leave town, including a stop at Walmart to stock up on snacks for the nine-hour drive.\u003c/p>\n\u003cp>“I have a question,” Vroman-Nagy says to the cashier. “You used to have Mickey Mouse shaped cheese. Do you not carry it anymore?”\u003c/p>\n\u003cp>Instead, she got \u003cem>Frozen\u003c/em>-themed cheese sticks, with characters from the hit Disney film on the package. The radio in her car is primed with a series of Disney soundtracks, from \u003cem>Tarzan\u003c/em> to \u003cem>Beauty and the Beast\u003c/em>, songs which Vroman-Nagy knows well from her days singing with a show choir in high school.\u003c/p>\n\u003cp>Overall, Vroman-Nagy is doing much better. She works part time at the local In-N-Out Burger, and she’s training to volunteer for a suicide hotline. She’s also studying psychology and music at the local junior college.\u003c/p>\n\u003cp>She plans to become an adolescent therapist one day. But first, she’d like to be a character singer at Disneyland.\u003c/p>\n\u003cp>“I would love to be in their entertainment,” she says, and imagines herself in a princess costume singing and dancing in the park’s stage shows or parades. “That would be my dream.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Have a story about mental health that you think KQED should cover? Email reporter \u003ca href=\"mailto:adembosky@kqed.org\" target=\"_blank\">April Dembosky\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Regulators Examining Whether Health Net Is Stiffing Drug Treatment Providers",
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"headTitle": "State of Health | KQED News",
"content": "\u003cp>California insurance officials are looking into whether Health Net Inc. has improperly withheld payments to addiction treatment centers for months while the company investigates concerns about fraudulent claims.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Health Net has stopped payment for services already provided and it’s unconscionable.'\u003ccite>Stampp Corbin, Addiction Treatment Advocacy Coalition \u003c/cite>\u003c/aside>\n\u003cp>The California Department of Insurance began an inquiry after receiving numerous complaints from substance-abuse treatment facilities statewide that Health Net had not paid them since at least January, according to providers questioned by the agency. Health Net is California’s fourth-largest health insurer, acquired in March for $6 billion by Centene Corp., a St. Louis-based insurer.\u003c/p>\n\u003cp>Officials at the California Department of Managed Health Care, the state’s other insurance regulator, said they are reviewing a May 20 complaint about Health Net’s actions signed by executives and owners of 118 for-profit treatment centers.\u003c/p>\n\u003cp>The treatment providers say they can’t afford to accept Health Net patients without reimbursement, and that the insurer is harming its policyholders by limiting their access to treatment. Drug and alcohol treatment centers in Arizona have filed similar complaints about Health Net with insurance officials there.\u003c/p>\n\u003cp>A Health Net spokesman said “our policy is to not comment on these kinds of inquiries.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>All this comes as the country grapples with an opioid epidemic and more people need help getting sober.\u003c/p>\n\u003cp>“Health Net has stopped payment for services already provided and it’s unconscionable,” said Stampp Corbin, president of the Addiction Treatment Advocacy Coalition, a nonprofit group in Los Angeles that represents California’s for-profit treatment centers. “The net effect is some small facilities may go out of business if they had a high concentration of Health Net clients.”\u003c/p>\n\u003cp>Janice Rocco, the insurance department’s deputy commissioner, said she can’t comment specifically on complaints that are still under investigation.\u003c/p>\n\u003cp>“If we receive complaints from a number of providers about the same insurer not paying in a timely fashion, we would take that very seriously,” Rocco said. “We do communicate with insurers immediately when we receive these types of complaints.”\u003c/p>\n\u003cp>After confirming the complaints, a spokeswoman for the Department of Managed Health Care said “ensuring consumers have access to mental health services which they are entitled to under the law is a priority for the DMHC.”\u003c/p>\n\u003caside class=\"pullquote alignright\">Health Net is examining whether treatment providers paid kickbacks to brokers, labs or doctors who might give referrals.\u003c/aside>\n\u003cp>The current dispute began in January when Health Net’s director of special investigations, Matthew Ciganek, sent a letter to numerous treatment facilities in California outlining a “number of potential concerns” about “false and/or fraudulent claims.”\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.files.wordpress.com/2016/05/health-net-january-letter.pdf\" target=\"_blank\">In his Jan. 8 letter to providers\u003c/a>, Ciganek cited concerns that people who came for treatment from out of state were obtaining benefits for which they were not eligible because they didn’t “continually reside in our defined California service area.”\u003c/p>\n\u003cp>The letter also said Health Net was looking into allegations that providers had waived deductibles or copayments to attract patients or had paid kickbacks to brokers, testing labs, physicians or other providers who might give referrals.\u003c/p>\n\u003cp>The company followed up with similar letters to rehab facilities in March and, in addition, contacted patients for information about their treatment.\u003c/p>\n\u003cp>The letters to patients asked them to show evidence they had paid their deductibles, copays or coinsurance and to furnish a copy of the state license for the treatment facility they visited.\u003c/p>\n\u003cp>“This is to notify you there will be a delay in finalization of this claim until the requested information has been received,” Health Net said in its March letters to patients.\u003c/p>\n\u003cp>[contextly_sidebar id=\"PkgqpVSxuWYsUdCJN0h4IQQof6nk2jyE\"]In the meantime, some Health Net members say finding a treatment center has become more difficult.\u003c/p>\n\u003cp>Gary Millman of Santa Rosa said his adult son sought help in April for his heroin addiction, and two facilities refused to take him because they had concerns about his Health Net coverage.\u003c/p>\n\u003cp>“When they found out he had Health Net, they wouldn’t touch him,” Millman said. “The facilities don’t know if Health Net will come through on paying for treatment, yet the insurance company takes your money easy enough.”\u003c/p>\n\u003cp>Millman’s son eventually located a rehab center with the help of a family friend.\u003c/p>\n\u003cp>Health Net’s action comes after years of criticism and \u003ca href=\"http://www.cnn.com/2013/07/29/health/rehab-racket-siu-cir-part-one/\" target=\"_blank\">media coverage faulting health insurers and the state’s Medi-Cal program\u003c/a> for lax oversight of drug rehab facilities. Some have billed for services never provided or sought to boost revenues by enrolling patients in health plans without their knowledge.\u003c/p>\n\u003cp>Industry representatives acknowledge that the rehab business has a history of fraud and abuse that warrants close scrutiny, but they say Health Net’s audit goes too far.\u003c/p>\n\u003cp>“There are bad players in every industry, but this dragnet is too broad,” said Joan Borsten, a co-founder of the Malibu Beach Recovery Center and vice president of the Addiction Treatment Advocacy Coalition.\u003c/p>\n\u003cp>She said some treatment centers in the coalition report being owed $1 million or more by Health Net for residential or outpatient care. The total amount billed and left unpaid is unclear, she said.\u003c/p>\n\u003cp>Treatment providers in Arizona express similar frustrations.\u003c/p>\n\u003cp>In a recent letter to the Arizona Department of Insurance, the Northern Arizona Recovery Association said Health Net’s “sweeping and indiscriminate audit … has caused significant and undue hardship for quality providers, and more importantly, for the individuals who have paid their premiums and are seeking medically necessary services.”\u003c/p>\n\u003cp>A spokesman for the Arizona agency said it doesn’t comment on matters that might be under investigation.\u003c/p>\n\u003cp>Even before the present standstill over payments, Health Net fell short in ensuring its patients received timely treatment for drug and alcohol problems, data in California show.\u003c/p>\n\u003cp>Only 25 percent of Health Net’s HMO members started treatment within 14 days of being diagnosed with a drug or alcohol addiction, according to 2014 data from the California Office of the Patient Advocate. That was second-to-last among 10 health plans rated. The score for top health plans nationally was 44 percent.\u003c/p>\n\u003cp>Health Net did only slightly better on its PPO plans. Thirty-one percent received treatment within 14 days of diagnosis, placing Health Net fourth among six insurers that were rated. Nationally, top-performing PPO plans posted a treatment rate of 43 percent.\u003c/p>\n\u003cp>Health Net had similar below-average results for providing timely follow-up treatment for addicts.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>California Insurance Commissioner Dave Jones approved Centene’s acquisition of Health Net in March with a number of conditions. One of them is that the new company make efforts to improve Health Net’s ratings on the Patient Advocate’s report card.\u003c/p>\n\n",
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"excerpt": "Health Net has been sifting claims for fraud, but regulators have received complaints that the insurer has not paid rehab claims in months.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California insurance officials are looking into whether Health Net Inc. has improperly withheld payments to addiction treatment centers for months while the company investigates concerns about fraudulent claims.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Health Net has stopped payment for services already provided and it’s unconscionable.'\u003ccite>Stampp Corbin, Addiction Treatment Advocacy Coalition \u003c/cite>\u003c/aside>\n\u003cp>The California Department of Insurance began an inquiry after receiving numerous complaints from substance-abuse treatment facilities statewide that Health Net had not paid them since at least January, according to providers questioned by the agency. Health Net is California’s fourth-largest health insurer, acquired in March for $6 billion by Centene Corp., a St. Louis-based insurer.\u003c/p>\n\u003cp>Officials at the California Department of Managed Health Care, the state’s other insurance regulator, said they are reviewing a May 20 complaint about Health Net’s actions signed by executives and owners of 118 for-profit treatment centers.\u003c/p>\n\u003cp>The treatment providers say they can’t afford to accept Health Net patients without reimbursement, and that the insurer is harming its policyholders by limiting their access to treatment. Drug and alcohol treatment centers in Arizona have filed similar complaints about Health Net with insurance officials there.\u003c/p>\n\u003cp>A Health Net spokesman said “our policy is to not comment on these kinds of inquiries.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>All this comes as the country grapples with an opioid epidemic and more people need help getting sober.\u003c/p>\n\u003cp>“Health Net has stopped payment for services already provided and it’s unconscionable,” said Stampp Corbin, president of the Addiction Treatment Advocacy Coalition, a nonprofit group in Los Angeles that represents California’s for-profit treatment centers. “The net effect is some small facilities may go out of business if they had a high concentration of Health Net clients.”\u003c/p>\n\u003cp>Janice Rocco, the insurance department’s deputy commissioner, said she can’t comment specifically on complaints that are still under investigation.\u003c/p>\n\u003cp>“If we receive complaints from a number of providers about the same insurer not paying in a timely fashion, we would take that very seriously,” Rocco said. “We do communicate with insurers immediately when we receive these types of complaints.”\u003c/p>\n\u003cp>After confirming the complaints, a spokeswoman for the Department of Managed Health Care said “ensuring consumers have access to mental health services which they are entitled to under the law is a priority for the DMHC.”\u003c/p>\n\u003caside class=\"pullquote alignright\">Health Net is examining whether treatment providers paid kickbacks to brokers, labs or doctors who might give referrals.\u003c/aside>\n\u003cp>The current dispute began in January when Health Net’s director of special investigations, Matthew Ciganek, sent a letter to numerous treatment facilities in California outlining a “number of potential concerns” about “false and/or fraudulent claims.”\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.files.wordpress.com/2016/05/health-net-january-letter.pdf\" target=\"_blank\">In his Jan. 8 letter to providers\u003c/a>, Ciganek cited concerns that people who came for treatment from out of state were obtaining benefits for which they were not eligible because they didn’t “continually reside in our defined California service area.”\u003c/p>\n\u003cp>The letter also said Health Net was looking into allegations that providers had waived deductibles or copayments to attract patients or had paid kickbacks to brokers, testing labs, physicians or other providers who might give referrals.\u003c/p>\n\u003cp>The company followed up with similar letters to rehab facilities in March and, in addition, contacted patients for information about their treatment.\u003c/p>\n\u003cp>The letters to patients asked them to show evidence they had paid their deductibles, copays or coinsurance and to furnish a copy of the state license for the treatment facility they visited.\u003c/p>\n\u003cp>“This is to notify you there will be a delay in finalization of this claim until the requested information has been received,” Health Net said in its March letters to patients.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In the meantime, some Health Net members say finding a treatment center has become more difficult.\u003c/p>\n\u003cp>Gary Millman of Santa Rosa said his adult son sought help in April for his heroin addiction, and two facilities refused to take him because they had concerns about his Health Net coverage.\u003c/p>\n\u003cp>“When they found out he had Health Net, they wouldn’t touch him,” Millman said. “The facilities don’t know if Health Net will come through on paying for treatment, yet the insurance company takes your money easy enough.”\u003c/p>\n\u003cp>Millman’s son eventually located a rehab center with the help of a family friend.\u003c/p>\n\u003cp>Health Net’s action comes after years of criticism and \u003ca href=\"http://www.cnn.com/2013/07/29/health/rehab-racket-siu-cir-part-one/\" target=\"_blank\">media coverage faulting health insurers and the state’s Medi-Cal program\u003c/a> for lax oversight of drug rehab facilities. Some have billed for services never provided or sought to boost revenues by enrolling patients in health plans without their knowledge.\u003c/p>\n\u003cp>Industry representatives acknowledge that the rehab business has a history of fraud and abuse that warrants close scrutiny, but they say Health Net’s audit goes too far.\u003c/p>\n\u003cp>“There are bad players in every industry, but this dragnet is too broad,” said Joan Borsten, a co-founder of the Malibu Beach Recovery Center and vice president of the Addiction Treatment Advocacy Coalition.\u003c/p>\n\u003cp>She said some treatment centers in the coalition report being owed $1 million or more by Health Net for residential or outpatient care. The total amount billed and left unpaid is unclear, she said.\u003c/p>\n\u003cp>Treatment providers in Arizona express similar frustrations.\u003c/p>\n\u003cp>In a recent letter to the Arizona Department of Insurance, the Northern Arizona Recovery Association said Health Net’s “sweeping and indiscriminate audit … has caused significant and undue hardship for quality providers, and more importantly, for the individuals who have paid their premiums and are seeking medically necessary services.”\u003c/p>\n\u003cp>A spokesman for the Arizona agency said it doesn’t comment on matters that might be under investigation.\u003c/p>\n\u003cp>Even before the present standstill over payments, Health Net fell short in ensuring its patients received timely treatment for drug and alcohol problems, data in California show.\u003c/p>\n\u003cp>Only 25 percent of Health Net’s HMO members started treatment within 14 days of being diagnosed with a drug or alcohol addiction, according to 2014 data from the California Office of the Patient Advocate. That was second-to-last among 10 health plans rated. The score for top health plans nationally was 44 percent.\u003c/p>\n\u003cp>Health Net did only slightly better on its PPO plans. Thirty-one percent received treatment within 14 days of diagnosis, placing Health Net fourth among six insurers that were rated. Nationally, top-performing PPO plans posted a treatment rate of 43 percent.\u003c/p>\n\u003cp>Health Net had similar below-average results for providing timely follow-up treatment for addicts.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California Insurance Commissioner Dave Jones approved Centene’s acquisition of Health Net in March with a number of conditions. One of them is that the new company make efforts to improve Health Net’s ratings on the Patient Advocate’s report card.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "San Diego Mother Mourns While Mental Health Gaps Persist",
"title": "San Diego Mother Mourns While Mental Health Gaps Persist",
"headTitle": "State of Mind | State of Health | KQED News",
"content": "\u003cp>Maria Spivey was driving the #1 bus in San Diego one spring day two years ago, when her cellphone started ringing and ringing. She figured it was her 17-year-old daughter Chloe.\u003c/p>\n\u003cp>\"There was no way I could stop and answer the phone,\" she remembers. So she kept going.\u003c/p>\n\u003cp>\"When I get to the end of the line,\" she told herself, \"I'll take a break. I'll call Chloe.\"\u003c/p>\n\u003cp>When she got to the terminal, the calls became more insistent. Now it was her partner, Charles.\u003c/p>\n\u003cp>“‘You need to get home,’” Spivey remembers him telling her. “’Get home now.’”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She rushed home to find police cars parked in every direction outside her house. Charles opened her car door.\u003c/p>\n\u003cp>\"Chloe's gone,\" he told her.\u003c/p>\n\u003cp>Chloe had killed herself.\u003c/p>\n\u003cp>“I think I almost fell to my knees,” Spivey says, holding back tears. “But I didn’t want to lose complete control. My kids were watching me.”\u003c/p>\n\u003cfigure id=\"attachment_189450\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-189450\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS19311_IMG_1779-e1464305449405.jpg\" alt=\"Maria Spivey, riding a bus in San Diego. She's on leave from her job as a driver. \" width=\"1920\" height=\"1920\">\u003cfigcaption class=\"wp-caption-text\">Maria Spivey, riding a bus in San Diego. She's on leave from her job as a driver. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At first Spivey blamed herself.\u003cstrong> \u003c/strong>But later, she blamed Kaiser Permanente. Spivey says the HMO failed to take care of her daughter. When Chloe started having trouble with depression and anxiety in middle school, Kaiser told her she couldn’t get weekly individual therapy.\u003c/p>\n\u003cp>“There's no one-on-one,” Spivey remembers being told.\u003c/p>\n\u003cp>Chloe had attempted suicide once before, when she was 16. Even then, Kaiser did not schedule her into individual therapy. Instead she was put into a weekly group for teens with drug abuse problems.\u003c/p>\n\u003cp>“They didn't discuss depression, anxiety, PTSD,\" Spivey says. No one asked if she was feeling suicidal. “Chloe told me more often than not, ‘Mom, this is not what I need.'\"\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/266777047\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003cstrong>History of Complaints\u003c/strong>\u003c/p>\n\u003cp>Complaints like these had been building up at Kaiser for years. Mental health clinicians at Kaiser who were members of the National Union of Healthcare Workers started to organize across the state. They sent thousands of pages of internal Kaiser documents to state regulators.\u003c/p>\n\u003cp>The clinicians said Kaiser was understaffing its psychiatric department. They said patients were being shuttled into groups or forced to wait four to six weeks for individual therapy appointments.\u003c/p>\n\u003cp>The Department of Managed Health Care, the main regulator of health insurers in the state, found merit in these claims and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">fined Kaiser\u003c/a> $4 million, which Kaiser initially contested, then agreed to pay in 2014.\u003c/p>\n\u003cp>But the union was still not satisfied. It said patients were still waiting too long for appointments, and in 2015, they went \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/12/kaiser-mental-health-workers-launch-7-day-strike/\" target=\"_blank\">on strike\u003c/a>.\u003c/p>\n\u003cp>Kaiser eventually reached a contract agreement with the union, building more time into therapists’ schedules for patient care, and offering “competitive” salaries and benefits, said Yener Balan, Kaiser’s executive director of behavioral health quality, in a statement. It also hired hundreds of new therapists last year and is \"aggressively\" recruiting more.\u003c/p>\n\u003cp>“Kaiser Permanente is actively working to meet the challenges that everyone in the mental health treatment community is facing,” Balan said. “As one of the largest mental health providers in California, we recognize that we are in a position to lead, and that is what we are committed to do.\"\u003c/p>\n\u003cp>While the union is pleased with the changes, union president Sal Roselli says there’s still more work to do.\u003c/p>\n\u003cp>“We want to make Kaiser the poster child to take to other [insurance] providers, in terms of how to do it right,” he says.\u003c/p>\n\u003cp>\u003cstrong>Kaiser May Be 'Victim of Their Own Data' \u003c/strong>\u003c/p>\n\u003cp>Kaiser is the only insurance company that’s been fined in California for forcing patients to wait excessively long for mental health visits. But is it really the only one with problems?\u003c/p>\n\u003cp>Last year in Sacramento, Shelley Rouillard, the head the state's Department of Managed Health Care, testified before a senate committee on mental health that Kaiser's integrated system -- where the insurer and medical provider are one entity -- made it something of an easy target.\u003c/p>\n\u003cp>“Kaiser probably has much better data than anyone else,” she told state lawmakers. \"And so to some extent they may be a victim of their own data.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"Pj1zuPmPSNXAFV3QoGyu3PznrAQcrKbd\"]Other insurers don’t have a centralized call center that tracks appointment wait times, like Kaiser. They have fragmented networks of self-employed therapists. There’s no way to count how many calls a patient makes before they find one who’s available. Or how many patients simply give up.\u003c/p>\n\u003cp>Right now in California, insurance companies monitor themselves to make sure they have enough clinicians. Insurers are responsible for surveying therapists in their directories to make sure they are accepting new patients. But these surveys do not simulate the typical patient experience -– as therapists’ answers about whether they are taking new patients can vary dramatically if the person calling is a patient or the insurance company who pays them.\u003c/p>\n\u003cp>For example, a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">KQED survey of 100 psychologists \u003c/a>in the Blue Shield network in San Francisco found that only 28 were actually taking new patients, a rate Rouillard said was “not acceptable.”\u003c/p>\n\u003cp>Mental health clinicians and advocates criticize the Department of Managed Health Care for going easy on insurance companies.\u003c/p>\n\u003cp>The fines are too low and too infrequent, says Meiram Bendat, a plaintiffs’ lawyer in Los Angeles. “They’re a slow bureaucracy that takes way too long to respond to consumer complaints.”\u003c/p>\n\u003cp>\u003cstrong>Difficulty of Enforcement \u003c/strong>\u003c/p>\n\u003cp>Rouillard says the mental health parity laws her agency is tasked with enforcing are extremely complicated, so it makes more sense to work with the companies to correct problems.\u003c/p>\n\u003cp>“We want the plans to do the right thing from the beginning,\" Rouillard says. \"It's worth it to spend the time to help them understand what the law is and what their responsibilities are and for us to work with them to get it right.”\u003c/p>\n\u003cp>Right now, the agency is reviewing health insurance plans’ mental health benefits. Where there are violations of the law -- say a plan charges a higher copay for mental health services compared to other medical services -- the agency tells the insurer to fix the plan so the copays are the same. Of 25 insurance companies reviewed this year, 24 had a violation like this, according to the department. Later this year, department officials will visit insurance companies on site to audit patient files.\u003c/p>\n\u003cp>“It's been a good process,” Rouillard says. “It’s been a little long and dragged out, but we’re getting there and we’ll see on the back end how well it really works.”\u003c/p>\n\u003cp>Other states are taking a much more aggressive approach.\u003c/p>\n\u003cp>In New York, the state attorney general has been suing insurers, using subpoena power to demand data from companies about what kind of care patients are actually getting, not just what the companies say they’re giving.\u003c/p>\n\u003cp>“It doesn’t seem like there’s any lack of winnable cases available,” says Keith Humphreys, a psychiatrist at Stanford who served as a policy advisor to the Obama administration. “The reason we see that in New York is not that New York is an unusual place -- but that you had a public official who was engaged enough and talented enough to expose it.”\u003c/p>\n\u003cp>He calls the New York attorney general a hero.\u003c/p>\n\u003cp>The investigations pursued in New York and by California's Department of Managed Health Care have depended largely on consumers submitting complaints about their health plans. This can be a tall order for people suffering from a mental illness, who may be too distraught, or even cognitively impaired by their condition to navigate the web of agencies, and the web of forms. Advocates believe the number of complaints submitted to regulators represent only a fraction of potential violations of mental health laws.\u003c/p>\n\u003cp>Maria Spivey says when her daughter Chloe was struggling, she didn’t have the energy to file a complaint with state regulators. She didn’t know how -- or even that it was an option.\u003c/p>\n\u003cp>“I didn’t have time to waste on Kaiser and what they weren’t doing for Chloe,\" she says. \"I was trying to save Chloe and find people that would help me.”\u003c/p>\n\u003cp>Spivey is now one of several plaintiffs in a lawsuit against Kaiser. She wants to see Kaiser make a more meaningful overhaul to its mental health system -- to provide one-on-one therapy to all patients who need it, as soon as they need it.\u003c/p>\n\u003cp>\u003cem>Consumers who feel they have been unfairly denied mental health coverage can file a complaint with the \u003ca href=\"http://www.dmhc.ca.gov/fileacomplaint.aspx#.V0dHwFeOuUg\" target=\"_blank\">Department of Managed Health Care\u003c/a> or the \u003ca href=\"http://www.insurance.ca.gov/01-consumers/101-help/\" target=\"_blank\">Department of Insurance\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Got a story about mental health that you think KQED should cover? Email reporter \u003ca href=\"mailto:adembosky@kqed.org\" target=\"_blank\">April Dembosky\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Maria Spivey was driving the #1 bus in San Diego one spring day two years ago, when her cellphone started ringing and ringing. She figured it was her 17-year-old daughter Chloe.\u003c/p>\n\u003cp>\"There was no way I could stop and answer the phone,\" she remembers. So she kept going.\u003c/p>\n\u003cp>\"When I get to the end of the line,\" she told herself, \"I'll take a break. I'll call Chloe.\"\u003c/p>\n\u003cp>When she got to the terminal, the calls became more insistent. Now it was her partner, Charles.\u003c/p>\n\u003cp>“‘You need to get home,’” Spivey remembers him telling her. “’Get home now.’”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She rushed home to find police cars parked in every direction outside her house. Charles opened her car door.\u003c/p>\n\u003cp>\"Chloe's gone,\" he told her.\u003c/p>\n\u003cp>Chloe had killed herself.\u003c/p>\n\u003cp>“I think I almost fell to my knees,” Spivey says, holding back tears. “But I didn’t want to lose complete control. My kids were watching me.”\u003c/p>\n\u003cfigure id=\"attachment_189450\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-189450\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS19311_IMG_1779-e1464305449405.jpg\" alt=\"Maria Spivey, riding a bus in San Diego. She's on leave from her job as a driver. \" width=\"1920\" height=\"1920\">\u003cfigcaption class=\"wp-caption-text\">Maria Spivey, riding a bus in San Diego. She's on leave from her job as a driver. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At first Spivey blamed herself.\u003cstrong> \u003c/strong>But later, she blamed Kaiser Permanente. Spivey says the HMO failed to take care of her daughter. When Chloe started having trouble with depression and anxiety in middle school, Kaiser told her she couldn’t get weekly individual therapy.\u003c/p>\n\u003cp>“There's no one-on-one,” Spivey remembers being told.\u003c/p>\n\u003cp>Chloe had attempted suicide once before, when she was 16. Even then, Kaiser did not schedule her into individual therapy. Instead she was put into a weekly group for teens with drug abuse problems.\u003c/p>\n\u003cp>“They didn't discuss depression, anxiety, PTSD,\" Spivey says. No one asked if she was feeling suicidal. “Chloe told me more often than not, ‘Mom, this is not what I need.'\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/266777047&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/266777047'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>History of Complaints\u003c/strong>\u003c/p>\n\u003cp>Complaints like these had been building up at Kaiser for years. Mental health clinicians at Kaiser who were members of the National Union of Healthcare Workers started to organize across the state. They sent thousands of pages of internal Kaiser documents to state regulators.\u003c/p>\n\u003cp>The clinicians said Kaiser was understaffing its psychiatric department. They said patients were being shuttled into groups or forced to wait four to six weeks for individual therapy appointments.\u003c/p>\n\u003cp>The Department of Managed Health Care, the main regulator of health insurers in the state, found merit in these claims and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">fined Kaiser\u003c/a> $4 million, which Kaiser initially contested, then agreed to pay in 2014.\u003c/p>\n\u003cp>But the union was still not satisfied. It said patients were still waiting too long for appointments, and in 2015, they went \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/12/kaiser-mental-health-workers-launch-7-day-strike/\" target=\"_blank\">on strike\u003c/a>.\u003c/p>\n\u003cp>Kaiser eventually reached a contract agreement with the union, building more time into therapists’ schedules for patient care, and offering “competitive” salaries and benefits, said Yener Balan, Kaiser’s executive director of behavioral health quality, in a statement. It also hired hundreds of new therapists last year and is \"aggressively\" recruiting more.\u003c/p>\n\u003cp>“Kaiser Permanente is actively working to meet the challenges that everyone in the mental health treatment community is facing,” Balan said. “As one of the largest mental health providers in California, we recognize that we are in a position to lead, and that is what we are committed to do.\"\u003c/p>\n\u003cp>While the union is pleased with the changes, union president Sal Roselli says there’s still more work to do.\u003c/p>\n\u003cp>“We want to make Kaiser the poster child to take to other [insurance] providers, in terms of how to do it right,” he says.\u003c/p>\n\u003cp>\u003cstrong>Kaiser May Be 'Victim of Their Own Data' \u003c/strong>\u003c/p>\n\u003cp>Kaiser is the only insurance company that’s been fined in California for forcing patients to wait excessively long for mental health visits. But is it really the only one with problems?\u003c/p>\n\u003cp>Last year in Sacramento, Shelley Rouillard, the head the state's Department of Managed Health Care, testified before a senate committee on mental health that Kaiser's integrated system -- where the insurer and medical provider are one entity -- made it something of an easy target.\u003c/p>\n\u003cp>“Kaiser probably has much better data than anyone else,” she told state lawmakers. \"And so to some extent they may be a victim of their own data.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Other insurers don’t have a centralized call center that tracks appointment wait times, like Kaiser. They have fragmented networks of self-employed therapists. There’s no way to count how many calls a patient makes before they find one who’s available. Or how many patients simply give up.\u003c/p>\n\u003cp>Right now in California, insurance companies monitor themselves to make sure they have enough clinicians. Insurers are responsible for surveying therapists in their directories to make sure they are accepting new patients. But these surveys do not simulate the typical patient experience -– as therapists’ answers about whether they are taking new patients can vary dramatically if the person calling is a patient or the insurance company who pays them.\u003c/p>\n\u003cp>For example, a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">KQED survey of 100 psychologists \u003c/a>in the Blue Shield network in San Francisco found that only 28 were actually taking new patients, a rate Rouillard said was “not acceptable.”\u003c/p>\n\u003cp>Mental health clinicians and advocates criticize the Department of Managed Health Care for going easy on insurance companies.\u003c/p>\n\u003cp>The fines are too low and too infrequent, says Meiram Bendat, a plaintiffs’ lawyer in Los Angeles. “They’re a slow bureaucracy that takes way too long to respond to consumer complaints.”\u003c/p>\n\u003cp>\u003cstrong>Difficulty of Enforcement \u003c/strong>\u003c/p>\n\u003cp>Rouillard says the mental health parity laws her agency is tasked with enforcing are extremely complicated, so it makes more sense to work with the companies to correct problems.\u003c/p>\n\u003cp>“We want the plans to do the right thing from the beginning,\" Rouillard says. \"It's worth it to spend the time to help them understand what the law is and what their responsibilities are and for us to work with them to get it right.”\u003c/p>\n\u003cp>Right now, the agency is reviewing health insurance plans’ mental health benefits. Where there are violations of the law -- say a plan charges a higher copay for mental health services compared to other medical services -- the agency tells the insurer to fix the plan so the copays are the same. Of 25 insurance companies reviewed this year, 24 had a violation like this, according to the department. Later this year, department officials will visit insurance companies on site to audit patient files.\u003c/p>\n\u003cp>“It's been a good process,” Rouillard says. “It’s been a little long and dragged out, but we’re getting there and we’ll see on the back end how well it really works.”\u003c/p>\n\u003cp>Other states are taking a much more aggressive approach.\u003c/p>\n\u003cp>In New York, the state attorney general has been suing insurers, using subpoena power to demand data from companies about what kind of care patients are actually getting, not just what the companies say they’re giving.\u003c/p>\n\u003cp>“It doesn’t seem like there’s any lack of winnable cases available,” says Keith Humphreys, a psychiatrist at Stanford who served as a policy advisor to the Obama administration. “The reason we see that in New York is not that New York is an unusual place -- but that you had a public official who was engaged enough and talented enough to expose it.”\u003c/p>\n\u003cp>He calls the New York attorney general a hero.\u003c/p>\n\u003cp>The investigations pursued in New York and by California's Department of Managed Health Care have depended largely on consumers submitting complaints about their health plans. This can be a tall order for people suffering from a mental illness, who may be too distraught, or even cognitively impaired by their condition to navigate the web of agencies, and the web of forms. Advocates believe the number of complaints submitted to regulators represent only a fraction of potential violations of mental health laws.\u003c/p>\n\u003cp>Maria Spivey says when her daughter Chloe was struggling, she didn’t have the energy to file a complaint with state regulators. She didn’t know how -- or even that it was an option.\u003c/p>\n\u003cp>“I didn’t have time to waste on Kaiser and what they weren’t doing for Chloe,\" she says. \"I was trying to save Chloe and find people that would help me.”\u003c/p>\n\u003cp>Spivey is now one of several plaintiffs in a lawsuit against Kaiser. She wants to see Kaiser make a more meaningful overhaul to its mental health system -- to provide one-on-one therapy to all patients who need it, as soon as they need it.\u003c/p>\n\u003cp>\u003cem>Consumers who feel they have been unfairly denied mental health coverage can file a complaint with the \u003ca href=\"http://www.dmhc.ca.gov/fileacomplaint.aspx#.V0dHwFeOuUg\" target=\"_blank\">Department of Managed Health Care\u003c/a> or the \u003ca href=\"http://www.insurance.ca.gov/01-consumers/101-help/\" target=\"_blank\">Department of Insurance\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Asking Mom: 'Did You Know I Was Depressed In High School?'",
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"content": "\u003cp>Rose has dealt with depression since high school. She'd put her head down, focus on school and get through. But during her senior year of college, Rose couldn't even concentrate on school anymore.\u003c/p>\n\u003cp>\"I was struggling. I was feeling depressed. I was feeling isolated,\" Rose, now 24, says. \"I was crying at Cheerios commercials, which is not normal.\"\u003c/p>\n\u003cp>Rose started seeing a therapist and now feels like she has everything under control. She's even on her way to becoming a therapist herself, in her third year of a Ph.D. program in clinical psychology. (We're using first names only in this story to protect her patient-therapist relationships.)\u003c/p>\n\u003cp>She has never told her parents anything about her own depression. She worried about disappointing them. She also worried that her mental health issues were frivolous compared with the struggles that her parents, who grew up in Pakistan and emigrated to the United States, have endured.\u003c/p>\n\u003cp>And she was particularly worried about what her mom would say.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"So I had moved out for college, and that's not really the norm for my cultural background,\" Rose says. \"I was afraid that I was going to share this with her and the response would be: 'I told you it wasn't good for you to move out. You should have stayed home.' \"\u003c/p>\n\u003cp>A few weeks ago, Rose decided to take a huge step. In talking about this story, she realized this could be a good opportunity to tell her mother for the very first time about her struggles with depression. She got her mother's permission to record the conversation:\u003c/p>\n\u003cblockquote>\u003cp>Rose: I don't think I've ever asked you how do you feel about my decision to be a psychologist?\u003c/p>\n\u003cp>Mama: Mmmm.\u003c/p>\n\u003cp>Rose: (Laughs.) Complicated feelings.\u003c/p>\n\u003cp>Mama: Yeah.\u003c/p>\u003c/blockquote>\n\u003cp>One of the reasons Rose was interested in sitting down with her mom for this story was because she plans to do her thesis on this very kind of thing. In general, children have trouble talking to their parents about mental health issues. But in Rose's case, and for a lot of first-generation Americans, there's not just the generation gap — there's also a culture clash.\u003c/p>\n\u003cblockquote>\u003cp>Rose: I know you've seen family that's depressed. You've seen the symptoms like being cranky, sleeping a lot, not eating much. Those kind of things. Did you ever notice any of that in me when I was living here or even now?\u003c/p>\n\u003cp>Mama: No.\u003c/p>\n\u003cp>Rose: You never noticed any of that?\u003c/p>\n\u003cp>Mama: I don't think you have any of this problem.\u003c/p>\n\u003cp>Rose: Well, it actually has been a problem for me.\u003c/p>\n\u003cp>Mama: I know, but I think this is no big problem.\u003c/p>\n\u003cp>Rose: OK. So, you've noticed those things but it's not a big problem.\u003c/p>\n\u003cp>Mama: Yeah.\u003c/p>\u003c/blockquote>\n\u003cp>After that, Rose goes on for a while, explaining to her mom that she sort of hid her depression and maybe that's why it didn't look like a big problem.\u003c/p>\n\u003cblockquote>\u003cp>Mama: You have depression, I understand. You live alone and nobody talk to you. And I know this is depression.\u003c/p>\n\u003cp>Rose: But you know I don't think it's because I live alone. Because I felt this way in high school when I lived here. This isn't brand new.\u003c/p>\u003c/blockquote>\n\u003cp>Then Rose told her mother that she was worried that her mother would judge her.\u003c/p>\n\u003cblockquote>\u003cp>Rose: I didn't want you to think that I'm weak or ... broken or anything like that. Do you think of me any differently?\u003c/p>\n\u003cp>Mama: No. I am proud of you, and you are the angel of our life.\u003c/p>\n\u003cp>Rose: So after this conversation, what, if anything, do you think is going to change?\u003c/p>\n\u003cp>Mama: You move here.\u003c/p>\n\u003cp>Rose: (Laughs.) I'm not moving here. I think you know that.\u003c/p>\u003c/blockquote>\n\u003cp>That conversation ended on what seemed like a pretty nice note. But then Rose shut the recorder off. At that point, she says, her mom got mad about Rose going public, and told her that she would have a harder time getting married because of it. Rose says now:\u003c/p>\n\u003cblockquote>\u003cp>I tried to be like, that's the point. That's why we're doing this. Because both in our American culture and in our Pakistani culture there's a stigma, and she knows it. Because now she's afraid that people are going to know this about me and judge me for it, and it's going to make it harder to have a future the way she wants me to have a future.\u003c/p>\u003c/blockquote>\n\u003cp>She regretted having shared all this with her mom. But then, the next day, Rose's mom started asking these little questions like, \"Where did this start?\" or \"What could I have done differently?\" Even, \"Is this because I wouldn't let you wear makeup to school?\" Rose started to feel like her mom was coming from a place of wanting to understand better, rather than judging.\u003c/p>\n\u003cp>And with a little time, Rose found herself doing the same thing — trying to understand her mom's reaction instead of judging it:\u003c/p>\n\u003cblockquote>\u003cp>I've had years to come to terms with this knowledge about myself and I gave her, what, maybe an hour-long conversation and then expected her to, at the end of it, be totally understanding and calm and collected about it, which wasn't fair on my part.\u003c/p>\u003c/blockquote>\n\u003cp>Rose thinks that sharing and being open about mental illness may ultimately bridge these kinds of generational and culture gaps.\u003c/p>\n\u003cp>But people have to be prepared for a process, she says, not a hit-and-run conversation.\u003c/p>\n\u003cp>Laying everything out has made her and her mom more reflective. So maybe it wasn't such a bad idea after all.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by WNYC's \u003c/em>Only Human\u003cem>\u003ca href=\"http://www.wnyc.org/shows/onlyhuman/\" target=\"_blank\"> podcast series on mental health\u003c/a>. You can stay in touch with \u003c/em>\u003ca href=\"https://twitter.com/onlyhuman\" target=\"_blank\">@OnlyHuman\u003c/a>\u003cem> on Twitter and \u003c/em>\u003ca href=\"https://www.facebook.com/OnlyHumanPodcast/\" target=\"_blank\">@Only Human\u003c/a>\u003cem> on Facebook.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 WNYC Radio. To see more, visit \u003ca href=\"http://www.wnyc.org/\" target=\"_blank\">WNYC Radio\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Asking+Mom%3A+%27Did+You+Know+I+Was+Depressed+In+High+School%3F%27&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Rose has dealt with depression since high school. She'd put her head down, focus on school and get through. But during her senior year of college, Rose couldn't even concentrate on school anymore.\u003c/p>\n\u003cp>\"I was struggling. I was feeling depressed. I was feeling isolated,\" Rose, now 24, says. \"I was crying at Cheerios commercials, which is not normal.\"\u003c/p>\n\u003cp>Rose started seeing a therapist and now feels like she has everything under control. She's even on her way to becoming a therapist herself, in her third year of a Ph.D. program in clinical psychology. (We're using first names only in this story to protect her patient-therapist relationships.)\u003c/p>\n\u003cp>She has never told her parents anything about her own depression. She worried about disappointing them. She also worried that her mental health issues were frivolous compared with the struggles that her parents, who grew up in Pakistan and emigrated to the United States, have endured.\u003c/p>\n\u003cp>And she was particularly worried about what her mom would say.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"So I had moved out for college, and that's not really the norm for my cultural background,\" Rose says. \"I was afraid that I was going to share this with her and the response would be: 'I told you it wasn't good for you to move out. You should have stayed home.' \"\u003c/p>\n\u003cp>A few weeks ago, Rose decided to take a huge step. In talking about this story, she realized this could be a good opportunity to tell her mother for the very first time about her struggles with depression. She got her mother's permission to record the conversation:\u003c/p>\n\u003cblockquote>\u003cp>Rose: I don't think I've ever asked you how do you feel about my decision to be a psychologist?\u003c/p>\n\u003cp>Mama: Mmmm.\u003c/p>\n\u003cp>Rose: (Laughs.) Complicated feelings.\u003c/p>\n\u003cp>Mama: Yeah.\u003c/p>\u003c/blockquote>\n\u003cp>One of the reasons Rose was interested in sitting down with her mom for this story was because she plans to do her thesis on this very kind of thing. In general, children have trouble talking to their parents about mental health issues. But in Rose's case, and for a lot of first-generation Americans, there's not just the generation gap — there's also a culture clash.\u003c/p>\n\u003cblockquote>\u003cp>Rose: I know you've seen family that's depressed. You've seen the symptoms like being cranky, sleeping a lot, not eating much. Those kind of things. Did you ever notice any of that in me when I was living here or even now?\u003c/p>\n\u003cp>Mama: No.\u003c/p>\n\u003cp>Rose: You never noticed any of that?\u003c/p>\n\u003cp>Mama: I don't think you have any of this problem.\u003c/p>\n\u003cp>Rose: Well, it actually has been a problem for me.\u003c/p>\n\u003cp>Mama: I know, but I think this is no big problem.\u003c/p>\n\u003cp>Rose: OK. So, you've noticed those things but it's not a big problem.\u003c/p>\n\u003cp>Mama: Yeah.\u003c/p>\u003c/blockquote>\n\u003cp>After that, Rose goes on for a while, explaining to her mom that she sort of hid her depression and maybe that's why it didn't look like a big problem.\u003c/p>\n\u003cblockquote>\u003cp>Mama: You have depression, I understand. You live alone and nobody talk to you. And I know this is depression.\u003c/p>\n\u003cp>Rose: But you know I don't think it's because I live alone. Because I felt this way in high school when I lived here. This isn't brand new.\u003c/p>\u003c/blockquote>\n\u003cp>Then Rose told her mother that she was worried that her mother would judge her.\u003c/p>\n\u003cblockquote>\u003cp>Rose: I didn't want you to think that I'm weak or ... broken or anything like that. Do you think of me any differently?\u003c/p>\n\u003cp>Mama: No. I am proud of you, and you are the angel of our life.\u003c/p>\n\u003cp>Rose: So after this conversation, what, if anything, do you think is going to change?\u003c/p>\n\u003cp>Mama: You move here.\u003c/p>\n\u003cp>Rose: (Laughs.) I'm not moving here. I think you know that.\u003c/p>\u003c/blockquote>\n\u003cp>That conversation ended on what seemed like a pretty nice note. But then Rose shut the recorder off. At that point, she says, her mom got mad about Rose going public, and told her that she would have a harder time getting married because of it. Rose says now:\u003c/p>\n\u003cblockquote>\u003cp>I tried to be like, that's the point. That's why we're doing this. Because both in our American culture and in our Pakistani culture there's a stigma, and she knows it. Because now she's afraid that people are going to know this about me and judge me for it, and it's going to make it harder to have a future the way she wants me to have a future.\u003c/p>\u003c/blockquote>\n\u003cp>She regretted having shared all this with her mom. But then, the next day, Rose's mom started asking these little questions like, \"Where did this start?\" or \"What could I have done differently?\" Even, \"Is this because I wouldn't let you wear makeup to school?\" Rose started to feel like her mom was coming from a place of wanting to understand better, rather than judging.\u003c/p>\n\u003cp>And with a little time, Rose found herself doing the same thing — trying to understand her mom's reaction instead of judging it:\u003c/p>\n\u003cblockquote>\u003cp>I've had years to come to terms with this knowledge about myself and I gave her, what, maybe an hour-long conversation and then expected her to, at the end of it, be totally understanding and calm and collected about it, which wasn't fair on my part.\u003c/p>\u003c/blockquote>\n\u003cp>Rose thinks that sharing and being open about mental illness may ultimately bridge these kinds of generational and culture gaps.\u003c/p>\n\u003cp>But people have to be prepared for a process, she says, not a hit-and-run conversation.\u003c/p>\n\u003cp>Laying everything out has made her and her mom more reflective. So maybe it wasn't such a bad idea after all.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by WNYC's \u003c/em>Only Human\u003cem>\u003ca href=\"http://www.wnyc.org/shows/onlyhuman/\" target=\"_blank\"> podcast series on mental health\u003c/a>. You can stay in touch with \u003c/em>\u003ca href=\"https://twitter.com/onlyhuman\" target=\"_blank\">@OnlyHuman\u003c/a>\u003cem> on Twitter and \u003c/em>\u003ca href=\"https://www.facebook.com/OnlyHumanPodcast/\" target=\"_blank\">@Only Human\u003c/a>\u003cem> on Facebook.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 WNYC Radio. To see more, visit \u003ca href=\"http://www.wnyc.org/\" target=\"_blank\">WNYC Radio\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Asking+Mom%3A+%27Did+You+Know+I+Was+Depressed+In+High+School%3F%27&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>There’s something that really bothers Stanford psychiatry professor Keith Humphreys. When he thinks of all the years he spends training the next generation of psychiatrists, the enormous investment in medical school and residency, he wants them to devote that education to taking care of people with serious mental illness.\u003c/p>\n\u003cp>But many of them instead set up a private practice, where they can charge $400 an hour in cash to help people who Humphreys calls “the worried well” –- people who enjoy the self-exploration of therapy but do not necessarily have a mental health problem.\u003c/p>\n\u003cp>\"A minute I spend training that person is a minute of my life wasted,” Humphreys says. “That very well-trained person should be taking care of very, very troubled people. When they don’t, everyone who needs that care loses out.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'They’re horribly addicted to OxyContin or their child is showing signs of bipolar disorder, and they can’t find somebody to take their insurance. It’s unjust.'\u003ccite>Keith Humphreys, Stanford Psychiatry Professor \u003c/cite>\u003c/aside>\n\u003cp>Humphreys says this trend of mental health clinicians shunning the health insurance industry and decamping to the cash market dates back 70 years, to the end of World War II.\u003c/p>\n\u003cp>In 1946, the majority of veterans cared for by what was then called the Veterans Administration were mental health patients, Humphreys says. But there weren’t enough mental health providers to take care of them. So the VA partnered with several medical schools, including Stanford where Humphreys teaches, to train mental health professionals.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Those schools started turning out hundreds and hundreds of psychologists a year. The expansion dovetailed with soaring American affluence -- and soaring American interest in self-exploration.\u003c/p>\n\u003cp>Having a psychoanalyst became \"a sort of status symbol,\" Humphreys says.\u003c/p>\n\u003cp>A lot of psychologists who were trained to work in the public sector saw a better financial opportunity and jumped ship. They hung shingles and started their own private practices where they could charge wealthy people much higher rates.\u003c/p>\n\u003cp>“When you put in a free market in a society where people were very interested in self-exploration, a lot of them went out and did their own thing,” Humphreys says.\u003c/p>\n\u003cfigure id=\"attachment_187932\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-187932\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/keithatDavos-400x225.jpg\" alt=\"Stanford psychiatry professor Keith Humphreys\" width=\"400\" height=\"225\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-960x540.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Stanford psychiatry professor Keith Humphreys \u003ccite>(Courtesy: Keith Humphreys)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The reason this was possible is because of how the overall U.S. health care system was established, Humphreys says. Most people got their health insurance through work. Employers competed with each other for the best employees by offering better benefits.\u003c/p>\n\u003cp>So the standards for coverage developed over time in a piecemeal, haphazard way.\u003c/p>\n\u003cp>As health policy evolved, mental health benefits continuously lagged, Humphreys says. Coverage for mental health treatments or hospitalizations was meager or nonexistent.\u003c/p>\n\u003cp>“We don’t seem to have this problem with cardiology or oncology,” Humphreys says. “You don’t see people lining up to pay cash for those services because the benefits are so low.\"\u003c/p>\n\u003cp>This wouldn’t happen in places that have single-payer health systems, like Canada, Humphreys says, because all the health care payments are controlled by the government. Mental health care was baked into that system earlier on.\u003c/p>\n\u003cp>As a result, people in Canada with more severe mental illness are more likely to get services, according to \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJM199702203360806\" target=\"_blank\">a study\u003c/a> published in the New England Journal of Medicine.\u003c/p>\n\u003cp>That’s not the case in the U.S. People with less serious mental health conditions get more services here. Humphreys says it's mainly wealthy people who fall into the worried well category, who are consuming psychotherapy.\u003c/p>\n\u003cp>“If it’s a market where you pretty much have to pay for yourself, the rich are always going to win,” he says.\u003c/p>\n\u003cp>The growing workforce of psychiatrists, psychologists, marriage and family therapists, and licensed social workers has responded to that market demand.\u003c/p>\n\u003cp>And not just because it’s better money. Treating high-functioning professionals in a private office is a lot less stressful than doing rounds on a psychiatric ward of a public hospital.\u003c/p>\n\u003cp>“It’s understandable why someone would say this is really demanding,” Humphreys says. “For my own well-being or professional satisfaction, I’m going to stop doing this and move into doing outpatient psychotherapy with executives from Google who have angst. My salary goes up dramatically and my work is much, much easier.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"tU61AbaxNL1XAbjFbyvdGvgJyPnAKYCV\"]Especially in affluent places like the Bay Area, this creates a divide, a culture of mental health haves and have-nots. Mental health clinicians don’t need to participate in the health care system or take insurance to keep their schedules full -- making it harder and harder for people of lower income to find a therapist.\u003c/p>\n\u003cp>“That’s why you can have a lot of mental health professionals in an area, but still have a shortage of care for people in need,” Humphreys adds. “The person who’s hurt is the person who’s suicidal, maybe they’re horribly addicted to OxyContin or their child is showing signs of bipolar disorder, and they can’t find somebody to take their insurance. It’s unjust.”\u003c/p>\n\u003cp>Mental health advocates have worked to shift this balance, passing the Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act in 2010. Together, those laws require health plans to offer mental health coverage on par with other medical coverage.\u003c/p>\n\u003cp>But so far, it hasn’t put a dent in the cash market for mental health. Humphreys says given the nature of mental health care and the American obsession with self-improvement, the cash market will be here to stay.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Accessing mental health care is often pleasurable and enjoyable, and accessing a lot of other health care isn’t,” Humphreys says. “I mean, who goes to the dentist for fun?”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There’s something that really bothers Stanford psychiatry professor Keith Humphreys. When he thinks of all the years he spends training the next generation of psychiatrists, the enormous investment in medical school and residency, he wants them to devote that education to taking care of people with serious mental illness.\u003c/p>\n\u003cp>But many of them instead set up a private practice, where they can charge $400 an hour in cash to help people who Humphreys calls “the worried well” –- people who enjoy the self-exploration of therapy but do not necessarily have a mental health problem.\u003c/p>\n\u003cp>\"A minute I spend training that person is a minute of my life wasted,” Humphreys says. “That very well-trained person should be taking care of very, very troubled people. When they don’t, everyone who needs that care loses out.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'They’re horribly addicted to OxyContin or their child is showing signs of bipolar disorder, and they can’t find somebody to take their insurance. It’s unjust.'\u003ccite>Keith Humphreys, Stanford Psychiatry Professor \u003c/cite>\u003c/aside>\n\u003cp>Humphreys says this trend of mental health clinicians shunning the health insurance industry and decamping to the cash market dates back 70 years, to the end of World War II.\u003c/p>\n\u003cp>In 1946, the majority of veterans cared for by what was then called the Veterans Administration were mental health patients, Humphreys says. But there weren’t enough mental health providers to take care of them. So the VA partnered with several medical schools, including Stanford where Humphreys teaches, to train mental health professionals.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Those schools started turning out hundreds and hundreds of psychologists a year. The expansion dovetailed with soaring American affluence -- and soaring American interest in self-exploration.\u003c/p>\n\u003cp>Having a psychoanalyst became \"a sort of status symbol,\" Humphreys says.\u003c/p>\n\u003cp>A lot of psychologists who were trained to work in the public sector saw a better financial opportunity and jumped ship. They hung shingles and started their own private practices where they could charge wealthy people much higher rates.\u003c/p>\n\u003cp>“When you put in a free market in a society where people were very interested in self-exploration, a lot of them went out and did their own thing,” Humphreys says.\u003c/p>\n\u003cfigure id=\"attachment_187932\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-187932\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/keithatDavos-400x225.jpg\" alt=\"Stanford psychiatry professor Keith Humphreys\" width=\"400\" height=\"225\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-960x540.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Stanford psychiatry professor Keith Humphreys \u003ccite>(Courtesy: Keith Humphreys)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The reason this was possible is because of how the overall U.S. health care system was established, Humphreys says. Most people got their health insurance through work. Employers competed with each other for the best employees by offering better benefits.\u003c/p>\n\u003cp>So the standards for coverage developed over time in a piecemeal, haphazard way.\u003c/p>\n\u003cp>As health policy evolved, mental health benefits continuously lagged, Humphreys says. Coverage for mental health treatments or hospitalizations was meager or nonexistent.\u003c/p>\n\u003cp>“We don’t seem to have this problem with cardiology or oncology,” Humphreys says. “You don’t see people lining up to pay cash for those services because the benefits are so low.\"\u003c/p>\n\u003cp>This wouldn’t happen in places that have single-payer health systems, like Canada, Humphreys says, because all the health care payments are controlled by the government. Mental health care was baked into that system earlier on.\u003c/p>\n\u003cp>As a result, people in Canada with more severe mental illness are more likely to get services, according to \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJM199702203360806\" target=\"_blank\">a study\u003c/a> published in the New England Journal of Medicine.\u003c/p>\n\u003cp>That’s not the case in the U.S. People with less serious mental health conditions get more services here. Humphreys says it's mainly wealthy people who fall into the worried well category, who are consuming psychotherapy.\u003c/p>\n\u003cp>“If it’s a market where you pretty much have to pay for yourself, the rich are always going to win,” he says.\u003c/p>\n\u003cp>The growing workforce of psychiatrists, psychologists, marriage and family therapists, and licensed social workers has responded to that market demand.\u003c/p>\n\u003cp>And not just because it’s better money. Treating high-functioning professionals in a private office is a lot less stressful than doing rounds on a psychiatric ward of a public hospital.\u003c/p>\n\u003cp>“It’s understandable why someone would say this is really demanding,” Humphreys says. “For my own well-being or professional satisfaction, I’m going to stop doing this and move into doing outpatient psychotherapy with executives from Google who have angst. My salary goes up dramatically and my work is much, much easier.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Especially in affluent places like the Bay Area, this creates a divide, a culture of mental health haves and have-nots. Mental health clinicians don’t need to participate in the health care system or take insurance to keep their schedules full -- making it harder and harder for people of lower income to find a therapist.\u003c/p>\n\u003cp>“That’s why you can have a lot of mental health professionals in an area, but still have a shortage of care for people in need,” Humphreys adds. “The person who’s hurt is the person who’s suicidal, maybe they’re horribly addicted to OxyContin or their child is showing signs of bipolar disorder, and they can’t find somebody to take their insurance. It’s unjust.”\u003c/p>\n\u003cp>Mental health advocates have worked to shift this balance, passing the Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act in 2010. Together, those laws require health plans to offer mental health coverage on par with other medical coverage.\u003c/p>\n\u003cp>But so far, it hasn’t put a dent in the cash market for mental health. Humphreys says given the nature of mental health care and the American obsession with self-improvement, the cash market will be here to stay.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Accessing mental health care is often pleasurable and enjoyable, and accessing a lot of other health care isn’t,” Humphreys says. “I mean, who goes to the dentist for fun?”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Frustrated You Can't Find a Therapist? They're Frustrated, Too",
"title": "Frustrated You Can't Find a Therapist? They're Frustrated, Too",
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"content": "\u003cp>When San Francisco resident Natalie Dunnege needed a therapist, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">she couldn’t find one\u003c/a> who took her insurance.\u003c/p>\n\u003cp>“When I would call them they wouldn’t return my phone calls or they wouldn’t be accepting patients,” she says.\u003c/p>\n\u003cp>Insurance companies say there’s a shortage of therapists.\u003c/p>\n\u003cp>But it’s not that simple. Especially in urban areas, there are lots of therapists. They just don’t want to work with the insurance companies.\u003c/p>\n\u003cp>Take Michael Klein, a psychologist practicing in San Francisco for more than 20 years. He considers it his spiritual calling to help people calm their social anxiety and to help couples stop fighting and build trust.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“With the right kind of support, they blossom,” he says.\u003c/p>\n\u003cp>Klein doesn’t accept insurance -- and he’s far from alone. Nearly half of therapists in California don’t take insurance, according to a \u003ca href=\"http://www.camft.org/ias/images/PDFs/articles/mariam/2015_demographic_survey.pdf\" target=\"_blank\">recent survey\u003c/a> from the California Association of Marriage and Family Therapists. The same is true of \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967759/\">psychiatrists\u003c/a>. There are two reasons why, Klein says.\u003c/p>\n\u003caside class=\"pullquote alignright\">Insurance companies say there's a shortage of therapists, but therapists struggle to be accepted into a network.\u003c/aside>\n\u003cp>“One, because the reimbursement rates don’t provide a living wage,” Klein says. “You can’t own a home and drive a car and survive on what in-network providers pay you.”\u003c/p>\n\u003cp>Most insurance companies pay therapists in their networks between $60 and $80 per session. In the Bay Area and Los Angeles, therapists say the market rate for therapy is more like $150 or $200 a session.\u003c/p>\n\u003cp>“The second thing is the paperwork. For an hour of psychotherapy you spend a half hour of paperwork. So, I got into this field because I don’t like paper work,” Klein says with a laugh.\u003c/p>\n\u003cp>On that first point -- money -- insurance companies acknowledge that they may have to raise their rates to attract more therapists, particularly in rural areas. But they also say it’s on therapists to compromise.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/265685067\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>“I think it’s unrealistic to expect either the state of California taxpayers or for health plans to just pay providers whatever they ask to be paid,” says Charles Bacchi, CEO of the California Association of Health Plans, a trade group for the insurance industry.\u003c/p>\n\u003cp>“That's not sustainable,” he continues. “So you're either in the system, and you want to be part of our health care system. Or you want to do concierge service outside of it and just pretend our health care system doesn't exist. That's your choice as a provider. Our job is to find providers that are willing to be part of the solution and willing to provide coverage to those of low and moderate income.\"\u003c/p>\n\u003cp>That’s exactly how San Francisco psychologist Jonathan Horowitz feels. He wants to take insurance. But he’s hit roadblock after roadblock. He sent out 10 applications to insurance companies and got nowhere.\u003c/p>\n\u003cp>“I might knock on Cigna’s door and say, 'Hey are you guys accepting any new therapists in 94105?'” he says. “And they might say, 'No we’re not doing that. We’re totally full.'”\u003c/p>\n\u003cp>[contextly_sidebar id=\"eS6QVmoo2kjciQQ0tu4JO43ybZNtSzAw\"]\u003c/p>\n\u003cp>Six different companies told Horowitz their networks were full.\u003c/p>\n\u003cp>So even though a patient like Natalie Dunnege might call seven therapists in her insurance network and not be able to get an appointment, insurance companies are telling new and willing therapists that there’s no demand for them.\u003c/p>\n\u003cp>“I definitely think it’s to control costs,” Horowitz says. “That’s very clear.”\u003c/p>\n\u003cp>He tried for a year, and one company finally said yes. Sort of. Horowitz never got a formal notice saying his clinic was admitted to the network.\u003c/p>\n\u003cp>“It was just like, 'Oh wait, it looks like we’re suddenly getting a couple referrals from them. I wonder if we’re in their directory,'” he explains.\u003c/p>\n\u003cp>They were. Sort of. The clinic was listed in the directory. But the therapists who work at the clinic weren’t approved yet, meaning there was no one who was allowed to see the clients calling the clinic.\u003c/p>\n\u003cp>So Horowitz tried to call the insurance company to clear things up. He tried many, many times. Here’s what happened during his latest attempt to navigate the automated phone system:\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company automated attendant:\u003c/strong> First I’ll need your provider identification number. If you need a moment, say, hold on.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Hold on.\u003c/em>\u003c/p>\n\u003cp>Sound familiar? Turns out therapists get the automated run around as much as patients do. Horowitz persevered.\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Okay, please say or enter your pin.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> My pin? Is this my pin? (He enters a few numbers).\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> I’m sorry I couldn’t find an account using the info you gave me. Do you already belong to the network?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> I think so?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Sorry, yes or no.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Um, I don’t know ... yes?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Alright. And have you already requested a credentialing application?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Yes.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Sorry could you repeat that.\u003c/em>\u003c/p>\n\u003cp>These experiences did not bode well from Horowitz' perspective.\u003c/p>\n\u003cp>“Honestly, I got a really bad feeling about it,” he says.\u003c/p>\n\u003cp>He figured, if this is what it’s like just finding out if he’s in the network, how’s it going to be when he has a problem with a claim and can’t get paid?\u003c/p>\n\u003cp>“I could just see that getting out of hand really quickly,” he says. “So at that point we just said, do we really even want to do this?”\u003c/p>\n\u003cp>Not just that. The reimbursement rate was even lower than he expected, and the billing was so complicated that he was going to have to hire someone to do it. He says he couldn’t afford that.\u003c/p>\n\u003cp>“We made the decision that we’re just going to cancel the contract and continue to go with cash,” he says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Easier said than done. Horowitz hasn’t been able to get through to anyone on the phone to cancel the contract. In the meantime, prospective patients are finding his name on the directory and are calling for appointments. Horowitz says he just has to say no.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When San Francisco resident Natalie Dunnege needed a therapist, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">she couldn’t find one\u003c/a> who took her insurance.\u003c/p>\n\u003cp>“When I would call them they wouldn’t return my phone calls or they wouldn’t be accepting patients,” she says.\u003c/p>\n\u003cp>Insurance companies say there’s a shortage of therapists.\u003c/p>\n\u003cp>But it’s not that simple. Especially in urban areas, there are lots of therapists. They just don’t want to work with the insurance companies.\u003c/p>\n\u003cp>Take Michael Klein, a psychologist practicing in San Francisco for more than 20 years. He considers it his spiritual calling to help people calm their social anxiety and to help couples stop fighting and build trust.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“With the right kind of support, they blossom,” he says.\u003c/p>\n\u003cp>Klein doesn’t accept insurance -- and he’s far from alone. Nearly half of therapists in California don’t take insurance, according to a \u003ca href=\"http://www.camft.org/ias/images/PDFs/articles/mariam/2015_demographic_survey.pdf\" target=\"_blank\">recent survey\u003c/a> from the California Association of Marriage and Family Therapists. The same is true of \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967759/\">psychiatrists\u003c/a>. There are two reasons why, Klein says.\u003c/p>\n\u003caside class=\"pullquote alignright\">Insurance companies say there's a shortage of therapists, but therapists struggle to be accepted into a network.\u003c/aside>\n\u003cp>“One, because the reimbursement rates don’t provide a living wage,” Klein says. “You can’t own a home and drive a car and survive on what in-network providers pay you.”\u003c/p>\n\u003cp>Most insurance companies pay therapists in their networks between $60 and $80 per session. In the Bay Area and Los Angeles, therapists say the market rate for therapy is more like $150 or $200 a session.\u003c/p>\n\u003cp>“The second thing is the paperwork. For an hour of psychotherapy you spend a half hour of paperwork. So, I got into this field because I don’t like paper work,” Klein says with a laugh.\u003c/p>\n\u003cp>On that first point -- money -- insurance companies acknowledge that they may have to raise their rates to attract more therapists, particularly in rural areas. But they also say it’s on therapists to compromise.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/265685067&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/265685067'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“I think it’s unrealistic to expect either the state of California taxpayers or for health plans to just pay providers whatever they ask to be paid,” says Charles Bacchi, CEO of the California Association of Health Plans, a trade group for the insurance industry.\u003c/p>\n\u003cp>“That's not sustainable,” he continues. “So you're either in the system, and you want to be part of our health care system. Or you want to do concierge service outside of it and just pretend our health care system doesn't exist. That's your choice as a provider. Our job is to find providers that are willing to be part of the solution and willing to provide coverage to those of low and moderate income.\"\u003c/p>\n\u003cp>That’s exactly how San Francisco psychologist Jonathan Horowitz feels. He wants to take insurance. But he’s hit roadblock after roadblock. He sent out 10 applications to insurance companies and got nowhere.\u003c/p>\n\u003cp>“I might knock on Cigna’s door and say, 'Hey are you guys accepting any new therapists in 94105?'” he says. “And they might say, 'No we’re not doing that. We’re totally full.'”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Six different companies told Horowitz their networks were full.\u003c/p>\n\u003cp>So even though a patient like Natalie Dunnege might call seven therapists in her insurance network and not be able to get an appointment, insurance companies are telling new and willing therapists that there’s no demand for them.\u003c/p>\n\u003cp>“I definitely think it’s to control costs,” Horowitz says. “That’s very clear.”\u003c/p>\n\u003cp>He tried for a year, and one company finally said yes. Sort of. Horowitz never got a formal notice saying his clinic was admitted to the network.\u003c/p>\n\u003cp>“It was just like, 'Oh wait, it looks like we’re suddenly getting a couple referrals from them. I wonder if we’re in their directory,'” he explains.\u003c/p>\n\u003cp>They were. Sort of. The clinic was listed in the directory. But the therapists who work at the clinic weren’t approved yet, meaning there was no one who was allowed to see the clients calling the clinic.\u003c/p>\n\u003cp>So Horowitz tried to call the insurance company to clear things up. He tried many, many times. Here’s what happened during his latest attempt to navigate the automated phone system:\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company automated attendant:\u003c/strong> First I’ll need your provider identification number. If you need a moment, say, hold on.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Hold on.\u003c/em>\u003c/p>\n\u003cp>Sound familiar? Turns out therapists get the automated run around as much as patients do. Horowitz persevered.\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Okay, please say or enter your pin.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> My pin? Is this my pin? (He enters a few numbers).\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> I’m sorry I couldn’t find an account using the info you gave me. Do you already belong to the network?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> I think so?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Sorry, yes or no.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Um, I don’t know ... yes?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Alright. And have you already requested a credentialing application?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Yes.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Sorry could you repeat that.\u003c/em>\u003c/p>\n\u003cp>These experiences did not bode well from Horowitz' perspective.\u003c/p>\n\u003cp>“Honestly, I got a really bad feeling about it,” he says.\u003c/p>\n\u003cp>He figured, if this is what it’s like just finding out if he’s in the network, how’s it going to be when he has a problem with a claim and can’t get paid?\u003c/p>\n\u003cp>“I could just see that getting out of hand really quickly,” he says. “So at that point we just said, do we really even want to do this?”\u003c/p>\n\u003cp>Not just that. The reimbursement rate was even lower than he expected, and the billing was so complicated that he was going to have to hire someone to do it. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Easier said than done. Horowitz hasn’t been able to get through to anyone on the phone to cancel the contract. In the meantime, prospective patients are finding his name on the directory and are calling for appointments. Horowitz says he just has to say no.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Suicide Rates Climb In U.S., Especially Among Adolescent Girls",
"title": "Suicide Rates Climb In U.S., Especially Among Adolescent Girls",
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"content": "\u003cp>In the '80s and '90s, America's suicide trend was headed in the right direction: down.\u003c/p>\n\u003cp>\"It had been decreasing almost steadily since 1986, and then what happened is there was a turnaround,\" says \u003ca href=\"https://www.researchgate.net/profile/Sally_Curtin\" target=\"_blank\">Sally Curtin\u003c/a>, a statistician with the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.\u003c/p>\n\u003caside class=\"pullquote alignright\">Though they make up a very small portion of total suicides, the rate in girls ages 10-14 jumped the most, tripling over 15 years.\u003c/aside>\n\u003cp>The suicide rate has risen by a quarter, to 13 per 100,000 people in 2014 from 10.5 in 1999, according to \u003ca href=\"http://www.cdc.gov/nchs/products/databriefs/db241.htm\" target=\"_blank\">an analysis\u003c/a> by Curtin and her colleagues that was released Friday.\u003c/p>\n\u003cp>She says it's heartbreaking to work with these data. While other causes of death are on the decline, suicide just keeps climbing — and it's doing so for every age group under 75.\u003c/p>\n\u003cp>\"I've been losing sleep over this, quite honestly,\" says Curtin. \"You can't just say it's confined to one age group or another for males and females. Truly at all ages people are at risk for this, and our youngest have some of the highest percent increases.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>There is one age group that really stands out — girls between the ages of 10 and 14. Though they make up a very small portion of the total suicides, the rate in that group jumped the most — it experienced the largest percent increase, tripling over 15 years from 0.5 to 1.7 per 100,000 people.\u003c/p>\n\u003cp>And, Curtin points out, in any given year, there are a lot more suicide attempts than there are suicide deaths. \"The deaths are but the tip of the iceberg,\" she says.\u003c/p>\n\u003cp>Until the suicide trend reversed upward, there had been a number of improvements in the past few decades.\u003c/p>\n\u003cp>In the late '80s, things were probably looking up partially due to \u003ca href=\"http://www.ncbi.nlm.nih.gov/books/NBK54346/\" target=\"_blank\">new antidepressants\u003c/a> that were more effective and had fewer side effects, says \u003ca href=\"http://profiles.columbiapsychiatry.org/profile/maoquendo\">Dr. Maria Oquendo\u003c/a>, a psychiatry professor at Columbia University Medical Center and president-elect of the American Psychiatric Association. \"We saw this very encouraging decrease in suicide deaths,\" she says, and the parallel between antidepressant prescription and a decline in suicide was mirrored in \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3804897/\">other\u003c/a> countries. \"It was really very remarkable, and somehow that trend toward decreasing suicide rates abruptly stopped in 1999.\"\u003c/p>\n\u003cp>What changed? One possibility is economic stagnation, which left more people out of jobs and probably made it harder for people to access health care and treatment. There was also a switch from the use of cocaine and crack to use of \u003ca href=\"http://www.cdc.gov/vitalsigns/heroin/\" target=\"_blank\">heroin\u003c/a> and prescription \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm\" target=\"_blank\">painkillers\u003c/a>, which can be lethal in case of an overdose.\u003c/p>\n\u003cp>And there's also the matter of health insurance — a lot of people weren't covered or didn't have access to treatment for depression, the most common \u003ca href=\"http://afsp.org/about-suicide/risk-factors-and-warning-signs/\" target=\"_blank\">risk factor\u003c/a> for suicide. (Since 2014, however, the Affordable Care Act has \u003ca href=\"http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/\" target=\"_blank\">led to a substantial increase\u003c/a> in insurance coverage.)\u003c/p>\n\u003cp>\"Now, the other thing that we were anticipating with some dread was the aftermath of the black box on antidepressants,\" says Oquendo, referring to a \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2004/ucm108363.htm\" target=\"_blank\">warning label\u003c/a> that in 2004 the Food and Drug Administration required for commonly prescribed antidepressants.\u003c/p>\n\u003cp>The label says that in people under age 26, the medications can actually increase the risk of suicidal thoughts and actions. Research \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1408480\" target=\"_blank\">has suggested\u003c/a> that the warning scared doctors away from prescribing antidepressants to people of all ages.\u003c/p>\n\u003cp>\"And some of the increment in suicide deaths in the younger populations is potentially linked to an understandable reluctance by physicians who see these youngsters to prescribe antidepressants, even when they're aware that the individual is suffering from depression,\" says Oquendo. Research has shown that the benefits of prescribing antidepressants to mentally ill children tend to \u003ca href=\"http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml\" target=\"_blank\">outweigh\u003c/a> the risk of suicidal tendencies.\u003c/p>\n\u003cp>But why such a sharp rise among adolescents, particularly girls? \"We don't know what's going on, to be quite honest,\" says \u003ca href=\"https://www.linkedin.com/in/arielle-h-sheftall-9504bb67\" target=\"_blank\">Arielle Sheftall\u003c/a>, who works at the Center for Suicide Prevention and Research at the Research Institute at Nationwide Children's Hospital in Columbus, Ohio. \"We have thoughts, that maybe it's this, maybe it's that. It's really hard to pinpoint one specific risk factor that really, truly is driving this trend.\"\u003c/p>\n\u003cp>She and her colleagues \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25984947\" target=\"_blank\">study\u003c/a> the risk factors that might push a depressed child or teen to attempt suicide. One \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0193953X08000191\" target=\"_blank\">hypothesis\u003c/a> about what's going on with girls is pretty surprising: earlier puberty.\u003c/p>\n\u003cp>\"It's usually been referred to as the storm-and-stress period of life because there's just a lot of change happening all at one time,\" says Sheftall.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-176694\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM.png\" alt=\"Screen Shot 2016-04-25 at 2.27.51 PM\" width=\"1514\" height=\"1098\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM.png 1514w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM-400x290.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM-800x580.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM-768x557.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM-1440x1044.png 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM-1180x856.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM-960x696.png 960w\" sizes=\"(max-width: 1514px) 100vw, 1514px\">\u003c/p>\n\u003cp>Boys tend to hit peak puberty around 13 years old, and girls around 11 years old, though some studies show that girls are starting their periods earlier.\u003c/p>\n\u003cp>\"Research has shown that puberty, unfortunately, is associated with the onset of psychological disorders, specifically depression,\" says Sheftall.\u003c/p>\n\u003cp>And depression is a big risk factor for suicidal thoughts and actions. So, because of the shifting age of puberty onset, girls might be opening the door to anxiety, depression and other psychiatric disorders earlier on in life.\u003c/p>\n\u003cp>Sheftall and Oquendo say the hypothesis hasn't been carefully studied, but it's possible. Another potential factor is that girls attempting suicide could be using more lethal methods, resulting in more deaths.\u003c/p>\n\u003cp>\"It's frustrating because you want to never ever see these trends increase,\" says Sheftall. \"That's what we kind of have dedicated our lives and research to: What is causing these increases to occur?\"\u003c/p>\n\u003cp>For now, there are still more questions than answers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>If someone shows the \u003c/em>\u003ca href=\"http://afsp.org/about-suicide/risk-factors-and-warning-signs/\" target=\"_blank\">warning signs\u003c/a>\u003cem> of suicide: Do not leave the person alone, remove any firearms, alcohol, drugs or sharp objects that could be used in a suicide attempt, call the U.S. National Suicide Prevention Lifeline at 1-800-273-TALK (8255), and take the person to an emergency room or seek help from a medical or mental health professional.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Suicide+Rates+Climb+In+U.S.%2C+Especially+Among+Adolescent+Girls&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"excerpt": "After a decline throughout the '90s, suicide rates have reversed course. Suicide has increased in almost every age group over the past 15 years.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In the '80s and '90s, America's suicide trend was headed in the right direction: down.\u003c/p>\n\u003cp>\"It had been decreasing almost steadily since 1986, and then what happened is there was a turnaround,\" says \u003ca href=\"https://www.researchgate.net/profile/Sally_Curtin\" target=\"_blank\">Sally Curtin\u003c/a>, a statistician with the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.\u003c/p>\n\u003caside class=\"pullquote alignright\">Though they make up a very small portion of total suicides, the rate in girls ages 10-14 jumped the most, tripling over 15 years.\u003c/aside>\n\u003cp>The suicide rate has risen by a quarter, to 13 per 100,000 people in 2014 from 10.5 in 1999, according to \u003ca href=\"http://www.cdc.gov/nchs/products/databriefs/db241.htm\" target=\"_blank\">an analysis\u003c/a> by Curtin and her colleagues that was released Friday.\u003c/p>\n\u003cp>She says it's heartbreaking to work with these data. While other causes of death are on the decline, suicide just keeps climbing — and it's doing so for every age group under 75.\u003c/p>\n\u003cp>\"I've been losing sleep over this, quite honestly,\" says Curtin. \"You can't just say it's confined to one age group or another for males and females. Truly at all ages people are at risk for this, and our youngest have some of the highest percent increases.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>There is one age group that really stands out — girls between the ages of 10 and 14. Though they make up a very small portion of the total suicides, the rate in that group jumped the most — it experienced the largest percent increase, tripling over 15 years from 0.5 to 1.7 per 100,000 people.\u003c/p>\n\u003cp>And, Curtin points out, in any given year, there are a lot more suicide attempts than there are suicide deaths. \"The deaths are but the tip of the iceberg,\" she says.\u003c/p>\n\u003cp>Until the suicide trend reversed upward, there had been a number of improvements in the past few decades.\u003c/p>\n\u003cp>In the late '80s, things were probably looking up partially due to \u003ca href=\"http://www.ncbi.nlm.nih.gov/books/NBK54346/\" target=\"_blank\">new antidepressants\u003c/a> that were more effective and had fewer side effects, says \u003ca href=\"http://profiles.columbiapsychiatry.org/profile/maoquendo\">Dr. Maria Oquendo\u003c/a>, a psychiatry professor at Columbia University Medical Center and president-elect of the American Psychiatric Association. \"We saw this very encouraging decrease in suicide deaths,\" she says, and the parallel between antidepressant prescription and a decline in suicide was mirrored in \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3804897/\">other\u003c/a> countries. \"It was really very remarkable, and somehow that trend toward decreasing suicide rates abruptly stopped in 1999.\"\u003c/p>\n\u003cp>What changed? One possibility is economic stagnation, which left more people out of jobs and probably made it harder for people to access health care and treatment. There was also a switch from the use of cocaine and crack to use of \u003ca href=\"http://www.cdc.gov/vitalsigns/heroin/\" target=\"_blank\">heroin\u003c/a> and prescription \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm\" target=\"_blank\">painkillers\u003c/a>, which can be lethal in case of an overdose.\u003c/p>\n\u003cp>And there's also the matter of health insurance — a lot of people weren't covered or didn't have access to treatment for depression, the most common \u003ca href=\"http://afsp.org/about-suicide/risk-factors-and-warning-signs/\" target=\"_blank\">risk factor\u003c/a> for suicide. (Since 2014, however, the Affordable Care Act has \u003ca href=\"http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/\" target=\"_blank\">led to a substantial increase\u003c/a> in insurance coverage.)\u003c/p>\n\u003cp>\"Now, the other thing that we were anticipating with some dread was the aftermath of the black box on antidepressants,\" says Oquendo, referring to a \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2004/ucm108363.htm\" target=\"_blank\">warning label\u003c/a> that in 2004 the Food and Drug Administration required for commonly prescribed antidepressants.\u003c/p>\n\u003cp>The label says that in people under age 26, the medications can actually increase the risk of suicidal thoughts and actions. Research \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1408480\" target=\"_blank\">has suggested\u003c/a> that the warning scared doctors away from prescribing antidepressants to people of all ages.\u003c/p>\n\u003cp>\"And some of the increment in suicide deaths in the younger populations is potentially linked to an understandable reluctance by physicians who see these youngsters to prescribe antidepressants, even when they're aware that the individual is suffering from depression,\" says Oquendo. Research has shown that the benefits of prescribing antidepressants to mentally ill children tend to \u003ca href=\"http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml\" target=\"_blank\">outweigh\u003c/a> the risk of suicidal tendencies.\u003c/p>\n\u003cp>But why such a sharp rise among adolescents, particularly girls? \"We don't know what's going on, to be quite honest,\" says \u003ca href=\"https://www.linkedin.com/in/arielle-h-sheftall-9504bb67\" target=\"_blank\">Arielle Sheftall\u003c/a>, who works at the Center for Suicide Prevention and Research at the Research Institute at Nationwide Children's Hospital in Columbus, Ohio. \"We have thoughts, that maybe it's this, maybe it's that. It's really hard to pinpoint one specific risk factor that really, truly is driving this trend.\"\u003c/p>\n\u003cp>She and her colleagues \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25984947\" target=\"_blank\">study\u003c/a> the risk factors that might push a depressed child or teen to attempt suicide. One \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0193953X08000191\" target=\"_blank\">hypothesis\u003c/a> about what's going on with girls is pretty surprising: earlier puberty.\u003c/p>\n\u003cp>\"It's usually been referred to as the storm-and-stress period of life because there's just a lot of change happening all at one time,\" says Sheftall.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-176694\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM.png\" alt=\"Screen Shot 2016-04-25 at 2.27.51 PM\" width=\"1514\" height=\"1098\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM.png 1514w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM-400x290.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM-800x580.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM-768x557.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM-1440x1044.png 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM-1180x856.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/Screen-Shot-2016-04-25-at-2.27.51-PM-960x696.png 960w\" sizes=\"(max-width: 1514px) 100vw, 1514px\">\u003c/p>\n\u003cp>Boys tend to hit peak puberty around 13 years old, and girls around 11 years old, though some studies show that girls are starting their periods earlier.\u003c/p>\n\u003cp>\"Research has shown that puberty, unfortunately, is associated with the onset of psychological disorders, specifically depression,\" says Sheftall.\u003c/p>\n\u003cp>And depression is a big risk factor for suicidal thoughts and actions. So, because of the shifting age of puberty onset, girls might be opening the door to anxiety, depression and other psychiatric disorders earlier on in life.\u003c/p>\n\u003cp>Sheftall and Oquendo say the hypothesis hasn't been carefully studied, but it's possible. Another potential factor is that girls attempting suicide could be using more lethal methods, resulting in more deaths.\u003c/p>\n\u003cp>\"It's frustrating because you want to never ever see these trends increase,\" says Sheftall. \"That's what we kind of have dedicated our lives and research to: What is causing these increases to occur?\"\u003c/p>\n\u003cp>For now, there are still more questions than answers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>If someone shows the \u003c/em>\u003ca href=\"http://afsp.org/about-suicide/risk-factors-and-warning-signs/\" target=\"_blank\">warning signs\u003c/a>\u003cem> of suicide: Do not leave the person alone, remove any firearms, alcohol, drugs or sharp objects that could be used in a suicide attempt, call the U.S. National Suicide Prevention Lifeline at 1-800-273-TALK (8255), and take the person to an emergency room or seek help from a medical or mental health professional.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Suicide+Rates+Climb+In+U.S.%2C+Especially+Among+Adolescent+Girls&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How LSD Makes Your Brain One With The Universe",
"title": "How LSD Makes Your Brain One With The Universe",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Some users of LSD say one of the most profound parts of the experience is a deep oneness with the universe. The hallucinogenic drug might be causing this by blurring boundaries in the brain, too.\u003c/p>\n\u003cp>The sensation that the boundaries between yourself and the world around you are erasing correlates to changes in brain connectivity while on LSD, according to a \u003ca href=\"http://www.cell.com/current-biology/fulltext/S0960-9822(16)30062-8\" target=\"_blank\">study \u003c/a>published Wednesday in \u003cem>Current Biology\u003c/em>. Scientists gave 15 volunteers either a drop of acid or a placebo and slid them into an MRI scanner to monitor brain activity.\u003c/p>\n\u003cp>After about an hour, when the high begins peaking, the brains of people on acid looked markedly different than those on the placebo. For those on LSD, activity in certain areas of their brain, particularly areas rich in neurons associated with serotonin, ramped up.\u003c/p>\n\u003cp>Their sensory cortices, which process sensations like sight and touch, became far more connected than usual to the frontal parietal network, which is involved with our sense of self. \"The stronger that communication, the stronger the experience of the dissolution [of self],\" says Enzo Tagliazucchi, the lead author and a researcher at the Netherlands Institute for Neuroscience.\u003c/p>\n\u003cp>Tagliazucchi speculates that what's happening is a confusion of information. Your brain on acid, flooded with signals crisscrossing between these regions, begins muddling the things you see, feel, taste or hear around you with you. This can create the perception that you and, say, the pizza you're eating are no longer separate entities. You are the pizza and the world beyond the windowsill. You are the church and the tree and the hill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Albert Hofmann, the discoverer of LSD, described this in his book \u003cem>LSD: My Problem Child\u003c/em>. \"A portion of the self overflows into the outer world, into objects, which begin to live, to have another, a deeper meaning,\" he wrote. He felt the world would be a better place if more people understood this. \"What is needed today is a fundamental re-experience of the oneness of all living things.\"\u003c/p>\n\u003cp>The sensation is neurologically similar to synesthesia, Tagliazucchi thinks. \"In synesthesia, you mix up sensory modalities. You can feel the color of a sound or smell the sound. This happens in LSD, too,\" Tagliazucchi says. \"And ego dissolution is a form of synesthesia, but it's a synesthesia of areas of brain with consciousness of self and the external environment. You lose track of which is which.\"\u003c/p>\n\u003cp>Tagliazucchi and other researchers also measured the volunteers' brain electrical activity with another device. Our brains normally generate a regular rhythm of electrical activity called the alpha rhythm, which links to our brain's ability to suppress irrelevant activity. But in a different \u003ca href=\"http://www.pnas.org/content/early/2016/04/05/1518377113.full?sid=4396f1ed-3885-49bd-bab1-21b161793e12\" target=\"_blank\">paper \u003c/a>published on Monday in the \u003cem>Proceedings of the National Academy of Sciences\u003c/em>, he and several co-authors show that LSD weakens the alpha rhythm. He thinks this weakening could make the hallucinations seem more real.\u003c/p>\n\u003cp>The idea is intriguing if still somewhat speculative, says \u003ca href=\"http://www.harboruclapsych.com/charles-s-grob-m-d/\" target=\"_blank\">Dr. Charles Grob\u003c/a>, a psychiatrist at the Harbor-UCLA Medical Center who was not involved with the work. \"They may genuinely be on to something. This should really further our understanding of the brain and consciousness.\" And, he says, the work highlights hallucinogens' powerful therapeutic potential.\u003c/p>\n\u003cp>The altered state of reality that comes with psychedelics might enhance psychotherapy, Grob thinks. \"Hallucinogens are a catalyst,\" he says. \"In well-prepared subjects, you might elicit powerful, altered states of consciousness. [That] has been predicative of positive therapeutic outcomes.\"\u003c/p>\n\u003cp>In recent years, psychedelics have been trickling their way back to psychiatric research. LSD was considered a good candidate for psychiatric treatment until 1966, when it was outlawed and became very difficult to obtain for study. Grob has done work testing the treatment potential of psilocybin, the active compound in hallucinogenic mushrooms.\u003c/p>\n\u003cp>He imagines a future where psychedelics are commonly used to treat a range of conditions. \"[There could] be a peaceful room attractively fixed up with nice paintings, objects to look at, fresh flowers, a chair or recliner for the patient and two therapists in the room,\" he muses. \"A safe container for that individual as they explore deep inner space, inner terrain.\"\u003c/p>\n\u003cp>Grob believes the right candidate would benefit greatly from LSD or other hallucinogen therapy, though he cautions that bad experiences can still happen for some on the drugs. Those who are at risk for schizophrenia may want to avoid psychedelics, Tagliazucchi says. \"There has been evidence saying what could happen is LSD could trigger the disease and turn it into full-fledged schizophrenia,\" he says. \"There is a lot of debate around this. It's an open topic.\"\u003c/p>\n\u003cp>Tagliazucchi thinks that this particular ability of psychedelics to evoke a sense of dissolution of self and unity with the external environment has already helped some patients. \"Psilocybin has been used to \u003ca href=\"http://archpsyc.jamanetwork.com/article.aspx?articleid=210962#ref-yoa05049-27\" target=\"_blank\">treat anxiety with terminal cancer patients\u003c/a>,\" he says. \"One reason why they felt so good after treatment is the ego dissolution is they become part of something larger: the universe. This led them to a new perspective on their death.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Follow Angus Chen on Twitter @angrchen.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+LSD+Makes+Your+Brain+One+With+The+Universe&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Some users of LSD say one of the most profound parts of the experience is a deep oneness with the universe. The hallucinogenic drug might be causing this by blurring boundaries in the brain, too.\u003c/p>\n\u003cp>The sensation that the boundaries between yourself and the world around you are erasing correlates to changes in brain connectivity while on LSD, according to a \u003ca href=\"http://www.cell.com/current-biology/fulltext/S0960-9822(16)30062-8\" target=\"_blank\">study \u003c/a>published Wednesday in \u003cem>Current Biology\u003c/em>. Scientists gave 15 volunteers either a drop of acid or a placebo and slid them into an MRI scanner to monitor brain activity.\u003c/p>\n\u003cp>After about an hour, when the high begins peaking, the brains of people on acid looked markedly different than those on the placebo. For those on LSD, activity in certain areas of their brain, particularly areas rich in neurons associated with serotonin, ramped up.\u003c/p>\n\u003cp>Their sensory cortices, which process sensations like sight and touch, became far more connected than usual to the frontal parietal network, which is involved with our sense of self. \"The stronger that communication, the stronger the experience of the dissolution [of self],\" says Enzo Tagliazucchi, the lead author and a researcher at the Netherlands Institute for Neuroscience.\u003c/p>\n\u003cp>Tagliazucchi speculates that what's happening is a confusion of information. Your brain on acid, flooded with signals crisscrossing between these regions, begins muddling the things you see, feel, taste or hear around you with you. This can create the perception that you and, say, the pizza you're eating are no longer separate entities. You are the pizza and the world beyond the windowsill. You are the church and the tree and the hill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Albert Hofmann, the discoverer of LSD, described this in his book \u003cem>LSD: My Problem Child\u003c/em>. \"A portion of the self overflows into the outer world, into objects, which begin to live, to have another, a deeper meaning,\" he wrote. He felt the world would be a better place if more people understood this. \"What is needed today is a fundamental re-experience of the oneness of all living things.\"\u003c/p>\n\u003cp>The sensation is neurologically similar to synesthesia, Tagliazucchi thinks. \"In synesthesia, you mix up sensory modalities. You can feel the color of a sound or smell the sound. This happens in LSD, too,\" Tagliazucchi says. \"And ego dissolution is a form of synesthesia, but it's a synesthesia of areas of brain with consciousness of self and the external environment. You lose track of which is which.\"\u003c/p>\n\u003cp>Tagliazucchi and other researchers also measured the volunteers' brain electrical activity with another device. Our brains normally generate a regular rhythm of electrical activity called the alpha rhythm, which links to our brain's ability to suppress irrelevant activity. But in a different \u003ca href=\"http://www.pnas.org/content/early/2016/04/05/1518377113.full?sid=4396f1ed-3885-49bd-bab1-21b161793e12\" target=\"_blank\">paper \u003c/a>published on Monday in the \u003cem>Proceedings of the National Academy of Sciences\u003c/em>, he and several co-authors show that LSD weakens the alpha rhythm. He thinks this weakening could make the hallucinations seem more real.\u003c/p>\n\u003cp>The idea is intriguing if still somewhat speculative, says \u003ca href=\"http://www.harboruclapsych.com/charles-s-grob-m-d/\" target=\"_blank\">Dr. Charles Grob\u003c/a>, a psychiatrist at the Harbor-UCLA Medical Center who was not involved with the work. \"They may genuinely be on to something. This should really further our understanding of the brain and consciousness.\" And, he says, the work highlights hallucinogens' powerful therapeutic potential.\u003c/p>\n\u003cp>The altered state of reality that comes with psychedelics might enhance psychotherapy, Grob thinks. \"Hallucinogens are a catalyst,\" he says. \"In well-prepared subjects, you might elicit powerful, altered states of consciousness. [That] has been predicative of positive therapeutic outcomes.\"\u003c/p>\n\u003cp>In recent years, psychedelics have been trickling their way back to psychiatric research. LSD was considered a good candidate for psychiatric treatment until 1966, when it was outlawed and became very difficult to obtain for study. Grob has done work testing the treatment potential of psilocybin, the active compound in hallucinogenic mushrooms.\u003c/p>\n\u003cp>He imagines a future where psychedelics are commonly used to treat a range of conditions. \"[There could] be a peaceful room attractively fixed up with nice paintings, objects to look at, fresh flowers, a chair or recliner for the patient and two therapists in the room,\" he muses. \"A safe container for that individual as they explore deep inner space, inner terrain.\"\u003c/p>\n\u003cp>Grob believes the right candidate would benefit greatly from LSD or other hallucinogen therapy, though he cautions that bad experiences can still happen for some on the drugs. Those who are at risk for schizophrenia may want to avoid psychedelics, Tagliazucchi says. \"There has been evidence saying what could happen is LSD could trigger the disease and turn it into full-fledged schizophrenia,\" he says. \"There is a lot of debate around this. It's an open topic.\"\u003c/p>\n\u003cp>Tagliazucchi thinks that this particular ability of psychedelics to evoke a sense of dissolution of self and unity with the external environment has already helped some patients. \"Psilocybin has been used to \u003ca href=\"http://archpsyc.jamanetwork.com/article.aspx?articleid=210962#ref-yoa05049-27\" target=\"_blank\">treat anxiety with terminal cancer patients\u003c/a>,\" he says. \"One reason why they felt so good after treatment is the ego dissolution is they become part of something larger: the universe. This led them to a new perspective on their death.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Follow Angus Chen on Twitter @angrchen.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+LSD+Makes+Your+Brain+One+With+The+Universe&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Kids' Grades Can Suffer When Mom Or Dad Is Depressed",
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"content": "\u003cp>When parents suffer depression, there can be a ripple effect on children. Kids may become anxious, even sad. There may be behavior problems. Health may suffer.\u003c/p>\n\u003cp>Recently, a large \u003ca href=\"http://archpsyc.jamanetwork.com/article.aspx?articleid=2488039\" target=\"_blank\">Swedish study\u003c/a> showed that grades may decline, too, when a parent is depressed.\u003c/p>\n\u003cp>Using data from 1984 to 1994, researchers from Philadelphia's Dornsife School of Public Health, at Drexel University, measured school grades for more than 1.1 million children in Sweden and compared them with their parents' mental health status. The study was published in a February issue of \u003cem>JAMA Psychiatry.\u003c/em>\u003c/p>\n\u003cp>At age 16, children of mothers who had experienced depression scored about 4.5 percentage points lower in their school grades than children of nondepressed mothers. Similarly, 16-year-olds with fathers who had experienced depression scored about 4 percentage points lower.\u003c/p>\n\u003cp>Even though 4 or 4.5 points may not sound like much, it \"can mean a lot for a student,\" says Drexel epidemiologist \u003ca href=\"http://drexel.edu/dornsife/academics/faculty/Felice%20Le-Scherban/\" target=\"_blank\">Felice Le-Scherban\u003c/a>. It may be the difference between an A grade or a B — or between a D and a C — and small grade differences can add up, sometimes shaping a decision about whether to stay in school or quit.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The quantity and quality of education can make a difference well beyond school years, says Le-Scherban. It's one of the \"strongest predictors of health and life expectancy that we have,\" she says.\u003c/p>\n\u003cp>Studies \u003ca href=\"http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2012/rwjf403347\">show\u003c/a> that better-educated individuals are less likely to smoke cigarettes, drink alcohol or be obese than those who don't finish high school or college. They tend to have a lower risk of heart disease and diabetes.\u003c/p>\n\u003cp>There are a number of reasons why depressed parents can have a difficult time nurturing their children, says epidemiologist \u003ca href=\"https://www.mailman.columbia.edu/people/our-faculty/mmw3\" target=\"_blank\">Myrna Weissman\u003c/a>, of Columbia University Medical Center in New York.\u003c/p>\n\u003cp>\"Just think about the symptoms of depression — the feelings of hopelessness, helplessness, loss of energy, interest in things that usually give you pleasure,\" she says. \"And think about having those symptoms and trying to take care of children.\"\u003c/p>\n\u003cp>The needs and demands of children can be overwhelming even for mentally healthy parents, much less those struggling to cope with depression.\u003c/p>\n\u003cp>\"A parent who's depressed may not arrange an appointment with a teacher; may not have time to go; may not listen to the child; and may not find some solution to problems so that it lingers,\" says Weissman.\u003c/p>\n\u003cp>But, there is a silver lining: Depression is extremely treatable. Weissman has done numerous studies, including one that \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/16551710\" target=\"_blank\">focused\u003c/a> on depressed mothers. \"We showed that at the end of three months, if mom got better, the children got better,\" she says.\u003c/p>\n\u003cp>The women who recovered from depression got interested in their children once again and were more loving and able to show it. Weissman says she heard from children themselves that their mom \"just loves me more and listens to me.\"\u003c/p>\n\u003cp>She and others have found that psychotherapy or medication alone or a combination of the two can be effective treatments, she says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Unfortunately, clinical depression is \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/16203955\" target=\"_blank\">common\u003c/a>, and a large number of adults can be expected to suffer a serious episode at some point in their lives. But even if you've inherited a propensity to depression, Weissman says, you can get diagnosed and \u003ca href=\"http://archpsyc.jamanetwork.com/article.aspx?articleid=2488037\" target=\"_blank\">treated\u003c/a> as soon as possible, to good effect.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Kids%27+Grades+Can+Suffer+When+Mom+Or+Dad+Is+Depressed&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When parents suffer depression, there can be a ripple effect on children. Kids may become anxious, even sad. There may be behavior problems. Health may suffer.\u003c/p>\n\u003cp>Recently, a large \u003ca href=\"http://archpsyc.jamanetwork.com/article.aspx?articleid=2488039\" target=\"_blank\">Swedish study\u003c/a> showed that grades may decline, too, when a parent is depressed.\u003c/p>\n\u003cp>Using data from 1984 to 1994, researchers from Philadelphia's Dornsife School of Public Health, at Drexel University, measured school grades for more than 1.1 million children in Sweden and compared them with their parents' mental health status. The study was published in a February issue of \u003cem>JAMA Psychiatry.\u003c/em>\u003c/p>\n\u003cp>At age 16, children of mothers who had experienced depression scored about 4.5 percentage points lower in their school grades than children of nondepressed mothers. Similarly, 16-year-olds with fathers who had experienced depression scored about 4 percentage points lower.\u003c/p>\n\u003cp>Even though 4 or 4.5 points may not sound like much, it \"can mean a lot for a student,\" says Drexel epidemiologist \u003ca href=\"http://drexel.edu/dornsife/academics/faculty/Felice%20Le-Scherban/\" target=\"_blank\">Felice Le-Scherban\u003c/a>. It may be the difference between an A grade or a B — or between a D and a C — and small grade differences can add up, sometimes shaping a decision about whether to stay in school or quit.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The quantity and quality of education can make a difference well beyond school years, says Le-Scherban. It's one of the \"strongest predictors of health and life expectancy that we have,\" she says.\u003c/p>\n\u003cp>Studies \u003ca href=\"http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2012/rwjf403347\">show\u003c/a> that better-educated individuals are less likely to smoke cigarettes, drink alcohol or be obese than those who don't finish high school or college. They tend to have a lower risk of heart disease and diabetes.\u003c/p>\n\u003cp>There are a number of reasons why depressed parents can have a difficult time nurturing their children, says epidemiologist \u003ca href=\"https://www.mailman.columbia.edu/people/our-faculty/mmw3\" target=\"_blank\">Myrna Weissman\u003c/a>, of Columbia University Medical Center in New York.\u003c/p>\n\u003cp>\"Just think about the symptoms of depression — the feelings of hopelessness, helplessness, loss of energy, interest in things that usually give you pleasure,\" she says. \"And think about having those symptoms and trying to take care of children.\"\u003c/p>\n\u003cp>The needs and demands of children can be overwhelming even for mentally healthy parents, much less those struggling to cope with depression.\u003c/p>\n\u003cp>\"A parent who's depressed may not arrange an appointment with a teacher; may not have time to go; may not listen to the child; and may not find some solution to problems so that it lingers,\" says Weissman.\u003c/p>\n\u003cp>But, there is a silver lining: Depression is extremely treatable. Weissman has done numerous studies, including one that \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/16551710\" target=\"_blank\">focused\u003c/a> on depressed mothers. \"We showed that at the end of three months, if mom got better, the children got better,\" she says.\u003c/p>\n\u003cp>The women who recovered from depression got interested in their children once again and were more loving and able to show it. Weissman says she heard from children themselves that their mom \"just loves me more and listens to me.\"\u003c/p>\n\u003cp>She and others have found that psychotherapy or medication alone or a combination of the two can be effective treatments, she says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Unfortunately, clinical depression is \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/16203955\" target=\"_blank\">common\u003c/a>, and a large number of adults can be expected to suffer a serious episode at some point in their lives. But even if you've inherited a propensity to depression, Weissman says, you can get diagnosed and \u003ca href=\"http://archpsyc.jamanetwork.com/article.aspx?articleid=2488037\" target=\"_blank\">treated\u003c/a> as soon as possible, to good effect.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Kids%27+Grades+Can+Suffer+When+Mom+Or+Dad+Is+Depressed&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"tagline": "Art is where you find it",
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"soldout": {
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