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Health Insurers Are Still Skimping On Mental Health Coverage

Because of low reimbursement rates, Harbin said, professionals in the mental health and substance abuse fields are not willing to contract with insurers

Health Insurers Are Still Skimping On Mental Health Coverage
November 30, 201710:38 AM ET

It has been nearly a decade since Congress passed the Mental Health Parity And Addiction Equity Act, with its promise to make mental health and substance abuse treatment just as easy to get as care for any other condition. Yet today, amid an opioid epidemic and a spike in the suicide rate, patients are still struggling to get access to treatment.

That is the conclusion of a national study published Thursday by Milliman, a risk management and health care consulting company. The report was released by a coalition of mental health and addiction advocacy organizations.

Among the findings:

In 2015, behavioral care was four to six times more likely to be provided out-of-network than medical or surgical care.

Insurers paid primary care providers 20 percent more for the same types of care than they paid addiction and mental health care specialists, including psychiatrists.

State statistics vary widely. In New Jersey, 45 percent of office visits for behavioral health care were out-of-network. In Washington, D.C., it was 63 percent.

The researchers at Milliman examined two large national databases containing medical claim records from major insurers for PPOs — preferred provider organizations — covering nearly 42 million Americans in all 50 states and D.C. from 2013 to 2015.

“I was surprised it was this bad. As someone who has worked on parity for 10-plus years, I thought we would have done better,” says Henry Harbin, former CEO of Magellan Health, a managed behavioral health care company.


What holds us back before we start – From When Hope is Not Enough

The skills I offer in this book are counter-intuitive. They go against many of the things that we have been taught to believe about relationships.

What holds us back before we start

Poor Attachment Leads to Misunderstanding One Another.

I often see on my support list “newbies” who are not teachable. They arrive at the list seemingly willing to listen to the experienced members, yet in reality they subconsciously feel they have it all figured out. The experience of the “old timers” is extraordinarily valuable. In fact, that experience is the greatest asset available on the list. It is why I decided to revise this book to reflect the teaching from the sharing of that experience. Many newcomers to the list are unwilling to listen to guidance from the experienced members. When someone is unable or unwilling to listen to wise advice, this person usually has one of the next few approaches as a hindrance to progress.


Willfulness is the opposite of willingness. If you have an open mind, you have the willingness. You’re teachable. Yet, if your mind is closed and unwilling to listen to suggestions, things will not change. I’ve heard it said that insanity is doing the same thing over and over and expecting different results. To me, that’s a willful, close-minded approach to the Non/BPD relationship.

The skills I offer in this book are counterintuitive. They go against many of the things that we have been taught to believe about relationships. If a concept is alien to your current way of thinking, if you do believe that it will work, only willingness will provide the key to open the closed mind. Without a willingness to listen, to reflect and to experiment with concepts that you may think will never work, nothing will change.

I’ve also heard it said: nothing changes if nothing changes. Nothing changes without willingness and an open mind.

Continue reading What holds us back before we start – From When Hope is Not Enough

Prescription drug abuse leading to more grandparents raising grandchildren

Opiate Abuse

Their daughter had struggled with being bipolar and borderline personality disorder and prescription drug problems and eventually was unable to take care of her two children.

Prescription drug abuse leading to more grandparents raising grandchildren

By Steffi Lee
Published: November 24, 2017, 1:00 pm Updated: November 24, 2017, 5:49 pm

AUSTIN (KXAN) – The bond between grandparents and their grandchildren is unwavering and Gail Gallagher remembers the day more than a decade ago that feeling grew even stronger.

“The older one took the hand of the younger one and said we’re safe now,” Gallagher said.

It was the day Gallagher and her husband, Dr. W. Neil Gallagher, became parents again. Their daughter had struggled with being bipolar and borderline personality disorder and prescription drug problems and eventually was unable to take care of her two children.

Gallagher said the pair decided to step up for the safety of their grandkids, who are now 19 and 20 years old. She said her daughter’s health condition hindered her from being able to make right decisions for the children.

“There were issues beginning to form which put the children in harm’s way – physically and emotionally,” Gallagher said.

The couple went through months of legal challenges but eventually was able to adopt the kids.

Gallagher’s husband said in an interview he was already preparing to sell his business and both were preparing to move to a lake home before the dynamics of their family changed.

“Love is the action to do the right thing, whether you feel like it or not,” Neil Gallagher said.


11 Subtle Signs Your Mom Might Have Borderline Personality Disorder

She can become so disappointed in you, that you feel awful, without really knowing what you can do to improve the situation.

11 Subtle Signs Your Mom Might Have Borderline Personality Disorder


Some people are lucky to have a healthy, loving relationship with their mom. But if that’s never been the case for you, you might be wondering what happened, what went wrong, or why you just can’t get along. While there are countless causes of unhealthy mother-daughter relationships, one possible explanation could be that your mom has borderline personality disorder (BDP).

BPD makes it difficult to have stable relationships — and that can play out in toxic ways between moms and their kids. “It’s really, really hard to have a mom with BPD,” licensed clinical psychologist Natalie Feinblatt, PsyD, tells Bustle. “Primary caregivers of infants are ideally stable and predictable, which is pretty much the opposite of someone with BPD. If your mom never enters treatment specific to BPD it will be difficult, or maybe even impossible, to have a consistently positive relationship with her.”

That’s because this personality disorder is marked by a rigid pattern of unhealthy and abnormal thinking and behaving, and is focused on chronic instability in mood, behavior, relationships, and self-image, Feinblatt tells me. That can, for obvious reasons, truly take a toll on how your mom feels, and how she treats you as a result.

Below, some subtle signs she might have BPD, as well as what you can do to help yourself and your mom.

1. She Constantly Thinks You’re Going To “Abandon” Her

2. She Loves You, Then She Hates You

3. She Has Intense Angry Outbursts

4. She Won’t Back Down During A Fight


Borderline Personality Disorder: Treatment Resistance Reconsidered

A major longitudinal study of BPD and other personality disorders with 16 years of follow-up showed that virtually all subjects with BPD achieve sustained remission for at least 2 years, and 78% sustain remission for 8 years.

Borderline Personality Disorder: Treatment Resistance Reconsidered

November 27, 2017 | Special Reports, Borderline Personality, Psychopharmacology
By Lois W. Choi-kain, MD, Ethan I. Glasserman, and Ellen F. Finch

The concept of treatment resistance deserves reconsideration. Originally formulated in psychoanalytic terms, resistance in treatment referred to the inevitable ways patients unconsciously express their psychology in terms of defense mechanisms and transference enactment. This form of resistance provides a window into the patient’s problems; therefore, it is a major focus of the inquiry and intervention. Modern psychiatry defines treatment resistance as a lack of response to adequate treatment. Both conceptualizations locate treatment resistance within the patient, rather than as a product of limited, underdeveloped, and ineffective treatments. As a result, the term “treatment resistant” can fuel views of patients as “oppositional” and recalcitrant, instead of expectably symptomatic.

Treatment resistance is highly prevalent across most psychiatric disorders—even in common diagnoses generally associated with positive outcomes, such as depression. There are many more obstacles to effective treatment (Figure 1) than the patient’s psychological resistance alone. Identification of specific factors that diminish treatment response may provide more useful points of intervention than the label of treatment resistance.

Comorbid disorders contribute to poor treatment response. Treatment guidelines are often based on a false assumption that patients present with single disorders that respond to specific evidence-based treatments. Regardless of increasing attention to problems of comorbidity, guidelines for combining and prioritizing the treatment of different diagnoses remain largely underdeveloped.

Comorbid personality disorders complicate treatment. Over 50% of patients in specialized psychiatric settings have personality disorders.1 These patients are more likely to face social adversity, suffer from complex comorbidities, and drop out of treatment or not adhere to medication regimens—all of which contribute to an increased risk of a lack of response to treatment. The presence of a personality disorder, particularly borderline, predicts persistence of anxiety and substance use disorders as well as poorer outcomes in depressive disorders. Moreover, 13% of those who complete suicide have personality disorders.2


Why giving your mental illness a name can help you recover

Being diagnosed with a mental illness can be life-changing.

Why giving your mental illness a name can help you recover

Fiona Thomas for
Sunday 5 Nov 2017 8:00 am

Studies show that one in four people have been diagnosed with a mental illness at some point in their lives, but how does the diagnosis itself impact the individual?

You would think that labeling someone with a mental illness might illicit a negative response, and maybe even make their symptoms worse.

But Dr Jelena Goranovic, Director at the Sussex Wellbeing Company, confirms that there are positive aspects when someone receives a formal diagnosis. Dr Goranovic says you may be ‘feeling like you’re not alone and that others are on the same boat with you’ and that naming your condition ‘helps you feel more ‘normal”.

She suggests that patients may also be in a better position to receive treatment from a GP, support group or access financial support. ‘Once there is a diagnosis, it’s easier to get help.’

Ali Strick has been diagnosed with borderline personality disorder, but only after years of struggling internally with the mental illness. ‘I spent many years thinking I was a bad person who was going off the rails but to know I was sick and not bad was comforting, and to know other people felt the same was comforting.’