From Bloomberg…

Mental Health Coverage Expanded by Rescue Package (Update2)
By Aliza Marcus

Oct. 3 (Bloomberg) — Health insurers that provide mental- health benefits will be barred from providing less coverage than they do for other medical services under the $700 billion financial-markets rescue package approved by Congress.

The plan was backed by a 263-171 vote in the House of Representatives today and signed by President George W. Bush. The package incorporates a measure requiring so-called mental health parity for health plans enrolling more than 50 employees.

“Aren’t we all pleased across America that this legislation includes the mental health parity act?” House Speaker Nancy Pelosi, a California Democrat, said in a speech before the vote.

The mental-health measure was among provisions added to the financial rescue package to win support after the House initially rejected the bailout legislation. The Senate, which supported the expansion of mental health coverage benefits in tax legislation passed last month, approved the revised financial rescue plan on Oct. 1.

“It seemed like it was getting lost after the bailout issue arose, but now with this bill it’s just happened,” said Steve Vetzner, spokesman for the Mental Health America advocacy group in Alexandria, Virginia. “This has been a long struggle and long fight.”

The act is intended to eliminate what supporters call unequal access to care from insurers that set higher co-payments and other limitations on services such as mental health counseling compared with physical ailments.

$3.4 Billion

The House and Senate previously disagreed about how to cover the cost to the federal government of the expanded benefit, estimated at $3.4 billion over five years by the Congressional Budget Office in 2007.

The estimate is related to tax revenue that would be lost because employers would pay more for health insurance premiums, to cover the expanded benefits, instead of turning over some of this money as taxable wages to employees.

Health insurers and businesses worked with Congress on the measure, which built up wide support from stakeholders in the health-care field, said Aetna Inc. Chief Executive Officer Ronald Williams in a statement on Business Wire.

“They had a deal for a long time,” said Kim Monk, an analyst at Capital Alpha Partners, in Washington, in a telephone interview. “The challenge was how to off-set the cost,”

Employers will now be looking for well-managed mental health networks to help them reduce costs associated with implementing the legislation, Monk said. “Not all insurers have this, so they may have to beef it up.”

To contact the reporter on this story: Aliza Marcus in Washington at amarcus8@bloomberg.net

Last Updated: October 3, 2008 15:26 EDT

Bon Dobbs :: Oct.06.2008 :: Resources, Treatment :: 1 Comment »

This is an editorial from the NY Times…

October 1, 2008

Editorial

Oh So Close to Mental Health Parity

Congress is within a whisker of passing a sound and fair-minded bill to require that group health insurance coverage for mental illness and substance abuse be provided on the same terms as coverage for physical illnesses. It would be a shame if the legislation, which caps more than a decade of struggle to achieve mental health parity in insurance coverage, were allowed to die while Congressional energies are focused on the all-consuming economic crisis.

The bill would not require employers or health plans to cover mental illness or drug or alcohol abuse. But if they do, the treatment limits and financial requirements could be no more restrictive than those that apply to medical or surgical benefits. A 1996 law had required parity in setting annual and lifetime spending limits, but insurers found ways to circumvent it. The new bill closes loopholes by requiring parity in deductibles, co-payments and out-of-pocket expenses — and in setting treatment limitations, such as the maximum number of doctor visits and days of coverage allowed.

The bill is endorsed by President Bush, business groups, insurance companies, the medical community and mental health advocates. Both the House, in a stand-alone bill, and the Senate, as part of a broader tax relief bill, have approved it by large margins. But it requires a final shove because the measure is snarled in a broader legislative struggle over how to pay for tax revenues that would be reduced by this measure and others. Is there a statesman who can push this worthy parity legislation through to final passage before adjournment?

Bon Dobbs :: Oct.01.2008 :: Resources, Treatment :: 1 Comment »

Many times I’ve seen Non-BPs mention that couples counseling doesn’t really work for them. One member of an Internet support list I used to be a member of posted a message about his BP “snowing” the couple’s therapist. In fact, just about every message (of hundreds) was about this subject. Clearly, Non-BPs are upset about the dynamics of couple’s counseling and feel that they get “dumped on” by the BP. The Nons end of feeling blamed for everything. When this subject came up in the ATSTP group recently, I turned to a knowledgeable member about this subject. She posted the following message (which I’ve edited slightly because I wanted to remove any reference to others in the group). BTW, I don’t normally repost messages from the group here on my public blog - I only do so when the message contains as much wisdom as this one does, doesn’t contain any identifyable “marks” and is not “personal” in nature.

Well, my experience has been that marital counseling doesn’t really help
much when a BP is involved, because counselors really don’t understand the
dynamics of BPD.  While their goal is to promote better communication
between partners, they tend to focus on resolving the complaints.
Of course, BPs have LOTS of complaints (which
really are not the problem), so nons just end up feeling attacked… even by
the counselor at times.  When counselors do this, it tends to validate the
BPs feeling that their nons really are the problem.  It sometimes even
leaves the non feeling like he/she really is the problem.

I suspect you may want to continue this “counseling” approach, since it is
SOMETHING your BP has agreed to.  If so, my suggestion would be for you to
be as honest as possible with the counselor about YOUR FEELINGS.  Don’t
waste your time (and money) defending against your BPs accusations and don’t
point fingers back.  (This only makes you look bad to the counselor… like
you never let your BP talk or express himself… ha!, I know!)  Simply ASK
for advice on how to communicate better (since that is the goal of the
counselor to get you communicating with one another.)  Try the suggestion a
few times, and if it doesn’t work, then you can come back the following
session and express your disappointment and confusion about why it isn’t
working.  Eventually, after enough times of doing this, your counselor will
(hopefully) recognize that he/she cannot help you and will refer you to
someone more qualified (like a DBT specialist, if your lucky enough to have
one of those in your area.)

My only comment on this statement - which is wonderful IMO - is the idea that the complaints are “not really the problem.” If those complaints are not really the problem, what is? Well, I believe it is that the BP FEELS bad (negative emotions) and judged (so they judge back). I think if someone who DOES understand the dynamics of BPD works with a couple, the therapist can hopefully deal with the real issue: the painful emotions.

Bon Dobbs :: Sep.05.2008 :: Blame, Treatment, Emotions, Borderline Personality Disorder :: No Comments »

The  next “Telephone Hour” put on by the National Education Alliance for Borderline Personality Disorder (NEA-BPD) focuses on partners. Here is the notice put out by the NEA-BPD:

Alan E. Fruzzetti, Ph.D., author of The High Conflict Couple: A Dialectical Behavior Therapy Guide to Finding Peace, Intimacy, & Validation, (foreword by Marsha Linehan, Ph.D.), will be the keynote Presenter on the NEA- BPD Call-In Hour on Friday, July 11 at 6-7 pm EST. Dr. Fruzzetti is Associate Professor of Psychology at the University of Nevada, Reno. He is also the Director of the Dialectical Behavior Therapy and Research Program there, which treats adolescents, adults, couples and families with BPD and related problems.

Registration is limited to allow participation in dialogue and pre-registration is required. To reserve your spot, please register today by going to NEABPD.org.

Bon Dobbs :: Jul.08.2008 :: Resources, Treatment, Borderline Personality Disorder :: No Comments »

Ignored Psych patient dies in NY hospital….

Ignored Psych Patient Dies on Hospital Floor

Video Shows Death in NYC Hospital Already Faces a Lawsuit for ‘Squalid’ Psych Care

By DAVID SCHOETZ

July 1, 2008—

Even pared down to a few minutes, the hour-long surveillance video is disturbing.

At 5:32 a.m. June 19, a woman in a hospital gown in the waiting area of the psychiatric emergency room of a New York City hospital topples first to her knees before collapsing on her face.

A full hour passes. Other people stream in and out of the waiting room, including hospital security guards. The woman writes something on the ground before going completely still. Finally, someone takes notice and alerts the staff. But by then, at 6:36 a.m., the woman is already dead.

The woman, 49-year-old Esmin Green, died on the floor of the waiting room at the Kings County Hospital Center Psychiatric Emergency Department. Her exact cause of death has not been released.

The native of Jamaica, who had been waiting for a bed when she collapsed, had been involuntarily admitted the previous day for “agitation and psychosis,” according to the City Health and Hospital Corp., which acknowledged June 20 that Green had been left unattended on the ground for an hour.

Alan Aviles, the president of the Health and Hospital Corp., had already announced that six hospital employees, including staff members who oversee patient care and security, face disciplinary action for their lack of response. Two of the employees were fired, while four unionized staff members must go through termination proceedings.

The hospital, in the Brooklyn borough of New York City, may have a much bigger problem on its hands. In May, Kings County Hospital was targeted in a federal lawsuit by three organizations that described hospital conditions as “inhumane.” Attorneys for the plaintiff released the footage of Green’s death Monday night to illustrate in brutal detail some of the allegations made in the suit.

The Mental Hygiene Legal Service, New York Civil Liberties Union and Kirland & Ellis LLP filed the lawsuit after an investigation at the hospital “showed that Kings County psychiatric facilities are overcrowded and often dangerously unsanitary and that patients — including children and the physically disabled — are routinely ignored and abused,” according to the groups’ May 3 release announcing the suit.

The groups claim that alleged mistreatment of patients at the hospital is a violation of the federal Americans With Disabilities Act as well as several New York State provisions that guarantee the delivery of mental health services in a safe and sanitary manner.

Aviles is named as one of the lead defendants in the 36-page suit, which specifically cites five patients, all with some type of disability, who allege “abusive and neglectful” treatment at Kings County.

One patient, L.D., claimed that she was laughed at when she asked to call her family and was placed in a bed with soiled sheets. Another patient, identified as J.P., said that she had to sleep sitting up in a wheelchair after she got up in the night to use the bathroom and returned to find another patient in her bed.

The New York Daily News reported that in addition to the neglect in Green’s case, staff members entered false information into her medical chart during the hour in which she lay on the ground to cover up the lack of treatment.

At 6 a.m. on the morning of her death, according to the Daily News, Green’s medical chart reportedly listed the patient as “awake, up and about, went to the bathroom.” Green had been in the same spot on the ground for more than a half-hour. At 6:08 a.m., she stopped moving, according to the footage. But her chart described her at 6:20 a.m. as “sitting quietly in the waiting room.” In reality, she may have already been dead.

Ana Marengo, a spokeswoman for the Health and Hospital Corp., would not address the exact entries in Green’s medical chart, but did say, “There appears to be some discrepancies” that have been forwarded, along with the entire case, to various New York City investigative departments.

“It is clear that some of our employees failed to act based on our compassionate standards of care,” administrators wrote in a statement last night that followed the video’s release.

Hospital administrators outlined a series of improvements already made to the Kings County psychiatric program, including the addition of staff and expanding space to cope with overcrowding. They pledged a series of improvements, including the appointment of an “interim administrator” who will report directly to Aviles, and a guarantee that patients in the psychiatric emergency unit will be checked on every 15 minutes.

In June, USA Today reported that nearly 80 percent of hospitals said that mentally ill patients sometimes wait up to four hours or more for emergency care, citing a study by the American College of Emergency Physicians that surveyed 328 emergency medical directors.

Physicians blamed the delayed care on shrinking budgets that have prompted many hospitals to either consolidate mental health services or shut them down completely. Since 2000, the number of psychiatric beds has dropped 12 percent, according to the medical organization’s statistics.

Copyright © 2008 ABC News Internet Ventures

Bon Dobbs :: Jul.01.2008 :: Odds and Ends, Treatment :: 1 Comment »

From USA Today…

Mentally ill face extra-long ER waits

By Julie Appleby, USA TODAY

Psychiatric patients who need hospitalization wait for hours in emergency departments for admission because hospitals are dropping mental health units and beds are scarce, a new survey says.

Nearly 80% of hospitals said mentally ill patients sometimes wait four hours or more to be admitted, says the American College of Emergency Physicians, which surveyed 328 emergency medical directors. About 10% said patients wait more than a day on average.

Average admission times for non-psychiatric patients were shorter: Only 30% of directors said those patients waited four hours or more. Yet 84% of the medical directors said ER wait times for all patients would drop if their hospitals had better psychiatric services.

Only half of the hospitals surveyed had psychiatric units. The rest transferred patients, sometimes far from homes and families. Hospitals are closing their units because of inadequate payments from government and insurers, unpaid costs for the uninsured and too few psychiatrists willing to work in hospitals, says James Bentley of the American Hospital Association.

Patients with mental illness “are the ones we hold the longest because there are so few psychiatric services available, and the ones that are available are overwhelmed,” says David Mendelson, of the physicians group.

The long waits can be troublesome for mentally ill patients, says Bruce Schwartz, director of psychiatry at Montefiore Medical Center in the Bronx, N.Y. “For individuals in need of admission because they’re psychotic or severely depressed, it can be a very uncomfortable, scary, disorienting time.”

The survey found 61% of hospitals do not have psychiatry staff caring for ER patients while they wait, although they receive treatment for other medical problems.

The poll comes amid growing concern about wait times and overcrowding in the nation’s ERs, which experienced a 14% jump in visits for all illnesses and injuries from 2001 to 2005.

Since 2000, the number of psychiatric beds in U.S. community hospitals dropped 12%, the association’s statistics show. The number of hospital beds overall fell 4%.

In March, the closure of Santa Rosa Memorial Hospital’s psychiatric unit left California’s Sonoma County without hospital-based care for mentally ill patients. Now patients must be taken 40 miles or more away to other hospitals.

“It’s not unheard of for people to spend a night or even a couple of nights (in the ER),” says Sonoma County Mental Health Services Director Art Ewart.

Bon Dobbs :: Jun.23.2008 :: Treatment, Borderline Personality Disorder :: 1 Comment »

Here is a study conducted by the University of Iowa and developer of STEPPS. The STEPPS program stands for:

Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up.

Blum N, St John D, Pfohl B, Stuart S, McCormick B, Allen J, Arndt S, Black DW.

Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.

OBJECTIVE: Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a 20-week manual-based group treatment program for outpatients with borderline personality disorder that combines cognitive behavioral elements and skills training with a systems component. The authors compared STEPPS plus treatment as usual with treatment as usual alone in a randomized controlled trial. METHOD: Subjects with borderline personality disorder were randomly assigned to STEPPS plus treatment as usual or treatment as usual alone. Total score on the Zanarini Rating Scale for Borderline Personality Disorder was the primary outcome measure. Secondary outcomes included measures of global functioning, depression, impulsivity, and social functioning; suicide attempts and self-harm acts; and crisis utilization. Subjects were followed 1 year posttreatment. A linear mixed-effects model was used in the analysis. RESULTS: Data pertaining to 124 subjects (STEPPS plus treatment as usual [N=65]; treatment as usual alone [N=59]) were analyzed. Subjects assigned to STEPPS plus treatment as usual experienced greater improvement in the Zanarini Rating Scale for Borderline Personality Disorder total score and subscales assessing affective, cognitive, interpersonal, and impulsive domains. STEPPS plus treatment as usual also led to greater improvements in impulsivity, negative affectivity, mood, and global functioning. These differences yielded moderate to large effect sizes. There were no differences between groups for suicide attempts, self-harm acts, or hospitalizations. Most gains attributed to STEPPS were maintained during follow-up. Fewer STEPPS plus treatment as usual subjects had emergency department visits during treatment and follow-up. The discontinuation rate was high in both groups. CONCLUSIONS: STEPPS, an adjunctive group treatment, can deliver clinically meaningful improvements in borderline personality disorder-related symptoms and behaviors, enhance global functioning, and relieve depression.

Bon Dobbs :: Jun.10.2008 :: Treatment, Borderline Personality Disorder :: No Comments »

 Here’s an article on mentalization based therapy (MBT). A snip:

The study, “8-Year Follow-Up of Patients Treated for Borderline Personality Disorder: Mentalization-Based Treatment Versus Treatment as Usual,” is the latest analysis of a randomized trial first reported in AJP in October 1999 and titled “Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial.”

Joel Paris, M.D., an expert on BPD, explained that mentalization therapy, developed by Bateman and Fonagy in the 1990s, is based on attachment theory and on observations that BPD patients have a failure of “mentalization”—the ability to observe their own emotions and those of other people and to appreciate how their behavior may affect others.

“Mentalization-based therapy can be considered as an amalgam of psychodynamic and cognitive methods,” he told Psychiatric News.

For instance, a case report included in the study describes a 24-year-old woman who was referred from forensic services after her arrest for setting fire to her university dormitory.

She had a history of recent suicide attempts and regularly burned herself with cigarettes and a hot iron. In individual sessions, treatment initially focused on clarifying her own feelings and others’ experience of her; later it progressed to helping her appreciate how her experiences of self-doubt and emotional turbulence led to a sense of fragmentation that was controlled only by experiences of intense physical pain, according to Bateman and Fonagy.

“The individual therapist identified these processes while focusing on the way she represented her own mental states and those of others with whom she interacted,” they wrote. “Gradually this was explored within the relationship with the therapist.”

They report the patient as stating, “It never occurred to me that what I did had an effect on anyone else.”

I have to say the suicide figures are astounding, especially when it comes to attempts. I mean, over 80% in two of the categories!

Bon Dobbs :: May.14.2008 :: Suicide, Resources, Treatment, Self-Injury, Borderline Personality Disorder :: No Comments »

A few months ago a member of my Google Support List for Non-BP’s issued me a challenge. I have noticed that many people with BPD abuse prescription drugs, particularly anti-anxiety medication. Mainly the abuse seems to be of benzodiazepines (aka benzos) which include Xanax (generic alprazolam), Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam) and others (although those seem to be the most popular). I listened to a podcast by a psychiatrist who treats borderline patients. He says almost all of them eventually ask for Xanax.

Xanax has to be the absolute worst drug to treat BPD. Why?See the results of these (rather old) studies:

Alprazolam (benzodiazepine)

Gardner, D.L. & Cowdry, R.W.
Am. J. Psychiatry. 1985 - Alprazolam-induced dyscontrol in borderline personality disorder.
The short-acting benzodiazepine alprazolam has been associated with precipitating serious dyscontrol in one placebo-controlled crossover study of patients with BPD
The authors suggest that caution be used in prescribing alprazolam to patients with similar histories.

Alprazolam (benzodiazepine) / carbamazepine and trifluoperazine and tranylcypromine.

Cowdry RW, Gardner DL. - Intramural Research Program, National Institute of Mental Health, Bethesda
Arch Gen Psychiatry. 1988 - Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine.
Physicians rated patients as significantly improved relative to placebo while receiving tranylcypromine and carbamazepine. Patients rated themselves as significantly improved relative to placebo only while receiving tranylcypromine. Patients who tolerated a full trial of trifluoperazine showed improvement, those receiving carbamazepine demonstrated a marked decrease in the severity of behavioral dyscontrol, and those receiving alprazolam had an increase in the severity of the episodes of serious dyscontrol

My wife has gotten much better since I started on this quest of learning about BPD and what, as a loved one, I can do about it (and what I can’t). Yet, she still over-medicates on benzos. So, my list member basically issued me a challenge to see if there is anything I can figure out to do to reduce the pill taking. One member of the list locks up his wife’s pills and doles them out when she needs them. I hesitate to follow his example because I don’t want to be in the position of being my wife’s keeper. Plus, in the past when I have held her pills for her (usually at her request), I have been raged at for “hiding” or “stealing” them (neither of which I do).

Here is my question/challenge: Have any of you been able to come up with an effective way to reduce over-medicating on benzos? That question goes out to the people with BPD (if you have found a way yourself) and to the family members (if you have found a workable solution). This area is one where I have made little head-way and would like some help.

Thanks.

Bon Dobbs :: May.14.2008 :: Treatment, Substance Abuse, Borderline Personality Disorder :: 12 Comments »

I have created a new version of my book, which fixes some typos and clarifies some points. I also was able to drop the price! It’s now $19.95, instead of $20.95. Since it got 3 pages shorter, I will be able to make a decent profit at the lower price. That price anticipates the cost it will have to be when I get it on Amazon (shortly).

Anyway, I suggest you check out the preview, and pick up a copy (shameless self-promotion). You can see the preview or buy the printed or downloadable version of When Love is Not Enough at Lulu.com.

If you are one of my readers with BPD, I would suggest getting a copy for anyone with whom you’d like to have an on-going relationship. Why? Because this book teaches a “Non-BP” the attitudes and tools to be more effective and more validating toward someone with BPD. The purpose is to rebuild the lines of communication. Like I said in a previous post (or comment), if I can quote myself here:

The BP/Non-BP relationship seems to me to be one of misunderstanding and miscommunication. I hope that I can help each learn the language of the other. And I agree most public awareness is important - BUT it has to be the right kind of awareness - not the “stay away from these people” or “these people are evil” kind.

Enjoy!

Bon Dobbs :: May.13.2008 :: Pain, Treatment, Boundaries, DBT-FST, Resources, Impulsiveness, Suicide, Shame, Mindfulness, Validation, Lying, Manipulation, Self-Injury, Emotions, Substance Abuse, Parenting, DBT :: No Comments »