treatment/medical care: how to pay?

[rocket]

Not sure which is the best forum for this question...but to receive therapy and medical help one must be able to pay for it. How do those with mental health conditions and low or no income deal with medical costs? Need advice. Daughter is adult and my employer no longer covers her. I could continue with Cobra but that is still going to be very expensive with a big out of pocket...do I just let her fend for herself with the local mental health center, and emergency room services when needed? It is a horrible choice to have to pay 4,000 per year for a premium and still have a 1.500 deductible.. But of course if she needs hospitalization for an extended time, it would be worth it. Or would it be just as well to rely on community health centers with sliding scales? I am full of conflict about what would be the best thing to do. Any advice is appreciated. We live in Colorado.

[weezie]

Hi,

How are you? I hear the pain in your voice as you struggle with finding the best care for your daughter. I do want you to know that this is an issue most of us face and your daughter will most likely face for life. I have part of my fee's covered through Medicare. I worked for many years, so now that I am totally disabled I have disability benefits-I am poor. Your daughter may also qualify for benefits depending upon her situation.

Actually, what I wanted to tell you though, is that I receive wonderful care through our sliding scale clinic. Most adults here who have mental illness use this clinic and that means that they actually have a ton of knowledge and experience. Mental illness is very different from simply having "issues" and I know that finding the right medications takes a real commitment from the person involved and most likely will take numerous medication changes. The same things don't work for everyone. I am hoping that your child is as committed to getting and staying well as you sound for them. I am afraid that as an adult, if they are not, you may not have a lot of success. I will also tell you though, that family support and understanding are huge and a key piece in any wellness plan. She/he is very lucky.

W

[rocket]

Dear Weezie:

Thanks for your support and encouragement. It is good to hear that your sliding scale community mental health center provides good service.

I, too, relied on our county mental health center for therapy years ago, and I had very good experiences there...but I was never on medication.

My fear is that there may be a high turnover of mental health practitioners due to low wages and other conditions, so that patients may not be able to establish a long term relationship which I think is so important.

So much emotion in the past few months since the crisis. I am now in a stage of letting go and giving up, especially considering that she has moved out and is not sharing my living space anymore. The "giving up" is not losing hope but realizing that it is in her hands and it won't do me much good to keep urging her to get help at this point. I did a lot of research and gave her a lot of info, and she is more than aware of what I think she should do.

But I am so heavy hearted still, and very very sad. I cry easily thinking about it. I have bad memories of things I said in anger, mistakes I made. All of that guilt which is mine to deal with. I only hope she will be brave and dare to face her problems head on, admit she needs help and be successful at managing her disease. It is so hard to accept that bipolar is a disease when she seems so normal in so many ways. That's another subject...

Thanks again.

[weezie]

First let me say that you may well be right that she may not have a terribly long term relationship with her Pdoc, but may well with her therapist. Usually your Pdoc appointments are brief and set up to deal with medication issues only. The Pdoc is focused on medication. Not as great a loss if they don't stay as long, because you don't have the same type of relationship that you do with your therapist.

Next let me say that you must not take on responsibility for your childs illness. She got bad genes because you or her other parent got bad genes. This is a genetic illness and even if they haven't been diagnosed, I am sure there are other people in your family tree's who also have this illness. Many times it looks like a drug or alcohol issue, because a lot of people use substances to deal with it.

Were there probably times when you said things in anger you shouldn't have? Times you were too busy to be as supportive as you could have been? etc. etc. Yes, I am sure there were. That is part of having a relationship with another person.

Do not ever give up your love and support, but do give up responsibility for your adult child and the choices they make. This is something that is not within your control. You can make suggestions, but unless you feel that she is a danger to herself or others, there isn't much you can do.

Just know that if your child has this disorder, she is probably very bright, very creative and very sensitive to others. The illness is a physical illness that affects the brain. This isn't caused by poor parenting, her inability to cope, etc. etc. It doesn't even mean she has "issues" as you can have the illness without having "issues." The illness can cause issues, granted. You would not blame yourself if she had diabetes and you wouldn't feel that she was less than "normal" if she had diabetes. Anyway, I am rambling along, but know that I will be happy to listen when you need to talk. I am both a person who deals with this disorder AND a parent of adult children.....so can relate on both levels. Hugs to you. I think that you must be a wonderful parent.

[weezie]

Hi all,

I wanted to share a couple of links with you. The first is a really good article because it discusses all of the brain abnormalities that are normally seen in Bipolar disorder. I post this because I think that we are all busy blaming ourselves, our parents, our significant others at times and we really just need to focus on the fact that we are dealing with a physical illness and how do we manage those symptoms and what types of things might help us to better function in the workplace/world in general. I am sure that many of you may have already seen or read these, but for those who haven't, I hope it may be of help in some way.

http://bjp.rcpsych.org/cgi/content/full/196/3/245-b

patients with bipolar disorder are characterised, in comparison with healthy controls, by significant reductions of whole-brain and prefrontal lobe volumes and by enlargement of lateral ventricles and globus pallidus, although most of the brain changes detected in bipolar disorder do not seem to be diagnostically specific and some clinical variables, such as patients’ age, duration of illness and pharmacological treatment, appear to be relevant in determining the magnitude of observed effect sizes.

Next is the part I want to quote because it says it all in very plain English:

http://psychcentral.com/news/2011/05/04/possible-brain-biomarkers-for-bipolar-disorder/25908.html

involving 443 bipolar disorder patients and 551 mentally healthy controls.

Compared with controls, patients with bipolar disorder had decreased activity and/or reduction in gray matter volume in the right inferior frontal gyrus, the right superior frontal gyrus, the anterior cingulate, and the precuneus. These areas are a cortical-cognitive brain network associated with the regulation of emotions, the researchers noted.

On the other hand, bipolar patients also had increased activity in ventral-limbic brain structures (the parahippocampal gyrus and the amygdala) compared with controls. These brain areas mediate the experience of emotions and generation of emotional responses, observes the team.

“These results support and refine previously proposed neurobiological models of the disorder and suggest that an imbalance between cortical-cognitive and limbic brain networks may serve as a neurobiological marker of bipolar disorder,” Wessa said.

http://http://bipolar.about.com/cs/menu_science/a/press_umich0210.htm

The scans let them see the density of cells that release the brain chemicals dopamine, serotonin and norepinephrine.

These monoamines, as the chemicals are called, send signals between brain cells, or neurons. They're involved in mood regulation, stress responses, pleasure, reward, and cognitive functions like concentration, attention, and executive functions. Scientists have hypothesized their role in bipolar disorder for decades, but have never proven it.

The new University of Michigan result points to a clear difference in the density of monoamine-releasing cells in the brains of bipolar people even when they are not having symptoms. and later in the same article:

found that bipolar patients averaged 31 percent more binding sites in the region known as the thalamus, and 28 percent more in the ventral brain stem. In the thalamus, bipolar women actually had levels nearing those of healthy comparison subjects, but bipolar men had a 42 percent higher binding rate, suggesting that there may be specific biological causes for the clinical differences in the course of the illness in men and women.

Adding in the results of functional tests, they found that the more monoamine cells patients had, the lower their scores on tests of executive function and verbal learning. This finding confirms earlier results from research at the University of Michigan, and suggests that the altered brain chemistry due to the excess monoamine cells may directly impact the patients' cognitive and social function.

Thanks for being here to share this journey

W

[weezie]

The post above points to why this is a physical illness that affects how things are felt, how those feelings are interpreted, executive function such as planning and carrying through on things and verbal functions as in how we relate to and understand others. That is a lot of your brain function to have affected by one illness, but hopefully will help guide you in dealing with your loved one and also help you to understand that this isn't about parenting or lack thereof or "quality time" or her just plain having issues. I am sure that she is doing the best that she can right now with the abilities that she has. It is just that the emotional content/problems can be so very, very painful. I truly believe that aside from medication attending a class called wellness recovery action planning as set up by Mary ellen copeland is one of the most positive things that you can do for your illness. Hugs!

W