Dr. Henry Paul, MD

Psychiatrist, Author and Educator

PSYCHIATRY HOSPITAL CARE AND INSURANCE COMPANIES

December 30th, 2014

When insurance companies deny treatment for the mentally ill, it can be devastating to patients and difficult for doctors to prescribe treatment. It can also be tragic. CBS 60 Minutes ran a segment in early December that looked precisely at the role that insurance carriers play in the treatment of patients.

Scott Pelley, who did the interview for 60 Minutes, interviewed the mother of 14-year-old Katherine West, who had bulimia that was supposedly rooted in deep depression. Her mother, Nancy West, had said that her daughter had also been a “cutter.” West’s daughter was recommended for a twelve-week hospital program that would cost nearly $50,000. Against the recommendations of her doctor, the insurance company pushed for Katherine West to be released after only six weeks. She came home as an outpatient. She died shortly after arriving home.

“Did it make sense to you that a doctor at the insurance company was making these decisions based on telephone conversations?” Pelley asked in the interview.

“No. No, they didn’t observe my daughter. You’re talking about a psychiatrist, a pediatrician, a therapist who observed my daughter on a daily basis. But some nameless, faceless doctor is making this decision. And I was furious. Because to me he was playing God with my daughter’s life,” said Nancy West to Pelley.

27354900_s (2)What is frustrating about the Katherine West story is that an insurance company doctor who had never seen her was making the decision on the best course of treatment. As a practicing psychiatrist, I know that insurance companies are dictating hospital admission and discharge. It has become more difficult for me to get people admitted under the policies defined by the insurance companies — policies that lend themselves more and more towards non-hospitalization. When I do get a patient admitted I also find that insurance carriers are shortening the length of stay, just like in the case of Katherine West.

What is at issue here is the overall health and welfare of the patient. I find the decrease in admission to be a folly since patients are often discharged before even the effectiveness of the prescribed medication can even have an effect. These patients are not even in the hospital long enough for deep exploration of the psychological/social circumstances that brought them there in the first place.

Worse, when they are discharged early and without a full course of treatment they are most often sent back to the stressful environment that precipitated the need for admission. Discharging too early makes it difficult for them to recover and can lead to relapse. Discharging a patient too soon also leads to a “revolving door” syndrome of hospital care with quick re-admissions. When a patient is being discharged, the hospital has to make an appointment with an outpatient facility or program in order for the patient to be discharged. In many cases, an outpatient appointment is scheduled even before the hospital and treating psychiatrist have even been able to prepare a status report. In many cases, it is also before remission of the symptoms that led to the admission in the first place.

The solution lies in more collaboration between the insurance carriers and the doctors who are treating the patients. We are talking about peoples’ lives not just statistics. We are talking about loss of life too. Just read some of the news headlines, and you will often find that a tragic psychiatric mistake was made all too often because of an early discharge or the refusal to allow someone to be admitted in the first place.

Click here to watch Scott Pelley’s 60 Minutes interview “Denied”.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

COPING WITH THE HOLIDAYS

December 29th, 2014

“People with mental problems are our neighbors. They are members of our congregations, members of our families; they are everywhere in this country.  If we ignore their cries for help, we will be continuing to participate in the anguish from which those cries for help come. A problem of this magnitude will not go away. Because it will not go away, and because of our spiritual commitments, we are compelled to take action.”   Rosalynn Carter

33275392_s (2)The holidays can be a very fun and joyous time for many, but for others it is stressful and lonely. As we enjoy our holidays, let’s keep in mind those that may find this holiday season a difficult time. Those who are grieving, dealing with divorce or struggling with addiction. Those who have lost their job and are stressed about making ends meet. Those who have loved ones serving overseas and those who are dealing with illness.

NAMI (National Alliance for the Mentally Ill) has some good “tips for dealing with the holidays” that I would like to share with you. These tips are for those dealing with their mental illness and for those who need to be supportive of their loved ones who are dealing with mental illness including family, friends and the religious community. These holidays are steeped in religion and for many this can be a time to reconnect with their faith and spirituality.

If divorce or loss of a loved one has occurred in your family, make sure to make time for your children if they want to talk. It is important to embrace the season together – whatever it may bring.

Wishing you all a safe and happy New Year!

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

A LIFETIME OF SUPPORT FOR SANDY HOOK

December 16th, 2014

Just the mention of “Sandy Hook” conjures up memories of that horrific day two years ago when 20 children and six educators died in a shooting at an elementary school in a quiet Connecticut town. That was a horrific day for Newtown, CT, the United States and the world. So many of us watched with horror as the tragedy unfolded, and we grieved along with the first responders, the school staff, the community, and the families.

This time of year, as the anniversary of the shooting is upon us, so many of us think about Sandy Hook. Sadly, two years after the shooting, information is emerging about the numerous mental health issues that plague parents, children and other victims of the tragedy.

Last week the Associated Press ran a story looking at the emerging mental health issues two years later. In “Mental health problems still emerging, 2 years after Sandy Hook school shooting” Beth Hegarty, who survived, tells what it has been like for her and her daughters over the past two years.

Many of those suffering since Sandy Hook are dealing with mental health issues ranging from anxiety to sleeplessness to depression and substance abuse to PTSD and a sense of being alone. Marriages and jobs are suffering, too.

Traumatic life events like Sandy Hook often leave victims tormented by memories and emotions that sometimes come-and-go and other times never leave at all. Dealing with severe trauma – the kind that can last a lifetime – is not easy. The healing process is based on an individual’s constitution, the degree of support in the environment, and treatment.

How can we help? Recovery can be bettered by reaching out to individuals we
know who are suffering and by implementing programs that can reach out on a community-wide basis, too.

Since Sandy Hook, there have been millions of dollars donated to counseling programs, and numerous organizations and government agencies have set-up long-term programs, but more will be needed. If you want to make a donation this holiday season why not consider Sandy Hook. Here are a couple of links you might want to consider:

Sandy Hook Elementary School Victims Relief Fund This is a fund started by a former Sandy Hook Elementary student to gather support for the victims, families, and all others affected locally by the tragic shooting.

Newtown Community Fund The fund itself is a memorial. It’s not a plaque or a statue or even a building. It’s an ongoing remembrance that provides care and support for those directly affected today, and for the entire community, for the long term.

Thankfully, those who keep Newtown on their radar are making sure that programs and counseling will be available for a long, long time. The kindness of so many will go so far!

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

A CHECKLIST TO FOR PARENTS TO HELP THEIR TEENS GRIEVE

December 16th, 2014

Teenager’s experiences and expressions of grief vary greatly. Some teenagers

will experience shock and denial, even disbelieving that the death has occurred. Others might show very few signs of grieving. Keep the following points in mind as you help your teen deal with grief:

  • Respect the form and time that your teen takes to grieve.
  • Assist your teen in expressing thoughts openly, on the teen’s terms, not yours. Encourage your teen to share feelings, even if they are scary, unusual, and frightening.
  • Help your teen by gathering articles, old pictures, and old stories about the dead person. Some people even suggest making a collage as a way of helping the healing process.
  • Be as present and available as you can to your teen. Many teenagers feel neglected when people, especially parents, and close family members aren’t physically and emotionally there for them. (The neglect sometimes happens because the teen’s grief may make others feel anxiety about death and thus may give in to the desire to avoid the teenager).
  • Look for signs of hyper-sexuality, drug abuse, risky behavior, depression, and suicidal thoughts or plans which are pathological expressions of grief.
  • Involvement in a grief support group can be very important for a teenager and surviving relatives. Support can be in groups devoted to dealing with grieving – groups that may involve only peers or the whole family. The sense of belonging to a group provides a safe place to talk about feelings and lessens the sense of isolation and sadness that are normal parts of the grieving process.
  • Listen to your teen. Be supportive and don’t immediately try to fix it. Work together through your grief.
  • Don’t be afraid to ask for help from other family members, mental health professionals or friends. Be sure to contact a mental health professional if you feel there is a deep depression or suicidal thoughts or plans.
  • Lastly, be sure that your attitudes about death are as healthy as possible to set a good example for your teenager. As always, we affect teens more by what we do and how we act than by what we say.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

UNDERSTANDING TEEN GRIEF

December 15th, 2014

So, in my last blog I touched on bereavement counseling in general. Now I want to talk about bereavement specifically with teenagers.

Adolescent grief or bereavement is normal and natural. Grief is not an illness; it is a normal reaction to loss. Teenagers need to ask questions. Give them prompt and correct information. Allow them to express every concern and to participate in all rituals having to do with the death and the grieving process. Allow them to be comforted by those who are still alive.

Do not keep your teenager from going to funerals; encourage and support them to do so. Unlike very young children, teenagers can be given details about how a loved one died. Grieving involves many complicated feelings, such as anger, guilt, shame, conflict, and even rage. Teenagers may sometimes feel that they want to join the dead loved one. Sometimes they may even feel that they see or hear the image or voice of the dead person (read my “Dreams of the Departed” blog from November). You should encourage discussion about this. Of course, if the wish to be with the loved one is accompanied by actual suicidal plans or behaviors, or the wish to be dead, you need to seek immediate professional help.

Emphasizing the positive relationship that your teen had with the dead person – going through old pictures, telling old stories, and answering all questions about the deceased – will go a long way.

Parental honesty, availability and support are the key to helping the teenager work through grief. Harm is done not from honest confrontation and discussion of death but rather from misguidedly trying to protect the teenager through avoidance, hypocrisy, duplicity, and misinformation. Not only should family members be honest and open, but they should tend to their grief, as well. Shared grief ultimately becomes less of a burden to all.

Whatever the means of achieving it – the real goal is to keep communication open at all times!

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

 

COUNSELING THE BEREAVED

December 7th, 2014


“Grandma was different.  I could talk to her.  She never judged me.  I can’t imagine her not being here.  Sometimes – to tell the truth, Mom, I wanna go wherever she is.  What will I do without her in this world?”

I was reading the CNN Heroes piece posted online “Helping Baltimore’s grieving kids heal” by Marissa Calhoun (CNN).  A great story about “Roberta’s House” founded in June of 2007 by the children of the late Julia Roberta March.  March was the matriarch and co-founder of the March Funeral Homes in Baltimore, Maryland. She was known as the heart of the business, and she counseled and comforted many who were bereaved.   Her children decided it was only fitting to create a bereavement center in her name.

“Roberta’s House” volunteers and staff counsel children, teens and adults on dealing with their grief.   It is a place where trained volunteers and staff help individuals and families share their feelings, memories and experiences in a safe and loving environment.

As a child psychiatrist, over the years I have received many calls from worried parents concerned about children who have lost someone through death.  With the younger children the concerns tend to be more about whether they should attend funerals, and be talked to about death and the process of dying.   Most calls about teenagers who are grieving are from parents who are worried that their child might suffer serious depression or other pathologies during their teenage years.

Adolescent grief or bereavement is normal and natural.  Teenagers who are grieving have many characteristics of adults who are grieving such as becoming somewhat withdrawn and isolated, to feeling anger, guilt, and helplessness.  They often yearn for the return of a loved one.  It is important to allow our grieving children and teenagers to experience this stage in life normally, without interfering in the process they must undergo to get through it.

I think it is wonderful that “Roberta’s House” is not only guiding the children and teens, but working with the whole family to get through it. I sometimes think that it is not the death of a loved one that causes problems as much as the mishandling of the grieving process by others (whose intentions are good, but misguided).  In other words, normal grief does not cause pathology, but grief that is interfered with might.

Roberta’s House is one of the top 10 CNN Heroes of 2014. They will be honored at the annual tribute show, which airs Sunday, December 7.  Here is a link to their website:  “Roberta’s House”.  Check it out and let me know what you think!

I will share with you some of my own thoughts on how to deal with teenagers and grieving in my next blog.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

YIK YAK! WHAT IS A PARENT TO DO?

December 5th, 2014

A college in New Jersey is pursuing disciplinary action against students who spread a sex tape via Yik Yak without the subject’s permission. Two students at the University of Southern Mississippi were charged with felonies over posts made to Yik Yak in late September. In Atlanta, the city where Yik Yak is headquartered, Emory University’s student government just passed a resolution denouncing the app as “a platform for hate speech or harassment.” — The Washington Post 10.07.14  [click to read the full article]

Right when you thought that bullying couldn’t get any worse — meet Yik Yak. What is Yik Yak? Yik Yak is a smartphone app that allows anonymous posts. The app released last year allows people anonymously to create and view posts within a 1.5 mile radius of their current location.

DrPaulSocialMedia (2) purchased123RFInvented by Tyler Croll and Brooks Buffington, two graduates of Furman University in South Carolina, Yik Yak  was designed for college students so that they could post anonymous “yaks”.  It has become incredibly popular with young people in the United States.

Most recently the app “geofenced” high school campuses in the United States. Meaning the app recognizes when you are trying to access it while on school property, and it doesn’t allow it.

The problem with a social media app that allows anonymous postings is the potential for cyberbullying. Bullying is seen in all age groups, starting even in the preschool years, increasing during the elementary school years, and peaking in middle school and junior high before declining somewhat in high school. The key issue in bullying is that the intimidation repeatedly occurs.

Cyberbullying takes bullying to a whole new level. Words can hurt and for young people who are the victims of cyberbullying it is very difficult to overcome the day-to-day harassment. Even if you choose not to engage on social media, you still can be cyberbullied. Sadly, other students will tell you what is being posted about you online. Some will tell you out of genuine concern; others are just gossiping, and yet others are doing so to perpetuate the bullying.

There is not a lot a person can do to stop cyberbullying, other than to report it to the appropriate school administrators or to law enforcement. With the anonymous Yik Yak, it is much more difficult to find the real person behind the post as the app requires very little information when you sign up. Only a phone number is needed.

If your child is being cyberbullied, there are things you can do to help them to deal with it. The first is to encourage him/her to talk to you about it. Together you should discuss how to handle it. Listen to your child and try to understand the feelings and fears that go along with being the subject of cyberbullying.

Secondly, you should reach out to the proper mental health officials. Whether it is at school or through your pediatrician’s office, you need to make sure that your child has a place to go to discuss the situation. A mental health professional will provide tools for them to put in their toolbox that will help them to overcome and deal with what is being said about them. The more confident and self-assured your child becomes, the easier it will be to deal with this.

Here is a good link for parents and teens dealing with cyberbullying.  Tips to Help Stop Cyberbullying is from ConnectSafely.org, a Silicon Valley, Calif.-based nonprofit organization dedicated to educating users of connected technology about safety, privacy and security in social media.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.