(Psychiatric Emergency and Evaluation Center)
I have some very intelligent, kind, thoughtful friends who are absolutely opposed to universal health coverage. Their arguments are sound and logical. And I disagree with them wholeheartedly.
During my training to work as a waitress at a local pub in Charlottesville, the owner told us, “In my ideal world, everyone would have to work at least one year of his/her life as a server. What you learn about others, about yourself, about what it means to be at the service of others–it’s invaluable.”
In my ideal world, everyone would spend at least one night meeting and interviewing patients in the PEEC, the place where patients who presented to the Emergency Department with possible psychiatric problems are evaluated for admission. In what world would it be better for society for these patients to not have health care coverage? In which the alone schizophrenic woman who is beaten and raped, and almost smothers her infant child during a period of postpartum psychosis (like one of my patients), is denied treatment for her condition?
The drift hypothesis is an argument that mental illness causes one to have a downward shift in social class that often, in turn, exacerbates the problem and causes further drift and isolation. A famous, albeit controversial, study by E. M. Goldberg and S. L. Morrison examined the relationship between schizophrenia and social class. It determined that there was a strong association between schizophrenia and a lower social class. However, the social class in which the participants were raised was found to be similar to that of the general population. Schizophrenia led to a fall in social class, rather than the reverse.
The vast majority of my patients are either without health insurance entirely or on medicaid. Medicaid provides some assistance, for sure, but it’s still disheartening to put these young men and women on second-line antipsychotics that are going to leave them with irreversible side affects later in life because the first-line drugs are outside their coverage.
Just a piece of the argument…a far stretch from completely thought out on my end.
anna in med school 
I don’t think you’ve ever met our son, Michael. After getting Psych degrees at Georgetown, we decided to take a year off and serve as group home houseparents. We ended up living in LaHabra, California for a year. The group home population was unique – children between the ages of 6 and 12. These were all severely afflicted youngsters. A few with schizophrenia, one very violent, one girl who had schizophrenia and autism who never slept, a girl who had a weird blend of diagnoses that didn’t make sense but was passive aggressive to the point of being a danger to herself and others, a boy who one could best describe as a severe psychopath, a very little girl (sometimes they bent the minimum.or maximum age rules to keep the place “populated,” a boy who was a deaf-mute without any signing skills and a bigtime penchant foe destroying things, people, anything, and a very little developmentally delayed boy who had been found living in squalor in a crib. He had, as you can imagine, little language, no social skills and little muscle tone. Michael, then known as Kias Bashira Kahn (yes it was Khan, but some social worker misspelled it and it became part of his very, very thick “permanent record.”), was primarily schizophrenic. He was tiny for his age, but wiry, had amblyopia ex anopsia, a condition where his eyes did not had coordinated movement and was the most hyperactive kid EVER! The eye problem made for a peculiar addition to his schizophrenia diagnosis. each rye was essentially operating one at a time. The brain always tries to suppress a nonsensical image. when one’s eyes don’t work in concert, the brain essentially flits back and forth from one visual field to snother. the consequence, is that a person, especially a child, would report that still objects eere jumping around. The diagnosis: hallucinations! Thank you, medical geniuses in the state system. He could only go to school 15 minutes a day, had little language and no ability to use symbolic language, the basis for math. Luckily, we only had room for six kids at a time. We had a non-therapeutic relief couple 2 days a week. During those days, we usually took one of the kids for an outing or to a doctor’s appointment. Most group home houseparents burned out after a year. We scoffed, thinking two years minimum. We left after 13 months. Before we left, however, we discovered that Kahn was severely hypoglycemic. This explained his behavioral depression followed by skyrocketing hyperactivity. We put him on a very high protein, high carbohydrate diet and he, much to the astonishment of his teachers, no longer had to be peeled off the ceiling. Within a few months, he was going to school 2 hours a day!
Well, we ended up, through a blend of compassion and naïveté, adopting Kahn. The adoption was actually illegal. he had been adopted before and given back. The State of California was pretty firm on this, but yhrough the efforts of a very persistent, knowledgeable and, in many ways brilliant social worker, the board allowed a “remissions” interpretation (there’s really no such thing in childhood schizophrenia). Then, surprise!, he didn’t want to be adopted by us! he wanted to live in a big house, or as he put it, a castle and have horses. He was remembering his former adoption. After a very long talk with his social worker, he begrudgingly relented. One glitch in yhe system: he had to be simultaneously discharged from the group home and we still had a few weeks to go. Luckily, one of his teachers volunteered to act as a surrogate parent while we got our travelling orders. Unfortunately, she and her husband were not truly prepared for him and, for example, washed his mouth out with soap for his incessant lies. you get used to lies as a houseparent. It’s pretty low priority stuff. Actually, our horror was unfounded. he realized we weren’t so horrible afterall. As part of the adoption, he changed his name to Mike, Of course adopting your client is the biggest no-no in the psychotherapeutic field, but we were young (22 and 21) and not well versed in how bad things can get for a kid like him. To make a long story short we immediately had a few victories. Having moved back to the Washingtton area, we had the fortune of having access to really great doctors. His eyes were corrected by the chief of Pediatric Opthamology who invented the surgery, his endocrine system balanced by a renowned pediatric endocrinologist at Georgetown, and found a great Special Ed program in Reston, Virginia. He was growing so fast he could polish off a gallon of milk a day. One weekend, we reluctantly put him on Ritalin, fearing it would stunt his growth, a common side effect, and that very Monday his teachers called excited and happy. He actually sat in his chair and took a stab at schoolwork! Well, this is the nice part.
As you mentioned, there’s a coverage problem. Mike started to deteriorate psychologically. Depending on where we worked, there was little or no coverage for psychiatric interventions. Even 10 years later, in the 80’s, the best coverage I could get. Was a $50,000 lifetime family maximum. It was the same year we hospitalized him, tearfully but responsibly, at Graydon Manor, a hospital in Leesburg. We had no choice. As many child schizophrenics do, when they get hit by the onslaught of raging teenage pressures and the psychological shock of imprnding adulthood, he became suicidal. Their minimum fee was $80,000 per year. He spent 2 there. One learns a lot about fooling the credit card companies…
Of course, a lot had happened between the little miracle in Reston and hospitalization. Parents hope, hope hope. First, the problems were medical and educational. He had a family, now. But as hints of his schizophrenia resurfaced, the consultants changed to more psychiatric , and as you mentioned, expensive and unreimbursed burdens. Today, insurance companies must cover psychiatric costs like medical costs. But here’s the fly in the ointment. I spent three months trying to find a psychiatrist that would take our insurance. Yes, they were on the list given by our insurance company. But psychiatrists in the Metro DC area get $300 to $500 per hour. Our insurance’s ” fair and equitable rate” was $190. One, two, three sessions a week. And, as they say, pretty soon it adds up to real money. Our solution to tackling the costs was to forego a retirement fund, college savings for the other children and multiple refinances. So, yes, Anna, you are very right. Universal healthcare tackles the problem that few even realize exist. Thirty years after hospitalizing Mike, we are still playing “catch-up,” not with the direct costs, but with the ones that catch up to you later. As a medically endowed but only-for-the-rich country, the frail still suffer. Makes you want to move, doesn’t it?
hi anna, thank you for this post. i am so angered by the negativity surrounding obamacare. expanded healthcare for our nation’s children and limits on the ability of illnesses to cause bankruptcy are of paramount importance.
to your specific point on mental illness – when i worked at a legal aid office, i learned that a large number of people who were homeless and unable to “get back on their feet” in my city were suffering from untreated or irregularly treated mental illness. i wholeheartedly agree that granting greater access to mental health care is in the best interest of the state.
Hello there! First off, my sincere apologies for the delay in response. Thank you so much for your eloquent thoughts.
Working at a legal aid office, I would imagine you would have seen (or helped in some way) a large number who suffered from illness, mental or otherwise. Thank you so much for your service and your invaluable input.