THE STRUGGLE TO ACCESS MENTAL HEALTH AND ADDICTIONS CARE

The Struggle to Access Mental Health and Addictions Care

By Andrew Malekoff© February 2018

It’s a heartbreaking scenario that is far too common: Someone makes the difficult decision to seek out professional help for a mental health or substance abuse problem for themselves or their loved one and is faced with a myriad of roadblocks. They start calling providers on their insurance plan and find that they are not taking new patients, or they no longer accept insurance and only want cash. And the cost of paying out of pocket is too much for many to afford.

Here is the reality: Health insurers are required by law to offer an adequate network of providers for their beneficiaries to choose from, and not just for physical illnesses. This requirement is known in the health insurance industry as network adequacy.

Along with the difficulty of finding a provider who will accept your insurance, the problem is often complicated by a family’s reluctance to seek help for a mental health or drug problem, as opposed to physical illnesses like cancer or diabetes. Despite progress in public education, stigma still looms large.

Once someone takes the leap of faith to ask for help, he or she is too often told, “I’m sorry, I don’t accept your insurance any longer.” When this happens there is a chance they will give up.

It is this reality that spurred North Shore Child & Family Guidance Center to launch a research initiative called Project Access. This entailed creating a survey that was completed by almost 650 people across Long Island. Here is some of what we found:

·       Almost 50% of the participants said that it was more difficult finding help for mental health or drug problems than finding help for physical illnesses, especially when they were in crisis.

·       Nearly 40% said that their insurance company did not have an adequate number of providers.

·       66% reported that their insurance company was not helpful in finding a suitable provider for themselves or a loved one.     

·                                                                  

One survey respondent wrote: “A  family member within my household required therapy and we had difficulty finding a provider; when we did, scheduling was a nightmare because so many patients were trying to see him. I believe it was because he was one of the few willing to accept multiple insurance policies.” This was a familiar refrain.

Health insurers reimburse mental health and addictions care providers at such low rates that they flee health insurers in droves. This is a civil rights issue and a situation that puts lives at risk.

The NY State agency that Gov. Cuomo has charged with monitoring and enforcing network adequacy is the Department of Financial Services. We are using the Project Access data to demand that Governor Cuomo and the Department of Financial Services launch a full scale investigation of access to care in New York State and to hold commercial health insurers’ feet to the fire.

If you agree, clip this column, add a note saying “I agree” and include your name and address. You can write to the governor at: The Honorable Andrew M. Cuomo, Governor of New York State, NYS State Capitol Building, Albany, NY 12224; email him at Press.Office@exec.ny.gov; or call him at 518-474-8418.

Published in Long Island Weekly, February 28 2018

PARKLAND YOUTH, ACTIVISM AND TRIUMPH OVER HELPLESSNESS AND DESPAIR

By Andrew Malekoff© February 19, 2018

The 2018 Valentine’s Day massacre at Douglas High School in Parkland, Florida has elevated beyond cliché status the oft-stated sentiment about a loss of innocence in childhood. For many, the events of that day evoked painful memories of the 2012 Sandy Hook Elementary School shooting and scores more in recent decades. Schools, movie theaters, concert venues and more have become American killing fields.

After “thoughts and prayers” are paraded around by politicians from all sides, what happens next? 

Many gun rights advocates, refusing to allow for the fact that our forefathers were talking about the right to bear arms such as muskets and had no conception of guns that could shoot down dozens in an instant, stand in the position that it’s not about guns but rather mental illness.

As the Executive Director of North Shore Child & Family Guidance Center, which serves children and their families facing issues such as depression, anxiety and substance use disorders, I have seen the many faces of mental illness and addictions for more than 40 years. It is incredibly rare for those who are labeled as mentally ill to be violent. In fact, they are far more likely to be the victims of violence than the perpetrators.

Nevertheless, we do need to have a discussion about mental illness at times like these. That discussion, however, needs to be about how health insurance companies and the elected officials who count on their donations are failing miserably at having adequate numbers of providers on their lists who take insurance.

Over and over again, we hear that, before they found North Shore Child & Family Guidance Center, which never turns anyone away for inability to pay, they made numerous calls to the mental health providers on their insurer’s list and found that they no longer take insurance or are booked for months.

Aside from receiving emotional first-aid, the surviving students from Douglas High are demonstrating that they need to take action; action that represents triumph over the demoralization of helplessness and despair. 

Noted trauma expert Bessel van der Kolk said that “talking about the trauma is rarely if ever enough.”  Survivors have a need to create symbols such as memorials or participate in action that “enable them to mourn the dead and establish the historical and cultural meaning of the traumatic events.”

The surviving students from Parkland are turning their heartbreak and rage into activism by demanding a new look into America’s gun laws, as Emily Witt wrote in the New Yorker (Feb. 17). In her encounters with some of the surviving students she reported that “Their grief was raw, their rage palpable.”

“Emma Gonzalez, a senior at Douglas, had the most searing indictment:

“The people in the government who were voted into power are lying to us. And us kids seem to be the only ones who notice and are prepared to call B.S.

“Companies, trying to make caricatures of the teen-agers nowadays, saying that all we are self-involved and trend-obsessed and they hush us into submissions when our message doesn’t reach the ears of the nation, we are prepared to call B.S.

“Politicians who sit in their gilded House and Senate seats funded by the N.R.A., telling us nothing could ever be done to prevent this: we call B.S.

“They say that tougher gun laws do not prevent gun violence: we call B.S.”

From Columbine to Parkland, there have been so many shocking events in between. Too many have faded from consciousness.

As Journalist Gary Smith, who wrote about a lesser known 2012 shooting at Chardon High School in Ohio, stated: "The clock is already ticking in the land of amnesia."

How long before Parkland, too, is gone? If it is up to the young activists in Parkland, never.

Published in Blank Slate media February 2018       

ONE GOOD PARENTAL TURN

By Andrew Malekoff© Published February 7, 2018

Remembering without awareness is a phrase I really like. It suggests the retrieval of a memory that escapes conscious awareness.

Recently, I passed the 20-year mark without either parent, and many more years without grandparents. One grandmother, Annie, died before I was born. I was named after her. The other, Jenny, died when I was too young to remember her. My grandfathers, Harry and Joseph, died a few years later, still during my childhood years, but I have memories of both of them.

Each had disabilities and prostheses. Both of Grandpa Harry’s legs were amputated as the result of diabetes. Grandpa Joe lost his eye as the result of a carpentry accident. Their disabilities were never hidden from me. I went with my dad and Grandpa Harry when he had his prosthetic legs fitted.  Grandpa Joe regularly took his eye out and showed it to me on request. I used to wonder if I would have artificial parts when I got older.

In my first year of graduate school in 1976, I was assigned to intern in a program called “Aged in Distress.”  It was a crisis intervention program for older people. I made home visits to people with physical and mental disabilities, as well as one woman who was bedridden and terminally ill.

Although my primary interest in becoming a social worker was to work with children and teenagers, I was surprised at how much I liked working with older people. I was 25 at the time. Thinking back, it shouldn’t have come as such a surprise to me. Sometime after the internship, 

I realized that I was remembering without awareness the short time I had with my grandfathers.

Now I know that my early memories and recollections, whether I am consciously aware of them or not, influence how I feel about and relate to others in the present. As a child who experienced my grandfathers’ lives and deaths, I wasn’t conscious of the fact back then that one day I would be dealing with my parents’ aging, illnesses and deaths.

My father had cancer and my mother had heart and kidney problems. I traveled often from my home on Long Island to New Jersey to help care for them, some of that time at the same hospital in Newark where I was born in 1951.

One memorable evening—which also happens to have involved artificial body parts—was the time my mother fell and was taken to the hospital. She called me at 2 a.m. and said, “Andy, will you bring my Polident to the hospital?”  Broken arm and bruised face, all she could think about was what she needed to keep her dentures in place so that she would look good.

I took the 90-minute drive from Long Beach to Newark at 2:30 am, retrieved her tooth powder from the medicine cabinet in her home, headed to Beth Israel hospital, spent a few hours with her and drove back to Long Island with enough time to make it to my office for work.

Although the trip was inconvenient, I was aware all along that one good turn deserves another. 

Both my mother and father took time caring for their parents when they aged while also caring for me and my brother. It is these kinds of life lessons that seep into your unconscious and define the person you become, with many generations to thank.

Long Island Weekly: https://longislandweekly.com/one-good-parental-turn/

WHEN YOUR CHILD RELATES BETTER TO SCREENS THAN HUMAN BEINGS

By Andrew Malekoff© November 2017

On Friday, October 20 North Shore Child & Family Guidance Center hosted psychotherapist, author and parenting expert Sean Grover for a workshop titled “When Your Child Relates Better to Screens than Human Beings.” We were pleased to offer this program to help fortify parents during these difficult times.

As tech-dependence increases, many kids move through the world in a self-centered bubble, separated from their own thoughts and feelings, as well as the thoughts and feelings of others. As conversation skills and positive interactions crumble, technology even starts to change kids’ sense of humanity; they are less compassionate and sensitive to others. The workshop explored these vital issues and offered advice about what parents can do to help.

“Everywhere you look, children are staring into cell phones, screens, computer screens, tablets, iPads and more,” said Grover, who has appeared on the Today Show, in the New York Times and in many other media outlets. “While some kids use technology as a pastime, others are absorbed by it.

Technology devours their lives. They can’t put it down or turn it off. These kids tend to be more isolated and anxious, have poor people skills, difficulty maintaining friendships or an unstable sense of self.”

In his workshop, Grover gave parents guidelines on how to take back control and help their offspring wean off their technology addiction. Here are some of his tips:

1. Tech Blackouts

Set aside specific times at home when no one (parents included) uses technology. Cell phones, computers, iPad...everything is off. If you want your kid to be less tech-addicted, you must lead the way. Tech-free time can be spent reading, talking, playing games, cooking, making art...anything creative or social will do.

2. Tech Hours

Kids resist structure — but fall apart without it. Technology needs limits. For instance, I often recommend that families establish tech hours; time for homework, gaming or surfing the Internet. Scheduling tech time will help to limit battles by setting clear guidelines. For instance, when it comes to gaming, many parents may allow thirty minutes a day during the school week and two hours a day on the weekends.

3. Tech Spaces

When possible, keep all technology in a common space like the living room — not in a child’s bedroom. Establish communal places for tech time; try to avoid allowing your kid to disappear for hours behind a closed door.

4. Tech Limits

There are plenty of online services that can filter out inappropriate or violent material. These services can also limit Internet access by scheduling times that the Internet is available and times when it is not. One example of such a service is Net Nanny.

If you haven’t already read between the lines, you should know that how you use tech devices influences your ability to effectively guide your kids. Although your example is not the sole factor, keep in mind that as distant as some kids become from adults as they are moving through their teen years, they continue to observe you, and more closely than you know.

As the lyrics from the 1970s-80s new wave rock band the Police advise: “Every breath you take, Every move you make, Every bond you break, Every step you take, I'll be watching you.”

Published in Long Island Weekly, November 2017

IN THE COMPANY OF ONESELF

By Andrew Malekoff©  2017

In New York it is illegal to use a hand-held cell phone while driving. Although drivers have the option to use hands-free devices, studies show that talking or texting on any cell phone while driving is so mentally distracting as to suggest it is a serious safety hazard. Nevertheless, not a day goes by that I do not see drivers talking on both hand-held and hands-free devices. Safety aside, what does all this chatter in the car portend about one’s ability to be alone?

More than 50 years ago Clark Moustakas, a psychologist and the author of the existential study Loneliness, wrote, “Being alone, for me, usually means an opportunity to think, imagine, plan. I choose to be alone because I desire to be quiet for awhile to consider aspects of my life. It is usually a tranquil time of self-expression and self-renewal.”

Can you remember a time when a solitary ride in the car offered such an opportunity, to simply be alone with your thoughts, feelings and sensations—maybe with your favorite soundtrack playing in the background?

We now live in an era when, because we are plugged in 24-7, the simple pleasure of being alone is something that we avoid. For many people, young and old, aloneness is a source of discontent. Why? Are we afraid that it might lead to loneliness?

Loneliness is not just about a lack of companionship but an inner sense of being alone, regardless of the external circumstances—of feeling lonely even when with friends or family. 

I believe that the recent popularity of mindfulness—a mental state achieved by directing one's awareness on the present moment, while calmly noticing and accepting one's feelings, thoughts and bodily sensations—is a counterforce to the busy-ness of our perpetually plugged-in lives.

As if to foreshadow the current era of mindfulness, Moustakas said, “Loneliness anxiety is a widespread condition in contemporary society. The individual no longer has an intimate sense of relatedness to the food he eats, the clothing he wears, the shelter which houses him.”

According to Maria Gonzalez, an author and corporate executive whose most recent book is Mindful Leadership, 9 Ways to Self-­Awareness, Transforming Yourself, and Inspiring Others, “The daily commute is a great opportunity to train the mind.” She recommends practicing simple techniquies repeatedly, to train the mind in three areas:

1. To be more focused and better able to concentrate;

2. To experience more clarity in our thinking and decision-making; and

3. To approach all of life with a sense of balance, whereby we can “go with the flow” when a situation cannot be changed in the moment.

“The idea,” Gonzalez says, “is that you are continuously aware of three things: your body, what you see and what you hear. This is what it is to be mindfully present as you drive. Do your best to stay present for the entire commute.”

Although it seems elementary, it’s not as easy it sounds. As your mind wanders you may have the impulse to check your phone, or give in to some other distraction. When that happens, intentionally pull yourself back.

Like all things worth mastering, being mindful takes practice. As you do this you are preparing yourself to be present, to be at ease in your own company and, at the same time, you’re making the road a safer place for us all.

Published in Long Island Weekly, October 2017

MENTAL HEALTH EDUCATION A MUST FOR SCHOOLS

New legislation signed by Governor Cuomo in 2016 requires that public schools in New York State begin providing instruction in mental health on or after July 1, 2018. The legislation was co-sponsored by Senator Carl Marcellino (R-Nassau) and Assemblywoman Kathy Nolan (D-Queens).

The new legislation adds mental health education to areas of learning that were already required by law, including education on the use and misuse of alcohol, tobacco and other substances and the early detection of cancer.

According to Glen Liebman, CEO of the Mental Health Association in New York State, “By ensuring that young people are educated about mental health, we increase the likelihood that they will be able to recognize signs in themselves and others that indicate when help is needed and how to get help.”

Why is this legislation so important? One in five adolescents ages 13-18 is diagnosed with a mental health problem, yet only 40% get help. The average time from onset to seeking help is eight to 10 years. According to Centers for Disease Control and Prevention, one in 12 high school students attempt suicide, the third leading cause of death for 10 to 24 year olds.

Teaching about mental health in schools and educating to reduce stigma is long overdue. There is great misunderstanding and fear among many who have erroneous ideas about people with mental illness. Consequently, young people suffering with mental illness walk around school feeling isolated, believing that there’s something inherently wrong with them that will never change.

These children and teens often feel shunned, unlike their peers who have a physical health problem and who have others rally around them. I can vividly recall a news report and photo of a middle school boy afflicted with cancer who was receiving chemotherapy. In the photo he was surrounded by his teacher and a smiling group of his classmates, all of whom shaved their heads in solidarity with him. Imagine if instead of cancer he was depressed and suicidal. There would be no such image of public support, only one of isolation, shame and despair.

A caring school community can offer a young person a safety net of meaningful and helpful connections. It is not unusual for a teenager to feel defective when struggling alone with a mental illness. Mental health education in schools can begin with mental wellness practices for children as early as four or five years old, for example, by teaching social skills and how to manage angry feelings.

As children grow they can learn about the concept of wellness including self-care and personal responsibility. They can learn to recognize the signs and symptoms of developing mental health problems, how to manage crises such as the risk of suicide and self-harm and how to identify appropriate services and supports for treating and maintaining recovery from mental illness.

can already hear those voices that will decry using educational resources for addressing the emotional needs of kids. If that is your view, I ask you to consider that approximately 50% of students age 14 and older who are living with a mental illness drop out of high school. Youngsters’ mental health and their ability to learn and become productive citizens in the community and workplace go hand-in-hand.

We owe it to our children to support this vital new legislation by encouraging schools to incorporate meaningful education into the curriculum that reinforces the idea that mental health is an integral part of wellbeing. Our children need to learn that there is help that can lead to recovery.

Andrew Malekoff is the Executive Director and CEO of North Shore Child & Family Guidance Center, which provides comprehensive mental health services for children from birth through 24 and their families. To find out more, visitwww.northshorechildguidance.org.

This article first appeared in Long Island Weekly, an Anton Media Group publication, on September 27

LOOKING FOR A PATH BACK TO CIVILITY

Looking for a path back to civility

http://www.newsday.com/opinion/reader-essays-expressway-newsday-1.2505342

Appeared in Expressway in Newsday, September 17, 2017, p. A29

By Andrew Malekoff     

My family lives in a high ranch in a section of Long Beach known as “the canals.” The houses sit close together, sometimes just yards apart. One warm August afternoon many years ago, one of my neighbors lit his fireplace. Our windows were wide open and in no time our house filled with smoke. We appealed to our neighbors to wait until the weather was a little cooler. Later that evening, we were again invaded by smoke.

After one more attempt to address the problem civilly, it became clear to me that our neighbors did not appreciate that their pleasure was our pain. Drawing on my knowledge of nonviolent tactics to resolve conflict, I went door to door on the street to enlist support and called local officials. Some neighbors spoke up about the problem. The fireplace problem was soon resolved.

Years later, I was out for an early morning bike ride on East Park Avenue in Long Beach when I was run down by a driver who subscribed to the now-popular practice of turning right on red without coming to a full stop. The irate driver exited his car, pointed up and hollered, “I had green!” He backed off when I corrected him, loudly, from my prone position underneath my mangled bicycle. I survived with a few bumps and bruises. When he saw the shape of my bike, he threw a $50 bill at me and said, “This is for your bike.”

Most people I talk to agree that civility is on the decline. Everyone seems to have his or her own horror stories, whether it is inconsiderate neighbors or co-workers, aggressive driving or just plain rudeness. There are books on the subject. Titles include “The Twenty-five Rules of Considerate Conduct” and “A Short History of Rudeness.” Another is “The Duel in Early Modern England: Civility, Politeness and Honour.” Ah, yes, those were the days.

We have become all too familiar with the epidemic of F-bombs that pepper civic discourse, pervasive public cellphone calls and drunkenness at sporting events. We live in a time when every movie theater begins with a public service announcement stating ground rules for being considerate.

Highways have become the Wild West. Hardly anyone comes to a complete stop for a stop sign. The yellow traffic signal has evolved from its original meaning, slow down, to speed up. And, of course, there are tailgating, middle-finger salutes and rampant road rage.

Today, there is so much talk about putting an end to bullying in schools. Yet, we live in a world of adults who don’t think twice about trampling personal boundaries through rude, intimidating and obnoxious behavior.

It never fails to surprise me, when I travel somewhere, to see drivers stop for pedestrians, and people of all ages wave and say, “Good morning.”

If we cannot reverse the trend, we can at least slow down and teach our children, after we remind ourselves, the importance of putting a pause between impulse and action. Perhaps it is somewhere inside of that sacred space that we can find our way back to a civil society.
  
Andrew Malekoff, Long Beach.