A MATTER OF CIVIL RIGHTS

A Matter of Civil Rights

By Andrew Malekoff

Did you know that every day more than 290 Americans die from suicide or a drug overdose? With proper treatment, many of these tragedies could be prevented—but despite a law that guarantees coverage, people face enormous roadblocks when they seek care.

In 2008 President George W. Bush signed the landmark Mental Health Parity and Addiction Equity Act (Parity Act). The Parity Act mandates equal insurance coverage for mental health and substance use disorders (MH/SUD) as compared to other medical/surgical benefits covered by the plan.

According to its new website parityat10.com, “Parity at 10 seeks to ensure that insurance carriers and state Medicaid programs comply with the law so that consumers can access the evidence-based health care they need and are entitled by law to receive.”

What does equal insurance coverage mean? It means ending insurer discrimination against access to timely and affordable care including high out-of-pocket costs and shorter lengths of care for MH/SUD. Parity—which is another word for equity—in this case means that MH/SUD coverage must be provided on par with coverage of medical and surgical care.

Notably this legislation was the result of a bipartisan effort by Senators Paul Wellstone, a liberal Democrat, and Pete Domenici, a conservative Republican. What the senators had in common were personal family experiences that motivated their tireless efforts to pass this law.

Parity saves lives. Parity law is a civil rights law that has not been vigorously enforced by the States, which have the primary responsibility for enforcement of private insurance and Medicaid.

One of the most pernicious violations and barriers to care is inadequate networks of MH/SUD providers. North Shore Child & Family Guidance Center documented this in its 2018 Project Access Study which surveyed 650 Long Island consumers of MH/SUD care. Nearly 50% of respondents said that it was easier for them to access medical/surgical care than MH/SUD Care.

Nationally, patients responding to a National Alliance on Mental Illness (NAMI) survey reported being denied twice as often for mental health care as for medical surgical care under the Affordable Care Act.

The actuarial firm Milliman reviewed claims data in New York and found that patients had to go out-of-network for MH/SUD care far more often than for medical/surgical care—a very expensive proposition that flies in the face of the Parity Act.

At North Shore Child & Family Guidance Center, we are a proud partner of the Parity at 10 Compliance Campaign. On August 10 I attended an inaugural Parity at 10 meeting in Albany with my fellow advocates and top officials in the Cuomo administration.

Some of the details in this column were included in the policy brief provided to Governor Cuomo. The consensus among the advocates was that insurers do everything in their power to skirt parity.

Another staunch supporter of the original legislation was Patrick J. Kennedy, a former member of the U.S. House of Representatives. Kennedy struggled with mental illness and addiction for most of his life.

In his book A Common Struggle, Kennedy said the battle ahead is for the law to be enforced in the face of health insurers who stand to profit by denying the full range of coverage for people living with mental illness and addictions. Kennedy rightly frames the inequities that people with mental illness and addictions face as a matter of civil rights.

Discriminatory insurance coverage for those with mental health and substance use disorders must end. When insurers do not comply with the law and enforcement is inadequate, millions of Americans are at risk.

Andrew Malekoff is the Executive Director 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, visit www.northshorechildguidance.org.

This article appeared in TheIslandNow.com on August 16, 2018

CONTEXT COUNTS IN CARING FOR CHEMICALLY DEPENDENT KIDS AND FAMILIES

By Andrew Malekoff©

Despite feeling blindsided, many of us now know that we are living in the midst of an unprecedented drug epidemic. According to the U.S. Department of Health and Human Services, since 1999, the rate of overdose deaths including prescription pain relievers, heroin and synthetic opioids such as fentanyl, nearly quadrupled.

In the intervening years, many steps have been taken to help save lives. These include improving prescribing practices and expanding access to medication-assisted treatment and the use of Naloxone. 

Medication-assisted treatment combines behavioral therapy and medications such as methadone or buprenorphine to treat opioid addiction. Through affordable, accessible and quality care people can recover and go on to live productive lives.

Naloxone is used to treat a narcotic overdose in an emergency situation by reversing the effects of opioids, including slowed breathing or loss of consciousness.

Notwithstanding the increased attention to lifesaving measures, there is relatively little focus on the devastating impact of addiction on children living in families where a parent is addicted to drugs or alcohol.

There are more than 8 million children under 18 years of age that are growing up in homes with alcohol and other drug-abusing parents. These young people are likely to become alcohol or drug abusers themselves without intervention.

Parental alcoholism and drug addiction influence the use of alcohol and other drugs in several ways. These include increased stress and decreased parental monitoring that contributes to adolescents’ joining peer groups that support drug use.

Children who grow up with an addicted parent learn to distrust to survive. When unpredictability dominates one’s life, he or she is likely to be wary, always sensing disappointment lurking nearby.

Children growing up with an addicted parent become uncomfortably accustomed to living with chaos, uncertainty and unpredictability. When a child grows up under these conditions, they learn to guess at what normal is.

Denial, secrecy, embarrassment and shame are common experiences of children who live with an addicted parent. Even seeking help outside of the family might in itself be seen as an act of betrayal, a step toward revealing the family secret. The stigma of addiction can leave chemically dependent persons and family members feeling utterly alone in the world.

Children who grow up with an addicted parent live with the unspoken mandate - don’t talk, don’t trust, don’t feel.

Growing up with an addicted family member leaves children with little hope that things will ever change. I am reminded of a parable about the small village on the edge of a river.

One day a villager saw a baby floating down the river. He jumped in the river and saved the baby. 

The next day he saw two babies floating down the river. He and another villager dived in and saved them. Each day that followed, more babies were found floating down the river. The villagers organized themselves, training teams of swimmers to rescue the babies. They were soon working around the clock.

Although they could not save all the babies, the rescue squad members felt good and were lauded for saving as many babies as they could. However, one day, one of the villagers asked: "Where are all these babies coming from? Why don't we organize a team to head upstream to find out who's throwing the babies into the river in the first place!"

Mobilizing resources to pull babies from the river, while neglecting the ones left behind makes no sense.

Published in Behavioral Health News, FALL (2) 2017 Issue, Volume 5, Number 2, p. 20

DEPRESSION, SUICIDE, DISCRIMINATION AND PARITY

Depression, Suicide, Discrimination and Parity

By Andrew Malekoff© Summer, 2018

In the immediate aftermath of the suicides of Kate Spade and Anthony Bourdain Gov. Cuomo issued a press release about new funding to address the rising rate of suicide.

He stated: "Two high-profile suicides this week put mental illness front and center, but while those names were the ones in the press, every day there are thousands of New Yorkers who struggle with suicidal thoughts, and we must do everything we can to support them. Depression does not discriminate. It affects every part of society and people from all walks of life."

I applaud the Governor for bringing this matter to light. He stated, “Depression does not discriminate.” Nevertheless, health insurers that do not comply with federal parity law, denying timely access to care, do discriminate. When New York State government does not enforce this law, they aid and abet discrimination against the “thousands of New Yorkers,” who the Governor referred to as those “who struggle with suicidal thoughts”.

The difficulty people have accessing mental health and addiction care is not simply a matter of stigma. It is a matter of discrimination. This is a civil rights issue that an announcement of new funding alone will not solve.

On December 15, 2017, North Shore Child and Family Guidance Center held a press conference at its headquarters in Roslyn Heights and issued the results of a research study – Project Access that we conducted in collaboration with LIU Post Department of Social Work. 

In this year-long study, hundreds of Long Islanders were surveyed about their experiences attempting to obtain help for mental health and addiction problems.

Of the 650 Long Islanders who took part in the survey, almost half said that it was more difficult finding help for mental health or substance abuse problems than finding help for physical illnesses, nearly 40 percent said that their insurance company did not have an adequate number of providers and two-thirds said that their insurance company was not helpful to them in finding a suitable provider for themselves or a loved one.

NY State Senator Todd Kaminsky, who attended the December 15th press conference, stated that the findings were “Damning.”

In a bipartisan effort, Kaminsky and Senator Elaine Phillips wrote to the Department of Financial Services (DFS) on January 9, 2018 citing the Project Access study and requesting “a thorough investigation to determine why insurance companies are not being held accountable for network adequacy.” Network adequacy is the part of the federal parity law that states that health insurers who cover mental health and addiction care must have an adequate number of providers in their network. Many more people wrote directly to Gov. Cuomo, requesting the same.

Almost five months later Scott Fischer, Executive Deputy Superintendent for Insurance, a division of DFS, responded in writing to the Senators. Fischer wrote: “DFS’s review of the various networks has confirmed that each of the insurance companies in Long Island exceeds the standards for mental health and substance use providers, for the purpose of the commercial products sold outside of NYSOH.”

Translation: There is no problem. There is nothing more to do. This does not square with the results of Project Access.

Health insurers and government ignoring federal parity law is discrimination. When it comes to suicide prevention: access delayed, is access denied.

Discrimination deserves a place alongside stigma when the conversation turns to access to care.

It’s a matter of civil rights.

Long after the tragic deaths of Kate Spade and Anthony Bourdain fade from the front pages, the lack of compliance and enforcement of federal parity law will persist and the thousands of people that the Governor spoke of in hispress release will still be unable to access care.

Published in the New York State Behavioral Health News, Summer 2018 issue

NO MATTER WHAT YOU'RE GOING TRHOUGH YOU'RE WORTH SOMETHING

On March 9, 2017 I had the honor of introducing Darryl “DMC” McDaniels, a founding member of the early hip hop group Run-D.M.C. Young and old of all backgrounds gathered together at the Leeds Place of North Shore Child & Family Guidance Center in Westbury for a community forum.

If you don’t already know, DMC is a hip hop pioneer, a rap poet and an inspiring prophet. The packed house at the Leeds Place got to experience all three in a two hour tour-de-force in which Darryl taught us about the history of hip hop, delighted us with rap lyrics and moved us with intimate stories of resiliency.

When I introduced Darryl, I told the audience that I learned that his favorite things to do as a child were to read comic books and pretend to be a superhero. In fact, I told them, he now produces comic books under the DMC – Darryl Makes Comics – label.

Darryl’s comics are not about traditional superheroes like Batman, Superman, Spiderman or the Incredible Hulk. Darryl, I learned, believes that there are heroes in everyday life with powerful stories to tell. Just like everyone in the room tonight, I said.

Darryl is 52 years old, six feet tall and solidly built, with muscular arms bulging from his tight black t-shirt. He spoke for two hours without a break, moving about energetically without breaking a sweat.

He inspired the crowd with the story of when he was a young boy growing up in Hollis, Queens, and he was a self-described Catholic School nerd who wore thick-framed glasses and read comic books all the time. He said he liked school.

He gave a great history lesson about the birth and meaning of hip hop. He described how neighborhood kids who had little in the way of physical resources brought music and art to the parks and streets by plugging  turntables and speakers into light poles, making dance floors out of cardboard boxes and creating street art by painting and drawing on walls.

In his talk, Darryl encouraged the young people in the room with transcendent and core messages of hip hop: “Always be open to do something different. It could change your life.”

Darryl spoke about his unexpected rise to fame and fortune, exhorting the young people to develop what they like to do, try new things, take chances and, most important, to know that “no matter what you’re going through, you’re worth something.”

He went on to say that despite his early rise to fame and fortune, at the age of 35 he discovered that he was adopted and was a foster child. Around the same time he went through a period of suicidal depression and became addicted to alcohol.

When he finally sought professional help, he discovered that he had been suppressing powerful feelings his whole life, especially things that angered him. Despite the powerful lyrics in his raps, he said that he never wanted to make waves in his personal relationships. 

Some of the lessons he learned were: “You have to express your truth. It’s normal to feel. Release what you’re going through. Your situation doesn’t define who you are.”

In time, with the help of his adoptive parents, Darryl met his biological mom who told him that she gave him up so that he could have a better life.

In the end, before Darryl patiently signed autographs, posed for photos and chatted with kids and parents, I closed the meeting by saying, “DMC gave his music to the world. And, tonight Darryl gave us his heart.”

Andrew Malekoff

Appeared in Long Island Weekly, April 2017

https://longislandweekly.com/no-matter-youre-going-youre-worth-something/

TREATMENT LAWS AREN'T BEING ENFORCED

Tucked into the heartbreaking story by Newsday about a young women’s lack of access to lifesaving healthcare to treat her addiction (“A daughter lost to heroin,” Editorial, May 15, 2016) is the fact that Bridgette Kurtzke was diagnosed with bipolar disorder as a teenager.

A 2014 study by the U.S. Substance Abuse and Mental Health Services Administration, 7.9 million people had both a mental health disorder and substance use disorder.

Newsday’s editorial stated that Gov. Andrew M. Cuomo has created a task force on opioid addiction that will propose new legislation. The fact is, we already have federal legislation; namely, the Mental Health Parity and Addiction Equity Act and the Obama Patient Protection and Affordable Care Act. Both state that it is illegal to treat diseases of the brain differently than those of any other part of the body.

Before proposing bills, the governor and his task force should know that these laws aren't being adequately enforced in New York, especially as it relates to having an adequate network of services. Insurers must provide enrollees with timely access to a sufficient number of providers included in the benefit contract.

Andrew Malekoff is executive director for the nonprofit children’s mental health agency North Shore Child and Family Guidance Center in Roslyn Heights, NY

HOW INSURERS ARE FAILING CHILDREN WITH MENTAL HEALTH NEEDS

http://nynmedia.com/news/how-insurers-are-failing-children-with-mental-health-needs

What happens when something that affects children’s lives is widespread but hidden in plain sight? What if it is something that creates untold heartache in lives that are already unnecessarily damaged? It should be addressed and corrected. Yet, because it is hidden from our collective consciousness it remains unaddressed, it persists, and this has consequences.

I am referring to the plight of countless middle-class families with children who have mental health and substance abuse problems and who have health insurance but cannot gain access to timely care.

Under a government mandate called network adequacy, commercial health insurers, used by many working, middle-class families, are required by license to offer adequate networks of providers (child psychiatrists, psychotherapists) for families confronting mental health and substance abuse problems. In other words, they are expected, as per their insurance plan, to provide ready access to a provider near where policyholders live. The reality, though, is that too often they do not.

Why? Because commercial health insurers that pay substandard reimbursement rates have too few in-network providers. Their low rates of reimbursement serve as a disincentive for providers, including community-based mental health agencies that should be providing universal access to care, to enroll in their networks. Consequently, many community-based agencies, along with those in private practice, will accept only higher paying Medicaid insurance.

The gap between reimbursement rates for commercial health insurance and Medicaid is vast. In some cases, for example, the rate paid to providers by commercial insurers is half the rate paid by Medicaid. Although a health insurer is expected to help families find an in-network provider, most often they do not. They simply give them a list of names, and few if any of those providers accept the insurance because the rates of reimbursement don’t come close to covering the cost of services. This then frustrates already anxious parents who have had to work up the courage to ask for help.

It is very difficult for a parent to pick up the phone and seek help when their child is suffering from mental illness or addiction. When they are repeatedly turned away by their supposedly in-network providers, who tell them “I no longer accept that insurance,” it is devastating. When a child is denied access to timely care for mental illness or addiction the results can be life-threatening. 

A few weeks ago a mother seeking mental health care for her teenager came to us at North Shore Child & Family Guidance Center and told a familiar story.

"It's very hard. Decent psychiatrists don't take new patients and the rest don't take our insurance. Most of them don't take your insurance," she said. The intake worker asked her how many turned her down before she called us. She said 20.

What needs to be done? The New York State Department of Financial Services, a relatively new state agency formed by Gov. Andrew Cuomo, has regulatory jurisdiction over insurance companies. However, in my experience, their inaction on this issue indicates that they do little, if anything, to monitor network adequacy.

Substandard rates of reimbursement (e.g. the gap between Medicaid and commercial insurance rates) may be considered a violation of the Affordable Care Act’s parity protections, which require health insurance companies to treat annual or lifetime dollar limits for mental health and substance abuse the same as they do medical benefits. If that is the case, the attorney general also has the power to address this matter if DFS will not. But what remedy is there if they do not take action?

The New York State Comptroller’s Office has the primary responsibility to ensure that state agencies such as DFS are using taxpayer money efficiently and effectively. If DFS does not investigate the issue of network adequacy, then they are open to the scrutiny of a state audit as it relates to their effectiveness in the use of taxpayer dollars to properly monitor insurance companies under their jurisdiction.

Although mental health legislation, The Helping Families in Mental Health Crisis Act, has been introduced in Congress, it will do little good if families cannot find a provider. The act will only work when the issue of access to care is monitored and enforced. It’s time for DFS to do its job and launch an investigation of any commercial insurance company suspected of not having an adequate network of providers. It could truly save lives.

Andrew Malekoff is the executive director of the North Shore Child & Family Guidance Center in Roslyn Heights, a nonprofit that provides comprehensive mental health services for children from birth through age 24 and their families. To find out more, visit www.northshorechildguidance.org. - See more at: http://nynmedia.com/news/how-insurers-are-failing-children-with-mental-health-needs#sthash.omFazlzp.dpuf

(c) 2016 City and State NY, LLC. All rights reserved.

FAMILIES CAN'T AFFORD TO WAIT FOR MENTAL HEALTH SERVICES

L.I. Business News, March 4, 2016 

Access delayed is access denied.

These are words that ring true for thousands of families across Long Island who have been unsuccessful in accessing timely and affordable mental health and addictions care through their health insurer.

How do I know this? From the stories that people tell us at North Shore Child & Family Guidance Center, a 63-year-old children’s mental health agency in Nassau County.

Health insurers are mandated by government to offer panels of providers so that families can find easily accessible, quality care for their loved ones; and not only for physical illnesses. This requirement is known as network adequacy, referring to adequate networks of care.

The problem of access for mental health care, however, is more complex and may begin with a family’s hesitance to ask for help and to reveal that they are living with someone who is suffering from a mental illness. Families coping with mental illness or addiction do not as readily seek help as they might for heart disease, cancer or diabetes. Why? Because of stigma and the shame it generates. When there is a mass shooting for example, and the perpetrator is labeled mentally ill, it casts a shadow on all people with mental illness, despite the fact that mentally ill persons are disproportionately the victims of violence.

In the United States we have chronically failed to treat illnesses above the neck the same as illnesses below the neck. For example, a parent who would not hesitate to reach out for help if their child was in an accident and appeared to have broken an arm, might wait weeks and months, if not longer, to ask for help if it was a mental health or substance abuse problem.

What makes all this so insidious is that once a parent picks up the phone to ask for help, and they are told repeatedly by providers, “I’m sorry I don’t accept that insurance any longer, I only accept cash,” there is a chance they will give up.

When a parent gives up, they risk their child deteriorating further. This is also true for adults with mental illness and increases the odds that they will ultimately need more costly care or confinement; hospitalization or incarceration.

What to do? Gov. Cuomo created the Department of Financial Services, charged with the responsibility to monitor private health insurers to ensure that they have adequate networks of care as a condition of their license. This means they must demonstrate the consistent ability to provide timely access to care for individuals and their families.

Just this week parents who came to the Guidance Center after taking their child to the emergency room, told us that they called no less than 20 different therapists or agencies and were turned down by all of them. Finally they called another hospital that made the referral to us. We turn no one away for inability to pay.

This is an all too familiar story that we hear frequently and that my colleagues from sister agencies tell me as well. You might wonder why this happening.

Private health insurers pay substandard rates of reimbursement for mental health and addictions care, as compared to Medicaid; sometimes 50 percent or less the than the Medicaid rate. Consequently, participating providers bail out because they cannot afford to accept such low rates. The insurers fail to carefully monitor their lists and the state fails to monitor and regulate the insurers.

In the case of delayed care for a child, this represents corporate and state child abuse.

I have reached out repeatedly to the governor, attorney general and numerous state legislators to issue a call to action to demand that DFS do their job. There is sympathy, but no action.

Andrew Malekoff is executive director of North Shore Child & Family Guidance Center in Roslyn Heights.

If you subscribe to Long Island Business News: http://libn.com/2016/03/04/malekoff-li-families-cant-afford-to-wait-for-mental-health-services/

WHO'S THROWING THE BABIES INTO THE RIVER

Despite feeling blindsided, most of us now know that we are living in the midst of an unprecedented drug epidemic. According to the U.S. Department of Health and Human Services (HHS), since 1999, the rate of overdose deaths including prescription pain relievers, heroin and synthetic opioids such as fentanyl, nearly quadrupled.

Some of the steps taken to save lives include improving prescribing practices and expanding access to medication-assisted treatment and the use of Naloxone.  

Medication-assisted treatment combines talk therapy and medications such as methadone or buprenorphine to treat opioid addiction. Through affordable, accessible and quality care people can recover and go on to live productive lives.

Naloxone is used to treat a narcotic overdose in an emergency situation by reversing the effects of opioids, including slowed breathing or loss of consciousness.

Notwithstanding the increased attention to lifesaving measures, there is less focus on the devastating impact of addiction on children living in families where a parent is addicted to drugs or alcohol.

Perhaps nothing drove home the reality of America’s opioid problem more than the recent photo taken in Ohio of two overdosed adults spread out in the front of a car, while one of their young grandsons looked on from the back seat.

There are more than 8 million children younger than 18 years of age that are growing up in homes with alcohol and other drug-abusing parents. These young people are likely to become alcohol or drug abusers themselves without intervention.

Parental alcoholism and drug addiction influence the use of alcohol and other drugs in several ways including increased stress and decreased parental monitoring.

Children who grow up with an addicted parent learn to distrust to survive. When unpredictability dominates a child’s life, he or she is likely to be wary, always sensing disappointment lurking nearby.

Children growing up with an addicted parent become uncomfortably accustomed to living with chaos, uncertainty and instability. When a child grows up under these conditions, they learn to guess at what normal is, with no roadmap to assist them.

Denial, secrecy, embarrassment and shame are common experiences of children who live with an addicted parent. Even seeking help outside of the family might in itself be seen as an act of betrayal, a step toward revealing the family secret.

Children who grow up with an addicted parent live with an unspoken, emotionally numbing mandate - don’t talk, don’t trust, don’t feel.

Growing up with an addicted family member leaves one with little hope that things will ever change; unless, we take steps to change it. I am reminded of a parable about the small village on the edge of a river.

One day a villager saw a baby floating down the river. He jumped in the river and saved the baby. The next day he saw two babies floating down the river. He and another villager dived in and saved them. Each day that followed, more babies were found floating down the river. The villagers organized themselves, training teams of swimmers to rescue the babies. They were soon working around the clock.

Although they could not save all the babies, the rescue squad members felt good and were lauded for saving as many babies as they could. However, one day, one of the villagers asked: "Where are all these babies coming from? Why don't we organize a team to head upstream to find out who's throwing the babies into the river in the first place!"

Mobilizing resources to pull babies from the river, while neglecting the one’s left behind makes no sense.

Andrew Malekoff is the Executive Director 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, visit www.northshorechildguidance.org. 

A COMMON STRUGGLE

Patrick J. Kennedy is a former member of the U.S. House of Representatives who has struggled with mental illness and addiction for most of his life. He has become a leading force in the passage of the Mental Health Parity and Addiction Equity Act of 2008, a U.S. law that states that it is illegal to treat diseases of the brain differently than those of any other part of the body. The battle ahead is for the law to be enforced in the face of health insurers who stand to profit by denying the full range of coverage for people suffering with mental illness and addictions.

In his 2015 book, A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction, Kennedy offers personal reflections on the impact of trauma, addiction and mental illness on the extended Kennedy clan. He talks about the rocky relationship he had with his dad, the late U.S. Senator Edward “Ted” Kennedy and about his mom Joan’s battle with alcoholism.  

At the heart of the memoir are Kennedy’s own revelations about his co-occurring mental illness and prescription drug and alcohol addiction, his path to recovery, and his ascendance to becoming, arguably, the nation’s leading advocate for parity and equity in mental health and addiction care. Kennedy has fought hard to lift the veil of ignorance about mental illness and addiction and to expose the health insurance industry’s tradition of denying and restricting access to care for individuals with brain illness.

Kennedy radiates a fire for eradicating stigma and ending discrimination against people with brain illness. According to One Mind, a nonprofit organization he co-founded, that is dedicated to benefiting all affected by brain illness and injury, “One of the harmful effects of stigma is that it can lead to discrimination. It could be as obvious as someone making a negative remark about your mental illness or as subtle as someone avoiding you because they think you could be unstable, violent or dangerous.”

On their website, One Mind lists some of the ways that these attitudes can be damaging and even dangerous. For example:

·      Reluctance to seek help or treatment due to the labeling

·      Lack of understanding by family, friends, co-workers or others you know

·      Fewer opportunities for work, school or social activities or trouble finding housing

·      Bullying, physical violence or harassment

·      Health insurance that doesn't adequately cover your mental illness treatment

·      The belief that you'll never be able to succeed at certain challenges or that you can't improve your situation

Kennedy rightly frames the inequities that people with mental illness and addictions face as a matter of civil rights.

What he has accomplished, which he freely acknowledges is the result of a collective effort, has already gone a long way to wiping out stigma and increasing people’s access to mental health and addictions care. His goal, he states, is to launch “a new civil rights movement, to finally force medical equality for diseases of the brain.”

Tens of millions of Americans owe Patrick Kennedy a debt of gratitude for leading the way. Now all of us must carry the ball forward by treating children and adults with brain illnesses with dignity; and demanding that government enforce parity and equity for all and put an end to discrimination.

https://longislandweekly.com/a-common-struggle/ 

Andrew Malekoff is the Executive Director 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, visit www.northshorechildguidance.org.

MENTAL HEALTHCARE GETS SHORT SHRIFT FROM INSURERS

Have you ever sought mental healthcare for your child? What about care for a drug addiction? Have you made calls to multiple providers on your health insurer’s “list” and had the door slammed repeatedly in your face? Or were you fortunate enough to make a good connection and then unceremoniously have the rug pulled out from under you, with your insurer denying continued care?

Welcome to the club.

If you have a child with a mental health or addiction problem, you know how hard it is to make that first phone call. A parent with a child with cancer or diabetes doesn’t hesitate to call for help. But when mental health is the problem, it can take weeks, months or even years because of the crippling effect of stigma. But what about the two situations I described above: You make that call, but you are denied continued care, or you’re denied access to care in the first place?

The federal parity law, formerly known as the Mental Health Parity and Addiction Equity Act, is designed to prevent group health plans and health insurance companies from imposing less favorable benefits than they do for other medical conditions. The law is supposed to guarantee that people with mental illnesses have the same access to treatment as patients with diseases like cancer or diabetes, but some insurers have continued to limit treatment in subtle ways.

According to a recent report by NPR, since 2010, the Department of Labor, which is the main federal agency in charge of parity, has found 140 instances in which a patient's parity rights were violated. Although all those issues were resolved voluntarily, no insurer has been fined, and none of the results are public.

Regarding gaining access to care in the first place, network adequacy refers to a health plan's ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all healthcare services included under the terms of the contract. The reality is that, because private insurers pay substandard rates as compared to Medicaid, middle class families are finding it harder and harder to find providers to help their children. They look at their insurer’s list of providers, make phone calls, and are repeatedly told, I’m sorry, I don’t accept your insurance. The lists are inadequate, outdated or just plain falsehoods.

On July 22, 2015, Assemblyman Todd Kaminsky authored a letter to the New York State Department of Financial Services to express deep concern about the lack of commercial insurance coverage for mental health services for middle class families on Long Island. He requested that DFS launch an investigation to determine the scope of this pressing problem.

Assemblyman Kaminsky said, “After hearing from numerous constituents and closely studying this issue, it is clear that commercial insurance companies do not have adequate mental health service networks for hard-working families.  This lack of access to care is alarming, and I hope DFS will immediately respond by commencing a thorough study of this issue.”

While Medicaid covers comprehensive mental and behavioral health services, commercial insurance frequently does not provide coverage, or if they do, the rates are miniscule compared with the cost of treatment.  The reality today is that fewer community-based mental health clinics are accepting privately insured clients who earn too much to qualify for Medicaid, which leaves these families with nowhere to turn for affordable care. They have few options to access care for their children, even those experiencing life-threatening crisis situations.

“In this day and age, it is disgraceful that mental health treatment is still not being taken seriously.  Turning children and their families in need away is simply unacceptable,” said Assemblyman Kaminsky.

I applaud Assemblyman Todd Kaminsky’s calling for a NYS Department of Financial Services investigation of commercial insurance companies with respect to network adequacy and substandard rates of reimbursement for behavioral healthcare.

By ignoring the enforcement of the federal parity law, the majority of representatives in government are turning their backs on the millions of Americans who are in need of essential mental healthcare services. We cannot trust insurance companies, whose eye is on their bottom lines, to do the right thing. It’s no exaggeration to say that lives have been and will continue to be lost unless we pressure our politicians to make this a top priority.

Andrew Malekoff is executive director of North Shore Child & Family Guidance Center, a nonprofit children’s mental health center in Roslyn Heights, NY.

When Parents Drink and Drug

Anton Community Newspapers  • 

132 East 2nd Street

 •  Mineola, NY 11501  

When Parents Drink and Drug

by Andrew Malekoff© advance proof June 2012

The problematic use of alcohol, drugs and tobacco is unquestionably the nation’s number one health problem. While all segments of society are affected, the future of young people is most severely compromised by this epidemic.

There has been increased media exposure and public education on the rise of young people’s abuse of pharmaceuticals – prescription drugs – that often leads to heroin use and addiction.

Parents have been alerted to the fact that the most likely source of prescription drugs is the medicine cabinets of friends and family, where the pharmaceuticals can be easily attained at no cost; and, that the cost for a bag of heroin is less than that for a six-pack of beer.

Despite enhanced media coverage on these drugs, what the public hardly hears about anymore is the fact that there are millions of children who grow up in homes with parents who are addicted to alcohol and other drugs.

It has been estimated that approximately one in four children in the US is exposed to alcohol abuse and drug dependence in the family at some point before age 18. There are multiple impacts on children growing up in these homes. These young people are likely to become alcohol or drug abusers themselves without intervention.

Children who grow up in families with alcohol and drug addiction learn to distrust to survive. They learn how to walk on eggshells. The behavior and attitude of the addict and the related emotional tone in the home is a day-to-day mystery. When unpredictability dominates a child’s life, they are likely to be perpetually wary, always sensing disappointment or danger lurking nearby.

Children who grow up in addicted families become uncomfortably accustomed to living with chaos, uncertainty, unpredictability and inconsistency. These children have no idea what is normal. They live vastly different internal lives than their peers from homes where coping with addiction in the family is not a daily challenge.

Denial and secrecy are common for children who live in alcoholic or addicted families. Their lives are organized around concealing the truth. Asking for help is out of the question as that would trigger exposure to the outside world, disloyalty inside the family and it would evoke intense feelings of embarrassment and shame.

In an addicted family there is an ongoing and, most often, unspoken agreement to hide the problem to prevent exposure that will erode the image of a “perfect family.” Children may avoid bringing friends home and cringe at the thought of having the family secret revealed. Their own needs and desires take a back seat to fronting for their family and preserving the image that belies the reality.

It is hard to be a child in an alcoholic or addicted family. It takes a lot of energy just to get through the day. Growing up in such a family leaves children with little hope that things will ever change. Children who live in these homes often feel trapped, depressed, alone and desperate.

There are no simple answers, but there is help. Family members, friends, pediatricians and school personnel who are attuned to this problem can help to break the conspiracy of silence. Understanding the barriers, gently inviting trust and seeking professional support is the first step to overcome the problems involved. If you need guidance about how to proceed, call Tyrone Anthony, coordinator of chemical dependency services at the Leeds Place, a branch of North Shore Child and Family Guidance Center, at 516-997-2926.

Andrew Malekoff is Executive Director, North Shore Child and Family Guidance Center, Roslyn Heights, New York 11577
amalekoff@northshorechildguidance.org

NATALIE CIAPPA'S LAW

Natalie Ciappa’s Law

By Andrew Malekoff©

One month ago the Nassau County legislature passed a bill that requires police to notify school districts about heroin arrests. The bill, Natalie Ciappa’s Law, is named after a teenaged girl from Long Island, who died of a heroin overdose in June, 2008.

My heart goes out to Natalie’s family and to the growing number of families on Long Island that grieve the loss of their children to heroin and other addictions. Having worked in the addictions field for over three decades there are a few simple truths that I have learned. One is that drug addiction is a disease that destroys families. Another is that it doesn’t have to.

A Disease Suffered Secretly

Those that are afflicted with heroin addiction and their families have been stigmatized by an unforgiving society that view it not as an illness but as the consequence of a moral failing, lack of will power or poor parenting. Although progress has been made in dispelling such damaging myths, I am afraid that we still have a very long way to go.

Most people with physical illnesses are the beneficiaries of widespread understanding, sympathy and support. Not so with addiction. Can you imagine for a moment lecturing a parent whose child is diagnosed with brain cancer and telling them that if they had enforced an earlier curfew that the cancer could have been prevented. Such is the twisted logic of the self righteous and ignorant who refuse to accept that addiction is a disease that does not discriminate by race, faith, upbringing or privilege.

The stigma of addiction necessitates that it is most often suffered secretly, only deepening the pain for all that care for an addicted child. Public support must replace secret pain; and therein lies the challenge in Natalie Ciappa’s Law. With this law comes enormous responsibility. School officials will no longer be able to keep a straight face and say, “There is no drug problem in my school district.”

A Call to Action

Will the passing of this law bring with it dialogue and collaboration among stakeholders that will ensure that notification of arrest information will cause no further damage to suffering families? Will the passing of this law protect and prevent others from criminal activity, and also help young people and families to find and get the help that they need?
The answer to these questions is: It depends. It depends what school district leadership does with it. I assure you that it will not be easy. But nothing worth fighting for ever is.

Natalie’s Ciappa’s Law will shake things up and create dilemmas and concerns among school officials, family members and others. Sometimes it is worth the risk to shake things up in order to make a difference.

Beyond notification, I hope that the law that bears her name will do two things. First, I hope that it will serve to remind all parents that Natalie was not a bad girl. She was a beautiful young woman who suffered from an insidious and progressive disease. In addition to the good that it can do, passing this law is a step towards publicly restoring Natalie’s good name and the dignity that she deserves in death. Second, I hope that the New York State Office of Alcoholism and Substance Abuse Services (OASAS) will provide adequate funding and strong leadership for drug and alcohol treatment for teenagers and their families.

Natalie’s Legacy

Finally, although there are those that believe strongly that this new law is flawed, either because it does not go far enough to expose other illegal drug activity or because it goes too far in exposing vulnerable individuals, it is my hope that Natalie Ciappa’s Law will be a step forward in the ongoing march to ensure that all our children are healthy and safe.

Originally published in the Anton Newspaper chain, Long Island, NY in January 2009.