EQUAL INSURANCE COVERAGE FOR MENTAL ILLNESSES [PARITY]

In 2008 a law was passed that required parity in coverage so that coverage for mental health and substance abuse services had to be the same coverage as that for medical and surgical services. However, this law did not require.mental health and substance abuse services and there were other loop holes so that insurers could get around the parity mandate. 

Now the Affordable Care Act mandates that mental health and substance abuse services be provided by all insurers and that parity exist with medical and surgical services.  It is easy to underestimate the significance of the availability of mental health and substance abuse services to millions of people who previously did not have them.  Even though there have been predictions of increased costs to insurers, it is likely that the costs will go down since it is estimated that 67% of primary care visits are due to psychiatric or substance abuse problems.  Having these problems effectively treated will likely lower the costs for insurers for all the problems that are caused by stress and only effectively treated by addressing the stress directly by mental health and substance abuse services.  This does depend on the services being available and the insurers providing the coverage for them.  This will also depend on state insurance commissioners enforcing the law for those insurers who refuse to follow the law.

I hope that the availability of mental health and substance abuse services and parity will help remove more of the stigma that is all too often attached to those of us who require these services.  It is time that this kind of ignorance is no longer tolerated.  

15 MILLION CHILDREN...SILENT VICTIMS OF EXPOSURE TO DOMESTIC VIOLENCE

In the October 31, 2013 [Vol.369, No. 18] New England Journal of Medicine, Drs. Bair-Merritt, Zuckerman, Augustynand Cronholm report on the fact that there are evidence-based recommendations from the Institue of Medicine and the U.S. Preventive Services Task Force regarding detecting the presence of domestic violence [termed Intimate Partner Violence [IPV]] and reducing the impact of this on the intimate partner without considering the impact on their children.  These Pediatricians and Family Physicians consider these children to be silent victims as their plight is not addressed as a public health problem.  The impact on children of being exposed to domestic violence has been noted in a number of studies with more than 15 million children living in homes where domestic violence occurs.  Also, 7 million of these children are exposed to severe violence. The consequences of this exposure includes increased risk of developing a number of physical problems with some of these problems linked to an altered neuroendocrine stress response.  Being in highly stressful environments leads to repeated fight or flight type reactions that then activates the autonomic nervous system and the hypothalamic-pituitary-adrenal [HPA] axis resulting in changes in multiple systems that then can lead to physical problems.  As an example, repeated exposure to domestic violence can lead to chronic activation of the HPA with repeated cortisol release that can lead to an excess of type 2 helper T cells compared to type 1 helper T cells that then causes airway inflammation and airway hyperreactivity, increasing the incidence and the severity of childhood asthma.  

There are also consequences of witnessing domestic violence that affects social and emotional health. These health problems are also related to the impact of chronic stress that can actually change the brains of children such that the stress response area of the brain is overrepresented and the interpretive functioning part of the brain is underrepresented.  This change in the brain makes it difficult to help children stop reacting with fear to so many situations. There are trauma based cognitive-behavioral therapies [TB-CBT] that can be very helpful but is often not available for these children who are still mostly not even identified as being exposed to this violence.

Hopefully, more attention will be given to stopping domestic violence and identifying the victims of this, including the children, and being sure that protection from the ongoing violence is available and treatment of the consequences of chronic stress is also available. 

BULLYING AND PHYSICAL COMPLAINTS

Children who are being bullied are more than twice as likely to have psychosomatic [physical complaints caused by stress] complaints compared to children who are not being bullied.  This was reported in a study in Pediatrics by G. Gini, Ph.D. and T. Pozzoli, Ph.D.  They did a meta-analysis of 30 studies involving more than 219,000 children who had psychosomatic symptoms.  Some of the children had been bullied.  The study determined that any repeated and/or unexplained somatic [physical] symptoms are a warning sign of the possibility that the child is being bullied. The somatic complaints can include: recurrent headaches. breathing problems, poor appetite, sleeping problems, etc.  

So, if your child has somatic complaints with no reason for them besides stress [psychosomatic] then it is very important to check for bullying as one of the causes of the stress. 

BEING AN INSPIRATION TO OTHERS

I have met people who inspire me by how they live their lives.  I often can't pinpoint what it is about them accept a feeling that they seem to be sharing with others.  After I get to know some of these inspirational people, I wonder if part of their inpiration comes from being aware of themselves and not feeling a need to hide who they are [and what they believe and feel is important] and don't seem to need to go along with what others are doing or saying. Also, they don't take themselves too seriously and don't seem to take personally what others say about them.  In addition, I don't hear them telling others what to do and I don't hear them expecting others to agree with them or change what they do.  They also don't [try not to] judge others and do not dwell in the past.  Finally, I don't hear them predicting the future.

So, from the positive side, these inspirational people are: self-aware; can laugh at themselves; stick to what they believe in and are open about this; are accepting and non-judgmental of others; encourage and support others; and are focused on what is happening today. 

So what is inspiring about these people?  They genuinely care about others and resist judging or criticizing other people.  They trust that how they live their lives will influence others in a positve way, even though they may not see this happening.  Finally, they also live their lives with reverence for living things.

So, who is capable of being someone who is an inspiration to others?  I believe that we are all capable of this.  All we need to do is believe in ourselves, stop living in the past, stop judging others and then see what happens in our lives.  I guarantee that our stress levels will be a lot lower. 

WE ARE STILL CREATURES OF HABIT

I have written before about our being creatures of habit.  I keep being reminded of how important this is when I am are trying to change behaviors [my own].  My brain is very good at maintaining patterns of behavior/thinking/feeling.  It seems to be able to do this effeciently with little energy output and seemingly almost automatically without my having to ask it to.  This is one of many amazing things about our brains.  It can store information that we tell it to [often apparently not fully aware that we are doing so].  Then it retrieves it when we need it to.  Our brains monitor us constantly and can virtually instantly access a specific stored memory to fit the occasion.  But what if we want to change this stored memory?

Our brains do not change these patterns on a whim or casually.  If this were to happen, our brains might take our change in breathing as a command to change the stored pattern that supports our breathing and then we could be in big trouble.  So, some of our behavior patterns are critical to our living.  Actually, studies have shown that we drive a car without activating our frontal lobes, relying on stored memory. In fact, if we have a head injury we often have a great deal of trouble driving as our brain is automatically focused on trying to fix the impact of the injury and it is harder to access our stored memory patterns.  So, it seems that we can perform complex activities [driving a car] using stored memory with our brain comparing what is happening to stored information and adjusting what we do without our having to process new information about what is happening, as we drive.  That is very efficient and quite amazing.

However, what if we want to change a pattern?  Well, presumably we do it frequently by giving our brains clear messages about what to change and why.  This works if we are calm and not feeling any stress about the change.  If we are feeling stressed and want to change a pattern but are still uncertain about it, our brains take this as a vote not to change the pattern.  

So what to do.  Well, it may be clearer now why some patterns are hard to change and why we act in certain ways even though it is not in our best interests.  To change patterns, we must give our brains [ourselves] a clear message that we are serious about the change and why.  It helps to tell our brains this outloud [really!].  It also seems necessary to have the change be a big one, not a little change, as our brains will treat little changes as no changes.  So, to change patterns of behavior, we must committ to a big change in our behaviors and then see what happens.