My last blog on this site was about how our federal and state governments are looking to make huge changes to our health care system. This is our window of opportunity to ask for everything that people on this site have said we needed to do to fix mental health care. This is our window to tell our managed care companies how they can help us, and get that locked into their state and federal contracts. http://www.madinamerica.com/2012/05/managed-care-is-a-big-deal-speak-up-now/
Right now 31 states have proposals in various stages to turn over some or all of the entire publicly funded health care systems to managed care monopolies. I gave links to places people could comment publicly on this information. This is our window of opportunity to ask for medication optimization, medication tapering protocols, effective mental health care menus like massage, service animals, talking to someone who’s been there, help finding a job, help keeping housing, whatever our people need.
YET…. I do not see many comments on the public forums where we can suggest changes. Comment here: http://cmsideas.uservoice.com/forums/141980-medicaid-gov/filters/new
SO….Now I need to know, and I need to know in your comments below…
WHAT….is the hesitation to ask for everything we’ve ever wanted on this site? How can we speak up? What are the obstacles we face to spending 3 minutes of our time to make (theoretically) effective public input? (Click here to do this.) Because if people have barriers or legitimate concerns I need to know them so we can move forward from here. The federal government may or may not be really listening to you, but right now I am.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Who is “we”? And what do you believe “we” want?
“We” is “You” so speak up!
And post quick because Corinna does a mean Harai-goshi!
Is it just for people on Medicaid in a particular state or for members of the public ?
There’s a link that goes to a how to improve the medicaid.gov website. It’s not for suggestions on how to improve medicaid itself just the website.
This is where the comments for section 1115 are supposed to go. It’s state by state listed on the right. Is that what you are talking about?
Yes, state by state it tells how managed care is going to take over a part or all of public healthcare and you can comment on your own state or any other state, too.
Corrina, can you give an example of what you mean by a medication optimization plan?
Here’s one: http://www.mentalhealthexcellence.org/Portals/2/Foundation%20Documents/Medication_optimization_in_the_service_of_recovery.pdf
Yes, this is the plan we’re using in Ashland, Ohio. We had two local participants involved, Pat Risser, Advocate Extraordinaire and Steve Stone, the Executive Director of our Mental Health & Recovery Board.
The Ohio folks have hit 3 nails on their heads!
“It is not known if conditions treated with psychiatric medications are permanent and will always require use of these medications.
We agree that everyone taking medication should have an ongoing opportunity to taper medication (which, in the context of this paper, may include discontinuation).
The goal is to find the minimally effective dose as defined by the consumer and provider. This may include the use of no medication in the treatment approach.”
The concept of “minimally effective dose” is particularly important. The dosages supplied by the pharmaceutical manufacturers are arbitrary and, to some, toxic.
Very much appreciate the detail about tapering. If I may suggest — “very gradually” is interpreted variously, I would add the recommendation of a 10% taper each month for 2 months, increase speed of taper if no withdrawal symptoms or if they last only a few days, lower the amount of decrement (e.g. 5%) if withdrawal symptoms appear at 10% decrements.
(The 2-month trial taper is because sometimes it takes some weeks for withdrawal symptoms to show up.)
Thanks very much for this excellent model of a medication optimization plan.
Submitted “Medicate with lowest effective dose, disseminate safe tapering plan” for California, with link to the pdf Corrina posted above.
Submission reads as follows:
Medicate with lowest effective dose, disseminate safe tapering plan
Patient safety should be the paramount goal in any medication optimization plan. Dosages should be adjusted to the lowest effective dose for an individual, which may be much lower than those set by pharmaceutical companies in clinical trials.
Every patient should be afforded the opportunity to safely discontinue medication upon remission, lack of efficacy, or should adverse effects outweigh benefits.
Please consider this excellent plan developed by a coalition of patient advocates and adopted in Ashland, Ohio
As “taper very gradually” is interpreted variously, I would add a recommendation of a 10% taper each month for 2 months, increase speed of taper if no withdrawal symptoms or if they last only a few days, lower the amount of decrement (e.g. 5%) if withdrawal symptoms appear at 10% decrements.
(The 2-month trial taper is because sometimes it takes some weeks for withdrawal symptoms to show up, and if they do, slowing the taper will reduce neurological damage to the patient.)
Medicaid and Medicare recipients would benefit by a voucher system, allowing more choice for treatment; to include non-drug options with both integrative medicine and counseling.
It’s addressed in this vision for proposed legislation –
Duane Sherry, M.S.
Now, I take my meds like a good girl, but I do so with no real hope due to the status of therapeutic nihilism in this country. Drugs aren’t an answer; they’re a paycheck. A 34 billion dollar one if my memory serves,(schizophrenia and bipolar diagnosis). They shouldn’t be a lifetime requirement. Additionally, there long list of side effects, (some irreversible) and the most recent study showing an average loss of life equally 32 years in those treated for long term mental illness. Drugs are either not designed for, have no medical hypothesis to support, or have questionable, if not completely biased studies associated. Two years ago, I found myself taking 4-6 mg of attivan a day (and working, going to school, and driving) Additionally, I had xanex for emergencies, and kolonopin as a back up, along with my other meds, and I happened on the original xanex research… I decided that I was really having just as many if not more (quite a bit more) panic attacks with the meds, but I was so doped up, I would never be able to identify their origin. I quit taking the benzos. I keep attivan around for emergencies, but now, I may take one once a month, but I could control one thing in the chaos. Get rid of the ADA. Remove the overwhelming payouts and bribes from the APA, and disallow the polity to create stigma in a Durkheim esque attempt to manipulate and stratify. Personally, I have to wonder about political figures that are so intent on warning about the dangers of the mentally ill, when they seem quite at home labeling an into portion of society as disposable in the name of money. Sociopathic tendencies? Perhaps, they should see someone.
Hey, we won! At least in Kansas, they are going to slow way down on their transfer of care: