Mental Health Parity Law

Included as part of the recent financial rescue/bailout bill signed by President Bush, was the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. This will end health insurance benefits inequity between mental health/substance use disorders and medical/surgical benefits for group health plans with more than 50 employees. This means that equity in coverage will apply to all financial requirements, including lifetime and annual dollar limits, deductibles, copayments, coinsurance, and out-of-pocket expenses, and to all treatment limitations, including frequency of treatment, number of visits, days of coverage and other similar limits.

The new law will go into effect on 1/1/10, in order to give insurance companies time to change their policies. Medicaire and Medicaid are exempt. Medicare co-payments for mental health services are currently at 50%, while medical co-payments are at 20%. However, a Medicare parity bill passed last summer, so in 2014, mental health co-payments will be reduced to 20%. This bill was vetoed by President Bush, but the Congress overwhelmingly overrode the veto.

Forty-three (43) states have enacted parity laws. While some of these laws provide for strong parity protections, most are not as comprehensive as the new federal law.

Parity will not effect the millions of Americans who are still uninsured.

Best wishes,

Mike

The How of Happiness (Pt 1)

There has been a relatively recent and growing movement referred to as "Positive Psychology." Much of this has grown from the work of Martin Seligmann, PhD author of Learned Optimism and other books. Historically, most psychology studies focused on depression and other problems. There was a movement beginning in the late 50's called "Humanistic Psychology." Positive Psychology focuses more on "everyday" people and giving them tools to beat negative thinking and living more fully, while Humanistic Psychology has focused more on "extraordinary people and topics such as self-actualizing and peak experiences.

The How of Happiness. A Scientific Approach to Getting the Life You Want by Dr. Sonja Lyubomirsky, PhD was published in 2007. Dr. Lyubomirsky is a researcher at Stanford University. The findings of her and others' researchers on happier people is summarized below:

1. "They devote a great amount of time to their family and friends, nurturing and enjoying these relationships.
2. They are comfortable expressing gratitude for all they have.
3. They are often the firs to offer helping hands to coworkers and passersby.
4. They practice optimism when imagining their futures.
5. They savor life's pleasures and try to live in the present moment.
6. They make physical exercise a weekly and even daily habit.
7. They are deeply committed to lifelong goals and ambitions (e.g., fighting fraud, building cabinets, or teaching their children their deeply held values).
8. Last but not least, the happiest people do have their share of stresses, crises, and even tragedies. They may become just as distressed and emotional in such circumstance as you or I, but their secret weapon is the poise and strength they show in oping in the face of challenge.

(pages 22 - 23)

An interesting and worthwhile read. Dr. Lyubomirsky also has a blog on happiness at http://blogs.psychologytoday.com/blog/the-how-happiness

Best wishes,

Mike

Drugs vs. Therapy

As I touched on in my previous posting about depression, there are interesting studies comparing the treatments of medications and psychotherapy/counseling. One sees medication ads almost any tie you turn on the TV, look in a magazine, etc. Research proves that the advertising works. Increasing numbers of people are taking medications for depression, stress, etc. The number of people seeking counseling may be decreasing.

Many of the studies with depression, even severe depression, show them to be about equally effective. Therapy has been shown to have greater durability, with lower relapse rates following the end of treatment. There are also lower drop-out rates for therapy, due to medication side-effects. It is common practice for people to receive both treatments. One might think this to be more potent than either treatment by themselves. Some studies do support this, but other studies do not.

There is some evidence that therapy may be the better choice for those experiencing panic attacks. One study "found higher treatment effect sizes, lower attrition rates, and favorable cost profiles for talk therapy as compared to medication treatment for this disorder." There are fewer studies for panic than for depression. Therefore, one should be slower to declare a conclusion.

It may be surprising (including to many mental health professionals) that therapy can also be very helpful in the treatment of schizophrenia. An examination of many studies (a meta-analysis) "found that people treated with talk therapy in addition to medication were significantly better off than those treated with medication alone."

There are several other interesting findings from the huge muti-site research on depression. More effective therapists focus less on medications. Also, that the relationship with the psychiatrist is predictive of how helpful medication will be. There was a parallel with some behavior therapists, years ago. The parallel is that the medication or behavioral treatment are what is important and that the relationship is not. Behavior therapists have come to understand this. Some psychiatrists still have this lesson to be learned.

What can one conclude? First, that treatment works for most people. Second, the relationship with any mental health (and probably non mental health) providers is critical. Third, that the drug companies have great influence on what treatments people seek. This posting is not intended as anti-medication. I have encouraged numerous individuals to try medications for a variety of conditions. Rather, medications are not the only choice and sometimes the lesser choice. Lastly, if you are unhappy with your provider, try to make your complaints known to that person.

Best wishes,
Mike

For full report: http://www.talkingcure.com/archives.asp?id=129&fragment=0&SearchType=AND&terms=depression+relapse

Inspiration

Today I ran my first road race, a 5K (3.1 miles) in perhaps 4 or 5 years. I fully anticipated doing some walking. I surprised myself by managing to run the whole way. I further surprised myself by being able to pick up the pace the last 50 yards or so and passing several people. My time was 31:03 (a VERY pleasant surprise).

There are several points of this posting. All too often, we limit ourselves with negative expectations. It's a good idea to periodically push ourselves beyond what we think we can do. Someone said that if you have never failed, that you've never risked enough. I ran much of the race with Matt, a 80 year old man who started running at 50. Since then, he has run over 2000 races, including over 100 marathons! Matt, as well as several others were very encouraging to me when I commented on tiring. Runners generally are very encouraging to others. This is a good reminder for us to look to be more encouraging, more affirming, and treating others more often in positive ways. It also reminds us that inspiration is all around us. Sometimes we cannot see past the blinders of depression. Other times, we focus on looking for negatives, to affirm our notions that people, politicians, the world, etc. stink and will let you down. Better to be more positive towards others and to look for inspiration around us.

Best wishes,
Mike

Introduction

My name is Dr. Mike Miller and I want to introduce you to my blog. The purposes are to give people a sense of who I am, as well as to write about what it means to be human, present some behavioral research findings, book reviews, and who knows what else! I hope that you will enjoy and benefit from the variety of postings that I am envisioning. Suggestions are welcome. Go to http://drmike miller.com to learn more about me, as well as to find self-help information and tips for most behavioral health concerns.

Best wishes,
Mike