I was thinking about this repost as I was walking my dog just now, thinking that maybe Americans are incapable of synthesis. After all, beyond the commenters on this blog, how many people are going to consider this piece along with the preceding piece about the ineffectiveness of SSRI's? How many will look at the fact that the reason insurance companies don't pay for psychotherapy beyond a certain amount of visits is because data proves it's not helpful? How many are even capable of seeing beyond the black and white for or against all health care reform to the real issues? Very few I fear. This reminds me of the national and international news I was listening to on my walk, ipod, about how the "underwear terrorist" and the various US agencies' inability to synthesize information to prevent this guy from getting on a plane, of the business community's failure to see the real estate and economic collapse when it was right in front of them and on and on.

Hmm. Some people might think the bill contains a $1.25 billion gift to people who suffer from depression and their families. But probably those people are ignorant, or in the pocket of the drug companies, or high on seroquel, right?

Captain Caveman,

If the bill contained direct financial aid to citizens, a lot of the problems people labeled as having depression report like poverty and inability to get real medical care and dental care would be solved. In fact if we just took 1.25 billion dollars and divided it between each citizen instead of starting some government program, we could really help a lot of people. Never happen. Better to pay psychologists to monitor the unhappy but at least some new construction will probably be doled out which will trickle down to a few new construction jobs and palms of political cronies all the way will be greased on the dime of the US citizen.

I guess the idea of this being a gift is bizarre in this way to, these are not going be free therapy centers and they're not going to be places where you can get drugs for free.

I wasn't aware that people who believe they suffer from depression and their families feel that there are not enough places to get treatment in existence.

I think their problem is that they can't afford the treatment, again they don't want or need more mental health providers they want or need more money to pay for the "treatment" that already exists and perhaps to fully staff state and local mental health centers already in existence.

The only people carping that more money is needed are folks that think more inpatient treatment is needed, and again, like our current state mental hospitals, that's not free to the "patient."

And furthermore, why depression centers, why not aging centers, daycare centers, obesity centers, diabetes centers, even cancer centers...why does depression get a special gift when their are so many other at the very least equally important areas of need to "give" 1.25 billion tax dollars?

The 1.25 billion does not go to people with depression and their families. It goes toward the creation of more bureaucracy. If you want it, you pay for it.

I recently found out that my med cocktail for less than a year cost my insurance company $15,000. My inpatient hospital stay for only TWO DAYS, was $10,000. My visits to the outpatient psych doc were around $2,000 for the year. For that kind of money, I expect to be dancing a jig every day. I guarantee you I'd have been a lot less "depressed" if someone had given me that money instead of the "treatment" which made me suicidal.

Kimbriel, I feel your pain. I remember when I saw one of my psych hospital bills. I called my insurance company and suggested that they might want to come investigate the hospital so they could see what they're paying for. Also, this is why psych patients are threatened that they won't be able to go outside or loss of various other "privileges" if they don't attend the groups - the hospitals can't bill for services not rendered and this is a lot of money to them. Especially if you have multiple groups a day - we had morning goals group, wrap-up group, etc. The patients are half asleep. They can hire someone at minimum wage and bill for all this stupidity. As my former psychiatrist said the groups are a cheap way for them to entertain patients.

There's no telling how much money my insurance company and I paid for all the worthless drug cocktails, the hospitalizations, etc over the years.

I can't blame insurance companies for being resistant to paying for mental health care. I wouldn't pay it either, or at the minimum I would expect that there be some indication that the services provided are actually helping the patients.

I'm bankrupt from paying those bills, the per day billing is outrageous, and yeah, for what? $20,000 cash out to one inpatient hospital a decade ago--the groups are diversion at best and a freaky control requirement for discharge.

The money spent in a decade, is unfathomable, all for ending up in a state funded institution for my daughter.

Obama and his minions will never experience this, and will never relate to real people; ever.

Groups only serve two purposes.

1. A venue to monitor patients behaviour and score them (e.g: are you taking your meds?)

2. They are billable.

Sally,
The US Department of Labor classifies the various forms of cognitive activity required to work. Synthesis, as you may have guessed, is the top tier. I learned this little factoid in a job that consisted almost entirely of synthesizing information, probably the most absorbing work I've ever done. That's why reporting is such interesting work--there's all that research and interviewing, then you go home and synthesize what you've learned and try to communicate it in coherent and interesting form.

I'm so on board with all the comments above. I am appalled at what Medicare and my insurance has paid out over the years. Once hospitalization in the early 1990s cost over $58,000. And I was lucky to have survived the vengeful "treatment" of the presiding egomaniac. The fact it was mostly for a condition that is treatable with ten dollars a month medication and one or two blood tests a year is unconscienceable (which I've probably spelled wrong) and really puts the icing on the cake for me.

Yet when I called my local mental health center (you know, those places Dear Abby's always telling people will treat them for no or low cost, the ones supported by our tax dollars) and asked for help because I was remembering mother-daughter incest (yes Virginia, I have PTSD in addition to hypothyroidism) and was actively suicidal I was told "We charge $90 an hour." This was in 1990. I begged for help, told them "I feel as if I'm falling off a cliff." "$90 an hour" was all I got for a response, not even a phone contact or referral.

My therapist friends, meanwhile, were being paid $20 an hour by this agency with no benefits and no pay for the time spent doing paperwork--they get a room and the right to draw clients from the pool.

Of course, it could have been worse. I might actually have gotten "services" from them.

Sherry,

You're right, the US Department of Labor publishes a book called the Dictionary of Occupational Titles in which it assigns a 9 digit code to all jobs it recognizes and again you're right that synthesizing information is one of the code numbers. Of course like all government data this document is incredibly accurate and relevant having not been updated since 1991. There's supposed to be a migration to ONET, but it's never really happened.

Meanwhile, the reason most people labeled as mentally ill are able to get disability is because if you believe the DSM, correlated with the DOT, a math formula folks for your disability checks, then it's because we can't synthesize information.

Huh, That last post about the DOT was by me, Sally, not Sherry. Sorry for any confusion.

captain caveman: The thing is, if you're going to spend a large amount of money, purportedly to address a stated problem, it makes sense to get as much value as you can out of that money. Whereas it sounds like they're mostly just fucking around with this bill. Why reinvent the wheel? There are organizations _already in existence_, that have ties to communities, that can use that money.

There is a shortage of mental health services in some places (south-central Wisconsin, for example); i know of people who have gone inpatient just to see a psychiatrist, because their schedules were all full for over a month. And others who couldn't get into inpatient drug and alcohol rehab because there were no openings.

The proposed solution is dumb because it lacks flexibility. And what's the point of a gift if it doesn't end up helping people?

Sherry,
Either I'm hearing an echo in here or I've posted again without knowing it. {;>

Actually, my best friends is also named Sherry. We often forget this is unusual, until we show up together at a hotel or workshop registration desk and give our names. The stunned stare usually clues us back in and we assure the registrar no, we are not joking.

I cannot believe they haven't updated the DOT yet. That's pretty amazing, really. Our state is notorious for screwing up every computer system or major change they attempt. They once bought a software package from the state of Connecticut that sorted jobs ala DOT.

Clients were encouraged to use the system to explore career options. They came out with a list of all the jobs that had Data, Person and Thing codes that match their level of functioning and below. Sounds great, except... all the DPT numbers were backwards. Clients were given lists that had jobs on their functional level and ABOVE it. The less functional you were, the more career "opportunities" you were given. If you had an IQ of 80 and were exceptionally clumsy why, you too could be a brain surgeon.

The really funny thing is that it took three years before anyone noticed! My colleagues were actually very smart people but we were all so used to the state screwing up anything computer related no one thought to examine these lists. The clients were probably mostly bewildered.

The DOL job descriptions never worked well for us because we were in a rural and largely impoverished job market so everyone had to do five different jobs at once. I remember the DOT as being quite a marvelous little engine if you were able to figure out how to use it. I went to a three-day workshop (your tax dollars at work) and in true "use it or lose it" fashion the big book ended up being a doorstop in my office, too.

In our state Voc Rehab does disability determination. I always wondered what cookbook they used. I should have figured it out. The Dis. Determination Unit (DDU) was where they put Voc Rehab people who were half a step from disability. It was your last stop. (I went to grad school instead.) I suppose that was actually a kindness because at least you learned how to fill out your application. Special Ed was where the state put the people who were inept and incompetent or just plain strange. Sometimes they used it as a holding tank for someone from Central Office who lost their job in a cutback. They'd keep them there until they could bring them back to home base.

My knowledge of agencies and how they function enabled me to survive my 25 years in the mental health system. It also caused me to ask too many questions so I was kind of a marked woman most of the time. It was very odd, being on both sides of the desk.

Thank you Lisa. And with mental health treatment there's no end in sight. How can one ever be happy enough? At least with diabetes, they can measure your blood sugar and see that the drugs are working. With cancer, the cells metastasize or go away. But mental health treatment? If a patient doesn't respond, it's the illness. If they get worse, it's the illness. If they get better, well then thank god for psychopharmacology, but you'll still need to be taking that mix forever and come in to see your doctor at least every few months. It's such a racket.

In all of this, what I take away is that there will be no increased reform or help for people with bipolar disorder, since depression is only half the story. That's a sad fact, as bipolar disorder affects 2.6% of our population. In addition, antidepressants are not effective (by themselves) for people with bipolar disorder, and can even trigger a manic episode in them. I think this is all a bunch of scare tactics to cover up alot of money given to the wrong person.

Steve,

Isn't there a fight to get all depression classified as bipolar spectrum disorder? I think the battle for funding between depression and bipolar does have a lot of money involved, but don't worry, just as the increase in bipolar diagnoses is linked to the fact that when someone gets "treated" for drug and alcohol abuse double billing is available to the provider on those labeled dual diagnosis drug and alcohol addicted and bipolar, a chronic condition which means the payor can't look for some pesky cure as an excuse to withhold the big bucks, if the government money swings back to depression your diagnosis will probably get converted and you'll take whatever drug the pharmaceutical companies can make the biggest profit on. If you're currently on lithium, look to be converted to depression and don't worry, it's treated with the group of major tranquilizers advertised as anti psychotics these days.

Sherry, your story is both funny and tragic. I love the DOT as a historical relic but the fact that it is still relied on to determine how government funds are finally allotted to citizens is, as you know, horrible.