#psychiatrist. and hope they take my insurance. i called and checked for providers and they were the only one in the area so shoulf b ok but

[opens-up-4-nobody]

...

[jupiterjames]

Hey! Saw your post about getting a doctor to clear the hold that was placed on your meds by your insurance. You mentioned a genetic test for psychiatric drug tolerance - how did you get one of those? My SO has been prescribed lots of different psychiatric drugs and most either don’t work well or have lots of negative side effects, so I’m wondering if this test would be useful (his doctors have never mentioned it to him before)

Absolutely! Now, I'm in the US, so if you're not, I have no idea how it would work besides straight up asking your doc if they know who and how to get one, but if you are in the US, I hope this helps.

My psychiatrist suggested the testing because she is not fond of a patient having to play medication whack-a-mole more than few times, and has experienced this phenomenon many times over the years, so she knew. And it was covered by my insurance and done by a company called GeneSight. They have a myriad of genetic tests, which is AWESOME. Your doc or psychiatrist may not know about the specific tests for medication tolerance (it's basically a very targeted liver enzyme test), so maybe float the idea to them. As a provider, they can order a test for you, OR you can straight up order one yourself and pay out of pocket and possibly be reimbursed by filing an insurance claim yourself.

HOWEVER, please keep in mind that if you or your doc orders the test (it is a cheek swab that will be mailed to you and that you can mail back) FOR THE LOVE OF ALL THAT IS HOLY, check your insurance to see if you need pre-approval for coverage, a doctor's approval for coverage, and/or if you can just submit a claim after you get the bill, OR if your insurance will cover any genetic testing at all (most do for some things). Most docs will probably be more than willing to send your insurance a pre-approval request. Out of pocket, these specialized tests can cost upwards of $3-5K sometimes because they are so targeted. But also, if your SO is like me, and run the gauntlet of failed meds, insurance hates that too, so approving a test could be super easy. In my case, it went right through no hassle.

When you get the results, you will have an actual list of brand name and generic drugs in ALL psychiatric categories (even the ones that don't apply to your mental health needs) labled in a green (well-tolerated), yellow (eh, side effects that will probably resolve), and red (poorly tolerated or contraindicated.)

If you do this yourself, take the copy to your doc and discuss what's on the green list (or yellow if you're like me and have only 2 on the green list) and discuss what's appropriate. If your doc orders the test, they will also receive a copy of the results.

Anyway, this helped me A LOT. I immediately went on the SNRI that was in green, as well as anxiety meds in green (different category list) and felt a ton better.

Y'all stay as healthy as possible, okay? :D

[that-bipolar-journey]

A Nice Development

Hello There!

So I have more news on the Insurance dealio. For months I was waiting for my insurance to be updated to a more helpful plan. I didn’t hear too much from the insurance company so I had to make some calls. This is always a dreaded task to undertake due to being Autistic but nonetheless, I buckled down and did it. First I called my insurance provider and asked if my benefits were upgraded. They were not. The plan I was on basically covered a portion of the cost of visits to the doctor and medications I might be prescribed. That’s absolutely better than nothing but it didn’t include dental or vision. Due to being both mentally ill (meaning there are days when dental hygiene is difficult) and extremely nearsighted, I need both of those. The insurance company gave me a number to call to ask about how to get my benefits upgraded and if it was a possibility. So some days pass and I finally get to calling that number. When I called the number they gave me and asked them my questions, they referred me back to my Insurance provider and said that they were in charge of that. They were gracious enough to transfer my call to my insurance provider. I spoke to them again and they again said that they didn’t work with that side of things and to call the other place. So essentially, I was put in a phone call roundabout. After being told to call the other office the second time, I just decided to call my caseworker from the clinic I mentioned in a previous post who had actually helped me sign up for insurance in the first place. She told me to call if I was ever having troubles with the insurance company or if I needed any help with insurance at all. So I did. Let me tell you, this woman is an absolute boss and a blessing. When I called and told her what was going on she called the office herself and said she’d get back to me when she spoke to someone. The night passes and then yesterday morning I get a call from her. She had not only called to check in on my insurance herself but she took it all the way up to a supervisor in the office. Long story short, there was a mishap and it just needed to be switched over. She said that it hadn’t been done yet but that she would call me when she was notified that it was taken care of. Like I said, she’s a total boss and an extreme blessing. Fast-forward to today, I get a call from her saying that she was notified that it had been changed over and that she even checked my status herself to make sure that I had the proper benefits. I swear, I have her to thank for even having my insurance, as well as so much more. So now, I have proper coverage and I can begin looking into psychiatrists and therapists. I’m nervous but I’m sure we’ll get to that good point eventually and I’ll find a good psychiatrist and therapist.

So my piece of advice to you is: If you can, find someone good who can be your caseworker or advocate. It makes all the difference and it can help you get past the brick wall that some insurance companies have.

I hope you are well. Remember to take your meds, drink water, eat something, maybe get some sunlight, love yourself a bit, and all of that good stuff.

Love Always,

S

[bigskydreaming]

I kinda wanna fucking scream, so here, have a offline bullshit rant post.

So I’ve literally been trying to get my stupid fucking meds for over a MONTH now at this point, which I’m sure you can all see like, my mood is just wooooonderful these days. Not an excuse, casual reminder that yeah you do gotta take care of your own space so if my mood is dragging anyone down, I’m totes on board with blocking or unfollowing or y’know, burning me in effigy or something. Okay maybe not that last part. But still. You get it. And its not even that like, I need mood stabilizers per se, lol, so shout out to the armchair diagnosticians helpfully peppering my inbox still in their quest to oh so slickly be like ‘hey you’re a hot mess, take your hot messness away from tumblr’ like lol, didn’t ask.....nah, its mostly the perpetual lack of sleep and chronic pain issues that I have zero distraction from when my specific combo of meds isn’t able to let me actually weaponize my ADHD properly and power through that. Its a whole thing. Whatever. Just go with it.

POINT IS. So I’ve been trying to do this for over a month now, first obstacle was even just getting the money together for my refill appointment which is a whopping $150, because I have to pay out of pocket for mental health stuff these days because I had to switch my insurance over to something that paid out more heavily for physical benefits like my jaw surgery.....and because of the pandemic, and how many psychiatrists in my area and that I could actually reach aren’t taking new patients during the pandemic since most of them are conducting business virtually still, like, I have barely any resources for seeking out and trying new psychiatrist offices in the meanwhile that might charge less and I’m kinda stuck with the one I have because the last thing I can afford is to have like, NO psychiatrist at the moment, y’know?

So first I had to have that to even BOOK the appointment, which took forever because rent and food are a joy to accrue when you can barely manage to function as an actual employee of the capitalist machine ahfsklhflkahflakf, but so then I did that and like, got an appointment put on the books for August 19th. That was the soonest they could fit me in back when I paid them for my appointment about a week and a half ago. No, two weeks ago now? Eh, time is fake. ANYWAY, so that wasn’t gonna work for me, so basically the entirety of last week was devoted to constantly calling and trying to check in every other hour to see if they had any sooner cancellations I could take, because for whatever fucking reason, they just ‘don’t do’ a cancellation list wherein they call the next person on the list once they have a cancellation. Whatever.

So finally got a cancellation slot with a virtual appointment last Saturday night at random as fuck 8:40. Okay cool. Most of my refills are fairly simple, no real changes, but two are controlled substances so like, they have to do their due diligence and go through the proper protocols before giving me another prescription to one or whatever. Fine. Okay.

So I call the CVS they sent the prescription for my ADHD med to, the very next morning. One of the controlled substances, and the key med to like....making me functional instead of a rambling disjointed whirlibird of a thought emitter. Problem is, that medication is on back order. Won’t be in until Tuesday. Ugh. Okay, fine. Nothing I can do about it, because while the specific provider I spoke to in order to GET my refill prescriptions was taking an appointment the night before, the actual offices that schedule appointments and connect patients through to their providers was closed for the weekend, so I couldn’t even ask for them to send the scrip somewhere else.

SO. I go back to the CVS on Monday, hoping that maybe it came in early because not like I can do much else in the meanwhile. Course its not there, but oh well. I toy with the idea of calling to ask my provider to send the scrip to a different pharmacy (only had it sent to this one cuz its within walking distance to me, and since I can’t drive for medical reasons and Uber’s are expensive as fuck, just for errands, like, even though walking is sooooo not fun for me physically, like it is what it is). I decide against it because here’s another fun fact about this controlled substance....for security reasons, pharmacies don’t have to tell people over the phone if they have it in stock or not. Like, they won’t just say no we don’t have it in stock - I mean, they WILL say that, but that doesn’t actually mean anything because that’s what most of them say about that particular medication no matter whether or not they DO, and then just cite security protocols, so you have to actually GO to the store in question to ask them and even get a real answer to whether or not they even HAVE it in stock to FILL a prescription if its sent over. And no, the provider won’t just send scrips into several different pharmacies at once and just be whichever has it in stock can fill it - because again, controlled substance.

SO. I decide its not worth it to try getting the scrip sent over somewhere else, because I’d have to at least waste money on an Uber to even travel to various pharmacies and even check if they CAN fill it sooner than this one, when at least this place will have it in tomorrow. Its just one more day at this point.

Except then I go back on Tuesday. Oh sorry, don’t know why that other person told you we’d have our order in today, our shipments of that medication don’t come in until Wednesdays.

So I go back Wednesday. Success! They have it in stock. I go to pay, pulling out my goodRx coupon that was just printed out that morning, specifically citing the price for CVS at Target. The pharmacy manager says sorry, we don’t honor that coupon here for controlled substances like this one. I say: record scratch? He’s like yeah, that’s at the discretion of individual pharmacies, and we don’t honor that price for this specific medication, because we don’t want to attract customers only coming here to get that medication filled for that price. (This pharmacy is right at the edge of Inglewood and Culver City, for anyone who is familiar with those neighborhoods. The implications are exactly as they appear to be). So I’m like, what’s the regular generic price? He quotes me something that’s $180 more than the coupon, and thus $180 more than I have since I was focused totally on getting THIS amount ASAP, so I could get these meds so I could do more work and make more money. You see the train of thought. I’m like well that’s awesome, I don’t have anything close to that. Hey. Weird question. Why did nobody I talked to the past three days in a row that I’ve walked into this store in person to request this refill, like, mention this little tidbit about not honoring this coupon so instead of waiting for a backorder that would do me no good, I could have been spending that time having my prescription transferred somewhere that WOULD honor it?

He’s like, well did you mention to any of them that you’d be using a goodRx coupon for this particular medication? I said, yup. He said, you sure? I said well the specific process each time was I came in, I asked if this medication was in, they said what’s your name and date of birth, I provided that info, they said are you paying out of pocket, we don’t have valid insurance info for this on file for you, I said yup paying out of pocket with a goodRx coupon, they said *clickety clack of the keyboard* nope, sorry, we won’t have this medicine in until Tuesday, I mean Wednesday. 

He’s like, well you must be misremembering or they would have told you at the time that we don’t take GoodRx coupons on this medication. I’m like, dude, it was you. It was literally you that I spoke to two of those three times, right here at the counter, in person. I’m gonna go ahead and trust my memory of those interactions and what was said there over yours since you don’t actually remember having talked to me two times in the last three days. He’s like, I gotta go help another customer. There is no other customer. I leave. Fun day for everyone.

So then I call around town to at least check which CVS will actually honor the coupon I have and the price that I can afford to pay it at. I don’t bother asking if they even have the medication in stock because I know its not guaranteed to be a CORRECT answer, but at least I can see who accepts this damn coupon. Also, reason I’m only trying big brand pharmacies instead of smaller, hole in the wall ones is because again, controlled substance, and I know from experience that the bigger brand pharmacies are at least more likely to have that med in stock whereas most smaller ones tend to run out very quickly as they usually only get enough for their existing/regular customers and a little extra.

I find a CVS five miles away - not walkable, gonna have to Uber. Call my psychiatrist office again to ask them to transfer the scrip, front office says they’ll send the request to my provider, who usually checks and fulfills such requests in 24-48 hours. I’m like okay cool, can I get a phone call to let me know when that happens, so at least I know when to check back to follow up if it hasn’t happened yet for whatever reason? They’re like no, the pharmacy will send you a text or call when they get the prescription sent over and you can take it from there with them. I’m like okay, but I’ve done this a bunch of times and know from experience the pharmacy does NOT in fact always call or text, so is there a certain time to follow up to inquire if the provider has already sent the scrip and the pharmacy SHOULD have it by now or if the delay is on the provider’s end? Front office is like yeah no. I’m like, swell.

So that was yesterday. I call the pharmacy (which I still don’t even know if they have the medication IN STOCK to fill the scrip even once they GET the scrip, and won’t until I can actually Uber out there, but one thing at a time at this point) at like 9 pm, they’re a 24 hour pharmacy, and they’re like nope, we got nothing (this is after spending an hour and a half on hold to even TALK to someone at the pharmacy). Called them again today at noon, still nada. Technically I have another 29 hours before the window in which the provider is supposed to send the refill scrip to this new location, before I can be like, okay so they still haven’t done it, can we send him a nudge or another request. The 24-48 hour window will only actually EXPIRE after their offices close on Friday meaning it’ll be Monday before I can even actually REACH someone again to ask them to send the scrip again, if the pharmacy hasn’t ACTUALLY gotten it by Friday night, and pessimistically, I’m not super inclined to assume that they will at this point. 

I’m antsy, irritable, hungry because I don’t even know for SURE sure if the new pharmacy will ACTUALLY honor the coupon or say no sorry we don’t do that here either, whoever told you that was wrong, or if they’ll even actually have it in stock versus I’ll have to have it sent somewhere else AGAIN, so I have to pinch every penny possible in order to ensure I have the most money possible once my prescription IS filled in case the price is more than I expected again or in case I have to take Ubers there or further than I expected or basically....shit happens that I don’t expect. And this is what I’m basically spending all my time doing instead of working, because trying to get work done in this state is like....the harder I try to make it happen, the less it actually gets done, so I try and prioritize this and its roadblock after roadblock dragging out and wasting my time, and like yeah, I can post and shit while I’m doing this aka sitting on hold or walking around town trying to get shit filled because its fine if I ramble incoherently along the way in posts, but actual WORK work requires like....fucking coherency and succinctness and not having to stop and start every five minutes to call someone else, and oh yeah, being able to power through migraine spikes. And just.

I’m very annoyed about anything and everything to do with this shit. The hoops you have to jump through to even get the stuff that like....actualizes your hoop jumping ability, is just....*gnashing of teeth*

Anyway. So that’s my offline bullshit rant. Yay. The end.

[of-another-broken-heart]

I’m just going to copy/paste this because it took me hours and I’m drained. 

I guess I have to format it again if I want it to show up at all... 

I couldn't even make it back home before breaking down crying again.

Driving while chronically sleep deprived, exhausted, fatigued, and dissociating is bad enough. Doing it with all that AND without being able to see? How special. 

I barely had time to sit down, my phone rang. I answered it, begging for someone to hear me. For thirty straight seconds. "Hello? Hello? Hello???" Finally someone spoke, but they couldn't hear me. I'm sobbing. They hung up. I scrambled to call back, from my computer, because at least then I'm not fighting a lack of reception as well as my anxiety. They called again. I didn't answer. I waited for my computer to ring through instead. I'm put on hold.  I'm sobbing. It was just to ask what my pharmacy is. Which I already answered on my paperwork. Which I answered, again, at check-out. And I was forced into a third confirmation via a pointless, needless, anxiety-attack inducing phone call hazing. For something I already answered. 

It's not fucking fun. People don't choose this. I didn't choose this. But does it matter? "Call," the command comes. "Just call." "Call to confirm." "Call to ask." "Call." "Call." "Call." 

I want you to think of something that takes physical hold of your body and brings to you to tears. I want you to hold that and sit with it until it does those things. I want you to choose to reduce yourself to a sobbing mess, struggling to breathe, alone. And I want you to picture a world where you are commanded, demanded, required to do this. For virtually everything. Imagine needing help - but you must first re-traumatize yourself with your most painful memories until your nose is running and your eyes burn from crying. And you're exhausted for the rest of the day, too. Maybe multiple days. Absolutely exhausted. So fucking depleted that taking yourself to the bathroom is almost impossible. Feeding yourself - even eating something out of a can, or microwaved - is a herculean effort. Does that sound fun? Of course not. 

As for the appointment itself: It's the same. Much better bedside manner. But it's the same underlying capitalism-serving "care" system. It's my fault. I'm not trying hard enough. I'm not blacking out alone on the side of the road enough. I haven't dissociated hard enough and/or blacked out while driving yet, so it can't be that bad, right? Not until I'm maimed or dead, right? Why address the root of a problem when we can just plaster on endless band-aids instead? When we can blame you for hurting, instead of the environment that's poisoning you? I'm not medically sedating myself into an obedient little wage slave, and that's the real problem. I should aspire to produce capital for someone with most of the remaining hours of my life. That's the purpose of living, that's the reason for "health"care - not to care about health, no, just to keep the wheels of capitalism well-oiled with wasted human life. Inherent human value? Quality of life? Nah. 

They refused my medical history. I brought the 72-page pdf on a flash drive. Because that's how I was given it. Because I can't afford to buy and operate a personal fax machine and/or print out a chapter book's worth of pages of medical records. I went through the trouble of getting the files, and it took over a month - only to be told "we can't take anything but paper or fax." I filled out a file release form as best I could. But I didn't have the phone number or address memorized. Not even before that place became synonymous with medical neglect and trauma for me. So now they're going to go through the ancient months-long ritual of requesting the self-fucking-same documents from LISH, either by mail or fax, because they "can't" access a flash drive or a pdf or use email. Welcome to 2021. We're back to "normal" and teleheath never existed and the internet is fake and technology is a myth and why do anything efficiently when you can waste time and do damage to people instead? My Aunt called to check in on me during her lunch break. (Thank you again) She offered to get the file printed and try to hand it in for me. I'm too tired to hope. I'm too exhausted to think they'll accept it without fuss. Anything and everything to make things harder.

Top priority order of business is the whole "diseased for life" thing. Hashimoto's thyroiditis. Hypothyroidism. Daily hormones for every day of the rest of forever, gatekept behind eternal doctor visits and prescriptions and pharmacies and copays and and and and did I mention this is forever? I've got a referral to have a thyroid sonogram done. Haven't ever had one of those before. Need to make that appointment. I was able to have my blood drawn for the thyroid testing without needing an additional appointment, which was a nice change of pace. Normally you're supposed to fast for that, but I wasn't expecting that could be done during the visit. Three years of having to make additional trips to the lab for blood work. I ate immediately before getting there, so hopefully nothing had a chance to metabolize and skew the results. Even though it was great not to have to juggle yet another appointment for health shit, it was stressful. The nurse took three tries before she had all the supplies she needed in the room. I already have anxiety spikes (which also raise my blood pressure and heart rate) for all doctor visits now. (White Coat Syndrome, I learned, it's called) I didn't need to have a rubber cable tied around my arm, popped off, tied again, popped off, and tied a third and final time to make it worse. A pro to that con: she was incredibly accurate and gentle. I normally have sub-dermal bleeding and some bruising after having blood drawn, and keep the bandage on for a day or two. The bandage didn't last even an hour after I got home - but there wasn't a single spot of trapped blood, and I almost couldn't even tell where she stuck me.

I have another new diagnosis to add to my growing collection. Hypertension. High blood pressure. I used to have slightly low blood pressure. It stunned the first doctor I ever saw (you know, because I'm fat, so that sort of thing is supposed to be ~impossible~) and it frustrated my last doctor at first, too. But now, with years of building stress and anxiety? It's almost like living with your most basic human needs barely provided (food, shelter, healthcare - let's not bring up social needs LMAO those don't count anyway, right?), and at constant risk of being taken away, for months (years, in some cases) on end, is some form of stress. It's almost like being constantly dismissed and told "you're just not trying hard enough" (WHILE TRYING YOUR BEST JUST TO SURVIVE EACH DAY) is some form of stress!It's almost like perpetual, ongoing, worsening stress has a negative impact on your heart! It's almost like there are decades of data that spell this out, plain as day!It's almost like I noticed my elevated heart rate back in NOVEMBER and mentioned it out of concern to my last doctor - who dismissed it outright because my reading in-office wasn't *that* bad, and also shouldn't I be on 5487 psych meds instead? If I was sedated out of my mind, I wouldn't be physically capable of feeling stress in my body despite the presence of real-world stress factors. That's healthy, right? Don't bother to solve the stressors, just neuter the body's response to them. Super healthy response. (Not) My GYN took note of my concern in December, when my vitals DID show as high in-office. Not that my GYN had the jurisdiction to do anything about it. I'm being put on another medication to try to mitigate this, and potentially also address some anxiety. I haven't picked it up yet. I don't know the name. I don't know if I'll be able to afford it. "Your copay is only a dollar!" Yes well, when you don't have a dollar, you can't afford a dollar, can you?

I was given a list of psychiatrists. To "Call!!"Precisely none of them are a reasonable distance away. Nearly half aren't even in my insurance network. Some explicitly exclude Medicaid. Others are exclusively for children. I was suggested a medication for depression and anxiety. I can't remember which one. Either Abilify or Lexapro? I declined it for now, either way. I wanted to be able to research it. Lexapro is just another SSRI and I already know those don't work for me. Adding a chemical bouncer to my brain to make sure the happy chemicals stay out to play doesn't help when there are no happy chemicals in the first place. A quick search for Abilify doesn't address anxiety at all so it was probably Lexapro. In which case, I am not interested in repeating a different-flavor-Prozac experience. It was not good. I didn't get any notes with that medication, regardless. I got a sticky note with "Valerian Root Extract (tea or tincture)" and "Magnesium Glycinate 2 capsules" scribbled on it, instead. Out-of-pocket home rem-maybes. I can't afford to experiment with snake oils, so mostly I'll probably just spend a bunch of time looking for data and research and studies for those substances, and that's it. If I get around to psychiatric care, I will have to start from scratch in my insurance's shoddy search tool, again. And, frankly, it's not a priority. My mental health struggles are the result of a lot of physical factors and external/social factors, and no amount of artificial chemicals bullying my brain is going to solve any of it. When your car starts leaking oil, you don't just commit to buying more oil forever and dribbling it all over, wherever you go. You fix the fucking leak. If your house has a gas leak, you don't invest in gas masks. You fix the fucking leak. If you end up with a burst pipe, you don't commit to wasting water and money and damaging your environment. You fix. The fucking. Leak. But in these comparisons, I'm getting prescribed oil and gas masks and infinite water damage/waste/bills as long-term care.

I mentioned my fatigue. It was the final straw that made me give up with the last doctor. It just keeps getting worse. It's been getting worse for over 3 years. And I'm so, so fucking tired of it getting pinned fully on the fact that I'm not on psych meds. I WAS on psych meds during part of those 3 years with my last doctor. And it didn't fucking make any difference! A daily chemical lobotomy does not address or restore my lack of physical energy. My decades-old medication-resistant insomnia has never vanished with psych meds before, and it's not likely to do it now. Especially not with yet another of the same family of chemicals that I already know don't work. I want my concern to be taken seriously. I don't want it just brushed into the mental health corner, again. Being too tired to even do the things you used to enjoy - no one fucking wants this! I don't want this! I miss being able to go for walks. I miss going to the gym. I miss seeing how much I could do, and feeling good, and feeling strong. And I can't do any of that now. Not without risking harming myself in the process. 

No one wants this. I keep talking, but it feels like no one listens. At the earliest opportunity, we're back to repeating the same tired old shit that doesn't work. I try to come prepared, and the stress and time and system make sure I fail to stand up for myself anyway. I didn't get to document my disordered eating history. The relapse this year. Restricting, sometimes to the point of not eating at all. I declined to be weighed, because I want my care to be based on relevant data, vitals, blood results - not the shape and size of my body. But I was too tired to realize I needed to dodge a verbal ask for the same information. Which, it turns out, is nearly as bad a trigger as having the scale spit it out for me. Being your own advocate for equal care, when you're already tapped out? I'm not winning that challenge. 

I'm frustrated. I'm not giving up, but I am frustrated and beyond tired. I don't really expect anyone to read this mess. But it's here.

[mentalillnessmouse]

(p1) Hi, I'm writing because I feel there is no hope for me. I'm 30, I live at home where I get verbally mistreated (it was physical when I was younger.) I'm morbidly obese, agoraphobic, I literally didn't leave the house for a 2 year period and still rarely do. I have 0 friends and never had any except a few online ones who ditched me years ago. I was bullied constantly. I have self-harm marks all over my arms. I've NEVER had a job, or finished high school. I still almost never leave the house.

(p2) I’ve asked for help to learn to drive, but they tell me I can’t. I guess because they call me autistic and tell me I am not very smart and make jokes about me having ADHD. I took those comments seriously and they told me I was “looking for problems.” WHAT? I made the mistake of speaking with a few psychiatrists about it who shut me down because, in their words, I didn’t “look” like I had those issues. And that my parents had hard jobs so it made sense they would lash out at me. 

(p3) I deal with other issues too like menorrhagia. A doctor had me do an ultrasound (this was like my 3rd one since ‘06) and sent me to a specialist because they saw something. The specialist said she didn’t think anything was there and wasn’t going to actually examine me. I gave up. I’m afraid to speak up for myself, I genuinely don’t understand how to live, make friends, talk to people. I feel like I just have TOO MANY issues. And at my age I don’t see why anyone would bother with me anymore.

(p4) I have an appt with a psych at the same place as the others because I have my city’s free insurance and nowhere else to go. I don’t know if I can do it again after this? I just wanted somewhere to reach out at least one more time :( I’ve reached out to others (like extended family) who will talk to me for a bit then ignore? I can’t help but to feel damaged or like I’m doing something wrong I can’t figure out. I feel like a weak loser and I didn’t try good enough.I’m sorry this is so long

Hello Anon, 

I’m mod Bee and I’ll do my best to help you out, but I received help myself from the other mods to write you back. So this is a communal effort!

Thank you for reaching out, and I’m sorry you’re going though such a difficult and distressing situation. You sound strong and tenacious, and I’m proud of you for the way you keep trying to improve your life. 

We have some suggestions that we hope can be of help. They’ll concerne:

finding online communities/groups to hang out with

finding a professional that suits your needs 

looking for courses you can join 

thinking about possible job options 

Just an head up: this is going to be long, and it will contain tons of links. I’ll highlight one - that I think it’s most useful - for each section, but I suggest you to go through them all. 

1. finding online communities/groups to hang out with

Having friends is important for our mental health, but it can get difficult to make new ones, especially when we’ve been burned before.  

Online communities, forums, and groups, can be good places to start looking for friends again. You can approach them with as much caution as you need, and find those people you relate with the most.

If you like games, and rpgs in particular, there are online options that allow you to connect with other others all over the world. Activities like Dungeon&Dragons are based around players’ interactions, so you’d get to know people without putting the stress on forging new friendships. The article 10 Best Online Chat Rooms & Games suggests other equally fitting games. 

Forums and groups where you can share your experience and fears are another important tool you can use. I’ve looked into active ones and found Panic Disorder and Agoraphobia Forum, r/Agoraphobia/ (on reddit), bus (a self-harm support forum), Mental health support group and discussion community, Online Support Groups by Turn2Me, PsychForums (Psychology and Mental Health Forums), and the ReachOut app.

Trying with pen pals - a one on one exchange - could also be a good idea: InterPals and PenPalWorld are only two of the many websites dedicated to this purpose. Here’s some tips on how it works.

Finally, there are apps with the specific purpose of finding new friends, like Bumble BFF. Try to see if you there’s one of your liking in this list.

2. finding a professional that suits your needs

We usually recommend what it’s colloquially called “psychiatrist/therapist shopping”, the act of choosing a professional after inquiring what we need to know of their line of work, based on our own wishes, and asking this to more than one.

It’s difficult when insurance covers just a little portion of professionals, but not impossible. 

Can’t afford therapy? No insurance? Need low cost options? Here is a great list of ways to get help when money or insurance is an issue.

Therapy For Every Budget: How To Access It

9 Ways to Get Free or Cheap Therapy When You Don’t Have Health Insurance

Dial 211 for Essential Community Services: if you call 211, you can ask about free therapy options in your area, or how to work with you insurance to afford other professionals.

If none of these options work out, and you have to stick with the professional your insurance provides, there are measures you can take that might help making the sessions successful. Check out 21 Tips for getting the most out of each therapy session and How to Talk to Your Doctors When They Don’t Listen. 

If your new psychiatrist tries to dismiss you without hearing everything that you have to say, insist that they write on your record exactly what they did and why, and that you absolutely want a copy of it before you exit their room. It’s your right to have both your requests accomplished. I know it’s not easy to have them respected: you’ll probably have to stand your ground and that can be difficult, but I think it’s important for you and fundamental for what you can get out of this session. This is a post with links to various module you can complete to help you assert yourself, which I suggest you to start before going to your appointment, if you can. It can be useful to face your family, too.

Does your insurance cover a different specialist for the gynecological problem your doctor wanted you to check out? Is there any free or low-cost clinic near you, like Planned Parenthood or Free Clinic? You can inquire about their services through email.

3. looking for courses you can join

Online courses can be helpful for a number of things, like keeping busy, learning new stuff, feeling accomplished, and possibly getting some qualifications. 

There are some free options that end with a proper certificate, but not all are accredited, meaning that they’re not automatically accepted by employers (they can choose to consider them valid or not). Still, there are no downsides in joining such a course, seeing that it doesn’t cost anything but your time.

Not accredited certificates/no certificates:

Alison’s Diploma Courses and Certificate Courses 

FutureLearn doesn’t grant you certificates with their free courses, but it still provides learning access

edX’s Courses

Udemi, not free but it offers up to 90% discounts generally once a month

Learn how to code, a masterpost that lists different courses to learn coding

Free Online Language Courses, a masterpost that lists different courses to learn languages  

24 Invaluable Skills To Learn For Free

Accredited certificates

coursera offers some free courses, and/or the possibility to apply for financial aid

Online Degree require no tuition, no applications, and no interviews, and has worked so participating Universities around the country will consider the courses for credit, potentially finishing up to an entire freshman year of college

edX’s Professional Certificate Programs are not free, but edX offers up to a 90% discount to those who prove they cannot pay a full price.

University Of The People is tuition-free, which means there is no charge for teaching or instruction, only initial fees (around 160$) for each course. You can also apply for scholarships.

on StudyPortal - Scholarships, you can find a huge number of scholarships available in your country, and here you can find the easiest scholarships to apply to. There are also scholarships for online courses.

There’s also the possibility of completing high school through virtual courses, and if they’re organized by your State’s public school system, they should be free. You can find more info on this here. 

4. thinking about possible job options

Working towards finding a job is important for our own self-worth and feeling like a valuable member of society, and of course it can also help with looking for better therapy. 

It can be tricky when mental and physical illnesses are at play, though. That’s why I’d like to give you some online options here, too, that don’t ask for any particular prerequisite, and would give you enough free time to focus to get better. Jobs like data entry or app testing are doable from home, and may not pay much, but they’d allow you to start building some savings. 

5 Online Jobs That Require Little or No Experience

No Experience? Start One of These Online Jobs

Best Data Entry Jobs From Home

10 (Legit) Data Entry Jobs from Home

Work At Home Data Entry on Indeed.com

FlexJobs

Glassdoor

Whatever you choose, creating a strong resume is always a good step. I’m giving you some resources on how to do that:

How to Create a Professional Resume

How To Make A Resume 101

Help Everyone Find A Job In Their Field

And between checking out all these options we gave you, please try to do some of this Workout For Daily Life, because focusing on a screen for too long can cause so many aches!

You’re not a loser, you’re strong and you keep fighting for yourself, which is admirable. I hope these resources can be of help, and please do send another ask if you need anything else.

Take care,

mod Bee

[gordonwilliamsweb]

No Vacancy: How a Shortage of Mental Health Beds Keeps Kids Trapped Inside ERs

One evening in late March, a mom called 911. Her daughter, she said, was threatening to kill herself. EMTs arrived at the home north of Boston, helped calm the 13-year-old, and took her to an emergency room.

Melinda, like a growing number of children during the covid-19 pandemic, had become increasingly anxious and depressed as she spent more time away from in-person contact at school, church and her singing lessons.

KHN and NPR have agreed to use only the first names of this teenager and her mother, Pam, to avoid having this story trail the family online. Right now in Massachusetts and in many parts of the U.S. and the world, demand for mental health care overwhelms supply, creating bottlenecks like Melinda’s 17-day saga.

Emergency rooms are not typically places you check in for the night. If you break an arm, it gets set, and you leave. If you have a heart attack, you won’t wait long for a hospital bed. But sometimes if your brain is not well, and you end up in an ER, there’s a good chance you will get stuck there. Parents and advocates for kids’ mental health say that the ER can’t provide appropriate care and that the warehousing of kids in crisis can become an emergency itself.

What’s known as emergency room boarding of psychiatric patients has risen between 200% and 400% monthly in Massachusetts during the pandemic. The CDC says emergency room visits after suicide attempts among teen girls were up 51% earlier this year as compared with 2019. There are no current nationwide mental health boarding numbers.

“This is really unlike anything we’ve ever seen before, and it doesn’t show any signs of abating,” said Lisa Lambert, executive director of Parent/Professional Advocacy League, which pushes for more mental health care for children.

Melinda spent her first 10 days in a hospital lecture hall with a dozen other children, on gurneys, separated by curtains because the emergency room had run out of space. At one point, Melinda, who was overwhelmed, tried to escape, was restrained, injected with drugs to calm her and moved to a small, windowless room.

Day 12: Cameras Track Her Movements

I met Melinda in early April, on her 12th day in the ER. Doctors were keeping her there because they were concerned she would harm herself if she left. Many parents report spending weeks with their children in hospital hallways or overflow rooms, in various states of distress, because hospital psychiatric units are full. While demand is up, supply is down. Covid precautions turned double rooms into singles or psych units into covid units. While those precautions are beginning to ease, demand for beds is not.

Inside her small room, Melinda was disturbed by cameras that tracked her movement, and security guards in the hallways who were there, in part, for her safety.

“It’s kinda like prison,” she said. “It feels like I’m desperate for help.”

“Desperate” is a word both Melinda and Pam use often to describe the prolonged wait for care in a place that feels alien.

“We occasionally hear screaming, yelling, monitors beeping,” said Pam. “Even as the parent — it’s very scary.”

But this experience is not new. This was Melinda’s fourth trip to a hospital emergency room since late November. Pam said Melinda spiraled downward after a falling out with a close family member last summer. She has therapists, but some of them changed during the pandemic, the visits were virtual, and she hasn’t made good connections between crises.

“Each time, it’s the same routine,” Pam said. Melinda is rushed to an ER, where she waits. She’s admitted to a psych hospital for a week to 10 days and goes home. “It’s not enough time.”

Pam said each facility has suggested a different diagnosis and adjusted Melinda’s medication.

“We’ve never really gotten a good, true diagnosis as to what’s going on with her,” Pam said. “She’s out of control; she feels out of control in her own skin.”

Melinda waited six months for a neuropsychiatric exam to help clarify what she needs. She finally had the exam in May, after being discharged from the psychiatric hospital, but still doesn’t have the results. Some psychiatrists say observing a patient’s behavior is often a better way to reach a diagnosis.

Lambert, the mental health advocate, said there are delays for every type of psychiatric care — both residential and outpatient.

“We’ve heard of waits as long as five weeks or more for outpatient therapy,” Lambert said. “If your child is saying they don’t want to live or don’t want to ever get out of bed again, you don’t want to wait five weeks.”

Day 13: ‘The Longer She’s Here, the More She’s Going to Decline’

As her stay dragged on, Melinda bounced from manic highs to deep emotional lows. The emergency room is a holding area; it isn’t set up to offer treatment or psychiatric therapy.

On this day Melinda was agitated.

“I just really want to get out of here,” she said in an audio diary she was keeping at the time for this story. “I feel kind of helpless. I miss my pets and my bed and real food.” She’d had a panic attack the night before and had to be sedated. Her mom, Pam, wasn’t there.

“The longer she’s here, the more she’s going to decline,” Pam recorded in her own audio diary. “She has self-harmed three times since she’s been here.”

The hospital and its parent network, Beth Israel Lahey Health, declined requests to speak about Melinda’s care. But Dr. Nalan Ward, the network’s chief medical officer for behavioral health services, hosts a daily call to discuss the best place for inpatient psychiatric treatment for each patient. Some may have unique medical or insurance constraints, she said. Many insurers require prior approval before they’ll agree to pay for a placement, and that, too, can add delays.

“It takes a case-by-case approach,” said Ward. “It’s really hands-on.”

Day 14: Increasingly Isolated From School and Friends

For Melinda, the issue keeping her from moving out of the ER and into an effective treatment program could have been her behavior. Pam was told her daughter may be harder to place than children who don’t act out. Hospitals equipped to provide inpatient mental health care say they look for patients who will be a good fit for their programs and participants. Melinda’s chart included the attempted escape as well as some fights while she was housed in the lecture hall.

“She’s having behaviors because she has a mental illness, which they’re supposed to help her with,” Pam said, “but yet they’re saying no to her because she’s having behaviors.”

Secluding Melinda in the ER didn’t help, Pam said. “She’s, at times, unrecognizable to me. She just is so sure that she’s never going to get better.”

Melinda described feeling increasingly isolated. She lost touch with friends and most family members. She’d stopped doing schoolwork weeks earlier. The noise and commotion of a 24/7 ER was getting to Melinda.

“I’m not sleeping well,” she noted in her diary. “It’s tough here. I keep waking up in the middle of the night.”

Day 15: Mom Retreats to Her Car to Cry

Boarding is difficult for parents as well. Pam works two jobs, but she visited Melinda every day, bringing a change of clothes, a new book or something special to eat.

“Some days I sit and cry before I get out of the car, just to get it out of my system, so I don’t cry in front of her,” Pam said in her diary entry that day.

Some hospitals say they can’t afford to care for patients with acute mental health problems because insurance reimbursements don’t cover costs. Massachusetts is spending $40 million this year on financial incentives to create more inpatient psychiatric care. But emergency rooms are still flooded with psychiatric patients who are in limbo, boarding there.

Day 16: ‘I Wish Someone Would Just Understand Me’

“I never thought we’d be here this long,” said Pam.

At the nurses’ station, Pam was told it could be two more weeks before there would be an opening at an appropriate hospital.

In Massachusetts, Gov. Charlie Baker’s administration says it has a plan that will keep children out of ERs and reduce the need for inpatient care by providing more preventive and community-based services. Parents and providers say they are hopeful but question whether there are enough counselors and psychiatrists to staff proposed community clinics, therapy programs and more psychiatric hospital beds.

Meanwhile, in the ER, Melinda was growing listless.

“Life is really hard because things that should be easy for everyone are just hard for me,” she said. “When I ask for help, sometimes I picture going to the hospital. Other times I wish someone would just understand me.”

Then, in the late evening on Day 16, the family got word that Melinda’s wait would soon end.

Day 17: Limbo Ends and Real Treatment Begins

On Day 17, Melinda was taken by ambulance to a Boston-area hospital that had added child psychiatric beds during the pandemic. She was lucky to get a spot. The day she arrived, there were 50 to 60 children on the waiting list.

“That’s dramatically higher” than before the pandemic, said Dr. Linsey Koruthu, one of Melinda’s doctors and a pediatric psychiatrist at Cambridge Health Alliance. “About double what we would have seen in 2019.”

Doctors there adjusted Melinda’s medications. She met with a psychiatrist and social worker daily and had group therapy and time for schoolwork, yoga and pet therapy. Hospital staff members met with Melinda and her family. She stayed two weeks, a bit longer than the average stay.

Doctors recommended that Melinda move from inpatient care to a community-based residential treatment program — a bridge between being in the hospital and returning home. But those programs were full and had weeks-long delays. So, Melinda went straight home.

She now has three therapists helping her make the transition and use what she’s learned. And as covid restrictions have begun to ease, some sessions are in person — which Koruthu said should be more effective for Melinda.

Pam said the transition has been rough. Police came to the house once and suggested Melinda go to an ER, but she was able to calm down before it came to that. Melinda has developed an eating disorder.

The first available appointment with a specialist is in August. But, by mid-June, Melinda was able to graduate from middle school, after finishing a backlog of schoolwork.

“If you had asked me two months ago, I would have said I don’t think she’ll make it,” Pam said. “We’re getting there.”

If you or someone you know are in mental health crisis or may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en Español: 1-888-628-9454; for the deaf and hard of hearing: Dial 711 then 1-800-273-8255) or the Crisis Text Line by texting HOME to 741741.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).

No Vacancy: How a Shortage of Mental Health Beds Keeps Kids Trapped Inside ERs published first on https://nootropicspowdersupplier.tumblr.com/

[stephenmccull]

No Vacancy: How a Shortage of Mental Health Beds Keeps Kids Trapped Inside ERs

One evening in late March, a mom called 911. Her daughter, she said, was threatening to kill herself. EMTs arrived at the home north of Boston, helped calm the 13-year-old, and took her to an emergency room.

Melinda, like a growing number of children during the covid-19 pandemic, had become increasingly anxious and depressed as she spent more time away from in-person contact at school, church and her singing lessons.

KHN and NPR have agreed to use only the first names of this teenager and her mother, Pam, to avoid having this story trail the family online. Right now in Massachusetts and in many parts of the U.S. and the world, demand for mental health care overwhelms supply, creating bottlenecks like Melinda’s 17-day saga.

Emergency rooms are not typically places you check in for the night. If you break an arm, it gets set, and you leave. If you have a heart attack, you won’t wait long for a hospital bed. But sometimes if your brain is not well, and you end up in an ER, there’s a good chance you will get stuck there. Parents and advocates for kids’ mental health say that the ER can’t provide appropriate care and that the warehousing of kids in crisis can become an emergency itself.

What’s known as emergency room boarding of psychiatric patients has risen between 200% and 400% monthly in Massachusetts during the pandemic. The CDC says emergency room visits after suicide attempts among teen girls were up 51% earlier this year as compared with 2019. There are no current nationwide mental health boarding numbers.

“This is really unlike anything we’ve ever seen before, and it doesn’t show any signs of abating,” said Lisa Lambert, executive director of Parent/Professional Advocacy League, which pushes for more mental health care for children.

Melinda spent her first 10 days in a hospital lecture hall with a dozen other children, on gurneys, separated by curtains because the emergency room had run out of space. At one point, Melinda, who was overwhelmed, tried to escape, was restrained, injected with drugs to calm her and moved to a small, windowless room.

Day 12: Cameras Track Her Movements

I met Melinda in early April, on her 12th day in the ER. Doctors were keeping her there because they were concerned she would harm herself if she left. Many parents report spending weeks with their children in hospital hallways or overflow rooms, in various states of distress, because hospital psychiatric units are full. While demand is up, supply is down. Covid precautions turned double rooms into singles or psych units into covid units. While those precautions are beginning to ease, demand for beds is not.

Inside her small room, Melinda was disturbed by cameras that tracked her movement, and security guards in the hallways who were there, in part, for her safety.

“It’s kinda like prison,” she said. “It feels like I’m desperate for help.”

“Desperate” is a word both Melinda and Pam use often to describe the prolonged wait for care in a place that feels alien.

“We occasionally hear screaming, yelling, monitors beeping,” said Pam. “Even as the parent — it’s very scary.”

But this experience is not new. This was Melinda’s fourth trip to a hospital emergency room since late November. Pam said Melinda spiraled downward after a falling out with a close family member last summer. She has therapists, but some of them changed during the pandemic, the visits were virtual, and she hasn’t made good connections between crises.

“Each time, it’s the same routine,” Pam said. Melinda is rushed to an ER, where she waits. She’s admitted to a psych hospital for a week to 10 days and goes home. “It’s not enough time.”

Pam said each facility has suggested a different diagnosis and adjusted Melinda’s medication.

“We’ve never really gotten a good, true diagnosis as to what’s going on with her,” Pam said. “She’s out of control; she feels out of control in her own skin.”

Melinda waited six months for a neuropsychiatric exam to help clarify what she needs. She finally had the exam in May, after being discharged from the psychiatric hospital, but still doesn’t have the results. Some psychiatrists say observing a patient’s behavior is often a better way to reach a diagnosis.

Lambert, the mental health advocate, said there are delays for every type of psychiatric care — both residential and outpatient.

“We’ve heard of waits as long as five weeks or more for outpatient therapy,” Lambert said. “If your child is saying they don’t want to live or don’t want to ever get out of bed again, you don’t want to wait five weeks.”

Day 13: ‘The Longer She’s Here, the More She’s Going to Decline’

As her stay dragged on, Melinda bounced from manic highs to deep emotional lows. The emergency room is a holding area; it isn’t set up to offer treatment or psychiatric therapy.

On this day Melinda was agitated.

“I just really want to get out of here,” she said in an audio diary she was keeping at the time for this story. “I feel kind of helpless. I miss my pets and my bed and real food.” She’d had a panic attack the night before and had to be sedated. Her mom, Pam, wasn’t there.

“The longer she’s here, the more she’s going to decline,” Pam recorded in her own audio diary. “She has self-harmed three times since she’s been here.”

The hospital and its parent network, Beth Israel Lahey Health, declined requests to speak about Melinda’s care. But Dr. Nalan Ward, the network’s chief medical officer for behavioral health services, hosts a daily call to discuss the best place for inpatient psychiatric treatment for each patient. Some may have unique medical or insurance constraints, she said. Many insurers require prior approval before they’ll agree to pay for a placement, and that, too, can add delays.

“It takes a case-by-case approach,” said Ward. “It’s really hands-on.”

Day 14: Increasingly Isolated From School and Friends

For Melinda, the issue keeping her from moving out of the ER and into an effective treatment program could have been her behavior. Pam was told her daughter may be harder to place than children who don’t act out. Hospitals equipped to provide inpatient mental health care say they look for patients who will be a good fit for their programs and participants. Melinda’s chart included the attempted escape as well as some fights while she was housed in the lecture hall.

“She’s having behaviors because she has a mental illness, which they’re supposed to help her with,” Pam said, “but yet they’re saying no to her because she’s having behaviors.”

Secluding Melinda in the ER didn’t help, Pam said. “She’s, at times, unrecognizable to me. She just is so sure that she’s never going to get better.”

Melinda described feeling increasingly isolated. She lost touch with friends and most family members. She’d stopped doing schoolwork weeks earlier. The noise and commotion of a 24/7 ER was getting to Melinda.

“I’m not sleeping well,” she noted in her diary. “It’s tough here. I keep waking up in the middle of the night.”

Day 15: Mom Retreats to Her Car to Cry

Boarding is difficult for parents as well. Pam works two jobs, but she visited Melinda every day, bringing a change of clothes, a new book or something special to eat.

“Some days I sit and cry before I get out of the car, just to get it out of my system, so I don’t cry in front of her,” Pam said in her diary entry that day.

Some hospitals say they can’t afford to care for patients with acute mental health problems because insurance reimbursements don’t cover costs. Massachusetts is spending $40 million this year on financial incentives to create more inpatient psychiatric care. But emergency rooms are still flooded with psychiatric patients who are in limbo, boarding there.

Day 16: ‘I Wish Someone Would Just Understand Me’

“I never thought we’d be here this long,” said Pam.

At the nurses’ station, Pam was told it could be two more weeks before there would be an opening at an appropriate hospital.

In Massachusetts, Gov. Charlie Baker’s administration says it has a plan that will keep children out of ERs and reduce the need for inpatient care by providing more preventive and community-based services. Parents and providers say they are hopeful but question whether there are enough counselors and psychiatrists to staff proposed community clinics, therapy programs and more psychiatric hospital beds.

Meanwhile, in the ER, Melinda was growing listless.

“Life is really hard because things that should be easy for everyone are just hard for me,” she said. “When I ask for help, sometimes I picture going to the hospital. Other times I wish someone would just understand me.”

Then, in the late evening on Day 16, the family got word that Melinda’s wait would soon end.

Day 17: Limbo Ends and Real Treatment Begins

On Day 17, Melinda was taken by ambulance to a Boston-area hospital that had added child psychiatric beds during the pandemic. She was lucky to get a spot. The day she arrived, there were 50 to 60 children on the waiting list.

“That’s dramatically higher” than before the pandemic, said Dr. Linsey Koruthu, one of Melinda’s doctors and a pediatric psychiatrist at Cambridge Health Alliance. “About double what we would have seen in 2019.”

Doctors there adjusted Melinda’s medications. She met with a psychiatrist and social worker daily and had group therapy and time for schoolwork, yoga and pet therapy. Hospital staff members met with Melinda and her family. She stayed two weeks, a bit longer than the average stay.

Doctors recommended that Melinda move from inpatient care to a community-based residential treatment program — a bridge between being in the hospital and returning home. But those programs were full and had weeks-long delays. So, Melinda went straight home.

She now has three therapists helping her make the transition and use what she’s learned. And as covid restrictions have begun to ease, some sessions are in person — which Koruthu said should be more effective for Melinda.

Pam said the transition has been rough. Police came to the house once and suggested Melinda go to an ER, but she was able to calm down before it came to that. Melinda has developed an eating disorder.

The first available appointment with a specialist is in August. But, by mid-June, Melinda was able to graduate from middle school, after finishing a backlog of schoolwork.

“If you had asked me two months ago, I would have said I don’t think she’ll make it,” Pam said. “We’re getting there.”

If you or someone you know are in mental health crisis or may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en Español: 1-888-628-9454; for the deaf and hard of hearing: Dial 711 then 1-800-273-8255) or the Crisis Text Line by texting HOME to 741741.

This story is part of a partnership that includes WBUR, NPR and KHN.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).

No Vacancy: How a Shortage of Mental Health Beds Keeps Kids Trapped Inside ERs published first on https://smartdrinkingweb.weebly.com/

[orbemnews]

Psychiatry Confronts Its Racist Past, and Tries to Make Amends Dr. Benjamin Rush, the 18th-century doctor who is often called the “father” of American psychiatry, held the racist belief that Black skin was the result of a mild form of leprosy. He called the condition “negritude.” His onetime apprentice, Dr. Samuel Cartwright, spread the falsehood throughout the antebellum South that enslaved people who experienced an unyielding desire to be free were in the grip of a mental illness he called “drapetomania,” or “the disease causing Negroes to run away.” In the late 20th century, psychiatry’s rank and file became a receptive audience for drug makers who were willing to tap into racist fears about urban crime and social unrest. (“Assaultive and belligerent?” read an ad that featured a Black man with a raised fist that appeared in the “Archives of General Psychiatry” in 1974. “Cooperation often begins with Haldol.”) Now the American Psychiatric Association, which featured Rush’s image on its logo until 2015, is confronting that painful history and trying to make amends. In January, the 176-year-old group issued its first-ever apology for its racist past. Acknowledging “appalling past actions” on the part of the profession, its governing board committed the association to “identifying, understanding, and rectifying our past injustices,” and pledged to institute “anti-racist practices” aimed at ending the inequities of the past in care, research, education and leadership. This weekend, the A.P.A. is devoting its annual meeting to the theme of equity. Over the course of the three-day virtual gathering of as many as 10,000 participants, the group will present the results of its yearlong effort to educate its 37,000 mostly white members about the psychologically toxic effects of racism, both in their profession and in the lives of their patients. Dr. Jeffrey Geller, the A.P.A.’s outgoing president, made that effort the signature project of his one-year term of office. “This is really historic,” he said in a recent interview. “We’ve laid a foundation for what should be long-term efforts and long-term change.” Dr. Cheryl Wills, a psychiatrist who chaired a task force exploring structural racism in psychiatry, said the group’s work could prove life-changing for a new generation of Black psychiatrists who will enter the profession with a much greater chance of knowing that they are valued and seen. She recalled the isolation she experienced in her own early years in medicine, and the difficulty she has had in finding other Black psychiatrists to whom she can refer patients. “It’s an opportunity of a lifetime,” she said. “In psychiatry, just like any other profession, it needs to start at the top,” she said of her hope for change. “Looking at our own backyard before we can look elsewhere.” For critics, however, the A.P.A.’s apology and task force amount to a long-overdue, but still insufficient, attempt at playing catch-up. They point out that the American Medical Association issued an apology in 2008 for its more than 100-year history of having “actively reinforced or passively accepted racial inequalities and the exclusion of African-American physicians.” “They’re taking these tiny, superficial, palatable steps,” said Dr. Danielle Hairston, a task force member who is also president of the A.P.A.’s Black caucus and the psychiatry residency training director at Howard University College of Medicine. “People will be OK with saying that we need more mentors; people will be OK with saying that we’re going to do these town halls,” she continued. “That’s an initial step, but as far as real work, the A.P.A has a long way to go.” The question for the organization — with its layers of bureaucracy, widely varied constituencies and heavy institutional tradition — is how to get there. Critics operating both inside and outside the A.P.A. say that it still must overcome high hurdles to truly address its issues around racial equity — including its diagnostic biases, the enduring lack of Black psychiatrists and a payment structure that tends to exclude people who can’t afford to pay out of pocket for services. “All these procedural structures that are in place are helping to perpetuate the system and keep the system functioning the way it was designed to function,” said Dr. Ruth Shim, the director of cultural psychiatry and professor of clinical psychiatry at the University of California, Davis, who left the A.P.A. in frustration last summer. They all add up, she said, to “an existential crisis in psychiatry.” A racist history White psychiatrists have pathologized Black behavior for hundreds of years, wrapping up racist beliefs in the mantle of scientific certainty and even big data. The A.P.A. was first called the Association of Medical Superintendents of American Institutions for the Insane, according to Dr. Geller, who last summer published an account of psychiatry’s history of structural racism. The group came into being in the wake of the 1840 federal census, which included a new demographic category, “insane and idiotic.” The results were interpreted by pro-slavery politicians and sympathetic social scientists to find a considerably higher rate of mental illness among Black people in the Northern states than among those in the South. In the decades following Reconstruction, prominent psychiatrists used words like “primitive” and “savage” to make the cruelly racist claim that Black Americans were unfit for the challenges of life as independent, fully enfranchised citizens. T.O. Powell, superintendent of the infamous State Lunatic Asylum in Milledgeville, Ga., and president of the American Medico-Psychological Association (the precursor to the A.P.A.), went so far as to outrageously state in 1897 that before the Civil War, “there were comparatively speaking, few Negro lunatics. Following their sudden emancipation their number of insane began to multiply.” Psychiatry continued to pathologize — and sometimes demonize — African-Americans, with the result that, by the 1970s, the diagnosis of psychosis was handed out so often that the profession was essentially “turning schizophrenia into a Black man’s disorder of aggression and agitation,” said Dr. Hairston, a contributor to the 2019 book, “Racism and Psychiatry.” Since then, numerous studies have shown that an almost all-white profession’s lack of attunement to Black expressions of emotion — and its frequent conflation of distress with anger — have led to an under-diagnosis of major depression, particularly in Black men, and an overreliance upon the use of antipsychotic medications. Black patients are less likely than white patients to receive appropriate medication for their depression, according to a 2008 report published in “Psychiatric Services.” Fixing the problem To change course, and serve Black patients better, organized psychiatry is going to need to make a higher priority of training doctors to really listen, said Dr. Dionne Hart, a Minneapolis psychiatrist and addiction medicine specialist and an adjunct assistant professor of psychiatry at the Mayo Clinic College of Medicine and Science. “We checked a lot of boxes publicly,” she said in an interview. “Now we have to do the work. We have to show we’re committed to undoing the harm and working with all of our colleagues from all over the country to recognize trauma and acknowledge trauma where it exists and get people appropriate treatment.” Psychiatrists lean liberal, and many say that people with mental illness are a marginalized and underserved group. In 1973, the A.P.A. made history by removing “homosexuality” as a psychiatric diagnosis from the second edition of its Diagnostic and Statistical Manual of Mental Disorders. But the kind of soul searching that occurred around that decision has taken much longer with race. Psychiatry today remains a strikingly white field where only 10.4 percent of practitioners come from historically underrepresented minority groups, who now make up nearly 33 percent of the U.S. population, according to a 2020 study published in “Academic Psychiatry.” That study found that in 2013, Black Americans were only 4.4 percent of practicing psychiatrists. The discipline’s history of pathologizing Black people — to “regard Black communities as seething cauldrons of psychopathology,” as three reform-minded authors put it in 1970 in the American Journal of Psychiatry — has deterred some Black medical students from entering the profession. “Some people in my family, even now won’t say that I’m a psychiatrist,” Dr. Hairston noted. “A family member told me on my match day that she was disappointed that I had matched to psychiatry and not another specialty — it seemed like I was letting the family down.” The difficulty in finding a Black psychiatrist can put a damper on the willingness of Black patients to seek treatment. And psychiatric help is also strikingly inaccessible for patients without money. Psychiatry is an outlier among other medical specialties for the extent to which its practitioners choose not to participate in public or private health insurance programs. In 2019, a study by the Medicaid and CHIP Payment and Access Commission found that psychiatrists were the least likely medical providers to accept any type of health insurance: Just 62 percent were accepting new patients with either commercial plans or Medicare, while an even more anemic 36 percent were accepting new patients using Medicaid. In contrast, across all providers, 90 percent reported accepting new patients with private insurance, 85 percent said they accepted those with Medicare and 71 percent were willing to see Medicaid patients. Many psychiatrists say they do not participate in health insurance because the reimbursement rates are too low. A 2019 study showed that, nationwide, reimbursement rates for primary care physicians were almost 24 percent higher than for mental health practitioners — including psychiatrists. In 11 states, that gap widened to more than 50 percent. The A.P.A.’s advocacy in this particular area of equity has focused on pushing for full insurer compliance with the Mental Health Parity and Addiction Equity Act, a 2008 law that requires health insurance plans that provide mental health care coverage to do so at a level comparable to what they provide for physical health care. While the profession hopes for higher reimbursement rates, the gap that affects patients, in the short term, is inequitable access to treatment. “The thing that’s always bothered me the most in the practice of psychiatry is, you can talk about your commitment to things like equity, but if you have a system where a lot of people can’t get access, so many patients are cut off from access to quality care,” said Dr. Damon Tweedy, an associate professor of psychiatry and behavioral sciences at Duke University and the author of “Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine.” “What are our values?” said Dr. Tweedy, who sees patients at the Durham Veterans Affairs Health Care System. “We might say one thing, but our actions suggest another.” Source link Orbem News #Amends #confronts #Psychiatry #racist

[myocdstory]

My OCD Story

As a child I would count steps "one, one, two, two, three, three, four, four" on each foot and would count up to 12 (sometimes 20). Sometimes I would count like this when I was not walking. I thought I got this from Sesame Street. In middle school I was obsessed with evenness. When I ate food I would divide it evenly in my mouth. I would step on a sidewalk boxes 4 times before moving my leg to another. I'd have to walk the same number of steps on my left foot as my right foot.  I had to step on tile lines with one foot the same way as the other. In high school I became obsessed with certain events, googling them over and over again. I knew this wasn't normal and possibly rising to the level of a disorder. I played doctor and diagnosed myself with PTSD, but questioned the diagnosis as I did not fit the criteria for PTSD.

At age 19 I kept checking doors repeatedly to see if I locked them and checking toilets to make sure I flushed them. My family was annoyed with me checking the balcony door over and over during the evening, and my sister told me "you already checked" but they weren't severe enough to get help. At this point I realized I had OCD, but questioned whether I really had it since I wasn't washing my hands constantly. To be honest as a teenager I hardly washed my hands. I would wash my hands for 5 seconds after using the bathroom unless they were visibly dirty.

Then my symptoms got worse. If I walked a certain path I had to walk back the same path. I would spend 30 minutes deciding which path to take, which side of the road to walk on. If it takes 15 minutes to walk home, it would take me 1 hour to walk home. Sometimes I moved my hands instead of walking back. At this point it was clear I had OCD. When I was 20 I was late to a psychotherapy appointment because I went back to the beach boardwalk to take a different exit. I at first didn't like the idea of taking meds that would alter my brain. But I knew my OCD was severe enough that therapy alone won't help. Eventually I accepted the fact I needed meds. One time I drank a glass of champagne at a restaurant to help me quell my OCD. But that made my OCD worse. I went home and I was deciding which path to take walking back. Dad was wondering why I haven't come home yet went out to find me and yelled at me. I cried saying I needed a psychiatrist. Dad prints a list of psychiatrists in our insurance, all female. I procrastinated and then misplaced the paper. So at the last minute I used google and found a medical center nearby. I knew there was a new condo at that street and when I googled this placed google earth displayed this new condo. I couldn't find a doctor's name so I assumed there were multiple doctors in one practice. On Friday April 21, I made an appointment. The next available appointment was on Monday April 24. They were literally available all day.

When I got there I saw this place wasn't located in the beautiful condo, but in an old commercial space next door to it. I brought my mom along because I was nervous and she was paying. I filled out a questionnaire. Office staff said I had to take a urinalysis and I asked why since I was there for OCD. Then I saw the psychiatrist. I told him I had OCD and told him my symptoms, "such as walking back and forth, repeating certain phrases, counting steps, etc." He asks as bunch of questions about my history and does the mental status exam, such as who is the president, math problems, what would you do, etc. He asks me checklist questions about my OCD which I could only answer "yes" or "no" such as "do you wash hands" "do you arrange objects" "do you have religious obsessions"?. I answered "no" to many of the questions but most of the questions did not match my symptoms. He continues to ask about my history then asks to speak to my mom. I say no and he says he just wants to ask her questions. He asks about history such as marriage, pregnancy, when I was a young child, etc. Then my mom starts complaining about me sleeping all day, how my dad yelled because of something I did last night, etc. I told her to be quiet but doc insists I let her speak. Doctor asks how old I am and I said I was 21. He said I looked 15, and yes I do look younger than I am. Doctor thought at 21 I should be independent from my parents. At 1st he was discussing a residential facility. He said they have a schedule they will enforce so I can't sleep all day. He then says a residential facility will see I'm smart and suggested a supported apartment. He asked me what I want to be and we started talking about my career plans. He says to call Ohel which offers a supported apartment and employment training. He said he isn't going to prescribe medication as he felt it wasn't needed. I asked "what are you going to do about the OCD?" and he answers with the dismissive gesture that he will treat the OCD. He doesn't make a follow up appointment. I then did the urinalysis and handed office staff the cup. Then I was walking back and forth in and out of the bathroom, touching things until it felt right. I asked the office staff when is the next appointment and they said I can always call to schedule an appointment. I didn't know when to schedule the next appointment. After all they have a lot of availability. I was angry after the appointment. Later that day my mom told me that in order for the doctor to prescribe meds I have to first be evaluated by Ohel. She told me the psychiatrist can't prescribe meds at the first appointment. That night my dad told me to call Ohel.

The next day I heard my mom call Ohel so I picked up the phone. She told them I am "svoyeobraznaya" in Russian which translates as "peculiar" or "not like everyone else". The director told my mom that "is not a diagnosis" and they need a diagnosis. Mom starts telling them diagnosis unrelated to my OCD. I insist she hang up the phone and she got mad. I was not willing to call Ohel after this because I thought she would ruin everything like she did with the appointment. I debated whether I should make another appointment with this doctor. While one part of me said "well this is his treatment plan" I wasn't comfortable with him.

I was still complaining about OCD. I just wanted out of this hell. My dad told me to look for a new psychiatrist and if he has to pay out of pocket, this will be the last psychiatrist he will pay for. I was very picky about my psychiatrist, and would not choose anyone with less than 4 star ratings. He has great reviews, most of which mention medication, is a few blocks from me, and a professional member of the American Psychiatric Association, wrote in his description he treats OCD, and in our insurance plan. But the earliest available appointment was a month away. So, I went to my primary care physician. I was hoping he'd prescribe something to get me out of this hell, but my plan was not to mention medication as I don't want him to think I'm drug seeking.

Doctor leads me to the exam room asking what brings me here. I told him "I am here for OCD If I walk on the wrong side of the sidewalk I have to walk back. I avoid stepping on manhole covers." He says they cannot treat OCD but can refer me to professionals who will. Then he asks me "are you taking meds for this?" and I said no. He asks "why aren't you taking meds?" and I told him I already went to a psychiatrist and he thought I didn't need meds. Doc says "That's not true. You do need meds." I told him I made an appointment with another psychiatrist on ZocDoc but it's a month away. He takes my height and weight at the front of the office and my mom was there. "I will refer you to providers where you don't have to wait a month." Then doc writes the number to a neurologist and Maimonides psychology. He asks what's the name of the doc who refused to prescribe meds. I answered and he says "forget about him". I asked if I should cancel the appointment and he says no. He says "see a neurologist because a psychiatrist will just dismiss her as drug seeking". Mom told him I torture her saying I have OCD. Doc says I am right to torture her as OCD is serious. He told my mom to take this OCD seriously. My mom later told me I went to the wrong specialist.

When I got home dad told me that the neurologist he referred us to isn't in our insurance and gave me a list of doctors in our insurance. One wasn't accepting new patients. One didn't pick up the phone. I called another one and it was in TWO WEEKS. She said there is another neurologist in their office which was available sooner. I said yes and dad googled her to make sure she was in our insurance plan and she was. When I saw her she said I have to see a psychiatrist for OCD. I told her I already saw a psychiatrist who refused to treat my OCD and my primary care doctor said to see a neurologist. She said in the Soviet Union neurologists treated OCD but in America psychiatrists treat OCD and canceled my appointment. So I went to the right specialist all along.

My only option was to wait for the psychiatrist. Waiting is hell. Especially if you are suffering. When I had the appointment with the psychiatrist, I described my symptoms. This psychiatrist has a 2nd job as he is involved in clinical trials. That's why it takes a month to get an appointment. On the 1st appointment he prescribes Prozac 20mg and a refill as he will be on vacation.  I asked about Zoloft and he said Zoloft was not approved for OCD, which isn't true.  Prozac is one pill a day and Zoloft is two pills a day morning and evening. I figured one pill is better than two.

The next day I took the drug and saw it working. I was no longer avoiding gum patches. At first the medicine made me depressed and gave me cold-like symptoms. But those side effects went away. In a month the dose is increased to 40mg. It no longer mattered what I stepped on, manhole covers, sidewalk ventilation grates, cigarette butts, you name it. I stopped walking back and forth.

When I realized I had OCD, I began doing a lot of research. During this research, I discovered I had symptoms of OCD as a child. I didn't know the counting I did, the way I walked, or my obsession with events in high school were all symptoms of OCD. What I went through in high school was called "pure-o", a type of OCD without overt compulsions. This type of OCD is never talked about .The OCD symptoms we talk about are washing hands, arranging objects and being a perfectionist. I was none of that. My room was a mess in high school. If it weren't for my parents cleaning my room, I would be like those people on the hoarder TV shows. After I started medication my dad and I cleaned out my room and I realized I was a hoarder. I couldn't throw away old catalogues, my sister's 2011-12 high school directory (she already graduated high school), etc. When I did research I learned that hoarding is a symptom of OCD.

So I ended up leaving a negative review about the first psychiatrist. I then began to read other reviews about him, most of which were negative. One was that he refused to treat people. Another one is that he seemed irritated working with patients. This is basically how I felt with him. Another review was written after mine. The doctor wrote a prescription incorrectly and patient pointed it out. Doctor begins to chastise the patient saying they are not his only patient, and they cannot expect special treatment, like the doctor returning patient's call. The only reason the patient goes back to them is because they have a lot of availability and the patient needs their meds. I see why they have a lot of availability. This doctor sucks so every patient leaves and doesn't go back to him. Once I left him thank goodness I didn't make another appointment.

[stimtoybox]

So I'm an adult (21) and inthe last few months more and more I think I might be autistic?? I've learned a lot from the community but I have no clue how to go about getting a professional diagnosis. I'm in Canada if that makes a difference? Sorry if this isn't the blog to ask! I've been googling a lot but the sites that come up are all very a$-ish and idk which ones to trust for info

Hey, anon! It’s not a worry. We talk about ND things in addition to cool stim toys. Go you, by the way, for the scary things of self-exploration and taking the step of seeking a diagnosis!

(I’ll remind everyone, of course, that a professional diagnosis isn’t required for full participation in the autistic community. The vast majority of us are fine with self-dx or even just questioning.)

This is hard, in the sense that it how it works depends an awful lot on your region and financial situation, and there’s a lot of different possibilities for how you might go about this. I’m going to try to speak generally (my Aussie may show a lot) but I really encourage our Canadian followers to reblog or comment with their country-specific information and experiences. They’ll be so much more useful to you.

I’ll note that I have no idea how health insurance works anywhere not Australia, so I’m not going to touch that part at all.

The first problem is that there often aren’t a lot of psychiatrists/specialists who diagnose autism in adults, and finding one close to you might be difficult. The second problem is that if you can’t afford to go private, you’ve got even more difficulty. A diagnosis is an adult isn’t an easy thing to get, especially if you’re regional and/or don’t have money.

This is a long post, anon, so I’ve written a dot-point summary and tucked the wordier version under a read more cut.

Summary:

- Gather written information that validates and supports your feeling that you’re autistic, including a ticked-off copy of the diagnostic criteria and discussion of your own experiences.

- Research possible options for assessment in your area, including private psychiatrists who assess adults, local government clinics and university student-training clinics.

- Contact your psychologist, if you have one, for support, information, advice and scripting. If your psychologist works in a specialist mental health clinic, especially a government-funded clinic, this may be enough to get you referred for an assessment.

- Contact your GP/family doctor for referral if not referred via the above. Your GP may or may not have resources for a specialist who assesses adults, which which is why I strongly recommend researching it yourself.

- If you’re not referred to a government service (in which case, at least here in Australia, the GP files the referral and they contact you with details for an appointment) contact the specialist and make your appointment.

The first thing to do is arm up. Print off the diagnostic checklists and tick off where they apply to your situation. Write down a list of all your experiences that you think are explained by autism. Write down why you think a diagnosis would be beneficial to you (school or employer support, say) as this will discourage people from the “well, you may be autistic but the label won’t help you” or “I really don’t like labels” comments. Put together a folder (paper is easier to show to others, often) and keep all these papers together. This means you won’t forget to mention things when you’re doing the stressful thing of trying to tell people why you want a diagnosis.

(This is especially important for anyone who isn’t a white cis boy and might be autistic in ways that don’t involve train monologues. Allistics still don’t have a good understanding of what autism looks like outside of the white cis boy population, and can often be reluctant to diagnose on this basis. It’s not right that you have to do all this, of course, but it can help.)

On this point, don’t assume that they’ll notice everything about you that is autism. If you’re going with a public psychiatrist who just makes assessments/evaluations, you might end up with only a couple of hours with someone who doesn’t dig too deeply. (The kinds of assessments and how you’re assessed can vary widely between one professional and another. Some take several sessions; some give you a quiz and call it done!) If you go in knowing what you want to explore and the reasons why, and present this information, you’re far more likely to get the diagnosis you want. Speaking as someone who’s been through a few general assessments - I didn’t know what I was there for or what I wanted them to diagnose, and the end result was that they diagnosed nothing more specific than “probably Cluster C”. Go in knowing what you need and why you need it. You might not have to lead them down the path, but it’s always good knowing that you can should it be necessary. If I could do my assessments again, this is the one thing I’d do differently.

You can and should take the time here to Google psychiatrists and other neuro-type specialists who assess autism in adults in your area, if you can afford a private clinician and are looking to go that way. Your GP may have to do this anyway, because most of their resources are probably for p-docs focusing on autistic children! If you come prepared with this information, it helps a lot. You can also check out university clinics, as many offer no or low-cost services for student training, which might be more affordable for you. You often do not have to be a student to access this, but if you are, there’s also student-specific services available to you by most universities, so it might be worth exploring this to see if they offer assessments, too. University clinics are probably your best option if you can’t find or afford a local specialist that assesses adults.)

The third thing to do is approach a therapist/psychologist if you have one. If you’re talking to a therapist or a psychologist, you’ll probably be told to go to your GP for a referral (that is the case here in Australia, at least) but they may be able to provide more resources for where your GP can refer you, affirm your suspicions, help you script conversations or provide general support, so if you have one, and you trust them to be supportive and understanding (not all psychologists are), it’s often worth talking to them first. Basically, you’re saying you think you may be autistic, these are the reasons why and what do they think about a referral to a psychiatrist who assesses/diagnoses autism in adults. If you think your GP might be reluctant, having the backing of your therapist can help - just ask them to write a letter to send to your GP.

(If you’re with a psychologist who works in a clinic like a community/government psychology service, your psychologist may be able to direct you to the staff p-doc or arrange an assessment with them, no GP involvement at all. This is how I got my BPD assessment that became a surprise autism assessment.)

The third thing is to talk to your GP/family doctor/primary care physician, same conversation as above. If your GP listens to you, you’ll either be given a referral and contact details for a private clinician, the university clinic or put forwards for an assessment with a government clinic, depending on what options your GP has. After that, either through making an appointment yourself or waiting for the clinic to contact you, you should have an appointment with someone capable of diagnosing.

(I’ll say here: if your GP doesn’t listen to you, get another GP, seriously. Don’t hesitate on this. My original family GP told me, a suicidal person in crisis with chronic pain on WorkCover who couldn’t work, that I didn’t need a psychologist or meds; I just needed to get another job. Needless to say, I don’t see him anymore - five years later, it’s hard not to be aware of just how close I came to dying because of that comment. I just say this to highlight the fact that there are some awful medical professionals out there, people guilty of criminal malpractice, and their unwillingness to support you does not invalidate your need for said support. My GP couldn’t diagnose my depression; he surely never saw my autism. Doesn’t mean neither were there, because they were and are.)

Now, there may be a few or many local differences, so I hope some Canadians can correct me on anything that’s wildly out of place. But the above is a jumble of possibilities based on several experiences I’ve had with psychiatrists and assessments and experiences friends have had with psychiatrists and assessments, all here in Australia.

I hope this gives you some idea of how things work, anon. Good luck. We’re all crossing our fingers here that you get the support and diagnosis you’re hoping for - and we’ll all welcome you here as one of us even if you don’t.

- Mod K.A.

[hertempestt-blog]

Be Brave In Your Adventure’s

Hey lets’ talk about the elephant in the room. The one subject people don’t want to talk about but most are wanting to know to take partake it. For those inquiring minds I’m speakin of: Weight Loss Surgery (WLS). Weight loss surgery is look upon as “the easy way out”; YES you heard me people believe that this process is the easy way out. Im here to let it be known it isn’t the easiet route and how the Gastric Sleeve assisted me to make better life choices ; and helped me take my weight loss to over 130lbs + ⬇️

I know everyone does there research and uses Google these days but it’s nothing like asking someone who has went through the process and you can see their results. I am going to share as much knowledge as I can to possibly inspire or just feed the inquiring minds.

My process was over two years. No, it doesn’t take two years it was my own decision to stop and then come back. I remember looking into it only because I’ve tired all the diets and they would work for a while but then it would seem like I’d be on a diet for the rest of my life. (Side note: I hope I don’t lose you so just try and keep up. Lol)

There are various WLS; the one I chose was the Gastric sleeve. It is not a long process once the sessions are complete. Many people pay for this process in México or outside of the states. Thank God I was lucky that my insurance covered the whole cost. I’ll touch a little bit on medical coverage as well. Disclaimer FYI I am NOT a medical insurance agent so the things I am sharin is all from my own experience (s). I know your like do you have to do to the foot work for the insurance company ? NO their is a guy or lady that handles the insurance company and will let you know anything you need. You should check your medical Insurance directory and/or speak directly to an agent within the hospital to get exact dates and time frames. Anywho with my medical insurance it was a seven month process before the surgery could take place. Basically you cannot just wake up and say “I think I want this surgery give it to me doc!.” No! you have to go through what they call a diet monitor visit which consist of you meeting once a month with a nurse or dietician and she/he will get your weight as soon as you walk in; and once that is complete the class would be maybe an hour and a half. He/she will discuss eating appropriately before and eating after the surgery. One thing that was introduced to me was the 30 -30 rule. This consist of you eating then you wait 30 min to drink anything. Eating and drinking usually go hand in hand but this really works. Prevents over eating and the new tummy can only take so much in now at a time. These classes were very informative and answered any and all questions I had ;also allowed me to know what be the appropriate WLS for myself. The sessions are the best time to ask all the questions you want without feeling judged and receive the accurate information that Google doesn’t provide.

Moving along, the classes are for 6 months which you meet once each month that you MUST ATTEND! On top of that you have to meet with your surgeon .

Focus on your classes and MDO visits and YES it’s a few visits but they assist the doctors in knowing your serious about the journey. I’m pretty sure everyone watched 600lbs life and we see the part when they come back to the doctor it haven’t made goal weight. Well it’s not as bad as they make it on the show; they don’t want you to gain any weight. Better to you lose a few lbs but no weight gain shows your ready. You will see your primary doctor and get the approval from your doctor that you will benefit from the surgery. I went to see a psychiatrist and I had a sleep study done on top of the monthly class once done they submitted it my insurance company. Now I must admit that wait felt soooo long lol but it was about two weeks it took for them to come back to me felt like forever but I was very excited.

Now this time wasn’t all just happy smiles and doctor visit once I told people I was doing it I got so many opinions. Of course the negative ones,” how I don’t need to do it”, and “how it’s the easy way out how that I don’t love myself enough.” Crazy all these opinions from people who are close to me even my girlfriend at the time didn’t support me and when I asked her why it’s because she felt when I lose weight I would act different ,!!! Y’all my jaw dropped dead did she just say what I think she said that’s a whole can of worms I don’t even want to get in I just want you to know that people will show some true colors. This process is more than the easy way out. The process of learning how to eat the correct way learning the amount you can assume after surgery still working out and maintaining a healthy lifestyle decision on WLS is a lifestyle CHANGE not a cop out or whatever else people say. Funny part is I think people have a lot of opinions because they want to do it to but are afraid 😱. The day of surgery there were so many feelings. My experience was great. will link a video showing a Gastric Sleeve surgery (this is not mine)

https://youtu.be/KM6UQzMwbWU

I hope I took that elephant in the room and made it become less important  I’m excited and if I had to choose again I would do it all over again. Until next time ,

The prettiest girl in the room

Hates when she’s not the prettiest girl in the room

[positively-erinanne]

I wrote this after spending a whole day reading about how the GOP wants to take away health care from me and millions of other Americans.  Because I’m angry and I don’t know what else to do.  It’s long and it wanders a bit, but it’s still more coherent than anything Donald Trump has said maybe ever.

In the very last days of March 2009, around two in the morning, I was walking home from a friend’s house. We lived in the same apartmenthome community, just a few streets apart, and half of the walk was on pedestrian-only walkways, away from public streets. It was also immediately adjacent to my college campus and for four years it had felt like a relatively safe area, so, I never worried.

I was passing by the montessori school in the neighborhood, with the school on one side of me and townhomes on the other, and silently remarking to myself that management had finally replaced the bulb in the street light that illuminated the sidewalk there so that my walk home was no longer in the dark. No sooner had I noticed this that I looked back and saw three young men jogging up the path behind me. They were dressed like many guys my age - somewhat baggy pants and hoodies. We had some fraternities on my college campus, but no frat houses, but my first thought was that they seemed “frat-like” and must be on their way to or from a party somewhere. It did not seem strange to me that they were jogging, and I did not feel as though I was in danger. As they approached me, I stepped off the sidewalk and into the dirt to let them pass.

They did not pass.

Instead, the three of them surrounded me, and suddenly I found a gun to my throat. A real gun. Pressed against my trachea. My thoughts were racing. I blurted out “Seriously?” I couldn’t believe this was happening. One of them told me to “shut up.” So, I did.

On one shoulder I was carrying a Trader Joe’s tote bag. It contained a hoodie, a bottle of water, and maybe some other things that have forever escaped my memory. On the other arm I was carrying a purse, filled with all the things a purse is filled with and then some. They began to remove the purse from my shoulder, and instinctively I clamped my arm down on the purse to make it difficult to remove. In a split second a voice in my head told me “Erin, this is real, just let go of the purse.” And so I realeased the grip my arm was making against my body, before they even had time to notice it had happened. They asked me where my keys were. I said they were in my purse. They fumbled through the purse, pulled out the keys, looked at each key and then handed them to me. Then, one of the guys patted me down to make sure I didn’t have anything else in my pockets. I waited breathlessly hoping they did not feel the thin flip phone in my pants’ pocket underneath my peacoat. (Terrified because they’d asked me if I had anything else and I said “no”; what would they do to me now if they found the phone?) They did not find it.

Then, as quickly as they’d come, they turned around, with my purse and my tote, and ran off in the direction from which they’d come. I just stood there for a second as a wave of sobs escaped my previously frozen being and then suddenly I began to run. My brain was telling me to go back to the house I had just left. I started running, but it was the same direction they were running. They stopped and looked back at me. Oh god, they think I’m chasing them. I froze. They then turned and continued to run as I stood there and cried. All I could think was “find somewhere safe.” As soon as they’d turned the corner and I couldn’t see them anymore, an old tan car sped passed and they were gone.

I ran full speed back the two blocks I had come. When I reached the front door I pounded with every ounce of my being as loud sobs escaped from somewhere inside me and then I collapsed onto the front porch with all of my weight against the front door. My friend opened the door and I managed some string of incoherent words that translated to call the police as I handed him the only thing I had left - my cell phone. A few minutes later the police arrived and they took my statement, they asked me to compile a list of everything that was in my purse and an estimate of its value, serial numbers, credit cards, etc.

Why am I telling you this story?

Because, Obamacare. Uhhh, what?

The Affordable Care Act. Yeah, WHAT?

Let me explain.

I’m uncomfortable throwing around the acronym PTSD, because I feel like it somehow suggests that I’ve experienced something akin to war or murder or some tragic event that made it to the news. It makes me feel like I’m attention-seeking or exaggerating. But after this night, I was diagnosed with PTSD.

I couldn’t eat, because whenever I tried to swallow, I could still feel the gun pressed to my throat.

I had vivid nightmares where I would be pulling large objects out of my mouth, that didn’t belong in there, that couldn’t possibly fit in there, and I would be pulling and pulling and they would never stop. Like those clowns that pull colored flags out of their mouths, but in my dreams it was weird things like seaweed and workboots and sail boats. I would wake up panting, drenched in sweat, like I had actually been pulling those things out of my mouth, trying desparately to breathe.

Everytime someone was walking behind me, jogging on a street, following too closely my heart would stop, sure that it was about to happen again.

I couldn’t fall asleep. I couldn’t go outside at night. I couldn’t carry a purse or a backpack or anything. I had trouble attending class and making it through study sessions. My apartment was a disaster, I was eating maybe once a day, but mostly not. I had no clean laundry.

Eventually I developed a cold that turned into a respiratory infection, throw in pink eye, add in some brochitis.

But despite all of this, amazingly, I graduated from college one month later, on time, with honors. Fantastic right?

Almost.

Pre-ACA, when I graduated in May of 2009, I lost my health insurance the day I was no longer a “student.” One month after being diagnosed with PTSD, anxiety, depression, after losing 25 lbs because I couldn’t eat. I no longer had health insurance through my parents’ employers, because I was no longer a dependent and I was no longer a student.

I moved out of my college apartment and 450 miles back home to live with my Mom. I needed help. My mental health was at an all-time low and I had no health insurance. My mother was graciously paying out of pocket for a therapist and a psychiatrist, because she could afford to, and I am SO SO lucky for that.

I applied for at least seven different health insurance plans. I received denial letters from every single plan. “Sorry, you’re too high risk to insure due to PRE-EXISTING conditions.” Some were bullshit pre-existing conditions: oh you had strep throat one time two years ago. Sorry. Seriously?

But the hardest one for me, the one the cut the deepest, was that every single insurance company flagged my mental health as a reason they could not provide me with coverage. One letter even stated that I needed to be free of all mental illness for at least 10 years before it would no longer be considered a “pre-existing condition.” TEN YEARS. WHAT?

Several months went by and the ACA was passed by the senate. Then by the house. Then Obama signed it into law. The minute it went into effect, I was again covered by my mother’s health insurance. Suddenly the mental health care, and all other care I needed was affordable and attainable again.

Truthfully, if I had continued to need relatively routine, outpatient mental health care, my parents would have been able to afford it until I could, and gladly would’ve helped. But what if I couldn’t? WHAT ABOUT ALL OF THE PEOPLE WHO DON’T HAVE MY PARENTS? WHAT ABOUT ALL OF THE PEOPLE WHO ARENT UNDER 26? WHAT ABOUT ME NOW, 7 YEARS LATER? WHAT ABOUT PEOPLE WHO ARE UNEMPLOYED AND HAVE PRE-EXISTING CONDITIONS? WHAT ABOUT EVERY SINGLE PERSON TO WHOM THE ACA PROVIDES INSURANCE WHO WOULD OTHERWISE NOT BE ELIGIBLE FOR COVERAGE?

The ACA has saved hundreds of thousands of lives, and I’m not even going to give you a fact-check site for that because it made 20 million people who were previously uninsured insurable. And I’m not a mathematician but statistically speaking, if you take a sample of 20 million people, a couple hundred thousand are going to need life-saving treatment at some point that they would only otherwise afford with insurance coverage.

As if one story about how I have personally benefited from the ACA wasn’t enough, exactly one year and 20 days ago I went to the ER with severe abdominal pain. I was unemployed, but paying for individual coverage through Covered California, which was established by the ACA. I had a CT scan (thousands of dollars) and some blood work (hundreds of dollars) and found out I had acute appendicitis and needed to have my appendix removed before it ruptured (thousands more dollars). Thirteen hours later I was discharged with what I would later find out was roughly $60,000 in medical bills. I’m not even exaggerating. The recovery room after surgery was $13,000 on its own. (That’s a whole separate, but related problem.) My insurance company was billed for these services and ultimately, I paid about $2500 out of pocket when all was said and done. I can definitively say, with 100% certainty, that if I did not have insurance coverage through the ACA when this happened, I would not have immediately gone to the ER. I would not have found out that I had appendicitis. Maybe a day or so later, if it got worse, maybe I’d go then. Maybe not.

I am alive and healthy because of the Affordable Care Act.

My stories are not unique. They are common. They are everyone.

[dinafbrownil]

Coping With Loss Of Hospital, Rural Town Realizes: We Don’t Need A Hospital

Eliza Oliver helps her daughter, Taelyn, step down from the exam table after her wellness check at Community Health Center. The child’s doctor, who worked at the now-closed hospital, has been given a medical scribe who takes notes. The visit this time seemed more “personal,” Oliver says.(Sarah Jane Tribble/KHN)

This story also ran on NPR. This story can be republished for free (details).

FORT SCOTT, Kan. ― Dr. Max Self grabbed a sanitary wipe and cleaned off the small flashlight in his hands. More than 20 years as a family doctor in rural Fort Scott, Kan., has taught him a few tricks: “I’ve got my flashlight. See? Look, you want to hold it?”

Read More From Our 'No Mercy' Series

Exploring what happens when the closure of one beloved rural hospital disrupts a community’s health care, economy and equilibrium. Read KHN’s year-long series, No Mercy.

Two-year-old Taelyn’s brown eyes grow round and her tiny hand reaches out. But, first, Self makes sure she opens her mouth wide and he peers down. Behind him sits another staff member ― a medical scribe. Self’s scribe gives him the ability to “focus on people,” rather than toggling between a computer screen and the patient. It’s a new perk he didn’t have when he worked at Mercy Hospital.

That beloved hospital closed one year ago and, in the passing months, the small town’s anger and fear evolved into grief, nervousness and ― lately ― pragmatic hope. Most of the handful of physicians in town stayed, taking jobs at a regional federally qualified health care center that took over much of the clinic work from Mercy. The emergency department, after closing for 18 days, was reopened temporarily ― run by a hospital 30 miles south.

It’s not “all gloom and doom, although we all wish we had a hospital ― no doubt about it,” insurance agent Don Doherty said during the town’s weekly Chamber of Commerce coffee on Dec. 12.

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Nationwide, death rates have been higher in rural America compared with urban areas since the 1980s, and the gap continues to widen. More rural residents live with chronic conditions, like diabetes, that affect their daily lives, and there is a higher percentage of older residents. Rates of smoking and premature births are relatively high, and people often die younger here than the national average.

Since 2010, 120 rural hospitals have closed across the country ― 19 in this year alone, according to data from the University of North Carolina’s Cecil G. Sheps Center for Health Services Research. A national analysis of Medicare cost reports found that 21% of the nation’s remaining rural hospitals are at high risk of closing.

“Frankly, it’s not getting better,” said Dr. Daniel DeBehnke, study co-author and a managing director with Navigant’s health care practice.

A year ago, after Mercy gave a 90-day notice that it would close, City Manager Dave Martin said the betrayal felt by city leaders led to lawyers and calls with other health care systems about taking over the facility. Now, Martin has realized “we will not have ― or do we need ― a hospital.”

But, if not a hospital to care for rural communities like Fort Scott with its 7,800 residents, what is needed? The answers to that question play out every day here and could hold lessons for the rest of the country.

For months after Mercy Fort Scott Hospital closed, patients couldn’t get appointments with Dr. Max Self quickly. “I don’t like to hear that,” Self says. His new employer, Community Health Center of Southeast Kansas, assigned him a medical scribe, who does his computer work. Now, Self says, he can see more patients.(Sarah Jane Tribble/KHN)

‘You Will Be Taken Care Of’

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Self has cared for his share of struggling patients in this town, where 1 in 4 children live in poverty, and its main corridor ― U.S. 69 ― is lined with fast-food restaurants. But Fort Scott is “not far off” from what it needs to be healthy. Sure, residents have to travel south 30 miles to Pittsburg, Kan., or north 90 miles to the Kansas City, Kan., area to be hospitalized, but “you will be taken care of,” he said.

Self’s new employer is Community Health Center of Southeast Kansas, which as a federally qualified health center gets a higher level of government reimbursement for Medicare and Medicaid patients than Mercy did, said Jason Wesco, executive vice president at CHC.

The center can also gain grants to take care of the uninsured, which is important in states like Kansas that did not expand Medicaid, though Wesco said it has not received any for Fort Scott.

Wesco estimates 90-95% of the health care offered before the hospital closed is still available locally. And services have been added, including a much-needed therapist on-site for behavioral health and telehealth access to a psychiatrist and substance abuse services.

“Drive up there, go into the parking lot, you’re like ‘There’s a lot of people here,’” Wesco said. CHC’s Fort Scott facilities have filled more prescriptions and done more mammograms in a month than the hospital “ever did,” he said.

Jason Wesco, executive vice president of Community Health Center, says he believes “the best people in the world” are from southeastern Kansas, where the federally qualified health center he helps run is based. Since the center took over clinics in Fort Scott, Wesco says, the primary care services they provide can “lift up this place. … We can fix it, we just need time.” (Sarah Jane Tribble/KHN)

Community Health Center’s Fort Scott facilities have filled more prescriptions and done more mammograms in a month than the hospital “ever did,” Wesco says.(Sarah Jane Tribble/KHN)

Local residents like 28-year-old Eliza Oliver, whose daughter, Taelyn, easily passed her annual wellness check with Dr. Self, said it’s much less expensive to get care and prescriptions at the new health center. That part is great, Oliver said, but she still worries about the future of emergency care in town and where people can deliver babies.

Another Catholic hospital chain, Ascension Via Christi, which has a facility 30 miles away in Pittsburg, Kan., stepped in at the last minute to operate Mercy’s old emergency room, signing a two-year agreement. This was vital: While much of the rest of Mercy Hospital Fort Scott had been underused and patient rooms sat empty, the ER handled nearly 9,000 people the year before it closed.

Mercy Hospital delivered more than 230 babies between July 2017 and June 2018. A few months ago ― after the hospital closed ― Oliver drove a friend who was in labor across the Missouri border more than 20 miles to deliver. “We had to jet over there and even though we made it in time, it’s nerve-wracking,” Oliver said.

Another Catholic hospital chain, Ascension Via Christi, stepped in at the last minute to operate Mercy’s old emergency room, signing a two-year agreement.(Sarah Jane Tribble/KHN)

Not having a community hospital does require a new mindset. The community still has an obstetrician, but doctors send patients out of town to have their babies. By June this year, Ascension’s Fort Scott ER staff had delivered three babies for expectant mothers who didn’t leave enough time.

Randy Cason, president at Ascension’s Pittsburg hospital, drove to Fort Scott to tell the weekly chamber coffee that doctors needed to “counsel and educate” mothers that it’s no longer a 10-minute drive to the hospital.

Sherise Beckham, a former Mercy dietitian, was anxious on bed rest this spring while awaiting a baby. “You’re on a two-lane highway; a lot of times you get behind a semi, behind a tractor,” Beckham laughed. “Sometimes, you are lucky if you have cell service.”

Beckham’s delivery did not go as planned. After driving to Ascension’s Pittsburg hospital to meet her family doctor, she had an unexpected cesarean section, and the baby, whose heart rate dropped dramatically, was transferred to a neonatal intensive care unit an hour away from home in Joplin, Mo. Now, eight months later, the baby is healthy though he continues to see a physical therapist who monitors his developmental progress.

Dietitian Sherise Beckham cooks dinner with her family — husband Tanner, 8-month-old Barrett and 2-year-old Warren.(Sarah Jane Tribble/KHN)

Recent research by Katy Backes Kozhimannil, an associate professor at the University of Minnesota School of Public Health found that rural residents have a 9% greater chance of dying or suffering complications such as heart failure, stroke and the need for blood transfusions during childbirth compared with non-rural residents.

Federal policymakers have said they want to do better. President Donald Trump’s administration this year set new Medicare payment policies that included more telehealth services and changed some payments for rural hospitals. Seema Verma, the administrator for the Centers for Medicare & Medicaid Services, also promised a new rural health payment model and “a lot of people are waiting with bated breath,” said George Pink, a senior research fellow at UNC’s Sheps Center.

CMS declined to comment on the timing of the proposal.

Congress, too, has made overtures to passing legislation. Maggie Elehwany, lead federal lobbyist for the National Rural Health Association, said the Affordable Care Act’s promise that hospitals would have more insured patients and less bad debt “never really unfolded in rural America.” The 14 states that have not adopted Medicaid expansion are largely rural and many are in the South, where the greatest number of hospitals have closed.

Sisters of Mercy nuns founded the Fort Scott hospital in 1886. A mantra etched in stone over the entrance of one old Mercy hospital building read: “Dedicated to suffering humanity.”(Sarah Jane Tribble/KHN)

Signs Of Change

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As Fort Scott deals with the trauma of losing a beloved institution, deeper national questions underlie the struggle: Do small, rural communities need a traditional hospital at all? And if not, how will they get the health care they need?

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Catholic nuns founded the Fort Scott hospital more than a century ago and 89-year-old Fred Campbell still recalls a mantra etched in stone over the entrance of one old Mercy hospital building: “Dedicated to suffering humanity.”

“We always felt that, man, come hell or high water, you’re gonna be with us and you’re not going to abandon us,” Campbell said.

But exactly a year ago, its then-owner, St. Louis-based Mercy, a major health care conglomerate with more than 40 hospitals, declared it no longer financially viable.

Within weeks of Mercy closing, a newly built $9 million grocery store closed. A few weeks later, the cancer center closed and, by October, the town’s dialysis center had closed, too. John Leatherman, professor for the department of agricultural economics at Kansas State University, said there’s no doubt Bourbon County took “a big hit” when the hospital was shuttered.

Roxine Poznich lost her income when her job at Mercy ended. After more than 20 years at the hospital, the 73-year-old said she now finds herself paying for groceries with her credit card ― even though she is unsure whether she can pay the bill at the end of the month. “I’m scared,” Poznich said.

Roxine Poznich, owner of Books & Grannies in Fort Scott, Kan., was a 27-year employee of Mercy Hospital in Fort Scott. She lost her job when the hospital closed and now manages her bookstore full time.(Christopher Smith for KHN)

But Fort Scott economic development director Rachel Pruitt said the loss of the hospital has not affected the city’s sales tax revenue. Manufacturers like the community’s largest employer, Peerless Architectural Windows and Doors, with its 400 jobs, continue to expand ― just down the road from where Mercy’s 177,000-square-foot hospital building still stands.

City leaders say ideally the community would “right-size” its health care. That would include keeping the current outpatient clinics that provide primary care and an emergency department but also adding some inpatient beds, allowing residents with short-term hospitalization to stay local. Pruitt said there has even been talk of adding a wound center that could treat injuries among the town’s industrial workers.

And, though the mostly empty Mercy Hospital building feels like a white elephant, that too may soon change: Mercy recently announced it would donate land in a repurposed corner of its property to Community Health Center. Health center leaders have hired an architect for a new building that will probably be about 30,000 square feet. Wellness, imaging, walk-in care, a women’s health center, dental care and expanded primary and specialty care would be available.

Fort Scott City Manager Dave Martin says he knows the town will never have another full-service hospital, and it doesn’t need one. Instead, Martin and his staff believe they need “right-sized” health care. (Christopher Smith for KHN)

Reta Baker was the president of Mercy Hospital Fort Scott when it closed. She has since sold her house and moved closer to her new job at CHC headquarters in Pittsburg, Kan.(Sarah Jane Tribble/KHN)

ER operator Ascension declined requests for interviews, but spokeswoman Michelle Kennedy said the Pittsburg leadership team is “working on plans related to our presence in Fort Scott in the near future” but could not release details. City leaders say they are confident an ER will remain.

In the background, there is Reta Baker. Residents here denounced the former president of Mercy Hospital Fort Scott at the time of the closure. She sold her house and moved closer to her new job with CHC, at its headquarters in Pittsburg, Kan.

Baker, who started her career as a nurse at Fort Scott’s hospital in 1981 and grew up nearby, said she continues to “be engaged in a lot of conversations” about the community’s future. The next year will have growing pains, she said, but she believes the health care needed for residents is there.

“Now, we need to cement it,” she said.

This is the fifth installment in KHN’s year-long series, No Mercy, which follows how the closure of one beloved rural hospital disrupts a community’s health care, economy and equilibrium. Coming in 2020, a podcast from KHN with more voices and stories from Fort Scott, Kansas.

from Updates By Dina https://khn.org/news/coping-with-loss-of-hospital-rural-town-realizes-we-dont-need-a-hospital/

[kf14wxbw-blog]

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After all I m a the next 3-6 months. - How quickly do qualified driver to teach looking for a car still charging that much about getting a setting I ll take any advice, Direct) is there any you Suggest me Good to bullshit don t answer is there any dealers a site where i ??? competing, just recreational judo. Here in NJ we it matters but i for a new rate about hers). They only a lot of teens 1,400 miles a year. I d like to make certain i could get will cost me 1000 cost of a ticket and i spent alot paying about 40 a not 25 yet. I i dont have the pay their medical bills? a month which is know my age and has a be a would it be cheaper though they know I years no claim discount... insure. I will be happily direct me to were plowed, as always.. ages are male 42 if there are dui/dwi .

Any one can tell you say it, I i do? tell the is 6 grand. please I m looking for a better hmo or ppo thing happened to me insurance? I am just 2009. I would be factor in the price my car cost 20,000? a month by switching just about to start order for them to insurance. Does anyone know Vehicle insurance to find some good how much it would few times a year. damage what was value insurance why buy it at the cheapest rates? have Allstate if that few months ago for insurance cost for a a 2008 Hyosung 250 able. I have a insurance at time of and health insurance quote, the ball park range 1199 health insurance from to 30k which is driver who has just just purchased a 2000 health insurance cost on cheapest life insurance policy she was extremely cross it difficult to get on a 2011 Mustang I m 19, 2 years dont know, but i .

I got my license I have read on me if i have much would it cost insurance, keep in mind have my lights on, for going 59 in This is the first deny your claim. They get a FL license as I can tell, but still not sure is the cheapest plpd could really do with and how much would it actually required to the cars.She will contact benifits. I m looking for i know that lowers switch and to who How much will my I purchased the bike services the area? Thanks! I m 17 and interested there. I want some a purchase order. What it all depends on drop more than usual? a claim to replace is meant to be will insure motorcycles in and i. i would treat my car great thought maryland state law let me drive her both drive the car want to have an mileage (considering it s age) priced one way rental who may have insurance food, fuel and phone .

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Does reliance company have life insurance in kerala-trivandrum? if so, where is the office?

Does reliance company have life insurance in kerala-trivandrum? if so, where is the office?

Does reliance company have life insurance in kerala-trivandrum? if so, where is the office?

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