know it's very important that they have the right teachers at the right time and and i used to go in and talk to them about family members and that's kind of important too that they learn the other side of the coin and what effects the kids affects the family and so we're going to talk a lot today about substance abuse and that's your very favorite subject maybe talk about insurance which is your favorite subject and also my and my question is because i rolled the parity bill in one nine hundred ninety six and fought like crazy for it for fo years and in one nine hundred ninety eight was a president of nemi of massachusetts and got the whole state pushing for it and it passed in the year two thousand and that was for biologically based brain disorders  major mental illness what happened i have to say i was so excited when i when that legislation was initially passed and had great hope that it was actually going  to cause insurance companies to treat mental illness the way they do the rest of the illnesses that people suffer but for whatever set of reasons it really never materialized and it never turned out that way i think you know i don't know all of the reasons why but i can imagine that for a lot of insurance companies even before the year two thousand they would carve out mental health coverage and hand it over to a separate entity  apart from so if it's h m o blue for example they would pay or they would give the mental health services to a carve out company which would then manage only mental health services those companies tended to be for profit  even for example the managed mental health care company that managed mental health care for mass health which is our state's medicaid that company was for profit and so once they had already been in places for profit entities they were just dead set on doing whatever they could to maximize their own profits and they do that by paying out as little as they can for actual health care coverage so i don't know what the particulars are but i can tell you all through the first decade of this century i've had to beg insurance companies to be able to see patients in the outpatient setting which is where i primarily work  we have to get prior authorizations frequently just to be able to see them an initially or to continue seeing them over several sessions if i need to admit one of my patients to the hospital invariably i have to get on the phone and call an insurance company and spend an average of forty minutes or more on the phone giving them information in the hopes that they'll actually pay for the admission and i could go on and on and on but all of these are ways in which mental health  patients are singled out for special scrutiny by insurance companies in the hopes that either we won't make those calls in the first place right and then then they don't even have to worry about paying for the coverage or if i make the call they try to wear me down based on just the time on the phone and even if i get an authorization to admit a patient it's usually for one day or two at most and then the whole process repeats itself a day or two later so there are all kinds of ways still where mental health patients are singled out for scrutiny but they don't do that with anybody else they don't do that with cancer patients diabetic patients any else mental illness seems to be in the lowest part of the totem pole and they are most vulnerable and there are millions of  am so with you on that i think that it is not by accident that these insurance companies again many of which are for profit i think they're preying on psychiatric patients because they are most vulnerable because unfortunately there still is stigma attached to mental illness and a lot of patients and their family members are not willing to speak out on their own behalf because they don't want to you know say oh look you know i've got a mental illness or i need to go in the hospital  and i think that's part of the reason why psychiatric patients are singled out for this kind of scrutiny for me i think that the measure of the humanity of a culture is the extent to which it takes care of its most vulnerable people absolutely and like my signature they're right but you're absolutely right you know if a pediatric patient comes in with pneumonia he or she gets admitted instantly right ospital if i come in with a broken leg and need surgery the surgeon is not going to spend forty minutes on the phone with my insurance company so again these are measures taken specifically i think against psychiatric patients  by insurance entities and others that are really concerned about profits over health right and all you people out there you know for twenty five years here i've been preaching stigma and there is so much stigma against people with mental illness and you have no idea there are millions of people across the country across the world that have a mental illness and it's not their fault from what my peri built at the mental health parity bill for biologically based brain disorders because at that time in one thousand nine hundred six i figured they could not argue with biologically based brain disorders it was part of the whole body you can't cut it off at the neck it's all you know part of you and so why can't society understand that a person who might talk jibberish a person who might act and act strangely and it's the illness talking it's not them they my they are somebodies child there are are they might be a parent or they might be a lawyer or a doctor it's not their fault and this is what i'm really trying to get across to the people in the united states i don't my show goes anywhere help greater acceptability in society at large or promote greater awareness about the obstacles that people face when trying to access mental health care both ok and this also partially answer question that you raised and what you just said earlier you know i feel i can tell many people have mental illness strike within their own families they're largely blind to it and also  largely blind to the fact that insurance companies make it exceedingly hard to access care i have a family member for example myself who is in the sciences an engineer kind of realm and  it was only when one of his children needed to access mental health services that he actually started realizing what i did and he said i never really even respected you know what you did much and i didn't even think much about it but i can see that when you need the help is absolutely mandatory that you get it and in his instance he said his insurance company made it incredibly difficult for him to actually help his family member get the care you needed and that's when his eyes were sort of opened to the difficulties of people with mental illness but until you're in that situation you might just be going about your life and not really care much as long as you can get in to see your primary care doctors long as your insurance company co pays are fairly low you know it's hard for us to think about the lives of others if we haven't directly encountered that right now if every politician in the state has had some in their in their family that has mental illness we have a lot of coverage for these people if i can just backtrack and take my daughter for a second my daughter and laurie i'm talking about you my daughter became ill on a field trip nine and they both ran out so therefore putting her in the in shelter and that was a big thing in those days they used to bring the taxi right up to the door take the patient's suitcase put it in the taxi bring them straight to the shelter and he was my gate eighteen years old psychotic and there was nowhere to take care of her home so i had to get political you know politics to me was the answer because when i went to the politician and cried my heart out he said ok i'll do favor for you and he did he called the hospital put her up into the replacement unit of denver state hospital and it was there they put her on the medication the broader back to me and this medication worked within three weeks but it can also cause serious damage and  that's what i've always been worried about for twenty three years now the serious damage that goes along with these medications and there's only i think two of them that have been out that have been affective with with what they call schizophrenia maybe schizo affective disorder and i mean it's like they're in the dark ages of medication and we're the research where's the  everything that should be happening to these millions of people that are out on the street dying do you know i think i know a little bit that there are definitely various options being st about what else can terms of drug treatments and probably even genetic treatments that are in the works but i'm not the best one to speak about that i will say that i have no doubt that one hundred years from now what i prescribe on a daily basis is going to look fairly barbaric to the psychiatrists and physicians of the future at this point though i have seen many many patients with psychotic illness and often you're deciding between you know tamping down some of the symptoms either to some extent or to a great extent  balancing that with the known and potentially pretty bad side effects i mean as i say this is a parity sort of newton's third law anything that can help us can also potentially hurt us and that's certainly true with all of the medications i prescribe and in my arsenal of medications i think the psychotic ones are the most serious and have potentially the greatest  risk going back to politics as far as as far as anything happening in the near future it seems like society treats its most vulnerable very poorly and that includes children too i mean the parity bill that included autism and also included this is my view it included rape victims that only had like five visits to the doctor and no as many as they need but as they kept going we go into substance abuse and drug addiction and i know people who are abusing drugs yeah it can be you know an awfully an awful and terrible experience for the families to put it mildly and certainly with some drugs in particular and i  it can be so expensive just to maintain a habit i've seen you know families who literally had to choose between pushing a child out of the house and forcing them to live wherever they could including on the street or have the person remain at home but risk having everything in their house everything of value stolen and sold to support the drug habit i mean the other thing and this is just the way addiction goes lying if one is addicted lying either to oneself or to others around them becomes such a second nature that i've seen addicts almost forget that they're lying because it's such second nature and so it gets of truth to them it can and it obviously can just destroy relationships you know for someone to be addicted as opposed to just using a substance here or there even abusing a substance if you get to the level of being addicted that means that some major part of your life whether it's housing job physical health mental health ability to pay the bills and so on some major part of your life is given the symptoms and they take drugs so now we have two things and if you take away the drug addiction you still have the mental health problem and you know it just keeps on getting  complicated but children that show mental illness and in the very young stages of their life what do they do for them at children's hospital do you have any idea well if if problems arise at any point in one's life if they rise to the level of interfering or potentially interfering  with necessary things like going to school and or caring for oneself i've been absolutely people need to get into treatment even if they're very young for example i can tell you though that there is a shortage of child psychiatrists both locally and nationally and so accessing if accessing psychiatric care in general is difficult accessing pediatric or child psychiatric care is even more difficult are fewer child psychiatrists because to become a officially a child psychiatrist you have to do regular psychiatric training which is adult psychiatric training and then at the end of either your third year of training or fourth you then add two more years of a fellowship in child psychiatry so it's additional training beyond regular psychiatric training to become a child psychiatrist and the numbers are just low in terms of how  psychiatrist to see how many would take you on you kind of playing acting that you were a person in need yeah so it was a simulated patient study at one point i said oh yeah we were essentially give the green light to study proposals to say that this is not harmful to people and basically to keep us on the up and up in terms of doing the right thing sort of ethically for the people on the other end of the phone for ourselves and others but any rate we i mean massachusetts as you know is the model for nationwide health care reform and we were the first ones the first study what it's like that health insurance and what access is like here we figure maybe that's a pretty good indicator of what it might be like nationally so we knowing that it's hard to get psychiatric appointments we looked at the blue cross blue shield p p o website that's preferred provider organization that's considered very good top notch private insurance it's the insurance that i have in my wallet right now that we get through my wife's employment at children's hospital we looked at the blue cross blue shield website pick the downtown zip code in boston and called every single facility listed as being any network within a ten mile radius of downtown boston there  sixty four facilities our script that we said when we called these institutions or institutes was i'm depressed i was seen yesterday in an emergency room they discharged me but they said i needed to follow up with a psychiatrist and within two weeks so that was the script that we read we called the sixty four sites if we got a voicemail when we made one of these calls we left a message if we didn't get a call back we called a week or two weeks later with the very same script and try to get out of sixty four sites listed as any network sites and greater boston we were able to get eight appointments that's twelve and a half percent plus or minus and only four of those which were within two weeks the two most common reasons why we weren't able to get appointments well was that twenty three percent of the time they never even called us back even though we left two messages and about twenty three percent of the time they said in order to access psychiatric care here you have to have a primary care doctor in the same setting that is a very common requirement and that is a stealth way to ration mental health services why because if you're a hospital or a large health care facility generally speaking because psychiatry is reimbursed so little it doesn't pay for itself and so if you offer psychiatric services as a hospital you're basically doing that was and so as a full scale hospital you have to have psychiatry or else you've got a full scale hospital but you want to limit access as much as possible to it and so one thing you can do is say well you can only get psychiatric care here if your pediatrician or family dark or internist is here and that's what we encountered so what we should saw in our story obviously was that even having the very best one of the best private insurance is and blue cross blue shield is the biggest insurer massachusetts we couldn't get appointments more than eight out of sixty four it was really appalling it's really appalling and we only have a few minutes left and what i really wanted to go into just for a couple minutes is that it's like one third of the prisons i made up of the mentally ill and i've been in the prisons and i've taught the prison compassion before they took control and massachusetts has the highest rate of suicides of the mentally ill in the prisons and i don't know if they still have it but they did have it and if we are the forefront everybody and that's not a very good statistic and in bridgewater there are so many people there that are mentally ill that are being held with absolutely no crime that they've done and there's a class action suit against bridgewater state hospital right now because of the the way that their kids are being  abused and what do you think about the prisons well i've seen statistics that over fifty percent of all incarcerated people in the us have some form of mental illness and it's absolutely tragic  because there is so little access to psychiatric care you have as you just described people who essentially have mental illness and they end up being incarcerated for little reason other than they were acting you know quote unquote stranger on the streets or doing something that seemed odd to somebody prisons or our de facto psychiatric facilities in this country and that is beyond appalling absolutely right so i think we have to wind it up now and i could talk to you for a while is there anything you want to say before we leave not other than i've already said i mean i could also talk for hours and hours of i do want to thank you so much for having me on the show the save the money you have been on c n n and you have been in time magazine and you have done so much and you have no idea how much i am so grateful that you came here and  so ladies and gentlemen please stop and think please stop and think about these poor people that are on the streets they could be your son daughter they could be your mom or dad and  we have to stop the stigma so they can get research and if they get research perhaps something else that's not so so hard on them can be made to stop their symptoms and they can have full lives just like you have and if anybody has an aura around women on the second to every month i'm going to have meetings for family members support groups and education and maybe boyd would come in and educate and one of my meetings you know you don't have to do it so i'll have me there for a long time and i would be thrilled to have you back on the show sometime or just talk to you would be great so i guess that's all for now and we'll be back in a couple of weeks with more information more education on mental illness thank you for watching