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A New Crisis in the Making or a Crisis Averted? Mental Illness & Chronic Pain Management Under the ACA

The post below this introductory paragraph was published almost a year ago. Yesterday, my fears became reality in ProPublica’s article on the rise of controlled substances through medicare, “As Controlled Substance Use Rises in Medicare, Prolific Prescribers Face More Scrutiny.”  Although the statistics used in this article was before the ACA went into effect; the same potential for abuse and abuse has been established through this reportage. Under-served communities have suffered enough without a new host of drug addictions plaguing them. I applaud this investigative piece and pray it truly reflects an overwhelming overtone of scrutiny to prevent a new generation of heroin addicts. On the other hand, I also pray that alternative treatments, health and wellness methods of healing the wounds of chronic community trauma will become the norm over prescription drugs for all! Below is my original post on this issue:

In light of the new Affordable Care Act, I have been analyzing what could be unintended consequences of providing health care and mental health care to populations that have not had previous access to these resources. The historical trend for medical providers has been to take the quick route in treatment through the medical model. For this reason it is vital that all public health Imageleaders, health care providers, program designers and policymakers be critically aware of what could be our next health care crisis through the possible escalating of profiteering by the Health Disparities Industry.

I was first made aware of the possibility of a medically-induced crisis in 2013 while conducting a mental health assessment of public housing residents. During interviews, several residents expressed disappointment in the one available mental health clinic; with clinicians that had a standard procedure of dispensing medications. Some residents avoided this clinic to address their mental health needs and instead, expressed the strong desire for counseling services. Consequently, I started imagining the future of mental health and medical providers lacking resources, without systems in place to handle the immense needs associated with deferred mental health and wellness care in vulnerable urban populations; populations rife with ongoing family and community trauma. They avoided this clinic to address their mental health needs and instead, expressed the strong desire for counseling services. Image

Prescribing medications could quickly become the default as a quick fix, making it easy for more pharmaceuticals to slip into urban environments, merely replacing illegal with legal drugs; with guaranteed payment through the ACA. We have already seen the suburban heroin epidemic resulting from a similar pattern of treatment with painkillers. A new, national explosion of ‘legal’ drug addicts will further traumatize families and communities. Legal or illegal, treating mental health challenges primarily through a medical model is a lose-lose; especially if mental health symptoms are PTSD the result of persistent, un-addressed personal and/or community trauma. If providers do not have the built in resources to address trauma with counseling and coping skills along with supportive upstream policies to prevent trauma from occurring, we as a nation will be suffering a host of much more costly side effects down the road from this oversight.

Looking deeper, in low-income urban communities where unemployment, racial profiling, absent fathers, violent crime and drug use are prevalent, generations of disenfranchised populations of color have been experiencing high levels of personal and community trauma. This trauma is just now being identified as untreated PTSD in many cases. Concurrently, these populations have not had access to preventive health and wellness care, so they have coped in their own ways, which is often repeating the cycle of self-medication, which can lead to drug abuse, crime, violence and child neglect. So my question is: What will happen when these people, virtually overnight, have access to overwhelmed medical providers that can just make the problem go away, for a moment, by prescribing a medication; a medication that may become a lifetime prescription and addiction? This is a serious question everyone in the public health field should be asking.  This is the new frontier of the Health Disparities Industry that the pharmaceutical industry will no doubt be willing to capitalize on unless public health leaders have a system of accountability by medical providers and a system of resources to address decades of deferred mental health and wellness treatment.

Treatment of mental health challenges can be aided with medications in some cases, but the most effective and self-sustaining treatment addresses the underlying issues of mental illness and drug use; the traumas that may be associated with mental illness and drug use. Trauma-informed care takes these factors into consideration. Just as the Veteran’s Administration (VA) has seen the exponential leap in prescription drug abuse and suicides by veterans suffering from PTSD, we must see the same potential for this practice to infect vulnerable urban communities. ImageJust as the VA has found very effective replacement methods of addressing PTSD for veterans through behavioral therapy, yoga and meditation, shouldn’t we as public health professionals be advocating for these treatments for the public, rather than a costly medical model of treatment?

Treatment of chronic pain often shares the same paths of potential abuse and can also be helped more effectively through alternative methods. How do we get ahead of this potential trend? How do public health professionals advocate for preventive and alternative treatment solutions before millions of urban trauma victims become addicted to ‘legal’ prescription medications that the public and the Health Disparities Industry condones? Perhaps the American Public Health Association (APHA) can take leadership on this issue to circumvent this potential disaster.

Further Research:

* Abram, K. M., Teplin, L. A., King, D. C., Longworth, S. L., Emanuel, K. M., Romero, E. G., … & Olson, N. D. (2013). PTSD, Trauma, and Comorbid Psychiatric Disorders in Detained Youth.

* Corbin, T. J., Rich, J. A., Bloom, S. L., Delgado, D., Rich, L. J., & Wilson, A. S. (2011). Developing a Trauma-Informed, Emergency Department–Based Intervention for Victims of Urban Violence. Journal of Trauma & Dissociation, 12(5), 510-525.

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Leno? Conan? The Real Score is: Media-2 Other Corporations-1 & Everyone Else-0 !

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NBC Wars - Just another Weapon of Mass Distraction with Media Taking the Ultimate Prize!

Well, as an American citizen, I have just about had it! Between the Supreme Court decision to allow a Pandora’s Box of financing to flow into the hands of Television & Radio Moguls for Campaign ads to the Contrived Drama between Jay Leno & Conan O’Brien that made light of overspending millions of dollars on his last show, I have one question for Americans:  

Don’t we need Schools & Teachers & Health Care & Jobs & Infrastructure & Renewable Energy? Don’t we need high-speed rail and insulated homes? Don’t we need lowered tuition so low & middle-income students can actually attend college? Don’t we need representatives that are more focused on doing their job than in raising money against bigger corporate influences?  

WHY ARE WE ENCOURAGING ALL OF THE MONEY THAT CORPORATIONS COULD BE USING TO FINALLY BECOME A LARGER PART OF THE SOLUTION TO INSTEAD, FUNNEL THESE BILLIONS TOWARDS MORE SELF-SERVING CAMPAIGN FINANCING? Didn’t we learn anything in the last 2 years? How will this help California’s financial rating? How will this help states gain funding and support for job growth?  

IF YOU DOUBT ME, JUST WATCH THE STOCK MARKET AFTER THIS RULING! I’M SURE IT WILL SHOOT BACK UP AFTER YESTERDAY’S DROP FOLLOWING THE ANNOUNCEMENT ABOUT OBAMA’S STIFFER BANK REGULATIONS. Now, investors can be comforted their interests will be maintained by “their” government representatives.

AT LEAST IT APPEARS THAT OBAMA IS BACK ON THE SIDE OF THE MASSES ONCE AGAIN & WE ARE WILLING TO SUPPORT HIM IF HE IS!

DOES THE AVERAGE AMERICAN REALLY HAVE ENOUGH TIME & MONEY TO TRY TO FIGHT & MATCH CORPORATE FINANCING JUST TO GET REPRESENTATIVES WITH THEIR INTERESTS IN OFFICE? I think not! This is an argument Newt Ginrich will lose in the long run! He is snowballing his followers once again for his own personal gain.  And don’t feed me that “Trickle-Down-Dung!” It hasn’t worked before and it will never work because most people with power get greedy and more self-serving the more privilege you give them! 

SHOULDN’T WE BE SPENDING OUR MONEY ON SOLUTIONS, NOT ON CAMPAIGNS?  

SHOULD UNIONS BE SPENDING MEMBER’S DOLLARS ON BUYING CANDIDATES? SHOULDN’T THESE MEMBER DUES BE DIRECTLY HELPING MEMBERS AND THEIR FAMILIES INSTEAD?  

IS THIS WHY THE MEDIA DID NOT COVER THE LEAD UP AND THE DEBATE ON THIS ISSUE BEFORE IT WENT TO A VOTE?  IS THIS JUST ANOTHER WEAPON OF MASS DISTRACTION WITH THE NBC WARS & OVER-COVERAGE OF HAITI TO ALLOW THIS TRAVESTY?  

WHERE WAS NPR DURING ALL THE DEBATES ON THIS RULING? YES, NPR has also become subject to corporate interests and beating a dead horse with singular story distractions! I have been getting tired of the repetitive tunnel vision media coverage this past year and this takes the cake! My listener loyalty just shifted another place to the left and I don’t know if NPR is residing there! 

I AM SO FURIOUS AND DISTRAUGHT AND APATHETIC AND WORN OUT BY FIGHTING AGAINST THESE INFLUENCES AND NOW IT SEEMS THE GIANT JUST GOT A WHOLE LOT BIGGER AND BADDER TO FIGHT AGAINST!  This feels like the nightmares I used to have as a child where my mother and father would be fighting with pillows. His pillow would get bigger and bigger while hers would get smaller and smaller until poof! It was gone!  The voice of the voiceless just got smaller like those pillows. 

THANKS ABC, NBC, CBS, NPR, FOX, TNT, & ALL OF THE OTHER TELEVISION AND RADIO NETWORKS WHO WILL BE THE ONLY ONES WHO TRULY PAD THEIR POCKETS WITH EVERY ELECTION AFTER THIS LATEST SUPREME COURT RULING . THOSE ADVERTISING DOLLARS JUST GOT THE ADRENALINE BOOST THEY NEEDED TO KEEP YOU IN BUSINESS!   Congratulations Rupert Murdoch! I am sure you and your peers are quite pleased with this ruling!  

NOW, WHAT ARE YOU GOING TO DO TO MAKE SURE SCHOOL CHILDREN IN LOS ANGELES HAVE BREAKFAST AND LUNCH AND TEACHERS AND CLASSROOMS AND SUMMER SCHOOL TO KEEP THEM OFF OF THE STREETS?  

OR WILL YOU JUST INVEST YOUR PROFITS IN THE FUTURE OF PRIVATIZED PRISONS TO MAKE ALL OF THOSE PROBLEMS GO AWAY?  

As an American, I am so disgruntled with the warped priorities of popular culture that falls so gracefully into the hands of the manipulators, while ignoring the real important issues. The drama of the day seems to wipe the American conscience clean of all accountability or responsibility to insist we have a “fair and balanced” country. Shouldn’t we be heading in the other direction to make elections shorter, fairer and less expensive as they do in other countries like Australia?   Ahhhhh!!!!!!

Is There Anyone Out There That Can Help us??????http://www.youtube.com/watch?v=XKazKb5f79A

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