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 leaders, 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. 

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. Just 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.

The Womanly Art of Listening to Our Bodies

First of all, I need to make a disclaimer. A portion of this post heading is taken from a wonderful and well-respected book by La Leche League I read over 38 years ago, “The Womanly Art of Breastfeeding.” I read it during a time when I was preparing for my first child and preparing for childbirth and beyond. This was my first lesson in learning to listen to my body.

This morning, some 38 years later and a lifetime of listening, I was awakened by this thought, “The Womanly Art of Listening to Our Bodies” and how even though the time may not be the best to write this, because I have scholarships to apply for and work to do to prepare for the next semester of grad school, I cannot help but listen to this message and put it out there.

The message is: Our thoughts and feelings (or emotions) are inextricably linked to our bodies! Once we recognize this, the knowledge is immensely powerful. I have been so fortunate to attract mentors and educational opportunities in my life from the days I was a pregnant teen at 15 to my life today, a mother of 3 and grandmother of 8; now the age of 54.

I learned from natural childbirth that “attitude IS everything!” If you think it is pain, it is painful! If you think of it as the process that brings you your angel, then it is manageable.

I learned from 7 years in La Leche League that if you always remember in the back of your mind that breastfeeding is a normal, natural process that mammals have been doing successfully for millenia and trusting this natural process, your milk will come and challenges are only bumps in the road, not roadblocks.

I learned from reading Adelle Davis’ “Let’s Have Healthy Children” that our foods are full of everything we need if we learn to trust the foods that have been provided by nature. We do not have to buy expensive food to nourish our bodies properly. By being more efficient with our food choices, we can bring health to our families within any budget.

I learned from my 10 years working in the field of biofeedback, that the mind and our inner emotions are incredibly powerful and that our body speaks to us continually. Whether we listen or not is the real challenge! When we listen, we reduce suffering and illness and increase our quality of life. When we ignore the signs, we suffer from a variety of ills, including accidents and injuries.

So much more to share and no time to do it right now, but I want to leave you with this thought, please take the time to just be quiet without any outside electronic or other interference at least once every day. Listen and acknowledge and make the little adjustments you know deep down that you will benefit from. Little by little, you will find that the simple adage “An ounce of prevention is worth a pound of cure” will improve your daily quality of life, your health and your future!

Until next time,
Granny Pants
(Oh yeah, this photo was taken of me in 2002. I just found it and had to use it to brighten my day. The Yuba River is in the background. Love that place!)

Grandma Heads Off To College: A Recession Era Tale

GRANDMA HEADS OFF TO COLLEGE

A RECESSION ERA TALE

               I drove through the quiet, manicured suburban Roseville neighborhood I would no longer call home this morning. My swollen eyes and red splotchy face were the affirmation that I had made the right decision not to put on make-up after my morning shower. That was the last shower I would take as a permanent resident in my daughter’s home. At one point, my daughter knocked asking, “Are you OK Mom?” which I answered, “Yes” though I didn’t tell her I had been in the bathroom for an extra-long time this particular morning because I had been balling my eyes out while writing my two little grandchildren, Hudson (4) & Dayton (2) their good-bye, I will miss you cards. I also didn’t tell my daughter that the first time I walked into a drug store to buy a Thank You Card for their family, I started crying so much that I just had to leave!

Yes! Today is the day I headed off to college! Yet, unlike the eighteen year-old, I am leaving behind six of my eight grandchildren, two of my three daughters, my roses, the vegetable garden, most of my belongings (in storage), my two son-in-laws (who probably aren’t crying) and Baxter, my daughter’s ten year-old pug that may not live to my next visit. (I just realized that in my blubbering, that I forgot to say goodbye to Baxter!)

The impetus for my unstoppable fountain of tears is because I am leaving my youngest grandchildren whom I have lived with for most of their little lives. How will I get along without anyone to share with when I see a magnificent bird, an egg shell from a nest or a giant caterpillar? Who will be there to be just as amazed at the sunset as my little 2 year-old granddaughter Dayton, who asked me to pull the blinds up last night so she wouldn’t miss the “set-sun?” Who will care about whether or not the “owie” on my finger has healed yet? Who will be there to never tire of playing card games, like my three oldest grandsons?

Regardless of the monumental suffering these daily dilemmas and others will create for my aching heart, I had to leave! I had to leave for the very reasons my eighteen year-old granddaughter, Elora left her friends and family behind last year to head to college. If I didn’t leave, I would have the pressure of a poverty-stricken or very family dependent retirement looming large over my loved ones. I had to get my rear-end to graduate school quick!

This was never my plan, yet it was always an unspoken dream cast away after decades of repetitive mental reality checks every time I saw those enviable titles after someone’s name that I knew I could never compete with, no matter what I had accomplished in my life: MPH, PhD. EdD. MSW, etc…

If I listed the journeys I have taken to get to this moment, I would never get through this post, so I won’t. Briefly, after losing my home, my retirement, my marriage and with wages plummeting, I only had the hope to work for $12-15 hr. with little chance for benefits, if I worked in the field I Ioved, without those three initials. My daughter and her husband and 2 babies took me in and we have helped each other for the last 2 ½ years. I am so grateful for them and what they did to bring our family together. Truly one of the better outcomes of this recession has been the return of the extended family experience.

Grandiose plans to be a famous author and “child expert” six years ago were quickly dashed during the recession after I self-published my first book, The New Physics of Childhood (IUniverse, 2009).  Not only was it rejected by many because I did not have a credential behind my name like, PhD., MSW, EdD., etc. I realized that the tone of it (due to a lifetime of pent-up experiences) was somewhat arrogant and harsh. I began the rewrite immediately, along with edits by several professionals. Then the publishing industry took a dive and so did my income. It was time to set idealistic dreams aside and make way for Plan X.

Foreclosure, bankruptcy and divorce (in that order) were juxtaposed to my extinguished author dreams. I knew that the once well-paid work I had done earlier as a caregiver was a very temporary replacement and sabbatical to my teaching career, yet this job title had lasted for over a decade and seemed it was my only real option for earning income forever, unless I had a Master’s Degree! With a Master’s, I could finally earn the respect of my years, since wrinkles don’t show well on a resume. After researching and allowing the dream to simmer, I knew that a Master’s in Public Health was the only way for me. It would allow me to focus on my passion for Preventive Health Education, while also giving me incredible opportunities to influence public policy and the health of communities. It would also provide me with the potential for a real income and benefits so I can rebuild my life and my nest egg before I allow myself the luxury of retirement in my mid-70’s.

I could have never imagined that when everything was gone, save my beautiful family, that the only option was actually the dream I had so wanted, yet had never uttered or allowed myself to think of. This dream also occupies the same space as my dream to be a well-known and respected author one day. *

For now, the reality is one dream at a time! I prepared for two years by taking brush-up courses and using the time to finally become fluent in Spanish. All of my experiences and preparation in the last two and a half years got me accepted to the 3 programs I applied for! In August, I begin my journey in San Francisco State University’s MPH Program in Community Health Education. Yeah!!!!!!

I am saving money by couch-surfing for a month, while I work in my field of choice, in preparation for grad school. I am not thrilled about taking any student loans out and am hoping my second year in school is funded solely by scholarships and part-time work. I have a lot to accomplish professionally, and am committed to being a full participant in my graduate school experience.

During my undergrad career, I was a single mother raising three daughters. I had no time for friends or campus activities. All I wanted to do was race home to my daughters every day after school. The 3-hour commute to higher education ate up many precious hours with my daughters as it was. Now, I am one mile from campus and by myself to focus on school work, etc. Maybe I will even make some friends, something that hasn’t really been a part of my life with every second going to family. Though I am realistic enough to know that I won’t really have time to do much of this or to sit around and play cards while I am in grad school. However, I am already looking forward to visits “back home” to indulge my inner card playing junkie.

Yes, this day, this life, this new chapter is the perfect description of a bitter-sweet moment. I will miss my family in Roseville, but I will actually have more time with my youngest daughter and other grandson, now that I am closer to them.

Beyond the tears and tugging of little heart strings, life is good! I even received a $1,000 scholarship by a wonderful organization that felt compelled by my personal journey. Perhaps there are more angels like this in my future. I sure hope so, because as this Grandma heads off to college, I need all of the angels I can get, yet nothing will take the place of the beautiful family I have waiting for me when I return home after I receive my Master’s in Public Health! It will be the 1^st. Master’s Degree in our family, just as my AA & BA were when I received them, years ago. I hope one day I can be an inspiration for my grandchildren so they know that it is never an option to give-up or give-in and that it is never too late for your dreams to come true!

*CONFESSION   – In the middle of preparing to leave for grad school, the writer in me just had to get that one last lick in! I formatted the 30+ years of my children’s stories and printed them out for my grandchildren to read in my absence. More on this project in future posts.

Hasta Luego!  Got places to go, things to do, people to see!

Christina Ivazes

aka Granny Pants

Education Reform and the Over-Inflated, Over-Rated 4-year College Degree

by Christina Ivazes  

 The current state of the US economy, our unskilled labor force, the need for educational reform, and the skyrocketing costs of a college education demand we be smart and efficient about solutions that affect and connect all of the above. Perhaps a better strategy is to back away from the ideal that every American should go to college. Yes, we can all agree that every American should have the opportunity to go to college if they choose. However, to give our students and our nation the best educated and skilled workforce, we should not focus on every American going to college, but first, on every American graduating from high school with two years of career training. This pragmatic strategy offers numerous benefits to our country. 

   By becoming more efficient and effective in preparing students for the real world and college, the US will save money and jobs. In 2010, The Fiscal Times reports, “just 56 percent of those who enroll in a four-year college earn a bachelor’s degree…Some students drop out because of the trouble paying the cost—the average college debt upon graduation is a whopping $24,000” (Reynolds Lewis). According to the U.S. Dept. of Education Institute of Education Sciences (IES), the cost of a four-year college education is from $18,900 to $35,500 and rising. We also know that these quotes are a low-average and not really what a four-year is typically costing our college graduates, where $50-$100,000 is a more common estimate today in 2011. And graduation does not necessarily equate employment as we see with a glut of unemployed college graduates today weighed down with inflated student loan and credit card debt. There are jobs however, that are immune to outsourcing and which do not warrant an expensive four-year degree.

Secondary and post-secondary vocational and technical training programs are historically lower in cost with competitive salaries to those earned from four-year college degrees. Matthew B. Crawford advocates for the many benefits of trade-based training in his bookShop Class as Soulcraft, “You’re likely to be less damaged, and quite possibly better paid, as an independent tradesman than as a cubicle-dwelling tender of information system or low-level “creative” (53). The Houston Chronicle published an article supporting Crawford’s concept stating, “Mechanics of all types are in high demand and can command a high hourly wage… Many blue collar jobs require training through apprenticeships or vocational training programs and others may require on-the-job training or passing an aptitude test prior to employment” (Nielson). This is not a proposal to eliminate the college track for high school students in America.

Shouldn’t we beg the questions: Why are we so single tracked about how to create a productive & competitive job force? And, shouldn’t we think about downsizing the cost of education along with our lifestyles? The IES reports that in 2008, earnings for an employed four-year college graduate are on average of $55,000/males, $45,000/females per year. Compare the costly four-year college degree with training and apprenticeship (which can begin as a junior in high school) for an electrician who can earn from $34,000 and upwards with no student loan debt with just two more years of post-secondary training for $400-$1000/yr. “Semi-truck drivers…start out making $50,000 annually…and only requires about four weeks of training to obtain a license” (Nielson). Debt free high school training in the trades or technology/health careers can yield from $34,000-$50,000+ per year. Another pragmatic idea Crawford suggests is “even if you do go to college, learn a trade in the summers” (53).    By increasing high school career training programs, we can create a stronger buy-in for students, reducing training costs while also reducing the costs of high school dropouts for our society.

  The costs of high school dropouts are far-reaching beyond the costs of college dropouts. According to the 2007 report The Economic Losses from High School Drop-outs in California, the significant impact from high school dropouts come from lost tax revenue, Medical and Medicare expenditures, fiscal costs to fight crime, prosecute and incarcerate felons, and increased assistance for both felons and their families. “The economic magnitudes are substantial” (2 Belfield, Levin). After deducting the cost of education, the average total lifetime social gains for a high school graduate is $391,910 per graduate in the State of California, with the savings for black males being the highest at $681,130 (Table 18, Belfield and Levin). My point is not to stereotype but to acknowledge that we need to do everything in our capacity to invest in our high school students to become ready employable adults and/or ready for college, not inmates and/or recruits for drug cartels.

Career and technical training can be a ray of hope for all high school students, not just the disenchanted. Crawford makes a strong case in favor of the trades in Shop Class as Soulcraft, including his highlight on their little recognized intellectual merit, “I quickly realized there was more thinking going on in the bike shop than in my previous job at the think tank” (27). With a PhD. he describes a collegiate fall from grace as a blessing because it led him back to his original high school training as a motorcycle mechanic.  Crawford describes his own cognitive journey as well as those of other tradesmen he interviewed. The conclusion is worth a new focal point in our education reform. In Crawford’s view “Given the intrinsic richness of manual work— cognitively, socially, and in its broader psychic appeal—the question becomes why it has suffered such a devaluation as a component of education” (27). Some may view this idea as undermining a college education, but what Crawford is really pointing out is that “Practical know-how… is always tied to the experience of a particular person. It can’t be downloaded, it can only be lived” (162). Children and teenagers have always responded positively to the value of hands-on learning, especially when it has a practical application in their lives.

At the age of 16, a teenager’s cognitive maturity starts him or her on the path towards the reality of the adult world and all that entails. You may wonder what cognitive maturity has to do with a broad-based high school career and technical training program, but if students are struggling in school, have no money or family support for college, many see no future in the value of their junior and senior years. Challenged students need full engagement to prevent them from becoming avoidable statistics. By focusing on Math and English proficiency by the end of sophomore year, juniors and seniors can take core subjects and science classes with their half day of training courses to ensure they are ‘college ready’ at graduation. This schedule does not limit a student’s education, it enhances it by making it relevant; it prepares the student both for life and for college should they choose to attend.

   Though career and technical training in high school is not the solution for every student, it can serve a healthy percentage of our labor force. Some model programs in the US illustrate the potential of every high school, such as the Howard High School of Technology in Delaware.  The 2010 report by the Delaware Department of Education declares, “Howard has a high graduation rate (97 percent) and daily attendance rate (95 percent) and a low serious infraction rate….In addition to an academic program, Howard students choose one of the following career pathways: finance and business; carpentry; computer network administration; cosmetology; culinary arts; dental assisting; electrical trades; engine technology; legal administrative assisting; medical assisting; nursing technology; public service; or structural steel detailing.”  This richly diverse program serves a variety of student and community needs. It is a model that deserves replication.

There are still many questions to address in more detail before programs like Howard can be implemented effectively across America.  Questions like: How will we pay for this?  How can we make a solid case for the benefits of high school career training that will not be sabotaged by budget cuts every time state and federal revenues fluctuate? How can we refocus dollars from punitive institutions to education so we can create a higher skilled work force, reduce high school dropouts and prison populations while also reducing student loan and credit card debt? The answers to these questions and are necessary for the design of lasting and effective education reform that will strengthen our economy and society.  Of course, to change the current system, we may also have to challenge for profit college and prison industries that have benefitted by the shrinking of high school career education in the U.S., but it’s a challenge worth taking up.

Work cited

Belfield, Clive R. and Henry M. Levin. “The Economic Losses From High School Dropouts in California.” University of California, Santa Barbara: California Dropout Research Project Report #1, August 2007. PDF.(Table 18) Web. 7 April 2011.

Crawford, Matthew B. Shop Class as Soulcraft. New York: The Penguin Press. 2009. Print.

Delaware Department of Education. “Delaware Partnership Zone: Howard High School of Technology.” PDF. 2010. 21 April 2011.

Nielson, Lisa. “Highest Demand Blue Collar Careers.” The Houston Chronicle. 2011. Web. 7 April 2011.

Reynolds Lewis, Katherine. “High College Dropout Rate Threatens US Growth.” The Fiscal Times. October 28, 2010. Web. 22 April 2011.

 Wei, Christina Chang. “What is the Price of College?” U.S. Department of Education. December, 2010. PDF. (Table 1). Web. 7 April 2011.