Opioids Are Not The Problem
-Badly broken systems at every turn impede recovery and behavioral health-
By the time I finish writing my blog, How About We Think Out Loud?, many families in America will be shocked, horrified, and devastated at the loss of a loved one to some form of opioid concoction – probably heroin and Fentanyl. It’s tragic, indeed, but predictable. Insensitive? Perhaps, but tell me after you read this by leaving a comment.
All the politicians and their crisis task forces and the media with their expert interviews are searching for answers. The State of Vermont made it their number one priority almost two years ago. Other governors and federal agencies are pouring millions of dollars into existing treatment agencies and their Help Lines. Very good and dedicated people are participating in large coalitions of frightened citizens down to a handful of folks at church information nights. They include professionals from law enforcement, behavioral health, education, media and medicine.
The deaths continue every day in all zip codes, but opioids are not the true reason.
-What was built to help is badly broken-
What we thought were responsive behavioral health systems are overwhelmed, ill prepared and struggling for answers when the TV microphone is pointed their way. The behavioral health infrastructure has been broken for years and is a serious part of the current inability to respond. Opioids are not the problem. The preparedness to respond to a neighborhood, county, state or national behavioral health rampage is not in place. It’s the toughest pill to swallow but it is painfully apparent to me. Mental health remains the bastard child of healthcare – hospital administrators say it takes up expensive floor and bed space. Insurers still do what they can to avoid a fair reimbursement while they deflect subscriber calls for help. One family was referred to a hospital in Buffalo, New York that was closed for about five years. Even now, they limit the number of mental health providers approved to be on their panel – parity laws have been window dressing, let’s face it. Ask any parent or spouse who called to get help if they felt compassion on the other end of the phone. Yes, there are some wonderful people on those lines, but they are not the majority. A depressed and suicidal teen might wait 8-12 weeks to see a child psychiatrist and 6-8 weeks to see a psychiatrist treating adults. Psychiatrists are opting out of the intentionally cumbersome approval and paperwork processes, imposed by insurance companies, to see their patients hassle-free. If you are a trained clinician from another state with a Master’s degree in clinical psychology or marriage and family therapy you cannot get a license in New York State or get on any insurance plans. Sadly, these issues date back 30+ years, but it has created a shortage of approved providers.
Our prison facilities now treat more of the mentally ill than our psychiatric hospitals by a very large margin. Many jails refuse to administer certain medications claiming safety concerns while watching inmates go through the horrors of withdrawal even when the individual has a legitimate physician prescription. I’ve mentioned broken systems and I’ll add inhumane, too.
EARLY EDUCATION MUST BLEND ADDICTION AND MENTAL ILLNESS INTO BEHAVIORAL ILLNESS PREVENTION
Prevention funding goes very heavily toward addiction prevention with very little mental health messaging. It should have always been behavioral health education, instead of splitting the two, but then again most schools do not have nearly enough behavioral health education in the curriculum – it needs to be in K-12, especially with the amount of trauma children experience or witness. Consider this, two years ago more than 1,400 high school students in the Buffalo Public Schools attempted suicide. I co-chair the Mental, Emotional and Behavioral Committee at the Buffalo Public Schools. We received a solid three-year grant from a large, local foundation to address the high rate of suicide attempts and our committee’s efforts proved successful. District administration, I’m told took responsibility for filing the required report to the foundation, but failed to meet the deadline and the grant was rescinded. Accountability, you ask? None. Broken? Painfully obvious. A senior member of all our efforts was given two minutes to make an annual report and the minute she got to the podium every School Board member went to their cell phone. Another seriously broken, yet critical system for children’s mental health looking the other way.
Fresh out of graduate school, I was employed as a Supervisor of a 30-slot adolescent day treatment center (8:00 a.m. to 6:00 pm – M-F). I carried a caseload of 10-12 teens. We were required to provide individual, daily group and family therapy to our clients. It was during those years, in the late ’70s and early ’80s, I learned not one of the teens woke up one day and said, “I think I’ll become a drug addict.” UBMD Addiction Medicine’s Dr. Rick Blondell says the same thing about opioid addicts today in 2017. No one wants this life. No one wants any illness, right? The tragic reality is other diseases have far better systems, professionals, and community support in place to respond and I salute those who do.
WHAT HAPPENED TO ACTIVE LISTENING AND ACCOUNTABILITY?
Fragmented healthcare systems caught up in creating the next best program, company name or theme have been missing the core humanity of behavioral illnesses, namely, people and their families are in pain and full of fear. The simple things like a human being on the other end of the phone, getting compassionate, but more importantly, helpful information they can use, a warm touch of comfort, a follow up call and a payor working with you instead of posing confusing alternatives and long waits. How is someone dying from opioid abuse any less critical than the guy who walks in to the local emergency room with chest pain? I’ll tell you. People look at the chest pain patient as potentially close to death. Even healthcare providers, who are supposed to be beyond any prejudice, treat addicted patients with a different watch. They are not trained, need active listening skills and are not usually held accountable for poor hospitality. Patients with a behavioral need or disorder wait double the hours even in our million-dollar renovated emergency rooms.
My degrees, continued studies, executive positions, committee posts, mentoring and 35+ years experience working in this field brought these broken systems to the surface. What I’ve heard very loud and clear is too many services are not working toward a positive outcome and patients feel they would be better off with cancer. They hurt. As a therapist in Florida, my teens were victims of sexual abuse, incest, school failure, home failures, bullies, parental abandonment and used by dealers interested in creating new customers. They needed to be heard with “unconditional positive regard.” In those days, alcohol, marijuana, and Quaaludes were given away to troubled kids – like opioids and heroin today. Many dentists are still prescribing Lortabs for extractions despite what we know. Middle school and high school athletes with injuries are also given powerful painkillers. But we don’t dare confront the physician’s practice regime or tell a dentist how to treat a patient. I went to a local managed care company and was told, “we can’t tell them (dentists) how to practice.” No accountability.
INTEGRATION OF CARE, REALLY?
-Every Visit is an Opportunity to “Check-in” with Your Patient-
Although there is a great deal more broken, the concept of primary care and behavioral health gets talked about today as if it’s some new brilliant idea or medical break through. The truth is it has been window dressing, not practiced, and fundamental screenings are not conducted at opportune times. I attended all of the Health Home meetings at WNED when the concept was taking a small step forward; however, I was deeply concerned because the thrust of much of the activity was jockeying for turf and forging power bases to keep others out. As an independent, I had fresh eyes on a tough subject. I’ve been advocating major changes for years as I felt it was a calling and a professional duty. I was lucky to have a platform on radio with Mind Matters on Oldies 104 FM, Frankly Speaking on WBEN 930 AM and for 16 years with Spotlight on Health. In Buffalo Business First, I wrote about workplace behavioral health (and primary care integration in 1991) as a regular guest columnist in the ’90s. Recently, my volunteer time has opened my eyes to the inexcusably broken way we care for our veterans with mental illness and addiction and I was actually criticized a few years back for “doing what the VA was paid to do.” I was criticized for supporting the emerging WNY Heroes, Inc. and bringing in Barbara Van Dahlen, Ph.D., named to TIME Magazine’s 2012 list of the 100 Most Influential People in the World, president of Give an Hour http://www.giveanhour.org. A colleague of mine told me about Give An Hour and suggested we become a chapter – turns out we were the first in the country. For veterans with a mental health or addiction legal challenge, I created Take a Case with the Erie County Bar Association. In August 2016, a musician buddy of mine and I were sipping a ‘Cup ‘O Joe’ at Spot Coffee in Orchard and we talked about the mental health tragedy of veteran homelessness. In about an hour, Buffalo Blues for Homeless Veterans was born and we agreed to a big bash benefit at Sportsmen’s Tavern in Buffalo, N.Y. with a CD featuring all local musicians called HOME was produced by this same buddy, Bob James. Bob took the project and concept to 10 more bars and found creative ways to support veterans, including getting Mayor Byron Brown and County Executive, Mark Polancarz involved – all benefitting the WNY Veterans Housing Coalition run by Celia O’Brien. Bob raised a nice chunk of money and the veteran condition was given the attention it needed. A badly broken government service agency further crippled mentally wounded veterans, yet a community of western New York musicians led by a former mental health agency executive and a Buffalo Music Hall of Fame musician, all in one, created a response. One of the major reasons so many systems are broken is the lack of creative solution development – and I don’t mean form a committee.
I’ve become a Reserve Deputy Sheriff on the Scientific Committee in Erie County that has given me more and more perspectives to see opioids are not the problem.
GREAT PEOPLE IN BADLY BROKEN SYSTEMS
Extremely dedicated professionals, many my long-term friends, in the behavioral and neuroscience fields are doing herculean work. They serve on committees, take the 3:00 a.m. crisis call, go to the jails, sit in the ERs with frightened parents, march to Albany, battle prejudice and stigma, buy food out of their own pocket for others, sit with the addicted 3.0 lbs. newborns, talk the veteran out of suicide and much more.
Tragically, that precious time to save a life is within a badly broken behavioral health system that wastes that life-saving time, government and grant money, and defends the broken systems. All the combined systems created to ease anxiety, support treatment, and achieve a happy path in life are doing the polar opposite in too many ways. Therefore, accept that opioids are not the problem. See that the recommended roadmaps to recovery are filled with broken pathways poorly structured to address this opioid crisis, and so people will continue to die in the hopeless hallways jammed with addicts, mentally ill, spouses, parents, boyfriend/girlfriends and family members suffering in broken systems. How many died today?
What do you think?
Tom is a consultant who facilitates change, develops marketing plans, conducts program evaluations, builds creative programs and conducts presentations along with speaking engagements. He’s hosted 800+ radio shows, produced five short films and three long form television specials. He is an adjunct professor at Hilbert College for six years teaching two MPA courses on Financial Resource Development and Marketing and Public Relations. He is founder of a not for profit, Spotlight on Hope, Inc. in 2005 and president of his firm, Success Stories, Inc. since 1990. He is a screenwriter and currently in production of a full length film in the field of behavioral health. He resides in Orchard Park, New York with his wife, Nancy. They have three adult children, Ryan, Colin and Bridget. (716) 481-4578 or firstname.lastname@example.org