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Opioids Are Not The Problem

As I’m writing my blog, How About We Think Out Loud?  by the time I finish, 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 Fentaynl. Tragic, indeed, but predictable if you truly knew your loved one.

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 150+ people down to a handful of folks at church information nights.

The deaths continue every day in all zip codes.

System Failures

What we thought were responsive behavioral health systems are overwhelmed, unprepared and struggling for answers when the TV microphone is pointed their way. In my opinion, the behavioral health infrastructure has been broken for years and is a serious part of the current inability to respond. Mental health remains the bastard child of healthcare – hospital administrators say it takes up expensive floor and bed space. Insurers still do as much as they can to avoid a fair reimbursement while they deflect subscriber calls for help. Even now, they limit the number of mental health providers approved to be on their panel – parity was window dressing, let’s face it. Ask any parent or spouse who called to get help. A depressed and suicidal patient might wait 8-12 weeks to see a child psychiatrist and 6-8 weeks to see a psychiatrist treating adults – maybe faster if you pay cash. Psychiatrists opt out of the intentionally cumbersome approval and paperwork process 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, you cannot get a license in New York State or get on any insurance plans. Sadly, these issues date back 20+ years, but it has fostered a shortage of approved providers.

Our prison facilities now treat more of the mentally ill than our psychiatric hospitals by a very large margin. Yet many jails refuse to administer certain medications, instead watching the inmate go through the horrors of withdrawal despite that individual having a legitimate physician prescription. I mentioned broken systems and I’ll add inhumane.

Early Education Blending Addiction and Mental Illness = Behavioral Health

Prevention funding goes very heavily toward addiction prevention with very little mental health messaging. It should have always been behavioral health education, not splitting the two, but then again most schools do not have near enough behavioral health education in the curriculum – it needs to be K-12. Consider this, two years ago more than 1,400 high school students in the Buffalo Public Schools attempted suicide – a far more serious answer than, “I thought about it at least once.” I co-chair the Mental, Emotional and Behavioral Committee at the Buffalo Public Schools. You can’t make this stuff up folks.

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 that 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.

What Happened to Active Listening and Accountability?

What I heard very loud and clear is something wasn’t working in their life for an episode or over a long time. They hurt. My teens were victims of sexual abuse, incest, school failure, home failures, bullies, parental abandonment and used by dealers interested in creating new customers,  In those days, quaaludes were given away to troubled kids – like opioids and heroin today. Many dentists are still prescribing Lortabs for extractions. 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 how to practice.”

Integration of Care, Really?

Finally, although there is a great deal more that is broken or hampers people from dying, the concept of primary care and behavioral health gets talked about today as if it’s some new brilliant idea. I was advocating, and wrote a piece in Buffalo Business First in the early ’90s, for years in my various roles as vice president of marketing, vice president of addiction medicine and creator of an employee assistance program (EAP), Progressive Corporate Care. Further support came from 16 years as host of Spotlight on Health on 96.1 FM and Mind Matters on Oldies 104.5.I tried like hell to push the agenda and added the inexcusably broken way we care for our veterans with mental illness and addiction. During my own annual physical, I get a 15th generation copy, barely legible that asks me about 10 Yes or No circle answers about depression. Sadly, there are too many that don’t even do that including pediatric, ob/gyn, emergency medicine, family medicine and geriatricians.

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. You won’t find them at the “You Are Great, No You Are Great” award shows because that time is better spent.

Sadly, that precious time to save a life is within a badly broken behavioral health system.

It’s not an opioid problem. What do you think it is?

Tom McNulty

Tom is available as a consultant to facilitate change, conduct program evaluations, build programs or marketing and do presentations or 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 NFP, Spotlight on Hope, Inc. in 2005 and president of his firm, Success Stories, Inc. since 1990. He resides in Orchard Park, New York with his wife, Nancy. They have three adult children, Ryan, Colin and Bridget. (716) 481-4578 or tomsuccess@verizon.net

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