Friday, August 31, 2012

What a Creative Mad Mind Maketh, Psychiatric Meds Taketh Away : Shulamith Firestone Lived in "Airless Spaces" (But she took her medication)

I had a client who was schizophrenic, male, in his 20's.  He frequently laughed to himself and could be heard talking to others that did not exist by his parents.  But he was a fiercely original graffiti artists.  I tried to buy some of his art but his mother, who was an art collector, realized full well the depth of his originality and would not part with it.

Due to the challenges of keeping the young man at home, he was placed on more potent psychiatric meds which, his mother explained, removed all of his creative interest.  He no longer wanted to create.  He moved into a famiy care home where he resides today. 

If you have ever been in one of these places, you full well realize that mostly people are there pleasantly being stockpiled.  Their meals are cooked for them; they have a room; they take their meds; they sit on the front porch and smoke cigs.  They watch TV.  That's their life. 

Shulamith Firestoe, 67, Feminist Writer and schizophrenic has just passed (see:

A movie was made about her painting and writing in 1997. 

She wrote one more book, besides her first earth-shaking one subtitled, "The Case for Feminist Revolution" with the pubication title being, "The Dialectic of Sex."  She wrote it when she was 25. 

'.....The book, which was translated into several languages, hurtled Ms. Firestone into the front ranks of second-wave feminists, alongside women like Betty Friedan, Kate Millett and Germaine Greer. It remains widely taught in college women’s-studies courses....."

Her last and only other book was a report on how it felt after receiving treatment with psychiatric meds:

".....Her only other book, “Airless Spaces,” was issued in 1998 by the experimental publisher Semiotext(e). A memoir-in-stories that employs fictional forms to recount real-life events, it describes Ms. Firestone’s hospitalization with schizophrenia, which by the 1980s had overtaken her.......

In “Airless Spaces,” Ms. Firestone writes of life after hospitalization, on psychiatric medication. The account is in the third person, but the story is her own:

“She had been reading Dante’s ‘Inferno’ when first she went into the hospital, she remembered, and at quite a good clip too, but when she came out she couldn’t even get down a fashion rag. ... That left getting through the blank days as comfortably as possible, trying not to sink under the boredom and total loss of hope.”

The story continues: “She was lucid, yes, at what price. She sometimes recognized on the faces of others joy and ambition and other emotions she could recall having had once, long ago. But her life was ruined, and she had no salvage plan.”   I guess it was no mistake that she was reading Dante's Inferno when she went into the hellish bowels of a psychiatric institution which was the start of the road associated with the removal of her creative process.   Joan Osborne, fragile on stage when I saw her years ago, understood the value of the 'spider web' in her head:  (from her very excellent album: Relish: nominated for a Grammy)   I dreamed about ray charles last night
And he could see just fine

Dreamed about ray charles last night
And he could see just fine, you know
I asked him for a lullaby
He said, honey, I dont sing no more
No more, no more, no more
Ray dont sing no more

He said, since I got my eyesight back,
My voice has just deserted me.
No georgia on my mind no more...
I stay in bed with mtv.

Then ray took his glasses off
And I could look inside his head
Flashing like a thunderstorm
I saw a shining spider web

Spider web
Spider web
Spider web
In ray charles head

I dreamed about ray charles last night
He took me flying in the air
Showed my own spider webs
Said, honey, you had best take care.
The world is made of spider webs
The threads are stuck to me and you
Be careful what youre wishing for
cause when you gain you just might lose

You just might lose your...
Spider web
Spider web
Spider web

What ray charles said
When youre feelin lonely
When youre hidin in your bed
Dont forget your string of pearls
Dont forget your spider web

When I go to sleep tonight
Dont let me dream of brother ray
No, no, no, don't...

Dont get me wrong, Im glad he sees
Just like him best the other way

Spider web
Spider web
Spider web
What ray charles said...
In ray charles head

All I got's my spider web
Keepin me alive
Cmon ray

Tuesday, August 28, 2012

James E. Holmes and The Failure of Mental Health Treatment in This Country: How Available Was the Mental Health Care at the U. of CO, Denver for Him?

I was sitting on my front porch this evening after reading the NYT article on James Eagan, who played 'the Joker' (there is some psychic link in what he did and that of actor Heath Ledger who played that role, so astoundingly, you can never forget it: the tight, coiled, ruthless, poignant madness) as he blew away the lives of 12 people in Aurora, CO a few weeks ago.  Here is the NYT article; such a paper there never has been/ never will be again in the US or maybe the world, certainly not for Americans:

I looked at the face of the boy, in highschool, smiling too brightly----to the left of the photo with which we are now familiar which is that of a forlorn soul who has piteously cursed his community and perhaps his own soul itself. 

As I meditated on the matter, I found myself winging into his jail cell.  What I saw there was a circle of angels, guarding him; they were forlorn, distraught, heads down, in confession, as it were, praying about the human dilemma.  I envisioned myself holding his hands, looking in his face, and saying, 'Friend.'  For surely, this young man must have a sense of being split assunder from the rest of humanity. 

I saw the angels' circle open in order to allow the slain souls to move out of the circle in order to find some measure of peace somewhere else in the cosmos. And then it enclosed around James Holmes again.

I don't know why this guy affects me like this.  Maybe its because of my client, I'll call him, Hank.  The first time I saw him he came into my office with his hand in his pocket, working something.  I thought: 'what has he got in his pocket.'  He told me sometime later that it was a knife.  That afternoon he was diagnosed by me as having schizoaffective disorder, bipolar type. 

James Holmes, as per the NYT article, texted a friend in his PhD program a query as to whether she knew what 'dysphoric mania' was---as he was crashing.  Its a kind of bipolar disorder, associated w/ psychosis.  My client, Hank, had been psychotic in the past. 

A couple of years ago he told me that he saw the devil standing behind me.  I looked around and said, "Hank: the devil is not there', poking my hand into the void. The other day Hank told me that a local lay preacher suggested to him that his mental illness was 'caused by the devil.'  Hank has a habit of calling me on an almost nightly basis to simply check in. 

Do you think that the psychiatrist or other mental health people at the U. of CO, Denver, were available to James Holmes like this?  I admit to being peeved that my diligence is dismissed as associated with NC Mental Health 'Reform.'  What do 'those jokers' think this business is about?  Do they think it is a 9-5 job?  If not, then why don't they pay us and give us street cred for the work we do?

But I digress. 

This past Saturday Hank, when he called me at 7 pm, Hank related the story about the preacher to me.  I told him that 'this is an old way of thinking about mental health stuff' and that what goes on with him is related to a problem w/ the chemistry of his brain. I suggested that he has an opportunity to educate others about what goes on with him.  And, thank goddess, Hank does this more and more regularly.  Why, the other day, he stopped his car, and simply talked to a man to tell him that his name was 'Hank' and that he was 'glad to meet you.'  In the little town of Waynesville this was not thought of as weird but simply a friendly if slightly strange gesture. 

On the other hand, I said, to Hank, that if that preacher wants to pray for you, I would recommend that you ask him to. 

Tonight Hank called me and advised me that while waiting to see the new psychiatrist at the local private company in Waynesville, NC, that another person with Bipolar Disorder was sitting in close proximity to him and they exchanged information about how it is to live w/ Bipolar disorder. 

Hank told the other person waiting to see the psychiatrist that 'I'll pray for you tonight.'  Understandably, the other person was grateful. 

So, tonight I have prayed for James Holmes.  I winged him a message suggesting that he was not devoid of people praying for him and all those sentient souls he sent hurdling away on that dark night, as he evoked Heath Ledger's Joker: a poignantly lost soul who in fact flamed out no so very long after he played that part.

Send a prayer up for James Holmes and the souls he inadvertently blew out into the cosmos. 

Or as my supervisor at University at Alabama Birmingham/ VA Hospital told me upon finishing my internship there, as associated with a little card he handed out to interns: "Pray for your profession."


Wednesday, August 22, 2012

Western Highlands Network has taken Nine Months to Credential me in any way

I first started sending in my re-credentialing information...all 45 pages of it currently.....on 1.23.2012.  I have been in repeated correspondence w/ this LME for 9 months re: this application.

I have been a Medicaid provider for over 10 years yet I cannot see my Medicaid clients due to the inefficiency of WHN LME.  Yet, WHN LME has applied the Medicaid Waiver in such a way that they are $3 million in the hole and I believe the reason is that the private companies, to whom they refer (I have never received a referral from WHN LME or SMC LME though I am in-network w/ SMC LME) is that the private companies stack services.

What do I mean by this?  STACKING services is associated with providing multiple Enhanced Benefits associated w/ Medicaid.  A Medicaid client with a SPMI (Severe Persistent Mental Illness) or a Developmental Disability, will receive, on average, from these companies:

1. Psychosocial Rehabilitation : meets 5x/ week for about 5 hours, includes cognitive skills training in a group therapy setting
2. access to a psychiatric provider (they are scarcer than hen's teeth out here in western NC and none of them are going to take Medicaid clients or they just eat the costs as they are not going to fill out 45 pages of paperwork)
3. Community Support Team
4. a therapist.

Today is August 20, 2012.  I received this e mail today re: my Out of Network Credentialing application (they have told me I cannot be an In Network Provider as I did not file by the deadline of 1.3.2012):

"Dear Ms. Hammond,

I have received your Credentialing application. Your application is
scheduled to go to the Credentialing Committee on September 20, 2012.
This is the next scheduled meeting of the Credentialing Committee. If
the committee needs further information I will be in touch with you. If
you have any questions, please feel free to contact me.

Mistie Sellers
Credentialing Specialist
Provider Network Operations
828-225-2785 ext 2231"

Monday, August 20, 2012

Defunding of Sheltered Workshops is Surely Related to Stacked Services Consuming Most of Medicaid $$ as the LME/ MCO's refer Medicaid Patients for Yet More Stacked Servies

This is my reply to a long article by the fine mental health writer/ journalist, Richard Craver:

This is a bit of what he was writing about, which it a picture of 75 families of undoubtedly mostly Developmentally Disabled children/ adults, who are begging for services to continue and I will eat my hat if these people are not the ones who are massively benefiting from the stacked services that the private mental health care companies are servicing.  I'm not trying to get on the wrong side of these families, but they do not seem to realize what is taking place re: tax payers' money re: the stacking of services within these private companies.  What has happened, in part, re: this population, is that all the funding for JOBS---remember those?-----and sheltered workshop jobs at that----has been cut----such that these people are left w/ few options as to what to do w/ their time.  So, they go to the private mental health care companies who stack services.

Relatedly, I had a call from a woman from HVO this past week, re: me trying to get a Cerebral Palsy client of mine into HVO in Waynesville, ,which employees disabled people, under the CAP plan, which SMC LME administers.  What SMC LME tells me is that they give HVO a fixed (and diminishing) amount of money for these positions and so you are back to the mental health care companies being the care-givers for these people when what would be so much better for them would be to have a sense of self accomplishment/ working/ and being around other people.  The HVO woman begged me to call my state representatives re: the defunding of these positions.

Here is what Craver wrote, in part:

"....Whisenhunt said she is opposed to CenterPoint's request because $1.53 million is a lot of taxpayer money to tie up in a sour economy.

She also said she's put off by CenterPoint's unwillingness to search deeper for internal solutions. CenterPoint's budget for fiscal 2012-13 is $93.2 million, according to its website.
"$1.5 million is a small percentage of its overall budget," Whisenhunt said. "Surely to goodness they could come up with that amount through cutting their expenses rather than cutting consumer services.
"The county has had to make due with what we have for years now. Why can't CenterPoint?"
CenterPoint officials have been putting pressure on Forsyth commissioners, telling them that without their action, local residents will lose services. At last week's Forsyth commissioners meeting, about 75 people lobbied the board to provide the allocation. Several speakers shared poignant stories of dealing with behavioral-health issues, whether their own or those of family members...."
Here is my comment to his article: 
"Western Highlands Network (WHN) LME/MCO in western NC will, undoubtedly, also be asking for 'loans' from the local counties.  The CEO for 12 years, Arthur Carder, was fired about 3 weeks ago because of this shortfall which featured, in addition, to the sound of the screen door slamming as he walked out, the Chief Financial Officer claiming she had 'no idea.'  Right.

So, why are these LME's plowing thru so much money re: this Medicaid Waiver.  Well, first of all, they have limited the independent practitioners from becoming In Network Providers (I have been denied access to this and my 45 PAGE---yes, you heard right----application is still awaiting approval and I have been trying to get approved since 1.23.2012).  Either that, or given the 45 page application process, many independent providers have simply said, 'NO THANKS."

Why are independent providers, such as myself, a Licensed Psychologist, useful for Medicaid clients?  Because we are the well trained mental health providers.  We are the little people who do not work for the private companies who are STACKING SERVICES which is causing these over-runs.  We follow our chronically ill patients for years or for as long as it takes until they are considerably better which would mean that they seldom go into a psychiatric unit which costs thousands of dollars/ admission-----for they are able to call upon us when a mental health emergency takes place.

What am I paid to see a client for 45-50 minutes, one session? As a doctoral level psychologist, for a CPT code of 90806, mostly what Medicaid will approve, WITH ME SEEING THE CLIENTS IN THEIR HOMES which is never done by these companies, I am paid approximately $80/ session.  We are paid what we are worth whileas the companies hire people who are lesser trained and an hourly fee, with the profit going to the founder(s) of the company.  Capitalism at its best!

Returning to the matter of the private companies, and the billing by them which is causing these over-runs, what does 'stacking services' mean? It means that when a Medicaid client is 'admitted to a company, to whom they have been referred by the LME/ MCO (I never get referrals from either WHN LME or Smoky Mountain Center LME), they are then able to receive an array of Enhanced Benefits Services such as PSR (Psychosocial Support) which can meet 5 x/ week, for 5 hours/ day; additionally the client can have a 'therapist' (not a psychologist) via that agency; additionally, the client has a Community Support Team, which refers to all the other ancillary services.

All these services are then billed to Medicaid and the LME's allow this massive, inefficient, in my opinion, expenditure because of the model that was proposed as associated with NC Mental Health Reform which was one associated with REHABILITATION.  Chronic mental illnesses, which the people have who receive treatment by these companies which were created when the NC State Legislature created mental health reform in 2000, are CHRONIC ILLNESSES and there is little point in throwing megatons of money at the issue for 3 month spurts at a time, only to find that the chronically ill person has---surprise-----residual symptoms.

Do you 'rehabilitate' diabetes? Do you 'rehabilitate' HIV? Do you 'rehabilitate' hypertension? You know the answer and the answer is the same re: people who have SPMI,Severe Persistent Mental Illness.

Until the MODEL is changed and it is recognized that these are chronic illnesses (OMG: mental illness is not spotty and intermittent), the LME/ MCO's who refer patients to the companies, will continue to come around to the county commissioners with their hands out.

Good luck.  Meantime, you might consider allowing the well trained mental health providers to do their jobs instead of creating massive barriers to their functioning.  That way, you would save money.

And the county commissioners might even puzzle over just how much money is being wolfed down by the LME/ MCO who is strictly an administrative paperwork machine.  All they are doing is managing paperwork.  I would be very interested in knowing how many Medicaid $$ are going towards the usual 50+ grand/ year salaries plus benefits for the employees of the LME/ MCO's.  And how many $250,000 'medical directors' there are.  And how many $150,000/ year CEO's there are.  And how many ignorant Chief Financial Officers pulling down at leats $100,000/ year----there are.

Oh, did I mention that we need a ONE PAYER SYSTEM and Medicare is the model for that? With its 5% administrative overhead (the paperpushers), and with the private insurance companies or 'Medicare Advantage' (oxymoron if there ever was one) companies like Humana/ United Health Care, etc and their 15%+ administrative overhead-----what do you bet that the LME/ MCO administrative overhead is approaching 25% of NC Medicaid money----for the delivery of mental health services to VERY FEW PEOPLE.

Marsha Hammond, PhD, Licensed Psychologist, Asheville, NC
see my blog which can be found using my name and its title 'Madame Defarge'; if I print it here, this page will not publish w/ a URL. "

Thursday, August 16, 2012

Why ALL the NC LME's Will Suffer Shortfalls: the Private MH Companies Creates by NC Mental Health Reform are STACKING SERVICES

I posted this as re: my comments associated with the article associated with Forsyth County commissioners being asked to cough up some more money for that part of the state as associated with the Medicaid Waiver.  Sorry: don't do it.  Until the commissioners figure out that it is the STACKING OF SERVICES BY THE PRIVATE COMPANIES which was allowed by NC DHHS, each one of the LME's is going to ask each county's commissioners for a 'loan' re: this Medicaid Waiver.  These are my comments and this information is anchored by the article associated with the 'reason' that was given as to why WHN LME was $3 million in the hole pertaining to the firing of the CEO for 12 years, Arthur Carder.

Here is the news article and below that is my comment which was posted:

UPDATE: Backers of CenterPoint Human Services ask Forsyth County Board for $1.5 million

"The LME's are suffering a shortage of money due to the process that NC Mental Health Reform put into place, as deemed by the NC state legislature, which was to create private companies (the argument was that competition was 'good' for the business: nevermind that mental health consumers have no money and it is public money e.g., medicaid, medicare).

These private companies STACK SERVICES which is to say that if a Medicaid consumer is referred to a company by the LME, which they always are (I have not been allowed, as a solo provider to work as an In Network Provider for Western Highlands Network LME in western NC), the clients/ consumers are given the following services by such a company: CST (Community Support Team: enhanced beneficts); therapy; PSR (Psychosocial Rehabilitation; the client attends 'classes' 5 days/ week, 9 to 3 pm, as associated with a more or less cognitive rehabilitation model), etc..

Arthur Carder, CEO of WHN LME for about 12 years now, was fired about two weeks ago as WHN LME had a shortfall of $3 million and the reason given in the well written news article (see my blog: google up: Marsha Hammond Madame Defarge: if I put the URL in here, this will not post) was that STACKING of services had caused the shortfall.

So, NC DHHS, in conjunction w/ NC State Legislators, have created the mini-monsters which are the private companies which stack services.

I have several clients who continue---as they have for some time---to receive therapy services from me (they are dually eligible clients, w/ Medicare always being primary and paying the bulk of the fee and medicaid being primary) who receive Medicare services from me and these stacked services which are paid for by Medicaid ONLY.

This is idiocy.  I am a doctoral level psychologist, who knows well my clients, is able to render an array of services for clients, and yet these private companies, put into action by NC Mental Health Reform, are going to bankrupt Medicaid as associated w/ mental health services in NC due to the STACKING OF SERVICES.

This asking for money will not stop until this STACKING OF SERVICES matter is tackled.

Oh, did I mention that we need a ONE PAYER SYSTEM which would collapse Medicaid and Medicare into one entity such that these kinds of duplicitous services could not take place. "

Thursday, August 02, 2012

Medicaid Waiver: WHN LME Budget for July, 2012

Baby, if you can decipher this mess, you're an actuarial genius. This is associated with finances for this LME in their 5th month of the Medicaid Waiver. These numbers are associated with May, 2012 finances.

This is what this non-actuarial person has noted as being of interest:


2. Adult mental health expenditures are greater than for any other category.

3. "Contracts" and "Grants" consumed the greatest amount of money, specifically, approximatl6 $2.7 million ; what is a 'contract' and a 'grant' please?

4. The Medicaid 'approved budget' for the year is approx $56 million; what has been used, year to date is approx $47 million.  So, how are they going to continue services when they have spent over two-thirds of the allocated budget?

5."Innovation Services' is by far ($17 million year to date) is consuming the most money.  What is
'Innovation Services'?: These are the people with developmental disabilities: see:  For instance, I have a client w/ cerebral palsy in Waynesville, NC, under SMC LME, who is trying to work at the sheltered workshop, HVO, and SMC LME has allocated a set amount to HVO which can be used however they desire.  I don't know of any sheltered workshops within the WHN LME catchment area so it is not clear to me how this money is being used.

6. (the pdf will not allow you to cut and paste so here is summary): RHA, a private company billing WHN LME is problematic. They have "several problems w/ their billing." How much of the services paid for by WHN LME is associated w/ RHA? Who is RHA?: "RHA Health Services, Inc. is one of North Carolina’s leading non-profit providers of services and supports for people with developmental and intellectual disabilities.":

7. When the Director of Buncombe County DHHS asked about the 'cash flow' problems, it is stated in the pdf that it is 'very difficult' to anticipate these.

Boy, what a mess.

Wednesday, August 01, 2012

Medicaid Waiver: 45 Pages of Information Required to Get Re-credentialed for Already Medicaid Provider at WHN LME: Goddess, Please let SMC LME take-over WHN LME

I just sent in 45 pages associated with re-credentialing (I am already a Medicaid provider) for Western Highlands Network (WHN) LME, which is the mental health authority sandwiched between the two regions for Smoky Mountain Center (SMC) LME.  Goddess: please allow SMC LME to take over WHN LME.

This does not even take into account the 10+ pages I had to fill out as associated with ONE MEDI CAID CLIENT for outpatient services.

This is what I have discovered about the two LME's over the past several months:

1. WHN LME required me to send in a tax return, an attestation associated with how my clients could get me after hours, tax returns for last year, and an outline of what kind of clients I see PRIOR TO ANY APPLICATION PROCESS even as an Out of Network provider.

2. Today, and yesterday, when I called SMC LME regarding a cerebral palsy client of mine, as associated with the client being possibly able to work at the sheltered workshop in Waynesville, I got almost immediate call-backs from SMC LME personnel. When I call WHN LME, it could be days/ weeks before I get an answer back.

So, the CEO of WHN LME was fired last week and they now have an interim CEO.  I pray that the powers that be 'make it so' that WHN LME be subsumed by SMC LME.  Given the better organization of SMC LME under this Medicaid waiver, let the 'best man win' and that entity would be SMC LME.