Wednesday, January 3, 2024

By Courtney Wise

Greetings, MindSite News Readers! I hope you’ve had a safe and warm introduction to 2024. In today’s Daily: Millions of seniors just gained greater access to mental health care, thanks to changes in Medicare. Cats in Chile’s largest prison offer love and purpose to the confined. Plus, what to do when the various “parts” of you and your psyche are in conflict?

We also bid a fond farewell to the LA Times’ Group Therapy newsletter. I’ve followed the column for more than a year, benefiting personally from writer Laura Newberry’s research and interviews. It’s been a great place to find accessible information, which I’ve shared here several times. But now that Newberry has finished her training and will start providing mental health services, she’s moving on from the paper. Her words will live on, though, in the newsletter’s archive. 

Access to therapists just expanded for 65 million Medicare recipients

As we rang in the new year, some 65 million Americans enrolled in Medicare got expanded access to mental health care. Congressionally approved changes to Medicare took effect Jan. 1, making therapy from licensed counselors and marriage and family therapists into covered benefits.

Together, the two groups account for nearly 40 percent of the nation’s therapists, NPR reported. Previously, Medicare recipients could only get mental health care from psychiatrists, psychologists, licensed clinical social workers and psychiatric nurses. 

Other changes will allow up to 19 hours per week of intensive outpatient care for people with severe mental illness and extend mobile crisis services to serve both housed and unhoused people, according to KFF Health News. 

Counselors are especially appropriate for addressing the needs of seniors, Youngstown University professor and licensed counselor Victoria Kress told NPR, because “we focus on people’s strengths, their resources and their capacities within themselves, within their families, within their communities and within society.” 

Kress said the changes could have a big impact in rural areas, where one in three people are Medicare recipients. But they were also a long time coming, with Congress reluctant to spend the money. Bringing these new therapists into the Medicare program may help address the workforce shortage, but it’s also unclear how many of the newly eligible 400,000 will sign up. That’s because Medicare reimbursement rates remain significantly lower than the out-of-pocket rate many providers charge. Before making appointments, patients should verify that a provider accepts Medicare by visiting the Medicare website.

Cats provide love, meaning and purpose to people locked up in Chile’s largest prison

No one planned a pet therapy program for incarcerated residents of Chile’s oldest and largest prison, yet that’s exactly what has developed at “The Pen” in Santiago, where 5,600 prisoners live with some 300 cats. Whether they came for rats or shelter, the cats have been there as long as anyone remembers. But they have changed the moods and mindsets of their cellmates. “Prisons are hostile places,” the prison’s warden, Col. Helen Leal González, told the New York Times. “So of course, when you see there’s an animal giving affection and generating these positive feelings, it logically causes a change in behavior, a change in mindset.” The cats have strengthened inmates’ sense of responsibility, she said.

“They’re our companions,” said Carlos Nuñez, who is serving a 14-year sentence for home burglary. He shows off the 2-year-old tabby he adopted and named Feita – ugly. “A cat makes you worry about it, feed it, take care of it, give it special attention,” said Nuñez. “When we were outside and free, we never did this. We discovered it in here.” The cats provide love, affection and acceptance in a place infamous for poor conditions and overcrowding, where nine men can occupy a single cell. “Sometimes you’ll be depressed and it’s like she senses that you’re a bit down,” said Reinaldo Rodriguez, who has seven years left to serve. “She comes and glues herself to you. She’ll touch her face to yours.”

The Pen’s program grew organically from the relationships residents formed with the feral cats. Until 2016, prisoners provided the vet care. But when a contagious illness  swept through the cat population, prison administrators let the Felinnos Foundation come in to treat, spay and neuter the cats. The prisoners aid the Foundation’s efforts, said social worker Carla Contreras Sandoval, tracking the cats and bringing those that need care to the volunteers. “You dedicate yourself to the cat. You tend to it, keep an eye on it, give it love,” explained inmate Denys Carmona Rojas. “The feeling that comes out of that — there’s nothing bad about it, man.”

A therapy model that eases our internal battles

Back in the 1980s, he noticed that patients often referred to different parts of themselves in sessions. For example, “one part of me really loves this person and wants to stay in this relationship but another part of me wants to run for the hills,” Newberry wrote. Schwartz observed that these different parts were organized a lot like the different roles he saw in families. The IFS model attempts to help patients see these dynamics by helping people identify, understand and heal their varied inner parts. 

While each of the parts has valuable qualities and can play a valuable role, Schwartz wrote, they often are forced out of these roles, “by life experiences that can reorganize the system in unhealthy ways.” For example, a person may have a part of themselves that wants to drink lots of alcohol to avoid frightening feelings and another part that feels disgusted with themselves for drinking too much. Yet the intent of both inner identities is the same – to protect the person and feel safe. 

Schwartz has identified three main parts of our inner selves: 

Exiles are our inner children, our most vulnerable parts. They may be stuck in a trauma from early life. Like children, they’re playful and trusting, but also highly sensitive and easily hurt. 

Managers are our operations leaders. They’re what we hear as our “inner voice” as they tend to our daily needs and look out for the exiles within. Managers try to protect us by controlling situations and relationships to avoid feelings of pain and rejection. 

Firefighters also want to protect, but rather than work in an orderly way, they react to emotional distress by trying to exterminate it immediately. This could look like self-medication, self-harm, and lashing out at other people. 

Self is our true whole identity. It’s our core that is emotionally well, holding compassion and empathy for the parts of us in exile, management, and the front lines. In IFS, it’s hoped that patients will eventually allow their exiles, managers, and firefighters to rest, leaving room for the Self to shine forth and live free.

IFS avoids labeling parts of ourselves as bad, even if they’re harmful. Behaviors like eating disorders and substance use are seen as ways these inner parts try to protect us. “Belonging and connection are so core to being human and our well-being, and it’s the same for our parts,” said IFS therapist Sand Chang. “When they feel cared for, they start to realize that they don’t have to be completely alone or responsible for taking care of us. Then, a lot of times, things that look like symptoms will shift.”

In other news…

Philadelphia hospital faulted in death of a behavioral health patient. Pennsylvania health inspectors issued a severe warning against the Hospital of the University of Pennsylvania – Cedar Avenue for failing to respond to a patient’s medical distress. The patient slumped over a walker, then collapsed, but staff members walked away, uncertain about what to do, the Philadelphia Inquirer reported. The patient was left for 10 minutes without CPR and died. Inspectors said the patient might have survived if staff had acted quickly and placed the hospital under close scrutiny. It will remain under close watch until January 25. 

Take some inspiration with you on your next promenade. This Morning Walk is a podcast designed to offer you tips to reduce your stress, create healthy boundaries. You can even practice breathwork while walking. It’s available wherever you listen to podcasts. 

If you’ve been looking for free ways to begin your mediation journey, Yoga Journal hosts a playlist of 13 guided meditations for everything from healing from a broken heart to finding inner peace to achieving financial abundance. Videos range in length from 5 to 20 minutes, with half of the playlist running for 8 minutes or less. 

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.