January 8, 2025

By Courtney Wise

Greetings, MindSite News Readers. In today’s Daily, a look at hoarding’s impact on the mental health of older adults in the US and programs for loved ones with hoarding disorder. One woman’s plight after her insurer ended coverage for treatment because it was working. More than 300 leading organizations call on Congress to protect Medicaid.  Plus, a few apps for Dry January.

Overcoming the stigma of hoarding disorder

My father was a hoarder, and I had no idea about that until his death. Thirteen years later, I’m still astounded. I’ll never know how long he lived in such cramped, hazardous quarters. I just wish he hadn’t felt the need to hide it. I don’t know what I’d have done if I had known, but Bernadette, a 72 year old from Pennsylvania, has me hoping I would have been kind. She’s struggled with hoarding since her retirement, she told NPR. “I’ve had a few relatives and friends that have condemned me, and it doesn’t help,” Bernadette said. She no longer allows guests into her home. 

The thing is, experts estimate that 2.5% of the general population lives with hoarding disorder, and as Baby Boomers age, the numbers increase. “All of a sudden you have to downsize this huge home with all the stuff and so it puts pressure on individuals,” said psychologist Kiara Timpano. While psychiatrists and researchers haven’t identified the biological and environmental factors that trigger hoarding, UC San Diego psychiatry professor Catherine Ayers said that it’s the only mental health disorder besides dementia that worsens with age. 

With boomers representing roughly 20 percent of the US population, the federal government is imagining what it can do to address the growing issue. Experts hope to see Medicaid and Medicare one day cover peer support specialists trained to support people with hoarding disorder. While plans are at a preliminary stage, it is understood that hoarding is strongly associated with isolation, depression, and homelessness among its sufferers, along with other health and safety concerns for those who live nearby. Those concerns include increased risk of fire, hoarding-related mold, and in some cases, pests spreading to other households. 

People seeking to help a loved one struggling with hoarder disorder must first accept that rushing over to throw out everything deemed unnecessary is the opposite of help. It’s a great way to break trust and increase isolation, experts said. More effective are programs like Fight the Blight, a Pennsylvania-based organization dedicated to helping hoarders declutter their homes, inside and out. Services include outdoor debris removal, vines and overgrowth removal, home cleanouts, and still bettert, a Hoarding Disorder Support Program. Led by mental health professionals, the program offers personalized support, including a 16-week course in which participants uncover what drives their hoarding. 

Bernadette and her friend, Sanford, who she met in the program, believe it should be available everywhere. Besides acquiring new, good friends, Sanford said the course has taught him to be patient with himself and persistent in decluttering and advancing toward wellness. “Even if it’s a little job here, a little job there,” he said, “that all adds up.”

One woman’s treatment for severe mental illness was working, so her insurer ended coverage for it

It’s confounding: You prepay for health insurance to cover health costs in the event you get sick. Then, you get sick. Insurance springs to action – but just enough for you to improve, not get well. Their reasoning? Despite your doctor’s pleas, the insurer argues, your diminished symptoms are proof that a less expensive treatment plan is good enough. This kind of thinking, an investigation from ProPublica discovered, is Geneva Moore’s living nightmare. 

Despite a documented history of severe mental illness, including persistent suicidality, and the impassioned attempts of her therapists to sustain 10 weeks of medically-necessary coverage in an intensive outpatient treatment program already proven to decrease her symptoms, Blue Cross Blue Shield of Texas refused to continue Moore’s coverage. “You have made progress,” the denial letter said. Insurance coverage ended immediately. Unable to pay the $350 per day cost of treatment, Moore ended up in the emergency room, triggering a mental health spiral that would cost BCBS Texas nearly $30,000 more to treat her than simply approving the 10 weeks of treatment her mental health provider noted as necessary. It is a story many Americans intimately understand.

As a general practice, health insurers review patients’ progress to determine their eligibility for lower (read: cheaper) levels of care. In some instances, when insurers deem patients’ progress too slow, coverage is eliminated with the argument, ‘The condition is chronic; patient has reached a baseline level of function.’ Other times, insurers cite internal guidelines, or proprietary standards as they are called, to cut coverage after patients make minimal progress. Mental health care is especially impacted by these practices. 

X-rays can prove bones are healed, said one psychiatrist, but mental illness is not so straightforward. It’s like when a house catches fire, explained Massachusetts-based psychiatrist Eric Plakun. “I got a hole in the roof, and the windows have been smashed in, and all the furniture is charred, and nothing’s working electrically,” he said. “How do we achieve recovery? How do we get back to living in that home?” 

Equally concerning, ProPublica’s investigation revealed claims reviewed by former employees of health insurers, some of whom are mental health professionals themselves, who felt company guidelines conflicted with their own clinical judgment. Although companies defended their proprietary guidelines, “it’s very hard when you come up against all these rules that are kind of setting you up to fail the patient,” said Brittainy Lindsey, a licensed mental health counselor who worked at two separate insurers for a total of six years. 

More Than 300 Organizations Urge Congress to Protect Medicaid or Risk Disaster

As Congress was sworn in this January, 344 national, state and local organizations called on its leaders to protect and strengthen Medicaid, which covers 80 million Americans, according to Families USA, a nonprofit, nonpartisan consumer health advocacy organization. Although Trump has said that he will not cut entitlements like Medicaid, Medicare or Social Security, some House and Senate Republicans are proposing to cut or cap Medicaid to pay for tax cuts that benefit the wealthy.

Cutting Medicaid “would betray your constituents of all political affiliations who are seeking more economic security, not less,” stated Families USA in its letter. “Proposals to cap funding [and other restrictions on Medicaid]…all have the same effect: If instituted, Americans will lose access to lifesaving services, states will be strapped with massive budget holes, hospitals and clinics revenues and be forced to scale back services, and American families and workers will be unable to afford essential care and get sicker – leading to a loss in productivity and the economy suffering as a result.”

In other news…

Need more  help staying “dry” this January? There’s an app for that: In this roundup from NPR, suggestions include Sunnyside, Reframe, and the UK-based DrinkAware, all which are available for Android and iPhone. Both Sunnyside and Reframe require the purchase of a subscription at the conclusion of a free trial. DrinkAware is currently free to download and free to use. 

Fans of Stephen “tWitch” Boss, the professional choreographer, dancer, and television producer  who was widely known for his work on the Ellen Show and So You Think You Can Dance are learning more details about the struggles that led to his suicide in 2022. In an interview with People magazine, Boss’ wife, fellow professional dancer Allison Holker, said that she learned after his passing that he’d been struggling with the impact of childhood trauma, depression, and addiction. 

“Reading Stephen’s journals, and even going back into the books he had read and the things that he was highlighting and lining, really gave me a better perspective of where he was in life and the type of things he was struggling with,” Holker said. “It did have me feel a lot of empathy towards him and sadness for all the pain that he was holding.” She added that her intention in sharing these details is to encourage people who may be carrying similar pain to not struggle alone or in silence. “It’s hard to think that he never opened up to someone and wanted to face it, to get through on the other side. I really hope people dealing with the same thing will help themselves out of the shadows and [know] you’re going to be okay.”

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.