“Ghost Networks” for Mental Health

March 31, 2022

Happy Thursday, MindSite News readers. Today we’re reporting on yesterday’s federal hearing on mental health parity, on the Disney and Pixar film Turning Red as a touchstone for Asian mental health, and on a grieving father working to bring an Italian model of mental health to Scotland. Plus, why physicians are reluctant to ask for coverage for a therapist.

---

MINDSITE NEWS ORIGINALS

---

Senate finance committee goes to bat for mental health parity

The United States Senate Committee on Finance held its third hearing on mental health yesterday in a bipartisan push to make high-quality mental health care accessible to all Americans. 

In the hearing, which focused on mental health parity, Sen. Ron Wyden (D-Ore) made an impassioned call for expanded mental health coverage, declaring that more needed to be done to hold health insurance executives accountable.

“The parity law was supposed to be a game changer, but mental health patients have still spent the last 13 years all too often bogged down in insurance company foot dragging, red tape and piles of excuses,” said Wyden, who chairs the Senate Committee on Finance.

Wyden began by ticking off roadblocks to mental health care, including “arbitrary” limits on hospital stays, loopholes to deny coverage, stonewalling on paying claims, and what he called insurers’ “ghost networks” for mental health.

“Too many Americans are getting shoved by insurers into ‘ghost networks,” Wyden said at the hearing.  “When you’re stuck in a ghost network, you can’t get a provider to take your insurance. The insurance company’s directory of providers is often wrong, even years out of date. Or insurance companies often pay so little for mental health services that patients get stuck with the entire bill. When families pay good money for insurance and wind up with a ghost network, you don’t feel like you’re getting parity, you feel like you’re getting ripped off.”

Senator Mike Crapo, R-ID, also stressed “the profound importance of ensuring all Americans have access to high-quality mental health care services.” Americans living in rural and frontier areas often face serious barriers in finding mental health care, he added in his prepared remarks.

Witnesses testifying for the need for expanded mental health services and parity included representatives from the U.S. Government Accountability Office; the Advancing Integrated Mental Health Solutions (AIMs) Center; the Meadows Mental Health Policy Institute in Dallas, Texas; and the Commonwealth Fund.

The day before the hearing, the Senate Committee on Finance also released a 33-page report criticizing the “array of shortfalls” in mental health care and calling for federal action. 

In the report, Wyden characterized the nation’s mental health crisis as an emergency: “The house is on fire, and the nation is short on firefighters equipped to put out the blaze.”

This issue is deeply personal for him, he adds. “For years, my brother struggled to access the mental health care he needed and our family struggled against the painful stigma that has surrounded mental illness for as long as I can remember. It is a tragedy that helping a loved one get care is still a challenge for millions of other families around the country.”  (Find out more about the hearing here.)

Disclosure: Hearing witness Andy Keller is on the advisory board of MindSite News.

                                                                                                         –Diana Hembree

---

NEWS FROM AROUND THE WEB

---

Turning Red as a touchstone for Asian mental health

Much has been written about the well-received Disney and Pixar film Turning Red, including its depictions of experiencing puberty and growing into one’s self. In this essay for Nerdist, writer Sayaka Matsuoka reminds us that the film addresses Asian mental health, too. “Turning Red teaches us not to suppress our feelings, not to hide or shrink parts of ourselves to maintain a detrimental status quo, but rather to let our pandas out because they are what makes each of us unique,” she writes. “And though these issues aren’t specific to the Asian American experience, it’s the culmination of decades of our existence in this country and hopefully, the beginning of our stories being told.”

---

Seeking care in secret: Worried doctors hide pursuit of their own mental health care

Despite an expanding body of research on the need for physician mental health support, pediatrician Seema Jilani wrote a revelatory op-ed for the New York Times that describes the mental health stigma that keeps doctors from getting mental care – and often forces them to keep any help they do seek secret.

“Even before the COVID pandemic, mental health issues were an occupational hazard for physicians,” she wrote, adding that the pandemic seems to have made things worse: A survey conducted in the fall of 2020 suggested that as many as 36 percent of frontline physicians suffered from PTSD. The grueling nature of residency—with sleep deprivation, hunger, frequent professional discouragement, 100-hour work weeks, and staggering student debt—certainly contributes to such stress.

Still, for physicians to admit they need help is daunting. 

“Ticking those boxes can feel like risking everything we have worked toward over years,” Jilani said. “It could result in the medical board reviewing our personal medical records, possibly in psychiatric and drug testing and perhaps even in having our medical license reviewed, suspended or revoked, all under the guise of establishing our professional competence.” It’s all helped to establish an underground system of care where doctors search for therapists outside of their home cities, require minimum documentation in their charts, and pay with cash only so as to avoid a paper trail.

Spreading the Trieste model of mental health care ‘

Very little in the world is perfect, but one mental health treatment model seems pretty close to it: an Italian mental health system that’s based on the principles of dignity and respect and integrating patients into the daily life of the community. Named for the city in Italy where its effectiveness was first widely realized, the Trieste center was long “hailed by experts as ‘the best place in the world to be a patient with a mental disorder”– although it has lately come under attack by the new right-leaning regional government.)

Now an article published in The Herald, a Scotland-based newspaper, spotlights the efforts of one grieving father to spread the work of Italian psychiatrist Franco Basaglia’s “Trieste method” to the rest of the world. Mark Smith is a former Herald deputy business editor, who after losing his 24-year-old daughter Joshi to an overdose in 2020, became a nonprofit founder and mental health advocate. The Joshi Project, named after his daughter, is dedicated to establishing the Trieste method of mental health care in Scotland, in an effort to offer compassionate, flexible, and life-saving care to people with mental health issues. 

According to Dr. Roberto Mezzina, the former director for mental health in Trieste, Italy, the model’s open door approach and practice of determining care in concert with the patient helped “to cut Trieste’s suicide rate by 40 percent in its first 15 years.” A hallmark of the model is 24/7 community mental health centers that serve upwards of 60,000 people, with less than ten overnight “crisis” beds. Simply enacting a holistic, social and health approach, he says, has been enough to prevent emergency hospital care. 

Versions of the Trieste method are currently in practice in 30 countries across the globe, including a Trieste model pilot  in Hollywood, California.

---

If you or anyone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255. And if you’re a veteran, press 1.

---