Monday, May 1, 2023

By Don Sapatkin

Good Monday morning! In today’s Daily: We look at the growing incidence of dementia – and how people are trying new strategies to delay its progression. The Minneapolis Star Tribune examines why insurers do such a poor job covering mental health conditions (and finds lots of reasons). And why Medicare Advantage might not be the best idea for your mental health.

“Not My Grandmother’s Alzheimer’s”

When University of Denver Chancellor Rebecca Chopp was diagnosed with mild cognitive impairment at 67, her neurologist said she wouldn’t be able to dress or feed herself in two years. She resigned immediately – but she didn’t surrender. The Washington Post spoke with Chopp for a story that explores how she and others are becoming their own advocates – and are taking a page from AIDS activism.

Tens of millions of Americans have MCI − about 7% of people aged 60 to 64 and 25% of those 80 to 84. Many – but not all – will develop Alzheimer’s, which currently afflicts about 7 million people and disproportionately affects Blacks and Latinos. Despite billions of dollars spent on research, no drugs have been developed that cure or dramatically slow the disease.

As a result, many people with MCI are trying to buy time by changing their lifestyle. A 2015 trial in Finland found that strategies involving exercise, diet, and intellectual and social stimulation could help people at risk for Alzheimer’s but without symptoms to maintain or improve their cognitive function. Some studies emphasize a Mediterranean diet with plenty of leafy green vegetables, nuts and fatty fish like salmon. Others found that regular aerobic workouts or balance and stretching exercises delayed progression in people diagnosed with mild cognitive decline.

Four years after her diagnosis, Chopp is writing a book tentatively titled “Not My Grandmother’s Alzheimer’s.” Taking a page from AIDS activists, she and other patients launched an advocacy group called Voices of Alzheimer’s. “People like Rebecca and me, we are the new face of Alzheimer’s,” said writer Phil Gutis, a fellow board member. “We are trying to say, even after a diagnosis, that this is not an immediate death sentence. There is still a lot of life left.” He added: “There has got to be a place for those of us who are angry and don’t want to be polite.”

Case study: How laws that aim to force insurance companies to pay for services get stymied

Health insurers should pay for illnesses of the brain on the same basis as they pay for illnesses of the body. That’s the idea behind so-called parity laws that have been on the books for more than two decades at both the federal and state levels. These laws have helped a little – but why haven’t they done more? That question is explored by reporter Christopher Snowbeck in part 2 of a powerful series for the Minneapolis Star Tribune.

Snowbeck understands complexity. Profit-seeking insurers – and the employers that contract with them – are a big part of the problem, but there are many others. The laws have holes. Enforcement is difficult. And the devil is in the details: It’s far easier to measure the progression of a tumor – and the effect of chemotherapy – than the course of complex, often overlapping, psychiatric diagnoses and the impact of residential treatment. And stigma continues to prevent patients from demanding treatment and building a movement to achieve it.

Snowbeck uses a wealth of statistics to flesh all this out. In Minnesota, for example, people with commercial insurance are forced to go out of network for mental health services three to four times more often that for medical and surgical services. He also tells human stories – like that of a young athlete who found it easy to get wrist surgeries to remove cysts that made it painful for her to pitch, but hit roadblock after roadblock when she tried to get treatment for anxiety, depression and an eating disorder. To read the full article, click here.  

Beware behavioral health coverage limitations in Medicare Advantage

Medicare Advantage plans administered by private insurers have been growing fast: More than half of enrollees opted for them this year, instead of traditional Medicare  – double the portion from 2011. A new brief from Kaiser Family Foundation provides an eye-opening look at an understudied area: what Medicare Advantage plans actually provide for mental health and substance abuse treatment. Although these plans are required by law to cover everything that traditional Medicare does, they make money by limiting how those services are provided.

The brief provides a detailed look at the benefits and costs to people enrolled in Medicare of obtaining various kinds of services for mental health and substance use disorders. But it also notes that there is a profound lack of information on the ability of people enrolled in Medicare Advantage plans to actually find mental health clinicians who are part of a plan’s network, or how often plans impose requirements for prior authorization of services or impose other restrictions that may delay treatment.

In other news…

Teach your teachers well. Two Alabama high school students led a mental health training for teachers last week during a professional development day, the News Courier of Athens, Ala. reported. The two students are leaders in a school club affiliated with Active Minds, a national organization that works to break the stigma surrounding mental health. They led the teachers in Validate, Appreciate, and Refer (VAR), a training they had been certified in through Active Minds. 

“Coercive compassion” is how the Washington Post describes a controversial new program in California known as CARE Court that aims to get seriously mentally ill people into treatment. The new program, which was proposed by Governor Gavin Newsom and passed overwhelmingly by the Democratic legislature, will roll out in the coming months. It will allow police officers, mental health clinicians, relatives of people with mental illness and others to petition a court to order a person into treatment. The concept is widely supported by legislators, mayors and other elected officials – and opposed by advocates for homeless people and disability rights organizations. The Post story takes a deep look at how the mental crisis has been playing out in California and how Newsom’s initiative aims to address it.

Voters in King County, Wash., which includes Seattle, approved a property tax measure to build and operate five walk-in centers for people experiencing mental health and substance abuse crises, the Seattle Times reported. Each center will be open 24/7 and include a behavioral-health urgent care clinic, an observation unit for up to 23 hours and a short-term stabilization unit where people could stay for up to 14 days before being discharged or referred elsewhere. The levy is expected to raise $1.25 billion over nine years.

Policies that aimed to make it easier for doctors to prescribe a medication that treats opioid addiction may not have as much impact as hoped, researchers reported. The medication, buprenorphine, has the potential to help large numbers of people because it can be prescribed by individual doctors outside formal addiction treatment programs. Federal changes, rolled out in 2021, loosened limits on how many patients each trained and certified doctor could treat. The limits were eliminated in January of this year. A new study in JAMA found that after the restrictions were eased in 2021, the number of providers that were certified to prescribe buprenorphine did indeed grow as expected. But many of those who got certified didn’t actually start prescribing the drug and buprenorphine uptake didn’t grow. The authors concluded that “additional investments may be needed” to boost the number of doctors actually treating opioid use disorder.

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.

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Type of work:

Don Sapatkin is an independent journalist who reports on science and health care. His primary focus for nearly two decades has been public health, especially policy, access to care, health disparities...