Ukraine: Life During Wartime

Wednesday May 31, 2023

By Courtney Wise

Also in this edition: Rage over ‘prior authorization’ denials by insurers of lifesaving mental health care and other coverage. A Carter Center report that Rosalynn Carter, who championed family caregivers, has dementia “and is living happily at home with her husband.” A study that found taking a certain multivitamin for three years helps protect against memory loss as you age. And more more.

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Ukraine: Life During Wartime

A photo essay by Jeremy Bigwood

War isn’t only about bombs, bullets and deaths on the battlefield. It is also about people away from the fighting, struggling to maintain a modicum of normalcy and hope in their daily lives. In Ukraine, where about 70 percent of the population lives in cities, residents lived with intense stress and uncertainty as the unthinkable prospect of war loomed. The actual invasion in February 2022 triggered a different phase – one of “stay and adjust” or take flight, which lasted a little over a month. The third and current phase – one of frequent air raids, missile strikes and blackouts – has led to exhaustion, anxiety and post-traumatic stress disorder. Read the introduction here.

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Battle over the ‘Kafkaesque absurdity’of mental health care denials heads to local lawmakers in D.C.

Carol Ann Dyer, a youth psychiatrist in Washington, D.C., left direct patient care because the delays in getting patients crucial medication and treatment began taking a toll on her mental health. “I could no longer tolerate the sense of demoralization, the sense that my clinical care of my patients was being interfered with,” Dyer said during testimony to a special committee on the DC Council. “And in light of the huge workforce shortage in child and adolescent psychiatry, it was not a decision I came to easily.” 

Dyer is part of a group of patient advocates and medical providers imploring DC’s legislative body to better regulate ‘prior authorization,’ an insurance company practice in which an insurer determines if a treatment is medically necessary before paying for a portion or all of it, The Washington Post reports. A bill is currently before the DC Council that would set deadlines for insurers to respond to preauthorization requests and appeals, restrict denials to District-licensed physicians with the same specialty as the patient’s doctor, make approvals last at least a year and uphold approvals for 60 days when a patient changes plans. According to the Post, 30 other states recently considered similar bills.

Insurers assert their goal is to cut expenses to patients and prevent them from receiving unnecessary care. But the American Medical Association says that prior authorization is overused, saddles medical providers with additional costs, and wastes time they could spend on serving patients. Moreover, it delays treatment to people with mental health and/or substance use disorders who are at risk of relapse during interruptions to care. This is  precisely what happened to a patient of psychiatrist Jacob Swartz. While awaiting an insurer’s preauthorization, a student Swartz had been successfully treating for ADHD went from stellar to failing grades, was suspended from school, and began struggling with their self-esteem due to the loss of impulse control no longer supported by much-needed medication. In the case of opioid-addicted patients who use medication like suboxone to control their cravings, such delays and denials can be life-threatening.

In addition, insurers’ clunky bureaucracy for preauthorization is maddening. Clinic staff may wait hours on the phone to receive insurer approvals, only to learn that a denial was already sent to a patient’s home via mail. Even electronic portals intended to cut down on approval wait times can take days to offer responses. “It really is a big burden on our patients and on our fellow physicians,” said Swartz. “The delays can be really damaging to their momentum as people who are getting their life back on track.”

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In other news…

Former First Lady Rosalynn Carter is in good spirits despite dementia diagnosis: Earlier this week, the Carter Center announced that former First Lady Rosalynn Carter has dementia. Her family shared that, despite her illness, she continues to live well at home with her husband, enjoying visits from loved ones. The Carter family statement and this six-minute clip from PBS NewsHour is a reminder of her efforts to destigmatize mental health issues and increase Americans’ access to mental health care. 

The Carter family wrote, in part, “We hope sharing our family’s news will increase important conversations at kitchen tables and in doctor’s offices around the country…Mrs. Carter often noted that there are only four kinds of people in this world: those who have been caregivers; those who are currently caregivers, those who will be caregivers, and those who will need caregivers. The universality of caregiving is clear in our family, and we are experiencing the joy and the challenges of this journey.”

Widespread distrust is taking a toll on the mental health of Russian journalists in exile. Earlier this year, New Yorker writer Masha Gessen wrote a devastating piece in which they examined Russian reporters who had escaped to Latvia, one of the few nearby countries who welcomed them in. Forced to flee Russia after the Kremlin took control of the media after the invasion of Ukraine, they faced widespread anger and suspicion even though they oppose Russia’s war on Ukraine. Said Sabine Sile, the former head of the media-studies department at the Stockholm School of Economics in Riga, Latvia, who had opened a co-working space for Russian journalists, “I propose we see each other as humans. We have common values, and they are the only things that will make it possible for us to survive this war.” However, an earlier on-air mistake resulted in many of the Russian journalists again having to move, this time to the Netherlands.

“Black People Breathe.” The title of Zee Clarke’s book is as much a declaration as it is instruction. Since leaving her high-stress, high-stakes corporate job in 2017, she’s learned the power of breathwork in managing stress and her mental health. Clarke told Oprah Daily that breathwork helps her to stay calm during frightening and frustrating moments. “For Black people and other people of color: We have the power to control how we’re feeling inside, regardless of what’s going on around us,” Clarke said. “For allies and aspiring ones: I want them to be aware of the realities that happen in this country so they will be inspired to be better, to speak up when they see these things happening, and help amplify Black voices, because we’re often invisible.”

Earlier this month, U.S. Surgeon General Vivek Murthy issued a public advisory warning about the risks that social media pose to mental health, particularly for children and teens. But with social media platforms so ubiquitous these days, what are ways teens can still engage with Instagram and TikTok and protect their mental wellbeing? A handful of experts shared some practical advice with the New York Times, which you might want to share with your teens and tweens. (1) Notice how you feel when scrolling and unfollow accounts that cause you stress, make you feel anxious, or tap dance on your self-esteem. (2) Place boundaries around when social media can be used. For instance, turn off your  phones and other devices during dinner and family time, or place your phone way out of reach during certain periods of the day. Better yet, delete social media apps off of your phone and make them accessible only on your computer.  (3) Turn off notifications! For daily users of social media, this instruction leaves ‘nuff said.

Taking a daily multivitamin may help delay loss of memory as you age. Adam Brickman, a neuropsychologist at Columbia University and co-author of a study on forgetfulness and aging, told NBC News that after analyzing data from more than 3,500 older adults who took a daily dose of Centrum Silver over three years, his team found that those who used a multivitamin had better memories than people who took a placebo. “Cognitive change and memory loss are a top health concern for older adults,” he said. “And we don’t have many strategies to mitigate the changes that come with aging. So it’s encouraging that a supplement can help address one of the main health concerns older adults have.”

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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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