Sometimes I get sad, though, because my struggle is also one of stigma. It cannot be shared as openly or as candidly, because it is not just me that is impacted. If it were, I would have no problem shouting from the rooftops about my cause. But I am not the sick one here, and my life, while deeply moved, is only peripherally touched by someone else's struggle. For me, I can never truly know the extent and impact of a struggle until I am launched into the deep end. Even then, I suffer silently, because to speak out may do more harm than good and impact another person’s life negatively. Just as I would gladly take up for others' causes when asked, I'm sure many would do the same for me. But there is something that can only be felt severely and significantly by those facing a particular problem head on to be truly lived in and worn. The realness, the intimate understanding, and the enmeshed ways it impacts your life only make the desire to fix, manage, and control it greater.
For me, being confronted with a mental health crisis in my family has been that struggle. I had heard in passing that America was also in the midst of a mental health crisis, but I never really understood what this meant. Unfortunately, as the days go by, I now understand this particularly shocking and disturbing issue all too well. From being juggled between psychiatrists, doctors, therapists, and hospitals, it is undeniable that mental health care in this country is severely lacking and disjointed. To me, it's a crisis of epidemic proportions that only became visible once I was in it's midst. Often times, mental health illness can be harder to diagnose, treat, and manage, and it seems it is not made any better by the lack of resources, awareness, and education given to the topic. But in a long and growing list of grievances with the system, this last interaction has been by far my most frustrating moment.
My husband, as this blog demonstrates, has been struggling with his own mental health and addiction crisis for some time now. Because he has not been able to find the proper help and treatment, and because of the severity of his illness, his struggles and hurdles have become significantly worse over time. Episodes grow increasingly concerning and severe, and we have failed to find the long-term treatment and tools he needs to function and maintain a healthy and productive life. In his last episode, he relapsed on alcohol to cope with his mental instability, threatening my life, his own, and cutting his wrists. It was clear to me that after three separate psychiatric hospitalizations, a previous suicide attempt, three extensive outpatient programs, and work with a therapist, doctor, and psychiatrist over the past year, that he has not found any relief from his illness.
He still struggles to find proper diagnosis, medication, and a recovery plan, and unfortunately, this is not unexpected or outside the norm. Medication and diagnosis of mental illness can be very much a trial and error process because each body works and responds differently. Episodes are hard to diagnosis as they often times are over before diagnosis is even attempted. Professionals are forced to rely on descriptions from the impacted person and family members to draw conclusions from. There is no test that can be run to determine the source of the illness. This leads to a significant number of undiagnosed or misdiagnosed mental health issues. Because of this and after his last episode, it quickly became apparent that it would only be a matter of time before Jeff succeeded in hurting himself, me, or both of us if he didn't receive some sort of intensive treatment. We had exhausted all of our possibilities to try to attack this illness, and not for lack of effort. The only course of treatment left that we hadn't explored or tried was at the residential level.
Calls to the insurance to get actual help are futile, at best. I knew that he needed in-depth and daily help from trained specialists; people who could help diagnose and treat him to ensure longer term recovery and success. The initial reaction from the insurance company has always been, “take him to the emergency room.” At first, this was a fine solution as I did not understand the state of mental health care in the United States. What I have learned for Jeff is this: The emergency room is not going to help him become well. It is merely going to contain him to ensure safety until he can be shipped to voluntary (or involuntary in other cases) commitment. A psychiatric hold on him will expire after five to seven days. The hold will serve to stabilize him, allow him to take part in some basic process groups, and meet once or twice with a social worker. However, it will fail to give him the long-term tools he needs to actually and holistically recover. It's a bandage for a much larger problem. He can be released into an IOP (intensive outpatient), which he has done three times, but combined with the rigors of daily life, stresses and triggers of the home environment, and inferior care, these sessions have failed to stabilize Jeff for any significant amount of time. Usually they are focused on mental health or addiction, rather than the dual diagnosis treatment that he desperately needs.
When I called Cigna to get a recommendation for an approved treatment facility, I knew I would have to get them to look past the initial response to “take him to the emergency room.” Cigna, as expected, could not give me anything other than a listing of facilities in the vicinity of my home. The first place Cigna recommended was the psychiatric facility he had already been hospitalized in TWICE. The next was a residential treatment center on the West side of the city, who upon calling, told me they could not accept him into the program until Monday (this was a Friday). Desperate for help, I was prepared to do anything to get him what he needed to survive, and that wasn’wasn't “waiting until Monday.”
I worked with my mother-in-law who was also grasping at straws, and finally we found an in-network, Cigna approved treatment facility, focusing on dual diagnosis, with significant accolades. The facility is in Memphis, and they were willing to accept him immediately. At that point, I would have taken him to Antarctica if that is where he needed to get treatment. The facility staff had listening ears, an understanding of his illness and struggles, and were willing to help. All the things that Cigna, the overworked social workers in the psych wards, and the underpaid hospital staffers failed to do in the past year. Jeff and I have spent an entire year of our life trying to find someone who was willing to help, and this seemed almost too good to be true. Jeff, at his very core, wants the help. He lashes out as a child throwing a tantrum does when he is sick: He cannot cope or fix this on his own, and the only way to get the relief he needs is to go to extremes to get anyone to listen.
That's the way I see it. Jeff’s episodes have been increasing in severity over a year because he is crying out for someone to help; to relieve him of his pain and misery. Therapist after therapist, medication after medication, no one could actually sit down and pinpoint what his issues were. It was treat the alcoholism, feed the illness meds. But it was never, “Maybe we should treat these together?” or “Maybe we should figure out what’s at the bottom of this?” You can say what you want about me, about my clarity on the situation, the perceptions I have that may not be reality. It may just be easy to say, "She just wants someone to blame." After all, it is hard to see clearly through the weeds when you are sinking in the mud. But one thing I do know is this: Suppositions , trying to the connect the dots, and analytical dissection of the issues aside, my need to control this situation . . . none of my thoughts or beliefs of the situation take away the fact that my husband has been hospitalized four times for suicidal ideations and twice for suicide attempts. At the core, a huge alarm bell should ring that shouts, “This man needs a little more help than some occasional classes and therapy on his mental illness and addiction!”
I knew somewhere in the back of my mind that getting a recommendation from Cigna or finding an in-network treatment facility myself would not mean guarenteed approval of the treatment claim, but I didn't even consider that denial would be an option. After all, he still had the marks on his wrists, the clear and well-documented psychiatric history, a police report from his first suicide effort, many attempts to get his illness under control, and a desire to get well. Furthermore, this was the only treatment we hadn't tried, and the only place left where I (the person who has lived with him, and his illness for a year now) felt and still feel he has any chance of living, distraction free, to become acquainted intimately with his illness, his recovery, and his goals for the future. It just didn't cross my mind that they would or could deny treatment.
But, in the middle of this already severe and critical trauma, they did the unthinkable. They denied his treatment request, twice. So now, on top of having to deal with the continual stress of the illness, of managing a household on my own, and of losing his income while he is in treatment, I also have to deal with getting the authorization my husband desperately needs to save his life. Cigna did authorize four days of his stay, which conveniently met my deductible and out-of-pocket max. Four days to fix something that has been occurring for a year and probably has roots a lifetime old. Does that seem right? Four days is not even enough time to stabilize him on his new medication, let alone to assess if it’s working correctly and to properly diagnose the underlying issue. They recommended intensive outpatient, which would make at least his third attempt at outpatient recovery. I have records of all of his hospitalizations, IOP treatments, medication switches, suicide attempts, police report, 12-step work, individual and couples therapy, but none of that, not even the marks on his wrists or the blood work showing his .383 BAC, can appear to deter them from their heels in the sand approach that several weeks of a few hours, daily sessions should fix an illness that drove him to attempt taking his own life. It’s so sad that they are so shortsighted to want the quick fix, which in reality is no fix at all. But me? I can't live in this Groundhog Day world.
I understand that people abuse the system, but legally, we live in a place of innocence until proven guilty. I say this as someone impacted profoundly by this issue, but I would rather pay for nine people abusing the system to save the life of one, and particularly the life of my “one.” This is not fun and games, this is a person’s life, and it is in the balance. I have no idea if this treatment will actually work, but I will tell you what won’t: bouncing around from doctor to doctor, therapist to therapist, meeting to meeting. Just because we don't know, doesn't mean it isn't worth the effort. A simple education on depression, addiction, and the “tools” he needs to be well will not cut it. You cannot use a rational minded process to heal an irrational mind. Without any real understanding of the illness at the core, and without any real treatment that looks at Jeff from the inside out, Jeff stands no real chance of recovery. If he had the tools and knew how to use them, he would be well by now. He doesn’t wake up in the morning and maliciously try to ruin his life and the life of those around him. He is not well, and he needs help. And by everything I hold dear, by the air that I breath, Jeff will get the proper treatment he needs at this point to save his life and mine.
If he had cancer, would he be denied treatment? What if the treatment failed, would he be denied another kind of treatment? How is a decision about someone’s life made by a “Cigna psychiatrist” that has never once spoken to my husband, me, or his doctors directly to understand his situation, one that I guarantee you, is not unique? What will it take for his situation to be severe enough for Cigna to approve? Do I need to send the police report of his attempted suicide in September? Do I need to take out a restraining order from when he had a psychotic break and threatened to harm me? Do I need to contact his old employer for documentation on his erratic behavior and substance abuse at work? Do I need to send the Cigna psychiatrist pictures of his sliced wrists from his most recent attempt? Or will it take him finally killing himself before they are willing to do something?
Since the denial, the decision has been appealed, ad nauseum. But until then, every day he is in his treatment facility trying to focus on getting well, our family could be becoming financially ill as Cigna causally determines the outcome in the decision of their bill vs. Jeff’s life. If they deny the treatment, then I will be responsible for all those days he has been there in limbo (anywhere from $260-$560 a day). As this drags on, it could be a days, it could be weeks, which seems even more unfair. At this point, I am resigned to the fact that they will not be reversing their decision. But I guess it does not matter either way. Regardless of who is paying or how it’s being paid for, he needs to be well and I will exhaust every opportunity I have to do that.
When I was married, I made a commitment to be there, in sickness and in health. My husband is sick, and I will be damned if he will be a casualty of bureaucracy and politics that a corporation places above a person’s life. I have no idea where Jeff’s recovery will take him. He could recover and we could very easily move back into our happy life and move forward without looking back. We could decide that it is best for his recovery if we break our co-dependency and recover individually. It could be that Jeff never gets well. But I will at least give the option of recovery a fighting chance. One thing is for certain: It may appear to be David vs. Goliath in the case of me vs. Cigna, but if it comes to it, they will rue the day that they deny my husband the service and care that he deserves and is owed.
My story will have a happy ending, no matter the circumstances. Maybe not his, and maybe not ours, but through this, I have learned a powerful lesson: that I will be okay. My major concern now is for the people who may not be able to afford a fight, have the resources at their disposal, or know how to keep at the system. What happens to their rights when someone decides their life isn't worth the cost of care? Who will fight for their lives?