Challenges in Mental Health Care: The Sickness v. Wellness Perspective (By: Michele Babcock-Nice)

Mental health care is a challenging, but rewarding field.  There are many positive sides of mental health care, and also areas that need improvement.  One of the biggest rewards of mental health care is observing and experiencing progress, recovery, and a return to wellness of clients.  Healing, recovery, and a return to wellness of clients in mental health settings requires patience, understanding, respect, and sensitivity.  Agency and organizational stability is also needed for clients in order that they receive optimal care.  While each agency and/or organization has its own culture, a culture in which workers live in fear of becoming a statistic in extremely high turnover is unhealthy in itself.

As an individual working toward licensure in the mental health profession, I am one whose perspective is from a position of wellness.  First and foremost, one must view a person as a person.  To perceive and treat a person with respect, kindness, nonjudgment, and impartiality are requirements in supporting and empowering the wellness, healing, and recovery of clients.  In the counseling profession, one based on a view of wellness in people, there exists a positive and supportive hope for the overall optimal health of the individual.

This view is different from many other mental health professions in which the general view of the client is one of sickness.  Certainly, approaching an individual with a perspective of what can be improved is helpful, and for insurance purposes involving payment for services rendered, a diagnosis of the client is required, however it is my perspective that viewing the client from a wellness standpoint is much more healthy for all involved rather than judging a person as being sick.

Those who view and describe an individual as a “sick person” have already negatively judged him or her.  They have not viewed the person as a person, but as an “ill person.”  Such a perspective held by such individuals causes them to treat the client differently, as one who needs more and more treatment, more and more medication, more and more confinement.  In these situations, the positive view of wellness is gone, and is replaced by a judgment that the “sick person” is unable to become well.

While clients have challenges to achieving and maintaining wellness, it becomes even more of a challenge when many in the mental health field view clients as sick, and only they as the professionals who hold those views have the power and expertise to make them well – or they have already judged that they will never become well.  A professional who approaches a client from a perspective of wellness (a perspective that is in the minority), therefore, faces even more challenges, not only for themselves but also for their clients when others view them as sick and unable to become well.  A person is still a person, regardless of their diagnosis or disorder.  A person is still a person, and has the capability of becoming well.  A hopeful perspective toward client wellness must exist in the mental health profession – rather than client sickness – in order that clients are supported and empowered to experience that wellness.

A further challenge in agencies and/or organizations in which a “sickness” perspective prevails is that experienced clinicians fall into the trap of believing that their views and judgments about clients are the best – that they are the experts.  Certainly, the experience of a veteran clinician is extremely valuable in treating clients, however experienced clinicians who believe that only their views, judgments, and culture of sickness are the most helpful approaches create a potentially dangerous situations for their clients.  Clinicians of all levels of experience must be open-minded to considering and perceiving different views – including those from a wellness perspective – so that their clients receive optimal care and so that they profession, itself, can grow and develop in a healthy way.

Clinicians who view clients from a perspective of illness and negative judgment place their clients at risk for further illness.  Clinicians who are set in their ways of expertise toward mental health treatment, and who are unable to be open-minded toward viewing different perspectives regarding it have already erected walls around themselves that are harmful for themselves, their clients, the culture of their agency/organization, and the field of mental health.

What clinicians must always place as a primary priority is that people are people.  As such, people should be treated with dignity, understanding, kindness, respect, and sensitivity.  If a perspective of client wellness is lacking or absent, clients will likely experience a more difficult road to recovery and may not achieve wellness.  What is healthier – being an “expert” clinician whose views of client illness cause him or her to be closed to considering a client’s optimal recovery, or being a clinician who treats a person as a person, and who applies a wellness perspective that supports rather than negatively judges the client?  You be the judge.

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Paying the Price for Sight (By: Michele Babcock-Nice)

Glasses (from allaboutvision.com, September 5, 2014)

Glasses (from allaboutvision.com, September 5, 2014)

I gave in.  I tolerated it for about one year, but finally decided that I needed to go to my optometrist for another eye exam.  One year ago, it had been five years since my previous eye exam.  I really had not needed to go because there were no changes in my vision.  I decided to go last year just to have a routine eye exam completed, and to get new glasses. 

Last year, I went to a different optometrist than my usual doctor.  I went to a lady in my immediate area, and she completed my eye exam so fast that I have resolved never to return to her again – or take any of my family members to her either.  She lost my business.  Her eye exam reflected that my vision had improved, but in fact, the prescription for lenses that she gave me was not strong enough.  This is what my regular optometrist confirmed upon my inquiry during my most recent eye exam about two weeks ago.

The lady who completed my eye exam last year prescribed me lenses that were not strong enough, and thus, the reason for the headaches I had been having.  Rather than return to her and have another eye exam, I reverted back to my old glasses (my five year old glasses) and wore them.  A couple of months ago, the frame of my glasses popped apart, and I paid $65 at a local jewelry store to get it repaired.  I like those frames, so it was worth getting them repaired.  But, I was back to wearing my five year old glasses again.

In the past year, I also experienced another issue.  Not only could I not see objects at a distance clearly, my vision was worsening while reading close up.  At 42, I knew I would need separate glasses for reading, or have to get bifocals soon.  It took me one year of trying to navigate with my vision changes for reading close up before I gave in.  I am now getting bifocals.  It is a sure sign of age when people have to get bifocals.  I joke with my son that I’m truly an “old lady” now because I can’t see.  Lol.

Last year, I spent $100s on my eye exam and the two new pairs of glasses that I purchased – that were the incorrect vision strength.  It is a hardship for me to pay that much money.  I was burned, and so I will not return to that optometrist, nor will I recommend her.  That was money down the drain.

Two weeks ago, I again spent $100s on my vision.  My eye exam was $90, while my glasses frames were $100, and each lens was $105.  This time, I didn’t get myself a spare pair of glasses, but settled for one.  If my vision worsens soon, I will be out those $100s anyway.

Even at spending $400 for my eye exam and new glasses, I probably spent less than I would have if I purchased vision insurance independently.  I don’t have any insurance, so I have to pay out-of-pocket for everything.  It gets very costly, and I have to pick and choose which healthcare providers to see and for what reasons.  It would be nice to have health insurance, and not be too poor to be eligible to receive Medicaid. 

So, again this year, I have paid the price for sight.  I had not intended to spend another several hundred dollars on my vision again this year.  That money could have gone for other things.  I did really well with my vision going unchanged for about five years, however, and am grateful for that.  Now that I’m an old lady, I’m sure that I’ll be getting much use out of my new bifocals.

Poorest People Still Left Behind in American Healthcare Coverage, Including Medicaid (By: Michele Babcock-Nice)

I am a person who is an advocate for universal healthcare coverage in the United States.  When President Barack Obama persistently pushed for the achievement of universal healthcare in the United States, I was definitely a supporter.  I think it is wonderful that people who so desperately need healthcare coverage in the United States are now able to receive it, in many areas of the country.

I, however, still do not have healthcare coverage.  Why?  My income falls below the federal government’s poverty level guidelines for who is eligible to receive universal healthcare.  And, my state, Georgia, has not expanded Medicaid for individuals and/or families who would otherwise be eligible to receive Medicaid due to income guidelines.

So, while there is universal healthcare coverage that is available in the United States, it is not available to me.  I have not had healthcare insurance coverage for about 4.5 years since becoming divorced.  Prior to that, I had healthcare coverage either through my employer and/or my spouse.  In 2009, I was employed with a company that guaranteed healthcare insurance coverage after working for several months; I was laid off before that time came.

For the past 4.5 years, I have paid out-of-pocket for all of my medical and healthcare-related expenses.  I have paid out-of-pocket for visits to my regular doctor, gynecologist, dentist, and optometrist.  I have also paid out-of-pocket for all of my prescriptions, laboratory work, and all other healthcare-related services and appointments.

Last year, after going five years without having an eye exam, I finally had one and got new glasses, with monies withdrawn from my retirement account.  This year, I have noticed further changes in my eyesight, but cannot afford to get my eyes checked, or get new glasses again, with having to pay out-of-pocket.

Typically, my gynecologist and dentist appointments cost me much more than any of my regular doctor appointments.  It has been several years since I went to my OBGYN, and my last mammogram was about five years ago.

Thankfully, most medical practitioners provide some sort of discount for people who pay out-of-pocket.  Such a discount is helpful, though there is a wide range in discount percentages, usually 5%-20%, as I’ve experienced.

When I lived in New York State, from the time I graduated from the University at Buffalo (December 1992), and was removed from my parents’ coverage, until I became employed full-time as a teacher in Georgia (August 2000), I did not have healthcare coverage.  Either my employers did not offer healthcare coverage, or they required at least one’s year’s employment with them before they provided it.  In the places in which I worked part-time, and/or left employment to obtain other employment within one year (typically, for a higher salary and the opportunity for better benefits), I did not have healthcare coverage.

To date, that makes a total of 12.5 years of my life that I have not had healthcare coverage.  After reading a newspaper article related to a lack of healthcare coverage in Georgia for individuals who do not qualify for Medicaid, I realized that I am not alone.  Misty Williams wrote “Ga.’s Medicaid call affects thousands,” being published in the April 6, 2014 issue of The Atlanta Journal Constitution.

In her article, Williams stated, “Statewide, more than 400,000 of Georgia’s poorest, most vulnerable citizens have been left behind by the health care law that was supposed to benefit them the most.”  Because Georgia has not expanded Medicaid (and has, therefore, caused me to be ineligible for coverage, unless I am pregnant), all of these people are still without healthcare coverage.

Throughout the United States, there are 5.7 million people without healthcare coverage – because their states have not expanded Medicaid.  All of the seven states in the Deep South are included in the 24 (nearly half of the US!) states that have not expanded Medicaid.  A WhiteHouse.gov website put’s Georgia’s number of people without coverage at 478,000 – ranked third behind only Texas and Florida – for all those without healthcare coverage due to Medicaid not being expanded to cover them.

If I was younger and perhaps had more faith that an issue such as this would change, I would likely be highly upset about it.  But, now that I am older and somewhat wiser, it really comes as no surprise to me, and is actually a disappointment that people such as myself, who are in the greatest need of healthcare coverage, still do not have it – because they are too poor!

When I am driving on the road, I hope and pray that I am not involved in a serious vehicle collision that causes me bodily harm.  I hope and pray, and do my best to stay healthy, so that I do not acquire a serious illness or disease.  I am cautious and careful about what I eat and who I date, as well as about cleanliness and personal hygiene.

I try to stay as healthy and as well as possible in order to avoid being hospitalized for some situation or condition that could cause bankruptcy.  Sometimes, even with the best of intentions, situations cannot be avoided, and so, I continue to be aware, healthy, and do the best I can.  What I would really like is gainful, stable, and enjoyable full-time employment so that I can obtain and maintain healthcare coverage.

Lawmakers in Georgia – and in other states that have not expanded Medicaid – have truly let down those people such as myself who are so poor that they do not qualify for universal healthcare coverage, including Medicaid.  I thought that the idea behind establishing universal healthcare coverage was so that it would be universal.  Unfortunately, in states such as Georgia, I have seen that it is really not universal.

The Affordable Care Act has, therefore, made absolutely no positive difference in my life to date – because my state has not expanded Medicaid and I am too poor to be eligible to receive Medicaid.  I continue to pay out-of-pocket and do not have any healthcare coverage.  When the poorest of the poor are overlooked and ineligible for even the most minimal healthcare coverage that is supposed to be provided to those who are poor – Medicaid – there is definitely something very wrong with this situation. 😦

References:

24 states are refusing to expand Medicaid (April 3, 2014). Here’s what that means for their residents. WhiteHouse.gov.  Washington, DC: The White House. Retrieved on April 18, 2014 from http://www.whitehouse.gov/share/medicaid-map?utm_source=twitter&utm_medium=social&utm_content=110613p1&utm_campaign=healthcare

Is my state expanding Medicaid coverage? (2014).  Healthcare.gov.  Baltimore, MD: U.S. Centers for Medicare and Medicaid Services.  Retrieved on April 18, 2014 from https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/

Williams, Misty (April 6, 2014).  Ga.’s Medicaid call affects thousands.  Atlanta, Georgia: The Atlanta Journal Constitution, Vol. 66, No. 96.