Archive | July, 2013

“Mind over Mood: Recovery Refresher” by Stephen Propst

26 Jul

From BP Magazine:


Over the past five years, “Mind over Mood” has provided practical, recovery-oriented approaches to managing bipolar and maintaining balanced living. We’ve examined everything from sleep and self-esteem to wellness workouts and mental makeovers. Now, it’s time for a refresher. Here, from previous columns, are 20 of the most recurring themes and best strategies for keeping on course, when it comes to helping yourself or someone you love who’s on the road to recovery.

SELF-INVENTORY: Every now and then, it’s a good idea to take inventory of your thoughts, emotions, beliefs and behaviors, and ask yourself where there’s room for improvement. Doing so may provide some insight, which is crucial to recovery and a better quality of life.

THINKING: What you think and believe impacts your self-esteem, your well-being and your recovery. In the midst of mania, thinking you are indestructible can have devastating consequences. In the depths of depression, believing that your situation will never improve can put you into a deeper slump. When you have a twisted thought or backward belief, stop and restate the remark more realistically. Change “I’ll never get better” to a resounding “I can recover!”

PERSPECTIVE: Are you guilty of looking at the glass half empty, rather than half full? Do you find yourself thinking that you’ll never get better or never achieve your dreams? When you actively adopt a more positive outlook, that step alone brings wellness into closer reach. A change in perspective begins by focusing more on possibilities and less on problems.

IDENTITY: Having a mental illness is not easy, and it doesn’t help matters to define yourself as the illness. Identifying with your symptoms while ignoring everything else that makes you unique makes no sense. Don’t let bipolar become the sole focus of your life, because there’s so much more that’s singularly sensational about you.

SENSITIVITY: As someone with bipolar, it’s easy to let even the smallest things get to you. And wearing your emotions on your sleeve can thwart recovery as well as hurt your relationships. If you develop a Teflon-like outer shell that allows some of the small stuff to slide, you’ll eliminate a lot of stress and have fewer messes to clean up.

LAUGHTER: Laughter is an excellent prescription for better health. It reduces stress, wards off illness, and helps us manage pain. It also provides a feel-good outlet for pent-up emotions. Make a commitment to laugh out loud each and every day. I can always tickle my funny bone by spending time with friends who make me chuckle.

ANGER: Allowing your anger to get the best of you can lead to hostile, aggressive behavior with regrettable consequences. If you are having trouble controlling your anger, seek out help from your therapist or a professional who specializes in anger management.

SELF-ESTEEM: When bipolar disorder coexists with low self-esteem, a vicious cycle can occur. Poor self-esteem creates anxiety and stress, which negatively affects your stability. High self esteem gives you a more solid foundation from which to manage bipolar, work on your recovery, and move on with your life. Therapy can be invaluable in helping you accept yourself for who you are.

CHANGE: Even if you recognize that you need to take steps to improve your situation, you may become paralyzed out of fear that you might go too far down the wrong path. Once you know that you want to make the changes necessary to reach your full potential, trust yourself to take a step in a new direction.

STRESS: Use stress to your advantage. Instead of letting it wear you down, turn it into a catalyst for building strength, stability, stamina, and self-esteem. When you learn to control your reaction to the source of stress, you turn stressful situations into opportunities for growth.

SLEEP: Getting plenty of sound, restful sleep positively impacts the brain’s capacity to control emotions, handle decision making processes and govern social interactions. The better you manage your sleep, the better you’ll manage your mood.

MEDICATION: The right medication is an essential ingredient in recovery, but it’s not the only one. Drugs are no panacea. A prescription is not going to teach you effective behaviors or generate positive reinforcers. If you must, seek professional help to change false assumptions and beliefs or negative thinking.

SUPPORT: Support groups can be a safe harbor in the midst of a storm. They offer the opportunity for people with a common burden to provide mutually beneficial encouragement for one another. Explore support groups in your community, for a safe environment for sharing thoughts, gaining new insights and renewing hope.

MINDFULNESS: A total wellness workout means minding both mood and muscle. It means tackling triggers as well as working out with weights. And it means sleeping well and eating right. Only when you pay attention to both mind and body can you look and feel your best.

FEAR: There are times when fear may keep us from participating fully in life. Once we realize that fear is a state of mind, we can choose to face our fears, change our minds, and create the life we want to live. Start by separating what you desire from what you fear. For example, don’t let the fear of trying a new medication keep you from finding one that might have fewer side effects. Sort out your thinking, and stay focused on your goal.

PATIENCE: We all want immediate results, but with bipolar disorder there simply are no quick fixes. Counting on a miracle cure will only cause frustration. The road to recovery is not a straight shot; it’s a winding path with delays and detours. Progress can be made, but it takes time. So let patience be your guide. And here, some tips for loved ones and others who make up the important support networks for those with bipolar.

UNDERSTANDING: Educate yourself about the illness and try to understand its implications on your loved one’s life. Armed with knowledge, you’ll be better equipped to offer the kind of encouragement, motivation, and support that can make a world of difference.

COMMUNICATION: Before you “fire away,” take a moment to consider how what you say may have an effect on someone with bipolar. Choosing your words carefully can strengthen relationships, fuel recovery, and make for a better quality of life for everyone.

NURTURING: If you care for someone with bipolar, don’t forget to take care of yourself, as well. You won’t be of any service to anyone, if you get exhausted or sick. So, take a deep breath, be easy on yourself and don’t believe it’s solely your responsibility to turn things around and make everything right.

HOPE: If there is one piece of advice for anyone who cares for or about someone with bipolar disorder, it is this: keep the faith and never give up. Many times in my life I had nothing to fall back on but hope (and the fact that I am still writing this column is living proof that it kept me going). So, let your hope for a loved one spread—it’s contagious!

Remember, you don’t have to squash your appetite for a rich, satisfying life. Using the right recovery tools can help you function productively, cultivate meaningful relationships and feel better through and through.


“More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States” by E. Fuller Torrey et al

22 Jul
The Treatment Advocacy Center and the National Sheriffs’ Association released this report in 2010:

Executive Summary

(a) Using 2004–2005 data not previously published, we found that in the United States there are now more than three times more seriously mentally ill persons in jails and prisons than in hospitals. Looked at by individual states, in North Dakota there are approximately an equal number of mentally ill persons in jails and prisons compared to hospitals. By contrast, Arizona and Nevada have almost ten times more mentally ill persons in jails and prisons than in hospitals. It is thus fact, not hyperbole, that America’s jails and prisons have become our new mental hospitals.


(b) Recent studies suggest that at least 16 percent of inmates in jails and prisons have a serious mental illness. In 1983 a similar study reported that the percentage was 6.4 percent. Thus, in less than three decades, the percentage of seriously mentally ill prisoners has almost tripled.


(c) These findings are consistent with studies reporting that 40 percent of individuals with serious mental illnesses have been in jail or prison at some time in their lives.


(d) It is now extremely difficult to find a bed for a seriously mentally ill person who needs to be hospitalized. In 1955 there was one psychiatric bed for every 300 Americans. In 2005 there was one psychiatric bed for every 3,000 Americans. Even worse, the majority of the existing beds were filled with court-ordered (forensic) cases and thus not really available.


(e) In historical perspective, we have returned to the early nineteenth century, when mentally ill persons filled our jails and prisons. At that time, a reform movement, sparked by Dorothea Dix, led to a more humane treatment of mentally ill persons. For over a hundred years, mentally ill individuals were treated in hospitals. We have now returned to the conditions of the 1840s by putting large numbers of mentally ill persons back into jails and prisons.


(f) Any state can solve this problem if it has the political will by using assisted outpatient treatment and mental health courts and by holding mental health officials responsible for outcomes. The federal government can solve this problem by conducting surveys to compare the states; attaching the existing federal block grants to better results; and fixing the federal funding system by abolishing the “institutions for mental diseases” (IMD) Medicaid restriction.


Full Report:

“The Role of the Family in the Course and Treatment of Bipolar Disorder” by David J. Miklowitz

22 Jul

Curr Dir Psychol Sci. 2007 August; 16(4): 192–196



Bipolar disorder is a highly recurrent and debilitating illness. Research has implicated the role of psychosocial stressors, including high expressed-emotion (EE) attitudes among family members, in the relapse–remission course of the disorder. This article explores the developmental pathways by which EE attitudes originate and predict relapses of bipolar disorder. Levels of EE are correlated with the illness attributions of caregivers and bidirectional patterns of interaction between caregivers and patients during the postepisode period. Although the primary treatments for bipolar disorder are pharmacological, adjunctive psychosocial interventions have additive effects in relapse prevention. Randomized controlled trials demonstrate that the combination of family-focused therapy (FFT) and pharmacotherapy delays relapses and reduces symptom severity among patients followed over the course of 1 to 2 years. The effectiveness of FFT in delaying recurrences among adolescents with bipolar disorder and in delaying the initial onset of the illness among at-risk children is currently being investigated.



“Delusional Bipolar Depression More Common Than We Think?” by Natasha Tracy

16 Jul

From the blog Breaking Bipolar:

Delusions are false beliefs that are held in spite of a lack of evidence or even evidence to the contrary. For example, a delusion might be believing that the FBI is surveilling you every day or that you can predict the future. Delusions are a part of psychosis which can be present in bipolar depression or bipolar mania.

Delusions are easiest to spot when they’re exaggerated, like in the above examples, but I would suggest that delusions are much more common when we give them credit for. I would suggest that delusions are present in most cases of severe bipolar depression.

I’m the Worst Person in the World

People with bipolar depression often believe things that are decidedly untrue. Examples of this are:

I’m the worst person in the world.
The world would be better off without me.
I’m the ugliest person on the planet.
Everyone hates me.

These things are clearly untrue but can be staunchly held beliefs anyway. I don’t think these statements would get you diagnosed with psychotic delusions, but I would argue they certainly are. Even when a person can state they know they aren’t true, they will frequently also admit to believing in them anyway. That’s a delusion plain and simple. It doesn’t involve the FBI, but it’s a false belief nonetheless.

Dealing with Psychotic Delusions

In bipolar disorder we fight our brains on what we know to be real in many ways. We fight the hypomania when we know it’s not a good idea to paint our living room purple at 2 o’clock in the morning and we fight the depression when we don’t kill ourselves. Fighting delusions is, in some respects, the same. We have to fight the poor signals coming from our brain with what we know is real. And once we can grasp that our beliefs truly are delusional, this can be easier to do.

Treating Bipolar Depression Delusions

As the name implies, antipsychotics were developed to treat psychosis, traditionally in schizophrenia, but many antipsychotics are now prescribed for bipolar disorder whether recognized psychosis exists or not and they work quite well. And maybe the reason they work in the cases of severe bipolar depression is because what we’re really experiencing is delusions, is psychosis, but is not recognized as such. Maybe the reason why they work is because that end of bipolar disorder is closer to schizophrenia than we think.

(And, by the way, research on the brain supports the link between bipolar disorder and schizophrenia. It’s pretty common to see similar brain deficits between the two disorders only, in the case of schizophrenia, it tends to be more pronounced.)

I could be wrong about this, but I don’t think I am. I think what we’ll find as brain research matures is that the underlying problems in severe depression where these kinds of false beliefs are held are similar to the problems in the brains of people with schizophrenia.

So maybe it’s time for some of us to recognize that what we’re experiencing is delusions and not just garden variety depression. It might help to put things in a new perspective and make those beliefs easier to handle.

Protecting Your Psychic Space

15 Jul

I have a very bad habit of letting negative people into my life and tolerating their toxicity. This is not good for anyone, but it is actually dangerous for those of us with mental health issues because such people throw us off balance and sap us of emotional energy that we need to take care of ourselves. They can also be triggering as hell.

One trait PTSD and mood disorders share is sensitivity. We are finely tuned to our emotional environment. There are potential benefits to this, such as empathy and strong communication skills. But if you don’t protect your psychic space, as certain as a shark loves blood, serial victims and emotional vampires will gravitate towards your openness and vulnerability. They will prey upon your empathy. They will suck you dry. And you can’t get and keep your shit together if you allow that to happen.

I’ve culled people who triggered breakdowns, who exploited everything they knew about my past and my symptoms to hurt and control me, and who caused me moral distress by expecting me to turn a blind eye to, if not actively enable, dysfunctional and abusive behaviors. I used to think that ridding my life of such individuals would be a finite process, but like most things relating to my mental health, I am discovering that it’s ongoing and requires a fundamental shift in my perspective and MO. Removing the toxic people I know is only the first step. I must also learn to identify and protect myself from the ones I encounter. Until I do that, all of my efforts towards recovery are futile.

If you have mental illness, especially PTSD or a mood disorder, clean your house, and keep it clean. You won’t be able to achieve anything close to stability otherwise.

Here is an overview of the usual suspects who crop up in my life. It’s not an exhaustive list and the categories are by no means mutually exclusive. Speaking from my own experience, beware the following:

The Bottomless Pit of Need

I have found this is the most common variety of toxic individual, and one to whom I easily fall prey because I feel loathe to judge. I too have been in crisis more times than I care to count. I too have felt that the whole world was against me and there was nothing I could do about it. I’d venture to say that everyone who grapples with mental illness can relate to this on some level. We all need help sometimes, and if someone is working towards addressing the problem, there is nothing wrong with giving them a hand.

But Bottomless Pits of Need do not address problems. They do not desire or seek agency. Instead, they embrace and wallow in their helplessness while harvesting as many resources (e.g. emotional support, favors, money) from you as they can.

Don’t Get Fooled: Occasionally, a Bottomless Pit of Need will seem to rally and try to cast off their self-forged shackles so that they can live a life of decency and self-respect. Once in a blue moon, this effort is genuine, and if the BPoN commits to change they may redeem themselves. Nine times out of ten, however, such essays are nothing but ephemeral, illusory attempts to keep you around so they can continue sucking you dry. Should you encounter a seemingly contrite BPoN, keep your distance until you are convinced beyond the shadow of a doubt that they are truly reformed. When in doubt, shut them out.

The Drama Magnet

There are two types of Drama Magnets. The most well known type is the person who endlessly pursues and manufactures crises, catastrophes, and interpersonal strife. Writer Suzan Bond refers to these individuals as Drama Creators. Many of them have been raised in chaos and now cling to it because it is familiar. They often do it to obfuscate the overarching issues that are fueling their behavior. It is also a handy method of control because the Drama Magnet’s crisis du jour will always take precedence over whatever else is going on.

Don’t Get Fooled: There is little hope for Drama Creators. As uncharitable as it sounds, the truth is that such behavior is usually pathological and unlikely to change. These people can ruin your life in a mind-boggling multitude of ways. Eliminate them. Extricate yourself. Run for the fucking HILLS.

Bond calls the second type Drama Allowers: people who let the Drama Creators in and don’t evict them from their lives. I am currently escaping from this category. We don’t seek out or actively cause drama, but we don’t take the necessary steps to protect ourselves from it, so it follows us wherever we go. Many of us have become so used to this state of affairs that we think it is simply our lot in life. A lot of us have savior and martyr complexes.

Don’t Get Fooled: Obviously, I believe that we Drama Allowers can be rehabilitated, but only if we realize that this is a pattern over which we have control and commit to actively interrupting it and enforcing our boundaries. If the Drama Allower will not do this, cut them loose, or at the very least distance yourself so you don’t get sucked into their vortex.

For more on Drama Magnets and other musings on self-determination, check out Suzan Bond’s excellent blog Word is Bond:

“It’s Not My Fault”

This is not uncommon to people with attachment issues and personality disorders, but PLENTY of “normies” are guilty of it, too. This is someone who endlessly recreates the same problems but devises a unique set of extenuating circumstances on which to blame each one as it individually occurs. In doing so, they completely escape accountability. They never learn from their mistakes or feel any need to change their ways. Their anger and defensiveness set up a positive feedback loop, and over time they become more stubbornly entrenched in their conviction that everything and everyone else is to blame for their woes.

People exhibiting the “It’s Not My Fault” mindset have a propensity for abrasiveness, manipulation, even emotional abuse. They tend to fight endlessly with everyone around them: family, friends, significant others, and professional colleagues.  A hallmark of these interpersonal conflicts is that such people rarely, if ever, offer sincere apologies. If pressed, they say that they’re sorry you took whatever unacceptable thing they said or did the wrong way, or that you deserved whatever they did to hurt you. Should you attempt to hold them accountable for their actions, they will denounce your instincts and observations and do everything they can to put you on the defensive, a charming technique known as “gaslighting.”

Don’t Get Fooled: These folks have an ever-increasing backlog of guilt and shame from which they are constantly fleeing, and many of them would rather eviscerate you than hear anything you have to say that threatens the reality they have constructed for themselves. Do not engage. Avoid at all costs.


The Willful Martyr

The Willful Martyr is a close friend, family member, or romantic partner of another toxic person.  The Martyr normalizes and accepts their toxic counterpart’s behavior and, to at least some extent, expects everyone around them to do likewise. Their full-time job is caring for their toxic counterpart and “saving” them from the big bad world. They are constantly putting out fires, convoluting excuses, and compensating for their counterpart’s dreadfulness. Willful Martyrs must work very hard to maintain the cognitive dissonance necessary to do all of this. As their sense of reality erodes, they become blind to their counterpart’s destructive qualities and behaviors, and may even come to emulate them.

Identifying Willful Martyrs can be tricky because many seem like nice people. Often, their toxicity becomes apparent only when viewed in the context of their counterpart. But rest assured, anyone who seems fine on their own but is in a close relationship with a toxic person is a Willful Martyr, and must be shunned lest their counterpart’s nonsense seep into your life.

“But he seems so nice!” “She’s just a regular person!” Do not fall into this trap. Willful Martyrs are enablers, however harmless and well intentioned they might seem. Let them in and you open yourself up to the counterpart’s poisonous nature and all it engenders. Worse yet, you may become complicit in the Martyr’s enabling campaigns.

Don’t Get Fooled: Even if the Willful Martyr shuffles off their toxic counterpart, they are likely to take up with another one. A Martyr between toxic counterparts is still bad news and should be kept at arm’s length until they demonstrate that they have changed their ways.

Now, if you’ll excuse me, I have some housecleaning to do.

“NAMI and Robert Whitaker” by Claire Weber

9 Jul
From the website Mad in America:

Fireworks and heated debate were expected by many when Robert Whitaker recently addressed a group at the National Alliance on Mental Illness (NAMI) annual convention in San Antonio, Texas. NAMI has historically been criticized as a ‘front’ for pharmaceutical companies and Whitaker has been painted by many as ‘anti-psychiatry’ and ‘anti-medication’. The views are understandable. There were several pharmaceutical companies sponsoring and exhibiting at this year’s NAMI annual convention and the organization still receives funding for its operations from pharmaceutical companies, and Whitaker’s work is openly critical of both the American Psychiatric Association and the mainstream approach to psychiatric medication.

So why was Whitaker invited to the national NAMI convention and how did it turn out?

According to outgoing NAMI national Executive Director, Mike Fitzpatrick, “Having Bob Whitaker here was important. It is important to have dialogue about the use of pharmaceuticals. NAMI wants to make sure this dialogue happens. The NAMI tent is big enough for many perspectives.”

Whitaker was introduced by the President of the NAMI Board of Directors, Keris Jan Myrick, to a standing-room-only crowd of over 325 people. He started by explaining what led him to uncover the information that ultimately led to his books Mad in America and Anatomy of an Epidemic. He was seeking to confirm conventional wisdom about treatment for mental illness when he wrote an investigative journalism piece about a clinical trial that was taking people who had been diagnosed with schizophrenia off of their medications to see how they fared. Convinced that this was abusive, he sought to expose what was happening. Through a series of events, he came upon information that pointed to a story that was not being told. One study that he found was by the World Health Organization and it included the following statement: “Living in a developed country is a strong predictor for poor outcomes for schizophrenia.”

This line was pivotal for Whitaker. “People claim that I am ‘anti-psychiatry’ but the truth is that this sentence is why I started studying all of this. I thought it was shameful that we should have such poor outcomes.”

After explaining why he got interested in this topic, Whitaker went on to share research for his talk entitled “The Case for Selected Use of Neuroleptics.” Here is the description of his talk from the NAMI convention brochure:

“The usual standard of care for prescribing antipsychotics for people diagnosed with schizophrenia and other psychotic disorders is to use the drugs immediately and, at least with schizophrenia, to maintain use of the medication. However, a review of the long-term outcomes literature reveals that a selective-use protocol, which would involve using the antipsychotic medications in a more limited fashion, would produce superior results. Such a protocol would involve treating some first-episode patients without antipsychotics for the first few weeks, as well as supporting some patients, after their initial use of the medications, in going off the medications. Northern Finland adopted this selective-use protocol in 1992, and that region now has the best documented long-term results in the western world.”

Throughout the talk, Whitaker emphasized the importance of slow withdrawal and highlighted how most studies only look at abrupt withdrawal which can cause reactions that look like ‘symptoms’.

After presenting overviews of the research, Whitaker asked the question, “Do we as a country want to embrace a paradigm of care that is expensive, ineffective and – for many – harmful? Or, do we want a paradigm of care that supports people who want to come off of antipsychotics with help and support?”

Continuing, he said, “I am coming here with a story that is upsetting. I think NAMI should be congratulated for having me here.” There was a loud round of applause.

At the end of the presentation, Whitaker opened up the floor for commentary and questions.

The first was from a woman who brought up a point about the time that is needed for people to be able to reduce medication safely. She pointed out that in the 1950s, people could stay in the hospital for longer periods of time. Her experience was that people stay in the hospital for 5-7 days and come out with a prescription. In a distressed voice, she asked what is to be done about the information Whitaker presented.

Whitaker responded, “We have so much wrapped up in all of this. We believe that meds can stabilize people fast, so we discharge people quickly. We have put all of our eggs into one basket: meds, meds, meds. As far as ‘what do we do?, we have to continue to discuss this, to look at the painful things…. NAMI is a powerful storyteller in our society. If NAMI discussed this story, it could be game changing. We need to have places where people can go. The original meaning of the word asylum was ‘refuge’, and in the early 1800s, Quakers built asylums in the United States that provided people with a healing environment — fresh air, exercise, good food, and so forth. And historians who have studied Quaker asylums have concluded that their outcomes were better than we have ever had since.”

One man, a NAMI member and member of a NAMI consumer council, spoke up, “As a person with 37 years of lived experience with schizophrenia, what you are saying here about the poor outcomes has borne out in my life. I came up in the time of Thorazine and all those drugs. They were terrible. They were only good for eight months and then you had to find a new one. When I would try to stop taking them abruptly, I would become terribly psychotic, so I had to stay on them. Drug companies don’t look for what they can cure; they look for compounds they can sell you forever.”

Another man spoke of his son who started having auditory and visual hallucinations at age seven. He said that he and his wife were educated people who sought out every option and found that they ultimately needed to opt for medication. He said that even among people in the NAMI organization, they felt that their choice was controversial. He told Whitaker that he appreciated him coming to speak in such a balanced way and that it would be helpful to NAMI and people like him if we could come together and continue to discuss this topic in a balanced way with the goal of finding a unified voice to speak to legislators.

One of the audience members said he had come expecting that it would turn into a “firefight,” but that hadn’t happened at all. Whitaker said, “We all have the same shared interest, to do right by people that we love.”

One woman said of Whitaker’s website,, “I’d like to thank NAMI for having you here… One thing I notice about the website is that people who are attracted to write there tend to be a self-selected group who really hate psychiatry. This inability to speak with a united voice is damaging our community.”

Whitaker said, “Sometimes I am uncomfortable with the overall sentiment on the website, in that we don’t have as much diversity of opinion as I would like. (ref: It’s a work in progress. We need to have a place for all voices. We want to have voices of people trying to grapple with what all of this means. It doesn’t have the breadth of writers we want to have. In the beginning, we had invited psychiatrists and others with more mainstream views, but critical comments by readers, which at times were overly personal, chased them away. We didn’t have the resources to manage comments so that the discussion remained civil. We’ve gotten much better with that.” He emphasized that historically, the voices of people being treated for mental health issues were not represented. “We’ve opened our website to that voice.”

The following day was the closing event and the annual NAMI business meeting. It was called, “The Many Faces of NAMI.” Myrick addressed the crowd and spoke of the importance of including many voices and hearing all perspectives. “When ‘I’ is replaced by ‘we’, illness become wellness.”

I for one am ready for more ‘we’ in this dialogue. I am a member and employee of my local NAMI affiliate and an avid reader of the Mad in America webzine. On a daily basis, I hold the tension of many points of view and constantly seek to find the places where these two tribes merge and where we can have more influence together than apart. I am seeking more ‘we’ on this journey of grappling with all of this. Are you in?

“What Can the Affordable Care Act (Obamacare) Do to Improve America’s Mental Health System?” by Michael Cahill

1 Jul

Reblogged from Bipolar Burble:

Since the 2008-2009 financial crisis, America has put funding for mental health treatment on the back burner. Consequently, mental health services and facilities nationwide have suffered.

In the wake of tragedies like Aurora and Sandy Hook, the government is now determined to address the issue of mental health policy in the United States, which will be no easy task.

What will surely go a long way towards helping those suffering from a mental illness will be getting them access to treatment and making that treatment affordable. According to the Substance Abuse and Mental Health Services Administration, the high cost of mental health care is the number one culprit for people not getting treatment. Even those with health insurance often have significant limitations on their access to mental health services.

The Affordable Care Act (ACA), sometimes more commonly referred to as Obamacare, has great potential to improve access to mental health treatment and make it affordable. Here are five ways it can do it:

1. Minimum requirements will include mental health coverage.

Starting in 2014, all health insurance plans are required to cover medical services in ten “essential health benefits” categories as mandated by the ACA. This includes treatment for mental health, behavioral disorders, drug addiction, and alcohol abuse.

No doubt this is a big improvement over previous years when nearly 20 percent of people who bought health insurance on their own did not have mental health coverage. A further third had no coverage for substance abuse treatment, according to the U.S. Department of Health and Human Services.

2. Patient rights will be protected.

Insurers can no longer discriminate based on a customer’s medical history. That means you cannot be denied coverage or charged extra because of any pre-existing condition.

The new law also gets rid of lifetime and annual caps on spending for your health benefits. This is great news for people who suffer from mental health disorders who would normally rack up thousands of dollars in bills every year from their treatment.

3. Health insurance exchanges will make it easier to purchase health insurance.

The creation of health insurance exchanges is also a mandated measure under the ACA. These exchanges are the new marketplaces where health insurance companies will present their plans to potential customers. Each state will have its own exchange with enrolment starting later this year on Oct. 1, 2013 for coverage rolling out on Jan. 1, 2014.

Those who suffer from mental health illness will have an easier time comparing plans and purchasing the one that suits them. Four different levels of plans with varying degrees of coverage will be available in the exchanges. All of them will include mental health benefits.

Low income Individuals and families can also find out at the exchanges if they qualify for government subsidies through the exchanges. Those who earn between 133 and 400 percent of the federal poverty line will not spend more than 9.5 percent of their income on health insurance. The 9.5 percent is also a sliding number, so those earning less will pay less for coverage.

4. Medicaid coverage will be expanded.

A study conducted by the National Alliance for Mental Illness, found that the planned Medicaid expansion that’s part of the ACA will extend coverage to more than 2.7 million uninsured Americans with mental health disorders.

Those who are qualified will receive a 100 percent subsidy for the first three years and at least a 90 percent subsidy for the next seven years. Those who earn up to 133 percent of the federal poverty line will be included in the expansion.

Unfortunately, the Medicaid expansion will not be available everywhere. Fourteen states have rejected the expansion while twenty states and the District of Columbia have signed up to implement it.

5. Quality and availability of service will be improved.

The Affordable Care Act also includes measures that will help to improve the quality and delivery of healthcare services.

Treating mental illness is an expensive and complex endeavour, and response to treatment varies among patients. Mental health practitioners often see patients going in and out of treatment.

Monitoring and re-evaluating the delivery of care is important to improve mental health coverage. Affordable Care Act has mandated the creation of the National Strategy for Quality Improvement which aims to improve healthcare delivery across the country. It will prioritize high-cost chronic diseases such as mental illness.

The Care Act will also establish the Centers for Excellence in Depression. Its goal is to develop coordinated and integrated care, encourage positive health behaviors and outcomes, and promote interdisciplinary training of mental health professionals.

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