Suicide and insurance coverage.

Amidst all the Oscar talk on the radio this morning (Gaga should have won for best song), CBC News mentioned a possible change coming to the insurance coverage and legitimacy perception of suicide.

They had this piece from 2015, Suicide attempts and insurance: Why you might not be covered.

In a more recent piece, Insurance companies reconsider 'dated' policies for suicide attempts, the faulty logic of "avoidable" injury is called out.

The article quotes Mark Warder, a man whose America hospital bill was not covered due to the insurance companies policy that rejects suicide, and instead focuses only on depression to a certain point. After going public he very aptly stated:

Let's face it, most people if they've gone through this and [the insurance claim] gets turned down, they don't have the motivation to fight it.

 Preach. The piece goes on to quote Bill Wilkerson, a former insurance insider:

It's one of those hangovers from an ancient time of stigmatizing mental illness and viewing the destruction of someone under those circumstances as either a crime or a sin when it is neither.

The act of "committing suicide" was a crime in Canada until 1972.

There is a lot of work to be done in terms of insurance and access. I worry that this news coverage will go away and insurance companies will be quick to sweep it under the rug.

I plan on printing out the article and mailing it to my insurer and the HR deparment where I work.

Dog encouragement.

Image source.

I love dogs. So much. More than any other thing. They make me happy, just by my looking at them! Sometimes I spot them while driving. One of my favourite things is when I'm in traffic and a car rolls up beside me and I'm face to face with a back-seat dog. It's even better when it's summer and our windows are down. Sometimes while out walking, I'll make a detour, just to walk by a nice-looking dog.

When I walk around down-town, I'll often see city dogs in little jackets or in bags. They always make me smile. City dogs are harder to impress, they're desensitized to new folks, since they see people all day long. It takes more work to engage them.

Last week I pretended to be interested in fancy headphones in order to walk into an urban wear store and pet a baby pit bull / american bull dog puppy. She was so cute. She was like a tiny barrel of muscles and puppy teeth.

I miss having a dog in my life. Sometimes I'll babysit my brother's dog, but it's not the same. I care about him a lot, and I take good care of him, but he's not mine. He's not my dog-buddy. He's like a third nephew. He's like the quietest, cleanest of them. He listens the best. Really.

The struggle for more coverage: pay for my therapy you dicks!

Just took the time to look over an article in the Montreal Gazette about Quebec's National Institute for Excellence in Health and Social Science (INESSS), and their finding that provincial healthcare should cover psychotherapy.

The INESSS research team found that for people with moderate anxiety or depressive disorders, there is no significant difference between psychotherapy and drug therapy when it comes to reducing symptoms.

However, it concluded, psychotherapy's benefits are longer lasting — even after as few as five or six sessions —providing better protection from relapse.

The research spokesman, Michael Sheehan, lost a son to suicide, and relates access to psychotherapy to the implementation of vaccines:

"It's not a vaccine, but...it's as close as we can get to a vaccine... If we did have a vaccine for most common mental illnesses, such as depression and anxiety, don't you think we would be screaming to have access to it, and it would be scandalous if we didn't?"

The piece goes onto state that only 1 in 3 of practising psychotherapists are in the public sector, with the majority of those benefiting from talk therapy relying on private insurance or simply having the means to pay for the services themselves.

Let me remind you here that I pay 50$ bi-weekly for sliding-scale therapy. Of that, 80% is covered by my insurance, so 40$. This involves paper-work and a reimbursement process. So, I need to be able to afford paying that 50$, since my reimbursement will take a while. I'm covered for 800$ worth of services per year, so that's about 20 sessions, hence my going bi-weekly and not weekly. My former therapist, who charged me 60$ a session as a student, now charges 160$ an hour. Hence my no longer seeing her. 

Jason Gilmour's story is far too common. A resident of Danville, in Quebec's Eastern Townships, he has grappled with depression and occasional panic attacks most of his adult life. Yet for a decade, he didn't even have a family doctor, despite being told for years that he was near the top of waiting lists in the region. 

"A lot of the stuff I've done has been on my own, searching online, reading a lot of books on the subject," he said. "At a certain point, no matter how hard you're trying on your own, you still need a professional — an objective opinion to try to help you to see some issues that maybe you don't see on your own." 

"You just have to hold out hope that one day these things are going to change."

Well, head-nod to you Jason Gilmour, I hear you. Here's to hoping that the discussion of these topics in the public sphere and increased sensitization will lead to concrete change, sooner rather than later.

CLSC: "Nope."

I just got off the phone with the CLSC - another discouraging interaction with the mental health system.

Turns out they can’t really help me since they only offer short-term help and not long-term follow-up. So, they referred me to four places, UQAM’s mental health clinic (run by students. I called, they’re waiting list is full), a clinic that offers sliding-scale services (I called and left a message) and two women’s shelters.

Being referred to a women’s shelter makes me angry. I feel as though those are clearly emergency services that I’d rather not impede. Those services aren't for me. I have a roof over my head and a job, and I'm not in a dangerous relationship.

Of course, the CLSC representative ended the call as all other mental health services seem to, “I'm sorry I couldn't help you more, good luck, and if your situation changes please call us back.” What this means of course is if I'm actively suicidal I can call back and then they’ll (potentially) sort me out.

So unless I want to kill myself live, on the phone - they don’t have shit for me.

Walking into judgement.

I was lucky recently. A friend posted on facebook that a clinic in Westmount was taking new clients for gynaecologists and a few family doctors. I called and booked an appointment right away. My first appointment went really well. I really like my new doctor, he seems to be genuinely caring and concerned. He's young, and approachable, and doesn't seem like a douche. Our report was excellent, and he was engaged and listened.

My first appointment with him also meant discussing why I was there. This meant broaching my issues with mental health. I gave him a sparks notes version, and he ended up referring me to Dr. Singh, who is apparently part of McGill University's psychiatry department, and is heading up some type of practice at St-Mary's hospital. I called and booked an appointment, and a month and a half later, here I am.

My appointment with Dr. Singh is tomorrow around noon. I have mixed feeling about this.

Of course, I want to do everything I can to supply myself with emergency services and support if I ever need them. I want follow-through. My doctor seems to think Dr. Singh can potentially refer me to free or sliding-scale services I've yet to find. Maybe he's a wizard.

I also have a desire to be clinically assessed. I've experienced doctor's of all kinds, but I've never been clearly diagnosed. My assumptions are my own. Certain terms have been used. Nothing is official.

The only reason I'm even worried about this, is that months ago when a walk-in clinic doctor refused to be my doctor, he said psychiatric cases frightened him and that he wasn't comfortable taking on the responsibility of someone "like that."

What if one day I'm hit by a wave of depression so bad I can't function? Will it being clinically recognized aid me in asserting the legitimacy of what I'm living?

The legitimacy of my mental illness can only be recognized by others - since my brains and insides are nothing but glumness and tricks. How can faulty wiring calculate it's own efficiency?

And so I am filled with a sense of dread about tomorrow. I was told I would be evaluated by three doctors. Two residents and Dr. Singh. I will be asked to lay everything out. I will be asked questions I don't feel are pertinent. I will be asked questions that are cutting to me.

I want to think if I feel something is inappropriate or that someone is being a dick I'll have the gaul to say something about it. But I'm not sure. These spaces for assessment are cold and difficult. And as is often the case, so are the assessors.

How is it one can be a doctor of the psyche, yet have so little understanding of compassion and empathy?

Maybe I'm getting ahead of myself...

I sit here and try and think of the things I should or could say tomorrow. It ends up a long list, a long list of ways in which sickness can warp into different areas of your life.

Are there links I can't see? Are the habits I feel trap me, obvious to others?

Can you see that I'm in pain by looking at me?

I have questions. But that's not what tomorrow is about.

I am going to try and be... not bitter. It's very difficult. There are only so many times a doctor can ask you to regurgitate your pain without it leaving a bad taste in your mouth.

Scrambling for access.

Mental Health awareness campaigns trigger a lot of anger in me.

First, I want to say that visibility and the ability to name our experiences (and disabilities) openly is important. It's important to hear people's stories and for those without mental health issues to hear how devastating living with / surviving depression can be. I hope that hearing personal accounts and understanding how pervasive mental illnesses are lead to a more open dialogue and to a more empathetic view of these issues.

Having said all of this, these campaigns - for me - bring forth a lot of resentment.

A lot of front-line mental health services are there for those in crisis. This is important. My issue is with what comes next, namely, the silence that greets you when you are no longer in crisis.

I called a suicide hotline once. I had been unemployed for months and was feeling especially useless. The operator had a warm, soothing voice and she didn't have to say much in order for me to finally cry (I don't cry. My depression is painful but I am often despondent and very far from my ability to cry and release tension). Her next move was to ask me to call a friend. I lied about calling a friend next and then survived the night.

The big picture over the next few months involved my struggle to find English free or sliding-scale mental health services in and around Montreal.

If you'd like to picture the ensuing shit-show google "two girls one cup."

Basically: there are very few free services available to Anglophones in the Montreal area.

Highlights include:

• The West Island support group where I was the only female-identified person, at which I listened to one guy talk loudly about himself for over an hour (we were 7). The group moderator did not moderate shit. Including racist and misogynist comments. Considering the long trek out there and the abysmal experience I never returned.
  
• The Concordia psychiatry department and it's free services. Oh fun. This means you're therapy is with a student. Mine was about 19 and immediately looked like a deer in the headlights within a minute of my sitting down. I understand kids need to learn but this was a total train-wreck of an experience. Disheartening to the max.
  
• Various phone calls and emails to orgs of all kinds, most of which couldn't even refer me elsewhere.
  
• French-only websites and services. 

* Though I am fluent in French, I asked if they knew of English support groups or services (since talking about issues is hard enough and wanting to do so in your mother-tongue means having the ability to use precise language in a more natural, effortless way.

I also contacted various therapists, and asked about sliding-scale services. I got a lot of negatives.

Finally I was referred to The Argyle. The services were not free but I was able to access sliding-scale services. I saw a lovely counsellor who I'll call A for about 10 sessions. This helped me a great deal. What sucked was the limit to sessions with the same counsellor. This totally negates the report we build.

Unfortunately A had to go back to school. This also sucks because I liked her tremendously. So I’m back to seeking services, ideally something long-term so I can feel I have a support structure around me.

Asking for help is the first step. But it is the first step in an uphill battle.

I wish strength and resolve to those going through similar struggles.

First you survive yourself, then you do everything you can to make that easier tomorrow. Unfortunately you'll have to rely on yourself for a lot of the work, an irony that pains me considering we ourselves are the problem.