By Robert Landauer – editorial columnist for The Oregonian, June 29, 1999. Not available elsewhere online.

Our lawmakers in Salem are more open to a good scare than to good advice.

The basic points are clear in their quivering handling of a medical insurance issue:

• Scientists have proved that some serious mental illnesses are biologically based and can be treated medically.
• Workers with company-paid health plans want treatable mental illnesses such as schizophrenia and major depression to get the same coverage as physical ailments such as diabetes and epilepsy. Anything less, they say, is discrimination.
• Some employers fear that parity for mental illnesses would produce runaway costs. Lobbyists say this would force firms to drop all mental -disorder coverage, harming other Oregonians. However, fewer than 1 percent of companies dropped coverage as a result of the 1996 federal parity law.
• Overwhelming evidence shows that insurance parity for mental illness is cost-effective. Twenty-five states have adopted parity; two more bills await governors’ signatures.

Legislators here, though, are set to keep our separate and unequal system.

“This Legislature has conducted a stalling action in refusing to hold even one public hearing,” Doris Cameron-Minard, president of the Oregon chapter of the National Alliance for the Mentally Ill, said last week.

Public opinion and cost aren’t valid alibis for delay or piecemeal action.

A 1999 survey of 500 voters conducted for the Oregon Medical Association by Moore Information found that 85 percent favor or strongly favor requiring insurance companies to pay the same level of benefits for mental and physical illnesses.

Rand Corp. found that equalizing annual limits would increase costs by about $1 per worker per year under managed care.

A 1999 study for 14 Oregon organizations by PricewaterhouseCoopers found that parity’s net effect — costs minus benefits — would be to raise employers’ health outlays 1.2 percent, or $1.27 per member per month.

Assuming an average of three members per family, that cost increase translates to a pay raise of $.022 per hour — one-fifth of 1 cent.

Stonewalling over such a paltry sum is more than chintzy; it is contemptible.

The human face of our lawmakers’ embracing old error rather than new truth is grotesque, too.

Families in Oregon run out of mental illness insurance every year.

“Then they use money intended for one child’s education to pay for the health care of another,” says Portland lawyer Phillip D. Chadsey.

Finally, they face bankruptcy as they try to pay for loved ones’ treatments.

The earlier and the more adequately the mentally ill get treatment, the better the chances of recovery.

The community pays for neglect. The costs add up in joblessness, homelessness, jailings, hospitalizations and referrals to the Oregon Health Plan, foster care and other public assistance.

Also, as the system operates now, so many restrictions have been placed on covered mental health visits that it often is tough to do what is medically appropriate or necessary, says Dr. Mark Olfson of Columbia University, a researcher in the field.

Susan Dore, who studies parity for the National Alliance for the Mentally Ill, underlines his point:

“You don’t do one coronary bypass if a patient needs three. If patients need weekly therapy and you allow fewer visits along with prescriptions they can’t afford to fill, don’t act surprised that they live on the streets with ulcerated feet.”

Oregon is coldheartedly falling a decade behind most states.

From The Oregonian, June 20, 1999 – not available elsewhere online

[Eds. Note: One informant for this story asked politely to have this story removed from the MHAP site. It's an important story so we agreed to redact the name.]

Three Oregonians who have manic depressive illness find that dedicated therapists and proper medications are key.

Family and friends remember Lilla Moler, Stephanie Lynn Russell and Alexandria Ison as loving and creative despite lives full of struggle.

These three women, found strangled this spring in Forest Park, were mentally ill, among the voiceless in society.

But others who live with mental illness are beginning to break that silence.

REDACTED NAME, Kevin Fitts and Anne Potter are among them. They are part of a national movement of people with mental illness who are joining or forming organizations to make their voices heard.

These three Oregonians did not know Moler, Russell or Ison. But they live with the diagnosis that the young women apparently shared: bipolar disorder.

Moler, Russell and Ison died with bipolar disorder. Drake, Fitts and Potter have something to say about how to live with it.

An estimated 2.3 million American adults — or 1 percent of the general population — live with bipolar disorder, also called manic depressive illness. It is part of a larger family of depressive illnesses that affect 19 million men and women in this country.

Bipolar disorder is like living on a teeter-totter, swooping from intense euphoria and irritability to desperate sadness, while often feeling normal in between. No one knows its cause. But researchers have found genetic links, explaining why it runs in families.

Eighty percent of disorders such as manic depressive illness can be treated with combinations of medication and therapy. And new technology allowing scientists to better study the brain gives hope for improved treatments.

REDACTED NAME kicks off her moccasins in her tree-top apartment in an old Southeast Portland house and shows a visitor how to swing dance. Music, motion and passion have defined REDACTED NAME’s 57 years.

REDACTED NAME remembers growing up in Texas in the 1950s, waging shouting matches with her father about politics and race. Her dad’s moods seemed unpredictable. Jekyll and Hyde. Just this year she learned that her father’s mother spent years in a mental hospital. Now she knows why her father warned her never to end up there.

REDACTED NAME used her master’s degree in education and her periods of immense energy to teach elementary school and then college classes. She started her own secretarial service.

She gave piano lessons, but she tried to teach her students not to depend on her. She never knew when she might become too depressed to keep teaching. Yet when that happened, she always lined up other teachers her students could try.

She worries that her students might be upset to learn of her diagnosis. She hopes they understand that personal character and mental illness are separate.

REDACTED NAME used various medications to cope with her moods. But it wasn’t until three years ago that she had a name for what ails her. Her diagnosis led her to find the right medication.

Now when in Salem lobbying legislators for mental health causes, she avoids getting too revved up or too run-down. She and her family have worked through differences. She uses art therapy. She plays the organ. She leads a calligraphy class. Calligraphy is so orderly. It makes her feel calm.

She has written a list of how to interact with manic depressives in the workplace. Reward cooperation. Discourage harassment. And remember to take care of yourself.

Kevin Fitts darts up from his office chair to demonstrate the difference between mania and depression. It’s like a ladder, he says, using his office door as a prop.

Sometimes you’re way down here, he says, stooping in his khakis and blue Oxford to touch the hardwood floor. Then he reaches with his slim frame high above the door to signify mania.

Fitts’ parents divorced when he was a child. His father often left him and his brother alone at their Wisconsin home. When Fitts’ father was home, he was working his way through a bottle of Cutty Sark. Later Fitts learned that his father’s grandmother had been locked away in a mental hospital in Illinois.

In high school, Fitts either skipped his classes or disrupted them. “I just had a lot of anger, rage,” he says.

At 17, he remembers thinking that if he could just stay drunk all the time, maybe it would help.

Fitts bounced from National Guard training in Virginia to his mother’s home in Corvallis to the streets of Portland, where he slept on heating vents. Cocaine and alcohol fueled his delusions.

For Fitts, life had always been something that slammed into him. A counselor at a group home helped him see that he could have some control. The counselor gave Fitts choices. If you come home drunk, I will kick you out.

Fitts used those lessons after he was formally diagnosed with a mood disorder. He made some choices. He stopped using drugs and alcohol. It was 1986.

Fitts tried antidepressants and lithium. He didn’t like the weight gain or the numbing effects caused by the drugs. Now he uses what he has learned in therapy to manage his behavior on his own.

He knows that when he lies in bed, wishing himself dead, that those feelings are not real. He jogs to channel his energy. He eats better. And last year, he and two friends who also live with mental illnesses started a grass-roots organization called the Office of Consumer Technical Assistance to support and advocate for their peers.

“It’s crucial to listen to the voice of the person and what they’re going through,” says Fitts, now 34. “This isn’t like a new pair of jeans. Shouldn’t we have some choice over our own health? It is time for the liberation of the patient.”

Anne Potter doesn’t remember the first time she met the psychiatrist who saved her life. She only remembers calling the ambulance in Portland in 1990 because she felt completely out of control.

She remembers struggling with the hospital attendants, wanting to explain why she had come. She remembers them pinning her down with restraints instead. She remembers the injection.

Potter, 49, knows now that she met Geraldine Price during that hospital stay. Later, Price called Potter, asking her to come see her.

Potter says too many psychiatrists just want to figure out your diagnosis, prescribe some medicines, and that’s the end of it.

Price did much more. She worked with Potter for several years to find just the right drugs for her bipolar disorder. She gave Potter her home number in case Potter needed guidance. She taught Potter to understand and control her moods.

Price recognized Potter’s intelligence. Potter graduated at the top of her class from Reed College in 1971 despite a constant knot of depression in her stomach that she combated by holing up alone with her books.

Potter received master’s and doctoral degrees from Stanford University. That’s where she first tried therapy.

In 1978, Potter’s mother shot herself to death in the Forest Grove home where Potter grew up. Her own treatment for mental illness had failed.

Potter spent years trying anti-depressants and lithium, still holding down teaching and consulting jobs. In 1983 in Washington, D.C., she was forced to learn to talk and move again after contracting pneumonia and winding up almost paralyzed in the hospital, the lithium in her blood having reached toxic levels.

Her physical disability drove her from the work force. She suffered increased bouts of mania. Once she went out to buy a condominium even though she had no money. Her friends were alarmed.

Now in Portland she uses a motorized scooter to get around her neighborhood. She talks haltingly, carefully enunciating words. Yet she speaks with a smile and twinkle in her dark brown eyes.

Potter spends her days corresponding with friends via e-mail, devouring history books and novels, going out to dinner or coffee occasionally with friends. And she is editor of the newsletter for the Mental Health Association of Oregon.

She is not optimistic that others will be so lucky to find the right therapist. Insurance plans limit mental health coverage, and managed care formulas for financing mental health programs are causing significant cuts in services in Multnomah and other counties.

She says she knows the secret to surviving mental illness.

“If you don’t want to end up on the street or in Forest Park,” she says, “you need really decent help.”

From The Oregonian, June 8, 1999 – not elsewhere online

THE CITY LINKS WITH THE WHITE HOUSE FOR A CONFERENCE BROADCAST LIVE TO 6,000 SITES NATIONWIDE

Sandy Hayden suddenly sat up in her threadbare easy chair and focused on the television.

It was January, and President [Bill] Clinton had just announced plans for a White House Conference on Mental Health in his State of the Union speech.

Hayden, 46, thought immediately that the conference should include people like herself — people who live with mental illness.

She didn’t realize that Oregon’s reputation for innovative mental health services would mean that the conference would come to her.

On Monday, Hayden sat in the front row of the Providence Portland Medical Center amphitheater, one of three sites in the nation chosen for a live satellite feed of the Mental Health Conference. She was one of only 120 people invited to the Portland site to observe the first such White House event.

The administration’s stated goal: to attack stigmas, identify treatments and recognize efforts to improve the lives of the 50 million Americans with mental illness and their families.

The conference linked with Portland, Flint, Mich., and Atlanta, giving each city a chance to showcase innovative mental health programs. It was also beamed to 6,000 sites across the nation, including more than 20 in Oregon, from Baker City to the Oregon State Hospital in Salem.

Tipper Gore, wife of the vice president, moderated the conference. She set the tone by talking about her own experiences with depression after her son was struck by a car and nearly died in 1989.

More than a dozen speakers told their stories, from Mike Wallace of TV’s “60 Minutes,” who has battled depression, to a young man with schizophrenia, to the mother of a mentally ill boy and volunteers in mental health programs.

“Mental illness is not just something that happens to other people,” Gore said. “This is the last great stigma of the 20th century that we need to make sure ends here and now.”

The president, first lady Hillary Rodham Clinton and Vice President Al Gore used the conference to announce a dizzying list of public policy proposals: to provide parity, improve treatment, bolster research and expand community responses to help people with mental illnesses.

President Clinton announced his intention that all federal employees’ insurance coverage put mental health services on a par with physical health treatments.

“As a nation founded on the principles of equality, it is high time that our health plans treat all Americans equally,” Clinton said to applause from the Washington, D.C., audience at Howard University.

Oregon was chosen as a live link because of such initiatives as the Portland Police Bureau’s Crisis Intervention Team, which has trained 100 officers to work with people with mental illness to de-escalate crisis situations.

Portland Police Sgt. Karl McDade stood as he addressed Vice President Gore, saying: “Every night in this country on a street corner somewhere, there is a dangerous dance that goes on between an untreated, mentally ill person in a crisis, destitute, homeless, who is frightened, and a young policeman who is probably not trained (for the situation and) who is frightened, too.”

Hosted by Providence

Portland’s link-up was hosted by Providence Portland Medical Center, home to the Crisis Triage Center . The center, a public-private partnership, provides the only 24-hour emergency care for people with mental illnesses in the Portland area.

The Oregon Health Plan also helped the state secure involvement in the conference. The plan covers diagnosis and treatment for physical and mental illnesses equally.

Yet, despite Oregon’s innovations, the state’s private insurance companies still limit coverage for mental illness. A bill to reverse that is in the Oregon Legislature. Senate leaders have yet to give it a hearing.

Hayden says the failure to get private insurance to adequately cover mental health impedes her return to the productive life she led before she became ill.

Hayden, who has a master’s degree in physical education and a bachelor’s in psychology, had wanted to teach fitness as a motivational tool. She co-authored a book on the topic. She worked as a reporter while trying to write her doctoral dissertation in Georgia in the early 1980s.

Hiding the anger

But writing became a struggle. She forced herself to sit at her computer for hours, but she couldn’t concentrate.

She fought to hide the anger that welled up in her at work. She had always given more than 200 percent to her job. Now she felt the steam knocked out of her. She felt she had to quit. That was 1984. She hasn’t held a job since.

Ten years later in Oregon, her doctor diagnosed her with bipolar disorder. He said the illness is characterized by extreme mood swings, from intense energy and agitation to profound depression. For Hayden, knowing what was wrong with her was a relief. Finally, she said, “he had my story.”

She eventually found a blend of four drugs that help her manage mood swings..

Managing her own medication has helped Hayden regain her energy and sense of control.

She joined a state advocacy group run by people with mental illnesses. She became interested again in motivating others.

Now she would like to work part time. But she would risk making too much money to qualify for the Oregon Health Plan. Because private insurance won’t cover her therapy and medications, she needs the Health Plan to survive.

A new Oregon program that lets people with disabilities return to work and keep their public health coverage may help her. But Hayden wants private insurance companies held accountable.

In the meantime, she remains in public housing in a Northwest Portland high-rise, where the noise from neighbors and the light from the street keeps her awake.

Learning about the White House conference galvanized Hayden.

She started networking with other mental health consumers and their organizations. She wound up with three invitations to the Portland site for the White House conference.

Sitting in the audience Monday amid mental health specialists, state and local leaders, consumers and other advocates, Hayden smiled. For years, she felt she could tell no one about her diagnosis. Now she listened as people throughout the country told their stories to a national audience.

“If the wave you can sense from this can be cast farther and taken up by other portions of the country,” she said, “it will be absolutely wonderful.”