Articles Tagged with depression

Two decisions this week emphasize the importance of submitting treating physician and patient statements in support of an ERISA administrative appeal. For ERISA health cases involving medical necessity denials, an appeal which gets to the heart of why treatment was medically necessary is crucial and can actually determine the course of the lawsuit.

In Katherine P. v. Humana Health Plan, Inc., No. 19-50276, __F.3d__, 2020 WL 2479687 (5th Cir. May 14, 2020), the Fifth Circuit revived life into a claim by a young woman seeking mental health benefits for partial hospitalization treatment. Katherine received partial hospitalization treatment in 2012 for multiple mental health disorders including an eating disorder. Humana paid for the first 12 days of partial hospitalization treatment and then denied benefits, claiming such treatment was no longer medically necessary based on two Mihalik Criteria.

The Fifth Circuit found that judgment for Humana was improper because the administrative record showed a genuine dispute as to whether Katherine satisfied one of the Mihalik Criteria, ED.PM.4.2.

Even though most of us are still sheltering in place in an attempt to lessen the immediate spread and most severe health consequences of COVID-19, it is not too soon to start considering possible long-term health impacts that may arise in the wake of the coronavirus pandemic.

Because the virus affects many organs and systems within the body – from the lungs and cardiovascular system to the liver, kidneys and likely the brain – it now appears likely that at least some patients will suffer long-term physical symptoms.  These long-term and even permanent problems may result from the virus itself, the body’s own immune response or even medical interventions, especially respirators, or a combination of all these factors.  But whatever the cause, doctors are already seeing heart damage, kidney and liver damage and, unsurprisingly, lung scarring and damage in a number of COVID-19 patients who are no longer actively infected.

And these are still early days. Some patients present during the illness with serious neurologic problems such as strokes and encephalitis, as well as other more mild neurologic symptoms such as dizziness, headache and loss of smell.  There have been reports of some patients suffering from Guillain-Barré Syndrome, an auto-immune disease where the immune system responds to an infection by mistakenly attacking the body’s own nerve cells.  It seems possible that at least some of these patients may continue to suffer neurologic and autoimmune issues, and related pain, fatigue and cognitive difficulties for at least some time.

Millions of people are affected by mental illness each year. While 1 in 5 people will experience a mental illness during their lifetime, everyone faces challenges in life that can impact their mental health. As the increase in the number of COVID-19 cases affects our entire country, so too will the need for access to mental health treatment and awareness of mental health issues. So far, older adults, along with those who have underlying health conditions, have been hit the hardest by the COVID-19 outbreak, with many developing severe, life threatening illnesses. Another group that is expected to be acutely affected by the pandemic include those who have severe mental illness.

Mental illness is a real and treatable set of conditions that includes major depression, bipolar disorder, eating disorders, panic attacks, generalized anxiety disorder, attention deficit hyperactivity disorder, and schizophrenia, among dozens of others. These disorders are serious enough to significantly impact a person’s daily life functioning, whether at school, work or in their relationships with others.

Mental health issues often coincide with a unique set of challenges that make it difficult for people to access even the most necessities, such as food, medications, stable housing, and healthcare. Combined, all these factors put people with severe mental illness at a much higher risk for contracting and transmitting the new coronavirus and dealing with COVID-19.

The COVID-19 pandemic has uprooted the lives of millions of Americans in many ways and has taken its toll physically and mentally on millions of Americans across the country. But for people who suffer from mental health issues, the COVID-19 pandemic has created a new wave of panic, chaos, stress, and uncertainty.

More than 2 million Americans are estimated to be affected by obsessive compulsive disorder (“OCD”), according to the Anxiety and Depression Association of America. Nearly 7 million people in the U.S. are affected by generalized anxiety disorder and about 6 million people in the U.S. are affected by panic disorder. Fear and anxiety about COVID-19 can be overwhelming and cause stress in both adults and children.

Stress during COVID-19 might include:

Parents, educators and clinicians are seeing an alarming increase in mental health problems among young people. An ongoing topic of discussion among educators, medical health professionals and politicians is what can be done to curb this problem.

Following similar moves in Florida, Oregon and Utah, a recently introduced bill in the California State Legislature would allow students time off to treat or attend to mental health needs. Senate Bill 849, written by California State Senator Anthony Portantino (D-La Cañada Flintridge), would allow students in elementary school through high school time out of school to treat or attend to mental health needs without risk of being considered truant, a violation that could lead to penalties for students and fines for parents.  Under California’s current education code, mental and behavioral health problems are not eligible for excused absences.

Studies show that a rising number of school-age children in California are struggling with depression, anxiety or thoughts of self-harm. According to the national Centers for Disease Control and Prevention, suicide is the second-leading cause of death among young people ages 15-24. The CDC reported in 2017 that the number of girls 15-19 committing suicide had doubled from 2007 to 2015. The statistics cited show 5.1 suicides per 100,000 in that age group — a 40-year high. The boys suicide rate in that age group climbed 30 percent, to 14.2 per 100,000, in the same time period.

National Suicide Prevention Week (“NSPW”) is September 8th-14th this year. Each year, the nation’s largest suicide prevention organization, the American Foundation for Suicide Prevention (“AFSP”), hosts NSPW. One focus of NSPW this year is: Creating A Safety Net.This blog is a little bit about how I created a Safety Net for myself, and why you need one, too.

Why Do You and I Need A Safety Net?

Each of us lives a life in which our experience of living may bring along some challenges. I venture that most would agree that life is not a linear or static journey -neither in a practical or emotional sense. Personally, I have found that this great sweep of things we call “Life,” although a wonderful journey, it has not been one of predictability. While I have enjoyed years of stability and joy, years of happiness, years of feeling inspired, I have also faced years of hard-times, loss, defeat and great suffering.

Suicide is a Leading Cause of Death in the United States. According to the Centers for Disease Control and Prevention (CDC) WISQARS Leading Causes of Death Reports, in 2017:

  • Suicide was the tenth leading cause of death overall in the United States, claiming the lives of over 47,000 people.
  • Suicide was the second leading cause of death among individuals between the ages of 10 and 34, and the fourth leading cause of death among individuals between the ages of 35 and 54.

We represent a number of clients who suffer from Rheumatoid Arthritis.  This often misunderstood and “invisible” disease causes extreme pain for its sufferers.  On top of the pain, many also deal with the disbelief of friends, family and employers as to the disabling nature of their illness.

Rheumatoid Arthritis (“RA”) is a chronic disorder in which the body’s immune system attacks joint tissue and causes inflammation that can spread throughout the body.  It can also cause excruciating pain.  Because there are very few visible symptoms during most stages of this disease, its sufferers appear to be fine when in reality, they are in extreme pain.

Another difficult aspect of RA, from a disability standpoint, is that there is no single test for diagnosing the condition. Rather, it is diagnosed by clinical evaluation, lab tests and imaging. This makes meeting your long term disability plan’s definition of disabled more difficult as insurers are often looking for “objective evidence” of disability.

In the last decade in the U.S., teenagers and young adults are experiencing a dramatic increase in mental health conditions that is not present in other American age groups. According to a recent article in the Journal of Abnormal Psychology, 2010 teenagers are much more likely to develop major depression, have suicidal thoughts, or live with crippling anxiety than teenagers from the 2000s.

Why are today’s teenagers more susceptible to depression and anxiety? Researchers who studied the data theorize that because the biggest increase occurred around 2011, it is unlikely the cause is the political climate, the economy, or genetics. Instead this uptick in mental health concerns is attributed to the cultural changes in the way young people spend their time outside school and work and how they communicate with each other. Teenagers are sleeping less, exercising less, and spending less time interacting with other people face-to-face, instead spending significantly more time scrolling through social media and communicating electronically. The researchers conclude that teenagers and young adults should focus on activities known to improve mental health – face-to-face social interaction, exercise, and sleep. You can read more about the study and its findings HERE.

Put the Phones Down for a Bit

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