Leslie Carpenter is an advocate for improving the treatment of people with serious mental illnesses in Iowa and across the country. -promoted by desmoinesdem

While speaking at the National Alliance on Mental Illness Iowa Annual Conference on November 16, Iowa Department of Human Services Director Jerry Foxhoven advised the attendees that it was a good thing that two of the state’s four in-patient mental health institutions (MHIs) were closed, and that we have moved to community-based care. He further shared that it was a good thing to go from more than 700 beds to the current level of 64 beds for adults in the whole state.

We should recall that this reduction of state-operated acute care beds has caused Iowa to be ranked 51st by the Treatment Advocacy Center.

Matt Chapman had a “visceral reaction” to the governor’s campaign ad about mental health. -promoted by desmoinesdem

If you watch Jeopardy! or the local news, you have been seeing a lot of campaign commercials for Governor Kim Reynolds. The first three were biographical in content, and the latest attacks Fred Hubbell over his leadership of the Younkers department store chain. (Iowa Starting Line pointed out that ad featured local GOP activists posing as people affected by store closures.)

The fourth Reynolds campaign spot, “Leader,” gaslights Iowans on our state’s inadequate mental health system.

Peggy Huppert is the executive director of the National Alliance on Mental Illness in Iowa. -promoted by desmoinesdem

Governor Kim Reynolds signed two mental health bills on March 29 in an emotional ceremony in the capitol rotunda. I was one of the hundreds of legislators, lobbyists and advocates who witnessed the event.

The two bills are quite different. What they have in common, in addition to dealing with mental health and being signed into law on the same day, is that they passed both chambers of the Iowa legislature unanimously. That in itself is extraordinary.

Governor Terry Branstad and Republican leaders in the Iowa House and Senate are finally poised to eliminate Planned Parenthood’s state funding, a cherished goal Democrats had repeatedly blocked in recent years.

Branstad said during his Condition of the State address on Tuesday that his budget “redirects family planning money to organizations that focus on providing health care for women and eliminates taxpayer funding for organizations that perform abortions.” House and Senate leaders likewise depict their plan as a simple change to reimburse different health care providers, creating “better options for more women.”

What Iowa Republicans don’t broadcast: they are setting the state up to spend ten times more on family planning services, without a reliable funding stream.

{Originally posted at my blog Senate Guru.}

First thing’s first.  I’m not a doctor.  I’m not suggesting that Republican Chuck Grassley has any particular illness.  Simply, I have noticed that Chuck Grassley, over the last many months, has been making increasingly bizarre, aggressive, explicit, and violent remarks – and that such comments coincidentally happen to be early symptoms of dementia, particularly frontotemporal dementia.  It stands out to me because, as a political junkie, I have long considered Grassley to be among the most mild-mannered denizens of the Capitol.  2009 has apparently become the year that the 75-year-old Grassley (he turns 76 next month) has shed his mild-mannered image, perhaps by choice, perhaps not.

In response to the story this Spring about AIG executives receiving exorbitant bonuses after the company was rescued by a massive infusion of public dollars, Grassley said on March 16, 2009:

“I suggest, you know, obviously maybe they ought to be removed, but I would suggest that the first thing that would make me feel a little bit better towards them [is] if they would follow the Japanese example and come before the American people and take that deep bow and say I’m sorry and then either do one of two things: resign or go commit suicide.”

Grassley added, “In the case of the Japanese, they usually commit suicide before they make any apology.”

The comment was rude, racist, and extremely aggressive, even violent.

The next day, still critical of AIG executives, but in an attempt to tone down the violent “suicide” comment from the previous day, Grassley went the more sexually explicit route:

“From my standpoint, it’s irresponsible for corporations to give bonuses at this time when they’re sucking the tit of the taxpayer,” Grassley explained.

When talking about government spending, “sucking on the teat” is not in and of itself bizarre rhetoric, but that Grassley used the more sexually explicit “tit” instead of “teat.”  In fact, such a nuanced difference might have flown under the radar entirely if not for a sexually explicit comment Grassley made at a budget hearing toward the end of the same month as his earlier comments, on March 26, 2009:

But yesterday he [Grassley] regained his bounce on the Senate floor, livening up an otherwise dull budget hearing with a joke about banging another senator’s wife. His opening came after he pressed Budget Committee chairman Kent Conrad to include an amendment of his to a budget resolution by bringing up the fact that Conrad owed him a favor.

“Oh, you are good,” Conrad responded.

To which Grassley replied: “Well, your wife said the same thing.”

Sure, this comment, in a vacuum, could be one Senator good-naturedly ribbing a colleague.  But a joke intimating sex with a colleague’s wife, told, again, at a budget hearing, seems like bizarre behavior.  Further, when you add up these comments, what you have is a pattern of behavior.

Last week, Grassley’s pattern of behavior was reinforced by his take on health care reform:

We should not have a government program that determines if you’re going to pull the plug on grandma.

In fairness, this one comment has become a sick talking point of many Republicans shilling for corporate interests.  Nevertheless, it particularly stands out for Grassley given that, when he is not flying off the cuff, he is one of the GOP’s key negotiators on health care reform.  He should have had the self-control to avoid such aggressive rhetoric.  But that’s been Grassley’s pattern lately.

So what we have seen from Grassley in 2009 – and this is just in public; no telling what his comments and actions are in private – is a pattern of bizarre, rude, physically aggressive, sexually explicit, and even violent remarks.  Such a pattern even led The Iowa Independent to the headline: “Grassley: Strategic or just eccentric?”  Eccentric may be putting it mildly.

Grassley is not the first Republican Senator in recent years to have his mental health questioned.  During his 2004 re-election bid, the Kentucky media began openly questioning Jim Bunning’s mental health after a similar pattern of bizarre comments and actions.  Also, in 2006-2007, Pete Domenici’s mental health was questioned after a pattern of erratic behavior including reportedly walking around the Capitol in his pajamas.  Subsequently, in late 2007, Domenici revealed that he had a degenerative brain disease and opted against a 2008 re-election bid.  Domenici was 75-years-old at the time of his 2007 diagnosis, the same age Grassley is now.

Now for the coincidental symptoms.  If you hop over to WebMD.com, best friend of the armchair hypochondriac, you can find a page that lists symptoms of dementia.  Such symptoms include “having trouble finding the right words to express thoughts,” “having trouble exercising judgment,” and “having difficulty controlling moods or behaviors” while noting that “agitation or aggression may occur.”  What especially caught my eye was the following passage:

The first symptoms of frontotemporal dementia may be personality changes or unusual behavior. People with this condition may not express any caring for others, or they may say rude things, expose themselves, or make sexually explicit comments.

Agitation or aggression?  Check.  Personality changes or unusual behavior?  Check.  Saying rude things?  Check.  Making sexually explicit comments (again, at a budget hearing!)?  Check.  Lack of inhibition?  Check.

Again, I’m not suggesting that the 75-year-old Chuck Grassley has frontotemporal dementia.  I am, however, noting that Grassley’s pattern of behavior over the last six months coincidentally happens to match the early symptoms of frontotemporal dementia.  With Grassley turning 77-years-old before Election Day 2010, it would not be unfair or unwise for Iowans to get a clean bill of health from Grassley before signing him up for another six-year term (at the end of which he will be 83-years-old).

Doctors go through a lengthy period of education and training before they are certified to practice medicine.

So why are insurance company bureaucrats routinely able to second-guess or overrule doctors’ orders?

Rekha Basu’s column from the Sunday Des Moines Register provides another shameful example of this common practice. Last December, Angela Ira’s 18-year-old son Nicholas, who had a history of depression, severe anxiety and borderline agoraphobia, was suicidal.

Scared and desperate, she said she persuaded him to go with her to the hospital emergency room, though he fears leaving the house. The doctor threatened to have him involuntarily committed if he didn’t agree, said Ira. She finally talked him into it. But half an hour later, the doctor returned to say the insurance company refused to pay. […]

Magellan’s clinical director, Steve Johnson, said he couldn’t discuss individual cases. But in the letter to Nicholas mailed last Dec. 10, Magellan cited as reasons for the non-authorization:

– “You do not appear to be a danger to yourself or others, and you are capable of activities of daily living.”

– “The information provided supports that other services will meet your treatment needs.”

– “You no longer have the symptoms and/or behaviors you had on admission, and you have shown progress in meeting your treatment goals.”

How could the company determine, when Nicholas’ doctor was saying he was suicidal, that he was making progress toward goals? The letter said, “If we disagreed with your provider’s clinical decision, we consulted with a licensed psychiatrist or other qualified professional and recommended an alternate service.”

As if someone who hadn’t met or spoken to the patient could better understand his needs than the doctor treating him.

Conservatives love to demagogue about “government-run health care,” but I notice that they don’t seem bothered when insurance company employees deny access to treatment recommended by the patient’s own doctor.

Basu’s column is a reminder that even Americans who have private health insurance are often forced to go without medical care they need.

Barack Obama and the Democratic Congress need to stop insurance companies from substituting their judgment for that of doctors. This needs to be part of a broader universal health care package.

The Des Moines Register’s editorial board again called for single-payer health care reform in an unsigned editorial today:

Our view: What’s needed is a government-administered health-insurance program – similar to Medicare, which covers seniors and disabled people – available to all Americans.

A single system could reduce administrative expenses associated with facilitating thousands of different private health-insurance plans in this country. It could increase leverage for negotiating lower prices. It could facilitate the expansion of electronic medical records, which would streamline paperwork and help prevent costly medical errors. It would boost the country’s economy in the long run.

Every health care delivery system has its flaws, but on balance I agree that a Canadian-style single-payer system would serve this country well. A few days ago DCblogger chided me for my “defeatism” about the prospects for enacting single-payer. I stand by my assessment, though. Even if President Obama were fully committed to “Medicare for all,” getting HR 676 through Congress would be extremely difficult. But Obama has not endorsed single-payer and is not going to put his political weight behind it, even if 93 members of Congress have co-sponsored the bill.

This is an open thread for any comments related to health care or health care reform proposals.

UPDATE: The latest from nyceve continues to make the case for single-payer, with lots of statistics on the high cost of our for-profit health insurance industry. Naughty Max Baucus: “The only thing that’s not on the table is a single-payer system.”

It’s the eleventh hour of the eleventh day of the eleventh month. Ninety years ago, the Armistice between Germany and the Allies went into effect and the Great War (which later became known as World War I) ended.

NavyBlueWife has a nice piece up at MyDD on the history of Veterans Day and what it means to honor our veterans.

Via BarbinMD I learned that the Iraq and Afghanistan Veterans of America (IAVA) and the Ad Council have launched a “national multimedia public service advertising (PSA) campaign.”

The campaign aims to address the mental health consequences of combat, which threaten to overwhelm a new generation of veterans. The 1.7 million men and women who have served, or are currently serving, in Iraq and Afghanistan are facing an increased risk of mental health issues. Nearly 20 percent of military servicemembers who have returned – 300,000 in all – report symptoms of post traumatic stress disorder (PTSD) or major depression, yet only slightly more than half have sought treatment, according to a RAND Corporation study released in April 2008. Untreated mental health conditions can cause or aggravate other debilitating problems in the veterans’ community including high rates of unemployment, suicide, homelessness, substance abuse, divorce and child abuse.

Created pro bono by ad agency BBDO New York, the campaign seeks to increase the number of Iraq and Afghanistan veterans who seek treatment for mental health issues by connecting them with other veterans with whom they can discuss the issues they face as they readjust to civilian life. The campaign includes television, radio, print, outdoor and Web advertising. The TV spots feature Iraq veterans who are Purple Heart recipients.

You can view the ad here or at the new Community of Veterans website, which is designed for veterans of Iraq and Afghanistan.

Here is the home page of Iraq and Afghanistan Veterans of America.

The “IGTNT” team of diarists at Daily Kos write tributes to all American troops who have died in Iraq or Afghanistan. Today’s edition of this series contains links to many organizations that support and honor veterans.

Thanks to all veterans who have served in peacetime or wartime.

Thanks also to all the members of Congress who voted for the “new GI Bill” in May (you can find the roll call votes for the U.S. House and Senate here). My dad went to college on the GI Bill in the 1940s, and his family would not have been able to afford the tuition otherwise.

This is an open thread for any thoughts you have related to Veterans Day, or anyone you are remembering today.

UPDATE: I learned something new today in this letter to the Des Moines Register: Remember veterans: Fund ALS research

Very few people, including those serving in the military today, know that veterans are twice as likely to die from ALS – the deadly disease known as Lou Gehrig’s Disease.

We don’t know why vets are more likely to develop ALS. But we do know that the disease takes the strongest among us – our military heroes – and robs them of the ability to walk, move their arms, talk, eat and even breathe on their own. They are isolated and awake, alive with the knowledge that they are trapped inside a body they no longer can control.

As the disease progresses, there is little they can do, for there is no treatment for ALS. It is fatal in an average of just two to five years.

Urge elected officials to support funding for ALS research at the Department of Defense so we can learn why the disease is stealing our heroes and take action to protect them. Recently both Congress and the Veterans Administration have supported ALS research and provided benefits to veterans with the disease, but more must be done.