ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Tuesday, January 14, 1997 TAG: 9701140094
SECTION: EXTRA PAGE: 1 EDITION: METRO
COLUMN: BETH MACY
SOURCE: BETH MACY
She is a New River Valley graduate student in her 20s, an overachiever, extremely bright.
She works two part-time jobs - and maintains a 3.5 grade-point average - while stretching her $500 a month income over rent, car and car-insurance payments. She suffers from chronic depression and post-traumatic stress disorder.
She had a full-time job with medical benefits last year before deciding to go back to school. She extended her insurance through the COBRA program, which would have prolonged her Trigon Blue Cross Blue Shield benefits for $175 a month.
Melanie, I'll call her, was nine days late with her first payment.
Her policy was immediately canceled.
In the struggle to control health-care costs - where the bottom line rules - her story comes as no surprise. But what happens, down the road, to people like Melanie? What are the long-term costs?
Dr. M. Patel, her psychiatrist, describes the worst-case scenario: ``She is still a very young, otherwise smart girl who can ruin her life, her career, everything - and that would be very sad.''
A victim of childhood molestation, Melanie has battled depression all her life. She'd been working with the Roanoke psychiatrist for two years before they hit upon the right combination of medications for her treatment last spring.
Without insurance, her medicine costs $300 a month - definitely not affordable on a grad student's budget. Melanie has tried to get other coverage but has been turned down due to ``pre-existing conditions.'' And student health insurance covers only hospitalization, not medicines or therapy.
So, she makes do. Patel switched one of her medications to the generic variety and gave her free samples of another. In desperation, she scrounged a third medication from a friend who had been prescribed the drug but couldn't take it because of side effects. The fourth drug she's doing without.
``I think I've been going downhill, but it's hard to tell because the holidays are such a hard time for me, anyway,'' she says. Migraines she used to get have resurfaced because of the stress.
Patel describes Melanie as the first among his caseload to be summarily dropped for a late payment. What's more common is insurers covering only a certain list of drugs - formularies, they're called - not because they're the most effective, he argues, but because they're cheap.
One of his patients, who suffers from manic depression, takes a new drug that reduces by 100 percent the chance of her having psychotic episodes. But her insurance company won't pay for it.
Patel managed to get the right drug through a pharmaceutical company, many of which have special programs for indigent patients. It's a strategy he hopes to employ for Melanie as well.
``In her three years of seeing me, she's come along a fairly good way, staying focused with her career and continuing education,'' Patel says. ``But she needs more therapy, and she needs these medicines. If she regresses enough, it's like the bag of worms. A lot of these issues [underlying her depression], without the regular care for stability, could ruin her.''
There are financial arguments to be made on Melanie's behalf. Medicine is cheaper than taxpayer-funded hospitalization. ``And think about her increased productivity and ability to contribute to society'' when she's healthy, adds Diane Kelly, executive director of the Mental Health Association of Roanoke Valley.
Mental illness is still a long way from being treated as seriously - by general practitioners, insurers and society at large - as physical illness, she adds. ``Many times people go to a physician up to four times for treatment of other kinds of symptoms - back pain, fatigue, stomach problems, whatever - and the diagnosis ends up being depression.''
Among people who go to the emergency room for heart-attack symptoms, 60 percent are actually experiencing panic attacks, according to a study done by the Medical College of South Carolina.
Kelly also noted a recent medical-journal article that explored doctors' deliberate misdiagnoses of depression. ``Either they were trying to get the patient's insurance company to cover it - by giving it another name - or they didn't want to have the diagnosis of mental illness on the person's records.''
The stigma explains why Melanie didn't want her real name used for this column. She was afraid professors, peers and future employers might hold it against her.
And rightly so, Kelly says. ``There are so many things out there that perpetuate the stigma,'' she adds, offering as the latest example WFIR's billboard promoting its ``Dr. Laura'' call-in show.
The slogan makes a joke out of one effective form of treatment: ``Shock Therapy.''
``It's got to come full circle,'' she adds. ``People have got to understand that the brain really is part of the body.
``While we are very open about the value of treating diabetes, we need to realize the treatment of depression addresses a chemical imbalance just as the use of insulin does.''
IN THURSDAY'S COLUMN: The story of Salem psychiatrist Enrique Perez, who is leaving his private practice - and the Roanoke Valley - because he's tired of being forced to treat patients as widgets. ``If I wanted my MBA, I'd have gone to business school,'' he says.
LENGTH: Medium: 98 linesby CNB