Monday, April 6, 2009

Senator Grassley queries NAMI regarding funding and policy

Senator Charles Grassley (R-Iowa) has sent a letter to National Alliance for Mental Illness (NAMI), requesting information about the non-profit mental-health-advocacy to disclose if and how its sources of funding may have influenced its policy decisions.

“I have come to understand that money from the pharmaceutical industry shapes the practices of nonprofit organizations which purport to be independent in their viewpoints and actions,” Grassley wrote in his letter. 
This is unsettling news. NAMI has done a lot of good for a lot of people, particularly for people who, because of the nature of their illnesses, often are not able to advocate for themselves. That the potential for a conflict of interest (or worse) exists leaves a particularly vulnerable population adrift.
Stay tuned.

Work and depression

In an effort to manage health care costs and (we hope) to promote well-being among employees, employers are increasing their efforts to help employees manage chronic health conditions.
This, as we might suspect, is a complicated development. The financial and productivity costs assocated with chronic conditions, such as depression, can be substantial. (Here's way to quantify the costs - Workplace Depression Treatment Savings Calculator.) Bringing those costs under control is generally regarded as a good thing.
Planned carefully, work can be good for a person with depression, helping to build confidence, self-worth, and purpose.
Another article shows that employers reap benefits from knowing about their employees’ depression. Again, they're better able to manage the costs, attendance, and productivity concerns if they know what they're dealing with.
For the employee, however, such visibility and candor doesn't always lead to a good place. An Australian study showed that one in five Australians would not work closely with someone suffering depression, and older men and migrants tend to view the illness negatively. Also, such program are often costly and ineffective.
A few additional notes:

  • The level of support that I've received from my employers, as I've dealt with depression at work, have ranged from excellent to decidely unhelpful. In my experience, most employers will try to do the right thing and will succeed. Some will make well-intentioned mistakes.
  • The Americans with Disabilities Act (ADA) provides you with significant protections, including privacy rights. 
  • Because of the ADA, as much as an employer might genuinely want to help, there are limits to the amount of detail that an employer can receive regarding an employee's medical condition.
  • Most wellness programs are administered by insurance companies, on behalf of the employer. Even though insurance companies can and do have a great deal of detail regarding your treatments, they cannot share your information with your employer.
Disclaimer: I am not a lawyer. Your mileage may vary. May contain peanuts. Coffee is hot. Contents may settle during shipment .Driver does not carry cash.

Finding our way back and then forward

In a Nichols and May skit, Elaine May plays a mother who wishes that her son would call and visit more often. She reports that she's going into the hospital so that the doctors can x-ray her nerves.
I've noted that, of late, things are going pretty well. My days are full with interesting and often useful activities, my mood is good, and I can often make and meet commitments - all signs that point toward health. I feel like I'm on my out of the woods, but I also know that I've felt like this before.
Even a momentary distraction can have one turned around and headed back into the underbrush. Yesterday evening, for example, a chance reminder of a difficult relationship at a former job was enough disorient me. It didn't last long and that's also part of the good news, that a bad moment doesn't always have to lead to a bad night, day, month. You get the idea.
There's a very good blog post over at Recovery, Well-Being and Purpose | Storied Mind, addressing this change of perspective, getting beyond survival mode and (back) into living with a purpose for a future.
One of the continuing challenges, though, is staying grounded, being able to observe and accept what's really going on with us, not just what we wish would or wouldn't be happening. 
Wouldn't it be great to have some definitive, external, verified, repeatable test that could a) diagnose depression, b) determine the severity, and c) chart our progress over time so that we could know if a treatment is making a positive difference.
Instead, we have to rely on the BDI and other self-reported measurements. It's a lot like those eye tests ("Which is better, 1 or 2?") where your ability to see clearly for the next months or years is dependent on making a fine distinction that you just don't know how to make.
There is some encouraging research, such as in these articles, Dr. Francis Lee Recognized For Developing Genetic Test To Guide The Treatment Of Depression and Possibility Of Brain Scan-assisted Diagnosis For PTSD A Step Closer. Other research (Early Brain Marker For Familial Form Of Depression Identified By Columbia Researchers) may lead to early identification of people who are greater risk for development of depression. (We'll leave aside the ethical, political, and insurance risks of such predictions for another discussion.)
Getting where you're going depends on knowing where you are. Or something like that.