Canadian Insurance Companies Bullying Depressed People

I found the memo below on the internet after I posted my post about my insurance company requesting detailed notes from my pdoc. It is a memo from the Canadian Medical Association's general council meeting in Winnipeg.

I am really mad about this now and I may contact a mental health advocate to challenge my insurance company's request. It seems Canadian Insurance companies are bullying people who may not have either the energy or the resolve or the financial resources to challenge them. Now I'm mad...look out!!!

Here's the memo I found:

"Insurance company demands concern MDs" http://www.cma.ca/index.cfm/ci_id/8394/la_id/1.htm

Isolation

Yesterday I managed to get out of the house to meet an acquaintance, M, at a restaurant. When I walked into the restaurant I saw two people who I used to meet for lunch on a weekly basis.

They were friends I had met in a psychodynamic group therapy group a number of years ago. They were people I have been very open with about my ongoing struggle with depression. I felt safe with them as they had both dealt with depression on an ongoing basis as well.

About 3-4 months ago they simply stopped inviting me. I admit that I am not good (read really bad) at initiating any meetings, but I always was excited to meet with both of them. In the weeks just prior to their stopping calling me I was in a severe downward cycle and my pdoc was talking seriously about my being admitted into the hospital.

As the weeks went on I felt they had made a conscious decision not to call me. I recognized that I was so depressed all the time that I burned out the people around me. I cared for them and, in my depressed mind, not calling them was protecting them from me.

Today when I saw them I felt so ashamed and guilty for not calling them. I felt this tremendous sense of responsibility for the friendship having failed. I started to cry when I went up to them to say hello, and I felt so much tension in the air. I thought I was going to be sick.

I want so badly to meet with them again, but I feel so ashamed for being the way I am. My husband yelled at me when I came home and tried to explain what had happened. He said, "You have to stop being so down. You cannot be constantly in a downward spiral"

WTF??? It is as though he believes I could change if I only chose to change. It is how I think everyone sees me and why I think most of my relationships fail. Others believe I am burdensome and I feel that way, so I give up the relationship because I do not want to hurt others.

I feel like that at the Art Clubhouse too. I feel like I'm the only one who never seems to get well. The head OT's telling me I need to change I cannot be crying etc. was akin to my husband telling me to stop being depressed. Now I do not feel safe at the clubhouse to be myself. I feel constantly on edge, afraid I will disappoint. Because of my fear I hold back and keep so many thoughts to myself, because I want to belong, I want to be more supportive and less of a drain on people.

I despise this illness. It has destroyed my sense of self, my sense of self worth, my ability to be resilient and my sense of connection to others. I cannot imagine that I chose to be this way, that I chose a life that makes me want to die every single day I exist.

One Therapy Session a Week Will Not Make Me Well

Dr X. and I met this a.m., like we do every Tuesday morning. His office is the one place I feel safe. I knew I was anxious this morning, like all week, but I thought my mood was a bit up this past week, at least up from where I spend most of my time.

As soon as I began to talk a flood of tears began pouring out of me and as they came I felt so alone, helpless and hopeless. I started to feel like I was a burden to Dr. X. I started to feel like I was going to lose his support if I don't get better faster. I started to feel like it is my fault I'm still so depressed. It's my fault the medications are not working.

By this time I was sobbing and having a hard time breathing I was so anxious. Dr.X told me I am not burning him out and he will be here for me to celebrate and embrace the days that I feel good, but also to support me on the days that are bad.

We talked a lot about creating a life where there are all kinds of opportunities for that kind of support, because one therapy session a week is not enough to keep me on the path towards wellness. I need a life that does that too.

So ideas were to get a personal trainer again to help me get back on the exercise path. Also, to have a set schedule for these things so that everyday at a particular time I exercise, or grocery shop, or meet friends, or cook dinner. Cooking a healthy dinner everyday is another idea...a good way to add more vegetables and healthier eating into my diet. Take my vitamins and supplements everyday, meditate etc.

The art clubhouse I go to is important too, even though I am really struggling since the OT incident. I feel really angry about this still because I no longer feel safe there. I feel scrutinized and devalued. I know I love art and I really enjoy some of the people there though so I am really trying to use a behavioural approach to my fear and anger and face it even if I am feeling that way.

Dr X. says he understands how hard any one of these things is, but if I am going to get well I need as much support as I can muster. Having a healthy body, eating well, being around people at the clubhouse...these are all systems that can contribute to my getting and staying well.

Psychiatric Confidentiality: Our Laws are Only as Good as Our Resolve

I wrote the following in response to a question about confidentiality on a Mental Health Discussion Board/Support Group I belong to.

In the thread about effective treatment someone had written they were afraid of their employer or potential employers finding out they were depressed. The site is managed by a psychiatrist and he wrote, in part, the following:

"It is medical malpractice to release your medical records to anyone without your permission. The only exception is that your psychiatrist is expected to send your referring family physician a consultation letter, and then progress notes every few months.

Employers, schools, government officials are not allowed (at least in the western world) to have access to your private medical records."

This has not been my experience.

First, when I went off on disability my employer was given my diagnosis and medical info because I had to consent to their receiving it in order to receive short term disability payments which they paid.

Second, I am on LTD and receive some of my money from the government. In order to receive those payments I had to provide my health information to the government and I had to sign a release form allowing the government access to my medical records.

Third, I have recently had a serious dilemma in terms of my employer's Long Term Disability Insurer. I will describe what follows as "coerced consent":

Last year my employer's insurance company sent me a document requesting that I release ALL my psychiatrists notes to them, not just a brief description or progress report...instead, every single thing he ever wrote about me.. In the release form they explained I could only continue receiving my insurance payments if I signed the document. Given I have no income without their payments and I have to eat/live and am unable to work; because of my precarious financial situation I did not have the resolve to say no to the insurance company. I feel I was COERCED into signing the document.

Lucky for me my pdoc does have the resolve to stand up and say no. My Pdoc has refused to send his notes to them. He says he will send what he has always sent...a brief recap of treatment, but he will not send his notes.

I feel I am very lucky to have a pdoc who has my best interests in mind, but I am not certain many Pdocs would take his stance, especially when the patient has signed such a broad ranging release form.

As you can imagine, the Insurance Company's request has impacted what I feel safe talking about in my therapy sessions. Even knowing they receive ANY information is upsetting and makes me very cautious about what I say in my sessions. Knowing they could potentially receive every note my pdoc writes makes it impossible for me to talk about some things.

Fourth, the other difficulty I have had in terms of confidentiality and potential abuse of power is that while I have been off on disability my employer's disability insurance company has changed 3 different times, so now, rather than one huge Canadian insurance company having my disability/mental health records, the three biggest insurance carriers in Canada have my mental health records. I find this very disturbing.

It may impact my ability to find work when I am well, especially if my potential employer uses one of those insurance carriers. I know the psychiatric records are supposed to be confidential, but employer's and insurance companies are well versed in finding ways around this and I just want everyone to be aware of this.

Independence

I think lack of independence has, in many ways, led to my depression and kept it from going away. My husband is away and I am noticing that I am free in a way I have not allowed myself to be in a long time.

I am free to turn on the heat when I want to without being afraid he will criticize me (I pay the bill...so not sure why he cares either way). I am free to go anywhere, with anyone, without being afraid he will get mad at me. I am free to do the things I like to do without feeling guilty about doing them. These things are informing me that I allow my husband to control me in so many ways. I give up independence to keep our relationship comfortable, to avoid conflict. I don't like that I do this.

I feel like I give away bits of myself by giving up my independence. I notice that whenever he has gone away I feel a sense of freedom that I do not feel when he is home. Alternately, my strong sense of needing my independence can be a big problem. I push people away because I feel suffocated, or feel like I need my space. I think this is a defense mechanism. I push them away before they get the chance to push me away.

I struggle so much with my fear of being rejected by others. I believe this stems from two things in my life: As a child and teenager I had to move with my family to different parts of the country every 2-3 years. Each time I moved I had to make new friends. I think I gave up some of my independence and became who people needed me to be in order to make and meet new friends.

Also, I had a father who dismissed my ideas all the time. He was the most important male role model in my life. His dismissiveness was heartbreaking as all I wanted to do was please him. I am 42 and he still dismisses me and I still try to please him. It still hurts me every time he rejects me. I do not know how to become independent in this relationship, other than avoid him, which is what I end up doing.

I have replaced my father with a husband who does the same thing. It is strange, but the more I feel dismissed, the more I struggle to be close to the person dismissing me. This affects my independence. I do not feel safe being independent because I fear I will be rejected.

Is it a Love Hurt Thing?

1. My husband hates pharmaceuticals, especially psychiatric medications and especially if my pdoc augments or mixes medications to try to help me. He says the meds have kept me chronically depressed. We get in HUGE fights over my being on meds/trying different meds.

2. I understand/believe I have an illness. I believe, and my pdoc has told me he believes, my illness is biological and/or genetic.

3. Two days ago my husband came to my therapy session with my pdoc. He sounded much more rational and understanding about medications when talking to my pdoc than he is when he talks to, or yells at, me.

4. Today I went and saw my pdoc again and he says he thinks I should go off all medication for a while and really work on my relationship with my husband and other non-medication things (like exercise, eating well etc.)

5. I lost it...I feel so ashamed of how I reacted:

• At first I thought he was concerned about me using medications he prescribes to commit suicide. I said something really stupid like, "I can commit suicide without the medications. I don't need them for that"...partly because a couple weeks ago he was asking me about whether I was hoarding meds again. He caught me off guard and I felt really embarrassed that I had been saving any leftover meds. I have not been hoarding meds that I am supposed to take...When I left his office I was worried he might have been left with the impression that I have been noncompliant with my meds. Not so. I (almost) always take my meds the way he prescribes them. The ONLY times I have not is with benzodiazepines and sleeping medications...I sometimes have increased them, or reduced them on my own, either because, I feel like I can't calm down, or sleep on the dose he prescribes, or alternately , I start to feel addicted, and want off them "NOW".
• Then I felt like it was too much of a coincidence that he makes this decision right after he met with my husband and myself.
• I really do not think my marriage is fixable. I do not even know if I want to be married anymore given how my husband has treated me while I have been struggling so hard. The last few days I believe I have come to terms with the failure of our marriage. So why do I want to risk my well being for something I do not even know I if I want to preserve?
• I feel like my life is finite and I want to get well as fast as I can. I do not want to waste six months not trying to find medication/s that might help only to find that time off meds was a waste of precious time.
  

6. My pdoc says no medications will be able to help me if I am constantly having battles with my husband at home about the medications.

7. I felt like my pdoc was taking my husband's side and my family's side.

8. I already feel let down by the therapist at the clubhouse I go to. The feedback she gave me has increased my paranoia and suspicion about all the therapists and the members there and what they think of me. I feel like a couple members may have complained about me...(they are nice to my face, but talk negatively about other people)...so I extrapolate that to... "They talk bad about me". Plus, I feel like all the therapists must have been involved for the head therapist to say something...especially given the day prior to being talked to it was another therapist who talked to me when I was upset. I feel like I am an outcast.

9. Now I feel like my pdoc is on someone else's side. Except, I am pretty sure, based on my past experience with him, he is on my side...but I'm feeling really confused by this reversal of our previous discussions.

10. I feel like my husband and family are underestimating how depressed I've been, how much it impacts my life and the consequences and potential consequences of my being severely depressed for this long (six years...almost the whole time) Their "Get out and do more things" comments make me feel like they have no idea what it is like to be INCAPACITATED by depression for this long.

11. Now I wonder what my pdoc is thinking? I thought he understood how desperate I am to get well and how important it is that I get well as quickly as possible. I am really upset by this sudden turn in his treatment plan. For months we have discussed treatment plans in terms of medication and maybe my going to the hospital and maybe ECT. He has never pushed medications, but has always talked in terms of our eventually finding a medication, or medications, that would help me . I know I need to do more than take medication. I need to work hard to get my life back, but I cannot manage to do those things when I am this depressed. I need something to help lift my mood enough so I can manage to become motivated to begin living again.

12. I have never, ever read "stop medications" as a strategy to treat Chronic Major Depression, or Treatment Resistant Depression. It feels like he is giving up on me.

13. My husband says he is looking into his future and does not think he wants the rest of his life, what life he has left, to be impacted by my depressed and unstable mood. We have talked several times in the last 4 days about my moving out.

14. I love my husband and I feel so sad I have impacted his life in such a negative way. It was me who initially suggested I move out both because I know my not getting well in a timely manner is hard on my husband's wellness. He is depressed now because of it. Also, I feel I will not get well with us constantly fighting over my medications.

15. I asked my pdoc to let us first try increasing my Carbamazepine to 800mg for 3 weeks to see if that will help my mood. It has not helped thus far, however, I have also had no bad side effects and that's good. My pdoc agreed to try, but he did not sound very hopeful.

16. I feel so confused, sad, angry, and abandoned by my husband, my family, my pdoc, the art clubhouse I go to, my friends (all of them have given up on me), even my dog, because he is really sick again and I know he will pass away soon.

17. Over the past couple days, it's hard to explain, but I have a cloak over all those emotions. I feel nothing, despondent, like I have no emotions anymore...nothing left to feel. Everything is so bad in my life right now that I see no hope anymore.