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ADA and Disability

Finding Relief with Mind-Based Therapies

By Jen Jenkins

According to national health figures, one in four adults in the United States has experienced back pain within the past month. Back pain is the second most common cause of disability for American adults and is a leading cause of disability worldwide. Sufferers have tried it all, from painkillers and shots to physical therapy. In our previous post on MCNTalk we discussed chronic pain in the United States and the growing concerns surrounding opioid painkillers, their addictive nature, and the rise in opioid-related deaths. Amid this evolving crisis, a new study is now reporting that many people may find relief with a form of meditation called mindfulness-based stress reduction. This technique harnesses the power of the mind to help manage pain and involves a combination of meditation, body awareness and yoga.

“This new study is exciting, because here’s a technique that doesn’t involve taking any pharmaceutical agents, and doesn’t involve the side effects of pharmaceutical agents.”

– Dr. Madhav Goyal

Dr. Madhav Goyal of Johns Hopkins University School of Medicine co-wrote an editorial accompanying the paper published on the study of mindfulness-based stress reduction. Participants in the study were assigned to meditation or cognitive behavior therapy and they received eight weekly two-hour sessions of group training in the techniques. Six months later, those learning meditation had an easier time with activities such as getting up out of a chair, climbing stairs, or putting on socks; a year later, they were still doing better and expressed meaningful improvement. The sheer size of this study is considered one of its strengths – it included 342 participants ranging from age 20 to age 70. However, Dr. Goyal does warn, “It may not be for everybody.” Some people with back pain might find yoga and certain movements too painful, but Dr. Goyal thinks that this technique is very empowering for people who want to do something using their own mind to help their pain.

Mindfulness-based stress reduction was developed in the 1970s by scientist Jon Kabat-Zinn, who used Buddhist meditation practices as a template for his technique. Dr. Cherkin explained that the goal is for pain sufferers to increase their awareness of their experience through meditation. They are meant to understand how their pain is affecting them and more importantly, how they respond to it. The idea is for participants “to change their mindset and, in a way, almost befriend the pain, and not feel it’s oppressing them.”

It is important to be able to offer a lot of options for chronic pain because while some treatments may help some people, they may not work well for others. Dr. Cherkin believes that mindfulness-based stress reduction is helpful because even if someone does not use it all the time, it is a skill they will never forget and it is something that can be used anywhere. Currently, the downsides for those who are interested in mindfulness-based stress reduction revolve around getting access to is, which is problematic without certified instructor training available everywhere; and, as an alternative remedy, receiving instruction in it may not be covered by health insurance.

View this New York Times article on mind-based therapy and back pain. Also, please share your comments with us!

Hospitals Are Getting Bigger (And Not Just In Texas)

by Jen Jenkins, Market Analyst

Parkland Hospital in Dallas, Texas is gaining exposure, and it isn’t due to its plush newness, updated equipment, sophisticated technology, or a tragic event of 1963 (for readers who are familiar with the name “Parkland Memorial.”). Instead, Parkland is getting attention because each room in the hospital has been specifically designed to more effectively treat overweight patients, or more accurately, “the bariatric population.” This population is made up of patients who typically have a body mass index of 40 or higher and as the need to accommodate these patients has grown, so has the trend to redesign hospital rooms across the country.

According to Nancy Connolly, a senior executive at a hospital consulting group, “Most hospitals we are building are providing an increasingly larger percentage of rooms that can accommodate the larger person.” These changes are necessary due to the unique challenges obese patients tend to face: beds, wheelchairs, and other equipment need to be larger and sturdier which also means that door frames and the rooms themselves need to designed differently. This is now routinely kept in mind as old hospitals are updated and new hospitals are built.

Regardless of what this new trend may indicate, the overall idea moving forward is for hospitals to be designed with the “universal patient” in mind so that every single person may feel comfortable and accounted for. Many arguments can and are being made about what this means about our society, food consumption, economic issues, etc. However, in this scenario hospitals are simply doing what is necessary to be in a better position to care for patients in every way possible – which is undoubtedly their most pertinent responsibility.  According to an article featured in The New York Times, although this trend is being seen across the country, Parkland has done an especially remarkable job in its new design, which will likely be replicated here on out.

 

West Point Professor and Iraq War Veteran Weighs in on Disability Pay

Disability benefits, especially for veterans, can be a difficult, often emotional issue to discuss as is witnessed in this The New York Times article and accompanying comments. Lt. Col. Daniel Gade, a professor of public policy at the United States Military Academy, lost a leg while serving as a tank company commander in Iraq in 2005. He spends much of his spare time publishing essays and traveling the country pushing the idea that the Department of Veterans Affairs should move away from paying veterans for their wounds and instead create incentives for them to find work or create businesses.

“It’s a difficult issue to broach. People immediately think you are trying to shortchange veterans,” he said in an interview. “But I’m in a position to do it because I have skin in the game, literally.”

Colonel Gade wants to avoid a partisan fight over his ideas which says are first about helping veterans and second about saving money: “I think we can show we have a no-kidding better way to help veterans that is cheaper and more effective.”

One comment author summed many points up not just on veterans’ benefits but the disability system in general: “We can say that ‘disability status’ can become a disability in itself, without suggesting any sort of malingering or intent to defraud. This applies to vets and civilians alike. There are many cases of disability where the person really can’t work; gaining disability status is a godsend for them. It enables them to actually be more successfully productive in the community than continually failing in the workplace. BUT…Some people don’t do well being disabled. The status itself seems to undermine their ability to take charge of their lives.” Read more…

Emergence of the Trauma Industry

This article from The New York Times focuses on a particular criminal ex-cop. But reference is made to many other defendants involved in this particular crime, of “feigning mental illness” and invoking the 9-11 attacks as a source of psychological scarring. These crimes did not take place in a vacuum. They occurred in a social context where the defendants, many sworn officers, believed they could get away with it, and likely saw themselves as damaged and entitled.

The experience of trauma and even the development of a diagnosis such as Post Traumatic Stress Disorder does not correlate with a person being damaged or disabled. Trauma is part of the human condition, and in most cases the victims adjust, move on, and support themselves and their families – at times with the help of some therapy. Men and women have gone to war, and returned to productive civilian lives. A bureaucracy of entitlement for compensation and pensions based upon ones experiences, rather than one’s actual impairment, did not exist.

Only in recent years have we observed an emergence of a trauma industry, where both individuals and clinicians all too frequently appear to correlate an unfortunate experience or experiences with damage. The ability to obtain compensation likely has driven this process and outcome.

Those who die in performing their jobs or who sustain serious injury warrant eternal respect and honor. What of those who ride on the coat-tails of dramatic news, and do their sometimes unpleasant and highly stressful jobs? Has the human condition and the nature of trauma and war changed fundamentally in the past couple decades to explain or justify the increased level of diagnoses and compensation for trauma-related experiences?

The article reflects some who were caught. In the culture of cynical entitlement that appears to be reflected in the article, what remains unrecognized? Does one really believe that this case and the Long Island Railroad abuses cover and resolve the core issues?

106 Indicted in $21.4 Million New York Disability Fraud Scheme

An indictment unsealed on Monday by the Manhattan district attorney’s office charges 106 people, four of whom are accused of fraud in a scheme involving Social Security disability payments.

Many of the 72 city police officers and eight firefighters named in the 205-count indictment had blamed the Sept. 11 attacks for what they described as mental problems: post-traumatic stress disorder, anxiety and severe depression.

Several of the defendants documented their activities on Facebook. The bail letter includes photographs culled from the Internet that show one former officer riding a water scooter and others working at jobs including helicopter pilot and martial arts instructor. One is shown fishing off the coast of Costa Rica and another sitting astride a motorcycle, while another appeared in a television news story selling cannoli at the Feast of San Gennaro in Manhattan.

Read more…

Emotional Support, with Fur

Pocket, the author's pet, aka emotional support animal.

Pocket, the author’s pet, aka emotional support animal.

That a dog provides comfort to owners is a given. That’s why we call them pets. But now, under the guise of subjective criteria of any physician or licensed therapist and the perceived needs of certain individuals, some are claimed as a necessity that others must tolerate in the public sphere.

Some are claiming and demanding that their pets have therapeutic impact and address an emotional disability and must accompany them on planes, at work, in restaurants, and in pet-free housing. Others claim their animals can retrieve dropped items that they can’t stoop down for, or have the uncanny and improbable talent of detecting and stopping seizures.

Please note that highly trained service animals such as seeing eye dogs actually DO something and deserve respect and access to any setting. But a clear line must be drawn when it comes to animals whose sole talent is BEING. By all means, enjoy your pet, dress it up in silly costumes, feed it from the table, and pay for its chemotherapy. But someone else’s pet provides zero social good to society at large. It will never pay taxes, teach our kids, or shovel the snow off your walk out of altruism. They have earned no dispensation or right to privilege or sacrifice from the rest of us. As one commenter queried, she derives comfort from their husband — can he fly free and sit at her feet on a plane? One’s perceived needs and wishes need not be indulged by society, or endorsed with misguided and abused rules.

Benefits suspended for Long Island Railroad retirees

MCNTalk previously discussed the abuse of the disability system at the Long Island Rail Road. With this follow-up we see hundreds having their benefits cut off and reference is made to one doctor going to jail. While we have not followed this story closely, the article begs a number of questions:

  • Who else if anything was held to account for this glaring abuse? Reference is made to another defendant in the case going to trial soon? How many defendants are there?
  • For the Railroad Disability Board to not know or have reason to suspect abuse long ago is not credible. Is the leadership still in place? Ultimately the Board had to approve each application and there were individuals working there along with management who were fully aware of the nature of the claims. They were fully capable of using their heads to review and challenge. How many of the L.I.R.R. applicants had their claims reviewed and denied? What about other Railroad employees at other companies? Are their claims being similarly approved?
  • Are managers at the L.I.R.R. who were involved in this travesty still working there and are any of them facing charges?

Lastly, let’s look to the 600 retirees losing their benefits. In the original Times article, we note the following:

Virtually every career employee — as many as 97 percent in one recent year — applies for and gets disability payments soon after retirement, a computer analysis of federal records by The New York Times has found. Since 2000, those records show, about a quarter of a billion dollars in federal disability money has gone to former L.I.R.R. employees, including about 2,000 who retired during that time.

The L.I.R.R.’s disability rate suggests it is one of the nation’s most dangerous places to work. Yet in four of the last five years, the railroad has won national awards for improving worker safety.

“Short of the gulag, I can’t imagine any work force that would have a so-to-speak 90 percent disability attrition rate,” said Glenn Scammel, long one of Capitol Hill’s top experts on railroads. “That defies both logic and experience.”

Said Dr. J. Mark Melhorn, co-editor of a book on occupational disability published by the American Medical Association: “No one has a rate that high — that just doesn’t happen.”

Clearly those who applied for and received disability included a significant number of individuals who were engaged in fraud and theft from the government – from all of us. What is their punishment and account? To lose future benefits! How many if any will face prosecution and restitution? Just because everyone does it does not make it right. These individuals were not forced to apply for benefits and they were not forced to see particular doctors. They applied for benefits and most were fully aware of the scam they were engaged in.

Sentencing in the Long Island Railroad Disability Fraud Scheme

What is missing in this New York Times article is any reference to the consequences for those many claimants who engaged in the fraud, and the management and employees of the Long Island Rail Road, who clearly were aware that such fraudulent claims were the norm. Perhaps they were only counting the days until their own disability retirements. How many of those who Dr. Ajemian helped obtain benefits have been criminally charged for fraud and how much of the millions of dollars of ill-begotten compensation has been returned to the public from which it came?

What this doctor did, based upon the article, was reprehensible, but let’s not kid ourselves. The culture of disability is alive and well in the public and private sector. Well intended efforts to addresses excesses and distortions in the system may lead to personal attacks on those who try.

Release of the DSM-V

The American Psychiatric Association unveiled this past week the fifth edition of its handbook of diagnoses, the D.S.M-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth edition), after 14 years in the making.

This article in The New York Times neatly summarizes a major, on-going discussion over the publication. Per the author,

The media will trumpet the release of the new D.S.M., but practicing psychiatrists will largely regard it as a nonevent. Unfortunately, the same cannot be said for other institutions — insurance companies, state and government agencies, and even the courts — which will continue to imbue the D.S.M. with a precision and an authority it does not have.

Psychiatrists tend to treat according to symptoms. However, the manual carries a fair amount of clout with the rest of society: They are the passports to insurance coverage, the keys to special educational and behavioral services in school and the tickets to disability benefits. Sometimes a diagnosis of a condition like autism, A.D.H.D. or conduct disorder is necessary for students to qualify for special therapies. And diagnoses also figure in disability determination.

As noted, the D.S.M. is an imperfect guide to predicting what treatments will benefit patients most — a reality tied to the fact that psychiatric diagnoses are based on clinical appearances that tend to cluster, not on the mechanism behind the illness, as is the case with, say, bacterial pneumonia.

There are definitely changes in the D.S.M.-V over the fourth edition, and as the article notes much of this this will most likely change as researchers learn more about genetics, brain circuitry and cognitive data to fashion better guides to what to prescribe for patients, and in terms of what new compounds to develop. Read more…

Trends with Benefits: The Growth of Federal Disability Benefits in the U.S.

One of MCN’s favorite radio programs is “This American Life” from National Public Radio. The March 22, 2013 show, “Trends With Benefits,” was on the massive growth in federal disability benefits in the U.S. Much of this is no surprise to those of us who work in the sector. To quote their blurb:

“The number of Americans receiving federal disability payments has nearly doubled over the last 15 years. There are towns and counties around the nation where almost 1/4 of adults are on disability. Planet Money‘s Chana Joffe-Walt spent 6 months exploring the disability program, and emerges with a story of the U.S. economy quite different than the one we’ve been hearing.”

Well worth a listen. This American Life: Trends With Benefits

And additional information in available from the author on the web at:

http://apps.npr.org/unfit-for-work/