Kentucky Gov. Steve Beshear, right, and Kentucky Health Benefit Exchange Executive Director Carrie Banahan discuss insurance reforms at a press conference in Frankfort, Ky., on Sept. 10. (Roger Alford/AP)
Kentucky Gov. Steve Beshear (D) added his voice to the public debate on Obamacare on Thursday, perhaps leaving readers to scratch their heads trying to make sense of how this governor represents the same people who voted Sens Rand Paul and Mitch McConnell into office. His message to Republicans in Washington frantically working to obstruct implementation of the health-care law: “Get over it …and get out of the way so I can help my people.”
In a New York Times op-ed piece titled “My State Needs Obamacare. Now.” the governor argues that the Affordable Care Act is essential to the radical health-care reform needed in the Bluegrass State, where 640,000 people are uninsured and the collective health of Kentucky residents is “horrendous.” Noting that Kentucky “ranks among the worst, if not the worst, in almost every major health category,” the governor provides a glimpse of the day-to day stresses of Kentucky residents living without adequate health-care coverage while also making the case that Obamacare will bolster the state economy.
As a clinical social worker working with poor families in central and eastern Kentucky, I have directly witnessed the problems of uninsured Kentuckians: a middle-school girl whose foot became so infected it almost had to be amputated; a woman sawing off the cast on her broken wrist herself to avoid the cost of the doctor visit; toothless 40-year-olds who accept chronic dental pain as a fact of life.
But I also see the less graphic but no less profound reality of mental health problems in the lives of low-income families. I have observed how the poor mental health of an uninsured parent can affect the well being of the children and the family as a whole.
In the case of one 9-year-old child I worked with, Zach (not his real name) suffered from extreme separation anxiety and could not bear to go to school and leave his father alone at home. Due to his distress, Zach was unable to focus while at school and began to act out, shouting in the classroom, refusing to do his work, insulting teachers and threatening peers. At one point, his symptoms became so severe that his teacher heard him “talking back” to (what she assumed was) a peer out of her line of sight. When she investigated, she saw that no other student was present in the boys’ bathroom with Zach, despite his insistence that voices were harassing him. That’s when he qualified for a state-funded program providing services to children with severe mental health needs, and I became his therapist.
As soon as I met with the family, I learned that Zach’s father suffered from long-term major depression that had never been treated. Although the mother worked full-time as a cashier, the family lacked health insurance. The father had plunged into a depression three years earlier and had not received any mental health services during that time. He coped with the depression by sleeping as much of the day as possible.
Zach’s anxiety about separating from his father was well founded. Just before Zach’s disruptive behavior began to escalate, his father had slit his wrists -– a suicide attempt that took place in the home. Zach knew all about it, right down to details about the cutting instrument. The father was treated at the state mental hospital and discharged after a short stay, but with no health insurance he had not received any follow-up services.
Fortunately, there is a free clinic in the community that offers psychiatric medication management services and psychotherapy, as well as medical care. After much persuading, the father agreed to visit the clinic, where he was immediately treated for high blood pressure and depression. Even his medications were provided at no cost.
Within a month this man’s health showed signs of improvement: His blood pressure was lowered, and his depressive symptoms responded to the anti-depressant prescribed by the psychiatrist. Not only did he sleep less, he began to talk about looking for work, improving his marriage and family life, and taking care of his health. Moreover, he understood that by working to manage his depression he was taking responsibility for the well-being of his family, especially his son.
Zach quickly noticed the difference in his father. And although not all of Zach’s behavior problems immediately disappeared, the most severe symptoms related to separation anxiety did. Even after he stopped taking anti-psychotic medication, Zach no longer heard voices. He was able to tolerate longer separations from his father and to recognize that his father was no longer so sad. Most important, Zach was able to verbalize that his father had a therapist, just as he did, and that it was the role of his dad’s therapist to monitor his dad’s depression. That didn’t need to be Zach’s job anymore.
One takeway for 9-year-old Zach was to rest easy knowing that it’s the responsibility of grownups to care for his dad’s mental health. I’m relieved that Gov. Beshear agrees and is ready to roll up his sleeves to begin the hard work of improving the health of Kentuckians. And I echo his message to “those more worried about political power” than the well-being of the people of the commonwealth: “Get over it…Here in Kentucky, we cannot afford to waste another day or another life.”
