We want to believe that our healthcare system will be there for us when we need it. And we rightly expect that those entrusted with our care can (and will) do everything in their power to give us the care we deserve. Yet, unfortunately, I—and millions of others—have found that our healthcare system is terribly broken. When we are too sick, fragile, weary, or ill-equipped to self-advocate and push forward—the times when we need support the most—the system often fails us terribly.

From alcoholism and opioid addiction to anxiety, depression, and schizophrenia, countless people are suffering without any hope of support. Our prisons and unhoused (homeless) populations are filled with individuals who suffer from underlying mental health issues. Those who are without financial resources often suffer the most, although no demographic is immune to this problem. What can we do to make a difference? Dr. Alice Feller, physician, advocate, and author of American Madness: Fighting for Patients in a Broken Mental Health System, offers a wise, shining light. When healthcare becomes big business, humanity loses in the long run. As Dr. Feller notes, “We need to get together and have a political change. We need to take medicine out of the for-profit realm.”

Get your copy of Dr. Alice’s book on Amazon or Barnes & Noble!

 

Get the help you need:

https://www.nami.org/advocacy/policy-priorities/improving-health/medicaid-imd-exclusion

https://www.aa.org

https://al-anon.org

https://na.org

https://www.nami.org/support-education/nami-helpline

https://www.samhsa.gov/find-help/988

https://mentalhealthhotline.org/ptsd-hotline

https://www.sossobriety.org

https://www.aasecular.org

 

Books by Dr. Carla Manly:

Joy from Fear: https://www.amazon.com/Joy-Fear-Carla-Marie-Manly/dp/1641701218

Date Smart: https://www.amazon.com/Date-Smart-Transform-Relationships-Fearlessly/dp/1641704675

Aging Joyfully: https://www.amazon.com/Aging-Joyfully-Optimal-Relationships-Fulfillment/dp/1641701412

The Joy of Imperfect Love: https://www.amazon.com/Joy-Imperfect-Love-Creating-Relationships/dp/1641709057

 

Oracle decks by Dr. Carla Manly:

Etsy: https://www.etsy.com/listing/1757477615/imperfect-love-reflection-oracle-cards  

Amazon: https://www.amazon.com/Imperfect-Love-Reflection-Oracle-Cards/dp/B0D1Z5M4YK

 

Connect with Dr. Carla Manly:

Website: https://www.drcarlamanly.com

Instagram: https://www.instagram.com/drcarlamanly

Twitter: https://www.twitter.com/drcarlamanly

Facebook: https://www.facebook.com/drcarlamanly

LinkedIn: https://www.linkedin.com/in/carla-marie-manly-8682362b

YouTube: https://www.youtube.com/@dr.carlamariemanly8543

TikTok: https://www.tiktok.com/@dr_carla_manly

 

Book by Dr. Alice Feller:

American Madness: Fighting for Patients in a Broken Mental Health System

 

Connect with Dr. Alice Feller:

Website: https://www.alicefellermd.com

Facebook: https://www.facebook.com/profile.php?id=61556805335369

LinkedIn: https://www.linkedin.com/in/alice-feller-m-d-751b3a132

—

Watch the episode here

 

Listen to the podcast here

 

MENTAL HEALTH MADNESS: Fighting for Support in a Broken Mental Healthcare System with Expert Dr. Alice Feller

Tips on Getting the Mental Health Care and Support You Need and Deserve!

Introduction

We want to believe that our healthcare system will be there for us when we need it. We rightly expect that those entrusted with our care can and will do everything in their power to give us the care we deserve. Unfortunately, I and millions of others have found that our healthcare system is broken. When we are too sick, fragile, weary, or ill-equipped to self-advocate and push forward. The times when we need support the most, the system often fails us terribly. What can we do to make a difference? Dr. Alice Feller, physician and author of American Madness, Fighting for Patients in a Broken Mental Health System, offers a shining light.

In this episode, we’ll focus on this listener’s real-life question, “My partner and I work hard, but we barely make our rent. We’re both tired and stressed. We have two kids. The 13-year-old suffers from awful anxiety and the 18-year-old drinks and vapes constantly. Our health insurance is terrible, so I contacted a local mental health program, but I got blown off. Can you point me in the right direction to get support?” With that question as the focus of this episode, I’m Dr. Carla Manly and this is Imperfect Love.

 

 

I’m joined by a very special guest, Dr. Alice Feller, who as a physician and educator, will be sharing her expertise on serious mental illness and the broken mental health care system. Her 2024 book, American Madness, Fighting for Patients in a Broken Mental Health System, is a provocative clinical memoir based on patient vignettes and personal accounts of her experiences in medical school, hospital wards, private practice, public clinics, and beyond. Spanning a career from the 1970s to the present day. Thank you so much for joining us, Dr. Feller. It is such a privilege and a joy to have you with us.

Thank you.

Before we launch into the meat of the show, would you please tell our audience a little bit about what makes you you?

What makes me me? Let’s see. I’m a thinker. I’m inquisitive. I like to look behind the covers and see what’s going on. I’m very friendly. I treasure my friends and my family. I’m very lucky to have friends and family. That’s probably about it.

Broken Mental Healthcare System

That’s a lovely peek behind the covers of your life. You have been in medicine since the 1970s and have seen so many changes. Before we launch into responding to the listener’s question through the lens of your considerable experience, would you for our audience maybe give us a snapshot of how you see the healthcare system today, specifically the mental healthcare system if you like to focus on that?

Some things are happening across medicine, all of it. One thing that I don’t think is so obvious to the public is that our medical records are now electronic. Almost all are electronic. That means a couple of things. It means that combined with HIPAA, which is health insurance portable or something rather, anyway, it’s privacy for all medical records and all medical information. It gets in the way of every communication.

Between that and the fact that it’s computerized means that we don’t get the information that we need on our patients. It used to be when we had paper records, an incoming patient, new patient, hospital, or outpatient, the first time we saw them, we’d write a long entry. What brought them here, who they are, work, family, symptoms, and past medical history.

We would get a lot, but the next time we saw them, we wouldn’t rewrite all that. Now, particularly in my experience, we get the same computer form that we fill out exactly the same way every single visit. Unfortunately, people spend half their time on the computer. This is across the board for doctors, nurses, and other practitioners.

The time that you used to spend face to face with patients, some of that has been taken away and put into doing all of the computer records. It’s interesting because not being in your field, it would seem to me when I go to the doctor that the electronic format that they’re using would be intended to make things easier and more comprehensive. That’s not what you’re finding at all.

It’s handy. I’m a Kaiser patient. The Kaiser is completely computerized. Since they’re not billing insurance, they are all in one. They’re a nonprofit organization. When you write a note, you know that that’s going to only be used for medical records for the benefit of the patient and to communicate with other people who see that patient, as opposed to the clinics that I’ve worked in recently. That EMR record is a billing tool. It’s designed to get the highest payment from Medi-Cal or Medicaid, whatever.

We didn’t bill private insurance, but people would write including the diagnosis. People would write schizophrenia. Almost every patient I had was diagnosed with schizophrenia officially, although many of them were not, and I could see that, but I couldn’t change the diagnosis on the computer. People would get their diagnosis when they first came into this system. That means that they would be diagnosed by the code put in by their case manager as someone who’s working to provide them with food, clothing, housing, and all that.

Kaiser, for our audience, is a managed healthcare system. It is a big organization, so it keeps all of your care ideally in one place within the Kaiser system. There are definite upsides and downsides to the Kaiser system. I happen to be a Kaiser patient. I have lots to say about that, but this isn’t the forum for that. I can see that when we look at what you’re talking about, already we’re looking, even though Kaiser is a “non-profit,” it is a big for-profit machine, which is what has happened to medicine today, at least through what I’ve seen. Is that what you tend to see that the people who want to make money off of medicine and healthcare are the ones who are thriving, whereas the clients might not be doing quite so well?

I worked at Kaiser for five years in the psych department, so I have an inside view, as well as an outside view, but I was already a Kaiser patient when I came. I’ve been a Kaiser patient for almost all of my life. It’s not so obvious why they would do that, but it’s obvious from my experience.

American Madness

We don’t need to get into some details that might not pertain to your book. Let’s look at your book, American Madness. Could you tell us a little bit about what drove you to write that book?

I didn’t start out to write a book. It’s my habit to write just to think. I write and after I write, I’ll realize something that I didn’t realize before or something about. It’s a way of exploring. I started working in these outpatient clinics that were for people with serious mental illness. I’d worked a lot of time. I’d worked for many years before early on in my career with people who were seriously ill, but it was before the EMR, before electronic medical records. I don’t think it’s just the EMR. It’s just the belief that medicine should be for profit, like every other industrial application. It shouldn’t be. It shouldn’t be profit-oriented.

That’s a big statement to me. I’d like to pause there because I very much appreciate that sentiment. When you say health care should not be for profit, could you tell me why? Could you tell us why?

I think we owe it to all of our citizens, all of our people, to give them good medical care that’s needed. There are things that come under medical care that I don’t think we need to provide everyone with like plastic surgery, long-term inpatient or intensive individual therapy, I can go on. That’s a different thing. I think short-term therapy and certainly vigorous care of people with all kinds of mental health issues should be absolutely part of it.

 

 

We’re somewhat talking about the obvious here for many people, yet we’ve gotten so far away from the obvious. It’s that if we monetize healthcare, then it becomes those who have financial assets get good healthcare. Those who are often most in need, impoverished, or suffering, even if they have finances, cannot navigate their way through the system.

Particularly those who don’t have good health insurance, such as our listeners’ question, where there seems to be some sort of a problem with healthcare insurance, which is not uncommon. They’re finding the person who wrote in, I don’t know the gender, but they’re writing in and saying, “Wait a minute.” It sounds like that individual and their partner are struggling, but the 13-year-old and the 18-year-old are also exhibiting problems.

They go to the community clinic and many of the community clinics or free programs are already overwhelmed. They’re not seeing somebody where they can send them right off to the emergency room or something, They feel as though their hands are tied. We get back to when we monetize basic healthcare, including psychiatric services, that we have made it so that a huge segment of the population cannot get the care they need.

Part of that is insurance. Private insurance has discovered that they don’t need to pay practitioners for mental healthcare. The word on the street is that we won’t take private insurance because they don’t pay enough. Actually, they don’t pay. They’ve discovered that they don’t have to pay because who’s going to go into court and challenge them and say, “I have a mental illness and you need to do right by me.”

People don’t do that and we cannot do it as doctors because of confidentiality. We cannot do that. Unfortunately, what happens is people in my field refuse to take private insurance often because they won’t get paid. We won’t get paid and you don’t want to start with a patient and then discover that yet again you’ve found another situation, another insurance company that’s blowing you off.

I can feel my ire rising as you’re speaking because there are many clinicians in America, whether it’s a physician or a psychologist who is not taking insurance. I’ve experienced this which is why I don’t take insurance because you spend hours and hours trying to advocate for a patient to get the reimbursement, and they stonewall you at every turn. I’m thinking of several situations where the clients gave up.

They gave up because it was too exhausting for them. I agree the insurance companies have it down. You go through these lengthy queues to speak to an agent who may or may not be in the US, who may or may not be understandable, and they send you to another line and another line and it is a game. Who loses?

The patients lose and the doctors lose. The practitioners lose because it sounds like you’re much like me. I want to do as much good in the world as I can. I want to help, help, help. If I’m spending 5 hours a day or 20 hours a week trying to advocate for patients. That’s 5 hours to 20 hours that I cannot be doing what I do best. I’m not cut out to be an insurance negotiator.

That’s not where I want to spend my time. I know I’m not alone. I know it sounds exactly the same for you. It’s so frustrating because for most of us, whether we have lots of higher education and many clinicians are still paying off student loans and have big debt burdens, we get into the field of healthcare because we want to help people and we want to do good in the world. It is a huge problem, as you’re saying, with insurance companies.

You the reach out, for example, in California, I’m a big believer in not complaining, but doing something about it. You reach out to the California Department of Insurance. They don’t do anything. They do nothing. I’m very sad to say that. As I was saying in the introduction, you have individuals who when you are suffering physically or mentally, often don’t have the energy to engage in the fight. You simply don’t. The people who need the support the most are the ones who are saying, “It’s okay, it doesn’t matter.”

I know several cases where people, and even in our county, I’m in Sonoma County, California, where one person who was a Kaiser patient committed suicide because Kaiser did not offer the mental health care that the wife who was, I believe, a Sonoma County supervisor was advocating for. The individual committed suicide. I think it’s terrible because even if you have a wife, a husband, a parent, or somebody advocating for you, those caregivers and advocates often get tired as well and frustrated. Tell us a little bit about what your book does and how it’s intended to help us.

A lot of these twists and turns that keep people from getting good care are not obvious to the public. I wanted to bring them out so we could campaign together and make things change. I also wanted people to read it, enjoy it, and keep turning the pages because otherwise, they wouldn’t get my message. I told people my patient’s stories and sometimes their parents because I would see their parents too. Their parents would bring them to their appointments and then we could talk a little bit. I think that’s important for patients with severe mental illness.

I wouldn’t do it. I wouldn’t meet with the mother of a boy, a young man who came in for OCD or something like that, but for people who are disconnected from reality, their parents need help. Often, their parents are the ones who are invested in making the treatment work or getting the treatment period because people who are in a state of psychosis often don’t think that they’re sick. It’s very helpful to have the parents come in.

 

 

Case Studies

Here’s a question for you. When we look at the vignettes that you offer in your book, the real-life vignettes, do you have one or two that you want to give us a gentle overview of so that the audience can see what it is like in your experience and how you see hope in these situations?

I can tell you a little bit about Chris, who was the exception. He came in with a psychotic break. He had schizophrenia. The worst possible thing you can have, but his mother brought him in and she also paid for the treatment. What happened was over a couple of years, he got better and better. That’s early intervention in psychosis, which we barely have.

Even if you have a lot of money, it’s hard to get that because it involves more than a single therapist or a single doctor. It involves a whole program, which is not well known, but it involves someone who can do meds, a psychiatrist, maybe a nurse practitioner. Someone who can do long-term therapies well, excellent therapies. It’s not just you ought to do this and that.

It involves including the family and bringing the family members in. It involves also rehab to get people back to school and back to work. They’re back into the fold part of everything else rather than being stuck in their psychosis by themselves. That actually can work if you start early enough. What happened with my patient was he flew home after being hospitalized at his college and his mother brought him in.

I could see that he didn’t want to be in. I was the third psychiatrist in California who had seen him. It’s a lot to take on somebody like that. I had questions. Why was I doing this? He didn’t believe he had anything wrong with him. His friends were playing tricks on him. That’s where he heard these voices. It took months before he thought maybe those were hallucinations. Even then, he wasn’t sure at all. He didn’t want to commit to that.

Gradually, as he stayed on the medication, we adjusted it according to what was working and what wasn’t. He got on the right combination of meds. I saw him for therapy too. I was both the med person and the therapist and his mother was the family. His mother also got him starter jobs so that he wouldn’t be doing nothing. That is an example of early intervention in psychosis which is a rare thing. We need it all over. We need it in every county because even people who are well off, their kids are getting left behind to deteriorate.

Early intervention in psychosis is rare, and we need it everywhere, in every county. Share on X

It’s interesting because we have so many issues with talking about mental health and openly discussing concerns on huge mental health disorders such as psychosis. People are embarrassed about it. They don’t want to talk about it. They want it to go away or they want a quick fix. We can look at Chris, your patient, as an example. You did say the parents have money. That is a huge asset because the mother could afford the time and the financial investment.

She was able to track you down. Thank goodness they fell into your hands where you were able to watch the meds rather than just throwing something at the individual, which happens a lot. People are given a medication, whatever the medication du jour, and it’s thrown at the individual. If it doesn’t work, the individual thinks they’re broken, not the fact that it often takes repeated tries and ongoing tries to regulate the dosage to find the right medication, the right combination of medications.

Often clients, patients don’t get that level of treatment, that level of care they deserve. Let’s imagine that Chris is the child of the listener and instead of it being anxiety, because they wrote about anxiety and the vaping and drinking issue, let’s imagine that this family is faced with an individual who is suffering from psychosis. What would the outcome look like from your perspective with the situation that they’re talking about?

Is it a good outcome or an unfortunately not-so-great outcome?

What you would expect in America, given the level or might we say low level of healthcare services?

Unfortunately, what often happens is people don’t want to think that their kid has psychosis or schizophrenia or anything like that. That isn’t in the standard conversation. It doesn’t cross their mind. They think he’s having a hard time, not doing so well in school, and he’s withdrawn from his friends, and he seems in a bad mood, and sometimes he’s a little weird, but they don’t think, “This is psychosis or this could be, and we need to get them evaluated.”

What happens is often the young person will be provided with psychotherapy, and they won’t get anywhere, but that happens. In the meantime, they’re getting sicker and sicker until you have to get in early. That’s one thing about early intervention. You have to get in early, like within weeks or months, not years.

 

 

What I’m hearing you say is the outcome for this individual in an ordinary or lower-income household, the outcome might be quite awful.

Yes, it is.

I know you have vast experience in addiction and working with individuals who are suffering from addiction. Do you have a vignette that might speak to the older child, an 18-year-old who’s vaping? It sounds like the child is vaping and drinking constantly. Do you have a vignette or a case study that speaks to that or close enough?

I had a young patient who had been in the system for quite a while, but he had gone to juvenile hall when he was in high school. He came out of that experience using heroin, alcohol, and marijuana. After that, he remained addicted and he’d get kicked out of his housing because of it. He was diagnosed as schizophrenic. The other thing about the wrong diagnosis of schizophrenia is that it is also generally assumed to be correct and the patient is put on antipsychotics which don’t do them any good and can cause a lot of harm. Tardive dyskinesia is a long-term side effect.

Could you say for people who don’t know Tardive dyskinesia, how difficult it is for individuals because it’s frightening and it often does not correct even over time?

It’s a movement disorder and it’s much less common today than it was when people were coming out of those state hospitals where they’d been for years. You often see people with chewing motions and they’re not chewing anything. They cannot suppress it. If they think about it, they can suppress it. That’s the one that we see most often. Some poor person will climb on a bus and they’ll sit there and they’ll be chewing and it’s not anything that they’re eating. It’s weird. It’s off-putting. It isolates them more than they already are.

That is a huge piece of what makes me so passionate about this topic, that individuals who are already suffering from mental health disorders, which is difficult enough, end up feeling so broken, so damaged. A large proportion become homeless, and a huge proportion of our homeless people suffer from mental health issues that haven’t been addressed.

A huge proportion of our prison population is stalked with people who never got the early intervention and appropriate care that they needed and deserved. I love that your book calls it out, the main title, American Madness, because it doesn’t have to be this way. I have worked with enough clients where the listener of today’s question doesn’t surprise me.

I know from my client stories, from friend stories, and from actual life experience how difficult it is in this very wealthy nation that we have. It is so difficult to get the basic care you need, particularly the basic mental health care because for some reason, we prioritize physical health care over mental health care.

I often ask people when we get into discussions about mental health care, “If you could have perfect physical health or good mental health, which would you take?” People will pause and look at me and they’ll say, “Can I have both?” I said, “In my little situation that I’m offering you, you have to choose one.” For me, it always comes down to, and most people choose, good mental health because if you have good physical health, but you have terrible mental health, then what good is physical health because you’re in constant torment, whatever the affliction?

Expert Advice

Taking it back to our listener’s question, what would you recommend for individuals who are struggling to find the support and the care that they need? Not just focusing on one area of the country or one area of the world, but globally or we can keep it more to the US because other healthcare systems are managed than ours. As an expert, what would you recommend?

For a family with a son or daughter who is abusing alcohol and vaping?

We can stay with that, or we can look at the one where there’s chronic anxiety. Let’s stay with the addiction one because I think that one is so common and one that brings up so much embarrassment for families even when we do have programs. Alcoholics Anonymous is such a fabulous program for many people and there are lots of good resources for parents like Al-Anon. Sometimes that’s not enough and what somebody needs is residential treatment, yet getting good residential treatment is extraordinarily difficult.

Part of that is if you’re under 21 or under 18, it’s much more possible but once you go over that age, there’s a law called the IMD exclusion. Have you heard about that?

No, actually, please.

The IMD exclusion was put into place when Medicaid was created in 1965. What they decided was that they would not cover inpatient mental health care, and they wouldn’t cover inpatient addiction care except for people under 18 or over 65. It’s a long wait you have before you can get help.

That’s called the IMD exclusion.

IMD is the Institute for Mental Disease. It applies to mental hospitals or inpatient residential treatments for drug addiction.

I’m dumbfounded. In this state, we do not have to provide inpatient care for drug addiction, or mental health issues.

That’s right.

I hope there’s a change in the wind on that one. Nothing that you see?

I think it’s so important. I think it’s the basis of so much because money speaks.

Money speaks. It’s the basis of so much. Share on X

I believe that when we’re talking about inpatient treatment, I used to volunteer pre-pandemic at a drug and alcohol rehab facility on Tuesday mornings, and there was such good work being done, such fabulous work being done because when you are in a facility where you are with people who are struggling with similar issues, where you have a certain layer of insulation from the stresses of the outside, where you have time for your brain to get reprogrammed, for your daily habits to get reprogrammed.

Addiction is not a moral failing. Addiction is a disease. When we look at any other disease, we would happily give somebody inpatient treatment after suffering a severe stroke or an automobile accident. Yet for some of these other issues, and I’ve seen again and again where people get a modicum of treatment, a little bit of therapy, maybe some AA meetings, and then they’re back out, and then we blame them for their drug addiction when they simply haven’t had the ongoing support that they need.

It’s very hard. Addiction is difficult to face. I have friends who’ve dealt with it and on with their lives and patients who’ve taken advantage of our care and stayed in groups. I think groups are very important for chemical dependency, more important than individual therapy.

Groups are very important for chemical dependency and may even be more important than individual therapy. Share on X

I agree with you. I’ve said so many times on this show. I used to run a very large women’s support group. It had 300 members. The power of the group, once you get through the fear of being an outsider or having other people know who you are because maybe you’re a doctor or a lawyer or you work at the front desk of a restaurant where everybody will know you whatever it is, people are afraid.

When you have confidentiality in place and good policies, people learn from each other in groups. You get the support, you get to hear other people’s stories, you get to see yourself in other people. You feel as though you’re not broken because you’re with groups of people who are struggling with the same issues because we are all so much more alike than we are different.

When we realize that support groups, whatever works for somebody. It might take some time to find the right support group. That’s one of the things I appreciate about AA and similar support groups. They have a variety of groups. You can pop in and visit one until you find the right one. I remember going to an Al-Anon group as a visitor because some of the groups allow parents or people to go simply as visitors. They’re fabulous and generally free.

It’s the most successful method of treatment.

I agree. For people who don’t like the AA paradigm, there are some that don’t look at having a higher power that is also good, For the listener who wrote in, who is so frustrated in your community or somewhere within driving distance, I am hoping you can find for the older child, the AA group, or for the parent, the Al-Anon groups. I was helping a client yesterday. I believe that as practitioners, we often become advocates for our patients, for our clients in ways we don’t expect to.

They’ll be confounded. They’ll say, “I don’t know how to do this.” It takes me a few minutes to Google and out come resources right and left for elder care, for this, for that. That’s part of what we do as clinicians, and I’m sure you do as a physician. It’s to offer resources and I believe part of our responsibility is to make resources available because for those who are stuck and struggling, what might be as easy as typing on a keyboard for us feels like a monumental task for them.

That’s true.

HIPAA And Patient Advocacy

You do such important work, Dr. Feller. I am so impressed. When we go back to HIPAA, the Health Care Information, Portability, and Accountability Act, do you see that working for patients or against patients?

Against patients, definitely. You can get a signed release of records permission from your patient and you can send it to the last place where he was hospitalized. It’s happened with a guy that I told you about who has had several drugs. He had been in a long-term place, a kind of step-down facility, but it was locked. He stayed there for six months I think. Since it was an inpatient unit, even though it wasn’t acute care, I thought that they would take him off his drugs and see what he was like.

Did he have schizophrenia? I wanted to know. They signed a form and I sent it off and never heard back. I called and wrote and begged, but never heard back. It’s this idea that we’re protecting the patients, we’re doing the right thing by not revealing anything. I think also that it slides into an easy way for the other side to not take any responsibility.

To use it as an excuse to drop the ball.

Right. To not reveal how little they did. I don’t think they took anybody off their meds. I think they kept everybody on their meds the whole time without any thought of whether that was right or whether they needed them.

Path of least resistance in many cases I thought is something that I see all too often when families reach out to me because often a child is struggling with something. You start getting into the thick of it and you realize that the cases have been mismanaged and the mismanagement is cloaked. The parents don’t know how to advocate and get out of that web.

I know with Kaiser, it’s interesting. I’ve discovered how they use the client’s information to do all sorts of surveys and studies and fact-finding about their patient population. People don’t realize that they are doing it. They think that they’re protected, but they’re not protected in that way. It is a big science experiment in many ways, so to speak. They’re not getting the care that they need, although they believe that they’re protected and they aren’t getting the protection that they deserve as well. It’s interesting that you say that when you called the facility that your client was in, you as a physician weren’t given access.

There are no ways. I don’t think they wanted to come clean and say, “We don’t do that here. We take the money, we have a good snippet. This place is run by a corporation.” I think it was even more money-focused than some others.

If there’s a takeaway on this part, I’m hearing you say that we as consumers, we as patients, and we as caregivers need to keep our eye out for the good of the individual that we’re dealing with, whether it’s the self or a child or a partner, and realize that in many cases, we are working with money focused, money-making entities. We cannot let down our guard because it’s so easy to look at a physician and say, “The physician is going to do the right thing by me.”

I’m not maligning physicians,” but they are operating under this corporate umbrella where we have to realize as consumers, their hands are often tied because of the big business behind them. As you’re saying, where your one client ended up, there was a big business behind it, and they weren’t focused on your client’s well-being. They were focused on keeping your client in their streamlined process, whatever that was, so they had the income, and whatever happened with your client was going to happen. It wasn’t the client’s well-being they were interested in.

No, and I think the family had no idea. The family had pulled levers to put him in that place. They thought it was a good place. They made a nice presentation, this outfit. I’m sure that they made a pleasant impression on the family. The family thought he’d be well taken care of. How do they know? They don’t know about differential diagnosis. They don’t know about the wrong diagnosis and looking into that. They don’t know how to look at treatment and see if it doesn’t make sense.

You’re right. For some people, they’re lucky enough to have a physician or a psychologist in the family where they can bounce things off. For many people, they don’t. We go back to that place. We’re all human. We all get weary. No blame and no shame to parents at all, but it is important for us to realize there are advocates out there.

There are agencies, even if not the health California Department of Insurance. There are agencies out there where we can go and make some noise and we can write letters to our congressmen. We can write letters to our local newspaper. We can get on podcasts and we can talk about this. A big takeaway I know from my experience is if you as a parent have a child or someone you love and they aren’t getting the treatment they deserve, then be an advocate.

If it’s an elder, reach out to elder care services. If something doesn’t feel right in your gut, listen to your gut. Don’t override your gut. Be that person who is a “pest.” Be pesky. Be curious. There are resources out there and often if you have the bandwidth, you can find them by googling something like community resources, community support groups, or talking to other people. Don’t be afraid, don’t be ashamed to talk to people in your community about their experiences. Ask for support. What would you say about that, Dr. Feller?

I agree, and also I think that we should take political action. We should abolish the IMD exclusion. It has no reason to be there. People think, “If we pay all this money to put these people in an actual hospital instead of in jail or on the streets, it’ll cost way too much money.” Think of all the money that we’ve saved if we gave people at the beginning of a psychotic illness the early intervention treatment right then and there. That would cost something that it would save. They probably wouldn’t end up in jail. They probably wouldn’t end up disabled. They probably wouldn’t end up on the street. All those things, we pay so much for our prisons, our homeless assistance, and lifetime disability.

 

 

I am 100% behind you and I’ll echo what you were saying earlier, not just with psychosis but with every aspect of our lives. Early intervention. It is so human for us as imperfect beings to want to ignore problems in a child, to ignore a problem in ourselves or a partner or a parent, yet listeners, early intervention, when you notice something is awry, reach out.

Even if you’re tired, I get it. I get tired. It’s so difficult to be an advocate when you’re tired. Remember, early intervention, whether for eating disorders, depression, anxiety, most of these issues, schizophrenia, childhood issues that are manifesting. Reach out for support. Reach out. Be curious. If somebody’s just throwing medicine at the situation, I’m not anti-pharmaceutical, but have questions. Ask for a psychotherapist. Ask for a psychiatrist. Ask. Demand a body-mind-spirit approach to the situation rather than somebody throwing a $20 bottle of pills at you to try and cure the situation and then feeling broken if that $20 bottle of pills isn’t the quick fix. It usually isn’t. What do you think about that, Dr. Feller? I’m very passionate about this.

I agree. That makes a lot of sense.

Listeners, if you have a takeaway and for the dear person who wrote in, when we’re exhausted, it’s very difficult to continue the fight. Remember, there are local resources. If you’re angry about this, and I’m a big believer in this, if we’re angry about something, let’s channel our energy into making a difference. The IMD exclusion, which as you were speaking and once you gave the date of 1965, remember maybe listening to a podcast about it where there was a big shift in the health care, but they stopped midway.

 

 

Wrap-Up

They didn’t go the whole way to affecting the greater changes that were on the horizon and so it got stuck there. The intention was good, but it got stuck and left behind. We can all make this world a better place by being a voice individually and collectively. Dr. Feller, you are so wise and you have so much to offer. Are there any other pieces before I ask where our audience can find you and your book that you’d like to share?

At the back of my book, I have twelve recommendations that come out of the book. There are twelve things that we ought to do. I would say even if you don’t buy the book, which I hope you do because it’ll explain it much better, look at those suggestions. We need to get together and have a political change and take medicine out of the for-profit realm.

Thank you. That is a very good way to end. All of my listeners are tenacious. We are a tenacious group of people. That’s why we listen to podcasts and want to learn and grow because we are tenacious. We can make a difference. Dr. Feller, where can our listeners find you?

Physically, I’m in Berkeley, California. Probably more relevant is the book which you can buy at Amazon, and five different other places online. You can go to my website, which is probably the best place to find me, which is AliceFellerMD.com.

Thank you, Dr. Feller, for sharing your time, your expertise, and your wisdom with us. I thank you, our audience, for joining us. This is Imperfect Love.

Thank you for having me, Dr. Manly.

Thank you, Dr. Feller.

 

Important Links

• Dr. Alice Feller
• American Madness, Fighting for Patients in a Broken Mental Health System
• AA group
• https://Al-Anon.org
• https://NA.org
• https://www.NAMI.org/support-education/nami-helpline
• https://www.SAMHSA.gov/find-help/988
• https://MentalHealthHotline.org/ptsd-hotline
• https://www.SOSSobriety.org
• https://www.AASecular.org
• https://www.BarnesAndNoble.com/w/american-madness-alice-feller-md/1144470063
• https://www.NAMI.org/advocacy/policy-priorities/improving-health/medicaid-imd-exclusion/
• Website: https://www.DrCarlaManly.com
• Instagram: https://www.Instagram.com/drcarlamanly
• Twitter: https://www.Twitter.com/drcarlamanly
• Facebook: https://www.Facebook.com/drcarlamanly
• LinkedIn: https://www.LinkedIn.com/in/carla-marie-manly-8682362b
• Youtube: https://www.YouTube.com/@dr.carlamariemanly8543
• TikTok: https://www.TikTok.com/@dr_carla_manly

 

About Dr. Alice Feller

Dr. Feller has been in practice since she graduated from medical school in 1977. She began her residency training at Chope Hospital in San Mateo and finished at UCSF, after which she did a two year physician fellowship in substance abuse treatment at the Fort Miley VA Hospital in San Francisco. After that she spent five years at Kaiser Oakland, where she was hired to expand and improve their substance abuse treatment program.

It was at the height of the crack epidemic in Oakland and they doubled and vastly improved the program. Following that she entered private practice. In addition to providing individual psychotherapy and medication as needed she provided couples therapy and conducted therapy groups, especially for people in recovery.

She has witnessed the power of groups in recovery, including the Twelve-Step program. In addition to clinical work she has served as an expert witness in civil cases and a consultant to the California Medical Board on issues of substance abuse.

She is a psychoanalyst member of the San Francisco Center for Psychoanalysis (SFCP) and has taught classes for SFCP and for the UC Berkeley Extension program, with subjects such as analytic listening, analytic writing and the bio-medical basis of addiction.