Many art, music, drama, poetry, dance and other creative arts therapists in New York State, now that we have Licensing (thanks to the tireless efforts of NYCCAT: the New York Coalition of Creative Arts Therapists) want to know more about how health insurance works in NY, especially those in private practice, so this post is some clarification about what I know in my experience since I got licensed in 2005, when we first got licensing.
Before getting my license, I was operating a private practice without a license and not able to take any insurance from patients, so I was naturally more than excited to be recognized finally as equal to social workers and other psychotherapists. The license was far more meaningful in terms of respect for our work and for the creative arts therapies than about insurance reimbursement, but money is a big part of respect.
Having the license gave art therapists working in hospital and other settings the chance to be paid equal to other clinical practitioners. Those in private practice were able to use the license to get reimbursed by SOME health insurance companies.
At present, Cigna, Aetna, and United Health/Oxford are the health insurance companies which I have had good experience with, in terms of getting any reimbursements and having the ability to take on patients who wanted to use their insurance for therapy. There is only a small percentage of such patients who would be willing to come to a therapist if their particular insurance would not reimburse, so this is pretty important for those who want to take insurance and want a large bulk of their practice to involve health insurance reimbursement. The reason a therapist chooses this is for building or keeping their caseload to a certain amount, not because it is easier!
Taking on patients with insurance brings many challenges. First of all there is the difference between in network and out of network reimbursement. Many people think it’s good to get on “panels” otherwise known as being an “in network provider”, which means that people who have that particular insurance can pay you a copay for each session, which is usually the part on the member’s insurance card that says “Specialist” and then an amount, which usually ranges from 0-$45, sometimes $50. People with the same insurance can have a range of copays, so if you are in network with Cigna, for example, you may have a patient who has no copay at all and no deductible in network, in which case, you usually have to fill out the 1500 claim form and submit it to Cigna and wait to get paid. You may have other patients with copays. With Cigna, if it isn’t 0, it ranges from 25$-45$. The advantage of a patient having a high copay is simply that you get paid quicker, as the fee you get per session is exactly the same no matter what the copay. A patient got the mistaken idea that when her copay went up, at least I was being paid more, but I explained to her that I get the same $67.93 per session no matter what amount she pays. This brings up a big disadvantage with being an “in network provider” with an insurance company. The fee is set and you have no say about how much it will be per session. For every individual session you get paid the same amount. Most insurance companies don’t seem to raise the fee properly every year to account for adjustment in cost of living. In the many years I have been in network with Cigna, and paid $67.93 per session, this year was the first year Cigna raised the individual therapy session fee to $71!
So one advantage of being in network is that most people do not have mental health or medical deductibles in network. However, this seems to be changing a lot, and is an important thing to check out when you get a new in network patient. The reason for this is the following: a patient comes and only has one or maybe 5 sessions. They pay you the copay as it says on the card. You submit the claim to the insurance company, only to find out that the person has a deductible of $600 if you’re lucky, or maybe $2000. This is most problematic with someone who comes one to 6 times and then stops, as you get stuck chasing an ex patient for money they now owe you. I have two of these situations going on. In one case the first session which insurance companies pay more for, Cigna pays $150 for the initial session, so I’m stuck texting and leaving messages with this patient that came once. It’s been at least 6 months now and she still owes me $150. In another case, the patient came about 5 times and owes me for those sessions. Through numerous emails and texts, I finally got this patient to start a vague payment plan which is already imploding. I don’t remember how much the patient owes, but it is probably about $300 or more, and I still don’t have it.
Another problem with being an in network provider is that insurance companies have all kinds of strange deals with agencies and schools, which may not be obvious until you have submitted a claim. I have a terrible situation going on because one of my patients had a very confusing plan with Cigna due to the school the patient is affiliated with. I am used to submitting claims to one Cigna fax number and then following up with a phone call to make sure the claim is processing. (Another part of the annoyance of dealing with insurance in network and out of network, paperwork, submitting claims and following up to make sure the claim is processed and paid, a very frustrating and time consuming activity that basically sucks and makes you want to scream at the poor customer service people who have the terrible job of dealing with irate providers all day. So in this weird case, it took a few months to even figure out that I had submitted the claim to the wrong place and faxed it to another place which was incorrect as well, or sent it in the mail. I finally through a few frustrating phone calls and looking again at the patient’s card, found an address to send the claims to. These claims now represent about 18 sessions from January to June 2013, and I have not been paid a cent by Cigna. Through more phone calls to different numbers and getting claim statements in the mail that my claim was being processed, I found out that the institution that handles the claims is waiting for a price quote from Cigna. I won’t go into further detail about this, as it is obviously incredibly frustrating to imagine not being paid for about six months of sessions! The only way to avoid this kind of disaster is to look very carefully at the patient’s insurance card the very first time s/he comes to a session to make sure you have all the info, not just the ID number and the usual stuff but look at the address and contact info and see what kind of Cigna or whatever insurance it is and what it is called, as the companies are huge and have all kinds of subsets of different arrangements.
Also, if you have longterm in network patients, watch out for the new year, which is when their plan could change drastically; the copay could go up or down, and there could suddenly be a large deductible, which, depending on the patient, could drastically change whether or not s/he even is able to continue therapy. Also in July, some employers change things around and have their fiscal year start over, so that is another time when you could suddenly find out your in network patient got their insurance switched to another insurance. It just happened to me with a patient, but luckily I take the other insurance out of network, the deductible was low enough and the patient is invested and ok with these changes…
OK: Out of network, advantages and disadvantages…: As an “out of network” providor, you set your own fee, which is really great, believe me! It means I can finally charge my full fee! The insurance company, if they pay your particular type of license, will pay you a percentage of that fee, and the patient pays a “coinsurance” fee which is the rest, and can range from 50%, not so great, to lower. Of course the more the insurance company pays, the better, and the more likely your patient is to be ok with having you as an out of network provider. Most therapists have these patients pay the fee in full and then they submit the claim to the insurance company, and the insurance reimburses the patient. Of course, being in NYC, and being a “nice” therapist when it comes to these things, as most of these out of network patients tend to be students, often either Aetna or United Healthcare, and as such, they cannot pay up front unless I am lucky enough to get a student whose parent pays me directly, anyway, I usually end up just submitting to the insurance and then either having the patient pay part of it or none of it until the insurance company sends the check to me directly for their portion of the fee. So this can be tricky, as there are many patients who don’t really want to have to pay up front, and given the choice, would just find an in network provider so they could simply pay a low copay. As an LCAT, I am paid out of network by as I mentioned above, Aetna and United Healthcare/Oxford. Blue Cross Blue Shield and GHI do not pay LCATs otu of network, so you cannot bill them. I have some patients who have Blue Cross, for example, who are committed to working with me and just pay me on my sliding scale. This is one of the good cases of not being able to take someone’s insurance. You get paid by your patient and don’t have to submit claims and waste time with insurance companies.
In addition, you don’t have to figure out a diagnosis for the patient, which in some cases is a big relief, as it can be tricky figuring out the right diagnosis for some patients. Not everyone has an obvious depression or anxiety disorder, which is most common for private practice, and some people present with symptoms that do not fit any particular diagnosis very well, so putting down the number for the diagnosis on the claim form is another big important potentially headache making part of taking insurance. Luckily in most cases with insurance the diagnosis is obvious; it is especially helpful when someone comes in who already takes prescribed psychotropic meds, though that is not always an obvious pointer to the diagnosis. There are no particular meds usually for such disorders as the skin picking or hair pulling disorder, which are now included in the chapter on Obsessive Compulsive Disorders; it could take a long time to even find out that your patient has such types of symptoms.
Anyway, I digress. All this is to say that people are wrong when they say to wait until your patient walks in the door to discuss fees. This is an old fashioned out dated point of view. It is actually much easier and usually you have no choice about it, to figure this out in a phone conversation or by email before your patient comes to you. I had someone come in only to find out that I did not take her credit card which she was using for all medical fees with Cigna. I was not sure she would find many therapists who would take her credit card, but maybe some therapists out there have started taking credit cards. Anyway it was a waste of her and my time. Sometimes it is clear that the person will not be using their insurance and in most of these cases I do wait to meet them to discuss fees. However, it is much easier to figure out what’s going on with insurance payment right away, especially with non Cigna patients.
In most cases, the patient does not know much about their mental health benefits and needs to be guided to contact Aetna or United or whatever and ask the following questions and then call you back if they find out they can work with you or figure out what they want to do about the fee:
Do I have out of network benefits for outpatient mental health providers? Is there a deductible? How much is it? What percentage of the providers fee does the insurance pay and how many sessions are covered? The last question is very important, as some companies only cover 20 sessions. The average used to be around 32, but now it can be as low as 20. Supposedly, insurance companies are not allowed to limit sessions if the patient has what is called a “biological disorder”. As far as I have found, that only refers to a few diagnoses, depression and bipolar disorder, schizophrenia and maybe a few others, but no anxiety disorders are included. I’m not sure about PTSD. However, even this “rule” seems to not be followed by all health insurance companies…
In addition, Medicaid and I think Medicare patients get no reimbursement for LCATs, so you either have to charge Medicaid patients a super low fee and consider them to be your “Pro Bono” patient, which I have done in rare cases. In my experience, it is worth it to do this when you have a very interesting kind of patient and the work is extremely rewarding and different from any other kind of work you have done. One of my most transformed patients is such a person, and it is one of the most rewarding experiences I have had recently in my private practice. As they say, great things come in small packages, ie. low fee!
Also, with art therapy groups in private practice, check with the insurance company what the rate is for that, because it is usually much lower than for individual therapy. Cigna pays only $40 per group session, for example.
Note to LCATs out there: as far as I know, Blue Cross, Medicaid and other insurance companies that limit their reimbursement to psychiatrists, psychologists and social workers do not care about the benefits of art therapy or other variants of creative arts therapies and there seems to be nobody to contact who would have any influence whatsoever on whoever decides what professionals to reimburse or not in NY state, so I would not waste time with individual companies trying to convince them to start paying us. Probably the more politically active among you may know which politicians or other organizations to work with to lobby or promote paying LCATs, so that is a great thing to do, but the insurance companies themselves do not care and are such huge beaurocracies, you might as well bang your head against the wall rather than waste any time trying to change their policies…
I am still interested in raising more questions about society’s views, perceptions, misconceptions, stereotypes and prejudices regarding mental illness, as well as asking, “How far have we come in a positive way?” because it is true that we are improving.
Let me make this post more reflective of some positive progress in our society in understanding mental illness. Recent disclosures of celebrities regarding their struggles have been invaluable. Like it or not, celebrities can have a huge influence on citizens’ thoughts and perceptions, regarding everything from attractiveness to mental illness. (Of course, Angelina Jolie’s recent public revelation about her double mastectomy has been instrumental in helping women cope with the possibilities of developping breast cancer, and I even know people who, after hearing about this, decided it’s about time I go get that mammogram I’ve been avoiding. How amazing and wonderful!)
Catherine Zeta Jones comes to mind as the most recent “celebrity confession” regarding serious chronic mental illness. She suffers from Bipolar 2 Disorder, which is less severe than bipolar 1, but her mere talking about her struggles and explaining them even went further to educate people, because the vast majority of people do not even know what Bipolar 2 is or about its existence, so one could argue that though she has a less severe form of Bipolar Disorder, she has been couragesous and invaluable in helping people understand how complicated Bipolar Disorder is and also even more importantly, that many people who have any form of Bipolar Disorder are able to function and contribute greatly to society. The mere fact that many individuals with Bipolar Disorder are “in the closet” about it at work and in other arenas, reveals how easily those people who are taking their medication and other treatments are able to “pass” as not having any type of mental illness.
Wow! How timely. I just googled her and bipolar and she has just the other day, emerged from going to a treatment facility for Bipolar 2. Here is the article in the LA Times:
Actually she first revealed her struggles with bipolar a while ago. In fact, she was “outed” in the fall of 2012 and discussed her struggles in her cover issue interview in InStyle magazine, so actually it should not have come as a shock that she sought out treatment very recently, as most people knew back in fall 2012, as InStyle magazine is pretty mainstream:
Zeta-Jones is not the first to discuss her struggles with mental illness and really help dispel a lot of stigma about it. I don’t usually like to quote from Wikipedia as it is so easy to just go there for info, and I like to cite a variety of websites, but they do have one of the most extensive lists of celebrities who have suffered from some form of schizophrenia:
There are many celebrities who have talked about their battles with depression, whether as a teenager or adult. Kirsten Dunst was all over the news in August-November 2011 talking about her most recent bout with depression. I learned about it from watching of all things, the E channnel’s coverage of Celebrities with mental illnesses. This supposedly “superficial” channel about celebrities actually did a great show quite a while ago and extensively covered the range of disorders from eating disorders to depression to anxiety, bipolar and also drug/alcohol abuse. I just looked it up and it came out in 2008; I remember watching the show and I really thought it was a great way to help people understand mental illness and related disorders and see that wealth and fame have nothing to do with mental health. This is the summary of that show:
“Celebrity Crises: 10 Most Shocking Mental Disorders is an American television entertainment special produced by E! Networks which documents the mental trials and tribulations of some of Hollywood’s biggest stars.
The special originally aired in the USA on E! Entertainment on 22 August, 2008. It is 50 minutes long.
When Hollywood stars are diagnosed with a mental health ailment it’s big news. From rumours about Britney’s bipolar disorder to Heath Ledger’s bout with depression, phobias and mental illness are getting more attention.
But of course, mental illness can affect anyone. Close to 58-million Americans — about one in four adults — suffer from a mental disorder.
From eating disorders (Mary Kate Olsen) to depression (Heather Locklear, Kirsten Dunst, Mia Tyler, Jim Carrey, Heath Ledger), to cases where stars have harmed themselves (Christina Ricci – cutting) this one hour special will explore ten troubling mental disorders, with interviews from doctors, psychologists and the stars themselves.”
The show may not have been extensive and totally informative about all these disorders. Who could do that in 50 minutes? However, it was great in scope and just introducing these different issues to the public.
There are also people in politics who have a lot of power to help the public understand mental illness and decrease the stigma and shame. There are also pioneers in the mental health field, such as Kay Jamison, who is not only an expert on mood disorders but wrote a great memoir of her own struggles with Bipolar 1 Disorder, titled “An Unquiet Mind”. The fact that she is well known for her own “coming out” about her personal struggles, indicates we still have miles to go in decreasing stigma, as we see that in the field of mental health itself, the majority of psychologists, psychiatrists, psychotherapists that suffer from any mental illness do not actually feel safe disclosing about their personal struggles. Another author and therapist who has written some great personal accounts of her own struggles is Lauren Slater. Her work is more on the edge and less well known to the general public, but she has written many interesting books about a variety of struggles.
So, in closing, I do believe that some of the best ways to educate the public about mental illness is through the mainstream media, whether it be a celebrity disclosing their struggles and talking openly about their treatment, or even films that attempt to focus on the topic, whether documentary TV shows like the one mentioned above, or the many biopics and fictions films about mental illness, such as the film “A Beautiful Mind” and the TV shows “Homeland”, “Six Feet Under” and “The Sopranos”, as well as numerous others. Even when such films or tv shows don’t give a totally accurate depiction of a specific mental illness (see my reviews of “Silver Linings Playbook,” they are still contributing to the more healthy dialogue that we need to have about this topic. A little misinformation is worth it if the subject at hand becomes more familiar to the general public and helps people view this topic with more compassion and less judgments…
ok. I had a terrible day today, so it feels like the perfect time to have fun writing this post because I saw Silver Linings Playbook for the second time the other day and I was blown away — by how much worse it was on a second viewing! I almost felt scammed or literally “played” that I had such a “manic” experience loving it after a first viewing.
Basically for me, the big test of a movie is, does it stand up to being seen a second and then a third and then maybe even a fourth or fifth time? Doesn’t matter how soon you see it again. As I said in my last post, that is why I love films like “Bringing Up Baby” and more modern ones like “Spotless Mind”; every time I see them, I find something else to love about them and get great enjoyment out of seeing scenes I could practically play over in my head between viewings, such as the dog and dinosaur bone garden digging scene in “Bringing Up Baby.” In fact when I realized how much lower Silver Linings sank on the second viewing I remembered that I talked a lot about Bringing Up Baby in my glowing post; and I realized it was because the elements I liked about Silver Linings reminded me of that classic and maybe reminded me too much of how great that movie was! A really good movie like the “Spotless Mind” one doesn’t remind you so quickly of other movies because there are really great cool things in it to enjoy that seem totally unique to the movie even if it is a familiar “genre”.
So what took the silver linings out of “Silver Linings”? Just about everything except the characters of Tiffany and the father played by DeNiro. The fact that on second viewing the main character Pat did not seem like a real person and those other “supporting” characters were more interesting did not help it. Other complaints that can be quickly listed off: too many montages (I challenge you to watch it again and count how many long montages there are and how much time they take up in between real scenes)– unless you’re watching a cool music video, you do not want to be aware of having a montage much less five or more of them in a movie. OK. I guess my other criticisms do not fit into a short list. Let’s take the most important one, the portrayal of bipolar disorder:
Anyway, that is a big problem with the movie on second viewing that makes me change my opinion of the TV show “Homeland”. I was a bit hard on it in my last review of this movie. I still think the ECT was strange and not well explained and that I would like to see the character have a session with a psychiatrist or therapist and also know what meds she takes, however at least her episodes are more realistically portrayed. We see that she is not in reality but we see how subtle it is that her reality is becoming out of wack, which is really well done on that show in that her job is already an inherently stressful and crazy paranoid making job and her obsession with the other character makes sense.
So “Silver LInings” still gets my approval for an ok portrayal of therapy and for the character taking the right medications. Probably the best scene in the movie that reflects the stigma of all kinds of mental illness is when he points out to his family and the others in the scene that maybe he and the other two “crazy” characters in the movie see things and understand things in a way that the others do not; I think that is true. If there is a silver lining to having a serious mental illness, it is that you experience life in a way that others do not and have a unique sensitivity towards others. The way seeing impaired people report that they their sense of hearing is very good…
So, lesson learned: watch out for getting too seduced by a movie that already has a lot of hype. Watch it at least two times before writing a big “I love it” blog post!!! We therapists sometimes get it wrong, that is for sure!
I am very excited to announce that the first of a two part interview that took place in my studio/office with art therapist Victoria Scarborough is now online at the above link! The interview is about how I started out in the field, my past experience, my present experience and current projects I am working on, as well as how I balance being an artist with being an art therapist. As on this blog, there is some personal information in it, in case you don’t want to know too much about me. (ie. patients out there and former patients and others, only read it if you don’t mind knowing a bit about how my personal life impacts my professional life…)
I will announce on this blog when she posts Part 2 of the interview.
Ok. I’m interrupting my attempt to get deeper into the issues around money and therapy because I have until the end of May to do my part in raising awareness around mental illnesses and the paths to mental health and stability…
I think this is too great an opportunity to pass up. On my personal Facebook I pledged to post at least once a day a fact or question to do with this subject. Then I decided to do the same on my LinkedIn “share” with connections. I am in too many professional LinkedIn groups to post on all of them! Then I decided to post about it on my public Facebook Artist Page. In fact after I’m done with this post I will announce it on my Artist Page.
I confess as a therapist and human who works closely with people on their very personal paths towards health and real soul fulfillment, feeling myself to be, or at least aspire to be, a sort of modern times Shaman or Doctor of the Psyche, I am really excited about this discovery that May has been Mental Health Awareness Month for over 50 years! How dare they not tell us in grad school or at our jobs and internships! How many therapists know about it??? Check with your therapist and/or psychiatrist to see if s/he knows about it! Spread the word! Thank goodness for the Internet and social media, as they help us raise awareness of such an important topic. There is just too much stigma out there about mental illnesses and so much ignorance. Why do health insurance companies still limit outpatient mental health treatment to 20 or 32 visits a year!?? How dare they set a limit on something so important in such an arbitrary manner! I’ve never had a patient with a mental illness who was invested in his or her therapy, who thought 20 visits or 32 sessions was enough per year. That has to change. What would people with one kidney do if they limited their dialysis visits per year? Unthinkable…
To get back to the point, though I don’t think I’ve strayed that far, in this post I will do what I’m doing daily on Facebook and LinkedIn: I’m going to make a list of ten questions or lesser known facts about various mental health issues. By mental health I include addiction, eating and personality “disorder” issues as well as trauma of various kinds and healthy positive behaviors related to this topic…
1. The relatively new phenomenon of personal blogs about how a person is living day to day with his or her symptoms and feelings about having some type of mental health issue is a wonderful way that people can see up close the courage and strength it takes for people to face their life day in and day out, struggling with staying healthy. It’s also a great testament to how far we’ve come with medications that work for people and with diagnostic criteria that help people come to terms with and manage their daily self care. Of course there is a lot more to improve with medication and treatment, but these very raw personal and honest blogs out there are a great way for people to feel less alone with their particular struggles. For some, the blogosphere is the only community they have and place they feel safe discussing such personal issues and struggles. So I start with a very positive aspect of mental health awareness by saluting all you people out there blogging about your struggles and triumphs. I follow many great blogs of this type and hope to find many more…
2. Schizoaffective Disorder: how many of you have heard of it? I first learned about it at an internship at a Continuing Day Treatment program long ago, so I have worked with individuals given this diagnosis. The term was first coined in 1933, but I have a feeling most people haven’t heard of it unless they have it, know someone with it, or work in the mental health field. You can find very particular detailed explanations of it on the Internet. I would describe it as bipolar and mood disorders meets and marries schizophrenia types of symptoms. What a challenge to be dealt this card! You have some sort of mood instability, whether primarily depressive, manic or both, as well as possible psychotic episodes, paranoia, hallucinations and delusions. For a really up close and personal account of it, read the memoir “The Quiet Room” by Lori Shiller. There’s still a lot of controversy about this diagnosis, and it comes up in this very moving book. In my experience, I think this diagnosis can be helpful to people suffering from such a confusion of symptoms because usually Bipolar Disorder and Schizophrenia thankfully now are seen and recognized and treated as very different because they are completely distinct. In the past people with either of these illnesses were lumped together , but we know a lot better now. However, there are some people who suffer from symptoms described by this “cross sectional” type of disorder. In my experience it really does exist, and the diagnosis is helpful, as people can be treated with both a mood stabilizer or anti depressant and an antipsychotic type of medication that people dealing with schizophrenia take, and they can have potential relief of their mix of symptoms and also begin to experience themselves as functioning at a much higher “level” in their lives which can be greatly improved and a lot less painful and confusing…
3. So, on the topic of mood stabilizers and “anti psychotic” medication, otherwise referred to as “psychotropic” medications: In contrast to what I said above, it can be confusing for people suffering from Bipolar Disorders, Schizoaffective Disorder, or other schizophrenia related disorders on terms of the wide variety of medications currently used to treat such illnesses. On the one hand, modern medicine has put to rest the confusion of what used to be called “manic depression” and “schizophrenia.” We all know now how different these are, but some of the medications treat both types. The difference is in the dosage. Old fashioned medications like Haldol, as well as the newer “anti psychotics”, such as Geodon, Risperidol, Seroquel, Zyprexa and many others, are prescribed for any form of psychotic episode, as well as being maintenance medication for schizophrenia and related “schizo” type disorders. To make matters more confusing, people with Bipolar Disorders, for whom a typical mood stabilizer like Lithium or Depakote, just to name 2 main ones, does not help enough to stabilize moods, can now take such medications as Zyprexa or Seroquel as mood stabilizers, usually on lower doses than for schizophrenia type symptoms. Some people with a kind of Bipolar Disorder take a typical mood stabilizer, as well as one of these other meds, and as well as an anti-depressant and other medications such as those for anxiety, which are in a totally different classification. So we’ve come all this way in distinguishing Bipolar type symptoms from those of schizophrenia related illnesses, and yet the same medications may be used to treat both. A little confusing. However, it is great that these other medications were discovered to have mood stabilizing properties, as some people need to take them instead if or alongside their regular mood stabilizers. Seroquel is also considered to have anti depressant properties, so probably some of the others like it also do.
4. While in my experience with working with people who suffer from very serious mental illness, mood stabilizers and medications like them can really be miracle workers for those suffering from Bipolar type issues in that, once the right medication or combination is found, people who take their medications daily can experience a great relief of symptoms and a sudden experience of real stability, those suffering from “unipolar” depressive illnesses such as dysthymia and major depression, tend to have more struggles with their medications. There are the lucky people who find the right anti- depressant and get relief; unfortunately of those people there is the group who after 6 months to a year find the medication no longer works, and they are plunged into a depressive episode and have to try some other anti-depressant(s) to see if a different one will work. For others, none of the different types of anti depressants out there seem to work. Some women in the latter group find a doctor who decides to try the more innovative treatment of using hormone medications to treat their depression. I read an interesting article about this a few years ago which really amazed me, as many people I know who suffer from mood disorders tend to complain that they can’t take birth control pills because it sets off depression. Others take hormones for birth control alongside their other meds without any trouble. Thankfully now there is a small group of women who take only hormonal medications to relieve their depressive symptoms! What a great medical breakthrough!
Ok. I have not yet reached number five and this post turned out to be much longer than I expected. So, the above is my food for thought on this topic thus far. I pledge to reach number 10 before Mental Health Awareness Month is up!!!