Monday, January 08, 2007

This afternoon I heard a gentleman here from the CDC talking about the ACE study. This is a very large, ongoing study, with fascinating outcomes.

ACE stands for Adverse Childhood Experiences - it's another way of saying emotional, physical or sexual abuse; neglect; substance abuse by parents; violence toward mother; divorce or separation of parents; incarceration of parent, etc. etc. etc. The list of adverse childhood experiences is so long it's hard to quantify.

What we know is that there is a relationship between the number of these a child has and their later health - physical and mental.

Adverse Childhood Experiences lead to social, emotional and cognitive impairment, which leads to high risk behaviors that gives us disease, disapbility and social problems and ultimately lead to an early death. The trick is to figure out how those experiences lead to the impairment which leads to the risky behavior - we know it does, we just don't know why. Yet. We will. Then the question will become what to do about it.

Interestingly enough, most of us have one or more ACEs - about 34 percent of women and 38% of men report none. The rest of us fall into the scale somewhere else. But, it's cumulative - if you have one you're at less risk than if you have three. By the time you have four there doesn't seem to be much distinction above that - i.e. having four is about the same risk as having seven.

When you look at the population as a whole, you find that behaviors such as smoking, risky sexual behavior, alcohol abuse, etc. do not fall randomly into the population. They cluster, and people who have one risk factor tend to have others. That's what prompted the research. The common factor is ACEs and how many of them we have.

This is important stuff - there is a correlation between these and everything from obesity to STDs to diabetes to heart disease.

This is not new research, but it is onoing. You can read more about it at It's exciting, but also painful. This is just one more example of how our mental health affects our physical health. There are new ones every single day, it seems, but still in most places insurance companies are not required to cover your mental health the same way they are to cover your physical health.

Did you know that people who are depressed are four times more likely to have a heart attack? But, we'd rather treat the damage to the heart muscle instead of treating the depression. By the way, the success rate with treating heart disease is about 45%, while the success rate with treating mental illness is about 85%. So, we'd rather wait until the person has a greater chance of dying before we do anything. There's some good thinking. Newt Gingrich is right when he says the health care system in the US is so broken it just needs to be thrown out and we need to start over.

What can you do? Bug your representatives. There's a good chance the Wellstone bill will pass in this session of congress with democrats in control and insurance companies will have to cover mental health sufficiently. The votes have been there to pass it, but republicans would not bring it to a vote. With democrats in control, mental health advocates think it will be brought to a vote and pass.

Oh, and when the lobbyists tell you how expensive it's going to be to cover everyone, they're lying. In Vermont, the only state that has true parity (equal coverage for mental and physical health), it did not cause a dramatic increase in premiums - it just meant that people got care and insurance companies made a tiny bit less money. How often do you hear of them going out of business? Exactly.

Many health insurance plans cover mental health at only $10,000 for a lifetime. Guess how long that takes to use up? It would be like saying heart disease is only covered for the first $10,000. Families mortgage everything they own to get care for their children. People go bankrupt. People lose their homes. Surely we can put an end to such foolishness. Surely.

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