It's been a long week. It's kicked my ass, but rest assured I've been fighting back. Monday, as you know, I learned that the VA (the Central TX VA healthcare system in particular) does not provide psychiatric treatment for women veterans during their pregnancies. They don't provide treatment because a pregnant veteran who requires (or at least wants to utilize) medications as part of her treatment during her pregnancy is carrying a potential lawsuit in her womb.
It doesn't matter if the medications she's on are deemed safe by reproductive psychiatrists, obstetricians, and maternal mental health experts in the civilian sector. It doesn't matter if the risks of the potential birth defects associated with those medications are significantly low, and the benefit of the mother being treated outweighs the risk. How the mother's illness affects her and her child during pregnancy does not matter to them. In their mind, the risks associated with a mother's untreated mental illness during pregnancy and its effects on her child in the womb aren't that important.
The VA made it clear to me on Monday that by discontinuing my medications, they could care less about my mental health and they are far more concerned with being held liable for an incidence that the research and my obstetrician says is less than 1%.
The stupidity of this whole situation is they failed to see that by discontinuing my medications, especially without notice, THEY ARE STILL LIABLE if something were to happen to myself or the baby. Discontinuing medications during pregnancy for a woman with a mood disorder can exacerbate her symptoms and puts her at risk for relapse. (For more, read this from Postpartum Progress) Discontinuing a patient's medications and psychiatric treatment-especially without their knowledge-is dangerous and unethical; to so do during a patient's pregnancy not only puts the patient in grave danger but also the developing baby-you know, the one they are so concerned about being held responsible for when it's born.
Stopping meds cold turkey and without supervision can have serious, and even deadly consequences. My illness is hard enough to manage with medications-without them my ability to function and care for myself and my family is significantly impaired, and the risk of my falling prey to suicidal ideation increases significantly.
The VA has been in charge of my mental health care since my diagnosis in July 2011; for them to just decide to "drop" me and try to dump their responsibility on my obstetrician, (not knowing if he would even be able to continue my medications, as they had never spoken to him about my mental health or OB care)? Yes. I took it personally and the desperation I felt about the situation only deepened my anger. The thought of continuing on in this pregnancy without comprehensive psychiatric treatment (medication + therapy at a minimum) terrified me, as did knowing my risk of developing postpartum psychosis is 25-30% higher than others just because I have bipolar disorder. I felt and still feel that I shouldn't have to fight to find and pay for treatment through a private psychiatrist and therapist when the VA has already been treating me. (For the record, Austin lacks psychiatrists who treat pregnant women AND who offer affordable care. Trust me, I've called 38 of them.)
If you follow me on Twitter you probably witnessed my emotional and enraged tweets to the Dept of Veteran Affairs' national account. Sure, I made phone calls to voice my anger and search out an answer and resolution, but I threw caution to the wind and let my anger do the talking tweet after tweet in the hopes they'd answer. I knew it was a long shot, but as desperate and fed up as I felt, I figured I didn't have anything to lose. So I unleashed my fury. I ranted. I wrote a post here and cross posted it on BlogHer.
Guess what? They listened. The social media manager for the VA's twitter account responded to one of my tweets Monday evening and Tuesday morning DM'ed me asking for my last name and last four of my SSN to pass along to the patient advocate in Austin. I don't know what was said during their conversation, how many people they called or who on the VA totem pole here in Central TX they got ahold of, but at 4:30 on Tuesday, the director of the VA mental health clinic in Austin was issuing me an apology. AN APOLOGY. From the VA. Y'all. This just doesn't happen. If it's one thing I know from dealing with them since I separated from the Air Force in 2006, it's that they don't apologize for shit, no matter how royally they screw things up for you.
So next Tuesday, I will be seeing a new psychiatrist-one who is a "clinical pharmacologist who is well versed in medications and can assess your treatment plan with [my] OB," since my OB "doesn't have a problem with you taking these medications and deems them safe." (But I thought the VA here didn't have anyone "well versed" in such matters? They must have hired someone pretty quickly if that was the case up until Tuesday!) I'll also have my own therapist and will FINALLY be getting the psychotherapy I've been requesting since I moved here in August.
I also called my OB and informed him of what was going on. Naturally he was both hesitant to prescribe me my meds and confused as to why the VA was refusing to treat me, yet expecting him to. Although this upset me, I didn't blame him-I'm a new patient, he's not the one who originally prescribed me the medications or diagnosed me, and the VA didn't even call him to discuss my mental health history! Nevertheless, he DID prescribe me my Lamictal and refilled my Prozac, saying he would call the VA clinic himself and advocate for me. "We will FORCE the VA to be responsible, and threaten malpractice if they don't. They're still liable for your care. This is unheard of!" (Have I mentioned how much I love my OB?)
So. Tuesday I find out if this is all legit. I'm hoping it is. I'd really like to be done with this and be able to work toward my goal of being well this pregnancy, hell even enjoy it. I haven't been able to do that so far because physically it has sucked, and mentally I haven't had the tools I need to manage my illness. Hopefully now I do. I have my meds, and hopefully Tuesday I find that I have a medical team dedicated to overseeing my treatment. Cross your fingers for me?
Last thing: This isn't the end of this issue for me. Sure, I got their attention and pressured them to take effective action to fix this for me and they did (which, I'm telling you is a miracle), but now that I know that I have the power to get their attention? I plan to advocate my ass off until their approach to maternal mental health changes and they incorporate it in their efforts to serve and care for women veterans. As I stated in my last post women veterans account for at least 10% of the veteran population and are affected by mental illness. Why should their mental health care be discontinued or pushed off on an outside agency during pregnancy? In my opinion, if the VA wants to truly care for women veterans, then maternal mental health MUST become a priority. It's not enough to contract out and cover a woman's prenatal care-the VA needs to ensure that psychiatric treatment continues for those who rely on them for their mental health treatment as well. I don't have the answers on how they can do this, but I have some ideas ranging from collaborating with obstetricians, hiring and working with reproductive psychiatrists, to support groups for pregnant veterans with mood disorders, to ensuring psychotherapy services are accessible and utilized.
Women veterans with mood disorders deserve comprehensive psychiatric care and support during pregnancy-maybe I went through this to help ensure that this becomes a reality for us. I will work my ass off for years if I have to, to see such a systemic change happen.
After all, aren't women veterans Warrior Moms, too?
Oh and this right here? Made all the hell of this week worth it. I'm so glad I fought for us.