Making Like Madea: “Oh, Hell to the NO!”

Mental Health Awareness Week is the first week in October

Mental Health Awareness Week is the first week in October

For the past two weeks, I have been in PTSD/suicidal hell.  I lost count of the number of times I have talked myself out of swallowing a bottle 50 Oxycodone pills that I didn’t need for post-surgery pain on my knee.  These trips to suicide hell are courtesy of my former mental health provider, Compass Health.

Some people call them Compass Death, and I think it is apt.  The government has been paying them $155/hour (actually 45 minutes) to help me heal.  My former therapist has the educational chops that theoretically were a great match for my professional aspirations.  It isn’t that she couldn’t help me.  She just didn’t.

Instead, she participated in an evil abuse of power.

Compass Health gets an exceedingly generous, guaranteed revenue stream via various housing vouchers that mandate case management.  The theory of these vouchers is brilliant, but the door is wide open for abuse of power and fraud by unscrupulous mental health providers.

HUD placed strings on this generous revenue stream.  How generous?  If my calculations are correct, they picked up a $4 million annual revenue stream when my former mental health agency closed.  Big bucks.  Huge bucks.  Enough money for the taxpayers and clients to expect miracles.


Compass Health is mandated by HUD to provide case management.  The intent is to make sure people in these programs have ready access to ALL the resources we need to be able to thrive and find joy and ultimately become financially self-sufficient.  In fact, mental health providers are mandated to report monthly on the referrals to services they make for clients.  Locally, particular emphasis is placed on access to medical care.

On top of these HUD mandates, Compass Health promised in April to provide quality case management during an RSN-level grievance meeting.  At that meeting, I expressed frustration that I had access to brilliant team medicine, but I hadn’t gotten quality mental health support since my previous case manager left in October.  My new therapist doesn’t like to do case management.  So, she didn’t.  Screw the promise Compass Health made during the grievance meeting.

My previous case manager helped me meet my Medicaid spenddown.  What’s a spenddown?  It is legislative insanity.  Disabled people over age 62 are expected to cough up two months’ income each year to essentially get six months of medical insurance.  The theory is that we are so rich on Social Security that we can pay for our medical insurance.  Except the premiums must be paid in full, upfront for six months.  It is insane to think people on minimal Social Security can afford to do this.

Most people my age incur sufficient medically necessary expenses to meet our spenddowns, but we can’t cough up six month’s of expenses at the start of a spenddown period.

By the time we accumulate enough incurred medically necessary expenses to meet our spenddowns, the window on our spenddown period is closed. Until we meet our spenddown, we don’t have access to physicians, prescriptions, medical equipment, or transportation to medical appointments. In plain English, it is survival of the fittest and essentially a holocaust on disabled people.

Huh?  When disabled people on SSI reach age 62, we are kicked out of SSI and forced into Social Security.  This means we are ejected from the protective haven of WASHCAP and into the icy waters of DSHS.  It didn’t take me long to realize it is survival of the fittest until we reach age 65 and are eligible for Medicare.

My case manager at the time told me not to worry about it.  There was a fund available to meet my spenddown.  She scheduled her case management so that I could quickly meet my spenddown and resume access to medical care.  This was HUD’s intent when they set up my housing voucher program.

However, she quit and her agency closed.  I was told that to keep my housing, I was compelled to go to Compass Health each week.  I’ve subsequently discovered this is a blatant lie.  The first of many.


The joke of Compass Death isn’t funny.  The transition between agencies was handled horrendously.  I filed a grievance.  It was escalated to the RSN-level.  Local officials were furious.  My case was supposed to set precedent.  It was supposed to compel Compass Health to deliver quality mental health services and treat clients with dignity and respect.  The dearth of quality mental health service is my county’s number one health issue.

Via some vicious ex-parte discussions with the governing body, North Sound Mental Health (NSMHA), Compass Health set me up on a path I didn’t understand.  I believe the woman in charge of the local Compass Health offices has a narcissistic personality disorder, and she did what narcissists do:  she retaliated.  She set up a trap that would deny me access to medical care unless I submitted to her reign of terror.

This isn’t my first time at the rodeo.  I’ve been down that road, and I’m not going there again.  I did, however, naively go down the trust road with NSMHA.  I forgot to notice that the actions weren’t matching the words.

Big mistake.  Huge mistake.

I had one of the best months in my life in May. I was given a computer with the muscle to maintain this site.  My knee surgery was a fantastic success. I won second prize in my mentor, Susan Wiggs’ Sonoma contest. I got to meet Elizabeth Gilbert at a YWCA fundraiser two days after my surgery. Eve Ensler came to town and confided her theme for One Billion Rising, 2014: justice. OMG. What a perfect way to celebrate Navigating Uncharted Waters’ 5th anniversary.  I was flying high at the end of May and believed I was finally, finally, finally ready to launch.

The last person I expected to shoot me down was my therapist.  Oh, how wrong a person can be.  At my first appointment in June, I was ambushed by her office manager.  Although the fund that had been meeting my spenddown had agreed to continue this practice, Compass Health insisted that I agree to pick up the tab too.  Too.  Important word.  Too.  NSMHA was paying for my therapy appointments as soon as I walked out the door.

Yet, Compass Health told me that they wouldn’t submit paperwork to DSHS indicating that I had met my spenddown unless I agreed to pay them for my services.  Too.  WTF?  They’d been paid.  In full.  $155/session.


On July 17, I received a letter from them with a laundry list of threats of what they were going to do to me unless I submitted to their abuse of power.  It also included a laundry list of evil deeds they were going to do to me if I did submit to their abuse of power.  I might have mental health issues, but I’m not fucking nuts enough to agree to letting somebody terrorize the hell out of me.  I don’t smile and say “yum!” when I get fucked over.

I spent all day on July 19 with that bottle of Oxycodone on my desk.  It took every survival skill that I possess to keep from swallowing those pills.  I do what I do when somebody sends me into PTSD hell:  I tried to hold Compass Health accountable for an egregious abuse of power.  I filed an expedited RSN-level grievance because I naively thought that the grievance process had integrity.

In the process of researching the law and distilling down exceedingly complex issues, I discovered that I could have easily met my spenddown by charging (versus paying cash) my medically necessary expenses in April and May.  Y’all know how much my flowers mean to me.  April and May are when I hit the nurseries.  It’s expensive.  Technically, my flowers are “medically necessary” expenses because they are essential to my mental health.  Ditto for my therapy animals.  I was way beyond livid ~ if y’all know the word for this level of rage, please leave it in the comment section.

WTF?  If my lazy-assed therapist had invested a few seconds in a basic Google search, she could have and should have told me that I could meet my spenddown on June 1 via charging my flowers, stocking up on therapy animal supplies, and popping for my C-PAP machine.  Oh, hell to the NO!  This avenue would have enhanced my mental health, helped me get over my aversion to credit cards, AND given me the fastest access ever to a resumption of my medical insurance.  In other words, it was exactly HUD’s intent when they brilliantly set up my housing voucher program.


But, Compass Health has too much fun terrorizing the crap out of their clients.  I have a strong hunch that they’re double-dipping ~ collecting fees twice ~ from NSMHA and from clients ~ engaging in Medicaid fraud.  At the grievance meeting, I discovered that they are relying on an obscure WAC to sever the strings that HUD tied to their multi-million dollar revenue stream.  In the legal biz, federal law trumps administrative code.

At the expedited RSN-level grievance meeting, I quickly discovered that I was fighting for my life.  NSMHA dispensed with their practice of keeping minutes of the meeting.  They didn’t want a record of the ambush.  One of my ombuds was so focused on his issue of unequal application of spenddowns that my issues with the quality of mental health support and the breach of Compass Health’s promise to deliver quality case management got swept away.  Screw HUD’s strings.  In the crazy world of NSMHA, WACs trump federal law.  I got royally fucked.  Gang raped.

This week, Joe Valentine, the head of NSMHA, confirmed via e-mail that he isn’t remotely embarrassed that the dearth of quality mental health services is my county’s number one health issue.  He’s supposed to be the watchdog, but he’s Compass Health’s lapdog.  He doesn’t give a shit that his grievance process lacks integrity.  His e-mail message echoed the message I got loudly and clearly during the grievance meeting last week:  “Fuck you.”

Squash her like a bug

Squash her like a bug

Ironically, the state of Washington has several laws on the books that make it a felony to block access to medical care for disabled, senior citizens.  These laws are buttressed by HUD’s case management mandate which assures ready access to medical care.  I’m planning to talk to friends in local law enforcement to find out how crazy it would be for me to ask for somebody to be arrested for attempted homicide by abuse.  At my grievance meeting, Compass Health said that they knew their actions would send me reeling.

Mr. Valentine, you might bully the hell out of other vulnerable people who desperately need for you to be a watchdog.  But, you will NOT bully me.  The government paid good money for me to get quality help.  I’m sure there are hundreds of private therapists would work their asses off for a guaranteed weekly revenue stream of $155/hour for the three years remaining on my housing voucher.

Mr. Valentine whined about budgetary restraints.  Seriously?  If he wants the public to buy this bullshit, he’d be wise to make sure we never see statements for mental health services.  Most folks think $155/session is pretty damned generous.  It’s more than most disabled people get/month for food stamps.  It’s more than HUD pays for my housing, and I get to live in my apartment 24/7.  HUD has made a wise investment in my housing, but the government is getting fleeced on my mental health services.


A lot of y’all share your angst.  When I’m in deep distress, I go silent.  It has never been safe for me to share and become intimate.  Hell, my fucking therapist used every damned one of my known PTSD triggers to try to coerce me into renegotiating my contract with her agency.  I am SO glad that I listened to my instincts and didn’t give her the complete list of my PTSD triggers that she requested.  I vividly recall reading a particularly intimate passage from my journal to her when my instincts said, “shut the hell up.  You can’t trust this bitch.”  I slipped into a dissasociative state and left her office with suicidal ideations.  She should have never let me leave.  But, she did.

I wandered around for three hours at the local mall unable to figure out how to get home.  And, I’m supposed to pay them $155/hour to send my life into suicidal hell?  I don’t think so.

With Suzan DelBene in 2012

With Suzan DelBene in 2012

When I shared my experiences with Rep. Suzan DelBene (D-WA) at a recent parade, she said the federal government doesn’t like getting fleeced.  Neither do I.  Neither do I.

$155/hour ought to buy first-class mental health support, but it doesn’t in the county where I live.  The list of NSMHA’s approved providers is a sorry-assed bunch.  Two of them have taken me from thriving to suicidal hell and destitution.  And, NSMHA thinks this is quality.  Oh, hell to the NO.

Mr. Valentine said I could file for an Administrative Hearing.  Right.  Wait two years to have an issue heard that is already moot.  I’ll be on Medicare in three months.  I just have to pray that I’m healthy enough to survive this holocaust.  In the meantime, asshole, I have the court of public opinion and an international audience of over 420,000 people.

A huge shout-out to my FB friends, especially Kit Gruelle, for the illustrations to this post.  Now, I need to find the Irish in me.  I need to find the humor in this absurdity.


5 responses to “Making Like Madea: “Oh, Hell to the NO!”

  1. Good god, Carolyn, I had no idea what you’ve been going through and I’m left speechless and horrified. I wish I were your neighbor and could physically do something to help. All I can say is, hold on. Just hold on.

  2. This sounds horrible 😦 I’m so sorry you’re going through this! Your therapist should be helping you not throwing you under that bus!

    This is all just so upsetting to read, here is Australia I thought things were tough getting help finically to see my Therapist – but it’s nothing compared to this 😦 stay strong and I hope things get better

  3. Thank you both very, very, very much. After I published this post, I took a long bubble bath, washed my hair, and started doing my laundry. My intent is to wash away all the pain and angst.

    I can’t tell you what a healing balm it was to read your comments. . .like the start of a fresh chapter.

    In a lot of respects, I think I knew on a soul level that my therapist was wrong when I told her that a therapist in Australia had recommended my site. I was trying to suggest that it would be nice if my own therapist bothered to visit just once. No reaction. No visits. Says a lot, eh?

    Bless you both for your concern and comforting words. Means the world to me to know that I’m not alone.

    Sending hugs and deep gratitude,
    Anne Caroline

  4. Bless you and thank you, Helen. It is such a comfort to hear from you. If you are on Facebook, there is a button at the bottom of the post that you can click on and share.

    I hope you are doing well this summer. Tomorrow (8/8) is a big deal day for me. So, I’m hoping the next post will be more uplifting.

    Sending hugs and very best wishes,

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