Medication plays a very important role in the treatment of mental illness. It is one part of treatment in the battle versus mental illness and a very important part as well. Medication is not something that is uncommon. One in six people in the United States are on some form of a psychiatric medication.
However, medication in and of itself carries a big stigma. People still refer to them as "happy pills" and don't see them as being necessary for productive living. People are repeatedly shamed for having to take medication for their mental illness. Many times they are told to do things like change their diet to this plan or that plan or make sure their getting enough sleep or just exercise more and while these things are good things they do not solve the issue that depression and anxiety create inside the body. Mental illnesses are caused by real physical deficiencies in the brain and that is why medication is so important to recovery. Mental illnesses are medical illnesses in nature and this is something that needs to be recognized. Pill shaming should be a thing of the past and peer acceptance should be a thing of today. Only then will we move forward, away from the stigma.
My experience with medication began when I was a teenager. At the age of 15, I was put on an antidepressant and an anti-anxiety medication. I didn't have steady mental health professionals throughout the end of my teen years so I took those medications for a couple years and eventually went off of them on my own. At the age of 19, I realized that I needed help again and sought out to see a psychiatrist. This started out the new medication trials which eventually led to an overdose on those medications which once the psychiatrist found out about the overdose, led to a psychiatric hospitalization. From that point until now, I was put on so many different medications and medication combinations it is impossible to count them. I have been on almost every SSRI and SNRI that exist (SSRI and SNRI are classes of antidepressants). I have been on mood stabilizers, anti-psychotics, multiple different types of sleep medications and many different kinds of anti-anxiety medications. I am the person the black box warnings were created for. I have had medicines make me more depressed and more suicidal. We also just recently learned that medicines can make me more suicidal for a period of a couple days as my body adjusts to them and then everything will calm down and I'll be okay. My body is just super sensitive to medication and medication changes and it is super important that I keep my medications the same in my system. In the year 2017, I spent 6 months in a hospital setting. The first 4 1/2 of those months were basically used to figure out which medication combination would work best for me. It literally took 4 1/2 months of changing medications on sometimes a daily basis to figure out what I needed and what would actually work for me. But finally I am on a regimen that works and I am grateful for that. Because of all I have gone through with medication, I feel like I have the ability to share my knowledge with others because I know what medications do what and what they can help with and I have a basic knowledge of most medications that are out there. I hope to use my experience to help others.
Here are some guidelines and suggestions I have come up with when it comes to medication:
1) Know what you are taking. And by know I mean really know. Know the name of it, know the dosage, know what time you take it, etc. Also do a little research on it. This is helpful if you start to experience side effects especially since no medication doesn't come without a side effect. It's important to know what the side effects are so you can discuss them with your doctor. Additionally, you should know how to take the medication. This includes knowing when you should take the medication as some should be taken in the morning and some at night. This also includes whether it should be taken with food or not. Some medications also have interactions with other medications that you should be aware about. Many psychiatric medications interact with grapefruit so it is important to know if you medication has that interaction. All of this is basic information that can be found on the internet. Know your medication so you know what to expect.
2) Keep a schedule. Try to take medications around the same time each day. One helpful reminder is setting a timer on your phone or using a phone app that can help remind you. The phone app I use to remind me is called RoundHealth. Another thing I use to help me is weekly pill containers. This is really helpful if you take multiple medications.
3) Be an active participant. What I mean by this is start researching. If a medication doesn't work for you, start researching and see what an alternative option would be. Being an active participant can mean coming to your appointments and telling your doctor "Well I read this and wanted to know your opinion". Doctors want you to be an active participant in your care. They can always disagree with you and you can discuss going a different route but having knowledge of what is out there is very powerful in your appointments with your psychiatrist. One example I will use is that there is a medication they are just starting to use for nightmares that works better than the current one and I brought research to my doctor and he researched and we agreed to put me on it and it has worked so much better. I would have never been put on that medication if I had not researched it in the first place. It is important to be involved in your care. Active participants tend to get better quicker because they are advocating for themselves and what they feel they need.
4) Do NOT go off medication without doctor's orders. I repeat do NOT go off medication without a doctor leading you through it, even if you are starting to feel better. You are probably starting to feel better because of the medication. Additionally, going off of medications suddenly can have dangerous symptoms including things known as "brain zaps". Going off of medications without a doctor's order is very dangerous and can put you in a worse state than you were in before. I know this because I've done this, twice with dangerous results both times. Both times I ended up in a hospital shortly after because of going off the medication. Stay on your medication as prescribed until your doctor tells you otherwise.
Medication is something that can be very useful in our battle with mental illness. It is something that is often necessary for people to function and there should be no shame in that. We should move forward to live in a world of acceptance, not shame so that everybody can achieve a healthy functional state of being whether that includes the use of medication or not.
(If you have any questions, feel free to ask. NOTE: I am NOT a doctor, just someone who has been through the ringer with this.)
Sunday, January 21, 2018
Monday, January 15, 2018
PTSD
Trauma.
What comes to your mind when you see that word? A bad high school experience? Bullying? Parents' divorce? Or do things like war, 9/11, abuse come to mind?
The reality of it is that all these things are traumas. Webster Dictionary defines trauma as "a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury." Traumas can be a one time occurrence or something that lasts every day for years on end.
Traumas affect every person differently. What one person may see as traumatic another person may not. What deeply affects some people may only minorly affect someone else. 70% of the population will experience some type of trauma. 20% of those people will go on to develop Post Traumatic Stress Disorder or PTSD.
Post Traumatic Stress Disorder is defined as when the reaction from the trauma becomes life-interfering. Post Traumatic Stress Disorder has been found recently to develop specifically because of changes in the brains of those who have it. Generally those who have it have been living on edge for such a period of time that their body has learned to stay in that mode and therefore adjusted to it and it never stops. Living in that mode changes the brain and makes it more susceptible to developing PTSD.
PTSD is diagnosed when someone exhibits symptoms from three categories.
The first symptom is re-living of the event. This can happen in multiple ways. This can happen when someone has a nightmare, an intrusive memory, or a flashback. A flashback is when the mind sends the body back to a specific time in the past and one feels like they are back in that moment. This is usually done through the senses. Flashbacks are experienced in different ways depending on the person. A person can still be present in the world and understand what is going on or they can be completely disconnected with what is going on around them. It varies from person to person.
The second symptom is avoiding reminders of the event. This can include people, places, thoughts or anything that may be connected to the trauma. Additionally, they may withdraw from people that they are close to and feel detached emotionally from their friends and family. They may also lose interest in their activities.
The third symptom is being on guard of hyper-aroused. This means that people are on the edge all the time, worried about what may come next. This can lead to bursts of anger, anxiety, jumpiness, difficulty sleeping, and an inability to focus.
The combination of these three symptoms lead to a diagnosis of Post Traumatic Stress Disorder.
So what options are there to treat PTSD?
There are generally two options: medication and therapy.
Medication can be used to help with things like mood, anxiety and any co-occurring disorders. Additionally, doctors have been using a blood pressure medication to help with nightmares and that has worked well for many.
For therapy, there are many different types of therapy that can be used to help someone with PTSD. One type of therapy is called EMDR or Eye Movement Desensitization Reprocessing. It is when a specific eye motion is used to help your mind reprocess some memories so that when they resurface they don't carry the emotional weight that they did before.
Another type of therapy that is used is exposure therapy. This type of therapy is what a person is slowly introduced to things that trigger them in order to help them to not become so triggering.
Another therapy that is generally used in all spectrums is cognitive behavioral therapy which works with thoughts and thinking errors and things like that.
The combination of therapy and medication can help life become more manageable.
Post Traumatic Stress Disorder is challenging to deal with. It can even be debilitating if not dealt with. However, with the right treatment, there is hope. There is always hope.
Post Traumatic Stress Disorder Fact Sheet. (1995). Retrieved January 09, 2018, from https://www.sidran.org/resources/for-survivors-and-loved-ones/post-traumatic-stress-disorder-fact-sheet/
What comes to your mind when you see that word? A bad high school experience? Bullying? Parents' divorce? Or do things like war, 9/11, abuse come to mind?
The reality of it is that all these things are traumas. Webster Dictionary defines trauma as "a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury." Traumas can be a one time occurrence or something that lasts every day for years on end.
Traumas affect every person differently. What one person may see as traumatic another person may not. What deeply affects some people may only minorly affect someone else. 70% of the population will experience some type of trauma. 20% of those people will go on to develop Post Traumatic Stress Disorder or PTSD.
Post Traumatic Stress Disorder is defined as when the reaction from the trauma becomes life-interfering. Post Traumatic Stress Disorder has been found recently to develop specifically because of changes in the brains of those who have it. Generally those who have it have been living on edge for such a period of time that their body has learned to stay in that mode and therefore adjusted to it and it never stops. Living in that mode changes the brain and makes it more susceptible to developing PTSD.
PTSD is diagnosed when someone exhibits symptoms from three categories.
The first symptom is re-living of the event. This can happen in multiple ways. This can happen when someone has a nightmare, an intrusive memory, or a flashback. A flashback is when the mind sends the body back to a specific time in the past and one feels like they are back in that moment. This is usually done through the senses. Flashbacks are experienced in different ways depending on the person. A person can still be present in the world and understand what is going on or they can be completely disconnected with what is going on around them. It varies from person to person.
The second symptom is avoiding reminders of the event. This can include people, places, thoughts or anything that may be connected to the trauma. Additionally, they may withdraw from people that they are close to and feel detached emotionally from their friends and family. They may also lose interest in their activities.
The third symptom is being on guard of hyper-aroused. This means that people are on the edge all the time, worried about what may come next. This can lead to bursts of anger, anxiety, jumpiness, difficulty sleeping, and an inability to focus.
The combination of these three symptoms lead to a diagnosis of Post Traumatic Stress Disorder.
So what options are there to treat PTSD?
There are generally two options: medication and therapy.
Medication can be used to help with things like mood, anxiety and any co-occurring disorders. Additionally, doctors have been using a blood pressure medication to help with nightmares and that has worked well for many.
For therapy, there are many different types of therapy that can be used to help someone with PTSD. One type of therapy is called EMDR or Eye Movement Desensitization Reprocessing. It is when a specific eye motion is used to help your mind reprocess some memories so that when they resurface they don't carry the emotional weight that they did before.
Another type of therapy that is used is exposure therapy. This type of therapy is what a person is slowly introduced to things that trigger them in order to help them to not become so triggering.
Another therapy that is generally used in all spectrums is cognitive behavioral therapy which works with thoughts and thinking errors and things like that.
The combination of therapy and medication can help life become more manageable.
Post Traumatic Stress Disorder is challenging to deal with. It can even be debilitating if not dealt with. However, with the right treatment, there is hope. There is always hope.
Post Traumatic Stress Disorder Fact Sheet. (1995). Retrieved January 09, 2018, from https://www.sidran.org/resources/for-survivors-and-loved-ones/post-traumatic-stress-disorder-fact-sheet/
Monday, January 8, 2018
The First Episode
My first major depressive episode happened when I was 14 years old. It was the summer after my freshman year of high school. I believe multiple factors helped bring the depression on. The first one was simply the fact that it was summer time and that meant no school, so there was very little to do. Both my parents worked so there were no opportunities to join things like summer camps or different activities, my brother and I were stuck at home during the day. The second factor was the news that two important people in my life were moving which was devastating news to me at the time. The third factor was the fact that I was living with Juvenile Rheumatoid Arthritis and struggling with a lot of pain due to that. The fourth thing that I believe brought it on was the environment I was living in. My parents were verbally attacking me at various times for various things and nothing I ever did was right. There were extremely high expectations and long to-do lists. The combination of these four things plus a genetic predisposition brought on my first depressive episode. I remember displaying all the classic symptoms. I would sleep late into the day and stay up until 2 or 3 in the morning. I lost my appetite and would eat maybe one meal a day. I holed myself up in my room for most of the day and only came out when I had to. I still communicated with my friends through text and Facebook and still went to church like usual but I was more standoffish than usual. I also had multiple crying spells and was very sensitive. I was sad most of the time. Many things began changing during the first few weeks of the summer.
When my friends began noticing all the changes that were occurring in me, they started mentioning depression to me. I denied it immediately saying there was no way. It took a couple weeks of them mentioning it before I finally began to admit that I actually was experiencing depression. From there, they were trying to figure out what they could do to help me. My parents were very much still in the dark about what was going on with and had not picked up on any of the signs or the fact that I was struggling in anyway and going to them was not an option. It was a difficult task and there really were no options out there for help without parental involvement. I was stuck in a horrible situation.
Not too long after, things came to a head. I started experiencing suicidal thoughts and posted something on Facebook about wanting to die. The youth pastor's wife saw it and messaged me asking if I was suicidal. I said yes. Next thing I knew, our doorbell was ringing and my dad was coming to get my mom and I out of our rooms and there were cops standing in the opening between the kitchen and living room of our house. They had me come down and asked me if I was suicidal. I said yes. They asked me if I had a plan. I said no. My mom began to freak out and cry. My dad then told the cops that my mom's mom had killed herself. The cops called back in to their headquarters about the situation and it was decided that a mental health tech would come to the house and evaluate me to determine if I was safe or if I needed further treatment. The evaluator came and he asked me a lot of questions and eventually decided that I was safe. At this point the cops left and it was just me, my parents and the mental health evaluator. The man told my parents that they needed to get me into counseling and told them some of the stressors in the environment that could be worked on, which my parents were close minded to. He left and things were very tense from then on.
Once my parents found out that it was the youth pastor and his wife who had called the cops, they immediately had a phone call with them where my dad yelled at them and demanded that they no longer communicate with me. My parents also contacted the lead pastor at the church to make a complaint against the youth pastor. It was an extremely difficult time for me because those people were really important to me.
As far as counseling went, my parents took me one time. The first part of it the therapist asked what everyone hoped to get out of it and my dad took that moment and ran with it as he used it to tell the therapist how horrible of a daughter I was. My mom tried to pacify him but it didn't do anything. My mom's response was more of a wanting to stop of the suicidal stuff. I didn't say much. Eventually the therapist sent my parents out of the room and that's when I was given the chance to talk and I talked to the therapist. The therapist even mentioned going on medication. When I mentioned that to my mom after the fact, she scoffed at the idea. I never went back to see the therapist.
When my friends began noticing all the changes that were occurring in me, they started mentioning depression to me. I denied it immediately saying there was no way. It took a couple weeks of them mentioning it before I finally began to admit that I actually was experiencing depression. From there, they were trying to figure out what they could do to help me. My parents were very much still in the dark about what was going on with and had not picked up on any of the signs or the fact that I was struggling in anyway and going to them was not an option. It was a difficult task and there really were no options out there for help without parental involvement. I was stuck in a horrible situation.
Not too long after, things came to a head. I started experiencing suicidal thoughts and posted something on Facebook about wanting to die. The youth pastor's wife saw it and messaged me asking if I was suicidal. I said yes. Next thing I knew, our doorbell was ringing and my dad was coming to get my mom and I out of our rooms and there were cops standing in the opening between the kitchen and living room of our house. They had me come down and asked me if I was suicidal. I said yes. They asked me if I had a plan. I said no. My mom began to freak out and cry. My dad then told the cops that my mom's mom had killed herself. The cops called back in to their headquarters about the situation and it was decided that a mental health tech would come to the house and evaluate me to determine if I was safe or if I needed further treatment. The evaluator came and he asked me a lot of questions and eventually decided that I was safe. At this point the cops left and it was just me, my parents and the mental health evaluator. The man told my parents that they needed to get me into counseling and told them some of the stressors in the environment that could be worked on, which my parents were close minded to. He left and things were very tense from then on.
Once my parents found out that it was the youth pastor and his wife who had called the cops, they immediately had a phone call with them where my dad yelled at them and demanded that they no longer communicate with me. My parents also contacted the lead pastor at the church to make a complaint against the youth pastor. It was an extremely difficult time for me because those people were really important to me.
As far as counseling went, my parents took me one time. The first part of it the therapist asked what everyone hoped to get out of it and my dad took that moment and ran with it as he used it to tell the therapist how horrible of a daughter I was. My mom tried to pacify him but it didn't do anything. My mom's response was more of a wanting to stop of the suicidal stuff. I didn't say much. Eventually the therapist sent my parents out of the room and that's when I was given the chance to talk and I talked to the therapist. The therapist even mentioned going on medication. When I mentioned that to my mom after the fact, she scoffed at the idea. I never went back to see the therapist.
Grief and Mental Illness
Grief. The process you go through after you have had a major loss in your life. This can be the death of an important person, loss of a job, loss of a pet, loss of a house when moving and so on. Generally the basics of the grief process include that there are five stages and everyone goes through them in different ways. Those five stages include denial, anger, bargaining, depression and eventually acceptance. One can move through this process quickly or one can take years to work through it depending on the loss.
Mental illness brings about many changes when it begins. For example, the onset of depression is determined by the symptoms of depressed mood, sleep changes (sleeping too much or too little), appetite changes (eating too much or too little), loss of interest in activities and others. This can look like someone who is usually very motivated to go to work and spend time with friends to someone who struggles to get to work on time and isolates by laying in bed when not at work.
When mental illness strikes, it can take many things from a person. The first thing it takes is the reality of having a good mental health. This can be devastating to many people. It can ruin relationships, take jobs, take away aspirations and dreams and ultimately the reality that someone will be able to function the same way ever again. This reality leads one into the grieving process.
I have severe mental illness. I do not hide that fact. I have struggled with mental illness since I was a child and it has only progressively gotten worse since then until coming to a final climax this year where I spent 6 months in hospitals before finally receiving the treatment that I needed all along. When my mental illness began to grow in severity, there were things that I couldn't do anymore. I could no longer hold down a full time job. I could no longer maintain a full time student status at school. I had to give these things up. When I gave up these things, I entered the grieving process, the process you go through after you have experienced a major loss. Mental illness took away my first career dream. Mental illness took away the opportunity for me to have a normal college experience. Mental illness took away many friendships that I have had. Mental illness took away my ability to work full time. Mental illness took away my ability to do a full time online college experience for a period of time. Mental illness made me unstable in every aspect of my life for a good period of time and I only made it through because others had my back.
The thing that one has to know is that with mental illness, while it does take away many things, it does give back some things. Mental illness has given me a few things through my experiences with it. The first thing it gave me was that it taught me was that I have more in common with people than I ever thought that I did. Spending lots of time in hospitals meant spending lots of time with people I would have never spent time with outside of the hospital. I made so many friendships throughout my stays in the hospital and many of the people I met in hospitals I am still in contact with and have very strong friendships with. The second thing it gave me was a ton of knowledge that I can now use to help others. The fact that I've been through as much as I have with hospitals, doctors, therapists and medications means I know a thing or two about how the system works and am able to give advice to other people based on my experiences. This is at least one of the things I have hoped would come out of all my negative experiences. The third thing I have gained is some knowledge about myself. One thing I have learned is just how strong I really am and how much I have to contribute to the world. I also learned how much I matter to the people around me. I have learned how to have strong legitimate friendships again.
Overall, mental illness has taken a lot from me. But I have gained a lot through my experiences with it. I may have lost one dream. But I have gained a new one, and I am pursuing that one. Mental illness will not define my life and it is important to understand that while grieving is a normal process to go through after a mental illness diagnosis, it can not be the end there. Mental illness cannot be the defining factor in someone's life. It is important to learn to manage it and learn to overcome it as difficult as that may be. We define our own lives, mental illness does not.
Mental illness brings about many changes when it begins. For example, the onset of depression is determined by the symptoms of depressed mood, sleep changes (sleeping too much or too little), appetite changes (eating too much or too little), loss of interest in activities and others. This can look like someone who is usually very motivated to go to work and spend time with friends to someone who struggles to get to work on time and isolates by laying in bed when not at work.
When mental illness strikes, it can take many things from a person. The first thing it takes is the reality of having a good mental health. This can be devastating to many people. It can ruin relationships, take jobs, take away aspirations and dreams and ultimately the reality that someone will be able to function the same way ever again. This reality leads one into the grieving process.
I have severe mental illness. I do not hide that fact. I have struggled with mental illness since I was a child and it has only progressively gotten worse since then until coming to a final climax this year where I spent 6 months in hospitals before finally receiving the treatment that I needed all along. When my mental illness began to grow in severity, there were things that I couldn't do anymore. I could no longer hold down a full time job. I could no longer maintain a full time student status at school. I had to give these things up. When I gave up these things, I entered the grieving process, the process you go through after you have experienced a major loss. Mental illness took away my first career dream. Mental illness took away the opportunity for me to have a normal college experience. Mental illness took away many friendships that I have had. Mental illness took away my ability to work full time. Mental illness took away my ability to do a full time online college experience for a period of time. Mental illness made me unstable in every aspect of my life for a good period of time and I only made it through because others had my back.
The thing that one has to know is that with mental illness, while it does take away many things, it does give back some things. Mental illness has given me a few things through my experiences with it. The first thing it gave me was that it taught me was that I have more in common with people than I ever thought that I did. Spending lots of time in hospitals meant spending lots of time with people I would have never spent time with outside of the hospital. I made so many friendships throughout my stays in the hospital and many of the people I met in hospitals I am still in contact with and have very strong friendships with. The second thing it gave me was a ton of knowledge that I can now use to help others. The fact that I've been through as much as I have with hospitals, doctors, therapists and medications means I know a thing or two about how the system works and am able to give advice to other people based on my experiences. This is at least one of the things I have hoped would come out of all my negative experiences. The third thing I have gained is some knowledge about myself. One thing I have learned is just how strong I really am and how much I have to contribute to the world. I also learned how much I matter to the people around me. I have learned how to have strong legitimate friendships again.
Overall, mental illness has taken a lot from me. But I have gained a lot through my experiences with it. I may have lost one dream. But I have gained a new one, and I am pursuing that one. Mental illness will not define my life and it is important to understand that while grieving is a normal process to go through after a mental illness diagnosis, it can not be the end there. Mental illness cannot be the defining factor in someone's life. It is important to learn to manage it and learn to overcome it as difficult as that may be. We define our own lives, mental illness does not.
Thursday, November 23, 2017
When the System Fails You
Living with mental illness is a challenge in and of itself. Struggling through the different disorders and all the symptoms that come with it is a daily battle. Some days you win and some days you lose. One of the battles that comes with living with mental illness is learning to fight through the mental health system. While no system is ever perfect, the mental health system is clearly broken and in need of some major help. There are many areas in which it is lacking.
The first major area that it is lacking in is simply the number of professionals available to treat mental illness. There is currently a national shortage of psychiatrists. A study commissioned by the U.S. Department of Health and Human Services concluded that there is at least a 6% shortage throughout the country and that this deficit would continue to rise as time went on if something isn't changed. While this doesn't seem like much, spread that around the country and there are many counties that don't have a psychiatrist at all and some that have one to service an entire county. Additionally, there is also a pooling of doctors around schools so there are more psychiatrists in certain areas than others which makes it harder to get treatment if you don't live in one of those areas. The national shortage is the first thing that needs to be corrected in the mental health system because we need the professionals to help the people who struggle with mental illness. We need to get people trained to help those who are struggling.
The second area that the system needs to fix is the differences in cost and coverage. First I will give a disclaimer that we have come a long way in the past few years and it has gotten better but we still have a long way to go. Currently, Medicare only gives a limited of lifetime psychiatric hospitalization days and once they are used up the only way to get more is to get another plan and that plan also has limited days. Many insurance companies consider therapy to be a specialist service and charge higher copays for it which makes it difficult to do on a weekly or bi-weekly basis for people who really need counseling that often. There is a considerable cost difference between going to a regular doctor and going to a therapist or psychiatrist, simply because it is mental health and not physical health. Another part of this that comes into play is that many providers do not take insurance at all. They are self pay only which makes it even more challenging for people to get the care they need and leaves even fewer people to see who do take insurance. If people cannot get access to the care they need, simply because of funds, how are they supposed to get better?
The third thing that the system needs to correct is making sure they do not turn people away who need the help. I won't spend too much time on this point because I have an entire post about it (see When You're Turned Away). Simply, there are many people who various professionals and hospitals turn away simply because they are "too sick" and they don't know what to do to help them. They give various reason for this but ultimately it doesn't make sense why they would turn someone who needs help away. However, it does happen, and it does need to be fixed. Everyone deserves help, no matter how sick they are.
The fourth thing that the system needs to change is the number of long term facilities that are available. There are many long term facilities available throughout the country but most of those facilities however do not take insurance and require a massive down payment of thousands of dollars. There are close to no facilities that take insurance that are available to help people with real issues. This needs to be corrected. There are many people that are stuck in state hospitals for months, even years who could benefit from a long term facility if one was available. Long term facilities need to be created to help those who need them and need to be focused on the help, not the money.
Overall, these four things are major problems that need to be corrected in the mental health system. Of course, there are many other things as well that need work. Every system has room of improvement and the mental health system is no exception. With these improvements, many more people would benefit and would be able to get the help they so desperately need. It would make a world of difference in our country.
The first major area that it is lacking in is simply the number of professionals available to treat mental illness. There is currently a national shortage of psychiatrists. A study commissioned by the U.S. Department of Health and Human Services concluded that there is at least a 6% shortage throughout the country and that this deficit would continue to rise as time went on if something isn't changed. While this doesn't seem like much, spread that around the country and there are many counties that don't have a psychiatrist at all and some that have one to service an entire county. Additionally, there is also a pooling of doctors around schools so there are more psychiatrists in certain areas than others which makes it harder to get treatment if you don't live in one of those areas. The national shortage is the first thing that needs to be corrected in the mental health system because we need the professionals to help the people who struggle with mental illness. We need to get people trained to help those who are struggling.
The second area that the system needs to fix is the differences in cost and coverage. First I will give a disclaimer that we have come a long way in the past few years and it has gotten better but we still have a long way to go. Currently, Medicare only gives a limited of lifetime psychiatric hospitalization days and once they are used up the only way to get more is to get another plan and that plan also has limited days. Many insurance companies consider therapy to be a specialist service and charge higher copays for it which makes it difficult to do on a weekly or bi-weekly basis for people who really need counseling that often. There is a considerable cost difference between going to a regular doctor and going to a therapist or psychiatrist, simply because it is mental health and not physical health. Another part of this that comes into play is that many providers do not take insurance at all. They are self pay only which makes it even more challenging for people to get the care they need and leaves even fewer people to see who do take insurance. If people cannot get access to the care they need, simply because of funds, how are they supposed to get better?
The third thing that the system needs to correct is making sure they do not turn people away who need the help. I won't spend too much time on this point because I have an entire post about it (see When You're Turned Away). Simply, there are many people who various professionals and hospitals turn away simply because they are "too sick" and they don't know what to do to help them. They give various reason for this but ultimately it doesn't make sense why they would turn someone who needs help away. However, it does happen, and it does need to be fixed. Everyone deserves help, no matter how sick they are.
The fourth thing that the system needs to change is the number of long term facilities that are available. There are many long term facilities available throughout the country but most of those facilities however do not take insurance and require a massive down payment of thousands of dollars. There are close to no facilities that take insurance that are available to help people with real issues. This needs to be corrected. There are many people that are stuck in state hospitals for months, even years who could benefit from a long term facility if one was available. Long term facilities need to be created to help those who need them and need to be focused on the help, not the money.
Overall, these four things are major problems that need to be corrected in the mental health system. Of course, there are many other things as well that need work. Every system has room of improvement and the mental health system is no exception. With these improvements, many more people would benefit and would be able to get the help they so desperately need. It would make a world of difference in our country.
Wednesday, October 25, 2017
The Change
Hey everyone. I am here writing as myself. I just wanted to share with everyone what has happened this year and the experiences that have led me to where I am now.
When I began the year 2017, I never thought I would be where I am now. I was anticipating a hospitalization right off the bat. I initially created a health care power of attorney and psychiatric advanced directive to protect myself from being sent to hospitals that have been harmful in the past. I was going back to crisis group at the local mental health center and was going to go see my psychiatrist that first week of the year. That was when I discussed with him the idea of doing ECT or electroconvulsive therapy (see link at the bottom for information). We agreed and then started the process. My first hospitalization occurred in January and ECT began. I was committed to doing the full 6 month process and go as long as I needed to to see results. The problem was we weren't seeing results. I was still falling into self-harming behaviors as before and ending up in the ER time and time again. Starting in February I had hallucinations for the first time. I began seeing and hearing things that weren't there. I knew they weren't there so I wasn't totally gone but they were there. We still can't figure out why this occurred but it is something that we fought with for a little while. I ended up in the hospital for a second time in February for suicidal ideation. I was continuing with the ECT but with no improvement. Eventually after I was released the doctor decided that it was not working and that he wanted to stop. I had 11 treatments over 4 weeks before he decided to stop because it wasn't working.
From there, I went back to the mental health center for outpatient care. I didn't like the therapist I had and asked for a new one. My old therapist was being difficult about finding me a new one and I wasn't getting anywhere so I eventually stopped going to therapy. I started having reactions to my medications and couldn't get in to see a psychiatrist so I stopped all my meds. Things just crumbled from there.
During this break in therapy, my job was basically blocking me from going back to work so I had to switch jobs and give up the job that I loved and then my dog died. Things just continued to get worse.
When I finally admitted that I was on the edge of a breakdown, it was the end of March. I was suicidal and self-harming. I checked myself into a psychiatric hospital that was close to 4 hours from where I lived. When that hospital would not give any help that I desperately needed, I checked myself out after 4 days and found another hospital that would help me that was 2 hours away. I stayed there a month. They messed with my medications over and over again desperately trying to get a combination that would prove effective. My hallucinations returned during this hospitalization as well and had to be dealt with as well. It was at this hospital that I finally gave in to the idea about looking into something more long term. However, there was no long term hospital that would take me that would also take my insurance. From there it was decided to try ECT again. I was transferred to hospital #3 to restart ECT. Keep in mind during all of this time I was still suicidal and unsafe to be discharged.
Hospital #3 (End of April to Mid-May) was miserable. Staff were non-helpful and nurses were not consistent in giving me my medication which really messed with my head. I gave up on ECT after they did 4 sessions in a week and it took too much out of me combined with the poor care of the nurses. I discharged myself in hopes of going back to hospital #2 to get into a long term facility. When I got out and asked to go back to hospital #2, I was denied. The hospital would not take me. They had given up on me. I freaked out and overdosed, trying to end my life. My friend who lived in the city came (I was still 2 hours from home) and picked me up and took me to the ER which I have no memory of. I spent the next few days in a daze, waiting for another hospital to take me. Eventually a hospital in my hometown accepted me and I was transported by a cop. Except this time the transport was in handcuffs. Yes, you read that right. Handcuffs. Like I was a criminal. It was miserable.
Hospital #4 (Mid-May to Mid-June and end of June to beginning of August) was a hospital I had been at before and a hospital I liked. I made it very clear when I first got there that I wanted to do long term treatment. They began that search quickly and hit some roadblocks but we continued to search until finally I was accepted to a program. I was discharged after a month with hope that we could line all the insurance information up and set up an admission date while I was doing outpatient treatment. It didn't work out. I spent 8 days out and insurance wasn't cooperating and I was falling apart again. So I went back in for another 6 weeks. This time we had to wait for all the insurance information to get put together and then we had to figure out how to get through the 3 day period that I had to be out between stays. Once that was figured out, we made everything work and I was discharged. I made it through the 3 days and traveled to New Orleans, Louisiana, where hospital #5 also known as River Oaks was.
River Oaks is nationally recognized for their trauma program. People like Dr. Phil have sent people to River Oaks. News stations have asked River Oaks for guidance on how to handle situations like 9/11 because they are one of the top trauma programs in the country. Going in to this program I wasn't sure if I really deserved to be there, if I met the requirements. I had no idea what I was getting myself into.
I was pleasantly surprised by the whole experience. I learned more at River Oaks than all of my hospitalizations combined (and that's saying something considering there's 24 other hospitalizations). I learned very quickly that I deserved to be there and that I needed to be there. I received help and compassion and validation that I have never received in my entire life. Things I have needed and have been searching for so desperately. They had so many aspects of their program that put together made everything work. We had groups from 8:30 in the morning until 3pm or 5pm and then a 6:30pm reflections group. We had homework assignments to do. It was almost like being in college again. The therapy included art therapy, expressive therapy, music therapy, lectures on so many topics, dialectical behavioral therapy and so much more. We also received individual therapy 5 days a week which has never taken place in any other hospital I've been at. Everything was geared towards us working through our trauma and our emotions and our struggles that came out of that. We had trauma group to process what had happened to us, skills groups to learn specific skills to manage different aspects of ourselves, inner child groups and psychodrama to act out things we needed to get out. They focused on the root issues and things that grew from the roots. It was all-encompassing treatment. They also had a psychiatrist on staff to help make sure medications were regulated. They had a dietician on staff to make sure our nutricion needs were getting met. The whole experience was amazing.
What was most amazing about it was how much it changed me. So many people kept commenting on the changes they saw in me. I walked in with no hope. I walked out with hope. I walked in sheepish and quiet (according to my therapists) and walked out more comfortable with myself. I walked in completely depressed. I walked out with a smile and a hearty laugh. I walked in unable to handle stress. I walked out with the ability to handle stress in positive ways. I changed in so many ways because of them. They changed my life.
I never thought an end to the life that I was living was possible. I never thought I would shake the thoughts that constantly haunted me. I never thought living a life free of self-harm or suicidal thoughts would be a possibility. But I can say that I did not self-harm while at River Oaks (I had never not self-harmed in a hospital before) and have not self-harmed since I have been home and I have been home about a month. I haven't really had any suicidal thoughts either. I've had a LOT of stuff thrown my way since leaving the hospital and a LOT of stress put on me about many different things and I've been able to handle it. Life hasn't been unicorns and rainbows but I've managed. I feel completely different.
As I move forward in my recovery, because there is still a long way to go, I hope to continue to grow and maybe make another visit to River Oaks for a tune up but we will see what happens.
It's been a long year so far but it looks like things might just be turning around. I'm going to try to make these last couple of months count.
Information about ECT: https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/basics/definition/prc-20014161
When I began the year 2017, I never thought I would be where I am now. I was anticipating a hospitalization right off the bat. I initially created a health care power of attorney and psychiatric advanced directive to protect myself from being sent to hospitals that have been harmful in the past. I was going back to crisis group at the local mental health center and was going to go see my psychiatrist that first week of the year. That was when I discussed with him the idea of doing ECT or electroconvulsive therapy (see link at the bottom for information). We agreed and then started the process. My first hospitalization occurred in January and ECT began. I was committed to doing the full 6 month process and go as long as I needed to to see results. The problem was we weren't seeing results. I was still falling into self-harming behaviors as before and ending up in the ER time and time again. Starting in February I had hallucinations for the first time. I began seeing and hearing things that weren't there. I knew they weren't there so I wasn't totally gone but they were there. We still can't figure out why this occurred but it is something that we fought with for a little while. I ended up in the hospital for a second time in February for suicidal ideation. I was continuing with the ECT but with no improvement. Eventually after I was released the doctor decided that it was not working and that he wanted to stop. I had 11 treatments over 4 weeks before he decided to stop because it wasn't working.
From there, I went back to the mental health center for outpatient care. I didn't like the therapist I had and asked for a new one. My old therapist was being difficult about finding me a new one and I wasn't getting anywhere so I eventually stopped going to therapy. I started having reactions to my medications and couldn't get in to see a psychiatrist so I stopped all my meds. Things just crumbled from there.
During this break in therapy, my job was basically blocking me from going back to work so I had to switch jobs and give up the job that I loved and then my dog died. Things just continued to get worse.
When I finally admitted that I was on the edge of a breakdown, it was the end of March. I was suicidal and self-harming. I checked myself into a psychiatric hospital that was close to 4 hours from where I lived. When that hospital would not give any help that I desperately needed, I checked myself out after 4 days and found another hospital that would help me that was 2 hours away. I stayed there a month. They messed with my medications over and over again desperately trying to get a combination that would prove effective. My hallucinations returned during this hospitalization as well and had to be dealt with as well. It was at this hospital that I finally gave in to the idea about looking into something more long term. However, there was no long term hospital that would take me that would also take my insurance. From there it was decided to try ECT again. I was transferred to hospital #3 to restart ECT. Keep in mind during all of this time I was still suicidal and unsafe to be discharged.
Hospital #3 (End of April to Mid-May) was miserable. Staff were non-helpful and nurses were not consistent in giving me my medication which really messed with my head. I gave up on ECT after they did 4 sessions in a week and it took too much out of me combined with the poor care of the nurses. I discharged myself in hopes of going back to hospital #2 to get into a long term facility. When I got out and asked to go back to hospital #2, I was denied. The hospital would not take me. They had given up on me. I freaked out and overdosed, trying to end my life. My friend who lived in the city came (I was still 2 hours from home) and picked me up and took me to the ER which I have no memory of. I spent the next few days in a daze, waiting for another hospital to take me. Eventually a hospital in my hometown accepted me and I was transported by a cop. Except this time the transport was in handcuffs. Yes, you read that right. Handcuffs. Like I was a criminal. It was miserable.
Hospital #4 (Mid-May to Mid-June and end of June to beginning of August) was a hospital I had been at before and a hospital I liked. I made it very clear when I first got there that I wanted to do long term treatment. They began that search quickly and hit some roadblocks but we continued to search until finally I was accepted to a program. I was discharged after a month with hope that we could line all the insurance information up and set up an admission date while I was doing outpatient treatment. It didn't work out. I spent 8 days out and insurance wasn't cooperating and I was falling apart again. So I went back in for another 6 weeks. This time we had to wait for all the insurance information to get put together and then we had to figure out how to get through the 3 day period that I had to be out between stays. Once that was figured out, we made everything work and I was discharged. I made it through the 3 days and traveled to New Orleans, Louisiana, where hospital #5 also known as River Oaks was.
River Oaks is nationally recognized for their trauma program. People like Dr. Phil have sent people to River Oaks. News stations have asked River Oaks for guidance on how to handle situations like 9/11 because they are one of the top trauma programs in the country. Going in to this program I wasn't sure if I really deserved to be there, if I met the requirements. I had no idea what I was getting myself into.
I was pleasantly surprised by the whole experience. I learned more at River Oaks than all of my hospitalizations combined (and that's saying something considering there's 24 other hospitalizations). I learned very quickly that I deserved to be there and that I needed to be there. I received help and compassion and validation that I have never received in my entire life. Things I have needed and have been searching for so desperately. They had so many aspects of their program that put together made everything work. We had groups from 8:30 in the morning until 3pm or 5pm and then a 6:30pm reflections group. We had homework assignments to do. It was almost like being in college again. The therapy included art therapy, expressive therapy, music therapy, lectures on so many topics, dialectical behavioral therapy and so much more. We also received individual therapy 5 days a week which has never taken place in any other hospital I've been at. Everything was geared towards us working through our trauma and our emotions and our struggles that came out of that. We had trauma group to process what had happened to us, skills groups to learn specific skills to manage different aspects of ourselves, inner child groups and psychodrama to act out things we needed to get out. They focused on the root issues and things that grew from the roots. It was all-encompassing treatment. They also had a psychiatrist on staff to help make sure medications were regulated. They had a dietician on staff to make sure our nutricion needs were getting met. The whole experience was amazing.
What was most amazing about it was how much it changed me. So many people kept commenting on the changes they saw in me. I walked in with no hope. I walked out with hope. I walked in sheepish and quiet (according to my therapists) and walked out more comfortable with myself. I walked in completely depressed. I walked out with a smile and a hearty laugh. I walked in unable to handle stress. I walked out with the ability to handle stress in positive ways. I changed in so many ways because of them. They changed my life.
I never thought an end to the life that I was living was possible. I never thought I would shake the thoughts that constantly haunted me. I never thought living a life free of self-harm or suicidal thoughts would be a possibility. But I can say that I did not self-harm while at River Oaks (I had never not self-harmed in a hospital before) and have not self-harmed since I have been home and I have been home about a month. I haven't really had any suicidal thoughts either. I've had a LOT of stuff thrown my way since leaving the hospital and a LOT of stress put on me about many different things and I've been able to handle it. Life hasn't been unicorns and rainbows but I've managed. I feel completely different.
As I move forward in my recovery, because there is still a long way to go, I hope to continue to grow and maybe make another visit to River Oaks for a tune up but we will see what happens.
It's been a long year so far but it looks like things might just be turning around. I'm going to try to make these last couple of months count.
Information about ECT: https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/basics/definition/prc-20014161
Thursday, August 17, 2017
Ways to Help When Family/Friend Discharges From the Hospital
Transitioning out of a psychiatric hospital is one of the most difficult and vulnerable times for someone. There is a high suicide risk right after someone discharges and some people will end up right back in the hospital if they are not careful. So what can you do to help a friend or family member transition from the hospital back to normal life?
1) Help make sure the environment is safe to return to. This is something hospitals usually check for before discharging someone from the hospital and sometimes people need help making sure that everything is removed from the environment temporarily for when they return. This can be a variety of things depending on the person. Most hospitals check to make sure there aren't any weapons in the house and if there are, that they are locked up securely as to not be easily accessible. Other items can include sharps like knives, razors and excess medication. Not only does the environment have to be made safe physically, it also has to be made safe emotionally. What I mean by this is that for people who attempted before going into the hospital, there are often things left behind from that attempt that could remind that person of their attempt and this could be triggering for them. Removing these triggers help make the environment safe for them to return to from an emotional standpoint. Helping to make sure the environment is safe to return to is a key first step to helping a person transition from the hospital.
2) Ask what specific household things you can do to help. When someone leaves the hospital, they go from having almost everything done for them to having to do it all for themselves again and this can be stressful to handle all at once. Additionally, transitions back to normal life can be stressful on families as a whole and many times doing specific household things can make a huge difference. These can include things like cooking a meal, helping clean the house before the person comes home, helping with transportation to appointment and things like that. The key to doing this is to offer specific things you know you can do. Instead of asking generally "what can I do to help" ask "can I help you clean your house before they come home" or "does your lawn need to be mowed" and things like that. Offering a specific service helps you know what you can do and takes pressure off the other person to come up with specific tasks that they need help with.
3) Help them make and keep a schedule. Keeping a schedule is one of the key things someone can do when they are transitioning out of a hospital. In a hospital setting, every hour of the day is planned out and people are usually kept busy with going to groups and activities. This can make transitions difficult due to going from having everything scheduled to having nothing scheduled. One of the best things you can do to help someone is to help come up with a schedule for the first couple weeks of what you are planning to do hour by hour. Granted, this doesn't need to be kept to a T but having a guide and plan for each day really helps people transition from the hospital back into real life.
4) Provide support during difficult times of day. For many people coming out of a hospital, there is usually a period of time during the day that they have a more difficult time with. For some people evenings are more challenging. For others mornings are more challenging. Asking the person coming out of the hospital which times of the day are more difficult for them and coming up with a plan on how to work through those difficult times can really help make sure that they stay safe during those times and even lessen the struggle that those times can create. This is something that can be critical to whether a person remains out of the hospital or not.
5) Check-in with them often. This goes along with numbers three and four. In a hospital setting, people are used to having support 24/7. There are constantly staff there to help them through difficult times and through their struggles. This is one of the benefits of being in a hospital setting to begin with. So transitioning out of the hospital can be challenging because that constant support is lost. Having someone check-in with them throughout the day can be beneficial to them because they really need that support to transition out of the hospital. One thing I've seen done before is having someone stay with them at their house if they live alone so that they can have more support the first few days out of the hospital. Support is extremely critical when transitioning out of the hospital. At the same time, this is something you would want to check with the person with to make sure that it isn't too much and it isn't overwhelming. Giving them a healthy level support can really help make the transition easier from inpatient hospitalization to normal life again.
Overall, these 5 things can really help friends and family transition out of the hospital and can help you know what to do to help them through this challenging time. Knowing how to help is the first key step in giving help. Ultimately, the love and care that you have for the friend/family member will shine through in whatever steps you take to help them and that is the most important thing.
1) Help make sure the environment is safe to return to. This is something hospitals usually check for before discharging someone from the hospital and sometimes people need help making sure that everything is removed from the environment temporarily for when they return. This can be a variety of things depending on the person. Most hospitals check to make sure there aren't any weapons in the house and if there are, that they are locked up securely as to not be easily accessible. Other items can include sharps like knives, razors and excess medication. Not only does the environment have to be made safe physically, it also has to be made safe emotionally. What I mean by this is that for people who attempted before going into the hospital, there are often things left behind from that attempt that could remind that person of their attempt and this could be triggering for them. Removing these triggers help make the environment safe for them to return to from an emotional standpoint. Helping to make sure the environment is safe to return to is a key first step to helping a person transition from the hospital.
2) Ask what specific household things you can do to help. When someone leaves the hospital, they go from having almost everything done for them to having to do it all for themselves again and this can be stressful to handle all at once. Additionally, transitions back to normal life can be stressful on families as a whole and many times doing specific household things can make a huge difference. These can include things like cooking a meal, helping clean the house before the person comes home, helping with transportation to appointment and things like that. The key to doing this is to offer specific things you know you can do. Instead of asking generally "what can I do to help" ask "can I help you clean your house before they come home" or "does your lawn need to be mowed" and things like that. Offering a specific service helps you know what you can do and takes pressure off the other person to come up with specific tasks that they need help with.
3) Help them make and keep a schedule. Keeping a schedule is one of the key things someone can do when they are transitioning out of a hospital. In a hospital setting, every hour of the day is planned out and people are usually kept busy with going to groups and activities. This can make transitions difficult due to going from having everything scheduled to having nothing scheduled. One of the best things you can do to help someone is to help come up with a schedule for the first couple weeks of what you are planning to do hour by hour. Granted, this doesn't need to be kept to a T but having a guide and plan for each day really helps people transition from the hospital back into real life.
4) Provide support during difficult times of day. For many people coming out of a hospital, there is usually a period of time during the day that they have a more difficult time with. For some people evenings are more challenging. For others mornings are more challenging. Asking the person coming out of the hospital which times of the day are more difficult for them and coming up with a plan on how to work through those difficult times can really help make sure that they stay safe during those times and even lessen the struggle that those times can create. This is something that can be critical to whether a person remains out of the hospital or not.
5) Check-in with them often. This goes along with numbers three and four. In a hospital setting, people are used to having support 24/7. There are constantly staff there to help them through difficult times and through their struggles. This is one of the benefits of being in a hospital setting to begin with. So transitioning out of the hospital can be challenging because that constant support is lost. Having someone check-in with them throughout the day can be beneficial to them because they really need that support to transition out of the hospital. One thing I've seen done before is having someone stay with them at their house if they live alone so that they can have more support the first few days out of the hospital. Support is extremely critical when transitioning out of the hospital. At the same time, this is something you would want to check with the person with to make sure that it isn't too much and it isn't overwhelming. Giving them a healthy level support can really help make the transition easier from inpatient hospitalization to normal life again.
Overall, these 5 things can really help friends and family transition out of the hospital and can help you know what to do to help them through this challenging time. Knowing how to help is the first key step in giving help. Ultimately, the love and care that you have for the friend/family member will shine through in whatever steps you take to help them and that is the most important thing.
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