Stigma in full

"A community health program manager got a surprise when she e-mailed her NH Senator recently to ask him about why he had voted to cut money from mental health programs. The Senator told her that society would be better without disabled people, and he wishes he could ship disabled people to Siberia."

Um... what the fuck? I read this and then read it again, and then read it a third time. He confirmed to the newspaper that he said this, and meant it. It's not like she made up the emails. He really does think the mentally ill, addicted, etc. are a financial burden that we shouldn't have to carry along.

If ever there was a time to write your senator about something, it would be about censuring this guy for being an idiot. I can not believe people think like that.

Campaign for mental health

"She compared to the level of understanding regarding mental health issues as about the same as it was for cancer patients in the 1970s.

'Back then, you didn't talk about cancer, you didn't even say the word,' she said. 'People were afraid to talk about it with cancer patients because they were afraid they might upset them.'

Later, however, it was well understood that cancer patients needed an emotional support system that would be there for them throughout the course of the illness.

'And we need the same,' she said."

That's the second article in as many days I've seen compare mental health to cancer in the 70s. It seems that before they had breast cancer awareness ribbons and month and walks, people didn't want to talk about cancer. It was a big secret. So maybe, just maybe, mental illness can build on that model. We already have Out of the Darkness walks about suicide prevention. Do we have a ribbon color like all the cancers and other illnesses? Can we do a wear ___ color for mental illness? Or remember when you could wear jeans to work on Friday and they would donate money to, I think, heart disease? Is this what mental health needs? A campaign?

Danger to self or others

Pete Earley tells us the story of why we have to be a danger to self or others before commitment. As you can probably guess, it comes down to a man who was involuntarily committed for years because of his illness, though he wasn't dangerous. He fought back, and eventually won freedom.

There had to be something done. Back then, men and women were committed because of mental illness, but also some people were committed because they were a pain in the butt. There are all sorts of horror stories about wives thrown into institutions because the husband was cheating and wanted a "free" life of his own.

But only putting people in hospitals when they are "dangerous" has become a dangerous proposition on its own. Sometimes you're not obviously a danger to self or others, but it's truly obvious you need help. My mom used to walk naked around the city walking an invisible dog, but I couldn't get her committed. She was always so eloquent before the judges. She never seemed sick, but there was a history of bizarre behavior. Or she would try to kill herself but be released because she was no longer a danger. Made so much sense.

"Over the years, states began to lessen criteria, in part, because persons who were clearly mentally incapacitated where literally dying on the streets because they were not dangerous and they were not getting any meaningful treatment or services. This is where criteria, such as “gravely disabled” or “unable to care for self or others” came into play. The court’s “without more” ambiguous language provided the states with a opening that could be used to add these lesser criteria.

As the Fairfax father discovered, many judges, especially those with a strong civil rights background, refuse to consider anything but dangerousness when an ill person is brought before them– even if it means releasing someone who is clearly psychotic — even if it means putting their lives in jeopardy."

Yep.

A crazy dance team? Respond!

Check out Amy's response to the high school dance team who did a "psych ward" routine. She's pissed at NBC because they did a story basically saying "what's the big deal?" she's asking all of us who have been affected by mental health woes to speak up for ourselves and say it's not ok to make fun or portray us as zombie-like. So go read the original article and leave a message telling NBC just what you think Of discrimination.

Adequate care doesn't sound good

"More than 26 percent of American adults have a diagnosable mental health disorder, but of those, only 33 percent are receiving care, according to data from the National Institute of Mental Health. And of that number, one-third is receiving treatment that is considered only minimally adequate." (Emphasis mine.)

I am really horrible at math, but if 1/3 of people with mental illness are receiving care, and only 1/3 of that number is getting care that meets the "adequate" standard, then we have a huge problem here. That's a lot of people without any care, and lots of people getting substandard care.

I wonder how we compare to other countries. According to @Skypilotofhope Canada spends 5% of the GDP on mental health, while European countries spend 14%. I can't find any good numbers for what the U.S. spends, but I'm sure it's close to nothing. Just try and go out and get mental health care here. It's impossible if you don't have the money for it. Therapy for me is $30 a week, and that's the rate for unemployed people. Most people don't have the luxury of spending that much.

And meds. Meds! We already had this discussion, but I'll say it again: $967 for 3 months of three drugs is still insane. I can not afford that. No one can, unless you're wracking up credit card debt to pay for sanity. And that was the price of drugs shipped from Canada. You don't even want to know what the local pharmacy was trying to charge me.

There's just no way to get mental health coverage in this country without having health insurance, and they don't have to cover you if you have a pre-existing condition. So where are you then? You're here in the boat with me. taking the meds that have the most side effects but are at a reduced cost ($300 for 3 months). You're seeking out nonprofit assistance for therapy and getting seen by therapists in training because they're cheaper. You're fighting tooth and nail not to have to be hospitalized, because that just wouldn't be financially possible.

What a mess.

Mental health screening

What would have happened in your life had you been diagnosed with mental illness earlier? I was lucky to have been diagnosed and begun treatment in my early teens, but most people don't get treatment until their 20s. So how would your life have been better?

There's a movement brewing to get mental health testing in schools. From Pete Earley's blog: "David L. Shern, Ph.D, the president and CEO of Mental Health America, made a statement that I found interesting.

Half of all people with a mental health diagnosis first experience it by age fourteen, but will not receive treatment until age twenty-four…Just as we have tests for hearing and vision, we need to have mental health check-ups with effective follow-up to reduce the prevalence and disability associated with these developmental disorders."

There's also apparently a movement against testing.

Earley also points us to a link for Mental Health First Aid.

Screening and first aid sound good on the outset, but what if it just creates more stigma? What if people start identifying mental illness everywhere? You get what you look for, you know? And teenagers are all mentally ill. It's part of the process. With kids who are obviously ill these kinds of programs can surely help them get help, but what about the ones who wobble the line of angsty teen vs bipolar? Will this start us on a path of drugging more kids? We don't even know how the meds effect adults long-term, let alone how meds effect a growing body.

You also have to worry about our litigious culture. What if a teacher identifies a student as possibly having a mental illness and the parents sue for "branding" their child? Or will these children be moved into special classrooms? What if it just creates a whole new load of stigma?

Education is better than ignorance, though, so I'm pulling for mental health screenings in schools and teacher training to identify these things. I think I would rather know something is up with my child than have it hit me out of the blue one day.

Don't cut our budget

In the late nineties, early 2000's I worried a lot about hospital bed availability. My mom was constantly in need of one, and it seems that she was always able to find a place just for a night. I never really worried that they take her in; she was always dripping blood by the time it came to that, but I always knew they would release her before anything good could come of that visit. She was homeless and unable to pay anything, and so she would usually just stay overnight. She was never stable when she left.

And now more states are cutting mental health funding so there will be less places for people like her to go. "Budgets for mental health services in some 30 states were slashed an average of almost $19 million in 2009 and more than $24 million in 2010." That's hundreds of beds gone, nurses out of work, and mentally ill people still out on the streets with no where to go to get stabilized.

I don't know what's happening with cuts in our area, but I'm sure it's a lot different than it was. Just look at all the buzz in Texas about cutting their mental health services, again. Lots of states are following that trend, even after the tragedy in Arizona brought mental illness back into the light.

Where do the acutely mentally ill go when they're released prematurely or can't get in to treatment? They go back to families who can't handle them, back to suffering in silence, and often back to the streets.

That's where my mom would go. Back out to the streets or into housing my family paid for, when she could tolerate housing. Luckily, we had the resources to help her. But what about people without resources? Who've alienated their families, or have no family? Without the help of the government, these people end up homeless, in jail, or dead.

So go ahead and cut the mental health budgets. See what happens. Don't say I didn't warn you.

Zero is the perfect number

There's a really interesting thing going on in Detroit. The Henry Ford Health System came up with a plan for zero suicides, and actually achieved it two years in a row. How?

Some of the performance improvements in the program include:

* Establish a consumer advisory panel to help with the design of the program.
* Establish a protocol to assign patients into one of three levels of risk for suicide, each of which requires specific intervention.
* Provide training for all psychotherapists to develop competency in Cognitive Behavior Therapy.
* Implement a protocol for having patients remove weapons from the home.
* Establish three means of access for patients: drop-in group medication appointments, advanced (same-day) access to care or support and e-mail visits.
* Develop a website for patients to educate and assist patients.
* Require staff to complete a suicide prevention course.
* Set up a system for staff members to check in on patients by phone.
* Partner and educate the patient's family members.

Imagine if every health system could take the time to do this. It just looks like staff training, patient and family education, and easier access for the patients. I used to be on Kaiser, which had email visits, too, and that was so helpful. I could email my doctor and tell her how I was doing instead of having to go through the nurse helpline, which was awesome for quick questions. Access is one of the best things in healthcare. If you can get your doctor quickly, you're going to have better treatment success, in my opinion.

Mental health parody

Dear Congress,

Ok, first, thank you for voting in the mental health parity laws. I'm very happy that insurers have to provide coverage equal to physical coverage, and at the same rate. But there are some things you missed.

No one HAS TO offer mental health coverage. They can just avoid it right there. Sure, maybe in 2014 something will happen, but that's really not helpful. It doesn't cover individual policies or small businesses. I understand that for small businesses it would mean no one gets health insurance, so good compromise, there. But for all of us who don't get coverage through our employer, or qualify (yet) for high-risk pools, or better yet, WANT to be taking out meds instead of using up emergency beds, what do we do? How do we get coverage?

Do you know how much meds cost on their own? Thousands of dollars. I'm not exaggerating. One month of one of my meds cost me $1,000. Or would cost me, if I had that kind of money to throw around. And I'm on three meds. Which, with the current state of the economy and my current unemployment means I'm off meds for the first time in 6 years. And I don't WANT to be non-compliant. I want to be a productive member of society. Instead, because no health insurance company will cover me, I have to pay out of pocket for medication, and I can't.

Thanks for making health care for all.

"Q: Since the law does not apply to individual policies, what advice do you offer those patients and families seeking care right now?

A: It's not so bright for the next four years. Everyone I've gotten calls from in the individual market who wants to go to a high-risk pool … well, you have to be uninsured for six months [to qualify]. In all fairness, I think the pools great and they have enormous potential. There's a reason for [the waiting period]. … And the high risk pool requirements won't change between now and 2014. For a lot of people, they will have to wait."

Being a teen is hard

Another study on those poor rats. They found that kids who binge drink in high school, or who smoke pot before the age of 16, have higher levels of cortisol, which is associated with high stress levels.

“That is the same type of profile that we see in adult patients who have been diagnosed with post traumatic stress disorder” and other mood disorders, says Pak. “They are not able to get used to stressors and they have very exaggerated responses to mild stress....Stress can pull the trigger on the genetic gun.”

In other words: that high stress life in childhood might just be the trigger that set off your genetic pre-disposition to depression, bipolar, schizophrenia, or other diseases/disorders.

I know I had a lot of drug/drink use in high school, as well as a lot of external family stressors. They know kids who are lonely are also predisposed to this kind of disorder, and I sure had 2 years in public school where I had one friend, and I was absolutely miserable. I had a boyfriend who was just with me to make his ex jealous, and I still think that some guys are tricking me. Especially with Adam. I thought it was too good to be true.

I wonder all the time if a lot of my bipolar symptoms are actually the result of all that LSD I did in high school. I was up to maybe 16 tabs, which is past the "legal limit" for sanity. I wonder, too, what my brain looks like. And what my poor liver looks like. I should donate my body to science.

Health insurance and jobs

I just canceled the "health insurance" I have, which as you know from previous posts, doesn't do anything. It is a prescription discount card, which discounted my $2,000 medication by $200. Still completely unaffordable. So instead of paying $200 a month for "insurance" I'll pay $967 every 3 months for prescriptions. It all about evens out, huh? Still highway robbery. I'd better get a job soon, or I'll run out of credit card space.

Speaking of money and jobs, I have 3 more interviews this week. One in the City, and one in two in a nearby northern state. One is close to my family up north, but far from any major town. It would be a tough dating situation, and I'm not sure I would want to do it. The other is at a premier organization, in a cool town, near my uncle.

I've had so many job interviews this year, and I just wish one of them would pan out. I'd like the ones farther away, I think. Not that this town isn't awesome, but the more I think about it, the better it was to be a little farther away from home. I love the people here, but it really does obligate me to spend a lot of time with them, and a lot of energy chasing my old friends.

We'll see!

I hate health care

So I'm fighting with the health insurance companies again. I tried to fill my prescriptions with my discount card, and it was still $2,000 for one med for 90 days. The other two were close to $1,000 each, and there were no generics. Jesus. I couldn't even put that on my credit card!

I called medicaid and they denied me because I have a pre-existing condition. That's right, kids, they can totally deny you because you have bipolar disorder, even if you've been covered by the same company for years before. Until 2014, they can still deny you. So every company denied me, and someone told me about a "high risk" insurance I could call. I called, and they need an official denial letter from an insurance company, so I'm applying AGAIN just to get the letter.

How incredibly frustrating. But I need meds now. I'm going to be out soon, and I need them in the mail. So I went to Canada drugs and got my meds, prescription free (which I wish I had known before I spent $200 on the psychiatrist). It was still $967 for 90 days of all my meds, where it used to be $90, but that I can stick on a credit card and pay slowly. How depressing to add more debt!

Parity or parody?

Your tax dollars at work? Apparently in a county in Ohio, most of the people treated in abuse and recovery centers are covered by tax money when they are ordered to attend. People who have insurance often have to rely on their own money to fund recovery because insurance doesn't cover visits to recovery or mental health institutes. But all that is supposed to change. On January 1, 2010 they passed the Mental Health Parity Act, which was supposed to make abuse and mental health services available the same way surgeries and other health benefits are.

"Benefits for treating substance and alcohol abuse have been much more limited than medical care benefits. Previously, insurance companies would pay for the health issues caused by the abuse, but not treatment for the abuse itself. For instance, someone with liver problems would receive medical treatment, but limited or no alcohol recovery treatment, Hollingsworth said."

But: "The law does not require that all MHSA conditions be covered. However, once an employer or other payer decides to cover a MHSA condition, then that coverage must be on par with the medical-surgical benefit. Some payers/group health plans may decide to exclude certain MHSA diagnoses."

So really, they don't have to cover anything. They can pick and choose among the DSM-IV to see what they will cover or not cover. Pretty shitty, eh? One would think that they would want people to be healthy and survive illnesses. To treat the disease and not just the symptoms. But, of course, the health insurance companies only care about the bottom line. How disgusting. If only we could protest by not getting insurance, but then where would we be? My dad broke his pinkie and it cost $8,000 AFTER insurance. Imagine what it would have cost him without insurance? Too much.

So let's see as time goes on just how much "parity" we get.

Bring us back to nature

"Forests -- and other natural, green settings -- can reduce stress, improve moods, reduce anger and aggressiveness and increase overall happiness."

Have you ever read Last Child in the Woods? It's a really incredible book about "nature deficit disorder" in which children of our "wired generation" who don't get enough exposure to the natural world end up with depression, obesity, anger, and more illnesses.

I remember as a kid my parents tried to use all of our vacation time to visit as many national parks as possible. We always camped (I didn't stay in more than 2 hotels until I was 20-something). I loved spending time in the woods. I would roam around and play with the clay ground, listen to the crickets late at night, and climb over rocks and streams. I always felt better in the woods. That's why I tried paganism once (but I just can't seem to shake Catholicism).

I believe we've all got nature deficit disorder. We don't get outside enough (as I'm typing in front of the tv...). We need to get back together with nature. To take our illnesses outside into the world. So grab your 12 and 12, grab your mental health books, and head outside into the sun, or if you prefer, the shade.

Health insurance is a necessary evil

I'm totally resentful of my health insurance company. They keep hanging up on me while they try to transfer me to the 32rd person who is supposed to help me do one damn simple thing.

I'm resentful at the whole process of health insurance. How can they deny the sickest people treatment under the guise of "pre-existing condition?" Isn't that illegal? Shouldn't it be? Luckily, even with my diagnosis of bipolar, I (knock on wood) haven't had any trouble getting health insurance through my places of employ. I know people who have had cancer who now have trouble getting health insurance, and it just seems so ridiculous. People who have pre-existing conditions need healthcare the most in order to stay well and not get sick again. Without it, I couldn't afford my medications. Sometimes I see on the receipt that my meds, for three months, would be upwards of $800. It costs me $50. I would be unmedicated if it weren't for insurance.

I had no insurance during college, and I was crazy. Even my alcoholism took off. I was trying to cover my incredible mania with something, anything! I was so manic that I was paranoid and freaked out at almost anything. And then I would swing into deep depressions that had me crying during class, or just generally acting like it was the end of the world.

So I'm mad at insurance companies, and yet grateful for them. I suppose all resentments will be a like and dislike balance for me. I'm unfortunately good at seeing the good in anything. Damn optimist.

The science of mice

"There are big drawbacks in the current therapies for depression," says senior author John Traynor, Ph.D., professor of pharmacology at the U-M Medical School and director of the U-M Substance Abuse Research Center. "Therapeutic benefits are delayed, there are unwanted side effects, and it's not unusual for depressive symptoms to return."

They discovered, through messing with mice (again, poor mice), that there is one specific serotonin receptor that deals with depression, and now they might be able to target just that one. Usually, SSRI's "flood the brain with serotonin" and hit all the receptors. That's what causes side effects, and sometimes the brain can get immune to the SSRI, which is why sometimes you have to change meds until you find one that works, and even then, you have to mess with them occasionally.

Science is fascinating.

Poor rats

They do such insane testing on animals now-a-days. I mean, injecting them with cocaine and fucking up their amgydalas? Jesus. I am grateful everyday to rats who have made the medication I take available. Anyway....

“Early emotional trauma, paired with a certain genetic background, may alter the early development of neural networks intrinsic to the amygdala, resulting in a cascade of brain effects and functional changes that present in adulthood as a dual-diagnosis disorder.”

These researchers did tests on rats whos amygdalas (the part of your brain that regulates fear and anxiety) were genetically messed up, and rats whose brains they messed with. It appears the brains that were genetically messed up (like those of us with mental illness) were more likely to become addicted to substances than even the rats who had trauma later in life.

So we do, in fact, have a pre-disposition to addiction. Of course, mentally ill people often search out fearful situations, or have trouble feeling fear anyway. I know I don't get scared often, and I like that rush from an adrenaline inducing experience. And drugs give you that great adrenaline, too.

But then they said something else: "dual diagnosis patients do less well on psychiatric medication." Really? I haven't been able to find anything to confirm this, but it doesn't really surprise me. People with addiction tend to a) abuse their prescription drugs (I never took mine when I was going to do other drugs) b) don't take them on time (it helps if you take them the same time every day) and c) drugs and alcohol react with meds. They all process through the liver, and that poor organ can only do so much.

I love reading articles on mental illness and addiction. It's good to know as much as you can about your illnesses. When you understand yourself, you don't have to go back. You can "think through that drink" or "play the tape all the way through" as they say in the program. You can be more aware of where you are, and what you're doing to yourself. Knowledge is power.

What the hell is bipolar?

"Bipolar disorder is a serious illness that causes a person to experience unusual thoughts and mood swings."

So you wonder, what is she talking about? What the hell is bipolar disorder? Bipolar is a mental illness which causes mood swings, like it says there. You can go from really, really "happy" to so depressed you can't move out of your bed. Some people swing like this (rapid-cycling) in days or even during one day. Some folks, it takes a little while to go back and forth.

Lots of people have "normal" periods between these swings. You can be perfectly fine - feeling happy and sad, but in regular ways, mostly due to situations in your life, but not so high or low that it's a mood swing.

Mania. Oh, mania can be fun, until it's not. Mania is the part when you're really high. You feel like you're on top of the world, and often have feelings that the world revolves around you. You're the most important person, and you have thoughts that others just don't understand, because you're so much smarter! But mania can also turn bad. You can have hallucinations, thoughts that you can fly (or other really grandiose thoughts), and often get so high that you can't even stand yourself anymore. It's a common thought that only depression leads to suicide, but often so does mania.

Depression is not fun, unless you like to wallow in self-pity all the time. Depression can make you feel like you're the shit on someone else's shoe. You're so low, you're not even an amoeba. You're unimportant, and this can become a paralyzing thought. All you want to do is lie in bed and hide from the world. But this isn't usually when suicide happens. You just don't have to energy to think up a plan.

But hypomania, that's when you have to look out. Often, when depressed people start to feel a little better, that's when they have the energy to make that kind of bad decision. Hypomania is that state of inbetween, when you're not quite normal, and you're not quite depressed or manic. You can still have thoughts that you're shit, or the shit. It just depends. Most people kill themselves while they're hypomanic.

Wow! This is so depressing, you think. It's not. It's a controllable illness (mostly) with modern medication and close observance by a therapist. You can limit the high and the low with medication. You may still get up, and still get down, but often it's not that bad. Medication can keep you semi-stable. It's not all bad news.

So I'm advocating for meds, here. All you bipolars who think, "But it changes my personality! It makes me fat! I get dumb!" Boo hoo. Get over it. The dumbness fades as you take it regularly (REGULARLY and on time. Don't skip doses or it doesn't work). And you can moderate the fat, well, ok, so sometimes you get fat, but it's better than wanting to kill yourself or jumping off buildings cause you think you can fly.

And be kind to yourself. You're not shit because you have this disease. It's just a disease, like diabetes. You have it, you treat it, you feel better.

Impulsivity? What impulsivity?

"Personality traits associated with impulsivity normally decrease during emerging and young adulthood, and these decreases are associated with reduced substance use."

It's interesting that impulsivity decreases in college-aged kids. You would think it would increase, but I'm sure that the upper ages of this group skew it downward. People in their early 20's are often starting careers, and learning how to be responsible. This leads to less impulsivity in their drinking and drug use.

Except us alcoholics and mental illness folk!

"Impulsivity is a problem with anyone who is an alcoholic, but alcoholics with antisocial and borderline personality disorders may be particularly troubled by inhibitory-control issues."

Like you would guess, those with mental illness are more likely to be substance abusers, and have impulsivity issues. I know mania makes you uninhibited by rational thought, so it would make sense to be impulsive.

So I guess we just have to watch ourselves closely. If you have a problem, 12 step groups are really helpful. But keep an eye on your moods. Too up, and you may develop that problem with alcohol and drugs.

Abuse and mental illness

There are a lot of folks in AA who talk about their dual-diagnosis, as well as problems of incest and rape in their early lives. Many of them were raped while in intoxicated situations. Now, there is a study that may link sexual abuse to mental illness.

"Our most recent study identified an association between rape and subsequent diagnosis of a psychotic disorder over a 10-year period."

It's really not surprising. Children who are abused often withdraw and use substances or food to hide the pain. We all have pains, and we often drown them in booze and drugs. People who are abused often have hidden pain; they block out the situation and don't know why they drink.

Not that I've been abused. I had a weird thing with my cousin once, but I don't know if I would label it rape or abuse. Who knows. I just know life is hard, but AA IS the easier, softer way. It's good to be sober, and to be able to deal with your pain instead of push it down and let it fester.