My Experience Only. YMMV.

The relationship between law enforcement and mental health is, to say the least, fraught. It often seems that every other day we hear about a police officer shooting someone who is mentally ill or mentally disabled. Throw in the present militarization of police and the remains of a shoot-first-ask-questions-later culture, and you’ve got tragedies in the making.

The good news is that there are police departments around the country that are trying to revamp systems so that the needs of the mentally ill are considered and treated more sensitively. Part of this is in response to the fact that many jails and prisons have become de facto mental institutions. Part of it seems to be an offshoot of the community policing movement. Some of the programs sound progressive or at least promising. Others may be more dubious.

The effort I read about recently that struck me as dubious is Indianapolis’s approach. As the IndyStar reported, “Ten officers with the Indianapolis Metropolitan Police Department are testing out a tool designed to help them assess whether a person is exhibiting symptoms related to a possible mental illness.” The “tool,” or questionnaire, “is still being developed, so all officers are testing now is how easy it is to use and whether the questions that are part of the assessment aren’t too ‘technical’ or ‘cumbersome’ for officers in the field, IMPD Lt. Catherine Cummings said.” Which is probably a good thing, seeing that the tool uses “questions that medical professionals use to detect mental illnesses, according to [Paul] Babcock, [Director of the Office of Public Health and Safety (OPHS)].” It is designed to be used from a cell phone or laptop.

That does indeed sound technical and cumbersome, not to mention the fact that it is rather difficult to see how police officers would use it in the field. It’s hard to picture officers with cell phones and laptops filling out a questionnaire to determine if someone needs to go to jail or to the emergency room. The project is still in the testing phase, so it has a long way to go before it sees use in Indianapolis or elsewhere.

The Iowa approach seems more practical.  It is “a response to the increased burden law enforcement agencies face in trying to make America’s frayed mental health system function. The team helps get people into treatment before they spiral further out of control and wind up arrested for behavior rooted in their mental struggles.” Police officers, often in small towns where they know the people they serve and protect, do this partially by “bringing people in for court-ordered treatment….They also provide security at a threadbare courtroom at [the local medical center], where commitment hearings are held several days a week.”

One of the deputies says he “focuses on the fact that the people he’s tracking down are experiencing mental troubles that could happen to anyone. He doesn’t want them to feel like they’re being arrested. ‘These people are not criminals,’ he said. ‘They haven’t done anything wrong. They’re people in need of our assistance.'”

Mental health advocate and activist Pete Earley sees the problem as one requiring a number of solutions: “We still need to work on building supportive housing. We still need to push for expanding problem solving dockets (mental health and drug courts). We now need our judges and prosecutors to understand that individuals charged with both misdemeanors and felonies should be eligible for diversion because it is not the crime that should be the determining factor but whether or not the accused has a criminogenic personality. (Persons with chronic, serious mental illnesses often get charged with felony assault for resisting arrest.)”

He is undoubtedly right. But most of these approaches remain rather far in the future. Finding the political, municipal, departmental, and financial will to implement them is, for many jurisdictions, simply not possible.

And of course, the problems are hardly solely the fault of law enforcement. Sensitive, caring police officers exist nearly everywhere and people who work in correctional facilities recognize that their institutions have become substitutes for mental health treatment and that this is hardly a solution.

But at least some people in some places are beginning to address the problem.

 

 

Big Box Mental Health

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According to an article published on the blogsite She Knows, “a Boston-based company that manages mental health care for 40 million people, has opened a small clinic in a Walmart location in Carrollton, Texas, and has plans to expand the program in other retail locations throughout the country.”

And I don’t know whether to vomit or applaud.

Walmart’s ubiquity is one point in its favor. They’re everywhere. And for some people, whether they love or despise Walmart, it’s the only choice they have for groceries, household goods, or much of anything else. Those areas are also likely to be underserved by the mental health system, such as it is.

And sparse as the options offered by the Walmart walk-in clinics is – treatment for anxiety, depression, grief, relationship issues, and stress management – it’s more than a lot of people have access to now. The trial site is said to be staffed with one licensed clinical social worker, has a sliding fee scale for those with no insurance, and will soon be approved for Medicaid reimbursement (it is hoped). There will even be remote Skype therapy services if necessary.

All that is good, as far as it goes. But does it go far enough? Will people be able to get more than a pat on the head and a pep talk as they do their weekly or monthly shopping? How will the walk-in clinic handle referrals for people with serious mental illness or a need for psychotropic medication, something that clinical social workers can’t provide? How many people can get help from a single professional? How good is internet therapy? And what percentage of Walmart shoppers have access to the internet?

The walk-in clinics are touted as reducing stigma around mental health issues. After all, the thought is, getting your mental health services at Walmart will become as natural as getting a haircut or an eye exam there. Well, maybe. On the other hand, how many people are willing to have their friends and neighbors see them publically, sitting in the waiting room or ducking surreptitiously through the door? It seems to me it might perpetuate stigma, rather than lessening it.

Besides, Walmart is hardly a bastion of high-quality goods and services. Will the mental health services be second-rate as well? It could be that even second-rate care is better than no care at all. But it’s surely not enough to deal with issues that require long-term therapy with actual treatment plans; scheduled repeat visits; building a relationship with a particular therapist; access to medications; and all the other aspects of more effective treatment, especially considering complicated disorders like bipolar, OCD, or anorexia.

I fully admit that I hate Walmart – the way they have driven out local Mom and Pop stores, for example, and the way they treat their employees. But I have many choices of where to shop near where I live, and access to both therapists and psychiatrists, and insurance that covers my appointments and medications. If I weren’t looking through the lens of privilege, I might see things a lot differently.

So for now, I guess my attitude is to wait and see. One test location does not a Walmart Psych Empire make. Perhaps it will succeed; perhaps not. Perhaps it will become the Great Clips of the psychotherapy world.

But while I’m waiting, I’m hot holding my breath.

 

Birthdays on the Tightrope

One year on my birthday I woke up in Venice. The next year on my birthday I woke up in excruciating physical pain. For me, anyway, birthdays are like that–a crapshoot.

It’s been a long time since I really enjoyed birthdays (except for the one in Venice). As a young teen, I experienced a humiliating, traumatic event at a birthday party that triggered a severe depression. It wasn’t my birthday party, but it left me deeply wary of birthdays in general and birthday parties in particular.

Now my birthday is approaching again and I don’t know which way it’s going to go. Oh, I know I won’t wake up in Venice and I hope I don’t wake up in excruciating pain. But it’s going to be a crapshoot for sure.

You see, this year I’m walking that tightrope so familiar to people with bipolar disorder. Though I’ve been fairly stable through most of the year, now I find myself teetering. If I fall off to one side, there’s depression waiting to catch me. If I stumble the opposite way, hypomania beckons. One way or the other, I fear I’m going to be triggered.

Last week I wrote about my husband’s heart attack and how it was my turn to be the caregiver (https://wp.me/p4e9Hv-Kx). In that post I blithely claimed that I could handle the financial stuff for us. What I mean was that I could handle dealing with the bills and bureaucracy and the assorted financial frustrations that go with a medical crisis.

What I can’t do is make enough money to get us through it all. Dan hasn’t been able to work since his heart attack in late August. We’ve gotten by so far largely due to the generosity of family and friends, which I have been able to organize, track, budget, and spend. But now we’re running out of money.  And I’m afraid.

Naturally, I’m catastrophizing, one of my less-effective “coping” mechanisms. We might make the next mortgage payment, but after that I just don’t know. Even with Dan going back to work next month (we hope) and the small amount I make, I know it won’t stretch to cover the mortgage and all the other bills. I imagine that soon we will be living under the Third Street bridge and fighting stray dogs for cold french fries.

Plus, desperate finances, particular long-lasting and seemingly unrelenting, is one of my depression triggers. Dealing with our own finances at the same time as taking over my mother’s was deeply involved in the last major meltdown I experienced.

Dan is already taking up the slack, planning and coming up with ideas to get some more money to tide us over. But then I feel defeated, as though I’m not shouldering my weight in the caretaking department.

The ensuing chaos should descend right around my birthday. And I may descend right along with it.

On the other side of the tightrope lurks hypomania. My first book (on bipolar disorder) is getting closer to being published by Eliezer Tristan Publishing, which is a brainchild of Sarah Fader of Stigma Fighters. Publishing a book is a goal I’ve had for a good many decades and to have it about to happen is a real rush.

But. I can already feel myself planning fabulous things once the book exists. A launch party. T-shirts. Bookmarks. A promotional sign. Speaking engagements. Networking. Bookstore visits and author signings.  I may just be getting ideas that are beyond my ability to organize and pay for. I’ve already bought a top to wear to the not-yet-and-maybe-never-existing launch party. I may be planning things that I don’t have enough spoons to accomplish. I may be getting overwrought at the thought of reaching this goal and that way lies hypomania.

Or maybe depression, when reality doesn’t meet with my unnaturally inflated notions. Or both, I suppose. I have little experience with mixed states and may not recognize one until it bites me.

When my birthday comes, I may still be teetering this way and that. Or I may have either fallen or flown. I suppose it’s possible that I won’t lose my hard-won balance, though I’m not counting on it.

Whatever way it goes, it looks to be an interesting birthday. And not in the festive sense.

 

My Turn to Care

My husband had a heart attack this fall. He got a total of five stents, avoided open heart surgery, and is now in cardiac rehab. And I am helping take care of him.

Dan has been my caregiver as long as I’ve known him. He has stuck with me through the various ups and downs of bipolar disorder – when I was untreated, when I was struggling with finding the proper medication, when I shouted at him, when I was immobilized – whatever. I couldn’t have got through what I’ve been through without him.

Now I get to pay him back, at least a little, for all he has done for me. I have no training and little experience as a caregiver. But there a few things I can do for him, in addition to loving and supporting him as he has loved and supported me.

I can facilitate his appointments, meds, and procedures. Dan has a tendency to forget when is next appointment is, and with which of his many doctors. I have a perfectly good whiteboard in my study on which I note my own appointments as well as keep track of my work. It’s no trouble at all to add his and remind him.

Getting to his appointments is another area where I can help, especially since his cardiologist has a number of offices in various parts of town and in nearby suburbs where he practices on different days of the week. Since I’ve lived here most of my life, I know the area better than he does and I go with him to navigate. (He’s never gotten used to GPS.) I suggest routes that are easy to retrace and figure out when to leave to get there on time.

Dan has in the past had a habit of forgetting to take his various medications.  When that involved sertraline, I didn’t worry much since I know that once a certain level has built up in the body, missing a dose is not such a big deal. But with his blood thinner, a missed dose could lead to a clogged stent and another heart attack. So I proactively encourage him (as my therapist suggests I call nagging) to take them daily and on time.

I can handle financial stuff. With Dan being off work for so long and hospital and doctor bills adding up, our finances are getting pretty tricky. I can make sure I have steady work and even take on extra sometimes. I can fill out the forms for short-term leave, financial assistance, insurance, and other necessities.

I’ve even been able to set up PayPal and Facebook funding pleas to help us get a little extra cash to pay the utilities and other bills. (GoFundMe may be next once all the medical bills are in.)

I can handle computer stuff. Finding locations of offices and hospitals and the cardiac rehab place, phone numbers of financial aid programs, and names and side effects of medication are easier and quicker for me to do on my Mac than for him to do on his ancient PC. I can find things he needs on ebay for the lowest price. I can find and email various forms and records of expenses to wherever they need to go. This may sound minor, but believe me, it can take up a lot of time and frustration. I think of it under the heading of relieving his stress.

I also know how to network. A Facebook friend of mine teaches Tai Chi at a local Y. Through him I found out that the Y does not charge for his classes. And through Google I found that this month the Y waives membership fees if you donate canned goods to a local food pantry. The Y’s amenities include exercise classes and water aerobics, which I also could use. I also found a local Senior Center that has yoga and free weights (and community theater) as well.

I can understand his depression. Being faced with intimations of one’s mortality, combined with money problems and not being able to work can make anyone depressed. And Dan was already taking meds for depression before this current crisis even started. I am, of course, a third-degree black belt when it comes to depression. I know how he feels, why he’s feeling it, and what will and won’t work in helping him through it. I can be patient, supportive, and there to communicate or simply hug when he needs to, as he has so often done for me.

There’s not much care that my husband needs in the way of actual physical care. He is not so incapacitated that he needs help with feeding, dressing, bathing, or other tasks of daily living (other than changing his bandages when he cut his finger open and required eight stitches).

But I like to think that the support I can give him helps in his recovery by taking some of the stress off him, which his doctor recommends and which he has done for me innumerable times. We’re a team and this time it’s my turn to take some of the weight.

anise aroma art bazaar

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FDA looks to ban trans fats. Exceptions made if consumed while depressed, anxious, or without anything better to do.

The Daily Show

If that were true, I could eat all the trans fats I wanted, because my bipolar 2 often leaves me depressed and/or anxious.

In fact, my friend Leslie, who is my partner in depression, invented the perfect snack for depressive times: a ruffled potato chip dipped in cream cheese with an M&M on top. My husband starts to worry about me when I ask him to get those ingredients at the store.

But there’s a reason for our peculiar snack. Leslie and I are simply self-medicating.

“Blood sugar and carbohydrate intake are very important to the brain,” according to Everyday Health. “Your brain runs on glucose and depends on carbohydrates to supply the energy it needs. Carbohydrate intake also prompts the production and release of important neurotransmitters, such as serotonin, which creates a feeling of calm and well-being and reduces depression. So people with bipolar disorder may be indulging in a form of self-medication when they eat sugary snacks during depressive lows or manic highs.”

Not that self-medication is good for us. Bipolar people are more likely to have type 2 diabetes than the rest of the population. Three times more likely. One of the risk factors for type 2 diabetes is excessive weight and we all know and bitch about the weight gain from our assorted meds. Prescribing ourselves the Ben & Jerry’s treatment is not going to help, even though it may feel like it at the time.

So what are we supposed to be eating to help stabilize our moods? Of course, people will recommend turmeric, cider vinegar, or the latest “superfood.”  But every serious list I saw looked like this:

  • complex carbohydrates, especially fruits, vegetables, and whole grains
  • protein in the form of lean meats, poultry, fish, and low-fat dairy
  • omega-fatty acids from fatty fish (such as salmon), walnuts, and flaxseeds

In other words, exactly the kind of diet that is recommended to everyone for general good health! I think this comes under the heading of self-care, which is not always easy to do. Especially when I’m so depressed I can’t even manage a microwave cup of mac-n-cheese, or when my husband brings home a rack of ribs that he bought on sale.

But if I am stable enough to shop and cook and eat properly, those recommended foods may be good for my mood disorder as well as my body. According to bipolar.newlifeoutlook.com, eating protein “promotes serotonin and improved moods.” They also note that researchers in Italy say “increased consumption of omega fatty acids helps reduce depressive episodes and decreases the risk for suicide in patients with bipolar.” So apparently fish is brain food after all.

The other common suggestion in this realm of self-care is to keep a food journal, or I guess in this case a food and mood journal, to keep track of what you’re eating and how it affects your moods. If you’re the journalling sort, by all means, give this a try. As for me, I blog rather than journal and I know you don’t want to see a lot of “ate salmon, felt energized; ate chips with cream cheese and M&Ms, felt sad.”

The fact that food and mood are related is just one more example of how the brain and the body are intertwined, interdependent. It gives us a clue about the kinds of self-care that may do the most to help us stabilize our moods. And it gives us a chance to take more control, if we can, of our mental as well as physical health.

The Fire and the Window

fire orange emergency burning

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When Anthony Bourdain died by suicide and I told someone the news, he asked me, “Why?”

I was taken aback. “What do you mean, ‘why’?” I replied.

“You know,” he said. “Did he have money trouble? Break up with his girlfriend? Have some disease?”

That’s a common reaction to suicide and it’s uninformed. Real-life stressors can contribute to suicide, but they are almost never the whole story. People die by suicide when the pain of living seems greater than the pain of dying.

Gregory House, the misanthropic, genius title character of House, M.D., once said, “Living in misery sucks marginally less than dying in it.” People who kill themselves don’t believe that. They believe the opposite.

The best metaphor I ever heard for suicide was the plight of people in the World Trade Center’s upper floors on 9/11. There were the flames. There was the window. And that was the choice. Suicide happens when a person sees only two alternatives and both are equally horrible, or nearly so.

The bullied child does not take her own life because she was bullied. She was in pain, for a variety of reasons that included bullying. It was a factor, but it wasn’t the reason. She was hurt. She was isolated. She was depressed. She couldn’t believe that things would improve. She wanted the pain to stop. She believed she faced the choice between the fire and the window.

The politician who dies by suicide in the face of a major scandal does not kill himself because of the potential scandal. He dies because he sees his choices limited to shame, humiliation, despair, and ridicule. He believes that what happens to him will be as bad as dying. He is caught between what he sees as the fire and the window.

Mental illness can make it difficult to see that there are other choices. The distortions of thinking associated with serious mental illness can make us see only the fire and the window.

The one time that suicidal ideation got the better of me and I was close to making the choice, my thinking was just that twisted. I was faced with a choice that seemed to me would ruin someone I loved. I thought that I could not live with either choice. One was the fire and the other the window.

My thinking, of course, was severely distorted by my mental disorder. The thing that I thought might rain destruction on the other person was much smaller than I believed. There were ways out of the dilemma other than dropping a dime or killing myself. If we continue the metaphor, the fire was not that big, or that implacable, or that inevitable, but I couldn’t see that. In the end, I hung on long enough for my thinking to clear and for me to see other options.

I don’t actually know what was going on in the minds of the souls who were trapped in the Twin Towers. I don’t mean to lessen the horror of their deaths or wound their families by speaking of suicide this way. The reality of their choice is so far distant from the choices that other people who consider suicide face.

But that’s kind of the point. People who die by suicide don’t see any other way out. If they seem to be responding to what most people see as survivable hurts or solvable problems, people say they can’t understand how someone that rich, that successful, that beloved, that full of potential could have not seen that help was only a reach away.

The person who dies by suicide doesn’t see the hand reaching out. Only the fire and the window.

 

If you are considering suicide, call the National Suicide Hotline: 1-800-273-8255.

Mental Illness and Voting

people standing with signage on street

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No, I’m not going to tell you how to vote. And I’m not going to say the country is bipolar just because we’re so divided. What I am going to do is talk about the issues you should be concerned with during these mid-term elections and what you need to do in order to make your vote count.

Despite the fact that mid-term elections are usually boring, plagued by low turn-outs and minor local issues, this time they are likely to have national significance. This time we are voting on people – representatives, senators, and governors – who will make the policy for our states and our nation, including policies that affect the mentally ill.

Health policy. We’re not voting directly on national health policy, but we are voting for or against the people who make those policies. Those policies include support for the ACA (Obamacare), especially its protections for those with pre-existing conditions.

This has become a hot-button issue this year and you will likely hear and see ads that tout the various candidates’ support for insurance that covers pre-existing conditions. The key here is to do a tiny bit of research. Whatever a candidate says now, has he or she always supported coverage for pre-existing conditions? Or does the candidate have a history of trying to do away with such insurance coverage? Promises are not the point here. Past actions are. Given the choice between an incumbent and a newcomer, I personally will go for the newcomer if the incumbent has a track record of trying to dismantle coverage for pre-existing conditions.

Another important issue for the mentally ill is safety net programs, particularly Social Security, Medicare, and Medicaid. Many people with mental illness depend on these programs to cover their basic living and medical expenses. Believe a candidate who wants to gut these programs. Many of them see the people who benefit from these programs, particularly SSDI, as “moochers,” “freeloaders,” and drags on society. If you or a loved one needs this kind of assistance, vote accordingly.

There may also be local issues regarding police training, housing, and the homeless that are relevant to persons with mental illness. Spend a few minutes researching before you vote. Some Internet sites such as BallotReady.org and Vote411.org can help.

Your vote. Your vote only counts if you actually cast it and that can be a problem for those with mental or emotional disorders. Going to the polls can seem an impossible feat. But given the significance of the coming elections, spending some spoons to do so can have long-term repercussions.

If you have trouble getting to the polls, first make sure you know where your polling place is this year. It may have changed since the last time you voted. Then ask around. Some cities, like mine, are offering free bus rides to polling places and some services like Uber are offering discounted fees. Neighbors who go to the same polling place or members of support groups you belong to can potentially provide transport. Don’t forget to ask friends and family, if you can. They may not realize how important voting is to you or the difficulty you have getting to the polls.

If your difficulty is not getting to the polling places, but being at them, plan ahead. There are likely to be crowds this year and you may want to have a support person with you, especially one who also plans to vote. You may even be able to call the polling place ahead of time and find out when their peak voting times are so you can avoid them. If possible, avoid the noon rush, when many people take a voting break from work, and just after local businesses close for the day.

You may have heard rumors of intimidation at the polls this year. These are likely exaggerated, as are predictions of civil unrest after the results are known.  If anyone tries to interfere with or influence your voting, find an official poll worker or ask for a provisional ballot, which is your legal right. Call the police if you have to. Rely on a support person to help you get through the process.

Remember that this year’s elections are important. If at all possible, VOTE.

 

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