Beyond “get help.” The reality of accessing mental health services.

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A few months ago, Robin Williams’ suicide sparked a rash of posts on social media urging those struggling with mental illness to “get help.” This was massively frustrating to me because, while well-intentioned, the people who posted and re-posted these pleas clearly had no idea how hard it is to access mental health treatment in this country. It also assumed that Mr. Williams had not sought help for his condition which is not an assumption I’m willing to make without knowing the man.

What I do know about Robin Williams, though, is that he was in the elite class of people who would have had no problem accessing or paying for mental health services. He had plenty of money, was white, and lived in an urban area. Take any one of those things out of the equation and his chances of accessing good treatment would have been much lower.

The problem of access begins with the high cost of care and the lack of insurance coverage (one in five people with a serious mental condition are uninsured), but extends further to lack of providers in low-income and rural areas (89 million Americans live in federally-designated Mental Health Professional Shortage Areas), low numbers of providers who are trained in issues specific to minority communities, high numbers of psychiatrists who either limit the number of Medicaid patients they will accept or transition to private practice so they don’t have to at all. I could go on. And on. And on.

To give a specific example, the health system that my insurance covers here in town has 15 psychiatrists on staff. The hospital serves a geographic area of nearly 500,000 people and has close to 2 million outpatient visits per year. You do the math. That’s just not enough. I am in that privileged area of intersection of money, insurance, race, class, and geography and I still only get 15 minutes every three months with my psychiatrist. We discuss medications, he orders prescriptions and tests, and that’s it. He’s a great man and I adore him, but that’s just not enough. I’m sure he wishes he could do more.

Of course you can always hit up the emergency room in a real psychiatric emergency. I did, and I was admitted to their in-patient facility for about three days back in 2006. But again, I had insurance and the money to cover what insurance didn’t pay. The in-patient facility I was in doesn’t accept Medicaid, flat-out. It is a non-profit, faith-based hospital system so they will work with charity cases, but imagine for a moment that you’re feeling suicidal and you have no insurance, no Medicaid, no money, and a family to support. I can guarantee you that figuring out a way to pay for mental health care is going to factor high in the decision about whether to “get help.” In fact, my guess is that a lot of mentally ill people go right on ahead and kill themselves, rather than saddle their families with debt resulting from an extended in-patient stay. That is so horrible and wrong it makes me ill to type.

There is so much more I could go into about lack of access to mental health services. I could probably write a book. Maybe I will write a book. Some day. But for now, having laid out why “get help” is an utterly inadequate response to someone struggling with mental illness or suicidal thoughts, what can you do to help change things and improve access to services?

Advocate. Write letters. Call your congressman. Adopt mental health care as one of your top political causes. Donate money to organizations that advocate for the mentally ill (NAMI is the bomb). Please do that last thing. There is no pink ribbon campaign for suicide prevention. Nobody runs in a “please don’t off yourself” 5k. College-age folks? Consider training to be a therapist or LCSW. It’s a tough, but rewarding career and the need is so very high. Offer hands-on assistance in navigating the existing system to someone you know who is struggling (I will expand on this in a later post).

In other words, stop forwarding, re-posting, and allowing Facebook to serve as your social conscience and get out there and make some change. We need you.

peace…

Mental health self-care: Tips for sick days

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sickdaysAs I mentioned yesterday, I hadn’t posted in a while because I had been sick. Pretty much everything falls apart around here when I’m not physically or mentally well and the writing is the first thing to go. Followed by the proper eating, sleeping, exercise and…you get the drift. Here’s the thing: people who struggle with mental illness absolutely must pay meticulous attention to self-care, even when they’re sick, depressed, anxious, or otherwise not on top of their game. Because once you let basic physical self-care slide, mental deterioration is almost a given and the downward spiral can last for much, much longer than the initial physical illness.

But if you’re like me, the last thing you want to do when you’re sick is prepare meals, sleeping is hard and you want to do it at weird times, and exercise is right out the door (especially for me since when I get sick it always goes straight to my lungs). Also, I have multiple people to care for me when I’m sick. Not everyone has that privilege.

So how do you handle taking care of yourself when taking care of yourself is really hard? Maximize your good days and spend a little time preparing in advance for those times when you’re just really not feeling it. Here are some tips:

Food

  • Take some time on a good day to make an emergency meal plan. Write down five to seven days worth of simple meals that you can easily prepare in the microwave or on the stovetop. Here are some ideas for things that don’t come from a can:
    • Soup and crackers (Prepare homemade soup in advance and freeze it. Put some veggies in there.)
    • Black bean quesadillas (Heat a tortilla in a skillet, add some canned black beans and shredded cheese, fold over and serve with salsa.)
    • Chili (again, prepare in advance and freeze in single-serving portions)
    • Scrambled eggs and toast
  • Once you have created your emergency meal plan, pick up the ingredients at the store and stash them in your pantry and fridge. Always keep these things on hand. Nothing sucks more than having to schlep to the store when you don’t feel well.
  • Don’t worry too much about whole, organic foods, but also don’t eat junk. Try to stick with nourishing, semi-healthy foods. Your body and mind will thank you for it.

Sleep

  • Keep an extra set of sheets on hand and make sure they’re clean. Having clean sheets on the bed is an instant way to feel better when you’re sick.
  • Invest in a humidifier. When you have a cold, your nasal passages can get dried out and lead to a sinus infection. The steam will also help you breathe easier if you have chest congestion.
  • Get some extra pillows to prop yourself up in a comfortable position. Lying flat on your back is no bueno for nasal or chest congestion.
  • Try to stick to your regular sleep schedule as much as you can. You may need a nap during the day, but try to get up and go to bed at the same time you usually do. Keeping a regular sleep schedule is the number one thing, bar none, that you can do to keep your mood level.

Exercise

  • Obviously a full workout is out of the question when you’re sick, but if you’re feeling even a little bit ambulatory, it can do you a world of good to take a short walk around the block in the fresh air.
  • If you can’t exercise at all, at least sit outside for a few minutes if the weather permits, preferably in the full sun.

Other stuff

  • Be sure to check with your psychiatrist or primary care doctor about what cold medicines are OK to take. Some, like decongestants, can make you feel anxious and others, like antihistamines, can double up on any drowsiness that your regular psych meds cause.
  • Remember to take your regular medications at the proper time. Set an alarm if you have to. It’s stupid easy to get your meds wonky when you’re sick.
  • Don’t malinger (I love that word). The hot minute you’re feeling up to it, get your carcass out of bed. Shower. Dress in real clothing. I mean it. The last thing you need is an excuse to lie around in bed all day. That will become a habit quicker than you can imagine.

Finally, be patient with yourself and try to keep a good sense of humor. Sickness is frustrating for everyone, but it can seem like one more horrible thing in a parade of horrible things for a mentally ill person. It’s not personal. You didn’t ask for it. It will pass and you will get better. Especially if you care for yourself properly so that your mood stays level.

peace…

A thank you note

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**waves** Long time no see! I haven’t posted in a few weeks due to being sick as a dog and also…

…I took a road trip!

If you know me at all, you know that solo road trips are my favorite thing in the world. I do my best thinking on long drives and I always come home refreshed with lots of new direction and ideas. However, things had gotten so bad with my mental state that the last time I was able to hit the road solo was in the fall of 2010. So, yay! for better living through chemicals because I just got back from a 1,500-mile, four-day trip to see Jubilee Riots in Michigan and Ohio.

The trip, and the fact that I was able to make it, was an amazing, affirming experience. I carried my own bags, did my own navigating, managed my own hotel check-ins, found parking spaces, and only freaked out once or twice. For someone who struggled for four years with putting on my shoes in the morning, I can’t overstate the importance of this. So, all that by itself would have made it worth it.

But of course, I was on the road to hear music which made it even more special. And not just any music. Brand-new, amazing music by my favorite band. Live music is like air to me, so you can imagine how great that was. (You really should check out Jubilee Riots. They’re worth your time and music dollars. For real.)

I could wrap up the story now, saying that I came home having accomplished everything I set out to do and had a great time. But something else happened. Something so incredible that it’s taken me three days to fully process it into words.

Jubilee Riots wrote a song for me.*

No shit.

Here’s how it went down. The latest album, “Penny Black” is a concept project where all the songs were inspired by letters written by fans. When they put out the call for letters a year ago, I wrote one. I had fun writing it, but I sent it off without any real expectation that it would inspire a song. It was just a rambly account by an aging hippie about the first epic road trip I ever took, nearly twenty-five years ago (ack), to see the Grateful Dead.

Fast forward to last Saturday night at The Ark in Ann Arbor. I’m sitting there, enjoying the show and all of a sudden, the guys announce that there’s someone in the audience who inspired the song they were about to play. Everyone’s looking around. *I’m* looking around. They say my name. My mouth falls open like a landed fish and all I can think to say is, “ARE YOU KIDDING ME?? SERIOUSLY??” Then they started playing the song. It’s called “Rapture.” I’d already heard it, having had the album for a couple of weeks now. It’s a gorgeous, soulful, bluesy ballad about memories, and time passing, and the stories that define us.

Of course, me being me, I started shaking and I cried like a baby. It was a rather embarrassing spectacle, no shit.

It’s amazing enough that my writing inspired my favorite band to create a song (and wow does that give me confidence as a writer…). But the fact that they wrote *this* song, about *this* story, at *this* time in my life…my measly words can’t do justice to what an incredible gift that is and how much I treasure it.

So I’m writing this post to say thank you. I tried, I think, to say so in person, but for someone who’s so good with words on paper, I’m not terribly good at face to face communications with people I don’t know well. And even though I’ve known these guys for a long time, I get a weirdo social-anxiety thing that kicks in and makes me shy about approaching them. I never know if it’s the right time or what I should say and even if I do get up the courage I walk away thinking I said dumb stuff. So I’m writing it down.

Guys, thank you. Seriously. I don’t know how you did it, but you put the essence of so much that I am into that song. You captured things I didn’t even remember I’d put into the letter until I went back and reread it. You *got* the wistful longing, the nostalgia, and how much I *miss* my old life and my old self. But you also caught that there’s been a full life in between that long-ago road trip and this one.

And I get that a lot of this might be projection on my part, knowing the place in my mind the letter came from. But the thing is, this song touched me deeply before I even knew it was “mine.” Something about it spoke to me from the very first time I heard it. (I just went back and re-read my Facebook posts from the first time I heard it and yep…it did make me cry the very first time.) So…wow…just…wow.

This is the best gift I have ever received.

peace…

p.s. *I fully realize that Jubilee Riots did not write this song for me, personally. I just thought I’d disclaim that here! :-)

Weekly Five – Mental Health News Roundup – October 24, 2014

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Mental health issues put 34,500 on New York’s no-guns list. (New York Times): Well. This is a thorny one. On the one hand, keeping guns out of the hands of mentally ill people who might harm themselves or others is probably a good thing. On the other hand, how do you fairly determine that? The stigma that mentally ill people are prone to violent behavior is one that needs to be vigorously challenged. That said, suicide rates are demonstrably higher when people have guns in their homes. I have no idea what a good solution is, here.

How Medicare covers outpatient mental health services. (Huffington Post): Important information for seniors on how Medicare covers outpatient mental health services. Mental health care for seniors is extremely important and not talked about enough. Don’t get me started on Medicaid, though…

Oilers goalie unveils new mask dedicated to mental health awareness. (USAToday Sports): This is the second story I’ve come across this month about hockey and mental illness. It makes my heart glad to see this, because I know of several former players who have really struggled with this. As I cruised around google after reading this article I discovered that, at least to the Canadian teams in the NHL, mental health awareness is A Thing. I believe I will have to post about this more at a later time.

Proposed Uptown mental health facility expansion draws criticism. (The Montana Standard): Butte, Montana Council of Commissioners chairwoman Cindi Shaw can kiss my ass. She doesn’t want a mental health facility in her neighborhood because the “area is saturated” and “there are enough services.” That’s dogwhistle for we don’t want the damned crazies in our neighborhood and I see right through it, ma’am.

Obesity, cancer, mental health. What links them all? (The Conversation): Really interesting, open conversation about the links between non-communicable diseases (like heart disease, diabetes, etc.), obesity, mental health, and social engineering. Smart people realize that there’s way more to all those things than “poor choices.” Our willful refusal to admit that these problems are as much societal as they are personal is killing people.

That’s it for this Friday!

peace…

p.s. Here’s a late-breaking story I just came across in the New York Times. A study has been done busting the narrative that lower enlistment standards are responsible for the increase in mental health problems in soldiers.

Way leads on to way. Recognizing transformative experience.

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For the last nine years, I’ve been involved with a local renaissance faire. I started off as a performer, then dropped back for a while to being a patron. Now, somehow, I am one of the people In Charge. I have no idea how that happened. Anyway, I’m passionate about it and I think a lot of people don’t understand why. It’s a dinky little faire that always teeters on the edge of financial viability. Our show is earnest, but decidedly amateur. It’s a shit-ton of work for two measly weekends a year. I could bitch at length about how screwed up it can be (and believe me, I know people who do…one wonders why they still bother if it annoys them so much), but I’d rather talk about the reasons why it’s so important to me.

To really understand what this faire means to me, you have to go pretty far back in my personal history. When I was a kid, I was always on the outside looking in. I was not allowed to be involved in the things I cared about. I tried out for plays, but never got a part. Those were for the popular kids. I was on the drill team for a year, until my place got taken by a more popular girl. I didn’t get invited to parties, ever. I was a friendly extrovert forced by circumstance to be a solitary introvert.

Attending a hippy-dippy college and touring with the Grateful Dead for six years helped me make more friends and discover more about who I was and who I wanted to be. But I still carried the imprint of high school, like an angry handprint on my cheek, and remained convinced that a social life was not something I was entitled to have. After college, and after Jerry died and I stopped touring, once again I fell into my unnaturally introverted ways. For a long time, I had no friends at all. Then I met my husband and he became the center of my world and my best friend. I didn’t need anyone but him for a long time.

Once my daughter was born, and I decided to stay home with her, I knew I needed some kind of socialization or I was going to lose my mind. I thought, “I’m an adult now. I can handle this. Surely it won’t be the same as it was in high school.” So I joined a mom’s group. Big. Mistake. Nothing in my life prepared me to be able to swim with those women socially. It was as though they all communicated in some secret hieroglyphic code that I wasn’t allowed to know. They weren’t bad people, but they weren’t particularly authentic or warm, either. I simply don’t know how to keep people at arms length and I think my desire for depth in friendship puzzled them. In the immortal words of Anne Shirley, they were not kindred spirits.

Then we moved to Missouri. Through a weird set of circumstances too circuitous to go into here, we discovered a local renaissance faire and decided to get involved. We had been long-time patrons of the Florida Renaissance Faire, so it seemed like a good place to meet people. It turned out to be so much more than that. For the first time in my life, I was surrounded by people who not only wanted to spend time with me, but who also had the patience and understanding to see who I really was underneath the social awkwardness.

The seemingly simple decision to join the faire changed the entire course of my life. It has been one of the most transformative experiences I have ever had. I met my best friends through the faire. I was allowed, finally, to be part of something bigger than myself and to use my skills to benefit it. I found, in it, a safe space to learn how to be a friend and how to be part of a team. I have never met such a tolerant, gently loving group of people.

Of course I didn’t realize that immediately. We rarely do, when we’re in the middle of a transformative experience. In fact, some people never recognize transformative experiences for what they are. They don’t look back far enough or dig deep enough in their own histories to recognize the points where their life changed. Other people never *have* transformative experiences because they don’t allow themselves to. They approach life as a series of deliberate decisions leading to an ultimate goal and reject anything that doesn’t fit the plan.

That’s all terribly philosophical, I know, and maybe a little deep for a Thursday morning.

Anyway, look at my life. Just look at it! I’m surrounded by friends. I’m doing work that I love. I’m included. I’m one of the gang! It’s the one thing I’ve always longed for and it all happened because I got involved with this faire. That is why I am passionate about my faire because without it, I would not be who I am and I would not have many things that are beautiful and good in my life.

peace…

p.s. Tell me about your transformative moments. What choices have you made that led you to becoming you?

Guess what? You don’t hate change.

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I can hear the cries of protest now. “I HATE CHANGE. I hate it with the fire of a thousand burning suns! How dare you tell me I don’t hate it.”

You don’t hate it. If you did, you’d be so paralyzed by indecision that you couldn’t function. Life *is* change and everything you do changes something about you and the world around you. We all know that, on some level.

What we hate is change we can’t control. We hate change we don’t approve of. We hate change that doesn’t benefit us. We *really* hate change that challenges our emotional safety net and makes us look inward to face things we’d really rather not admit about ourselves.

We’re fine with the changes we choose (or the ones that benefit us…tell me you wouldn’t be happy if you won a million dollars tomorrow). However, we would prefer to proceed through those changes in an environment of safety and comfort and predictability, at our own pace.

But the world doesn’t work that way. Unless we choose to go sit cross-legged on a mountaintop, living a life devoted to meditation, we have to deal with the changes we choose and the ones we don’t at the same time. Because the changes that are imposed on us from the outside don’t wait for the “right time” to happen. We don’t get to pick when a loved one gets sick or dies. We don’t decide when we get laid off. We don’t wake up in the morning and think, “You know, today would be a good day for the car to die because I’m mentally prepared!”

Given that the monkey of life isn’t going to stop and ask for your opinion before flinging poo at you, how do you deal?

  • Spend an appropriate amount of time grieving the change. People may try to push you into acceptance before you’re ready because as I implied, change is cascading. They want you to be OK again so they can be OK again. But your process is your process and you have to go through all the steps to get where you’re going.
  • Sit with it. Often, people feel compelled to deal with change by doing something to fix it, or make it go away. If it’s true that change is inevitable, it’s also true that what is different now will become routine in time. If meditation or prayer is your thing, it can come in handy at this juncture.
  • Look to your foundations. This step calls for a little belly-button examination because while change will inevitably alter some things, there are other things that remain the same. Sometimes you have to dig deep to find these things. When your life is a country song, your truck’s broke down, your dog died, and your girl left you all in the space of a week, it’s hard not to think that everything is falling apart. But if you look hard enough, you will find constancy. It might be in friendship, extended family, or in your own resilience. What is still unchanged in your life?
  • Have a mantra or a list of affirmations. This can be something as simple as “I will be OK.” “I can survive this.” “In time, this will be a memory.” Making a list of affirmations about the personal qualities you have that will help you through the change can help. “I am a resilient person.” “I am a strong person.” Etc. Put it on your computer screen, bathroom mirror, fridge, or wherever your eyes will fall on it during the day. Read the list out loud (trust me when I tell you this will feel foolish as hell, but it really does work…)
  • Keep your perspective. When you’re in the thick of it, even minor changes can seem huge. It’s important to step back and analyze how important the change really is in the grand scheme of your life.
  • Avoid confirmation bias. There’s something to be said for seeking out the company of others who are going through the same things you are. But at some point, group inertia can interfere with your personal growth and acceptance of change. Think of it as a cocktail hour with former co-workers who were all laid off from the same company. Are you exchanging leads and contacts and building each other up? Or are you bitching endlessly about the Unfairness of it All? If it’s the latter, you may need to avoid those people and conversations for a while.

I’ve had a lot of change happen during the last few months. Some small things, some that have rocked the foundations of my world. The above coping skills are some things I’ve learned along the way, and I hope they help you.

peace…

p.s. Do you have a coping strategy? Please share it in the comments.

 

Tough talk Tuesday: Maintaining your friendships through a depression

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“The world owes you nothing. It was here first.” ~Mark Twain

“Life is what we make it, always has been, always will be.” ~ Grandma Moses

Sense a theme?

I’m tackling a touchy subject today that lies at the intersection of what you do and need and what other people do and need. It’s at those intersections that the thorniest problems in our personal lives, and society writ large, arise. I’m going to talk about social life and how to make it work for us, particularly in the context of depression.

Have you ever had that moment when you feel like the unpopular kid? No one is calling you to make plans. Everyone is off doing fun things without you. Worse still, you’re hearing about it on social media? That moment sucks. I’ve experienced it and I’d call you a liar if you said you never had. It happens to everyone, but it feels particularly cruel when you’re struggling with depression.

That’s because depression lies to you. It tells you that the reason you’re not getting those calls and invites is because you are somehow flawed and unlikable. It tells you that your friends aren’t true friends because you’re not at the top of their agenda 24/7. Depression is an insidious creep because it never gives anyone the benefit of the doubt. It makes no allowances for any behavior that does not revolve around you. Busyness, forgetfulness, lack of mind-reading skills, none of that gets a pass from depression.

Worse still, depression turns you into a passive victim of circumstance. It strips you of your ability, and your responsibility, to manage your own social life. It feeds off the negative energy created by day after day of sitting around waiting for the phone to ring until you get stuck in an endless feedback loop.

How can you reclaim your social life from depression’s lies? Here are some ideas.

  • Be proactive. People are not clairvoyant. They don’t know when you’re having a good day, or a bad day. On your good days, or even your semi-good days, reach out to a trusted friend. Your friend may not be able to meet up with you on such short notice, but even having a brief chat on the phone can help you feel connected. Don’t rely on social media for this. What you’re after is connection, and you’re not going to get it on Facebook. Trust me.
  • Communicate. If you hear about a gathering involving your closest friends, and you didn’t get an invitation, call someone you trust and ask why. Most of the time, you’ll discover it was an oversight. Or perhaps, your friends assumed you weren’t feeling up to it. Or, honestly, people have invited you to so many things you didn’t attend that they gave up. Regardless, it’s on you to find out the truth and not allow depression to fill in your gaps in knowledge with lies.
  • Develop a thicker skin. Sometimes, you’re just not going to be invited. There are various reasons for this, but they mostly distill down into a simple truism. Not everyone wants to herd around in a big group all the time. Sometimes, it’s OK to get together with a few friends for TV or dinner or shopping and not include the whole world. It’s not because you’re not loved, or thought about. However, if you’re consistently not getting invited to things, see “Communicate” above.
  • Ask for what you need. Let your friends know the kinds of activities you feel up to doing. If you feel up to seeing a few friends, but don’t feel equal to coordinating a get-together, ask another friend to do it for you. Here’s a script: “Hey, I’ve been feeling really isolated lately. I’d like to see you and X and Y, but I don’t feel up to a big gathering. Can you arrange something?” If you need the visit to occur at your place, say so. Explain how long you would like the visit to be or any other limiting factors.
  • Be as reliable as you can. This one is hard, I know. When I’m in the middle of a depression, I can be a serial plan-breaker. It just seems like so much effort to get dressed some days, let alone leave the house. But the more you can make that effort, the more likely it is that people will continue to include you in social plans. If you are having an outrageously bad day, be honest and offer an alternative. “I’m really depressed today and I don’t feel up to going out. Instead of going out shopping, would you mind coming over for an hour or two and just hanging out with me?”
  • Be a good friend. Depression, sadly, can turn you into a taker if you let it and that wears people out. They start to feel like no matter what they do, or how much they do for you, it’s never enough. Once their emotional bank account is empty, if you don’t refill it, they’re going to quit on you. Ask me how I know. It’s old school advice that doing something nice for someone else can help alleviate depression, but it’s also a critical component of self-care to nurture your friends on your good days so that they can be there for you on the bad ones.

Bottom line, like Mark Twain and Grandma Moses said, no one owes you a social life. Your social life is what you make of it. It’s the product of the amount of effort and care you put into it. And you know what? You may not feel like putting much effort and care into it when you’re in a depression and that’s totally understandable. But part of living with depression is owning the fact that rebuilding your friendships and social world after a bout with depression is something you’re going to have to do. Repeatedly. It sucks and it’s not fair. But that’s the way it is. Cowboy up, cupcake.

peace…