Year: 2018

“It’s Looking A Lot Like Christmas”

gail louise Giving and Receiving Support ,

Jim and I have fond memories of and admiration for the many, many special holidays that our parents provided all the years they were healthy. Christmases were joyous whether or not the preceding months had been difficult or pleasant for them. What an enduring gift!

This season we’re enjoying many Christmas traditions:  The festive wreath and evergreen trees – three this year (Yes, three trees!), decorated with old and new ornaments.  Outdoor lights glowing in the night for all; especially our lighted “Peace on Earth” sign. This proclamation a family tradition and prayer.  The many beautiful, rich and inspiring recorded melodies. Christmas services – this year we’ll attend Gail’s paternal grandparent’s church.  Holly.  Mistletoe.  Colorful poinsettias and flowering cyclamens.  The wonderful challenge of finding just the right gifts for our two fine children, terrific son–in-law and beloved grandchildren.  Grandmother’s ceramic Christmas tree (Alright, four trees).  All of us together preparing and serving delicious holiday meals.  Jim’s hot cocoa, and if I’m patient and persevering, my homemade large German Gingerbread House – this I’ll bake and frost featuring delightful Christmas candies and home-baked cookies!

Our blessings are too many to name; good health to be sure, but always beginning with loving family and friends.

Our wish for you is peace in the Christmas spirit; hope and joy in the new year. Hallelujah!

The Subtleties of an Illness: Depression

gail louise Chronic/SeriousMental_Illness, Real Life; Real Challenges ,

This past month and a half has been pretty darn difficult for me. Depression descended and stole all the beauty of the lovely fall season.  It terrorized me and made me feel helpless and without hope. I was close to losing my compass in life.

Depression does this by altering my thoughts, behaviors and feelings. It is powerful, life altering; so  sadly and tragically that it can kill by suicide. During depression my feelings are mistaken and flawed. Instead of knowing that I am capable of meeting life’s daily challenges, I feel overwhelmed by them. Getting dressed, for example, is an achievement. What? Why? With depression all little decisions are magnified and threatening. Choosing what to wear on a ordinary day is fueled by anxiety that whatever I choose, I will choose wrong. The negative thoughts that occur with depression are very real. Frequently, those  negative thoughts whisper that all is wrong with my life and my family’s life.  The thoughts and feelings attack my fundamental beliefs and values.

With beliefs and values shaken, depression is left to achieve a stranglehold on my mind.

Sadness pervades.

And I feel especially saddened for those who lived with depression before effective medications were realized and discovered. It was harder to live with depression back in the decades of the 50’s, 60’s and 70’s.  People with depression, or those who had had a nervous breakdown, were thought of as weak, or lazy or both. Lacking in character. Deficient.

Today we have become more open-minded. We know depression is an illness. Before long scientists will uncover exactly what gets tangled in the suffers brain. And luckily, we’ve found new medications that can be life saving.

My new medication will become active in about 3 weeks. Please understand that 3 weeks to me sounds like an eternity.

Understanding families and friends do ease the experience of depression, but In the meantime, I will endure and live through a bit of hell.

Fall. Tears.

gail louise Beyond Recovery to Healing ,

October 4th, a Thursday, was a truly beautiful fall day. Crisp, clear, with a big blue sky. My husband and I went for a long afternoon drive in the rolling hills that characterize the driftless country that we live in and around.

I was taken by surprise when the tears started falling. Around every bend the tears fell. My old nemesis, depression was gaining a hold. It didn’t make any sense to be crying on this glorious day. But  I knew depression well enough by now to realize that depression doesn’t necessarily make sense.  It can literally appear out of the blue.

I got through the day by practicing mindful, close attention to my surroundings and my companion.  These kept me anchored.

But the depression has returned and is trying to take a permanent position in my daily life.  If I don’t work very hard to fight it, the depression will take a serious hold for many months. Shorter fall days of sunlight are a trigger to the seasonal disorder.

Clearly I can’t change the seasons nor would I want to change fall into summer, etc. Autumn is my favorite time of year. So what do I do? The depression is misleading. It tells me all things are bad, negative, and deeply darkly foreboding.

So what do I do?

I have two strategies to help me out of depression’s trap.  One is to revisit my list of things and people for which I am grateful. And the other is to create list of all the things and events I am looking forward to in the next 3 to 4 months. Some of those things and events bring a smile, even now.

I’ll name a few: homemade applesauce, baked squash and chili; college football and basketball games; celebrating Thanksgiving and Christmas with family and friends. Two pastimes, coloring and writing.  And , of course, discourse with my family. As I make this list I brighten up. The world is more inviting and rewarding with each minute.

I truly wish and hope for a fall that is fun and fulfilling and a winter with many sunny days for all of us. And that any depression that occurs can be cut down to size.

Thank you kindly.

Note On Preventing Suicide

gail louise Real Life; Real Challenges

Suicide is preventable. Truth is: most suicidal individuals want to live; they are just unable to see alternatives to their problems.

Truth so true: When I was 32, I was severely suicidal. I could see no end to my problems. The pain was all consuming and unbearable. My anxiety level was very high. I could hardly hold my hand still. Death seemed the only way out……..Yet, I really wanted to live.

My husband was a fierce and loving support. He asked how I was feeling. He was there for me, helping me connect with professional treatment. He kept me safe and supported. That someone who knew my worst thoughts about myself accepted me, warts and all, was invaluable. Most of all he taught me to have hope in life again.

The experience of being suicidal at that time and at others times in my life has created in me an empathy for all those who attempt or commit suicide.

Here are some principles of suicide prevention, principles that are used by prevention specialists across America. Please learn them and commit to suicide prevention.

# BeThe1To

If you think someone might be considering suicide, be the one to help them by taking these 5 steps:

  • ASK
  • KEEP THEM SAFE
  • BE THERE
  • HELP THEM CONNECT
  • FOLLOW UP

Be Aware of the Warning Signs

Hopelessness

Rage, uncontrolled anger, seeking revenge

Acting reckless or engaging in risky activities, seemingly without thinking

Feeling trapped – like there’s no way out

Increase in alcohol or drug use

Withdrawing from friends, family and society

Anxiety, agitation, unable to sleep or sleeping all the time

Dramatic mood changes

No reason for living; no sense of purpose in life

Here is some advice for responding to someone in despair and considering ending their life:

(From Mental Health America of Wisconsin)

Do:

  • Be aware. Learn the warning signs.
  • Get involved. Be available. Show interest  and support.
  • Ask if he/she is thinking about suicide.
  • Be direct. Talk openly and freely about suicide.
  • Be willing to listen. Allow for expression of feelings. Accept the feelings.
  • Be non-judgmental.

Don’t:

  • Debate whether suicide is right or wrong, or feelings good or bad.
  • Lecture on the value of life.
  • Dare him/her to do it.
  • Ask why, as this encourages defensiveness.
  • Act shocked. This creates distance.
  • Be sworn to secrecy. Seek support.
  • Offer glib reassurance; it only shows you don’t understand.

Offer:

  • Empathy, not sympathy
  • Hope that alternatives are available

Take action:

  • Remove means!
  • Get help from individuals or agencies specializing in crisis intervention and suicide prevention.

NATIONAL SUICIDE PREVENTION LIFELINE

               1-800-273 talk (8255)

               suicidepreventionlifeline.org

 

 

 

 

 

 

 

 

 

How about Our Rural Neighbor’s Mental Health?

gail louise On Suicide, On Support

Those of us who live and work in cities often forget there is a whole other way of living alongside our own metropolitan or suburban way of life: A large part of the US is still rural. According to US census bureau director John H Thompson, rural areas cover 97% of our land area and contain 20 percent of our people (60 million people).

Rural America is facing a health crisis.  Although the prevalence of mental illness is similar between rural and urban residents, rates of suicide are not.  Suicide rates (Reference – See chart attached) have been growing in the US as a whole since 2000; increasing by nearly 30 percent for both adults and children. That alone is cause for concern.  But the suicide rate in rural areas has increased by more than 40 percent in the same period.  Data from:  Trends in Suicide by level of Urbanization – United States, 1999 – 2015

Growing up in the country and on a farm in the 50’s and 60’s gave me some firsthand appreciation of rural health concerns, including mental health. My father became ill with was what then called a “nervous breakdown”. It was something shameful and no one talked it. It was all a personal failing.  Besides, the work never stops, how could one take “time off” to recover lost mental health?

I think about this issue every time I drive on our nearest rural county highway. I wonder about the health of my rural neighbors. Most of the farms are family farms and their appearance suggests times are tough.

A report entitled The Stigma of Mental Illness in Small Towns notes another of the barriers contributing to the rise in rural mental health problems is that many residents believe that that “I should not need help.”  Or simply don’t know where to go for assistance. Many times there is no mental health professional near and it is a significant burden of time and distance to travel for help.   

A study published in the journal JAMA Pediatrics in 2015 analyzed data on US youth suicide rates from 1996 to 2010. It found that the rates of suicides for rural Americans aged 10 to 24 was almost double the rate compared to their urban counterparts. This was attributed to social isolation, greater availability of guns and difficulty accessing healthcare

It seems that the stigma – that mental illness is shameful – may be felt more acutely in small rural communities. And there is a lack of anonymity there.

Again from The Stigma of Mental Illness in Small Towns:
“We as a society have a hard time asking for help, so it’s hard enough to ask for help without feeling that everybody’s going to know it,”……”Your neighbors don’t have a clue in a city if you’re to get some help. But everybody in a small town will know if your pick-up is parked outside the mental health provider’s office.”(same reference; quote by Dennis Mohatt, VP of the behavioral health at Western Interstate Commission for Higher Education (WICHE) and director of the WICHE Center for Rural Mental Health Research.

The upshot is that rural citizens with mental health needs enter care later in the course of their disease than do their urban peers; enter care with more serious, persistent and disabling symptoms and require more expensive and intensive treatment response.

A policy brief by the National Rural Health Association, The Future of Rural Behavioral Health, February, 2015, makes the case that rural needs can be met by behavioral health reforms addressing the availability, accessibility, affordability and acceptability of services. (new reference). “ Three-fourths of counties with populations of 2,500 to 20,000 lack a psychiatrist and  95 percent lack a child psychiatrist.” Primarily due to this shortage of mental health professionals, primary care caregivers provide a large proportion of mental health care in rural America and may lack the training and experience to handle serious mental health issues.

What would help the situation?

  • Increased emphasis on rural practice during professional training
  • Rural community residents, such as school counselors and members of the clergy, should receive educational material and information from Medicare, Medicaid, and private insurance companies concerning available resources for mental health issues.
  • Programs like Mental Health First Aid (MHA) may be useful in providing basic training to providers and other community resource people and reducing the stigma in the community.
  • Paraprofessionals and emerging professions can also augment the mental health workforce. One example is the emerging field of Peer Support Specialists. Peer Support Specialists themselves have personal experiences with mental illness and can offer invaluable perspective to patients in acute care settings.

And we all need to be more supportive of our rural neighbors.

Mass Shootings and the Myths that Arise

gail louise Real Life; Real Challenges

The recent mass shooting has lead me to serious consideration of the relationship between mental illness and violence. I’ll share what I have learned from my studies with you.

Four Myths Arise After Mass Shootings

One: Mental Illness Causes Gun Violence

Two: Psychiatric diagnosis can predict gun crime before it happens

Three: Because of the complex psychiatric histories of mass-shooters, gun control “won’t prevent” mass shootings

Four: US mass shootings “prove” that we should fear mentally ill loners

All four of these assumptions are incorrect, though understandable. Research by Dr. Jonathan Metzl and Kenneth T. MacLeisch finds that an isolated focus on mental illness is misguided.

In their article [1]“ Mental Illness, Mass Shootings and the Politics of American Firearms”, the two researchers analyzed data and literature linking guns and mental illness over the past 40 years.  The result of the research: most people with mental illness are not violent.

Fewer than 5 percent of the 120,000 gun-related killings in the US between 2001 and 2010 were perpetrated by people diagnosed with mental illness.

Misdirected Blame

“There are 32,000 gun deaths in the United States on average every year. People are far more likely to be shot by relatives, friends or acquaintances that they are by lone violent psychopaths.” Metzl and MacLeisch stated “We should set our attention and gun policies on the everyday shootings, not on the sensational shootings because there we will get much more traction in preventing gun crime.”

Mental Health Screenings Cannot Predict Gun Crime

Psychiatric diagnosis is in and of itself not predictive of violence. In fact, the vast majority of persons with serious mental illness do not engage in violent acts [2]. Those with mental illness are far more likely to harm themselves and frequently find themselves victims of violent crimes. [3].

Signs to Predict Gun Violence

If we focus on mental illness, we ignore those other factors that do predict gun violence more broadly:

  • Drug and alcohol use
  • History of violence
  • Access to firearms
  • Personal relationship stress

“People are far more likely to be shot by relatives, friends, enemies or acquaintances than they are by lone violent psychopaths“ [2].

What we can pay more attention to, as a nation, and as local governments, is the quality and availability of mental health care, medication, and health insurance.

“In a way it is a failure of the system often that becomes represented as a failure of the individual“ [1].

Sources cited:

[1] Mental Illness, Mass Shootings and the Politics of American Firearms
[2] Mental Illness is the wrong scapegoat after mass shootings, experts say
[3]  Gun Violence and mental illness: Study addresses perception vs. reality

– Gail Louise

Facts and Misdirection: Gun Violence and Mental Illness

gail louise Real Life; Real Challenges

I wanted to write an introduction on the criminalization of mental illness in my February posting. But there has been so much misinformation about the relationship of mental illness and gun violence in mass shootings that I am compelled to write to set the record straight. Here are the highlights of the true story on gun violence by people with mental illness.

The truth is that guns kill people and like it or not, we need effective gun control here in the US.  Focusing on people with mental illness as villains keeps us from tackling that fact, which is unpopular. Those for gun control know that we are up against the NRA and the politicians who kowtow to them.

According to research and experts on mental illness, as gathered and reported in the New York Times February 16th:

While gun violence experts have said that barring sales to people who are deemed dangerous by mental health providers could help prevent mass shootings, several more measures —including banning assault weapons and barring sales to convicted violent criminals—are more effective.

The Times also reported that Americans do not appear to have more mental health problems than other developed nations of comparable size, nations which experience far fewer mass shootings.

A 2016 study estimated that just 4 percent of violence is associated with serious mental illness alone. (National Institutes of Mental Health, National Institute of Health.)  Here is the conclusion of the study: ”Evidence is clear that the large majority of people with mental disorders do not engage in violence against others, and that most violent behavior is due to factors other than mental illness.”

A 2015 study found that less than 5 percent of gun-related killings in the US between 2001 and 2010 were committed by people with a diagnosis of mental illness.

So let’s stop being side-tracked by mental illness. Focus on the tough issue of gun control. Take on the protectors of the NRA!

Amen.

I Have Long Been Concerned …

gail louise Beyond Recovery to Healing, Real Life; Real Challenges, Shame

I have long been concerned with people who have mental illness and need care, but don’t recognize the need for treatment. Civil commitment (involuntary psychiatric care) can result if the circumstances dictate. But such involuntary care is controversial. Indeed, I have been conflicted about it for many years.

A personal experience has made me examine the issues involved with civil commitment square-on.  My father had involuntary psychiatric care when he was committed to a mental hospital in the 1950s. He always spoke negatively of the experience with feelings of anger. He was dangerous to himself at the time, threatening to shoot himself with a shotgun. One thing is clear however, as episodes of major depression reoccurred over the 1960’s, 70’s, and so on, he never sought help. He relapsed, got more depressed and Instead of getting care and treatment, he would attempt to take his own life. Surviving these suicide attempts, he would cooperate with the offered mental health care…. for a while.

In the 1950s, it was weak to be mentally ill and weak to be treated. I have always wondered whether the experience of forced care, of involuntary care, hurt and shamed my father so much that it clouded his otherwise good judgment.  Did it, finally, interfere with Dad’s asking for more help when needed?

To help me grapple with the issues, I’ve just completed reading the  book, “Committed, The Battle Over Involuntary Psychiatric Care,” written by Dinah Miller and Annette Hanson.(2016) Both writers are physicians.

In their research and writing, Miller and Hanson sought to refocus mental health professionals and others to consider this possibility: “Involuntary psychiatric care may be damaging. It may never be appreciated and the fear of forced care may prevent people from seeking help.”

The book presents a rounded picture of involuntary care. (Many times only one side of the story is featured.) I appreciated the fair handedness with which the authors addressed the issue. They interviewed former patients who had been helped as well as those who had not been helped by the process.

One of the biggest take home messages I learned from the book, was that even people who had been committed and HAD been helped found the experience to be traumatic. That was troubling to learn. Active mental illness itself is traumatic. We are talking about people living enduring a double trauma .

Hanson and Miller made the following recommendations:

  1. Encourage people with psychiatric disabilities to prepare an advanced directive. In the document it is possible to specify which medications are preferred, which facility one is to be admitted to, and even who should care for the person’s children during a hospitalization.
  2. Train inpatient and emergency room staff/personnel in the use of verbal de-escalation techniques.
  3. Crisis intervention training (CIT) should be mandatory and routine for all correctional officers and all state and city police forces. (Currently, these trainings are limited to a handpicked or volunteer teams of specialized officers in some locations.)
  4. Handcuffing patients who are brought to hospital by police should NOT be a standard practice..
  5. Support creation of mental health courts and pretrial diversion services to shorten incarceration times pending trial and to tie a defendant closely to needed community services.
  6. Expand use of mobile treatment teams, assertive community outreach, crisis centers, peer support services, patient directed initiatives, and a variety of housing options.
  7. Suicide hotlines should be made available to everyone and widely publicized. (Hotlines are available now but patients/clinicians are often unaware of them.)
  8. Increase efforts to detect serious mental illness in the early stages. Specifically: more training of primary care physicians and other non-psychiatrists so there is better recognition of when referrals should be made to psychiatrists. If mental disorders were recognized and treated earlier, involuntary treatment could often be avoided.

In 2018, we’ll examine some of these issues.

I appreciate your readership,

GL