Choose life… Insure Tennessee

by hopeworkscommunity

Choose life. When in doubt, when you are not sure... When there is a question choose life.

The question of Insure Tennessee is a question of whether or not we will choose life. It is not a question of a better way to choose life. It is not a question of not this but that. As more and more stories pour in it is obvious. For thousands of Tennessean it is increasingly each day a question of life or death... a question of life or needless and preventable suffering... a future of hope or one bound by despair. It is not about finding an answer. It is about the common sense and political will to grab the one (the only one) in front of us and stop the unnecessary misery that defines the lives of so many vulnerable Tennesseans.

Chattanooga voted last night to choose life. Their city council voted overwhelmingly in favor of a resolution supporting Insure Tennessee. They joined a growing movement of cities and towns saying they support their neighbors, their friends, their families. No one should have to unnecessarily suffer or suffer as a direct result of governmental policy. Insure Tennessee.

The movement is growing. Thanks to the leadership of people like Pam Weston in East Tennessee and Meryl and Randall Rice in West Tennessee and the stories and words of more and more Tennesseans the movement is growing. It is the growing crescendo of more and more ordinary Tennesseans saying "CHOOSE LIFE!!!!!"

Imagine a flood, a hurricane in Tennessee. The waters are rising.. People are dying.... Many are on top of their houses waiting for a miracle.. a boat... a something... someone who cares.... hope. The government has boats. But they decide to wait. "Let's make sure this is a good idea..."

The waters still rise. For some it is too late. For others it will soon be too late. Action matters. The hurricane is here for thousands of Tennesseans. And they are on top of their houses waiting.

Join the movement to choose life. Talk to your local government. Ask them to join Chattanooga and the other towns and counties that have acted.

Today. Today please choose life.

Insure Tennessee

Larry Drain ~

This is a new campaign launched by national DBSA. Remember, "I'm here. "

https://www.facebook.com/story.php?story_fbid=10153744595606122&id=95920556121

Thanks to BP magazine for shining a bright light on a dark topic. I am glad to be a part of a support group that helps prevent suicide. For over 13 years our group has served the Jackson, Tn. community faithfully. "Thank you" to , A Better Tomorrow inspirational support group.

TAKING SUICIDE PREVENTION UPSTREAM

Across the country, school districts are providing mental health awareness and suicide prevention training for teachers and school personnel. Some are mandated or encouraged to do so by state law, others are motivated by recent incidents, and some introduce this kind of education because suicide is now the second-leading cause of death among youth aged 15-24.

Teacher and parent training are key components in any plan to address teen suicide. Increasingly, however, communities are recognizing that kids need to learn about mental health, too. Social and emotional learning across the lifespan reduces risk factors and promotes protection factors for violence, substance abuse, negative health outcomes, and suicide. One way to provide universal student training is by including a mental health component in the standard wellness or health curriculum. School districts and individual schools can implement individual, more targeted programs as well.

Knowing how to cope and developing resilience are at the core of mental health awareness and suicide prevention efforts being implemented in Massachusetts with children as young as elementary school. The Commonwealth of Massachusetts places a high value on suicide prevention, with dedicated line-item funding in the state budget for the Department of Public Health Suicide Prevention Program. With support from state officials, the DPH has launched suicide prevention programs across the state and for people across the lifespan.

Some of the skill-building and suicide prevention programs in Massachusetts schools are

• The PAX Good Behavior Game, which has been introduced by schools in collaboration with the DPH, teaches students self-regulation, self-control, and self-management in order to create an environment that is conducive to learning. (Ages 6-12)
• The Open Circle program, which strengthens students’ social and emotional learning skills to increase pro-social behaviors and reduce problem behaviors, is utilized by many school districts. (Grades K-5)
• Whyville utilizes problem-solving and other skills to help kids learn about their emotions in an online computer game. (Teens and pre-teens)
• SOS Signs of Suicide® focuses on prevention through education by teaching students to identify symptoms of depression, suicidality, and self-injury in themselves and their peers. (Grades 8-12)
• Break Free from Depression, developed by the Boston Children’s Hospital, focuses on increasing awareness about adolescent depression, how to recognize it, and how to get help. (High school)

There are dozens of programs that schools can use to promote skills development while fostering students’ mental health and their willingness to seek and accept help for mental health concerns. SAMHSA’s National Registry of Evidence-based Programs and Practices and the Suicide Prevention Resource Center Best Practices Registry include searchable descriptions for a wide variety of educational programs. For high school students, the SAMHSA Preventing Suicide: A Toolkit for High Schools has a comprehensive list of programs, but a search of the NREPP and BPR may yield programs added since the Toolkit was published.

What can you do? Find out how your school district handles mental health training and emotional skill building for students. If there is not currently a program and there is no interest from school officials, you might work with the parent-teacher organization, local mental health groups, and the local board of public health to raise awareness of the issue, then advocate for implementation of one or more programs. There may be grants available to cover the cost of training or there may be organizations in your community that would help subsidize the program.

The bottom line is that suicide prevention requires a comprehensive approach. It’s never too early to start and everyone – families, schools, communities, and peers that create supportive environments; individuals who learn and leverage positive coping skills; and mental and public health systems that treat and prevent risk factors – plays a part.

Your Turn

• What do you think about the mental health awareness and/or suicide prevention programs that are provided to kids in your community?
• What role should a school have in developing kids’ emotional and social skills?
• What steps will you take to improve mental health awareness and suicide prevention in your local schools?

Editor’s Note: The Families for Depression Awareness Teen Depression Webinaris an accessible, free resource for training parents, teachers, and others who work with youth to recognize depression, talk about depression with parents and youth, and know what to do to help a young person struggling with depression. Register for the Teen Depression Webinar live with Dr. Michael Tsappis on September 30. 

Thanks to the MA Department of Public Health Suicide Prevention Program and the Suicide Prevention Resource Center for their support in developing this post.

Healthy Grieving-Denial

Amber Wilsey

After the diagnosis, I have had to walk through a grieving process.  I grieve for the “death” of who I was, for the person who I am, and for my future self. Confusion and loss of self are huge players in this grief process.  Of course, sadness does too, much sadness.  I believe it is the same type of journey we go through when we lose our loved ones. Except this time, the person is me.  

Those five stages of grief are denial, anger, bargaining, depression and acceptance. I would imagine the denial stage is probably the most difficult to move out of after being diagnosed with a mental illness.  It has been for me.  The denial phase looked similar to this:  I cannot believe I am bipolar; all I went in for was for ADD; the doctor can’t be right; I don’t even know what bipolar is, how is that ME?  As Gru’s minions say “Wha???”  It even looks like: these meds are making me worse; I’m not sick or have mental problems; maybe I was misdiagnosed; maybe I’m really not bipolar since the medicines are not working. On and on and on…

Since I am still fairly new with the diagnosis, I can see the reoccurrence of denial throughout the past few years.  Thankfully, I am not stuck in the vortex of complete denial.  It helps to read, to learn, to use the internet, to search for others who are walking the same walk.  Thankfully, you are out there for me to glean from and from you I have hope.  

http://news.vanderbilt.edu/2015/05/locating-the-brains-sad-center/

I'm writing my story in hopes that it will inspire others to share their story. I don't know if there is a "book" in everyone but I know for certain there is a story in there. I encourage you to share your story of overcoming some of life's challenges. Someone needs to hear what you have to say. They are waiting!

Tragic California Case Exposes Failings in Our Mental Health Care System

CareforYouMind Feb 10,'15

Rusty Selix
Executive Director, Legislative Advocate
California Council of Community Mental Health

In April 2012, Fred Paroutaud, a California man with no history of mental illness, experienced a psychotic episode. Mr. Paroutaud was hospitalized and diagnosed with bipolar disorder. Just 72 hours after he was admitted, and despite the fact that he was still experiencing hallucinations, he was discharged and referred to outpatient group therapy. Because his condition remained unstable he requested alternate therapy and one-on-one sessions with a psychiatrist. He was denied both by his health plan and his condition deteriorated.

Concerned by his worsening depression, his wife appealed to the health plan again and again. She pleaded that her husband required more supervised and personalized treatment. While waiting for an appointment with his psychiatrist, and just two months after his first psychosis, he died by suicide.

Mr. Paroutaud’s widow is convinced that if more intensive and timely care had been available, her husband would still be alive. In October 2013, she and two other plaintiffs filed a class-action lawsuit against the health plan claiming they were harmed by its systemic denial of timely access to mental health services.

Why this story sounds familiar
While Mr. Paroutaud’s story is unique, his circumstances were not. Upon his release from the hospital, he needed intensive, monitored care. That’s not what he got. Generally speaking, commercial health plans limit coverage to two levels of care: level one is a once a week therapy visit for mild to moderate problems and medication management; and level two is hospitalization.

Those two narrow levels of care are appropriate for many people, but not all, and certainly not for all stages of mental illness. The absence of those critical, in-between levels of care is one of the ways that our mental health system falls short and where it fails people like Fred Paroutaud and his family.

When someone is in the midst of a manic episode or considering suicide, hospitalization can provide the opportunity to stabilize the condition. Upon discharge, many patients require medically monitored care in a residential facility or highly personalized care in a medically-monitored outpatient setting. Unfortunately, that level and type of care is almost impossible to find in commercial health plans.

There is another way
My hope for a health system that offers comprehensive mental health services to better address the needs of individuals with a mental health condition is not pie-in-the-sky wishful thinking. In fact, this model of care, with multiple levels and degrees of intensity, already exists within the California Medicaid system. In our public programs, care ranges from community-based health management through low-intensity community-based services, high-intensity community-based services, medically-monitored non-residential services, medically-monitored residential services, and medically-managed residential services (i.e., inpatient treatment).

This structure, with six levels of care, is the backbone of the mental health system under California’s Medicaid system, and it provides a complete, stepped approach to rehabilitation.

This type of care should not be exclusive to the Medicaid population. One of the 10 essential health benefits under the Affordable Care Act is rehabilitation; another is mental health care. This means that rehabilitation for mental health care isan essential benefit, and all Americans in commercial health plans are entitled to more rehabilitation-focused mental health services.

What you can do now
Fred Paroutaud was denied access to stepped treatment and his story is tragic. It is thanks to his widow and her persistence that we know about it at all. Unfortunately, many people suffer similar situations and denials of care, but we do not hear about them.

With increased national attention on access to mental health care, now is the time to tell us about the problems you are having in accessing the care you need. We want to know what services you were denied and the barriers you faced, such as unaffordable out-of-pocket costs, transportation issues, or lack of trained providers in your plan’s network, etc.  We also need to know what you did or didn’t do in response and how this impacted your or your family member’s recovery. As advocates and advocacy organizations, we are positioned and prepared to knock on the door of government regulators and health plans and point out the disparity in care and demand access to appropriate rehabilitative services.

Many commercial insurers don’t cover rehabilitation services because they don’t believe they have to. And if no one demands otherwise, they are unlikely to ever change. Share your story. Don’t take ‘no’ as the only answer. Let’s realize the parity we deserve.

Questions

• How have you been denied equal insurance coverage for a mental health condition? Tell us your story.
• What levels of treatment are available to you under your health plan? Are they sufficient?

Bio

Rusty has been Executive Director and Legislative Advocate for CCCMHA since 1987. He is co-author of California’s Mental Health Services Act, a tax on personal incomes over $1 million to expand community mental health care. At CCMHA, he has been instrumental in moving forward a variety of critical mental health-related initiatives, including ensuring the implementation of the federal Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program to serve children with severe emotional disturbances. He also serves as Executive Director of the Mental Health Association in California.

What are some symptoms of BP? See what bipolar disorder can be like. Pass this along to someone in need. Dark Glasses & Kaleidoscopes - YouTube http://bit.ly/1ExeuNA

Allen Reflects on Thriving in 2014

As DBSA’s 2014: The Year of Thriving comes to a close, it seems appropriate to reflect on what we’ve accomplished this past year, and to think about what’s yet to come.

At the beginning of 2014, we outlined our vision of a future where every adult and child living with a mood disorder has the opportunity not just to survive, but to thrive. To some, this was a message of hope; to others, it seemed a goal almost impossible to imagine. I completely understand how some of my peers might find total wellness to be an unattainable goal. Indeed, I too have experienced times in my life when the only reality I could imagine was the intense pain of depression. In fact, I experienced times this very year when thriving seemed so very far away for me personally. But amidst messages about the danger and drain of people with mental health conditions, and my own concurrent thoughts of self-loathing and self-stigma, to know that there was a community that would hope for the return of my best self was a blessing. To hold hope when we cannot carry it ourselves: this has always seemed, to me, the fundamental purpose of peer support. DBSA was founded on a model of peer support, and DBSA will always be about creating opportunities for peer support, and through peer support—the thousands of people meeting in communities across the country—we are creating a world in which all of us may be reminded of our potential, our strength, and our best selves.

For me to return to a place of thriving took a lot of time and work and collaboration. It also took some luck. For I have been very lucky: to have found clinicians that do not put limitations on what my life can be; to have the support of loved ones and colleagues who remind me of who I am, not what condition I live with; to have insurance that gives me access to quality health care that covers both my physical and mental health; and to find inspiration in my work and the amazing people I have the privilege of working with, and for, in my role at DBSA.

Such good fortune—in clinical collaboration, in supportive community, in access to resources, in meaningful work—are what I, and the DBSA Board and staff, want for everyone, not just the very lucky.

So in 2014, we asked our peers, families, clinicians, researchers, politicians, and the public to expect more. We asked our community to promote and seek full wellness—because better is not well, and everyone deserves the opportunity to thrive. 

I am proud of the work DBSA accomplished in 2014, and I encourage you to review our 2014: Year of Thriving programs. I believe that we did open minds—and even a few doors—to the possibility of thriving. A few highlights include:

• In January, DBSA welcomed the Balanced Mind Parent Network into our family of programs to enable us to provide critical support for parents and to create a thriving future for children living with mood disorders.
• In April, Target Zero to Thrive asked clinicians and peers to set zero, not just reduced, symptoms as a new standard for successful treatment. 
• In May, DBSA kicked off our six-month Positive Six: Thrive campaign, challenging us to make a small change each month to support our health.
• In June, DBSA completed a third contract with the VA to train their Veteran peer specialist workforce.
• In August, DBSA joined forces with DBSA New Jersey to host the From Surviving to Thriving weekend of public and chapter educational events featuring a special interview with Demi Lovato.
• In September, DBSA hosted Better Is Not Well—a peer and professional panel that explored ways to elevate mental health treatment to complete wellness.
• This fall, DBSA hosted a series of webinars on Treatment Choices, Health Care Reform, and Restoring Intimacy.
  
• In November, DBSA issued the WHO-Five Challenge to mental health professionals to integrate wellness measurements, like the WHO-Five, into their practice.

But so much more must be done. So we ask,

“What needs to happen for us to have wellness change from being a possibility for some to a probability for most?”

It will require:

• Better Treatments: DBSA will continue to work with our esteemed Scientific Advisory Board to integrate peers into the development of new and better treatments— medical and non-medical. And, to connect our peers and parents to studies that hold the promise of a brighter future for ourselves, our children, and our peers.
• New Measurements: DSBSA will continue to promote widening the definition of treatment success to include not just elimination of symptoms, but presence of wellness.
• Access to Quality Mental Health Care: DBSA will continue to advocate for the rights of all adults and children living with mood disorders to receive access to quality mental and physical health care.
• Increased Expectations: DBSA will continue to spread the message that better is not good enough. That wellness IS possible. That everyone deserves the opportunity to not just survive, but thrive.
• Peer Support: DBSA is committed to continuing, and increasing both the availability and quality of, life-saving in-person and online peer support for people who have diagnoses, parents, family, and friends.
• Inspired, Imperfect Action: DBSA will continue to ask ourselves, our peers, our parents, our clinicians, our legislators, and our communities to take action. It may be small. It most certainly will not be perfect. But it will be progress—action inspires action, which in turn inspires more action.

We made some significant strides this past year, but we do not fool ourselves by believing that these first steps have produced monumental change. That will take persistence. That will take courage. That will take time. That will take hope. That will take ALL of us.

It is through thousands, indeed millions, of inspired, imperfect actions that we will slowly transform these small steps into big changes and create a future where wellness is no longer a possibility for only some lucky few, but a probability for all.

Thank you for joining us on this journey,

– Allen

I have many cherished friends living with major, "invisible" health challenges. Everyday they work very hard to prevent others from knowing of their struggles. They work to "pass" as being just another face in the crowd.

OCT 2014 State Meeting
DBSA  TENNESSEE  STATE  MEETING -   October 11th, 2014
        @ Hopepark Church, 8001 Hwy 70 South, Bellevue, TN
                held in the outbuilding called "The Onion"
         ~   Lunch begins at 11:00 a.m. , Bellevue Community Church
                                                 *cost $10/person.

                   Agenda

I.   12:00 p.m - Call to order, Welcome

II.  12:05-12:30 p.m.  Election of officers
                     - State Director
                     - Assistant State Director
                     -Secretary

III.  12:30-12:35 p.m.Approval of Meeting Minutes

1V.  12:35-12:40 p.m.- Financial Report  -  Susan Parks

V.  12:40- 1:30p.m.  Chapter reports

1:30 - 1:40 p.m.   Break

VI.   1:40 - 2:15 p.m. Cheryl Magrini, Chair DBSA National Board presenting
                        on "Resilency"

VII. 2:15- 3:00 p.m.  Marya Hornbacher, author,  presentation focus to be
                     announced.

VIII.   3:00- 3:30 pm.  Q & A

VIII.  3:30 - 3:40 pm.  Legislative Report  - Larry Drain

IX.3:40- 4:00 p.m.Miscellaneous business including setting  date of next  
                                  State  meeting

IX.  4:00p.m.  Adjournment

Ordinary heroes: Drains honored for speaking out for health care equality

B

y Linda    Braden

Larry and Linda Drain are quiet, unassuming people. But when circumstances arose that threatened Linda’s life, they both began speaking out, their voices ringing loudly to bring awareness to — and a solution for — themselves and others who have fallen through the cracks of the health care system in Tennessee. Their income is too high to qualify for TennCare, Tennessee’s public insurance program, and too low to qualify for federal subsidies under the Affordable Care Act, also called Obamacare.

In acknowledgement of their efforts, the Tennessee Health Care Campaign presented the Drains with the 2014 Heroes for Health Award in August at the John Seigenthaler First Amendment Center, Nashville. The award was given “for your dedicated support to affordable access to high-quality health care for all Tennesseans.”

The event honoring the Heroes was part of the Tennessee Health Care Campaign’s 25th Anniversary celebration. In addition to the Drains, Laura Sell was honored for the major work she did as a volunteer to promote and support enrollment in the Patient Protection and Affordable Care Act, collaborating with the Blount County Public Library.

Larry said, “It was a very eventful night. We got to speak to a lot of people, meet a lot of people that were heavy-hitters that we knew about or read about. That was neat. And to get people to treat us like we were important. As we were walking out the door, I said, ‘Linda, do you ever get over being surprised when people treat us nice?’ I’m surprised every single, solitary time. It’s just been a strange happening. When it first started out, we didn’t have a clue ... The way we look at it is that we are extraordinarily ordinary people, and the idea that people would know who we are or that people would listen to what we have to say — I wouldn’t have predicted that in a thousand, million years. Then when it took off, it went insane.”

Story begins

The story began with Linda, who has been drawing Supplemental Security Income (SSI) for some time because of epilepsy, brain surgery and additional health conditions. Larry said, “She has TennCare. She has to have the TennCare in order to live. If she does not have the medication, if she doesn’t have the medical care, she will die.

“Ten years ago, a good day for her was having 10 to 15 grand mal seizures. She went through brain surgery, and the last 10 to 14 years have been extraordinarily eventful, but the medication is her pathway to life.”

After Larry turned 62 last September, he decided to take early retirement and begin drawing Social Security.

“If I had to take all the dumb, stupid, worst things in my entire life that I have ever done, that one is so far to the top that there is not a second place,” he said. “The way we had it figured out, we could live if we took what she made in SSI and what I made in retirement. We weren’t going to be rich — in fact, we were going to be poor — but we would be able to pay our bills, do what we needed to do. We were going to be OK.

“After a couple of months, Social Security called us in and said, ‘You guys make way too much money.’ They were very nice, not cruel or mean or anything like that. ... But they said, ‘We have a limit on unearned income, and you guys are way over it.’”

Larry questioned how that could be, and was told that his Social Security retirement is considered unearned income. He said, “I asked them, how could that be unearned income? I worked 47 years for that. It’s my money. They said, legally it’s unearned income. They told Linda that her check for $720 was going to become $20. We were going to lose $700. I said, ‘I’ll just give the retirement back. I’ll just get another job and we’ll be OK.’ And they said, ‘Well, you can do that, but the only way you can do that is to give us back every single penny we have given you today.’ Well, if I could give it all back today, I would never have needed it to begin with.”

No recourse

Larry thought he could continue drawing his retirement and also have a job to make ends meet. He said, “What they said after that has basically driven the whole situation. They said, ‘You have to understand, that because your wife is on TennCare, if you make over $85 in a month, she will lose her TennCare.’ So we went home, and we did all the figuring we could.”

Their projected budget for January would leave them with $30 for essentials such as food and gasoline, and the following months would be worse. “We looked at everything we could, trying to find a way. ... But there wasn’t a way,” Larry said. “We were in a position where, if I got a job to give us enough money to live on, it would kill my wife. It would take her insurance away, and it would kill her. If I didn’t get a job, we couldn’t live. We couldn’t live on a dollar a day. It just wasn’t doable. So on Dec. 26, after 33 years of marriage, we separated.”

The original plan was for Linda to stay with a relative until they could find her a permanent place so she could retain her SSI and TennCare. Larry would then find a place as close by as he could. Larry said, “At that time, our understanding was that, according to the way the laws were in the state of Tennessee, we would never again live together as man and wife.”

There were two possible solutions: Change Social Security laws or expand TennCare, the state’s managed Medicaid program which provides health care coverage primarily for low-income children, parents, pregnant women and elderly or disabled adults. Social Security laws were not going to be changed, but Tennessee Gov. Bill Haslam could spearhead expansion of Medicaid. Larry said, “If he expanded Medicaid, then Linda didn’t have to be a member of a category, she didn’t have to be ‘disabled,’ to get it. All she had to do was be poor. If he expanded Medicaid, then she would have her insurance, which meant we could live together, I could get a job, and although we’d struggle, we would live. Without him expanding Medicaid, we had no help at all.”

Letters to governor

Larry began drawing attention to the need for TennCare expansion by writing a series of letters to the governor. Some were very personal, some general and policy oriented, but in each letter, Larry pleaded with Haslam to submit a plan for TennCare expansion. The 100th letter was emailed on Sept. 2. As of that date, the governor had not responded to the Drains, but he did announce on Aug. 28 that he plans to submit a proposal to Washington to expand Tennessee’s Medicaid program. He did not release any details, however.

Larry said more than 1,200 individuals from across Tennessee have told him they also contacted Haslam. Larry’s 100th letter to the governor begins to list the names, and he plans to continue adding names in subsequent letters until every one is included.

Each letter is available atdeargovernorhaslam.wordpress.com and is viewed by 4,000 to 6,000 persons daily. In addition, a petition entitled “Gov. Haslam: Expand TennCare and Let Me Stay With My Wife!” at www.thepetitionsite.com has almost 46,000 signatures in support of the Drains.

The Drains’ story was told in the Nashville Tennessean and other major news outlets, drawing even more attention to those who, as Larry said, “didn’t fall through the cracks — we live in the cracks.”

Twenty-five miles separate this couple now. Linda is in Knox County, while Larry is in Blount County. They are waiting for the time when they can once again live together as man and wife without Linda losing her life.

Larry said, “I should not have to drive 25 miles to see my wife. It’s wrong in every sense of the word.”

The Depression and Bipolar Support Alliance (DBSA) is the leading patient-directed national organization focusing on depression and bipolar disorder. The organization fosters an environment of understanding about the impact and management of these life-threatening illnesses by providing up-to-date,

scientifically-based tools and information. DBSA supports research to promote more timely diagnosis, develop more effective and tolerable treatments and discover a cure. The organization works to ensure that people living with mood disorders are treated equitably. Assisted by a scientific advisory board comprised of the leading researchers and clinicians in the field of mood disorders, DBSA has more than 750 peer-run support groups across the country. Nearly two million people request and receive information and assistance each year. DBSA’s mission is to improve the lives of people living with mood disorders. For more information about DBSA or depression and bipolar disorder, please visit www.DBSAlliance.org or call (800) 826-3632.

Allen Doederlein, President, DBSA

Nelly Piraja

Steve Brannon, State Director, DBSA Tennessee

WDEF 12 of Chattanooga

Linda and Larry Drain

Helping me through my depression

Blogger, Kelley Baker, shares hints her family uses to help her through depression.

By Kelley Baker

Most of the time, I’m the one you call when you want someone to cheer you up. I like to dance. I love rock concerts, farmers markets, dogs and children. But there’s another side to me: I have been living with clinical depression since I was a child.

Thanks to treatment, coping tools and lifestyle changes—working from home, eating a natural diet—I am better now than I have ever been. Still, every so often I feel the depression returning. I have described it to my husband as a demon eating my brain.

I know it’s confusing for him as one day I seem fine and the next I am sad, distant, or even angry and pushing him away. And I know he wants to help me, but sometimes it’s hard for family members and friends to know what to do.

I had to learn how to be more open with my husband about how I’m feeling and what I need from him. These are some of the things I’ve shared with him:

Help keep clutter at bay. A person spiraling into depression may feel like they are slowing down while the world around them speeds up. The daily routine feels overwhelming: The mail stacks up, dishes pile up in the sink, laundry goes undone. It feels more and more impossible to keep up. Getting extra help with kitchen chores and other mundane tasks keeps things under control so everyone in the house is happier.

Pitch in on meal plans. People who are depressed tend to either eat too little or overeat—usually going for something less than nutritious. Plus, driving through the pick-up lane at a fast food restaurant or ordering a pizza feels so much more manageable than fixing a meal. Having someone make a healthy meal not only contributes to my physical and mental well-being, but also eases my “mom guilt” over what my kids are eating.

A simple ‘Do you want to tell me what you’re feeling?’ makes me feel less alone.

Ask how I’m feeling. If I am able to articulate what I am going through, it helps my husband understand what I am dealing with—and sometimes it helps me understand better, too. Unfortunately, I won’t talk about what I’m going through unless someone asks me. I don’t want to impose, or I don’t think they care. A simple “Do you want to tell me what you’re feeling?” makes me feel less alone.

Encourage self-care. A lot of things fall by the wayside during a depression, including personal appearance. Brushing your teeth and taking a shower just don’t seem to matter—much less getting a haircut or going to the dentist. It all just seems too hard. That attitude can snowball quickly into greater feelings of worthlessness: “Now I’m such a mess, no one could ever love me.” Hearing something like, “I’m going to do the dishes, why don’t you go enjoy a bubble bath?” is often what I need to make me feel okay about doing something self-loving.

Offer a hug. Studies show that a sincere hug lasting longer than 20 seconds can release feel-good chemicals in the brain and elevate the mood of giver and receiver. The fact that people who are depressed often don’t want to be touched can make this tricky, but a hug from the heart, with no expectation of anything further, just may help.

Offer reassurance. Along with the feelings of worthlessness, anger and even guilt that are part and parcel of depression, there’s often fear of ending up alone because really, who would want to put up with these episodes forever? Being reassured I won’t scare away my family because I have an illness takes a huge weight off my mind.

Give a reality check. A never-ending loop of painful, destructive thoughts—“I’m unlovable, I’m a failure, I’m ugly, I’m stupid”—loop through the mind of someone with depression. When my husband reminds me how hard I worked to get a teaching credential, or tells me I’m a great mom or that he loves me, it helps me keep those kind of thoughts in check.

Remember the good. When I’m depressed, I sometimes forget that I was ever happy. Looking at pictures of vacations with my family, watching home movies, hearing things from my husband and kids that they like about me, reminds me that while I may feel sad or numb right now, I’ll get through it.