After an accident onboard a Navy ship, I had major, extensive surgery by a neurosurgeon to remove a tumor from my spinal cord. The tumor tethered my spinal cord and placed pressure on my brainstem. After the nine hours of surgery I experienced serious complications that continued for years. Predictably, I developed chronic depression that required professional, long-term treatment. Over time, I, like most people living with chronic depression, learned to wear a mask in order to go about life during the tough days. The author of the article describes many of my life experiences as I work to maintain wellness.
It’s a great article. Click on the link:

https://www.hopetocope.com/blog/masking-our-depression-and-anxiety-our-potemkin-villages/email/

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.

The big payoff of well-chosen words

By Stephen Propst

You may think that talk is cheap. But, when words are used thoughtlessly, carelessly, or hurtfully, they can take a heavy toll. Like an arrow, “wrong” words can be sharp, piercing a person’s spirit, ripping away at self-esteem, and making a person feel belittled or even betrayed. Ill-chosen words can strain friendships and create stress. And especially vulnerable are people who have bipolar disorder.

Now, let’s be honest. Dealing with bipolar disorder is not only tough for the people who have the illness, but it’s also a challenge for those who live with them. Taking time to consider the impact of what you say before you “fire away” makes it easier. Choosing your words carefully can strengthen relationships, fuel recovery, and make for a better quality of life for everyone.

“Never tell anyone that he looks tired or depressed,” says H. Jackson Brown Jr., in his book Life’s Little Instruction Book (Rutledge Hill Press, 1991). That’s good advice! Now, let’s look at 10 more comments to avoid making to someone who has bipolar disorder. These observations come from more than two decades of dealing with the illness and from years of leading support groups and consulting with families. The goal is to help family and friends to more peacefully coexist with those of us who have bipolar.

What not to say

You sound a little down today.
That’s what a friend said to me within the first 30 seconds when she phoned the other day. No kidding! Since I live with bipolar disorder, of course I don’t always feel 100 percent up to par. I just don’t need my symptoms constantly gauged or continually evaluated. It’s like having a never-ending physical. Most people with a mental illness know how they feel. Being told you are not sounding well is not constructive, nor is it a substitute for true compassion.

I thought you were taking your medication.
Dealing successfully with bipolar disorder cannot be reduced to whether or not someone has taken a pill. There are no quick fixes. Confronting a chronic, serious illness is an ongoing process, and there are bound to be ups and downs. The more you take the time to learn about bipolar disorder, the more you will understand how difficult managing such a condition can be. There are countless resources—books, videos, support groups, etc.—that address and reduce the mystery and misunderstanding surrounding bipolar disorder.

You’re too smart to have bipolar disorder.
When I first heard that remark, I felt so horrible, as if I could have prevented what had happened. Even worse, I felt that someone, such as a homeless person, was somehow more “deserving” of such an illness than I. The brain, like any organ in the body, is subject to having problems. It is cruel to say something that suggests that bipolar disorder doesn’t exist, isn’t legitimate, or isn’t as significant as any other medical condition.

You know he’s ‘bipolar,’ don’t you?
Reducing someone to the illness he faces is destructive. In fact, it is cruel to see a person only through the lens of a diagnosis. Unfortunately, it happens all too often. A person who has bipolar disorder should not be defined by that with which he might struggle. Guard your tongue. Focus on the person you know and love, and dwell on all that makes that individual special. Your friend or family member still has a life.

Stop acting like a fool!
Granted, some conduct associated with bipolar disorder can be very difficult to contend with. When you realize, however, that a particular behavior is actually symptomatic and born of the illness, it makes accepting and dealing with it much easier. I see families who think that their situation is unmanageable, until they meet other families facing the same circumstances. With education and patience, these families come to realize that there is an explanation for what they’ve been witnessing.

Guard your tongue. Focus on the person you know and love, and dwell on all that makes that individual special.

It doesn’t take much to set you off!
Those of us who have bipolar disorder are often more vulnerable and responsive to what happens around us. When you make careless statements, your tongue becomes a trigger that can rouse a reaction and escalate symptoms. You unnecessarily incite a mood change in the person you really want to help.

You’re lazy and don’t have a life anymore.
Are you pushing someone who has bipolar disorder to get on with life? Doing so might create stress, counteract recovery techniques, and worsen overall health. If you have a family, a job, social engagements, etc., consider yourself not only lucky, but also far apart from the typical individual who deals with bipolar disorder. Such a person has often dealt with a radical departure from any sense of a normal routine. Recovery takes time and work, and the role you play is critical. Help by using constructive dialogue that acknowledges progress. Don’t push too hard and don’t expect everything to happen overnight.

We used to have high hopes for you.
I sat at a support group and heard a mother say: “My son was going to be a doctor and have a wonderful family, but now he has bipolar disorder.” As I listened, I watched the young man’s face just drop. He was crushed by his mother’s words. Such a statement is not healthy, because it does not convey unconditional love. What you say does matter. Remember that we are all human beings, not human “doings;” the more you acknowledge our being, the more we can end up doing. There is no need to squash hope or diminish dreams.

Don’t take everything so personally.
With bipolar disorder, there are obvious physical symptoms, such as changes in appetite or sleep; the mind, as well as the brain, are impacted. The patient’s self-esteem also takes a tremendous hit. That’s why a promised phone call that never comes may be taken much harder than you might imagine. Likewise, saying things that ignore or make light of someone’s sense of self-esteem should be avoided.

You seem a little overly enthusiastic.
Remember that someone who has bipolar disorder is still entitled to a personality. Before I had bipolar disorder, I was outgoing, happy-go-lucky and quick-witted. Now even though I have this illness, those same personality traits still exist. At a support group recently, a young man was very energetic and expressive. Someone accused him of being manic. Fortunately, a psychiatrist was present. He said that the young man was displaying no manic symptoms whatsoever and that it was cruel to strip a person of his personality merely because he has a diagnosis. The doctor added that anyone is entitled to a full, normal range of emotions.

What you can say
Sticks and stones can break bones, but words hurt, too. Talking carelessly can shatter self-esteem and stifle a person’s motivation to have a life again. Instead, use statements that are more likely to strengthen relationships and support recovery.

Here are some simple phrases to get started:

“I love you, and I care.”
“You’re not alone in this.”
“I’m sorry you’re in so much pain.”
“I’m always willing to listen.”
“I’ll be your friend no matter what.”
“This will pass, and we can ride it out together.”
“You are important to me.”
“When all this is over, I’ll still be here.”

Speaking of differences
Last year, at the Fernbank Museum of Natural History in Atlanta, Georgia, an amazing, special exhibit revealed that every imaginable genetic differentiation—body size, health, anything—is attributable to less than one percent of all genes (Human Genome Project). We are more than 99 percent identical. So, if you know someone who has bipolar disorder, why not concentrate on speaking to the 99 percent of that person’s humanity that really matters?

Talk is not cheap. It pays to use words that encourage, enlighten, and empower. You can make a positive difference in your loved-one’s recovery and in your peace of mind.

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.

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.

May 2014: Kathy Flaherty

Kathy Flaherty works as a senior staff attorney at Statewide Legal Services of CT, Inc.  She has dedicated her professional life to advocating for the rights of the underserved.  A graduate of Kingswood-Oxford School, Wellesley College and Harvard Law School, Kathy has 17 years of experience in poverty law, specifically focusing on housing, benefits, and consumer law. 

Kathy lives with bipolar disorder.  She makes full use of her work place’s very generous sick leave benefits and a flexible schedule.  Kathy was diagnosed her first year of law school after being civilly committed.  She was not permitted to return to Harvard until the next fall, at which point the school put conditions on her return. 

During her third year of law school, she used the Harvard Law School newspaper as the forum to come out about her illness.  Against the advice of the Office of Public Interest Advising, when applying for jobs after law school, she included her position on the council of former patients of McLean Hospital, making her disability fairly obvious.  “If someone didn’t want to hire me because of my disability, I didn’t want that job.” Kathy says that she has gotten jobs because she has disclosed.

Kathy shares that her biggest barrier to the legal profession was getting admitted to the Connecticut Bar.  Despite the fact that she had already been admitted to the Massachusetts and New York Bars, she had to wait for a year and a half and then was conditionally admitted. For the next nine years, she had to report that she was taking her medication, as well as provide a doctor’s note twice a year confirming that she was in fact taking her medication. 

Since 1999, Kathy has served as a volunteer trainer, presenter, and facilitator for Connecticut’s chapter of the National Alliance on Mental Illness (NAMI-CT).  Combining her personal experience as a recipient of mental health services and her legal background, she is able to speak to issues affecting those living with mental illness from a multi-faceted perspective.  Her advocacy work has earned her numerous honors including the Dr. Karen Kangas Advocacy Award from Advocacy Unlimited in 2010.   “Winning an award named for someone who is a role model for advocacy and a very dear friend is humbling.”

Kathy currently serves as a member of the Board of Directors of Advocacy Unlimited, Lawyers Concerned for Lawyers-CT, and the Connecticut Alliance to Benefit Law Enforcement (CABLE). She also serves on Governor Malloy’s Sandy Hook Advisory Commission.  Her goal for the future?  “To continue to do work I enjoy.”