Wednesday, January 30, 2013

Robert’s Rules of Order

Humans are creatures of habit. Anybody who’s ever tried to give up coffee or nail-biting can tell you that. But it is even more important if you live with a serious psychiatric disorder.

Think about it: doesn’t being mentally ill inject chaos into your life? If you suddenly have to drop everything to go into the psych ward, it tends to disrupt things. If you’re steaming through your to-do list and you start hearing voices, you’re liable to be derailed. And if you have a stay-in-bed depression, not much of anything will get done. Mental illness imposes a persistent random quality on our routine.

Keeping things in order around you can help. I had this brought home to me recently. My study was being remodeled, and I fell apart.  The floor was torn up, the furniture was in the garage, and my books and papers were sprawled in anarchy all over the guest room. I couldn’t find anything, and most of the stuff I do all day every day was not really possible. Within a week I was lying on the couch in fetal position, wondering suspiciously why I even bothered to breathe.

It reminded me of a friend who killed himself a number of years ago. His mother died - something he had been expecting very calmly for years. He had to move, since without his mother’s social security he could not afford the rent on their house. This was also expected.  What was unexpected was the way he came completely to pieces. In the end, despite everything his friends or his therapist could do, he shot himself in the backyard.

At the time, I was confused by the whole thing. I think I understand better now. Yes, he had clinical depression, and that alone can be fatal. But he also had all his familiar landmarks taken away. His lifetime companion was gone, AND all his usual surroundings, belongings, and routines. Environment was of particular importance to Paul. He was Obsessive Compulsive with a hoarding instinct, and his 175 boxes of bric-a-brac were locked in someone’s garage where he could not see, touch or use them. He was lost in an alien country in the fog, and he couldn’t find his way.

Life is confusing. It’s wise for us to impose some kind of order in our lives. It could be organizing your belongings in a certain way. It could be doing two or three chores every day in the same order, or drinking out of a favorite cup. It could be taking a walk twice a week, or watching the news at the same time every night. Find something that comforts you, something that is dependable, even when the rest of your world is coming apart.

I’m not saying ‘never change things.’ But give yourself something to cling to, however small. It can literally save your life.

Deborah is the author of Is There Room for Me, Too? 12 Steps & 12 Strategies for Coping with Mental Illness, available at, Kindle Editions, iBookstore, and other major vendors. Visit her web page at, or see her catalog at

Wednesday, January 16, 2013

Hope on the Horizon

I feel I can do no better service with this blog than to list the parts of Obama’s new 23-point plan, in response to the Newtown tragedy,  that apply to mental health. This information is copied directly from today’s newsletter from Jessica Cruz, the Executive Director of NAMI California. Thank you, Jessica!

The goals below are good news! When I was 13, I was bipolar and sometimes psychotic without knowing it. My parents, in their great wisdom, decided that therapy of any kind might “interfere with my religion,” so it was vetoed and I was never told  (I found this out 30 years later). And no one in the school system or anywhere else suggested that the extremely miserable depressed teenager with the strange disconnected emotional outbursts might need some help. I had to figure it all out for myself, 13 years later. Here’s to no one else having a story like that!

Deborah Fruchey

“ This morning, President Obama presented 23 executive actions related to both mental health and gun control...The plan includes the thrust of many of NAMI's recommendations that were offered to Vice President Biden's task force in the days immediately following the Newtown, Conn. tragedy.

Out of such tragedy, Americans today have an opportunity that we hope we will never face again. The mental health care system in the United States has long been broken. The challenge is not only to fix it, but to build parts anew, focusing on early screening, diagnosis, treatment and prevention...Below is an excerpt of the President's outlined plan that focuses specifically on Mental Health.

Excerpt from President Obama's 23-point Executive Order:


As President Obama said, "We are going to need to work on making access to mental health care as easy as access to a gun." Today, less half of children and adults with diagnosable mental health problems receive the treatment they need. While the vast majority of Americans with a mental illness are not violent, several recent mass shootings have highlighted how some cases of mental illness can develop into crisis situations if individuals do not receive proper treatment. We need to do more than just keep guns out of the hands of people with serious mental illness; we need to identify mental health issues early and help individuals get the treatment they need before these dangerous situations develop.

Three-quarters of mental illnesses appear by the age of 24, yet less than half of children with diagnosable mental health problems receive treatment. And several recent mass shootings, including those at Newtown, Tucson, Aurora, and Virginia Tech, were perpetrated by students or other young people.

Reach 750,000 young people through programs to identify mental illness early and refer them to treatment: We need to train teachers and other adults who regularly interact with students to recognize young people who need help and ensure they are referred to mental health services. The Administration is calling for a new initiative, Project AWARE (Advancing Wellness and Resilience in Education), to provide this training and set up systems to provide these referrals. This initiative, which would reach 750,000 young people, has two parts:

Provide "Mental Health First Aid" training for teachers: Project AWARE includes $15 million for training for teachers and other adults who interact with youth to detect and respond to mental illness in children and young adults, including how to encourage adolescents and families experiencing these problems to seek treatment.
Make sure students with signs of mental illness get referred to treatment: Project AWARE also includes $40 million to help school districts work with law enforcement, mental health agencies, and other local organizations to assure students with mental health issues or other behavioral issues are referred to the services they need. This initiative builds on strategies that, for over a decade, have proven to decrease violence in schools and increase the number of students receiving mental health services.

Support individuals ages 16 to 25 at high risk for mental illness: Efforts to prevent school shootings and other gun violence can't end when a student leaves high school. Individuals ages 16 to 25 are at high risk for mental illness, substance abuse, and suicide, but they are among the least likely to seek help. Even those who received services as a child may fall through the cracks when they turn 18. The Administration is proposing $25 million for innovative state-based strategies supporting young people ages 16 to 25 with mental health or substance abuse issues.
Helping schools address pervasive violence: Twenty-two percent of 14 to 17 year olds have witnessed a shooting in their lifetime. Research shows that exposure to community violence can impact children's mental health and development and can substantially increase the likelihood that these children will later commit violent acts themselves. To help schools break the cycle of violence, Congress should provide $25 million to offer students mental health services for trauma or anxiety, conflict resolution programs, and other school-based violence prevention strategies.

Train more than 5,000 additional mental health professionals to serve students and young adults: Experts often cite the shortage of mental health service providers as one reason it can be hard to access treatment. To help fill this gap, the Administration is proposing $50 million to train social workers, counselors, psychologists, and other mental health professionals. This would provide stipends and tuition reimbursement to train more than 5,000 mental health professionals serving young people in our schools and communities.

Launch a national conversation to increase understanding about mental health: The sense of shame and secrecy associated with mental illness prevents too many people from seeking help. The President is directing Secretaries Sebelius and Duncan to launch a national dialogue about mental illness with young people who have experienced mental illness, members of the faith community, foundations, and school and business leaders.

ENSURE COVERAGE OF MENTAL HEALTH TREATMENT: While most mental illnesses are treatable, those with mental illness often can't get needed treatment if they don't have health insurance that covers mental health services. The Affordable Care Act will provide one of the largest expansions of mental health coverage in a generation by extending health coverage to 30 million Americans, including an estimated 6 to 10 million people with mental illness. The Affordable Care Act will also make sure that Americans can get the mental health treatment they need by ensuring that insurance plans cover mental health benefits at parity with other benefits.

Finalize requirements for private health insurance plans to cover mental health services: The Administration will issue final regulations governing how existing group health plans that offer mental health services must cover them at parity under the Mental Health Parity and Addiction Equity Act of 2008. In addition, the Affordable Care Act requires all new small group and individual plans to cover ten essential health benefit categories, including mental health and substance abuse services. The Administration intends to issue next month the final rule defining these essential health benefits and implementing requirements for these plans to cover mental health benefits at parity with medical and surgical benefits.

Make sure millions of Americans covered by Medicaid get quality mental health coverage: Medicaid is already the biggest funder of mental health services, and the Affordable Care Act will extend Medicaid coverage to as many as 17 million hardworking Americans. There is some evidence that Medicaid plans are not always meeting mental health parity requirements today, an issue that will only become more important as Medicaid is expanded. The Administration is issuing a letter to state health officials making clear that these plans must comply with mental health parity requirements.”

Bravo, Mr. President!