A Good Use of Our Money

When I was 13, I became bipolar with psychotic features. Nobody knew. No bells or whistles went off. My father had the same condition, but we dismissed his scary irrational rages as “Daddy has a bad temper.” Just so, my endless misery and dramatic oversensitivity was dismissed as “Debbie’s a difficult teenager.” Never mind that I wanted to die, made strange scenes, and thought God was talking to me sometimes.

Decades later, my parents admitted to me that they suspected I had a serious condition. But they decided that if I saw a psychologist, it might interfere with their carefully inculcated Fundamentalist religion. So they did nothing.I was 26 before I was diagnosed, and it was another 8 years beyond that before I could be stabilized. That is 21 years of agony that can never be returned to me.

What would my story be like if somebody in charge had recognized the truth? What if I had been treated in time, before I wrecked my teens and twenties and lost all my childhood friends? I’ll never know.

But somebody is about to do something. President Obama’s latest budget includes $130 million to train teachers and other authorities to identify signs of mental illness in students and provide them with access to services. Another $50 million will go to training people at the Master’s level, to augment the shortage of mental health professionals. You can see more details of his plan in a Washington Post article, here: http://wapo.st/12MlAvJ.

It is vital that our students are reached and treated early in the onset of their disease. Early treatment makes an enormous difference in outcomes, particularly for schizophrenia. This is a budget appropriation that all the mentally ill and those who love them should be solidly behind. Because I expect there will be lots of lawmakers who do not want to spend this kind of money.

Lawmakers love to talk about improvements, but when it comes time to write the checks, the mentally ill are often the very last in line. Unfortunately, there are people out there who believe that the answer to tragedies like Newtown is merely to register us all like criminals and make sure we can’t buy guns - not take the time to recognize our problems and treat us.

I’d like to urge all of you to keep a watch on this part of the budget, whatever you may think of President Obama on other issues. This is going to come up for argument, and we need to be ready to write letters and make phone calls to support this use of our tax dollars. Nobody has to have a story like mine. In the land of the free, nobody should.

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

Mental Illness, Smoking, and Weight Loss

First of all, my apologies for being late with this blog, friends. I am being tortured by Lulu Press, and it is taking all my free time. To make a long story short, they are requiring their authors to resubmit EVERYTHING, and they are insisting on uploading it in a new format with new rules I do not understand. Tech woes...I am not swift at this stuff. But I'm sorry to have made you wait. Also, while I've got your attention, let me just announce that I will be giving a webinar with the International Bipolar foundation on April 4 entitled "Outer Tips to Inner Peace." You can see the foundation's URL in my list.

Now, on to the news. I have suspected for years that the mentally ill smoked more than the general population, and now comes a study that proves it. The report is by the Substance Abuse and Mental Health Administration, also known as SAMHSA. They found that while the general population contains about 20 percent adult smokers, the percentage among those with mental illness or substance abuse was a whopping 38.3 percent - that translates to 94 percent higher! Differentiating between substance use and mental health, they found that substance abusers who smoked represented about 5 percent of the population but smoked 9 percent of the cigarettes. Contrast this with mentally ill smokers, who represented only 4 percent of the population but smoked nearly 10 percent of all cigarettes. So among us there are not only more smokers, but heavier smokers as well. Or as SAMHSA Administrator Pamela Hyde put it, “People dealing with mental illness or substance abuse issues smoke more and are less likely to quit” (Please note that most of the percentages I am using are approximate. You can view the article yourself at http://bit.ly/10lDxeZ ).

Translate that to real life for a minute. We have hard lives, and we smoke to de-stress from it. Well, what happens when we break down and go into a hospital? First, we want to smoke MORE, because we are under more stress than average (by the way, since many of us cannot work, we are less likely to be able to afford this habit). Secondly, we relapse and go into the hospital, where 90 percent of the time  the nurses righteously take away our smokes for the duration of our stay! What’s wrong with this picture? We go into the hospital because our coping devices are not working, so they take another coping device away? Hello? This does not make sense.

I am not a smoker, but I have been in the past, and I can tell you that being deprived of cigarettes just when my emotions were at their rawest was not helpful.While I understand the hospital’s desire to keep second hand smoke away from other patients, and their health objections to smoking in general, I think they are being inconsiderate towards their patients’ needs for comfort. Just two cents from someone who’s been there.

But what was SAMHSA’s conclusion on reading this study?  That they should offer more smoking cessation programs in treatment facilities. They include substance abuse treatment facilities in their plans, and this is an even worse idea. I can tell you from experience that if you are trying to quit alcoholism, it is NOT the moment to try to quit smoking as well. You will almost surely crash BOTH efforts. Generations of rehab counselors will agree with me. Again, the crusade is understandable and well meant, but absolutely not practical and possibly counterproductive.

Well, enough of that. Some of you are bound to disagree with me, and that is fine. I’d like to hear about it.

One more study, this a hopeful one, published March 21 in the New England Journal of Medicine. In a nutshell, they have found that mental illness does not have to impede weight loss. Many patients tend to be overweight due to their medicines, and often feel there is nothing they can do about it. It is a serious problem, since the death rate of overweight or obese mental health patients is 2 to 3 times higher than the general population, mostly due to obesity related complications.

But this study enrolled 144 patients with major psychiatric disorders in a program that included nutrition advice, counseling and regular exercise classes, as opposed to a group of 147 who did not receive the extra help with weight loss.

At the end of 18 months, 38 percent of those enrolled in the weight loss program had lost 5 percent or more of their body weight, and 18 percent had lost more than 10 percent. The control group scored lower on both counts.

The study authors added that these figures are similar to figures in the general population among those who use some of the more successful weight loss programs. And for the record,  in the last two years I myself have lost 53 pounds on the popular Jenny Craig program. So maybe losing weight is not the problem, per se. Maybe the problem is just that changing a life style is hard for anybody. Maybe a little professional help is all we require.

You can see this article, too, at http://bit.ly/Xfo5EL .

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

A Big Victory in Reversing U.S. Stigma

For a long time, people in the general populace have assumed that those plagued by mental illness are dangerous. That attitude has spilled out in books, movies, newspapers, ad nauseum. Almost nobody knew the long proven psychological fact that we are LESS likely to be violent.

Two things have happened which will go a long way to turning that around. On March 5 in a publication listed only as BMJ, a Swedish study conducted by a Stanford researcher, Casey Crump, cited proof that people who have or have had psychiatric disorders are in fact more likely to be victims of homicides rather than perpetrators - up to 5 times more likely! They used national registries to determine how many victims of homicide had been diagnosed with a mental illness and found the incidence was 23%, compared with a rate of 9% in the general population. A brief but clear article can be found in 'Time' at the following address: http://healthland.time.com/2013/03/07/mental-illness-increases-risk-of-being-homicide-victim/

Within days - apparently not as a result of this study, but through the efforts of California Mental Health Services Authority and the Entertainment Industries Council - the Associated Press  issued new guidelines for its AP Stylebook, which is hugely influential in the industry. The stylebook now says, in brief, that mental illness is not necessarily to be looked for or reported about in violent crimes unless it truly is a factor, which they have determined only from the proper sources. No more assuming, “This guy must be crazy,” and running off to look for proof. The press release can be found here: http://www.ap.org/Content/Press-Release/2013/Entry-on-mental-illness-is-added-to-AP-Stylebook. The National Association of Broadcasters has made a follow up statement which you can find here: http://www.nab.org/documents/newsRoom/pressRelease.asp?id=2886

The press release reads, in part, “Do not use derogatory terms, such as insane, crazy/crazed, nuts or deranged, unless they are part of a quotation that is essential to the story.
 
Do not assume that mental illness is a factor in a violent crime, and verify statements to that effect. A past history of mental illness is not necessarily a reliable indicator. Studies have shown that the vast majority of people with mental illness are not violent, and experts say most people who are violent do not suffer from mental illness.”

This is truly good news for the rest of us, and will doubtless lead, in the long run, to decreased fear and stigma about psychiatric disorders. There’s not a word I need to add to good news like this.

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

Something to Inspire

Folks, I am too overwhelmed with stuff to post a blog this week, but here is a wonderful video I found just today to inspire you about the possibilities of recovery. I'll try again next Monday.

The Outer Limits, Again

You and I both know this blog is a week late. I apologize. But I just had a little emotional breakdown, and I needed time to recover.

I’ve been intending to write a blog about learning your limits. Now is a good time, because I have just become a perfect object lesson. I ignored my own limits, and was within two minutes of calling the psych ward. When you ignore your limits as a mentally ill person, a breakdown is what you can expect.

Here is the lowdown, in case you don’t know. Many of us with psychiatric conditions are not symptomatic all the time. We have episodes: periods when we are more or less fine or functional, and periods when something goes haywire and we walk on the wild side. Some of these episodes are beyond our control: they seem to be chemical surges that medical science doesn’t understand yet. But those of us who have been at this game awhile have probably found that we have triggers, environmental phenomena that make us more unstable, more likely to have symptoms or episodes or psychosis, or relapse into whatever condition we carry.

These triggers tend to include anything that one would normally consider “stressful,” plus maybe a handful of things that don’t make sense at all. Take me, for instance. I do badly around noise, crowds, hurry, anything that involves multitasking (even listening to a conversation while the radio is playing), hunger, frustration, and of all things bright sunlight. I have no idea why. It could be a case of photo-sensitivity gone wrong. All I know is that if I walk around on a bright day without a hat or frequent retreats to the shade, I end up with irrational attacks of rage that ruin everybody’s day. I am also oversensitive to stimuli in general. If I don’t get some complete solitude and quiet every 24 hours, I start to fall apart within days. That’s just a sample list. Any other patient could have a different one.

When you know what your triggers are, you can work around them or avoid them. If you can’t avoid them, you can at least be aware that you are in the danger zone, and make arrangements to duck out if necessary. What happened last week was that I ignored my triggers for 3 days straight, 8 hours a day, thinking I could handle it. I ended up shaking and sobbing in an empty room, crying out, “There’s no safe place! There’s no safe place for me!” and wondering if I would ever stop feeling such terror, whether I would ever take a deep, calm breath again without sedation. I don’t know how long this went on. It felt like a long time. A few minutes more and I would have called some kind of emergency services. It’s called decompensating, and it’s not pretty. All the defenses you have built to protect you in the world come completely undone, you shatter, and the men in white coats come and take you away. I ignored my personal limits, and it happened to me. And I should have known better.

Respect your limits! This is how you stay out of the hospital. This is how you live a relatively normal life. When the pressure builds up inside you, back off. Whatever you’re doing, however important it seems, it is NOT more important than your sanity. The job can wait. The partner can wait. ANYTHING can wait, when your sanity is on the line. Anything or anyone who will not let you take care of your sanity first does not belong in your life. You are allowed to look stupid, you are allowed to act like a jerk, so long as you save your sanity. Really.

I know this, but somehow after decades of practice I forgot it. I won’t be doing that again any time soon.

Next blog, I’ll talk about some of the ways I learned to identify triggers. Anyone can do it with time and observation.

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

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 Amazon.com, Kindle Editions, iBookstore, and other major vendors. Visit her web page at www.lafruche.net, or see her catalog at www.lastlaughproductions.net.

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:

4. IMPROVING MENTAL HEALTH SERVICES

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.
 
MAKE SURE STUDENTS AND YOUNG ADULTS GET TREATMENT FOR MENTAL HEALTH ISSUES:

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!