Sunday, December 30, 2012

For Shame: Mental Illness, Violence and Discrimination

When some toll the bells for the deaths at Newtown, they ring them 26 times for the poor dead children and their educators. They do not ring the bell for Nancy Lanza, shot four times in the head while she slept. It's true, she violated a basic tenet by keeping guns ... lots of incredibly dangerous guns ... in a lock box in her house while she had a clearly emotionally disturbed son at home. I don't understand that. But I do know that Nancy Lanza didn't get the help she needed to deal with a situation that turned out to be vastly more dangerous than any speculative future she was armed for.

The Christian Science Monitor reported on Dec. 19 that Nancy Lanza may have been trying to get her son into treatment against his will.  The article notes:

Mothers are the highest percentage of people murdered by mentally ill young men, (Professor Liza) Gold (of Georgetown University) said. "The (young men) are usually living at home because they are dysfunctional ... The moms don't bail. These are their children.  They hang in with them, they try to get them help. And they're the ones that get killed."  

Sometimes they are just the first ones.

The NRA ... an organization that seems to exhibit its own mental health problems on a regular basis  ... has responded to Newtown by demanding more guns in schools and a national database of the mentally ill.  NAMI and other organizations ... like anyone with sense, really ... has condemned this.

Law already exists, it points out, to report the names of people "adjudicated as mentally defective" to the National Instant Background Check System.  This has never been implemented correctly because of the terms "adjudicated" and "mentally defective."  No one knows what they mean, but they offend almost everyone.  NAMI is calling once again ... as it did after Virginia Tech ... for Congress to clean up this law by adopting standards for the system that are consistent with modern medical knowledge and clear legal procedures.

The discrimination against people with "mental illness" is overpowering, and the fact that less than one-third of people who have it get treatment is appalling.  What if less than one-third of the people with brain cancer, with epilepsy, with dementia ... got treatment?  All are brain diseases. Period.

People don't get help because of the discrimination. And the discrimination gets worse when someone with a mental illness starts shooting people.  It's a terrible cycle that needs to stop.

The facts are that the vast majority of people with mental illness ... or brain diseases ... are not violent. They are, in fact,  more likely to be the victims of violence ... shot by police, robbed, killed ... than you are.

But the system had to change to make it easier for families to get help when a person is dealing with an emerging psychosis. Often the young person is angry, scared, confused, paranoid. Families need a clear path to get help and support. They need the colleges they are paying to call them and tell them their concerns about their son. They need the schools and workplaces to call when they drop out. They need the therapist to call even when the child is a young adult. They need easy access to psychiatric help and medication ... not eight-month-long waiting lists.  They need to be able to allow the young person stay in a treatment facilities for more than three days when the meds don't start working for weeks.  Families need help, and because of the discrimination, they don't get it.

During the early days of the AIDS crisis, Dr. Don Francis asked a famous question at a meeting with the American Red Cross and other blood bankers who continued to deny that AIDS was a blood-borne illness: How many dead hemophiliacs will it take? "Tell us a number you need.  If we have 20, 40, 100 cases ... will you believe it then?"  I'm beginning to wonder how many of these terrible events will take place before families finally get help.

Sunday, November 18, 2012

Five Things I Wish I'd Known When a Loved One Was Diagnosed With a Mental Illness

1.  The diagnosis is difficult.

We don't yet diagnose mental illness with real lab or blood tests. Virtually everyone has the experience of the diagnosis changing from doctor to doctor.  And many people have more than one diagnosed disorder. Dual diagnosis of mental illness and an addiction are particularly common. Up to 80 percent of the people with bipolar disorder have an alcohol/drug addiction.

2.  It's hard to get help. 

You face long waiting lists for psychiatrists and case managers.  The rules generally are that you have to be assigned help when you leave the hospital unless, of course, you have private insurance. That can mean you are looking at waiting lists of as long as eight months.  If you are in that situation, look for a psychiatrist who doesn't take insurance. You'll have to pay some money, but you'll be able to get in faster. You also can look for psychiatric nurse-practitioners to get faster help. In some cases, family doctors are comfortable prescribing medication, but often they are not, particularly for schizophrenia. If you are in an emergency situation, need to get a prescription and can't get an appointment, your only options may be a hospital emergency room or Netcare, a psychiatric emergency service. And, you're right, that's expensive and doesn't make sense.

3. One aspect of mental illness is lack of insight.  And the medications do have bad side effects. So it's really challenging to get people to take their medicine.

The ill person often doesn't see himself as ill, which makes it hard to get him to stay on medication or go to therapy.When the medication has bad side effects, that's doesn't help either.  One-half of people with serious mental illnesses don't take their medicine.

4. You have to find a friend who understands the system.

Make friends with social workers through Mental Health America or NAMI support groups so you can learn how the system works ... at least, for this month. These social workers, who are assigned to the groups that meet at community mental health centers, can make phone calls for you and tell you what to do.

5.  This is a marathon, not a sprint. 

This is going to go on for a decade or two or three.  You must adjust your response and the pace at which you work so that you maintain your own strength and sanity. Do everything possible to prevent the unpredictability of the situation from making your own life disorganized and chaotic. Figure out your own limits. Find ways to bring joy into your life.

Wednesday, November 14, 2012

The Holiday Survival Guide

The holidays can be some of the worst days of the year when your family is dealing with mental illness.  Not only is it TOO DARN DARK AND COLD, but it's also a time when expectations of being Merry and Bright can seem especially hard for your family. The stress can make your loved one have more symptoms, and that can make you even more anxious.

To help, I'm repeating the tips from last year's holiday planning post, plus some new thoughts on being your own caregiver this Christmas. 
  1. Accept this ain't gonna be pretty.  If you can get rid of your unrealistic expectations and be honest with your loved one and all the other family members, it will go better.
  2. Help your loved one to keep her dignity. Provide a gift fund or another way to allow her to give gifts, so she won't feel left out if she has no money. Scan every situation that's coming up to make sure that your loved one won't get unwelcomed attention.
  3. Hey, it's a good excuse to keep the unofficially crazy family members away.  You want a small gathering of your own family.  Period. Otherwise it's too stressful for your loved one.
  4. Keep it short. Keep it informal.  If you have to do the Big Family Thing, let your loved one stay home. Big groups are too much for your loved one, especially when you have to Put On a Happy Face. And do your own celebration. 
  5. If any of your extended family members really want to see your loved one, they know your phone number and where you live. Something private is better.  And try not to be bitter if no one asks. (There's a reason God chose you to be this person's lifeline. Not everyone can deal with this.)
  6. The best answer I've found to the question ... How is he? ... is "About the same." That's tough enough for you to answer.  So please don't put your loved one in a situation where he or she has to answer the question.
  7. If you are having an event at your house, discuss it in advance with your loved one so he or she knows what to expect. Accept his limits.  Accept her choices. Acknowledge his feelings. 
  8. If the person wants to be more visible during the holiday, brainstorm some things in advance.  What will he say when asked how he is? What will she do during the gathering? Is there a quiet place to retreat if needed?
  9. Tell the person whose home you are visiting what you may need in advance.  Please don't put yourself in a position ... helping cook at someone else's home, for example ... where you can't leave with little notice. If you are stuck, have someone ... a sibling or spouse ... available to get the person home if needed. 
  10. All your great preparation may result in your loved one refusing to participate at the last minute. And that's OK. 
  11. If someone offers to help you with any holiday preparation, ACCEPT. 
  12. When you make out your own Christmas wish list, see if you can ask for things that will reduce stress, whether it's a massage, a day trip, a cleaning service or a gym membership. 
  13. Eat right. Avoid the alcohol. Sleep. And write out a list of things that you are grateful for this year.
  14. A nice thank you card to people who have been helpful to your loved one personally or professionally is always good.

Sunday, September 2, 2012

How to Behave When It Gets Bad

Mental health crises can arrive in dramatic ways: A phone call that you will never forget as long as you live or a police officer at the door. But crises also can build, so you don't realize how bad things are until someone else points it out.

How can you tell if you are in a crisis? Here are three questions to ask:
  1. Has someone been hurt? Is your loved one or someone in danger of being hurt? 
  2. Has property been damaged? Does it seem likely that it could be?
  3. Does the behavior you are seeing indicate that a serious relapse is taking place? 
If you answer "yes," you need to take immediate action.  Go to your crisis plan and begin to implement it. You need to trust your instincts as well as you determine how quickly you have to act.

Step One: Get help. Call the treatment team or Netcare immediately. If you need to call the police, ask for officers who have had Crisis Intervention Team training. These officers are especially educated to deal more effectively with people whose mental illnesses are symptomatic.

While you are moving to get help, you need to watch your own behavior. You are trying to help your loved one regain control, so you need to be in control of yourself. Be calm. Speak slowly and firmly. Don't criticize or yell. 

You'll also need to start thinking about safety. The warning signs of imminent physical violence include tremor, rigid posture, clenched jaws and fists, verbal abuse, profanity and hyperactivity.

Obviously, remove any weapons from your home, and alert others who live there. Tell your loved one if his or her behavior is scaring you. 

Allow your loved one to have physical space. Don't block the doorway or stand over them. Don't make them feel cornered. Make sure you have an easy exit from any room and get out immediately if violence starts.

Many people who have a serious mental illness have at least one serious relapse. We all pray that the relapse doesn't end with serious consequences. The best thing that could happen is that it influences the loved one to take treatment seriously and do the things necessary to stay well. 

Sunday, August 26, 2012

Taking Steps When You See Mental Illness Relapse Warning Signs

Now that you know the early warning signs of your loved one's relapse, what do you do when you see them?  First, realize that relapses in major mental illness often are connected to one (or more) of these three things:
  1. The person stops taking medication or treatment.
  2. The person is experiencing a high level of stress.
  3. The person is abusing alcohol or drugs. 
The first step to take is to talk about it. Meet as a family, if possible, with the person to explain why you are concerned. You'll need to be specific, explaining what changes in behavior you are seeing and for how long.  Together you can agree about whether this is a problem. If you have a relapse looming, you'll want to look for the three common causes.

Medication: Of course, you will ask if the person has been taking medication. But you may have to do more than just ask. If the person lives with you, you can start to count the pills in the bottle every day. If the person isn't taking the medication, you will need to talk together about why and how. You can help with increased monitoring and reminders. Again, this sounds a lot easier than it is.

Stress: Evaluating your loved one's stress level together can help.  Ask questions like these:
  • Has your loved one experience a recent life event that's stressful?
  • Has there been a significant change in routine over the last two weeks?
  • Has there been a change in the treatment team or plan?
  • Have there been conflicts with family, friends, coworkers or others?
  • Has there been a change in an important relationship?
  • Has there been an increase in responsibilities?
  • Has your loved one stopped participating in activities that he or she enjoyed? 
If your loved one's answers indicate that stress is building, work together to find a way to reduce it. You can reduce responsibilities, cut back on work hours, add more leisure time, and get or give a temporary loan to reduce any money problems.

Alcohol and drugs: Talk about this, and check for evidence.  If you live with your loved one, remove alcohol and drugs from your home.  You'll also want to contact the treatment team to discuss this.

In any case, you should call the psychiatrist and case manager to express your concerns and even suggest a medication adjustment.

Keep an eye on the situation, but do not let it consume your family life.  Keep to your regular routines and make sure you have fun as a family.  Just check back every day or two to determine: Is it getting better, worse or the same?

Friday, August 17, 2012

Early Warning Signs

Mental illness is episodic, so things get better and then things get worse and then things get better again. As we mentioned in the previous post on preparing a crisis plan, it's important to be aware of your loved one's early warning signs of a relapse so you can mitigate a full-blown crisis.

Looking at these early warning signs will help you, your loved one and his or her treatment providers minimize setbacks.

Generally speaking, it's hard for the people with the illness to fully recognize the warning signs. So often his friends and family will start to see problems first.  Here are some typical signs:
  • Increased irritability. 
  • More noticeable tension, anxiousness or worries.
  • Increased sleep disturbances (such as hearing your loved one being up all night and sleeping through the day).
  • Depression.
  • Social withdrawal in more extreme forms, such as refusing to leave his or her room even to eat.
  • Concentration problems (taking longer to do tasks, have trouble finding tasks, having trouble following a conversation or a TV show).
  • Decreasing or stopping medication or treatment (such as, refusing to go to the doctor or the case manager appointment, skipping the vocational program).
  • Eating less or eating more.
  • Excessively high or low energy.
  • Lost interest in doing things.
  • Poor hygiene or lost interest in the way he or she looks.
  • Saying that he or she is afraid that he or she is "going crazy." 
  • Becoming excessive in religious practices.
  • Feeling bothered by thoughts that he or she can't get rid of.
  • Feeling completely overwhelmed. 
  • Leaving bizarre voice mail messages, outgoing messages or writings.
Your loved one also may have other specific signs of relapse or crisis that she or he has told you about. Ask yourself as well:
  • Did any unusual changes in behavior take place in the weeks just before the last relapse?
  • Did your loved one do anything that seemed "out of character" just before the last relapse?
  • Have the same behaviors preceded other relapses? 
Next you move to activating a crisis plan.

Sunday, August 5, 2012

Creating a Relapse Prevention Plan

The best way to do crisis planning is to do crisis prevention planning. When you love someone who has a mental illness, that's called relapse prevention.

Mental illness, especially bipolar disorder and schizophrenia, is episodic, meaning that symptoms vary significantly over time.  One of the hardest aspects of living with the illness in the family is that you know that things could change dramatically on any given day.

That's why it's smart to get the family together, including the person with the illness if at all possible, to develop a plan for how to prevent a relapse that could lead to a crisis. Writing down the answers to the questions below will help you to prepare the plan. 
  1. Who should attend family meetings if warning signs occur?
  2. What are your relative's early warning signs of a relapse? What was the very fist sign of crisis? (Do not write down more than five signs. Only write down the earliest or most important signs.  Typical signs could include irritability, severe insomnia, depression, social withdrawal and refusing to go to the doctor.  We'll cover more of the typical signs in an upcoming post.)
  3. How will you evaluate whether your relative is taking medication regularly?
  4. If your relative is not taking medication regularly, what will be the plan to help him or her resume doing so?
  5. How will you evaluate whether your relative is abusing drugs and alcohol?
  6. If your relative is abusing drugs or alcohol, what will you do?
  7. What situations have been too stressful for your relative in the past?
  8. If your relative is overwhelmed with stress, what will you do? 
Complete the plan by writing down this information:
  • The nearest psychiatric emergency facility's address and telephone number
  • Suicide Hotline number
  • Psychiatrist name and number
  • Case Manager  name and number
  • Therapist name and number
  • Social worker name and number
  • Any other services you could use
Then finish by setting a date six months into the future for when the family will meet again to discuss this.

Although I have no experience with this, some people with mental illness do create advanced psychiatric directives. This gives them the ability, while they are healthy, to name a health care agent to make decisions for them in an emergency. The directive also can cover preferred hospitals, physicians, psychiatric medication, electroconvulsive therapy, emergency medical interventions, people to be notified if they enter a psychiatric facility,  and the care and temporary custody for any minor children.

Sunday, July 29, 2012

Warning: Crisis Ahead

The phone calls came pouring into mental advocacy hotline, psychiatrist offices and community mental health centers in recent days.  The question was often the same: "I've got a son with paranoid schizophrenia. What are the warning signs that he might become violent?"

In response, NAMI wrote a blog that many have called the most reasonable answer to the question yet published. Responding to the tragedy in Colorado, NAMI says:

No. 1: You can't diagnose mental illness by watching someone on TV. Even if they look really, really mentally ill.

No. 2: The likelihood of violence from someone with mental illness is low. A U.S. Surgeon General report called the contribution of mental illness to violence in the United States "exceptionally small."

No. 3: Sometimes the mentally ill do commit violence, and sometimes it's because the mental health system has failed.We don't know what happened to James Holmes and his family. In my talks with families, I've seen that the smarter the person, the better they are able to hide the development of schizophrenia. They know exactly what the illness is, and they don't want it. An open letter to the Holmes family from other mother who is trying to help her son against all odds was printed in the Pittsburgh Post-Gazette. It's heartbreaking. 

And she's right. This needs to prompt a discussion on what we are doing nationally to help the mentally ill.  But that should have happened when Gabby Giffords got shot, when Virginia Tech happened and so on.

So far, even David Brooks, who I respect enormously, is going for a "If you see something, say something" approach to preventing violence.  So what are you looking for? Other than cartons of bullets arriving on the UPS truck? Violence from someone with paranoid schizophrenia tends to happen early in the illness (which usually strikes around 20), to those who have substance abuse issues, had violent tendencies before they got sick and/or are descending into psychosis.

Signs of psychosis are:
  • Serious drop in academic or job performance
  • Trouble concentrating or thinking clearly
  • Writings that reflect disorganized thinking, paranoia or just plain crazy thoughts
  • Spending a lot of time alone
  • Decline in personal hygiene
  • Unusual suspiciousness or uneasiness with other people
  • Unusual decline in talking to you and turning away from friends
  • Having no feelings at all
  • Intense anxiety and fear
  • Bizarre outgoing voice mail messages (This evidently happened with James Holmes and it's happened to others I know.)
Next time: Planning for a Mental Health Crisis

Sunday, April 29, 2012

Break Down: Why People With Mental Illness Act That Way

Patience is one of the best byproducts of having children with special needs.  And I have plenty of it ... except, I've discovered, for parents who exhibit no compassion for their adult children with mental illness.

NAMI's Family-to-Family class is a great help in that arena. This course on mental illness for families dealing with it is a must. Families learn about mental illness, and, just as important, find out that the terrible behaviors that they see at their house are happening at everyone else's house as well.

For me, the most effective class was called "Inside Mental Illness: An Empathy Workshop." We learned that any serious illness ... from cancer to heart disease and everything in between ... causes a psychological impact. The trauma is two-fold:
  • You lose forever the "magical belief" that you are exempt from harm.
  • You lose a predictable, dependable future.
When the serious illness is schizophrenia, bipolar disorder or another major mental illness, this psychological trauma is even more debilitating. Even when the illness is under control, those who suffer from it rarely get to enjoy things that we take for granted.  Often they have lost the ability to be component and successful in jobs, marriages, parenting and friendships. This is called "life constriction."

The resulting trauma sets up a process in which the "core self" must be protected at all costs. The resulting  behaviors don't make a lot of sense to family members and onlookers, but they are often coping strategies. They are the direct result of an effort to maintain some dignity and self-respect in the face of continual failure, disappointment, shame and stigma.

Here are some of the behaviors you can expect to see:

  • Denial (refusing to acknowledging having the illness)
  • Refusing medication
  • Self-absorption
  • Irritability
  • Haughtiness
  • Controlling and manipulation
  • Anger and attack
  • Rejections of friends and family
  • Blaming others and defensiveness
  • Drug and alcohol abuse
  • Doing nothing
  • Resisting change
  • Refusing mental health services
  • Apathy
  • Bargaining
  • Suspicion
  • Withdrawal
  • Dependency and envy
  • Running away
  • Quitting a job
  • Abusive criticism of others
  • Sleeping 
  • Refusal to discuss the situation 
These defensive coping strategies make things worse.  Of course, they do. But they do provide the person with the illness with a temporary psychological refuge when their feelings about their core self are hitting bottom.  And honestly, in all my years of working with parents of the mentally ill,  I've seen plenty of them doing the same things from time to time. I've even done some of it myself.

We'll talk more about how to deal with this in the next post.

Sunday, March 18, 2012

Signs of Suicide

When you love someone who has a severe mental illness, you worry occasionally ... at least ... about suicide.  Some types of mental illness, such borderline personality disorder, have a lot of focus on suicide, as threatening it regularly is one of the symptoms.  For others, including schizophrenia, bipolar disorder, post-traumatic stress (PTS) disorder and clinical depression ... it is a reality that death is sometimes the outcome. 

In fact, the military is now dealing with a rash of suicides, blamed on multiple deployments, PTS and depression.

The most important predictor of suicide is one or more previous attempts. Suicide also may happen more frequently among people who are younger, who are feeling hopeless, or who abuse drugs and alcohol.

For those with schizophrenia, suicide is more likely in the midst of a relapse when the voices are especially critical or are ordering the person to harm himself. For bipolar people, you not only have to worry about depression but also the manic period, especially if the person is delusional and thinks he is indestructible or has supernatural powers.

Asking a person about suicide does not generally put the idea into his head. In fact, letting the person know that you care about them will probably be a good thing. Here are some questions to ask:
  • Are you feeling sad?
  • Does it seem to you like it's not going to get better?
  • Have you been feeling so bad that you are thinking about hurting yourself? 
  • Have you thought about how you would do that? 
  • Have you made any plans to do it? What are your plans? 
The more concrete the answer ... in, other words does the person have a plan and the means to do it ... the more serious the issue.

If the person has a plan and the means, take steps immediately. Do not let the person out of your sight. Call the psychiatrist. Call the suicide hotline. Get the person to an emergency room or a public mental health intake center like Netcare. Remove lethal objects. You can't handle this alone, so don't try.

If things are not as serious, notify everybody ... case manager, psychiatrist, therapist ... anyway. Make sure you have the numbers for the psychiatrist, Netcare and suicide hotline in your cell phone. And take good notes about what is happening so you can see the pattern building in the future. 

The best way to prevent a crisis is to prepare for it in advance. Do everything you can. Because you will have to live with yourself no matter what happens.


Sunday, February 26, 2012

Looking for Trouble: Signs of an Impending Mental Health Crisis

Seeing the smoke helps to identify the fire.  So it's important to know the early warning signs of a mental health crisis and to act so you can minimize relapses. 

Family members and close friends are typically those who see the signs first.  That's because those close to someone with mental illness are most likely to know both the characteristics of the illness and the personality of the individual.  Signs that something is wrong can include:
  • A distinct change in sleep pattern
  • An increase in irritability
  • Statements that show disorganized thinking or bizarre thoughts
  • Exaggerated fears
  • Excessive or inappropriate emotions
  • Angry outbursts 
  • Volatile behavior
  • Increased isolation
  • Weight gain or loss
  • Difficulty doing things that could be done easily before
  • Any other unusual behavior that has preceded a relapse in the past
When you notice these issues, you should:
  1. Talk to others involved in caregiving to discuss impressions and form a plan of action.
  2. Contact the psychiatrist and suggest an evaluation of current medication.
  3. Keep any changes in routine to a minimum as much as possible.
  4. Keep the person's environment as safe and peaceful as possible.
  5. Keep emergency telephone numbers in your cell phone and carry it with you at all times.
  6. If possible, talk to your loved one about the situation. 
Next, we'll take a look at signs of suicide and what to do if you see them. 

Sunday, February 19, 2012

Worshipping God On High. Via Southwest Airlines.

The flight took off at 6:05 a.m., signaling the beginning of a business day that would end when another flight landed around 11 p.m. It was a lovely day, a useful day.  But I had worried about it as my stamina ain't what it used to be.

What I didn't expect took place around 6:15 a.m. as I sat in a window seat flying east above the clouds into a brilliant red horizon, a preface to sunrise. Getting up at 3:50 to make the flight, I had planned to do morning prayer while in the air. I just hadn't expected how touching it would be.

Opening my Worship Music playlist, I randomly selected "Holy, Holy, Holy."  "Early in the morning our song shall rise to thee." Indeed.  Even better ... "All the earth shall sing Thy praise in earth and sky and sea."  I realized that I might be the only person on earth in an airplane silently singing those words while looking at the red horizon.  And I realized once again that I am so grateful for God's creativity in creating this planet and all that's on it.

I came to loving worship music late.  A fan of jazz and classical music mostly, I didn't much like Christian rock music. When we came to Vineyard, where worship music is the first 25 minutes or so of service, my husband and I at first spent much time looking at our watches. My, how we have changed.

Worship music is part of our daily practice today. I use it if my mind gets stuck on my troubles, if I can't sleep, when I begin to spiral into negative thinking. An iPod with a worship music playlist is an essential to any caregiver prone to late night emergencies.  And it works great on an airplane, too!

Sunday, February 5, 2012

Creating a Support Network

"You're not going to live forever. He has to learn to be on his own, and the sooner, the better." My husband and I recently heard those words, and they struck us at a very deep level.  Like everyone who has caregiving responsibilities, we worry about what will happen to our loved one when we are gone.

That's why every caregiver needs a supportive network. The larger and more helpful your network is, the better off you are. But, as we all know, building a supportive network around your loved one is not easy. Who do you know who isn't busy? Who is willing to learn about mental illness, and who is has enough compassion to enter that world?

I will confess that this is an area in which I haven't found much success.  So far my support network is small, and that counts two family members with paws. (Quite honestly, the most extraordinary among us is a calico cat who always seems to know when bad times come and parks herself on top of my loved one, purring. Her companionship is quite a blessing.)

The most obvious choices for a network are spouses, siblings, grandparents, aunts, uncles and other relatives. Some, if not most, will decline the offer to become involved.  This is an area in which we must strive to not become bitter. You don't want reluctant recruits anyway, do you? If at all possible, build a network that will outlast your life.

For that reason, it's important to keep inviting people over time. It's easier to get paid professionals involved. (Because you pay them, apparently.) You also can branch out to include volunteers from organizations. Never turn away anyone who can occasionally check on your loved one when you are on a respite trip, cook a meal or take your loved one to a doctor.

Regular visits from family members can help your loved one, even if the reaction is not ideal. (As Tom Smith wrote in "A Balanced Life," the more unpredictable your loved one is, the more you need balanced and mature people in your network who will not be offended.) You can encourage people to take NAMI's Family-to-Family class on mental illness to learn more. People in your network not only need to understand the situation, they also are encouraged to share observations with you.

Does all this make you feel sorry for yourself because no one is helping you? Reach out at least online or join a support group.  I'm active in Mental Health America's Families in Touch as well as co-leading a Christian support group called Loving Someone With Mental Illness. That gives you a place to find support and get help when you need to figure it all out.

Sunday, January 29, 2012

Is Law Enforcement the New Mental Health System?

The thesis is titled "Management of the Severely Mentally Ill and Its Effects on Homeland Security." A sobering title. Even more sobering is the research that Michael C. Biasotti did for this thesis, presented to the Naval Postgraduate School in Monterey, Calif., in September 2011.

Biasotti surveyed 2,406 senior law enforcement officials. Seventy-five percent of them have been in law enforcement for more than 20 years. He found that they are overburdened by the "unintended consequences of a policy change that, in effect, removed the daily care of our nation's severely mentally ill population from the medical community and placed it with the criminal justice system."

Seriously? Yes, indeed.

Biasotti, whose day job is vice president of the New York Chiefs of Police, discovered:
  • 84 percent of the law enforcement officers said they have seen an increase in the mentally ill population during their careers.
  • 63 percent reported the time spent on calls for service involving people with mental illness has increased, with another 18 percent saying it has substantially increased.
  • 56 percent said the increase in calls is due to the inability to refer people with severe mental illness to treatment.
  • 61 percent said more people with severe mental illness are released to the community.
  • Mental illness calls take significantly longer for officers than calls related to larceny, domestic dispute, traffic and other things. 
Biasotti reports that the need for law enforcement to run a "shadow mental health system" is putting an unsustainable drain on resources and diverting law enforcement from other important security tasks. He called for the implementation of Assisted Outpatient Treatment laws to improve care for people with mental illness, conserve law enforcement resources and keep patients and the public safer.

It seems that making budget cuts that impact mental health care is having consequences on everyone. Imagine my surprise.


Sunday, January 15, 2012

When You Want God to Talk to You

Announce that you practice "lectio divina" in a group of good solid Christians, and you may get some funny glances. It sounds a little too holy for thou & company.  But it is really wonderful ... and easy.  If you want God to talk to you, you have to listen.

Lectio divina is Latin for divine reading. It's a traditional prayer that combines the reading of scripture, meditation on that scripture and prayer. You read the scripture for formation, not information. It transforms the word of God into the Living Word of God as applied to your specific life.

Traditionally lectio divina has four steps, although my church often teaches the addition of a beginning and an aftermath.  The four steps are: reading, meditation or reflection, prayer or response, and contemplation or resting in loving relationship with God. If you are an ultra-Myers-Briggs J like me, you have to fight taking the four steps as four things to check off.  This is, like it or not, an exercise of relaxation in God's word.

Prepare: For this to work, you need to be calm. Go someplace quiet. Turn off the ringer on your phone. Perhaps put on some soft music. Invite the Holy Spirit to meet you in this time of prayer. (The Holy Spirit has a significant role in revealing the meaning of the Word of God.) In other words, "Be still and know that I am God."

Read: Slowly read a passage of the Bible, perhaps several times, perhaps out loud. Read it so you hear every word. You also can personalize it by inserting your own name into it rather than the generic "you."

Meditate or Reflect: As you listen to the Living Word, what comes to mind? What word or words catch your attention?  What is stirred up in your spirit?

Pray or Respond: Ask God why these words have caught your attention. What is the Holy Spirit trying to say to you? How does it apply to your life today? Listen for God's response.  (Any true response will be consistent with the Bible.)

Contemplate or Rest:  Rest in God's presence.  And don't worry if you got nothing out of the reading. Sometimes that happens. 

Return: Through the rest of the day, return to the passage in your mind and reflect on it.

If this sounds interesting to you, there are two easy ways to start.  "Solo" by Eugene  Peterson, the genius behind the Message translation of the Bible, is a wonderful introduction with well over 100 lectio divina meditations in it.  It's available for the whole Bible or just the New Testament. I also have it as an e-book on my Nook, so it's convenient for travel.

A podcast called "Pray As You Go" from the Jesuits also does lectio divina in the Catholic tradition each day.  It's available on iTunes as well.

God has something to say about your life. Lectio divina will help you to hear it.

Monday, January 2, 2012

Rust Never Sleeps ... and Neither Do You

"It's better to burn out because rust never sleeps," wailed Neil Young, back in the day. I think even Neil has changed his mind about that idea by now. Let's make a pledge to avoid burnout in 2012, shall we?

In fact, keeping yourself in reasonably good shape is one of the core principles of being a caregiver.  Put on your oxygen mask first before you help those traveling with you, as the flight attendant says. Yet burnout is a constant threat because of the time-consuming nature of the demands on you.

M. Ross Seligson, a psychologist writing in Today's Caregiver, pointed out that you might not even see the burnout coming.  It's important to listen to the feedback of people around you. They may be able to see it before you can.

Some of symptoms are classic signs of depression: 

  • Constant fatigue.
  • Loss of interest in your work.
  • Loss of interest in your hobbies.
  • Decreased work production.
  • Withdrawal from friends and associates.
  • More use of alcohol or drugs.
  • A lot more eating or a lot less eating.
  • Feelings of helplessness.
  • Feelings of hostility.
  • Too much sleep or major sleep disturbances.
To avoid burnout, put yourself on your to-do list. First, make sure you make time for something you love to do.  Other thoughts:

  • Take a quarterly respite away from home, if that's where the caregiving takes place.
  • Get involved in a support group.
  • Take your nutritional and exercise needs seriously.
  • Focus on what you have accomplished, rather than what you did not do.
  • Keep a gratitude journal.
  • Listen to uplifting music.
  • Make a list of people who should be helping you and are not. Visit them with requests.
  • Let go of the guilt. You cannot solve this problem.
  • Be firm in what you can commit to, and don't establish a pattern of breaking your own boundaries.
  • Pray and meditate. 
This is a marathon, not a sprint. So keep yourself in the kind of training schedule that allows you to sustain energy.