Tips For Successful Family Therapy

For most my life, my mom and I have had a turbulent relationship. Vague reassurances from others that “everyone has family problems” never helped with our nonsensical fighting or how I felt. I never knew what to do, but I knew it had to stop.

Family relationships are sometimes responsible for life’s biggest conflicts. They’re often complicated and can span decades. For many, it’s the steady drip of unresolved arguments and personality clashes that leave lasting feelings of resentment and bitterness. But there is a way to work through this. There is a hopeful course of action—it’s called family therapy.

Giving It A Chance

Family therapy is a collaborative and inclusive process which focuses on the family as a unit. Family therapists are skilled in dealing with a variety of conflicts whether it involves communication issues, estrangement, financial problems, divorce, a death in the family and more.

There might be a time before starting therapy when you won’t want to go. I certainly didn’t. My mom certainly didn’t. The pains of having to sift through years of battles wasn’t appealing. But without confronting the past, we are bound to repeat the same mistakes. Therapy may lead to the resolution you’ve been searching for. It’s important to give it a chance.

Finding The Right Therapist

I knew that the family therapist I chose was effective because within our first few sessions, I felt comfortable. I knew I would be able to open up to her. And I never dreaded talking in session. She also brought up Narcissistic and Borderline Personality Disorder in regards to my mother. This helped me to trust my therapist and her expertise even more, because she was able to spot that early on.

If you feel that a therapist is not effective, it’s okay to keep looking. In my experience, most therapists don’t take it personally. In fact, they encouraged my family to find the right fit for us. Your comfort level and ability to open up are essential in a therapeutic relationship.

Over time, your therapist will learn your family’s communication style. Some families are louder than others, while some fill the minutes with silence. Certain family members may be withdrawn at tense moments, while others might be aggressive. Your therapist will be see these differences and guide each of you accordingly.

How To Have Effective Therapy Sessions

A typical therapy session is 50 minutes, once a week. It’s a short amount of time to work through a lot of issues among multiple people. In order to best use your time with your therapist, here are a few tips to have effective sessions.

  • Prepare prior to therapy. Each family member should jot down questions or issues they would like to discuss.
  • If there is one family member you don’t get along with, carefully decide what you’ll say to them when you have your chance to speak.
  • Remain strong and respectful.
  • Speak calmly.
  • Try not to argue.

You may feel as though your family will never resolve long-standing conflicts. But it is possible. With listening and restraint, your family can reaffirm its bond and clear up old disagreements and hurt. Or you may decide it’s time to move on. For me, the decision to lessen contact with my mother, while controversial to some, was the right choice. I am no longer consumed with guilt about not being able to get along. Without therapy, I know I would still have an extremely close and volatile relationship with her.

Because it was such a positive and powerful experience for me, I always recommend family therapy to others. Even the more exhausting and uncomfortable sessions were necessary. Without them, I wouldn’t have been able to identify toxic patterns of behavior, understand my depression, or take control and realize what I needed to do in order to change my life.

There is nothing to fear about family therapy—it’s a safe place to work through negative feelings and move forward. Any decisions you make with your family will be based off careful discussion and thought. When I look back now, I know I wouldn’t have made the same choices without the support of my therapist.
Amanda C. Dacquel is a mental health writer and advocate. In 2014, she started TheCurrentCollective.com to share mental health experiences, resources and news. You can connect with her at AmandaDacquel.com.

Overcoming Stigma

I was sitting alone in the hallway of the Carter Center conference area in Atlanta during the 2012 Rosalynn Carter Symposium on Mental Health Policy. I had just finished being a panelist and talking about how employment and education helped me overcome the stigma associated with my depression. The conference was still in session, so I had the hallway to myself. I sat quietly, reflecting on the fact that I had been invited to speak here as both a clinician working in community mental health and a person living with depression.

Two scenes flashed through my mind highlighting two very different points in my life: getting offered a job as a therapist at the mental health center where I completed my internship for my Master’s in social work, and sitting in a psych ward on the eve of my 18thbirthday, wondering if I would graduate from high school.

Persevering Through Depression

It took many years of perseverance for me to become that professional sitting on a panel at a national conference. Though I managed to graduate from high school, I dropped out of college at 19 as my depression worsened. I was unemployed, and my only income was Social Security disability. Years of failed depression treatments included medication and talk therapy.

I spent most of my time alone doing what I refer to as “stewing in my own depressive juices.” This lasted for 10 years. During that time, I was challenged by the symptoms of mental illness— insomnia, loss of appetite, lack of concentration, suicidal thoughts. After a decade of being unemployed and living on Social Security, I decided that for my own survival, I had to return to school and complete my social work degree. Of course, my depression was against this:

“You can’t go back to school; you will fail.”

“You won’t be able to concentrate enough to complete your assignments.”

“You’re too stupid to get a college degree.”

Somehow, I decided to talk back to these negative thoughts. My response was simple: “I’m just going to do the best I can.”

And I did. I got myself back to school and finished my degree in social work. Around that time, I also tried a different treatment for my depression, and it worked. Things got easier.

Today, I feel incredibly lucky to say that I am doing exactly what I want to be doing. But really, luck had little to do with it. Besides my symptoms of depression, I faced an additional barrier to school, employment and inclusion in general: unhelpful attitudes from well intentionedhealth professionals—in other words, stigma.

Learning To Reject Stigma

One mental health professional once told me, “Maybe you’re not getting better because you’re not trying hard enough.” Another warned me, “You might not be ready to go back to school full time. Shouldn’t you just take one class and see how that goes?” A psychiatrist decided, without asking for my opinion, that I should be sent to live in a group home for people with mental illness. (That did not happen, and that treatment relationship ended that day.)

These scenarios were fueled by the stigma associated with mental illness—stigma that ultimately serves to limit and exclude rather than encourage and include. Had I listened to those professionals, I might never have returned to school or entered the workforce.

So how did I overcome the stigma that I faced? I rejected it. Rejecting—or overcoming—stigma, whether it be self-stigma, public stigma or structural stigma, is one of the keys for those of us living with mental illness. This is not an easy task, to be sure, but it is becoming more possible and a bit easier as more and more of us of speak out about our mental health conditions.

 

After working as a therapist and witnessing the negative effects of stigma on clients and their family members, I decided to develop a stigma-reduction training curriculum called “Overcoming Stigma.” I spent several months reading every scientific article I could find about stigma research. Most of it simply documented that stigma exists (in hospitals, in psychiatry, in substanceusetreatment centers, in pharmacies, universities, employment, housing, etc.) and that levels of stigma have not changed over the last decade.

According to many studies, effectively reducing stigma pointed to one intervention: contact with someone successfully managing a mental illness. One shining example of this is NAMI’s In Our Own Voice (IOOV) program. People with mental health conditions share their powerful personal stories in this free 60- or 90-minute presentation. I decided to integrate elements of IOOV into the beginning of my trainings by briefly disclosing my own depression and giving a few examples of my experiences with stigma. The rest of the training includes a description of the seven most common types of stigma experienced by people with mental illness and substance-use disorders, research about the effects of these stigmas, ways to reduce stigma, and the clinical and agency assessment tools I developed.

I have presented Overcoming Stigma trainings in many different health care settings, and the curriculum continues to evolve, always guided by the latest stigma research. Recent research shows that stigma training needs to be ongoing instead of a one-time thing and, it likely needs to address many stigmas all at once.

My trainings get everyone involved in the discussion; I like to ask for anecdotes from attendees. Here are some real-life examples of stigma shared by health care professionals who have attended my trainings over the past several years:

• A cardiac surgeon said he would not do surgery on a person with schizophrenia because he didn’t think the person would be able to do the required follow-up care.

• A therapist shared that as a Ph.D. student, he was told he would lose his scholarship if he left for “depression” treatment but could keep it if he left for “medical” treatment.

• A mother puts off making an appointment for her daughter to see a therapist despite her daughter experiencing severe symptoms of anxiety because she doesn’t want her daughter to be labeled as “crazy.”

• A physician attendee said it was well known in her neighborhood that her son had been hospitalized with bipolar disorder and no one acknowledged this fact (much less offered any type of support).

• A mental health clinician working in an emergency room said doctors and nurses often referred to patients in the ER with mental illness as “her patients,” rather than “our patients.”

If I do my job well, attendees leave with the understanding that we all have a role to play in reducing these harmful kinds of stigma. Personally, I still experience stigma, but I am no longer limited by it. I sometimes even chuckle when I hear someone say something particularly stigmatizing because I immediately think, “Well, that’s going to be part of my next training.” That’s not to say it isn’t still discouraging to see or hear things that continue to perpetuate stigma, but for me, there is a feeling of freedom and power in being able to turn a potential lost opportunity into one that is gained.

 

Gretchen Grappone, LICSW is a trainer and consultant with Atlas Research in Washington, D.C. Her work includes projects with VA medical centers, community mental health centers and other health care settings around the country. She lives in New York City.

https://www.nami.org/Blogs/NAMI-Blog/October-2018/Overcoming-Stigma

Reflections On Medicine, Shame And Stigma

As I was entering medical school, I found out that my mother had made a postpartum suicide attempt. I did not find out from her; it was shared with me in hushed tones by another family member who thought I should know, “now that I was going to be a doctor.” I was quite surprised by this information. And it made me sad to think that this wasn’t a topic she felt she could openly discuss.

Suicide is a challenging issue for all of us. Secrecy surrounds the topic, with shame as a common co-traveler. That’s why it’s an honor for me to be a small part of NAMI’s movement to make seeking help and support more acceptable. I’ve met many resilient people in the NAMI community who have overcome suicidal thoughts or actions. Often because there was a person who stood by them during a crisis or a new treatment approach that made a difference in their life. Some found sobriety for a co-occurring substance use disorder. Others found clozapine or lithium, which have been shown to reduce suicidal thinking. Some learned coping skills through a psychotherapy like cognitive behavioral therapy or dialectical behavioral therapy. Many found relief in the community of NAMI. Regardless of how, their suicidal thoughts or actions were talked about and changed.

My field sorely needs similar conversation and change. Doctors also have high rates of suicide and it’s a major issue that some of the doctors we turn to for care are often not taking care of themselves. We need to teach help-seeking behaviors in the medical and psychiatric fields. Doctors need the same support and encouragement to get help as their patients.

I lost a patient to suicide early in my psychiatric residency. This was a person with many strengths, who was also in tremendous psychological pain. I worried about him during off-hours and felt powerless to help at times. After I learned of his tragic outcome, I was upset, slept poorly and struggled at work for months. I was worried I had said the wrong thing or had failed in some way as an inexperienced psychiatrist. I seriously considered leaving the field and entering another specialty. I was lucky to receive support and empathy from my colleagues and supervisors as they encouraged me to seek therapy. I did my best to carry on, but I never forgot about this patient and his suffering.

Last year, at an American Psychiatric Association (APA) event, I was impressed that even doctors are wondering if they worry, struggle and stress too much. APA president Anita Everett reviewed the stresses that commonly consume doctors and announced that psychiatric wellness would be a core feature of her leadership. Dr. Everett’s thoughtfulness and openness on the stresses doctors face and her emphasis on help-seeking was powerful; her efforts have started many overdue conversations across the entire field of medicine. Unfortunately, the same shame that led to the secrecy around my mother’s postpartum suicide attempt is alive and well in the medical field.

Doctors don’t have all the answers for stress, mental illness and suicide—our most challenging aspects of being human. Medical culture needs to continually evolve and learn from the remarkable and resilient people like those I have met at NAMI. Facing your mental health challenges head-on and working to get help with a supportive community behind you is a key piece of NAMI culture. It’s a culture we can all learn from.

 

Ken Duckworth is medical director at NAMI.

https://www.nami.org/Blogs/NAMI-Blog/September-2018-(1)/Reflections-on-Medicine-Shame-and-Stigma

5 Common Myths About Suicide Debunked

Suicide affects all people. Within the past year, about 41,000 individuals died by suicide, 1.3 million adults have attempted suicide, 2.7 million adults have had a plan to attempt suicide and 9.3 million adults have had suicidal thoughts.

Unfortunately, our society often paints suicide the way they would a prison sentence—a permanent situation that brands an individual. However, suicidal ideation is not a brand or a label, it is a sign that an individual is suffering deeply and must seek treatment. And it is falsehoods like these that can prevent people from getting the help they need to get better.

Debunking the common myths associated with suicide can help society realize the importance of helping others seek treatment and show individuals the importance of addressing their mental health challenges.

Here are some of the most common myths and facts about suicide.

Myth: Suicide only affects individuals with a mental health condition.

Fact: Many individuals with mental illness are not affected by suicidal thoughts and not all people who attempt or die by suicide have mental illness. Relationship problems and other life stressors such as criminal/legal matters, persecution, eviction/loss of home, death of a loved one, a devastating or debilitating illness, trauma, sexual abuse, rejection, and recent or impending crises are also associated with suicidal thoughts and attempts.

Myth: Once an individual is suicidal, he or she will always remain suicidal.

Fact: Active suicidal ideation is often short-term and situation-specific. Studies have shown that approximately 54% of individuals who have died by suicide did not have a diagnosable mental health disorder. And for those with mental illness, the proper treatment can help to reduce symptoms.

The act of suicide is often an attempt to control deep, painful emotions and thoughts an individual is experiencing. Once these thoughts dissipate, so will the suicidal ideation. While suicidal thoughts can return, they are not permanent. An individual with suicidal thoughts and attempts can live a long, successful life.

Myth: Most suicides happen suddenly without warning.

Fact: Warning signs—verbally or behaviorally—precede most suicides. Therefore, it’s important to learn and understand the warnings signs associated with suicide. Many individuals who are suicidal may only show warning signs to those closest to them. These loved ones may not recognize what’s going on, which is how it may seem like the suicide was sudden or without warning.

Myth: People who die by suicide are selfish and take the easy way out.

Fact: Typically, people do not die by suicide because they do not want to live—people die by suicide because they want to end their suffering. These individuals are suffering so deeply that they feel helpless and hopeless. Individuals who experience suicidal ideations do not do so by choice. They are not simply, “thinking of themselves,” but rather they are going through a very serious mental health symptom due to either mental illness or a difficult life situation.

Myth: Talking about suicide will lead to and encourage suicide.

Fact: There is a widespread stigma associated with suicide and as a result, many people are afraid to speak about it. Talking about suicide not only reduces the stigma, but also allows individuals to seek help, rethink their opinions and share their story with others. We all need to talk more about suicide.

Debunking these common myths about suicide can hopefully allow individuals to look at suicide from a different angle—one of understanding and compassion for an individual who is internally struggling. Maybe they are struggling with a mental illness or maybe they are under extreme pressure and do not have healthy coping skills or a strong support system.

As a society, we should not be afraid to speak up about suicide, to speak up about mental illness or to seek out treatment for an individual who is in need. Eliminating the stigma starts by understanding why suicide occurs and advocating for mental health awareness within our communities. There are suicide hotlines, mental health support groups, online community resources and many mental health professionals who can help any individual who is struggling with unhealthy thoughts and emotions.

 

Kristen Fuller M.D. is a family medicine physician with a passion for mental health. She spends her days writing content for a well-known mental health and eating disorder treatment facility, treating patients in the Emergency Room and managing an outdoor women’s blog. To read more of Dr. Fuller’s work visit her Psychology Today blog and her outdoor blog, GoldenStateofMinds.

Traveling With A Mood Disorder

I was diagnosed with bipolar II disorder when I was 14. It has taken me decades to come to grips with what that means, and to be in a place where I’m comfortable talking openly about it. Nowadays, I’m really open, because I work as a travel blogger, connecting with people and places for a living. I actually started my career at a nonprofit office job, thinking that was what I wanted. But the traditional professional life was something I couldn’t live up to, and I frequently used travel to re-center. I’m very lucky to have turned it into a career, because I’ve learned that travel can be one of the most incredible experiences for those of us struggling with our mental health.

For many of us, myself included, it can be hard to get out of bed some days. Depression comes crashing down, and just the thought of moving becomes overwhelming. Needless to say, the idea of journeying to the other side of the world can seem downright impossible.

But I’ve found that waking up in a new place can be very effective in breaking a downward spiral into an extended depression. My brain becomes too preoccupied with learning about a new place to focus on my mood. That said, traveling with a mood disorder also has its perils. So here are some tips and lessons (some of which I learned the hard way). May they help you, too!

Before You Go

Make Sure You Have Enough Medication. Most of us go month-to-month on our meds. That can be a challenge for an extended trip that overlaps with your refill period. I usually work with my doctor to get a two-month’s supply when I know I have a trip coming up to help with that issue. My pharmacy is also aware that I travel often and works with me to push up refill dates if needed.

Brief Travel Companions on Your Needs. Solo travel is easier for me in many ways because I don’t have to justify my emotional needs to anyone. However, when I travel with others, I try to discuss with them what I need (downtime, alone time, etc.) before we go. That way, we can work out systems that allow me to get what I need within the framework of our trip.

For example, I love taking road trips with my father, and it’s something we’ve been doing since I was a little kid. One of the systems we have in place is that when I feel like I need some alone time, we stay at a hotel with one-bedroom suites. He sleeps in the bedroom, and I sleep on the couch in the living room. Just that one wall and a few feet gives me the precious personal space I need.

Plan. For many of us with mood disorders, our anxiety worsens with the unknown—so having a plan can help with that. This doesn’t mean I have every day planned out, but I go into a trip with at least a rough itinerary. I also try to alternate busy days with lighter days to build in some downtime for myself.

While Traveling

Prioritize Self-Care. I refuse to neglect my self-care when traveling. For me, emotional balance begins with a good night’s sleep (at least eight hours, preferably more). I’ve accepted that this means I will rarely enjoy the nightlife in a new place, and I’m okay with that.If your self-care involves exercise, meditation or something else, structure that into your trip. Try to find hotels with fitness centers, room in your suitcase for your meditation materials, or anything else you may need.

Know Your Triggers. Our illnesses (unfortunately) don’t disappear because we’re on vacation. Our triggers are there as well, so we need to continuously pay attention to situations that can activate them. Knowing what our triggers are ahead of time can help us avoid things that might set them off, but sometimes it still happens. What do we do then?

When I was in Japan, I visited the Fushimi Inari Shrine in Kyoto. It was extremely crowded, and at one point, people were all around me, and I felt like I was trapped. I had a panic attack, and I decided that rather than push

through the rest of my day, I would take care of my needs and leave. I told my travel companion that I would meet him back at our hotel, and I left.

Practice Self-Compassion. This one is still hard for me. After a situation like the one in Kyoto, my natural inclination is to be upset with myself. What I (and my illness) needed that day prevented me from seeing a place I wanted to see. While shame, guilt or disappointment might be our natural first reaction, it’s important to then be compassionate with ourselves. Doing what is necessary to maintain balance is hard, and doing it at the expense of something we were looking forward to is even harder. We make tough choices like that every day, but prioritizing our emotional needs is never the wrong choice.

Keep Your Support Structure Engaged. For some people, this means doctors or therapists. For others, like me, it means certain friends and family members. My friend Ana is one of my first calls when I have panic attacks or depression spirals at home. So even when I was in Kyoto, she was my first call when I got back to the hotel. Hearing her voice, even while on the other side of the world, made me feel like I wasn’t helpless or isolated just because I was gone.I do my best to make sure my support structure is aware of what’s going on with me while I’m gone, and I have emergency procedures in place with my therapist and psychiatrist just in case.

After You Return

Update Your Doctor and Therapist. I find it helpful to do a “debrief” with both my psychiatrist and therapist when I return from a trip. What situations did I handle well? What do I wish I would’ve handled differently? How did my meds work in a completely different environment? I believe that we learn by doing, and keeping the professionals we trust informed of our discoveries along the way is important.

Congratulate Yourself. Regardless of whether or not you handled every situation in a way you consider “perfect,” you were able to travel with a mood disorder. That is an accomplishment that needs to be celebrated! Look through your photos, tell stories to your friends, and know that if you did this, you can do anything.

 

Jonathan Berg is a volunteer facilitator for the Depression and Bipolar Support Alliance and the founder and editor of the travel blog The Royal Tour (www.theroyaltourblog.com). He struggles to keep his bipolar disorder in check and shares his adventures and struggles with his readers.

https://www.nami.org/Blogs/NAMI-Blog/August-2018/Traveling-with-a-Mood-Disorder

College Students Of Color: Overcoming Mental Health Challenges

July is Minority Mental Health Month which provides an ideal opportunity to talk about the mental health of young people of color. Our country is becoming more and more diverse—the proportion of children of color are projected to become the majority by 2020 and people of color are expected to make up the majority of the U.S. population by 2045. It’s crucial that we pay attention to the mental health of young people of color as they become the future of our nation.

Mental illness affects young people of color at similar rates as white young adults. However, they are less likely to be diagnosed or seek mental health services. This is largely due to stigma and a cultural mistrust of mental health professionals who lack cultural competence.

Not seeking needed mental health care is problematic for this (and any) population—but especially for college-aged people of color. Because 75% of all lifetime cases of mental illness begin by age 24, college is a time during which many mental illnesses first appear. Coping with an untreated mental illness can affect a student’s social experience and academic performance. And for students of color, there’s often more under the surface working against them.

How Discrimination Affects Mental Health

The social determinants of mental health include factors such as where people are born, live and work as well as their age. They also include things such as discrimination and exclusion, socioeconomic status and access to health care.

Some colleges and universities have recently become settings of discrimination, racial profiling and xenophobia. Universities that create these feelings of marginalization and isolation can be harmful to mental health, and for students of color who have a pre-existing mental illness, such acts of alienation can actually worsen their condition.

Many of us grew up hearing the adage: “Sticks and stones may break my bones, but words can never harm me.” Dr. Altha Stewart, who, in May 2018, became the first African-American President of the American Psychiatric Association, stated recently that “this old saying is incorrect and the truth is that  negative words, can be damaging to mental health, especially for young people.”

Racially hateful expressions broadcasted on social media or communicated face-to-face are harmful to the mental health and well-being of college students of color. This is especially true when cyber-based comments are anonymous. Not knowing if comments are coming from a classmate or someone living next door in the dorm can be frightening and anxiety-provoking.

Colleges and universities should create environments in which young people of color are valued. This can be done by recruiting and retaining a diverse staff and faculty; establishing zero-tolerance policies to racist actions; and developing and maintaining cultural supports, such as culturally-themed clubs, dorms and diverse student identity groups.

Positive actions like these are delineated in the Equity in Mental Health Framework developed by the Steve Fund in collaboration with the Jed Foundation. These resources can help young people of color thrive socially, academically and emotionally.

 

Annelle B. Primm, M.D., MPH is currently senior medical adviser to the Steve Fund, and senior psychiatrist adviser to Hope Health Systems and several other organizations. During her career, Dr. Primm has been Deputy Medical Director of the American Psychiatric Association; Director of the Johns Hopkins Hospital Community Psychiatry Program; an editor of the books, Disparities in Psychiatric Careand Women in Psychiatry: Personal Perspectives; and a lecturer and video producer on the mental health of diverse and underserved populations.

Getting Involved With Minority Mental Health

Mental health conditions do not discriminate based on race, color, gender or identity. Anyone can experience the challenges of mental illness regardless of their background. However, culture, race, ethnicity and sexual orientation can make access to mental health treatment much more difficult.

America’s entire mental health system needs improvement, including when it comes to serving marginalized communities. When trying to access treatment, these communities have to contend with:

  • Language barriers
  • A culturally insensitive system
  • Racism, bias and discrimination in treatment settings
  • Lower quality care
  • Lower chance of health care coverage
  • Stigma from several angles (for being a minority and for having mental illness)

These are all in addition to the usual road blocks. Many cultures also view mental health treatment as a luxury, considering symptoms a “phase” that will eventually pass. These harmful perceptions of mental illness can further isolate individuals who desperately need help.

We can all help ignite change against these disparities and fight stigma this Minority Mental Health Awareness Month. It simply starts with learning more about mental health and informing your community.

Consider Giving A Presentation

Starting conversations about mental health in your community may feel intimidating—especially if your community views mental illness as a personal fault or weakness. But the more we talk about mental illness, the more normalized it will become. And NAMI is here to help!

Consider giving NAMI presentations to your community, like Sharing Hope for the African American community and Compartiendo Esperanza for the Hispanic and Latino communities. These presentations go over the signs and symptoms of mental health conditions as well as how and where to find help. If neither of these presentations fit your background, feel free to use them as models to create your own presentation tailored to your community’s needs.

Emphasize Treatment

Make sure to stress the importance of a culturally competent provider. These mental health professionals integrate your beliefs and values into treatment. To find a provider that does this, you may have to do a significant amount of research. In addition to searching online, you can also ask trusted friends and family for recommendations or ask for referrals from cultural organizations in your community (like your local AKA Chapter).

In your first session, make sure to ask any questions you may have about the professional’s cultural competence. For example:

  • Do you have any experience treating someone from my background?
  • Have you had any cultural competence training?
  • How would you include aspects of my identity into my care?

Be confident when disclosing relevant information about your beliefs, culture, sexual orientation and/or gender identity that could potentially affect your care. Your provider will play a vital role in your treatment, so make sure you feel comfortable and can communicate well with them before committing to them. Remember: If you feel like your provider doesn’t understand you, it’s okay to leave. Cultural competency is very beneficial to effective treatment. It might take a bit of effort to find the right fit, but recovery is worth it.

Share Your Story

When a person experiences symptoms of mental illness, one of the most helpful and comforting feelings is knowing that they’re not alone. It can be incredibly reassuring to know in this moment right now, someone else is going through similar struggles as you are—regardless of where they are, who they are, or how they identify.

If you’re ever feeling isolated or that your community doesn’t understand mental illness, explore story-sharing platforms like Ok2Talkand You Are Not Alone. On these platforms, everyday people write about their deepest struggles with mental illness and their hopes for recovery. If you feel comfortable, post your thoughts and feelings about or experiences with mental illness—it’s rewarding to know you are helping others feel less isolated.

Minority Mental Health Awareness Month is an opportunity to raise awareness and stop stigma in diverse communities. It’s time to improve the harsh realities minority communities face when it comes to mental illness treatment. In fact, it’s long overdue.

By Laura Greenstein

https://www.nami.org/Blogs/NAMI-Blog/July-2018/Getting-Involved-with-Minority-Mental-Health

How Fireworks Can Trigger PTSD

You may see the signs popping up around your neighborhood this July 4—red, white and blue notices that indicate the home of a vet with the request to “Please be courteous with fireworks.”

The signs are the work of a Facebook-launched nonprofit, Military With PTSD, begun by Shawn Gourley, whose husband, Justin, served in the Navy for four years and returned with post traumatic stress disorder (PTSD). Sudden and loud noises can trigger episodes of PTSD, bringing veterans back to traumatic experiences they have lived through during their service. According to the U.S. Department of Veteran Affairs, up to 20% of military personnel who served in Iraq or Afghanistan experience PTSD each year.

The signs are posted on the lawns of veterans’ homes to alert people to be more considerate when setting off fireworks in the area. According to Gourley, who spoke to CNN, the group has mailed 2,500 signs, some of which were paid for by donations and others by the vets themselves, while 3,000 people remain on a waiting list.

The signs are not meant to quash any Fourth of July celebrations, but to raise awareness that the explosive sounds, flashes of light and smell of powder may trigger unwelcome memories for some. “If you are a veteran, on the one hand July 4th should be one of the most patriotic holidays that you feel a part of,” says Dr. John Markowitz, professor of psychiatry at Columbia University. “On the other hand, the rockets’ red glare and the bombs bursting in air are likely to evoke traumatic memories, and you might want to hide. It’s a tricky one.”

Having advanced knowledge of a fireworks display can help some people with PTSD to better prepare and cope with any symptoms they may experience. “A big component of the startle response and PTSD is the unexpected,” says Rachel Tester, program director of the Law Enforcement, Active Duty, Emergency Responder (LEADER) Program at Harvard Medical School’s McLean Hospital. “When people are able to anticipate, they are able to put into place mechanisms they have to cope ahead of time.”

That might include things such as relaxation techniques or being able to see the fireworks show and therefore know that they’re coming, as well as having headphones, music or other distractions at the ready.

Such strategies may not work for every PTSD patient, but being more aware that the explosive celebrations of the holiday might affect those with PTSD is an important step toward ensuring that everyone can enjoy the holiday without fear, anxiety or pain.

By ALICE PARK

http://time.com/3945001/fireworks-ptsd/

Opioids And Substance Abuse: What Can We Do?

Opioids and other substances that alter how we feel, think and act have overtaken our culture, and have been declared a public health epidemic. We are losing our loved ones, friends, co-workers and neighbors to these substances. But we have yet to implement the solutions that will beat back this epidemic, as we have so many others, like HIV/AIDS, polio, smallpox and tobacco.

Substance use and abuse—of opioids, heroin, cannabis, stimulants, alcohol, etc.—is universal and the casualties of drug addiction affect all classes, races and regions of the U.S. These substances are too frequently used as an answer to pain, mental and physical, and have become a cure-all for people who’ve fallen on hard times. That’s why so many people use them and that’s why so many people become addicted.

Substance use disorders commonly co-occur with mental health conditions, especially serious mental illness like schizophrenia, bipolar disorder, depression, eating disorders, PTSD and other forms of trauma. People with mental illnesses often turn to drugs and alcohol to quiet their symptoms, and drugs and alcohol can adversely affect our nervous system and increase risk for mental illness.

The Solution

We are failing with this epidemic because of this country’s dogged attachment to policies and programs that have never worked for addiction. Vast sums of money continue to be wasted on campaigns of drug control and on public messages, especially for youth, that rely on scare tactics. We can and must do better. We can beat this epidemic with three public health approaches.

  1. Prevention. This includes school-based programs that provide youth with decision-making skills and methods of controlling their moods and impulses. One proven program is called the Life Skills Training. Prevention also extends to the family, such as “positive parenting,” or actively modeling and teaching children about positive behaviors. Big Brother/Big Sister programs—where an older youth of the same background takes on a younger, high-risk child—is also highly protective. These prevention programs work, and we have hardly started to apply them.
  1. Screening. Early identification of a problem means early intervention, before the substance use disorder becomes more firmly rooted. We have good screening instruments, (such as the Alcohol, Smoking and Substance Involvement Screening Test), and need to make them standard practice in schools, pediatric and family medicine offices.
  1. Treatment. Families and people affected by addiction should advocate for the strong, comprehensive treatment approach they need. Effective treatment means first detecting the presence of a co-occurring mental (or physical) condition and assuring it’s also treated. Treatment for a substance use disorder should then combine:
  • Cognitive therapy that focuses on reducing the triggers of relapse
  • 12-Step programs like Alcoholics Anonymous and Narcotics Anonymous
  • Family education and support
  • Medications

This public health epidemic that is seizing our country can be beaten. And by following these steps, we save lives, help families and restore communities.

 

Dr. Sederer is a psychiatrist, public health doctor and medical journalist. His new book is The Addiction Solution: Treating Our Dependence on Opioids and Other Drugs(Scribner, 2018). www.askdrlloyd.com.

https://www.nami.org/Blogs/NAMI-Blog/June-2018/Opioids-and-Substance-Abuse-What-Can-We-Do

You Can Be Prepared For Crises

Each year, there are about 5 million visits to emergency departments due to mental illness. Five million people whose symptoms escalate to the point of crisis. Five million people who don’t understand what’s going on or what to do and rush to the ER.

However, this number doesn’t include the people who experience mental health crises without going to the ER—people who are scared and unsure if their situation is a “true emergency.” This number also doesn’t account for the caregivers and loved ones of those experiencing a mental health crisis, standing beside someone they care for, watching them struggle, unsure of how to help.

Mental illness is unpredictable by nature and crises can, do and will happen. Although these crises can’t always be prevented, it is possible to be prepared.

Learn As Much As You Can

The first step in being prepared is gathering any information, resources and support that is available. Start by fully understanding your loved one’s condition: What are the primary symptoms? How can you tell if symptoms are getting more severe? What can you do to support them? And the list goes on. It can be helpful to go with your loved one to see their mental health professional, so you can ask these questions and any others you may have.

Next, learn more about what a mental health crisis is and what to expect when one occurs. NAMI’s new guide: “Navigating a Mental Health Crisis: A NAMI Resource Guide for Those Experiencing a Mental Health Emergency” is a great resource. This free, downloadable guide offers practical strategies on how to deescalate a crisis, information about available resources, tips for advocating for a person in crisis and a sample crisis plan. Details like these are often critical in supporting your loved one during a crisis.

Make A Crisis Plan

Creating a crisis plan should be a collaboration between your loved one and you. The best time to develop this plan is when things are going well. Take the time to ask them questions that will help build a crisis plan, like: What would be most helpful for you? What would you like to do? Who would you like to call? Waiting to ask these important questions can make it difficult to make decisions during a crisis episode.

A crisis plan should include:

  • Your loved one’s general information (date of birth, social security number, insurance information, etc.)
  • Current medications and dosages
  • Current diagnoses
  • History of suicide attempts, drug use or psychosis
  • Addresses and contact information for nearby crisis centers or emergency rooms
  • Contact information for health care professionals
  • A determined behavior/symptom that would prompt going to the hospital or calling 911

Once you create a plane, share it with family members, mental health professionals or anyone else you think should have it. Make sure to update it whenever there is a change in diagnosis, medication, treatment or provider. A crisis plan can be a life-saving resource, so keep it up-to-date and in a safe place.

Notice Behavior Changes

A person with mental illness will typically experience changes in their behavior before a crisis occurs, such as sleeplessness, mood swings or paranoia. These changes are warning signs and shouldn’t be ignored. “Psychiatric illnesses, for the most part, evolve slowly, so there’s going to be a lot of warning,” says Dr. Daniel Lieberman to U.S. News and World Report.

If you notice warning signs, talk to your loved one and encourage them to visit their treating mental health care professional or doctor. “If somebody has a relationship with an outpatient psychiatrist, that’s the first place to go,” Lieberman says.In many cases, there might be enough time to get in contact with a provider before escalating symptoms become a crisis.

Mental health crises can be frightening for everyone involved. However, being prepared can take away some of the fear and uncertainty around what to do and how to help your loved one. Your preparation and support alone can help deescalate a crisis situation—just knowing you’re there, as a stable force, can be an enormous comfort.

By Laura Greenstein

https://www.nami.org/Blogs/NAMI-Blog/June-2018/You-Can-Be-Prepared-for-Crises