Legislative Update: Governor Walz Signs Three Much Needed Executive Orders

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Governor Walz Signs Three Much Needed Executive Orders

On Friday afternoon, Governor Walz signed executive orders 20-10, 20-11, and 20-12. These executive actions were absolutely necessary to ensure that mental health programs have the flexibility needed to continue providing services but in alternative ways during the COVID-19 pandemic. A recent article in the Star Tribune, as well as an opinion piece make the need for this action clear.

The most important executive order for the mental health community is EO 20-12. This executive order reflects SF 4200, which is bipartisan legislation that would easily pass on a floor vote if the legislature were able to convene. However, given the uncertainty in the legislature – including a staff person being diagnosed with COVID-19 in the House – Governor Walz correctly recognized the urgency of the situation and took executive action.

EP 20-12 provides the Department of Human Services with short-term flexibility to alter background study requirements, licensing and certification standards, requirements for in-person assessments, eligibility renewal standards for public programs, work or community engagement requirements, service delivery standards including treatment setting and staffing ratios, payment procedures, and more. The most important change for the mental health community relates to telehealth, where the executive order allows for flexibility regarding telehealth and other electronic strategies for communicating with providers or patients. Private plans in Minnesota have already agreed to reimburse telehealth from a person’s home and by phone.

This means that a community-based mental health provider will be able to bill for services provided via telehealth, even if this is a phone call and not the more intensive telehealth systems that would usually have to be used. This will increase much-needed mental health access while ensuring that healthcare providers and people with mental illnesses can follow best practices to avoid contracting COVID-19. Many people with mental illnesses don’t have computers or smartphones and people in rural Minnesota don’t have Internet. This step, allowing services by phone, was a top priority for NAMI Minnesota.

More detailed information on how DHS will be implementing the orders will be placed on the DHS website in the coming days.

EO 20-11 was also issued on Friday and allows the Department of Human Services to seek federal authority to waive or change federal requirements for all programs and services, including the Minnesota Family Investment Program (MFIP), Medical Assistance, MinnesotaCare, and other programs to maximize federal funding, maintain enrollee coverage and provider participation, and to ensure public health and safety.

The other order issued on Friday was EO 20-10, which prohibits price gouging for essential goods and services including food, gasoline, medical supplies, health care goods like hand sanitizer, and other essentials.

It’s important to know that your emails made a difference! Special thanks to senate leaders – Abeler, Hayden, and Marty and house leaders – Schultz, Liebling, Kiel, Albright, and Schomacker. We now have bipartisan support for this action in both the House and Senate.

More needs to be done at Federal Level on COVID-19 Response

As the Senate prepares the third in a series of COVID-19-related relief bills, please urge Senator Klobuchar and Senator Smith to ensure people affected by mental illness can maintain their treatment, get health and mental health coverage, access needed support, and lift up the nonprofits they depend on, like NAMI.

We need you to ask your U.S. Senators to do 4 things:

1. Remove barriers to mental health treatment. People need ways to manage existing mental health conditions and maintain mental wellness while reducing their exposure to the coronavirus. To do this, Congress should:

  • Eliminate all barriers to widely implementing telehealth in all public and private health plans and encourage all health plans to provide extended supplies and/or mail order refills of prescriptions. Both actions will help people with mental illness avoid the risk of exposure to COVID-19.
  • Approve funding for Emergency Response Grants at the Substance Abuse and Mental Health Services Administration (SAMHSA) to assist states in continuing to provide treatment for people with mental health conditions and substance use disorders.

2. Promote coverage for health and mental health care. People with mental health conditions are often uninsured or face barriers to getting needed treatment and support. These challenges are even greater during a crisis. To address this, Congress should:

  • Immediately launch a special enrollment period for commercial health insurance in the Marketplace (HealthCare.gov) to make sure people have access to affordable, quality healthcare coverage.
  • Require the use of “presumptive eligibility,” which allows certain providers like hospitals and clinics to enroll people in Medicaid that they believe meet eligibility criteria.
  • Ensure free COVID-19 testing and treatment for everyone, including people who are uninsured.

3. Ensure safe housing for people with severe mental illness. Many people with severe mental illness experience homelessness or housing insecurity and are uniquely vulnerable to being exposed to the virus and outbreaks in shelters or encampments. With the loss of steady income, many more individuals are also at risk of losing housing. Congress must act by:

  • Providing $5 billion to serve people who are homeless and help them stay safe and healthy during this emergency.
  • Approving an additional $5 billion to provide rapid rehousing for people who are at immediate risk of becoming homeless and funding for rental assistance to help low-income renters weather this crisis.
  • Putting a temporary stop on evictions to ensure that renters and homeowners maintain stable housing during this crisis.

4. Support nonprofits’ capacity to serve. The economic impact of this crisis will also touch charitable organizations like NAMI organizations and our partners. Nonprofits need support to meet greater demand and fill important gaps during this time. To assist, Congress should:

  • Provide targeted assistance to 501(c)3 organizations to help them keep their doors open during this crisis and offer paid leave to their employees.

Senator Klobuchar and Senator Smith need to hear from you TODAY. Please contact them now to ensure people with mental illness are helped in their response to COVID-19.

News from the State Level

COVID-19 Update

NAMI Minnesota is working very hard to ensure that our members and supporters have access to the most up-to-date information about COVID-19 and the resources that are available. All this information is available at NAMI Minnesota’s website. Please also note that our support groups have been moved online and many classes are being scheduled online as well.

Special Open Enrollment Period for MNsure

In response to the COVID-19 pandemic, MNsure has opened a special enrollment period to obtain health insurance on the private marketplace. Starting on March 23rd, any Minnesotan can apply for health insurance on MNsure for coverage starting on April 1, with a deadline of April 21st to get coverage under this special enrollment period. Here is the broad eligibility criteria:

  • This special enrollment period is for eligible Minnesotans who do not have current health insurance. 
  • You do not need to be sick to qualify.
  • If you are currently enrolled in a plan through MNsure, you cannot use this special enrollment period to change plans.

To learn more about this opportunity, all you have to do is go to MNsure’s website.

Governor Walz Signs Executive Order on Elective Surgeries

Governor Walz signed another executive order in response to the COVID-19 pandemic, requiring health-care providers to postpone elective surgeries, including elective dental procedures. This will reduce the strain on Minnesota’s health care system will experience and is in alignment with recommendations from the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS). The executive order defines a non-essential or elective surgery as a procedure that can be delayed without undue risk of the current or future health of the patient. Potential criteria to consider when determining if a procedure is elective can include:

  • Threat to the patient’s life if the surgery or procedure is not performed
  • The threat of permanent dysfunction of an extremity or organ system, including teeth or jaws
  • Risk of metastasis or progression of staging

You can read the full executive order here.

News from Federal Level

Federal Action on COVID-19 Outbreak

This week, Congress and President Trump were able to reach a compromise and pass H.R. 6201. While we can expect the passage of additional legislation in the near-term, this marks the first spending bill made in response to the COVID-19 pandemic. This legislation includes a number of funding increases and short-term policy waivers that will help people access the supports they need during the pandemic. Here are the key changes that NAMI members should be aware of:

Food and Nutrition:

  • $500 million to provide nutritious food to low-income pregnant women or mothers with young children who lose their jobs due to COVID-19
  • $400 million to meet the increased demand at local food banks, with $100 million set aside to support the storage and transportation of food.
  • Allows the Department of Agriculture to approve state plans to provide emergency food stamps to children who qualify for free or reduced lunch when the child’s school has been closed for at least 5 consecutive days.
  • $100 million for food assistance to U.S. territories.
  • $250 million for a senior nutrition program to provide 25 million additional home-delivered and pre-packaged meals to low-income seniors who are homebound, have disabilities, have multiple chronic illnesses, or are caregivers for seniors who are homebound.
  • Work and work training requirements are suspended for low-income jobless workers on food stamps.
  • Allows states to request a waiver in order to have additional flexibility with food stamp benefits.

Emergency Paid leave

  • In order to be eligible, the person must have been employed for 30 or more days before they were impacted by COVID-19, work for an employer with fewer than 500 employees, and meet one of these criteria
    • Worker has a COVID-19 Diagnosis
    • Worker is quarantined on the recommendation of health care provider, employer, or government official to prevent the spread of COVID-19
    • Worker is caring for someone with COVID-19 or under quarantine
    • Worker is caring for a child or another individual who is unable to care for themselves due to the COVID-19 related closure of a school, child-care facility, or other care programs.
  • This benefit will be available for up to three months when the employee had to take more than 14 days of leave from their work in response to COVID-19.
  • The benefit will amount to two-thirds of an individual’s average monthly earnings up to $4,000 and must be offset by any state or private paid-leave benefit the individual receives.
  • SSI benefits do not count as income or resources for the purposes of this program.

Unemployment Benefits

  • $1 billion for emergency grants to the states related to processing and paying unemployment insurance benefits.
  • For states that experience an increase of 10% or more in its unemployment rate, the federal government will pay for 100% of the costs for extended benefits, which normally requires 50% funding from the states.

Paid Sick Leave

  • All employers with fewer than 500 employees must allow workers to gradually accrue seven days of paid sick leave, as well as offer 14 days of sick leave immediately following a public health emergency.
  • Paid sick days cover staying home when a child’s school is closed due to a public health emergency, when the employer is closed due to a public health emergency, or if you or a family member is quarantined or isolated due to a public health emergency.
  • The federal government will reimburse small businesses with 50 or fewer employees for the costs of providing the additional 14 days of sick leave.

Health Insurance

  • Requires private health plans and Public Health Plans to cover COVID-19 testing without any cost-sharing by the enrollee.
  • The federal government will pick up costs related to COVID-19 testing for people without health insurance.

National Council Breakdown of CMS Actions on COVID-19

CONDUCTING TELEMEDICINE VISITS

CMS has clarified and provided more flexibility for states to respond to the coronavirus. The allowances outlined below will remain effective for the duration of the COVID-19 public health emergency.

Medicaid Telehealth

  • CMS made clear to states that they already have the flexibility to utilize telehealth services, including audio-only services, in their Medicaid programs. States can cover telehealth using various methods of communication such as telephonic, and video technology commonly available on smartphones and other devices. No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.
  • Note: States themselves, not CMS, are responsible for making these options, including audio-only telephonic services, available to providers.

Telehealth and Prescriptions of Controlled Substances: The DEA has announced that for the duration of the public health emergency, registered practitioners may issue prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation, providing the following conditions are met:

  • The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice
  • Telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system.
  • The practitioner is acting in accordance with applicable Federal and State law.

This temporary relief of the Ryan Haight Act has been a long-term advocacy goal of the National Council and its members. We thank all members who worked to build this case with DEA over the years to make this emergency declaration possible.

Medicare Telehealth

  • Retroactive to March 6, Medicare will temporarily pay clinicians to provide telehealth services for beneficiaries across the country. Previously, Medicare only covered particular services in specific situations, such as if an enrollee lived in a rural area and was unable to receive in-person services within a reasonable distance. A range of providers, including clinical psychologists and licensed clinical social workers, will be able to offer Medicare-covered telehealth services to enrollees based in any health care facility, including physicians’ offices, nursing homes, as well as from enrollees’ homes.
  • Additionally, the Families First Act corrects language included in Congress’s first COVID-19 response package to clarify that, for the purposes of establishing a relationship with a provider to waive current prohibitions surrounding telehealth services in Medicare, any services allowable under Medicare will qualify as an existing relationship, even if Medicare was not the program paying for the service.

Telehealth Best Practices

The National Council has compiled a reference document that includes details on these changes and more, titled “Best Practices for Telehealth During COVID-19 Public Health Emergency.” This document is intended to provide mental health and substance use treatment providers with the background and resources necessary to help begin or expand the use of telehealth.

TELEHEALTH AND PRIVACY: HIPAA & 42 CFR PART 2

HIPAA: The Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) announced that it will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communications technologies during the COVID-19 public health emergency. This applies to widely available communication apps such as FaceTime or Skype when used in good faith for any telehealth treatment or diagnostic purpose, regardless of whether the telehealth service is directly related to COVID-19.

42 CFR Part 2: SAMHSA issued guidance related to the sharing of substance use disorder health records throughout the public health emergency. SAMHSA makes clear in the guidance, information disclosed to the medical personnel who are treating such a medical emergency may be re-disclosed by such personnel for treatment purposes as needed. SAMHSA notes that Part 2 requires programs to document certain information in their records after a disclosure is made pursuant to the medical emergency exception. SAMHSA emphasizes that, under the medical emergency exception, providers make their own determinations whether a bona fide medical emergency exists for purpose of providing needed treatment to patients.

INCREASED HEALTH FUNDING 

  • Federal Medicaid Funds: The federal government’s share of Medicaid payments, known as the Federal Medical Assistance Percentage (FMAP), has been increased by 6.2 percentage points. This increased assistance comes with the requirement that state Medicaid programs cover COVID-19-related treatment, vaccines, and therapeutics at no cost to enrollees as well as states not making eligibility standards more restrictive or increasing any cost sharing for enrollees.
  • More Funding for CDC & NIH: The Trump Administration is updating its Fiscal Year 2021 Budget Request to include a request for an additional $45.8 billion and the necessary authorities for the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to address ongoing preparedness and response efforts.

Mental health, addiction treatment important amid crisis

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It’s no surprise that people are feeling anxious right now.

Workers are worrying about how they’ll pay the rent as hours are cut back. Young parents are trying to do their jobs remotely while watching their children who are home from school. Older people are weighing the health risks of making a quick run to the grocery store.

Most people’s lives have been turned upside down by the coronavirus.

As Congress takes action to keep our economy strong and our people healthy, we can’t forget those who far too often have been left behind – people who are living with mental illness and those struggling with addiction.

It’s estimated that 1 in 5 people in our country are living with mental illness or substance use disorders. Sadly, people with mental illness and people with substance use disorders may fail to get the treatment they need in a typical year. And as we know, this year is anything but typical.

We know that people who misuse opioids are at high risk for coronavirus. According to the National Institute on Drug Abuse and other health experts, opioids impact the respiratory and pulmonary health of users and make them more susceptible to respiratory infections, including coronavirus.

People who are living with a mental illness or addiction often have other health conditions that make them more likely to suffer severe complications from the coronavirus.

Responding to the coronavirus pandemic requires a comprehensive health care strategy, including increasing access to community mental health and addiction treatment services. And the best way we can do that is to include the expansion of Certified Community Behavioral Health Clinics in the next emergency package passed by Congress.

Six years ago, we worked together to pass our Excellence in Mental Health and Addiction Treatment Act. It created quality standards of care and funding to open community clinics that are transforming mental health and addiction treatment.

After only two years of operations, communities that have CCBHCs are providing life-saving services. They work closely with law enforcement and our schools and coordinate with hospitals to dramatically reduce emergency room visits.

According to the Department of Health and Human Services, they’ve led to a 60% decrease in time spent in jails, a 41% decrease in homelessness and a 63% decrease in emergency department visits for behavioral health. That’s a big deal when every hospital bed matters right now.

CCBHCs also are well-positioned to support those struggling to cope with the stress of coronavirus, whether it’s anxiety, depression, loneliness brought on by social isolation or even trauma faced by front-line health care workers. And many CCBHCs provide telemedicine services, allowing people to access help without increasing their potential exposure to the virus.

As our nation confronts COVID-19, we must not leave those with mental illness and addiction disorders behind. And the good news is, by working together, we can make sure that doesn’t happen.

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Coronavirus Florida: How mental health providers are responding

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How mental health providers are responding

Centerstone, Mental Health Community Centers, and others respond to help prevent the spread of coronavirus in Sarasota-Manatee.

SARASOTA — Canceled group meetings and therapy consultations over the phone. This is how mental health providers are adapting services in light of the novel coronavirus.

“Now is a time where people are so stressed out, they need calm, they need support and we are trying to deliver that no matter what,” said Melissa Larkin-Skinner, Centerstone Florida’s regional chief executive officer.

Centerstone has implemented system-wide strategies that reduce the risk of COVID-19 exposure while preparing to respond effectively as threat levels escalate.

Centerstone Hospital and Addictions Center is fully operational and continuing to serve clients, Larkin-Skinner said.

The walk-in center in Bradenton remains open and has extended its hours. Centerstone’s other programs continue to remain operational, and it is increasing care via video/telephone to reduce risk of exposure.

Centerstone is screening people who come to the hospital campus and clinics and is asking questions about recent health and travel history. This screening includes taking temperatures using an infrared thermometer.

Those screenings are also conducted during client phone intake interviews. Centerstone has stopped participation in offsite meetings and instead offers video or phone options.

Centerstone has also stopped volunteer participation and is checking the temperature of its staff, including cleaning crews, before each shift.

They have also increased cleaning procedures and have posted additional information regarding hand washing and virus symptoms.

To help prevent the spread of coronavirus, visitors are no longer allowed at Sarasota Memorial Hospital, the Bayside Center for Behavioral Health and other facilities.

Coastal Behavioral Health Centers could not be reached for comment. However, they have announced a number of event cancellations.

At Mental Health Community Centers’ three locations, most of its staff is working from home, making phone calls or sending emails to clients. Volunteers are asked to stay home

Support groups and other activities have been suspended this week and most likely will be next week. The Wellness Centers still provide grab-and-go meals and some one-on-one crisis intervention.

“Most people get a lot of stability in our day-to-day activities because it provides a dependable order to their day,” said Arin Norris, executive director of the Mental Health Community Centers. “That’s the piece that we don’t feel like we can safely provide right now.”

The Academy at Glengary has canceled all of its classes and group activities.

Through myriad culinary, hospitality, technology, and other programs, the Academy helps its members build friendships and employment.

Closing its doors is especially hard on a nonprofit whose mission is building a social network for people diagnosed with mental health disorders, said William McKeever, it’s executive director.

“It was a hard decision,” said McKeever. “One of the major challenges with mental health is social isolation.”

One consolation is that members now communicate regularly on the messaging service Slack. Staff is also routinely on the phone to check in on members.

“The main thing is that we’re trying to maintain daily contact to reduce that sense of isolation that they’re going to feel during this time,” McKeever said.

“It’s not the perfect solution, but the message we want to send is that we care about each other and we are in this together to get through this,” he said.

Most services at Forty Carrots closed alongside Sarasota County Schools and will not reopen until April 15. While preschool programming, parenting, and other education classes are canceled, individual therapy will resume over the phone.

“Everyone is shell-shocked at this point,” said Michelle Kapreilian, CEO at Forty Carrots.

Program directors are working on new strategies to get information about the coronavirus out to families, she said.

Colleen Thayer, executive director of the National Alliance on Mental Illness of Sarasota County, said that family support groups last week were canceled in North Port and Venice. The family-to-family class has also been postponed until the fall.

NAMI Sarasota County has begun circulating a coronavirus guide to answer frequently asked questions regarding the intersection between COVID-19 and people with mental illness, including how to find emotional support. You can find that guide at NAMI.org.

People unsure about attending therapy sessions outside the home, especially those whom the CDC has described as being at higher risk, can ask their healthcare provider about teletherapy or mental health services online.

Anyone worried about access to prescribed medications can ask their healthcare provider about getting 90-day supplies vs. a 60- or 30-day supply. If this is not possible, physicians are encouraging you to refill your medications as soon as they are allowed.

The CDC also has a webpage with information on dealing with fear, anxiety and stress brought on by the coronavirus pandemic.

The National Institute of Mental Illnesses recommends developing a plan for telehealth sessions with your provider if you (or your provider) are quarantined. It also recommends reaching out virtually to friends and family for support.

Help! Being in Quarantine is Creating Conflict

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COVID19 has changed the way we do business, how we finish out the school year, and how we engage with others. Unfortunately, changes in routines can also create conflict. The anxiety and uncertainties only compound to a sense of “new normal” many of us are figuring out as we find ourselves sharing a space, while practicing social distancing.

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How to Respond to Self Harm

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Have you ever looked at someone and noticed a series of scars on their wrists? Did you make a face or pass judgement about that person without knowing who they are or what they’re going through? Likely.

Of the many symptoms of mental health conditions, self-harm is one of the least understood and least sympathized. It’s also one of the few physically visible symptoms. Therefore, it’s often responded to in a way that’s derogatory and potentially harmful. For example:

“That’s just teenage angst.”

“Why would anyone do that to themselves?”

“You’re just trying to get attention.”

These reactions grossly undermine how serious self-harm is. Self-Harm is usually a sign that a person is struggling emotionally and isn’t sure how to cope. It’s a sign that a person needs support, understanding and professional help. Most importantly, it’s a sign that shouldn’t be ignored or judged.

Your Initial Response

It can be shocking to notice a person’s self-harm scars. Your instinct may be to stare or immediately express shock. But self-harm is a sensitive topic that should be approached in a certain way.

Whether you know the person or not, it is essential not to display shock or horror even if that’s how you feel. Don’t say anything that could shame them or make them feel judged or foolish. You don’t want to draw attention to their scars, especially in public.

If the person is a close friend or family member, don’t ignore what you’ve seen. Wait until you are with them in private, and then talk to them about what you noticed.

Having A Meaningful Conversation

The most important part of talking to someone about self-harm is to frame the conversation in a supportive and empathetic way. Show concern for their well-being and be persistent if they don’t open up right away. When having a conversation about self-harm, consider the following do’s and don’ts:

Do:

  • Show compassion
  • Respect what the person is telling you, even if you don’t understand it
  • Stay emotionally neutral
  • Listen, even if it makes you uncomfortable
  • Encourage them to use their voice, rather than their body as a means of self-expression
  • Encourage them to seek mental health care

Don’t:

  • Pity them
  • Joke about it
  • Guilt them about how their actions affect others
  • Give ultimatums
  • Remind them how it looks or what people will think
  • Make assumptions

Continuing Support

After that first conversation, it’s important to follow-up with your loved one to show your ongoing support. If they have not sought out care, continue to ask about it and offer to help them find a mental health professional.

You can also offer to help identify their self-harm triggers. You can do this by asking questions like: “What were you doing beforehand?” “Was there anything that upset you or stressed you out that day?” If a person is more aware of their triggers, it could help prevent future self-injury. Assisting your loved one find and practice healthier coping mechanisms is also a great way to help.

Self-harm is a serious issue that should be addressed as soon as you find out it’s happening. Keep in mind that one of the best things you can instill in a person who is self-harming is that you are there for them and that you care about them. You can always be helpful to someone even if you don’t understand what they’re going through.

 

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Unconventional Grieving: Grieving someone Alive

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Grieving someone alive is not a conventional form of grief that is often talked about, but is a real issue that is faced by the living. Death is often viewed as the base requirement for grief but mourning the deceased is only one facet of death. If you have never experienced this, you likely do not understand what we’re talking about. How can you grieve for someone that you haven’t lost? If you have experience this sort of grief, you probably are cheering inside your head that someone has finally put to words what you’re feeling.

Grieving for someone alive, is not the same as anticipatory grief. Anticipatory grief is the type of grief that comes about when you know that you will soon be experiencing a loss, such as when a loved one is dying or in the hospital. If you are experiencing anticipatory grief or looking for resources on it, please visit the following link: http://www.whatsyourgrief.com/anticipatory-grief/.

WHY UNCONVENTIONAL GRIEF HAPPENS

If you’re not familiar with this form of grief, you may be unsure how this is possible or what often triggers this form of grief in people. Often, this form of grief is caused by a loved one becoming someone that you no longer know or recognize.

COMMON CAUSES OF UNCONVENTIONAL GRIEF

• Mental Illness
• Drug or Substance Addiction
• Dementia or Alzheimer’s
• Brain Injury
• Family Trauma

The unfortunate truth of grieving someone alive is that they are still there as the person you once knew but psychologically are a different person than they were before. Also, many of these factors are outside of the control of the person experiencing them or the person who is watching their loved one suffer. It can be hard for either party to recognize because the person does not always look like they are sick.

Don’t look at these causes and think that they mean that you love this person any less though. This form of grief, just like grieving someone who is deceased, does not change the level of attachment to the person. Simply, this person is no longer acting how they were before and have had a dramatic shift in personality. If your brother is suffering from a drug addiction, his behavior may become erratic and he might start stealing from yourself or other family members. Some will grieve the life that he is not living as he focuses living for his addiction. If someone is dealing with a mental illness, they may now be dealing with depression so badly that they are unable to go on living their life or they may be experiencing delusions or hallucinations.

A person will experience many emotions while grieving someone alive. These emotions may be more powerful and more confusing than the grieving process for someone who has recently passed. Anger is a prominent emotion that shows up. The grieving individual could feel anger towards their loved one for the issues they are dealing with and have a hard time understanding that they may not be able to change, such as in the case of mental illness. While experiencing anger, you may feel guilty as well that you are experiencing anger or guilty that you cannot control or change the situation.

Unlike when someone dies, you are unlikely to experience positive emotions while grieving someone alive. When someone passes, you are surrounded by the comfort of their loved ones and are often able to look at the joy of their life. This rarely happens with unconventional or ambiguous grief. Just like when someone dies, you are likely to be overcome with sadness. However, the reminder of your sadness is constant every time you think of this person or hear about them.

How to Grieve Someone Alive

• Let yourself grieve. Don’t attempt to hide or suppress your grief for this situation just because society or your loved ones don’t understand or acknowledge what you’re going through. Be open to sharing how your feeling to close family and friends and don’t push yourself to be someone you’re not at this time.
• Find other people in the same situation. Connecting with other people who are experiencing the same kind of personal loss as you is an invaluable resource. This can come in the form of a support group or finding an individual to speak with. Having someone understand what it is like to be grieving someone  alive will help to put your situation in perspective and help you to gain insight on the validity of your feelings.
• Don’t forget your memories or the past. When you are experiencing ambiguous or unconventional grief, it is easy to forget why and how you previously loved someone in the midst of their hurtful behavior. Remind yourself of the good times that you had and why you originally loved them. It is okay to cherish old moments and mourn that they are gone. Remember that that person is still here though, just not at the moment.
• Open yourself up to change. One of the hardest parts of grieving someone alive is that you are forced to accept a changed relationship that you do not want. It may be difficult for you to look on a loved one in a different life, but you may be able to experience a rewarding relationship with them in new ways than before. Focusing on finding joy in your new relationship will help keep your mental state positive rather than gloomy.
• Always remember that the illness is not the person. For many people, this is the hardest mental hurdle to overcome while grieving someone alive. Stop yourself from thinking of your loved one as the disease they’re dealing with, whether it be addiction, Alzheimer’s, or depression. You will still likely feel angry towards the person but understanding what they’re actually dealing with can help you process some of those feeling.

Unconventional Grief, Ambiguous Grief, or grieving someone alive are all very real and pertinent forms of grief that need to be treated, understood and addressed. Become a member of The American Academy of Bereavement today to find more resources on grief.

 

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March is Self Harm Awareness

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Anxiety Training Tips

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By: Bridget Eickhoff

Anxiety, worry, and panic are felt by many of us at some point in our lives. After attending a training by David Carbonell, Ph.D. on chronic anxiety, I picked up some helpful tools that I would like to share.

The more you oppose unwanted thoughts, feelings, and sensations the worse they can become

A big reason behind anxiety symptoms is self-protection. People often interpreted anxiety as a signal for danger, meaning fight, flight, or freeze; but what if that was a false signal. What if this feeling is intense discomfort that will eventually pass if it is not forced to be silence. Next time you are experiencing anxiety check-in with yourself and if you indeed are in danger or is this discomfort? If it turns out to be discomfort allow yourself 5-10 minutes to worry, you may be surprised how different it feels to allow the worry to have its time rather than continue to suppress it.

 

The Rule of Opposites

Think of yourself swimming and trying to avoid a large wave coming your way. You may ask yourself “what is the best way for me to avoid this wave?” Your instincts may say to swim away from the wave and hope you can be faster, but in reality the easiest way to avoid the wave is to swim under it. The same can apply to feelings of anxiety and worry. During a panic attack your gut may tell you to hold your breath or take in more breaths at a time, when what is shown to help is taking deep belly breaths. Next time you find yourself beginning to feel anxiety or panic, try to recognize how your gut tells you to react and think about what the opposite might be.

 

The next time you are experiencing high anxiety or a panic attack be AWARE

Acknowledge and accept the feelings

Wait and Watch – recognize what the sensations in your body and your thoughts (this could be a good time to try doing the opposite of your usual)

Action – make yourself comfortable while waiting for it too pass

Repeat – go through steps a-c and try to think to yourself it will end no matter what I do

End of intense anxiety or panic attack

 

Our therapists at CARE Counseling are trained and competent in working with those experiencing symptoms of anxiety. Your counselor will be able to help explore with you common patterns of negative thinking, help you develop successful coping skills, and teach calming strategies.

 

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For more helpful information on anxiety click here

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