What is a Peer Mentor in the Mental Health Field?

2 Comments

Note: I will use the term “client” to refer to someone with a mental health diagnosis receiving mental health services.

I have served as a Peer Mentor in the mental health field for many years, and I currently am a Lead Peer Mentor at the adult peer mentoring program which I work for. The role of a peer mentor is invaluable for several reasons, but the thing is, not many people know about peer mentors, and for those who do, there is a large misunderstanding of what peer mentors do and what they are capable of.

First and foremost, peer mentors have lived experience with mental health (which means experience with mental health issues either personally or through a family member). This means we have walked in the shoes of the client, and know what it is like to have a mental illness on a deep level – and it is because of this experience that peer mentors can connect with clients in a way that other professionals cannot.

One of the best ways to understand Peer Mentoring is through this analogy about a client who is stuck in a hole (I cannot remember where I heard this, so I apologize for not citing). The clinician will throw a ladder to the client to help them get out, but the peer mentor will go and sit with the client in the hole until the client is ready to leave. The peer mentor meets the client where they are, empathizes with the client, and demonstrates to the client that there is hope for being in recovery – things that other mental health professionals (clinicians and doctors) cannot do in the same way. Peer mentors do this by skillfully sharing their lived experience (personal or family experience with mental health issues) with the client and serving as examples of recovery.

Note: There are other job titles equivalent to Peer Mentors, including: Peer Specialist, Peer Support Specialist, Peer Paraprofessional, Peer Professional, Recovery Partner, and perhaps more. Regardless of the title, the role is essentially the same, and I will just use the term “Peer Mentor.”

Peer mentors have a wide variety of diagnoses, severity of mental health issues, and many different ways they cope with their issues, which does not necessarily mean they are on medication or go to therapy. In addition to having experience, peer mentors are at an advanced stage of recovery. What this means they can manage their mental health issues, whether or not they still experience symptoms, and be able to function in society by volunteering or holding a job. They have a treatment and/or life regimen that allows them to cope successfully with their mental health issues, so that they can serve as examples of recovery.

While there is often a restriction on sharing personal experiences as a clinician and especially as a doctor (some clinicians are more comfortable with self-disclosure, though I couldn’t quantify it), peer mentors are encouraged to skillfully share their experiences, when appropriate and helpful, to show that recovery is possible and that there is hope.

I do want to emphasize that Peer Mentors are not “recovered,” however. At times Peer Mentors, especially those with a chronic diagnosis, may experience heightened symptoms due to a variety of factors. Recovery is not static, and things do happen, but a recovery-oriented, supportive environment will help Peer Mentors get back on their feet.

How to Find a Good Therapist in 6 Steps

Leave a comment

1. First, find out what type of professional you need.

Psychiatrists (MD): Psychiatrists give you medications for your symptoms. This is the only type of doctor that can give you psychiatric medication, as well as your Primary Care Physician.
Psychologists (PhD, PsyD): These are therapists that help you work through your mental health issues that have doctorate degrees.
Therapists (LMFT, LCSW): LMFT is a Licensed Marriage and Family Therapist, and LCSW is Licensed Clinical Social Worker. These are also therapists that help you work through your problems. They have Master’s Degrees – which doesn’t necessarily mean that they are worse than psychologists. (FYI. LCSW’s are trained social workers too.)

2. If you have insurance, call your insurance or go to their website to see if you can find a list of professionals by specialty.

3. If there is a list, you can go through each name and search them on Google for reviews. Note: Reviews can be (and often are) pretty unreliable, but if you find someone who has only negative reviews, that might be a sign not to go for them. There could be good information about the style of a therapist.

If there isn’t a list, you may have to go to a low-cost clinic for help – this is likely if you have governmental insurance. Call your local NAMI (find yours through www.nami.org) to see if they have a list of free or low-cost clinics who provide therapy. Note: You’re likely to get interns who are trying to get their hours to get licensed (e.g. MFT interns) who are being supervised by a licensed professional – so the quality of therapy can vary.

4. For private therapists, you can ask for a free consultation, which would typically be around 10-15 minutes. This can be done in person or on the phone, depending on the therapist. This is so you get a feel for whether that therapist is right for you.

5. Remember, it can be hard to find a good therapist for you. If you encounter a bad one, I strongly encourage you not to give up and try another one. You can always ask therapists for referrals to other therapists – their feelings won’t be hurt because it happens all the time!

It’s also very easy to tell when therapy isn’t working. You either know within a few sessions, or sometimes, much sooner.

6. And never, never, never care about hurting your therapist’s feelings. If you don’t like how therapy is going, tell them. If they’re a good therapist, they’ll either try to change their therapy tactics in order to serve you better, or let you know if that’s not something they can do (so you can move on to someone else). Ideally, they would refer you to someone else. Communication is CRUCIAL – therapy should be a collaboration, not someone talking at you for 50 minutes.

Here is an excellent article on figuring out whether a therapist is good for you from US News.

If you have any questions, feel free to ask.

 

9 Ways to Help Your Loved One See They Have Mental Illness

Leave a comment

I’ve spoken to patients, family members, police officers, students, nurses, providers – mostly the former two groups. Of the family members, the most frequently asked questions are:

How do I get my loved one to accept they have a mental illness?
How do I get my loved one to take their medication?

I call them the Golden Questions, because I never know what to say.

Until now.

The two go hand-in-hand, but I’ll answer the first question as best I can, because I have helped people accept they have a mental illness in the program I work for. I’m not going to address the second question separately.

So, this is how I helped individuals with mental illness (we refer to them as “members” in this program) accept that they have a mental health condition – and that IT’S OKAY TO HAVE ONE. In the field, this is called “building insight (into one’s mental illness).”

I must note this is specific to my program – which is voluntary – that rehabilitates individuals with co-occurring mental health and substance abuse disorders coming from jail and prison. I use all of these at once.

1. Housing
In my program, all members MUST be housed, typically in a sober living home or board and care. This is to provide a stability that is required to advance in one’s recovery.

2. Injectable medications
Members are required to take medication if they want to participate in our program. They can decline medication, but then they can no longer be in our program.

Injectable medications are shots that are given typically 1-2 times per month. They take the place of daily pills, which has advantages in several ways. First, it reduces the issue of people forgetting to take their medication (or just plain not taking them). Second, it also reduces the stigma associated with taking medications every day – frequently a reminder of having a mental illness, which numerous people shun.

Third, it provides a more uniform dosage of medication into the body – thus, enhanced stability. (I can explain the difference between injectables and pills in another post.) This is frequently used for individuals experiencing psychosis. The medication will help reduce or eliminate their symptoms, which allows people to focus on other aspects of their recovery. A simplistic (but not unrealistic) example is that the injectable medication may eliminate voices saying, “Don’t take your medication.” Without that distraction, members can start to believe they have a mental illness or start working on things like therapy and coping skills.

3. Education
I lead a Symptom Management group which focuses on teaching members about the various mental illnesses. If I have a member who has poor insight, I add them to this group.

In this group, members are educated on all the symptoms that members of that group experience, e.g. depression, anxiety, hypomania, mania, and psychosis. The power of education is that it shows that mental illness is separate from one’s identity. It is an illness that someone has and can successfully maintain, just like diabetes. It teaches members to identify the symptoms within themselves, empowering them to self-monitor.

The member must be given educational materials as well. You can easily get them from the NAMI (National Alliance on Mental Illness) website or DBSA (Depression and Bipolar Support Alliance). This further emphasizes that mental health is something physical, tangible, and real.

4. Peer Support, Support Groups, and Sharing Experiences
It is crucial for the member to be around other individuals with mental illness, preferably the same or related mental illness. They need to know that they are not alone. I know hundreds of people with mental illness, and one thing I see constantly is that people with mental illness think they are the only ones going through their symptoms…which is certainly not a shock, because our society does not talk about it!

Whether it is in a support group setting, or just among members hanging out, the member needs to hear similar experiences to reduce the stigma they feel because of having mental illness. The mental illness must be normalized.

In my groups, I specifically talk about stigma and self-stigma. Actually calling it out helps members to discuss it, see it within themselves – and learn how to counter it.

5. Therapy
Members must have a professional to help them process how they are feeling about having a mental illness. They need someone to listen to them, to guide them to acceptance.

6. Someone by their Side
This is the role I always take on. I am there to help members vent, to remind them they are not alone, to help them separate their mental illness from their identities, and to share my experiences. Show them that their condition is not who they are. Inspire them.

7. Serious Stigma Smashing
Something that always reaches people are stories of recovery – especially from famous individuals with mental illness. People always flip when I say that Abraham Lincoln had depression (I like to say, “See, Abraham Lincoln freed slaves when he was depressed. You can still accomplish great things with a mental illness!”) and the countless other people who have mental illness.

8. Time
Members need time alone, too, to process what’s happening to them. For many, having and accepting mental illness is a paradigm shift, full of conflicting emotions and confusion. It took me six years to accept that I have a mental health condition – and that it’s okay to have one.

Also, whereas I tend to do all of these things in close proximity to each other time-wise, it may benefit your loved one to take a more step-wise approach to this. That is up to your discretion, though.

9. Hope, Encouragement, and Praise

Hope. I’m not just talking about the loved one having hope – I’m talking about you having hope, too. Both of you need to believe that the future will be better, that what they are going through is temporary, that they have the potential to be someone with a more meaningful life. If you don’t believe that your loved one will get better, how can they?
Encouragement is also important, including praising your loved one for all accomplishments, no matter how little, and especially noting changes and differences. Things like, “You struggled to get out of bed before, but you did it all by yourself today, and that shows you’re getting stronger.” “I’m really proud of you for doing __.” “You’re doing a really good job and I know things are going to get better.” “I know things are rough right now, but they won’t always be this way.” (Etc.)

I know this is a lot. This is the full package that I know has worked for members in my program, specifically, though I believe this can help many others, too. I hope that if you have loved ones who do not understand or deny their mental illness, any of these components will help them find recovery.

Anything I’ve forgot? Leave a comment and let’s talk about it!

The Danger of Using Labels to Describe Individuals with Mental Illness

1 Comment
Countless people use labeling terms like “the mentally ill” or “he’s a schizophrenic” without a second thought – especially among providers of mental health services. Few see the wrongs in that. But I’m here to tell to explain how imperative it is to avoid these terms, which are detrimental in the fight for equal treatment of individuals with mental health issues.
There is a distinct difference when you use a label versus a phrase that separates the person from the illness. I’ll begin with a generic example everyone uses:
“He doesn’t tell the truth. He lies.”
versus
“He is a liar.”
In the first phrase, we are describing his  actions. Actions that just about every person on earth commits.
In the second phrase, we are tying the action of lying to his personality and characteristics. Once labeled as a liar, you expect things associated with liars – all negative things, such as ill will and manipulation – from him. I’ll say this again. You expect the things associated with liars from him in his previous and future behaviors.
Another example is a something I strategically use to make myself look better during job interviews.
“I work hard”
versus
“I’m a hard worker.”
Which one is more appealing to the person interviewing me? The latter. Being a hard worker is my identity, and I convey this by labeling myself.
Given how much stigma (i.e. discrimination, prejudice) surrounds mental illness, equating people with their disorder ties them to their symptoms and the effects of their disorders. 
And what’s equated with those labels right now? Disabled, weak, incapable of working, incapable of taking care of herself, crazy, moody, unreasonable, lunatic, sick, ill, and more.
No one should have to needlessly carry the burdens of stereotypes, especially while struggling with the challenges mental illness provides. We are people too. We deserve to be seen as individuals with an illness – not be defined by our illnesses. 
Please, please, please do not fall prey to labeling. 
Now, I must recognize that when writing, it becomes easier to use one word, rather than several words, to describe a group of people, especially under the constraints of word counts. For example, news articles typically use “the mentally ill” and “schizophrenics” because they have a strict word limit. Certainly in my blog posts, it would be easier to use labels instead of saying “individual with mental illness.” However, given the stigma that is currently glued to the terms, I think it’s best if we avoid them. It’s a tricky subject though, I must admit. What do you think?

An anecdote on Schizophrenia from Ajahn Brahm, a Buddhist monk

Leave a comment

I told the above story at a conference on mental health a few years ago. One of the department heads at a prestigious mental health facility was very impressed. He invited me to “bless” his building.

“What form of mental illness are you involved in?” I asked.

“Schizophrenia,” he replied.

“And how do you treat the schizophrenia?” I enquired.

“Just like you explained in your presentation,” he responded. “I don’t treat the schizophrenia. I treat the other parts of the patients.”

I raised my hands up in the Buddhist gesture of respect to him. He had understood.

“What are the results?” I asked, even though I knew what the answer would be.

“Brilliant! Much better than any other treatment,” he answered.

When you call people schizophrenic, they are likely to live up to your label. You have stigmatized them. When you regard them as people who suffer episodes of schizophrenia, that they are more than their illness, then you give the healthy part a chance to grow.

Hope-Based Curriculum to Counter Suicide

1 Comment
“1 in 9 children attempted suicide before graduating from high school. 40% of those were in grade school.” (Source: Schools for Hope)

I had no idea this many children attempted suicide. I thought my 10-year-old attempt was an anomaly, which I wished beyond anything would not befall another person that young. Unfortunately, I was wrong – but at least this raises awareness of the problem.

Schools for Hope has curriculum designed to prevent suicides by increasing the power most opposite to it: hope. Yes, this curriculum teaches hope, with both a fall curriculum and a spring one.

The fall curriculum is as follows (click the picture to go to the curriculum explanation):

Lesson One Lesson Two
Lesson Three Lesson Four

Lesson Five

 I e-mailed the curriculum coordinators and hope that I can adapt this to the members I work with: individuals in the criminal justice system with mental illness and substance abuse disorders. The curriculum is geared towards children, but the simplistic design can be modified for all audiences, I believe. I’ll be keeping Schools for Hope informed on how it works for our members.

What do I do if I think a friend or family member has mental illness?

Leave a comment
I’ve had many people ask me: What should I do if I think my friend or family member has mental illness?

Mental illness is a touchy subject. There is a lot of stigma surrounding mental health conditions, as well as a great deal of misunderstanding. I think we are all afraid of bringing up something, in case we might anger or offend the person. But if you really are concerned, here is my suggestion for how to proceed.

Step 1: Know and Recognize the Signs
Drawing from the American Psychiatric Association, Everyday Health, and Mental Health America, here are common warning signs of mental illness in adults as concisely as I can put it:

•    Thoughts of suicide and death, or attempts (IMMEDIATE RED FLAG)**
•    Delusions or hallucinations
•    Differences in usual behavior or decline in functioning
•    Prolonged sadness, irritability
•    Excessive fears, worries and anxiety
•    Rapid or dramatic shifts in feelings or “mood swings.”
•    Increase in risky behavior, which is unusual for the person, such as spending extravagant amounts of money or becoming hypersexual
•    Substance abuse
•    Dramatic changes in sleeping, eating, and self-maintenance

Additional signs are (quoting the above sources directly):
•    Confused thinking
•    Feelings of extreme highs and lows
•    Social withdrawal
•    Strong feelings of anger
•    Growing inability to cope with daily problems and activities
•    Denial of obvious problems
•    Numerous unexplained physical ailments
•    Recent social withdrawal and loss of interest in others.
•    An unusual drop in functioning, especially at school or work, such as quitting sports, failing in school, or difficulty  performing familiar tasks
•    Problems with concentration, memory, or logical thought and speech that are hard to explain
•    Heightened sensitivity to sights, sounds, smells or touch; avoidance of over-stimulating situations
•    Loss of initiative or desire to participate in any activity; apathy
•    A vague feeling of being disconnected from oneself or one’s surroundings; a sense of unreality.
•    Unusual or exaggerated beliefs about personal powers to understand meanings or influence events; illogical or “magical” thinking typical of childhood in an adult.
•    Fear or suspiciousness of others or a strong nervous feeling.
•    Uncharacteristic, peculiar behavior.
•    Dramatic sleep and appetite changes or deterioration in personal hygiene.

Step 2: Look at the circumstances
•    Does mental illness run in the person’s family?
•    Does/Did this person abuse substances?
•    Did this person undergo any major life changes, such as going to college, starting a new job, experiencing the death of a loved one, or divorce?
•    Did this person undergo any traumatic event recently or in the past?
(Partially drawn from WebMD)

Step 3: Decide whether to bring it up to the person directly, or tell someone close to that person
First, don’t throw in the mental health card right away. I also encourage you to avoid the word “illness” during the conversation because it is so stigmatized. Talk to the person and bring up the signs you’ve noticed gently and gradually. Try to understand why they are behaving, thinking, or feeling the way they are.

Express that you are concerned and you want to help. Listen to them empathetically.

For example:

“Hi Hufsa. Are you alright? … I just wanted to let you know that I’m concerned about you because of a few things I’ve noticed. Is it alright if I point them out to you? … Well, I noticed that you haven’t been going to class lately and just stay in your room. This worries me because you don’t normally do that. I’ve also heard you cry in your room at night. Have you noticed these things?”

Step 4: Address the stigma and bring up the mental health issue
It’s a fact that people don’t understand mental illness and that mental health is as real as physical health. Bring up that you care about the person, and also relate it to a physical illness like the diabetes. Again, I don’t recommend saying the word “illness” because that is charged and stigmatized (at this time).

“Hufsa, I care about you, and I’m only telling you this because I want you to be better. If I noticed that you were eating a lot of sugar, getting dizzy, and having blurry vision, I would let you know that I think you have diabetes and encourage you to seek help. I’m doing the same thing right now by telling you I think you’re not well mentally and physically.”

Step 5: Let the person know they’re not alone and offer your help
It is important that the person knows that they are not alone. I cannot stress this enough. Let them know that there is help available and that you will (or have someone else) go with them to their first appointment. Help them make a call to their local NAMI for information and resources and where to seek help.  Give them information from the NAMI website on mental illness to educate them and normalize what they are going through.

“I know this might be a lot to take in. But I want you to know that you are not alone. I will be there to help you through this process of getting help if that’s what you want to do…here is information I found about mental health and there’s an organization called NAMI that can help you too. I can call them with you…”

Step 6: Follow up and help the person build a support system
Be sure to check in with the person after. Taking in the concept of having a mental health condition can be frightening, confusing, and overwhelming. It is frequently a long process and the person needs people by their side.

Again, these are just suggestions for what to do. I have consulted with several individuals with mental illness about how they would like to be approached by someone else about their illness, and this is what I’ve come up. By all means, if you have something to add, please do so in the comments!

** IF SOMEONE HAS VOICED SUICIDAL THOUGHTS, call 1 (800) 273-8255 with the person, the Suicide Lifeline IMMEDIATELY.**