How to Stop Temporarily Becoming Pro-suicide Prevention

The heartfelt and emotional post you wrote about Anthony Bourdain?

I URGE you to:

Write a message like that about your friend who suffers from depression or another mental illness and send it to them.

Send a message like that to the person who posts on Facebook about how depressed they are. Especially if the post is concerning.

Call up someone you know who has history of suicide and tell them how you feel about them.

Text, Snapchat, hang out, grab a coffee, Skype, reach out in any way to friends you know struggle.

Heck, say it to *anyone* you feel that way to!

If people who die by suicide had heard heartfelt, supportive messages like that *before* they died, I wonder what a difference that would make.

We need to stop becoming temporarily pro-suicide prevention right after a famous person dies by suicide and elongate its impact by providing more kind words and support to each other. Loving someone from afar is not what prevents suicide: SUPPORT does.

#mentalhealthmatters #suicideprevention

Relapse is Part of Recovery, TEDx talk is out!

“Relapses are opportunities for growth, not something to be ashamed.”

“We all need to be supportive of the people who relapse, because we all relapse.”

“STIGMA SMASH!”

Just some quotes from my new TEDx talk, which is about how the lowest points in our lives bring us insight and are NOT something to be ashamed of. I talked about my mental health history but expand challenges to apply to anyone and everyone – we are all in the same boat, which means we ALL need to support each other. Check it out!

Please share, like, comment!

 

Announcement!

Hi everyone! Hope that you are well! I have some great news…I will be giving a TEDx talk in New Jersey on April 7, 2018! My talk is called “Relapse is Part of Recovery.” I’m interviewing 100 people to really flesh out my talk, and here is a summary:

“Relapse is part of recovery” is a term frequently used in the addiction world to encourage people to continue if they lose their sobriety. But relapses (which I define as “rock bottoms”) happen outside of addiction and mental illness: there are relapses in careers, relationships, societies, identities, etc.

When people relapse, they are often faced with shame, disappointment, and see it as a failure. But what I’m finding is that frequently, as a result of a relapse, we gain some sort of insight that changes our lives for the better.

My talk argues that we need to rethink our views of relapse and how we handle relapses. We need to recognize that they are frequently an opportunity for growth. When someone relapses, we need to be supportive, encouraging, and hopeful. And that, my friends, will lead to “A Better Future” (the theme of the TEDx I am part of).

I am documenting my whole journey of building this TEDx talk on instagram: @hufsathegreat. I can’t tell you how many people are coming together to help me with this talk: allowing me to interview them, sending me pictures…I even have local actors who are going to help me film a scene for my talk. Wow!

Stay tuned! I’ll be posting about some of the stories I have been hearing!

Why Saying Donald Trump Has Narcissistic Personality Disorder (NPD) is Unnecessary, Unethical, and Harmful to People with Mental Health Conditions

All over the Internet, you see articles along the lines of “Therapists agree that Donald Trump has Narcissistic Personality Disorder (NPD),” or “A Neuroscientist Explains…” or therapists saying they will be using clips of Donald Trump in their classes.

This needs to stop!

First, I need to preface this by saying this is not an argument whether Trump has NPD or not. It is an argument that we should not even be discussing his diagnosis, because:

1. Donald Trump should not be President because of his words, actions, and views. That is absolutely enough reason to be against him. We do not need to diagnose him with something to create a new reason why we should not vote for him. (There is undoubtedly enough solid evidence already!)

(Really, you could stop reading here. That’s my biggest point, and it doesn’t need any further explanation. But if you’re interested, there are a few other reasons.)

2. Associating Donald Trump with NPD means that people with NPD will be associated with Donald Trump. (I certainly wouldn’t wish that upon anyone.) It is increasing the stigma of not just NPD, but also other mental health conditions. And why should one stop at NPD? I fear that this argument would be extended to other mental health conditions and other important positions. For example:
“We can’t elect Senator Patrick Kennedy to be a President because he has bipolar disorder, and his mood swings would destroy our international relations.”

3. Diagnosing someone who is not your patient and sharing their diagnosis without their consent is unethical, as stated in the code of ethics for psychiatrists, psychologists, and therapists. In order to diagnose, you must be trained on and fully knowledgeable of the DSM. Psychiatrists, psychologists, and therapists typically take AT LEAST one full hour to assess a new patient’s mental health history in order to properly diagnose them.

The American Psychiatric Association states “When a personal examination has not been performed and when a psychiatrist is asked for a professional opinion about a person in light of public attention, a general discussion of relevant psychiatric topics — rather than offering opinions about that specific person — is the best means of facilitating public education” (https://www.psychiatry.org/psychiatrists/practice/ethics). The American Association for Marriage and Family Therapists warn against the impact of public statements (https://www.aamft.org/iMIS15/AAMFT/Content/legal_ethics/code_of_ethics.aspx), and the American Psychological Association states “psychologists provide opinions of the psychological characteristics of individuals only after they have conducted an examination of the individuals adequate to support their statements or conclusions” (Section 9.01, http://www.apa.org/ethics/code/index.aspx).

4. This is something often forgotten by nearly all, including numerous clinicians: people diagnosed with personality disorders are, first and foremost, people—people who have treatable illnesses. Not everyone with a PD or mental illness is the same and not everyone with NPD is a “horrible person.”
Burnt out or old school clinicians and medical professionals have told me that people with PDs are “too hard to deal with.” Some have even gone so far to say that they are “untreatable.” But there is hope. I’ve seen people with PDs move on to graduate from the clinics where I worked, gain meaningful roles and activities, and have strong relationships.

5. Yes, I have in fact worked very closely with many people with NPD and other PDs as a case manager at an intensive outpatient mental health clinic and other jobs in mental health. It can be very hard, but they are not evil people. Just because someone has a diagnosis does not mean they are a bad person!

Note: There is typically a distinction between mental illness and personality disorders. However, I’m considering both them under the umbrella of “mental health conditions,” because the general public does not know the difference, as well as similarity of symptoms, comorbidity, and the need to be knowledgeable of both to make a diagnosis.

So please, world, start saying that Donald Trump should not be President because of who and what he is—and then stop before bringing mental health into this. You have more than enough evidence already.

What is a Peer Mentor in the Mental Health Field?

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

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

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!

An anecdote on Schizophrenia from Ajahn Brahm, a Buddhist monk

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 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.