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!

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!

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

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.**

How To Fight the Stigma of Mental Health: Part I

How can we fight against the stigma of mental illness – a surmounting task? I hope to do a multi-part segment on ways that one can combat the stigma of mental health conditions. The first point I will bring up is the power of analogies to physical illness.

I was a private math and science tutor for two years. Hands down, the best way to teach a student something they didn’t know was to put it in terms of what they already understood.

The vast majority of the world does not understand mental illness – including people who have mental illness themselves. But if you put it in terms of what people already know – physical illness – you will make greater strides in conveying the message that mental disorders are real disorders that affect the brain the same way other illnesses affect the heart, or lungs, or kidneys, etc.

I use this technique when I speak to various audiences, including the people I serve in the community mental health system. I explain that mental illness is a lifelong illness, just like physical illnesses. Mental health requires healing and self-monitoring, which can consist of medication and therapy. Is taking pills for diabetes something to be ashamed of? Is going to the hospital after having a heart attack different than going to the hospital for a mental breakdown? Is knowing the symptoms of your mental illness as necessary as knowing the symptoms of a physical health condition, even a stroke or heart attack?

When I put mental health in terms of physical health terminology and principles, people start to nod their heads, with an occasional “ahh” or “mm-hmm.”

To make strides towards eliminating stigma – to work hard to combat the stigma of mental health – let’s work together with these suggestions.

What is Stigma?

Before I move forward with this blog, it would be worthwhile to define what exactly stigma is.

Stigma literally means a mark of shame or discredit. In a wider sense, it means prejudice and discrimination towards a certain action or characteristic. There is a stigma attached towards obtaining welfare benefits, and there is the stigma I will be focusing on in this blog: the stigma towards mental illness.

Stigma in the mental health world can be manifested as:

Shame or humiliation about carrying mental illness, or knowing someone with one
Disbelief in or denial of mental illness;
False stereotypes, harsh judgment, even fear of mentally ill individuals;
Discouragement towards seeking professional help;
Discrimination in the employment process;
Mislabeling as crazy, psycho, and unfit to be in society.

The list goes on. Congressman Patrick J. Kennedy explains that stigma is anything that prevents someone from getting care – “attitudinal barriers” towards seeking help [1]. Moreover, there is not only stigma in society towards mentally ill people, but also self-stigma. People with mental illness oftentimes look down upon themselves because of their illness. For instance, I stigmatized myself when I called myself a psycho and weak for not successfully living with my illness.

I am no social psychologist, so if you would like a more technical explanation of stigma, I recommend this article:

I believe that stigma towards mental illness is not talked about as frequently as it should be (admittedly, times are a-changin’, due to unfortunate tragedies such as in Newton, CT, but fortunate things like Silver Linings Playbook). It’s so important because as stigma is reduced, more people will be willing to get help for themselves or their loved ones. We won’t have to live in shame or fear. More of us can lead healthy, productive lives.

Beyond just the emotional argument, there are very, very practical reasons why stigma needs to be eliminated and mental illness must be treated in the U.S.:

It’s common. One in four adults in the U.S. are affected by mental illness in a given year, yet only 60% get the help they need [2].
It’s crippling. Four of the ten leading causes of disability are mental disorders [3].
It’s life-threatening. There are over 38,000 suicides every year, and 90% of the people who commit suicide have a diagnosable mental illness. And yes, I will add a nod to the couple of percentage points of increased violent behavior in untreated mentally ill people. 5-7% people with severe problems will harm others in a given year, compared to 2-3% general population [4, 5].
It’s an economic burden. Serious mental illness costs $193.2 billion in lost earnings per year due to loss of productivity [6].
It’s costly indirectly as well as directly. Mentally ill people suffer a higher rate of unemployment, alienation, and homelessness. There are also costs from social care, education, housing, criminal justice and social security systems [7].
It’s the right thing to do! We can’t let so many people suffer unnecessarily. (I refuse to believe this is an emotional argument.)

So that is what this blog is dedicated to: the elimination of stigma. I hope you’ll join me.



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