Bipolar 2 From Inside and Out

Posts tagged ‘mental illness in the news’

Young Children and Involuntary Commitment

Involuntary commitment. In California, it’s a 5150. In Massachusetts, it’s a Section 12. In Florida, it’s the Baker Act. But right now, we’re talking about Florida. Whatever the Baker Act was meant to do, it wasn’t meant to do it to six-year-olds. Yet in Florida, a six-year-old girl was involuntarily committed for two days of psychiatric evaluation after a temper tantrum at school. The child has attention deficit hyperactivity disorder and a mood disorder.

According to CBS News, a sheriff filed a report, and a social worker stated the girl was a “threat to herself and others,” “destroying school property” and “attacking staff.” Duval County Public Schools told CBS that “‘the decision to admit a student under the Baker Act is made by a third-party licensed mental health care professional'” and that the response was “‘compliant both with law and the best interest of this student and all other students at the school.’”

Florida’s Baker Act was established around 50 years ago and allows authorities to “force such an evaluation on anyone considered to be a danger to themselves or others.” Danger to self or others has long been the standard for involuntary commitment, but until recently, it has seldom been used on young children, especially without immediately notifying their parents.

“The number of children involuntarily transported to a mental health center in Florida has more than doubled in the last 15 years, to about 36,000,” according to a 2019 report by the Baker Act Reporting Center. In another such incident, a “12-year-old boy with autism was taken to a facility in a police cruiser. It was the boy’s first day in middle school and during a meltdown, he scratched himself and then made a suicidal reference,” according to CBS. The boy’s mother says that the school had a plan to follow if the boy made threats, but the plan was ignored.

It’s certainly true that six-year-olds have threatened suicide and some, unfortunately, have completed the act. And 12-year-old boys definitely have the potential to harm themselves and others. But for schools – with the help of law enforcement personnel and mental health professionals – to “Baker Act” children is an extreme interpretation of the law. “The law specifies that minors can only be held for 12 hours before [a mental health] examination is initiated. For minors, notification must be provided as soon as the child arrives at the facility,” according to the Family Center for Recovery. The law does not say that parents must be notified when the child is taken away from the school.

The Family Center adds, “The statute specifically calls for ‘substantial’ evidence, which is [a] much higher bar than simple suspicion. As a result, people cannot be involuntarily institutionalized simply because they’re acting strangely, refuse to seek psychiatric examinations, or have occasional mood swings or outbursts.”

Need I point out that all children, not just special needs children, experience occasional mood swings or outbursts? School personnel are supposed to be trained to handle these situations.

But “zero tolerance” policies for “acting out” and threatening school property have led to such excesses and others, such as the use of in-school restraints and seclusion. Restraints and seclusion are now being called into question, especially since they have been used capriciously and brutally, especially on children with special needs. IEP plans that specify procedures to follow if a child has a meltdown, as with the 12-year-old, and in schools that supposedly have staff trained to handle special needs children, like the six-year-old, are too often not communicated to staff or simply ignored.

Of course, such treatment is the exception rather than the rule. Some states are beginning to enact laws regarding restraint and seclusion. And many well-trained special needs educators would never countenance such treatment of mentally ill or neurodivergent students. But 36,000 children is a lot. Two-day commitment away from parents is excessive for a six-year-old. Police officers taking children away in cruisers before notifying parents is unconscionable. The law specifies that minors can be held for only 12 hours before [a mental health] examination is initiated. For minors, notification must be provided as soon as the child arrives at the facility.

Florida state lawmaker Jennifer Webb has introduced a bill to reform the Baker Act. It includes training for school officials and resource officers and establishes rules on when a parent should be notified that their child might be committed.

“[The Baker Act] should only be used as a last resort,” she told CBS.

 

What Should Medical Students Learn About Mental Illness?

I recently saw a news story reporting that a single medical school, Des Moines (IA) University, has made it mandatory for medical students to learn how to care for patients with mental illness.

Funny. I would have thought that was already happening in medical schools across the country. Apparently not. Although medical schools teach prospective doctors to diagnose mental illness, the article notes, they do not require students to learn how to care for the mentally ill. When the class started in 2018, it was an elective, but it later became a requirement.

The curriculum includes having people in recovery from mental illness, loved ones of patients, and healthcare providers speak to the class. It is hoped that this will combat the stigma that arises from student doctors only seeing mental patients on locked wards when they are in severe crisis.

Of course, confinement on a locked ward is not typical for people with SMI. Many people with bipolar disorder and even schizophrenia, for example, require inpatient treatment only occasionally, spending the majority of their lives receiving treatment, medication, and therapy as outpatients. One wonders if the stigma surrounding mental patients extends to them as well. Do some GPs tend to ignore physical disorders while focusing on the mental ones? It’s fairly well known that doctors sometimes focus on a person’s weight as being the cause of all their symptoms instead of looking for (or testing for) other conditions. Might there be a similar narrowing of focus regarding mental patients?

Looking at the course, the answer may be yes. Interestingly, the main concern in developing the course seems to be that because doctors were so uncomfortable treating psychiatric patients that they focused on the SMI and never diagnosed and treated conditions such as heart disease, hypertension, and other medical problems. Professor Dr. Lisa Streyfeller cites what she calls “really horrifying statistics that folks with severe mental illnesses die on average 15 to 30 years earlier than people who don’t have those illnesses.”

As important as it is that people with SMI receive treatment for their psychiatric conditions, physicians need to be aware that such people have physical needs and illnesses as well. And as encouraging as it is that mental patients themselves, and their loved ones and caregivers, are included in the curriculum, the article made no mention of teaching prospective doctors how to interact with mental patients they encounter in their practices. If such courses do not exist in medical schools other than DMU, where are doctors going to learn how to talk with and understand the many, many patients they will have who suffer with anxiety, depression, mania, anorexia, and the dozens of other diagnoses?

In some communities, first responders such as police and EMS workers are beginning to have mental health practitioners go on “ride-alongs” to help educate emergency personnel on how to handle situations involving the mentally distressed. Classes like the one at DMU (if others existed) could benefit from having students “ride along,” doing internships or rotations with established doctors who treat the physical as well as the mental symptoms of their patients. Perhaps psychiatric rotations in medical schools could include student practice in community or campus mental health centers instead of just locked wards. Perhaps medical schools could involve students in role-plays involving speaking with and treating the mentally ill, the way they sometimes do for prospective doctors’ encounters with terminal patients.

With NAMI reporting that 1 in 5 U.S. adults – 20% – experience mental illness each year and that
1 in 25 U.S. adults – 4% – experience serious mental illness each year, the odds are overwhelming that future doctors will need to learn how to treat patients both physically and mentally, as well as simply on a human level.

Here’s hoping that the DMU model class idea spreads – and that medical school education on mental health someday will be covered more thoroughly than a single class and a visit to the locked ward.

 

Reference:

DMU Becomes First Medical School to Require Mental Health Course for Students

Children’s Bodies, Children’s Minds

I read recently that the Duchess of Cambridge was visiting a series of schools to mark Children’s Mental Health Week. The duchess is the royal patron of Place2Be, a children’s mental health charity. The article said that this year’s theme for Mental Health Week would be “Healthy: Inside and Out, focusing on the connection between physical and mental health.”

The article explained, “The charity works with more than 280 primary and secondary schools across England, Scotland and Wales, providing support and expert training to improve the emotional wellbeing of pupils, families, teachers and school staff.” 

The duchess, it says, would be meeting with members of the school community to discuss students’ school readiness, teacher welfare, the wellbeing of the school community, and the importance of being active; and also talk with parents about good routines and habits around sleep, screen time, healthy eating, and exercise.

All of which sounds fine and worthy. But does anyone else see something missing from this public relations tour? Maybe it’s just me, but there doesn’t seem to be much actual emphasis on children’s mental health.

Yes, we know that the body and the mind are intimately connected. Yes, we know that children need a sense of wellbeing. Yes, we know that being active and eating healthy are important for kids. And we know that parents, teachers, and school communities have important roles to play in students’ healthy development. We also know that sleep, healthy eating, and exercise are good for people with mental illnesses. Hell, they’re good for everyone.

But there’s a lot more to mental health than physical fitness and a sense of wellbeing. If that was all it took, we could just eat kale and kiwis, meditate, and send the therapists home.

Of course, the article was short and seemed to focus on the duchess’s meetings with the youngest kids, who after all the most photogenic. Maybe the charity and the duchess also educate about the thornier aspects of mental health. Maybe they promote dialogue about self-harm, suicide prevention, childhood depression, and other conditions. I would like to think that they do.

But the article and many others like it focus on the physical and feel-good aspects of mental health and not the mental and emotional. Bubble baths for self-care! Pets as the best therapists! Super foods for regulating moods!

Memes are not the answer. And the physical aspects of mental health are certainly important. But we’re talking about mental illness and mood disorders here. Can’t we at least spend time talking about the mind and the emotions?  Maybe even have a dialogue about what happens when something goes wrong with them? Stress the importance of seeking help when one is confused, overwhelmed, and despairing?

I think society at large is still uncomfortable talking about mental illness and twice as uncomfortable talking about mental illness in children. Many of us are still laboring under the illusion that childhood is a uniformly happy time. In fact, many kids suffer from serious mental illnesses. If the statistics give any indication, 20% to 25% of them will experience a mental health problem at some time in their lives.

We should talk about this and ultimately do something about it. Something more than emphasizing good physical health and getting celebrities to do 30-second spots about how they too experience depression, though these are indeed good things.

I’ve written before about what I think a mental health curriculum in schools should look like (https://wp.me/p4e9Hv-Jw, https://wp.me/p4e9Hv-Hl). I suppose that first we need to be aware that children can and do have mental health problems – that it may not be “just a phase they’re going through” or something they’ll “just get over.” It’s a serious problem and requires serious attention, not to mention serious actions.

Whatever else we do, let’s put the mental back into mental health.

 

 

Self-Medicating: Bipolar and Booze

Self-medicating – using alcohol or drugs to dull the emotional pain of a mood disorder – is pretty common among people with bipolar and other mental disorders, particularly the undiagnosed.

It’s a dangerous thing to do. People with major depression are said to be twice as likely to develop a drinking problem if they self-medicate with alcohol a lot. Then there’s the possible interaction between alcohol or drugs with a person’s prescribed meds.

To be perfectly honest, there were times in my life when I self-medicated with wine, beer, or liquor. During one particularly dark time, when I had been prescribed benzos for a physical ailment, that was thrown into the mix. And, again with the honesty, I still sometimes have wine or beer with dinner, though I know I shouldn’t. I could say that I know how much I can drink without it affecting my reaction to my meds, but the fact is that I just shouldn’t.

Recently, however, a study was published in the journal Nature Communications which said that “getting drunk causes the same molecular changes in the brain as taking rapid antidepressants.” Here are the basics.

It was a study done on mice, which means it’s a long way yet from applying to human beings. The set-up was this: Mice were given alcohol, then placed in a container of water. Being passive and willing to drown was taken as an indication that the hapless creature was depressed. Sure enough, the mice that were given alcohol proved to be more active and energetic in trying to swim, which was taken as a sign of not being depressed.

The study did not end happily for any of the mice, however. Their brains were examined to determine how the alcohol achieved its antidepressant effects.  The scientists say that changes in the boozy mouse brains showed that alcohol has effects on neurotransmitters that were similar to the way antidepressants affect the brain. That’s a long way from saying that alcohol is good for the depressed, though.

The premise of the experiment sounds a little shaky to me. I mean, assuming the swimming mice to be less depressed than the drowning mice strikes me as just a wee bit anthropomorphic. Plus, the mice seem to have been situationally depressed (by being left to drown), rather than chronically, as in clinical depression. However, the brain study seems more interesting to me. After all, it compared the effects of alcohol directly with the effects that antidepressants have on neurotransmitters and said that the former “mimicked” the latter.

What’s the takeaway from all this? Well, first of all, it’s hardly blanket permission for the depressed to go out and indulge indiscriminately. Further experiments are needed, presumably ones that will work their way up the animal kingdom until they come to depressed humans, though one hopes that they are not thrown into water to sink or swim.

If those further studies go the same way as the mouse study, I rather imagine the result will be something like the medical advice that you can take a glass of red wine to stave off heart disease – not a blanket approval, but the use of a potentially hazardous thing to ward off a potentially worse thing. Of course, that will not apply to alcoholics or others who must avoid the substance altogether for any of a variety of reasons.

I also note that the study focused on the effects of alcohol in relation to depression only. The manic phase of bipolar disorder was not part of the study and drinking while manic is well known to be a really bad, though often occurring, thing. Of course the same can be said of drinking and depression.

For now, the best advice is simply not to drink if you are depressed or bipolar. Don’t use me as an example. I’m not sharing this to encourage anyone to indulge in potentially destructive, even lethal, behavior. As always, Your Mileage May Vary, especially when compared with that of drunken, depressed, or dead mice. But drinking is still far from a good idea for the bipolar.  And don’t mix it with benzos either.  Trust me on this. It’s a slippery slope.

 

Men, Women, and Mental Health

My husband is no stranger to situational depression. He experienced it when his father died, when a beloved pet passed unexpectedly, and when his job turned suddenly more stressful and meaningless.

But he didn’t understand clinical, chronic depression. “What would it be like if those feelings lasted for months at a time, or even years?” I asked. He said he couldn’t even picture it. “That’s the way my life is,” I explained. Then he lost his job, and after a brief period of relief from the stress, he finally experienced depression that lasted more than two weeks – two years, in fact, during which he was unable to work.

He did not seek help for it until his best friend and I both proactively encouraged (i.e., nagged) him to do something about it. He’s been on an SSRI ever since and has occasionally seen a psychologist.

Lately, there has been a movement to educate men about mental illness and mental health. Primary among its goals is to help men understand that mental illness is a thing that can affect them and that there is no shame in asking for help.

Certainly, the statistics bear out that the majority of mental health consumers are women. Psychology Today reports: “Research suggests that women are about 40% more likely than men to develop depression. They’re twice as likely to develop PTSD, with about 10% of women developing the condition after a traumatic event, compared to just 4% of men. It’s easy to write off this epidemic of mental illness among women as the result of hormonal issues and genetic gender differences, or even to argue that women are simply more ’emotional’ than men. The truth, though, is that psychiatrists aren’t really sure why mental illness is more common among women.” Perhaps the answer is that seeking treatment for mental illness is more common in women.

Prevention magazine says that there are four mental health conditions that affect women more than men: depression, anxiety, PTSD, and eating disorders. That PTSD is twice as common in women may surprise you, though the stats about eating disorders are not likely to. The fact is that, although few women experience the traumas that soldiers do, they are much more likely to experience other sorts of trauma, such as rape, which can also lead to PTSD.

But men experience societal and psychological barriers to getting help when they need it. Among the excuses you hear are these:

  • I don’t really need help.
  • I can handle this myself.
  • I don’t want to appear weak.
  • I might lose my job if anyone finds out.

In other words, a lot of bullshit that boils down to “I’m a man and mental illness is not manly. Asking for help is not manly. Talking about emotional problems is not manly. Taking medication for a personal problem is not manly. Not being able to deal with my problems, especially emotional problems, is not manly. Therefore I have no mental problems and don’t need treatment for them because I’m a man.”

Or, looked at another way, the campaigns against stigma around mental illness have been less than effective for most men. Now the attention to that problem, which is surely needed, is beginning to be heard and, one hopes, acted upon.

Still, it’s important to remember that mental illness is not just a men’s problem or a women’s problem. It is a human problem, affecting both genders (and all ages and races) if not equally, then without discriminating.

It is important to get men the mental and emotional help they need, in a timelier and more comprehensive fashion.  I would have liked to see my husband be willing to recognize when he needed to get help and to get it without being pushed. But it would be wrong to push the needs of women aside to accomplish this. This is a societal problem, and while right now spreading the word to men is particularly important, our goal should be to make sure that all people are aware of the prevalence of mental illness, the fact that it can happen to them, and that there are places to get help. That message, at least, is not gender-specific.

The Fire and the Window

fire orange emergency burning

Photo by Little Visuals on Pexels.com

When Anthony Bourdain died by suicide and I told someone the news, he asked me, “Why?”

I was taken aback. “What do you mean, ‘why’?” I replied.

“You know,” he said. “Did he have money trouble? Break up with his girlfriend? Have some disease?”

That’s a common reaction to suicide and it’s uninformed. Real-life stressors can contribute to suicide, but they are almost never the whole story. People die by suicide when the pain of living seems greater than the pain of dying.

Gregory House, the misanthropic, genius title character of House, M.D., once said, “Living in misery sucks marginally less than dying in it.” People who kill themselves don’t believe that. They believe the opposite.

The best metaphor I ever heard for suicide was the plight of people in the World Trade Center’s upper floors on 9/11. There were the flames. There was the window. And that was the choice. Suicide happens when a person sees only two alternatives and both are equally horrible, or nearly so.

The bullied child does not take her own life because she was bullied. She was in pain, for a variety of reasons that included bullying. It was a factor, but it wasn’t the reason. She was hurt. She was isolated. She was depressed. She couldn’t believe that things would improve. She wanted the pain to stop. She believed she faced the choice between the fire and the window.

The politician who dies by suicide in the face of a major scandal does not kill himself because of the potential scandal. He dies because he sees his choices limited to shame, humiliation, despair, and ridicule. He believes that what happens to him will be as bad as dying. He is caught between what he sees as the fire and the window.

Mental illness can make it difficult to see that there are other choices. The distortions of thinking associated with serious mental illness can make us see only the fire and the window.

The one time that suicidal ideation got the better of me and I was close to making the choice, my thinking was just that twisted. I was faced with a choice that seemed to me would ruin someone I loved. I thought that I could not live with either choice. One was the fire and the other the window.

My thinking, of course, was severely distorted by my mental disorder. The thing that I thought might rain destruction on the other person was much smaller than I believed. There were ways out of the dilemma other than dropping a dime or killing myself. If we continue the metaphor, the fire was not that big, or that implacable, or that inevitable, but I couldn’t see that. In the end, I hung on long enough for my thinking to clear and for me to see other options.

I don’t actually know what was going on in the minds of the souls who were trapped in the Twin Towers. I don’t mean to lessen the horror of their deaths or wound their families by speaking of suicide this way. The reality of their choice is so far distant from the choices that other people who consider suicide face.

But that’s kind of the point. People who die by suicide don’t see any other way out. If they seem to be responding to what most people see as survivable hurts or solvable problems, people say they can’t understand how someone that rich, that successful, that beloved, that full of potential could have not seen that help was only a reach away.

The person who dies by suicide doesn’t see the hand reaching out. Only the fire and the window.

 

If you are considering suicide, call the National Suicide Hotline: 1-800-273-8255.

Mental Illness and Voting

people standing with signage on street

Photo by Rosemary Ketchum on Pexels.com

No, I’m not going to tell you how to vote. And I’m not going to say the country is bipolar just because we’re so divided. What I am going to do is talk about the issues you should be concerned with during these mid-term elections and what you need to do in order to make your vote count.

Despite the fact that mid-term elections are usually boring, plagued by low turn-outs and minor local issues, this time they are likely to have national significance. This time we are voting on people – representatives, senators, and governors – who will make the policy for our states and our nation, including policies that affect the mentally ill.

Health policy. We’re not voting directly on national health policy, but we are voting for or against the people who make those policies. Those policies include support for the ACA (Obamacare), especially its protections for those with pre-existing conditions.

This has become a hot-button issue this year and you will likely hear and see ads that tout the various candidates’ support for insurance that covers pre-existing conditions. The key here is to do a tiny bit of research. Whatever a candidate says now, has he or she always supported coverage for pre-existing conditions? Or does the candidate have a history of trying to do away with such insurance coverage? Promises are not the point here. Past actions are. Given the choice between an incumbent and a newcomer, I personally will go for the newcomer if the incumbent has a track record of trying to dismantle coverage for pre-existing conditions.

Another important issue for the mentally ill is safety net programs, particularly Social Security, Medicare, and Medicaid. Many people with mental illness depend on these programs to cover their basic living and medical expenses. Believe a candidate who wants to gut these programs. Many of them see the people who benefit from these programs, particularly SSDI, as “moochers,” “freeloaders,” and drags on society. If you or a loved one needs this kind of assistance, vote accordingly.

There may also be local issues regarding police training, housing, and the homeless that are relevant to persons with mental illness. Spend a few minutes researching before you vote. Some Internet sites such as BallotReady.org and Vote411.org can help.

Your vote. Your vote only counts if you actually cast it and that can be a problem for those with mental or emotional disorders. Going to the polls can seem an impossible feat. But given the significance of the coming elections, spending some spoons to do so can have long-term repercussions.

If you have trouble getting to the polls, first make sure you know where your polling place is this year. It may have changed since the last time you voted. Then ask around. Some cities, like mine, are offering free bus rides to polling places and some services like Uber are offering discounted fees. Neighbors who go to the same polling place or members of support groups you belong to can potentially provide transport. Don’t forget to ask friends and family, if you can. They may not realize how important voting is to you or the difficulty you have getting to the polls.

If your difficulty is not getting to the polling places, but being at them, plan ahead. There are likely to be crowds this year and you may want to have a support person with you, especially one who also plans to vote. You may even be able to call the polling place ahead of time and find out when their peak voting times are so you can avoid them. If possible, avoid the noon rush, when many people take a voting break from work, and just after local businesses close for the day.

You may have heard rumors of intimidation at the polls this year. These are likely exaggerated, as are predictions of civil unrest after the results are known.  If anyone tries to interfere with or influence your voting, find an official poll worker or ask for a provisional ballot, which is your legal right. Call the police if you have to. Rely on a support person to help you get through the process.

Remember that this year’s elections are important. If at all possible, VOTE.

 

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