Bipolar 2 From Inside and Out

Posts tagged ‘news stories’

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.

 

Big Box Mental Health

photo by rawpixel.com from Pexels

According to an article published on the blogsite She Knows, “a Boston-based company that manages mental health care for 40 million people, has opened a small clinic in a Walmart location in Carrollton, Texas, and has plans to expand the program in other retail locations throughout the country.”

And I don’t know whether to vomit or applaud.

Walmart’s ubiquity is one point in its favor. They’re everywhere. And for some people, whether they love or despise Walmart, it’s the only choice they have for groceries, household goods, or much of anything else. Those areas are also likely to be underserved by the mental health system, such as it is.

And sparse as the options offered by the Walmart walk-in clinics is – treatment for anxiety, depression, grief, relationship issues, and stress management – it’s more than a lot of people have access to now. The trial site is said to be staffed with one licensed clinical social worker, has a sliding fee scale for those with no insurance, and will soon be approved for Medicaid reimbursement (it is hoped). There will even be remote Skype therapy services if necessary.

All that is good, as far as it goes. But does it go far enough? Will people be able to get more than a pat on the head and a pep talk as they do their weekly or monthly shopping? How will the walk-in clinic handle referrals for people with serious mental illness or a need for psychotropic medication, something that clinical social workers can’t provide? How many people can get help from a single professional? How good is internet therapy? And what percentage of Walmart shoppers have access to the internet?

The walk-in clinics are touted as reducing stigma around mental health issues. After all, the thought is, getting your mental health services at Walmart will become as natural as getting a haircut or an eye exam there. Well, maybe. On the other hand, how many people are willing to have their friends and neighbors see them publically, sitting in the waiting room or ducking surreptitiously through the door? It seems to me it might perpetuate stigma, rather than lessening it.

Besides, Walmart is hardly a bastion of high-quality goods and services. Will the mental health services be second-rate as well? It could be that even second-rate care is better than no care at all. But it’s surely not enough to deal with issues that require long-term therapy with actual treatment plans; scheduled repeat visits; building a relationship with a particular therapist; access to medications; and all the other aspects of more effective treatment, especially considering complicated disorders like bipolar, OCD, or anorexia.

I fully admit that I hate Walmart – the way they have driven out local Mom and Pop stores, for example, and the way they treat their employees. But I have many choices of where to shop near where I live, and access to both therapists and psychiatrists, and insurance that covers my appointments and medications. If I weren’t looking through the lens of privilege, I might see things a lot differently.

So for now, I guess my attitude is to wait and see. One test location does not a Walmart Psych Empire make. Perhaps it will succeed; perhaps not. Perhaps it will become the Great Clips of the psychotherapy world.

But while I’m waiting, I’m hot holding my breath.

 

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.

 

What Schools Are – and Aren’t – Doing About Mental Health

I believe that mental health education belongs in schools. I’ve written about that (https://wp.me/p4e9Hv-Jw). There’s good news about the subject and there’s less-good news. I’ll let you sort out which is which.

First, two U.S. states are now required by law to include mental health in their curriculum – New York and Virginia.

New York’s law mandates teaching the subject as part of the K-12 health curriculum, which has only two other specifically required topics: alcohol, drug and tobacco abuse and the prevention and detection of certain cancers. According to the law, the new education requirements seek to “open up dialogue about mental health and combat the stigma around the topic.” Free resources for New York schools, such as teacher training, are available online. These include lesson plans, though schools and teachers are free to design their own curricula.

In Virginia, mental health education is required only in grades 9-10. Huffington Post reports that the legislation came about “after state Sen. R. Creigh Deeds (D-Charlottesville) saw that three high school students had researched, developed and presented the proposed legislation, which struck close to home for the legislator, who had lost his son to suicide in 2013.”

Indeed, those laws are good things, though one could wish that the other 48 states would take note and do likewise. They are, of course, not forbidden to teach mental health education, and many do, especially around the topics of drug and alcohol prevention and suicide prevention. Some of them even require education on those two topics, along with bullying. Many of these efforts are sincere, significant, and even life-saving, but it is worth noting that bullying and student suicide are events for which schools are at risk of legal liability. One might wonder whether that has influenced the laws, rather than supporting more comprehensive mental health education.

Contrast the U.S. experience with England, where all secondary school teachers and other school staff are being given training that will help them identify mental health issues in children, including depression and anxiety, self-harm, and eating disorders. This is thanks in part to Prince Harry’s openness about needing counseling to help him deal with the death of his mother, Princess Diana, which happened when he was 12. The Prime Minister has said that the prince’s disclosures will help “smash the stigma” regarding mental illness and the need for getting help.

“The programme is delivered by social enterprise Mental Health First Aid (MHFA) England, backed by £200,000 in Government funding,” notes the Telegraph, “and will be extended to primary schools by 2022.”

The campaigns around the mental health mandate, especially those featuring Princes William and Harry, have focused on the need for Britons to abandon their “stiff upper lip” image and to accept that men can and do need to seek help for mental difficulties. While that is indeed a vital message, one hopes that girls and women do not get left behind in the efforts.

What about U.S. states where mental health education is not a fact of life?

For schools in the U.S. that have not mandated mental health education, the National Alliance for Mental Illness (NAMI) has developed resources that can help districts, schools, teachers, and families address the problem through the NAMI Parents & Teachers as Allies program of training.

They have also developed a presentation for students called NAMI Ending the Silence, “designed for middle and high school students that includes warning signs, facts and statistics and how to get help for themselves or a friend.” These programs are offered free to schools and communities. For more information, go to https://www.nami.org/Learn-More/Public-Policy/Mental-Health-in-Schools.

For a more DIY approach, youth.gov (https://youth.gov/youth-topics/youth-mental-health/school-based) recommends that schools “partner with community mental health organizations and agencies to develop an integrated, comprehensive program of support and services.” Among the actions they recommend are for schools and partnerships to:

  • develop evidence-based programs to provide positive school climate and promote student skills in dealing with bullying and conflicts, solving problems, developing healthy peer relationships, engaging in activities to prevent suicide and substance use, and so on.
  • develop early intervention services for students in need of additional supports such as skill groups to deal with grief, anger, anxiety, sadness, and so on.

In other words, for schools to spend the time and energy to do for themselves what the state and national governments are unwilling or unlikely to do.

To me, this is one of those times when a national curriculum makes sense, or at the very least a mandate in every state. Mental health education should be comprehensive, freely available, easy to access, and scientifically accurate for all schools and schoolchildren. The education this would provide and the statement it would make would be invaluable. Drug and alcohol, bullying, and suicide prevention are just a start, but a start that many states have not made.

 

 

Low-Jacked Pills and High-Tech Mental Health

I’m a known geek and ordinarily a fan of technology – though not technology for its own sake. It has to do something useful and needed.

Imagine my surprise to learn that tech companies are now doing what so many of our public institutions aren’t, and devising possible solutions to assorted mental health problems. Stat reported (in their Business section) that now:

with an influx of funding, companies are revamping pills with digital sensors, designing virtual reality worlds to treat addiction and other conditions, and building chatbots for interactive therapy.

But are these techno-wonders likely to be any help? Let’s take the innovations in reverse order, shall we?

Chatbots. We already have remote counselors, which may be a godsend for people with no access to mental health clinics (although they charge a fee, which may be prohibitive for some). I’ve never investigated this service, so maybe some of you who have can tell me how they work and how well.

Remote counselors rely on already existing technology, however, and are therefore not of interest to tech innovators (or potential funders). Chatbots are something else. They are, essentially, computers that respond to human input with output that is supposed to simulate human responses.

To my knowledge, no computer has ever passed the “Turing Test,” which means that a person has no idea whether they’re chatting with a real person or a computer. A psych computer is likely to respond with generic responses such as, “Why do you feel angry with your sister?” “What do you mean when you say anxiety?” “Explain how depression affects you,” and “Tell me more about your mother.” The supposed AI is in no way trained in psychology or any therapeutic techniques.

One company that received funding for “telepsychiatry” (called Regroup Therapy and Woebot Labs) brands their idea as “Your charming robot friend who is ready to listen, 24/7.” Admittedly, many persons with mental health issues need someone who’ll listen, but that’s far from all they need.

Virtual reality for addiction (and other conditions). Startup Limbix wants to sell its programs to therapists and clinics. According to Stat,

Among the company’s VR programs is an exposure therapy for patients with phobias or trauma associated with driving. While patients strap on the headset, clinicians can work with them to introduce different conditions (a clear or rainy day) or different road situations (a bridge or a tunnel or blind left turns).

This sounds promising, though the cost of VR headsets and the programming for various conditions again might be prohibitive for your average community or campus or rural mental health clinic. I’m not clear on how it would work for addiction, unless combined with aversion therapy, which is generally brutal.

Pills with digital sensors. Aren’t psychotropic medications already too expensive, especially for people who have no insurance? Now we need technological pills that must make a profit for both drug and tech companies?

And what a pill they’re talking about. Basically, it’s a pill that rats you out if you don’t take it, or rather alerts your doctor when you do take it. Presumably, your doctor has enough staff to monitor whether clients take the pills and record it if they don’t. Then what? A robocall telling you to take your meds? A visit from a social worker?

Admittedly, such low-jacked pills might have a place in situations where schizophrenics are court-ordered to take their medication, but again there is the problem of what to do about non-compliance.

Another company plans to sell “a cardiac drug meant to be popped like a mint to people anxious about public speaking and first dates.” Would people need prescriptions for those, or will they be dispensed like Tic-Tacs? Even anti-anxiety drugs aren’t meant to be “popped like a mint.” And a cardiac drug? I can’t see any possible downside there.

If only the ingenuity and investment that goes into these products were instead available to fund and repair the shaky mental health system instead. What we need are more psychiatrists and therapists, more hospital beds for psych patients, less expensive drugs, better insurance, more education for the public about mental illness, and an end to stigma.

But those would require systemic reform and political backing, not just some new-fangled gadget. And good luck getting investors for those.

Reference

https://www.statnews.com/2018/07/20/tech-developers-tackle-mental-health/

Talking to Ourselves

people woman relaxation girl

Photo by Public Domain Pictures on Pexels.com

Recently on Facebook I asked how many of my friends knew the meaning of the semicolon – other than as a mark of punctuation. About two-thirds of those who responded did. The rest either didn’t or had some vague idea but no real knowledge. But I’m pretty vocal about mental health issues and a fair number of my friends have similar problems and difficulties, so that two-thirds figure is likely not representative of the population at large.

Yet I see increasing numbers of t-shirts, bracelets, and other paraphernalia adorned with semicolons and sometimes colorful butterflies or the word “warriors.” But nowhere does it say what the semicolon stands for. For those of you who don’t know, the semicolon marks that place in a sentence where a writer could have stopped, but chose to go on. As such, it has become a symbol for suicide prevention and mental health awareness.

I have a semicolon tattoo myself. I don’t regret getting it. It reminds me, as the saying goes, that my story isn’t over. But when I got it, I also hoped it would be a tool for education – that I could explain to those who saw it and asked what the symbol meant.

Unfortunately, no one has asked.

I’d hate to think that the semicolon has become like a secret handshake that identifies members of our tribe to one another, but leaves out the rest of the world. As stigma-fighting symbols go, it doesn’t seem terribly effective.

The political conversation has become so fraught that no one talks to anyone who doesn’t believe in the same things. And I’m afraid that, like them, we’re largely talking to ourselves.

Self-talk is important – definitely something we should pay attention to and work on improving. But if we really want to fight stigma, we need to talk to other people about it.

I see a fair number of stigma-fighting memes and discussions, but unfortunately, most of them take place in mental health support groups, where the message is not as much needed as in the larger world outside our band of the mentally ill.

Of course, there are organizations such as NAMI, Bipolar Awareness – Stop the Stigma, and Stigma Fighters that dedicate effort to reducing stigma. And they are doing a good, necessary thing.

But what about the rest of us? What can we do to break out of our shells and involve the rest of the world in our cause?

One thing is to question other people’s assumptions when we see or hear them. When you read a post that calls the weather bipolar, answer it. Explain why that’s not a good comparison – that it trivializes a very real problem that millions of people face every day. And when someone assumes that a mass shooter or other terrorist must be mentally ill (or “off his meds”), remind them that those with mental illness are more often the victims of violence that they are the perpetrators of it.

Will people get the message, or will they just dismiss you as “politically correct” or a “social justice warrior”? Personally, I can think of worse names to be called, and many of us have been called them. But just as “retarded” and “gay” are no longer acceptable as synonyms for “weird” or “stupid,” we should try our best to make “crazy” and “mental” and “psycho” and that annoying little twirl of the finger by the temple no longer acceptable as shorthand for behavior that one doesn’t understand. (I still haven’t figured out how “dumb” and “lame,” both ableist language, have managed to skate by.)

What I’m saying is that to fight stigma we need to engage with the world outside. We need to explain why certain uses of language are hurtful and what the truth is about the many people who are affected by mental illness.

I’ve had to smack a few friends on the nose with a rolled-up newspaper when they get it wrong and I try to put my two cents into other discussions that are portraying the mentally ill insensitively. I think about what I’m going to say and even practice it before I speak or press send. (Sounding well-informed and reasonable is the way I want to express my message.) I post my blog entries to “public” as well as to friends and support groups. Sometimes I even talk to my family about stigma.

As a group, we need to do a whole lot better at not hiding from stigma but confronting it wherever we see it. We can live with stigma or we can fight it.

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