Grey Matters

It’s already starting…..including right here on the Tucson Citizen site……..the man, Major Nadil Malik Hasan was “crazy.”  If you have read any of my blogs before, you know how important it is to me to try and create a world where people living with mental illnesses do not feel stigmatized and one of the first steps is to stop using horribly discrimating terms like “crazy” or “crazed.”  Yes, I agree that someone who goes on a rampage killing 12 people and wounding at least 31 others is not of sound mind, but why don’t we take a look at why this happened? 

If you believe, as I do, that mental illnesses are illness just like any other, than why was this man, who supposedly treated other people with brain disorders, not receiving treatment himself?  Did  anyone not notice how he was struggling?  According to the “God Blogging” post on this site, NPR interviewed others at Walter Reed who said he was. 

Which brings us back to the same problem, the same issues that continue to plague people with mental illness and their families.  Because of the stigma, because of the inattention by our health care system that doesn’t think the mind is part of one’s physical health, because of an overburdened mental healthcare system, because people suffering from a mental illness can feel isoloated and abandoned by their support structure, people with diagnosable brain disorders are falling through the cracks.  One again, as President Obama called this tragedy, “a horrific” catastrophe has occured in this country.

Who knows what was going on in Hasan’s head……Certainly listening to war stories from our returning Veterans experiencing Post Traumatic Stress Disorder was not an easy thing to do, but why is it that no one saw the signs, especially when he was set to deploy at the end of the month? Maybe Major Hasan will be able to shed some light on our questions.

What are shame and guilt?
Shame and guilt are the:
* Feelings of embarrassment, blame and responsibility for negative circumstances that have befallen yourself or others.
* Feelings of regret for your real or imagined misdeeds, both past and present.
* Sense of remorse for thoughts, feelings or attitudes that were or are negative, uncomplimentary or non-accepting concerning yourself or others.
* Feelings of obligation for not pleasing, not helping or not placating another.
* Feelings of bewilderment and lack of balance for not responding to a situation in the “correct way.”
* Feelings of loss for not having done or said something to someone who is no longer available to you.
* Accepting of responsibility for someone else’s misfortune or problem because it bothers you to see that person suffer.
* Motivators to amend all real or perceived wrongs.
* Strong moral sense of right and wrong that inhibits you from choosing a “wrong” course of action.
* Driving forces or masks behind which irrational beliefs hide.

If you are a family member or loved one of someone who has a mental illness you undoubtedly have experienced one if not all of the feeling listed above.  I know I have.

When my son was first diagnosed with a serious mental illness I blamed everything from the flu I had while I was pregnant with him to the bug spray I used in the house when he was growing up.  Could it have been my parenting?   Was I too permissive or over-protective?  Did I spoil him, or not give him enough? Should I have re-married after his father died in a car accident? (one very cruel psychiatric nurse suggested that) Did I not handle the grief properly?  (Both my children went to grief counseling) What about the early signs?  Did I ignore them or was it that I was just ignorant of the symptoms?  Did I get him into treatment early enough? 

The questions can go on forever, but now I know something that anyone with a family member with a brain disorder should know……….IT IS NOT YOUR FAULT!!!  It never was and it never will be.  You certainly cannot blame yourself if mental illness runs in your family.  Yes, there is a genetic component, but who says that’s your fault?

All family members of those living with mental illness can do is support and love them.  Be encouraging, but don’t pressure.  Especially after a serious crisis……it will take your loved one time to heal – just like an injury to the physical body takes time. And, don’t feel guilty because you may have pressured  him, quarreled, or  not understood what was happening before.  Be empathetic and put yourselves in their shoes.  Imagine what it must be like to have the rug pulled out from under you and your reality.  And, then imagine what it will be like when a sense of balance returns. Your relative is in recovery and he’s able to feel your love and support and you’ve been there to assist him in his journey. 

If I’ve said it before, it needs to be repeated.  It’s important to educate yourself about mental illness.  It’s not an easy road to be on……actually it’s more like a roller coaster with the ups and downs and sometimes terrifying sense of no control.  So learn what you can and remember to take care of yourself as well!  If you are not doing well and your guilt is making you ill, you can’t be there for your loved one either. 

An article in the New York Times today motivated me to talk about housing.  A Federal Judge has ruled that the state has discriminated against people with mental illness.

http://www.nytimes.com/2009/09/09/nyregion/09mental.html

Above is the link to the New York Times article about discrimination against people with mental illness in poorly run adult “care” homes.  I put the word in quotes because I don’t think “care” is appropriate in many cases.  Evidently in New York privately run adult homes aren’t much better than many of the facilities in Tucson. The article states that the residents are essentially warehoused and in the case of New York, unlike some in  Arizona, their facilities are licensed!

My son spent less than 2 months in one 3 bedroom apartment that his provider had arranged for him.  It was a nightmare.  Without going into too many details, suffice it to say that street drugs are rampant, nutritional meals don’t exist, personal safety and privacy is not garanteed and in his case the house manager who was supposed to be on-site would disappear for days on end leaving the 6 residents to fend for themselves.

The Tucson Weekly reported in their article, “Slums or Salvation,” that the local unlicensed “necessary evils” are finally beginning to draw some attention and the Pima County Human Rights Committee are starting to make visits to some of these homes.

The annual state audit of the mental health system’s performance that was released this year found it fails nearly all of its patients on key measures.  Among other things,  placing them in stable housing is at the top of the list.  For those who have not been in jail or hospitalized for their illness, the system failed 86 percent of the time. 

And, now with budget cuts who knows how much worse this system is going to get.  For some, living on the streets may be a better choice, but a stable environment is key to mental health recovery and I’m not sure the wash under a bridge qualifies.

Did you know that 50% more people die by suicide each year than by homicide? Most experts believe that people that do complete this horrible last act don’t really want to die, they just want to end the pain they are experiencing. But, it is preventable, when suicidal risk or intent is detected, lives can be saved.

The Community Partnership of Southern Arizona, (www.cpsa-rbha.org) the regional behavioral health agency, offers classes on suicide prevention.  Obviously, depression plays a big role in someone contemplating suicide – about 2/3 of the people that complete suicide are depressed at the time of death. I believe for my son, it was most certainly his schizophrenia.  As I have said…..I believe it was the mental illness that took his life. 

Most people that do attempt or complete suicide have some sort of mental illness.  It’s an act of desperation for someone that doesn’t see the alternatives.

Individuals who are depressed and exhibit the following symptoms are at particular risk of suicide.

• Extreme hopelessnessIf you or anyone you know if thinking about suicide…..please get help.  Speaking from experience, the survivors never get over it.
• A lack of interest in activities that were previously pleasurable
• Heightened anxiety and/or panic attacks
• Insomnia
• Talk about suicide or have a prior history of attempts
• Irritability and agitation

IF YOU ARE IN CRISIS AND
NEED IMMEDIATE HELP,
please call 1-800-273-TALK (8255).

www.sostucson.org

Suicide Prevention Week is September 6th -  12th 

When it comes to state dollars it certainly seems that way!

I attended a screening Monday night with some local mental health advocates of a film in the Fred Friendly series called “Minds on the Edge.”  See info at www.mindsontheedge.org  The film is a very comprehensive panel discussion on facing the issues of severe mental illness.  It will be aired on PBS during Mental Illness Awareness week the first part of October.  Afterward NAMI Southern Arizona hosted the discussion on how to help promote not only the film, but how to use the series as a catalyst to increase dialogue and education in our community surrounding this topic. Stay tuned for more information regarding the series!

We are passionate about creating awareness about mental illness, but we invariably end up talking about the inadequacies of the public mental health system and the overall frustration  with the continuing decline in the meager  funding. Then we factor in the state’s formula to give us (Tucson) less support per patient and it’s a wonder Pima County is able to provide any mental health services! 

In Arnold vs Sarn,

a lawsuit filed alleging the state and Maricopa County did not fund a comprehensive mental health system, new services called Assertive Community Treatment Programs were instituted. Case managers in Maricopa County saw the number of patients they see decreased to around 30 per person while Pima County Case managers, who are paid just enough to get by,  continue to have as many as 100 active patients in their files! Imagine what it’s like for that person when several of her patients are in crisis and need focused, immediate attention!

Sometimes I feel like the little baby bird in the nest outside my window, just waiting for my Mama bird to bring me some little morsel to help me grow and be on  my own.  The problem with our public mental health system, is that the little birdies in Pima are struggling to get just enough nourishment from the Big Birds in Phoenix to learn how to fly.

And, as we all know, it’s just getting worse.  In fact, “state only” dollars for programs for the seriously mentally ill have decreased by more than 10 million since fiscal 2001. And, funding levels have never been adjusted for inflation. What is going to happen to these people?

Our legislators need to stop turning a blind eye to our most vulnerable population and increase funding for people living with brain disorders and they also need to start treating the citizens in Pima County as equal to those 100 miles up the freeway.

For more info on Arnold vs Sarn, see S.B. 1196

I watched this beautifully put together HBO documentary on Monday night.

Mournful and emotional,  “Boy Interrupted” is about a mentally ill boy who committed suicide when he was only 15 years old. Having experienced the same tragedy, I really wanted to see how the story could be told without being exploitative or sensationalized. They couldn’t have done a better job……..the parents put the film together. Both of them are in the film industry, but a good part of the documentary was made from actual “home” movies that they and that Evan, their son had personally filmed. Some of the clips even give you a sense of how difficult life for Evan was when he was struggling with his bi-polar illness that wasn’t diagnosed until he was eight years old. Eight years old??? I’m sure you’re thinking that’s incredibly young…..and it is. But, it happens. And in Evan’s case, he started threatening suicide as early as age five.

His parents did everything they could to get Evan help. Finally by age 10 he was experiencing some normalcy in his life with the help of medication, therapy and family and academic support. Tragically, at age 15 when all seemed to be going well he ended his life by jumping from his bedroom window several floors up. He left a note explaining how disconnected he felt…….something many 15 year old boys will experience. But, for Evan his sadness was overwhelming and his bi-polar illness prevented him from facing another day. In my case, I always say, schizophrenia took my son. – I know he wouldn’t have purposely “ripped my heart out.”

According to the National Alliance on Mental Illness about one in ten children have a serious mental or emotional disorder, but fewer than half receive any mental health services in a given year. Over half of students with a mental disorder age 14 and older drop out of high school – the highest dropout rate of any disability group and many of the teenagers that have a mental disorder “self-medicate” with illegal drugs. Despite effective treatment, there are long delays, sometimes decades, before people seek and receive treatment.

These are pretty grim statistics, but I’m hopeful. As I have said before, I see people every day that have achieved mental health recovery. It’s something they have to work on- every day, and who knows, maybe one day we’ll find a cure or at least something to stop someone from wanting to end their life. Suicide causes unimaginable pain for those left behind.

This week local law enforcement officers are participating in a special one week training for crisis intervention. A mental health crisis is more than just a “melt down.”  If not handled properly, people can get hurt……..and sometimes even worse.

 The curriculum was designed after a Memphis, Tennessee model that was created over 20 years ago after an incident in which a police officer shot and killed a man with mental illness.  Referred to as “suicide by cop” a local resident in Tucson, Joe Mucenski, spearheaded the effort in Tucson in 2000 after personally witnessing his son’s tragic death in the same manner.

The Crisis Intervention Team consists of representatives from the local National Alliance on Mental Illness, Pima County Legal Services, , the Department of Mental Health, the Mental Health Court, the local Police Departments, and the Pima County Sheriff’s Department. Some of the most illuminating education comes when local people living with mental illnesses as well as family members of someone with a brain disorder share their experiences.

The CIT training has had positive feedback from both mental health agencies and officers who received the training.  Patrol officers who weren’t trained have been thankful for having a CIT officer on-hand as crisis situations can be de-escalated and many times incarcerations and hospitalizations can be avoided.

At the very least, deaths and injuries, to all parties, can be minimized and likely  avoided all together.

If you or someone you know is experiencing a mental health crisis, be sure to ask for a CIT trained officer if you feel the need to call for emergency assistance. The key to remember is to try and de-escalate the situation and remain calm.

For more information on crisis intervention visit: http://www.nami.org/template.cfm?section=CIT2