3 things I’ve learned about fake news from mental health advocacy

February 20th, 2017

I was plunged into the mental health world when my son was 7 and made his first suicide attempt.  I got him help, of course, but I needed to understand what was happening to him and to our family.  Overnight, I became a mental health researcher and devoured any and all stories I could find about mental illness.  I depended on the integrity and truthfulness of good reporting.  I also developed a pretty good hogwash detector.

I’ve discovered lately that I need all those skills and more.

Stories and accusations about fake news crop up everywhere you look.  According to the Mirriam-Webster dictionary, the word “fake” is in the top 30% of words looked up and means not true or real.  When it’s applied to a news story or new information, it’s intended to disparage the reporter, the sources or the content.   I can tell you from personal experience, however, that just because the truth or information is hard to handle, doesn’t mean it’s fake.

Fake news and information rely on the vulnerability of the person hearing or reading it to gain traction.  Believe me, I’ve been there.  When my young son would have a meltdown and then weep afterward that he was bad, I wanted to believe it was temporary, didn’t need serious treatment or was just a phase.  Sure, he was out of control.  Yes, he sometimes hurt himself.  But he felt remorse, so didn’t that count for something?  When therapists and teachers told me not to worry, part of me wanted to stop looking for the tough answers.  I was tired and overwhelmed.   I didn’t want to hear anything that was hard to handle.

Media outlets, whether they are mainstream, lean to the right or left, often report stories differently.  They don’t agree on the focus.  Just like the media, different parts of the children’s mental health system never seem to agree.  One professional will offer a different prognosis for your child than the next one.  Another one will come up with a completely new diagnosis, when you’ve already got three. Like many parents, I heard wildly different recommendations from the psychiatrist, the teacher and the therapist.  The psychiatrist (who turned out to be right) thought my son had a pretty serious mood disorder.  The teacher thought my divorce, our move and change of schools were to blame.  The therapist didn’t want me to be alarmed since children often grow out of their problems.  They couldn’t be all right, could they?

I had to learn to listen with both my head and my heart.  I needed to face the difficult facts and also feel the compassion being offered to me.  I learned that people have different training and biases and are often blind to the fact that they could be misleading you. Sometimes it’s not intentional.  Sometimes it feels like it is.

My son had four different psychiatrists before he turned 12.  One, Dr. G, was especially charming and very confident of his viewpoint and recommendations.  During one visit, he looked me in the eye and spoke charismatically and sincerely.  He said he wanted to retry a medication that had been a disaster a year ago.  He said, “We both want what’s best for your son and this is absolutely the right move.  As soon as we get up to the right dosage, he is going to be a different child.  You’ll be amazed. Just trust me.”

I am a pretty good critical thinker and know how to wade through information.  But I didn’t listen to myself.  Instead, I did trust him and that medication was a disaster once again.  My son ended up in psychiatric crisis.

Dr. G was likeable, charming and smart.  He was confident that he was a good doctor and overall I think he was.  But I had a very complicated son, whose medication reactions were unusual and extreme.  What Dr. G told me – that my son was going to do well and be a different child – was wrong.   I trusted his information because he was the one saying it, not because it was true.  I relied on how much I liked Dr. G.  I confused the speaker with the speech and forgot I was an expert too. After that, my hogwash detector got louder and less forgiving.

Between my hogwash detector, wisdom gained from advocating for my own child and later, other families, I’ve learned some key points.  Those things are turning out to be pretty useful when confronted by fake news.

  1. Don’t confuse how you feel about the source with the story being told. Just like Dr. G, many people are wonderfully persuasive and you want to believe them.  I’ve had several friends tell me news items that I half believed because I liked them, later checking the items out and seeing they weren’t real after all.  We all know who has rigorously checked something out and who isn’t so careful.  How you feel about someone cannot substitute for carefully vetting the information.
  2. Watch out if the information or news is focused on attacking someone. Reliable sources report the facts, which are different from opinions.  I have been disparaged and disrespected as a parent more times than I can count.  Not because I was wrong but because emotions were high or bias against parents was in play.  Good information and real news is about what is happening in front of us and not about personality.  Did I mention that someone attacking me or another parent has ramped up my hogwash detector?
  3. Beware of polarizing tactics. I found out early on that different parts of the children’s mental health system often don’t agree.  There is a lot of finger pointing by schools, by hospitals, by clinics and others.  No one wants to be accountable.  When polarization is at its worst, nothing productive happens.  Children and families don’t get what they need.  It’s the same in a polarized news environment.  We agree on very little and very little gets done.

There were times when the news about my son’s illness was awful and I confess I said to myself, “I just don’t believe this.”  I wanted to believe the less troubling stuff and ignore the rest.  Sometimes I did, but mostly I learned that the truth helps me make better choices.  I learned to value integrity and good reporting.  These days, it goes far beyond the mental health world.

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Asking “Do you need a toothbrush?” can be a small bridge to support

February 7th, 2017

When you take your child to the emergency room in any part of the state, you know you’re there for a bunch or reasons:  unavailable doctor hours, urgency, crisis, and most of all, acute evaluation to get you connected to admission. For parents, it feels pretty overwhelming the minute you step through the door.  You are scared, devastated and shaken and it feels like you need everyone there to get you through it. If your child needs to be admitted to an inpatient bed, you also look to connect to the doctors, nurses and staff.  Sometimes, you begin to trust and lean on them.

That is especially true for psychiatric emergencies. Here in Massachusetts we have mobile crisis and community supports to hopefully guide the process.   There might be a family partner, a person with lived experience, who knows what this all means and can explain to you or support you as you walk through it.  That person can listen, increase how comfortable and connected you are.

Emergency rooms and hospitals can be a pretty different experience, especially when you have a child with mental health needs. When your child is a young adult over the age of 18, it’s even harder and there is extra anxiety and fear.  I remember sitting with my son who had requested that I stay with him as he was being seen. He had turned 18 and I wasn’t allowed in – unless he asked me. Fortunately for me, it was a time when he was not in a psychotic state and could invite me to support him. My fingers were crossed and  I was thankful his level of paranoia and hallucinations was low so that we could remain a united front — a family of an adult child with an adult mom.

It was different and it was scary. Adults who had overdosed were there and some were detoxing.  Adults with acute psychiatric symptoms were there and some were screaming or violent. Some people had been waiting for days for help.  There were 2 or 3 who were locked in another room or tied down and medicated to be quiet. They were being managed, but not treated.  Where do you go? What do you do?

I felt like I was reliving the noise, visions and memories that I’ve had when I have supported families across the state who need mental health treatment for their child. But here, it was so hard to make the connection with people so they’d understand that the reason that they were waiting 7 days, 10 days or even more in an emergency room for care wasn’t them.  It is the lack of beds and the multiple other people waiting to get treatment too.

As a parent you wait, sleep and walk back and forth trying to count down the time that is passing. You are trying to remain the strong wall for your child.  You are there. You crave conversation, you crave a break, you have to ask many times for a toothbrush, food, water and to use an outlet to charge your cell or use someone’s phone to call and check on the rest of your family.   You wonder why they make waiting so tough on parents.

If you are in the emergency room for medical care,  you are offered these things. When you are there for a psychiatric crisis, it’s different.  Mental health has stigma, blame and judgement woven into the approach sometimes and it spills out on the young person and the parent.  I smile when people talk about “complex children.”  Myself, I call them the ”unique children” who need support and so much else.

Who are they, these unique children and their families? They are children and youth with autism, violent behavior, eating disorders, gender identity concerns, and sexualized behaviors. They are children who are sometimes hard to treat successfully.  They are children who burn out their parents and often their siblings. They are the children that need support ASAP, not waiting in the hospitals until someone or something is asked or pushed or goes the extra mile to get that kid in.

When I first began to advocate for my child’s education program, I never thought I would have to learn the special education laws or strategies to use them.  When I first brought my child to treatment, I didn’t realize I would need to learn to call the insurance company and even appeal.  Most of all, I thought that if I could get medical care for my child with mental health needs it would be much easier to get care for his brain!

In Massachusetts and across the country, we are talking about integrating medical health care and mental health care to create a brave new health care world.  This is exciting.  It’s going to be quite an undertaking and will need the voices of youth and families to work and tackle the problems.   It also is going to need all that stigma and  judgment and blame to go away and have real empathy for  what families go through and that the heart and brain are equal in care.

One way to start is that if your see a family waiting with their child or young adult in the middle of a psychiatric crisis, show that caring right now.  Ask, “Do you need a toothbrush, a phone charger, some water or something to eat?”  We have to start somewhere to make this happen.  Let’s start first in treating all people like humans in the emergency room and teach the system that the brain deserves respect and understanding.  The parents, youth and young adults do too!

Meri Viano is our guest blogger.  She is the parent of two sons and a daughter who continue to inspire her blog posts.

 

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7 tips from a support group fan

January 23rd, 2017

Okay, I’ll admit it.  I’m a support group fan.  I think groups can do lots of things all rolled up in one place – support (of course) and hearing about resources you never knew were there.  But other things, too, like receiving high fives for getting through a tough school meeting or finding shortcuts to strategies you need.  Through it all, you know you aren’t alone.

So what’s the draw in this age of social media?  Online, we can congregate, stay in our sweats or PJs and never leave the house.  It has to be worth it to venture out.

I started out as a support group member.  My son was seven, having meltdowns three or four times each day and I was overwhelmed and fresh out of ideas. I was running to appointments, talking to the school every day.  Regular errands, like going to a grocery store were a surefire way to add in more fireworks, turning a half hour task into 90 minutes or more.  When I looked in the mirror I saw someone who was discouraged and depleted.  She needed help.

I had my own therapist, as did my sons, and they were great.  But they hadn’t lived what I was living.  They didn’t know the mixture of dread, fear, sadness, anger, guilt and exhaustion I lived through each day.  I went looking for someone like me.

I didn’t find her. Instead, I found another mother who was just as overwhelmed and depressed but had great ideas on how to fit in some mental health breaks during the day.  I found parents whose children had a range of special needs and they had a menu of strategies for success with their insurers and their schools.  I heard about books to read, movies to watch and experts to seek out.  I met people who reminded me to laugh. Evem better. they were all in one group. My knowledge increased and what’s more, I learned to see value in the little successes and try out new ideas – often ideas I hadn’t had myself.

We moved a year and a half later and it was brutal losing that group.

Not long after, someone asked, “Why don’t you start your own group?  You’ve been a group member,” she said.  “It will be a piece of cake.”  Not knowing what I was getting into, I said yes.

The first meeting seven people showed up.  They weren’t sure why they decided to come and I wasn’t sure what I could offer.  At the end of two hours we were laughing, sharing stories, eating food and rooting for each other.  We were all parents who had children with emotional and mental health issues, some with diagnoses, some without.  By the end of the second month, people were talking and meeting outside the group.  By the end of six months, they were going to hospital and school meetings with each other.  One mom broke her ankle just before Christmas and another went shopping with her, carrying bags she couldn’t manage on her crutches.  “It’s not even my holiday, the other mom told the group. “I’m Jewish.”

Every support group has a kind of individual chemistry and a lot of that comes from the facilitator.  If you are kind and compassionate, your support group will be too.  If you like rules, it will be orderly and if you like laughter, people will share their humor.  If you are curious, hopeful, determined, accepting and friendly, those qualities will show up.

Although we had a short list of group “rules” two were repeated often by group members.  They were, “what’s said in the group stays in the group” and “no blaming.”  A third rule – the group belongs to the group – was taken as a given.

One mom, Mary, would come to the group regularly with her husband.  She had a teenage son with bipolar disorder and told us he got it from her.  She felt so guilty, she said, that she passed on the bipolar.  Another group member put a stop to that.  “There is no blaming here, not even blaming yourself.”  Once Mary came and was frazzled, spoke rapidly and had difficulty staying still.  “I’m off my meds, she told us.  “I’m worried I might be pregnant and I don’t want to take a chance my psych meds could hurt a child.”  She couldn’t afford a pregnancy test until the next paycheck.  Another group member grabbed her car keys, ran to the local Walgreens and bought a test.  She and Mary disappeared, then came back with the results, which were negative.  Mary promised to start her meds again that night – she did – and group members called to be sure she was back on track.  She was supported and directed but never judged.

Tell me, can you do all that online?

Another member, Maureen, found a way to make us laugh no matter how dire things got in her life.  Her nine year old son had tried to jump out a classroom window.  Instead of agreeing that he needed special education, the school system moved his class to the first floor, so he wouldn’t have far to fall.  Her son also saw things that weren’t there.  One day, she told us, he ran to her and said there was a man in his room and the man was jumping on his bed.  “Honey, she responded, “I should be so lucky.”

I began a second group a few months later and both lasted for seven years, until I began a new job and couldn’t do it anymore.  It was even harder leaving those groups than it was my first one.  Each meeting was like watching a soap opera or a reality show and I would be drawn in, rooting for people, holding my breath at other times.  I was left wondering what happened next to everyone.  Occasionally, I would hear a snippet, get an email or connect with someone online.  Considering what they had braved, most everyone was doing pretty well.  They certainly deserved it.

I’ve thought a lot about what makes a group work, because when it does, there is nothing like it.  Here are my top 7 tips.

1.  Create a community, not a group. Groups have a set time, specific rules and guidelines.  While those are important, they don’t make a group successful.  When members feel like this is their community, things take off.   Communities are built on a sense of belonging, shared experiences and knowing what you can expect from each other.

2. Share the emotional connection. The members of the group will come looking for someone just like her, or him.  Like me, they won’t find it.  But their experiences will echo one another’s.  In one group, a mom described her son’s intense depression and how isolated he was.  “At least he doesn’t use drugs,” she said.  The next mom said, “My son uses,” and went on to describe his isolation and how it tore her heart.  They connected that night and sat next to one another for the next several meetings.

3. Emotional safety is essential. Parents live with chaos at home and frequent unpredictable behaviors. When a group has group rules, a lack of judgement, a commitment to honesty, clear boundaries around confidentiality, members can breathe.   Sometimes you don’t get all the rules right, though.  I was terrible at ending on time, often finishing a conversation in the parking lot.

4. The facilitator must have personal experience raising a child with emotional and mental health challenges. Some experience with support groups is pretty important, too, as facilitator training alone doesn’t do the trick.  Culture matters a lot as well especially when groups draw from communities that are diverse.  Remember, the facilitator is not the authority, but should be the catalyst for creating a community.

5. Foster networking and mutual support.  Parents often feel pretty alone.  They are like Atlas holding up the sky, not able to let go of the responsibility.  Groups work when the group doesn’t just support the members, but the members support one another.  I knew one group leader who did a lot of one-to-one work with parents.  When she formed a group, the members tried to continue their individual relationships with her, instead of forming new ones with each other.  It didn’t work out very well. Some group members will cook for the group, make calls, form carpools or even advocate for one another.  It’s their group so they know what works.

6. Continue to grow the group. Group members come and go, but if you’re lucky you have a mix of long time members and newer ones. It’s hard for parents to locate groups, so facilitators have to get creative when marketing.  I took a lot of calls from parents before they ever stepped into a meeting.  They’d say, “Do you think I’ll fit in?” “Do I have to talk?”  Facilitators have to reach out – often by phone – before meetings, afterward and in between.  Connection fosters community.

7. Nurture future leaders. When you run a group, everyone at the group watches you.  It can be unnerving at times, but this is how we all learn.  When someone offers good advice or brings in a new resource, sit back and smile.  They might be doing this too someday.  We’ll need them.

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Redefining family

January 8th, 2017

It’s been hard having to deal with a diagnosed mental health challenge for most of my life. Every day I have to be aware of where my emotions are heading, how low is “too low” and the difference between seriously wanting to die and just having a really bad day.  I have to have the recognition that, at least right now, one of the major reasons for my prolonged stability is taking the right combination of psychiatric medications consistently every day.  Having to deal with all of that, and adding a clear lack of family support on top of it, made my journey to my now-almost-four-years of stability a much harder place to get to.

Growing up in a big family, a relatively happy person in a relatively safe small town, family was important to me. Being adopted, I already knew family didn’t have to be blood-related, but as far as I was concerned being part of a family, even an adoptive one, meant that we all looked out for each other. And that even if we had challenges or conflicts, that family was family and you never turned your back on them.

That all changed when I hit an all-time low in my mental health journey when I was 19. I’d been hospitalized off and on about six times before that over a three year period, but I was always able to change a medication, continue therapy, and get back to my life in the community. That year, though, I was hospitalized 13 times, had been admitted to and decided to quit my partial-hospital program twice, and had switched therapists multiple times. On top of all of that, all of a sudden, the little emotional support from my family that I had been receiving was taken away.

I was in the lowest emotional spot I’d been in my life, and now even my family couldn’t stand being around me anymore. In this particular circumstance, I was told by my parent during an inpatient hospitalization, during a three minute phone call, that I would not be welcome to come back home after I got out, leaving me effectively homeless. This one phone call extended that admission for over a month due to my increased suicidality and hopelessness.

Four years later, I have learned some valuable lessons about family through the few rough years that followed that phone call. I’ve learned that family is however you want to define it, and whomever you want to include in that definition. It doesn’t have to be blood-related, or a legal bond, like adoption. It can be whomever you feel is your family.

For me, I now have a self-made family that is my most important support system. It’s made up of close friends from all walks of life who I have chosen to become my family. They’re the adult supporters who cheered me on when I became homeless and supported my decisions in my mental healthy journey. They knew that I was capable of more and stood by my side to help me achieve it. They’re former clinicians who went above and beyond their job descriptions and to this day maintain a connection with me. And they are peers from all walks of life and age groups who sat by my side and heard my lamentations and knew where I was coming from because they’ve experienced challenges too. Peers who would validate my situation, but also wouldn’t let me drown in the despair because they knew all too well the dangers of dwelling too long in the deep end.

I think one of the hardest lessons I’ve had to learn for my own mental well-being is the recognition that even if people are supposed to be family, it is unrealistic to expect support when  that person is not capable of being that supportive person for you. And for me, in my individual journey, that recognition also meant forgiving those people for past hurts, and not holding on to those negative feelings within myself and letting it taint my interactions with them today.

Because for me personally, if I’m still letting those past hurts inform my present, then I’m still being held back from being the best version of myself that I can be. And me not becoming the best version of myself isn’t something I’m willing to risk.

Dani is a 24 year old college student and mental health advocate living with bipolar disorder.  She enjoys writing poetry and singing, as well as being the proud parent of 2 adorable felines.

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What’s in my wallet? Not much after mental health costs.

December 27th, 2016

My ex-husband and I divorced when my sons were 8 and 5 years old.  My 8 year old had already been through three psychiatric hospitalizations, was in regular therapy and routinely threatened to hurt himself as well as his brother.  Unsurprisingly, his brother was in therapy too.  I thought I was smart; as part of the divorce negotiations we set aside $15,000 to cover co-payments and other costs not covered by our very good insurance.  Naively, I thought it would last for many years.  Instead, we blew through that amount in less than 18 months.  So much for lasting.

This is the part of mental health care we don’t talk about enough:  the high cost of paying for it even when you have good insurance.  In the December 2016 issue, Money Magazine takes this topic on and points out, “A mental health challenge can strike deeply at a family’s financial well-being.”  The article goes on to point out that “patients bear 16% of the total costs of mental health treatment, the highest portion of any common illness, including high blood pressure and diabetes.”  Let’s get real here, much of the time, it’s the family taking on the costs.

Many of us have figured out how to make it paycheck to paycheck, maybe even with some extras like taking the family to the movies, or going on a vacation or buying little extras when they go on sale.  But the costs for co-pays, medications and other things not covered by insurance often make that impossible.

Like many parents whose children have mental health needs, at one point I was shouldering the co-payment for three visits per week (both sons and my own) and very high co-payments for four medications each month (because the ones that had been around long enough for there to be a generic version simply weren’t effective).  Like many children and young adults, my son was on several medications targeted to different concerns – anxiety, cycling moods, insomnia, inattention and outbursts. Each medication came with a high price.

My son also had to try medications we were sure wouldn’t work because our insurance had a policy of “failing up.”   He had to be on the cheaper, ineffective medication for two weeks to prove it was a no-go.  That’s two weeks of slowly increasing the dosage, deciding it was a bust, then weaning him off.  This might make financial sense, but it’s an awful way to zoom in on good care. I was gambling that the new medications would work – and was therefore willing to cough up the money.  I am not alone.  Just last month a parent emailed that she had been paying more than $900 per month for her son’s medications – and that was the part insurance didn’t cover.  She added that she had two other children and one was beginning to show signs of a mental health challenge.  She didn’t know where the money was going to come from.

Medicaid (MassHealth) often has better mental health coverage than commercial insurance, paying for more kinds of care and at a lower cost.  But there are still those “other costs,” the ones parents share in story after story.  One mother told me that she had bought 16 remote controls in 6 weeks.  When her son had a meltdown, she said, he threw them and damaged them. If she or her other child wanted to watch television, she had to replace them. He often threw them at lamps, so she was making do with overhead lights. Other parents report that there are holes punched in walls – it cost what to repair that?—in lots of homes.  Until my son was in middle school, he chewed through t-shirts at a rapid clip.  One fall, I bought 15 for the school year and they were all shredded by November.  It can add up to hundreds of dollars, dollars that used to go for family movie night.

Money Magazine also reports that insurance claims for mental health services are denied at a high rate.  Many families pull money out of other places to fund what insurance refuses to pay.  (Yes, they know that they can appeal, but often don’t have the extra wherewithal to take it on.)  One dad told me that his daughter was passively suicidal. He explained that, “She would deliberately walk in front of moving cars unless stopped or would lie down in the street and beg cars to run over her.”  His insurance refused to pay for a neuropsychological evaluation, which he (and the therapist) believed was needed.  “The good news, he told me, “Is that I just received a small inheritance from an aunt.”  He used that money to pay for the evaluation and later for a therapeutic school.  Unfortunately, the money ran out before she stopped needing care.

Not everyone thinks that mental health problems can be life threatening, but they often are.  When your child talks about death or not wanting to live, parents will raid that college fund, go into credit card debt and blow the family budget.  But sometimes, we try and stretch the dollars by spacing out the therapy visits, having treatment breaks or forgoing care for ourselves, even when we need it badly.  This is a stressful job, caring for a child with mental health needs, and can leave even the healthiest of us feeling depleted and enormously stressed.  The choice is between what we can afford and what we need.

What’s harder to measure is the impact on a parent’s earnings.  I worked part time for many years so I could go to countless school meetings, respond to emergencies and drive my son to therapy and other appointments.  Parents turn down promotions, switch to jobs that are more accommodating for employees with erratic home demands and learn the ins and outs of the Family and Medical Leave Act. A great many carve slices out of their work life to accommodate the demands of raising a child with mental health challenges.  Many times, things improve and parents are back on their chosen career track.  But the lost earnings have a long term impact.

There’s a growing recognition of the financial impact of raising a child with mental health challenges, often through young adulthood.  It’s not the first thing parents talk about when they tell their story, but it’s a universal experience.  The multiple co-payments, the high costs of psychotropic medications, the extra costs (like the several dozens of t-shirts I bought each year) all have their impact financially and emotionally.  We all know that someone has to pay, but can we figure out a way to make this work better?

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