First Person Singular: Relapse and the return of depression

Ever since my worst bout of depression, I’ve lived in fear of relapsing, of going through the insanity again. There have been a few occasions where I’ve felt it creeping up on me, but I’ve managed to ride the wave – I took time off work; I sought support from my loved ones and my doctor. I increased my medication, which helped, for a while at least. I kept my mind active; through blogging, studying, reading; anything I could find to keep my thoughts at bay.

Unfortunately, it wasn’t enough. I went out one night, had a few drinks and, whilst walking home, slipped over on ice and strained the ligaments in my left ankle. As I tried to stand up, I went over on the same ankle again. I went to the doctors, and I was signed off work for two weeks, and given strict instructions to rest my ankle.

It was quite pleasant for the first couple of days. I had been feeling a little burnt-out from studying and working, and the chance to rest and relax with no pressure to do anything was enjoyable. Sadly, the feeling didn’t last.

Sitting around all day left me far too much time to think. It also left me feeling extremely lethargic, yet unable to sleep as I hadn’t done anything all day. I’d lie awake all night, with nothing to do but think. My thoughts often become dark during the night, even when I’m doing well. But I wasn’t doing well. I was struggling, my defences were lowered, and the depression was returning.

The problem I had was that I didn’t actually realise. It crept up on me slowly, with a subtlety that took me by surprise. I’ve spent so long fighting the illness that I didn’t realise that I had lost the balance of power; the depression had used my physical injury to worm its way back. I misread the usual tell-tale signs; I put them down to my injury, to boredom, to the stresses of Christmas. A foolish mistake, but one that was easy to make.

I should have noticed that I was withdrawing from interaction with people. Even though I had nothing to do with my time, I wrote nothing. I could barely muster the energy to tweet, never mind write a blog or an email. There were days I couldn’t even bring myself to turn my laptop on. I just lay in bed, repeats of Two and a Half Men and Jeremy Kyle on a seemingly endless loop. Yet, although I watched them, I wasn’t taking any of it in. It was just background sound, something to break up the tedium, the silence.

I didn’t notice that I was becoming more insecure. I didn’t realise that I was caring less and less. I couldn’t comprehend that it wasn’t the physical injury causing me to be in a bad mood – it was my mental illness flaring up.

With so much time on my hands, it flared up a lot faster than I could have expected. Previously, when my illness raised its ugly head, I could keep myself busy and stave it off. But not this time. The worst part was that it was an English winter, where it becomes dark around 4pm. Too much darkness, too much isolation, too much time to think.

The dark thoughts returned. Everything became pointless. I realised I was ill again, but that didn’t help the situation. If anything, it made it worse; because it was the very embodiment of the thing I’ve feared the most for the last couple of years – the return of the ‘madness’. Once again, I couldn’t trust my thoughts. My brain was telling me things, I was having thoughts that I knew weren’t right, yet I couldn’t stop them.

Much like the last time, I felt I was going insane. Yet, this time, I found myself wishing I actually was. That may be hard to understand, but I can’t express how hard it has been fighting this illness. I’ve been fighting it for fifteen years now, and it’s so, so tiring. The constant feeling of being on edge; overanalysing every bad day, every negative thought, it’s worn me down so much. I couldn’t face going through another massive bout of depression. I just wanted it to all go away. If I was in a hospital, if I gave in to my thoughts, at least I wouldn’t have to worry about all the particulars of daily life. I wouldn’t have to expend so much energy appearing ‘normal’ all the time. I wouldn’t have to face the world every day.

The thing is I’m not insane. I’m not a freak, or a madman. I’m just unwell. Deep down, I know that. But in many ways, that’s what makes it so hard. The mind is such a mystery, there is so much we don’t understand about how it works, and I’m scared. I don’t understand my mind, but it feels like there are two different sides in there, the ‘normal’ Andrew and the ‘mentally ill’ Andrew, and they are constantly at war. I’m terrified that one day, ‘mentally ill’ Andrew will win the war, and ‘normal’ Andrew will be lost forever.

Maybe that will happen, I don’t know. I’m exhausted from the constant battle, but I’m still fighting. I’m not going to lose ‘normal’ Andrew. I went to the doctors: my medication has been changed yet again, and I will be undergoing a psychiatric assessment in the New Year. My doctor thinks I may be bipolar, and if so, then maybe I can find the balance that has always been missing from my life. But then, maybe it isn’t bipolar. Maybe it’s something else; maybe it’s nothing at all. Part of me doesn’t even want to know if there is anything.

The thought of a psychiatric assessment is scary. Admitting it here is even scarier, and I’m concerned about the reaction. But I’m not going to hide from it, and I’m damn sure not going to be ashamed of it. After all, the only way mental health stigmas will ever be broken down is with honesty, and by confronting those who abuse people with mental illnesses. I’m not going to allow narrow-mindedness to cause me to go into hiding or to make me feel ashamed of whom I am. We look back now at the abuse people have suffered for the colour of their skin, and we are rightly appalled. I firmly believe that, at some point in the future, the abuse of people with mental health issues will be treat with the same disdain.

In the meantime, I’ll keep writing, and I’ll keep fighting, both my personal battle with the illness, and the wider battle against the prejudice. It’s all I can do.

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How to tell if your child needs mental health services

By Amy Wang, The Oregonian, Jan. 12, 2013Teenage girl

A study of more than 6,000 U.S. teens and their parents, published last week in the journal JAMA Psychiatry, found that most adolescents who consider or try suicide have received some mental health treatment, according to The New York Times.

READ – “Study Questions Effectiveness of Therapy for Suicidal Teenagers,” The New York Times

READ – “Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents,” Matthew Nock, et al, JAMA Psychiatry, Jan. 9,2013 (PDF, 249KB)

Meanwhile, tragedies such as last month’s shootings in Clackamas Town Center and Newtown, Conn., have indicated that other young people who need mental health treatment never get it.

Here are tips on how to tell if your child needs mental health services from Chris Bouneff, executive director of NAMI Oregon, the state chapter of the National Alliance on Mental Illness; Cyndy Rutto, a psychiatric-mental health nurse-practitioner in private practice in Portland; and Sarah Mack, a certified parent coach with Skelton Thomason and Associates, a Portland educational consulting firm specializing in therapeutic programs for children and adolescents.

Trust your gut — After years of hearing from concerned parents, Rutto said, “I don’t think I’ve ever had a call that wasn’t appropriate.”

Know the signs — For school-age children, Rutto said, red flags include a sudden unexplained decline in academic performance, constant worrying, persistent nightmares and resistance to typical social activities.

Prolonged aggressive behavior — more than six months — and frequent unexplained tantrums are also cause for concern.

There are physical red flags, too: extreme anxiety presenting itself in the form of severe stomachaches, constant fidgeting, inability to sit still or pay attention for any length of time and invading others’ personal space.

Any child who threatens to kill himself or others should be evaluated, Rutto said.

Bouneff said parents should also take note of a child who starts having problems with daily life, such as becoming next to impossible to manage on outings.

The easiest thing for a parent to see, he said, is sudden inability to succeed at or progress in an area where a child once did fine.

Adolescence is a particularly important time to observe a child’s behavior, Bouneff said — mental health disorders start between ages 14 and 24 in about three-quarters of cases.

It’s normal for teens to be moody, but “a kid who’s locking themselves up and in the depths of despair for two or three days at a time, or for 50 percent of the time over a two-week period,” needs evaluation, Rutto said.

Other possible symptoms of teen mental illness, especially in combination, include significant changes in eating or sleeping patterns, hyperactivity, increased agitation or irritability, sexual acting out, obsession with body image that has no relationship to actual weight, excessive dieting or throwing up, self-injury or other self-destructive behavior, repeated threats to run away and criminal activity or opposition to authority.

Mack noted that parents should give behavior more weight than words during discussions of possible problems or treatment. “Sometimes your child will tell you they don’t want treatment, but their behavior is a cry for help,” she said.

See a pediatrician — Bouneff cautioned that pediatricians are often just the first stop. “Particularly in younger children, it’s really hard to tease out if there really is something going on,” he said. “Recognize that whatever your pediatrician’s able to tell you or refer you to … it may just be the beginning of the process.”

A knowledgeable pediatrician can refer parents to agencies that do screenings, which vary, Bouneff said. Some focus on sensory problems, while others focus on disorders such as ADHD.

Prepare for a marathon
— “Just because a screening indicates something, that’s not necessarily the diagnosis,” Bouneff said. “With children it’s very tricky to diagnose anything. … It can be a long series of observations and trial and error to see what a child is dealing with.”

“Kids are a moving target,” Rutto said. “You don’t want to jump right to a major diagnosis; in fact, it might be something less.” The best approach, she said, is “looking at the big picture but constantly reassessing as you’re going along.”

Rutto, Bouneff and Mack all stressed that mental health treatment takes time, including the time it takes to find the best-fitting practitioner and/or treatment.

Take notes — One thing NAMI Oregon teaches parents is how to document all the various doctor visits, Bouneff said. He also recommended that parents keep journals of children’s symptoms, writing down “things that are unusual, things that stand out, that cause you concern. Then that’s a good well of information when you do go see a clinician.”

Stay connected at school
— Educators are good at spotting symptoms because they see a lot of kids, Bouneff said. However, he added, some educators try to diagnose kids themselves, so parents must become advocates for their kids, including blocking attempts to prematurely label a child.

Be wary of medication
— “Pills are not the answer,” Rutto said. “No child should ever be on medications without being in therapy. Therapy is the thing that gives you tools for your tool box.”

If things get worse
— When standard outpatient therapy doesn’t work, families often begin looking for long-term treatment, and that’s when Mack meets them. Her company helps parents sort through the options, including wilderness and residential programs.

Skelton Thomason’s clients are typically between ages 12 and 26, with problems such as anxiety, depression, grief and loss, bullying, adoption and attachment disorder, substance abuse and gaming and Internet addiction.

Mack said the staff has 10 risk factors it uses to assess whether a young person is a suitable candidate for long-term treatment:

  •  No significant progress after at least six months of outpatient therapy.
  •  Escalating negative behavior.
  •  Behavior that has profound negative effects on family dynamics.
  •  Acting in a way that puts him/her at physical risk.
  •  Acting in a way that already has or could put him/her at legal risk.
  •  Attending school erratically, failing classes and/or showing changes in school performance.
  •  Changing friends or showing significant negative influence from friends
  •  Dropping out of activities that he/she once enjoyed.
  •  Exhibiting extreme behavior that is out of character.
  •  Experimenting with drugs and alcohol.

If parents aren’t ready to consider residential treatment or want to give a child another chance at home, Mack said, Skelton Thomason also offers coaching on developing rules, setting boundaries and determining expectations and consequences.

Practice self-care — Parents can’t do what’s best for their child if they themselves aren’t sound of mind, Mack said. “Surround yourself with supportive friends and family members who can provide assistance and objectivity while making a very emotional, important decision.”

Resources

  • Health insurers: If parents don’t know where to start, Mack suggests they call their insurer. That includes the Oregon Health Plan, which covers mental health services such as therapy, behavioral health day treatment and psychiatric health facilities.
  • NAMI Oregon: The state affiliate of the National Alliance on Mental Illness has phone and email helplines: 1-800-343-6264 and namioregon@namior.org. It offers classes and referrals to support groups and resources.
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Tour Central City Concern’s exceptional response to mental illness

Tour presented Kathleen Roy & Rachel Solotaroff, Director of Mental Health & Medical Director, Central City Concern

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‘Cut for Bieber’ Internet hoax targets young fans

By Jenny Westberg, Portland Mental Health Examiner, Jan. 9, 2013

Justin Bieber

Justin Bieber

Fans of teen heartthrob Justin Bieber are the targets of a virulent Internet hoax that uses fake Twitter accounts and hashtags like #Cut4Bieber to manipulate them into cutting themselves, supposedly to convince the singer not to smoke pot, The Oregonian reported yesterday.

Earlier this week, as the sham trending topic soared to over 26,000 hits in 12 hours, alarm and disgust also rose. Miley Cyrus joined in Jan. 7, retweeting a message from another user:

“Who tweeted “‪#cutforbieber? Cutting is NOT something to joke about. There are people who are actually suffering from self-harm, this is so disrespectful.”

The shocking hoax started on a message board at the 4Chan website, Complex revealed Jan. 7, with an anonymous troll suggesting they “get some little girls to cut themselves” by starting a fake movement to get Bieber to stop using marijuana. The thread (which has since been removed) included several, similar hashtags and suggestions to post pictures of acts of self-harm.

While some of the pictures were obvious phonies, TheCelebrityCafe said others appear to be genuine.

The trolls also created fake Twitter accounts, for Mary “Jazzy” Richards and Addison Smith, and falsely claimed the two were dead because of the scam.

Bieber has so far been silent about the hoax.

Cutting and other types of self-injury are not rare. According to HealthyPlace,1 in 5 females and 1 in 7 males self-harm each year. Even that might be low. Many who cut or self-harm feel shame about it and try to keep it secret.

Yesterday a new web page sprang up, called “Don’t #Cut4Bieber.” Here are some resources to help.

Resources on self-harm:

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Rally for Universal Health Care in Oregon on February 4

Of all the forms of inequality, injustice in health care is the most shocking and inhumane. – Martin Luther King, Jr. 1966

jwj bw

Rally for Universal Health Care in Oregon
February 4 – State Capitol, 10:30 AM – 12:30 PM

Representative Michael Dembrow has reintroduced the Affordable Health Care for All Oregon Act, a comprehensive, equitable, publicly funded, high quality health care system serving everyone in Oregon. It is time to get behind the bill and push for passage. This is a tremendous job and to do it, we need to create a massive grassroots movement. Can you commit to be there?

Please sign up at one of the links below:

More information? Contact the Jobs with Justice Healthcare Committee 503/236-5573

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AMA Coalition files court papers to intervene in city-DOJ negotiated settlement on police reforms

From The Oregonian, January 7, 2013

The Albina Ministerial Alliance Tuesday afternoon filed a motion in federal court to intervene in the city agreement with the U.S. Department of Justice governing Portland police reforms.

Eds. Note: The motion for intervention was filed by the Albina Ministerial Alliance Coalition for Justice and Police Reform – not the Albina Ministerial Alliance. The AMA Coalition is a project of the AMA, but also includes other organizations and individuals which are not members of the AMA, including Disabity Rights Oregon, the Oregon chapter of the National Lawyers Guild, the Mental Health Association of Portland, and Portland Copwatch which is a project of Peace and Justice Works.

The alliance seeks to intervene as a plaintiff in the pending case United States of America v. City of Portland.

READ – Memorandum in support of AMA motion to intervene, 21 pages (PDF)
READ – Declaration of Dr. LeRoy Haynes iso AMA motion to intervene, 6 pages (PDF)
READ – Intervenor-plaintiff AMA Coalition’s motion to intervene, 2 pages (PDF)
READ – Officer-involved shootings and other in-custody deaths by the Portland Police Department, 2000-2011, Albina Ministerial Alliance Coalition, 31 pages (PDF)

The alliance argued that the settlement agreement failed to address concerns raised about police use of force against people of color; lacks strict restrictions on police use of Tasers and provides no formal process for court oversight once an agreement is signed.

“Thus it is critical that an intervener representing the public’s interests be part of this process,” attorneys J. Ashlee Albies and Shauna Curphey wrote in a motion on behalf of the alliance.

The alliance is a group of 125 Portland-area churches that has been engaged in social justice work since the 1970s. The Albina Ministerial Alliance Coalition for Justice and Police Reform was founded in 2003 after the officer-involved fatal shooting of Kendra James.

“The AMA Coalition, with its diversity and deep roots in the communities most affected by the Portland Police Bureau’s excessive use of force against people with mental illness and persons of color, and long history of police reform advocacy in Portland is best suited to represent the interests of the community as an intervenor,” the attorneys wrote in a memorandum in support of its motion.

The Albina Ministerial Alliance submitted to the court a chart of shootings over the past decade. Its research found that at least 30 percent of the 61 people shot at or killed by Portland police were people of color, in a city that is almost 79 percent white. Of those 61 people, 14, or 23 percent were African American, according to the Alliance’s court filing. Twenty-two of the 61 people, or 36 percent, were unarmed, according to the alliance’s analysis.

Tuesday was the deadline for any person or group to file a motion to intervene in the case.

The Portland Police Association is the other group to have sought such intervention.

The U.S. Department of Justice and City of Portland have until Jan. 22 to respond to the motions.

U.S. District Judge Michael H. Simon will hold a hearing Feb. 19 to rule on them.

The court filings stem from the U.S. Department of Justice’s nearly 15-month investigation into use of force by Portland police. The inquiry found police engaged in a pattern or practice of excessive force against people suffering from or perceived to have a mental illness.

The settlement, approved by the City Council on Nov. 14, calls for widespread changes to Portland police policies on use of force, Tasers, training, supervision and oversight. A community liaison official would be hired to oversee the agreement, under the settlement. A federal judge would maintain jurisdiction over the agreement, and could be asked to intervene if the agreement is not followed.

The Portland Police Association also has filed a motion to intervene. In court papers filed last month, the police union argues that the negotiated changes to Portland police policies and procedures undermine the collective bargaining rights of union members.

The union cited a 9th U.S. Circuit Court of Appeals case that allowed the Los Angeles Police Protective League to intervene in a consent decree before the federal court on Los Angeles police reforms in 2002.

Members of the public will be able to participate in a so-called “fairness hearing” before the federal judge at a future time to express their opinions on whether the negotiated settlement is “fair, adequate and reasonable.” No date has been set for that public hearing.

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Columbia River Mental Health Services lays off 16

From the Columbian, January 5, 2013

Columbia River Mental Health Services has eliminated 16 positions in an attempt to reduce the nonprofit’s infrastructure and recoup financial losses.

The cuts were primarily to support staff positions, rather than staff who directly provide services to clients. As a result, the cuts will not affect programs, said Lynn Samuels, executive director of Columbia River Mental Health.

The big driver for the layoffs was financial, she said.

For the last two years, the nonprofit has lost money. Eliminating those 16 positions will save the nonprofit about $800,000 a year in salaries and benefits, Samuels said.

“Being a nonprofit doesn’t mean you can operate in the red,” she said. “Eventually, you run out of money. It’s not a business model that can be sustained.”

The other reason for the layoffs, Samuels said, is that the organization’s client base has shrunk, making a large infrastructure unnecessary.

Clark County currently has one of the lowest rates of Medicaid patients seeking behavioral health services. In addition, the nonprofit lost the contract to operate Hotel Hope, an inpatient facility, three years ago, Samuels said.

The declining client population left the organization too top-heavy, she said.

Columbia River Mental Health began offering voluntary layoffs last summer. A few people accepted the offers, but the nonprofit issued the bulk of the layoffs in December, Samuels said.

The positions included three directors, three managers, one IT position and one accounting position, among other support positions, she said. The nonprofit now has about 180 employees.

It will now focus on getting back to its core services and business model, and work to strengthen those areas, Samuels said.

“Three thousand people, on any given day, are counting on us,” she said.

Columbia River Mental Health, founded in 1942, provides a range of behavioral health services for children, adults and families in Clark County.

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Help is sought for annual homeless count

Portland Housing Bureau is looking for volunteers to help with “One Night Shelter” counts – volunteers gather information about people sleeping in emergency shelters, motels, and transitional homes. Other volunteers will help with a street count, visiting areas around Multnomah County where people are sleeping outside, without shelter.

Volunteers can also help with data entry following the count.

The count is done Wednesday, January 30 – so CLICK HERE NOW to get signed up and start helping end homelessness

Trainings are on Tuesday, January 15, Thursday, January 17, Tuesday, January 22, and Wednesday, January 23.

If you are unable to attend any of the trainings, please contact Mary Welch at mary.welch@portlandoregon.gov to make special arrangements.

If you are interested in volunteering, please contact Mary Welch at Mary.Welch@portlandoregon.gov or (503) 823-3403. Although not required, organizers encourage those who wish to volunteer attend one of three training sessions being held. If you are unable to attend any of the trainings, please contact Mary to make special arrangements.

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