Frustration, Anger, and Hopelessness

Many people cannot understand why NAMI people are frustrated and angry so much of the time. Almost every day, or at least several times a week, we receive phone calls and e-mails from NAMI members totally frustrated by the "mental illness treatment system." With permission I would like to share an e-mail we received last Friday.

Hello Gary & Sandy,

My daughter who is 30 years old was committed to the state hospital in nearby state. While waiting for a bed she broke out of the private hospital they were holding her in until a bed was ready. She was caught and booked into jail and the next morning she was released on her own; homeless with no meds. Two days after getting out of jail she was again arrested with 4 felonies that carry life sentences. i was down there in January with my wife and helped her get into a hospital for treatment. She had an assessment done by the county mental health folks there back then and I talked to them and told them she was a danger to herself and others, but they let her go and that's when she went on a crime spree. She has lost her home and her three children now and the mental health professionals agree they made a mistake in not committing her back in January.

I am so tired of the broken mental HELL system. She has catastrophic PTSD, severe depression, poly substance abuse issues and Bi-Polar,..right now she is in the county jail with no meds. Oh, she tried to kill herself in jail a few weeks ago and was flat lined and taken to the hospital, then put back into treatment and then committed to the State Hospital when she broke out.

There is no cure for mental illness at this time. Successful treatment is extremely difficult, but it is possible. I have been in Montana's mental illness treatment system for over 26 years. After our family's 7 years of Hell we were able to get a diagnosis and develop a relationship with caring, compassionate, competent mental health professionals. Things have only gotten better, but we are not the average family who gets involved in this system. We were fortunate to have mental health professionals who believed in the collaborative treatment model which involved the individual with the illness and the family in developing a plan to manage serious mental illness.

When will ALL mental health professionals embrace the collaborative model? When will individuals with mental illness and their families be recognized as part of the solution and not the problem? Montana's Olmstead Report (Which is gathering dust on a shelf somewhere) concluded what is really needed to improve and change Montana's mental illness treatment system is a change in attitude.

And, until we see that change in attitude, Montana's individuals living with serious mental illness and their families will continue to be frustrated, angry and feel hopeless.

Dr. Gary Mihelish
NAMI Montana's Director of Government Affairs

Thoughts on Suicide

The tragic suicide yesterday of Mark Madoff gives me cause to reflect and advocate. This was once again a terrible and unnecessary tragedy. I have also just completed, "Myths about Suicide" written by Dr. Thomas Joiner from Florida State University. It is a must read for anybody wanting to understand suicide.

Every year over a million people worldwide commit suicide. The most recent statistics in the U.S. indicate over 34,000 suicides occurred in that year. The most recent statistics from Montana in 2008 indicate 202 Montanans took their own lives. Montana annually has, if not the highest, one of the highest suicides rates in the nation. A suicide attempt occurs every minute of each day and a person dies from taking their life every 16-18 minutes in the U.S.

Dr. Thomas Joiner: "We need to get it in our heads that suicide is not easy, painless, cowardly, selfish, vengeful, self-masterful, or rash; that is not caused by breast augmentation, medicines, "slow" methods like smoking, or anorexia, or, as some psychoanalysts thought, things like masturbation; that it is partly genetic and influenced by mental disorders, themselves often agonizing; and that it is preventable and treatable. And once we get that into our heads at last, we need to let it lead our hearts."

" And so I am prepared to defend the view that 100 percent of suicides are characterized by the combination of learned fearlessness, perceived burdensomeness, and profound alienation from others, and that these factors, in turn, arise from underlying mental disorders, mostly of the full-blown type, but sometimes of the partial syndrome variety. As discussed in other sections of the book, people can have these conditions, especially depression, and not be psychotic or deluded, and certainly in the case of people with terminal illnesses, people can have subsyndromal depression that most of us can readily understand, sympathize, and even identify with. But none of this changes the fact, in my view, that mental disorders represent the matrix from which serious suicidal behavior emerges."

It is simple, but yet so difficult to reduce suicide. If 10-15% of individuals living with serious mental illness (mental disorders) end their lives by committing suicide, we must better treat mental illnesses. We must end the discrimination and stigma individuals living with serious mental illnesses and their families endure. Its all about EDUCATION, EDUCATION, EDUCATION! We all must develop an understanding of serious mental illness and also develop caring, compassion for those who live with these illnesses.

As we say in NAMI, it is the responsibly of families, friends and mental health professionals to keep our family member alive until they can obtain effective, evidenced-based treatment.

Dr. Gary Mihelish, President
NAMI-Helena

Tips for Coping with the Holidays

TIPS FOR COPING WITH THE HOLIDAYS

from NAMI Connections

• Stay close to family and friends who understand your illness.
• Take your medications as prescribed. Be sure to get the sleep you need.
• Celebrate the holidays in ways that are comfortable for you.
• The holiday season does not stop feelings of sadness and loneliness. Give yourself permission to work through these feelings.
• Don’t compare this season with previous ones. Enjoy all the little things you have now.
• Talk about the stress you feel with family and friends.
• Keep expectations manageable. Plan your work and work your plan.
• Set a budget and stick with it. Many items that you can give do not cost money – a phone call to a friend may mean more.
• Do something nice for someone else. Do something nice for yourself.
• Stay out of department stores.
• Play your favorite non-holiday music.

Happy holidays from NAMI Montana

A Simple Way to Save Lives

NAMI Montana supports, educates, and advocates for Montanans who live with serious mental illnesses and their families. The most basic part of our mission is teaching that these illnesses are medical conditions of the brain that require treatment by both a psychiatrist and a therapist. I’d like to share the words of one young mother that followed this lesson.

Matt, I have been on medication since January, and my life has changed entirely! I am experiencing only happiness and genuine excitement about waking up each day! No more panic attacks, no more anxiety, just a whole lot of me being honest about my condition and really trying to do something about it! Had I taken your advice sooner, I would have probably healed much more quickly. Cognitive therapy works so much better (I speak only for myself here) with medication. Thank God we live in this day and age where it is easily accessible.

I passed this hopeful message on to an email list. Someone used it to convince another young mother who was nearly suicidal due to depression why she needed to see a therapist. The message worked again. It’s what NAMI is all about.

Thoughts from NAMI 2010 Convention

Six members of NAMI-Montana were among the 1300 NAMI members who participated in the annual NAMI Convention in Washington, D.C., June 30th thru July 3rd. Of course the highlight of the convention was NAMI-Montana's own Quentin Schroeter was presented the Lionel Aldridge Award, which recognizes and individual with mental illness who has exhibited courage, leadership and service on behalf of all people living with mental illness. CONGRATULATIONS QUENTIN

We also participated in an awards ceremony in the Russell Senate Building where NAMI presented Senator Max Baucus and award for his role in healthcare reform and his continued advocacy on behalf of individuals and families who live with serious mental illness. Thursday was Advocacy when we met with our Congressional Representative on Capitol Hill. We were able to meet personally with Senator Baucus and his staff, Representative Denny Rehburg and his staff and the staff of Senator John Tester.

There are always so many presentations and workshops that educate and inspire. I would like to mention three.

The research plenary discussed the NIMH RAISE Study: Altering the Course of Schizophrenia. The presenters were Tom Insel, M.D.. Director of the National Institute of Mental Health and the lead researchers, Dr. Jeff Lieberman Chairman, Department of Psychiatry, Columbia University and Dr. John Kane, Chair Schizophrenia Research, Zucker Hillside Hospital, Glen Oaks, N.Y. RAISE is a large scale research project to explore the effectiveness on early and aggressive treatment in reducing the symptoms of schizophrenia and preventing the gradual deterioration of functioning that is characteristic of chronic schizophrenia. In other words, early intervention and treatment can prevent cognitive deficits and promote a higher level of recovery. We hope to have a leading researcher at the Montana State Conference on Mental Illness in October in Billings.

The panel of Dr. Xavier Amador, Jonathan Stanley, J.D. and Delaney Ruston. M.D., presented a overcrowded presentation on "Confronting Anosognosia: How to Get Help to Those Who Don't Know They're Sick." It was interesting and provocative. Remember: TREATMENT WORKS IF YOU CAN GET IT!" Hopefully. Dr. Ruston will be a presenter at the Montana State Conference in October. She will screen her documentary film, "UNLISTED" which will premiere on PBS in October. It is a film about her relationship with her father who lived with schizophrenia. She will also present a workshop" Psychiatric Advanced Directives: Giving a Voice to Consumers."

But the "Ask the Doctor" session are always great. My favorite was "Recovery and Neuroscience by Jill Bolte-Taylor Ph.D., author of My Stroke of Insight (For $15.00 a must read), and spokesperson, Harvard Brain Tissue Resource Center. Dr. Jill is a Harvard trained brain scientist, a NAMI members and former National Board member whose brother lives with schizophrenia. Her book was on the New York Times best seller list, she has appeared on the Oprah Winfrey Show and at a reception last Saturday we learned they will be making a movie of her life. The movie will star Jodie Foster and the only problem is that Jodi Foster is not as good looking and Dr. Jill. Dr. Jill currently teaches at the University of Indiana Medical School. She has been a featured presenter at two Montana State Conference on Mental Illness and she is a friend. On December 10, 1996, she suffered a massive stroke in the left hemisphere of her brain. Complete recovery took eight years. Her presentation stressed the similarities of recovery from a brain injury (stroke) and mental illness. The most memorable quote from the convention for me was:

'SLEEPING TIME IS HEALING TIME!"

TEN PRINCIPLES FOR RECOVERY; For Individuals who live with mental illness and their families. Maybe even for mental health professionals.

1. Honor the healing power of sleep.
2. Treat me like I will recover completely.
3. Challenge my brain systems immediately.
4 Love me for who I am now.
5. Help me define my priorities for energy use.
6. Focus on my abilities.
7. Give my brain years to recover.
8. Divide every task into small action steps.
9. I am not stupid, I am wounded. Repeat for me!
10. Come close. Do not be afraid of me.

Lastly, I am not deaf. I am wounded. Raising your voice will wound me.

2011 NAMI Convention, Chicago, Illinois
2012 NAMI Convention, Seattle, Washington CLOSER!!!!!!!


Dr. Gary Mihelish
NAMI Montana

Goodbye to a Friend and Advocate

NAMI Montana friends and family. I am sorry to announce the death of our dear friend and fellow advocate Carol Waller. Carol lived with Bipolar Disorder and was a strong advocate for effective treatment for mental illness. It's an honor to have worked with her as NAMI Montana's volunteer Senior Specialist.

I'd like to share with you an article that Carol wrote about this time last year so her wisdom will continue to live on.

Thank you for all of your work Carol. Rest in peace, but please keep praying for us. It's a tough fight and we can still use your help.

matt

Dear Readers:

My name is Carol Waller. I fall into the Senior Citizen category according to the census figures. I live independently and drive my own car. I live a fairly active life and get along pretty well. But the most important thing I can tell you about myself is that I have a mental illness; depression and anxiety, and I am concerned over other people who might be in the same age range. And possibly they have mental illness, such as depression, and may not even be aware of it!



First let me give you some statistics. Montana has the highest rate of suicide in our nation! From the Census 2000, senior citizens, 65 years of age and older account for over 10% of the total population, with the numbers rising each year as the “Baby Boomers” come into their golden years. Now consider the fact that about one out of ten people in this age group suffers from some sort of mental illness, most of which is some type of depression. Of this number, two will make a suicide attempt, half of which succeed. When you consider all of this data, it seems that depression and the elderly are not taken as seriously as it might need to be.



Why do so many seniors with depression go untreated? I have often wondered that as I have been treating my own depression since my early 20’s. One reason is very obvious to me and that is the stigma that still hangs over mental illness. I grew up in a time when a person with a mental illness was classified as “crazy” and often shunned and rarely understood. Today it is not quite as bad, but still the stigma exists and can be the cause of denial in order to appear to be “normal”. Today it is also viewed as a disease by most educated people and it can be treated and you can live a fairly normal life. But still there is a stigma attached that can keep people from getting the help that they need.



So how can you tell if a person is suffering from depression? Most people have periods of sadness in their lives which is normal and different from depression. I have listed some of the signs which seem to indicate some degree of depression is present.



Of course the obvious sign is sadness: like after a death or loss of a loved one, but one that does not go away in a reasonable length of time. Usually a person suffers mild forms of depression at times like this about two times in their lifetime. A more serious depression can develop from this with other signs present.



One of the obvious signs of depression is disruption of sleep patterns. Either there is excessive sleep, not wanting to get up and start their days. The other is insomnia, where the person has trouble falling asleep and staying asleep. Personally, I had trouble with both, wanting to sleep during the daytime and then not being able to fall asleep or stay asleep. Either way usually there is no feeling of being rested.



Appetite is another thing that is affected. Either there is over eating or no appetite. I fall into the no appetite group. But in either case there is very little enjoyment of the food.



Decision making becomes very hard and at time impossible. This causes frustration and the feeling of not being up to “snuff”.



There is a loss of energy and movements may become slower and harder to make. Another loss is that of interest. Things that have excited or pleased the person in the past loose their attraction.



Low self esteem is a common problem with depression. There are memories of losses or failures and the depressed person takes the blame and feels as though they are not “good enough” or guilty of something.



As the depression episode continues there is a feeling of hopelessness; that no matter how temporary a situation may be in reality, the feeling that it will never get better hangs on. This leaves the person with no incentive for living or motivation for changing the things that depress the person.



People who observed the depressed individual apply labels which are untrue but appear to be valid, like being lazy or stupid or changed to the point that they are so ill they are useless.
This is usually followed by the thoughts of suicide. If you are thinking in these terms or have friends or family talking or thinking in terms of this being the end, do not take it lightly! This is a serious situation and needs medical attention as soon as possible. This is a case for medical attention such as a personal physician, psychiatrist or even the emergency room.



I can tell you that the road back from the brink is a hard one! Many times it is one step forward and two steps back. But this road of ups and downs is well worth the trouble. Remember, suicide is a permanent solution to a temporary situation. Recovery is an arduous journey but it is possible.



This journey usually involves medication which may alleviate some of the symptoms, psychotherapy of some sort, group activities, the love of family and friends and understanding. For more information on this topic, I suggest you contact the NAMI, MT at 443-7871, and Center for Mental Health at 443-7151, the Crisis Line at 443-5353, Warm Line at 1-877-688-3377, or your personal physicians. If it is a case of emergency, you will probably get the quickest results with 911.



It is my hope that I have provided my senior friends with some understanding of this disease, this mental illness, called depression and that the statistics do not continue to grow at such an alarming rate. This does not have to be the end, but rather a beginning of recovery.



Thank you for your interest and time.

Sincerely,
Carol Waller

Mental Illness and Justice: The Need for a New Paradigm

Last fall, I received a call from a distressed father asking me to review his son’s case. His son had been diagnosed with bipolar disorder (manic depression). The son was on parole for a crime that he had committed when he was in a manic stage. He quit taking his medication again, went manic, and committed another series of crimes. The son was eventually sentenced to seventy years in prison with twenty suspended.

I talked with the son’s attorney before sentencing and expressed my sorrow that the parole officer, family, or someone else hadn’t been able to force the son into treatment when it became clear that he was off his medication and headed for serious trouble. In many cases, a couple of days or a few weeks with the proper medical care would be all that it takes to stabilize a patient’s brain chemistry so they can return to their normal life.

The attorney looked at me in disgust and responded “but that would have violated his civil rights.”

I can’t think of a clearer depiction of our profession’s inability to grasp the realities of mental illness. The system that we’ve established and operate helped this young man avoid a short involuntary stay in favor of a lifetime in prison. It’s not surprising that under this system our State Prison houses several times more people with serious mental illness than the State Hospital.

Last month, our office worked with the family of a Helena man who suffered from a mental illness-induced psychosis that involved a major battle between angels and demons. According to his delusions, the battle would end on a specific day in early March when the man must kill the Antichrist. The family was terrified that the delusion of the Antichrist would be projected on an innocent victim on the street. The legal and medical communities felt legally blocked from averting potential tragedy.

While I understand that there is a real need to revise some of Montana’s laws pertaining to mental illnesses, I can’t help but think that part of the problem is our profession’s failure to understand the role of brain chemistry in mental illnesses and crises. Would we be this paralyzed if the dangerous delusions had been caused by someone slipping him LSD? I have to believe that we would have done more to keep this poor man’s path from intersecting with the SWAT Team or the coroner.

The man was arrested before the delusional apocalypse and sent into treatment. While we can all be happy that broad tragedy has been averted, it is shameful that he had to become a criminal in order to be freed from his debilitating hallucinations.

We can and must do better than that.

The legal system flounders when faced with someone whose biological brain disorder affects how they think, feel, and act. People who live with serious mental illnesses and their families expect us to do better than seizing someone who acts irrationally because of a medical condition and punishing them for acting irrationally. Our profession must update our conception of mental illness to reflect society’s new understanding of the effects of mental illnesses on the functioning of the brain.

The realities of the challenges presented by mental illness mirror the plight of a person who is “involuntarily intoxicated.” For instance, bipolar disorder drastically alters the release of the brain chemicals dopamine, serotonin and norepinephrine. The different levels and timing of these chemicals affect mood regulation, stress responses, pleasure, reward, and cognitive functions to cause mania, depression, or even a mix of both. A man or woman in the grips of a manic or depressive episode has effectively been drugged by their illness.

While not a silver bullet, the involuntary intoxication paradigm can be can be a valuable tool to help attorneys navigate through the complex civil rights, neglect, and public safety issues presented by someone in a mental illness crisis. It offers a major step forward in adapting our legal system to reflect the medical realities presented by these devastating illnesses.