Steps to take when you or a family member are in crisis

"Remain calm"... Easy to say, tough to do when things fall apart.

Anything from a minor fender bender to a full blown "something really bad" can send us into a state of crisis, sometimes at the drop of a hat.

What is the definition of being in crisis? In mental health terms, a crisis refers not necessarily to a traumatic situation or event, but to a person’s reaction to an event. One person might be deeply affected by an event while another individual suffers little or no ill effects.

A crisis presents an obstacle, trauma, or threat, but it also offers an opportunity for either growth or decline. (Read more on defining crisis here)

I would like to report I am better now about how I react to a crisis than I was in years past about navigating crisis. But you know how that goes. One simple utterance and the next thing we know, something even worse than we could ever imagine is standing right in front of us. So, I will keep that thought and those words to myself.

Some days it feels like we are floating along and managing, while others feel like our whole world is falling apart. Right now, as I write this, there are people marching and protesting in my city - and maybe your city too - about a black man in crisis who was shot down within minutes by the police who were called upon to help him. This story is happening all over our country. I would like to say that many of us are in a state of community crisis and some of us have that spilling into our personal lives.

Here are some steps to take "When Crisis Calls"*:

*Note: these tips are geared towards those living in the general San Diego/Southern California area. If you are living outside this geographic region, please consider checking into the mental health resources within your city. Certainly, there is a need for getting the word out to your community. Consider a grass roots effort by sending a Letter to the Editor of your local newspaper and asking to have your letter published as a way of offering tips and tools as a resource for your community members dealing with a mental health crisis.

1. Call 911, AND:
2. When you are on the phone with 911, request they send an officer who has been trained by the PERT Team. (San Diego and Southern CA area) PERT stands for Psychiatric Emergency Response Team.  PERT pairs licensed mental health clinicians with uniformed law enforcement officers/deputies. More info can be found here. *NOTE: If you call 911 and ask for the PERT Team to come and you are told it is after hours, or no one is available now, ask for a PERT trained police officer to accompany the team who will answer the call.
3. Call the San Diego Access and Crisis Line at 888-724-7240 (24/7 service provider in all languages)
4. For children and youth under the age of 18 needing emergency psychiatric evaluation in the Central San Diego area, contact the Emergency Screening Unit (ESU) at (619) 421-6900 (24/7 service provider).
5. For youth ages 4-17, in the North County area of San Diego, contact the North County Crisis Intervention and Response Team at (760) 233-0133. Hours of service are M-F 12-8 PM and Sat 12-5 PM.
6. The Emergency Medication Clinic will assist with emergency/crisis medication refills by appointment during their clinic hours M/W/F 9:00 AM - 12:00 PM. Call (619)397-6900 to set up an appointment.
7. Download the oscER app on your smartphone or tablet device. oscER is a navigational guide and support companion in a mental health crisis, and provides you with resources and information on how to prepare for, handle and recover from an emergency. Learn more here.
8. Call the NAMI Helpline M-F 9am - 5pm at 619-543-1434 OR 800-523-5933.
9. When you have a bit more time after the crisis has passed, sign up for a FREE education class. NAMI's Family to Family class - sign up at f2f@namisd.org or call 888-523-5933.

Please do not disregard the idea of reaching out to friends and family to talk about the crisis and how you're feeling. It really does help and can make all the difference in how you cope with the situation.

Do you have other tips that have come to mind that you think should be included? If so, please feel free to respond to this post by leaving a comment. I will make sure your suggestion is added to the list. And... thank you!

News about the CYF Liaison and my New Job!

I have big news. BIG.

Since we were last "together" here in this space, I was invited to apply for a job with NAMI San Diego. Now, as you may or may not know, I am a big supporter of the work NAMI does. NAMI (National Alliance on Mental Illness) has been there for me when my husband and I didn't know where to turn when dealing with our son's illness. NAMI Texas was there for me when I was looking for a helper to assist me with a Guardianship order for my son (read more here). They put me in touch with one of their board members who knew of a lawyer in that area who could help me, and she did. About that time, my husband and I took the Family to Family class, and received a TON of support, education, and learned about becoming an advocate for not only our son, but my husband's brother, who suffers from Schizophrenia. During that period, when I was fighting our insurance company for continued care for our son, I was educated by written literature NAMI supplies on their website. (You know I won a major victory in that fight, right?!)  After taking the Family to Family class, I was invited to become a teacher of this powerfully life changing class, and I gladly accepted. I taught my first class this past Spring, and really have to say that it was one of the most rewarding experiences of my life. Along with my team teacher and the class participants,

We all had the incredibly rich and rewarding experience in working as a group to learn how to best support a loved one who suffers from a debilitating mental illness.

Over the summer, it was brought to my attention that NAMI San Diego would soon be taking over the contract for the CYFL, or the Children, Youth and Family Liaison. The CYF Liaison are the connective helpers between the San Diego County Behavioral Health System of Care and the families who use these services. Supportive services are brought to the public through workshops, training, speakers, blog writing, focus groups and webinars. The CYF Liaison also acts as the Mental Health Service Act (MHSA) resolution point-of-contact for issues within the CYF Behavioral Health System of Care.

I invite you to meet the new Coordinator for the CYFL program: ME!

Honestly, I couldn't be more proud. Here I am after nearly ten years spent advocating for my son in ways I didn't know how, but as a mom will do, I made my way through it as best I could. Here I am after nearly ten years with the lived experience this CYFL program requires as a job prerequisite. (Who even knew this was such a thing?) Here I am after ten years of petitioning for my son as best I knew how, and being invited to bring my knowledge base to other families who are struggling with this very same thing, and searching for answers just like I was. Wow...

So, please know this: the work we do as Moms (and Parents) in the Arena who know what it takes to fight the tough fight is big, important work. Once we learn tools that help our loved ones, and figure out the things that work within our family, we can take this information outside the family arena and bring it to the table of Advocacy. This is powerful and important work, and I am very happy to do this work! :o)

To learn more about the CYF Liaison and NAMI San Diego, please visit our website by clicking here. You can reach us directly via email at CYFLiaison@namisd.org or contact us via phone at (858) 987-2980. You can leave me a comment here and I will make sure your needs are addressed and met. We are here to help!

The problem with stigma

What is stigma? The dictionary defines it as

a mark of disgrace or infamy; a stain or reproach, as on one's reputation. 

The archaic meaning is a mark made by a branding iron on the skin of a criminal or slave. 

If you, or someone you love, is dealing with the stigma of a mental health condition or an addiction, or perhaps both of these together, then stigma probably matters to you quite a bit. Maybe it feels like your loved one (and you too) - or even your whole family is wearing a giant red brand - right on your forehead - that says something really harsh. (ADDICT) or (ENABLER). And it's right there for everyone to see....  (THIEF) ... Yeah, I know it feels like that to me.

As if people with a dual diagnosis aren't dealing with enough in their lives, the people who talk behind their backs while smiling at their face, asking them how they are doing and then speak meanly about them to others as soon as they walk away. Rumors are spread (which may be true or untrue - basically it is Gossip). It just makes me very, very sad.

I have learned about stigma. I have watched it crumble fragile people as they learn what other people think about them. I see how past misdeeds these people have overcome are brought back to the surface time and time again, like pouring salt into old wounds. I observe the disappointment and witness their hopelessness that relationships will ever change.

It makes me really sad.

So, how do we fix this?

Given all that is talked about regarding mental illness and addiction and the fact that "it's a brain disorder" is now regularly being reported in the media. This implies it's not your fault or your parent's fault. Sadly, this is not helping matters regarding stigma.

We need to be able to get to a place of empathy and understanding about what is behind the actions that drive the behavior. Behind what impels someone to use drugs, act out inappropriately, or steal. We need to stop blaming and begin to look for helpful answers, solutions rather than labels. Inclusion instead of exclusion. We need to stop being judgmental. To put ourselves in their shoes...

I am a changed person today based on what my loved one has had to endure. As a mom, I will do almost anything to stop my child's pain, or at least help him to understand the reasoning behind it. Of course, I want him to take responsibility for his actions and realize it's not easy to erase bad deeds in other people's eyes. I do hope these are the consequences that will help to change future behaviors.

People can recover from mental illness. People can recover from addictive behaviors. People can change and behave differently. People can. People do. I believe recovery can happen a little quicker within a supportive environment.

I'm not saying it's easy (just so we're clear). But I believe casting people away does far greater harm than good. Sure, they might finally be out of your life, and certainly, that might be exactly what you need. I get that. I am a proponent of taking care of oneself first. Setting clear boundaries about what you will and will not accept is key, rules and expectations definitely play a role here.

My aim is to inspire compassion while also emphasizing that people can change. If you are someone who has stigmatized others, I hope you will think about your role in the relationship. Please ask, listen, and find a way to empathize. If you are someone who has been stigmatized, please talk with others about how this made you feel. We all need kindness. This world definitely needs more empathetic people.

Recovery Tools

This is me today, however I haven't always been this way. Most every day finds me with a kind heart. When I take care of myself properly, my mind is unstoppably fierce. And brave spirit... well yep, I can call myself that now.

I didn't always have a brave spirit. I was so meek and mild growing up. But I did have one part of me that felt very brave. Once I figured out I could take that part and rely on it, I finally learned that many more parts of me were braver than I thought. Now, I see that braveness can seep into every aspect of my character and finally I am proud to call my spirit "Brave" :o)

In advocacy, I have learned a big dose of being Brave. Once I learned the tools to advocate successfully for myself and my family, my Brave qualities have grown exponentially. Even though I am still working on this in my professional life as an artist, I know in my heart I will get there one day. Of that I am sure.

I have had people tell me I am the bravest and strongest person they know.  I wasn't always like this, let me tell you! How do we get to that Brave Place when we are struggling deeply? My "Tools" are what I use to take me from a place of fearfulness to a place of strength.

How do we get these "Tools"?  

First, we have to put a name to our needs. For me, it was learning as much as I could about my son's disabilities. From there, I did many google searches so I could understand complex terminology and workings of the brain. One thing would lead me to another. Information gathering became the first tool in my tool belt. Even today, I may learn a new piece of information that tags onto old learning. I never waste the chance to stop what I'm doing and check into this new piece of information. Informational gathering takes us from a place of hopeless mystery to the place of knowing.

Second, we have to align ourselves with the right people to help us navigate this new path. I don't take this tool lightly. I firmly believe that in asking, we receive. So, put your desires out there. Name them by speaking them aloud. Write them down, or talk about it with someone you trust. Pay attention to the answers you receive. Answers can come in all forms. Opening a magazine to a page that totally touches on your dilemma is one example. Meeting someone new that is (unbelievably) struggling with your same dilemma is another. Do not cast aside freak experiences to chance! When you ask for answers, you will receive them if you are truly open to finding them.

Third, support groups are your friend. That is were you will meet those people we talked about in Tool 2. Locate support groups that cover your particular situation. Even if you are not sure if it's a good fit for you, go. Sometimes, the group might not cover your exact situation, but someone there might know of a new group for you to try. Other times, you might stumble upon a wealth of information. What is one evening, or 1-2 hours of your time when you could potentially learn so much about how to deal with your dilemma?

Fourth, take a class. This will help you get to the nitty gritty part of the learning about your dilemma. Some classes are free, like NAMI's wonderfully supportive Family to Family class. Other courses might have minimal charges. Contact the website for the cause you are concerned about and ask about any classes they may offer. Consider taking a class offered by your local community college. Can you believe there are organizations that are funded by the government that will pay for you to take a class? Free, people, that means free!

Fifth, don't be afraid to pick up the phone and call. I do want to caution you about saving this step until you have completed Tool 1 (information gathering) and possibly Tool 4 (taking a class). I have picked up the phone and asked to speak to the head of Neuropsychology at a Children's hospital. I have tracked down the top decision maker for my family's insurance company. The most important consideration before doing this is making sure you have full comprehension about your family member's situation. If, for example, they start speaking about a particular brain situation, it would be best that you know a little bit of what they are talking about. You want to use as little of their time as possible, but you want to get your questions answered.

Sixth, speak out. Don't be afraid to share some of what you've learned with others. In our NAMI Family to Family class, we tell our class participants that they are all an expert in what they have had to deal with in supporting their family member. So, that goes for you too. Yes, you. You are an expert in your situation and you can help others with your lived experiences. In my case, I tell people I am always happy to talk with someone who is struggling and help out in any way I can. People helped me when I was first navigating this path, and I was so grateful. It is the least I can do to give back, and help out someone who is just getting started in their information gathering period, or Tool 1 as I like to call it :o)

What tools have worked for you? I'm sure there are so many more. Please post a comment below if you have something to add, so others can hear your voice in all of this as well. And, thank you in advance for caring enough to speak up.

PS. To get your own version of the wonderful print at the top of this post, please visit this link: http://etsy.me/1ZYx4pk

Daily Miracles

I might add; "and where your head is at during the walk..."

What I have noticed lately is that things rarely change exponentially. Meaning, they might change slightly, or maybe they will improve a bit before they return to a semblance of the way they were before. Sure, there may be life moments like marriages, births, deaths; those major changes. But the everyday? I find what is resonating with me right now is how I am choosing to handle the everyday challenges. And what I have finally learned deep down in my heart is that what truly matters is where exactly my head is at during the handling of ... the thing... the person... the situation... That is the challenge.

In AA and Alanon there is the saying of the 3 Cs:

We did not cause it

We cannot control it

We cannot cure it 

I will be the first to admit that I have been working prettttttty hard to control it. What "it"? Um, pretty much Everything. I've spent the better part of my life to be Captain At The Control Panel of everything in my life. Without me, things would certainly fall apart, right? And all those nasty little sidebars like perfectionism, being judgmental, feeling stuck because things just weren't "right" or weren't "good enough" and then the shame, blame, name game until I just want to lie down.... it all gets really tiring, this control business.

So, what about letting go? I have talked about it before. I've done the letting go, and handing it over to my higher power. What I'm going to say next is said with a weary shake of my head....

It is never easy to "give it to my higher power" when watching a loved one struggle, especially when they take themselves to such dangerous places. But I've had to really ask myself: who am I to stand in their way of learning the natural consequences of life? I am not God. I do not count like that. Really, if death is their consequence, I will only drive myself to the brink of death in trying to personally control their outcome. So, no. It is way, way easier to step out of the way, and let God (my higher power) take the reigns.

So, yeah....

Thank you, Pema. I have read your book many times, and I know this. But knowing something in your head and taking it to heart like a missing puzzle piece are two different things. I have finally, THANKFULLY, learned what it means to truly TRUST, to Let Go, to Give it to God. And it is working for me. Yes, thank God, it really is. 

So, yeah. Teaching me time and time again is my very own son and this time was different. It was different in a small way, but a very good way. It was different because this time, I stepped out of the way.

So, I am going to name off a few miracles. Like the title of this post says, they are Daily Miracles. And they do indeed come each and every day. And simply the fact that I can look at life now through my daily blessings is miracle number 1. So, here goes... 

1. Seeing daily blessings and miracles. Somehow they have always been here, but I wasn't looking at them the same way. I'm so thankful I can see them now for what they are.
2. My son turned 20 on April 24. This in itself is the True Miracle. I made a promise with God during my son's pregnancy, and God made a promise to me. In that I/we got him through the teen years, I have fulfilled my promise. I told God then that if He allowed me to carry the pregnancy to term and give me a healthy baby (I had gone into pre-term labor at week 21, with my doctor telling me they could not save the pregnancy), I would do whatever it takes (took) to get my son through his teen years. And it took A LOT. Way more than I ever thought I could do, more courage than I ever thought I had, enduring more heartache than I ever thought a person could bear. (Who is the teacher in this? I swear, it's my son...)
3. My other son turned 18 yesterday, and he is doing so well. *big smile*
4. My husband and I work at daily thankfulness, and we both feel so blessed in all of this.
5. Completing my first time teaching NAMI's Family to Family class. What an amazing experience for me! I am equally as thankful as our class participants :o)
6. "In the asking, we have found the answer" Our Rock Recovery Families meeting has found a new leader. *Feeling so thankful and amazed that Ryan and his family showed up at the zero hour and volunteered to lead this wonderful Al-Anon based meeting. 
7. In this journey, I have found my true friends. Thank you all. You know who you are. I love you all so much!
8. For such a "doubting Sally" I have been led to the truth. In that, I am forever thankful, forever changed....

Thanks for listening. I am leading tonight's meeting, and this is my share. 

Does Suboxone work as a treatment model for opioid addiction?

It is with great interest that I am hearing all the press being given to the crisis of opioid and heroin addiction in our country. On my way into my office today, I heard a piece on NPR that discussed this crisis along with a sound bite from President Obama. Afterwards, they discussed Suboxone as a possible treatment therapy. As someone with a family member who struggled with a heroin addiction and tried Suboxone as a treatment therapy, I would like to give my own 2 cents about the use of Suboxone as a treatment for getting off heroin or dealing with opioid addiction.

Suboxone is a daily medication that is given under doctor's supervision. It is a strip that is dissolved under the tongue. Not every doctor can prescribe Suboxone therapy. You must find a psychiatrist who specializes in addiction treatment and is licensed to prescribe Suboxone. Each licensed doctor can only have 100 Suboxone patients they treat at a time. Legislation is working to increase that number to 200 patients per doctor.

Like methadone, it will help the heroin addict to not use heroin by substituting another (albeit highly addictive) drug to the user's system. If the user is driven to stop using heroin or other opioids, they might be a successful candidate for Suboxone use. However, Suboxone, like heroin, must be taken at a regular time, or the user will go into uncomfortable withdrawals. Many Suboxone users say Suboxone is a harder drug to use and get off of than heroin. (Read this account, and use care with Suboxone) In my family member's case, they quickly discounted the Suboxone use, returned to using heroin, and sold Suboxone as a street drug. Suboxone is not for everyone.

Other treatment models are available that can be a much better choice than Suboxone.  This article discusses other medications on the horizon for opioid addicts. Personally, and it goes without saying that my family member has not tried all the methods listed in the article, I have seen promise with a drug called Vivitrol. Vivitrol is an injection given once a month. Unlike opioids such as methadone and Suboxone, which produce a limited buzz to control cravings, Vivitrol dulls the brain's receptors so users don't feel cravings and won't get a high even if they take opioids. It can help reduce cravings and assist the addict in making more positive choices in life. Just knowing they are not going to be able to get high (or will get instantly very sick if they use opioids) allows them to occupy their life with things other than drug procurement and use.

From What is Vivitrol:

"Vivitrol ... can treat both opiate and alcohol addiction. It blocks other opioids from acting on the receptors in the brain and can also help ease drug cravings. By blocking the effects of other opioids it takes away the pleasurable effect, with can help with preventing relapse. Although it is not fully understood as to why an opioid antagonist works in treating alcoholism, it is believed that Vivitrol blocks the pleasurable effects of alcohol by blocking the release of endorphins caused by alcohol. This treatment can help you stop misusing opioids and alcohol and, when combined with counseling, can help you rebuild your life."

I am really hopeful about the changes in our society towards the stigma of addiction and drug abuse, and with new treatment methods being developed to help our loved ones. Granted, nothing can tear apart a family like living with an addicted person, but once treatment goals are accepted, treating an addicted person with compassion and hope is so much more productive than the alternative.

As a society, I believe we can effect positive change on the terrible opioid addiction epidemic gripping our country and in helping our loved ones battling this disease. 

Teen brain development and drug use

Lately, (and just "for fun" :o) I've been watching YouTube videos featuring talks by Dr. Nora Volkow, the Director of the NIH/NIDA, the National Institute of Health and National Institute on Drug Addiction. Dr. Volkow is a psychiatrist and has spent her life studying the human brain and how it is affected by drugs of addiction. I believe she is taking part in some of the most current and forward thinking topics on addiction, teen brain development, teen addiction and the need for vaccines to treat addiction. 

I have written in the past on addiction and mental illness, and posed the question of whether drug addiction is a mental illness (more here). The truth is that the teen brain is delicate and the process of maturing and becoming an adult brain should not be taken lightly. Given that the teen brain goes through a huge period of development and the fact that many teens expose themselves to risk taking behaviors (which may include drug use) means that a brain that might have the predisposed condition towards mental illness will be adversely compromised if exposed to chronic drug use during the early teen years. 

Many teens think the marijuana is "harmless". Please look at the video above, particularly at the 6:45 minute mark where Dr. Volkow answers a teen's question about whether marijuana use is harmful. The answer and explanation Dr. Volkow gives made this entire lecture hall of teens think twice about using marijuana. 

In particular, I am very interested in the 'why?' behind drug use and abuse, and the role dopamine plays in the addict's choice to use, even when he states 'I don't even really enjoy it anymore.' Dr. Volkow's description on how dopamine is tied to the brain's function, and that the brain is conditioned almost more by the actions associated with preparing to use a drug than to the actual affect the brain receives by the actual drug use. Dr. Volkow states the brain of an addict sees drug use as critical to their survival. More on this can be found in this presentation on Addiction: A Disease of Free Will).

Will there be a vaccine for drug addiction? Currently, the issue is at the center of a large debate. Drug companies are not convinced it is "necessary". The bottom line is, of course, profits. But, the driving force is the fact that addiction is still very stigmatized. It is seen as a choice, or an issue of free will. "If they really wanted to stop using, they would." The true question is why would someone risk the loss of absolutely everything in life, including their very OWN life, in order to fuel their addiction? 

It is necessary to embrace addiction as a chronic disease of the brain, where drug use disrupts the circuitry of the brain that enable a person to make healthy decisions for themselves. When the stigmatization of addiction is dropped, and the healthcare system embraces addiction and mental illness as a disease, when the person dealing with a co-morbid disorder of addiction combined with mental illness can get necessary treatment from the medical community without feeling inferior or shamed by society, then things might change. When we can treat these people with empathy from a disease we call addiction, they may finally get the help they need.   

  

An open letter to yourself

I begin each day with a prayer and a deep message of kindness towards those in my life who struggle with self doubt and addiction. I'd like to share my message today. I hope this might help just one someone.
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Dear You,

Today it is time for you to be kind...to yourself. 

You are the only one who knows the parts of you that need kindness the most, and for this reason, only you can provide this kind of deep kindness that you so need.

Try to be kind to the weak parts of yourself. Be kind to your addictions and your frailties, your mistakes and all of your human parts. Rather than treating these parts of yourself with hatred and disgust, please just take hands with these parts and say, "I am with you, we will make it through this." 

Even though you have stumbled and fallen SO MANY TIMES, today you can choose to put your arm around the broken parts of you. Today, you can look inward and try to heal the deep wounds and cracks in your heart and soul by treating each hurt with care and love. You can do this. 

Just try,  -- just try. BE KIND to ALL of you. Let YOU know that it's gonna be ok, that you are gonna love YOU no matter what as you work through all of this. 

You are so deeply loved.

xx

*inspired by BGC message 1-14-16