I had a terrible realization…

I had this little realization the other day…

See I just bought a bike a few days ago.  I was all excited because this meant I could run errands on my bike, bike to work (cause my new job is super close!), and get some exercise/relaxation at the local bike paths and forest preserves.  All around, pretty happy right?

Within a mile of my first fucking outing my self kicked in.  My brain.  My stupid brain.  My stupid internal competitiveness and attitude of self-hate.  All of the sudden, instead of going for a leisurely bike ride, I was competing with myself.  Timing myself and setting immediate goals.  What’s my time now?  What’s my speed?  How far can I go today?  How long until I can do 20 miles?  That’s too easy, 30 miles by the end of the month.  What schedule should I be on?  How many days a week can I get in an hour bike ride?  What’s my speed now?  What if someone is better than me?  How long before I’m better than them?  How much weight can I lose?  How much muscle can I gain if I do this 5 times per week?  Should I take a class or do a race?  Not until I can finish in the top 5%.  What’s even the point of doing this unless I’m going to compete.  I should at least be better than that rando I just passed.  I bet I can be healthier than my sister if I stick with this.

This thinking style sneaks up on me pretty much every time I start a new thing.  If I start running, I can’t just run.  I have to building.  I have to be competing with someone, even though they usually don’t know that they’re competing with me.  I can’t just have a hobby, I have to do it to until I pass out.  I have to give it my all.  It’s do or don’t.  And I don’t just let myself enjoy any of it.

It’s a terrible mentality that was drilled into me when I was a kid.  I was already a kind of obsessive kid (neurotypicalities kinda run in my family).  And then I started playing basketball.  Just a little background: in the town I grew up in, girls’ basketball was INSANE.  Like, we were just kind of expected to go to state.  You played year round, be it summer leagues, preseason conditioning, etc.  It was hypercompetitive to even make the team, let alone get any playing time.

I think my parents tried to put some limits on it when I was younger.  I wasn’t allowed to play travel teams (although I think this was also partly cost).  But my parents told me that high level of competitiveness wasn’t good for kids.  I was just bitter about because it meant I was falling behind.  So, just to make the team, I had to work harder and harder and harder.  Dedicate so much time to it.  It wasn’t healthy.  I knew it, because I wasn’t eating well, I wasn’t focusing, and I didn’t even care about playing so much as I just wanted to be better.  I was actually pretty miserable playing.  Especially once I started high school.  I didn’t even have any friends on the team and I’m pretty sure I cried out of frustration or physical pain every time I came home.  But I played for another year, and intended to play the following year.  I quit partly because of depression and partly because I felt I had to work.

But then that hyperfocus, hypercompetitiveness just transferred into my work.  I took like all of the hours that I could at work.  I wanted more and all the responsibilities.  I ended up moving jobs to get more time and experience and money.  By my senior year of high school, I worked two jobs, was enrolled part time in college courses and part time in high school, and was acting as a tech crew leader for the theater.  I was also applying to colleges and trying to get scholarships.  I don’t think that I ever stopped to enjoy any of this stuff.  I mean, it helped me to avoid the depression.  That was great.  But I just had to keep doing things and keep doing better and be a better worker than everyone around me.  Even if no one else knew.  (In fact, the other AP students would often say I didn’t deserve to be in the AP classes because I wouldn’t do the homework and they thought I was dumb.  Fuck those guys.  I killed the tests, which was all that mattered).

I struggle to slow down.  I struggle to relax and enjoy what I do and what’s going on around me.  I just have this constant need to work harder.  Go faster.  Do better than whatever I was doing.

That doesn’t sound like a terrible thing to some people, right?  No.  And in some ways it has been super helpful in getting me through college and grad school.  Getting a good job, two good jobs.  And putting my life back together when things get rough.

But at the end of the day, I end up exhausted.  Burnt out.  Isolated from the people and things around me because of my hyperfocus.  I know that it pushes people away.  And maybe I do it because, in addition to helping me avoid negative moods, it enables my social anxiety.  When I’m focused on work, I have a reason to avoid people.  I feel like if my friends saw this, they would be confused.  Because I don’t really do hobbies, at least I don’t get into them.  I don’t because I hate myself within 6 months after I start them; I’m burnt out and angry that I spent money.

Since I’ve had this realization, I’ve decided to try and be mindful about it.  Use it when I want to and try to manage it when I don’t want it interfering.  It’s a work in progress.

Love/Hate Relationship with Electronic Medical Records

When I first posted this, I realized it was too serious for me.  So I decided to add a ponderous Bowie.

When I first posted this, I realized it was too serious for me. So I decided to open it up with a ponderous Bowie.

I recently started my Pre-Doctoral Internship.  Much like my previous training site, I’m in the Community Mental Health (CMH) world.  Unlike my previous site, I have Electronic Medical Records! (EMR)

I am actually excited about this fact because paper record keeping was absolute shite at my old training site.  Things got lost, accidentally shredded, or re-done a thousand times because it had a minor error.  Everything was constantly a mess.  Intake appointments were up to 3 hours long and required over 50 pages of documentation, most of which had to be hand-written.   Even after that 3 hour intake appointment, there was at least 2-3 more hours of cleaning up and re-checking paperwork before it could be sent off and *hopefully* approved for billing.  You can imagine how exhausting this was for both the staff and the clients.  And of course none of that paperwork time was billable.  So a 40 hour work week for staff (therapists, respite workers, case managers) would usually consist of maybe 15-18 billable client hours (I know this because I’m obsessed with counting and quantifying things and looking at charts of things).  It took up to 3 months to get feedback on this crazy paperwork.  If things did not get into the record immediately, there were often massive miscommunications between members of the treatment team.  A psychiatrist would change a client’s medication and the therapist would not know about it for weeks.  A client would skip therapy or skills or job training and the psychiatrist would know nothing about it.  Crisis alerts for clients were often mis-filed or not provided to the client until days later.  If paperwork expired and we weren’t on our toes about exact dates and made sure to schedules ourselves a few extra hours to update paperwork on the plucked-out-of-thin-air medicaid-demanded dates (all of which were different between treatment plans, evaluations, updated consent forms, etc), we lost billing, meaning we lost the only funding that keeps the doors open to the only mental health resource available to most of the people we served.

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Overall, it interrupted treatment.  It interfered with the ability to provide treatment.  So much time was spent completing paperwork and ensure that medicaid would pay for the work that was done, that client need often had to be put aside for the time being while we made sure we were compliant with governmental demands.  And of course when client charts or information got lost, it was always the one with pre-existing paranoia ideation.  Serendipity, bitches.

And this was not because of poor management of the site.  They honestly did the best they could trying to stay on top of everything.  But it honestly felt like every month or so medicaid was demanding more documentation.  We were overloaded, understaffed, and underfunded for what was placed on the agency.  Because of these outrageous demands, we were forced to keep relatively small client loads, which lead to an overflowing waitlist.  This means that both adults and children with mental illnesses, developmental disabilities, trauma, and other problems demanding mental health care were forced to wait up to 6 months for services.  This includes people released from the hospital following a suicide attempt.  People with active psychosis.  And those with a history of violence and aggression.  These are all people that are in desperate need of care, low-to-no income, and are struggling to meet the demands of their daily life.  However, they are all also people who had the potential to succeed and contribute with the right help and resources.  Many of them are children and adolescents whose potential you could feel if you could just get them and their families in the door and on your caseload.  This is the story of many CMH’s out there.

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Oh, and did I mention that, because CMH is so underfunded that nearly every staff member has to travel between multiple sites and rarely has a consistent schedule?  So communication between treatment providers is difficult to say the least.  A CMH psychiatrist (that’s the one that prescribes meds but does not provide skills training or psychotherapy) may work at 4 different locations throughout the week and see upwards of 50 clients per day (10-15 minute appointments).

So, my at my new site we have EMR.  Which is so much more convenient.  Everything is right in front of us on a single website, from Treatment Consents to Intake Assesssments to communication forms between treatment providers.  Because everything is in one location, you get alerts for when things are coming due.  If a client misses an appointment, the entire treatment team can be alerted immediately.  Rather than 3 hours, intakes are about 1 hour.  I have constant access to everything in my clients’ records, no matter what office I’m at, or even if I’m doing a home or school visit.  It is infinitely easier to get my work done and move on to focus on my clients’ needs.  I can instant message my supervisor or other member of a client’s treatment team the moment there is an issue or just to alert them to progress made.  A client can review their records easily with me and helps fill out progress notes, which feels more open and honest, and opens to door to discussions about how they view the therapy and their progress.  If a client’s medications get changed or they are assessed by the crisis team, I know immediately that a change was made to their record.  It’s golden.

Unfortunately, the Orwellian in me cannot fully embrace this.  Being CMH, it is a government agency, funded primarily by medicate and overseen by the Health Department and everything that goes with that.  I’ve been on a bit of a paranoid kick myself lately–how could you not be in America right now?  I’ve been following the NSA/Manning/Snowden stories and I’ve been appalled by what I’ve been reading.  How much information is viewed and stored about people.  How many emails and searches are read.  There is no guarantee that any of my emails are secure and everyone that comes in the door is made aware that their information is reported to various agencies.  Most clients, though, are in too great of a need to worry about confidentiality and governmental information gathering.  How do I explain confidentiality to a client when I know that nothing is really confidential because it is being reported to various agencies.  There is nothing so great about out EMR that makes it hack-proof.  Do I think that the NSA really cares that much about a 15 year old girl’s depression?  No.  But the fact is, nothing about EMR really is secure.  But with the massive integrating of all of this information, is it really that outlandish to believe that this information could show up somewhere else in the future where it might hurt the person?  What if the 15 year old girl later decides to apply for positions in the Military or CIA and they have access to these mental health records?  Could that affect them?  I really don’t know.  I am being told that this information is secure and confidential, but to be honest even my supervisor does not sound that convinced of it.  What if I do have to write a report on a client having paranoid ideation regarding the government?  What if I have to email my supervisor regarding a client’s flight of ideas about militias and terrorism?  How secure and safe are these mental health records?  (Our voice mails also go directly to email)

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So, I am still torn over the EMR thing.  It is amazingly efficient and leads to better record keeping and communication within the treatment team and therefore more effective and ethical treatment.  However, I have significant concerns over confidentiality and how long this information is kept and for what purposes it can be used.  My fears being heavily influenced by the happenings within my country.

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My depressed brain and why it sucks

When people write or talk about their depression, they’re usually reflecting on it.  They’re talking about how much it affected them, what they learned, and how they recovered or coped.  That is mostly bullshit when you are in the midst of depression.   I’ve had episodes of depression since about 13.  I’ve definitely learned some ways to deal with this and, for the most part, I accept that it happens because my brain likes to fuck with me randomly.

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I do not believe in the psychoanalytic mythology that I have suffered some deep trauma that leads me to self-sabatoge or avoid pleasure, or whatever the fuck those assholes insist is wrong with me.  At least not any more, any worse, or any deeper than what everyone on this planet experiences.  When I meet the person who has not experienced some major loss in their life, the person who has never experienced at least one shitty relationship, the person who is at complete peace with their family history, or the person whose coping skills are perfect and adaptable enough to get them through every adjustment and distressful aspect of life, I will bow my hat to them and wish them luck with the rest of their life.

But coming from this very moment of being depressed, I can tell you this: everything is hard.  Getting out of bed sucks.  Walking the dog is excruciating.  Strangers talking to you feels like the world is ending.  Getting work done seems impossible.  Eating anything more than a bag of chips or a box of cookies feels pointless.  You know you shouldn’t isolate yourself, but being social makes you want to cry or throw up.  Even being with the people you love sucks.  I don’t want to be talked to or touched.  Everything everyone does feels like an attack.  You don’t see the point of working or accomplishing anything because you never feel accomplished.  And, for me at least, the worst part is knowing that there is no reason for any of this.  Knowing that, if you could get your head back together everything would be okay.  But your head won’t let you see that.  One of the more insidious parts of depression is it sometimes comes when everything else is going well.  I’m three weeks from completing coursework for my doctorate.  I’m a few weeks from defending my dissertation (hopefully).  I matched at a fantastic internship.  Shit is good, but my brain is stuck in “feel like shit” mode.

My Brain is Full

Don’t worry.  I’m not going crazy.  I’m still able to function at work and getting stuff done.  It’s harder, I won’t lie.  Sometimes I need to lay down, cry, and watch MonsterQuest for a few hours before I can even gather the strength to work.  I use my coping skills, but even that is hard.  They do help and I need them, anyone with similar issues knows that learning the best ways to cope may be the only thing to get through.  Relaxation, distraction, self-care (and all of its glory).  I take mental health days.  Completely indulgent days where, if I feel like it, I eat pizza and ice cream, watch documentaries, and complain to my best friend over facebook about my life.

^My last ditch coping mechanism.

^My last ditch coping mechanism.

This blog is a coping skill for me.  I rarely talk about stuff like this, but it helps me vent and get shit off my chest in other ways.  That is why I don’t really care about gathering followers.  I actually get kind of anxious when people start to follow me and see views spike.  I think someone is going to figure me out, think I’m crazy, and be like “WTF is wrong with this chick?” or worse, “why is this chick in child development?  She’s way too fucked up to let her work with kids and families!”  But the I think of Marsha Linehan ( ❤ )  who, at the peak of her psychological fame, wrote  an open letter discussing her personal history of depression and suicide attempts.  Then I’m all like, fuck you guys.  I’m awesome.

See, I’m already starting to feel better.  I hate my self a little bit less now.  Still thinking about gorging on chips and queso and watching MonsterQuest instead of finishing the diss or putting together the two presentations I have this week, but I don’t want to cry and my dog is laying on my feet to show he loves me no matter what.  🙂

Fucking Pundits–my reaction to the Newtown coverage.

The news is all still a flutter about the Newton tragedy.  As, I suppose, it should be.  Lucky for all of us with any intelligence level, the conversation has moved away from violence in video games and the media to something substantial, mental health.  Unfortunately, the conversation about mental health, causes of mental illness, and access to mental healthcare has been disgustingly shallow.

When I turn on the TV and find myself watching any news about this event, I begin to hear about how we need to address the “causes of mental illness” and “increase access to mental healthcare.”  My issue with this is how flippantly it is said by people with no understanding of mental illness and no understanding of how difficult it can be to get mental health care, or even what mental healthcare entails.

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What causes mental illness?  Truth is, a million things…we think.  Trauma, genetic abnormalities, poor social structure, inherited diseases, poor models of behavior, neglect, abuse, malnutrition, neural abnormalities, lack of concrete resources such as food, neighborhood violence, drugs, in utero toxins, anything…bad luck.  I’m sure every psychologist,social worker, etc. can think of more.  I would love to see how Congress and the powers that be would address each of these and more.  Short of eugenics and parenting licenses, you can truly prevent all mental illnesses.  And as a big believer in Positive Psychology, Resilience, and Prevention, that takes a lot for me to say.  There will always be mental illness, no matter how hard we work.  There are things that we can do to prevent or lessen the impact of mental illness.  We can give families, school, and communities more education and resources to understand how to respond and live with mental illness.  We can fund better research to understand the origins, process, outcomes, and interventions (community-wide) to address all different disorders.  We can make it easier for mental health professionals to practice, by which I mean lessening their load of bureaucracy so they can focus on the treatment aspect and not on checking off the right boxes.  We stop closing mental health facilities.  We can make real services available in schools, rather than the shit they get right now.  We can recognize the effect of neighborhood trauma on children and intervene.  We can build more community mental health centers to prevent 6 months wait lists.  We can do more than medicate people.  Again, I’m pretty sure everyone that reads this can think of more things.

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My point is, every time I hear pundits talking about “we need to address the causes of mental illness” “we need to address the issue of mental illness” “we need to asl;dfalkdfjla!”  I want to throw the TV across the room because they have no idea what they are talking about.  I want to strangle everyone from the NRA president to Rachel Maddow.  You can’t make mental illness a sexy issue like media violence.  So stop.  Fuck off.  Get out of my field.  Or at least talk to someone with some fucking intelligence and background in the area.

**Oh, and BTWs, lack of god in school does not cause mental illness.  Fuck yourself., Huckabee.

The State of Mental Healthcare


I currently work in the community mental health setting.  A setting that is primarily funded by state and federal dollars and primarily serves low income, high need clients.   Clients that seek community mental health are usually those that are ill to the point their disorders and symptoms interfere with their ability to function in a work or school setting, many with a history of incarceration or hospitalization (in my experience there is little difference between these two, both revolving doors of shitting care and overmedication), but with regular care and appropriate support would be able to live like “normal” people.  Unfortunately, rarely is this care ever provided consistently or appropriately.

Since I started working in my field, I’ve pretty much rotated between working in schools (alternative and traditional) and community care.  But my disgust at how the system fucks some of, not only the most needy clients, but some that could have massive potential if they were given proper care.  Children with learning, behavior, and sensory integration disorders are routinely put on the back burner in schools, not receiving proper assessments or interventions.  They fall behind a little bit more every year until they are failing, their sense of self and identity become defined by failure.  The risk factors add up, one after another until they become absorbed by the mental health and education systems that failed them in the first place.

For individuals with chronic mental illness, thought disorders, personality disorders, severe emotional disorders, or developmental disabilities the bureaucracy  that is mental health is worse.  Wait lists of many community mental health centers number in the hundreds.  Social workers, whose caseloads should be no larger than about 20 in order for them to actually help the individuals they serve, are usually closer to 50-60.  Psychiatric hospitals deal with overcrowding by over-dosing clients on sedatives.  Hospitals rarely provide treatment, instead the have settled for assessment, stabilization, and providing guardians/family with a list of recommendations so vague they can hardly be followed.  That list usually includes a recommendation for individual therapy, psychiatric medication consultation, and case management….at those community mental health centers with the hundred person wait list.  This leaves a 3-6 month gap in treatment in which clients are left to their own devices.  Some, depending on the severity of their symptoms and the level of dedication of their support systems, can manage to go back to some semblance of a life, perhaps a job or school.  Others, however, cannot.  They will cycle in and out of crisis care and hospitalization, most end up in prison.  Millions self-medicate with street drugs, leading to addictions and worsening of the core symptoms.

Then you get to the systemic problems caused by this failed system.  Families are effected, parents, children, siblings, grandparents.  Because lack of treatment leaves them so ill they cannot hold a job, they are forced to go on disability.  Not only does that have an economic impact, but it leads to boredom and decreased motivation to get better.  Mentally ill individuals are viewed by others as lazy, dangerous, or stupid, which has an impact on their own self-image and sense that they can do something more with their lives.  Constant failed attempts at getting help lead many to give up.  Institutions and psychiatric hospitals that could have provided treatment (the level and kind of treatment provided is a completely separate issue) have been replaced by prisons.  Most mentally ill are still placed in general population, provided little to no treatment outside of medication, and eventually released with no resources.    Again, we cycle back to economic and family impacts.  The cycle repeats year after year.

Our culture likes to put mental health on the back burner.  As a society, we think the mentally ill are mentally ill.  They cannot be helped.  We think this because it is what we see.  Chronic mental illness equates to stupidity, laziness, and criminality.  But this comes from what the system has done to mental health care.  And it is also self-perpetuating.  If we think about the mentally ill as dirty, stupid, homeless criminals, we can accept their lack of care.  They are the “other.”  They’re not like us and they don’t deserve our federal dollars because they will always be that stupid, gross, crazy person.  So, it become easier for us to ignore or be okay with the lack of mental health care.  The media’s portayal of the shooter from the Colorado spree is perfect.  He was crazy, therefore he was dangerous and must be locked up.  This must also apply to all other crazy people.

There are thousands of trained therapists and social workers dying for work.  People go into this field wanting to help.  They have ideas and dedication, they just need the funding.  Every time I see a mental health center or service be closed down, funding cut, etc, I go a little crazy inside.  Where do politicians think this will save money?  They are leaving high need adults and children without care and vulnerable to everything I already talked about.  Funding cuts for mental health will lead to an increase in crime and dependence on federal disability money.  Many of the clients they put out want to work and want to contribute to society, but they need continuous support to be able to function.  With that support, they can do amazing things.

So, fuck you bureaucracy.  And shitty run around that causes crime and death.