nurse and doctor comfort patient

Who’s Who on a Mental Illness Team

The United States does not have a well-organized system to treat substance abuse and mental illness. Sometimes it’s hard to know who to turn to for your needs. This overview answers the question: Who does what?

Primary care physicians can prescribe and monitor medication, but often prefer that you work first with a psychiatrist.

Psychiatrists are licensed medical doctors with medical and psychiatric training. They can diagnose and prescribe medication.  Some provide therapy.

Psychiatric nurse practitioners have a master’s or PhD and specialized training. They can assess, diagnose, prescribe medication and do therapy. You can usually get an appointment with a psychiatric nurse practitioner more quickly than with a psychiatrist.

Clinical psychologists with doctoral degree make diagnoses and provide individual and group therapy.

Psychiatric or mental health nurses, depending on education and licensing, can assess and treat illness, do case management and provide therapy.

School psychologists can make a diagnosis, provide therapy, and work to provide healthy school environment. My personal experience is that school psychologists do not have enough bandwidth to do an effective job with children who are struggling.

Counselors can help find better ways of thinking and living, as well as help people develop life skills. Some can diagnose and treat.

Clinical social workers has a master’s degree in social work. They make diagnoses and provide counseling, case management and advocacy.

Peer specialists are individuals who have experience with a mental illness and can help others with recovery.

Social workers with a B.A. or B.S. can provide case management, inpatient discharge planning and placement services.

Psychiatric pharmacists have doctoral training and residence training to provide comprehensive medication management. They usually work in a health care system like Veterans Affairs, hospitals, clinics., etc.

abandoned mental hospital interior

Our Mental Health “System”: A Shameful History

When you are navigating the mental health system, have you felt:

  • Confused?
  • Frustrated?
  • Angry?
  • Insulted?

To say that the United States does not have a well-thought-out mental health system is a great understatement. Here’s a brief review of how we got here:

In the 1700s, mental health treatment began to move from the horrific asylums to hospitalization. By the first half of the 20th century, mentally ill people were usually either at home or in institutions.

The year 1954 introduced the first antipsychotic drugs, which improved functioning for many people.  So many thought that people with mental illness could live outside of hospitals.

In the early 1960s, the Kennedy administration introduced a plan for more humane mental illness treatment.  In 1963, President John F. Kennedy signed the Community Mental Health Centers Act. The program proposed closing the hospitals and replacing them with community mental health centers, where the mentally ill could be treated in homelike settings.  This included strict standards so only individuals “who posed an imminent danger to themselves or someone else” could be committed to a state psychiatric hospital.

Mental hospitals began to close in the mid-1960s. But Congress never approved the funds needed to open the equivalent number of community mental health centers.

President Jimmy Carter’s Mental Health Systems Act of 1980 was passed to continue federal funding for mental health programs.  In 1981, President Ronald Reagan, in The Omnibus Budget Reconciliation Act , repealed that act, eliminating the money needed for these centers.

In 1955, 558,239 severely mentally ill patients were institutionalized at public hospitals (Torrey, 1997). By 1994, by percentage of the population, we have 92% fewer hospitalized individuals (Torrey, 1997).

Today, community mental health centers do provide mental health services. But many people released under deinstitutionalization became their families’ responsibilities.

They also became homeless (26% of homeless have mental illness, according to HUD). Many of them are in prison. People with mental illnesses are overrepresented in prison. It’s estimated that 55 percent of male inmates and 75 percent of female inmates have mental illnesses.  Meantime, the CDC says there are 5.7 million emergency department visits with mental illness as the diagnosis annually.

Take Action Today

Today is Mental Health Action Day, and we’ve had a bad couple of years.

If you are worried about anyone, getting answers to these questions may show the person needs some extra support:

  • Have things that used to feel easy started feeling difficult?
  • Does the idea of doing daily tasks like making your bed now feel really, really hard?
  • Have you lost interest in activities and hobbies you used to enjoy?
  • Do you feel irritated, possibly to the point of lashing out at people you care about?

If the answers are yes, visiting a counselor for an assessment is needed.

Life doesn’t have to be so hard. You can find more answers in this blog.

brain

Caregiver’s Guide to Brain Basics

Mental illnesses are brain disorders. Trying to understand the “why” behind an illness or the “how” behind medication requires caregivers to know some detail about how the brain works. For example: What’s a neurotransmitter? What are synapses? And what’s the difference between serotonin and dopamine?

This basic overview, which answers those questions, comes from material on the National Institute of Mental Health’s website. The site contains lots of information to answer your questions about the complexities of mental illness.

NIMH research shows that mental illnesses can be related to changes in the anatomy, physiology and chemistry of the nervous system. When the brain malfunctions, symptoms of mental illness start to appear.

Neurons are the basic working unit of the brain and nervous system, each enclosed by a cell membrane. These highly specialized cells conduct messages. Each neuron has three main parts:

  • A cell body with a nucleus (containing DNA and information the cells needs for growth and repair) and cytoplasm, the substance filling the cell where all the chemicals and small structures named cell organelles reside.
  • Dendrites that branch off from the cell body and are the neuron’s point of contact for receiving chemical and electrical signals (called impulses) from other nearby neurons.
  • Axon that send impulses and extend from the cell body to meet and deliver impulses to another neuron.

Synapses are tiny gaps between neurons where the impulses or messages move from one neuron to the other as chemical or electrical signals.

The brain continues to mature at least until a person is in his 20s. As scientists learn more about brain development, they can see what goes wrong when a person develops a mental illness. One of the mysteries of schizophrenia, for example, is why it often occurs for the first time when a person is in his late teens or early 20s. Many believe scientists will find the secret as they learn more the processes in the brain at that time.

What can go wrong in the brain?

Every cell contains a complete set of DNA, with all the information inherited from our ancestors. As we grow, we create new cells, each with a copy of the DNA. Sometimes the copying process goes wrong, resulting in a gene mutation.

Scientists also study epigenetics, which looks at how environmental factors, such as sleep, diet and stress, can influence our genes. Unlike gene mutations, epigenetic changes don’t change the DNA code. They affect how a gene turns on or off to produce a specific protein.

The role of neurotransmitters

All that we do depends on neurons communicating with each other through electrical impulses and chemical signals. Neurons activate with small differences in electrical charges, called action potentials. The ions (atoms with unbalanced charges) concentrate across the cell membrane and travel very quickly along the axon. (It’s a bit like dominoes falling.)

When the action potential gets to the end of the axon, most neurons release a neurotransmitter, or a chemical message, that crosses the synapse and binds to receptors in the next neuron’s dendrites. So neurotransmitters are key to sending chemical messages between neurons. In mental illness and other conditions like Parkinson’s disease, this process doesn’t work correctly.

Important neurotransmitters include:

  • Serotonin controls functions including mood, appetite and sleep. People with depression usually have lower levels of serotonin. Some medications that treat depression block the recycling, or reuptake, of serotonin by the sending neuron. So more serotonin stays in the synapse for the receiving neuron to obtain. This medication, called selective serotonin reuptake inhibitor (or SSRI) causes more normal mood functioning.
  • Dopamine controls movement and aids the flow of information to the front of the brain, where thought and emotion take place. Low levels of dopamine can result in Parkinson’s disease, which affects the person’s ability to move and causes tremors, shaking and stiffness. Some research suggested that having too little dopamine in the thinking and feelings sections of the brain could play a role in schizophrenia and attention deficit hyperactivity disorder.
  • Glutamate is the most common neurotransmitter. When it is releases, the chances that the neuron will fire increase. So it enhances the electrical flow among brain cells. It also may be involved in learning and memory. Problems in making or using glutamate have been linked in autism, obsessive compulsive disorder, schizophrenia and depression.

Regions of the brain

Many neurons working together form a circuit. And many circuits working together form specialized brain systems. Research into the causes of mental illness tend to focus on these regions:

  • Amygdala activates the “fight-or-flight” response to confront or flee from a situation. Scientists are studying the amygdala’s involvement in anxiety disorders, including post-traumatic stress disorder and phobias.
  • Prefrontal cortex is where the brain’s executive functions are. These include judgment, decision making and problem solving. The prefrontal cortex also works in short-term memory and retrieves long-term memory. It helps to control the amygdala during stressful events. Research shows the people with post-traumatic stress disorder and attention deficit hyperactivity disorder have reduced activity in the prefrontal cortex.
  • Anterior cingulate cortex has many roles, including controlling blood pressure and heart rate. It also helps us respond when we sense a mistake, feel motivated, stay focused on a task and manage emotional reactions. Reduced activity or damage in this area is linked to attention deficit hyperactivity disorder, schizophrenia and depression.
  • Hippocampus helps create and file memories. When it is damaged, the person can’t create new memories. However, the person can still remember past events and learned skills, as well as carry on a conversation, because those activities are in different parts of the brain. The hippocampus may be involved in mood disorders through its control of a major mood circuit called the hypothalamic-pituitary-adrenal axis.

No one expects caregivers to become brain scientists, but having a general understanding of the brain will help when learning about medicines and research. The more knowledge we have, the better.

a dead person with a COVID toe tag

Stigma at Its Worst: Schizophrenia and COVID

I am furious about this.

Do you know what the second highest risk factor for dying from COVID is? The highest is old age. The second highest is having a diagnosis of schizophrenia.

This was first reported much earlier in the pandemic. I heard about it. I even mentioned it to an Ohio State University friend who used to head up my city’s health department. But scientists seem to be repeatedly surprised by it. And the government has done basically nothing about it.

Now it’s Year 3, and it’s news on NPR????

If the second highest risk factor for COVID deaths were health disease or lung disease or diabetes, do you think something would have been done to reach out to those folks? Of course. So why was there no effort to help people with schizophrenia?

People with schizophrenia were left off the priority list for help in my state, Ohio, and many others. My loved one with a schizophrenia diagnosis had to wait until people his age were allowed to get vaccines.

NPR interviewed Katlyn Nemani, a neuropsychiatrist and researcher at New York University. She described the initial reaction to the data showing that people with schizophrenia were three times more likely to die from COVID than the general population. It was disbelief.

“They said it must be because people with schizophrenia are already worse off health-wise, or because they have trouble accessing health care,” she said. That turned out to be wrong.

Studies from countries with free universal health care … the United Kingdom, Denmark, Israel, South Korea and so on … came in, also showing that people with schizophrenia were two to five times more likely to die from COVID.

Yet, the CDC didn’t add schizophrenia to the list of high-risk conditions until people began getting booster shots in October 2022. Other countries, like England, Germany and Denmark, put people with schizophrenia on the priority lists for vaccines at the beginning.

Nemani told NPR that this discovery could be good for people with schizophrenia. She said it may mean that the badly understood illness has a component in the immune system or elsewhere in the body. It could lead to new understanding and new treatments … for those with schizophrenia who are still alive, that is.

My own guess? It’s stigma. Far too many people think that the lives of people with schizophrenia do not matter. If they die from COVID, so what?

Schizophrenia is tough enough without the stigma. It affects 24 million people in the world, including 2.8 million in the United States.

This is barbaric. It’s time to fight for people to see the disease as a disease, not a disqualifying condition for living a good life. I am furious. I am sickened. I am sad.

This image of sunlight coming through clouds illustrates God talking to us.

Talking and Listening to God

“Developing a conversational relationship with God” is the subtitle of Dallas Willard’s book “Hearing God.” Willard was a philosopher and respected Christian “teacher to the teachers” who went to be with Jesus in 2013.

Many of us who love someone with mental illness would like to speak with God. We want answers. And often we want direction.

Willard believed that God still speaks today. In fact, hearing God’s voice fits into the larger context of walking in a close friendship with him.

There is one caution: God speaks mostly to people who obey His teachings and want to do His will. Again: You need to be willing to do what God says before you are likely to hear his voice speaking to you.

As Jesus said, “If you abide in me, and my words abide in you, ask whatever you wish and it will be done for you.” Abiding in Jesus minute by minute through Christian mindfulness puts us in a position to hear God specifying His will. We become as Willard wrote “someone who leads the kind of life demonstrated in the Bible: a life of personal, intelligent interaction with God.”

Feasting on God’s word

The Bible fixes the boundaries of everything that God will say to humankind, Willard wrote. Indeed, God speaks most often during Bible reading and study. Have you ever had a verse jump off the page to you, even though you’ve read it many times? That is God speaking.

But this can also happen while listening to another person, whether it be a sermon or a conversation. I also believe that synchronicity can point the way to a message. If you hear the same verse repeatedly … in Bible study, in a sermon and in a book you’re reading … it may be God emphasizing something to you.

God also speaks through dreams, visions and events. But most of the time he speaks through a small, still voice that can only be heard in quiet. God’s voice comes in a spirit of peace, joy and good will. So God’s voice sounds like Jesus. And we can only know what Jesus sounds like through Bible study.

Seven steps toward hearing God

This summary may help you as you seek to hear God’s voice.

  1. Begin with a prayer in Jesus’ name for protection from evil influences.
  2. Ask the Holy Spirit to help you to listen well.
  3. Remain alert.
  4. Reject anything that is contrary to Biblical truth.
  5. Feel welcome to write down the thoughts that come for further study.
  6. Understand that real communications from God are:
    • Biblically sound
    • Glorify God
    • Advance the kingdom
    • Help people
    • Help you to grow spiritually
  7. Thank God for the time together.

Walking with God in Christian mindfulness is a sweet time of communion. We should expect that God will help us learn what we should know and what we should do.

treasure in darkness

Discover Treasure in the Darkness

Several years ago, I went to a retreat for mothers with children who have mental illness at Saddleback Church’s retreat center. Rick and Kay Warren, Saddleback’s founders and senior pastors, know the struggle of parents who have a child with mental illness in an intimate and devastating way. Their son struggled for many years before the illness took his life.

Kay Warren, who led the retreat, told a story about having a dark, no-sleep night. She went downstairs to the office and looked up all the references to dark or darkness in the Bible. She found 25 pages of them in Psalms alone.  When she read this passage, she felt the Lord speaking to her.

“I will give you the treasures of darkness and riches hidden in secret places, so that you may know that it is I, the Lord, the God of Israel, who call you by your name.”

Isaiah 45:3 (NRSV)

This verse has haunted me since. Is it possible that those of us who love someone with mental illness can find treasures of darkness? I studied the verse more, and it gave me even more comfort.

The verse is part of a prophecy, 210 years before the fact, about Cyrus, who defeated Babylon and was instrumental in allowing the Jews to return to Jerusalem. God is talking about treasures of gold and silver that had been buried underground in Babylon.

So more than 200 years later, someone showed the book of Isaiah to Cyrus. He saw his own name and his actions predicted in it. Cyrus understood that his victory and these buried treasures came to him because of the Hebrew God. He decided to release the Hebrews because of it.

Why did God do this for Cyrus? He was a pagan. Some historians of the time wrote that he was haughty and cruel.  This much is implied: Cyrus may have undertaken his campaign of wars for his own motives, but God gave him great success so that the God of Israel could be glorified and the will of God regarding the captive Jews carried out.  When Cyrus read the prophecy, he knew that the Lord, the God of Israel called him by name.

God has called us by name as well. As our walk is deepened with Jesus, our character is deepened. In our situation, the sorrow is too deep for us to fake a relationship with God anymore.

From the Bible we know that not everything that happens in this broken world is God’s will. Just listen to Jesus in Matthew 23:37:

“Jerusalem, Jerusalem, you who kill the prophets and stone those sent to you, how often I have longed to gather your children together as a hen gathers her chicks under her wings, and you were not willing.”

But, as with Cyrus, God can work in difficult situations. God has hidden treasures in the darkness of suffering. Each of us has to ask ourselves: Will I surrender myself to God in the darkness? Will I listen?

“These trials are only to test your faith, to show that it is strong and pure. It is being tested as fire tests and purifies gold … and your faith is more precious to God than mere gold. So if your faith remains strong after being tired by fiery trials, it will bring you much praise and glory and honor on the day when Jesus Christ is revealed to the whole world.” (1 Peter 1:7 NLT)

As we know from the Bible, every Christian experiences trouble. The question is how we respond. Sometimes we envy Christians who don’t seem to suffer much. But Scripture and observation can tell us that those Christians may not learn to depend on God in a deep way (2 Corinthians 1:9). Their faith may be shallow, and their ministry skills less developed. Pain produces love in a Christian who is filled with God’s grace.

God brings extensive blessings on those of us who suffer much. Bitter blessings, to be sure. But we learn so much about how God feels about his children. We know that God gives us joy and treasure, even in deep darkness.

During the retreat, Kay Warren pointed out that enemy of our souls wants to separate us from intimacy with God. Satan wants us to focus on our pain, disappointments, cynicism and troubles, in the night especially. He wants us to dwell on the hurt and to believe that God is not there for us.

When this happens, people run from Jesus. And some never find him. I have seen first-hand the people in our situation who rely on themselves and do not have a relationship with the Lord. It isn’t pretty.

So what is the reality of our situation? It is that our child is sick and God is present. We don’t know why or how it will all work out. We don’t know the eternal plan. If God tried to tell us about it, it would be like a person talking to an ant. It’s just not possible for the ant to understand.

We truly do not know the reality of our situation and how God is working in it. As Paul wrote in 1 Corinthians 13:12 (NIV), “Now we see but a poor reflection; then we shall see face to face. Now I know in part; then I shall know fully, even as I am fully known.”  1 Cor. 13:12 (NIV)

We do need to reject the voice of the enemy and establish even deeper intimacy with God. We can gather the buried treasures in the darkness.  I think these treasures may be the thing that Jesus called “living water.” God has put it there for us so that we have what we need to survive and thrive.

Bring your grief and loss, your hopes and dreams, to Jesus in prayer. Spend as much time with Him as you can. As James writes, “Come close to God, and he will come close to you.” God is hurting with you over your loved one’s mental illness. He is inviting you to come, rest in His presence and drink the living water and other treasures of the darkness.

To be in God’s presence, we need to be accessible (or present), responsive and engaged. You can use the acronym ARE to check in on yourself. This intimacy with God will carry you, and even give you joy and peace.

God invites us to pray for healing of our loved one, but we must understand that some other plan may be operating that we don’t get to know about. Kay Warren pointed out that the focus of our intimacy with God cannot be on the health of our children. What has to carry us is our intimacy with God. Your desire for God has to be great, whether or not you are suffering. Frankly, the only way to do that is to ask for the graces and the treasure necessary.

“Let the one who walks in the dark, who has no light, trust in the name of the Lord and rely on their God.”

Isaiah 50:10 (NIV)
file cabinet folders showing types of mental illness

Mental Illness in the USA: Pandemic Edition

Note: The National Institute of Mental Health, Mental Health America and NAMI have all released statistics about the state of mental health in America. Much reports on the year 2020, the first of the pandemic. Below are highlights from the reports. You can see the full information by clicking on each organization’s link above.

Twenty-one percent of U.S. adults experienced mental illness in 2020. That’s 52.9 million people. The annual prevalence of condition for 2020 is:

  • Anxiety Disorders: 48 million people (19.1% of U.S. population)
  • Major Depression: 21 million (8.4%)
  • Posttraumatic Stress Disorder: 9 million (3.6%)
  • Bipolar Disorder: 7 million (2.8%)
  • Borderline Personality Disorder: 3.5 million (1.4%)
  • Obsessive Compulsive Disorder: 3 million (1.2%)
  • Schizophrenia: 1.5 million (less than 1%)

Fifty percent of all lifetime mental illness begins by age 14 and 75 percent by age 24. About 7.7 million U.S. children ages 6-17 experienced a mental health disorder.

The percentage of people getting treatment continues to be low (46% of adults, 65% of adults with severe mental illness and 50% of youth). The average delay between the onset of mental illness symptoms and treatment is 11 years. And the number of U.S. counties that do not have even one practicing psychiatrist: 55%.

Impact of Mental Illness in 2020

Mental illness and substance use disorders are in involved in one out of 8 emergency room visits (12 million visits). Mood disorders like Bipolar and Major Depression were the most common cause of hospitalization for people under 45, excluding childbirth. People with serious mental illness are:

  • 21% of the homeless
  • 37% of adults in state and federal prisons
  • 44% of adults in local jails
  • 70% of youth in juvenile justice system
  • 15.3% of U.S. veterans

Twenty-five percent of the people shot and killed by police between 2015 and 2020 had a mental illness.

At least 8.4 million Americans provide care to an adult with mental illness. They spend an average of 32 hours per week providing this care, although that seems high to me.

Ranking of States

Mental Health America does an annual ranking of states that show which are doing the best job dealing with mental illness, based on 15 measures. The Top 10 are:

  1. Massachusetts
  2. New Jersey
  3. Pennsylvania
  4. Connecticut
  5. Vermont
  6. New York
  7. Wisconsin
  8. Maine
  9. Maryland
  10. Minnesota

My state, Ohio, fell from No. 11 in the ranking last year to No. 25 because of the large increase in the number of youth who have a mental health diagnosis and are not getting treatment.

988

988 National Suicide Hotline

A new national suicide hotline number will be available in July: 988.

In Ohio, the 988 number will connect to one of 15 designated lifeline call answering points. Trained mental health specialists will answer the calls, providing both counseling and direction to resources for mental health care.

The new number is based on the success of 911, which has been used as an emergency number for all types of crises since 1968. Officials hope that sending suicide calls to 988 will take pressure off the 911 system, which sends police and/or paramedics to a scene.

The 988 calls will connect people immediately to mental health crisis services. It also will improve the information provided. At present, more than 40 percent of Ohio’s suicide prevention calls are answered by people from other states who don’t know the Ohio system and cannot give advice about accessing its resources.

All this will change with 988. In Ohio, the Department of Mental Health and Addiction Services is implementing the new line with federal startup funds of $400 million.

In addition to the designated call line, NAMI Ohio is also asking for the development of a better, more thorough crisis response system, allowing the specialist to help direct people to housing, rehabilitation services and employment services. I agree with this, although I know it will be difficult to get the funding. After all, it doesn’t help much to answer the phone if you can’t direct people to the help they need.

Loving Someone With Mental Illness Support Group

Loving Someone With Mental Illness is a Vineyard Columbus support group that’s open to all. We meet at 7 p.m. Eastern Time on the first and third Thursdays on Zoom. Meetings last about one hour.

We share, have a brief teaching and pray for each other. The conversation is confidential. The teachings include practical information about helping loved ones with mental illness. We also include faith-based teachings on how to walk with Jesus through this difficult situation.

As leaders of the group, my husband and I have loved ones who have diagnosed mental illnesses. The group has been in existence for more than 10 years. You are welcome to attend regularly or whenever you feel the need.

To obtain the Zoom information, feel welcome to email karentwinem@gmail.com