How to Navigate HIPPA

Note: Ken and I attended a NAMI Franklin County workshop on February 8, 2020, that included a presentation on Navigating HIPAA for Families and Caregivers.  We learned some good information that, in addition to info we had or have found out the hard way,  we’d like to share with you. 

The Health Insurance Portability and Accountability Act (HIPPA), which went into effect in 2003, has been a major barrier for many families dealing with a loved one with mental health issues.  Sometimes this is because the law is being used correctly.  And sometimes because health care providers are over-interpreting or misinterpreting it.

Here’s one example:  My cat, Chester, needed medicine that the vet didn’t have. So she wrote me a prescription to take to the pharmacy.  Once there, the pharmacist looked at the prescription for Chester Twinem (feline) and asked me how old he was.  I said, “16.”  The pharmacist said, “That’s good.  That means you can sign his HIPPA form for him.”

I was thankful that he wasn’t older because he would not like going to the pharmacy to sign the form for himself with his little paw.

That’s how it can be.  Systems are set up based on HIPPA that actually not in the best interest of all patients. There are the true HIPAA regulations, and then there are the interpretations of those regulations by hospitals, doctors, pharmacists, etc. Here’s a look at the truth:

Who has to comply with HIPAA?

  • Most health care providers (physical, mental health, addiction services providers)
  • Health plans (private insurance companies, such as Anthem
  • Public benefit payers, such as ADAMH boards

These people and organizations are called “covered entities.”

What is protected information under HIPAA?

Basically, it’s any information that a covered entity has in its records about a person who has received health care services, including demographic information. The rule is that HIPPA covers:

  • Information that relates to the individual’s physical or mental health or condition,
  • That a HIPAA covered entity created, received or transmitted in the provision of health care or payment for health care services AND
  • Which either identifies the individual or can be used to identify the individual.

Covered entities must obtain written authorization to disclosed protected information unless HIPPA contains an exception that applies to the disclosure. One exception is sharing between treatment providers.

What disclosures are permitted to families and caregivers? 

 Information can be disclosed to a Personal Representative, an individual who has the authority to make health care decisions under Ohio law.  Other states have different laws on this. Under Ohio law, covered entities (providers) must disclose information to the individual, the personal representative or both.

The people who have legal authority to make health care decisions for another person under Ohio law are:

  • Those with a Health Care Power of Attorney
  • Those identified in a Declaration for Mental Health Treatment
  • A court-appointed legal guardian
  • The parent or guardian of a minor child

What is a Health Care Power of Attorney?

This authorizes a second person to make health care decisions when a person can no longer make them. Two health care professionals have to agree that the person can no longer make decisions for themselves. When that happens, the second person becomes a Personal Representative.

The Health Care Power of Attorney document can also authorize the designated second person to obtain health care information for and on behalf of the individual at any time. It must say specifically: “I specifically authorize my agent to obtain my protected health care information immediately and at any future time.”

 What is a Declaration for Mental Health Treatment?

This document authorizes a proxy to make mental health treatment decisions when the individual does not have capacity to consent to treatment decisions. When the declaration goes into effect, the designee becomes the personal representative. (Note: This form is long and can be difficult for a mental illness person to fill out.)

Unless limited in the declaration, the proxy has the right to obtain personal health information regarding the proposed mental health treatment of the person and to receive, review and consent to disclosure of records relating to that treatment.

 What about court-appointed legal guardians?

The court-appointed legal guardian of an incompetent person is a personal representative. An incompetent person is incapable of taking proper care of themselves and their family as a result of a mental or physical illness/disability, intellectually disability and chronic substance abuse. The process of obtaining legal guardianship takes many months.

What are the rights of parents and guardians of minors regarding information?

The parent, legal guardian or other person acting in loco parentis with legal authority to make health care decisions is a personal representative.

Exceptions include when the minor is receiving confidential mental health services and the parent/guardian has agreed to a confidentiality agreement between the provider and the minor.

The covered entity may decide not to treat a parent, etc. as a personal representative if the covered entity has a reasonable belief that the parent has abused or neglected the child. Or if treating the parent of the personal representative could endanger the individual and the covered entity decides it’s not in the child’s best interest to treat the parent as a personal representative.

What information can be given to persons involved in care?

Health-care or payment-related information can be disclosed to a family member, other relative, close personal friend or other person identified by individual. The information must be directly relevant to the person’s involvement with the health care or payment of health care.

An organization’s policies may supersede and be more restrictive than HIPAA.

Covered entities can notify family members, personal representatives and other people responsible for an individual’s care of the person’s location, general condition or death.

If a person is present in the room and has the capacity to make health care decisions, the covered entity must obtain agreement to disclose personal health information, give the ill person the opportunity to agree or object, or reasonably infer using professional judgment that, based on the circumstances, the ill person would not object.

If a person is not present, or if the opportunity to agree or object cannot happen due to incapacity or emergency circumstances, the covered entity must use its professional judgment to determine whether disclosure is in the best interests of the person.

How do you get written authorization?

The form to obtain written authorization, in which the individual authorizes the Covered Entity to disclose personal health information, has many names:

  • Release of Information
  • Written Authorization
  • Consent to Disclose
  • Standard Authorization form

The form must contain some specific elements from the HIPAA law. Generally, the covered entity is not required to disclose the information.

Ohio’s Standard Authorization Form, which is a national example, says the covered entity is REQUIRED to disclose the information.

So what should you do to get access to the information you need to help your loved one? 

First, you need to act before there’s an issue.  Make sure that your loved one’s health care providers know that you are involved in the person’s care.

Get Health Care Power of Attorney, a Declaration for Mental Health Treatment and, if in Ohio, the Ohio Standard Authorization Form signed and given to the providers.  Do this when your loved one is well enough to discuss and sign to provide you with updates or notifications in the event of an emergency.


Tips to Reduce Anxiety About the Coronavirus

Scary dreams and worries can kick off an overwhelming level of anxiety during this pandemic.  While it’s bad for everyone, it’s worse for people who have mental illness.

Those who have existing issues with panic disorder, depression and generalized anxiety are almost certain to have more intense symptoms unless we take preventive measures. The symptoms can include digestive problems, dizziness, elevated heart rate, fatigue and insomnia, among other things.

I got the idea for this list from an article by Noma Nazish in ForbesLifeand have adapted for my website mindfulchristianyear.com

Control what you can control. And that means you. Wash your hands. Stay six-feet away from people. Still, it helps to smile and be friendly when you pass people from this distance. We also can pray for each person we pass on the street or in the park.

Schedule times for prayer and quiet. If you don’t already have a routine for regular prayer during the day, it’s a great time to start. An alarm on my phone reminds me to stop about every three hours to pray or read Christian materials. Sarah Young’s books, starting with Jesus Calling, are excellent. Her app is very good as well. I also use materials in apps like Pray-As-You-Go, the NIV Bible, Ending Your Day Right, Centering Prayer and the Divine Office.

Make this a good time for your children or grandchildren. Our attitudes will decide how the kids remember this time. Model faith, calm and self-care. Let your kids talk through their fears and concerns. Listen for increases in symptoms.  Determine whether you need to make a call to your child’s psychiatrist to provide information. Make sure you also find some ways to have fun together.

Use block scheduling to set up a routine. Setting up a routine will help to keep you and your family focused on the good. Block scheduling – setting aside an hour or two for each major kind of activity – has been very useful. Activities can include: reading, homeschooling, housework, paperwork, making things, exercise, shopping online, etc.

Reduce your exposure to news and social media. I look at my social media channels once a day. I also read the COVID-19 round-up on my Associated Press app and one local news app in the morning and at night. We do watch the PBS NewsHour as well. Other than that, I try to concentrate on my own life. I think the most reliable sources of information are the Centers for Disease Control and Prevention (CDC), WebMD, the Weather Channel’s COVID-19 section, the World Health Organization (WHO) and the John Hopkins’ Coronavirus Resource Center.

Stay connected to family and friends. This is the era of FaceTime calls and Zoom/Skype meetings. There’s also the good old-fashioned phone call and new-fashioned texting. Check in with your loved one with mental illness on a regular basis without seeming too anxious yourself. Make an effort to cheer your friends and family up. It will cheer you up, too.

Do a daily stress-reduction exercise. My isolation gift to myself was a subscription to the Breethe app, which is offering specific relaxation exercises regarding coronavirus anxieties. I also use Calm, Meditation Oasis and the Cleveland Clinic’s Stress Meditation. The relaxation exercise is on my block schedule for a specific time in the afternoon.

Eat well. Stress eating is one of my problems, but I do know that mindfully choosing to eat a nutritious meal before I can have my salty/sweet treat is cutting down on the overeating.

Get out in the fresh air and sunshine. Take a daily walk. Set up your patio furniture early or sit out on your porch to read.

Be the hands and feet of Christ. Get involved in helping other people during this time. Your church may have ideas. You also can call a humanitarian organization to see if you can help. Many people are helping from home by calling others to see how they are doing.

Like everything in life, this crisis is offering opportunities to grow as Christians.

Know Your Meds: Long-Acting Injectables

NOTE:  This information came from NAMI and other sources, as well as my own experiences.

Long-acting injectables (LAIs) can be helpful when an individual with mental illness either refuses or is not compliant with medication, often with very unfortunate results.  Most of the people I’ve met who are using LAIs got started in a hospitalization or a situation in which they had regularly become a danger to themselves.

LAIs slowly release medicine into the blood. Injectable medications used for individuals living with mental illness include: Abilify Maintena®, Aristada®, Haldol decanoate®, Invega Sustenna®, Invega Trinza®, fluphenazine decanoate, Risperdal Consta®, and Zyprexa Relprevv®. The LAIs can last anywhere from 2-12 weeks with just one dose, which helps to control symptoms of mental illness.

What do LAIs do?

LAIs treat psychosis (hallucinations or delusions) in individuals with schizophrenia. Some LAIs may be used as mood stabilizers in individuals with bipolar disorder.

How can an LAI help?

Living with active psychosis causes many people to make very bad decisions, which can result in arrests and involuntary commitments.  LAIs can help individuals stick to a medication plan.

When comparing LAIs to pill medications, LAIs may lower the chances of someone going to the hospital. LAIs allow for a steady level of medicine in the blood. These steady levels help lower the chance of side effects. The LAIs may also help improve quality of life and satisfaction with medicine.

How are LAIs given?

LAIs are given as an injection in the muscles of the arm or bottom. When starting a LAI for the first time, individuals may also have to take pill medication for a few weeks. The pill allows the injection to have time to start working. Injections are given every two to 12 weeks depending on the medication.

What if I’m interested in an LAI?

If interested in a LAI, talk to a doctor. A LAI may not be right for every person with a mental illness. The main side effect of a LAI is pain at the injection site.

When talking to a doctor, ask:

  • How will a LAI help?
  • What symptoms will a LAI control?
  • What side effects may occur?
  • What blood work will need to be done?

How can I pay for an LAI?

LAIs are usually expensive.  Many insurance plans should help cover the cost of one of the LAIs. The drug company for each medicine may also be able to help.

Know Your Meds: Mood Stabilizers

Mood stabilizers are typically used to treat intense, repeated shifts in a person’s mood, which may be common for those experiencing bipolar, schizophrenia, or borderline personality.

Many mood stabilizer drugs are also commonly categorized as anticonvulsant medications.

The oldest of them, lithium, has been in use for over 50 years and has proven very effective, particularly for bipolar disorder, type I. However, regular blood tests are required when taking lithium because of potential serious side effects to the kidneys and thyroid.

Newer mood stabilizers, many of which were originally used to treat seizure disorders, may work better than lithium for some people. Mood stabilizers can prevent manic or hypomanic episodes and depressive episodes. but also have side effects to know about and monitor.

Common mood stabilizers include:

Know Your Meds: Anti-Anxiety Medications

The next class of medication are anti-anxiety medicines, which reduce the emotional and physical symptoms of anxiety.  Benzodiazepines such as alprazolam (Xanax) can treat social phobia, generalized anxiety disorder and panic disorder. This information comes from NAMI and goodtherapy.org

These medicines work quickly and are very effective in the short-term. However, people prone to substance abuse may become dependent on them.

Because the body can become used to the meds, doctors may need to increase the dosage over time to get the same therapeutic effect. People who stop taking benzodiazepines suddenly may experience unpleasant withdrawal symptoms. Other potential side effects include:

  • Low blood pressure
  • Decreased sex drive
  • Nausea
  • Lack of coordination
  • Depression
  • Unusual emotional dysfunction, including anger and violence
  • Memory loss
  • Difficulty thinking

Antianxiety and antipanic medications on the market include:

Know Your Meds: Antidepressants 101

Antidepressants improve symptoms of depression by affecting the brain chemicals associated with emotion, such as serotonin, norepinephrine and dopamine. The following information comes from NAMI, goodtherapy.org and other sources.

Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are newer antidepressants with fewer side effects than older drugs, but no medication is entirely free of side effects. Potential side effects of SSRIs and SNRIs include:

  • Nausea
  • Nervousness, agitation or restlessness
  • Dizziness
  • Reduced sexual desire/difficulty reaching orgasm/inability to maintain an erection
  • Insomnia, drowsiness
  • Weight gain or loss
  • Headache
  • Dry mouth
  • Vomiting
  • Diarrhea

One antidepressant (Bupropion) affects mostly the brain chemical dopamine and is in a category of its own.

Meanwhile, older types of antidepressants, including tricyclics and monoamine oxidase inhibitors (MAOIs), may be prescribed by a mental health professional if newer medications do not seem to be effective. Common side effects of tricyclics include:

  • Dry mouth
  • Blurred vision
  • Constipation
  • Urine retention
  • Drowsiness
  • Increased appetite, leading to weight gain
  • Drop in blood pressure when moving from sitting to standing, which can cause lightheadedness
  • Increased sweating

MAOIs are the least-prescribed of all antidepressants because they can cause dangerously high blood pressure when combined with certain foods or medications. People taking MAOIs must watch their diets carefully to avoid potentially life-threatening complications. Off-limits foods typically include aged cheese, sauerkraut, cured meats, draft beer and fermented soy products such as miso, tofu or soy sauce. Some people may have to avoid wine and all forms of beer.

Some antidepressants may be useful for post-traumatic stress disorder, generalized anxiety disorder and obsessive-compulsive disorder but may require higher doses. Symptoms of depression that are part of a bipolar disorder need more careful assessment because antidepressants may worsen the risk of mania and provide little relief from depressive symptoms. As always, ask your doctor about what treatment options are right for you.

When will the medication work?

In the first few days, the person may have better sleeping and eating habits. In the first 1-3 weeks, the person may have better memory, sex drive, and self-care habits. They may also feel like they have more energy and start to have less anxiety.

After 2-4 weeks, the person may start to have a better mood, less feelings of hopelessness, and less suicidal thoughts. They may also start to feel interested in hobbies again. It may take 6-8 weeks for the medication to fully work.

What are the common side effects?
These are most common in the beginning, and usually get better within 1-2 weeks.

  • Headache
  • Upset stomach, diarrhea
  • Sleepiness or feeling more awake

Some antidepressants can cause sexual problems, such as a decrease in sex drive or problems with ejaculation.

How long do people need to take this medication?
Some people need to take medicine for up to 1 year after they feel better. Others need to take medicine long-term to prevent their symptoms of depression or anxiety from coming back. The length of time depends on how bad the depression or anxiety was, how long they had it, and how many times they have had depression or anxiety in the past.

Here are some of the medication names and their types, with some links to their descriptions in goodtherapy.org

Know the Meds: Antipsychotics 101

Note: This information came from the websites of NAMI, goodtherapy.org and other sources, as well as my own experience. 

Antipsychotics come in two major categories: typical and atypical. Occasionally they are called first and second generation.

The antipsychotics developed in the mid-20th century are the typical and first generation class.  Atypical or second generation were developed more recently. These medications reduce or eliminate the symptoms of psychosis, such as delusions and hallucinations, by affecting the brain chemical dopamine.

Both types of antipsychotics are used to treat schizophrenia and schizoaffective disorder.  The atypical also are used to treat acute mania, bipolar disorder and treatment-resistant depression.  Both kinds work, but they have different side effects.

What are the names of these medications? 

What are the side effects?

Side effects are most common at the beginning, and most get better over time.  The most common are:

  • Sleepiness
  • Dizziness
  • Upset stomach
  • Increased appetite

First generation antipsychotics are more likely to cause movement issues, such as tardive dyskinesia (a condition in which the brain misfires resulting in random, uncontrollable muscle movements and tics.)

The second generation can cause weight gain.

How long does it take to produce results? 

It often takes four to six weeks for the medication to fully work.  However, in the first three days, the person may feel less upset and angry.

After one or two weeks, the person may have a better mood and improved self care habits.  You may see clearer thinking, with fewer hallucinations and delusions.

How long do people take this medication? 

It depends on the situation: how bad the problems were, how long the illness lasted before treatment, and how many times they have had episodes.  Some people only need it for one or two years, while others need it for a lifetime.

 

 

Know the Meds, Part 1

The treatments for mental illness conditions vary from person to person, which doesn’t make things any easier.  People with the same diagnosis can have vastly different experiences with treatments and medications.

Of course, your loved one’s mental health provider is the best source for information about treatment.  Getting a HIPPA release so you can discuss the situation with them is very useful.  The articles in this series, based on information from NAMI and my experience, are general information to help you understand the treatment options when they are discussed.

Psychotropic, or psychiatric, medications influence the chemicals in the brain that regulate thinking and emotions.  While they can be more effective when combined with therapy, often a person needs the medication first to reduce symptoms to allow them to participate in the therapy.

Predicting what works is a challenge.  One field of research called pharmacogenetics does genetic testing to help determine how medications will interact with a person’s genes.  Some people I know have taken these tests, so it’s worth discussing it with the doctor. It’s also helpful to tell the doctor if a medication has worked well for someone else in the immediate family.

Another major challenge is that the medications rarely work instantly.  A person may need to take medication for as long as a few months to see a difference, which becomes even more irritating if side effects are causing issues.

To try to stop that, physicians usually start with small doses and build up to get to the point where the symptoms are better.  It’s important that your loved one does not stop medicine at once.  Usually, it’s better to taper off to avoid unpleasant effects.

The main categories of psychotropic medicine are:

  • Antipsychotics
  • Antidepressants
  • Anti-anxiety medicine
  • Mood stabilizers

We will look at each in this series.

15 Ways to Abide With Jesus

Want to enjoy the presence of Jesus in your life as a caregiver?  Here’s 15 steps to help you get there.

  1. Try a daily prayer of surrender. “Today, this is Your day… Today, I am Yours… May Your Spirit lead, guide and prompt me throughout my day… May I be sensitive to Your prompting and respond accordingly… Today, I surrender my life to You…
  2. Read a short section of Scripture or a devotional book as often as you eat.
  3. Pray Bible verses. Even if it’s just a few verses, pray the Bible back to God.  This is easier if you put up Bible verses around the house. That can be in framed calligraphy, a perpetual calendar of Biblical thoughts or simple Post-it notes.
  4. Be in the day with a plan and the willingness to disregard the plan to respond to what God allows.
  5. Keep focused on what you are doing. When you walk with Jesus, everything you do can be a prayer. This is where the practice of Christian mindfulness comes in.
  6. Listen to yourself and be compassionate. Overcoming restlessness and the need to focus on the trivial to avoid the pain of grief is a problem that I have, and I think many others who are caregivers of people with mental illness have as well. The Three Things exercise can help you to focus your attention, reduce restlessness and add calm: Stretch or drink some water. Note three things you see, three thinks you hear and three feelings you have. 
  7. Refocus during transitions. Try to center yourself as you move from place to place, from event to event. You can say:  I am calm, peaceful and aware of the presence of God as I enter this home/door/time/event.
  8. Carry on a conversation with God and try to make it continual.
  9. When you run out of words, say the Jesus prayer. Using a “Jesus” prayer when you need to calm down or you are in a situation in which you would just look at your phone helps. You can pray “Jesus, Jesus, Jesus” over and over.  I use “Come Holy Spirit.”  It’s also a nice way to go to sleep at night.
  10. Stop to praise God
  11. Be a “yes” to all that is in God and to each circumstance and person who comes into our lives. Have faith that God is at work even in horrible circumstances. We should look at all circumstances, environments, and even all persons as coming through God’s hands so we can serve Him. This is the “good” that all things work for as mentioned in Romans 8:28: 28 And we know that in all things God works for the good of those who love him, who have been called according to his purpose. Acceptance of this kind makes caregiving less depleting and exhausting.It’s so challenging, but you can accept the reality of the circumstance and not argue in your mind that it should be different.  Second, you also need listen to yourself rather than taking a treat (food, a drink or a nap). Acceptance is not the same as being happy in sad circumstances. You cannot pretend everything is fine, because your mind knows it’s not. Accepting that everything is not fine, but it is impossible for you to change allows you to offer more empathy without draining excessive energy. We are not in heaven yet, and bad things happen in a fallen world.  God is still present and wants to abide in you.  The joy of the Lord is your strength.  Follow an energy draining situation with an energy builder such as reading, meditation, pray, eating something healthy and tasty.
  12. In everything give thanks
  13. Think on these things. Philippians 4:8:Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable – if anything is excellent or praiseworthy – think about such things. I made up a phrase to help me remember this: The normal real person likes an excellent pizza. (true, noble, right, pure, lovely, admirable, excellent, praiseworthy).  This helps me to do a thought check when I seem to be on the wrong track.
  14. Give yourself a GIFT list.The GIFT list idea originated with Pam Young and Peggy Jones, and I adapted it to give myself something else to think about. I keep the daily list with my to-dos. GIFT stands for: Grace, Imagination, Focus and Thanksgiving.  I ask for a Grace from the list of the fruits of the Holy Spirit (love, joy, peace, patients, kindness, goodness, righteousness, gentleness and self-control). For Imagination, I pick a virtue and image how I could incorporate that virtue into my day.  Focus is the day’s predominate activities.  (Attending meetings, writing, planning, cleaning, making things, running errands, enjoying the family, taking a Sabbath, etc.)  And Thanksgiving is a gratitude list I fill out as the day goes on.  When my mind goes on a tear, I deliberately turn it back to the Grace, Imagination or Focus of the day.
  15. Summon up your courage and pray the welcoming prayer. This is the scariest prayer I’ve ever prayed: Welcome, welcome, welcome. I welcome everything that comes to me today because I know it’s for my healing. I welcome all thoughts, feelings, emotions, persons, situations and conditions. I let go of my desire for power and control.  I let go of my desire for affection, esteem, approval and pleasure. I let go of my desire for survival and security. I let go of my desire to change any situation, condition, person or myself.  I open t the love and presence of God and God’s action within. 

This practice of the presence of God, somewhat difficult in the beginning, when practiced faithfully, secretly brings about marvelous effects in the soul, draws down the abundance of God’s grace upon it, and leads it imperceptibly to this simple awareness, to this loving view of God present everywhere, which is the holiest, the surest, the easiest, and the most efficacious form of prayer. People who lean on Jesus know things that other people don’t know.

 

The Aim of Christian Meditation and Mindfulness

The prayer of the presence of Jesus and Christian mindfulness are two parts of a whole:  the experience of abiding in Jesus.

In their book “Practicing the Prayer of Presence,”  Adrian van Kaan and Susan Muto wrote:  “The best way to cope with suffering is not stoic indifference or pessimistic complaints, but constant conversation with God in all matters, great or small, at all times and in all places.

“A deeper way of learning to pray is to try to live in the presence of God. This is the beginning of always praying as the Gospels and St. Paul recommend. We try in a relaxed way to become aware of His Presence all the time we are awake. We need the grace of quiet concentration and perseverance to develop this habit.

“If we practice the prayer of Presence, we will be better able to check our speech.  Is it agitated, restless, disquieted?  Or is it calm, deliberate and quietly rooted in Christ, who is our Way, Truth and Life?”

What they are talking about has similarities to secular meditation and mindfulness.  But it is quite different.  What the world calls meditation is just a preliminary step that Christians call “recollection” exercises.  It is necessary to bring our spirit together again in inner stillness if we want to be fully present to the Lord.

The aim of Christian mindfulness meditation is:

  • To make our minds familiar with the truths of God.
  • To dwell on those truths.
  • To apply the insights we receive to our lives.

One of the reasons that mindfulness is a popular today is that research shows that it helps to reduce stress and even pain.  Mindfulness can release the mind from an overgeneralized state.  It relieves the automatic brooding, avoidant mind.  Loving kindness meditation and kindness to one’s self also help to decrease the fears that come from feeling responsible when anything goes wrong.  Being overly responsible is an issue I have.

Abiding in the Lord has elements of this mindfulness: seeking to concentrate on the present moment.  “The day’s own trouble is sufficient for the day,” as Jesus said. But it goes beyond that to recognize that God is present in the here and now.  God is here.  God is now.

The condition to receive the presence of God is emptiness.  We must empty ourselves inwardly of all that is not God, including distraction, agitation, fear and nervous tension.  All must give way to the flow of quiet presence.

The person who is experienced with this kind of effort is not a person whose mind does not wander.  Everyone’s mind wanders.  The experienced person is someone who gets very used to beginning again and again and again.