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.

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

sad caregiver at Christmas

Holiday Tips When Someone You Love Has a Mental Illness

The holidays can be some of the worst days of the year when your family is dealing with mental illness.  Not only is it TOO DARN DARK AND COLD, but it’s also a time when expectations of being Merry and Bright can seem especially hard for your family. The stress can make your loved one have more symptoms, and that can make you even more anxious.

Here are 14 tips to handling the holidays. Some ideas were suggested by an excellent book:  “When Someone You Love Has a Mental Illness: A Handbook for Family, Friends, and Caregivers” by Rebecca Woolis.  Others are things I’ve learned, often the hard way, over time.

  1. Accept this ain’t gonna be pretty.  If you can get rid of your unrealistic expectations and be honest with your loved one and all the other family members, it will go better.
  2. Help your loved one to keep her dignity. Provide a gift fund or another way to allow her to give gifts, so she won’t feel left out if she has no money. Scan every situation that’s coming up to make sure that your loved one won’t get unwelcomed attention.
  3. Hey, it’s a good excuse to keep the unofficially crazy family members away.  You want a small gathering of your own family. Period. Otherwise it’s too stressful for your loved one.
  4. Keep it short. Keep it informal.  If you have to do the Big Family Thing, let your loved one stay home. Big groups are too much for your loved one, especially when you have to Put On a Happy Face. And do your own celebration. 
  5. If any extended family members really want to see your loved one, they know your phone number and where you live. Something private is better.  And try not to be bitter if no one asks. (There’s a reason God chose you to be this person’s lifeline. Not everyone can deal with this.)
  6. The best answer I’ve found to the question … How is he? … is “About the same.” That’s tough enough for you to answer.  So please don’t put your loved one in a situation where he or she has to answer the question.
  7. If you are having an event at your house, discuss it in advance with your loved one so he or she knows what to expect. Accept his limits.  Accept her choices. Acknowledge his feelings. 
  8. If the person wants to be more visible during the holiday, brainstorm some things in advance.  What will he say when asked how he is? What will she do during the gathering? Is there a quiet place to retreat if needed?
  9. Tell the person whose home you are visiting what you may need in advance.  Please don’t put yourself in a position … helping cook at someone else’s home, for example … where you can’t leave with little notice. If you are stuck, have someone … a sibling or spouse … available to get the person home if needed. 
  10. All your great preparation may result in your loved one refusing to participate at the last minute. And that’s OK. 
  11. If someone offers to help you with any holiday preparation, ACCEPT. 
  12. When you make out your own Christmas wish list, see if you can ask for things that will reduce stress, whether it’s a massage, a day trip, a cleaning service or a gym membership. 
  13. Eat right. Avoid the alcohol. Sleep. And write out a list of things that you are grateful for this year.
  14. A nice thank you card to people who have been helpful to your loved one personally or professionally is always good.
job interview sticky note

Jobs for People With Mental Illness

Note: The sources for this post are NAMI.org, southeast.org, ood.ohio.gov, “When Someone You Love Has a Mental Illness” by Rebecca Woolis and my own experience working for a program that linked jobs to people with mental illness.

Families of people with mental illness frequently pin much hope on their loved ones getting jobs. It can even become almost a fixation. “If he would just get a job …” There’s often hope that a job will lead to more stability, but it usually has to be the other way.

Unfortunately, many people with mental illness are too ill to function in the workplace. They lose job after job, not because they are difficult, but because they are too ill.

However, once a person is on a treatment plan, symptoms can reduce. Increased stability makes it more possible for the person to have a positive work experience. Others can never deal with the stress of a full-time job, which can make symptoms worse. But they may be able to work part-time or on a volunteer basis, instead.

What the Law Says

As we said previously, the lack of sufficient funding for people with mental illness has a big impact on their families. There’s not enough money to hire enough case managers, social workers and vocational counselors. So families often have to get involved to ensure the system works for their loved one.

The first step to getting involved is understanding what the Americans with Disabilities Act (ADA) says. And what it does not say.

Most government regulations define an individual with a disability as a person who has a physical or mental impairment that substantially limits one or more life activities: walking, talking, hearing, seeing, learning, performing manual tasks, caring for oneself, thinking, concentrating and interacting with others. This applies to most people with severe and persistent mental illness.

Title 1 of the ADA covers private employers with 15+ employees, state and local governments, services funded by the government, labor unions and employment agencies. It prohibits them from discriminating against qualified individuals who have disabilities in hiring, firing, advancement, etc. The law does not cover employers with less than 15 employees.

The law says employers may not ask prospective employees about the existence, nature or severity of a disability. What they can do is ask about the prospective employee’s abilities to do the job. (Remember: The law protects qualified people with disabilities.) And none of this applies if the person has an active substance abuse problem.

The ADA requires that employers provide reasonable accommodation to the known mental limitations of an individual with a mental disability unless it would impose an undue hardship on the employer’s business. Undue hardships are due to significant difficulty or expense to the employer based on size, financial resources, etc. 

Reasonable accommodations include job restructuring, part time or modified work schedules, reassignment to a vacant job position, and modification of training materials.

The ADA also impacts colleges and universities. It can require them to restructure exams and materials. Many universities and colleges have offices for disabled students that help them get reasonable accommodations.

Returning to Work Gradually

One pathway to returning to working is to move through a system that gradually requires more responsibility and work skills. This can mean starting as a volunteer in an organization with tasks and required hours.

Then, if this works, vocational rehabilitation counselors can help the person find supportive employment, maybe even part-time. In supportive employment, the employer knows that the worker has a mental illness under treatment. This helps the employer to understand if problems arise and to contact the vocational counselor.

Finally, once a person has the workplace skills and dependability needed, they can get a job.

Getting a Job in Ohio

Since I have lived and worked in Ohio, it is the system I know. Other states’ systems may vary.

The Ohio Bureau of Vocational Rehabilitation provides people with disabilities the services and support to get and keep jobs. The bureau’s staff does these things:

  • Evaluation and treatment of an individual’s disability
  • Information and referral services
  • Vocational counseling and training
  • Job search and job placement assistance
  • Educational guidance (tuition resources and other support)
  • Transportation services
  • Occupational tools and equipment
  • Personal attendant services (reader, interpreter, etc.).

The bureau customizes its services for each person using assessments and one-on-one meetings with professional vocational rehabilitation counselors.

After an application is completed and submitted, an interview is scheduled between your loved one and a counselor. You or another friend or family member may accompany your loved one to the interview. A counselor will talk about career goals, work history, educational background, disability and the services necessary to reach an employment goal.

Eligibility for vocational rehabilitation services is based on four factors:

  • The individual has a physical, cognitive, or mental impairment documented by the appropriate qualified professional (doctor, psychologist or other).
  • The documented impairment causes a substantial impediment (barrier) to employment.
  • The person can benefit from vocational rehabilitation services that lead to an employment outcome.
  • The person requires vocational rehabilitation to prepare for, secure, retain or regain employment

The vocational counselor will be honest if they feel that your loved one is not ready for employment. How much you have to help your loved one with the meeting is a part of that, whether it is said or not. If your loved one can’t get up to go to the meeting or can’t answer the questions without your help, he or she is probably not yet ready for a job.

When your loved one is determined eligible for services, an Individualized Plan for Employment (IPE) is created with the counselor. The IPE is an agreement between your loved one and OOD describing services that will be provided according to your loved one’s choices. Your loved one may be responsible for some costs of the vocational rehabilitation plan, especially college tuition.

When your loved one is ready for employment, the counselor and other OOD staff will help them prepare for the job search. The counselor can offer information on accessing public transportation (if available in the community) or arranging for private transportation. The counselor also can help your loved one with job site modifications for accessibility and efficiency.

They also may be able to set up supportive employment, which can transition to a regular job where people are not told about the illness.

OOD also can help your loved one keep the job if they are having trouble working because of their disability. The counselor can work with your loved one and their employer to determine the services necessary.

In Columbus, Southeast Vocational Services, formerly COVA, is another vocational services program.  I served on the board of this organization, which works with everyone from people with PhDs to those with entry level skills.

Its Transitional Employment program or “Project Work” provides temporary employment to people with a history of severe and persistent mental illness and substance abuse disorders. People get up to 1,000 hours of paid employment services within a 12-month period with the goal of moving from transitional employment to permanent employment full or part-time.

Southeast also offers benefits counseling and re-entry support for people leaving prison. Call Southeast at (614) 294-7117 to ask about it.

Filling out applications

It’s best to work with a vocational counselor, social worker or case manager to fill out applications for jobs. Legally, your loved one only needs to elaborate on the diagnosis if it impacts the ability to do the job. Otherwise, they should not volunteer information about their medical history.

They should tell the truth about their employment history. (Again, this is where recent volunteer jobs can come in handy.) The counselor can help with good answers to explain the gaps in the history.

You can practice with your loved one as a coach for the interviews. They may be anxious and fearful, so a practice … even a dress rehearsal … helps. Help your loved one with the appropriate dress. You can fill out the applications together and make copies in case they get lost or damaged. You also can use relatives who have knowledge of the loved one’s level of responsibility for references. If your loved one has had volunteer experience, those individuals also may make great references.

Getting back into the work world can be a great challenge. If benefits are involved, be sure to learn what the impact will be. May God bless you and your loved one in this effort.

housing

Housing for People with Mental Illnesses

Note: Sources of information for this post are NAMI.org, southeast.org, ood.ohio.gov, “When Someone You Love Has a Mental Illness” by Rebecca Woolis, and my six years working in an organization that provided housing for the mentally ill.

The lack of safe and affordable housing is one of the most powerful barriers to recovery from mental illness. When this basic need isn’t met, people cycle in and out of homelessness, jails, shelters and hospitals.

I agree with a philosophy called Housing First: Having a safe, appropriate place to live can provide stability to allow people with mental illness and/or substance abuse to stabilize and recover. Unfortunately, this housing is relatively rare. It takes organization and effort to get someone into the system.

As we all know, there’s not enough funding to cover the needs of people with mental illness. If the funding existed, case managers, social workers and vocational counselors would be handling housing and money issues for our loved ones. Since there isn’t enough money to go around, families often have to get involved.

Because of this, my No. 1 tip in dealing with the system is to make friends with a social worker. I met social workers at NAMI family support groups and events. This was invaluable in helping me understand how the system REALLY works. I also got excellent advice about where my son should be placed on a waiting list for housing.

What the Law Says

Several pieces of federal legislation prevent discrimination against people with mental illness in employment and housing. The most important in obtaining housing is Title VIII of the Civil Rights Act of 1968 (the Fair Housing Act). For most residential buildings (except some small owner-occupied buildings), this law forbids discrimination, such as refusing to rent or sell, denying that housing is available, and renting or selling on different terms.

That said, a history of arson and/or sexual assault usually keeps individuals out of housing for people with mental illness. Housing for people with mental illness is usually called housing for the disabled, in part to keep the neighbors from fighting it. People who are currently homeless usually get more help from organizations than those who are not.

Obtaining Housing

Many people with a serious mental illness live on Supplemental Security Income (SSI), which averages just 18% of the median income and can make finding an affordable home near impossible.

Housing options range from completely independent living to 24/7 care. The type of housing that is right for your loved one can depend on whether they need assistance paying bills, cleaning and making appointments or require no assistance at all. Here’s a look at some of the housing available.

Supervised Group Housing: Trained staff members are present 24/7 to provide care and assistance with things like medication, daily living skills, meals, paying bills, transportation and treatment management. These group homes provide their residents with their own beds, dressers and closet space, and shared bathrooms and common areas. This is the best type of housing for people experiencing a serious mental illness which may affect their ability to perform their daily tasks.  There’s virtually none of this in my part of the country, central Ohio.

Partially Supervised Group Housing: Some support is provided for the residents, but staff isn’t there 24 hours a day. The residents can be left alone for several hours and are able to call for help if needed. People who choose to stay in these group homes can perform their daily living tasks independently or semi-independently, help with cooking and cleaning and may even hold a part-time job or participate in a day program.

Permanent Supportive Housing: Supportive housing provides very limited assistance. The residents of these homes live almost independently and are visited by staff members infrequently. Community mental health center and social workers on site to help. Health care comes in.

Rental Housing:  Rent can be paid for in full by the individual or subsidized by a third party, such as the government or a non-profit agency. Someone who chooses this type of housing can take care of all their basic needs like cooking, cleaning, paying bills and managing their medication. They also may have a job and have or be seeking custody of children. If this is the right type of housing for your loved one, then they will still most likely work with a caseworker to manage their recovery.

Affordable Senior Housing: When your loved one becomes 55 or older, they usually qualify for affordable senior housing, such as offered by National Church Residences in 25 states. This housing for low-income seniors has no supportive services.

Ways to pay

Section 8: The United States Department of Housing and Urban Development (HUD) provides a number of housing assistance and counseling programs. The Housing Choice Voucher Program (Section 8) is the federal government’s program for assisting low-income families, the elderly and the disabled. HUD also helps apartment renters by offering reduced rents to low-income residents. Under this program, a renter pays 30 percent of their gross adjusted income for housing and utilities. The landlord then receives a voucher from the federal government which covers the remainder of the rent.

Section 811: The Supportive Housing for People with Disabilities Program (Section 811) is a federal program dedicated to developing and subsidizing rental housing for very or extremely low income adults with disabilities, like a chronic mental illness. The biggest difference between this program and similar ones is that it provides housing specifically for the disabled and ensures that all housing has access to appropriate supportive services like case management and employment assistance.

Applying for housing

If you can get a social worker or case manager to help fill out applications for jobs and housing, do so. You can practice any interview with your loved one. Interview tips include:

  • Don’t volunteer information about medical history.
  • Do not lie about job history, including positions held or lengths of time worked.
  • If asked about gaps in employment history, you can say “I was recovering from an illness,” “I was participating in a vocational rehab program” or “I was taking some classes.”
  • If there’s concern about ability to pay rent, you can say, “I have a guaranteed disabilities payment.”

Co-signing a lease makes you legally responsible for making sure the rent is paid during the period of the lease. Before you decide to do this, assume that you will pay all the rent and look at how that will impact you. Make your decision based on that. You also may become responsible for damages to the apartment, so be aware of that as well.

Housing in Columbus Metro Area

To apply for Community Housing Network housing, please call the Community Housing Network Intake Department at 614-487-6700. CHN has developed and manages more than 1,200 apartments. CHN provides rent subsidies to an additional 400 residents renting from private landlords. CHN also provides all customary property management.

National Church Residences takes its residents through Community Shelter Board, so call there.

To apply for Unified Supportive Housing System, apply for Alcohol, Drug and Mental Health Board of Franklin County housing, go to the Community Housing Network website, complete the CHN USHS Housing Request and submit to the CHN Intake Department.

Housing providers include:Alvis, Equitas, Community Housing Network, Maryhaven, National Church Residences, Volunteers of America of Greater Ohio, YMCA, and YWCA. These organizations usually take the homeless first. Ways to be homeless can vary, including couch surfing, or staying for one friend after another.

Next time we will talk about processes for getting a job when your loved one is recovering.

the road to recovery

Recovery: How Do We Get There?

Note: This information comes from my own lived experience, notes from various seminars I’ve attended and “Grace for the Afflicted: A Clinical and Biblical Perspective on Mental Illness” by Matthew A. Stanford.

No matter how difficult the circumstances are, people who have mental illness may recover. In fact, between 60 percent and 80 percent of people with mental illness who get and stay in treatment show recovery.

Mental illness is a chronic condition, meaning we can manage symptoms but not cure the disease. So what does “recovery” mean?

The Substance Abuse and Mental Health Services Administration defines recovery as “a process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential.

What does recovery look like?

For people with mental illness, it means going from Distress to Stability to Function to Purpose. For you, it means moving from Caregiver to Manager to Partner to Family.

The process is hardest on Americans because of our culture

Mainstream American culture values individuality and independence more than any other culture. This can cause U.S. caretakers to think caring for an adult is unusual, while it’s accepted as part of life in other cultures.

Recovery requires a holistic recovery effort that takes months or years, not days or weeks. Here are some of the issues that need to be addressed:

Physical needs

Sleeping well: Up to 80 percent of people with mental illness have chronic sleep problems as opposed to 10 to 18 percent of people without. The most common issues are insomnia and late insomnia. This is important because sleep deprivation can result in suicidal ideation, paranoia and agitation. To sleep well, encourage your loved one to try these tips:

  • Have the same bedtime with same routine every night.
  • Reduce caffeine.
  • Talk to their doctor.
  • Take effective medication.
  • Learn relaxation techniques.

Eating healthier

Doing exercise such as walking or gardening

Emotional and mental needs

Developing healthy thinking patterns: Your loved one’s therapist can work with them until they maintain healthy thinking patterns. Some things they need to learn are:

  • How to suppress negative thinking
  • How to accept a negative situation
  • How to recognize cycles and triggers
  • How to take a preventative approach when a relapse seems likely

Doing activities that heal the brain: Research suggests that active mental activities have a healing effect on the brain. Watching TV or movies are passive activities, which do not help. Active mental activities include:

  • Painting and drawing
  • Reading
  • Photography
  • Music
  • Gardening
  • Word games or puzzles

Living a structured life: Daily and weekly routines also reduce stress and bring a sense of safety.

Spiritual needs

Discovering hope in Jesus: We can help our loved ones understand what they mean to God. People with mental illness often feel that God doesn’t love them or that their faith isn’t strong enough. You may be able to help them to understand their identity in Christ. Even heroes of faith like David (Psalm 13), Job (Job 3), and Jeremiah (Lamentations 3) struggled with times of intense hopelessness. Encourage your loved one to share their feelings, requests and gratitude for what is good in prayer.

Finding purpose: Your loved one has a purpose in God’s plan that is just as important to God as everyone else’s. In fact, their heaviest cross … a mental health situation … can be an opportunity for God to manifest in their lives.

Growing spiritually: Focus on God’s love and your loved one’s identity in Christ rather than working on scriptures that focus on sin. Brief daily encouragements from the Bible are better than in-depth Bible study. Encourage them to check with you or others when they think they are hearing directions from God’s voice. Worship is good, but it should not be too stimulating or overwhelming.

Living in community: My church, Vineyard Columbus, has a One-Minded in Christ support group for people with mental health diagnoses. Check to see if you can find something like this in your community.

Relational needs

Stay connected to a few trusted and supportive people: Supportive friends and family are essential to recovery, but the friends and family also need the support of others. Some of the best ways you can help are:

  • Learn to resolve conflict, to defuse your own tension.
  • Learn to validate emotions.
  • Learn to affirm their faith in Christ.
  • Help them find opportunities to serve.

Recovery is possible. As we hope and pray, let’s take these steps to help our loved ones.