re: “… Do not focus on “getting more beds” or “providing better treatment.” This is just one ‘place’ that deeply bothers me, as my little corner of the world (near Sequim, WA) is adding in a 16 bed “E & T” psychiatric hospital, where there will be 16 safe rooms with 24/7 video monitoring. I ache for the folks who – in their deepest despair – contact our region’s Crisis Line (I was on the committee that selected the organization). I fear that people in need of support – will, instead, find a “crisis team” (or just law enforcement or paramedics) coming to their ‘rescue’ – most likely the very thing that caller hoped to avoid while reaching out for support. I ache for these folks in that their freedom can be taken away on the whim of others, and a system of faces they do not know will decide what they can wear or eat and watch them in their deepest despair from a “safe” distance. I fear that the local community benignly assumes the mental health care “works” – without actually seeing any “customer satisfaction survey”. No one has heard the stories of local folks who’ve been discharged as ‘depressed’ (then wander off in the middle of the night) while in active psychosis or threatened with refusal for much-needed medical care when answering that – yes, they had been deeply depressed (but spoke with trusted therapist) because, first, they need to go get a psychiatric exam. These true stories come from community volunteers with deep commitments to wellness. Nowhere in this… nowhere at all – NOWHERE – is a scintilla of understanding re: peer respites. Nowhere. Read that about a million times. I ache for the upcoming anger from the local very NIMBY “Save Our Sequim” people, who utterly lambasted those seeking treatment for opioid use (2018-2021) at the soon-to-open MAT center – characterizing all who seek treatment as villains, robbers, violence-prone and coming on one-way Greyhound free bus passes from Seattle to rid Seattle of its homeless so that these homeless “addicts” can live in the fields around Wal-Mart and Costco and rape/pillage nearby seniors. They raised money and filed lawsuits. The Washington Post carried the story of ‘Save Our Sequim”s NIMBY mindset because our county also has a very high rate of opioid use. I ache because I have sat on multiple councils and boards re: mental health and disability and see how it is so much easier to maintain the status quo than to put it to the side and consider what we don’t know we don’t know. We hear/see/do what the Powers want us to hear/see/do. It’s like we talk, discuss, chat, write, listen, report, read, think… and all the while “mental health” grows increasingly convoluted – tied up. And whatever ‘should’ underpin our thinking about how we care about our fellow sentient beings… is repeatedly thrown under the bus because of bureaucracy.
re: “… Do not focus on “getting more beds” or “providing better treatment.”
This is just one ‘place’ that deeply bothers me, as my little corner of the world (near Sequim, WA) is adding in a 16 bed “E & T” psychiatric hospital, where there will be 16 safe rooms with 24/7 video monitoring. I ache for the folks who – in their deepest despair – contact our region’s Crisis Line (I was on the committee that selected the organization). I fear that people in need of support – will, instead, find a “crisis team” (or just law enforcement or paramedics) coming to their ‘rescue’ – most likely the very thing that caller hoped to avoid while reaching out for support. I ache for these folks in that their freedom can be taken away on the whim of others, and a system of faces they do not know will decide what they can wear or eat and watch them in their deepest despair from a “safe” distance. I fear that the local community benignly assumes the mental health care “works” – without actually seeing any “customer satisfaction survey”. No one has heard the stories of local folks who’ve been discharged as ‘depressed’ (then wander off in the middle of the night) while in active psychosis or threatened with refusal for much-needed medical care when answering that – yes, they had been deeply depressed (but spoke with trusted therapist) because, first, they need to go get a psychiatric exam. These true stories come from community volunteers with deep commitments to wellness.
Nowhere in this… nowhere at all – NOWHERE – is a scintilla of understanding re: peer respites. Nowhere. Read that about a million times.
I ache for the upcoming anger from the local very NIMBY “Save Our Sequim” people, who utterly lambasted those seeking treatment for opioid use (2018-2021) at the soon-to-open MAT center – characterizing all who seek treatment as villains, robbers, violence-prone and coming on one-way Greyhound free bus passes from Seattle to rid Seattle of its homeless so that these homeless “addicts” can live in the fields around Wal-Mart and Costco and rape/pillage nearby seniors. They raised money and filed lawsuits. The Washington Post carried the story of ‘Save Our Sequim”s NIMBY mindset because our county also has a very high rate of opioid use.
I ache because I have sat on multiple councils and boards re: mental health and disability and see how it is so much easier to maintain the status quo than to put it to the side and consider what we don’t know we don’t know. We hear/see/do what the Powers want us to hear/see/do.
It’s like we talk, discuss, chat, write, listen, report, read, think… and all the while “mental health” grows increasingly convoluted – tied up. And whatever ‘should’ underpin our thinking about how we care about our fellow sentient beings… is repeatedly thrown under the bus because of bureaucracy.
I would imagine that my vignettes, though born from my own rare experiences… are ‘not so’ rare. In other words, when one gathers a handful of distinctly different reasons for avoiding ‘the system’, commonalities are very apparent.
1- I already ‘did my penance’ – 25 years “believing the lies”… of being on medication forever, of diagnoses that had no basis in fact, of a system that only saw “medication management”. After finally saying ENUFF, and daring my brain to work without Wellbutrin, Provigil, Seroquel and whatever else, I had to titration myself off meds because the psychiatrist wouldn’t. And since I have absolutely done better than those 25+ years of drugging… I am BEYOND averse to anyone with a remotely similar Med management mindset. TRY FINDING A PSYCHIATRIST WHO RESPECTS THIS TODAY.
2- Therapy… In ‘group therapy’ (outpatient) I was given ‘worksheets’… one was to (literally!) color (YES) in some ‘gardening group’. Another ‘worksheet’ was to match cognitive distortions to vignettes. Lest I forget, there was the group leader/therapist who INSISTED that each attendee rate (0-10) how homicidal/suicidal they were each morning. I recall one patient (a professor at a nearby university) describe how traumatized she was by a clinical psychologist who diagnosed her with schizophrenia. Much to my surprise, as I share my brief experience with a psychologist who really and truly sucked in my first session with him… that professor looks at me and says, “is his office on…?” YES. The incompetent therapist she had seen was the same one I saw weeks later.
Had these been dental appointments, allegedly free of emotional baggage, one could chalk these up to unfortunate luck. Much like the folks who hire bad contractors and regret it.
Just today, I was to Zoom a new therapist. I haven’t really seen anyone in 6 years. Not that life has been peachy and there was no reason… quite the contrary! So… 10 minutes into the Zoom (no pick-up by therapist) I hang up.
Stuff is triggered. From way back to. A whole collection of stuff.
So… when anyone points out that people don’t reach out to seek help… too many of us have tried, and have been burned in the process.
Most of all… for my friend Jane… I wish SomeBody with Someone Degree of Insight… would nicely BLAST THROUGH the clogged-with-concrete chunnels of Healthcare in Los Angeles County and FIND A PHYSICIAN WITH A BRAIN.
Someone who could accurately plumb the signs and symptoms, then contemplate with This Test and That One Too…. and start narrowing things down a bit.
How do we”delete” the healthcare propaganda of “once a psych patient, always (first and foremost) a psych patient”?
Yes! I’ve known Jane since we both completed the Peer Support Specialist training at Project Return, in 2016. Her artistry is phenomenal… same with her persona.
I would hope that MIA starts to deeply “connect the dots” that are deep, metaphorical cigarette burns on the souls of countless teachers, administrators, education specialists, students and parents across America. These “cigarette burns” are gifts from policies of Presidents Of Past and Present. One truly needs to be an education expert to recognize them … for starters, get really friendly with Diane Ravitch, because she can name all the cigarette burns and the policies that brought them.
Then connect with the Badass Teachers Association. Not only am I a “frequent flier” to MIA’s largely excellent material, I deeply know the realities of public education, special education, prejudice, disability discrimination and much more.
It’s NOT “Toxic Schools”. BAD TITLE.
It’s POLICIES that make schools toxic. Believe me, if BATs and other education groups had their way, public education would be fully funded. And oh so much more! Unfortunately, it’s far easier to skimp here and then “pay the piper” with full funding for prisons down the road.
WE ARE NOT THE BAD GUYS. “Toxic schools…” in this title erroneously ascribes blame to schools and all who work/learn there and have suffered through so many metaphorical “cigarette burns” that all one sees when entering some schools is ignored scar tissue.
IT IS THE POLICIES THAT ARE TOXIC. They have worked as a horrible acid (largely hidden from view, except those IN that scene feel and breathe the acid of bad policies and ultimately DEMORALIZATION. Not burnout!
PLEASE PARTNER WITH TEACHER ACTIVISTS WHO CAN SHED LIGHT ON ALL THE “CIGARETTE BURNS” THAT HURT… The scary thing? State boards of education see our concerns as “union grievances”. And mental health people see us as being in a separate silo from them.
IS IT NO WONDER THERE ARE TEACHER STRIKES, MARCHES AND WALK-OUTS?
WHAT WILL IT TAKE FOR TEACHERS TO ACTUALLY BE HEARD.
We want teachers as peers. We want school districts to comply with the ADA. We want a mentally healthy work and learning environment.
Not only do I totally agree with you, I posted a lengthy comment DAYS ago that is still “awaiting moderation”(?)
When “researchers” plan ‘research’ using only part of the picture – as here… teachers’ “well-being” and student “mental health” while tacitly ignoring all the exceedingly real factors that lead to the presence of absence of a teacher’s “well-being” (the demoralization that comes from working amidst violence, poverty, testing that has no correlation to needed skills, workplace bullying, harassment..,) not only is the “research” invalid, it’s not even looking at education concerns evident now for probably 100 YEARS.
“Well-being” and “mental health” are not vacuous end products. They are the sums of very concrete realities that seasoned teachers have now brought to large marches, strikes and other actions to draw attention to what this country is doing to its own children.
Start creating “research” that measures the realities as school communities experience the school as center for work and learning. What about the Quality of Work life? It’s been surveyed (2015) and researched now (2017) by Badass Teachers Association and AFT. Start asking relevant questions (such as “why do teachers leave the teaching profession?”).
School mental health needs to be far more than trauma informed schools, mindfulness and teacher self-care. Teachers deeply know that school mental health includes (in no particular order) experiencing lock downs that are realistic and unannounced, teaching 35+++ kids while lacking adequate furniture, teaching in 55 degree classrooms in winter, and 90 degree classrooms in late spring.
Those who surveyed the mental health of teachers somehow failed to survey the strikes and actions that teachers have engaged in. Perhaps they are interrelated? How NOVEL!
Do your homework. I’m a retired teacher so…
1- First, look up American Federation of Teachers/Badass Teachers Association Quality of Work life Survey 2015. In three sentences, identify three top reasons for teacher stress. We can give you many more, such as the high rate of bullying/harassment for teachers with disabilities and the LGBT community. Then there are urban vs rural issues, seasoned vs new teacher differences and so many more.
2- Then look up AFT/BATs visit USDOE July 2015. We brought these truths to the USDOE four YEARS ago. Grass roots!
3- Then look up the AFT/BATs educator quality of Work life survey we conducted in 2017. With NIOSH.
4- Did I mention suicides? We started our work in November, 2014, after four teachers died of suicide in under 10 days. Strangely (?), while there are suicide rates for dentists and veterinarians and attorneys… there seem to be no awareness that teachers die from suicide.
5- How many of you work in places where (a) warmth and compassion are the trademarks of your job- as it is for teachers… yet (b) politicians would hope you’d carry a gun to shoot and kill the intruder who enters your classroom?
6- Workplace Bullying and harassment are very real. Until the REALITY of work environments are seen just as clearly as the myopic vision of “mental health in education” we will only be putting bandaids on abscesses.
If you truly care about education and mental health, see what Badass Teachers Association has been doing since 2013. The work our Quality of Work life team has accomplished via two surveys … is now an integral part of cutting edge work on teacher stress.
It’s not depression. It’s demoralization, mostly.
While Dr. Shipko may have been within his legal rights, he failed in knowing how to help a deeply depressed person.
(1) At the very least, at a deeply human level, he needed to be cognizant of how to use empathy or human connections in recognizing the intensely frayed emotions being cautiously and fearfully shown him. He made no attempt at inferring compassion or concern. None. This is at the heart and core of Emotional CPR and other peer-based interactions. Something that inferred he cared and understood/believed me.
(2) At a basic level of being in mental health as a psychiatrist, he – more so than ANY other professional/peer/agency in the entire “mental health industrial complex”… as someone who blogs here about what’s missing in psychiatry… he’s absolutely missing the key ingredient – PEERS. Dr Shipko knew NOTHING about mental health resources. He explicitly told me this when we met. I have since then found a veritable treasure trove of local, regional, national resources. I, as a patient, naively assumed he, as a professional in mental health, knew of them. He knew nothing. In fact, he even told me he knew nothing much about Mad in America.
I’ve found the local leaders in mental health recovery to be deeply insightful of experiences such as these, for they’ve had theirs too. I deeply wish that I had connected with the local peer run agency at the start rather the end.
Me thinks you didn’t read what I wrote, old head. Please read it again. I specifically mentioned alternatives. No one is “shrink hopping”. That demeans anyone who lives with a complex ‘anything’. (Just look at what happened to Justine Pelletier and her family when they went to Boston children’s hospital. In essence, the hospital alleged they were guilty of medical child abuse …)
Again, I am saying that while I am sure Dr. Shipko is entirely knowledgable re: getting off meds, patients can and do present more complex pictures. At the very least, the local psychiatric community should forge relationships with the local peer movement and local parent/family movement to create some ‘tool’ regarded as generally useful/a starting point for people seeking support/help. Create a brochure… something… that lists local groups and contact information. Update it periodically. People just don’t know these things thru osmosis.
Some thought was put in to your response, and for that, I thank you.
Perhaps the most important concept that psychiatrists (no matter how pro, or con, re: meds) need to embrace is that psychiatric things inextricably link body/mind; and it’s most likely nearly impossible for any professional to wear the dual hats of overseeing the body’s needs while understanding the deep chasms brought on by the mind itself. So when a patient is “stable”, s/he can independently access friends, acquaintances, hobbies, jobs, etc. And Dr. Shipko helps people reduce amount of antidepressants in a way that hopefully maintains that balance. He tapers them off meds and they remain stable. A Win Win. That’s the kind of work setting we all want (i.e., a calm day as a cop or firefighter, no major traumas in the ER, a typical teaching day, etc.)
But psychiatrists, like cops, firefighters and teachers, in the real world, occasionally are challenged by unfortunate realities, We see what happens when we aren’t prepared. Cops shoot mentally ill. Teachers physically restrain kids. Psychiatrist mishandle problematic patients. No, it doesn’t make the headlines but it’s a big deal to the patient, nonetheless.
My thought as that ‘mishandled’ patient? That ‘we’ develop a sound program so that psychiatrists literally have a brochure with names/contact info for local peer driven groups that are specially trained in connecting with deeply depressed people. Massachusetts RLC has a training program so that peers can communicate with people in these dark places. Perhaps it’s time that local psychiatric associations network with peer groups in order to create brochures that local psychiatrist could literally give to patients as a “supplement”. Dr. Shipko told me I knew more about MH resources than he did. (??? While I know of MIA, etc.) I’ve not “networked” with confidence and assurance… remember, I’m dealing with depression…)
There needs to be open, candid, talk here, between the folks who carry the Power (psychiatrists) with those who carry the Knowledge (us). When I’m wearing my non-suicidal ideation hat, I can see what I’ve accomplished in life. But when I’m wearing that hat… that ideation hat… all bets are off. I suspect that there are many folks who’ve also worn these two hats and gradually one is worn more than the other. AT THOSE TIMES, I truly need to connect with folks who deeply “get” that reality. People who ***know*** how dark (!!!!!) that place gets over time. This just isn’t understood via coursework, no matter how well directed.
Please, all who work in psychiatry… soberly know where your lived experiences end and ours begin. Our experiences have come from both living in your abilities and ours… and living in an experience defies book learning. Perhaps, if you were forced to hold a hot cup of coffee (for the next week) you might understand how a ‘pain’ X ‘time’ = ‘deeper pain’. It’s a nuisance, then a bother, then denial and nuisance, then denial, then deadening, then…
NETWORK WITH US. Find the folks who’ve “been there/done that” re: living with mental ‘illness’. Develop a mutually respectful yet separate relationship. Then, “next time”, when you have a ‘patient like me’ (one whose alleged problems would make Donald Trump look presidential)… just give them the brochure.
1- He is a practicing, licensed physician in California. A psychiatrist. He runs a statistical risk (especially when his practice focuses on taking patients off of medication) that he will see patients with suicidal ideation. This, to a psychiatrist, is like something needing immediate attention in an ER. ITS HIS JOB.
2- Google “suicide ideation treatment” and the non-informed layperson can read a wide selection. It’s already there. He wouldn’t have to create one.
3- He WASN’T honest. He didn’t say he couldn’t help me. His “plan” was seeing me in a week.
4- HELLO? And your knowledge regarding suicide ideation is…? Would you believe that “this” (talking about feeling this bad) is something people don’t want to hear? Imagine having breast cancer… yet no one wants to hear about it. http://melissainstitute.org/documents/35_Years_Suicidal_Patients.pdf
I suspect Dr. Shipko was writing this article when I went to see him last month. While he probably waxes eloquent re: nuances of getting off medication (so there is a need for his expertise), he is incapable of treating a severely depressed person who is already off meds. I sent him an email after seeing him the first time, in the hopes that he might have some ideas. Plan A was getting help. Plan B was Gravitas, in Switzerland. The depression was THAT bad. I thought that, by emailing him just how bad things were (vs. verbalizing them on the spot) he could “prepare” for the appointment, much like we teachers “prepare” lesson plans.
He immediately called me. I should NOT be emailing such info. (He had just told me contact is done via email!) Even threatened to call 911. Not good, when suicide ideations are essentially rebuffed rather than listened to. After all, we know they are too intense for even a good friend. Besides, Gravitas needs an application, a current passport, an airline ticket… none of which I had done. He knew that.
I truly hoped he’d “hear me”. That somewhere in his expertise he’s worked successfully with people like me. That if he saw the downside in medication, he was aware of complementary protocols and could HELP me.
He told me (1) the mental health system was all messed up. (2) that I knew more about resources than he did. And… (3) go to a movie.
I have since found there ARE suicide ideation treatment protocols. Dr. Shipko, you failed to use one when I really needed it. I’m sorry if my deep despair bothered you. I thought that perhaps you were sufficiently knowledgable to handle it. Or at the very least, to refer me to someone who could.
Now I know the truth re: people who reach out when feeling suicidal ideations. There is no safety net. It’s truly a free fall.
No therapy? Why kill the golden goose when it’s eggs need to hatch?
CBT is a bandaid. It doesn’t address the long term ACEs responsible for treatment resistant depression in the first place. I’m speaking as somebody who’s been there/done that with CBT. It never ever ever addressed the ACEs. In fact, even the ACEs themselves don’t address ALL of them (for me- stuff from growing up with a disability). It’s a vanilla pudding one-size-better-fit-all approach. And the assumption that Things go Better with Pills is wrong, too. …. Somewhere I read an article about some Scandinavian country that went Whole Hog on CBT and EVERYONE used it (since it was so good!)… And their post test (after EVERYBODY used it) was absolutely unremarkable.
I too have given NAMI many opportunities over the past 15 – 20 years. I’ve gone to California conferences – even to a national one – and sensed that the ‘consumers’ were the passive recipients of everyone else-s “care”… as though we/they ‘didn’t know better’.
This bothered me, because I kept getting the felt sense that, as a “consumer”, I am *expected* to be that way. It never fit. It chafed, yet what was I to do… there was no one else there who seemed to exhibit the spirit I felt within.
I even did that “peer to peer” training and found it (a 3 ring binder, etc.) ‘canned’. The “take your meds” really stuck in my craw, as I had just gotten off all of mine, “rough justice” style a few months before… and finally could FEEL for the first time in 25 years.
At the last CA NAMI conference, I would loved to have decked a psychiatrist for advocating staying on meds. Instead, I went into the lackluster exhibit hall and started asking people there if ANYONE knew any other group… with LIVING PEOPLE who had more FIRE IN THEIR BELLY?
(OK – maybe not the exact words, but… )
One lady said, “There’s a conference called the Alternatives conference. I think its in Portland this year.”
I Googled “Alternatives conference Portland”.
As I read the materials, I felt like I had died and gone to heaven. The materials absolutely, INFINITY PERCENT, spoke to me.
I went… I saw… I listened … I met … It was like dying, going to heaven …
The difference between what I experienced in NAMI with what I experienced at Alternatives is the difference between pretending Crisco is ice-creaming (trying to enjoy each…. scoop), and eating real Ben and Jerry’s.
NAMI, like Crisco, has uses … but for someone who lives with ‘mental illness’ to find something of value there is like trying to enjoy cold Crisco as ice-cream.
Before anyone living with ‘mental illness’ finds real benefit from NAMI, the deep issues that have not been discussed must be aired fully and heard. I deal with depression … NAMI never, ever, came even remotely close to understanding an experience like mine.
I am guessing the *only* reason they even listened to Mr. Whitaker is because of ‘the handwriting on the wall’, that he and others put there – the very handwriting they have ignored, covered up, denied.
I only WISH, fervently WISH, that people stopped regarding them as “America’s voice on mental illness” or whatever the phrase is. They NEVER asked me; they NEVER listened to me.
THEY NEVER REPRESENTED ME.
I cringe at the power of your words… I cringe because I know what happens when the mental health system ‘breaks’. My grandfather was alcoholic, and from what I understand via an aunt who shared with tears – violent when drunk. He was arrested for vagrancy just days before my older brother was born, in 1948. He hung himself in jail …
All I knew was ‘this’, told me essentially once, with clenched teeth by my mother.
I was born with a disability, and I found asking questions provoked anger – “DO YOU WANT ME TO END UP IN THE STATE HOSPITAL SOME DAY?” That was the ’50’s…
My dad … became alcoholic, depressed … and committed suicide, too. Us kids – we never talked about it …
While my ‘version’ of mental health care was less onerous than yours (25++ years of ‘everything’… ) I know – even for someone who never ‘tried it’ … the system has been badly broken.
You write with deep clarity. You write compellingly. In having both visible and invisible disabilities, I am struck by the unique challenges of each. I tend to believe that ‘this one’ – mental ‘illness’ – is the one that people fear will suck them Over the Edge to a point where they ‘lose it’ and never return. Your writing shows so deeply the flaws in that logic. It is not ‘us’ who go “off the deep end” … it is those who fear what our experiences are, that drag us to where no one should go and dump us there.
Most profoundly, people like you show you are more human, clear-headed and rational than those who would ‘dump’. THANK YOU.