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Panic Attacks: What to do if they happen to you.

Here are some of the things I’ve learned and continue to practice in order to not debilitate

my life with panic attacks. Before I begin this list, let me explain that I still have panic attacks

but because I’ve learned coping skills and exercises to help me with them they have never been

as severe as my first panic attack.

A panic attack includes a combination of the following:

Shortness of breath or hyperventilation

Heart palpitations or a racing heart.

Chest pain or discomfort.

Trembling or shaking.

Choking feeling.

Feeling unreal or detached from your surroundings

Learn how to control your breathing. . By learning to control your breathing, you

develop a coping skill that you can use. I’ve talked about my breathing technique. Smell the

roses, in other words take a deep breath and hold it for a second. Blow out the birthday candles,

or take a strong breath out through your mouth. This breathing technique helps your heart rate to

slow down and for your body to calm down.

Learn about panic. Simply knowing more about panic can go a long way towards

relieving your distress. You’ll learn that the sensations and feelings you have when you panic are

normal and that you aren’t going crazy. You can learn that what you’re going through isn’t life

ending. Also, panic attacks generally only last five minutes and never more than fifteen minutes.

You can get through whatever it is that you are experiencing.

Practice relaxation techniques. When practiced regularly, activities such as yoga,

meditation, breathing exercises, and progressive muscle relaxation strengthen your ability to

relax during stressful situations. Not only do these relaxation techniques promote relaxation, but

they also increase feelings of joy.

Watch what you put into your body. Smoking and caffeine can provoke panic attacks

in people who are susceptible. It’s best to stay away from caffeinated drinks such as coffee,

sodas, and energy drinks. Quit smoking or at least try to reduce how many cigarettes you’re

smoking per day. Also be careful with medications that contain stimulants, such as diet pills and

non-drowsy cold medications. Avoid alcohol, which can induce panic attacks. Avoid illicit drugs

that are stimulants such as amphetamines and cocaine.

Treat your body well. Getting plenty of exercise. Exercise reduces stress, improves your

health, and decreases the likelihood of panic attacks. Get plenty of sleep. A rested body tends to

be more relaxed. Have a scheduled day. It’s easier on your body if you go to sleep and wake up

at the same time each day. It’s also easier on your body if you have regular meals at certain times

instead of sporadically.

Have realistic expectations. When I first started going to therapy I believed that after a

few sessions I would have an answer to the cause of my panic attacks. I also believed that once I

learned to deal with them I’d never have them again. Ten years later I still get the rare panic

attack. To get there I’ve had to put in a lot of hard work in therapy. I’ve also realized that this is

how my body is built and that I have to work with what I have instead of hoping for something

different. That kind of thought process will only stress you out more and continue the cycle of

panic attacks.

Panic Attacks: My First Experience

 

When I moved into a small apartment in 2005, it was my first time living on my own with no roommates, no family, and what I felt was no safety net if something went severely wrong financially. I put a heavy an unnecessary amount of weight on myself.  I was working full time at nonprofit so I could pay the bills, including full time college tuition.  I felt I had to get straight A’s. I was creating my own perfect storm.

I woke up in the middle of the night and I was unsure what had woken me up. Deciding that a quick trip to the bathroom would help me shake off the strange feeling something was wrong.  I noticed my arms and legs were very cold. My bathroom was cold so I excused the feeling of my cold limbs to that. When I looked at myself in the mirror and couldn’t see my reflection it seemed as if someone had put a bright light in front of my face.  Trying to see my reflection despite the bright lights I noticed that my legs and arms were getting numb and my heart rate was going up while my breathing was becoming more difficult. I dragged myself to a chair only a few feet outside of my bathroom and tried to breath. It felt as if an elephant was sitting on my chest, while someone flashed a light to my face. To add to my frustration when I tried to stand up I fell down I couldn’t hold myself up.

I was grateful that my phone was on a nearby table. Not knowing what was wrong with me but worried I was losing the capability to use my muscles I called 911. All I could think of was that my muscles were not working which had caused my paralysis and my inability to breathe normally. My only thought as I waited for the dispatcher to answer was that my heart was a muscle too and it soon would stop working and I would die. The dispatcher quickly answered and I let her know what was wrong. She informed me that an ambulance was on its way. Worried that I would die before the ambulance would get there I begged her to stay on the phone with me. The dispatcher tried to calm me down as I waited but seeing my despair called the fire company to get to my house since they could get there before the ambulance. The firemen arrived and took my pressure and asked me questions. I let them know where my medications were. Within minutes they were able to realize I was having a panic attack. Although they couldn’t calm me down they coached me through breathing exercises and decided to take me to ER.

A sweet female paramedic talked to me while on the ambulance. She kept reminding that everything was going to be ok. The most important thing she told me and something that ten years later I hold on to as to one of the most precious things I’ve learned. She just called it breathing; I call it happy breathing. It’s an easy two step technique. She told me to breathe in the roses and to then blow out the birthday candles. This technique I’ve found helpful because it’s not just the breathing that is calming you down but also the visuals are putting calming happy thoughts into your head. Few people would be unhappy smelling flowers or blowing out candles.

After calming me down I was seen by a psychiatric nurse at the hospital. She and I talked for what felt forever but in reality was more like 30 minutes. She explained that what I had experienced was a panic attack and even though most people don’t get severe panic attacks like the one I had experienced the fact that my stress levels were high enough to cause one of such severity I was more than likely to experience at least another panic attack of that severity. She strongly suggested that I go into therapy to talk to someone about my stress. So began my journey into therapy. In one of my first blogs I wrote about finding the right therapist for you. About two weeks after my trip to the ER I was seeing a therapist and beginning my journey to a healthier life with less stress. In the second blog, I will share tips I’ve learned on how to control panic attacks.

Pennsylvania Insurance Update: Healthy PA, MAWD, & ACA

Pennsylvania Insurance Update:
Healthy PA, MAWD, & ACA

Kevin Moore, PsyD

December 18, 2014

Healthy PA is the New Medicaid

—The 14 current eligibility categories are being reduced to 3 categories as of Jan 1
—Low Risk “Healthy”
—High Risk “Healthy Plus”
—Private Coverage Option (PCO)
—Notification letters have been mailed to all Medicaid recipients
—Everyone will receive new MA cards but not new Medicaid HMO cards, e.g. Keystone First, etc..
—Healthy PA Will Expand the Number of People who Can Be Covered
—The newly eligible earn $11,670 to $16,105 for a single adult (add $4,060 per each dependent)
—This is estimated to be a maximum pool of 600,000 Pennsylvanians
—They will not pay a monthly premium in 2015
—It is only in this sense that Healthy PA is “Medicaid expansion”- it expands the number of people covered
Healthy PA is Medicaid Reduction
—Healthy” plans limits annual benefits to $350  for lab work, 2 inpatient admits, 30 D&A outpatient visits, 30 MH outpatient visits, 4 specialist visits, 6 radiology tests, and yet-to-be seen pharmacy formulary changes.
—“Healthy plus” has NO SERVICE LIMITS.
— ”Private Coverage Option” (PCO) plans will lose their current health plan and CBH/Magellan coverage. They will not have transportation nor dental benefits.  They can choose (or will be assigned to) a new PCO plan with very restricted provider networks.  For example, many hospitals only take one or two of the four plans.
What is the Low/High Risk Distinction?
—Enrollment is designed to put as many people into low risk “Healthy” plans as possible
—Adults will get “Healthy Plus” if they
—Receive MA in an SSI related category
—Healthy Horizons
—Nursing Home MA
—Home and Community Based Services
—MAWD (more on this later)
—Over 65
—Pregnant
—“Medically frail”
What is “Medically Frail”?

Serious and complex medical conditions

—HIV/AIDS or immune deficiency
—On a ventilator or dialysis or hospice
—Chemo/radiation therapy for cancer
—Sickle cell or hemophilia
—Cystic fibrosis or Gaucher’s disease
—Post-transplant
—Resident of a LTC facility or public/private ICF
—Or 2+ hospital admits in 12 mo AND 3+ ER visits in 6 mo AND 4+ prescriptions per month
—Physical disability such as MS or paraplegia
—Disability designation by Social Security
—Certain mental disorders: major depression, bipolar disorder, schizophrenia spectrum (including schizoaffective, delusional disorder, and “psychotic disorder”), anxiety disorder (OCD, PTSD, “severe panic disorder”)
—Chronic substance use disorder
—Intellectual or developmental disability
How is the Low/High Risk Distinction Made?
—By the state’s medical review board
—By the state’s claims review board
—By completing Employability Assessment Form (PA 1663) with box 1 or 2 checked
—By appealing an incorrect determination within 10 days, call the statewide customer service line: 1-877-418-1187.  This appeal can not be done at “DPW”, the County Assistance Offices, but only over the phone.

(By the way, DPW is changing its name to DHS which will surely confuse everyone in Philly because those initials are already used by the child welfare service.)

Who can I asked general questions about a possible appeal?If you have HIV, Jacob Eden, Attorney

—AIDS Law of Pennsylvania
—1211 Chestnut Street, Suite 600, Philadelphia, PA 19107
But isn’t the PCO for expansion?
—Yes, but we’ve seen some current Medicaid recipients placed in PCO plans by mistake.
—
—Even more strangely, even if you are correctly applying for a PCO plan through COMPASS because you are in the expansion category, you are screened for low/high risk and high risk places you in a “Healthy  Plus” plan.
—
—Read about PCO palns at healthypa.com
—
—Enrollment will be on-going through 2015, which is good: no end to open enrollment.
Recommendation for Action

To maximize the chance to get Medicaid patients enrolled in “Healthy Plus,” I recommend:

—Prompt all patients to open their mail and make sure they will be enrolled into “Healthy Plus.”
—Clients who have not received a notice may call the DHS/DPW  Change Center at  215-560-7226 or their local county assistance office to find their plan assignment.
—If not assigned to “Healthy Plus,” complete a “health screening” through COMPASS (www.compass.state.pa.us) or phone number (866-550-4355)
Health Screening Tips
•Whether on COMPASS or on the phone, patient will be asked about 14 questions to subjectively rate their physical and mental health, e.g. “How would you rate your physical health: a) excellent, b) good, c) fair, d) poor, e) very poor?”

 

•If patient responses with “good” across the questions, they can be classified as “Healthy.”

People need to say they feel “poor” in order to be correctly classified as “Healthy Plus.”

Expansion Enrollment Tip

—We have seen a few people who make 133-138% of Federal Poverty level, who get referred out of COMPASS to an healthcare.gov.
—
—This is a mistake on the states part having to do with the 5% disregard.  Please help people get around it.
—
—When COMPASS says “not eligible”, you can still click the “APPLY NOW” button at the bottom right hand corner and it will let you apply!
Medical Assistance for Workers with Disabilities (MAWD)
—MAWD survived being cut this year because it is a great program.
—MAWD recipients will receive a “Healthy Plus” plan.
— You are eligible for initial enrollment up to $29,175 (250% Federal Poverty Level) regardless of how much you work.
Typical premium about $50/month, but no co-pays, deductibles, or co-insurance
MAWD vs ACA
—ACA is inferior to MAWD in that it has higher monthly premiums, deductibles, co-insurance, and co-pays.
—Therefore if you qualify for MAWD, I recommend you take it.  If not, ACA is the best option.
—Reminder that there is a tax penalty in 2015 of 2% of income to a maximum of $325 for not having insurance (paid by April 15, 2016).
I Recommend the Following:
—If under $11,670, try to get “Healthy Plus” through COMPASS
—If under $16,105, try to get PCO and thus “Healthy Plus” through COMPASS
—If under $29,175, try to get MAWD and thus “Healthy Plus” through COMPASS
—If under $46,680, buy a “Silver” ACA plan through healthcare.gov
“Silver” ACA Plans in the Health Insurance Marketplace
—Silver” plans have the premium tax credit and the cost-sharing subsidies.  Educate patients not to bother looking at other plans unless above $46,680 as it averages half the cost.
—Generally cover 70% of costs with different plans varying around how much premium, deductible, co-insurance, and co-pays.
—I recommend plans with an open panel approach (credentials any provider who asks – such as IBX) vs. plans with a closed panel (you can only see their providers – such as Aetna).
Already Had an ACA Plan?
—Should update information on healthcare.gov
—Ensures correct premium tax credits and cost sharing subsidies
—Different plans available, some slight increases in plan prices in Philly area
—Consider MAWD if under $29,175
—If you do nothing, same plan will continue
Full Medicaid Expansion is Coming
—Governor elect Wolf calls it a “top priority”
—Will be inaugurated Jan 20
—Staff needs to write a request to CMS
—Obama’s administration says they are ready to approve quickly, “within a few weeks”
—At best: March, but probably later
—Historically, MA lets you back bill 90 days, so Healthy PA could be retrospectively eliminated
With Full Medicaid Expansion
—Restoration of no service limits
—Simplified application: no asset test
—If under $16,105, apply for Medicaid through COMPASS
—If under $29,175, apply for MAWD and thus Medicaid through COMPASS
—If under $46,680, buy a “Silver” ACA plan through healthcare.gov, if eligible for a special enrollment period
Summary
—Healthy PA is Medicaid reduction as of Jan 1
—This is a dark cloud and we need to act now to protect the people we serve
—Check their letter for “Healthy Plus”
—Silver lining #1: more people can be covered
—Silver lining #2: Healthy PA is only temporary
Thank You!

Please email me questions/comments/ corrections: kevinmoore@aidscaregroup.org

PA’s Insurance Update

Kevin Moore, PsyD talks about PA’s Insurance Update in his presentation he did for our medical offices.
Healthy PA is the new Medicaid
•The 14 current eligibility categories are being reduced to 3 categories as of Jan 1
–Low Risk “Healthy”
–High Risk “Healthy Plus”
–Private Coverage Option (PCO)
•Notification letters have been mailed to all Medicaid recipients
•Everyone will receive new Medicaid cards
Healthy PA will expand the number of people who can be covered
•The newly eligible earn $11,670 to $16,104 for a single adult (add $4,060 per each dependent)
•This is estimated to be 600,000 Pennsylvanians
•They will not pay a monthly premium in 2015
•It is only in this sense that Healthy PA is “Medicaid expansion”- it expands the number of people covered
Healthy PA is Medicaid reduction
•“Healthy” plans limits annual benefits to $350  for lab work, 2 inpatient admits, 30 D&A outpatient visits, 30 MH outpatient visits, 4 specialist visits, 6 radiology tests, and yet-to-be seen pharmacy formulary changes.
•“Healthy plus” plans limits annual benefits to $450 for lab work, 3 inpatient admits, 60 D&A outpatient visits, 60 MH outpatients visits, 8 radiology tests, and yet-to-be seen formulary.
What is the low/high risk distinction?
•Enrollment is designed to put as many people into low risk “Healthy” plans as possible
•Adults will get “Healthy Plus” if they
–Receive MA in an SSI related category
•Healthy Horizons
•Nursing Home MA
•Home and Community Based Services
•MAWD (more on this later)
–Over 65
–Pregnant
–“Medically frail”
What is “Medically Frail”?

Serious and complex medical conditions

–HIV/AIDS or immune deficiency
–On a ventilator or dialysis or hospice
–Chemo/radiation therapy for cancer
–Sickle cell or hemophilia
–Cystic fibrosis or Gaucher’s disease
–Post-transplant
–Resident of a LTC facility or public/private ICF
–Or 2+ hospital admits in 12 mo AND 3+ ER visits in 6 mo AND 4+ prescriptions per month
•Physical disability such as MS or paraplegia
•Disability designation by Social Security
•Certain mental disorders: major depression, bipolar disorder, schizophrenia spectrum (including schizoaffective, delusional disorder, and “psychotic disorder”), anxiety disorder (OCD, PTSD, “severe panic disorder”)
•Chronic substance use disorder
•Intellectual or developmental disability
How is the low/high risk distinction made?
•By a medical review board
•By a claims review board
•By completing Employability Assessment Form (PA 1663) with box 1 or 2 checked
•By completing a “health screening form”
–Form not released- “just questions that are asked”
–Only available through phone or COMPASS (on-line), not available at County Assistance Offices
–November 26th deadline!
What about the PCO option?
•PCO will be run through new PCO marketplace, i.e. not existing Medicaid HMOs nor Health Insurance Marketplace
•This will likely be even more problematic than healthcare.gov was last year
•Plans aren’t available yet but Keystone First, Aetna, and United Health Care speculated to all have plans
•Enrollment will be on-going through 2015, which is good: no end to open enrollment
PCO benefits
•On the one hand, PCO has fewer limitations than low or high risk: only limits on D&A, MH
•On the other hand, if you are “medically frail” you get “Healthy Plus” anyway!
•Need to apply through new PCO marketplace, even though end up in the same place
•PCO marketplace site not ready although healthypa.com is running and presumably where it will be hosted
Recommendation for Action

To maximize the chance to get Medicaid patients enrolled in “Healthy Plus,” I recommend:

•Proactively inform your patients immediately
•Prompt them to open their mail and make sure they will be enrolled into “Healthy Plus”
•If not assigned to “Healthy Plus,” complete a “health screening” through COMPASS (www.compass.state.pa.us) or phone number (866-550-4355) before Nov 26th
Medical Assistance for Workers with Disabilities (MAWD)
•MAWD survived being cut this year because it is a great program, although it will be less great when it becomes the “Healthy Plus” plan
• You are eligible for initial enrollment up to $29,175 (250% Federal Poverty Level) regardless of how much you work.
•Typical premium about $50/month, but no co-pays, deductibles, or co-insurance- only “Healthy Plus” service limits
MAWD vs ACA
•ACA is inferior to MAWD in that it has higher monthly premiums, deductibles, co-insurance, and co-pays even if thought it does not have the services limits.
•Therefore if you qualify for MAWD, I recommend you take it.  If not, ACA is the best option.
•Reminder that there is a tax penalty in 2015 of 2% of income to a maximum of $325 for not having insurance.
I recommend the following:
•If under $11,670, try to get “Healthy Plus” through COMPASS
•If under $16,104, try to get PCO and thus “Healthy Plus” through healthypa.com
•If under $29,175, try to get MAWD and thus “Healthy Plus” through COMPASS
•If under $46,680, buy a “Silver” ACA plan through healthcare.gov
“Silver” ACA Plans in the Health Insurance Marketplace
•“Silver” plans have the premium tax credit and the cost-sharing subsidies.  Educate patients not to bother looking at other plans unless above $46,680 as it averages half the cost.
•Generally cover 70% of costs with different plans varying around how much premium, deductible, co-insurance, and co-pays.
•I recommend IBX plans because they have an open panel approach (credentials any provider who asks) while Aetna has a closed panel (you can only see their providers)
Medicare
•Advantage Plans (Part C plans) are predatory entities with an aggressive sales force in PA
•New data shows that Advantage Plans are inferior for patients with complex medical needs
•Pros are simpler cost-sharing arrangements and some perks like gym memberships
•Cons are service restrictions that are nearly always problematic for anyone with a chronic care condition and premiums average the same as adding together Part B and Part D premiums
Assist Patients with Medicare
•Can only change plans once a year
•Open Enrollment ends December 7th
•I recommend advising people to drop Advantage Plans and enroll in Part B/ “straight Medicare” and Part D plans
•I’ve seen patients with Part B who didn’t know they could enroll in Part D -> education
•I’ve seen patients with Medicare who are dual eligible but not enrolled in Medicaid -> education

When are you done with psychotherapy?

It had been a total of three years that I had been in therapy when an acquaintance declared to me that, after her six sessions of therapy, she was cured of all her mental health issues and did not need to go to therapy again. Part of me wondered what was wrong with me that after a second course of treatment with a therapist and a total of three years in therapy, I still had a list of things that I knew I needed to work on. Another part of me remembered a time when I thought therapy had fixed all my problems.  I reminded myself that I had set myself for failure at that time.

The first time I went to therapy I received a diagnosis of an anxiety disorder. At that time, insurances could still cap how many therapy sessions per year you could have. My insurance capped my sessions at 22 per year. When my 22 sessions were over, I believed that I would never have to go to therapy again because I had gained all the tools I needed to live a mentally healthy life.  The artificial boundary created by the insurance company had helped convinced me that I was done.   I was very surprised when, 18 months later, I was back in therapy for a different diagnosis.

Based on my experience as a patient, I would make the following recommendation on how to decide when to end therapy:

  1. Begin therapy with time limited goals on which you want to work on. As an example, people going to therapy for panic attacks could decide some of their goals can be mastering techniques to calm down during an attack, what their triggers are, and how to learn to deal with those triggers.

  2. While in therapy, focus on the original issue; if anything else comes up, “car park” those issues unless they are pertinent to the original problem. Remember it is okay to go back to a specific issue later.

  3. If you’ve completed the issues you’ve “car parked”, ask your therapist if he or she thinks that you are ready to be done. Your therapist has your best interest at heart and will let you know if he or she believes you are ready to be done with therapy.

  4. Ask yourself if you believe the problem you went into therapy for has become manageable to you. Do you think that you can comfortably control life’s difficulties on your own? If you can do these things, it might be time to finish with therapy.

  5. Just because you have worked out these issues, understand that other issues might arise and it is okay for you to go back to therapy. As humans, we never finish growing and we sometimes need help during a growth spurt, so know it is okay to go back to therapy.

The Mental Health Scarlet Letter Part 3

A third story in this series on stigma is about Megan, a college student. Megan’s story interested me because she, like me came from an immigrant family who has different views on mental health than Americans. When she tried to talk to her friends and family about her depression, they told her it was all in her head. She was told she needed to get over it and that she was being over-dramatic in order to get attention. She described her depression as a dark cloud that took over all of her and got worse due to her family and friends not understanding it.

Mental health stigma can come from so many places in our society. Stigma can come from news media that are unsure how to talk about mental illness. It can come from our own friends and family who do not know what those of us with mental health issues are going through because they have never experienced it themselves. It can come from our church congregation who is unsure how to deal with such an illness. It can also come from co-workers or employers who question how someone with mental illness can fit in the work place or if their productivity will go down due the employee’s mental issues.

How do I, one person, break down the barriers of stigma?I have come to realize that to break down the stigma of my depression I cannot keep it a secret. I talk about my mental health issues openly. If you are not keeping your mental status a secret, it will no longer be something people are trying to figure out. Talk about what your condition does to you. After several years of explaining my depression and panic attacks to my mom, she finally has begun to understand that I am not crazy but that my body works differently than hers or others. My supervisor and I made a plan so I could see my therapist every week and still carry my portion of the work. I remember being told that if I were myself people would love me. I have learned that there was truth in this childhood phrase. There will always be those that do not understand mental illness but if you surround yourself with those who are willing to learn about your struggles, life becomes better and a little easier.

The Mental Health Scarlet Letter Part 2

The first story about mental health stigma is from a woman I’ll call Cheryl, a mother of six children, a devout member of her church, who has been married for fifteen years. When I met Cheryl, I was fascinated by how vocal she was about her depression and what she does to make it better. She’s a member of a church that openly talks about mental health issues and how there should be no stigma for those in her church who suffer mental health issues. Yet, Cheryl says her experience was not one of being stigma free. She talks about being ignored by other members in her congregation and not being asked to participate in church activities because of her depression. She related to me how stigma she felt made her depression worse.  By speaking out about her experiences, she advocates for herself and others.  She feels that speaking out directly makes her depression better.

Our second story is about Dave a single father of four, who suffered from chronic depression since high school. When I asked him if he had ever suffered stigma due to his illness he immediately replied he had been lucky to never have suffered any stigma.  He does not remember ever being told negative things about having a mental illness.  He also related throughout his career he has been very careful about what he tells his supervisors about his illness and his constant doctors’ visits. Why has he been so careful?  A previous manager eventually fired Dave after he explained his frequent doctor’s visits were due to treat his mental illness.  I would argue that Dave has suffered stigma, although he hasn’t endured the bad metaphors of mental illness that I’ve heard throughout my life.

Both Cheryl and Dave give us examples of stigma in its various forms.  The next blog will give another variation and share some thoughts on breaking down stigma.

The Mental Health Scarlet Letter

“If I got rid of my demons, I’d lose my angels.”
― Tennessee WilliamsConversations with Tennessee Williams

Often, people use metaphors when talking about mental illness, usually with mental illness as a mythical battle between good and evil.  While some metaphors might be necessary, I feel I’ve been hurt by bad metaphors.  When we use bad metaphors for mental illness we are making it harder for others to accept mental illness.

I’m referring to some of the language my family has used to talk about my mental illness and that of other family members.  When family members witnessed me crying inexplicably at a young age, they told me that the devil had gotten to me.  I later learned I was depressed.  When talking about other family members, depression was described either as “crazy” or an unwillingness to accept Christ in our life.  During my last bout of depression, a well-intentioned family member told me they did not understand why I was sad since I had such a great life.  Would anyone ever say that someone shouldn’t have diabetes because they have a great life?  Should I just “get over” having asthma because I have a good life?  If I have a heart attack, should I solely pray harder or should I pray, see my doctor, exercise, eat right, etc…?

One dictionary definition of stigma is a mark of disgrace associated with a particular circumstance, quality, or person.  I see bad metaphors of mental illness as stigmatized Scarlet Letters. This is the first of a series of blogs that will talk about some of the Scarlet Letters those of us that live with mental health issues are made to wear. This blog will also try to discuss ideas on how to turn that Scarlet Letter into a badge of merit instead of one of shame. We will begin by explore the stories of several people that have suffered from depression and its stigma.

Depression and Suicide: A Personal Blog

When I was asked to write about my experience as someone who suffers from depression in therapy, it seemed like an easy task.  However, once the writing started, there was so much to say that I realized it needed to be done in pieces. This is the first of three blogs on this topic. Robin Williams committed suicide during the writing of these blogs.  This blog is dedicated to him.

Many people do not understand how such a funny man as Robin Williams could not only suffer from depression but chose to end his life. Each person’s depression is different but there are many similarities in our illness. Please understand that depression is an illness just like cancer, high blood pressure and diabetes. Just like any of these other illnesses, depression does not discriminate against whom it attacks. Just like the other illnesses that were mentioned depression is hereditary. Just like the other three illnesses, you never know when it could first happen.

How could such a seemingly happy man not just suffer from depression but kill himself? Describing how depression changes your thought process is not an easy thing to do for someone who is not a scientist or a doctor but a sufferer themselves.  I am usually a happy person who loves talking to others, eating and to learn, but when I am depressed, I change.

Think about how you feel when you are hungry and your usual lunch hour has come and gone. You are hungry but you do not have time to stop to eat. The longer you go without eating the crankier you get. Suddenly the small things your co-workers do that usually do not bother you are now annoying you. Rude things you usually would not say suddenly are coming out of your mouth and you cannot control it. This is the closest I can describe to one of my depressive episodes. Suddenly, my usually happy persona disappears.

When I first become depressed, I cannot tell that I am not my usually happy person until it gets worse. My joy in learning goes away. Normally, I love to read interesting facts and ask questions to my co-workers, but when I am depressed even the most interesting book has no appeal to me.  Normally, food is a source of happiness, but when I am depressed it is not interesting for me and even can make me sick to my stomach. Something in my brain switches and my happy inner voice is now telling me that I am worthless and that no one can love or appreciate me. This “depression” inner voice is so rough on you that it tires you out to a point you cannot do anything and you question your will to live.

How can a depressed person try to get better? The first and easiest thing to do is exercise. The movie Legally Blonde has the best quote on depression and exercise; “exercise releases endorphins, endorphins make you happy, happy people don’t kill their husbands, they just don’t.” Happy people also do not commit suicide. Second if you are depressed look for help in the form of therapy. In the last blog on depression, how to find the right therapist was detailed. Finally talk to your doctor or a psychiatrist about if your depression is bad enough to be prescribed anti-depressants.

What if you are not the person suffering from depression but a loving family member or friend? What can I do for them? How can I help them? These are hard questions to answer. Different people can react differently to you trying to help them. These are some things that my friends and family did to help me during several of my depression episodes.

1)      Call, text, or email to send a small message letting them know that you love them and are worried. While your inner voice tells you are worthless, others telling you differently can help.

2)      Do something unexpectedly nice.  My older brother is known to come into my house to fill my refrigerator with food when he knows I am depressed. The idea being that he knows I will not do it and maybe I will not eat but if I do want to eat, the food is ready for me. My mom takes it to the next level and has not only made me food she’s fed it to me the same way she did when I had a cold as a little girl or when I’ve had surgeries.

3)      Ask about their safety.  Both my best friend and I once took away another friends medications and dispensed them to her on a daily basis so she would not try to overdose on them.

4)      Involve them in social activities. My brother and sister-in-law came to my house and made me come out to the movies with them once. I had not seen daylight in a week and that small interaction with humans helped.

While I was depressed, I did not always feel the above things were helpful.  None of the things I mentioned that my friends and family did for me were appreciated at the time. Remember that your reaction to them helping them is not them – it is their depression.

Looking back on it now, I am beyond grateful.  These small things that were done for me are the reason I am alive today.  If you suffer from depression, please hear that things can get better even if at the moment it does not seem like it.

Patient gives tips on how to see a psychotherapist

This guest blogger writes about what she’s learned about getting into therapy.  The following practical steps are helpful to people who could be helped by – but have never gone to-  therapy.

Therapy is a strange thing if you have never been before. You sit across a total stranger who asks you open ended questions about your most intimate most private thoughts and moments. You not only answer these questions honestly but you do it willingly. As you answer their questions, they give you, advice and opinions on the problem you went to see them for. You listen to their advice because their years of schooling and experience. The strangest part is if you answer honestly and do the work, they ask you, you can slowly see progress with the issue you came for help with. This can only happen if you know what to look for to find the right therapist for you.

How do you find a therapist? The easiest way to find one that takes your insurance is to call your insurance and to ask for providers that take your insurance. They can give you a list of providers closest to you. The number you can call to ask can be found in the back of your insurance card. You can also go to your insurance provider’s website and look for a mental health provider that way. Another way to find a provider is by word of mouth. Ask your friends and family for recommendations on health providers that they personally know. If you choose a health provider this way you will want to call either your insurance or the provider themselves to ask if they take your insurance.

There are some important things to know about the therapist you choose and your insurance before you start therapy. For your therapist you want to know where they went to school and their credentials. For your insurance, know what your copay is. Some insurances charge you the same copay as they would if you were seeing any other specialists. Other insurances charge you the same as if you were seeing your primary doctor. Finally, you should also know about the mental health parity law. The Bureau of Professional and Occupational Affairs is a good way to check on your therapist’s credentials. The things you need to know are if the therapist you have chosen is licensed and if any complaints have been filed against them with the states licensing board. The therapist having a license means that the state granting the license has assured that they have had up to 3,000 hours of required supervised experience. If any complaints were filed against the therapist, what were they and how were they settled. You can check with your state’s the licensing board to see if the therapist you have chosen is under investigation.

To know what your co-pay for seeing your therapist look at your insurance card. On the front of your insurance card, the prices for your co-pay are there. Calling your insurance will let you know if your copay is that of a specialist or the same as your primary doctor. Due to the Mental Health Parity Law, your insurance cannot charge you a higher co-pay than that to see a specialist. Your insurance also cannot limit the amount of visits you have per year to your therapist. Before 2008, insurances could and usually did limit how many visits you had per year. If your insurance refuses to pay for your mental health, they are required to tell you why they have refused to do so.

Knowing all these things can help you begin a great therapy experience. There are other things, which can help you have a good therapy experience. What some of these things are will be discussed in other blogs from the viewpoint of someone who is not only not only in therapy herself but also works in the mental health field. Hear her story of being in therapy, the stigma, and how she sees herself before therapy and while she has been in therapy.