#going off my meds to see if they’re exacerbating my health issues

[jennifersbod]

either making the best or worst decision of my life rn

[dontcallmecarrie]

Replying to the commenters of this post [heads up for angst]:

To @kine-iende, who said:​

hot damn. if "our" justin was a mom-friend in their home-universe, here people would start questioning if justin was in secret a very motherly scrull or something (and be fine with it ^^). but yeah, love the trope too. was it "for the want of a nail" or "through a mirrorm darkly"? well, contrast and a what could have been would be lovely. feel enabled, whenever you want to write this :)

.

I am not very familiar with the concept of Skrulls [...iirc, that’s something introduced in Captain Marvel, which I have yet to get around to], but yeah, that tracks. Assuming it’s a thing they know to look for, though, because here Justin’s being themself is the biggest and most obvious way to establish that they are not canon!Justin.

Sure, they’re identical physically, but the moment either Justin opens his mouth, the jig’s up. 

As is, not five minutes into this strange hellscape where their oldest rival looked at them with no small amount of disdain in his eyes at first, Justin had already managed to charm their way out of holding and into a very relaxed “we’ll keep an eye on him” Avengers custody. 

Well, on paper at least— in reality, most of the team doesn’t really give a damn one way or another, whereas Tony starts out morbidly curious as to just how different NHDD!Justin is to the one he’s used to dealing with, and ends up getting a concentrated dose of All The Feels™ because the moment NHDD!Justin realized this Tony had a metric buttload of undiagnosed-and-constantly-belittled mental health issues and a support system that was equal parts duct tape and caffeine, he went “oh, so this universe is the Hell Timeline, okay, makes sense :) :) :) dammit Ivan you’d better fix this stat”. 

In retrospect, Justin’s not sure when exactly the horror show started; if it was the absolute lack of concern or care the Avengers had for their Tony, or the minute they noticed the gauntness in his face. Maybe the tension between Iron Man and Captain America, or the obvious bravado this Tony used– and the fact that none of the others so much as noticed.

All Justin knows is, a version of someone they care about is hurting, hurting badly and has been for a long time now, and that’s more than enough for them to go “oh, okay, mine now”.

.

For his part, Tony has no idea what the hell’s going on. The non-annoying Justin Hammer who crash-landed an Avengers debrief is...something else, and he’s torn between shock, pleasant surprise, and no small amount of existential angst and jealousy because in the span of a few hours, Tony’s had a brief taste of what some other version of him had for a lifetime, and...

Tony’s not sure how he feels about it. He’s a genius, he can wrap his head around string theory and all that good stuff, but numbers are one thing, having to live with the fact that somewhere out there, a version of him grew up with someone so unfailingly kind and supportive and—Tony can’t think of a better word for it than nurturing— and, in the span of seconds, had been able to call him out on his bullshit and seemed to instinctively push him to be better but not in the demanding way his father or the rest of the world had—

If he thinks about it too long, it makes him want to cry, just a little. Somewhere out there was a Tony who’d been enough for someone, who had never been asked to change himself, who’d been pushed up instead of repeatedly torn down and he didn’t know how to deal. 

He’d thought having a non-annoying Justin around would be funny.

This was not, it was goddamn distressing is what it was, because Tony hadn’t even known it was a possibility but now he is acutely aware of the fact that he got stuck with his Justin— the human embodiment of one of those yappy dogs who nipped at people’s heels thinking they were so tough, despite not being able to back it up.

This Justin was, uh, not that. Tony wasn’t sure if he was always like this, or if it was only with him because he shared a face with someone Justin cared about, but... was he always this much of a mom friend? And where’d that granola bar even come from, anyway? Not that he minded, it was a nice change of pace, but really?

...Tony was really going to miss him, once they figured out a way to send him back home.

.

To the commenter who said:

Stephanie isn’t a canon character, is she? Because if not, NHDD!Justin might be able to pull off a “the birth of my little sister awakened my previously deeply buried parental instincts” to explain his whole… [gestures uselessly].

.

Technically, she could be, in that Justin Hammer has a sister and nephew in canon [according to the wiki and a deleted scene, apparently]. I chose to make her a younger sibling in NHDD, to really emphasize the ‘reincarnated with shitty memory’ aspect of this AU. Specifically, while it’s never specified, Justin’s past life was...not great, and part of it was the fact that their younger sibling was sick. 

With what, they don’t remember anymore, but sick enough that they know health isn’t something to take for granted; sick enough that towards the end, they remember their parents had to choose between paying hospital bills and electricity, remember going to bed hungry because meds were expensive and their next paycheck wasn’t until Friday.

...suffice it is to say, there’s a reason Justin’s so protective of those he cares about, even if his memories faded a bit on the specifics as time went by.

To be fair, canon!Justin also cares for his sister and nephew; it’s just that NHDD!Justin acted more like a third parent than a sibling, once Stephanie was born. 

Bear in mind that canon!Justin’s situation is very different than NHDD!Justin’s, because canon!Justin was basically set up to fail from the start as a normal kid who was constantly compared to a child prodigy two years younger than him and terrible parents. While NHDD!Justin’s situation is similar on the surface, the difference is they’re literally a reincarnated OC, with all the baggage that entails.

Maybe, if their second life hadn’t been surrounded by adults with A+ Parenting Skills, 0/10 Do Not Recommend, their issues and traumas from last time wouldn’t have been exacerbated. If they’d been born to a regular family, Justin would’ve been a good kid but nothing special, and their memories of a past life would’ve faded away by the time they hit puberty.

But instead, they were born to the Hammer family, and proceeded to be put through the wringer. 

Which is bad enough, and meant they immediately started leaning hard on everything from their past life because these people wouldn’t know good parenting if it bit them on the nose, but...then Justin’s little sister was born, which immediately kick-started every older sibling instinct they’d ever had because last time they’d been responsible for their younger sibling’s health and safety and you can probably see where this is going. 

aka yes, some of Justin’s behaviors could arguably be called trauma responses and/or coping mechanisms and it’s something I only realized as I was writing this, and no, this AU was not supposed to be this messed up

Justin’s responsibility, their willingness to deal with shitty parents and do tremendous amounts of emotional labor if it helped anyone they took under their wing? That’s no accident, that’s what happens when a soul has to be the adult, has to step up because nobody else is going to. There’s a reason Justin has so much disdain for Hank Pym and Howard Stark’s immaturity, why they have so little patience for their parents as time goes on; their mental age means the older they get, the more they’re looking at the adults around them and judging them hard.

...ahem. Sorry for getting a bit off-topic, but hey, at least now you know a bit more about what’s going on inside Justin’s head!

And yeah, if he had to bs an explanation for why he’s such a mom friend, Justin’d be more than happy to point to his little sister as an excuse. So long as they know she exists, anyway; if not, he’ll just laugh it off and try to chalk it up to one of the differences between their universes.

.

edit to remove the stuff that got through my nonexistent brain-to-mouth filter because I was averaging a not-optimal amount of sleep as I got used to my new job

[alienfishbabe]

lots o stuff - family stuff and health stuff

one of my aunts is pretty sick, like scary sick, and my mom has been tasked by my family to take care of her and its making me so upset. my mom is also very sick! and takes lots of meds that make her sicker! she’s been sick all her life and used to be a nurse and taught herself a ton of medical shit so her family just relies on her for everything and it makes me so angry. my aunt has a healthy husband who could be working from home and doing the treatments and everything that’s needed and he’s not but he also helped decide that my aunt should go home instead of staying in the hospital for treatment so my mom is like.... stuck at my granddads taking care of my aunt. my mom had been taking care of my granddad for a year and then taking care of my grandmom before that and that was all day work as well as cleaning out that whole huge house because nobody else fucking would even tho her siblings were all healthy at the time

my mom does so fucking much on top of how sick she is and all the doctors she has to see and meds she has to manage and i feel like her family is taking advantage of her again but i dont know what to do! they live close enough for me to drive down so im going to visit sun/mon and try to help my mom however i can even if its just bringing a care package and providing distractions but i feel sick over everything. ofc my dad isn’t doing anything for my mom at all and is probably making things worse somehow like he tends to do

my mom has to take the cat to the fucking vet cause my dad won’t take off work so she’s gonna be doing so much fucking driving even tho thats what makes her pain flare the most and its make me so angry. and like her cats that she loves and have been her main source of happiness are kept locked in a small room all day and i know they’re probably freaking out cause my dad mistreats them (except the one he has deemed “his” even tho he didn’t take this cat to be spayed like what the FUCK DAD my mom had to stay up w/ her while she was in heat because my dad didn’t get her fucking spayed?????? and he didn’t mention it until that happened??????? even tho he claims she’s HIS CAT like this is the cat my mom is taking to the vet to get stitches out because my mom is the one who went and got the cat spayed)

i already broke down and cried about all this shit and it isn’t even all of it i just feel so goddamn useless and im so angry about it. im not even working right now i should be able to take care of my mom while shes taking care of others but she kept insisting i not do it and i dont know! i dont know! all of this shit is happening exactly a year after my grandmom died and my mom didn’t even get to visit her grave and that pisses me off so much too

im just so scared this is going to like. kill my mom. like literally. she has so many health issues and so many exacerbated by stress and she’s pushing herself beyond all limits (she sleeps for 2 - 3 hours most days and drives for at least 3 most days if she isn’t going to doctors or whatever else)

i know my aunt doesn’t have a ton of money and i know its family and i know my mom has always been a caretaker but its too much. its too much. this isn’t fair to my mom.

[bubonickitten]

My mom's gone as far as to not trust vaccines anymore and thinking my brother's epilepsy can be improved w/ THC oil. i had a panic attack during an exam and my mom told me to smoke weed before exams...... like i can get expelled for showing up high to school, plus it can worsen my panic attacks!

YUP, like… I’m not saying I support Big Pharma 100% – pharmaceutical companies are interested in profit above all else, I have zero trust in corporations in general. 

And I’m also not saying trust the medical or psychiatric systems 100% – both have an ongoing history of ableism, racism, sexism, ethnocentrism, classism, sizeism, etc. etc. etc. Scientific racism and medical/psychiatric abuse have existed throughout history and continue to exist. There are a lot of shitty health providers out there (I’ve encountered more shitty ones than good ones personally). Science and medicine aren’t wholly benevolent or objective – they’re subject to people’s individual biases and historical and cultural factors. 

Plus, formal medical and psychiatric care aren’t the be-all end-all of treatment options. I totally support anyone who doesn’t want to personally undergo a given mode of treatment. Compulsory treatment often does more harm than good. Holistic and spiritual and alternative treatments, or relying primarily on self-care and community support, or whatever works best for an individual person are cool for those who want to go that route. (Though I draw the line at parents not wanting to vaccinate their kids based on fearmongering and misinformation. Herd immunity is important, the idea that vaccines cause autism has been debunked time and time again, and the idea that autism is the worst thing that can possibly happen to a person is awful and ableist. Personal choice regarding one’s own medical care is one thing, but when you’re making medical decisions that can harm another person or people, that’s a different beast.) And a lot of people don’t even have access to formal medical or psychiatric care due to any number of reasons (health insurance, affordability, transportation/distance issues, unsupportive family, trauma, discrimination, fear/distrust of the medical and psychiatric systems, providers within transportation distance not taking new patients or not taking health insurance, etc. etc. etc.). 

BUT that said, I have little patience for people who try to belittle the way I choose to manage my conditions. I don’t enjoy having to take so many medications, and no they don’t cure me or make me completely symptom-free, but they help me manage my symptoms to the point where I can live. I’ve been seeing the same therapist for ten years, and that’s helpful for me, but I’m not gonna tell everyone they need to open up to a therapist. And like… wrt weed – I’m not denying that marijuana is helpful in symptom management for a wide variety of symptoms for many people, but it isn’t the only option and it isn’t a viable option for everyone, for various reasons (legal, medical, financial, etc.). 

Personally, I have a history of paranoia and psychotic symptoms, esp during my extreme mood episodes, and marijuana can make me incredibly paranoid and anxious, so I have to be careful. I get together with my college friends twice a year and during those times I might have a bit of pot brownie or some other edible, but that’s basically the only time I partake, because it’s a safe space for me, and I’ve also gotten pretty decent with judging when I can handle a slight high versus when it’s not a good idea. 

Also, I have asthma, and I constantly have to remind my dad that I can’t smoke weed because it irritates my lungs and risks an asthma attack (I mean, some ppl with asthma can handle it, but personally it exacerbates my symptoms). When I ingest marijuana, it has to be in edible form. And even then I have to be careful for the aforementioned reasons. 

I don’t have anything against marijuana, and I’m in favor of legalization all the way. I just hate this idea that weed should be the solution for every ailment for literally everyone. That goes for any other treatment or self-care choice. There’s no such thing as a treatment or self-care technique that works for everyone all of the time. 

And, a lot of marijuana legalization discussion I hear totally ignores racism when it comes to the war on drugs. I feel like any discussion of marijuana legalization has to center the issue of POC – particularly Black and Latino people – being the targets of the war on drugs and mass incarceration over the past few decades. That’s not to say that there aren’t economic and medical incentives to legalize marijuana and end the war on drugs, and I also think people should be able to use it recreationally without risking legal repercussions that can change their lives forever, but to ignore the legal and discriminatory aspects of marijuana and other drugs is entirely misguided. It’s not right for so many (especially white) people to be benefiting financially from the growing marijuana industry while totally ignoring all the POC who have been and continue to be convicted of felonies (which disenfranchises and allows discrimination against them even after released from prison) for just being in possession of marijuana and other drugs. 

I’m white, and this obviously has been said better time and time again by POC. But my dad isn’t about to read any of the sources I suggest – like, I have a copy of The New Jim Crow and tried to suggest it to him recently and he blew me off. So I try to summarize the issue for him, but whenever I try to broach that aspect of the conversation with him, he totally loses interest and changes the flow of the conversation to the medical benefits of marijuana and how I should just smoke some weed and maybe I wouldn’t have to be on so many meds. 

sorry, I’m rambling. I just get so frustrated with my dad’s idea that his coping mechanisms should be universal and constantly commenting on my treatment choices as if they’re less valid. And I want to bang my head against a wall every time I hear the phrase “it’s from the EARTH” as if that makes it superior to human-made medications, because holy shit, a lot of stuff that grows out of the ground ISN’T good for you, and I hate that “chemicals are SCARY and BAD and GMOs are inherently EVIL and everyone should eat organic or they’re sheep” nonsense. 

[nancygduarteus]

<em>New Amsterdam</em> Is a Medical Drama That Fails Doctors—and Viewers

In an early episode of NBC’s medical drama New Amsterdam, viewers see a 10-year-old boy named Leo sitting on a hospital floor, listless and unspeaking. “He used to be energetic. Silly,” his mother laments. She explains to a doctor that, for several years, Leo has been taking a powerful cocktail of antipsychotic medications following a series of violent outbursts at school. “Who needs breakfast, am I right? Fistful of pills like that every morning,” the child psychiatrist Dr. Iggy Frome (played by Tyler Labine) quips as he reviews Leo’s list of prescriptions.

Within minutes of meeting Leo, Frome decides to take him off his meds, later exposing the boy to the absurdly risky process of “rapid-detox dialysis” to remove the medications from his system as quickly as possible. This detox, viewers are told, is intended to allow a trial course of behavioral therapy. But by the end of the episode, therapy is largely unnecessary. Freed from his psychotropic prison, Leo is restored to his old self: He smiles, hugs his mother, and freely articulates the guilt he’s been feeling over his father’s death. It’s a storyline that caters to nebulous fears and conspiracy theories about health care and pharmaceuticals. It’s also one of many times on New Amsterdam when complex medical problems evaporate as soon as anyone cares enough to address them.

Medicine is approaching a moment of reckoning in the United States. Costs are skyrocketing, physician burnout is rampant, and the health-care system is plagued by inadequate staffing, rushed appointments, and byzantine insurance rules as the population continues to grow sicker. Addressing these challenges is the raison d’être of Dr. Max Goodwin (Ryan Eggold), the new medical director of America’s oldest public hospital in New Amsterdam, which aired its fall finale Tuesday. The current state of medicine is a topic ripe for incisive critique and could offer fodder for meaningful TV drama. Unfortunately, the NBC series grossly oversimplifies the issues it portrays and leans into hero worship, which may lead viewers to troubling—even dangerous—conclusions about health care.

Since debuting in September, the show has followed Goodwin as he tries to overhaul New Amsterdam Hospital, a fictional behemoth based on the real-life Bellevue Hospital in New York, where I’m a resident physician. (The series was inspired by the 2012 memoir Twelve Patients: Life and Death at Bellevue Hospital.) Goodwin’s character is a familiar archetype: a maverick Man of Principle who jogs to work every morning, delivers self-righteous diatribes, and shows cynical onlookers the errors of their ways.

Soon after taking charge, Goodwin fires every cardiac surgeon (for placing “billing over care”), eliminates “untrained residents” from the hospital workforce, and does away with the emergency-department waiting room. In a recent episode, he encourages physicians to defraud the hospital through “downcoding”—providing expensive and time-consuming care to patients, then lying about it in the medical record. In doing all of this, Goodwin claims to be putting patients first, defying the nebulous higher-ups of the hospital, who, despite having only recently hired him, now seem bent on thwarting his efforts. That Goodwin also has cancer, as it’s revealed in the first episode, only adds to his zeal. “Let’s get into some trouble. Let’s be doctors, again,” Goodwin tells the hospital staff on his first day on the job, implying that health-care providers today are, somehow, something else.

From left to right: Tyler Labine as Dr. Iggy Frome, Finn Egan-Liang as Leo Chen, and Anupam Kher as Dr. Vijay Kapoor in the episode “Rituals.” (Francisco Roman / NBC)

New Amsterdam, which was the first new show of the fall to receive a full-season order, has proven popular with audiences, despite widespread critical consensus that it is simplistic and patronizing. I took a personal interest in the series ever since its television crew first appeared in the lobby at Bellevue a few months ago. At the time, it was easy for me to separate the telegenic TV doctors from the overworked, under-hydrated real ones, and the disparity between on-screen and real-life medicine is equally vast. But while accuracy has never been a requisite of primetime programming, skewed medical dramas like New Amsterdam can have a more insidious effect, poisoning how the health-care system and physicians are viewed by the public.

Television doctors can hold powerful sway over how people perceive medicine. Research has found that programs depicting physicians in an unflattering light correlate with negative and distrustful feelings toward doctors in the real world. Meanwhile, frequent viewers of valiant and courageous doctors on shows like Grey’s Anatomy tend to have positive beliefs about physicians, as well as higher satisfaction with their own medical care.

[Read: Health care in the time of ‘Grey’s Anatomy’]

This is worrying in light of the fact that over the past 50 years, TV doctors have devolved from caring, honest, and authoritative figures—as in the 1954 drama Medic, for example—into the arrogant and unethical characters we often see today. The hit series E.R. was among the first to depict hospitals as cold, inhumane environments staffed with callous and overworked (yet sympathetic) physicians, paving the way for the eponymous Dr. Gregory House, a pompous, rude, and drug-addicted (yet brilliant) diagnostician. Recently, Fox’s The Resident has taken the notion of bad doctors to the extreme, portraying physicians who routinely kill patients through medical error then cover up the deaths as accidents, all while belittling and abusing their patients and one other. Against this backdrop, distrust in physicians is rising, with only 34 percent of Americans now expressing confidence in medical leaders, down from 73 percent in 1966. Crucially, this decline has occurred despite the fact that most people still trust and admire their own physicians; it’s the medical profession more broadly that many see as increasingly suspect.

New Amsterdam is a throwback to the old-school, superhuman TV doctor with a notable twist. While Goodwin and his apostles are unflinchingly noble, they’re also clearly intended to be exceptions to the rule. Other doctors, the audience is told, are the problem: They are “corrupt and lazy,” perform unnecessary procedures to inflate billing and prioritizing golf over patient care. Even the lone surgeon who escapes the chopping block scoffs at Goodwin, saying: “You do know the whole system is rigged, don’t you? I mean, they’re not going to let you come in here and just … help people.” In another episode, Goodwin meets a homeless woman who is “skeptical” of doctors. “So am I,” he tells a colleague.

Working with patients, I’ve come face to face with the end result of this distrust, which often manifests as a deep reluctance to accept evidence-based treatments like vaccines, antibiotics, and needed medications and procedures. Frequently, patients and their families mention seeing something on TV, online, or in the news that scared them, though they often can’t express more than a dark, nagging suspicion that something nefarious is lurking behind the scenes. Once, a woman told me that The Resident had lifted the veil for her on how medicine really works. Other patients, perhaps bolstered by fictional storylines like Leo’s, have told me they believe doctors will only make them sicker. It can sometimes be impossible to assuage my patients’ fears, to the real detriment of their health.

There are, unfortunately, doctors who game the system, and who care more about money than about helping people, though they are outliers. There are also patients who are rightfully frustrated and angry due to negative or harmful encounters with these doctors. But in New Amsterdam, valid critiques of the incentives that allow bad actors to enter (and flourish) in medicine are supplanted by vague fear mongering and outlandish claims; scapegoating all doctors means overlooking the real, serious flaws with the health-care system.

Ryan Eggold as Dr. Max Goodwin (Francisco Roman / NBC)

If New Amsterdam has erred in identifying depraved doctors as the single biggest problem with American health care, the solutions the show proposes are equally disturbing. Never mind that banning residents from patient care, as Goodwin suggests, would dismantle the pipeline for training new doctors, exacerbating the impending physician shortage. Or that removing the emergency-department waiting room would mean filling beds on a first-come, first-serve basis rather than by medical need. Or that hiring 50 new attendings and an unspecified number of nurses, as Goodwin does in the first few episodes, would strain any hospital’s budget. In the only episode thus far to directly address the finances of the hospital, Goodwin offers a rare glimpse into his ostrich-like mindset, declaring, “The fiscal thing is really not my strong suit. I prefer to talk about the patients.” The absurdity of this statement, coming from the director of a hospital, confirms that Goodwin lives in a world without consequence. There are no trade-offs in this medical fantasy.

At the forefront of the show is Goodwin’s haphazard, manic leadership style, apparently inspired by Jim Carrey’s character from Yes Man. Goodwin’s colleagues repeatedly note that the medical director previously ran, and turned around, a failing clinic in Chinatown. Yet viewers are left with no sense of how he accomplished that—unless it was by uncritically accepting every offhand suggestion from the people around him. Attention spans, like cardiac surgeons, seem to have no place at New Amsterdam. Whims become policy, facing only token, if any, objections from the quietly skeptical administrator who tails Goodwin through the hospital, the business-minded Dean of Medicine, or the comically mute board of directors. The audience is meant to admire Goodwin’s fast-moving, shoot-from-the-hip reforms (he’s the anti-bureaucrat!), but the reality is that in medicine, pure intuition has fallen out of favor. With evidence-based medicine still in its relative infancy, many doctors are only now coming to terms with how frequently our gut instincts can be wrong.

Part of the problem with New Amsterdam is format. If the medium is the message, primetime procedural dramas venerate the quick-fix at the expense of substance. They rely, by necessity, on simplified, stylized versions of difficult medical problems. Surgical and medical “cures” abound. Ideas invariably work—if not on the first try, then certainly on the second or third. Storylines wrap up neatly by the end of each episode. Relative to real-world medicine, which is often messy and uncertain, TV medicine can be intensely satisfying and comforting to watch, tapping into an ever-growing societal obsession with instant gratification. The danger is that an inability to delay gratification, and to weigh nuance, is what brought about much of the dysfunction in the health-care system in the first place. Good medicine, and effective reform, takes patience.

Max Goodwin’s obvious redeeming feature is that he does seem to genuinely care about his patients. The fatal error of the show is assuming that other doctors don’t. Without Goodwin, physicians in the New Amsterdam universe are apathetic and inert, waiting to be inspired into action. At the real Bellevue, I have yet to meet a doctor who doesn’t care deeply about the well-being of their patients. Medicine is also teeming with people who are passionately working to reform health care through advocacy and research. The reality is that if good intentions alone were enough to improve American health care, the problems facing Bellevue—and so many other hospitals—would’ve been solved long ago. Addressing medicine’s many ills requires acknowledging their complexity; New Amsterdam does the opposite, leaving only frustration and fear in its wake. For a show about healing the system, it may do real harm.

from Health News And Updates https://www.theatlantic.com/entertainment/archive/2018/11/new-amsterdam-nbc-show-physician-distrust-bellevue/576712/?utm_source=feed

[stopsubstanceabuse1-blog]

12 Comments that Are Unexpectedly Detrimental to People’s Mental Health

New Post has been published on https://www.substanceabuseprevention.net/12-comments-that-are-unexpectedly-detrimental-to-peoples-mental-health/

12 Comments that Are Unexpectedly Detrimental to People’s Mental Health

If a friend suffers from mental illness, wanting to help or offer supportive words is understandable. Seeing someone you love in pain hurts your heart, too. There’s nothing wrong with reaching out about a friend’s mental health — but respect and delicacy is paramount. A callous or poorly thought-out comment can cause a spiral or depressive episode for someone with mental health challenges.

Pay attention to your words. These 12 comments might actively damage someone’s mental health — and at a minimum, they won’t help improve their well-being.

“Someone else has it worse off than you.”

Mental illness doesn’t stop just because someone out there suffers more than you. We wish we could tell our brain, “Things aren’t so bad, comparatively!” Mental illness often doesn’t listen to reason. The world is dark and full of terrors, so don’t make us feel guilty about our own struggles.

“You can do it! You’re so strong.”

Thanks? But strength doesn’t help. Mental illness is a life-long battle, and just because we’ve knocked out the anxiety demon for the day doesn’t mean it won’t come back next week. Praising our strength now may lead to worse lows later, when our mental illness returns and we struggle to loosen its grip.

“Snap out of it.”

Believe us: we would if we could. But if mental illnesses disappeared with a snap of our fingers, why would anyone suffer? Telling us to “snap out of it” can even make our problems worse. When our mental illness doesn’t magically evaporate, we worry we’re disappointing you.

“Everyone gets stressed out!”

Sure, this is accurate. Everyone does get stressed out! But being “stressed out” is not equivalent to “having an anxiety disorder.” Mental illnesses don’t go away when midterms are over — this is something we deal with our entire life.

“You’re making excuses.”

Yes, depression can cause avoidance or tardiness. An anxiety attack might mean leaving a party early. We might miss a date. But the mental illness isn’t an excuse — it’s the cause, and our behavior is the symptom. Saying our anxiety or depression is an “excuse” is like saying the flu is an “excuse” for a nasty cough.

“Why are you still stressed out? It happened so long ago!”

Don’t dismiss the concerns of someone suffering from diagnoses like post-traumatic stress disorder by reminding them that the event in question happened “a long time ago.” Events in the distant past can loom large in our memory, meaning they don’t feel “long ago” to us.

“Face your fears! You can do it!”

No, we literally can’t — and frankly, it’s not that easy. We’re facing our fears every day. Acrophobia (or a fear of heights) won’t be miraculously cured because we decide to jump out of a plane. And social anxiety doesn’t disappear because we attended our best friend’s birthday party. If we do face our fears, it will be on our own terms, or with a therapist’s care and guidance.

“You’re just looking for attention.”

Actually, the opposite. If our mental illnesses could stop attracting so much attention, that would be great! Please don’t look at a friend suffering from depression and think their tears are just for show.

“Chill out.”

A mental illness is not a refrigerator. Believe us: We would love to relax. We’d be thrilled if we could tap our heels together three times and suddenly be less high-strung. But requesting we “chill out” might just exacerbate our spiral and lead to more stress — for everyone — in the long run.

“Do you really need meds? Or: Maybe you need meds?”

Are you a doctor? Are you my doctor? Clearly not, because no doctor would suggest we suddenly dump our medication. And if we’re not taking medication, please trust that we’ve fully considered the slate of options, and determined med-free is the best strategy for our specific illness. We want your support, not your unqualified medical opinions.

“Have you thought about what you’re putting your family through?”

All the time. Literally every day. Most people with mental illness struggle with the belief they’re hurting their family, making this guilt trip highly effective. But if you’re hoping to help us overcome our mental illness by invoking our loved ones, think again. All you’re doing is adding weight to our burden.

“Think positively!”

Yes, practicing positive thought patterns is a valuable treatment for some mental illnesses. But it’s a long process, typically undergone with a therapist’s guidance. If we could “think positively!” on a whim, we wouldn’t have a mental illness, or could at least lessen it’s symptoms. So while your positivity may be appreciated, please keep these thoughts to yourself. Otherwise, you’re adding to the weight that mentally ill people carry every day.

We’re All Working Through Something

The best way to support someone working through mental health challenges is to listen, not talk. We all want what’s best for each other, and are eager to provide any solution to help ease someone’s pain. But suggesting random solutions isn’t always the answer. Sometimes all we need is to know someone cares enough about us to stand by us and understand our issues without judgement.

Source: https://www.talkspace.com/blog/2018/11/12-comments-that-are-unexpectedly-detrimental-to-peoples-mental-health/

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Rural Jails and Mental Health: The Hardest Challenge

“There is nothing, nothing worse than seeing someone in jail for a misdemeanor nonviolent offense who has a mental illness,” said Vicki Maca, director of criminal justice/behavioral health initiatives for a region that encompasses northeast Nebraska.

They’re not in a therapeutic, trauma-informed environment,” she added .

And staff shortages are making things worse.

As Nebraska wrestles with shortages in psychiatric providers, officials are concerned that individuals struggling with mental illness are becoming increasingly entangled in the criminal justice system, frequently winding up in county jails.

And those jails, particularly in more rural communities, face unique challenges in meeting the complex needs of mentally ill inmates, according to mental health providers, jail administrators, county officials and criminal defense attorneys.

At these jails, there is no full-time staff devoted to mental health needs, as there is in the state prison system—which, while facing its own challenges with crowding, has a mental health unit.

The restrictive jail environment isn’t conducive to individuals struggling with mental illness, officials say. Yet those individuals face greater challenges moving through their criminal proceedings—such as long waitlists at the state’s Regional Centers, which conduct court-ordered competency restorations—which lengthen their stays.

Officials worry that challenges in providing continuous care out in the community increase the likelihood that mentally ill individuals may find themselves back in jails multiple times.

At the Saunders and Washington County jails, officials believe that mental illness is playing a far larger role in inmate populations than in the past.

“I’ve been doing this for 37 years, and I don’t ever remember the number of people with mental health issues being as dramatic, or significant, as large as it is right now,” said Captain Rob Bellamy, head of corrections in Washington County.

A 2006 report from the Bureau of Justice Statistics found that 64 percent of inmates in local jails across the country had some sort of mental health problem. The Virginia-based Treatment Advocacy Center estimates that 16 percent of inmates in jails and prisons have a severe mental health illness, such as schizophrenia or bipolar disorder.

More recent, localized data on mentally ill inmates is hard to come by. But generally, rising jail populations are becoming a greater concern for area counties.

The average daily population of Dodge County inmates at the Saunders County jail, which holds inmates from Saunders, Dodge and Sarpy counties, has increased from 61 to 81 since 2012, growing to encompass more than two-thirds of the total jail population, according to Jail Administrator Brian Styskal.

Washington County, meanwhile, is constructing a new, $24.5 million justice center—complete with a 120-bed jail—to accommodate a growing population that routinely exceeds its 17-bed capacity, and requires housing inmates in other counties.

Officials attribute jail growth to a number of factors, such as changes in sentencing laws and rising drug use, which is often coupled with mental illness, especially when individuals face obstacles in receiving proper medication or treatment.

“A lot of crimes are committed are when folks that I know, because I’ve dealt with them over the years, I know they have mental health issues, and doctors and psychiatrists have told me that,” said Dodge County Attorney Oliver Glass.

“I can tell you from my experience that a lot of [mentally ill individuals’] criminal activity occurs when they are self-medicating with alcohol or illegal street drugs.”

A rising population also leads to rising costs. To house its inmates in Saunders County, Dodge County pays a baseline cost of $64.50 per inmate per day, Styskal said, and that doesn’t include additional expenses, such as medical costs, which have been rising. This past year, the county spent $346,569.58 on inmate medical costs, more than double the original budgeted amount of $140,000.

That expense has increased every year since the 2013-2014 fiscal year, when it was just below $30,000. Medical costs have increased in Washington County as well, Bellamy says.

Mental health can play a big role in driving those costs.

A 2017 suicide in the Dodge County jail accounted for $114,000 after the inmate was flown to Lincoln for emergency medical treatment.

But even more alarming than the burden on counties’ budgets is the concern that jails are not an appropriate environment for the mentally ill.

“They’re in a jail, they’re having limited contact with other people, they may or may not be on their meds, they’re not getting support from family and friends like they may need, they’re not maybe seeing the mental health people as frequently as we would all like, ”  said Maca who coordinates mental health services for Behavioral Region 6, which covers five Nebraska counties, including Dodge and Washington.

The jails also lack re-entry planning services, Maca said, which are available in the prison system or in larger jails, like in Douglas County. Those services could help line up mentally ill inmates with the resources they need out in the community to stay out of jail: counseling, substance abuse treatment, housing, vocational training and more.

Through Region 6, Washington and Saunders are currently exploring the possibility of adding those services, though there are challenges at the jail level. In prisons, release dates are based on fixed sentences that are easy to predict. For jail inmates whose cases are being processed at varying lengths, preparing such services can be more difficult, Maca said.

Both jails have access to mental health crisis intervention services, which can respond in emergency situations. But those services are provided from outside the jails by local community-based programs, such as Blue Valley Behavioral Health and Lutheran Family Services.

Managing psychotropic medications in the correctional setting is also a challenge, as the medical practitioners from Advanced Correctional work to verify that prescriptions are accurate and that medical and mental health needs are legitimate.

Area defense attorneys are often concerned about how medications are doled out, especially at the larger Saunders County jail. They grow concerned that their clients are being forced off stabilizing medication “cold turkey.”

“That kind of confinement, and that kind of treatment of them really exacerbates some of their mental illness, especially when you restrict them on their access to meds going in,” said Fremont attorney Richard Register, who also sits on the county mental health board, which determines whether mentally ill individuals should be committed to state hospitals.

Generally, getting incarcerated poses frustrations for individuals who are on medications, especially if those medications have withdrawal symptoms, said Lindsay Kroll, Crisis Response Supervisor at Lutheran Family Services in Omaha.

Even in the period of time it takes to verify prescriptions, those symptoms can begin to manifest, she said.

Jail administrators, meanwhile, have to ensure that they are meeting inmates’ medical and medicinal needs while guarding against the potential that medications may be abused. With substance abuse becoming increasingly prevalent, jails need to ensure that prescriptions are legitimate, that needs are real and that inmates struggling with addiction aren’t seeking to compensate for lack of access to street drugs, Styskal argued.

  “It makes it a problem for our contract medical provider where, their license is on the line for whatever they prescribe, so they have to be definitely cautious and make sure there is a medical need versus a medical want,” Styskal said.

And often, at the request of attorneys, judges will intervene, signing orders compelling the jails to prescribe those medications, Styskal said, though he believes that those decisions are often made without considering the full history of the inmate and the possibility that they may seek to abuse those medications.

Additionally, inmates with mental health issues often spend longer times in jails than other inmates. Among other contributing factors here in Nebraska is the lack of available inpatient beds at the state Regional Centers—inpatient psychiatric institutions that also provide court-ordered competency evaluations and restorations, when a defendant appears incompetent to stand trial.

Meanwhile, wait times for admissions at the still fully operational Lincoln Regional Center have increased. Mentally ill defendants ordered to receive competency evaluations can be put on long waitlists, awaiting court-ordered resources that must occur before their case can proceed.

The average wait time for a bed at the Regional Center in 2018, through Sept. 30, is 85 days—more than double what it was in 2014. Dodge County inmates have waited for anywhere between 30 to 100 days, said County Attorney Glass. In Washington County this year, one inmate spent more than 10 months waiting for a competency evaluation.

“That’s frustrating from the jail and the jail administrators’ perspective because apparently, the system recognizes that he has a problem that needs to be treated, but yet he continues to be warehoused in a jail because there’s, obviously and apparently, there’s nowhere else for them to go,” Bellamy said.

The Regional Center conducts competency evaluations both inpatient and outpatient, according to the state’s Department of Health and Human Services. The number of those evaluations are up: in 2018, through Sept. 30, there were 223 competency evaluations compared to 138 in 2016. Most of those were conducted in an outpatient setting.

But the higher number of calls means more individuals found to be incompetent to stand trial, which puts them on the waitlist for an inpatient bed for competency restoration, which can only be conducted at the Lincoln Regional Center, DHHS said.

Still, officials and attorneys say that the biggest frustration is the barriers to care outside of jail, like expensive medication or a shortage in psychiatrists. And for those who face those barriers, the criminal justice system may be their first exposure to treatment. Fremont-based attorney Leta Fornoff has seen that firsthand.

“I can say that there have been people that I have represented before that have wished to be incarcerated so that they can get the help they need,” Fornoff said.

“Now that’s few and far between, but it has happened.”

James Farrell is a John Jay Rural Justice Reporting Fellow. This is an edited version of a story published this weekend in the Fremont Tribune, first in a two-part series exploring the intersection of mental health and the local criminal justice system. The full version is available here.

Rural Jails and Mental Health: The Hardest Challenge syndicated from https://immigrationattorneyto.wordpress.com/