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26 Jan 2022

Category: symptomsCategory Archives:

My journey in mental health housing and recommendations for change and reform

Those of us with mental illness know full well that there are many challenges required of us. Acquiring and maintaining stable housing is one of the biggest challenges of them all. With a complicated condition, the healing journey can be difficult and even more dangerous without stable housing.

My mental health housing system was strenuous and trying throughout and during the tenure of time, healing from a brain injury and schizoaffective illness living wasn’t exactly a cakewalk. My dual diagnoses presented unexpected challenges that created multiple obstacles to living independently without incident.

To live the way I wanted was viewed as impossible by the ‘higher-ups’ and powers in charge at my prior mental health living residences. It was hard to show my strengths and how resilient I was despite my illnesses. Thinking back, I have to ask: why did it take over 12 years to transfer me from continuing inpatient hospital care to private living? Seems like a long time to wait for living in a residential neighborhood of my choice?

I must stress that I am thankful for the skills I picked up along the mental health system. From self-management skills in hospitals and supervised living residences, I relearned how to be more independent. At one point, it seemed like a stretch to my case managers at the group home to move me to apartment care. They opened my eyes to things I never knew that I was doing to interfere with that goal. We all needed a lot of patience exhibited at certain times to learn how to get closer to my destination without further setbacks.

On the other hand, I am not thankful for how the mental health system delegitimized my goals for independence. It’s one thing to be instructive or ‘directive’ about following instructions and recommendations for self-care, but it’s another thing altogether to underestimate a client’s intelligence.

A primary goal of mine at the state hospital in 2008 was to make something of myself after all that I had been through. After a self-harm episode left me in a six-week-long coma with a subsequent frontal lobe traumatic brain injury, I was lucky to have an exceptional neuropsychologist who inspired me to show the world my mettle.

This yearning Paid off: By 2017, I had earned two scholarships and had maintained my position as a group facilitator at the state hospital for four years. This achievement started in 2009 when I went through an educational training program and continued my SUNY studies.

However, recovering from frontal lobe traumatic head injury with lots of stimulation in subsequent group residences was a difficult task indeed. Thankfully, I maintained the same residential housing for seven years after my discharge from the hospital.

It was the transition into apartment living that threw me for a loop. The continuation of care across all levels was indeed a challenge for the case managers and me.

Some symptoms of TBI plus schizoaffective came out more frequently at the apartment level. Two episodes created a significant problem for me. They led to a supportive apartment arrangement through SPOA (single point of access), resulting in a two-week-long stay at a motel between residences.

For most of my time at the group home level, my positive symptoms were generally under control. Yet, due to the increased stress at the supervised apartment level, positive signs made the worst appearance they had since my hospital stays ten years prior.

Because of these sudden episodes, I believe there was a lack of communication across all levels of care in hindsight. The transition could have gone smoother. One thing that would have helped would have been a greater acknowledgment of my favorable traits by case managers. Also, my counselor at my treatment agency could have helped me mentally prepare amidst everything I was involved in. The road ahead would mean Consecutive scholarships, orientation for Roswell Park Cancer Institute, and group facilitation at the state psychiatric hospital, amongst my move.

Yet, I think it’s common practice for treatment providers to delegitimize patients and clients, unfortunately, because of this. I had a tough time In the 2.5 years spanning group home to my current neighborhood apartment. I am thankful; meanwhile, I now in my independent apartment, and I know I had to get here in one way or another. If I had stayed at the group home level, I would have felt cheated out of my destiny. This conflict may have created worse problems down the line than what I have already described.

Since I understand my dual conditions complicate my level of functioning, I feel very fortunate to be where I am now.. Since there is little outside stimulation in this arrangement than there was at the congregate care, there’s been practically no issues that can’t be resolved without my treatment agency or my landlord. There have been very few problems here.

I am Also thankful for a hospital diversion program at my treatment agency that allows for phone communications throughout the pandemic. They were instrumental in my transition from a treatment apartment to a residential apartment.

Some things worked out well for me. Other experiences could have worked out with less incident. The overriding theme is that communication could have been better across different levels of care coordination. Especially since I experienced significant trauma that not even my counselor considered until I made clear it was a real issue.

Indeed, more effective trauma-sensitive approaches in residential treatment should become prevalent since people with mental illness experience trauma at a high level.

I know that with an in-tune trauma-sensitive approach executed with more respect, the transition would have been better, and some incidents would have never happened in the first place. Mental illness is a thing, but better communication will ease its effects across all mental health care systems.

Plan B: Relapse and reconstitution  

The anxiety of a small problem has the potential to eat us alive. Imagine the stress around a significant mental illness and lifelong disorder? Like most thoughts surrounding fear, paranoia, and anxious thinking, they all snowball, combining and multiplying our worst thoughts.

 

Following my self-care plan across the lifespan will mean living a life free of this fear—or at least regulated as best as possible to reduce the likelihood and chances of paranoia and the fear that we will see one day relapse or become sick without warning. This would pose to be quite tricky. With such a connected group of friends, some angry with me, others sitting on the fence, and some with a mouth so big, and any sort of help usually backfired on all of us.

 

My biggest concern was always to position myself the right way. With friends, providers, and co-workers, I learned to do this well. In doing so, I allied with my therapist, treatment team, and close peers with a vested interest in my mental health.

 

I firmly believe in the importance of establishing a deep trust with close personal everyday contacts. In doing so, if my collaterals begin to detect an extreme and toxic abnormality in my health, I felt safe enough to take their advice and concerns seriously. Sure, no clinician or friend can get a perfect read on our health.

 

However, for those of us without a great deal of self-awareness or drive to look after ourselves, there are still options and strategies to stay healthy without relying entirely on your own devices. Such is the case for people like my friend and others I would encounter along my healing path.

 

Indeed, not everyone cares enough about their health to self-monitor all the time. In other cases, the day’s priority will capture our attention—for example, paying the rent, housing, employment, or even just showing up to work on time. If not also addressed in our lives, all of these would disrupt our mental health and even jeopardise our lives regardless of our diagnosis.

 

Staying connected with collaterals to delegate health needs is a great ‘Plan B when your self-care takes a back seat to life’s priorities (which only seem like they come before focusing on maintaining or working toward good mental health). During the first few years out of the hospital, I provided regular, almost weekly reports to my friends regarding my treatment status and medication changes. This served multiple purposes:  (a) kept me firmly treatment focused; (b) communicating my treatment needs to other people; and (c) allowed my friends to get a better idea of where I was at, so they could be as attentive as possible with my needs on a moment-by-moment basis.

 

Avoiding or reducing the risk of relapse does not mean handing out your mental health’s full responsibility to others. Instead, as a prosumer, I recommend you hand part of it to family, friends, and those you trust to keep them looped into your clinical treatment. These natural supports are excellent advice sources even when we may disagree with their reasoning (unless it puts us directly or indirectly at risk of harm).

 

I am suggesting that regardless of how we feel or think about the validity of our friends’ opinions on our mental status, our disorder disrupts our capacity to stay connected to reality. This may take the form of elaborate delusions about our life, which complicate our own interpretive eye’s ability to know what is truly happening with our health.

 

In the end, anyway, people want to manage their mental health is a significant step but do at least that much. Have a plan and have another goal when the original roadmap to better health becomes unworkable. Ultimately, whether you have a chronic condition or an acute diagnosis, relapse is only to be feared when you are not doing what you need to do to work toward better health and healing.

 

Relapsing and experiencing the renewal of old symptoms can still remind you to get back on track with your recovery. Keep going, and do not stop. When you stop taking care of yourself, be prepared for your worst fears not just to haunt you but become the grim reality you feared so vehemently instead of investing the same mental energy in health and healing.

 

In my opinion, as a prosumer, the best part of recovery is gaining access to new responsibilities, materials, information, and all the good things that come with stable living. Given that relapse is an inevitable part of recovery, the loss of materials, access, and resources attributed to relapsing and mental status degradation is the worst part of relapsing, in my opinion.

 

Usually, the biggest loser in a person’s life relapsing is hygiene, and on a broader level, the person’s living environment or home. It may be a matter of neglecting cleaning or not being aware of dirt and disorganisation in the house, or it may go even more profound.

 

I even treated a former psychiatrist in his home, providing him psychotherapy. Sadly, I watched this psychiatrist lose ground weekly on my watch, knowing full well what was happening. He was decompensating rapidly. For this man, this means a growing delusional system and potentially aggressive behaviour, according to his case history. While he was never free of his delusions, earlier on, the distortions were much less fixed and pronounced in what he was reporting to our team in session.

 

According to him, he was set up’ by extra-governmental agents and was in his position because he was the target of a more massive governmental conspiracy. This conspiracy was becoming more problematic for the psychiatrist, and ultimately, he became so agitated in session and adversarial that all treatment failed.

 

When our team returned, we came back with the local police. With the shield’s help, police entered the apartment against the psychiatrist’s will, sitting him down on his couch, handcuffed. On the sofa, he was sitting upright, screaming utter nonsense and profanities and the police. This was hard to watch both as a provider and as a person with lived experience. Someone who knows what it is like to be handcuffed amid a delusional rage.

 

Sadly, I have also witnessed police storming doorways with shields to access a home fortified for the ‘end’ to avoid being evicted. Barricading yourself in the home or something even worse is never the answer. It may even further your risk of relapsing more acutely – if you go against police orders or personnel, it will only exaggerate your problems and complicate your relapse even more deeply. The worst privilege to lose during relapse is the freedom of healthy living. With healthy living comes life circumstances that support wellness and mental hygiene.

 

There is no question that when we lose healthy living practices, we lose the freedom to be useful to our bodies and minds and treat ourselves kindly and with respect at all times. Relapsing means surrendering some of these healthy moments for symptomatic periods of distress in which it is more difficult to live peaceably with the world at large and adjust to our situations accordingly.

 

Relapse ages the body. During my many meals with Caroline, I would just gaze at her face. She looked tired all the time. Sadly, she aged twenty years in a span of ten. She was no stranger to the police and emergency service intervention.

 

‘I climbed into the city fountains wearing all white robes and began cutting myself. The fountains turned red. It was a horrific scene that I thought was directly from the Bible. The end of time,’ my friend would recant.

 

I would try to tell people in similar shoes as my friend about my injection and how much I preferred getting medication administered through my muscle tissue so I would not have to take medication daily, just once a month for the shot. I explained the benefits and tried to seem like an expert. She would consider speaking to her doctor about it. I was an expert, but my friend always knew better yet was still wrong about the following steps to take in her recovery.

 

For people living in a group home or apartment treatment facility, relapse usually brings with it more concrete freedoms that may be stripped away. Sometimes, relapsing means changes in curfew or even may trigger reduced independence in the community; doors to your residence that are usually open for residents to come freely may become restricted.

 

Such is the case of people like my friend. She has to ‘pack’ her medication. Every few days, in front of the agency personal, before transporting her meds back to her apartment in the community, my friend has to provide visible proof she had medication on hand.  In cases like hers, this might also mean increased home visits, if the person is living on their own, or added chores in the community home of a residence if they live in an adult home or community residence.

 

Relapse can mean many things. It can also mean losing mental health housing or moving into a residence with more supervision and more restrictions on your freedoms. In any event, be mindful of what the losses mean for the bigger picture. Ultimately, what matters is your pathway back to health and wellness.

Lived experience as a self-diagnostic tool  

The concept of recovery and healing is so complicated. Let us assume that people ‘heal’ as a by-product of their recovery, including many other aspects.

 

These aspects include their overall stance on healing, approach to recovery, rate-of-recovery, and so many other nuances that contribute to our overall healing from trauma, self-inflicted harm, and organic brain disease. I would like to explore my own lived experience with first-onset psychosis.

 

I always knew the qualities of my personality were altered by schizophrenia. I approach problems differently today than before my disorder. I even approach positive insertions into my life differently today. These insertions can be as simple as good conversation during the workday or meeting a new person and experiencing a budding relationship blossom. However, what exactly do I mean by different? The difference is at the level of how I handle such occurrences. These extend beyond the normal development of my personality, I believe. We all grow and mature over time. There is no question that some of the changes I am gesturing towards are due to my development’s natural progression. However, I know myself better than that. I also know I have had to mature a lot faster than most people my age.

 

This is mainly because, developmentally, I cannot afford to make the same mistakes people at my development stage make. Since my psychological landscape has little room for error, I need to be extra cautious, extra careful, and speedy in how I go about maturing and the maturation process.

 

I need to handle things differently. However, my question is: how much of this is a by-product of the changes due to the first onset? I genuinely wonder if the resultant changes that manifested in my brain necessitated me to handle things differently. Meaning, because my mind now functions differently, is the need to feel things differently from the first onset, or is it a result of how my brain went about healing? Are the changes the direct result of trauma to the brain or the development of my mind healing ‘normally’? I will tell you one thing. For the most part, I have not changed how I handle things because I wanted to be spontaneous and change things. No, I have had to because, after the first onset, I was so disordered that I could not speak intelligibly enough for others to gather anything meaningful from my speech. I have written extensively on stilted language and the changes during my episode when the first onset first hit my brain’s synapses. However, I rarely evaluate how my speech was before my disorder and after my recovery. More importantly, given my findings, how I find my own brain’s capacity to heal from psychosis? I am no speech analyst. In truth, my expertise is in rhetoric and only helpful when studying the words used, delivery, style, memory, and delivery.

 

However, even with my limited knowledge of how rhetoric works. A side-by-side comparison of my speech and ability to communicate before the first onset and after is bothersome on many levels and remarkably telling on others. Incredibly speaking of the energy, I invested in my recovery, the specific skills I was able to relearn, and how far I could push forward in areas that benefited from relearning how to speak and communicate. That is to say, not every aspect of my rhetorical canon was repaired or responded to the work I invested in regaining my language facilities.

 

In my 2006 Radio Show, County Speak, on WHRW 90.5 Binghamton, I was at the height of my college speaking career. Thoroughly before any schizophrenia symptoms, I was in complete command of what I wanted to say and how I went about saying it. After listening to the show alongside a recent interview from this year, I was taken aback. I sounded like an altogether different person years ago.

 

Let us break it down on the level of rhetoric. In terms of style, my speech was certainly more spontaneous in 2007, with less effort and energy expended on my part to seem so. My memory was remarkably better in 2007. I needed to pause less to gather my thoughts, and the flow and diction were more even and smooth. All these aspects of rhetoric have taken a turn after the first onset.

 

These aspects of my speech responded well to the effort and energy I invested in my treatment targeting my language. However, they did not reconstitute completely and heal up without a hardened scab and layer of nonfunction or impairment, still visible to this day. Only on the level of delivery have I been able to learn how to be more impactful. This has nothing to do with my illness, however. This harkens back to what I was speaking about earlier. That I have had to invest a ton of energy into the process, and my delivery, how I capture my audience’s attention, keep it, and redirect my life’s sheer inertia into the work is clear as day and uncontested.

 

I cannot help but cite the greatest, Mohammad Ali, who was not as fast on his feet as he once was after returning to boxing after years of political exile. He learned to lean on the ropes with the famous icon ‘rope-a-dope’ strategy and outpace his challengers with the imposition of will and his unrivalled stamina. While I am not as savvy with my ability to choose words as quickly and effectively or speak smoothly and spontaneously, I have learned to lean on my energy.

 

My sheer will to rise above my impairment is genuinely the main asset I have in my corner. Sure, identifying my weaknesses and pinpointing what works and what has not along the way was also important. However, indeed, my energy and the level of intensity I put into the work ahead is what continues to drive my healing forward.

Eleven years and no progress

The entire mental health system is not only broken, but it has fractured into tiny shards of ineffective state and local level outpatient programs, underfunded outpatient psychotherapy clinics, and psychiatric in-patient hospitals with limited beds and shortened length of stays.

This is the case for so many people in the public mental health system who cannot afford other treatments.

I still remember starting off my journey in the “system of care” after being discharged from a six-month inpatient stay in a state hospital facility operated by my state’s Office of Mental Health (OMH). I was still dysregulated at the time of my discharge, albeit eager to return home. The state hospital system simply doesn’t have enough open beds for the sheer volume of patients requiring this level of care.

Eleven years ago, my psychiatrist in the state hospital discharged me. I was clinically stable for discharge but still slightly symptomatic. While I could maintain my own safety (and not pose a risk to the safety of others) in the community, I needed 24-hour assistance and support from my parents if I was ever to survive in the world. The plan from the hospital was partial hospitalization until I could benefit from outpatient treatment.

I can still hear my friend Minerva prattle on the phone in our partial program about her career as a big-time writer.

“I’m on Lexington and Fifth, darling” Minerva repeated, loudly. “Darling! I’m with my literary agent! We just got out of a meeting in the boardroom, and it seems I am being published again!”

“Again! Yes, well, when you’ve been published this many times it’s a real bore!” lamented Minerva, taking off her sunglasses to look to check her makeup and fix her eyelash makeup through the tinted glass reflection. “A bore, can’t you hear me?!” she screamed into the phone.

“Minerva, is that you screaming? You know, there is a noise policy in this program!” A distant voice echoed.

“Minerva! I said, please stop screaming!” The voice was moving closer in proximity.

“Yes, Nurse Gottlieb! What is it now?” Minerva was almost smug with her tone, but more so with her eye-rolling.

“Minerva, you missed your afternoon meds! Wipe that smirk off your face! This is serious, you can’t just skip your meds, and make noisy calls outside the hallway when the group is in session. There are rules in this program, Minerva, and you will follow them!” Nurse Gottlieb exclaimed, starring Minerva in the eye, who was almost in shock by the directness and the tone of the nurse at the Ongoing Day Program (Partial Hospital) for the Mentally Ill.

“Get me out of here! I can’t stand this program!” Minerva said as she turned to me and kicked my leg in the treatment room.

“We’re going to the beach house this weekend, and you have an invite, Minerva. Everyone will be there. Just make sure you’re packed and ready,” I told Minerva to calm her down so she wouldn’t kick my leg anymore and we wouldn’t get in trouble with the staff in the program.

~

“How did you two meet?” My therapist inquired.

“In partial hospital…”

I elaborated at length.

I met Minerva in the Partial Hospital program after my discharge in 2008. I’ve known her for over 11 years, just about a third of my age now, 33. When I met Minerva, she had recently been in the hospital for a long time and was still hypomanic. Back then, Minerva was younger, hopeful, and supposedly ready to recover after a decade of ups, downs, manic extremes, and depressive lows. If it was an altered mental health state, Minerva had experienced it. In fact, she was passing through over the better half of the last two decades of experiencing severe bipolar disorder.

We bonded over mental health stories, mostly our own, and would meet for coffee during our stint in partial hospital.

When I attended graduate school for social work a few years into my recovery, we lost touch for a bit. After all, I was three hours away in a rigorous graduate program trying to stay afloat given the extreme nature of my illness and being new to recovery and healing from my own mental health diagnosis.

After returning home with my Master’s in Social Work (MSW), and becoming a licensed master (then clinical) social worker, I entered the system of care in my community on the other side as a clinician with my own psychotherapy practice. Given I was ramping up again, this time with employment and working, I didn’t have as much time for weekly coffee visits with anyone, Minerva included.

Venturing out into my own community where I had been hospitalized several times in the past and even had therapists of my own, I would run into people who treated my illness during the earlier days of my recovery. I also stumbled upon old faces, people like Minerva, and others, who I knew from treatment from when I was discharged from years ago. Now on the other side, it was rather awkward, especially in the case of Minerva.

I say this because when I reengaged with Minerva she was in the same spot as she was 11 years ago. Maybe even worse off. I am judging this by her level of care. Also, by the sheer amount of time that elapsed with little or no gains made in terms of insight into her illness or judgment when it came to repeated relapses without gaining additional perspective on her condition. Minerva was now in a Continuing Day program called PROs, which was on the campus we met at 11 years ago, just in a different building.

I couldn’t fathom going to the same small mental health campus for over a decade, and not benefiting from it whatsoever. During the last 11 years, Minerva had crashed another two cars during additional manic episodes and gone off her meds two more times without doctor supervision. When I found Minerva this last time, she was washing her laundry at the local halfway house, which was connected to the agency that subsidizes her supported housing program.

Eleven years and no progress, I thought to myself. This can’t be the case. I mean, it must take real work to stay in a holding pattern in life for so long without budging. Either that or she must be very sick or symptomatic most of the time. I would later find out that cases like Minerva exist everywhere, and she is no more unique than her biography is to other people with a mental health disorder who share their story.

“We meet for coffee every so often at the diner…” I said to my therapist, finalizing my thought.

faceless woman with pill in teeth and nose piercing

Reflections on Mental Health treatment: Recommendations for reform

There are general themes that circulate in the mental health world. Mainstream mental health seems to reflect the sentiment the patient comes to the mental health system broken. If this is the case, people need to rely on nurses and counselors for a sense of wholeness to heal and recover.

The work of doctors and social workers is invaluable. I question, however, that any healing or restoration of ‘the self’ is done without patient participation. What doctors do to accommodate humanity is essential. However, proper communication must be emphasized by treatment team staff and to patients by providers. Good communication relies on humility, too; often, doctors have a sense of superiority, eliminating the essence of humanity in care.

Psychiatry should consider that having problems is ‘ok’. Understanding people do not need to be fixed by medical staff should be another consideration for psychiatric training. Since human life and recovery are a puzzle, a sense of “complete” or “finished” is ongoing.
Since a doctor or counselor cannot restore a sense of wholeness fully, it is crucial to consider an inventory of factors before making a diagnosis or determination. Notably, the right balance of system intervention and self-determination is possible but takes time.

Faith in doctors and belief in one’s self are necessary. The ultimate balance relies on the individual.

Doctors continually prescribe different levels of restriction within a treatment, depending on the status of a patient and their behaviors/needs. In any case, maintaining humane treatment must be a necessity. Exclusion from a quality and unrestrictive treatment needs to hinge on more than perceived disobedience from a doctor. What is disobedience? Afterall?

Understand that there can be meaningful motives in rebellion. From my own experience as a hospital patient, doctors responding to noncompliance rather than reacting did a world of good.
I have overreacted in the past to psychiatric workers.

My overreactions were to behaviors I considered threatening. The threatening behaviors were from staff and based on patient/doctor relations. Yet, rather than looking into these origins, most teams suppressed or punished me. Instead of simply explaining why treatment was set up and operated the way it was and how the clinical process works. If they had spent just a little bit of time explaining all of this to me on a more humane level, I might not have been labeled as ‘noncompliant.’
Noncompliance carries with it certain connotations, mostly pejorative. When a patient is ‘noncompliant,’ it is essential to distinguish between the symptoms and allow for space and freedom to express their needs.

Making this distinction can make the difference enough to create a good outcome and a thriving individual. Inserting this freedom can also allow for the pathway to more voluntary treatment and reinforce ‘adherence’ over forced ‘compliance’ in care.

Reflections on ‘Peerness’, Social Work and Supported Housing

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Lack of caring can create unthinkable tragedy

Throughout my life, I have done and said things that I regret.

From self-inflicted injuries to other people, I find it problematic to count all the regrets I have had throughout my life.

I feel accountable for each of these regrets, which have deeply hurt the people I care for in my life.

I think of my days growing up filled with joy and how they contrast to the stark worlds I encountered in later adolescence to adult years.

The inner world of jubilation and joy I once experienced as a kid lifted as I approached my teenage years and made life more complicated. I felt utterly lost as I left a life of innocence to a dark cloud. Spontaneity and freedom of life were no longer present as early as 16 years old.

Now at 39, I have more than half of my life to look back on.

Best described as bipolar or schizoaffective illness, which has been a significant player in the changes I experienced throughout my life. Other factors are rooted in abuse issues from peers or lack of recognition for counseling or additional support.

In any case, is it a return of an earlier version of myself that I need? Or is it perhaps something at a higher level- the love of others and a higher spiritual level that I could connect to more fully?

However, the placement of extreme moods in my daily life has made it difficult to arrive at this peace of mind. Additionally, the interaction of these moods with medicine and mental health practitioners complicates my level of functioning.

Therefore, the importance of counseling and mental health to help others emotionally must be made clear to those who need the help. To make statements like “pick up your bootstraps” or ‘be strong’ is simply the wrong approach. If mood and behavior issues are present, it is essential to address the problem, not exacerbate using inappropriate language.

In my case, I spent well over five years in my childhood suffering in silence before being able to talk to a mental health professional about my thoughts and feelings. I had no idea what it meant for me to be experiencing what I was.

The trauma of these unaddressed concerns left me in the wrong position the second half of high school. The effect of my unaddressed needs as an adolescent was to leave me hospitalized repeatedly and in an unconscious state at 25.

So, yes, I feel bad for the wrongs which I have committed. However, I think it’s fair to say that most of this did not need to happen. The biggest culprit is untreated mental illness. It is the delay in treatment that had the worst effect on events, even years later. Also, this is true for countless others.

When treatment is stigmatized and the reality of severe mental illness is not recognized, there will continue to be instances of heartache and preventable tragedy.

A loved one’s heartaches need to be listened to by people who care. Lack of caring can create unthinkable tragedy.

time lapse photography of cars on road during night time

The relationship between “Inner work” and Symptom Management

Why have things happened the way they have in my life? The mental health diagnoses I was labeled with during the course of treatment created major havoc in my life.

First, medication has played a major part in regulating my mood and thoughts over large spans of time. To regulate my mood even further, more inner work needs to be done. Understanding inner conflicts in my psyche opened up opportunities for me to experience a higher quality of life during the past year.


The resolution of inner conflicts has a direct impact on how my life has unfolded. There have been times I could have been labeled as “manic” or “agitated” improperly and without real justification. These are just temperaments, though. They were rooted in temporary issues and were partly due to uncomfortable living conditions.

I think that mental health service providers have a lot to gain from having empathy towards the living conditions of patients…


Therapists and psychiatrists should not judge a person’s behaviors. Judging only interferes with the person needing help does not get the right help, and defers progress towards stability. I often know people cannot speak up for themselves or themselves in the midst of a crisis.


It is a tough question of how much responsibility is owed to the patient or consumer and how much is owed to the doctor or social worker. This is tough territory to navigate, and I think requires some compromise between individuals.


Influencing personal development with an encouraging attitude. Treatment providers often help prevent major crises or issues flaring up further.

One thing is for sure, patients surrounded by demeaning and discouraging counselors will see less positive developments than those who is surrounded by encouraging counselors…I have seen this myself personally to be true during the course of my treatment when observing other people in similar care.

Some people diagnosed with mental illness are, despite what some people think, autonomous Autonomy is a learned behavior. As a result, psychiatrists, nurses, and social workers can positively or adversely affect the course of someone’s treatment purely by their attitudes.

Ultimately, I think it is important to find a healthy balance between symptom management and person-centered treatment.

The reality of any given case is always broader than what it first appears.

Discretion on an individual basis is critical when it comes to making prudent choices during the course of managing the self or others.

I suppose, in the end, the question of why life turned out the way it did for someone can never fully be answered in hindsight.

The ‘Point’ Person: Care-Coordination

For people with severe chronic and unpredictable symptoms stemming from a mental health condition having a reliable, trustworthy, and rational person is critical.

A point person can be anyone on your treatment team. That is to say. A point person can be your therapist, friend, family member, psychiatrist, or case manager.

It doesn’t matter which role they are assigned to on your team. Good leaders aren’t dependent on them being clinical savvy or carrying out complex case management. Instead, good leaders take on responsibility, own their mistakes, reap the benefits of reflecting on learning moments, and are passionate in their approach to the helping process.

My first clinical supervisor would remind me of these ethical and without question moral underpinnings of providing therapy or other services in mental health treatment settings. Indeed, my supervisor’s ethical and moral questions became even more frequent when I would allow other clinicians to take the lead in certain cases instead of taking on the leadership role myself.

Many clinicians, friends, supports, and allies of people with a mental health diagnosis don’t want to either be responsible if their loved one’s or patients’ condition worsens.

These brave and compassionate clinicians often absorb the blame of their colleagues and lose face or damage to their reputation when perfectly plausible interventions fail or were ineffective in impacting or providing relief to a patient’s symptoms, seemingly increasingly resistant to treatment.

That’s why so many people in the helping profession, psychologists, psychiatrists, friends, and family, sometimes take a step back and put distance between themselves and the person in crisis who would benefit from that sort of attention in the provision of their own treatment.

When people need a lot of care, either from stepping down to a lower level of care or discharge from a programme or inpatient facility, people in these circumstances require extra help. This is always the case. Whether it’s because people are adjusting to fewer supports or experience a reduction in the frequency and intensity of psychotherapy or pharmacological therapy, people in this position must find a way to compensate for the fall off and titration down of their mental health treatment.

Also, since adjustments themselves can exacerbate symptoms, patients recovering from a mental health disorder are likely to be surprised, blindsided at times, and always in suspense of other new or similar problems ahead while transitioning to a new level of care and step down in support. Which, in some cases, depending on how difficult or compromised their situation is, can be enough to trigger, invoke anxiety, and other more serious symptoms to reactivate.

Leaders, and natural point people, must sometimes make ethical and value-based decisions for their loved one or patient. These are decisions, which, at times, impact the care and provision of their loved one or patient’s treatment.

Patients need to believe in their therapists to help them make the right decision – there are undeniably times when people with certain mental health diagnoses experience symptoms that interfere with good decision making, and in many cases, are appointed lawyers and health proxy, in advance of losing the capacity to make the right treatment decisions for their ongoing care.

A point person may need to step in with a case like this or take the lead in these emotionally difficult situations for loved ones. With this said, when treatment takes a problematic direction, the point person becomes even more important. This happens in the tragic event treatment ‘fails’, and a more restrictive treatment fit needs to be put in place for their patients or family member’s safety.

For mental health patients in particular, who are likely to have wrap-around services, live-in treatment homes in the community, and in a supervised living situation, many patients with severe conditions live out their lives in these adult homes.

Since these adult homes are little more than a freestanding and self-sufficient ward scattered and dispersed in the community, we shouldn’t forget when thinking about a patient’s clinical picture, including a deep understanding of the patients living situation.

This should always incorporate the general housing arrangements to get a complete picture and direct treatment moving forward. Thus, being a leader means knowing the immediate mental status of their patients and, in clear terms, how stable the patient is in the larger clinical picture to ensure the health of their patients continues to prevail over their symptoms.

SNL’s ‘LOCO’ Speaks a Truth about ‘Displays’ rooted in Mental Illness

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This writer’s brief tenure in mental health brought with it the opportunity to observe the most obscene, ornate, loud, and grandest ‘displays’ from clients and colleagues. 

Center-staging is not just about the magnitude, energy, and investment in thought gone through by patients to create a figurative and literal circus around them. Instead, both worker and client’s seductive pull and mystique experienced enacting these outrageous behaviors—rooted in creating one giant emotional and behavioral maelstrom. 

Center-staging can create countertransference for workers and peers in the mental health field who find themselves trapped in their client’s very life. This shift in the power dynamic becomes a remarkable turn of fate for everyone involved. This turn brings with it irony and inserts it deep into the relationship and work process. When the worker finds him or herself front and center in the life of the client. Becoming the object of their desire and madness, emotions and even feelings of safety become subsumed into the client’s new playground.  

This writer recalls one client who moved into an adult home. After living independently for her entire adult life, our ACT (Assertive Community Treatment team) serving team signed off on the client’s constant requests to reduce her living standard and give up her independence. All of a sudden, the client’s mental status was in free-fall. 

She began persevering over her ongoing capacity to perform even the most basic ADLs and maintain livable conditions in her apartment within the adult home already partially supported by the staff.  It was as if our client relinquished all ability to function within her new environment with even fewer responsibilities than before and zero added stress. 

At this point, our team was scrambling to figure out how someone could have decompensated so quickly and lost all hope to reconstitute in the process? As our team answered these questions, we realized our staff within the seductive energy of diagnosed ‘borderline’ and ‘histrionic’ patients in a full-blown crisis.

Discovering ourselves center-stage in our client’s life, almost working harder at introspection and self-reflection, is a dark and dangerous place. The countertransference can and will build slowly, then faster and faster as the energy implodes all within its reach. This particular ACT client was having trouble living independently in the community and stated she wanted to move into an adult home to receive round-the-clock care, e.g., help toileting, meal preparation, transportation to doctor visits in the surrounding community. The house also had an in-house case manager assigned to each of the residents. 

The impulse of the borderline patient who has histrionic traits to self-sabotage goes deep. It can be too confusing for the patient experiencing the symptom and even more beguiling, profoundly a-motivational for someone with a long history of loss and relapse. For a borderline patient now ready to lose all control for “one last” opportunity for attention, sympathy, and guilt, watch out and be prepared. 

This patient decided our team was not helping her because we let “this” happen. The fall-out of weeks of bad decisions and maladaptive reasoning put into action. The next week we visited, we learned the patient had admitted herself to the local ER and threw her body, lunging at a medication tray to collapse on the floor. The ER staff, all too familiar with this behavior, discharged the patient back to her adult home hours later. 

Patients with PTSD diagnoses who are also chronically homeless are also tricky clinically to treat. These folks become very symptomatic, lose everything repeatedly, and then experience a spike in their PTSD symptoms from the re-traumatization. For a person treating the displays and emotional outbursts, it can be tough to separate the extreme nature of some client’s self-destruction during a break, episode, or short lousy turn in their path to recovery. 

Some clients can be very, very loud and agitated, that it becomes dangerous to be close to both parties and may become a physical risk to everyone involved. The potential legal risk if one party needs to press charges on the person who lost behavioral control. To tease out when this is the case, or when just supportive listening and maintaining an open stance in engagement is the most beneficial in creating the best outcome for the patient in treatment.

So, in these cases, what works? How does a therapist treat chaos and inconsolable behavior? 

The trick is…well, there is no one specific clinical therapy per se but rather the application of trauma-centered skills and techniques applied with clinical precision. In cases like these, listening, some re-direction, and disputing irrational cognitive distortions as they surface in the dialogue is the best a person will do unless unlocking the mystery of a puzzle with no clear answer. 

Rolling with the resistance as best as possible, without accumulating too much countertransference, will go a long way in the patient feels heard and listened to when they were in crisis. Since there is no solution for solving, try to be less problem-focused. Shift the thinking from reparative to creative and less crisis-driven work. 

Since the issues are far too deep and too complicated, there is no long-term solution aside from being overly reactive and triggering the client to feel out-of-control. Hopefully, the clinician feels in control of the situation because clients can sense and are in touch with clinicians, afraid of their clients and feeling like they have lost control of the intervention. Modeling self-control and providing some verbal self-assurance may be required at the moment.

Mental Health Affairs 2022

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