homophobia · Mental Health Stigma Suicide

To the white Hetero’s,

Our neighbor put up Trump flags. Our neighbors behind us clearly are also supporters they just don’t have the flags up. Our neighbors to our left are on the Blue team. Our neighbors to our right have never spoken to us…so assuming they are on the Red team. We’ve literally waved, run over to greet them, and our kids have tried engaging them, and nada. So we are assuming it’s homophobia and conservatism.

I’ve had to start turning away referrals lately because I’m booked; specifically teenage and kid referrals. I like to keep them at half or less of my caseload as they are more labor intensive (aka their parents are more labor intensive), and I’m finding the younger kids struggle with the telehealth. I also would rather invest my time and energy into the Queer folk.

I never want to have to turn away a Queer referral, so I have to turn away the hetero’s to keep some space.

Some people get salty. I get it. They want what they want, they’ve often been referred to me by some one they know, and have heard from some one that I know what I’m doing. All good things. But I have to set my own boundaries as a practitioner. I won’t be a good practitioner if I take on too many clients who require too much of my time and energy. New teens always require a lot of my time and energy. I need to reserve it for the Queer people.

I know that being very up front about who I’m reserving my time and emotional space for, especially when they don’t fit that criteria, rubs some people the wrong way. It rubs practitioners who want me to take referrals and patients the wrong way. Especially when they are white and straight.

I say this with love. Because I used to be white and straight. I get it.

What I’ve learned is that if a practitioner has basic training and skills they can treat any one who is white and straight. I’ve also learned that it takes more training, more empathy, and more skills to treat niche and minority populations. I reserve my time for Queer people because I know they are mistreated by the general medical and psychiatric community. I know this because I am a Queer person who has been mistreated and discriminated against by the general medical and psychiatric community in my area.

Some one asked me recently if I treat any #45 supporters. I responded that to my knowledge only 1 out of 500. They didn’t really believe me. I said it used to be more before I made clear my priorities to myself.

Let’s talk statistics.

Queers have up to 6-8 times more likelihood of committing suicide. I can cite about a dozen studies. Gay men have 3 times higher risk of suicide. Trans individuals up to 8 times higher liklihood of suicide attempts and completed suicide.

Gays, lesbians, and trans folk have 3-6 times higher rates of depression than the general heterosexual population. Again this is in multiple studies. I have a bibliography from a presentation I have on Queer mental health that I am happy to provide.

13 states do not recognize crimes perpetrated against the LGBTQ population as hate crimes and they all have actively voted down legislation to say otherwise.

5 states have “Don’t say gay” education laws and policies

2 states do not allow changing your gender on your birth certificate. Period.

About 50% of the LGBTQ population is protected by current laws. Meaning 50% of the Queer population have NO legal protections related to discrimination.

Make no mistake the Queer population faces violence, murders, rape, and many other overt and covert aggressions on a daily basis no matter where we are located geographically.

So when I say I keep room open for my Queer folk this is why. Because we are put down, we are killed for being who we are. Why would I not prioritize the mental healthcare of my own minority status community?

Knowing three out of my four neighbors support our current administration makes me feel unsafe and unsupported. Every Queer person living with a Red flag next door is feeling unsafe and unsupported. My Queer clients are cutting off family members or being cut off by family members during this election year. My Queer clients are cutting themselves with self loathing and abusing substances at higher rates, and are homeless at higher rates than their heterosexual peers.

I shouldn’t have to justify prioritizing a minority population that is suffering. But I find myself doing just that.

Recognize your privilege and stop. Stop and think. Do you need specialized care? Are you a minority? Do you have minority stress on top of baseline mental health issues?

I’m not trying to minimize the plight of the white heterosexual who suffers from mental illness. I’m pointing out that your needs may be met at any number of practices and with any number of practitioners. If you try to insist on seeing a practitioner who specializes in any minority when they have explicitly said no, just stop. Ask for referrals to other providers. Recognize that you do not need a specialty provider.

If this makes you uncomfortable it’s because you have not examined your privilege and are guilty of acting out with entitlement.

I’d suggest you examine your privilege and stop acting out of entitlement.

Mental Health Stigma Suicide

(Non-Pandemic Post) Racism in Mental HealthCare.

This has been digging at me for awhile. I collaborate with several therapists and prescribers of African American (also Jamaican and Haitian) descent.

There is one in particular who practices close to where I am located, and who is simply phenomenal. I refer practically everyone to her. She’s seasoned, she doesn’t get phased by high acuity, and she can take on complex families and cases, and she is always open to collaborate.

I’ve had more than one client come back to me after a couple sessions with her (often white parents of a white kid) who ask for another referral as they “don’t feel it’s the right fit.”

You can imagine my facial expression right now. It’s the one that smells and calls out bullshit.

I always pry to the Nth degree…exactly what is not the right fit? Yeah but exactly what didn’t go well for you/your child…I need to know precisely the issue because I don’t want the same issue to happen with the next person I refer you to. They usually smile because people tend to smile when they get uncomfortable. They squirm in their chairs, and make super vague statements about what went wrong.

I push until it is awkward to push any further.

I’ve then spoken to the therapist and we hash it out. We are comfortable enough with one another that she can say if she feels it is related to race or not and I agree or disagree. Most often I agree.

There was one case that the family just didn’t want to do therapy work. It was almost palpable relief to us both in that dialogue that there was one white family who wasn’t racist, just lazy. We laughed about it.

As I said, she is seasoned. I value her input and I value her clinical opinion. I don’t think I can put into words the enormous respect I have for her clinically. It’s hard to find good therapists. Especially forty years into a career when they can be burned out or a little crazy and not as invested in their clients. But she invests everything in her clients. I definitely have a top ten therapist list of who I would refer my own family members to. She’s on there. Probably at the very top.

To hear her question herself and her skills because of ignorant people who discontinue treatment abruptly because they are racist creates this anger and hurt that again is hard to put into words.

I’ve read “Me & White Supremacy” by Layla F Saad which helped me explore my own internalized racism and white privilege because I have Black clients who have made me do better and be better. Hearing experiences of African American women who have been abused and marginalized and ignored creates a space that cannot be ignored by any white person I would hope.

I’ve fired a client after they fired that therapist. One client admitted to me it was because of race. One client admitted to me it was because they didn’t feel they could benefit from treatment from a Black woman. I told them they likely then couldn’t benefit from treatment with a lesbian. So I’d provide them a referral and they could leave.

No one else has ever admitted to me that it was due to race. Though I have asked outright. I told her recently that I fired that person and she remembered them even though it was a few years ago. I didn’t tell her at the time. I didn’t know if it was right or wrong or what.

The older and more experience I gain the less tolerance I have for racism, hate, homophobia, bullshit.

It eats at me that a skilled clinician questions their skills because white people are ignorant.

I can’t apologize for other’s behaviors but I can ask white people to do better. Check your privilege at the door because there are plenty of brilliant Women of African American Descent who know so much more than you and who can support you and just do their jobs as clinicians. Skin color should not qualify a person to be or not be your therapist. That’s ridiculous.

I’ve lost clients because I’m out about being Queer. But I don’t wear it on my skin. I have it easier.

To all the clinicians of minority status whom I work with please know I’m challenging clients in my office. I’m not letting it go if they discontinue treatment abruptly and if they admit to discontinuing treatment due to the color of your skin I’m discharging them from care.

And Dear white people. Do Better.

Mental Health Stigma Suicide

The Broken Hearts of Nurses

Sometimes when I write my patient notes I actually have to pause in between them. On busy days when I do three intakes I likely still have three intake notes to finish late at night after the boys go to bed and it’s just me and the laptop. Intakes can range from easy to me curled up in a ball on my bed watching The Office trying to forget the horror I heard today.

I remember working in the emergency department and documenting abuse cases. I tried to write as little as possible, as I didn’t want there to be any conflictual information between my notes and the MD’s notes. And good lord I didn’t want to be subpoena’d.

I’ve had my charts subpoena’d now. It happens eventually in healthcare. I’ve been called on the phone by judges who just found my chart in the middle of a trial who demand to speak with me about a patient I saw four years ago and asking about a note I wrote and did I think they would actually harm some one.

I’ve spoken to district attorneys and defense attorneys and divorce attorneys and DCF workers. Inpatient I spoke with the Secret Service, the Federal Marshal’s Office, the FBI, and several police departments.

Working outpatient mental health now I generally can avoid the Secret Service and the FBI so that’s a plus.

But sometimes the hardest cases and the toughest stories are the ones who never were reported to law enforcement. Because I know and they know that they suffered and that no one stepped up and protected them. No one made the call for them.

Now here they are all those years later telling me their story. All I can do is listen, document it, and support them now in that moment. I’ve learned a hollow “I’m sorry” doesn’t cut it. They’ve heard that before.

My general response is a poker expression, so they keep talking, and/or if they are looking for some verbal confirmation that I’m listening, “That’s fucked up.” or “That’s horrible.” I’m sorry isn’t enough. But when you acknowledge that it was fucked up with a straight face that looks like maybe you would fuck a person up for this client for what they’ve been through. That had I been there all those years ago I would have called the police for you or DCF or both…that’s when they make eye contact and really see you.

They can really see that your heart breaks for them.

I always see articles about nursing being the most trusted profession. Then commentary on why it’s nurses and not MDs. I’m always thinking why would it be MDs? Why not nurses? Do people even know what nurses do every day?

I’ve had a long week. Hard week. I’m also approaching my first birthday without my Dad. That’s been weighing on me in the background.

But this week in between being yelled at, threatened, etc. by patients and former patients, I’ve had parents call and tell me “They wanted to fire you and I told them oh hell no because she’s the only one who gives a shit about you and your medications. She’s the only one that’s done a damn thing for you. So she was what? Brutally brutally honest with you?! Good. You freaking deserve to hear the truth and she’s too real to not tell it you. They are coming back to see you. Because I don’t trust any one else to see them.”

Some times I need to hear that.

There’s a Frasier episode when he starts private practice. His first day of course is a disaster. He starts by trying to welcome’s each client. By the end he says just come in a sit down. That’s how I felt by 3 PM Friday. Just get in here and sit down and let’s get through this.

But you can’t do that. I can’t do that. I had to be there. Present and accounted for. I did a lot of intakes this week. I kept thinking about how to welcome them into my practice. I find though that I’m an acquired taste.

I had a few clients disagree with me this week. What’s great is that they keep coming back. I teach through modeling that it’s okay to disagree. That I disagree without judging their opinion. That we can disagree about certain aspects to their diagnosis or treatment and still work together often by reaching a compromise and often by me working hard to understand and validate their point of view.

Psychiatry is hard. Nursing is hard. Because at the end of a week like this week I don’t want to spend time with my kids. I don’t want to be a wife. I want to curl up and watch The Office. Space out. Forget and not feel. But if I do that. If I numb out I don’t feel my heart aching for some of my clients. That would defeat the reason I became a nurse.

Instead of numbing out with tv or alcohol or anything else. I am writing my notes. Charting. In between my notes I’m writing this blog post. To feel. To process. To know it’s okay for my eyes to well up when I think of the experiences some people have lived through. It’s okay for me to feel something for my work for my people. Because if I didn’t feel that. If I lost my empathy then I’d be useless at my job.

That’s why nursing is the most trusted profession. We allow ourselves to be vulnerable with patients. We feel their pain we work ourselves to exhaustion trying to help people. It’s also why we have incredibly high burnout rates but…that’s a different blogpost.

Tonight my heart aches for people who were never helped by anyone but themselves.

Tonight my cheeks may be wet with tears as I chart notes from this week.

Yes tonight my heart breaks with the pain that I bear witness to each day in my office.

I don’t regret my job I don’t even hate it. I love it. Which I suppose makes me a bit of a masochist. But all the notes don’t make me cry. Just a few. There are many more that report “significant improvement in symptoms” and a call from a parent who had to tell me they would never trust anyone else with their child.

Mental Health Stigma Suicide

Therapy for the Therapist

I did a couple years of therapy when I was getting my master’s in psychiatry. It was helpful. Then I felt rather done with it. My therapist agreed. We had done a lot of work and covered a lot of ground and I was much better after I graduated and started working in mental health and out of the emergency department.

I’m generally quite open with my own clients about my therapy experience- not the actual content- but the process; especially when trying to talk people into therapy who are reluctant. Essentially I relate that I found it helpful,  that it can be time limited, and it’s important to find some one you vibe with and it may take a few tries to find that “right fit”. My first therapist was nuts- I didn’t see her for very long.

My second one was awesome. I actually sent him a birth announcement when I had the boys with a little note thanking him for all the work we did together as I felt I would not have made it through the fertility treatments without having gone into it in the best mental state of my life.

After my Dad died last April and I was coping with significant stressors at work I started feeling like I didn’t get to grieve my Dad. I also felt like I was becoming generally more depressed and less motivated. I knew the cause was the death of my Dad and generally watching his decline over the last two years.

I also knew it was time for me to go back to therapy. The issue became finding a therapist who could see some one in a Queer marriage, because trust me heterosexual therapists just are not the same. I say that with love for all the straight therapists out there. It’s just easier for me to talk to some one who is Queer because they get it.

So Queer competent at the least and some one I didn’t share a ton of patient’s with and who takes my insurance and who could accommodate my schedule. Yeah. That task was daunting to me. I talked to a couple of my therapist friends and got some recommendations. Waited a few months. Talked to them again. Got different recommendations.

Then made the call. It’s always good for me to do something like this because it makes me appreciate how nervous clients must be when they are calling me for an intake. I went to the intake, and am super happy with my decision to go back to therapy.

I forgot how nice it is to have a space to break down. I needed to break down. I needed to grieve and discuss my grief with a neutral third party. It’s been incredibly validating and empowering. I also needed to talk to some one who didn’t know my Dad so I could tell stories about him and describe him in detail.

After three or four sessions I felt great. I was thinking, I think I’m done with therapy. Then the non-crazy side of my brain was like, uh no. You don’t fix two years of watching your Dad decline and die after four sessions. We were just scratching the surface.

I also knew of my own clients who felt like they were “done” with therapy, who really weren’t, and who needed to go out and suffer and realize they weren’t done and call a month later for an appointment.

I’ve been open with my family and friends about going back to therapy as I work in mental health and want to #stopthestigma.

I’m not crazy. I was mildly dysregulated due to unresolved and unprocessed grief. I’m working on it. I told my therapist about my impulse to stop coming when I felt so much better and then the reality check I gave myself about it. He laughed and agreed that it’s a thing. People feel better initially and drop out of treatment too early before getting to the real issues.

He also agreed I don’t need to be in therapy forever. But likely a 3-6 more months is realistic. For an hour a week I get to take up space in a way that allows me to be vulnerable and process the death of my Dad. It’s important that I do this work. Unresolved grief can lead to many other sequelae none of which I want to experience.

I also feel it’s important that I practice what I preach. If I’m struggling I need to recognize that and seek treatment. I tell clients every day that they need therapy. I also always say it’s not going to be life long but it takes time to work through complex emotional issues.

I’m giving myself that time. I’m making myself and my feelings a priority.

At the intake he asked me what was the tipping point that made me schedule an appointment. I told him that I now have two extended family members who committed suicide. One was a teenager several years ago, and one was a grown adult earlier this year. Both very different scenarios and both highly functional people one with a bright future snuffed out too soon, and one with a very successful career and family.

I told him that I have been touched by suicide. That I don’t feel suicidal or depressed to that degree at all, but that if I didn’t intervene for my emotional health now I didn’t want to wait until I was at the point of either of these relatives. I’ve seen the worst possible outcomes of untreated mental illness in my own extended family. I don’t want that to be me. I don’t want that to be anyone else in my family or among my clients so I have to walk the walk and not just talk the talk.

I didn’t say it quite that cogently in fact I said it through tears because I feel a deep pain for these family members who took their own lives.

I am a mental health professional and I am in therapy for the second time in my life. I am working out grief related to the loss of my Dad.

I hope any one struggling with mental illness in any way shape or form has the strength and ability to reach out for help when you need it. I hope no one else I know ever commits suicide again. I hope for a future without stigma for my clients and for myself.

I hope if you’re reading this you feel empowered to reach out for the help you need.

National Suicide Hotline: 1-800-273-8255

 

Mental Health Stigma Suicide

“That could have been me,” One teenager’s response to suicide.

I see a lot of teenagers in my practice. I actually really enjoy working with teenagers. I often have parents in the room for most of the visit because it helps me see the family dynamic for one, and two I want parents to know how their kids are actually doing.

I want them to hear how their child is still struggling or not because they need to know. I am often surprised at the number of parents who I have to practically glue to the chair to get them to stay in my office. They seem skittish when we talk about depression and suicidal ideation. They will often ask to leave or if we can talk separately or not talk at all about suicide.

If there was an attempt in the past I can’t tell you the number of times I’ve been told that we need to discuss it without the kid in the room. I always respond with, “Well if they want to leave that’s fine, but they were there, so I’m pretty sure they are actually the best person to ask about it.” I’ve never had a kid leave. I’ve never had a kid not tell me what happened.

What’s fascinating about this interaction is that if I ignore the parent the child does too, and we continue to talk about their current and past mental health status. If a kid asks to talk to me alone or declines to answer something I always respect that. But over and over I see kids decline to have their parent leave and then talk openly about their depression and suicidal ideation.

Kids want their parents to know. I want their parents to know. Why do parents not want to know? It’s so rare for us to be let into the world of our teenagers- because they have their own world- so why would you run from that opportunity to be let in?

Don’t run. Sit your butt in that chair.

Recently it was one such moment. I was checking in with a kid I knew had been affected by the death of a classmate. The parents were sitting there after I ignored their questions about leaving. The teen and I kept eye contact and they said, “This may sound weird, but I just keep thinking, that could have been me.” 

I nodded my head, and said yes I can see that you’d have a lot in common. Both are/were very successful, hard working, and both wear/wore facades so bright that no one would think they are depressed and struggling to live.

It’s important to keep eye contact in that moment. To let them know I can handle them. I can handle the darkness of that thought. I see them. Eventually we moved on in the conversation and I looked at the parents.

They both had silent tears streaming down their faces.

That’s why I make them stay. They needed to hear that. They needed to know how badly their child struggles with the day to day that they identify more with a child who committed suicide than with anyone else.

I wasn’t going to write this post. But it’s been bouncing around my head since that visit. That very clear and distinct voice, “That could have been me.” The insight and wisdom of that one little statement said so meekly and with such fear. The way it tore through me and their parents.

I hugged my sons a little tighter that night. I maybe cried a little harder than I should have at Frozen 2 because I was thinking of all the teenagers who reach a point of wanting to die.

In 2017 suicide was the second leading cause of death in kids ages 15-24. Specifically ages 14-19 there was a 47% increase in suicide from 2000 to 2017 (Harvard study published in June JAMA).

I grew up in that space where kids are dying. Because this last wasn’t the first suicide in my hometown. When I was in high school 1999-2003…yes that means I’m 34…it wasn’t exactly an accepting culture. It’s been 16 years. I sorta hoped it changed in that time. But I don’t think it has based on what I see in my private practice.

Kids are still bullied. There are still mean girls. Athletes are still allowed to get away with more than non-athletes. I’m hoping there aren’t any teachers still having sex with students, but who knows.  

I don’t know what the answer is. But it’s not a coincidence that I opened a mental health practice and am known for taking teenagers just a few exits down.

I see all kinds. The weird artsy quiet ones. The high achieving three sport scholar athlete. The bullied. The bullies. They all struggle with their own demons.

We’ve lost so many children to mental illness. We will lose many more if there are not kids who are willing and brave enough to ask for help. To speak their truths.

We will lose many more if there are not adults and parents willing to listen and willing to start the conversation. Even if it hurts. Even if it feels uncomfortable and awkward. Because if you walk out of the office, you will miss that moment when they choose to let you in. And that moment can lead to more moments. Those moments can be the difference between life and death.

 

***** This is in no way meant to take the place of actual mental health advice/treatment from a licensed provider.

***** This is in no way meant to detract or cause pain to families who have lost their child to suicide. Even with treatment. Even with open conversations and a loving open supportive family there is still a mortality rate to mental illness.

Suicide Hotline: 1-800-273-8255

Translifeline: 1-877-565-8860