#COVID-19 · homophobia · Mental Health Stigma Suicide · Nursing

Ten Things I’ve Learned as a Mental Health Provider During COVID-19

  1. People can only handle stress for just so long. When I explain chronic anxiety and depression to patients I often use the analogy of a teapot. When you are walking around filled up with stress/anxiety/trauma/depression for years eventually you do not have room for normal every day stressors. This leads to epic breakdowns over seemingly innocuous things. Did you ever cry when you couldn’t open a jar of sauce? Or start screaming when you can’t find your keys? We all have a boiling over point. February 2021, about eleven months in, seemed to be most peoples boiling point. In the Northeast we had a lot of snowstorms which I think compounded things for many of us. My practice received upwards of ten-fifteen calls a day just from new referrals, not counting our five hundred plus current patients who also all started to melt. These calls were desperate. Crying into voicemails. There were suicides in our communities. There were drug overdoses and relapses. February 2021 honestly was one of my hardest months as a mental health provider.
  2. Women bear the brunt of childcare and homeschooling responsibilities. This is a gross generalization. Please note I know that there are many wonderful Fathers and husbands who have supported their families during the pandemic in every way imaginable. But in my own practice I have seen my female clients taking responsibility for the organizing of homeschooling. They have described screaming matches with their partners about who has to sacrifice work time. I’ve had women clients leave their full time jobs, drop to part-time, and/or change positions in order to accommodate their children suddenly being home full or part time. I have seen women making sacrifices and publicly smiling but privately falling apart with grief, anger, and sadness.
  3. Minorities are under more minority stress. From the LGBTQ community to POC to children to the elderly. All vulnerable populations have been made more vulnerable. The death rates of COVID-19 are disproportionately higher in the African American communities. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/disparities-deaths.html Does a nice job of objectively presenting this evidence. The LGBTQ individuals who have lost jobs and been forced to move back in with homophobic and transphobic families are real. LGBTQ children, teenagers, and college aged individuals who have to live with homophobic and transphobic families is real. Suicide risk is high in this population already. The social isolation and inability to be “out” due to COVID-19 has added to these already significant issues for minorities. I literally have had telehealth sessions with a client crouched in a dark closet (and the irony of them being in a closet is not lost on us) in order to obtain privacy in order to cry in despair at not being able to be “out” and to have to experience homophobia and/or transphobia in every day life with their family. These sessions are gut-wrenching.
  4. Postpartum Moms and Dads have stress you can’t understand. I’ve often said the most unsolicited advice I ever received was during my pregnancy and in the first year of my twin boy’s lives. People who have been parents or not have opinions and stories and think everyone should hear them. Being postpartum regularly is hard. Being post partum during a pandemic when so little is known about the impact on newborn health is terrifying. Newborns can’t wear masks. Babies in daycares crawl and touch each other’s boogers. Parents have delayed putting their children in daycare because there is no true protection against exposure for infants. They are told that they are right, wrong, stupid, smart, and everything in between by people around them. I have never treated as many postpartum women as I have in the last year. SO much of it is providing reassurance that they are doing everything right. That there is no one right decision. That they know their baby and their lives best and they have to make the best decision for themselves. I offer validation and objectivity and I have seen them cry when I’ve told them they are doing everything right. Because no one has validated them since they gave birth. Unless you sit with people who have newborns day in and day out and see the agonizing choices they have to make; you don’t understand. And you shouldn’t be offering anything except validation and support.
  5. People NEED people. I’ve also said before I’m not a hugger. But the first time my friend and I hung out after we were both vaccinated and she asked if she could give me a hug and I enthusiastically consented. We weren’t big huggers before COVID-19 but after a year of isolation we unashamedly and laughingly embraced. One of the most poignant sessions in the last year, that has consistently stuck with me, was a young adult who lived alone and who did a Zoom with her family for Thanksgiving. Through tears she said, “I had to do a Zoom with my family. I just. want. to. hug. them.” Her breath hitched with each word and the tears turned to sobs and we sat for several minutes with her sobbing and me watching; neither of us speaking. I held back tears of my own as I wanted to reach through the screen and pat her shoulder and tell her it would all be okay. I heard so many of these stories but her vulnerable and raw pain in that moment touched my core. I had clients tell me their parents cried during their Zoom Christmas’ and they couldn’t stand to see their Mom cry. I sat with them through that pain. I offered nothing but space and understanding to feel pain. I have never known with such certainty after the holiday season of 2020 that we need physical touch to survive. We need our families. We need connection. Of all the long term sequelae that COVID caused, the isolation and desolation of being alone is by far the worst.
  6. Never underestimate the power of pets. I don’t have to explain much about this. If you have animals then you know what I am referencing. The isolation of this past year has made people get new pets and appreciate the ones they have. Pets are some of my clients purpose in getting out of bed every morning. They have truly saved lives this past year just by existing and offering unconditional love. To all our four legged friends, you have my true admiration and thanks.
  7. People who treated their mental illness before COVID faired better. One of my clients who was extremely ill a few years ago, but has since stabilized, greeted me smiling at our six month check in. She was doing great, and felt validated in her own experience of mental illness. “People know now how it feels to live with anxiety. I can now explain to people mental illness and they get it. Because their anxieties about COVID are exactly how I felt about everything all the time.” She wasn’t my only client who had severe mental illness in the past and stabilized with medication and therapy who have done excellent during the pandemic. They had coping skills, we knew what medications work for them, and they were connected to providers. My takeaway from them is to deal with your mental illness before you boil over.
  8. After people boil over Desperation sets in. I think it’s hard for some one to truly understand desperation until they have experienced it. Desperation is finding cuts on your childs arms or legs and bringing them to a hospital and being told they are not sick enough to be admitted and to connect to outpatient care, then calling forty providers and being told no one is accepting patients. Desperation is watching your loved one suffer and struggle and slip away and not be able to find them help. The mental health system’s flaws are fully exposed now. There are not enough providers. The providers that are in practice are un-paneling from insurance because insurers have made the last year so much worse than it needed to be for small practice owners. I have been screamed at on the phone more times than ever in my career when I call to tell people I am full or not accepting their insurance or not taking pediatric referrals. I have been threatened. I have been told through tears that they are desperate. I have been begged and pleaded with. I have been offered twice my normal rate just to fit some one in. I had to not return every phone call because I became fearful of what would be said to me when I told them I was not accepting patients. I had to hold my own boundaries and not take new patients in reaction to other people’s desperation. Because I was becoming burned out. I grew as a clinician and a business owner in the last year in more ways than I ever imagined. I also heard and saw desperation in ways I never imagined I would.
  9. I will always accept Medicaid. So many of my clients have been on and off Medicaid and commercial plans this year. Medicaid’s rates of reimbursement in my state are disgustingly low. But I will always have it as a plan I accept because my patients who lost commercial plans this year with job loss needed to have continuity with their mental health provider. I do not want my practice to be fully medicaid as that’s not sustainable revenue wise for a small practice. However, it will always make up a stream of our revenue because it has to be an option when clients lose jobs.
  10. Everyone has it bad. In the past year I’ve heard why the people in their 50’s and 60’s have it the worst. I have also heard why kids in high school, college, in their twenties, single people, married people, parents and non-parents all have it the worst. Every one thinks their lot is the worst. Young people are missing out on proms, college admission is being delayed in some cases, parents are overly burdened with childcare duties, single people are the most isolated, etc. I’m just throwing this out here; it’s been a shit year for everyone. There have been highs and lows for all ages all social statuses and in every way imaginable everyone has undergone stress, loss, and an understanding that things will never be like before. There is a before and there is a now and there will be an after but life will never be the same.

Through this past year of COVID-19 I have lived history. I am a front lines provider during a global pandemic. I have been through more personally and professionally than I could have imagined. My biggest and best takeaway from this past year though is to be grateful. I am grateful for my children. I am grateful for our health. I am grateful that I have been able to see my mom and sister, sister-in-law and niece, throughout the last year. I have known loss. I have grieved. I have cried. I have hoped.

About a month ago, I went to the office. I saw a long term therapy client for the first time in person for several months. He sat down, and I sat down. We both removed our masks. And we smiled. We were both vaccinated. The window was open. We sat eight feet apart. And then we had a therapy session in person without masks. It was possibly the most beautiful moment of the last twelve months.

#COVID-19 · Mental Health Stigma Suicide · Nursing

When I’m Called Out by Clients for Swearing, Caring, and Everything Else…With Love. A Day in The Life of a Mental Health Nurse.

An unexpected perk to having a therapist on staff full time with us is hearing from her what my patients think of me. I have referred more than a few of my clients to her though some of them I’ve seen for over three years for medication management and for one reason or another they needed a therapist at this time. Apparently the impressions are hilarious.

Occasionally my clients will directly throw my words back at me. Recently a young adult attending college in state needed to see me urgently. After we processed the current crisis and made decisions about medication I smiled and said, “Isn’t this great that your in state and we can do telehealth?” The client laughed and said, “Well I recall you saying if I went to school in Iowa, one of my top choices, that I’d be in ‘East bum fuck middle of fucking nowhere and there’s no way in hell I’m managing your meds out there'” I have a chagrinned smirk including blushing cheeks that emerge when properly embarrassed and I replied, “Yes well, that does sound like something I’d say…” We were both able to laugh. Now I know that client didn’t go to school in Iowa for a few reasons, including COVID, not just because I wouldn’t manage their meds in east bum fuck nowhere. But it is a humbling reminder to know that I do play into people’s major life decisions.

One of my clients did an imitation of me to the therapist at my practice…who texted me while laughing to tears because it was incredibly accurate and I am funny without meaning to be which usually makes it funnier. The impression was from our intake. Our intake was over three years ago. I was very direct. I warn people I’m direct. I don’t think any one really believes me until they experience it. And again, I was humbled. Because these moments in time are so important to clients. They stick in their brains these intermittent appointments with me. Words are so powerful. Body language. Facial expressions. This client nailed it all.

What I learn over and over is that my clients are paying attention. That I have an hour intake and thirty minute follow-ups maybe once every three or six months if they are stable and those minutes are precious. I try and respect them. I swear a lot. That’s not going to change. But apparently between the swears, the sarcasm, the checking in, I impart an energy and words that stick with people. It’s a privilege to be that person. We in mental health should never take it for granted.

I have a client I have been seeing for a few years, and the parents brought up at our last appointment, “Hey do you remember when you made us leave the room because you had to have a ‘Come to Jesus’ moment with them?” The Dad was cracking up. He said, “We didn’t know if we would see our kid again! But we knew then we were in the right place.” I did that embarrassed smirk as I thought back a couple years, and in fact I did remember telling the parents to leave. I didn’t raise my voice. I got down at the kid’s level though and told them to take their ear buds out when I ask them to take them out. To respect my fucking time because I’ve shown them nothing but respect even when they are acting like a little entitled punk. I may also have told them to undo their wedgie and let’s start again.

Sometimes I remember those moments and do a facepalm. I obviously do not speak to all people this way. It’s my job to read people. I’m good at it. I know who it’s going to be effective for and who it won’t be. And that kid never wore the ear buds again, and honestly has been very respectful to this day in our appointments.

Recently a parent asked me if I thought their educational plan for their child was “crazy”. I didn’t hesitate when I responded nodding, “Yes. I do.” I remember the parent looked at me and laughed a little and said, “Well you’re the first one who’s at least been honest with me.”

Honesty can be a bitter pill for people to swallow. It’s definitely not for everyone. Again, I give myself a disclaimer up front to any prospective clients. “I’m direct. I will call you out. I encourage you to call me out too if there’s anything that needs to be addressed.” But it can open doors to take your head out of the sand. My honest response to that parent opened up an entire conversation about their own self doubts and their strengths and weaknesses as a parent. It allowed a space for them to be vulnerable that wouldn’t have been there if I had just smiled and said “No of course not,”.

I’ve also learned that as long as I’m honest without being judgmental…which is a hard skill to master…it goes over a lot smoother. My clients that I take time to build rapport with and I really get to know and who get to know me, they know when I give them direct feedback it’s not from a place of judgement. It’s from a place of genuine curiosity and caring. I want to know if I’m on target with my assessment. I want to know if they know I’m on target or not. I want them to think and feel things that they haven’t let themselves think and feel. I want them ultimately to get better.

I was asked recently by someone how I felt about “…profiting off the pain and sorrow of others. I mean people have to be suffering in order for you to get work right?!” This was not a friend. And was said with some malice toward mental health professionals. I responded that I think about that a lot. And that should there come a day when my services are no longer needed I will feel such immense joy that it actually brings tears to my eyes to think of that day existing.

I remember resisting the impulse to defend all that I do; all that I give to my work. It doesn’t feel like a profit when a client is hospitalized for suicidal ideation. It doesn’t feel like profit when I end a day sitting on my floor wiping away tears because of all the emotional trauma I’ve held space for in the last eight hours…trying to pull myself together in the five minutes I have before my sons bounce through the door. It doesn’t feel like a success to educate my client about their diagnosis of schizoaffective disorder- how it’s lifelong and they will have more episodes of psychosis and we need to plan for when not if.

Those are all the moments that stick with me. So it’s nice to hear from clients who remember other moments. Who remember me swearing with love. Who remember the limits I set with fond affection and admiration. Some of my clients have done impressions in front of me and they are pretty good. I should be a meme.

Clients send me videos of their engagements. Wedding pictures. Newborn baby pics. Those hilarious therapist memes. Some one sent me a Christmas card thanking me for all my help and crediting me with helping them be healthy enough to become a Mom. I cried hardcore when I opened that one. I am allowed into these intimate moments in people’s lives because I know more than anyone the emotional labor they have put in to get to these crucial turning points in life.

The positive feedback is few and far between for healthcare providers, especially mental healthcare providers, but it’s there. Even the impressions. They crack me up. This year more than any I needed the positive feedback. I am beyond grateful for it.

To consumers of the mental health system- I thank you. For trusting me with your mental health. For seeing me for who I am even in moments of tough love. To families of consumers- I thank you. You have trusted me with your most precious cargo. I don’t accept that responsibility lightly. To the therapists who have to endure impressions of me- Enjoy. I’m pretty freaking funny especially when I’m not trying to be and yes. I swear that much.

#COVID-19 · Mental Health Stigma Suicide · Nursing

You Don’t Know Me At All. Me: to every hospital I’ve worked for.

I recently received a heavy metal coin in the mail from the hospital I work at per diem. It was accompanied by a trifold letter thanking me for my hard work during the pandemic and ended with a “we are all in this together” statement. It explained the coin too. Likening it to soldiers being honored with metal coins for acts of bravery.

I didn’t work much at the hospital this past year. I had enough to keep me busy with my practice. I also felt that the hospital left a lot to be desired in terms of infection control measures in the psychiatric hospital. I felt safer working remotely at my practice.

But there were many essential frontline workers working day and night caring for COVID patients. Caring for NICU patients during a pandemic. Caring for maternity patients who had to give birth alone wearing a mask after their partners tested positive.

I opened and read the generic letter, held the coin, and though of the scene in the Office when the CEO of the company, Robert California, looks at the regional manager Andy and says, “Sometimes I think you don’t know me at all,”

If you’ve seen The Office you know it’s satirical. It’s a commentary on how every one lower on the totem pole from management feels that management doesn’t actually know them at all.

I felt this viscerally holding that coin. I felt affirmed with every atom of my being with my decision to leave hospital and agency work full time and venture into the risky world of self employment via private practice. The few times I’ve worked at the hospital I thought I would have lost it if I was working there full time this past year. And the nurses and doctors and respiratory therapists working there full time for the past year deserve more than a worthless coin and generic thank-you letter.

I’m going to give the example of how I treat my employees. Because I’m a big bad boss now. My employees received everything necessary to do telehealth at home. Headphones. Lifted desks. Second monitors. Printers. Scanners. Anything they needed I got them. I screen all their calls and messages and deal with whatever I can on my own without bothering them. If they ask me to intervene and discharge some one I do it. No questions asked. Because I trust their judgement. For Christmas I gave my part time employee a bonus. I gave my full time employee the option of a cash bonus or tax exempt options like insurance premium, HSA contribution, student loan payment, etc.

I ask for their input on what charity to give to locally whenever I make a donation through the business.

I give them positive feedback whenever I get it from clinicians and patients. I pay them an extra hour a week if I know it was heavy on administrative time outside of client time. I say thank-you whenever I ask them to do something and they do it. I have never bought them pizza. I have bought them sushi and nice chocolate and wine and beer. I’ve given gift cards to restaurants and Amazon for nurses week.

One of my friends who is an APRN asked how much money I make from my employees. I told her I don’t make much because I didn’t take on employees to profit from them. I took them on because I wanted other prescribers to practice with me. And when I decided to take on employees I made a conscious decision to never treat them the way I had been treated by my employers and managers in hospital systems and private practice. I want my time that I spend doing their billing and scheduling and call backs to be covered. But aside from that I’d rather invest leftover money back into my business and subsequently back into my employees. Because I know what it feels like to work myself to the bone. Giving literal blood, sweat, and tears to a system that rewards you with pizza and a coin.

My fourth full time employee came on recently and took time to decide to increase to full time. The reason she gave for doing so was because she knew that the first two employees both started at less hours and both have continuously increased their hours in the past three years, one to full time and one to part time. She said that spoke to the business in terms of retention and in terms of them continuing to give more to the business. That moment felt good.

I despise how hospital systems cry poor. All the time. I didn’t get consistent raises my first eight years as a nurse. I felt powerless to fight for them. The systems were designed for us to fail to get increases. These are billion dollar organizations. Not million. Billion. Tell me they can’t give their employees something bigger. Why not cancel all current medical bills being held by their employees? Why not cover their health insurance premiums fully for at least a month? Why not provide free or discounted care for their employees? Why not pay 1000.00 toward every one’s student loans? Why not skip their CEO’s bonuses and give it back to their staff? Why not invest in their front lines essential heroic workers?

Freaking coin.

On the other end are burned out healthcare workers who think they don’t or can’t have better or more.

You can. You just have to work for it and you have to be willing to take risks.

Before the coin. Back before the pandemic back in 2017 when I opened my own practice. I put a 2$ fake paper bill from my hospital system on my wall. It’s still there. Taped over my desk. I treat employees of the system who recognize it and always ask why I have one of them taped on the wall. I encourage them to read the message on it. They lean in and then understanding dawns and they inhale sharply. Then they turn to me in disbelief. I nod. “Thanks for saving the life of a patient.” They always say it out loud. Like they are reading it wrong.

I nod again. “But I mean like you actually saved some one or it was just a close call?” they stammer trying to disbelieve it still.

“The patient was blue. I cleared her airway. I was told by multiple people there that day and after the patient would have died if I was not there.” Then they always nod their head and shrug their shoulders in resignation, “I believe it. 2 bucks. And a fake 2 bucks. That’s all we are worth around there.”

The two fake bucks that can only be used at the cafeteria of that particular system was not the first nor the last time I was let down by an employer in healthcare. But it was the first time I remember feeling resolute in my decision to get the hell out of there. I knew I needed to be somewhere that valued a patient life and my ability to save it. The coin six years later affirmed that decision.

To all my healthcare provider friends reading this. I see you. I know what you give every day. I know what it takes away from you. I’m sorry you are not valued more. But know that you are valued by me. I see you. You are not alone. You deserve more. If you are reading this and you have any say or control over how employees healthcare systems are treated: do better.

If you or someone you know is struggling with suicidal thoughts please call:

1-800-273-8255

#COVID-19 · Mental Health Stigma Suicide

Call Your People

I did a data collection at the hospital I used to work at when I was still there. I examined the medical records from nineteen suicides that occurred over the course of three years. They were all completed within three months of discharge from an inpatient unit. This was perhaps six years ago. So no pandemic. No cheeto as President yet. Life was supposedly good.

I found some patterns. 18 out of 19 completed suicides were white people. I remember asking a Black nurse manager if she was surprised by that. She laughed and said “Oh no, we take care of each other. We know the meaning and value of community. White people are more isolated. Make no mistake we have mental illness in the Black community and so much stigma. But we take care of each other.”

The rates of completed suicide from 2009-2018 nationally were double for white people than Black people- the following link shows a nice graph. https://sprc.org/scope/racial-ethnic-disparities

It is no surprise then that in the midst of a pandemic when white people, who suck at community on a good day, are killing themselves more frequently. And I’m sure we will see an increase in suicides in the Black community also during this time because there is less “together” and more isolation.

When I think about the last year I think immediately of the isolation. I am grateful to have my kids. But I know so many who don’t have kids or who can’t see their kids because of exposure risks both ways. I know people who received chemotherapy during COVID and couldn’t see any one. I know people who have given birth and they couldn’t see any one when they were pregnant, and couldn’t see any one after they gave birth.

My own life personally and professionally has been touched far too intimately with suicide in my extended family, among former co-workers, and in my work in mental health.

I don’t go into my therapist groups online anymore because at least weekly there is a post about a client who committed suicide. There used to be posts like that maybe twice a year.

The news and politicians keep talking about the economy- which sucks yes. People are jobless. Homeless. Without medical insurance. But the most pressing, distressing, and completely devastating issue that we are not talking about enough is the ever present unrelenting alone-ness. I have felt it too in shades. Sundays are my dreaded days without my kids because they are now with my ex.

Some Sunday’s I’m okay. But then it snowed. The snow is still here. Feet of it. I can’t go hiking anymore. I can’t go to a bar for a drink with a friend. Because we can’t just go to bars anymore. I can’t go to hot yoga. Because my one studio is closed and my other studio doesn’t make people wear masks.

There have been hours spent binging Hulu. There have been hours spent catching up on my accounting and billing for work. There have been minutes of true despair that come from a deep loneliness that can be intolerable.

Divorce on a good day sucks. Divorce and splitting custody mid-pandemic, mid-snowy Winter just blows.

I yelled at my therapist one day. He told me that it would be good for me to have time alone to do self care. I said through angry tears, “I’ve done that. I’ve been alone. I was twenty-one in a city after a break up getting through nursing school seven hours from my family and friends. I’ve been alone. It sucked. I know how to live alone and be by myself. I don’t want to do it again. I want my kids. I want to be able to see my friends without masks. I want to hug my friends. I have two friends over sixty I haven’t seen in a year! I want to see them! I want to tell every one who tells me it will be good for me to be alone to go fuck themselves.”

After I cried a bit he said, “I think you just told me to go fuck myself.”

I laughed and agreed. I said, “Well this is what you get when you agree to treat a nurse;)”

I have coping skills. I have a therapist. I have family I can see (many who I cannot). I have a couple friends I can see (many who I cannot). I am now fully vaccinated. I know rationally I am blessed. But I can see how any one with fragile mental health, with no treatment, no friends, or no family can dive down the rabbit hole of isolation and see no light through the darkness.

We never thought this would go on for a year. Life after will never be the same as life before. That is fully sinking in for those of us who have known births, deaths, divorces, marriages, loss, and life. Because even though it seems stagnant life has gone on through this year of stagnation.

I grieve all those we have lost to COVID-19. The ones with the virus. And the ones with the terrible diseases of Depression. Bipolar Disorder. PTSD. Grief. I grieve the lives lost due to the devastating isolation this illness created.

I hope the one thing on the other side of this that changes is our community; or lack thereof. I hope we never take for granted that we can have each other for support and love. If only the people dying by their own hand could feel connected to some one, anyone, it might save them.

To put it in perspective I know of four suicides completed in the last week. Four. Two were teenagers. In a week. I personally and professionally pre-Covid would hear of four maybe within eighteen months to two years. Four suicides in a week. This cannot continue. So many more lives will be lost.

If you haven’t talked to a friend in a while who you know is single or doesn’t have family or doesn’t have kids or is fresh post divorce or who you know just may not have any connections outside of you…please give them a call.

My cousin called me on Valentines Day. It meant the world to me. I think most people don’t know what to say to some one freshly separated on a holiday about love. Valentine’s Day was never a thing with my ex. It was more a thing with my Dad. He would always get me a card and a gift. Usually chocolates that I despised, which is hard to do, because I generally love chocolate. But it was the thought that counts.

No horrible heart shaped chocolate this year. No card that looked like it had been beaten up and thrown around his truck. I can’t think of a day recently where I’ve missed him so much.

Laughing and talking with my cousin on my ear buds while I braved the mall was just what I needed. She coached me through Sephora and we laughed through the Disney store.

Any connection is so needed right now. People are dying. People are depressed. People miss people. You are people. You have these people in your lives. Call them.

Some of my clients are stable in terms of medication. But they beg me to be seen sooner when I try and push them out three months. They are often the single people with few friends and few family and no one they can see in person. I’ve been seeing patients monthly and doing nothing with their medications. It feels better to them I think to know they have a commitment in a month. Some one cares to see them in a month. I have a number of these clients. I have some who insist on being seen every two or three weeks right now.

I never fight them on it. Because I see them. I feel it too sometimes; the loneliness. If they feel better knowing they have to see me in two weeks. Fine with me.

Every one who works in mental health is seeing this. This desperation to be seen. We are trying to meet the need but we need help. We need you. People. Call your people. Make a community again. Connect in this age of isolation. Please. Save. A. Life.

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