Tag Archives: classes

Failure & Stress

1 Feb

I feel like a failure and if you don’t know me, you might think I am one, heck you might think I am one if you do know me.  I’m having a hard time with my classes, for the first time in my life.  I’m trying to work on transitioning within a medical establishment that maintains I must stay mentally stable under a presidency that guarantees I stress out about my rights and fear about even being able to transition if I ever get stable.  And roundy round goes the pattern.  I missed school again today, I managed to do some homework- but feel paralyzed right now.  I need to unfreeze but I don’t know how and assignments are due tomorrow, more quizzes and my first midterm Friday.

I don’t fail, or do I?

Call from psychiatrist

22 Nov

Just got off the phone from my psychiatrist and it’s just what I needed.  I had no intent to go to classes today.  I couldn’t sleep again last night with the voices and the paranoia and when the thoughts started to turn to sleeping under the bed to hide “just in case” I got out of bed and took some extra PRN Latuda and Valium.  This helped me get to sleep, but unfortunately I woke up with nightmares that Trump had declared war and drafted all the men to go to war.  When I got up to go to class I managed to take a shower.  I really needed one, since Monday I just wore a snow hat and pajamas to school.  However, that put me over the edge and once dressed for school I became fearful and crawled back into bed.  I set my alarm for my 2nd class but near time to attend, turned it off and resent it for a trans clothing fair I hope to go to.  My psychiatrist called and we are upping my antipsychotic Latuda by 1/2 which is what I have PRNing on a regular basis until I feel less vulnerable and more confident in DBT skills.  He wants me to not associate taking a pill with the behavior which is fine, as long as I have some medical relief.  I will also be using my coping skills I use- mostly DBT to deal with what voices, paranoia, and distress break through.  And yes some always break through.  Medication is no cure.  During thanksgiving break I’ll go through my packets and go over some skills. My psychiatrist wasn’t me to set up a phone session with the therapist to go over how DBT skills are working with this stuff.  So far I have the music skills I’ve been using and rationalizing.  It’s been 2 years without voices so I need to re-look through my skills.

Advice for those who work in mental health

11 Dec

National (Mental) Health Blog

 

Today I am doing an alternative to the two given prompts.  It is: Advice for new doctors or nurses.

I’m also going to expand this to therapists, social workers, mental health technicians, psychiatrists (doctors) both regular and inpatient, nurses who assist psychiatrists or work in inpatient settings, volunteers/professionals who run support groups/group therapy/or psycho-education (classes or skills groups), case mangers, and just about anyone else who works in the field of mental health.

Directed to:

Everyone:  Do not judge people.  I think this is really important because even with people who work in the field of mental health there are judgement on specific behaviors.  The main ones that come to mind are self-harm, eating disorders, and substance abuse.  Many people and even some professionals believe people chose to act this way and depending on how severe the behavior is sometimes think people can just stop.  Another tip of advice is that people are not their disorder/illness.  There is no box that fits every person diagnosed with borderline personality disorder, bipolar disorder, depression, anxiety, ADHD, etc.  Most disorders have multiple criteria that you only need to meet a certain number to be diagnosed.  Also some have a symptoms that can be taken different ways an example would be in depression, some people have difficulty sleeping (insomnia) while others sleep too much.  Even in personality disorders for example impulsive behavior could be binging and purging, reckless spending, gambling, being promiscuous, etc. So do not instantly base treatment on how you think the disorder/illness typically manifests itself.  Listen and ask questions, this goes for everyone but specifically for doctors (psychiatrists both in inpatient and outpatient settings.)  Usually appointments with doctors are short and end in being given a medication or a dosage change.  Doctors are suppose to look at charts (read notes) of patients for notes others working with the patient have made, this is especially if in an inpatient setting but also with big health care companies like mine where everything in networked, unfortunately most doctors don’t have time and use medication to treat the symptoms of the illness.  With out listening and asking questions you can see criteria that could be attached to a number of illnesses and without getting a broader picture will most likely misdiagnosis and mistreat, an example is the symptom of impulsivity which can be found in bipolar disorder, borderline personality disorder, and ADHD.

Therapists and social workers:  Here in the US, neither of these have the ability to prescribe medication.  They help by conducting different types of therapy.  My first piece of advice would be to recommend the patient to a psychiatrist if you think need be, but make sure not to medicalize everything, in other words every problem can be fixed by medication.  Since therapist and social workers are the main people that you talk to, they need to be patient.  Majority of people will not just open up their life and trust you from the moment they meet you.  And part of being patient is figuring out when to ask questions and when to stop pushing.  Also no one likes to be told what to do by someone who thinks they know everything (this goes with the doctors too), just because you have a license or a medical degree doesn’t mean you know everything, especially how life factors may be influencing the illness.  Some therapists and social workers will tell you that you need to get out of a relationship, that you need to set boundaries, you need to this or that; and that is in part what therapists and social workers are suppose to do.  But they need to suggest solutions and explain why it might work, not just tell you what to do because I say so.

Mental health technicians (MHTs)/nurses who assist psychiatrists or work in inpatient setting- In the US that is what we call the people who work in the hospital as sort of supervisors of the patients, they make general notes and check on the patients every 15 minutes.  There are usually at least two on a unit and they do not conduct therapy of any kind, but may do check in groups where they handout questionnaires and then put them in the charts.  Being hospitalized many times I’ve meet many MHTs and they all have had different personalities and different roles.  First don’t just talk to each other in between your 15 minute checks and not interact with the patients.  Be willing to listen, help explain the schedule and logistics to new patients, and calm fears.  I have had MHTs who threaten patients that if they don’t get out of bed, they will never get released- MHTs make most of the notes about what you do with your day and how you are acting.  Obviously don’t threaten.  I have had MHTs that encourage patients to interact with each other and also let the patients know they can talk to them.  Many people are scared on their first hospitalization, they don’t understand that there is a routine or how things work, it is usually up to the MHTs to explain how many groups there are a day, what type they are and if they know who will be leading it.  They also need to explain meal times, visiting hours, hygiene and interaction expectations, how often you will meet with a psychiatrist, how you get privileges and how they can be taken away.  MHTs should also be able to direct you to help if you need it and not ignore you, this could be like finding a medicine nurse if you need some PRN pain medicine or anxiety medicine.  Tell you who to talk to certain things about. Nurses who work in psychiatric hospitals can dispense medication and occasionally lead groups talking about nutrition and specifics about medications.  They should be willing to answer questions and giver information, if they don’t know they should find the answer/information and get back to you.  Nurses who work for psychiatrists sometimes will see patients more than their actual psychiatrist, since they can prescribe medication and help answer questions about side effects and usually are communicating closely with the psychiatrist.

Psychiatrists (Outpatient and inpatient)- Listen to patients, which I elaborated on in the everyone section.   With out listening and asking questions you can see criteria that could be attached to a number of illnesses and without getting a broader picture will most likely misdiagnosis and mistreat, an example is the symptom of impulsivity which can be found in bipolar disorder, borderline personality disorder, and ADHD. Read charts/notes and talk to other providers for the patient for a more complete picture.  And then a lot of the advice for therapists/social workers like not medicalizing everything, know when to refer patient to other services like therapy, groups, classes, support groups, etc  And the this is what you do because I said so, give reasons and options of different medications if possible.  Explain medical treatments along with the diagnosis.  I have had some psychiatrists who haven’t even told me my diagnosis before and it made me much less likely to adhere to treatment.

Volunteers/professionals who run support groups/group therapy/or psycho-education (classes or skills groups)- Realize that everyone in the group is different.  In hospital settings you will most likely have people of different ages, genders, cultures, and diagnosis- you need to be sensitive to that.  In a lot of classes or skills groups the people in the group will have something in common usually a symptoms or diagnosis, it is still important to realize that everyone is different and be sensitive to that.  For just about any group/class whether more of a sharing group like a support group or group therapy or a leader run group like a skills or psycho-education group needs to have rules.  One big one is that whoever is facilitating the group is monitoring the group, so if someone begins to say things that are rude or insensitive they need to step in.  If in the case of a support group or group therapy someone is monopolizing the time they need to redirect.  Leaders should encourage group participation (even in classes or skills type groups) but not force people to talk who are not ready.  Leaders should be able to refer people to additional services or suggest them if appropriate.