Balance

Here I am, purple marker in hand, ready to give a lecture on balance. I have been giving this lecture every month for the past ten years; each time I present it, I enjoy it and learn something new from my clients. I am enthusiastic, ready to enjoy interacting with my patients. My hope is that I can teach them about how to live a balanced life when they are fragile, vulnerable, leaving the hospital, and beginning to come out of a depression or other mental illness, and that they will learn how they can take control of their lives.

I wrote the word depression on the dry erase board. I asked the audience, “What are the signs and symptoms of depression?” One by one, most everyone in the room offers a word to describe depression. They give me the usual list of words and phrases such as:

·     You feel hopeless

·     You can’t stop crying

·     You want everything to stop

·     No energy

·     Appetite changes

·     Too much sleep or not enough sleep

·     No sex drive

·     No memory

·     No concentration

·     Increased irritability

·     Increased restlessness

·     You feel worthless

·     you feel hopeless

·     You feel helpless

·     So much pain

·     Isolation

·     Loss of previously enjoyed activities

·     Suicidal thoughts, plan, intent, means to carry you death out

·     Giving away treasured tangible items

·     Death

Next, I asked, “How many people in this room have been suicidal?” Three-fourths of the people sitting in the room raised their hand. I said, “Depression is real. Depression takes over your entire life. I understand your desire to end the physical and emotional pain. Most people would rather have surgery because they know the cut will heal and the pain will go away. With depression, you don’t know when the pain will go away. You don’t think you will ever heal.” My hope is that this lecture will change your mind about dying by your own hand.

If for no other reason you choose to stay alive, I say, life can change on a dime and you gotta be here to experience it! “Most people who have had serious suicide attempts and have survived are grateful their attempts were unsuccessful.”

I then direct their attention to the dry erase board already littered with the depression adjectives. I ask, “What are some things you can do to help yourself and change your mood?” I write the responses on the board with my purple marker because purple is soothing and transcends love.

The responses include:

·     To get help if you are thinking about talking your life by suicide

·     Get out of bed every day

·     Take a shower every day

·     Brush your teeth every day

·     See you doctor regularly

·     Take your prescribed medications

·     See you doctor right away if you have bad side effects from your medications

·     See your doctor right away if your medications are not working

·     Talk to another person every day, on the phone or in person

·     Connect with your community

·     exercise, stretch, walk in place, try yoga

·     Eat 3 balanced or 6 small balanced meals every day

·     Drink plenty of healthy fluids every day

·     Sleep 6 to 8 hours every day

·     Meditate

·     Allow your spiritual self to blossom and grow

·     Go to church and engage in the fellowship of the church community

·     Talk with a counselor

·     Talk with your clergyman

·     Pray

·     Attend to the priorities and details of your life every day

·     Use stress reducing techniques when things get intense

·     Ask for help

·     Feel your feelings, they are yours, own them, embrace them, accept them and yourself

·     Keep a journal to measure your progress

I add, “Trust yourself and know you will have the tools to succeed. You have to do the footwork because no one else will do it for you!” Pointing to the full dry erase board, I ask, “What does this new list look like?” Everybody laughs because of my messy handwriting and misspelled words. I laugh with them. I say, “Look at this list, what is this? What do these words describe?” The usual answer to this question is given to me just as in previous lectures: “Balance.”

I pause and let them consider what balance means to them.

“Now that we are all living in harmony, centered, and are balanced, let us talk about the real world.” I hear groans from the audience!

“Let’s talk about the cost of your medications. The medications most doctors are using today are very powerful and very expensive. It is not fair to you if you become stabilized on a medication you cannot afford in the future. It is extremely important for you to talk with your doctors; let them know you don’t have access to money. They can change your prescription to an older, less expensive, and just as effective medication.

You can contact any of the drug manufacturers for a free three-month supply of your medications. You can call any pharmacist and he/she will give you the 1-800 number of any drug manufacturer. You will have to work along with your doctor because he/she will be attaching the prescription to the application and the medications will ultimately be sent to your doctor’s office for you to pick them up.

Also, remember most doctors have samples of medications in their offices. Use them! Don’t be shy! The drug representative will be happy to bring back more. Free drug programs are popping up all over the place; just watch for them and ask questions.”

I include information about various community pharmacy programs that are available in our city which are under-used because nobody knows about them. I start to see hopeful expressions in the room. Next, I ask, “How do you get food without money?” We talk about the food pantries and how they provide three days’ worth of food once a month (granted you have a residence and a photo ID) with the assumption you have the equipment to prepare your meals. We talked about the daily soup kitchens and where they were located and how you could get to them.

We talked about governmental entitlements like food stamps and how to get them. When a new Momma was in the room, I would always include information about WIC, (Women, Infants, and Children). This program provides high protein foods and fluids for the new mom and formula for the baby. The next question I have for my audience is, “How do you get your state ID with no money, birth certificate, or social security card?” I explain that they will need $7.00 to get their birth certificate and $9.50 to get their State ID. “What do you do first? Bum a ride off someone and go to the Social Security office. They can give you a free printout of your social security number to serve as an official document while you wait for your card in the US mail. The next thing you do is go to a day labor situation. Be creative with this one. You need cash and you need it fast. Clean your neighbor’s home. Wash some one’s car. Mow a lawn. Help with gardening. You get the idea. Make sure you are paid in cash. You should have about $35.00 dollars in your pocket after a day’s worth of work at minimum wage. You now have enough money for a copy of your birth certificate. Get down to your Health Department give them $7.00 dollars and they will give you an official copy of your birth certificate. Now you can go to the Bureau of Motor Vehicles and obtain your State ID. Then get a library card after you get your State ID. This will help identify you as well. Keep your important papers together and put them in a safe place.

Now that you can identify yourself, the sky is the limit on what you can do!

Most importantly, spend the rest of your money on things you can’t currently get for free! Prioritize!”

We talked about the nuances of each homeless shelter for the folks headed in that direction. I finish my lecture with a rant. I ask the people in the room, “How long does it take you to get attention from your social worker if you are involved in a community mental health center?” Just about everyone speaks at once. I let them vent for a little while and then I give them inside information.

 “I know how frustrating it is to wait for that helpful phone call which never comes and I know how furious you may feel when your appointment gets changed for the third time in a row. There is no excuse for imperfect care. I want to let you know what your social workers go through and how the agency is run as a whole. Your social worker has a case load of 92 plus Clients.” I let that soak in. “He/she is responsible for everything from housing and food, to medical and psychiatric emergencies, etc. You can see how you may be ignored when you are considered stable and high functioning. Those case managers depend on you to carry out all your daily instructions such as taking your medications as prescribed. You are all very intelligent people. I’m sure you can you can see the reason for a missed phone call and a broken appointment from time to time. When I worked in the community, I took care of two teams which equaled 160 people by managing their doctor visits, medical conditions, and all their medications! The doctors see everybody! A typical assignment for a doctor working in a community mental health center is over 25 plus patients everyday! I hope you see the need to keep your appointments. By law the doctor has to see you every three months. If you miss that appointment, you are dropped from the mental health community center. Please, if you are going to miss an appointment call the agency and reschedule. They are always happy to assist you. Remember in a community mental health center, it is hurry up and wait. Don’t get angry because you spent the entire day waiting for your life-saving medications. You are worth it! So bring a book!

The only way to survive in this setting is as follows:

·     Keep your appointments!

·     Call to reschedule if you have a conflict with the date or time.

·     Stay in weekly contact with your case manager/social worker to give him/her updates on your anticipated future needs.

·     Let your case manager/social worker/doctor know when you will be out of medications.

·     Let your case manager/social worker know if you do not have transportation to your doctor’s appointment. They will consider this request a priority because of the consequences of a missed appointment. Sometimes they will give you a cab voucher, a bus pass, or they may pick you up in their car to get you to your appointment.

·     If you situation changes, notify your case manager/social worker in a timely fashion.

·     You will have to be persistent.

·     If you think your needs are not being met, tell someone and keep telling them until someone listens.

·     Remember a squeaky wheel gets the oil (you don’t have to be a rude squeaky wheel, just a persistent one!)

All of the survival tactics used to manipulate the community mental health centers is true for your private doctors too. The doctors, social workers, and nurses in the private sector are just as busy as the community mental health centers, if not more.

I reiterate that, “There is help to be had out there if you stay focused and keep at it, because you’re worth the effort!

Okay, that’s my rant. Go chew on that information. Thank you for your feedback and sharing your personal experiences.” My beloved clients applaud after the lecture ends. I feel humbled and hopeful I have made a difference in some one’s life. I listen to my clients and I have learned so much about the human condition over the years because of the teachings of my client’s.