Overcomers

The Statewide Suicide Prevention Council has a member who shares her experience with attempting suicide. Thankfully, she survived her attempts and has made involvement in suicide prevention a part of her healing. In the language of suicide prevention, she is an “attempter.”  But she calls herself an “overcomer.”

Previously I’ve posted on the power of language in our work, and how important it is to use empowering and inclusive language. So I love (LOVE!) the idea of considering people who have survived an attempt to commit suicide as “overcomers.” Overcoming despair, overcoming hopelessness, overcoming depression, overcoming suicide – whether it’s for a day, a month, or a year –   is an achievement we should support and celebrate.

The data shows that someone who attempts suicide is more likely to attempt suicide again within the next 6-12 months. In Alaska, 819 people attempted suicide in 2007 and 149 people died by suicide. We focus on the lives we’ve lost, and the grief we feel over those losses – but shouldn’t we also celebrate and support the 670 people that lived?

What prevents us from supporting and caring for someone who has attempted suicide?

Are we afraid that if we talk about it, they will try again? (That’s just not true – research shows that talking with someone about their feelings of suicide and how to find help actually can prevent suicide.)

Are we afraid it might be our fault? (We can’t assume responsibility for the feelings of suicide experienced by someone else. We can take responsibility for helping, or choosing not to help, someone in crisis.)

Are we afraid we don’t know what to say? (You can find something to say. You can seek out training, like Mental Health First Aid or ASIST, to learn how to listen and what to say. Or, you can simply say “Your life matters to me.”)

If we acknowledge our own fears, and recognize that those fears are unfounded, we can then be brave and open our hearts to someone who needs support and love in their journey of overcoming.

A Quilt Made in Honor of Loved Ones Lost to Suicide

Listen, Learn, Love and Live

Today, at the American Association for Suicidology conference, I heard from people who have attempted suicide about their experiences and how folks can best support the journey of recovery. The advice they gave on how to support someone who has attempted suicide was to “listen, learn, love and live.”

Listen

Too often we are busy thinking about what we want to say, rather than listening. But listening is one of the best things you can do for someone who has attempted suicide. In your listening, be honest and open with them and with yourself. Part of that is, if you say “you can call me anytime,” make sure your phone is on and you’re able to be there any time.

Learn

Learn what helps the person by listening and asking them “how can I help?” Then, support them in the way(s) that best help them. Learn what services and supports are available in your community so you can encourage the person to seek help and support (and you can seek help and support for yourself if you need it).

Love

The panelists who had attempted suicide shared the value of love in supporting someone who is at risk. Their advice: express care and concern for the person who has attempted suicide. Be brave and confront stigma and your own misunderstandings about suicide (part of that learning aspect). Take care of yourself, too. Know your own limitations and honor them – don’t take on more than you can handle emotionally or mentally.

Live

This was a surprising point made by the panelists, who warned against making supporting someone who has attempted suicide the central part of your life. It’s understandable that we would want to make the safety and health of someone we love the most important thing in our lives – but that turns out not to be helpful to the person who has attempted suicide. Living and sharing our own lives is an important way of supporting someone who has attempted suicide.

We can support a friend or loved one after an attempt. We can help them on their journey of recovery, if we are brave and honest in our efforts.

And if you are someone who has attempted suicide, know that you are courageous and strong. And on days when you feel hopeless and alone, know that there are people – many of whom have walked the same road you are on — who want to support and care for you.

Your life matters.

If you are interested in finding or providing support for yourself or someone who has attempted suicide, there are some resources available. While there are not formal support groups for attempt survivors in Alaska, the Peer Support Consortium can help you find a peer support organization in your community. NAMI has chapters in communities in Alaska. If you know about other resources, or are interested in developing supports in your community, email kate.burkhart@alaska.gov.

The Power of Language

During a meeting this week with primary care and suicide prevention experts from across the country, the topic of language came up. The field of suicide prevention has its own language, its own “terms of art.” How that language is used can exclude the very people we’re trying to engage in this work.

Interestingly enough, the same topic came up in several of this week’s discussions related to updating Alaska’s state suicide prevention plan. There was concern that the language we use in our planning and prevention work might be confusing or even off-putting to the very people we want to engage.

In suicide prevention, a “survivor” is someone who has lost a loved one to suicide. A person who survives an attempt to commit suicide is referred to as an “attempter.” So, in order for there to be a survivor, someone has to die. That just doesn’t make sense.

Suicide prevention is broken into three categories: prevention – intervention – postvention. When I started this work, I wondered “what the heck is postvention?” I learned it’s a label created for how we respond after a suicide to prevent the domino effect often seen after someone dies by suicide.  If the point is to prevent additional suicides, why isn’t it just “prevention?”

This laguage issue is a possible barrier to bringing primary care providers into the suicide prevention effort. Suicide prevention focuses on preventing death in a time of crisis – kind of like the way emergency rooms treat people.  This focus on the end, and the emergency nature of the end, of the spectrum has made it hard to get primary care providers involved in this work. Their job is to diagnose and manage diseases, not do triage and emergency medicine. So why would they focus on what are thought to be exclsuively mental health emergencies?

Maybe if we explained that suicide responds to the same protocols and interventions as other chronic diseases, that would make more sense. You wouldn’t treat hypertension without checking (and rechecking) a patient’s blood pressure. You wouldn’t treat hypertension without explaining to the patient what he can do to help lower his blood pressure. And you wouldn’t treat hypertension without connecting the patient to the services and supports he needs to improve his condition. All those things – screening, patient education, referrals  — work to help someone early on to prevent the crisis that can lead to suicide.

There is a movement to help people stay healthier so they avoid the health conditions that can end up in the emergency room (heart attacks, strokes, etc.), Shouldn’t suicide prevention include a similar focus, helping people stay mentally and emotionally healthy so they don’t end up in that place where they are considering suicide and need emergency services?  And shouldn’t we use common language?

Maybe we need to think about how we talk about suicide, and find ways to use empowering and common sense language in this work? If so, how would we do that?

What is Suicidology?

The field of suicide prevention has some terms of art that sound like they are just plain made up. Like “suicidology” and “postvention.” Yet those weird-o words mean something really important when it comes to saving lives at risk of loss to suicide. I’m learning that this week.

So, what is “suicidology?” It’s a term for the research and study of suicide and suicide prevention. Many people see it as an area of study that crosses many disciplines, rather than being narrowly focused on psychology or psychiatry. The  American Association of Suicidology is a national organization of researchers, suicide prevention professionals, survivors of suicide and others committed to furthering research and evidence based prevention strategies.

I am honored to have been invited by the American Association of Suicidology to not only present at their annual conference in Portland, but to work with a rock star group of experts tomorrow to problem solve the integration of suicide prevention in primary care. This is especially exciting for me, given the work the Suicide Prevention Resource Center, Alaska Native Tribal Health Consortium, and the Boards have put in to developing a pilot project in Alaska.

The Suicide Prevention Resource Center has developed a primary care suicide prevention toolkit to help physicians and community health providers screen and respond to patients at-risk for suicide. (This is the tool I’m hoping we can pilot in Alaska.) The National Association of Pediatric Nurse Practitioners will soon have a new online resource for pediatric nurse practitioners (I got to meet the creator, Dr. Ginger Biddle tonight at dinner). These are just two examples of efforts to help family practitioners, nurses, optometrists, dentists, and other primary care providers serve as a resource for early identification of suicide risk and better intervention to save lives.

I’ll be blogging about AAS and everything I learn this week, so please check back and share your thoughts and ideas. Together, we can all act to prevent suicide in Alaska.

Pay Attention

Part of the Sound Minds in Sound Bodies campaign is to develop the skill of mindfulness. What does it mean, to be “mindful?” It might mean something different to you, depending on your background or experience. In this context – mental health promotion – it’s taking notice or paying attention to the world around you and the world within you.

“The sun feels warm on my face.”
“The yummy smell of that soup on the stove reminds me of my grandma’s kitchen. I used to love to sit there and watch her cook.”
“My legs are sore after that workout, but I feel so much less stressed now.”

That sounds simple (and maybe silly), but think about all the times you looked down and your plate was clean but you had no idea how your dinner tasted.  Or looked up at 5:00 p.m. and wondered where the day went.  Or realized that you just hung up the phone and couldn’t remember what you and your friend had talked about.

A wandering mind will not lead you to happiness and well-being. According to recent research, people spend almost half their time (47%) thinking about something other than what they are doing. 

(Yes, I’m multi-tasking as I write this.  I’ll stop and come back later when I can pay better attention to it.)

. . .

All that day-dreaming and distraction, according to recent research reported in the Harvard Gazette and Science, can lead to unhappiness. Psychologists Matthew Killingsworth and Daniel Gilbert (both of Harvard University) reported that the “human mind is a wandering mind, and a wandering mind is an unhappy mind.” 

 That’s kind of depressing – we’re naturally disposed to woolgather, but that means we’re naturally disposed to being unhappy?

Their study involved 2,250 people aged 18-88.  According to the study, participants reported their minds wandered away from whatever they were doing nearly half the time.  What they were doing didn’t really matter – their minds drifted to other things 30% (or more) of the time.  The researchers found that people were happiest exercising, having a conversation with someone, and  . . . (yes, it’s what you think).  They were least happy when resting, working or using their home computer. 

So, the fact that you are vegging out on the couch reading this blog means you are probably less happy than you would be if you were at the gym or gabbing with a friend.

According to Matthew Killingsworth, “mind-wandering is an excellent predictor of people’s happiness.” How often our minds leave the present — and where they end up – is a better predictor of happiness than the activity we’re doing.  Which led him and his research partner to conclude that the idea that happiness is “in the moment” – and that being aware and present in the here and now is healthier than always thinking about what’s next or what was – is probably right.

Knowing that, how can we learn to be mindful? For some people, it can be as easy as slowing down, taking a breath, pausing. For others, it’s yoga or meditation. Mary, a participant in the Sound Minds in Sound Bodies campaign, shared that she is using basic yoga to help her boost her awareness of her mind and body, and she’s feeling happier: “I feel totally grounded and have way more energy.”  Just by making time to pay attention each morning (before the day’s distractions kick in.)

The common theme to these mindfulness-building exercises is single-mindedness. Not texting and talking. Not thinking about what’s for dinner while you wolf down your lunch. Not making your list of household repairs while your dad is trying to tell you about his colonoscopy.  (Okay, maybe you get a pass on that last one. . .)

The essential idea is that, by paying attention and noticing what’s happening around you and how you feel inside, you can actually increase your happiness, which boosts your mood and leads to better health.

When You’re In A Hole . . .

A guest post by Rebecca Busch

When we first started talking about doing this campaign, it was a complete no-brainer for me.  In my daily (non-campaign) life I strive to get exercise, eat well, and make sure I am connecting with people around me.  I think these things are what really help me be a better “me.”  When I go without exercise for a couple days, either because of other obligations, lack of motivation or something else, I definitely feel the decline from my best self. I get grumpy and irritable, I take more things personally, I feel the stress more from even just small stuff. 

When I realize this is all happening, it reminds me that I need the people in my life who understand and care about me to be around me. I need to burn out the toxins (physical and psychic) and restore my energy by moving my body to exert energy.  These two together really sustain me.  Sustain, and entertain.

So here’s a funny story.  I love going out and doing something fun and physical with friends.  Last weekend, I skied both days with friends.  We battled the wind and hiked up onto the breathtakingly beautiful ridges around Eaglecrest, our local ski area.  Up there, the wind is cold as it blows over the mountain but the sun is warm on your face.  You can see the channel framed by more lovely snow capped peaks on the other side.

Despite the wind crust on the snow we had fun, touring the backside of the mountain. Skinning up and skiing down — my body felt heavier each time I went up and came down. On a trip back up the mountain, I was on a steep slope when my ski skin detached from my ski making it impossible to hold without sliding backwards. Two steps up, four steps back – grrrr!  Then, I got a little stuck.  Or . . . maybe a  lot stuck.

My crew was on up the hill, so I found myself digging out of a deep (and cold) hole in the snow, but not making much progress.  I started to feel alone, frustrated, goofy, bitter, angry . . . until my good friend Chris came to see why I was not right behind him still heading up the hill.  He had skied all the way back to find me, and what he found was a very frustrated and exhausted me fighting the snow (and not really winning).  He gave my predicament a chuckle, but then helped me get out of my snow trap and back on track. 

That’s what friends do.  When they find us in a hole, they help us dig ourselves out.  No matter how deep (or cold or foolish) that hole may be, I know that with a little help (and maybe sometimes a little laughter) from my friends, I can make it out again.

Friends Get Friends Moving

In looking for ways to promote the mental health of our amazing staff, we wanted to find something fun that everyone could do and enjoy all together.  We talked about a lot of things, but decided on . . . BOWLING!  We had a great excuse for a field trip — celebrating our amazing assistant Lance’s birthday.

Now, this isn’t rocket science.  Six people go bowling, have a great time getting some exercise and hanging out.  Is that really related to our resiliency and psychological health?

Well . . . yes.  For example, one of our folks hadn’t had the best day that day.  So when we started, they were kind of sluggish and withdrawn.  By frame 6 of the first game, there was more pep in their step and by the end of the first game, they were smiling. 

Sure, there was some ribbing when the ball hit the gutter (isn’t there always?).  But there was also a lot of cheerleading and not a little coaching.  And then there are all those warm fuzzy feelings that come from celebrating together.

The point is that, unlike having to weigh your brussels sprouts and count your carbs, protecting your mental and emotional health is usually FUN!  You don’t need any fancy equipment or to see a special kind of trainer — all you need is someone else’s shoes and a crew who will cheer your strikes and not mock you too much for your gutter balls.

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Connect ~ the Power of Friendship

Friendship is a sheltering tree.  ~Samuel Taylor Coleridge

One of the five Sound Minds in Sound Bodies steps is to CONNECT — with friends, family and others.

It’s easy to think of friends as the people we watch the game with, go to the movies with, share a pizza with.  Not always, though, do we think of our friendships as the bonds that weave a strong net for when we swing out on that trapeze (and catch us if we fall), a warm blanket when we are cold and need comfort, a banner to proclaim our success. 

Hopefully, we all have someone we can call for comfort when our heart is broken or to help celebrate when we get a promotion.  It’s those friends that help us maintain – and even improve – our mental and emotional health.  They are our “sheltering tree.”

The health benefits of strong friendships include increased sense of belonging, reduced stress, increased self-esteem, and decreased risk of serious mental illness.  By helping us to weather life’s storms (divorce, loss of a loved one, etc.), friends help us capitalize on our own resilience and make it through.  By celebrating our triumphs (new jobs, new babies, new haircuts), friends support our feelings of happiness and self-worth.  Friends can also encourage us to adopt healthier lifestyles (like my friend who is always dragging me on speed hikes up and down the trails in Juneau).

Just like it’s easy to overlook the powerful effect of friends on our health, it’s also easy to forget how important it is to make new friends.  Connecting with new people helps us keep our minds open to new perspectives and new adventures (wear a helmet if that new friend wants to go skydiving). 

Earlier in the series, we explored the Move part of this mental health promotion campaign.  Move and Connect fit together really well.  Walking with a friend, playing a game of bocce ball, going to the Governor’s Inaugural Ball and dancing the night way – these are all ways to strengthen the connections with your friends AND get your body moving.  You can also make new friends while getting out and about – take a kayaking lesson or join a hockey team.  You might meet someone groovy and make a new connection.

 

 

Move!

During the Sound Minds in Sound Bodies campaign, we are taking five steps to improve and maintain our mental and emotional health.  One of those steps is to MOVE!  We’re not talking marathons or situps (unless that’s your thing).  We’re just talking about getting up and getting going. Yoga, rumba, juggle, jiggle — whatever feels good as long as you’re moving.

Most of us have heard that regular physical activity can lower your blood pressure and cholesterol levels and can reduce the risk of illnesses such as type 2 diabetes or heart disease.  What you may not know is how physical activity affects your mental and emotional health.

According to Dr. Daniel Landers, research shows that exercise can reduce anxiety and depression — sometimes significantly. Since diabetes and heart disease are often co-morbidities (conditions that occur with, but are not a cause or result of, the primary diagnosis) of mental illness, the fact that movin’ and groovin’  reduces the likelihood or the severity of all three is pretty cool.

As part of the Sound Minds in Sound Bodies campaign, folks are getting at least 30 minutes a day of physical activity.  To help keep track — and stay motivated – folks are taking part in the President’s Active Lifestyle Challenge.  In addition to providing a tracking system and a points system to keep up all motivated, it provides lots of great information.

What are we doing to stay active?  Walking, running, shoveling snow, bowling, stretching, shoveling snow, vacuuming, skiing, shoveling snow. See how easy it is?  Just 30 minutes a day is all it takes.

What are the results? First, a greater awareness of how easy it is to move more.  One board member shared that, when she wore her cool AMHB and ABADA pedometer while cleaning house, she got nearly half her daily recommended steps.  Second, a greater to attention to how we feel (not just a little sore) after we get our activity.  Proud, happy, empowered, cool — just some of the feelings participants have shared so far.

Sound Minds in Sound Bodies isn’t about weight loss or body building, or trying to reach some socially accepted norm of beauty or health.  It’s about feeling better from the neck up AND from the neck down. 

Sound Minds in Sound Bodies

Mental and emotional health is an integral part of our overall wellness, but not everyone thinks about it that way.  There are a lot of people — and doctors — who think of health in a “neck down” sort of way, leaving the “neck up” to psychiatrists and counselors.  But what more and more research and individual experiences are teaching us is that your health from the neck up is all part of your health from the neck down  — and vice versa.

The Alaska Mental Health Board and Advisory Board on Alcoholism and Drug Abuse are partnering in a mental health promotion campaign, Sound Minds in Sound Bodies.  The goal is to show people that they can take control of their mental and emotional fitness the way they can their physical health.  And it doesn’t take any extraordinary measures.

Research shows that, in just five simple steps, people can improve their overall mood, health, and feeling of happiness.  Board members invite everyone to try it out, and see whether or not (over eight weeks) they can improve their sense of well-being by:

1. Connecting with friends and family.

2. Moving your body 30 minutes a day.

3. Being mindful of your experiences, in the world and inside yourself.

4. Learning something new, take a class, or dust off an old skill set.

5. Giving to your community or someone in need by volunteering or sharing with others.

Research has found these actions effectively build the resiliency that helps people reduce or avoid serious mental health and substance abuse problems.

Want to get involved?  Here’s how:

• Follow examples on the Sound Minds in Sounds Bodies webpage and share your ideas here or on the AMHB and ABADA Facebook pages.

• Sign up for the AMHB and ABADA President’s Active Lifestyle Challenge group at http://www.presidentschallenge.org (group number 96386) and get moving 30 minutes a day.

Why are we really doing this?  Well, for some us, it’s to beat the wintertime blahs.  For others, it’s part of an overall focus on improving health – complete whole-person health. 

And for some of us, it’s to draw attention to the health needs of an estimated 55,000 Alaskans (adults and youth) who experience serious mental health issues and/or alcohol dependence each year.  There are ways to prevent those serious health problems, and promoting overall wellness is one of them.  If we can improve our health, one person at a time, we can start to make a dent in the more than $90 million the State of Alaska spent on mental health and substance abuse treatment services from mid 2009 to mid 2010.

Happier people and a healthier budget – what better reasons do we need?

Stories of Loss and Ideas for Change at Suicide Prevention Listening Session

A guest post from Eric Morrison, assistant to Alaska’s Statewide Suicide Prevention Council:

Hearing a parent tell of the loss of a child is absolutely heartbreaking.

Hearing parent after parent stand up in a room full of hundreds of strangers on Tuesday and talk about their children who have taken their own lives emphasized just how much pain and sorrow the suicide epidemic in Alaska has caused. 

More than 400 people filled the Cook Room at the Egan Convention Center in Anchorage on Tuesday as part of a suicide “listening session” hosted by the Indian Health Service, the Bureau of Indian Affairs, and the Substance Abuse and Mental Health Services Administration. The event is one of ten listening sessions being held around the country to address the Obama administration’s increased concern about suicide rates among Alaska Natives and Native Americans.

The numbers speak for themselves. Alaska Natives and Native Americans have a suicide rate 72% higher than the general American population, according to IHS. Young Native Alaskan males currently have the highest per capita rate of suicide of any demographic group in the country. And Alaska has the highest per capita rate of suicide of all 50 states.

It is encouraging to see the federal government begin to take action to prevent suicide. Tribal leaders across the nation met with President Obama last year on Native issues. The President was troubled by the suicides in Alaska, said Dr. Rose Weahkee, director of the Division of Behavioral Health at the Indian Health Service.

IHS is listening to public comments, concerns and recommendations made at these sessions to help shape the goals and agenda of a national Native American suicide prevention conference in 2011. If the other listening sessions are anything like the one in Anchorage, than IHS will have plenty of material, ideas and concerns to sort through.

Some of the main concerns and problems brought up Tuesday were ones often associated with suicide in Alaska – domestic violence, sexual abuse, bullying, drug use, and particularly, alcohol abuse. Barbara Franks, a tireless suicide prevention advocate and vice-chair of the Statewide Suicide Prevention Council, called those problems the “cousins of suicide.” And while these are still major problems in the state, she feels hopeful about suicide prevention efforts in Alaska and the momentum being built throughout the state.

Thirteen years ago, Barbara’s son committed suicide only days before his father died of cancer. Back then, Barbara says there wasn’t a place for suicide survivors to go for help. People weren’t willing to talk openly about the issue. Now people are finally willing to talk about suicide.  There are places where family and friends can go for help coping with the loss of a loved one to suicide. Tuesday’s listening session shows that – people coming together to share their stories of loss and to support each other in their grief.

James Sipary Sr., a suicide survivor from Toksook Bay who lost his son, described suicide in Western Alaska like a plague that has swept the region like the flu. James said it is time to declare war on alcohol, sexual abuse and domestic violence in order to prevent suicide. There is “no miracle,” but he encouraged Alaskans to put their heads together so we can reduce this problem for future generations. James wants people to “celebrate who we are” to rely more on elders and traditional ways of knowing to stop suicides in Alaska.

Bill Martin, chair of the Statewide Suicide Prevention Council, spoke about Alaska’s rich history of taking care of its elders, and suggested that we should also put our children “on a pedestal” and show that we are proud of our young people. Janice Jackson, Grand President of the Alaska Native Sisterhood, said it is the duty of tribal leaders to reach out and speak to the young people and protect them.

Many ideas about preventing suicide were discussed Tuesday. People asked for culturally relevant programs, including culturally based alcohol rehabilitation centers. Others asked for more suicide prevention materials on the radio, television and in newspapers and magazines. Some proposed mandatory suicide prevention training for teachers in rural Alaskan schools. Almost everyone concluded that it is time for the federal government to provide more financial support to reduce the rate of suicides for Native Alaskans. 

One of the more memorable stories I heard was from an elder.  She described suicide as “a bad fruit.” She said there are “good fruits that come from good roots,” but alcohol abuse and domestic violence are “bad roots” that have, over time, come to bear the “bad fruit” of suicide. Hopefully Alaska can come together to create healthy, good roots that will bear good fruit to nourish Alaskans for generations to come.

If you or anyone you know has talked about or contemplated suicide, there is help available. To talk to someone that can help, call Careline crisis intervention at 1-877-266-4357 or visit www.carelinealaska.org.           

What is Mental Health?

I am attending the Sixth World Conference on the Promotion of Mental with the Boards’ two planners, Tom and Rebecca.  This is an international conference, occurring every two years, that brings mental health policymakers and experts together to discuss ways to promote mental wellness worldwide.

One of the very basic ideas being discussed is what does “mental health” mean?  Many people think “mental health” means “mental illness.”  Which is kind of interesting, since we would not normally equate the word “healthy” with “sick” in other contexts.

Pinning down a definition of mental health or mental well-being isn’t as easy as you’d think.  Some people say it means “not mentally ill.”  Others define it as “happiness” — which of course leads to the question “what is happiness?”  Still others look at is as describing a level of acceptable functioning or behaviors.

This afternoon, Corey Keyes shared his working definition of mental health, and it makes a lot of sense.  He describes mental health/well-being as a state of being that includes positive functioning and positive feeling (doing well and feeling good). 

Positive functioning includes psychological and social well-being, balancing the person as an individual and the person as a member of a community.  Psychological functioning involves self-acceptance, positive relationships with other people, opportunities for personal growth, having a purpose in life, having control over environment, and autonomy.  Dr. Keyes explained this as being accepting of ourselves as we are, being able to trust other people in our relationships, having personal challenges in our lives, feeling like our lives matter, and being able to exercise self-determination.

Then there is the community aspect — social well-being.  This means accepting other people (like we accept ourselves), being integrated in a community (through those positive relationships), being part of a community that evolves and grows (like that personal growth we need to be well), contributing to the community (as part of that purpose for living), and having a sense of coherence in our community (echoing that need for control over ourselves and our environments). 

That’s Dr. Keyes explanation of the “doing well” part.  Then there’s the “feeling good” — emotional well-being — part of mental health.  That has fewer criteria, but might be harder to achieve.  Dr. Keyes explains emotional well-being as happiness PLUS satisfaction with life PLUS zest (or interest in living).  Those seem like terms which would mean different things to different people, but “feeling good” makes sense to me.  And I love the fact that he includes “”zest!”

As we move forward with mental health promotion in Alaska, we will need to have a common definition for what mental health or mental well-being means to us.  So I’m interested to know, what does “mental health” mean to you?

School Mental Health ~ A Whole School Effort

The International Alliance for Child and Adolescent Mental Health and Schools and the American Institute of Research sponsored a session today on the science behind school mental health and how to successfully promote students’ mental wellness.   The information provided was fascinating, and reinforced how important it is to understand that school mental health is not simply clinical services delivered in schools — it involves the whole school community working to create a school climate and ethos that promotes wellness.

With the current national focus on bullying in schools, and how it affects children so deeply, it makes sense to think about targeted prevention approaches to solve specific problems faced by a select population.  But one of the ideas I took away from today’s workshop was that, without a universal prevention effort (one aimed at the entire school population) to serve as the foundation for overall wellness, the targeted approach can actually make things worse by increasing stigma.  And we know that stigma is one of the biggest barriers to individuals and famiies seeking mental health services.

Another principle I learned was the importance of having students and parents engaged in prevention efforts with teachers and administrators.  This is based on an idea of school community working together to promote mental wellness, rather than leaving it to health educators to try and do in 1 hour a week.  When students and parents and caregivers receive education related to prevention efforts, they can support and reinforce the skills and concepts taught through whatever health promotion/prevention program is being used.  And that in turn can help children grow up healthy and have positive school experiences.

Really, what I learned today is that I need to learn a lot more about school mental health.  To broaden my perspective beyond school psychologists and mental health clinicians who provide services on school grounds, and to think about how overall mental health and wellness affects students’ ability to learn well and teachers’ ability to teach effectively.

“In Their Words” – Employment Supports and Challenges

The Advisory Board on Alcoholism and Drug Abuse and Alaska Mental Health Board were lucky enough to have the chance to learn from a group of people in recovery who found and maintained employment through vocational rehabilitation and/or peer support services. We heard from folks from Polaris House in Juneau and the Wellness Innovations Center in Anchorage, as well as a young woman who worked with the Division of Vocational Rehabilitation to find meaningful work.

Andrea Schmook is the director of the Wellness Innovations Center.  She explained that she is in recovery from mental illness, and shared her story of recovery.  When she was diagnosed with mental illness, no one ever talked about “recovery” or getting better.  But she decided she would do everything people said she couldn’t.  It took her several years to achieve recovery and get back to work, but she did it – thanks to the fact that she had an employer who understood that she could work with support and understanding.  This was before anyone offered “supportive employment.”  They were just people who treated her with kindness and respect, even when she had trouble or made mistakes, and encouraged her to find the strength and courage to overcome obstacles at work.  She shared that “Recovery is very spiritual.  It has to do with people not looking down on you.”  That connection with people is what made recovery possible. 

Alvin, an employment specialist at Wellness Innovations Center, shared his story from when he was a child.  His grandfather taught him the value of working.  He would collect cans to recycle.  His grandfather would take the cans and turn them in, and then bring back $5-7.  (Now he knows that was way more than what the cans brought it, but he’s grateful for the lesson to work hard.)  He had several jobs as a young man – “working was always a part of who I am.”  Then, he experienced the onset of mental illness.  He lost his job, and his family, and felt suicidal.  It took him a while to find the right services.  Luckily, he did.  His treatment providers supported his decision to go back to work, to get back to himself, to recover. 

The first time Alvin tried to go back to work, he only kept the job 2 weeks.  He continued to find – and get – jobs, over time maintaining the employment for longer and longer.  In 2005 he took a job as a peer support provider, and in 2009 he was promoted to a full time position as a peer support employment specialist.  “Work will always be a part of myself.”

Darryl from Juneau shared that “life is still a recovery.”  He experiences chronic depression and has had some troubles in his past. Two years ago he lost his job, his place to live, and almost his life.  He was feeling suicidal.  But luckily someone told him about Polaris House, the peer support clubhouse in Juneau.  He stopped in, and learned how the members there help support each other.  He wasn’t sure he wanted that.  He was convinced he’d never be able to maintain employment, be accepted for who he is, be able to build a life again.  But he started stopping in once a week or so anyway.  Someone there told him “You amount to something.  You mean something to us, and we miss you when you don’t come in.”  That’s when he decided that he’d try and get his life back together.

Now Darryl works for a company that has employed him several times in the past.  At first he thought they’d never hire him again, but with encouragement from the other members at Polaris House he tried anyway.  “There are people out there willing to give you that second chance, that third chance, if you just ask for it.”  He got the job, and last week he signed the lease on a new apartment.  “If it wasn’t for the peer support of Polaris House, and the people there reaching out, I would probably have committed suicide 14 months ago.”  By connecting with him, they helped him see that life is worth living.

Dorothy Green is a “cheerleader” – she is the director of Polaris House.  Polaris House is a certified clubhouse (the only one in Alaska) offering peer support services to people experiencing mental illness.  They are “intentionally understaffed,” to ensure that members are providing the services and support to each other.  A lot of their members have been told they can’t work, shouldn’t work.  But they’ve learned that “working is one of the most rehabilitative things people can do.”  What we do, where we work is a big part of who we are, so Polaris House offers more than a welcoming place where everyone belongs.  They offer empowerment through work.  They help their members find and maintain work.  Good work, good jobs, with good wages.  In 2008, their members earned over $200,000.  They did in 2009, too (despite the economic downturn). 

Caitlyn shared her story, even though she was very nervous and her story was really hard for her to tell. After a long road to recovery, she was able to access the Division of Vocational Rehabilitation’s services.  It was a long process, but now she owns her own business.  It’s not easy, and every day is a day of recovery.  She wishes there was more help for her as she builds her business, and keeps her life “on the right track.”   But now she knows she can work, support herself, and live the life she wants to live.

This was an amazingly powerful conversation for us all.  Tomorrow board members will talk about everything they’ve learned here about supportive employment, what works, what doesn’t, what’s needed — and then decide how they can help improve employment opportunities for Alaskans with behavioral health disorders.

Community Resources in Ketchikan

The Alaska Mental Health Board and Advisory Board on Alcoholism and Drug Abuse are holding their quarterly meeting in Ketchikan this week.   We spent all day yesterday learning about behavioral health resources and hearing from members of the community.  And boy, did we learn a lot.

Despite the never-ending rain in Alaska’s First City, the level of energy in the community of Ketchikan is astounding.  There are some great children’s mental health resources, at Community Connections and Residential Youth Care.  They work closely with the local school district and other service providers to provide treatment and support services to children experiencing serious emotional disturbances.  We were impressed with the leadership, longevity, and very positive outcomes reported for the kids they serve. 

We also learned about the changes afoot at the community mental health center, Gateway Center for Human Services.  Now being operated by Akeela, Inc. out of Anchorage, the mental health center is restructuring to provide better services to the community.  There is a lot of hope — and high expectations — for Gateway from people and agencies in the community.  They will also run KAR House, the residential substance abuse treatment center.  Set to open in early November, KAR House will offer 12 residential treatment beds (but not detox services).

We heard from Hearts, a local peer support organization, about the services they offer.  Exciting news was shared by Southeast Alaska Independent Living — they are partnering with NAMI-Ketchikan to offer recovery support groups for people with mental illness.

Ketchikan is the home location for one of the rare for-profit substance abuse prevention programs.  TSS, Inc. has locations in Ketchikan, Craig, Juneau and Anchorage, providing drug screening, safety training, crime scene decontamination, and other specialized services to ensure workplaces are safe and sober.  Unlike the vast majority of Alaska’s providers, which are non-profit agencies, TSS, Inc. is a privately owned business.  We learned that they aren’t just in it for the money — TSS, Inc. is a major partner in the local community’s wellness promotion efforts.  They have funded suicide prevention education materials and host the substance abuse task force meetings.  This unique partnership of for-profit and non-profit efforts has resulted in a stronger connection between the business community and health promotion efforts.

The Ketchikan Wellness Coalition is an amazing network of community task forces looking at health and wellness.  We got to sit in on a Substance Abuse Task Force meeting, and saw a dynamic and inclusive group of people tackling a major problem.  We also heard from SPEAK, the local suicide prevention coalition.  They have worked to raise awareness as a way to prevent suicide (which has been a heartbreaking epidemic in Ketchikan over the last 2 years).

Gaps in services are still present, though.  Specialized mental health and substance abuse services for seniors and adults with developmental disabilities aren’t available in Ketchikan.  Only a few agencies, like Community Connections, are able to provide services in the nearby communities on Prince of Wales Island.  And those communities are in serious need for mental health and substance abuse treatment services.

One of the coolest things about this meeting so far is the people of Ketchikan.  They have welcomed us, and shared their successes and troubles with us with such openness.  We are very grateful to have the chance to spend time here.

Listening to Young Voices in Bethel

Yesterday, a group of Native Alaskan youth and elders joined together for a roundtable in Bethel convened by Senator Lisa Murkowski.  The issue before us was suicide and how to prevent the continued epidemic of youth suicide in Alaska’s communities.   A panel of federal and state officials, including Governor Parnell and members of the Statewide Suicide Prevention Council, sat together and listened for 4 hours to young people and elders sharing their stories about how suicide has touched them — and how they think we can work together to prevent suicide.

I was struck by the words that poured slowly, quietly, sorrowfully from the young people.  The pain that fills their lives, that hides any hope, was enough to break my heart.  They shared losses throughout their short lifetimes, as recently as three days ago.  The wisdom that has come from that pain, so early in life, was inspiring.

How do we prevent youth suicide?  We talk to our children about suicide and other hard issues, we love them openly and with embarassing abundance, we model healthy lives, and we support their dreams. 

Interestingly, not one child asked for more federal or state money.  Not one child asked for clinical interventions.  Not one child asked for a fancy new program.  The solution, as they see it, is time, respect, and love.

The wisdom shared by the elders, earned through long and sometimes difficult lives, echoed that learned through pain.  The elders spoke of the need for healthy lifestyles among adults and parents, a return to the traditional values of respect and communal care, and a need to take responsibility for the issue — to be the “hands and feet” of the solution.

It was a beautiful day in Bethel. Not just because the sun was shining and it was a crisp fall day in bush Alaska.  It was a chance to see the beauty and strength of the Yupik people, and the compassion that comes when we just sit quietly and listen.

More on Brain Injury and Substance Abuse

Yesterday, I attended another session presented by Dr. John Corrigan.  The focus was narrower that the day before – effective interventions for co-occurring substance abuse and traumatic brain injury (TBI).  The information was fascinating, and yet seems like just common sense.

Early models to treat substance abuse and TBI were limited to residential TBI treatment settings.  That didn’t help people who didn’t need residential care. 

Now, there are a variety of ways people are treating TBI with a co-occurring substance use disorder. Some models use motivational interviewing, with mixed results.  Models that blend cognitive behavioral therapy and skills-based treatment look promising, but there isn’t much research on the outcomes.  That’s really a problem overall – there is very little research about how standard substance abuse treatment models work when applied to individuals who have experienced a TBI.

Dr. Corrigan shared research that shows that people 1 year after hospitalization for a TBI who need substance abuse treatment have trouble getting help (78% had trouble accessing treatment).  So he and his colleagues in Ohio looked at a model that looks at the severity of the addiction AND the severity of the TBI.  Once you know that, you can see where the best intervention setting might be.  For “low level addiction + mild TBI” the best setting is primary care (the basic doctor’s office).  For the most severe,  very specialized care is needed.  This is how Dr. Corrigan broke down the analysis:

High Level Addiction + Low Level TBIBest setting:    Substance Abuse Treatment       Centers Best intervention: Screening for TBI,                            Accommodation, Referral, Case Mangement	High Level Addiction + Severe TBIBest setting:  Specialized TBI + Substance Abuse Treatment  (doesn’t really exist except OH) Best Intervention: Truly integrated care that is  collaborative & individual
Low Level Addiction + Low Level TBIBest setting: Primary Care or Trauma Center Best intervention: Screening, Brief Intervention   (SBI)	Low Level Addiction + Severe TBIBest setting: TBI Rehabilitation Centers Best intervention: Education, SBI, Referral

What’s the best way to provide treatment for co-occurring addiction and mild brain injury?  Dr. Corrigan explained that one of the best ways is simply to dispel myths and stereotypes about cognitive impairments.  Treatment providers may not understand how the brain injury affects behavior, and so they might think that the person is being impulsive or rude or annoying.  This makes it hard for the provider and the person to build a relationship, which undermines the whole treatment process.

Dr. Corrigan shared that he and his colleagues have treated co-occurring TBI and addiction for almost 20 years.  In that time, they have noticed some major issues:

• There is a greater disconnect between wanting to change behavior and doing it for people who have experienced a TBI.  No matter how much the person with a TBI wants to get sober, that disconnect makes relapse much more likely.  People with a TBI are often seen as “non-compliant” because they drop out of treatment – but really it’s because of their brain injury and not because they just “don’t want to get sober.”  That brain injury also makes it harder for the person to participate in the typical substance abuse treatment model.
• People who have experienced a brain injury may not learn like everyone else, may not be able to remember things, or may not be able to pay attention for a whole 90 minute group session.  This may come across as the person not “buying in” to their treatment, when really it’s their brain injury getting in the way.  They need to have the treatment model adapted to meet them where they are (rather than demanding they change to fit the model).
• TBI makes it harder for a person to maintain sobriety once they leave treatment.  Without strong supports during and after the treatment, only about half of individuals with a TBI who go through treatment stay sober.
• People who have experienced a TBI are more likely to also experience a serious mental health disorder.  For most, these are affective disorders (like major depression, personality disorders, etc.).  Treatment that address the TBI, the addiction AND the mental health disorder is very important.

So, success depends on taking the client with a TBI as a whole person and addressing all the behavioral health and cognitive problems at the same time.  Makes sense, doesn’t it?

P.S. The Ohio Valley Center for Brain Injury Prevention and Rehabilitation has a toolkit for working with people who have a TBI and a substance use disorder.

You Learn Something New Everyday

The Alaska Brain Injury Conference is going on this week in Anchorage.  One of the presenters is Dr. John Corrigan from the Ohio State Department of Physical Medicine and Rehabilitation, an expert on the connection between substance abuse and traumatic brain injury.  This is what he shared:

TBI is most likely to affect the front part of the brain – which means a lot when it comes to addictions.  The pathways most involved in addiction are the connections between the front part of the brain.  The nucleus accumbens in the front part of the brain is possibly the part of the brain responsible for that process of becoming addicted (to anything).  It’s near the brain network involved in making choices between a lesser reward now over a greater reward later.

A prior history of substance abuse disorder was more associated with TBI-related death or disability than intoxication at the time of injury.  About 60% of people in physical rehabilitation (after a TBI) presented with a history of substance abuse disorders.   That’s an awful lot of people.  Why is this?

Part of it is that injury while intoxicated is more likely to result in TBI.  Dr. Corrigan reported that, if the BAC is .15-.199 at the time of injury, the likelihood of TBI is 300% higher.  If the BAC is over .20 at time of injury, the likelihood of a TBI is 900% greater.  Since folks don’t often reach those really high BAC levels without a long history of alcohol abuse, the conclusion is that the issue isn’t how intoxicated you are at time of injury but how chronic the alcoholism is before the TBI.

Dr. Corrigan reported that people who experienced a TBI drinking alcohol 1 year after injury are pretty high.  Research shows that 50% of survivors who were hospitalized are drinking too much or using drugs a year after injury, and 30% of survivors who were treated in a rehab setting were drinking too much or using drugs a year after injury.  He shared data and studies that show 16% of TBI survivors reported heavy drinking and 30% reported moderate to light drinking – when often any alcohol is too much given their medical condition.  The rate of binge drinking among TBI survivors is higher than the general population, with 48% reporting at least 1 episode of binge drinking in the first year after injury.  Dr. Corrigan also reported that 5-10% of TBI survivors develop a substance use disorder after the injury, when they had no problem before the injury.

You can see the connection in other ways.  Substance abuse treatment providers who screen clients for TBI find that more than half of their clients report a TBI.  For clients with co-occurring mental illness and addiction, the rate of TBI is almost 75%.  Most of the time happening during adolescence.  This is important – the TBI most involved with substance abuse is an old one (and often there have been more than one).

He shared that current research indicates that the age of the person at the first TBI is a big predictor for future substance use disorders. The data show that after this early TBI, substance abuse disorders can develop, and then the person can start to experience additional TBI injuries again and again, often getting more and more severe.  (This research is happening now at OSU, so we’ll have to keep an eye out for it.)

Research from New Zealand – a longitudinal study of 1,265 children born in 1977 – shows the same connection between TBI and substance abuse.  All of the TBIs experienced before age 6 were mild, and 80% of those experienced between age 6-10 were mild.  Those children who had been hospitalized for a TBI (even if it was mild) were more likely to have substance use/abuse problems in their teens.  Those children who’d been hospitalized before age 6 for a TBI were 3 times more likely to have substance abuse problems in later teens/young adulthood and many times more likely to have been arrested as a young adult.

So, what I learned from this is that the front part of the brain is affected by TBI and addiction.  TBI and addiction are very likely to occur together.  And early childhood TBI, even if it’s a mild one.

If you want to learn more about TBI, or if you have experienced a TBI and are looking for support or resources, contact the Alaska Brain Injury Network at 907-274-2824.

Support for Attorney General Daniel Sullivan’s Pro Bono Summit

During this week’s meeting of the Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse in Valdez, board members took time out to recognize Attorney General Daniel Sullivan’s efforts at Monday’s pro bono summit to encourage attorneys to represent victims of domestic violence and sexual assault free of charge. Alaskans affected by domestic violence and sexual assault, whether directly or indirectly as witnesses of domestic violence, often require mental health and/or substance abuse treatment services.

Substance abuse is a major factor in domestic violence in Alaska, for perpetrators and for survivors.  According to the Alaska Network on Domestic Violence and Sexual Assault, many victims of domestic violence and sexual assault who struggle with substance abuse disorders “experience discrimination and barriers to services.”  This includes access to quality legal representation.

 There is still a lot of stigma around substance abuse.  People think it’s a character flaw instead of a disease.  Which means many victims feel like they can’t ask for help. By making access to a pro bono attorney easier, we help these people access the legal system and find security. 

Victims of domestic violence and sexual assault experience serious emotional and mental trauma as a result of these crimes. This often makes it hard for them to represent themselves in custody and other cases. Ensuring that they have effective and compassionate legal representation from a pro bono lawyer gives victims of family and interpersonal violence access to justice.

The Alaska Network on Domestic Violence and Sexual Assault offers free training and mentoring for pro bono attorneys accepting cases for domestic violence victims.  This has been a great asset for the legal community in Alaska, and we appreciate all that ANDVSA and these volunteer attorneys do for victims of violence – especially those with disabilities.

What’s On Your Bookshelf?

Not every publication about mental health is a dry scientific article, and not every story about substance abuse is like an episode of Celebrity Rehab.  In fact, there are several interesting books out that are sitting on my coffee table, just waiting for me to come to rest and have time to explore them.  So, I thought I would share what’s on my reading list:

Former First Lady Rosalynn Carter has been a tireless advocate for individuals experiencing mental illness.  This month, she released her latest book, Within Our Reach: Ending the Mental Health Crisis.  She addresses the fact that, despite many improvements in the mental health system, stigma remains a barrier to real change.  And the problems caused by the ups and downs of public funding for mental health services — especially relevant now in times of economic problems.  The book does not simply criticize the system, but notes reasons for hope.  Mrs. Carter notes that, when she started advocating for reform, she never dreamed that people could receive the services they need to really live lives of recovery.  But now, that’s not just possible — it’s happening.  (Full book review) 

Legend of a Suicide is an award winning novel, but really it’s the (loosely fictionalized) story of the author, David Vann from Alaska, and his struggle to deal with his father’s suicide.  In a collection of stories spanning the main character’s life from childhood to adulthood, the author explores the shame and guilt often experienced by family members who survive a suicide. (Full book review)

Also in the memoir category — without the facade of fiction — is Lit.  This is Mary Karr’s powerful story of addiction and recovery: tracing her descent into alcoholism and “her conflicted, piecemeal return from that numb hell.”  It sounds like a hard read, but promises to also chronicle how she found her creative voice through her recovery.  (Full book review) 

So, this is what’s on my summer reading list.  What’s on your bookshelf?