Business Can Lead the Way on Addressing Mental Health

From theSpec.com comes this post about workplace mental health concerns and how corporations may be in a better position to do something about it.

Here is a link to an executive summary of the report referenced in the above item.

Wavelength

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When I was a kid, one of the high points of my day used to be coming home from school to watch the Merv Griffin Show.

Long before he was a real estate tycoon and game show visionary, Griffin was a singer and, for a quarter of a century, he was a talk show host.

The show's format was similar to that of Carson's Tonight Show and he had many of the same guests; you just didn't have to stay up past 11:30 in order to see it.

We saw the show on a UHF station out of Burlington, Vermont. UHF was fascinating to us because, unlike the “regular channels” two through 12 that you selected with the rotary switch tuner that had hard, definitive stops for each channel, UHF was more of an interpretive spectrum and its stations were literally “tuned in” in the same way that you tuned in a radio.

I watched the show in the same way that an anthropologist watches a new culture: I most often had no idea what they were talking about, but I was captivated because these were adults talking to other adults about adult things. Perhaps, in some way, I was looking for a way to understand the adults in my world.

I have a few very clear memories of the show: the banter with trumpeter Jack Sheldon whose voice I recognized from the seminal “I'm Just a Bill” segment of Schoolhouse Rock; the regular appearances of Arthur Treacher, the British character actor who went on to lend his name to a chain of fish and chip shops; David Letterman appeared on the show early in his career as a stand-up and one of his jokes was “Hands up, everyone who's in the country illegally.” Mel Torme was on the show many times and I remember them talking about how he came to write “The Christmas Song” that Nat “King” Cole made unforgettable.

The genesis of that song is the stuff of legend now, but I can recall marveling at the disconnect between what they wrote and the circumstances that inspired it. It was the middle of summer and the hottest day of the year and Torme, with his writing partner Bob Wells, wrote the piece in an effort to imagine themselves into a cooler place.

As I have gotten older, I have come to the position that it is in the remembering that this time of year has its greatest power.

When you're a kid, the details of any given holiday season are a blur: it's uncomfortable clothes, strange foods, toys, visits to people you don't know, but who seem to know an awful lot about you. All that you want to do is play with your stuff, or depending on your age, the packaging it came in.

There is not a lot of nostalgia for this time of year when you're young. Like doctor's visits and exams, it comes around every year and the only thing that changes is the quality and variety of the gifts you receive.

Once you become an adult, once you break the annual cycle of holiday celebrations, you are driven to replace them with some sort of idealized facsimile.

Each of us I think goes through their first experience of this time of year as an adult when we are separated from family and familiars, from tradition and history. It can be a very disturbing, disorienting experience. It's like going from having your own room to staying in the guest room: nothing is where it is supposed to be and you are under some pressure to get up on time so the rest of the house can use the restroom. This is probably one of those foundational experiences that we all have to have in order to define ourselves as distinct from our families of origin.

And, as hard as it might be to experience, it is more difficult for parents when their children no longer come home for the holidays. It's one of those benchmarks that are as inevitable as they are unsettling. A corner has been turned when the annual holiday portrait can no longer be organized without benefit of negotiation and trips to the airport.

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So, even though this might be the “most wonderful time of the year” our hearts our full and our feelings mixed with a kind of sad nostalgia We look back on our memories of holidays gone by and while we might speak in terms of Currier & Ives, what we see in our mind's eye is more akin to an Escher drawing—exquisite in its detail but something that could never exist in the real world.

And yet every year we relaunch our efforts to turn our holiday fantasies into reality because we all want to do a good job. Long after we may have abandoned Santa Claus we still try to make it onto his list and avoid the lump of coal in our stockings.

Like so many of our traditions associated with Christmas, this high-stakes behavior modification has its roots in central Europe where more than just the weather is grey.

http://ow.ly/82PTe

Deeply rooted in our celebrations are the figures of St. Nicholas and Krampus. St. Nicholas would reward children's good deeds and Krampus would round up the bad ones and eat them. In those days, being good for goodness' sake was not good enough; it was literally a life or death proposition.

To this day, we frame Christmas as a merit-based holiday where we expect to learn our place on the naughty-nice axis and be rewarded accordingly. If we are nice, we get a gift from St. Nick and if we are not, we get eaten. Even as adults, as the days get shorter, we alter our behavior in a kind of campaign for recognition and reward. Our self-worth is tied to the quantity and quality of the presents we receive.

Intellectually, we might know this is not true, but this risk-versus-reward idea is so ingrained that parents will question the love of their children if they are not able to provide the latest and the hottest gifts each year.

Celebrating the holidays is to hold oneself to an impossible standard: the tree is never big enough, the gifts are never exactly what was wanted and the meal was never good enough. Making matters worse are the seemingly endless array of self-appointed experts with tips and tricks on how to get the “perfect” this or the “ideal” that.

Lubricating the entire year-end celebration machine is a relentless musical soundtrack designed both to evoke and to provoke.

We are the the shoppers who “rush home with their treasures” so that we can get out “walking in a winter wonderland.” We buy chestnuts even though we don't have open fires. We commit to memory the names of the reindeer by humming the one about Rudolph and yet, when pressed can never come up with Comet, Donder, Cupid and Blitzen.

http://ow.ly/82PXk

My favorite music for this time of year is instrumental. I am a big fan of the music recorded by Vince Guaraldi in 1965 for “A Charlie Brown Christmas.”

I haven't quite figured out whether it's the music itself, or my associations to it, but every time I hear a cut from that recording I think of a warm fire, hot chocolate and many of the items from the “Most Wonderful Time of the Year” list. Most of all, I think of a time when Christmas was much less complicated.

In the days before the VCR it was always a challenge to figure out when the special would air each year and arrange our lives accordingly.

Even as a kid, I strongly identified with Charlie Brown and his struggle to come up with his own definition of Christmas.

It is a tribute to Schulz's artistry that, in just over twenty minutes, he and the animators are able to capture the complexity of Christmas. Each of the characters in the Peanuts universe speaks to some aspect of Charlie Brown's character. His eternal optimism comes from Linus, his ego from Lucy, his artistry and imagination from Schroeder and Snoopy, his self-worth from Pigpen. In the show, these and other characters literally dance around to their own music until Charlie Brown is able to direct them toward a coherent holiday celebration.

In the end, we are not presented with a simple answer: that this or that is the true reason for the season. Schulz uses Biblical language, but the real lesson is Charlie Brown's search for a meaning that makes sense to him, a personal vision.

Each of us has a spectrum of memories about this time of year. Each Christmas has a different character and each of those characters has its own music, or theme, and, like Charlie Brown, it is our responsibility to find a personal coherence. It's like the radio in that regard, you have to keep adjusting in order to stay on the proper wavelength.

--Graham Campbell
Associate Director

How Would You Feel If You Were in Poverty?

At a recent Prosperity and Problem Solving Supper (PPSS) for the Licking County Bridges Out of Poverty ininitiative, we asked students from a youth group at St. Francis de Sales church in Newark to interview one another about poverty.

What follows is an assembly of their answers to one of the questions.

Thanksgiving

The following is from a letter received at our YES Clubhouse.

Through the generosity of local organizations (churches, service clubs, etc.), we are periodically able to provide care packages to the families of our YES Club members.

Thank you so much for the food you sent home to our family.  On two separate occasions your staff sent us food.  I appreciate this so much, without this food our family would have not been able to eat any meals.

I work 45-50 hours a week to try and make things work, but unfortunately it doesn't always happen.  After paying bills and gas to get to work, there is not always enough money for food.

Holidays are rough for me, as it takes everything I have to just pay daily living expenses that there is no money left for anything extra. 

I thank God my children understand this, but it breaks my heart that can't even put up a Christmas tree. 

I hope all of the YES Club staff have a wonderful holiday and again, from the bottom of my heart, thank you for making sure my family does not go hungry.

We don't always hear back from our parents, but when we do, it quickly puts the holiday season in the proper perspective.

On behalf of the Board of Trustees and the staff of Mental Health America of Licking County, including the YES Clubhouse, please accept our very best wishes for a happy Thanksgiving.

--Paddy Kutz
Executive Director

More Questions Than Answers

I write about my dad because I can't talk to him anymore.

I remember when he turned the age that I am now and it seemed, looking back, that he had a lot more worked out then, then I do now.  I want to ask him about that, but I can't.

I want to ask him about fear and see what he has to say. 

The more time I spend in the mental health arena, the more I recognize the paralytic that fear has been in my life.  And, perhaps I flatter myself, but I think it played a part in his as well.  I know he forced himself through it and I would love to know his secret.

In the two decades since his passing, I have been carefully crafting this myth about my dad that is informed equally by "Death of a Salesman" and the Jimmy Stewart role in "The Greatest Show on Earth." 

I believe that he was a great salesman because he had some significant accounts with some of the largest employers in Canada.  I know he was a great salesman because he had a genuine interest in people.  I saw flashes of this growing up, but I really understood this when there were many more people that I did not know at his memorial service.

I believe that he had a very deliberate mind.  He seemed to find great comfort in the logic of mechanical systems and would spend hours in quiet solitude taking things apart, examining their components, cleaning them and putting them back together.  He would look forward each year to the last two weeks of August and his annual vacation.  He did not spend this time trekking around from one tourist destination to another, nor did he want to lay on a beach somewhere.  His ideal vacation was to trade in his suit for his work clothes and do things like take trees down, fix plumbing problems, or move large rocks.

Central to many of these projects was the practical application of physics.  My dad looked for every opportunity to explain the importance of the lever, the inclined plane, the wedge and the pulley.  It didn't seem to matter what the job was or even how many times we might have done similar tasks in the past, he would introduce each of these basic machines with such proprietary pride that it seemed he must have invented them all.

I can recall, with what feels like painful precision, the many trips I would have to make from wherever the job site happened to be to his workshop to get a piece of pipe.  There was always a stubborn bolt somewhere that would not yield to the crescent or pipe wrench until its handle had been extended and mechanical advantage applied.

I tell people to this day that my dad invented leverage.  Who says he didn't?

My dad was quite skilled when it came to felling trees.  He seemed to like the geometry of each instance.  He would scrutinize the location with great care and determine where he wanted the tree to fall.  Sometimes it was a simple job with a chainsaw, but the ones he took greatest pleasure in were the ones that involved redirecting the tree's natural fall.  So, for example, the tree was on the side of a hill and would, logically be expected to fall in the direction of the bottom of the hill, my dad would excel at rigging the tree to fall in the opposite direction.  Not only would these efforts involve his beloved leverage, but he could also bring out the block and tackle and lots and lots of chains.

I watch "Ax Men"--the reality show about commercial loggers--because it reminds me of those times I spent with my dad.

I would like to ask my dad about this, because I never really understood why he had such an affinity for this kind of work. 

I just sort of accepted that he would have been happier running a garage in a rural community because he had that sort of a personality.  People would come to him with their problems--not personal problems, although I think he might have dabbled in that to a certain extent--but primarily their mechanical problems.  If he couldn't fix it, he would certainly know where it could be fixed and by whom.

Despite having grown up in an urban environment and spending his entire professional life in a white collar job, he just always seemed more content gossiping at the local hardware or meeting the Guay brothers who owned a lumber mill.  I would like to know more about this aspect of his personality.

I write about my dad because I am trying to understand myself, trying to work out the answers I can no longer find out just by asking.

As I get older, I think that my dad and I are more alike than I would have been comfortable acknowledging when he was alive.  Now, I think I could talk to him about that.

I think that between my older brother and my younger sister and me, we received a pretty even distribution of his personality traits; each balanced by my mother's compassion.

My brother is the mechanic.  Trained as an artist, he has painstakingly built a business from a thousand and one moving parts, each of which has to be disassembled, cleaned and put back together.  In order to meet the needs of his clients, he will chase the solutions to problems with a ferocious tenacity. 

Like my father, my brother is always thinking, always analyzing, always working out ways to have the tree fall right where he wants it.  And, like with my father, it is profoundly frustrating to recognize that all of his hard work has not provided him the kinds of objective measures of success that he has earned and deserves.

My sister has the greatest portion of my father's interest in people.  She was a past master of social networking long before the term became part of our idiolect.  When she smiles, it is as though you have been picked out of the darkness by the beam of a lighthouse.  It is positively transformational in its effect causing, with only slight exaggeration, flowers to bloom and trees to bear fruit.

I joke that she is the son my father never had because, whereas my brother and I gravitated toward the arts, she ended up following my father into the investment business and, like my father, was able to build for herself a pretty respectable portfolio of clients.  My sister also is the only one of us three to have had children, which, I am certain, would have pleased my father very much.  (Both that she had them and that my brother and I did not.)

The three of us share my dad's temper, although I think we manage it each in our own way.

The myth of my father is that he experienced depression which can be defined as an anger turned inward.  When I was growing up, my brother turned his anger outward and expressed it physically.  As he has gotten older, he has learned other ways to work through his frustrations.  As I get older, it is getting harder for me to hide mine.  I was never big on any kind of physical expression, but I am capable of saying some pretty hurtful things. 

Here is where I should make some comments about my sister's temper, but I don't have a real understanding of that.  I have seen less of it because for too many years we have lived too far apart.  I do know that she has a temper which means that she has let it out at least once.

It is one of those eternal ironies that, as children, we seek to differentiate ourselves from our parents and emphasize those aspects that we think make us unique and individual.  As we age, however, we learn that, in the words of the great Buckaroo Banzai, "No matter where you go, there you are."

I write about my dad, not because I want to upset my mom, but because I see him more and more each day I look in the mirror.

--Graham Campbell
Associate Director

Voices from the Poverty Simulation

On October 8th, Mental Health America of Licking County's Bridges Out of Poverty Initiative, in partnership with Denison University, conducted a poverty simulation.  This activity is designed to show participants in a tangible way the many complex challenges faced by those who live in poverty.

After the simulation, the participants, some of whom role-play as persons in poverty and others as those public and private sector service providers on whom the poor are so dependant, were given the opportunity to reflect on their experience.

Two of these reflections were captured on video.

Meanwhile, Over on Facebook

The mind is willing, but there isn't always the time to write for this blog. So we have opted to put this up as a kind of place-holder until the next big idea comes along.

More People Using Free Preventative Benefits Provided by Affordable Care Act

Number of people who received 50 percent discount on prescription drugs also rises

The Centers for Medicare and Medicaid Services (CMS) reported today that nearly 20.5 million people with Medicare reviewed their health status at a free Annual Wellness Visit or received other preventive services with no deductible or cost sharing this year. In addition, nearly 1.8 million people with Medicare have received discounts on brand-name drugs in the Medicare Part D coverage gap, also known as the "donut hole," between January and August of this year. The total value of discounts to people with Medicare in the donut hole is nearly $1 billion through August of this year, with an average savings of $530 per beneficiary.

“Thanks to the Affordable Care Act, more people with Medicare are getting preventive services like mammograms for free,” said HHS Secretary Kathleen Sebelius. “The new health care law is also making prescription drugs more affordable for millions of seniors and people with disabilities.”

Some of the free preventive services available to people with Medicare include:

• Mammograms and cervical cancer screenings
• Annual Wellness Visit
• Cholesterol and other cardiovascular screenings
• Colorectal and prostate cancer screenings

“October is National Breast Cancer Awareness month – a great time for women with Medicare to schedule a free Annual Wellness Visit with their doctors. At that visit they can talk about their personal risk for breast cancer, if they should have a mammogram or how often to have one,” said CMS Administrator Donald Berwick, MD. “If you and your doctor decide that a mammogram is in order, Medicare will cover that preventive screening annually, free of charge. Already, more than 4 million women have taken advantage of that benefit this year.”

The rising number of people who are taking advantage of preventive benefits and prescription drug discounts comes as people with Medicare are beginning to review their plan options for next year. The popular web-based Medicare Plan Finder is now available to help beneficiaries, their families, other caregivers, and senior program advocates look at all local drug and health plan options that are available for the 2012 benefit year.

The annual enrollment period begins earlier this year than last year, on October 15, and runs through December 7. People with Medicare will have seven weeks to review Medicare Advantage and Part D prescription drug coverage benefits and plan options, and choose the option that best meets their unique needs or keep the plan they have today. The earlier open enrollment period also ensures that Medicare has enough time to process plan choices so that coverage can begin without interruption on January 1, 2012.

Every person with a Medicare Advantage or a Part D drug plan will also see better value in those plans for the second year. Average Part D drug plan premiums will remain virtually unchanged in 2012. Those in the Part D coverage gap, or do nut hole, will continue to be able to get discounts on covered brand name drugs. People with Medicare will get deeper discounts in the years ahead until the gap is closed in 2020. On average, Medicare Advantage premiums will be 4 percent lower in 2012 than in 2011, and plans project enrollment to increase by 10 percent. All beneficiaries will have access to Medicare-covered preventive services with zero cost-sharing, including the Annual Wellness Visit, bone-mass measurement, colon cancer screenings, and diabetes screenings, as well as influenza and pneumococcal vaccines, to name a few.

To access the Medicare Plan Finder, go to: https://www.medicare.gov/find-a-plan/.

For more information about how the Affordable Care Act closes the donut hole over time, go to: http://www.medicare.gov/Publications/Pubs/pdf/11493.pdf

For state-by-state information on the number of people who are benefiting from discounts in the donut hole in 2011, go to: https://www.cms.gov/Plan-Payment/

For state-by-state information on utilization of free preventive services and the Annual Wellness Visit, go to: http://www.cms.gov/NewMedia/02_preventive.asp

For more information on Medicare’s prevention benefits, go to the Share the News. Share the Health! website: http://www.medicare.gov/share-the-health/ or call 1-800-MEDICARE.

From SAMHSA CMHS Consumer Affairs E Newsletter Oct. 6, 2011

Losing

Last week, I came across this video post...

It's hard to watch because it feels very honest and direct.

As adults, we are caught off-guard.  It challenges our ideals of what childhood should be like knowing full well that, at the same age, we all kept secrets and pretended to be somebody who only really existed in family snapshots. 

To watch this is to have unfocused outrage.  Tillie has experienced things that no child should experience, even though to be an adult is to experience everyone of them in some form or other.

We want to help, to reach through the little YouTube window and try in some way to make it better even though we would, at best, only be delaying the inevitable disappointments of adulthood.

The real message of this video is not in the incidents of her life--shocking though they may be--but in how she has chosen to respond.  The take-away is that, after all that has happened to her, she is still accepting, still willing to listen, still thinks that everybody, no matter who they are, is "beautiful."

* * *

One of my jobs is to keep the Agency's Facebook pages supplied with new material.  To do that, I look at lots of blog posts, news stories and videos from all over the world.  Lately, there has been a whole lot of material relating to teen suicide.

It doesn't seem to matter whether the suicide happened in the developing world, the developed world, across the street or across the country, it was remarkable to me how similar the stories are one to another.

The players in each of these dramas have experienced loss, or have been threatened with loss; have been shamed, or believe they have brought shame to their families.

One story that has produced a number of different articles concerns a murder-suicide in Mississauga, Ontario near Toronto.  A 16 year-old male jumped from an overpass onto a busy expressway just prior to the discovery of the body of his 17 year-old female friend.  The young man survived the fall and being struck by at least one car only to succumb to his injuries a week later.

In the days since this double tragedy, it has come out that the male and female were friends, but that the male wanted more of a romantic relationship and the female did not share the same feelings.

The impact of this story and others like it on adults is generally one of shock and surprise.  We can't seem to understand why the young man would take the life of his friend and then try to kill himself.  Surely, this was just a case of unrequited puppy love.  What's the big deal?  Right?

The arc of childhood development is the evolution of empathy.  As infants we are completely self-obsessed and, hopefully, before we are turned loose on the world, we have some sense that others may have equally, if not more, compelling needs and desires than our own.

Researchers are now telling us that the brain is not fully developed until the mid-twenties.  Seen in that context, the challenges of navigating high school and relationships--romantic and otherwise--seem much more perilous.  As adults, we think we are lucky when we find the love of our life, but, as teenagers, every relationship is the love of your life.

I remember the last day of elementary school very clearly. 

It was a bright late June day and I was walking home from school crying.

I was absolutely inconsolable because I was never going to see Jane again.

This WAS a big deal.  For most of the previous 7 years, Jane had been part of my life.  She, along with the Wood sisters, was one of the three who were perpetually ahead of me in terms of grades. 

It's not like she and I were friends, but now that school was over, we never would be.  She and her family were moving to Ottawa and I wasn't.

I think I can still find the park bench that I collapsed on and where I spent what seemed like an eternity sobbing.

I was learning about loss. 

And it was more than the loss of a pet, or a cherished toy, or even a beloved relative:  this was the loss of an idea.  A secret vision of a theoretical future that was so special that I had dared not speak of it to anyone.  In fact, I don't think I really understood how I felt about Jane until I realized that I would never see her again and even that wasn't really real until after I had seen her for the last time.

But when I did, it hurt a LOT.

Everyone has had an experience like mine; one where you figure out what you want and then learn that not only can you not have it now, you won't ever have it.  The kind of want that so easily gets mistaken for need.  The kind of want that makes your heart race and your chest feel tight and your breath seem hard to catch.  The kind of want that makes an 11 year-old kid think that he could take a 90-minute bus ride to Ottawa despite having no earthly idea where to find Jane and a sneaking suspicion that she wouldn't exactly be happy to see me if I showed up.

Everybody has been that way about something, or somebody and so, no matter how hard we might wish to deny it, we all have a way back to understanding what it is, and how it is, that our teenagers are thinking. 

We can make that journey--make that connection--if we want to.

But, paradoxically, to be a teenager is to be in a rush to be an adult and we learn from our parents that teenage thinking is not nearly as important as adult thinking.  Teenagers are encouraged to "grow up" and to "get serious" even while their brains are still changing and their passions are so monumental because they are so new.

After the constant upheaval of being a teenager, what is desired is to have "adult passions" that are properly sized, proportional, manageable.

It is only after having been an adult for a while that you recognize the trade off that has been made and the space that has been emptied of outsized passions and filled with many too-small and far too trivial sentiments.

* * *

I try to take my dog for a walk every night after work.  I should be better about doing this considering all of the things he continues to teach me.

We have two or three routes that we take on a rotating basis.  A couple are pretty short and one is so long that he is dragging his tail before we are two-thirds done.  I try to mix them up just to keep it interesting for him--go a different route every day--but what I have come to understand is that it really doesn't matter.  We could walk the same route every day and it would be the same treat for him.  The choice to change up routes is one that I am really making for myself.  As far as the dog is concerned, so long as he is out walking, he's happy.  I might not be able to tell, but every tree--even though it was in exactly the same spot yesterday--is a new discovery, a chance to catch up on current events.

I have to keep reminding myself of this.

I watch him engage with his world from the other end of the lead.  I have to correct myself, stop myself from getting impatient as he makes his tree-by-tree, post-by-post inventory of the neighborhood.  I catch myself thinking how could he possibly be interested in smelling the same dried smells that he smelled the day before.  To him, they are of course fascinating and nuanced because he receives a lot of his information about the world through his nose.  I get much of my information about the world through my head.  I associate new information with old information, I see, or perceive, patterns based on experience.  As I get older, it takes less and less input to create new, fully formed impressions of the world.  My dog gets up every day thinking that it is the best day ever.

* * *

I'm much older now.  In theory, I could go to Ottawa any time I wanted. 

In theory.

I want to be absolutely clear. I have no interest in tracking down Jane, or anybody else.  I'm married and have a dog.  (We have a cat too, but we're never sure he's made up his mind to stay with us.)

In theory I could do a lot of things, but the other lesson you learn as an adult is that every choice has a consequence, every decision to move toward something is to move away from something else.  And choice by choice, day after day, the once seemingly endless possibilities of your future become the responsibilities of your present. 

Instead of treating each new opportunity as a sensation to be experienced, it become an obstacle over which it becomes harder to see from where you have come and that blocks your path to the future.

Tillie, for all the growing up she has already done, has not yet done so much that she can't see her future.

We all know a Tillie, probably more than we realize.  Get to know their stories.  Listen without judging.  Acknowledge them.  If you're feeling brave enough, tell them what scares you.  The life you save, just might be your own.

--Graham Campbell
Associate Director

World Mental Health Day 2011

The following post was developed with material from the website of the World Federation for Mental Health.  Where the pronouns "we" and "our" are used, they should be read as World Federation for Mental Health.

World Mental Health Day 2011 is October 10. World Mental Health Day raises public awareness about mental health issues. The day promotes more open discussion of mental disorders and investments in prevention and treatment services. The treatment gap for mental, neurological and substance use disorders is formidable especially in poor resource countries.

Physical and mental health are intertwined. There is a real need to deal with the mental health problems of people with chronic physical illnesses and physical care of mental health consumers through a continued and integrated care.

This year’s theme is “the Great Push for Mental Health.”

The major themes of the Great Push are Unity, Visibility, Rights, Recovery, and planning of this program is now in progress.

• UNITY - Perceptions of disunity in the mental health world, probably exaggerated need to be dispelled. The first round of the WFMH (World Federation for Mental Health) Great Global Consensus has demonstrated substantial agreement on fundamental issues with over 530 replies from organizations and individuals demonstrating over 95% agreement on the 10 principles of the World Federation The second round is in preparation and will address the inclusion of mental health as one of the Millennium Goals. The Consensus is designed to culminate in a WFMH/MGMH Consensus Summit" where participating organizations will be invited to fund one representative to the Summit at which the Consensus will form the basis of a WFMH /MGMH “Charter” to the United Nations and Governments stating clearly what mental health related and consumer/users/survivor organizations around the world require governments to do to improve mental health.

• VISIBILITY- Mental illness and the mentally ill are invisible, but stigma is everywhere. Our support for mental health must be made visible to governments. How can that be achieved but by public events? We will encourage organized parades, rallies and parties starting on World Mental Health Day (October 10, 2011), involving consumers and their families marching in public together with the support of mental health associations, professionals, academics, volunteers, managers of services and students! Countries will be encouraged to create and fund their own national parades. WFMH insures they happen together on World Mental Health Day. Parades should celebrate good mental health with celebrities and sports persons while calling for better awareness of, and services for mental illness. Parades should be attractive and entertaining for the general public while carrying a strong message. They could collect signatures to hand to governments with demands to do more for mental health both in their own country and abroad. Parades might continue year by year growing in strength and entertainment until a significant change in public opinion and government action is demonstrated. This is already happening in many places, particularly in India and in 2009 in Kalmunai, Sri Lanka, where nearly 5000 students, government and non-government sectors participated in a march two kilometres long. We need to be visible. They have shown us the way.

• RIGHTS - Appalling conditions are tolerated in many mental hospitals and abusive treatments for mental illness are common. Governments must not be allowed to tolerate these conditions: There is clearly a strong grass roots need to bring together legal experts and existing organizations to collect evidence and to lobby governments to address these issues across the world and bring them to public attention. We proposed the setting up of a Centre for Mental Health and Human Rights to tackle such issues with governments.

• RECOVERY - is an important concept but the term is used in many different ways. WFMH will convene a conference to sharpen the concept and define its principal features. Meanwhile, thousands, perhaps millions, receive no mental health care because of the absence of professionals to assess and diagnose their illnesses, the first rate limiting step to recovery. We now have methods using computer technology able to empower nurses and health assistants, aimed at improving the detection, diagnosis and treatment of mental illness. We recognize that these are only the first steps to true recovery; nevertheless they are an essential starting point. Such methods are already being successfully piloted in India, Europe and Australia. They have potential to bring relief to the untreated. The campaign will promote any appropriate and culturally acceptable method for bringing relief to those suffering mental illness.

Some major activities that WFMH is embarking on include:

• The development of a grass-roots campaign so that mental health can have more visibility and priority in the public mind internationally;

• Work with the Commonwealth Secretariat in anticipation of the UN Special Session on Non-Communicable Diseases scheduled for September, 2011;

• Participation in the United Nations process to reformulate the Millennium Development Goals;

• Developing strategic partners with international agencies and advocacy groups to promote the Great Push; and

• Promotion of the Great Push using both traditional and social media.

The World Health Organization has recently (September, 2010) released a report titled Mental Health and Development which makes the case for the integration of mental health in development efforts. Mental health is intimately tied with key areas of development such as education and human productivity. Our World Mental Health Day theme this year underlines the relationship of mental health with chronic physical illnesses. As we identify non-communicable diseases like heart disease, diabetes, cancer and respiratory diseases as the new scourge, the relationship to mental health is both intimate and unavoidable. The bottom line is that there is no health without mental health and that there is no development without health AND mental health.

Physical and mental health are intertwined. There is a real need to deal with the mental health problems of people with chronic physical illnesses and physical care of mental health consumers through a continued and integrated care.

Suicide and Social Media

http://www.editorsweblog.org/special.php?tag=social%20media

A key strategy in suicide prevention is to talk about suicide and to ask those you suspect of being suicidal whether they are thinking of harming themselves. 

Somewhat paradoxically, it is also true that suicides, especially among teenagers, appear to happen in clusters and so there is this notion that suicide is contagious.

A recent internet posting from New Zealand prompted this blog post on our Suicide Prevention page on Facebook.

Why We Care

by Paddy Kutz, Executive Director, Mental Health America of Licking County

At your age, why are you still working? I hear this question frequently and my current answer is “because not everyone in Licking County is mentally healthy.” Seriously though, I am driven by our vision for our county which is of a just, humane and healthy society in which all people are accorded respect, dignity and the opportunity to achieve their full potential free from stigma and prejudice.

One in four people will experience a serious mental disorder in his or her lifetime, including major depression, bipolar disorder, schizophrenia and severe anxiety disorders.

Mental illnesses are no-fault, biologically based brain disorders which cause disturbances in thinking, feeling and/or relating. Persons living with these disorders deserve the dignity of medical treatment and a wide range of supportive services from mental health care providers, friends and family, including caring congregations.

Though the majority of individuals living with mental illness can successfully be treated, stigma and misinformation continue to be significant barriers to treatment.

Consider these facts: this is “Why We Care”

• depression is the number one illness around the world (not just in the United States)
• one third of homeless people experience mental illness
• 90% of persons who die by suicide have a serious mental illness
• there are more people with mental illness in jails and prisons than in state mental institutions
• at least 67% of youth who drop out of school have an untreated mental health condition
• treatment works and people recover
• there is no health without mental health

It is our mission to promote good mental health, wellness and for victory over mental illness. We need everyone’s help in understanding these disorders and what it takes to be mentally healthy. Good mental health isn’t just the absence of illness. We must have good self-esteem, get along with others, and cope with life’s demands. When you have a mental illness, all of these things can be tougher to achieve but possible.

Having good self-esteem means to like oneself, but remember, you have to be likeable. Good self-esteem is a quiet feeling of liking who you are. So anyone who is boastful or a braggart does not have good mental health.

Getting along with others includes respecting differences and leaving the person alone if you don’t like them. A mentally healthy person doesn’t bully, name call, fight with, put down, or intimidate other people. You maintain self control and deal with conflict and anger in healthy ways.

Coping with life’s demands means that you use positive ways to deal with stress. There are many good ways to relieve stress, but drinking and drugging doesn’t solve anything and just leads to more problems.

Consider some of these constructive choices: this is “Why We Care”

• Figure out what is really causing the stress, write it down and then brainstorm solutions that will reduce the stress. Turn to a trusted friend, family member, school counselor, professional, minister, priest, rabbi, faith leader or call Mental Health America of Licking County at 740-522-1341 or email at mhalc@alink.com. Don’t suffer in silence, talk it out
• Eating right, sleeping right and exercise are so important to deal with life’s demands too. In fact, new research shows that exercise works just as well as many anti-depressant medications, so get up and move it.
• Get rid of that stinking thinking and remember this is where many people need help, so ask for it.

I met former first lady, Rosalyn Carter, many years ago and have never forgotten her quote “People living with mental illness are our neighbors. They are members of our congregations, members of our families; they are everywhere in this country. If we ignore their cries for help, we will be continuing to participate in the anguish from which those cries of help come. A problem of this magnitude will not go away. Because it will not go away and because of our spiritual commitments, we are compelled to take action.”

This is a perfect time for you to help me help others. Our website has lots of helpful information about mental health and mental illnesses as well as the services we provide throughout Licking County. Check us out at www.mhalc.org. On the left side click on the donate sign to contribute. If you have questions, please ask. I care and I want to be helpful for another 30 years.

Glob

Golb – that’s blog spelled backward which is exactly how I feel when dealing with such “modern” ways to communicate. How about rettiwt or koobecaf – those too are backward and are even more accurate about my skills in using them. When Mental Health America of Licking County first got computers – how many years ago? – our staff gave me an etch-a-sketch. Their message was loud and clear “get with it girl!” Even though I ordered the computers and support stuff to use them, they tortured me over being backward about these modern day tools. Of course today we can’t do without them.

I would encourage you to read a wonderful blog. It is on our website and written by Graham Campbell, Associate Director. He is a very talented writer and has so many fabulous things to say. Let me know what you think of our website: www.mhalc.org . We can always make improvements. It is our mission to promote good mental health, wellness and for victory over mental illness. Get on our bandwagon and contribute your time, your money, your talents. I can be reached at 740-788-0302.

Paddy Kutz, Executive Director, Mental Health America of Licking County

To the End of Love

I went to visit my Aunt Marjorie and Uncle Bill and they shared something very profound with me:  in preparation for death they taught me an important lesson about living.

Marjorie is in the last act of a 5-year battle with kidney failure.  Most of her factory equipment is gone and what little is left doesn't work well enough on its own.  She has been on home dialysis and on hospital dialysis and at 86, she is nobody's ideal candidate for a transplant.

For the last few months she and Bill have been making every-other-day trips from Truro down to Halifax where she undergoes a 4-hour session with refrigerator-sized dialysis machine.

I had no understanding of what dialysis was prior to this trip.  I had seen episodes of "House" and "Medical Center" and "Marcus Welby, M.D."  I thought that it was a pretty passive process where they hooked you to a machine and you just sat there until the final spin cycle was over.  It seemed like you could read a book, or watch a movie and when you were done and your blood was all clean, you could go on to your next appointment.  What I didn't understand was that there is a fair amount of suction required in order to get your blood into the machine and the whole experience can literally leave the patient failing drained.  Marjorie described it as feeling like having the life sucked out of her.

Repeated trips to the dialysis unit have taken their toll on Marjorie and her blood vessels.  Earlier this month, her veins collapsed and they were unable to hook her up to the machine.

It was while sharing this news with me that my mother let me know that she thought her sister was ready to stop fighting.

It’s uncomfortable for me to even write that sentence. I don’t come from people who make those kinds of decisions. I have no experience of family members preparing for death. I know only prolonged illness, or sudden death. I know about processions to the bedside and to the hospital and how to be awkward at a reception. And I know about remote death where the relative got sick and died out of site, so all there was to experience was the service and the absence of their presence.

When my dad learned that he had lung cancer, it seems that he decided pretty quickly that it was a death sentence. From diagnosis to memorial service was, for me, a slide show: a series of images and impressions that I continue to try and make sense of.  Marjorie’s illness and some additional health conditions much closer to home have made my mom get her affairs in order and to have “the talk” with me about what she does and doesn’t want when the time comes. But even this seems disconnected from my reality. I’m not certain if it was for my benefit, but when we had the talk, when she showed me where papers were and introduced me to Ed who could help me when the time came, she said she was perfectly comfortable with the whole process. For me, it was like I was a tourist in the conversation: in town for three brief days and then back to my own planet.

In my family, we have a pretty limited vocabulary:  we either don't talk much at all, or we go right to the grand gesture--there is no in-between.  It goes from "Could you pass the salt?" to that scene in "The Godfather" where Michael tells Fredo, "You're not a brother, you're not a friend. I don't want to know you or what you do. I don't want to see you at the hotels, I don't want you near my house. When you see our mother, I want to know a day in advance, so I won't be there. You understand?."  No passing "Go", no collecting $200.  I am largely absent from Marjorie and Bill's life for two decades and suddenly I want to be on their doorstep in forty-eight hours

This would be the part where I try to explain some of why there was such a gap in my relationships with my aunt and uncle and my three cousins. If I had any skill as a writer, I would carefully illustrate my good intentions and the missed opportunities so that I strike a balance between looking bad and being too self-serving. The simple truth is that for too long we did not affiliate with my mom’s family. My maternal grandmother stayed in New Brunswick even when both her children moved to Quebec. And prior to relocating to Nova Scotia, my aunt and her family did not live all that far away, but they might as well have been living on Mars. We would see them a few times during the summer, but not that much. My cousins are all older than me and there was never really much to talk about.

We spent more time chasing relationships with my father’s side of the family where there was even less to talk about and even greater differences in ages and, as a result, we let my aunt’s family slip away.

I was also driven to try and close some of this time and space distance because, having turned 50 this year, I have become acutely aware of being disconnected from my own life and history for too long.  I made choices that took me away from my family that were, at the time, intended to give me some perspective, but instead have left me feeling rootless and alien.

These questions of my personal identity and place in the world may be the refuge of the chronically self-involved, but they are nonetheless powerful.  I am very lucky that I have been able to share the last 23 years of my life with the same person.  We have a good life together, but there is still the other 27 years to try and make sense of and for that you need family.

That's where I was when my mother called, so the decision to go was clear.

As I was trying to book my flight, my mother called back and said that end-stage kidney failure might not be something that my aunt and uncle would want to share with a long-distance relative.

A fair point. I know first-hand how painful it can be to pass a kidney stone, I could only imagine how much more painful complete failure might be.

It was at this point that I elected to do something completely out of character: I called my aunt.

I’m not sure where this idea came from, probably from my wife--she is fluent in many strange forms of communication--but it was the right call and also my first indication that I would have no template for my visit, no relevant frame of reference.

I called and offered my services to be a “relief driver” for their next trip down to Halifax. My only condition was that if I was going to make the trip, my aunt had to be there when I arrived: no early departures! She agreed and reservations were made.

My mother had prepared me for the conversation by sharing that she had spoken to Marjorie the previous day and that she was, during that call, at a very low point. She didn’t want to go on and, to my mother’s understanding, was ready to catch the next bus out of town. (Stop me when the metaphors become too much.)

The Marjorie that I spoke to on the phone the following day was apparently a much different person. She was clear and focused, practical and deliberate. She and Bill would be happy to see me, but they had a schedule that was driven by her illness and that would determine what was and was not possible during my visit.

Reservations in hand and the prospect of a series of short-hop flights punctuated by extended waits in Detroit, and New York City ahead of me, I began to worry about how to behave once I got there. 

I went through all the possibilities:  the wailing, the gnashing of teeth and the rending of garments.  I thought about the first scene in "Citizen Kane" complete with the solitary house on the hill and the heavy curtains and the gloom.  (I watch a lot of movies.) It didn't help that I got into Halifax late in the evening and had to drive an hour to get to Truro.  Too much time to think. 

What do you say to someone you haven't seen in almost a generation and then, when you finally do show up it's because they are at the end of their life?

The laughter caught me completely by surprise.

I was there for two days and, aside from the trip to Halifax and the dialysis session, there was a lot of laughter.  Marjorie and Bill and I had a laugh.  There was laughter when my cousin Iris and her husband came by.  More laughter when cousin Audrey and John and their dog Enzo took Bill and me to a classic car cruise-by in Halifax.  And when cousin Karen came on Sunday..., well you get the idea.

Instead of finding Marjorie husbanding her energy in preparation for her trip to Halifax, I found her in her chair, by a bright sun lit window looking at her iPad. She wanted to hear about my trip and about what I was up to and about how I had spent my morning prior to showing up at her door.  She was a sponge:  thirsty for information and for stories and for life.

I had been prepared for a series of brief visits so as not to tire Marjorie.  She had said herself at one point that she was good for about an hour at a time.  But somehow that all changed when I arrived.  They had a  full day planned with lunch, Iris and Greg's visit, a field trip to see the tidal bore and then an evening trip to Halifax for dialysis, cousin Audrey and the car show. 

This was not denial or misdirection; there was no anger or bargaining:  this was acceptance.

One of the first things that Bill did was show me the boxes of sterile fluid that they had stacked in their breakfast area and the machine that they had relied on when home dialysis was still feasible.  His life's work as an educator was on display as he explained each step in the process needed to connect her to the machine.  His background as a Maritimer was on display as he expressed regret at having to discard all of the unused and unusable inventory.

No, there was no ignoring the fact that Marjorie was sick and that she was wrestling with deciding how much longer she would continue to fight.  She and Bill had been dealt a crappy hand and, instead of turning away, they were determined to face it and make the best of it that they could.

I should have expected nothing less.

I recognize in myself a painful habit of living in tenses other than the present.  I dwell on the past and wait for the future and am generally ignorant of the present.  Marjorie and Bill, and from what I can tell about Karen, Audrey and Iris, live in the present.  To a certain extent, kidney disease has dictated that response.  There are good days and bad days, bad hours and worse hours, but I think they are able to cope as well as they have because they are very familiar with the present tense.

After lunch. after bearing witness to the tidal bore and after a brief conducted tour of Truro, it was time to go to Halifax.

Watching Bill get Marjorie ready and get her into the car was like watching a precision military exercise.  It seemed to happen purely on muscle memory.  I wanted to be helpful, but I quickly recognized that I was in the way.  It was not that I was impeding the process, so much as they knew what to do and how to do it and having an extra hand would be like having an extra hand--they couldn't quite figure out how to work it in.

He helped her from her chair into her walker, from the walker to the lift that helps her down the handful of steps to the carport and then there is the wall and the car itself to support Marjorie as she takes the painful steps to the passenger seat. 

Once she is in and secured, Bill seems to spring into his spot behind the wheel and, suddenly it seems, we are on the road down to Halifax.

It's a pretty quiet trip.  Not too much talking.

Occasionally, Marjorie will tell Bill where to turn or whether there is traffic coming from the right, but on the highway, it's pretty quiet.  It's as if Marjorie is preparing for the ordeal ahead of her.  Every so often, Bill reaches over and pats her hand, but he doesn't interrupt.  Again, it seems that repetition has taught them the best way to manage this aspect of their lives.

Marjorie has a counter she keeps with her in the car.  It's one of those hand-held mechanical counters that used to be a popular way for counting the number of people in a line at tourist attractions and movie theatres.  They use it to count recreational vehicles--campers and travel trailers.  When I catch a glimpse of the reels, I see that she is closing in on 400.  It's a distraction and also an indication of how unpleasant the ordeal of dialysis is.

We pass a water tower and Marjorie quickly calculates their anticipated arrival time in Halifax from this, their half-way marker.  Turns out she is within a minute of her projected ETA.

Once we get off the highway, Marjorie is like an on-board navigation system as she directs Bill to the hospital.  Right turns, left turns, alternate routes, anticipated obstacles, special events:  she seems to account for them all.

Marjorie's dialysis clinic is in a part of Halifax that seems mostly closed down for the weekend.  We are able to park less than 50 feet from the front door and are the only car in the lot. 

After we check in, there is a bit of a wait while they prepare the machine.  Marjorie and Bill sit quietly in the waiting room with other patients and family members waiting for their name to be called.  Surprisingly, the television is set to CNN and they are currently obsessed with some very domestic American news story.  Everyone and everything, including the TV, seem to be occupied with their on proprietary thoughts.

Occasionally, Marjorie and Bill will recognize a familiar face and greetings are exchanged.  There are "regulars," even here.

Finally, her name is called and we wheel Marjorie into the clinic and to the hospital bed that will be her home for the next few hours. 

Once she has been safely maneuvered into bed and her wheelchair parked, Bill and I are dismissed.

We go to dinner, we go and meet Audrey and John and Enzo, we go so that Marjorie can concentrate on what is ahead of her.

When we return three hours later, after dinner, after a cruise-by car show, after spending a couple of hours with Audrey and John and Enzo, there is still about an hour to go before Marjorie will be ready, so we sit in the waiting room.  Bill starts to read the paper, but quickly falls asleep. 

While we were gone, someone has changed the channel on the television and, instead of CNN, there is an episode of Survivorman.  This is the show where they leave a survival "expert" in an extreme environment and then we watch as he adapts and survives and finds his way back to civilization.  So as not to be confused with the multiple variations on this theme, this one is produced without benefit of a production crew.  The survivor is his own camera crew. 

In this particular episode, he was in an arctic environment.  He has to search for food and make his own shelter and find drinking water.  In addition, he has to set up cameras, change tapes and make sure he gets the shot.  There are several instances where he shoots himself climbing a hill to get his bearings, or pulling a sled across a frozen body of water and when he is done with these activities, he has to go back and get the camera.  So, in effect, he has to "survive" everything multiple times. 

The longer I watched the show, the more it made sense to me as a way to understand what was happening around me.  The TV host, Marjorie and Bill were all engaged in trying to adapt to their environments, make sense of their surroundings and make it through the day. 

I don't think this was how Bill imagined spending his Saturday nights, but to look at him is to understand that he would much rather be sitting in this green and yellow waiting room than be anywhere else if it meant that he would be without Marjorie.  The whole time I am with them, he is unfailing bright and cheerful and positive.  It would be ridiculous to infer that there are no bad days, but he seems determined to make the best of whatever happens and that is a more powerful survival technique than anything happening on the television.

Before the show was over, before the Survivorman made it back to civilization, Marjorie was done.  As she said later, she couldn't take it anymore.

The nurse wheeled Marjorie over to where Bill was still sleeping and she prodded him awake.  Intermission was over and it was time for the second half of tonight's play:  the return trip to Truro.

This is what they do:  drive to Halifax, drive home, spend a day recovering and then repeat.  It used to be worth it because it gave Marjorie a good day, some respite from the pain and discomfort, but now the recovery is no longer complete and the good days are harder to come by.

I am overwhelmed by their perseverance and their commitment to one another.  As Marjorie decides what she wants to do, or stop doing, it is a personal choice, but it is not a selfish one.  She doesn't want to keep putting herself through this process and she does not want to do it to Bill.  As for what Bill wants:  he just wants Marjorie.

My mom told me that, if I got a chance, I should go downstairs and see Bill's desk.  Bill took me down and showed me the wall of photos over his computer.  There were photos of my grandfather and of my grandmother's family, but the photos to see were the ones on the table to the right of the desk.  These were pictures of Marjorie, of how he saw her when they were at the beginning of their love.

And now, having ticked off all of the options covered by the wedding vows, richer and poorer, health and sickness, through three kids, grand and great-grandchildren, they are coming to the end with heads up and eyes wide open.

I am so grateful for the opportunity to visit with and learn from Marjorie and Bill.  They are an example and an inspiration.

There is no neat ending to this story, no tidy resolution.  It will just stop and it will be up to all the parties concerned, as it is to the reader, to make their own sense of it.  I will, instead, leave you with the words of a far better writer, Leonard Cohen. Like most other things in my life, I discovered him too late. His 1984 song,  "Dance Me to the End of Love" seems to capture best what I am trying to say.  Cohen's rich, world-weary voice is a perfect match for the lyric that reads in part:

Dance me to the wedding now, dance me on and on
Dance me very tenderly and dance me very long
We're both of us beneath our love, we're both of us above
Dance me to the end of love
Dance me to the end of love

Dance me to the children who are asking to be born
Dance me through the curtains that our kisses have outworn
Raise a tent of shelter now, though every thread is torn
Dance me to the end of love

Dance Me to the End of Love - Amazing videos are here

--Graham Campbell
Associate Director