Mom's With Disabilities

The patient I'm going to blog about I didn't get to meet. (This is a patient from phys. dys. FW) All I saw was her medical, OT and PT charts. She is a 42 yof, married with a 2-year-old. There was an incident where she jumped/fell into a 4 ft. deep pool. She suffered an incomplete SCI and a broken back. Her charts noted that she is currently on Zoloft and Wellbutren, narcotic pain killers (pill and patch form) and other medications specific to her SCI. Her chart noted that she has been a no show to multiple appointments. On the 25th she was scheduled to come in for a functional evaluation. This evaluation was scheduled to last 4 hours, she didn't show up or answer the phone when my supervisor called her. I couldn't figure out why someone just wouldn't show up to an appointment, at least not without calling to reschedule. Later on that day we had a man who was dragged in by his parents. He didn't want OT, he didn't want to do anything. He was suffering from severe depression. It then occurred to me that maybe it was her depression that was keeping her from coming to her appointments. She has severe depression due to the fact that she cannot care for her child the way that she would like to be able to.

At first I was annoyed that she didn't show up b/c if left me with 4 hours to kill wandering around and observing PT sessions but after coming to this realization I had a change of heart. I felt strong empathy for this woman. A lot of us in this class are mothers. Could you imagine not being able to do the things you want to with your child? Or not even being able to care for them the way you want to? That is probably the worst feeling in the whole wide world.

The charts stated that she had received disability papers while she was in acute rehab. Those papers cannot be completed without this evaluation that she missed. I'm sure that disability would help with the financial stress that her disability has caused. Then another possibility for her not showing up popped into my head. Maybe she had a fear that her child could be taken from her. Maybe she is thinking that if the eval shows that she meets the requirements for disability then she is too disabled to provide quality care for her child. It wouldn't be the first time that a disabled mom lost custody of her child.

I feel so much for this woman. She is in what probably feels like a no-win situation. All I can do it hope that she has a strong support system and someone to share her feelings with.

The internet has made it so easy for people all over the world connect with each other. These are links to on-line support groups for mom's with physical disabilities: http://www.facebook.com/group.php?gid=30111267180#!/group.php?gid=30111267180&v=wall; http://www.circleofmoms.com/stay-at-home-moms/disabled-moms-585913

Double click my title to find a link of a video where disabled mothers talk about their struggles and successes.

Here is a additional youtube video of a mom who uses her feet to care for her child. She is truly amazing! She has other videos on her of her doing other tasks with her feet. http://www.youtube.com/watch?v=AmBOCkfbDG0&feature=related

Gus

I recently had the pleasure of meeting Gus. As Gus made his way down the hallway at my fieldwork site, I saw the huge impact he had on the residents and staff as well. He didn't say much, actually didn't make a sound. The smiles he brought were contagious! I do believe that a few of the pt's. seemed to work harder at their activities, even seemed to press on for the ultimate goal. As Gus sat quietly waiting in the PT/OT lab, it was obvious he knew his place. He waited patiently for his turn- and he knew exactly when that was! When Ms. E finished her card game (working on the B UE), and Mr. M finished ROM activities, the hands were extended and Gus's time had arrived. His tail was wagging, and the smiles were everywhere! Gus had arrived!! I saw the joy, love, and the sheer power that this one big dog could bring to so many. It was amazing to see the powerful impact and comfort that he brought to the residents!

Postpartum depression

I recently met someone suffering from postpartum depression. I have two children myself and I never had to deal with this issue. Postpartum depression is something I do not know a lot about. Therefore, my understanding of it's impact on a mother is limited. Having suffered from another form of depression and how debilitating it was, I know how hard it is to go through something others don't understand unless they have been through it themselves. This person I met had a lot of medical problems other than PPD. It seemed to me that the PPD was the last thing the medical field was concentrating on or treating. I wonder if the PPD had been considered among the top things being treated, would some of the other conditions improve faster? I think attitude is one of the most important things in getting well. If a mother has PPD, I'm sure her attitude would be affected. The mind can have both a healthy and unhealthy effect on the body. If you think someone is suffering from PPD, don't judge them, please talk to them and get them to seek medical advice. Click on the title for signs and symptoms of PPD.

Psychosocial Effects of Disability

I recently had the privilege of working with a patient who had suffered a M.I. He had a pacemaker implanted and was recovering well. I met him in the middle of his OT therapy and despite the recent attack and the new addition to his body, was in relatively good spirits - I soon discovered why. This man was married and his wife was obviously a big part of his life. He spoke of her constantly, she visited at least a couple times each day, often staying most of the day. She brought him everything he needed and things she thought he might like to have in the hospital to keep his spirits up, like things to do and read, pictures and cards etc. She was obviously a constant source of comfort and encouragement.
In therapy, he spoke about his M.I. and what a shock it was to realize he was in bad health. He spoke about his future limitations and how he would have to pace himself now. He did his therapy in good spirits and was talkative and pleasant. But his conversation always centered around his wife. What they used to do together, where they would go, what he made for her and what he would make next. He spoke of when she came last and when he was expecting her again. I soon realized that this man's wife was a huge part of why he was accepting his medical condition so well, and why he was facing his limited future with confidence.
When it came time for him to be discharged, his wife was there to do "family therapy" along with him. We talked about his limitations and the importance of how he needed to move his body, his need for rest and slow activity. His wife was very involved, talking about what she would do to help him and basically reassuring him that "they" would handle this together.
After they left, I was left wondering about the patients who have no one to visit them, no gifts or words of encouragement while they are there, and no one waiting at home to help them. They certainly have the concern of the doctors, nurses and therapists and many of these are well trained to give words of encouragement and reassurance, but what happens after their stay is done? Many have to go to a SNF temporarily or even permanently.
There is no substitute for the moral and even physical support that we get from our family and friends. What bigger motivation to recover is there than to return home to a happy supportive system? Our role as therapists, beyond basic rehab, will be to teach the patient coping skills, educate the family on how to support the patient, and then give resources for them to move forward.

Attached is an article about returning to life after a heart attack.
http://familydoctor.org/online/famdocen/home/common/heartdisease/recovery/002.html

Pets and Rehab

When on my fieldwork this past Friday, I discovered an issue that I'm surprised doesn't come up more when dealing with inpatient rehabs and elderly patients. A patient had a R CVA and had been in the hospital for a few days. The patient had a good prognosis, good strength and was on the road to being independent in his ADL's. There was one thing holding him back from putting all he had into therapy - his dogs at home. His wife was frail and living at home, be he knew that she was no match to their two dogs, a 6month old german shepard and a 1 year old black lab. He was more worried that they were not being taken care of than how his wife was doing. Apparently these dogs were his newly found children and followed him where ever he went on their farm, essentially staying with him all day. Now that he was in the hospital and hadn't seen them in days, he was in complete distress over how they were being cared for. He was almost depressed because he hadn't seen his dogs. This was a wake up call that this situation was hindering him from progressing his rehabilitation. What I saw next was amazement. The recreational therapist came in and told him that she could set up a visit from his dogs. As long as they were bathed, up to date on shots and had their nails clipped, that they could come in and visit him. You would have thought that they told him that he had won a million dollars. I could see the life come back in him. He called his son and had the trip set up for the next day. The rest of the day all that he could talk about were his dogs and how happy he was that he was going to see them the next day. His therapist described how much of an impact that his dogs coming to visit had on him. He was actively participating in therapy and actually putting some work into it. I think that this was a great example on the effects that psychosocial impact can have on rehabilitation. All this patient needed was to see his dogs, to know that they were ok to give him the motivation to get well. I can also see how a physical disability can affect your identity as a person also. I have had previous contact with a patient who had a lower extremity amputation. This fellow thought that his life was over after the surgery. He didn't think that anyone would look at him the same, or even look at him at all. As a young, single male, I could see how this had taken a tole on his self confidence. And why wouldn't it? Losing a leg is hard enough but when you are young and in the best part of your life, a traumatic thing like this happens? Devastating. The way that we helped him cope with this was to set him up with a support group with other amputees to help him express some of his grief from losing his leg. They were able to share their experiences with him and also how they had went on with life and made the best of it and not staying down and negative all of the time. They were able to meet out at places and he became more and more comfortable with his new life and also his new leg (he was able to get a prosthetic). I think that a support group is the best way to cope with something like this. You are surrounded by people who are in the same situation as you and are able to share experiences that others may not be able to help you with. Support is the key, you feel accepted. Here is a website that I love; www.petsastherapy.org , that tells all about pet therapy, when animals can come into the hospitals to have the same impact that this mans pets did, to all patients.

Colic and Depression

My daughter in law (DIL) and two young babies has come to live with us while our son is deployed. Our newborn granddaughter has colic. According to the kidshealth.org website colic is defined as 3 or more hours of crying for at least 3 days per week for over 3 weeks. The baby does not have the traditional type of colic which is usually in the evening for several hours at a time. She cries for 1-2 hours at a time two or three times a day.

Brown University has completed a study finding a link between colic and depression in women with colicky babies. The study is quick to point out that colic and depression are not a cause and effect relationship, but there is some connection. Brown University sponsors a Infant Behavior, Cry and Sleep Program to help parents find support during this difficult baby behavior. The study will help pediatricians to at least screen mothers for depression if the baby has colic.

My DIL is dealing with so many feelings right now as my son is in training to be deployed, caring for a 19 month old and a newborn with colic and new living situations. The added feeling of not being able to help the baby stop crying makes my DIL feel inadequate, anxious and depressed.

Many days after I get home from school, I spend the next hour or two holding a crying baby while my DIL takes a well deserved mental health break. Also I have encouraged my DIL to talk with her doctor to about the possibility that she might have PPD since she is at greater risk for developing PPD. (She had PPD after her first baby.) The doctor was very responsive in treating her.

Some tips for a family dealing with colic include taking a break, understanding it is no ones fault that the baby is crying and to put the baby in the room if needed. No baby has ever cried to death. Also most babies outgrow colic between 3-4 months old.

The following website offers advice on dealing with colic: kidshealth.org/parent/growth/growing/colic.html#

The link for Brown University study:

www.brown.edu/Administration/News_Bureau/2005-06/05-114.html

I am glad that our family is able to help out our DIL and relieve some of the stress of dealing with colic. Some parents are not as fortunate to have help around and the stress can be tremendous for everyone in the family. If you know of a family with a baby that has colic, volunteer to take care of the baby so the parents can take a break.

Restaurant Outing

My triad and I, along with a staff member, took our guys on a field trip to a healthy restaurant. We did this to reiterate eating healthy and practice controlling portion sizes, which we have been discussing for a while now. The guys are pretty self-sufficient in their own environment, but it's a totally different story when we went out.

Our book keeps emphasizing the importance of clients learning a new activity in their normal environment or at least a simulated one. After having first-hand experience in dealing with individuals with mental illness who are not in their normal environment, I get it now! When our guys are at home, they come and go as they please around the house and nearby outside, so one doesn't really get the full affect of their limitations. However, when we were at the restaurant, we had to escort them everywhere they went. To be honest, it was exhausting! It was so worth it though! The guys are so appreciative of everything we do for them. It's really humbling to work with such great people. I was trying to find a link on tips for taking brain injured clients on outings but didn't have much luck, and then, I came across this article about tips for taking children to restaurants, and it seemed to fit the criteria perfectly, so click on the title to view them.

On a different note, I went to a conference today where I interacted in groups with either COTAs or OTs and it really is amazing how some people act like they are better than you just because they have a degree attached to their name. Don't get me wrong, I'm really only referring to one individual, but they had a big impact on my life today. You see, I was having a pretty good day until I had to be in a group with this person. I could go on and on, but I won't. Moral of the story: Treat everybody with dignity and respect and remember, he who knows the least, knows it the loudest.

Effect of Environment on OT work

As OTA students we learn that the three things that affect a therapy session are: us (the therapist) through therapeutic use of self, the activity, and the environment. Today I had a chance to see through OTAS eyes, how environment truly does affect a therapy session.

We were working in a large room full of therapists with a variety of patients. The OTs use of self was evidenced non-stop and the activities were quite varied. It would have warmed the heart of any OT instructor to see how well those sessions were being conducted and as a student I was sufficiently impressed. But today I was particularly focused on environment, and there were three main events that took place that changed this fairly consistent environment of the treatment room.

The first was when one of the volunteers who was well known by staff and patients, got the news that she had been accepted into a graduate program. She exploded with delight and shared her news and it quickly spread throughout the room. Within minutes everyone was smiling and congratulating her, even the patients. I realized that it wasn't just the good news that made them smile, but the smiles and tears of someone who is so happy and positive and that made them feel happy too.

The second event was a bit more subtle. While we were all busily working, someone turned on the radio just loud enough for those in that area to hear the oldies songs. People immediately took notice and the whole time it was on, I noticed one person after another singing, commenting on the song "I remember that song from when I was young" and some of them just smiling and moving a hand or foot to the music.

The third event was when someone brought a dog into the treatment room. He had been trained to assist a patient and was taken to that person and introduced, but as he walked by, all eyes were on him (the dog) and as I looked around, everyone was smiling and commenting on the dog and some started sharing stories about their dog, or a dog they once had with each other. I could almost feel the mood lighten as everyone reacted to a simple thing like a dog walking in.

I truly realized today how important environment can be to patients. Beyond good equipment and trained therapists doing their job well, environment can make a big difference. If laughter, a song or the sight of an animal can change the mood of a patient, then it really does matter. If we are to make the most of our sessions, we must take into careful consideration the environment as well. A happy, positive environment makes us feel happy too, even if it isn't specifically directed at us.

I came across a video that talks about the importance of pets to those who are terminally ill, and an organization that promotes this connection between pets and patients. I hope that in the future as an OTA, I will have the opportunity to incorporate pets into treatment.

http://www.youtube.com/watch?feature=player_embedded&v=vfXIbmp9YmQ

MI

It is time to blog again and I still do not feel comfortable doing so. As we study MI, and the different types of this disorder, I look at people I pass on the street in a different way. Since MI is not as visible as a physical disorder, I play a game with myself and wonder if the person I pass has a MI. Some of the questions I ask myself are: Does this person have a job? Are they able to go to work everyday sober? Do they fly off at co-workers when things don't go their way? Are they a perfectionist? Are they on medication for depression? Are they on medication for anxiety? No one knows what goes on behind closed doors at someone's house, but I ride by people's houses and wonder what kinds of things happen in that house. Does anyone else ever do this? I guess if we really thought about it, all of us have some kind of MI!
Click on the title for a link to signs and symptoms of MI.

Finding My Balance

In class we have talked about many different mental illnesses. We have discussed mood disorders, bipolar, depression, schizophrenia, and OCD to name a few. A common term I keep hearing about is "finding balance". Balance is a key theme missing in most every case we have discussed thus far. The recovery phase of MI requires balance and I also see balance as a key role in determining the "revolving door" process discussed in class today. If a person with a MI maintains balance in their lives, the less likey a relapse might occur. So I got to thinking about balance and what balance means to my life? I am lucky in the fact that I am forced to mainitain some sort of balance between school, home life and personal time. My boys make sure of that. They demand attention and have needs that must be met. I am there mother and that is simply the way it is. This required attention takes me away from school work and the pressures of school. I am forced to put the books down for at least some part of the day. Something funny has been happening the past two weeks and I have just now put my finger on it. I have been happier in life lately. My dog Toby is getting fat and I decided to start walking him everyday. The boys go with me and this small decision to "break" from life and walk with the dog and boys has truly put balance back in my life. We walk, we talk, we smell the fresh air, we laugh and we get exercise. Everyone has a different set of balance needs. It depends on your situation and we should all sit down and really analyze what balance means to us. Balance is important for our mental health. If you don't have this balance I believe you are more prone to the mental illnesses that really can affect anyone at any time. Just like any physical disease, if balance can be a tool to help ward off MI, I will take it!! I wonder what balance aspects were missing in Robert from the film we watched today. The film documented his "recovery" or his attempt to live outside the hospital. Robert searched for a balance life of socializing with his brother, shopping, eating and also trying to live Indepentely. I think some heathly lifestyle choices such as exercising and good food habits seemed to be missing? I am sure in some of Roberts down cycles, exercising was the last thing of his list, but what if it was on top. Would this had made a difference? Balance=Good Mental Health so No Balance=? poor or no mental health. Imagine what this could lead to? Go......find your balance!!

If you need some ideas of how to create this balance in your life please double clik and review the website. There are also some great links to further explore this topic of balance.

Grown-Up Stress In Homeless Children

I ran my FW group last week on stress relief/reduction. My FW site is a transitional living facility for homeless families. During my intro I asked the children what stress was thinking that they would not know. I heard two answers that both surprised and saddened me. One child said that stress is when you are really sleepy but can't fall asleep and another child said stress is when her tummy hurts. No child should be so stressed out that they cannot sleep or have stomach aches.

Prior to beginning this FW our instructor sent us an attachment with statistics on homeless families. This got me thinking and I began to do a little research on my own. Here are just a handful of the statistics that I found: 21% of homeless children must repeat a grade due to absence, 42% attend 2 schools in one school year, 28% attend 3 or more (MISD). When I asked who had to switch schools almost everyone raised their hand. 10% report sexual abuse (this number is 3X higher than other children). I also found statistics on what leads a family to being homeless: 22% is due to domestic violence, 11% is due to eviction, 11% is due to family breakdown, 10% is financial difficulty and 11% is left for other reasons. 51.8% of single mothers are homeless due to domestic violence. These are staggering statistics! I can't help what wonder what these children have seen and/or experienced. Could you image having to go to school every day while worrying if you'll have a place to sleep, food to eat or whether your family will be safe that night? It is easy to pass these children off a "bad" but really I think they are all just seeking attention. I think that if we could look into their pasts we would be able to see why they do certain things that they do. I look at these children and wonder where they will be in 10-years. I hope that what we are doing will make some kind of difference. I want these children to grow up and be anything they want to be and have every opportunity that every other child has. Where they are living now is taking great steps to assure that this happens.

When I look at these children I see my child. If I didn't have the support of my family I could easily be in the same situation, anyone could. Before passing off a child as "bad" I think we all need to step back and consider what kind of grown-up stress a child may be going through/dealing with.

Here is one of the links for where I got my statistics from: http://www.misd.net/homeless/statistics.htm

I could not find the other websites that I used. I had previously recorded this information for my own personal use and did not cite the resources. I will update my blog once I find them

I have also attached a really great article on the effect of childhood stress. I think that everyone should take a look at it, especially the other members of my FW team.

As I begin this blog, I am hit with this huge feeling of how uncomfortable this still seems to be, blogging that is. I was thinking of what to write about, what to say and what not to say, how much info to provide......All of a sudden I am taken back to my Abnormal Psych. class last summer.
I had the most fantastic instructor. He presented the info. in such a way that really made me want to hear more!! There was a lot of class participation and sharing that was equally as good. I have spoken to him several times since the summer, and he is just as wonderful now as he was then!
He did suggest that I journal. We discussed some things I really needed to talk about, and he suggested that one way for me to express my feelings would be for me to journal. I am hugely verbal, but there are certain people that are not open to this. He knows who I am talking about! I did this for awhile, and then stopped due to time restraints. I came up with this excuse all by myself!! I write like I talk, so I could be journaling for a very ling time.
Anyway, where I am going with all this is that maybe if I continued with the journaling, this whole blogging thing would be easier, and not cause me anxiety. So, as I resume an old habit, hopefully this will be less stressful!!!
I know longer want to "fix" people. I want to understand them. This particular instructor taught me about depression, and how it looks from the individual. We had a family wedding in August of last year, and a gathering was held at my house the day after. Lots of people, conversations, laughter, swimming. It was just fun. At least from where I was sitting!!!
I remember wondering why a certain individual didn't join in, connect, or even attempt to participate. It was so frustrating to me--to think how someone can be around so many family members, both young and old alike, and look like they wished the ground would open and swallow them!!
Opening the shades to let the sun in, is not really what a person with depression needs. Being around a whole slew of people is uncomfortable and exhausting. A nap is preferred. Talking about issues is my way of communicating, but this is not for everybody. I hope to be able to recognize depression in people that I may see on fieldwork, and remember that my quick fix is not their quick fix.
So as I plan to pick my journal up again tomorrow morning, I am again thankful for the suggestion. I no longer want to fix people, just understand them. As we have talked about in class this semester, there are certain ways to speak to individuals with different forms of MI. Just learning about different approaches will help us as OTA's to respond in the best way in order to treat our clients. I believe that a bit of encouragement and a reminder that they are necessary to the activity or to the group, is a good place to start. This is probably a good place to start for those that are not in our groups!

Who Are The Diagnosed and How Many Are There?

I started thinking about how many people in this world are suffering from a mental illness and are either in denial or embarrassed to find out the truth. According to the statistics, 1 in every 4 people suffer from a mental illness, but what would this ratio be if everyone who was really suffering from a MI was counted? Let's take my family for instance. My husband has recently been diagnosed with ADD. He could always seem to remember to do things for other people and loved the recognition, but at home it was an entirely different story. I would have to practically beg him to do anything for our house or family, which is why I became quite good at being a jack of all trades. Before I started school, I did all the handyman work, yard work, painting, as well as all my mommy chores, so I was pretty busy! I found myself hating cubscouts because he would spend countless hours preparing for camping trips and would even take an entire day off of work to pack, but when did he ever take a day off for me or to do anything to our house? I began to feel like, "Am I not important or good enough for him?" So, after a lot of long talks, he has started delegating some of his cubscout duties to other parents, because he was being taken advantage of without even realizing it.

I have 5 people in my immediate family, so we're at 1/5. My son has also recently been diagnosed with a mental illness, ADHD, so, of course, I told my husband he can't blame me for this one. This is all his fault, just joking, but kinda not! Okay, now we're at 2/5.

My oldest child has social issues. He does not like to be in crowded situations and would rather just stay home if there is even a chance he will be in an uncomfortable situation. He did see a psychologist for awhile and the conclusion was that he has anger management issues and is not where he should be in respect to being empathetic towards others. If we had continued treatment, he most likely would have some sort of diagnose by now. So, if we count him, that's 3/5.

My youngest child has his issues as well but not diagnosed, yet!

And as for me, who knows? I was a little baffled to find out that stuttering is considered a MI, which I have started to do when I get frustrated. I do believe, however that moms are the largest group of individuals that go undiagnosed, mainly because we don't have time and we always put everybody's needs before our own! I didn't have such a great childhood, so if for no other reason, it probably would benefit me to talk to someone about that, but I don't have the time or the money! Anyway, I find that the best therapy is just having friends. At least once a week, my girlfriend and I get together and complain about our husbands and whatever else we can think of, and it's awesome!!! If we're still keeping score, that's 4/5. At least there's one "normal" person in my family.

I believe it's such great therapy for anyone to just have friends and be around other people who they share something in common with. And as we have learned this semester, that's why psychosocial clubhouses, ACT programs, support groups, and just participating in leisure activities in general, even if it's nothing more than getting together and going for walk, are so beneficial to us all.

I found this very interesting chart that I would like you guys to look at. I want go into too much detail about it, because it's pretty much self-explanatory, and it just goes to show all of us how much of an impact MI can have on a person's life! Just click on the title to view it.

A Personal Experience with ED

I recently helped write a report on Eating Disorders (ED). During my research I discovered the surprising fact that 33% of women suffer from an ED at some time in their life. That reality struck me when I realized that beyond the obvious sufferers of anorexia nervosa (who are often quite good at hiding their body shape) we can't tell that the remaining sufferers of an ED even have an eating disorder. In addition, I personally I see so many thin teenagers, I'm not sure that I could tell the difference between a girl who has this illness and one who doesn't.

Most enlightening to me during my research was the startling fact that for most sufferers, the cause of their illness is not just wanting to be thin, and sometimes it is not at all about wanting to be thin, but is really mostly about wanting to have control over their lives.

I have a teenage friend who suffers from anorexia nervosa. She was always a skinny little girl and according to her, never really worried about staying thin as she became a teenager. She was naturally built slim and as a gymnast, was more concerned about her strength and flexibility than her weight. Her coach regularly discussed the importance of proper nutrition and rest, which she took to heart.

When my friend was 14, her life changed dramatically when her father sexually abused her. She was removed from her home by the authorities and suffered in fostered homes for 2 years, emotionally devastated by all the events that had occurred. We talked at length about how lonely and helpless she felt about being away from home, apart from her mother, and how embarrassed she felt when she went to school. She told me that she had no say in anything in her life, her place to live, her visitation with her mother, her school, counseling etc. She said her sense of helplessness added to her traumatic experience. By 16 she was back living with her mother, but by this time she was suffering with diagnosed full blown anorexia. Most of her life was still out of her control and though back with her support system, she now had to deal with her mother's problems as well - unemployment, foreclosure on her house, and court proceedings.

It is not hard to see why this girl's anorexia was mainly the result of her trying to control something in her life, the only thing she could, her body. The fact is that anorexia nervosa is very commonly diagnosed in girls who have been abused. The girl is now 18, finishing high school. She has been in counseling for 4 years but insists that the counselors don't help her much. She said that they just "tell her what to do" and I realized that they haven't given her what she needs the most - a sense of control over her life. At the moment she is suffering many physical problems that can result from anorexia. Her kidneys no longer function normally, her blood pressure is abnormal, and she has serious heart issues.

My deepest hope is that she is not too far gone that she can recover physically from her illness as she regains control over her life as an adult and heals emotionally. I intend to stay in touch with her as she leaves home for college and encourage her to regain a sense of control over her life, making decisions for herself and directing her own future.

More information about anorexia nervosa can be found at this website:

http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=102975

Speakers on mental health

Wow! The speakers we had during class were wonderful! My reaction after hearing their stories was, how can I even think I have problems and trials when these two men have had way more than their share! We all have problems, we all have trials, we all have our own way of dealing with them. My parents have always told me that that God would not give me more than I could handle. Sometimes I question why some people seem to have greater burdens than others. Did everything these men go through contribute to their mental illness or did they have a mental illness to begin with and their problems brought the disease to the surface? I applaude their strength and their desire to help others who have a mental illness. Both of the men talked about the stigmas that go along with having this disease. The stigma about taking meds hit home. My son always felt inferior because he had to take meds and was made fun of at school for taking them. Of course, he always had to go to the office for the meds so the other kids knew about it. It is amazing to me how one of the speakers was able to wean himself off of all his meds (with the help of his therapist) and had been off of them for a year. I have attached a link about the stigmas of MI.

Mental Health and Jail

I have always been intrigued by the fact that there are so many inmates in jail that have a serious mental illness. This has to tell the world something right? These folks have a mental illness and are in jail? What do they think that this is doing to help them? If jail is a time of punishment, why don't they send more of the people who are in jail to a mental health facility to be treated? So that they are less apt to commit a crime again. A report (listed below) said that 40% of people with a serious mental illness have been in jail at some point in their lives or will be in jail. This is a staggering fact, knowing that there is help out there for these folks but some just choose not to pursue it or just don't know how to access it. I was also surprised to find out by this article that when someone on Medicaid is sent to prison, they automatically get dropped from their services. So when they get out of jail and are back on the streets, if they are on meds then they can't get them anymore - does this help this situation any? There are some major changes that need to be made in the mental health field, especially related to prisons. I believe that they need a mental health professional to screen these folks that are coming in to the prisons to be able to recognize the ones that need mental help. The only ones that get the help they need are the ones that stand trial and are able to get checked out by a psychiatrist so they can be held "criminally insane". The ones that come in over and over for petty crimes don't stand trial or are not able to afford a lawyer to have them stand trial. Many issues.. .little answers.

My link to the article is enclosed in the title!

The Value of Group Therapy

Throughout our program there has been a lot of talk of group therapy. We have been practicing running groups and have talked a lot about the value of groups. Besides the obvious time and cost savings which are required by both the insurance companies and therefore employers, groups serve many other purposes, such as the benefit of sharing and learning from other experiences, recognizing that you are not alone in your struggle and finding moral support in your peers. Support groups are similar, though often without a therapist leading, they provide many of the same benefits as group therapy. I recently attended a PD support group as part of a homework assignment. Though I was only silently observing, I was able to experience all these things going on in their group. I saw the sort of camaraderie that the people in the group shared as they all dealt with the same illness, and the way they drew comfort and moral support from the experience.

Groups also serve other purposes that we as OT practitioner (students) know. Groups allow us to help our clients work on social skills, learning to tolerate the presence of others, and increase their awareness of others. Groups can be a very valuable tool. A recent guest who works with mentally ill patients spoke of how she uses group therapy and the value of that in teaching those patients how to overcome the difficulty of interacting because of their illness. Learning to deal with others while you address your illness is valuable practice for daily living. When she said that she had only ever had one violent outburst, I thought that she must have a very good understanding of the patients and recognize their triggers well. That is a sign of a great group leader.

Online group therapy can be beneficial for those in society who are not willing or able to physically participate in sessions. This type of therapy works really well for some people for whom anonymity is important. Although this may not be the best therapy option overall, I think it is a good compromise for those who would otherwise not seek therapy and therefore be left to suffer alone.

The following link is an article regarding the details of online group therapy.

http://ezinearticles.com/?The-Value-Of-Group-Therapy&id=803876

Panel of guests

The panel of guests we had in class gave us a wealth of information about different types of settings for people with MI. The work places were totally different in the way clients received treatment. One had an open door policy where clients could come in on a daily basis. Another had clients that were admitted short term and long term. Another seemed to be more of a medical setting. I still do not know if a psych setting is an option for me when I graduate.
As far as the roles we will have as OTA's, the panel answered a lot of questions that I have thought about myself. Questions such as, what advice can you give us? Have you ever felt in danger? What would you change about your job? The answers helped to calm my fears about working with the MI. The job that impressed me the most was the one where the staff worked side by side with the clients and how they "do things with people, not to people".
A member of our family, a friend, or even one of us, could one day be a client at one of these facilities. A a future OTA, I want to treat everyone with compassion and dignity, the way I would want to be treated.
Click on the title for a link about compassion for the MI. Also, NAMI sent out a stigma buster about the incident in the link (name calling).

"clubhouse model of rehabilitation"

Having heard from a person who works with the mentally ill, I have gained an awareness, almost a new perspective, on the interactions between those with SPMI and those without. The connection that we as OTA's establish with a person with a mental illness can hugely impact their daily lives, in both a positive or negative way. If our uncertainties are visible, the person who is already "weak" is inclined to pick up on this and respond in a negative manner. If we can work together with this person or individuals, while still maintaining safety precautions, the potential for a positive impact is huge.

In her organization, "members" work side-by-side with staff in a number of activities that are geared toward improvements in the quality of life and meaningful opportunities. How better to help alleviate the stigma that comes with mental illness, than to be partnered with one dealing with the condition. A boost of self confidance can be a very powerful tool!

This unique approach to serving those with MI falls under the clubhouse model. Members have the opportunity to receive job skills and employment opportunities, but also receive a "family" feeling. And don't we all have a desire to be accepted and valued as individuals? The clubhouse model of approach sets out to do just that--to provide their members with the resources to be productive members of society.

I have attached a link for more information on the "Clubhouse Rehabilitation Model." This is accessed by clicking on the title of my blog post.

A Real Story About ADHD

Yesterday while I'm driving my phone rings, of course I dropped it while attempting to answer it, and as a result had to wait 5 mins to return the call. I see that it's my son's school, and my first thought was, what did he do this time, sigh. He was in the office because he had impulsively spoke out of turn, again. So, since they couldn't reach me the first time, they called my husband. As I'm finishing up the call to school, my husband is calling. Now my son is thinking he's really in trouble because mom and dad have both been called, and he's crying.

This morning after he ate breakfast, he went outside to nail a birdhouse to a tree. He had put on clothes that were dirty and had not completed several other things that needed to be done before school, including brushing his teeth. The dentist doesn't seem to understand why he had cavities, but he has no clue what it's like to get him to brush his teeth. It's a battle to say the least! He has gotten very smart about making me think he's brushed them, including wetting the tooth brush. People say, "Why don't you just watch him" and I would like to reply, "Do you think this is the only problem he has." I cannot watch him do everything that he's suppose to do everyday. I did get upset with him this morning, because I just don't get it. We have done the same things everyday for years, and he still can't get it right, and now he's crying, again, and I feel like crying but have waited until now to do so.

We talk about developing routines and patterns and developing habits in class, and my husband and I do the best we can to provide him with the best environment possible. We have tried charts and visual cues, eating healthy foods and yes, it seems to work but only for about a week. My son has been diagnosed with ADHD, and I used to think that parents who put their kids on medication were just lazy, but now that this mental illness has affected my family, I get it. Even still, I didn't want to medicate my child, so I got him some herbal medication from a whole food store. It has helped but not enough. His teachers are frustrated, his father and I are frustrated, but most of all he's frustrated. I feel defeated... As much as I don't want to, tomorrow I'm taking him for a medicine consultation, because I don't know what else to do.

I feel lately like if I'm going to get through this program at the same time as being a mom to 3 boys, wife, daughter & friend, I'm going to have to live the healthiest life I can, so I provided a website on how to have good mental health and some techniques to improve our resilience.

Lay-offs and Mental Health

The current recession has taken a huge toll on America's workforce. Almost everyone knows someone that has been laid-off from his/her job. Being unemployed causes great stress in the individual's life and can lead to depression and other mental health issues. Hopefully, within a short time, the unemployed person "bottoms out" and finds support groups and new ways to cope with the unemployment situation and a new job.

However, the people who remain at the job suffer from mental health issues too. According to Brenden Buchell, a University of Cambridge sociologist, the people who got to keep their jobs lives with constant uncertainly as to when or if they will lose their jobs in the future. In order to keep his/her job, the employee will try to work longer hours and become more valuable to the company. Hopefully by working more, the company will not lay off the employee during the next round of cuts. This uncertainly caused greater stress for the employed person than for the person that actually lost his/her job. Over time, the stress and increased workload leads to depression and anxiety.

This is the case at my husband's workplace. All the lay-offs announced last August were finally finished last week. This week the company announced that projected revenue is down and there will new a new round of lay offs in the future. Again, my husband is stuck in limbo wondering "Will I be next?" with his anxiety increasing daily.

Link: http://www.time.com/time.health/article/0,8599,1883614,00.html

Where do these people go?

While driving home today I caught the tail end of a great story from NPR. Recently while working on a group project and paper about schizophrenia, my mind started to focus on what happens to the people with chronic and persistent mental illness much like schizophrenia when they have no where to go. I was so surprised to find out how many people with schizophrenia and other mental illnesses are homeless, although the more I thought about this, the more logical it became. Many people with schizophrenia or other debilitating mental illnesses can not maintain a job or career and eventually have no source of income. This can quickly lead to the streets where more and more people find themselves. Once on the streets with no housing, the cycle is hard to break. The disease takes over and these people become a statistic. This semester I have not heard about many positive programs helping this population. It seems like everywhere you turn, more and more cut backs, leads to less and less funding, especially in the mental health field. This news article from NPR shed a little bit of light and hope on the situation for me.

Basically "common ground" converted a run down one bedroom hotel building into housing for the homeless around Time Square in NYC. The model is set similarly to how we run groups as OTA's. Common ground starts with an assessment of the homeless population. They ask people what their medical and mental conditions are, if they want housing, and how long they have been on the streets. They provide housing for the most severe cases which happens to include folks with mental illness like Ravi who has schizophrenia and alcohol abuse problems. Once Ravi has been placed in a room he will receive medical and job training. I would like to think even some OT treatments could be offered. Just think about the difference we could make in a situation like this. The model is working and many other cities are on board to try the model in their city. Isn't this the way we as OTs sometimes base our treatment and groups. We model are services after a model that has been proven to work for a certain population, for example MOHO. Please be sure to read this article. It gave me a little hope to answer the questions of where will these people go?

Be Aware Of Your Surroundings

Today we had a speaker from a mental health hospital. When asked about safety situations she said that she has never been in a dangerous or scary situation. This surprised me a lot. I think a lot of people (including myself) think of mental hospitals as scary places full of "crazy" people who will hurt you. I got the impression that she too felt this way after she accepted the job. She said that she called her mom and told her that she didn't know if she was going to be able to work there. She then went out and bought lip stick pepper spray, a push whistle and a clothing alarm. Not once has she ever had to use any of those devices. I found an article on violence against staff members in psychiatric facilities. According to the article, "75% of 999 psychiatric nursing staff reported that they had been assaulted at least once in their career." Nurses are probably more likely to be threatened or attacked than the OT department because they have more contact with the patients. Still, I think that number is incredibly high. This statstic was from 2000. According to an artticle from 2003, "the majority of psychiatrists are involved in the management and treatment of violent behaviour, and 50% report having been assaulted by a patient at least once" (World of Psychiatry Association). I was unable to get specific stats. for OT's and OTA's. If you double click on my title you will find a very interesting article that claims that violence is on the rise in mental hospitals. The article is from Dec. 2010. The main point that the speaker made was that you need to constantly be aware of what is going on around you.

http://www.dangerousbehaviour.com/Disturbing_News/violence%20and%20mental%20health.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525086/

Mental Healthcare cuts in 2011

In the last budget, mental health was cut significantly.  In Alamance County, the budget of a major part of the mental health system, the LME'(Local Management Entity), was cut by 10%.  They are expecting another 10% budget cut coming again this fiscal year.  Financial times for this entity have become so tight that the LME has decided to proceed with plans to merge with a private mental healthcare organization, Piedmont Behavioral Healthcare, based out of Concord, NC.  The current LME organization funds projects like Friendship House, a work-based place for those with mental illness.  For those like Alison Fletcher, who suffers with schizophrenia, these cuts and changes directly impact her quality of life.  She sites Friendship House as being a major reason for her not having been hospitalized in many years. 

According to the article, mental healthcare in NC started a downfall when it changed from a public-private partnership to privatizing in 2001.  Services have been harder to find and even harder to fund.  Thousands of mental health professionals in NC lost their jobs due to these cuts.  Changes have been slowly making things a little easier since the 2001 privatization, but accorking to Deby Dihoff, executive director of the National Alliance on Mental Health in NC, things were much better when mental health was a public-private partnership. 

Dihoff also states that those incarcerated in NC prisons are being somewhat pushed to the side.  There need to be more programs for these people.  About 24% of the prison population in NC has some form of mental illness, as opposed to 6% in the general public.

Things may be looking a little better though.   Instead of the 10% cut that the state legislature has recommended for mental health, Governor Bev Perdue is only recommending a 1.2% spending cut state-wide.

Now, what do I think?  We have to choose.  There is so much need ... education, elderly, mental health, poverty ... where do all these things fall on our "to do list?"  That is something that I hadn't really considered until recently.  My focus, as well as most with small children, has been on education and education funding for quite a while.  However, I think we have to think of it like this.  What if my child had a mental illness.  Could I afford to pay for his/her treatment completely out of pocket?  For how many years?  Many mental illnesses last forever.  We have an obligation to these people to make sure that they have the education, medication and therapy that they need so that, if at all possible, they can become productive, happy people.  This is not free and may require some serious looks at how we spend our tax money.  Would you be willing to spend .5% of your salary on mental illness funds?  For a $40,000 income, that's roughly $200.  It doesn't sound like that much in the grand scheme of things, but could make a huge difference in the lives of those affected by mental illness.

The article from which I got this information

Another article which highlights the budget crunch and its affect on mental illness

The Face of Alcoholism

What does an alcoholic look like? If I described a homeless man, dirty and disheveled, laying on the sidewalk with a bottle in his hand, you might agree. If I described a college boy waking up after another night partying, bleary eyed, having his “hair of the dog” beer when he wakes up, you might agree that he too looks like an alcoholic. What if I described a clean-cut, well-dressed man in an expensive suit and tie, a doctor even, in his white coat, with a thriving career, a professor whom others look up to and learn from? Would you think he looks like an alcoholic? Probably not.

Substance Abuse is the clinical term used for disorders that involve recreational drugs, like alcohol. The distinction is made between dependence, which is not having adequate control over the use of the substance, and abuse, which means the user is dependent on the substance, with evidence of maladaptive behavior, such as driving while intoxicated. The American Psychiatric Association states that alcohol is “by far the predominant cause of premature and preventable illness, disability and death in our society”. The list of health problems that result from alcohol abuse are endless and shocking and well known, especially to doctors. They face the results of substance abuse at work regularly in one form or another. They are the people who commit their lives to healing, preventing illness and death, committing themselves to “doing no harm”.

On 9/11 in 2009, Dr. Raymond Cook with a blood alcohol level three times over the legal limit, drove his car down Strickland Rd. in Raleigh, speeding up to 85 MPH, ran a red light, and smashed into another car killing the driver, Elena Shapiro. Raymond Cook is 41 years old and records show that he had a DWI as long as 20 years ago. After the accident he willingly surrendered his license to practice medicine, and joined AA. AA’s 12 step program has been helping people attain and maintain sobriety with it’s only requirement being the desire to stop drinking. Dr. Cook maintains that since that day he has not had a single drink. Good for him, but Dr Cook knew he was an alcoholic, he openly admitted it. Why did he wait until he took another person’s life to face it and deal with it?

Elena Shapiro was the 20 year old woman killed by Raymond Cook that day. She was the prima ballerina at the Carolina Ballet, preparing to perform the lead in Swan Lake. Elena died shortly after the accident. Raymond Cook was found guilty of involuntary manslaughter, felony death by motor vehicle and driving while impaired. He was sentenced to 3 years in prison...and then? He has his career, his freedom and his life back.

Fieldtrip

The fieldtrip yesterday made me proud of the facility in my hometown. I was very impressed with the gym and the equipment that was available for patients. The young man and young lady that allowed us to see into a very emotional and private part of their lives was inspiring to me. I could not get them off my mind last night. The advice from the lady about how to treat future clients was something we all need to remember. Her advice was to remember that the clients disability was just a part of them, that they were a person with feelings and dreams and they wanted to be treated with respect. Even though she went through a period when she could not communicate verbally, she said she was still there and knew what was being said and done. Some people may have thought she had a mental illness even though she did not. Some people may have thought by watching and listening to the young man that he had a mental illness, but he did not. When a person has a mental illness it is not always visible. If it is visible, we should not assume the person does not understand what we are saying. To quote from the trailer we watched the other day, "different, not less".
Because of the stigma's attached to mental illness, many people do not seek help. Click on my title for an article on stigma's and mental illness.

We recently got to visit the OT dep't. in a hospital. The OT on staff is fabulous--has an abundance of energy, a wealth of knowledge, and had clearly developed a fantastic relationship with her clients. While we were there, she guided us through hands-on activities with two people who were invited for our purpose. Both had suffered strokes--and while facing and accepting their limitations thus far--both had an enormous amount of motivation to continue moving forward. It was wonderful that both of these remarkable people were willing to share their stories--and remind us of some things that as OTA's, we must be mindful of as we serve our clients. It really is very difficult to hold back, not jump in too quickly to help. We have to remember that it is an accomplishment to be able to find the correct word, or to be able to complete a task independently. For some, these things may take a bit longer, but it is all a part of the process.
I was in awe of K. She spoke about her situation in such a knowledgeable way. She clearly demonstrated an understanding of her condition and the effects that it has had on her body. Hopefully, she will continue to engage in therapy, and take advantage of the "free stretches" while she can! K. did share that she would like to write a book--I believe we will be seeing and hearing from her again. She sure did enjoy the "cat walk"!!!!
M. was another client who came back for our purpose, and the fact that he seemed to adore the OT at this facility. He was willing to share many things about himself, including the different therapies that he is eager about and committed to. Another example of a highly motivated individual who is determined to reach his full potential.
The hands-on was very interesting. To feel the spasticity in one joint,and the hypertonia or "catch" in another was amazing. It was great as an OTAS to "feel" what had just been discussed in lecture! The amount of motivation between therapist and client, can hugely impact the therapy process. For me, the ability to engage the unmotived person is going to be a challenge. Finding different ways to engage/include the withdrawn person is going to be part of the learning process.

I have included a short paragraph I found online today, enjoy!!!

Motivation is literally the desire to do things. It's the difference between waking up before dawn to pound the pavement and lazing around the house all day. It's the crucial element in setting and attaining goals--and research shows you can influence your own motivation and self-control. So figure out what you want, power through the pain period, and start being who you want to be.

www. psycologytoday.com

Field Work with Homeless Children

I ran my field work group for 10 homeless children yesterday. My activities were engaging to the children and they seems to enjoy participating. Trying to present activities as part of a group was challenging as the children craved individual attention rather than wanting to be part of group activities.

I met the goal of my field work which was to provide a leisure enrichment activity, however I am not sure I am really meeting the needs of the children. So many of the children need to develop social skills of self-awareness and self-management. Some of the activities did address social skills, but so much more is needed. When the children played a game with a leader on a ratio of 1:2, the children were much more responsive and cooperative. The 1:2 ratio allowed the children to work on basic developmental needs which need to be in place before the children can be effect group participants.

I found an article "5 Steps to Help Homeless Children Become Effective Citizens" written by Amy Kinkade of Cap City Kids, a non-profit organization dedicated to helping homeless school children in Austin, Tx. Ms. Kinkade addresses five areas that homeless children need to develop to function in life: self-awareness, self-management, social awareness, relationship skills, and responsible decision-making. Unfortunately, homeless children usually lack a stable environment to learn these basic foundations.

Homeless children are at higher risk for mental health issues according to CapCityKids. We as a society need to invest the time and energy to help these children succeed in life and break the homeless cycle.

For more information on Cap City Kids, link www.capcitykids.org.