Category Archives: mental health

Is it okay to talk about suicide?

Standard

*Warning – the following discusses mental illness and suicide. This may be a trigger for vulnerable community members. 

 

There remain a number of taboos around suicide, rendering seeking help potentially more difficult to seek than it needs to be. Moral, religious and even Aristotle’s economic contribution ideology have historically fed into the taboo that has arisen around both suicide, talking about suicide and living with suicidal ideation.
The rate of suicide in the US is more than twice that of people that die by homicide each year, but we seem to only hear about homicides. In Australia suicide is the leading cause of death for 15 to 44 year-olds. One of the greatest concerns around talking about suicide is that if we bring it up in conversation, we’ll put those thoughts in the person’s head. There is simply not enough evidence to suggest one way or another that direct questioning is helpful or harmful. Here are some thoughts.

Gender and suicide:

In Australia, 80% of completed suicides are men. In 2016 a Black Dog study found the increased risk where the following are present:
– A period of disrupted or depressed mood
– Unhelpful conceptions of masculinity – the ‘tough Aussie bloke’ stereotype in particular
– Social isolation
– At least one personal stressor, like unemployment or relationship breakdown.

Poor mental health remains the most common factor in complete and incomplete suicides, with men in the Black Dog study reporting that unaddressed mental health problems led to an increased inability to manage stressors, leading to unusual decision making and a sense of a lack of resilience (see discussion on resilience here).

In Australia, men complete suicide three times more often than women. Having said that, women are more likely to experience incomplete suicide (formally suicide *attempts*), and over the past year we have seen a 26% increase in completed suicide by women. The highest rate of suicide reported in 2015 was men in 85+ age group with 68 deaths, controversial, though if we could begin to talk about euthanasia (another great taboo), what would this particular rate look like for people over 80 with chronic and terminal illness? I digress.

We also know Aboriginal and Torres Strait Islander people are twice as likely to die by suicide than non-Indigenous people. The only State or Territory to see a decline in suicide rates (2015-16) was South Australia, while all other areas of Australia reported stable or increasing figures.

Since this blog is primarily centred around Bipolar Disorder, let’s talk about that. Bipolar, mental illness and suicide. I’ve got issues, and my diagnosis of Bipolar is the least of them! 

cover3-320x240

I’ve been known to hold controversial opinions via my lived experience of Bipolar Disorder, and while I do not claim to speak for all people with Bipolar, my 20+ years in the area of mental health has confirmed to me some of my views to be held of reasonable truth.

– The distinction between Bipolar I and II and suicidal ideation has most recently been found to be more similar to one another than distinct, as has been historically reported.

– Suicide doesn’t kill us, Bipolar Disorder does.

– A person with Bipolar Disorder can experience suicidal ideation even when well. The thought of cycling through mania and depression when well has been reported to be a factor in ideation while well.

– People living with bipolar have a suicide risk 17 times that of the general population.

– The majority of people with mental illness do not attempt suicide, though, with a condition like bipolar, the connection is undeniably strong: around 1 in 4 people living with bipolar attempt suicide and bipolar accounts for 12% of all suicides each year, while accounting for 2.5% of the population.

– We need to STOP using the term ‘resilience’ and start talking about resourcefulness! (subsequent post to come)

Language and why it matters: Society, community and the personal self. 

tragedy_graphic.jpg

 

The Personal Self:
Ever heard someone say “they went psycho”, “he *must* be manic”, “she’s hysterical/manic/insane etc”? These terms have become fair game in the realms of bantering and in *the spirit of fun*, listening to these sorts of throwaway comments is far from fun or jovial, they are thoughtless insults which act to characterise a persons frailty or perceived fault…and it isn’t funny.
Replace any of these terms with words that relate to a persons culture, other disability, HIV status, cancer, chronic illness etc, and well, you get the point. These terms associated with a persons mental health status are often thrown around; at one end subtly implying a person has “psychological disturbances”, through to the other end of the spectrum, as targeted insults towards a person with a mental health problem. Designed to separate the speaker from the *other* person, to state separation, to elevate the speaker, and even where the target isn’t in the room, anyone with a mental health problem (or anyone with half a brain) could see how these words would hurt.

More seriously, these sorts of insults are a form of STIGMA. While stigma is a term which has evaded clear, operational definition, it can be considered to contain three inter-related problems:
– a lack of knowledge (ignorance),

– negative attitudes (prejudice),

– and excluding or avoiding behaviours (discrimination)

For young people, still finding their voice, still working out how to best manage their mental health problem, this type of language acts as a barrier to seeking help. If your child, niece, nephew, etc heard this kind of ignorant speech from you, guaranteed it will lessen the likelihood of them seeking help via you…and that’s a real fucking problem.

As few as 4% of young people with a mental illness seek help from a family doctor or health professional. Primarily they are going to seek help from friends and family, from those they trust, and where we are not aware of the way in which our language hurts and stigmatises mental health problems (and subsequently the young person), the language we use is a contributory factor towards the reluctance of many young people to seek help for mental illness. The good news is that this is reversible. Start to consider the language you use, the way in which you speak to young people around you about mental illness and mental health, since through direct positive contact, it can be extrapolated that for every positive conversation we have with our young people about mental health, it will take 6-8 negative contacts to undo the positive effect our interaction has had.

We’re always telling our young people to watch their language, now we need to watch ours. Doing so is one easy step we can take to encourage young people around us to seek the help they need in relation to their mental health.

The Community Approach:
The jury is out in relation to whether or not we should have direct conversations about suicide with someone who is potentially vulnerable. In Australia we have seen a push towards having these direct conversations, asking the question “are you thinking about suicide?”, though the fact remains, there is simply not enough evidence to say this approach is effective and doesn’t cause further harm.
For people with reduced resourcefulness (a lack of services in their area, a lack of family or friend support, unawareness of what supports are available), potentially asking this direct question can cause further harm since they are left unsupported and with their own thoughts, we simply haven’t done the research to know the results.
Hence at a societal and personal level, reducing stigma is known to increase the likelihood of someone seeking help themselves. There remains a difference between someone coming to you to share their thoughts of suicide, and that of noticing a change in behaviour or having our own worries about someone and asking THE question. With not knowing the impact of asking “are you thinking about suicide?”, surely then addressing any mechanism possible to increase the likelihood of self-help seeking behaviour is key.
Considering the lack of evidence in the area of asking about a person’s suicidal ideation, I would no longer do this, and recommend a more subtle (and potentially more suitable) approach like ensuring the person is aware of professional services in the area; “I’m worried about you. I’m here to listen and I have some help service numbers if you want them?” versus “I’m worried about you. Are you thinking about suicide?”…controversial, I know! and flies in the face of the general approach here in Australia.

Society, community and personal approaches to address suicide:

– Address stigma where and when we see/hear it. Be aware of the language we use, since we know that stigmatising language (even between a parent and child or peer to peer) reduces the likelihood of that person seeking professional help.

– Have a specific mental health curriculum embedded in schools.

– Make crisis support information more readily available. In schools/workplaces/public spaces, have flyers or posters with support service details displayed.

– Target people at higher risk, those with Bipolar Disorder, Schizophrenia, clinical depression.

– Address Indigenous rates of suicide through genuine actions towards enhancing cultural connectedness and individual and kinship autonomy.

– Train up community facilitators to identify those at risk and by building public awareness about mental illness and suicide.

– Provide young people with meaningful engagement and have at hand information in relation to mental health/illness and suicide support.

– Put in place a community-oriented national suicide prevention strategy and action plan which goes beyond clinical support.

– Challenge current approaches to suicide prevention, fund research into approaches and acknowledge findings, even if they are counter to our current approaches.

– Recognise that simply opening up discussion without supports in place may be more of a harm than a benefit.

 

Just having a conversation is insufficient. If you go to a high school and you have a suicide expert stand up in front of 1500 students and talk about suicidal warning signs and then leaves and that’s all you do, there is evidence to suggest that that is dangerous.” – Ian Manion, PhD, C. Psych.University of Ottawa.

 

 

Advertisements

Being Bipolar – Dis-Ordered systemic narrative and an opportunity to regain control.

Standard

The National Disability Insurance Scheme in Australia and mental illness.

 

There really seems to be two trains of thought around medication and Bipolar Disorder. Those who think medication is a certainty, an absolute Medication is crucial for managing bipolar disorder”, “Bipolar disorder is probably the main psychiatric disorder where medication is absolutely essential. I’ve had people ask me if there’s any way to do this without medicine. [My answer is] absolutely not.” 1 and the anti-medication and anti-psychiatry movement (and the points in between where the two movements meld). Head along to any anti-medication page on the web and you will read plenty of points as to why they are opposed to medication, with little focus on how to achieve better outcomes on the whole. The anti-medication movement seems set against medical ‘tools’ (in this instance, medication) that can assist in managing fluctuations and outright swings in moods. I found a handful of useful sites that propose ways in which to manage Dis-Order without medication who also were reasonable enough to recommend the use of medication if required to stabilise.

 

The more medicalised and psychology and psychiatry based sites reveal the opposite. Some suggesting that the Dis-Order in Bipolar is unmanageable without medication (see above quotes). As with most topics the two opposing arguments seemed ‘preachy’ and self-righteous and for myself personally, both were as hard to stomach as the other.

 

Unlike many other illnesses, it appears that when it comes to mental health and mental illness everyone has an opinion. Unlike other illnesses there appears to be a perception that the general populous is somehow entitled to have a point-of-view about our lived experience. “You should be on medication”, “psychiatry is a money-making and corrupt industry and you should be off medication”, “have you tried just controlling your moods better?”

Jars

On occasions I purposefully choose not to disclose my lived experience for want of not changing the dynamics of the conversation at hand. I get to hear both the good and the archaic opinions and perceptions in relation to mental illness. Working in an executive role within the field of mental illness/health I get to hear it all and while I recognise there have been great improvements, we still have some way to go. I sat in a meeting recently with some case managers/workers who were discussing a change coming through Australia at the moment – the National Disability Insurance Scheme2 (NDIS). In a nutshell the NDIS has the power to mobilise and enable people (such as myself) who have a mental illness to make their own choices around the services they receive to assist manage their illness. It’s an interesting time as the power balance between services/carers shifts towards the service user themselves. The rolling out of the NDIS seems to have (at least in my experience) heightened the entitlement to ‘have an opinion’ of those of us with a lived experience.

 

The NDIS means that people with a lived experience who have previously been (with all due respect to carers) disempowered to make their own decisions around their care and now being encouraged (at least by the NDIS) to-do so. This is creating a remarkable amount of Dis-Order within the system and the way in which we (again) talk about those with a mental illness. Here we have people who have been ‘unable’ to make their own care decisions for 10, 20 and 30+ years, who under the NDIS are suddenly able to make choices to achieve the best possible outcome for their health. There are murmurs in the mental health sector that service users are ‘struggling’ to make these choices and are thereby missing out on services they are entitled to (services now only get paid when a service user selects them over another service provider, so you can see how this can seem problematic for the service providers, while being great for people with lived experience in the long run). What service providers are forgetting is that a Dis-Ordered system has been created around us, one which disengages us from autonomy and self-control, a system, which has historically silenced our care choices and made decisions for us and on our behalf. Especially for those with more severe and persistent mental health issues, the new liberating and enabling system under the NDIS is a new narrative for many – What? I get a choice in my health care? Yes we do.

 

The NDIS has bought about the polarising opinions of many, of carers, of guardians and of service providers. Again, like with the medication debate, those WITHOUT the lived experience are expressing their point-of-view, speaking on behalf of people with a mental illness, albeit guised as concern for the individual (concern which may be genuine to an extent) and cloaked in a thin veil of caring. I say this because I am privy to these conversations without people knowing of my experience of Bipolar and when I dig a little deeper under people’s concerns for ‘us’, it becomes apparent that there is apprehension about the shift of power from services and carers to the service user themselves. Undoubtedly if a carer or a service provider were to read this, I’m sure to have caused offence and to be criticised as not understand their actual intentions. Fine.

 

The NDIS brings about a remarkable change and with this there is a throw-back to mental illness being something to have an opinion about, rather than a health issue that is best managed by the person with a lived experience themselves (and supported when need be). One of the largest risks I see in relation to mental health and NDIS narrative at the moment is that while the NDIS rolls out and embeds, the voices of those without a lived experience of mental illness will cause such a din that people with mental illness will be hard to hear. Having said this, the core principles of the NDIS are genuine empowerment – the choice and control of our own health care will sit squarely with us. While the NDIS still has some bumps in the road to navigate, it’s potential is revolutionary and where we have been silenced in the past, once we regain our voice and confidence in decision making, the future is resoundingly ours to take.

 

  1. http://psychcentral.com/lib/10-small-steps-you-can-take-today-to-improve-bipolar-disorder/00016916
  2. NDIS http://www.ndis.gov.au/funnelback/search?query=mental%20illness

Bipolar Disorder and the highly sensitive person

Standard
Bipolar Disorder and the highly sensitive person

Bipolar Disorder and the highly sensitive person (lived experience and those that care for us) – the lived experience perspective.

According to J. Raymond DePaulo Jr., M.D. caring for someone with Bipolar Disorder is akin to caring for someone with severe and terminal cancer. There are no other illnesses that compare to the continued effort and exhaustion experienced by carers of people with a lived experience of Bipolar Disorder (BD).

The manic depressive episode experienced by people with BD and those that care for them can (believe it or not) enhance family communication and ‘tightness’. It all comes back to how the sufferer and the carer manage. A person with a lived experience of BD can in actual fact enhance your life. Our perspective and our insight can enrich the daily grind. When managed well, a person with BD can change the way you see things. Thinking outside the square and the necessary need to develop insight and awareness can actually benefit those around the person with the BD lived experience. It’s how we survive. Often seen as ‘highly sensitive people’, intuitive and responsive, it is true that we can live our life in a state of high alert (elation), with intermittent periods of downtime (depression).

Expressing our lived experience to those either “around us” or those who care for us can be a difficult experience. To be able to demonstrate that our experience is an illness and not a weakness, can be the most difficult thing of all. Our sensitivity or acute awareness may manifest as a panicked episode or a heightened sense of our environment, resulting in an inability to manage information which for other people, may be easily processed (think trauma, animal cruelty and exposure to disturbing communication/s). For myself personally, I have had a number of events occur in my life where I am extremely sensitive to ‘energy’ around me. (Bare with me, this is left of centre…of course). I once was driving with my son into the valley where I live. It was late at night and I had a ‘sense’ that there was a meteorite about to strike the earth. My son was asleep as I began to panic. Then from his hazy slumber he said the word “meteorite”. It was enough to stop me in my tracks. I had to call my husband for him to come and collect us. Within my heightened state of awareness, I had an overwhelming sense of harm to people on earth. I think it was early 2013, maybe February? That night a meteorite struck the earth injuring over a thousand people in Russia. How do I know? Every time I get this type of sense, my husband watches the media for reports that what I felt to confirm whether my senses were valid. More often that not, it is. We use this as a tool to manage my wellness, since too many ‘misses’ means I may be heading into dangerous territory (psychosis, paranoia et al).

This is what makes my husband my greatest carer. He doesn’t disregard my experience. While I recognise that this is not what it is like for all people with BD, I have come across too many other ‘sufferers’ that have had similar experiences to disregard my own as coincidence. Fortunately my husband doesn’t look for coincidences either, he looks for the ways in which my senses align themselves with reality.

I can imagine (if I were a carer) that it would be much easier to look for more plausible explanations, or to disregard and not pay much attention. I truly see that this would be a reasonable response…after all we are “insane”.

The highly sensitive person (HSP) has been well documented. The person as highly sensitive and with BD is yet to be fully explored, although there are plenty of lived experience blogs which address this, yet for many the correlation can be disregarded. Part of the HSP/BD complex is that, where in Western culture success is measured by how busy you are, how much you earn and how well liked you are, all of which can be triggering for a person with lived experience. Unless I’m in a state of mild to moderate the mania, I’ll be frank, you would probably find me bothersome and with a history of holding down a job for no more than 2 years (mostly due to boredom and sometimes paranoia) it is difficult to achieve the stability required to be considered a success. In fact, what many people without BD seek to achieve in life, I find a stressor, triggering episodes of either depression or mania.

The experience of being a person with a lived experience of BD and thus a HSP means that during times of mild to moderate mania, I can be flooded with inspiration, creativity and a wealth of ingenious ideas. Now of course not all of these ideas can be harnessed, yet those that can may lead to the start of something great. For myself, these ideas often stop in their tracks due to the pattern of my experience. Mania; influx of ideas, the sense that things move too slowly and then the abandonment of the ideas due to restlessness, irritability and agitation, often resulting in a depressive episode.

I envy the HSP who tends not to fluctuate between mania and depression, since my fluctuations can indeed be life threatening, this is (to me) what distinguishes the HSP from the HSP/BD person. It’s not so much my down turn into depression that is the most risky moment for me, it is the stability that follows, the not knowing when the next up and down will be that really has me come undone. It is the thought of the depression that fills me with fear, not the actual depression itself (as strange as that may sound).

I have openly described myself as a HSP, well before I was ready to disclose my lived experience of bipolar. It seemed (and still does) that it is much more acceptable to be a sensitive type than to be a mood disoriented/fluxing person. After all, we all feel sensitive at some point, yet not all sensitive people loose their sense of self in the ride between the two opposing points; mania and depression. The highly sensitive facet of my illness is (to me) a gift, the rest (the disassociate highs and the unbearable lows) is a burden I feel I must bare, a circumstance of the sensitive self.

My husband has reflected to me that I appear to have a great capacity for empathy, for spirituality and a thirst to seek greater meaning in life. He and I also recognise that this quest for meaning can be interrupted by my illness, I take two steps forward into awareness and one-step back…this is guaranteed.

At one stage I could barely put one foot forward, so the effort of taking two steps resulting in one, is a good outcome all things considered. Through my BD lived experience I have come to recognise the value of meditation, of following a spiritual path, of getting out in nature and I am learning to master the art of distraction. Through distracting myself from my sensitive thought patterns (fear, gloom, paranoia, elation) I am able to begin to break the BP cycle. It isn’t perfect, but it is an improvement.