Providing Care For The Caregiver

Taken from  NAMI Blogs  which is found   HERE.

Dawn Brown with her son, Matthew. 

My name is Dawn Brown and I am my son’s caregiver. My son, Matthew, is 33 years old and has been living with a mental health condition since he was 8. He has schizophrenia.

In addition to being Matthew’s caregiver, I am professionally committed to making a difference in the lives of other families and individuals affected by mental illness as NAMI’s Director of Information and Engagement which includes member and HelpLine services.

The research study being released today, On Pins and Needles: Caregivers of Adults with Mental Illness mirrors my experiences as a caregiver and also reflects those of thousands of moms, dads, husbands, wives, sisters and brothers whom I’ve spoken to on HelpLine calls. So I want to think that this opportunity allows me to speak for them as well.

When mental illness strikes an individual, it affects every aspect of their life, and everyone in the family. In most families, caregivers emerge as the ones that step up and step in to meet the challenges of providing care and support to their loved one with the mental health condition.

In my family, I am and will always be Matthew’s caregiver. It’s a lifelong responsibility.

Matthew was a very difficult child to parent. By second grade, he’d received a psychological evaluation and afterwards, meeting with the psychologist and psychiatrist, we were told that our son was psychotic. I was heartbroken and grieved the loss of what I’d hoped and dreamt for my son. This was the beginning of our journey through the mental health system.

When a minor is living with a mental health condition, parents are key participants in decisions about treatment, special education services and meeting their child’s needs. Matthew received the best in all these areas. Still over the course of his childhood and teenage years Matthew required three hospitalizations because violent rages and manic episodes. I was taught how to drop him to the floor and physically restrain him until he regained control as a way to protect him and us from harm.

The stress and isolation were significant. Every outing was unpredictable and friends and family feeling helpless drifted away. The exhaustion of daily battles with Matt was unending. The strain on our family’s relationships rose to the breaking point, and Matt’s father and I divorced. Matt’s older brother broke ties with him. The break-up of families is common and leaving single parent caregivers with a huge responsibility that negativity affects even their ability to maintain employment.

When I remarried, Matt moved in with his father. Still I was the parent that took Matthew to appointments and worked with the school. At his father’s house Matt’s mental health deteriorated. The summer Matthew graduated high school at 18; he moved back into my household and experienced a major psychotic break.

Since Matt was now an adult, I’d lost the ability to have him hospitalized, require he take medication, and see a psychiatrist or even doctor. Becoming progressively worst, Matt would wander through the community sometimes running or hiding because he believed people were hunting him. He’d sit outside of the basement storage area listening and sometimes talking to the voices he believed were from dead people living under the stairs. He thought I was dead and needed his help to get to heaven. He refused to get help. I couldn’t force him, and the mobile crisis team that visited said he wasn’t sick enough or “a danger to himself or others”. There was nothing they could do. “Be careful and call us back when he gets worse,” they advised.

Matthew’s psychiatrist suggested I stop offering him medication expecting that within a few days he would become even sicker, and we’d be able to get help. “Be careful,” he warned. This is one of the most heartbreaking and dangerous situations we deal with on the HelpLine. A caregiver and the individual with the mental illness are put at great risk because help isn’t available until a dangerous situation develops.

Without medication, Matthew’s behavior became even stranger. As precautions, we removed all the knives and sharp objects, placed motion detector alarms in all the hallways and dead bolted the doors at night so he couldn’t leave. We moved the other children into our bedroom. Within four days Matthew’s condition had deteriorated and the Mobile Crisis Team arranged for Matt to be hospitalized. He was cuffed and taken by police to the state’s psychiatric hospital. My beautiful son, so young; he’d never even shaved.

Caregivers of adults with mental illness have great responsibility and very limited authority. After Matt was hospitalized, I was faced with a maze of social support services, mental health care providers and treatment options that required competencies in social work, psychiatry, psychology, case management, negotiation and conflict resolution.

Helping caregivers at this early point after a diagnosis or hospitalization could avoid missed opportunities and false starts and insure that all resources and services were utilized.

As Matthew’s caregiver some of the things I needed to learn, on the fly, included:

  • What was HIPPA? How could I overcome this obstacle, so I could be informed about Matt’s condition and participate in treatment decision?
  • What was needed to apply for disability and access Medicare and Medicaid benefits?
  • What were our community mental health services and how could Matt access them?
  • What were supported housing, day programs, peer support, job training and rehabilitation and what role would they play in Matt’s recovery?
  • What was cognitive behavioral therapy and how to apply its’ principles?
  • Nine different medications required learning about psychiatric pharmacology and drug interactions.

Struggling to comprehend what had happened and how it would change our future, I asked at the hospital about programs for patient families and was told there were none. As an afterthought, I was given a day and time when an “outside group” met at the hospital. It was a NAMI Family Support Group. Later I attended the NAMI Family-to-Family education program. Peer support and family education play an important role in a caregiver’s well-being and equip them better help their loved one.

After two weeks in the hospital, I was informed that Matthew was being discharged and when I could pick him up. Despite the fact that he was still activity psychotic, they felt he was stable enough to come home. I was faced with one of the hardest decision of my life. As my son pleaded to come home, I was advised to say no. Far too often patients are released to a caregiver while they are still in crisis.

Refusing to allow Matthew to come home was also a strategy for finding a long term solution to meeting his overwhelming needs. Patients in state psychiatric hospitals that can’t be discharged to a family member and are too fragile or vulnerable to be dropped off at a homeless shelter are kept inpatient until appropriate community services become available. In fact, they are moved up the waiting list ahead of people in the community because of the expense of keeping them hospitalized is far greater than community services.

It’s all about the money and lack of community resources. A person can wait years, and without a long term solution for meeting the needs of a person with mental illness, caregivers often watch as their loved one begins cycles of repeated hospitalizations, criminalization and substance abuse.

I didn’t abandon Matt when I refused to take him home. Two evenings each week and one afternoon on weekends were spent with him at the hospital. I was a member of his treatment team. I was lucky. Many families are miles away from their loved one because the only available psychiatric hospital is across the state or they live in a rural areas without services.

Matthew was discharged from the hospital into community mental health services 12 years ago, and while he’s made amazing progress, I’m still his caregiver. We talk every day and twice a month we go shopping together. Matt’s receiving disability and working part-time, but I still need to contribute to his income for essential needs. I’m his representative payee for SSDI. I meet twice a month with his group home manager and twice a year with this treatment team. I manage his doctor and dentist appointments. I fuss about hygiene and eating habits.

Occasionally, there have been set backs and my involvement has become essential. Matthew had a period of homelessness, and I spent weeks finding emergency housing and providing transportation. He was falsely accused of a crime, arrested and jailed until the investigation cleared him. I hired his attorney and paid the legal bills. He didn’t receive his medication in jail and required exhaustive support and crisis care services until he stabilized. He fell and broke both elbows that required four surgeries, and I was with him through the hospitalizations and rehabilitations. A housemate and friend was stabbed and killed at their day program, major setback.

Everyday caregivers wait on pins and needles for another call that turns their life upside down, and for many of us the endless stress and uncertainty leads to depression and anxiety.

Despite the schizophrenia and all that Matthew’s been through, he’s accomplished so much. He’s comfortable and happy with his life. I’m his caregiver and recovery partner. I can only imagine how things might have turned out if I’d not been there.

If I had a message for other caregivers it would be “Hang in there.” Well-informed, supportive caregivers are best positioned to provide the time and effort necessary for essential support. A family’s involvement is the best indicator that an adult with mental illness will reach and sustain recovery.

Today, I work at NAMI helping to inform and support other caregivers so they can continue to play this important role.

Today, I want to ask all of you to consider how to best support caregivers through legislation, resources and recognition for their role in the support and recovery of others.

The above post is Dawn Brown’s remarks she shared with members of Congress, policy makers, family caregiving advocates, mental health professionals and others for the release of the research study On Pins & Needles: Caregivers of Adults with Mental Illness on Feb. 23, 2016. It has been edited for clarity and length.

– See more at:

Depression, Mental Illness Endemic Amongst Syrian Refugees

Taken from   DW  which is found  HERE.

Depression and mental illness are now starting to be recognized by the UN and aid agencies as problems that many Syrian refugees face. And it is children who are in the firing line, as Martin Jay reports from Lebanon.

Since the outbreak of civil war in 2011, nearly 9 million Syrians have been displaced, with 3 million fleeing to Lebanon, Jordan and Turkey. A number of studies have recently identified mental illness, depression and stress as a serious concern in refugees arriving both in Europe and the United States.

Yet mental health issues are hardly a new experience for aid agencies on the ground in Syria and its neighboring countries. “Most people suffer from long-term profound stress, which makes them go into survival mode,” Jane MacPhail, of Mercy Corps in Jordan, told DW via Skype. Children are particularly vulnerable, and donors are placing great emphasis on education. “We do a lot of informal learning, which keeps kids engaged so they continue to be lifelong learners,” MacPhail said, “and the donors recognize this.”

“A lot of the young people we talk to have low-level depression, which comes from chemical change…but when we talk about long-term depression with these kids, there’s clear evidence that it can trigger long term mental illness,” MacPhail said.

Stress and depression

Young men are especially susceptible. A number of projects are being organized to give boys “adventure” to stimulate their brains and thus possibly avoid the early stages of mental health problems.

According to the research of Helen Verdeli, a professor of clinical psychology at Columbia University’s Teachers College, the most common stress that Syrians living in refugee camps have is worrying about the well-being of relatives “who have dispersed to other refugee camps, moved to other countries, or remained in Syria and might have been tortured or killed.”

This was particularly evident in the case of a 15-year-old girl who was separated from her mother and whom DW recently interviewed in a camp in Zahle, eastern Lebanon.

Even inside the camps themselves, there are ways for mental health and stress to take root, according to the study. “Although refugees residing inside the camps are protected from military violence, inside the camps they are vulnerable to physical violence, torture, sexual assault, and rape,” it reads. “Many adults and children have been victims of or witnessed multiple acts of violence.”

Traumatized girls

Children, and in particular girls, are subject to high levels of stress. Approximately half of the Syrians living in refugee camps are children, who experience “interpersonal violence along with their parents, and many girls, under the age of 18 years, must confront the extra burden of being married off,” the academic paper states.

Refugee camp with tents.
Copyright: Martin JayHarsh living conditions in the refugee camps are a major contributing factor to the stress suffered by the refugees

It is widely reported by journalists that around a quarter of all Syrian refugee marriages registered in Jordan involve a girl under the age of 18. Parents often resort to arranging marriages for their daughters at a young age, believing that this reduces the girls’ chances of being victimized by rape in the camps.

From as early as 2013, the Rome-based crisis group Caritas estimated that approximately one-fifth of refugees needed help with psychological disorders. This year, the UK-based Save the Children put the figure higher and estimated that one in four refugee children were suffering from one form or another of mental health.

Downward spiral

In Lebanon, Caritas reports that many people are suffering different kinds of trauma and need therapy. Caritas Lebanon social workers say they have noticed “many social and family problems, such as domestic violence, couples breaking apart and children who are traumatized after experiencing being kidnapped in Syria,” according to a recent report.

Violence within the refugee communities is both a result of depression and a cause. It is a downward spiral that the United Nations and aid agencies struggle with as many refugees battle against all the odds just to survive harsh conditions.

In a recent interview, UNICEF’s Lebanon boss, Tanya Chapuisat, admitted to DW that depression and violence were both getting worse, especially for children. “We’re very conscious of depression and on-going levels of violence in the family as a direct consequence of despair and depression and lack of hope,” she said.

“The violence gets internalized as men and families are not earning incomes, the tensions rise and so there’s more domestic violence – so kids are experiencing high levels of violence in their families and not just having to cope with their past experiences and what they’ve lived through now as a result of very difficult circumstances.”

Left Alone-Streams In The Desert: February 27th, 2016

And Jacob was left alone; and there wrestled a man with him until the breaking of the day Genesis 32:24

Left alone! What different sensations those words conjure up to each of us. To some they spell loneliness and desolation, to others rest and quiet. To be left alone without God, would be too awful for words, but to be left alone with Him is a foretaste of Heaven! If His followers spent more time alone with Him, we should have spiritual giants again.

The Master set us an example. Note how often He went to be alone with God; and He had a mighty purpose behind the command, “When thou prayest, enter into thy closet, and when thou hast shut thy door, pray.”

The greatest miracles of Elijah and Elisha took place when they were alone with God. It was alone with God that Jacob became a prince; and just there that we, too, may become princes–“men (aye, and women too!) wondered at” (Zech. 3:8). Joshua was alone when the Lord came to him. (Josh. 1:1) Gideon and Jephthah were by themselves when commissioned to save Israel. (Judges 6:11 and 11:29) Moses was by himself at the wilderness bush. (Exodus 3:1-5) Cornelius was praying by himself when the angel came to him. (Acts 10:2) No one was with Peter on the house top, when he was instructed to go to the Gentiles. (Acts 10:9) John the Baptist was alone in the wilderness (Luke 1:90), and John the Beloved alone in Patmos, when nearest God. (Rev. 1:9)

Covet to get alone with God. If we neglect it, we not only rob ourselves, but others too, of blessing, since when we are blessed we are able to pass on blessing to others. It may mean less outside work; it must mean more depth and power, and the consequence, too, will be “they saw no man save Jesus only.”

To be alone with God in prayer cannot be over-emphasized.

If chosen men had never been alone,
In deepest silence open-doored to God,
No greatness ever had been dreamed or done.

Praise & Worship: February 26th, 2016

1. Hold Me Jesus-  Rich Mullins

2.  Didn’t It Rain-  Sister Rosetta Tharpe

3.  Glorious-  Katie Torwait/ Jesus Culture

4.  My Soul Longs For The Lord- Keith & Kristyn Getty

5.  The Unmaking-  Nichole Nordeman

6.  Warrior-  Steven Curtis Chapman

7.  Oh Lord You’re Beautiful/ East And West-  Jonathan & Melissa Hessler

8.  The Well-  JJ Heller

9.  Hurt-  Johnny Cash

10.  Because He Lives (Amen)-  Matt Maher

11.  I Want To say I’m Sorry-  Andrew Peterson

Streams In The Desert: February 25th, 2016

I am handing over to you every place you set foot, as I promised Moses.   Joshua 1:3
Beside the literal ground, unoccupied for Christ, there is the unclaimed, untrodden territory of Divine promises. What did God say to Joshua? “Every place that the sole of your foot shall tread upon, that have I given unto you,” and then He draws the outlines of the Land of Promise—all theirs on one condition: that they shall march through the length and breadth of it, and measure it off with their own feet.
They never did that to more than one-third of the property, and consequently they never had more than one-third; they had just what they measured off, and no more.
In 2 Peter, we read of the “land of promise” that is opened up to us, and it is God’s will that we should, as it were, measure off that territory by the feet of obedientfaith and believing obedience, thus claiming and appropriating it for our own.
How many of us have ever taken possession of the promises of God in the name of Christ?
Here is a magnificent territory for faith to lay hold on and march through the length and breadth of, and faith has never done it yet.
Let us enter into all our inheritance. Let us lift up our eyes to the north and to the south, to the east and to the west, and hear Him say, “All the land that thou seest will I give to thee.”
—A. T. Pierson
Wherever Judah should set his foot that should be his; wherever Benjamin should set his foot, that should be his. Each should get his inheritance by setting his foot upon it. Now, think you not, when either had set his foot upon a given territory, he did not instantly and instinctively feel, “This is mine”?
An old colored man, who had a marvelous experience in grace, was asked: “Daniel, why is it that you have so much peace and joy in religion?” “O Massa!” he replied, “I just fall flat on the exceeding great and precious promises, and I have all that is in them. Glory! Glory!” He who falls flat on the promises feels that all the riches embraced in them are his.
—Faith Papers
The Marquis of Salisbury was criticized for his Colonial policies and replied: “Gentlemen, get larger maps.”

A First- Aid Class For Mental Illness

 Taken from the Atlantic  which is found     HERE.


And unfamiliarity, as many people with mental illness know all too well, breeds stigma. Since 2001, the National Council for Behavioral Health has attempted to combat that stigma with its Mental Health First Aid program, which teaches participants how to recognize when someone is going through a mental-health crisis, and how to help them get through it.

“It really gives you the skills you need to identify—and ultimately help—someone in need,” First Lady Michelle Obama said in a speech last year after going through the training. “Because you never know when these kinds of skills might be useful.”

I recently discovered Mental Heath First Aid while paging through the free community events section of a local magazine. The ad, sandwiched between listings for a yoga class and a church bake sale, promised to teach even people who were ignorant about the basics of mental illness how to recognize the signs of a crisis. Intrigued, I signed up.

On a Saturday morning a few weeks later, I found myself with a handful of other people in the basement of a public library, unsure what to expect out of the eight-hour training. I had no background in the subject: It’s one thing to lend a sympathetic ear to a friend, something I’ve done plenty of times, but quite another to know how to handle a more serious situation.

One of the primary goals of Mental Health First Aid, a program created in Australia by the nurse Better Kitchener, is to make people like me less afraid of those situations. This is especially important in rural or poorer areas where professional mental health treatment isn’t readily available, according to Betsy Schwartz, the vice president of public education and strategic initiatives for the National Council for Behavioral Health.

“The training is designed to help people realize that it’s real and treatment is available—and that people with mental illness can live normal lives,” Schwartz says.

The training started off with big-picture overviews on some of the more common mental disorders: depression and mood disorders, anxiety disorders, trauma, psychosis, and substance-use disorders. It also walked us through an action plan for helping someone who’s experiencing a panic attack, suicidal thoughts, psychosis, self-injury, or substance abuse. The plan—which uses the acronym ALGEE—outlined the major steps of first-responder aid for a person experiencing a mental-health problem:

Assess for risk of suicide or harm;

Listen non-judgmentally;

Give reassurance and information;

Encourage appropriate professional help;

Encourage self-help and other support strategies

Not every step is applicable to every situation, but ALGEE is meant as a more general tool, a road map to help bystanders assess a problem and determine if professional intervention is needed.

Program organizers stress that mental-health first aid can’t prepare someone to diagnose and treat a mental illness, much like someone trained in regular first aid wouldn’t be expected to stitch up a gaping wound.

“We’re not teaching people to make the diagnosis or tell people what is right,” adds Schwartz. “You’re there as an immediate help to know what to do and see the signs if someone is experiencing a mental-health crisis.”

Dealing with a physical injury is pretty cut-and-dry in terms of what first aid can be provided, but every mental-health situation is different because every person’s mind works differently. The trainers in my class gave quite a few personal anecdotes of their own experiences, along with a few example situations we had to assess as a class, but it obviously couldn’t cover everything that could possibly occur in everyday life. I learned a lot that day, but I still left the training feeling overwhelmed by all the things I didn’t know.

According to Schwartz, that’s a common reaction. “Our training emphasizes that it’s not necessary to go really in-depth to provide help,” she says. Instead, trainees learn enough to manage an acute situation until someone with the proper professional background can step in.

I haven’t yet been in a situation where I had to use my new knowledge, but on the other side of the training, I do feel more prepared should I ever need to. At the very least, I know I won’t be afraid if someone I encounter experiences a mental-health crisis, and I may even have a better understanding of what they’re going through—and that alone made the training worth it.


Confessions Of A Depressed Pastor

Taken from  Relevant Magazine  which is found   HERE.

I am a pastor and I struggle with depression.

I know you’re not really supposed to say that as a Christian, and certainly not as a pastor. But the truth is I have struggled on and off with depression for as long as I can remember. The problem is I grew up in a church where we didn’t talk about mental health issues like depression. The result was a lot of confusion about what depression is and what it is not.

For those of us that found ourselves in painfully dark seasons at times the rhetoric seemed clear: real Christians are happy.

At times this caused me to question whether my faith was real. Am I doing this wrong? Am I defective? Did my salvation not take? Had I somehow missed Jesus somewhere along the way? Other times it left me feeling very alone and confused, like a closet leper too afraid to admit my illness for fear of being cast out. It’s only been in recent years that I’ve begun to realize just how common my struggle is. Just look at the stats:

–In 2010, more than 253 million prescriptions were written for anti-depressants in the U.S. (To put that in perspective, there are only 311 million people.)
–Anti-depressants have become the second highest volume drug in the U.S., second only to cholesterol medication.
–The number of people diagnosed with depression increases by 30% every year.
–In 2013 someone committed suicide every 12.8 minutes. And for every “success,” there are over 100 more attempts.

Depression is a very serious issue that the Church can no longer afford to ignore.

I’ve been a part of a lot of different kinds of churches in my lifetime – Presbyterian, Southern Baptist, Evangelical Free, Converge, non-denominational, you name it. In all of my experiences, I can’t remember a single time in which depression was addressed directly from the stage. Earlier this year when I prepared to teach a series on depression I struggled to find more than a handful of churches anywhere that had tackled the issue head on.
Friends, this has to change.

Why? Because there are people in churches every week who are suffering. And if we’re not talking about depression in our churches, chances are very good those people are suffering alone.
The truth is there remains a lot of confusion about depression. If we won’t address it, people will continue to misunderstand it. And when we misunderstand it, we make things a lot worse.
It’s time for the Church to step up.

Whether you struggle with depression or know others that do, I do hope you’ll take the time to give these two messages a listen. If you are a pastor, I plead with you to break the silence and help those in your community better understand and lovingly respond to this very real issue. (If you don’t feel comfortable teaching on it, let’s talk. I’d be happy to help in any way I can.)

For those who struggle with depression, as I do, please know this:

You are not alone.

Even the most conservative numbers I’ve found estimate there are over 120 million others across the globe who struggle with depression and anxiety. They are fathers, mothers, sons, daughters, doctors, lawyers, teachers, entrepreneurs, and yes, even pastors who struggle just like you. Don’t ever buy into the lie that you are alone in this.

Your faith is not broken.

History is full of extraordinary men and women of faith who struggled with depression and anxiety. Saint Bernard, Charles Spurgeon, Martin Luther, Mother Theresa – each walked through their own “dark nights of the soul.”
The bible itself is full of examples. David made a habit of saying things like, “My bones are in agony. My soul is in deep anguish. I am worn out from groaning. All night long I flood my bed with my tears” (Ps 6). Jonah grew so angry with God that he wanted to die (Jonah 4). Jeremiah thought his life so void of hope or value that he cursed the day of his birth (Jer 20:14-18). Elijah was so ridden with anxiety that he begged God to end his life (1 Kg 19:3-4). Despite their struggle, each was hand picked by God to be used in unique and extraordinary ways.

God is for you and He offers to walk with you.

When Elijah became suicidal God didn’t berate him for not being joyful or having enough faith. Instead, God met him right in the middle of his struggle with tender grace. His offer to you is the same.
Jesus said this in Matthew 11:28-30: “Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy and my burden is light.”

This is the kind of God that God is. He is never surprised when we find ourselves overwhelmed or exhausted. Instead, he fully expects it and he invites us to find life and rest in Him.

Depression is not just a spiritual issue.

Sadly, Christians still tend to make the mistake of only treating difficult issues like depression spiritually. As a pastor, I’m all for addressing the spiritual, but depression is far too complex to be treated so simplistically. Depression is more than just a spiritual issue. It is also a physiological one that can affect even spiritually healthy people in debilitating ways. If you are a Christian who struggles with depression, don’t make the mistake of thinking if you just pray enough, claim enough, repent enough, or believe enough you will be cured. That may be part of the solution, but you may also find you need to treat the issue medicinally and therapeutically as well. Each is a gift and an expression of God’s grace. Please ignore anyone who tries to shame you into thinking otherwise.

We can no longer afford to ignore mental health issues in the church. Though this may be new ground for many of us, we’ve got to lean in so that we do not make the mistake of continuing to misunderstand and mistreat the growing number who suffer among us. For some, this can literally be the difference between life and death.

As Christians, let’s commit to approach mental health issues with an extra measure of grace and humility as we seek to love and learn together.
Lord, may it be so.