Posts Tagged ‘Mental Health’


Related imageThe Heroes in Crisis mini series has been excellent. Well paced with the super hero action, and the crime mystery noir feel of mystery to it. Who invaded Sanctuary? Who did the spree killing? Who removed the safe space for heroes to heal? These are the underlying questions.

But then the questions erupt even more as the mysterious Puddler has leaked the story to the media of Sanctuary. Lois Lane can only sit on the story for so long, and as issue 4 came to a close, it was revealed the story was going out.

This is the opening to issue 5. As Booster Gold and Harley Quinn, partnered with Blue Beetle and Bat-girl respectively seek out answers. Flash and Batman deep dive into this weird mystery.

Superman and Wonder Woman address the press. It is a timely tale within the week of Belle’s Let’s Talk, a social media initiative to remove stigma of mental health. It reveals that there is much more needed than simply social media awareness raising. It is a concerted effort by governments around the world to appropriately fund mental health care equally, and as part of universal health care. It is understanding what is happening, that it is shifting how one experiences the world. It takes courage to live differently, but it also takes courage to understand when one needs help, to seek that help out and to heal.

This is what Superman addresses to the world. The fear that they human citizens are feeling knowing that metas are struggling with trauma, and PTSD. The thoughts of someone that can level cities now being afflicted with what has been mistaken for violence trigger. It is a key piece of Superman’s press conference, and something everyone needs to understand with any first respondents, front line workers:

“The nightmares, the nightmares they will forever endure. Yes Sanctuary exists. It exists to help these heroes recover from this pain, to help them recognize themselves under these scars, to help them wake from these nightmares. But its existence, it should not scare you. On the contrary it should comfort you. This suffering, is needed for healing. It is not the mark of a madman. It is the wound of a warrior. It’s a sign. A sign of their love…”

-Superman, Heroes in Crisis #5

Will you live in fear of the unknown, or know that by someone opening up they will discover whey they are under the scars, and discover love of life once more.

 

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 What follows below is my speaking notes from this morning, the pdf is just below for the power point slides noted in the bolded brackets throughout.

Men’s Prayer Breakfast, Centennial Presbyterian Church January 26, 2019 

mens prayer breakfast january 2019

Good Morning. We are exploring some aspects this morning of mental health and belonging, as was advertised it is a personal and professional faith journey. In our time this morning we are by no means going to touch upon the entire spectrum of mental health concerns, diagnosis, disorders and spectrums out there. I am going to share a bit about my journey, and the ones that have touched upon me the most. Now I am sure you are probably asking well who is this guy? 

That’s a good question, short answer in my name is Ty, and I have lived in Rundle my whole life, my goal in life is simple to make my own corner of the world a better place. I am currently travelling through the echoes of a life spent fighting back the darkness of our world, and creating safe courageous space for all to belong, but more on that piece later. I am a pilgrim, the ad described me as a monastic-psychologist. It is true, I hold a Doctor of Psychology, I sought it out because I needed to skills to aid folks in healing. I have a Bachelor of Arts from Alberta Bible College, and my Master or Arts is from Canadian Theological Seminary now Ambrose Seminary. Each degree earned with classes that aided me in my goal of making the world a bit better, not for any other reason. I am monastic, because at the core of my journey is a formation in the Franciscan Charism. St. Francis of Assisi founded an order about 800 years ago of the open hand, those that embraced justice, simplicity, and living out the gospel message of love. Many believe it is an anti-educational-intellectual order because of a teaching of Francis that you first must learn the first scripture before going to the next. He was not counselling us to be the frozen chosen, but rather to so live into the scripture that we are living it without even thinking about it, it simply becomes part of our DNA. 

For me, the journey of learning has been centered on the scripture that brought me into organized church and ministry, at 19 years old I was contemplating my 6th attempt at suicide. I had gone through a horrendous time for that time of my life where my then fiancée had decided to abort our child, and re-enter the sex trade to feed her addiction. I was at home, quietly putting things in order, giving/selling things. When I stumbled across the little red Gideon’s New Testament they used to give out in grade 5. It was in the bottom of my closet and the spine was broken open, and these little red letters spoke to me: 

(slide of Great Commandment) 

Something shifted in my depression, and I decided to go see my Nan that weekend, and try out this church thing, and the tumultuous seasons of my ministerial life would begin, as I started to be like the lawyer. 

(slide of Good Samaritan). 

This led me to a life journey involved in many aspects of church ministry, continuing an active writing and activism career that was already in place, building ministries, writing curriculums, entering into service in the homeless sector during the darkest times of our province, as austerity measures created a humanitarian crisis in Calgary where threat to human life was imminent each winter. I would also serve during my time as a chaplain to those with dementia, childrens and youth pastors, pulpit supply, college and university instructor from bachelor to post-graduate courses in a variety of topics, practicum supervisors, mentor for at risk youth and re-integration mentor for youth re-entering society from the young offender’s centre. I would do outreach in many of the cities in Canada for those in need, aiding those camping rough to find safety, and if they could not the next morning aiding authorities in identifying the bodies. Publish a few books. Oh and in the midst, I would find time to run for office and shape many policies for parties at both the Federal and Provincial level, but hey a man needs a hobby. 

Throughout this I began to shape a concept of belonging. That it is about aiding folks in understanding who they truly are, how the experience the world, and how we as community can aid them in achieving wholeness. 

(slide on mental health) 

In my teens and early 20’s like many Albertans I struggled with alcohol. It would not be until later that I would find out about my family’s predilection to alcoholism. But I made a hard decision at that time, after my one birthday where I woke up sore and alone at home, alcohol was not a good thing for me, it made me violent, it needed to end: 

(slide of Dix) 

Addiction comes in many forms.  

(addiction slide)  

It is a form of self-medicating, a numbing agent, a replacement for authentic belonging and authentic self. The challenge in our world, is that so many things that become addictive can be seen as societally acceptable: gambling we use to fundraise for our schools and hospitals and other non-profits, alcohol you are seen as abnormal if you do not drink in social settings- try being politically active and sober? Or a writer; work or fitness or religion- all things that are acceptable, but can also so overtake our lives that we can no longer function. 

(Opioid crisis slide) 

Today we are in a crisis in Canada as a result of our triage and siloed method of dealing with people in health care. We are in what the media and health care have termed an opioid crisis, it is due to the prevalence of Fentanyl. A drug originally designed for end of life pain allevement. Now opioids, when used for pain relief within medicine are not bad, that is the all or nothing view of our world. What is wrong, is those using them to self-medicate their own personal pain. Pain caused by our own inhumanity towards one another. What would change with the crisis if we moved out of isolation and fear mongering, into authentic community? A courageous safe space where we understand pain, we understand the journey of healing, and we are willing to believe and help at a deeper level. We are willing to allow belonging, knowing that the greatest fear in belonging is that when the person is no longer there, we shall mourn.  

That is why we avoid belonging. Whether it is belonging in our own skin (Love yourself) or opening space for belonging for neighbour (love your neighbour as yourself). 

(won’t you be my neighbour slide) 

I have already touched on a bit of my own struggle with depression. Depression is a normal reaction in the grief process of loss, it can also be more than short term however, and that is okay. It is how some experience life 

(Depression Slides) 

It is ironic, as a child I had convulsions, they were so severe in my toddler years I am told there was multiple times I stopped breathing and was blue. In the late 70’s early 80’s the treatment for such a thing was an anti-psychotic- Phenobarbitrol. It is a harsh long-term treatment, but it saved my life and my brain. Many children who were put on it, lost their lives to suicide or addiction in adolescence, or dropped out of life. It is still used in short term cases for stabilization before another anti-epileptic or anti-convulsant will be prescribed. I was on it from roughly age 2 to 9 years old, my convulsions left my brain scarred, and unbeknownst to us at the time, the medication had rewired things significantly. 

As my Mum entered into the journey of Breast Cancer that would eventually take her life; I was the Director of Youth and Children’s Ministries at a church; teaching and writing; working as a vocational coach for persons with disabilities; working on my Master’s oh and just for fun running for office while editing a political journal provincially, and a spiritual journal internationally is when the repercussions of what saved my life would hit. 

(I don’t wanna slide) 

Panic attacks. Tears or anger for no reason. Medication as my brain chemistry was out of balance. 

I was always and still am open about my own journey, if those who seek to facilitate healing cannot be open, how do we expect those seeking help to be open. There was a backlash, churches skittered away from me, as I transitioned back into a leadership role in the homeless sector I was abruptly informed that I was a weak leader for sharing my mental health with my team. That self-care and mental health care were not up to leaders to mentor staff in, it was their job to deal with the challenges of the job. 

Stigma. 

But through medication, self-care, what I termed soul work through spiritual direction and life coaching I emerged through that time on medication for a few years and things had improved.  It was also during this time that I lost my ordination by taking a stand that yes children with disabilities belong in God’s kingdom (but our journey of that is a tale for another time). 

As Shawna, my wife, is always proud to say, I taught many how to care for themselves, while caring for neighbour. Soul care, ensuring you can love yourself and are being the true you, while helping others become the true them. We did not expect what was to begin in 2016, but there are 4 scary letters out there that we need to remove the fear from: 

(PTSD Slides) 

Whether personally or professionally we as a family had created safe spaces for belonging, whether they found me through work, or showed up on our door step. Literally meals can be added to, coffee or tea can go on, kids can play, and life can happen as we just are: 

(Quote slide) 

I am going to share with you an article I wrote about what is happening in the now, it is the outcome of years of journeying in the darkness as the light, and taking a beating for views of belonging. A lifetime, as we spoke of before in a Franciscan way of learning how to live out the Great Commandments, and answer the question, Who is my neighbour? 

(PTSD-PNES Slide) 

613 is my number, what is yours? 

It is amazing the conversations one has as a parent, and then the journey it causes you to reflect upon. Before May 2016 sitting in an ER I never thought I would be here. See, growing up and throughout my life I admit to being socially awkward (to be kind), but there was something that always was wonderful, my mind. When it came to numbers it was something like Charlie on Numbers that the solution would come to me, but has no real idea what took me from problem to solution. My everyday mind would be able to focus on 3 or 4 tasks in front of me, while crunching solutions and dreams/plans for multitudes of other things (one of the main reasons I never took up this thing called driving). 

It is the blessing of this mind, with my heart for changing the world that allowed the drive in school (and the multiple degrees earned and given honourary); building programs; running for office; editing and writing; book publishing; teaching; outreach work; mentoring; life coaching; spiritual direction; public speaking; pulpit supply; and the list can go on in my short life I had packed in multiple life times. Standing in the darkness and walking with those in the midst so they could come into their light. Discover who they truly were; teaching and facilitating others in discovering their passions and ways to make a living at it. I believe my life showed that you can chase dreams, and still hold true to your core values, not having to surrender who you are to make a difference in this world. At one point I looked back on my time in ministry and realized I had the opportunity to speak into nearly 1,000 young lives for the better. 

But it started to shift in May and then October 2016 in the ER with weird brain activity, memory loss, chest pains and left-hand tremors. But I was told I was normal and fine, so carry on at discharge, after a day or two at home back at it. Back at the work of walking with folks to create home and community. 

In the later part of 2017 as summer approached, professional and personal griefs/stressors were there. Waying on one’s spirit. I felt tired, and my brain was foggy. Like I had taught so many though, back to the daily practice, self-care, seeking out those who can aid you in debrief and carry forward, keep yourself healthy. And why wouldn’t I be tired? It was a phase, been there done that. My vocabulary, and understanding of some basic concepts began to fail me. Again, I looked back on what was happening with those in personal and professional life passing away, assumed it was a grief cycle (my son’s friends were passing away, always hard). 

But then my birthday hit and the game changed. 

Seizures (Grand Mal and absent), multiple in rapid succession. Lost memory and time. Not only in the now, but lost memories, I could not recall things. It kept happening, I became the ER’s daily flier if you will…and oh so cold, my body had gone hypothermic, in retrospect to protect my heart. Medical science couldn’t answer the question. Weird things being vomited out. Tests were toss ups. 

But when the seizures hit, and I would come back so would the pain. The life of being a light in the darkness, but only the darkness would come back. Decades of being in the pain, looking back and having my mind lie to me saying that I was a failure, had not made a difference. My memories that would reboot, it was like an old DOS computer with dust on the floppy, the self-care wouldn’t come with it. My healing and growing of scar tissue were gone, it was rapid succession of the pain that cut to the very core of who I was. I tried to work through, my agency was wonderful in their support. 

But I was not me. My beautiful gift, my mind, was failing. Things that I knew by rote, and was simple neurological muscle memory were gone, fog was constant, stabbing pains, tremoring arm, in ability to sleep, hypothermic and I won’t share how when I went down finally for health reasons the days of weird chemicals I had been exposed to expelling from my body (oh and the constant daily seizures, at one point almost 40 a day). Tests of the blood, body and brain, but the flashbacks persisted. 

It wasn’t something that was expected. I had learned to take care of myself, to rely on supports, to keep healthy, to use vacation time and to chase passions. This was against the narrative. But it persisted. Advancing from basic neurology to complex, in hospital observational stays, and all the epileptoligists/neurologists looking at my brain scans and medical files to reach a decision on what was happening. Finally, in the last month or two having confirmed diagnosis, PTSD-PNES, and now due to the Third Way boondoggle that was Klein’s legacy, I wait for the aid to cure and move forward. In the mean time the seizures are not epileptic but bring all the fears of those types of seizures with them everything from falls to sudden death, with no medications that can be prescribed to control them. 

With each seizure my number reminds me of where I have walked. 613 that is 613 in my life of family, friends, children, parishners, and clients I was unable to do more than journey with to the final transition to the next life. Most I was present for last rites or the passing or performed the celebration of life, if not all of it. In the travels I continue to use that which some may say is fruitless. Yet I persist. I pay the price for the persistence to keep going, I am not as good as I used to be, not even close…but I keep trying, working on myself while I wait. 

This time I feel like Alice having stepped through the looking glass, or Kirk into the Mirror Universe. I have seen what the darkness unchecked has done to my soul. I know what the light is. I struggle to believe in myself once more for with each reboot I still have to work through the lies my heart tells me that I am a failure, for even if it is a simple spark I need to hold to it…that I make a difference simply by being. 

What is your number? 

 (Authentic you slide) 

The Great Commandment lays out a challenge for us. It is about realizing that we are created in God’s image. As such we cannot say we love God with our everything, if we do not love ourselves. To love ourselves speaks of belonging in our own skin, having our purpose, it is not about jobs, it is about knowing why we are here and having a means to live it out. It is also understanding we need to love our neighbour who is also the image of God. Creating the courageous safe space for belonging so they can discover themselves. Within that space journeying with one another in the same vein. 

People constantly ask me what’s next? I honestly do not know, step one is to get the healing work done, then look at a return to work. What will that look like? I do not know. In the mean time I have purpose, I write, I teach when I can, I do some research and writing for my Dad and his wife’s project, Countess Country Musuem. I am beginning to work on a family memoir on the topic of mental health and belonging to remove the stigma. Most importantly though in this time of healing, I am a husband and a Dad in an amazing loving family. 

I leave you with a question to mull, 

What’s next for you? 

(Christian Counsellors slide) 

mens prayer breakfast ad

 


Good Night,

Sleep tight,

don’t let the bed bugs bite.

-Ancient bedtime incantation against the blood sucking buggars

Image result for bed bugsBED BUGS! Feel it. That uncontrollable desire to itch or scratch? Don’t hide it. I know you did. I spent years being the go to in infestation control for multiple buildings. It is a creepy feeling. I have seen infestations so bad that there was a symbiosis created by tenant and insect, to the newest ones that are picked up in life transit.  We have all heard the news reports of the explosions of bed bugs on airplanes, in churches, movie theatres, low rent motels, high rent hotels, and schools. These are travelers, see bed bugs are searching for hosts. They love our carbon dioxide. The ones in public spaces are seeking a person to take them home. There is so many because 1000’s can literally be born in days. The female bed bug is impregnated by thousands of mates all at once, and births the babies in a cycle.

They are translucent until they feed. There source of food? Us. If there is a huge infestation, and they cannot sufficiently feed I have seen situations where they will feed on a pet, but usually a pet in used as a public transit mechanism for them to go to other places and spread their colonies. By what are they making a comeback so strongly in Canada? Well, we had them obliterated, unfortunately the chemicals used to wipe them out were also wiping us out via carcinogens. Dang it.

Image result for bed bugsBy mechanical function how early an infestation is detected states how many sprays are needed (minimum usually two). If you rent, the landlord in Alberta is responsible for footing the bill for the spray (sorry homeowners, its on us for our own). The responsibility of the tenant (and the infested if you own) is to promptly follow through on all instructions laid out by the pest control company to ensure the efficacy of the sprays.

Appears very simple. One notes like the picture above or less and calls in; or has noted 3 clustered bites (breakfast-lunch-dinner)together resembling small or large mosquito bites and calls for pest control (keep in mind not everyone shows bites, for the bite showing is an allergic reaction so you can be being feasted on and never even know it, it is why in communal living like hotels, condos, and apartment blocks random inspections help by trained pest control).

Yet this is not a simple carpet beetle infestation where carpet replacement or vacuuming will cure, or flour beetles that require cleaning and food disposal. This is a very intimate type of infestation and that can be missed is that part of the process is mental health supports. Sadly in 2013 in Montreal, a gent with pre-existing mental health conditions completed a suicide due to recurrent Bed Bug infestations. Though I can attest one does not need pre-existing mental health or health conditions to provide an unkind end.

Image result for bed bugsBed bugs get in your most intimate spots–truly. They disrupt sleep. They interrupt sexual relations. If you talk to others about it, they recoil and stigmatize you. See we assume bed bugs equate to dirty lifestyle or living. That is a fallacy. Bed Bugs are seeking food (us), they do not care if you are a hoarder or a minimalist, hospital clean or junkyard mucky, young, old, senior, Millennial, wealthy or poor. They just want your blood.

One would then think, well treatment happens it ends right. No, it does not, one is encouraged not to abandon their resident during treatment cycles as you are literally the bait to contain the infestation. Best case scenario, after two weeks it is free and clear with maybe a lingering of psychosomatic itchiness. Worst case scenario, multiple sprays and many if not all belongings disposed of to ensure reoccurence stops. Literally losing one’s life (material, or completed suicide).

What can this do? Lack of sleep is never a good thing for the human body. Isolation due to stigmatization is never a good thing. Fear of an area of the house (usually happens with where you sleep), but can happen with the whole residence. During treatment cycles, prep, stress, already existing mental health concerns can be exacerbated or new ones can be created: panic attacks to psychotic breaks are not out of the realm of possibility for a rather mentally healthy individual (recurrence after treatment has also been termed Post Traumatic Bed Bug Stress Disorder). For addictions, they can get worse and reach crisis levels, most prevalent being gambling, alcoholism, and drug use. One can also become more open to addiction symptoms to deal with the stress and trauma of the infestation. Sadly as well, pre-existing domestic violence can increase rapidly around this as the infestation can become the focal point of rage and blame.

Knowing that inspection brings people into one’s sanctuary (home); treatment brings others into the sanctuary and tears it apart; living with the buggars has its own terrors. Is it any wonder that mental health is something that needs to be navigated, acknowledged, and treated during and after this time? If we ignore it, we are simply ignoring what is right for our neighbour and ourselves.

Best pest control company I have worked with in Calgary is Martin’s Pest Control.

Image result for bed bugs

 


Unconsciously I must have known this allegory of me as Bionic Knight (read B.K. pulps here) was needed as 18 months of unknown physiological and neurological symptoms that two previous visits to ER saw everything come back as normal. Mysteries persisted and sick time evaporated, culminated in the ER cluster storm of my 39th b-day forward. A new reality that has seen symptoms evaporate due to attrition of time, not medical intervention while others persist. Yet it is in the writings of the story of a middle-aged hero that was my first super hero creation that I could begin to unpack what was going on within my own mind, heart and soul.

labyrinth

I love writing, as many who know me know… Whether it is fiction, non-fiction, poetry or plays I just love to share worldviews and percolate thoughts…I dislike recently after a good run the beating my own brain gives me as tonight I feel like I was on the losing end of a boxing match. And left outside in a winter storm. #neurolife (Facebook post from December 4, 2017)

brain-labyrinth

“4 months since 39. 9 weeks since “I can’t”.

and my faith broke.

For it is within the allegory of Super-hero we can honestly look at those that serve those in most need go through, without having to just yet look at our society in a mirror and go: we collectively decided that it was okay for this level of poverty to exist within our society, for our children, youth, young adults, elders, seniors and neighbours to live like this as we worshiped the zero-based budget.

Yet that choice, as with every choice, is like a pebble in a pond or a butterfly flapping their wings. No one can know what those ripples or wings will cause down the line, but know it is a question each of us most be prepared to ask.

It was easily summed up with these for words and punctuation many a time over:

Who is my neighbour?

stepping stones

And today we MUST continue to ask:

And how shall we live justly, safely and healthily together in community?

Where is hope found in my life?

How does my faith heal?

Advent of something new?

heart


It is so weird when we speak of inclusion that there are still the “stigmatized” out there. I remember years ago when I first entered my mental health journey being told, “don’t say anything” or “others will see you as weak if they know” or “leaders don’t speak of their weaknesses.”

Weakness?

That is the wrong term to be used in regards to depression/anxiety, or even disabilities. All misnomers. Our world is made up of many different types of people, who have different abilities, and also mentally/spiritually experience the world differently. By moving towards exclusionary terminology, labels or even worse degradation to less than they are capable of being. For it is in building a world, where each person can excel to their fullest potential that is needed, not one where we place our own ideal of what is “normal” or “civilized” or “healthy” onto everyone else. For it is in trying to bring others up to our desired level that isolation, aloneness and seperatedness from community happens to the point where I believe it creates a huge contributing factor to the rise of addictions of every shape, for it is easier to allow something to overtake your life to the point of not being in touch with the reality around you, than to be a constant disappointment to the reality around you.

Think about it?

Are you willing to provide support for individuals to become full partiicpating members of community in a healthy way?

Are you willing to look beyong labels to who they truly are as a divine being?

Is the community you are a part of willing to open their arms in a welcoming fashion regardless of cultural/societal label and create a courageous and safe space for all?

Hmmm… or are the words of inclusion empty platitudes to make us feel better while we do not need to transform ourselves or our world for the better?

What is inclusion for you?

What does it take to shine the light into the Dark Nights? And allow the rainbows through the bleakness of day?

How much does it cost for everyone to find a true Home?


It is an ugly emotion

Let’s be honest

we think jealousy or greed

but really, Grief is what destroys

it latches on to our most carnal desires,

allows anger to seize control of a system that is too love…

Our command to love neighbour as self,

in grief possibly we can fake loving neighbour, but as the anger eats away at our insides, we truly are destroying ourselves faster than any addiction or razor blade would.

it is the root, of self-destruction, much like the love of money is the root of evil,

but grief festoons,

simply because

with loss we toss about so easily

“it is God‘s will”

What a load

of bull shit…

for how does God deem one beloved matriarch dies, while a beloved patriarch lives?

How one Mum wastes away from illness in the cells and another from illness unseen?

How it become easy, to hate one’s siblings, blood or other

as senses heightened like a were-wolf

smells out the weakness

and attacks to props one self up as higher…

Grief is destructive….

Needs the consolation of a beloved grandmother…

yet it is Nan that I miss

as she smiles down from Nirvana.


 

Mental Health (Powerpoint)

Mental Health Made Simple

Prepared by

Ty Ragan Psy.D; LPL;

May 17, 2011

Bio:

Dr.T.R. Ragan holds a doctorate in Psychology, a Masters and Bachelor’s in Leadership & Ministry with a focus on community building, integration, and
action.  He has a 25+ years experience as
a human rights and peace activist, outreach worker to those experiencing
homelessness across mainland Canada
that has earned him a shamanic designation of Wisdom Keeper, 2 honourary
doctorates and an ordination.  His work
history has been centered on working with individuals reintegrating from young
offender’s facilities; high risk for dropping out of school; street involved
youth; children in the sex trade; close to 12 years of involvement on the front
lines with Calgary’s Mustard Seed Society, and working as a vocational
counsellor for differently abled adults through Hull Child & Family
Services.  He has taught courses in
spiritual formation, and vocational discernment at the University
of Calgary and Spiritual Directions in
Calgary, pulpit supply through a variety of
Christian Denominations throughout Western Canada
and is the author of 4 published books, and many articles centred on improving
practices and building community.

 

Abstract:

 

This
is a simple article to explain how the DSM-IV-TR works, how diagnoses are
handled, and medication possibilities.
It is not meant to replace a formal mental health clinician (i.e.:
therapist, psychologist, psychiatrist) but to guide one’s referral process with
presented information.

Introduction

 

            Mental health is an
often misunderstood, stigmatized, or maligned piece of holistic care. It can
often go ignored, in the past they were the “eccentric” or the “special” family
member.  Why should Mental Health matter
to our population? Simple, in 1993 following the first steps of the Waterloo
Model (1984) of integration, the Alberta Progressive Conservative Government
closed extended care facilities for those with severe mental illness and
discharged them to the community.

The full Waterloo Model was discharge into community
based housing with supports such as home care, mental health ACT teams, and
social networks, this was not followed in Alberta and overnight the population
demographics on the streets changed and created a revolving door with medical
facilities for lack of care for those most vulnerable within our
populations.  Current estimates place
between 60-85% of people experiencing homelessness are experiencing life with
severe mental health issues, yet it is a chicken and egg scenario currently on
which factor caused which currently.

This short paper will explore process of diagnosis,
DSM-IV-TR made simple, assessments simplified, and rudimentary
psychopharmacological treatments.

Diagnosis

 

            This simple process
of diagnosis is adapted from James Morrison’s’ Diagnosis Made Easier: Principles and Techniques for Mental Health
Clinicians
(2007).

There is an inciting incident that precipitates the individual
seeking help.  At this juncture is
preliminary information gathering:

  1. Patient
    First Interview
  2. Informants-
    personal & professional individuals involved closely in the person’s life.
  3. Psychological
    Testing
  4. Laboratory
    Data & Imaging
  5. Medical
    Records
  6. Psychological
    Testing.

This
information is gathered to discern a syndrome: a gathering of major symptoms to
produce a diagnosis (i.e.: alcoholism; depression) (p.5).

From the Syndromes then all possible diagnosis are listed
(Differential Diagnosis).  Through taking
into account the full history, and please note the person’s history trumps
variables present during crisis, a working diagnosis is chosen and if needed
comorbid diagnosis which are ranked in order of importance.

These working diagnoses then bring around a treatment
team for a holistic approach that engages nutrition, health,
psychopharmacological treatments, monitoring, therapy, and spiritual
care/formation.

Throughout the course of treatment the clinician will
continue to be the funnel for information, 1 to 1 meetings with the individual,
retesting and adjustments to treatment as needed.

DSM-IV-TR

 

            The American
Psychiatric Associations’ Diagnostic and Statistical Manual of Mental
Disorders Fourth Edition Text Revision
(2000) is the benchmark used for
diagnosis of Mental Health in the world by clinicians.  The manual uses a multiaxial diagnostic tool,
and provides one psychological language throughout professions for aiding those
in need.  The Fifth Edition is expected
for release in 2013 after final approval and will continue to broaden the
spectrum of understanding for mental health in the world and continue to strive
to remove stigmatization of the individual for how the experience the world.

Axis I

Axis I diagnosis are listed in
Figure 1.

Figure 1: Clinical
Disorders

Diagnosis pre-18 yrs Schizophrenia and other psychotic disorders Factitious Disorders
Delirium, dementia, Amnestic and other Cognitive
Disorders
Mood Disorders Dissociative Disorders
Mental disorders due to a General Medical Condition Anxiety Disorders Sexual & Gender Identity Disorders
Substance related disorders Somatoform Disorders Eating Disorders
Sleep Disorders Impulse-Control Disorders Not Elsewhere Classified Adjustment Disorders

In addition to Figure 1,
Axis I also includes other conditions that may be a focus of clinical
attention. Axis I is the first foray into diagnosis that can usually be
quantified through testing, and for the most part treated with therapy and
pharmaceuticals.

Axis II

 

Where Axis I is fairly quantifiable, Axis II moves more
into the social science or artistic form of psychological practice.  It includes all Personality Disorders (see
Figure 2 for a list.) and Mental Retardation, which for the Canadian ear is an
abrupt term, but equates to lower mental acuity than average.

Figure
2:

Paranoid Schizoid Schizotypal Antisocial Borderline
Histrionic Narcissistic Avoidant Dependent Obsessive-Compulsive
Not Otherwise Specified

Personality Disorder is
defined in Miriam Webster’s Medical Dictionary (2007) as:

a
psychopathological condition or group of conditions in which an individual’s
entire life pattern is considered deviant or nonadaptive although the
individual shows neither neurotic symptoms nor psychotic disorganization.

Axis III

 

Axis III are mental disorders arising from a medical
diagnosis as found in the International
Statistical Classification of Diseases and Related Health Problems
(ICD-10-CM/ICD-9-CM).  These medical
triggers include diseases such as: (a) Infectious/Parasitic (001-139); (b) Neoplasms
(140-239); (c) Endocrine, nutritional, & Metabolic, Immunity (240-279); (d)
blood & blood forming organs (320-389); (e) Circulatory system (390-459);
(f) Respiratory (460-519); (g) Digestive Systems (520-579); (h) Genitourinary
System (580-629); (i) Complications in pregnancy, childbirth, and the pueperium
(630-676); (j) Skin and subcutaneous tissue (680-709); (k) Muscoloskeletal
System and connective tissue (710-739); (l) Congenital Anomalies (740-759); (m)
Certain conditions originating in Perinatal Period (760-779); (n) Symptoms,
Signs, and Ill defined Conditions (780-799); and (o) Injury and Poisoning
(800-999).

Axis IV

 

Axis
IV is where the information gathering of the diagnostic puzzle becomes the most
important.  For this is the Axis that
feeds needed information to inform the diagnosis of an Axis I or II
diagnosis.  These are the intangibles if
you will. The problems that arise within the following spectrum: (a) Primary Support Group (Family. e.g.: death, health
issues; abuse); (b) Related to Social Environment (e.g.: racism, retirement,
death of friend); (c) Educational (e.g.: school environment, literacy); (d)
Occupational (e.g.: un/underemployed; stressful work schedule); (e) Housing
(e.g.: homelessness; safety); (f) Economic (e.g.: insufficient governmental
supports; insufficient Income); (g) Access to health services (e.g.:
inadequate, transportation, insurance); (h) Legal (e.g.: judicial involvement –
perpetrator or victim); and (i) Other (e.g.: disasters; war; famine; hostility;
discord with professional supports; lack of governmental supports).

Axis V

 

The Fifth Access is a Global Assessment of Functioning
(and other functionality assessments).
It is multiple questions that the clinician ranks from 0 to 100 and then
averages the score for there complete G.A.F. score with the caveat of score
placed in brackets afterwards.

i.e.: Axis V: G.A.F. = 32
(at discharge).

What is not brought into the assessment is functioning
that is impeded by physical or environmental limitations are not included. In a
team care environment the functionality assessments could be carried out by an
Occupational Therapist for the Axis V.

 

Assessment
Simplified

 

The psychological quantifiable piece of assessment is
found in many spectrums.  They range from
those that need specialized training, to a standard set of questionnaire
answers that are applied to a set matrix for results.  The list of assessments are:

  1. Behavioural – looks at antecedents,
    conditions surrounding behaviour, and consequence.
  2. Weschsler Intelligence Scales – 3 IQ
    rankings (Full, Verbal, & Performance) in which the main thrust is
    predicting future behaviour, long term behaviours however fall short and
    results can be skewered based on gender, culture, ethnicity, and
    socio-economics.
  3. Weschsler Memory Scales – core
    component of any cognitive assessment, takes up to 42 minutes to
    administer.
  4. Minnesota
    Multiphasic Personality Inventory (MMPI) – is a standardized questionnaire
    for the diagnosis of Axis I disorders.
  5. Millon Clinical Multiaxial Inventory
    (MCMI) – is a self report assessment used in the diagnosis of Axis II
    disorders.
  6. California
    Psychology Inventory (CPI) – is a culturally relevant interpersonal
    assessment for typically developing young adults.
  7. Rorschach – is 10 inkblot assessments
    given systematically to aid in bypassing one’s conscious inhibitions.
  8. Thematic Apperception Test (TAT) – 20
    pictures given in sequence to aid in revealing dominant drives, emotions,
    sentiments, complexes and conflicts of personality.
  9. Neuropsychological impairment – a
    battery of tests designed to seek out any brain injuries.

All
nine of these assessments can be or are used to aid in the diagnosis process
for an individual presenting with minor to severe mental health issues.  It is another piece of the puzzle, another
block in building the foundation.

 

Psychopharmacological
Treatment

 

Once one enters the treatment phase, one needs to explore
all options and through informed consent choose a method of treatment. The
reason for the holistic approach in information gathering leads one to these
assessments for treatment:

  • Psycho-Therapeutic
    • This is meeting 1 to 1 with a
      counsellor or team of clinicians to address the underlying root emotional
      causes of the presenting mental health issue.
  • Medical-physical
    • Many mental health issues as noted in
      the diagnostic phase can be tied to medical issues, or cholesterol, part
      of any treatment plan needs to eliminate or work with these as these
      could be either a catalyst or a symptom of the presenting mental health
      issue.
  • Psycho-pharmacological
    • The important aspect of any treatment
      is a trusted pharmacist and consistent pharmacy to work with the
      individual.  Through testing, and
      trial & error the right combination of pharmaceuticals can be found
      to treat the chemical imbalances or misalignments of the presenting
      mental health issue.
    • The pharmacist is imperative as they
      will be able to guide the individual through all their behind the counter
      medications, and over the counter remedies and herbal remedies.  Essentially they are the pharmaceutical
      case worker to ensure nothing interacts badly with the individual’s
      bio-chemistry.
    • A consistent pharmacy is needed
      because each pharmacist has a slightly different mixture for their
      pharmaceuticals and with some, it could be a drastic change in effect
      with a change in pharmacy.

As you would not be a
trained pharmacists or prescribing physician it is best to partner with a
reputable professional, and work through them to ensure that this facet of care
is handled safely and professionally.

Conclusion

 

            Diagnosing and
working with mental illness is 1/3 quantifiable test results, 1/3 qualifiable
information gathering, and 1/3 putting the pieces together to solve the mystery.  It is the hope of this writer that there is a
better understanding of mental health disorders that will aid in removing
stigmatization and fear, but also equip and enable workers to be able to
communicate more effectively with the clinicians in the field.