Mental Health First Aid

Thanks to Kalamazoo County Community Mental Health & Substance Abuse Services (KCMHSAS) for providing me with a full scholarship to attend this training, I went to an 8-hour Adult Mental Health First Aid course yesterday afternoon. According to their website, this course “teaches you how to identify, understand and respond to signs of mental illnesses and substance use disorders. The training gives you the skills you need to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis.”

The program was initially developed in Australia and has since been adapted for use in over 20 countries, including the United States. The main goal is to equip people with the tools they need to start a dialogue about mental health so that individuals who are in crisis can get the help that they need.

“Most of us would know how to help if we saw someone having a heart attack—we’d start CPR, or at the very least, call 9-1-1. But too few of us would know how to respond if we saw someone having a panic attack or if we were concerned that a friend or co-worker might be showing signs of alcoholism.

Mental Health First Aid takes the fear and hesitation out of starting conversations about mental health and substance use problems by improving understanding and providing an action plan that teaches people to safely and responsibly identify and address a potential mental illness or substance use disorder.” The Mental Health Action Plan utilizes the following acronym: ALGEE (pronounced like the word, “algae”)

  • Action A: Assess for risk of suicide or harm
  • Action L: Listen nonjudgmentally
  • Action G: Give reassurance and information
  • Action E: Encourage appropriate professional help
  • Action E: Encourage self-help and other support strategies

In the course, we learned the signs and symptoms of depression, anxiety disorders, suicidal behavior, non-suicidal self-harm, psychosis, and substance use disorders. We did a lot of group work, where we were given hypothetical situations and asked to use the Mental Health Action Plan to determine how to help the individuals in our case studies. We learned that the action plan is non-linear, meaning that you don’t necessarily complete all of the steps in order and you don’t have to complete all of the steps in each situation.

There were a dozen individuals in the class with me and the majority of them are social workers, but there were a few people who work outside of the mental health/substance abuse field, including business professionals, a college student and so on. I think that everyone found the course to be helpful. Much of the material seemed like common sense to me, but that may be because I have lived a lot of it. I found it interesting listening to people talk about the signs and symptoms. For example, we did an activity related to hearing voices (psychosis) in which we broke into groups of three and two people had a conversation with each other while the third person whispered into one of the other people’s ears. Everyone was shocked at how distracting this is but I have experienced auditory hallucinations, so I was not very surprised. I’m glad that it helped them to better understand what an individual that is hearing voices might be experiencing.

I think that the most important activity of the day was breaking into groups of two for role playing, having a conversation with a friend that we think might be suicidal, and asking them directly, “Are you having thoughts of suicide?” or “Are you thinking about killing yourself?” This activity is required in the course because how can we help someone who is suicidal if we can’t even ask them if we are? I had never said those words out loud and it was hard but we all did it and now I know that I can. I guess I just assumed that I would be able to do it before. We learned not to ask vague questions such as, “Are you thinking about harming yourself?” or “You’re not planning on doing anything crazy, are you?” because the individual may not see suicide as harmful or crazy. We need to be very direct. If the person says “yes,” there are four follow-up questions to ask:

  1. Do you have a plan?
  2. Have you decided when you would do it?
  3. Have you collected the things you need to carry out your plan?
  4. Do you have another plan?

I’m going to share two crisis resources here.

  • The National Suicide Prevention Lifeline is 1-800-273-TALK (8255). It is “a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week.”
  • The Crisis Text Line is a 24/7 anonymous service for anyone experiencing any kind of crisis. Text 741741 or message them on Facebook and you will be connected to a trained counselor. If your cell phone plan is with AT&T, T-Mobile, Sprint, or Verizon, texts to 741741 are free of charge. If you have a plan with a different carrier, standard text message rates apply.

We covered a lot of material throughout the day, but we didn’t have to try to memorize everything because we were given a copy of the book, “Mental Health First Aid USA” to keep. It’s full of information about mental health conditions, plus statistics and vetted resources. KCMHSAS also provided us with a detailed resource list specific to our county.

If you’re able to attend a Mental Health First Aid training, I highly recommend it. Did you know that 19.6% of American adults (1 in 5) have a mental disorder in a given year? This is equivalent to 45.6 million people. These types of disorders can have a huge impact on their education, work, relationships, and health. Early intervention can greatly reduce the impact and first aiders can make a big difference by helping individuals that are in crisis to have their needs met. Can you imagine what the world would be like if we had as many people trained in Mental Health First Aid as we do in First Aid and CPR?

Advertisements

GeneSight Test: Part 3 (Results)

Welcome to part 3 of my GeneSight series! I have submitted my spit and received my results! Did you miss my intro and/or procedure posts? You’ll want to read those first. This is the longest and most complex of all of them. I hope that you will find it as interesting as I do.

I received my reports within 2 weeks from my healthcare provider and was eager to see what they said. The GeneSight Psychotropic test report is 9 pages long and my GeneSight MTHFR test report is one page. Are you ready to hear about how my genetic makeup affects the way drugs work in my body?

The reports are pretty easy to read. My provider showed me an example of a report that he receives, which is color coded. Green means “Use as directed.” These are the medications that your body doesn’t have any issues responding to. Yellow means “Use with caution.” These have a moderate gene-drug interaction, so they might not work well for you. Finally, red means “Use with increased caution and more frequent monitoring.” These have a significant gene-drug interaction. Pages 1-4 of my report feature the green/yellow/red gene-drug interaction results.

The psychotropic test analyzed my gene-drug interaction with 22 antidepressants, 12 anxiolytics and hypnotics, antipsychotics, and mood stabilizers. Most of the drugs fell in the green category (note: my report printout is in black and white, but it is still very easy to interpret). I have moderate gene-drug reactions with 2 antidepressants: doxepin (Sinequan) and fluoxetine (Prozac) and one antipsychotic: asenapine (Saphris). I have never tried any of those medications. I have significant gene-drug interaction with one antipsychotic: olanzapine (Zyprexa) and two mood stabilizers: carbamazepine (Tegretol) and lamotrigine (Lamictal). I have tried the mood stabilizers and experienced side-effects that led me to see my prescriber and change meds. Note that the mood stabilizers Neurontin, Eskalith, and Topamax do not have proven genetic markers, so I have no results for those.

If a drug has a gene interaction, the reason is notated. For example, both of the antidepressants that are in the yellow zone might require lower doses because of high serum levels.

The next two pages of the report are more complicated to read and understand. These pages list “patient genotypes and phenotypes,” with pharmacodynamic genes on page 5 and pharmacokinetic genes on page 6. Some definitions:

  • Genotype: genetic makeup
  • Phenotype: observable characteristics (based on genotype/environment interaction)
  • pharmacodynamic: drug effects and how they work
    pharmacokinetic: movement of drugs within the body

These reports seem to be mostly full of “normals” for me, which is good (I think). There are a couple that are not normal, which leads us to the next section: a 2-page table with all of the drugs listed on the left side, all of the genotypes listed across the top, and a key at the bottom that has the following two options:

  1. A solid black circle = “Variation was found in patient genotype that may impact medication response.”
  2. An empty circle = “This gene is associated with medication response, but patient genotype is normal.”

I have 18 drugs that have solid black circles under one or more genotypes: (Wellbutrin, Remeron, Zoloft, Effexor, Trintellix, Valium, Lunesta, Restoril, Ambien, Clozaril, Prolixin, Haldol, Depakote, Sinequan, Prozac, Saphris, Zyprexa, and Lamictal). I have been on 10 of these drugs and I currently take high doses of Depakote. It would have been cool to have these results 16 years ago, when I first sought treatment for my issues!

Page 9 is the last page of my psychotropic report. It lists all of the details about the test (specimen collection details, a list of scientific procedures performed on the sample, etc.), a statement that the test hasn’t been approved by the FDA, a disclaimer of liability, customer service information, and a signature from the doctor that verified the report.

The last page of my document is a 1-page report on my folic acid conversion test. The MTHFR results are reported in a very simple and straightforward manner. A check mark is located in one of three categories: “Normal folic acid conversion,” “Reduced folic acid conversion,” or “Significantly reduced folic acid conversion.” I have reduced folic acid conversion. Just like the psychotropic test report, this report also has a short genotype/phenotype section. Based on my genotype, it is expected that I have reduced folic acid metabolism, moderately decreased serum folate levels, and moderately increased homocysteine levels. The report states that my serum levels may be too low and folate supplementation or higher daily intake of folic acid may be required. I will discuss this with my prescriber in April. Again, test information, disclaimers, and so forth are listed and the document is signed by someone who verified it.

This is getting to be a ridiculously long post, so I think I will stop here and say “to be continued” until after my follow-up appointment.

GeneSight Test: Part 2 (Procedure)

Welcome to part 2 in my GeneSight series! If you missed part 1, click here to read it really quick before proceeding. Part 1 gives an overview of what the test is, why it is used, why I had it done, and a list of other tests available from this specific company.

After my Nurse Practitioner and I decided that I would get tested, a Medical Assistant walked me you through the DNA sample collection process. The process that I experienced:

  1. I signed a form authorizing Assurex Health, Inc. to bill my medical insurance for the tests. I was told that the GeneSight Financial Assistance Program is available to help make GeneSight affordable for those who qualify. My provider told me that the test is expensive (several thousand dollars), but Assurex is very good at getting insurance companies to pay, and individuals usually end up paying no more than $300 out-of-pocket. I was told that I will receive a bill if my insurance doesn’t cover everything, at which time I can appeal and/or apply for assistance.
  2. The Medical Assistant gathered the testing supplies and I completed two short identical forms (one for each test) that were submitted with my samples. I was told that my samples and results would be kept confidential and comply with HIPAA (Health Insurance Portability and Accountability Act) and GINA (Genetic Information Nondiscrimination Act) that ensure the security of personal and genetic information.
  3. I was given two large cotton swabs and asked to rub them inside my cheek until they were soaked with spit. This was quick and painless. She had me drop the swabs into a plastic pouch, which she sealed and packaged for shipment.
  4. That’s it! The office mailed my samples (pre-paid FedEx) to Assurex. I was told that my results would be available to my healthcare provider within 36 hours after the lab received my samples, and that I would receive a copy of the results from my healthcare provider. I received a copy of my report in the mail just under 2 weeks after submitting my spit/cells. I have an appointment with my Nurse Practitioner in April to discuss the report.

Check back soon for part 3: the results!

 

GeneSight Test: Part 1

Earlier this month, my Psychiatric Nurse Practitioner suggested that I submit DNA samples for GeneSight Psychotropic and GeneSight MTHFR combinatorial pharmacogenomic testing. What does that mean? Why would I want to do that? I’m glad that you asked! If you didn’t ask those questions in your head, feel free to move along.

According to their website,

“The GeneSight test analyzes a patient’s genes and gives healthcare providers information to help them select the medicine(s) that are more likely to work for an individual patient. GeneSight provides answers that can lead to a personalized treatment plan and faster response and remission for patients.”

They currently offer 4 tests:

  • GeneSight Psychotropic (for mood-altering prescription drugs used to treat depression, anxiety, bipolar disorder, schizophrenia, and other behavioral health conditions)
  • GeneSight Analgesic (for prescription painkillers)
  • GeneSight ADHD (for prescription attention-deficit/hyperactivity disorder drugs)
  • GeneSight MTHFR (tests how well your body can convert folic acid into its active form)

 

I decided to get tested because I have been struggling for over 16 years with finding medications that work well for me and don’t have intolerable side effects.

I have already typed out a really long blog post about my experience having the test done and my results and then I decided to break it up into manageable sections. Because who wants to stay up all night reading this? Probably not you. So, stay tuned for parts 2, 3, and maybe 4! And for now, get some sleep. Monday is going to come too early.

I Found Some Hope!

Have I mentioned that I’ve been struggling with depression for the past month or so? I’m trying to avoid going to the hospital and it has been tough, but today I discovered a potentially helpful community resource.

My day started with 3 fillings at my dentist. With 2/3 of my mouth numb, plus my right eye, ear, and my nose, I sat in my car after my appointment and tried to figure out what to do for the rest of the day before dance practice. I had 7 hours to blow. I sat in my car for a good 45 minutes, basking in the sunlight on Michigan’s first warm spring day of the year and farting off my unfortunate breakfast choice, as I tried to decide whether I should drive home (a 30-minute commute) and sleep off the anesthesia or parade my crooked smile around Salvation Army, looking for deals on stuff that I didn’t need. I finally left with no plan, but then remembered that I had seen a mental health office on my drive in. I would pop in and see what they offered!

With a VERY wonky face, dental chair hair, and (probably) a faint eau de fart aroma about me, I walked into Pine Rest Christian Mental Health Services. No, I’m not Christian. But I am desperate and I would hope that my treatment wouldn’t be heavily peppered with religion. Anyway, the receptionist kindly informed me that their office only offers therapy, med management, and a substance abuse group. I’m looking for bipolar and/or depression groups and possibly partial (day) hospitalization. She made it sound as if the other local branch offered day hospitalization, so I drove there. I could have just called, but I have a stupid aversion to talking on the phone.

The next place was the same story, but they were kind enough to suggest the Elizabeth Upjohn Community Healing Center. So I drove there. This place was the same deal as the first, but with more substance abuse options, plus child therapy. Have I mentioned that every time I open my mouth to speak, the right side of my mouth and face doesn’t move? The reaction from the various people that I interacted with was pretty comical. Usually a look of slight confusion and then terror. Anyway, this time I was referred to the local DBSA  (Depression and Bipolar Support Alliance) chapter. I had to call :(. Nobody answered, but there was a message stating when their group meets (Mondays from 7-9 pm). I was really hoping to find something during the day, when my husbeast is not home with me. He works a lot of hours and I usually only get to spend 3 hours per night with him + Sunday and sometimes I see him on his day off, depending on which day that falls on.

So, feeling like I was at a road block, I got on my phone and tried to see if there was a DBSA chapter in the neighboring county. I’m not clear on the answer to that, but I stumbled across the local NAMI (National Alliance on Mental Illness) chapter, which listed several support groups in my area for family members of individuals living with mental illness (a good find, although not sure the husbeast will ever be able to do it due to his work schedule) AND I read about the Recovery Institute of Southwest Michigan, Inc.

Sorry that this story has gotten so long! Here’s the point: this sounds like exactly what I need right now. The Recovery Institute of Southwest Michigan, Inc. is a peer-run non-profit organization for individuals that are embracing recovery. There are weekly peer support groups for substance abuse, addictive behaviors, mental illness, for veterans, and for members of the LGBTQ community. There are ongoing wellness classes such as “whole health action management,” tobacco reduction, writing about recovery, meditation, yoga, and even an “open studio” time, when people can play games, play music, and share skills with each other. There is individual peer support and recovery coaching available, as well as special events and activities like computer lab, reading and writing tutoring, access to the local YMCA gym and pool, movie screenings, workshops, luncheons, and field trips. All of these resources are available to me for FREE, thanks to individuals like myself who volunteer to make the Recovery Institute work.

I picked up the March and April schedules, and I have so many good options! And all of them are during the day. I look forward to embarking on this new leg of my recovery. I’m sure that I will meet some great people and learn a lot about myself and others.

Do you participate in any groups to help you manage your mental illness? What are you doing on your own to manage your symptoms?

Dr. Copeland’s Concepts Essential to Self-Help

Concepts that are essential to self-help, according to Dr. Mary Ellen Copeland:

  1. There is hope. It is only when you feel and believe that you are fragile and out of control that you find it hard to move forward.
  2. It’s up to you to take responsibility for your own wellness.
  3. Education is a process that must accompany you on this journey.
  4. You must advocate for yourself to get what it is you want, need, and deserve.
  5. Support is essential.

Source: Copeland, M.E. (2002). The Depression Workbook: A Guide for Living with Depression and Manic Depression (2nd Ed.). Oakland: New Harbinger Publications, Inc.

I wish that someone had told me these five things the very first time that I experienced symptoms of bipolar disorder. I kind of want to have them printed on a card that will fit in my wallet so that I can remind myself of these concepts when needed and even share this knowledge with others that may benefit from it. I was going to talk about which aspects I think are the most important, but they are equally crucial. What do you think? Is there anything that you would add to the list?