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Mental Health Works is a blog dedicated to reflecting on past experiences, respecting our stories and the stories of others, and providing comfort to those who need it.
The World of Mental Health and Insurance
I still remember my first day in the Intensive Outpatient Program (IOP). I had been released from the hospital’s behavioral health unit the Friday before, and after an emotionally volatile weekend, it was time to begin extensive therapy. The nurse checked my vitals and when I began to cry, she assured me: “This is nothing like the hospital.”
That statement stuck with me. For one, it was relieving. The hospital had been traumatizing and dreadful. But why was IOP different from the hospital? One word: insurance.
IOP could only be attended by those who had health insurance coverage. Those who did not, unfortunately, were left having to scramble to find other options. This may not be true of every Intensive Outpatient Program, but it was true of the one I was in. While I am extremely grateful that I have insurance and that my insurance was willing to cover my stint in IOP, I cannot help but think about the differences between hospitalization- where insurance was not required- and Intensive Outpatient.
The Differences: For one, I was treated with respect at IOP. The rooms were clean and cared for, nurses were kind, and the employees liked their job. Group therapy was the norm, but individual therapy was also offered for those who needed it. The program could last anywhere from 3-9 weeks (about 2 months), and you were not committed- rather, you were there because you chose to be. The therapists were not overworked nor spread too thin, so they had time to address your issues head on. While I cannot say I enjoyed my time in IOP (primarily because I was still processing tremendous trauma) I did find it to be a much more pleasant experience than the hospital.
The hospital, on the other hand, was dirty, and literally and figuratively cold. During the seven days I was there, we did not go outside once. Many of the staff seemed like they did not want to be there, and the nurses were underpaid. The two therapists who rotated running group worked at multiple hospitals and had to run from one unit to another to lead therapy. The doors remained locked, and you had to ask permission to use the bathroom before 7 am. Due to COVID, visitors were not allowed, and phone calls could only be made at certain times a day from the 3 landlines. Safety was the standard, and while I cannot argue with the essential need to keep patients in crisis safe from themselves, you were not kept safe from the psychological, emotional, and (for some) physical neglect which frequented the halls.
Why is this important?: I do not know much about insurance, and I do not feign knowledge where I am ignorant. However, I am and was perfectly capable of seeing how vastly different treatment was for those who were insured vs those who were not. This is so important to note, because it is not uncommon for people experiencing severe mental illness to struggle with holding down a job, leading, often, to a lack of insurance (https://www.who.int/news-room/fact-sheets/detail/mental-health-at-work). Those who need help most are, once more, forgotten on the sidelines. I hope as the mental health world continues to change and grow, that mental health programs will become more cognizant and receive more funding to support patient wellbeing as well as safety, and that those who need help most will receive it. Just as we battle our own demons, the mental health field has its own hurdles to tackle, insurance and patient care being one of them. However, I do believe that with time and advocacy, things can change. Participate in missions to lessen the gap in mental health care. If you are a practitioner, serve those who need it, and not just those who can afford. We can make a difference, but we first must make the choice.
Understanding Self Injury
I hardly dare whisper about it, better yet speak of it. I hide it from others and at times even from myself. I tuck it away for months, then, in moments of desperate pain, I spiral, headfirst, into it. I am talking about self-injury. To make matters worse, my self-harm started when I was an adult. When we think of self-injury, we often think of teenagers. Not me. I was 19 when it began. I am 26 now.
But I am not alone. Research tells us that 5 percent of adults partake in non-suicidal self-injury (NSSI), and 15% of college students self-injure (The Recovery Village, 2021). Self-injury does not discriminate. It does not just impact teenagers. It can impact mothers, fathers, grandparents, teachers, construction workers. It can affect anyone.
For me, self-injury has been a dance. It racks me with shame, yet eases, if temporarily, my anxious thoughts. It gives me a momentary sense of invincibility against the pain yet leaves me ravished and broken when it is done. It is a suffocating secret that, in the midst of it, I feel like there is no escape from.
However, there is hope for those of us who experience self-injury. Self-injury does not have to be a life sentence. Many people come to know recovery, and healthy coping skills are real, it’s just a matter of learning them. Dialectical Behavioral Therapy, Cognitive Behavioral Therapy, and Mindfulness-Based Therapies have all been found to be effective treatments for non-suicidal self-injury (Mayo Clinic, 2022).
I can remember the first time I self-injured up until the last, and the many times in between. The scars etched on my body are a reminder of the pain I have experienced but also the hope of healing that comes when the scabs fade and my flesh knits back together to create newness and second chances. Yes, I can still see the scars of my self-injury, but they are battle scars now from a war I have fought long and hard to win. A war I have won. I am not a monster. I am not broken. I am not a “cutter.” I am human. Just like all humans, I need outlets and places to express myself, especially when it comes to pain. Unfortunately, I did not have the skills to release my pain in a healthy way for a long time. But, thanks to therapy and a lot of hard work on my part, I now do. I have reached the light at the end of the tunnel, the one that in my darkest times I did not think existed. I have known deep pain, but I have also known recovery. I have made peace with the self-injury of my past, and I move forward into a brighter future. You can, too.
If you self-harm, whether you are an adult, teenager, or child- know there is hope. Reach out to someone you love. Ask for help. Seek counseling. Things can, will and do get better.
Important facts and statistics about self-harm: Prevalence, risk factors, & more. The Recovery Village Drug and Alcohol Rehab. (2022, May 2). Retrieved January 10, 2023, from https://www.therecoveryvillage.com/mental-health/self-harm/self-harm-statistics/
Mayo Foundation for Medical Education and Research. (2022, November 10). Self-injury/ cutting. Mayo Clinic. Retrieved January 10, 2023, from https://www.mayoclinic.org/diseases- conditions/self-injury/symptoms-causes/syc-20350950
Why We Need Love: Miss Maci and Me
I don’t know where she is now. I don’t know if she is alive or if she has passed on. I don’t know her middle name or her last name or even her age. But I know her. Miss Maci.
I met Miss Maci in the behavioral health unit of a hospital. She was wrinkled and small, with a curving spine and startlingly white hair. She leaned on a walker and shuffled slowly through the halls of our ward. Most people found her to be negative and a little bit silly. I knew better. Miss Maci was wise. She may have been cranky and a bit cantankerous, but she knew a thing or two about life.
She had come to the hospital because of suicidal ideation. In truth, I think she was afraid of her rapidly increasing incapacity. There is no terror quite as slow and dreadful as age. Miss Maci did not want to leave her home, her independence, her life. I may not be old, but that is a fear I understand. I think we all can. No one wants to lose what they have worked a lifetime to create.
Miss Maci was in love with a jailbird named Bill who rode a motorcycle and had died the year prior from cancer. She told me about him one afternoon in the day room. She said he had loved her well and completely, the two of them riding off on his motorcycle into the sunset before his cancer set in. I told her one evening how beautiful her hair looked and she smiled to the point her eyes filled with tears. She looked like a little girl. Miss Maci wanted, above all things, to be loved.
Love. We throw it around. We withhold it. We forget that there are people out there who desperately need it. Miss Maci showed me what it is to be a strong woman, even a hard woman. But, more importantly, she showed me the power of love- through her love for Bill, her jailbird, but most of all through her love of me. Miss Maci loved me. She treated me with love. She treated me with compassion and kindness during the darkest point of my life. That’s not something easily forgotten or swept under the rug.
Miss Maci, wherever you are, I hope you find all the love in the world. Thank you for loving me.
How We Can Heal Others and- by proxy- Ourselves
I’ve hurt people. Not intentionally, but it does happen. I say the wrong thing, am not in the right place at the right time, get frustrated over something small, forget to wish someone important happy birthday. Yes, I’ve hurt people.
However, I’ve also helped people. I’ve helped friends walk through and process trauma. I’ve held doors open for passerby’s. I’ve let people know when something falls out of of their bag onto the sidewalk. Yes, I’ve helped people.
There’s nothing quite so humbling though as recognizing when you have hurt someone and making amends. It takes humility to recognize a wrong and to try to make it right. It takes discipline to apologize and ask for forgiveness. We all hurt people. It’s whether or not we are willing to recognize our wrongdoings and change our future actions that decides who we are.
So, yes. I’ve hurt people and I’ve helped people. Next time you hurt or help someone too, just remember: your darkness- like your brightness- make you human, and extend yourself grace.
Grief And The Death of Dreams
We expect people to grieve death. We forget that people also need to grieve dreams. I dreamt of earning my Education Specialist degree and becoming a mental health counselor, but this dream did not reach fruition. It took time for me to understand the deep sadness I felt around this loss was not depression, but rather grief.
My senior year of college I bought into the dream of being a counselor. It was the opportunity I craved: a chance to listen to people and analyze thoughts and behavior. I’m also relatively nosy, so it satisfied my desire to get an inside look into people’s lives as well. I began graduate school immediately upon finishing my undergrad degree (there was a two week period between my final college classes and my first graduate level ones). I loved what I was learning while simultaneously being completely overwhelmed. This was the overall theme and feeling of my time in graduate school: enamored with the material; desparate for a break.
My time as a student came to an abrupt halt when I tried to take my life. The stress had not meshed well with my diagnoses, and I was pushed past my breaking point. I was hospitalized, a traumatic event in and of itself, and when I was released I found myself not quite kicked out of graduate school, but highly encouraged to withdraw. Being the diligent student I am, I immediately did so, but at the cost of my dream.
You may be thinking, why don’t you just go back to school? This is exactly what I am doing. I found a university willing to accept me despite my past and work with me towards my future goals. However, this did not change my need to grieve what could have been. I did not graduate (as anticipated) with my friends that spring. I did not get to complete the program with my friends. The relationships I had built with my former professors were cut off, as they all ceased to speak to me once news of my attempt got out. I had to grieve these relationships, this future I had promised myself where I graduated on time, surrounded by people I admired and respected, supported by my program, and with a wealth of professional connections.
I say all this so you know that it is okay to grieve your dreams. Big ones. Small ones. Ones inbetween. We all have a vision for our life, and when reality falls short, it’s okay to miss what could have been. However, as has been the case for me, it is possible to dream new dreams and build a new future. I may not be graduating with the class I originally thought I would or from the school I originally attended. Instead, I have gained a wonderful job, new friends, a supportive learning environment, and a respect for the present moment I lacked prior. I have had the gift of seeing this dream begin to bear fruit.
Grieve your dreams, but don’t be afraid to dream new ones.
Three Things I Learned From My Suicide Attempt
My suicide attempt was exhausting and traumatizing. I spent a week in the hospital following it that left me feeling afraid and spent. However, I walked away with three lessons I may not have learned otherwise. I’d like to share them with you.
- Ask for help- before it’s too late.
When friends asked, I told them I was okay, just going through a phase. This, obviously, could not have been further from the truth. It’s better to ask for help now than to wish you had later. Had I received help sooner, I may have avoided a traumatizing stay in the behavioral health ward of the hospital. Regardless, I learned from my experience the importance of reaching out when you need it. Call or text a suicide hotline, phone a friend, talk with a family member. Most importantly, don’t pretend you’re okay if you’re not.
- People care.
Instead of being abandoned, I found myself surrounded by love and support. My family, friends and pastors leaned in instead of turning away. With their help, I was able to slowly recover and find mental wellness.
- There is hope.
No matter how hopeless the moment feels-which can be pretty damn hopeless- I have found there really is hope. Things do, in my experience, get better. I would have missed out on my fiancé proposing, getting my dog, and getting a new job. I would have missed out on the smaller things too, like time with my family and the way the air feels on a chilly day. I’m incredibly grateful I have not missed these things and that I have gotten to be here for them. No matter how dire the circumstance, you can come out on the other side.
Suicide is a real threat to lives in our communities, and I hope you can take these lessons from my experience rather than having to learn them on your own. While my attempt was traumatizing, I walked away stronger and more resilient. I hope you are able to find peace. Recovery is out there, it’s real, and it’s possible.
Elizabeth Beasley mental health Leave a comment December 14, 2022 1 Minute
Intense. Edgy. Broken. 3 words to describe me.
In the hospital, there was a night I lay awake crying. I had a minor stand off with a nurse. I asked her to leave me alone. She told me I would have plenty of time alone in my room the whole night. I lay on my bed and cried.
Another night, they removed a woman from in front of my door, dragging her kicking and screaming “don’t do this to me! Please don’t do this to me!” Then they injected her with something and she went quiet. I lay in my bed, silently sobbing and shaking. I shook a lot while I was there. My muscles so tense they shivered with the slightest addition of anxiety. They lock the doors. The windows don’t open. There is no way out. You wine, dine and shit all in the same place and it feels terrible. There is no sunshine; you don’t go outside. You stay locked in, doing laps around the ward and basic aerobic exercises in a lame attempt at physical activity. You feel trapped in your mind- you are, quite literally, trapped in the ward.
What do you do in there? How do your survive? Two things got me through: coloring and other people. I colored for hours every day, my friend and I hiding the colored pencils so that Miss. Alis wouldn’t steal them and leave us with the broken crayons. I colored in pictures of faeries, trees, lions, hearts. Any coloring sheet I could get my hands on, I drew all over. I gave them out as gifts to elderly people in the ward. They treated them like treasure, stashing them in safe places and breaking into huge smiles for the first time in days. It made me wonder when the last time they received a gift was. Certainly not while they had been on the ward.
Aside from the coloring, the people kept me afloat. We were a group of depressed individuals pretending not to be depressed despite our depressing circumstances, and we bonded quickly. We didn’t talk about the deep stuff, like our sadness and anxiety. Instead, we talked about the food, the sleeping arrangements, what movie to watch, how they locked the bathrooms at night. It was easier to exist in small moments then to remember where we truly were and why we were there. We bonded though, despite our circumstances. It was us against the ward. Us against ourselves.
It has been over a year since these events. But I can still feel them in a distant, disassociated kind of way. It is like they occurred in an alternate universe. I’m there, yet, I’m not.
Intense. Edgy. Broken. 3 words to describe who I was. Who will I be?
Authors Note: Each Sunday, I will post a process piece. These are different from the usual blog posts, as they are meant to serve as an opportunity for me to process the event while also working on my writing. Blog posts will feature an overarching theme and conclusion. Process Pieces will be more fragmented yet on-running. I hope you enjoy them both:)
Why We Need To Change The Narrative Around BPD For Counselors-In-Training
I have a secret. One that began in the behavioral health unit of a hospital, and has haunted me ever since. I am diagnosed with Borderline Personality Disorder.
When I first received this diagnosis, I was horrified. I could not be a “manipulative borderline”, or an “unstable borderline”, phrases I had heard time and again in reference to people with BPD. Yet, here I was, receiving the diagnosis of Borderline Personality Disorder. I was crushed.
I left the hospital a wreck. Not only was I recovering from a suicide attempt, but I was now a dreaded “borderline”. How was I going to face my professors and classmates in my counseling graduate program? They had heard the term borderline and feared it. How was I going to return to my life, how could I expect people to respect me? I was marked. Worse, I was borderline.
Enter my therapist. He met me where I was and did not judge my BPD traits and anxious mannerisms. He saw what a diagnosis of BPD really is: a person in pain. With the support of good therapy and close family and friends, I have been able to know recovery.
However, my fears of judgement by the medical community and beyond were not completely misplaced. As a student studying to be a counselor, I have heard the way many professors and counselors-in-training refer to those with BPD, and it is not positive. BPD and those diagnosed with it still experience significant stigma within the mental health community. This is in spite of research which has found that it is treatable. The counseling community as a whole, particularly those in the profession who teach or mentor counselors-in-training, needs to reconsider its view on BPD and how it is presented in the classroom.
For example, I have heard a professional counselor describe “borderlines” as manipulative individuals who fake their pain. I have heard jokes from other patients saying, “I smell a borderline” when a new patient who has BPD enters the room. I had a professor state that the villainous and abusive mother in a book was “probably borderline”. Finally, I have seen the reaction of my peers, the way they described abusive people they had known as “manipulative borderlines”. All of this impacted me deeply. Had BPD been presented to me as a severe but treatable illness, I may have been more open to my diagnosis and received help sooner. Instead, I was terrified of being labeled a monster.
It is the job of our clinicians and counseling faculty to learn and begin introducing the truths of BPD. It’s a diagnosis of pain that presents through turbulent emotions and behavior. Remission is possible and there is hope. Borderline Personality Disorder should not be a clinical death sentence. It should be the start of proper treatment and a chance at recovery.
I am so thankful to have had a therapist that could see my humanity, and for friends and family that saw and see me as far more than any diagnosis. The conversation around Borderline Personality Disorder can change, and it starts with counselor education and, by proxy, the education of the public. The narrative can change, just like those diagnosed with BPD can and do get better. Let’s change the conversation around BPD, starting in our counselor education programs and moving out into the world.
What I Learned From My Stay In The Hospital
My time in the hospital was emotionally and physically exhausting. Although we only did light exercise- walking a lap around the ward- the mental toll of being hospitalized left my body tired. I colored and watched TV frequently, but I yearned for sleep, my mind and body aching for what my turbulent thoughts wouldn’t allow me.
I tell you all this so that you may glimpse what the behavioral health unit of a hospital feels like. Empty, sterile, and full of apathy and a deep dread. It is a void carrying within it dozens of broken people.
It is so easy for me to remember the painful parts of my stay. The parts of loneliness and isolation. The parts where I was forced to wear scrubs because I was considered too high risk to wear my own clothes. The parts where someone watched me sleep to ensure I didn’t hurt myself in the night.
How did I get through this? How did I get through the embarrassment and humiliation and pure pain of being hospitalized for a mental health crisis?
Community. My parents, boyfriend and pastors called me daily. My friend wrote me a letter reminding me I “wasn’t crazy”. I got to know my fellow patients in the ward. We became a team, a mismatched family of sorts. Tied together by our grief and desire to leave.
But I was one of the lucky ones. Not everyone received phone calls every day. Not everyone had someone advocating for them on the outside. Not everyone’s family supported them. We say mental illness is invisible, but in that hospital I saw the very tangible evidence of it. I saw the broken communities, homes and people that desperately needed support but received none. I saw the way mental illness left people isolated, alone and helpless. It impacted their physical health, their communal health, their societal health. It left them aching and defenseless. It left them facing the world alone.
This serves to remind me of how much we need each other. How, without connection, our souls whither. We long to be known. Had I allowed myself to be known sooner, perhaps my story would be different. Regardless of how my story began, though, it was my community that changed how it ended. That kept me alive and lifted me up. May each of us know what it is to love one another, and may this push us all to bring about a deeper sense of relationship in our communities.
The hospital is likely still cold and sterile, but my heart is not. My heart has been cultivated by the love of my community. I hope that yours will be, too.