How to Fix a Broken Mental-Health System.

Though set in an American context, How to Fix a Broken Mental-Health System does have parallels to Canada, and I'm sure many parts of the West. The piece speaks to laws enacted to get the mentally ill out of institutions with deplorable living conditions and into community-based centres.

The law was built around a two-step process—release and catch, as it were. De-institutionalize the mentally ill in these deplorable institutions, and then get them into the system of community health centres. But there was no step two. More than half of the proposed community health centres were never built.

In a Canadian context, similar policies were put in place. In a Quebec/Montreal context it's been said that CLSC's (our local health clinics), are meant to pick up the slack. My local clinic said there was a 3-year waiting list to see a psychologist, and closer to a 5 + year wait if I wanted one who spoke English. Hence my decades worth of travel and high-cost to access English services.

The read is interesting, especially if you're American. There is so much work to do be done.

Lisa Ling and PTSD.

I watched an episode of Lisa Ling's This Is Life last night. It's playing on OWN, after originally playing on CNN.

I really liked Our America by Lisa Ling on OWN, and this is in a similar vein.

I don't know why she left OWN, Our America had a better production value, but the content is similar, and I really like and respect Lisa Ling. According to an interview with Ling, cited on Wikipedia, she could look at "edgier" content with CNN.

Last nights episode "Jungle Fix," was all about ayahuasca, a plant-based hallucinogenic that is espoused by some to be a useful tool in confronting and dislodging trauma. 

Ling travels to Peru and interviews folks who flew down there specifically to take the drug, and to try and face their demons. 

The most powerful interviews come out during her interviews with veterans. They are clearly (understandably) angry at the lack of help they're getting back home, and with about 22 American veterans committing suicide daily, they're willing to try anything to alleviate some of their pain.

While on Our America, Ling did an episode called "Invisible Wounds of War" that, to this day, my friend S and I talk about. It deeply, deeply moved and upset me. The pain was palpable. I could taste it and feel it and it was just an overwhelming viewing experience.

That might make it seem frightening, but it was beautiful and important. 

I recommend both of these episodes. 

Treatment looks like different things to different people. We don't all have the same needs. We don't process things the same way. We all struggle to access help, and our drug laws are antiquated, maybe access to assisted retreats with certain drugs could in fact dislodge certain things for certain people. 

If someone is in deep pain, they deserve the opportunity to try whatever they can to help themselves.

For depression, primary care doctors could be a barrier to treatment.

Featured on PBS, For depression, primary care doctors could be a barrier to treatment has a few important points I'm going to pull-out.

Often referred to as the “common cold of mental health,” depression causes about 8 million doctors’ appointments a year. More than half are with primary care physicians. A new study suggests those doctors may not be the best to treat the condition due to insurance issues, time constraints and other factors.

That’s important. Most people with depression seek help from their primary care doctors, the study notes. Why? Patients often face “shortages and limitations of access to psychiatrists,” the authors write. For example, patients sometimes have difficulty locating psychiatrists nearby or those who are covered by their insurance plans.

I can attest to this, but my experience is isolated.  For me, I'm lucky to have access to basic insurance plan through work, which would cover up to 800$ of session through a co-pay structure. I think it covers 80% of the cost. And I'm reimbursed after several days. To me, this isn't ideal. I'm sure it's fine when you don't live pay-check to pay-check, but when you do, shelling out 60-160$ for a session upfront is brutal. It's not always even possible!

“The approach to depression should be like that of other chronic diseases. By and large, primary care practices don’t have the infrastructure or haven’t chosen to implement those practices for depression.” 

My experience with Dr. Rishi, and the countless folks I interacted with before, leads me to think this is very generational. Younger doctors seem to have a more inclusive view of wellness. I often think this has to do with their inclusion in that generation themselves. They know. They're part of a generation or two that has high anxiety, and for which mental health is a part of the vernacular.

“When we treat high blood pressure, the blood pressure may start at 150 over 95, and then it’s monitored over time until it gets to a level that’s being aimed for. If somebody has depression, their symptoms need to be monitored until it gets to a level that the depression is lifted.”

If we actually treat depression as a chronic illness and use the level of tools we’re using for diabetes, then we’ll be able to better treat patients — and help them live healthier lives and more productive lives."

Well... yes. It is a chronic illness. I need to be checked-in on. I need to be able to say when things are going better or worse. We need to be aware of my treatments. I need to be followed. If I stop taking my medication, I become disabled by the withdrawal. I lose my mind! When winter comes around - I have to prepare myself for a few months of an additional bout of seasonal affective disorder, and my doctor needs to play a role in that as well. 

The ultimate goal is to have a witness to my health. To be able to map out if there are cycles and methods of coping with those cyclical ups and downs that work for me. I feel that Dr. Rishi could be a partner in that, and everybody deserves that support. 

Everything is expensive. Please be less expensive everything.

So on a slow day at work I had started to look into further training and classes I could take. 

I get bored sometimes, and I also worry about my job security and my employability.

I ended up on the OCAD website, taking a look at their Inclusive Design master's degree. 

Turns out, their inclusive design graduate degree is made pretty exclusive by the 20,000$ price-tag. 

I think inclusive design could be an interesting field, and find it especially interesting in regards to mental health. While in crisis, sometimes I'm non-verbal. Design tools that cater to that, and that aim for a non-verbal representation of needs could be really helpful. 

I was introduced to K through a buddy while in Victoria. K is doing a masters revolving around disability at Concordia University. We talked at length on a beach in Victoria (not too shabby). She recommended Feminist Queer Crip and On Being Ill by Virginia Woolf. Both are on my to-read reading list. 

I hope I can talk to her about her experience with the Concordia master's program - I think she's doing it with the school of fine art though - I'm not sure.

I feel kind of stuck these days. I don't have much money coming in. I still have some credit card debt to pay off, I have a minimum amount saved up for a down-payment (10,000$) and now time is just passing. I'm still living pay-check to pay-check. I guess I just feel I need a project. 

I'm attempting to take better care of myself but I have good days and bad days. I haven't been cooking. 

I went for brunch with a buddy yesterday and she talked about her having greatly benefited from an elimination diet, which helped her figure out which foods aggravate her fibromyalgia and chronic eczema. We talked about it at length, since she says she feels drastically different, and feels her general mood, depression and energy have changed for the better. 

She's not one to preach on this kind of stuff, but she said I might find it interesting and helpful, which I might. I do feel lethargic and tired after bread and carbs, so I would probably see a big difference in reducing my wheat consumption. 

I am thinking about housing and I'm thinking about work and I'm thinking about what I want, and I just go back and forth on a lot of it. Sometimes I'm bored and feel like I could do more. Other times I feel like I should limit my responsibilities and commit to the least amount possible. 

Ups and downs. 

Suicide and insurance coverage.

Amidst all the Oscar talk on the radio this morning (Gaga should have won for best song), CBC News mentioned a possible change coming to the insurance coverage and legitimacy perception of suicide.

They had this piece from 2015, Suicide attempts and insurance: Why you might not be covered.

In a more recent piece, Insurance companies reconsider 'dated' policies for suicide attempts, the faulty logic of "avoidable" injury is called out.

The article quotes Mark Warder, a man whose America hospital bill was not covered due to the insurance companies policy that rejects suicide, and instead focuses only on depression to a certain point. After going public he very aptly stated:

Let's face it, most people if they've gone through this and [the insurance claim] gets turned down, they don't have the motivation to fight it.

 Preach. The piece goes on to quote Bill Wilkerson, a former insurance insider:

It's one of those hangovers from an ancient time of stigmatizing mental illness and viewing the destruction of someone under those circumstances as either a crime or a sin when it is neither.

The act of "committing suicide" was a crime in Canada until 1972.

There is a lot of work to be done in terms of insurance and access. I worry that this news coverage will go away and insurance companies will be quick to sweep it under the rug.

I plan on printing out the article and mailing it to my insurer and the HR deparment where I work.

Suicide, once-removed.

One of my best friends is upside-down because an old friend of hers committed suicide. She hasn't been close to him lately, but he was a best friend to her for years in high school. That happens. Life leads us around and we don’t stay friends with everyone, but that doesn't mean we don’t care for them. I know that I still carry people in my memories, especially through the nostalgia of youth. I can’t help look back and a lot of the silly things we did and still think of everyone fondly. We had a lot of fun, being dumb teenagers.

It's always tremendously sad when someone sees suicide as the only real option to ending their pain, but I guess lately it’s also something I understand, so my shock is dulled. Maybe part of the reason she and I are so saddened by it is because we understand so well. We understand what it is to want to end it all, and this is someone whose name we know, and who took that desire and realized it. It's so close to us.

It's also infuriating because this person was apparently the only thing keeping a non-profit community drop-in centre for children open. A lot of my friends in the social sector / non-profits work insanely hard and give everything they have, to be met with little to no support by the organizations and systems that employ them. I've seen too many people burn out. I see breakdowns and anxiety because these people are lovely and caring and want to help people, and they carry that burden to a point where it’s detrimental to their health.

People who work with/around mental health, sexual health, sex work, racial discrimination, outreach, youth, violence, poverty and in social support networks of all kinds are being taken for granted, and are risking their own health and wellness daily because it’s in their nature to care, and to support. This makes me really sad, and this makes me really angry.

When my friend worked with youth in the criminal justice system (technically youth corrections I guess, she worked in “youth and family centres”) she would tell me stories that made me sick to my stomach. Horror stories. How is it that she faced this daily, as a full-time job and wasn't mandated to go to counselling or therapy as part of her work process? Same thing with all sorts of high-risk, difficult jobs where you face abuse, violence and traumatic realities. How is it not part of the god-damn culture?

It makes no sense to me. This friend ended up on burn-out because of the trauma of having a kid she was working with commit suicide while she was working. She was then hassled by insurance company psychologists and had to constantly defend her right to be fucking traumatized.

I didn't know Jean-Pierre personally, my condolences to all who knew him.

My condolences to all of us, who suffer when good people die because our systems are broken.

The struggle for more coverage: pay for my therapy you dicks!

Just took the time to look over an article in the Montreal Gazette about Quebec's National Institute for Excellence in Health and Social Science (INESSS), and their finding that provincial healthcare should cover psychotherapy.

The INESSS research team found that for people with moderate anxiety or depressive disorders, there is no significant difference between psychotherapy and drug therapy when it comes to reducing symptoms.

However, it concluded, psychotherapy's benefits are longer lasting — even after as few as five or six sessions —providing better protection from relapse.

The research spokesman, Michael Sheehan, lost a son to suicide, and relates access to psychotherapy to the implementation of vaccines:

"It's not a vaccine, but...it's as close as we can get to a vaccine... If we did have a vaccine for most common mental illnesses, such as depression and anxiety, don't you think we would be screaming to have access to it, and it would be scandalous if we didn't?"

The piece goes onto state that only 1 in 3 of practising psychotherapists are in the public sector, with the majority of those benefiting from talk therapy relying on private insurance or simply having the means to pay for the services themselves.

Let me remind you here that I pay 50$ bi-weekly for sliding-scale therapy. Of that, 80% is covered by my insurance, so 40$. This involves paper-work and a reimbursement process. So, I need to be able to afford paying that 50$, since my reimbursement will take a while. I'm covered for 800$ worth of services per year, so that's about 20 sessions, hence my going bi-weekly and not weekly. My former therapist, who charged me 60$ a session as a student, now charges 160$ an hour. Hence my no longer seeing her. 

Jason Gilmour's story is far too common. A resident of Danville, in Quebec's Eastern Townships, he has grappled with depression and occasional panic attacks most of his adult life. Yet for a decade, he didn't even have a family doctor, despite being told for years that he was near the top of waiting lists in the region. 

"A lot of the stuff I've done has been on my own, searching online, reading a lot of books on the subject," he said. "At a certain point, no matter how hard you're trying on your own, you still need a professional — an objective opinion to try to help you to see some issues that maybe you don't see on your own." 

"You just have to hold out hope that one day these things are going to change."

Well, head-nod to you Jason Gilmour, I hear you. Here's to hoping that the discussion of these topics in the public sphere and increased sensitization will lead to concrete change, sooner rather than later.

1 in 4 shot by the police are mentally ill.

Alternet has a piece out on how One Quarter of People Police Have Killed This Year Were Mentally Ill. The article cites a Washington Post article which focuses on the lack of training police have when it comes to dealing with the mentally ill.

...The dead account for a quarter of the 462 people shot to death by police in the first six months of 2015... 

The vast majority were armed, but in most cases, the police officers who shot them were not responding to reports of a crime. More often, the police officers were called by relatives, neighbors or other bystanders worried that a mentally fragile person was behaving erratically, reports show. More than 50 people were explicitly suicidal. 

More than half the killings involved police agencies that have not provided their officers with state-of-the-art training to deal with the mentally ill. And in many cases, officers responded with tactics that quickly made a volatile situation even more dangerous.

I see this daily on the streets of down-town Montreal. It seems more and more of the homeless population is mentally ill (often visible schizophrenic, or visibly struggling) and it isn't uncommon to see police engaging them, or often corralling them away from the tourist-focused areas of the city. 

We have a similar story locally, when news reports described a man being shot after he attacked police with a hammer. Little else was said. Now, we know a little more about the man, Alain Magloire, a biologist with two-children who was homeless and mentally ill at the time of the attack. His brother, Pierre testified at the inquest (from The Gazette):

Pierre Magloire began his testimony asking for better police training in times of crisis management involving people with mental health problems. 

“We can’t treat these people the same way we treat someone who just committed a crime,” he said. 

In addition to training, he questioned the weapons being carried by officers on patrol, calling them unnecessary for crisis intervention. He was especially critical of the use of a patrol car by one officer to run into his brother. “I do not believe that using a car as a weapon of opportunity is adequate for an individual that suffers from mental illness.” 

Magloire’s brother, who works as a teacher, said he knows from experience that a crisis can be managed without force. 

“A person in a crisis needs to be given time to wind down,” he told the coroner’s inquiry. “We need to give them the space to have the time to manage their crisis.” 

Months before he died, Pierre Magloire said his brother sought help, but was let down by a system that works in “silos.”

Boy does this echo with me. I've mentioned countless times how difficult it is to access services, and I'm someone who is relatively functional when in the grip of my depression and anxiety. One bad day, and one trigger happy cop - that's all it takes.

Magloire mentions groups working in "silos" - which I had to google. Apparently this is a business terms that refers to departments that refuse to work together or share information. In the mental health care system, I don't know that the intent is to be terribly organized, but that's definitely the working reality of the health care system.

It seems so little information is centralized. So much of my time and energy has been recounting my mental health history to practitioner after practitioner.

Again, let me take a moment to highlight the innate irony and flaw of asking someone who is mentally ill to be the sole keeper of their story. 

There needs to be a centralized information system for this information. For the medication. For the breaks. For the crisis points. There needs to be follow-up and follow-through.

The Washington Post also has a breakdown of the people shot by police, mainly men, and though the breakdown seems quite mixed, it would be interesting to further break this down my race and class. No doubt these men didn't have access to proper care.

Alain Magloire sought care, and was "let down by a system that works in silos." No doubt every one of the 466 people referenced in the Post article also have a story about how they were let down by the system. Hopefully more and more people will share their stories, so the way in which we're approached by police can be drastically changed.

Meeting Ranjana.

After an ongoing attempt to access free mental-health services (specifically therapy) I've had to settle for the sliding-scale services offered by The Argyle. If you're unfamiliar with my journey attempting to access mental health services, just check out the "access" label to the right of the page.

I called the Argyle several weeks ago and was told I would be called back by an in-take professional. A week or two later they contacted me (they basically ask why you need the services) and I was asked to e-mail them my tax return for last year, which would establish my income and thus the hourly rate they'd charge me.

They're charging me 50$ a session. I can't swing that weekly, but I should be able to bi-weekly for now. Some of that 50$ will be reimbursed by my private insurance. Since our first session last week, I also saw her yesterday. She asked to see me next week and I told her I can't afford it, that our sessions would have to be bi-weekly. She seemed surprised by that, but she accepted it.

I wasn't sure at first if Ranjana and I would hit it off. The last two therapists I've seen were roughly my age. In my previous intakes, I mentioned wanting a young-woman who was atheist identified (or at least had an understanding of an atheist/non-religious mindset). That might seem like an odd stipulation, but if you're a non-believer and your therapist uses underlining themes of faith or divinity it can be patronizing and completely dismissive.

My request for female-identified, atheist-friendly therapists with an understanding of eating disorders, sexuality, gender and depression resulted in both of my therapists (over the last decade) being young jewish women.

This time, I just stipulated a woman. I think gender is a significant part of my experience, and an understanding of being a woman, a girl, sexualized, and feminism is an important fundamental starting point for shame, identity and body-awareness.

The only other request I made was that it be permanent staff. I saw Alexa for ten session last year and I thought the world of her. But, she had to go back to school and I wasn't able to keep seeing her. I don't want that to happen here. I want long-term, on-going therapy. Even if I lapse for a while, I want follow-through. I want to be able to go back and see the same person, or for there to at least be a file on me.

I'm tired of starting over. At some point you're "telling your story" in a way that seems completely impersonal because you feel as though it's lost its value in repetition.

Ranjana is an older (than me) Indian woman, her website describes her work with the local Indian and Hindi communities. Our first session went well, I think it'll be good for me to move outside of my comfort zone and to have conversations with someone who is outside of my realm of reference, and who can see things in a different way.

My goal in this round of therapy is to be more of an active participant in it. With Putterman I was a mess. With Alexa I was also in crisis. Now, I've plateaued, and I think it'll be helpful to move through certain things, with help.

We'll see how things go.

Onward.

The Dr. Scavenger Hunt.

Yesterday was an interesting day. After the Doctor-debacle of 2015, I finally went out to Montreal-West to see Dr. Rishi. First, I don’t go West, so bus'n along Monkland was nice, it’s a really nice area. It’s all brownstones and anglos, it’s like being in another world.

I took the afternoon off of work, since my appointment was at 1:45 and google estimated about an hour for me to get there. I waited nearly an hour past my appointment time, but any annoyance washed away when Dr. Rishi saw me and said hello. He’s so jovial.

Any-who. . . The appointment went well. He informed me of his plans, he’ll be starting his own family practice with 4 other doctors, and it’ll be located in Westmount. This’ll be convenient for me since I can walk over when it’s nice (still about a 30 minute walk) and I can take the subway if I’m pressed for time. Either way it’s accessible from work.

I ended up talking with Dr. Rishi for over an hour. We talked about my depression, and we made a plan. We’re trying stronger meds, and he’s booked a phone consult for me and a nurse who might be able to get me some free therapy. I don’t think it’ll happen, since it’s a CLSC that’s outside of my service zone, but he’s going to try and make it happen. Side-note: The CLSC is called Benny Farm, which is insane sounding to me. It makes me think of Benny Hill (an observation Dr. Rishi actually got, and we laughed about) and also a farm where maybe Ben Affleck goes to get away from it all.

Meanwhile, I contacted the Argyle and I would be charged 50$ an hour for therapy there. So that’s an option too. I'm going to check it out.

You know, I'm kind of surprised by how much better I felt after seeing Dr. Rishi. There’s a French expression that says someone feels prise en charge which means, when literally translated being taken into someone's charge (like back-in-the-day English where a charge was a kid you took care of). Although it probably comes from this type of history, today we usually use it in a positive context, it means being handled, and you or a situation being taken care of. 

Well, I never feel that way, so yesterday was an odd sensation for me. He said his priority is my depression right now, and then we'll go into overall health. We also talked about what the St-Mary's Doctors thought about me, and he said they felt I could totally handle myself and that I seemed mildly to mid-level depressed. 

This irritated me, and I explained how I feel my verbosity and funny-nature (and big fat round face/head) often masks the intensity of my depression. My being able to talk circles around what I'm feeling often leads me to talking myself away from how dark my thoughts can be. My funny, absurd nature can also just detract from what I'm feeling and just leave people with a different impression of me than what might be needed for me to be read as "seriously depressed." He got that. 

I mean, the guy makes me sound like a dullard. He's well spoken, clear, and very quick. He's super charming, so he was able to understand that aspect of representation versus internalization. 

I also mentioned that other than "suicidal ideation" there is very little follow-up for mental health. Planning a suicide, an actively pursuing your death is a crisis. But, wishing you were dead all the time is a slow painful way to be. 

I have to go out and get my new meds, and then Dr. Rishi wants to see me in a few weeks. Once I talk to the nurse he referred me to, and I have a few weeks of meds in me. 

Overall I'm happy that . . .

1. I found him (I didn't hallucinate getting a GP).
2. He is still practising and wanted me as a client / I can follow him.
3. My first impression of him was correct, he's kind, funny, warm and I can really talk to him he also seems to like me, which is nice. I like when people like me. 

I feel hopeful, which is so god-damn rare I can't even.

Maz & Juan: Black Mental Health & A Hanging in Mississippi.

Just listened to a few Maz & Juan podcasts, one of which discussed mental health, specifically in communities of colour. I was linked to Maz & Juan through Ayesha Siddiqi’s podcast, pushing hoops with sticks. I follow Ayesha on Twitter and have read some of her work, she’s brilliant and I want to be friends with her. She's a great example of someone having some serious fucking things to say and then saying something funny about Kanye and not thinking it negates everything serious you've ever said. We are capable of having many opinions on various things, and they can occupy our mind at the same time. She did an episode of Maz & Juan on how white women hijacked the feminist movement (I'd argue feminism's roots are inherently racist, so it's not even about hijacking the movement but closer to neglecting / rejecting anything “other” to upper-class whiteness from the beginning). Feminism, like all anti-oppression spaces, has a lot of work to do.

After the episode, I made my way to another podcast, this one about mental health and black men. One of the main guests, Terrell Starr wrote an article on Buzz Feed about his experience with depression and suicide, his article discusses his experience. Our stories are different, but the pain is the same.

Terrell talked the importance of access to mental health, how he himself has access to insurance, but how those who usually need it desperately, do not. There was also mention of co-pay - what I understood to be the up-front cost of these services (that are then reimbursed by the insurance company). This has been an ongoing issue for me, since so few places are sliding-scale, and I can’t front 100+ dollars a week, or bi-weekly for therapy. It makes me so angry. Ask for help, but you know, once you do, shit kind of falls apart unless you've got money.

Terrell mentioned how part of the next step is helping people navigate the process of accessing mental health services. YES. YES THIS. How many times have a griped about the exhaustion I face attempting to find, locate, and access free or sliding-scale services? What kind of a success rate do I have? It's a discouraging process on a good day, let alone on a day when you feel like you're stuck in the anus of the devil. There are little organizations here and there, but there is nothing cohesive and all-encompassing, especially due to first-language access.

Another great point brought up by Terrell was the importance for him to find a therapist with which there was already a commonality. For him, that was a woman of colour with an understanding of racism and inequality. When I contacted the Argyle Institute, I asked for someone with an understanding of atheism, feminism, gender norms, body dysmorphia and eating disorders. Having someone to speak to who understands certain fundamental pressure points for you is so important. I was able to find a real connection with A (my 10-week therapist at The Argyle) and I adored her. It changed everything. Therapy can be excruciating on a good day, I needed a safe space and she immediately offered that. I was bummed that she had to stop seeing me to finish her doctorate, but I'm happy I had her when I really needed her.

Maz & Juan end their podcast with a segment called Tell Me Something Good. It’s heavy, discussing racism and oppression all day, so I think it's a nice feature to end on a positive note, or with something encouraging or beautiful. We gotta go back into the world every day.

I recommend listening to their podcast. Check it out. 

My Tell Me Something Good is how the lone-female guest of the podcast (on the mental illness episode) Indrani Balaratnam, mentions Rupi Kaur's photography projects surrounding menstruation, and it clearly makes the guys uncomfortable. This made me smile. She challenges them to go check it out, as should you.

CLSC help-line: a line to nowhere.

I received a letter in the mail from my local CLSC regarding my request for a family doctor. They said I was already registered to Dr. Rishi (the doctor who went missing) so I was denied. They then say if I have any questions to call them.

I called them. It’s one of those automated phone systems that just hangs up on you.

Legit. Press 1, or it hangs up on you. Listen to a short explanatory message, it hangs up on you. What you’re calling for isn’t listed? It hangs up on you.

I was hung up on 4 times. I got no information. I wasn't able to speak to anyone.

Adding to this hot-mess of medical legitimacy was the fact they they gave Dr. Rishi’s cell phone number. So I called him. This is how that went:

Dr. R: Hello?

K: Hello, this is weird. I’m sorry to be calling you but the CLSC gave me your phone number because I tried to sign up for a medicare doctor and they said I can’t because I’m attributed to you.

Dr. R: I’m sorry there’s been a lot of change with my work situation, but I can definitely help you either sign back up for medicare or you can follow me to my new practice.

K: When I called Curel-Med they were super sketchy about your whereabouts. One day you said to call you back. I called you back and you didn’t work there anymore.

Dr R: Who is this?

K: It’s Kristin (last name omitted).

Dr. R: Oh hi Kristin! I have your medical report from the hospital!

K: I know. I know you do. That’s why I’ve been trying to reach you.

Basically he left the practice at Curel-Med because of a bunch of administrative errors on their part, and he’s starting a smaller clinic near Concordia’s Layola campus. He apologized for the hot-mess, and said they were supposed to mail out letters to his clients, but didn’t (no doubt an example of their shittyness). He said he was on vacation until the new clinic opened. So I apologized for bothering him, and I’ll be able to see him in a few weeks. In theory.

The adventure continues!

On and around Germanwings.

The last few days have been odd for me. The news coverage has been all about the Germanwings crash, the 150 people aboard who died, and the co-pilot who crashed the plane deliberately. As things usually go following something horrible happening, we’re soon inundated with information about the perpetrators of the crime, we see their facebook profile photo, we hear about them from acquaintances. Usually we hear about them being radicalised by a cult or group of some kind. Instead, this week we've been privy to the mental health history of Andreas Lubitz.

There is a lot of talk about his treatment for “suicidal tendencies” and for an apparent doctor's not that told him not to go to work. The validity of these things will make their way to the public soon enough.

This isn't a suicide. He willingly, and with intent, killed 150 people. It took him several minutes to crash the plane. Though he may have been in a dissociative mind set, or maybe was having some type of psychotic break, this was not a “normal” suicide.

Michelle Cornette over at the American Association of Suicidology likens this type of mass murder/suicide to school shootings. I can see that link. Through there seems to be something way more intimate about hunting people in a closed space. Pot-ay-toes / pot-ah-toes of murder/suicide I guess.

Also, as an aside (though linked) the existence of an American Association of Suicidology and the application of a science to studying suicide as a cultural phenomenon will be increasingly important as time goes on. Just last night I was on the edge of discussing the pervasive culture of depression and anxiety with a friend. We broached the subject, but both capitulated to the enormity of the discussion due to the late night hour.  But this is important. And it makes no sense that so many in my age-group live with anxiety and depression. 

Where does this come from? How is it so generationally situated? How do we address it? How do we prevent it in the generations following us?

Everything is linked.

I hate to be so clichéd but I can't help but think of  Chuck Palahniuk's / David Fincher's Fight Club.

Man, I see in Fight Club the strongest and smartest men who've ever lived. I see all this potential, and I see it squandered. God damn it, an entire generation pumping gas, waiting tables – slaves with white collars. Advertising has us chasing cars and clothes, working jobs we hate so we can buy shit we don't need.We're the middle children of history, man. No purpose or place. We have no Great War. No Great Depression. Our great war is a spiritual war. Our great depression is our lives. We've all been raised on television to believe that one day we'd all be millionaires, and movie gods, and rock stars, but we won't. And we're slowly learning that fact. And we're very, very pissed off.

But here's the thing... Anger is exhausting. Often what comes next is despair. Is it spiritual despair? Is that what this is? Are we a generation (or generations) of people who just don't see the point?

What I'm seeing now in the coverage of Germanwings is loose talk about stigma. The fact is if you start obstructing people with depression from doing their jobs, the system will fall. We're everywhere, we sad fucks, we mopey folks, we with our glasses half-empty.

When I see anything about Germanwings, I see ways systems failed. I see stigma. I see a lack of follow-up. I wonder about his treatment and what he needed. As more comes out about all of this, I hope the dialogue becomes more engaged, more critical, because right now it's stagnant and over-simplifying depression.

Statistically speaking, of the 150 victims of the crash, some also lived with some sort of mental illness. Many live with it. Those who die by it are often under-represented. In the case of Germanwings my only hope is that the surviving families are able to get support and care, the way most living with depression also require.

Now you Doctor, now you don't.

HAHAHAHAHA!

Finally got a family doctor after 15 years without one. I was waiting to hear back from him about a psychiatric evaluation I did so I sent him an e-mail.

I got one from the secretary back, and was just told he no longer works at that clinic.

I had a family doctor who was engaged, caring, open, interested and had excellent bed-side manner for all of a month.

WHATEVER I GUESS I'LL JUST DIE THEN.

CLSC: "Nope."

I just got off the phone with the CLSC - another discouraging interaction with the mental health system.

Turns out they can’t really help me since they only offer short-term help and not long-term follow-up. So, they referred me to four places, UQAM’s mental health clinic (run by students. I called, they’re waiting list is full), a clinic that offers sliding-scale services (I called and left a message) and two women’s shelters.

Being referred to a women’s shelter makes me angry. I feel as though those are clearly emergency services that I’d rather not impede. Those services aren't for me. I have a roof over my head and a job, and I'm not in a dangerous relationship.

Of course, the CLSC representative ended the call as all other mental health services seem to, “I'm sorry I couldn't help you more, good luck, and if your situation changes please call us back.” What this means of course is if I'm actively suicidal I can call back and then they’ll (potentially) sort me out.

So unless I want to kill myself live, on the phone - they don’t have shit for me.

I'm having a bad day Temple Grandin.

Today I don’t feel too great. I’m tired. I know the eternal winter that is 2015’s snow-dump doesn’t help. Seasonal Affective Disorder - or S.A.D - because why the fuck not.

Monday I found out that I’ll soon need a root canal. So there’s a few grand in medical expenses I wasn’t expecting. Hopefully my work insurance will cover most of it.

It’s odd though. The hygienist put this weighted protective vest on me in order to take x-rays, and I really liked it. I thought it was calming, and when she removed it I was tempted to ask her to leave it on me.

This made me think of Temple Grandin and how folks on the autism spectrum often like weighted blankets or feeling compressed. I think I’m going to look into this. Sometimes when I get overwhelmed I like lying on my stomach/on my face.

I’m going to look into possible getting a weighted blanket - or maybe there are at-home DIY versions that can help in self-soothing. An idea! Huzzah!

Onward!

So I can potentially access sliding-scale services through The Argyle again (between 40 and 60$), or through The Montreal Therapy Centre, which charges 80$ a session.

Still nothing regarding a psychiatrist.

This is what’s been made available to me so far. I saw Dr. Rishi yesterday and he mentioned contacting Dr. Singh from St-Mary’s to see if there was anything else I could access, but I take the silence to mean that there isn't.

So I have to figure out what I want. What’s next? From this vantage point it seems like The Argyle is where I’ll start. I'm not pumped about the commute, or the cost - but maybe I could go once or twice a month in hopes of it helping.

Part of my wonders if it’s really worth it. What am I trying to discover? There is no root, it’s just sadness. It’s just constant.

Not feeling great today, going to go home and sleep on my face.

Psychosociales.

First of all, as an Anglophone reading a French title I’d like to acknowledge that the clinic title sounds like “Psycho Socials” which rings like some type of débutante ball, but with less dancing and more internal-struggling. What it is actually is a program title within Quebec’s local clinics. It’s basically an intake service for psychological and social services.

I attended one yesterday, in order to potentially access sliding scale services locally.

It went alright. Though at this point I've answered the same series of questions a dozen times over the last two years attempting to access the golden ticket of mental health care. It’s redundant and demoralizing. Let me tell you the my story, so it can be filled away somewhere...

The nurse, Emilie, was kind and young. She was the only nurse who spoke any English. She struggled. I switched to French occasionally, but she never switched out of English, which I appreciated.

So, after an hour of questioning, I'm on a 9-month waiting list for therapy services. Of course, this could go longer since I requested someone who speaks English. I expect to be on some fictional waiting list, tantamount to having written a letter to Santa. My name is somewhere - but really who gives a shit.

My visit to the CLSC is a direct result to the 3 references given to me by the doctor’s at St-Mary’s:

First, I was referred to Suzanne Marcotte (514-369-9193). I'm not sure why. She’s French and Charges 100$ for 50 minutes. This didn't seem to align with my language preference or my budget constraints, so she referred me to L’Ordre des Psychologues du Quebec. I called and left two messages and never heard back.

Second, the Montreal Therapy Centre (514-244-1290) here sessions are 80$ a session and they’re located in NDG.

Lastly, CLSC Psychosocial Intake, where it wasn't easy pressing for English services, and where I met Emilie last night. Basically I'm on a waiting list (I'm still on a waiting list for a family doctor by the way, it’s only been a decade) and if I want to kill myself I should call them and give them a heads up.

Faith in the system: little to nil.

Scrambling for access.

Mental Health awareness campaigns trigger a lot of anger in me.

First, I want to say that visibility and the ability to name our experiences (and disabilities) openly is important. It's important to hear people's stories and for those without mental health issues to hear how devastating living with / surviving depression can be. I hope that hearing personal accounts and understanding how pervasive mental illnesses are lead to a more open dialogue and to a more empathetic view of these issues.

Having said all of this, these campaigns - for me - bring forth a lot of resentment.

A lot of front-line mental health services are there for those in crisis. This is important. My issue is with what comes next, namely, the silence that greets you when you are no longer in crisis.

I called a suicide hotline once. I had been unemployed for months and was feeling especially useless. The operator had a warm, soothing voice and she didn't have to say much in order for me to finally cry (I don't cry. My depression is painful but I am often despondent and very far from my ability to cry and release tension). Her next move was to ask me to call a friend. I lied about calling a friend next and then survived the night.

The big picture over the next few months involved my struggle to find English free or sliding-scale mental health services in and around Montreal.

If you'd like to picture the ensuing shit-show google "two girls one cup."

Basically: there are very few free services available to Anglophones in the Montreal area.

Highlights include:

• The West Island support group where I was the only female-identified person, at which I listened to one guy talk loudly about himself for over an hour (we were 7). The group moderator did not moderate shit. Including racist and misogynist comments. Considering the long trek out there and the abysmal experience I never returned.
  
• The Concordia psychiatry department and it's free services. Oh fun. This means you're therapy is with a student. Mine was about 19 and immediately looked like a deer in the headlights within a minute of my sitting down. I understand kids need to learn but this was a total train-wreck of an experience. Disheartening to the max.
  
• Various phone calls and emails to orgs of all kinds, most of which couldn't even refer me elsewhere.
  
• French-only websites and services. 

* Though I am fluent in French, I asked if they knew of English support groups or services (since talking about issues is hard enough and wanting to do so in your mother-tongue means having the ability to use precise language in a more natural, effortless way.

I also contacted various therapists, and asked about sliding-scale services. I got a lot of negatives.

Finally I was referred to The Argyle. The services were not free but I was able to access sliding-scale services. I saw a lovely counsellor who I'll call A for about 10 sessions. This helped me a great deal. What sucked was the limit to sessions with the same counsellor. This totally negates the report we build.

Unfortunately A had to go back to school. This also sucks because I liked her tremendously. So I’m back to seeking services, ideally something long-term so I can feel I have a support structure around me.

Asking for help is the first step. But it is the first step in an uphill battle.

I wish strength and resolve to those going through similar struggles.

First you survive yourself, then you do everything you can to make that easier tomorrow. Unfortunately you'll have to rely on yourself for a lot of the work, an irony that pains me considering we ourselves are the problem.

Detonating outwardly.

I originally wrote this in October of 2014, as a response to several weeks of news coverage following the Ottawa shooting at Parlimant Hill. I wanted to post it here, as it touches on the themes of my blog.

-

A poll in October of last year showed 38% of Canadians recognize the misery of the Parliament Hill shooting as being the result of mental illness, and not a "terrorist attack." I want to say something about this. It's been on my mind for a while.

This man was neglected and our systems ignored him when there were clear signs of distress and danger. Same goes for the guy behind the death in St-Jean. There's all this talk about how he came to be radicalised, the websites, the messages, but what about the actual path that led him to that "radicalisation?" I'm talking about the everyday, about the flagrant dismissal of family members attempting to intervene. About these people themselves asking to be removed from the world.

Mental health, or more concisely, the lack of mental health care systems and access is a growing shortfall. It infuriates me that the varied vocalizations of "I am in pain," go unnoticed, and that the only thing that is heard is the eventual scream of an individuals utter collapse of self.

Whether living through/with post-partum, anxiety and panic, bipolar disorder, chronic depression or some other disordered hurt, we all live with this or love someone who does - so I implore us all to be more compassionate, more understanding, and above all else incensed with the ways in which this on-going pain is ignored - often resulting in internalized horrors detonating outwardly.

This has been in my mind since the shooting. Nathan Cirillo was a kid. He lost his life doing his job, standing guard at a memorial for those he'd come to represent so fucking tragically.

And the other, he lost himself and his life over a longer period of time. And though he made choices, he was also forfeited to his diseases - diseases of the mind, and diseases of hate. All of it painful.

To be honest, I was surprised that 38% of Canadians understood the role mental health probably played in this heartbreaking story. Like most living with mental illness, I internalize, and I often feel alone, unable, and conquered. So, this statistic opened me up to the reality that there are folks out there who understand what’s going on for some of us.

It's only as I get older that I start to comprehend what health care really means to people and to a nation and culture. We here in Canada don't have a functioning mental health care system. We don't have the resources. We don't have the spaces. We have suicide hotlines that say "don't kill yourself" but we have deafening silence for all that comes afterwards.

Locally, here in Montreal I take the metro and walk-by people visibly living their mental health issues, daily. If I walk from Peel metro to Berri, I will walk by dozens of people who seem to be in distress. I can't help but identify with them. Maybe if I had turned to drugs, my mental illness would look very different today. Maybe you'd walk by me. I'd be one of those with a dog and a clever sign.

In Quebec, countless of us do not have a family doctor, myself included. Will it take protesting? Is that the only way our elected officials pretend to give a shit? I am able and be active in my own wellness, seeking what I need, and facing brick wall after brick wall in the form of waiting lists and non-existent referrals. Phone-calls to busy signals and disconnected phone lines. Put me in a room with a "hang in there kitty" poster and I'll burn the fucking building down.

I'm frustrated with the ways in which isolationism is applied to every event, every individual. As if nothing is connected. Context is never considered. Black boys being shot in parks, and it being represented as having nothing to do with his race or gun-culture. At 12, he's a "young man," a white girl at 15 is still considered "a child" in sex-crime related reporting. Their childhoods are not of the same value, and are not given the same space. I make the mistake of reading the comment section of an article, and I want to weep for humanity.

It's all connected. Our misery and the misery of others.

It’s too easy to de-contextualize. Too easy to blame the individual and not their environment and everything that came before.

Prevention is what I'm highlighting here, and prevention is only possible through support and access to the necessary services.
Let's all try and be better. But more importantly, let's start demanding better of the systems our ancestors built and that we maintain.