Adopting a Cat Helped Me Find Recovery

JAN. 12, 2022

By Anna Smith

cat in bed with its owner

It was November, just after I had been discharged from my fourth inpatient stay that year. I was depressed, anxious and unsure if I could finish out freshman year at my university. I had moved home so I could focus on recovery without the stress of living in an on-campus dorm.

My mom, desperate to find something to help me engage with the world, brought me to the local animal shelter. Immediately, I was overwhelmed by the number of animals with their faces pressed against the bars of the cages. My eyes fell on a young Siamese cat with a striped face and tail. She cowered at the back of the cage. A shelter volunteer told us that she had been there for six months, ever since she was found trapped in a wall as a kitten.

I reached my hand into the cage. She tentatively rubbed her head against my hand before flinching and retreating to her hiding spot. The volunteer told me that she would need a lot of work if we were to adopt her, and she was unsure if the cat would ever come around to being a tame house cat. I signed the adoption papers a few minutes later and brought her home. Little did I know how impactful she would be on my recovery.

 

A Reason To Get Up In The Morning

The new medication I was taking often sedated me, so I slept for most of the next few days. When I was awake, I spent most of my time bonding with my new cat, whom I named Maya. She stayed hidden underneath the bed I bought for her, never coming out to eat or drink. I brought out my favorite book, “Pride and Prejudice,” and began reading it out loud so she would get used to my voice.

By the second day after adopting Maya, she took a few steps toward me with trepidation. I held a treat in my hand and watched as she took it from my fingers. I took a few deep breaths, calming my anxiety that rushed through me. I had to be calm for Maya.

After a few days of reading to Maya and feeding her out of my hand, she seemed to open up to me. She let me pet her, as long as I let her approach me first. Having an animal that I was responsible for gave me a reason to get up in the mornings. I had to clean her litter box, feed her and play with her. I couldn’t just retreat into my thoughts and refuse to interact with the world like my depression wanted me to. Maya needed me as much as I needed her.

 

A Constant Companion

After the week was over, I returned to my online classes for the first time since returning from the hospital. I did all my classes in my room with Maya, continuing to let her acclimate to my presence. One day during class, she climbed into my lap and settled down to sleep. I felt my first positive emotion in a long time that day. I even allowed a small smile to creep onto my face.

Maya became popular in my online group therapy sessions where she would beg to play fetch by bringing me a toy mouse to throw as if she was showing off for a crowd. She started sleeping on my bed every night and would follow me around the house during the day.

I started to see small improvements in my mental health after I adopted Maya. I had days where I was able to get out of bed and get dressed. Having an animal that was completely reliant on me calmed the intrusive suicidal thoughts I had been struggling with for the past year. Having a soft cat that was nearly always on my lap helped to soothe my anxious mind and gave me a companion to help me through my hardest days.

 

A Source Of Unconditional Love

I chose to withdraw from my university in the spring semester and take a couple months to focus on my recovery. The following months were difficult, as I underwent medication changes and treatments to focus on healing. Maya was by my side as I suffered through medication withdrawal and while I adjusted to the new medications. She was there when I came home exhausted from my daily transcranial magnetic stimulation sessions.

As spring turned into summer, I started seeing bigger improvements. I had more days where I was able to be myself and laugh, and I chose to interact with the world more. When my family went on vacation that summer, we brought Maya with us. I was able to enjoy myself for the first time in several years, and when I felt overwhelmed, I could always go to my room and find Maya, who would instantly climb onto my lap and settle in. Together, we could help each other.

At the end of the summer, I chose to enroll again in university. I felt that, with intensive support, I was ready to return to my education. Finding recovery took a good medication regimen, the right kind of therapy and an arsenal of coping skills, but in the end, it also took the unconditional love of a little Siamese cat named Maya.

 

Anna Smith is a sophomore at Virginia Tech studying communication with a minor in psychology. She hopes to work in the mental health field one day as a lived experience counselor. She lives in Virginia with her two cats, Maya and Blueberry. In her free time, she loves to write, read and ride horses.

Understanding Mental Illness Triggers

JAN. 10, 2022

By Katherine Ponte, JD, MBA, CPRP

person clutching head with hands

A trigger, sometimes referred to as a stressor, is an action or situation that can lead to an adverse emotional reaction. In the context of mental illness, referring to triggers usually means something that has brought on or worsened symptoms.

In the ongoing dialogue about mental health, we don’t talk enough about triggers. Most often, the discussion focuses on what happens after a person has been triggered, which is when the situation is much harder to address. Understanding, identifying and working to prevent triggers can be more empowering and effective.

 

Understanding Triggers

Triggers are individualized experiences that vary widely from person-to-person. For example, a trigger may elicit a physical reaction, such as heavy breathing or sweating. A trigger can also spur an emotional reaction, like thinking “I am being attacked, blamed, controlled, disrespected, hurt and judged.” After experiencing a trigger, a person may feel overwhelmed, powerless, scared, unloved and weak, among many other feelings. These feelings can be very difficult to address and quite detrimental to mental health.

A person’s behaviors based on their emotional reaction can range from relatively minimal to serious, such as acts of violence. Someone exposed to a trigger while symptomatic may be more vulnerable and the emotional reaction may be stronger. Additionally, a trigger can impair judgment and some people may lack insight about their reactions.

It is important not to assume that you understand the emotional response of someone who has been triggered or suggest that someone who has been triggered is overreacting, being “too sensitive” or being irrational, even if the trigger may seem insignificant.

 

Types Of Triggers

Many different stimuli can be possible triggers, and they are often strongly influenced by past experiences. Personally, as someone who lives with mental illness, I have experienced numerous triggers when I’ve been symptomatic. These triggers have led to extreme discomfort, family conflict, onset of illness, worsening of symptoms, episodes and hospitalizations.

External triggers: In the summer of 2006, I became engrossed watching the inexplicable war and tragic loss of life in the middle east on CNN. This triggered a severe psychotic manic episode. Similar geopolitical events triggered me twice more. Each time I was hospitalized. To prevent this trigger from repeating, I stopped watching televised news.

Internal triggers: I was triggered by feelings of abandonment when my spouse avoided contact with me to minimize conflicts. I would at times spontaneously angrily erupt. To address these feelings, I talked to my spouse and let him know how our strained communications made me feel, and he reassured me that he had no plans to leave me.

Trauma triggers: I live near the hospital where I experienced a traumatic hospitalization. It was along a convenient route for me to access public transportation, but every time I walked by it, I recalled that hospitalization and was “re-traumatized.” After being triggered several times, I decided no longer to walk past the hospital and took a longer, alternative route.

Symptom triggers: A lack of or reduced need for sleep has occasionally triggered the symptoms of my bipolar disorder. In this situation, I quickly address any sleep disruption, often with a medication adjustment in consultation with my doctor.

 

Ways To Cope

There are many possible coping strategies. Strategies should seek to eliminate, avoid and reduce the impact of triggers and emotional reactions. Each person must identify what works best for them through trial and error. Different coping strategies may work for different triggers and emotions.

Learn to identify: Consider reactions to past triggers; who or what was involved, where, when and why it took place. Observe patterns and obvious signs of risk to prevent a similar situation (like ceasing to watch televised news).

Make a plan to address: Create a plan to address triggers and emotional reactions. You may want to talk to loved ones or your treatment team to let them know how they can best help you when you are triggered. Be sure to carefully address triggers that occur repeatedly, because each time they do, the emotional reaction may be greater.

Try problem-focused coping: Confront your stressor directly or try to find a solution to the stressor. For example, driving your kids to school may cause you to worry, because you’re afraid you might arrive late to work. Instead, you can ask someone else to drive your kids to school.

Try emotion-focused coping: When you cannot eliminate or avoid a trigger, focus on regulating your reaction to a stressor which may help reduce the stressor’s impact. For example, meditation can help reduce stress, anxiety and depression.

Communicate if someone is triggering you: A person triggering another person often does so unintentionally. Talk to them about their actions and their impact to clear up any misunderstandings and consider possible solutions. Have an open, calm and understanding dialog. Be willing to work with them. If the person who is triggering you refuses to act sensitively, it may be best to set clear boundaries.

Find the right therapy: Specific types of therapy have been shown effective in addressing triggers. Specific therapies especially helpful for addressing trauma triggers include exposure therapy and EMDR therapy.

Reality-check your thoughts: To minimize the escalation of thoughts and feelings, it may be helpful to “reality check” thoughts to assess their reasonableness. A few ways to do this include:

  1. Fact checking: Consider the facts and whether they support your interpretation.
  2. Apply cognitive distortions: Identify faulty or inaccurate think, perceptions or beliefs.
  3. Reframe: Reshape automatic negative thoughts into positive thoughts.
  4. Proportionality: Ask yourself, is the reaction disproportionate to the trigger?

Look for trigger warnings: Triggers warnings can help alert you to triggering material, especially materials related to suicide or violence. Sometimes, an article will provide a trigger warning at the start of the piece. You can even ask others to provide you with a trigger warning about materials they share.

Practice self-care: Prioritizing your mental health can help build resilience against potential triggers. You can start by talking to someone, such as a loved one, friend or therapist. You may also want to practice mindfulness, meditation, deep breathing or journaling.

It’s difficult to control our triggers; however, we can learn from our experiences. We can apply what we learn to manage and limit the risk of being re-triggered. We can’t diminish or dismiss the trigger or only focus on what happens after we’re triggered — we must also focus on what we can do beforehand.

Each time we’re triggered is a learning opportunity that can help us manage our reactions in the future. If we can’t control the trigger fully, we may be able to limit the emotional reaction to it before it becomes problematic and harder to address. We might even be able to prevent the trigger by preparing for it. We can have some control, and anything that gives us a little control over our mental illness can help keep us well.

 

Katherine Ponte is happily living in recovery from severe bipolar I disorder. She’s the Founder of ForLikeMinds’ mental illness peer support community, BipolarThriving: Recovery Coaching and Psych Ward Greeting Cards. Katherine is also a faculty member of the Yale University Program for Recovery and Community Health and has authored ForLikeMinds: Mental Illness Recovery Insights. She is on the NAMI-NYC Board.

Return to Work: The New Normal Centers Mental Health

JAN. 07, 2022

By Wema Hoover

employees in an office

What does return to the workplace look like after two years of empty offices, makeshift home offices and employees struggling to balance work and life demands? How do organizations create a workplace that supports the mental health of their employees during another transition?

Much like assembling the pieces of a puzzle, organizations are piecing together a “new normal” — and the ones that do it well will bring a mental health perspective to the conversation. This will go a long way toward retaining employees while keeping productivity and innovation high.

So, what does “bringing a mental health perspective” look like?

Each company and employee are unique, as are their needs and demands. If we have learned anything the past year and a half, it has been the need for a flexible approach to work, heightened emotional intelligence and resilience. Companies that lead with this, while centering the mental health of their employees, will come out ahead.

The Current Landscape

Prior to the pandemic, many believed that productivity and performance were dependent on being in the office, with points given for partaking in activities that provided visibility and the opportunity to be seen: Things like actual “face time,” networking and an emphasis on building strategic work relationships.

After transitioning to working from home, we learned that productivity and performance didn’t suffer — and in many cases, it flourished. That’s a benefit that companies can continue to make use of. However, one challenge remains; lines have become blurred as employees answer emails after hours, on weekends and even in the middle of the night. Boundaries have become unclear (and sometimes even disregarded) as the sense of “always being on the clock” has become the new norm.

Regardless of the stressors and even isolation that many reported due to working from home, employees enjoyed the increased flexibility and independence. Fast-forward to today, and many have finally found ways to make the unexpected change work, and are more than a little reluctant to let it go, which seems to be feeding the current exodus from the workforce.

All these factors impact the mental health of employees who don’t want flexibility just for flexibility’s sake. They want it to avoid the all-too-familiar stress, burnout and overwhelm of outdated productivity and performance metrics. Organizations that understand this landscape can create environments that empower their employees and teams by prioritizing mental health.

What The New Model Needs

Organizations should create an environment that incorporates employee needs and engages feedback. Companies that survey their employees are better positioned to create a workplace solution that fits their employees’ needs as well as their own. Command and control are a thing of the past; if companies want to retain employees and engage productivity and innovation while avoiding burnout, they will need to take an open and exploratory approach to reinventing the workplace.

Here are some ideas companies should keep in mind to create not just a new normal, but a better one.

  • Include Mental Health in Benefit OfferingsThis is particularly important in terms of mental health care and should include Employee Assistance Programs. Often referred to as EAPs, these employee benefit programs assist employees with personal problems and/or work-related issues that may impact their job performance, health, mental or emotional well-being. Additionally, offerings should include parental assistance, such as emergency childcare or reimbursement offerings, and general wellness and fitness offerings that have shown to decrease stress and burnout.
  • Respond to Employees Individual NeedsEmpower managers to use empathy and understanding while responding to employees’ individual needs. The World Health Organization has officially designated workplace burnout as “chronic workplace stress that has not been successfully managed.” Indisputably, the multiple demands placed on workers as a result of the pandemic led to significant workplace burnout. In some cases, this increased the mental health support and policies offered by organizations and became one of the most critical employee benefit offerings. These policies and support took form as extra paid time off, mental health training, accommodations reflecting more frequent breaks from work and time during the day for therapy appointments.
  • Offer Mental Health Days or WeeksCompanies such as Nike and LinkedIn, among others, gave their employees a week off to acknowledge the toll the pandemic has taken and used the time off to encourage employees to prioritize their mental health. Additionally, highlighting mental health breaks throughout the day is important, particularly in a global work environment that no longer begins at 9 a.m. or ends at 6 p.m.

Prioritizing Mental Health Is A Win-Win

Companies that engage their employees in creating a new workplace that centers on mental health gain more than productivity. They foster highly connected employees who are committed to being flexible, not only for their own personal needs, but for the needs of their teams and the company as a whole. They build leaders who are skillful in imparting empathy and understanding to support the needs of their team, recognizing that each employee has different needs, just as they have different talents and attributes.

Throughout this process of engagement, feedback and flexibility, companies demonstrate their values in tangible ways, thus creating a workplace responsive to the needs of the environment and the people who inhabit it. This will allow the “new normal” to be translated into strong and effective workplace practices, which increases employee retention and supports ongoing productivity and innovation. These are the outcomes where mental health thrives — in this new normal and the next one to come.

Wema Hoover is an executive and a culture, diversity, equity and inclusion practitioner. She has more than 15 years of experience leading culture and global DEI teams across Fortune 500 Companies.

How You Can #Act4MentalHealth During the Next Legislative Session

JAN. 05, 2022

By Jessica W. Hart and Brandon Graham

Capitol building

With most state legislatures convening in January, now is the perfect time to start getting ready to put mental health on the legislative agenda.

Together, let’s make mental health a priority issue — from your local city council to the halls of Congress.

What Should You Advocate For?

NAMI cares about many policies, especially ones that ensure people get help early, get the best possible care and get diverted from justice system involvement. What policy issues are important in your community? Check with your local NAMI office to see what they’re working on locally.

One issue that you can always advocate for is budget funding for mental health services and supports. Budgets reflect community values and constituent needs. As an advocate, you can raise your voice to urge elected officials to invest resources in mental health care.

With Whom Do You Advocate?

Many elected officials at the local, state and national levels play a role in allocating budget funding for mental health services and supports. Direct your advocacy toward these decision-makers to ask them to prioritize mental health funding.

Nationally, members of Congress and the president are responsible for federal funding decisions. These include funding for community services through the Community Mental Health Block Grant, veterans’ mental health care through the Department of Veterans Affairs, innovative research at the National Institute of Mental Health (NIMH), housing assistance through the Department of Housing and Urban Development, and community policing and diversion initiatives through the Department of Justice. The federal government also funds mental health care through Medicare and Social Security Disability Insurance (SSDI).

At the state level, state legislators and governors decide on funding for community-based mental health services and supports, as well as funding for longer-term care and state-run psychiatric hospitals. If you’re looking to advocate for First Episode Psychosis programs or crisis services funding, direct your advocacy toward state legislators and governors.

Local officials like mayors, council members or county commissioners also make funding decisions for community-based mental health services and supports in their communities, especially if your local government provides care directly.

How Can You Advocate?

Being an advocate means speaking up for the change you wish to see. This can be accomplished by calling, emailing, tweeting, attending a town hall or sitting down and meeting with an elected official or their staff. If you want your policymaker to focus on mental health, you can:

  • Connect with your local NAMI office at nami.org/local to see how you can get involved locally as an advocate;
  • Text Advocate to 855-469-6629 to sign up to receive NAMI advocacy alerts; and
  • Find a local NAMI Smarts for Advocacy class at nami.org/smarts to get trained on how to be an effective advocate.

What Should You Say?

Communicating with elected officials can seem a little scary. But with the right tools, you will be advocating in no time! Talking points are a great tool to help support your argument. You can use talking points with elected officials as a place to start your conversations in person, through email or on the phone. If you’re comfortable, add a brief personal story — no more than 90 seconds — about how mental health impacts you and how funding mental health services and supports will help you and your community.

Here’s some sample language to help you advocate for mental health funding:

  • 1 in 5 Americans has a mental health condition, but tragically, more than half go without needed treatment.
  • Mental health services and supports ensure that people with a mental illness receive treatment when they need it — helping them to stay in school, on the job and in recovery.
  • Too often, mental illness is overlooked, marginalized and stigmatized.
  • Please protect and strengthen [state/county/city]’s mental health programs and invest in proven community services and supports that promote and maintain recovery.
  • Mental illness does not discriminate. It affects adults and children of every background, race and religion.
  • Funding for mental health is a public health imperative. Please invest in mental health.

What Else Can You Do?

Fortunately, there are more ways to communicate with elected officials than email, phone and in-person. Now, elected officials are interacting with constituents on social media. You can find your elected officials’ social media accounts by going to nami.quorum.us/officials.

Want to engage your elected officials on social media? You can post the sample message below on their Facebook pages or @ them on Twitter or Instagram. Feel free to write your own posts and use #Act4MentalHealth so we can follow your advocacy!

1 in 5 Americans has a mental health condition. Funding for mental health is a public health imperative. Please invest in mental health. #Act4MentalHealth

NAMI is strong because of advocates like you: people who will raise their voices and speak out for all affected by mental health conditions. Thank you for helping make funding mental health services and supports a legislative priority!

Stay up to date on NAMI’s advocacy and public policy by following @NAMIAdvocacy on Twitter (twitter.com/NAMIAdvocacy).

Tips For Interacting With Elected Officials And Staff

  1. Do your research. Read the policymaker’s bio, find their picture and learn about their previous support or work on issues relevant to NAMI.
  2. Build a connection. Encourage conversations by looking for common interests or connections between you and the elected official or staff member.
  3. Be prepared. Talking points support your ask and stories move people — but keep your story to 90 seconds or less.
  4. Keep politics out of it. NAMI is nonpartisan. Respect your elected official’s political views, even if they are different than your own.
  5. Follow-up. Thank the elected official or their staff for their time and support (if applicable). Mention that NAMI is a resource that offers free local education and support programs. Thank-you notes are highly encouraged.

Jessica W. Hart is Senior Manager, Field Advocacy, at NAMI and Brandon Graham is Senior Manager, Advocacy Campaigns, at NAMI.

Note: This article was originally published in the Winter 2019 issue of the Advocate.

How My Mental Health Support Group Became My Lifeline

JAN. 03, 2022

By Betsey O’Brien

person in virtual meeting

I’ll admit that the first time I entered the room, I was really, really scared.

It was my first time in a mental health support group. I felt uneasy, thinking about telling my family’s story to people I’d never met before. What if they judged me? How would I react if there was a long, uncomfortable silence after I’d shared a painful truth?

As it turns out, I didn’t have to worry. The people sitting around the table were friendly and welcoming. They reassured me that I didn’t have to say a thing, especially that first time. I could just listen, take it all in and decide when I was ready to take part.

This group had been created especially for people like me — people who were providing care for someone with a mental health condition. They had created thoughtful guidelines that made me feel more comfortable. For example, members pledged to protect each other’s confidentiality. They agreed to “share the air” so that no one person would monopolize the group’s time. The people guiding the conversation were peers, which meant they’d faced many of the same struggles I was bringing into the room.

It took time, but before long, my weekly support group became the place I felt safe releasing the pain behind my experiences. There was no need to hide because no one was there to shame or criticize. We all wanted and needed the same things — compassion, support and suggestions for coping with the difficulties of supporting someone with mental illness.

What Can A Mental Health Support Group Give You?

Unlike talk therapy, a support group offers you the chance to explore your thoughts and experiences with others who are going through similar challenges. While some groups are led by mental health professionals, many (like mine) are organized and run by peers. This gives people the chance to form a unique circle of caring that offers connection, comfort and perspective.

Here are five unique benefits I gain from attending a free, drop-in support group each week (or as often as I can make it):

    1. I don’t have to explain a lot. Because the people in my group understand what it’s like to live with mental health struggles, there’s an instant understanding between us. As we check in with each other, smiles and nodding heads reaffirm that we’ve all been there.
    2. I can just listen. My group has an explicit agreement that no one has to share. If it’s been a good week for my family, I might add to what others are saying. If I’m feeling especially fragile, I can remain silent, gaining strength from spending an hour with compassionate friends.
    3. I hear about useful strategies. Caring for someone who’s struggling can be a tough, exhausting job. While there aren’t any magic answers, I learn a lot from my peers, including ways to talk with my loved ones, set boundaries and work as part of their treatment team.
    4. I feel less alone. Isolation is a real risk for caregivers. (It may be one reason that 40% to 70% of people in caregiving roles have their own mental health issues.) Getting together with peers eases my loneliness and gives me strength.
    5. I enjoy a good laugh. Our group guidelines give us permission to burst into laughter when it feels natural. That might sound unexpected, but it’s a wonderful release. The seriousness of mental illness can feel incredibly heavy. Letting ourselves be honest and real lightens the burden.

How Can You Find A Group That Works For You?

Mental health support groups can be found in most communities. There are also hundreds of online groups. In fact, my group has been getting together on Zoom since the pandemic began, and we’ve found that in some ways, meeting virtually works even better for us.

Groups are hosted by mental health organizations, hospitals, clinics and community groups. Some are fully independent and run by group members. You can also explore the support groups offered by local NAMI affiliates.

Nearly eight years after that first anxious night, I see my support group as a true lifeline. Spending time with these thoughtful, caring people restores my balance, especially when worries about my loved one loom large. And for many of us who struggle with our own mental health conditions, the relief our weekly group provides is a double blessing.

Though you might feel reluctant at first, I encourage you to give your local support group a try.

Betsey O’Brien is an independent writer focused on mental health and its impact on individuals, families and communities. She lives in Oak Park, Ill., and is a past contributor to the Advocate, NAMI’s flagship magazine.

Recent Changes May Affect Access to an Important Medication

DEC. 29, 2021

By Ken Duckworth, M.D.

prescription pad

Our team at NAMI remains focused on access to the best care, so we’re sharing information on changes to how the medication, clozapine, is prescribed and dispensed.

Clozapine is an effective medication, and the only one that is Food and Drug Administration (FDA) approved for treatment-resistant schizophrenia. Clozapine also reduces the risk of suicide for people with schizophrenia or schizoaffective disorder. It’s an important tool for treatment, and individuals who take clozapine report significant improvements in their symptoms. This means a lower need for hospitalization, and a meaningful improvement in quality of life.

Clozapine offers many benefits, but as with any medication, there are potential risks. One of those risks is a rare side effect of a loss of white blood cells, which are vital in helping the body fight infection. Prescribers and pharmacists monitor this risk using a system called the Clozapine REMS Program, and this system is now undergoing a major change which could affect those who take this medication.

The goal of this change is to simplify the reporting system for prescribers and, in turn, make it easier for pharmacists to dispense the medication.

NAMI invited our colleagues from SMI Adviser, an initiative funded by SAMHSA and administered by the American Psychiatric Association, to share the latest information regarding this change. We thank them for their collaborative efforts to help prescribers and pharmacists adjust to the new system and avoid disruption in treatment for those who rely on clozapine to manage their mental health condition.

From SMI Adviser:

Any hiccups in access to medication can create serious issues for patient care. That’s why we created a new guide that helps prescribers and pharmacists navigate recent changes to the Clozapine REMS Program. We also created a guide for individuals and families who may be impacted by the system updates. These guides are a collaboration between NAMI and SMI Adviser, a national program funded by SAMHSA and administered by the American Psychiatric Association.

The goal of the Clozapine REMS Program is simple. It helps make sure that the benefits of taking this medication outweigh the risks for each person who takes it. And since 2015, the system has worked to fulfill that purpose. However, in July 2021, the FDA approved changes to the system. The changes went into effect on Nov. 15, 2021.

These changes require action from anyone who prescribes or dispenses clozapine. You must take a series of steps on behalf of yourself and any patients in your care who are on clozapine.

We strongly urge you to access the new guide, which provides detailed guidance on what you need to do in order to:

  • Recertify to prescribe clozapine
  • Reenroll your patients to receive it
  • Recertify your pharmacy to dispense it

If you have questions, that’s okay. SMI Adviser offers other resources that you may find helpful as you process these changes. You can access these free resources at any time:

  • Submit your questions and we will directly answer them within one business day.
  • The Clozapine and LAI Centers of Excellence Exchange is an interactive community you can use to share ideas, ask questions, compare notes and network with colleagues across the country.
  • The Clozapine Center of Excellence lets you access education and resources to help guide clinical decisions around clozapine.

After reading the guide for individuals and families, those who include clozapine in their treatment plan may have additional questions. We encourage you to talk to your prescriber, as well as your pharmacy, to help reduce the potential for interruption in treatment. Communication with your treatment team is always a key part of self-care, and this is an important opportunity to build on it.

We hope that you find this information useful. It’s critical to ensure access to this lifesaving medication for those who need it.

Ken Duckworth, M.D., is NAMI’s Chief Medical Officer.

How I Developed a Healthy Relationship with Exercise to Help My Mental Health

DEC. 27, 2021

By Margot Harris

woman exercising

When things got bad, everyone told me to exercise.

“It always helps me to take a workout class — just to sweat a little,” my well-meaning friend said as she stroked my unwashed hair. “Just try it.”

“Come to the gym with me!” My co-worker begged. “We both need the endorphins.”

“How have you moved your body today?” I read on a wellness influencer’s Instagram stories.

My family was more direct. “It’s because you don’t exercise,” they would tell me when I confessed how bad my anxiety and depression had become; how getting out of bed was exhausting, how panic attacks occupied all my waking hours, how everything just hurt. How my only relief was the cocoon of blankets that protected me from having to live my life.

Research backed them up. Numerous studies have found that physical exercise is meaningfully and significantly associated with self-reported mental health improvement. But my loved ones’ urging and even the peer-reviewed academic journals didn’t seem to account for the crushing weight of depression that kept me confined to my bedroom. Nothing addressed that exercise seemed like a painful chore when everyone around you was forcing it and expecting you to just get happy.

Two years later, my mental health has improved — thanks to a lucky combination of effective medication, regular therapy, a career change and, notably, a newfound healthy relationship with exercise. But new habits did not emerge overnight. They came with gradual changes made on my own terms.

 

My Outlook Changed During The Pandemic

When the COVID-19 pandemic struck in 2020, I found myself packing up my New York City apartment to move back home with my parents in Washington, D.C. After spending every hour of the day inside with my parents and the flood of Slack notifications and emails, the outdoors suddenly had a new appeal.

No one mentioned exercise to me; perhaps they were too busy worrying about a global pandemic and scanning the headlines for more catastrophic news. With no one nudging me — demanding I “fix” myself — I actually wanted to move my body. I even caught myself eying my running shoes in the back of my closet. Somewhere, deep down, I wanted to feel the D.C. humidity on the back of my neck. I craved the burn in my thighs from walking up a steep hill. I wanted to try shedding my cocoon of blankets just to see what it felt like.

Naturally, my enthusiasm for walking lasted only a few minutes into my first attempt. After one uphill block, I was winded. My persistent, negative internal dialogue told me I was too out-of-shape, too depressed, too lazy, too unwilling to make a lifestyle change — that I should just give up and go home. I resolved to walk for 30 minutes, just to finish out the optimistic Spotify playlist I had designated for exercise.

The next two weeks of walking weren’t much different. I forced myself into running shoes, blasted energetic music through my headphones and dragged myself around my neighborhood, block by block. My internal critic mocked my efforts and assured me that my mental and physical health wouldn’t improve. But I managed to drown her out with enough base drum.

On my 20th day of walking, I noticed that my first hill hadn’t left me winded. I had barely noticed it go by. In that moment, I wasn’t overwhelmed with cruel self-talk. I felt something almost like pride.

 

I Began To Enjoy Exercise For Myself

Despite the occasional interjections from my internal bully, I started to have fun on my daily walks. I walked faster and longer. I began jogging every other block. My exercise playlists became more whimsical, as I no longer had to rely on a crushing downbeat to motivate myself.

Once moving my body no longer felt like a chore, I found myself wondering about what else I could do. I tried online workout classes and discovered I actually liked them. They gave me structure and purpose during a confusing time that felt otherwise out of my control.

 

Now, Walking Is My Self-Care

In the past year, I have walked an average of 5.7 miles every day. This is a number that would have intimidated me just a year earlier. But I have truly reached a place where moving my body feels safe and fulfilling. Walking has even become a reason to get out of bed on the tougher days.

When I need to re-center myself or disconnect from my computer screen, I walk. When I need to work through a spiral of anxious thoughts and negative internalized messages, I walk.

I walk without a desire to satisfy anyone else.

Walking around the block didn’t cure my depression, but trusting myself to try new habits and make changes on my own terms has been nothing short of a blessing.

 

Margot Harris is the Associate Editor of Marketing and Communications at NAMI. She has an MFA in nonfiction writing from Columbia University and previously worked as a digital culture reporter at Business Insider. She lives in Washington, D.C., with her very energetic emotional support dog, Lyla.

Taking the Leap of Faith to Healthy Self-Esteem

DEC. 22, 2021

By Susie Moore

woman hugging herself

A young client of mine was recently describing her struggles with low self-esteem. She doesn’t like the way she looks on the outside or who she believes she is on the inside. She doesn’t see any good qualities in herself, nor does she feel she has any purpose. She feels she isn’t useful or helpful to anyone and believes she is a burden to others.

There’s a natural urge in this situation to try to convince the person otherwise — to help them see the errors in their thinking and to reassure them of their positive qualities. However, I refrained from doing that because I knew she wouldn’t believe me. With people who only experience occasional self-doubt, a pep talk may be helpful and appropriate. But chronic and pervasive low self-esteem is a harder problem to tackle, and it requires a more comprehensive approach.

I write from the perspective of an experienced professional counselor, but also from the perspective of someone who has dealt with this issue firsthand. For much of my life, I have been haunted by what I like to refer to as the “demon of self-doubt,” which has often spiraled into self-loathing. I have worked diligently on this issue, and I believe I have made progress. On most days, I can maintain a realistic and balanced view of myself and treat myself with compassion. However, developing and maintaining a healthy self-esteem is an ongoing process. It continues to shift and evolve as I respond to the ups and downs of life.

If you struggle with self-esteem, you may be wondering how you can learn to like yourself — especially if, at your very core, you don’t. How do you start to see yourself as a person of value, goodness and potential? My first answer is: It’s hard! It takes time, effort and maintenance. But my second answer is: It’s possible, and the rewards are plentiful.

Here are some suggestions to begin your journey toward greater self-esteem.

Take The Leap Of Faith

Improving your self-esteem is daunting task, especially if a negative self-view is deeply rooted and long-standing. Therefore, this work requires a leap of faith — a belief that the endeavor is worthwhile and that success is possible. To succeed, you must have the commitment to see it through.

This will serve as an anchor to keep you grounded and as a catalyst to push you forward. Take the time to do some research about self-esteem or speak with a professional who can guide you through the process. The more knowledge, resources and support you have, the more likely you will be able to take that leap of faith.

Entertain The Possibility

Of course, having a healthy self-esteem is not something we can just easily talk or think ourselves into. The client I mentioned earlier told me that when she tries to change the way she thinks about herself, it just doesn’t feel true to her.

I told her she can begin by entertaining the possibility that she isn’t as bad as she thinks she is — that maybe her critical view of herself is not entirely accurate. That way, she is not trying to force something that feels rushed or artificial, but rather, open some space in her mind for new possibilities and ways of thinking about herself. To put this another way, experiment with letting the negative thoughts you have about yourself mingle with some positive, self-affirming ones.

Strengthen A New Muscle

Another client, who has chronic, debilitating negative thoughts about himself, once said, “Well, I’ve been thinking this way for close to 30 years, so I can’t exactly change it now.” I told him that learning to like yourself when you are disinclined to do so is like building physical stamina or strengthening a new muscle group.

I chose this analogy for him because he had recently lost close to 50 pounds. It might feel awkward, uncomfortable and even painful at first, but through practice and repetition, we gain strength, and we feel more comfortable and confident.

Understand That Self-Esteem Is Not Narcissism

Another client told me that when she tries to acknowledge her strengths and positive qualities, she feels like she’s showing off or being narcissistic (having an excessive interest in one’s self). I explained that having a healthy self-esteem is not the same as being narcissistic. Having a healthy self-esteem is about having a balanced and reasonable view of oneself as a complex, imperfect human being. It has just as much to do with acknowledging our shortcomings as it is about acknowledging our strengths, skills, gifts and potential.

Additionally, a truly narcissistic person would not worry about being narcissistic, whereas a person with low self-esteem would. It is the voice of low self-esteem itself that says: “Maybe I’m showing off,” or “maybe I’m self-absorbed,” or “that makes me sound so narcissistic.”

Practice Being An Objective Observer

One way to begin the process of increasing self-esteem is by learning to observe your internal dialogue. It requires you to take a figurative step outside of yourself so that you can be an objective observer. Then, you can begin to take note of how you interact with yourself:

  • What are your responses to both positive and negative events and/or stimuli?
  • How do you talk to yourself when you are struggling with something difficult?
  • Do you tend to downplay the good things that you do, while berating yourself for every mistake you make?
  • Do you negatively compare yourself to others and/or feel inferior?

The point of this observation is to become more aware of the automatic and habitual patterns of thought that feed into your low self-esteem. That way, gradually, you can develop healthier patterns, and a more accepting and loving relationship with yourself.

Name The Challenge

I have found it helpful in my own life to come up with names, visual images or analogies for different issues and challenges, such as my “demon of self-doubt.” Doing this helps me to gain some control over it. It allows me to gain some mental distance from the problem and view it from a different perspective.

Low self-esteem can become tangled inside of us, making it hard to manage and overcome. But by naming the problem, we can begin the process of taming it as well.

Susie Moore is a licensed professional counselor living and working in Philadelphia, Pa. Susie can be reached at mooresusanna77@gmail.com.

How to Prioritize Self-Care During the Holidays

DEC. 17, 2021

By Kevin Connors, M.S., MFT, and Kathryn Hamel, Ph.D.

person sitting by Christmas tree

The holiday season is typically seen as a time of joy and merriment; of family and friends gathering and celebrating together. However, many have begun to have honest conversations about the darker side of “the most wonderful time of year.”

For many with mental illness, or those who have family and loved ones who face mental health issues, these can be tremendously difficult times. Perhaps we hope to feel connected to — and understood by — those around us during upcoming celebrations, only to be disappointed. Or maybe we imagine fulfilling family dinners, only to struggle fitting in. We might plan for parties with friends, only to find we’re feeling trapped in our own minds and lost to waves of depression.

These “holiday blues,” however, can be managed. Here are a few ways to create self-care activities to help carry us through the season.

Know And Respect Your Limits

The holidays are often accompanied by a long list of obligations, errands and events. While these to-do lists can sometimes be fun or exhilarating, they can also be exhausting and emotionally draining. It’s important for you to know when to say “enough” or “no.” Small, successful outings are much better than running yourself into the ground or over-extending yourself.

You can set boundaries around how much time you spend on holiday tasks; plan for an afternoon trip instead of an all-day excursion, limiting yourself to only one or two stores. Don’t forget to take breaks and recharge. Going with one or two friends may also provide support and make the outing a fun activity.

Setting limits can also extend to your social interactions around the holidays. Invest your time and energy in relationships with people who are willing to give back. You need not attend every event you are invited to. Some people are emotionally draining to be around. If you need to, protect yourself by declining their invite. A brief phone call to express your “apologies” and to wish them a happy holiday season offers limited engagement and an easy exit.

Set Reasonable Expectations

It’s natural to have high expectations of the holiday season; everywhere we look, we’re reminded that this is a time for family, joy and abundance. However, it’s equally important to check in with ourselves about managing our hopes and expectations.

Setting unrealistic expectations for people and events can lead to disappointment. Having no expectations is equally unrealistic and conveys that others don’t need to think about you, which can lead to disappointment. An honest and open appraisal of how people have treated you helps to predict how they will treat you in the future.

Avoid Known Triggers

For some, the holidays are a time of painful reminders. If you find yourself triggered by certain activities or interactions, do your best to replace them with emotionally fulfilling ones. If certain holiday movies remind you of sad times or lost friends, don’t watch them.

If a problematic relative or acquaintance is going to a holiday event, consider if you really need to be there. And if you do, then don’t actively engage with that person. You can also drop by for a brief check-in rather than attending the full event.

Find Ways To Give Back

Giving back, or helping others out around the holidays, is an excellent way to make a positive contribution and provide a sense of purpose and meaning.

If you’re looking for ways to get involved during the holiday season, consider offering support to service members deployed in remote areas or dangerous locations. You can also consider donating time to a local food bank. Another option to contribute to your community is by creating Care Kits for individuals experiencing homelessness.

Decorate For Comfort

During the holiday season, you may find yourself surrounded by an overwhelming number of decorations. This kind of celebration, however, is not a requirement for your own space. You need not use traditional holiday colors or symbols for decorating (unless they bring you joy, of course). Pick colors that give you a sense of happiness peace, safety, lightness or calm.

Consider a soft blanket to snuggle in with or a favorite pillow to cuddle. Choose a color that makes you cozy. Are there certain fragrances that remind you of a special time or place? Perhaps a new scented candle or an essential oil might help make your house feel a bit more like your safe space and sanctuary.

Be Extra Giving To Yourself

While the holidays are an excellent opportunity to look outward and appreciate the people in your life, don’t forget to appreciate yourself. Amid holiday shopping and gift giving, perhaps you can buy or make a present for future you — maybe something that will support your mental health or encourage a new and healthy hobby.

Consider mailing yourself a card or two. Think of an encouraging phrase or perhaps write a note reminding you of a strength or a special time. Jot these thoughts down in a card and send it to your future self. Plan that special time to care for your most important commodity — YOU!

We, at The Hecht Trauma Institute are wishing you peace and happiness during the upcoming holiday season. Make sure to carve out time or schedule time for your self-care; it is important for you, and it is important for your friends and family, too.

Kevin Connors, MS, MFT, is Senior Vice President at the Hecht Trauma Institute creating trainings on interpersonal trauma, a licensed Marriage & Family Therapist, and a national and international presenter on trauma and dissociation. He is co-author of “Treating Complex Trauma and Dissociation: A Practical Guide to Navigating Therapeutic Challenges.”

Kathryn Hamel, Ph.D., is the CEO of the Hecht Trauma Institute. She worked in law enforcement for 25 years, rising to the rank of lieutenant before transitioning to her current role serving those impacted by trauma. Dr. Hamel has served as an adjunct faculty member on the board of several non-profit organizations.

How the “Laziness Myth” Affects Those with Mental Illness

DEC. 15, 2021

By Ashley Nestler, MSW

woman doing yoga

Recently, I have been reflecting on a concept I like to call “the laziness myth.” This myth, as explained by social psychologist Devon Price, is born from a workaholic culture and capitalistic ideals. It tells us that our value is derived from productivity and that we are never working “hard enough.”

As I have navigated a variety of mental and physical health challenges, I have learned just how damaging this myth can be for those with chronic illness or extensive medical needs.

Professionally, I am a mental health specialist. Currently, however, I am not working, and I’m on disability due to chronic illness. My conditions include fibromyalgia, multiple eating disorders, obsessive-compulsive disorder (OCD) and complex post-traumatic stress disorder, among others.

As I’ve attended to my health issues, I’ve run into stigma — both self-imposed and from others — surrounding mental health and taking time off from daily demands to recover. It has taken me a long time to combat this stigma and to accept that resting when I need to does not mean that I am lazy.

Making Time For My Health Is Critical

Maintaining my health is a job in itself. I attend multiple therapy sessions each week; I work with a psychiatrist for medication management; I also see multiple other specialists for my physical health conditions.

Prior to being admitted to the hospital for a severe mental health crisis two years ago, I pushed myself through school to get my Bachelor of Science in Social Work and Master of Social Work. During this time, I was struggling with my mental health and using unhealthy coping mechanisms because I was afraid to get help.

I learned how to hide my symptoms from others; I put on an ambitious face and became a “workaholic” so I could feel as though I was succeeding when everything was crumbling around me. It was only after a traumatic loss of a relationship that my mental illnesses became all-encompassing, and I experienced an episode of severe suicidal ideation. I was taken to the emergency room because I was not able to function at all.

The hospitalization was a wakeup call that — in order to survive — I need rest. Afterwards, I took time away from school and work to focus on my mental and physical health.

I Still Struggle To Prioritize Myself

Unfortunately, centering my health and responding to what my body needs has not been easy. I feel guilty for taking time to rest or for being unable to do certain things because my health is in jeopardy.

For example, many of my medications increase my sensitivity to heat and make heatstroke more likely, on top of my current heat sensitivity due to fibromyalgia. As a result, I often spend summer days inside, and I tend to need more sleep. While I see other people spend extra time outside with increased activity, I find myself feeling guilty, as though I am doing something wrong for needing the extra time to ensure that my body is comfortable and safe.

This guilt is often compounded by criticism. Others do not always understand why I am currently unable to work. I have also experienced blatant distaste and outright disrespect from some people who learn I am on disability primarily because of my mental illnesses. As several interactions I’ve had have suggested, rest is often seen as “laziness” and the antithesis of productivity. I used to believe this, too. I was raised to value arduous work above anything else. Needless to say, trying to separate my need for rest from the shame resting brings is something I am still working on every day.

Each day is an uphill battle of trying to choose my health and what my body needs first, rather than what others expect of me. Before receiving help, I didn’t set any boundaries when it came to choosing my needs first. It is hard to make these choices — but I have learned to respect my own limitations, set boundaries, and speak up about my health and well-being.

I Have Hope For The Future

For far too long, people have misunderstood mental illness, and this misunderstanding has forced us to be overly critical of ourselves and challenge the reality of our needs. The emergence of a more honest dialogue surrounding mental health, rest and productivity (like in Price’s work) has taught me that it is perfectly acceptable to function differently than those without with chronic illnesses. I have come to understand that taking care of myself and my own needs is a priceless level of productivity that is more than valid.

Despite what our world might tell you, your outward “tracked” productivity that results in economic gain does not define your worth. You, right now, without having to accomplish a feat, are worthy and important. You are precious as you are. Don’t let society tell you otherwise.

Ashley Nestler, MSW, is a survivor of schizoaffective disorder, borderline personality disorder, fibromyalgia, multiple eating disorders, generalized anxiety disorder, obsessive compulsive disorder and complex post-traumatic stress disorder. She is also a mental health specialist, author and empowerment coach.