Who, Me, Dating?

DatingNews.com
interviewed me about dating and marriage while living with bipolar disorder.
Here’s how the article starts:
Kitt O'Malley: Love, Learn & Live with Bipolar Disorder. Blogger Kitt O'Malley Opens Up About Her Experiences Living, Loving & Laughing with Bipolar Disorder

At age 30, Kitt O’Malley moved in with her parents after treatment for debilitating depression resulted in psychotic mania which left her unable to do her work as a licensed marriage and family therapist. She left her career aspirations behind, and she started seeing a psychiatrist and a therapist who treated her for what was still thought to be chronic depression.

So when the guy she was dating said “You’re the most independent woman I’ve ever met,” Kitt couldn’t help but laugh. She had never been more dependent in her life, but he didn’t see those circumstances or her mental illness. He saw her, and that in itself was a small miracle…

Read the rest of the interview here. Thanks!

Lynn Nanos Guest Post: Revolving Door of the Mental Health System

Thank you, Lynn Nanos, LICSW, author of Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry, for this guest post.

Can We Slow the Revolving Door of the Mental Health System?
“When hospitals release seriously mentally ill patients too soon without outpatient follow-up, the patients can end up homeless, jailed, harming others, or even dead.”
— Lynn Nanos, LICSW

As a mobile emergency psychiatric social worker in Massachusetts, I evaluate many patients who have learned that getting psychiatrically hospitalized is more likely when they don’t take their medication and attend psychotherapy sessions. Too many patients are repeatedly readmitted to emergency services before inpatient is secured, despite that they needed this level of care months ago. Among those whose treatment implementation was delayed because they were not transferred from emergency services to inpatient care when this was needed, would they have become stable sooner if inpatient access was not delayed? For those who were repeatedly admitted to inpatient, could this have been prevented if they were discharged at the appropriate time? 

As a mobile emergency psychiatric social worker in Massachusetts, I evaluate many patients who have learned that getting psychiatrically hospitalized is more likely when they don’t take their medication and attend psychotherapy sessions. Too many patients are repeatedly readmitted to emergency services before inpatient is secured, despite that they needed this level of care months ago. Among those whose treatment implementation was delayed because they were not transferred from emergency services to inpatient care when this was needed, would they have become stable sooner if inpatient access was not delayed? For those who were repeatedly admitted to inpatient, could this have been prevented if they were discharged at the appropriate time? 

Not encountering a couple of patients who I previously evaluated in any given week is rare. I describe the revolving door of the mental health system in my newly published book, Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry

Breakdown: A Clinician's Experience in a Broken System of Emergency Psychiatry by Lynn Nanos, L.I.C.S.W.

While the inpatient course lengths have declined since deinstitutionalization, the rate of readmission to inpatient units has increased.[1] The revolving door in the mental health system refers to the rapid cycling of admissions to and discharges from inpatient units and hospital emergency departments, jails, and prisons. It is common to see psychotic patients cycle through hospital emergency departments five times in less than two months before they are moved to inpatient units.

The nationwide shortage of inpatient beds creates a backlog of patients waiting excessively for placement in emergency departments. Many sources indicate that the number of inpatient beds has declined by approximately 96 percent since deinstitutionalization, despite the population increase.

If a patient who meets inpatient criteria is prone to violence, doesn’t want any help, has no health insurance, or is expected to present extremely challenging barriers to discharge from inpatient, the wait for an inpatient bed will be longer than average because inpatient units discriminate against patients with these characteristics. I evaluate a highly psychotic young man, Fred, age 32, at the hospital. He doesn’t want to be there and had been brought there by police officers after he threatened to assault his cousin. Due to his history of assaulting hospital staff members, no inpatient unit accepts him. Colleagues, including myself, consistently confirm he qualifies for inpatient daily. After a couple of weeks, the emergency physician discharges him to the streets. Did he receive any psychiatric help other than the interviews we employed? No. Would he continue to deteriorate and pose a risk of danger toward others because of his psychosis after discharge? Yes.

Involuntary hold law is especially needed for some patients who lack insight into being ill and dangerous. Like most states, Massachusetts’ involuntary hold law emphasizes the risk of imminent danger while neglecting to prevent danger. When I find that patients do not meet this stringent standard, there is usually no choice but to discharge them home or to the streets.

Craig, age 25, presents to emergency services with his mother, Vera. They have been living together for years and she knows him better than anyone else. Craig immediately reveals to me he has no interest to meet with me. Vera clearly pressed him to come. She urges me to use her written journal to get him hospitalized. It shows his deterioration in functioning over the last year. He has increasingly isolated himself socially from others, dropped out of college, often been found mumbling to himself when no one is around, and once in the last month told his mom that he planned to cut his wrist in a suicide attempt.

As I refer to the above-noted concerns reported by Craig’s mom, he acknowledges most of them but minimizes them. He is not psychotic and states he never hallucinated. Nor is he suicidal. He clarifies that he had told his mother he wanted to kill himself approximately two weeks ago in the context of an argument they were in. He stated this with much more intention to upset her than to die. He easily lists reasons to continue living – love for his mom, dog, and brother. He lists coping strategies that he plans on using. He doesn’t qualify for inpatient.

What could I offer to Craig? He does not qualify for a state-funded residential program because he has not been deemed eligible for state-funded care. Even if he were receiving state-funded care, a residential program would probably not be available to him because there aren’t enough. And the state would hypothetically not prioritize him because he is not homeless. He cannot fund a private residential program. Partial hospitalization programs (PHP) involve a daily series of structured group psychotherapy sessions and a chance to see a psychiatrist. But many insurance companies, including Craig’s, do not cover this level of care. If he were covered by the “correct” insurance, would he follow through with this? I cannot predict the future but would guess not. Massachusetts, fortunately, has Community Crisis Stabilization (CCS) units in all areas. People in crisis sleepover in CCSs for a few days, where they receive ongoing support, the structure of psychotherapy groups, individual psychotherapy, nursing, and psychopharmacology adjustments. Although it lacks the supervision possible on inpatient units, it helps thousands of people who don’t qualify for inpatient. But it is a voluntary level of care, which Craig is not interested in.

Solutions can be implemented to slow the revolving door. More inpatient beds are needed. Inpatient units that discriminate against the most challenging cases should be held legally accountable. Legislative changes are needed to enable professionals to invoke involuntary emergency and inpatient care with less difficulty. Treatment options for patients who are not finding basic outpatient treatment enough, but who don’t qualify for inpatient care have to be easily accessible.

Lynn Nanos, LICSW
LynnNanos.com


[1] Appleby, L., D. J. Luchins, P. N. Desai, R. D. Gibbons, P. G. Janicak, and R. Marks. “Length of Inpatient Stay and Recidivism Among Patients with Schizophrenia.” Psychiatric Services 47, no. 9 (1996): 985-90. doi:10.1176/ps.47.9.985; Appleby, L., P. N. Desai, D. J. Luchins, R. D. Gibbons, and D. R. Hedeker. “Length of Stay and Recidivism in Schizophrenia: A Study of Public Psychiatric Hospital Patients.” American Journal of Psychiatry 150, no. 1 (1993): 72-76. doi:10.1176/ajp.150.1.72.

I Got Out of the House This Week!

Outside

My major achievement this week was to get out of the house TWICE for ME – not just driving my son to and from school or caring for my parents.

Monday: OC Writers Write-In

Monday I attended an OC Writers write-in where I wrote 3282 words freely. The words need editing. They need shape. They possibly need to be fictionalized. Not sure.

Wednesday: Brain Disease Advocacy

FEDUP4Brain_Cropped
Yesterday I had a lovely lunch with Mary Palafox of FEDUP – Brain Disease Advocacy. FEDUP4Brain advocates uniting mental and physical health under ONE health care delivery system. Stop treating serious mental illnesses such as schizophrenia and bipolar disorder differently than other brain disorders.

Folie à Deux

As for the writing I did Monday, my focus was a delusion shared (folie à deux) by my parents. The delusional thoughts originated from my mother, but my father backed her up, and in doing so failed to protect us from verbalized delusions better not shared with one’s children. The delusional thinking was and still is disturbing.

Understand that delusional thoughts are a SYMPTOM of mental illness, of a brain disorder. When a couple reinforces each other’s delusional thoughts, they get stuck in a reinforcing feedback loop. In isolating themselves from others, they fail to test their version of reality against outsiders’ views.

My mother lived with an unacknowledged, undiagnosed mental illness. As her daughter, I’m in no position to diagnose her. Loyal and devoted – adoring, in fact – my father always backed my mother up. He might agree (in secret) with us, but then he would make us apologize to our mother for something SHE said, explaining to us that our mother didn’t feel appreciated and it was up to us to give her the attention she needed.

Not a healthy dynamic, but by the time we were teenagers, we knew it was not healthy. Thank God, my sister and I had each other to tether ourselves to reality.

As an adult, as a mother, in many ways I identify with my mother. I can see myself in her. I can see my illness in her illness. So, I feel compassion for her. But we differ in how we have dealt with our disordered brains. I had insight and sought treatment early.

As it turns out, since my mother had her stroke, I learned that she was being treated for depression. She told me a few years ago that she took an SSRI for anxiety, for panic attacks, but she told me she stopped cold turkey (dangerous). I was unaware that she went back on them for depression.

Father’s Day Bits and Pieces

Fathers Day MTB

We plan to do some mountain biking today. When my husband and son do steep downhill runs (downhill mountain biking), I just have enough time to drop them off at the top of a mountain and pick them up at the bottom. Hopefully today, if we ride (they went on a very long ride Friday which our son is still recovering from), I can ride, too.

***

On the Way to Father’s Day with My Dad

Audio Transcript

I’m on my way to my parents’ memory care to celebrate Father’s Day with my dad. Yesterday when my mother learned that I was going to be celebrating Father’s Day with my dad and not be taking her to her communication recovery group in Newport Beach, she became very distraught, cried, and tried to leave the facility. So, I got a phone call asking if they could hire somebody to take her to the course. It freed me up to meet with my father for Father’s Day.

Granted, I’m not able to take my kid to and from school on Fridays when I go and spend Fridays with my parents. So, whenever I go and spend Fridays with my parents during the week, it interferes with my parenting. Luckily, today my husband’s home and he’s taking my son to school. My son goes to school too far to ride his bike.

So, I’m anxious because I’ll be seeing my mother before she leaves, and I don’t know how she’s going to react. I’m just anxious because whenever I see them, they expect me to get them out of there (their locked memory care community). And, I can just only take so much of it emotionally. It’s very trying.

So, it interferes with my ability to do my passion, which is writing, blogging, which I haven’t been doing as much. And, yes, I know people, some people, are a little concern that I’m doing this while driving. But, it’s a long drive. It’s like a 20 minute, half hour drive. We’re in neighboring cities, but Mission Viejo is a long city. And, then, it takes a while to get from their memory care facility to the Newport Beach communications recovery group.

I just don’t want to keep taking my mom. I want to start backing out of being a caregiver. I still basically am. But, I want to start putting up more boundaries and protecting myself, which I had to do before all this. I had to protect myself. I have to protect my time.

I have to make sure I have enough energy to take care of myself and my son. First and foremost. I have nobody else, beside my husband. Yes, my son is an adolescent, but he doesn’t drive, and it’s just not safe for him to ride his bike to and from school because of super busy streets. The speed limit is like 50 mph. He doesn’t feel comfortable riding on these streets. He feels comfortable on mountain trails, but not on these streets.

***

Mental Illness and Violent Acts

My response to Marisa Lancione’s excellent post: Can we stop blaming mass shootings on mental illness?

Honestly, some mass shootings are perpetrated by people with untreated mental illness. I’ve had to stop myself from doing violent things. I’ve had completely horrifying thoughts and impulses, which I’ve had to tell myself not to act on, had to harness all my self control to not do. At the time, in fact, I was amazed that more violent acts don’t occur.

***

My response to Henrietta M. Ross’ post: We’re All Serial Killers Now

Brilliant. Just responded to another article that I have fought murderous (and postpartum incestuous and cannibal) thoughts and impulses. At the time, I was amazed that more murders don’t occur (and more infants not eaten).