Friendships you never doubt

They say true friends go long periods of time without speaking and never question the friendship.

It’s true, I think. But I only think, I don’t know, because for me, crippling anxiety surrounds most interactions I have with people, and friendship is one of the hardest things to feel confident about.

People scare me, because of what they might say or do a lot more than what they actually say and do. I’m forever fearing what I might do to offend or hurt people, and trying my best to avoid doing things wrong, and forever feeling that I fail. The reality of living with mental illness is that your interactions with other people just aren’t like those of ‘normal’ people. You interact differently – people with anxiety will identify with what I feel when I interact with people, the hopes and fears I have, much more than a typical person, who might feel passing rather than crushing anxieties.

In my purely logical mind, I know that there are people who are part of my life who would pick up where we left off as if we’d seen each other only yesterday. Meeting up with a person like that, though, is a morass of what my rational mind knows are baseless fears. Logic and rationality don’t protect me from a mind that wants to tell me that I’m a failure at interpersonal communication, and that people just don’t like me.

I have friends that I do see regularly, good friends. It’s not fair that I can’t shake the feeling that they don’t really care for me all that much. The things depressed and anxious brains tell us are cruel and untrue, but they’re so believable in the moment.

Depression has spent Sunday chewing on me, so things are a bit hazy and rambly at the moment. I feel the effects of it a lot more on weekends because theres no strict routine to keep me going, unlike weekdays. I worked for a chunk of Saturday, and that helped me engage the healthy part of my brain. My unhealthy brain took over for the rest of the weekend though, and it’s thrown me into a bit of a spin. I hope the weekday routine will pull me up.

Being young and unemployed

I read an article about being young and unemployed today, and it raised an issue that I don’t think is discussed enough in relation to unemployment – the effects of unemployment on developing mental illnesses.

Everyone knows that having mental illnesses puts you at higher risk of unemployment. It’s just logical – if you’re seriously unwell in any way then your risk of struggling to find or keep work is much higher. Mental illness has a lot of stigma attached to it, making it hard to get work, and the illnesses themselves make it hard to keep work at times.

So it’s not a great surprise that the mentally ill are somewhat overrepresented in the ranks of the unemployed. But how many perfectly healthy people found themselves on the dole, and became unwell because of it? There are anecdotes in the article of a couple of people that had that experience – of suffering depression and anxiety related to being unable to find work. I would hazard a guess that this is not an unusual experience, and that even the most mentally healthy individuals have periods of unwellness if they are unemployed for a protracted length of time.

What kind of provisions do we make for this? Oh, that’s right. None. Because unemployed people suffering mental illness are doubly derided by society. Not only are you lazy and incompetent, goes the narrative, but you’re also crazy. Stay away, kids!

It’s worse than just having the psychological struggles of the unemployed ignored, though. WINZ processes actively make people unwell. The struggle of trying to get your entitlements, the constant losing of paperwork and other little errors, the unending pressure to get a job and get off the dole (I’m trying, miss, but there aren’t any jobs!), all these things cause stress that can turn into illness. Being unwell already and having to jump through the WINZ medical exemption process is even worse, and no more mercy is shown than to the least co-operative of recalcitrant beneficiaries.

WINZ is a recipe for mental ill health. Unemployment is a potent ingredient all on its own. The melting pot of financial pressure and debt turn it all into hot mess of psychological distress. But support is offered only to the most unwell of people, leaving people easily treated to get worse and worse. They could go to their GP, of course, and be referred for counselling or given anti-depressants – except they chose their GP back when they had a job, or access to student services, and now they can’t afford to go. Tough luck, kid.

The situation for the unemployed actively seeking and not finding work is dire.The stress brings their mental health under pressure, and there’s little out there for them to get support or help from.

Mental health in Christchurch

An article came out today, telling me some things that I thought everyone must know about post-earthquake Canterbury, and some things that I didn’t know, things that make me both angry and sad.

Mental health issues have become more prevalent in Christchurch since the quakes, something that is entirely expected, at least from where I stand. People who have been through a major traumatic event, like a huge earthquake, are more likely to have PTSD relating to the event, but are also more likely to have other mental health issues like anxiety or depression triggered by the circumstances and the pressure they are under. Zero surprises here.

The statistics are startling but not surprising:

– 43 per cent increase in adult community mental health presentations.
– 37 per cent increase in emergency presentations.
– 69 per cent increase in child and youth mental health service presentations, which would be higher without CDHB’s schools programme.
– 65 per cent increase in rural mental health presentations.

Canterbury District Health Board has a lot on its plate to deal with. In addition to the increase in mental health presentations following the quakes, 30,000 people moved into the area post-quake to help with the rebuild, and those people have a range of mental health issues, just like any other population. The problem here is that mental health services in Canterbury have received less than a puny 1% increase in funding, with even the growth in population ignored, never mind the increase in the incidence of mental illnesses in the area.

The lack of funding makes me angry and sad. At bare minimum, there should have been a funding increase in line with population growth. To present themselves as having even a scrap of humanity, the architects of the health budget needed to have acknowledged the effects of the quakes on people’s mental states and provided at least a token gesture toward relieving the pressure on an overstretched service. But none of that has happened, and it is disgraceful.

Where now for CDHB’s mental health service? Well, it’s the same as everywhere else in the country, scrambling to try and make things work on a shoestring budget. It’s worse for them than many others, but two things they have going for them is a well-performing service before the quakes, and the amazing resilience that people, communities, and institutions have shown in the last four years. They shouldn’t be struggling with this, though. We can do better, damn it, and why don’t we?

We’ve prioritised a bloody convention centre over so may more important projects. Health services of all kinds go without. Social housing has been 98% destroyed, and the shortfall has not been addressed in any useful measure. There are still people living in garages and tents, struggling through the winter, because their houses are written off and their insurance hasn’t come through. There is overcrowding due to a lack of suitable and affordable housing in the area. Why on earth would we need a conference centre, which will be empty for significant stretches of time, when there are so many other, more urgent needs? The misguided waste of it all is painful.

The Canterbury region has suffered mightily these past four years, and yet still the carry on. We should be supporting them in any way we can, not letting them down as attention drifts away from their needs due to the passing of time and the waning of urgency.

A sick brain that thinks sick thoughts

Recently, my brain has been even less useful than usual at thinking real thoughts, instead of fantastical crazy depressed thoughts. It’s frustrating, because there is a part of me that looks at life logically and thinks, ‘Brain, you’re being stupid. Try and get in touch with reality, won’t you?’. But that nice logical part of me isn’t always on, and when it is the rest of my brain usually isn’t paying it the slightest bit of attention.

I haven’t been properly suicidal in months, and yet when my psychiatrist prescribed me amitriptyline, the thoughts came back. I have known for a very long time that tricyclic antidepressants, particularly amitriptyline, are dangerous in overdose, and having them temptingly within reach was overwhelming. I have had my husband put them somewhere I can’t find them. It’s crazy, because I was in a moderately depressed state but not catastrophically bad, and the moment I had the drugs within my grasp it all went to hell.

I’ve been volunteering for a non-profit for a couple of months now, and really enjoying it. It felt good to come out of university and be immediately occupied. It didn’t give me any time to sink into a deeper depression. Now, they have some funding that means that I might have a chance to be paid for what I do, which is pretty neat. I have a meeting with the chief operations officer today to talk it over and sort things out.

Brain? This is awesome. Brain? Brain?? Oh hell there it goes again. They feel obliged to do this because I’m the wife of one of their software developers. They’ll replace me as soon as they find someone better, and that won’t take them long. Oh god what do I wear? If I get that wrong what will they think of me? . . . Brain. BRAIN! Stop it! Things will be fine!

I read about the protective effects of good parenting on mental health and I think ‘Oh. My kids are screwed’. Brain? I’m a perfectly adequate parent, thank you. Things like that, all the time. Intrusive thoughts that make me so miserable. Even when I’m able to let them go because I logic my way around them, they still leave a lingering negative feeling.

I wish, so much, that I could have a brain that just thinks normal-people thoughts. That had negativity and positivity in reasonable balance. That understood interactions as not inherently frightening and dangerous. That just bloody well played nice!

Maternal mental health – treatment options in NZ

Maternal mental health is a big thing (most of my data comes from that link this time). Around 15% of pregnant women and new mothers will have some form of mental illness during the perinatal period (from conception through to baby’s first birthday). Floating around 60,000 births per year, that means a lot of mental illness for New Zealand women. 9,000-odd women will have some form of mental illness in the perinatal period. I’m not talking about the ‘baby blues’, either. This means serious mental illness – depression, anxiety, bipolar episodes, schizophrenia, and so on.

To deal with this there is a primary health care plan in place. General practitioners, lead maternity carers, Plunket nurses, and the like are trained to identify maternal mental illness and in many cases treat, whether with reassurance, various forms of support referral, or medication. For many mothers that’s what they need.

What happens when they need more? Well, that’s when it gets a bit hairy. There is no national secondary maternal mental health service co-ordination. Each DHB is on its own, and some do quite well, but some are all at sea. Many leave maternal mental health care at secondary and tertiary level to their regular emergency mental health teams, which does not really cover the special needs of a mother and child.

At the extreme end, some mothers really need inpatient treatment. There are two options for this, one vastly superior to the other. On the crappy hand, you can separate mother and baby while mother receives inpatient treatment – which can last weeks or months. On the better hand, you can have dedicated mother and baby mental health beds. This option is so much better for both mother and baby, as it keeps them together during a crucial phase of attachment and bonding.

We have five mother and baby beds here. Here being the entire country. Five.

Those five beds are located in Christchurch, and they are available to Southern DHB cluster mothers – women from the South Island. Around a quarter of New Zealanders live in the South Island. Northerner? Well, tough.

Around one or two in 1,000 mothers will experience post-partum psychosis. this is an incredibly serious mental health issue, one that really requires inpatient treatment, as the woman can be a danger to herself and others around her.

How do we deal with this? Honestly, I don’t know. Do we separate mothers and babies or do we leave seriously ill women to the care of their families – or lack of care, as the case may be? I suspect the former, but the latter would be horrifying. Some hope is on the horizon, though – maybe. The Healthy Beginnings paper that I linked to, released mid-2012, advocates the establishment of between 16 and 33 mother-baby beds around the country. On the other hand, the paper recognises that there is no new funding for any of its recommendations, so moving forward with them may be rather . . . doubtful.

The number of beds proposed for the country is still problematic. It’s enough to cover the national cases of post-partum psychosis – maybe. Just about. Where does that leave the mothers suffering from schizophrenia or a severe bipolar episode? They’re acutely unwell. And what about the severely depressed? They’re not able to care for themselves. Here, the families must come in.

Let me tell you a little story. When I had my first daughter, I ended up with pretty severe depression. Like, can’t dress myself not eating can’t care for baby depression. My partner was at university full-time, and worked weekends. My family were miles away (literally in Africa). In the evenings things were ok, I managed to cook for my partner and my flatmate because I had to, and somehow I pulled it together enough for that. During the day, though, I just couldn’t do it. I remember just holding my daughter and both of us crying until we were exhausted, then sleeping in a heap on the couch until it was time to do it all again.

My grandmother travelled an hour each way once a week to take me to do my groceries. But that was the extent of the support I received. I desperately needed care of some kind, but it was left up to my family and my family just could not provide the care I needed. And mine was bad, but not as bad as many. There are women who lie in a darkened room all day, feeding baby when it cries and managing little else, every day. They need better.

How do we deal with suicidal women? The ones who have come to the conclusion that their baby and their family is better off without them? The current answer is, we leave them to family care and hope, or we split them from their child. None of this is a good solution.

We don’t have mother-and-child respite care, where mum can go for a few days and be looked after a bit by nurses or social workers, and feel supported and start getting things back on track. There are some day programmes for mothers and babies run by Plunket and others, but there aren’t enough, and they’re not accessible to women who are too unwell to leave the house unaided.

We are failing the mentally ill mothers of this country. We have the beginnings of a good programme in that primary interventions are in place and work well, more or less. But we need higher level interventions to be available, and I’m sick of hearing ‘we don’t have the money’. We find the money for flag referendums, and we waste money on by-elections that didn’t need to happen. We fund a military, perks for retired MPs, ever-escalating MP salaries. Gather together some of these hundreds of thousands, these millions. We can find better uses for them.

Next step forward

I went to the psychiatrist yesterday, and we’re raising the dose of one of my medications. At least it’s not a new drug to trial. I hope it works.

Things are still going downhill. I’m getting intense anxiety when I drive again. I thought I was getting over that, but it’s back with a vengeance.

I’m struggling to cope with everyday things, like cooking a meal. I melt down more often than I have in months. If two people talk to me at once, it’s hard not to curls up into a ball and scream.

The answer to everything is ‘I can’t. Please leave me alone’, but I can’t say that. I have to keep going and trying to do things, or I might get even sicker. Or something like that.

Things aren’t good, but I’m sort of holding it together. I hope I get better soon.

The joys of dealing with WINZ

A heart-wrenching story came out today of one woman’s latest clash with the denizens of the WINZ office. A sufferer of a condition that causes her much pain, coupled with anxiety, makes going into the WINZ office very difficult. It’s not good for her to need to attend the office too often, as her medical forms state clearly.

WINZ showed their usual remarkable competence by losing her paperwork at a critical time – only a week or two before they were going to cut her benefit for not putting in enough paperwork. The usual rigmarole that they put their clients through on a regular basis (pro tip: if it’s common knowledge that you often lose paperwork, perhaps it’s time to look at your systems). She was subjected to the stress and cost of redoing all of her paperwork, a task that’s not ideal for a very unwell person.

Finally, she had the joy of meeting a WINZ functionary who appeared to know nothing about what might be going on and recommended contacting her case manager – an activity that she had been engaged in trying for the best part of a week.

This is unacceptable.

WINZ is dealing with some of the most vulnerable people in the country. Those in poverty, those taking care of kids on their own, those who are too ill to work. Their job is to make sure these people are not having to turn to crime or begging to survive, or quietly starving. I know they really don’t want anyone getting a benefit, but that’s not realistic. Making it difficult to get a benefit, especially one that is as sorely needed as a sickness benefit, is despicable.

WINZ should have better document logging and handling. Losing stuff is so unprofessional that they should hang their heads in shame. Maybe if it happened once or twice, it would be understandable. Once or twice per person? That’s ridiculous. That’s a critical failure in processes.

WINZ need to critically assess what their staff are doing. They simply do not treat people like people. There are some lovely case managers, but the culture of those offices is one of humiliation and degradation. Their goal is not to support people into a job, it’s to shame them into taking whatever is available, no matter how unsuitable it is. Or to shame them just for being people who are down on their luck. Sir Bob Jones would be proud.

Classifying sick people as ‘Jobseekers’ is ridiculous. Many have jobs that they cannot do because they are too ill. They’re not being lazy. They’re sick, damn it! They don’t need to be lumped with those who are genuinely looking for work (or not, depending on the person). There’s a reason that sick people (and sole parents, but there’s a rant for another day) were in a separate category from the unemployed. Their needs are different. And they don’t need the pressure of being told to get ‘work ready’ while they’re doing their best to recover.

WINZ is incompetent, inefficient, and humiliating to their ‘clients’. Those in poverty deserve respect, just like their wealthy countrymen. They’re people, and should be treated as such. They also deserve to be treated professionally, with all the efficiency and competency that involves.

What we have now is unacceptable.

Just a little change of plans

Today I had close to a complete meltdown. There was panic, there were lots of tears, and in general it was messy. What happened? My partner was a couple of hours late back from a trip.

It’s not like I didn’t know about it. He kept me updated the whole time, so I knew what was happening. It’s not like it was his fault. It was well out of his control. It was just an unexpected delay.

When he’s here and someone changes plans without notice or is really late, I feel safe and am free to be angry at them for throwing me off balance. But I discovered today that it’s his support that makes me able to cope with sudden changes of plan. When it was him changing plans I felt like I was drowning.

Is that kind of dependence unhealthy? I’m really not sure either way. It’s good that I have a way to feel safe and cope with what life throws at me. It might be bad that the thing that makes me safe is a person. It’s all very confusing.

Back to school

The kids go back to school tomorrow. I can’t lie, it’s going to be a huge relief. Our holiday plans were messed up by a bout of chicken pox each, which meant that a lot of our activities were replaced with staying home so as to not spread the virus. Too much time cooped up, and they’ve been winding each other up, and tears and screaming got pretty constant in the last five or six days. It’s time for them to go back.

I feel a fair amount of guilt for being so happy about them going back to school. When I mentioned getting sick of the sight of each other after a while, my aunt asserted that she never ever felt that, and that ‘it must just be the kind of mother you are’. It was one of those ‘I think I’m a better parent than you’ moments. I get them a lot, being a teen mother signs you up for that load of horseshit. But it still hurt. What if I am a crap mother for wanting to send my kids to holiday camp and so on instead of having them home for six weeks solid? What if my wanting them to be back at school sooner is a deficiency in my parenting? I don’t know, I don’t think so, but in a way it’s not about how I feel, it’s about how other people see me and treat me.

What Do You Do For A Racing Heart?

Today I got a message from someone who rather upsets me. I try not to have contact with this person, but unfortunately that’s not always possible. It affected my whole day, sent my mood down the toilet, and had me off getting a new phone number.

The first thing that happens when this person (and a few others that upset me in various ways) contacts me is that my heart rate skyrockets. It feels like it’s trying to beat its way out of my chest. And I have no idea what to do about it.

My various mental health people have told me that it’s anxiety that causes this, and that I need to learn how to break the cycle so I can cope. But what I really want to know is how to slow that racing heart. It’s a pretty strong physical reaction to an emotional stimulus, and I honestly have no idea how to stop it. I try to breathe slowly can calmly, I try to distract myself, but it doesn’t seem to matter what I do, that racing heart just will not quit. It takes anywhere from ten minutes to an hour before it goes back to normal.

Even if I deal with stressors like what happened today relatively well, I still find the physical symptoms of my heart racing, coupled with a good dose of shaking, very difficult to cope with. But I honestly have no idea how to deal with it.