Category Archives: Wellness

Oral Health Series Part I: Why Human Services Should Partner with Dental Schools

This post is Part I of a three part series on ORAL HEALTH beginning with discussing, the importance of partnering, collaborating and identifying strategies, interventions, and resources to better engage people living with psychiatric disorders about their oral hygiene.  Part II focuses on, how oral healthcare impacts socialization and Part III its impact on vocational pursuits.

I attended a university colloquium (presentation of a scholarly literature review to faculty, students and the public at large for discussion) presented by Associate Professor, Dr. Vaishali Singhal called, “Oral Implications of Psychiatric Disorders.” Vaishali Singhal, a doctor of dental medicine is currently working on a Ph.D. in Health Sciences with a concentration in Psychiatric Rehabilitation. As a dentist she is keenly interested in developing better partnerships and collaboration between medical and mental health providers. Singhal’s literature review addressed growing concerns about the accessibility of dental care for people living with psychiatric disorders with a focus on persons diagnosed with schizophrenia. Lack of oral healthcare increases negative health risks for physical (i.e., stroke and heart attack) and psychological (i.e., low self-esteem, isolation, depression) distress impacting social and vocational goals. A contributing factor to this lack of oral healthcare is the absence of training for oral healthcare professionals to better engage patients with psychiatric disorders. As a person living with bipolar disorder I know I could have benefitted from focused preventive education on oral hygiene.

I do believe mental health professionals should be interested in collaborating with dental care providers. There is tremendous financial, emotional, and physical increased risk of premature disability and death among the people we serve. Through interdisciplinary collaboration we can help better integrate medical and psychiatric needs to empower individuals like myself to balance their attention in both physical and mental health coupled with all providers strengthening engagement skills. Here is a link: Building Infrastructure and Capacity in State and Territorial Oral Health Programs (April 2000) prepared by: Association of State and Territorial Dental Directors (ASTDD) http://www.astdd.org/docs/Infrastructure.pdf . This is a document to develop ideas from for organizational and systematic approaches.

I believe that it is important that as professionals we seize opportunities for cross training; attending seminars, and workshops outside of our focused area of expertise to collectively help strengthen quality services as an interdisciplinary team. For example, agencies can reach out to local dental schools for consultation, resources, i.e., oral hygiene checklist, psycho-education materials for varied literacy needs. Have oral healthcare listed as an agenda item for team meetings. Consider having both a dental hygienist and nutritionist as guest speakers. Identify i.e. service recipients for some formal oral healthcare training to serve as role models in residential settings. Here is a couple of links from the CDC Home page but not limited to adult and older adult oral hygiene: http://www.cdc.gov/oralhealth/publications/factsheets/adult.htm and http://www.cdc.gov/oralhealth/publications/factsheets/adult_older.htm Furthermore, a link for free and low cost dental care that may be similar in your location. http://www.prnewswire.com/news-releases/free-and-low-cost-dental-care-available-to-underserved-through-delta-dental-of-new-jersey-foundation-grants-197520961.html

Words of Hope: Keynote Address Inspires Many

On April 10, 2013, the Cape May County Employment Consortium, a group of key employment and mental health services stakeholders, hosted its annual Employment Summit at the Elks Club in North Wildwood, NJ. One of our faculty members, George Brice, Jr., Instructor in the Integrated Employment Institute gave a heartfelt, motivational keynote address on the important role that employment has played in his recovery from serious mental illness. Many attendees, who also live with mental illness, were moved and touched by George’s story.  Others have heard George speak in the past and shared with the group that George’s inspiring words motivated and enabled them to move forward in their lives and live beyond the label of mental illness.  George continued throughout the event to speak with individuals personally and to provide encouragement to them in their own recovery journeys.  One attendee was so inspired that she wrote an editorial piece for the Cape May County Herald newspaper about the event and George’s encouraging message.  The link to the article is: http://www.capemaycountyherald.com/article/91593-employment%2Bsummit%2Boffers%2Bhope%2Bdisabled?utm_source=dpcs&utm_medium=email&utm_campaign=sendToFriend.

The day also included presentations from a Social Security Benefits planner as well as local education and employment programs.  Participants provided positive feedback about the event and presenters.  Overall, this year’s Employment Summit was a success and attended by close to 80 individuals, including people with the lived experience of mental illness, providers, and family members.

Is a Driver’s License a Dilemma too?

I was talking to a peer who works 30 plus hours a week by getting up at 4:00AM to be on a train by 5:20AM. The person walks to the train station, takes the train, and then connects to a bus. This is a long day- – but more importantly a rewarding routine of earned income, feelings of social inclusion and more. I can empathize as I didn’t drive for 16 years.  I walked and learned to navigate a bus and train in order to work a part time position. I didn’t have to  get up as early as this peer and I applaud them and others who acknowledge the importance and value of employment in one’s recovery journey.

When speaking to this person I was reminded of a provider’s concerns last year about promoting driver’s licenses for people living with mental health concerns. That well-meaning provider and others are concerned about the potential stress put on people with psychiatric conditions to have an expectation of getting a driver’s license.  As I mentioned, I didn’t drive for 16 years, though I actually had a driver’s license.  I lost confidence in driving becoming both vocationally and socially limited. However, I am glad I continued to renew the license which gave me respected and non-stigmatizing identification. Fondly, I remember a friend who moved to Florida giving me round-trip tickets to visit because I earned my Bachelor’s degree in Social Work. I took airport transportation with my “undisputed” driver’s license for airport security check-in. No need for a state issued “non-driver’s licensed” ID. I have now been driving for 10 years affording me expanded work/career opportunities.

So what do you think about persons living with mental illness getting a driver’s license and managing the responsibilities that come with it like anyone else (drive to help out, an emergency situation, ID., etc.)?

George Brice

When the System Works Against Medication Adherence

Between 2004 and 2005, while serving as the Vice-Chairman (mental health consumer representative) on the New Jersey Governor’s Task Force on Mental Health, I had extreme difficulty seeing a psychiatrist. Ironically, this occurred when the task force was discussing Involuntary Outpatient Commitment (IOC) which is now accepted into New Jersey law even though it was strongly opposed by advocates and psychiatric rehabilitation professionals. I was in my 25th year as a service recipient in the public mental health system. I was working full-time and took the day off to attend the psychiatrist appointment. On my way out of a police academy, where I considered renewing my certification as a volunteer certified police instructor, I checked my voicemail to find a message stating: “Your appointment is cancelled today because the psychiatrist can no longer take your health insurance. You will be rescheduled with another staff psychiatrist.” Despite my paraprofessional status and own inferiority complex I went to the agency anyway. After meeting with a person of “authority” I was given permission to see the psychiatrist and thoughtfully informed I would be billed as if I were uninsured. The psychiatrist had no problem seeing me despite the internal agency bureaucracy and I left with my prescriptions. 

Needless to say, I detailed my experience to the task force. About 3 months later I went to see the new psychiatrist, well not really “new” as I had seen that psychiatrist before, but insurance approved. We know psychiatrists are stretched thin and see a lot of people and unfortunately the quality of service sometimes suffers.Nevertheless; when I tried to meet with the new psychiatrist after handing over my co-pay I was informed the psychiatrist was dealing with a crisis and could not give me a time when the psychiatrist would be available: i.e., 15 minutes, 30 minutes or an hour? The expectation was that I would sit and wait. I refused and asked for the prescription to be called in. The response, “we don’t do that.” I left and the psychiatrist called me. I stepped out of my deemed paraprofessional status and inferiority complex as we bantered over the telephone. The psychiatrist reluctantly conceded and called in my prescriptions.

The stigmatizing drama doesn’t stop there as 3 months later, for my next appointment, the same thing happened.  This time the psychiatrist and agency refused to call in my prescriptions, “they don’t do that” and really meant it.

The agency disregarded my time and whether or not I got my medication. However, they were timely mailing me a termination letter as if I were “non-compliant.” The letter failed to state I showed up for my appointments, I paid my copay, and then was told the psychiatrist was unavailable. Despite being in complete distress I advocated elsewhere for a referral. I was given a public system psychiatrist who I could only see if I would “commit” to see a therapist at the agency (see more on shared decision making here). I hadn’t seen a therapist in 3 years. I now figured I was going to lose my job, my career path and my social standing in the community. I was tired!And not going to beg anymore for medication! I’d end up in a state hospital or criminal justice system because of system’s lacking monitoring and oversight.

Fortunately, I got assistance from a friend who put me in touch with a private psychiatrist who even picked up their own phone. After the initial visit with the private psychiatrist I was asked to come back monthly then every 3 months for over a year. Since 2007 I see the psychiatrist every 6 months. Furthermore, I have met courageous individuals, who despite the organ damaging side effects, have relentlessly “adhered” to medication. After 20 years on a medication, I was taken off, as it would have damaged my kidneys. A different medication now processes through my liver.

I believe medication is only a small, often unflattering complex delivery system, and limited aspect of one’s recovery. My recovery is participating in valued social roles beyond the trial and error and limitations of medication. I welcome you to share your own medication experiences; nameless story of a loved one; and as providers your challenges/barriers and resolution ideas to improve medication services so that the system doesn’t impede consumer social roles such as worker, student, and more.

George Brice

Video

The Light Bulb Moment: How A Career Journey Began

George shares his story of recovery and the important role that work has played in his life. He discusses his struggles to complete college and the feelings of envy as he compared his accomplishments to those around him. As George continued his career journey, these feelings of envy gave way to those of pride and success as he continued to achieve the goals he set for himself. George recalls a time when he was receiving services and a peer came to speak about his own recovery and the valued roles he held in his life. This moving story provided George with the informative nudge needed to return to school and embark on a life of career success. He refers to this moment as the “light bulb going off.” This is a good reminder of the influence we can have on one another.

A Personal Story

As we work to improve opportunities for people with the lived experience of mental illness, we inevitably find ourselves battling misinformation and prejudice. Whether you’re a peer, a consultant, a provider, a family member, or an educator, you have probably found yourself up against people who have very low expectations for people with mental illness. As vigorously as we challenge those beliefs, nothing is more powerful than a personal story. This link is to an article recently in the New York Times written by a law professor who has a diagnosis of schizophrenia. It is well worth the read.

Work, Choice, and Recovery

Some years back, as a provider of supported employment services, it always appeared that work was indeed a choice for the jobseekers I worked with. On many occasions individuals changed their mind about wanting to go back to work for whatever reason. And I was aware that in probably all cases the person was receiving disability benefits from Social Security. In addition, in most cases the person appeared to be in a reasonable state of wellness or “psychiatrically stable” from a clinical perspective. My position was always that work was a critical component of the recovery process, and I’ve seen people transform themselves from the experience of returning to work. Thus, I felt they may have made an ill-advised choice by not pursuing employment as a recovery goal. However, I was also aware that “choice” is one of the principles of Psychiatric Rehabilitation, and at that point I didn’t think much further about this issue.

One thing is clear, I had never thought about this issue of work being a choice in the terms that my colleague George Brice Jr. stated. George is really clear that if one is healthy, able-bodied and in a state of wellness, that one is expected to work as an adult in our society. In addition, he states work should not be a choice! Further, George makes the point that Social Security benefits should be there for people who need them, and if one becomes well enough, one is obligated to get off benefits. Clearly, George is making a powerful point here, and one that is usually not addressed in the community mental health field.

Consequently, after reading George’s recent blog, I was speaking with another colleague who made the observation that she knows many people in recovery who volunteer at self-help centers, and participate in unpaid committees, all of which take up as much time as a full time job. Again, the point was made that these individuals are clearly healthy, able-bodied and in a good state of wellness. This conversation bought to mind some of the literature on self-help centers and their focus on empowerment. However, in my colleagues and my own experiences with self-help centers, there is often little emphasis placed on career development. And I think this point may bring up the issue that, how can the choice not to work, especially if one is not financially well-off, be empowering?

Clearly, the impact on getting on Social Security benefits help to foster an “illness identity.” In addition, the lack of expectation of work from too many community mental health providers also reinforces an illness identity. In addition, there are numerous barriers to employment for persons with disabilities. Nevertheless, I think my colleagues make a cogent point that perhaps even the self-center movement, for which I have great respect, may need to rethink what empowerment is really about? Can one be healthy, able-bodied and in a good state of wellness and not pursuing some career or employment oriented goal, while collecting Social Security benefits and thus living in poverty, and truly be empowered?

As a provider who is strongly influenced by the person-centered philosophy of Carl Rogers, I am surprised I progressed to the point to even write a blog that perhaps can be perceived as highly challenging to persons in recovery. However, from listening to my colleague’s perspectives, I am forced to rethink the meaning of two important concepts in the field, choice and empowerment. And I am reminded by another principle of Psychiatric Rehabilitation that I adhere too as well, that everyone has the capacity to learn and grow, and that includes me!

New Year’s Resolution- Conveying Economic Hope to Persons Served!

As I prepare and plan for our new year, like many of you, I’ve reflected about my own personal and professional needs. In 2013 I will improve my emotional, physical, and spiritual health. Professionally I will increase attentiveness to detail, develop time management and computer skills, scholarly publishing, listen to classical, jazz, nature sounds, and instrumental music to lessen stress while driving to work so I have the energy to better serve others.
During the first week of January I was making a “Work, Education, and Recovery,” presentation to both peers and staff. Insightfully, a person served expressed wanting to be supported holistically; that the staff, clinical team and family view them as a “whole person” in order to be successful at pursuing educational and employment goals. For example, having emotional and medication (side-effects) needs timely addressed and flexible medical appointment hours that support pursuing education and work goals. Furthermore, another person mentioned balancing intake of sugar, caffeine tobacco products, watching TV, and sitting too much. Plus, gaining access to quality foods and making informed food and life choices. I noted, we also need to thoughtfully challenge one another through “peer support” and self-help. The lack of physical health is a challenge and barrier to maximizing one’s skills and talents of gainful employment. In addition, regardless of the economic climate we need to dispell the notion that there are “no jobs” when developing skills and “job searching is not a priority.” Our health and social standing depends on it!

Join the Pledge!
• Work is not a Choice!
• Work is an Expectation!
• Avoid Life Long Poverty!
• When paid work is available I will not volunteer instead!
• If I am going to be unsuccessful let it be during relentless employment/school attempts!
• Employment is healthy risk taking!
• Accept (as needed) supports for work/school!
• I know work/career improves my health!

I welcome your New Year employment thoughts to support individuals living with mental health and addiction concerns.

George Brice

Dismissing the Diagnoses of Unemployment: Our Health & Recovery Depends On It!!!

I often hear that work is a “choice” for people living with mental illness. This view needs to be actively challenged by stakeholders such as clinicians, families/caregivers, organizations, and even by recipients of psychiatric services. Living in poverty is not limited to finances but can negatively impact overall health, self-worth, and feelings of citizenship in valued social roles. As a person living with bipolar disorder I am angered about my own history on social security for 14 years that began at the age of 26. I am currently 50 years old and have been competitively working mostly full-time the past 10 years and living my life “system dependent free” by planning healthy risk taking. Viewing work as an expectation promotes lives of community inclusion (integration).  Employment is our most recognized cultural health tool of “hope and promise” toward wellness and recovery. Here are some common themes I hear:

  1. Lacking access to public transportation
  2. I had to get rid of my car since I’m now at a boarding home
  3. There are no jobs
  4. I need to work part-time to not interrupt “my” social security benefits
  5. Professionals/family/caregivers/peers tell me that work will increase my symptoms
  6. I am volunteering
  7. I’m pressured not to miss day treatment program to look for a job
  8. I need the benefits to pay for medication
  9. I’m satisfied on social security
  10. I don’t have the energy or physical stamina to work

We need to actively challenge these beliefs, values, and the people created system barriers of misinformation, and underused resources perpetuating this fear to support work. Creating social security exit plans and tailored social security benefits to meet specific needs of individuals. For example, living with my parents I did not need emotional stigmatizing social security check. Those monies could have been utilized elsewhere. I will explore these issues further in future posts. Your comments are welcomed!

 

Physical Wellness & Employment: Just Right Together

As a practitioner it is important that we focus on our own physical wellness. Though work is exciting and brings a pay check it can also be stressful, challenging, and difficult to meet the changing demands of our funders and person served. Too often we neglect our own self-care in pursuit of serving others. The following are some suggestions that staff may consider personally and to share with individuals seeking employment:

Be sure to get enough sleep at night:  Sleep is critical for being alert and attentive to support people in their employment efforts. Tending to our sleep hygiene give us energy to meet with employers, do job development and rapid job search.

 Prepare healthy meals:  Healthy meals can go along ways instead of catching fast food on the run.  Bringing healthy lunches and snacks several days a week can remind us about taking needed lunch breaks to refresh the mind and body.

 Relaxation and Stress Management:  Planning weekly distressing activities outside of work whether its, yoga, walking, running, swimming, and or weights are important to balance job tasks and responsibilities.  When I have not balanced physical health needs my work performance suffers, I’m easily frustrated, and I do not enjoy my work; unless, I am demonstrating self-care practices. 

 Role model:  As I actively participate in self-care practices I feel much better about the good work I’m doing including meeting the demands of the people I serve and supervisor. Many of these self-care practices are important to share with the people we are helping to get a job.  As a practitioner we are role modeling self-care practices to help people we support.  An additional benefit is that we may also feel better about the work we are doing and feel physically well.

I welcome you to share the self-care practices you are using for your own physical wellness.