By Shelly Missall
Outreach Coordinator, Wisconsin Lifeline

When someone experiences a mental health crisis, it means they are facing the lowest of lows as well as a significant loss of control. This loss of control has the potential to escalate into self-harm, harm of others, suicidal ideation and even suicide attempts.

The struggles of someone experiencing a mental health crisis often do not immediately diminish when the person reaches out for or gets help. They may not be believed or understood. The person in crisis may also experience an even greater loss of control through things such as restraints and isolation, hospitalization, or even jail time. When the mental health crisis is resolved and the person can return to his or her life, you might expect the worst to be over. Unfortunately, that isn’t necessarily the case – but there are ways that we, as a community, can help make that transition easier.

Upon completion of a stay in jail or inpatient treatment, the person who was in crisis will often return to a significant amount of uncertainty. It may mean returning to a life built on secrecy and isolation due to the stigma of mental illness. It could also mean greater uncertainty and isolation from the loss of a job, home, or personal relationships because of their crises.

Mental illness is often referred to as not being a “casserole” disease. If someone you know and care about has a cancer diagnosis, you would tend to rally around the person. You might show your support by wearing colored ribbons or bringing a casserole to help the family out. Likewise, if someone you know or care about reveals a recent diagnosis of diabetes or Crohn’s disease or arthritis, you might inquire what that means for them and maybe even ask how you can help. In the case of a mental health diagnosis, however, these same supportive efforts are rarely offered.

For many of us, mental health triggers uncertainty and discomfort. We aren’t sure what to say or do. We don’t know what might offend or trigger a person, so we avoid. We give the person space and assume that if there is something we can do, that person will reach out and let us know.

Unfortunately, it is because of this same uncertainty, coupled with experiences of stigma, judgement and avoidance, that a person who recently experienced a mental health crisis likely won’t feel safe in making that contact. Worse yet, this time of uncertainty after returning from in-patient care is the most tenuous. According to the National Suicide Prevention Lifeline (NSPL), the risk of suicide is greatest in the first week after in-patient care.

Although, the NSPL notes that 70% of those who attempt suicide do not attend their first appointment or rarely make it past the first or second session, evidence also shows that follow-up contacts have a drastic impact on reducing suicide in the next three months and create a reduction in suicide likelihood reaching five years beyond.

While crisis centers and outpatient facilities can offer a variety of life-saving follow up, the key to unlocking mental health is community integration. Connecting people to their communities, reducing isolation and stigma can better support those who need it now, while reducing the negative stigma and isolation in the future.

This doesn’t mean you need to bring someone discharged from in-patient following a mental health crisis a casserole, but breaking the cycle of silence and avoidance can create significant impact. The next time you hear of a friend, family member, or co-worker who is struggling with their mental health, try reaching out to let them know you care and you’re here to listen. This can go a long way toward helping create a feeling of belonging in a person’s support network and community. Checking in can be as simple as a text, note or a phone call. It is less about how you connect than making the effort that you do connect to offer your support.

When the person does decide to open up, it is important to be patient, show respect and avoid judgement. Offer your support without delegitimizing their experience. Share with them that while you cannot relate specifically to their illness or situation, you do know what it is like to struggle.

Listening with empathy can help minimize the feelings of fear and uncertainty and move toward a community of acceptance for everyone. Together, we can help reduce the stigma of mental health crises and ease the transition from crisis to healing for those who struggle.

Sources:

Appleby, L., Shaw, J., Amos, T., McDonnell, R., Harris, C., McCann, K., Kiernan, K., Davies, S., Bickley, H., & Parsons, R. (1999) Suicide within 12 months of contact with mental health services: national clinical survey. BMJ, 318(7193), 1235-1239. https://doi.org/10.1136/bmj.318.7193.1235

National Association on Mental Illness (2020, August 21). Practice guidelines: Follow-up. https://networkresourcecenter.org/display/practiceguide/Follow-Up

National Suicide Prevention Lifeline (2020, August 21). Follow-up matters. https://followupmatters.suicidepreventionlifeline.org/follow-up-starts-here/

“The Only Thing That Is Constant Is Change -” ― Heraclitus

By Erin Neilan, LCSW
Clinical Supervisor
Wisconsin Lifeline 

2020 has been a year of lows, and even lower lows. There is a global pandemic. The United States is amid a social justice crisis. Unemployment is skyrocketing, and everyone is faced with the difficult decision of what is the safest way for them to live their lives as normally as possible. One is routinely faced with the question “what IS normal now?”

Everyone knows change is something which is inevitable. The uncertainty of it can cause many of us to do our best to avoid it. Why? Because it is uncomfortable. It is different. It takes us out of our routines, and it can disrupt our lives. Even good change, like a promotion, marriage or buying a house can create a new level of stress and anxiety. These things, although positive, shift our routines. Our version of “normal” changes. However, we are often able to adapt. Typically there is a period of readjustment, but we do in fact, adjust.

Change means unknowns. It requires us to face the reality that we are not in control. Change is often the catalyst for us to confront the things within ourselves we would prefer to avoid when things are the status quo. COVID-19 has disrupted our status quo. Our worlds have been turned upside down.

In April of this year, the Journal of the American Medical Association wrote that economic stress, social isolation, reduced access to religious services and overall national anxiety increased both firearm sales and healthcare worker suicides. The number of Americans reporting increased symptoms of anxiety and depression, according to the Centers for Disease Control, has tripled since this time last year. The CDC also reports that 11% of adults surveyed in the last 30 days have had thoughts of suicide.

Job loss, economic insecurity and worries of losing housing due to eviction are thoughts millions of Americans experience daily. Monumental changes that threaten being able to maintain our basic needs is not the form of change many can just “roll with.” For many, positive affirmations, motivational statements, and reassurance that everything will be okay, simply isn’t enough. There are too many people who simply do not want to wake up in the morning.

It is crucial to recognize the individual trauma and the collective trauma we have all experienced since the pandemic began. Communicating our experiences honestly, validating others’ experiences, and acknowledging the grief that has come with COVID-19, is now our normal; and it is critical we talk about it!

Most people are not comfortable opening up about their feelings. It isn’t something that comes naturally for many. Being vulnerable with another person can be scary. However, talking, processing through thoughts and feelings and having another human validate us and be present for us, is how we can heal. It is how we can survive this incredibly difficult time in our lives.

If you or someone you care about is experiencing feelings of anxiety, fear or depression related to COVID-19, there are resources available.

Wisconsin 2-1-1 has launched a hotline specifically designated for anyone struggling with the effects of COVID-19. There are trained counselors available 24 hours a day, 7 days a week, who can talk and provide resources for anyone seeking assistance. Brown County residents can also call the Crisis Center of Family Services at (920) 436-8888 to talk to a trained crisis counselor. In some situations, a crisis counselor may be able to come to you.

Yes, change is constant. But we are experiencing changes that are truly out of the ordinary. It is important to know we are collectively grieving as a country. Although we are physically distanced, we do not have to handle the emotional consequences of this pandemic on our own.

Andrea Peltier, LCSW
Day Treatment

Parents often feel alone and not good enough with the tough jobs they have to do. Whether it is coping with the challenging times we are currently facing or dealing with past trauma, abuse, neglect, divorce, loss, or other hardships. Children and teens can also face significant struggles in their lives and sometimes have extreme difficulty coping with them. Just like adults, they may begin to suffer from mental health problems. These problems can begin to emerge even from a young age.

When a child is younger, their behaviors may seem more manageable. But as they age, things may become more out of control or difficult to manage. Their emotions and behaviors may begin to have a negative impact on their relationships with family and friends. They might have trouble functioning within the community or at school. Eventually, the issues they are struggling with may begin to affect their ability to gain independence and hold a job or participate in other social activities.

While child mental health treatment and counseling is becoming more accessible, it is still difficult for parents, caregivers, and teachers to know when to take the first steps and where to go for help. It is often helpful to hear some concrete ways to know whether your child or teen’s moods or behaviors could be more serious and are cause to get outside support.

Below are five examples and explanations that will help you know the difference between typical concerns and symptoms of a real mental health problem.

If your child becomes upset when things don’t go their way, cries easily, regularly gets down on themselves, displays negative thought patterns, or blames others for their problems you may worry that your child is depressed. These characteristics not accompanied by any other serious trauma and for a child under 10 are typically normal at times. However, if your child cries every day and they can’t resume back to typical functioning afterwards, this may be more of a concern.

If in addition to a sad or depressed mood your child is also irritable more often than not, is overeating or has no appetite, or if they have insomnia or are over sleeping — this may be a sign of a more significant issue. If your child also displays low to no energy, has difficulty concentrating or with making decisions, and expresses feelings of hopelessness, your child may be suffering from depression.

Some other things to watch for are more significant behavior change, such as: lack of interest in things they used to enjoy, isolation, and lack of interest in playing with friends or socializing as they once did and especially talk of wanting to be dead or threats of killing themselves. If your child has only had these symptoms within the context of the loss of a loved one, they may only need help working through the grieving process. Loss of a loved one does not only occur when someone dies but may occur as a result of a move, loss of a pet, or while parents are going through a separation or divorce. If the symptoms above have gradually increased over time or are causing your child behavioral changes, withdrawal and talk of suicide, you must take it seriously and seek out help immediately.

If your child argues with you, talks back, is often snippy and doesn’t always listen to you, try and take comfort in knowing that these are normal kid behaviors. Children are constantly testing our limits to see what they can get away with. However, if your child’s outbursts are extreme overreactions for the situation, or turn into physical aggression or destruction of property after the age of 7, you may need to seek additional help. If these verbal or physical outbursts occur more days than not and have persisted for one year, this may be a sign of a more serious problem.

If your child only displays these behaviors at home and never anywhere else, you may benefit from seeking support for yourself and considering new or different strategies for discipline, rewards, incentives, etc. All children are different and what works for one child, doesn’t necessarily work for another. Parents should also remember the importance of taking care of their own mental well-being and stress levels. This will serve as a health model for your child. You’ll also have more energy and creative solutions to deal with your child’s most challenging of behaviors.

If your child becomes stressed before returning back to school in the fall, before a sleepover or a test, or when meeting someone new, your child is likely experiencing normal worry and anxiety. These are emotions that we all experience throughout life. But if your child’s regular daily functioning is impacted negatively by their worrying more days than not throughout a week, this may be cause for more concern.

If a child is having difficulty sleeping, seems on-edge, is tense or uneasy and becoming irritable more often, they may be dealing with more serious anxious symptoms. With that, therapy has proven to be very effective in helping children deal with anxiety. This intense worry would usually be present for more than six months and not within the context of a recent traumatic experience or loss.

Many parents and caregivers have concerns about a child’s arguing and defiance. It would be so much easier if their child would respond when called upon and do what is asked of them, without getting into an argument and yelling for 10 minutes over a simple task. Unfortunately, not listening is often a typical part of a child’s natural development.

Consider yourself lucky if your child rarely argues and usually listens! There is a difference, though, if your child’s argument or defiance also includes being vindictive, spiteful, and blaming of others regularly. A negative, irritable mood usually also accompanies these behaviors. Additionally, this would typically not be present until 5 years of age or older.

Keep in mind that at times children who are depressed may present with irritability as well. However, they may not necessarily present with aggression or to these extremes. It isn’t uncommon that the symptoms only present at home, however, would be considered more severe if they are displayed in other settings, such as daycare, school, or in social or job settings.

If your child seems to not hear you when you are talking, your child is not alone. However, not listening or responding back to you sometimes does not mean that your child has Attention Deficit Hyperactivity Disorder, or ADHD. It likely means that your child is engaged in an activity and is sort of tuned out while in the activity. Be open with your child that you expect them to at least acknowledge you and how soon you expect them to do what is asked. Parents and caregivers should also keep in mind that kids don’t have the same priorities or timeline as adults, so picking up those dirty socks may not be as high on their priority list as it may be on yours.

However, if a child displays inattentive, hyperactive and impulsive symptoms prior to the age of 12 years old and these symptoms have persisted for more than 6 months, your child may be dealing with ADHD. If your child’s lack of listening, problems with organization, and/or hyperactivity, and/or impulsivity is negatively impacting their functioning at home and their grades in school, they may have characteristics of ADHD. If your child often makes careless mistakes with work, lacks attention to details, has difficulty with sustained attention to tasks, or seems to be bouncing off the walls more often than not, your child may be struggling with more severe symptoms that need attention.

When and Where to Get Help

There are several factors to consider when determining whether a child or adolescent is truly suffering from a mental health disorder. Some of these factors are: age, culture, gender, history, trauma, genetics, and even societal influences. Many people have faced challenges with mental illness for many years and were unaware of what was happening to them. Many have felt alone, embarrassed or in disbelief that counseling or other outside interventions would help. Some are nervous to talk about their struggles, while others are concerned about the financial implications.

There is good news, though! Whether you or your child have ever received an actual mental health diagnosis or not, you can always seek out counseling. Therapists get into the field because they care about people and they have significant empathy for the challenging situations that occur in life. They are specifically available to give anyone an outlet to cope, talk, heal and process difficult times that have caused increased stress. Many insurance companies have eased restrictions and are allowing much better coverage for counseling services. With that, much of the stigma surrounding mental health is also decreasing, especially surrounding the Covid-19 pandemic. Individuals, businesses and insurance companies alike are recognizing the toll that these difficult times are taking on us all.

It is important for parents to allow their child to tell them how they feel and do their best to empathize with them, even if they don’t feel the same way. The more that a parent can provide their child a listening ear without criticizing, the more likely their child will open up about what feelings they may be experiencing. If you are concerned that your child’s symptoms may be more severe, let your child know you are worried about them and want to do what you can to help them, because the situations that have been occurring seem to be unpleasant for the child but also for you and others around.

Resources Through Family Services

In Brown County the Crisis Center is available 24/7 to help support you and your child in a time of crisis and you can reach them at (920) 436-8888. There are other crisis lines available throughout the state and in your own local counties. The National Suicide Prevention Lifeline is also always available at 1-800-273-8255 or text HOME to 741741.

Family Services’ Counseling Clinic is always available and has immediate openings for therapy. Call (920) 436-6800 to schedule an appointment with a therapist.

If you have already had your child in counseling but intense disruption still continues, Family Services’ Day Treatment may be the right next step for your child. Call us at (920) 433-3372 ext. 100 for more information or to enroll.