Suicide Among LGBT People: Review and Recommendations

There is a long report in the most recent Journal of Homosexuality on suicide, suicidal behavior and suicidal ideation among lesbian, gay, bisexual and trans people. The report starts by defining the sexual orientation and gender identity minorities described in thsi paper. The authors are aware that gender identity and sexual orientation both run on a fluid continuum, and that hence LGBT is not the right term. However, they use it anyway because it is used overall in the research community. That makes me wonder whether no-one wants to change the terminology used in research papers to more accurately reflect the reality of sexual orientation and gender identity minorities.

The authors follow by examining the rate of suicide, suicide attempts and suicidal ideation among LGB people. It is thought that gay and bisexual males are more likely to commit suicide or to attempt suicide than heterosexual males, whereas lesbian and bisexual females are more likely to have suicidal ideation than straight women do. The fact that gay or bisexual men are more likely to attempt suicide, contrasts with findings in the genral population, where women are more likely to attempt suicide. As for age at suicide attempt, this varies across studies. Some studies say that adolescents are most likely to attempt suicide, while others report that suicide attempts are more evenly distributed over the lifespan. A potential explanation may be that suicide attempts are more linked to the age at which LGB people start to identify and disclose their sexual orientation than to chronological age.

Mental illness is one of the most significant risk factors for suicide attempts in the general population. Indeed, LGB people, particularly adolescents and bisexual men, are more likely to have a mental disorder than straight people. This, however, does not explain fully why LGB people are more likely to attempt suicide: when controlling for mental disorders, one study found that LGB people were still two to three times more likely to attempt suicide than straight people.

Another risk factor for suicde attempts and mental disorders is discrimination. Several studies found a relationship between parental rejection and school bullying or violence because of sexual orientation and suicide attempts among LGB adolescents. IN LGB adults, experiences with discrimination and harrassment were also correlated to suicde attempt. There was, however, an interesting racial disparity between Whites on the one hand and Latinos and Blacks on the other, where White LGB people were more likely to have mental disorders, while Black and especially Latino people were more likely to attempt suicide. The explanation for this might be that Latino/Black people are more likely to attempt suicide because of social stressors rather than mental illness.

Instituttional discrimination is also a factor in the increased rate of mental illness among LGB people. In states which do not provide protections from discrimination based on sexual orientation or that have constitutional amendments prohibiting gay marriage, there are elevated rates of mental disorders as compared to those in states with more equality. Poor health insurance, for example due to the lack of coverage for same-sex partners, may also lead to elevated rates of untreated mental illness.

Lastly, HIV/AIDS is also a possible risk factor for suicde attempts, but data on this are inconclusive. It is suggested that substance abuse and other mental disorders may be more relevant predictors of suicide attempt among HIV-positive men than is the virus itself. However, rates of suicide attempts among HIV-positive persons have decreased since there are better antiretroviral treatments available.

There are several protective factors against suicide among LGB people. Among adolescents, family connectedness, support from other adults, and school safety protect against suicide attempts. In adults, connections to an LGB community help. It is also suggested that intimate relationships protect against suicide attempts, but that has not been studied.

The authors go on to discuss suicide risk among transgendered people. One study reports an alarming 80-fold increase in suicide deaths among trans individuals as compared to the general popluation. Another study found that trans people were more likely than any comparison group – heterosexuals, gay and lesbian people, and cis people matched on age, relationship status and several other variables -, except for lesbian females, to attempt suicide. Several risk factors are being reported among trans people for suicde attempts, among them mental disorders and discrimination, particularly rejection by parents in adolescence and on-the-job discriminination and harrassment in adults.

The researchers make many recommendations to improve mental health services, suicide prevention services, and public policies relevant to LGBT individuals. With regard to mental health programs, they encourage furthering of LGBT-specific programs and interventions in mental health and substance abuse services. There areseveral guides to LGBT care, but none provide specific guidelines on suicide prvention. It is recommended, lastly, that DSM-V be revised to make it clear that sexual and gender identity minorities are not per se mentally ill.

There are very few suicide prevention programsspecifically for LGBT people. The only one mentioned in this study is the Trevor Project. It is recommended that interventions, education and awareness related to suicide among LGBT people be increased.

Lastly, several public policy changes are recommended. It is recommended that LGBT groups and allies advocate for:

• Better access to health and mental health services through non-discriminiation policies;
  
• Explicit protection against school violence and bullying based on sexual orientation or gender identity;
  
• Improvements in discriminatory legislation related to factors contributing to suicde or mental health problems;
  
• Inclusion of sexual orientation and gender identity questions on surveys relevant to health and mental health.
  

The authors conclude that, although many questions related to suicide among LGBT populations are as yet unanswered, there appears to be little doubt that a broad national effort will be needed to encourage and fund the needed research, raise awareness of the problem among LGBT and suicide prevention leaders, and develop
the interventions, prevention strategies, and policy changes through which suicidal behavior and suicide risk in LGBT populations can be reduced./P>

Reference

Haas AP, Eliason M, Mays VM, Mathy RM, Cochran SD, D’Augelli AR, Silverman MM, Fisher PW, Hughes T, Rosario M, Russell ST, Malley E, Reed J, Litts DA, Haller E, Sell RL, Remafedi G, Bradford J, Beautrais AL, Brown GK, Diamond GM, Friedman MS, Garofalo R, Turner MS, Hollibaugh A, Clayton PJ (2011), Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations. Journal of Homosexuality, 58(1):10-51. DOI: 10.1080/00918369.2011.534038.

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Mentally Ill Jailed, Not Treated

I just came across an interesting article on the situation for prison inmates with mental illness in forth Wayne, IN. According to a study* cited in the article, people with severe mental illness are three times more likely to end up in jail rather than hospital, while of course a jail cannot provide appropriate treatment. It was not clear to me whether the reason people end up in jail is related to poor preventive care, leading ot increased crimes, or whether people end up in prisons without having committed a crime – a situation which used to be the case for juveniles in the Netherlands.

However, whether or not inmates have committed crimes, and which or how many, is irrelevant to the fact that people with serious mental illness need and deserve appropriate treatment. Prescription medications can be accessed, but a psychiatrist and counselor visit the Allen County jail discussed in this article only once a week, for quite a large number of inmates with severe problems. This is not enough to provide quality mental health services, which every inmate should have a right to.

There are a few improvements being made, including the introduction of a crisis intervention team, which has the authority to take people to a hospital instead of jail. Most people assessed by this team, were taken to a mental hospital, hence preventing unnecessary incarceration in prisons. Of course, it is assumed here that inpatient treatment is needed at all, which may not be the case.

As the article says, a Mental Health Court was not established in or near Fort Wayne. A Mental Health Court is a courr where people convicted of misdemeanor crimes can have their cases handled voluntarily to determine treatment as an alternative to punitive sentences. This treatment would, of course, be court-ordered. The advantage of such a court is that people with mental illness are more likely to get the care they need rather than being jailed and released back onto the streets to potentially commit more crime, without any mental health services. Mental Health Courts are pretty widespread in the United States, and seem to be quite a success. Since we do not have them in the Netherlands – treatment orders are made by regular criminal judges -, I am not totally sure whether they are necessary as an adjuvant to regular criminal justice, as is indeed questioned in the article.

The take home message from this article, however, is that people with mental illness, including prison inmates, deserve appropriate treatmetn. How this is achieved, may be up for debate, but it is in the best interest of the individual and, ultimately, the public, if mentally ill people are provided with mental health services rather than pure inprisonmnent.

* This study was funded in part by the Treatment Advocacy Center, which is a proponent of involuntary outpatient commitment laws countrywide in teh United States. I am a strong supporter of patient autonomy, and hence do not advocate involuntary treatment. This does create some problems with regard to criminal justice, which I was unable to get into in this post.

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Psychiatric Deinstitutionalization and the Premise of Cost-Effectiveness

A few days ago, the author of Lunatic Fringe commented on the closure of Pennsylvania state hospitals as a positive thing. On the same day, however, Crazy Mermaid commented on the shortage of psychiatric hospital beds as something negative. These are two rather opposite views on the very same issue: should we be keeping or even building new psychiatric units for people with mental illness, or closing them down and sending former patients into the community?

First, let me be clear on this: I am all for deinstitutionalization. In this sense, I support the closure of state hospitals, where long-term patients are usually warehoused without any prospect of ever going back into the community. The solution to the homeless population is not to cover them away into psychiatric institutiotns far away from civilization. That might solve the “problem” for the general public, who no longer have to see homeless people on the streets, but it does not solve the problem for the homeless themselves: while they may now have shelter, their quality of life is likely not going to be all that good when warehoused in a state institution.

Unfortunately, the presumption behind deinstitutionalization, which I see popping up time and time again, is the exact reason it doesn’t work: it is supposed to be cheap. Long-term psychiatric patients are suddenly, through some shift in philosophical or political thinking from people who don’t have mental illness themselves, seen as oh so capable of living and working in the community. Go close the state hospitals and discharge the people into “normalized” society. Guess how cost-effective it is to provide them with community-based services? Wow, saving money, that’s great!

I see the so-called success rates over at Lunatic Fringe, but since there are no statistics, I have no clue what a “vast majority” is. Even if I had statistics, these would not really say much to me, because they don’t communicate the lives of real people in real communities. We do not know what success means. Does it mean the people have a good quality of life, or does it mean they are hanging on just enough so that the crisis team won’t have to take them seriously, like I was when I still lived at home? We do not know, but I will bet that there are a number of people who fall into the latter category. And then there are the people who do not fall into the “vast majority” of success stories. What happened to them? Have they found a warehouse bed in another state institution that didn’t close? What about the people who weren’t discharged upon the institution’s closure?

The presumption of cost-effective community care sets an artrificial barrier for people to live in the community: only those who are deemed to be cheap enough, are being deinstitutionalized, and if those who aren’t cheap enough, are being discharged, too, the risk is high that they will have as miserable lives as they had when living in the institution. These people, who cannot hold on to the standards of the rcovery model, apparently don’t matter.

I have said this a million times in reference to people with developmental disabilities already, and the same goes for people with mental illness: people need appropriate care in a place they want to live in. Deinstitutionalization is great, but it is only great when appropriate, individualized community supports are in place. These supports should not just cater to the crazies who really can have a job but no-one bothered to see, but also to those who can’t. Warehousing isn’t good for anyone, but we shouldn’t have to prove how cheap it is to release us in order to be allowed to live in the community.

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Too Low-Functioning for Mental Health

I am reminded by a post over at Spliit, that somehow links higher functioning in daily life to invisibility to the mental health system, to write about the functioning that is required to access healthcare in the first place. Of course, you may say that my own experiences are irrelevant to borderlines (I couldn’t access community mental health at first because I couldn’t communicate my needs, which is probably an autism thing), but I have seen some ways in which the healthcare system has set barriers for some people with BPD who do not have the skills to function in daily life, too. Here are just a few reasons why the mental health system may actually be inaccessible to people who have more difficulty coping in daily life. They are not meant to be exclusive to borderlines; even though I derived some points from the Spliit post, people with other conditions may face the exdact same problems. (By the way, I use the terms “high-functioning” and “low-functioning”, but I am not implying that there is a hard, black-and-white line between these or that people cannot function at different levels in different aspects of daily life.)

• People who are severely ill, may know that something is wrong, but not know what, or their illness may prevent them from knowing they have a problem. Randi Kreger, quoted in the post, connects denial to higher functioning, but I’ve also met people on my former ward whose denial (and blaming of family members or other relatives) was related to very low functioning in daily life.
• Community mental health providers usually expect clients to be able to ask for help in the specific areas they have trouble with. For this, the person has to be aware what their main complaints are and be able to communicate this to a mental health professional. Even acute inpatient placements may expect a patient to know what they need from the staff if they are not to be sent off as soon as their medical needs (eg. damage from self-harm) have been dealt with.
• Quite a large number of mental healthcare providers refuse to treat patients with severe acting out behaviors, such as aggression. This goes for group therapies like DBT (at least, what I’ve heard from the bordelrines I know), but even for some individual treatments.
• People who are unable to see a crisis coming, may not seek treatment except when they have already harmed themselves or others. Because at this point there is little use in therapy, people may be unable to access preventive therapies. But even if they are, they may be too unstable to be able to follow the therapy program, and/or the therapist may give up on them because they don’t make enough progress.
• Certain comorbid disorders, such as substance abuse, cause therapists not to want to treat people. It is a good thing that the number of dual diagnosis clinics is growing in the Netherlands, but there are still long waiting lists and these wards may require a certain level of mental stability.
• People who mostly act in may remain invisible to mental health providers, because they are ashamed of their self-harm, don’t know that it isn’t “just normal for someone my age” (pretty much every young female self-harms if we have to believe the media), or don’t know how to discuss this issue with a primary care provider, who must (in the Netherlands) write a referral to mental health. In this respect, people who mostly act out, may be more visible to mental health providers, because this behavior affects others (but of course in this sense the issue of shame applies, too).

These are just the things I can think of now. There are probably other barriers. Of course, if a person functions at an extremely low level and is an immediate danger to themselves or others, they may end up in the ER, but ending up in the ER is no guarantee that you will be able to access mental healthcare.

Of course, I am not saying that there are no barriers to mental health services for those who function better in daily life. As the post says, people who function relatively well at work or in social life, may have the ability to deny or mask their illness and avoid treatment. Since mental health providers don’t usually step in without the patient’s own explicit request unless the patient is a serious threat to themselves or others, family members cannot easily steer these people towards services. And even if they can, mental health professionals might turn the patients down because they make the professional believe that nothing is wrong. These are major concerns for families, too, so I’m not meaning to minimalize these. What I meant to write about, is that sometimes you may be too low-functioning to be able to access mental health.

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No Psychiatric Care in Juvenile Prison

John M. Grohol of World of Psychology comments on the lack of mental health services for juvenile prisoners. Juvenile criminals, of which a great number have one or more mental illnesses and/or substance abuse and are on psychotropic drugs, receive few or no mental health care. It didn’t surprise me, however sad this is. In the Netherlands, this has been known for years: even though most inmates in the juvenile system have mental disorders, there is only one juvenile prison employing a child psychiatrist, part time. Staff, rather than being trained to work with children with serious problems, come from all walks of life and all types of education or the lack thereof. To make matters worse, here, there are about 1,000 children nationwide in prisons who don’t even have a criminal record, but merely have serious behavioral or psychiatric disorders and no place in child psychiatry. This will be illegal from 2010 on, but I don’t think there will be enough child mental hospitals by then to help all of them. I’m pretty sure that in this economic crisis, the government has other priorities.

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The Complex Matter of Lying and Mental States

Joe Kraynak of Bipolar Beat asks: Have you ever lied to your doctor? The answer, however, is not as simple as it may seem.

Joe Kraynak assumes that some people in a depressive episode might not tell their doctor that they were at one point manic, in order to avoid the bipolar diagnosis. This may be a reason for misdiagnosis and inappropriate antidepressant treatment. However, what he fails to acknowledge is the possibility that some people don’t intend to lie about their former state at all. I was myself never diagnosed with any mood disorder, but have been in a number of situations in which I might be accused of “lying” about my mental state without intending to.

One of them occurred during my crisis in 2007. During that time, I have repeatedly asserted that I’d really never felt less overloaded than I was at that time. The reason for this “lie” is that, when I am in an extremely overwhelmed state, I cannot imagine ever having been in any other state, or will distort this idea in my mind to something more black-and-white. Because at that time the possibility that I was depressed was repeatedly considered – incorrectly so -, it may well be thought that I lied in order to influence the diagnostic process. I didn’t.

Another thing, also related to a non-existent depressive state of mine, is the incorrect pathologization of distressing but understandable states. My most recent “depression exam” occurred in December of 2008, after I had been in a terrible meltdown, including black-and-white assertions about my mental state. In a sense, I think I should’ve gotten a Noble prize for survivorship for *not* having been depressed, after a year on the locked ward, with little perspective on moving on. However, the staff did not recognize this, and sent the doctor to me to ask me the standard depression-screening questions (I am pretty sure the whole thing wasn’t really meant seriously by that particular nurse). I answered them, truthfully so to the best of my understanding – another complicating factor is that I find it hard to deal with open-ended medical questions -, and did explicitly mention having other negative thoughts besides the ones directly concerning my living situation. Of course, just because thoughts are not *about* the patient’s known stressors, doesn’t mean their occurrence is not influenced by these stressors: I at the time obsessed over the possibility of dying before the end of 2008, and by December felt bad that it was unlikely to occur, but of course these thoughts might not have been so dominant if I’d been in a living situation where I found life worth living, or knew that I would be going into one relatively soon. The bottom line was that the doctor said he wasn’t sure what to think – I had some symptoms, but wasn’t clearly depressed – and this whole event was never talked about again. It is possible that, again, the doctor believes I wanted him to think I was depressed. I didn’t: I knew I wasn’t in a depressive episode, but distressed I surely was, and significantly so. Who wouldn’t be, in my situation? I didn’t even find it necessary to speak to the doctor, but now that the nurses did find it necessary, I answered his questions, within his frame of reference, which is, of course, the DSM-IV. Of course the truth is that a medical doctor was not the right person to consult on my issues at all, but he happened to be the only one available. Besides, if I had asked this doctor, who had only worked at our ward for two weeks, where I should go with this problem, knowing that it didn’t fall within his expertise, he likely would’ve had no clue.

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Once You Got Into the System, You Never Get Out

Last November when my parents attended a meeting with my doctor, they said that once you enter the care world, and especially the psychiatric care world, you never get out. At the time, the doctor then in charge of my care, didn’t seem like he was of that opinion, and, in fact, was pretty much convinced that there was no reason why I should be in the psychiatric system apart from the fact that I’d made a suicidal threat two weeks before. Now, things are completely different. Why?

I think very few psychiatric wards, especially admission wards like mine, actually plan on keeping their patients long-term. This goes especially for acute patients like me. When you come in for crisis intervention, like I did, you’re supposed to stabilize and then leave. Stabilization is supposed to take a relatively short time. It is not as extreme as I thought it was, when I was frustrated cause, after seven weeks, I was still unstable, but people cannot take many months to stabilize.

I know quite a few patients who didn’t plan on moving into the psychiatric system long-term, but who ended up on more “chronic” wards because they stabilized so slowly that, apparently, they weren’t considered to be among the “acute” population anymore. This is all the more likely if structural stability requires a change in living arrangements. I am not sure why this is, but I assume that both the waiting lists and possibly not conforming to the new setting’s demands regarding mental stability, contribute to why several patients moved to longer-term wards while planning on moving to supported housing. In this sense, it’d help to have waiting lists for the longer-term wards themselves, as goes for the long-term living wards for adults here in Nijmegen, but, unfortunately for some senior patients, not for the senior wards.

I want to elaborate on that “not acute enough” predicate a little further. All patients I’ve so far met who’ve been transferred to longer-term wards, did not display the symptoms they were committed with, upon their transfer. Hence, it is not an issue of not getting out of their crises soon enough. However, this group generally does not consist of patients who are completely fine when they’ve stabilized, because of a number of social and psychiatric reasons.

In my own case, from the beginning of my stay here on, it’s been pretty clear that I couldn’t move back home, because returning home would be a recipe for another crisis pretty quickly. Now that I’ve stabilized, I’d likely be able to hold on for a while, but not for many months. Hence, it was already relatively clear that I’d stay on this ward for quite a while, just to bridge the waiting list for supported living. Now that I’m more stable, I in fact am willing to consider moving back home temporarily, if it’s clear where I’ll move from there and when – as to not make my hospital stay unnecessarily long.

But there is something else, that makes me much more worried about never getting out of the system. This involves the fact that, once I did not have suicidal thoughts anymore, I didn’t stop having meltdowns. This was not surprising to me, but it was to everyone else – who all chalked it up to unclarity about my future living situation. Hence, once the professionals realized that I’d pretty much stabilized – and once the psychologist who diagnosed me, had informed them that meltdowns are a chronic concern for me -, they swung all the way to the other end of the pendulum and decided I needed longer-term treatment “for my autism” and “didn’t I want to unlearn the meltdowns?” I am not sure if this was explicitly discussed at the “big meeting”, as the autism professionals meeting is commonly referred to, and Gerda denied having come up with her “you can’t do this if you want to be in society” logic, but one thing I do realize, is, in order to get out of the psych system, you have to be much better than you were before you got in.

Like, I came in with serious suicidal thoughts – after the crisis intervention team refused to commit me several times after a very bad meltdown. Well, I’m not suicidal anymore, so can I leave? No, I can’t, as I have meltdowns – that are far less severe than the ones I used to have before I came here. For meltdowns worse than my current ones – not as bad as the ones I experience while home though -, I could be in out-patient treatment in Apeldoorn. Now I’m in-patient (not committed because of the meltdowns!) and it’s said that I need to go to a longer-term psychiatric ward (the one in Deventer), and the meltdowns are the most convincing reason for that. So, I’m not allowed to get out of the psychiatric system, for a reason that I couldn’t get into it for a few months ago. This is a very good recipe to start a vicious cycle, always claiming that if the professionals had known you were this bad, you’d not lived in society for all of these years. It has to end somewhere, if I don’t want to spend the rest of my life in institutions – and I don’t want this.

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Autism Evaluation Done All Over Again: Do I Care?

Last Thursday, I had my first appointment at mental health Nijmegen – well, after the get-to-know-you last July. My diagnosis is being done all over again, because the doctor who formerly diagnosed me as autistic, threw out the original testing material and she did not write down why she diagnosed me with an ASD, so the psychologist can’t tell what my diagnosis was based on. This means I’d need to fill out a questionnaire and have a structured interview done, and my parents will need to fill out almost the same developmental questionnaire they got back in February. But psychiatry and clinical psychology are not objective medical specialties, and so with this new evaluation, there is a chance of getting new results – in other words, that my autism diagnosis might not be confirmed this time. Does it really matter?

In part, not really. I don’t buy into the belief that the label you’ve been given by a healthcare professional, defines who or what you are. When I was labeled autistic last March, I didn’t get any more or less autistic than I’d been during the twenty years before, and what will come from my current diagnosis, won’t define how autistic or neurotypical I am: my neurology isn’t going to listen to evaluation results. I’ll still be the same after this evaluation as I am now and I’m now still the same as I was last year – other than my having changed due to circumstances. It’s only that, before last March, I had no official diagnosis, then my diagnosis was an ASD and now it may or may not stay that way. It won’t change who I am.

Unfortunately, the rest of the world doesn’t think so. Autism advocates would discredit me if I lost my diagnosis, because how can someone who isn’t really related to an autistic person, claim to advocate for autistic civil rights? I never cared for this a lot, as my post on March 14 illustrates. This was, of course, two days before my diagnosis, but I didn’t know this at the time.

Did I not worry about what diagnosis I might get? Well, I did. In fact, for a while I worried about being diagnosed with something purely behavioral, like a disruptive behavior disorder or psychopathy or something, because of what I came into the doctor’s office with – aggressive behavior. But I didn’t worry about what actually the disorder was called. After all, contrary to training home staff, I didn’t come to be diagnosed – I came because I wanted help. If I had been labeled something like a DBD, I would most likely have asked what treatment the doctor suggested for that. In fact, I actually agreed to be referred for treatment more than three weeks before I knew my diagnosis.

Now things are a little different. Last February, I’d been looking for help in dealing with my difficulties for nine years, without ever having been properly diagnosed or treated. I and others had had many different paradigms about what caused my difficulties, and accordingly tried many different approaches – in fact, at training home, there was a new one every month -, before we’d ended up in the doctor’s office on December 12, 2006. I was about to have yet another paradigm stuck on me, and yet another approach tried. Yet this one started to work, though I moved not even three months after having started my discussions with Jeanine, and how much progress do you expect in such a short time? Now, I finally found something that helps me, so it’s understandable that I’m not as open about possibly different paradigms as I was before.

Then there’s something related to this, that is worse than ending up with a different paradigm than my old one: ending up with no paradigm at all. In other words, the “fine fine” answer. I half expected this last February – not anymore last March, because I’d been referred for treatment by then -, and it is one of my biggest fears now. What if I were declared fine?

Well, it’s pretty obvious: if I’m said to be fine, I’m likely to lose the support I have now, and will most certainly not get the support I need. After all, someone who is fine apart from blindness, should be able to live independently and manage at university. There’s still this little voice in my head who says that I am capable of this. I picture myself calling Gerda the day I’m given the “fine fine” answer, to tell her I don’t want Marion or Adrie to come anymore, cause really I’m just blind and someone who’s just blind should be able to live independently. Forget about Andrea, my buddy in the autism college project. All blind people arrange their own college education, according to the student counselor, so why don’t I? My mother still believes it’s all a matter of self-confidence, and I’m sometimes tempted to get rid of all support for a while until I fall apart – but how do you define falling apart? -, if only it were so that I won’t risk being given the “fine fine” answer.

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New Home and Mental Health Nijmegen

Went to my new apartment in Nijmegen today. I’m not sure what to think of it. It looks pretty old-fashioned and some of it is just a lot different from what I’m used to. I got frustrated and felt very uncomfortable. I feel strange, cause the whole freaking thing really isn’t getting anywhere yet. We are now trying to get the third independent living service agency we contacted to finally get to offer their assistance. In the meantime, Arda keeps saying it would be best for me if I could leave in the middle of July (so in two weeks!) and she wants me to leave by the end of this month, but she won’t kick me out till the freaking stuff has been arranged. I don’t know. I now have the keys to my place in Nijmegen, so I could really go away if I wanted to. I do have a place to go other than the homeless shelter when I can’t live here anymore. Yet it makes me scared that I will indeed be kicked out of here cause of behavioral difficulties, without the whole freaking thing having been arranged.

Other forms of assistance have been arranged or are a long way int he process. Spoke with an occupational therapist from Sensis, the southern agency for the blind, yesterday. Really didn’t speak about a lot other than making appointments. I will be practising the route to the shopping centre next week Tuesday and Friday and the week thereafter on Monday and Wednesday. There is still some trouble with funding, but it seems that may be arranged.

My first appointment with a psychologist from mental health Nijmegen, today, also seemed to go quite well. Before the discussion, he’d read the reports and papers my current psych nurse sent him. These included my care plan (the new one, cause I insisted on it), the eval report from rehab (I don’t know why anyone at mental health ever read it), the conclusions from the psychologist I saw last year (it appears he wrote in the thing that I might have an ASD, never knew and don’t understand how he got the idea), the papers from the admission / getting labeled stuff (folk commented that it was not stated why I had an ASD, weird!) and the notes from Jeanine (psych nurse). Because the folk had these documents, he didn’t ask much about my current mental health situation, exept whether my parents had filled out a particular questionnaire and how I would be filling out questionnaires. Arda took the parents questionnaire with her to show Jeanine and find out whether my parents filled it out, and we figured a questionnaire with lots of color-in spaces was unscannable so I commented it’s usually done orally (at least at rehab) but this might take a lot of time.

We straightened our ideas about getting further evaluation. You see, the evaluation that led to my current label, was not the most extensive ASD eval, so Arda insisted on further evaluation. Her argument was that she wondered whether I might have Asperger’s Syndrome, but I was like: well, I don’t need a label any more specific than my current ASD label, because the differences between ASDs are minor in adults and with a specific diagnosis come specific prejudices. The psychologist agreed with me that the point was not so much to get me labeled – he also seemed to think the differences between ASDs are not too significant -, but to get a better understanding of my strengths and weaknesses as far as an ASD is concerned. Arda said this was really what she had been meaning, too, and I agree with this idea.

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Brief Mental Health Update

Went to the mental health centre with my parents yesterday. Turned out the folk had gotten an ASD suspection herself, too, and that was why she wanted to see my parents. I could’ve known that she suspected one of those disorders with onset in childhood cause why else would she ask to see my parents, and an ASD sounded most logical to me (but well, you know the power of laypeople looking at mental health info), but I didn’t know in advance why she wanted to speak with my parents. Don’t know if it was an advantage or a disadvantage that, consequnetly, neither did my parents. In any case, they were quite cooperative, to my surprise. Of course, my father’s first remark was to say “So what?” to the ASD thing, but the folk clarified that it wasn’t so much meant to label me, but rather to determine if there was a possibility for treatment. We all also agreed that, while the staff problems at training home had been what led us to consult the mental health centre, it obviously wasn’t only a staff/client problem – if it were, I’d have left this place voluntarily ages ago. So the folk had some questionnaire which she administered to my parents – well, in fact my father was the one answering most questions cause a lot was about early development, which he knows more about since he was a stay-at-home Dad. I sometimes made a remark in between. Overall, I think the discussion went a lot better than I’d expected. Bottom line was that the folk did see some treatment possibility and asked me if I agreed. I obviously did, but wondered about the June 1 thing, cause of course they have a waiting list. The folk, who didn’t seem all that happy with the whole leaving training home thing in the first place even though I tried to be as objective as possible, said it would be no problem, cause they could hand over my case to Nijmegen once I was there. So that was a good thing. Discussed the situation with Arda today and she seemed to agree to my decision sort of.

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