The Harm Caused When Employers Do Not Follow the Spirit of the ADA

The statistics concerning mental illness and employment can appear bleak, at times. A 2019 research brief found on the ADA National Network (adata.org) website called: Mental Health, Employment, and the ADA, discusses the prevalence of those living with a mental illness who work full-time as follows:

Over 46 million adults in the United States have some kind of mental health condition, and 11.2 million adults have a significant psychiatric disability1. Mental health conditions are the most common disability in the U.S., yet there are significant disparities in employment. Only 38.1% of adults with significant psychiatric disabilities are employed full-time compared to 61.7% of adults without disabilities2. These disparities exist despite policy protections for people with disabilities, as seen in the Americans with Disabilities Act (ADA)”. (Parker Harris, S., Gould, R., and Mullin, C., 2019)

This information as well as other helpful guidance regarding the Americans with Disabilities Act (ADA) can be found on the website: ADA National Network (adata.org).    

Employers are required under the ADA to provide reasonable accommodations to an individual with a qualified disability absent “undue hardship”. Undue hardship, as defined by the U.S. Equal Employment Opportunity Commission (EEOC.gov), “means that the accommodation would be too difficult or too expensive to provide, in light of the employer’s size, financial resources, and the needs of the business”. The laws, however, surrounding these issues can be sometimes vague, leaving room for interpretation and ultimately causing some individuals seeking accommodations to feel vulnerable after disclosure. Imagine getting up the courage to disclose a highly stigmatized illness to an employer, only to feel less supported and valued by them! Although, each workplace and individual will approach the accommodations process uniquely, it can be helpful to share experiences in hopes that people can support one another in navigating the world of employment while living with a psychiatric disability.  

My personal experiences of requesting accommodations for both Bipolar 1 and ADHD in the workplace resulted in increased stress and anxiety, causing an exacerbation of symptoms, and in some cases, a constructive discharge or wrongful termination. Many workplaces are not equipped currently, due to both attitudinal and structural barriers, to appropriately accommodate those struggling with a mental illness in the workplace. There is a lot of education and awareness that needs to occur for employers to be truly inclusive and embrace diversity in the workforce, enabling opportunities for those with psychiatric disabilities who wish to work and remain competitive. 

As an individual who has worked for many years while struggling with a psychiatric disorder, I am intimately aware of the pervasive stigma attached to my disability. I have faced, what I believe to be, discrimination, while working. The last several work attempts I decided to disclose my disability in hopes to receive accommodations during times when I was symptomatic. I had hoped that by doing so, it would allow for increased awareness and support. Workplace stress can trigger symptoms and the disclosure of my disability and request for accommodations was a sincere attempt at helping my employer understand how my illness affects me at work and what approaches could be used to benefit both my employer and myself. I wanted this to be a mutually beneficial endeavor, a “win-win” for everyone involved. I had the support of my medical provider and he agreed that the request was reasonable and would not be considered as causing “undue hardship”. Even so, my request for accommodations left me feeling more vulnerable and less supported. 

Although there are many workplaces providing accommodations in a supportive manner, I wanted to give a voice to those experiencing vulnerability, or even discrimination, after disclosure. I have seen many people on-line with stories very similar to mine. Unless we give a voice to those being disenfranchised, we miss a true opportunity to help others understand why it is so very important to handle accommodations requests with a genuine desire to retain employees who live with a psychiatric disorder. The stigma surrounding mental illness doesn’t just disappear during a disclosure at work and many times the myths perpetuated about mental illness are reiterated and even perpetuated by those in the workplace. The ADA is written with inclusivity in mind, and yet, employers are often comprised of people subject to biases and prejudices with a mindset that is difficult to change. It’s up to us as a community to speak out and bring awareness to the harm and damage that stigma in the workplace can cause. 

Here are the 4 things I wish employers understood about accommodating those living with a psychiatric disorder in the workplace: 

  1. When I request accommodations, I genuinely want to be a successful employee of your organization and want the same opportunities to compete. The US Department of Labor website (dol.gov) defines a job accommodation as “an adjustment to a job or work environment that makes it possible for an individual with a disability to perform their job duties. Accommodations may include specialized equipment, modifications to the work environment or adjustments to work schedules or responsibilities”. Although, I might do the job a bit differently from others, my goal will always be to do so in a way that benefits and adds to the success of the organization. We have the same goals in mind. I might need, at times, to approach the way the work is completed differently in order to enable success. I’ve always been told I am creative and an “out of the box thinker”. I would love to be seen as an asset and continue to contribute competitively. Often, when I have disclosed a disability, the attitude that is displayed from the employer is that I am asking for a “favor” or that perhaps I  am even requesting accommodations to be excused from an unpleasant duty, etc. This could not be further from the truth. No one would risk disclosing a disability and being vulnerable, just to get out of an assigned duty. It is a stressful process that requires medical documentation and support. I want to continue being seen for my strengths and do not want the disclosure of my disability to change your view of my capabilities and strengths.   
  2. Please remember that the accommodation process is a flexible one that is guided by interactive dialogue and even trial and error. The Job Accommodations Network described this process on their website (askjan.org) as follows: “When an accommodation is not obvious, an appropriate accommodation is best determined through a flexible, interactive process. As part of this process, the EEOC recommends that employers: (1) Analyze the particular job involved and determine its purpose and essential functions; (2) Consult with the individual with a disability to ascertain the precise job-related limitations imposed by the individual’s disability and how those limitations could be overcome with a reasonable accommodation; (3) In consultation with the individual to be accommodated, identify potential accommodations and assess the effectiveness each would have in enabling the individual to perform the essential functions of the position; and (4) Consider the preference of the individual to be accommodated and select and implement the accommodation that is most appropriate for both the employee and employer”. There have been times after I disclosed my disability, that the process became very rigid and even punitive. For instance, I wanted to temporarily change my schedule for a few weeks to 32 hours a week instead of 40 hours weekly. They provided the accommodation, but permanently cut the hours, meaning I was now taking a significant pay cut and they would not allow me to return to full-time once my symptoms abated. In another workplace, I requested to revisit accommodations and was denied the opportunity to do so. When this occurred, it was accompanied by other actions and comments that leads to a constructive discharge as the employer wasn’t demonstrating a willingness to accommodate. I won my unemployment claim on this issue alone as the judge ruled it was a constructive discharge due to being denied accommodations.
  1. Denying accommodations in the workplace, wrongfully terminating an employee with a disability, or engaging in any other discriminatory practices is truly harmful on a variety of levels. Loss of employment for someone living with a psychiatric disability can be particularly devastating. Not only does this come with loss of income and potentially housing, it also can disrupt one’s medical care. Medical insurance in the US is usually tied to one’s job and losing employment can result in an individual not being able to afford to continue treatment and thus have a lapse in treatment. Often times, one has to move for employment or even to secure housing due to loss of income and an inability to pay rent, and this means starting over with new providers unfamiliar with the treatment regimen. It can potentially cause relapse. Also, moving and starting a new job are stressful for any individual and can be particularly distressing for those who live with a psychiatric disorder. A few of these “bad experiences” can be really devastating. In my own experience, two back to back experiences where I was wrongfully terminated and denied accommodations resulted in a relapse where the continuity of care was disrupted, housing and savings were lost, and a relapse occurred. I ended up applying for SSDI and was later approved. I applied for vocational rehabilitation while waiting for approval and was waitlisted for nearly three years. Employers should truly consider the full scope of damages that can occur when the ADA is violated in any way. Those who feel they have experienced discrimination can file a claim with the EEOC (EEOC.gov). In my experiences, however, they have been extremely slow to act and it took a year or more for the process of mediation to begin.  
  2. Employees who face discrimination of are left powerless and this can lead to exacerbation of their symptoms, disability, and even death. The cost of disability discrimination in the workplace can have real consequences, not only for the individual, but the greater community as well. While no one single employer could be said to definitely cause disability or death, multiple incidents over time, can certainly lead to those realities for some. Mental illness is deadly, for some, and experiencing periods where treatment is inaccessible can increase the risk for tragic outcomes for those struggling. For certain people, they get caught in the cycle of having to continually “start over” due to losing employment during their probationary period when workplaces often discourage taking time off and may even deny access to vacation/paid time off (PTO) time. PTO is accrued over time and in many instances this leaves those with disabilities, who need time off for medical appointments, more vulnerable. They may put off needed appointments for fear of consequences with their employer and as a result their health may suffer. When this occurs, accommodations might be requested, but by this time the employee is already feeling fearful and uneasy about doing so. The workplace, not having a longer history with the employee, might be wary about the request. The employee might lose the position and thus has to start over again, only to be right back in the same predicament. The stress of losing a job, starting over, and potentially moving, all while not getting one’s healthcare needs met can be extremely overwhelming and triggering to someone struggling with anxiety and/or depression. Often, people in these positions are left having to justify and explain gaps in employment, and with the concern of stigma, most are hesitant to divulge their diagnosis in an interview setting for fear of not landing the job. Those in this position are stripped of any real power. If they left a place where they were performing well, but were denied accommodations or experienced discrimination, the employer holds the power of providing a reference or not. Due to stigma, those experiencing a psychiatric disorder may not be viewed as credible by some. The burden of living with such a highly stigmatized illness becomes oppressive in and of itself. This ultimately leads some to despair and hopelessness which can cause continual relapse.  

In my case, after experiencing discrimination, I not only relapsed, but received the additional diagnosis of fibromyalgia from the continual stress and tension working caused. I do believe I could have been successful and wanted to work, but I needed the workplace to follow the spirit of the ADA and be sensitive towards the issues I was facing. Instead, I faced discrimination on a few occasions. The final straw that broke the camel’s back for me was being terminated by a state agency after an approved medical leave! They actually fired me my first day back from the medical leave at a meeting set up to address my accommodations request. This caused a relapse and I ended up on disability, losing everything, and was severely depressed for a few years.

My goal in writing this post is to inform others and bring awareness to the issues surrounding employment and mental illness. I hope to work in advocacy one day, helping others to navigate the system and perhaps even help employers see the value in employing those who live with a psychiatric disability. Diversity in our workforce is always a benefit! Learning to approach the workplace in a different way in order to make it more inclusive, is well worth the endeavor, both for the individual and the community.  

*Parker Harris, S., Gould, R., and Mullin, C. (2019). ADA research brief: Mental health, employment and the ADA (pp. 1-6). Chicago, IL: ADA National Network Knowledge Translation Center.

MHDD Digital Storytelling Series: My Story

The following is my story for the Digital Storytelling Series with the Mental Health and Developmental Disabilities National Training Center (https://www.mhddcenter.org). “The Mental Health and Developmental Disabilities (MHDD) National Training Center is a collaboration between the University Centers for Excellence in Developmental Disabilities at the University of Kentucky, University of Alaska Anchorage, and Utah State University”. Their objective is to improve the quality of services and supports for those living with a developmental disability. For more information about their organization visit: https://www.mhddcenter.org/about/.

In the podcast below, I discuss the multiple disabilities I live with and the challenges I have faced living with an “invisible disability”, both in employment and in accessing care. It is roughly 22 minutes, so listen at your leisure! My hope is that my story will resonate with you or someone you love who also struggles in a similar way.

My goal in sharing my story is to spread awareness and combat the stigma surrounding mental illness. Thank you for reading and feel free to share if you like.

A special thank you to Adam Potter, BA who interviewed me and edited my story and to the organization, MHDD, for the opportunity to share! I appreciate the work you do in increasing awareness and bringing a “voice” to our stories! Thank you!

An Open Letter To Those Treating My Mental Health Disorder

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A couple of weeks ago, I spent a few days engaged in a partial hospitalization program with the hope that I would gain a few more coping skills that would reduce the intensity of my PTSD and Bipolar 1 symptoms. The program actually ended up to be a more of a “one size fits all” program and it wasn’t truly beneficial to me. Without going into too many details, I had a couple of incidents of conflict where I felt disrespected by some of the employees there. This is not all that uncommon. It happens. Employees are just people in the end and some are not always sensitive, others might be experiencing a “bad day”, and still others are just there to “pick up a pay check”. The experience, however, got me to thinking about what I would like to say sometimes to those who treat me for my mental illness on my “worst days”. I decided to write an open letter to those who provide mental healthcare services, particularly those who do so in an inpatient setting or intensive outpatient program. The following sums up what I want those treating me to know. Maybe it will resonate with you as well.

Dear Mental Healthcare Provider,

To you, I am more than likely just another patient in a fast-paced program that has the goal of crisis-stabilization. I am one of many that you serve in a busy environment where safety is more than likely your primary concern. With the amount of people coming and going, it is to be expected that you might not ever truly know me. Between facilitating groups, completing necessary documentation, and other miscellaneous duties, there is very little time to actually connect to each patient in a meaningful and memorable way. In order to ensure safety, and a routine where programs run efficiently, the relationship between patient and provider is not one of equal power. Your role by it’s very nature, especially in an inpatient setting, is to enforce boundaries and rules to maintain the type of environment where people can receive the help they need in order to return to baseline. This dynamic, albeit necessary in ways, can be difficult for some of us to adapt to as it can feel not only constraining, but even oppressive, at times. In addition, the often sterile environment of some hospital settings and the loss of personal freedom, can seem disorienting and demoralizing to someone seeking help.

As a patient, I am coming to you at my worst, often in a place where I may not be in complete control of my impulses, moods, or perceptions. You see me when I am most vulnerable, often in the throes of an illness that I am doing my best to manage. Despite my efforts, there are times that the illness takes a hold, and I need a little help to return to my baseline. There is a lot of shame and embarrassment when I have to admit to myself and others that I need help to cope and manage the chronic illness of Bipolar 1 that occasionally rears it’s ugly head, robbing me of my time, joy, relationships, and even jobs.

When I walk through your doors or am brought in by an ambulance, I am instantly reminded of how powerless I am, at times, to this debilitating illness. All my possessions, like my purse and anything else I bring in with me to the hospital, gets stripped from me and I am asked to stand unclothed in a robe so that someone on staff can “search me”. I can remember being asked to do this each time I have been in inpatient, and yet, the actual occurrence of it I have conveniently blocked from my memory. As a victim of sexual assault, this is particularly dehumanizing and distressing for me. At one inpatient placement, I even was forced to wear a blue jumpsuit very similar to what is worn in a prison setting. The contents of my purse were dumped into a plastic bag. I felt violated, having my privacy breeched and felt nearly treated as if I were a criminal.

When you see me, I am coming to you to at my “worst” asking for your for help, but it can feel sometimes like I am part of a machine that doesn’t value or see my humanity. The first few days of treatment can feel somewhat numbing. Pink Floyd’s song: “Comfortably Numb”, comes to mind and the medications that I am pushed to take during an inpatient stay feels like what is conveyed in the lyrics: “just another pin prick” and “there will be no more, “Ahhahhhaaa, But you might feel a little sick”. Often the first day or two, I feel like just “another brick in the wall”, numb and disoriented, wishing I were anywhere else but back in this spot, vulnerable and raw.

When I walk through the hospital doors asking for your help, I carry with me 32 years of experience as a consumer of mental health services. I also am informed and aware of my patient rights. I may be struggling, but just in the past week or so, I was at work serving clientele as a social worker. I was sick and struggling, but holding it all together. I came to you because I had the insight and awareness to acknowledge that I need the help. I want to be seen as someone who is currently struggling, but respected as an individual who on most days is competent and insightful. Ultimately, I want to be seen as an individual who has many strengths, not just a mental illness you are treating.

Even on my worst days, when I am receiving care, I want to feel that I have a sense of agency over my healthcare. I want you to ask for my input and respect my right to decline treatment. Sometimes, it can take time for me to research and decide what I feel is best for my health. I’ve had nurses “talk over me”, even insist I was delusional, because I wouldn’t take the medications that were initially ordered by the prescribing doctor at the hospital. I once even had a nurse threaten to “tie me up in a rubber room and inject me with my medications” if I continued to refuse. Sadly, due to the stigma surrounding my mental illness I know if I had reported this incident I would have not be seen as credible. Yet, many of us in treatment have endured abuses or threats like the one above.

Just because I live with a mental illness and am requesting help, does not mean that I am incapable, even while hospitalized, of making informed choices. Had I taken the medications prescribed by the doctor during some of my stays, it would have been too much for me. I know my body and I also know my rights. I have the right to decline medications. I earnestly am asking you to educate me, provide me with the information about the medication you are prescribing, allow me to research it, and even provide alternatives. Wouldn’t you want the same for yourself if hospitalized?

I realize that providers are just people and they make mistakes. I’ve had to remind a few of my providers that I couldn’t take certain medications due to drug interactions. Sometimes, they are too busy to look up a medication or have forgotten that an interaction exists. I realize providers are not walking encyclopedias and their knowledge may be limited. And I also understand that most people willingly trust what the doctor “orders”. I am someone who has had a few truly negative and scary experiences while taking medications and I am hesitant to start any new drug. Please give me the time I need so that I will feel comfortable trying another new medication. And please don’t take it personally if I question a medication you prescribe or even decline it. It is my body and I will do what I feel is safe and comfortable for me.

I also again want to remind you that I am at my worst when I come to you. I am sick, vulnerable, and often raw. I again have to open up and tell a complete stranger things about myself that might be hard, stressful, and downright painful. I feel exhausted and depressed after having to explain my history and symptoms to, yet again, another individual that, in a few days, I will never see again. The mere thought of disclosing and repeating my history once again can send me into panic and is nauseating for me. To you, I might be the new admit going to bed 107 that you have to quickly assess before the next patient arrives. But, for me, the whole experience feels dehumanizing and it often makes me feel powerless and small.

I sit in the chair slumped over across from you, often sharing the things I don’t want to share with anyone. So, please excuse me if I appear on edge, easily angered, defensive, or irritated. For me, I am at the beginning of a stay where I will be thrust into groups with strangers, sleeping in a room on an uncomfortable bed with a roommate I do not know, and told when to eat and where I need to be for the next few days. Nothing feels normal at the moment.

For you, it is just another day at work and you’ll be home to your creature comforts soon enough. Your demeanor and approach with me can set me at ease and even bring a faint smile to my face, or it can make me feel ashamed, angered, or numb. I understand you are human as well, but I hope you are able to understand that I truly am at my “worst” and please be sensitive to that fact. It will make such a huge difference in my stay if you do.

During my stay with you, I will sit in groups and listen to some of the same approaches and interventions that have been introduced to me before. Initially, I may feel, on a certain level, that for me to wind up here again, I must of failed in some way. There is a lot of shame, grief, and even rage, that I am feeling. I wonder to myself: How did I wind up here again? I long for the group that tells me I am OKAY, despite my struggle of living with a mental illness. I appreciate the rare facilitator that starts the group out telling us that our chronic illnesses are nothing to be ashamed of and that we are not here because we “behaved badly” or that we somehow caused our illness. There is no shame in struggling. Many people “behave poorly” and have unhealthy habits, but do not land in an inpatient psychiatric setting requiring care. A mental illness is a true illness and if unhealthy habits were responsible for the struggle, many more people would carry a diagnosis. Please remember that I have an illness, not a “behavior issue” and that I do truly try to manage it.

I will also add while I am at it, that I wish I had a private room and the hospital would separate the men from women, particularly not allowing them to sleep on the same halls. This was distressing and distracting for me. I would also like for the environment to be less sterile and more homelike and for groups to be designed with functioning level in mind. Hey, I can have a wish list, right? Some groups are difficult for me to sit through because the information is not new to me.

On my worst days, when I find myself in an inpatient or intensive outpatient setting, please treat me exactly as you would like to be treated. I can respect certain safety measures as I am aware that they protect me as well as others in the program. And yet, please don’t talk “over me”, or refuse to accept my input. I would prefer you not ransack my purse or insist I dress in a blue suit. I also want to be seen as an individual.

And, please, if I have a “meltdown” or an angry outburst and I later come to you to share why I was upset or I wish to apologize, it would be nice if you accepted my effort to resolve things graciously. There have been incidents in the past where I have tried to smooth things over and it was met with stonewalling and a complete disregard for my struggle. Please remember if I am in the hospital for my mood disorder, I might not have the best control over myself. If I did, I would not need to be in an inpatient setting. Like others, there is a lot of shame that I experience during times when I lose dignity and become verbally abusive when upset. I genuinely am not proud of these moments and if I am making the effort with you to apologize, my hope is as, a professional, you will at a minimum try to acknowledge that not only am I “at my worst”, but I’m also in a position where my freedom and power has been stripped from me. The inpatient setting alone is abnormal and adapting to it can be a challenge for anyone. Often patients escalate as a result of responding to a system that is inherently dehumanizing, at times.

I feel so much needs to change regarding the structure of inpatient stays. So many of the patients need longer stays with additional services to truly stabilize. The current system is overwhelmed, rushed, and often the stay is too short to ensure a safe discharge. More time is needed to determine if the medication changes made are indeed actually effective. In the past, stays not only were longer, but the care was more individualized. I remember in the 1990s not only receiving a variety of physical and mental tests and assessments, but I also met a therapist 1-2 times a week. My recent hospital stays were too brief to actually ensure a correct diagnosis or to provide patient-centered care. Maybe it is too much to ask that a mental illness, be treated like a physical one? A holistic approach would benefit patients to ensure that there isn’t any other reason for their symptoms. I shudder to think about the accuracy rate of determining one’s diagnosis or the safety of the discharge when stays are often too short to truly know the patient’s needs. This causes unnecessary recidivism, but again I guess insurance companies prefer to take that “gamble”. Sadly, lives are lost doing so. And for many, who suffer for years without adequate care, their quality of life is greatly diminished. This can lead to poor outcomes for some such as incarceration, homelessness, or other health complications from lack of self-care.

My hope is that one day those who survey the hospitals to renew their accreditation involve a board of individuals who actually live with a mental illness who have been inpatient. Please consider our voices in the process. Many of us have ideas for how we wish to be treated and what we need for the experience to be better.

I will be the first to admit, I don’t always show my better side while in treatment. It is a demoralizing experience where as an independent, educated, and high functioning individual, I feel my rights are stripped from me. If I am unlucky, there might be a few staff members that can make the experience intolerable. I have experienced some truly effective and good providers in the mental health system and to those people, I am eternally grateful. But, the few “bad apples” can truly damage an individual who is already struggling, causing them to not ask for help again. That is why the quality of services matter so much to me. It can save a life. And it can enhance the quality of life for so many struggling.

Thanks again for taking the time to read my thoughts and concerns. It is just my perspective from the position of a patient being served in our current mental healthcare system.

With sincerity,

A Mental Health Consumer

A Heavy Burden to Bear: When Lack of Access to Affordable and Quality Healthcare Compounds Complex Trauma

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With the current focus on mental health issues relating to the Coronavirus Pandemic, I feel this is an opportune time to have an honest and frank discussion regarding access to affordable and quality mental healthcare services in America. Those of us who have been struggling for years living with a mental illness, are all too familiar with the challenges of finding the help that we need to not only reach stability, but maintain it. Often the services and programs to support recovery are difficult to access and some are virtually non-existent or not affordable. Most of us with lived experience have managed to piecemeal our recovery efforts over time to sustain our recovery, but we are also aware that services and programs fall short to meet the needs of many and, as a result, some unfortunately do not ever recover.

One of the main triggers for my depression is the lack of concern for those living among us who are struggling with a mental illness and/or addiction issues that often leads to incarceration, disability, or homelessness. I am particularly sensitive to these issues because of my own life long struggle with mental illness. It is also distressing for me to see those living with addiction issues who experience homelessness or incarceration because I have loved ones who struggle with addiction and I am empathetic towards the issues surrounding the disease.

For the past two years, I have been living in Los Angeles and the level of homelessness here in the city is at epidemic proportions. It is disturbing, to me, to see so many living on the streets in such dismal and dire circumstances. While not all who are homeless struggle with issues of mental illness or addiction, many of them do. As a consumer of mental health services for nearly three decades, I know first hand how difficult treatment can be to access and how, often times, the quality of treatment is poor. Services rarely include the continuity of care that leads to and enables long term recovery. Too many people are slipping through the cracks and it becomes nearly impossible for these individuals to remain in recovery when society lacks the infrastructure needed to support those rebuilding their lives. Most who have never experienced accessing mental health services firsthand are unaware of how deeply fractured the system is and make judgments without having the lived experiences of attempting to do so. As an educated individual who is able to advocate for myself, I have often been appalled by the way I have been mistreated, and even defeated, at times, by the lack of services available that would support and facilitate my recovery.

Many services and programs are often laden with structural and attitudinal barriers that even the most skilled, experienced, and educated individual would have difficulty navigating. My hope in sharing my story is to demonstrate the complex interplay between the individual struggling and the programs and services that are sometimes unavailable or of poor quality. Many times people seeking help are dealing with not only the symptoms of their illness, but also the consequences of struggling for too long in a system that lacks the wrap around services to truly help them. They also may be experiencing shame and frustration from having people in their lives who lack the awareness of how difficult it is to access help, make the false assumption that they are “just not trying hard enough”. Many who do not suffer have the wrong impression that help is easily accessible and they unknowingly invalidate the individual struggling. Using my own struggle, I hope to bring awareness of how one individual over the course of many years might experience several damaging experiences and this can lead, over time, to mistrust and a hesitancy to reach out. I am fortunate to have a good therapist at the moment who validates my complex history which is unfortunately littered with many incidents where I “hit a wall” when attempting to access help. I hope the following resonates with some of those struggling and sheds light on how challenging it can be, at times, to access quality care. The difficulty of accessing quality medical care, the services and programs needed to enable recovery, and the protections meant to prevent disability discrimination can create a challenging and difficult road for an individual who is struggling to recover from a mental illness or addiction. Below, I discuss examples from my own life to help contextualize each of these struggles in hopes to spread awareness and cultivate empathy for those doing their best to access the needed treatment and services to heal.

Lack of access to quality medical care and treatment. This can present itself in a variety of ways. Here are some actual incidents that have occurred to me personally that not only were damaging, but caused a relapse in my symptoms of anxiety and depression. Beginning with the most severe and damaging incident causing a distrust in the system, to the least offensive causing a delay in access to care, the following are my own personal experiences as a an educated individual attempting to access quality care for the disorders I live with: Bipolar 1, PTSD, Somatic OCD, and ADHD.

  • Denied access to an inpatient care facility for crisis stabilization: I was once forced to leave inpatient care prematurely after only one day of receiving treatment. I had waited roughly 36 hours in the emergency room department to be assessed by a social worker and was later admitted to the inpatient psychiatric unit. Once admitted, I was able to sleep a few hours. I made the error of requesting to leave after feeling mistreated by one of the staff there. I immediately changed my mind and communicated my wishes to the staff as I knew deep down I needed the help and more than likely needed my medications adjusted. I also was waiting to receive a test that was ordered due to having breathing difficulties from a recent respiratory infection. The doctor there decided to discharge me, even though I was openly requesting help for the suicidal ideation that I was still experiencing. They forced me to leave treatment stating that if I did not leave, I would be ushered out of the inpatient unit by the hospital security. I was discharged with no medication change and the test that was ordered for my breathing difficulty was also not completed. This incident was probably the most damaging experience I have endured during all of my years of treatment for my mental health disorder. It not only placed me at increased vulnerability for a suicide attempt, but the hospital placed my physical health in jeopardy by not completing a test to determine why I was visibly having breathing issues.The incident was traumatizing and has made me not want to ever seek inpatient services again. I also felt powerless to do anything about the incident because I did not feel I would be believed. Other than to write a poor review of my experience on their Facebook page, I have taken no other actions and have moved my life forward.
  • Medical providers who have been unwilling to support workplace accommodations. I have had therapists or psychiatric providers who were unwilling to provide documentation to support my request of setting up accommodations in the workplace. This was particularly damaging because the delay caused by having to find a provider that would assist me in this way, lead to employers doubting that I had a disability that required accommodations. This also caused significant stress for me which only exacerbated my symptoms. Some providers are unwilling to assist in letters regarding unemployment claims or accommodations requests. This leaves the individual struggling with no real pathway to gain accommodations in the workplace unless one decides to change providers and this can take a lot of time.
  • Inability to afford or being waitlisted for needed healthcare services. I cannot count the amount of treatment opportunities (particularly recommended DBT classes) that were thwarted by lack of insurance or long waitlists. Many times I was willing and waiting for treatment to become available and the waitlist was either too long or it was too costly without my insurance providing payment.
  • Certain services that would be helpful are not covered by insurance companies. I was told over and over that residential care would be the most beneficial for me. And yet, my insurance through my workplace did not pay for this type of treatment. Plus, it would have been nearly impossible to get the time off of work required to complete the program. The cost was “out of reach” for me.
  • Denied access to needed treatment due to having to rely on Medicaid which often does not cover speciality care. While waiting on Medicare to “kick in” after being approved for disability insurance (SSDI), I was denied multiple needed treatments by Medicaid which caused my condition to worsen and my symptoms were exacerbated as a result. The process of waiting to receive access to quality care for both my physical and mental health for 2 years was a dehumanizing experience where I truly felt invisible and devalued. I was even suffering with a new medical condition that affected my swallowing whereby I had lost nearly 80 pounds in 6 months and I was denied multiple referrals to a gastroenterology specialty clinic. It was a terrifying experience to lose so much weight and not get the help I needed and it actually thwarted my initial plans to attempt working part-time. I was too sick and unable to get the care I needed through Medicaid. With Medicare in place now, I get the care I need and am grateful.

Lack of access to services/programs that facilitate recovery. Many of the program from housing, disability insurance, vocational rehabilitation, etc. are often inaccessible due to long waitlists or other factors. Below are some of my personal experiences trying to access these services and programs.

  • Being waitlisted for vocational rehabilitation services. When I lost employment due to being denied accommodations in the workplace, I immediately signed up for vocational rehabilitation services in the state of WA. I was approved for services, but waitlisted for nearly 3 years. By the time my name came up to be served, I had already moved out of the state with a friend in order to prevent homelessness. I consider myself lucky that I have people who have supported me when needed. Being in a state of vulnerability where I could not access the services to help me return to work, has made me more empathetic to those who do not have a “lifeline” and end up homeless.
  • The long wait time to be approved for social security disability benefits leaves the disabled more vulnerable to homelessness and loss of needed medical treatment. Waiting for disability insurance (SSDI) to be approved, was yet another dehumanizing experience that included many roadblocks that appear to be “set up” to deter people from gaining benefits. With determination and grit, I was able to get my benefits awarded in a little over a year. However, I know many more who wait 2 and 3 years and lose everything in the process while waiting.
  • Programs, like section 8 that helps low income adults afford housing, have long waitlists and are often difficult to access. I have attempted to learn about housing opportunities here in Los Angeles so that I can be independent again and begin working a part-time job. I was told by the Department of Mental Health and another social agency that in order to receive section 8 here in Los Angeles, I would need to be experiencing homelessness. I have placed a few more calls to request about other programs for low income individuals who are dependent on their disability insurance as their only means of income, but they have been very slow to get back to me. I realize I have to be persistent, but again not everyone struggling has my education level or access to the stability I have in housing to make contact in a consistent manner. They might not have access to reliable internet or a phone. Not everyone who is struggling is well enough to voice their needs and remain consistent in pursuing services.

Lack of protection when there is a denial of rights or services. Often when an individual living with a mental illness experiences discrimination in the workplace, a denial of treatment, or another abuse, it is too easy to discredit the individual as often the above can be difficult to “prove”. Many times people who struggle experience poor treatment or other damaging incidents, but they are unaware of their rights or even if they are aware, it is common due to the stigma that surrounds mental illness for a lawyer to decline representation to provide a remedy.

  • Workplace disability discrimination is more common than one might think and victims often are unaware of their rights or have difficulty gaining representation. I have experienced multiple incidents of workplace discrimination in the form of denied accommodations and even the refusal to engage in interactive discourse to facilitate the process of getting accommodations set up. This has lead to job loss, loss of housing, loss of health insurance, and ultimately a disruption in continuity of care. The entity where one can file a complaint of discrimination, the EEOC (Equal Employment Opportunity Commission), is often very slow to act. It took a year for them to investigate a claim of discrimination that I reported and I was already in another place of employment when the investigation began. The American with Disabilities Act (ADA) is the civil rights law that protects those living with a disability from discrimination in the workplace, however, it’s language is often not specific enough to provide true consequences for those engaging in discriminatory practices. More often than not, places of employment are able to escape the consequences of discrimination and this leaves the employee extremely vulnerable, having to pick up the pieces and move forward. Many people who experience discrimination in the workplace are fearful to defend themselves as they may need a descent reference or might wish to avoid other negative consequences of doing so.
  • There is little protection for those who experience mistreatment from a mental healthcare provider. One can file a grievance and I have, but I have never had anyone follow up with me. Lawyers are very hesitant to get involved because the stigma lends many to believe that those living with a mental illness may not be credible, particularly when in an inpatient setting. Obviously, reaching out to report can be re-traumatizing for the victim in and of itself, especially when the victim is not “believed”.

Many of my examples are more than likely relatable to so many living with a mental illness. And believe it or not, I have many more stories that I could share. These experiences compound upon one another, and, over time, truly “break” a person. It becomes harder to trust the system and more difficult to trust medical providers enough to open up again and risk being vulnerable in order to receive help.

Living through so many tough experiences, I feel compelled to speak out regarding these issues. Many times, people lack the compassion towards those struggling because they only are viewing the one incident that is being shown to them at a particular time. Life is complex and too often I see people minimizing an individual’s struggle because they are simplifying their experience by looking at only one incident. Living with a mental illness often comes with many layers of struggle from living with the stressors of income instability, job and relationship losses, and dealing with the shame that stigma causes for those struggling. All of this is in addition to managing the symptoms of their illness. More often than not, when someone is requesting help, they have been “kicked around” a bit in the system, told “No” a lot, and are truly trying. It is truly hard out there.

This begs the question: “Why do so many not care? Where is our humanity?” I view our world as the interplay between us, the environment, and the systems we create to support a healthy relationship between the two. When we have many homeless living on our streets, we have to ask ourselves, how healthy is our society? Perhaps, those struggling with mental illness are more aware of these issues because some are faced with these risks and this makes them more attuned to the struggle. It is just a thought. My experiences over time have truly cultivated empathy. It hurts to see so many living on the streets. I personally know how hard it is to access the few services that exist to help people and I’m aware that the care is not always of stellar quality. I am acutely aware that had I not had a support system in place, I, too, may be at risk for homelessness.

I also am aware that many who struggle with issues of addiction were raised in families where their parents struggled in similar ways. The system failed to serve them as children and now they are adults mirroring what they have learned. Our society often devalues those who are currently incapable of contributing. And yet, the infrastructure simply isn’t there to help people to contribute. I am educated, persistent, and able to advocate for my needs and it was still impossible, at times, for me to receive the help I needed. As a result, I ended up relapsing and now I even have other physical illnesses, such as fibromyalgia, IBS, and migraines, that I feel are a culmination of living with an illness for so long and never “catching a break”.

I know in my heart that we have enough resources, talent, and creativity to address the problems of mental health issues and addiction that are now both at epidemic proportions. I feel if I want to see change in my community that I have a personal responsibility to act and to voice my concerns. Perhaps, in doing so people will become more aware of the challenges in addressing these issues, as they are complex and multi-layered. Isn’t it time to truly tackle mental healthcare in a creative way that not only changes lives, but changes our community and world? I would wager a guess that most people who do not see the value in serious mental healthcare reform would feel that it is too costly. In reality, the cost of the programs and services created to help families and individuals in need would be more than paid for by the decrease in rates of incarceration, disability insurance, and other medical costs incurred by individuals requiring repeated care due to relapse, etc. Investing in those who are struggling and early intervention/prevention will provide for less dependence overall.

Many times I can hear in people’s tired voices, who indicate that they are depressed, that they don’t know how to put their struggle into words. That is is “too much”. I hope by articulating my struggle I have shaved off a bit of the “iceberg’ so to speak that keeps so many of us immobile. It is too much and we shouldn’t have to work so hard to receive the treatment and services we need to help us truly recover. Society has a responsibility to meet us half way. No one is an island and the more we work collectively to address these systemic issues, the healthier our entire society will be. Our wealth, power, and sense of community is only as strong as our most vulnerable members living within it. How we treat those struggling is the difference between a decaying society and one that is flourishing, truly “rich”, and healthy.

I have hope in humanity. We are resilient and innovative. I hope by sharing my own complicated struggles that some become aware of the different issues impacting many of us who are still paddling at the surface, treading water. Give us a hand, pull us to shore. Be willing to listen. Many of us are willing to share, work, and engage with you. The struggle of so many has been weighing heavy on my heart this year and this is hopefully just the beginning of my own role as an advocate.

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The Political Divide and How it is Impacting My Mental Health

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This past year has been truly difficult for me. Election years in America seem nearly intolerable anymore, with hate and division sewn on both sides that have often left me feeling hopeless and “small”. Many times I feel as though people are talking over one another, belittling others, and even engaging in bullying behavior. Admittedly, I have, at times, engaged in these fruitless pursuits. But, many more times than not, I end up deleting my post or comments entirely, especially if it gains traction. It just doesn’t seem to be worth the energy to argue as I often wind up feeling defeated and even downright depressed.

This last year has been particularly hard for me. The rhetoric, tension, and dysfunction displayed on social media, parallels the narcissistic abuse I have been disengaging from in my own life. As many others, my leisure options have been somewhat limited due to the restrictions placed on our city to mitigate the spread of the coronavirus. Boredom sets in and I become restless, seeking stimulation on-line. The division and animosity felt on both sides leads me to retreating again and again, with a greater commitment each time to not “engage” anymore. But, I would be amiss to not share some of the observations I’ve made and what I’ve learned by disengaging.

Ultimately, and even oddly, this year has mirrored so much of what is occurring in my own personal life. I was diagnosed a few years ago with PTSD and this year has triggered my trauma while at the same time, providing the space and time to address it. The year 2020 has seemingly pushed me to my breaking point and forced me to deal with some of the harder emotions I had tried in the past to “stuff” and ignore. It’s been more challenging to distract myself when I’ve spent more time alone than ever before. As challenging as it has been for me to maintain stability in my mental health, I feel I’ve grown immensely during this time and have actually relied even more so on different and new ways to cope.

Here are some of the ways the political division and the coronavirus pandemic have impacted my mental health and the ways in which I am coping.

  • Becoming more aware of how stress is impacting my physical and emotional health. This year has allowed me to practice the skill of being more mindful and present. As a result of many businesses being shuttered, and having “less on my plate”, I have been able to slow down a bit and take notice of how stress is impacting my body. Being on social media with others during a time of less distraction, has allowed me to understand how unresolved conflict and the outward expression of it, causes an exacerbation of my symptoms of depression and anxiety. I began making the connection between the unhealthy relationships in my life and the impact they were having on my health. This has taught me to disengage more, not just on-line, but also with those in my life who are unhealthy for me.
  • Acknowledging when to disengage and practice self care. This last year has been difficult to witness. I can remember watching the first presidential debate and cringing. I couldn’t bring myself to actually “look” at the TV. The constant interruptions and “talking over one another” put me on edge and I found myself staring at the floor, almost feeling like I was the one being berated and criticized. I had to turn off the TV after a few minutes, because it was actually unsettling, and even triggering, to me in the end. Watching the debates kinda reminded me of the calm before the storm in my own life. The times I allowed too much from others, then later found myself swept up in emotion, raging. The constant on-line bickering also felt like a personal assault to me. I realized how toxic the on-line environment was and became more aware of certain negative patterns in my own life. This lead me to the process of disengaging and spending more time practicing self-care. This has allowed me to more quickly recognize my triggers and disengage earlier.
  • Acknowledging when relationships are truly hopeless, letting go, and redirecting my time and energy to worthwhile pursuits. The political divide, I feel, has mirrored, in ways, my own personal struggled with those in my life who often are not interested in compromise, yet still hold some level of power or influence in the lives of those I love. As a person who lives on disability insurance, I do not hold a lot of power in society, and voices like mine can often easily be muted or “drowned out”. The limited scope of power, both in my personal life and politically, has taught me to set stronger boundaries in order to protect and preserve my energy so that I can make a difference where I realistically can. Setting boundaries with myself and others and engaging in self-care, and not feeling guilty for doing so, has been a lesson I have learned during this time. Certain relationships are hopeless. Much like the futile attempts on-line to change someone’s political opinion, I have learned to just “let go” instead.

Election years are tough anymore. And this past one, coupled with a global pandemic, provided the space, time, and conflict to usher in a few “life lessons”. Even though it has been tough, I am grateful for what I have learned. I spent more time getting to know myself and was able to grow emotionally and spiritually during a time of turmoil. Life can be difficult and even painful, at times. With 2020 behind me, I feel like I have a few more tools in my toolbox as far as knowing how to disengage, set better boundaries for myself, and invest in endeavors that provide personal growth and contentment.

What lessons did 2020 teach you? Did you find yourself able to make some changes in your life that helped you, big or small? I definitely feel the the past year was a turning point. I’ve turned more towards myself and this has helped me to manage and cope with the symptoms of my PTSD. Here’s to hoping this year brings even more light and and self-love to everyone’s journey of healing!

Please Stop Scapegoating Those Living with a Mental Illness

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With all the on-line bickering and arguing as of late, I’ve noticed a disturbing trend. It’s become so commonplace, that I see something nearly every day that truly rubs me the wrong way. It is the “scapegoating” of those living with a mental illness in social media. And it is not something that is only being done by “one side” or the other of the political divide, it is actually rampant on both sides.

Some examples I’ve recently seen are:

*Referring to those who are “racist” as “mentally ill”.

*Calling either political party “mentally ill” because their beliefs are in opposition to yours.

*Stating that someone is “mentally ill” because the are unwilling to take the vaccine to prevent Covid-19.

*Responding to an article about an individual who committed a violent act as “mentally ill”.

*Referring to those who are members of extremist groups as “mentally ill”.

This list goes on and on. Many of the above examples “scapegoat” those living with a mental illness by generalizing an entire group of diverse individuals by affixing the label, “mentally ill”, in a context that is dehumanizing and demeaning to those who truly suffer. As someone who has lived with a mental illness for nearly 32 years, this obviously is upsetting to me. And, it also increases the stigma surrounding mental health.

For those of us actually living with a mental illness, we realize that our diagnosis, disability, or condition does not define us. When you collectively refer to any group of people as “mentally ill”; You are devaluing this population by stereotyping and generalizing a group of nearly 44 million adults (roughly 18.5% of the US population) who come from all walks of life, socio-economic backgrounds, educational levels, etc.

As someone who lives and struggles with Bipolar 1, PTSD, OCD, and ADHD, I get tired of having “mental illness” being used as the catch-all and “go-to” phrase as the rational for everything wrong with humanity. When humans behave in harmful ways, a mental illness is NOT always to blame.

Hatred and the type of ideologies that lead to violence or discrimination, stems from learned behavior. Fear as well as a lack of education and exposure to others and novel ideas, can also lead individuals to act in irrational ways.

It is crucial to understand that living with an actual psychiatric disorder, causes the individual who is struggling to experience limitations and symptoms that are disruptive to his or her life. This could take form in a number of ways to include difficulty with employment, relationships, and even basic self care. Some struggle more than others and each individual’s experience is unique.

Many people who live with degrees of racism/homophobia/misogyny etc. actually do not experience any limitations in their day to day functioning and they are still able to function with little to no problems. So, acting in a violent way, espousing racist ideas, etc. may not mean you actually would fit into the criteria of having an established psychiatric diagnosis.

On the converse, many of those who live with a mental illness might struggle in a variety of ways, but are caring and empathetic individuals who have never been violent and are competent members of society who contribute both at work and in their respective communities. This includes people from all walks of life: pastors, nurses, teachers, etc. Often, because of the stigma attached to mental illness, individuals do not always disclose their struggle.

Thus, when I see so many people use the term “mentally ill” to describe a violent or racist individual, etc. it is harmful to me and others who are working to debunk the myths surrounding mental health and decrease stigma.

I actually spend a lot of time on-line educating others. Sometimes, I have been pleasantly surprised to receive an apology when I explain to an individual who has just equated racism with mental illness, that their words are every bit as damaging to the mental health community as certain expressions are to POC.

Those of us living with a psychiatric disorder are like anyone else. We want to be seen for who we are, not for our disability. And we want to be seen in a positive light.

I live with a mental illness. I also am educated and hold a MS degree. I have never harmed anyone, nor have I ever been violent or arrested. When you take the word “mentally ill” and equate it with something truly negative, it is harmful to people like myself.

I hope this helps people to understand that changing what words we use actually matters, even when it is something as trivial as a comment on a Facebook or Twitter post. Words are powerful. They matter. Please respect them and use them responsibly.

I hope one day I see a lot less scapegoating and stigmatization of the mentally ill. It does make me more hesitant to openly discuss my psychiatric disability for fear that people will assume “the worst” about me. And this causes some individuals to not seek treatment because they don’t want to be identified as someone with a psychiatric disorder.

I am just like YOU. I am just another person journeying along in life, trying my best to improve, grow, and learn. Next time someone scapegoats an entire population of people, please remember me. There are 44 million more of me in this country and we want to be seen for who we are, not diminished to a label in a demeaning and disrespectful way!

Thanks for reading. I just felt this was something I needed to express, not only for myself, but for the many others who also might feel dismayed and discouraged by being scapegoated. Let’s lift each other up and see the best in all of us!