Open Letter to My Local Mental Health Center

Prepare for some rambling…

When I first sought your  help in 2009, I was worried I would not be accepted because I was considered out of your cachement area.  As it turned out, CMHC’s could not deny Medicaid clients based  upon cachement area.  This is a good thing, because in 2009 you allowed me to start your Intensive Outpatient Program in Dialectical Behavior Therapy (DBT).  I attended five days a week, for three hour days.  I can honestly say that this formal introduction to DBT saved my life.

You brought wonderful therapists into my life, some whom I thank God each and every day for.  There are too many to mention just one, but each of the IOP therapists are very special to me.  They gave me hope when I had none and taught me the skills necessary to survive with bipolar in a unipolar world.  The IOP program was just the tip of the iceberg.

After graduating IOP, you wanted me to do weekly DBT classes.  I was working at that point again and had difficulty with coordinating my schedule.  I hopped around to a few different groups, and then I gave up.  I went back to seeing the pdoc at my county’s CMHC, and continued therapy with Goddess of Mindfulness.

For a few years, my needs were fulfilled at my local CMHC.  It wasn’t the same, though — the therapists were not as invested, it was difficult to get a med appointment where the pdoc didn’t continuously cancel.  It was a fight to get any medication change.  It was if I would just come in to get the rubber stamp and then would be sent off on my way.

In 2012, I had a major bipolar meltdown and came seeking help from you again.  I needed that Intensive Outpatient Program, I needed those caring therapists, and I needed the care that I knew my own local CMHC couldn’t provide.

I started IOP again, and stopped seeing Goddess of Mindfulness, instead seeing Marty for individual DBT therapy.  IOP was very different this time.  The classes were extremely small, participation was minimal, the therapists often didn’t keep the group under control.

The times had changed — there was no longer a ten minute break after every hour.  I don’t think the therapists realized how difficult it was to sit for 90 minutes without a cigarette or a soda or a break when you are in such a mind-addled state.

One thing for sure — IOP wasn’t the same.  It wasn’t as helpful, I didn’t feel as successful, there was not much group interaction or cohesiveness, and frankly, most of the therapists seemed bored, as if they lacked passion for the subject now.

I moved quickly through IOP this course and started just seeing Marty individually.  She was a very different therapist than what I was used to.  She called it like she saw it, and the way she saw it was often very different from my view of things.  After about a year of seeing each other, she announced to me that she would be retiring the following summer.  After that, her heart wasn’t in it.  She certainly didn’t seem to care anymore, and it was like she had given up on me.

I decided to switch tactics and go for a non-DBT therapist there at the center.  That was worse.  She seemed cold and unfeeling, judgmental even as I would describe what was happening in my life.  I started to avoid appointments, and go for long periods of time without checking in.

During a time of mini-crisis, I attended a “Building Structure” group in which you basically made plans for each day and the day after.  It was a very useful group for me and I went for three weeks, then graduated.

I ended up going back to see Goddess of Mindfulness after that.  I couldn’t afford it financially in my budget, so I had to take $15 out of each weekly allotment and put it toward therapy.  In my eyes, it was a good use of money that I may have just frittered away elsewhere.  It still didn’t add up to what Goddess of Mindfulness should really be paid, but I was beyond thrilled when she accepted my request to be her client again.  Over the moon, really.

And since my 2012 return to the CMHC, there has been Dr. Wizard.  I kid you not, the man is a genius when it comes to medication.  He listens, makes small adjustments, is encouraging, worries that I am on too much medication, and, here recently, hospitalized me when it seemed to him like I was under too much duress.

I have never had a problem getting in to see my pdoc, and I thank the wonderful front desk staff for that.  Sure, calling the nursing line works sometimes, too, but the front desk staff are better at prioritizing clients and slipping people into time slots quickly.

When I came out of the hospital on Monday, I was in a daze.  I knew they had started me on a downturn of Geodon and had started me on Abilify, but I wasn’t given any titration recommendations.  I was just told to follow up with my pdoc at my next scheduled appointment on July 9th.  That was three weeks away.  I was feeling a bit better, but as a couple days went by, it was clear I needed more  support, possibly more medication.

On Wednesday, Goddess of Mindfulness had me call the CMHC to try and get an appointment.  I called the nurse’s line first, and left a message.  They called me back thirty minutes later and tried to tell me that there were no openings and I would have to “sit tight and wait” until the 9th.  The woman I spoke to barely spoke English and I actually ended up screaming into the phone, “I hope I don’t flip out before then!” and hanging up on her.  I know, real classy, Rose.  I’m out of my mind, I guess.

I then tried calling the front desk and asked to be put on the cancellation list.  I explained my situation and I was put as an “emergency priority I.”  I told them I only needed one hour’s notice and I could be there.  The front desk girl assured me I should be able to get in soon.

Much to my surprise, I received a call at 9:15 the next morning, asking if I could be there by 10:30.  Of course I can!  I made it down and Dr. Douglas kept the Geodon the same, but bumped up the Abilify.  He said, if all goes well, we can do it again at my next appointment on July 9th.  He was very understanding and caring, and we had a nice chat.

All in all, this is a good CMHC.  I think the DBT therapy program has possibly fallen by the wayside a bit, and I can tell you that the individual therapists like my last one should be fired, but what I really need is my pdoc and Goddess of Mindfulness, and I know I will be fine.

Sneaking Suspicion

When I saw my new pdoc last month, I was having some problems with a mixed episode.  She prescribed more Geodon and gave me Trazadone for sleep.  The Trazadone didn’t do anything for me, but the Geodon seemed to bring me out of my funk. 

I started to feel better and better.  Then I started to feel giddy and silly.  And I started spending too much money, blabbing on and on about nothing, pressured speech, flight of ideas, racing thoughts, dramatically decreased need for sleep.  And became very obsessed with cleaning, doing laundry, keeping the kitchen clean.  I mean, cleaning and working on things in the morning from the time I am waking up (around 3:00 a.m.) until I go to work (I leave the house at 8:15 a.m.). 

At first, it was great.  I thought, “Oh finally, I feel good and am getting some stuff accomplished.”  Things have been super-slammed at work, spending all my time working on one case when I have tons of other people to work on as well, including four people from the mental health pod leaving next month, the pod that I am supposed to concentrate on.  So I’ve been running around with a chicken like my head cut off at work, but really seem to be getting things done.  I’ve worked a lot of nine or ten hour days, leaving me totally screwed by the end of the week, as we are not allowed to have overtime.  It’s just been really busy and I am handling it really well, I think, and my supervisors are very pleased. 

Yesterday, however, I hit a brick wall.  Actually, it may have started the day before.  Racing thoughts became faster, intrusive, all over the place.  I had a hard time focusing and getting things finished, leaving a bunch of unfinished business in my wake.  I started running out of things to work on at home, leaving me to sit and watch my head spin ’round and ’round in the wee hours of the morning, not tired at all, completely feeling rested and like I need to DO something.  My body feels itchy and crawly and jumpy.  I may or may not be hearing things that aren’t there and seeing little shadows out of the corner of my eye.  My mind is driving me crazy and it just won’t.shut.up. 

Then it dawned on me.  Hello mania, goodbye mixed episode!  Sure I’ll see you around, keep in touch!

For the most part, I’m still feeling really good, really hyped up and euphoric.  My sense of self is probably blown out of proportion — feeling like I can take on anything, do anything, that I’m the best, the smartest, the most beautiful.  All of those negative feelings about myself are gone gone gone and I don’t even recognize the person I was a month ago. 

Because it.never.happened, ok?  I will always be happy, always have high self-esteem, always have enough energy to do it all, with an extra six hours in my day that I’m not WASTING sleeping.

Insight is a fucking bitch.

Dido, Isobel