• Falling Through the Cracks, Flaws in Long Term Mental Health Care in Rural Nova Scotia
• Stress Management
• Suicide
• How to deal with guilt
• Dealing with strong emotions
• Dealing with feelings about having a chronically ill child
• The grieving process - Bargaining and Acceptance

As a counselor, I was very concerned about the proposed changes to the long-term mental health treatment programs in rural Nova Scotia. These changes, started in the 1980’s, looked very good on paper. However, reality has proven the theories to be just that, theories. The programs put in place do not help enough. Some are very impractical such as expecting the general practitioner to be the primary care provider to people with long-term mental health issues.

Some of the most vulnerable citizens in Nova Scotia are those living with chronic mental illnesses such as schizophrenia. The care given to mentally ill people in a rural area is limited. For example, the primary care units for those living with long-term mental illnesses are medications and caregiving by family members. Family caregivers and other concerned citizens are advocating for changes to the Mental Health Care System of Nova Scotia. I am pleased these citizens are taking a stand and demanding more positive care for their loved ones.

There is another group of people in rural Nova Scotia needing long-term mental health care. It includes those suffering from some kind of abuse, for example, early childhood sex abuse. Unfortunately, many of this group are not diagnosed with depression and/or anxiety and therefore receive only the six to eight sessions allowed by MSI. It is not realistic to expect that chronic mental health issues such as these be helped in such a short period of time. Few alternatives are offered. Fortunately, groups like S.O.A.R. (Survivors of Abusive Relationships), a peer counseling service, does its best to address the needs of people recovering from childhood sexual abuse.

Good care in rural communities includes the family doctor prescribing treatment protocols besides medications. The community needs to offer appropriate long-term services, not just the local Emergency Room or temporary treatment programs at its Mental Health treatment facilities.

The Mental Health System in rural Nova Scotia is not user friendly. It assumes people have acute issues needing short-term treatment. People suffering a psychotic break receive inadequate attention at the local Emergency Room, offered a few pills and sent home or transported to a city hospital. There are too many clients for too few counselors, counselors traveling to different locations during the workweek and expected to be on call at the Emergency Room on regular workdays. A client is lucky if he sees a counselor once a month for six to eight months. There is no continuity of treatment, no time to build a good client-counselor relationship, little attention given to privacy needs. Psychiatrists are available along with the general practitioner only to prescribe medications but not the counseling needed to live in this face-paced world. The criteria to determine those in need of long-term mental health care have changed so fewer fit the definition of ‘need’.

Many of these individuals have little education and therefore are limited in employment opportunities. They cannot afford long-term mental health care services in their community, for example, private counselors. These counselors are not necessarily equipped to serve people with chronic mental health care issues. Insurance companies generally do not cover them. Of course, people earning low incomes or with Social Services cannot afford insurance to pay for treatment programs anyway. Rural Nova Scotians needing long-term mental health care covered by MSI are expected to travel long distances to urban centers such as Halifax. How can people obtain treatment when they have no easy way to the city? Many have no car and no family member available to drive them to appointments on a regular basis. The trip by bus from Kentville to Halifax round trip is close to twelve hours for a counseling hour of forty-five to fifty minutes.

Why are people being penalized for living in a rural area? Why should people in urban areas receive appropriate mental health care and those in rural areas not receive the same good care? Why should the citizens of rural Nova Scotia who are most vulnerable be sacrificed? It is time to draw attention to the needs of rural Nova Scotians needing long-term mental health care!

Most of us are familiar with stress. Let's face it, everyday living can be stressful. Job pressure, financial pressure, family difficulties, and feeling like you never have enough time are some of the stressors we face daily. Stress is defined as a biological reaction to an adverse stimuli which may be physical, mental or emotional. This biological reaction is known as the stress response. During the stress response adrenaline is released from the adrenal gland. Symptoms include increased heart rate and breathing, increased sweat production and decreased digestive activity. The role of the stress response is to counteract stress. Our stress mechanisms are designed to give us the energy needed to deal with stress. Our body reacts to emotional and mental stress the same as it would for physical stress- providing us with an energy boost needed to escape from danger. Typically, a mild stress response may go unnoticed. However, if the stress is prolonged or extreme, these stress control mechanisms can be overwhelming and quite harmful to the body.

Although we may not realize that we are feeling stress or we may not know what is causing us to feel stressed we can usually recognize the symptoms of stress. These may include insomnia, anxiety, depression, fatigue, headache, irritability, and upset stomach. Many physical conditions may be linked to stress, these include heart disease, cancer, the common cold, menstrual irregularities, ulcers and numerous other conditions. Virtually every physical illness can be made worse with stress.

To effectively deal with stress we must first recognize when we are feeling stressed out and what is causing our stress and then we must develop healthy mechanisms for managing stress. It is often impossible to avoid the everyday stress of life, but we do have control over how we react to life's stressors. Changing the way we react to stress may require an in depth look at our coping mechanisms. This often requires the help of a trained professional. In addition to seeking the assistance of a mental health care worker there are things that we can do on our own. A good stress reduction program needs to include the following areas: Techniques to calm the mind and body: This may include methods to induce a relaxation response such as meditation, prayer and relaxation exercises. Life style factors: This may include better time management or finding a less stressful job. Mental and emotional issues: This may include dealing with relationship issues or childhood issues. (Professional help is probably required here.) Exercise: Regular exercise helps the body to adapt to stress. A healthy diet: A healthy diet is designed to nourish and support physiological processes

We may not be able to avoid stress but we can learn to deal with stress in a healthy and effective way.

(First published in the Invisible Made Visible Newsletter)

• Involves more than just killing yourself
• Numbers of people that Shirley has talked to about suicide has increased
• Need to know more about this topic
• Something that doesn’t happen quickly, people think about this for a long period of time
• If you know someone that doesn’t leave the house, interact with other people, doesn’t read or watch t.v, bath etc., this is not normal behavior
• A person may being going through a grief process or depression
• There is a clinical depression that leads to suicide
• Knows of a family of 5 suicides in that family, an inherited problem
• This is not the kind of situation referred to here
• People with chronic illness may be changing in personality or lifestyle in a way that is not good
• When you talk to them they may say they are depressed but not thinking about suicide, at least they are communicating with you
• “However when a person says that they are thinking about suicide but are not going to do it, do not ever take that as truth.”
• Oftentimes a person that talks about suicide and brings up the topic of other people killing themselves, they are thinking about doing it themselves
• They are usually reaching out to you for help
• If you ignore these signs and that person kills themselves you are going to have to deal with a lot of guilt
• If you help them and they still do it you have nothing to be guilty about, they have made the choice
• Some people are scared of dealing with this issue because they don’t know how
• One of the most important ways to deal with it is to be educated about it
• Second is to verbalize with the person
• Go the next step and say “I am concerned about you” ask their permission to talk with someone in medical field, psychologist, etc
• First you must talk to the person about it
• Personal experience has been when tried to share a concern about suicide family members have gotten upset and denied it is an issue
• Try and be there as much as possible to make sure it doesn’t happen
• But no-one can force a person to live when they want to die
• Tell that person you love them and want them here
• Sometimes a person has gotten so low in depression that they are convinced that the people around them would be better off if they were dead
• They cannot appreciate that there are alternatives
• Someone who has gotten that far down needs love, patience and you have to get them to pursue an alternative
• If you are feeling this way talk to someone
• If you want to commit suicide because you are in such pain that you cannot foresee a future without pain then ask question “have you become your pain?”
• You have become your pain and that is all you focus on
• There are ways to deal with the pain
• There are clinics that help you deal with chronic pain
• They can help you see that you are not just a lump of pain but are a person in pain
• Your mind is active and alert and there are ways that you can use your mind to deal with your pain
• Your pain is one part but you have a life besides your pain
• Its not an easy road but there are opportunities there for you
• Ending your pain by killing yourself ends your life too
• It ends the relationships with family and friends
• They have to deal with just more than a death when someone takes their own life
• They feel like the cause and keep asking themselves “what if I had…”
• You may cure your pain but will bring even more pain upon those you love
• Pick up the phone
• If you cannot get out to a clinic or counselor you can still get help
• Sometimes when we are that far down what helps us out is faith
• “Pray even as you sense that you are not praying. When you sense your prayers are not being heard that is when you need to pray.”
• It may take a long time but it will help if you give it some time
• Call someone
• You may not be able to get on the phone and say that you are going to commit suicide but you need to get on the phone and ask for help
• Grab deep inside and get hold of that inner strength that will help you up
• Realize that you are not alone
• What do you do when you get a call from someone who is talking about ending their life?
• The first common sense thing is not to hang up
• Focus on what they are saying
• This person is not crazy
• They are not talking about something that they can’t do
• The conversation may go on for some time
• You may get frustrated because you may be offering good solutions and they are not listening to you
• They don’t want you to offer solutions at this point, they want you to listen to their pain, solutions can be offered later
• One thing that you need to do is realize whether they have the bottle of pills or gun right there, make them promise to not use it till you can get help to them
• Realize that if they do commit suicide and you have tried to help them it is not your fault
• Some things you can do is to listen to their pain, get help to them, try to get that person to talk about what is going on in their life in such a way that it will move toward a more positive way
• They are hoping you have an alternative

1. Avoid negative self-talk or self pity. Do not compare your sick self to your healthy self. It will lead you into depression and despair. Some forms of negative self-talk are the following:

All or nothing: seeing things in extremes, e.g. always do your best, no one likes me.
Labeling: giving yourself labels that have an all-or-nothing quality, e.g. "I'm a loser".
Filtering: paying close attention to some points and not others, e.g. "All I think about is my pain".
Rigid expectations: have lots of rules, e.g. "I should always give 100%".
Self focus: blaming oneself, e.g. "I'm being punished for being ill".
Psychic reasoning: assuming one always knows how things will turn out, e.g. "I'll always be ill and in pain".
Emotional reasoning: relying on feelings to interpret reality, e.g. "I feel so useless - I am useless".
Helplessness: feeling feelings and self esteem are controlled by outside factors, e.g. "I can't help feeling scared".

Accept the self you are now and create a new lifestyle around that. Use positive dialogue with yourself. Some forms of positive self-talk are the following:

Middle-ground thinking: see things in balance, some good/some bad, e.g. I did well to walk to the mailbox today.
Describing: objective observations that notices details, e.g. I am 20 pounds overweight.
Openness: try to see the Big Picture, e.g. The audience did not ask questions but did seem interested in what I was saying.
Flexible expectations: things do not always go your way, e.g. I can not go to the concert but I can listen to it on the radio.
Human-focus: you are not responsible for everything, e.g. I am not at fault for my husband's bad moods.
Experimental attitude: try things to see if they work, e.g. I'll tell my husband about my feelings instead of avoiding my feelings.
Reality-reasoning: relying on evidence, not feelings, e.g. I made a little progress today.
Empowerment: taking control of feelings and self-esteem, e.g. I will be less anxious if I remember I did this before and nothing terrible happened.

You can focus on something else, like a movie, a flower, talk about other things.

2. Maintain friendships. Do not let the illness isolate you completely. Long-term illness does not give you the right to be mean to others. Don't let your pain and irritability separate you from family and friends.

3. Attempt to problem solve those things you can control. Do it in short periods of time. Set goals that are flexible and reasonable. Goals should be positive, do-able, can be measured, clear and defined in terms that can be achieved, and important to you.

4. Fresh air is a great tonic. Sit in a chair. Absorb the sun's rays, feel the breeze, listen to the sounds of nature.

5. Counseling can help you deal with grief issues, depression, anger, financial stresses, etc.

6. Be in control. Stop when you feel tired. Do not push yourself beyond that point. When you do that, the illness is in control, not you.

7. Do not allow illness to become your sole identity. For example, perhaps you are an ill person who is interested in art, reading, etc. You are good at doing these things.

8. Do not allow others to upset you when they ask questions. For example, a person may ask "Are you sure it's not in your head?". You do not have to defend yourself. Answer with a short answer. If the person wants more information they'll ask. Being defensive can mean you feel responsible for your illness or are afraid that the person suggesting it is depression or in your head is correct. Sort it out for yourself first. Then you'll be able to answer questions.

9. Spend your energy wisely. Realize that you have limits. Be energy efficient. For example, sit on a stool to peel vegetables instead of standing. Remember the 50% rule. If you feel like walking 5 miles, walk 2.5 miles. When you return you may be relieved that you made it back or you may have energy enough to do something else, like wash those dirty dishes.

10. Resting for 10 minutes gives you 20 minutes of energy. By forcing yourself to do more than your body can do makes the illness worse.

11. Join a support group. Others know what you are going through. You are not alone. You can gain insight into your illness, its affects on you as well as share insights that may benefit others.

12. Allow yourself grieving time. There are loses you need to come to terms with and it takes time.

13. Set priorities. Make a list of what MUST be done, what you would like to do, and what doesn't matter.

14. Learn to adapt. You may not be able to go out to eat Chinese food, but a friend can bring it to your home.

Compiled from:
The Messenger: "What do You Say When", Ed Isenberg.
The Messenger: "Coping for Survival: Methods for Managing", Linda Abourna.
Dr. Brian Dufton, Psychologist, Valley Regional Hospital.
Shirley Soleil's lecture notes.

I feel guilty because I'm healthy, can go to work, do all the things I always did while my spouse suffers, is ill, has had to give up her/his work, interests and is more dependent. How do I deal with this guilt?

Dealing with strong and confusing feelings such as anger, hatred, resentments.

How do I deal with my feelings about having a chronically ill child?

How does the grieving process work? Grief : Bargaining and Acceptance