Mental Illness & The Tyranny of Forms

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postpartum depression formsI was recently contacted by a Warrior Mom, one who sought and received treatment for her PPD as one should, who had to fill out some forms for something that is very important to her family.  As she was filling out one particular form she came to this question:

“If either applicant has received treatment for a nervous or mental disorder, explain and attach.”

She told me how much she was concerned and even upset by the question, noting it made her experience with maternal mental illness feel worse to her somehow. She was afraid to answer truthfully as though it meant she might not be worthy of what she was seeking.

Ahhhh, the tyranny of forms. There’s nothing that makes me stop and pause like having to filling out an important form — often one required by some agency of government — for me to get something I want or really need, and arriving at ye olde mental illness question.

Why are they asking me this? What business is it of theirs? Why do I have to explain to anyone that I have suffered anxiety and then explain and attach? When you say attach, exactly how much of my experience do I need to explain to you?

ANDPLUSALSO, why the hell does this question seem to come up adjacent to the section where I’m asked if  I’ve ever been arrested or convicted of a crime?

Do these form making people not know that my mental illness — anxiety/OCD — is just an illness?

I notice that none of these forms ask me if I’ve ever had strep throat (yes). Or hepatitis (yes, but not the dangerous one). Or mononucleosis (yes). I haven’t had to explain and attach a list of the surgeries and hospitalizations I’ve received (3 for my spine and 2 outpatient for kidney stones, plus 2 babies, thank you very much). No one has requested a dissertation from me on that time I got pleurisy.

You get the point. When you ask someone a question about mental illness on an important form, what you are saying-without-saying is that it’s a problem. Mental illness is different. Separate. You have a problem. You yourself may be a problem. It’s inferred loud and clear.

I notice no one asks me the good things about myself on these forms — not whether I got good grades, or am a nice person, or if I volunteer or am helpful to others. When you only ask if I’ve ever done anything bad on this form and then you also ask me about mental illness, it’s like you’re saying, “Wink, wink and all, but if you answer yes to this question then you may be an issue. You may not get what you’re trying to get, which you may still 100% deserve. We’ve now got a get-out-of-jail-free card when it comes to you and what you’re asking for. It’s a crapshoot from this point on.”

I don’t like it. I don’t like it one bit. I think it’s unfair and also crappy. And I don’t deserve it. Yes, I sure as hell have received treatment for a mental disorder, and you sure as hell have have no business stigmatizing me, ESPECIALLY when you are a federal or state government which spends gobs of money on reducing stigma!

And don’t get me wrong, I realize in certain cases this question needs to be asked. You want to make sure I’m not in a position where I might do harm to myself or others. But why not ask me that then? Or some other question? Why ask the blanket “Have you ever received treatment for a mental disorder?” as though all of us are lurking around the corner ready to pounce?

I recently attended an event at the Scattergood Foundation where we talked about trauma informed care. It’s all about the idea that you shouldn’t re-victimize people who are already victims. We were taking a look at a variety of forms that elderly in poverty in the Philadelpia area would need to fill out to access much-needed services, and we were asked to redesign those forms using the principles of trauma informed care. How hard are they to fill out? How will the people filling them out feel or be impacted by the questions they’re asked? Will they decide not to fill out the form to get something they truly need because they are afraid of answering?

As described by the Trauma Informed Care Project, “Becoming ‘trauma-informed’ means recognizing that people often have many different types of trauma in their lives. People who have been traumatized need support and understanding from those around them. Often, trauma survivors can be re-traumatized by well-meaning caregivers and community service providers.” Yes. A million times over, yes. I see this happen to mothers with maternal mental illness so often. I’ve watched women suffer the PTSD in that sixth stage of PPD for years after they fully recovered from the PPD itself precisely because of that kind of lack of understanding and application of trauma informed care in every corner of this nation and the world.

The exercise at Scattergood was fascinating and it made me think about how often mothers are traumatized by the questions they are asked. Every form, script, brochure and communication needs a good going-over, and not by people who are healthcare experts but by the women who have lived experience. I know one of the reasons for Postpartum Progress’ success is that we’ve always operated from a position of trauma informed principles, mainly because we are survivors ourselves and we know how crucial it is to connect in an authentic, understanding and trustworthy way with each mom who struggles.  Still, we have a long way to go.

Photo credit: © bst2012 – Fotolia.com

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How The VA Healthcare System Can Help Pregnant and Postpartum Veterans pt.2

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Yesterday I wrote part one of my experience with the Department of Veterans Affairs mental healthcare system as a pregnant mother and veteran, giving my initial suggestion as to how they can improve their quality of care. You can read it here, and the rest of my story and suggestions below. 

IMG_4393Invest in Specialists and Training

My initial psychiatrist at the VA was woefully uninformed on the current research on maternal mental health, and medication use during pregnancy. As I said yesterday, once they decided to continue to treat me, the closest they could get to an “expert” on reproductive psychiatry was a psychiatrist on staff with a background in pharmacology.  While she was an improvement, I still had to point her to books and other resources online that contained up to date information. (For example, she had no idea books like Pregnant on Prozac or websites such as MGH Center for Women’s Mental Health existed) Unlike my OB, she was unfamiliar with the work of experts like Dr. Marlene Freeman, Dr. Lee Cohen, Dr. Karen Kleiman, and many others. When I was 8 weeks postpartum my care was transferred to yet another psychiatrist, who was in disbelief that I was actually breastfeeding my son while taking medications. She was also woefully uniformed and readily admitted she knew very little about postpartum mood disorders and methods of treatment, and would be deferring to her supervisor for help in my case. This was not only disheartening, it destroyed my confidence in the VA’s ability to manage my mental health care. Women veterans need mental health care professionals who understand the nuances of maternal mental health, informed on current guidelines and research regarding medication use, and trained on how to address the particular needs of women during pregnancy and the postpartum period. Reproductive psychiatrists should be hired and if it’s not feasible to have at least one on staff at every mental health clinic that sees the female veteran population, then there should at least be a team of these specialized psychiatrists professionals at local clinics can consult with for guidance and input on a case by case basis. Every psychiatrist and therapist employed by the VA should also receive some form of training specific to maternal mental health. I do know that the VA does indeed have a few experts on staff at clinics in places like Chicago and Dallas, but they simply aren’t enough. We need more.

Give Pregnant and Postpartum Veterans Scheduling Priority and Appointment Flexibility

I called the last month to try to speak with my psychiatrist. I was noticing a shift in my mood and was beginning to struggle a bit and wanted to reach out to her for treatment advice and support. I was told she was unavailable and that I should make an appointment. Her next available appointment? December 8th. When I was roughly 4 weeks postpartum, the maternal outreach coordinator called and screened me for postpartum depression, which I was extremely grateful for. However, when she went to put in a consult for me to be seen and have my care transferred to a new psychiatrist, it took another 6 weeks for that consult to go through…and we both had to make several follow-up calls to ensure it was being pushed through the system. I saw my new psychiatrist and talked with her about how I was doing at 8 weeks postpartum. I was then told my next appointment wouldn’t be for another 4 months because of the schedule rotation they had in place. A new mom’s first year postpartum is a critical time. Pregnant and postpartum veterans should have top priority in getting appointments with their providers, because not only does it support and enhance their mental health, but it supports and enhances the health of their newborn as well. Having the right support and access to treatment gives mothers and their new babies the strong starts they need to thrive-they should not be a the mercy of an overcrowded system and providers with heavy case loads.

Flexibility with appointment scheduling would help significantly as well. I was able to convince the therapist I saw very briefly during my pregnancy and my psychiatrist to have our appointments over the phone instead of in office because it was easier to ensure I’d be back home in time to pick my older two children up from school. My schedule was also packed with pediatrician visits and therapy appointments for my older two children, and the VA’s appointment availability wasn’t very accommodating to that either. Also-why not offer daycare services? I have to take my baby (and older kids if they aren’t in school) to every appointment with me, where it can be quite difficult to focus on informing my psychiatrist of how I’m doing, and what I need.

Support Groups and Talk Therapy

Since moving to Austin and enrolling in the VA mental health care system here in Central Texas, it has been nearly impossible for me to acquire talk therapy with a therapist who understands the particular needs and concerns of a woman and mother, as well as a peer-to-peer support group I can attend. After several starts and stops, I finally talked with the head psychologist at the mental health clinic here in Austin last Spring. She was earnest in her desire to offer me some kind of support that worked with my schedule and their available resources but she had to admit that there was very little they could do to help a woman in my situation. “We just don’t have the resources for your particular needs; all of our support groups are co-ed and we currently don’t have a therapist on staff with the right kind of training or experience that would benefit your particular situation. We’re trying to find a way to create it, but unfortunately there isn’t a lot we can do right now.” Mothers need support, especially during their first year postpartum. Either the VA needs to find a way to develop and provide it or agree to outsource it to a civilian provider like they do prenatal care and help the veteran cover the cost, if not cover it fully themselves. Many women’s health clinics currently have breastfeeding support groups for veterans who are nursing. I don’t think it’s out of the realm of possibilities to create a group that supports our mental health as well.

 

This experience has taught me a lot about the ups and downs of having the VA manage my mental healthcare as a pregnant and postpartum veteran. Strides in women’s health have been made over the last decade at the VA, but there is still more work that needs to be done. I’m hoping that sharing my experience exposes a critical gap in care and lends to the demand for change overall at the VA that’s currently taking place. We’ve been warriors for our country, and I hope the VA will honor our service by helping us and our families have the strong starts we deserve.

 

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How The VA Healthcare System Can Help Pregnant and Postpartum Veterans, pt. 1

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IMG_4403I’m what the Department of Veteran Affairs call a “100% service-connected OEF/OIF disabled veteran.” As such, I am entitled to a host of benefits, the most comprehensive being that of healthcare. When I first separated from the Air Force in 2006, I was a pregnant single mother caught up in the crash landing that is transitioning into civilian life. I spent the last two trimesters navigating unemployment, acquiring social services, and the waiting game every person who applies for disability compensation through the VA does. At the time, the VA’s standard policy was to outsource all prenatal care, cover the costs of labor and delivery, and provide insurance coverage for newborns during their first seven days…but only to those women veterans who were in their system and registered as disabled veterans, regardless of their rating. As a newly separated airman who had just filed my claims, I was unable to utilize the VA healthcare system for my prenatal care and had to apply for Medicaid through the state of Maryland.

Since that time, the VA has made significant strides in expanding the range of services it provides for women veterans, placing an emphasis on making these services more comprehensive in the women’s health department. Now they go beyond just covering the cost of prenatal care and delivery. They’ve hired maternal outreach coordinators who act as a liaison between pregnant veterans and the VA, provide breast pumps for nursing moms, cover the costs of nursing bras and lactation consults, and have breastfeeding support groups for new moms at their women’s health clinics.

The one area where there still remains a significant gap in care, however, is in that of the mental health of pregnant and postpartum veterans. My recent experience as a pregnant and postpartum veteran with the VA healthcare system has been complex. During this last year it was less than ideal; full of starts, stops and dead ends that left me incredibly frustrated and disheartened at times. However, I do believe wholeheartedly that the VA desires to improve their quality of care for women veterans. I’m grateful for the efforts they’ve made to remedy where they’ve misstepped in my particular case. After navigating this system both during pregnancy and over the last 12 months postpartum, I’d like to offer suggestions as to where and how I believe VA healthcare can remove current barriers to treatment and provide adequate, comprehensive care to pregnant and postpartum veterans; particularly those with mood disorders.

Treat Pregnant Veterans with Existing Mental Health Conditions

When I found out I was pregnant, my primary care doctor at the VA outpatient clinic told me to quit my medications immediately and wait for a call from my psychiatrist. I did, and never received that phone call. I instead received an appointment card in the mail two weeks later with a date and time to see her in her office. At that appointment, my psychiatrist told me that for someone in my “condition” (having bipolar disorder), getting pregnant was irresponsible. When I told her I’d like to discuss my treatment options and wanted to know what she thought about my staying on at least my mood stabilizer she laughed and said my only option was to go medication free-anything else would put my baby in danger and cause him irreparable damage. When I raised concerns about my increased risk of relapse due to having bipolar disorder and a prior incidence of PPD, she dismissed them completely. When I told her that my civilian OB (who the VA had outsourced my prenatal care to and who also happened to have extensive experience in treating pregnant women with bipolar disorder) had given me his suggested treatment plan and that it involved me staying on at least two of my medications, she got angry and told me that if I wanted to listen to him, then fine, but she wouldn’t treat me. Two weeks after that appointment I found out she cancelled my prescriptions when I called for refills. I had to go to my OB and request that he provide me with my medications, which he thankfully did. He also called the VA mental health clinic and advocated for me, insisting that they remain in charge of my mental health care.

It went all the way to the Chief Medical Director of the Women’s Health Clinic for Central Texas, who relayed this message to the maternal outreach coordinator who had been trying to help me as well:

 “The VA can’t assume responsibility for anything that may happen as a result of her staying on these medications during her pregnancy. Our psychiatrists are not experts in this area whereas a private obstetrician is. If he says these medications are safe for her to take during her pregnancy and he will write her a prescription for them, then she can bring that prescription to the VA pharmacy in Austin and we can fill them that way. If something were to happen, then this private OB is the one responsible, not the VA. Unfortunately this is what we have to do in situations such as this.”

While I understand the desire to avoid liability, I fail to see how flat out refusing to treat a veteran who’s been in your care is striving to provide the best level of care for a population you’re committed to serving.

As a result of serving in Iraq (Operation Iraqi Freedom) and Afghanistan (Operation Enduring Freedom), as well as the alarming prevalence of sexual assault in the military, many women veterans suffer from mental health conditions such as PTSD, bipolar disorder, anxiety, and depression.  As such, it places them at particularly higher risks for developing antenatal and postpartum mood disorders should they become pregnant. Refusing to continue to treat these veterans during such a critical time in their lives is negligent and dangerous, as is telling them the best thing to do is quit their medications cold turkey. You cannot leave these women out in the wind to navigate the journey through pregnancy alone.

Eventually, I was assigned to a psychiatrist on staff with a background in pharmacology who agreed to work with my OB’s treatment plan and offer input.

 

I would love to see the VA do away with such a harmful policy and replace it with one that is collaborative with the civilian providers they outsource care to, as well as guided by current research. My fellow veteran mothers deserve that.

Tomorrow, I’ll be sharing more of my thoughts on this. Stay tuned.

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Support for Military Moms with Postpartum Mood Disorders

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On this Veteran’s Day, the Postpartum Progress community would like to send out a giant thank you to all of our brave and dedicated military men and women, as well as a special note of thanks to the families who continue to make sacrifices on the home front.

Military MomImage via Pinterest

Military moms, including veterans, those on active duty, and the spouses of service men, can be at greater risk for postpartum mood disorders. So today, as we offer our thanks and support, please take this opportunity to think of the military moms in your life. Do you know a pregnant or new mom who has been in combat? Do you know a mom who’s spouse is currently on deployment? Does she seem to be struggling?

Are you a military mom yourself? Are you struggling?

It is vital to watch out for the symptoms of postpartum depression or other mental illness. Here are the signs in plain mama English. Take a moment today to familiarize yourself and bookmark this page in honor of our veterans who need support.

If you recognize the signs in a loved one, it’s so important to reach out to them, and help them find professional support.

If you are struggling yourself, I know from experience that opening up about these feelings is very scary. You may be feeling like a failure as a mom. A few years ago, I know I felt that way, but please believe me, it’s not true. Reaching out is the first step to true healing.

With your military training, postpartum depression may also leave you feeling weak. Why can’t you just use your skills to pull yourself up and push through?! Because postpartum depression doesn’t work that way. It’s a genuine illness that needs medical treatment, just like if you were wounded in combat. A doctor must help you to heal. But please know, you are absolutely not alone in this battle and if you reach out you can win the fight.

Please keep this list handy if you or a loved one needs help and support.

RESOURCES FOR MILITARY FAMILIES:

Military OneSource Confidential Help Call: 800-342-9647

Veterans Crisis Line Free Confidential 24/7 Support for Veterans and their friends and family. Call: 800-273-8255 and Press 1, or Text 838255. Online chat is also available.

PSI Support for Military Families

Are you familiar with other mental health resources for military moms? Please post them in the comments. 

Also, please don’t forget about our own Postpartum Progress Private Forum, a free peer to peer online forum for women with perinatal and postpartum mood disorders. Connecting online with others who “get it” has been a huge part of my own healing process, so I highly recommend it. Here’s how to join:

1. Go to this link: https://smartpatients.com/postpartumprogress
2. Underneath the Warrior Mom logo on the left hand side of your screen, input your email address and click “Request An Invitation.”
3. You’ll then receive an email from Smart Patients inviting you to join Smart Patients. Be sure to check your spam file if you don’t see it in your inbox. 
4. Click the link in the email and choose a name and password.
5. You will then be automatically added to the Postpartum community on Smart Patients. From that point on, clicking this link –https://smartpatients.com/postpartumprogress — will take you to the community

Thank you again to our Veterans and military service people. We support you today and every day.

If you are a military mom who has fought through a postpartum mood disorder and won, we’d love to share your story and your learnings with our community. Please contact cristicomes@gmail.com. 

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