Why “Just Getting Help” Is Easier Said Than Done

When you struggle with mental illness, everything is a chore. Getting out of bed. Talking to people. Routines, whether it be sticking to them or dealing with them being disrupted. It’s hard. There are things that help. Coping skills, therapy, medication, behavioral therapy tools, etc… But sometimes getting access to these is difficult.

 

I recently switched back to Kaiser Permanente as my health care provider. I have been away from them for three years now. In those 3 years, I maintained regular therapy, saw a psychiatrist, and *finally* got on a medication and dose that works for me. Coming back to Kaiser, I need to get in to see a psychiatrist and make sure that I stay on my meds, as one of the worst side effects (lethal rash) is most likely to occur when you aren’t on the medication regularly. Here are the steps involved in getting in to see a psychiatrist if you are a new patient (which I am, even though I had Kaiser for most of my life, and was a mental health patient with them for three years).

  1. Call the phone number on the mental health directory website, sit on hold for 2 minutes, have call answered by someone who can’t help you.
  2. Be told that I actually have to call another number, because this is the general line, and you have to call the general line first to be assessed for an emergency situation before you can call the mental health department.
  3. Call the mental health department, sit on hold for 3 minutes, speak to someone who tells you “you haven’t been here in a long time, you need to speak to triage,”and be transferred to triage.
  4. Wait 5 minutes on hold before a triage nurse answers. Answer some very pointed questions from the triage nurse (“You aren’t having thoughts about hurting yourself or someone else, riiiiiiiightttt?”) and then be told that a manager will call you back in 1-2 business days.
  5. When the manager calls you back in 1-2 days, they will do a slightly more in depth assessment and give you an appointment to see a therapist (even if you have been seeing the same non-Kaiser therapist for 3 years) 1-2 weeks out from the call.
  6. In 1-2 weeks, you will see the therapist, who will do a much more in depth assessment, and then get you an appointment with a psychiatrist approximately 4-6 from the day of your therapy appointment.
  7. Approximately 8 weeks from when you called, you will see a psychiatrist who can then prescribe you the medication you have been taking for 2 years. There is no guarantee that the psychiatrist will agree with your medication, and may attempt to change type or dosage of your medication.

This is arduous. It feels invasive and exhausting, even on the best of days. And there has to be a better way. There just has to be. I was told today that my primary care provider can prescribe a bridge dose for me until I see a psychiatrist, which is a blessing. But it is also another appointment, another copay, another person poking and prodding and asking the questions you come to dread when you struggle with mental health.

The stigma and baggage that comes along with depression, anxiety, bipolarity, BPD, PMDD and the like is already pretty overwhelming. When you add the hoops that need to be jumped through to get care, it’s overwhelming. I also made 3 appointments for my kids today and an obgyn appointment for myself. If I can make those appointments online, in seconds, easily and conveniently, why can’t we do the same to treat mental illness?

World Mental Health Day

One of my most favorite bloggers and mental health champions posted on her really wonderful blog today, and she inspired me to write as well.

Today is World Mental Health Day. It’s a day to bring awareness to the struggles that are associated with impaired mental health. It’s a timely reminder for me that I am not alone, because I have indeed been feeling so very alone.

My most recent bout with depression has been sitting on my shoulders for over a month now. It weighs a little more each day. It whispers something a little uglier in my ear every day. It dulls the colors and joy of my life, one day at a time. It is exhausting. Exhausting down to my bones, to my soul.

It’s not fun to talk about- depression makes other people uncomfortable or concerned. I can’t just wallow, and turn the world off. I have obligations to my kids, to my work, and to my education that prevent me from just staying in bed, even if that’s what I want to do. I have to paste that smile on and get shit done, because I know the me on the other side of this fog will be really upset if I gave up on her and her goals. But they feel like her goals, not mine. So I go through the motions, because I know she is waiting. 

Every mistake and bad choice I have ever made weighs on me. My life feels like a series of errors I will never recover from. Every achievement feels hollow, undeserved. I feel like the perpetual screw up. People will argue this point, refute it, insist that I am not in fact the pathetic loser I feel like I am. But the problem is, the depression lives inside of my head. It has a louder voice. It drowns out the positivity. It clouds everything around me. I can’t keep track of days, time, chronology, appointments or assignments. It all just becomes two grey areas of bitter past and looming future.

I am lucky- I have gotten to a point of acceptance and rationality that I did not have in the past. I can’t reconcile what the depression says with what the reality is. I can’t even really believe what I currently consider reality. But I do know, KNOW, that this is temporary. I will come out on the other side. I always have, and I always will. And while I feel like I am treading water in wet cement with an elephant on my back, it’s temporary. 

Today my therapist told me that I am a survivor, that I am a warrior. I don’t feel that way about myself. But I DO feel that way about the people I have known who have struggled with the demons that come along with bipolarity, depression, anxiety, BPD, and PMDD- that’s just to name a few. To me, they are warriors, survivors, champions. And if they are, that must mean that to someone else, I am. We are badass. We surmount obstacles and defeat odds that feel impossible. Obstacles that, for our fallen friends, were impossible. But we keep going. We breathe, we try to get out of bed, we will ourselves on in the hopes that tomorrow will be brighter. We force ourselves to remember there is a light, and to work our way, however slowly, back to it.

Today is a reminder that we are not alone. 

Molasses

Sometimes the cloud doesn’t lift on its own. I keep waiting for it to. The diagnosis I prefer to lean towards is PMDD, because my symptoms are heavily influenced by my cycle. But when the depression lingers and lingers, when I can’t catch my breath between cycles, it’s hard to remember that it will ever lighten up. 

It feels like swimming through molasses. I’m moving, but it’s arduous. And uncomfortable. And damn it, some days I am just ready to give up. 
So I go down the checklist:

1. Am I physically tired? It’s nearly impossible to function properly when you’re sleep deprived.  Did you know one of the most common reasons for wanting to commit suicide is “I’m just so tired”?And often, that’s literal exhaustion. The insomnia, trouble staying asleep, and trouble gathering energy are all depression side effects. So, do I need a nap? Have I been getting 4-5 hours a night instead of 7-8? Not getting enough sleep is my number one depression trigger.

2. Have I gotten any exercise? I work a pretty physical job, but it doesn’t put out the same endorphins that a solid workout, swim or hike does. It’s beyond difficult to find the energy to exercise when I feel like I am trudging through quicksand. But diet and exercise play a huge role in feeling better. Which brings me to…

3. Have I eaten, and have I made healthy choices? I have a tendency to eat my feelings, often in the forms of cheeseburgers and ice cream. Or I just don’t eat, because I don’t feel like it. Neither of these choices do me any favors. Forcing myself to eat more healthily when I am depressed is *hard*. If I feel like hell, I may as well eat the food that tastes best to me. Except when I’m depressed nothing tastes all that great, and I get the added bonus of struggling to lose weight after I make unhealthy food choices. Lose-lose.

4. What productive self care have I practiced? Have I showered? Have I knocked anything off of my to-do list? Sometimes self care isn’t indulgent. Sometimes it’s forcing yourself to go to the dentist, or get gas, or return the shirt that fit like crap. And the feeling of productiveness that comes along with this is a bonus.

5. What fun self care have I practiced? Reading a book, going to a movie, coloring, driving, singing- everyone has something. Making sure I do something enjoyable for myself is important. But it doesn’t help all that much if I’m tired, hungry, and blew off another responsibility to do something fun.

6. Have I talked to anyone? This can be a psychiatrist, therapist, family member, friend, or finding someone on an app like Talkspace. It’s incredibly important to have some sort of support system, especially in times of difficulty. Having someone you can vent to, complain to, lean on, and hold you accountable is crucial.
If I can make sure all 6 of these have been achieved in some way or another, I’m usually doing pretty well. But if I get to the end of the list, and I’ve checked them all off and I still feel like crap, it’s not the end of the world. Even when it feels like it is. I take a deep breath, and focus on a time when I felt worse. And then I focus on a time when I felt better. Reminding myself that I’ve gotten through it before helps me to believe that this really will pass.
It’s molasses, not cement. I will come out on the other side.

Today, I win.

As I lay in bed this morning, my body hurt from exhaustion. I’m sleep deprived, which is bad news for someone who suffers from depression. I’m frustrated with the way my new semester is going. I’m still recovering from a pretty gnarly bout of PMDD. And I absolutely do not want to get out of bed.

The internal struggle was real. I was coming up with different game plans, ways I could avoid my responsibilities and not feel like a total slacker. The benefit of being an over achiever on the surface is that I can slack off and still look like I’m keeping up. It was decided. I was going to stay in bed, blow off class, and try to get more sleep.

Except, I didn’t. School is important to me. I know that. Even as I’m telling myself that it doesn’t matter, I know below this layer of fog and exhaustion and apathy that it does. So I got my ass out of bed. I put my hair up, and it looked stupid. And I thought,”Screw it. I’m going back to bed. Even my hair is against me going.”

But I didn’t go back to bed. I went to school. Eff you, depression. You don’t get to make my decisions or sabotage me. Not today.

I don’t know what tomorrow will be like. I don’t know how I will feel. But I do know I’ll be able to tell myself, “if you did it yesterday, you can do it today.” And some days, that’s all I’ve got in me. Today, I win.