Tuesday, January 15, 2019

My Mental Health Education: A Tutorial

Since my eldest was diagnosed with severe general anxiety disorder nearly 5 years ago, my family has learned so much about resources available to help those with mental health issues. The good news is that there is more available today than there were then. The bad news is that there still aren't enough resources for everyone who needs help, leading to long wait lists for specialized services, hampered further by insurance companies' unwillingness to pay. Try telling your suicidal teenager to hold off on acting on those feelings until a bed opens up.

Unlike services for physical ailments, the kinds of options available for mental health care are not widely known to people until they need them.

Develop a weird rash? See a dermatologist. Have a strange skipping heartbeat once in a while? See a cardiologist. Develop life-stopping anxiety? See a...psychiatrist? Psychologist? Therapist? All of the above? Do I need cognitive behavioral therapy (CBT)? Dialectical behavior therapy (DBT)? Eye movement desensitization and reprocessing (EMDR)? Most people have an idea of the kind of specialist to go to for physical ailments; even if they didn't, they could go to a general practitioner who would steer them in the right direction. But for mental health care? Better start educating yourself.

I have recently helped steer a friend through a mental health crisis for her daughter. She is grateful because if she didn't have a friend to lean on, she wouldn't have known where to turn, and the hospital where her daughter is right now is not about educating her, just getting her daughter healthy enough to leave the hospital.

So I thought I'd share some of the education that I've learned for those who may need it. My disclaimers:

1. These are the terms as I've defined them through our family's experience. They're probably not the "right" ones, but they work for my understanding as a parent and advocate trying to get resources for my children.

2. I'm not intentionally ignoring other mental health conditions like schizophrenia, bipolar, manic disorders and others. I just have no experience with them, so I only speak to those resources that treat depression and anxiety/OCD.

Inpatient care is almost 100% reserved for those whose condition has deteriorated to the point that ending their lives is a viable option to them. Both of my kids' primary diagnosis is anxiety, but at that point in their lives their anxiety was so uncontrolled that it caused suicidal thoughts. Just because your kid does not have depression does not mean you won't encounter these programs in the course of his/her treatment. I have learned that depression and suicidal thoughts can be and often are completely unrelated.

First, the basics of who's who:

Psychiatrist/Psychologist/Therapist: The psychiatrist is the only one who can prescribe medications, the other two can't. We honestly have never used psychologists in our daughters' care, only therapists and psychiatrists.

If your child is in an inpatient program, the psychiatrist is the head of the care team. All decisions regarding your child's care will be run by and approved by him/her. Connect with this person daily if possible for updates and discussions on treatment.

For outpatient care, the therapist tends to head up the care for your child and the psychiatrist is one of the members of the care team.

Kinds of treatment programs:

Inpatient: This is when the child is in the hospital 24/7. There are different kinds of inpatient care, though. We've had experience with two.

Acute or Lock Down Units: This is for children and adolescents who are actively suicidal, meaning they have the thoughts, plans and intent to end their lives. These units have extremely limited visitation hours, limited contact with outsiders, restrictions on clothing and other items that can be used for self-harm. If your child is not actively suicidal, this is not the right fit for him/her. For both of our children, if they have been on a lock-down unit it would have made their anxiety so much worse.

Sub-Acute or Intensive Treatment Unit (ITU): This is a step down from a lock-down unit, still has some restrictions on clothing allowed (no draw strings, no shoe strings allowed) but much fewer restrictions in other areas.

Both of these provide the reassurance of 24-hour care to ensure that patients are safe. Parents of kids who have ever been suicidal know the fear of falling asleep at night and hoping that their children don't do anything to themselves while they're sleeping. Ready for bedtime? Not tonight, thank you, I'll sleep after my kid's gotten help.

These programs also provide group therapy, one-on-one therapy, family therapy and psychiatric care on a daily basis.

Outpatient: Outpatient means that they do not stay overnight in a facility. Both of my kids started with outpatient, went to inpatient briefly, then back to outpatient. Some kids start at inpatient because their mental health reaches a crisis point. Either way, they will go back to outpatient care. These are the kinds of outpatient programs we've learned about.

PHP (Partial Hospitalization Program):  This is an outpatient treatment program that lasts 5-8 hours of a person's day, making attending work or school difficult. Most people take a leave of absence while in a PHP. PHPs can sometimes be in a hospital, but many now are in clinics that are fully outpatient based and look nothing like a hospital. PHPs have daily one-on-one therapy, group therapy, time for patients to do whatever "assignments" they need to do for their mental health, and psychiatric care, as well as family therapy as the family is able.

"PHP" is the biggest misnomer of the entire mental health care system. This term has been around for 50 years or more, it needs a new name.

IOP (Intensive Outpatient Program): This is a program that lasts between 2-4 hours per day. It has many of the elements of a PHP but in shorter spurts. Not every element occurs every day; group therapy may occur once or twice a week instead of daily. It's another step back to normalcy, when mental health treatment no longer takes up a significant portion of each day.

Therapy: The last and usually longest step in returning to full mental health. For my daughter who recently completed an IOP program, she went back to her therapist on a 3x/week basis for a short time, then stepped down to 2x/week, hopefully back to 1x/week at some point. There are so many kinds of therapy, I'm just going to point you to a WebMD article that I think does a great job of summarizing all of the different kinds of therapy available. Click away.

Depending on your child's condition, your child may need to go from an inpatient program to a PHP program to an IOP program. And...the inpatient hospital may not always make the best recommendation. We wish we had known what a PHP program and IOP were back when our eldest was in the hospital. (Although there were very few if any IOP programs in the area at the time.) PHP programs existed then; the hospital she was in had one the floor above her! But they never recommended it for her, they said she would be good going back to once-weekly therapy. I believe she would've had a quicker road to recovery had she received intensive help right after hospitalization.

We also learned that lapses in care are extremely detrimental. We've had gaps in therapy for our oldest, once when her therapist left the practice and it took us a few months to find a new one, another time when the second therapist we connected her with was not a good "fit" and we didn't make her go until we found yet another. Like strength training, if you don't do it, you lose what you build. She regressed in both time periods and because anxiety is an invisible illness, we had no idea how badly her mental state had gotten until another crisis occurred. Now we are paranoid about making sure there are no gaps. If her therapist ever has to cancel we find another day within the week to replace the session, and for the holidays we schedule around days off far in advance, especially because her anxiety is highest around the holidays (like it is for many).

For some, maintenance care means therapy on a consistent basis for years. THIS IS TOTALLY OKAY AND DOES NOT MEAN A PERSON IS CRAZY. I see my chiropractor every two weeks if I want to avoid getting migraines. Why would I ever judge someone for seeing a therapist consistently for decades? Do it if it keeps you healthy.

And there you have it, everything I know about mental health resources in a nutshell. Of course, I wouldn't know ANY of this if I hadn't been open with others about what my kids were going through. Once I started telling friends and neighbors about what was happening, I learned that they had gone through similar challenges and I got educated from them. Many people had struggled with advocating for their child's mental health and no one ever knew to help! My point is...we can't solve the problem when we don't talk about the problem. I hope this guide helps even once person navigate the system.

Sunday, January 13, 2019

High Density Housing ≠ Highly Affordable Housing

This is a complicated issue, I'll try to make it brief. So the reader knows I'm not talking out of my ass without making this the length of a novel, I'm using lots of links to referring material.

The city of Minneapolis recently approved a 20-year growth plan called "Minneapolis 2040." It sets a vision for the city of Minneapolis in terms of housing, transportation, living-wage jobs and more, all with an underlying goal of eliminating disparities in our city.

Eliminating disparities?

You know how you drive through one neighborhood and it looks "tough," and you know you wouldn't want to be caught walking down the street after dark there, and you go to another neighborhood and it's got beautifully manicured lawns and luxurious homes? The disparity in which people of color tend to live in the first neighborhood described, whites in the second?

THAT disparity, which was brought about by redlining, which as recently as 50 years ago allowed people to discriminate on the basis of race, not allowing people of color to buy homes in certain areas of the city. This was further strengthened by zoning some areas as single-family and others as high-density, meaning that even if you had the "right" color skin you had to have the means to pay for a larger home. Which, people of color didn't tend to have back then, due to discrimination in job accessibility, transportation to those jobs, etc. There's a lot to fix.

Don't get me started on that weird jog in Interstate 94 that occurs in Minneapolis, either.

I am ALL FOR eliminating disparities. I would WELCOME varied housing in my area, I would VALUE sending my children to a school that is not 85% white.

The main ways in which Minneapolis is addressing this is to eliminate zone housing, making some neighborhoods single-family and others high-density. They would like to see a variety of densities spread across the city, so that people of varying income levels can live in many different areas of the city. The idea is that an apartment is more affordable than a duplex which is more affordable than a house, and if they're all on the same street then people of varying income levels can live there. It sounds great, but in practice, already it is not working.

Take these two homes, for instance. Caveat: they are not in Minneapolis, they are in Edina, but across the street from Minneapolis, and are a great example of how people interpret "high-density."

These are both duplexes. The first was built in the 1950's, the second was built in 2017 and sold in January 2018. The second was built on the site of a cute 1950's bungalow, which lives on in Google Streets memory.

Hey everybody, high-density housing! Surely they are both affordable, right?

According to the listing for the 1950's duplex, it rents for $1,495/month for a 1,350 sq ft. duplex. The latter, built in 2017, is 3,049 sq ft and was sold for $866,000. Zillow estimates that the rent for this duplex is $3,152/month.

On paper, they are both duplexes. In practice, they are wildly different. As a matter of fact, the home that was torn down to make room for the monstrous duplex was valued at $353,000 prior to being razed, an incredibly affordable home in Edina.

The best part? These two are right next to each other. You can see the disparity in size in this photo:

I bet that little duplex is missing the sunlight it used to get from its eastern exposure. No more sunrises for you, little guy!
The same thing is already happening in Minneapolis in light of the move toward high-density housing across the city.

Take, for instance, Ewing Place Apartments, being built just three blocks from us at the corner of Ewing and 51st Street.

Architect's rendering of Ewing Place, currently under construction.

Here's what used to be there:
Three little houses, all in a row.
Awww, aren't they cute?! The perfect starter home for a couple. Check out this cute little guy:

Seriously! One bedroom, one bath, 544 sq feet, built in 1920. So cute! It was sold in 2001 for $105,000.

The person who purchased that home in 2001 also purchased the other two next to it, and they were all rentals. Various families and couples would rent for a time, and he sold all three to a developer who tore them all down to build the coming Ewing Place apartments.

So...how affordable will these places be once the "high-density" housing is available?

According to the website for Ewing Place, they will rent you a 709 sq ft one-bedroom apartment for $1,935 per month. The largest floorplan available with 1,355 sq ft will rent for $3,618 per month.

So, let me get this straight:

We removed THREE tiny little houses, all renting very affordably, to build a high-density apartment building, with rental rates THREE TIMES that of the original homes?

Got it.

I understand the goals of the plan, truly I do, and I also want the same thing, but I do not believe that the changes that were made will have the desired impact. High density does not equal highly affordable. Not to mention the loss of history of homes that were approaching 100 years of age.

There's more, much much more, but I will save that for another blog post.

Saturday, January 05, 2019


The Floria-Horsman Christmas tree, 2018
Growing up, my mom used to make sure there was at least one piece of Christmas décor in every room during the holidays. This included my sister's and my bedrooms, which often had to make room for a Santa or reindeer on our dressers. Wreaths on doors, mistletoe hanging, beautiful centerpieces on tables, and, of course, the tree. Our home was warm and inviting all year round, but especially during the holidays.

As a kid, I looked forward to some day decorating my own home with similar items when I grew up. And then I grew up. And I realized that everything that comes out has to be put back away.

The undecorating. Ugh.
Sure, it's lots of fun to decorate the house for the holidays. It's an exciting time, you're looking forward to time with friends and family, and it's nice to spruce things up. But then, come January 1, the holidays are over, gifts unwrapped and put away, meals shared and guests gone, and everything has to go back. I hate the undecorating, it is the worst. Which means, of course, I procrastinate.

We don't procrastinate on the tree, of course, because we don't want a fire hazard in our house. But everything else? It could be February or even March before the last pieces of décor get put away. That is, if I was the only person in charge of the undecorating.

But, if you know anything about my other half, I am not the only one who can undecorate, and this particular person gets incredibly annoyed at having Christmas decorations out in February. So, if the décor is still out by January 31st, he dutifully goes around the house, gets everything picked up, and puts it away.

Therein lies the rub.

I have specific boxes for specific items, and each box has written on the outside what is supposed to go inside. This does not seem to matter, though, as each year, when I start to decorate, what I find in each box is usually different from what is written on the outside.

This year the box marked "Standing Santa" had a reindeer in it. The standing Santa never made its way into a box, while the box the reindeer was supposed to be in was utterly empty on its shelf.

I shouldn't complain, honestly, I appreciate that he does it. After all, he didn't unpack it, so he doesn't know which items came from where. Sure, it's clearly written on the outside of each box, but his goal is to put away, not to put away correctly. Over the years, it has created some funny findings.

I have a nativity set given to me by a family very dear to me, made of fragile ceramic. Each year, I find this set packed into a different box. Four or five, to be exact, all of which have said at one point or another "nativity set" on it, and either had it crossed out (or not), and had something else written over it. Or it still says "nativity set" but what's inside isn't.

If a stranger came into our house and looked at our storage area, he would wonder how many nativity sets one family needs.

But finally, this year, we have a teenager who cares. She cares as deeply as her father that not only does the house get decorated, but that it also get undecorated in an orderly fashion. God bless their genes!

Lindsey helped me decorate the house this year and was horrified by the state of the boxes and packing the décor was in, though she did enjoy reading up on the news of the times from 1997. She insisted that we go through all of the boxes that ever had "Xmas" scrawled on them and pull everything out. We found decorating items that she has never seen in her lifetime; we never use them. We purged the stuff that was never used and put out the items we wanted out. Then, on December 26th, we hit "The Christmas Corner," a pop-up store in Southdale Mall with beautiful Christmas décor and bought some new items at 50% off.

Just this past week, she and I undecorated. She insisted we buy a large RED tote, so we could instantly see which tote had Christmas items in it without even having to read the writing on it. Color coding?! What a novel concept!

We took every piece of Christmas décor down from around the house, put it all in the middle of the living room and began to pack. Okay, so I packed it, she directed from her sickbed, the couch, where she has been suffering from a miserable cold for the past week.

At the end we had two large totes and four small boxes of Christmas decor, and one empty shelf in our storage space.

Now I'm kind of looking forward to decorating next year and putting up the new items we purchased for the first time. And...putting them back where they belong.