Keys to Mental/Emotional Wellness and Recovery
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Proudly affiliated with
Keys to Emotional Wellness and Recovery including A Guide to the Monmouth County Social Service, Rehabilitation, and Mental Health System Join us on the road to Wellness and Recovery
NAMI Greater Monmouth PO Box 6212 • Freehold NJ 07728 Please Call or Email Us
NA 732-4NAMI-4U (462-6448)
[email protected] QUICK ACCESS SERVICES Please consider reaching out to us as a first step finding a resource. You can chat with your peers at our support groups, or call our NAMI Helpline any day at 732-4NAMI-4U (462-6448). Psychiatric Emergency Services for this county are provided by Monmouth Medical Center, with significant state funding. They can be contacted at * 732-923-6999. Several warnings about risks of forced hospitalization and police involvement apply to this service and the others marked with a * below. We suggest that you look at the warning regarding crisis services on page 25. Non-emergency services (e.g., medication management and psychotherapy to help avert a crisis) are available from the Early Intervention and Support Service, reachable at 732-922-1042. NJ residents dealing with mental/emotional wellness issues will want to be aware of three helplines operated by the Mental Health Association in NJ under state contract: * 866-202-HELP (4357) the statewide mental health service information and referral line. www.njmentalhealthcares.org 877-292-5588 the statewide peer support warmline, where people can find non-crisis support every day from people with the experience of dealing with mental/emotional issues.
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Self-Help Group Referrals throughout the state can be obtained by calling the NJ Self-Help Group Clearinghouse at 800-367-6274, or visiting www.njgroups.org. Individuals who are experiencing a mental health crisis and are seeking a place where they can work through the crisis with peer staff, rather than going to a hospital, may wish to use one of the new Peer Respite Houses funded by the state of NJ. A person seeking this kind of service must be willing to handle their own personal care, medication, and meal preparation. The Peer Respite Houses in Middlesex and Ocean Counties will welcome Monmouth County residents on a space-available basis. Collaborative Support Programs of NJ, New Brunswick, 732-354-4403 Legacy Treatment Services at Crosswinds House, Toms River, 848-221-3022 The state of New Jersey funds the following six specialized helplines operated. 844-REACH-NJ (732-2459), NJ Addiction Services Hotline, for assistance finding substance abuse treatment and support in NJ. www.reachnj.gov * 855-NJHOPE5 (654-6735), for in-state access to supports or help when suicidal www.njhopeline.com 866-COP2COP (267-2267), for NJ law enforcement officers and their families 866 VETS-NJ4 (838-7654), for veterans returning from service in Southwest Asia and their families 800-328-3838, for women/families dealing with post-partum depression 877-914-MOM2 (6262), for peer help and referrals for moms of special needs children Other suicide prevention lines are available at * 800-273-TALK (8273) or * 800-SUICIDE (784-2433). Some crisis and non-crisis services for children and teens are listed on page 28. People who want help dealing with an acute parenting problem can call Parents Anonymous at 800-THE-KIDS Contact information for AA, AlAnon, NA, and NarAnon is on page 9. With natural and “human made” disasters occurring frequently, the US Substance Abuse and Mental Health Services Administration (SAMHSA) has launched a Disaster Distress Helpline. This service offers 24/7 free, multi-lingual and immediate crisis counseling and support Call 800-985-5990 or text 'TalkWithUs' to 66746. http://disasterdistress.samhsa.gov.
Table of Contents Quick Access Services................................................................ 1 Introduction ................................................................................. 3 The Keys to Mental/Emotional Wellness and Recovery .........4 I. II. A. B. C. D. E. F. G. H. III. A. B. C. D. IV. V. VI.
MANY THINGS AFFECT OUR MENTAL/EMOTIONAL WELLNESS ................. 4 WE SUPPORT EACH OTHER IN MOVING TOWARDS EMOTIONAL WELLNESS AND RECOVERY 4 Common Characteristics of Peer Support Groups ................... 5 Choosing a Support Group ........................................................... 5 How Does NAMI Run Support Groups? ...................................... 5 Where are NAMI Greater Monmouth Support Groups? ........... 6 What Else Does NAMI Offer? ....................................................... 7 What Other Support Groups Are Available? .............................. 8 Community Wellness/Self-Help Centers.................................... 9 Peer Support for Substance Use Recovery and “Co-Occurring Disorders” 9 WE STRIVE TO UNDERSTAND RECOVERY AND WELLNESS ..................... 10 SAMHSA Definition..................................................................... 10 Guiding Principles of Recovery................................................. 10 Dimensions of Wellness ............................................................ 11 Three useful websites for learning more about the “nuts and bolts” of recovery EMOTIONAL WELLNESS AND RECOVERY REQUIRE MEANING AND PURPOSE11 EMOTIONAL WELLNESS AND RECOVERY REQUIRE GOOD COPING MECHANISMS 11 EMOTIONAL WELLNESS AND RECOVERY REQUIRE MINDFULNESS AND PLANNING 12
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Keys to Mental/Emotional Wellness and Recovery A. B. VII. A. B. VIII. IX. A. B. C. D. E. F. a. b. X.
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Mindfulness ................................................................................. 12 Wellness Planning ...................................................................... 13 EMOTIONAL WELLNESS AND RECOVERY REQUIRE – AND BUILD – EMOTIONAL STRENGTHS AND EMOTIONAL MATURITY The Four Agreements ................................................................. 14 Coaching ...................................................................................... 14 EMOTIONAL WELLNESS AND RECOVERY REQUIRE PHYSICAL WELLNESS 14 EMOTIONAL WELLNESS AND RECOVERY CAN BE SUPPORTED WITH PROFESSIONAL ASSISTANCE 14 Impact of Trauma ....................................................................... 15 Informed Choice ......................................................................... 15 Overview of Psychotherapies ................................................... 15 Role of Medication ..................................................................... 16 Medicine Issues and Side-Effects ............................................ 17 Finding Professional Help ......................................................... 18 For Our Service Members, Veterans, and their Families ...... 19 Help which Bridges the Professional-Layperson Line ........... 19 EMOTIONAL WELLNESS AND RECOVERY ARE SUPPORTED WITH ONGOING LEARNING AND GROWTH 19
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What’s Out There in the Social Service, Rehabilitation, and Mental Health System 20 A. B. C. A. E. D. E. 1. 2. F. G. H. I. 1. 2. 3. 4. 5. J.
BASIC SOCIAL SERVICES ...................................................................... 20 CARE COORDINATION/CASE MANAGEMENT ......................................... 20 PHYSICAL HEALTHCARE ....................................................................... 21 A SPECIAL WORD ON SMOKING ........................................................... 21 Dental Care.................................................................................. 21 TRANSPORTATION SERVICES ................................................................ 22 PSYCHOSOCIAL REHABILITATION .......................................................... 22 Introduction ................................................................................. 22 Specific Services ......................................................................... 23 HOUSING AND RESIDENTIAL SERVICES ................................................. 23 LEGAL RESOURCES.............................................................................. 24 FAMILY SUPPORT SERVICES................................................................. 25 MENTAL/EMOTIONAL CRISIS, DIVERSION, AND AFTERCARE .................. 25 Avoiding and Preventing Crisis ................................................. 25 Psychiatric Emergency Services .............................................. 26 Early Intervention Support Services......................................... 26 Inpatient Psychiatric Care ......................................................... 26 Hospital Alternatives and Aftercare ........................................ 27 CHILDREN’S CRISIS AND MENTAL HEALTH SERVICES ............................ 28
We Depend on the Kindness of Others –How to Join .......... 28
INTRODUCTION Keys to Mental/Emotional Wellness and Recovery is a philosophy, along with a system of educational programs. We of NAMI Greater Monmouth proudly offer this model and educational programs to the community. This booklet sets out to further explore these Keys, offer useful tips, and help provide some basic information for accessing professional services and peer support. We hope the information contained here is useful to you. A good deal of what this booklet contains has changed from prior editions. As our knowledge about ways to help people deal with mental/emotional issues has changed, our service systems have changed, and we constantly research and add information based on reader feedback. We welcome your feedback.
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Please contact NAMI Greater Monmouth for information on our support groups, to arrange a presentation of Keys, to request a supply of booklets (which may be downloaded from www.namigm.org), or to request other presentations by NAMI Greater Monmouth. (Please see the table on page 7). This document was updated on July 14, 2017. Please let us know if you find things in here which require clarification or updating. Thank you. Jay Yudof, MS, Certified Psychiatric Rehabilitation Practitioner VP (Programs), 609-642-6959.
[email protected].
THE KEYS TO MENTAL/EMOTIONAL WELLNESS AND RECOVERY I.
Many Things Affect Our Mental/Emotional Wellness
Most of us live our lives with some form of mental/emotional difficulty. We may have trouble controlling our impulses, acting our age, or dealing with life stressors. We may be going through the loss of someone we love, the breakup of a relationship, or the frustrations of a custody battle. We may have physical illnesses, and be emotionally impacted by those times of pain and illness. We may have a history of trauma. We may be distressed by problems in our jobs, schooling, families, or communities1. While the mental health profession may have diagnostic categories for some signs, symptoms, and aspects of mental/emotional health issues, those are not important to those of us seeking to come together for mutual support. There is no “magic formula” for treating mental distress, but many of us would consider at least seven things as “equals”
II.
Seeing and serving the whole person, including underlying physical conditions Problems in family, finance, lifestyle need to be addressed where they occur Medication Psychotherapy Learning and applying related techniques around breathing, stress management, mindfulness, and MindfulnessBased Stress Reduction Coping skills access and wellness planning Other lifestyle improvements, notably in substance use, eating, sleeping, and exercise.
We Support Each Other in Moving Towards Emotional Wellness and Recovery
We are the Monmouth County NJ affiliate of NAMI, the National Alliance on Mental Illness. We are an association of people who have personal experience dealing with various kinds of challenges in maintaining mental and emotional wellness, and want to share our experience to help others along the journey to mental/emotional wellness. Some make the journey in their own shoes. Some are more intensely impacted by emotional issues in someone they love or care about. Keys is about adults2 working together no matter what role they are in, or how they perceive their distress. We are one of many peer support groups in the local area. We encourage you to try out our groups and educational programs, come to our conferences and events, join our association, and volunteer with us. At the same time, we recognize that there are those who may want a live or online support group whose topic seems more focused on their current needs, or whose meetings may be more convenient. All support groups are different, but also have many things in common. It may help to try several in order to make an informed choice. You can find support groups anywhere in New Jersey by contacting the NJ Self-Help Group Clearinghouse at 800-367-6274 or www.njgroups.org.
Hint: If something is challenging your emotional health, try to fix that problem, so your emotional wellness can improve. Some information in this document is applicable to children and “transition-age youth.” Currently, our focus is on adults, and most of our groups and classes, by national policy, are limited to people age 18 or over. 1 2
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A. Common Characteristics of Peer Support Groups a) These groups have an “open door” policy. Normally no appointment or referral is required, and most groups are open to members and non-members. Costs, if any, are nominal and voluntary, and people who do not have any money to contribute are generally welcome. b) You should feel included and welcome in the group. The things which bring people together are more important in a group than differences of age, gender, or personal issues. c) Your experience should be one of understanding and identifying with others. This is known as empathy. d) You should feel safe and comfortable sharing at a support group. Groups have policies about confidentiality 3, and should leave you feeling safe and comfortable sharing. e) Stigma and discrimination is left outside of the group. Support groups are places where people give and get respect. The group should have some rules which help to enforce mutual respect. f) Almost all support groups have facilitators (members who are trusted stewards) whose role is to keep the group running and the conversations effective. Facilitators vary in their amount of training in how to keep a group running. g) Support groups often have “no taboos.” They should be safe places to discuss issues which may make you feel uncomfortable. They are therefore a good place to discuss issues like “firing your therapist.” h) Support groups are a place where you can benefit from the opportunity of helping others4. You do not need a lot of experience – a little bit of empathy goes a long way. i) You will often find that a support group is a stepping-stone to helping others deal with the same issues that bring you to the group, or to helping change the system.
B. Choosing a Support Group When thinking about attending a support group, you may want to follow these steps: a) Identify a group whose documented purpose, time, location, etc. meets your needs b) Where possible, confirm the group location and schedule. Often, support groups change schedules or locations. c) Go to a meeting. You are welcome to share (speak) in your turn, or only identify yourself and listen quietly to “get acquainted.” d) Listen carefully. You are there to decide what you think of the group. Do you like the structure and rules the group follows, and how the facilitator enforces these? Do you like the way people are interacting with each other? Bottom line question: will this group be helpful to you in dealing with what you came for? e) If the answer is yes, “keep coming back, it works if you work it5.” If the answer is no, don’t come back. Go back to step a. Do keep in mind: Often the first time you try something, it may not seem right. If you are unsure, return once or twice before making a decision. Individual groups of the same association or fellowship often have a very different feel to them. You may need to try more than one meeting of the same association or fellowship.
C. How Does NAMI Run Support Groups? Like many support groups, NAMI groups follow a simple agenda: Welcome Read Principles of Support & Guidelines Opening Stories (2 minute limit) Group Discussion Closing
Of course, nobody can “make someone else” keep a secret, so it makes sense to use caution when revealing personal information. 4 This is known as the helper-therapy principle. 5 A common saying from Alcoholics Anonymous 3
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and some basic group guidelines Start and stop on time Time limit for opening stories Absolute confidentiality Be respectful Keep it in the present Empathize with each other's situation One of the key structures of NAMI Support Groups is our “Principles of Support,” a set of common aspirations which many members strive to use in understanding the issues we face:
We reject stigma and do not tolerate discrimination. We won’t judge anyone’s pain as less than our own. We forgive ourselves and reject guilt. We embrace humor as healthy. We accept we cannot solve all problems. We expect a better future in a realistic way. We will never give up hope! Stages of Emotional Response” is a tool we use in our support groups to cope with the trauma created by dealing with emotional issues. We will see the individual first, not the illness. We recognize mental illnesses are medical illnesses that may have environmental triggers.6 We understand that mental illnesses are traumatic events. We aim for better coping skills. We find strength in sharing experiences.
NEEDS
CHARACTER-ISTICS
DEALING WITH CATASTROPHIC EVENTS
LEARNING TO COPE
MOVING INTO ADVOCACY
Crisis/Chaos/ Shock Denial; “normalizing” Hoping Against Hope
Anger/Guilt/ Resentment Recognition Grief
Under-standing Acceptance Advocacy/ Action
Support Comfort Empathy for confusion Help finding resources Crisis intervention Prognosis Empathy for pain NAMI
Vent feelings Keep hope Education Self-care Networking Skill training Letting go Co-op from System NAMI
Activism Restoring balance in life Responsiveness from System NAMI
D. Where are NAMI Greater Monmouth Support Groups? NAMI runs peer-led support groups for people seeking mental/emotional wellness and recovery in themselves or dealing with the challenges faced by a family member. The most current schedule as this booklet is printed is on the back cover, and updates will appear on our website, www.namigm.org. In Colts Neck, two separate support groups run at the same time, NAMI Connection Support, for people living with any kind of mental/emotional issue, and NAMI Family Support, for family members/ caregivers of someone dealing with the mental/emotional wellness challenges faced by a family member. Currently, we only run NAMI Connection groups in Neptune.
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Which is not to say that all forms of mental/emotional distress are biologically-based mental illnesses.
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All NAMI Greater Monmouth groups are open to members and non-members with no charge to attend! Information is always available by: calling 732-4NAMI-4U, e-mailing
[email protected], or visiting www.namigm.org We are trying to launch more groups, so please let us know where you think you would like to attend a NAMI Greater Monmouth group. If you live outside of our county, you can find NAMI groups elsewhere in the state at 732-940-0991, www.naminj.org, or outside of the state at 800-950-NAMI, www.nami.org. We have over 1000 affiliates nationwide, including some on college campuses. Information about NAMI and other supports in Spanish, Cantonese, or Mandarin, or our SAMHAJ (South Asian Mental Health Awareness in Jersey) program, please contact NAMI NEW JERSEY at 732-940-0991.
E. What Else Does NAMI Offer?
HelpLine Our NAMI Greater Monmouth HelpLine volunteers are available almost every day of the year to offer information and empathy. Call 732-4NAMI-4U. Advocacy. We help our members with individual advocacy – speaking out for themselves or a loved one, as well as systems advocacy – being involved in helping to change some of the systems which many of us depend upon. Including education, mental health, and social services systems. Fellowship, from theater outings to picnics, we provide people dealing with emotional wellness challenges a chance to network and become part of a community of peers. Family-to-Family Education, a 12-session course taught by experienced family members helping others to learn about mental health problems, how to deal with them, and how to help speak out to reduce ignorance and prejudice. This class focuses on the subset of people whose own emotional wellness is impacted by a loved one’s mental illness7. Other education options for people dealing with emotional wellness, issues, including speaker meetings, literature, and statewide conferences Free community education and outreach programs, including: Program
Audience
Fee
Keys community briefing sessions These 90-minute interactive talks overview the model, and help people think about ways to maintain or move towards emotional wellness.
Teens and adults
None
Law Enforcement Education
Police, corrections, related groups
None
Education for Professionals
Healthcare and human service workers8
None
In Our Own Voice
Any group high school age or above
None
Educating the Educators
K12 faculty and staff
Nominal
Every Mind Matters Curriculum Material
Grades 5-8 and 9-12
Nominal
Hearts and Minds
Mental health treatment programs
None
Videos about In Our Own Voice, NAMI Connection
Anyone – Videos can be viewed through www.nami.org
None
NAMI presences at community events
Town and congregation health fairs, school events, etc.
None
For all of these, please contact us on 732-4NAMI-4U,
[email protected]. Support – Advocacy – Fellowship – Education – all part of helping our members to feel SAFE as they pursue mental wellness and recovery.
Many family members dealing with that kind of disparity benefit from getting and reading a copy of Dr. Xavier Amador’s I am Not Sick I Don't Need Help 8 Ask about our free one-hour in-service for home health aides 7
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F. What Other Support Groups Are Available? If you live outside of our county, you can find NAMI groups elsewhere in the state at 732-940-0991, www.naminj.org, or outside of the state at 800-950-NAMI, www.nami.org. We have over 1000 affiliates nationwide, including some on college campuses. Listed below are some support groups in our county which people with mental/emotional issues often turn to. All other kinds of support groups, as well as groups outside of Monmouth County, can be found around NJ by contacting the NJ Self-Help Group Clearinghouse. 800-367-6274, www.njgroups.org. Some bereavement groups and some faith-based groups like Celebrate Recovery or Overcomers Outreach, are sponsored by local Churches, Temples, and Mosques, and may not be publicized through the Clearinghouse. Online discussion boards are available at www.nami.org, www.dbsalliance.org, and through Yahoo Groups. ANXIETY, PHOBIA AND PANIC DISORDERS SUPPORT GROUP * Provides people with anxiety, phobias or panic disorders the opportunity to share their experiences, ideas, hopes and coping skills with others who understand. Guest speakers. Building is handicapped accessible. Meets 2nd and 4th Tues., 7-8:30pm, St. Joseph’s Church, 376 Maple Place, Keyport. Call Lisa 908-770-4755.
[email protected] DEPRESSION AND BIPOLAR SUPPORT ALLIANCE * Self-Help Support group for individuals with depression, bipolar disorder, or similar conditions. Family members may attend with individuals. The national organization (800-82NDMDA, www.dbsalliance.org) is a major player in advocacy for mood disorders services and research). Local groups meet Thursdays, 7:30-9pm. St. Mary’s Spiritual Center, Rte. 34 & Phalanx Rd., Colts Neck. Call Tom (732-320-0029).
[email protected]. Sundays, 3-4:39pm. Freehold Community Wellness Center, 17 Bannard St. Call Daniel 908-433-1993.
[email protected]. EATING DISORDER SUPPORT GROUP * Professionally run. Support group for people with anorexia or bulimia & their families. Under 18 welcome. Meets 4th Saturday 10:30am-noon, Riverview Medical Center, Board Room, 1 Riverview Plaza, Red Bank. Call Monmouth Psychological Associates 732-530-9029 (day) (ask for free support group). EMOTIONS ANONYMOUS * Fellowship sharing their hopes and strengths, following a 12-step program, in order to gain better emotional health. Meets Saturdays 1pm, Oceanport. Call Chris or Lillian 732-440-4746. www.emotionsanonymous.org. GROW * A mutual self-help group to prevent and recover from depression, anxiety and other mental health problems. Caring and sharing community to attain emotional maturity, personal responsibility and recovery. Meets
Wednesdays, 6:30pm, Collaborative Support Programs, 11 Spring St., Freehold. Thursdays 6:45pm, St. Paul's Methodist Church, 80 Embury Ave., Ocean Grove.
Additional groups are scheduled monthly at the CARE and Freehold Community Wellness Centers. Call Caroline at 732295-1545. www.growinamerica.org. HEARING VOICES SUPPORT GROUP * For those who hear voices or have unusual experiences. The group is open to anyone interested and is free of charge. Meets9: Neptune Wellness Center, Neptune City. 732-455-5358 Freehold Community Wellness Center. 732-625-9485. For more information contact Lois at 732-460-1280 x1101. www.hearing-voices.org. OBSESSIVE-COMPULSIVES ANONYMOUS (OCA) * Weekly 12-step self-help support group for people dealing with the symptoms of Obsessive-Compulsive Disorder (OCD). Meets every Wednesday from 8:15-9:45pm, Southard Grange #218, 4860 Highway 9 South, Howell. Call Ron, 848-702-5044. Part of larger statewide association - www.ocdnj.org. POSTPARTUM DEPRESSION SUPPORT GROUPS * Provide support for new mothers experiencing any postpartum mood disorder. Pre-registration required. First Thursday, 11am-noon, Riverview Medical Center, Red Bank. Call Karen Edwards 732-706-5173 (day) or Diane Labrabera 732-778-2394 (day). Thursday, 3:30-5:30pm, Monmouth Medical Center, 300 Second Ave., Long Branch. Call 732-923-5234 (day).
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Group schedules shifting. Do call before attending.
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(varying dates) Community Affairs and Resource Center, 913 Sewall Ave., Asbury Park. Call Jackie Ramirez 732774-3282 (day). RECOVERY INTERNATIONAL * Self-help method of will training. Offers techniques for controlling temperamental behavior and changing attitudes toward nervous symptoms, anxiety, depression and fears. While there is currently no Monmouth County group there are meetings in Toms River. Meets Wednesdays 7:30pm, Presbyterian, Hooper Ave. & Chestnut St. Call Delores 732-557-5466. www.recoveryinternational.org. SHORE HOUSE * A psychosocial clubhouse - a working community of people living with mental illness which provides a platform for them to contribute their talents and abilities. Members offer each other assistance with education, employment, housing and other areas necessary to help realize their dreams and to successfully reintegrate into the community. Free lifetime membership for those who qualify. 279 Broadway, Long Branch. 732-759-1595. (www.shoreclubhouse.org) SUICIDE SURVIVORS SUPPORT GROUPS * Provides support and information to family and friends of someone who has committed suicide. Mutual sharing, literature, phone/email help. Meets 2nd Tuesday 7:30pm, Bayshore Community Hospital Holmdel. Call Peggy at 732-462-5267. www.suicide.org.
Meets 3rd Tuesday, 7-9pm, 3301 Highway 66, 1st Floor, Building B, Neptune. Call Jim at 732-923-6940. Meetings vary, 7-8:30pm, Common Ground Grief Center, Manasquan. Call 732-606-7477;
[email protected]. YOUTH PARTNERSHIP GROUP * Peer support and advocacy to empower youth (ages 13-21) with emotional or behavioral challenges. Rap sessions, guest speakers, literature, phone help and newsletter. Meets Tues., 6-8pm, Family Based Services Association, 6 Industrial Way West, Suite D, Eatontown. Call 732-542-4502 (day). www.fbsanj.org.
G. Community Wellness/Self-Help Centers The state of New Jersey funds a network of 33 peer support Community Wellness Centers (previously known as selfhelp centers or drop-in centers) around the state. Any adult with any kind of mental health issue is welcome at no charge to drop in, call for a ride in their general area, meet others in similar circumstances, use a computer or some exercise equipment, watch TV, come for a scheduled meal, and more. Each center is managed by a full time manager who pursues some kind of mental health recovery, aided by a crew of volunteer drivers and facilitators. Sometimes this is a place for people to get plugged in to local self-help resources, social services, or a chance to help change the system (systems advocacy efforts). Center days and hours vary, so please call ahead. Centers host other support groups, trips, and more. Both centers in our county offer monthly GROW groups, Hearing Voices groups twice a month, and a program known as “Informed Choices” – designed to help people understand their options around longterm use of psychiatric medications. They are not treatment centers – if you find a doctor, nurse, or therapist there, they have come wither to give a guest lecture, or as part of their own mental/emotional recoveries.
Neptune Wellness (formerly CARE) Center, 80 Steiner Ave., Neptune City. 732-455-5358. Freehold Community Wellness Center 17 Bannard St., Freehold. 732-625-9485.
H. Peer Support for Substance Use Recovery and “Co-Occurring Disorders” Alcoholics Anonymous (AA), Narcotic Anonymous (NA), and their associated family groups (Al-Anon, Nar-Anon) are among the most widely used support groups in the world. Groups meeting in our area can be found by calling: Alcoholics Anonymous - 800-245-1377, www.nnjaa.org Al-Anon/Al-a-Teen – 12 Step Groups for families of Alcoholics – 973-744-8686 Narcotics Anonymous – 732-933-0462, www.cjasc.org Nar-Anon Family Groups – 800-322-5525 It is important to note that many people deal with addiction issues and mental health issues at the same time. AA and NA do not discourage such people from coming to their groups, but instead takes the perspective that “There are those … who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be
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honest10.” Similarly, AA does not consider the use of prescription mental health medications, when used as prescribed, to be a breach of sobriety. Alcoholics Anonymous publishes a document, “The AA Member, Medications, and Other Drugs11,” which discusses the issues of using psychotropic and other medications while attempting to maintain sobriety. We want to mention that AA has generously allowed dozens of other support group models around the world to borrow their 12 steps and 12 traditions. However, there are some people who do not “click” with 12-step models, especially individuals who do not have some sense of faith or belief in “a higher power.” NAMI Connection groups do not follow a 12 step format, and we encourage people with and without faith beliefs to try out our meetings. There is also a network of “double trouble” or dual recovery meetings in our community, where a person may feel comfortable that all attending disclose both emotional and substance use issues.
Meetings at the Freehold Community Wellness are on a varying schedule. Call 732-625-9485. Park Place in Asbury Park is a treatment center which sometimes opens its groups to the community, call 732869-2761. Tuesday, 67-8PM, Neptune Wellness Center, 80 Steiner Ave., Neptune City. Transportation may be available. Call 732-455-5358. Friday, 7-8PM, Riverview Medical Center, Red Bank. Transportation may be available. Call 732-455-5358. Friday 7-8PM, All Saints' Memorial Church 202 Navesink Ave. Contact Sara, 732-778-4617 or Mike, 732-778-4618 Finally, we want to suggest that people who deal with co-occurring mental health and substance use issues who use professional treatment services choose providers who follow an integrated approach to dual disorder treatment (IDDT), which is the nationally recognized best practice.
III.
We Strive To Understand Recovery and Wellness
A. SAMHSA Definition The US Substance Abuse and Mental health Services Ammonization (SAMHSA) has released its new working definition of Recovery from Mental Health and Substance Use Disorders12: Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. SAMHSA also outlined four major dimensions that support a life in recovery:
Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way; Home: a stable and safe place to live; Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and Community: relationships and social networks that provide support, friendship, love, and hope.
B. Guiding Principles of Recovery
Recovery emerges from hope Recovery is person-driven Recovery occurs via many pathways Recovery is holistic Recovery is supported by peers and allies Recovery is supported through relationship and social networks Recovery is culturally-based and influenced Recovery is supported by addressing trauma Recovery involves individual, family, and community strengths and responsibility Recovery is based on respect Recovery is culturally-based and influenced
From Alcoholics Anonymous “How it Works” Available at many AA meetings, or online at www.aa.org/pdf/products/p-11_aamembersMedDrug.pdf 12 Get more details, including booklets and posters, at www.samhsa.gov/wellness. 10 11
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Recovery is supported by addressing trauma Recovery involves individual, family, and community strengths and responsibility Recovery is based on respect. For further detailed information about the working recovery definition or the guiding principles of recovery please visit: www.samhsa.gov/recovery.
C. Dimensions of Wellness SAMHSA also recognizes that wellness and recovery go hand-in-hand, and wellness challenges affect a person in all of life areas. It has adopted the 8-dimension model of overall wellness shown below. Issues of personal identity, balance, awareness, and empowerment are equally important, even if not clearly visible in the 8dimension model.
D. Three useful websites for learning more about the “nuts and bolts” of recovery
IV.
The Center for Reintegration, www.reintegration.com The Temple University Collaborative on Community Integration, www.tucollaborative.org The Institute for Wellness and Recovery Initiatives at Collaborative Support Programs of NJ, www.cspnj.org
Emotional Wellness and Recovery Require Meaning and Purpose
Whatever we deal with, it seems key to have some sense of meaning (why are we here?) This seems crucial. At the toughest times, our activities caring for our families, our activities living, learning, working, and socializing in our communities, and, for many of us, our relationship with our creator give us meaning, purpose, and structure. As human beings we need intimate and close personal relationships, and we generally work hard to get and keep those relationships.
V.
Emotional Wellness and Recovery Require Good Coping Mechanisms
From the youngest age, we use a variety of approaches to manage and cope with our environments, deal with what stresses us, and keep us going in tough times. Stress is inevitable, suffering is optional – so we need to learn to recognize and manage it. Coping mechanisms that have been shared with us over the years include
1. Mindfulness, Mindfulness-Based Stress Reduction, and Relaxation Breathing. These may easily be the most important thing most people can do for themselves – see Key 1.
2. Relaxation. Whether pursuing hobbies, spending time with friends, reading, watching TV, or any of countless other
relaxation techniques, we all seek – and hopefully find and employ – ways to unwind. One approach to relaxation is a vacation. Vacations need not be expensive – they can be as simple as a visit with an out-of-town friend.
3. Structure. Having a solid plan for each day, some reasonable goals, and a regular order of getting things done helps people stay out of emotional trouble. Others are not as fond of strong structure, and are more comfortable ad-libbing. For many, the key to planning is to set realistic, achievable goals.
4. God, faith, and religion. This may range from daily prayer or bible readings to participation in church choirs to faith activities of a less “organized” format. People who may have become separated from their faith can benefit from considering re-establishment of that relationship. It is also unfortunate that treating professionals have the potential to mistake religious behavior as a sign of psychosis.
5. Family relationships. Supportive family members can make all the difference. Many people benefit by focusing on the children in their lives; be they their own offspring, grandkids, nieces and nephews, or for some, their pets. In the
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darkest moments, focusing on lifecycle events (a son’s high-school graduation, an upcoming grandchild’s birth) can keep us going.
6. Acceptance. The serenity prayer is often quoted as “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference,” Nothing can trigger mental anguish faster than butting one’s head against a wall. Many of the people who cope best with mental/emotional wellness challenges do so with the acceptance that setbacks are a regular part of their lives.
7. Knowledge and Awareness. Many people are empowered to care for their mental/emotional wellness by understanding their problems and their coping and possible treatment options. Many engage in frequent Internet learning. Others have turned to NAMI and other support organizations for education.
8. Basic self-care. It’s easy in a troubled time to become neglectful of diet or personal hygiene, and sleep problems are a key symptom and aggravating factor of many forms of mental health distress. While ignoring medical and dental care is also a common symptom of emotional distress, people who put the energy into obtaining such care appear to fare better. Seeing one’s self (or a loved one) unable to stay on top of self-care issues is often the key to recognizing a dangerous decline.
9. Journaling. Many people use daily journaling as a means of expressing their frustrations on paper, others focus on the positives. Some report success with a gratitude journal, which forces them to identify five things to be grateful for before going to sleep each night. Our local bookstore has a wall full of gratitude and other journals (or a 59c exercise book will suffice).
10. Emergency Planning. Some people report that knowing the local crisis number and some professional mental health services are available allow them to stay stable. A growing number of others have more elaborate plans, including documented WRAP crisis plans and psychiatric care advance directives.
11. Mutual Support can range from a telephone relationship with someone with a similar issue to participation in NAMI or one of the many other support groups in our community. Nobody can give the kind of help that you get from someone who has been there.
12. Exercise is very often mentioned as a key to maintaining a healthy mindset. Research has proven the effectiveness of many kinds of exercise at raising a depressed mood. Yoga is often cited as a form of exercise which effectively combines physical and spiritual value.
13. Sleep is, in some ways, a universal coping skill. While it does not “make everything better,” none of us can go a few nights without enough good sleep and not experience emotional and physical symptoms. We may sleep too much or too little as a sign of poor mental/emotional health, poor sleep habits (often referred to as “sleep hygiene), medical symptoms, medicine side-effects, etc. Exerting the extra energy needed to stay on top of these can be the key to averting an emotional crisis. Sometimes, extra attention to the timing of caffeine and sugars and setting up the right milieu for sleep can make the difference on the sleep problem. Sometimes problems sleeping represent a “primary sleep disorder,” and may require medical treatment. Behavioral sleep medicine is the field of assisting people with resolving sleep problems through changes in actions and habits, such as mind clearing and progressive relaxation. Sleep cycle modification is sometimes used as a way to treat depression. Sleep issues are a common topic of discussion at our support groups. www.sleepeducation.org is a webpage some of our members have found helpful in learning more about sleep issues and treatment options. It also contains a “sleep diary,’ which is a good starting point for figuring out your sleep problem. Other important recovery tools cited by people include fresh air and sunshine, feelings of being capable, and music. One lesson we have seen, which is not a recovery tool in and of itself, is that different things work for different people. If you think something may work for you, consider trying it. If it works, stick with it, if it doesn’t, move on.
VI.
Emotional Wellness and Recovery Require Mindfulness and Planning A. Mindfulness This is about raising our thoughts, actions, and coping mechanisms from the subconscious to the conscious. Many approaches to mental/emotional wellness, including Keys, are built around maintaining mindfulness. To paraphrase a concept used in AA, many of us need to be most mindful when we are most vulnerable, including when we are “Broke, Actively Symptomatic, Intoxicated, Pained, Hungry, Angry, Lonely, and/or Tired. Mindfulness in mental/emotional wellness also includes “scaled decision making.” We make lots of decisions in our lives. Many can – and should – be made quickly. Complex decisions and those with far-reaching impact may require
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careful analysis of factors and looking at a “decision balance sheet.” This is another thing we help each other with in NAMI support groups.
B. Wellness Planning We feel strongly that many can benefit from developing and following a wellness plan. Many of us develop a Wellness Recovery Action Plan (WRAP). This model of coping skills management is extremely widely used in the recovery community, and is often discussed at support groups13. There are many other variations on wellness plans. At a minimum, we suggest that a personal wellness plan contain: a) Some statement of value and purpose. For many of us, this can take the form of an affirmation. b) A statement or description of “feeling good.” c) Identification of key habits and routines to main that good feeling – wellness – in all 8 dimensions. d) Identification of key coping mechanisms. e) Identification of the people in our lives who are part of that good feeling. This can be detailed with some practical ideas f) Common signs of decline. g) Possible interventions to prevent decline. h) A personal list of all actions that are “musts,” “must nots,” “shoulds,” and “should nots.” i) To the extent that you need it, clearly defined ways of tracking behavior, such as checklists for maximizing wellness.14 NAMI and other support groups often spend time helping people build and follow their wellness plans. We wish we could provide an easy checklist or form for a personal wellness plan. However, the more that you work through it yourself, the more you identify your own key insights and strengths!
VII.
Emotional Wellness and Recovery Require – and Build – Emotional Strengths and Emotional Maturity Many of us need to adjust the way we think, feel, and act in order to overcome mental/emotional wellness issues. Doing so makes us, and helps others see us, as emotionally mature. We do so by using workbooks, attending support groups, working with therapists, and through a range of other techniques. Among the many things which an emotionally well person needs to demonstrate are: 1. Impulse and Behavior Control: Considering risks and consequences, and thinking before you act 2. Resilience: The ability to deal with adversity and “bounce back.” 3. Resolve and Motivation: The ability to plan and stick to your goal. Sometimes, we get the aid of others to help us get – or stay – motivated. 4. Flexibility: The capacity to change thinking and approach in order to get beyond a failed method or problem way of thinking. 5. Responsibility and Accountability: Being responsible for ourselves and our recoveries. Carrying out our fair share in our households and elsewhere, and the understanding that our actions have consequences. 6. Distress Tolerance. The ability to accept a level of physical and emotional discomfort. This also includes accepting the frustrations of our circumstances and some of the systems which are there to “help us.” 7. Positive Self-Image and Self-Esteem. We want to look and behave appropriately to others, and at the same time, be happy with how we perceive ourselves. 8. Credibility. We may not always be honest, but dishonesty and deceit leave a pattern. It seems critical to be honest and accountable to ourselves. Other aspects of Emotional Maturity seem to include reducing over-reliance on others and poor follow-through.
13 14
See details at http://mentalhealthrecovery.com/wrap-is/ Some people use various forms of “mood trackers.” One simple one is online at www.dbsalliance.org/pdfs/tracking.pdf
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A. The Four Agreements Some of our members and friends have benefitted in their emotional maturity through a book written by Don Miguel Ruiz and known as “The Four Agreements: A Practical Guide to Personal Wisdom15. Outside of this state, some NAMI groups are incorporating The Four Agreements into their support and education program. The four agreements are stated as:
Be Impeccable With Your Word. Don't Take Anything Personally.
Don't Make Assumptions. Always Do Your Best.
B. Coaching Lots of people need help setting goals, compelling themselves to keep their goals, and managing the changes which may be needed to achieve goal attainment. This may or may not be a more significant need for those of us pursuing recoveries. Many people seek the help of coaches of various kinds to help them get going with their goals. Sometimes we work in our NAMI Connection support groups to allow a member to set and refine SMART goals (see box below) around some area of living, learning working, socializing, health, or emotional management and then to report on their progress at future meetings. Attribute
Description
Example
Specific
Goals must be clear and unambiguous
I will increase my intake of healthy vegetables to an average of 2.5 servings per day
Measurable
Results must be able to be measured in some way
I will keep a weekly log of vegetable intake
Attainable
Goals must be realistic and able to be achieved, considering my own history and other factors
I used to eat healthier, and I like salads so I feel that I can do this
Relevant
Goals must relate to the overall aim of my effort
This is important to me, and can help me Reduce junk food intake Reduce cholesterol Control lower GI issues
Timebound
Goals must have definite starting and ending points, and a fixed duration
I will build within 3 weeks to the 18 servings per week goal, and track and report my attainment for the next 12 weeks.
VIII.
Emotional Wellness and Recovery Require Physical Wellness
It’s hard to feel well when your body feels sick. Among the issues often brought up at support groups: Pain management issues Sleep management issues and techniques. Role of diet and exercise on wellness Medical conditions, including medicine side-effects and menstrual issues, which can cause mental health symptoms Difficulty getting medical care caused by poverty, discrimination, and/or emotional immaturity Risks of substances, including caffeine, nicotine, and herbal products, which may interfere with emotional issues Alternative health care options
IX.
Emotional Wellness and Recovery Can Be Supported With Professional Assistance
The Four Agreements: A Practical Guide to Personal Wisdom (A Toltec Wisdom Book), 1997, Amber-Allen Publishing, ISBN 978-1-878424-31-0. 15
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A. Impact of Trauma Many people have probably come to deal with a mental health condition due to life trauma, or have experienced trauma by hearing seeing or believing things which others are unable to, or from the trauma of forced care. Because of this, Trauma-informed is a standard of care in mental health systems and services. The US Substance Abuse and Mental Health Services Administration (SAMHSA) has published guidelines for trauma-informed care which can help you recognize those providers and programs which are serving you in a trauma-sensitive manner.
B. Informed Choice There are many kinds of professional support and services which can help a person deal with a mental/emotional issue. Just as with all decision we make, especially complex healthcare decisions, we need to make informed choices, and understand the risks and benefits of the things we choose. Good services can help us lead more productive and satisfying lives, and stay in our jobs, homes, and families. Bad choices can waste time and money, or even place us at risk of legal consequences, such as forced hospitalization or loss of gun ownership rights. Except when we are “completely out of it,” we want to make our own healthcare decisions, aided by good information from professionals. This is known as “informed decision making.” In some cases, we may find ourselves making decisions along with a professional, a model known as “shared decision making.” An emerging area of healthcare information is the development of comprehensive “decision aids.” These are typically computer tools you can use to learn about various options and alternatives for dealing with a health condition. Access to decision aids for seeking treatment for mental/emotional issues is very limited. In the meantime, the best we can do is learn about alternatives, and discuss them at support groups. Research about coping skills, medication, psychotherapies, and other ways to help people deal with emotional issues is conducted by people in a wide variety of disciplines, and shared via a wide range of journals, websites, e-newsletters, conferences, etc. In our groups, we sometimes discuss ways to interpret research and publications critically, helping us to make informed decisions. Informed Choice is a person’s right in all settings, including hospitals, and a person in a hospital setting has the general right to refuse any particular medicine or treatment, or the services of any given doctor. Hospitals have Patient Advocates who can assist with these issues. Another are which makes choice tough is the economics of healthcare. Many of us are covered by public or private health plans with limited networks. Some people find that they are served in crowded public clinics which feel that they cannot give people the “luxury” of switching doctors, therapists, etc. This is an area which calls for assertiveness and ingenuity, and a good topic for discussion at our support groups. The Recovery Library (www.recoverlibrary.com) is an extensive collection of videos, documents, and Decision Aids which can be helpful to people pursuing mental health recoveries. Subscription fees are modest ($5/month for individuals), and the wisdom comes from some of the leading peer advocates and providers in the mental health community. Check it out!
C. Overview of Psychotherapies Psychotherapy is a general term referring to various talk treatments provided by a trained professional to an individual client, family, couple, or group. Psychotherapists have a variety of credentials. They may be psychologists, clinical social workers, educational counselors, or pastoral counselors. Doctors (mainly psychiatrists) and some nurse practitioners may also provide psychotherapy. Psychotherapy is talk therapy, usually provided by a therapist to a client in private. Psychotherapy often involves skills teaching, which can take place in groups. Peer support groups are therapeutic, but they are not psychotherapy. Dozens of kinds of psychotherapies have been developed over the years. We will limit this section to list a few of the kinds of psychotherapy which people with emotional wellness issues often find helpful. Details can easily be found on the web. Psychoanalysis is a lengthy process of helping a person look at their emotional past in order to resolve unconscious conflicts and gain control of their emotions and behaviors. Psychoanalysis, along with a less time-consuming therapy known as psychodynamic therapy, focuses on the unconscious mind. Psychotherapy often includes supportive talk therapy; helping a person to deal with complicated issues and life choices, set priorities, and to learn and apply their own coping skills, especially techniques for relaxation. While supportive talk therapy can go on for months or years, depending on the clients need, it is generally provided as a brief therapy. Most of the following psychotherapies, many of which may be provided in conjunction with supportive talk therapy, are considered brief therapy. All therapies indicated with a * are included in the National Registry of Evidence-Based and
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Promising Practices (NREPP), which lists practices which meet certain guidelines for research, support, and standardization. Many other practices discussed throughout this document are also included in the NREPP.
* Acceptance and Commitment Therapy (ACT) * Alcohol Behavioral Couple Therapy (ABCT) Behavioral Therapy The *Coordinated Anxiety Learning and Management (CALM) Tools for Living Program Cognitive Behavioral Therapy (CBT) * Cognitive Remediation Therapy (CRT) * Dialectical Behavior Therapy (DBT) * Dynamic Deconstructive Psychotherapy Interpersonal Therapy and Interpersonal Social Rhythm Therapy Mindfulness may be incorporated into various psychotherapies. * Mindfulness-Based Stress Reduction (MBSR). MBSR may be especially helpful for people dealing with physical pain as part of their wellness challenges. * Motivational Interviewing/Motivational Enhancement is a goal-directed, client-centered counseling style. Psychodrama. Rational Emotive Behavior Therapy (REBT) * Relapse Prevention Therapy - a behavioral self-control program. * Relationship-Based Care * Systems Training for Emotional Predictability and Problem Solving. Trauma Therapy encompasses a range of interventions specifically delivered to people whose wellness is challenged by a sexual, emotional, and/or physical trauma. The recognized and effective trauma therapies include: * Eye Movement Desensitization and Reprocessing (EMDR) Trauma Art Narrative Therapy (TANT) * Prolonged Exposure Therapy is a cognitive-behavioral treatment program for PTSD. * Seeking Safety * The Trauma Recovery and Empowerment Model * Traumatic Incident Reduction Training
D. Role of Medication The decision whether or not to use medications (including herbal products) to help deal with mental/emotional wellness issues is complex. It is often conflict-ridden, and people may find their families pressuring them to use mental health (psychotropic) medications. It divides whole communities, and organizations can be seen as pro-medication or anti-medication. There are many reasons why medications can be helpful. They may provide faster relief from some kinds of symptoms, like hearing and seeing things, or high levels of anxiety, than self-management and therapy alone. They may be useful to help a person get out of a pattern of behavior which threatens their living situation. They certainly can enhance the effectiveness of self-management and therapy in dealing with symptoms of depression, anxiety, hearing and seeing things, or very unstable moods. The downsides of psychotropic medications are also significant, and include: Medications can create both short-term side-effects and longer-term challenges to health. At our support groups, we often talk about problems such as sedation, dry mouth, and weight gain, all very common psychotropic medication side-effects. Medications can be expensive. Medications can create a level of dependence. While very few psychotropic medications are “addictive” in the traditional sense, people who use them often become very sensitive to medicine adjustments and brand substitution. They experience emotional decline when their supplies are interrupted, or they need to change their medication regimen due to health or financial issues.
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Stopping any kind of mind-affecting substance, including caffeine or nicotine suddenly creates distress, and could be a formula for disaster. We encourage anybody coming off of prescribed psychotropic medications to “taper” their use slowly16, and strongly considering doing so under the care of a physician.
E. Medicine Issues and Side-Effects Sometimes selecting the right medication for a patient can be difficult. What used to be a mater or trial-and-error can now be assisted, in some cases, with genetic testing17. Having your own detailed history of medications tried and responses can often help speed the process. Responses to psychiatric medications can be similar within a family. If a particular medicine has been helpful to you, it may be helpful to one of your biological relatives and vice versa. The opposite will also hold true; what your react poorly with may also cause a bad reaction in a biological relative. Some psychiatric medications are expensive. People with limited incomes can go to www.needymeds.org to learn what public supports or Patient Assistance Programs they may qualify for. One common side-effect of psychiatric medications (often seen with anti-psychotic medicines) is that they can cause an impairment of the body’s ability to control its own temperature. This characteristic is true both of the older antipsychotics and the newer “novel” ones. This impaired heat regulation can result in heat exhaustion or heat stroke, with serious or fatal consequences. People taking these medications need to:
follow common-sense methods to avoid overexposure to heat and direct sunlight. seek medical attention immediately if they experience heat-related symptoms. Ask their mental health provider for a brochure describing these heat risks and preventive steps in more detail. A brochure can also be downloaded at www.state.nj.us/humanservices/documents/Summer%20Heat%20and%20Sun%20Risks.pdf . Another side-effect that comes on quickly and often surprises experienced mental health professionals is serotonin syndrome. Serotonin syndrome can happen when medication doses are too high, or when some medications are combined inappropriately. Not only brain and pain medications can combine to cause serotonin syndrome, but medicines like onandestron, (anti-nausea), dextromethorphan (cough suppressant), sumitriptan (migraine control), chlorphenamine (antihistamine), ritonavir (HIV/AIDS), sibutramine (weight loss), herbal products such as St. John’s Wort, and recreational drugs such as LSD and cocaine can all lead to this condition. Symptoms can include increased heart rate and blood pressure, shivering, sweating, dilated pupils, tremor or twitching, high fever, and mental status changes. A wide variety of other side-effects and interactions can happen, especially when medicines (psychiatric, non-psychiatric, over-the-counter, or herbal) are started. A more detailed discussion of this will take place during Keys learning sessions. More common long-term side-effects of some psychiatric medicines can include motor effects such as tremors, liver damage, dangerous levels of sedation, weight gain and diabetes. A smaller number of psychiatric medicines used currently can damage or eyes, kidneys, and thyroid glands, and/or cause irreversible movement disorders. Ways to help prevent medication problems include: Make sure to list all medications, other drugs, supplements, and herbal products for every doctor/dentist – cautious people who have complex medication regimens carry a current medication sheet at all times – the very cautious among us wear medical alert jewelry which can alert first responders to “look for a wallet sheet.” Point out your concern for interactions whenever any doctor starts you on a medication, or when scheduling surgery or other procedures which may involve receiving medications. Check all of your medicines and non-prescription products for interactions using a tool like www.drugs.com/drug_interactions.html Use only one pharmacy, and confirm that it uses interaction-checking software. Be very cautious with herbal products, supplements, and street drugs, as well as medication samples which might be dispensed by a doctor’s practice. Read up on side-effects, and seek immediate medical care for their symptoms. Talk to your prescriber if you plan to become pregnant, or learn that you are pregnant.
16
detailed guide to harm reduction and coming off psychiatric medications is online (in 17 languages) at www.willhall.net-
comingoffmeds/ 17
See, for instance, http://assurexhealth.com/pr-medicare/
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Pay attention to the warnings your prescribers and pharmacist provide. Make sure to keep recommended appointments for lab tests – the thorough among us keep our own lab records. Make sure that testing for side-effects does not “fall between the cracks” between mental health prescriber and primary care doctor. In hospital settings, consider having a trusted family member or friend as a decision-making proxy, and make sure that he/she understands your medication history and concerns. Be very wary when choosing to use a long-acting injectable medication, psychiatric or other.
F. Finding Professional Help There are dozens of psychiatrists and hundreds of psychotherapists in Monmouth County. It is often a process of figuring out what kind of care you need and working through the directory in your health plan. Relationships are highly individual, so it may take a few visits to decide if the practitioner you selected will work well for you. We often discuss these issues in our support groups. Sometimes, your therapist can recommend a psychiatrist he/she is comfortable working with or vice versa. Employee Assistance Plans (EAPs) are provided by many employers to assist employees and their families in resolving various kinds of difficulties, including emotional/behavioral, addiction, financial, marital, and legal. These services are provided at no cost to the employee and family and generally include a 24-hour number for crisis and referral. This may be a worthwhile means of initial access to mental health services if your employer provides an EAP. For various reasons, finding a psychiatrist or psychotherapist under Medicare or NJ Medicaid is difficult. In general, people using fee-for-service Medicare can only get psychiatry and psychotherapy reimbursed if they use a participating provider. The Medicare participating provider list is online at www.medicare.gov/physiciancompare/search.html18. Individuals using a Medicare HMO/Medicare Advantage plan should consult their plan directory. Each of the following offers both psychotherapy and psychiatry for adults on an income-based sliding scale: CPC Behavioral, Health, Aberdeen, Freehold, Red Bank, 732-842-2000 Jersey Shore University Medical Center, Neptune, 732-643-4400 Monmouth Medical Center, Long Branch, 732-923-6500 Riverview Booker Behavioral Health, Shrewsbury, 732-345-3400 Adults who qualify may receive psychiatric medication management through the Visiting Nurse Association clinics in Asbury Park, Keansburg, Keyport, or Red Bank. Other Community Health Centers may also offer medication management. Each of the following offers psychotherapy for adults on an income-based sliding scale:
Catholic Charities, Red Bank, 732-747-9660 Community YMCA, Matawan, 732-290-9040 Counseling Center for Human Development, Holmdel, 732-946-3767 Family & Children’s Services, Long Branch, 732-222-9111 Jewish Family & Children's Service of Greater Monmouth County, Asbury Park, Morganville, Red Bank, 732-7748809 Although people can expect to find services faith teachings in some of these, each welcomes clients of all faiths and backgrounds. Residents of cities and larger towns should check with their local Human Services departments for sliding scale psychotherapy. Students at Monmouth University can access a Counseling Center which offers a range of services and linkages by calling 732-571-7517. More limited student counseling resources are available at Brookdale Community College by calling 732-224-2395. Significant referral assistance is available for anyone by calling the NJ Mental Health Cares at 866-202-HELP, www.njmentalhealthcares.org. Besides therapists and psychiatrists, we may turn to other professionals or practitioners to deal with mental/emotional wellness issues. Various kinds of social service workers may help us access community services and supports (start by calling 2-1-1). For instance: Psychiatric Rehabilitation Practitioners may offer us support services to help us get back to work, school, or childcare. Much of the work being done in NJ under Community Support Services follows a Psychiatric Rehabilitation Model, even when not rendered by Psychiatric Rehabilitation professionals.
18
For therapists, answer the question “What are you searching for?” as “Clinical Social Worker.”
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Our doctors and dentists may help us deal with pain and other physical issues which make us unwell Accountants and other financial professionals may help us regain structure and sanity in our economics. College disability offices can help us access the services we need to help prevent our wellness issues from interrupting our studies. Clergy can help us along spiritual journeys. Trainers and coaches of various kinds can play an important role in helping us choose and take steps around improving our wellness. The list is endless. The Open Path Collective (www.openpath.org) is a service matching clients who do may be paying for their own psychotherapy with therapists willing to offer services for $30-$50 per session. Sometimes finding a therapist involves a “multi source” search. For instance, many of us need to visit the website of our insurer to identify therapists in our area covered under our plan, then visit the Psychology Today therapist finder https://therapists.psychologytoday.com/ or other public sources to run down some of the characteristics of the therapist. Many people come to our support groups to “chew” on issues around figuring out how well their relationship with their psychiatrist is working, how possibly to improve the relationship, or whether to seek other care. We have published a document, published online, entitled Seeing a Psychiatrist in the Community, which may be helpful.
a. For Our Service Members, Veterans, and their Families In addition to services through Tri-Care and offered through military post health centers, Eligible Veterans can get local services, including medication management and psychotherapy, at the Tinton Falls Community Based Outpatient Center, 732-5324500. Other VA services can be accessed by calling 877-222-VETS (8387). The NJ Department of Military and Veterans Affairs (www.nj.gov/military) and the Monmouth County Veterans’ Office (732-431-7450) offers a variety of services The Mental Health Association in Monmouth County has Veteran family and survivor support groups. 732-542-6422.
b. Help which Bridges the Professional-Layperson Line Throughout this booklet, we highlight the variety of support groups, wellness centers, warmlines, respite programs, etc. which are staffed by those of us pursuing our own mental health recoveries. The Support Place – Where Hope Lives (www.thesupportplace.com) is a wellness center which bridges that continuum. Located in Brick Twp and staffed by trained peer providers, the center offers workshops on topics such as Yoga and Wellness Recovery Action Planning.
X.
Emotional Wellness and Recovery Are Supported With Ongoing Learning and Growth
We all learn, grow, and have the capacity to do better. Many times, the emotional issues we deal with are complex, and we need to work hard to stay informed. The technologies of psychotherapy, wellness promotion, and mental health treatment continually evolve. We encourage everyone to: Come to our meetings and seminars Read on a variety of topics Learn from websites and conferences Consider the role of academic learning and research Expect their own self-perception and their perception of the overall topic of mental/emotional wellness to evolve. Several of our members have benefitted from the variety of TED19 talks on mental health topics.
19
“Technology, Entertainment, Design,” www.ted.com
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We are proud to note that a twice-monthly “Keys Learning Collaborative,” based on this document, takes place in New Brunswick at the Moving Forward Community Wellness Center. 732-317-2920. www.movingforwardshc.org.
WHAT’S OUT THERE IN THE SOCIAL SERVICE, REHABILITATION, AND MENTAL HEALTH SYSTEM While many of us deal with emotional issues using our own coping skills or the help of therapists and/or psychiatrists, others need more intensive help, or help dealing with basic issues. Some basics of our mental health and social service systems for adults are described below. Support groups can be a great setting for discussion of what kind of help people have been able to find from the kinds of programs listed.
A. Basic Social Services Includes help with access to emergency housing and public benefits. Start by calling: The County Division of Social Services, 732-431-6000 The United Way One Call for Help, by dialing 2-1-1 NJ Mental Health Cares, 866-202-4357. Monmouth County Division on Aging, Disabilities and Veterans Services, 732-431-7450 Some people disabled by their emotional issues choose to seek private disability insurance, long-term public or private disability benefits, or public supports such as Medicare, Medicaid, Social Security Disability Insurance (SSDI), or Supplemental Security Income (SSI). The Social Security Administration at 800-772-1222 Medicare at 1-800-MEDICARE. At our support groups, we help people sort out these options, and consider some of the risks of seeking benefits rather than staying employed. Assurance Wireless is a Government-supported program which provides free cell phone service to low-income individuals. Recipients cannot receive both this service and a lifeline credit on a home bill. The Meridian Health Community Wellness Center in Freehold Raceway Mall (lower level, Macy’s hall) is a multi-agency collaboration which bridges the gaps in access to healthcare and social services. In addition to a number of groups and programs (800-560-9990), individuals can walk in and get help filing for food benefits, cash benefits, Medicaid, and a variety of other forms of assistance.
B. Care Coordination/Case Management This may be provided in various treatment settings, including supportive housing and mental health day treatment, described below. It is also sometimes is provided a la carte to people who need it. It can include providing people with some combination of individual advocacy, acquisition and maintenance of benefits, coordination of social services, arrangement for medical services and housing, informal counseling, and instruction and reinforcement of Activities of Daily Living (ADL) skills, including financial management. Case Management is often performed by bachelor’s-level social workers and family caregivers. For people in many treatment settings, the case manager serves as the client’s and family’s connection to the remainder of the program and for referrals to other services. Programs of Assertive Community Treatment (PACT) are designed to serve mental health service recipients with a high risk of rehospitalization due to problems with treatment. The PACT team consists of a psychiatrist, nurse, social worker, vocational specialist, substance use specialist, and peer specialist. The team provides complete wraparound services for the person at home or anywhere else. The individual receives complete services (other than psychotherapy or housing), and generally is not referred to other community services. PACT clients can be served for life. PACT relies heavily on medications, and does not generally provide psychotherapy, so it may not be a good choice for someone who wants to deal with their mental/emotional issues without medicine. CPC Behavioral Healthcare, 732-842-2000 Integrated Case Management Services (ICMS) are mobile case management services which are provided at no charge to every patient who is discharged from a state or county psychiatric hospital for a period of 12 months after discharge. ICMS also participates actively in the state hospital discharge process. Community referrals are also possible. ICMS is designed to link clients with other services20; it is not designed to provide any actual mental health services other than case management. CPC Behavioral Healthcare, 732-842-2000.
20
A model known as “brokered case management”
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Transitional Case Management or Supportive Services are available to a small number of people who are not receiving case management from other sources. Easter Seals Society 732-380-0390.
C. Physical Healthcare This is of key importance to everyone, and accessing care is sometimes difficult when mental/emotional issues have resulted in a lack of full-time employment. One technique which often helps people access physical healthcare is ensuring that they have a primary doctor or “medical home.” “Fee-for-Service” Medicaid recipients can locate participating providers on www.njmmis.com, or by calling 732-761-3600 (Monmouth & Ocean Counties). Primary health centers accessible to anyone in Monmouth County include the Monmouth Family Health Center at 270 Broadway. Long Branch (732-923-7100), the Parker Family Health Center at 211 Shrewsbury Ave, Red Bank (732-212-0777) and the following health centers operated by the Visiting Nurse Association (VNA) of Central Jersey: 1301 Main St., Asbury Park, 732-774-6333 100 Main St., Keansburg, 732-787-125021 35 Broad St., Keyport, 732-888-4149 176 Riverside Ave., Red Bank, 732-219-6620 Additional free clinics and help getting medications and examinations can be located through www.needymeds.org. All general hospitals in NJ are non-profit entities which must offer charity care/reduced charge charity care, and almost every hospital in the US is covered under the Emergency Medical Treatment and Active Labor Act (EMTALA), which requires them to provide emergency medical care, including a screening exam and stabilizing treatment to anyone who seeks it, regardless of their ability to pay.
A. A Special Word on Smoking While many factors contribute to the early deaths of people with ongoing mental illness, one of the most significant ones is smoking. NAMI wants to help the peers of this county fight the powerful nicotine addiction. Please keep in mind: 1. NJ operates a QuitLine (866-NJstops, www.njquitline.org) 2. NJ Medicaid does cover nicotine replacement products (e.g., patch, gum) when prescribed. 3. Rutgers operates a comprehensive tobacco dependence program (732-235-8222, www.tobaccoprogram.org) 4. RWJ Medical School is nationally recognized for its programs focusing on reducing tobacco use in the mental health community. This includes the Consumers Helping Others Improve Their Condition by Ending Smoking (CHOICES program (732-235-8232, www.njchoices.org) 5. NAMI New Jersey Hearts and Minds presentations include helpful discussion of smoking cessation 6. Peer Wellness Coaches, offered by a number of mental health centers and mobile support programs, often focus on helping people quit/reduce their tobacco dependence 7. You can do it, we can help!
E. Dental Care People incapacitated by physical and/or mental/emotional disabilities often cannot afford22 dental care. Poor dental care leads to pain and early tooth loss for many, sometimes aggravated by the dental side-effects of psychiatric medications. VNA Clinic, Asbury Park. 732-774-6333. Monmouth Family Health Center, Long Branch. 732-475-3800. Jersey Shore UMC Clinic, Neptune. 732-869-5736. Sliding scale/charity care dental services may also be located at www.needymeds.org or https://www.nj.gov/health/fhs/oral/documents/dental_directory.pdf
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This is not a full-time facility. Call for hours. While dental coverage is a mandatory component of all Medicaid plans, it is rarely covered under Medicare.
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D. Transportation Services Resources offered to individuals with disabling physical or mental conditions include reduced fare cards and door-todoor transportation programs. NJ Transit has reduced fare identification cards available to individuals who are disabled for any reason. This card provides significantly reduced fares on NJ transit operated or contracted bus, train, and light-rail routes, as well as many private bus services. There is no requirement to be receiving social security or any other form of public benefits. A simple form needs to be completed and signed by a physician. See your current social service provider, or go to www.njtransit.com/pdf/ sf_tr_fo_reduced_passengers_RF_application.pdf . A person with a Medicaid or Medicare card can use those cards for reduced fare access, and does not need a separate card. Monmouth County residents with disabilities are eligible for county-operated disability transportation (SCAT) and subsidized shared-ride cab services). These can be used for transportation for work, medical appointments, and other life activities. Contact the Monmouth County Division of Transportation at 732-431-6480. Logisticare serves as the state’s “transportation broker” to provide non-emergency medical transportation to all Medicaid recipients in all counties. Call 866-527-9933 or visit www.nj.gov/humanservices/dmahs/home/logisticare.html Individuals who cannot travel by regular bus or train and live within ¾ mile of a bus route may be eligible for AccessLink, a door-to-door Paratransit service. Call 800-955-ADA1. EZRide provides volunteer transportation support to people with disabilities living in select areas of Monmouth County. 732-380-1299. www.ezride.org/5-1-0-FlexT.asp
E. Psychosocial Rehabilitation (PsyR) is the science of providing services to people with mental illness to maximize their independent recovery in the community. The theory and practices of the field emphasize helping people in psychiatric recovery to maximize their normal functioning in areas such as work, schooling, citizenship, and family/intimate relationships. To quote several pioneers in the PsyR field: If work makes people with mental illness sick, what do unemployment, poverty and social isolation cause?"23 “You Can Do It, we Can Help24” Information about PsyR can be found on the Psychiatric Rehabilitation website, www.uspra.org. Information about programs at Rutgers leading to certificates, undergraduate, and graduate degrees in PsyR can be located online. Vocational Rehabilitation
1. Introduction Almost all people with disabling mental/emotional issues can work, and many do. Programs described in this section are generally designed to assist people with choosing, getting, and keeping a job. In addition, various programs are designed to help people who receive public benefits (such as SSI, SSDI, Medicaid, Medicare, or housing subsidies) keep some or all of their cash benefits, as well as their health benefits, while going to school or transitioning back to work. A person receiving SSDI can earn $1140 a month or more without placing their benefits at risk by triggering a Continuing Disability Review (CDR). Complex programs are known as Trial Work Periods, NJ Workability, Plan to Achieve Self Sufficiency (PASS), Student Earned Income Exclusion, and Impairment-Related Work Expenses. If you are working with a vocational program, the staff there can help you understand many of these issues. The Moceans Center for Independent Living (described below) also has personnel with the complex knowledge needed to assist you. You can also contact the local office of the NJ Division of Vocational Rehabilitation Services (DVRS) and ask for an appointment with a “Benefits Planning Specialist.” You do not need to be receiving other DVRS services to get this kind of assistance.
23 24
Joe Marrone and Ed Golowka Larry Davidson, with gratitude to Home Depot
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2. Specific Services The Center for Vocational Rehabilitation (CVR), Eatontown offers Sheltered Work. This is a somewhat outmoded approach25 of providing rehabilitative jobs which pay less than minimum wage for people with major disabilities in a sheltered and supervised workplace. 732-544-1800. CVR also offers a wide range of vocational support services to the disability community. CPC Behavioral Healthcare, Aberdeen provides Psychiatric Supported Employment under state contract. The provider offers specific services based on a highly researched model focused on people with mental health issues including some combination of pre-employment groups, work evaluation/work hardening, transitional job placements, supported employment with available job coaching, and support groups for those who remain employed. Services can be coordinated with other mental health activities at the agency, or offered stand-alone. People do not need to be receiving any other services of the agency to use the state-funded supported employment service. Call 732-290-1700. The Mental Health Association in NJ runs Consumer Connections, a state-funded program that enables mental health peers to become providers in the mental health/ human services field. Graduates of the Consumer Connections course are able to serve alongside professionals as Peer Advocates, substituting their personal experiences for the academic credentials of the professionals. Consumer Connections is operated by 800-367-8850. Peer providers/peer advocates are moving through our mental health care system. Various other routes to this kind of career, including academic options, are available. We also suggest getting on the email list of the Consumer Provider Association in NJ by contacting
[email protected]. The Moceans Center for Independent Living (CIL) is a non-profit consumer driven organization run by and for people with various kinds of disabilities, it spans the lines between peer and professional support. 732-571-4884. www.moceanscil.org. At Moceans, like in other CILs following this national model, the consumer is at the center of the four core services.:Independent Living Skills, Information and Referral, Individual Advocacy, and Systems Advocacy Neighbors Helping Neighbors is a support group model to help people get back to work. Meetings are held in several libraries around the county. www.neighbors-helping-neighbors.com The NJ Division of Vocational Rehabilitation Services (DVRS) provides and manages services to assist all citizens with disabilities to return to the workplace. Services include skills testing, training, and job placement. 732-775-1799. One-Stop Career Centers provide job-seeking assistance to any resident needing such help. Job databases, resume preparation assistance, computer skills training. Some services are offered on a drop-in basis. 60 Taylor Avenue, Neptune, 732-775-1566 145 Wyckoff Road, Suite 201, Eatontown, 732-683-8850 Ext. 2011 Preferred Behavioral Healthcare operates a Supported Education Program in Monmouth County. This service assists adults living with mental illness in efforts to attend college or other post-secondary educational programs. Contact 732367-4700
F. Housing and Residential Services The Boarding Home Tenants’ Bill of Rights is set out by NJ law. If you or somebody you know living in a boarding home is being denied these basic rights, contact the NJ Department of Community Affairs at 609-633-6251: To manage your own financial affairs To keep and use personal property in your own room, except storage which is unsafe, impractical, or interferes with the rights of other residents To receive and send unopened mail To use a phone in privacy and to have a phone installed in your room, at your expense To privacy, including privacy regarding medical conditions and treatment To practice your own religion and to be active in the community To a safe and decent living environment and care that recognizes your individuality and dignity To have all legal rights you would have if you lived somewhere other than in a boarding house
25
A bibliography on the declining role of sheltered versus supported employment will be furnished upon request.
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To complain about the home to the Government or others without any fear of the home operator “getting even.” The first contact for emergency housing is the Monmouth County Division of Social Services - 732-431-6000. The Affordable Housing Alliance (732-389-2958, www.housingall.com) is a good source for housing information and support, as is the public housing authority in your own town26. All Residential Health Care Facilities and Boarding Homes are supervised by, and can be located through, the NJ Department of Community Affairs, 609-633-6251. All of the following programs provide residential mental health care or housing services with specific supports for mental health in our county. They are required to follow a rehabilitative model known as Community Support Services27. Collaborative Support Programs (CSP)/NJ, 732-625-9516 CPC Behavioral Healthcare, 732-290-1700 Declarations, Inc. 732-792-6990 Easter Seals Society, 732-380-0390. HABCore, 732-544-1975 Mental Health Association, 732-542-6422 RHD, 732-920-5000. Programs for Assistance in Transition from Homelessness (PATH) provides case management and intervention to people whose mental health issues place them at risk of homelessness. Mental Health Association of Monmouth County, 732- 383-8520
G. Legal
Resources Some “Free Legal Advice” If you are faced with a civil, criminal, or other legal matter where you could lose money, property, child custody, personal liberty and choice (e.g., “involuntary outpatient commitment”) or other privileges or be at risk of going to jail or having a criminal conviction, consider seeing a lawyer as soon as possible. Do your best to keep all paperwork regarding the issue, as well as the details of who has contacted or spoken with you regarding the matter. Do not discuss details of the issue with anyone, especially if it involves a criminal charge, until you have discussed it with a lawyer or chosen not to use a lawyer.
Legal Protections for People with Mental Illness involve a broad range of laws such as bias protection criminal laws, protection under the Americans with Disabilities Act, laws governing and controlling involuntary seclusion and restraint, insurance equality laws, and legal protection against disclosure of sensitive medical information. Contact the legal resources below, or your NAMI representatives. The following specialized legal resources are available (generally at no cost) to Monmouth County mental health service users. Community Health Law Project represents disabled individuals in civil legal issues, such as disability appeals/ benefits maintenance, debts and bankruptcy, child custody/family law, and landlord-tenant disputes. They also offer sliding scale civil legal representation for individuals who may not meet their typical low income guidelines for services. Their local office is located at 1 Main St., Eatontown, and a paralegal advocate sometimes makes house or treatment center calls. Call 732380-1012. Disability Rights New Jersey (formerly NJ Protection and Advocacy) is responsible for overseeing and defending the rights of institutionalized disabled individuals. This includes anybody in all a psychiatric hospital or local inpatient psychiatric unit, as well as people with mental illnesses in our state prison system. They can be contacted at 800922-7233. www.drnj.org. The Monmouth County Public Defender’s Office Criminal Division represents indigent individuals in criminal matters, and may be reached at 732-308-4320. The Division of Mental Health and Guardianship Advocacy represents individuals in psychiatric commitment and legal guardianship hearings, and may be reached at 732-869-2262.
26 All
public housing authorities in NJ are listed at www.state.nj.us/dca/codes/affdhousing/affdhsgguide/appendix_a.htm See, for instance, www.state.nj.us/humanservices/dmhas/information/stakeholder/2015_Presentations_Mtgs/CSS_Webinar_Presentation_Feb23_2013.pdf 27
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The Legal Aid Society represents Monmouth County residents in a variety of causes at no fee, based upon income guidelines. 732-869-5619 www.monmouthbarassociation.com/legal_aid.html While not legal representation as such, The Monmouth County office of Mental Health is often a good first stop for people who have frustrations with local mental health or related agencies which were not satisfied with in-agency complaint and appeals processes. 732431-7200. The Monmouth County Human Relations Commission maintains a bias incident hotline (732-303-7666), which is available for reporting hate and bias incidents, including those which arise from mental illness and other disabilities. The State of NJ also maintains a bias crime victim hotline (800-277-BIAS), to assist those who have been victims of apparent bias crimes. Legal Services of New Jersey maintains a website, www.lsnjlaw.org, offering help to address the civil legal needs of low-income residents. Psychiatric Advance Directives: The state of New Jersey has developed a system of Psychiatric Advance Directives to allow people with mental illness to make decisions regarding their care. This document takes effect when they are found to be temporarily unable to make decisions. You may Seek the help of a lawyer or other advocate in completing this form, but are not required to do so access information online at http://www.state.nj.us/humanservices/dmhas/resources/mental/pad/ 28 use a witnessed form of your own, including the crisis portion of your wellness/recovery plan, or discuss advance directives at a NAMI support group. Individuals seeking basic information about the NJ criminal justice process may want to visit www.judiciary.state.nj.us/criminal/crproc.htm.
H. Family Support Services Intensive Family Support Services (IFSS) are provided under a NJ Department of Human Services contract as a complement for the type of supports provided by our NAMI groups. IFSS offers family members of any adult dealing with a mental health issue personal consultations with experienced mental health professionals to help deal with issues and choices related to mental health care, as well as family education and support groups. All services are provided at no charge to the family member, and can take place in the home if necessary: Mental Health Association of Monmouth County, 732-542-6422. Remember that free Family Support groups are also offered by NAMI Greater Monmouth.
I. Mental/Emotional Crisis, Diversion, and Aftercare 1. Avoiding and Preventing Crisis There are many reasons to seek crisis care in a mental health emergency. Nobody wants to put themselves or someone else at risk of harm due to suicide or uncontrollable dangerous behavior. At the same time, often seeking emergency care, or disclosing dangerous intent to one’s psychiatrist, therapist, or other mental health worker, results in a traumatizing loss of liberty. Many seeking emergency mental health care find themselves coerced or ordered by law to stay in hospitals or pushed hard to take medications. Costs can mount up for hospital care and/or time off of work, leading to further emotional distress. Even a simple emergency department visit can take hours and cost hundreds of dollars. Downstream impacts can include loss of gun-owning rights and the potential to be subject to coerced community treatment orders. Consider all of the following ways to reduce or avoid emergency mental health care: Work through all of the Keys, including getting good physical health care, using professional services that you trust, maximizing coping skills, and tapering any psychoactive substances slowly29, using a physician’s care where appropriate. Use the peer support warmline, 877-292-5588 as a preventive step to avoid crisis.
If this link does not work, please try www.cspnj.org/psychiatric-advance-directive
28
This applies whether you are trying to get off pain or psychiatric medications, nicotine, caffeine, or other substances that affect our brains. 29
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Develop a personal crisis plan, and a Psychiatric Advance Directive. This could also be part of your Wellness Recovery Action Plan (WRAP). Seek the services of the Early Intervention and Support Service (page 26) if you are looking for mental health care and cannot access your own providers on a timely basis. Be cautious of what you say to people, especially mental health workers and people on telephone support lines. Some “help lines” will send the police to your door without telling you if they consider you at risk of harm to be having a crisis. Keep in mind that information you reveal to mental health workers can be used against you as evidence of dangerousness to yourself of others. If you must call psychiatric emergency services, do so directly (by calling 732-923-6999), rather than calling 9-1-1. If you cannot get the help you need by phone, insist on mobile outreach, and try to avoid letting police in until mental health workers arrive. Remember that police will not look away from criminal objects (drugs, weapons) they see on a mental health outreach, and that people who fight with police may be charged with assault or other crimes. If you are admitted to a hospital, remember that you do have the rights of refusing medication and firing your doctor. Both of these are often difficult to implement. Your lawyer can take action at any time to compel the Government to justify its continued holding of you (habeas corpus). If you are admitted to a hospital, make sure to ensure your living situation and employment is protected. Do not let someone use a hospitalization as an excuse to evict or fire you. See that your rent is paid.
2. Psychiatric Emergency Services evaluate patients anywhere in the county who may require involuntary commitment to mental health inpatient care because they are a danger to themselves or others30. It is also their duty to make appropriate referrals to divert patients who can be served in a less restrictive setting than a hospital. In Monmouth County this is provided by Monmouth Medical Center, Long Branch, 732-923-6999. For non-emergency issues you can contact them at 732-923-6930. “Affiliated Emergency Services,” including similar telephone support, are provided by the three other hospitals in our country with psychiatric inpatient units.
CentraState Medical Center, Freehold, 732-780-6023 Jersey Shore University Medical Center, Neptune, 732-776-4555 Riverview Medical Center, Red Bank, 732-219-5325
3. Early Intervention Support Services (EISS) are a “hospital diversion service” designed to provide quick access, and free services if needed. Adults who have mental illness and are at risk of needing hospital services can receive up to 30 days of outpatient behavioral health treatment. EISS program staff work with individuals to help them avoid the use of emergency department crisis units, and/or inpatient psychiatric treatment. Services include individual and group psychotherapy, medication management, and care coordination. 732-922-1042.
4.
Inpatient Psychiatric Care
in Monmouth County is offered at: CentraState Medical Center, Freehold, 732-294-2852 Jersey Shore University Medical Center, Neptune, 732-776-4369 Monmouth Med. Ctr., Long Branch, 732-923-6904/800-300-0628 Riverview Medical Center, Red Bank, 732-530-2478 Some of these units will accept patients who are “committed” by legal action, while others accept only “voluntary” patients. “Voluntary” patients are nonetheless housed on locked units, and can be held and evaluated for “commitment” if staff feels this is necessary. NJ also has some freestanding private psychiatric hospitals which can provide this type of care and sometimes care for committed patients and/or children. While none of the following hospitals are located in Monmouth County, they are
While many of us in the recovery movement advocate for an all-voluntary mental health system and elimination of forced hospitalization, that is not the law in NJ. 30
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accessible to and often used by our residents. People / families may wish to choose a specific hospital on the basis of personal preference or health plan coverage. Private psychiatric hospitals in Central/South Jersey include:
Carrier Clinic, Belle Mead, 800-933-3579 Hampton Hospital, Rancocas, 609-267-7000 Princeton House, Princeton, 800-242-2550 St. Barnabas Behavioral Health, Toms River, 800-300-0628 Rutgers Univ. Behavioral Healthcare, Piscataway, 800-969-5300
5. Hospital Alternatives and Aftercare Partial Hospitalization Programs (PHP) , Partial Care Programs (PCP), or Intensive Outpatient Programs (IOP) provide a social setting in which individuals recovering from mental illness learn social and Activities of Daily Living (ADL) skills in order to increase independent functioning. Therapeutic groups offer topics such as problem solving, symptom management, and medications, and often embed significant focus on Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and/or mindfulness-Based Stress Reduction (MBSR). The programs may also offer clients some mix of case management, medication management by a psychiatrist, recreational therapy, and individual psychotherapy. Longer- programs are used by many NJ service recipients, despite a lack of evidence that long-term use of day of treatment leads to effective resumption of education and employment. Monmouth County is served by: a. Short-term PHPs and/or IOPs operated by GenPsych, Brick, 855-436-779231 High Focus Centers, Freehold, 800-877-3628 Innerspace, Old Bridge, 732-332-8270 Princeton House Women’s Program, Eatontown, 888-437-610 Riverview Booker Behavioral Healthcare, Shrewsbury, 732-450-2900 StressCare, Manalapan and Matawan, 732-679-4500 b. Extended stay PHPs operated by Meridian Park Place, Asbury Park, 732-869-2761 Monmouth Med. Center PHPs, Long Branch, 732-923-5220 Riverview Booker Behavioral Healthcare, Shrewsbury, 732-450-2900. c. Extended stay PCPs operated by CPC Behavioral Healthcare, Aberdeen, 732-290-1700 Center for Vocational Rehabilitation (CVR)Eatontown, 732-544-1800 d. Several “adult medical day programs” focused on seniors and people with physical/neurological disorders e. Several long-term PCPs operated by for-profit agencies32 Hint: If you are considering using a day treatment program Figure out: what you need (e.g., a focus on co-occurring disorders, help planning and implementing your WRAP, Illness Management and Recovery Education (IMR)) Find a program which meets your specific needs, and works with your insurance, transportation, etc. Use that program no longer than your need it, then get back to your work, school, caregiving, etc. in the community. For a guide to choosing, using, and leaving day treatment, or a bibliography on the issue of overuse of longer-term day treatment, please contact Jay. First Episode Psychosis Program – Based upon a research-based national model, the NJ Office of Mental Health has established a set of First Episode Psychosis Coordinated Specially Care programs. The intent of the program is to serve individuals ages 15-35 who are experiencing an initial onset of what appears to be a major mental health illness with psychosis (hearing, seeing, or believing things others do not). A set of flexible and accessible services is designed to help these young men and women
GenPsych and InnerSpace are outside of Monmouth County, but are often used by Monmouth County Residents Not included in this guide, both because they are generally limited to Medicaid recipients and because they do not include any continuum of aftercare. 31 32
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avoid some of the disability which individuals with these conditions sometimes face maximize personal choice minimize long-term medication use live, learn, work, and socialize in their communities. Residents of Monmouth, Mercer, and Middlesex Counties may contact Rutgers University Behavioral Healthcare (UBHC) on 732-235-2868 for further information and appointments. UBHC will accept patients on Medicaid or Horizon Blue Cross Blue Shield, or uninsured patients. Other insurance plans may be accepted in the future.
J. Children’s Crisis and Mental Health Services This is a complex area not otherwise addressed in this booklet. If you are dealing with emotional/behavioral illness in a child/teen, you may want to learn more about all of the following: NAMI Greater Monmouth (732-4NAMI-4U) to get on the mailing list for our e-news, and to be kept aware of the schedule for “NAMI BASICS,” a course for family caregivers of kids with emotional disorders. The NAMI HelpLine (800-950-NAMI, www.nami.org) for an array of children’s mental health resources, including a free subscription to NAMI Beginnings, NAMI’s children’s mental health newsletter. Family Based Services Association of New Jersey (732-544-4502, www.fbsanj.org), which provides advocacy, education, and support (including weekly daytime and evening support groups and online support groups) for families of kids with emotional/behavioral issues. The 2nd Floor Youth and Young Adult helpline 888-222-2228. www.2ndfloor.org . Children’s Mobile Response and Stabilization Services statewide (call 877-652-7624) Children’s Crisis Intervention Services (CCIS) the inpatient services for providing short-term stabilization of acute emotional/behavioral symptoms for youth. Monmouth Medical Center, Long Branch, 732-923-6925. The Monmouth Resource Net (www.monmouthresourcenet.org) provides a compressive online directory of resources for Monmouth County children and families.
WE DEPEND ON THE KINDNESS OF OTHERS –HOW TO JOIN NAMI Greater Monmouth is a non-profit corporation run by a small crew of volunteers. Contributions received go to printing these booklets, providing conference scholarships, keeping our website and phone line going, toiletries for our “Bundles of Love” program, and more. We can use your donations: including monetary contributions, sponsorships for walkers, business partnerships, donations of goods, and more. We accept memorial contributions, and work to set up special funds as requested. We can use you: volunteers staff our booths at town and county fairs, run our annual “One in Four Gala,” walk in our NAMIWalks, etc. We always need your help to lend a hand getting us into your communities, companies, and congregations. Contributions may be sent to PO Box 6212, Freehold NJ 07728, or made online at www.namigm.org. Did you know that booklets similar to this one are available in some other NJ counties? Please visit www.namigm.org/keys_to_wellness
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Please Join Us We encourage you to consider becoming a member of NAMI Greater Monmouth. You may join NAMI Greater Monmouth for our regular annual dues ($40 per individual, $60 per household per year) by going online to www.nami.org and clicking on "become a member." If you wish to become a member, but cannot afford that price, you may join by sending your payment (of any amount between $5 and $40) to NAMI Greater Monmouth, PO Box 6212, Freehold NJ 07728. Please mark the envelope “new member” or “membership renewal,” and include your phone number and email address. automatically become a member of our local, state, and national organizations will receive regular newsletters from all of these groups are invited to our conferences, conventions, and other important events. Please join us in person at our support and education sessions, which take place from 7:15-8:45pm on the first and third Tuesdays of every month, Colts Neck Community Church, 25 Merchants Way (Separate NAMI Connection and NAMI Family Support groups.) Please join us at our NAMI Connection group which takes place from 1-2pm on the third Friday of every at the Neptune Wellness Center, 80 Steiner Ave., Neptune City. Our Neptune City group will follow the decisions of the Neptune Wellness Center (732-455-5358) for severe weather closures. All other NAMI Greater Monmouth programs and groups will follow Brookdale Community College decisions for all winter weather or other emergency condition closings. Visit www.brookdalecc.edu or listen to WBJB (90.5FM) or WJLK (94.3FM) - if they are closed - we are closed. You can always contact us by visiting www.namigm.org, calling our HelpLine at 732-4NAMI-4U or by email at
[email protected].
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