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An exploration of the mental health issues that affect more than a million Wisconsinites.

Photo illustration by Adam Ryan Morris.

Photo illustration by Adam Ryan Morris.

Edited by Claire Hanan. Written By Zach Brooke, Erik Gunn, Matt Hrodey, Trenni Kusnierek, Molly McKenzie, Rich Rovito, Cathy Perkins, Larry Sandler and Daniel Simmons.

Brittany Hawley is a junior at Cardinal Stritch University. She’s double-majoring in psychology and sociology with the goal of becoming a clinical psychologist. She has also been depressed. So when one of her professors tasked her class with creating a social justice-related, semester-long project, Hawley knew exactly what she would do.

Nearly three months down the road, in late November 2015, she released her project: a YouTube video featuring individual photographs and videos she’d taken of 185 people holding signs declaring why “it’s time” to talk about mental illness. In it, a uniformed soldier’s sign reads, “…because everyday [sic] 22 veterans commit suicide.” A young man with shaggy dark hair holds a sign explaining, “because I want to feel comfortable telling the people in my life that I suffer from severe bouts of depression.” Another sign, lying atop a blanket in front of stuffed animals, reads “because sometimes a baby isn’t ‘the most joyous time of your life.’” Yet another, held anonymously by thin hands, declares, “because my very loving and supportive parents still don’t know about my struggles with self-harm.”

The project became a hit within Cardinal Stritch’s 3,800-student community, and the university’s president and vice president praised Hawley for what she’d done. The YouTube video racked up hundreds of views, and Hawley says faculty members she’d never met approached her to talk about it. What moved her most, she says, were the participants or friends of participants who messaged her, saying, “I feel less alone now.”

Those messages are powerful reminders that a little conversation can go a long way in analyzing a topic that too often resurfaces only after tragedy. So it’s a conversation worth having, and part of this package’s contribution to it is personal essays, including two from the women pictured at left, sports broadcaster Trenni Kusnierek and student Molly McKenzie. They, along with University of Wisconsin-Milwaukee psychiatrist Cathy Perkins, share accounts that explore how mental illness affects them and those around them.

They hope the essays empower others to discuss their own struggles with a health issue experienced by more than a million Wisconsinites. And experts agree: Speaking up is the first step to ending the stigma surrounding mental health.

Those experts also shared wisdom on a broad range of related topics – how the mental health system is evolving, how law enforcement’s role within it is changing, treatment approaches for children and adults, the financial costs of care, and much more.

So let the conversation continue.


Primary Care

There are major flaws in our current mental health care system. So what’s the ideal? By Erik Gunn

Illustration by Kevin Whipple.

Illustration by Kevin Whipple.

If we could design the perfect mental health system to serve southeastern Wisconsin, what would it include? For those who work in it, seek treatment or turn to it when their family members or loved ones need help, the answers aren’t all that different. Patients, therapists, psychiatrists and people behind the scenes all say they want better, easier access to mental health care at all levels.

As much as anything, they want to see an end to the stigma that still surrounds mental illness – stigma that not only prevents many people from getting help early, but also, in the view of some, drives policymakers away from providing the level of resources that an adequate system would require.

For John Schneider, chief medical officer at the Milwaukee County Behavioral Health Division, part of the ideal is dispelling the paradigm “that psychiatric illness is not medical illness, and that there needs to be a separate health care system for behavioral health – as opposed to one broad, integrated system that takes care of everybody’s needs.” It’s a thought echoed by many.

“What’s critical is a much better linkage between primary care and mental health services,” says Pete Carlson, president of Aurora Behavioral Health Services, part of the giant Aurora Health Care system of hospitals and clinics.

Paul Florsheim, a faculty member in the Zilber School of Public Health at the University of Wisconsin-Milwaukee, focuses on mental health care for children and adolescents. He calls the idea “integrated mental health care” – with mental health practitioners and services working down the hall from primary care doctors. That makes them available to help when, for instance, a patient getting her regular checkup reports symptoms of depression.

Aurora is already trying out some examples of that closer collaboration at its Menomonee Falls family practice clinic, where a psychiatric nurse practitioner is standing by for a referral from primary care doctors, Carlson says.

At Milwaukee County – the primary mental health care provider for people with no health insurance – the entire system is undergoing a still-controversial overhaul. It was enabled in part by state legislation that transferred oversight of the behavioral health division from the County Board to a new Mental Health Board. (The legislation came after aggressive reporting by the Milwaukee Journal Sentinel.)

Improved access is part of the agenda there as well, according to Schneider and Patricia Schroeder, the administrator for the county’s behavioral health division. To that end, the agency is developing plans for a North Side facility that the division hopes to have operational by the end of 2016. The concept calls for multiple agencies all located in a setting that Schneider likens to a miniature shopping mall.

Just as prevention has been the focus in improving physical health, Florsheim says prevention or early warning for mental illness needs to come to the forefront. Explains Jerry Halverson, medical director at the Oconomowoc campus of Rogers Memorial Hospital: “The prevention piece is something we’re learning more and more about.”

At the most basic level, one that reaches beyond the individual hospital or clinic, is emphasizing parental care. “One of the things we do know that is correlated with mental illness is a history of trauma, neglect or abuse growing up,” Halverson says. “If there are things that can help prevent that, we should do that.” Schools can help identify and treat early signs of mental illness, and the Milwaukee Public Schools system has worked to include the development of social and emotional learning skills among the goals they seek to teach children. A “positive move,” Florsheim says.

At UWM, researcher Shawn Cahill points to another critical development for the long-term prospects of the mental health system: better tracking and better communication about what forms of treatment work. “We have evidence for the effectiveness of different forms of psychotherapy,”

Cahill says. Yet he warns how research has illustrated that working therapists often don’t know what the evidence actually shows, and many aren’t systematically incorporating that knowledge into practice.

Finally, there’s the stigma. “The No. 1 reason why youth and adults don’t seek treatment is because they don’t want to be known as crazy,” says Peter Hoeffel, executive director at the National Alliance on Mental Illness’ Milwaukee chapter. It’s a point echoed across the board by providers and academics, as well as by those who speak for patients.

Even health professionals who care for the mentally ill may inadvertently stigmatize their patients, says Sue McKenzie, co-director of the Wisconsin Initiative for Stigma Elimination, a research and training nonprofit that is now under the umbrella of Rogers Memorial Hospital.

But the aim goes further than sigma reduction, McKenzie says. It is “increasing inclusion, support and solidarity” with people who have mental illness. A key answer is for people with mental illness to get support for going public with their stories when they’re ready to do so.

“It takes a lot of guts,” McKenzie notes, “to say, ‘Yeah, let’s put my voice out there.’”

 


 

Platonic Forms

The flexibility of the brain may hold the key to combating mental illness. By Matt Hrodey

Through the late 1990s, conventional wisdom held that the human brain couldn’t generate new “brain cells.” A neuron lost through disease was gone for good. But experiments on animals had already shown that the hippocampus – a squiggly brain area involved in emotions and memories – sprouted new neurons all the time. Since determining whether the same was happening in human brains required cutting into one, researchers at Sweden’s Sahlgrenska University Hospital recruited five patients with terminal cancer, knowing doctors would, at some point, inject them with a chemical used to find cancer cells. After the patients died, the researchers took samples from their hippocampi and dyed all cells marked by the chemical – which showed up in both new healthy cells and new cancerous ones. The brain tissue showed not just stray dots but whole surfaces speckled like flypaper. Even the hippocampi of elderly cancer patients had been busily regenerating, a finding that, after it was published in 1998, turned neuroscience upside down.

Since then, studies have shown that the hippocampus and frontal lobe are in constant flux, and that antidepressants work in part by stimulating the growth of new neurons in the brain. Mood stabilizers also help nourish the cells, especially lithium, which James Phelps, an Oregon psychiatrist, calls “the universal solvent of mood disorders.” Previously supplanted by newer medications, it’s undergoing a revival given the 1998 study and the new emphasis on countering mental disorders by sending in neuronal reinforcements. Exercise also works well: In a 2010 study, schizophrenic patients who submitted to a three-month exercise program saw their hippocampi grow by 12 percent, as compared with a control group that played foosball and suffered a 1 percent decline.

If left untreated, mental disorders such as schizophrenia and depression can cause atrophy in the brain. One study suggested that a decade of untreated depression reduced the volume of the hippocampus by about 30 percent. According to Phelps, researchers have identified about 30 molecules involved in the “neuroplastic” push-pull that causes some neurons to swell and reproduce, and others to retract their dendrites and implode. Chronic stress, and the stress hormone cortisol, can set in motion a chain of events that tears brain cells apart. Before it does that, stress can weaken and short-circuit basic mental functioning, according to the research of Bruce McEwen, a professor of neuroendocrinology at Rockefeller University in New York. Like the Swedish finding, his discovery of stress’ all-importance has changed how psychiatrists view mental illness. In his estimation, the brain remains plastic throughout life, but “if it gets stuck, then you have a psychiatric disorder,” he says. Medications “may at best open a window of plasticity” to allow therapy or life changes to “drive the brain in the right direction.”


 

The Aftermath

What happened when one public figure opened up about her depression and anxiety. By Trenni Kusnierek

An Open Book: Kusnierek’s willingness to talk about her depression has inspired and comforted others. Photo by Adam Ryan Morris.

An Open Book: Kusnierek’s willingness to talk about her depression has inspired and comforted others. Photo by Adam Ryan Morris.

My heart was racing. It was September 2012, and I had just learned an article about me, which focused on my battle with anxiety and depression, was about to be published online by this magazine.

I’d been a Milwaukeean living with depression for as long as I could remember, maybe as early as sixth or seventh grade, but I was only formally diagnosed in my 20s. I had considered publicly telling my story, but I feared the backlash. As a sports broadcaster, my work is very public, and I wondered if it would affect my ability to get another job or if the revelation might disqualify me for health insurance.

Then the script flipped. When former NFL linebacker Junior Seau committed suicide and there was as much public confusion as compassion, I knew I had to speak out. So I offered to discuss my mental health in that 2012 story. I understood sharing my journey wouldn’t save every life, but it might help a few people who also felt trapped by their minds and emotions.

If knowing that my secret would suddenly become public wasn’t scary enough, this story was being published mere weeks after I’d moved to Boston to take a job with Comcast SportsNet New England. I was terrified that once my new bosses, colleagues and fans in Boston knew the story, my career would be over before it got going. I worried about how my family and friends would react. What if I was no longer seen as me and instead seen through the lens of “that girl with a mental illness?”

The story was published and the reaction was swift, starting with Twitter and later by text. I held my breath as I waited for the Internet’s famed vitriol, but none came. It was the sweetest kind of silence, broken only by overwhelming words of kindness and support. If anything, I was angry with myself for staying quiet for so long.

Since that fall, I have received hundreds of text messages, emails and social media messages from friends, family and strangers thanking me for sharing my story. Athletes have reached out, saying they’d experienced something similar. Fellow broadcasters pulled me aside on assignment to ask for my advice. Viewers sent emails bravely sharing their stories.

What stands out about every story is that they all felt familiar. None of them stood out individually, because our fight is a common one. Everyone felt alone, scared, overwhelmed and misunderstood. All they wanted was for someone to listen and not dismiss them as crazy or “going through a tough time.”

In the years since I opened up about my depression and anxiety, I’ve learned I needed others as much as they appear to have needed me. Every story I hear is a stark reminder of how many of us deal with these invisible demons. And a battle with your brain is not won easily or alone.

At the same time, I learned that the path to understanding and action is long and arduous. Despite talking openly about my mental health, I can still feel frustrated and even isolated. And I’ve learned that we still have a long way to go. Recently, I had someone very dear to me ask, “When do you think you’ll feel better?” Knowing his heart was in the right place, I didn’t have the fortitude in that moment to again explain that mental illness doesn’t pass like the common cold. That’s why I keep talking and challenging those around me to fight the stigma and misunderstanding. There is no perfect way to do this, but if I have learned one lesson, it’s that our voices and stories matter.

This is a fight for compassion and understanding, and it begins with our words.


 

An Uphill Climb

Experts agree that there are grave consequences for untreated mental health issues. So why is treatment so expensive? By Rich Rovito

On a warm December day, Mary Neubauer arrives at Autumn West Safe Haven, a shelter on Milwaukee’s West Side where she works part time as a certified peer specialist. Still on the mend from major knee surgery – the latest of many – her gait is slow and deliberate. For the 57-year-old Neubauer, the physical ailments are only part of her challenges. She has battled mental illness since childhood, and has been treated for bipolar disorder and attention deficit hyperactivity disorder. Despite her master’s degree in social work and ability to hold down a job, the cost of treatment, counseling and medication has, at times, left her nearly broke.

Neubauer’s financial situation has become especially dire recently due to an extended leave of absence from her job to deal with post-traumatic stress disorder, which she says is a result of a long history of abuse. On this December day, she has about 75 cents to her name.

Neubauer is convinced that many of her physical issues – diabetes, high cholesterol, obesity – stem from the side effects of the medication she takes for her mental disorders. Conversely, the physical effects have exacted a toll on her mental health. Taken together, it makes for a significant financial burden. Last year alone, the medications to treat Neubauer’s mental and physical ailments, including what her insurance covered, cost more than $60,000.

“It’s astronomical,” laments Neubauer, who has been on medication for mental illness for more than 30 years. She has battled alcoholism and first attempted suicide at age 11. Thoughtful and opinionated, she also serves as co-chair of the Milwaukee Mental Health Task Force and, as she says, its “head troublemaker.”

The tab to treat her mental illness far outweighs the cost of dealing with her physical ailments, she says. Ninety-day supplies of Latuda, an antipsychotic, and Strattera, used to treat ADHD, cost thousands, she says. Compare that with her three-month supply of blood pressure medication Lisinopril ($63), cholesterol medication Zocor ($77), and diabetes medication Metformin ($90). Although insurance covers a majority of the cost of Neubauer’s drugs and talk therapy sessions, her monthly premiums for Medicaid and Medicare cost more than $900. And, she adds, “Everybody isn’t as fortunate as I am.”

The Affordable Care Act built on the Mental Health Parity and Addiction Equity Act of 2008 by requiring coverage of mental health services at levels comparable to coverage for medical and surgical care. Nonetheless, patients may be faced with narrow provider networks. Quality of care then becomes an issue, says John Mantsch, chairman of the Biomedical Sciences Department in Marquette University’s College of Health Sciences. He’s also a co-founder of Promentis Pharmaceuticals, a startup drug company that’s focused on developing treatments for schizophrenia.

Of course, mental health care costs extend beyond prescribed medications. “Oftentimes, there is a need for extensive psychotherapy,” Mantsch says, which drives up costs even more for patients.

Part of the problem, Mantsch thinks, is that not enough has been done to “incentivize” providers of mental health services with adequate pay, causing barriers to treatment. Compounding this is a shortage of psychiatrists. “If people aren’t getting treatment, they often go off the grid altogether and end up homeless or dead,” he says.

Sandy Pasch is a former Wisconsin state representative and a psychiatric nurse. She worked to pass a series of bills to improve mental health care in Wisconsin and says the issue is further complicated because many hospitals have cut back on mental health care services.

“Many people aren’t disabled by their mental health issues,” Pasch notes, “but could be without proper treatment.”


A Time for Reflection: Walter Lanier at Progressive Baptist Church, where he serves as pastor. Photo by Adam Ryan Morris.

A Time for Reflection: Walter Lanier at Progressive Baptist Church, where he serves as pastor. Photo by Adam Ryan Morris.

Unequal Treatment

One side effect of racism is mental illness, and it’s especially hard to remedy. By Daniel Simmons

A student at Milwaukee Area Technical College wrote Walter Lanier asking for resources to help with his depression. A mother from Lanier’s church wrote seeking help dealing with her son’s mental illness. The two notes on Facebook came during the same weekend of December 2015, and they represented a small victory for Lanier. That’s because – in addition to being a pastor and MATC’s chief counselor – he has, since 2012, led the Miracle initiative to improve awareness of mental health in the African-American community.

“The high hurdle is bringing down that bar of stigma and shame,” he says of African-Americans dealing with mental illness. “Once it comes down, it allows people to seek help they wouldn’t otherwise pursue.”

The struggles for African-Americans in Milwaukee have been well-documented but poorly remedied. The area has gained infamous distinctions as a national leader in segregation, black incarceration rates and the achievement gap in schools. High-profile events – like Milwaukee Bucks player John Henson being denied entry to a Whitefish Bay jewelry store – have laid bare the area’s racial divides.

A leading researcher on the topic, Camara Jones, of the National Center for Chronic Disease Prevention and Health Promotion, says that racism plays out in three main areas: institutionalized racism, which can mean unequal access to services; personally mediated, wherein victims of racism experience a lack of respect, suspicion, devaluation, scapegoating and dehumanization; and internalized racism, which can include embracing “whiteness,” devaluing the self and hopelessness.

0216_mental-health_race_chart

The accumulation of perceived slights, or “micro aggressions,” can result in higher rates of disease and shorter life spans, according to federal health data. It also manifests in mental illness.

Poverty is also a factor. Among black people, those living in poverty are three times more likely than their better-off peers to say they’re living with psychological distress, according to a federal Health and Human Services survey.

For Latinos, mental illness is also a significant issue, but the transient nature of immigrants gives it different parameters than for black people. Rates of depression are twice as high for Latinos born in the U.S. compared with Latinos born outside the country, a phenomenon called “the immigrant paradox,” says Lucas Torres, a Marquette University psychology professor. A full explanation for it remains elusive, but some experts argue that Latinos tend to be treated as “perpetual foreigners” who don’t speak English and don’t understand American customs. It can be particularly scarring, Torres says, for longtime residents whose families have lived here for generations.

Getting help can be unusually difficult. Chronic underemployment means black people and Latinos in Milwaukee are less likely to have access to employer-sponsored health insurance and employee-assistance programs. Understanding of mental illness can be lacking among family and friends.

That’s partly why Lanier started the Miracle project: He saw people with mental illness being marginalized by church leaders and congregants.

Miracle’s efforts, including monthly meetings, support groups, and mental illness-related artistic performances by a partner group, have touched about 20 churches so far, Lanier says. The progress has come in more dialogue and more people seeking help, whether through a mental health professional, or by reaching out to Lanier or other ministry partners. And that’s why he keeps track of those Facebook messages, one post at a time.

 


 

The Force Awakened

The killing of Dontre Hamilton made the Milwaukee Police Department rethink its interactions with the mentally ill. By Larry Sandler

He was moments from death when the squad car pulled up. As the man stood on the edge of the 35th Street Viaduct, Milwaukee police officer David Wilhelm recalls, “My first thought was: I had to get him talking to me and get his mind off of jumping.” Using “active listening” skills that he had learned just days before, Wilhelm started asking open-ended questions that encouraged the man to talk. And the man talked. About how drugs ruined his life. About his fear that his son would think his father was a failure. About how he would rather kill himself before that happened. But also about the good times he had with the boy, which gave Wilhelm his opening.

The officer told the man his son would always love him. That “he had a purpose in life, and that was to be his son’s hero.” That police cared about him and would help him get the help he needed. Only then, after the two had made a connection, did Wilhelm ask the man to climb over the railing and sit beside him on the curb. By the time the city-county Crisis Assessment Response Team arrived, the man was agreeable to treatment.

That May 19 incident shows how officers can use their Crisis Intervention Team training. It was mandated for all 1,800-plus Milwaukee officers after then-officer Christopher Manney killed Dontre Hamilton, who’d suffered from mental illness. Police Chief Edward Flynn said the 2014 slaying could have been avoided had Manney properly approached Hamilton, whose death stirred protests and led to Manney’s firing.

But far more police encounters with the mentally ill end peacefully. Dispatchers classify 7,000 to 8,000 calls a year, about 3 percent, as related to mental health. That number is likely understated, says Lt. Liam Looney, crisis intervention coordinator.

Their approach is evolving. Years ago, Looney says, if police were told “there’s a crazy guy screaming in the street,” they’d cite him for disorderly conduct. In fact, a national study estimated that, in 2012, the Milwaukee County Jail held more mentally ill inmates than Wisconsin’s Mendota Mental Health Institute. Now, if the mentally ill seem dangerous to themselves or others, police can take them to the county’s Mental Health Complex. Emergency detentions by police accounted for more than half of the almost 11,000 psychiatric crisis service admissions in 2014.

Back in 2006, before she’d become a state legislator, Sandy Pasch was president of the National Alliance on Mental Illness’ Greater Milwaukee chapter. Seeking to improve local crisis outcomes, she turned to the Crisis Intervention Team training developed by NAMI. Pasch introduced the 40-hour training to Milwaukee-area officers on a volunteer basis. Officers learned how to recognize mental illness and substance abuse, de-escalate crises and use community resources, including the county’s two satellite Crisis Resource Centers. These were opened in 2007, and therapists there could stabilize the mentally ill without checking them into the Mental Health Complex.

Milwaukee also created Crisis Assessment Response Teams, pairing officers with county therapists for the most challenging cases. The first team, officer Chad Stiles and social worker Jeff Scott, started in 2013, and a second team followed in 2015. There were 223 CART cases in 2014, and 340 in the first 10 months of 2015.

Before the Hamilton incident, most officers had 16 hours or less of mental health training. Pasch says NAMI didn’t want the 40-hour CIT training to be mandatory, believing the program works better with volunteers. The compromise: All officers must be trained, but only volunteers – about 500 of the 700 trained so far – are designated CIT officers. They’re given first priority for mental health calls, Looney says, and are eligible for more training.

Looney says the training helps police “decriminalize mental illness.” But Stiles and Pasch say reduced hours at county crisis centers leave officers with few 24-hour options to get help for the mentally ill.

Peter Hoeffel, executive director of NAMI-Milwaukee, says the city needs both centers open 24 hours a day, as well as more CART units and a greater willingness by private psychiatric hospitals to accept patients brought in by police.

And police recognize the importance of change. Assistant Police Chief Kurt Leibold says the way police handle people who are mentally ill “is getting better. But for a city our size, it’s got to get a lot better.”

 


 

Illustration by Jonathan Bartlett.

Illustration by Jonathan Bartlett.

Childhood Struggle

When does a child’s unusual behavior become something more serious? By Daniel Simmons

The phone call came from her daughter’s new teacher. “I think there’s something really wrong with Jesse,” the teacher told Carla Pennington-Cross.

It would be rough news for any parent, but that was especially true for Pennington-Cross: Her daughter was just 5 years old and in her first week of kindergarten in Glendale. Jesse had had extreme behavior problems since infancy, but the teacher’s call was the first time someone suggested that she may be more than a fussy child.

0216_mental-health_parenting_chartThat phone call began a mental health journey that continues for Pennington-Cross and her husband, Anthony. They started Jesse in weekly talk therapy sessions when she was 5. Now 10, Jesse still meets with the same therapist, Craig Abrams, and doctors recently diagnosed her with obsessive-compulsive disorder and anxiety. Jesse has begun taking anti-anxiety medication to supplement therapy. Her parents – he’s a professor, she’s a former lawyer turned stay-at-home mother – have significantly altered their lives and changed their parenting strategy.

“We became much less disciplinarian,” Pennington-Cross says. Instead, she says, “We embraced positive, short-term goals.”

Mental illness may seem an adult disease, but it often takes root during the teen years. In half of all lifetime cases of mental illness, the illness had begun by age 14, when most kids are starting high school. Left untreated, kids suffering from depression and related illnesses may resort to self-destructive behaviors, including suicide. And half of all high school kids diagnosed with a mental illness don’t graduate. In the Milwaukee Public Schools system, teenagers reported much higher rates than the national average in three troubling areas: planning a suicide, attempting it, and attempting it in ways that resulted in injury, poisoning or overdose, according to a 2013 survey by the Centers for Disease Control and Prevention.

Parents play a key role in recognizing and managing a child’s mental illness, but mental illnesses rarely look exactly alike. Symptoms can range from physical ailments, such as stomachaches, to severe mood swings or intense feelings of worry or fear. Concentration problems, changes in sleep and appetite, and memory problems or confusion could all be signs of mental illness.

Parents concerned about a child’s behavior – provided it’s not an emergency – should talk to teachers or school counselors, who can often determine if out-of-character behavior is cause for concern. Pennington-Cross says parents need to become informed, aggressive advocates for their children. A child’s primary-care doctor can be another good resource.

“[Pediatricians] now have tools available to understand better when a child’s behavioral and mental health needs are beyond the scope of what primary care can offer,” says Sheri Johnson, a psychologist and associate pediatrics professor at the Medical College of Wisconsin.

Previously, meals for the Pennington-Cross family began with Jesse dumping her water then punching a wall four times. But her parents began putting the glass out of her reach, and then praising her for not dumping it. If she erupted into a tantrum, they didn’t scold or isolate her. They hugged her. “It’s a day-to-day balancing act,” Carla Pennington-Cross says. “We want her to feel as normal as possible.”


 

Taking Note

A college psychiatrist, on the unique stressors that can befall young adults. By Cathy Perkins

When you imagine college life, you picture a hopeful scene: limitless learning and occupational advancement; the independence of living in a dorm or apartment; hundreds of new people to learn from, grow with and, perhaps, befriend. Most young adults and their families go into this experience positively.

But what happens if your first-semester grades are poor or even failing? It is deflating to realize you have nothing in common with your roommate, or you struggle to meet people.

No one expects their father to pass away, and trying to get through finals in the middle of grieving seems impossible.

As a psychiatrist providing care at the University of Wisconsin-Milwaukee health center for the last 10 years, I may be overly wary of potential minefields that can befall our students. Sometimes these variables stack up, leaving students sleep-deprived, sad, sapped of energy, unable to focus, even suicidal. Persisting major depression or anxiety disorders, already present, can become harder to manage in college.

When Sara came to our health center, she was proactive about her health. She had been depressed with generalized anxiety since her early 20s, but was on effective medications she wanted to continue. Sara had been in recovery from alcohol use for a few years, and she continued to attend Alcoholics Anonymous meetings and meet with her sponsor. She did everything right: counseling, recovery, medication, academics.

And she continued to work 30 hours a week. Although some students may need only six months of treatment or less, she needed treatment until graduation.

Brian arrived at UWM from India after spending a semester at another university in Florida. Despite his academic success in India, he was bullied in Florida, became debilitatingly depressed and struggled academically. So he transferred to UWM and lived with extended family. He never integrated into that household and felt hopeless, occasionally suicidal. With intensive counseling and medication, he slowly became energized. He also developed a routine that included sleeping better, eating well and completing required readings. A year and a half later, his grades improved, and he was able to taper off of medication and therapy.

Although “Brian” and “Sara” are composites of students served over the years, they illustrate real experiences. When students call the Norris Health Center with mental health problems, they talk with a licensed, professional counselor who triages their symptoms and schedules an evaluation. In the initial session, either a psychologist, a master’s-level social worker or a licensed professional counselor will take their history and create a diagnosis and treatment plan. Roughly 25 percent of these students may have medications prescribed by one of our psychiatrists.

Sometimes, a student’s friend will urge the student to call us for treatment; sometimes a parent or professor may insist on it. Mostly, these students come in on their own because they know themselves, and they know they need help.

That’s a good thing.


 

The Long Road

A correct diagnosis was a positive milestone in an arduous journey. By Molly McKenzie

Right Turn: Twenty-six-year-old Molly McKenzie endured many years of confusion before receiving a diagnosis that made sense to her. Photo by Adam Ryan Morris.

Right Turn: Twenty-six-year-old Molly McKenzie endured many years of confusion before receiving a diagnosis that made sense to her. Photo by Adam Ryan Morris.

I was recently at an appointment where, as usual, the doctor reviewed my current medications for attention deficit hyperactivity disorder (ADHD), a diagnosis I received in 2012. After confirming the dosages and the reason for taking each medication, the woman asked, barely hiding her disgust, “Who prescribes you all of these?”

“My psychiatrist,” I replied. I wasn’t sure where she was going with this, until she looked up at me, took two steps backward, and said, “Are you sure you are mentally stable?”

It took me a couple seconds to level my mix of anger, hurt and confusion. I lifted my chin and told her proudly that I’m healthier and more mentally stable than I have ever been in my life. I was now the one feeling disgusted. Although I was proud of the way I responded, it was concerning to encounter another medical professional who judged me for my mental health.

I wouldn’t always have reacted that way.

I experienced a painful decade and a half of confusion and loneliness. I had long suffered anxiety, depression, self-harm and suicidal ideation, some of which started when I was just a child. Things worsened in high school and were hastened, in part, by my parents’ divorce. I started to view myself as sick and invisible. I thought everyone was looking at me, as if “broken” was written on my forehead.

But in 2012, my mom took me to Rogers Memorial Hospital for an assessment. We decided an intensive outpatient program would be a good place to start, and off I went. Three hours a day every weekday was spent working harder than I will ever work in my life. And the therapist who led my program was the first person I’d worked with who truly specialized in anxiety. Through the program, I was able to meet people who were close to completing treatment, and people, like me, who were just starting. For 10 months, I recorded everything I did and felt. I had to relearn who I was.

What I learned was that most of my life had become filled with cognitive distortions. I had a nearly impossible time focusing, and that really bothered me. In fact, it bothered me so much that I had a constant sense of failure. I couldn’t focus on anything else besides my fear of failing again. This train of thought, I learned, was an ever-present cycle in my 15 years of concurrent issues, depression and anxiety. During this time, I was finally diagnosed with ADHD, after spending all of those years without a proper diagnosis.

ADHD typically presents itself differently in females than it does in males. When you imagine a child with ADHD, most people envision a young boy who has lots of energy and doesn’t follow the rules. This is a potential case of ADHD, but those are often just two possible symptoms of many. Males tend to show external behavioral symptoms of “hyperactive-impulsive” ADHD, while females are more likely to have an “inattentive” type of ADHD. If it’s not treated, this may lead to a sense of failure, and then to internalized symptoms such as the depression and anxiety that I had for years. And females are much more likely to go undiagnosed, because we naturally treat what we can see, not what may be beneath.

I ended up missing a lot of life by being misdiagnosed. But with the appropriate treatment, I learned how to catch these distortions and switch to productive, healthy thoughts. I’d come home eager to teach my family what I was learning. I was educating myself to identify cognitive distortions, change my thinking, challenge my anxiety through exposure, and utilize mindfulness.

Currently, I’m 26 and am going to MATC to get an associate degree in human services. For the first time, I have a best friend who accepts all of me without judgment. I challenge myself every day to do things outside of my comfort zone. I can go out in public and tune out those constantly turning wheels. I am in control of my life and my emotions. I journal when I feel overwhelmed, and I still see my outpatient therapist every other week. I put a lot of effort into keeping myself on track.

Because of all of this, I am finally excited for my future and the potential it holds. My older sister and I even fantasize about opening up a dog rescue organization one day. We talk about allowing teens who struggle with mental illness to help care for the dogs, giving them the chance to connect with an animal that doesn’t judge or abandon them.

I am still discovering who Molly is and where I want to go in life, but I no longer worry if I will get there.


 

Everything You Want to Know About Personality Disorders But Are Too Afraid to Ask

By Zach Brooke

According to the National Institute of Mental Health, slightly more than 9 percent of the U.S. adult population, or 22 million people, experience a personality disorder. Included among personality disorders are familiar terms like paranoid, anti-social and borderline personality disorder, which, despite their prevalence, are largely misunderstood by the general public, mental health experts say.

➤ Personality disorders differ from character traits because they’re harmful.
All people have their own ways of interacting with the world, and many people exhibit behaviors that others regard as peculiar. Only when a behavior pattern causes problems in someone’s relationships does it rise to the level of a personality disorder. For instance, a person with a narcissistic personality disorder is “selfish and shows a sense of superiority,” according to psychiatrist Dr. James Winston, and such people’s persistent lack of empathy and sensitivity can often damage personal relationships. “The ways that [people with personality disorders] react oftentimes cause problems for them, and it’s not something that they can easily just think through,” says Dr. Jon Lehrmann, a professor in psychiatry and behavioral medicine at the Medical College of Wisconsin.

➤ Personality disorders are more nurture than nature.
Although research is ongoing, it’s generally accepted that personality disorders are more heavily influenced by environmental factors than genetics, setting them apart from other mental illnesses like schizophrenia and bipolar disorder. Relationship issues occurring in childhood can often develop into personality disorders in late adolescence by creating destructive behavior patterns. But not everyone who experiences a troubled childhood will develop a personality disorder.

➤ Personality disorders are classified in three groups.
Called clusters, these groups are broadly defined by their manifestations. Cluster A is known as the “odd” or “eccentric” group, and these disorders generally cause social awkwardness and withdrawal. Persons with Cluster B or “dramatic” disorders tend to have problems managing impulse control and regulating emotions. Cluster C is defined as covering “anxious” personalities that are avoidant, dependent or obsessive-compulsive. There’s also a designation for unspecified personality disorders, and a person can have more than one at the same time, or a combination of a personality disorder and another type of mental illness.

➤ The primary treatment is psychotherapy.
The therapeutic process is intended to help people identify the root causes of their illness and develop coping strategies that mitigate the effect of personality disorders. Pharmaceuticals, such as antipsychotics and anti-anxiety drugs, may be included as part of a mental health care plan, but usually as an adjunct and not a core treatment.
“With proper psychotherapy and sometimes medication, patients can look into their behavior and see how it’s destroying their lives and the lives of others,” Winston says. “They can also look into their childhood and understand some of the past behavioral influences, so they can change their current thinking pattern.”

➤ Personality disorders tend to be chronic rather than episodic.
Our personalities are forged in childhood and early adulthood, so personality disorders are harder to treat with age. Yet improvement to the point of remission is achievable, Winston says, ”if you can learn the right strategies and develop enough insight to alter your behavior.”

 


 

Instant Feedback

Psychiatrist-approved recommendations for what to say, and what not to say, if someone you know is experiencing one of these conditions. By Matt Hrodey

0216_mental-health_what-to-say_chart


 

Resource Guide

Achievement Associates
Multiple locations, 262-241-5099, achievementassociates.com

Adkins Counseling Services
6001 W. Center St., Ste. 208, 414-393-1099

AMRI Counseling
Multiple locations, 414-810-6691, amricounseling.com

Aurora Psychiatric Hospital
1220 Dewey Ave., Wauwatosa, 414-454-6600, aurorahealthcare.org

Aurora Behavioral Health Services
Multiple locations, aurorahealthcare.org

Bell Therapy
5555 N. 51st St., 414-527-6940, phoenixcaresystems.com/bell

Catholic Charities Behavioral Health/Counseling Services
Multiple locations, 414-769-3400, www.ccmke.org

Columbia St. Mary’s Behavioral Medicine
Multiple locations, 414-585-1620, columbia-stmarys.org

Community Advocates
728 N. James Lovell St., 414-449-4777, communityadvocates.net

Discovery and Recovery Clinic
4402 S. 68th St., Ste. 100, Greenfield

Forward Choices
6040 W. Lisbon Rd., Ste. 103, 414-442-1751, forwardchoices.com

Froedtert & the Medical College of Wisconsin Behavioral Health
Multiple locations, 414-805-3666, froedtert.com

Gateway to Change
2319 W. Capitol Dr., 414-442-2033

Grand Avenue Club
210 E. Michigan St., 414-276-6474, grandavenueclub.org

Lutheran Social Services
647 W. Virginia St., Ste. 200, 800-488-5181, lsswis.org

M&S Clinical Services 
2821 N. Fourth St, #516, 414-263-6000

Mental Health America of Wisconsin
600 W. Virginia St., Ste. 502, 414-276-3122, mhawisconsin.org

Milwaukee Center for Independence: Crisis Resource Center
2057 S. 14th St., 474-643-8778; 5409 W. Villard Ave., 414-643-8778, mcfi.net

Milwaukee County Behavioral Health Division
9455 W. Watertown Plank Rd., 414-257-6995, county.milwaukee.gov

Milwaukee Health Services
MLK Heritage Health Center, 2555 N. Dr. Martin L. King Jr. Dr., 414-372-8080; Isaac Coggs Heritage Health Center, 8200 W. Silver Spring Dr., 414-760-3900; mhsi.org

NAMI Greater Milwaukee
3200 S. Third St, Unit 6, 414-344-0447, namigrm.org

New Concept Self-Development Center
1531 W. Vliet St., 414-344-5788, ncsdc-inc.org

North Shore Psychotherapy Associates
5800 N. Bayshore Dr., Ste. A250, 414-962-6764, northshorepsychotherapyassociates.vpweb.com

Professional Services Group/ Community Impact Program
1126 S. 70th St., Suites 112-13 and N208, West Allis, 414-727-2789, psgcip.com

Rogers Memorial Hospital
Multiple locations, 800-767-4411, rogershospital.org

Shorehaven Behavioral Health
3900 W. Brown Deer Rd., Ste. 200, 414-540-2170, shorehavenbhi.com

Sixteenth Street Community Health Centers
1032 S. Cesar E. Chavez Dr., 414-672-1353, sschc.org

The Bridge Health Clinics & Research Centers
600 W. Walnut St., Ste. 39, 414-831-4500, thebridgehealthclinics.com

Vital Voices for Mental Health
912 N. Hawley Rd., 414-771-4368, vital-voices.org

Warmline
9455 W. Watertown Plank Rd., Wauwatosa, 414-777-4729, warmline-milwaukee.webs.com

Wheaton Franciscan Healthcare Mental Health & Addiction Care
Multiple locations, mywheaton.org

Wisconsin Department of Health Services Division of Mental Health and Substance Abuse Services
608-266-2717, dhs.wisconsin.gov

‘Mind Matters’ appears in the February 2016 issue of Milwaukee Magazine.

Find the February issue on newsstands beginning Feb. 1.

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