All mental health care, all health care, needs to be TRAUMA INFORMED CARE.

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I’m feeling frustrated about the barriers to receiving high quality, publicly funded, trauma informed mental health care.  Especially the barriers faced by trans and gender non-conforming folks.

I know that I’m blessed to live in a country that has free universal health care, but we still have a two-tiered system.  Psychological care, social work and counseling that happens outside hospital settings is fee-for-service.  There are many barriers for those without finances or work place insurance in terms of accessing mental health care.  Based on my own experiences, I believe that medication alone should almost never be the first line of treatment for mental illness, and that medication should never be used without corresponding counseling of some type.   This does not mean that I’m anti-medication or anti-choice or even fully anti-psychiatry.  It just means that I see mental health as more than just a chemical imbalance in the brain.  It means that I know that supportive, validating counseling can be helpful in treating most illnesses.  I highly value feminist based counseling, intersectional approaches, peer support models and any type of counseling where the patient has a say in what happens and is treated like the expert in their own lives.

I’m personally quite negatively biased against cognitive behavioural therapy.  That does not mean that I don’t think it has a place, or that it can never be useful.  I believe it can be helpful with certain types of issues, such as OCD.   But CBT leaves a LOT to be desired in relation to trauma therapy.  It focuses too much on the individual thoughts, feelings and behaviours and too little on trauma, societal oppression and practical barriers.

When I was younger, and I first entered into the mental health care system, my parents found a clinic and doctors that supposedly were experts in the field of eating disorders.  Now, maybe they were good doctors, but I can say with absolute certainty that they were not trauma informed.  I don’t really remember every being asked exactly WHY I had developed anorexia, or if anything had happened to me.

I’m not an expert, by any means, but I know that young people rarely (if ever) develop eating disorders and self harm just on a whim, out of the blue.  Generally eating disorders are symptoms of a larger problem, generally eating behaviours are coping techniques to deal with something.

I was a smart teenager.  I knew to some extent why I wasn’t eating.  I had learned that it was an effective way to zone out, feel lighter, feel empty and take up less space.  I became addicted to that feeling of zoning out, it helped me cope with the sexual abuse I was experiencing.  It wasn’t about my looks, it wasn’t about losing weight and it wasn’t about existential angst (per se).   I’m not sure if anyone actually ever asked me why I wasn’t eating.  And after a certain amount of time had passed, it became irrelevant to everyone.  Nobody cared why, they only cared about me eating so I wouldn’t die.  I didn’t believe I could die.   I’m not sure I REALLY cared if I died. I think I did at that time, but I certainly didn’t care by the time I started taking anti-depressants.  I pretty much welcomed the idea of death and started to think about suicide at 17.

These psychologists I went to see worked from a CBT model.  I remember being 16 and sitting in the psychologist’s office while he drew diagrams of how thoughts impacted feelings which impacted behaviours which further influenced thoughts and feelings.  I quickly picked up on the pattern of it.  I realized that a very specific set of responses were the desired outcome.  I followed the pattern and started saying what he wanted to hear.  I didn’t internalize any of it.  It became a game to me, not a game to manipulate or hurt anyone, but a test to see if I said what was expected if I’d be allowed to go back to school and stop missing music class for the appointments (which to me appeared pointless).

Fairly soon after that, I became physically starved to the point my brain wasn’t really working rationally anymore.  The physical side effects of the disease confused my brain and the restricting and exercising became obsessive to the point of OCD.  The behaviour self perpetuated and I lost track of why I started doing it.  I lost track of what happened to me.  I lost track of the abuse.  I lost track of everything.  I felt panicky most of the time.  I was always cold.

When someone is that sick, no type of therapy is going to work.  Eating is the only treatment.  I went to an inpatient program, started the process of weight restoration and my mind gradually cleared.  I don’t remember being asked in treatment why I starved myself to the point of near death.  I think people were relieved that I was eating and that I returned to some level of semi-normalcy.   I was still thin.  I still had strange eating habits and anxiety around food.  I still avoided eating with most people.  But I was well enough to “pass” as recovered.

I began to recover some memories around the age of 18.  But they weren’t concrete at first.  They were flashbacks, physical reactions, nightmares.  I remember talking about it indirectly to my boyfriend at the end of high school.  Telling him that something had happened with my last boyfriend.  I don’t remember if I shared many details.  I think the idea was only slightly formed in my head.   I didn’t connect the dots and fully disclose until I was 20.

Then I was thrust into the psychiatric, medical model.  I was drugged and drugged and drugged more.  The worse I got, the more drugs were given.  I was medicated to the point I could barely stay awake during the day time. I felt foggy.  I gained weight.   I was diagnosed with PTSD, but I still didn’t receive trauma informed care.

I did an inpatient program for PTSD.  It helped a LOT.  I learned a lot.  But I couldn’t fully actualize the learning because I was on too much medication and I was in an abusive unhealthy relationship.  I knew by then that the trauma piece was at the centre of my struggles, but I didn’t fully comprehend that my current situation was a major factor.

All this to say, that my life story is a testament to the perils of practicing medicine without considering the impact of trauma on physical and mental health.

I’m so passionate about looking at the roots of why people cope in the ways they do.  What societal circumstances and traumas caused them to cope in the ways they do?

Now I’m a parent.  My children struggle with anxiety.  My younger child is transgender.  She has secrets.  There are things she won’t talk about to anyone.  She struggles with focusing sometimes.  I see a lot of signs of trauma and of the impacts of things she has lived through.  Experiencing transphobia in and of itself is trauma.  Being misgendered, people using her old name, being treated as less than a real girl, being told that her mom is crazy for “forcing her” to be a girl….I could go on, but it’s a lot.  A lot for a child.  Rejection by a parental figure is one of the clearest predictors of mental illness in trans children and youth.  Acceptance is the highest predictor of mental health.

Again.  It’s not rocket science.  Of course a child will feel safer if they are accepted.

Now I’m the one trying to find the doctors, trying to access the care, trying to get referrals, wait on lists, be taken seriously.  20 years later, I’m still fighting to find a mental health care provider who truly understands the impact of trauma on a child and who is willing to practice trans positive, trauma informed care.  I don’t want her forced into CBT.  I don’t want her to be medicated.  I want someone to help her feel safe enough to express what is on her mind.  I want someone to hear why SHE uses the coping she does.  I don’t want doctors to guess and assume.  I don’t want them to misdiagnose her as well as mis-gendering her.

She deserves to be heard.  I don’t want her to be writing a post like this in 20 years.

Kids will say what they think adults want to hear.  They may do it consciously, or unconsciously or for their own reasons.  They do it to please, to stay safe, to feel a sense of control and many other reasons.  It takes a special type of doctor or counselor to help a child feel safe enough to tell their truth.   Because after enough time hiding, even she will be confused about what her truth is.

Mental health care for children should be free.  The practitioners should be trauma informed.  There should be enough funding that kids can access the care they need without lengthy wait lists.  There should not be a two tiered system where those who can pay can access things those in poverty cannot.  Poverty is a risk factor as it is, without it also limiting access to care.  Ideally there should be a system that is easier to navigate, where parents don’t feel they are fighting and advocating to the point of exhaustion.

Mental health care is a right, not a privilege.

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Photo: https://makingmomentsmeaningful.blog/2017/04/13/trauma-informed-care-values-youth-worker-values/

The Minutia. Barriers after Leaving: A rant.

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I’ve written quite a few posts about the struggles of leaving an abusive relationship.  Those posts were mainly focused on the large barriers, things directly related to the abuse and fear.  Today (4 years, 2.5 months) after leaving, I’m still facing minute and incredibly frustrating barriers.  This is a rant about jumping through fucking ridiculous hoops.  Hoops that would be frustrating after any separation, but downright impossible and dangerous after leaving an abusive situation.

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Four years ago, when I physically separated from my ex-husband, my cell phone was registered on a bill that was in his name.  We had all our cable/tv/phone services under one bill which was in his name.  Thus, even though I was living in my own home, the bill and all the information about my cell usage was sent to him.  I wanted as much distance as possible from him.  I didn’t want him to know if I called my doctor or a crisis line, or which of my friends I was in regular contact with.  I called the cell phone company and, even though my name was an authorized contact on the file, they would not consent to transferring my cell phone to my own bill without his consent.   He was the account holder.  They required him to call in.  I asked him to make the call.  He ignored me.  I asked him again, he refused.  I called the company multiple times, I begged, I cried,  I explained that I needed to keep my cell number because I’d sent out job application and resumes.  I told them about the divorce, the abuse, and I cried again.  They absolutely WOULD NOT release the phone number and contract to me without his consent.

I contacted him and told him that if he didn’t release the phone to me by X date, I would return the phone to him and he would be responsible for paying it to the end of the contract.  That date came, he still had not cooperated.  I wiped the SIM card, dropped the phone off at his place and got myself a new phone.

I lost my address, my home phone number and my cell phone number.  I’m certain he would not have passed on any mail, or messages to me.  I have no idea what I might have missed in those months following the separation. My home phone had recorded voice messages from Marian, which I had saved.  When she died, I knew they were gone and I wouldn’t hear her voice again.  I had to re-do my resume, contact doctors, schools etc. and give them not only my new address but my new cell phone number too.

It was frustrating.  It didn’t seem logical.  I felt the power of his control over my life.  He knew I wanted to keep my phone number, so he refused to give it to me.  He would have had to pay out the end of the contract, but he was willing to take a financial hit just to punish me.

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I need to renew my kids passports. I already delayed doing this for over a year, waiting to get custody, so I could put my address on the forms.  Ideally, they want both parents to sign the forms.  Do you think he would sign them? No.  Of course not!  He said that he forgot.  Then he started ignoring my emails.  So now I will have to bring the court order and divorce papers to the passport office and plead my case.  Maybe they will issue the passports, maybe they won’t.  But I will have to stand there and dredge up this embarrassing awful story about how we are separated, how he moved out of the city and I can’t contact him.  I will have to take my chances on whether or not the person working that day will process the forms with only one signature, or not.  And if they won’t?  Either we won’t be able to travel, or my lawyer will have to try to get him to sign.  But if he won’t sign?  Then what?  Go back to court, just to get a passport renewed.  Sigh.

***

About 18 months ago, I received extended health benefits through my place of employment.  I was so pleased and felt so good about being independent and self sufficient.  I was proud of my ability to work, after many years of being disabled by the violence and ensuring mental illness.

But my good feelings quickly diminished when I learned that I could not put my children’s health claims through my own insurance without claiming through his insurance first.  The rules are that the person whose birthday falls first in the year is the primary insurance, which made mine the secondary.  Since we were divorced, I was not an authorized contact on his insurance.  This meant that in order to submit extended health claims (psychologist, dentist etc) through my plan, I had to submit the claims through his plan first.  Which meant I needed his signature.

FUCK.

In 18 months, he was never once willing to coordinate the benefits.  All I needed was for him to submit the claims through his plan, then provide me with documentation about which portion was not covered.  I could then submit it through my  plan.  With the plans combined, most of the kids expenses would have been fully covered.

But he wouldn’t do it.  Absolutely just refused, ignored and at the same time, told the kids consistently that they didn’t need counseling.  He told them not to trust the counselor and that it was a waste of money, too expensive and it wouldn’t help because I was the crazy one.

So I wasn’t able to use the extended benefits.  I paid for my kids expenses on my own.  Legally we were supposed to be splitting the costs in proportion to our salaries, but that would require even more communication and the more he knew I wanted it, the less he would cooperate.

I’m extremely lucky, I’m in a position where I can pay for my kids extended health care.  But imagine how deep of an impact this would have on someone without a full time job.

The abuse, power and control can continue, financially and administratively for as long as the abuser wants.   There should be protections, that in cases of abuse, rules can be bent or made more flexible.  There should be recognition that continued contact with the abuser is mentally damaging to the survivor at best, and physically dangerous at worst.

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Fast forward again, to today, years after leaving.   My children’s father quit his job and moved to another part of the country.  Thus his insurance is no longer active.

But I STILL haven’t been able to use my own insurance.  I went to the pharmacy yesterday and his insurance was still on file.

Today, I spent probably 30 minutes on the phone with the provincial drug benefit.  They said they can’t reactive the coverage for my kids, unless they have a letter from Dad’s insurance company saying the insurance was terminated.

FUCK.

There is no way in hell I could get that letter.  I’m not an authorized person on the file for his drug plan.  They won’t talk to me.  If I email him, to ask him, he will ignore me.  He’s in another part of the country.

The frustration is immense.  I wanted to burst into tears and hang up the phone.

Luckily, there is another option, the pharmacy can write a letter to the drug benefit company explaining that the coverage through Dad was terminated.  So I spent another 10 minutes on the phone with them.  I’m hoping it will be sorted out within 1-2 weeks.

These are “minor’ frustrations.  Administrative hoops.  But for a survivor of violence, these hoops are a continuation of the power and control wielded by the abuser.  These phone calls and details can trigger me, make me feel powerless, angry or hopeless.  And they are still continuing 4 years after separation.

No, survivors can’t JUST LEAVE!

I’m writing this, partially to vent, but  partially to share details about WHY leaving is so hard.  WHY people stay in abusive relationship.  WHY the impact lasts for so long.  It’s not just the major stuff.  It’s the giant toppling pile of minute barriers which unite to form a wall of frustration.

It takes a lot of strength to keep climbing the wall.

If you are a survivor, I believe you.  I’m sorry you have to go through this.

If you know a survivor.  Believe them.  Give them a hug and tell them you are sorry for what they are going through.  Offer a helping hand. Let them vent, even if it was “a long time ago.”

The impact of intimate partner violence is long lasting.  Today, November 15th, SHINE the light on violence against women.  We all need to be a part of the solution.  We all need to work to end domestic violence.

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