Posted inAll Posts PTSD & Tough Shit

Mental Health Resource Guide

May 10, 2024No Comments
Table of Contents

    About

    Hello there friends! Here’s a bunch of stuff that I hope helps you on your quest to proactively improve your mental health. This thing is quite long; please use the above table of contents to navigate, and feel free to jump and skip around. Overall this stuff encompasess three general topics:

    1. Books: good resources to learn more about metal health and how to improve it. 
    2. Self-Care: practices you can do yourself
    3. Therapy: all things therapy related; how to find a therapist, how to go to one, how to pay for it, etc

    Please know that most of this information came from people way more awesome than me(JSD). People who wish to remain anonymous contributed much of this. The input of Jillian Jonsrud and Diania Merriam is also greatly appreciated. Three anonymous people really chipped in; known as Van, A Stranger from the Internet (SOTI), and LizWithLime. Anything good that you get out of this is owed to them. Any mistakes or errors are my fault entirely.

    You can probably tell from my writing that I’m not a doctor, therapist, or certified in much of anything. I’m just some dude. To the best of my knowledge, the other contributors aren’t medical professionals either. So, as always, seek legit medical advice before making any major changes. 

    If you’re having some issues, please skip down to the Therapy section and give somebody a call. If you’re thinking of hurting yourself, please, please PLEASE call or text 988 right now. Press 1 if you’re a veteran.  Then read this.

    Ultimately this guide has been assembled by a bunch of us who have/are dealing with some shit. We’ve found this stuff helpful, and hope you do too. 

    Books!

    And other Resources

    In no particular order, here’s some books that we’ve found helpful. Most of these books are mental health centric, while others delve more into self help (which ends up extending into mental health). Those that have little to do with mental health, and more about specific self care practices are towards the end. 

    A note about these books from JSD: Many of these books can be emotionally overwhelming to read. At times this has helped me identify some underlying issue I hadn’t confronted yet. And at other times I’ve had to take a break from a book until I’ve been in a less stressful period of my life where I could deal with such an emotional load. It’s totally ok to do the same. If you’ve got lots going on in your life, and you notice a book is not helping, please don’t feel that you’re required to finish it right away, or ever. 

    SFTI had these apt points to relay about using these resources: 

    “If you find that therapy isn’t for you for some reason or another, that’s probably okay. There are a lot of free resources you can use to help give yourself space and time to build the tools to do this work. I’m going to give you a list of resources. It isn’t super long or super detailed. But these helped me, and I hope they might help you. I really think you should get these for free from your local library. Don’t spend money on things you don’t need. If you don’t like reading? Try to find an audiobook version. Don’t want to spend the time on it? Use YouTube and just do a search for the title of these books. They’re pretty popular, and there are short and really long videos about them and others like them.”

    All these links are hooked up to amazon’s affiliate program. If you buy one, I get paid. I then donate that money to charity, minus what I owe on taxes. If you care, read more here.

    LizWithLime: I came across this book when I became a new parent and I just couldn’t keep all the balls in the air and felt terrible about it. I’m a high achiever and just thought I could “think” my way through the entrenched systematic challenges I had with all the demands in my life: career-parenting-marriage-adulting and everything else, let alone self-care.

    “Since hard choices are unavoidable, what matters is learning to make them consciously, deciding what to focus on and what to neglect, rather than letting them get made by default—or deceiving yourself that, with enough hard work and the right time management tricks, you might not have to make them at all.” -Burkeman

    Self Care Centric:

    YouTube (and 1 thing I learned from each-SFTI):

    1. YouTube: The power of Vulnerability The power of vulnerability | Brené Brown | TED (youtube.com) — Living life well requires skills which you may have come to believe are not necessary or not worth having. 
    2. YouTube: Listening to Shame – Listening to shame | Brené Brown | TED (youtube.com) — How you live with yourself now is not the only way to live. 

    Self Care:

    Sleep

    If you’re getting less than 7 hours of sleep a night, there’s a good chance it’s going to negatively affect your mental health. Furthermore, none of the other self care practices in this guide are going to make much of a difference if you’re sleep deprived. Many people say they’re fine with less than 7 hours, however data suggests that an extremely small percentage of people can maintain health on minimal sleep. Most people who say they’re fine are likely chronically sleep deprived, and have just become acclimated to the negative effects. 

    The good news is that the importance of sleep has become popularized recently, so there’s some simple, actionable recommendations you can follow. 

    Here’s a brief brochure the NIH put together that covers everything you need:

    Sleep Brochure

    One of the bigger influencers in this space is Andrew Huberman. His Toolkit for Sleep says the same thing as the above brochure, but goes more in depth. His toolkit also offers some additional ways to try to relax for bedtime, or after you’ve woken up in the middle of the night. He’s had plenty of podcast episodes where he’s gone on for hours about all the science behind everything to do with sleep. If you travel for work, experience jetlag, or do shift work, this podcast from him is helpful: How to Defeat Jetlag, Shift Work & Sleeplessness

    Huberman recommends Yoga Nidra, also called Non-Sleep Deep Rest (NSDR) to help get to sleep or back to sleep. Search for either in youtube to find plenty of free routines of any variety of time you desire.

    Another great free resource to help you get to sleep and/or back to sleep are bedtime stories for adults. The podcast Nothing Much Happens is a great place to find these.

    If you’d like to learn more about why sleep is important, this is a good book:

    Why We Sleep: Unlocking the Power of Sleep and Dreams

    Finally, if you try all of this stuff consistently for a month or so and you’re still not sleeping, it’s probably a good idea to see a specialist. Get a referral from your primary care, and maybe get a sleep study. Many people have told me(JSD) that doing so has been life changing. 

    Exercise

    Data suggests that just about any type of exercise is at least as effective at treating depression as therapy or prescribed antidepressants. When exercise is combined with either or both of these other interventions, their effect seems to increase. This effect also holds true for various other mental illnesses such as anxiety, schizophrenia, and others. The key is to exercise consistently, and the benefits tend to increase with the intensity of the activity, regardless of type.

    Here’s some journal articles if you want to nerd out:

    Effect of exercise for depression: systematic review and network meta-analysis of randomized controlled trials

    Role of Physical Activity on Mental Health and Well-Being: A Review

    Exercise and mental health

    Below is an infographic that sums up a bunch of this. While it is depression centric, the effects of exercise impact other issues in much the same way.

    How to Exercise

    A friend of mine(JSD’s) was a collegiate level powerlifter. One day his school had the world champion jump roper(I guess that’s a thing?) come and give their team a clinic. At the end, my friend, who’s kind of a sarcastic dick, asked this world champion what the best exercise was. My friend said he assumed this guy would say “jumping rope”, and was looking forward to destroying him by referencing all the data which suggests the relative superiority of strength training. 

    Instead, Champion Jump Roper said something like “whatever is fun for you; if you enjoy doing it, you’ll keep doing it”. 

    The important thing is to find some physical activity that you like. You may not absolutely love every minute of it, but if it’s mostly enjoyable it’ll be easier to turn it into a habit. With that said, one can get quite dogmatic about exercise. Ultimately it’s simple, yet not easy: find something that works for you, and keep doing it. If you haven’t found something that you like, please don’t give up-keep trying different stuff until you do.

    What may help you is documenting your fitness, much the same as you do your finances. This can be as detailed or as general as you like, and in whichever manner you enjoy. Marking days on a calendar, using a fitness app like strava, or building your own spreadsheet are all fine. The guiding light for this should be whichever form of documentation that helps you be consistent, and more importantly helps you to feel good about yourself, even when you miss a workout. If your tracking method becomes a source of shame when you miss workouts, then it’s time to back off on the tracking as it’s now counterproductive. This will involve some trial and error, but can greatly help you along your journey.

    Meditation

    This practice is helpful in building the space between something happening, and your response to it, so that you may consciously choose how you respond instead of unconsciously reacting. This practice can also help with your self-examination, so that you may start to figure out how and why you think certain ways.

    Data suggests that meditation can help improve mental health, though its efficacy is less certain than with exercise: Meditation and Its Mental and Physical Health Benefits in 2023

    There’s plenty of apps you’ve probably already heard about that can help with learning how to meditate, and build the habit of doing it. I (JSD) found Waking Up worked the best for me to build my practice. I now use the Down Dog Meditation app, as it was included in the Down Dog Yoga app my wife and I use. It works well too. But please know you can get great meditation for free on youtube and podcasts. Tara Brach offers hundreds of free guided meditations of varying lengths on her podcasts. They are of high quality, and I’ve used those for years.

    What really mattered for me was finding someone who’s voice didn’t annoy me, and was pleasant to listen to. This seems to be a common thing out there, so if you don’t like one meditation provider, give a few different one’s a try before you write off this practice entirely. 

    Mindfulness 

    As there is a specific type of meditation called mindfulness meditation, the lines between these two practices can become blurred. While the following distinction is flawed because of the great overlap between the two practices, I’ll use it to make things simpler: Meditation is something you do for a discrete time(for example, 5-20 minutes, once or twice a day), and Mindfulness is a mindset you try to embody throughout the day. 

    Approaching everyday life with mindfulness helps to keep you in the present moment, which is generally considered to be more mentally healthy than constantly ruminating about the past or worrying about the future. Mindfulness can help you to appreciate what you have in those moments, and research suggests that such a practice can improve mental health:

    Effects of Mindfulness on Psychological Health: A Review of Empirical Studies

    As with mediation, the efficacy of mindfulness in impacting mental health is less studied than exercise. But considering all you have to do is read a book, and maybe listen to some free “mindfulness meditations” on youtube, you may as well give it a try. 

    A great book to get started is:

    Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life

    Most meditation apps have selections for “Mindfulness” types, and you can find plenty for free on youtube. I’ve(JSD) found the ones by Jon Kabat-Zinn effective, like this one: Guided Mindfulness Meditation. I would recommend reading a book about it first, which will help you understand what you’re trying to do, and how to extend the practice to your everyday life.

    Nutrition

    What you eat can impact how you feel. Anyone who has destroyed an entire birthday cake in a single day is familiar with this. There is growing evidence that specific diets may be effective at treating different forms of mental illness, for example:

    Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial

    That said, the nutrition space seems to be highly dogmatic, even more so than exercise. This can be confusing, but seems to be an effect of nutrition being somewhat specific to each person’s physiology, which we still do not completely understand. There are some general principles that work for most people, like “don’t eat an entire birthday cake every day”. Beyond that, it comes down to some self-experimentation. 

    Just like exercise, it can be helpful to document what you eat, so that you may figure out which type of diet your body seems to like more. Also just like exercise, such documentation can be counterproductive if you start to engage in negative self-talk and shaming. What you’re trying to track is how food makes you feel. 

    Please understand that nutrition, just like any of the above, will take time to be effective, and you may go down some blind alleys before finding what works for you. 

    Therapy

    This section covers all things therapy. When it comes to type, Evidence Based Therapies(EBT’s) are a good starting point. They have been shown to be generally effective, and the process usually lasts from 6-16 weeks, usually with a one hour session each week. There are multiple types of EBTs, but if one doesn’t work for you, move on to the next one. 

    Though this page is from the Veterans Administration (VA), it gives a good overview of what’s currently considered an EBT:

    Evidence-Based Therapy

    Finding a type of therapy that works for you, as well as finding a therapist that you can work successfully with can be quite an ordeal. You should also know that even after plenty of searching and experimenting, some people don’t find therapy to be useful. That said, for many people, therapy can be extremely helpful. Please remember that finding what works for you is a process that will take some time, and you may feel like you’re going one step back for every two forward.

    In the following sections, several people contributed valuable insights on finding and going to therapy. Each one has some great takeaways. You’ve probably heard ads for Betterhelp, and that section provides highly useful information from someone who’s actually used it. Van’s tips are amazing, and cover some things you may not have thought of, as well as some practical information on payment and insurance. Finally, the How to Guide on Getting Therapy is absolutely incredible.

    I(JSD) encourage you to read each one, as together they put together a roadmap of your options and a framework for getting what you want out of therapy.

    For veterans, I’ve put some stuff at the end about how to use the VA. Before all of that, please be aware of one popular tool for finding a therapist:

    Therapist Search Tool

    Psychology Today put together an online tool to help search for therapists, which can filter by insurance, locations, types of issues, type of therapy, cost, availability of remote services, etc. Several people have recommended this tool, and used it to find a therapist they currently work with. Others have found a therapist just from a standard Google search in their area. You can also use the Psychology Today tool to find a specific therapist, then use Google reviews to help make your decison. 

     BetterHelp (Online Therapy) 

    from LizWithLime

    a.     I wholeheartedly supported friends and relatives who have and are receiving therapy. For some reason though, my “lizard brain” felt different when the time came that I needed help. The stigma is still real.

    b.     My cousin had mentioned this resource in passing & I ended up taking advantage of it. It’s an online therapy portal with video conferencing ability & you can get up and running very quickly.

                                             i.     The drawback: they don’t take insurance & it’s not in person. (Cost is 65-100/weekly, billed monthly, but you can cancel at any time. This is not a cost to be taken lightly, but there is financial aid available in some cases. Be sure to double check the pricing, as they change)

                                           ii.     The plus side: they don’t take insurance & it’s not in person. I had used so many excuses in my head to put off getting help:

    a.     Will my insurance cover costs?

    b.     How should I research providers?

    c.     How should I research a therapist once I find a practice?

    d.     What if they can’t see me for a long time?

    e.     How long will it take me to get there?

    f.       What if I don’t like the person?

    g.     What if they judge me?

    h.     What if I don’t like the person & it doesn’t help but I feel bad for switching therapists and am “stuck” in a situation that is not benefiting me?

    – In conclusion: for me, taking the insurance & in person piece out of it helped me take the plunge.

                                          iii.     My experience: I had too many balls in the air after returning to work from maternity leave, including the baby’s erratic sleep schedule. One night when I couldn’t get her down after a few hours, I asked my husband to take over & immediately filled out the survey for BetterHelp at like 3:00 am.

    a.     It was a pretty extensive survey if I remember correctly and took me some time to fill out.

    b.     The site took my submitted survey and then paired me with a therapist only hours later and I shortly scheduled my session afterward.

    c.   Having the service available via video was a huge help as it took the excuses out of it.

    d.     I held weekly meetings with my therapist, who was great, for a few months and it was very helpful for me during a tough time.

    e.     When I decided it was no longer worth the money, I canceled mid-month and was reimbursed for the two weeks I didn’t use.

    Van’s Tips Surrounding Therapy

    International Therapy Arbitrage

    Finding a counselor has been tough.  In 2021, I could not find anyone in my area taking new patients and the virtual counselors I spoke with were not a good match.  I ended up first in Group Therapy and then the doc that led the group recommended me to another for 1:1.  Both the first and second docs received their advanced degrees in the USA but were located in India — so not “in network” for insurance  and there were time zone challenges.  But it was worth it to get me through that tough time.  

    I would suggest people look globally for counselors — and it may have some advantages from a currency exchange standpoint (strong dollar) and practitioner availability.  

    Some therapists will take credit cards, which makes it easy as you just use as normal and make sure you are using a card that doesn’t charge foreign transaction fees.  But, other therapists will not.  What I found to be helpful in those second situations is Wise (https://wise.com/)  It is a service where you can deposit/transfer USD into the account and then buy other currencies (small but reasonable fees based on total amount) and then pay in that currency.  I’ve also found it helpful when traveling internationally, but that wasn’t where I started with it.  I’ve suggested it to others.  I had a HSA at the time and had no issues with getting reimbursed through my HSA for the therapy sessions — even though they were in a different currency.  What I would do is include both the invoice in IDR and the conversion and conversion fee receipt from Wise — and the HSA Administrator didn’t ask any questions or blink an eye

    Using Insurance for therapy and the “Single-Case Exception” Option

    1. Take careful, thorough notes anytime you need to search for a provider.


    2. If you’re calling numbers on a list, don’t wait for one provider to call back. Call and email many at once for the best chance of a quick response. Write a few paragraphs outlining what kind of care you need.


    For example:

    I received your name as a recommendation from (Resource: such as Psychology Today website).

    I was diagnosed with (DX or list of symptoms) caused by (Cause such as: work-related systems and lack of support).    I’m taking steps and actions to address my mental health and I think talk therapy would be helpful.

     Are you currently open to new patients, or have an open waitlist? 

    I have (Insurance Provider Name) insurance.

    3. If you or a member of your family is in a crisis, ask your plan for help finding a provider. If your plan won’t help, turn to the human resources department where you work, if there is one.


    4. If you’ve made a good-faith effort to find someone and can’t get help in a reasonable time from the list provided, don’t just give up and pay out of pocket. Ask your plan for a “single-case exception” — an option many health-care consumers are unaware of. It allows your insurance plan to reimburse an out-of-network provider while you pay no more than a co-pay.


    5. You can also request a single-case exception if the only available provider is a long distance from your home or doesn’t practice the specialty you need.


    6. Also ask for an exception if you’ve been allowed to see an out-of-network therapist online or by phone during the pandemic but now the plan has stopped covering it.


    7.  To contest a lack of coverage either for medical services needed or already provided, you must first appeal directly to your health plan. With a private plan, you must file within six months of care being denied. The insurer must make a decision within 30 days if your appeal is for a service you haven’t received, and within 60 days if it is for a service already received.


    8.  If you don’t get a satisfactory decision on an appeal, take your case to the government agency that regulates your insurer for an independent review. The customer service line of your health plan should tell you which agency to call. Don’t wait 30 days if there’s a health crisis. Contact your regulator immediately.

    Medication

    I think it is hard for some to consider RX…at least it was for me.  Confiding in one of my mentors about my situation and learning he was on antidepressants helped me normalize having that conversation with my doc.  It took three months before I was willing to try medication, and so was lucky in that it was a good match for me.  Today, if someone shares their story and challenges, I will share mine and my initial reluctance to take medication and why I changed my mind.  I also talk about how there are different ones and it is important to get a good match and have the conversation with their healthcare provider about what is or is not working.  I have been able to significantly decrease my dosage over time, and I regularly check in with my doc about its effectiveness and whether I may be able to step down dosage again.  

    Menopause or Perimenopause

    What I’ve recently learned is that this may have been a contributing factor in my experience.  Hormone changes may be impacting women’s mental health.  Particularly if their sleep is severely impacted.  I’ve recently been reading “Unlock your menopause type”. One of the “types” focuses on mental health impact and talks about various RX and non-RX steps to help mitigate symptoms such as insomnia, anxiety, depression, brain-fog, etc.

    How to Guide on Getting Therapy 

    From a Stranger on the Internet

    Dear you,

    I heard a question the other day from a stranger about how to start going to therapy, to get some help. It got me thinking this might be information that other people should have. I’ve had some experience with getting mental health support so I wrote out some tips and steps and resources. I’m a stranger from the internet, so if these work for you? Great. If they don’t work for you? I hope you find your own way to make it work. Because working on your mental health is important. And I think this is information worth sharing.

    Tips:

    Tip #1: Have an accountability buddy. At various points in life I found myself realizing that I needed help. Usually it was when talking to a friend, trading stories and suddenly hearing how they’d handle a situation would be completely different from how I’d do it. These were smart, settled, friends and we talked about work and personal drama. And they seemed to have so much less anger and stress and frustration in their lives. I got to thinking it might be me in my stories that was the issue. Having a close friend or family member hear me say the words “I think I need help”? It probably saved my life. Having that person promise me they’d go to therapy at the same time I did? That made it actually possible for me to go and keep going. It wasn’t like we went to therapy in the same room, my friend was in another state. But we’d go through the same steps of checking our insurance, finding a doc, and going to said doc and be checking in on each other at every step. That made it a series of steps, each of them doable, and we did them at the same time so we made it happen together.

    Tip #2: Be or have access to a Type-A motherfucker. I mean that slightly anxious, over-planning, super-diligent, files a tax return in like January, always prepared for everything, keeps a to-do list for their to-do list kind of motherfucker. These people are superhumans. They also tend to be super busy and are sometimes hard to deal with. In that case, try to find a caring and emotionally supportive “helper” that float around the world genuinely trying to do good. If you don’t have access to either, you can do this alone. It’s going to be harder, but this is doable. Block off time on your calendar and schedule it just like math class or P.E in  school. You get one step done during each block of time, and then do the next bit the next block of time.

    Tip #3: Have a talk with your Type-A motherfucker or your supportive helper (or yourself) and get comfortable with this fact: The process of finding a licensed doctor or licensed professional will be hard, expensive, time consuming, and exhausting. You will hate this process. It will be rude, mean, unfair, unkind, indifferent, and obnoxious. Accept that. You are not entitled to nor are you owed this. The world does not give a flying fuck about your needs or emotions, and no single individual has to either. Let alone some poor bastard/ette working a phone in an office or a website with some information. You can do this one step at a time. It will suck. It will be hard. And you can do it.

    Tip #4: Getting therapy, going to counseling, seeing a licensed doctor or professional is important. It is good for you. It may be necessary for your life. It is likely going to be important in helping you be the kind of person people want around. And you want good people around you, and good people want other good people around them.

    Tip #5: Much like dating is about finding someone with the right chemistry and the right pattern of behaviors for you, finding the right therapist can be the same way. You may not like them, but can you trust them? Are they good for you? Do you find that after several sessions you are discovering and learning things about yourself? If the answer to any of these 3 questions is no, prepare to go through this process again and find another doctor or licensed professional. Don’t stress about finding “the best,” or the “greatest,” you’re looking for someone that can help you do work on yourself. Keep in mind that you also have to be realistic about what you can afford and manage. If your best therapy resource is a 2 hour drive away and costs a mortgage payment every month, that’s just not practical. Keep the dating idea in mind: you want what’s good for you and works for you. Not the prettiest, most special, rides a fancy car and wears what you like. You’re trying to find what’s good for and works for you.

    Tip #6: You want to figure out and understand what a “licensed professional” actually is. I can print myself a licensed professional spiritual health guru cert in about 2 minutes. You want someone who is licensed by a professional organization, with a background in either medicine or social work or behavioral health counseling. Advanced degrees (Masters and/or PhD and/or Medical degree) are a very good then when evaluating a potential licensed professional.

    Tip #7: Everything I describe is a general rule. I’m a stranger from the internet so you should have doubts and don’t take anything you read as a mandatory instruction. Judge for yourself at every step whether it’s worth doing. Always act with a goal to keep yourself and your people safe, don’t let yourself get into unsafe situations.

    Tip #8: It is very important that you understand that a licensed professional who can help with your mental health can’t be your friend, your lover, or your family. You need someone who can keep their distance from you while helping you. A doctor doesn’t hold your hand while giving you stitches, they do their work as safely as possible for them and for you.   

    Steps:

    Steps to go through to find a doctor or licensed professional in the world of mental health, behavioral health, or social work who might be able to give you useful therapy. READ THE ENTIRE LIST BEFORE TRYING TO START STEP 1. Remember this is a guideline not a rulebook. 

    Step 1: You need information first. Get on the phone with the HR Benefits person from your job. You are going to get them to describe to you in as much detail as possible what your options are for mental health care. Don’t have a benefits person in HR? Get the paperwork for your Healthcare and plan to read it to see what coverage you have. Don’t have healthcare? Google “X free mental health” where X is the name of your town/city/county/state/country. Start at the smallest geographic unit and move up from there. Example: If you live in Monona, Iowa AND you don’t have Healthcare, you’re going to Google “Monona free mental health care” first. If that doesn’t work, try your County in the Google search and if that doesn’t work try the Google search again with the State. And get ready to work.

    Step 2: Getting the information is going to be hard. You need to have a good list of: 

    what is available

    • where is it available
    • when is it available
    • how much does it cost
    • how often does it happen
    • who you can work with
    • how does it happen 

    Keep in mind that some sessions are 1 hour once per week, some places require 2 day commitments, some places support remote therapy, some places require in person therapy, etc. The most important thing to do is make a list. It can be a long list (it probably will be). But it has to be written down, and you have to be able to see all the information for each option written down. Include phone numbers, websites, doctor names. Include distances from your home, how long it would take you to get there, can you drive or do you need public transit or rideshare or someone to take you. Include the type of service offered there and whether you think your healthcare/free service/program is accepted there.

    Step 3: If you can, clear a half day or so on  your schedule sometime between 9 am – 3 pm, Monday – Friday. You’re going to be calling each place. If you can’t do it, find a friend to help you do this. It is a mandatory step in the process. Every place you call you are going to try to confirm the information you have for them and ask them specifically about your insurance, and your needs.

    Note #1: Why are you calling them all? Because the information on a website has only a passing resemblance to factual truth. You want a human being employed by the place to confirm things for you.

    Note #2: ABOVE ALL ELSE, remember to ask 1 question before any other: “Is this office/clinic/center accepting new patients?” IF THE ANSWER IS ANYTHING OTHER THAN “Yes we are” then politely thank them, hang up, and cross them off your list. Move on to the next place.

    Step 4: From the much shorter list of places that are accepting new patients, and the still smaller list that work for you based on your own personal factors, find a doctor/specialist/licensed professional with whom you think you’d be able to connect. Or just pick two places that are closest, cheapest, easiest. Call those places again and ask for an appointment with any licensed professional.

    Note #3: You may get asked some personal questions at this point. Know that giving them information is part of the process and you’ll be sharing a lot about yourself. The more information you volunteer, the better they’ll be able to refine their offerings for you and/or realize they can’t help you and you should move on. Volunteering direct information honestly is a positive at this point. You can always say “I don’t feel comfortable answering that question.” Remember that you have control of whether to share or not and how much to share. 

    Step 5: Go to your appointment. If possible, spend some time beforehand thinking about why you wanted to go in the first place. When you sit down with your licensed professional, tell them up front why you are there. Feel free to ask them questions. You are now interviewing someone who may or may not be able to help you. Acknowledge that. If they can’t help you, ask them for recommendations on who to speak to. If they can help you or it seems like they can, evaluate them based on the criteria from Tip#5. If they can but based on the criteria it isn’t a good fit, AFTER a session you (or your friend/support human) will call the office and cancel your future appointments. If asked why, you’ll say it wasn’t a good fit and offer no further details.

    Note #4: Unless there is a medical emergency with paramedics and law enforcement involved, do not cancel/reschedule/skip your appointment(s) from here forward.

    Step 6: Therapy, behavioral health counseling, psychiatric practice, psychoanalytic sessions, whatever you call the time where you work with a licensed professional to unpack some part of yourself and reassess? The key word there is work. It is probably going to be hard. It is probably going to be difficult, it may be painful, it may sometimes be boring and/or strange and/or weird. Keep yourself open to the possibility that this may not be a good fit, and also lean into the fact that you are there to do work on yourself. If you’re finding yourself just venting to a pal for an hour every time you sit down? Re-evaluate why you wanted to go to therapy. It’s okay to just vent, but if you are venting to distract from the possibility of doing actual work on yourself? That’s a waste of time and money. Take the time to re-evaluate why you are there, whether it is worth it to keep going. Check in with yourself regularly. 

    Step 7: Do it again. As often as needed. You may stop for a while. You may come back to therapy again and again with breaks in between. You may work with different specialists. Recognize that you have unlocked a superpower of being able to connect with a licensed professional to work on yourself, and it’s a skill you can practice and set aside and then pick up again later. Like riding a bike or throwing a ball or baking a cake or any other skill you’ve done at least once and set aside. It’s there for you to try again.

    “But what I hope most of all is that you understand what I mean when I tell you that even though I do not know you, and even though I may never meet you, laugh with you, cry with you, or kiss you. I love you. With all my heart, I love you. ” Alan Moore, V for Vendetta

    Sincerely, 

    A stranger from the internet

    VA 

    If you’re a veteran, you may be able to get mental treatment for no or little cost from the VA. If you’re not already in the VA system for another service connected injury, your mental health issues do have to be service connected to get care. Please understand that while your issues may seem like they were caused by more recent stuff, they could have at least a partial root cause due to service related stuff. Does not hurt to try.

    The level of care I (JSD) have received at the VA has been really good. That said, it is a giant overburdened government bureaucracy; the scheduling and administrative hoops you have to go through to get care can feel frustratingly similar to the least awesome parts of military service. Despite these challenges, I think getting the care is worth it. Here’s how to get started:

    In order to service connect your issues, you have to file a claim with the VA. There are Veterans Service Officers (VSOs) that can help you with this for free. VSO’s are typically employed by non-federal government agencies at the state and local level, as well as your standard Veterans Organizations like the VFW, American Legion, and others. Here’s a good starting point to find one. Alternatively, googling “Veterans Service Officers near me” works. 

    In my experience VSO’s are a mixed bag, but net positive. I had one who basically shamed me for having any issues. I’ve had others on the opposite end of the spectrum, who tried to get me to file for everything possible to “stick it to the man”. I had success with the later type, and was firm that I was only filing for the issues I had that were directly caused by my service. 

    Working with a VSO usually involves meeting with them once for 30-45 minutes; getting your information and what you’d like to file for. They complete the paperwork, and they may ask you to send them more information if need be. They will submit this paperwork to the VA, which will start the claim process.

    If you’d like to skip the VSO part and file your claim yourself, try this VA page with more info.

    Once you’ve made your claim, at some point the VA will schedule an exam, and they’ll also review your records to see if there’s evidence of your mental health issue being service connected. This claim process is normally a lengthy bureaucratic nightmare. But since the veteran suicide rate is so high they’ve prioritized PTSD claims; if you’re filing for something like PTSD it is comparatively quick. 

    It will still likely take at least 3-4 months for your claim to be processed (many non-PTSD claims can take years), so if you’re having a hard time dealing with stuff right now, please use the recommended methods in the previous sections until you can get into the VA. Most localities have some sort of vet group that provides free mental health care for veterans, these can be an important bridge until you get VA care. Google is your friend here, as is asking local chapters of the VFW, American Legion, etc.

    Once you get rated for a condition, you still have to schedule therapy. In the paperwork the VA sends you notifying you of your rating, there should be information for how to schedule mental health counseling with your local VA. If there’s not, google your closest VA hospital or clinic, and give them a call. You will be put on hold, and their call system was provided by the lowest bidder, so it may inadvertently hang up on you. Be prepared to call back frequently until you get a hold of someone. 

    If you are not close to a VA hospital or clinic, the VA hospital in your state can be referred to community care (local providers that the VA will pay for), and you can also be seen virtually. 

    Your appointment might get canceled. This usually happens when a veteran in crisis (threatening suicide) walks into your therapist’s place of work and asks for help. This is an all-hands situation, so every therapist at that hospital or clinic stops what they’re doing and helps out. If you have an appointment when this happens, then it’s going to get canceled. This will cause a domino effect, where a bunch of appointments will then have to be reshuffled. As the VA’s scheduling system was also provided by the lowest bidder, your appointment may get inadvertently canceled. 

    Since there are lots of veterans who go into crisis, be prepared for this. Please don’t take it personally that your appointment got canceled. But don’t expect the VA to be perfect about rescheduling you when it does get canceled, instead proactively call them to set up a new appointment. 

    Once you get into VA provided therapy, make sure you ask your therapist what the best way to get a hold of them is in case things start to get rough. They usually will provide a more direct line, which is helpful if your appointment gets canceled and you really want to talk to someone but aren’t quite at crisis level. It’s good to have that contingency plan ready.

    Speaking of contingency plans, if you think it’s remotely possible you might ever go into crisis, think through now how you’d get care. I’ve been on the other side of these things, as the responder trying to help a vet, and they have been a mixed bag as the vet gets shuffled through various layers of bureaucracy until finally being sent to the VA. For me personally, if I ever go into crisis, I will uber my ass straight to the VA and cut out all the middlemen. While I hope this never happens, and I’ve done plenty of work to insure it won’t, I also know that I can’t foresee the future. I’m glad I’ve got that contingency plan ironed out. 

    Again, this whole process can be frustrating and occasionally disheartening. Don’t quit, keep going. It will be worth it. 

    Escaping Avalon

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          Last updated on May 10, 2024

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