Friday, November 30, 2018

Psychiatric Advance Directive (PAD): Discuss With Your Therapist and Loved Ones

Living with a mental illness can be challenging, however, with insight and proper interventions we can regain control of our lives, dignity, and independence faster by planning ahead. Over the course of 11 years in recovery from schizophrenia I was hospitalized twice;  at age 20, and age 31. I was single during my first hospitalization. However, I had much at risk during my second hospitalization; my family, home, and thus, livelihood. My experience will further support both newly diagnosed peers, and fellow peers already in recovery who can attest to the disruptions of crisis and hospitalization that may have been handled better had a post-crisis plan and intervention been in place.

From experience I learned an even greater lesson than 'take your medication.' The lesson I learned is simple, and not an innovative idea, but sadly overlooked across treatment planning and visits, which is to plan ahead and document it! The psychiatric advance directive (PAD) much like the advance directive, which is routinely utilized in all medical settings upon intake is a document that identifies decision-making preferences, delegated agents, and overall, interventions with instructions.

In fact, the National Alliance on Mental Illness (NAMI) defines the purpose of an psychiatric advance directive: “A PAD allows a person to be prepared if a mental health crisis prevents them from being able to make decisions. A PAD describes treatment preferences, or names a person to make treatment decisions, should the person with a mental health condition be unable to make decisions.” Moreover, NAMI's Peer-to-Peer Education Course identifies the psychiatric advance directive. Further, Mary Ellen Copeland's Wellness Recovery Action Plan (WRAP) details what the ideal psychiatric advance directive should include through its post-crisis planning workbook.

The psychiatric advance directive can be an empowering tool when utilized. First, let me elaborate on what is included in a psychiatric advance directive (PAD). The PAD may include, but not be limited to the following elements of documentation:
  • Delegation of the primary decision-maker whenever there is an unspecified demand that requires a decision to be made on behalf of the peer.
  • A list of preferred facilities and treatment centers or alternatives. Example: hospitals, respite center, and alternatives.
  • A list of medications, which are preferred.
  • A list of medications to avoid and reasons why.
  • Signs or symptoms that helps the people that intervene determine when to activate the peer's PAD.
  • Signs and indications that the peer is in a better place to regain independent decision-making and thus, minimize the guidance and direction from the delegated agent in PAD.
  • A list of supporters and delegated responsibilities. Example: who will contact the peer's employer, landlord, and review and pay bills, watch their home, and check the mail.
  • Contact information that specifies the treatment team (doctor and therapist, etc.), delegated agent (caregiver), and supporters (friends, family, etc.).
  • Signature page (notarized) within the peer's PAD.

Therefore, the psychiatric advance directive can be an empowering document that gives peers choices when established and discussed in advance during a time of wellness and clarity on preferences. The psychiatric advance directive will undoubtedly enable the peer to practice resiliency. After the crisis and hospitalization the peer can focus wholeheartedly on recuperating opposed to being over-stressed with losses and unnecessary problems that could have been minimized such as past due bills, poor communication with employers, disrupted academic coursework, and shift in expectations of attendance for children of peers, etc.

My advice is to talk to your therapist and only those individuals that will become a part of the psychiatric advance directive. Discussing your PAD with therapist and loved ones, caregivers, and supporters will assist in the development and effectiveness of the PAD. These discussions may best be started with the therapist, in order, to learn more about the PAD, how to discuss PAD with others, and to get support to complete and distribute PAD among those that need to know, only. Because it may be challenging finding a therapist one may seek one-on-one therapy online, which can enhance ease of discussion from the comfort of home.

Finally, here are some resources to gain more information about the psychiatric advance directive and online therapists, as well as additional information shared in this blog entry:

Let me know your thoughts on the need and benefits of implementation of a psychiatric advance directive for yourself or loved one. Anonymous responses welcomed! Thank you.

Wednesday, November 21, 2018

Re-play on Janssen's Champions of Science: The Art of Ending Stigma- Panel Discussion

Shade. Labels. Darkness. Negativity. Secrets. Shame. Guilt. Hiding. Discrimination... I am referring to the stigma of mental health conditions that plagues conversations, worsens our reality of living with a life-long health concern, and prolongs suffering, and silence. 

Janssen Pharmaceuticals' panel discussion about stigma, and art opens the conversation to so much! Dr. Adam Savitz (panelist, psychiatrist, Janssen), Jeff Sparr (panelist, Peace Love), and myself (panelist), and Vickie Mabrey (moderator) held a lively hour-long discussion, Tuesday, November 13, 2018, on a range of concerns impacting people living in recovery, and coping strategies. We spoke first-hand experience on how we cope through artistic means, therapy, and self-expression, and the role of creativity, specifically painting and writing. The arts play a significant role in the healing process of recovery living with mental health conditions including obsessive compulsive disorder (OCD), and schizophrenia. 

However, we also talked about real-life situations with discrimination and stigma, and how to manage in the workplace with the support of human resources, and the importance of our support system, among other topics. Moreover, a psychiatric advance directive is a crisis plan in place when us, peers, living with a diagnosis are at our worse, and planned in advance our preferences in the event that we cannot articulate our wishes in treatment, and life. 

Similar to a general advance directive, however, more specific a psychiatric advance directive is a document that controls how people intervene. The psychiatric advance directive gives voice to us peers in that our concerns such as our families, home, pets, and bills are properly managed by those individuals that we list in the document. Mary Ellen Copeland's WRAP (Wellness Recovery Action Plan) articulates this plan. Creating or updating one's psychiatric advance directive is my message in my upcoming book, What's On My Mind? Coping Takes Work! my publish date is to be announced next year (2019). 

Over the last 11 years of my recovery, having a psychiatric advance directive is one of the most vital lessons I've learned! In addition to learning more about my diagnosis, and rights to maneuver daily discriminatory situations, and social problems, in order, to combat stigma as discussed in this empowering hour-packed conversation a psychiatric advance directive is just as important as auto insurance, renter's insurance, and a life policy, and college fund. I've overcome two major setbacks and take it from me it's best to plan in advance how you want your house managed when you are at your worse!  

In short, Janssen's panel discussion with Dr. Adam Savitz, Jeff Sparr, myself, and Vickie was an amazing talk, and experience. Watching this panel discussion will enrich your familiarity on the latest demands in recovery today! Thus, get involved in your recovery through self-expression, and overcome the stigma by using practical coping skills, and creativity! Review Janssen Pharmaceuticals' Champions of Science: The Art of Ending Stigma, and our panel discussion that will empower you!

Click here to watch our live virtual panel discussion- November 13, 2018, 7-8 PM Eastern Time 

Moderator: Vickie Mabrey, & Panelists: Ashley Smith, Jeff Sparr, and Dr. Adam Savitz

As mentioned in our panel discussion, here are some resources:

  1. Champions of Science: The Art of Ending Stigma (Gallery, Resources, Janssen)
  2. National Alliance on Mental Illness (NAMI, support groups for families, peers, caregivers, etc.)
  3. The Georgia Mental Health Consumer Network- Peer Support Wellness & Respite Center (for Georgia residents)
  4. Mary Ellen Copeland's WRAP (Wellness Recovery Action Plan)
  5. PeaceLove (Jeff Sparr, panelist and co-founder)
  6. What's On My Mind? A Collection of Blog Entries from Overcoming Schizophrenia by Ashley Smith (panelist, lived experience expert and certified peer specialist) - Amazon

Wednesday, November 14, 2018

Recap on Virtual Panel Discussion Champions of Science: The Art of Ending Stigma

Last night I participated in a virtual panel discussion to promote Champions of Science: The Art of Ending Stigma, which is a an online gallery, and campaign that brings awareness to coping skills through the arts of self-expression. This website is a great resource for peers like myself living with a diagnosis, caregivers, and individuals seeking awareness on mental illness, and recovery. The discussion was moderated by Vickie Mabrey, who I had the pleasure of meeting and working with through Mona Terrell & Associates, The National Association of Black Journalist (NABJ), and Janssen Pharmaceuticals, in the past. Vickie Mabrey is a former ABC News Nightline Correspondent. I enjoyed working with her again on this important discussion, because it covered an array of information that the public should become familiar with such as coping through artistic means, and expanding our support system. 

Our discussion mentioned support groups, which the National Alliance on Mental Illness (NAMI) offers throughout the United States, which I am also a member of through NAMI Georgia. Our panel discussion mentioned the significance of establishing and updating a psychiatric advance directive, which I will elaborate in my upcoming book, What's On My Mind? Coping Takes Work! Panelist, Jeff Sparr, who is co-founder of PeaceLove, teacher and self-taught artist (, recovery story is amazing! I could relate to his experience of being diagnosed in my 20s and experiences with people who do not understand. Throughout the discussion he provided great insight that I wholeheartedly agree, and want to continue this conversation. Panelist, Dr. Adam Savitz, a psychiatrist and Director of Clinical Research at Janssen gave detailed information on the biology of mental illness and its effect on peers like myself, and commonalities. He offered explanations that was easier to digest and follow opposed to much doctor jargon. 

I really enjoyed being a part of this panel discussion because the public needs more information from lived experience experts and professions to reduce stigma. A great way for individuals to interact and learn more about living with mental illness is to read blogs by peers in recovery. In fact, my personal blog, "Overcoming Schizophrenia," details my own experience with the diagnosis. My blog was established in 2008, and is linked to fellow bloggers in recovery with much lived experience and artistic means of expression. Also, I thank our viewers for their engagement and questions and comments! Moreover, I thank everybody at Janssen for bringing me back to participate in this project, which sheds light on recovery! My relationship with Janssen began in 2010 with their non-branded documentary, Living with Schizophrenia: A Call for Hope and Recovery (2011) that is available to watch on YouTube. I am a strong supporter of Janssen, because of their educational campaigns that is community-oriented, and uplifting to my peers, our caregivers, and supporters. 

Janssen is a part of Johnson and Johnson, and Ruder Finn collaborated in the preparations of this event and Champions of Science: The Art of Ending Stigma. Lastly, I encourage you to learn more about Jeff Sparr's organization who co-founded PeaceLove, and to visit the Champions of Science:The Art of Ending Stigma website. The website features a gallery and a lot of resources to gain a better understanding of the effects of mental illness. Again, I thank Janssen for their continued engagement in spearheading non-branded awareness projects such as the documentary and this project, and for opening the door to more discussion on recovery, and coping through the arts. I will provide another link to watch this virtual panel discussion as soon as possible. In the meantime, I encourage you to review Champions of Science: The Art of Ending Stigma gallery and information online: 

Myself, Virtual Panel Discussion

Monday, November 12, 2018

NOV. 13 - Virtual Anti-Stigma Panel Discussion

Tomorrow, Tuesday, November 13, 2018 at 7-8 PM Eastern Time I will participate in a virtual panel discussion sponsored by Janssen Pharmaceuticals, "Champions of Science: The Art of Ending Stigma." This will be a lively conversation that I don't want you to miss!

This event is important to me because people living with a mental health conditions like myself cope, and manage, our diagnosis in diverse ways including artistic means. The Champions of Science: The Art of Ending Stigma is an anti-stigma campaign by Janssen Pharmaceuticals, who I support and worked with in the past through a documentary, Living with Schizophrenia: A Call for Hope and Recovery (available to view on YouTube).

As an advocate, peer, and writer I am looking forward to this conversation to share the truth about mental illness, which is recovery is possible despite stigma and setbacks. Individuals living with mental health conditions can overcome silence and stigma by coping within the arts. One of my coping skills is writing. In fact, I maintain my personal blog, "Overcoming Schizophrenia," which shares my lived experience and resources, since 2008.

This virtual panel discussion will be moderated by Vickie Mabrey as we explore the stories of Jeff Sparr, co-founder of Peace Love, a mental health advocate, and art teacher, Dr. Adam Savit, a psychiatrist and Director of Clinical Research at Janssen, and myself, a lived experience expert, and author of What's On My Mind? Do join the conversation with questions and comments to show your support! Thank you, Ashley Smith.

Sunday, November 11, 2018

International Survivors of Suicide Day- November 17, 2018

In 2016, "[s]uicide was the second leading cause of death among individuals between the ages of 10 and 34, and the fourth leading cause of death among individuals between the ages of 35 and 54" (National Institute of Mental Health).

Untreated mental illness could lead to premature death, suicide, for anybody despite age. Suicide is not a wish, it's relief to seemingly limited solutions, tormenting states of mind, and a range of different signs and symptoms associated with mental illness. Suicide is not always related to mental illness. However, I will focus on the mental illness and suicide connection.

Everybody has a breaking point where one experiences a catastrophic event or events. Many may seek refuge, but do not get what they need in time for recovery. Common problems leading to suicide are financial issues, broken relationships, and trauma, and untreated mental illness. Having such problems coupled with minimal healthy coping strategies, and limited access to resources for support increases the risks of suicide attempts.

I know a few individuals who attempted suicide. I've learned from them that repeated attempts is common. As stated in the facts above, children are not exempt from suicide. This is more than a family issue, suicide is a societal problem that demands attention, right now.

Here are signs that an individual may be suffering and are at risk of suicide: changes in behavior, withdrawal, changes in appearance, and making preparations (WebMD). Here are some resources:

  • National Suicide Prevention Hotline, call 1-800-273-8255 (available 24 hours everyday).
  • Veteran Crisis Hotline, 1-800-273-8255, press 1
  • Mental Health First Aid training
  • Self-help groups

If you, or somebody you know is at risk, or is a suicide survivor I encourage you to build a strong support system based on people that you trust, and know have your best interest. Treatment could include a variety of therapies. Professional support could be a strong asset to overcoming internal struggles and learning how to cope better.

I encourage everybody to engage in self-care because mental health defines our emotions, and thoughts that may or may not be healthy. Self-care may incorporate stress management, and relaxation. Self-care activities may incorporate meditation, faith-based groups, therapy, focusing on inspirational music, and reading, hobbies, pet therapy, art and music; or whatever practical effective coping strategies that helps an individual get through poor intense stressful times.

I never attempted suicide however, some of my friends have. I aim to continue to support them, and my peers on their recovery journey. Lastly, November 17, 2018 is "International Survivors of Suicide Day." My hope is this day maybe full of healing, and recovery-filled discussions, and support to our suicide survivors. My hope is that more people will research the facts on suicide, and how to help an individual get access to professional care if they are at risk.

National Suicide Prevention Hotline, call 1-800-273-8255 (available 24 hours everyday)

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