By all accounts, Caley Breese looks like a normal 25-year-old. She works, she socializes, she volunteers. You might never know that she also suffers from anxiety, depression, and occasional debilitating panic attacks. But, wait—Breese looks like a perfectly normal 25-year-old because she is a perfectly normal 25-year-old. She’s one of 5.7 million Marylanders…and happens to struggle with mental health illness.
The lack of conversation surrounding mental and behavioral health seems to create a self-fulfilling prophecy. No one wants to talk about it for fear of being labeled “crazy” or “weird,” but those labels persist because people don’t talk about it. The real craziness: In 2019, there’s still a stigma surrounding mental health issues because, the fact of the matter is, mental illness simply isn’t treated the same as physical conditions.
“Mental illness is greatly misunderstood,” says Amy Morin, a licensed clinical social worker and author of the best-selling self-help book, 13 Things Mentally Strong People Don’t Do. “It is still often looked at as a weakness, as if depression or anxiety is a character flaw or stems from laziness.”
It’s time to learn more. It’s time to start the conversation. It’s time to talk about mental health right here, where you live, in the state of Maryland.
The State of Mental Health in Maryland
Maryland ranks 12th in the nation for mental health, a position bestowed by Mental Health America, which added up the effectiveness of 15 measures such as the number of people with disorders, those with mental illness who are uninsured, and mental health workforce availability, among other factors, to come up with a definitive order of the 50 states. Using this list—which includes Washington D.C.— as a barometer might suggest that people in Maryland with mental health issues are better off in some ways than those in, say, Nevada, which is at the bottom of the list at No. 51. However, it could also indicate that Maryland doesn’t provide as many resources as those in Massachusetts and South Dakota, which earned the top two spots, respectively.
Over the past two years, the state has been working to integrate behavioral health into primary care settings, says Jo Deaton, a psychiatric nurse and senior director of nursing for behavioral health at Anne Arundel County Medical Center in Annapolis. “I think the realization is that depression is very costly to both our state and country, and if you can help people at the primary care level, it will be more effective,” she adds.
It’s a good thing there’s an effort on this front, because when it comes solely to access to mental health care, Maryland drops to No. 19 out of 50. This could be related in part to the fact that the state has a significantly limited number of psychiatric beds, which refers to places to put people who need psychiatric hospitalization. AAMC doesn’t have a psychiatric in-patient unit, Deaton explains, and there are just six beds in the emergency room. In early 2018, The Baltimore Sun reported that the number of psychiatric hospital beds in Maryland dropped almost 80 percent since the 1980s. The fiscal year 2017 report from the Maryland Health Care Commission put the total number of acute psychiatric care beds in the state at 740, with just 14 in Anne Arundel County and 47 on the Eastern Shore.
In fall 2017, a Baltimore judge held five top state officials, including then-acting Maryland Health Secretary Dennis Schrader, in contempt of court for the failure to increase the number of available psychiatric hospital beds available for mentally ill criminal defendants. Additionally, in 2016, Maryland law firm Venable LLP filed a lawsuit against the state to compel officials to transfer to hospitals the defendants who were determined to be mentally incompetent and a risk to themselves or others, instead of keeping them in jail cells.
The majority of patients that come into AAMC for mental health disorders who need acute psychiatric care are sent to Johns Hopkins in Baltimore or Sheppard Pratt in Ellicott City. Currently, Baltimore Washington Medical Center in Glen Burnie serves as the only acute psychiatric care hospital in Anne Arundel County, providing in- and outpatient behavioral health programs. However, AAMC has broken ground on a Mental Health hospital with 16 beds scheduled to open in summer 2020.
On the Eastern Shore, Peninsula Regional Medical Center in Salisbury opened an inpatient behavioral health unit with 13 beds in Spring 2016, and the University of Maryland Shore Medical Center at Dorchester in Cambridge includes a 24-bed inpatient treatment center.
It’s not enough. To make matters worse, Maryland—along with the rest of the country—currently suffers from a shortage of psychiatrists. When people make calls for mental health care, they often wait weeks or even months for an appointment. Breese, who works as What’s Up? Media’s community editor, experienced this struggle first-hand when her psychiatrist closed up shop and she had to find someone new. “For some people, the process [of finding a psychiatrist] can take way too long,” she says. “These wait times are crazy, and the whole situation with insurance coverage is crazy—but [the visit is] something that’s necessary.”
“For some people, the process [of finding a psychiatrist] can take way too long.”—Caley Breese
A 2017 report from the National Council for Behavioral Health found that by 2025, nationwide demand for psychiatrists may outstrip supply by anywhere from 6,090 to 15,600 professionals. Fewer medical students are going into psychiatry, so the percentage of psychiatric MDs retiring is now higher than in previous years. Mental health providers are reimbursed less than physical care doctors, making it a less desirable occupation. Finally, there’s a double-edged sword that affects the issue—there’s a greater awareness of mental health issues, so the number of patients seeking care is higher than ever before.
Understanding Mental Health Disorders
The spectrum of mental health disorders run the gamut from the diseases that people have often heard of, even if they don’t understand them, such as depressive and anxiety disorders, to those that are less common and even less understood, including personality, bipolar, and psychotic disorders. A significant step in creating a culture that understands mental health is knowing what these diseases entail, as well as which myths must be discredited.
Depressive Disorders. Depressive disorder might be one of the most common mental health diseases in the U.S., but it’s often the most misunderstood. More than just feeling sad, depression consists of a period of at least two weeks during which a person experiences not only a depressed mood or loss of interest or pleasure, but also a change in functioning, including problems with sleeping, eating, energy, concentration, self-image, or recurrent thoughts of death or suicide.
In the fall of 1995, Annapolis resident Isabel Tyson*, who is now 54, realized that something felt off but wasn’t necessarily wrong. She logically knew that everything was “right” in her life, including her 1-, 3- and 7-year-old children, her loving husband, the part-time professional career that she adored, and supportive family, but it didn’t matter. “It seems like it happened overnight, although I think it had been creeping up on me,” she recalls. “I tried to talk to my husband, and although he listened and cared, he had no idea what to say or how to help. I tried to talk to my mom, and she just made a comment like, ‘Why would you be struggling? You have beautiful kids, and everything in your life is great.’”
It was Tyson’s sister, a physician, who helped her realize that she was, in fact, struggling with postpartum depression, which can creep into a person’s life up to 18 months after giving birth. Other types of depression, which affect more than 16 million adults in America, include:
Depression is often treated with medication and therapy, which is what Tyson turned to in managing her symptoms. “I knew that I needed both therapy and medication. Meds because there was a physical/hormonal component and therapy because I needed to talk to someone who cared but didn’t know me,” she says. “I needed a ladder to help me climb out of the hole that I had fallen into.”
Persistent Depressive Disorder, also known as Dysthymic Disorder, which is a chronic low-level depression that’s not as severe but has lasted two years or longer;
Bipolar Disorder, sometimes called Manic Depression and is often categorized as a schizoaffective disorder, is characterized by episodes that range from extreme highs to the deepest lows;
Seasonal Affective Disorder (SAD), a period of time, usually in the winter, when days grow short, there’s not enough sun, and depression sets in;
Psychotic Depression, which is usually comorbid with major depression and includes “psychotic” symptoms such as hallucinations, delusions, and paranoia.
Some people, however, can’t climb out of that hole and experience serious thoughts of suicide, including an average of 3.7 percent of Marylanders. It’s the second-leading cause of death in people age 10 to 34 in America, and there are twice as many suicides as homicides every year in the country.
Anxiety Disorders. More than one-third of adults in the U.S. will experience some form of anxiety disorder at one point or another in their lives, but it’s more likely to be a woman who will understand the distress that anxiety can bring. “Anxiety feels like a moment that you want to escape, but you can’t,” describes 24-year-old Julianna Jessen* of Annapolis. “For me, it’s a feeling of being trapped in the moment with running thoughts that make my mind feel cloudy and full. I have a hard time listening to others when these thoughts arise.”
This cluster of conditions includes not only generalized anxiety disorder (GAD) but also panic disorder, agoraphobia, specific phobias, social anxiety disorder, and separation anxiety disorder. Agoraphobia refers to a disorder characterized by intense fear of a place or situation where escape might be difficult and often leads to people avoiding being alone outside the home, traveling in a car, or being in a crowded area.
Although Jessen has struggled with anxiety since a child, when she regularly experienced travel anxiety, she wasn’t diagnosed with GAD until her second year of college. As she got older, the symptoms increased, and situations changed, including socially. “I wouldn’t describe it as social anxiety, as I enjoy talking with others and making friends with strangers,” she says. “A lot of times, though, I feel trapped inside my own mind. My anxiety takes over, but it’s not about anything in particular. I struggle mostly because I can never pinpoint the nature of it—that makes it hard to control because I don’t know the source.”
Those who suffer from anxiety can also experience panic attacks, which often come out of the blue without any known trigger. This rush of intense fear joins physical symptoms, including chest pain, heart palpitations, dizziness, and shortness of breath, which is why it’s often confused with the beginning of a heart attack.
ADHD and Neurodevelopmental Disorders. Named as such because they are thought to originate as an impairment in the growth or development of the brain or central nervous system, neurodevelopmental disorders range from the broad category of intellectual disabilities (previously called mental retardation) to the autism spectrum and Down syndrome.
Additional Mental Health Disorders
A number of additional mental health conditions exist that there was simply not enough space to cover them all. However, they are just as serious and just as worthy of discussion as the others. They include: Dissociative Disorder, including dissociative identity disorder (formerly known as multiple personality disorder) Somatic Symptom Disorder, such as hypochondrias is Eating Disorders, including anorexia and bulimia nervosa Elimination Disorders, which includes the inappropriate elimination of urine or stool on accident or on purpose Sleep-Wake Disorders, such as insomnia Sexual dysfunctions Gender dysphoria Disruptive, impulse-control and conduct disorders, such as kleptomania Addictive disorders, including substance abuse and gambling addiction Neurocognitive disorders like Alzheimer’s disease Paraphilic disorders, including sexual interest that causes distress or impairment
One of the most prevalent, particularly in children, is attention deficit/hyperactivity disorder (ADHD), the preferred medical term for the condition that was once just called ADD. This disease consists of more than just having extra energy and being a little spacey; it’s a neurological condition that affects the brain’s ability to finish tasks, organize, remember, sit still, listen, or stay quiet to the extent that it negatively affects a person’s life. It’s one of the most common childhood disorders, but can—and does—continue into adolescence and adulthood for about one-third of people. ADHD affects more than four percent of adults, but experts estimate that significantly more suffer through the symptoms without a formal diagnosis.
Cate Reynolds, entertainment editor for What’s Up? Media, began exhibiting signs of ADHD at age 7 but wasn’t diagnosed until 14. “I remember a specific instance in a science class where we were talking about trees. There was this specific tree that looked very much like the tree on the commercials for the Keebler cookies, and my mind just went on this tangent,” she says. “I wondered how many elves lived in that tree. Why do they bake cookies in that tree? Do they live in the trunk of the tree or is there a basement? Why do some elves work in Santa’s workshop and others in the Keebler tree? How long is it until Christmas? The next thing I know, the bell rang, and I knew nothing about trees. There wasn’t a single note, I didn’t know if we had homework, but I had counted out each day until Christmas.”
Reynolds exhibited classic signs of what’s known as ADHD-Type 2, Predominantly Inattentive Presentation, which isn’t what most people think of when ADHD is discussed. Type 1 refers to Predominantly Hyperactive Presentation, which is the standard fidgety, misbehaved stereotype of someone with ADHD, while Type 3 is Combined Presentation, the most common subset of the disorder.
While some folks “grow out” of ADHD, Reynolds still feels the impact at age 23 (as does her mother, who was diagnosed at 35). She began taking Adderall in high school to manage the symptoms, but “Obviously, medication is just a tool, it’s not a total fix,” she explains. “There’s no cure, but the medicine gets me to the place where everyone else is.” She continues to explain that when she forgets to take her medication, “It feels like a house in that show ‘Hoarders.’ There’s so much stuff in this small space that you can’t even begin to sort through it. You can’t even get organized enough to get organized.”
Schizophrenia Spectrum and Psychotic Disorders. Fred Delp, executive director of the National Alliance on Mental Illness (NAMI) Anne Arundel County, didn’t know much about mental illness before having a son. Now, it’s safe to say that Delp, once a Navy jet pilot, is an expert at navigating the mental health system to care for that son, now 43, who suffers from schizoaffective disorder, as well as bipolar disorder and OCD. “We didn’t understand. He was combative and angry.” Delp explains. “We didn’t know what to do when trying to get him help. When we finally got help, one doctor would say one thing, and another would say another thing. We were out hundreds of thousands of dollars to find a cure. But there’s not a cure.”
“Obviously, medication is just a tool, it’s not a total fix. There’s no cure, but the medicine gets me to the place where everyone else is.”—Cate Reynolds
Schizoaffective disorder combines the symptoms of schizophrenia, which includes delusions, hallucinations, disorganized speech, general apathy, and disorganized or catatonic behavior, with major depressive symptoms. These diseases are persistent, severe, and, in most cases, disabling—in fact, it’s one of the top 15 leading causes of disability worldwide, even though its prevalence ranges from just 0.25 percent to 0.64 percent of people in the U.S. Schizophrenia is not multiple personality disorder, as often portrayed in the media; that is a separate disease known as dissociative identity disorder.
Nearly five percent of people with schizophrenia die by suicide, which is a significantly higher rate than the general population. Delp’s son has tried suicide twice, he said, “which is small compared to a lot of people. I’m very lucky in that regard.” He attends a day program at Arundel Lodge and is able to live alone, about three miles from Delp, but his range of mental health disorders keep him from working and isolates him socially. “My son didn’t go to college, and he doesn’t have a group of friends,” Delp says. “He goes to a day program at the lodge, but everyone goes home at 1 p.m., and the rest of the day, they don’t know what to do. They just don’t know how to make friends in their 30s and 40s.”
Obsessive-Compulsive Disorder. When it comes to myths about mental health illnesses, obsessive-compulsive disorder (OCD) might have some of the most. Here’s what OCD is not:
- A synonym for someone who’s uptight, a germaphobe, or a neatnik.
- A love or passion for another person or a hobby.
- A preference for seeing objects in straight lines.
- A joke about being very organized.
In other words, experiencing OCD is not a good thing. It’s a series of obsessive and compulsive thoughts or actions that affect a person’s job, school, relationships, and everyday living because of a cycle that is beyond control. It starts with intrusive thoughts, which are unwanted, troubling, and repetitive, which lead a person to perform compulsive actions to soothe those thoughts, if only just temporarily. Without performing those actions, someone with OCD will experience severe anxiety and limited ability to function.
More than half of the 1.2 percent of U.S. adults that reported having OCD in the past year said that it seriously impaired their life. Someone who suffers from OCD is more likely to also experience depression, substance abuse, ADHD, eating disorders, or anxiety disorder. Although diagnosis with OCD isn’t incredibly common, half of those who have it report that it creates a serious impairment.
PTSD and Trauma-Related Disorders. Post-traumatic stress disorder (PTSD) is commonly thought of as a soldier’s disease, but it can strike anyone who’s been through a traumatic event, including violent personal assaults, natural or human-caused disasters, or accidents like car crashes. PTSD suffering is not relegated to just those who experienced the event; family members can suffer from the disorder, too.
PTSD often afflicts women who have been a victim of rape or sexual assault, as well as people of both genders in dangerous or traumatizing careers. Military members fall into that category, of course, but also professions such as firefighters. The International Association of Fire Fighters runs a treatment center in Upper Marlboro for its members suffering from PTSD and disorders that often go hand-in-hand with it, including substance abuse. The center opened in 2017.
Research shows that around half of Americans will experience a traumatic event in their lifetime, but the majority of those won’t develop PTSD. They’ll feel shock, anger, fear, and guilt, to be sure, but as time fades, those feelings lessen and go away. Those with PTSD, however, will only experience an increase in those feelings over time, to the point where they can no longer live a normal life without intervention. Instead, they’re stuck repeatedly reliving the trauma through nightmares, flashbacks, or hallucinations. Reminders of the event, like an anniversary, can trigger them into distress. An estimated 3.6 percent of adults had PTSD in the last year.
Personality Disorders. Everyone has a personality that defines their own individuality. People with healthy personalities can manage stress effectively and form bonds with other people, but those with personality disorders—you might have heard of borderline personality disorder, though that’s just one of many types—aren’t as able to cope with both of those seemingly “normal” practices. They often don’t realize that their behavior is considered disordered and struggle with a rigid, narrow worldview. An estimated nine percent of Americans have at least one personality disorder; however, it has significant comorbidity with other mental health illnesses. The 10 recognized personality disorders are broken into three clusters:
Narcissistic personality disorder, part of cluster B, has shown up in the media more often recently; however, it goes beyond an over-inflated ego. Instead, narcissism is the primary characteristic of someone’s personality to the point where it destroys normal relationships and affects those who come into contact with the person suffering. Antisocial personality disorder, also known as sociopathy, refers to a person who doesn’t hold regard for right versus wrong and doesn’t show signs that they care about other people’s feelings or rights.
Cluster A: Odd, eccentric behavior, including paranoid, schizoid, and schizotypal personality disorders.
Cluster B: Dramatic, emotional, and erratic behavior, including antisocial, borderline, histrionic, and narcissistic personality disorders.
Cluster C: Anxious, fearful behavior, including avoidant, dependent, and obsessive-compulsive personality disorders, the latter of which is different than OCD.
Breaking the Silence
A significant number of local residents were willing to talk about their mental health struggles, but very few were willing to use their real names in doing so, as you might have noticed while reading their stories above. However, even those who weren’t ready to come out of the darkness noted the need to break the stigma surrounding mental health disorders.
“One in five people likely have a mental illness at any given time,” reiterates best-selling author Morin. “By not talking about it, we’re not helping people get the help they need. Most mental health issues are very treatable, and early intervention can be key to getting the most effective treatment.”
Organizations that work to increase awareness include NAMI, which has national, state, and local branches and does advocacy, training, education, and support for those with mental illnesses and their loved ones. “So many people aren’t aware of mental illnesses,” NAMI’s Executive Director says, “or even that their own family members are struggling with a disorder.”
“Funding is not where it should be for mental health care,” Delp adds. “It’s growing—it’s double what we had in the past. But it’s not where it should be.”
Society tends to be more focused on physical diseases, such as cancer or heart disease, he continues, but they don’t want to talk about what’s going on in the brain. Yet, it needs to be treated with the same amount of focus. “If you have strep throat, you take an antibiotic. If you have a headache, you take Tylenol,” Reynolds says. “Mental illness is still an illness.”
Coming Next Month
Mental health is a serious topic, but not all struggles are full-blown disorders. However, handling periods of stress, depression, and anxiety (even if it’s “just” the blues) is tough for everyone. In February, What’s Up? will dive into 15 scientifically proven ways to practice self-care to improve your emotional health.
Supporting Those Who Suffer
Mental health diseases don’t just affect the individual who is suffering, but also their family and friends. The network of support that surrounds a person can make a significant difference in the battle being waged, but it takes both education and communication. NAMI offers a number of free courses, including Mental Health 101, that help participants navigate a complicated health care system, including HIPAA laws, as well as twice-a-year 12-week family support courses and regular support groups.
If you notice a loved one exhibiting signs of mental illness, the best thing to do is have a conversation, Deaton recommends. Say something like, “I noticed over the past couple months, you have seemed really sad. I love you a lot. Can you tell me what’s going on and how I can help you?” A direct, supportive approach is ideal, Deaton says. If you’ve had your own struggles with mental health, open up to the person, Morin suggests. You might even offer to attend an appointment with a healthcare professional with them for support.
“Discuss how everyone is vulnerable to mental health problems,” Morin says. “You’ll encourage people to begin having more open conversations about mental health.”
*Not their real name.
