October 6, 2023 • 44 mins
What if you had the knowledge to identify a mental health crisis and the ability to step in at the right time? Join us in this heart-to-heart with Teele Becerra, LCSW, an expert on crisis intervention, and learn to recognize the signs of a mental health crisis, from panic attacks to suicidal thoughts. We explore the importance of creating a safe environment for those in crisis and early intervention's crucial role in preventing severe outcomes.
Navigating the world of mental health can be challenging, especially when a friend or family member is in crisis. Teal offers her insightful perspective on respecting an individual's autonomy, balancing it with the need for intervention, and setting boundaries to maintain our own mental health. We challenge the misconceptions around mental health, helping pave the way to more understanding and less stigma.
In the final part of our conversation, we focus on the importance of seeking help during a crisis and discuss resources such as the Crisis Text Line (988). We explore the role of acceptance in the healing process and discuss the significance of prescribed medication as a sign of safety. Further, we delve into the personal choice of medication in context of ADHD and tackle the stigma around this. Teal shares her thoughts on the power of social media as a platform for discussions on mental health and how to access free 24-hour crisis services. Turn the volume up for an enlightening episode that could well be the turning point for someone in need.
Kinder Mind offers therapy services in Illinois, Maryland, Massachusetts, Mississippi, Pennsylvania, Virginia, and Texas. Follow us and feel free to share with anyone looking for therapy in a state where we're located.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Barlow (00:01):
Welcome to the Kindermind podcast, where we're
devoted to opening upconversations and destigmatizing
mental health.
We'll bring you interviews withpractitioners in the field of
mental health, researchersuncovering new knowledge and
best practices for treatingmental health disorders, and
individuals sharing their mentalhealth journey.
I'm so excited to welcome toour episode four podcast Teele
(00:25):
Becerra, LCSW.
While we work together tounderstand crisis behaviors,
best practices and providingsupport and that providing
support piece is whether you'rea family member or a friend, or
even a mental health clinician.
So we'll talk through all theexamples of that.
First off, thanks so much, teal, for making the time to be here
(00:48):
to talk through this reallyimportant topic with us.
Teele Becerra, LCSW (00:51):
Of course, Hi everyone, Hi Dr Barlow.
Dr. Barlow (00:56):
Hi.
So to kick us off, can you talkus through what really
constitutes a mental healthcrisis?
So we know that folks who areexperiencing challenges with
mental health have differentlevels of things that they go
through.
What really is a mental healthcrisis?
Teele Becerra, LCSW (01:18):
Yeah, so you are absolutely correct.
I think that a crisis is.
Everyone is going to feel acrisis differently.
To some people, a panic attackmight be a crisis and to other
people, a crisis is there at asuicidal ideation level of
(01:39):
emotion.
It's really important to allowfor that broad definition of
crisis.
But in the psychiatric sensegenerally, a crisis is when
someone is either at risk ofhurting themselves or hurting
(02:00):
others, whether that be thatthey are just not in their
typical frame of mind and theymay not be safe to drive a
vehicle and therefore areputting themselves and others at
risk for safety.
Dr. Barlow (02:18):
Thanks so much for laying that out.
I think that's really importantto know.
So, thinking about what youshared, I know as clinicians
we're trained to kind of noticethe behaviors that are
associated with crisis.
For anyone not clinicallytrained, or even clinicians like
myself who really don't work alot with crisis, what are some
(02:41):
key behaviors, like some keyindicators of, hey, this person
might be in crisis.
Teele Becerra, LCSW (02:46):
That's a really good question.
Generally, when someone is incrisis, I would say that they're
not acting like themselves,maybe making rash or not thought
out decisions, potentially notsleeping.
One of the big characteristicsof suicidal ideation is giving
(03:07):
away objects or like possessionsto other people, but a crisis
can be anywhere between frommania to suicidal ideation.
So when we speak about mania asa crisis, my biggest concern is
when someone isn't sleeping,when someone is maybe spending
money that they don't have andthat they cannot potentially pay
(03:32):
back and putting themselvesinto debt or just again putting
themselves in harm's way as wellas putting others in harm's way
.
So those are usually theglaring things.
Of course, if someone presentsto you and says that they are
hallucinating, whether byhearing or seeing things, we're
(03:54):
definitely going to considerthat as a crisis as well.
But visually, you can't usuallytell when someone is in crisis.
It's all based on behavior.
Dr. Barlow (04:07):
Okay.
That's super important, I think, for folks to know, especially
who really are in the mentalhealth field.
So maybe they have a familymember or a friend who is acting
completely different from theirtypical personality.
They're engaging in these riskybehaviors, they've got these
things going on that couldindicate a crisis.
I know we talk a lot when we'retalking of situations like
(04:32):
suicide and substance abuse,about early intervention and
prevention and things like that.
Can you tell us about theimportance and kind of the act
of early intervention andprevention when it comes to
mental health crisis?
Teele Becerra, LCSW (04:48):
Yeah, so I think the best form of
prevention and intervention isjust awareness.
I think that the word suicideis very taboo and to the point
where now on social mediaplatforms you cannot use the
word suicide or you might getflagged.
(05:08):
So a lot of folks like onsocial media will use the term
on the live just to talk aboutsuicide because it is so taboo.
That I think that's the firstpoint of prevention is by
talking about it and by talkingabout these warning signs like
(05:30):
giving possessions away andengaging in risky behaviors.
Dr. Barlow (05:37):
So, just thinking about the importance of early
intervention and prevention,somebody's off their meds, just
like being a supportive friendor family member, and your
friend or family member hasthese behaviors or has this
diagnosis.
What are some things you can doto intervene and prevent, or
(05:58):
even connecting them with ahelping professional, or just
anything you can think of interms of intervention and
prevention?
Teele Becerra, LCSW (06:05):
Yeah, when, if you have a family member or
friend who you know is at riskof maybe suicide, an ideation
has been in the past.
I think it's really importantto ask them what they need for
those moments where they may goback to those behaviors and
thoughts that are unsafe.
Some people don't realize whenthey're becoming unsafe.
(06:31):
Those who have mania might noteven realize it until they're
looking back weeks later.
Oh, that, that pattern ofbehavior is something I
experienced monthly.
Or even folks who havediagnoses like premenstrual
dysphoric disorder.
They they will have mania orthoughts of self harm, thoughts
(06:53):
of suicide during theirmenstrual period and they don't
realize that until they're outof it.
So I think it's really importantfor anyone to one know that you
are supportive person to themand know and ask that person in
your life how can you supportthem?
But then I think it's reallyimportant to talk to them about
(07:15):
this when they are feeling safe,so they can identify what they
need in those moments.
A lot of people who experiencecrisis, whether that be one time
or many times in their life,are probably not going to ask
for help or identify whenthey're experiencing a crisis.
So I think the most importantpart of that early intervention
(07:39):
piece is to know what thosesigns are.
If you are living with someoneor working with someone that
experiences crisis frequently, Ithink, as I said with the just
talking about it in general,will create a safer space for
someone to know that they cancome to you when they're feeling
(08:02):
unsafe.
Dr. Barlow (08:04):
That's so important, because I know that a lot of us
like to think that we'resupportive and that we want the
best for others, and we make allof these statements, I feel
like a lot of times too, withthe best of intentions, but then
when that thing that we'resupportive of actually happens
and we feel the fear from that,or like the uncertainty which
(08:29):
causes fear around that, becausemaybe you don't have a lot of
experience supporting or dealingwith somebody that's going
through a crisis, that's when itcan take shape and create that
sense of freeze.
So you don't know what to do,you don't know what to say,
maybe you do nothing at all,which kind of leads me to that
next question I have.
If you're not a mental healthprofessional and you recognize
(08:53):
that something's very off withyour friend, what is that next
step?
What should you do?
Is it a conversation?
Should you call 911?
What does that look like interms of the timeline of helping
support someone in crisis?
Teele Becerra, LCSW (09:09):
It's a really important question.
I think that this question hastwo different answers, right.
So it really depends on whattype of crisis this person is in
, because if they aren't safe orif they, let's say, are a
parent and their children arebeing neglected because of that,
that is when it is your dutyalmost if you feel so like you
(09:37):
care for this person becausethey're part of your life to
potentially have interventionssuch as, like crisis services,
which most police departmentshave, mobile crisis teams and
social workers or cliniciansthat work alongside of the
police department to assessindividuals when they're unsafe.
(09:58):
So when you know someone istruly unsafe and they're at risk
or going to hurt someone orsomeone else, you definitely
need to bring in authorities.
I know that there's a hugestigma with police intervention
and I completely understand, andso typically you would be
(10:19):
calling maybe the non-emergencynumber instead of 911, which
then when the department istrained, those clinicians are
trained on how to react and mostsituations don't cause like
flashing lights with ambulanceand police showing up at
someone's house, which can alsoobviously cause a visual
(10:40):
disturbance to the community ofneighbors, if you have them.
The other part, of course, ifsomeone is unsafe, they're going
to hurt someone else, hurtothers.
They or you just have asuspicion that they're unsafe,
even if they haven't saidoutwardly that they're going to
hurt themselves or others, sothat you should get someone
(11:04):
involved that knows what they'redoing.
And the other part that I thinkis really hard for people to
deal with when it is a loved onethat is struggling is if
they're not actively going tohurt themselves or others.
There's very little that we cando unless, going back to the
(11:25):
previous question you've alreadyhad a conversation with them to
find out what is most useful.
Some folks choose I'm going togo back to mania some folks
choose not to take medicationand so therefore they may
experience mania and they mayexperience auditory or visual
hallucinations, and that's theirchoice.
(11:46):
Especially if someone is anadult, like over the age of 18,
they have every bit of agency tomake that choice.
So I think that again goes backto having that conversation
with that person.
You can preventatively todetermine what is going to be
the most helpful.
(12:06):
Otherwise, I think it's a caseby case basis, which is not
really a helpful answer to thisquestion.
But if you have a friend orconcerned about and you know
that they're safe and otherpeople around them are safe.
I think it's a kind of treadlightly conversation.
If you feel comfortable, if youfeel like that person is like
(12:26):
your partner or you, your bestfriend or whoever they are, your
sibling, if you feel like theywill receive the conversation
well in that moment, I thinkthat is okay to ask them.
I've been noticing thesebehaviors.
Is everything okay?
Maybe this is not the firsttime that you've seen this
happen, like I've noticed apattern of behaviors over time.
(12:50):
I'm just I'm worried about you.
I think that can be a reallyhard conversation to have,
especially because you don'talways know how someone can
react and people who are incrisis don't always react the
way they would if they were incrisis.
So that's it's a little bit ofa hard.
I wish there was a very clearlike line and direction on what
(13:14):
to do when someone is safe butin crisis, because it really is
a case by case basis.
Dr. Barlow (13:21):
For sure, and one of the reasons I'm so glad that
you were able to join us todayis because I know you have a
really established history ofexperience working in crisis.
Are there any specificexperiences that you're able to
share with us and the listenersabout a time when you have been
(13:42):
involved as a helpingprofessional in a crisis
situation, or, if you've beeninvolved as a friend or family
member in a crisis situation,anything you're comfortable
sharing?
Teele Becerra, LCSW (13:51):
So I have done extensive work in the
crisis field.
You're right, I used to work inpsychiatric emergency services.
Previously, I worked in thestate of Massachusetts, where we
are lucky enough the communityof Massachusetts is lucky enough
to have emergency servicesteams and every single catchment
(14:11):
area, which, basically, it'snot based on county, it's based
on towns and where they arelocated, and so I loved doing
the work that I did.
I worked in mobile crisis aswell as hospital crisis, and I
was experiencing a crisis.
They would call and I was thetriage clinician that would
(14:35):
either schedule them a same daypsychiatric emergency evaluation
or I would route them to thehospital.
So I have one example thatcomes to mind that kind of draws
to the last question that youasked about that, and I was
talking about that fine linebetween you know what to do if
someone is safe and what to doif someone is not safe.
(14:59):
If someone reached out to us andasked for support for their
friend Unfortunately again backto the whole agency piece when
someone is over 18, they havefull agency to choose whether or
not they need a psychiatricevaluation unless they're unsafe
or putting anyone else inharm's way.
(15:20):
So this person that reached outwas talking about an adult,
which already is, usually leadsto us.
At the time we would say andthis is still current that if
they're 18, over 18, they haveto call back and schedule
themselves.
Unfortunately, they have thatright, or the right to not get
(15:43):
an evaluation.
And this friend was reallyconcerned about their friend who
was experiencing some auditoryhallucinations as well as mania
and psychosis, in which theyfelt that they were connected to
a higher power.
So oftentimes folks willhallucinate that they are Jesus
(16:07):
or another spiritual figure orthat they have a direct
connection with God or Jesus orwhomever that they have a
connection to.
And the friend was reallylooking for support for the
person in crisis because theyknew that wasn't normal behavior
(16:28):
for their friend and I was in atricky position again coming
from a place of I love thatyou're reaching out about your
friend, but they have to callfor themselves and basically was
able to talk this friendthrough.
Similarly to the last question,what can you do when your friend
(16:48):
is like this?
And so I guided this friend onhow to communicate with them
that they were concerned abouttheir behavior and we talked
through.
They had a child and the childwas still getting their needs
met, so that wasn't a concern.
(17:09):
This person doesn't drive, sothey weren't leaving the house,
they weren't driving otherindividuals and really all of
their beliefs about themselvesas a part of that psychosis were
not hurt like harming anyone.
They were not having auditoryor visual hallucinations,
command hallucinations tellingthem to hurt themselves or hurt
(17:30):
someone else.
So really what I coached thisfriend through was to just
support their friend andcontinue to allow this person to
have their psychosis and unlessit gets unsafe, there's little
we can do as mental healthprofessionals, unfortunately,
besides to if you have therapport with them, to coach to
(17:52):
see if they can recognize thatthese are not true statements
that they would typically have.
And unfortunately, that's thething that stinks about this
experience.
That stinks about just havingloved ones who experience crisis
(18:13):
, because there's not alwaysanything that you can do and
sometimes the answer is just letthem live their life and
hopefully they will be able toreturn to their typical state of
mind and until then we can'treally do much unless they're
(18:33):
unsafe.
Dr. Barlow (18:35):
That's such a hard spot to be in and I know a lot
of people can really empathizewith that situation and spot of
you can only do so much.
I think historically that'sbeen one of those challenges
that I continuously hear fromclients is what can I do?
What can I do?
And one of the hardest but mostfreeing parts of therapy, in my
(19:00):
opinion, as a therapist, ishelping clients come to that
space where they understandtheir level of control, that
they do have and those thingsoutside of their control.
It makes it hard when it's afriend, it makes it feel
impossible when it's a familymember, because there's that
next level of connection and tosee that someone you love and
(19:24):
care about is hurting andhurting themselves maybe not
harming and self-harm of cuttingand things like that, things
that we know to be self-harm.
But, like you said, emptyingtheir bank account, buying a new
car, they can't afford engagingin sexually promiscuous
behaviors like things that aregonna.
They're gonna go through thatmania, they're gonna go through
(19:46):
that period and then they'regonna come to the realization oh
, what was I doing?
But then, like you said, theyhave their own agency, they're
their own person.
It's up to them whether or notthey wanna get help and if they
choose not to get help and thenthis bleeds over into the other
person the friend or familymember's life, and continues and
(20:06):
starts to take a reallynegative toll on that.
Unfortunately, it does enterinto that period where you have
to ask yourself like I reallylove and care about my friend or
family member, but it is.
What is it doing to me and whatam I gonna do about that and
how can I put cautions andboundaries or things in place so
(20:26):
that I'm not allowing the factthat they're not getting help to
continue to make me lose sleepor not have an appetite or take
time away from my family andwork, like things of that nature
.
So no, it's definitely a trickysituation, especially, as you
mentioned earlier.
There's a huge stigma.
There's a stigma around all ofmental health, and that's why I
(20:47):
love that I have the opportunityto bring practitioners and
experts in the field, likeyourself, on the show so we can
really open up theseconversations about mental
health and make it feel not soscary.
Tell me, in your experienceworking in crisis and really in
the mental health profession,what are some misconceptions or
(21:07):
stigmas surrounding mentalhealth crisis and how can we
address them effectively.
Teele Becerra, LCSW (21:14):
The great question, I think the biggest
stigma, is that folks feel asI'm saying this as a clinician,
as a therapist folks feel thatif they do seek out help
professionally and say, hey, Iam having these thoughts of self
(21:35):
harm, I'm having these thoughtsof suicide, I am having
thoughts of maybe hurtingsomeone else, that they are
automatically going to gethospitalized, and I think that
deters I know that deters peoplefrom getting help because they
think, okay, if I share with mytherapist today that I'm
(21:57):
thinking about cutting myselfthat automatically they're gonna
be hospitalized.
The truth of the matter is thattheir one is a huge crisis, just
in general, of having access tohigher level of care, so, like
inpatient care, right.
But the other part of this isthat we're not automatically
(22:19):
going to hospitalize you.
There are criteria you have tomeet in order to be hospitalized
and it's better that you'resharing it, because when you're
hiding it, it is more scary toindividuals to find out later.
And that would be more of aconcern to me if someone did not
share with me how they werefeeling and that, in fact, they
have been harming themselves formonths and now they have harmed
(22:44):
themselves so severely thatthey have to be hospitalized.
So I think that is another partof prevention.
But the stigma exists that justasking for help is gonna
automatically put you in thehospital, and that's completely
incorrect.
Dr. Barlow (23:00):
Okay, so, for our listeners who might be
experiencing a crisis themselvesor, like you mentioned before,
they've got those occurrences ofmania, or going through their
cycle when they're on theirperiod, they've got those times
of harmful behaviors.
What is one thing you'd like tosay to those folks in terms of
(23:24):
reaching out, getting support?
Maybe they're not working witha therapist, maybe they've never
opened up about this before.
Maybe they didn't even know itwas a problem.
They just thought that's theway they are.
What is something you'd like toshare to our listeners who
might be experiencing that, interms of how they can reach out
for support and what steps theycan take?
Teele Becerra, LCSW (23:45):
Yeah, ultimately, do not be afraid to
ask for help.
Tell someone, tell your friend,tell your family, tell someone
that is safe, that you know isgoing to support you, that loves
you unconditionally.
Tell someone that you trust.
But tell someone that just theact of telling someone how you
(24:08):
feel in itself is healing,because it is that first step to
getting help, whetherregardless of it is a therapist
or not, or your doctor orwhomever.
Telling someone opens you up topotentially getting help in the
future.
(24:28):
So I think my biggest piece ofadvice is telling someone.
There's so many resources outthere on where to find a
therapist, and I think one ofprobably the best resources that
we have in the US and Iactually don't know if it's
accessible from other countriesbut we have the crisis text line
(24:51):
, which I think is probably oneof the best resources that I've
ever found and ever referredpeople to, because it is a
anonymous, 24 hour support textservice, so you will text that
number at.
Whatever the number is sevenfour one.
Seven four one.
I haven't memorized Whateverhour of the day like.
(25:14):
I am feeling unsafe.
I'm having a panic attack, I'mthinking of harming myself and
thinking of harming others.
I'm experiencing mania.
I don't know what to do andthat person is going to be there
to walk you through how to getsupport and they are crisis
counselors that are trained andhow to help you.
So if you don't have a personthat you can trust in your life
(25:35):
that you have personally, Ihighly recommend the crisis text
line as the first person thatyou tell, because sometimes it
is actually easier to tellsomeone that doesn't know you at
all how you're feeling, becauseit can feel so hard to tell
people that you love because youdon't want to hurt their
feelings.
Dr. Barlow (25:56):
Oh, absolutely, that's such a great point.
And also there might be thatfear in there because of what we
talked about with that stigma.
What are they going to thinkabout me?
Are they going to think thatI'm not safe to be around, or
safe to have their childrenaround, or they even safe enough
to watch their dog?
There's just all these fearsthat kind of come into your mind
(26:17):
when you have to admit tosomeone that you're maybe not
that person that they thoughtyou were, or you're not perfect
because, as our ego is a veryimportant part of what makes us
so, then when we do things thatfeels like we're challenging
that ego, we're taking piecesaway from it, it can feel
(26:39):
terrifying because we worrythat's really going to change
who we are to the world.
And I think you mentioned areally great word healing.
So, thinking in terms ofindividuals who go through a
mental health crisis, theyengage in these risky behaviors.
They obviously in the momentdon't recognize what they're
(27:01):
doing, what's going on.
Everything is moving so fastand there's really not that
level of cognition there thatsays, hey, you're doing
something wrong, you need tostop fast forwarding to when
they do have that perspectiveand they can look back on that
and reflect what, as a therapist, what are some things that
these folks can do aroundself-care and really not beating
(27:25):
themselves up and not blamingthemselves for what they just
went through?
Good question.
Teele Becerra, LCSW (27:31):
I think just accepting that this is.
I think a lot of the stigmacomes internally, like you said,
from the fear that people aregoing to perceive you a
different way, and I think,along with healing, is that
piece of acceptance.
You didn't.
No one wakes up one day anddecides that they want to have
(27:54):
intrusive thoughts of self-harmright, no one wants that for
them.
No one wants to have to dealwith that on a daily basis or
monthly basis or what have you.
But I think when people acceptthat this is who they are or
what they're experiencing inthat moment it doesn't mean who
they are as a person, but, likebiologically, chemically,
(28:14):
something is going on that theyneed support with, and so I
think the term self-care isgrown around a lot, right?
People identify self-care asbubble baths and having tea or
your drink of choice when youlay out in the sun or whatever.
(28:37):
But self-care is really justlistening to your body and what
it needs, in my opinion, and sothat could be a bubble bath.
Maybe baths relax you, butultimately it could be taking
your meds.
I did also want to mention thatone of the signs as a clinician
that is concerning to me, whenI can tell when someone is being
(28:57):
unsafe, even if they're notintentionally trying to hurt
themselves or others, is whensomeone decreases or stops
taking their meds because theyfeel like, oh, I'm great now.
Usually that feeling of I'mgreat now is because their meds
are working.
So when someone stops takingtheir meds for a long period of
time without the help of apsychiatrist, that is also
(29:19):
somewhere I would be concernedthat they're in a crisis.
Dr. Barlow (29:22):
I love that, throw that in there.
No, I love that call out somuch.
It's interesting because I'mnot a therapist and I know
you're not either.
That's immediately gonna belike oh okay, a pill, you need a
pill that's gonna fixeverything.
I'm definitely not thattherapist.
I ride that line of I willalways refer you to a prescriber
if things seem like they aresomething that can't be tackled
(29:45):
with just therapy.
But at the end of the day, likeit's not my call to write you a
prescription.
I'm not a prescriber, butthere's nothing that hurts about
talking to a prescriber and Iknow we're not.
This isn't the medicationpodcast or like that episode
where we're talking aboutmedication.
But that's a really importantpoint because I think a lot of
stigma also comes frommedication and so a lot of
(30:09):
clients that I've worked withone of my specialties and
backgrounds is an ADHD.
When I do need to have aconversation with a client about
okay, you've tried to changeyour behaviors on your own,
you've put these things in place, you're using these skills that
you've learned, but youphysically can't make yourself
change this behavior and you'rerunning up against a brick wall.
Now it's time for me to likeget you referred over to a
(30:31):
prescriber to have aconversation about ADHD
medication.
A lot of what I hear is oh yeah,no, I don't think I wanna take
meds like I just I don't know, Idon't feel good about it.
And my response is always Ihear you and I don't think
anybody enjoys taking medicationand that's not the goal.
The goal and the point of it isthere's only so much that you
(30:53):
can physically do.
The other part of that ischemical and you can try to do
these behaviors, you can try toput these things in place to
kind of safety net yourself withthese behaviors If that does
not work or if it works for alittle bit and then stops
working and you can't physicallymake this change.
Now you know it's a chemicalchallenge.
(31:14):
There's a chemical imbalance,there's something chemically
preventing you from being ableto be healthy or have healthy
behaviors.
So I love that you mentionedthat.
I know I got off on amedication tangent a little bit.
Teele Becerra, LCSW (31:26):
No, I appreciate it.
You're absolutely right.
We're not as social workers, astherapists, we don't prescribe
meds.
We're taught in school thatwe're not supposed to talk about
meds, talk about dosing, and Iabsolutely am not advocating for
us to do that.
But I think that is a reallyimportant piece of taking care
of yourselves.
(31:46):
Self-care can be as basic asbrushing your teeth and taking
your meds, and some people needmore than that.
Some people that is at theirbaseline they take their meds
every day, they shower every day, they brush your teeth every
day, but they still have roughdays and self-care may look
different.
I think that exercise can do alot for your mental health, and
(32:13):
I'm not saying you have to go tothe gym, get a gym membership
and work out every day, but evenjust getting some fresh air,
standing outside, hopefully withthe sun shining because I love
the sun and the sun should beout all the time everywhere and
take getting fresh air, goingfor a walk, like that all can be
(32:33):
self-care.
But sometimes the most basicthing, if you cannot do anything
else in your day to take careof yourself, it is taking your
medication, but also acceptingthat, like you said with your
clients, like they're like oh, Iabsolutely not, I do not even
want to think about that andthat is their absolute right.
But sometimes that is what youneed and that can be the piece
(32:58):
of self care that you get done.
The one thing you do to takecare of yourself every single
day is take your medication.
Again, some people choose toabsolutely not take medication
and they have likehallucinations, and that is
their choice.
Dr. Barlow (33:13):
Absolutely.
And I think, to like anotheragain, like completely their
choice.
I'm not here to persuadeanybody one way or the other for
sure, but then, like one of mycomments that I love as a go to
is Okay, how many cups of coffeedo you drink in the morning or
throughout the day?
What is your goal for thatcoffee?
Your goal is to give you energy, wake you up and keep you
(33:35):
productive.
So then, obviously, a lot ofthese psychotropic medications
are either controlled substanceor you need prescription to get
them.
So I'm not trying to comparecoffee to a psychotropic drug,
but there's a purpose there, andI think that's that key point.
If your purpose is to live abetter life without these risky
(34:00):
behaviors or ADHD, like in myexample, you're going to need
something to make that happen ifyou have tried and failed,
because one of my things that Ijust hate for clients to go
through is they do the work,they try really hard and they
want the positive changevenomately, and then they
continue to fail.
(34:20):
So then they get in those likeself blaming behaviors and
thoughts of I'm not good enough,I'm not strong enough.
If I were stronger, I couldthen XYZ, and that's where it's
like, really, given that psychoeducation it's not you, it's
your chemicals.
Teele Becerra, LCSW (34:39):
It's your brain, like you said.
I think it's interesting.
We're talking about ADHD inthis podcast, about crisis, but
along lines of caffeine, the waythat caffeine affects the brain
for one person is differentthan the other.
So a lot of times withmedication, I bring up ADHD,
because caffeine can actuallymake the ADHD brain go, become
(35:01):
sleepy, which is hilariousbecause it's a stimulant for
some and not for others.
But that is that's howeveryone's brain is different.
Not one medication is going towork for every single person,
and I think that's also where alot of people get discouraged
because they either.
There are a lot of people I haveheard from like a lot of
(35:23):
clients who have said I went tothis prescriber and they just
wanted to throw all thesemedications at me, or they said
I didn't need any, or theydidn't listen to me.
I'm really glad to have formedrelationships with a lot of
psychiatrists who do listen andwho want it to be your choice of
what you can take, and I thinkthat's the most important part
(35:44):
in this is that you do have thatagency I'm going to keep using
that word that, if you go andhave that conversation with a
psychiatrist, just becauseyou're meeting with a
psychiatrist, like you said,does not mean you're going to
leave with a prescription.
They might make suggestions.
They most likely will makesuggestions on what.
(36:04):
Also, if they give you aprescription and you decide to
fill it and then say, you knowwhat, I don't want to try this
right now, that's okay too,because it is your body
ultimately, but there are.
It comes to a point where, ifyou're having symptoms so severe
that you are unsafe or makingothers unsafe and medications
(36:26):
may help, that's okay, and Ithink that they're like that's a
huge stigma.
Right, it is okay to takemedication and I'm really glad
that we're in this space nowwhere social media is so
prevalent.
I think, obviously, it can beso harmful, but I am on the side
of social media.
That is okay with talking abouttaking medication and okay with
(36:51):
taking medication in general.
Right, if it helps you, that'sokay.
Like it doesn't mean that youweren't.
You didn't choose to be borninto this world with a brain
chemistry that makes you sadevery day.
I think it's important to havethese conversations right, so to
provide safe spaces for yourfamily members who may be
(37:14):
struggling, or friends orwhomever in your life that is
struggling to have theseconversations and it can feel
really awkward or uncomfortable.
But I think at least a lot ofmy clients I know they
communicate with others and I dothe same through like ticktocks
(37:37):
and reels, and so sometimes avideo or a podcast use.
This podcast will open up aconversation of hey, I was
listening to this podcast and Ilearned about suicidal ideation
and like how to support myfriends, and I know that you've
dealt with that in the past likehow can I support you?
(37:58):
And so I think it's all abouthaving that conversation,
because that is activelyfighting against the stigma of
accessing health and mentalhealth care.
Dr. Barlow (38:10):
I know that you have some really great resources for
our listeners, either forthemselves or to share with
anyone they know that's goingthrough a mental health crisis.
Do you want to go ahead andprovide our listeners with those
now?
Teele Becerra, LCSW (38:21):
Yeah, I talked about the crisis text
sign before.
It is actually accessible 24hours a day, every single day,
in the United States, canada,the UK and Ireland, which is
really amazing.
So if you are listening to thisin another country, you, if
you're in the UK, please use thecrisis text line.
(38:42):
So you're going to text home HO M E to 741 741.
And again, that is a free, 24hour crisis service.
I like to get this out toanyone and everyone.
And then the other number,which is just local to the
United States, is 988.
So a lot of people know that weuse nine move one for emergency
(39:04):
services, and now we havecreated nine.
We, the United States, hascreated 988, which is a number
that you can call if there isanyone, if you or anyone else is
in a psychiatric emergency, andthey will connect you to those
call centers that I used to workat, as well as the ones that
(39:25):
have, like mobile crisis unitswith police departments or
mobile crisis units throughnonprofits in your community,
and so that is the centralnumber for the US to access
immediate crisis support.
I also wanted to mention that Iknow I'm not a parent, but I
have cared for a lot of kids andit's when you have a child or
(39:50):
you care for a child that islike a different type of love,
and I think it can be reallyhard for parents to accept when
their child is hurting becausethey created that child or has
have raised that child as theirown and they don't want to feel
(40:12):
like maybe they made a mistakein parenting or done done
something wrong or knowinggenetics, that the brain
chemistry, like you must have.
There must have been somethingduring pregnancy.
None of that is true.
You are a great parent and Ithink you need to give yourself
credit for recognizing when yourchild feels unsafe and just
(40:37):
ultimately trying to get themthe best support that they need.
But I think this also goes intowhere it's really hard is that
once your kid is over 18, theyare an adult, and so that is one
of the things that I used tocome into contact with all the
time.
Working in emergency services isa mom would call for their 19
(40:58):
year old son, for example, andthere's very little that we can
do unless that 19 year old againis unsafe or someone else is
unsafe that they're threateningto harm because they have to
consent to that help, and so Iknow that must be a terrible
(41:19):
situation to be in and I'm I'venever been in that situation
again as a, not a parent, but Ican only imagine and empathize
that that is probably one of thehardest situations to watch
your kids struggle.
But I think that's where thatprevention piece comes in.
Most importantly is like tryingto know the signs and,
especially if you have a historyof mental health disorders in
(41:42):
the family or in yourself, tofamiliarize yourself with those
diagnoses and have thoseconversations with your kiddos
when they are age-appropriateand able to talk with you about
their emotions.
I say age-appropriate but Ithink that it needs to be a
(42:02):
conversation that's had when wetalk about our emotions and
labeling our emotions, startingas toddlers and building it up.
Obviously you're not going totalk about suicide to a
five-year-old when theirteenager is talking about
depression and other diagnosesand maybe any family histories
and just opening up a safe spacefor when they are feeling
(42:25):
unsafe.
If they ever feel unsafe orthey know someone else in their
life that's unsafe, then theycan come to you and ask for help
and get that support.
Dr. Barlow (42:34):
I know that moment of what parents go through when
something goes wrong and maybeit's not mental health crisis,
maybe it's their kid acting out,or maybe they got arrested or
whatever happens that immediatestatement you make either out
loud or in your head where did Igo wrong?
That's not a thing.
(42:57):
But if you know that you were agood parent, you were most
likely a good parent, but youmade a very good point.
The communication is the gamechanger.
Being that person, like youmentioned earlier when you were
saying reach out to someonethat's safe if you're in crisis
or you need support.
Being that person that is safefor your child to reach out to
(43:21):
and share that things are goingwrong.
Or hey mom, hey dad, I'm havinga challenge with this.
Being that safe person for yourchild is everything.
Just fostering that piece ofcommunication and letting that
be known by your child.
Hey, yeah, you're going to makemistakes.
(43:43):
I'm your parent, so I'm goingto have to put consequences in
place for you when you makemistakes.
I will never love you any less.
I'm never going to judge youfor this and make you feel
unsafe.
Please always talk to me,always communicate with me.
Keep those lines open.
I think that can be a hugedifference between finding out
unfortunately when it's too late, after the fact, when something
(44:05):
has happened that'scatastrophic and maybe there's
been self-harm, or is it stillcalled a successful suicide,
death by suicide, yeah, or ifthey've had a death by suicide.
If you can get thatcommunication going and
fostering that at a young age,there's always hope.
It's not a guarantee, butthere's always hope that you
(44:27):
will be that person that yourchild reaches out to Exactly.
Thank you so much again forjoining us today.
Teele on this episodeUnderstanding Crisis Behaviors,
best Practices and ProvidingSupport.
Until next time, I'm Dr Barlow.
The Kinder Mind Podcast isproduced by Dr Elizabeth Barlow,
(44:47):
edited by Marco.
Antonio with music by PaxMinerva.
Welcome to the Kindermind podcast, where we're
devoted to opening upconversations and destigmatizing
mental health.
We'll bring you interviews withpractitioners in the field of
mental health, researchersuncovering new knowledge and
best practices for treatingmental health disorders, and
individuals sharing their mentalhealth journey.
I'm so excited to welcome toour episode four podcast Teele
(00:25):
Becerra, LCSW.
While we work together tounderstand crisis behaviors,
best practices and providingsupport and that providing
support piece is whether you'rea family member or a friend, or
even a mental health clinician.
So we'll talk through all theexamples of that.
First off, thanks so much, teal, for making the time to be here
(00:48):
to talk through this reallyimportant topic with us.
Teele Becerra, LCSW (00:51):
Of course, Hi everyone, Hi Dr Barlow.
Dr. Barlow (00:56):
Hi.
So to kick us off, can you talkus through what really
constitutes a mental healthcrisis?
So we know that folks who areexperiencing challenges with
mental health have differentlevels of things that they go
through.
What really is a mental healthcrisis?
Teele Becerra, LCSW (01:18):
Yeah, so you are absolutely correct.
I think that a crisis is.
Everyone is going to feel acrisis differently.
To some people, a panic attackmight be a crisis and to other
people, a crisis is there at asuicidal ideation level of
(01:39):
emotion.
It's really important to allowfor that broad definition of
crisis.
But in the psychiatric sensegenerally, a crisis is when
someone is either at risk ofhurting themselves or hurting
(02:00):
others, whether that be thatthey are just not in their
typical frame of mind and theymay not be safe to drive a
vehicle and therefore areputting themselves and others at
risk for safety.
Dr. Barlow (02:18):
Thanks so much for laying that out.
I think that's really importantto know.
So, thinking about what youshared, I know as clinicians
we're trained to kind of noticethe behaviors that are
associated with crisis.
For anyone not clinicallytrained, or even clinicians like
myself who really don't work alot with crisis, what are some
(02:41):
key behaviors, like some keyindicators of, hey, this person
might be in crisis.
Teele Becerra, LCSW (02:46):
That's a really good question.
Generally, when someone is incrisis, I would say that they're
not acting like themselves,maybe making rash or not thought
out decisions, potentially notsleeping.
One of the big characteristicsof suicidal ideation is giving
(03:07):
away objects or like possessionsto other people, but a crisis
can be anywhere between frommania to suicidal ideation.
So when we speak about mania asa crisis, my biggest concern is
when someone isn't sleeping,when someone is maybe spending
money that they don't have andthat they cannot potentially pay
(03:32):
back and putting themselvesinto debt or just again putting
themselves in harm's way as wellas putting others in harm's way
.
So those are usually theglaring things.
Of course, if someone presentsto you and says that they are
hallucinating, whether byhearing or seeing things, we're
(03:54):
definitely going to considerthat as a crisis as well.
But visually, you can't usuallytell when someone is in crisis.
It's all based on behavior.
Dr. Barlow (04:07):
Okay.
That's super important, I think, for folks to know, especially
who really are in the mentalhealth field.
So maybe they have a familymember or a friend who is acting
completely different from theirtypical personality.
They're engaging in these riskybehaviors, they've got these
things going on that couldindicate a crisis.
I know we talk a lot when we'retalking of situations like
(04:32):
suicide and substance abuse,about early intervention and
prevention and things like that.
Can you tell us about theimportance and kind of the act
of early intervention andprevention when it comes to
mental health crisis?
Teele Becerra, LCSW (04:48):
Yeah, so I think the best form of
prevention and intervention isjust awareness.
I think that the word suicideis very taboo and to the point
where now on social mediaplatforms you cannot use the
word suicide or you might getflagged.
(05:08):
So a lot of folks like onsocial media will use the term
on the live just to talk aboutsuicide because it is so taboo.
That I think that's the firstpoint of prevention is by
talking about it and by talkingabout these warning signs like
(05:30):
giving possessions away andengaging in risky behaviors.
Dr. Barlow (05:37):
So, just thinking about the importance of early
intervention and prevention,somebody's off their meds, just
like being a supportive friendor family member, and your
friend or family member hasthese behaviors or has this
diagnosis.
What are some things you can doto intervene and prevent, or
(05:58):
even connecting them with ahelping professional, or just
anything you can think of interms of intervention and
prevention?
Teele Becerra, LCSW (06:05):
Yeah, when, if you have a family member or
friend who you know is at riskof maybe suicide, an ideation
has been in the past.
I think it's really importantto ask them what they need for
those moments where they may goback to those behaviors and
thoughts that are unsafe.
Some people don't realize whenthey're becoming unsafe.
(06:31):
Those who have mania might noteven realize it until they're
looking back weeks later.
Oh, that, that pattern ofbehavior is something I
experienced monthly.
Or even folks who havediagnoses like premenstrual
dysphoric disorder.
They they will have mania orthoughts of self harm, thoughts
(06:53):
of suicide during theirmenstrual period and they don't
realize that until they're outof it.
So I think it's really importantfor anyone to one know that you
are supportive person to themand know and ask that person in
your life how can you supportthem?
But then I think it's reallyimportant to talk to them about
(07:15):
this when they are feeling safe,so they can identify what they
need in those moments.
A lot of people who experiencecrisis, whether that be one time
or many times in their life,are probably not going to ask
for help or identify whenthey're experiencing a crisis.
So I think the most importantpart of that early intervention
(07:39):
piece is to know what thosesigns are.
If you are living with someoneor working with someone that
experiences crisis frequently, Ithink, as I said with the just
talking about it in general,will create a safer space for
someone to know that they cancome to you when they're feeling
(08:02):
unsafe.
Dr. Barlow (08:04):
That's so important, because I know that a lot of us
like to think that we'resupportive and that we want the
best for others, and we make allof these statements, I feel
like a lot of times too, withthe best of intentions, but then
when that thing that we'resupportive of actually happens
and we feel the fear from that,or like the uncertainty which
(08:29):
causes fear around that, becausemaybe you don't have a lot of
experience supporting or dealingwith somebody that's going
through a crisis, that's when itcan take shape and create that
sense of freeze.
So you don't know what to do,you don't know what to say,
maybe you do nothing at all,which kind of leads me to that
next question I have.
If you're not a mental healthprofessional and you recognize
(08:53):
that something's very off withyour friend, what is that next
step?
What should you do?
Is it a conversation?
Should you call 911?
What does that look like interms of the timeline of helping
support someone in crisis?
Teele Becerra, LCSW (09:09):
It's a really important question.
I think that this question hastwo different answers, right.
So it really depends on whattype of crisis this person is in
, because if they aren't safe orif they, let's say, are a
parent and their children arebeing neglected because of that,
that is when it is your dutyalmost if you feel so like you
(09:37):
care for this person becausethey're part of your life to
potentially have interventionssuch as, like crisis services,
which most police departmentshave, mobile crisis teams and
social workers or cliniciansthat work alongside of the
police department to assessindividuals when they're unsafe.
(09:58):
So when you know someone istruly unsafe and they're at risk
or going to hurt someone orsomeone else, you definitely
need to bring in authorities.
I know that there's a hugestigma with police intervention
and I completely understand, andso typically you would be
(10:19):
calling maybe the non-emergencynumber instead of 911, which
then when the department istrained, those clinicians are
trained on how to react and mostsituations don't cause like
flashing lights with ambulanceand police showing up at
someone's house, which can alsoobviously cause a visual
(10:40):
disturbance to the community ofneighbors, if you have them.
The other part, of course, ifsomeone is unsafe, they're going
to hurt someone else, hurtothers.
They or you just have asuspicion that they're unsafe,
even if they haven't saidoutwardly that they're going to
hurt themselves or others, sothat you should get someone
(11:04):
involved that knows what they'redoing.
And the other part that I thinkis really hard for people to
deal with when it is a loved onethat is struggling is if
they're not actively going tohurt themselves or others.
There's very little that we cando unless, going back to the
(11:25):
previous question you've alreadyhad a conversation with them to
find out what is most useful.
Some folks choose I'm going togo back to mania some folks
choose not to take medicationand so therefore they may
experience mania and they mayexperience auditory or visual
hallucinations, and that's theirchoice.
(11:46):
Especially if someone is anadult, like over the age of 18,
they have every bit of agency tomake that choice.
So I think that again goes backto having that conversation
with that person.
You can preventatively todetermine what is going to be
the most helpful.
(12:06):
Otherwise, I think it's a caseby case basis, which is not
really a helpful answer to thisquestion.
But if you have a friend orconcerned about and you know
that they're safe and otherpeople around them are safe.
I think it's a kind of treadlightly conversation.
If you feel comfortable, if youfeel like that person is like
(12:26):
your partner or you, your bestfriend or whoever they are, your
sibling, if you feel like theywill receive the conversation
well in that moment, I thinkthat is okay to ask them.
I've been noticing thesebehaviors.
Is everything okay?
Maybe this is not the firsttime that you've seen this
happen, like I've noticed apattern of behaviors over time.
(12:50):
I'm just I'm worried about you.
I think that can be a reallyhard conversation to have,
especially because you don'talways know how someone can
react and people who are incrisis don't always react the
way they would if they were incrisis.
So that's it's a little bit ofa hard.
I wish there was a very clearlike line and direction on what
(13:14):
to do when someone is safe butin crisis, because it really is
a case by case basis.
Dr. Barlow (13:21):
For sure, and one of the reasons I'm so glad that
you were able to join us todayis because I know you have a
really established history ofexperience working in crisis.
Are there any specificexperiences that you're able to
share with us and the listenersabout a time when you have been
(13:42):
involved as a helpingprofessional in a crisis
situation, or, if you've beeninvolved as a friend or family
member in a crisis situation,anything you're comfortable
sharing?
Teele Becerra, LCSW (13:51):
So I have done extensive work in the
crisis field.
You're right, I used to work inpsychiatric emergency services.
Previously, I worked in thestate of Massachusetts, where we
are lucky enough the communityof Massachusetts is lucky enough
to have emergency servicesteams and every single catchment
(14:11):
area, which, basically, it'snot based on county, it's based
on towns and where they arelocated, and so I loved doing
the work that I did.
I worked in mobile crisis aswell as hospital crisis, and I
was experiencing a crisis.
They would call and I was thetriage clinician that would
(14:35):
either schedule them a same daypsychiatric emergency evaluation
or I would route them to thehospital.
So I have one example thatcomes to mind that kind of draws
to the last question that youasked about that, and I was
talking about that fine linebetween you know what to do if
someone is safe and what to doif someone is not safe.
(14:59):
If someone reached out to us andasked for support for their
friend Unfortunately again backto the whole agency piece when
someone is over 18, they havefull agency to choose whether or
not they need a psychiatricevaluation unless they're unsafe
or putting anyone else inharm's way.
(15:20):
So this person that reached outwas talking about an adult,
which already is, usually leadsto us.
At the time we would say andthis is still current that if
they're 18, over 18, they haveto call back and schedule
themselves.
Unfortunately, they have thatright, or the right to not get
(15:43):
an evaluation.
And this friend was reallyconcerned about their friend who
was experiencing some auditoryhallucinations as well as mania
and psychosis, in which theyfelt that they were connected to
a higher power.
So oftentimes folks willhallucinate that they are Jesus
(16:07):
or another spiritual figure orthat they have a direct
connection with God or Jesus orwhomever that they have a
connection to.
And the friend was reallylooking for support for the
person in crisis because theyknew that wasn't normal behavior
(16:28):
for their friend and I was in atricky position again coming
from a place of I love thatyou're reaching out about your
friend, but they have to callfor themselves and basically was
able to talk this friendthrough.
Similarly to the last question,what can you do when your friend
(16:48):
is like this?
And so I guided this friend onhow to communicate with them
that they were concerned abouttheir behavior and we talked
through.
They had a child and the childwas still getting their needs
met, so that wasn't a concern.
(17:09):
This person doesn't drive, sothey weren't leaving the house,
they weren't driving otherindividuals and really all of
their beliefs about themselvesas a part of that psychosis were
not hurt like harming anyone.
They were not having auditoryor visual hallucinations,
command hallucinations tellingthem to hurt themselves or hurt
(17:30):
someone else.
So really what I coached thisfriend through was to just
support their friend andcontinue to allow this person to
have their psychosis and unlessit gets unsafe, there's little
we can do as mental healthprofessionals, unfortunately,
besides to if you have therapport with them, to coach to
(17:52):
see if they can recognize thatthese are not true statements
that they would typically have.
And unfortunately, that's thething that stinks about this
experience.
That stinks about just havingloved ones who experience crisis
(18:13):
, because there's not alwaysanything that you can do and
sometimes the answer is just letthem live their life and
hopefully they will be able toreturn to their typical state of
mind and until then we can'treally do much unless they're
(18:33):
unsafe.
Dr. Barlow (18:35):
That's such a hard spot to be in and I know a lot
of people can really empathizewith that situation and spot of
you can only do so much.
I think historically that'sbeen one of those challenges
that I continuously hear fromclients is what can I do?
What can I do?
And one of the hardest but mostfreeing parts of therapy, in my
(19:00):
opinion, as a therapist, ishelping clients come to that
space where they understandtheir level of control, that
they do have and those thingsoutside of their control.
It makes it hard when it's afriend, it makes it feel
impossible when it's a familymember, because there's that
next level of connection and tosee that someone you love and
(19:24):
care about is hurting andhurting themselves maybe not
harming and self-harm of cuttingand things like that, things
that we know to be self-harm.
But, like you said, emptyingtheir bank account, buying a new
car, they can't afford engagingin sexually promiscuous
behaviors like things that aregonna.
They're gonna go through thatmania, they're gonna go through
(19:46):
that period and then they'regonna come to the realization oh
, what was I doing?
But then, like you said, theyhave their own agency, they're
their own person.
It's up to them whether or notthey wanna get help and if they
choose not to get help and thenthis bleeds over into the other
person the friend or familymember's life, and continues and
(20:06):
starts to take a reallynegative toll on that.
Unfortunately, it does enterinto that period where you have
to ask yourself like I reallylove and care about my friend or
family member, but it is.
What is it doing to me and whatam I gonna do about that and
how can I put cautions andboundaries or things in place so
(20:26):
that I'm not allowing the factthat they're not getting help to
continue to make me lose sleepor not have an appetite or take
time away from my family andwork, like things of that nature
.
So no, it's definitely a trickysituation, especially, as you
mentioned earlier.
There's a huge stigma.
There's a stigma around all ofmental health, and that's why I
(20:47):
love that I have the opportunityto bring practitioners and
experts in the field, likeyourself, on the show so we can
really open up theseconversations about mental
health and make it feel not soscary.
Tell me, in your experienceworking in crisis and really in
the mental health profession,what are some misconceptions or
(21:07):
stigmas surrounding mentalhealth crisis and how can we
address them effectively.
Teele Becerra, LCSW (21:14):
The great question, I think the biggest
stigma, is that folks feel asI'm saying this as a clinician,
as a therapist folks feel thatif they do seek out help
professionally and say, hey, Iam having these thoughts of self
(21:35):
harm, I'm having these thoughtsof suicide, I am having
thoughts of maybe hurtingsomeone else, that they are
automatically going to gethospitalized, and I think that
deters I know that deters peoplefrom getting help because they
think, okay, if I share with mytherapist today that I'm
(21:57):
thinking about cutting myselfthat automatically they're gonna
be hospitalized.
The truth of the matter is thattheir one is a huge crisis, just
in general, of having access tohigher level of care, so, like
inpatient care, right.
But the other part of this isthat we're not automatically
(22:19):
going to hospitalize you.
There are criteria you have tomeet in order to be hospitalized
and it's better that you'resharing it, because when you're
hiding it, it is more scary toindividuals to find out later.
And that would be more of aconcern to me if someone did not
share with me how they werefeeling and that, in fact, they
have been harming themselves formonths and now they have harmed
(22:44):
themselves so severely thatthey have to be hospitalized.
So I think that is another partof prevention.
But the stigma exists that justasking for help is gonna
automatically put you in thehospital, and that's completely
incorrect.
Dr. Barlow (23:00):
Okay, so, for our listeners who might be
experiencing a crisis themselvesor, like you mentioned before,
they've got those occurrences ofmania, or going through their
cycle when they're on theirperiod, they've got those times
of harmful behaviors.
What is one thing you'd like tosay to those folks in terms of
(23:24):
reaching out, getting support?
Maybe they're not working witha therapist, maybe they've never
opened up about this before.
Maybe they didn't even know itwas a problem.
They just thought that's theway they are.
What is something you'd like toshare to our listeners who
might be experiencing that, interms of how they can reach out
for support and what steps theycan take?
Teele Becerra, LCSW (23:45):
Yeah, ultimately, do not be afraid to
ask for help.
Tell someone, tell your friend,tell your family, tell someone
that is safe, that you know isgoing to support you, that loves
you unconditionally.
Tell someone that you trust.
But tell someone that just theact of telling someone how you
(24:08):
feel in itself is healing,because it is that first step to
getting help, whetherregardless of it is a therapist
or not, or your doctor orwhomever.
Telling someone opens you up topotentially getting help in the
future.
(24:28):
So I think my biggest piece ofadvice is telling someone.
There's so many resources outthere on where to find a
therapist, and I think one ofprobably the best resources that
we have in the US and Iactually don't know if it's
accessible from other countriesbut we have the crisis text line
(24:51):
, which I think is probably oneof the best resources that I've
ever found and ever referredpeople to, because it is a
anonymous, 24 hour support textservice, so you will text that
number at.
Whatever the number is sevenfour one.
Seven four one.
I haven't memorized Whateverhour of the day like.
(25:14):
I am feeling unsafe.
I'm having a panic attack, I'mthinking of harming myself and
thinking of harming others.
I'm experiencing mania.
I don't know what to do andthat person is going to be there
to walk you through how to getsupport and they are crisis
counselors that are trained andhow to help you.
So if you don't have a personthat you can trust in your life
(25:35):
that you have personally, Ihighly recommend the crisis text
line as the first person thatyou tell, because sometimes it
is actually easier to tellsomeone that doesn't know you at
all how you're feeling, becauseit can feel so hard to tell
people that you love because youdon't want to hurt their
feelings.
Dr. Barlow (25:56):
Oh, absolutely, that's such a great point.
And also there might be thatfear in there because of what we
talked about with that stigma.
What are they going to thinkabout me?
Are they going to think thatI'm not safe to be around, or
safe to have their childrenaround, or they even safe enough
to watch their dog?
There's just all these fearsthat kind of come into your mind
(26:17):
when you have to admit tosomeone that you're maybe not
that person that they thoughtyou were, or you're not perfect
because, as our ego is a veryimportant part of what makes us
so, then when we do things thatfeels like we're challenging
that ego, we're taking piecesaway from it, it can feel
(26:39):
terrifying because we worrythat's really going to change
who we are to the world.
And I think you mentioned areally great word healing.
So, thinking in terms ofindividuals who go through a
mental health crisis, theyengage in these risky behaviors.
They obviously in the momentdon't recognize what they're
(27:01):
doing, what's going on.
Everything is moving so fastand there's really not that
level of cognition there thatsays, hey, you're doing
something wrong, you need tostop fast forwarding to when
they do have that perspectiveand they can look back on that
and reflect what, as a therapist, what are some things that
these folks can do aroundself-care and really not beating
(27:25):
themselves up and not blamingthemselves for what they just
went through?
Good question.
Teele Becerra, LCSW (27:31):
I think just accepting that this is.
I think a lot of the stigmacomes internally, like you said,
from the fear that people aregoing to perceive you a
different way, and I think,along with healing, is that
piece of acceptance.
You didn't.
No one wakes up one day anddecides that they want to have
(27:54):
intrusive thoughts of self-harmright, no one wants that for
them.
No one wants to have to dealwith that on a daily basis or
monthly basis or what have you.
But I think when people acceptthat this is who they are or
what they're experiencing inthat moment it doesn't mean who
they are as a person, but, likebiologically, chemically,
(28:14):
something is going on that theyneed support with, and so I
think the term self-care isgrown around a lot, right?
People identify self-care asbubble baths and having tea or
your drink of choice when youlay out in the sun or whatever.
(28:37):
But self-care is really justlistening to your body and what
it needs, in my opinion, and sothat could be a bubble bath.
Maybe baths relax you, butultimately it could be taking
your meds.
I did also want to mention thatone of the signs as a clinician
that is concerning to me, whenI can tell when someone is being
(28:57):
unsafe, even if they're notintentionally trying to hurt
themselves or others, is whensomeone decreases or stops
taking their meds because theyfeel like, oh, I'm great now.
Usually that feeling of I'mgreat now is because their meds
are working.
So when someone stops takingtheir meds for a long period of
time without the help of apsychiatrist, that is also
(29:19):
somewhere I would be concernedthat they're in a crisis.
Dr. Barlow (29:22):
I love that, throw that in there.
No, I love that call out somuch.
It's interesting because I'mnot a therapist and I know
you're not either.
That's immediately gonna belike oh okay, a pill, you need a
pill that's gonna fixeverything.
I'm definitely not thattherapist.
I ride that line of I willalways refer you to a prescriber
if things seem like they aresomething that can't be tackled
(29:45):
with just therapy.
But at the end of the day, likeit's not my call to write you a
prescription.
I'm not a prescriber, butthere's nothing that hurts about
talking to a prescriber and Iknow we're not.
This isn't the medicationpodcast or like that episode
where we're talking aboutmedication.
But that's a really importantpoint because I think a lot of
stigma also comes frommedication and so a lot of
(30:09):
clients that I've worked withone of my specialties and
backgrounds is an ADHD.
When I do need to have aconversation with a client about
okay, you've tried to changeyour behaviors on your own,
you've put these things in place, you're using these skills that
you've learned, but youphysically can't make yourself
change this behavior and you'rerunning up against a brick wall.
Now it's time for me to likeget you referred over to a
(30:31):
prescriber to have aconversation about ADHD
medication.
A lot of what I hear is oh yeah,no, I don't think I wanna take
meds like I just I don't know, Idon't feel good about it.
And my response is always Ihear you and I don't think
anybody enjoys taking medicationand that's not the goal.
The goal and the point of it isthere's only so much that you
(30:53):
can physically do.
The other part of that ischemical and you can try to do
these behaviors, you can try toput these things in place to
kind of safety net yourself withthese behaviors If that does
not work or if it works for alittle bit and then stops
working and you can't physicallymake this change.
Now you know it's a chemicalchallenge.
(31:14):
There's a chemical imbalance,there's something chemically
preventing you from being ableto be healthy or have healthy
behaviors.
So I love that you mentionedthat.
I know I got off on amedication tangent a little bit.
Teele Becerra, LCSW (31:26):
No, I appreciate it.
You're absolutely right.
We're not as social workers, astherapists, we don't prescribe
meds.
We're taught in school thatwe're not supposed to talk about
meds, talk about dosing, and Iabsolutely am not advocating for
us to do that.
But I think that is a reallyimportant piece of taking care
of yourselves.
(31:46):
Self-care can be as basic asbrushing your teeth and taking
your meds, and some people needmore than that.
Some people that is at theirbaseline they take their meds
every day, they shower every day, they brush your teeth every
day, but they still have roughdays and self-care may look
different.
I think that exercise can do alot for your mental health, and
(32:13):
I'm not saying you have to go tothe gym, get a gym membership
and work out every day, but evenjust getting some fresh air,
standing outside, hopefully withthe sun shining because I love
the sun and the sun should beout all the time everywhere and
take getting fresh air, goingfor a walk, like that all can be
(32:33):
self-care.
But sometimes the most basicthing, if you cannot do anything
else in your day to take careof yourself, it is taking your
medication, but also acceptingthat, like you said with your
clients, like they're like oh, Iabsolutely not, I do not even
want to think about that andthat is their absolute right.
But sometimes that is what youneed and that can be the piece
(32:58):
of self care that you get done.
The one thing you do to takecare of yourself every single
day is take your medication.
Again, some people choose toabsolutely not take medication
and they have likehallucinations, and that is
their choice.
Dr. Barlow (33:13):
Absolutely.
And I think, to like anotheragain, like completely their
choice.
I'm not here to persuadeanybody one way or the other for
sure, but then, like one of mycomments that I love as a go to
is Okay, how many cups of coffeedo you drink in the morning or
throughout the day?
What is your goal for thatcoffee?
Your goal is to give you energy, wake you up and keep you
(33:35):
productive.
So then, obviously, a lot ofthese psychotropic medications
are either controlled substanceor you need prescription to get
them.
So I'm not trying to comparecoffee to a psychotropic drug,
but there's a purpose there, andI think that's that key point.
If your purpose is to live abetter life without these risky
(34:00):
behaviors or ADHD, like in myexample, you're going to need
something to make that happen ifyou have tried and failed,
because one of my things that Ijust hate for clients to go
through is they do the work,they try really hard and they
want the positive changevenomately, and then they
continue to fail.
(34:20):
So then they get in those likeself blaming behaviors and
thoughts of I'm not good enough,I'm not strong enough.
If I were stronger, I couldthen XYZ, and that's where it's
like, really, given that psychoeducation it's not you, it's
your chemicals.
Teele Becerra, LCSW (34:39):
It's your brain, like you said.
I think it's interesting.
We're talking about ADHD inthis podcast, about crisis, but
along lines of caffeine, the waythat caffeine affects the brain
for one person is differentthan the other.
So a lot of times withmedication, I bring up ADHD,
because caffeine can actuallymake the ADHD brain go, become
(35:01):
sleepy, which is hilariousbecause it's a stimulant for
some and not for others.
But that is that's howeveryone's brain is different.
Not one medication is going towork for every single person,
and I think that's also where alot of people get discouraged
because they either.
There are a lot of people I haveheard from like a lot of
(35:23):
clients who have said I went tothis prescriber and they just
wanted to throw all thesemedications at me, or they said
I didn't need any, or theydidn't listen to me.
I'm really glad to have formedrelationships with a lot of
psychiatrists who do listen andwho want it to be your choice of
what you can take, and I thinkthat's the most important part
(35:44):
in this is that you do have thatagency I'm going to keep using
that word that, if you go andhave that conversation with a
psychiatrist, just becauseyou're meeting with a
psychiatrist, like you said,does not mean you're going to
leave with a prescription.
They might make suggestions.
They most likely will makesuggestions on what.
(36:04):
Also, if they give you aprescription and you decide to
fill it and then say, you knowwhat, I don't want to try this
right now, that's okay too,because it is your body
ultimately, but there are.
It comes to a point where, ifyou're having symptoms so severe
that you are unsafe or makingothers unsafe and medications
(36:26):
may help, that's okay, and Ithink that they're like that's a
huge stigma.
Right, it is okay to takemedication and I'm really glad
that we're in this space nowwhere social media is so
prevalent.
I think, obviously, it can beso harmful, but I am on the side
of social media.
That is okay with talking abouttaking medication and okay with
(36:51):
taking medication in general.
Right, if it helps you, that'sokay.
Like it doesn't mean that youweren't.
You didn't choose to be borninto this world with a brain
chemistry that makes you sadevery day.
I think it's important to havethese conversations right, so to
provide safe spaces for yourfamily members who may be
(37:14):
struggling, or friends orwhomever in your life that is
struggling to have theseconversations and it can feel
really awkward or uncomfortable.
But I think at least a lot ofmy clients I know they
communicate with others and I dothe same through like ticktocks
(37:37):
and reels, and so sometimes avideo or a podcast use.
This podcast will open up aconversation of hey, I was
listening to this podcast and Ilearned about suicidal ideation
and like how to support myfriends, and I know that you've
dealt with that in the past likehow can I support you?
(37:58):
And so I think it's all abouthaving that conversation,
because that is activelyfighting against the stigma of
accessing health and mentalhealth care.
Dr. Barlow (38:10):
I know that you have some really great resources for
our listeners, either forthemselves or to share with
anyone they know that's goingthrough a mental health crisis.
Do you want to go ahead andprovide our listeners with those
now?
Teele Becerra, LCSW (38:21):
Yeah, I talked about the crisis text
sign before.
It is actually accessible 24hours a day, every single day,
in the United States, canada,the UK and Ireland, which is
really amazing.
So if you are listening to thisin another country, you, if
you're in the UK, please use thecrisis text line.
(38:42):
So you're going to text home HO M E to 741 741.
And again, that is a free, 24hour crisis service.
I like to get this out toanyone and everyone.
And then the other number,which is just local to the
United States, is 988.
So a lot of people know that weuse nine move one for emergency
(39:04):
services, and now we havecreated nine.
We, the United States, hascreated 988, which is a number
that you can call if there isanyone, if you or anyone else is
in a psychiatric emergency, andthey will connect you to those
call centers that I used to workat, as well as the ones that
(39:25):
have, like mobile crisis unitswith police departments or
mobile crisis units throughnonprofits in your community,
and so that is the centralnumber for the US to access
immediate crisis support.
I also wanted to mention that Iknow I'm not a parent, but I
have cared for a lot of kids andit's when you have a child or
(39:50):
you care for a child that islike a different type of love,
and I think it can be reallyhard for parents to accept when
their child is hurting becausethey created that child or has
have raised that child as theirown and they don't want to feel
(40:12):
like maybe they made a mistakein parenting or done done
something wrong or knowinggenetics, that the brain
chemistry, like you must have.
There must have been somethingduring pregnancy.
None of that is true.
You are a great parent and Ithink you need to give yourself
credit for recognizing when yourchild feels unsafe and just
(40:37):
ultimately trying to get themthe best support that they need.
But I think this also goes intowhere it's really hard is that
once your kid is over 18, theyare an adult, and so that is one
of the things that I used tocome into contact with all the
time.
Working in emergency services isa mom would call for their 19
(40:58):
year old son, for example, andthere's very little that we can
do unless that 19 year old againis unsafe or someone else is
unsafe that they're threateningto harm because they have to
consent to that help, and so Iknow that must be a terrible
(41:19):
situation to be in and I'm I'venever been in that situation
again as a, not a parent, but Ican only imagine and empathize
that that is probably one of thehardest situations to watch
your kids struggle.
But I think that's where thatprevention piece comes in.
Most importantly is like tryingto know the signs and,
especially if you have a historyof mental health disorders in
(41:42):
the family or in yourself, tofamiliarize yourself with those
diagnoses and have thoseconversations with your kiddos
when they are age-appropriateand able to talk with you about
their emotions.
I say age-appropriate but Ithink that it needs to be a
(42:02):
conversation that's had when wetalk about our emotions and
labeling our emotions, startingas toddlers and building it up.
Obviously you're not going totalk about suicide to a
five-year-old when theirteenager is talking about
depression and other diagnosesand maybe any family histories
and just opening up a safe spacefor when they are feeling
(42:25):
unsafe.
If they ever feel unsafe orthey know someone else in their
life that's unsafe, then theycan come to you and ask for help
and get that support.
Dr. Barlow (42:34):
I know that moment of what parents go through when
something goes wrong and maybeit's not mental health crisis,
maybe it's their kid acting out,or maybe they got arrested or
whatever happens that immediatestatement you make either out
loud or in your head where did Igo wrong?
That's not a thing.
(42:57):
But if you know that you were agood parent, you were most
likely a good parent, but youmade a very good point.
The communication is the gamechanger.
Being that person, like youmentioned earlier when you were
saying reach out to someonethat's safe if you're in crisis
or you need support.
Being that person that is safefor your child to reach out to
(43:21):
and share that things are goingwrong.
Or hey mom, hey dad, I'm havinga challenge with this.
Being that safe person for yourchild is everything.
Just fostering that piece ofcommunication and letting that
be known by your child.
Hey, yeah, you're going to makemistakes.
(43:43):
I'm your parent, so I'm goingto have to put consequences in
place for you when you makemistakes.
I will never love you any less.
I'm never going to judge youfor this and make you feel
unsafe.
Please always talk to me,always communicate with me.
Keep those lines open.
I think that can be a hugedifference between finding out
unfortunately when it's too late, after the fact, when something
(44:05):
has happened that'scatastrophic and maybe there's
been self-harm, or is it stillcalled a successful suicide,
death by suicide, yeah, or ifthey've had a death by suicide.
If you can get thatcommunication going and
fostering that at a young age,there's always hope.
It's not a guarantee, butthere's always hope that you
(44:27):
will be that person that yourchild reaches out to Exactly.
Thank you so much again forjoining us today.
Teele on this episodeUnderstanding Crisis Behaviors,
best Practices and ProvidingSupport.
Until next time, I'm Dr Barlow.
The Kinder Mind Podcast isproduced by Dr Elizabeth Barlow,
(44:47):
edited by Marco.
Antonio with music by PaxMinerva.
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