Access to Mental Health Care or the Jackson Pollock of It All

by Monica A. Ross, LPC

Problem-solving. Why would the ability to problem solve be a core component of resilience? My first thought on that one is that people who are struggling just to survive, for those who face steep obstacles in life, the ability to problem solve is critical in order to figure a way out of the crisis(es). 

Take a look at this clip, for instance, from the Center on the Developing Child at Harvard University called “How Resilience is Built.” It talks about the importance of relationships and the importance for the developing child of the ability to both monitor and problem solve. 

At the time of this posting, what comes up in a Google search on “How to problem solve” is this method:

1.     Identify the issues.
2.     Understand everyone's interests.
3.     List the possible solutions (options).
4.     Evaluate the options.
5.     Select an option or options.
6.     Document the agreement(s).
7.     Agree on contingencies, monitoring, and evaluation.

This is, of course, geared towards problem-solving in the workplace. That sounds about right, but we also know that people who find themselves in crisis at work or at home can’t even begin to complete number 1, let alone move smoothly along to 2, 3, 4, etc. The reason for this perhaps is because those living in crisis are living life from a scarcity mind-set. 

Mullainathan and Shafir in their book Scarcity: Why Having Too Little Means So Much explain that the focus on what we lack, or approaching life from a scarcity mind-set forces a type of preoccupation in life. When we are preoccupied we do not have the cognitive bandwidth to begin to address other problems. Or at the very least, addressing other problems becomes a daunting task.

The scarcity mind-set, as the authors point out, is not about lacking the capacity to process, but it is about lacking the mental resources. With the scarcity mind-set we tend to do things like incorporate tunnel vision, which is good when something deserves our sole focus and concentration, but towards how many singular things in life do we have the luxury of dedicating all of our attention? 

Scarcity also affects our executive control, making it hard to have self-control.

A lack of self-control can then interfere with problem-solving. Lack of self-control more often than not can exacerbate a problem. It is these types of psychological biases affecting those living with a scarcity mind-set that fuel sometimes poor choices despite the fact that the consequences of those choices can be extreme.

This lends itself to doing impulsive things despite the fact that the stakes are higher. Not only do those who are operating at the survival level (e.g., the poor) have less room to fail because they have fewer resources, but they also have a compromised ability to make good decisions. This, in turn, increases the likelihood of failure.

As clinicians, one of the modules we are typically called upon to utilize in working with clients and in conducting psychoeducation is the module on problem-solving. Why? Because people with severe mental health issues sometimes forget to take their medication, and when that happens they may stop taking medication altogether. They may act on impulse and find themselves running up gambling debts or maxing out credit cards in an impulsive spree, or making hasty, major life decisions like moving cross-country.

It’s important, then, both to gain some level of stability as a consumer or client either on or off medication and from there to work towards maintaining that stability. Stabilizing itself takes a certain amount of problem-solving ability and that problem-solving ability may never be reached if a person finds themselves in a constant state of making both impulsive and poor decisions.

Now let’s compound the issue for the person struggling with mental health issues by making access to help in and of itself confusing. If I were to describe the process of finding a psychotherapist from the consumer or client’s side, well it’s a bit like this:

Some Issues for Consumers

To me the current marketplace is like…..my own artistic interpretation:

scribble

 

Or

Like a Pollock Painting:

Pollock Painting

Or

Like my friend Yoon Lee’s paintings

Yoon Lee

It’s like a kindergartener took a piece of paper and did this:

kindergarten

To put it metaphorically. . .

It’s like a city wanted to build a new roadway system and they let everyone decide where they wanted to put the pavement, stoplights, lane markers, and highway signs.

Book Reference

Mullainathan, S., & Shafir, E. (2013). Scarcity: Why having too little means so much. London: Allen Lane.

That time I got arrested for a DWI—The Summer of 2017

by Monica Ross

arrested dwi dui jail

by Monica A. Ross, LPC

I had just moved back to Austin at the beginning of August 2017. It was my big reentry into the city after the 2 years of exile by choice and not by force that I had put into interning in East Texas. I was 2 weeks into a new job as a psychotherapist here at a successful group practice. Things were looking good.

My friends had invited me out to a private music concert downtown. These particular friends are longtime friends—one is a mechanical engineer and the other a product manager for a mobile software company. They offered to pick me up and take me home that night because I was going solo, and I decided at the last minute I would drive myself. 

The event itself was a lot of fun. The company of friends was even better. That night I had one vodka cranberry cocktail at 8:30 p.m. when I arrived, and by 10 p.m. the event was over. But instead of going home, I thought I would hang out a bit longer by myself downtown. I was thinking maybe just 1 more hour. After all, I had just come from living in a place where the nearest nightlife that was anything similar to Austin’s was a good 2- to 3-hour drive away.

I headed down the street to the warehouse district and had another cocktail. And then I ended up leaving downtown by I guess about 11ish. I hadn’t eaten since early afternoon that day, so I stopped by a popular place in south Austin on my way back home and had a light meal. 

It’s actually another nostalgic place for me—a homegrown wing and waffle fry place called Pluckers. The first Pluckers opened up a few blocks from where I lived as an undergraduate in West Campus, and dropping in there now and again makes me think of that time period.

So, I have my dinner and order a beer to drink with it. I barely touched much of the beer. And by then several hours had passed during the drinking of the alcoholic drinks. I had had my food by now to go with it. I thought I was safe enough to get back on the road and go home, which wasn’t too much of a farther drive for me.

So, I proceeded to do that. I headed home. I drove down a residential street in south Austin.

And off went the swirling red lights behind me. An officer pulled me over. “Have you been drinking, tonight?” Yes, officer I have. “How much have you had to drink?” About two cocktails. “Please step outside the car.”

The officer pulled me over for speeding. I had been driving over the speed limit because it was a street that I was not familiar with, it was also very dark at that point and the street signs were not well lit. I was driving what I thought to be an appropriate enough average speed for a residential area and then aimed slightly above that. It’s what any average Texas driver would do.

In all honestly, I was also rushing to get home because I was exhausted. I was out well past my bedtime at that point.

The officer asked me questions about my entire day. I answered every single one without missing a beat. He then gave me a field sobriety test. He had to give me a field sobriety test for liability reasons alone. Here I had been pulled over for speeding and then add to that the fact that I admitted to drinking.

I thought I passed the field sobriety test. Most people probably feel that way. You go online and read all the reasons for which people fail these tests and how it can have nothing to do with how much one has or has not had to drink.

It was only when the officer said, “Do you consent to a breathalyzer?” that I began to think there was something about this that wasn’t right. 

I asked him, by consent, do you mean I can refuse?
He said, Yes. 
Then I said: I refuse the breathalyzer.
He said, then I’m going to have to arrest you. 
I said, wait if arrest is on the table then go ahead give me the breathalyzer. 
He said, it’s too late at this point. I’m going to have to arrest you.
And that’s what he proceeded to do.

I was handcuffed and taken to Travis County jail. I put on jail garb—the whole thing. I got my mugshot taken. I sat in a room full of people who also had been brought in that night for similar reasons. I met nurses and other career professionals in jail. 

I visited with students and ne’er-do-well types who also had been brought it. It was a huge mix of both people who were repeat offenders and people who like myself were deer caught in highlights and kind of wondering wtf am I doing here?

They asked for my consent to draw blood, which I gave. They never explained the repercussions of refusing consent to a blood draw, by the way, but that didn’t matter because once I understood what was going on—that they intended to keep me in jail overnight—I consented to supplying evidence in my defense.

They took me down the road to Brackenridge where they proceeded to take my blood. They then brought me back to the jail.

The temperature in the jail was set to just below arctic temperature. They held us in an open space with benches and one shared bathroom. If we wanted something to drink, we had to drink from the fountain that was attached to the sink in the bathroom.

They offered some of us food and not others. Several of us asked questions about the nature of what was going to happen next. The guards gave information out sparingly—at times misinformation--and a bit of teasing.

I witnessed a lot of crying. A lot of handwringing. A lot of worrying about how the arrest would impact people’s careers, finances, family life. For some this was their second or third offense and for some it was their first.

There was a lot of regret expressed and a rehashing of events of the night—all the stories and all the details that led up to each individual’s arrest. I met people who were underage and people who were in their 50s or 60s or more.

Thankfully, I had been through a counseling training program and felt equipped not only to better deal with the hell I was going through, but to help others going through their separate hells as well.

There were a few phones provided for us and several of the women I was cordoned off with clamored around them and frantically tried calling friends and relatives and bail bondsmen all night long. If I was brought into the jail at around 1 a.m. or so we didn’t get an actual hearing until later that morning. 

At the hearing, which was out in the open for all of the other jail mates to hear as we were handcuffed to each other, I was granted a personal bond and told that I was being charged with a Class B misdemeanor. At that point, reality sunk in even further. It was a “this is really happening” moment.

After the charges had been dealt, I was taken to a jail cell with one small window on the cell door and left locked behind it for several more hours—alone. I had to wait until a guard came to check on me, if there was anything I needed. She came by sparse and sparingly. So, I spent much of that time desperately trying to sleep the night off.

I was in jail for a total of about 16 hours. I had been up for over 30 hours at that point. If I had been exhausted when the officer pulled me over at 12 a.m., I was well beyond exhausted by that time and with no idea how all of this would eventually play out. 

Had I been over the legal limit or under?

What I want to express is that for people going through this process, as I myself had to, there is an enormous amount of stress and waiting around and trying to figure the “what’s next’s” of the whole process. That stress doesn’t end when you leave the jail. It’s something that one can carry with them for the days and months that follow release.

I went to Brackenridge the very next day after I got released and asked that they give me my blood alcohol test results for peace of mind—after all it’s my blood they took, shouldn’t I have a right to see the results?

Wrong. 

They said they could not give them to me—they belonged to the City of Austin.

My blood was the property of the City of Austin? Wow. 

My next question was that at the point of blood taking, why did no one ask me if would like a separate blood draw, property of me? I guess that’s something they can’t do.

I found an attorney who was generous enough to work with me on the costs of representation. And when I signed the contract to hire him I still did not know at that point how much of his services I would need. 

Hiring an attorney in that sense was a bit like buying insurance. In other words, if my blood alcohol came back over the limit for whatever reason, I would definitely need his help to argue some kind of defense for a first-time offender, but if it were under, as I had hoped, then maybe not so much.

Well, we’re into April now. The blood alcohol test? Let’s just say I was pulled over on August 20, 2017. The results of that test didn’t come back until March 15, 2018—7 months later. That’s 7 months of waiting and wondering and paying monthly fees to an attorney. 

That was 7 months of potentially missed opportunities working for a well-known company that I made it all the way to the end of the interview process with, and then another potential missed opportunity working for a government position that I had all but been offered—pending background check. And we know what the background check at that point said.

The results—the BAC test—what did the results say? “NO ALCOHOL WAS DETECTED.” 

That’s right.

I still at this moment have an arrest on my record for a DWI. If I choose to get it expunged it’s another year of waiting before I can even begin that process. 

>On Mar 15, 2018, at 4:14 PM, Dan Garcia wrote:
> Hi Monica.
> Your blood results came back today.
> No Alcohol was detected.
> I have left a message with the prosecutor to call me to discuss how to
> dispose of your case. I will contact you as soon as I speak with the
> prosecutor.

Rejection of Misdemeanor Charges

How I'm Currently Answering the Question: "What's the Book Going to Be About?"

by Monica Ross

Dorothea Lange-Migrant Mother

by Monica A. Ross, LPC

I’ve run into people lately who know my intent of writing a book and they’ve been asking me, “Well what's it about?” I say that I have a loose sketch. There are several themes that I want to tie in together. The general themes are poverty, stigma, mental health, physical health, behavioral economics, and therapeutic techniques like cognitive behavioral therapy. 

I’ve thought about going back to school to advance my studies even further. And recently, I applied to a couple of doctoral programs. Both of these programs are online and shorter in length than a traditional PhD track program, which would be geared more towards someone who wants to end up conducting research and teaching in academia. The one doctoral program that I am looking at in particular would place the emphasis on clinical practice.

I don’t know whether or not I’ll get into my program of choice or whether or not having gained the acceptance I’ll sign the piece of paper that commits myself to even more student loan debt. But I thought I’d use this post to explain some of my background or reasoning for wanting to pursue the idea of writing a book.

I made some of the following statements in my personal statement submitted to the doctoral program that elucidate my intent a little bit more:

Extreme economic inequality is a public health problem. As a health care provider, I want to advance well-being practices geared towards overcoming the unique psychological barriers that economic inequality perpetuates in order to stimulate behavioral and economic change. The government focuses on prevention and early intervention for “at risk” youth, and this leaves out our adult population, an even larger demographic.

Some of the adults I have treated were not able to get early interventions and therefore find themselves struggling later in life. I am intrigued by the work of Eldar Shafir and Johannes Haushofer, both from Princeton University, who are leading the conversation linking poverty to psychology and tracing this linkage to its economic impact.

In my early years, in Texas, I saw the struggles my parents had with chronic health impairments and economic inequality. This influenced my decision to go into psychology and sociology as an undergraduate student and to focus my studies on resilience and well-being later in life.

I did not see the burden of my parents’ health and financial issues, or my own issues for that matter, as resting solely on our shoulders. Instead, I had some sense there were environmental and societal factors affecting our overall health and well-being. I am an advocate of personal agency and responsibility, while at the same time acknowledging that we, all of us, live in systems.

After graduation I spent many years working in California at corporate, government, nonprofit, and academic institutions. I chose this path of work because I chased after the financial security that these roles provided. In 2010 I made the decision to come back to Texas to be with family and I came up with a plan to pursue my calling—to return to the study of psychology and to become a psychotherapist.

By August of 2011, I was enrolled full-time in a counseling program at St. Edward’s University. By May of 2014, I finished my counseling program and graduated with a 4.0 GPA. With my master’s degree and LPC-intern license in hand, I made the decision to relocate to rural East Texas because of the experience it offered.

I began working at Burke, a Federally Qualified Health Center headquartered in Lufkin. It serves a 12-county region and houses services for people across the life span, from children to adults, with mental health and medical issues. At Burke, I worked initially with the most severely mentally ill in vivo as a caseworker.

In that role as an in vivo caseworker, I came face-to-face with the devastating effects of poverty in America and its relationship to mental health. After a year as a caseworker, I transitioned to the office and provided psychotherapy at the clinic for our clients that included 50- to 90-minute individual counseling, group therapy, and psychoeducational sessions.

I discovered a wellness self-management personal workbook from the New York State Office of Mental Health and used that as a tool to lead a 12-week series of group therapy sessions. I also drove once a week an hour outside of Lufkin to Crockett, a town of less than 7,000, in order to provide therapy to the neediest in that community. Crockett has a 39.1% poverty rate.

In some ways, I had escaped the financial and cultural struggles of my early years for an interlude while in working California only to willingly come back to my home state and face those same struggles again, but from a different perspective. Once I finished the licensure process, I moved back to Austin to embark upon my own private practice.

Throughout my experience as a counselor, I have continued to work with clients of all ages in all levels of socioeconomic status. I have clients who have been in and out of prison, who have had Child Protective Services (CPS) involvement in their lives, and who are struggling to maintain independent housing, access to proper nutrition, and transportation.

I have also worked with top executives of well-known companies who are somewhat more economically privileged, but often face similar mental health challenges and have had to overcome sometimes similar childhood trauma.

By addressing the unique psychological barriers that people coming from a place of extreme economic inequality face, we can more adequately advance long and productive lives. This may come through a process of creating social responses that include therapeutic techniques to adapt to the changing social environment.

The experiences that I have had throughout life, the witnessing of the effects of extreme inequality, which are influenced by both societal factors and internalized psychological barriers, have taken on new meaning for me. These experiences were not random occurrences, but instead have prepared me for the work that I currently do and for the legacy that I hope to one day leave.

 

Another Suitcase in Another Hall

by Monica A. Ross, LPC

There have been times in my life when I have had more money and less. And I’ve worked with clients who have been much wealthier than I and others much more impoverished. There was a time once that I was so low on funds that I stood in line at a church for assistance with paying a utility bill and for help with obtaining food. I can also remember times when I’ve had enough money to take vacations to Miami, Kauai, Tahoe, Europe.

But my earliest memories involved growing up in a family that lived below the poverty line. I had an aunt and uncle who were both counselors and who worked at a nonprofit helping families in need. They helped my family out with food, for instance, in our times of need.

I have to balance these memories with the memories of attending a very expensive private school in San Antonio that my grandparents paid for me to attend from Grade 3 to Grade 9. I sat in class with classmates who talked about their ski vacations while my immediate family struggled, as I said, to put food on the table at night.

I take stock of all these memories and moments. The moments when I was a sixth grader volunteering to open passenger side car doors for other students as their parents dropped them off at the school. I opened the Jaguars, the Porsches, the Mercedes, the BMWs as they rolled in.

And at the end of the school day I had to carpool and commute almost an hour in traffic back to my small hometown and listen to my mother and stepfather complain of money troubles. I moved over 13 times between the ages of 5 and 18 and all of those moves were within a 15 mile radius. And this was because my mother was forever chasing cheaper rent and different scenery and by my observation was forever restless.

Not only were we changing physical locations constantly, I would also come home to a house where the furniture itself was rearranged every few weeks. It was constant change and what for the better part felt like constant chaos. And somehow in that whirlwind of an environment I survived.

We all have our stories of times of ease and times of struggle on varying degrees. And because I know that, I feel completely comfortable sharing a bit about mine here. Today I just wanted to raise the topic, though, of restlessness.

How do we balance the days when we have $4 to our name and the inability to obtain loans or credit cards to the days when we are flying high and taking trips to Europe? I have had clients who have to balance the days of making millions on selling drugs to the days of homelessness—it’s not that much different.

I think one has to develop a strong sense of self and a strong core to weather that kind of change. One way of thinking of it is like tempering metal. Tempering metal is the process of increasing the toughness of metal by heating and then cooling it.

The purpose? It’s done to increase the metal’s ductility. The tempering process makes the metal less brittle and assists with the ability to stretch it.

And that’s my extent of knowledge about that. But the point is, resilience. That came up in the last post too. So maybe resilience is about going through all of those highs and lows in the hopes of stretching ourselves. The more we stretch, the more flexible we become and the greater capacity we have for adapting to differing environments and future change.

But this idea of restlessness, which Merriam-Webster defines as lack or denying of rest and continuously moving, with synonyms like anxiety, disquiet, edginess. What about that—the anxiety and disquiet? When you’ve lived in environments that have been breeding grounds for that kind of thing it’s good to do some work on bringing things to some kind of resting state, if possible.

It’s good to have spent some time doing some work on oneself, and sometimes for some people that means seeking therapy. And that doesn’t mean you have to lose the good things that come with growing up in a restless home like having a sense of drive and thinking on your feet and overall survival skills, but it does mean, I think, that it’s good to have the ability to balance that out with repose, with calm and quiet.

There are a few quotes that come from the Bible that I like and I think one of them applies here. “Be still and know that I am God.” Psalm 46:10