I know, I know.  From mental health to Rosie to Shoes and back again.  But this is a personal narrative blog, so I get to do that, I suppose.

Disclaimer:  We just adore Rosie and would not give her up for the world.
Truth:  Rosie is exhausting.

We had Rosie's first day of Puppy Class last night and while I was under no presupposition that it would go well, I was not at all prepared for how badly it went.

Rose is not a barker.  She maybe "Arf!!'s" once every two weeks.  She's more the chew up your underwear, steal a bunch of bananas and run away, mischievous type of girl.  But she barked throughout the ENTIRE class.  I had no idea she could bark that much.  At one point the instructor had to politely ask us to quiet her.

Oh, honey.  If we knew how to do that, we would have done that.  But we were BAFFLED.  At home, Rose can sit, wait, beg, shake your hand, find a treat if you hide it and lie down.  At puppy class, Rose can run around like a demented animal with her tongue hanging out the side of her head and open her eyes so widely she makes you wonder if she has rabies.

And bark.  She can definitely do that.

She could not walk on a leash.
She could not sit down.
She could not pay attention.

And apparently many of the things we have been doing (as advised by the books we've consulted!) are not the instructor's favorite methods.  Such as:  turn away when Rosie jumps on you so as to withdraw your affection.   According to Puppy Teacher, we have to step into Rosie to invade her space.

Apparently, Goldens do not have a sense of personal space.

Heavens knows ours doesn't.

So here's the truth about me.

I'm kind of a jerk.  I like to know how to do things and do them well.  I do not like to feel embarrassed, and I do not like, above all else, to feel like people view me as lazy.  Unfortunately, alllll of those buttons got triggered at Puppy Class.  (Rosie even did worse than our friends - Tom and Judy - dog Vinnie.  Vinnie can be MEAN.  He's adorable, but he guards Tom and Judy with his life!  And Vinnie did better?  What?)  My attitude was so awesome afterwards that Shoes had to honestly tell me, "If you're going to be like this after every class, I don't want to go anymore."

So, I appreciate his honesty.  And Rose and I will work on our homework every day, twice a day.  And I will hope for the best.

Otherwise, I will start pulling my hair out.  Or start drinking wine before class.  Either way.

It still hasn't really left me, and I am in no way personally tied to the events in Newtown, Connecticut.  (Not personally tied other than being a member of the human race, and thus, my heart breaks accordingly to the pain all families involved struggle with.)

I sat on our couch, with Shoes on one side of me, Dog on the other, sobbing quietly while we watched hours worth of news coverage.  Shoes teared, too.  There came a point where he softly said, "We have to get out of this house for awhile."

Because we knew we couldn't not watch.  (And even as we left, we were fully cognizant that we had the choice to leave this pain for a bit.)  As we drove away, we talked about when the words "mental health services" and "gun control" would pop up.

This post is about mental health services.
Gun control might be a different post.
I might skip gun control altogether.
We'll see.

The phrase that brought on this posting is the phrase:  "We need better access to mental health services in America."

So before we start, let's be honest about myself as a writer.  This post is in no way unbiased.  I am a 34 year old, Caucasian, middle class, heterosexual woman who holds a Masters Degree in Social Work, specializing in community outpatient mental health.  As a human being, I hold a ridiculous amount of privilege and cultural capital.  I say that because I recognize it and I want to invite you to honestly call out my biases as you see fit if you choose to comment.  I am completely open to that.

I know some of my readers have counseling backgrounds, but for those of you who might not, community outpatient mental health translates to:  I provide counseling services to a population who is assisted by Medicaid/Medicare.

When Adam Lanza heartbreakingly caused so much pain in Newtown, one of the first things I heard was, "Isn't it a shame, the state of mental health services in this country."

1.  Yes.
2.  Let's be careful.

Let's be careful because the coroner is still waiting on the results of Adam Lanza's toxicology report to see if there might have been any psychiatric medications in his system.  Initial reports seem to have initially suggested that Adam had Asperger's.  Let's be careful - AND - let's be clear.  Disorders on the Autism Spectrum are not mental health disorders.  Disorders on the Autism Spectrum are developmental disorders.  Violent behavior is not a characteristic, necessarily, of people who have disorders on the autism spectrum; while violent behavior may occur in people who have an autism spectrum disorder, the aggressive behavior is often directed towards the person him/herself and is often a result of being unable to effectively communicate needs, wants, frustration, etc.

Ok.  We're good with that distinction, right?  We can move on?  It was slightly tangential, but it irritated me to no end to hear news sources incorrectly link autism to mental health disorders.

Now.  Let's talk about the state of mental health services in my area.  (Because I don't know what it's like, but I might be able to guess, in Wyoming.  Or Texas.  Or New York.  Or Delaware.)

My agency is drowning.  We are drowning in a crush of people who need mental health services.  Our intake numbers are high.  After intake, there is most often a waiting list to get on a therapist's caseload.  Often times I have 6, 7, or 8 back to back appointments of ongoing therapy clients a day, which often get CANCELLED because we all cover crisis mental health calls as well.  Here's the shocking thing:  there are only 22,000 people who live in the county I primarily work in and just 2,000 people who live in the other county we serve.  The State of Washington estimates it takes between 2 and 3 years for mental health workers to gain enough of the required hours to apply/test for mental health licensure.  At my clinic, we average about 1.5 years.  Even though the population is so low, the need is so very high.  We have a disproportionately high number of people who live below the federal poverty line, are addicted to drugs/alcohol and who have severe (SEVERE) trauma histories.

Mental health services work best when there's a wraparound component, right?  We do have a chemical dependency team at our agency.  They are truly fabulous.  We do not have a detox center in all of the county or a homeless shelter.  Remember Maslow's hierarchy of needs?

So, tell me, in this rural county that has almost no services, how exactly I am supposed to address higher order cognitive thinking errors when what many of my clients are truly focused on is where they are going to sleep tonight in the 5 degree weather.  (This is when I start to miss Portland, because, even though the homeless shelters could be difficult to get in to, they still existed.  They were there.  And many churches opened warming centers in the winter.)

Here's another thing.  The clients we help qualify for Medicaid or Medicare (either food stamps or medical or TANF or SSI, etc.).  There's an entire population of people we have to turn away because they exceed our limited income / state assistance requirements, yet, they find the cost of a private counselor to be overwhelming.  We have a tiny grant to assist us with people who barely exceed the financial qualifications but can't afford a private counselor;  I don't feel like talking numbers, but even that is insufficient.

The state of mental health services in America?
It's in shambles, dear hearts.
The boat is sinking and we're using teaspoons to try to empty out the water that's pouring into said boat.

I work with a talented group of mental health therapists.  Seriously, show-stoppingly talented.  Sometimes we work 32 hour shifts.  We do not get paid well.   We barely have benefits.  We try to work on re-paying our student loans, but ... ha ha.  We want to meet with our on going clients.  We want to do the work.

There are barely any resources to do the work.
Often it seems like there are barely any benefits to doing the work.
Reaching 2 years as a therapist at my current agency is considered a true milestone.

So what do I do?

I write letters to congresspeople.  I am there for my clients.  I am there for my co workers. What do I do?  I keep going to work every day, 12 hours a day. I pray a lot. I  believe for the best a lot.  One of the scriptures I hold on to from my old church days reads, "I would have lost heart had I not believed that I would see the goodness of the Lord in the land of the living."  And so I believe that the goodness is for the living.  The here and now.  That change is possible now.

I want to end on what might seem to be a random note ... and that is:  who is it that is needing mental health services in America?  Who are those people who need therapy?

I would like to introduce myself as a consumer of mental health services.  I have struggled with anxiety intermittently for years (currently doing well with a combination of relaxation techniques and mindfulness approaches).  Had therapy on and off in the past.  Have taken a medication in the past (I almost identified which one, but then, remembering one of the goals of this blog is to NOT diagnose, treat or recommend, decided against it) for anxiety.  I come from a family who struggles with severe depression.  Many of my dear, many, and sweet friends have had:  anxiety, depression, bi-polar, trichotillomania, ptsd, adjustment disorder, schizophrenia .... Who are these people who need mental health services?

It is all of us. We all do well when we all do well.  So when we talk about the state of mental health services in America, I would like to remind all of us that we are not just talking about people I serve in community outpatient mental health (people who are - quite erroneously - all to easy to demonize and blame for their problems).  I am speaking about myself.  My family.  Possibly you.  Possibly your family.  Your neighbors.  Your friends.

The state of mental health services doesn't look too hot.  (I went to graduate school to be able to construct that well educated sentence.)  But those of us on the inside do it anyway.  And many of us will continue to do it.  But if you yourself are concerned and you're wondering what could be done, do me a favor.

Do not get caught up in fear.  Do not get caught up in demonizing people with mental health issues.   (After the shooting, I had a FLOOD of calls from my regular clients, in tears, mindful of the fact that they have been consumers for years, asking if people really believed they were going to hurt them.)  Do not suggest that all mentally ill people be hospitalized.  Or jailed.  If you'd like to be constructive, contact your state assembly-people and ask them, as they look at what budgets need to be cut, to consider the long range impact of cutting mental health services.  If you'd like to be constructive, call some of your local mental health agencies (county mental health is often a good place to start) and ask how you might help.

And be well.  And speak kindly.  And act lovingly.  To others, and also yourself.

That is also constructive.

I'm gearing up for a post on the state of mental health services in America.  Because, you know, obviously, (she said tongue in cheek) I'm the foremost authority.  (So, so ... not the foremost authority).  My thoughts are scattered though and I'm wondering how much to really share.  How much is enough to be authentic, but discreet enough to protect my agency and my consumers?  No genie in the bottle here, so while I wrestle, I'll share with you how big our darling Rosie has gotten.

We had our first snow weeks ago.  Rosie is a huge fan.  She likes burrowing, catching snow balls, sniffing and begs (BEGS) to slide down the hill with the little kids at the park near our house.  Of course, we don't let her do this as she would pin small children down and slay them with her 30 pounds of unbridled excitement.

Our new house.  Our new house from 1959.  O,  the work we have to do.  Rosie has decided that having her front half hang off the book shelf and her back half hang off the couch is quite luxurious.  We really shouldn't let her do this, but, you see, it keeps her occupied.  And keeping her occupied is worth its weight in gold.  She managed to take down that Christmas tree.  Twice.

But we forgive her for things like that because she is still such a puppy.  A BIG puppy, but a sweet snuggly girl just the same.

Snuggly still.

And on her favorite perch by the window.

Don't let her fool you, though.  She is still naughty.  And I mean, Naughty.
Puppy classes start 1/15.
I'm a little worried.
A lot worried.

... but it happens.  All the time.

In 2008, I entered my first little courtship after my divorce.  It was kind of cute.  It lasted for maybe 10 cute little weeks.  I respect the man it was with.  We had different ideas about life.  We had different ideas about where our little courtship was going.  He broke up with me twice.  But I was ok.  After the 2nd time, it was high time for me to move on.

I'm not sure we agree on what happened (which is code for I'm pretty sure there is large disagreement about what happened).  We have a lot of mutual friends, but this boy and I, we don't really talk anymore.  It still feels a little awkward.  But who's to drag things out?  I moved to Portland and got on with my life.

I got this job in August and found out I would be helping to cover mental health services for not one but TWO rural counties.  The other county is partway between here and the Vineyard Town.  The other county is the  boy's hometown county.


This isn't really a problem.  Several of my present co workers know the boy's family, and know him, and have heard a little about what happened, but I don't waste a lot of time explaining myself.

It was four years ago.

It's all good and fine until you've driven to this other rural county three horrendous times in one night to cover crisis.  I put 250 miles on my car that night (and 250 hard miles on my SOUL.  Just kidding.  Kind of.).  In the morning, when I was getting a client ready for transport at the hospital, the county ambulance's team came in and who should be in charge?

The boy's father.

He gave me the look that said, I think I know who you are and I think I know what happened.  I was going to do the polite rural thing and re-introduce myself, but there just wasn't time.  It just wasn't appropriate as we were discussing what type of restraints, if any, would be helpful.

Funny how in these rural counties you never fully put your decisions behind you.

I came home the next day and told Shoes, who laughed heartily and said, "Oh man.  Who would have known that this would keep hanging around you?"  Shoes doesn't care so much.  He likes this other boy.  Thinks the entire situation is amusing.

So here I am.

Back in Rural E Washington.

And even though I purposefully  did not return to the Vineyard Town, the Vineyard Town still has a hold on me.

Well, blessed be, I suppose.  Next time I'll just tell Bob the Ambulance Driver that I remember who he is.  That's another rural thing, I think.  You just have to own it and be out with it.

Horizontal linkages and such.  Theory right down into practice.  Sigh.
I do not know how much can change over the course of one year.  Except, I do.  The start of 2012 had me working, living and going to school in Portland - a city I loved ferociously.  And when I say ferociously, I mean:  You can laugh at Portlandia if you want to, but it's all true, and it's what I love about the area.  It's not for everybody.  But, in my own mainstream, straight laced, could never be called a hipster but I sure did want to raise chickens in the city way, it was definitely for me.

My out of control schedule had me interning in NE Portland at a community outpatient mental health clinic, racing downtown to catch the bus up my job at OHSU and driving to PSU several times a week for school.  It was exhausting.  I miss it dearly.  I miss Portland dearly.  I miss my dear therapy/advocate/social work/radical social change friends in Portland dearly.


I finished school.
Moved to Pullman.  (Pullman is 6 hours away from Portland and one state up).
Got a dog.
Got married.
Got a job.
Bought a house.

And now I'm a little tired.  2012 taught me more than I would have thought about myself.  Other people.  Shoes.

It was another year of astonishing Grace.  You think you're going to get down to the bottom of that crazy Grace barrel by a crazy Grace giver and then ... you just never do.  It was another year of being astounded by what Shoes and I are capable of.  This crazy man and I have been together for four years.  I'm pretty sure we can conquer the world.  (Just like we are all capable of conquering the world.) (We are not capable of successfully training the puppy out of our dog, though.  I think that's still ok, though, because she IS still a puppy.)

It was most definitely another humbling year of being blown  away by the healing and change my clients are capable of.    The things they teach me about love and forgiveness (and honestly, boundaries, too!) are indescribable.  (And if I tried to describe them, I'd probably be violating confidentiality.)  One of the hardest professional lessons I've starting to barely grasp this year is that people's work belongs to them.  I can give my best, most humane, most empathetic clinical self .... and the fact of the matter is:  people change when they are ready to change.  As one of my dear Chemical Dependency co workers said last week:  "We're not responsible for people's successes or failures."  And then Shoes, when I told him  that, said, "I guess it's up to all of us to define what "success" or "failure" is."

(I live in this strange world where other humans teach me about human life.  Is that true for you as well?)

I don't know how to pack any more into one year, but apparently, other people do -- the people who continue to ask Shoes and I when we are going to produce a miniature human.  I don't know the answer to that, and just thinking about it makes me want to flop down on the floor and whine, "I can't take anymore!"  Suffice it to say, we do not believe it is in the cards for 2013.   We are, with quiet appreciation, looking forward to a year of restoration and establishment.

2013, here's what I'd like to meet you with:  more grace;  more compassion;  more love;  more humility;  more understanding; more laughter; more zeal.  More radical acceptance.  More nonjudgmental empathy.  Nonjudgmental empathy and love are probably the biggest cries of my heart right now:  daily encounters with people in which I look for their true, most authentic selves.  Taking care of myself, sure, but also putting aside myself so that people understand that I genuinely believe in them (and gathering support from people who are dear to me.  Another hard lesson:  not everybody, no matter how fond I am of them, is capable of giving the support I genuinely need.)  Do I have actual goals?  Sure.  But I'm beginning to think more it's who I am as I try to meet those goals that's the important piece here.

And here is my wish for 2013 for you:
That you would know what you want from this year.
That you will  have support as you go forward.
That you will know and experience for yourself love and unconditional respect.
That you would listen to the soft, secret whispers of your own heart.
That you would meet yourself (all of you - even the parts you are most afraid of) with the most tender compassion.
In 2013, be blessed.