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A True Friend When Going Gets Tough

Friends are a demanded commodity when there are upsetting times.  In fact, more than not, teenagers oftentimes depend on their friends when things aren’t going well or unexpected things happen.  Teens can relate to each other at a level most adults have grown out of.  Adults only offer what adults offer, rational and mature advice or direction that really doesn’t resemble what kids seek.  They want to feel understood, like their friends who “get it”.    Friends are crucial fore-runners in helping each other out when things get hard.  Giving support, spending time, giving hugs, and just being there are “must do’s” for those kids hurting.  Friends truly understand and feel the pain their friends experience.  Nothing can take the place of what friendships can do.

The hard part comes when hugs, listening or spending time with a troubled friend isn’t enough    All the good intentions in the world just aren’t enough when friends have serious problems.    In fact, offering naïve advice, suggesting quick fixes, sympathizing too much or keeping the problem a secret can actually make the problems worse. 

Being a true friend is realizing when their friend’s problems are too much to handle without an adult or professional involved.   Teens struggle with many difficult problems these days.  When a friend is self-harming (e.g., cutting themselves), engaged in high-risk activities (e.g., speeding, promiscuity or unprotected sex, drugs/alcohol), throwing up their food, displaying drastic mood changes, doing poorly in school, withdrawing, or threatening suicide, the best thing to do is get them the right support from a trusted adult.  As a friend, you need to be there for them, stay by their side and let them know you care.  However, it is not your job to carry the burden of fixing their problems.  Your friend needs and deserves help from adults and/or trained professionals who take on that responsibility. 

Being a friend means being there in easy and more tough times. If your friend is experiencing a mental health condition, support them and make sure they get the help they need.   You can make a huge difference in someone’s life by being a true friend.

Claudia A. Liljegren, MSW, LICSW

St. Williams Mental Health

St. Williams Living Center Front Page

If you are returning to school, you likely are asking yourself many questions to prepare for what this new year may bring.  Common questions include what your teachers will be like and how much homework you’ll get, if you will like your classes and if they will be hard or easy, what friends will be in your classes, where will your locker will be located, how involved you will be and what activities will you join, what it will be like without last years’ senior class?  

Returning to school can be a strange experience indeed, captivated by the changes as you walk the hallways. You may even do a double-take as some kids have grown taller, or wider, or thinner; boys entering manhood as they wear mustaches/ beards and girls turning into young ladies, with make-up and swanky hair styles; those changing their garb style with shabbier, more suggestive or cosmopolitan dress.  After a couple days, you realize some have changed their character, like overcoming shyness and being outgoing, or taking up partying and risking so much.  Some may just seem more mature.  As you take in all of these changes, how are you different?  What do your school mates say about you?  And, as you ask yourself how school will be different this year, how much will you be able to adjust?  What feelings are you having as you face this next school year? 

Lots of kids are a little out of sorts during the first week or two of school.  Oftentimes, students display different levels of intensity with their emotions, and usually swarmed with many kinds of emotions, be it excitement, anxiety, relief, fear, eagerness, and even depression.  Some emotions can be severe, such as elongated mood swings with screaming outbursts at home in the bathroom with the door locked ; or heightened anxiety or panic reactions to a whirlwind of worries or fears, such as if there will be any rumors spreading from summer events, or if they will be teased or bullied again this year, or if they will fit in and if their friends will stay loyal or leave them, and so many more.   It is so important to know that there are plenty of people that can help calm the beast of emotions.  It just takes a nod to accept help from those available, be it friends, teachers, parents, or professionals.

There are some good suggestions that may help ease the transition of returning to school:

• Make sure you take care of your health by getting enough sleep, eating right and regular exercising. 
• Share your concerns or fears with someone you trust. It helps make the situation feel less intense; that way, you aren’t keeping things pent up inside which usually makes the problem worse.  We all need someone to care and listen to us when we are struggling.
• Try to solve the problems you are having; don’t let yourself feel stuck and unable to fix the situation.  And, don’t create drama or a crisis when there isn’t one; instead, figure out ways to get to the solution.  If you don’t understand an assignment, talk to the teacher.  If you are having trouble with a friend, find ways to communicate better and work it out.  If you made a mistake or didn’t do as well as you wished, give yourself a pat on the back for trying and learn from it.  If you feel insecure, sad, or are covered with bad thoughts inside, talk to someone who can help you see what a great person you are.  Being a kid is tough enough.  Let someone help.
• Focus on the positives.  Try to keep your worrying from becoming too gigantic.    Know that who you are is just fine.  Generally, you are doing the best you know how right now.   Don’t let your worrying take your energy.  Know that you are a good person and generally things work out in the end.

Claudia A. Liljegren, MSW, LICSW, Psychotherapist

St. William’s Mental Health Services

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…it is such a relief to finally get help after experiencing issues for a long time–

According to the WHO (World Health Organization), mental health is:  “… a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”

Mental health is all about how we think, feel and behave.  It refers to our cognitive, behavioral and emotional well-being.   It also impacts our ability to enjoy life – to find a balance between the stressors and activities we face and our ability to be resilient.  The lack of good mental health can affect our daily lives, our relationships and even our physical health.

We all have the potential to develop mental health problems, no matter how old we are, whether we are male or female, rich or poor, or which ethnic group we belong to.

2019 research shows:

1. In the United States, almost half of adults (46.4 percent) will experience a mental illness during their lifetime.
2. 5 percent of adults (18 or older) experience a mental illness in any one year, equivalent to 43.8 million people.
3. Of adults in the United States with any mental disorder in a one-year period, 14.4 percent have one disorder, 5.8 percent have two disorders and 6 percent have three or more.
4. Half of all mental disorders begin by age 14 and three-quarters by age 24.
5. In the United States, only 41 percent of the people who had a mental disorder in the past year received professional health care or other services.
6. In the U.S. and much of the developed world, mental disorders are one of the leading causes of disability
   
   

Out-Patient Psychotherapy

Provides a regular time and space for you to talk about your thoughts and experiences and explore difficult feelings with a trained professional. This could help you to:

• deal with a specific problem
• cope with upsetting memories or experiences
• improve your relationships
• explores thoughts, feelings and behaviors and seeks to improve an individual’s well-being
• develop more helpful ways of living day-to-day.

The Main Classes of Mental Illness Are:

 Mood disorder

These are also known as affective disorders or depressive disorders. Patients with these conditions have significant changes in mood, generally involving either mania (elation) or depression. These include disorders that affect how you feel emotionally and they can disrupt your ability to function. Examples of mood disorders include

Major depression – the individual is no longer interested in and does not enjoy activities and events that they previously liked. There are extreme or prolonged periods of sadness.

Bipolar disorder – previously known as manic-depressive illness, or manic depression. The individual switches from episodes of euphoria (mania) to depression (despair).

Persistent depressive disorder – previously known as dysthymia, this is mild chronic (long term) depression. The patient has similar symptoms to major depression but to a lesser extent.

SAD (seasonal affective disorder) – a type of major depression that is triggered by lack of daylight. It is most common in countries far from the equator during late autumn, winter, and early spring.

Bipolar and related disorders. This class includes disorders with alternating episodes of mania — periods of excessive activity, energy and excitement — and depression.

• Other Depressive disorders, not all   inclusive:

• Pre-menstrual Dysphoric Disorder
• Persistent Depressive Disorder
• Disruptive Mood Regulation Disorder

Anxiety disorders

Anxiety is an emotion characterized by the anticipation of future danger or misfortune, along with excessive worrying. It can include behavior aimed at avoiding situations that cause anxiety.  Anxiety disorders are the most common types of mental illness.  The individual has a severe fear or anxiety, which is linked to certain objects or situations. Most people with an anxiety disorder will try to avoid exposure to whatever triggers their anxiety.  Examples of anxiety disorders include:

Generalized Anxiety Disorder – Continual worry, feeling nervous and on-edge, difficulty concentrating, fearful that something awful might happen

Phobias – these may include simple phobias (a disproportionate fear of objects), social phobias (fear of being subject to the judgment of others), and agoraphobia (dread of situations where getting away or breaking free may be difficult). We really do not know how many phobias there are – there could be thousands of types.

Panic disorder – the person experiences sudden paralyzing terror or a sense of imminent disaster.  

Obsessive-compulsive and related disorders

These disorders involve preoccupations or obsessions and repetitive thoughts and actions. The person has obsessions and compulsions. In other words, constant stressful thoughts (obsessions), and a powerful urge to perform repetitive acts, such as hand washing (compulsion).

•           Obsessive-compulsive disorder

•           Hoarding disorder

•           Hair-pulling disorder (trichotillomania).

Trauma- and stressor-related disorders 

These are adjustment disorders in which a person has trouble coping during or after a stressful life event. Examples include post-traumatic stress disorder (PTSD) and acute 

stress disorder. This can occur after somebody has been through a traumatic event – something horrible or frightening that they experienced or witnessed. During this type of event, the person thinks that their life or other people’s lives are in danger. They may feel afraid or feel that they have no control over what is happening.

Dissociative disorders

These are disorders in which your sense of self is disrupted, such as with dissociative identity disorder and dissociative amnesia.

Somatic symptom and related disorders

A person with one of these disorders may have physical symptoms with no clear medical cause, but the disorders are associated with significant distress and impairment. The disorders include somatic symptom disorder (previously known as hypochondriasis) and factitious disorder.

Feeding and eating disorders

These disorders include disturbances related to eating such as:

           Anorexia nervosa

           Binge-eating disorder

Elimination disorders

These disorders relate to the inappropriate elimination of urine or stool by accident or on purpose. Bedwetting (enuresis) is an example.

Sleep-wake disorders

These are disorders of sleep severe enough to require clinical attention, such as insomnia, sleep apnea and restless legs syndrome.

Sexual dysfunctions

These include disorders of sexual response, such as premature ejaculation and female orgasmic disorder.

Gender dysphoria

This refers to the distress that accompanies a person’s stated desire to be another gender.

Disruptive, impulse-control and conduct disorders

These disorders include problems with emotional and behavioral self-control, such as kleptomania or intermittent explosive disorder.

Substance-related and addictive disorders

These include problems associated with the excessive use of alcohol, caffeine, tobacco and drugs. This class also includes gambling disorder.

Personality disorders

A personality disorder involves a lasting pattern of emotional instability and unhealthy behavior that causes problems in your life and

relationships. Personality disorders include the Paranoid, Schizoid, Schizotypal, Anti-social, Borderline, Histrionic, Narcissistic, Avoidant, Dependent, Obsessive-Compulsive types, and others.

Paraphilic disorders

These disorders include sexual interest that causes personal distress or impairment or causes potential or actual harm to another person. Examples are sexual sadism disorder, voyeuristic disorder and pedophilic disorder.

Neurocognitive disorders

Neurocognitive disorders affect your ability to think and reason. These acquired (rather than developmental) cognitive problems include delirium, as well as neurocognitive disorders due to conditions or diseases such as traumatic brain injury or Alzheimer’s disease.

Schizophrenia spectrum and other psychotic disorders

Psychotic disorders cause detachment from reality — such as delusions, hallucinations, and disorganized thinking and speech. The most notable example is schizophrenia, although other classes of disorders can be times.

Neurodevelopmental disorders

This class covers a wide range of problems that usually begin in infancy or childhood, often before the child begins grade school. Examples include autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD) and learning disorders.

Other mental disorders

This class includes mental disorders that are due to other medical conditions or that don’t meet the full criteria for one of the above disorders.

What a sad state of affairs when you don’t have a laugh.  Laughter is a key ingredient to good mental health.  It calms the soul and relaxes the body.  In fact, research shows that laughter is an excellent medicine that can actually change the physical well-being of those suffering from illness.  Laughter reduces the stress hormone, Cortisol when you laugh.  It also expands the lungs, allowing the oxygen to flow to the lungs and exercises the muscles in your body.  It also increases your energy.

Laughter also helps calm emotions.  Try being angry or anxious when you are laughing.  It is hard to feel negative when you are chuckling.    It also helps you be more self-confident and spontaneous when around others. 

Apparently, our brains are involved with the emotion of laughter, especially the limbic system and hypothalamus.   It affects our decision-making, our well-being, our judgments and in solving problems.   As endorphins are released into the brain when laughter occurs, it magically changes our mood and lightens our heart, and problems seem more manageable. 

So, what can help this “One Who Doesn’t Have a Laugh”, laugh?  An article by Marelisa, “How to Laugh More – 22 Ways to Bring More Laughter into Your Life”, has some good suggestions that help improve laughter skills.  As she points out, at least initially, there has to be intent.  You may have to work at it.  Setting a goal to increase your laughter helps you follow-through, just like setting goals to exercise.  Other suggestions include: Smile more, befriend a funny person, find a little kid you can hang out with, get a pet, play fun games with friends, learn to laugh at yourself, put laughter quotes up on a bulletin board, do more of what makes you laugh, imagine something that you find really funny and stay with it…. and reading and expressing jokes or funny stories.  So, this is an effort to get you started: 

OwlCityOfficial, found in Funny Beaver Jokes, gave a great example of a funny short story:  “One time in 1^st grade I caught a daddy long legs and put it in a jar and brought it to school for show and tell and all the boys cheered and all the girls screamed and then I opened the jar and let the spider crawl onto my hand and suddenly the girl sitting in the front row screamed so loud and shrilled that I violently jumped back in surprise and the spider got so emotionally confused it jumped off my hand and sailed across the room and landed on some kid’s forehead and the kid immediately went insane and started thrashing around and headbanging and punching himself in the face and kicking desks and chairs and other kids trying to get it off and the entire class erupts into a volcanic explosion of prepubescent chaos and everyone is running around in circles screaming and crying and shaking and then my teacher jumps onto a desk and shouts “FOR NARNIA” at the top of her lungs and dives headfirst into the crowd and takes out the entire class with a flying tackle and everyone goes down in a hog pile of 1^st graders and the whole time I’m just standing there in awe and the whole time the spider is like, ‘Ugh, seriously guys, I don’t need this right now’”.

Claudia A. Liljegren, MSw, LICSW

St. Williams Mental Health

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218-338-5945

If you are having difficulty coping with life’s stressors or your anxiety, depression or other emotional struggles spill into your daily life, how do you know when it is time to seek mental health services? It may be difficult to know when to seek treatment as stressors in life come and go, and oftentimes eventually resolve themselves in their own time.  A good measure oftentimes depends on the length and degree of suffering and how it is impacting your ability to manage your day-to-day responsibilities, such as at your job or school, or your ability to do routine tasks at home, or its effects on your relationships with family or friends, or your involvement in the community, and mostly on you. 

Oftentimes, the first rule of thumb is to seek consult about your concerns, be it your physician, your minister or even contacting a mental health provider yourself about scheduling an appointment.  It is likely most helpful to also contact your insurance provider to ensure coverage so that finances don’t add to the stressors you are already experiencing.

Mental Health Professionals are usually the profession recommended to be the primary mental health provider.  This is decided by most insurance companies and the Department of Human Services.  Mental Health Professionals include psychologists, licensed independent clinical social workers, marriage and family therapists, and others who have attained a Master’s degree and specialized training.  Therapists within each profession typically specialize in working with certain types of people and treatment modalities.  Most have specialized skills working with different age groups (e.g., children, adolescents, older adults). Others address certain issues (e.g., drug or alcohol abuse, eating disorders, depression).  All these professionals must have a license to practice, granted by the state, and, if they choose, have the ability to accept reimbursement from insurance companies.

Initially, after receiving a referral, a Mental Health Professional works with you to better understand the reason you are requesting services and the problems you are facing, such as your current stressors or struggles, areas of concern, and your current symptoms.  The Mental Health Professional asks you more information as well, including your current life situation, your family constellation and background, previous trauma history, any previous mental health treatment you may have received, your medical history, current condition and a listing of your medications, a family history of mental health or medical issues, substance abuse issues, cultural issues that may impact treatment, a review of risk factors and any other areas not included that would be relevant for treatment.  If you believe it would be helpful, information from your medical clinic, previous treatment providers or family members/friends could also be requested with your authorized consent so that a more thorough assessment can be developed.  Usually, this gathering of information takes approximately 1-2 sessions.  The clinician then formulates a comprehensive assessment (“Diagnostic Assessment”) that summarizes and examines your current condition so as to best capitulate recommendations for treatment.

Part of the Diagnostic Assessment includes making recommendations about the type of treatment that would most likely be effective for you.  This includes a wide assortment of mental health services, depending on your eligibility and need. 

• Out-patient Psychotherapy for children and adults provides mental health treatment in the office setting, usually covered by third party payers.  Sessions are usually 45-60 minutes in duration and scheduled weekly or alternate weeks, depending on the need and time line.  The length of treatment is dependent on the progress made on a treatment plan which is developed with the therapist and yourself after the Diagnostic Assessment is completed, and then reviewed on a quarterly basis. 
• Adult Rehabilitation Mental Health Services for adults and Children Therapeutic Support Services for children are programs that assist individuals within the home to learn skills so that they are more able to function at home, work/school or with friends and social settings.  This service is paid by MA or PMAP’s and is not covered under commercial insurance.
• Case Management is a service that helps children and adults get hooked up with and monitor mental health services you may be eligible for.  Individuals receive this service if their mental health symptoms are severe to a point in which they require more intensive services, such as psychiatric hospitalization, residential services or intensive aftercare or outreach services.  If eligible, this is a free service usually provided by the county or subcontracted out.
• Psychological Evaluation is a service in which children and adults get tested to determine current diagnosis and recommendations for treatment (e.g., IQ testing, personality testing, ADD/ADHD testing, gastro by-pass testing, etc.).  As third-party payers are particular about what battery of tests they will cover, it is important to contact your insurance carrier to ensure coverage.
•  Psychiatric Monitoring/Consultation is a service in which adults and children are reviewed and monitored for the effectiveness of psychotropic medications.  Although psychiatrists can provide counseling services, they oftentimes can only do so on a time limited basis due to the high demand for psychiatric time, especially in rural areas
• Other services may also be referred or recommended based on the findings of the Diagnostic Assessment, and can include vocational, medical, educational, public assistance, transportation options, school-based services, etc.

At St. Williams Mental Health Services, there are two primary mental health programs:

1. Out-patient psychotherapy for children and adults
   • Criteria
     • Third party coverage and signed fee agreement
     • Condition requires a mental health diagnosis identified in the Diagnostic Assessment
     • Condition can be improved/treated and a treatment plan is devised and tracked
2. ARMHS for adults in Otter Tail and Douglas counties.
   • Criteria
     • Reside in Otter Tail County or Douglas County
     • Third party coverage with MA or a PMAP and signed fee agreement
     • Individual requires skill-based services to reduce effects of mental health issues

**St. Williams is offering a one-time ½ hour free consultation to those that have not received services from St. Williams previously.  This could be used to review your current struggles and consider treatment options.  This can be scheduled with the mental health professional.

St. Williams Mental Health has two main offices at this time.  One office is located in a separate section on the east side of the St. Williams Living Center complex, at 212 West Soo Street in Parkers Prairie.  The other office is held at the Marian Building, Office 264, in Alexandria, MN at 700 Cedar Street SE. Contact Us today to learn more, you can reach us at 218-338-5945.

If you have any questions or concerns, please do not hesitate to contact us.  We would much appreciate the opportunity to further explain our services and how we better serve you.

Claudia A. Liljegren, MSW, LICSW, Out-patient Psychotherapist/Supervisor

Kayla Svor, BSW, ARMHS Director