I am a worker in the mental health field, currently working with people that have Schizophrenia AMA.

What is communicating with patients who are actively experiencing hallucinations like? /any tips on trying to help and communicate with people when they start an episode? ie. how to make them feel safe, calm down, become lucid etc.

My general rule is to be very aware of the person's baseline behavior and aware of the environment. Lot's of my patients will have hallucinations but they accept them and will continue to talk while they are happening. One used to ask me to wait in the middle of a conversation and would look up and to the side while moving his lips.

Can I piggy back this question?

I'm a new nurse and you probably assessed your patients if they are experiencing hallucinations by seeing or hearing things. What happens if they respond to you with "how do I know if I am hearing or seeing things?". Or, what responses do you usually get when you ask this question?

I know visual and auditory hallucinations can be very real to a schizophrenia patient.

Thanks!

Generally, if it is one of the "good" voices, I will follow along and ask open ended questions in order to have them keep talking about it. For many patients, being heard is one of the most important things. I don't usually try and convince a client that the voices aren't real unless I have a good relationship with them and can assess their frame of mind.

Could a person with schizophrenia still live a full and normal life?

Yes, it's entirely possible.

From my understanding of the new research on Schizophrenia, depending on your genes, people experience the illness differently and have different mental health symptoms. Some will constantly respond to internal stimuli in front of strangers, some just move their lips or grimace/contort their face, some internalize the hallucinations and need to be prompted to come back. I'd say depending on the severity of the symptoms and reception to treatment, both medical and therapeutic, you can definitely live a "normal" life.

My agency has peer supporters that were diagnosed and are living with Schizophrenia. They talk with new staff that are working for the company.

ALSO, a lot of psychotropic medication shortens life span, so many people that take them for a long time may die earlier.

Do you work at a nonprofit? I just switched from United Health Services (large for profit mental health organization) and had never heard of peer specialists

I love the idea of having people who have actually faced the challenges of the illness because one of the biggest complaints I hear from clients is "You dont know what I have been through"

Kinda of like when a therapist is helping someone through combat related PTSD. You can engage the client in CBT and exposure and what not, but I think it is a valid criticism on the client's part that the therapist likely doesnt know what it is like to be fired upon, see friends die, etc. "Just use your breathing exercises Dale" Ya, Im sure its that easy

I work for a non-profit. A lot of the peer support workers are old clients of the agency that have been hired on to be part of the company.

The meds shorten lifespan? How significantly? My dad has been on risperidone and other assorted antidepressants since the Vietnam War and reading that just broke my heart.

Generally, yes. I've heard that about Clozaril and Haldol though. Risperdal can lead to different side effects. You can always talk to a pharmacist as they will know.

Since there are so many different symptoms that not each patient has, how is it diagnosed? Are there different types of schizophrenia?

I'm not a psychiatrist so I'm not exactly sure how each patient is diagnosed. Good article about different types of Schizophrenia: http://news.wustl.edu/news/Pages/27358.aspx

Have diminishing hope for my nephew for full/normal life. He just keeps getting funnier every time I see him.

What's his diagnosis? Is he seeking help?

Why is it that despite the rising awareness of mental health issues in the country (I'm in US) is there such a lack of providers? Follow-up question: to the best of your knowledge is this true of other countries as well?

For example: I have two (that's right) health insurances. My primary covers mental health but there are only two providers in my entire state that are in network and neither are accepting new patients, and my secondary insurance doesn't cover mental health at all.

There seems to be so much awareness and yet not many options for actual treatment.

I've never really thought about it. It may be due to the amount of people getting the services. More and more people are requiring services for depression/anxiety. Maybe this is due to the awareness? That's a good question.

As for other countries, I live in the US as well, so I'm not sure.

In the areas you've worked have you felt like there is a shortage of care providers? Or is it just more apparent in certain areas of the country. I've noticed there seems to be a lot of volunteers willing to help, but fewer people with the right qualifications.

I've been working in the field for about 8 years and I can tell you the biggest issue we have with keeping people is that they are not nearly compensated financially as much as they should be. The current town I'm in you can easily get paid much more working at McDonalds or Walmart than working in direct care. Our company is for profit and they always blame the wages on the cost of living, insisting that they can't increase wages. Meanwhile, when each house is constantly short staffed everyone else around them are needed to pick up hours which easily leads to burn out and turn over.

I was working overnights at a house with young women with MI (aggressive/violent/suicidal). The current pay for that house is $10/hr. The shifts were 10p-7am. I was the only overnight person working for 4 months in a row. I had about 2 days off a month (other people in the house covered those nights for me). I elected to pick up those hours because I needed the money but I was never really the same after that. It was beyond exhausting and I needed to switch to a less difficult house after being there for 3 years.

Because they can't compete financially with basically McDonalds, our company will take a lot of people who are not very qualified. Those people get weeded out quick (also leading to turn over).

I completely agree with you. This certainly needs to change.

I definitely see a shortage and I'm sure some parts of the country are different from others. Turnover for people in this field is a huge problem. I honestly have some remaining burnout from some of the things I've witnessed. Suicide attempts, violence, stories from trauma survivors, etc.

Hello!

I am wondering what credentials you have? It is my goal to work with children and adolescents with Schizophrenia after I graduate. I am starting graduate school in January for my MSW. You essentially have the job I would like some day.

Also, is there any advice you can give me or knowledge you wish you knew before entering the mental health field?

Thank you!!

Hello!

I have some college under my belt, about 3 years in social sciences. I have my states version of a provisional social work certification. It includes CRMA, Mental Health support, First Aid/CPR, Crisis Intervention, etc. All the skills I use in my job are from experience in personal life or the other jobs in the field and the extensive trainings from each job.

I would suggest either case management or, if you'd like to work in a home, possibly managing one through an agency. Unfortunately, my specific job doesn't pay well for the workload that's expected.

Some advice, watch out for burnout. My agency has people work 4 10hr. shifts and gives us 3 days off. This helps a lot with managing my own mental health.

Hey, friend! I'm also in the mental health field. Mental health paraprofessional, mental health tech, and I'll have my MS next month. I've worked in a program very similar sounding to yours, but currently work in the psychiatric unit of my local hospital now.

I'm not entirely sure if you work with people who are diagnosed with personality disorders, but I find borderline behavior to be some of the most challenging symptoms to help a patient/client work though. My question is this: What, if any, tips do you have for individuals who are experiencing these symptoms?

Thank you for doing this AMA. Best of luck to you and your clients!

Hey there,

My agency has a program specifically for clients that frequent the hospital and are usually diagnosed with BPD. We use a DBT model approach. This is essentially a way to correct self-harm behaviors by not giving the client what they want when they choose to self harm but instead treat the physical situation and validate their feelings. For clients that use these as ways to seek help, they would strongly encourage and reward attempts at healthy attention seeking as opposed to self harm.

Thank you so much for using non-offensive terminology. All too often you'll see people with a mental health diagnosis described as that diagnosis (ex. "I work with a Schizophrenic") which only furthers the stigma attached to mental illness.

My question is, how do you cope with burn out aside from your work schedule? I work in victim services (have my MSW) and burn out is a HUGE problem in my agency. We're always looking for advice from other service providers on how they manage it.

In terms of the work environment, we do team building things and once a month will decide on doing something together. We spent a whole day out getting lunch on a beach while at work which was great. Our company pays for each team to do this.

I make sure I spend time with friends and family when I'm not at work. Pick up hobbies and take care of yourself physically/mentally. Leave work at work. When you leave, try not to think about what you need to do at work the next day or week. Sometimes I will quickly talk about my day after work if it was stressful, but then move on.

Have you ever personally questioned your own sanity? I feel as though the psyche is a very fragile concept and people with Schizophrenia are normal for the most part but have just had something small change which affects their whole reality. How does it affect your personal view of reality day to day?

I have a very scientific mind and agree with you that the psyche is widely not understood/fragile. In my experience, a lot of the people that work in my field have had their share of mental illness. I struggled with depression and anxiety as a kid. Still do, but I've learned what I need to do in order to manage it.

It interests me that they develop the illness later in life, like late teens, young adult. The earliest I've heard was at like 17, a high schooler had a psychotic break and started hearing voices.

In your experience, what are some of the best things to tell a person who has schizophrenia when they say they want to go off their meds/their meds aren't helping/the meds are actually causing the issue, not an illness, etc.?

I validate their feelings and would problem solve some alternatives. By working with them and getting them to understand you are on their side and want them to be healthy is important. I usually link some history of when they had been off their meds. For instance, remind the client that stopping medications without speaking to their psych doctor can have serious side effects and will make them feel worse, send them to the hospital, etc.

Advocate for them to explain WHY they want to be off of them and encourage them to speak to their Psychiatrist.

What types of treatment is there for patients expecially patients that don't want to be medicated?

For Schizophrenia, I don't know ANY success stories where they aren't medicated at least a little. A lot of the treatment is with a psychiatrist working on finding the correct balance of medications that works for each patient.

I've noticed that Cognitive therapies work sometimes in being able to make someone with a mental illness be more aware. We do a lot of providing education around their illness, medications, mindfulness, etc.

Follow up question. Is it possible for an individual starting to show signs of schizophrenia to be able to realize that they have schizophrenia?

I'd say it's entirely possible. There are some that haven't coped with the idea and refuse to believe it. Working with the patients that are around 20 years old, I've noticed that they try to repress all notice of the illness.

For someone developing the illness, the voices are things that they can recognize as being off. The delusions, on the other hand, are very real to them and they will often not even realize it is part of a mental illness.

Have you worked with children with schizophrenia? There's a series on YouTube about a 9 year old girl who lives with it and her parents are worried her little brother may also be showing signs. Kinda scared me...

No, I work with young adults. Some sad stories of kids with a bright future then they have a psychotic break.

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I have no idea. People I've spoken to about their hallucinations haven't really gone into detail about what they were seeing. Their minds just do their best to explain it.

What're your thoughts on patient confidentiality issues when it comes to people with mental health issues who have attached themselves to people who want nothing to do with them?

I currently have a situation where a woman has serious mental health issues and thinks that I'm her husband, except I have spoken with her less than a handful of times for work, and maybe met her once. She's actively tried to find me / where I live and I've found dealing with the police and mental health clinic has been an extremely frustrating process as all I can do is give any info I have to the health clinic / police, but they won't / can't tell me anything about her condition and I'm essentially trapped in limbo knowing she is out there, trying to find me, and pretty much just have to live with it. I feel like I am entitled to at least know a little bit about what her problem is so that I have a better grasp of what's happening. What do you think?

That's an interesting situation. They could speak to you if she signed a release for you. The workers have to abide by the rules of HIPAA. I would keep working with the police and attempt to get a restraining order possibly.

So.... What exactly do you DO? I see you didn't include any information about being a doctor, intern, student, etc. What is your job title, if you don't mind me asking?

My job title is Living Skills Specialist.

I work with clients on their goals in order to transition from the hospital to independent living. I develop treatment plans and file their paperwork. I work with all their providers to coordinate care. I apply to housing subsidies and make sure they maintain their benefits.

I also do various tasks to maintain a therapeutic milieu and a clean living space.

You are literally the best. I work in chemical dependency counseling at a therapeutic community in Texas. We DONT have people like you in our facility.

We have the MHMR case worker, we have the LCDC, we have the therapist, but we have no one to assist them (client) in the transitions from prison (or a psych hospital) to a TC to the "real/free world" .... They just walk around treatment either like Charlie Brown because they don't know where they're going or how to get a job or how to move forward, OR they walk around looking like a fucking crazed lunatic stressing about the same things. We don't have the resources to help these guys once they complete treatment, we don't have the funds to do job training, and the only life skills they learn is how to cook food for 40 men at once.

You're the best. You are needed. You are appreciated.

Apologize if my question came off sassy.

Lol thank you so much.

That is very unfortunate. The federal government doesn't really allocate enough for proper mental health rehabilitation in my opinion.

Hi there!

I don't really have a question but I saw this thread and wanted to show my support for the issue. I currently work as an Activity Instructor in the psychosocial rehabilitation program in my city. I work with a variety of mental illnesses - primarily schizophrenia, bipolar disorder and anxiety/depression. I'm training to become a psychiatric nurse (in my second year) so I can better help these people. We have a cool program here; people can stay at an acute-type facility with 8 beds. The goal is to work closely with our clients so they can live safely in the community relatively independently. There is a nurse and AI working 24 hours a day to help with anything. We help people re-learn skills to function in the community. We also have an advanced program where we have an entire apartment block and clients have their own apartment. We have an office downstairs where some come for meds and to talk. Others look after their own meds.

Anyway, just want to raise awareness regarding mental health. I hope one day there will be less stigma and it will be on par with physical health.

My question though, what do you think can be done better in the field of mental health?

I think that many people in the field would experience less burnout and stay with their job more if the money was better. I've helped clients get jobs and then found out they will be getting paid more than I do. That's very disheartening.

It also frustrates me that a lot of medical professionals don't care or clearly have little investment in the patients.

What is a common misconception people have about people with Schizophrenia?

People with Schizophrenia don't just hear voices, I think a lot of people think that's what the illness is all about. They will have tactile, auditory, and visual hallucinations as well as delusions. I had a client firmly believe that one girl he met at a hospital years ago was the love of his life and that he would be with her again in a few days. Broke my heart.

Even parents of the clients will call and ask me how I talk with someone that is clearly hallucinating. I think they focus on these hallucinations a lot and it gets in the way of being able to see them as a human being with an illness.

There's also the obvious stigma of "crazy" people. Lot's of the older men with the illness struggle with personal care and will generally look homeless as well.

First off, I just want to say thank you. People like you are incredibly under-appreciated. You have a hard job, but you help out people like me who have diagnosed family members understand what our loved ones are going through. Without people in your occupation, my brother would either be dead or living on the street, instead of living in his own place with a great job.

To piggyback on your answer, my brother has auditory hallucinations during his bad periods, and also some visuals. When his symptoms first started, he would typically see a black cat in his room out of the corner of his eye. Paranoia is also a common symptom, which can sometimes make it difficult to help those suffering from schizophrenia. You're bang on about trying to look past the symptoms though, I can't be afraid of my brother just because he's dealing with an illness that I may not entirely understand.

Thank you. I really appreciate that.

What are the most common misconceptions people have about schizophrenia and what is a true summary of symptoms etc?

People with Schizophrenia don't just hear voices, I think a lot of people think that's what the illness is all about. They will have tactile, auditory, and visual hallucinations as well as delusions. I had a client firmly believe that one girl he met at a hospital years ago was the love of his life and that he would be with her again in a few days. Broke my heart.

Even parents of the clients will call and ask me how I talk with someone that is clearly hallucinating. I think they focus on these hallucinations a lot and it gets in the way of being able to see them as a human being with an illness.

There's also the obvious stigma of "crazy" people. Lot's of the older men with the illness struggle with personal care and will generally look homeless as well.

Interesting article about the different types of Schizophrenia and how many people will have different experiences with it. http://news.wustl.edu/news/Pages/27358.aspx

Have you ever had a patient that seemed very different from the others? Either you thought maybe they didn't have the disease, or some other persona trait made you feel very strange about them?

I've had a bunch of patients that I honestly felt were mis-diagnosed. Unfortunately, I'm not qualified to make that assumption and really just have to forward them to a Psychologist for an assessment.

I worked with a 12 year old child that murdered an infant. Their personality traits from my perspective were very bizarre. We saw a very personal aspect of her life as they were in a locked residential facility. The room they were in was very interesting to say the least. It was almost as if they had two completely different sides of them.

The room they were in was very interesting to say the least.

Could you say more than the least (and describe the difference between her two sides)? I mean, I can imagine something, but the real story would be more interesting.

The side that she chose to show her peers and strangers was very fake. Her hygiene was horrible, she would wear a lot of makeup to the point where it looked awful, and she would wear sexualized clothing.

About her room, she was almost a hoarder but it was everywhere that you couldn't see from the outside. We found feminine products and literal feces in a trash bag in her drawer.

She put on a front for people and was a compulsive liar. She was also VERY manipulative with her mother and would often ask for gifts then get pissed if she did not get what she wanted.

Do you have any dramatic success stories? an extreme case that became manageable with treatment?

All the stories I've heard have one thread in common. The person with the illness has a desire to change and wants to be better. Services can only go so far for someone that does not want them. The success stories also almost always involve some sort of continuing care, med compliance, and establishing a routine that works for them.

I have a friend with schizophrenia. She is completely delusional. She thinks she is the daughter of a race of giants and her mother stole her from them. When I'm with her, I don't know what to do. Do I confront her beliefs, or do I accept it and try to lead her to reason? She is already on medication.

If it's a delusion that is causing her distress, try re-directing her by talking about something you know she will want to talk about. The delusions are very real to her and you may not be able to talk sense to her.

What is the saddest thing you have seen in your field?

One of my clients is a very nice guy, middle age, loves music and has tons of stories of great concerts. He's got a great sense of humor and loves to cook. When he's struggling, it shows as facial grimacing or moving his lips. He will often not hear something you had said because he is focusing on the voices.

Anyways, he has a son and an ex wife. His son is in high school. For a week or so he wasn't doing well and reported that he doesn't know where his family is and they won't answer the phone. I grabbed the office phone (different phone number) and asked him to dial the number to try and get ahold of his ex wife that has custody of their son. She immediately answered and sounded very annoyed to be hearing from him. He was very polite and respectful on the phone, like he genuinely missed talking to her. She didn't know I could hear everything she was saying but I could tell she didn't want to talk. Anyways, he is talking with his son and telling him that he loves him, cares about him, and thinks about him a lot. The son literally does not say a word back to him despite my client repeating it many times. You can tell in his voice that he didn't care about his father and didn't want to talk. It broke my heart to hear that. The client didn't pick up on the social cues and left the phone call in a better mood so I just left it alone.

Long story short, they had been ignoring his calls when they saw the client phone line pop up. Neither his ex wife or his own son wanted to speak with him or would say I love you back.

What is the path for diagnosis in a pre pubescent?

Lot's of mental illnesses aren't diagnosed before puberty, like Schizophrenia or Borderline Personality Disorder.

I have a friend who falls into the generally silent and unmotivated category of Schizophrenics. He wants to have hobbies of some sort but for him its just difficult and when we hang out he's just really quiet. What's the best way to go about engaging him and how can I help him get back into things that interest him?

I would use "people with Schizophrenia" instead of "Schizophrenics". They are people with an illness, not an illness itself.

I would talk to him about it and ask him open ended questions about it. Generally, if he's your friend, just spend time with him and listen. Eventually he will feel more comfortable and open about the issue.

Could you tell us your most interesting story working in the mental health field?

When I worked in a residential facility, we had a client that had killed an infant in their young teens and a teen that had set fire to multiple apartments. It was interesting seeing how they acted. They actually started dating at one point which was a little scary.

What interesting behaviour did they show?

For the one that killed and infant, I only worked with her.

The side that she chose to show her peers and strangers was very fake. Her hygiene was horrible, she would wear a lot of makeup to the point where it looked awful, and she would wear sexualized clothing. About her room, she was almost a hoarder but it was everywhere that you couldn't see from the outside. We found feminine products and literal feces in a trash bag in her drawer. She put on a front for people and was a compulsive liar. She was also VERY manipulative with her mother and would often ask for gifts then get pissed if she did not get what she wanted.

What's the real difference between schizophrenia and schizo-effective disorder?

Schizoaffective is all of the symptoms of schizophrenia (hallucinations, delusions, disorganized speech) but with an added mood component (depressive or manic episodes).

I've noticed that you can also have Mania with psychotic symptoms or Depression with psychotic symptoms.

How do you differ between a diagnosis of schizoaffective and this, does it have something to do with which set of symptoms are more severe?

Again, I'm not a psychologist so I am by no means a professional. From my understanding, psychotic symptoms are generally temporary and can include some hallucinations, delusions, disorganized thought, lack of insight, out of touch with reality. I've mostly seen these as a way to describe a psychotic break or leading up to one. With Schizophrenia, people will be having many of the symptoms for long periods and even at baseline.

How has working with people with mental illnesses changed you?

It's certainly opened my eyes to the stigma other people have. I've learned a lot about different mental illnesses and that despite the similarities of diagnoses, ever person has different symptoms and experiences things differently. There are a lot of things I would change about the whole system in general as well.

I suspect my brother has schizophrenia or a similar metal disorder. He lost all his money and is living on the streets. Recently he started sending death threat text messages and voice messages to my mother blaming her for all his life problems. I'm concerned he will follow thru. How do I ask him to seek help?

Unfortunately, if he is his own guardian, there is no way to mandate him to go to the hospital until he does something to warrant an arrest and hospitalization. The death threats may be enough to get him hospitalized. Then from there, they could connect him to services.

Try and find a way for him to get some buy in for services. He may be qualified for social security, case management, or vocational rehab. If he doesn't believe in his diagnosis and does not want help, there isn't much you could do.

My boyfriend has schizophrenia and I'm looking for more resources that can help him and I. We both see separate psychologists/psychiatrists but they haven't been very helpful explaining things. I'm looking for someone who can sit down with us and explain his diagnosis and what exactly his brain is going through. Basically someone who can answer his questions about WHAT he's hearing and WHY he's hearing it. The more he knows about it the better. Do you know where I can go or what places/people/organizations I can look into for more information?

NAMI is an excellent resource as they have many members that have mental illnesses themselves and medical professionals that specialize in education. I'm sorry that has been happening to you, unfortunately in my experience many Psychiatrists aren't focused on providing education. You may also have luck contacting mental health services to see if they can provide some insight.

How often do you still run into people under the mistaken impression that schizophrenia and multiple personality disorder are the same thing?

ACTUALLY, many scientists believe that multiple personality disorder (now called Dissociative Identity Disorder) is not even real. I can understand where people would think that but I haven't met anyone that has confused the two.

I have had anxiety problems for years. Stemming from my time in Prison to now some 17 plus years later. In your opinion what is the best way to treat anxiety issues? Thanks for your time.

Mindfulness. It's an excellent way to help calm yourself down and there are many techniques that you can practice so that they feel right for you.

Coping skills. Find what makes you relax and happy. Sometimes just closing your eyes, picturing your happy place, and taking deep breaths will help.

Triggers. Avoid things that you know make you anxious. If it's something you can't avoid, prepare yourself in advance and talk it out.

Thanks a ton for the response!

Best of luck to you!

It's something you live with for the rest of your life but it can definitely be managed. Seek out someone to talk to and try medications when it gets bad. I was on meds for a little while when I was young and it really showed me what is good anxiety and what is bad anxiety.

Hey there!

So I've worked in a home for (former) homeless people with severe mental health problems and addiction

Many of them are schizofrenic (usually paranoid). Now, this place is the end of the line. You can't get in if you haven't spend decades on the street, are crippeld by mental health problems and addiction/have huge problems with the law etc.

My schizofrenic clients are all extremely apathic, depressed and have a really hard time. Now this is all really understandable but I am really wondering how this is with a perhaps really different demographic apart from the schizofrenia part?

How would you say newly diagnosed people are coping with their situation? Are they apathic (although this is ofcourse part of the medication), do these people usually have a lot of comorbidity?

I guess I am trying to discover more about the way this disease affects people apart from the other factors like addiction and criminality of the people I work with

Thanks in advance!

My experience has shown me that young people repress or deny their symptoms to hold onto their adolescence. Some still have unrealistic expectations for the future.

I don't think their symptoms are necessarily different.

What are one of the first signs of Schizophrenia? I suffer from paranoia and I'm worried that eventually it will progress into full on Schizophrenia.

I'm not a licensed psychologist but the paranoia could just be a personality trait or mood disorder. I would see someone. The first symptoms are usually delusions or auditory/tactile hallucinations.

Thank you for doing the work you do! My dad was diagnosed with paranoid schizophrenia while serving in the Vietnam War, and has been classified as a 100% disabled vet ever since. His illness is well controlled with meds and he takes pretty good care of himself, and I really didn't realize the unusual things about his behavior until I was in my late teens. I have a few questions: how critical do you believe genetics are in this? I have some pretty severe (but controlled) depression myself, and as a female, I've always been worried about bringing a kid into the world someday with this mental illness variety pack in our family line.

What are the best things I can do to both better understand my dad's illness and to handle the "bad" days more effectively? Anything I can do that would help him?

Lastly, in terms of awareness and advocacy, what's the best thing to say to people who don't know much about it? I've had a few friends growing up who, when I told them my dad is schizophrenic, weren't allowed to come over anymore because their parents figured he was dangerous or something. That was always incredibly painful and I'd love to help stop the stigma.

Thank you so much, and I'd love to answer any questions from my 27 years of experience with my awesome dad!

The research that I've read mentions a pretty strong connection to genetics. Women also tend to develop the disease at a later age (this is heavily debated as it could be due to women hesitating to seek help). I have clients that have children and, honestly, just supporting and loving him no matter what will help him. It breaks my heart when family members distance themselves from some of our clients due to lack of understanding.

As for awareness and advocacy, obviously there is still a lot of stigma around mental illness and violence. Explain to your friends that your father just has a mental illness, not that he is schizophrenic. When we use identifiers like "he's autistic" or "he's schizophrenic" for someone that has a mental illness, it can be hurtful and perpetuate the stigma. Tell them about what kind of a person he is aside from the mental illness as that is such a small part of the man he is.

My SO suffers from Bipolar Disorder and Depression and often complains that "nobody understands" how he feels or tells me "you just dont get it" when i encourage him to be strong and try even if its the last thing he wants. Do you have any advice for me?

I use a tactic that is common in the field. We validate their feelings.

For instance, if you know they are feeling depressed or upset, say something to validate that like, "I can see you're feeling really upset right now". Continue to validate their emotions and connect it to your reality, "I would be very upset as well". Validate their reality, "you feel like nobody understands what you're going through and that's really hard. You're upset".

Sometimes this will lead to them talking about their feelings and sometimes that is the best way to help. Being a good and active listener is very important. Do some research on active listening, it may help you.

In my work, I've run into quite a few schizophrenics actually. Most of them, are not aware that they are schizophrenic. How would you handle a situation where you are faced with someone who is clearly experiencing mental health issues, and how would you direct them to proper help, or get them help?

If they don't see a problem with their behaviors than it will most likely be difficult to convince them they need help. If there are specific aspects of their behavior they would like to change, I would suggest directing them to a medical professional.

What is the worst part of working in this field and the best part too?

The worst part is probably the pay. The best part is being able to help clients and their families in their treatment despite the tough times.

I sae that one of your patients was expecting to meet someone who he claimed to be the love of his life in a couple of days. Have any of the dilusions or halucinatikns of your patients cone true or at least had some basis in reality that gave you the heeby jeebies?

I had one client claim that a meteor was going to hit on a specific date and cause the apocalypse. I looked into it out of curiosity and there was a cult claiming that this was going to happen. It obviously didn't happen but it was creepy.

One other client used to hold open every door she went through in order to let her dead parents through. She would even open windows in the winter time so that her parents could come and go as they please. She is very open about talking about it as well. Stepping into her shoes and thinking about how that would be was creepy.

Thanks for doing this AMA! My husband has bipolar II, and he manages it through medication and occasional therapy. He is a professional and works in management, and he has kept his diagnosis quiet in his professional and personal life.

He has experienced a lot of stigma when it comes to people's perception of people with mental illness. He has also experienced it with people that work in mental healthcare. Do you find that your colleagues view people with mental illness negatively? What do you think can be done to break the stigma?

Education is the best way to help people break the stigma. I think the medical field is making some positive moves to seeing mental illness as an important aspect of overall health. Many people are able to SEE physical illness so it is more understanding whereas mental illness is widely misunderstood amongst people that haven't take the initiative to learn about it. I have colleagues with various mental illnesses as well so we are generally very welcoming and open to seeing it as an illness that a PERSON has.

I know many people call other "Autistic" or "Schizophrenic" which contributes to the stigma. They are people first.

I was diagnosed with Schizoaffective disorder a few years ago. Still try to find the right balance of meds and keeping sober to balance me. Wondering what steps you took to get into this field? Having suffered from a lot, I feel like I could be a good help for young people going through similar problems seeing as I never had anyone I could relate with for a long time.

I went to school for social science and have had family members with mental illnesses/disabilities so I decided I would try it out. I moved around to different populations in the field with a variety of illnesses to gain experience and knowledge.

If you have a desire to help, finding a peer support group to be able to connect you with others that are still struggling would be very helpful. You seem to have a good amount of knowledge and personal experience which would be invaluable for someone recently diagnosed or someone like me that works with these mental illnesses. I wish you the best of luck!

Why has my depression lasted from age 14 or 15 till age 34? Am I actually chronically depressed or is there something else wrong with me? Will I always have to be on medication to maintain some kind of baseline?

There are many ways to live with depression, the trick is finding out healthy coping skills and being very self-aware of how you're feeling. Have you tried seeking a therapist to work on something like CBT? Medications are important as a tool and can be used in conjunction with therapy, just be careful and communicate with your providers.

I've tried therapy a couple of times and just never really felt comfortable with the therapists. I think part of it is that the first therapist I saw was sexually inappropriate. (Yes I did report him to the Navy who was the referring provider.) I guess it might be time to try therapy again. I just feel so apathetic about life right now and the reality of my depression and other medical issues is a bit overwhelming right now. Thanks so much for responding.

You're health comes first! It's the same as a physical ailment in the sense that it's causing negative feelings and you'd like it to be fixed. I hope for the best, if you ever have questions feel free to ask! I've been diagnosed with Depression and Anxiety before and feel like I have a pretty good handle on things due to self awareness, a good support network, and utilizing coping skills.

Is testing for toxoplasmosis common on your experience? I've read studies discussing some potential correlation between toxoplasmosis and schizophrenia and it seems like a really interesting facet to the disease.

I haven't heard of any clients that have been tested for toxoplasmosis but it may happen. That is a great question and I'll take that to my supervisor/nurse/clinical team. I just looked it up as I hadn't heard the study correlating the two. Have you read the study from this year about cat ownership in childhood being significantly higher in families where their children develop mental illness.

Here's the article if you're interested: http://time.com/3912258/cats-parasite-mental-illness/