A mental health disorder combined with substance abuse is known as a “dual diagnosis.” Often patients with a dual diagnosis use one disorder to shield the other because he or she is in denial, ashamed, or wants to hide one of the disorders.

Even when properly diagnosed, treatment for a patient with a dual-diagnosis may be difficult. Many who take medication for a mental disorder continue to self-medicate with alcohol or drugs. Mental healthcare patients with a substance abuse problem are almost twice as likely to drop out of outpatient treatment as patients without a substance abuse problem.

“In the short term, we need to address (both disorders) simultaneously,” said Alan I. Leshner, Ph.D., former director of the National Institute on Drug Abuse. “So for acute treatment and stabilization, focus on both disorders at once.”

A comprehensive residential mental illness program such as Pasadena Villa does just that. This approach provides mental health patients with the consistent care, medication, counseling, reinforcement and life skills they need to face, manage, and treat their disorders. Extended recovery time in a safe, professional environment enables patients to ultimately live a happy, productive and healthy life.

*Alcohol, Drug Abuse, and Mental Health Administration

I believe that we as professionals have a responsibility to provide the consumer with the most accurate information to help them obtain the best clinically appropriate care in a manner that is compassionate, respectful and cost-effective. I think that attending conferences like this allows each and every one of us the opportunity to increase our knowledge base and to pinpoint exactly what the best program would be when we receive a call from a family in crisis. We all have our specialties. Pasadena Villa’s is for the primary treatment of mood and thought disorders. A program I am very proud to be associated with. When I get a call from a family that is asking for assistance that does not meet the clinical criteria that we have established (i.e. they may be looking for a program specializing in the primary treatment of eating disorders or gender specific addiction treatment), you better be sure that I will provide them with several options that will meet their needs. I have a tremendous amount of passion for what I do and understand personally the needs that families have when in crisis. It’s these types of conferences that allows me to fully understand the philosophies and clinical design of the top programs that are available.

Ok, now that I am off my soapbox I must say that Santa Barbara certainly is a beautiful community. Besides being a little out of my price range to buy a house, it has some stunning views and wonderful restaurants. I hope to be back at this conference next year.
By the way, this was my very first blog…ever. So thank you for reading this.
Tom Maisel, RN, MBA

It’s important to identify what skills are needed for a young adult with mental disabilities to become independent and, if applicable, how they can be developed. In order for an individual to be able to live on his own successfully, he will need to be able to take care of his personal needs – dressing, eating, hygiene – as well as manage simple household chores such as the laundry and grocery shopping. But how well an individual is able to carry out these tasks will depend on his experience to date. For example, if he’s been involved in chores at home, then he will be better prepared than if he’s had no exposure at all. One way to prepare a young adult for independent living is to get him involved in the types of daily tasks that he’ll be undergoing himself when living alone. This will not only equip him with the necessary experience and skills, but also help to instill a degree of confidence in him. Coping with these tasks isn’t merely a matter of performing certain actions; they require decisions which a person with a mental disability may not be able to confidently make unassisted. Decisions must also be made when dealing with financial matters such as paying bills and managing a bank account, tasks which a young adult with a mental disability may not have experience of but which are all necessary if he wants to live independently.

It’s easy to overlook the simple everyday actions and behaviors that a person carries out that keep him safe and protect his well-being, and which, for a person with a mental disability, may prove challenging. For example, reading and understanding food labels is something that few people who live independently would ever have difficulty with, yet neglecting to do this, which an individual with a mental disability could conceivably do, could result in unfortunate consequences. Likewise, being able to cook and prepare food safely is another important factor for someone living alone. It’s these sorts of issues that have to be addressed before a person with a mental disability makes the move to live on his own, and, if necessary, support should be in place to provide help where it’s needed.

Depending on the severity of an individual’s mental disability, it may be wise for him to live close to support services such as his family, social worker, or a mental illness center. Factors such as proximity to his workplace will also have to be taken into account when deciding on a location, as will his mode of transportation. For example, if an individual’s disability prevents him from driving and he relies on public transportation to travel to and from work, then he’ll need to be located somewhere he can easily access it (he may also need help with understanding how the system works, e.g. bus or train schedules, routes, and fares).

There are also the emotional aspects to living independently that need to be factored in for someone with a mental disability. Some young adults relish the freedom of living on their own after being under the watchful eye of their parents for years. However, someone with a mental disability may find it difficult to cope with not having his parents or carers in his immediate environment, particularly if he’s not co-habiting or living in some form of assisted living accommodation. And although it may be tempting for a parent or care taker to visit every day to check on how he’s doing, unless it’s absolutely vital, this should be resisted. The transition to independent living for someone with a mental disability can be difficult for both the individual making that transition and for those he’s making the break from. However, it’s important that all parties understand why the move is being made and the benefits everyone will gain from it.

There are a number of programs set up to help young adults with mental disabilities make the transition to living on their own. The Substance Abuse and Mental Health Services Administration holds group meetings and provides personal counselors to help individuals apply for jobs, find accommodation, ride public transportation, and cook and clean for themselves. At Pasadena Villa, our Social Integration Model immerses clients into real life activities within the community thus preparing them for a life of independence.

It may take a little more adjustment for someone with a mental disability to make the transition to independent living but it’s not an insurmountable hurdle. In fact, almost a third of people with schizophrenia in the US live independently (approximately 28 percent), according to Surviving Schizophrenia: A Manual for Families, Patients, and Providers by E. Fuller Torrey .[1] Living independently is a rite of passage that can be experienced by all young adults. There’s no reason why young adults with mental disabilities shouldn’t enjoy living independently in the same way other young adults do. Providing the necessary support networks are in place, this rite of passage is one that they too can experience and benefit from.

It is estimated that approximately 28% of schizophrenics live independently, 20% live in group homes, and about 25% live with family members. Sadly, the remaining 27% percent are either homeless, living in jails or prisons, or living in hospitals or nursing homes. Many researchers believe that half of all persons with severe psychiatric illnesses, including schizophrenic disorders, are left untreated. Reasons for this may include the general public’s ignorance about where to seek help and the high cost of treatment. Also, some mentally ill people believe that they can solve the problem on their own without seeking medical treatment. One thing to remember about schizophrenia is that there is no cure for the disorder. Those affected by it must endure a life-long battle. Living independently with the disease does not mean living in complete isolation and control over one’s well-being. Schizophrenics must be surrounded by a community that they can trust.

Subtypes of Schizophrenia

There are varying forms and levels associated with schizophrenia.  Regardless of the type and level, if left untreated, the person suffering from any form of schizophrenia greatly reduces their chance to cope with the disorder and live independently within society.

–Paranoid Schizophrenia

One of the most well-known types of schizophrenia is paranoid schizophrenia. Paranoid schizophrenics often hallucinate and have deluded thoughts. They can quickly become hostile if they feel they are being threatened or conspired against.

–Disorganized Schizophrenia

Disorganized schizophrenics have significant trouble performing daily activities. They may neglect themselves physically by not bathing or getting dressed. They also may be incomprehensible in their speech patterns.

–Catatonic Schizophrenia

Catatonic schizophrenics often display disturbed movements. They sometimes repetitively perform the same futile movements. Repetitive movement is also seen frequently in those with obsessive compulsive disorder. Catatonic schizophrenics may sometimes make unusual facial movements or expressions and unusual movement of their limbs, which can be mistaken for dyskinesia. Sometimes catatonic schizophrenics mimic body movements of others or obsessively repeat what others say. These behaviors are also seen in Tourette syndrome.

–Residual Schizophrenia

Patients are said to display the residual subtype of schizophrenia when symptoms are no longer prominent. The patient may still show some signs of the illness, but the symptoms have declined in comparison to the severest forms of schizophrenia.

–Undifferentiated Schizophrenia

Undifferentiated schizophrenics show symptoms that are not easily categorized. The patient may exhibit symptoms of all of the other subtypes of schizophrenia with no discernable pattern. For example, the undifferentiated variety may sometimes show signs of paranoia, but at other times they may show stronger signs of being catatonic.

How to Live Independently with Schizophrenia

Regular visits to mental health professionals, taking prescribed meds on time, every time, and joining a support group are the three most important things a schizophrenic should do to help control their disorder. Psychiatrists are able to prescribe new meds that may combat symptoms more effectively. Psychologists and counselors can evaluate how well patients are adapting to their environment and make recommendations for non-medicinal treatment. Joining a group therapy session or support group provides a community for schizophrenics to lean on and learn from. Interacting with a community of schizophrenics will provide a network of people that understand symptoms and are able to provide suggestions if and when the disorder spirals out of control. Family members of schizophrenics should also stay involved in the lives of their mentally ill loved ones. Family members are familiar with the patient and are able to tell when something is wrong.

Risks of Living Independently with Schizophrenia

Schizophrenics sometimes stop taking their medication because of the medication’s side effects. Side effects often include loss of sex drive, restlessness, muscle spasms, blurred vision, fatigue and weight gain. When a schizophrenic stops taking their meds, symptoms return. Many people have been known to commit suicide, become excessively paranoid, and hurt themselves and others, especially when they are off of their medication.  Schizophrenics should contact a doctor if feeling depressed, helpless, suicidal, delusional, or if they are having hallucinations. However, schizophrenics cannot tell when they are hallucinating or delusional. To a schizophrenic, their hallucinations and deluded thoughts are real.

Alternatives to Independent Living

There are many state funded group homes for people with schizophrenia. Local community resource centers and mental health centers can provide more information on where to seek help. For those diagnosed with the disorder, contact a psychiatrist or health care professional before making the decision to live independently. Ask a health care professional to give advice about which type of living arrangement is recommended. Each case is unique, and each patient is different. The severity of the disorder often varies as well. For example, a severely disorganized schizophrenic may not be able to live alone. They may have trouble performing basic tasks, such as bathing and personal grooming.

Success Stories

Most schizophrenics are diagnosed in late childhood and early adulthood. It is very rare for people to begin showing symptoms after the age of forty. With the use of anti-psychotic meds, most patients are able to reduce the number of their psychotic episodes and increase their chances of living independently.

John Forbes Nash

John Nash, renowned mathematician and 1994 winner of the Nobel Memorial Prize in Economic Sciences, battled paranoid schizophrenia for over 30 years.  After extensive hospital stays, taking the prescribed medications, and even undergoing shock therapy, John claimed that he began to think and behave much more rationally and that he was able to have more control over the sickness. The book and movie “A Beautiful Mind” is based upon John’s life.

Tom Harrell

One of the most astounding jazz players and musical composers of the past 3 decades, Tom Harrell has struggled with paranoid schizophrenia since young adulthood.  Harrell is able to overcome this devastating disorder with a combination of medicine and his music, which serves as an extraordinary therapy for him.  In addition, the support of his wife, Angela, is a constant factor to his ability to live independently with schizophrenia.

Meera Popkin

High achiever and renowned Broadway star Meera Popkin was diagnosed with mild schizophrenia during her performance as Miss Saigon in Andrew Lloyd Webber’s award winning musical “Cats.”  After a 10 year struggle with the disorder, Meera is now married and enjoying watching her baby girl grow up.  While still taking low doses of medication, her schizophrenia is no longer discernable.

Variations of Autistic Disorders

Autism Spectrum Disorders affect roughly 1%-2% of the worldwide population and the numbers of children diagnosed seem to be progressively growing each year. The term Autism Spectrum Disorder (ASD) encompasses the three branches of the autism disorder: Autism, Asperger Syndrome, and Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS).

Autism

Autism is a developmental disorder displayed by roughly six out of every 1,000 children. It is generally apparent by age five, and is often characterized – though not limited to – delayed learning processes (displaying particular difficulties with the adoption of language) and apprehensions or awkward behavior in social situations. Autistic individuals are generally reluctant to socialize with others, but when they do they may not be receptive to the other person’s conversational tactics (such as attempts to change the topic or indications of discomfort). Their social interaction seems to consist more of delivering monologues than actually conversing. Autistic individuals may be very reliant on routine and are prone to respond to change with tantrums or severe anxiety. They will rarely make eye-contact with others and may display an interest in stacking or aligning household items. Many are acutely sensitive to touch and may feel great pain at the slightest bump or jolt.

Asperger Syndrome

Asperger Syndrome is defined by the same characteristics as those of autism. However, it is placed on the milder end of the ASD continuum.

One notable point of distinction between Asperger Syndrome and Autism lies within the shared characteristic of having very limited interests. With Asperger Syndrome, the individual’s interest is likely to be something conceptual, such as a type of intellectual dynamic or subject (math or a particular branch of science is common, but it can also be something more abstract or esoteric), whereas the limited interests of an individual suffering from severe autism may revolve around just one particular object, something very simple.  Those suffering from Asperger Syndrome generally exhibit a social ineptitude and an overall awkwardness.

Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)

PDD is often referred to as “atypical autism,” as it expresses very few of the diagnostic criteria of other autistic disorders.  Individuals with PDD are often somewhat socially inept and exhibit repetitive behavior.  While individual’s diagnosed with PDD share a few similar characteristics to those with other autistic disorders, PDD is generally much milder than any of the other autistic disorders.

Preparing for Adulthood

It is important that, as parents of an autistic child, you look into the options available for your child’s future while he or she is still very young. See if there are local services available, and research those nearest to you. If there is no available aid for disabled adults – be it a facility in which your child may live once mature or perhaps an organization that can visit and assist your independent child with such tasks as financial organization – you may find it to be to your advantage to take some steps toward having such a service established in your area.  Also keep in mind that, as many of these residential facilities as there may be, there still are not enough, and many homes for the disabled have a lengthy residential waiting list. This is why it is important to check on your options while the child is still young, so you have the time to prepare.  A guiding factor in your search for aid is in gauging the extent of assistance your child is going to need. If self-reliant and capable of living on his or her own, your child may still be eligible for Social Security Disability Insurance, which offers income to those who can’t work because of a disability, or Supplemental Security Income.

Living Independently with Autistic Disorders

Autistic adults capable of working generally prosper in jobs that require little social interaction. For example, when applying for work in retail stores, they may feel most secure day-to-day knowing that they’ll be working in the stock room and not confronting and tending to customers every day.

An online video of the Princeton Child Development Institute’s Adult Life Skills program focuses on Bob, a 42-year-old, who works as a custodian at the College of New Jersey. At the time of this video, Bob has worked at the college for over fifteen years. In the morning, Bob is instructed patiently and meticulously by his boss on what his tasks will be for the day, which he carries out dutifully, stopping at one point to eat the lunch he’s packed for himself. Bob shares an apartment with an autistic woman, and is visited regularly by therapists who come to his aid with certain tasks.  Though Bob still suffers from his autism, he is a liberating example – for parents, particularly – of the independence their child might achieve. Simple household chores, being entitled to such small decisions as what he’ll eat on a particular night, manage to remind Bob of his independence, and thus become pleasant tasks. Bob is not only independent; he’s happy.

Matt, a 29-year-old with autism, lives on his own as well. However, his disorder poses more of an obstacle than Bob’s. Matt is a college graduate and prodigiously gifted student of calculus. However, his social reservations can sometimes be crippling. Though he may write at a mature or even professional level when given the time to really organize his thoughts, extemporaneous conversation is a tremendous struggle due not only to his shyness, but also to his tremendous struggle with the extemporaneous formulation of language. But Matt gets by. His mother, his current employer, and a couple of therapists come together to form a job-search team wherein they contact likely employers as well as compile a “social story,” a sort of resume that points out the strengths and weaknesses of autistic applicants. As with Bob, and as with others, Matt will get by.

Bipolar disorder causes extreme high and low mood swings. Sometimes mixed episodes can occur, where there are feelings of both mania (high) and depression (low). These episodes are severe enough to affect and interrupt the individual’s daily life. During these episodes, people with bipolar disorder may have uncontrollable bouts of energy, be overly happy or sad, act on impulse (including sexually), engage in risky behaviors, go on shopping sprees, or have thoughts of worthlessness, suicide, or hopelessness. People may also experience a change in their appetite and sleeping patterns.

What Are The Types Of Bipolar Disorder?

Type 1

This is the most severe type of bipolar disorder, with the person needing immediate medical attention in most cases. The episodes of mania are present for a minimum of 7 days, while symptoms of the depression episodes can last two weeks or more. These episodes are often severe, majorly affecting the individual’s life if left untreated.

Type 2

Type 2 bipolar disorder exhibits episodes of mania and depression that alter back and forth without becoming full-set episodes lasting for lengthy periods of time as Type 1 does.

Bipolar Disorder Not Otherwise Specified

This is another type of the condition characterized by out of the ordinary behaviors that affect the individual’s daily life. People with this type of the disorder do not have episodes lasting long enough to be categorized as type 1 or type 2.

Is There Help For The Disorder?

Although there is no cure for bipolar disorder, there are many bipolar treatment options available to help you control these episodes and live life as any other person would. The first step is of course to receive the proper diagnosis. A doctor or psychiatrist can prescribe one of several medications (including anti-depressants and mood stabilizers) to help treat the condition. Psychotherapy is also a helpful tool in living life positively with the disorder. Many recommend adding natural remedies to your treatment, such as more fruits and vegetables and vitamins in your diet.  In addition to the medication, continue with therapy sessions. Even if you feel you do not need to talk, nothing is better than releasing the emotions you are feeling inside. The end results are all worth it.

It is important to seek the help of a doctor so that you are able to begin living life again. Keep track of your symptoms, their duration, and how often they occur to tell your doctor. Each person with the disorder is different, and it may take several different medications to find the one that is right for you. But don’t worry; there IS a medication that can help you. Patience is the key to overcoming the effects of a bipolar disorder.

Can Life Ever Be The Same?

Of course it can! As many as 56 million Americans are living happy and productive lives with this disorder. With proper medications and therapy, life can be the same for you. While it may seem that life is always going to be affected by the disorder, it is simply not true. People with bipolar disorder who are receiving treatment go on to live full lives with excellent careers, loving relationships, and happy homes. Bipolar disorder does not have to take over your life. In time, the changes you will notice in your mood and daily life will be remarkable. Just remember that you must allow and accept the help you are given!

This is a cause close to her heart. Close’s sister has bipolar disorder and her nephew has schizo-affective disorder. She refers to her sister and nephew as her heroes because of the struggles they face and overcome every day. They were her inspiration to get involved and fight the stigma associated with mental illnesses.

Statistics show that 1 in 6 adults and 1 in 10 children suffer from a diagnosed mental illness. That leaves room for a population of people with mental illnesses that are never diagnosed, meaning  a sizable portion of the U.S. population suffers not only from the everyday struggles of mental illnesses (often unaware), but also with stereotypes and negative misconceptions about their condition.

Close is on a mission to change things. She has partnered with Foundation House, the Child and Adolescent Bipolar Foundation, and Garen and Shari Staglin of International Mental Health Resource Organization to start a campaign called Bring Change 2 Mind.

The campaign is designed to combat misconceptions and assumptions about mental illness by providing easy access to reliable, accurate information and connect those in need with education, support, hotlines, and volunteer opportunities. These resources may be found at www.bringchange2mind.org.

“It is just the beginning, but I hope it will give people the courage to talk about mental illness, to lose their fear of the words, to conquer shame and stigma,” Close said. “There is nothing to hide. Schizophrenia. Bipolar disorder. Depression. I have no fear. We are all connected, and none of us should ever feel marginalized, stigmatized, and alone.”

Several different symptoms are present in those with Asperger’s Syndrome — or aspies, as they call themselves. The most common is difficulty in social interaction. This causes an already challenging task — living on your own — to become even more difficult. Despite the challenge, many aspies have learned to live — and even flourish — once they have their own place.

Employment

One of the keys to living an adult life is having the ability to hold down a steady job and pay the rent. For aspies, there is an added challenge caused by their difficulty understanding social interactions. This means that the best jobs for a young adult with Asperger’s Syndrome are those that are highly structured, do not involve deadlines, but do require attention to detail. Aspies need to focus on their strengths, not their weaknesses.

Many adults have found placement agencies that specialize in those with mental disabilities to be extremely helpful. These agencies will take in an individual, help figure out their strengths and weaknesses and point out what type of employment they’ll be suitable for. When consulting these agencies, check to see what their track record is like. Be sure to check whether the agency is government funded or privately funded, as you may have to pay out of pocket for the services provided. Family may be required to assist the individual with Asperger’s Syndrome with transportation to and from their job.

Social Isolation

A common symptom of Asperger’s Syndrome is a feeling of social isolation. This is partially caused by the individual’s inability to understand what’s appropriate in a social situation, which in turn leads to a difficult time connecting with other people. This feeling can become even more pronounced when an aspie is alone in a new place.

One solution is to live with a roommate. However, it can be difficult to find the right person who understands and can deal with an aspie. The right roommate will be patient and understand some of the quirks caused by Asperger Syndrome, such as the literal interpretation of dialog that may be intended as sarcasm. If roommates aren’t the answer, another solution is for the family to remain in contact, setting aside a scheduled social time to visit the individual. There are also a variety of social agencies and visiting nurses that have experience in dealing with aspies.

Overwhelming

Living on your own can be overwhelming — even more so to an aspie. Many will respond poorly to the sudden transition and general lack of structure that living on your own entails. In dire cases, an aspie will turn inwards to one particular interest and forget about the rest of the world, making it easy for them to brush off things like bills and rent.

It’s important for family to take on an active role in the aspie’s new life style in order to ease the transition. A family member should be around to help acclimatize the young adult to their new life, even if it means living with them for the first few weeks. Ideally, you want to set up a routine that the aspie can follow — any kind of structure will only help.

Successful Aspies

Despite the additional difficulties that aspies face, there is hope — those with Asperger’s Syndrome can have an incredible knowledge of a niche, making them capable of tremendous accomplishment. Albert Einstein, Henry Ford, Bill Gates, and Beethoven are some of the many world changing people who’ve suffered from Asperger’s Syndrome.

There are no statistics on how many aspies currently live alone, but it is possible. With the right set-up and a supportive family, there’s no reason that an aspie can’t lead a normal, adult life.

If all this seems to much and you need help, Pasadena Villa has people in place waiting to help. Please feel free to contact us for your mental health questions, treatment for dual diagnosis, schizophrenia schizoaffective, asperger syndrome in adults and  adult residential treatment. For more information, click here.

Sources:

Aspergers.ca, the Asperger’s Society of Ontarioninds.nih.gov, National Institute of Neurological Disorders and Stroke