'A serious epidemic' -- mentally ill speak of struggles

July 20--At age 44, the longest Lisa Vinsant has held a job is 18 months.

That was when she was a teenager and worked as an ER registrar for a health insurance company. It was a time when she was consistent in taking her medications, making it possible for Vinsant -- who three decades ago was diagnosed with adolescent bipolar disorder and who had attempted suicide at age 16 -- to work.

Vinsant is one of about 187,000 adults in Alabama who live with a serious mental illness. Almost 90 percent of these adults are unemployed. That rate is about 10 percent higher than the national average, according to the National Alliance on Mental Illness, which views the statistic as more about the lack of support for this group of people than it does about the economy.

"I am severely mentally ill," Vinsant said. "I know that. But I can hold a job, I can work. I can do anything anybody else does. I just have to do what's right for me. And that's take my meds, eat right. You really have to take care of yourself in every manner. You have to get enough rest. You have to keep your stress level down."

About 60 percent of people with mental illness want to work, and two-thirds can successfully hold down a job if they're given appropriate support, the report says.

Yet fewer than 2 percent of people in the public mental health system receive this help, a cost-effective program called supported employment, which has been studied in 20 high-quality clinical trials during the past 25 years.

At what cost?

For people living with mental illness, work can be a critical factor that helps promote health, recovery and social inclusion, according to NAMI. Yet, nationally 60 percent to 80 percent of people who live with mental illness are unemployed, and, for people living with the most severe mental illnesses, unemployment rates can be as high as 90 percent.

This disproportionately high unemployment of people living with mental illness is both unnecessary and very costly, the organization says. The nation pays a high price in loss of productivity, earnings and human potential, as well as in disability benefits and use of public services. An estimated $25 billion is spent annually for disability payments to people with mental illness.

"We promote employment through our affiliates," said Wanda Laird of the NAMI office in Montgomery. "We advocate for it through different committees, like through the department of mental health. Aside from the unemployment issues, we are just trying to advocate for more services. We are trying to educate and support those who suffer from mental illness, and their families."

So is Amy Hinton.

A mental health advocate, policy analyst and social scientist, the 39-year-old has Attention deficit hyperactivity disorder (ADHD), and said her passion in the field is driven by the understanding that "we know what to do, and we should be doing a better job of it. People do not have to live this way. Their lives are unnecessarily difficult because of the way our national mental health system is set up."

While the National Institute of Health estimates one in four adults suffer from a diagnosable mental disorder in a given year, Hinton said it doesn't mean the mental health disorder is impairing or disruptive to their life.

"We have been greatly liberated and helped by medications," she said. "But we still suffer as a group from poor access to care and poor care coordination."

Capable of working

Vinsant works at Friendship Mission North -- a homeless shelter for women and children -- as an administrative assistant. She answers the phone, makes the schedules for the kitchen duties, laundry, and the chores. She types memos and greets people as they enter the shelter.

And she has tried quitting several times.

"When I'm not on my medicine and somebody pisses me off, I quit," Vinsant said. "I walk off. I don't care."

It is important, said the shelter's director Tammy Middleton, that Vinsant stay busy.

"If she sits at home, at her house, her depression level will (get) so bad that she'll be suicidal again," she said. "It's very difficult."

The time Vinsant tried killing herself at 16 was only the first attempt. She tried again when she was 19. The third time was three years ago. Each time was with pills.

"Being on the employer side of it, it is hard when you work with the mentally ill because she is a roller coaster ride," Middleton said. "She has tried to quit here several times. I think sometimes why they can't keep jobs a lot of times is because they will say they can do a lot of things that they really can't do. So they might get hired, but it becomes obvious very quickly that they are not capable of doing that job.

"And then they can't keep the job, or the pressure becomes too much for them. And they quit."

Finding your way

Hinton said she has always had ADHD, but didn't know it.

"We run very high all the time," she said. "We tend to be very intense, and have difficulty focusing unless we try to focus -- that's called hyper focusing. The difficulty I've had is things that are incredibly easy for other people, like finishing something in 20 minutes, we have a hard time switching off all of the world around us. For someone without the disorder, it's not as difficult."

Hinton has found it easier to work her way, from home. On her hours, and in ways that best fit her needs.

"People with mental illness are very bright, very creative," she said. "One thing I've learned about myself is how I work and how I work most effectively. And how I work most effectively is in real intense two- to three-hour bursts. Often, I'll have to divide my day into blocks like that. I'll have to then take a nap at times, or (do) nothing for 15 to 20 minutes.

"I get up in the middle of the night and work for several hours. I just kind of have to go with it. I just have to do it when I can do it. That doesn't tend to work very well for a lot of structured work environments."

A serious epidemic

Vinsant has been drug and alcohol free for almost 17 months, and she is quick to note she does not blame being bipolar for most of these struggles.

"I made choices," she said, "to drink, take drugs. But my bipolar is a part of that. It doesn't define who I am."

Aside from being diagnosed with adolescent bipolar, she was diagnosed as manic depressive at age 15, and with (adult) bipolar when she was 30 years old.

"I have bipolar 1, rapid cycling, one of the worst forms you can have because it's the hardest to control," Vinsant said. "It's a mood disorder. You go from crying to being on a high where you're manic and everything is great and then you go to these deep lows to where you're severely depressed. I can go through those cycles within a day, sometimes within an hour, four or five times.

"They think that it started as an adolescent, because I had separation anxiety when they would send me to my aunt for Vacation Bible School for a week, I would break out in hives, throw up and cry and they'd have to come get me."

Alabama's public mental health system provides services to only 33 percent of adults who live with serious mental illnesses in the state, according to a 2010 NAMI report. Alabama spent just $64 per capita on mental health agency services in 2006, or $294.9 million, according to the report. This was just 0.9 percent of total state spending that year.

"It's a serious epidemic," Middleton said. "We're working with several of them right now, working to get their SSI. What happens a lot with the mentally ill is that they don't have the money to buy their medications. They don't have disability, they can't get a job, and therefore, they can't take their meds."

Vinsant is on disability, and said her goal is to be able to get well enough and stay stable long enough to help others like her.

"People are out there, and they are struggling, and they don't have the support I've had," she said. "And they don't know where to get it. I would love to be an advocate. I dream big."

Quick Facts

--The unemployment rate for adults living with mental illness is three to five times higher than for those without mental illness.

--Many people who live with serious mental illness who do work are underemployed; about 70 percent who hold college degrees earn less than $10 per hour.

--On average, people who receive SSI benefits have incomes that are just 18.2 percent of the median one-person household income.

--An estimated one-third to one-half of people who live with serious mental illness lives at, or near, the federal poverty level.

Source: National Alliance on Mental Illness

Need help?

Montgomery Area Mental Health Authority can be reached at:

Montgomery County: 279-7830 (271-2855 for Deaf-Interpreter TTY and Voice)

Autauga County: 365-2207 (Prattville)

Elmore County: 567-8408 (Wetumpka)

Lowndes County: 548-2578 (Hayneville)

Wings Across Alabama, a non-profit organization for consumers of mental health services: 395-7616

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