Monday, June 8, 2015
About the series
World-Herald columnist Erin Grace looks at the struggles of three people with severe mental illness — and the confusing health care system that isn’t always there to help them.
Part I: Despair
Sunday: Kyle had everything going for him. Except a brain he hated.
Part II: Adrift
Monday: Patricia has no permanent place to call home.
Part III: Hope
Tuesday: Nancy shows that recovery is possible.
Nancy Pinkelman has the training and certification to help adults with mental illness. But her biggest credential is the one she earned the hard way — through a years-long struggle with bipolar disorder.
There were 911 calls and forced commitments and not-quite-right medications that left her too foggy to complete a sentence. She lost her marriage, her job, her home and chunks of her 30s and 40s. Eventually, though, Nancy Pinkelman got better. She got much better.
And now, at age 46, she is in a position to help others do the same.
Nancy’s story is one of pain and loss but also recovery and hope. As an Omaha group prepares to address gaps in the city’s mental health system, its members want people to know that despite the challenges of a mental illness, despite a system that often falls short, people can get better. They can regain their independence. They can go on to be productive and reclaim their lives.
They can be like Nancy.
This is a message the authors of a report about Omaha’s mental health system want to emphasize: Treatment can work. People can recover. Mental illness does not have to be a permanent catastrophe, and the system can help by providing ongoing services, said James Zahniser and Andrew Keller, psychologists with the Colorado-based TriWest Group. Their report, released earlier this year, is guiding efforts led by Omaha philanthropists Rhonda Hawks and Ken Stinson.
Born the middle child in a sprawling family of 15 children, Nancy Pinkelman left home on a farm in northeast Nebraska for college at Wayne State and then, after getting a degree in fashion and business, landed in Omaha.
She had a son, and eventually she married someone who was a good spouse and stepfather. She lived in southwest Omaha and had a job at InfoUSA, which she later quit. She became a stay-at-home mom.
By her account and according to public records and a psychologist who treated her, things began to unravel in 2004.
Nancy was 36, diagnosed with depression and put on a medication.
She couldn’t sleep. For months.
“Maybe an hour each night,” Nancy said. “I was tired. I wanted to sleep. However, I guess the way I’d describe it is there were knots in my stomach. Stress in my head.”
She said she “was ruminating.” Not able to “let go of certain things.”
One of those things was a paranoid belief that “people were after me.”
By day, she handled the stress by walking. Everywhere. All over Omaha.
She even contacted people at her former job, InfoUSA, sending an erratically written email to an InfoUSA supervisor, and writing to Vinod Gupta, the founder of InfoUSA, that he was the worst boss she had ever had. She sent him a card that thanked him “for making me understand what company I do not want to work for.”
Gupta and the supervisor each sought a protection order.
Once, in 2005, Nancy fled into a Bellevue hotel bathroom, convinced “they” were after her. When police were called, Nancy resisted arrest, and police used a Taser on her. She was taken to the Douglas County Community Mental Health Center, where she was terrified to discover she was locked in.
“I didn’t know what medication they were giving me,” she said. “I was on suicide watch. My energy level was very high. It was very scary.”
Nancy thinks she was at the county health center for at least a month. That gave her some time to get stabilized and put on different medication. She was told her anti-depressant medication may have exacerbated her mania. She was diagnosed with bipolar disorder, which is characterized by huge swings in mood from mania to depression. She also spent about a month at a Kansas City, Missouri, mental health facility.
Meanwhile, her son’s father was petitioning for temporary custody, and the stress of that was almost unbearable.
Other dominoes fell: In 2006, her husband filed for divorce. Nancy didn’t show up for the hearing. In 2008 she was evicted from an Omaha apartment. In 2009, hounded by collection agencies, she filed for bankruptcy.
During this period, Nancy said there were other 911 calls. She said she was once arrested for being too loud in downtown Omaha. There were other hospitalizations.
Nancy’s climb back involved several things. The first was accepting her diagnosis and getting over the grief of having to live with a severe mental illness. She also had to accept the parts of her life she’d lost.
“I was very hard on myself,” she said. “It was very hard to accept what you were like.”
» Community Alliance, a nonprofit center that specializes in adult mental health: 4001 Leavenworth St.; 402-341-5128
» Kim Foundation, which serves as an information clearinghouse: 13609 California St.; 402-891-6997
» Region 6 Behavioral Healthcare, the State of Nebraska’s organizational network of providers: 3801 Harney St.; 402-444-6573
» CHI Health 24-hour crisis line/information and referral: 402-717-HOPE (4673)
» Nebraska Family Helpline: 888-866-8660
» National Suicide Prevention Lifeline: 800-273-TALK (8255)
» National Alliance on Mental Illness - Nebraska chapter: 415 South 25th Avenue, Bldg LH, 402-345-8101
The second was getting the right medication — one that tempered her mania and depression without knocking her flat.
But that process took years. Every time Nancy saw her primary care doctor, she asked: OK, do you have a cure? And her doctor replied: It’s so complicated.
Third, it was crucial to have support from family members and professionals. For Nancy, that included a psychiatrist who stuck by her side in child custody hearings, and a psychologist named Joe Rizzo.
“I always felt she was a very earnest person, a very honest person,” said Rizzo, who treated Nancy from 2005 to 2008.
What also helped Nancy was a day program at Community Alliance, which offers a one-stop shop for people with mental illness. She sat through meetings and took classes dealing with mental illness, medication and self-esteem.
She found her confidence growing. As it grew, Nancy tackled bills and got her finances in order.
She got a job at J.C. Penney, thrilled that her employee discount helped her afford sneakers for her son. She also got training to become a peer support specialist for Community Alliance, serving as a kind of role model for others with mental illness at the nonprofit’s office near 72nd and Jones Streets.
Nancy Pinkelman gently ribs John Riley before serving a chocolate cake she baked for his graduation day. Riley and his classmates completed a wellness recovery class Nancy teaches at Community Alliance. CHRIS MACHIAN/THE WORLD-HERALD
Nancy’s role is to share her experience with newcomers and guide them on creating a detailed wellness recovery action plan, called a “WRAP,” that identifies triggers, responses and ways to intervene, among them personal and community resources. Nancy, who had to make and follow her own WRAP, teaches a three-day class. Some of that is crisis planning: Who feeds the cat when I am hospitalized? How can I avoid being hospitalized?
A recent visit to such a class offered a window into how easy it can be for someone with a severe mental illness to be tripped up by a range of different experiences.
Maybe they hear voices. Maybe they’re hungry. Maybe they’re being treated poorly, overwhelmed by a long to-do list, under financial stress, stuck in bad relationships, undergoing family conflict. Maybe a potentially upsetting anniversary is approaching. Maybe the TV is too loud.
But there are ways to lessen the stress, and Nancy helped guide class members through what works for them: Exercising. Calling a sponsor. Seeing a therapist. Talking to Community Alliance staff.
One woman with bipolar disorder, a 37-year-old mother of five, marveled at Nancy and a fellow peer support specialist who helped teach the class.
“They look so strong now,” said Sarah Wallace. “It was a surprise to find out they also had this. It gives me hope for my own recovery and that I can give back someday. That I could one day be in that same place.”
Nancy does not define herself by her illness. She likes to garden, using containers for her apartment. She strolls through the Old Market and goes to movies. She plays tennis with her son, who is now 18. She also bakes. For a recent WRAP class, she brought a very moist from-scratch chocolate cake.
Nancy’s bipolar disorder turned her world upside down. She suffered for years. And she still has to work at it each day by taking her medication and being vigilant about her health. She said her illness has taught her to be more compassionate, more grateful and more appreciative of life.
“I have my days,” she said. “But I feel very good and I am thankful for that every day.”
Contact the writer: 402-444-1136, email@example.com, twitter.com/ErinGraceOWH
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Lessons from Nancy’s story
The World-Herald asked psychologists who studied Omaha’s mental health system to respond to the story of Nancy’s success so far in recovery and discuss how that relates to their findings.
Accepting one’s mental health condition
This is often found in people who achieve recovery, said James Zahniser, a psychologist and consultant with Boulder, Colorado-based TriWest Group, which studied Omaha’s mental health system last year. Zahniser said acceptance, however, should not be confused with docility. He said people who actively engage in their recovery — and even push back against providers’ recommendations to find what works best for them — can recover.
Finding the right medication
This underscores why we need more psychiatrists, said Andrew Keller, a psychologist and consultant with TriWest who worked on the Omaha report. Omaha has a shortage of psychiatrists. “Treatment compliance is often a matter of listening to people and helping them find the right medication, not just the first one prescribed,” Keller said.
Designing individualized recovery plans
Zahniser said it’s crucial that providers engage in “person-centered” planning, drawing on the patient’s goals, preferences and strengths. “It sounds like Nancy was helped by providers who respected her and engaged her as an active participant in the recovery process,” he said. The WRAP approach that Nancy used for her own recovery — and teaches to others — is a tested model for illness management, Zahniser said.
Having a job provides structure and consistency and adds to a sense of self-worth.
Developing peer-based support
People like Nancy, said Zahniser, “help us learn to imagine what recovery could look like for others.” Keller said the peer specialists benefit, too, because being able to give back restores their sense of purpose. “The things that Nancy wants remain the same things that all of us want: family, purpose, work, giving back, friends,” Keller said. “Mental illness doesn’t change that. And recovering from mental illness means recovering all of that.”
— Erin Grace