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How do I prepare a Personal Budget Sheet?

A Personal Budget Sheet (PBS) will help you budget your money and explain your financial situation to your creditors. In order to prepare a basic PBS, follow the six steps below.

If you need further guidance or help, contact a debt adviser who will be able to assist. You will find details of some organizations that provide debt advice in the Further information section. You will also see details of some online budgeting tools and downloadable templates.

Personal Budget Sheet 6 Steps

Step 1 – List monthly income
Step 2 – List essential expenditure
Step 3 – Calculate monthly surplus
Step 4 – List and negotiate with priority creditors
Step 5 – List non-priority debt
Step 6 – Calculate fair offers

Step 1 – List monthly income

For each item on the list, write down how much you receive each month.
If you do not get paid monthly you will need to do one of the calculations in below to work out the monthly amount. Once you have listed them all, add them together to work out your total income

If you get paid weekly:
Income (£’s) x 52 ÷ 12 = £’s per month

If you get paid fortnightly:
Income (£’s) x 26 ÷ 12 = £’s per month

If you get paid every 4 weeks:
Income (£’s) ÷ 4 x 52 ÷ 12 = £’s per month

If you get paid quarterly:
Income (£’s) ÷ 3 = £’s per month

Make sure you include:

• Income from any employment
• All benefits
• Tax Credits
• Pensions
• Maintenance
• All other income you receive

Example

Paul is living with schizophrenia and claiming Employment & Support Allowance (ESA) and Disability Living Allowance (DLA). His ESA is paid fortnightly at a rate of £210.10; his DLA is £207.40 every four weeks. He needs to work out his total income per calendar month (pcm), so will do the following calculations:

ESA £210 per fortnight
£210.10 x 26 ÷ 12 = £455.00pcm

DLA £207 every 4 weeks
£207.40 x 13 ÷ 12 = £224.68pcm

He can now add these two figures together to work out his total monthly income

ESA £455.00
DLA £224.68
Total £679.68

Step 2 – List essential expenses

Write down everything that you need to spend money on each month. You may need to use the same calculations that you did in the income section to work out monthly figures. Once you have written down all of your expenses, add them up to work out your total monthly expenses. Do not include payments to debts.

Include:
•Rent / mortgage / secured loan
•Service charge
•Council Tax
•Gas / Electric / Water
•Care and/or mobility costs
•Home insurance
•Food
•Phone bill
•TV Licence
•Clothing
•Hobbies
•Child care costs
•Cleaning products
•Travelling expenses

If you are unsure how much you spend on anything, try checking your bank statements for clues. If that doesn’t help you may need to have a rough guess, but try to be as accurate as possible.

Example

Paul has the following monthly expenses

Gas £45
Electricity £40
Water £25
Food £180
Care costs £150
Cleaning and personal care £30
Travelling expenses £40
Clothing £15
TV Licence £12
Telephone / internet / TV £40
Hobbies and leisure £40
Money for emergencies £10
Christmas & birthday fund £5
Magazine subscription £5

Total expenditure £637

Step 3 – Calculate monthly surplus

Your surplus income is what you have left over after all of your essential expenses are paid. Subtract your total expenditure from you total income to work out your surplus

If you have debt you should use any surplus income to make repayments. If there is no surplus income to offer creditors you should speak to a debt adviser to find out what options are available.

You can find more information on this in our ‘Options for Dealing with Debt’ section.

Example

Paul can now work out what he can afford to pay his creditors by subtracting his total monthly expenditure from his total monthly income

Total income £679.68
Total expenditure £637.00
Surplus income £42.68

Step 4 – List and negotiate with priority creditors

Include:
•Rent /mortgage or secured loan arrears
•Council tax arrears
•Gas / electricity arrears
•Magistrates court fines
•Tax arrears
•Benefit overpayments
•Hire purchase arrears
•Child Maintenance arrears

Priority creditors should be contacted as soon as possible. If you need time to get advice, let them know, they may be able to freeze any action for a short time while you get help. Provide them with a copy of your budget sheet and any other relevant information that helps explain the situation.

If you have priority debts there is a risk of losing something. It is important that you speak to a debt adviser to ensure they are dealt with appropriately. Contact details of various organisations that provide debt advice can be found in the Further information section.

Example

Paul had electricity arrears totaling £140 and gas arrears of £60. He contacted a debt adviser who reminded Paul that non-payment of these debts, could lead to disconnection of his fuel supply.

The debt adviser helped Paul complete a personal budget sheet, which showed he has £42.68 surplus income available. She suggested that he make an offer that would clear both debts in 6 months. Paul contacted the suppliers and offered to pay the following amounts on top of his ongoing monthly payments.

Gas arrears: £10
Electricity arrears: £25

These offers are accepted. Although this only leaves £7.68 for non-priority debts, Paul’s fuel debts will be paid in 6 months, at which time he can increase the repayment of the others.

Step 5 – List non-priority debts

Make a list of all of your non-priority creditors and write down how much you owe to each individual debt. If you have taken advice and made arrangements to repay any priority debt you have; and you have remaining surplus income, you can calculate fair offers to repay non priority creditors.

Include:

• Credit Cards
• Overdrafts
• Unsecured Loans
• Catalogues
• Water arrears
• Debts to family and friends

Step 6 – Calculate fair offers

All non-priority creditors should be treated fairly, so if you have money to offer, each should get a fair proportion based on the amount owed. The best way to do this is with a pro-rata calculation.

Pro-rata calculation

In order to calculate fair offers to your creditors you will need to know:

• How much you owe to each debt
• Your total debt (to all non priority creditors)
• Your surplus income (after priority debt arrangements)

To work out how much you should pay to each creditor, follow the calculation below for each of your debts:

Surplus income x each individual debt ÷ total debt = pro-rata offer

Example

Paul has 3 non priority debts totalling £600. He owes £150 water arrears, £350 on a credit card and has £100 overdraft. He has £7.68 per month to repay his debt.

To find out how much he should pay to each creditor, Paul needs to do the following calculations:

Water: £7.68 x £150 ÷ £600 = £1.92
Credit card: £7.68 x £350 ÷ £600 = £4.48
Overdraft: £7.68 x £100 ÷ £600 = £1.28

Anyone can fall into debt. A sudden unexpected change of circumstances could mean that although you used to be able to afford all of your essential payments and bills, you no longer have the money to manage. Studies show that one in four people with a mental health problem also has debts and that one in two adults with debts also have a mental health problem.

Living with debt can be stressful, however there can be a number of ways to deal with it. This section suggests the first steps you should take if you find yourself with unaffordable debt. It explains how you could negotiate affordable payments to creditors, what can happen if you do not pay, and provides details of organizations that can help.
•Seek help. There are organizations that provide free and confidential help and advice. You don’t have to deal with the debts by yourself.
•Ensure any income that is being paid into a bank account is protected by opening an account that is not linked to your debts.
•Complete an income and expenditure sheet in order to make sure any offers you make are realistic and sustainable.
Separate your debts into priority and non-priority – deal with priority debts first.
•Non-payment of priority debts may result in the loss of something, for example your home or fuel supply.
•Non-payment of non-priority debt may result in the debt getting passed to a debt collection agency or the creditor applying for a County Court Judgment (CCJ).
•If you are unable to repay your debts at the rate agreed when you entered into the agreement, it will be noted on your credit reference file. This can make it more difficult to obtain credit in the future.

How does ESA work?

There are two different types of ESA.
•Some people will get ‘contribution based ESA’ (CB-ESA) because they made enough National Insurance contributions while they were at work to qualify for it (similar to Incapacity Benefit).
•Others will get ‘Income-related ESA’ (IR-ESA) provided they have little or no income and little if any capital (similar to Income Support)

Everybody making a new claim for ESA (unless terminally ill) will go into the ‘assessment phase’ for the first 13 weeks. During this period, the Department for Work & Pensions (DWP) will assess your physical & mental health and your prospects of working or training for work. While this happens, single people will be paid the basic ESA allowance which will be the same as Jobseeker’s Allowance. This is £71.70 for people 25 or over and £112.55 for couples. These figures are correct for the period April 2013 until March 2014.

At the end of the 13 weeks (it could take longer) the DWP will make a decision about your eligibility for ESA. There could be three possibilities:
•Some people will be found ‘fit for work’ and could claim JSA.
•Some will remain on ESA and will move into the ‘work-related activity’ group.
•Some will remain on ESA and move into the ‘support’ group.

Both groups who remain on ESA will get an additional amount – £28.45 for the ‘work related activity group’ and £34.80 for the ‘support’ group. People in the support group who get Income-related ESA will also receive the Enhanced Disability premium – an extra £15.15.

It will be possible for people on Income-related ESA to be paid extra money called ‘premiums’ currently paid to people on IS who qualify for them (e.g. because they receive a certain level of Disability Living Allowance, live alone and nobody is claiming Carer’s Allowance for supporting them). This will be in addition to the basic ESA allowance and the additional amount paid for support or work related activity.

1 year cap on contribution based ESA for those in the Work Related Activity Group

If you are placed in the WRAG and are receiving ESA based on your National Insurance contributions, from April 2012 you will only get CB-ESA for 12 months. After this time, if you would also qualify for ESA because you have a low household income you can continue to receive it. If, however, you live with a partner who works and your household income is over the earning’s threshold or you have savings/capital over the allowed limits, you may no longer qualify for this benefit.

Phasing in ESA

If you are currently receiving IB, IS or SDA you may be entitled to less ESA under the new system than what you get at the moment. For example people now on IB who have partners or children (or both) are paid additional allowances for them but this will not happen with ESA. So when you move to the new benefit, you will get an extra payment called ‘transitional benefit’ which will bring your ESA up to the same level as your current payment. No existing claimants should be worse off because of the change to ESA.

The disability premium is not paid with ESA but some other premiums, such as the Severe Disability Premium, are available to people on Income-related ESA if you qualify for them. People in the Support group on Income-related ESA will also qualify for the Enhanced Disability Premium.

Different rates apply to couples. People who own their own home might receive help with mortgage costs in certain circumstances.

You can find the ESA regulations by visiting the government website at: http://www.opsi.gov.uk/si/si2008/uksi_20080794_en_1#Legislation-Preamble

You can also get more information on ESA on the DirectGov website: ttp://www.direct.gov.uk/en/MoneyTaxAndBenefits/BenefitsTaxCreditsAndOtherSupport/Illorinjured/DG_171894

This section gives information about the out of work benefit called Employment and Support Allowance (ESA). It will explain who the benefit is aimed at, how the Department for Work and Pensions (DWP) are reassessing people receiving the old-style sickness benefits for ESA, the different types of ESA, how you will be assessed, how to challenge a decision you do not agree with and how you may claim the benefit on behalf of someone else.
•ESA is paid to people who have ‘limited capability for work’.
•To start a claim for ESA you need a note from your GP to confirm that you are not fit for work.
•You are then asked to take part in a Work Capability Assessment (WCA) so the Department for Work and Pensions (DWP) can decide whether you are eligible for ESA.
•If you are eligible for ESA you will be placed into either the ‘Work Related Activity Group’ or the ‘Support Group’.
•If you are in the Work Related Activity Group you have to attend meetings with a personal adviser to discuss and prepare for an eventual return to work.
•If you are placed in the Support Group you don’t have to prepare for a return to work but you can if you want to.
•If the DWP decide that you don’t qualify for ESA then you will be expected to claim Jobseeker’s Allowance (JSA).
•If you disagree with any of the decisions the DWP make you have the right to ask them to look at the decision again or lodge an official appeal.

“BIPOLAR SYMPTOMS”

So much information about the symptoms of bipolar disorder (manic depressive illness) is confusing, misleading, or contradictory.
Symptoms of bipolar often get misinterpreted, leaving the real problems of bipolar disorder unaddressed.
There is still a shortage of accurate and reliable information about bipolar disorder symptoms, despite much interest.
There is no point working hard to overcome clinical depression if the REAL problem is bipolar disorder!
Traditionally bipolar disorder symptoms were framed in terms of mood swings.
However, today bipolar disorder symptoms are often framed in much broader terms.
One of the biggest difficulties is in distinguishing bipolar from major depression.
As well as confusing bipolar and severe depression, another common misdiagnosis is to mistake borderline personality disorder for bipolar disorder.
Also, bipolar symptoms are easy to confuse with other disorders such as ADHD, or physical problems such as thyroid disorder.
Discover the real symptoms of bipolar disorder. Don’t be one of the misinformed crowd who confuses bipolar with other illnesses and personality problems.
In some ways “bipolar” was easier to understand back when it was commonly known as “manic-depressive illness”.
This is because bipolar is all about mood swings. These are mood changes that are more extreme and pronounced then the usual ups and downs we all experience from day to day.

Symptoms of bipolar disorder: from National Institute of Mental Health (NIMH)

How extreme do these mood swings have to be? Psychiatrists use their professional handbook, the “Diagnostic and Statistical Manual of Mental Disorders” (DSM) in order to diagnose if mood swings are serious enough to be symptoms of bipolar disorder.

In America there is a precise, clinicalbipolar disorder definition.We will follow these official, professional definitions below:

Bipolar depression symptoms
Depression involves feelings of sadness and emptiness or a loss of pleasure or interest in things. These feelings last most of the day, on most days for at least 2 weeks. These symptoms are severe enough to impact negatively on work, relationships and everyday life.

Learn about medication for treating bipolar depression symptoms

bipolar symptoms of depression

Bipolar depression symptomsinclude:
1. Feeling sadness or emptiness.
2. Losing interest or pleasure in one’s usual enjoyments.
3. Changes in appetite (up OR down), and/or substantial and unplanned loss of weigh or weight gain.
4. Insomnia.
5. Excessive tiredness or sleepiness, and/or lack of energy.
6. Restlessness and agitation.
7. Reduced sex drive.
8. Lack of motivation.
9. Feeing worthless.
10. Feeling guilty about things you are not responsible for.
11. Indecision.
12. “Fuzzy” thinking, problems concentrating, or memory loss.
13. Thoughts of self harm or suicide.
14. Hallucinations.
15. Delusions.

Bipolar symptoms of mania
The word “manic” is often thrown around quite casually, but for genuine bipolar symptoms, mania must have some very definite characteristics. Specifically, to meet a diagnosis of mania, the mood changes must last for at least a week, or be so severe that hospitalization is required. These bipolar disorder symptoms cause significant disturbance to work, relationships and daily life.
Symptoms of bipolar mania include:

Bipolar symptoms of mania
1. Exaggerated high opinion of oneself.
2. Beliefs that one has great talents or gifts that extend beyond reality.
3. Hallucinations.
4. Reduced need for sleep.
5. Talking more than usual.
6. Pressure to keep talking.
7. Skipping from one idea to the next so there is a fragmented flow of thought.
8. Racing thoughts.
9. Easily distracted but some short periods of very focused attention.
10. Feeling restless and agitated, for example finding it hard to sit still.
11. Increase in goal directed activities, related to social, work, school, or sexual pursuits.
12. Excessive engagement in pleasurable activities without thought to their distressing consequences, such as big spending sprees,gambling, sexual indiscretions,poor business investments.

Symptoms of hypomania
Hypomania is a milder form of mania, and may result in a diagnosis of Bipolar Type II or “soft” bipolar.
The symptoms of bipolar mania and hypomania are the same – what is different is the DURATION and INTENSITY of the bipolar symptoms.
In hypomania, the symptoms must last for at least 4 days and are not serious enough to require hospitalization.
See this description of major bipolar disorder symptoms from a leading bipolar research institute.
And remember, bipolar symptoms are all about mood swings – there must have been BOTH depression AND mania/hypomania.

SEXUAL ISSUES are amongst the most common, but least discussed symptoms:
“A very common symptom in maniacal conditions is erotic excitement. This varies from mere coquetry, an extended application of the command “love one another”, an undue attention to the opposite sex, up to extreme salacity, when the mind is wholly occupied by urgent sexual appetite, and all restraint abandoned.” – DANIEL HACK TUKE (1827-1895)
Sometimes we need to consider outward manifestation of bipolar as well as a sufferer’s own subjective, internal states.
Regardless of what someone may report their mental and emotional state to be, valuable insight into their symptoms can be gained if you know some basic information about Bipolar Behavior.(HINT: PLEASE do read about this and do not base your image of bipolar symptoms on what you have read about Charlie Sheen.)

Cognitive bipolar symptoms

Bipolar symptoms may include cognitive problems.

This is a tricky area because sometimes cognitive problems such as “fuzzy thinking” or memory loss are due to the side effects of bipolar medications.
Also, many people with bipolar disorder are very gifted and often believe that mania, or at least hypomania, enhances their abilities.
However, there is also evidence to suggest that with bipolar, cognitive problems can be a pretty typical symptom.
This may be anything from being easily distracted, to mental fogginess, memory problems, or becoming easily confused.
The evidence about cognitive bipolar symptoms can be conflicting. For example, one study observed poor performance in all groups of bipolar people when compared to “healthy” subjects with tasks such as verbal recall and executive functioning.
Other research has shown that once stable, folks with bipolar do not show cognitive impairment.
Also, rather than having harmful cognitive effects, some bipolar medications such as lithium have neuro-protective properties and can help the brain regenerate grey matter and protect against problems such as memory loss.

Physical effects and symptoms of bipolar
Sometimes bipolar symptoms are caused, aggravated, or exacerbated by other underlying medical conditions such as thyroid problems.
Also, people with bipolar disorder are twice as likely to die prematurely from medical conditions such as heart disease and stroke than are members of the general population.
Even scarier, they are three times more likely to develop diabetes, and some diabetes symptoms look like bipolar. Discover how to overcome these with symptoms with THE BIPOLAR DIET.

Paying for Care
Receiving the proper care for your mental health condition is essential to your recovery. The best treatments are the ones prescribed by a doctor or mental health practitioner, and that may include counseling, medication, support, diet and exercise, and alternative therapy among others. Unfortunately, visiting mental health providers and paying for many of these treatments can be expensive. Not all people have access to affordable insurance.
Whether you’re insured or not, and whether that insurance coverage is adequate, there are ways that you can find help paying for your care.
Obtaining Coverage
Shopping for Insurance
Finding Care
Finding Supportive Services
Help Paying for Medication
Paying for Mental Health Care with Insurance

Paying for Care – Without Health Coverage
Much of the health care system in our country depends on health care coverage, which is usually provided by a form of insurance. If you don’t have insurance, it can be difficult to pay for treatment unless you are independently wealthy. Consider the options below to obtain coverage; in the meantime see Finding Care to get immediate help.

Obtaining Coverage
You may be able to obtain insurance if you are not currently insured. Here are some options:
Medicaid
Medicaid is health care coverage offered in combination by the federal government and your state government. It helps low-income individuals in certain groups pay for medical care and prescriptions. Medicaid is not a typical insurance program with monthly payments and deductibles; Medicaid pays providers directly for your care. Low-income beneficiaries aren’t the only group to receive Medicaid, as there are several other qualified groups that are covered (although some of this will change in upcoming healthcare reform).
In addition to covering those who are low income, Medicaid covers:
•Pregnant women
•Women with children under 6
•Children between the ages of 6-19
•Supplemental Security Income recipients
•Young adults up to age 21 living alone
•People over the age of 65
•Those who are blind or deaf
Many states also have a “medically needy” clause, which means you can receive Medicaid without falling under any of those categories if your state determines that you need the medical treatment and you are under the threshold of the Federal Poverty Level.
Many people with mental illness become eligible for Medicaid by qualifying as disabled, either as children or as adults after age 19. Adults determined to be disabled receive Supplemental Security Income (SSI) from the Social Security Administration. SSI provides a small amount of monthly income To find out if you qualify for SSI, visit http://connections.govbenefits.gov/ssa_en.portal.
Many children can receive Medicaid even if they are not otherwise eligible through their State’s Children’s Health Insurance Program (SCHIP). SCHIP requirements tend to be broader.
If you believe that you meet the income and eligibility requirements, you can apply for Medicaid. For specific questions about eligibility for Medicaid in your state, you should call your state office. For more information on Medicaid, click here – https://www.cms.gov/MedicaidEligibility/downloads/ListStateMedicaidWebsites.pdf
Medicare
Medicare, like Medicaid, is a health coverage plan run by the federal government. Medicare operates more like traditionally funded health insurance than Medicaid. Unlike Medicaid, Medicare is a federal program (without state differences) and is geared toward people based on age or disability status and not income. To enroll for Medicare, you must have received social security disability benefits (SSDI) for at least two years. [Add link on qualifying for SSDI]
Medicare mimics a private insurance plan and has deductibles and co-pays. Medicare is structured into four parts, and you may be eligible for one or more of the parts.
•Part A – Medicare Part A deals with hospitalization and inpatient services.
•Part B – Medicare Part B deals with outpatient services and routine medical care.
•Part C – Medicare Part C or Medicare Advantage is a way to extend benefits of A,B, and D
•Part D – Medicare Part D deals with drugs. People with very low income get extra help paying for the prescription costs and deductibles in Part D.
Coverage under Family Insurance
You may be eligible for coverage under your parents’ insurance plan if you are under the age of 26 due to new changes in the healthcare reform law. If you had previously been removed from coverage upon reaching age 22, you can re-enter the plan until you reach 26.
Employer Coverage
If you are employed, your company may offer health insurance as a benefit package. Employers may pay some or all of the monthly payments or premiums for your package. Employer plans tend to be more expensive and comprehensive than those on the individual market and frequently do not discriminate on the basis of pre-existing conditions. Often, employers who do not pay any part of your health insurance may still have a company plan that you can opt to enroll in.
COBRA
If you have recently lost your job, you may be eligible to keep your health insurance at a cost to you through the Consolidated Omnibus Business Reconciliation Act (COBRA). COBRA allows you to keep your health insurance for a specified period of time as long as you continue to pay the premiums.
School
If you are attending a state university as an undergraduate student, your state may offer a healthcare plan for you. Large schools and universities may have their own clinics or teaching hospitals. Some schools may offer programs for graduate students.
Private Insurance
If you are not able to obtain insurance coverage through family, work or school and you are not eligible for government insurance, you can consider buying insurance on the private market. Private insurance can be expensive, and you will need to evaluate your plan very closely.

Shopping for Insurance
There are several terms you will need to know before shopping for insurance:
Primary Care Physician – In many managed care plans or health maintenance organizations, you will have to choose a primary care physician, also sometimes called a general practitioner. Primary care physicians typically specialize in Internal Medicine or Pediatrics. Your primary care physician is the main doctor you will see for most of your ailments that don’t require urgent care. If you want to see a specialist, you may need a referral from a primary care physician.
Specialist – A specialist is a doctor such as an allergist, a gynecologist, or a podiatrist who specializes in treating one or more similar conditions or specializes in a specific age or gender group. Specialists may be able to run more tests and diagnose more problems than a primary care physician.
Referral – A referral is an authorization from your primary care physician to see a specialist or another doctor. It does not mean your insurance company will cover the cost.
Pre-approval – A pre-approval is when your insurance company “OKs” paying for a treatment before you take it.
Network – Insurance companies will typically list doctors or facilities as “in network” or “out of network.” Anyone who is “in network” has a pre-existing arrangement with your insurance company for how much can be billed and paid by the company. Out-of-network practitioners do not have a relationship with your insurance company; they may cost you more.
You will have to pick what kind of plan you want when you are shopping for insurance. There are several different structures of plans:
•A managed care plan, though often the most affordable, is the strictest when it comes to choosing your doctors. In a managed care plan, you may receive all of your services from pre-determined doctors or facilities. You might always have to go to Facility A to see your primary care physician and receive a referral before you can see a specialist chosen by your plan who also works in Facility A, and you may have to get all of your prescriptions at the same facility.
•A health maintenance organization is similar to a managed care plan, but instead of your doctors being chosen for you, you will have a choice as long as you remain “in network.”
•A point of service plan is similar to a health maintenance organization, but you may not need to visit a primary care physician for referrals to specialists as long as you stay within the network.
•A preferred provider organization (PPO) plan is the broadest type of plan, where you never need to see a specialist. You can go both in and out of network, but in-network care is cheapest.
There are several kinds of expenses involved when you are shopping for insurance.
•A premium is a monthly payment that you make to buy into the insurance,.
•A co-pay is any payment you make out of pocket when you visit a doctor or buy medication. For example, you may have to pay $20 when you visit your primary care physician and $40 when you visit a specialist.
•A deductible is the total amount you will have to pay out of pocket before your insurance coverage activates (although routine visits for general health may be excluded from this deductible). For example, you may have a deductible of $5,000. So if you are hospitalized and it costs $10,000, you will have to pay $5,000 before your insurance company will make payments on your behalf.
•A cap is the final amount that an insurance company will pay on your behalf either per year or over your lifetime, although this is going away. For example, you might have an annual cap of $100,000 and a lifetime cap of $1,000,000.
Generally, the higher the premiums are, the lower the deductible. Private insurance may also be more discriminatory than employer plans based on pre-existing conditions (although this is going away) and other statuses that affect your health (such as smoking or age). You may be able to find cheaper private insurance if you look for incentive-based plans that charge lower premiums for people who actively work to eliminate health risks such as smoking and obesity.
There are also some other things to watch out for: A pre-existing condition is a health condition you have before you applied for insurance, such as major depression. Before the passage of the health care reform law, insurance companies could deny you based on a pre-existing condition, give you a very high premium and/or deductible because of your condition, or agree to cover any illnesses except those related to your pre-existing condition. This will change as health care reform goes into effect.
Your insurance will have a list of covered conditions and procedures. You should always read this to make sure your plan is comprehensive. Insurance companies can refuse to cover certain diagnoses and treatments not on the list.

Finding Care
If you are applying for insurance or you can’t find affordable health coverage, there are a number of ways that you can still get care. You should never be turned away from a hospital if you are having a medical emergency, regardless of your ability to pay.
Free Clinics are non-profit organizations that perform medical safety net services for free or at a highly reduced cost. You can find free clinics in your area by visiting http://www.freeclinics.us/.
Free Clinics provide safety net services, which are intended to help people who are ineligible for Medicaid and Medicare but can’t find affordable health insurance. They are often found in hospitals or as stand-alone facilities in densely populated areas of poverty. Some, but not all, free clinics provide mental health services in addition to preventative general health and maintenance.
Generally, free clinics will perform services for free, charge a nominal fee ($15/visit, for example), or initiate a sliding scale fee based on your income. , When visiting a free clinic, you may need to take your identification, as well as proof of income, such as a prior year’s W2 form. Some clinics may take walk-in clients on a daily basis; others are more like doctor’s offices that you will have to join.
Community Mental Health Centers offer low-cost or free care on a sliding scale to the public. Typical services include emergency services, therapy and psychiatric care for adults and for children. You can expect to go through an intake interview that determines the kind of care you will receive. Mental health centers also may offer a variety of services on a long-term basis for clients with persistent mental health conditions. Find your local mental health center by contacting your local government.

Local Nonprofits that aren’t specifically designated as health clinics may still have therapists, psychologists, or psychiatrists who donate their time and agree to see patients for free or at a reduced cost. Many groups will organize professionals who will donate some time each week or month to see patients. These professionals will often meet at drop-in centers or other clinics.
Even if community mental health centers or local nonprofits don’t have a pro bono program, they may know of other resources available to you in your community.
Medical Schools may provide another way of finding help. Students and interns may meet with clients at a highly reduced rate, if you are comfortable seeing them. These students will be under the supervision of a licensed professional.

Finding Supportive Services
If you are interested in finding supportive services in addition to professional counseling look for these options in your community:
Hotlines and Warmlines provide immediate support by telephone for people in emotional crisis and people with mental health conditions. Where hotlines provide emergency support and crisis intervention, warmlines provide assistance, comfort and referral services. Hotlines and warmlines can be lifesaving, they provide referral to help and care, and they are comforting because they are anonymous and easily accessible by telephone.
Drop-in Centers are organizations that are generally run by people with mental health conditions for their peers. A safe, accepting place to go for company and support. Drop-in centers may organize activities such as support groups or trainings, but they may also be more informal gathering sites.
Support Groups may meet at various places in your community such as churches, schools or government buildings. You can find information about support groups on the Internet, on bulletin boards at local mental health centers and restaurants, or by asking other people with similar conditions. Some support groups also meet anonymously on the Internet, posting on forums or using e-mail to stay in touch. Support groups should either be free or should have a very low cost to cover food or activities ($5 a meeting).
You can find more information about support groups by visiting http://www.mentalhealthamerica.net/go/find_support_group.
The American Self-Help Clearinghouse (http://www.mentalhelp.net/selfhelp/) and the National Mental Health Consumers’ Self-Help Clearinghouse (http://www.mhselfhelp.org/) maintain listings of support groups on a broad range of mental health topics. The National Mental Health Consumers’ Self-Help Group Clearinghouse also maintains a Directory of Consumer-Driven Services (http://www.cdsdirectory.org/) that includes peer-run organizations throughout the United States that offer a variety of supportive services and activities.

Help Paying for Medication
The ongoing cost of prescription medications can be a challenge, especially if you are taking more than one prescribed medication.
Some pharmaceutical companies offer prescription assistance programs to individuals and families with financial needs. These programs typically require a doctor’s consent and proof of your financial status. They may also require that you have either no health insurance or no prescription drug benefit through your health insurance.
In addition, there are county, state, and national prescription programs for which you may qualify and special drug discount cards offered by some pharmaceutical companies.
The Partnership for Prescription Assistance can help qualifying patients without prescription drug coverage get the medicines they need through the program that is right for them. Many will get their medications free or nearly free. For more information, visit http://www.pparx.org/ or call 1-888-477-2669.
Cutting Costs
Discuss with your doctor if switching to generic drugs or less expensive brand-name prescription drugs is a safe option for you. It is important to let your doctor know if you cannot afford your prescriptions. He or she may be able to give you free samples of your medications.
Compare the prices of your prescription drugs at different retail pharmacies. Many retail pharmacies list their prices for commonly prescribed drugs online, or you can call local pharmacies to request prices for your medications.
Want to try out a comparison tool? Check out Destination Rx at http://www.destinationrx.com/ to compare pricing of your prescription medications.
Medicare Part D
Medicare prescription drug coverage, also referred to as Part D, is a program that helps individuals who receive Medicare benefits pay for prescription drugs. This program covers both brand name and generic prescription drugs at participating pharmacies in your area. Everyone on Medicare is eligible, regardless of income, health status, or current prescription expenses.
There are two types of insurance plans that vary in cost and drugs covered:
1.Medicare Prescription Drug Plans, sometimes called “PDPs” only offer the Medicare drug benefit.
2.Medicare Advantage Plans, sometimes called “MA-PDs,” are managed care plans (like HMOs and PPOs) that offer more comprehensive health care coverage, to which the drug benefit will be added.
Extra Help is a program that helps eligible people with Medicare pay for some or most of their prescription drug costs. To learn more about Extra Help, visit http://www.mentalhealthpartd.org/consumers/04_Extra_Help.php.
For more information on Medicare Part D visit http://www.mentalhealthpartd.org/, and click on “Consumers and their Families.”
Want to find and compare Medicare drug plans or enroll? Visit http://www.medicare.gov/Default.aspx.

Paying for Mental Health Care – With Health Coverage
Dealing with insurance plans can be challenging, especially when you are already stressed and worried about mental health issues you or a loved one are experiencing. For this reason, it is best to understand your benefits before you need to use them, if at all possible. The following are steps you can take to make sure you understand your benefits so that you can do whatever is within your control to have your treatment covered.

Reviewing Your Insurance Policy
The first thing to find out is what mental health benefits your insurance policy offers. Review your insurance policy so that you are clear about whether your policy includes coverage for mental health services, types of services that are covered and the amount paid for these services, and any steps you must take to have treatment covered. You should have received a copy of your insurance policy when you enrolled in the program, whether at work or independently. If you did not receive a copy of the policy or have lost yours, you can call your insurance company and ask for another one to be sent to you.
Even if you have a copy of the plan, it is always helpful to speak to someone else and clarify questions. This way you can identify any possible points of confusion before you receive a bill. You should have a number on your card or on the website that will tell you whom to contact.
The following are some questions you will want to ask your insurance company, if possible, before starting treatment:
1) Do I need a referral from my primary care physician to a mental health professional?
Many insurance companies, especially Health Maintenance Organizations (HMOs) require referrals from a primary care physician to visit any specialist, including mental health professionals. If you do not receive a referral before visiting a mental health professional, your insurance company may deny your claims. If you think you require a referral, you should always get it in advance.
2) Do I need any pre-approval from the insurance company before I see a mental health professional?
A referral is an authorization from a doctor saying that the treatment is medically necessary; pre-approval or pre-authorization­ requires that your insurance company agrees to make the payment. You should call your insurance company to see if you need pre-approval, but you should also keep other questions in mind-how many visits are you approved for? Do you need a new approval for each visit? If you are going to be hospitalized or in inpatient care, how many days are you allowed to stay?
3) Do I need to see a mental health professional who is on a list provided by my insurance company (in a “network”) or am I free to choose any qualified professional?
If you need an “in network” provider, you can usually find a directory online or ask your primary care physician to help pick someone out.
4) Does the amount paid by my insurance company depend on whether I see a professional who is “in their network or preferred provider list” or “outside the network”? If so, what is the difference in the amount paid or percent reimbursement for “in network” vs. “out of network” providers?
“In network” providers are almost always cheaper than “out of network” providers, although whether you want to save money or visit a doctor you prefer is a choice you will have to make. Bear in mind that your insurance company may not always have a flat difference. For some companies, seeing an “in network” provider may cost you a $20 co-pay, and an “out of network” provider will cost you $30; in others, “in network” may cost you $20 and an “out of network” may cost you 20% – which could be significantly higher than $30.
5) Are there dollar limits, visit limits or other coverage limits for my mental health benefits? Is there a difference in what is paid for outpatient vs. inpatient treatment? If so, what are my benefits for each of these?
It is not uncommon, based on your state and your plan, to have limits on psychiatric visits or medication management visits. Your plan may limit you to something like 25 sessions with a psychiatrist each year, up to 7 days of inpatient treatment a year, and 12 medication management visits a year. If you exceed these services, you will have to pay out of pocket.
6) Is there a specific list of diagnoses for which services are covered? If so, is my diagnosis one of those covered by my policy?
Insurance companies often have the option to not include certain diagnoses in all policies. If you applied with your condition as a pre-existing condition, they may not cover anything related to that. Your insurance company will provide you with a list of covered and uncovered diagnoses.
7) What prescription benefit does my policy offer? What are the co-pays for medications? Are there different levels of prescription coverage depending on the specific medication? Do co-payments vary depending on whether the medication is generic or name brand?
Not all health insurance plans offer a prescription benefit plan in addition to a treatment plan. Even if you have a prescription plan, not all medications are covered. Many prescription plans have “formularies” that determine how much you pay for different classes or brands of drugs. Covered medications fall into three categories:
•Generic: These drugs are copies of brand-name drugs that have been on the market for a number of years and are often offered at very cheap prices.
•Preferred: These drugs are name brand but are available to you at a price below the retail price.
•Non-Preferred: These drugs are name brand but are not offered at a very large discount.
Insurance companies regularly update their formularies to classify drugs under certain payment categories. It’s best to ask your doctor to help you find out what payment category your drug is in before you go to the pharmacy to avoid an unpleasant surprise when the bill arrives.
However, many prescription medications for mental health conditions are very expensive and even with health insurance, you can find yourself paying a lot for a prescription.
Mail Order Pharmacy – Some insurance plans will allow you to order a three- month supply of maintenance drugs through the mail for a reduced, standard price.
Seek Outside Assistance – Go here to find out other ways to help pay for your prescription medication.

Seeking Help in Understanding Your Policy
If you have trouble understanding the policy, see if someone from your doctor’s office, your employer, or a trusted friend, can help explain the information.
If you receive health insurance through your employer, you may be able to go to your Human Resources department. If your company is large, you may have a dedicated Benefits Specialist who will be able to help you navigate health care. If you work for a smaller business, you will want to talk to the person who arranged the health care. They may not be able to help and their knowledge may be administrative, but they may help put you in touch with an advocate who can put you on the right track. You may be hesitant to admit to your employer that you need help with a mental health condition, but it is not legal for your employer to fire you over a disability.
If you have private insurance, you can contact your state Insurance Department (http://www.naic.org/state_web_map.htm) or state Insurance Commissioner’s office (http://www.naic.org/documents/consumer_hipaareps.pdf (their consumer hotline may be the most helpful) for help in understanding your insurance policy. They can also help you find out whether your company benefits follow the state mental health parity laws (laws that guarantee equal coverage for mental health conditions as for other health conditions), and can assist you in dealing with your insurance company if you are having a problem.

Meaningful Work and Recovery
Although you will encounter roadblocks and setbacks on the road to recovery, working at something that is meaningful to you can bring you a sense of purpose that will anchor you. Meaningful activity expands your sense of self-worth by adding to your skills and helping you accomplish your personal goals and feel good about yourself. Meaningful activity, which includes school, volunteer work, part-time work and full-time employment, also enables you to meet new people and make friends.
We all need some form of meaningful activity in our lives and a means of supporting ourselves, but having a mental health condition can be an obstacle. Mental health conditions impact different people in various ways. Some people with mental health conditions may never stop working; others find that their condition interrupts their career, and still others may be able to do only limited work. As people recover from a mental health condition, they also face varied challenges in relation to work. Some people with mental health conditions find that they are able, with minor accommodations, to work in the same way they did before. Others may have to re-enter work gradually. And people on disability benefits will need to observe back-to-work rules when employed.
No matter your situation and no matter the hurdles you face, hold on to your goals for yourself and keep striving to incorporate meaningful activity into your life. In the past, people with mental illness were often discouraged from working, but today we understand that work is not only a possibility, but it can also play a vital role in recovery.
It’s true, however, that having a mental health condition can pose some practical barriers to working, such as having breaks in your career, feeling unsure of yourself, or needing to ask for an accommodation such as time for doctors’ appointments. You can figure out strategies to work around these barriers, often with the help of friends, mentors or an employment specialist. Don’t give up!
Supported Employment
Your Work Choices
Work-Related Issues

Supported Employment
Supported employment services assist you in preparing to work, finding and keeping a job and thriving in a work environment. Depending on where you live, you might be offered supported employment help through the local office of your state’s vocational rehabilitation service, through the mental health agency where you get mental health services, or through a nonprofit disability employment agency. Because of local differences, be sure to check with all of these sources. Your state’s Office of Vocational Rehabilitation should be able to help you find supported employment services.
In supported employment, a vocational counselor will help you assess your career interests, job skills, and work challenges. The counselor may suggest job categories that fit your interests, help you write a resume, coach you for interviews, and prepare you for what to expect if you haven’t worked recently. While you will get a lot of help, you will also be expected to work hard on solving problems, planning your career, and looking for jobs. Don’t expect to be handed a job or simply placed in work. The main responsibility will be yours.
The prospect of job hunting can seem daunting, and looking for work is like a job in itself. You need to put in regular hours and keep at it. Perhaps the biggest challenge is getting discouraged. In the competitive marketplace for work, expect to be turned down by many prospective employers before landing a job.
An important source of help that many job hunters in your community use is the local public employment office. These days, such offices are typically called “career one-stop centers”. They offer a wealth of self-help resources on preparing for and finding jobs, computers you can use, and trained staff. Many have a staff person trained as a disability navigator who will understand the challenges you face and guide you to sources of help. Find your state’s network of employment centers here.
Once you find a job, your next challenge is to keep it. Work is rewarding, but it also can be tiring, so be sure to get enough rest and care for yourself. Give yourself time to get used to the demands of working. Above all, it’s critical to use your support system – friends and family, your therapist or case manager and peer support group – so you can talk over your experiences at work and get help if your mental health condition is affected. Be sure to let your doctor know that you are going to work and get help in making any needed adjustments to medications as your situation changes.

Your Work Choices
What comes to mind when you think of a job? Is it working full-time, five days a week? If that prospect feels daunting to you, remember that there are other work choices to choose from. One of them might be more suited to your current abilities and stamina, and might be easier to find than full-time work.

Volunteer Work
While many people want to have a paying job, volunteer work is another form of meaningful activity for many people with mental health conditions. Some people use volunteer work as a stepping stone to paid employment; volunteering can help them re-learn skills and grow comfortable working with other people. Others decide to volunteer instead of work. Volunteering not only gives you a sense of pride, but it can make you feel good about yourself to help out in the community.
If you have a cause that you feel passionately about, you may already know where you want to volunteer. Most organizations that have a lot of volunteers will have a coordinator who can help bring you on board. To find volunteer opportunities, you can contact your city or county information line for the contact information for a coordinator. You can also look for “Volunteer Clearinghouse” or “Volunteer Center” in a phone book. The Internet can be a great tool to search for volunteer opportunities; try visiting http://www.volunteermatch.org/ or http://www.1-800-volunteer.org/.
Remember that just because you don’t receive a wage as a volunteer doesn’t mean you aren’t entitled to fair treatment and respect. You should feel safe and comfortable in your work environment, and people should treat you like a human being.

Internships
When most people think of internships, they think of college students working for free for credit. Internships aren’t actually student specific; they are a blend of education and work. An internship usually involves a close relationship with other staff at a business working on specific projects and tasks. Where a volunteer might answer phones or bring food to homeless people, an intern might help a program staff member develop strategies to bring the food to the homeless. Sometimes the line between intern and volunteer can be blurred. Some internships will offer an hourly wage or a paid stipend, although such internships can be highly competitive. If you are a full-time college student, ask your career office whether they participate in the U.S. Department of Labor’s Workforce Recruitment Program. Recruiters interview college students with disabilities early in the year for summer intern positions.
If you are interested in an internship, make sure you ask your employer at the interview about the specific tasks and projects you will work on. You should expect to spend some of your time doing administrative work like filing, but you should also get a sense of a real opportunity to learn on the job.

Temporary Employment
Temporary employment can be a good bridge to permanent work. You register with a temp agency that can then place you in short-term assignments in companies that need extra help. These assignments could last from a few days to several months and can sometimes lead to an offer of permanent work. By temping, you establish a current resume, sharpen your skills and test your own ability to return to work.

Part-Time Employment
Some people use part-time employment (working less than 35-40 hours a week) to transition to full-time employment; other people find that they prefer working part-time to working full-time permanently. Part-time employment can give you more free time to take care of yourself and your responsibilities. It may be more accommodating if you find that you need more time away from the office to handle your mental health condition. However, part-time employment usually pays less than full-time employment, and part-time work often comes without benefits.

Full-time Employment
Many people with mental health conditions are able to work full-time. Full-time employment usually includes sick leave and may include health insurance, making it easier to handle health problems. Company retirement plans for full-time employees enable you to grow your savings. You may want to look for government work, as local, state and federal employers have a good record of hiring diversity and respecting disability regulations.
Finding employment, whether full-time or part-time, usually involves preparing your own resume and job-hunting in your local employment market. Job hunting can be discouraging for anyone, especially if job openings are scarce and there is a lot of competition. If you are having a hard time finding a job, you can look for help from an employment agency, supported employment services or close family members or friends. It is important to have support while job hunting; seek it from friends, from a job-hunting club, a support group, or a peer-run drop-in center.

Self-Employment
Some people are not interested in traditional employment-working for someone else-but are able to work for themselves. You might want to start and grow your own business. Do you have a product or service that you can sell? Do you have a hobby or skill like jewelry making, baking, or playing and instrument? Can you provide a service such as lawn mowing, pet-sitting, or writing and editing?
Working for yourself enables you to set your own schedule, and avoids the problem of disclosing your condition that sometimes arises in the workplace. On the other hand, it demands self-discipline and for tax purposes, you need to track your expenses and income.
To prepare yourself, develop a simple business plan that outlines what you plan to sell, your customers, your competition, and your expenses. You can get help with starting your own business from local offices of the Small Business Administration, your county or state economic development office or craft guilds and associations. Also, be sure to contact your state’s vocational rehabilitation office for help with self-employment.
The Abilities Fund (http://www.abilitiesfund.org/index.php) is an organization that provides assistance to people with disabilities interested in self-employment and entrepreneurship.

Common Work-Related Issues

How will working affect my government benefits?
If you have a mental health condition, you may receive Social Security or other government-funded disability benefits, or private disability benefits from a previous employer. While disability benefits typically pay below a wage you would expect to get while working, they provide regular income. Additionally, if you are on disability and/or below the poverty line, you may receive health care through Medicaid or Medicare. Remember, too, that eligibility for housing programs and the rent you pay may be affected by your income.
Having a paying job or earning other types of income can affect your status in Medicaid or Medicare. This does not mean you should be afraid to work, it means it is important to understand the rules before you work. While the interaction between Medicaid and Medicare can be complicated, under either program, you can earn a certain amount of money without losing your benefits.
Because everyone’s situation is different, you should always talk to a trusted and knowledgeable person who can help you understand your work options and how your choices will affect your benefits. A good starting place is reading about Social Security Administration work incentives and reading the SSA manual called the Red Book. Contact your Social Security office, local Center for Independent Living or Office of Vocational Rehabilitation to find people with special training to help you understand how the rules apply to you. Case managers at your mental health center also may be able to help.
The Social Security Administration sponsors a program called Ticket to Work. Ticket to Work is a voluntary and free program where people with disabilities receiving social security are helped to go back to work by a local employment network. For information call 1-866-968-7842.

What are some things to watch out for?
If you haven’t worked in a while, here are some things you need to pay attention to:
Look out for advertisements that promise large sums of money for small amounts of work, such as making $2,000 a week while learning to buy and re-sell houses or making $3,000 a week sitting at home using your computer. Very few, if any, people make money doing these activities, and it may end up being harmful.
•The possibility of working from home may be very appealing to you. Be sure to look into such opportunities very carefully to be sure they are legitimate.
•When you work, your employer must withhold payroll taxes and Social Security tax. Beware of people who don’t ask you to fill out any tax forms or take taxes out of your paycheck. You can get in legal trouble if you don’t pay required taxes, and it might keep you from receiving government benefits.
•If you receive Social Security disability benefits, you must report your income regularly. Keep original pay stubs as proof of your earnings in case questions arise.

What are some other things I might need while looking for a job?
Documents – When you apply for a job, you will need certain documents to verify your identity and your right to work in the United States. A U.S. passport usually satisfies all requirements, but if you don’t have a passport, you will need other forms of ID, including a state-issued picture ID, a social security card or a birth certificate. If you don’t have a driver’s license, your state’s Department of Motor Vehicles (DMV) office can still issue you a walker’s ID.
E-mail, phone and permanent address – If you’re moving around frequently or staying with friends, you will still want an e-mail address, phone number and a permanent address that you can check regularly for your work. A cell-phone enables employers to contact you quickly. If you visit family and friends and trust them, ask if you can use their address temporarily. Otherwise, you might want to consider getting a P.O. Box from a local post office. You can get a free e-mail address from Yahoo, Google g-mail, MSN and other sources.
Transportation – You might also encounter a problem with transportation. If you do not have a car, you should always ask the places you’re interested in working for if they are accessible by public transportation.

How do I explain the gaps in my employment history?
If you have been out of work or changed jobs frequently because of your mental health condition, your resume may reflect that.
Highlight your skills first. Most people are used to a chronological resume, which shows the jobs you worked with your most recent job first. A functional resume displays your list of skills and qualifications before it shows a chronological breakdown of where and when you worked. Stress your skills, abilities and expertise first.
Be honest. One of the worst things you can do is lie in an interview or on a resume. If your employer finds out that you lied in the hiring process, he or she can usually fire you and leave you with no unemployment benefits.
Be prepared. Know what you’re going to say if or when your employer asks you why there is a gap in your employment. You do not have to disclose information about your condition during job interviews or when you are first employed.

How will my mental health condition affect my job?
If you’re already working when you are diagnosed with a mental health condition, you may be worried about the effect it will have on your employment. You may wonder how it will be possible to manage your condition and balance your work, or you may worry if you can even keep your job. Many people with mental health conditions lead very fulfilling lives, and work can be a big part of that life.
If your mental health condition affects your ability to work, you may need to ask for a reasonable accommodation under the Americans with Disabilities Act of 1990 (ADA). The Act requires that many employers make reasonable accommodations for employees with disabilities. A disability is legally defined as a physical or mental impairment that substantially limits one or more of the major life activities of a person, or a history or appearance of such impairment. You may have a disability as a result of your mental health condition.
It is illegal to discriminate against an employee in the workplace based on a disability if a reasonable accommodation can be made. However, an employer doesn’t have to make an accommodation if it would cause an undue burden-financial, administrative or otherwise-to the company. Asking your employer if you can take two small breaks instead of one large lunch break might be considered reasonable if it doesn’t interfere with your ability to help customers. Asking an employer to build you a soundproof quiet space if you work at a train station might not be considered reasonable. Some small organizations may also be exempt from ADA requirements based on their size.
Plan ahead before you bring up the subject of disability and reasonable accommodations. Make sure that you know what elements of your disability are interfering with what parts of your job and what specific steps you can take to address those concerns. Don’t assume that because the ADA is the law that your employer will be familiar with its requirements or receptive. Put your request in terms of help you need to keep doing a job for the employer, rather than a demand for an accommodation. It can be helpful to talk about your request with people who support you to get feedback and make you feel more comfortable. For free support, contact the Job Accommodation Network at 1-800-526-7234 or visit http://www.jan.wvu.edu/.

What if I’m uncomfortable in the workplace?
Despite efforts to educate the public about mental health and mental health conditions, you may still encounter prejudice from people who don’t know or understand what you are going through. If you think that your employer has illegally discriminated against you or violated your privacy rights because of your mental health condition, you should ask for help.
However, you might feel uncomfortable in your workplace even if your employer hasn’t done anything illegal. Maybe your co-workers are judgmental; maybe your work doesn’t offer enough benefits for someone with your condition. Or maybe, you are feeling self-conscious or awkward in a new situation.
Give yourself time to get accustomed to work and the people you work with. Be friendly, but use discretion in how much personal information, such as information about your condition, you share with others. Remember that the primary relationship at work is with your supervisor; listen carefully to what your boss asks of you, and ask for guidance when you need help or are unsure. Get feedback on the things disturbing you at work by talking with trusted friends or a support group outside of work.
You can suggest that your employer take steps to make your workplace more mental health friendly. Send your suggestions to your human resources department or your management team; many offices will have an anonymous suggestion box. Others might have a reward system in place for offering good suggestions.

What are the qualities of a mental health friendly employer?
A mental health friendly employer might have some or all of the qualities below:
•A Good Track Record – Employers who treat their employees with dignity and respect earn a good reputation. Ask people you know about any positive experiences they may have had with particular businesses that were especially accommodating. Ask your treatment team if they can recommend any local employers that stand out.
•Flexible Time and Scheduling – Businesses that allow employees to work outside of the typical hours of 9-5 have shown that they can balance worker and workplace needs to make employees more comfortable.
•Telecommuting and Part-Time – Employers who allow employees to telecommute and work from home on some or all days or allow people to work part time may be more accommodating.
•Time-off Benefits – You may want to consider an employer who offers a lot of sick and/or vacation leave or the ability to take “leave without pay.”
•Employee Assistance Program – An Employee Assistance Program (EAP) is a benefit that an employer provides where anyone who needs help can talk about his or her problems, confidentially by phone or in person. Some visits may be limited.
•Mental Health Benefits in a Health Plan – You can ask to see what kind of benefits an employer’s health plan includes. There may be different payment structures for mental or general health, depending on your employer’s size. You also might want to make sure that your mental health condition is covered and understand the process for mental health visits (if the plan restricts medication management or therapy).
•Short-Term and Long-Term Disability Plans – Short-term and Long-term disability can provide you 60% of your salary (including short-term disability) if a doctor decides you are too disabled to work. Some disability plans may also cover mental health conditions.

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Eat Well

How Healthy Eating Helps

Mom was right: You’ve got to eat well to function well. Just in case you didn’t gobble up Mom’s wisdom, here are some useful tidbits.
Among other benefits, good food can:
•boost your energy
•lower the risk of developing certain diseases
•provide fuel to your brain
• counteract the impact of stress on your body
•affect mood-related body chemicals
In an unhappy twist, good nutrition can help at times of stress, but that’s exactly when lots of us tend to eat less well. According to a recent survey nearly half of Americans overeat or eat unhealthy food to cope with stress. In fact, it’s not just that we’re seeking creamy comfort—our stress hormones actually give us the munchies.
Still, if you follow some reasonable guidelines you may be able to reduce your stress and promote your overall health and well-being.

The Basic Ingredients
No one knows exactly which foods promote maximum mental health. But following some basic suggestions can boost your energy, mood and overall wellness. We can’t cover all the elements of nutrition here, so we’re offering a few morsels:
•Consider Uncle Sam’s recipe. The U.S. Department of Agriculture, which builds the food pyramid, says a healthy diet •emphasizes fruits, vegetables, whole grains and fat-free or low-fat dairy products
•includes lean meats, poultry, fish, beans, eggs and nuts
•is low in saturated fats, trans fats, cholesterol, salt and added sugars

For additional nutritional information, see mypyramid.gov. You’ll find a food tracker, menu planner and other tools.

•Don’t skip meals. Eating consistently throughout the day provides your brain and body with a steady supply of fuel. It also prevents your blood sugar from dropping, which can cause nervousness, irritability and other problems.
•Snack well. Sustain your energy—and your ability to resist the vending machine—by packing healthy snacks. Try to keep some nuts, whole or dried fruit or other portable food in your bag or backpack.
•Work on your balance. Maybe you know that your body needs a varied diet. But have you thought about your brain? Your brain needs a healthy supply of carbohydrates, fats and proteins, or it can’t perform functions that affect your mood and thinking.
•Don’t over-diet. Eat to be healthy and fit—not to fit into a certain pair of jeans. Strict food rules usually backfire, and excessive dieting can be dangerous. If you or someone you know seems at risk of an eating disorder, professional couseling may help.

Food Warnings
Some foods just pack on pounds and bring no nutrition to the table. Others can deflate your mood or wreck your sleep. Still, you probably don’t have to give up all your goodies. Take a look at a few cautions:
•Be carb smart. Carbohydrates can boost the body chemical serotonin, creating a relaxed feeling. But sweets and other refined carbs can cause your blood sugar to rise and drop, ultimately resulting in a loss of energy. To stay steady, pick carbs that enter your blood slowly and evenly, like whole-grain breads, fruits and veggies.
•Reduce saturated fat and cholesterol. Your brain needs a strong blood supply to function well. Saturated fats and cholesterol can narrow your blood vessels, so watch out for too much red meat, egg yolks, butter and whole milk. Look for healthy fats like the ones found in fish, avocados, olive oil and nuts.
•Limit alcohol. If you’re stressed out, alcohol may seem to offer relief. However, it actually adds stress to your body and cause problems like disturbed sleep and poor judgment.
•Cut back on caffeine. Caffeine is a stimulant, so it can make you nervous and restless. A cup of coffee can also wreck your sleep—even if you drink it hours before bed. Caffeine also may worsen depression. If you’ve been imbibing a lot, cut back slowly or you’ll risk withdrawal.

Diet and Depression
Some evidence links depression and nutrition, though some of the research is still under debate. Nutrients that may play a role in combating depression include:
•Vitamin B-12 and folate. Good sources of B-12 are fish like salmon and trout and fortified breakfast cereals. Folate is found in dark leafy vegetables, almonds, dairy and fortified whole-grain breakfast cereals.
•Omega-3 fatty acids. The best sources of omega-3 fatty acids are fatty fish like salmon, catfish and trout. Other sources include ground flaxseeds, walnuts and omega-3 fortified eggs.
If you’re feeling depressed, diet alone is likely not the answer. Consider contacting a mental heealth professional.

BIPOLAR SERENITY PRAYER”
God- Life is about more than me. There is a meaning and design to the world independent of what I think or feel. The first (and maybe biggest) trap of bipolar is to convince you that “it” is all about you and the measure of how things are is how you feel. “Life is not about what I can or cannot control, thank goodness, because so much of this is beyond my control.” There is a “higher power.” There is someone to turn to when I feel all alone and powerless and all feels loss. grant me the serenity-“Grant”- that means it is a gift.

It is not something I earn or create. Serenity is not something that I accomplish. It is something I accept. And again it means giving up my need to control. “If everytime I say control I could change it to manage or influence my life would be so much better.” Serenity is a focus on here and now. It is not being angry or sad about things gone wrong, or anxious about things yet to go wrong. Serenity is about taking things as they come. To accept the things I cannot change-acceptance is such a major part of dealing with this. So much time is needlessly worrying about “what I got”, and not enough about “what I do with it.” Control is a focus on what I got. Management is a focus on what I do with it. A first rule of walls- “No matter how much you bang your head on them it doesn’t create a door to walk through.” the courage to change the things I can..

To live with bipolar means to be scared. There is a good reason some people call it a “terminal disease.” Positive steps are sometimes so small that they don’t always even seem a step. There are enough wounds and scars that you can’t help but worry sometimes about what is next. “And sometimes it so hard and so tiring and seems so impossible you just don’t want to try. Giving up seems to make such good sense.”

And the wisdom to know the difference-The beginning of all is to know. “Knowledge is necessity.” A big part of knowing what to do is knowing what you got. Another major part of wisdom is staying focused. Looking. Not assuming that because something feels so it doesn’t make it so. Wisdom also means realizing when you are not being so smart. The smartest thing is to be able to see our foolishness quick enough not to wreck. It is important to realize that these things don’t just happen sequentially. It isn’t just do this first and this second and so on. Each one feeds into the other and the other feeds into it. Serenity helps give you courage, but courage increases your serenity. Wisdom helps to develop both, but each of them also increases wisdom. It is a net in effect. The serenity prayer in a real way is a safety net to keep you from drowning in the high waters of bipolar.
God grant me the serenity to accept the things I cannot change the courage to change the things I can and the wisdom to know the difference.
Amen

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