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Nurturing Relationships through Recovery;

Having a mental illness shouldn’t keep you from enjoying fulfilling relationships of all kinds, from close friendships to romantic relationships and even marriage. Mental illness is fairly common. In reality, there are many people with mental health conditions in loving and nurturing relationships who share their lives with their partners, often raising families with them. Romantic relationships can be enriching, delightful and meaningful, but negotiating the ups and downs of such relationships can also be a major challenge, especially for those with a mental illness.

No relationship, no matter how loving, is problem-free. One partner may have a poor credit score, making it hard to find a place to live or lease a car; the other might work the night shift, making it difficult to schedule events during normal times; and couples who appear to get along perfectly may have disagreements over the smallest matters. Despite the difficulties that can occur in a relationship when one or both partners have a mental illness, relationships can thrive when both partners learn how to communicate and compromise.

Each partner brings many things, both strengths and limitations, to their relationships. Living with a mental illness may be your particular challenge. You are wise to be concerned in advance how you might affect your partner, but it is important to realize that hard times are a part of all relationships. Partners who care for each other can grow from facing difficulty.

Whether or not you are ready to enter a relationship largely depends on you. While it is true that many people harbor prejudices – a 2004 study showed that while 71% of people would be friends with someone with a mental illness, only 12.8% would be willing to marry.1 Yet, as long as you are taking good care of yourself and are willing to nurture another person, you have a good chance of finding a loving partner and developing a successful relationship. You must keep in mind, however, that relationships are two-way streets, and you will have to be prepared to take on the responsibility of having a significant other in your life. Their emotional needs must be considered as well as your own.

The more active you are in managing your condition and caring for your health, the easier it may be for you to maintain a relationship.

When should I bring up my mental illness?
Knowing when to bring up your mental illness can be a very difficult decision, but the choice is always yours.
Some people choose to be completely up front about having a mental illness. Others are more tentative. If you are casually dating, you may not want to bring it up on the first date. Many people expect that first dates are about small talk, and sensitive personal subjects like religion, politics, family history, and illness shouldn’t be brought up. If you have been dating a while, however, and are starting to become exclusive or serious, or if you’re talking about moving in or getting married, you should definitely talk with your partner about your mental illness if you haven’t already. Keeping a mental illness a secret from a romantic partner may harm your relationship in irreparable ways. If your illness is out in the open, you and your partner can work together to improve your life.

What is my partner feeling?
Your partner’s reaction to your mental illness can vary from day to day. Below are brief descriptions of some of the feelings that he or she may experience:
Confusion – Your partner might think that the symptoms of your mental illness represent a major change in his life; it may take your partner some time to realize that having a mental illness doesn’t change who you are.

Hurt – Your partner may be hurt if you have been keeping a secret or if your behaviors while unwell are damaging. She may feel betrayed or lied to. Sometimes, this can come across as anger.

Relief – If you have been struggling in your relationship for some time, fighting over small things or withdrawing into your corner, your partner may be relieved to hear that it is a new or changing symptom of your illness, not a problem with you.

Sadness – Your partner cares about you, so he may be sad to see you unwell.

Support – Your partner may be overwhelmingly loving and supportive.

Ignorance – Some people still do not understand what it means to have a mental illness. You may run into people who will never believe that your brain can be affected.

How can I educate my partner about my mental illness?

Unless your partner is a behavioral health professional, she probably knows little about mental illness, and what she does know may be based on incorrect assumptions or stereotypes. By educating your partner, you can better help him or her understand what you are going through and make it easier for him or her to cope with the symptoms and effects of your illness.

Talk to your partner about your disorder. It may be helpful to answer the following questions:

•What are the symptoms of the disorder?
•What are some common behaviors that people with this disorder exhibit?
•What are the treatments for the disorder?
•What are the side effects of the treatment?

Think about how your disorder could affect your partner. Symptoms of some mental illnesses or common behaviors associated with those conditions may have an impact on your interpersonal relationships. If you spend your entire paycheck in one day during a manic phase, for example, you may lie to your partner about it and create trust issues. If you are constantly worried that your partner will leave you, you may engage in clingy behaviors to try and constantly validate yourself.

Talk to your therapist or seek support from others who have been in relationships and learn how to understand your mental illness and how it impacts your relationship. Learn how your reactions to your symptoms and your behaviors may affect another person. It may be helpful to step back when you are well and make a list of all the behaviors you exhibit when you are unwell and think about how those are related to your condition.

When you are well is an especially good time to discuss your insights with your partner. If you know that withdrawing from the world is a sign of depression and you are prone to withdrawing, help your partner understand why you do it. He may assume that you do not like him, when it’s the opposite – you like him too much and are worried that you will bring him down.

Be prepared to offer constructive suggestions to your partner – and take suggestions as well. For instance, your partner may think he is helping you manage an eating disorder by following you into the bathroom after you eat, but you feel uncomfortable and violated. Instead, suggest that you both take a 30-minute walk after dinner so you aren’t tempted to purge. Or you may be embarrassed by your ill behavior when you are feeling well. It may be a sensitive subject and hard to hear about the things that you said or did when you were ill. Nonetheless, you will still need to listen to what he says.
Your therapist or your peers can be an excellent source of communication strategies. There are also a lot of people who are like you asking questions on the Internet.

Take Care of Your Partner:

Caring for another person is both motivating and rewarding, but it can put a lot of stress on a partner, especially if you are very ill for long periods of time. Always make sure to remember that a partnership goes both ways. You should make sure that you take time to acknowledge your partner because your partner may be worried that talking about his or her problems will burden you if you are not well.

Stay Well:
Stay as well as you can: eat well, exercise regularly, have good hygiene, follow the correct treatment course. When you have a romantic partner, you are not just staying well for you-you’re staying well for her. Your partner may expect you to stay on your treatment course in order to stay in the relationship. You also may need to be prepared to take some time apart.

Counseling Together:
If you are struggling in a relationship, there are many therapists who do counseling specifically with couples. Some people will be happy to go to family counseling. But while your partner may be comfortable with your treatment, he may be reluctant or opposed to going to counseling.
If it’s OK with your therapist, you can invite your partner to a counseling session so he can understand more.

Even if your partner won’t go to counseling with you, you can always talk about your relationship to your therapist. Your therapist or counselor can teach you coping and communication techniques and help you understand what another person is going through.

Encourage your partner to seek support:
There are numerous support groups for people whose loved ones have mental illnesses or addictions. A support group or online community of other friends and family members can provide a great place for your partner to talk to others.

Be the Best Parent You Can Be;

Mental health conditions can affect any person regardless of gender, age, health status and income, and that includes people who have or want to have children of their own. Parenting is both greatly rewarding and a daunting task for anyone, but it poses some particular challenges for people with a mental health condition. Here, you will find information about parenting and mental illness, where to go to get help for you and your family, and how to support yourself and your children.
Everyone can improve on their parenting skills. Consider taking a parenting class to learn the basics and lessen the anxiety of being a parent.

What impact does a parent’s mental illness have on children?
The effect of a parent’s mental illness on children is varied and unpredictable.[1] Although parental mental illness poses biological, psychosocial and environmental risks for children, not all children will be negatively affected, or affected in the same way. The fact that a parent has mental illness alone is not sufficient to cause problems for the child and family. Rather, it is how the mental health condition affects the parent’s behavior as well as familial relationships that may cause risk to a child. The age of onset, severity and duration of the parent’s mental illness, the degree of stress in the family resulting from the illness, and most importantly, the extent to which parents’ symptoms interfere with positive parenting, such as their ability to show interest in their children, will determine the level of risk to a child. The child’s age and stage of development is also important.

Will my child have a mental health condition as well?
Mental health conditions are not contagious, but research shows that some mental health conditions may have a genetic link. Bipolar disorder, for example, has long been shown to run in families. Other people may pass on hereditary traits that make a mental health disorder more likely without passing on a specific disorder.
Because you have a mental health condition does not mean that your child will have a mental health condition. But because of your own experiences, it may help you be better attuned to the psychological challenges that parenting can bring.

Risk Factors
Children whose parents have a mental illness are at risk for developing social, emotional and/or behavioral problems. An inconsistent and unpredictable family environment, often found in families in which a parent has mental illness, contributes to a child’s risk. Other factors that place all children at risk, but particularly increase the vulnerability of children whose parents have a mental illness, include:
•Poverty
•Occupational or marital difficulties
•Poor parent-child communication
•Parent’s co-occurring substance abuse disorder
•Openly aggressive or hostile behavior by a parent
•Single-parent families
Families at greatest risk are those in which mental illness, a child with their own difficulties, and chronically stressful family environments are all present. Many of these factors, however, can be reduced through preventive interventions. For example, poor parent-child communication can be improved through skills training, and marital conflict can be reduced through couple’s therapy.

The Prevention Perspective
Whether or not children of parents with mental illness will develop social, emotional, or behavioral problems depends on a number of factors. These include the child’s genetic vulnerability, the parent’s behavior, the child’s understanding of the parent’s illness, and the degree of family stability (for example, the number of parent-child separations). Preventive interventions aimed at addressing risk factors and increasing children’s protective factors increase the likelihood that they will be resilient, and grow and develop in positive ways. Effective prevention strategies help increase family stability, strengthen parents’ ability to meet their children’s needs, and minimize children’s exposure to negative manifestations of their parent’s illness.[2]

Protective Factors
Increasing a child’s protective factors helps develop his or her resiliency. Resilient children understand that they are not responsible for their parent’s difficulties, and are able to move forward in the face of life’s challenges. It is always important to consider the age and stage of development when supporting children. Protective factors for children include:
•A parent’s warm and supportive relationship with his or her children
•Help and support from immediate and extended family members
•A sense of being loved by their parent
•Positive self-esteem
•Good coping skills
•Positive peer relationships
•Interest in and success at school
•Healthy engagement with adults outside the home
•An ability to articulate their feelings
•Parents who are functioning well at home, at work, and in their social relationships
•Parental employment
References:
1. Joanne Nicholson, Elaine Sweeny, and Jeffrey Geller. Mothers With Mental Illness: I. The Competing Demands of Parenting and Living With Mental Illness. Psychiatric Services. May 1998. Vol. 49. No. 5.
2. Ibid.

How do I talk to my child about my mental health condition?
How you talk to your child about your mental health condition will depend on the age and maturity of your child and your willingness to open up to him or her.
In general, children, especially as they grow older, are very astute and knowledgeable about their surroundings. They can sense emotional changes and can often tell if something is hidden from them without their knowledge. Some children may be able to fully understand what it means to have a mental health condition. In talking with children you can help them to know how to cope when you are not feeling well. And, a child may be able to support you in your recovery by reminding you when to take your medications or help you stay on track.

Your decision to talk to your child about your condition should also take into account your readiness. Parents often want to appear invincible and strong to their children, as they think it is the parents’ role to care for a sick child and not the other way around. The decisions you make should be made with both parent and child in mind.
Before proceeding, you should always talk to your doctor or therapist about the best ways to bring this information up. You may want to consider the possibility of inviting a child to a session to explore this information.

What can I expect from my child?

Your child might experience some of these feelings:

•Anger – Your child may be angry at you for having a mental health condition. The child may think that it was your fault that you had a mental health condition and that it is your fault that they will experience a harder life. Your child might also be angry at external forces, such as a higher power or the world, for unfairly hurting you or your family. Your child may also be angry at him or herself. If you notice anger problems in your child, you should talk to your therapist or doctor about arranging for your child to join in sessions.

•Fear – Your child might be scared about what the future will bring. Your child might be afraid about how your mental health condition will change your relationship. They might be afraid about your ability to take care of them. Your child may also be scared about what others will think if they found out that you have a mental health condition. Sit down and talk to your child about these issues, reassure them you still love them.

•Guilt – Your child may blame himself or herself for your mental health condition, especially in cases or anxiety or depression. Your child may express guilt by taking over an inordinate amount of household duties. Your child may try and hide his or her own problems so as not to make your life any worse.

•Shame – Despite efforts to educate the public about mental illness, mental illness is still often a stigmatized and misunderstood condition. Your child might be embarrassed. He or she might think that your condition will have negative impacts on his or her social life and might be worried.

•Sadness – Children can become very sad when they learn that a loved one, especially a parent, is hurt or sick. You should talk to your doctor about ways to cope with sadness and ways to know when sadness becomes depression.

•Anxiety – Your child may become overanxious or worried about you if he or she learns that you have a mental health condition. These children tend to be overly helpful and may miss out on their own lives.

•Relief – For some children, learning that you have a mental health condition might be a relief. It might help explain behaviors or incidents that they experienced that they previously could not understand.

•Supportiveness – Your child may be very supportive of your mental health, regardless of his or her previous attitudes toward mental illness. Often, having mental illness in a family can change someone’s orientation toward mental illness.

How can I care for a child while caring for myself?
In addition to being a parent, you are also a person of your own. Your recovery plans and activities should always include time for yourself that is relaxing and beneficial.
If you have a crisis action plan or a psychiatric advance directive, you should designate someone to help with your parenting duties. If your child is old enough, you should discuss your plan with your child and identify resources and options together for handling things when you are not well.

Could I lose my child because I have a mental health condition?
A higher proportion of parents with serious mental illness lose custody of their children than parents without mental illness. There are many reasons why parents with a mental illness risk losing custody, including the stresses their families undergo, the impact on their ability to parent, economic hardship, and the attitudes of mental health providers, social workers and the child protective system. Supporting a family where mental illness is present takes extra resources that may not be available or may not be offered. Also, a few state laws cite mental illness as a condition that can lead to loss of custody or parental rights. One unfortunate result is that parents with mental illness might avoid seeking mental health services for fear of losing custody of their children. Studies that have investigated this issue report that:

•Only one-third of children with a parent who has a serious mental illness are being raised by that parent.

•In New York, 16 percent of the families involved in the foster care system and 21 percent of those receiving family preservation services include a parent with a mental illness.

•Grandparents and other relatives are the most frequent caretakers if a parent is psychiatrically hospitalized, however other possible placements include voluntary or involuntary placement in foster care.[1]
The major reason states take away custody from parents with mental illness is the severity of the illness, and the absence of other competent adults in the home.[2] Although mental disability alone is insufficient to establish parental unfitness, some symptoms of mental illness, such as disorientation and adverse side effects from psychiatric medications, may demonstrate parental unfitness. A research study found that nearly 25 percent of caseworkers had filed reports of suspected child abuse or neglect concerning their clients.[3]
The loss of custody can be traumatic for a parent and can exacerbate their illness, making it more difficult for them to regain custody. If mental illness prevents a parent from protecting their child from harmful situations, the likelihood of losing custody is drastically increased.

Legal Issues

All people have the right to bear and raise children without government interference. However, this is not a guaranteed right. Governments may intervene in family life in order to protect children from abuse or neglect, imminent danger or perceived imminent danger. When parents are not able, either alone or with support, to provide the necessary care and protection for their child, the state may remove the child from the home and provide substitute care.
Adoption and Safe Families Act

The Federal Adoption and Safe Families Act, Public Law 105-89 (ASFA) was signed into law November 19, 1997. This legislation is the first substantive change in federal child welfare law since the Adoption Assistance and Child Welfare Act of 1980, Public Law 96-272.4 It is intended to achieve a balance of safety, well-being and permanency for children in foster care. It requires that state child welfare agencies make “reasonable efforts” to prevent the unnecessary placement of children in foster care and to provide services necessary to reunify children in foster care with their families. ASFA establishes expedited timelines for determining whether children who enter foster care can be moved into permanent homes promptly-their own familial home, a relative’s home, adoptive home, or other planned permanent living arrangement.

While ASFA is designed to protect children, it also includes provisions pertaining to parental rights. For example, under ASFA, parents have the right to receive supports and services to help them retain custody and keep their families intact. The child welfare system must provide these services according to an individualized plan that has been developed and agreed upon by all parties to ensure parents with mental illnesses are not discriminated against due to their illness. A plan with parental input also helps ensure that, when appropriate, efforts are made by state welfare agencies to promote family permanency, including establishing whether children in foster care can be moved into a permanent living situation.

Helping Families Stay Intact

Parental mental illness alone can cause strain on a family; parental mental illness combined with parental custody fears can cause even greater strain. Such strain, as well as the lack of specialized services for families in the child welfare system and the overall stigma associated with mental illness, makes it difficult for families to get the help they need. With the right services and supports though, many families can stay together and thrive. The following efforts by advocates can help families living with mental illness maintain custody and stay intact:

•Help parents become educated about their rights and obtain legal assistance and information.
•Advocate for parents as services plans are developed, and assist adult consumers to develop their own self-care plans and advance directives to strengthen their parenting skills and manage their own illness.
•Enable parent-child visitation during psychiatric hospitalization to maintain the bond between parent and child.
•Train child protective services workers to better understand parental mental illness.
•Educate the legal system about advances in the treatment of serious mental illness.
•Advocate for increased specialized services for parents with serious mental illnesses available through the court system.

If your community has been hit by a natural disaster, you’re probably trying to make sense of what happened and deal with the stress of the situation. These events create a tremendous amount of stress and anxiety for those directly and indirectly affected. In the days and weeks following the disaster, you may begin to have some of these common reactions:

Common Reactions

•Disbelief and shock
•Fear and anxiety about the future
•Disorientation; difficulty making decisions or concentrating
•Apathy and emotional numbing
•Nightmares and reoccurring thoughts about the event
•Irritability and anger
•Sadness and depression
•Feeling powerless
•Changes in eating patterns; loss of appetite or overeating
•Crying for “no apparent reason”
•Headaches, back pains and stomach problems
•Difficulty sleeping or falling asleep
•Increased use of alcohol and drugs

Tips for Coping

It is ‘normal’ to have difficulty managing your feelings after major traumatic events. However, if you don’t deal with the stress, it can be harmful to your mental and physical health. Here are some tips for coping in these difficult times:

•Talk about it. By talking with others about the event, you can relieve stress and realize that others share your feelings.

•Spend time with friends and family. They can help you through this tough time. If your family lives outside the area, stay in touch by phone. If you have any children, encourage them to share their concerns and feelings about the disaster with you.

•Take care of yourself. Get plenty of rest and exercise, and eat properly. If you smoke or drink coffee, try to limit your intake, since nicotine and caffeine can also add to your stress.

•Limit exposure to images of the disaster. Watching or reading news about the event over and over again will only increase your stress.

•Find time for activities you enjoy. Read a book, go for a walk, catch a movie or do something else you find enjoyable. These healthy activities can help you get your mind off the disaster and keep the stress in check.

•Take one thing at a time. For people under stress, an ordinary workload can sometimes seem unbearable. Pick one urgent task and work on it. Once you accomplish that task, choose the next one. “Checking off” tasks will give you a sense of accomplishment and make things feel less overwhelming.

•Do something positive. Give blood, prepare “care packages” for people who have lost relatives or their homes or jobs, or volunteer in a rebuilding effort. Helping other people can give you a sense of purpose in a situation that feels ‘out of your control.’

•Avoid drugs and excessive drinking. Drugs and alcohol may temporarily seem to remove stress, but in the long run they generally create additional problems that compound the stress you were already feeling.

•Ask for help when you need it. If your feelings do not go away or are so intense that they interfere with your ability to function in daily life, talk with a trusted relative, friend, doctor or spiritual advisor about getting help. Make an appointment with a mental health professional to discuss how well you are coping with the recent events. You could also join a support group. Don’t try to cope alone. Asking for help is not a sign of weakness.

“FINDING A HOME”

One of the biggest issues some people with mental illness face is the availability of housing. For many people, having a mental health condition has no impact on their housing. Most people can and do live independently in apartments or in their own homes. For others, the cascading effects of mental illness might leave them in a precarious housing situation, or even cause them to lose their homes. Having a safe and secure place to live is an important part of recovery, along with access to services that enable those with mental health conditions to live as independently as possible.
Having a mental health condition can make finding and keeping a home challenging.

If you are poor, renting an apartment may be beyond your means. Affordable housing may be available, but located in unsafe or hard to reach places. You may be placed in a group home or apartment where there will be rules to follow and you will be living at close quarters with people you don’t know. Your illness can interfere with your ability to comply with rules, keep your home up, get along with others or meet lease requirements. Nonetheless, there is cause for hope as you travel along your road to recovery. Although it may take some time to find yourself a home, the different types of housing described here can provide you with the services, support and affordability that you need at this time in your life.

Affordable Housing
Temporary Housing
Permanent Housing
Keeping Your Home

AFFORDABLE HOUSING:

A number of different kinds of affordable housing have been developed that might be available in your area. They are geared for people with mental illness and other disabilities, homeless people, low-income people and elderly people. Choices and waiting lists vary greatly depending on where you live. To find out what is available, you can talk to your community mental health agency, your local housing authority, social service agencies, and mental health or housing advocacy organizations.

Centers for Independent Living frequently provide housing referral assistance and advocacy for people with disabilities, including those with mental health conditions. You can find a virtual list of Centers for Independent Living at http://www.virtualcil.net/cils/.

TEMPERARY HOUSING:

Each state has information on temporary housing, often through a bureau or office for housing or disability assistance. The U.S. Department of Housing and Urban Development (HUD) has information on local homelessness assistance and help with preventing housing loss.

Their portal-http://portal.hud.gov/portal/page/portal/HUD/topics/homelessness/localassist-can direct you to state specific resources.

Homeless Shelters provide emergency housing for adults or families with children. Operated by local governments, nonprofit organizations and churches, some shelters provide mental health counseling and other supports. Shelter residents usually have to be out of the shelter during the day, and may be required to look for employment.
SocialSecurityLaw.com has information on low cost and temporary housing resources by state. Their website directs you to shelters and describes the specific populations they serve and the additional resources they provide.
Some mental health agencies operate transitional housing programs for their clients as a bridge between homelessness and permanent housing. In such a program, you may be required to attend meetings and classes and follow rules to remain in the program.

PERMANENT HOUSING:

Licensed care homes, assisted living facilities and nursing homes provide highly structured living for people with severe mental illness, disability or medical complications. With access to staff 24-hours a day and meals provided, residents usually pay most of their income except for a small allowance. While necessary for some, these institutions generally do not promote independence and recovery.
Group homes and other types of supportive housing combine housing and services in an enclosed and supportive setting. Participants in supportive housing share rooms or rent individual apartments in a location set aside for people who meet specific criteria. Some group homes or apartments, for example, may be set aside for those who are both homeless and have a mental health condition; while other locations might be available only for women with mental health conditions.

Supportive housing residents usually receive life skills or job training. They also tend to have access to 24-hour crisis support services, although these services may not be available onsite.
Supported housing services place people with mental health conditions in a variety of living arrangements where they may live among people who do not have mental illness. Thus, supported housing integrates people into the community. The degree of support residents receive while living in supportive housing can vary from frequent visits by a housing counselor to independent living with minimal support. While you live in supported housing, you may be required to attend group therapy sessions or see a psychiatrist. You may also receive help with transportation or supported education. Supported housing service will give you more choice and autonomy, but it may not offer the quick availability of services-you may have to go to another place, such as a mental health center or a drop-in center, to find those.

Consumers who are able to live independently and meet low-income guidelines qualify to live in many kinds of public housing. In these circumstances, you will usually live with other people eligible for the same type of housing. Your rent will generally be fixed at about one third of your income at the most.
Contact your local government or housing authority. You can locate your housing authority at the following link-http://www.affordablehousingonline.com/section8housing.asp. There are often waiting lists for public housing; if you’re interested in living in public housing, you should apply to be on the wait list as soon as possible.

You may also be able to use a housing voucher under a federal program known as Section 8. Usually, this works two ways. If you receive a tenant-based voucher, you can use it to rent an apartment or home where you live. The voucher is portable, so you can continue to use it when you move to a new area. A project-based voucher is attached to a particular property. If you live in a unit with a project-based voucher and you move, the Section 8 stays with the property and the next tenant uses the voucher. Under either type of Section 8, work through your local housing authority to access housing.
U.S. Department of Housing and Urban Development (HUD) has a Public Housing Program aimed at helping low-income families, the elderly, and persons with disabilities gain safe and decent housing. To be eligible you must provide information on your income, US citizenship or immigration status, and qualification as a person with a disability, an elderly person, or family member. To find out more information for this program, visit

http://portal.hud.gov/portal/page/portal/HUD/topics/rental_assistance/phprog.

If you do qualify and obtain housing through the HUD, then it is their responsibility to maintain sanitary, decent, and safe conditions. They also have the responsibility to move families to different housing, reevaluate family’s income at 12-month intervals, make sure leases are being followed, and set other charges.

KEEPING YOUR HOME:

If you lose your job and medical bills begin to pile up or your mortgage payments escalate, you may be afraid that you will lose your home. There are many resources, however, available to help you.
The U.S. Department of Housing and Urban Development (HUD) provides information on avoiding foreclosure at http://portal.hud.gov/portal/page/portal/HUD/topics/avoiding_foreclosure. You can talk to a foreclosure avoidance counselor and get information on keeping your home. To learn more about your state’s foreclosure laws visit http://www.foreclosurelaw.org/.

Hope Now-http://www.hopenow.com/-is an alliance with counselors, mortgage companies, and investors. Hope

Now provides resources for their groups and tries to facilitate conversation between them.
Making Home Affordable.gov has information and help for eligible homeowners on refinancing a home and modifying mortgage payments. If your loan is with Fannie Mae or Freddie Mac then you can look up your loan and see if you can refinance or modify it. There is also information on other mortgage service providers at http://www.makinghomeaffordable.gov/contact_servicer.html.

ADDITIONAL RESOURCES:

The National Housing Law Project is a law and advocacy center dedicated to helping low-income families get the justice they need with regards to housing. Their efforts are geared towards increasing the amount of and preserving the quality of affordable housing, improving current housing, expanding the rights of low-income tenants, and increasing opportunities for minorities. Their website, http://www.nhlp.org/, includes an attorney/advocacy resource center as well as support and help for tenants, homeowners, and the homeless.

What is Dual Diagnosis?

A person who has both an alcohol or drug problem and an emotional/psychiatric problem is said to have a dual diagnosis. To recover fully, the person needs treatment for both problems.

How Common Is Dual Diagnosis?

Dual diagnosis is more common than you might imagine. According to a report published by the Journal of the American Medical Association*:

Thirty-seven percent of alcohol abusers and fifty-three percent of drug abusers also have at least one serious mental illness.

Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.

What Kind of Mental or Emotional Problems are Seen in People with Dual Diagnosis?

The following psychiatric problems are common to occur in dual diagnosis – i.e., in tandem with alcohol or drug dependency.
■Depressive disorders, such as depression and bipolar disorder.
■Anxiety disorders, including generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and phobias.
■Other psychiatric disorders, such as schizophrenia and personality disorders.

The following table based on a National Institute of Mental Health study, lists seven major psychiatric disorders and shows how much each one increases an individual’s risk for substance abuse.

Psychiatric Disorder

Increased Risk For Substance Abuse

Antisocial personality disorder
15.5%

Manic episode
14.5

Schizophrenia
10.1

Panic disorder
4.3

Major depressive episode
4.1

Obsessive-compulsive disorder
3.4

Phobias
2.4

Thus, someone suffering from schizophrenia is at a 10.1 percent higher-than-average risk of being an alcoholic or drug abuser. Someone who is having an episode of major depression is at a 4.1 percent higher-than-average risk of being an alcohol or drug abuser…and so on.

Which Develops First – Substance Abuse or the Emotional Problem?

It depends. Often the psychiatric problem develops first. In an attempt to feel calmer, more peppy, or more cheerful, a person with emotional symptoms may drink or use drugs; doctors call this “self-medication.” Frequent self-medication may eventually lead to physical or psychological dependency on alcohol or drugs. If it does, the person then suffers from not just one problem, but two. In adolescents, however, drug or alcohol abuse may merge and continue into adulthood, which may contribute to the development of emotional difficulties or psychiatric disorders.

In other cases, alcohol or drug dependency is the primary condition. A person whose substance abuse problem has become severe may develop symptoms of a psychiatric disorder: perhaps episodes of depression, fits of rage, hallucinations, or suicide attempts.

How Can a Physician Tell Whether the Person’s Primary Problem is Substance Abuse or an Emotional Disorder?

At the initial examination, it may be difficult to tell. Since many symptoms of severe substance abuse mimic other psychiatric conditions, the person must go through a withdrawal from alcohol and/or drugs before the physician can accurately assess whether there’s an underlying psychiatric problem also.

If a Person Does Have Both an Alcohol/Drug Problem and an Emotional Problem, Which Should Be Treated First?

Ideally, both problems should be treated simultaneously. For any substance abuser, however, the first step in treatment must be detoxification – a period of time during which the body is allowed to cleanse itself of alcohol or drugs. Ideally, detoxification should take place under medical supervision. It can take a few days to a week or more, depending on what substances the person abused and for how long.

Until recently, alcoholics and drug addicts dreaded detoxification because it meant a painful and sometimes life-threatening “cold turkey” withdrawal. Now, doctors are able to give hospitalized substance abusers carefully chosen medications which can substantially ease withdrawal symptoms. Thus, when detoxification is done under medical supervision, it’s safer and less traumatic.

What Is Next After Detoxification?

Once detoxification is completed, it’s time for dual treatment; rehabilitation for the alcohol or drug problem and treatment for the psychiatric problem.

Rehabilitation for a substance abuse problem usually involves individual and group psychotherapy, education about alcohol and drugs, exercise, proper nutrition, and participation in a 12-step recovery program such as Alcoholics Anonymous. The idea is not just to stay off booze and drugs, but to learn to enjoy life without these “crutches.”

Treatment for a psychiatric problem depends upon the diagnosis. For most disorders, individual and group therapy as well as medications are recommended. Expressive therapies and education about the particular psychiatric condition are often useful adjuncts. A support group of other people who are recovering from the same condition may also prove highly beneficial. Adjunct treatment, such as occupational or expressive therapy, can help individuals better understand and communicate their feelings or develop better problem-solving or decision-making skills.

Must a Dual Diagnosis Patient Be Treated in a Hospital?

Not necessarily. The nature and severity of the illness, the associated risks or complications, and the person’s treatment history are some of the facts considered in determining the appropriate level of care. There are several different levels or intensities of care including full hospitalization or inpatient treatment, partial hospitalization, and outpatient treatment.

What is the Role of the Patient’s Family in Treatment?

With both rehabilitation for substance abuse and treatment for a psychiatric problem, education, counseling sessions, and support groups for the patient’s family are important aspects of overall care. The greater the family’s understanding of the problems, the higher the chances the patient will have a lasting recovery.

How Can Family and Friends Help with Recovery from the Substance Abuse?

They need to learn to stop enabling. Enabling is acting in ways that essentially help or encourage the person to maintain their habit of drinking or getting high. For instance, a woman whose husband routinely drinks too much, might call in sick for him when he is too drunk to go to work. That’s enabling. Likewise, family members or friends might give an addict money which is used to buy drugs, because they’re either sorry for him or afraid of him. That’s enabling also.

When family and friends participate in the recovery program, they learn how to stop enabling. If they act on what they’ve learned, the recovering substance abuser is much less likely to relapse into drinking or taking drugs.

How Can Family and Friends Help with Recovery from a Psychiatric Condition?

They should be calm and understanding, rather than frightened or critical. They should be warm and open, rather than cool or cautious. Although it is fine to ask the person matter-of-factly about the psychiatric treatment, that shouldn’t be the only focus of conversation.

If Someone I Know Appears To Have A Substance Abuse Problem And The Symptoms Of A Psychiatric Disorder, How Can I Help?

Encourage the person to acknowledge the problems and seek help for themselves. Suggest a professional evaluation with a licensed physician, preferably at a medical center that’s equipped to treat addiction problems and psychiatric conditions. If the person is reluctant, do the legwork yourself – find the facility, make the appointment, offer to go with the person. A little encouragement may be all it takes. If you talk to the physician first, be honest and candid about the troubling behavior. Your input may give the doctor valuable diagnostic clues.

There Is Hope

As a relative or friend, you can play an important role in encouraging a person to seek professional diagnosis and treatment. By learning about dual diagnosis, you can help this person find and stick with an effective recovery program.

The more you know about dual diagnosis, the more you will see how substance abuse can go hand-in-hand with another psychiatric condition. As with any illness, a person with dual diagnosis can improve once proper care is given. By seeking out information, you can learn to recognize the signs and symptoms of dual diagnosis – and help someone live a healthier or more fulfilling life.

“Recognizing Warning Signs and How to Cope:”

Most people believe that mental disorders are rare and “happen to someone else.” In fact, mental disorders are common and widespread. An estimated 54 million Americans suffer from some form of mental disorder in a given year.

Most families are not prepared to cope with learning their loved one has a mental illness. It can be physically and emotionally trying, and can make us feel vulnerable to the opinions and judgments of others.

If you think you or someone you know may have a mental or emotional problem, it is important to remember there is hope and help.

What is mental illness?

A mental illness is a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life’s ordinary demands and routines.

There are more than 200 classified forms of mental illness. Some of the more common disorders are depression, bipolar disorder, dementia, schizophrenia and anxiety disorders. Symptoms may include changes in mood, personality, personal habits and/or social withdrawal.

Mental health problems may be related to excessive stress due to a particular situation or series of events. As with cancer, diabetes and heart disease, mental illnesses are often physical as well as emotional and psychological. Mental illnesses may be caused by a reaction to environmental stresses, genetic factors, biochemical imbalances, or a combination of these. With proper care and treatment many individuals learn to cope or recover from a mental illness or emotional disorder.

How to cope day-to-day

Accept your feelings

Despite the different symptoms and types of mental illnesses, many families who have a loved one with mental illness, share similar experiences. You may find yourself denying the warning signs, worrying what other people will think because of the stigma, or wondering what caused your loved one to become ill. Accept that these feelings are normal and common among families going through similar situations. Find out all you can about your loved one’s illness by reading and talking with mental health professionals. Share what you have learned with others.

Handling unusual behavior

The outward signs of a mental illness are often behavioral. A person may be extremely quiet or withdrawn. Conversely, he or she may burst into tears, have great anxiety or have outbursts of anger.

Even after treatment has started, some individuals with a mental illness can exhibit anti-social behaviors. When in public, these behaviors can be disruptive and difficult to accept. The next time you and your family member visit your doctor or mental health professional, discuss these behaviors and develop a strategy for coping.

Your family member’s behavior may be as dismaying to them as it is to you. Ask questions, listen with an open mind and be there to support them.

Establishing a support network

Whenever possible, seek support from friends and family members. If you feel you cannot discuss your situation with friends or other family members, find a self-help or support group. These groups provide an opportunity for you to talk to other people who are experiencing the same type of problems. They can listen and offer valuable advice.

Seeking counseling

Therapy can be beneficial for both the individual with mental illness and other family members. A mental health professional can suggest ways to cope and better understand your loved one’s illness.

When looking for a therapist, be patient and talk to a few professionals so you can choose the person that is right for you and your family. It may take time until you are comfortable, but in the long run you will be glad you sought help.

Taking time out

It is common for the person with the mental illness to become the focus of family life. When this happens, other members of the family may feel ignored or resentful. Some may find it difficult to pursue their own interests.

If you are the caregiver, you need some time for yourself. Schedule time away to prevent becoming frustrated or angry. If you schedule time for yourself it will help you to keep things in perspective and you may have more patience and compassion for coping or helping your loved one. Being physically and emotionally healthy helps you to help others.

“Many families who have a loved one with mental illness share similar experiences”

It is important to remember that there is hope for recovery and that with treatment many people with mental illness return to a productive and fulfilling life.

Warning Signs and Symptoms

The following are signs that your loved one may want to speak to a medical or mental health professional.

In adults:

Confused thinking

Prolonged depression (sadness or irritability)

Feelings of extreme highs and lows

Excessive fears, worries and anxieties

Social withdrawal

Dramatic changes in eating or sleeping habits

Strong feelings of anger

Delusions or hallucinations

Growing inability to cope with daily problems and activities

Suicidal thoughts

Denial of obvious problems

Numerous unexplained physical ailments

Substance abuse

In older children and pre-adolescents:

Substance abuse

Inability to cope with problems and daily activities

Changes in sleeping and/or eating habits

Excessive complaints of physical ailments

Defiance of authority, truancy, theft, and/or vandalism

Intense fear of weight gain

Prolonged negative mood, often accompanied by poor appetite or thoughts of death

Frequent outbursts of anger

In younger children:

Changes in school performance

Poor grades despite strong efforts

Excessive worry or anxiety (i.e. refusing to go to bed or school)

Hyperactivity

Persistent nightmares

Persistent disobedience or aggression

Frequent temper tantrums………..

“INPATIENT what to ASK”

Of the 5.4 million people who sought mental health treatment in 1990, less than 7% required hospitalization. More than half of those who needed inpatient-care had schizophrenia, one of the most severe forms of mental illness. If you or someone you know may have a mental illness, the chances are that you will not need hospitalization. But, if you do, the following information will help assure you of the best care possible.

Questions To Ask:

■Has the person been professionally evaluated? By whom? Do I understand the diagnosis?

■If the patient has not been evaluated, why am I seeking admission for the person?
a) A doctor’s recommendation?
b) Need to have patient removed from family situation? Why? Because of behavioral problems?
c) What are they? Because family cannot care for him or her? Why?
d) What symptoms is the patient exhibiting which cause concern?

The Hospital/Treatment Center At Check-In:

■Does your facility treat patients only for this specific diagnosis?

■If the patient has other health or emotional problems will he/she receive treatment for these problems also?

■Does your facility require tests when admitted? If so, what are they?

■Who will perform these tests?

■Who will evaluate the patient when he/she is admitted?

■What are the person’s qualifications/ title?

■Will this person continue to treat the patient?

■Will the patient be seen by this professional on a regular basis?

■When will the initial evaluation take place?

During the Patient’s Stay:

■When can I (or another family member) talk to the therapist or doctor?

■Will we be able to discuss treatment with the doctor or therapist? When? How often?

■When can family members visit? For how long?

■Will the patient be allowed to receive phone calls?

■Will the patient have a daily schedule of activities or treatments?

■If so, what activities will the patient be involved in?

■Is therapy group or private and is it part of the treatment plan?

■What clothes should the patient bring?

■How long will the patient be at the facility?

■Who makes this decision?

■Will the family be advised of changes in treatment?

■Who will make the evaluation for discharging the patient? When will this happen?

Leaving The Hospital:

■Will someone advise the patient and family about adjustment concerns such as the need for further counseling or a medication schedule?

■What can we expect when the patient is discharged?

■Will he/she be on medications? Which ones?

■How will these medications help? Are they habit-forming? What are the side effects? What is the dosage?

■How long will the patient have to take this medication?

■If the patient leaves the hospital without permission how will the hospital handle this?

■If this occurs, what is the parent or family’s responsibility?

■Will the patient be able to continue school work while in the hospital? Or how soon after he or she is discharged?

■If classes are offered to patients, what are they and who teaches them?

■What follow-up treatment or support group options should the family and patient consider?

Financial And Insurance Issues:
Ask the treatment center and/or insurance company the following questions:

■Does the hospital accept this type of insurance? If not, what are the alternatives? If it does, what is covered?

■Can coverage be reviewed with a member of the staff?

■Are there separate charges and how much are they for physicians, therapists or caretakers? What may these separate charges be?

■How are fees assessed?

■When will billing occur?

■If insurance only covers part of the cost, what other arrangements can be made for payments?

■Is there other assistance available? Will the facility accept partial payments or payments on a schedule?

Ask The Therapist:
What can the patient and family expect during the treatment process?

■What can be the expected reactions/behaviors of the patient?

■How should the family respond?

■How can the patient and family prepare for unexpected behavior and possible setbacks?

SEASONAL AFFECTIVE DISORDER :

Some people suffer from symptoms of depression during the winter months, with symptoms subsiding during the spring and summer months. These symptoms may be a sign of seasonal affective disorder (SAD). SAD is a mood disorder associated with depression and related to seasonal variations of light. SAD affects half a million people every winter between September and April, peaking in December, January, and February. The “Winter Blues,” a milder form of SAD, may affect even more people.

Prevalence:
•
Three out of four SAD sufferers are women.

•
The main age of onset of SAD is between 18 and 30 years of age.

•
SAD occurs in both the northern and southern hemispheres, but is extremely rare in those living within 30 degrees latitude of the equator.

•
The severity of SAD depends both on a person’s vulnerability to the disorder and his or her geographical location.

Symptoms:

A diagnosis of SAD can be made after three consecutive winters of the following symptoms if they are also followed by complete remission of symptoms in the spring and summer months:
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Depression: misery, guilt, loss of self-esteem, hopelessness, despair, and apathy

•
Anxiety: tension and inability to tolerate stress

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Mood changes: extremes of mood and, in some, periods of mania in spring and summer

•
Sleep problems: desire to oversleep and difficulty staying awake or, sometimes, disturbed sleep and early morning waking

•
Lethargy: feeling of fatigue and inability to carry out normal routine

•
Overeating: craving for starchy and sweet foods resulting in weight gain

•
Social problems: irritability and desire to avoid social contact

•
Sexual problems: loss of libido and decreased interest in physical contact

Causes
•
As sunlight has affected the seasonal activities of animals (i.e., reproductive cycles and hibernation), SAD may be an effect of this seasonal light variation in humans. As seasons change, there is a shift in our “biological internal clocks” or circadian rhythm, due partly to these changes in sunlight patterns. This can cause our biological clocks to be out of “step” with our daily schedules.

•
Melatonin, a sleep-related hormone secreted by the pineal gland in the brain, has been linked to SAD. This hormone, which may cause symptoms of depression, is produced at increased levels in the dark. Therefore, when the days are shorter and darker the production of this hormone increases.

Treatments for Seasonal Affective Disorder
•
Phototherapy or bright light therapy has been shown to suppress the brain’s secretion of melatonin. Although, there have been no research findings to definitely link this therapy with an antidepressant effect, light therapy has been shown to be effective in up to 85 percent of diagnosed cases. Patients remain in light up to ten times the intensity of normal domestic lighting up to four hours a day, but may carry on normal activities such as eating or reading while undergoing treatment. The device most often used today is a bank of white fluorescent lights on a metal reflector and shield with a plastic screen.

•
For mild symptoms, spending time outdoors during the day or arranging homes and workplaces to receive more sunlight may be helpful. One study found that an hour’s walk in winter sunlight was as effective as two and a half hours under bright artificial light.

•
If phototherapy does not work, an antidepressant drug may prove effective in reducing or eliminating SAD symptoms, but there may be unwanted side effects to consider. Discuss your symptoms thoroughly with your family doctor and/or mental health professional.

“HOW SLEEPING HELPS:”

Sleep may seem like a waste of time. You could instead be answering e-mail, doing the dishes, repairing the deck or decking the halls. But research shows that you’re more likely to succeed at your tasks—and enjoy greater well-being—if you get some serious shuteye.
Of course, it’s not easy to sleep when you’re feeling overwhelmed. In fact, nearly two-thirds of Americans say they lose sleep because of stress. That’s especially unfortunate because sleep combats some of the fallout of stress, and poor sleep has been linked to significant problems, including:

•greater risk of depression and anxiety
•increased risk of heart disease and cancer
•impaired memory
•reduced immune system functioning
•weight gain
•greater likelihood of accidents

Creating Good Nights

Are You Getting Enough Rest?
Experts suggest that adults get seven to nine hours of sleep a night. Everyone is different, though, and you may need more after a few days of burning the midnight (or 2 a.m.) oil.
To assess your sleep deficit, ask yourself:

•Am I often tired?
•Am I using caffeine to get through the day?
•Do I sleep well?
•Do I wake up feeling refreshed?
•Do I get drowsy while driving or watching TV?

Tips for Upping Your Sleep
To sleep longer—and better—consider these suggestions:

•Set a regular bedtime. Your body craves consistency, plus you’re more likely to get enough sleep if you schedule rest like your other important tasks.
•De-caffeinate yourself. Drinking caffeine to stay awake during the day can keep you up at night. Try resisting the coffee and colas starting six to eight hours before bed.
•De-stress yourself. Relax by taking a hot bath, meditating or envisioning a soothing scene while lying in bed. Turn off daytime worries by finishing any next-day preparations about an hour before bed.
•Exercise. Working out can improve sleep in lots of ways, including by relieving muscle tension. Don’t work out right before bed, though, since exercise may make you more alert. If you like, try gentle upper-body stretches to help transition into sleep.
•Make your bed a sleep haven. No paying bills or writing reports in bed. Also, if you can’t fall asleep after 15 minutes you can try some soothing music, but if you remain alert experts recommend getting up until you feel more tired.
For additional sleep guidelines, see the National Sleep Foundation’s website. (But no computer right before bedtime!)

More Sleep Aids

If you’re considering sleep medication, you can buy one of several over-the-counter products, which generally can be used safely for a few days. As for prescription medications, the National Sleep Foundation suggests a limit of four weeks—and simultaneously working on one’s sleep habits. Never combine sleep medications with alcohol or other potentially sedating medicines, and be sure to allow at least 8 hours between taking a sleep medication and driving.
If you’re wondering about the hormone melatonin, there is evidence of its usefulness in improving sleep and helping to regulate an off-kilter sleep cycle. Still, some experts urge caution, arguing that more research is needed to determine correct dosing and timing for taking a melatonin supplement.
If you’re having serious sleep problems, see your doctor, especially if you have trouble more than three nights a week for a month. Your doctor can check whether your sleep issues are caused by some underlying health problem, like depression or a thyroid disorder, and can help with a treatment plan or referral to a sleep specialist.

Also contact your doctor if you suspect a sleep disorder, like sleep apnea, which involves snoring and gaps in breathing, or restless leg syndrome, which causes sudden urges to move your body, or if you are experiencing any unusual nighttime behaviors. It’s also reasonable to see a health care professional if you still feel tired despite getting enough sleep.
If you want help learning to cope better with sleep problems, try to locate a therapist who offers cognitive-behavioral therapy for insomnia. This treatment works by changing sleep-related beliefs and behaviors. You might, for example, rethink your notion that the whole night is ruined if you’re not asleep by 10. A sleep clinic may be able to help you locate such a therapist…..

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 following organizations may be able to help qualifying patients without prescription drug coverage get the medicines they need:
■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, call 1-888-477-2669.
■Together Rx Access can help qualifying patients without prescription drug coverage save on hundreds of name-brand and generic products and connect patients to resources about coverage options. For more information, call 1-800-444-4106.

Your local and/or state Mental Health America office is a resource for information about state and local prescription assistance programs.

Your state Medicaid office may offer information about prescription assistance and drug discount programs available in your state.

Medicare Rights Center offers information about state and national prescription assistance programs, drug discount cards, mail order and internet discount pharmacies, and prescription drug price comparison web sites. This information is not only for Medicare Part D plan participants but for anyone needing information about help paying for their prescription drugs. Use the “Help Paying for Prescription Drugs” option on the left-hand side of the page to access this information.

RX Hope has program descriptions and downloadable applications for prescription assistance programs for specific medications including psychotropic medications.

RX Assist offers a patient assistance program directory along with information about a variety of programs including drug discount cards, prescription assistance programs for generic medications, programs that help with medication co-pays, programs that provide free and low cost health care, as well as information for Medicare Part D beneficiaries.

Needy Meds has a searchable list of disease-specific assistance programs (primarily for other medical conditions) with program description and contact information (Use link under “Additional Programs” on left-hand side of home page.) Some of these programs provide a broad range of financial assistance including help with other necessary expenses such as utility bills. They also have a list of state sponsored programs which can be accessed from the link under “Government Programs” also on the left-hand side of the home page. Once you have identified programs, you can contact the Partnership for Prescription Assistance at 1-888-477-2669 for free assistance in applying for these programs.

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.

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. They are:
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.

Visit Medicare.gov to find and compare Medicare plans or to enroll