Dear Mr. President: Congratulations on your recent victory. Now, as you plan the next four years, I'd like to offer a few suggestions on how you can help those of us living with mental illness. Fight for parity in mental health treatment, work to reform the fragmented mental health system, and attack the stigma behind mental illness.

As I write this, I feel a mixture of disappointment, anxiety, betrayal and anger. While I was admitted to the alcoholism treatment center last week for rehab, treatment did not go as planned. Short version: the staff decided my psych symptoms (anxiety and flashbacks) necessitated a trip to the psych ward. They transferred me by ambulance, held on to my medication and property, then decided I no longer met criteria for inpatient admission at their facility after I spent five days on the psych ward. Sometimes treatment providers screw up. We have to know how to face it when that happens.

Last night, I decided I wanted to get sober. Since I've been drinking heavily the past few days and have had DTs in the past, I went to my treatment team's hospital and told them I was afraid to sober up in an outpatient setting. The crisis counselor and I talked for a while, then she told me they didn't have inpatient treatment for alcohol and drugs. She gave me a one-page list of places that offer substance abuse treatment and sent me home. Dual diagnosis treatment, at least in Indiana, is hard to find. And that makes a difficult situation almost impossible.

Suicide is one of the most stigmatized topics of a highly stigmatized subject. Quite frankly, we don't talk about it even if we do talk about severe mental illness. This is especially unfortunate for people with borderline personality disorder (BPD), as suicide is sadly common. But the fact that this is National Suicide Prevention Week is a way to start the conversation.

When someone suffers from borderline personality disorder (BPD), he or she needs to beware of the word "masochism". According to Dr. Aphrodite Matsakis' I Can't Get Over It, some people are quick to label a person who has experienced multiple traumas a masochist and interpret their misfortunes as a desire to be miserable. For example, when I was sexually assaulted, I was told I was "maybe not consciously" asking for it.

It's bad enough to be a trauma survivor with symptoms of borderline personality disorder (BPD). However, sometimes people hurt us further when we reach out for help--this is called "secondary wounding".

When people ask what I do, I tell them I run a freelance writing business. I'm too proud--and afraid--to tell them my major income comes from Social Security disability. If I do that, I often hear "You look fine to me." Then I'll need to explain I'm on Social Security disability due to a psychiatric condition, in which case I fear hearing "Isn't that all in your head?" There's a heavy stigma against receiving social security disability, and a bigger stigma against receiving social security disability for a mental illness.

The stigma attached to mental illness is powerful because of ignorance.  But is living openly with mental illness in an effort to change the stigma a good idea?  More Than Borderline's Becky Oberg considers this.

While I would recommend being open about one's own struggles as a way to fight stigma, which is usually due to ignorance, openness is not for everyone. Ultimately, each person has to decide for himself or herself what is right. I understand the reasons for keeping quiet about a diagnosis, especially some of the more misunderstood ones. Yet the only way we can hope to get rid of stigma is by education, and education begins with openness.

While substance abuse may or may not be present in one person's case, it is common enough to warrant suspicion on the part of the doctor, and this suspicion affects what kind of medical treatment is received.