{"id":6683,"date":"2023-10-06T15:50:30","date_gmt":"2023-10-06T15:50:30","guid":{"rendered":"https:\/\/www.sicklecelldisease.org\/?page_id=6683"},"modified":"2024-01-11T16:26:12","modified_gmt":"2024-01-11T16:26:12","slug":"mental-health-and-wellness","status":"publish","type":"page","link":"https:\/\/www.sicklecelldisease.org\/mental-health-and-wellness\/","title":{"rendered":"Mental Health and Wellness"},"content":{"rendered":"<h3 style=\"text-align: center;\"><span style=\"color: #ff0000;\"><em><span style=\"font-weight: 400;\"><strong style=\"font-size: 16px;\"><a href=\"https:\/\/www.canva.com\/design\/DAFwC2NAbqc\/2bGriCVck6H77_d225GTrA\/view?utm_content=DAFwC2NAbqc&amp;utm_campaign=designshare&amp;utm_medium=link&amp;utm_source=publishsharelink\" style=\"color: #ff0000;\">Download the presentation from the 2023 Annual National Convention!<\/a><\/strong><\/span><\/em><\/span><\/h3>\n<h1><span style=\"font-weight: 400;\"><strong>I Believe in Therapy Toolkit<\/strong><\/span><\/h1>\n<p><strong>Prioritizing Mental Health as a Sickle Cell Warrior, Caregiver, and Healthcare Worker<\/strong><\/p>\n<p><span style=\"font-weight: 400;\">As an individual living with sickle cell, caregiver, or healthcare worker, you may be accustomed to prioritizing physical health needs above all else. However, mental health is critical for overall well-being and should not be ignored. Although mental health challenges can be stigmatized and overlooked in the Black community, it is important to erase the stigma and seek the care that is needed. In this mental health toolkit, we discuss the importance of prioritizing mental health as a sickle cell warrior, caregiver, or healthcare worker and how therapy can help to achieve that goal. This resource is a sample of what is offered in the Sickle Cell Community. If you have additional resources please let us know by <\/span><a href=\"mailto:info@sicklecelldisease.org\"><span style=\"font-weight: 400;\">clicking here<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Why Mental Health Matters for Sickle Cell Warriors, Caregivers, and Healthcare Workers<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Sickle Cell Disease (SCD) is a chronic illness that affects both physical and emotional health. Individuals living with SCD may experience chronic pain, fatigue, and other physical symptoms that can negatively impact their mental health over time. Caregivers may experience<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/10\/Heather-Aruvant.png\" alt=\"\" width=\"138\" height=\"138\" class=\"size-full wp-image-6685 alignright\" srcset=\"https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/10\/Heather-Aruvant.png 138w, https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/10\/Heather-Aruvant-100x100.png 100w\" sizes=\"auto, (max-width: 138px) 100vw, 138px\" \/> emotional stress from caring for a loved one with SCD, while healthcare workers may experience burnout from caring for chronically ill patients.<\/span><span style=\"font-weight: 400;\"> \u201cPatients often feel misunderstood about the trauma of being ill.\u00a0 Missed work, school, and life in general can make it hard for a person with sickle cell to cope. Trauma surrounds each hospitalization and every emergency room visit.\u201d\u00a0 said Heather Avant, a professional photographer and Sickle Cell Warrior. <\/span><span style=\"font-weight: 400;\">Seeking therapy can provide warriors, caregivers, and healthcare workers with the emotional support and coping skills needed to manage the mental health challenges associated with SCD. As a result, each group mentioned should regularly assess their mental health from time to time.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Erasing the Stigma of Therapy in the Black Community<\/span><\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/10\/Dr.-Dejoie.png\" alt=\"\" width=\"144\" height=\"144\" class=\"size-full wp-image-6684 alignleft\" srcset=\"https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/10\/Dr.-Dejoie.png 144w, https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/10\/Dr.-Dejoie-100x100.png 100w\" sizes=\"auto, (max-width: 144px) 100vw, 144px\" \/><\/p>\n<p><span style=\"font-weight: 400;\">The \u201cI Believe in Therapy Campaign\u201d is incredibly important to us because Mental health stigmas can prevent individuals in the Black community from accessing therapy and seeking treatment for mental health challenges. Discussing mental health and seeking care can be especially challenging for individuals in positions of caregiving or healthcare service, as it may feel there is a weight of expectation to be the perceived helpers instead of the helped. \u201cHaving support, perspective, and options is essential when addressing the mental health challenges that arise along our health journey, said Dr. Majorie Dejoie-Brewer, a physician and Sickle Cell Warrior. Seeking therapy, however, is far from weakness; in fact, it\u2019s <a href=\"https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2024\/01\/Wellness-fundamentals-SCD.pdf\">a proactive step<\/a> towards a path of healing and mental well-being.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">To erase the stigma of therapy in the Black community, it is essential to have open conversations about mental health. It is important to acknowledge these conversations can occur in safe and understanding environments such as with medical professionals or, if available, support groups. We must normalize the idea that everyone struggles with mental health challenges and promote seeking help is a sign of profound courage and emotional strength.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Here&#8217;s a mental health toolkit for warriors, caregivers, and healthcare workers impacted by sickle cell disease:<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Talk to a therapist:<\/b><span style=\"font-weight: 400;\"> A mental health professional is a licensed and knowledgeable resource dedicated to treating the mental health challenges associated with SCD. Here are a few great resources to find a therapist:<\/span>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><a href=\"https:\/\/cayennewellness.org\/mental-health-and-wellness-services\/\"><span style=\"font-weight: 400;\">Cayenne Wellness Center<\/span><\/a><span style=\"font-weight: 400;\"> offers free counseling to California residents who are Sickle Cell Warriors<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><a href=\"https:\/\/www.psychologytoday.com\/us\/therapists\"><span style=\"font-weight: 400;\">Psychology Today<\/span><\/a><span style=\"font-weight: 400;\">\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><a href=\"https:\/\/providers.therapyforblackgirls.com\"><span style=\"font-weight: 400;\">Therapy for Black Girls<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><a href=\"https:\/\/mhanational.org\/im-looking-mental-health-help-myself\"><span style=\"font-weight: 400;\">Mental Health America\u00a0<\/span><\/a><\/li>\n<\/ol>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Self-Care Activities<\/b><span style=\"font-weight: 400;\">: Make time for simple acts of self-care such as exercising, taking a bath, practicing deep breathing exercises, enjoying your favorite hobby, getting adequate sleep, and eating a healthy diet. Also, prioritize doing something special regarding <\/span><a href=\"https:\/\/cleverlychanging.com\/2017\/08\/7-days-self-care-moms-school-starts\/\"><span style=\"font-weight: 400;\">your self-care daily<\/span><\/a><span style=\"font-weight: 400;\">. Elle Cole, author and sickle cell caregiver, says that it\u2019s important for her to create a daily self-care schedule even if she only spends as little as five minutes per day on self-care. She also encourages others to add self-care tasks to phone reminders or a home<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/10\/Elle-Cole.png\" alt=\"\" width=\"126\" height=\"126\" class=\"size-full wp-image-6686 alignright\" srcset=\"https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/10\/Elle-Cole.png 126w, https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/10\/Elle-Cole-100x100.png 100w\" sizes=\"auto, (max-width: 126px) 100vw, 126px\" \/> calendar so it\u2019s incorporated into a person\u2019s everyday routine.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Counseling and Support Groups:<\/i><\/b><span style=\"font-weight: 400;\"> warriors, caregivers, and healthcare workers should be encouraged to seek counseling to help them manage the emotional toll of this chronic illness. They can also join support groups where they can share their experiences and get support from others who understand what they are going through. Group therapy and support groups exist for individuals impacted by SCD, where individuals can find a vent space as well as a genuine chance for connection and support.<\/span>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Here are a few online sickle cell support groups that you can check out:<\/span>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"3\"><a href=\"https:\/\/cayennewellness.org\/community-groups-patient-awareness\/\"><span style=\"font-weight: 400;\">Cayenne Wellness Center\u2019s Community Support Groups<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"3\"><a href=\"https:\/\/mythreesicklers.org\/hangout\/\"><span style=\"font-weight: 400;\">My Three Sicklers<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"3\"><a href=\"http:\/\/www.supportsicklecell.com\"><span style=\"font-weight: 400;\">Supporting Our Sicklers (S.O.S.) Parent &amp; Guardian Support Group<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"3\"><a href=\"https:\/\/www.onescdvoice.com\/\"><span style=\"font-weight: 400;\">Onescdvoice.com<\/span><\/a><\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Educational resources:<\/i><\/b><span style=\"font-weight: 400;\"> It is important for warriors, caregivers, and healthcare workers to have reliable information about sickle cell disease so they can understand its impact on mental health. Organizations such as the <\/span><a href=\"https:\/\/sicklecellconsortium.org\/mental-health\/#1540391981930-f2864b18-9724\"><span style=\"font-weight: 400;\">Sickle Cell Community Consortium<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"https:\/\/sickcells.org\/blog\/mental-health-is-wealth\/\"><span style=\"font-weight: 400;\">Sick Cells<\/span><\/a><span style=\"font-weight: 400;\"> both provide resources on their website.<\/span>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>The Sickle Cell Mental Health Initiative:<\/b><span style=\"font-weight: 400;\"> The Sickle Cell Community Consortium has created an initiative focused on raising awareness, education, and destigmatizing mental illness for individuals with sickle cell disease. You can find more information on their website: <\/span><a href=\"https:\/\/sicklecellconsortium.org\/mental-health\/\"><span style=\"font-weight: 400;\">Sickle Cell Consortium Mental Health Initiative<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>Medical News Today: <\/b><span style=\"font-weight: 400;\">This online resource provides an article discussing the link between sickle cell disease and mental health. It offers insights into the challenges faced by individuals with SCD and how it can impact their mental well-being. Read more at <\/span><a href=\"https:\/\/www.medicalnewstoday.com\/articles\/mental-health-and-sickle-cell-disease\"><span style=\"font-weight: 400;\">Sickle Cell Disease and Mental Health: What is the Link?<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>Nicklaus Children&#8217;s Hospital: <\/b><span style=\"font-weight: 400;\">The hospital offers information on mental health disorders in individuals with sickle cell disease. It provides insights into potential mental health challenges such as anxiety, depression, and psychosis, and their causes. Learn more at <\/span><a href=\"https:\/\/www.nicklauschildrens.org\/conditions-we-treat\/mental-health-disorders-(sickle-cell-disease)\"><span style=\"font-weight: 400;\">Mental Health Disorders (Sickle Cell Disease) &#8211; Nicklaus Children&#8217;s Hospital<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>National Institute of Mental Health (NIMH):<\/b><span style=\"font-weight: 400;\"> NIMH provides resources on managing mental health in the context of chronic illness. Their publication on chronic illness and mental health provides insights into recognizing and treating mental health conditions that may arise from living with chronic diseases like sickle cell disease. Access the publication here: <\/span><a href=\"https:\/\/www.nimh.nih.gov\/health\/publications\/chronic-illness-mental-health\"><span style=\"font-weight: 400;\">Chronic Illness and Mental Health: Recognizing and Treating &#8211; NIMH<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>Suicide Prevention Hotline:<\/b><span style=\"font-weight: 400;\"> The<\/span><a href=\"https:\/\/988lifeline.org\"><span style=\"font-weight: 400;\"> 988 Lifeline<\/span><\/a><span style=\"font-weight: 400;\"> provides 24\/7, free and confidential support for people in distress<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>Cure Sickle Initiative<\/b><span style=\"font-weight: 400;\">: <\/span><a href=\"https:\/\/curesickle.org\"><span style=\"font-weight: 400;\">The Cure Sickle Cell Initiative<\/span><\/a><span style=\"font-weight: 400;\"> is a community of individuals living with sickle cell disease, advocates, researchers, and scientists who work together to help the community understand the opportunities that curative gene therapies can bring to assist in curing sickle cell disease in the future.<\/span><\/li>\n<\/ol>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Mind-Body Therapy:<\/i><\/b><span style=\"font-weight: 400;\"> Mind-body therapy techniques such as meditation, mindfulness, and breathing exercises can help manage the pain and anxiety associated with sickle cell disease. Warriors, caregivers, and healthcare workers should be encouraged to incorporate these techniques into their daily routines. Check out our <\/span><a href=\"https:\/\/www.youtube.com\/watch?v=JXVQyvy1pc0&amp;list=PL-y1rFrMnoXc9MceIeDd3vkh_5czXa9rA\"><span style=\"font-weight: 400;\">Mindful Mondays<\/span><\/a><span style=\"font-weight: 400;\"> and the <\/span><a href=\"https:\/\/www.facebook.com\/groups\/SCDmentalhealth\/\"><span style=\"font-weight: 400;\">Sickle Cell Mental Health &amp; Wellness Initiative<\/span><\/a><span style=\"font-weight: 400;\"> on Sunday evenings at 7 p.m. EST to actively learn new techniques.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Positive thinking and goal-setting:<\/i><\/b><span style=\"font-weight: 400;\"> Set achievable goals and focus on positive thinking to help cope with the challenges of sickle cell disease. This can help warriors, caregivers, and healthcare workers develop resilience and better manage their mental health.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Emergency Preparedness Planning:<\/i><\/b><span style=\"font-weight: 400;\"> Develop an emergency plan that takes into consideration the potential impact of sickle cell disease on mental health. This can help individuals living with sickle cell disease, caregivers, and healthcare workers prepare for and manage mental health issues that may arise during an emergency.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Regular Check-ins:<\/i><\/b><span style=\"font-weight: 400;\"> Schedule regular check-ins to ensure mental health needs are being met. During those appointments, identify any areas where additional support may be needed.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Mindfulness Apps:<\/b><span style=\"font-weight: 400;\"> Mindfulness apps such as <\/span><i><span style=\"font-weight: 400;\">Calm<\/span><\/i><span style=\"font-weight: 400;\"> and <\/span><i><span style=\"font-weight: 400;\">Headspace<\/span><\/i><span style=\"font-weight: 400;\"> can assist with day-to-day stressors or anxiety. They offer features like breathing exercises and calming guided meditations. There are also a few sickle cell apps that can help warriors keep track of medications, appointments, community groups, and more.<\/span>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><a href=\"http:\/\/bit.ly\/registerscdevent\"><span style=\"font-weight: 400;\">SCD Companion app<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><a href=\"https:\/\/cscfkids.org\/cscf-living-well-with-sickle-cell-mobile-app-promo-1\/\"><span style=\"font-weight: 400;\">The Living Well with Sickle Cell App<\/span><\/a><\/li>\n<\/ol>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Communication: <\/b><span style=\"font-weight: 400;\">Have open and honest conversations with peers and family members about mental health. By sharing a dialogue, it encourages a safe and candid atmosphere of support and understanding.<\/span><\/li>\n<\/ol>\n<h2><span style=\"font-weight: 400;\">Words to Inspire<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Sickle cell warriors, caregivers, and healthcare workers, you are not alone in this journey. We understand that many are struggling with mental health challenges, and we hope these resources will help. Remember, it\u2019s essential to prioritize mental health. In fact, seeking out a therapist is a sign of resilience and emotional strength. Let\u2019s normalize therapy and adopt it within our culture, and have more open conversations about mental health within our society. We are all human, and we all deserve to receive the help when needed. Together we can erase the stigma of seeking therapy. Ultimately, we must learn how to prioritize our mental health just as much as we prioritize our physical health.<\/span><\/p>\n<p><b>Please join us and share the &#8220;I Believe in Therapy Campaign&#8221; message through<\/b><a href=\"https:\/\/linkprotect.cudasvc.com\/url?a=https%3a%2f%2fdrive.google.com%2ffile%2fd%2f1Xopq5p6vvCuUOEURP-BCfG3Xfj6lEB8v%2fview%3fusp%3dsharing&amp;c=E,1,hPvHHEcNHsCmkWac6Z8uY-xx9YnvDdZT_JgTBKs72uDCq8hhqWakAbUV0Y70rUJNxRDkWqa9gCrBrX3o3Q79QREvD4MOoZCa45N0Ir02fa8l&amp;typo=1\"> <b>videos by clicking here<\/b><\/a><b> to download the full-length videos.<\/b><\/p>\n<p><i><span style=\"font-weight: 400;\">This toolkit is intended for educational purposes only and is not an endorsement nor a replacement for mental health services or medical advice. Please connect with a medical professional for your individual care needs.<\/span><\/i><\/p>\n<p><b>This toolkit is provided by:<\/b><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2019\/01\/scdaa-logo-circle.png\" alt=\"\" width=\"110\" height=\"110\" class=\"alignnone size-full wp-image-1611\" srcset=\"https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2019\/01\/scdaa-logo-circle.png 110w, https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2019\/01\/scdaa-logo-circle-100x100.png 100w\" sizes=\"auto, (max-width: 110px) 100vw, 110px\" \/>\u00a0 \u00a0 <img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/06\/Rare_Disease_Signature_Color_RGB-scaled.jpg\" alt=\"\" width=\"216\" height=\"105\" class=\"alignnone wp-image-6516\" srcset=\"https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/06\/Rare_Disease_Signature_Color_RGB-scaled.jpg 2560w, https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/06\/Rare_Disease_Signature_Color_RGB-300x146.jpg 300w, https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/06\/Rare_Disease_Signature_Color_RGB-1024x499.jpg 1024w, https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/06\/Rare_Disease_Signature_Color_RGB-768x374.jpg 768w, https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/06\/Rare_Disease_Signature_Color_RGB-1536x749.jpg 1536w, https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/06\/Rare_Disease_Signature_Color_RGB-2048x998.jpg 2048w, https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/06\/Rare_Disease_Signature_Color_RGB-400x195.jpg 400w, https:\/\/www.sicklecelldisease.org\/wp-content\/uploads\/2023\/06\/Rare_Disease_Signature_Color_RGB-600x292.jpg 600w\" sizes=\"auto, (max-width: 216px) 100vw, 216px\" \/><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Download the presentation from the 2023 Annual National Convention! I Believe in Therapy Toolkit Prioritizing Mental Health as a Sickle Cell Warrior, Caregiver, and Healthcare Worker As an individual living with sickle cell, caregiver, or healthcare worker, you may be accustomed to prioritizing physical health needs above all else. However, mental health is critical for [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":6689,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-6683","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Mental Health and Wellness - Sickle Cell Disease Association of America Inc.<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.sicklecelldisease.org\/mental-health-and-wellness\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Mental Health and Wellness - Sickle Cell Disease Association of America Inc.\" \/>\n<meta property=\"og:description\" content=\"Download the presentation from the 2023 Annual National Convention! I Believe in Therapy Toolkit Prioritizing Mental Health as a Sickle Cell Warrior, Caregiver, and Healthcare Worker As an individual living with sickle cell, caregiver, or healthcare worker, you may be accustomed to prioritizing physical health needs above all else. 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