#shattering stigma

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National Minority Mental Health Awareness Month

July is National Minority Mental Health Awareness Month. If you have read any of my previous posts on this blog, you know that mental illness does not discriminate by race or ethnicity. Unfortunately, people of color still have more difficulty accessing quality mental health services. For that reason, July has been established as a month to increase awareness around this issue and advance mental health equity.

Here are some statistics from Substance Abuse and Mental Health Services Administration (SAMHSA):

Over 70% of Black/African American adolescents with a major depressive episode did not receive treatment for their condition.

Almost 25% of adolescents with a major depressive episode in the last year were Hispanic/Latino.

Asian American adults were less likely to use mental health services than any other racial/ethnic groups.

In the past year, nearly 1 in 10 American Indian or Alaska Native young adults had serious thoughts of suicide.

In the past year, 1 in 7 Native Hawaiian and Pacific Islander adults had a diagnosable mental illness.

According to the Health and Human Services Office of Minority Health “the Agency for Healthcare Research and Quality (AHRQ) reports that racial and ethnic minority groups in the U.S. are less likely to have access to mental health services, less likely to use community mental health services, more likely to use emergency departments, and more likely to receive lower quality care. Poor mental health care access and quality contribute to poor mental health outcomes, including suicide, among racial and ethnic minority populations.”

How can we enact change to close these treatment gaps? If you are a clinician or otherwise providing mental health services in your job, it is essential that your training and continuing education include cultural competency, including a deep understanding of structural racism. Please know that this is an ongoing. lifelong learning process! 

It also helps to identify resources so you can refer your clients to quality care. In my job, we have a partnership with two mental health providers as part of a grant. Prior to this, we used to research and facilitate referrals to outside providers who accepted our student’s insurance, including Medicaid. We strived to connect students to therapists based on their preferences of gender, race, and location. It was sometimes difficult, but always worth the effort.

If you are someone who is living with mental health challenges, please share your story. That in itself goes a long way to shatter stigma. NAMI has an online docuseries called Strength Over Silence: Stories Of Courage, Culture And Community. I also recommend Therapy for Black Girls for both women of color and white clinicians who want to increase their awareness. It also has a ‘find a therapist’ guide comprised of culturally competent clinicians. 

There is much work to be done, especially under the current POTUS who appears to have very little value for mental health and wellness and has defunded many essential resources. Those of us working in CBOs, especially those that include mental health services, can still take action to advance health equity and should make this a priority.

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Talking About Addiction

Addiction is a complex behavioral health condition that requires compassionate treatment and this starts with the language we use to talk about it. The Harvard Gazette article ‘Revising the Language of Addiction’ effectively explains this and summarizes it in the graphic above.

With many other diseases, we tend to treat patients with care and use person first language. When someone is struggling with Substance Use Disorder, terms like “substance abuser” and “addict” are typically applied with little thought about how those descriptors might negatively impact recovery. There are much worse labels that I choose not to share here.

It is equally important to be mindful of the language of recovery. When someone is being treated with evidence-based medication such as buprenorphine (brand name Suboxone) or methadone, this is not “one addiction replacing another”, but instead pharmacotherapy. Would you ever question a person with cancer undergoing chemotherapy, a person with diabetes taking insulin, a person with asthma using a pump? Think of medication assisted treatment (MAT) in the same way. 

When a person struggling with substance use disorder has a positive toxicology, using terms like ‘clean’ and ‘dirty’ can carry judgment and implicit bias which can make it much harder for the person in recovery to feel supported. Instead, talk about using or not using and/or positive or negative toxicology results. Again, think about cancer--would you tell someone who had a recurrence of this disease ‘dirty’? 

This leads to the most important consideration when talking about addiction and treatment as recommended by the article: “We should ask, ‘Is this a term that we would use for another medical condition?’ If the answer is ‘no,’ we shouldn’t use it.”

Once you start thinking about addiction as any other disease, it becomes easier to talk about it and those impacted by it in a way that includes empathy and supports recovery. It’s easier said than done, I know, but changing our language is a crucial step in shattering the stigma of a disease that is currently killing too many people.

[hellowellmeaning]

Mental Health Literacy

I was heartened to read the article ‘After long battle, mental health will be part of New York's school curriculum’. In my role as Director of Work Wellness and the CBO Lead of a major mental health grant (Connections to Care), I have been teaching mental health and wellness for several years. Our students are all 18 and older and many of them are learning and talking about mental health for the first time in their lives.

I have observed fear about delving into this issue, mostly due to a lack of understanding and stigma. Gradually, as we learn about the prevalence of mental illness, they start to feel less alone. Dispelling the mythology that has resulted from years of silence about mental illness also helps:

Misconceptions about mental illness, experts say, include believing individuals who suffer from it are more likely to commit violence than those who do not (the opposite, actually: they are more likely to be the victims of violence), or that recovery from mental illness is not possible (it is). Or, more broadly, the belief that mental illness only presents in obvious ways, such as behaving strangely, hearing voices or hallucinating. On the contrary, the most common mental illnesses are anxiety disorders.

The reality is that most mental illness begins in the teenage years into early adulthood. Therefore, it’s essential that schools provide information to encourage early intervention:

The onset of mental illness often begins at a young age, advocates say, so early education is crucial.

Half of all chronic mental health conditions begin by age 14, according to the American Psychiatric Association, and half of all lifetime cases of anxiety disorders begin as early as age 8.

In addition, 22 percent of youth ages 13 to 18 experience serious mental disorders in a given year, according to the National Institute of Mental Health.

"If these statistics seem startling, it's because the reality of when most mental illnesses begin is obscured from our view because most of us don't recognize the signs and symptoms when they appear, ignore them or mistakenly confuse them with other characteristics of adolescent such as changes associated with puberty," reads an October 2017 white paper by the Mental Health Association in New York State.

I work with adults with untreated mental illness as well as those who are being treated, but are under the false belief that they are taking anti-psychotic medication for insomnia or know that they have schizophrenia and are afraid to accept this, for good reason as the stigma is daunting.

As a mental health educator, I advocate taking care of one’s brain as any other organ and how quickly we would run to the doctor if we broke an arm or use an inhaler when we have an asthma attack, but will suffer in silence if we are experiencing symptoms of anxiety or depression. I use my own challenges with anxiety as an example. 

The introduction of mental health in school curriculum is especially important and timely because teenagers today have a whole new set of stressors and need more support than previous generations:

They've grown up in an era of over-testing, jam-packed schedules, high expectations to get into a top college, and dual lives — one in the real world and one online, where the pressure to curate a picture-perfect life and rack up "likes" is ever-present.

The cost of not addressing mental health issues takes a heavy financial toll and will only increase if we don’t take proactive steps:

The economic cost of untreated mental illness in America is more than $100 billion a year. Depression, anxiety and other mental illnesses cost the world upward of $1 trillion a year.

The article has a side bar with all of the statistics that more than support this much needed initiative:

Youth and mental health

• One in four people are diagnosed with mental illness over the course of a year in the U.S.

• Half of all chronic mental health conditions begin by age 14.

• Half of all lifetime cases of anxiety disorders begin as early as age 8.

• 22 percent of youth ages 13-18 experience serious mental disorders in a given year.

• More than 60 percent of young adults with a mental illness were unable to complete high school

• Young people ages 16-24 with mental illness are four times less likely to be involved in gainful activities, like employment, college or trade school.

• Those with a psychiatric disability are three times more likely to be involved in criminal justice activities.

• Each year, 157,000 children and young adults, ages 10-24, are treated at emergency departments for self-inflicted injuries.

• One in 12 high school students have attempted suicide.

Sources: American Psychiatric Association, National Institute of Mental Health, Centers for Disease Control and Prevention

Congratulations to the state of New York for responding to this need. Hopefully other states will soon follow.

[hellowellmeaning]

Book Recommendation

I just finished the book ‘No One Cares About Crazy People: The Chaos and Heartbreak of Mental Health in America’ by Ron Powers. The title comes from an actual email exchange between Scott Walker and a high level staff member during his campaign for Wisconsin governor. I was drawn to this memoir because I am encountering more individuals with psychotic disorders in my work and am striving to learn more about this condition. Ron Powers does an excellent job of weaving his own family’s tragic story with the history of mental health. 

As stated in this insightful Washington Post opinion piece entitled ‘A Family’s and a Nation’s Struggle With Mental Illness’, we must make mental health awareness and treatment a much higher priority:

We learn crucial details about the widespread closure of psychiatric hospitals through the 1960s and 1970s, the limitations of antipsychotic medications, and the inability of an underfunded public mental health system to care for the chronically sick. Powers persuasively asserts that these forces have led to rising rates of homelessness and incarceration among the mentally ill, where they “live under conditions of atrocity.” In the midst of this sweeping overview, Powers gives us powerful stories of real suffering and societal apathy toward the plight of our fellow citizens. Their struggles must not be forgotten as we continue to debate reforming our health-care system.

The author, a psychiatrist, continues by reminding us of the humanity of people living with mental illness:

This human aspect of mental illness can’t be overstated. Early in medical school, I saw those with serious psychiatric problems as people best avoided. Not until I lived through the experience of a close friend becoming manic and psychotic did I begin to truly consider the full personhood of those afflicted. My interactions with the mentally ill changed. As Powers so astutely observes: “To begin consciously searching into the world of mental illness is to see it snap into focus before your eyes. It is everywhere. It has been hiding in plain sight, awaiting notice.” Indeed, after my friend’s ordeal, I began to see how common psychological problems were among the medical patients I treated and the many ways they made people even sicker. All too often, I saw doctors neglect these emotional concerns. At the end of my medical internship, feeling that a great need for patients was being unmet, I chose to pursue my training in psychiatry.

Having been out for graduate school for over 20 years and spending many of those years working indirectly with clients, I need to regain my clinical skills. Schizophrenia is particularly challenging due to one of its main features, anosognosia, which leads the person with the disease to believe that they are not afflicted and thus refuse treatment. Learning to work with people who are displaying symptoms of psychosis has been humbling since I struggle with how to assist them. I also find hope with those students who are benefitting from treatment and sometimes fearful that they may stop taking their medication or miss their monthly injection. 

In addition, the stigma of mental illness remains strong, especially for those people diagnosed with schizophrenia. In the psychoeducation classes I teach, I have been awed by the bravery of some students who choose to share that they are being treated for schizophrenia. If they did not do so, we would probably never know due to the effectiveness of their treatment. When one person shares it enables others to feel safe to explore their own mental health issues or those of their family. I have come to realize that we are all impacted by mental illness, whether directly or indirectly. 

I am grateful for writers like Ron Powers who are willing to openly tell their stories and bring greater awareness around mental health. As he says, “I hope you do not ‘enjoy’ this book,” he writes. “I hope you are wounded by it; wounded as I have been in writing it. Wounded to act, to intervene.”