RELIGION, CULTURE & MENTAL HEALTH
“Can I have her ID back, please?”
I all but snatched the driver’s license from the receptionist and handed back it to Dahiana Rojas, a 25-year-old Latinx health aide who works with developmentally disabled people in New York. “We’ll figure something else out,” I told her.
We were standing at the Helen Atkinson Health Center—the clinic in Harlem where we were inquiring about therapy—and the person behind the desk had just finished telling Rojas that there was a new patient appointment available in two weeks, and that it would cost $120 for her first visit and $80 per weekly appointment thereafter. Despite being sliding scale pricing, it was steep considering her income. This was the 8th place we’d checked, and I was at the end of my rope.
It had been about a month since I promised to help Rojas, who’s now a friend, find a therapist in New York after she confided in me about her anxiety and depression. I was becoming frustrated. I’d come across research about how hard it is for young people of color to find and keep a therapist, and I’d experienced it myself. But it still felt jarring to be clawing at clinic doors in what’s supposed to be one of the most progressive cities in the world.
I met Rojas six years ago when I was her writing tutor. After watching her breeze through her first year of community college, I moved out of state and we lost touch. When we reconnected a year ago, I was surprised to hear she’d put a pin in her education and gotten a job.
The topic of therapy came up naturally, as we caught up over frozen yogurt one evening last July. She told me about how her anxiety had recently worsened and was now manifesting itself in physical symptoms such as panic attacks. “During those times, I can’t talk. I can’t communicate. I just have to let it ride out, and it’s terrifying,” she said, her tone despondent. “Not being able to breathe right makes you feel like you’re going to die.”
Rojas had never seen a therapist, and wanted to. “I’m doing the affirmations and mantras and stuff, but there’s something deeper I just can’t get to,” she said. “I need to figure out how to handle my triggers.” She was already crushing the pre-requisites: She knew exactly how to name the beast—she’d read enough to know what was likely afflicting her—and now wanted to tame it.
Last summer, Rojas was making $450 a week, after taxes. She didn’t have insurance—she used to have Obamacare, but behavioral health wasn’t covered on the bronze plan she could barely afford, so she axed it entirely. If a community clinic in Manhattan had two counselors to go around, and they wanted this much money from her based on her income, was our quest doomed?
This wasn’t my first time acting as a therapy sherpa. I’ve taught writing at colleges in several different cities, and every semester at least one student has inquired about how to find a therapist. There are always roadblocks: insurance, parents’ disapproval, long wait lists at the university’s clinics, or straight-up embarrassment. And another thing—the people seeking my help were all students of color.
I’d always made suggestions and offered emotional support, but none of them had ever followed up to tell me they were settled into a therapy routine. When I offered to help Rojas, I decided to crack open the inquiry: Why is it so challenging for young people of color to get therapy?
It’s easy to point to the socioeconomic factors that disproportionately affect young POCs’ wellbeing: Households headed by Black Americans “are at least twice as likely as whites to be poor or to be unemployed.” And the wealth gap between white and Latinx households is still a significant one. Much of this points to a history of systemic inequality—to phrase it gently—whose tentacles have stretched into several aspects of young Black and brown people’s health today. But money and class are only a part of the race-related accessibility problems in mental health care.
Young Black and Latinx people in the U.S. have a very different relationship with mental illness than their white peers, including higher rates of attempted suicide. And in communities of color, it’s still largely taboo to talk about mental illness openly, let alone seek help for it. Data shows that many of these young people don’t seek it, or when they do, have very limited access.
“For African Americans and other young people of color, the stigma really manifests in a couple of ways,” said Alfiee Breland-Noble, a psychologist and mental health disparities researcher at Georgetown University’s Center for Trauma and the Community. “One is that many of us don’t see mental illness as a physical or physiological health problem.”
There’s a strong body of research (which includes much of Breland-Noble’s work) that’s referred to as “treatment engagement”: How do you get and keep people in therapy? “We don't necessarily, in general, buy into the idea that [mental illness] is hereditary, it's genetic, and there are chemical components. And so the idea is that if it's not a ‘medical illness,’ why do you need to go see a doctor for it?” Breland-Noble said.
Jamir Milligan was a 19-year-old student living outside Philly when he first sought out therapy. He struggled with “classically millennial identity issues,” as he described them. “I knew I was brought into this world for great things, but I wasn’t experiencing that on the day-to-day,” Jamir, now 28 and working in media technology, said. “And then I was in a tough relationship where the girl I was dating kind of used that—the knowledge of what I was going through—to her advantage, which ultimately turned into me wanting to commit suicide.”
Jamir wanted to try and make sense of all of it—and thought a therapist might offer unbiased help. “Once I actually began going to therapy, finding someone who genuinely aligned with my concerns was an uphill battle,” he said, referring to the few he saw before finding a clinician who fit. And while his therapy was covered by insurance, the co-pays sometimes didn’t fit into his budget. Yet when he missed a session, he felt like he was sacrificing his overall wellness.
Just getting to that first session, though, was challenging. Jamir told me that he didn’t have any friends or family members who’d been to therapy, so everything was self-guided. “My mom is a preacher and she never made me feel like it would be weird,” Jamir said. “But internally you kind of just have that feeling.”
“That feeling,” as I and so many other Black and brown people know, is centuries’ worth of shame surrounding mental illness—especially depression, which is what Jamir was primarily dealing with. Depending on your background, depression and other mental illnesses have been addressed in a plethora of ways, including praying it away in Black, Latinx, and South Asian cultures, self-medicating, or just ignoring it.
“I think we have culturally sanctioned ways in which we cope, and none of those include traditional forms of talk therapy,” Breland-Noble said. She finds that there’s huge resistance, spanning multiple generations, that can be summed up as, "We don't do that. That’s what white people do.” One of Breland-Noble’s therapy clients, a Filipino teenager, once told her that her parents referred to what she was going through (an anxiety disorder) as “first world problems.”
“A lot of the Latin American community does not necessarily agree with therapy, especially for men. You’re called a ‘maricon’—a vulgar term meaning ‘faggot’—which then triggers people who are in the LGBTQ+ community,” said Pablo Zuniga, a 27-year-old Guatemalan-American from Redwood City, California. “I’ve faced this many times when I would bring up therapy to my family. It was only accepted when I [told them] that at one point in time, I considered self-harm.”
Pablo recalled, specifically, trying to tell his mother about his depression when he was 19. "I told her, ‘I think I need therapy. I've been feeling sad. There are a lot of issues that I'm ignoring, and I hate feeling like this,’” he said. Pablo’s mother wondered why. “She told me that her life was so much harder than ours, and how all the challenges that my sister and I face are nothing compared to what she did.”
“I’m also the child of immigrants and this conversation is not unfamiliar to me,” said Harrald Magny, a New York City-based psychologist. Magny is young, Black, and has had several clients like Pablo, who are fed the idea that they should sack up because their life isn’t hard compared to the previous generation’s. Magny stressed that the immigrant experience was traumatizing yet transformative for so many, including his own parents. Ultimately, though, he said that parents who dismiss the idea of their kids seeking help are poorly educated about what therapy actually is.
As Breland-Noble put it, seeking help indicates weakness in a cultural narrative where weakness has never been an option. “The societal expectations of Black men are a hyperbolic extension of the emotional standards men are held to,” Jamir told me. “Black men are portrayed as hyper-masculine, almost anti-emotional, and that affects the way we see ourselves and the range of emotions we’re able to show.”
Stigma is merely one part of the battle for every student I’ve tried to help, and every person I spoke to for this story. There were also the matters of money and accessibility.
I can confidently say that the struggle is real if you don’t have insurance. It ultimately took Rojas and I two months to find her an affordable therapist after visiting and calling more than 14 places that offer a sliding scale payment system. If you have insurance you purchased as a part of the Trump-era ACA, getting therapy can still be nearly impossible, since the mid- and lower-tier plans don’t cover it until you get a $5,700 deductible out of the way.
Research from 2016 shows that Black and Latinx Americans have had “persistently lower insurance coverage rates at all ages” and that even people who do get insurance at certain points in life are significantly more likely than their white counterparts to lose it. Even after the ACA was passed, the disparities in insurance coverage for Latinx people are alarming.
When I bring up accessibility, I’m not just talking about disparity in counseling services available in your neck of the woods, but also “a mental health system weighted heavily towards non-minority values and culture norms,” as NAMI puts it. This means that therapy and most mental illness diagnostic screenings, until quite recently, were designed for white people. They often don’t account for differences in values, norms, or variations in verbal and nonverbal expression.
Even more egregious is the seemingly unconscious discrimination that a mental health practitioner might exhibit, even before the first meeting. In a phone-based experiment that the Atlantic reported on, researchers had voice actors try to make first-time appointments with therapists. Even after controlling for variables like stated insurance coverage, the researchers found that Black voice actors—purposely distinguished by Black-accented English—were “significantly less likely than whites to be offered an appointment.”
Still, it’s encouraging that more young people of color are vocal about wanting help. And the system, however slowly, is making “considerable progress in addressing gaps in research, training, and the provision of culturally sensitive mental health treatment,” said Lakeisha Sumner, a clinical psychologist at UCLA, and a member of the American Psychological Association. Sumner, who works with a diverse group of students, told me she’s inspired by their perspective on mental health. “Many of them are proactive in seeking treatment and often pursue psychotherapy as a preventive measure in strengthening their ability to take better care of themselves.”
Rojas ultimately landed with a 20-something Black woman therapist, a grad student training at NYU, and it felt right to her. On a rainy morning in September, I accompanied her to her first appointment at a church in midtown (the counseling is church-sponsored, but not religion-based). It was the only program we found in the city that was taking new clients who don’t have insurance. At $35 dollars a session, it was manageable.
Talk therapy can take several weeks or months to take any effect. But as I sat in a lumpy chair in the musty church hallway, waiting for Rojas walk out of her first session, I wanted magic. I wanted her to skip out and say to me, “I have the tools now! I’m going to be great! No more shortness of breath!”
Of course, she just walked out with the nervous smile she walked in with. At that point though, just having a therapist locked down felt like magic. Several months in, she’s updated me on the good, weird, uncomfortable, and very useful parts of her sessions. We’ve also talked about the disturbing nature of how hard it was to get there. “Even if I can’t afford their services, isn’t it their job as a person in the healthcare field to suggest an alternative?” she said. “It’s frustrating. I felt kind of helpless. Even when I went out to seek help, it felt like no one was willing to help me.”
There are no easy answers, but a recent east London charity event laid out options to make ill health feel less overwhelming.
In late March, East London wellbeing charity Shoreditch Trust held a “Men and Mental Health Unconference” at the local Healthy Living Centre. The stated aim of the free event was to encourage ordinary local people to “help lead the conversation around men’s mental health” in the area. I know what you’re thinking: that word “Unconference” sounds like something out of The Office or W1A. But in practice, it just meant that everyone’s voice was treated equally and there were no stuffy formal speakers or cheesy pre-ordained targets.
Instead, the Unconference was a relaxed and productive affair, a few hours in which a diverse group of local men – and a smaller number of women – were all able to have their say. No one claimed to have any quick-fix solutions to the problems surrounding men’s mental health, especially in an era of psychologically damaging Tory austerity, but here are eight suggestions that gained traction on the day.
MEN REALLY NEED MORE SAFE SPACES WHERE THEY CAN TALK ABOUT MENTAL HEALTH
I was surprised by how freely men at the Unconference spoke about the mental health issues that they and their friends had faced – and so were the organisers. "What we found on the day was that people had so much to say and just needed a space to express themselves,” Marion Brossard of The Social Innovation Partnership (which supports Shoreditch Trust) told me afterwards. “It was almost more of a challenge making sure everyone had their turn to talk, because I think many of these people hadn't necessarily been given this kind of space before. We say too often that 'men don't talk about these things', but maybe it's more that they aren’t given the opportunities to talk about them?”
BUT MEN’S MENTAL HEALTH SERVICES SHOULDN’T BE RESTRICTED TO TRADITIONAL SPACES
Thanks to the National Pharmacy Association, we know that men are less likely to visit GPs and pharmacies than women. We also know they’re less likely to access mental health services, even though 78 percent of people who committed suicide in 2013 were male. So, it was suggested at the Unconference that mental health services could be introduced to spaces where men generally feel more comfortable. The Lions Barber Collective is already pioneering the idea of talking about mental health and suicide prevention at barbers’ shops. Could similar initiatives be trialled at sports venues, community gyms and even pubs?
‘MEN-ONLY’ SPACES COULD BE BENEFICIAL TO MEN’S MENTAL HEALTH
Hang on, doesn’t the phrase “men-only space” conjure up images of some throwback “gentlemen’s club” or a posh golf course refusing to be dragged kicking and screaming into the 21st century? "I found this interesting when it came up at the event," Marion Brossard tells me. "I can imagine how it might get twisted – but with the right intention, I don't see how the idea of a men-only mental health group could be a problem. At the end of the day, it's about creating a space for people to speak about a really sensitive topic that they might not feel comfortable sharing with people outside that circle – at least not to begin with. It's not anything to do with creating an exclusive club in the sense of superiority; it's more of a space to allow for vulnerability through being with people who you perceive as similar to you."
ENTERING THE MENTAL HEALTH SYSTEM SHOULD BE MADE LESS INTIMIDATING FOR MEN
Some men at the Unconference said they expected to feel “judged” or “stigmatised” by mental healthcare professionals; others admitted they felt “intimidated” by the idea of entering the mental healthcare system. One solution proposed on the day was a kind of buddy system, whereby men who enter the system would be paired with someone who’s already navigated its ups and downs. The buddy, who’d probably be a volunteer, would be well-placed to answer any questions about the process and ease any nerves.
MEN SHOULD BE ENCOURAGED TO TALK ABOUT MENTAL HEALTH FROM A VERY YOUNG AGE
PE, or Physical Education, is part of the National Curriculum because the government believes that every child should be encouraged to look after their physical wellbeing. Now that we’re finally waking up to the UK's mental health crisis, isn't it time for PE to expand into PMHE, or Physical and Mental Health Education? It was pointed out that teachers should never be expected to become de facto mental health professionals, but teaching kids about the importance of their emotional and mental wellbeing from a young age was definitely a popular suggestion at the Unconference.
MEDIA PORTRAYALS OF MENTAL HEALTH NEED TO CHANGE
It was felt that books, films and TV shows have traditionally perpetuated sexist and reductive views of these issues; too often, women experiencing mental health issues are portrayed as “shrieking and hysterical”, while men are depicted as “calculating psychopaths”.
WE AS A SOCIETY NEED TO CHANGE THE TERMINOLOGY WE USE TO TALK ABOUT MEN’S MENTAL HEALTH
“Be strong” and “don’t cry” are never the right things to say to a man experiencing mental or emotional turmoil. Equally, “man up” is a great name for an East London drag king contest, but has no place in the conversation around men’s mental health.
AND FINALLY, MEN SHOULD BE MORE INVOLVED IN DESIGNING THE MENTAL HEALTH SERVICES AVAILABLE TO THEM
“I think this is essential – and not only for men's mental health," Marion Brossard says. “Traditionally, we've had a group of polished professionals getting together and saying, 'Well, we think these are the challenges in getting people to access mental health services, so let's come up with a great idea, launch it and see if it pleases people.' But really this is a question of lived and learned experience and how those two can come together. We need people who have first-hand experience of the problems we're trying to solve involved in designing and delivering the programmes we roll out, because obviously they know all about them from actually living them."
Artists Bex and Nic Gaunt’s project to raise awareness about mental health in Hong Kong shows images of people holding giant stones as a metaphor for the weight that sufferers of mental illness must carry each day. Photo: Bex and Nic Gaunt
When photographers Bex and Nic Gaunt put a call out on social media seeking models to take part in a project to raise awareness about mental health, they had no idea the response would be so overwhelming.
“So many people reached out – it’s really snowballed,” says Nic. “So far we’ve taken 40 images and there’s a waiting list of others wanting to take part and share their stories about grief, depression, bipolar – whether it’s their personal story or the story of someone they know.”
The husband-and-wife team got creative for the project, with images showing ordinary people holding up Photoshopped out-of-proportion stones, a metaphor for the weight and burden that sufferers of mental illness must carry on a daily basis.
“When you pass someone on their way to work, you have to understand that they might be suffering from a mental illness, experiencing personal problems that you can’t see,” says Bex. “We wanted people to break their silence, to lay bare their issues and help break down barriers and stigmas surrounding mental illness.”
Bex says people from all walks of life and of various races, genders and nationalities have shown interest in the project. “An Indian lady was so happy to get involved – she said she found it difficult to broach the subject in her culture,” says Bex.
According to the World Health Organisation, one in four people globally will be affected by mental or neurological disorders at some point in their lives. It says about 450 million people suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide, Hong Kong included.
A survey by the City Mental Health Alliance found mental ill health is a common and widespread issue among Hong Kong professional services employees. The results in 2018 showed that 37 per cent of respondents have, at some point in their life, experienced mental ill health in employment (compared with 35 per cent in 2017), while 25 per cent of respondents experienced mental health problems while working for their current employer (compared with 24 per cent in 2017).
And it’s not just working professionals. According to figures from the Hospital Authority (HA), the number of Hong Kong children and teens aged below 18 diagnosed with depression jumped by 118 per cent in five years.
Psychiatric patients under 18 treated in hospitals under HA management jumped from 26,740 in the 2014/15 financial year to a projected 36,380 patients in 2018/19, according to written replies from the Food and Health Bureau to the Legislative Council. Psychiatric patients included people diagnosed with the autism spectrum disorder, attention-deficit hyperactivity disorder, behavioural and emotional disorders, schizophrenic spectrum disorder, and depression.
Among those taking part in what the Gaunts have tentatively called the Stones project are Wings Turkington and Rob Flack, both of whom have struggled with depression. British-born Flack says he was under a cloud and felt closed in, brushing his depression “under the carpet” after a string of traumatic experiences, from deaths to divorce, over a short time.
“Six months of weekly cognitive and group therapy sessions incorporating meditation and exercise helped me out of this dark place,” says the 42-year-old.
The IT engineer says the experience has made him better at recognising symptoms of depression – from being withdrawn and distant as well as behavioural changes and changes in body language – not just in himself, but in others.
Hong Kong-born Turkington, who studied in France, Italy and Britain before returning to Hong Kong 14 years ago, says she has dealt with a “portfolio” of mental health issues – centred on anxiety and depression – since she was young.
“I had a misspent youth. I was popular with my peers but had difficulties connecting to that ‘happy side’ … depression is not the same as being sad, it’s beyond that,” says Turkington, who works in the legal industry.
The pair, who are getting married in July and want guests to donate to charities that support mental health in lieu of gifts, say talking with trusted people is a vital step in managing depression.
James (who did not want to disclose his surname), 37, is also featured in the photo series. He says he has suffered from the extreme highs and lows associated with manic depression. Born in the Philippines, James moved to Hong Kong 13 years ago but in 2015 hit rock bottom when he overdosed on crystal meth, a powerful and highly addictive stimulant also known as ice, and GHB, a nervous system depressant.
He says he was caught up in the partying lifestyle in the LGBT community at the time – “a scene that glamorised drug use."
“I woke up [after my overdose] handcuffed to a hospital bed with two police officers in my room. Something had to change,” he said, adding he recovered after 10 months in rehab in Thailand and the Philippines.
He says it’s great that artists like the Gaunts are providing a platform to help bring mental illness into the open.
“Talking about mental health issues and showing people that there’s light at the end of the tunnel, and people out there who can help, is so important.”
Source: South China Morning Post
Religious people tend to turn to clergy for help and support in times of trouble.
But when that trouble manifests as a mental health issue, odds are their pastor or rabbi is not well-equipped to respond effectively, said Jared Pingleton, a licensed clinical psychologist.
"They were trained in theology," said Pingleton, clinical director for the American Association of Christian Counselors.
"They're not trained to deal with that 2 o'clock call with a suicidal emergency," Pingleton said. "They're not trained to know how to care or cope with people who are in the throes of a serious depression controlled by an addictive substance or behavior or headed to a divorce lawyer."
Mental health and relational issues can be complicated, costly and labor intensive, Pingleton said. And clergy members do not have the training nor do they have the time to give these types of crises the attention they need, he said.
That is the reality for the Rev. Jim Hughes, who leads Belle Meade United Methodist Church.
It is not that Hughes doesn't want to help his 400 or so church members, but he knows from 43 years of ministry experience that professional counselors are far more effective than he could ever be at addressing mental health issues.
"I tend to kind of limit myself to three conversations," Hughes said. "If whatever is going on with somebody can't be really addressed and gotten on a good path, if that can't be done in three, they need to be referred."
Sermons on mental health, list of resources key
The stakes can be high for how pastors respond, too. An oblique or cursory response can leave someone feeling dismissed, intensifying a person's shame, Pingleton said. And a mental health crisis for someone who is suicidal can be a matter of life and death.
But strides are being made in the faith community on how to recognize and address mental health needs.
More and more, seminaries and Bible schools are introducing their students to mental health issues, Pingleton said. Churches, especially large, healthy and progressive congregations, are adding counseling staff to their ministry teams, he said.
Just 14 percent of churches have a counselor on staff trained in mental illness and 13 percent train leaders to recognize the signs, according to a 2014 LifeWay Research survey of Protestant pastors. Only 27 percent have a plan to assist families affected by mental illness.
Not nearly enough churches are adding counselors nor can they all afford to do so, but pastors still have the ability to move the needle in their church, Pingleton said.
Pastors need to preach about mental health, acknowledging the reality of the issues, Pingleton said. According to the LifeWay Research survey, 49 percent of pastors rarely or never speak about acute mental illness in sermons or large group messages.
"When there is a sermon about mental and relational health needs, that ends the silence, it eliminates the shame and it erases the stigma," Pingleton said.
Clergy members also need to build a list of trusted counseling professionals they can refer congregation members to in times of need, Pingleton said.
"They need to learn the art of making an effective referral," Pingleton said. "You need to make sure the parishioner or congregant isn't offended or feels rejected."
Belle Meade church has counseling center on-site
At Belle Meade United Methodist, Hughes has a resource list for moments when needs go beyond his abilities.
The church also opened its doors in the last year to a counseling center led by Chris O'Rear, a licensed clinical pastoral therapist. They see it as a ministry of the church, but it serves the wider community. The first visit is free for church members, and follow-ups are offered on a sliding scale. Hughes has already referred church members to it.
To offset the financial cost of therapy, the church received a grant to help seniors pay for it. The rent the counseling center pays the church goes into a fund to assist those who need financial help.
It is not just congregation members seeking help from the Belle Meade church, which is in an affluent part of the city and located on a bus line and major thoroughfare. Hughes receives calls and visits from those experiencing homelessness or those recently released from jail who are in need of help. Mental illness and addiction are present in both populations.
"Most clergy are not equipped. We're not. We might pretend like we are, but we're not," Hughes said. "We need these resources. We need to be able to put people in the right hands."
SACRAMENTO, Calif. (CNS) -- California's Catholic bishops issued a pastoral letter outlining ways the church could do a better job of serving those who struggle with mental illness, stressing that it is an "essential part of the pastoral care of the church."
The letter, "Hope and Healing," was published in English, Spanish and Vietnamese online on the website of the California Catholic Conference, the public policy arm of the state's bishops, May 1, the start of the Mental Health Awareness Month.
It said all Catholics are "called to provide hope and healing to others" and in recognizing that every human life is sacred, they should not only "attend to those in our midst who suffer in body or mind" but also work with families, mental health professionals, community organizations and all individuals and institutions engaged in such work.
The bishops pointed out that often people with mental illness suffer in silence in contrast with those who have a medical illness and usually receive an outpouring of sympathy and support from their parish and community.
"This should not be so in our civic communities and cannot be so in our Catholic communities. Those living with a mental illness should never bear these burdens alone, nor should their families who struggle heroically to assist their loved ones," the letter said, emphasizing that Christians must "encounter them, accompany them, comfort them and help bear their burdens in solidarity with them -- offering our understanding, prayers and tangible and ongoing assistance."
The California bishops also identified the scope and burden of mental illness today, noting that the National Institute of Mental Health says one in five adults in the U.S. suffered from a mental disorder over the last year and nearly 10 million American adults -- about one in 25 -- have a mental illness that is severe enough to cause serious functional impairment. And 20 percent of adolescents currently have, or previously had, a seriously debilitating mental disorder, according to the institute.
They point out the increase of depression and anxiety for young people, the rise in suicides from men and women in nearly every age group, the number of drug overdoses and alcohol-related death, and the current opioid crisis.
They note that the nation's jails and homeless populations are filled with people suffering from mental illness, which they called "unacceptable."
"These crises of our time represent an urgent call to all Catholics. We must respond," the bishop letter said.
One response is not to stigmatize or judge those suffering a mental illness because it is "neither a moral failure nor a character defect" nor a "sign of insufficient faith or weakness of will."
The bishops also noted that Christian faith and religious practice "do not immunize a person against mental illness" noting that leaders and even saints "suffered from mental disorders or severe psychological wounds."
The suffering produced by mental illness is something that Catholics should have a distinctive understanding about, knowing that Catholics are not promised freedom from suffering or affliction and that spiritual practices "will not cure mental disorders or alleviate all emotional suffering," the bishops said.
What is needed to improve mental health care, the bishops said, is cooperation from church members and leaders, health care professionals and scientific researchers.
In response to those who say psychiatry or clinical psychology are not compatible with Catholic faith, the bishops said discernment is necessary and that "good science that recognizes the life and dignity of people and the Catholic faith are never at odds." They also pointed out that "medical science has discovered many useful treatments to help those with mental illness, and Catholics should welcome and make use of these -- including medications, psychotherapy and other medical interventions."
But at the same time, Catholics struggling with mental illness or helping those with this should not "neglect the role of pastoral care and spiritual direction." The bishops note that the sacramental life of the church can "provide grace and spiritual strength."
They also acknowledged the increasing amount of medical research demonstrating health benefits of prayer and meditation, religious worship, active participation in faith-based activities, groups and communities, and cultivating Christian virtues like gratitude and forgiveness.
"These spiritual practices -- while they do not entirely prevent or cure mental illness -- can reduce the risk of mental health problems and can assist in recovery. Modern medicine is rediscovering that there is a deep connection between the body and the soul: What affects the one has profound effects on the other," they added.
The bishops' letter-- http://www.cacatholic.org/resources/mental-health -- also provides links to resources and programs that serve as models for parishes and communities which the bishops describe as "a good starting point."
They stressed that Pope Francis has encouraged Catholics "not to remain securely behind the doors of our parishes, but to reach out to everyone, especially those who are marginalized and forgotten" -- a call that must include people who suffer from severe and persistent mental illnesses. "For them, our communities and parishes should be places of refuge and healing, not places of rejection or judgment," the bishops said.
They also said that outreach should be proactive rather than reactive and should make sure that those who need help are also resources for others.
Another solution is simply to get to know or befriend those struggling with mental illness, to listen to them, walk with them or pray with them.
"Prayer is a powerful source of healing and peace. Some parishes are teaching teams of people in their parishes to be available to pray with people: It can make a great difference when we move from praying for people to praying with them," the letter says.
The bishops said families who have experienced a suicide of a loved one also need help from their Catholic communities. They said the church "teaches that suicide is contrary to the will of God who gave us life," but at the same time it recognizes in the Catechism of the Catholic Church that "grave psychological disturbances, anguish, or grave fear of hardship, suffering, or torture can diminish the responsibility of the one committing suicide."
They also said those who lose a loved one to suicide need particular care and attention, often for considerable periods of time. "Catholics must convey to them that we are not afraid to open this difficult conversation, that they need not feel ashamed to discuss their profound anguish and loss," and parishioners and leaders must be "willing to walk this long road with suicide survivors, to help console them with our unconditional friendship and with sensitive pastoral care."
The letter ends with a message of hope saying the church "never abandons those who suffer from mental illness" and that in eternity with God "every beautiful thing in our lives that is now unfinished will be completed, all the good that is scattered will be gathered together, everything that is lost will be found, all hopes that are now thwarted will be realized and all that is broken will finally be restored."
Source: OSV NewsWeekly
Mental health of people in south Cumbria made worse by 'humiliating' benefit assessments
National charity Mind says nine out of 10 people were negatively affected by being assessed
A LEADING figure in the south Cumbria mental health community says benefit assessments are a "process of humiliation" for those who experience them.
Jane Gordon, chief executive of Ulverston Mind, says an increasing number of clients come to them with their conditions exacerbated because of changes to the benefit system.
Nationally Mind has said for nine out of 10 benefit claimants assessments for Personal Independence Payments made their mental health worse.
Ms Gordon said: "We have had people here concerned who have applied for benefits because they cannot work. It's a process of humiliation. The process makes them feel like they are not a credible person."
"It's a process of humiliation. The process makes them feel like they are not a credible person"
PIP was introduced in 2013 as a replacement for Disability Living Allowance. People being assessed for PIP are seen by a healthcare professional and scored on how much help they need. This has led to thousands seeing a reduction in the amount of benefit they are entitled to.
Barrow Mind, which also covers Millom, said it too was seeing a higher proportion of people negatively affected by reassessment.
First contact worker Laura Clawson deals with people attending Mind in Furness in crisis.
She said: "We have noticed a significant increase in the deterioration of people’s mental health as a direct result of them receiving yet another form, assessment and/or medical regarding their benefitchanges. We would say this is in line with national Mind's statistics."
Even though the situation in south Cumbria is a difficult one, Ms Gordon says mental health counsellors are trained to provide as much support as possible.
She said: "We make sure that people have access to someone even just to talk to. It can be really crushing for people, in particular families in the run-up to Christmas."
The Mail contacted the Department for Work and Pensions but no comment was made before the time of publication.
Reassessment: The consequences
First contact worker at MIND in Furness, Laura Clawson elaborated on just what is causing people's mental health to deteriorate when they are reassessed.
She said: "Most of the people we see are having their benefits re-assessed and as a result have financial worries.
“This impacts on their lifestyle and choices, meaning they have to decide between putting food on the table, making a phone call to support workers at MIND in Furness or getting a bus to see us but unable to do all three.
“This leads to further isolation which escalates their poor mental health.
“We have also seen more and more people needing food bank vouchers as a result of benefit sanctions.
“We offer help and counselling for this issue and we are increasingly attending personal independence payment and employment support allowance appointments with individuals and helping them with associated housing issues.”
What other help is available?
First Step centres across Cumbria offer free talking therapies across the county for people suffering a range of conditions.
These include: depression, anxiety, panic attacks, social phobia, obsessive compulsive disorder and post-traumatic stress disorder.
You can be referred by your GP or by filling in a form yourself online.
Anyone can also contact the Samaritans, 24 hours a day, all year round on the free phone number 116 123.
Duchess of Cambridge speaks on mental health:
It is not only adults who increasingly face mental health issues. The Duchess of Cambridge recently spoke about on the importance of supporting children in school to avoid future mental health problems.
In a speech at a Place2Be forum on how schools can tackle mental health problems she said: "I believe what you all know to be true, that getting help and support to young children at the very earliest stage helps improve their outcomes later in life.
"Whether we are school leaders, teachers, support staff or parents we are all in this together.
"We are all working to give children the emotional strength they need to face their future lives and thrive."
A spokesman from DWP said: "Assessments for PIP and ESA are carried out by health professionals who are trained to understand multiple and complex conditions, including mental health.
“PIP looks specifically at how someone’s life is affected by mental health, unlike the old system which did not sufficiently recognise mental health problems. In fact, there are now more people with a mental health condition receiving the higher rates of both PIP components. Regular reassessments mean we can ensure people get the help they need as their condition changes."
NW Evening Mail
Some female inmates with serious mental-health conditions are being sent to a men's facility for treatment, a practice the federal prison ombudsman calls "completely unacceptable" in a new report.
Canada's correctional investigator, Ivan Zinger, also said that while the use of solitary confinement has decreased significantly in the past few years, conditions "continue to be problematic" and Indigenous inmates are still overrepresented.
In his first report since being appointed to the job in January, Mr. Zinger focused on the conditions of confinement in Canada's federal prisons, which "serve no underlying correctional or rehabilitative purpose."
The wide-ranging report touched on everything from poor food quality, unsatisfactory work opportunities and unsafe transport vehicles, making 17 recommendations to the Correctional Service of Canada (CSC). It also calls for terminally ill inmates to be able to access medical assistance in dying, as well as a safe tattooing program in federal prisons.
In particular, Mr. Zinger's report highlighted the treatment of female offenders, especially those classified as maximum-security inmates.
Mr. Zinger found that women with serious mental-health issues are more likely to be placed in maximum-security units, which are "far from therapeutic," and noted nearly half the maximum-security population in women's prisons is Indigenous.
While Indigenous people make up less than 5 per cent of the total population, they comprise 26.4 per cent of the total federal inmate population, the report said. In the case of women offenders, 37.6 per cent are Indigenous.
"I cannot help but think that the over-incarceration of First Nations, Métis and Inuit people in corrections is among the most pressing social-justice and human-rights issues in Canada today," Mr. Zinger said in his report.
Mr. Zinger criticized the federal prison system for not having a stand-alone treatment facility for women with serious mental-health problems.
He pointed to cases of acutely ill female offenders on the West Coast who are being sent to a men's psychiatric facility and kept separate and alone, which he said contravenes international human-rights standards. Mr. Zinger called for more treatment spaces for mentally ill women and a ban on such transfers.
"It's just unacceptable. You do not put a woman in an all-male institution, completely isolated in segregation-like conditions," Mr. Zinger told reporters at a news conference in Ottawa.
In cases of complex or significant mental illness, his office is calling for inmates to be placed in external psychiatric hospitals.
"There continues to be inadequate treatment space for significantly mentally ill persons who cannot be safely or humanely managed in a federal correctional facility," the report said.
In a response to Mr. Zinger's report, the CSC said it will enshrine in policy that men's treatment facilities be used to house mentally ill women "only in emergency circumstances" and only for short periods of time. The CSC also said it has an external expert looking into women's mental-health needs.
"CSC fully supports the recommendation to provide hospital-level care for mentally ill women at local external community psychiatric hospitals," it said.
The report also found that administrative segregation – the CSC term for the practice of isolating inmates for upward of 22 hours a day – has sharply declined in the past three years.
As of Jan. 1, there were 391 inmates in solitary, compared with 780 in April, 2014. "That's extraordinary, and that's a really good thing," Mr. Zinger said. But he added that many units lack proper ventilation, natural light and windows, with exercise "yards" that are little more than bare concrete pens topped with barbed wire. Indigenous inmates in solitary are still overrepresented, he said.
The average stay in solitary has dropped from 34.5 days in 2014-15 to 23.1 days in 2016-17, the report said. The United Nations' Mandela Rules define prolonged solitary confinement as a period lasting more than 15 days.
In June, the Liberal government introduced Bill C-56, which proposes a 21-day segregation threshold for all inmates locked away in segregation, as well as an independent review if inmates are kept longer. Eighteen months after the legislation is passed, the threshold would drop to 15 days. The bill has yet to progress in Parliament.
The federal government also made funding investments in the 2017 budget to help address the overrepresentation of Indigenous people in the criminal-justice system, and for mental-health care in prisons, Public Safety Minister Ralph Goodale said in a statement.
"I am committed to ensuring that Canada's correctional system is fair, humane and effective," he said.
The Globe and Mail
The Swedish government has ordered the Public Health Authority to carry out an in depth study into the living conditions and mental health of transgender people.
The decision comes after a report showed that mental illness is widespread among transgender people in Sweden and a large percentage of them have at some point considered taking their own lives.
The authorities will also allocate project grants to non-profit organizations working with mental health and to prevent suicide among transgender people, with a focus on the young.
"Young trans people are a group where suicidal tendencies have increased in an especially clear way -- we can't have that. We need to make targeted efforts," said Minister for Social Affairs Annika Strandhäll.
The Public Health Authority has been given 1.6 million kronor for the project.
A report based on a comprehensive survey of transgender people shows that 60 percent of those between the ages of 15 and 19 have considered taking their lives at some point over the past year, while 40 percent have attempted suicide.
The report was created by the Public Health Authority together with the Stockholm-based Karolinska Institute.
Until earlier this year, Sweden's National Board of Health and Welfare automatically applied the diagnosis “gender dysphoria” to transgender patients, following a World Health Organization decision to remove the transsexualism classification from the chapter on mental illness in its diagnostic guide.
Transgender people have complained of receiving unwelcome questions and stigmatizing treatment when dealing with health professionals in Sweden.
As part of efforts to create awareness on the consequences of mental health issues on Nigerians and the economy, a mental health expert and the Chief Executive Officer, The Retreat Healthcare, Dr. Olufemi Oluwatayo, has called on the citizens to avoid factors that cause mental health issues.
He said mental health in a workplace was one of the challenges affecting the productivity of a society, hence the need to tackle it.
Stating this in a message to mark this year’s Mental Health Day, the Consultant Psychiatrist, said while most Nigerians spend significant parts of their lifetime at work in order to add more meaning to their lives and improve their self esteem, the work itself and the environment where it takes place can have a negative impact on the people if not managed properly.
“Employees suffering from mental health issues are likely to have impaired work output. This is therefore in the interest of the employer to support them to recover as soon as possible and to provide a workplace that foster mental well-being.
“In Nigeria, there are no data on financial losses to businesses resulting from poor mental health of employees. Estimates from the UK indicate that up to £70 billion pounds is lost annually due to mental ill health and reduced productivity of employees with up to 20 per cent of the workforce taking on average, one day off annually because of stress and other mental health related issues.”
He said it was obvious that poor mental health of individual employees has significant repercussions for businesses including poor motivation, increased staff turnover, sickness, absence due to stress, burnout and exhaustion.
For employers of labour and organisations to provide enabling working environment for their employees and help them deal with mental health issues, the Psychiatrist said awareness represents the starting point, such that employers recognise that they have a responsibility to their employees, some of which are statutory.
“The workplace must be an environment that challenge, support and help develop a sense of purpose of the employees. A mentally healthy workplace is built on good basic line management relationships, clear human relations policies and engagement of staff in decision making.
“There should be a clear grievance process and ways of seeking redress when things go wrong. When employees have a mental disorder and it is disclosed, employers must keep the information confidential and the employee should be supported to return to work after recovery with reasonable adjustments made to their job if necessary and/or be allowed to return in a graded fashion or be placed in less demanding and more appropriate roles within the organisation. There should be access to stress management courses, occupational health services and to mental health specialists, preferably outsourced,” Oluwatayo stated.
On the employees’ part, he said they are under no obligation to disclose a mental disorder to their employers except on some positions that for instance involve having contacts with vulnerable people.
He said, however, it would be impossible for the employers to provide support if nothing is disclosed. “This is obviously a very sensitive issue in our society with potential adverse outcomes including loss of job and inappropriate use of the disclosed information. This is further compounded by the general culture of silence in our society when it comes to talking about mental health issues or how it impacts us.”
World Mental Health Day is commemorated every year on October 10. The Retreat, Nigeria’s first privately-owned mental health facility, joined health stakeholders in marking the day through awareness programmes.
COURTESY OF MARIE ERIEL HOBRO
Marie Eriel Hobro, 21, said her parents didn’t want to talk about the family’s history of mental illness.
When Sandy Tran, 24, was in seventh grade, she locked herself in a bedroom on her birthday. Her mom became angry, and things quickly escalated to a shouting match. At the end of the night, Tran stood in the doorway of the kitchen and said, “I think I might be depressed.”
Her parents just stared, not saying anything, she recalls.
“That was that first experience of coming out with mental health issues. It was shot down quite quickly,” Tran said.
Years later, she realized most of her family members suffered from symptoms of depression. One night, her brother had to go to the hospital after months of undereating. Her family was worried about his physical condition, as he was severely underweight. But when doctors attempted to give him a psychological evaluation, Tran’s parents declined.
Looking back, Tran says, “My parents didn’t take into account that it was a mental stress situation. They were just like, ‘You need to eat.’”
“Being Asian, especially from an immigrant Asian family, we avoid these things,” Tran said. “There’s ... a cultural idea that if you have a mental illness, you’re kind of like a person in the family that needs to be hidden away.”
"My family has always been like, ‘You’re just sad.’ It took them a long time to understand."
-Marie Eriel Hobro, 21
When it comes to seeking help for mental health, the Asian-American community lags behind other groups, including by avoiding it completely. In fact, research shows Asian-Americans are three times less likely to seek mental health help than white Americans.
In the case of Asian immigrants like Tran’s family, many come from cultures that do not see mental illness as a legitimate illness, leading to stigma.
But a new generation of mental health care providers is trying to change that. They’re offering services like family-directed therapy and employing specialists who speak different languages to help immigrants who can’t comfortably express themselves in English.
Dr. Samantha Liu of Asian Community Mental Health Services has seen the effects of mental health stigma firsthand in her 20 years as a psychiatrist. She specializes in working with Asian-American patients, especially Chinese-Americans.
“When I see them, a lot of these patients come to me in severe conditions compared to patients of other ethnicities,” Liu said. “By the time they go to the doctor or psychiatrist, they are already in bad condition. It’s very hard for them to recover.”
Marie Eriel Hobro, 21, felt constantly paranoid throughout high school, fearing that people were trying to kill her. But it wasn’t until college that she was diagnosed with depression and obsessive-compulsive disorder. Although she tried therapy a few times, she would “run away” from it, she said.
A turning point came when her uncle died by suicide, and Hobro realized she needed to get help. Now, she’s been on medication and therapy for almost a year.
Although Hobro’s family supports her decisions, her parents are still unwilling to talk about the family’s history of mental illness.
After her uncle’s suicide, Hobro’s dad denied that he had killed himself. Her grandmother would often say that anxiety and depression is “just in the mind,” she said. And initially, Hobro had resisted seeking help herself, because she felt too prideful.
“As a Filipina woman, it’s very hard for people in my culture to talk about mental illness,” Hobro said. “Now they’re opening up to it, and they’re happy that I’m getting ahold of myself. My family has always been like, ‘You’re just sad.’ It took them a long time to understand.”
Struggling To Bring Up Family Secrets
Liu said Hobro’s experience is common. People with mental health issues often resist their family members’ suggestions that they seek help, she said, but it’s the patient who must give consent for treatment.
“There is a fear among the community that if anyone finds out, they will be ostracized,” said Dr. Vasudev N. Makhija, founder and president of the South Asian Mental Health Initiative and Network. “They will be worried about what others think and might say. Even for seeking emotional support, they just keep quiet and just suffer in silence instead.”
Many psychiatrists who focus on Asian-American communities believe it’s most effective to educate the entire family while treating the patient.
One approach that works is informing the immediate family, said Dr. Albert Gaw of Asian Community Mental Health Services, who has written about best practices for working with Asian-American patients. Makhija agrees, saying that when he sees Asian-American patients, the family often accompanies the patient to the interview room ― with the patient’s consent.
Using this strategy, doctors will fully inform the family about the medications and treatment, as well as what symptoms to watch out for.
“You cannot divorce the family from individual care,” Gaw said, “but in the American culture, usually patients are being treated as an individual.”
Community Outreach Is Slow, But Improving
To spread awareness about mental health in Asian-American communities, some organizations host public workshops, health camps and community outreach events that offer screenings and discussion of common conditions like depression and substance abuse.
It can be difficult to get people to attend these events, Makhija says, but it helps when patients work with doctors who have similar backgrounds or who speak the same language. Getting help from a native speaker can help immigrants feel like they’ll be understood.
“In psychiatry, people have to explain their deepest emotions,” Liu said. “It’s not like other types of illness, like saying, ‘My chest hurts’ or ‘My leg is broken.’ People often need their native language to be able to comfortably express how they feel.”
Likewise, it helps to hear from other people in the community who have sought treatment and are open about their experiences with mental illness. This type of visibility helps decrease stigma.
Roopak Desai, 44, who moved to the U.S. from India, started seeing Makhija earlier this year. Since then, he has decided to volunteer with the South Asian Mental Health Initiative and Network, hoping to spread awareness to other South Asian immigrants that mental illness is nothing to be ashamed of. Although he just started volunteering, he plans to participate in presentations, panel discussions and other events.
Desai recalls attending therapy with his family after he had his first anxiety episode in high school. Although his parents were supportive about him seeking treatment, they did not want it out in the open.
Throughout his life, Desai would receive therapy and medicine on and off, usually after an anxiety episode occurred. Before, he would stop taking his medicine once he started to recover, but he’s since learned that he needs to keep taking it.
“People say I’m suffering from diabetes, I’m suffering from this disease or that,” Desai said. “But [mental illness] never came to the open. You don’t hear, ‘My son, my husband, has certain conditions and has depression.’”
For Asian-Americans who may be in a similar situation, Desai has two pieces of advice.
“There is nothing wrong if you’re depressed or feeling anxious or having panic attacks,” Desai said. “Second point, you should not be feeling bad that you have to reach out to psychiatrists. It’s nothing wrong. It’s equivalent to any other specialist. Take the right medicine.”
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