RELIGION, CULTURE & MENTAL HEALTH
Over the course of five consecutive days last month, Dr. Jamye Coffman saw seven children and infants who had been abused so severely that they required hospitalization at Cook Children’s Medical Center in Fort Worth, Texas. At the time, the city, along with the rest of Texas, had recently declared an emergency over the rapid spread of novel coronavirus. Typically, the hospital sees fewer than 10 cases of fatal child abuse in a year, but that week, two died from their injuries.
It is too early to link this single — and anecdotal — spike in severe child abuse to the COVID-19 pandemic and the stress it’s causing, said Coffman, who serves as medical director of the Cook Children’s Center for Prevention and Child Abuse and Neglect. In fact, it will take more than a year to get a clearer picture of what’s happening nationwide, due to the lag in collecting and sharing child welfare data.
But Coffman said she is concerned that a trend she has seen before will play out again as the nation reels from the profound effects of the virus and the stresses brought on by mass unemployment, food insecurity and illness. During the last financial recession, which rolled out much more slowly than the current crisis, the rate of physical abuse and child deaths linked to abuse both increased at her hospital, she said.
“It all just adds stress on top of stress,” she said. “Any time there’s increased stress increases the risk of abuse on children.”
So she said she alerted the Fort Worth community through the local news to raise awareness of a possible rise in child maltreatment and prevent more children from dying, if the trend bears out. “It is hard to know if the numbers have gone up in the last few days or if medical providers are looking carefully and reaching out,” she said. “It’s too soon to tell if what we’re doing is making a difference.”
But even when federal data is available for this period, it may not show the full extent of abuse because of the ways crises also inhibit reporting.
Why the pandemic could play a role
No one knows how long this pandemic will last, and that uncertainty can cause anxiety, tension and irritability for children and caregivers. The United Nations has already raised the alarm that reports of domestic violence have soared around the world, underscoring how unsafe homes can be during a pandemic.
In the extreme, child abuse may happen when a caregiver is “pushed over the edge” by circumstances often outside their control, said Dr. Robert Sege, who directs the new Center for Community-Engaged Medicine at Tufts University.
Child welfare experts are most concerned about three conditions happening right now.
Routines are being disrupted. With businesses, schools and daycares shuttered, parents and children are in each other’s constant company, sometimes in close quarters. That may be welcome time spent together, but it can also be incredibly stressful when coupled with the demands of work, bills and other anxieties. Children, too, may act out when they are under stress.
Jobs have evaporated. By March 28, 6.6 million Americans had filed first-time jobless claims in a single week. Before that, nearly a fifth of Americans said they’d lost wages or jobs due to COVID-19, in a PBS NewsHour/NPR/Marist poll conducted March 13-14. That means more households are straining under the weight of debt and economic insecurity.
Children are isolated from others who care. Before the COVID-19 pandemic, the act of going to school and being seen by teachers, staff and fellow students stretched a modest net to help catch children who might be mistreated. Before, someone outside the home might spot a bruise and ask how things were going. Amid social distancing, that oversight is gone.
“These are all conditions that set up what might lead to child abuse and neglect,” said Sege, who served on the American Academy of Pediatrics’ Committee on Child Abuse and Neglect.
Under normal circumstances, the highest risk period for a child to die after being abused or neglected is during the first year of life, he said. Given the stress summoned by a pandemic, Sege said that risk for the youngest children only rises.
“It’s that additional toll on vulnerable families that we’re worried about,” said Jessica Bartlett, who directs early childhood research for Child Trends, a nonpartisan organization that studies children’s well-being. “It can be the straw that broke the camel’s back.”
What the data says (and what it may miss)
For care professionals, a 15-month lag in data can hinder their ability to combat maltreatment. Bartlett said that the more real-time data they have about abuse, the better they can “respond appropriately.” But getting national data more quickly is tricky, said Sharon Vandivere, senior research scientist at Child Trends.
Twice a year, states and localities submit data that tracks child abuse and neglect to the federal government, she said, where it is then compiled, cleaned, analyzed and published. The most recent data available is from 2018. For years, child advocates and researchers have explored new ways to update child welfare data systems, but haven’t made substantial progress.
When life is disrupted by a natural disaster, research has shown that incidents of abuse have increased, and children in dangerous situations can fall through the cracks in the system. That may be happening now, since teachers, early childhood education providers and home health clinicians are obligated to file reports of suspected child maltreatment, Bartlett said, but the COVID-19 pandemic has interrupted or suspended those services.
When it comes to the Great Recession, the official government data do not reflect an increase of abuse. In 2007, at the outset of the financial crisis, 794,000 children in the U.S. were abused or neglected, according to the federal Administration for Children and Families. Amid the throes of the banking crisis in 2008, that estimate appeared to dip to 772,000 children and in 2009, official estimates said 702,000 children were maltreated. But a 2015 report by a children’s advocacy group found that hospital admissions for serious child abuse and traumatic brain injuries did increase during the time period, and found that these upticks were geographically aligned in areas with higher home foreclosure rates and unemployment rates.
There has been a push to explore ways social media or online searches can fill in gaps and offer more immediate insights about how and where children might be suffering, but questions must be weighed, about how reliable and accurate those data points might be, Vandivere said.
What to do when stress takes over
The daily stress of the current pandemic, and the isolating measures taken to combat it, make impulse control increasingly difficult, said Dr. Steven Berkowitz, a child psychiatrist at the University of Colorado School of Medicine.
To those who feel at risk of causing harm to their children, Sege suggests:
There is no shame in asking for help during times of unprecedented stress, Coffman said, adding that community members need to watch out for their friends and step in if they think someone needs help.
“Social distancing doesn’t have to be social isolation,” she said.
It is more important that people support families who may already have been struggling with child maltreatment, domestic violence, substance use or other issues to prevent trauma from happening in the first place, Bartlett said, rather than simply identifying families where a child has been hurt or overlooked.
For those who identify a family who may be struggling and want to help, Sege suggests calling, texting or video-conferencing with them to ask how they’re doing, or offering to pick up groceries, diapers or other essential supplies.
“Sooner or later, the viral infection will pass,” Sege said. “We want to make sure our children are physically and psychologically safe through all this.”
A new study investigating factors that contribute to psychological distress in adults has found that that risk of malnourishment is linked to psychological distress among Canadians aged 45 years and older.
"These findings are consistent with other research which has found links between poor quality diet, and depression, bipolar disorder, and psychological distress," says study lead Dr. Karen Davison, Health Science faculty member at Kwantlen Polytechnic University in Surrey, BC. "Collectively, they indicate that nutrition may be an important consideration in mental health care."
Adults who have insufficient appetite, face challenges in preparing food, or consume low-quality diets are identified to be at risk of malnourishment. Indicators of a poor diet found in the study that were associated with psychological distress included low fruit and vegetable intake and higher levels of chocolate consumption.
Given that lower grip strength is a measure of poor nutrition, the researchers also explored the relationship between grip strength and psychological health. Men with low grip strength had 57% higher odds of psychological distress.
"This finding is consistent with previous studies which suggests that psychological problems such as depression are associated with an increased risk of frailty" says co-author Shen (Lamson) Lin, a doctoral student at University of Toronto's Factor Inwentash Faculty of Social Work (FIFSW).
Other factors associated with psychological distress among older Canadians
In addition to nutrition indicators, other factors found to be associated with psychological distress include chronic pain, multiple physical health problems, poverty and immigrant status.
One in five older adults with three or more chronic health problems were in distress compared to one in 17 who did not have any chronic conditions. One-third of women and one-quarter of men in chronic pain were in distress.
"Distress is common among those experiencing uncontrollable and chronic pain. Furthermore, dealing with multiple physical health problems can be upsetting and can make day-to-day activities, work and socializing much more difficult." says senior author, Esme Fuller-Thomson, professor at FIFSW and director of the Institute for Life Course & Aging. Fuller-Thomson is also cross-appointed to the Department of Family and Community Medicine and the Faculty of Nursing.
The prevalence of distress was highest among the poorest respondents; One in three older adults who had a household income under $20,000 per year were in distress.
"It is not surprising that those in poverty were in such high levels of distress: Poverty is a chronic and debilitating stressor. It can often be challenging even to pay one's rent and put healthy food on the table. Poverty may also result in poorer housing and neighborhood quality, and greater residential turnover which are also stress-inducing," says co-author Yu Lung, a doctoral student at FIFSW.
The study also found that immigrant women living in Canada less than 20 years had a higher prevalence of distress than women who were Canadian-born residents (21% vs 14%).
"Unfortunately, this survey did not identify the reasons for the greater distress among immigrant women, but we hypothesize that it may be due to the difficulties of resettling in a new country, such as language barriers, financial strain, complications of having one's qualifications recognized, distance from family and other social support networks and perceived discrimination" says co-author Hongmei Tong, Assistant Professor of Social Work at MacEwan University in Edmonton.
"Although immigrant men also face many of these settlement problems, they were not at elevated risk of distress compared to their Canadian-born peers," says co-author Karen Kobayashi, Professor in the Department of Sociology and a Research Affiliate at the Institute on Aging & Lifelong Health at the University of Victoria. "One idea we hope to explore in future research is whether these gender differences could be due to the fact that the husbands initiated the immigration process and the wives may have had limited or no say in the decision to leave their homeland."
The study team analyzed data from the Canadian Longitudinal Study on Aging which included 25,834 men and women aged 45-85 years. The article was published this month in the Journal of Affective Disorders.
"The team's findings suggest that policies and health care practices should aim to reduce nutrition risk, improve diet quality, address chronic pain and health problems and poverty among those experiencing poor mental health," adds Dr. Davison. "Given that mental health conditions place a large burden of disability worldwide, such program and policy changes are becoming critically important."
When you’re struggling with depression, there are days when leaving the house can feel like a challenge.
Add on the demands of a job and life can feel overwhelming.
For Lisa, who asked Global News to change her name to protect her identity, depression has affected her ability to function at work. The 29-year-old has dealt with anxiety and depression since her teens, but when she lost her mother a few years ago, her mental health greatly suffered.
“I would find myself sitting at my desk having no idea what I was doing there,” she said. “I couldn’t focus, I would stare at my screen and let tears roll down my face without any emotion.”
What is depression?
Lisa is not alone. Around one in five Canadians will experience a mental health problem, like depression or anxiety, at some point in their lives. While depression has various markers, common symptoms include trouble concentrating and a loss of interest in work, which can directly affect how someone functions in the workplace.
Aside from work, people dealing with depression can also experience a lack of interest in friendships, hobbies and relationships. Symptoms of depression also include suicidal thoughts, irritability, trouble concentrating or making decisions, and crying easily.
There are often physical symptoms, too, including muscle aches and pain, psychomotor impairment (like slowed speech), changes in appetite and low energy levels.
While everyone experiences sadness, major or clinical depression is a mood disorder that affects the body and mind. One of the main differences between sadness and depression is a despairing mood that lasts more than two weeks, the Centre for Addiction and Mental Health (CAMH) points out.
Depression can be caused by various factors including genetics, personality, hormones, brain chemistry and major life stress, according to CAMH.
How does depression affect work?
For people with severe depression, getting out of bed to go to work may not always be possible, said Steve Joordens, a professor of psychology at the University of Toronto.
“Many of the people who are most severe are not going to work. They’re literally not leaving their bed, not leaving their bedroom, and that’s when it gets really dangerous,” he said.
People experience different levels of depression, he explained, meaning those with mild or moderate cases may still maintain professional commitments — even if it’s very challenging.
“A critical feature of depression is nothing seems to matter; there seems to be no point in doing anything,” he said.
At work, depression can make it harder for people to concentrate and be productive, said Nasreen Khatri, a registered clinical psychologist and clinician scientist with Baycrest’s Rotman Research Institute in Toronto. Depressed workers may also feel exhausted or overwhelmed.
Depression can also make employees more socially withdrawn, and all of this impacts workplace productivity.
“Mental illness costs the Canadian economy $51 billion a year, and 500,000 Canadians call in sick every week due to a mental health issue,” Khatri said.
“Most short- and long-term disability claims are made for a mental health issue.”
When 29-year-old Natasha was going through a hard mental health period, getting through the workday was often a challenge.
Natasha, who asked Global News to change her name for privacy reasons, works with children. While her therapist told she was experiencing depressive symptoms, those symptoms really affected her job.
“I was super distracted,” she said. “In my job, I literally have to be excited and upbeat, and it was just hard for me to do that.”
Getting help for depression
Depression is a health condition like any other, and it’s important people speak to their doctor if they’re experiencing symptoms or struggling with low mood, Khatri said. Treating depression is key to managing its symptoms.
A health professional will recommend the best treatment plan, which can include medication and therapy. Joordens says cognitive behaviour therapy (CBT) can be very helpful in treating depression as it helps change thinking patterns.
In addition to treatment, Khatri said doctors can also help patients figure out a professional plan that may include accommodations at work or a leave of absence.
“It’s important to focus on the basics when depression can make even the smallest task seem like an effort,” she said. “Doing your best to get adequate rest, sleep, eating well and reaching out to supportive friends and family is key.”
There’s unfortunately still a stigma around mental health issues, which can prevent employees from seeking help or asking for accommodations. But workplaces need to recognize depression as a serious health issue, and implement ways to support workers, Khatri said.
This can include crafting a “practical road map” of how to support workers dealing with mental health issues, she said, like making employees aware of assistance programs and creating a step-based approach that makes it easier for employees to approach bosses about their mental health concerns.
It’s also vital for workplaces to model positive mental health behaviour, she said.
“Cultivating a culture of psychological safety, so that everyone at work feels welcome, safe, comfortable, confident, and feel that they can share ideas and speak up when they want or need to is key.”
Natasha was close enough with her colleagues that when they learned she was struggling, they offered support.
“They would step up and take more of a lead … because I was just not myself,” she said.
Both Lisa and Natasha found therapy to be helpful for managing their conditions at work and in their personal lives. Through medication and therapy, Natasha says her mental health has greatly improved and she can now better cope with work.
Lisa says her partner is very supportive, and always listens to her when she’s struggling.
“Depression is something that I know I will always deal with [and] for me it’s important to have people I can talk to and won’t be judged by,” she said.
“My biggest fear for my mental health in the future is when I go through another trauma with loss. I truly hope I am able to see the light at the end of the tunnel but when you’re in it, it just feels like a black hole.”
After more than a decade of hugely successful mental health awareness campaigning, 2020 is the time to focus our efforts on more complex problems such as schizophrenia and borderline personality disorder (BPD).
In my role as CEO of a mental healthcare charity, I work closely with patients who live with these incredibly complex mental health problems. Their experiences can be both debilitating and life changing. For many, ongoing care and rehabilitation is a necessity. But hope is also important – it’s the difference between surviving and living. That’s why we need to open up conversations around mental health, in particular a discussion of our response to patients who are struggling with these conditions.
Thanks to the success of mental health awareness campaigns – including those run by Mind and Rethink Mental Illness – we have made great leaps in dismissing unhelpful prejudices surrounding conditions such as anxiety and depression. In fact we are in a completely different place today, compared to where we were in 2007, when such campaigns began.
But I think as a society we need to understand what it’s like living with more complex conditions such as psychosis, schizophrenia and borderline personality disorder.
To find out how big the variance in stigma is, we conducted a public survey – the results of which are significant. It found that despite increased understanding of common mental health problems, complex conditions are still hugely misunderstood. For example, three in five people still believe the adage that schizophrenia means having a split personality, while one in 10 confused schizophrenia with someone who has psychopathic traits.
This misunderstanding of schizophrenia has undoubtedly led to fear and stigma. One in four people admitted they would be nervous if someone they knew was diagnosed with schizophrenia, compared to just one in 20 when asked the same question about depression. Imagine the impact that has on the person living with the illness, particularly if they’re living in the community.
One patient, who was recently in our care, couldn’t have described it better; she explained that schizophrenia is not a choice, just like someone wouldn’t choose to have cancer. She said people’s judgements often come through a lack of knowledge and understanding, rather than anything malicious.
It’s unsurprising that we, as a society, have such views. With a lack of voices emerging about complex mental health conditions, we often rely on Hollywood films to fill the void. But depictions in films can often be unhelpful and tend to perpetuate the notion that mental deterioration leads to violence, which is quite simply misleading, especially when you consider someone living with schizophrenia is more likely to be the victim of violence, than be the perpetrator of it.
You could also argue that depression and anxiety require greater awareness because they are more prevalent in society, but the statistics suggest otherwise. According to Mind, three in every 100 people will experience depression, compared to two in 100 people for BPD or one in 100 for psychosis.
The results from our survey show we should aim to focus the conversation on severe and enduring mental health problems. Educating people and addressing these issues will make it easier for people to live the lives they want to lead in the community, without fear of being judged.
But changing public perception is not something that one charity or one campaign can tackle alone. If we all consistently, and responsibly, challenge myths around complex mental illness and have more open conversations, together we can break the stigma.
Soaps such as Hollyoaks and Coronation Street have gone someway in tackling this already and should be praised for their responsible explorations of experiences such as psychosis. I’d love to see more stories like this being told through characters we know and love, as well as more real-life case studies being featured in the media.
People living with schizophrenia or BPD can often feel ashamed and isolated. Add that to the impact of their clinical symptoms and life can become quite despairing.
It’s time we saw the person first, and the illness for what it is. Yes, complex conditions can be distressing, but with the right care and support many people go on to live happy and purposeful lives. Let’s open up the conversation and stop being afraid of talking about complex mental health problems.
Katie Fisher is CEO at mental health charity St Andrew’s Healthcare
According to this year’s “Stress in America” survey, Americans report various issues in the news as significant sources of stress, including health care, climate change, mass shootings and the upcoming presidential election.
“There is a lot of uncertainty in our world right now — from mass shootings to climate change. This year’s survey shows us that more Americans are saying these issues are causing them stress,” said Arthur C. Evans Jr., Ph.D., the American Psychological Association’s (APA) chief executive officer.
“Research shows us that over time, prolonged feelings of anxiety and stress can affect our overall physical and mental health. Psychologists can help people develop the tools that they need to better manage their stress.”
The APA’s Stress in America survey was conducted between August 1 and September 3, 2019, by The Harris Poll among 3,617 adults living in the U.S.
According to the findings, around 7 in 10 adults (69%) say that health care is a significant source of stress — nearly equal to the 71% who say mass shootings are a significant source of stress.
Among adults who experience stress about health care at least sometimes (47%), the cost of health care is the most commonly cited source of that stress (64%).
Adults with private insurance (71%) are more likely than those with public insurance (53%) to say the cost of health care causes them stress. More than half of adults overall (55%) worry that they will not be able to pay for health care services they may need in the future.
Mass shootings are the most common source of stress cited by U.S. adults in 2019, with more than 7 in 10 adults (71%) saying mass shootings are a significant source of stress in their lives. This is an increase from 2018, when more than 6 in 10 adults (62%) said mass shootings were a significant source of stress.
By demographic, Hispanic adults are most likely to say mass shootings are a significant source of stress (84%), followed by black (79%), Asian (77%), Native American (71%) and white (66%) adults.
More than half of U.S. adults (56%) identify the 2020 presidential election as a significant stressor, an increase from the 52% of adults who reported the presidential election as a significant source of stress when asked in the months leading up to the 2016 contest.
Stress related to climate change/global warming has increased significantly since last year (56% in 2019 vs. 51% in 2018). And more adults are reporting that widespread sexual harassment causes them stress today than said the same in 2018 (45% in 2019 vs. 39% in 2018).
Immigration is cited as a stressor by nearly half of adults (48%), with Hispanic adults most likely to identify it as a stressor (66%), followed by Asian (52%), Native American (48%), black (46%) and white (43%) adults.
Discrimination is another stressor that has become more prevalent in recent years (25% vs. 24% in 2018, 21% in 2017, 20% in 2016 and 20% in 2015).). In 2019, the majority of people of color (63%) say that discrimination has hindered them from having a full and productive life, with a similar proportion of LGBT adults (64%) expressing the same sentiment.
When looking at the responses of people of color, this year’s results represent a significant increase from 2015, the last time this set of questions was asked, when less than half (49%) said that discrimination prevented them from having a full and productive life.
“This year’s survey shows us that current events affect Americans differently, with people of color more likely to say they feel stressed about health care, immigration and discrimination,” said Evans.
“While these are important societal issues that need to be addressed, the results also reinforce the need to have more open conversations about the impact of stress and stress management, especially with groups that are experiencing high levels of stress.”
Regarding the nation’s future, fewer than 2 in 5 adults (38%) feel the country is on the path to being stronger than ever, but nearly three-quarters (73%) feel hopeful about their future.
While average reported stress levels remain constant compared with last year (4.9 in 2019 and 4.9 in 2018 on a scale of 1 to 10, where 1 is “little or no stress” and 10 is “a great deal of stress”), there continues to be a generational difference, with Gen Z adults reporting the highest average stress level (5.8), followed by Gen Xers (5.5), millennials (5.4), boomers (4.2) and older adults (3.0).
Among the stressors that the survey tracks each year, work (64%) and money (60%) continue to be the most commonly mentioned personal stressors. However, the economy is cited as a significant source of stress less frequently in 2019 than it was at its height in 2008 (46% in 2019 vs. 69% in 2008).
Source: American Psychological Association
Annastasya Watts has a busy life.
Along with studying psychology at university, the 19-year-old from Western Australia is also a manager at a fast-food outlet and a volunteer with a number of community organisations.
Annastasya was also diagnosed with depression and generalised anxiety disorder at the age of 15.
Her symptoms were further affected after she was sexually assaulted when she was 16.
"Even just talking about it with my friends now, it's kind of insane to me how many people go through this," she told SBS News.
Annastasya said the assault resulted in post-traumatic stress disorder.
“I denied it for a long time. It took me a long time to come to grips that this happened. For people who are going through that, I want them to reach out. If you can't talk to your friends and family about it, talk to a professional."
One in four reporting mental health challenges
A study of more than 28,000 Australians between the ages of 15 and 19 has found they are more likely to report feelings of psychological distress than they were seven years ago.
The report, released on Wednesday by homelessness charity Mission Australia and mental health research not for profit The Black Dog Institute, also shows young females are twice as likely to report mental health challenges than young males.
The 'Can we talk?' report is a summary of reports spanning seven years between 2012 and 2018, looking at levels of mental distress in people aged 15-19.
It found almost one in four young people in 2018 say they are experiencing mental health challenges, with a rise from 18.7 per cent in 2012 to 24.2 per cent 2018 in the number of people experiencing psychological distress.
A higher proportion of Aboriginal and Torres Strait Islander young people also met the criteria for psychological distress than their non-Indigenous peers, with reporting current rates of 31.9 per cent.
CEO of Mission Australia James Toomey said there may be a number of reasons behind the increase.
"There is a greater confidence and understanding of what actually constitutes psychological distress for young people,” he said.
Mr Toomey said those surveyed also reported feeling like there were more expectations on them, triggering more feelings of distress.
The director of the Black Dog Institute Professor Helen Christensen said it was difficult to pinpoint the exact reasons behind the increase.
"What we can say is the kids have not really changed in terms of their psychological and biological makeup. So we have to look for external influences,” she said.
“We really can't say what it is, but we can say that it is reliably increasing."
Girls more likely to report
Girls and young women are twice as likely to say they are experiencing mental health challenges than males in the same age group, the report found.
Mr Toomey said one of the reasons may be because of a greater understanding of what might constitute psychological distress in young women as well as more pronounced concerns about body image.
Annastasya said in her experience there was more pressure on young men to hide their emotions.
"It's that whole stigma of for men of 'you have to be strong, you have to act tough, you have to be the man', while for girls, we're more prone to sharing our feelings and opening up.”
As to where people go to for help, respondents said friends, parents, and the internet were their top three sources of help, but in remote Indigenous communities where internet access was patchy, that avenue wasn’t always available.
There are also concerns the children of migrant and refugee background are also less likely to seek help with mental health issues.
Swathi Shanmukhasundaram is a youth advisor and a Shout Out speaker at the Centre for Multicultural Youth, and speaks on mental health issues.
She said shame can be a factor in young people from some communities coming forward.
"There's a huge burden of feeling like you have to save face and carry the family honour and recognising or even speaking about that you have a mental illness or that you're dealing with that in your family," she said.
She said some people worry speaking out "can taint that public image and dishonour your family".
Annastasya, who was born in Indonesia to an Indonesian mother and an Australian father, says her Indonesian family favour a spiritual approach to mental health.
"It was a really big worry for me at the start because I was brought up in a western society, but my background is not completely western. Indonesia is a very religious country so it was very different," she said.
Policy recommendations in the report include more funding to find out why females report high rates of distress, improved social media literacy, and more input from young people in the design of services.
Annastasya says she decided to speak out about her experience in the hope of helping others as well as herself.
She does this as a youth spokesperson for the Black Dog Institute, sharing her experience with high school students.
Therapy, she says, has helped her better identify symptoms of stress.
"If I start feeling like everything I do is a chore and that I am not succeeding in anything, and that life kind of feels a bit hopeless, that's when I know I really need to start looking out for my mental health.”
Suicide attempts are rising among black teens in the U.S. even as they fall among youth from other racial and ethnic groups, a study suggests.
Researchers examined nationwide survey data from nearly 200,000 high school students collected between 1991 and 2017. While the overall proportion of teens reporting suicidal thoughts or plans declined for all racial and ethnic groups during the study period, the proportion of black teens attempting suicide surged by 73%.
“Whatever is happening to result in a downward trend among teens in the general population is missing black teens,” said Michael Lindsey, lead author of the study and executive director of the McSilver Institute for Poverty Policy and Research at New York University.
Overall, 7.9% of teens attempted suicide during the study, and 2.5% sustained injuries as a result. Almost one in five teens reported suicidal thoughts and 14.7% planned a suicide, researchers report in Pediatrics.
Self-reported suicide attempts rose in black teenagers, even as they fell or followed no significant pattern in white, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native teenagers, the study found.
While suicide attempts decreased among teen girls overall, they increased among black teen girls.
There was also a surge in injuries from suicide attempts among black teen boys.
More research is needed to determine why traditional precursors to suicide attempts like thinking about or planning a suicide are decreasing while actual attempts are going up, Lindsey said by email.
The current study can’t explain why suicide attempts and injuries are rising among only certain groups of youth.
“We believe that it’s important for parents, mental health service providers and school personnel to learn the signs of depression in black youth,” Lindsey said. “We know that suicidality can stem from untreated depression and, in addition to the classic signs of depression, such as becoming withdrawn or having a depressed mood, black teens may present with physical complaints, such as persistent headaches or stomach aches or with interpersonal challenges, such as angry outbursts, which may be construed as behavioral problems rather than cries for help.”
A separate study in Pediatrics looked at suicide rates for cisgender teens - youth whose gender identity matches their sex assigned at birth - and for transgender teens - whose gender identity does not match their sex assigned at birth.
This study examined online survey data from 2,020 teens ages 14 to 18, including 1,134 who identified as transgender.
Compared to their cisgender counterparts, trans teens were more than twice as likely to report having a death wish or suicidal thoughts. Trans youth were also 82% more likely to plan a suicide and 65% more likely to attempt suicide.
“Trans teens are under much greater potential societal pressure, such as parental disapproval, bullying, and difficulty in finding romantic and other friends,” said Dr. Benjamin Shain of NorthShore University HealthSystem in Deerfield, Illinois and the University of Chicago Pritzker School of Medicine.
Teens are increasingly in danger for suicide and from related mental health problems such as depression, Shain, author of an editorial accompanying the studies in Pediatrics, said by email.
Parents should keep an eye out for evidence of depression, severe mood changes, substance misuse or suicidal thoughts or behaviors, Shain advised.
Other warning signs may involve changes in how teens behave in school or in relationships with friends and peers, Shain said.
In particular, parents should get help for teens when they see a “change in functioning such as lower grades, less interest in activities, isolating from friends and/or family, or dangerous or impulsive behaviors,” Shain added.
Mumbai, India - Nyana Sabharwal was 13 years old when she lost her mother to suicide.
Having struggled with alcoholism and what Sabharwal now understands was an undiagnosed mental illness, her mother had hanged herself while everyone else was asleep.
Her mother had told her, on several occasions, that she wanted to take her own life.
"I knew growing up that my mother was thinking of suicide, I just didn't know what I should be doing about it as a child," she says.
Growing up, Sabharwal was her mother's primary caregiver.
"It was difficult because I didn't know really what was the right thing to do and how to take care of my mum.
"As a child, you don't recognise what suffering is because you look up to your parents as these people who are supposed to be perfect."
Most evenings, Sabharwal would follow her mother around the house, making sure she didn't drink too much or hurt herself, until she finally went to bed. She would then finish her schoolwork.
The next morning, she would head off to school worrying about what she might face upon her return.
"Every day when I came back from school, I wondered whether my mum would be there and whether she would be sober or not. I think that my childhood was an extremely difficult time of my life."
In the years after her mother's death, Sabharwal attempted suicide twice.
It wasn't until much later, as an adult, she finally understood her mother's struggle.
"Only now I've started to understand what she went through, but I could only understand it as a woman and not as a child," she says.
In January 2018, Sabharwal and a friend, who also lost her father to suicide, cofoundedWe Hear You, a support group.
"When we started talking, we realised how easy it was to talk to somebody who had experienced the same loss, and that it was easier to understand this kind of pain and [these] experiences, the emotions and the manifestation of them."
The group, now 20 members strong, meets on the first Tuesday of every month to support each other through their personal journeys of healing.
37 percent of global female suicides
Sabharwal's mother is one of the thousands of women who die by suicide every year in India.
In 2018, according to research published in the Lancet Public Health October issue, Indian women make up nearly 37 percent of global female suicide deaths.
Although the rate of death by suicide for Indian women has dropped since 1990, it has not fallen as fast as elsewhere in the world.
In 2016, suicide was the ninth leading cause of deaths in India. In many cases, victims were educated, have had successful careers, they belonged to the middle class and/or they were married.
"Globalisation and the ensuing media blitz have increased the aspirations of women while society at large has failed to live up to the changes thereof, so there's a definite discord between aspirations and reality," said Johnson Thomas, director of Aasra, a suicide prevention hotline in Mumbai.
"The change towards nuclear families has increased the pressure on women to earn well, as well as maintain the home," he says.
Support from extended family members is no longer the norm, meaning women bear the double burden of career and household responsibilities.
But Anna Chandy, chairperson of the Live Love Laugh Foundation, a charitable trust focused on creating awareness about mental health and reducing stigma, says suicide is not necessarily more prevalent among educated women.
"This is because of better reporting and not because incidence is [more so] among the educated," she explains.
Until 2017, suicide was a criminal offence in India - and an attempt carried a prison sentence of up to one year or a fine, or both.
In 2017, suicide and attempted suicide were decriminalised.
According to the Mental Healthcare Act, 2017, people who attempt suicide "shall be presumed, unless proved otherwise, to have severe stress and shall not be tried and punished under the said Code".
The government is now mandated to provide care to victims.
But analysts say decriminalisation, while important, is not enough.
The implementation of the new bill was not comprehensive.
Some hospitals, medical clinics and police stations have not yet been briefed about the new bill, which means that in practice things remain relatively the same.
"The act hasn't been notified at the police stations yet, so outdated laws are still referred to when booking an attempted suicide," says Thomas. "Though the bill was passed, it hasn't taken effect yet in all the regions of the country."
There is still some ambiguity about the wording of the bill, which states that there is a necessary level of stress required for the act not to be a crime.
"This is a very vague and ambivalent way of framing whether this is a criminal act or not and it can be taken either way," says Sabharwal.
"The language that we use is still 'committed suicide' when actually it's a person dying by suicide. They don't commit suicide like they commit a crime."
The stigma surrounding suicide remains; victims' relatives continue to hide the cause of death, reporting it as the result of an accident, drowning or fall.
Sabharwal still sees a reluctance to talk openly about mental health, especially to friends and family.
This is perhaps why anonymous suicide prevention hotlines have become so popular.
"I think it's fear of being judged and the stigma," says Sunitha Ramachandram, shift coordinator at Samaritans Mumbai, a suicide hotline that has been active since 1993.
"Mental illness carries a lot of stigma in our community and a student or a young person would never want their peer to know their weakness, however close they may be."
Removing the fear of being judged is neither straightforward nor easy.
"There's no magic formula," says Thomas. "It's usually the conditioning of a person and resilience developed over time that enables a person to overcome his or her difficulties.
"Education and training in problem-solving, developing mental strength and emotional wellbeing will certainly help the cause."
But without a marked shift in attitudes, real change will be slow.
According to Chandy, "It will take years of awareness, sensitisation and education on mental health issues until it will become embedded in the DNA of our culture."
SOURCE: AL JAZEERA NEWS
“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."
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