RELIGION, CULTURE & MENTAL HEALTH
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."
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
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