Thursday, February 24, 2011

The State of Homlessness in America

by Michael J. Fitzpatrick, Executive Director

Last month, the National Alliance to End Homelessness (NAEH) held a press conference to announce the release of their report entitled The State of Homelessness in America 2011, documenting the depiction of homelessness in America between 2008 and 2009. The report is available in summary format online with interactive maps or as a pdf download. We frequently see one image of homeless people depicted in the media, but the fact that no map is coded with a single color reflects that homelessness is not a uniform phenomenon. For instance, Vermont saw a 27 percent increase in overall homelessness while experiencing one of the lowest foreclosure rates. Michigan’s overall homeless rate decreased by about 4 percent but it still has the highest unemployment rate, 13.6 percent. It’s important to keep in mind that what may show as a benign color on the map may be far from favorable in reality. In South Dakota, which has the lowest severe housing cost burden, almost 60 percent of households below the poverty line are spending more than half their income on keeping a roof over their heads.

For those who are not so lucky, living without a residence can mean “sleeping rough,” or out in the open, on a city street or in the woods. It can also mean fighting for an ever-moving square of space in a subway, train station or library. Others are eating, sleeping and washing according to someone else’s rules in a shelter run by a church, public authority or private charity. In every case what dominates is the constant, wearing certainty that someone else—the person who tries to take your backpack, the shopkeeper who asks you to keep moving or the kindly shelter volunteer who serves up a meal not of your choosing—has more to say about your life than you do.

Being homeless could be the definition of a Catch-22. Jewel, a participant in the Oral History of Homelessness in Minnesota, shared her story.

“I want to go back to school to be a nurse anesthetist, but I don’t have the funds for school. If you don’t have education you can’t get the job. If you don’t have a job you can’t get an apartment. If you can’t get an apartment then you are stuck in the shelter. And it is like—when does the cycle end?”

According to the NAEH, about 25 percent of people who are homeless also live with a serious mental illness. We at NAMI can picture someone living with mental illness in one of these scenarios and easily grasp how many extra challenges this would pose for treatment and recovery. Keeping a hold of all your belongings is a full-time job, in addition to having to eat and do everything else on someone else’s schedule, both of which may make taking medication regularly more difficult. Continuity of care is extremely rare for people relying upon uncertain transportation, walk-in clinics and poor insurance coverage. One of the most exhausting things is the environment itself. What must it be like for someone living with PTSD who has nowhere to go to get away from overwhelming stimuli, or someone living with schizophrenia who has no routine or support to help her establish a sense of continuity?

Perhaps it is easier for us because we are all too aware of how easy it is for someone to not be caught by the mental health system’s safety net and end up on the street. We react to a group often called “the homeless” and recognize the syntax that feels wrong when people say “the mentally ill.” It makes sense that this group, like any lumped together by a stereotype, would be made up of individuals with undiscovered talents and insight.

Dr. Daniel Kerr wrote about just this sort of discovery as part of the dissertation he wrote while working with the Cleveland Homeless Oral History Project. The name of his paper, “We Know What the Problem Is”: Using Oral History to Develop a Collaborative Analysis of Homelessness from the Bottom Up” shows his move towards a more cooperative role as an academic studying homelessness.

Dr. Kerr reveals that while he was collecting the stories he found something unexpected: many of the individuals he interviewed had a good grasp of the big-picture forces that helped cause homelessness. Specifically, his participants mentioned real estate trends, the criminalization of poverty, growth of the temporary labor industry and changes in the welfare system, to name a few. He documented grassroots organizing efforts among homeless individuals, including the formation of a Day Laborers’ Organizing Committee and a successful squatters’ rights protest.

Perhaps the big picture hasn’t been filled in with the proper solutions because these voices speaking from the bottom up haven’t been included in the equation. Since the Arizona tragedy, the nation’s eyes are turned towards stitching up the holes in our neglected safety net and NAMI has been trying to publicize the idea that investing in mental health treatment is less costly in the long run. The same can be said of homelessness. A report prepared for the Los Angeles Homeless Services Authority found that “the typical public cost for residents in supportive housing is $605 a month. The typical public cost for similar homeless persons is $2,897.” Yet the NAEH report says that federal dollars earmarked for targeting homelessness are scarce. Learn more about homelessness and mental illness on the NAMI website or in the Veterans Resource Center.

Thursday, February 17, 2011

Making Possible More Transformative Moments: NAMI’s AAPI Listening Session

By Jeong Shin, Program Manager, NAMI San Francisco
Jeong Shin, Program Manager, NAMI San Francisco 

I began working for NAMI San Francisco in April 2010. At that time I already knew of NAMI's reputation as a mental health advocacy organization. Until I joined as staff, however, I didn’t understand the prevalence of mental illness, nor was I familiar with NAMI's history and the important role that families can play in recovery. Later, I would find out that my husband's grandmother found support from the San Mateo affiliate in the 1970s when her adult son was diagnosed with schizophrenia. She still talks about how NAMI provided her with the support and education that helped her understand his mental illness in a way that she could not and did not find anywhere else. This is a phenomenon that I hear repeatedly in people's stories about their experiences with NAMI—that it was transformative and gave them the feeling that they were no longer alone in dealing with this illness. These people found support through NAMI that changed their lives for the better.

As a staff person in an affiliate located in San Francisco, I find it puzzling that we don't have a broad diversity among those who engage in our programs and services. The city of San Francisco is diverse in every way you can possibly think of, so the San Francisco affiliate should be triumphantly diverse as well. And yet, this is not the case. The experience that my husband's grandmother had is one that I would wish for anyone who faces severe mental illness, whether as someone who has a diagnosis or as a family member. However, as a first-generation Korean American, I struggled to understand how the stigma of mental illness can be overcome within my own community.

When I received the invitation to attend the Asian American Pacific Islander (AAPI) Listening Session hosted by the NAMI Multicultural Action Center, I felt skeptical about the effectiveness of such a meeting. I hadn't even realized that the Multicultural Action Center existed. I agreed to attend because as an affiliate, we are struggling with finding ways to develop relationships with communities that have long-underserved populations. Our affiliate and many NAMI affiliates across the country are small grassroots organizations. NAMI San Francisco has one part-time staff person supported by a group of very dedicated volunteers. The obstacles to the development of culturally competent programs seemed immense when combined with the need to develop and maintain infrastructure and existing programming.

What I appreciated most about the listening session was the opportunity to sit in a room with other people facing the same challenges. Most of all, the meeting lived up to the name “listening session” with its productive and meaningful discussions. There were no prescribed assumptions about what we as AAPI community members or advocates should implement. Representatives from other NAMI affiliates as well as other community organizations across the country discussed what they were doing at the ground level. We shared what worked and what areas needed further discussion or development, while as a group we collaborated on how we as a community address the barriers we face.

For me, the listening session was less about finding a definitive solution for connecting AAPIs to mental health services and peer support and more about the beginning of a conversation. It is my hope that the report published this week from that Listening Session provokes even more conversation. And it is in that conversation that I hope will be the beginnings of more possibilities for more people to have an inclusive and meaningful transformative moment like the one my husband's grandmother experienced.

Thursday, February 10, 2011

Grocery Receipts for Mental Health

By: Jacob Berelowitz, LMSW

Jacob Berelowitz, founder and executive director of Talk Therapy Television
This entry by guest blogger Jacob Berelowitz is an example of the kind of work NAMI was founded upon—ordinary people finding creative solutions to help address the challenges faced by people living with mental illness and their families. From getting involved in our StigmaBusters campaign to contacting legislators to becoming an educational support group instructor, there are many ways to bring the NAMI message of awareness, education, and advocacy to the community.

It all began during my time as a clinical social worker in a psychiatric hospital. Every day I saw people that could have avoided crisis and hospitalization had they known a little more about mental illness. The stigma, misinformation and general lack of focus on this area of health contributed to people needing the level care provided by a hospital instead of a lower level of support that would not intrude on their daily life in the same way. Witnessing this made me feel I had to find a way to get more accurate information out to the public about mental illness.

I founded Talk Therapy Television with this motivation in mind. This cable television show on mental illness, Talk Therapy TV, is broadcast throughout New York City. However, I am always looking for new and innovative ideas on how to raise awareness and knowledge about mental illness.

The Quick Fact Campaign

I had just finished shopping at my local grocery store and the cashier gave me my receipt. I turned it over and found a coupon printed on the back and had an ah-ha moment. Why not put mental health information on the backs of these receipts and spread the word in a new way? The Mental Health Quick Facts Campaign was born.

When we met with the company, I was delighted to discover that they had an appreciation for the cause and were willing to help out. As we thought about it more, we realized that with the limited amount of space on the receipt, the message would have to be short but still create an impact. Borrowing a move from Snapple’s playbook—their bottle caps printed with “Real Facts”—we decided to put facts about mental illness on the backs of the receipts. These “Quick Facts” would get the conversation going and inspire people to learn more. We then created a website connected to the campaign where people can get more information about mental illness.

We now print thought-provoking facts about mental illness on the backs of receipts at major grocery stores throughout New York City, including Stop & Shop, Pathmark and ShopRite. Just a few months later, an average of 25,000 shoppers every day are handed receipts with Quick Facts printed on them.

Media Coverage

The initiative engaged the public so well that the NY Daily News wrote an article about it and asked their readers for feedback. When I noticed that alongside the online article they posted a poll asking “Are people undereducated on mental health issues?” I realized that they were trying to get a sense of how important this issue is to their readers.

It is important for all of us who care about mental illness to vote on the poll. As we were recently reminded with the Arizona tragedy, media coverage for mental illness is almost always attached to tragedy, violence and sensationalism. What is unique about this Daily News article is that they covered the topic of mental illness without any tragedy associated with it or motivating the discussion. In fact, it was a positive story about the movement to generate awareness for mental illness. Hopefully, our responses will inspire the Daily News to continue reporting on positive stories about mental illness and awareness.

A Final Note

As I reflect on the beginnings of the Quick Facts campaign, I realize that it all started with an idea during an ordinary shopping experience. I have seen receipts with ads printed on their backs for years but never thought to use it for mental health awareness. What changed?  Because I was in the mindset of looking for ways to promote awareness, I noticed the receipts. Sometimes, all it takes is opening your eyes and paying attention to find a whole new way to get the message out to the public.

Jacob Berelowitz, LMSW, is the founder and executive director of Talk Therapy Television. He can be reached at jacob@talktherapytv.org.

Wednesday, February 2, 2011

Football: A Mind Game

by Brendan McLean, NAMI Communications Intern

Brendan McLean, NAMI Communciations Intern
With less than one week left, the final game of the NFL season is upon us, pitting the Pittsburgh Steelers against the Green Bay Packers. With six Super Bowl trophies calling the Steel City home and three under the watchful eyes of the Cheeseheads, two of the most storied franchises in NFL history are facing one another on the biggest stage for the first time.

This Sunday, Feb. 6, will feature two of the five top defenses in the league, each team readying itself for a black-and-blue, grind-it-out game. However, what has been underlying many of the games this season, and what some have claimed has affected the physicality of the game, is worry that the implementation of a new rule will affect this off-season. Prior to the beginning of this season, NFL commissioner Roger Gooddell expanded rules to limit head injuries by adding a clause that more explicitly outlawed helmet-first hits to the head and neck area. Perhaps this was the league’s best defense all season.

Previously, the NFL stated that concussions from football had no long-term effects on player’s health. However, a study conducted by the University of North Carolina’s Center for the Study of Retired Athletes based on a general health survey of 2,552 retired NFL players, showed otherwise. It found concussions greatly increased the likelihood of depression later in life. Of the 595 players who recalled having three or more concussions, 20.2 percent said they had experienced depression—a rate three times higher than both that of the players who had not sustained concussions and the national rate.

Organizations like the Sports Legacy Institute are beginning to research the long-term effects of repeated brain trauma, revealing the potentially disastrous ramifications of concussions. Among some of the approaches being designed to limit the effects of hits to the head are new helmets constructed with better protection.

Depression: Not Just from Concussions

Although stories about players battling depression are a rarity in the NFL, the incidence of depression among athletes is similar to the rest of the population. Depression can, of course, arise for reasons unrelated to the incidence of a concussion—as it did for Terry Bradshaw. This former Steelers great and Hall of Famer is one of the most identifiable players living with depression. Bradshaw quarterbacked Pittsburgh to four Super Bowl wins in the 1970s and was elected Super Bowl Most Valuable Player twice.

Terry Bradshaw retired from the NFL in 1983 and went on to become an NFL commentator on TV. After his third divorce in the late 1990s, he was no longer able to manage his anxiety and was subsequently diagnosed with depression in 1999. Bradshaw admitted that throughout his career he often experienced anxiety attacks after games, regardless of whether his team won or lost. On many occasions, he would find himself crying for no apparent reason.

Bradshaw did not feel his identity as a football player allowed him to be “emotionally weak” and attempted to self-medicate with alcohol. Realizing this was merely leading him on a path of self-destruction, the sports icon finally came forward. With a combination of talk therapy and selective serotonin reuptake inhibitors (SSRIs), Bradshaw has been able to manage his depression. Consequently, he has become a mental health advocate, urging people to not shy away from receiving help.

The High Price of Self-medication—or No Medication

Another player who was diagnosed with depression after entering the NFL is 1998 Heisman Trophy winner and current Miami Dolphins running back Ricky Williams. Considered an oddball for his off-field behavior, Williams often shied away from media attention. Later reports indicated that Williams was beginning to experience feelings of depression in college. During his senior season at the University of Texas, Williams smoked marijuana one night and felt the mild depression he had been experiencing lift. As a result, he continued to smoke for the first years of his career, ultimately testing positive for drugs on numerous occasions. Because he was facing a four-game suspension and $650,000 fine for multiple failed drug tests, Williams retired from football in 2004.

Why didn’t he simply take an antidepressant, or another legal form of treatment for depression? Ricky Williams believed that marijuana proved much more effective than the SSRIs he had taken. During his time away from football in 2004, Williams traveled to India and Southeast Asia, where he discovered that the benefits of yoga and meditation could combat his feelings of depression. He claimed these techniques were even more effective than smoking marijuana for treating his social anxiety and depression.

Williams’ experiences have some scientific backup. In multiple research studies, including Mendelson et al., 2010, Descilo et al., 2009 and Duraiswamy et al., 2007, yoga and other forms of meditation have proved beneficial in treating depression as well as schizophrenia, Posttraumatic Stress Disorder and the effects of chronic stress. However, it is important to note that in general it is not solely yoga or meditation that helps battle depression, but one of these practices in combination with other treatments.

Williams, however, continued to smoke marijuana and, as a consequence of his multiple failed drug tests, was suspended from the NFL for the entire 2006 season. Other players have battled depression in recent years, some with more tragic outcomes. Three-time Pro Bowl selection Shawn Andrews, now with the New York Giants, has battled depression throughout his career. Twenty-three-year-old Broncos wide receiver Kenny McKinley began experiencing depression after being placed on injured reserve. Unfortunately, he did not receive help in time and committed suicide prior to the 2010 season.

Regardless of the amount of mental health support the NFL is providing for its players, the stigma associated with depression and other mental illnesses tends to affect men profoundly. According to the National Institute of Mental Health, while men are four times more likely to commit suicide than women, they seek treatment half as often.

The Battle Behind the Game

This Sunday in the hours leading up to the Super Bowl you will see Terry Bradshaw on Fox’s NFL pre-game show. With no previous knowledge you would most likely never suspect that this jovial individual, who often serves as a comic foil for the rest of the broadcasters, suffers from depression.

But Bradshaw is not the only individual on the field or on the sidelines that has experienced symptoms of depression. Just as losses come with wins, it is important to remember that with triumphs come heartaches. And as noted in the case of Kenny McKinley, sometimes those setbacks can take a tragic toll.

Some of the players on the field may be diagnosed with depression, while others may refuse to accept that they are experiencing depression. Regardless of the color of the jersey or helmet the person is wearing across the field—an athlete should extend a hand to help him off the ground—at least once the whistle blows and the game is over. As we fight against stigma and for quality information and treatment for depression, we at NAMI can find inspiration in this spirit of teamwork that extends beyond teams.