Tuesday, September 24, 2013

Latinos: Has Mental Illness Knocked at Your Door?

By Lynda Cort├ęs-Avellaneda, Program Manager, NAMI Multicultural Action Center

It is a sunny mid-September morning in the Washington, D.C. area. The cool air and the smell of my last stash of Colombian coffee transport me back to the Equator. If really high mountains were to pop up in the background, the street were to shrink and traffic were to suddenly jam resulting in massive honking and other anathemas, I would feel right back home in Bogota.

I breathe in. I am back in the States where Latinos like me now constitute 17 percent of the nation’s total population. According to the U.S. Census Bureau:

  1. In 2012, we were 53 million, making people of Hispanic origin the nation's largest ethnic or racial minority.
  2. While we used to be concentrated in a few areas, Latinos are now the largest minority group in 21 states: Arizona, California, Colorado, Connecticut, Florida, Idaho, Illinois, Iowa, Kansas, Massachusetts, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, Oregon, Rhode Island, Texas, Utah, Washington and Wyoming.
  3. Georgia, South Dakota, Mississippi and Wisconsin experienced the fastest Latino population growth at the county level between 2000 and 2011.
  4. 12.9 percent of U.S. residents 5 and older speak Spanish at home. This places Spanish as the most spoken non-English language in American homes.

Beyond the all-encompassing figures and language commonality, Latinos are a highly heterogeneous group. We come from different places, we have different backgrounds and we experience migration differently. These factors are critical to understand the complex and variable impact of immigration on an individual’s present and future mental health—which is worth examining during National Hispanic Heritage Month, which continues through Oct. 15 and includes Mental Illness Awareness Week, Oct. 6-12.

The experience of the migration process is linked to major adjustment stressors. Pre-migration abuse or disasters (i.e., political persecution, economic hardship, etc.), uncertain legal status and substandard living conditions once in the United States, represent additional strikes on human beings already stressed by having left behind the world they know. For Latino generations born in this country, the story isn’t less challenging, but it is different.

I belong to the wave immigrants that fled excruciating socio-political turmoil a decade ago. Without a return date in sight, the excitement of a new beginning soon enough turned into hard work to adjust. The process of acculturation, sadly, was not cited in my passport—trust me, I checked.

Despite having a supportive family undergoing the same process with me, the implications of such a dramatic change had a mental health toll on all of us. The forced separation from a “hyper-extended” family, the challenges intrinsic to adolescence and the frustration of not being able to communicate in a different language were crushing. For a long time, anxiety and depression were professed members of my family.

Acknowledging that something was chronically unbalanced, talking about it and seeking professional help were crucial aspects to regaining and maintaining our mental health. However, we also faced a few additional challenges in the process:

  1. Stigma—Vulnerability to judgment was a huge burden before grasping that mental illness as any other illness had biological causes and was treatable.
  2. Unfamiliarity with the health care system. We had to learn about it and make sure mental health services were at least partially covered by our health insurance.
  3. Scarcity of bilingual and culturally competent specialists.
  4. Lack of access to bilingual mental health education and continuous networks of support.

Even though Latinos are a resilient and strong community, it is important to understand that mental illness affects everyone. And considering the Hispanic population numbers and projections, more people will face the challenges of living with a mental illness. Luckily, we are not alone. Organizations like NAMI are dedicated to building better lives for those affected by mental illness by offering not only bilingual but culturally competent resources, education and support.

United we can fight stigma!

As proud Latinos who care about the wellness of our community, let’s commemorate the National Hispanic Heritage Month by taking action against inaccurate and hurtful representations of mental illness.

  1. Learn about Latino community mental health and resources.
  2. Find support for you and your loved ones by joining a free NAMI education class and/or support group near you.
  3. Be a voice in Compartiendo Esperanza (Sharing Hope).
  4. Stay informed!

Monday, September 23, 2013

How Shootings Stigmatize People Living with Mental Illness

By Michael J. Fitzpatrick, NAMI Executive Director

On Sept. 20, CNN.com invited and published the following guest article by NAMI Executive Director Michael J. Fitzpatrick. NAMI also released statements on the Navy Yard tragedy on Sept. 17 and Sept. 19.

When tragedies occur, such as the one at the Navy Yard in Washington, all Americans are deeply affected.

They include the one in four American adults who experience mental health problems. That's approximately 60 million Americans. Their first reaction is much like that of anyone else: feelings of anger and anguish and wanting to know when such events will ever stop.

But there's another, secondary impact to this community if a history of mental illness is suspected. Tragically, in the case with the Navy Yard gunman, mental illness appears to be a factor. But in too many cases, people simply assume that it is, no matter how much we caution that it's best not to attempt to diagnose any medical condition speculatively through the news media.

Unfortunately, stigma surrounds mental illness. It's most associated with a violent stereotype. The result has always been fear, prejudice and discrimination toward anyone struggling with a mental health problem.

The stereotype endures despite the fact that the U.S. Surgeon General has found that the likelihood of violence from people with mental illness is low. In fact, "the overall contribution of mental disorders to the total level of violence in society is exceptionally small."

Despite the impact of the Navy Yard tragedy and those of Newtown, Aurora and Virginia Tech on perceptions, a much greater, different reality exists. Many thousands of veterans experience post-traumatic stress disorder. Civilian employees of the military seek help for depression; teachers live with anxiety disorders. Students succeed academically while managing bipolar disorder.

People living with schizophrenia may be psychologists, professors, peer counselors or businesspersons. They are all members of their communities. Few are violent.

In the face of violence, people may simply be unable to fathom how an event could occur other than through mental illness, thought of often in non-medical terms such as "madness" or "insanity." Their perceptions also are conditioned by headlines that largely overshadow the greater reality.

Stigma perpetuated by the Navy Yard tragedy will be internalized by many people living with mental health problems, causing them to stay silent and withdraw from others. This will impede their recovery in many ways.

Stigma will remain a major barrier that keeps people reaching out for help when they need it.

In the wake of such tragedies, some will call for persons with mental health problem to be "screened out" by employers in the hiring process or to deny them security clearances. In the first case, the Americans with Disabilities Act (ADA) provides some protection against discrimination, but it is not always followed or easily enforced.

With top secret security clearances, just ask any member of the military or government official or contractor about the anxiety they often feel if they need to see a psychiatrist and then need to disclose it as part of a security clearance application or review.

Many issues need to be addressed in the case of the Navy Yard tragedy and the tragedies before it. They include what happened -- or didn't happen -- in the military and veterans mental health care systems, particularly when the gunman allegedly sought help from the Veterans Health Administration. Was there effective engagement?

The response of law enforcement should also be addressed. In theory, had the police both arrested and charged the gunman in past incidents involving a gun or disorderly conduct, he would have been put into the National Instant Criminal Background Check System (NICS) database and prohibited from buying a gun, regardless of his mental health status. It is also possible that his case might have been handled by a mental health court, leading to supervision and treatment.

Had Rhode Island police who responded to the gunman's 911 call for help in August been trained for crisis intervention and worked with a mobile crisis unit to have him medically evaluated, then perhaps this past week's horrors could have been averted.

Those are issues that must be pursued. But in the haste to respond, let's not stigmatize or discriminate against the millions of American who live productively with mental illness and who share the anguish and anger of other Americans in response to tragic horrors.

If stigma wins, things won't get better.

Thursday, September 19, 2013

Mental Health in the Marketplace

By Sita Diehl, NAMI Director of State Policy and Advocacy

CMSHHSgov Youtube

Oct. 1 is right around the corner and it is time to spread the word that new health insurance options are available in every state as part of the Affordable Care Act (ACA). We all know someone whose quality of life would improve if they were able to obtain the mental health care they need. The website www.healthcare.gov provides clear, simple answers on what is available, including for those who has been turned down for private insurance in the past.

For nearly 11 million uninsured Americans who live with mental illness, obtaining mental health care is a daunting prospect. If you are lucky, you can acquire basic medication or counseling on a sliding fee scale from a community mental health agency or health clinic. Some resort to self-medication, despite its immense risk, to find relief. For those who are self-employed, counseling and medications can cost hundreds of dollars a month. Moreover, case management and other evidence-based recovery supports are only offered through the public system and unavailable for purchase. A person may also be under-insured, wherein mental health benefits are not included or deductibles and copays are so high that doctor’s visits are delayed and medications rationed.

But changes will be made on Oct. 1 when the new Health Insurance Marketplace opens for enrollment. You, your family, your affiliate members and their families will be able to apply and enroll in quality health coverage with parity mental health benefits—at little or no cost—with coverage activating as early as Jan. 1, 2014.

Are you confused about what this really means for you?

Don’t worry, there are resources out there. To promote mental health advocates’ and consumers’ understanding of what the new health care law provides, NAMI and our allies partnered with the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop a narrated training toolkit called Getting Ready for the Health Insurance Marketplace. In just 30 short minutes, the toolkit reviews a wealth of free information to assist you and those you care about in taking advantage of the new coverage. The presentation is available here.

We all have an important role to play in making sure everyone has the best health coverage available to meet their needs. Learning about these resources is a crucial first step in helping both yourself and those around you lead a fuller, healthier life.

Monday, September 16, 2013

Suicide Portrayals and "Suicide Contagion" are not a Frivolous, Comic Concern

By Michael J. Fitzpatrick, NAMI Executive Director

It’s a safe bet that few people start the day expecting to protest a comic book. Unfortunately, that’s what happened last week after DC Comics announced a “talent search” for an additional artist for the upcoming launch of a Harley Quinn comic book.

Harley Quinn is a fictitious super-villain and sidekick to one of Batman’s arch-enemies, the Joker. She’s about to get her own comic book in November. The problem is that DC Comics invited aspiring artists to submit for four panels  that end with “Harley sitting naked in a bathtub with toasters, blow dryers, blenders, appliances all dangling above the bathtub and she has a cord that will release them all…the  moment before the inevitable death.” Apparently, the panels are intended to be a momentary dream sequence, but the imagery crossed a line with many comic book fans. Ironically, it also coincided with National Suicide Awareness Prevention Month.

NAMI and the American Foundation for Suicide Prevention (AFSP) and the American Psychiatric Association (APA) quickly joined to condemn the talent search’s theme and imagery. The issue was not simply the company’s insensitivity to millions of individuals and families who have been traumatized by a suicide attempt or lost someone to suicide.

“We know from research that graphic and sensational depictions of suicide can contribute to contagion,” declared the joint statement

“Contagion” is sometimes called the “copycat” effect. A news story or media portrayal can influence a vulnerable person to already vulnerable person to act.

In Night Falls Fast: Understanding Suicide, Kay Redfield Jamison noted that places and methods can become “suicide magnets.” When a local newspaper reports for example that a certain mountain cliff has been the site of several recent suicides, others may be drawn to it—unless the newspaper is careful how the story is presented.

It’s not a new concern. Over a decade ago, AFSP, NAMI and others developed Recommendations for Reporting on Suicide. Although developed primarily for the news media, they apply in principle to the entertainment industry.

  • There are almost always multiple causes for suicide, including psychiatric illnesses that may not have been recognized or treated Avoid reporting that death by suicide was preceded by a single event, such as a recent job loss, divorce or bad grades.
  • Avoid sensational headlines or putting expert opinions in a sensationalistic context. Don’t quote first responders about possible causes.
  • Avoid photos or videos of the location or method of a suicide death or of grieving family members and friends or memorials and funerals.
  • Inform readers about general suicide facts, warning signs and treatment options. Include the National Suicide Prevention Lifeline at (800) 273-TALK (8255).

DC Comics has apologized “to anyone offended.” By the end of the week, they initiated a dialogue with AFSP, NAMI and APA. We’ll now have to see what the first issue of the book presents in the four panels when it is published in November. There are no promises, but they at least have been sensitized.

We don’t think DC Comics intended to offend or were even aware of “suicide contagion” as a concern. Unfortunately, they aren’t alone. That’s why we encourage everyone to become familiar with the reporting guidelines, to refer editors and reporters to them, and cite them in letters to editors or other public statements.

 It is not just NAMI making the recommendation—but also the U.S. Centers for Disease Control and Prevention (CDC), National Institute of Mental Health, (NIMH) and other leading institutions in both the mental health community and communications industry.

Everyone can make a difference by educating others. One of the most inspiring aspects of the DC Comics protest was that comic book fans themselves sounded the first alarm—through posts on the company’s own Facebook web page, as well as ours. It has truly been a grassroots protest.

Tuesday, September 10, 2013

Suicide Prevention: Supporting Our Troops

By JB Moore, NAMI Military and Veterans Policy and Support Manager

September is Suicide Prevention Month—a time to raise public awareness that suicide is a serious and preventable public health concern.

As commercial news beats the war drum, its a good time to reach out to veterans, active duty service members, National Guard members, reservists and military-connected family members impacted by the invisible wounds of war and encourage them to trust that there are constructive ways to resolve whatever challenges they face. The American people owe so much to these individuals.

Now is the time to play a role in preventing suicide—to reach out in a timely manner to someone at risk, especially current and former service members, and encourage them to seek help. It is a myth that seeking help is a sign of weakness. The truth is seeking mental health treatment is a choice that embodies moral courage and integrity. It is a sign of strength and effective treatment is available.

So, what can you do?

  1. Know the suicide warning signs.
  2. Know who is at risk for suicide, how suicide can be prevented and what friends and family members can do to help.
  3. Know where to turn during a suicide-related crisis:

Todd Rich, a member of NAMI Mississippi and NAMI Veterans and Military Council Representative learned from personal experience with a veteran peer that was considering suicide that camaraderie with another veteran can help prevent suicide. Rich recommends being assertive with the individual at risk: “Talk to the individual with some authority. Find common ground. Tell the person: What you’re doing is wrong and you know it. Let him or her know that there is another way out. Don’t sugar coat it!”

Despite some improvement over the years, society still adheres to many negative stereotypes towards individuals living with mental illness. Such stereotypes lead to discrimination against those who need help most. As we recognize Suicide Prevention Month, let us imagine a near future when persons affected by mental illness, including current and former service members and their families, receive the same full range of integrated diagnosis, treatment services, and supports across a continuum of care available to all people with serious mental illness. We must inspire hope and work together to stem the tide of suicide among veterans and military families.

Veteran’s Stories

A Veteran’s Journey with Schizoaffective Disorder

My Journey Back Home: PTSD