"Nerve-Us" Breakdown

I recently completed an interview with BIG THINK — Mental Health Channel on mental health issues in the Black community. BIG THINK does incredible life enhancing work, via a media platform, on various health, political and social topics.  I will keep you posted on when it airs.

Here’s the transcript of the interview:

BIG THINK: Please tell us about yourself and the focus of your work.

Dr. Michael Lindsey: I am an Associate Professor at the Silver School of Social Work, New York University. I am also an affiliated faculty member at the Center for School Mental Health, University of Maryland, Baltimore.

I am a child and adolescent mental health services researcher. My research investigates the factors that prohibit mental health service use for youth and their families. We know from large-scale epidemiological investigations that only about a 3^rd of the youth who need mental health treatment actually receive the necessary services to address their needs. The problems of access to and use of care can be particularly problematic for youth of color. And, so, my work is especially attuned to the factors that influence mental health treatment among African American youth with serious mental health needs. To be even more concrete, my program of investigations has focused on the development and test of a targeted intervention to combat the perceptual and actual barriers to treatment for African American youth. What we know is that when this population does not receive the requisite mental health services to address their needs, the outcomes for them are most severe – particularly those who live in urban, high-stressed environments. We’re talking about increased engagement in suicidal behaviors, poor school performance, substance abuse, early sexual experimentation, to name a few of the many deleterious consequences associated with untreated mental illness for this population.

In the last few years my work, in conjunction with my colleague, Dr. Laura Mufson (Columbia University), has focused on the delivery of stigma reduction and depression treatment in urban school settings, again, specifically targeting African American youth with serious symptoms of depression. Our work in this regard focuses on the amelioration of depression as it relates to improving poor school performance among youth. In addition, we are addressing the matter of how to bring evidence-based practices into the “real-world” context of schools and urban communities so that those in need might benefit from the best of what we know works regarding depression treatment.

BIG THINK: How does mental health needs in the black community compare to society at large?

Dr. Michael Lindsey: Most large-scale epidemiological studies will indicate that the prevalence rates for mental disorders are higher for Whites than African Americans (Williams et al., 2007; Lincoln et al., 2010). While this is true, the bigger concern regards the chronicity and burden of mental health problems, e.g., depression, which tend to be more problematic for African Americans. There is also the fact that many African Americans, relative to their White counterparts, do not receive treatment for mental health problems. This consistently continues to be true across all disorders. African Americans simply do not get the appropriate level of mental health treatment to meet their emotional, psychological needs.

Lack of treatment for depression, in particular, accounts for the rising rates of suicide among African Americans.

BIG THINK: What forces impact mental health in the black community? Historical and present-day.

Dr. Michael Lindsey:

Historical

From a historical perspective, you cannot consider the matter of mental health without discussing the issue of slavery and its vestiges. African Americans have been traumatized from this experience and the enduring forces of racism and discrimination continue to take its toll on the emotional, psychological wellbeing of African Americans today. The scars of trauma are fairly evident for African Americans, which creates a lack of trust in institutions or entities that ostensibly adhere to the wellbeing of all mankind, yet continue to treat Blacks in dehumanized ways (e.g., the state of the police force and African American males in the U.S.). The distrust is far-reaching, leading African Americans to socialize their children against “taking their problems outside the home.” “Outsiders” are not to be trusted, and there is the perception that no one can handle your cares better than your family. African Americans have historically been treated unfairly by “the system,” and thus families and others among their social networks promote the perception, even if unintentional, that the system cannot be trusted.

Present-day

I would say lack of trust of mental health providers. And, the perception that services will be irrelevant to one’s presenting concerns. Concerns about what others may say regarding one’s mental health treatment. Or, concerns about how going to services would make one look and providers lack of understanding and cultural attunement to the African American experience.

 BIG THINK: How would you characterize the way mental health is dealt with in the black community, both on an individual level and at large?

Dr. Michael Lindsey:

At an individual level

Many individuals suffer in silence. They are afraid to acknowledge a mental health struggle for fear of being ostracized due to family or community members’ stigmas regarding mental illness. And, it is not just the shunning. Mental illness in our society is accorded personal failure—one’s inability to weather a storm in their life. I think when you add the complexity of race, for African Americans, there is a double-edged sword, so to speak: At one end, there are the attempts to overcome and live with a mental illness. At the other end, there is the matter of living in a world that is hostile toward and micro aggresses against African Americans. At the individual level, that is a pretty intense struggle for African Americans who suffer with mental illness.

At large

Again, as a society, we shun those who suffer from mental illness. We see it as a personal defect. In the African American community, it is no different. The world (and its stressors) is already a struggle unto itself, and to have a mental illness is yet another thorn in the side, so to speak. I remember hearing as a kid, in my community, about people “going down south” for a while. I used to wonder what that meant. As I grew older, I came to understand that people were sent down south when they were struggling with some emotional or psychological problem. Drugs may have been involved, you know, as a coping mechanism. Generally, the African American community at large has been afraid to talk about mental illness. It is a taboo subject. In the church, from a historical perspective, mental illness has been associated with demonic possession. The African American community has been conditioned to believe that if you just pray about it, Jesus will take your burdens away. Meanwhile, professional care is never sought, which then leads to coping or self-medicating through alcohol or drugs.

BIG THINK: What are some of the obstacles that African Americans face in receiving treatment? Culturally and socioeconomically.

Dr. Michael Lindsey:

Culturally, I’d say this notion that going to therapy is something that Whites or individuals who have money do. As mentioned, there’s also the belief that you can pray your burdens away. Let Jesus fix it. We have to put these perspectives on how best to deal with mental illness in context, though. These are not erroneous or far-fetched perspectives. They are very proximal to the daily struggles accorded to what it means to be African American in the U.S. Therapy is not seen as a option, historically, because how many people in our network do we know who are therapists? Are there clinics or private practices in majority African American communities? Even if there were clinics, who would frequent them for fear of being stigmatized? These are very real concerns.

Socioeconomically, you know, is an interesting one. Sure, mental health treatment is seen as expensive, and perhaps not affordable. To some extent, creating better financial access to care increases the likelihood that services will be used. Some studies of the federal Medicaid/Medicare programs suggest that having health insurance increases access to care. Extant research, however, tells us that access alone will not totally eliminate the disproportionate amount of individuals who will not receive mental health treatment. Perceptual barriers (e.g., the perceived relevance of services, stigma associated with having a mental illness or seeking treatment) still factor hugely in the receipt of care for African Americans.

BIG THINK: Can you speak to some of the socioeconomic factors that limit access to mental health care for many African Americans?

Dr. Michael Lindsey: Again, we are talking about lack of insurance coverage, perceptions that services will not be affordable, and the number of providers who have a sliding fee scale, all work to limit access to mental health care for African Americans.

BIG THINK: Does the church, and a reliance on faith, factor into the mental health care trajectory of many?

Dr. Michael Lindsey: Absolutely, it does. Many are consoled to pray about the problem. Or, pastors or lay ministers offer counseling, but they are not always equipped to do so. Some do not have the requisite specialized training.

I believe that faith and spirituality are quite important, but I also believe that mental health treatment for those with mental health needs should be a combination of professional care and being part of a supportive community that will lift your spirits and encourage you to keep focused on the healing process. And, to attend your appointments.

BIG THINK: How can the church help the black community in its understanding of and response to mental health?

Dr. Michael Lindsey:

How can it do a better job of this in the future?

• Pastors are key.
  • In their sermons and messages to congregants, I think they need to emphasize that it is okay to seek professional help for mental health needs. It would be incredible if pastors were knowledgeable about the signs and symptoms of mental illness, and even highlight examples from the scriptures. Several biblical figures struggled with depression, anxiety, for example. In other words, pastors can go a long way in humanizing the experience of mental illness.
  • In the same vein, I think pastors are key to organizing programs to assist those with mental health needs. Since many folks in the church will take their cares/concerns to the church, pastors can be a bridge to connecting those in need to treatment. Imagine the church as a triage unit, whereby they would do an initial assessment of needs, but then refer those in need to treatment.
• At a minimum, churches should have a list of providers on hand – a list of providers from therapists to psychiatrists.
• Churches should also do mental health promotion programs, but the kind that screen and get folks connected to care, e.g., education programs that train on the signs and symptoms of disorders, or that promote mental and psychological wellness.
• No one should attempt to deliver mental health treatment without the proper training. Nor, should people fashion themselves as “counselors” without the proper training and credentialing. This happens a lot in churches, and it can be dangerous.

BIG THINK: Can you speak to how African American men in particular deal with depression? Often feel that experiencing depression or seeking help makes them “less of a man?”

Dr. Michael Lindsey: Certainly, and this is a huge problem with respect to help-seeking and service use for depression. We have all kinds of ill-conceived notions of what it means to be a man. We socialize boys differently than girls. We tell them it is not “man-ly” to cry, or even to express emotions. “Man-up.” “Fight it off.” “Be tough.” These are all familiar edicts expressed to boys versus girls. Notions of masculinity have much to do with how men with depression conceptualize their problems and whether they will actually admit to being depressed, and actually seek treatment because “real men” tough it out.

This is so off base and out of touch with the healing process for a condition like depression.

Normally, asking for help, seeking guidance, and even acknowledging vulnerabilities related to depression is a sign of strength. But, for African American men, these postulates are antithetical to the experience of masculinity, i.e., what it means to be a man. In many of the contexts and spaces African American men are operating in, whether in corporate America or in the “hood,” one cannot afford to be weak. For, to be weak or even express weakness in some form, may make one more vulnerable or susceptible to ridicule or harsh treatment. Many African American men will NEVER admit to being depressed.

We see these same notions of masculinity impact other health behaviors, e.g., going to a medical doctor for a physical health issue. You would be hard pressed to get many men, and certainly Black men, to go in for an annual physical.

If you want to improve access and connections to mental health and health care among African American men, you definitely have to combat the perceptions of masculinity and what it means to be man.

BIG THINK: Can you speak to the need for culturally competent mental health care providers, and culturally appropriate treatment strategies?

Dr. Michael Lindsey: Culturally competent care is so critical to everything. If patients perceive that the provider is inauthentic or the nature of the services do not speak to their unique circumstances, you have lost before you have even started. Services have to be experienced as meaningful, and meaning is derived from going through a process that speaks to the challenges going on in one’s life. For example, you do not go to the supermarket to get a haircut. One is most likely to go to the place that meets their needs.

I endorse something that I’ve framed as “authentic engagement,” and I believe providers must exemplify this. What do I mean? Cultural competency, for example, is not just about having knowledge of someone’s unique history insofar as ethnicity. You cannot read it all in a book and then purport to be competent. It is as much about knowing the culture of your patient’s community. What are the current and historical trends in their neighborhood? Having an earnest interest in this information builds ones authenticity as a provider. One may say our patients are not there to “teach us” or we are not there to learn from them. No, but what are you doing outside of the treatment context to better understand your patients’ lives?

Treatment strategies should be adherent to the norms and expectations that patients bring. How might one apply an intervention strategy to Black adolescent boys versus White adolescent girls? There you have an ethnicity by gender interaction, but the point is that your treatment is not so much a cookie cutter approach.

Some might argue that interventionists need to stick close to the intervention model as intended, and I agree. I simply mean that at least some thought should be given to the unique vantage point from which our patients present. Boys might respond differently than girls. Blacks differently than Whites. I would argue there’s a need for more clinical flexibility. One should be beholden to the model, but be quick on their feet as well, and perhaps bring that nuance presentation into the model of care.

BIG THINK: Recent studies suggest that African Americans may metabolize psychotropic medication more slowly than whites, yet often receive higher dosages. As a result, many experience more severe side effects and are less likely to stick with a course of treatment. Can you speak to this and whether there is any work being done to make sure that treatment can be more effective for this group?

Dr. Michael Lindsey: I believe these studies to be mixed. Some have found that Blacks metabolize psychotropic medication slowly than Whites, and some have found that there may be heterogeneity within Blacks. So, we want to be careful about these assertions. We need more data to confirm. What we do know is the following:

• Blacks tend to be receive antipsychotic medication at higher rates (Arnold et al., 2004).
• They receive higher doses (Arnold et al., 2004).
• They tend to receive older drugs (Arnold et al., 2004; Puyat et al., 2013).
• And, they tend to be less likely to receive antidepressant medication, which is consistent with their lower rates of overall treatment for depression relative to Whites (NHANES Survey, 2005-2010).

BIG THINK: What could be done to help reduce stigma, increase access to care, and improve treatment in the black community?

Dr. Michael Lindsey:

Campaign efforts. There needs to be more stigma reduction campaigns. We need more popular people, be they athletes, entertainers, politicians, or even ministers to acknowledge their struggles with mental illness and how they sought help for their struggles. Such messages of struggle and triumph with respect to mental illness would be so incredibly powerful.

• Raise the level of surveillance. Mental illness occurs in a context, and those close to the individual struggling with a mental illness are critically important. Thus, we need to raise the level of surveillance, universally, regarding the signs and symptoms of a mental illness. If you see something, say something is a popular refrain regarding terrorism. Well, it strikes me that mental illness, if gone untreated, can result in catastrophic outcomes, and so we need to have our antenna up regarding greater awareness and recognition of one’s cry for help, and the signs/symptoms of mental illness. We know works, and what are effective forms of care. For example, in the care of those with psychosis, we know that families play a critical role in the receipt of care. We have to raise the level of awareness in critical ways. Thus, families, teachers and professors, friends, co-workers, ministers play a pivotal role helping one get connected to care.

• Market testimonials. It would be wonderful if we have concerted marketing efforts to advise of the warning signs, or as mentioned earlier, provide testimonials of struggle and triumph. We love the story of the underdog, and how one overcame personal struggles to achieve success. I so wish we could frame mental illness in the same way.

• Be real with yourself. We all struggle with emotional or psychological turmoil from time to time. Let’s stop pretending, living behind a veil, and be forthright about these struggles. If you cannot talk about something, it is out of control.

BIG THINK: What would you say to an individual experiencing symptoms of depression or another disorder who is afraid to seek help due to this stigma?

Dr. Michael Lindsey: We know that untreated depression is associated with a host of negative outcomes. In the long run, it will do irreparable damage. Getting help is a sign of strength, not personal weakness.

I would identify with that person what things get in the way of treatment. Fears, insecurities, what is it? I would also ask that person to identify the things that would help him or her get to treatment, e.g., a supportive family, an earnest interest in wanting to change. I would then sort through with that person how we can use those facilitators to overcome the barriers to care. I would emphasize that treatment works, and provide examples of it working. I would not leave it to chance. I would also support that person getting treatment, and follow-up to make sure that person has actually received treatment.

BIG THINK: What do you see for mental health in the black community in 10 years? 50 years? What are you most hopeful about in this area?

Dr. Michael Lindsey:

In 10 years, in 50 years:

This is a great question. Honestly, I see greater awareness and recognition of mental illness. This is unfortunate, but there will likely be high profile suicides and other calamitous events that will increase greater awareness of the fact that untreated mental illness can be extremely problematic. Professional help is a sure best way to address mental illness given that we know effective treatments.

I see the language of mental illness, its signs and symptoms, becoming a part of the typical nomenclature of families, schools, and churches. Of course, I see care as being delivered in non-conventional ways, e.g., through computers, or interactively via multi-media or even gaming platforms.

Most hopeful

The historical barriers and prohibitions no longer having an impact on treatment access because people will see that mental illness is normalized and accepted in our society. I am hopeful that people, in general – not just Blacks, will go to get annual check-ups for their mental wellbeing just like they do for their physical wellbeing.

I am also hopeful that federal, state and local policies will continue to create opportunities for innovative programs to be developed, but most importantly that greater access to care is created.

References

1. Arnold, L. M., Strakowski, S. M., Schwiers, M. L., Amicone, J., Fleck, D. E., Corey, K. B., & Farrow, J. E. (2004). Sex, ethnicity, and antipsychotic medication use in patients with psychosis. Schizophrenia research, 66(2), 169-175.

2. CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2010. http://www.cdc.gov/nchs/data/databriefs/db135.htm

3. Lincoln, K. D., Taylor, R. J., Watkins, D. C., & Chatters, L. M. (2011). Correlates of psychological distress and major depressive disorder among African American men. Research on Social Work Practice, 21(3), 278-288.

4. Puyat, J. H., Daw, J. R., Cunningham, C. M., Law, M. R., Wong, S. T., Greyson, D. L., & Morgan, S. G. (2013). Racial and ethnic disparities in the use of antipsychotic medication: a systematic review and meta-analysis. Social psychiatry and psychiatric epidemiology, 48(12), 1861-1872.

5. Williams, D. R., Gonzalez, H. M., Neighbors, H., Nesse, R., Abelson, J. M., Sweetman, J., & Jackson, J. S. (2007). Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: results from the National Survey of American Life. Archives of General Psychiatry, 64(3), 305-315.

Guest Blogger: Amaris Watson, MSW

Most recently, I had the opportunity to have lunch with a childhood friend. During conversation, we discussed our lives and career paths. He began to tell me about the stressors that come along with his career including but not limited to long hours, lack of viable resources and unpredictable events He expressed that the continuous pressures from his career often leave him feeling overwhelmed, tired, anxious and frequently stressed. We then begin to discuss stress, its signs and ways to effectively deal with it.

Stress is inevitable. It is our body’s natural response to change and can be defined as emotional and mental tension that ignites as a result of demanding circumstances. These circumstances for many of us quite often arise in both our personal and professional lives. Forty-eight percent of Americans report stress has negatively impacted both their private and professional life (American Institute of Stress, 2014). Experiences of loss, pressure, hurt, or unexpected events may leave us feeling extremely tensed and anxious. A number of people experience tension as a result of pressures within both their home and work environment. According to the American Psychological Association, 65% of Americans reported work as their top stressor. Thirty-three percent of Americans are living with an extreme degree of stress. In addition, 48% of Americans stay up at night as a result of feeling stressed (American Institute of Stress, 2014).

It’s essential to recognize the signs of stress to alleviate its long and short term consequences. Signs of stress include but are not limited to headaches, difficulty falling and remaining asleep, muscle tension, fatigue, chest pain, loss of appetite or comfort eating, forgetfulness, and irritability (American Psychological Association, 2014).

If you’re feeling stressed, here are six steps that may help ease your tension:

• Identify Stressors. Recognize your body’s response to stress. Record details of stressful occurrences in your life and your response to them. Keeping track of stressful events and your response can help you discover your triggers of stress and reactions to them.
• Develop Boundaries. Create a boundary between your professional and personal life. For instance, schedule specific blocks of time for work and avoid completing work past that time. Establishing boundaries can help ease stress that results from your professional life.
• Take a Break. Take time to relax and rejuvenate. Utilize your vacation time or schedule weekly time to focus on pleasurable activities (e.g. reading or playing games).
• Exercise. Participate in at least 30 minutes of physical activity per day. Exercise can help improve your mood and alleviate stress.
• Practice Relaxation Techniques. Practice deep breathing exercises and mindfulness techniques (e.g. yoga). Take time daily to purposely focus your mind on a specific activity (e.g. savoring a meal) to help ease stress.
• Seek Support. Seeking mental health support may be beneficial in helping you cope with pressure from all realms of life. Connecting with friends and family who can provide emotional support may also be helpful in alleviating stress.

Recognizing Depression: The Seven Signs

Depression is a serious mental disorder that has the ability to deprive one of their emotional stability and increase their chances of partaking in risk behaviors. According to the Center for Disease Control and Prevention (CDC), about 9% of the total U.S. population report having feelings of depression. The 2013 Gallup-Healthways Well-Being Index suggests a relationship between unemployment and escalated depression rates among U.S. citizens. Statistical data from the index reports about a 16% increase in depression among unemployed Americans in comparison to their employed counterparts, which is a clear indication of the prevalence of depression and the impact it has on society. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) characterizes major depressive disorder (MDD) by a sum of symptoms. The symptoms are described below. Recognizing the signs and symptoms of depression are the first steps to getting treatment and overcoming this mental illness.

The Seven Signs:

• Feelings of hopelessness and worthlessness. You may have a bleak outlook regularly, feel as though there is no tomorrow and as if things will not improve in your life. You may also notice a decrease in your self-esteem and self-worth.
• Low energy level: You may have feelings of extreme tiredness, loss of energy majority of the day and not feel like doing much of anything.
• Poor concentration. You may have an inability to focus on things and activities that you normally can direct your focus on, or you may have difficulty making simple, every day decisions.
• Abnormal sleep patterns. You may notice significant changes in your sleep pattern as evidenced by problems falling or staying asleep. You may wake up odd hours of the night and/or fall asleep for prolonged periods of time throughout the day.
• Weight Loss. You may experience a significant amount of weight loss or weight gain in addition to changes in your appetite.
• Loss of interest. You may have minimal to no interest in doing activities you once found pleasurable and have trouble motivating yourself to do them once again.
• Suicidal thoughts. You may have repeated thoughts of harming yourself, that life isn’t worth living and/or you’re better off not living. You may have also developed a plan for committing suicide and/or have recurrent thoughts of carrying it out.

If you or your loved one experience a number of these on a regular basis, it is vital that you seek help from a health care provider for assessment and determination of the next steps.

Note: Special thanks to Amaris Watson, MSW for her research and work on the initial draft of this post.

Posted by Guest Blogger: Amaris Watson, MSW, LGSW

Courage. Acceptance. Perseverance. Hope.

I was recently reviewing online content regarding stories of triumph for those suffering from a mental illness and came across this story in the Washington Post. Link: http://www.washingtonpost.com/lifestyle/style/cool-disco-dan-opens-up-about-his-battle-with-mental-illness/2013/10/28/e81bef10-3da2-11e3-b7ba-503fb5822c3e_story.html

Almost one year ago, Danny Hogg (also known as Cool “Disco” Dan) achieved virtue and notoriety after sharing his battle with mental illness to his community and ultimately the world. Cool “Disco” Dan, one of Washington, DC’s most well known, artistic icons admitted to being diagnosed with schizophrenia, bipolar disorder, and personality disorder all of which caused great strife in his life.

To help cope with his mental illness, Hogg admitted to regularly seeking mental health treatment to prevent outbursts of rage. This is remarkable as we know African American males are less likely to utilize services. According to work by Dr. Michael Lindsey (NYU Faculty Profile: http://socialwork.nyu.edu/our-faculty/full-time/michael-lindsey.html), Black males are less likely to admit emotional struggles and experience internalized struggles regarding mental illness and treatment services. They see treatment use as a sign of weakness. According to a 2012 article by Lindsey and Dr. Arik Marcell, published in the American Journal of Men’s Health, Black males fear the stigma that comes with a diagnosis. Lindsey and Marcell also note that cultural mistrust of providers, lack of access to and negative perceptions towards mental health services also serve as barriers to black males participating in mental health treatment. Such was the case with Hogg. But, he overcame those barriers to care. In addition to seeking mental health treatment, Hogg also exercises and watches television to help relieve symptoms.

To the untrained eye, a person with schizophrenia can appear “crazy” because they may engage in “bizarre” behaviors. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition – DSM-5, persons with schizophrenia may experience delusions and hallucinations, experience disorganized thinking and catatonic behavior. Bipolar disorder is a mood disorder characterized by an extreme change of emotions. The individual may experience a continuum of feeling joyous and deep distress over the same period of time. Lastly, a personality disorder represents a continuity of behavior, which deviates from the expectations of one’s culture. They may include but are not limited to patterns of instability, impulsivity, social inhibition and detachment from social relationships. As you can imagine, such behaviors if not properly treated can have a devastating impact on the development and maintenance of relationships.

Each of these mental disorders can elicit major changes in a person’s thoughts, moods and behaviors. Any form of mental illness may make it quite challenging for an individual to interact with others and deal with the constant changes and demands of life. Lack of understanding of these mental illnesses causes many to fear, mistreat, or in Hogg’s case, shy away from those suffering from a mental disorder. This is disheartening. To help combat this, mental health professionals should passionately collaborate to produce impactful mental health education materials, interventions and strategies that will provide knowledge regarding symptoms and the various forms of expression portrayed by mental disorders such as schizophrenia or bipolar disorder. Such education and work with family members can ensure that those who need mental health treatment get to it and stay connected.

Here are five things you can do to help the Hogg (“Cool Disco Dan”) in your life:

1. Take a non-judgmental approach when conversing about recent problems or behaviors
2. Offer emotional support by letting your loved one know you care
3. Become educated about the signs and symptoms of mental illness (Here’s a helpful site: http://www.nimh.nih.gov/index.shtml)
4. Encourage your loved one to visit a mental health professional
5. Offer a ride, provide child care or even accompany your loved one to sessions

 Amaris Watson is a 2014 graduate of the University of Maryland’s Master of Social Work program. Amaris’ passion lies with helping underserved adolescents and their families both identify their mental health needs and seek treatment services. She is a research assistant on the Making Connections Project, led by New York University Silver School of Social Work Associate Professor, Dr. Michael A. Lindsey. Amaris plans to pursue a PhD in Social Work to continue her research in the area of mental health service delivery to ethnic minority adolescents. Her contact email is: amariswtsn@yahoo.com

Terrie M. Williams (author of Black Pain: It Just Looks Like We’re Not Hurting) continues to raise our consciousness:

Karyn Washington death puts suicide, mental health back in spotlight

Twelve victims.  And the thirteenth fatality—the presumed perpetrator, Aaron Alexis.  Unfortunately, the Navy Yard shooting tragedy has become commonplace in our society.  And, once again we learn the perpetrator had underserved or inadequately treated mental illness.  All too often, we connect with these mass shootings on levels other than mental illness.  The proponents for stiffer gun ownership legislation will point to this tragedy as another indication that too many guns on the streets, in the wrong hands led to this unfortunate and very sad outcome.  On the other side of the argument, those who lobby for gun ownership suggest that it is a fundamental right to bear arms—consistent with the protections offered under the Second Amendment.  Gun ownership, they argue, may even be a deterrent to criminal behavior.

However, in the case of mass shooters, we are continually learning of their untreated/undertreated mental illness.  How can we learn from these tragedies?

First, we can become more impassioned about creating better access to treatment, particularly in school- and community-based settings.  Studies show that when mental health services are co-located in communities that tend to have an overrepresentation of mental health need they create better access to treatment, and thus more use of those services.  Second, we need to have more public health campaigns that target messages toward mental illness stigma.   Third, we need to offer stronger support to those who experience mental illness; family members can be vital cogs to ensuring that loved ones connect to treatment.  Offer to accompany a loved one with mental illness to treatment.  Be patient and listen to their concerns or struggles with life.  Finally, there is also an interesting gender perspective to this issue.  That is, what we tend to see in mental health services research and practice is that men have a tougher time both connecting to and staying in treatment.  There is an implicit gender bias in our society in terms of what it means for a man to ask for or seek help when he experiences an emotional, psychological struggle.  There is a pervasive masculinity ethic suggesting that men are supposed to “tough it out,” or “show no sign of weakness.” Such perceptions counter positive, help-seeking behaviors one might engage in to get connected to mental health treatment.

Such tragedies as the September 16th Navy Yard shooting remind me that we have so long to go in terms of how we as a society view and treat mental illness.

Michael Lindsey, PhD, MSW, MPH holds a joint appointment as associate professor in the School of Social Work and a faculty affiliate in the Center for School Mental Health, School of Medicine (Department of Psychiatry) at the University of Maryland, Baltimore. Dr. Lindsey’s research and mental health practice experiences examine the prohibitive factors that lead to unmet mental health need among vulnerable, Black youth with depression and other serious mental health needs. Dr. Lindsey is developer of the Making Connections Intervention (MCI), a program designed to prepare adolescents to be positively involved in mental health services for depression. He can be reached by email at nerve.us.breakdown@gmail.com. He can also be followed on Twitter @DrMikeLindsey.

Two weeks ago, the Prince George’s County (Maryland) police shot my friend, Keith. At the tender age of 38, he died from six bullets to the chest. The police took him out in front of his sons’ daycare center. His parents, wife, friends and I – the mental health professional in his network – are still asking, “How did it get to this?”

Did the police really have to shoot to kill Keith? I pondered how many times Black males across this country reached a similar fate as Keith. Police officers are not sufficiently trained to handle mental health-related calls. They are trained to protect the innocent and themselves if the person is exhibiting any threatening behavior. But to those of us who knew him, Keith was also “innocent;” a victim of his own mental anguish.

Check out the work of my colleague, Dr. Michael Compton at George Washington University. Michael has developed a program to train police officers on how to respond to psychiatric crises without resorting to violence. (Link: http://www.gwumc.edu/faculty/comptonmichael)

For two weeks, Keith acted out of character. He said he felt the pain of African slaves. He feared his life was in danger. He believed Lil Wayne was God. His increasingly strange behavior scared everyone around him. Keith was losing his mind and we didn’t even know it.

Keith’s wife, Brittany, tried to make sense of her husband unraveling right in front of her eyes. She confronted his delusions. She prayed with him. She called his friends and asked if they could spend time with him. She hoped some male bonding would make things better. Nothing worked. By the time Brittany called me, she was freaking out. She wanted a referral to a mental health professional. She tried to understand what all this madness meant. I could tell, as I explained that Keith was having a psychotic break, she had no idea what was happening to her husband. She was in shock.

My advice that Keith get immediate professional help did not reach him in time. While I was on the phone with his wife, Keith was at his sons’ daycare center for the second time that afternoon trying to pick up his one- and two-year old boys. This time, he had an ax! Of course, the daycare professionals called the police and what the officers saw by the time they arrived on the scene was a Black man with a weapon.

Did this have to happen to Keith, though? Obviously, no because if mental health problems like a psychotic break are identified early, they are highly treatable. Might the awareness of the signs of a psychotic break, like when Keith thought people were out to get him, and knowledge about how to get help, have saved Keith’s life? Perhaps, yes.

However, many Black males fear asking for help because of the male ego. We are reluctant to go to a mental health professional because we are afraid to be called “crazy.”  We fear being misunderstood by professionals; told we are psychotic or schizophrenic instead of receiving some understanding about the tough time we’re having as we navigate a bad situation. We fear that we are alone; that no one else is feeling the kind of “blues” we feel. And we don’t like to say, “I’m just – you know – depressed.” Why not? Because we expect to be rejected by our “boys,” our family and our community with comments like, “Man, you heard about Junie? They said he ‘trippin.’ I guess he couldn’t handle the pressure.”  Yet, mental health struggles can be as benign as “having a bad day” to more intense conditions, behaviors like having psychosis (i.e., delusions or hallucinations).

Remember the time you saw that dude running down the street in a ski suit, rocking a fur coat in 100 degree weather?  You cast off him off as “crazy,” or “tripping.”  Or, what about the “bag lady”  you saw talking to herself at the bus stop as she guarded her grocery cart stuffed with newspaper? These are illustrations of the “break” I’m talking about. We all shun those people never realizing that what they are experiencing is already beyond their control. They’re in need of serious professional help and you may be the one that helps them get it.

Most often, a psychotic break can be brought on by drug use like PCP. Or, someone can be “pre-wired,” to experience a mental break down because of an inherited gene, you know, it can “run in the family.” Being “pre-wired” is the scariest, though, because psychosis can lie dormant and then surface out of nowhere, often brought on by life’s stresses. But for many reasons, we are not connected to mental health support and treatment. I challenge you, my reader, to identify why that is.

Granted, our mistrust of mental health professionals because of the past may be legitimate. There has been an uneasy relationship between Blacks and the U.S. healthcare system, in general. Remember the Tuskegee Syphilis Experiment? But this shouldn’t hinder us from seeking help for ourselves or our loved ones.

Although there is no rhyme or reason for knowing when a psychotic break might occur, getting help at the first sign of a break (e.g. paranoid thoughts or delusions) is VITALLY important. Pick up the phone, call for an ambulance. Mental health professionals suggest that there are psychotropic drugs and talk therapies that can successfully treat the patient. A combination of both may well have saved my dear friend, Keith’s life.

Now, he is another statistic of the Black community: a Black man gunned down by the police; a father never to be known by his sons; a husband gone too soon; a son whose parents are burying their own child; and the beloved friend who has left us to make sense of the inexplicable. Keith deserved a better outcome.

Many of you out there, like Keith, are “dying to ask for help.” Or, you may know someone dying to ask for help. My hope is that, through this blog, we begin to have serious conversations about the mental health challenges we all face. If you cannot talk about something, it is already out of control!

Michael Lindsey, PhD, MSW, MPH holds a joint appointment as associate professor in the School of Social Work and a faculty affiliate in the Center for School Mental Health, School of Medicine (Department of Psychiatry) at the University of Maryland, Baltimore. Dr. Lindsey’s research and mental health practice experiences examine the prohibitive factors that lead to unmet mental health need among vulnerable, Black youth with depression and other serious mental health needs. Dr. Lindsey is developer of the Making Connections Intervention (MCI), a program designed to prepare adolescents to be positively involved in mental health services for depression. He can be reached by email at nerve.us.breakdown@gmail.com. He can also be followed on Twitter at DrMikeLindsey.