WASHINGTON — When Tom Starling first heard the statistic that 1 in 5 Americans have a mental illness, he thought it had to be a mistake. The number simply seemed too high.
Then he remembered the number of women who have postpartum depression, and the veterans left with post-traumatic stress disorder from military service. He thought about suicide statistics and those who experienced childhood trauma, the rise in anxiety and depression and how many families have lives marred by domestic violence.
Starling, the board chairman of Mental Health America, reconsidered. He decided if you take those and so many other factors into consideration, the original figure is probably way too low. It’s probably closer to 1 in 2 who struggle with mental health, he said Thursday during the group’s annual conference.
Hundreds of mental health experts, advocates, public health officials, community organizers and school officials have been meeting here this week for Mental Health America’s annual conference. The 2019 theme “Dueling Diagnoses” is a nod to the fact that mental health challenges seldom travel completely alone. It’s more likely that people with depression are also anxious, or that someone has autism and a mental illness, each condition complicating care for the other. And treatment requires seeing and screening the whole person.
The Deseret News received a Mental Health America media award for its yearlong "Generation Vexed" series on teen anxiety. And we've been listening to and learning from conversations at this conference. Here are eight things experts want you to keep in mind about the connections between mental health and everything else:
1. Mental and physical conditions often coexist.
That's according to Simone Lambert, who trains counselors and is president of the American Counseling Association and a professor at Capella University. “Most people struggle with more than one thing,” she said, pointing to research from the Robert Wood Johnson Foundation that says 68 percent of adults with mental disorders have medical conditions and nearly 3 in 10 adults with medical conditions have a mental disorder.
For older adults, the number dealing with a chronic illness, mental or physical, rises to 80 percent — but the elderly are not the sole group disproportionately affected by chronic disorders, either. Ethnic and racial minorities experience them at twice the rate of whites, while the poor also have elevated risk compared to people with more resources.
Lambert pointed out that receiving proper care involves recognizing and addressing all the mental and physical disorders a person may have and acknowledging that they are “complex and bidirectional.”
2. You can’t treat cancer without addressing mental health.
Nearly 40 percent of Americans will be diagnosed with cancer in their lifetime, and “the usual reaction to cancer is to feel traumatized,” says Elizabeth Franklin, executive director of the Cancer Policy Institute.
Yet the majority of time and energy is spent talking about aggressive and immediate treatment, rather than asking the person about what’s important to them, what they’re worried about and what emotional and mental support they need.
During her time at George Washington University Cancer Center working to manage patient navigators, Franklin said the top day-to-day concern expressed by patients was a worry about transportation. And child care issues weren’t far behind.
While cancer can cause an onslaught of mental health concerns like depression and anxiety, it’s also crucial that folks who are dealing with chronic mental health concerns before a cancer diagnosis get connected to support early.
One resource is The Cancer Support Community, which offers a help line from 9 a.m. to 9 p.m. ET at 1-888-793-9355, plus a list of support groups where cancer patients and survivors can connect with others for support beyond medical procedures.
3. Mental wellness is a community affair.
When Mayor Scott Fadness learned that his police officers had detained 157 people in 2014 because they were in crisis and at risk of hurting themselves or others, he vowed that Fishers, Indiana, would do more to help people “suffering in quiet despair.”
So in 2015, Fadness gathered police and fire chiefs, school officials, religious leaders, community advocates and business leaders to address mental health and make systemic and substantive changes that would benefit their community of 92,000 just outside Indianapolis.
The city first increased mental health training for first responders, police and firefighters — the folks most likely to see people in moments of crisis. They also created an Emergency Duty Officer who goes on any mental health call and then follows up with the person within 72 hours to check on the care and build a relationship, because relationships make the difference.
Fadness told of one young woman with behavioral concerns who, on a rough day, ran out of her school and into a busy road. The police officers were unable to calm her down until one officer remembered that she responded well to questions about her pet lizard. Almost immediately, the situation de-escalated and they were able to get her the help she needed.
And the need is growing. In Fishers, firefighters responded to 42 fires this quarter, but 164 mental health calls — 41 of which were suicidal ideation.
4. Schools play a crucial role in supporting kids.
Schools in Fishers were a big part of the mental health initiative — intervening before kids reached crisis mode and needed police involvement.
The Hamilton Southeastern School District now trains teachers in suicide prevention, teaches evidenced-based suicide prevention classes to eighth-grade students and recently partnered with a community health organization to add more licensed providers to its 22 schools.
Before the partnership, the school provided mental health services to about 50 children a year, but since January 2017, professionals have reached 1,254 children in a school setting, said Brooke Lawson, Hamilton Southeastern Schools mental health and school counseling coordinator.
In the 2018-2019 school year, counselors provided 8,424 individual therapy sessions for 843 students.
Among kids receiving mental health treatment, grades have gone up, while disciplinary action and days of schools missed are going down.
And though the school is hearing from more students saying they’re thinking of harming themselves, the uptick is strangely encouraging.
“We want more and more kids coming forward and telling us they’re struggling,” Lawson said. “We do feel like we’re creating a culture (where it’s OK) to say, ‘I’m thinking about wanting to hurt myself,’ and kids know who to go to when they’re feeling that way.”
But the most celebrated number in Fishers is zero: They haven’t lost a student in the district to suicide since 2013.
5. Childhood trauma is often overlooked.
As a licensed professional counselor in Pennsylvania, Denise Takakjy often gets referrals from local school teachers, asking her to “fix this child because we need them to learn.”
Teachers are concerned with students’ fearfulness, avoidance, irritability, aggressive behavior, sexualized behavior, sensory issues, emotion-regulation issues, developmental regression, difficulty trusting others and social isolation, among many other problems.
Yet, when Takakjy talks to the kids, she usually finds that “at the root of these behaviors is a trauma response.”
And our bodies respond to trauma in a host of negative ways.
For Elizabeth Breier, 14 years of abuse and neglect in a dysfunctional home (she had 9 out of 10 Adverse Childhood Experiences) meant she was constantly sick and fidgety in elementary school, and began using drugs and alcohol in high school.
By the time she was 40, she had received five different mental health diagnoses, experienced four surgeries and had three different autoimmune disorders — all stemming from her unaddressed childhood trauma.
“So as you can imagine, I feel really passionate about catching this early,” said Breier, who now works as a training and implementation specialist at the Center for Rehabilitation and Recovery in New York.
Catching it early means encouraging parents, teachers and professionals to look beyond behaviors and consider the impact of obvious trauma on children as well as not-so-obvious life changes, and be willing to delay a mental health diagnosis and/or medication until after considering the impact of ACEs.
And if a child does have ACEs, the best way to help them is by creating safe, stable and nurturing relationships and environments, because everyone does better when they know they are loved, and that such love is unconditional and constant.
6. Genetics is just part of a person’s well-being story.
Where folks live and work, what they earn and if they have support networks account for nearly half of their personal health outcomes. The tough part of social influences — factors like housing instability, language and financial barriers, immigration status and an area’s political atmosphere — can drag down an individual’s well-being. Throw in behavioral factors like exercise or nutrition and whether people smoke and the overall impact on health may jump as high as 80 percent.
Those are startling numbers shared by Thomas J. Hart of Anthem, whose public policy institute studied the issue in “Bridging Gaps to Build Healthy Communities,” and Timothy Livengood of Mental Health America of Eastern Carolina.
Those types of factors are called social determinants or drivers of health and different groups expand the list to include whether people feel safe, if their personal identities are respected, how educated they are and more.
7. Stable housing is key to recovery from mental and physical health conditions.
America’s affordable housing crisis — a shortage of at least 7.2 million units nationwide — increases the vulnerability of low-income people who have a mental illness.
Mike Koprowski of Opportunity Starts at Home said that the “connection between housing and mental health are clear.” For someone with a serious mental health challenge, problems finding safe and affordable housing “are among the biggest barriers to recovery.” He noted that for every 35 affordable available housing units, there are 100 families that need one. And just one-fourth of those eligible for federal housing assistance will get it.
The National Alliance on Mental Illness’ Andrew Sperling said that “no social determinant of health drives more bad outcomes than inadequate housing” for people with mental illness. Housing instability makes homelessness, incarceration and hospitalization more likely for them.
Both of their organizations are actively involved in an alliance with other groups to push for public policies that increase the availability of affordable housing. “Housing policy is mental health policy,” they said.
8. Everyone has a place in finding answers to mental illness.5 comments on this story
Dr. Joshua A. Gordon, director of the National Institute of Mental Health, made a recruiting pitch for the “All of Us” initiative, which has the ambitious goal of getting 1 million Americans to volunteer for National Institutes of Health research. The project needs all kinds of people to help sort out health outcome differences made by biology, environment and lifestyle. The ways people are different can illuminate medical challenges and their answers.
“To be helpful to people with mental illnesses, people with mental illnesses need to sign up,” he said, noting the need for the massive study effort to include those with everything from eating disorders and obsessive-compulsive disorder to those who have psychosis or bipolar disorders.
Study focus is not just mental health, but health overall. And those with no diagnosed medical or mental health condition are needed, too. To learn more and sign up, visit joinallofus.org.