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May 26 2013

Small Things You Can Do To Improve Mental Health In Your Community

[Content note: suicide, mental illness]

A few weeks ago Northwestern lost yet another student to suicide. There’s been pressure building all year for improved mental health services on campus, and I think that pressure will soon culminate in real, helpful changes on campus.

At the same time, some have been saying that what we need is not better mental healthcare services, but changes in campus “culture,” such as a reduction in the stigma of accessing mental healthcare and an increase in our willingness to discuss mental health which each other.

I don’t think that these things are mutually exclusive; I think we need both. People whose troubles are relatively minor will benefit from increased openness about mental health on campus without needing any improvements in mental healthcare, but those who suffer from serious mental illnesses–the kind that can contribute to suicide–need more than just supportive friends and professors. They need treatment. Right now, it’s becoming clear that many of those people are not getting the help they need.

Echoing these debates, a blog run by Northwestern students called Sherman Ave posted a piece called “A Reflection on Death, Privilege, and The College Experience.” (Sherman Ave usually sticks to humor, but this time it poignantly diverged.) The author wrote:

In writing these words and thinking these thoughts, I do not believe that a “call to action” here ends in throwing more money toward psychological services. As much as I believe that funding of psychological services at this university should be increased, I would hesitate to claim that another few thousand dollars would have stopped Alyssa Weaver and potentially Dmitri Teplov from committing suicide. Rather, I encourage everyone reading this article to think carefully about the state of those without the privilege of stable mental health.  We should seek to sympathize with members of our community instead of ignoring them for the sake of convenience. If we have the tremendous power to come together in grievance of a lost classmate, then there’s absolutely no reason we shouldn’t be able to show the same love and solidarity for that classmate before they give up on our community.

And a commenter responded:

I agree with the need to come together to “show the same love and solidarity” to members of our community who need or want support and communication from others, but what does that practically mean? I find myself asking–how can I, as one person, contribute to a positive dialogue that moves our community towards supporting each other in the face of hardship? How do I even “identify” someone who needs my help? Or how do I make myself open to facilitating healing in my peers?

I don’t think there’s any easy answer to this. Practically speaking, changing a culture is like voting–it’s pretty rare that the actions of a single individual make an immediately noticeable difference. Westerners are used to thinking of themselves as individual agents, acting on their own and without any influence from or effect on their surrounding culture, and this is probably one of the many reasons it’s so difficult for people to even conceive of being able to make an actual impact when it comes to something like this.

You don’t have to be an activist, a therapist, or a researcher to make a difference when it comes to mental health. The following are small things almost anyone can do to help build a community where mental illness is taken seriously and where mental health is valued. Although I’m specifically thinking about college campuses here, this is applicable to anything you might call a “community”–an organization, a group of friends, a neighborhood.

1. When people ask you how you’re doing, tell them the truth.

This is something I’ve been really making an effort to do. This doesn’t mean that every time someone asks me “What’s up?” I give them The Unabridged Chronicles of Miri’s Current Woes and Suffering. But I try not to just say “Good!” unless I mean it. Instead I’ll say, “I’ve been going through a rough patch lately, but things are looking up. How about you?” or “Pretty worried about my grad school loans, but hopefully I’ll figure it out.” The point isn’t so much that I desperately need to share these things with people; rather, I’m signaling that 1) I trust them with this information, and 2) they are welcome to open up to me, too. Ending on a positive note and/or by asking them how they are makes it clear that I’m not trying to dump all my problems on them, but I leave it up to them to decide whether or not to ask more questions and try to comfort me, or to just go ahead and tell me how they’re doing.

2. If you see a therapist or have in the past and are comfortable telling people, tell them.

One awesome thing many of my friends do is just casually drop in references to the fact that they see a therapist into conversation. This doesn’t have to be awkward or off-topic, but it does have to be intentional. They’ll say stuff like, “Sorry, I can’t hang out then; I have therapy” or they’ll mention something they learned or talked about in a therapy session where it’s relevant. The point of this is to normalize therapy and to treat it like any other doctor’s appointment or anything else you might do for your health, like going to the gym or buying healthy food. It also suggests to people that you are someone they can go to if they’re considering therapy and have questions about it, because you won’t stigmatize them.

3. Drop casual misuse of mental illness from your language.

Don’t say the weather is “bipolar.” Don’t refer to someone as “totally schizo.” Don’t claim to be “depressed” if you’re actually just feeling sad (unless, of course, you actually are depressed). Don’t call someone’s preference for neatness “so OCD.” These are serious illnesses and it hurts people who have them to see them referenced flippantly and incorrectly. One fourth of adults will have a mental illness at some point in their life, and you might not know if one of them is standing right next to you. Furthermore, the constant misuse of these terms makes it easier for people to dismiss those who (accurately) claim to have a mental illness. If all you know about “being totally ADHD” is when you have a bit of trouble doing the dense reading for your philosophy class, it becomes easier to dismiss someone who tells you that they actually have ADHD.

4. Know the warning signs of mental illness and suicidality, and know where to refer friends who need professional help.

You can find plenty of information about this online or in pamphlets at a local counseling center. If you’re a student, find out what mental health services your campus offers. If you’re not a student, find out about low-cost counseling in your area. If you have the time, see if you can attend a training on suicide prevention (and remember that asking someone if they’re okay or if they’ve been feeling suicidal will not make them not-okay or suicidal). Being aware and informed about mental health can make a huge difference in the life of a friend who needs help. This doesn’t mean you’re responsible for people who need help or that it’s your fault if you don’t succeed in helping them–not at all. It just gives you a toolbox that’ll help you respond if someone in your community is showing signs of mental illness.

Learning about mental illness is also extremely important because it helps you decolonize your mind from the stigma you’ve probably learned. Even those who really want to be supportive and helpful to people with mental illnesses have occasionally had fleeting thoughts of “Why can’t they just try harder” and “Maybe they’re just making this up for attention.” That’s stigma talking. Even if you didn’t learn this from your family, you learned it from the surrounding culture. Studying mental illness helps shut that voice up for good.

5. Understand how social structures–culture, laws, business, politics, the media, etc.–influence mental health.

If you learned what you know about mental  health through psychology classes, your understanding of it is probably very individualistic: poor mental health is caused by a malfunctioning brain, or at most by a difficult childhood or poor coping skills. However, the larger society we live in affects who has mental health problems, who gets treatment, what kind of treatment they get, and how they are treated by others. Learn about the barriers certain groups–the poor, people of color, etc.–face in getting treatment. Learn about how certain groups–women, queer people, etc.–have been mistreated by the mental healthcare system. Find out what laws are being passed concerning mental healthcare, both in your state and in the federal government. Learn how insurance companies influence what kind of treatment people are able to get (medication vs. talk therapy, for instance) and what sorts of problems you must typically have in order for insurance to cover your treatment (diagnosable DSM disorders, usually). Pay attention to how mental illness is portrayed in the media–which problems are considered legitimate, which are made fun of, which get no mention at all.

It’s tempting to view mental health as an individual trait, and mental illness as an individual problem. But in order to help build a community in which mental health matters, you have to learn to think about it structurally. That’s the only way to really understand why things are the way they are and how to make them change.

25 comments

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  1. 1
    Ichthyic

    well said. One of the biggest problems with mental health care has always been overcoming the irrational stigma involved with it. Frankly, if we could get rid of that, the money issues would go a long way towards taking care of themselves.

    Instead, what I have seen in my lifetime is no decrease in that stigmatization at all; instead it seems to have increased, somewhat, likely in response to the rightward movement most of Western Society has seen in the last 40 years. Paralleling that then, has been the severe reduction in available facilities to even deal with mental health care issues. I saw the very last government funded treatment facility devoted specifically to mental health care in the entire Riverside County (CA) close during the few years I spent living there. That county is home to well over 2 million people. Similar trends across all of California.

    I do hope that the AMA and APA can figure out more effective ways to stop this trend; I know they have tried, but it sure seems like nothing has really worked so far.

  2. 2
    Jadehawk

    on my campus, one of the problems I’ve encountered is that counseling for example is about making sure you make it to class, not making sure you get better; in fact, I’ve even received “advice” about how to make it to class that I had previously explained would make me worse. Response: ” well, once the meds kick in, you won’t feel worse from that anymore” (meds never kicked in as intended, btw.)

    and on a highly personal note: I can’t stand the “suicide prevention” billboards and leaflets (esp. in the absence of more general depression-fighting billboards/leaflets). Makes me feel like mental illness is only a problem when it negatively affects others (i.e. when a suicide causes hurt to those who were close to the person who just killed themselves), and the solution is to make sure depressed people don’t ever cross the line into ending their pain; but anywhere before that, where the pain is not great enough to overcome self-preservation and therefore it’s not affecting others? not a problem; or at least not one worth a billboard.

    1. 2.1
      Lindsay

      OH MY GOSH YES.

      I even had your bog-standard suicidal depression, so on some level the messages helped me (I had managed to absorb the notion that constantly obsessing about how to kill oneself was A GREAT BIG RED FLAG that meant I needed help and needed it pronto, which was lucky because I was not the most clued-in or self-aware of people), but on another level I always had an unshakable sense that it wasn’t me they cared about, it was the living, the people who might be traumatized by witnessing my suicide or the bad press that I might bring down upon the school.

      I can see how a person who was in just as much pain, but wasn’t suicidal, would find the exclusive focus on preventing suicide all the more alienating.

  3. 3
    RealityEnforcer, Roaming Bear, terror of the Boy Scouts

    Just going to add two things.
    1) Mistreatment of women in mental health? I know about that! When I went into therapy for depression and anxiety, my therapist had this wonderful habit of deciding what my problems were, and that the solutions was be more feminine. She’s now my former therapist.

    2) Seconding Jadehawk. I wasn’t ever really suicidal, I just had horrible anxiety attacks almost every night(eventually depression snuck in as well). But almost all of the resources I found were for suicidal depression.

  4. 4
    Eristae (@Eristae)

    I remember one of the things that surprised the bejesus out of me was when I was calling the mental health center after hours and the answering machine said something along the lines of “If this is an emergency, please hang up and dial 911.” Bizarrely enough, it had never occurred to me that I could call 911 if I was suicidal. It is unfortunate that I didn’t have access to this information when I was suicidal.

    1. 4.1
      Lindsay

      I didn’t know that either!

      (Still didn’t know it, after almost ten years of having depression, until I read your comment.)

  5. 5
    lochaber

    How does the risk of getting involuntarily committed (for suicide risk, etc.) factor in to people avoiding treatment/help?

    I understand that it’s a necessity for some situations, but I’m under the impression (from stories I’ve heard, etc., no reliable sources) that it’s quite easy to involuntarily commit someone.

    I’m also under the impression that once someone is involuntarily committed, they permanently lose some rights and privileges, and can be barred from certain jobs, etc.

    I don’t know how accurate any of that is, but it’s an impression I and many other people I’ve met have gotten, and it certainly wouldn’t encourage someone to seek counseling.

    :/

  6. 6
    Eristae

    @lochaber I can’t answer most of your post, but:

    You can indeed be permanently barred from jobs for mental health issues. Air traffic control is one example, as are many flying related fields. I’m told that it doesn’t even make a difference if you get over the issue, you’re still out for good. I came across this nugget in some of the group counseling sessions that I’ve been in; my school has an aerospace program and that makes for lots of aerospace students. I knew one individual whose aerospace degree was rendered permanently non-usable for flight purposes precisely for this reason. But I’ll also note that he was sent to counseling by his workplace because he had a meltdown; it isn’t like he went in, got help, and his counselor ran to his employer. I imagine that FERPA usually applies. Also, he wasn’t committed. And yes, those regulations were known within the aerospace program to make people less likely to seek help for fear of getting tossed out of the program.

    Scary.

  7. 7
    surreptitious57

    We agree with all five points that Miri made here
    Though we were a bit worried about one of them now
    But another reading and it appears to be finr by us

  8. 8
    Kevin

    I don’t think the average person knows the difference between being “sad” and being “depressed”. So, if they say they’re “depressed”, shouldn’t you believe them until further notice?

    1. 8.1
      Miri, Professional Fun-Ruiner

      I do believe them until further notice. But that’s why I’m saying here that people should learn the basics about mental illness and use terms appropriately.

      Once someone told me casually that they’ve “gotten sober.” I of course I assumed that they meant that they were in recovery from addiction and said, “Congratulations, good for you!” And then they laughed and were like “oh I didn’t mean I was an alcoholic, I’ve just been drinking less now.” And I felt pretty silly.

      Of course, that could’ve gone much worse. Say I was a recovering addict and I disclosed that, thinking that this person and I had this shared experience. I would’ve felt pretty stupid and embarrassed to realize that I’d disclosed to the wrong person.

      Learning what mental illness is and isn’t is not hard. And I’m NOT talking about people who genuinely think they have depression but might be wrong; I’m talking about people who are not claiming to have a mental illness, but have appropriated the terminology because it helps them make a point.

  9. 9
    Giliell, professional cynic -Ilk-

    I should note that I’ve had nothing but the best experiences with therapy, my college’s counselling programm and my therapist. So yeah, it fucking works! (at least for me)

    If you see a therapist or have in the past and are comfortable telling people, tell them.

    That’s the thing, isn’t it?
    There’s a limited number of people who know I’m in therapy, but I have no problem talking about the fact taht my immune system is eating up my thyroid (btw one factor that definetly worsened my mental health issues). It shouldn’t be that way. Dualism is bullshit and it shouldn’t matter if I need a professional to deal with my thyroid or psyche, but one of them is tough luck and gets you sympathy, the other one is a personal failure and gets you contempt.

    Don’t claim to be “depressed” if you’re actually just feeling sad (unless, of course, you actually are depressed).

    Difficult one, too.
    Sure there are the clear cut cases. No, you’re not actually depressed because you broke your favourite mug.
    But I have difficulties putting a word to my condition.
    I do not have a “diagnosis”, I do not take meds. I think I managed to recognize that something was going horribly wrong and that I needed to do something just before I tumbled down into full blown depression.
    But I still recognize many traits of people with clinical depression in me, and I also recognize that there are some big differences. And what’s really the big difference is that I know have a coping-mechanism, that I have awareness. I hope that’ll last me some time.
    But what word do I use? I’m clearly not just “sad”. And I’m clearly not just a little nervous and a bit anxious. I often say I’m depressive to indicate taht I’m somewhere between “healthy” and full blown depressed, but, yeah. I think that “depressed” is much closer to where I am than “sad”

    1. 9.1
      Lindsay

      Good comment!

      I was very ignorant of mental-health stuff when I was in college, so the first thing I did when I noticed something wrong was write to my parents. I could not name what was wrong, but I could describe what was happening — lots of crying fits, being unable to move, speak or think for long periods, and vivid visions of death — and it was obvious enough, to me and to them, that that wasn’t normal, so I went to my school’s Counseling and Psychiatric Services. When I told them what was going on, they said that my problems were too severe for them to treat, so they sent me on to a community mental health center, where I did get therapy. It was very helpful, but ultimately I needed medication, which I was able to get years later.

      But if I hadn’t been experiencing something that obviously crazy — seeing things, a feeling of being taken over by a hostile entity — that shit is very, very obviously Not Normal! — I’m not sure I would’ve known to talk to anyone about it. And I have since heard that most depression is not like mine, does not involve such dramatic symptoms.

      So I don’t know what I would tell someone who is worried about whether they need to seek help or not … I guess I’d say a false positive (i.e., going to CAPS for what turns out to be nothing) is better than a false negative (i.e., not going when something really *is* wrong).

      (I also formulated a joke in my head about how my school’s CAPS seemed unduly picky about whether your problems were at the right level of severity for them to treat you … I was turned away because mine were too serious*, and I had a friend turned away because his weren’t serious enough. I decided that they must only let you in if, on a scale of one to ten, your psychic distress comes out to be exactly pi. This is probably not an optimal way for a campus mental-health clinic to operate!)

      *Which is not actually a thing I fault them for … I probably needed the more experienced, better trained people at the community mental health center, and I actually think the CAPS people showed great wisdom in recognizing this.

      1. 9.1.1
        Giliell, professional cynic -Ilk-

        AFAIK my college doesn’t offer psychiatric help either since they’re not a medical facility, but it’s also important to note that I live in Germany so, yay public healthcare*.
        But yes, what helped me to seek mental healthcare was that I knew other people who’d done so before because I grew up with booo, stigma.
        But my sister was in therapy before, I knew from some of the wonderful people I met on Pharyngula that they were/had been in therapy, so if those great folks were in mental healthcare and definetly totally not crazy contemptible failures it was OK.
        I’m trying to pay forward.

        *Although mental healthcare is horribly understaffed and outside of the college setting you often wait for weeks to get an appointment which is definetly not helpful.

  10. 10
    surreptitious57

    Miri can you please remove these two comments
    by surreptitious57 as he is banned from posting
    on your blog and he knows it too so thank you now

    1. 10.1
      Miri, Professional Fun-Ruiner

      Sorry, what? I haven’t banned you from my blog, and if I had, your comments wouldn’t be showing up.

  11. 11
    doublereed

    The Unabridged Chronicles of Miri’s Current Woes and Suffering

    If you ever need another name for a blog.

    1. 11.1
      Miri, Professional Fun-Ruiner

      I’ll have to consider it. :P

  12. 12
    smrnda

    Since people asked about involuntary hospitalization, I’ve had 5 of those so I thought I’d share.

    Each time I was only committed after police observed me behaving strangely in public – in no case was I actually violent until they attempted to force me to go, when I put up resistance, but the EMTs were there and hit me with a tranquilizer. I’ve never had anyone I knew personally try to make me go, except one relative who was very patronizing, but it was just she wanted to dump me off at a hospital and didn’t want to offer any personal help. (Advice – if a person with mental health issues says they need a friend, be a friend first and then talk about whether or not they need to go in for treatment. ) It doesn’t seem to be easy to get anyone in unless they’re actually dangerous. I was actually walking around delusional but functioned well enough at work and such that I was never suspected in some cases.

    Being hospitalized is like being in a college dorm without homework. I tell people this since I think a lot of the stigma associated with being ‘in’ is that people’s ideas about it are based on movies which, if they were accurate when they were made, are definitely not accurate now.

    I’m not sure what permanent restrictions this can have; perhaps gun ownership? But I haven’t pursued that so it hasn’t been an issue. One problem is that when people want to know what sort of workplace accommodations you need, mental health issues don’t always lend themselves to easy answers, which can make some employers less cooperative in finding accommodations.

    Something I find is that people are surprised that I can have had such bad episodes given that I’m pretty much totally functional now. For that reason, I keep bringing it up to show them that sometimes, people who seem pretty normal can still have occasional,extreme issues come up, and that people with serious mental health issues can still function most of the time if they get adequate treatment AND social support .

    1. 12.1
      smrnda

      I guess my comment is in moderation – I’m using a different email address than I used to.

      1. 12.1.1
        Miri, Professional Fun-Ruiner

        Yup, I have first-time moderation on for obvious reasons. Sorry about that.

        1. 12.1.1.1
          smrnda

          No problem – I think first-time moderation is a good idea. Probably weeds out lots of things we’d all rather not read!

  13. 13
    lochaber

    Hey smrnda, thanks for the first hand account.

    Firearm ownership is one of the obvious things that I’m aware of, and as Eristae mentioned above, certain jobs.

    I’m not sure what else, but since there are those two things, I wouldn’t be surprised if there are many more. Plus that sorta thing is occasionally used to discredit people/witnesses in legal hearings and such.

    I’ve just read some accounts where a spiteful cop, or irritated healthcare provider takes a rather broad view of ‘danger to self or others’ and gets a person committed.

    It really bothers me that there seems to be no way to argue/appeal this, and it can have some pretty severe legal ramifications.

    When I was trying to look up some info regarding firearm ownership and depression, I had to venture onto several right-wing websites (pretty unpleasant in of itself :(… ), and there were quite a few 1st and 2nd hand accounts of individuals who claimed to be depressed, even suicidal, but didn’t seek treatment out of fear of loosing the right to own firearms. I can understand some of the reasoning for that, but it seems like a broken system. :(

    1. 13.1
      smrnda

      I think a lot of how people get treated are related to other factors like the person’s demographics. If I were a Black male instead of a white female, they cops might have decided to hit me with a taser and taken me to jail.

      Speaking of spiteful cops, I talked to a guy who was hospitalized and who was being dealt with/restrained by the EMTs, nurses and security. The hospital cop decides to walk in and intervene even though his help was not requested, and then decided to press charges against the guy for pushing him (though the same cop also did not seem inclined to file charges because nurses or security guards got pushed. I guess cops are part of some special caste. You can push/hit/bite medical personnel, and it’s part of their job, but not cops.) Either way, the case got thrown out but it caused a lot of headaches at a time when the guy didn’t really have the resources to deal with them.

      Firearms ownership.. .that’s kind of sad that people would place such a high value on firearms ownership that they’d avoid getting psychiatric help. Not only is the system broke, but if our culture places such a high priority on gun ownership, that’s just sick and twisted.

  14. 14
    Eliana

    Also worth mentioning is that normal sadness feels fundamentally different from clinical, biologically-based depression. I wouldn’t know thank G-d, but my friend who suffers from clinical depression told me that she can tell the difference between when she is crying over something that happened and when she is crying because from diagnosed depression.
    Just another reason that people should not use the word “depressed” in everyday conversation unless they are actually talking about the illness.

  1. 15
    Bisexuality and mental health | uni(di)versity

    [...] The piece that sparked the idea for this post was Miri at Brute Reason, who recently wrote about “small things almost anyone can do to help build a community where mental illness is taken seriously ….”* [...]

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