Tag: Public Policy

Good public policy can improve mental health, part 9,645,856

There’s a new study available that shows that, for the gazillionth time, public policy can truly make a positive impact on mental health.

First, the study itself. It specifically pertains to the most recent rounds of stimulus checks. Specifically:

A new analysis of Census Bureau surveys argues that the two latest rounds of aid significantly improved Americans’ ability to buy food and pay household bills and reduced anxiety and depression, with the largest benefits going to the poorest households and those with children. The analysis offers the fullest look at hardship reduction under the stimulus aid…Among all households, frequent anxiety and depression fell by more than 20 percent.

This is a remarkable number. Direct financial aid helped to improve rates of depression and anxiety.

It’s also unsurprising. Generally speaking, wealth is not directly related to suicide rates, but subjects related to wealth are. For example, living near people who are wealthier than you may lead to increased rates of suicide. A decline in income – often one that leads to homelessness, housing insecurity, or unemployment – is correlated with higher suicide rates. Furthermore, a landmark study from a couple of years ago showed that raising the minimum wage can directly reduce suicide.

We also know that expanding access to health care can make a positive impact on suicide rates. Of course, you don’t need an advanced degree in public policy to figure out why: When you make health care easier to obtain, this usually involves mental health care, and this means people can be treated for their mental illnesses. This, in turn, can help to attack these illnesses and make someone feel better.

There are ancillary reasons why this is true, as well. One of the less-discussed causes of suicide is pain and chronic pain – I actually had a dear friend lose someone very close to her because of her partner’s pain. Medical care, of course, can treat or mitigate the impacts of countless diseases. This, in turn, can improve someone’s quality of life – and help prevent suicide.

Last, the third rail of politics: Gun control. Like it or not, means reduction policies – policies that make it harder for someone who is suicidal to get a gun – can help to reduce suicide rates. For example, there is a well-established link between gun ownership and suicide. Furthermore, states with stricter gun laws tend to have lower suicide rates. In other words, we CAN do something about suicide rates in government, we already have done quite a bit, and we can do a lot more.

Suicide is not something that just happens. It is not some magical, mystical thing that we have no control over. Yes, there are factors that are well beyond governmental control…but there are also plenty of things we can do to reduce suicide. Things we must have the courage and fortitude to do. I’ve always found mental health to be an under-tapped political issue. Many people know its pain – more than we are willing to admit. And I wish more people spoke about this issue for both the sake of politics and policy.

LGBT Marriage Equality Saved Lives

I’ve written extensively on the connection which society forces upon people who are LGBT and have a mental illness. To be clear, there is nothing inherently mentally ill about anyone who is LGBT: It is the societal pressures and discrimination faced by people who are gay or transgender which can give them a mental illness. This is a tragedy and a sin that we must address at a societal level.

If you’ve read this blog long enough, you know that one of the items I regularly harp on is the connection between mental illness and public policy. That connection was first driven home for me in a 2015 study which showed that members of the LGBTQ population had higher rates of mental illness and addiction in states where marriage equality wasn’t the law of the land than in states where it was legal. To be clear, this may be a classic case of correlation not equalling causation, as there may have been other reasons which LGBTQ people had better mental health in these states. However, it would certainly imply that there is a connection between mental illness and discrimination – a finding which was picked up in other countries, like Australia and New Zealand.

Finding that study was a critical moment for me, at least in terms of how I viewed mental health and public policy. Not only does public policy influence mental health, but it influences it in ways which we may not expect.

Well, here’s more proof: As noted in this Upworthy story, suicide attempts by LGBT youth dropped in states that legalized gay marriage and didn’t drop in states that didn’t. Similar findings were replicated in other countries that embraced marriage equality.

Again, the findings aren’t necessarily causational, but they would seem to pretty strongly imply a connection between societal stigma. Countless other studies have proven that treating any typically discriminated group with love, acceptance, and support can reduce their suicide rates. The legalization of gay marriage can make a massive difference here, as it ended a societally-enforced piece of discrimination.

Public policy and mental health matter, and matter deeply. We can, and should, examine all aspects of public policy through a mental health prism, as this connection exists in dozens of public policy spheres – everything from transportation to minimum wage to licensure laws and more.

Another Study Ties Higher Minimum Wage with Reduced Suicides

I’ve written about it before: Economics and suicide are tied. To be clear, that’s not to say that poor people are more likely to die by suicide; by and large, suicide crosses economic boundaries. What is more likely to be associated with increases or decreases in suicide rates is a change in economic status: An increase leads to lowered suicide rates, while a decrease leads to higher rates.

And that brings us to this study, published in the Journal of Epidemiology & Community Health. The study examined 25 years of economic and suicide rates in all fifty states and Washington, D.C. From the results of the study:

The effect of a US$1 increase in the minimum wage ranged from a 3.4% decrease (95% CI 0.4 to 6.4) to a 5.9% decrease (95% CI 1.4 to 10.2) in the suicide rate among adults aged 18–64 years with a high school education or less. We detected significant effect modification by unemployment rate, with the largest effects of minimum wage on reducing suicides observed at higher unemployment levels.

In other words, an increase in the minimum wage can save lives.

This study was picked up in numerous major media outlets, including CNN and NPR. As the CNN story noted, if you assume that the data from this story is accurate, an increase of $2 could have saved upwards of 40,000 lives between 2009-2015.

This study shows many things, but there are two, in particular, I want to focus on.

First: It challenges the idea that suicide is exclusively related to mental health, or at least adds a qualifier and a modifier to that idea. I think that when most people think of suicide, they think that a person who dies by suicide must be mentally ill. That makes sense, of course, and it’s a perfectly logical conclusion to reach. However, it’s not completely supported by the evidence. If depression was the only thing that mattered when it came to a suicide attempt, the minimum wage wouldn’t make a difference unless you assume that economic status is tied directly to mental health.

What this shows, again, is that suicide is not simply a matter of mental illness.

And that leads me to my second point: Everything is connected. Mental health is deeply connected to economics, and if we can ensure a robust social safety net, fair wages and equal opportunity, we can reduce suicides and save lives. This study proves it – again – and it isn’t even the first to make the argument that work and work hours are tied to minimum wage.

As public policymakers, we have a job to address major problems (like the massive spike in suicides) in a manner that is holistic and comprehensive. That means not only improving access to mental health care but reducing the causes of suicide.

That means increasing the minimum wage.

The Best Way To Help Veterans With Mental Illness

Today is Veterans Day, the day of the year in which we are supposed to remind ourselves about the importance of the veterans who have served all of us. It’s a solemn day…one which most people know better by the kind of sales they can get and if they get the day off or not.

As an elected official, I’ve certainly been to my share of Veterans Day events, and had three leading up to today. That being said, they are events which always leave me feeling inadequate. Why? I never served in the military, and while I don’t believe that is necessary to be a good public servant, I do always worry about talking to veterans and thinking that they must think I don’t understand what they have been through. That’s me projecting, to an extent, but of course, I don’t understand what they have been through, the things they have seen.

As a politician, I’ve always said that I want to be judged by my actions, not my words. And when it comes to taking care of our veterans, far too many of our actions come up short. This goes double when it comes to mental illness. A brief look at the facts reveals:

These numbers are unacceptable. Those who give so much for us should receive even more in return. That being said, for the vast majority of us, our options are limited. Let me pose this question, then, if you’d like to learn more about how to help our vets: What can you do to help veterans who are suffering from a mental illness?

Here are a few thoughts.

Understand what you don’t understand

One of the things I have realized in my time in government and the mental health universe is that you will not understand everything – and that’s okay. You don’t have to understand what it was like to serve. You don’t have to actually have experienced someone else’s pain to understand that it exists. Not being a veteran doesn’t disqualify you from this conversation, but it does require extra effort. Read up on the specific challenges which veterans face. Learn more about what they need and how you can help. This broader prospective will put you in a better position to help those who need it.

Support groups who support vets

While the need is great, the response has been as well. Numerous organizations do a fantastic job of taking care of our veterans. If you can afford to do so, please contribute to these organizations, because while the passion is there, the funding often is not.

Read up on veteran-specific mental health issues

Part of understanding veterans issues is learning more about them. PTSD and TBI (traumatic brain injury) are both tragically common for veterans. If this is something you want to learn more about, read up on these two devastating diseases, and learn more about how you can help.

Talk about it, and find others who know more

The best way to address and reduce stigma is to talk about it – but to do so in a way which is inclusive. Discussing mental illness is important, but talking about it from the perspective of a veteran even more so. Make sure to be inclusive when discussing mental illness and stigma, and make sure to rely on other voices (like veterans) who may have more experience than you.

I know I missed a lot here – as usual, I’d love your thoughts. Do I have a goo handle on this? What am I missing? Fill us in in in the comments section!

How Politics Helps Keep Me Sane – And How It May For You, Too

 

So, I’ve written extensively about mental health, depression, my book, etc. But, if you’ve followed this blog for long enough, you’ve probably seen me allude to my full-time career. I want to talk about it for a second – and talk about why I think that getting involved politics and governance is actually really good for your mental health.

My full time job is to serve as a Pennsylvania State Representative, where I work for 65,000 people who live in the City of Allentown and South Whitehall Township. I’m a Democrat, and involved in a slew of issues, but mainly working in education and mental health.

One of the more common things I get when I discuss my long-time issues with anxiety & depression is, “IN YOUR LINE OF WORK!?!?!”

I mean, yeah. To quote Finley Peter Dunne, Politics Ain’t Beanbag. And there are times where the hard parts of this job – the negative mailers, the nasty comments – they get to you. They weigh on you. And when you combine the normal stresses of this abnormal job with a mental illness, it can be ugly. I should note something here: If I hadn’t had years of therapy, and medication, I’d never be able to cope with the stresses and requirements of this job. I’d have never been able to hold it, and I hope do well at it, as I hope I have.

That being said, I firmly believe that politics has been good for me and my mental health, and if you are similar at all to me, you may feel the same.

Why? A few reasons.

First and foremost, politics & government gives me a chance to make a difference. I firmly believe that, with my type of depression, I feel worst when I am hopeless, helpless, and out of control. That includes a variety of things in my life, including the health of my loved ones or the state of the planet around me. Being in government, I firmly believe, is one of the most noble and powerful callings that there is. It also gives you a modicum control over one of the most powerful entities in the country. As a result, this job let’s me have a say in the direction of resources and state authority towards what I believe to be just pursuits. That acknowledgement, alone, is often enough to help combat the helplessness I feel as a citizen of a country and planet for which that I am deeply worried.

Second, it gives my mental illness meaning. On those bad days – where I’m sitting with my hands in my head, plagued by some very silly demons – I can’t help but wonder, Why me? Yes, there’s that tendency to stew in your own sad juices if you have some sort of mental illness. Being in government and politics – helping people – is the perfect antidote for that self-indulgent question, because I know I’ve helped people by telling my own story.

To be clear, government isn’t required to find meaning. But I get to be someone who is part of a good story – how mental illness is being viewed by our society, and how those views are evolving. I’ll take that.

Third, I can speak with authority. One of the biggest challenges we have in government is people don’t believe us. Much of that we bring upon ourselves, so I get that. However, it’s hard for people to ignore you when you speak on an issue which personally affects you in a deeply personal way. As humans, we are built to better understand stories – personal stories – and when I tell mine, I think that people are inclined to listen. I can speak with authority on this issue. Honestly, that helps me sleep at night.

There’s more, of course, but I’d say those are the biggest reasons I’ve found government to be helpful to me when it comes to dealing with my own depression. This is just me – your mental illness may have helped motivate your career choice, and if that’s the case, I’d genuinely love to hear it.

The American Public Gets It: Stigma Is Real, and We Need To Do More

CBS News ran this fascinating poll on mental illness. I’d argue that there aren’t many surprises in the poll, but I got two key takeaways.

First, to summarize the findings:

  • 51% of Americans say that people living with a mental illness face “a lot” of stigma and discrimination – 31% say “some.”
  • 38% of people say that mental illness stigma has gotten better, 22% say worse, and the rest say that it hasn’t changed.
  • 66% of people say that mental illness is a very serious public health problem – 28% say somewhat serious.
  • People do believe that mental illness is a real medical condition (79%). Roughly 2/3 of those polled also said that virtually anyone can get a mental illness and most people who are treated right can lead productive lives.
  • A mere 12% of people say that services for the mentally ill are adequate – but 49% said they are not.
  • A whopping 77% of people say that celebrities speaking about mental illness are doing a good thing – only 18% said no.
  • 73% of Americans know someone diagnosed with a mental health disorder (I guarantee that number is higher and people just hid their own mental illnesses), while 58% said that they had a family member who sought care for mental health (again, I’m sure that number is higher).

So, here’s what I got out of this. First, those support numbers are just overwhelming. 66% of people think mental illness is a “very serious” public health problem. 28% say it is at least “somewhat serious.” That’s 95% of the American public who think that mental illness is at least somewhat serious. That is not a small number! The key question is this: What does that translate to? Are people willing to dedicate more time and money to mental health care? Or is this simply a, “Gee, that sucks…moving right along” sort of things?

At the bare minimum, it is good to know that people understand just what a major problem mental illness is.

Second, the stigma questions got me thinking: What if the stigma is all self imposed? I mean, take a look again at that top finding. 51% of people think individuals with mental illness face “a lot” of stigma, while 35% say they face “some” stigma. That is not a small number. But if that many people think stigma is so real, what’s really the problem here? People who acknowledge stigma is real must also have stigma-inducing thoughts, right? Or, what if the stigma is just the fear of being stigmatized? Or self-stigma? I’ve always thought that self-stigma is a bigger problem then actual stigma.

The findings, in my mind, mean that we have to rethink our traditional definition of mental health stigma, because I don’t think that a traditional understanding of, “People with mental illness sure do face a lot of stigma” is enough.

But, as always, I ask: What do you think? What are your thoughts on this poll? Let us know in the comments!

More Than Stigma: Shifting the Nature of the Conversation Around Mental Health and Suicide

Advocates for suicide prevention and mental health often talk broadly about “the stigma” which surrounds mental illness and suicide. Many of us – myself included – believe that if we can just get more people talking and thinking of mental illness, if we can have people discussing their issues with depression, anxiety, addiction and more without shame or fear, we can help to put an end to this epidemic. I firmly believe that this is the case.

I also know its not enough.

And that’s where the conversation around public policy, resources and taxation has to come into pay.

I happened to catch a fascinating column on mental health the other day – I obviously can’t find it now, that would be too easy, but the column made a great broad point: Ending mental health stigma is like cutting holes in a wall, but then there’s nowhere to go because our system of mental healthcare is so broken in this country.

Many of us concentrate our efforts on stigma for a couple of reasons. I think it’s one of the most important things that we can do. But let me expand on the second part of that sentence: That we can do. People do need to know it is okay to seek help and to treat themselves. They need to know that these issues are real, powerful and can kill you. But, as any studies have shown, individual conversations are the best way to break mental health stigma. A face to face talk can make a huge difference in that area. That means that, without question, the most important person to ending mental health stigma is you.

Second, it’s the easiest.

Making society-wide change is really hard, of course. Particularly in areas where colossal interest groups are at play. I’m an elected official – theoretically one of the people who makes state-wide decisions in Pennsylvania – and I fully understand just how difficult this can be.

And the simple truth is that we must make systemic changes to help reduce rates of mental illness and suicide.

From a mental health and suicide perspective, there’s an awful lot that needs to be done. This includes increasing access to mental health care, increasing the number of mental health care practitioners and addressing the mental health care practitioner shortage, reducing costs, enforcing parity in insurance care, reducing access to deadly means of suicide and more. And that’s to say nothing about the major societal problems that we face which contribute to mental illness and suicide, including improving housing options, strengthening the social safety net, increasing the minimum wage, making housing more affordable, etc.

Many of us tackle stigma because we can’t get at these issues. And stigma is something we can control.

So, what does that mean? Should you stop talking about mental health stigma? Hell no. Of course it’s vitally important, but it’s important in more ways than you think, because the more you discuss mental health, the more pressure you can bring on policy makers to address the fundamental inequities and gaps in our system which allow for mental illness to run so rampant. Keep fighting.

But make sure you fight in a public policy realm, in addition to addressing individual changes. Tell policy makers and elected officials that you expect them to do more to address rates of mental illness and reduce suicides. These issues require government intervention, and that requires public pressure. Please help make this happen.

 

Mental illness and gun violence are barely related – it’s just a convenient scapegoat for cowards

As you know, it was a bloody week in America, with a massacre in El Paso and Dayton leaving 22 and 9 dead, respectably. It’s been another awful year in America when it comes to mass shootings – 255 in 217 days by August 5.

As can be anticipated at moments like these, Democrats and Republicans turned to their expected policy solutions to stop the bloodshed. Democrats argued for stronger gun control laws, including reinstating assault weapons bans and Emergency Protective Orders which could get the guns out of the hands of those who seek to use them to kill people or hurt themselves. Republicans tried to pivot to mental health and argue that the problem is just too dang complex to solve. In a speech after the shootings, President Trump said, “Mental illness and hatred pulls the trigger, not the gun” (whatever that means).

Other Republicans echoed these comments. Ohio Senator Rob Portman said, “Look at the mental health crisis in our country today, there aren’t enough laws…” South Carolina Senator Lindsey Graham said:

Here’s the thing – the whole argument that this is a mental health problem, not a gun problem – is rank, stinking bullshit.

I’ll start by quoting those who make the argument far more eloquently than I ever could. In a blistering press release which gained national attention, Dr. Arthur Evans, CEO of the American Psychological Association, blasted the notion that perpetrators of mental illness were behind the spike in mass shootings. Said Dr. Evans:

Blaming mental illness for the gun violence in our country is simplistic and inaccurate and goes against the scientific evidence currently available.

“The United States is a global outlier when it comes to horrific headlines like the ones that consumed us all weekend. Although the United States makes up less than 5% of the world’s population, we are home to 31% of all mass shooters globally, according to a CNN analysis. This difference is not explained by the rate of mental illness in the U.S.

“The one stark difference? Access to guns…

As we psychological scientists have said repeatedly, the overwhelming majority of people with mental illness are not violent. “

Evans went on to say that America desperately needs more gun control.

Former Presidential candidate Hillary Clinton also chimed in with a similar comment:

Indeed, experts have repeatedly blasted the notion that mental illness is tied to a rise in mass shootings. According to Adam Lankford, a University of Alabama criminologist who reviewed gun violence in 171 countries, access to guns is a far better predictor of gun violence than mental illness. The Secret Service has said, “Mental illness, alone, is not a risk factor” for predicting violence. The Washington Post notes that, in a 2018 analysis, 25% of active shooters had some sort of mental illness. A 2015 study on the same subject had that number at 22%.

This notion that it’s the mentally ill are the perpetrators of mass shootings is, generally speaking, unmitigated crap. Indeed, multiple studies have shown that the mentally ill are far more likely TO BE VICTIMS of violence, and gun violence – not the perpetrators of it. According to one study, the mentally ill are 3.6 times more likely to carry out an act of violence than the general population, but 23 times more likely to be that victim. The same study said that the vast majority of violent behavior occurs “due to factors other than mental illness.”

But hey, why let a good soundbite get in the way of avoiding a solution to a problem, right?

Oh. And one more thing. Republicans in Congress and at the state level have said that this is a mental health problem. So, naturally, they want to address it by increasing funding and access for people who suffer from mental illness, right?

Hahahaha.

President Trump and his Republican allies spent the first two years of his Presidency trying to eviscerate the Affordable Care Act, which has done a few little things for mental health care, you know, like improve access and reduce costs for people with mental illness…small stuff, I guess….

Let’s stop the bullshit: Trying to blame gun violence on the mentally ill is a convenient excuse for those who don’t want to actually deal with gun control. It’s not based in reality. And the rhetoric certainly isn’t matched up by the actions taken when it comes to improving mental health care.

Be smarter than they think you are. Don’t fall for this lie.

 

Oregon students can now take mental health days

So, in my political world, I’m a pretty progressive guy. One of the states which I have always watched closely has been Oregon. Oregon has been a progressive success story of epic proportions: From the environment to minimum wage increases to abortion rights to gun control to expanding economic opportunity to all residents, Oregon has led the way. 1

And then, I came across this story: Teens in Oregon can now take mental health days as an excused absence from school. It was done largely to address the stigma which surrounds mental health. According to Debbie Plotnik of Mental Health America:

“The first step to confront this crisis is to reduce the stigma around it. We need to say it’s just as OK to take care for mental health reasons as it is to care for a broken bone or a physical illness.”

The law specifically states that students can have up to five absences in a three month period – and anything more requires a written excuse to the principal.

In response to concerns that the law would make it easier for students to get out of school, Haily Hardcastle, one of the teenagers involved with the lobbying for the law, said, that students would take time off with or without the law – but the new law may encourage students to take their own mental heath more seriously, and would require schools to recognize mental health in their attendance policies.

Oregon’s rate of suicide is 40% higher than the rest of the nation.

I’m…I’m really intrigued by this. It does seem like a lot of days. And I wonder how this effort would interact with other attempts to remedy chronic absences – something that we really struggle with in my home school district of Allentown. But, I believe that Mrs. Hardcastle’s comments are correct – a kid is gonna take a day off if they want to, and if we can encourage them to discuss why, maybe we can help save their life.

Regardless, I’m extremely intrigued, and I’m hoping to pursue this one more. And if you have any feedback, I’d love to hear it!

 

An in-depth look at America’s suicide numbers

This Bloomberg story came out about two weeks ago and reviewed America’s rising suicide numbers. It’s findings, as you can imagine, are damning. Some of the salient points:

  • In 2017, 47,000 people died by suicide – and 1.4 million made attempts.
  • From 2000-2006, the suicide rate increased by 1% annually. From 2006-2016, that increased to 2%.
  • Life expectancy has fallen for three straight years – the first three consecutive year drop since 1915-1918.
  • Suicide is the 2nd leading cause of death for 10-34 year-olds.
  • Suicides cost U.S. businesses between $80-100 billion annually.
  • A lack of resources is to blame for many of these issues. According to some experts, the United States needs 50 mental health beds for every 100,000 people – but some states have numbers as low as 5 per 100,000.

The article goes on to say something I’ve discussed in the past – part of the intractability of our mental health and suicide crisis is the intertwined nature of the problems. Health care, genetics, finances, social support, culture – they all interact to influence mental health. As the article notes, combine that with a rapidly changing economy, advances in technology and a changing cultural scene, and you have a recipe for the disaster we’re currently experiencing.

Mental Health parity (reimbursing physical and behavioral health care at the same rates) and a lack of doctors play a role as well. As recent court cases have noted, many insurers still aren’t adequately reimbursing for mental health services, or they are resorting to alternative methods (such as steering patients to doctors who are no longer even in their network) in order to keep people out of treatment.

The story also noted that changing the way we gather data could lead to additional insights which may result in better treatment of mental health disorders: In 2010, England started measuring overall life satisfaction and recently created a “Minister of Loneliness.”

So, what’s the conclusion of this article? Besides “holy crap this is bad”?

I think I’m gonna be repeating myself a bit here. But the conclusion is that addressing suicide for real will require a huge investment of resources and an acknowledgement that it’s more than just mental health. We have to address insurance and fiscal policies. Create a culture which is more accepting of mental health challenges. Understand that the challenges of mental health are comprehensive ones which tie a variety of areas together.

And I think we have to be willing to pay. For care. For insurance access. For bed space in the event that there are emergencies.

I hated reading this article because it was painful. But we need to know the truth about mental illnesses. And the truth is that this problem will take a long, long time to fully address.