Yes, people really are this stupid about mental illness and suicide

Sometimes, I find myself falling victim to the availability heuristic, and if you read this blog on a regular basis, I bet you do too.

For those of you unaware, the availability heuristic is defined as: “A mental shortcut that relies on immediate examples that come to a given person’s mind when evaluating a specific topic, concept, method or decision. The availability heuristic operates on the notion that if something can be recalled, it must be important, or at least more important than alternative solutions which are not as readily recalled.”

Why am I mentioning this now? Well, if you read this blog, I’m guessing you have an interest in mental health and mental illness. It’s probably a subject you follow closely and in which you are are well educated. I bet you have more evolved views on the causes and symptoms of mental illness and understand it’s complexities. And, I’d bet that the vast majority of people you interact with feel the same way.

Ahhhh, dear reader, allow me to share portions of an Email I just received. Among it’s gems:

  • “People commit suicide because they lack hope. True hope comes from putting your trust in the Lord Jesus Christ.”
  • “A troubled person who believes in evolution and does not know anything about the Bible, may turn to suicide as an escape.”
  • “If you want to reduce suicide, introduce the Bible back into school and stop teaching the fairy tale of evolution.”

First, a disclaimer, and let me make it crystal clear: The purpose of this entry is not to mock anyone’s faith or sincerely held beliefs. Rather, it’s to point out an absolutely ridiculous example of thinking. Faith absolutely assists some in the fight against depression and hopelessness. That’s wonderful. If that’s something which may work for an individual, I highly, highly encourage them to find a method of counseling which fits their views on religion, God and spirituality.

But the notion that prayer, Jesus or teaching creationism will cure depression and suicide for everyone is absurd.

Mental illness is highly complex. It often requires time, resources and multiple, simultaneous methods of treatment and lifestyle changes in order to fully address and treat. There is no one size fits all bullet. But what absolutely will not help is judgmental statements like the above, or the adherence to a one-sized fits all approach.

I’d also challenge anyone who makes a statement about reducing depression, mental illness and suicide to make sure that their comments are backed up by research. As I’ve noted in previous entries, there is a complex relationship between religion and mental illness, but as best I could find, there is ZERO relationship between teaching evolution and mental illness. Someone correct me if I’m wrong.

We’ve made great strides in the area of mental illness of late, but we still have a long long way to go. And absolute statements like the ones made above will do nothing but drive people further into the shadows.

There are people this uneducated out there, and I hope this is something we can all remember.

Five ways YOU – yes, you – can help beat mental health stigma

One of the things I am most passionate about when it comes to mental health is trying to beat the stigma surrounding it. I was asked a very interesting question yesterday: What does that look like? What is a stigma free world?

The best answer I have for that very valid question is this: We treat and view physical and mental illness in the same light. And we don’t view mental illness as being anything other than what it is: A serious, dehabilitating and potentially deadly category of diseases which require time, resources and care to heal.

Unfortunately, we don’t live in a society where that is currently the case. We know that nearly one out of five American adults have some sort of mental illness, but only 30-40% seek treatment.  Stigma continues to play a role in this disconnect and in people’s assumptions of what it’s like to live with a mental illness.

So, rather than asking a broader question about what we can do, as a society, let me put the question to you in a more direct, personal terms: What can you do to help end mental health stigma?

Here are five suggestions. They are all relatively simple. You may have thought about them already. But I think it’s important that all of us realize we have a role to play in terms of ending mental health stigma.

1) You have to talk about it: One of the most difficult things which people can do in terms of mental health is also one of the simplest: You have to talk about it. If you are depressed, say it. If you are anxious, say it. According to research, anti-stigma campaigns which are most effective are those which feature real, “normal,” identifiable people discussing their mental illness. This means that the most effective person to attack mental health stigma is…well, you.
2) Encourage people to seek help: If you are one of the lucky ones who has avoided mental illness, that’s wonderful. You still have an important role to play: If someone you know is in pain and needs help, encourage them to get it. Be supportive and non-judgmental, but help them get the help that they need and deserve.
3) Encourage an equal perspective between physical & mental illness: I might be off here, but I believe ending stigma means that we take mental illness the same way we take physical illness. That, I believe, is important, because most people aren’t going to look at a broken arm and think, “Gee, I can just tough it out!” When someone gets physically sick, we usually don’t think twice about helping them get the help they need. I think this is a good model for breaking mental health stigma.
4) Watch your language: Here’s one that I must confess I sometimes violate, and I need to stop. Expressions like, “I’m crazy” or “You’re nuts” don’t help anything. All that does is reinforce a negative stigma about mental health. There has been an awesome campaign in the past couple of decades to eliminate use of the word “retard” as a negative description, and it’s fantastic. The campaign operates on the principle that we are a better society if we are more inclusive. This has to extend to how we discuss mental health as well.
5) Don’t just talk about failures and pain – talk about successes and joy. I think part of the problem with the way we discuss mental health is we discuss it. We talk about failures, about challenges, about struggles. When you discuss mental health, don’t just concentrate on the negatives. Talk about joys and victories. Talk about beating struggles, about thriving. Mental illness can, of course, be extraordinarily painful, but that makes our victories sweeter. Talk about thriving, not just the pain.
As always, I’d love to hear from you! Anything you want to add? Let us know in the comments below!

Want to tell your story? Great. Here’s how.

Last week, I wrote an entry about why telling your story – your own personal experience with mental illness (or anything, really) is so important. Study after study shows that the best way to reduce stigma is to put a human face on it. The power of saying, “Me too” cannot be underestimated – that’s why it is literally called the #MeToo movement.

That being said, telling your story can be absolutely terrifying. You may have no idea what to say, how to say it, or what the reaction is going to be. The fundamental truth is that once you put yourself out there, there’s a before and after in your life. As I’ve said repeatedly about my own life, I found the ability to tell my story in the courage of those who told there’s. To that end: Here are some tips about what to say, and how to say it:

Pick your medium. You don’t need an op-ed. You don’t need to stand on a chair and scream, “I HAVE DEPRESSION!” Telling your story may be as simple as opening up to a friend of colleague, or resolving yourself to do so in the future. It may be a long-winded Facebook post or blog entry (and I am the MASTER of those, with an emphasis on long-winded!). In all seriousness, understand that different medium will have different impacts. Pick the one that works best for you.

Read/watch others. Reading and watching what other people have said will give you a much better idea of how to say what you want to say. You’ll learn what works and what doesn’t. More importantly, paying attention to the stories of others will remind you of a fundamental and very important truth: You aren’t the first, and you aren’t alone.

Read from the experts. Related to the point above: Read what others say when discussing your particular issue. Know what words and phrases are good, and what don’t work as well.

Understand that most people will be overwhelmingly supportive. In a weird sort of way, one of the things that disoriented me the most was how kind people were. It never felt like something that was “so brave” or anything like that – it just felt like something that had to be done. And that became almost a source of anxiety – that now I had this standard to live up to. So, as strange as it may sound, brace yourself for the weird sensation of people being really, really nice and appreciative.

Understand that some will not. There will always be morons and unkind people. Just keep in mind that when someone inevitably says something ignorant, it says more about them than you.

If medium-appropriate, make it a story. Part of making in impact with your story is telling it as a story. When I discuss my own battles, I always begin with something like this: “On August 11, 2014, my life changed forever. That was the day that Robin Williams killed himself.” I think that’s a good hook and a good way to start. Anyone reading will think, “Huh. That’s interesting. Why did that have an impact on him?” And it goes from there. Tell your story as a story. Be specific. Use visuals. Give dates, times and locations. Don’t approach your personal story as an academic book report, replete with cold numbers that fail to convey passion – tell your story with the personal power it deserves.

Understand the impact. This is the one that I missed the most. Depending on who you are and how you choose to say your piece, you may wind up having a greater impact than you realize. When I told my best friend what I was going to do, he correctly noted that this would have a much greater impact on me or my career than I could have ever anticipated. When I told my mentor, she told me that she’d be surprised if the piece I wrote didn’t make state-wide news. Both were correct. Understand that people will look at you differently – and probably in a better light.

There. Hopefully, this post can serve as a guide to help you tell your story. As always, let me conclude with a question: What did I miss? What helped you tell your story? What didn’t? Please let us know in the comments!

The dream scenario: How society should treat mental health

Many of us, including me, regularly talk about how important mental health is. We talk about how important it is that, as a society, we change the conversation around mental health. Something occurred to me as I was debating what to write: I had no idea what that specifically meant. I mean, I have some general ideas, but I want to take a minute to expand upon what I’m talking about – what I mean – when I say that we have to have better and more helpful conversations about mental health in this country.

What do I want? Easy.

  • No one blinks about seeking treatment for mental health. There is no shame, no stigma. You say “I have depression” with the same breath that you say “I have the flu.” In my dream world, no one is afraid to talk about having an anxiety attack. No one is afraid to say they are having a bad day. In our current society, fear of being “discovered” creates more anxiety, more depression, more stress. That, in turns, has a dramatically negative impact on mental health and creates a vicious cycle. We shouldn’t be afraid about discussing who we are and the repercussions that may come with it.
  • There are no barriers to seeking treatment for mental illness in terms of finances or access, and I mean this in a few ways. First, like many areas of medicine, there is a major shortage of mental health care practitioners. This is a major problem and one that exists for many reason, but I’d argue that the chief problem is money. Physicians go into fields for many reasons, and those reasons are similar to decisions that the rest of us make: They are often financially based, and reimbursement rates for psychiatrists are far too low. This keeps doctors out of this vitally important field, and I’d argue that these rates are too low because we are too afraid of talking about mental health to begin with. Insurance companies often create plans that have different and lower levels of reimbursements for mental health care. That leads to worse mental health, and worse outcomes.
  • In my dream, as a society, we’ve stopped even hesitating about talking about mental illness. One of the things I learned quickly when I started talking about my own depression/anxiety? It’s everywhere and everyone. No, obviously every person in the world isn’t mentally ill. But just about every person in this country knows someone with mental illness. After all, one in five Americans suffer or will suffer from mental illness. We have to acknowledge this pain if we are ever going to cope with it.
  • There are no disparities in healthcare among various demographics. I’m lucky; I’m a relatively well-off white male with easy access to health care. While I’m grateful for my own circumstances, we have to acknowledge that other groups – including racial minorities and members of the LGBT community – lack the easy access that I and others like me are fortunate enough to have. This isn’t fair, and it isn’t right. A society is only just when everyone has the same access to life-saving resources.

There’s more – so much more – but these are the first things I’ve come up with. I’d love to hear from you – what else am I missing? Let me know in the comments below!

Talk to the kids: Why you should tell your mental health story

This past Friday, as part of the real job, I had the pleasure of attending career day at one of my local elementary schools. During that time, I spoke with about 70 5th graders about what it’s like to be a State Representative, what I do, what my issues are, etc. In doing so, did what I always did: I spoke about mental health. I also made sure to be very clear – no euphemisms, and no sugar-coating. I spoke about having depression and anxiety disorders – what that means – and how I see a therapist as needed and take medication on a daily basis.

I make this part of an overall anti-stigma conversation. If I’m talking to younger kids, I broach the subject like this:

“Okay, let’s say you’re riding you’re bike, and you fall off and your arm is hanging at a funny angle.” (imagine me holding my arm at a funny angle) “What’s the first thing you are going to do?”

“Cry!”

“Yes, well, there’s that, but AFTER that.”

“Call 911!”

“Right! Exactly! You’ll call 911! And you would’t even think about it, right? You wouldn’t be embarrassed. Well, imagine having a mental illness….”

And I take it from there.

Sometimes, the kids ask me questions about this stuff. Other times, they delve into other areas of my career. In two of the three classes I had, the mental illness did come up. I was asked questions about it, and they were strikingly perceptive. Two that stick out in my mind:

  • Is suicide a mental illness?
  • Is it a mental illness if you do drugs?

And then a few kids opened up and discussed their own experiences – or that of their family – with mental illness. I know no one would be able to identify them from this, but I’d still rather not say what they said. Suffice to say – it struck me. It left a mark. And it reminded me of one of the many reasons I always discuss my mental illness, but particularly with kids: It can give them a little bit of hope. As many of you unquestionably know, one of mental illness’ greatest challenges is the way it warps your mind, makes you feel like you are alone. I want all of these kids to know that they aren’t alone.

This leads me back to my main point: Tell your story. Please understand I say this not to toot my own horn, but the smartest decision I have ever made in my life was to publicly discuss my own struggles with depression and anxiety. The experience has become astonishingly positive, and has helped me help other people. According to research, a contact-oriented strategy, one in which regular people share their own struggles with mental illness, can be invaluable towards fighting the stigma that keeps people locked in shame and out of treatment. Telling your story can provide incalculable hope to others who need it.

As always, I’d love to hear your thoughts and perspective. Have you “gone public” with your struggles? What has your experience been like?

National Depression Screening Day

I’m a bit late on this, but October 5 was National Depression Screening Day.  The day itself, first created in 1990, is an effort to encourage people to determine if they are depressed and seek treatment for their illness.

Common depression screening tools

There are multiple depression screening tools available.  These tools, often available in online questionnaires, allow users to determine if may be suffering from depression.  Ideally, an appropriate screener will then link to resources which will enable a person to get help.

From what I have seen, the Patient Health Questionnaire (PHQ-9) is the most common tool to determine depression.  It’s brief – just nine questions – and allows for the user to easily determine if they are potentially suffering from depression.

There are, of course, many more depression screening tools, including:

  • Hamilton Depression Rating Scale (HDRS)
  • Beck Depression Inventory (BDI)
  • Patient Health Questionnaire (PHQ)
  • Major Depression Inventory (MDI)
  • Center for Epidemiologic Studies Depression Scale (CES-D)
  • Zung Self-Rating Depression Scale (SDS)
  • Geriatric Depression Scale (GDS)
  • Cornell Scale for Depression in Dementia (CSDD)

Does depression screening work?

There is evidence which shows that depression screening can make untreated individuals aware of their problems and encourage them to seek treatment.  Depression screening also appears to be relatively accurate, and its systemic use can make doctors more aware of depression with their patients.

The biggest benefit of depression screening

Depression screening is a useful, if flawed tool, which allows for an individual to determine if they are depressed.  That being said, depression screening increases awareness of depression.  It allows someone to determine if they may be suffering from depression, and seek help.  It also treats depression just like any other physical aliment – this, in turn, has the power of reducing stigma.

Google launches depression screening tool

I caught this over the weekend and found it to be very interesting: Apparently, Google has launched a tool that serves as a brief depression screening.

First, about the screening.  It is the PHQ-9, which is only nine statements.  It asks users to select the level of agreement with nine statements, ranging from “Not at all” to “Nearly every day.”  They include items like, “Little interest or pleasure in doing things” and “Feeling tired or having little energy.” The information can then be shared with the user’s health care provider and used to seek treatment.

This is noteworthy for many reasons.  The screening will pop up in the event that “depression related searches” are made, similar to the way that the number for the National Suicide Prevention Lifeline (1-800-273-8255) pops up for suicide related searches.  Given the prevalence of Google in modern life, this can, hopefully, help make people more aware of mental illness and steer them to treatment options.  This is also particularly important, given the spike in suicide-related Google searches.  That spike, incidentally, is tied to 13 Reasons Why on Netflix, a show I suspect I will be writing about in the future.

Indeed, I’d argue that the most significant reason that the availability of the depression questionnaire is important is because of the major rate of spikes in suicide that we are seeing.  Suicides are rising across the board, but particularly for young girls aged 15-24, who have seen suicide rates increase to 40 year highs.  Obviously, this is the generation that is the most technologically dependent, so increasing their awareness about mental illness and treatment options can be a very, very good and healthy thing.

As good of a thing as this is – and it really, really is a good thing – depression screenings are not without their problems.  There are some studies which report that versions of the PHQ can demonstrate “poor specificity in detecting major depression” or false positives.

That being said, for the sake of argument, let’s assume the absolute worst about the PHQ-9: That it leads to an unacceptably high amount of false positives for depression.  Google’s use of it is still a great:

  • First, false positives is very different than false negatives.  A single accurate, positive test about the PHQ-9 can steer people into treatment and give them the help that they so desperately need.
  • Second, it can help move positive views of mental illness in a positive direction.  Too many people still view mental illness as a weakness or something that can simply be conquered by willpower.  That, of course, isn’t the case anymore than a broken arm can be healed by well-wishes.  Having a source viewed as positively as Google advertise depression screenings can, hopefully, convince people of the importance of seeking treatment for mental health.

As always, I’d love to hear your thoughts.  Let us know in the comments!

The mentally ill are more likely to be victims of violence – not perpetrators

One of the common misconceptions of mental illness is that the mentally ill are a monolithic group of lunatics, running around, committing violent acts.  This is perpetuated in a variety of ways, including popular culture and the media, who tend to highlight and sensationalize the unfortunate incidents when someone when is mentally ill commits an act of terrible violence.

Of course, that isn’t the case at all.

Let me address this stigma in two parts.  First, as has long since been established, mental illness, like most physical disorders, exists over a spectrum.  Nearly 1 in 5 American adults has some form of mental illness.  Breaking that down further, however, reveals a far more nuanced picture.

First of all, I vehemently object to the idea that “mental illness” is a big block.  It comes in a variety of symptoms, severity and specific diseases.  As noted above, nearly 1 in 5 American adults have some sort of diagnosable mental illness over the course of a year.  Roughly the same number of 13-18 year olds fall into the same category.  Over the same time period, 1 in 25 adults suffers from a mental illness that is severe enough to qualify as a “functional impairment.”  At the same time, roughly 100,000 people, per year, have their first episode of psychosis.

So, first and foremost, let’s dispatch the idea that all mental illnesses are the same.  They  vary in a variety of respects.

Second, it’s important to keep this in mind: Being mentally ill makes someone far more likely to be a victim of crime, not a perpetrator of it.  I get that the popular stereotype of the mentally ill has led people to believe that this isn’t the case, but again, reality is very different than perception, and when you think about it, this makes sense.  Someone who is mentally ill is far more likely to lack complete control over their faculties, health, finances, etc.  As a result, they are vulnerable to society’s criminal elements.

Let’s take a look at the research.  According to a 2014 study by North Carolina State, roughly 24% of the mentally ill who were surveyed (out of 4,480) had committed an act of violence over the past six months – but 31% had been a victim of it.  Breaking it down further, of those who had committed an act of violence, 63.5% had done so in a residential setting, while only 2.6% had done so at school or the workplace.  This doesn’t make the act of violence any less important or tragic, but it does mean that the mentally ill are rarely a danger to the general public.  Unfortunately, it may mean that family members can be.

Taking this research a step further: According to governmental surveys, only 3-5% of violent acts come from someone living with a serious mental illness.  And this, again, makes an important distinction: A serious mental illness is more than just someone who gets periodically anxious.  It is defined as:

a condition that affects “persons aged 18 or older who currently or at any time in the past year have had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within DSM-IV (APA, 1994) that has resulted in serious functional impairment, which substantially interferes with or limits one or more major life activities”

As a study from Washington notes, this leads to exaggerated views of the connection between mental illness and the general public.  This, in turn, leads to widespread stigma, discrimination, treatment avoidance and a lower quality of life for those who suffer from mental illness.

 

I suppose, ultimately, it comes down to this.  The mentally ill – from a mildly anxious teenager to the most severely schizophrenic homeless senior – deserve to be treated with basic human dignity and respect.  Stigma is so dangerous because it is pervasive, and any broad-based, inaccurate characterization of mental illness dehumanizes those who suffer and forces them to keep their illness in the dark.  Violence among the mentally ill is rare – tragically, becoming a victim of violence is a far more likely scenario.  It is vitally important to the destigmatization movement that we continue to fight back against all inaccurate portrayals of mental illness, including this one.