Across the U.S. and world, employers are doing their best to follow public health data on Covid-19 to try to make the best decisions on how to protect their employees and those they serve. But this data is only part of the story. To safely reopen, stay open, or remain at home, and ultimately recover to whatever the “new” normal will be, organizations also need to monitor and make decisions based on mental health needs.
The most effective mental health metrics will be continuous, providing real-time insights on how the workforce is faring in the midst of Covid-19, protests for racial justice, and other disruptive events. Early research from the World Health Organization, Kaiser Family Foundation, and others have already demonstrated the pandemic’s immense toll on mental health. Now, employers can play a critical role in continuing to assess mental health and ensure employees have access to needed resources.
A new workplace mental health project, the Mental Health Index: U.S. Worker Edition, co-sponsored by the National Alliance, HR Policy Alliance and One Mind and produced by Total Brain, helps to meet this need. Every month, the Index presents updated findings from a random sampling of hundreds of U.S. workers, across topics like risk for anxiety and depressive disorders, emotional awareness, and negativity. The result is an ongoing, detailed look into how mental health impacts are evolving and where needs are the greatest. For example, data released on July 17 showed that U.S. employees’ risk of Depressive Disorder, Post Traumatic Stress and General Anxiety Disorder each increased by at least 40% since February. Interestingly, the reopening of some businesses in June seems to have brought some relief, particularly for women who were the most affected segment in the study. However, the worsening rate of infection and cases across the country means that the numbers are likely to get much worse before the get better.
Even if numbers from June are encouraging, mental illness is an important concern for long-term economic recovery. Even before the pandemic, depression, alone, cost tens of billions of dollars in lost productivity in the U.S. each year. Without a concerted response from employers, the costs of mental illness threaten to spike to an unsustainable level in the wake of Covid-19.
Organizations can take three critical steps to protect workers not just from risk of infection, but also mental illness:
Provide tools foremployees to assess mental health
There are a wealth of employee mental health assessment tools and applications available; employers just need to decide which is best for their workers and which mental health metrics will help guide decisions. The most effective tools will be easy to use and understand, protect workers’ privacy, and provide actionable findings and resources. However, simply providing or using a tool is not enough. Organizations should also engage their leaders and managers to actively discuss the importance of mental health, share their own experiences, and encourage workers to take advantage of resources. Stigma and fear of discrimination don’t go away easily. It takes a concerted, long-term effort.
Ensure access to mental health resources
Once workers have assessed their mental health needs, they need access to resources, services, and providers to meet those needs. Leading employers are stepping up to bolster these offerings in this area given the challenges of Covid-19. For example, EY provides employees with free access to apps for building emotional resilience, one-on-one or group counseling, and daily drop-in sessions where employees can learn tips for managing anxiety, stress and social isolation. Similarly, PwC is providing access to well-being coaches throughout the pandemic to discuss stressors, while the U.S. Department of Veterans Affairs released a comprehensive toolkit to help leaders support their staff during a national emergency.
Continually improve response with evolving resources and discussions
2020 has shown that stress, life disruptions, and mental strains can change suddenly—and the future remains uncertain. While employers cannot predict the course of Covid-19 or other challenges – which could include national disasters, pandemics, or social movements – they can establish the infrastructure, tools, and conversations to respond effectively to any new mental health impacts, whatever comes next.
Workforce mental health metrics are essential to charting a path forward during the Covid-19 pandemic and beyond. Just as employers are central to mitigating the spread of the virus, they can take an active role to understand and respond to evolving mental health impacts. This will protect workers’ lives and health, speed economic recovery, and lay the foundation for mental health in the workplace on a permanent basis.
Black, Indigenous, and Persons of Color (BIPOC ) populations can face giant differences in the accessibility of quality mental health care. The Agency for Healthcare Research and Quality (AHRQ) reported that racial and ethnic minority businesses within the U.S. Are more likely to be uninsured, more likely to seek emergency departments services, much less possibly to gain access to mental wellness services, less probable to use network mental health support, and much more likely to acquire decreased quality care.
July marks BIPOC Mental Health Awareness Month which shines a light on the awesome struggles that underrepresented populations face with mental health needs in the United States. Many are embarrassed to seek helo for a fear of being shamed.BIPOC Mental Health Awareness Month provides an opportunity to destigmatize speaking about mental health needs, and substance abuse problems. By focusing on this issue in July and all year round we can help close the gap of inequality of services in marginalized communities and fight stereotypes that keep those in the BIPOC community from receiving services.
To highlight some of the unique subject matters of BIPOC Mental Health Awareness Month, including the stigma of mental illness, access to treatment, and resources read below:
Mental Health Stigma Minority groups automatically have limitations to getting help if they are trying to find treatment. When it comes to supporting marginalized communities’ ability to navigate life with a mental health condition, a number one reason for the roadblocks is different forms of cultural/social stigma.
For instance, in some BIPOC communities, one stigma is that seeking mental health support means you’re “crazy” or “weak.” Also, a loss of access to culturally capable mental health experts who can meet BIPOC clients’ needs often prevents those suffering from seeking care.
Access to Treatment BIPOC communities experience racism or discrimination in therapeutic settings and language barriers among providers due to a loss of cultural competence amongst organizations that provide care. The National Alliance on Mental Illness (NAMI) stresses the significance of obtaining a culturally aware provider.
When seeking support, you can ask potential mental health health care providers about their schooling and background to get a higher sense of whether or not or not you want to work with them. You may want to ask the following.
Have you had any cultural competence schooling?
Are you inclined to consist of my values and cultural beliefs into my care?
Do you have experience treating persons from my cultural background?
Available Resources Mental health conditions do not discriminate based on race, color, gender, or identity. However, way of life, race, ethnicity, and sexual orientation can make getting mental health treatment lots tougher. The National Alliance of Mental Illness (NAMI) is an excellent place to start to study more about mental wellness and ways to support and bring awareness to your community.
When Keisha Lewis comes into contact with a police officer, one of the first emotions she feels is fear. Lewis, a 35-year-old Black transgender woman and office manager at the Morris Home, a residential recovery program for the transgender community in Southwest Philadelphia, can’t be sure of the reception she will get.
“It’s like, ‘Is this person going to be mean to me?’” Lewis said. “It plays on your psyche and messes with you very badly. I’m a human, too, and I deserve protection, and I deserve to be taken care of like everyone else.”
After the June murder of Dominique “Rem’mie” Fells, a Black transgender woman in Philadelphia, the outcry to address violence against transgender people is louder than ever. The problem is not unique to Philadelphia. In 2019, at least 26 transgender or gender-nonconforming people were killed in the U.S. — 91% of them Black women — according to the Human Rights Campaign.
Black transgender people often already are at higher risk for mental-health issues. Their problems are only made worse by the violence that they experience, a lack of acceptance within their families and communities, and a shortage of mental-health care specific to their needs.
Lewis, who has experienced the pain of rejection and the fear of gendered violence, said she struggles with mental health issues because of it.
“The proximity to trauma for Black trans women is very real,” said Shana Williams, clinical director at the Attic Youth Center, which serves LGBTQ youth in the Philadelphia area. Williams is also a therapist with the Morris Home and identifies as a Black queer woman. “The average lifespan of a Black trans woman is 35 years old, and if you constantly see that around you, you cannot help but to mentally accept and be prepared for death as a Black trans woman navigating society.”
For Black transgender people, the mental health impact is likely even worse — a 2013 study found that experiencing transphobic and racist events increased depressive symptoms for transgender women of color.
But “the idea that being transgender is the mental-health problem” is incorrect, Williams said. The trouble is with “the world functioning as a gatekeeper,” rejecting anyone who doesn’t meet certain norms.
“It’s really about society and family rejection,” Williams said. “Being a Black person who already has to navigate oppressive systems, with the added layer of being trans, leads to another way to be discarded, shunned, and not supported.”
Lewis said that many people in her community have abandonment issues that stem from the rejection they experienced after coming out to their families.
“A lot of us are ostracized by our community, our family, the people who are supposed to love you, when we come out,” she said. “But it’s like they throw you away and discard you like trash. When you’re young, you don’t know what you’re supposed to do then. You’re lacking love, and no one has provided you with any type of tools to move forward with, and over time, that begins messing with your mind.”
Lewis said suicidal thoughts may begin taking hold when it feels as if people have lost their family’s love through no fault of their own.
“They think that they don’t want to be here if they can’t have their family,” she said. “This is just who they are, and the people who are supposed to love them unconditionally don’t want them around.”
Needed: More Black LGBTQ therapists
Okichie Davis, a Philadelphia therapist who works with queer people of color through their private practice, Endeavoring Wellness, has found that Black transgender people experience all of the same mental-health challenges that the general population faces. But “the difference is that [Black LGBTQ+ folks] are marginalized for our gender identity and sexuality, which makes it difficult for us to manage those challenges,” said Davis, who identifies as a queer Black woman.
Transgender people deal with higher levels of housing and food insecurity, violence, difficulties accessing affordable, affirming health care, Davis noted. “All of these barriers serve to exacerbate any symptoms that already exist, and compounds the severity of the mental-health challenges that folks deal with. When people are making the choice between paying for food, medicine, or keeping the lights on, therapy gets bumped,” Davis said.
That’s why it’s so important to have more therapists from the Black LGBTQ community who understand those challenges, Davis said. Many of Davis’ clients search for months before making an appointment.
“When you work with clinician not from your racial background or sexual identity, sometimes you encounter racism, transphobia, homophobia, or the pathologizing of Black and LGBTQ people,” Davis said. “That drives people away.”
Williams also stressed the importance of exploring implicit biases around gender and identity as clinicians. She said she still hears about clinicians who insist on using their clients’ legal names instead of their preferred names and fail to ask which pronouns they use.
“Any clinician in 2020 has to do the work to educate themselves on how to be open and affirming,” she said. “Being trans is who someone is, and we should feel able to support that.”
Lewis knows Black transgender people who will not see a therapist because “there’s nobody that looks like [them].” She said they are afraid of being judged by someone who can’t relate to them.
“I remember years ago when I wanted to see a therapist, I couldn’t find an African American or a trans therapist,” Lewis said. “I just want to tell all the Black professionals out there who are becoming therapists — we need you, keep doing what you’re doing, we want to see more of your faces out here, doing the work.”
Two decades of life experience made a mental-health activist of Kai Koerber. When he was 16 and a student at a Parkland, Fla., high school, a gunman killed 17 people, including one his friends.
“I really did suffer a domestic terrorist attack, and that’s not something that happens to you every day,” Koerber says.
But as a young Black man growing up in the South, Koerber had already faced threats of racial and police violence routinely, and those experiences, too, shapedhis relationship with the world. He’s coped with that stress, he says, through a lifelong practice of meditation. And after the school massacre, Koerber also sought emotional support from a therapist with a deep empathy for his personal traumas.
“Finding a Black therapist really saved me some time, and there was more connection, in terms of the kinds of struggles that I might feel or the the kinds of ways I might think about certain scenarios,” Koerber says.
Now a rising sophomore at the University of California, Berkeley, Koerber says having access to good mental health care is critical to both preventing and dealing with the after-effects of violence.
Dr. Rhea Boyd says many members of the Black community feel emotionally raw and tapped out.
“We haven’t been asked to publicly bear our pain as frequently as we are now, and we haven’t had to witness other Black folks publicly baring their pain about it as frequently as we are now,” says Boyd, a Bay Area pediatrician who studies the effects of police violence.
She says racism’s toll threads through the psyche, manifesting in many ways, and shaping the youngest of brains. She worries most about Black girls, for whom suicide risk is increasing — not just among teenagers, but among preteens as well.
Misdiagnosis of Black people,Shim says, is still prevalent today — often by non-Black doctors who misread emotional cues like anger.
“We look at these things and call them ‘disruptive behaviors,’ we misdiagnose young people with things like ‘conduct disorder’ instead of the result of chronic trauma from racism,” because many physicians haven’t experienced it, Shim says.
For many Black patients, access to mental health treatment often comes in places of last resort: Jails, schools, emergency rooms. And studies show that African Americans tend to be given psychiatric diagnoses that are incorrect or especially severe or less treatable — such as schizophrenia instead of depression or bipolar disorder — and that can lead to inappropriate treatment. So, not surprisingly, Black patients who do get treatment tend to fare worse than white counterparts.
“I do think changing the workforce and changing the face of the workforce is probably the most critical thing that we can do now to start to address some of these issues,” Shim says.
The scarcity of Black mental health professionals in the U.S. is now an acute problem, says Dr. Altha Stewart, a Memphis psychiatrist who became the first Black president of the American Psychiatric Association two years ago.
“I get calls from people right now asking, ‘Can’t you refer me to a Black psychiatrist?’ And because there are so few of us, I’m limited in how many of those people’s referrals I can make to their satisfaction,” Stewart says. And that contributes to a lack of faith in health care among African Americans.
Stewart sees some signs of hope. In recent years, Black celebrities in sports and entertainment — like former NBA star Ron Artest, radio personality Charlamagne Tha God and actress Taraji P. Henson — started openly advocating for the importance of mental health screening and support. She says more Black faith leaders in churches and mosques are partnering with programs that help them connect congregants to treatment.
But at the moment, Stewart says, in the aftermath of the killing of George Floyd, the need is simply too great. “This was one bridge too many, one act too many, one heinous crime too many. It’s something too much.”
The current wave of protests following the killings of George Floyd, Breonna Taylor, Tony McDade, and so many others has been an urgent and much-needed push for change. On a personal level, and especially when it comes to mental health, it can be empowering to experience this sense of unity. But the constant flow of energy and emotion can also become draining, overwhelming, and traumatizing, specifically for Black activists.
How Can Activism Affect Your Mental Health?
Activism impacts your mental health in many different ways. “From a positive perspective, it can be empowering and liberating to experience a collective sense of community,” said Shaketa Robinson Bruce, LPC, NCC, CCH, a licensed professional counselor at Open Arms Counseling Center in Atlanta. This is especially true for Black people and other historically marginalized populations, she told POPSUGAR. “Historically, we haven’t felt empowered to speak up about issues that affect us,” she said. Participating in protests that amplify those voices and those issues can feel freeing and fulfilling, because “you are addressing social issues and racial injustices that matters to you,” said Marline Francois-Madden, LCSW, an author and licensed clinical social worker in New Jersey. “What I’ve heard, specifically from protesters, is ‘I didn’t realize how much I needed that.'”
But protesters may also experience negative emotions, sometimes alongside these feelings of strength and liberation. That’s because activists are working to change injustices that Black people have experienced both for centuries and day in and day out, Francois-Madden explained. “Institutional racism and structural racism have existed for a long time,” she said. “Many activists can feel very exhausted during the fight for racial justice.”
After protests, Bruce has also heard activists speak of feeling overwhelmed or experiencing emotional breakdowns, feeling sadness, grief, anger, or any combination thereof. Parents in particular may feel worried or afraid, “especially if they’re raising Black boys,” Bruce said.
Many protesters are dealing with this emotional stress while actively trying to push for change, a combination that can take its own toll. “We’re seeing a lot of people come together and a lot of organizing,” Bruce said. “But if you’re constantly doing that, it can be exhausting.” When it all comes together – the emotions, the energy drain, the triggering conversations and videos and social media posts – this work “can be traumatizing,” Bruce said. If you neglect your own personal mental health, “it can take a toll that can lead to depression.”
How Can Activists Take Care of Their Mental Health?
If you have the passion to do this work, you have to have the passion to take care of yourself as well, Bruce explained, because “a car can’t run on an empty tank.” If you don’t take care of your mental health, you won’t be able to create change – but Francois-Madden said some activists may find it difficult to set those boundaries and deal with the sense of guilt that can come from taking a break, as necessary as it is.
Here’s what activists can do to boost their mental health:
Take a break. “You have to recharge and refuel in order to keep going,” Bruce said. If you’re feeling emotional strain and exhaustion, take some time off from protesting (as well as social media), whether that’s a day, a few days, a week, or longer.
Meditate. Meditation is really good for promoting mental health, Bruce said. She recommended Liberate, a meditation app for people of color with specific meditations for microaggressions and racial trauma. (Here are more meditation apps you can try.)
Journal. When journaling for mental health, Bruce recommended writing down how you feel as well as affirmations. “Take time to check in with yourself and reflect on how you’re feeling.”
Prioritize sleep. “If you are not getting adequate restful sleep, that can affect your concentration, your energy level, your mood,” Bruce explained. She recommended getting eight to 10 hours of sleep, if possible.
Let go of guilt. Activism is important work, but taking care of yourself is also crucial. “We have to be intentional about our self-care, but also not feel guilty” when prioritizing emotional well-being, said Francois-Madden.
Talk to a mental health professional. “Seeing someone professionally is definitely very critical right now,” Bruce said. She noted that some therapists are offering free groups you can join or other virtual gatherings that give you the space to express your emotions.
The work of activism, while often rewarding, “is very grueling and taxing,” Bruce said. “It’s important to take time out for yourself in the midst of this. In order to keep going, you have to take care of yourself.”
When the mind senses a potentially harmful situation, it tells the body to prepare by increasing its heart rate, breathing, and blood pressure. This response helped earlier humans outrun or fight predators and enemies.
Today’s stressful situations, more likely a challenging interaction at work or a misbehaving child, result in the same physical reactions even though we are less likely to experience physical danger. The problem is, when this stress response is repeated frequently over time, evidence shows it leads to health problems including depression, anxiety, insomnia, heart disease, skin rashes, and gastrointestinal problems—just to name a few.
Now a growing body of evidence demonstrates that racial discrimination triggers this stress response. As a result, racial minorities may experience more health problems compared to others. One review of 121 studies published in 2013 found that youth between the ages of 12 and 18 who experienced discrimination were significantly more likely to experience mental health problems such as depression and anxiety compared to those who did not experience discrimination. Another review of 66 studies found that black American adults who perceived they were subjected to racism were more likely to experience mental health problems and more likely to report a lower quality of life.
A lead researcher in the field is Anthony Ong, a professor of human development in Cornell University’s College of Human Ecology. Ong explains that experiencing discrimination or mistreatment regularly can affect health through eroding a person’s self-esteem and by robbing marginalized individuals of opportunities.
“Although increasing evidence suggests that chronic exposure to unfair treatment or day-to-day discrimination increases the risk for poor health, the overall dearth of data on biological mechanisms indicate it’s important to continue studying this topic,” Ong said.
He published a study last year of more than 200 African-American adults followed over the period of a decade. Participants filled out questionnaires about everyday mistreatment such as being called names, insulted, threatened, or harassed. They also answered questions about larger occurrences of unfair treatment, such as being discouraged from continuing their education, not receiving a loan or being hassled by the police.
Participants also underwent blood tests to identify 22 biomarkers of diseases including heart disease, diabetes, nerve problems and inflammation.
Ultimately, participants who reported experiencing more discrimination were in poorer health. Ong said that’s because experiencing discrimination on a regular basis, even small instances of daily mistreatment, lead to “wear-and-tear” on the body over time.
“Our findings suggest that coping with chronic experiences of day-to-day mistreatment and discrimination can elicit a cascade of response that over time ‘weather’ or damage the physiological systems that regulate the body’s stress response,” he said.
Ong published a second study of 152 Asian-American college students, who kept a diary of their daily events, moods, and physical health for two weeks. The study found that when participants experienced mistreatment, what Ong calls “daily microaggressions,” they reported poorer sleep quality and shorter sleep duration the following day. Participants who experienced reported more “stigma consciousness”—that is, they believed discrimination influenced their daily interactions with others—were more likely to experience poor sleep quality on nights after they reported experiencing mistreatment.
“Being constantly vigilant to race-related threats in the environment may keep you from getting a good night’s sleep,” Ong explained.
The broad take-home message here is that racial discrimination can lead to health problems that detract from minorities’ quality-of-life over the course of a year or even a lifetime.
Mental-health advocates call for a rethink of public safety
Thirty-one years ago, the Eugene, Ore., mobile crisis-intervention program Cahoots (Crisis Assistance Helping Out On The Streets) was born. The 24/7 service, provided by the nonprofit White Bird Clinic and integrated into the city’s public-safety infrastructure, dispatches a medic and crisis worker to respond to non-criminal crises involving people experiencing mental illness problems, substance abuse and homelessness.
“In those situations where there’s not a criminal issue, there’s not an emergent threat to the safety of an individual or a neighborhood, why do we need the police to be the ones responding?” Tim Black, Cahoots’s operations coordinator, told MarketWatch. “Why can’t it be folks from that community who are coming with unconditional positive regard and empathy, instead of force?”
“For the past three decades, we’ve been really demonstrating how public-safety dollars can go to something other than law enforcement,” Black said. “So when we hear these conversations around ‘defund the police’ that are happening now, what we’re hearing is an opportunity to really engage in meaningful dialogue about what public safety actually means.”
Advocates at Cahoots and elsewhere have long argued that trained mental-health and medical professionals, not armed police, should be the ones deployed to respond to people experiencing behavioral-health distress — a view that some people with law-enforcement backgrounds appear to share.
After all, these interactions sometimes prove deadly: Adults with severe mental illness account for one in four people killed in police encounters, according to a 2015 report from the Treatment Advocacy Center, a national nonprofit based in Arlington, Va., and individuals with untreated mental illness face a 16-times-greater risk of being killed in a law-enforcement encounter compared to other civilians.
An ambulance and medical professionals represent a standard response for someone having a heart attack or stroke — but ‘for some reason, we have decided that mental illness needs to be treated differently.’— John Snook, the executive director of the Treatment Advocacy Center
And despite misconceptions about individuals with serious mental illness, they account for just 3% to 5% of violent acts, according to the Health and Human Services Department. But they are more than 10 times more likely than the general population to be victims of violent crime.
An ambulance and medical professionals represent a standard response for someone having a heart attack or stroke — but “for some reason, we have decided that mental illness needs to be treated differently,” John Snook, the executive director of the Treatment Advocacy Center, told MarketWatch.
‘Mental-health crises are not appropriate criminal-justice matters’
A history of past negative encounters with police can inform how some individuals in crisis respond to interactions with law enforcement, Black said.
“You’re already feeling scared, you’re already feeling escalated, your heart rate’s up, you’re stressed. And this officer arrives on scene — maybe you’ve never met that officer before, but you know how your cousin was treated when they were arrested three months ago. Maybe you’ve had more severe mental-health symptoms in the past and had some tough interactions with other police in another city,” he said by way of example.
“If you’re already feeling really elevated [and] fearful, and then there is a further trigger to continue to escalate that fear and anxiety, it’s a lot harder to really compose yourself in a way that police generally want us to compose ourselves when interacting with us,” he added.
Cahoots staff, in contrast, show up to a scene in a white van wearing informal attire, Black said: “We can send a clear message that we’re not the police, that we’re not the fire department.”
A number of factors have led to a need for community-based crisis responses for people experiencing serious mental illness, including a decrease in inpatient psychiatric beds over the past several decades, a lack of adequate funding for community-based mental-health services, and “the widely accepted principle — and law — that care should be provided in the least-restrictive environment, ideally in the community,” according to a 2019 literature review of police-based and other crisis-response models published by the Vera Institute of Justice.
While mental-health advocates can’t decide how cities set their budgets going forward, “there’s been broad agreement that mental-health crises are not appropriate criminal-justice matters,” Snook said.
Snook says individuals with mental illness should get the treatment they need before they become very sick, and communities should add sufficient capacity for inpatient psychiatric beds. In the event of a mental-health emergency, dispatchers should contact mental-health professionals, he added; law enforcement might play a supporting role if there’s a criminal or safety concern.
Ideally, Snook added, “this isn’t the first time anyone’s heard that you’re in need of care — and someone coordinates with you to ensure that you get the response that you need.”
“In America, we have not prioritized things like health care. We have not prioritized mental-health treatment. We have not prioritized early intervention or safe communities in ways that feel right for those communities,” Theresa Nguyen, the chief program officer for the nonprofit Mental Health America, told MarketWatch. “So I think we’re all called to ask ourselves why that’s the case and how we should do better.”
One survey respondent said, ‘We should not be in the mental health transport business. … We are a police department, not doctors.’ Another asked, ‘Since when did we consider the idea, even with the best intentions, that placing someone in need of psychiatric care in the back of a squad car is a good thing?’
‘If you don’t have resources, you’re just sending whoever is there’
About one-fifth of total law-enforcement staff time and 10% of law-enforcement agencies’ total budgets in 2017 went toward responding to and transporting people with mental illness, a separate 2019 survey of sheriffs’ offices and police departments by the Treatment Advocacy Center found. The study estimated that law enforcement nationwide had spent an estimated $918 million transporting individuals with severe mental illness that year.
One survey respondent said, “We should not be in the mental health transport business. … We are a police department, not doctors.” Another asked, “Since when did we consider the idea, even with the best intentions, that placing someone in need of psychiatric care in the back of a squad car is a good thing?”
Law-enforcement officials have become “the de facto facilitators of treatment for individuals with serious mental illness and those in the midst of a psychiatric crisis,” the report added, despite many not having planned or trained to be in that role.
“What we often see is because cities or counties don’t have mobile response teams, they have to rely on law-enforcement officers to respond to these calls — not because police officers want to, but because [communities] haven’t invested in having other people there,” Nguyen said.
“The hardest thing for a city or county is that if you don’t have resources, you’re just sending whoever is there — and when you send whoever is there, that’s not the same thing as sending who is best,” she added.
‘They realize that we’re not part of that same system’
Around one in five calls that come in to the Eugene police department results in a Cahoots response, Black said. During a typical Cahoots call, a person experiencing a crisis or a third party will put in a call to dispatch (through the police non-emergency line and/or 911), and a Cahoots team is sent to the scene, Black said. The workers approach the interaction “from a lens of least intervention necessary” — aiming to listen to and empathize with the individual, he said, and identify what they need to feel safe, supported and stable.
Workers arrive unarmed and don’t carry tasers or pepper spray, he said: “Our line to safety is the radio that we wear on our shoulder.”
The team is equipped to provide first aid and non-emergency medical care; when necessary and appropriate, Cahoots will also provide transportation to services, Black added. “For those communities that have either directly or indirectly experienced violence and oppression by traditional public-safety institutions, when they see us coming, they realize that we’re not part of that same system,” he said.
The program’s total operating budget for this past fiscal year totaled $1.9 million, he added — “and that’s to serve a metro area of 250,000 people with a total of 24,000 calls last calendar year.” The Cahoots program costs on average $71 an hour, which covers equipment, operational expenses and salaries for a medic and a crisis worker, he said.
“You can do the math on how much it costs to have two officers show up, with everything else that comes along with that,” Black said, suggesting Cahoots is the cheaper option. Of those 24,000 calls, just 150 interactions (less than 1%) escalated to the point of Cahoots responders calling for police backup. The program is funded entirely by the city in Eugene, and by a combination of city funds and a state grant in Springfield, he said.
The Cahoots model has inspired similar efforts around the country, including a pilot program in Denver, Colo., and a program in Olympia, Wash. Cahoots is in conversation with Houston, Texas city council members, Black added, and is supporting development of the Portland Street Response in Portland, Ore.
Cahoots is just one model for how communities have changed how they respond to people experiencing mental-health crises. Other approaches include pairing police officers with mental-health professionals, and the widely used Crisis Intervention Team (CIT) model, whose 40-hour curriculum trains law-enforcement officers in responding to behavioral-health crises.
‘What we’re doing now isn’t working, and in fact it’s resulted in more deaths — so it’s time for us to try something new.’— Matt Kudish, the executive director of National Alliance on Mental Illness of New York City (NAMI-NYC)
‘The time is now’
Matt Kudish, the executive director of National Alliance on Mental Illness of New York City (NAMI-NYC), supports a non-police response for people in emotional distress. While NAMI isn’t against CIT training in general, Kudish argues that it hasn’t worked in New York City specifically, pointing to reports that more than a dozen individuals in mental-health crisis have been shot and killed by city police over the past three years.
“Reducing the NYPD’s budget is the right move for our city, and the time is now,” Kudish said. “Our stance for quite some time now has been to fund a non-police response, and I think that reducing the NYPD’s budget and reallocating these dollars into community-based services that address mental health and mental illness, that address health care in general, that address issues of homelessness, is an appropriate reallocation of funds.” (The NYPD did not return a MarketWatch request for comment.)
Kudish endorsed the Cahoots model or some variation of it, acknowledging that every city and its needs are different. Leaders would have to determine whether the Cahoots model in its current form would have a meaningful impact on a city like New York, which is very different from Eugene or Springfield, he said.
“What we’re doing now isn’t working, and in fact it’s resulted in more deaths — so it’s time for us to try something new,” he said. “If we can leverage these dollars from the NYPD’s budget to fund a pilot that’s proven in other areas — that could actually have a profound effect on the lives of those among us who are living with mental illness — it just feels like a no-brainer.”
The recent spotlight shone on Cahoots feels “surreal,” Black said. But it signals to him that the country is ready for a new conversation about public safety.
“Mental-health advocates like myself, we want to see a response that is appropriate for the situation at hand,” he said. “Part of the answer is a very close reevaluation of how public-safety dollars are being spent, whether law-enforcement agencies need the size of budgets that they have, and whether some of those dollars could be making a bigger impact by going towards services to respond to mental health, housing [and] addiction.”
The ungodly massacre of nine black worshippers at a church in Charleston, S.C., reignites the question: Is extreme racism a mental illness? The prime murder suspect, a young white man, allegedly hated black people and hoped to incite a race war. Media outlets categorized the alleged perpetrator as deranged, demented, and delusional. Nevertheless, mental health professionals are reluctant to classify racial terrorists as mentally ill.
The American Psychiatric Association contests extreme racism (as opposed to ordinary prejudice) as a mental health problem. The psychodynamics of extreme racism were all but ignored until the 1960s. After multiple racist killings in the civil rights era, a group of black psychiatrists sought to have extreme bigotry – not ordinary bigotry – defined as a mental disorder. The association’s officials rebuffed the recommendation, arguing that so many Americans are racist that even extreme racism is normative and better thought of as a social aberration than an indication of individual psychopathology.
Some felt that a mental illness diagnosis would serve as an excuse and absolve perpetrators of personal responsibility for their gruesome acts. Others believed a psychiatric diagnosis would open doors to an insanity defense plea that might lead to exoneration. However, such fears do not hinder diagnosing mental disorders in other capital murder defendants. Raising these extraneous issues evades the point.
Similar questions have arisen with regard to genocide. Whether individual Nazis exterminating Jews were insane or merely acting out the extremes of a pathologic society is an ongoing debate. Describing these killers as evil falls far short of a psychological evaluation. Reports document that Hitler suffered from diagnosable paranoia. Were his followers ill as well? There is a point at which the cultural norms with regard to racism clearly separate from extreme racism, a manifestation of serious individual psychopathology. Societal racism facilitates incorporating bigotry into a person’s racist psychotic and antisocial dysfunction. Many murderous paranoid schizophrenics have had racial targets at the core of their psychotic delusions. The criminal justice system (perhaps a step ahead of psychiatry) now refers to such violence as hate crimes – but that tells us little about the offender’s psychological state.
Not everyone professing a prejudiced belief about a particular group is mentally ill. On the contrary, most racism is learned behavior. Racism in a broad sense may be adaptive human behavior; homo sapiens are hard wired with a tendency to fear strangers and protect their own turf to foster their survival.
Racist attitudes that interfere with an individual’s ability to work with people from a particular group should not in itself be considered mental illness. However, if that person believes he has to kill black people, such ideation must be examined as an expression of a mental disorder. Acting out extermination fantasies is readily classifiable as a delusional and a psychotic disorder. To continue perceiving extreme racism as normative and not pathologic is to lend it legitimacy.
The psychiatric profession’s primary index for diagnosing psychiatric symptoms, the DSM-5, does not include racism, prejudice, or bigotry in its text or index. There is no support for including racism (affecting perpetrators or victims) under any diagnostic category. Unfortunately, too many psychiatrists believe that extreme racism cannot and should not be recognized as a potentially treatable symptom of mental dysfunction.
Anecdotally, I have known psychiatrists who treated patients who projected their own unacceptable behavior and fears onto ethnic minorities as scapegoats. Often, their strong racist feelings were tied to fixed belief systems impervious to reality checks, reflecting symptoms of mental dysfunction. These colleagues have told me that as their patients became more aware of their own problems, they grew less paranoid – and less prejudiced. Community and family members should know that they can seek professional help for individuals who exhibit violent racist thinking.
It’s time for mental health professionals to examine their resistance to accepting extreme racism as a symptom of serious mental illness. Such a focus in the future may prevent tragedies like the Charleston massacre.
Dr. Poussaint is professor of psychiatry at Harvard Medical School, Boston.
The COVID-19 pandemic has disrupted many aspects of our daily lives, but its impacts are especially acute for people living with disabilities. Emerging research on COVID-19 shows that the coronavirus pandemic has increased distress among high-risk groups. There are unique stressors and challenges that could worsen mental health for people with disabilities during the COVID-19 crisis. Behaviors such as physical distancing, as well as their social and economic impacts are also known to play a significant role in mental health consequences.
Research on past pandemics shows that disabled people find it harder to access critical medical supplies which can become even more challenging as resources become scarce. Some people with disabilities report higher levels of social isolation than their nondisabled counterparts (O’Sullivan & Bourgin, 2010). They may experience intensified feelings of loneliness in response to physical distancing measures which can lead to depression as well as other mental illnesses.
None of this is surprising and let me tell you why, people within this community already experience social isolation and feelings of loneliness just do to the mere fact that they are disabled so just imagine the stressors that are added to an already difficult situation. People with disabilities have always had more of a difficult time accessing the basic medical needs, now it even tougher because the supplies are so limited.
There is another piece to this puzzle that I have not seen or heard discussed, what about those group of people with cognitive -disabilities, that are accustomed to routines, it could be going the library at a certain time of the day or going to the mall a certain day of the week and now they can’t do that due to the COVID-19. Throughout this pandemic I have seen numerous news reports and articles about nursing homes and people becoming ill in these nursing homes due to COVID-19, but not once and have I heard any mention of group homes for people with disabilities, what do their numbers look like how are they dealing with this situation.
My real issue, communication, or lack thereof. Finding ways to get information has become increasingly difficult for people with disabilities due to the variables associated with being disabled. For example, disability is not just one category that is made up of various sub-categories. It is visually impaired and that blind (yes there is a difference). There is hearing impaired and the deaf (again, there a difference) and even. It is the responsibility of news sources to do their best to make the information as accessible as possible, to all this large subgroup of people, especially when information is changing quickly. As a visually and hearing-impaired person this something that I had to struggle with firsthand. Keeping all of us informed is key to the COVID-19 public health response, but the information is not always accessible to the disabled community, leaving us sidelined. That is not right nor is it fair, we deserve access to what going on just like everyone else especially if it directly impacts our health.
According to the Center for Disease Control (CDC), Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication, and behavioral challenges. There is often nothing about how people with ASD look that sets them apart from other people, but people with ASD may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. Some people with ASD need a lot of help in their daily lives; others need less. A diagnosis of ASD now includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. These conditions are now all called autism spectrum disorder.
The Importance of Autism Advocacy
Autism awareness and advocacy are important for so many reasons and needs to be a 365-day a year conversation, and not just during Autism awareness month every year during the month of April. The CDC estimates that roughly 1 in 54 children in the United States live with ASD, with boys being nearly five times more likely to be autistic than girls. Now more than ever there is a need to help fight for the betterment of those who live with and are affected by the dynamic of autism. Autism advocacy and awareness helps us strive to meet the overall needs of the autism community. This includes the need for the standardization of care, and the need for more job opportunities for those who live with autism.
As a community, it imperative that we advocate for autism and help those who live with autism learn how to advocate for themselves. One such person who is dedicated to helping those who live with autism learn how to advocate for themselves is autism activist Marcus Boyd. Marcus, who lives with autism, is a voice and advocate who enlightens, encourages, and gives hope, peace, and awareness to those living with or caring for someone living with autism.
When providing support Marcus uses an approach, where he assesses desired goals and builds mutual understanding and trust. He also helps those with autism and individuals that support them to achieve fulfillment and productivity. This is done by teaching the importance of self-advocacy, as well as by helping them understand what supports and accommodation they need. Marcus understands the struggles, pain, and emotional disconnect that you experience because you just want to be accepted. As an advocate, Marcus strives to use his voice and platform to make a difference in the lives of people impacted by autism. Marcus wants the autism community to know that they are not alone and they have someone that is standing in the gap for them.