One of the first funerals I attended that wasn’t a relative was that of an old school friend. Everyone adored Sally – she was so clever, funny, cool and charming. That she died by suicide absolutely floored me.
Of literally anyone I have ever met, Sally would have seemed the least likely to do so. I thought of Sally as I listened to Prince William on Radio 1 calling the taboos around mental health and suicide prevention “a national catastrophe” and again as I read the president of the Royal College of Psychiatrists (RCP) today warning that there is a “silent mental health pandemic” affecting people across England, because of stigma minimising funding, because people “can’t see” mental illness.
“People can’t see it, they think it’s not as important," said Dr Lade Smith, pointing out that mental health gets under 9 per cent of NHS funding despite comprising 20 per cent of Britain’s disease burden, and that health service money is more likely to be diverted to people waiting on trolleys in corridors because “the cog that squeaks gets the oil”.
I couldn’t “see” Sally’s illness, but that didn’t stop her from dying.
England, historically, is not a squeaky country. We pride ourselves on our stoicism, even at the same time as being nimby-ish. The old Monty Python joke of the Black Knight missing both arms and stating, “It’s just a flesh wound,” is underpinned by our relatives drawing a silent line around what they experienced in wartime.
Yet, staggeringly, less than a third of people who need mental health care can access it. For the longest time, it was because we didn’t know that we did need it. If reasonably wealthy, the “absent-minded” or “eccentric” man was held together by a team of secretaries and, most likely, a wife.
Shame has long been used to “treat” mental health problems in the UK. Shame has suppressed it, making people live horrified and secretive lives. What is now PTSD was known as “lack of moral fibre” in the RAF during the Second World War to shame psychological casualties into returning to active duties.
I hadn’t faced anything like that. I was just a little girl, clever and tall, and so moved up a year at school at seven. I was 10 when I first tried alcohol and developed the binge-eating disorder that wouldn’t be identified until I was 35. Twelve, when I developed the insomnia, depression and anxiety that I wouldn’t be treated for until I was 18 and outlining how to kill myself.
#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space. #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy
Click Here For More Information About James Donaldson
Click here to follow James Donaldson's Blog
Yet all this happened quite silently. I didn’t want to bother anyone. Indeed, I genuinely only didn’t kill myself because I didn’t want someone to have to find my body. I used alcohol and cigarettes as an escape, but otherwise I was trapped by my own, terrifying brain for decades.
All that while I worked, I studied and fulfilled my social responsibilities and filed my tax returns. Does that make me more or less deserving of relief? The cost of a “silent” mental health crisis must be paid. I paid it when I had physical health problems in my late thirties, which meant that all the invisible pain I had been carrying since I was a little girl was transferred onto the visible pain that was socially understood.
There is always a cost. Investing in those people – and yes, those children – who are suffering is not only a pragmatic way to address economic inactivity in the UK, but a kind way to help people to live rather than to simply endure. Suicide is the leading cause of death among men under 50 in the UK, and 75 per cent of all people who die by suicide are male. An average of 19 people died by suicide every day in 2023. Now, imagine the number of people living with that pain.
I do accept that the burden on the state is significant. I also believe the government cannot have its cake and eat it, too, regarding SEND (special educational needs and disabilities), welfare, and the economically inactive. According to the RCP, up to 80 per cent of mental illnesses are driven by poverty, debt, trauma and other social determinants. If the government wants more people to be in work, it requires children to receive a diagnosis and support from a young age, so that they don’t fall through the cracks into Neet (not in education, employment or training). It requires sensible thinking on hybrid, remote and part-time working (all of which your gentle author and her fellow columnists benefit from – as indeed do our MPs). And it probably requires a judicious muting of the landlord-sponsored blasts on how everyone who works from home is a laundry-addicted lazybones, and that work is only work if you tap into a building once a day. Some of the laziest people I’ve ever met have been gold stars of presenteeism, counting down until retirement.
Above all, it requires understanding. Everyone knows someone who has struggled – or worse – with invisible health issues. The silent pandemic of mental illness has only ever been silent to keep things looking nice and polite. When it becomes too much of an effort to stay silent, the reverberations are truly shocking.
If you are based in the USA, and you or someone you know needs mental health assistance right now, call or text 988, or visit 988lifeline.org to access online chat from the 988 Suicide and Crisis Lifeline. This is a free, confidential crisis hotline that is available to everyone 24 hours a day, seven days a week. If you are in another country, you can go to www.befrienders.org to find a helpline near you.
https://standingabovethecrowd.com/james-donaldson-on-mental-health-i-didnt-see-my-friends-suicide-coming-and-as-a-nation-were-blind-to-mental-health/
And how to discuss treatment options with cultural sensitivity
Photo by August de Richelieu on Pexels.comWriter: Faith Wilkins
Clinical Experts: Rhonda Boyd, PhD , Jonathan Shepherd, MD , Robert Harris
“Iam deeply concerned that mental health services will rely too heavily on medication rather than seeking the root cause.”
This sentiment — expressed by a participant in a recent study that explores the views and experiences of Black families and young adults seeking mental health care — reflects a common concern within the Black community.
The study, conducted by the Child Mind Institute in partnership with The Steve Fund, included a nationally representative survey of 1,000 Black parents seeking mental health care for their children and 500 young adults seeking care for themselves. When asked about their concerns around mental health care, about half of the respondents (both parents and young adults) agreed that “mental health professionals are too quick to prescribe medication for mental health issues.”
This sense of mistrust around medication treatment is also reflected in other studies. For instance, a 2021 review of data on African American caregivers deciding whether or not to give children with ADHD medication, caregivers were less likely to trust the efficacy of the medication and were more concerned about side effects and addiction than white caregivers.
“I work in an integrated mental health system, which includes psychiatry. So, concerns about medication come up a lot,” says Rhonda Boyd, PhD, a mental health advisor for The Steve Fund, psychologist, and associate director of the Children’s Hospital of Philadelphia’s (CHOP) Child and Adolescent Mood Program. “Black families in particular want to start with therapy first and see how it works before considering medication if therapy is not working.”
One source of medication reluctance, Dr. Boyd says, is concern about side effects — will it stunt their child’s growth? But it also may come from feeling pressure from schools. “Schools oftentimes refer kids for treatment if the kid’s behavior is disruptive, which could be for a number of reasons. And that’s where the pressure comes in — you have to do this, or we can’t treat your child in a regular classroom. They may not even be able to be in this school.”
But concerns about medication run deeper, in no small part because of the historical use of psychiatric medication to silence and control Black people in the United States.
Historically, the overmedication of Black patients in the mental health care system has been linked to their frequent misdiagnosis. The background of schizophrenia characterization and diagnosis is a clear example.
In the late 1950’s, as psychiatric hospital wards began to desegregate and the Civil Rights Movement gained momentum, the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II) was published. Schizophrenia previously had been separated into subtypes, including “paranoid schizophrenia,” which was characterized by delusions and/or frequent auditory hallucinations. But in the DSM-II, researchers redefined characteristics of that subtype as a “masculinized belligerence” in which patients displayed violent delusions, hostility, and aggression. Based on racial bias, researchers and clinicians began to associate this type of schizophrenia with Black patients — specifically Black men. Schizophrenia diagnoses among Black individuals drastically increased, and by 1969, the National Institute of Mental Health found that Black patients had “a 65% higher rate of schizophrenia” than white patients.
As more Black people were diagnosed with schizophrenia, psychiatrists started to conflate civil unrest with the disorder’s “violent delusions” characteristic. Two prominent New York psychiatrists coined the term, “protest psychosis,” arguing that Black Liberation rhetoric and art caused hallucinations and acts of violence among Black men. In response, clinicians argued Black patients should be given higher doses of tranquilizing antipsychotic medication to quell these violent tendencies. For Black patients, medication transitioned from treatment to a form of control.
While the language in theDSM has since changed, recent studies have shown that Black Americans are still 2.4 times more likely to be diagnosed with schizophrenia than their white counterparts. Additionally, researchers have found that Black patients are more likely to receive higher doses of long-acting antipsychotic drugs — indicating a persistent belief among providers that Black patients not only need more medication than typically necessary but are also less likely to take it as prescribed.
This idea that Black people are inherently more prone to violence and disruption continues to be perpetuated to this day. And in classrooms, Black children are much more likely to be viewed as disruptive or displaying behavioral challenges than their white counterparts.
“If Black and brown children display behavioral challenges like biting or hitting — things that you may see in the pre-K years or early childhood years where this type of behavior is developmentally appropriate — these children are seen as more aggressive, more forceful, and much more of a concern,” explains Robert Harris, an early childhood intervention supervisor for the D.C. Healthy Futures Program.
Worried about the disruption in learning, educators are quick to find a solution — and this most likely involves referring the child to a mental health professional. But according to Harris, “Even in the referral process and the description of the challenge, they tend to lean towards or hint at the use of medication to mitigate this issue that may exist. This is before parents have even spoken to a mental health professional.”
So, by the time parents are consulting a provider, they may already have their guard up, especially if that provider goes on to prescribe medication for their child’s mental health issues.
#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space. #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy
Click Here For More Information About James Donaldson
Click here to follow James Donaldson's Blog
Clinicians worry that in some cases, reluctance towards medication treatment runs the risk of impeding a child’s quality of life. “Negative perceptions about medication can delay treatment longer than you want,” says Dr. Boyd. “If someone has severe depression, for instance, what is recommended is both therapy and medication at the same time to get the kid out of that episode. I understand exactly why parents have concerns, but it can be frustrating.”
To find the best solution for the child’s mental health challenges, the first critical step is to create a comfortable and collaborative environment, according to Jonathan Shepherd, MD, a child, adolescent, and adult psychiatrist who is chief clinical officer at DC Department of Behavioral Health. “For those initial appointments, I do my best to develop a form of trust where they feel comfortable enough with me,” he says.
And to do so, Dr. Shepherd suggests the following:
When a school is pushing for a quick solution to a child’s disruptive behavior, such as medication treatment, parents may feel backed into a corner. Harris wants them to know that there’s still a choice. And if you feel uncomfortable with what you’re being told, you can say, “Yeah, when you said this, it really made me feel like I needed to go for medication.” This way, says Harris, educators might take a step back and re-evaluate how they approach the situation.
He also reiterates the importance of parents arming themselves with the knowledge of early signs to look for in their child, whether it’s a behavioral issue, mental health disorder, or learning challenge. “I think that’s why mental health consultation, particularly for infant and early childhood is paramount, because through education, we provide families as well as professionals with an understanding of what’s appropriate, what’s typical, what’s developmentally acceptable, and what you should expect.” For instance, it can be helpful for parents to know that there are several alternatives to medication treatment for disruptive behavior in a classroom, such as therapy, parent training, specialized programs, and a change in classroom structure.
And in a clinical setting, Dr. Shepherd says, if you’re feeling skeptical about what your provider has prescribed for your child, you can start by making it clear to them that you don’t feel like they’re hearing you. “You can say, ‘I’m not sure if we’re hearing one another. I’m not sure that we are on the same page regarding what I’m saying I see in my child or what I think is necessary for my child at this point in time.’”
And that’s when it’s important to pay attention to the provider’s reaction, says Dr. Shepherd. Are they receptive to what you have to say? Are they open to answering questions or engaging in a dialogue about different treatment options? “Someone who does not allow you to ask questions or glosses over your questions, that’s a physician that you should run from.”
When parents and providers are able to have the tools and language they need to enter these types of conversations, it can make finding the solution to a child’s mental health challenges much easier.
Photo by August de Richelieu on Pexels.com
https://standingabovethecrowd.com/james-donaldson-on-mental-health-why-are-black-parents-concerned-about-medication-treatment-3/
Why young Black males are less likely to seek professional support and how parents, faith leaders, and youth leaders can help them
Writer: Alexa Imani Spencer
Clinical Experts: Brandon Jones , Deborah Moon, PhD , Keith Pettus, PhD , Jonathan Shepherd, MD
“I’m only here because my grandma made me come here.”
When Brandon Jones was a public school counselor in Minneapolis, he heard those words regularly from a 12-year-old Black male student who wore a tough exterior amid a dysfunctional home life. But after three or four months of therapy sessions, Jones says, the young man stopped mentioning it.
“I remember I asked him, ‘Why are you still coming here? Because your grandma wants you to come here?’ He was like, ‘No, I come here because I like you,’” says Jones, who wears jeans and Jordan sneakers just like his young clients do.
Now the executive director of the Minnesota Association for Children’s Mental Health, Jones crossed paths with the student over a decade later. The former counselor sees how being “a voice of reason” and helping the student “see a future for himself” may have had a positive effect on him. A life that could have ended in incarceration or premature death transformed into one of service instead, as the student had become a basketball coach in the same school district where they’d met.
“I would just try to say, ‘Man, you have so much talent. You’re so smart. You don’t have to do these things,’” Jones recalls.
Despite having an overall positive attitude toward mental health care, many young Black males are resistant to professional care, according to the Mental Health Support for Black Families study conducted by the Child Mind Institute in partnership with The Steve Fund. The study — which surveyed 1,000 Black parents seeking mental health care for their children and 500 Black young adults seeking care for themselves — found that young male participants were less likely than their female counterparts to seek help from a mental health professional. Among survey participants, 44 percent of young Black males (compared to 31 percent of females) said they were more likely to turn to family members and friends for support, with 37 percent (compared to 24 percent of females) seeking out church leaders.
Results of the survey suggest that the hesitation of young Black males to seek professional mental health care could be due to stigma. While both parents and young people said they were concerned about stigma, young adults were more likely than parents to say that stigma prevented them from seeking care.
And lack of trust in mental health professionals may be a legacy that historians can trace back to slavery. In 1848, John Galt, the medical director of the Eastern Lunatic Asylum in Williamsburg, Virginia, said that “Blacks are immune to mental illness.” He also stated that enslaved Africans were “exempt” from mental illness because they didn’t own property, and that people who had the highest risk of psychiatric illness were those who were exposed to the “mental excitement” of a free life.
In spite of this false ideology, in 1868 the Freedmen’s Bureau negotiated with the Virginia legislature to open the Central Lunatic Asylum for Colored Insane — the first mental asylum for Black Americans. This was an important step towards acknowledging the mental health needs of Black people. But historians have noted that medical racism and implicit bias among clinicians contributed to high rates of admission and severe diagnoses.
In the late 1950s, when psychological hospitals began to desegregate and the Civil Rights Movement gained momentum in the United States, clinicians would use a schizophrenia diagnosis to categorize Black men as violent and unstable. They especially applied this label to those who spoke out against racial injustice. The rates of schizophrenia diagnoses remain disproportionately high among Black men to this day.
“Some studies have revealed that Black men see professional mental health-seeking as a sign of weakness,” says Annelle Primm, PhD, a licensed psychiatrist and senior medical director at The Steve Fund. “And with high rates of misdiagnosis of schizophrenia among Black males and involuntary inpatient hospitalization, help-seeking through informal sources may be seen by Black males as a safer alternative.”
Unfortunately, even after Black males overcome stigma and make it to a mental health professional’s office, more barriers exist. There, they may be met with continued bias.
“When a person sees a Black man who’s emotional, they see us as an angry being. They don’t see us as a person who may actually have a disorder,” says Jonathan Shepherd, MD, a psychiatrist and chief clinical officer at the D.C. Department of Behavioral Health.
A costly consequence of racial bias in a mental health setting is misdiagnosis, especially of mood disorders.
“You have to be with a skilled mental health professional who can tease out the difference between ADHD and a mood disorder, because some of the symptoms overlap,” Dr. Shepherd says. “A person who has depression has poor concentration.”
Research shows that Black kids are more likely to receive the wrong diagnosis when they show signs of a mood disorder. For example, a Black boy who is inattentive or fidgety in class may be diagnosed with ADHD or a conduct disorder, while his white classmate with the same symptoms may be diagnosed with depression.
“How you treat ADHD and how you treat depression are two totally different ways,” Dr. Shepherd says about the dangers of receiving improper treatment.
Additionally, reactions to trauma and adverse childhood experiences — such as living in a hostile neighborhood or having an incarcerated loved one — share the same symptoms of ADHD: agitation, restlessness, and volatility. Without the correct diagnosis, Black males don’t receive the proper care and risk remaining stuck in unhealthy cycles.
For this reason, it comes as no surprise to Dr. Shepherd that young Black males are leaning on loved ones, mentors, and church leaders for support.
“It makes perfect sense. Men need to have safe, confidential, and peaceful areas to express themselves.”
As a significant percentage of young Black males in the Mental Health Support for Black Families study said they were more likely to reach out to a church leader than a mental health professional for support, experts suggested that it would be beneficial to work with churches to encourage these young men to seek mental health care.
Pastoral counseling is an important part of the faith experience. In a study that included interviews from nearly 100 Black pastors, the respondents averaged more than six hours of counseling work per week, in which they often addressed serious problems similar to those seen by mental health professionals.
Keith Pettus, PhD, serves as lead pastor at Truth Center on Long Island, outside New York City. In the four decades that he’s worked as a minister, he’s counseled many Black boys and men navigating life’s issues.
“Pastoring gives you a front row seat to the darkest moments of people’s lives and the brightest ones,” Dr. Pettus reflects. “We are with people from the cradle to the grave.”
He agrees that one of the main reasons why Black males avoid mental health providers is due to a general distrust in medical professionals.
“The challenge with Black boys is they become Black young men, and they become Black adult men who don’t go to doctors,” says Dr. Pettus, who encouraged the men in his congregation to get check-ups after he survived prostate cancer last year.
Because therapists may be viewed as just “another doctor,” he believes it’s easier for his congregants to seek him out for support. Two of the main reasons why young Black males come to him is for low self-esteem and anxiety about the future.
As a former school counselor, Jones appreciates when faith leaders are involved in resolving the mental health needs of community members. He hopes to see more innovation and collaboration between the two groups in the future.
“It’d be amazing if there were therapists that were housed inside churches,” he suggests. “A lot of church buildings are not active after Sunday…. They could be mental health centers at this point. Or they could have therapists in there working.”
Historically, the church has functioned as a social service hub for Black Americans, providing information and resources that might otherwise be inaccessible. Church members also use it as an emotional outlet. With that in mind, researchers and organizations are utilizing the institutions to find new ways to address mental health needs.
In 2019, the University of Pittsburgh’s School of Social Work launched CHURCH (Congregations as Healers Uniting to Restore Community Health), a research initiative that seeks to develop evidence-based training to build more capacity for African American faith leaders to provide mental health support to their congregation members.
For the past four years Deborah Moon, PhD, a mental health therapist and assistant professor in the School of Social Work at the University of Pittsburgh and the CHURCH project team, has worked alongside local Black pastors to develop a training that would equip local Black pastors with the knowledge and skills in cognitive behavioral therapy (CBT), a form of talk therapy that helps people change negative thought patterns and behaviors.
“There’s lots of evidence that CBT works,” Dr. Moon says. “But then , we try to highlight that those same principles that are proven by science are already in the Bible.”
She and her team compiled a day-long workshop as the final curriculum. The program was separated into four sessions that covered the relevance of mental health topics in Black churches and the various levels of human cognition that are targeted in CBT. All sessions integrated core CBT principles and skills with spiritual teachings in Black churches. The workshop also included a music therapy element within the faith-based praise and worship. Their main goals were to change attitudes toward evidence-based mental health treatment, raise confidence in providing informal mental health support, and increase the knowledge of CBT concepts and skills among faith leaders in culturally sensitive ways through spiritual integration.
“We saw significant improvement in all of those areas in a recent pilot,” Dr. Moon says. The team is planning to conduct larger studies with a sufficient number of participants to more rigorously test the training effects. Like the participants of CHURCH, Jones recommends that all pastors who respond to mental health needs take up some form of CBT education. Dr. Pettus, the pastor at Truth Center, agrees but also sees the limits of what spiritual advisors can do. If he feels that a matter requires clinical services, he refers congregation members to therapists in the area.
“I’m not the last step. I have people above me that can take them even deeper.”
#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space. #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy
Click Here For More Information About James Donaldson
Click here to follow James Donaldson's Blog
Jones offers the following tips to parents and mentors who seek to support young Black males:
Parents:
Mentors/youth workers:
For pastors:
