Get Well Wednesday: How To Get Your Mind Right

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WHY ARE AFRICAN-AMERICANS STILL LESS LIKELY TO SEEK PROFESSIONAL HELP?

The stigma of mental illness and mistrust of the health community are preventing many African-Americans from seeking the care they need. African-Americans have similar rates of mental illness as the general population, however they come into treatment later, receive less and poorer quality of care and often lack access to appropriate care.

Only 1 in 3 African-Americans who need mental health care receives it. Although barriers exist, we can overcome them. We must educate providers about mental health differences and disparities. We can do that by adding cultural competency and bias training to academic programs. We also have to address stigma so that anyone with mental illness is no longer hesitant to seek treatment.

IS MEDICINE OR HOSPITALIZATION THE ONLY SOLUTION?

There is no one-size-fits-all solution to mental illness. In some cases, “talk” therapy is the best option and in others, medication is needed. In other cases, a combination of the two is the best approach. The best treatment option is determined by a physician after consulting the patient.

IS THERE A PLAN TO REDUCE THE NUMBER OF PEOPLE WITH MENTAL ILLNESSES IN JAILS?

The American Psychiatric Association Foundation is one of the founding partners of the Stepping Up Initiative. This is a national movement to decriminalize mental illness and divert people with mental illness from the judicial system into treatment. Right now, our jails and prisons are the largest mental health treatment facilities in many counties, notably Los Angeles and Chicago.

That is unacceptable. We need to look at increased use of jail diversion programs and mental health courts as solutions to this problem. For more information, I encourage people to visit the Stepping Up site: 

DO YOU THINK INCREASING THE NUMBER OF BLACK PSYCHIATRISTS WOULD ENCOURAGE MORE BLACK PARENTS TO SEEK HELP?

Yes, we need more diversity among psychiatrists. I think more diversity and improved cultural sensitivity will help all physicians better relate to their patients. For instance, research has found that physician-patient communication differs for African-Americans and whites. One study found that physicians were 23% more verbally dominant with African-American patients than white patients. A more diverse physician population can help address that issue.

WHAT ARE SOME OF THE MENTAL ILLNESSES WITHIN OUR COMMUNITY THAT ARE OFTEN OVERLOOKED?

Depression, anxiety, bipolar disorder, ADHD, PTSD to name a few. The culture in the Black community often views these diseases as being due to weakness, lack of faith, lazy, etc. and many believe that people with symptoms of these illnesses can “snap out of it” or “go to church/pray about it”. These culturally-based beliefs contribute significantly to the stigma and discrimination that keeps people from seeking treatment.

WHEN SHOULD YOU START TALKING TO YOUR CHILDREN ABOUT MENTAL ILLNESS?

Parents should feel free to address mental illness with their children the same way they address physical illnesses. If a child is ready to discuss a physical issue, then they can discuss mental health as well. Use of age-appropriate language and examples is important to making sure that we don’t encourage stigma, shame and discrimination in our children.

“I DON’T WANT ANYONE IN MY BUSINESS” IS A COMMON EXCUSE WHEN DECIDING AGAINST PROFESSIONAL CARE – HOW CAN WE CHANGE THIS STIGMA?

Physicians are here to help, not to divulge your “personal business” with outsiders. People should view mental illness just like any other ailment, such as heart disease or diabetes. And the same laws that protect our general health information protect our mental health information also. And that should never keep someone that needs help from getting it. People need to know that treatment is available and it works.

WHEN MENTAL ILLNESS IS SEEN IN CELEBRITIES (LIKE MAIA CAMPBELL) WE TEND TO PAY ATTENTION – IS THERE ANY CELEBRITY INVOLVEMENT WITH THE APA?

The APA is more focused on the grassroots level, but we are open to working with like-minded celebrities. When celebrities like Terrie Williams and Brandon Marshall speak openly about their mental illness and treatment it helps get the message out to others in our community about the importance of getting help. We have had celebrities address our meetings in the past, but we don’t have an ongoing involvement at this time.

MENTAL ILLNESS IS NOT A COMMON CONVERSATION IN BLACK HOUSEHOLDS – HOW CAN WE CHANGE?

We have to call on our “trusted, credible community messengers” to work with us and go into the communities through churches, community groups and frontline doctors and raise awareness on stigma, signs of mental illness, and the connection between mental health and chronic diseases like heart disease and diabetes. I can’t say this enough, but treatment exists and it works.

HOW CAN WE COMMUNICATE WITH FRIENDS OR FAMILY THAT ARE DEPRESSED?

Start with educating yourself about depression signs and symptoms and types of treatments available. Our site has up-to-date information on many mental health topics: https://www.psychiatry.org/patients-families

When you talk with them, make sure they know you care about them and their health and well-being. Be sensitive and not judgmental. Don’t tell them what they should do, ask what you can do to help.

Offer to go with them to talk with a therapist, counselor, or pastor to get counseling and support them as they go through with the recommended treatment.

 DO YOU THINK MENTAL ILLNESS SHOULD BE DISCUSSED IN SCHOOLS?

Absolutely. And APA has a program developed just for that purpose – Typical or Troubled? It helps teachers, guidance counselors, coaches and others at the school to know and recognize possible signs of mental health problems. We must also educate families not to be afraid when they hear their child might be experiencing a mental health problem.

For example, there’s a long history of over diagnosis of ADHD in Black children and it’s stopped many in the community from believing there may be a treatable mental disorder in their child. No child should suffer needlessly due to our lack of education about what might be distressing them, including childhood PTSD as a result of exposure to violence in their homes or community.

Dr. Stewart answers your “Text Tom” questions below:

Doc. I’ve been in a 15 yr relationship with a Vietnam vet with PTSD. He suffers depression and behavior issues, mood swings and some verbal abuse. He changes like the wind. He receives VA counseling sporadically. Suggestions for me and him? I’m at wits end.

Hopefully you are also talking with someone about your feelings about the challenges in the relationship. Consider seeking support from groups like National Alliance on Mental Illness (NAMI) www.nami.org and Mental Health America (MHA) http://www.mentalhealthamerica.net/, which help families deal with these issues and empower you to see how you can help change the care the system provides for your loved ones and others. Both groups have programs directly related to veterans and their families.

I see a psychologist for sleep terrors. She gave me exercises before I go to bed. What should I do to get these things out of my sleep? The terror is a “sex incubus.’ That’s what I read about online. I only have this about 2 or 3 times a month.

I encourage you to continue working with your psychologist regarding this issue. They are in the best position to help you understand and deal with what you describe.

Dr. Stewart, I am a 47-year-old woman still suffering the effects of being molested by several family members starting at the age of 5 years old. Once it was discovered in my teens, nobody did anything about it ,including my father. I have really bad depression and anxiety and my family just ignores my cries. I think about dying every single day. Am I suffering a form of PTSD?

The symptoms you describe suggest you should talk with a mental health professional about these childhood experiences that are still impacting you. There are therapists that specialize in working in these areas so seek out one in your area to work with. There are also many support groups for people that have had similar experiences that you can attend.

I am 50 years old and I’m in great shape and pretty decent looking my mental health question or problem is I think I’m a narcissist. I have women from ages 30 to 47 coming at me and it’s hard to say no.

No mental health professional makes a diagnosis without fully evaluating an individual. If you are concerned that this behavior is impacting your ability to function at home, work or in relationships you should consult a local mental health professional.

I went through a tortuous time when my son was depressed and diagnosed as bipolar with schizophrenic tendencies. I reluctantly let them medicate him, not knowing what else to do. 24 years later still not sure if medicine helps or hurts. Where can we go for an assured diagnosis and treatment?

There are mental health professionals in most areas that will provide second opinions. Check with local groups like National Alliance on Mental Illness (NAMI) www.nami.org or Mental Health America (MHA) http://www.mentalhealthamerica.net/ for help with locating them. They also help families deal with concerns in these areas and empower you to see how you can help change the system providing care to your loved ones and others.

Are weed and alcohol the self-medication of the mentally ill?

Often the psychiatric medications have side effects or don’t work quickly enough and some patients will try other substances to get relief from their symptoms.

Dr. Stewart is an associate professor of psychiatry, chief of community and public psychiatry, and director of the Center for Health in Justice Involved Youth at the University of Tennessee Health Science Center in Memphis, TN. Dr. Stewart is currently the president-elect of the American Psychiatric Association (APA). When she becomes president in May 2018, she will be the first African-American to lead the APA, which was founded in 1844.

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