Without a doubt, the mental health crisis in America is as big or bigger than any other crisis of health we are facing, among which are Diabetes, Heart Disease, Obesity and variety of Auto-Immune diseases. By their very nature, epidemics are hard to wrangle because of their scale, and they often rise to such proportions to highlight a blind spot in our health care delivery. So in a sense, we are always learning the hard way. In addition, mental health is further complicated by our relative lack of understanding of the brain compared to most of the body, and the strong social stigma associated with receiving support for psychological strain and stress.
I went to a mental health awareness fair yesterday in Harlem. It was a fascinating and educational experience to witness this neighborhood-oriented microcosm of NYC’s mental health landscape. Harlem faces many significant health challenges – medical and mental – but the later is extraordinary. Many efforts are now off the ground to help educated and manage the epidemics of obesity and diabetes, but mental health is largely unaddressed, and often poorly addressed. Adult psychiatric hospitalizations in Harlem far outweigh the average for other neighborhoods as well the numbers for Manhattan and NYC overall. This statistic alone clearly indicates a problem in need of attendance.
Roughly three types of attendees at this event represented different sides and perspectives of the mental health landscape, and the conversation between them portrayed a pattern of understanding and collaboration that could at best be described as jagged. It seems to me this poor flow of information, communication and effort is likely a major contributor to the overall issue of mental health. Likely, this is most apparent in neighborhoods like Harlem that experience high rates of trauma often with scarce familial or social support.
In the room this day, mental health consumers were almost exclusively represented by seniors. This was apparently the result of lopsided or inattentive efforts to promote the event. Community organizations with tables of information about their rather extensive programs lined the edges of the room. On the stage along one side, chairs were ready for a row of approximately six academic panelists and a moderator. Politicians and their staff might be described as a fourth element in the room. Inez Dickens hosted the event and made a brief appearance, and Gale Brewer was represented as well. The politicians had no designated location, but they were identifiable by their tight aesthetic presentation and upbeat personalities.
Consumers came in and briefly visited various tables. Since they were mostly elders, they got seated in the center area early on. The conversation with panelists got going, it shortly became clear that everyone in the room was on different sides of a proverbial fence and unable to find productive or useful exchange. There was not a clear focus or purpose to the conversation as being either clinically or consumer focused. That is to say it was neither a clincical conversation between the academics and the community organizations (many of whom had their program directors present). Nor was it a conversation geared toward the consumers. Some of the questions from the moderator implied an effort to create a consumer-oriented conversation, but that perspective did not carry through to the choice of panelists. Sadly, it did not seem expected to have a room full of seniors and there was not much conversation oriented toward serving their needs.
Here was an incredible opportunity for conversation around improving mental health for elders and it was missed. All parties necessary for a creative, dynamic and productive exchange were, miraculously, in the room and brought genuine concern for the issue and all it’s complexities. The community organizations care deeply about the populations they serve, and provide the best programs they can but the budgets are so tight, and the suffering population is large. The academics are on the right track. More and more they are wrapping their heads around the capacity for strong community ties, quality nutrition and exercise, structured stress management programs, and a sense of purpose to calm many agitated states. Yet, we are still a ways away from seeing these insights implements in a focused way. Policy makers see the problem and it should go without saying that no one wants to see another home grown mass shooter, but sadly, it's likely not far off. Consumers need a way to find the support they are so desperately looking for. Many people are emotionally and psychologically frayed, nearly to the snapping point. If they are lucky enough to have insurance, a powerful current trend is that many or most therapists no longer accept insurance. If the consumers don’t have insurance it’s because they can’t afford it, in which case they certainly can’t afford the retail prices on good therapy either. They are thoroughly abandoned and loosing their ability to take it in stride.
At risk of sounding pessimistic, I am confident in saying we are not yet at a turning point in mental health delivery. We need to stop raising awareness and create room for tighter, more focused and productive conversations. The Harlem event was beautiful in it's intention, but a purposeful event was possible - one that may have yielded fleshed out specific collaborations and early stage action steps for change.
Janine Guerrier did a lovely job organizing the event and bringing her passion and dedication to the issues we face in mental health. I left both inspired by the attendance of organizations and academics doing critical work in this field, and frustrated by the lack of representation for the power of natural health in this area.
Shout out to:
- Porsche Martin for not only advocating, but actively counseling the importance of nutrition and exercise in her clinical practice with children and families.
- Alexis Jamal for a lovely response to my question about a vision for better mental health care delivery in the face of crumbling insurance coverage. Yes – I also believe the answer is in building the community based responses we need, and not waiting for someone else to design them for us.