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CHAPTER 1
[Part I The Faces
Just as mental illness comes in various diagnoses, it shows up in different kinds of people, at different stages of their lives.
1. Start with Mother and Child
Let me say at the outset that mothers don't cause mental illness. That myth was dispelled long ago. But a mother can foster lifelong mental health. That's tough to do when she's depressed.
In the early months, no doubt Wanda was.
I didn't know it as post-partum depression. Was there such a term in 1965? But I can still see her sad face as I'd walk through the door in our Shirley Place apartment in Cincinnati's western hills. She might still be in her housecoat, strawberry blonde hair not combed. She seemed so frustrated, so inadequate with this baby who had no interest in taking naps during the day. The child seemed happy. The mother wasn't.
I tried to be sympathetic. But in truth, I didn't know how to help her.
Wanda, who died in 1997, was my first wife. We'd been married about three years when Robyn was born, in October, 1965. I had dropped my plan to be a minister and was doing student teaching in the morning and early afternoon, then typing freight bills at Mason-Dixon Truck Lines during the evenings. So the two of them, mother and child, were stuck together for much of the day.
It's pretty common for a new mother to get the blues. Most snap out of it within a few weeks. But for others, the blues turns into a major depression. Untreated the depression can last for years. It can become a lifetime of battling the disability, with only periodic remissions.
The story doesn't end there. Most of us can readily grasp this. The relationship between mother and child is critical to the child's mental health. It's the early bonding. It's the thousand ways a mother communicates to the child that he or she is wanted and loved without condition. Or, in tragic cases, she fails to communicate all that. Maybe the father's love rescues the child, maybe not.
The mother's mental health could be the most precious gift she can give to her child. If you see a baby who appears depressed, listless, it's not a great leap to assume that the mother has been depressed too. She hasn't been able to engage the child.
When the depressed child becomes a toddler, you're apt to find the child cries more easily than other children. That child is the one who develops sleep problems and might act out. In pre-school, that child's problems take on a social nature, disrupting a class and driving the teacher crazy.
As any clinician will tell you, mental health problems in a teenager can often be traced back to early childhood. Fortunately, professionals are beginning to find ways to connect young parents with resources. But reaching everyone who can use the help can be an uphill battle. New mothers may not admit they're depressed. Family members might not pick up on the mother's distress. Or the stigma associated with mental illness blocks out sympathy and understanding.
Outside the family, things aren't much more enlightened. Family doctors aren't well-trained in the pathologies of mental illness. They're especially likely to misdiagnose depression in racial and ethnic minority mothers. Other health care workers face the same limits of knowledge. Further, few persons who work in child care have more than the most cursory understanding of mental illness. As for high-school-age babysitters, I hate to guess. I imagine ignorance abounds.
I'd start with the pediatricians. I don't assume that they're as uninformed as the rest of us. But I'd conduct an inventory on how they deal with a new mother's depression. See if they include any material on post-partum depression in the packet they send the mother home with. Meantime, I'd approach the pediatricians. Find out whether they see any shortcomings in their training and get their proposals for addressing those gaps.
To raise awareness for professionals, we're talking about regular workshops on mental illness. The practices of family doctors and some specialists could be greatly enhanced by adding a psychiatric nurse, psychologist or social worker who is experienced in helping children who suffer a mental illness. As a rule, doctors know that many of the physical complaints people bring to them have an underlying mental health problem. Do most doctors know enough to diagnose a mental illness in the case of an infant or toddler? Do they know enough to treat such a child? These are issues any community's advocates in mental health can investigate.
Short of organizing conferences, advocates can invite doctors to put out reading materials on infant and childhood mental health. They can encourage doctors to run videos on mental health instead of the cable news shows on their TV monitors in the waiting rooms. What about after-school training in mental health for parents? What about offering tips on mental health on the back of menus the schools send home with the kids? And don't assume it's the first time mother who is most at risk. Often, the mother's depression doesn't develop until the third or fourth child. Ask beauty shops to subscribe to parenting magazines. Or barber shops. Be sure to include fathers.
Helping young parents cope pays dividends years into the future. I've interviewed a number of prison officials in charge of young men and women who've become a menace to others. It's as if these officials have memorized some required catechism: "We don't start to fix these people early enough."
Don't misunderstand. Again, I'm not saying that a child's mental health problems can be traced back to a mother's depression. (My daughter, a mother of two teenagers, is a successful teacher and parent.) But even if a child suffers no long-term ill-effects from the mother's depression, the stress on both isn't the best way to begin a lifelong relationship. That stress can only reinforce whatever mischief is in the child's genetic inheritance. Further, let's say the mother got lucky and completely skipped any episode of depression. That fact doesn't completely insulate a young child from a risk of early mental illness.
In recent years, national organizations and a few at the state level have cropped up to offer programs that address mental health in infants and children. Yale's Child Study Center has been a leader. Zero to Three in Washington, D.C., has coached people not to think of the issue in infants and young children as one of a serious mental illness. Most times, we're not even considering medications for treatment anyway. Instead, Zero to Three advises us to think of the issue as one of mental wellness. That's the whole point, isn't it? Nurture mental wellness in a new mother and she then can nurture it in her child. Mom isn't the culprit. She can be a child's best therapist.
2. Let Them Be Workers
This often is the crown jewel of recovery for persons with a mental illness.
Consider this simple fact. Those who work at least part-time seem do better with their illness than those who don't work. It can beat therapy. It can beat medications. It ranks right up there close to family love. Surveys have found that most people with the disability do want to work. Contrary to the stereotype, about half of these folk actually hold jobs.
I'm most familiar with the clubhouse model. We know it here in Fort Wayne under the name Carriage House. Like nearly 300 worldwide, our clubhouse is modeled after Fountain House in New York City. This is a highly successful pro-work program I'll describe in detail in Chapter 28.
Despite this and other job programs, persons with a mental illness are employed at only two-thirds of the rate of persons in the general population. That figure could be much better. Trouble is, most programs tend to direct people into low-status jobs: dishwashers, custodians, file clerks. Otherwise talented, often highly educated people not only find such jobs boring but also demeaning. Indeed, one thing we've known for years is that persons whose employment is a match for their schooling are more likely to stay on the job and to better manage their illness. Education is the best predictor of success in a job.
Hurdles to greater participation in employment remain. Since some mental disorders strike a person in his or her teens, they often get to middle-age without ever having held a job long enough to develop a work ethic. They don't understand the dos and don'ts. Even at that, a person can start a job, find it stressful and give up within a few days or a week. The person often assumes the illness tripped them up. That's not necessarily the case. Employers, family members and job coaches should encourage the person to stick it out, at least until the disabled person has learned the job. Fact is, you don't have to be mentally ill to find a new job stressful at first. A new job is likely to be stressful for anybody.
Under the Americans with Disabilities Act, a person with a mental illness doesn't have to disclose his or her medical history. Unfortunately, if that person is discriminated against in the workplace, he or she might not know to invoke the ADA, fearing retaliation.
I'd like to see it become routine for local NAMI chapters and other advocacy groups to man a booth at job fairs. It's a good way to offer sound advice to persons with the disability. It's also a good way to make connections with employers and enlighten them about the valuable work a person with the illness can do for them. Advocates, with the support of mental health services, can institute a job fair of their own.
Community leaders always want to see everyone who is capable of working in some kind of a decent job. If you're a NAMI member or an advocate on your own, you can challenge these leaders to survey employers to discover who welcomes those workers battling a mental illness. Meantime, the community mental health center and other agencies can survey those who use their services. Find out who has a job. Find out how long they've been in the job. Find out what schooling they need to get a better job. Join any "Hire the disabled" campaigns. Or let the advocates and agencies launch their own.
I appreciate that a small number of persons with mental illness are too disabled to work. Others will get caught in the trap of having a low, self-defeating opinion of themselves. The idea of a job may scare them to death. But there's a great alternative to a regular job. Persons with a mental disorder can be encouraged to volunteer. That can mean serving at a soup kitchen or tutoring kids in a pre-school. Volunteer work can be just as fulfilling and liberating as working for a paycheck. Volunteering can foster the old-fashioned work ethic and work habits. Volunteer work can be the key to recovery.
A job can be the salvation of most people with a mental illness. I've seen up close the good that having a job can do. It can provide a big boost to a person's self-respect so central to recovery. Having a job shows that the person belongs to the mainstream of society and isn't someone merely existing on the fringe. That person is making a contribution. There's something to be said for being able to hold your head high.
3. Save the Suicidal
After my wife Toni and I spent a night in the ER when my son had taken an overdose of a powerful antidepressant, I was always on the lookout for a way the community could reduce suicide. John's near-successful attempt provided a crash course in the subject.
It was then U.S. Surgeon General David Satcher who gave me the idea for a council.
I called Dr. Phil O'Shaugnessy the afternoon I read about Satcher's call to treat suicide as a pressing public health issue.
I proposed to Phil, an old friend, that he create a suicide prevention council. I didn't have to say much else before he told me to suggest people who should be included on the group.
Phil had served as our coroner or deputy corner for as long as I could remember. Because of that, I was pretty sure he'd been on the scene of more suicides than anyone in the history of Allen County. I couldn't imagine anyone more compassionate with the family, or more helpful.
That phone conversation marked the start of the Allen County Suicide Prevention Council. Sadly, cancer took Phil's life before he could see the fruition of his central role in its creation. We sponsored a major conference featuring 60 Minutes legend Mike Wallace. Under the leadership of Indiana University Purdue University's Vice Chancellor Kathy O'Connell, we've also put on a number of workshops and training programs. We've hooked up with a statewide suicide prevention network. We now enjoy something of a national reputation. I formally joined the council when I retired from the newspaper.
Our community's suicide rate consistently runs in the mid-range, 10 or 12 a year for every 100,000 citizens. That's the state average and close to the national average. A few states see as few as 6 suicide deaths per 100,000. Several western states can have as many as 22 deaths per 100,000. What's so alarming is that the total suicide rate, from state to state, stays about the same year to year, except that the rate among teenagers and young adults has been on the upswing since the 1990s.
It is interesting to make international comparisons. Russia has a rate three times that of the United States. China's is twice that of our country, as is Japan's suicide rate. But a few countries, such as Sweden and Iceland, which launched a national campaign to reduce suicides, have a much lower rate. In the Philippines and Greece, suicide appears to be extremely rare, although the World Health Organization concedes that some of its figures may not be reliable.
Even if the United States doesn't rank among the worst for suicide, the loss is still staggering. 30,000 or so deaths every year totes up to more than 300,000 deaths over a decade. That's a third more than homicides. As Dr. Satcher put it, this is a major public health issue, ranking right up there with some cancers, and AIDS back in its early years.
To give this a broader perspective, consider that researchers estimate that there are more than 650,000 suicide attempts every year. I assure you, even the attempt by a family member will rattle one's life to the foundations.
Our local council could be a model for any community. It includes doctors, a nurse from the board of health, folks from the hospitals and advocacy agencies, counselors, family members, a survivor of her doctor husband's suicide, an investigator from the coroner's office, an assistant sheriff, a chairperson from the university who also leads the institute for behavior studies and the CEO of the community mental health center. In other words, we've got a cross-section of the stakeholders.
This means that we can get the answers we need to craft any kind of response. How many suicides? Where do we target our efforts? So we begin thinking about who needs to be trained. Persons who work in the jails? In juvenile centers? Nurses and doctors who work in the ER? Family members of persons with a serious mental illness who are most at risk? Family doctors? What about teachers and other school personnel? My answer is yes to all these groups. But you can't just round up the usual suspects in need of education. You've got to get people from these groups interested.
I like the approach where you ask for the advice of somebody who represents the group. Even better: Enlist them to help you plan a training program. The council's main goal is to help people identify suicide risk, and to intervene. That is, we need to intervene in a way that actually prevents suicide.
A small group of community leaders, including the coroner and the head of a mental health advocacy agency, can get things started by looking at the community's resources for suicide prevention. To get you grounded in the issue, I haven't seen anything more comprehensive and practical than the National Strategy for Suicide Prevention, developed in 2000 during Dr. Satcher's tenure as surgeon general. That manual is full of resources. In addition, there are a number of suicide prevention groups that any community council should get acquainted with. There's the National Council on Suicide Prevention, the American Foundation for Suicide Prevention and the National Organization for People of Color Against Suicide.
It's not easy to show results from these efforts. Suicide occurs episodically. That is, you can go several years and not see a death in the population or demographic group you're following. We have 13 public high schools in our county and several private schools. Some years, none of our high schools will report a suicide. In other years, you'll have two or three suicides. So far, over the last decade, the activity of the suicide prevention council doesn't appear to have affected the numbers. Yet the rate has held steady during a period when the overall population has grown. It may well be that with the relative numbers being so small and the size of the population, less than 300,000, we simply don't have enough suicides to see clear-cut results.
(Continues…)
Excerpted from "Mental Illness and Your Town"
by .
Copyright © 2009 Larry Hayes.
Excerpted by permission of Loving Healing Press, Inc..
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