The death of Alfred Olango, disability, and “failure to comply”

A black man, Alfred Olango, was killed by a police officer on Tuesday in El Cajon, CA. It’s the first major city to the east of San Diego, about 20-25 minutes by car from where I live.

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Site of shooting in downtown El Cajon, Sept 27 2016

Not much is known for sure, other than that the dead man was “acting erratic.” A woman identified as his sister said he had mental health issues. According to the NBC report, the police “did not release details on the specific threat he presented to officers.” There is also contention about whether the police confiscated cell phones of bystanders who may have had video of the incident. They likely did, given how often the police aim to suppress video that may run counter to police testimony. There’s also little reason to give police the benefit of the doubt. Look no further than the recent allegations of gun planting in Charlotte  and a much clearer case of planting in 2011 in St. Louis.

The killing of a mentally ill man echoes last year’s killing of Fridoon Nehad, which involved a long fight to release surveillance footage of the incident. The details I covered in December 2015 here. A big similarity in these cases is the difference between being erratic and being dangerous. Erratic behavior has many sources- in Olango’s case it looks like a seizure is the reason. A variety of disorders like bipolar disorder, schizoaffective disorder, schizophrenia, and some types of depression can also make individuals confused and incapable of responding to police demands- which are often given loudly, on top of one another, and with a very small time window for compliance. At my low point in 2012 when my mental health was worst, I could have easily been described as erratic. And I now realize that can put my life at risk, in a way never before considered.

Alfred Olango, from twitter.com/uaptsd
Alfred Olango, from twitter.com/uaptsd

Police protocol in these cases is infested with ableism. It assumes a perfectly compliant, quick, enthusiastic response to police orders. If someone fails on any of these counts, their life can be in danger. Sometimes the cops will just open fire before any real attempt at less-lethal options- Fridoon Nehad was shot by an officer who spent about 25 seconds from parking his car to killing him. But consider the case of Charles Kinsey, a black man shot for trying to help a young autistic man in his care, Arnaldo Rios. Kinsey served a perfectly compliant surrogate for someone who was unable to do so, and yet police did open fire on Rios, missing and hitting Kinsey instead. The resulting trauma for Rios has been awful, with him not getting proper therapy. But many people with mental or development disorders don’t survive their encounters with police. Robert Ethan Saylor, who had Down’s Syndrome, was tackled and asphyxiated over a dispute about a movie ticket. Again, defensive behavior or tics was interpreted as a threat. People who are deaf or hard of hearing routinely suffer from violence, since a basic assumption is that all people can hear instructions. And of course, many people don’t speak English, so being yelled at in the foreign language is just confusing and may lead to so-called ‘erratic’ actions. Police always filter civilian behavior through a lens of perfect ability. That is, those who are not fully able and somehow lesser and more likely to be targets of violence. The most vulnerable sections of the population are threatened by the institutions that in theory should protect and serve them.

These issues would be much less prevalent if American police really committed to deescalation, and had proper understanding of the symptoms and nature of mental illness. I was even part of a county program in 2014 that helped explain mental illness and stigma to schools, crisis lines, and yes, police departments. But it’s not working- street-level cops still can’t process disability at any level. The existence of the ADA, and the sense that people with mental and physical disabilities have rights has no place among the police.

Screencap of ABC 10 report: https://www.youtube.com/watch?v=zi5Xa_ja_7I

The true answer, to help make sure there is never another Alfred Olango, is community policing. Community members and organizations band together to help keep things safe, using their pre-existing trust to make bonds that the police will never be able to. And a community effort means more local knowledge, including those who live with mental or developmental disabilities. Communities also don’t want gun homicides and violence- they have the most vested interest in deescalation. Restorative justice can change mindsets in a way mass incarceration and the school-to-prison pipeline cannot.

Alfred Olango is not the first, not in this country or this county. But he is a reminder that police departments have the most sinister and deadly ableism one can imagine.

San Diego will participate in 022, the October 22nd National Day of Protest to Stop Police Brutality, Repression and the Criminalization of a Generation. Event details are on Facebook here. The national event website is here.

Mental illness as disability in college

So I was reading a 2012 report by the National Alliance on Mental Illness (NAMI) recently. Over 750 college students were surveyed, with NAMI attempting to determine views of mental illness among young adults, and the quality of campus services. The report is located here (PDF).

Most interesting to me is the data on disability accommodations (pages 12-13). While there is a lot of current data on students and mental health, they usually focus on counseling services. In that area, the rate of students getting help has sharply increased, though college-age adults remain the group least likely to seek help. This isn’t a terribly good survey in terms of research design, but any information is good.

A couple key insights emerge, which I’m fairly confident would hold in a more rigorous study.

  1. There is a substantial difference between how many people with mental health conditions who know about accommodations, and those that actually use them. About 20 points separate the two.
  2. Disability resource centers are orientated to physical disabilities, and aren’t designed with psychological conditions in mind.
  3. Among those that dropped out of college due to mental health issues, getting accomodations may have kept them in school.

The conceptualization of disability in the United States has created these conditions. This gap between physical and mental doesn’t emerge from modern disability law necessarily, where the definitions are broad and inclusive. Rather, society has yet to shift its perspective on mental illness. Some tendencies:

  1. People discount any claimed disability that is not clearly visible to outsiders. When I served on a county disability commission a couple years ago, a long impromptu discussion broke out during a meeting about people being harassed for parking in the special spaces because they didn’t “look like they needed it.”
  2. The stigma against mental illness and disability are different, and a sizable group of people accept their belonging in the former group but not the latter.
  3. The type of assistance given to people with psychological conditions, including more time on exams, exams in a quiet room, and longer deadlines, may seem unearned by those who qualify. Accomodations otherize. If you take your exams in a different room, or have different deadlines than your classmates, there may be resentment.
  4. Faculty treat psychological accomodations as less important than physical accomodations.

The disability office as an institution is caught in the crossfire. It can be a key part of students succeeding in college, but many people have no concept of mental illness as being connected.

 

 

Campus mental health (II)

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UC campuses received poor scores on the accessibility, diversity, and outreach of their mental health services

This is part two of a series on UC mental health and the campaign to reform it. A previous post outlining areas of concern is located here.

The UC Students Association (UCSA) has released their evaluation of campus mental health resources, part of a new reform campaign (#HowAreYou) which was adopted last August. Three areas were measured: accessibility of the system, diversity of current staff, and extent and quality of outreach.

Results: not good. UC students would be appalled if their own academic grades were this bad. Campuses scored best on outreach, which is the least important of the three criteria. The core issue is accessibility. Diversity among counselors is only meaningful if students can get appointments within a reasonable amount of time- and are allowed a sufficient number of sessions per term. Outreach is key- it destigmatizes mental illness, and plays a key role in the increasing number of college students looking for treatment in the last fifteen years. But effective outreach magnifies accessibility issues. The more students who seek Counseling and Psychological Services (CAPS) or an equivalent service, the more meaningful staff to student ratios become. It’s clear that the rise in demand for counseling and psychiatry is outpacing general student growth and funding allocations.

These issues aren’t new. A 2006 UC Office of the President report (PDF) outlined the same basic problems. Their findings summary stated:

The increased need by students for campus mental health services has resulted in an overtaxed delivery system at UC that falls significantly short of meeting the actual student demand and expectation for services

The cumulative toll of this shortfall in service capacity has had and continues to have a significant negative impact on all campus populations, including other students, faculty and staff; on the affected individual student’s academic performance; and on that student’s overall mental and physical well-being.

Further, it is the Committee’s considered view that this situation will not improve over time, and indeed given general societal trends can only further deteriorate, without aggressive intervention on the part of the institution. This intervention must include a systematic review of policy, enhanced communication mechanisms, and a renewed commitment to campus-wide collaboration along with an infusion of new resources commensurate with both the nature and magnitude of the challenge now facing the University.

As usual, the issue boils down to money. The reason is the corporate-like administrative structure that ties up over a billion dollars more than is needed to run the UC. A low-cost, high revenue structure will always underfund student services like counseling. This combines with the ‘progressive’ state government abdicating its duty to provide quality higher education. Thus we are told that any investment in students will raise tuition, because in 2016 there is increasingly little difference between private and public universities. Remember how K-12 is a right, but once you hit around 18 education becomes a paid-for privilege? Students and faculty are hostages of a mindset we see in corporations all the time, where investment in people makes the system uncompetitive.

With that out of the way, I’d like to talk about the disability services for students, in the context of mental health. There are several names for this office:
Office for Students with Disabilities at UC San Diego and UCLA;
Disabled Students’ Program at UC Berkeley and UC Santa Barbara;
Student Disability Center at UC Davis;
Student Special Services at UC Riverside;
Disability Resource Center at UC Santa Cruz;
Disability Services Center at UC Irvine; and the Disability Services Office at UC Merced.

When #HowAreYou was first presented in a public meeting at UCSD, I had issues with its depiction of a full coalition of groups and university services. I like the focus on collaboration- as improving mental health is not just about psychologists but peer mentors, wellness education, student groups, resource centers, etc. But mental illness as disability was never mentioned. Laws like 5150 involuntary commitment were mentioned, but the Americans with Disabilities Act (ADA) was conspicuous in its absence.

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Updated design of the International Symbol of Access

Under the ADA, the definition of disability (Section 12102) is broad and non-exhaustive. In public perception, the term “disability” has been strongly tied to physical disability. The International Symbol of Access is the image most closely tied to the concept of disability- part of an inherent bias towards conditions that others can perceive and verify. Part of stigma is how people may not perceive psychological issues as potentially chronic or severe.

So let’s turn the three branches of #HowAreYou– accessibility, diversity, and outreach. All of this is based on my own experience, the experience of many friends and people I come across, and hour-long meetings with a case worker who deals with the largest portion of students seeking help with psychological conditions, dedicated to talking about the mental health system.

Accessibility: There are many different accessibility issues inherent in psychological conditions being the basis of disability accommodations. Here are some that come to mind initially:

  • Especially in cases of mental health, there are few connections between disabilities office and other parts of the university. Professors rarely, if ever, talk about it or put information on their syllabi. It’s seldom a topic of conversation in student groups.
  • Documentation is difficult for someone with no prior experience.
  • The ratio of case workers to students leads to logjams early in each term as everyone is trying to get their accommodations set and given to professors.
  • Faculty may block accommodation requests, which the student must then solve by going back and forth between the office and faculty.

Diversity: The same issues exist here, as it does when talking about CAPS.

  • Case workers and staff must be equipped to deal with a very broad spectrum of disabilities (movement, deafness, blindness, learning disabilities, anxiety, depression, mood disorders, PTSD)
  • Students may lack confidence in a staff member without shared experience (for instance, a deaf person may feel their obstacles can’t be fully experienced, or a depressed student may feel their issues are being devalued because it’s not visible)
  • Students may come from cultural backgrounds that don’t talk about mental illness, and may stigmatize those who have problems. This is brought up frequently by Asian Pacific Islander (API) students, and is relevant with both CAPS and disability services.

Outreach: Stigma is a big factor here, but I’m very insistent here- the stigma of having mental health problems is very different from the stigma of having a disability. So campaigns launched by #HowAreYou will have limited effect if they are only talking about the direct stigma of mental illness.

  • The disabilities office, like CAPS, is given a very limited slice of time in orientation. With so much information in a day-long event, students are unlikely to follow up with the office if they had heard about it for the first time.
  • Faculty aren’t trained at all about disability accommodations. Thus they often treat accommodations as guidelines rather than legal rights. If faculty have to go out of their way to meet standards, they will often refuse to honor entitlements.
    • Many faculty are new to teaching, or from countries that do not have an equivalent to the ADA. So a large chunk of teachers every year will have no prior experience with the system.
  • Because mental health is usually placed in a therapy/treatment rather than disability context, anti-stigma campaigns rarely address that there are two stages of stigma of mental illness.
  • The disabilities office rarely has a robust outreach component. They will table at resource fairs and present at orientation, but there is rarely a push to get staff and student mentors in club meetings, classes, and hold events specifically about disability.
    • It should be said that everything here applies more to psychological disabilities than other types. Many people have no idea psychological conditions are legally disabilities.

So this concludes my second post about mental health in the context of the UCs and the #HowAreYou campaign by the UC Students Association. I welcome any information by those that have experience with disability services and mental health, especially outside UCSD.

My next post will be about the structure of how students give accommodations. An exchange with someone at a community college in Northern California shows that there are multiple ways to go through the process, and I think some are superior to others.

First thoughts: campus mental health

 

This post is to mark the beginning of  How Are You at UC San Diego, a student mental health overhaul instigated system-wide by the UC Student Association (UCSA). Mental health for students, from elementary school on through graduate education, is in crisis on a structural level. The toll of mental illness has always been underestimated, and thus few schools have services to match need. Nationwide studies find sharp increases in college students seeking counseling.

Dr. Victor Schwartz in the linked article outlines two potential reasons that campus services are being overwhelmed. Number one, that college students as a population are having more issues than before. Number two, more people with existing issues are seeking treatment, so it’s not the density of the problem but the response rate.

I’m firmly in the camp that thinks reason two is the key issue. In my previous post on student health, “The fantasy of perfection,” I wrote about the crisis that appears when mental illness is viewed as weakness. Society waking to the reality that mental health problems, both acute and chronic, are common features of the human experience is a huge development. So while the present is a challenge on a resource level, it is at the same time an incredible opportunity.

So I’m just going to list nine things that should be considered by the How Are You campaign at the UC schools, and campus mental health campaigns in general.

The introduction of mental health resources to new freshman and transfer students. Existing orientations tend to lump all resources together- first-generation college students, sexual assault counseling, centers for racial and ethnic groups, reporting discrimination, with psychological services and disability services mixed in among them.

Identification of students who may need help. In particular, the training that RAs, graduate assistants, professors, and student leaders have, and the criteria by which they intervene.

Outreach to special groups. This can be split into vulnerable populations at risk of dropping out, and those coming from a culture where mental illness is a taboo subject. This includes having diversity in personnel, as in America counseling often defaults to white women.

Handling of acute crises. Some students need to see someone more or less now. There needs to be slack in the system to deal with an irregular number of special cases.

Handling of chronic cases. Each new person with a chronic need aren’t filling up one slot, but several each term. This leads to:

Referral. At some point, a delay for someone with chronic need becomes excessive, and off-campus help is preferable. The system needs to provide a sufficient variety of options- not only diversity of practitioners but choice easily accessible by students without a car. This includes student health insurance being accepted at most practices, and referrals being timely.

Connections with disability accommodations. Under the Americans with Disabilities Act, people with chronic psychological conditions have special rights and can qualify for accommodations to make academics easier. However, the stigma of mental illness is distinct from the stigma of having a disability. Thus additional outreach must be made. The counseling office and disability office need to be well-connected.

Faculty education. In particular, making sure that accommodations students receive for a psychological issue are respected. Professors may resist making changes to their routine, such as letting students take a test at a different time. This needs to be restated as a civil rights issue.

and

Letting peers tell their own stories. Having experience with a speaker’s bureau, I can attest to the power of having people with mental health issues open up. Having the ability to educate is empowering. People dealing with mental illness should be able to self-liberate.

Onwards and upwards.

 

The fantasy of perfection: student suicide and the lies that cause it

There is a corridor of collective hysteria in this country. It is the stretch of land between the 101 and 280 freeways, starting in San Francisco and moving south, eventually ending when the latter turns into 680 and intersects with 101 due east of downtown San Jose.

For the billions of people who know nothing about northern California, I’ve marked the area for convenience.

A corridor in the San Francisco Peninsula that contains many high-pressure prep schools.
A corridor in the San Francisco Peninsula that contains many high-pressure prep schools.

This isn’t exact, but this post deals with places that are within two miles of either side.

The feature “Campus Suicide and the Pressure of Perfection” by Julie Scelfo in the New York Times is excellent. Halfway through, I was not at all surprised to learn that Kathryn DeWitt, the centerpiece of the story, is from this area.

Ms. DeWitt is younger than me, but we both lived through a different Gunn High School suicide cluster around the time we graduated. This is an excellent piece about the two clusters– which are very rare but happened twice at the same school within five years of each other. Student suicide is so commonplace that I’ve never had a conversation about California’s high speed rail project with someone my age without a detour into “will they build it so that kids won’t be able to jump in front of it?”

Student suicide is a classic social problem. It’s complex. There are a ton of institutions that may play a part. Norms are established about academic performance and image are difficult to change. If any part of the system is poisonous, it can undermine everything else. School, peers, parents, media, society, politics, money, sanity- all play a part in the problem, and all have to be addressed to create a real solution.

The prep school culture in the Bay Area isn’t unique. But it is unusually concentrated and reinforcing. It’s a high concentration of wealthy adults, often from immigrant backgrounds and low economic standing. Their kids are expected to make similar progress in their own lives. The high population means not one but many schools that mesh together to create a social scene where failure means weakness and worthlessness. Harker, Crystal Springs, Castilleja, Bellarmine, Pinewood, Woodside Priory, Sacred Heart. Then there’s all the larger Catholic schools; St. Francis, St. Ignatius, and so on. Then there’s the public schools like Aragon (where Ms. DeWitt went), Gunn, Palo Alto High. All the public schools have a substantial honors track that’s insular and indistinguishable from the private prep schools.

Anyone who’s not in the culture would find the whole apparatus absurd. It is, and you should.

William Deresiewicz, former Yale faculty and current polemicist against the narrowness of mind that selective schools of all levels create, points out that elite schools that fail their students when you look away from the resume-building:

Look beneath the façade of seamless well-adjustment, and what you often find are toxic levels of fear, anxiety, and depression, of emptiness and aimlessness and isolation. A large-scale survey of college freshmen recently found that self-reports of emotional well-being have fallen to their lowest level in the study’s 25-year history. (“Don’t Send Your Kid to the Ivy League“, The New Republic, July 2014)

Suicide clusters at elite high schools and universities should not be a surprise. These institutions have taken the regular level of stigma in society and piles on. Not only is mental illness stigmatized, as it is everywhere, but a million different forms of imperfection are as well. All the contributing factors to suicidal ideation are turned into overdrive. As all three of the stories I’ve linked to concur, students think they are isolated in their unhappiness. It’s a lie that’s allowed to persist. In Scelfo’s profile, it’s the college counselor who breaks through the illusion. People are messed up. There’s a culture supposedly based on intellect and critical thinking that frequently uses neither. And people are dying because of that.

Stopping stigma early

Mental illness as a topic is something society just has no idea how to handle. I’ve written about how mental illness is misused to score political points (usually by creating the illusion that a mental disorder is a prerequisite for horrendous crimes). Thankfully I stumbled across a compact guide, written by Margarita Tartakovsky, that tackles myths about mental illness and treatment. If you need to educate in a hurray, highly recommended.

The best section deals with the fact that children’s content is stigmatizing in a way that we don’t often consider. It’s not just murder-mystery hour-long dramas on CBS, the process of misrepresentation begins early:

Adult programs aren’t the only ones that portray mental illness negatively and inaccurately. “Children’s programs have a surprising amount of stigmatizing content,” Olson said. For instance, Gaston in Beauty and the Beast attempts to prove that Belle’s father is crazy and should be locked up, she said.

When Wahl and colleagues examined the content of children’s TV programs (Wahl, Hanrahan, Karl, Lasher & Swaye, 2007), they found that many used slang or disparaging language (e.g., “crazy,” “nuts,” “mad”). Characters with mental illness were typically depicted “as aggressive and threatening” and other characters feared, disrespected or avoided them. His earlier research also showed that children view mental illness as less desirable than other health conditions (Wahl, 2002).

What everyone loses in a suicide

Sulome Anderson’s feature last week, “How Patient Suicide Affects Psychiatrists” is a great inversion of a big social problem. Most features on suicide and mental illness (including the great The Cost of Not Caring series by USA Today) tend to focus on the individual who committed suicide and the impact on their family and community. Anderson did quality journalism to create this feature, which helps humanize doctors who naturally become the bad guys in some of these cases.

Personally, last year someone I knew tried to end their life- I had talked to them the a few hours prior to the attempt, having a short conversation about family relations that turned out to be much more important in hindsight (they wanted to know if I had special insight on why I have a good relationship with my parents, and they had the opposite. I wasn’t helpful, though I tried to be). When I visited this person the following day, they were still attempting to die in the confines of the hospital room. Never have I seen desperation more fully realized. It’s profoundly disturbing, and the feature gets across that this sentiment crosses all lines of profession or experience. You don’t become truly adjusted to suicidal people in your life, even if you chose psychiatry as a profession.

Personally, I thought that my history of mental illness would help deal with this experience. I’ve never been particularly suicidal, but my choice to be an activist and socialize within the community has put me into contact with many people who are open about their past with suicide. Turns out that was all (I suppose) wistful thinking. It’s horrible to witness, even in the context I had, where I had some time to mentally prep.

This feature helped develop a three-dimensional picture of the tragedy, which I wish was available with all social problems. Everyone loses someone in a suicide, and we each lose a part of ourselves when someone we know personally attempts or completes it. And yes, as Anderson comes to- sometimes there is nothing that can be done. Zero suicides is an ideal to strive towards, but no free society can ever attain it.

We are all humans with flaws and we are not omnipotent. There is only so much we can do for those we love. All we can do is our best.