mental illness – Unspoken Politics

Police ignore own mental health policies in killing of Alfred Olango

The police have released cell phone and surveillance footage of the Alfred Olango shooting by El Cajon, CA police. It’s obviously disturbing, but CNN is hosting it here.

The video also has a very good picture of what Olango was holding- it looks pretty much like what I described in my last post.

Police say their job is very hard and dangerous. It’s not the most dangerous occupation, and these shootings continue to show the very low expectations society and the justice system have for police officers.

If I was telling you that we were going to help someone who’s having some mental health trouble, when we arrived you would be prepared for certain behavior. You might expect that this person may be agitated, not want to be approached, and would not respond well to escalation. You would know that this would not be a typical conversation.

In the death of Alfred Olango, the police were called on a 5150. That’s the same thing as me briefing you in the above scenario. It’s a mental health call. Quoting Christopher Rice-Wilson:

“The PERT Team [Psychiatric Emergency Response Teams] should have been the ones responding to this. The police were aware of his mental illness: this was a 5150 call and they should have dispatched officers trained to deal with this and de-escalate the situation. El Cajon police didn’t do this; they didn’t follow their own policy.” (SD Reader, 9/28, “Police killing of Alfred Olango protested”)

This is the issue with the argument that bodycams would have saved Alfred Olango’s life. El Cajon PD has policies about mental health. They didn’t follow them, barged right into a delicate situation, and an unarmed black man is now dead. If bodycams become policy, just like the PERT Team, why do people expect that they will be used as needed? Going back to low expectations, the police rarely are rebuked for not following their own protocol. Who’s going to force them?

Protestors in El Cajon have been met with force, including bean bag rounds (video of someone hit by one here). From my own vantage point, with privilege, I can’t fully appreciate how it is to be a person of color in America, let alone a protestor of color. But as someone with a mental illness, and with friends who have very serious conditions, the Alfred Olango shooting is proof that rights on paper and in reality can be radically different.

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.

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.
Disability resource centers are orientated to physical disabilities, and aren’t designed with psychological conditions in mind.
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:

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.”
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.
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.
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.

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 culture of ‘imminent threat’

In my current home of San Diego, a man named Fridoon Rawshan Nehad was shot this spring by a police officer. While there was a surveillance video of the shooting, its release was blocked by much of the political apparatus, most notably District Attorney Bonnie Dumanis.

The video is obviously graphic, and is available here. Officer Neal Browder arrives on scene around four minutes in, with him opening fire about 25 seconds later. In this screenshot Nehad is in the foreground, and the white flash is a gunshot.

Screen Shot 2015-12-23 at 12.15.29 AM

I won’t go into the details of the video itself, since it seems discussion of systemic state violence gets bogged down into a ‘was the victim threatening’ discussion for each case. What I will say is that Nehad did not have a knife (he actually had a pen), he was experiencing a mental health episode, he was not moving any faster than a casual walk, and though he was walking towards Browder he was not walking at Browder.

That this situation even happened is testament to how people fall through the cracks- Nehad suffered from serious mental illness and houselessness for many years prior to his death. Despite the prevalence of mood disorders and schizophrenia, most police departments have no understanding of how to deal with individuals who are unable to understand and comply with police demands.

District Attorney Dumanis and the police leadership are selling the same justification as usual- the idea that as the victim was an imminent threat, lethal force is justifiable. cjones11292014

This thinking ties the domestic to the international. Drone strikes, airstrikes, and the wholesale invasion of nations are all justified based on imminent threat ideology. With the militarization of the police, calculations about the use of lethal force by American institutions sound the same no matter where on Earth you happen to be.

But the thing is, the definition of an imminent threat can only be stretched so far. Nehad was erratic, but he was not in any sense threatening. Most of the body count from drone strikes had no connection to threats against the US or the West. The structures of power, at any level, want the maximum amount of autonomy and the minimum amount of accountability. Eliminating threats is only the stated purpose. Gaining power by setting precedent and pushing against any and all limitations is the key. With DA Dumanis (known for being corrupt) as an ally to prevent judicial oversight, the police rise above the law.

Many cases since Mike Brown throughout the United States were even more egregious than Nehad- they lacked even the foundation of a defense. But almost nobody goes to jail. Police security culture makes investigation and prosecution- even if the courts are willing, all but impossible.

The list of those killed by city and county police in San Diego is long. The answer to ‘who polices the police?’ is pretty simple- it’s you. Agitation at the grassroots level have made sweeping lethal police shootings under the rug far more difficult. Popular opinion since Ferguson has shifted radically. The idea that America is not a color-blind, egalitarian society is creeping into the mainstream. Police power grows best in the shadows, and the institution never expects dedicated resistance.

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.

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.

One missed paycheck from mental health crisis

A new piece in The Atlantic examines the relationship between mental health and long-term unemployment. As they point out, it is a chicken-and-egg problem- does long-term unemployment cause more mental health problems, or are long periods without work a symptoms of existing illness?

That’s a tough relationship to investigate, but it does relate to issue that people with mental illness can have- a much lower tolerance for stress and loss. Losing a job is hard for everyone, but it can trigger a serious episode for someone living day-to-day with schizophrenia or bipolar disorder. Even two years of constant stability have not created any kind of illusion. I am still walking on eggshells. A very stressful set of situations, a few days without access to medication, these things can be the difference between being in recovery and being in crisis.

This piece also brings up another component of mental illness- economic hardship impedes growth and recovery. It’s not just those that work losing their job. Millions living with a diagnosis are on disability or otherwise living on a fixed income. The squeeze is bringing plenty of people to the brink, but mental illness just adds a whole set of other complications.

Every stressor that exists has its own extra, sinister side. And in an America that’s in year eight of a recession with no broad recovery for the most vulnerable, the stressors are many, multiplying, and always just a few wrong turns away.

Involuntary commitment: it needs to be on the table

There is a great, blunt editorial by a man named Tom Zoellner published, “Reforms shouldn’t protect ‘Big Mental Health‘“. Though the issue is contentious in the mental health community and among those living with mental illness, Zoellner is absolutely right: involuntary commitment could save lives if it could be used more. This is both in more public situations (mass shooters with obvious symptoms and warning signs), and to save the lives of individuals who will otherwise kill themselves.

Charles Krauthammer is wrong about most things (he’s just a more intellectual-sounding Rush Limbaugh), but his experience as a psychiatrist and his work with mania is extensive and undeniable. Thus even in a column where most of his logic is shaky, like this work after Newtown, his point on mental illness is correct. Several social problems persist due to inadequate resources to treat those who suffer from psychosis, major depression, and mania. And if involuntary commitment was a possible option in more states and situations, some prominent shootings would likely not have happened. Jared Loughner and Seung-Hui Cho (the Virginia Tech shooter) had plenty of warning signs that teachers and friends recognized, but this didn’t filter up to the relevant authorities, and even then their hands can be tied by personal rights and privacy.

This is a balancing act, which is par for the course with mental health. People shouldn’t be locked away like in the days of the massive mental facilities, but they shouldn’t be left to rot when they reach the point where they can’t help themselves. People should be entitled to their privacy and autonomy, but there are times when an imminent threat exists, towards self-harm or harm of others. People should be treated with empathy, but should recognize that involuntary commitment can be an expression of that empathy. The heartless thing is to nothing when nothing is not the best option.

The opening point of the oped, that Republicans currently have a better understanding of what needs to be changed than Democrats do, is correct. Though given the Republican interest in reducing healthcare spending, that basic good idea shouldn’t mean they get the keys on overhauling the system. It points to a need to look at American mental health policy and figure out what works and what does not. Zoellner is right that services may have no track record of success. It’s true that services are redundant and mismanaged- I’ve volunteered at the county level and it’s a complete mess. Even experienced people are finding new groups and services year after year they didn’t know about. The uniting factor is that most of these places get government grants and subsidies; transparency about where this money goes and whether it is overlapping is key.

There are two ways to look at mental illness, where neither is full right nor wrong. One is that anyone with a diagnosis is incapable of living independently and needs to be locked up. The other is that someone with a diagnosis should be given full privacy and any suicidal or dangerous statements shouldn’t be communicated to relevant authorities. It’s key to see involuntary commitment as a tool that shouldn’t be used carelessly (like in the past), but it shouldn’t be ruled out entirely. There have been points where I was in a dangerous place, and the last thing I wanted was a culture of silence where nobody felt obligated to get me more direct help.

Crisis: sometimes you gotta hit a brick wall

As I’ve said before on this website, I am a member of Stamp Out Stigma. It’s a speakers’ bureau dedicated to putting a human face on mental illness, and countering negative stereotypes that stigmatize those who deal with their disease.

Today we spoke at a training for a crisis line. The work that these organizations do is incredible; even though I have bipolar disorder, dealing with the pain of others in my community can be overwhelming. Just because I can understand doesn’t mean I can handle other people’s desperation. I am glad there is something I can help them with, because I can’t do what they do. It would be a serious threat to my present stability.

What our conversation eventually led to is how those in crisis can feel trapped when looking for help. What is important to know is that overcoming the fear of stigma and seeking professional help is only the first step in treatment. There is the fear of powerful, sometimes dangerous medication. Therapy is now commonplace, but it can still be a point of alienation. And when you ‘come out’ to family or friends about what you go through, you have to educate each one – because what mental illness is and is not are just not taught or discussed about.

So when someone calls a crisis line, it may not come from a lack of resources. Yes, a person may not know where or how to get help, but they may also fear the help they get. Unmedicated you can end up in crisis, but also after months or years of trying treatment and finding it only partially effective.

A friend of mine was diagnosed as bipolar not that long ago. She was older than me, so she got the news 12 years later in life than I did. She, like me, feared the side-effects and power of the medication. Ultimately it took a crisis to remove that psychological barrier and embrace treatment.

In the end, it’s a series of difficult choices. Mental illness evolves, and people are at different points in the process of understanding, denial, anger, and acceptance. Crisis can be necessary for transition, but not everyone lives through a crisis. That’s why crisis lines and trained staff is so important. The way forward is blocked by a sense of desperation and isolation, both physical and psychological.

Mental illness is a maze, but sometimes you need to bust through some walls to get out. My crisis in 2012 led to me hitting a brick wall – a massive increase in antipsychotic dosage that slowed me down to a crawl. But with that collision the chaos stopped, and a new, better life could be put together from the pieces.

Sometimes you gotta hit a wall. And there need to be people to make sure you get out safe on the other side.