By NAMI-WC's ETS Team
Ending the Silence (ETS) is a NAMI National signature program that provides mental health education presentations to schools and community organizations to raise awareness, reduce stigma, and share strategies and resources for treatment and support.
What is mental health?
Well, if you have a brain, then you have mental health. That can be either good or bad. Having a good mental health doesn’t mean you are happy all the time, but it does mean that you can generally enjoy life and feel good and you have positive ways of dealing with emotions and stress. Just like in physical fitness, there are ways that we can work on our mental fitness. Some ways are to have proper nutrition and not hit the fast food line every time you eat out, get enough sleep at night, and get enough exercise. However, it is important to note that even if we have these good habits in place, we may still develop mental health conditions.
Like physical conditions, mental health conditions are also medical conditions. These conditions can change the way people think, feel, and act, and may create difficulties functioning in daily activities. And they are common and treatable. It’s important to understand that mental health conditions are not something to be ashamed of. This can happen to anyone. Despite the symptoms and the limitations that an individual may experience, through resources, support, and treatment, they may still be able to achieve their goals and improve their quality of life.
Some factors that may influence mental health include:
Family environment, life stressors, and society and culture. Research has shown that poorer family environment is associated with less support seeking and more mental distress, while strong family support could be a protective factor of mental health conditions. For instance, familismo, an emphasis on the value of family, which is common to Hispanic cultures, has been shown to be protective. Does your culture have a strong commitment to family? If so, has this value been helpful in nurturing your wellbeing and resilience to challenges such as loss? If not, can you imagine how an emphasis on family could be protective in times of stress and loss?
There’s no doubt that a supportive social environment contributes to a better mental wellbeing. As for life stressors, one of the life stressors that a majority of us can relate to right now is COVID stress. Some other life stressors can include traumatic events that happened when you were a child or when you are an adult. Society and culture, too, impact one’s mental wellbeing.
There are many other factors that contribute to mental health, including one’s genetics and the physical environment in which one lives. Our bodies constantly interact with our external environment to shape our mental health. In the past, a lot of psychological research are limited to the individual, but in the recent years, more and more research studies are examining external factors, such as pollution, that may influence our cognitive abilities and emotional health.
The bottom line is that mental health conditions result from a complex interaction of biological, psychological, and environmental factors. It’s not one reason but a combination of different factors that contribute to and maintain one’s mental wellbeing.
Here are some examples of mental health conditions that you have heard of. PTSD, ADHD, eating disorders, depression, anxiety, etc. Although psychologists put these conditions into categories, in reality, they run on a spectrum of severity and complexity (also known as ‘acuity’). The spectrum ranges from low-acuity conditions that are oftentimes not clinically diagnosable, such as stress, to high-acuity conditions that may cause disruptions in daily function, such as substance use disorder. You can read more about the spectrum of mental health here: https://www.evernorth.com/articles/meaning-of-behavioral-health
More information on these diagnoses can be found at NAMI.org and NIMH.gov
On this slide are some common warning signs you may see in those with mental health conditions.
Everyone gets sad, quiet, and withdrawn every now and then. We got into an argument with our partner, we had a rainy day at work– these events may trigger sad thoughts. But what we are talking about here is sadness for greater than 2 weeks and withdrawal away from family. Another warning sign may be feeling anxious, worried, fearful, which are often emotions accompanied by racing heart rate and physical discomfort such as fast breathing. Individuals with mental health conditions may have sleep problems. Those with anxiety may have a harder time falling asleep and those with depression may oversleep, although still feeling fatigued most of the time. They may exhibit weight or appetite changes – this is often the case with those who have eating disorders. They might use negative coping strategies, such as using alcohol/drugs excessively, to deal with their conditions. These are negative ways of dealing with life stressors.
When we examine how severe the conditions are, we usually look at the 3Ds – distress, deviance, dysfunction. Severe mental health conditions cause extreme distress, are associated with behaviors (e.g., self-harm) that are not the norm, and may impact one’s day-to-day functioning.
Many types of treatments exist for those who have mental health conditions. The more well-known ones include talk therapies and medication. However, in the recent year, alternative treatments have become increasingly popular. These can include pet therapy, art therapy, acupuncture, mindfulness-based programs, biofeedback, etc.
Generally, what works best for many people is a combination of different treatments, which can be a mix of group therapy, yoga, and medication. But the main point is: we all have to find the treatment regimen that works best for us. The earlier you seek treatment, the better.
So why should we care about mental health? Statistics tell us that in a community of just 100 people, 20 people have a mental illness, 4 live with a serious mental illness such as depression, bipolar disorder, schizophrenia, and only 8 people received any mental health services. The stats demonstrate that mental health is a public health concern.
Compassion in Action
https://www.hhs.gov/sites/default/files/compassion-in-action.pdf?language=es
There are significant disparities in access to mental health care. In Michigan specifically, 51% of Michigan residents with an acute mental health condition did not receive treatment and 22% reported that they could not get treatment at all. So why may this be the case?
So there are a myriad of reasons why people may not get the help that they need:
- No insurance or limited coverage
- Shortage of psychiatrists and overall mental heath workforce. The demand for mental health services exceeds the capacity to deliver. Long wait periods. (For example, at U-M Depression Center, the wait is 6 months.)
- Lack of available treatment types, e.g., inpatient treatment, individual therapy, intensive community services
- Disconnects between primary care systems and behavioral health systems.
- Lack of advocacy (advocate for themselves and others)
Another reason people don’t get help for mental illness is the stigma and shame that are prevalent in our society.
Stigma is the negative belief or idea about those who are different from us. For example, you may have you heard (maybe on a social media post) that all people who have mental illness become violent at some point in their lives. That is a myth that perpetuates the stigma, and that is absolutely untrue. The truth is, people with mental health conditions are more likely to be victims of violence.
And one powerful way we can reduce stigma is through language. How many of you have heard of person-first language versus identity-first language? Person-first language puts a person before a diagnosis, describing what a person “has” rather than asserting what a person “is.”
An example is saying person with autism rather than an autistic person.
However, some people may prefer identity-first, so the best to do is ask the person whether they prefer person-first or identity-first language.
The way we talk about mental health can impact the way our society views mental health. Through being mindful, we each can do our part to normalize the conversation around mental health and mental health conditions.
No matter how a person wants to be referred, the important thing is that we talk about it.
Grief is a normal response of sorrow, emotion, and confusion that comes from losing someone or something important to you. Grief may be a reaction to different life events, such as death of a loved one. However, grief isn’t merely a reaction to death. We grieve due to the end of a relationship (such as a divorce), job loss, move away from family and friends, or loss of good health due to an illness. Scientists have researched grief extensively and propose that we grieve for a reason, that is, to ensure group cohesiveness for survival purposes.
The length of time spent grieving and the way grief is expressed is different for each person. Reasons include personality, health, coping style, culture, family background, and life experiences.
Even though grief is a normal reaction to losing someone or something important to us, sometimes the grief may stem from a sudden and unexpected event that causes trauma. This type of grief is referred to as traumatic grief. In some people, this may lead to prolonged grief disorder, also called complicated grief.
When we are grieving, we exhibit different signs of grief. These may include physical signs, such as appetite change, fatigue. There may be an increased substance use. You may also notice emotional changes or changes to the mental state. You might feel more anxious, experiencing little joy, and low productivity at work. Some other signs may be relational and spiritual, such as not reaching out to friends and family and feeling empty. It’s important to note that some of these signs of grief may overlap with depression. However, when individuals experience grief, these signs tend to fluctuate, whereas with depression, these signs may be more enduring and long-lasting. Signs of grief are directly associated with losing a loved one or something important to us, whereas the cause of depression is not directly attributed to this loss. However, it is probable that grief can exacerbate existing signs of depression.
Read Lisa’s story here.
It’s important to talk about coping with grief, and we don’t want to frame grief as something that we can completely move on from. Nora McInerny once said that ‘we don’t move on from grief. We move forward with it’ and I completely with this – it’s hard to erase the memory of our loved one or the memory of what’s once really mattered to us – from our life. Like Vicki Harrison said, ‘grief is like the ocean. It comes on waves ebbing and flowing. Sometimes the water is calm, and sometimes it is overwhelming. All we can do is learn to swim.’
Oftentimes, grief doesn’t operate in a step-by-step process. You may have seen or heard of the ‘stages of grief’, which begins with denial, then anger, depression, bargaining, and eventual acceptance. For many, as evidenced by Lisa’s story, grief is non-linear, unpredictable, complex, and the journey through grief has many twists and turns.
Because grief is complex and can take a toll on our mental health and wellbeing, it’s important for us to take care of ourselves and be gentle to ourselves. There are different ways of doing so:
- Join peer support groups (e.g., NAMI support groups)
- Join support groups moderated by a trained grief counselor
- Reach out to family/friends and/or form new relationships
- Practice mindfulness and deep breathing/ write about your feelings
- Practice self care (e.g., eat, sleep, exercise) and keep structure in your day
- Seek professional help
It is a good idea to keep handy who you can call in your community.
If calling 911, be sure to make it clear that this is a mental health crisis and you need a crisis response team.
SAMHSA: Substance Abuse and Mental Health Services Administration, U.S. Department of Heath & Human Services
You don’t have to be in a severe crisis to contact these resources.
[…] Lisa’s story was part of an Ending the Silence presentation on grief, loss and trauma. You can find the full presentation here. […]