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I Am Who I Am Because of You

Sep 10, 2014, 9:00 AM, Posted by Faith Ikarede Atte

Faith Ikarede Atte, RN, MSN, is a Future of Nursing Scholar studying for her PhD at Villanova University, supported by Independence Blue Cross Foundation. The Future of Nursing program is a project of the Robert Wood Johnson Foundation.

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There are things in life so personal and private that when one vocalizes them, there is fear of being judged. It was eleven years ago that I had a personal encounter with myself. It is admittedly odd to look back at the path that I have walked on, now overgrown and distant—yet still so close to my heart.

Eleven years ago is when I lost a sense of who I was in the eyes of society, and I had to look within myself to find my footing. It is during this time that I had arrived from Kenya, full of vigor, light spirited and quick to laughter. I was hungry for knowledge and the sky was the limit.

Little did I know that life was about to teach me a lesson. It became obvious to me that my accent was different. Most immigrants can identify with the situation of being different. The more I spoke, be it in class or in a group of people, the more I felt isolated due to reactions like, “What did you say? Speak up.  Your accent is too thick. I don’t know what you are saying.”

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A Survivor’s Take on Depression: We are the Sad Ones Try to Understand Us

Aug 15, 2014, 11:22 AM

Depression Painting to go with blog post Painted in the hospital after suicide attempt

(This post was written by a member of the RWJF family who has asked to remain anonymous.)

Every day I worry that I will be caught. It could happen any time, any place, and by any one person that looks past my smile and into my eyes and knows immediately that I am not like him nor her. He or she will not see the color of my eyes, but rather that I am hiding something.

I have been in and out of therapy since the age of 9, and on and off antidepressants of every color and brand for more than 20 years. Yet I stand here today with the same diagnosis that I had when I was a child, despite the “help” and the “work” that I have devoted to my illness ever since I can remember. I have clinical depression.

I will never be “okay” by conventional standards without medication. I have finally come to realize that this is not my fault, but rather a product of my DNA. Nonetheless, I hide in shame. No one knows of my diagnosis, or the medicines that I take to help control it, or the acting that I perform daily to hide it.

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Preventing Suicide: If You See Something, Say Something

Aug 13, 2014, 9:16 AM, Posted by Brent Thompson

Dave and Brent Dave and Brent

The second week of August is one of the worst weeks of the year for me. At least it has been since 2008.

Six years ago this week, my friend Dave decided he had enough of the daily struggles of this world and took his own life on a trailhead in the desert near Tucson, Ariz.

He was 31 years old and left behind a fiancé, family, and scores of friends who loved him deeply.

Dave was one of the most incredible people I’ve ever known: a generous soul, full of humor, creativity, compassion, and love. He had more friends than anyone I know. Dave elevated everyone who knew him, inspiring them to find joy, open their minds, chase dreams, and see beauty in the world. It is impossible to count the lives Dave changed for the better, including my own.

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An Ounce of Prevention, Even for Serious Mental Illness

Aug 7, 2014, 1:30 AM, Posted by Jane Isaacs Lowe

An educator works with a student on a hard problem

As we work to build a Culture of Health for all Americans, it is time to end the stigmatizing distinctions between mental and physical health. After all, the brain and the body are in constant contact, and affect the well-being of each other in too many ways to count. A true Culture of Health recognizes the interdependence of mental and physical health, and places a premium on prevention and early detection of illness, regardless of type.

We commonly provide preemptive treatment or suggest early lifestyle changes for people at risk for diabetes before the condition evolves into full-blown disease. Yet, we typically don’t approach care for serious mental illness in the same way. It’s time for that to change.

The results from a recently released national study of the Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP), a project RWJF funded between 2006 and 2013, demonstrate that early intervention to prevent the onset or progression of psychosis in teenagers and young adults improves health and well-being. By helping family members, pediatricians, teachers, young people, and other community members identify young people experiencing early symptoms of serious mental health problems, EDIPPP was able to engage and treat these young people early. That early intervention in turn helped them stay in school, remain employed, and maintain vital connections to family and friends. These benefits mitigated the effects of mental illness, and allowed these teens and young adults to lead healthier and more productive lives.

This study should shift our thinking about how we best treat young people at high risk of serious mental illness. It should also remind us to look at good health and good health practices through a much broader lens, because building a Culture of Health means finding and sharing solutions, and celebrating signs of progress.

Read a Washington Post article on the program

Read a first-person post about depression and the best way to support those who are suffering with it

Read a post by Brent Thompson on bipolar disorder and the death of a friend

Loneliness: A Significant Stressor that Requires Intervention

Aug 4, 2014, 10:00 AM

Laurie A. Theeke, PhD, FNP-BC, is an alumna of the Robert Wood Johnson Foundation Nurse Faculty Scholars program and an associate professor of nursing at West Virginia University School of Nursing.

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The Burden of Stress in America, a new report commissioned by NPR, RWJF, and the Harvard School of Public Health, makes it clear that Americans are experiencing extremely stressful life events that are contributing to poor health outcomes. As a researcher who studies loneliness and how it contributes to poor health, I found the report somewhat alarming. Many of the life events identified by survey respondents are already associated with loneliness in the health and social science literature. Stressful events like new illness and disease, losing a spouse or loved one, or major life transitions can all lead to a personal experience of loneliness. This is very concerning because loneliness is a unique psychological stressor that can be hard to recognize or remedy without professional help.

Loneliness is a significant biopsychosocial stressor that contributes to multiple chronic conditions. We have known since the 1950s that there is an association between loneliness and cardiovascular problems like hypertension (Hawkey, Masi, Berry, & Cacioppo, 2006). More recent studies have identified loneliness as a major predictor of stroke as well.

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Facebook: Friend or Foe?

Jul 23, 2014, 10:30 AM, Posted by Linda Charmaraman

Linda Charmaraman is a research scientist at the Wellesley Centers for Women at Wellesley College and a former National Institute of Child Health and Human Development postdoctoral scholar. She is a Robert Wood Johnson Foundation (RWJF) New Connections grantee, examining the potential of social media networks to promote resiliency in vulnerable populations.

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If you were stressed out and wanted to vent to your friends about it, how would you let them know? Would you pick up the phone and talk, or text? Would you set up time to grab coffee or go for a brisk walk? Or would you post to Facebook why your day just couldn’t get any worse?

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As I logged into the recent RWJF/NPR/Harvard School of Public Health-sponsored Stress in America discussion, I identified with the panelists who were dispelling stereotypes about “highly stressed” individuals being high-level executives or those at the top of the ladder. Instead of finding work-related stress as a top concern, as is often played out in the media and popular culture, the researchers were finding that individuals with health concerns, people with disabilities, and low-income individuals were experiencing the highest levels of stress. The panelists talked about the importance of qualities like resiliency and the ability to turn multiple, competing stressors into productive challenges to overcome, and the integral role of communities in shaping, buffering, and/or exacerbating stress.

We often consider our communities as living, working, playing in close physical proximity. But what about the online spaces? What about our opt-in networked friendship circles ... our cyber-audience who sign up to read our posts with mundane observations, proud revelations, and the occasional embarrassing photos?

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Filling in the Cracks: The Fight for Mental Health

Jun 11, 2014, 3:11 PM, Posted by Beth Toner

In December 2009, I found myself in a narrow, cramped waiting room that looked, via one small window, into the locked psychiatric unit of a suburban Pennsylvania community hospital. On the other side was my oldest son, just a week shy of his 17th birthday. He was clad only in a thin hospital gown, perched in a wheelchair that was outfitted for restraints—although he wasn’t restrained. He looked tired, frightened, and overwhelmed. My husband, his stepfather, sat next to me as we waited for answers. Tears sprang to my eyes. Could my son—and our family—find our way back?

That moment was the culmination of six months of escalating anxiety and mood swings in my son’s life. He had always been, from a very young age, an intense child: bright, intensely focused, and articulate—which occasionally manifested itself in stubbornness and a reluctance to back down from an argument. But the fall of his junior year of high school had proved to be something very different. Suddenly, his occasional anxiety multiplied exponentially, completely out of proportion to the stressors in his life. Ten-point assignments in an advanced placement bio class turned into all-night crying and screaming sessions that ended with him sitting in a corner sobbing—and us all exhausted and at wit’s end. We tried therapy, with minimal effect. His school guidance counselor, not really understanding the depth of Wesley’s despair, encouraged him to “tough it out.”

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The Effect of Cultural Stereotypes on Mental and Public Health

Jun 4, 2014, 9:00 AM

Lorenzo Lorenzo-Luaces graduated from the University of Puerto Rico–Rio Piedras, where he studied cross-cultural differences in suicidality. He is currently a graduate student in the University of Pennsylvania clinical psychology PhD program. Lorenzo-Luaces is an alumnus of Project L/EARN, a project of the Robert Wood Johnson Foundation, the Institute for Health, Health Care Policy and Aging Research, and Rutgers University.

Lorenzo Lorenzo-Luaces

The population of groups referred to as “minority” is growing at a faster rate in this country than Caucasians, with estimates suggesting that by 2060, 57 percent of the U.S. population will be non-White. This demographic shift could create a public health concern if racial/ethnic minorities remain underrepresented in mental health research. At present, these populations are less likely to receive mental health care than Whites. When they do receive care, it is usually of lesser quality.

Stereotypes among racial/ethnic minority communities regarding mental health are complex. Research suggests that they tend to have more negative beliefs about mental illnesses than White communities; for example, they are more likely to believe that mental illnesses occur due to factors outside of the individual’s control (e.g., spiritual or environmental reasons). However, despite generally holding more negative views about mental illnesses, research shows that racial/ethnic minorities tend to have less punitive attitudes about the mentally ill. Moreover, they tend to be more accepting about mental health treatments, although they express a clear preference for psychological services over medications.

Differences in access to care, rather than attitudes, likely explain the racial/ethnic gap in service use. Besides the obvious discrepancies in socioeconomic status (SES) between Caucasians and racial/ethnic minorities, the latter’s preference for psychological services may be one barrier to access. This is because, even among the insured, psychological services are more expensive in the short term and harder to access than psychotropic medications. There also are questions as to whether psychological interventions tested largely on White populations are effective for minorities. 

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Communities of Color and Mental Health

May 21, 2014, 9:00 AM, Posted by David Fakunle

David Fakunle, BA, is a first-year doctoral student in the mental health department of The Johns Hopkins Bloomberg School of Public Health. He is an alumnus of Project L/EARN, a project of the Robert Wood Johnson Foundation and the Institute for Health, Health Care Policy and Aging Research at Rutgers University.

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It is always interesting to speak with my relatives when an egregious act of violence occurs, such as the shooting at Sandy Hook Elementary School back in December 2012. They are always so disheartened about the mindset of an individual who can perpetrate such a horrible act. When I mentioned that this particular perpetrator, Adam Lanza, suffered from considerable mental disorder including possible undiagnosed schizophrenia, the response was something to the effect of, “Okay, so he was crazy.”

That’s it. He was crazy. I love my family dearly, but it saddens me as to how misinformed some of my relatives are about mental health. Notice that I say “misinformed” as opposed to “ignorant” because to me, being ignorant means you are willingly disregarding the information provided to you. But that is the issue: communities of color, in many cases, are not well-informed, if informed at all, about mental health. That is what drives the negative stereotypes that are highly prevalent within communities of color.

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The Culture of Mental Health Stigma in Communities of Color

May 20, 2014, 9:00 AM, Posted by Ayorkor Gaba

Ayorkor Gaba, PsyD, is a clinical psychologist and project manager at the Center of Alcohol Studies, Rutgers University, as well as a clinical supervisor at the Rutgers Psychological Clinic. She has a private practice in Highland Park, New Jersey and is an American Psychological Association-appointed representative to the United Nations. She is an alumna of Project L/EARN, a project of the Robert Wood Johnson Foundation and the Institute for Health, Health Care Policy and Aging Research at Rutgers University.

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Mental illness affects one in five adults in America. A disproportionately high burden of disability from mental disorders exists in communities of color. Research has shown that this higher burden does not arise from a greater prevalence or severity of illnesses in these communities, but stems from individuals in these communities being less likely to receive diagnosis and treatment for their mental illnesses, having less access to and availability of mental health services, receiving less care, and experiencing poorer quality of care. Even after controlling for factors such as health insurance and socioeconomic status, ethnic minority groups still have a higher unmet mental health need than non-Hispanic Whites (Broman, 2012).  

There are a number of factors driving these statistics in our communities, including attitudes, lack of culturally and linguistically appropriate services, distrust, stigma, and more. In our society all racial groups report mental health stigma, but culturally bound stigma may have a differential impact on communities of color. Stigma has been described as a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses (President’s New Freedom Commission on Mental Health, 2003).  Stigma in the general public often leads to internalized stigma at the individual level.  Several studies have shown that internalized stigma is an important mechanism decreasing the willingness to seek mental health treatment.

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