Facing its stigma by embracing mental health
By Judy Ly
The aroma of butter and popcorn fills the air. People ranging from toddlers with their parents to a group of college kids line up to buy their movie tickets. A Rainier senior, who asked to remain anonymous, checks the ratings and trailers beforehand, seeking to assure herself that she can handle the movie in theaters.
“I’m constantly avoiding things too, to make sure I don’t have to end up in a depressive state or end up having panic attacks. I can’t go to the movies with my friends unless I have like trigger warnings set out for me, and I look at the ratings and the trailers so I know I can handle it at the theaters. I can’t see things that have possible suicide mentions or anything that can be in any way triggering to me, just in case I end up going down that path again,” she said. This is only one of the many examples of her generalized anxiety disorder and panic disorder affecting her daily life.
“That path” refers to her depression: “For my depression, I guess every day I’m just kind of trying to pick myself up because it’s kind of — you’re kind of in a constant state of like you don’t want to be alive and everything is exhausting and everything is just kind of like, ‘I wouldn’t have to do this if I were dead, you know. I wouldn’t have to deal with being paranoid if I was gone, you know, and if my friends hate me, I should probably just die so they don’t have to deal with me,’ and things like that.”
She added, “I feel like I can’t live a normal teenage life because I’m constantly like wrapped in bubble wrap to keep me safe, I guess, so that’s kind of how it affects me.”
On FAFSA Cash Night, Rainier seniors accompanied with their family members slowly trickle into a classroom as one of the teachers starts grilling burgers in the quad. Posters for the following spirit day are stretched out on the asphalt, and seniors line up at a table nearby to get some food.
For Rainier senior Angela Flores, that night was a big deal: she would be the first generation in her family to attend college.
However, the night turned sour when she was trying to fill out the FASFA form and started having a panic attack. During her panic attack, her dad didn’t understand why she was panicking and became impatient. FAFSA Night wasn’t the first time her dad had reacted negatively to her mental health.
After taking diagnostic quizzes, Flores concluded the scores she received were higher than average. She then went on online chats and talked to multiple therapists.
While online tools can be informative and helpful to be able to identify a cluster of symptoms, Rainier school counselor Tati Pham explained that using them for a diagnosis can be tricky: “Without somebody there or a professional there to help you sort of process, one, you can be misdiagnosing yourself or two, when you get your diagnosis, sometimes it can be very jarring, right. It can be shocking almost to see what the results are, and so without having somebody to kind of walk you through that or process that, you’re just kind of left with just the shock and not more of the optimism or hopefulness, or practicalities that would come — or practical advice rather, that would come from sitting with a professional and getting your diagnosis that way.”
In addition, Ms. Pham said, “It is kind of hard to discern whether a website is credible, or the information is credible, or if the information is up-to-date and so that’s why — that’s the other thing why sometimes I would not recommend a student to go that route to get their diagnoses or diagnosis. It’s because we don’t know if that site is credible and so, going on a site that isn’t very credible and then getting a result that you’re now kind of attached to, whether that’s intellectually or emotionally, is not — that’s why. I mean, it could be detrimental.”
One of the next steps Ms. Pham suggested was to reach out to someone with a “professional lens” in the case where there’s some level of severity in the cluster of symptoms. That can be someone such as a counselor, a therapist or even your primary care physician or pediatrician.
This includes online teletherapy too. She added, “That’s still interacting with a professional rather than just like an assessment … So I’m all for online therapy / teletherapy.”
When asked how to see if an online therapist is credible, Ms. Pham explained that there are databases that would contain information such as where they went to school and what their credentials are, which should be available: “You can ask the therapist also what their credentials are and make a decision that way.”
Regardless, Ms. Pham concluded, “If they are licensed or if they are an intern, it means they took at least some steps to get where they are, and, even if they credible, it doesn’t mean necessarily that you will develop a good therapeutic relationship. There’s still some trial and error in interacting with your clinician or establishing a relationship with them.”
Flores recalls having her first panic attacks when her grandpa passed when she was nine years old. Growing up in a Hispanic household, she says there’s an expectation of having to be independent and mature at a young age: “I was taught not to seek for help, taught not to cry, or taught to be the bigger person, or taught to solve my problems on my own, and that’s literally everything that anxiety prevents me from doing.”
Similar to the case with Flores and her father, oftentimes mental illness is disregarded rather quickly due to the taboo associated with it. Seham El-Diwany, a pediatrician and director of the teen health center at Kaiser Permanente, gave an example of how someone might not want to seek treatment from a psychiatrist out of fear of having the diagnosis on one’s charge.
Dr. El-Diwany added, “That’s really a myth, and the brain, the mind has its own entity, and the body has its own entity and they both interact with each other. So having a mental issue shouldn’t be a taboo or, having a mental health need should not be a taboo, it should be easy access to.”
The previously mentioned Rainier senior talked about how the stigma affects her own willingness to get help: “It’s bad and annoying just because this stigma has honestly made my symptoms worse. Even if no one’s ever personally like insulted me or said that they believe certain stereotypes, I still believe them myself. I was in the hospital, and I’m like, ‘I’m crazy now, you know like, ‘I’m in the looney bin’ like I mean like, ‘I’m just insane now’ and it was like, I was scared to let people know I was hospitalized because I was scared they were going to think I’m crazy.”
She continued, “I didn’t want to start meds even though I needed them because I was like, ‘No, ’cause now everyone’s going to think that I’m crazy, they’re going to think that I am like this person that just hallucinates like, ‘straitjackets,’ like all that. So yeah, it’s definitely affected my self-esteem in the past, and it’s made it harder to seek out help from people other than like my mom and my therapist.”
Dr. El-Diwany said a way to help destigmatize mental health is to have those services inside regular clinics. Integrating mental health services shows that “health, mind, and body are very integral parts” and therefore normalizes mental health.
“We can reach out to somebody within reach in our department rather than sending people out and that would be like a one-stop shop. People come, we identify the problem … at least they get their screening and know they need help from an expert in our clinic, and then, if further follow up is needed, that can be on a regular campus, not on a separate campus, or a separate clinic,” Dr. El-Diwany said. “That really destigmatized it and normalized it, and people see it as part of their regular care rather than something very separate.”
Ms. Pham said it’s sad to see there are some really underserved communities where those who need help don’t have access to services. “I think there’s this underlying belief that mental health is a personal or individual problem and not a societal one, and I think until we shift that, I think we’ll kind of stay stuck, you know, in the same ruts.”
She explained that the way to shift those perspectives is to become less fearful of mental health conditions and to destigmatize mental health: “One kind of like big misconceptions that I often see, is that whatever someone’s experiencing isn’t like quote-on-quote bad enough to get help. I see and hear that all the time. People seem to think there is some sort of a threshold that delineates when it’s time to get help and when, you know, and when it’s not. And usually their threshold of where they think the bar is is pretty high, when in fact they could be seeing somebody or receiving help.”
Ms. Pham added, “I think we need to look at it more globally instead of just only personal or individual level at this point, and so if we can just streamline and better utilize spending and also open up who is being served and how that is made accessible.”
According to statistics provided by the National Alliance of Mental Illness, “Approximately 1 in 5 youth aged 13–18 (21.4%) experiences a severe mental disorder at some point during their life. For children aged 8–15, the estimate is 13%.” In addition, they also reported, “Approximately 1 in 5 adults in the U.S.—43.8 million, or 18.5%—experiences mental illness in a given year.”
See below for more information from Dr. El-Diwany:
Effects of mental health on the brain
A group of Kaiser Permanente staff who work in Santa Clara County explained that mental health is largely controlled by connections and chemicals in the brain. The two psychologists and four predoctoral psychology residents interviewed asked to remain anonymous due to company policy. They explained neuroplasticity, which is the brain’s ability to rewire its neurons to form a new connection. Those pathways become stronger the more they’re used, and the pathways that don’t get used often become weaker. Someone who might experience trauma learns how to respond fearfully, and what treatment can do is to help someone learn how to respond differently through new habits and behavior. This would restructure the neuron connections in the brain.
Early intervention is really important to ensure the brain is not developing in a “maladaptive” way. One of the psychologists used an analogy of a foundation of a house. If the foundation of the house isn’t leveled and strong, you’ll continue to have problems as you keep growing; with a weaker foundation, problems will get bigger. Regardless, they added that it’s “never too late to get help.”
Facing cultural differences straight on
Mental health issues are treated differently in different cultural contexts, and that can affect the quality of treatment plans. Sydney Tai is a clinician at Asian American Recovery Services (AARS), a program that aims to serve Eastside San Jose.
Ms. Tai clarified that although initially AARS was started to serve the Asian/Pacific Islanders population, due to their specific cultural differences, they now have expanded outside of that population. “I have a lot of clients that aren’t even able to emotionally and effectively communicate with their own parents because of translation, you know, there’s just so much is lost in translation,” she said.
The unique aspect of AARS, in addition to the mental health and substance abuse
services they provide, is the multilingual and multicultural staff. Ms. Tai said, “A lot of the clinicians work with their specific ethnic groups. Like one of our clinicians is Filipina, and she works specifically with female Filipinas, right. That is a way to be able to relate to your clients that you don’t find in a lot of the other county agencies, so I think that’s really important.”
She gave an example of how even if the clinician is not from the same background and experiences as the client, with a diverse staff, there might be another clinician who is. This results in a wide variety of perspectives to draw from, instead of just a one-way solution, “There [are] so many different experiences that [for] you as a staff, it’s always more along the lines of, ‘Let me gather as many tools as I can because I don’t know what might work. Let me have a whole bunch of different things to be able to try.’”
Ms. Tai also shared how her job influences her personal life: “When I see one of my clients — when I see one of them sitting and dealing with a feeling. So, you know, like literally, if they’re sitting on this couch and crying, and I get to sit with them and kind of share that space with them, and if they’re kind of reliving a trauma, I get to experience their courage and strength. And I get to sit with them while they’re experiencing that and then when, you know, it’s over, see that it didn’t kill them and have them realize like it didn’t kill them to like feel those feelings again. And that’s definitely one of those things that I get to stay like in awe of the resiliency of the human spirit. I get to experience that. So as much as I try to leave like that situation at work, I definitely get to carry the feeling with me.”
See below for more information from Ms. Tai:
AARS reinforces the idea that personal connections with clients matter significantly. Here at Rainier, the Respect Lab attempts to build those important connections with the students, in a new and different way.
How Rainier is using Respect Lab to meet its unique needs
In kindergarten, Rainier student Kira Levermore-Rich was diagnosed with depression: “Yes, it was very early on when the doctors were able to tell I had some very severe mental health issues.” Now a high school senior, Levermore-Rich is participating in Rainier’s Respect Lab in addition to attending therapy in response to a diagnosis of depression, ADHD, anxiety and autism.
Levermore-Rich sees the school therapist, a personal therapist and participates in both family and group therapy.
Levermore-Rich explained that many people don’t understand what depression is: “A lot of people see it as like, ‘Oh you’re sad all the time.’ It’s not that; it’s more of like you struggle to get up in the morning because you don’t see the point because we’re all going to die anyway so why do I need to do anything to make a difference? Because in the long run there is no difference, essentially; it’s like cynicism, essentially, but dialed up to 11, I guess, at least in my experience.”
Levermore-Rich added, “Autism and ADHD technically aren’t mental health disorders, but they do factor into my personal experience of mental health issues of feeling like I’m not like other people, and how no one can understand kind of ‘blah blah blah’ and no one can understand me because my brain is like different than everybody else’s and that’s one of the large factors in that.”
When asked why they felt the Respect Labs are important on a personal level, Levermore-Rich said, “A lot of people don’t see mental health a lot, and a lot of people struggle with mental health, and not talking about it is a detriment to people with mental health issues and if we don’t talk about it, a lot of people will start — will feel alone like, ‘There’s no one else like this. There’s something inherently wrong with me ‘blah blah blah’ kind of thing. So that’s why it’s important to talk about these things, in my opinion.”
Respect Lab was designed to be an immersive environment of restorative and resiliency building in a school setting, where youth influencers directly work with the youth. While this is the first school year the Respect Lab has been fully implemented, this isn’t the first year the campus has heard of this curriculum. Lissa Thiele, a juvenile justice attorney, curriculum designer at the Respect Institute and teacher on Rainier’s campus, piloted the Lab as an Expeditions course, Rainier Respect Lab, in the school year of 2017-18. It now operates as an invite-only small group for those who are recommended by their mentors.
Ms. Thiele enthusiastically recalls the first day and the prompt given to students: “If you were going to write a book about you right this second, what would it be about? What might you title it?” She recognized how the students did not hesitate to dive deep.
Ms. Thiele added, “The Respect Lab provides like a-day-to-day practices versus like sort of this birds’ eye view of like, ‘Well eventually you’ll get here.’ So it’s like, ‘No, I need to know what I need to do today. How do I practice getting through today?’ And so the Respect Labs give an actual structure – a framework – to be able to just meet life on life’s terms.”
Summit Public Schools have been using the framework of the 16 Habits of Success to help students recognize and learn emotional and social skills. The three foundational habits are self-regulation, attachment and stress management for healthy development, which Ms. Thiele said are a “core” for school readiness.
“There [are] a few different reasons why Rainier has one,” Ms. Thiele said, “Mr. Avarca and Mr. Roe and the entire front office have recognized that we have a lot of students who are not — don’t have that healthy development level yet, and so they felt like ‘You know what? Like we say in our mission statement ‘every student,’ and so ‘every student’ includes a group of students who struggles with things like different mental health needs, or learning differences needs, or life coaching … So because this is through the mental health research part of this, and because Mr. Avarca and Mr. Roe allow for me to be able to take this here, they were the ones who made it possible for me to bring my Respect Lab through.”
Respect Labs came from the national nonprofit organization, the Respect Institute (Ri). In an interview with Courtney Macavinta, the CEO and co-founder of the organization, she said, “We develop tools and training to help youth build not only their self-respect but their capacity for creating change to make a world in which respect for all is the status quo.”
The institute came to be when Ms. Macavinta wrote a book about respect for teen girls. Through the promotion of the book, she was able to hear about readers’ stories about how disrespect impacted them. This sparked the expansion in her personal curiosity of, “How could we create a world where everyone respects themselves and each other?” and “What would that look like?”
On their website, they offer a toolkit called Respect 360 that Ms. Macavinta describes as a “program in a box,” and it revolves around their Respect Basics. Through working with sociologists and social justice experts once the institute was formed, they defined the difference between self-esteem and self-respect.
Ms. Macavinta explained, “Where disrespect starts to happen is when our rights and our personhood, you know, isn’t valued equally to others, you know. We shouldn’t be above or below anyone else, and so a lot of like adults, right, when we’re growing up, and we all — you know, everyone comes from different cultures. I come from like a very mixed culture, like my dad’s Mexican and Filipino, my mom’s Portuguese and white, we have a lot of different religions and different things going on. But one common thing that they both kind of believed growing up and then taught us was that, you know, like respect had to be earned.”
She added that based on the research conducted by the organization, that is not the correct application of respect. “Trust has to be earned, right. Trust is a thing that can go up and down in a relationship, you know, from one day to the next based on people’s behavior,” said Ms. Macavinta, “Respect means to look again at its root, like ‘re’ like rewind, and ‘spect’ like spectacles, like glasses, so it means to look again. So it’s really rooted in like nonjudgment, compassion, [and] equity.”
When asked what makes her so driven to have the Respect Lab, Ms. Thiele replied, “These kids, the alumni of Rainier, are the driving force behind me, and that’s my driving force behind then, all of their siblings and all of our community that comes through. It’s a family thing; this is a family affair. This is not just a – something that happens in a silo. These are people who want the best for each other, who are looking for trusted adults, who are looking to positively influence the, you know, California education system.”
How Rainier seeks to use the mentor system to meet student needs
Before entering high school, Rainier senior Kalista Brand had struggled with depression and anxiety throughout her middle school years when her aunt passed away a year before seventh grade. She shared that she held her aunt’s hand as she passed away.
Brand reminisced about the memories of her aunt, like being taught how to quilt and write cursive. “She was very much my rock in this world, and suddenly that rock was taken away from me and so I just sort of spiraled into this hopelessness of like, ‘I would never recover from this, I will never — I don’t even know why I’m here anymore, she’s not here, I have no one to lean on, what am I going to do with my life? How am I going to get over this?’ And it sort of just kept spiraling down and down until seventh grade when I attempted suicide, and my mom found me trying to slit my wrists, and then she took me to the doctor and she said, ‘Yes, you have depression [and] anxiety.’”
Despite not having a formal treatment plan because she’s still looking for the right counselor and still dealing with her dad’s disbelief in mental illness, Brand has developed coping strategies. Ranging from dancing to Disney music to learning, she said, “I’m very much a learner and a creative mind, I think, when it comes to helping stir myself away from relapses and anxiety and stuff like that.”
Another way she copes with her mental health illness is through the support of her mentor, Rainier history teacher Ricardo Quezada. “In regards of my depression, Quezada, again my biggest supporter, sort of sat me down and said, ‘Let’s just talk,’” said Brand. “It helped to know he was there and that both he and Ms. Hernandez, the teacher resident, was there for me — is there for me, and to make sure that I don’t drown in my mind, if that makes sense.”
While students have reported that the mentor system has been really helpful, they have also reported that there’s been inconsistency. The mentor system is where every student at a Summit school is assigned, in their freshman year, a mentor group and a mentor. Summit faculty, usually teachers, act as a guidance and emotional support system for mentees.
Flores mentioned that her previous mentor seemed to lack a depth of knowledge on mental health: “[In] freshman year, I had a different mentor, and I told them I have anxiety and she said, ‘About what,’ and that’s like one of the misconceptions about having anxiety is that people use the dictionary term of anxiety, like having test anxiety or having anxiety about meeting a new person. That’s anxiety people [have], like everyone has that anxiety doing something new, but when you have anxiety, the mental illness, it’s something that’s constant in your state of mind.”
Fortunately, in her sophomore year, Flores’s mentor group got a new mentor, Rainier English teacher Karren Windsor, and ever since she opened up to her mentor about her anxiety: “She was really supportive of it, and, yeah, I really appreciate her that she’s a patient person, and I really appreciate that she’s very patient with me because not a lot of people usually are with mental illness, so I really, really appreciate that.”
When asked what can our community be doing to better assist the youth who have fallen under an upbringing of disrespect, Ms. Macavinta concluded, “I think the biggest thing is sort of, you know, we’ve been talking a lot about youth, but the biggest thing is to focus actually on the adults and make sure the adults in these environments have training in around all of these topics we talked about — so the adverse childhood experience study, trauma, how to build protective factors in youth and then those adults also need to know to use the same tools, which is what we do in our Respect Labs, to nurture their own selves, heal themselves because a lot of the times they’ve been through the same or worse you know.”
Advice for supporting someone living with a mental health illness
Advice for someone experiencing symptoms or living with a mental health illness