Inherited Conditions and Mental health

Guest blog by Tyrone Beverly

Photo by Mark Greenwood

Why is talking about race, inequalities, mental health, and suicide so challenging? Because it has the tendency to invoke uncontrollable emotions, subjectivity, and is a reminder about the open wounds that have yet to heal. We all see the world through our own lens, and we must do a better job listening to the voice on the other side of our personal narrative. It's okay to disagree but listen with clarity, emotional intelligence and work toward necessary changes.

We can strengthen and develop our emotional intelligence through our daily routines, the way we respond to conflict, and by seeing things for what they truly are. We have been conditioned to respond to discord in an unfavorable way. The moment a person or a situation can manipulate our temperament, we are easily controlled by it. Emotional intelligence is simply self-mastery, and self-mastery begins with self-acceptance, exploration, and discovery. I've come to realize that the majority of our problems are social, and it plays an instrumental role in the psychological warfare going on in the minds of many. In conversation, be slow to anger even when you disagree, decrease negative thinking, breathe peacefully, and be aware of those who strive to control you by your emotions.

When we truly seek to understand, we must realize that the innocence of a child is interrupted by the climate of their generation. At times, they are victimized by their inherited culture. What was your upbringing like? How did people in your community feel about other races and how has that influenced you? How many people from different cultures have you genuinely invited in your home on a regular basis, or vice versa? Our home is our most sacred space and celebrating our differences by opening the door says a lot about how a person views the world and the people in the world.

Fortunately and unfortunately, the era a person is born into and to what a person is exposed has the propensity to shape their reality. In 1851, Samuel A Cartwright diagnosed runaway slaves with a mental illness called drapetomania, which was considered to cause many enslaved to flee from captivity. What can possibly make a slave flee.... Today, drapetomania is considered pseudoscience and a contributor to the structure of scientific racism. Before drapetomania was debunked, people in that era believed and wholeheartedly accepted this condition to be true. Sadly, that could be said about many studies today, missing the underlying root causes ofwhat's classified as aberrant behavior.

In 2016, here in Colorado and across the country, the narrative is black lives matter, make America great again, tougher gun laws, the homeless crisis, an urgent need for mental health services, and so much more. One thing I would like to hear more of is labeling theory, as it relates to the transmission of functional and dysfunctional social relationships, behavior, and stressors from multiple generations to be next. Labeling theory is ingrained in the communal construction of a designed reality and continues to show up in everything previously mentioned (BLM, MAGA, the homeless crisis, etc). Whether or not drapetomania was real, the ideology that created the belief system is. Once a person is labeled, (NOTE there is a difference between label and identity) one of the easiest things to do is build stereotypes, separation, and pit people against each other. There is not one white person that represents all white people, there is not one black person that represents all black people, there is not one Hispanic that represents all Hispanics, nor is there one police officer that represents all police. When people get to a place where they can judge a person by the content of their character and not by the label they were giving, we will have a better chance at humanity, but people's values tend to be influenced by systematic thinking.

We all have inherited the history of this country, but have we addressed it? After slavery, Jim Crow laws, ills of segregation, drugs being brought into the communities and many other historical wounds, there were no mental health services addressing trauma for those being oppressed. There is growing research that suggests many classified as African American and other minorities still suffer from a psychological trauma that has been linked to post-traumatic slave and poverty syndrome.

When you see a Black Lives Matter protest after a police shooting, what comes to mind?

Everybody has an opinion, but everybody does not seek understanding. Police officers were once called slave patrol and many people are unaware of the historical trauma and mental health implications that still has on people today. I would love to see better relationships with law enforcement in minority communities. It's time to take a more holistic approach and deal with the psychology. Everyone is under what I call inherited conditions, and until we work towards understanding those conditions, the cycle will continue.

The complexity is vast, and there is no one answer.

Graphic by The Associated Press-NORC Center for Public Affairs Research

The truth is, no matter a person's label, everyone needs mental support and better living circumstances. We all occupy the same planet and we need to deeply evaluate our thinking. Minorities don't seek mental health services for several reasons. Some are:

• Motivated to help themselves
• Shame or pride
• Don't believe the provider is qualified to deal with the needs of minorities
• No relationship
• Have been hurt by a broken system that doesn't seem to care about minorities
• Don't want to be mentally molested by poverty pimps
• Lack of resources
• Financial hardships
• Don't know how
• Don't think they need help

Ultimately, everybody wants the best for themselves, their family, and community.So we must learn about the unique needs a person has on an individual level because one size does not fit all.

The Centers for Disease Control and Prevention recently reported that the rate of suicide in the US is increasing. Could it be the lack of social acceptance, people growing hopeless, the unknown, or a growing mental illness pandemic? I'm going with them all, but highlight the lack of social acceptance. In the 12th century in Japan, Seppuku (a samurai ritual for suicide) was performed from a lack of shame and to give or restore honor. When a person has private pictures released on the internet, like the samurai, suicide seems to be the only way to escape the shame and restore honor. Outside of the mentally ill, the thought of failing at life and not living up to the expectations people have for you or themselves, seems to be the common denominator. We live in a country that does not accept failure, and I believe we must look at the social pressures and truly acknowledge them to be major contributing factors surrounding the growing misconceptions about mental health.

When doing this work, we must continue to strengthen and develop our emotional intelligence. We need more kind-hearted and compassionate people. Compassionate about life and compassionate about endless possibilities. More people supporting those in need and just spending time together. Sometimes the only prescription that's needed is knowing that someone cares.

Let's fall in love with life and improve the quality of our relationships. To everyone reading this, smile because you're beautiful and you are what the world has been waiting for. When you wake up, wake up seeing how you can make a difference and never lose site of the beauty within.

*****

Tyrone L. Beverly, founder and Executive Director of Im'Unique, has been leading this type of community programming for several years and recently formed the organization in 2012 based on its popularity and demand.  His extreme passion for equality, humans rights, diversity, unity, physical and social health has lead him to become one of Denver’s leading advocates in health and wellness. He is both nationally and internationally known for his work in the yoga sector and his influence in the community.

Tyrone seeks to increasingly reach the global community as was successfully accomplished through his health initiative at the Ragamuffin summer camp in Settlement Jamaica and Wudang China.  Mr. Beverly’s enthusiasm and energy has continued to supersede stereotypes and create avenues to permeate social and cultural barriers. The culmination of Beverly’s life work serves as a foundation that represents his vision of a future, with more problem solvers and solution based thinkers that deal with the challenges we all face as a society. Which he believes will create a  better life experience for all people.

Mental Health From the Inside Out: Harnessing the Lived Experience of the Trans Community.

Guest Blog By Greta Gustava Martela and Nina Chaubal

No discussion about mental health and the Transgender community can be complete without addressing and understanding the community’s distrust of health care providers. The Trans community generally struggles with healthcare providers who have very little, if any, formal training in working with Trans patients. However, the widespread distrust of healthcare providers goes back further than that. For many years, the standards of care put forth by the WPATH included the practice of gatekeeping - where mental health providers became the arbiters of who was “trans enough.” These practices forced Trans people seeking transition-related health care to be put through a year of living as their gender before being allowed to access hormone therapy. Whether or not one could access transition-related healthcare such hormones, surgeries relied heavily on how well they would conform to society’s norms. The mostly heterosexual male mental health field perpetuated society’s homophobia and misogyny. Trans women who were queer or did not meet the stringent beauty norms our society places on women were often denied the care. Trans people who did manage to get the health care they needed were forced by their mental health providers to go “stealth”-live a life where they never disclose their Trans status to anyone.

In some ways, this has changed, in other ways it has not. The WPATH no longer restricts healthcare to queer Trans people, it no longer requires Trans people to go through a year of transitioning without access to hormones and it no longer requires letters from multiple mental health providers to access transition-related surgery. However, many mental health providers haven’t gotten the memo. It’s very common for a trans person seeking mental health care to find a provider who has never interacted with a trans patient before who will ask patients to wait a year before having access to hormones or bring up a Gender Identity Disorder diagnosis from an older version of the DSM - which in 2012 was updated to use Gender Dysphoria instead to avoid describing trans people as disordered. Even when a Trans person is able to find a mental health provider who is cognizant of the issues around Trans healthcare, insurance companies are more than happy to enforce antiquated requirements.

Transition is the most effective treatment for people dealing with Gender Dysphoria. Historically, this didn’t come from the medical profession. It came from the lived experiences of Trans people not being able to get the help of medical providers and self-administering hormones. The community designed a treatment that worked for its members because the medical profession at the time didn’t seem to particularly care. A community that’s been taking care of its own for generations, values lived experience. This extends beyond transition related care to mental health and psychiatric care. It is disappointing to see health care and mental health care providers consistently devalue their Trans patients’ experiences. The theories of healthcare providers are taken more seriously than the lived experiences of Trans people where these healthcare providers have no training around Trans lives and show a lack of understanding of Trans lives.

A classic example of this lack of understanding is what the Trans community calls the “trans broken arm syndrome.” It comes from the idea that a Trans person seeking care for a broken arm will have some health care provider blame it on their Trans status. The broken arm, of course, is a placeholder for any ordinary ailment. “Go off your hormones” becomes the default advice given to Trans people who are sick. The authors are well versed with this effect from their own experiences. Greta recently checked into the ER unable to breathe after a particularly bad asthma attack. As she was in the middle of the breathing treatment, a doctor noticed her hormones on her list of medications and started asking for her surgical history. How is whether or not a patient has had surgery on their genitalia relevant to their breathing? Nina is currently recovering from pancreatitis as a result of high triglyceride levels. In spite of her explaining her family’s history with high triglycerides, two different doctors tried to pin it on her hormones with one suggesting she go off hormones in the event of another bout of pancreatitis. Sadly, experiences of this nature are far from uncommon among Trans people.

Trans people on hormone replacement therapy repeatedly report increased levels of mental wellness. There are many anecdotal accounts of improving mental health coinciding with the onset of hormone replacement therapy.  We hear stories from a lot of Trans people saying they had to pick between transitioning and ending their own life. Asking a Trans person on hormones to go off hormones is one of the most misguided and irresponsible things a provider could recommend.

Trans people experience high levels of economic injustice and often have a difficult time finding jobs. Trans people who transition in the workplace, often lose their jobs as a result of their Trans status. Trans people experience losing their families and housing as a result of being Trans. It’s not that surprising that Trans people are angry about the systemic discrimination and scapegoating society throws at the Trans community. Frequently this righteous anger becomes the basis for stigmatizing mental health diagnoses such as Borderline Personality Disorder. Trans people with this diagnosis often report it to be inaccurate and as a result of their Trans status.

These are some of the experiences Trans people have with the accessing health care both historically and to the present date. The communal mistrust of healthcare providers is largely a reaction to the way healthcare providers have been treating Trans people. A community under stress can’t trust a profession that contributes to its stress.

The lived experiences of Trans people are also instructive in the realm of suicide prevention. Trans Lifeline is a crisis hotline for Trans people by Trans people and prides itself in being unapologetically informed by Trans people’s lived experiences. Our earliest decisions about care were drawn from Greta’s experiences trying to access suicide prevention care. She found herself, during a crisis, explaining what it means to be Trans to the crisis worker she was connected to. Greta found the workers reaction to her Trans status further isolating and alienating.

Photo from Trans Lifeline website

Later, Trans Lifeline conducted a survey of over 800 Trans people asking about issues surrounding access to suicide prevention care. Our biggest finding was around the attitudes of our community around emergency personnel. We found that on average the majority of our surveyed population was uncomfortable interacting with emergency personnel. We compared Nurses, Doctors, Paramedics, Firefighters and Police on a 1-5 scale, 1 being extremely uncomfortable and 5 being extremely comfortable. Nurses, who scored the highest, came in at an average of 2.88, just shy of the neither comfortable nor uncomfortable mark. We found that of all those who told us they had never called a crisis line, 51% reported not calling a crisis line in spite of having been in crisis. We asked this group to tell us about their experiences and while some of them talked about phone anxiety, the overwhelming majority talked of being afraid of being forced to interact with the police and of being admitted to psychiatric facilities without their consent. These experiences have informed Trans Lifeline’s policies and we only enact active rescue with the consent of the caller.

More recently, we have put together a survey that our new operators take before a training class. While it’s too early for the data to be meaningful, we’re seeing about 90% our operators reporting lived experiences of suicide. We are also seeing a lot of our operators report feelings of not fitting in anywhere (Joiner’s Thwarted Belongingness) and experiences with familial rejection. According to Injustice at Every Turn, one of the largest surveys of Trans people, 41% of their surveyed population reported attempting suicide. It’s not unsurprising that most Trans people have lived experience of suicide. It’s perhaps a little telling that it’s these folks with lived experience of suicide who are most keen to take a stand and help prevent suicide in the community.

We are continually confronted with a lack of quantitative data regarding suicide and the Trans community. The Census Bureau and the CDC don’t keep data on trans people. The above 41% number - a striking contrast to the 4.6% lifetime suicide attempt risk in the general population - mostly exists in isolation. We don’t have numbers on suicidal ideation in the Trans community. We don’t have numbers on loss survivors in the community. In an effort to address this, on June 27, 2016, The National LGBTQ Taskforce and Trans Lifeline announced a collaborative Trans Mental Health Survey. We hope to find the experiences trans people have that make them afraid of mental health providers and psychiatric facilities. We aim to gauge the general level of trans competency among healthcare providers and to figure out how often Trans people are taken off their hormones or given diagnoses for no reason other than their Trans status. We hope to uncover the degree to which mental illnesses interfere with the lives of Trans people and finally have some decent data about the extent of the mental health crisis in our community.

*****

Greta Gustava Martela is the co-founder and Executive Director of Trans Lifeline. Ms. Martela has drawn on her own experience with suicidality to create a resource that is able to respond to the needs of the Trans community. Prior to Trans Lifeline, Ms. Martela worked as a software engineer.

Nina Chaubal is a former Google software engineer who co-founded Trans Lifeline with her wife and transition buddy, Greta Martela. She currently serves as Trans Lifeline's Director of Operations as Chief Executive Officer of her tech startup Cupcake Systems.

Recovery as Liberation

By Jess Stohlmann-Rainey

As a suicide attempt survivor working in the suicide prevention field, my work is deeply rooted in social justice. During my tenure in suicide prevention, I have found it unsettling how little emphasis is placed on centering the voices of people with lived experience with suicidal intensity. The paternalistic approach to the field may be creating significant gaps in our ability to adequately support people with suicidal intensity and prevent suicide. People who have wanted to die understand in more depth than anyone else why and how the decision to live happens. The sublimation of those voices in favor of the voices of academic expertise has interfered with the field’s ability to create culturally relevant and effective strategies to prevent suicide. 

The underlying assumption of a social justice approach to suicide prevention is that liberation and efficacy come from a process that places equal value on the most current data available (science), strategies that have been proven effective (solutions), and the lived experience of those who have been oppressed or marginalized (stories).

The central goal of social justice work is liberation. In the context of suicide attempt survivorship, I have positioned recovery as liberation from a cycle of oppression that systematically mistreats people who live with suicidal intensity. Using Yariela’s Cycles of Oppression model, people living with mental health conditions and suicidal intensity are in the target group. Through these interlocking cycles of oppression, the experiences of suicide attempt survivors and their reactions to those experiences are used as justification for further marginalization.

Yariela’s model provides a good framework for understanding why suicide ought to be approached as a social justice issue. Within this framework, people who experience suicidal intensity become trapped in a cycle of oppression that self-validates, causing isolation, trauma, and internalization of stigma. This cycle works in direct opposition to recovery, and is reinforced by medical model of mental “illness.” This framework also shows how the dominant group participates in and benefits from the systematic mistreatment of people with suicidal intensity. The vast majority of the institutions that have been created for the purpose of supporting people with suicidal intensity actually alienate and isolate them, participating in their oppression and keeping them “sick.” Some of the best evidence for this is the astronomical suicide death rates of people leaving hospitalization. We have a system that tells people, “You are a danger to yourself,” then systematically increases their risk of death. This system is supported by legislation, law enforcement, mental health providers, schools, and many other institutions.

If this cycle is the means by which people are oppressed, recovery and liberation become synonymous. It is unusual for discussions about recovery to include activist language, but if these two are synonymous, perhaps people experiencing suicide ideation would benefit from understanding recovery in this way. The model below illustrates how recovery moves individuals experiencing suicide ideation out of a cycle of socialization that reinforces and perpetuates their suicidal thoughts.

The cycle of socialization starts at birth, is reinforced by families and institutions, and a primary contributing factor in our behavior. In the United States, we have been socialized to believe that people who experience suicide ideation are attention seeking, dangerous, and unpredictable. The cultural script we receive is that these people are weak, sick, and flawed. Rather than seeing suicidal intensity as symptomatic of deeply intense psychological pain, we treat suicide risk as a permanent and immutable characteristic. The message that is sent is that people having this experience are afflicted by suicidality, and it (and the individual) needs to be managed by any means necessary – forced treatment, incarceration, and even just allowing people to die.

To step outside of this socialization and into recovery is a radical act of liberation, and like all acts of liberation, can be dangerous and difficult. To push back against these cycles and say, “I deserve help and hope,” requires that we recognize how we have gotten to this place of helplessness and hopelessness. Entering into recovery disrupts and challenges the systems that have kept us shackled to our pain.  I can remember the moment I felt free, and it was powerful. Positioning recovery as liberation puts the people experiencing suicidal thoughts in the center of the discussion, asking them what it might mean to be free from their pain, and supporting them in their journey toward hope.

CDC Report on Occupation and Suicide: Carson J Spencer Foundation’s Response

Making Suicide Prevention a Health and Safety Priority at Work

Photo by Patrick Lenz

Denver, Colorado. July 6, 2016. When the CDC released its report on occupation and suicide last week, many employers took notice. For the first time, researchers were able to rank industries by highest rank and largest numbers of deaths by suicide across 17 states. This milestone report immediately got the attention of industry leaders concerned about the health and safety of their employees. The Carson J Spencer Foundation, the nation’s leader in suicide prevention in the workplace, fielded scores of inquiries over the holiday weekend as companies requested information on how to build a zero suicide safety culture in their workplaces and associations. For more information www.WorkingMinds.org.

Two issues tend to make industries more at risk – the demographics of the workforce and the nature of the work itself. Workforces that are male dominated tend to have higher rates for suicide because men die by suicide at nearly four times the rate of women and represent 77.9% of all suicides (CDC, 2015). Additionally industries that have the following qualities also tend to have higher risk for suicide:

• Access to lethal means (e.g., firearms, pills, high places)
• Ethos of fearlessness, recklessness and/or stoicism
• Exposed to trauma
• Culture of substance abuse
• Fragmented community or isolation
• Humiliation or shame
• Sense purposelessness
• Entrapment (feeling trapped in a distressing work situation)

“This report is a game changer,” said Dr. Sally Spencer-Thomas, CEO of the Carson J Spencer Foundation, a Denver-based organization known for leading innovation in suicide prevention and the umbrella program for the nation’s leading workplace suicide prevention program called Working Minds™. “For a decade, we’ve been helping workplaces build comprehensive and sustained suicide prevention strategies. This report now gives employers the data to help justify these efforts.”

Photo by Brandon Kish

The timing of the report release coincided with the conclusion of the Construction Financial Management Association annual conference in San Antonio where suicide prevention was a central focal point. Over the past nine months many new construction industry suicide prevention resources and publications emerged as the construction leaders started to acknowledge a growing concern. More information here: www.ConstructionWorkingMinds.org.

“Increasingly, we are hearing employers say, ‘Not another life to lose. What can I do to prevent this from happening with my employees?’” said Spencer-Thomas. “They want a road map to integrate psychological safety into their existing safety culture.”

Because most adults spend more waking hours at work than they do at home, workplaces are critical partners in a community approach to suicide prevention. Employers who value the well-being of their staff realize that it is not good enough to get people home safely from work, they also need to provide support in making sure employees get back to work safely from home. Like most cultural change, a multi-dimensional, long-term strategy is warranted integrating mental health services, training, communication strategies, leadership, and crisis response.

• Full CDC report here http://www.cdc.gov/mmwr/volumes/65/wr/mm6525a1.htm.
• The National Action Alliance for Suicide Prevention response here: http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicideprevention.org/files/CDCResponse.pdf

Occupational Rank for Highest Rates of Suicide Deaths[i]
RANK	Occupation	Rate per 100,000
1	Farming, fishing, and forestry	84.5
2	Construction and extraction	53.3
3	Installation, maintenance, and repair	47.9
4	Production	34.5
5	Architecture and engineering	32.2
6	Protective service	30.5
7	Arts, design, entertainment, sports, and media	24.3
8	Computer and mathematical	23.3
9	Transportation and material moving	22.3
10	Management	20.3

Occupational Rank for Highest Numbers of Suicide Deaths[ii]
RANK	Occupational Group	Numbers (%)
1	Construction and extraction	1,324 (10.8)
2	Management	1,049 (8.5)
3	Production	953 (7.7)
4	Installation, maintenance, and repair	780 (6.3)
5	Unknown	729 (5.9)
6	Student	665 (5.4)
7	Sales and related	651 (5.3)
8	Transportation and material moving	644 (5.2)
9	Homemaker, Housewife	534 (4.3)
10	Office and administrative support	481 (3.9)

  

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About the Carson J Spencer Foundation - Sustaining a Passion for Living

The Carson J Spencer Foundation (www.CarsonJSpencer.org) is a Colorado nonprofit, established in 2005.  We envision a world where leaders and communities are committed to sustaining a passion for living. As leaders in innovation in suicide prevention, our mission is to elevate the conversation to make suicide prevention a health and safety priority. We do this by:

• Delivering innovative and effective suicide prevention programs for working-aged people
• Coaching young leaders to develop social enterprises for mental health promotion and suicide prevention
• Supporting people bereaved by suicide

About the Working Minds™ Program

Working Minds™ (www.WorkingMinds.org) is the nation’s first suicide prevention program exclusively dedicated to the workplace. Our purpose is to give employers the confidence and competence to integrate suicide prevention into their overall health and safety culture. Since 2007, Working Minds™ has offered training and resources to industry leaders to help them build cost-efficient, effective, and culturally relevant suicide prevention strategies.

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[i] Source: McIntosh WL, Spies E, Stone DM, Lokey CN, Trudeau AT, Bartholow B. Suicide Rates by Occupational Group — 17 States, 2012. MMWR Morb Mortal Wkly Rep 2016;65:641–645. DOI: http://dx.doi.org/10.15585/mmwr.mm6525a1.

[ii] Ibid