In 2008, Congress named July National Minority Mental Health Awareness Month. The purpose of this month is to bring awareness to issues surrounding mental health in minority communities where, due to reasons ranging from stigma to finances, mental health treatment is sorely lacking.

Here are some mind-boggling statistics on the state of mental health in ethnic minority communities:

• Only 31% of Hispanic-Americans, 29.3% of African-Americans, and 21.6% of Asian     Americans with mental illness have received treatment of some kind
• 14.5% of African-Americans suffer from some sort of mental illness
• 17.7% of Asian-American adolescents have contemplated suicide   
• At the rate of 42.8 per 100,000, American Indians/Alaskan Natives have the highest suicide rate of any ethnicity   
• 29.2% of African-American high school students have reported feeling sad and hopeless

The National Association of Mental Illness (NAMI) and the National Institute of Health (NIH) have addressed the differences in the willingness and ability between white and ethnic communities to seek out mental health treatment. There are a few hypotheses for why this treatment is not forthcoming, despite the apparent need for more mental health treatment in minority communities. There are three great books that tackle this issue, as well.

1. Lack of understanding: There is a lot of misinformation in minority communities about mental illness. There is a lack of understanding of what to do when someone is having problems that should be treated by a professional versus “the blues” that someone is capable of snapping out of. This, I can speak to from personal experience. I remember in my freshman year of high school my mom found a stack of suicide letters I had written. She charged at me yelling, “You’re going to hell.” My mom spoke from a place of ignorance and an assumption that I was simply being oversensitive to the natural stressors of life.
2. Provider bias: There is substantial evidence to suggest discrimination against minority communities by mental health providers. This stems from the fundamental systemic racism that exists within our society that does not necessarily stop when a doctor closes the door to meet with a patient.
3. Poverty: Therapy and medications are expensive and may not be accessible to even those with medical insurance. As a result of not seeking treatment for financial reasons, there is a larger population of untreated mental health cases within poverty-stricken areas. This becomes blatantly obvious in major metropolitan areas with large homeless populations - more often than not, active panhandlers tend to exhibit mental or substance abuse issues. Poverty with racial bias is a double whammy against those minorities who should seek out treatment.
4. Mental health stigma: Within all of these communities, and indeed in any community, admitting to mental health or psychological distress is a sign of weakness. No one wants to appear “broken” and, as a result, even among the white population, only 48 percent of those with mental health issues seek out any treatment. The fact remains, however, that minority communities are one-half to one-third less likely to go into treatment than whites who are similarly situated.
5. Language barriers: Within the Latino and Asian American communities, finding providers that speak their native language is difficult and can impede getting proper care. If English is not their native language, trying to discuss feelings and get culturally appropriate care is challenging and can be a deterrent to treatment.

So what can we do about this situation? How can we increase the awareness within minority communities regarding mental health? First, we need to recognize that mental illness does not give a shit what your background is. One out of five people is affected by some kind of mental illness; meaning anyone is susceptible. Pretending otherwise is foolhardy.

Secondly, no matter who you are or what your background is, if you or someone you love is struggling with mental health problems, encourage them to seek help either by finding a therapist or looking for different mental health resources. Do not assume they can just “snap out of it”. Fighting this battle alone is not an option. Help is available, regardless of your ethnicity.

(Continued from Part One)

At 6:45 a.m. someone came by to take my blood pressure. This wasn’t how I envisioned waking up that morning, but I also did not envision being a patient in the acute psychiatric ward (or “the unit” as its patients and staff called it). After the initial shock of remembering where I was and why this nurse aide had taken my vitals at dawn, I tried going back to sleep, but couldn’t. Instead, I laid in bed thinking about everything and nothing: “Will my husband be able to get my son to school on time?” “Should I call my parents?” “Am I still actively suicidal?” It’s easy to ruminate when you have nothing to do and only have the clothes on your back.

My day nurse came by around 8 a.m. to give me my schedule for the day. The agenda included meal times and the recommended activities for the day. She was very friendly, and despite my complete antipathy toward her (and anyone else involved in this current state of events), I couldn’t lash out at her. I simply nodded and answered her questions. I even asked questions about the schedule. After she left the room, I went to the nearest lounge and called home.

I talked to my son while my husband was driving him to school on time. After hearing his voice, I begrudgingly walked to the cafeteria to try eating. The disgusting meal I was served in ER and the bland snack I received at the unit the night before were the only things I had eaten in the last 48 hours. So I was hoping that breakfast would be better. Sadly, it wasn’t. I’m not a food snob, but I have certain standards when it comes to scrambled eggs, which were not met - they should at least taste like eggs for starters. I ate alone in a corner observing the other people who were locked up in the unit with me. There were no actively “crazy” people. I noticed some young adults, talking with each other as if they had been friends forever, a smattering of people looking stern and muttering to themselves, and people who looked and acted “sane”, just like me. We had all been deemed “a danger to ourselves or others”, but based on the atmosphere in that room, you would think we were just in some office cafeteria. This one, however, happened to have nurses wandering about with medication carts.

At 9 a.m. there was a morning check-in, similar to a school homeroom, with a nurse and a small group of other patients. During morning check-in, there was a skills-based therapy topic introduced, and it was also a chance for nurses to check in with their patients for the day. Morning check-ins are technically required, but like everything else on the unit, if you don’t show up, no one will force you to attend. I attended just to see what it was about and also because I was bored with waiting.

I did a lot of waiting around that first morning. I had told my nurse that I wouldn’t be attending any group activities until I had a real toothbrush and some fresh clothes. My husband was bringing me a bag packed with clothes, books, toiletries, and the most important thing: my watch. There were no clocks in my room, and I had no idea what time it was or how much time had passed. While waiting for my stuff, I was also waiting for the doctors. I wanted to put in my request for discharge immediately. I also wanted to argue that I’ll be fine and that I’d be better off not stuck on the 13th floor of a hospital.

My stuff came first. The staff had to search everything for contraband and things that can be used to harm yourself or others. They thoroughly searched my things, and the list of banned items is quite long. I understood they took my pants with drawstrings and shoes with shoelaces, but they also took away my electric toothbrush (to change out brush heads, you expose a pointy metal tip). Also, instead of giving me my original luggage sans the prohibited items, they put everything in paper bags, which they handed to me to take back to my room. As I was returning to my room, I saw a staff member was putting my nametag on my door. That was not a good sign.

I unpacked and changed my clothes. I had been studying for the CFA at the time and was working through questions on corporate finance when the knock came. The attending physician, her resident, and two medical students entered my room and tried to make themselves comfortable despite the limited seating. They proceeded to ask me how I was doing and a lot of other questions similar to those which I’d answered the previous day at the emergency evaluation. I answered everything more stoically than the previous day, knowing that I was being evaluated for weakness. They then asked if I had any suicidal thoughts and I admitted that I had been thinking about it, but more in the context of that being the catalyst for my admission. Subsequently, the attending, Dr. A, recommended that the dose of one of my medications be adjusted, and the team would check in with me again the next day. No one had an answer to when I would be discharged nor an answer about what criteria I’d need to meet to be discharged. I agreed to the medication change (I would have agreed to a lot of things if it meant I would get out sooner) and they left. I went back to the lounge and called home for the third time that day.

Afterward, I decided to give lunch a try. The lunch staff provided every patient with a menu to fill out in the morning for the following day. Since I had just been admitted, I hadn’t made my food choices yet, so I just ate whatever they had brought up. Lunch was not as bad as breakfast, but I was definitely missing my kitchen and Whole Foods. For this meal, I was joined by a patient who was delusional. He would wear a blazer over a hospital gown and wander around. Sometimes he’d also wear a pair of Ray-Bans. Although he was the classic example of who I expected to see in a place like this, he stood out quite a bit compared to most of the other patients. He told me how he just was woken up from a coma and saw Jesus. I did a lot of smiling and nodding as he talked because I did not know who was a “danger to others.” I did not want to find out the hard way.

The staff on the unit tried hard to keep people connected to the real world. The unit had three lounges with networked computers, free phones, and TVs. I mustered up all the courage I had and sent open and vulnerable messages to my friends. I told them I was in the unit, safe, and hoped to be back soon. I kept checking during the day to see whether anyone had responded. At this juncture, I was playing with a mental game with myself: if everyone ignored my messages, I could justify my fucked up perception that no one cared about me, but if everyone showed their support, then I had to accept that people cared for me. The outpouring of support was real and heartfelt and shattered my perception that my world was a cold and unfeeling place. I made phone calls to some friends just to hear their voices - just to know that there was still a world outside the unit.

After lunch, I attended my very first group therapy session. A day prior, if anyone had suggested that I go to group therapy, I would have considered punching them in the face. But with no other choices to pass the time, I decided to give it a try. This was a patient-led therapy, instead of facilitator-led, meaning the floor was open to whoever had something to share or talk about. I had skipped everything else leading up to the group therapy, including socializing with anyone except the Ray-Bans guy. So there I was sitting in a circle with other strangers who were all in the same situation as myself. The hospital was good about ensuring that the patients participating in my group were all high-functioning depressives with a grip on reality. At the end of their time in the unit, these patients would be discharged to their homes, rather than a long-term care facility.

After a minute of sitting in silence in this circle of strangers, I finally decided to ask a question: “How do you get used to being here?” The response came back fast and succinct: “You don’t.”

I “voluntarily” admitted myself into a really shitty sleepover camp.

Continued in Part 3

Here you are. You’ve arrived at the stage of contemplating mental health treatment. For me, this came after a weekend of being unable to do anything but lie in bed and cry. I finally realized my mood swings and suicidal thoughts were not healthy and I should seek help and support from a professional. Some of you may even be at the preparation phase of seeking out treatment. In this stage, you have to engage in the dreaded task of finding a provider.

When looking for a provider the three best sources to get referrals are:

1. Your primary care doctor who can give you a recommendation (I strongly recommend against using your primary doctor for mental health treatment);
2. Your insurance website, if insured; or
3. Personal recommendations from friends or colleagues who have had treatment.
   
   

If none of the above sources have been useful, start checking websites like psychologytoday.com and even begin just a basic internet search that can start you down the rabbit hole on getting names and phone numbers. If cost is a major concern, there are places that offer sliding scale rates for mental health treatment or provide financial assistance.

Once you have your list, here are five pointers for choosing the best therapist based on my experience of being in and out of various therapies throughout the last 20 years.

1. Costs: Look at what your insurance will cover. Unfortunately, therapy, evaluations, checkups, medication, etc. can get expensive. This is by no means an excuse not to get help, but getting some of it paid for is valuable. When you schedule your first intake appointment (that will be longer since it is basically a mutual interview between you and the provider), make sure you go over costs. The last thing you want is to find someone you like and then not be able to afford them.
2. Distance: Consider how far you are willing to travel for your visits. If you are recommended for talk therapy, that could mean weekly visits or even twice a week visits for some or all of your time in treatment.
3. Provider type: There are three different types of mental health providers. Besides price, here are the differences:
   1. Psychiatrists are medical doctors who specialize in mental illness from a clinical standpoint. Although some can engage in talk therapy, many primarily just prescribe medication and do medication management.
   2. Psychologists are professionals with either a Ph.D. or a PsyD who study the mind and human behavior. They will pull from a laundry list of therapy styles, including CBT and psychoanalysis, and pick which one they feel would work for you.
   3. Licensed Clinical Social Workers (LCSW) are professionals with a master’s degree in social work. They tend to be less expensive than a similarly situated psychologist or psychiatrist. Unlike psychologists who are more flexible in their therapy style, LCSW tends to stick to strength-based therapy.
      Ask what therapy style the provider generally uses. At one point I had psychoanalysis therapy twice a week, and after a year I felt the needle had not moved in my treatment. I walked away and found something different. I have found better results with skills-based therapy, instead of the psychoanalysis treatment, so I switched to a provider who does Acceptance and Commitment Therapy (ACT), a skills-based therapy.
4. Specialty: Have you been crying all the time and feel shitty? Do you find yourself hearing voices and seeing things that are not there? Have your postpartum blues turned into postpartum despair? Do you have hang-ups about sex? These questions matter, because the provider you choose should know and specialize in treating whatever ails you. Usually, on the provider's website, they will note what their areas of expertise are. Take this seriously, as you would not go to an ENT doctor for a broken leg.
5. Background: Since you will be sharing a lot of personal details with this person, it may not be a bad thing to screen them based on the characteristics of a person you would feel comfortable talking with. If you are female, it is reasonable to want to use a female provider. If you are not comfortable talking about feelings or intimate details with someone your grandmother's age, that is also an excellent way to whittle down the list. (Note of caution - if you go to a provider based on ethnicity, do not assume they will relate just because they share your ethnic background).

Overall, the fact that you feel you need mental health treatment and you are seeking it is a big step. Furthermore, if you are having anxiety about making that first phone call, like I did, ask a friend or loved one to call around on your behalf. Do not get discouraged or give up when trying to find a provider you click with. Also, always remember that you can vote with your feet. If you are working with a provider who is not a good fit, just find a new one. You are the customer, and you deserve to find someone suitable to help you get well.