I am on a number of email lists and newsletters. This came to my attention this morning. I have worked in a number of fields for many years on both the micro and macro levels, and I'm often aghast at the treatment that is offered and the governmental policies that fail to direct or regulate or (at times) pay for those services. Dr. Lieberman wrote the following piece for other healthcare professionals. It was so nice to read the words of someone else so that I know that I am not alone in my frustration. I received his permission this afternoon to repost this, and I'm thrilled to pass it on to the readers of this site. _____________________________________________________________________ Jeffrey A. Lieberman, MD November 23, 2016 Hello. This is Dr Jeffrey Lieberman of Columbia University in New York City, speaking to you today for Medscape. Lately I have been feeling as though I am becoming more of a curmudgeon. I have been irritable and intolerant, and things get me more upset than they used to. But maybe it is for good reason. I owe my current distress to several events that underscore the continued neglect, inattention to, and prioritization of issues of clear need and benefit to the American people that we have not acted upon. When I say "we," I am referring to our government, the media, the healthcare system, and even the population at large, which should demand its rightful due in the way of services, policy, legislation, and funding. I am specifically talking about mental health care and mental illness. Mental illness has always been neglected and given short shrift. Psychiatry and mental health care are what I call the Rodney Dangerfield of medicine—they do not get the respect they deserve. As we become more and more aware of the deleterious consequences of this, one would think corrective actions would be taken, but they are not or they are happening much too slowly. Several recent occurrences dramatically highlighted this and, frankly, ticked me off. Missed Legislative Opportunity This summer, a piece of legislation that could be transformative for mental health care in the United States was finally passed by the House of Representatives. I have talked about this in previous blogs. The Helping Families in Mental Health Crisis Act, HR 2646, was initiated by Congressman Tim Murphy and Congresswoman Eddie Bernice Johnson in the aftermath of the massacre of children by Adam Lanza in Sandy Hook, Connecticut. It was meant to bring about sweeping changes in the way that mental health services are coordinated and financed by the federal government. This bill slogged its way through the political process for 3 years; in July it was finally approved by a nearly unanimous vote of 533 to 2. The Senate version, the Mental Health Reform Act, S 2680 (formerly S 1945), is a far cry from the House bill, and if passed, it would need to be reconciled with the House bill. Unless some measures of the House bill are incorporated into the reconciled bill, the whole exercise will not be nearly as effective as it could be. The opportunity to pass this meaningful legislation is running out of time, and the political challenges are particularly concerning to me, not least because Congress adjourned for the election and will return afterwards only for a lame duck session. If nothing is done before the end of this Congress, then the process has to start all over again the next year. This is a missed opportunity—big time. Agenda for Mental Health Care Ignored On August 29, 2016, in the midst of the presidential campaign, Secretary Clinton released an agenda for mental health care. When was the last time a presidential candidate—not a president but a presidential candidate—ever released a thoughtful, potentially comprehensive position statement on mental health care? I cannot think of any. There have been presidential commissions, but not a position statement by a candidate in advance of an election. That is noteworthy. The Clinton campaign released this agenda on a Monday, the beginning of the week, clearly hoping for continuing media attention during the rest of the week (in contrast to releasing something at the end of the day on a Friday before a holiday weekend, which would be buried). But what really got my dander up is that it got no attention. An August 31, 2016, editorialin the Washington Post took note, saying essentially that the Clinton agenda was released and no one was talking about it. It got next to no play in the media, which tells you how much interest the media believes the public has in this topic. Shameful. Psychiatrists Overlooked After Hinckley Released Ten days later, on September 10, news came that John Hinckley Jr, the would-be assassin of President Ronald Reagan, was being released from St Elizabeth's Hospital in Washington, DC. After he tried to murder President Reagan, a court found him not guilty by reason of insanity and he was remanded to St Elizabeth's, and presumably has been getting better for 35 years. He does seem fit to be released back into society, meaning that he is better and out of danger, and whatever punitive action was intended by his mandated residence at St Elizabeth's has been accomplished. The real issue is whether he really is better and is not a danger. I have no opinion about that because I do not know his mental status, his diagnosis, the treatment, and aftercare. In the wake of that announcement with all of the media coverage that attended it, there was commentary by lawyers, police, and criminal justice experts. No commentary by psychiatrists was included among those opinions. Psychiatrists presumably would be an integral, if not essential part, of any consideration of how such a case should be handled given the primary question: Is he better? Does he possibly continue to be a danger? How do we ensure that he is not a danger by providing the necessary treatment? No commentary by psychiatrists. What does that say about the way the media views this and the credibility of input from psychiatrists? Not much. The Displaced With Mental Illness A week later, on September 18, the New York Times published a very interesting article, written by a journalist who had been stationed in Asia for the past 25 years. He and his family had finally returned to the United States and he was assigned to cover a beat in northern California. The article was about returning to his home country and his impressions after having been away for more than a quarter of a century. Among a number of very interesting reactions, the author's dominant impression was of walking through the middle of San Francisco and seeing the homeless on the street, including large numbers who were displaced persons with mental illnesses. He commented that, despite the poverty and the much lower level of development in the many Southeast Asian countries he covered, he had not seen the kind of human detritus strewn through those communities that he saw in San Francisco, one of the richest metropolitan areas in the world. How could this happen in a country with the resources and the level of development of the United States? Awareness Is Growing but Policies Remain Shortsighted In the aggregate, these four developments, occurring within a relatively short period of time, point to a social problem that has existed historically yet has not been accorded the importance and the attention it deserves. This is how our society cares for people with mental illness, provides for them in terms of mental health care, and finances the social policies that govern how mental health care is provided and made accessible to people. Although awareness of the scope of the problem is growing in terms of the statistics, costs, epidemiology, and awareness of the consequences, particularly the burden of illness, our government does not act. This burden includes the monetary costs to society and the egregious social pathologies that crystallize in our society as a result of this neglect—homelessness, prisons crowded with persons with mental illness, rising rates of addiction, increasing demographic groups with suicidal behavior, and the mass violent incidents, some of which are perpetrated by individuals with untreated mental illness. It is infuriating. I hate to believe that I am becoming less tolerant and that my emotional response is disproportionate to the perceived problem. I do not believe that is so in this case. I simply have an acute awareness that appreciates how self-defeating and shortsighted our policies are. Rather than be discouraged and walk away from this, throwing up our hands, becoming angry and having a tantrum, I encourage you, as myself, to stay the course, redouble our efforts, and continue to try to make people appreciate the scientific, clinical, and social reality of mental illness. We must underscore our ability to provide evidence-based care that is effective and will reduce the burden of illness and the consequences and costs to our society. And we must press for change. Change will come. We will be using our ability full force to provide mental health care. The rate-limiting factor will be how quickly legislation, financing, and social policies will change. That will happen; the question is, when? Thank you for listening. Dr, Jeffrey Lieberman of Columbia University, References 1. Editorial Board. Clinton just made a very important announcement — and hardly anyone is talking about it. The Washington Post. August 31, 2016. https://www.washingtonpost.com/opinions/clinton-just-made-a-very-important-announcement--and-hardly-anyone-is-talking-about-it/2016/08/31/5379ddfe-6ef5-11e6-9705-23e51a2f424d_story.htmlAccessed November 10, 2016. 2. Fuller T. What San Francisco says about America. The New York Times. September 18, 2016. http://www.nytimes.com/2016/09/18/opinion/sunday/what-san-francisco-says-about-america.html?_r=0 Accessed November 10, 2016.
After a mind numbingly long 18 month election season, many of us hoped to return to a regular routine that involved less reading, discussing, and arguing about politics. Three days after the election, people are still debating the election, protesting, gloating, and generally extending what has already been an overly long process. Whether it was your candidate that won or lost, you might be more than a bit irritated with family members, friends, co-workers or facebook friends that voted for the other candidate. I have fielded a number of texts, messages, emails and calls from people that say something to the effect that “I don’t know if I can be friends with XXXX anymore.”
Very simply: you can and you should still be friends with that person (or people) in your life who voted for the other candidate. Here is a quick guide to help you get through this:
1) Spend less time on Facebook and other social media.
2) If there are people who voted for the other candidate that are gloating, arguing, complaining, protesting, attacking, or just posting a shit ton of political articles, you can unfollow them for a while. In a few weeks or months, you can refollow them as facebook returns to normal and they post annoying holiday photos of their children, write about how cold it is, share memes that aren’t funny, promote some event that no one wants to go to, and perhaps, just perhaps, share a heartwarming story or glorious photograph.
3) Take a few minutes and recognize why you are associated with the individual in question in the first place. Don’t cast them off just yet if they meet any one of the following criteria: if you have common blood; have broken bread together; suffered through war, incarceration, early recovery, freshmen year or a terrible boss together; one of you attended the funeral of the other’s loved one; you’ve gone on vacation together; there is a picture of the two of you smiling. If they are someone that you have no connection to other than you like to collect facebook friends, then by all means, purge them from your life.
4) Focus on those above mentioned commonalities rather than your profound irritation with their horrible political choices.Throwing that relationship away as you choose to surround yourself with people who only share your worldview is the move of a small and close minded individual. The ability to listen to those that you disagree with is a good one, and will help you deal in your professional and personal relationships (particularly in romance).
5) Before you blow off point #4 with “But they are so fucking stupid and annoying,” ask yourselves what other differences in people you have accepted. For example, I really disagree with the following lifestyle choices:
(a) eating vegetables
(b) those that think Eli Manning is even close to a Hall of Fame quarterback
(c) people who give me shit for smoking cigars
(d) people who thought Titanic was a good movie
(e) anyone who follows the Kardashians
(g) dogs – they are like babies that never get better
(i) not showering
(j) people who talk on their phone in public
(k) people who walk while looking at their phone
My curmudgeon list can get really long. I think I have a friend or a family member that believes or engages in every one of those ridiculous choices. And I still like them (and in a few cases, love them). My point is that almost all of us have accepted differing beliefs from people in our lives.
6) I have an uncle who has not talked to me for eight years because he disagrees with my politics. That was his choice, not mine. Of his four niblings (that term covers nieces and nephews), I was the one who sent him gifts most often and made a point to visit him when I was in California or he came to the East Coast. I accept the fact that he chose to end our relationship based on differing political beliefs, but I would not do that to someone else. Here is the tragedy of that relationship: other than politics, we got along really well. We like a lot of the same foods, books, movies and sports. He made me laugh and was really good to me when I was a teenager. The whole situation is sad.
(7) Over the next few weeks do some (or all) of the following:
(1) exercise more
(2) spend time with friends and laugh and don’t discuss politics
(3) go for hike in the woods
(4) plant bulbs for the spring
(5) binge watch whatever horrific shit of a tv show you like
(6) attend some kind of community event or service (religious, AA, bowling league, PTA fundraiser, etc…)
(7) Read that book you bought two years ago but never got around to reading
(8) organize your closet
(8) And if you really care about politics, then stop thinking that posting or liking articles on facebook or engaging in hashtag activism makes a difference. It doesn’t. It creates an echo chamber where you turn off those that disagree with you and are supported by those that already agree with you. Go get involved. Contact your local Republican, Democratic, Green, Socialist, Libertarian, Pirate, or Sith party and start doing real work. Pick an issue you really care about and become an expert in it. Advocate for it on the local or state level. Shit, run for office. All sides of the political map need good people.
* This does not apply to the netherworld of Twitter. Those are horrible people.
The piece below was written by Cynthia Diaz. She was my student at Rutgers during the 2015-16 school year. She graduated with her BASW in May and is working on her Masters at Fordham. She is currently interning at Advocates for Children in New York City. I asked her to write an article for me about her life, why she chose social work and what she hopes to do with her degree.
After Tuesday’s presidential election, I expect that Latino families will experience more of these problems and will have a harder time accessing services. Cynthia’s childhood serves as a reminder about the struggles that many members of the Latino community experience.
As a daughter of low-income Latino immigrant parents, I experienced a great deal of adversity growing up. I was surrounded by people who believed in a patriarchal society and domestic violence was a norm in my household. I witnessed my mom struggle with depression and endure domestic abuse. I never understood why this was or why she let it continue. It made me resentful and angry. Throughout elementary school, my mother struggled to help me with my homework; she only completed elementary school and did not know any English. I’ll always remember my mother sitting next to me with a Spanish- English dictionary as she translated the instructions for my homework. These struggles are common for Latino families. Unknowingly, I prepared for a career in social work as a child. As soon as I was fluent in both English and Spanish, I became the translator for my family and friends. I attended others parent-teacher conferences and went along to social service agencies to help my older cousins get help for their children.
I was the first person in my family to apply to college. My parents did not see any value in it so they did not support me. My mother wanted me to go to a county college so I could continue to look after my sister. I chose to attend Rutgers instead. Right before moving into the dorm, my father kicked me out of the house and forbid me from coming home. Leaving my hometown and being estranged from my father was quite stressful. It was difficult to maintain a good relationship with my mother after this because I was so hurt that she did not stick up for me. If I wanted to visit my mother and sister, I would stay at a friend’s house and only stop by when my father was not around. I felt lost and alone during my first two years of college, and I turned to alcohol instead of talking to people about my problems. I skipped class and did terrible my first year. I never thought about seeking help.
My little sister was growing up fast and I realized I had to change my lifestyle. I recognized that a business degree was not for me. I spent a summer working for AMARD&V (Artists Mentoring against Racism, Drugs, and Violence) and witnessed the numerous obstacles that Latino students have. I identified with problems they were facing but had no idea how to help them. Many of them had problems at home and did not feel safe. Some of them were only 11 years old. I did what I could – I listened to them and provided them with a safe place to go. This experience made me think about how my life was growing up, and how different my home life, education and relationships could have been if I had someone who understood and guided me.
After that summer, I realized that I could use my experiences to help others. Maya Angelou said, “You may encounter many defeats, but you must not be defeated. In fact, it may be necessary to encounter the defeats, so you can know who you are, what you can rise from, how you can still come out of it.” My experiences with domestic violence, lack of educational support, familial estrangement, and heavy teenage drinking could help me relate to others. I went to the School of Social Work to talk to the director of the BASW program. It was obvious that I should pursue a social work degree. The director and my professors made it clear that I could not just rely on my experiences to help others – that I would need to develop clinical skills, learn about social service resources, and maintain healthy boundaries with my clients.
I graduated with my Bachelor’s in Social Work last spring. It was a great accomplishment that I am very proud of. But I knew if I wanted to make a real difference that I had get a Master’s degree. I’m currently enrolled in Fordham University’s School of Social Service in the leadership and macro practice concentration. I’m interested in policies regarding children, families, and the Latino community. I want to advocate and help those who feel as if their voices can’t be heard. But I can’t just advocate for them – I know that I have to help them advocate for themselves. I hope to learn how to take leadership roles as both a female and a Latina. My life is just getting started. There is so much I want to see and do, and so many people I want to help. I have a strong urge to dive in and help people wherever I go. My professor and supervisors help me understand the big picture. They have taught me about the importance of education, training, consultation, supervision, healthy boundaries, and self-care. I’m 23 and they caution patience. I listen because I want to do this for the long haul.