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Category: Mental Health

  • 205 Republicans Vote Against Bill to Expand School Mental Health Services

    On Thursday, the House passed a bill aimed at expanding access to mental health services in schools that garnered only one Republican vote, despite the party’s ceaseless scapegoating of mental illness for issues in the U.S.

    The Mental Health Matters Act passed 220 to 205 on a largely party line vote, with all 205 “no” votes coming from Republicans. Rep. Brian Fitzpatrick (Pennsylvania) cast the sole Republican “yes” vote.

    The bill, introduced by Rep. Mark DeSaulnier (D-California) and supported by the White House, would provide grants for schools to hire more mental health experts and grow their mental health services, especially schools in areas with high need. It would also provide mental health protections to adults with private health insurance and children and staff in Head Start programs, which are aimed at serving low-income children from birth to age 5.

    “Educators have been forced to play an outsized role in supporting and responding to students’ mental health needs, leading to increased depression and trauma among educators, their students, and the families and the community,” DeSaulnier said on the need for his bill, per The Hill. “However, our schools do not have the specialized staff necessary to respond to the increased prevalence and complexity of students’ mental health needs.”

    Rep. Virginia Foxx (R-North Carolina) took issue with a portion of the bill that punishes employers when employees are denied mental health and substance use benefits and said that the “country would be better off without” the bill.

    Experts have said that children’s mental health is in crisis. The COVID-19 pandemic has taken a toll on children’s mental health, whether through trauma, loss, or otherwise, leading to a corresponding rise in mental health crises among children, research finds. Pediatric mental health professionals say that legislation aimed at permanently increasing resources for children’s mental health is sorely needed.

    Democrats condemned Republicans for voting against the bill. “This afternoon we voted to create more mental health services in schools and 99.5 percent of republicans voted no and told kids to go to hell,” Rep. Bill Pascrell Jr (D-New Jersey) wrote on Twitter.

    Others pointed out that Republicans have spent months, if not years, scapegoating mental health issues as a catch-all for problems like mass shootings — which, in reality, are often spurred by far right radicalization and white supremacist ideology. Indeed, Republicans often dig up supposed concerns about mental health in order to distract from other issues.

    After the elementary school massacre in Uvalde, Texas, Republicans and the far right scrambled to spread disinformation online about the shooter, pinning the problem on groups they wished to demonize — including trans people, those with mental illnesses and the Democratic Party.

    “Well, it’s just tragic what happened down there. We learn something new every day about how can we improve,” House Minority Leader Kevin McCarthy (R-California) said on Fox News after the shooting. He said that there should be a funding influx for “focusing on mental health” in response to the shooting. McCarthy voted against the bill on Thursday.

    In reality, Republicans who speak out in favor of mental health funding in response to horrifying mass shootings are likely readying for coming attempts to curtail gun ownership, curb the power of the gun lobby, and, in the case of Uvalde, scrutinize the police for their failure to prevent or act on the shooting.

    In other words, political commentators have noted, mental health issues act as a shiny object for Republicans to wave around, a political convenience that allows the party to continue expanding and perpetuating the roots of violence and antipathy.

    For instance, Republicans have repeatedly suggested that school shutdowns and remote learning were the real plague on children’s mental health during the pandemic. But the deaths of teachers and caregivers that likely would have resulted from hasty school reopenings would almost certainly have had an equal if not larger toll on children’s mental health.

    This post was originally published on Latest – Truthout.

  • Kaiser Permanente Therapists Keep Striking, Citing Dangerous Delays for Patients

    When most of us think of mental health care, we think of seeing a therapist once per week. But at Kaiser Permanente facilities in California and Hawaii, clinicians — including psychologists, clinical social workers, marriage and family therapists, and addiction medicine counselors — say their patients routinely wait months between appointments. Not only that: There’s no limit to the number of patients that can be assigned to one therapist.

    “You’re expected to follow anybody you have seen in the last two years. At times, the number of people I have seen in the last two years has been up to 600,” Sabrina Chaumette, a Kaiser therapist in Oakland, told Truthout.

    Since July 2021, Kaiser mental health clinicians in California, who are members of the National Union of Healthcare Workers (NUHW), have attempted to use contract negotiations to demand the resources they need to provide better care for their patients. But workers say management has been unwilling to budge on changes necessary to reduce their unmanageable workloads and reverse understaffing, so on August 15 — nearly 14 months after their first bargaining session — over 2,000 Kaiser therapists in California went on strike. Nearing two months, it is the longest mental health strike in history. And on August 29, 57 of their colleagues in Hawaii, also NUHW members, joined them.

    Kaiser is the largest nonprofit HMO in the United States, operating in eight states and the District of Columbia. It’s the largest health insurance plan in California, with more than half the market share, and the second-largest in Hawaii. However, despite reporting an $8.1 billion profit in 2021, Kaiser staffs only one full-time-equivalent mental health clinician for every 2,600 members in Northern California and just one therapist for every 5,500 patients in Hawaii, according to NUHW. Union members say this flies in the face of Kaiser’s key marketing promise: That by offering health insurance plans and operating hospitals and other facilities under one umbrella, patients receive better and more integrated care.

    “I call it the glitter cloud,” Rachel Kaya, a Kaiser therapist in Hawaii, told Truthout. “They put out into the world how they promote mental health care, how they help people thrive, and how they do fair labor bargaining. But in my field, we talk a lot about the difference between talking the talk and walking the walk.” Unlike their colleagues in California, whose contract expired, Kaiser therapists in Hawaii are still without a first contract four years after joining NUHW.

    “A strike is an absolute last resort. We have made numerous efforts to compel our employer to shift our model of care to reduce dangerous delays in terms of wait times that our patients face,” Ilana Marcucci-Morris, a Kaiser therapist in California and bargaining committee member, told Truthout. According to Marcucci-Morris, the union’s last contract cycle nearly ended in a strike over the same issues, but members ultimately accepted an offer from Kaiser when it agreed to form a committee, with equal participation between union members and management, that would make recommendations on how Kaiser could improve its model of care. After that committee met for over a year and made its final presentation, “Kaiser cherry-picked one or two pieces that they liked and then dumped the rest,” said Marcucci-Morris. Before walking out, NUHW members in Northern California accepted Kaiser’s financial terms. They’re not striking over their own compensation or benefits.

    “Our patients are waiting three months in between appointments and flooding the emergency room because they’re in crisis, or paying out of pocket to go outside Kaiser. That extreme moral injury is the crux of our strike,” said Marcucci-Morris. We want our patients to get better and we need the resources to help them do that.” Kaya agrees. “I just want to be really clear that the reason why we are on strike is not a financial issue,” she said. “It is absolutely a social justice issue. Kaiser being a multibillion-dollar company, yet choosing to underfund mental health care in these communities, is wrong. The entire community pays the price when we underfund mental health care.”

    Marcucci-Morris likens the Kaiser model, where there is no limit on the number of patients a therapist can be expected to take on, to “a house where you have a front door that’s wide open but no windows, no side door, or back door.” In addition to forcing clinicians to work many hours of overtime on non-patient-facing work like completing and reviewing notes and connecting with other members of a patient’s care team, union members say this approach actually compels them to break the law. In addition to recently strengthened federal law, California has some of the strongest mental health parity laws in the nation. SB 221, enacted in 2021, requires that mental health and substance use patients be offered return appointments within 10 business days, unless the treating therapist determines that a longer wait time is appropriate. If an appointment with an in-network provider is not available, insurers and HMOs are obligated to arrange for outside care at no additional cost to the patient. NUHW members say state regulatory bodies have been slow to enforce the new law, and that Kaiser was noncompliant even before their strike.

    “Our current contract compels therapists to break mental health parity laws on the state and federal level,” said Marcucci-Morris. When she went on strike on August 15, said Chaumette, her next available intake appointment was in mid-November.

    Barbara McDonald is a single parent to two daughters with mental health challenges. McDonald told Truthout that getting her younger daughter an appropriate diagnosis within the Kaiser system took so long that she was forced to pay out of pocket to go outside Kaiser. Once her daughter did have a diagnosis of borderline personality disorder, the only treatment she was offered within Kaiser was a series of classes — which were then canceled. After her daughter was hospitalized multiple times for self-harm, McDonald paid out of pocket again to get her the treatment she needed outside of Kaiser. All told, she has spent around $50,000. “I don’t think my daughter would be alive if I hadn’t been able to provide outside care for her,” she said. “And I’m still digging myself out of a financial hole because of that.”

    “My older daughter said, ‘Do I have to cut my throat to get a therapy appointment?’ She sees her sister only getting care if she escalates and hurts herself. That must feel really scary, that nobody cares unless you’re hurting yourself or threatening yourself,” said McDonald.

    Chaumette said that in her experience, it’s often patients with less severe symptoms who do manage to get a referral for covered care outside the Kaiser system. “If I’m seeing somebody with depression and they’re having a difficult time getting out of bed, dressing, bathing, eating, they’re not going to have the energy to be on the phone with Kaiser fighting for an outside referral. This system disproportionately hurts the people with more severe symptoms,” she said. Kaiser also encourages therapists to keep more severe cases in-house, purportedly to better manage care for those patients, and because they might be rejected by therapists in private practice. But Kaiser’s mental health providers are so overwhelmed that McDonald questions the safety of that approach. “Even though Kaiser is dispensing my daughter’s medication, they don’t have anybody following up with her. She can go six months between meetings with her psychiatrist,” McDonald said. “That’s just dangerous.”

    In California, Kaiser contracts with Medi-Cal, the state’s Medicaid program, and its failures to deliver timely care disproportionately affect people who can’t afford to go outside the system. “Any marginalized community that has been unused to advocating for itself is not going to fight the system to give them a referral to an outside provider,” said Chaumette.

    These untenable conditions have therapists leaving Kaiser in droves, according to NUHW. Between June 2021 and May 2022, said the union, 668 California clinicians left Kaiser — nearly double the 335 clinicians who left the previous year. In a survey conducted by NUHW, 85 percent of those clinicians said they had an unsustainable workload, and 76 percent said their inability to “treat patients in line with standards of care and medical necessity” influenced their decision to leave.

    In California, NUHW members are asking for several key changes: Up to an additional 30 minutes per day to perform indirect patient care tasks such as returning phone calls and emails from patients and communicating with other members of a patient’s care team; the ability for clinicians to stop taking new patients when they have no available appointments for new patients within two weeks; a ratio of one appointment for a new patient to every six appointments with current patients; and a requirement that Kaiser hire enough staff to comply with federal and state law. The only concession Kaiser management has offered, according to Marcucci-Morris, is an increase in indirect patient care time of just 12 minutes per day, applying to generalist therapists only, which would exclude a majority of the union. Representatives for Kaiser Permenente did not return a request for comment.

    In May, the National Committee for Quality Assurance, an independent nonprofit organization that accredits health plans, placed Kaiser under “corrective action” because of its violations of national mental health standards. Two California state agencies are also investigating Kaiser’s failures to follow state mental health parity law, though those investigations are not expected to conclude until next year. “I’d like to see them hit them with fines big enough to get their attention and to make it worth it for them to turn this around, because clearly they’re only interested in the money they make,” said McDonald. “Or if they’re not going to provide mental health care, then they should just say that rather than pretending they do.”

    In Hawaii, NUHW filed a complaint in November 2021 with the Department of Commerce and Consumer Affairs regarding Kaiser’s failure to address serious patient care problems. In its formal response in December, Kaiser pledged to hire 44 additional therapists. According to NUHW, the number of full-time Kaiser clinicians in Hawaii has actually decreased from 51 to 48 since then.

    Chaumette says that, because of its poor practices, Kaiser faces a reputational crisis among therapists. “They are never going to be able to hire enough therapists to treat all these patients, because nobody wants to work for Kaiser,” she said. “Our reputation in the community among therapists is bad. When I tell people I work for Kaiser, their first response is, ‘You don’t do therapy.’ I think this strike has increased my reputation within our community of therapists. We’re doing advocacy in ways I’ve never done before as a therapist.”

    Though roughly half of the clinicians who went on strike in California have returned to work out of financial necessity, Marcucci-Morris said support for the strike remains high — in a recent vote, 85.9 percent of union members still supported the strike. “It’s important to note what a union is. We are a collection of workers. This is not one or two people telling us what to do,” she said.

    According to Marcucci-Morris, therapists who have gone back to work informed the union that Kaiser is still booking appointments for patients with therapists who are out on strike, then canceling and rescheduling them. “If Kaiser felt following the law was a priority, they’d follow our proposal,” she said. “We’re ready to negotiate around the clock to get an agreement.”

  • Traveling the Psychic Hinterlands

    A conversation with Rachel Aviv, the author of Strangers to Ourselves: Unsettled Minds and the Stories That Make Us.

    This post was originally published on Dissent MagazineDissent Magazine.

  • Missing: a journey of both hopefulness and hopelessness

    In early August 2022 we marked National Missing Persons Week – a time when the Australian community can reflect on the stories of loss relating to those who have vanished, and those who are left behind. This year saw the largest number of police reports, relating to the safety and wellbeing of a person, with just over 51000 reports made about the whereabouts of a vulnerable person.

    That’s almost 150 reports a day.

    Missing Persons has the complete fascination of the community, the popularity of true crime means that there is often a significant disconnect between the reality of missing persons and the armchair detective experience.

    That experience is facilitated by podcasts like The Teacher’s Pet, docuseries’ allowing you to watch a case unfold and closed Facebook group speculations about the whereabouts of a person. So, what is the true lived experience of a person left behind when someone is lost?

    Almost 3000 families in Australia are classified as families of long-term missing people. A very small percentage relate to people who were the victim of a crime – mental health concerns, young women from First Nations communities, older women with dementia and misadventure are more likely the scenarios related to disappearance. A long-term missing person is one whose absence has exceeded six months, and can sometimes refer to years, or decades waiting for those last pieces of the proverbial puzzle.

    The experience of loss for those families is referred to as an ambiguous loss, a phrase used by an American Emeritus Professor – Pauline Boss – relating to her landmark work with families who had a family member missing in action. That loss is a harrowing, haunting experience.

    My PhD study, on the experience of hope for families left behind when someone is missing, identified that the loss is a ‘teasing journey’ of both hopefulness and hopelessness. It is a loss that does not get easier over time, the lived experience stories of families of the missing suggest it gets harder. The more they seek news, the less sure they are of the outcome. The more they share in the media about their loss, the more ideas people suggest about what may have happened. It is unresolved – both physically and psychologically.

    Loren O’Keeffe with "The Hope narratives," a box collection of reflective statements for families left behind. Picture: Supplied

    Loren O’Keeffe with “The Hope narratives,” a box collection of reflective statements for families left behind. Picture: Supplied

    A decade ago, I met Loren O’Keeffe – she was searching for her brother Dan. He had disappeared from Geelong, and she undertook a massive social media campaign called ‘Dan come home’ in her 5-year effort to locate him. What we found  in working together, me as an academic researcher, her with lived experience passion and commitment to her own journey and to other families of missing people in Australia, was a shared goal to reduce the isolation of other families of the missing.

    Last month we launched, after a year in development with communications company whiteGREY, was:  The Hope narratives, a box collection of reflective statements for families left behind, both here and internationally, to reflect on their journeys with hope while waiting for news about their missing person.

    Loren’s words shaped the approach to creating the cards: ‘When a loved one goes missing, there is no right way to deal with it. You oscillate from hope to hopelessness, overwhelmed by the physical, mental, and emotional burden, often feeling no one understands what you’re going through’.

    Alongside a group of long-term missing families, over some tough days in Melbourne, we captured reflective statements on the hard truths of having someone missing, ideas like a simple walk down the street could result in repetitive scanning of faces, to see if you could spot them.

    We captured new coping ideas; like reminding yourself that whilst today might not be the day you find them, you may one day. And then explicit acts of hope like reminding families to focus on what is present, and that resting and gathering strength to navigate another day is sometimes the only option available.

    "The Hope narratives," a box collection of reflective statements for families left behind. Picture: Supplied

    “The Hope narratives,” a box collection of reflective statements for families left behind. Picture: Supplied

    Our hope, as two women pushing for change in a law enforcement heavy sector,  is to see these cards used to start conversations – in counselling, within family chats when someone is missing, by journalists trying to grapple with the complexity of ambiguity, and most importantly for families as they wait for news.

    I started working in missing persons 18 years ago, and very early on a family reminded me that it was ‘the hope that hurts’. Collaborating with families on this project brought that home once again, however this time we can provide a tangible tool to navigate that hope, provide respite and offer connection when the outcome remains uncertain.

    The cards can be purchased from here (including the option to gift a set to a family that may not be able to afford the investment)

    • Feature image: Loren speaks on ABC News Breakfast about the project. Picture: Supplied

    The post Missing: a journey of both hopefulness and hopelessness appeared first on BroadAgenda.

    This post was originally published on BroadAgenda.

  • Want to do a PhD about cyberhate against female athletes?

    Remember when AFLW Carlton forward Tayla Harris got predator trolled simply for doing her job? 

    In case your memory needs jogging, back in 2019 a photograph taken by AFL Media senior photographer Michael Willson depicted Harris’ powerful kicking style, became subject to floods of vile online commentary.

    At the time, Harris correctly identified the harassment as “sexual abuse on social media“. In other words, she was sustaining an injury in an unsafe workplace. And this made what happened an occupational health and safety issue – not just for her, but potentially for every athlete. 

    For anyone interested in enrolling in a full-time PhD from February 2023, the University of Canberra is offering a scholarship to research ‘Online trolling and e-safety: Women athletes and women working in the sports industry’ together with Sport Integrity Australia.

    The Information session on the Women in Sports Industry partnership scholarships, will be held in person and on-line.

    Where: Clive Price Suite (1C50) @University of Canberra When: 27 September 5:30 until 7pm AEST

    What: Meet our industry partners and researchers, hear about our research in Women in Sport, and discuss your career goals

    Register your attendance by emailing UCSportStrategy@canberra.edu.au 

    Cyberhate in Australia is no small matter. The nationally representative polling I commissioned from the Australia Institute in 2018 found the upper cost of cyberhate and online harassment to the Australian economy is $3.7 billion. That figure only counts lost income and medical expenses — so the real cost is far greater.

    The same polling also showed women were more likely to report receiving threats of sexual assault, violence or death; incitement of others to stalk or threaten them in real life; unwanted sexual messages and publication of their personal details.

    Research around the world also repeatedly finds people of colour are attacked more. It further illustrates that being both a woman and a POC makes you extra vulnerable on the Internet. 

    As I discuss in my best-selling book, Troll Hunting, we know women in the public eye – people including but not limited to: journalists, politicians and sportspeople – are frequently subject to extreme and ongoing cyberhate that leads to real-life harm. In the most egregious cases, they may be killed. 

    Once I started investigating and reporting on cyberhate in the Australian press back in 2015, Aussie women in sport started telling me their own stories of being hunted online.

    These women were not just elite athletes like Tayla, but also female umpires, sports journalists and administrators.

    Heather Reid was the former CEO of Capital Football in the ACT. She gave up her career because of extreme and sustained cyberhate, and her organisation did very little to support her. 

    Although Reid had her day in court and won, her life was impacted in ways the justice system could never repair. She moved away from Canberra – a city she loved – with her partner. Reid also suffered extreme, ongoing health impacts as a result of stress associated with the vitriolic and homophobic online hatred against her.  

    Back in 2015, she told me: “This is my workplace and nobody should have to put up with abuse or harassment at work.”

    One last example: Freelance sports journalist and academic Kate O’Halloran has been the target of trolls on numerous occasions. At one stage, the predator trolling was so severe, O’Hallaron found herself afraid to leave the house. 

    Like Reid, she cops abuse that not only targets her gender, but her sexuality.

    Myself and my colleagues at the University of Canberra concur with Harris, Reid and O’Halloran; we do not believe your gender – or sexuality – should make you unsafe at work (or destroy your career).

    What we would like to know is: What’s the scale of this abuse against female athletes, non-binary folks and those working in the sports industry? What forms does gendered abuse take online? Most importantly, how can we stop it?  

    Dr Catherine Ordway lectures in sports integrity and ethics at the University of Canberra. (She’ll also be your primary supervisor if you successfully win this scholarship to investigate cyberhate against female and non-binary athletes. I’m also on the advisory panel!)

    Dr Ordway says: “Cyber violence against women and girls has now being recognised as, not only a work, health and safety issue, but a broader human rights issue.  Sport was designed by and for men. 

    “The deepest level of toxic, misogynist attacks are reserved for women who ‘dare’ to play, watch and work in sport – particularly if they are non-white, non-binary, and/or non-conformist in the cis heteronormative mould of femininity”.

    C’mon. Use the email address above to register your interest. You know you want to! (And it’s important you do.)

    This PhD research is proudly supported by the 50/50 by 2030 Foundation at the University of Canberra (home of BroadAgenda, publisher of this article!)

     

    Feature image at top: Women soccer players in a team doing the plank fitness exercise in training together on a practice sports field. Picture: Shutterstock 

     

    The post Want to do a PhD about cyberhate against female athletes? appeared first on BroadAgenda.

  • Psychologist believes we’ve been told devastating lies about mental health

    By: Sanah Ahsan

    We are living, we’re told, through a “mental health crisis”. Mental health services cannot cope with the explosion of demand over the past two years: 1.6 million people are on waiting lists, while another 8 million need help but can’t even get on these lists. Even children are showing up at A&E in despair, wanting to die.

    But there is another way to see this crisis – one that doesn’t place it firmly in the realm of the medical system. Doesn’t it make sense that so many of us are suffering? Of course it does: we are living in a traumatising and uncertain world. The climate is breaking down, we’re trying to stay on top of rising living costs, still weighted with grief, contagion and isolation, while revelations about the police murdering women and strip-searching children shatter our faith in those who are supposed to protect us.

    As a clinical psychologist who has been working in NHS services for a decade, I’ve seen first hand how we are failing people by locating their problems within them as some kind of mental disorder or psychological issue, and thereby depoliticising their distress. Will six sessions of CBT, designed to target “unhelpful” thinking styles, really be effective for someone who doesn’t know how they’re going to feed their family for another week? Antidepressants aren’t going to eradicate the relentless racial trauma a black man is surviving in a hostile workplace, and branding people who are enduring sexual violence with a psychiatric disorder (in a world where two women a week are murdered in their own home) does nothing to keep them safe. Unsurprisingly, mindfulness isn’t helping children who are navigating poverty, peer pressure and competitive exam-driven school conditions, where bullying and social media harm are rife.

    If a plant were wilting we wouldn’t diagnose it with “wilting-plant-syndrome” – we would change its conditions.

    Yet when humans are suffering under unliveable conditions, we’re told something is wrong with us, and expected to keep pushing through. To keep working and producing, without acknowledging our hurt.

    In efforts to destigmatise mental distress, “mental illness” is framed as an “illness like any other” – rooted in supposedly flawed brain chemistry. In reality, recent research concluded that depression is not caused by a chemical imbalance of the brain. Ironically, suggesting we have a broken brain for life increases stigma and disempowerment. What’s most devastating about this myth is that the problem and the solution are positioned in the person, distracting us from the environments that cause our distress.

    Individual therapy is brilliant for lots of people, and antidepressants can help some people cope. But I worry that a purely medicalised, individualised understanding of mental health puts plasters over big gaping wounds, without addressing the source of violence. They encourage us to adapt to systems, thereby protecting the status quo. It is here that we fail marginalised people the most: Black people’s understandable expressions of hurt at living in a structurally racist society are too often medicalised, labelled dangerous and met with violence under the guise of “care”. Black people are more likely to be Tasered, sectioned, restrained and over-medicated than anyone else in our mental health services today.

    The UK could learn a lot from liberation psychology. Founded in the 1980s by the Salvadorian activist and psychologist Ignacio Martín Baró, it argues that we cannot isolate “mental health problems” from our broader societal structures. Suffering emerges within people’s experiences and histories of oppression. Liberation psychology sees people not as patients, but potential social actors in the project of freedom, valuing their own lineages, creativity and experience, rather than being forced into a white, eurocentric and individualistic idea of therapy. It directly challenges the social, cultural and political causes of distress through collective social action.

    This framework makes complete sense when we hear that the pandemic in the UK has affected poor people’s mental health most. Does it mean wealthy, privileged white men don’t experience suffering? Of course they do. We’re still learning about the complicated ways these structural issues affect our everyday lives. For example, how the pressures of individualism and capitalism may lead to isolation and substance abuse, or how colonial violence towards immigrant families plays out within homes and on bodies.

    Let me be clear, I’m not saying people in distress should be out there on the picket line.

    Pain can be debilitating. But those of us who are supporting people in distress, such as mental health workers, have a key role in social transformation. Social action is the medicine that relieves people’s personal and collective distress.

    Instead of trying to change “mindsets” in therapy, we need to change race- and class-based hierarchies, the housing and economic system. Universal basic income has psychological benefits, and recent studies show how it improves the “crises of anxiety and depression”. As a clinical psychologist, some of my most powerful work has been not in the therapy room but in successfully advocating for secure housing for, or working in the community with, queer, black and brown facilitators in organisations such as Beyond Equality, to prevent gender-based violence. The network Psychologists for Social Change shows us a practical imagining of this work. We also need social change that is preventive, such as investing in young people and community-led services such as healing justice london and 4front. They work to shift trauma in marginalised communities through building social connectedness, social action and creativity, towards futures free of violence.

    None of this is to dismiss the value of one-on-one therapy (that’s part of my job, after all). But therapy must be a place where oppression is examined, where the focus isn’t to simply reduce distress, but to see it as a survival response to an oppressive world. And ultimately, I’d like to see a world where we need fewer therapists. A culture that reclaims and embraces each other’s madness. Where we take the courageous (and sometimes skin-crawling) risk of turning to each other in our understandable, messy pain.

    Meaningful structural transformation won’t happen overnight, though the pandemic taught us that big changes can happen pretty quickly. But change won’t happen without us: our distress might even be a sign of health – a telling indicator of where we can collectively resist the structures that are hurting so many of us.

    To return to the plant analogy – we must look at our conditions. The water might be a universal basic income, the sun safe, affordable housing and easy access to nature and creativity. Food could be loving relationships, community or social support services. The most effective therapy would be transforming the oppressive aspects of society causing our pain. We all need to take whatever support is available to help us survive another day. Life is hard. But if we could transform the soil, access sunlight, nurture our interconnected roots and have room for our leaves to unfurl, wouldn’t life be a little more livable?

    This post was originally published on Basic Income Today.

  • The isolation of being transgender: How I got here

    Nothing to Hide is Australia’s first mainstream anthology of trans and gender diverse writing. In this excerpt, Stacey Stokes writes about her tough and painful journey to become a woman. This excerpt is published with full permission. 

    Content notification: This post discusses sexual violence, stigmatisation and discrimination based on a person’s gender identity.

    When I was three years old, I started wearing my sister’s old dresses. They seemed so pretty to me. My favourite was the colour of a Cherry Ripe wrapper. The soft satin felt nice on my skin, and I loved the way it swirled around my legs. My parents must’ve told me that I wasn’t allowed to wear dresses because I hid them in a box deep inside an unused wardrobe, and wore them only when I thought I was alone.

    One night, I went to my hidey spot and discovered that all my pretty dresses were gone. Who had taken them? Did they know that I’d put them there? I didn’t know. I was devastated, and afraid that I’d be told off by my dad at any moment for my secret, lost collection.

    After all my pretty clothes had been taken away, I had to find new forms of beauty. Like fire. I loved the way that I could make it appear whenever I wanted and watch it dance around in its beau­tiful red colours.

    When I was four, I set fire to the lounge room by inserting rolled up paper into the pilot light of the wall heater, then using the lit paper to make little fires on the carpet. My parents asked me if I had set the fire, but I shook my head. Then they asked who did it. ‘A little boy with brown hair, a Transformers T­shirt and grey pants,’ I replied. That’s what I was wearing, of course, but I was no little boy.

    When I started primary school, I’d choose to play the princess in make­ believe games with the boys. It didn’t make me popular. I liked playing with the girls, but soon they began to exclude me too. I started to hate school, and did everything I could to avoid it.

    One school day, I told my mum that I was sick, and I stayed at home alone watching daytime television. Mum was doing the washing, dad was at work and my brother and sister had gone to school, so I had the run of the house.

    I sat cross­legged in the lounge room with the sun streaming in, watching our old boxy TV that looked like it had been sitting there since the Cold War era. TV was my window into the real world. At 12 o’clock, Jerry Springer came on. It was an episode about transgender people, and the audience cruelly pointed and laughed at all the guests. It hurt me terribly to see them being laughed at.

    At the end of the show, Jerry talked about being transgender. He said, ‘If you want to be a girl, then you can be a girl. All you have to do is want it enough.’ So every night before I went to sleep, I concentrated as hard as I could on my dream of being a girl. But every morning, I woke up to find that I still had a penis.

    My penis was so embarrassing to me. It was a dark and horrible shame that I didn’t want anyone to know about. When I dressed in trousers to go to school, I’d tuck it back and pretend it didn’t exist. I’d never, ever wear shorts, even in summer, because I couldn’t stand the sight of my little bulge. I refused to participate in sports carnivals, because they insisted that everyone wear shorts. I never even learnt to swim because I’d never,ever wear bathers.

    My mum is bipolar, and she was always in and out of psychi­ atric wards when I was growing up. In fact, a family member told me I was conceived in one. My mum’s condition had a large influence on everyone in my family, but challenged her the most. She’s a smart, caring and non­judgmental person who was deeply maternal, but the medication the doctors put her on really dumbed her down.

    When the meds stopped working or when she’d refuse to take them she’d get sad and cry a lot, or would stay up all night babbling on about things that made no sense, and laugh hysterically. My dad was deeply avoidant and just buried himself in his work.

    Nothing to Hide: Voices of Trans and Gender Diverse Australia

    Cover image: Nothing to Hide: Voices of Trans and Gender Diverse Australia. Picture: Supplied

    When I was 10, my parents separated for good. My mum took me up to NSW and my sister stayed in Victoria with Dad. I got sent back down to Victoria to see Dad from time to time, but I didn’t know how to act like a proper boy, which I knew I had to do in front of him. It made me feel awkward and withdrawn. My mum was either dumbed down from her medication or she was in hospital. I felt so alone, with no one I could tell my secrets to.

    I started missing so much school that the truancy officers started knocking on our door. My dad was so worried that I was falling behind that he got a Family Court order to say that I had to see a child psychologist. When I went to their office, the psychologist held up a picture of two dogs having sex and asked me if anyone had ever done that to me.

    My first thought was, ‘No, this is the first time an adult has shown me pictures of animals having sex, you pervert!’ They didn’t ask me anything about wanting to be a girl, and I didn’t know how to bring it up. They declared me a strange, troubled boy, and sent me back to Victoria to live with my dad and my sister.

    When I got back to Victoria, my sister told me I was gay. She tried to tell me that it was okay to be gay, and that I shouldn’t be ashamed. I kept telling her I wasn’t gay, but she didn’t believe me.

    Her boyfriend at the time wasn’t as nice about it. He called me ‘fag boy’, and would stick his tongue in my ear and ask me if I liked it. I didn’t, it made me feel upset and dirty. My dad joined in, and started calling me ‘poofter’ as a nickname.

    My dad decided I needed to be toughened up, and he sent me to a Catholic boarding school, wherethey trained us to be ‘Christian soldiers’. All weekend, we were made to march or pray to Jesus. I didn’t fit in, and the boys kept themselves entertained by taunting me. They covered me in shaving cream while I was sleeping and heated up bits of metal with lighters, burning me with them, which scarred me for life. It got so bad that I ran away from school one night and slept in a public toilet. I called my mum the next day, and she drove down from NSW to come and get me.

    I think my dad gave up on me after that. Back at Mum’s, I enrolled in a new school, which I was hoping would be a fresh start. I decided to make myself over as a ‘metal head’. I grew my hair long and got a guitar that I never did learn how to play. I would blast ‘Cemetery Gates’ by Pantera so loud that sometimes the police would come round to tell me to turn it off. I started smoking and drinking, and Ioften hosted drunken parties at my place when Mum was in the psychiatric unit. I stopped eating and lived off coffee and alcohol, and I lost heaps of weight.

    Eventually people started mistaking me for a girl because I was so skinny and long­haired. Whenpeople got a better look at me they would all react differently; girls would usually say sorry, assuming they’d offended me. Guys would do adouble­take and then call me a ‘fucking faggot’.

    When they pointed and yelled this at me out of car windows, it reminded me of the audience on the Jerry Springer show, treating the transgender people like circus freaks. I imagined how much worse things could be if I actually transitioned.

    Eventually, I dropped out of school altogether. I stayed up all night drinking and smoking and playing PlayStation. Somehow, I got a girlfriend, and for the first time in my life I felt I finally had someone I could trust. She would come over, stay the night, get changed into her school clothes and go to school, leaving her orig­inal outfit behind. All her clothes fit me really nicely, which I’d wear alone in the house while she was away. I thought I looked pretty nice, and things were going well between us. I even started to consider telling her about the real me.

    Instead, one night she looked at me and told me she wanted to cut off my hair. ‘It looks too girly,’ she said. ‘What’s wrong with that?’ I replied. She disclosed to me that her dad, who was no longer in her life, had had a ‘sex change’ just before she’d met me.

    She said that she’d never forgiven her dad, and that she’d sent him a letter telling him that she hated him and wanted nothing to do with him. While she told me this story, she kept using ‘him’ over and over again.

    ‘He’s dead to me,’ she said as she ended her story. I was devastated to discover that the first person I felt I could trust hated transgender people. I felt more alone than ever.

    I started to feel that my body was a stranger’s. I hated what I saw in the mirror. I didn’t know who Iwas or what to do, so I just drank, smoked and slept with every girl I came across. My girl­ friend and Isplit up, and I moved up to Newcastle. In 2000, I was such a drunken mess that when the Olympic torch went right past my flat, I was too smashed to even stick my head out the window and look.

    My flat was practically empty of furniture, and there was even a bullet hole in one of the windows thanks to some local criminals who did a drive­by shooting at my house after I pissed them off somehow. When 9/11 happened I only found out because they interrupted DragonBall Z—the only show I’d wake up before midday to watch—to show the footage.

    I had a new girlfriend by then. I often asked her to dress me up in her clothes, which were little miniskirts and tight cocktail dresses. My favourite was a green velvet dress that I paired with some knee­ high boots. She said I looked better in it than she did, which meant a lot to me, but we ended up splitting up because of my drinking.

    My dad put a lot of pressure on me to move back to Victoria, because he was worried that I’d die or end up in jail if I stayed in Newcastle. He gave me a job in his office, where my brother also worked, and I got to know him a little. I told him that Dad thought I was gay, which really frustrated me because I knew that I liked girls.

    Determined to prove how not gay I was, I slept with every girl that I could. I even called my dad to tell him I wouldn’t be coming into work as I’d torn my penis during sex. My brother, who overheard the conversation, drove over to see if that could really happen, and went really pale after seeing all the blood.

    I eventually got sick of my dad’s homophobic taunts, and decided to try and get my high school certificate at Victoria University. I made some nice female friends who also thought I was gay, mainly because I had stopped trying to have sex with women all the time. I had replaced that addiction with playing World of Warcraft obses­ sively as a female character. My beautiful avatar was a Night Elf, who was tall with long, platinum blonde hair past her waist, and an ever­changing array of dresses that noone could take off her.

    A beautiful girl started coming over and just sitting with me while I played World of Warcraft. She called me at night and we’d have long phone conversations, talking about anything and everything, and that’s how I started falling in love with her. She seemed to truly care about me.

    We started dating, and soon after I asked her to dress me up in her clothes. She put me in a stunning blue dress that matched my eyes. I asked her if she’d still love me if I was a girl, and she said that she would as long as she could see my beautiful blue eyes. But she didn’t think I was serious.

    Despite my new love, I was still drinking a lot and got arrested for drunkenly climbing the roof of a restaurant, apparently looking for a table with a view. I got charged and pleaded guilty, and copped a big fine.

    My girlfriend became pregnant, and soon we had two beautiful baby girls. We married, and I landed a job as a maritime security officer. I was desperate to get on the straight and narrow to support my family, and I swore off booze and smokes.

    One night, I asked my wife if she’d leave me if I got a sex change. She thought about it, and said that she definitely would.

    I was crushed. It brought me right back to the shame I felt when I’d first seen the audience laughing at Jerry Springer’s transgender guests. I started drinking again. I was passive aggressive, and increasingly painful to be around, as I projected my unhappiness onto everyone around me.

    My house stopped feeling like my home, it just felt like a stranger’s. I had such bad anxiety that I developed an eye twitch and had trouble swallowing food. I kept drinking more and more, and alienated my family through my increasingly toxic behaviour.

    "I started to feel that my body was a stranger’s. I hated what I saw in the mirror," writes Stacey.

    “I started to feel that my body was a stranger’s. I hated what I saw in the mirror,” writes Stacey. Photo: Shutterstock 

    One day, my kid’s teachers got so concerned that they called child protection, who started asking me lots of questions about domestic violence and child abuse. Pretty soon, the police took over asking all the questions, and I ended up in jail.

    When I finally got bail, I moved in with my nan and my mum, who were living together back in Victoria. It was at my nan’s house that I really had time to stop and think about what I’d done, and how I had pushed everyone away with my awful behaviour. I decided that since I was now a complete outcast,I might as well transition after all. How could things get any worse? I went to court back and forth, and disclosed to my defence lawyer that I was transgender.

    My lawyer disclosed this to the judge during my sentencing hearing. The judge said that I wouldn’t have any trouble with that since I wouldn’t have access to women’s clothes anyway. The judge said that I could minimise my harassment by growing a beard, cutting my hair and using my deadname. Basically, don’t be trans and you won’t be harassed. It really made me wonder about how out of touch the people who decide our fates really are.

    In prison, I began an epic battle to receive gender­affirming health care with longstanding help from a community legal service. It took years to get a referral from a doctor to get on hormone replacement therapy, to be allowed female clothing and for staff to refer to me with female pronouns. I’ve been on female hormones for years now, but I am still not allowed to legally change my gender marker as the government says it may ‘offend’ the community. I’ve only stayed sane because of an incredible social worker who has volunteered their time to support me and help me lodge endless paperwork.

    A men’s prison is not a safe place for a trans woman. Since I’ve been inside, I’ve been bullied, bashed and raped. I have nightmares most nights and I have tried to end my life many times. If it wasn’t for the external support I’ve received, I probably would’ve kept on trying until I succeeded.

    Despite the cruelty I’ve been exposed to in prison, I’m still glad that I finally know who I am. I’ve learnt that I can live without alcohol, and that I don’t need sex to make me happy. I am still haunted by some of the things I have done, and I am terribly sorry about the harm I’ve caused to the people who loved me. I wish I had been able to live as my true self when I was younger, as I might’ve been able tospare many people a great deal of pain and projected anger.

    I still haven’t gotten out of prison yet, and some days it’s tough in here. But I am grateful that my body is now mine, and that I am starting to love the person I see in the mirror.

    Nothing to Hide: Voices of Trans and Gender Diverse Australia is out now. 

    • Please note: the photos in this story are stock images. 

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

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    The post The isolation of being transgender: How I got here appeared first on BroadAgenda.

    This post was originally published on BroadAgenda.

  • More than a diagnosis, part 4: a whole-body approach to healing

    Content warning – this article discusses trauma, suicide, self-harm, and substance use. Reader discretion is advised.

    Mental health services in the UK are failing thousands of trauma survivors. Throughout this four-part series, I will be analysing some of the reasons behind this, and looking at some of the potential solutions. In part one, I looked at the current tendency to pathologise emotional distress. Part two considered how our current responses to trauma are often retraumatising, rather than dealing with the root causes of distress. In part three, the focus was on two potential alternatives to our current psychiatric system, and how these could benefit trauma survivors. In this final part I will discuss what is helping me heal from my trauma, and what we can learn from penguins.

    Trauma manifests in the body

    There is a lot of evidence suggesting that trauma can physically manifest in our bodies, not just our brains. Therefore, therapies which focus on thoughts and behaviours – such as Dialectical Behaviour Therapy (DBT) – do not fully address trauma’s complexity. 

    Trauma is multi-sensory. It can come with images, sounds, emotions, smells and sometimes tastes depending on the specific experience. This means it gets ‘stuck’ in our nervous system in the same way it’s originally experienced. When triggered, or when recalling a memory, you can hear, see, and feel things as if they’re happening again for the first time. Your body holds it all in your nervous system in an unfinished, unresolved state. Our bodies keep a physical memory of all of our experiences in the form of physical sensations and unconscious behaviours. 

    Learning from penguins

    I spend a lot of time with penguins which has helped me understand the non-verbal aspects of my trauma. My interpretation of their behaviour comes from linking personal experience, what we know about other wild animals, and conversations with zoo keepers.

    I realised that following traumatic encounters, penguins often appear unscathed. A zoo keeper explained to me that like many other wild animals, when penguins experience trauma in the wild they shake it off. They find somewhere safe and then they literally shake to discharge the trauma from their bodies. This means their nervous system can’t store it – preventing post-trauma responses.

    Unlike penguins, when people experience a lot of trauma, especially in early life, our brain and bodies become conditioned to react in a certain way. The memories, images, sensations and feelings from the original trauma are all linked. When I have flashbacks or remember traumatic memories from my childhood, my whole body reacts and I get the physical sensations as if it’s happening right in that very moment. This is because my body and brain have linked the memories, the sensations, and the emotions. 

    Trauma can often present itself as physical pain. People who have experienced childhood trauma often experience chronic abdominal pain, headaches, chest pain, fainting, and seizure-like episodes. These are all commonly related to a sensitised stress response, meaning that the prior exposure to severe stress leaves an individual in a state which is hyper-responsive to further stressors. Mental health professionals usually label these physical symptoms as ‘functional’ or ‘psychological’. This ignores the role that unhealed trauma plays in those symptoms developing. Therapies which aim to address trauma should focus on the whole body. 

    Therapies which focus on trauma felt in the body

    Eye movement desensitisation and reprocessing (EMDR) therapy is an effective psychological approach which has been proven to help people recover from trauma and other distressing life experiences. It uses bilateral stimulation to aid the integration and processing of painful memories or information. It’s considered a somatic therapy, because it is centred on the idea that trauma memories are stored in the body, and because it allows the release of emotional pain. 

    Most of the time, our bodies can process and store new information and memories without us knowing. Normally, a part of the brain called the hippocampus acts as a sort of filing system which processes and stores memories in the right place. However, if something traumatic happens, such as abuse at a young age, then the hippocampus is unable to do its job properly. It cannot file the memories in the right place. The brain stores them in their raw, unprocessed form. They are easily triggered, and for some people they keep causing distress. Bilateral stimulation, usually through eye movements, is thought to replicate the rapid eye movement stage of sleep, in which the brain processes memories. 

    EMDR is unlike many other types of therapy, as it does not require talking about the distressing memories. It allows the brain to resume its natural healing process, rather than focusing on changing emotions, thoughts or behaviours. This is often one of the biggest problems for abuse survivors. The things we have experienced often feel ‘unspeakable’. Sometimes this is because when the trauma happened, we didn’t have the words to articulate what was happening. Other times it’s because of things like society’s attitudes towards abuse. For me, EMDR means that I don’t have to struggle to find the right words – so far, it’s been far more beneficial than other types of therapy I’ve tried. 

    I am more than a diagnosis

    After years of trying to deal with the effects of my trauma, I finally feel like I’m getting somewhere. I’m extremely lucky to be getting EMDR therapy privately to reprocess my trauma. Along with this, I’m learning about why my body responds the way it does and slowly gaining the skills to regulate my emotions. Finding something that works for me has taken a long time. Although it’s hard, I definitely see the benefits already. A huge part of my journey has been realising I’m not ‘ill’. While I can never forget my trauma, there are things I can do to make it easier to live with. I am more than a diagnosis given to me by someone who hardly knew me. 

    No one should have to experience trauma, and the thought of accessing services should not terrify anyone, let alone retraumatise them. We can’t forget that every single person who’s experienced trauma is different – therapies should reflect that. This means that, sometimes, a whole-body approach is necessary. 

    A never ending ‘mental health crisis’

    Anyone accessing support should have options and feel empowered to question decisions about medication and labels. Services shouldn’t label anyone as ‘difficult’ or ‘too complex’ when they ask for help. Ultimately, this means they won’t be able to access help again in the future. Current NHS therapy focuses on making people ‘well’ enough to function, and therefore work. Having said that, it’s in services to capitalism, rather than individuals working in mental health. 

    We cannot expect anyone to experience violence, trauma, or injustice on a daily basis and carry on as normal. Suffering and distress are understandable, but mental health services don’t want to talk about that. It’s easier for services to label people as ‘ill’ or ‘disordered’ so that they can medicate patients and push them into therapy to make them compliant. Once someone thinks their issues are a personal flaw, they won’t question the wider injustice in society. So, until we start looking beyond a list of symptoms and think about why people are struggling, the ‘mental health crisis’ will never end.

    Featured Image via Amanda Dalbjörn on Unsplash

    By Hannah Green

    This post was originally published on The Canary.

  • More than a diagnosis, part 3: the power of a new perspective

    Content warning – this article discusses trauma, suicide, self-harm, and substance use. Reader discretion is advised.

    Mental health services in the UK are failing thousands of trauma survivors. Throughout this four-part series, I will be analysing some of the reasons behind this, and looking at some of the potential solutions. In part one, I looked at the current tendency to pathologise emotional distress. Part two considered how current treatments to trauma are often retraumatising, rather than dealing with the root causes of distress. In this part I will focus on two potential alternatives to our current psychiatric system, and how these could benefit trauma survivors. Part four will be published shortly.

    What are the alternatives to our current psychiatric system, which – as we have seen previously – diagnoses, medicates and blames? There are many problems with the current system as it is. However, not many people, either working in or accessing the services, realise that there are alternatives. We have to remember that every person who has survived trauma is unique and needs different things to begin healing.

    The Power Threat Meaning framework

    The first potential alternative is the Power Threat Meaning framework (PTMF), which offers an alternative way of viewing emotional distress – one that is not based on psychiatric diagnoses.

    Clinical psychologist Dr Lucy Johnstone, who I spoke to in part one of this series, gave up clinical work in 2016 to finish developing the framework, which was co-produced with a group of 40 professionals and survivors of psychiatry.

    The framework borrows some assumptions from the established trauma literature and, like trauma-informed practice, asks for a change in direction: from asking ‘what’s wrong with you?’ to ‘what’s happened to you?’

    Johnstone explained to me: 

    Not everyone has experienced abuse, or neglect, or other obvious sources of distress – but the framework expands on the trauma informed approach by offering principles that help us to understand why even people without an obvious history of trauma can be severely distressed and struggling.

    The PTMF suggests that non-diagnostic narratives can be based on the following core questions:

    • What happened to you?
    • How did it affect you?
    • What sense did you make of it?
    • How did you survive?
    • What are your strengths? 
    • And to integrate all of the above: what is your story?

    The PMTF is about all of us

    The framework is based on the assumption that all emotional distress is understandable when we view it in the context of a person’s relationships, life events, social circumstances, and the societal standards we are expected to live up to. This means that the PTMF is about all of us. It highlights the strong links between social contexts and personal, family and community distress – especially when there is injustice and inequality involved.  

    We all make meaning out of what happens to us, and this shapes the way we experience and express our distress. The PTMF provides us with tools to create new, hopeful narratives about the reasons for our distress – narratives which are not based on psychiatric diagnoses. 

    Johnstone told me:

    It’s been taken up much more widely than we ever anticipated, both within and outside services. It’s very far from the dominant model, of course, but there are six translations in progress. In Central and Northwest London Trust, a very committed group of clinicians has introduced trauma informed practice supported by the PTMF on two pilot inpatient wards. That was so successful, they’ve now rolled it out across their 14 inpatient wards.

    There’s been a dramatic reduction in levels of seclusion and restraint on those wards, and very significant increases in staff morale. And it’s only early evaluations still, but there is good feedback from inpatients on the wards about how helpful the approach was.

    Redefining reality

    Johnstone continued:

    A lot of people already have a gut feeling that ‘this approach doesn’t work and my distress must be something to do with the difficult things that have happened to me’. So for those people, the PTMF adds an extra degree of validation, and the realisation that. ‘Thank goodness, I’m not alone, I’m allowed to think this and other people are feeling the same’.

    However, as Johnstone explains, some people don’t even get that:

    But also there are many people who never even get offered that explanation at all, and who come across it with astonishment. And sometimes it’s quite upsetting and sometimes it takes a while to get your head around it. But it can also been enormously helpful, if people choose to think about their distress in that way.

    The power of a new perspective

    I came across the PTMF last year, at a time when I was particularly struggling. Previously, I’d only ever thought about the way I was feeling through the lens of the medical model: as ‘symptoms’ and ‘mental illness’. After some friends introduced me to the framework and we had lots of conversations, I realised I’d always viewed myself as ‘ ill’ and ‘disordered’. Over the past year I’ve learnt a lot about trauma responses. I’ve slowly come to realise that the way I’ve responded to my trauma over the years has been perfectly understandable. It’s been really helpful to look at it from a different point of view. To some extent, this stopped me blaming myself for how I was feeling. As Johnstone told me, my experiences are not uncommon:

    Labels and diagnoses can be welcomed, but also found tremendously damaging. For some people, it feels like an explanation. It may give relief from guilt and access to certain services and benefits and that’s fine. But this sometimes comes with a very, very high price. So it’s a powerful way of redefining reality in a way that people aren’t usually given a choice about. They’re told ‘you have bipolar’ or ‘you have a personality disorder’ as though it is an unquestionable fact.

    Trust in the medical system means that some people are actually harmed by diagnoses that don’t take into account the context of their trauma.

    Peer support

    I spoke to Sophie Olson, founder of The Flying Child CIC, in part two of this series. The Flying Child project is a non-profit organisation which aims to bring “lived experience into the heart of professional settings” – its website says:

    Real stories help to break down barriers and dispel myths that lead to victims of abuse being overlooked, and their normal reactions to trauma being misunderstood.

    In addition to this education and training, the organisation is aiming towards providing peer support groups for survivors. It was Olson’s own experiences of peer support groups that led her to want to set up her own for other survivors. The hope and belonging that she found there was not something she’d experienced anywhere else. Olson told me:

    What struck me immediately was that every woman in the room had similar experiences to me. And that was really comforting to look at them and just know that they had experienced sexual violence without hearing them speak. And to know that they knew what that I had as well. I’ve never experienced that before.

    It is clear that a sense of community and connection is really important to each individual starting to heal from their trauma.

    ‘The real me was trapped in trauma’

    Olson continued:

    My secrets were hidden from the outside world, the abused version of me. The real me was like a Russian doll encased in layer after layer of carefully constructed other needs – acceptable versions of myself that are presented to the world. The real me was trapped in trauma.

    When I went into peer support, it was like announcing my abuse without having to say anything at all. Like shedding all of these layers of me and just leaving them at the door and going in as the real me. Which was sort of liberating, but also very exposing. I felt really vulnerable and couldn’t make eye contact with other people. It felt really uneasy at first and I wanted to walk out. But I was also really curious because it was a sensation that I’ve just never had before.

    As Olson explained, being able to connect with people at different stages of their trauma journey can be really helpful:

    So I stayed and I was silent, and I listened to other people talk. I then went on to meet women at another peer support group who were further along in their journey than me. Seeing how they were living their life, despite what had happened to them, and despite the fact that they didn’t have any justice. It was just amazing.

    It took a long time before I was able to live like that, and specialist therapy. But peer support was a really important step up to that. I don’t think I could have done that as successfully as I did without peer support.

    All I needed was a cup of tea, a hug and someone to sit with me. It gave me a huge amount of hope. That kept me going.

    As we have seen so far in the series, NHS approaches to mental health are focused on making individuals “well” enough to go to work, and nothing else. Whereas we should be considering the person as a whole – helping them to feel connected to the world in what can be a really isolating and terrifying time.

    In the final part of the series I will consider the importance of a whole-body approach to healing.

    Featured Image via Instagram – Megan Louise Photography 

    By Hannah Green

    This post was originally published on The Canary.

  • More than a diagnosis, part 2: retraumatising women or dealing with the root cause?

    Content warning – this article discusses trauma, suicide, self-harm, and substance use. Reader discretion is advised.

    Mental health services in the UK are failing thousands of trauma survivors. Throughout this four-part series, I will be analysing some of the reasons behind this, and looking at some of the potential solutions. You can read part one here, where I looked at the current tendency to pathologise emotional distress. In this part, I will be considering how our current responses to trauma often retraumatise patients, rather than dealing with the root causes of distress. Parts three here and four will be out shortly. 

    Often, when people approach – or finally reach – mental health services in distress, they have already reached crisis point. Once they have been labelled and diagnosed, services may view psychiatric medication as the only solution to the crisis. This means unnecessarily medicating trauma survivors.

    Medicating normal responses to human suffering

    Psychiatric medication is often marketed as fixing a chemical imbalance. There is a growing consensus that this claim is insufficiently supported by evidence. This means the whole premise of prescribing antidepressants could be wrong. Services are misinforming people, thereby removing the possibility of fully informed consent.

    Psychiatric medication numbs emotions, which could be helpful in crisis situations. However, services can’t expect people to deal with the root cause of overwhelming emotions if they’re shut off.

    When something triggers my trauma, the feelings are overwhelming. However, if I completely numb those feelings, how would I know what I need to work on in therapy? Triggers point me towards the things that need my attention. 

    If we tell people they need medication to numb their emotions, we’re telling them that their responses and emotions are wrong, rather than them being an understandable response to suffering. 

    When I turned 16, a GP put me on antidepressants after one short appointment. I was having panic attacks which she said was down to a chemical imbalance in my brain, which the medication would fix. She didn’t ask what was triggering them. From that point on, I believed there was something wrong with me, which made the shame and self-blame for what I’d been through as a kid even worse. Obviously the medication didn’t fix anything. For a while it made me numb, until it stopped working. They kept increasing the dosage and eventually changed the medications. Each time it didn’t work, I felt more broken. 

    The psychiatric system is retraumatising women

    I spoke with Sophie Olson, founder of the Flying Child – a non-profit aiming to bring lived experience into the heart of professional settings, such as education. She discussed her experiences of being admitted to an inpatient psychiatric hospital. In her opinion, this was due to the effects of trauma. She told me:

    Mainly I felt misunderstood. The message is really loud and clear that you’re the problem – there’s something wrong with you. There’s an illness, that’s the problem.

    As Dr Jessica Taylor discusses in her book Sexy but Psycho, professionals in positions of power forcibly medicate women to make them compliant – especially in inpatient settings. This can be retraumatising when you have experienced childhood sexual abuse and there are huge power imbalances at play. It also completely ignores the root cause of the distress. Olson continued: 

    I remember being injected with haloperidol [antipsychotic], my distress was just more than they could manage. It’s easier to restrain us in this way than to take the time and to ask, What can we do? What do you need? Tell me what’s going on for you. Can you express why you feel this way? I was extremely distressed.

    Olson explained:

    The chemical restraint by antipsychotics is really terrifying. You feel it taking over your body as it knocks you out and there’s nothing you can do to stop it. It felt like being tortured. The amount of drugs they put us on was unbelievable.

    In the end, I walked away. After 10 years, I could see that nothing made the slightest bit of difference to my state of mind. It was the result of CSA [child sexual abuse] and rape, abuse and emotional abuse, not the result of a chemical imbalance, being disordered or being ill.

    Clearly, inpatient psychiatric hospitals are retraumatising women who have experienced trauma – and even more so when admissions are involuntary. However, therapies outside of psychiatric hospitals can be just as harmful, especially for women with trauma histories.

    Failing to deal with the root cause

    Dialectical behavioural therapy (DBT) is the most common treatment for ‘personality disorders’, and therefore women who have experienced trauma. Dialectic philosophy features several core beliefs. The most important is that two seemingly opposite things can be true at the same time. For example, ‘it’s possible to be angry at someone but still care about them’. 

    The second part of DBT is borrowed from cognitive behavioural therapy (CBT). Both DBT and CBT aim to change thoughts or behaviours that are destructive, damaging or unhelpful. The premise is that because your thoughts cause your emotions, if you change your thoughts you can also change your emotions. This completely dismisses the fact that, subconsciously, triggers often power the emotions of trauma survivors.

    Some people do benefit from DBT, but most of the current evidence base around its efficacy is flawed. This is because it does not separate out the specific needs of survivors. This means that it can be actively harmful for anyone with unaddressed trauma. 

    One of the skills in DBT is recognising and correcting ‘cognitive distortions’, which are:

    unrealistic perceptions and interpretations of what is happening around or inside us.

    For example, DBT would identify ‘they’ll be angry if I make a mistake’ as a thought that makes me panic. However, in my own experiences, these so-called ‘distortions’ are actually my brain’s way of protecting me from potential threats. When we put them in the context of the trauma I’ve experienced, they are understandable. The thoughts that are making me panic are based on previous experience and triggers, rather than ‘cognitive distortions’ and overthinking. When I did something wrong as a kid, people were angry at me. This is based on facts.

    Mental health services which mirror abusive situations

    Radical acceptance, one of the key skills in DBT, is based on the idea that suffering doesn’t come from pain but from our attachment to that pain. It involves a conscious effort to acknowledge difficult situations and emotions – completely accepting things as they are, instead of ignoring them, avoiding them, or wishing the situation were different. 

    In theory, acceptance is an important concept. On the one hand, it’s important that we can accept our trauma, because we can’t change it. At the same time, forcing us to accept things the way they are, but making us respond differently, almost puts the blame on us for perfectly valid emotions. 

    Radical acceptance creates compliance. Teaching someone in distress that they must accept their current situation means they won’t question treatment plans, medication, or involuntary hospitalisations.

    The ideal ‘mental health patient’

    In other words, it creates women who will sit down, shut up and not speak unless spoken to. The ideal ‘mental health patient’ is a woman who will do what she’s told, when she’s told it, in order to be eligible for help. No one should be forced to comply to get their basic human needs met – this mirrors what happens in abusive situations. Just as with abusers, we are told to do what healthcare professionals say and not question, or there will be consequences.

    For example, the withdrawal of warmth is one technique (read, consequence) used in DBT with the aim of making people compliant. Services will stop individuals from accessing their group or therapist if they don’t want to talk about certain things, or if they self harm. Or their therapist might sit back or shift to a more serious tone of voice. It says a lot when mental health services, which individuals are expected to put their trust in, mirror abusive situations. This simply reinforces trauma.

    However, there are alternatives. In part three, I’ll focus both on alternative ways of viewing emotional distress and other approaches to therapy. 

    Featured Image via Instagram – Megan Louise Photography 

    By Hannah Green

    This post was originally published on The Canary.

  • More than a diagnosis, part 1: trauma survivors are being retraumatised by mental health services

    Content warning – this article discusses trauma, suicide, self-harm, and substance use. Reader discretion is advised.

    Mental health services in the UK are failing thousands of trauma survivors. Throughout this four-part series, I will be analysing some of the reasons behind this, and looking at some of the potential solutions. In this first part, I will be looking at the current tendency to pathologise emotional distress. You can read part two here, part three here and part four here.

    The UK’s mental health system is retraumatising survivors by failing to respond to distress appropriately and humanely.

    Trauma is an emotional response to an event or series of events. It is deeply distressing and overwhelms one’s ability to cope. Roughly one in three adults in England report having experienced at least one traumatic event.

    Women who have experienced trauma are diagnosed with personality disorders at much higher rates than the general population. According to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM), 75% of people diagnosed with borderline personality disorders (BPD) are female. 71.1% of people diagnosed with it reported at least one traumatic incident during childhood. Why are services telling people who have experienced unimaginable pain that there is something wrong with them, while failing to address the root cause of their distress? 

    Trauma responses don’t mean illness

    When you have experienced trauma, reactions such as flashbacks, nightmares, fear, self-harm and being hyper alert are natural; although often much stronger. These are how our brain and body keep us safe. Everyone reacts differently to trauma, meaning there’s not one response that wouldn’t be understandable in context. 

    Unfortunately, the NHS – and other services which people are usually directed to if they are in emotional distress – often misses this. This is because most people who have experienced trauma fit the diagnostic criteria for multiple mental health conditions. There is lots of overlap. 

    There is also a tendency within the mental health system to start with a diagnosis from the first signs of distress. Whilst this might provide some people with validation, it can be unhelpful for many trauma survivors. Complex trauma can lead to shame, guilt, and believing that you are at fault for what you’ve experienced. When services then diagnose you with mental health conditions, or tell you that you are disordered, you start to believe there is something fundamentally wrong with you. 

    From the age of 16, I have had several different psychiatric diagnoses – the mental health team settled on ‘post-traumatic stress disorder’ (PTSD) in 2018. Even the word ‘disorder’ meant that I started to believe that my trauma responses were the problem. This only made things worse for me. I now know that’s not the case, and that my body and brain have simply adapted to extreme circumstances and the ridiculous levels of stress over many years, in a perfectly normal way.

    Emotional distress doesn’t need pathologising

    There have been many reports of a current mental health crisis among young people during the pandemic. However, the distress that young people are experiencing, and their emotional responses to isolation, loneliness, and fear are completely understandable in this context.  

    In Wales, 20% of adults living in the most deprived areas have received mental health treatment, compared to 8% in the least deprived. Suicide rates are two to three times higher in the most deprived neighbourhoods. 

    Living in poverty comes with constant stress. Whether it’s about paying bills you can’t afford, attending frustrating social security appointments or living in unsafe or insecure accommodation, poverty is a significant cause of emotional distress – you feel stuck. Not having the money to do things you enjoy, spend time in nature or connect with other people can also lead to an increase in fear or low mood. The type of society we live in is the biggest determinant of mental health: the more inequalities there are, the more people there will be who struggle with emotional distress as a result. 

    I spoke to Dr Lucy Johnstone, who is a clinical psychologist, trainer, speaker, writer, and long-standing critic of the biomedical model of psychiatry. She told me:

    ‘The trauma-informed literature is extremely valuable. However it does have some limitations. One is that it doesn’t always sufficiently make the links between traumatic events at a personal or family level and the wider conditions of society. The original trauma-informed literature comes from America. It doesn’t seem to me that sufficient connections are always made between personal experiences of trauma, racism and discrimination and so on, and the fact that America is probably the most economically unequal society in the entire world.’

    Identifying trauma early could prevent re-traumatisation from the system

    Child and Adolescent Mental Health Services (CAMHS) diagnosed me with ‘generalised anxiety disorder’ and ‘depression’ when I was 17, after one phone call. I only had a couple of appointments with them before I turned 18. They never asked me what was causing my panic attacks, or why I wanted to kill myself. 

    Dr Johnstone told me:

    ‘A defining moment is the one when you are turned from a person with problems to a patient with an illness.’

    One conversation sticks in my mind. I was trying to explain why I kept walking out of lessons at college. I know now that one of my teachers was a huge trigger. But at the time, I didn’t understand what was happening. I told her it was because I was “remembering” and “I couldn’t stop it happening”.

    She shut me down. She told me that I was walking out of lessons because I was panicking about remembering answers to questions. I didn’t have the words to tell her she was wrong. I knew then that I couldn’t try to tell anyone else what was going on.

    Reframing women’s distress

    In the UK, 20-36% of girls are sexually abused in childhood, and 20% of women have been sexually assaulted or raped after the age of 16. Most women have also experienced some form of sexual harassment, bullying or threats, witnessed something traumatic, or lost someone they cared about. On top of this, women also exist within the patriarchy – a system that has always positioned them as ‘less than’. 

    By taking a trauma-informed perspective, and given what we know about society, we would understand that behaviours, thoughts, and feelings that women and girls develop, make sense in the context of what they are up against. However, the current system reframes these as mental illness, including personality disorders. By convincing women and girls that their responses are in fact ‘disorders’ and that there is something wrong with them, isn’t this just another form of victim blaming? 

    Until recently, I didn’t understand most of my trauma responses. Like 42% of women surveyed by VictimFocus, I didn’t have enough information about my own trauma responses or coping mechanisms. If women experience distress after trauma – but don’t have the knowledge or tools to understand it, the chances are that they won’t know to question a psychiatric diagnosis. 

    Once you have a diagnosis of a personality disorder, you are often known to health services as manipulative, deceitful and emotionally unstable. Many health and social services in the UK – including the emergency services – now ‘flag’ women who have a personality disorder diagnosis as high risk, without their knowledge. This often leads to services believing women are exaggerating or unreliable when they ask for help. 

    ‘Too unstable for therapy’

    My best friend Leah had been given a diagnosis of BPD because of her frequent self harm, alcohol use, ‘risk taking behaviour’ and ‘difficulty managing strong emotions’. These are all in the diagnostic criteria for BPD.

    Because of her early experiences of complex trauma, she never gained the skills to manage her emotions. She learnt to hide them, keep secrets and self-destruct – which she carried into adulthood. The diagnosis (among all the others they gave) placed the blame on her for dealing with emotions inappropriately. This meant that professionals constantly put her in this box. They dismissed her trauma and told her she was ‘too complex’ for help. 

    Services told Leah she was too unstable for therapy. But how could they expect her to handle her trauma, when no one would help her? They judged her choices without knowing what options she had to begin with. She did the best she could, with what she had. Ultimately, the lack of support led to her death. My story is very similar to Leah’s, and I feel extremely lucky that I wasn’t given the same label. 

    For the second article in the series, I’ll be looking at why current approaches to therapy after trauma are often retraumatising, and fail to deal with the root cause of distress.  

    Featured Image via Instagram – Megan Louise Photography 

    By Hannah Green

    This post was originally published on The Canary.

  • Police have finally admitted that Oladeji Omishore was just carrying a lighter when they Tasered him

    On 4 June 2022, Oladeji Omishore fell to his death off Chelsea Bridge after police Tasered him multiple times. Initial police reports claimed that Omishore was “armed with a screwdriver”. But on 21 June, police watchdog the Independent Office for Police Conduct (IOPC) revealed that Omishore was only holding a cigarette lighter.

    This serious case of police misinformation shows that we can never trust what officers say when it comes to deaths following police contact or use of force. Particularly if their victims are Black and experiencing a mental health crisis.

    The death of Oladeji Omishore

    On 4 June, Metropolitan Police officers Tasered Omishore several times on Chelsea Bridge in London. In an attempt to escape the police’s advances, Omishore jumped into the River Thames. He died in hospital later that day.

    In a press statement regarding the fatal incident, the Met claimed that Omishore was “armed with a screwdriver”. However, on 21 June, the IOPC released a statement explaining that Omishore was actually carrying a cigarette lighter when officers attacked him.

    Expressing the ‘deep distress’ caused by their loved one’s untimely death, Omishore’s family said in a statement:

    Deji was clearly suffering from a mental health crisis and he was vulnerable and frightened. We have set out our concerns to the IOPC about how the officers communicated with him, their repeated use of force on him, and its impact.

    They added:

    We sincerely hope that the IOPC investigation, and ultimately the inquest, will hold the Metropolitan Police accountable for their actions and also shed further light on the very necessary policy and social justice changes that we need to see.

    The IOPC investigation into Omishore’s death is ongoing. Omishore’s family is now fighting for the IOPC to include the Met’s misinformation regarding the cigarette lighter in the terms of reference of the watchdog’s investigation of the police.

    Omishore’s family are also calling for the IOPC to investigate the officers involved for misconduct, and have expressed concern that they are still on active duty.

    Excessive and disproportionate use of force

    INQUEST – a charity which supports victims and bereaved families affected by state violence – is working to support Omishore’s family.

    In a statement regarding the incident, senior casewoker at INQUEST Selen Cavcav said:

    Deji’s death is part of a longstanding pattern of the disproportionate use of force against Black men by police, particularly those in mental health crisis.

    Indeed, Home Office data shows that in 2020, police in England and Wales were five times more likely to use force against Black people than their white counterparts.

    And according to BBC data, 8% of people who died in custody between 2008 and 2018-19 in England and Wales were racialised as Black, despite making up just 3% of the population.

    As Omishore’s family highlighted in their statement, in August 2021 the IOPC published a review of 101 cases involving the police’s use of Tasers in England and Wales between 2015 and 2020. In this report, the watchdog raised concerns about the police’s disproportionate and inappropriate use of the electronic weapon against Black people and people experiencing a mental health crisis.

    Police continue to target Black people with force. This is rooted in false, racist, and dehumanising narratives which frame Black men as inherently ‘criminal’, violent threats. This is compounded by ableist and punitive approaches to mental health.

    Misinformation

    Initial reports framed Omishore as a violent threat, not a vulnerable man in need of support.

    In INQUEST’s statement, Cavcav said:

    Misinformation and false narratives immediately following a death are a common tactic which deflect attention from serious public concern, and protect police from necessary criticism. These tactics must be independently investigated along with the wider circumstances of the death.

    This is another example of the police’s use of misinformation to justify deaths following police contact and police use of force.

    We saw this in the case of Lewis Skelton, who Humberside Police fatally shot in the back, then falsely framed as “aggressive”. And, when Bristol police officers told a “rather different” story from the reality reflected in CCTV footage of them Tasering an autistic man in 2018. We can’t always rely on footage, as there have been a number of cases of police withholding bodycam footage from bereaved families and the general public.

    Meanwhile, in 2017, health charities found the Police Federation to be spreading misinformation to justify officers’ brutal use of spit hoods.

    All this undoubtably contributes to the police’s ability to escape accountability time and time again when it comes to deaths in police custody and cases of police use of force, particularly against vulnerable and marginalised people. By actively denying bereaved families access to any form of truth, justice and closure, the police and those who protect them are exacerbating the pain and trauma of losing a loved one to state violence.

    The police don’t protect us

    In spite of evidence of the harm they can cause, the Home Office announced in 2019 that it would spend £10m on arming more police officers with the electronic weapon. This money would be better invested into public infrastructures of care – which the state has savagely defunded over the last decade – such as mental health services.

    Meanwhile, the Police, Crime, Sentencing and Courts Act – which the queen granted royal assent on 28 April 2022 – gives the police more powers and even less accountability. This will further harm people who already overpoliced, including Black men and those experiencing a mental health crisis.

    One thing’s for certain: the police don’t protect the public. They only protect themselves. We must rally together to defend our rights and protect our communities from all forms of state violence and authoritarianism.

    Featured image via INQUEST

    By Sophia Purdy-Moore

  • It’s frightening what happens to patients in Australia’s mental health units. Change is overdue | Simon Katterl

    Embedding our existing human rights laws into Victoria’s mental health system is long overdue and holds great promise

    Out the front of every psychiatric unit, before starting work, I would take a Valium, beta blockers (to rest my heart rate) and keep some smokes on hand. Being an advocate for people on compulsory treatment orders across most metropolitan psychiatric units was a scary experience, but not for the reasons you’ve been taught to believe.

    Violence pervades mental health units. But unlike what you’ve been told in the media, most of it is done to people with lived experience of mental health challenges.

    Continue reading…

    This post was originally published on Human rights | The Guardian.

  • The suffocating blanket of heteronormativity

    Look around you. Men and women couple up on TV shows like Love Island for millions of viewers. The latest Hello Fresh ad shows Mum cooking dinner for her husband and two children. You see a friend’s baby and coo “oh, he’ll break a lot of girls’ hearts when he’s older!” because even toddlers cannot escape the expectations of heteronormativity.

    Heteronormativity is defined as: “the privileged and normalized view of heterosexuality.” It is a social and cultural expectation of straightness and gender conformity.

    The term describes a system that harms queer people because firstly, it assumes we do not exist and seocndly, it demands that we suffocate part of our identity to engage with the world around us.

    Not cool – especially when you consider that more than 650,000 Australian adults consider themselves to be lesbian, gay, bisexual or an alternative sexual minority orientation.

    This marginalisation is internalised by queer people. Through the news and media that dominate my screen, the people in my life, and the values I was taught from a young age, I learnt to see myself as straight. Anything other than being straight and cisgender (identifying as the gender you were assigned at birth) was ‘wrong’. 

    For some queer people, this results in a state of ‘unknowing.’ What do I mean? Well, I think of it as a state of mind or being that many queer people may find themselves in. When you are bombarded by heteronormativity at every turn, you may repress your identity to the point that you cannot see yourself as a queer person. 

    I also must point out how this affects the mental health of LGBTQ+ people. In an Australian study conducted last year, “LGBTI people aged 18 and over were over eighteen times more likely to have considered attempting suicide in the previous 12 months.” 

    This is not because of any ‘inherent difference’, rather it might be seen as a consequence of living within a heteronormative, cisnormative society.

    Through conversations I had with other queer people – across generations and identities–I see the sharp edges and suffocating walls of heteronormativity. Here, we make known the state of ‘unknowing’. 

    I reached out to Robin Ladwig, an academic at the University of Canberra doing transdisciplinary research concerning gender and queer studies. Reflecting on heteronormativity, they said: “It means the limited freedom to express my whole self and the consistent evaluation of the possible risk of being discriminated against, stigmatised, or excluded. This is a shared experience with a lot of my transgender and gender diverse research participants.” 

    Robin Ladwig

    Robin Ladwig is a PhD Candidate at the University of Canberra. 

    They also spoke about the pressure this puts on LGBTQ+ people: “It increases the invisibility of gender and sexual diversity” and “..reinforces the social expectations of relationship status.”

    Bi- or pansexual people who “appear” to be in heterosexual relationships are assumed straight. 

    Robin continues: “A gender diverse person might get assigned the opposite gender to their partner, as this seems to be the only logical consequence based on heteronormativity.” Aromantic and asexual people are “pressured” to conform to the expectation that they should desire sex or to be in a relationship. 

    Robin’s words identify some of the ways queer people are asked to erase parts of themselves. I see how this invisibility may lead to the state of ‘unknowing’.  

    Megan Munro is a disabled and queer artist, who produced the Queer Variety Show in Canberra earlier this year. We spoke over Facebook, writing paragraphs back and forth as we shared our experiences with heteronormativity. 

    Megan recalls going to gay clubs once they’d turned 18, but says, “I went as a straight person.” They told me: “If you don’t know it’s a possibility […] you don’t know it could be you.” 

    This small statement spoke to me. In it, Megan captures an essence of ‘unknowing’.

    Even in queer spaces, a queer person who doesn’t know they are queer is denied connection to identity, and denied a space to explore that identity. 

    Megan also describes an afternoon they spent at a friend’s house: “I know now that she spent the entire time hitting on me… but I was so blind to it, I didn’t realise.” This prompts me to reflect on similar experiences; the intense friendship I had with one girl during my last year of school, the first time I went to a club at 18 and danced with a girl. 

    I remember the suffocating panic I felt then, because the lines between ‘unknowing’ and ‘knowing’ were beginning to blur. I had no words to describe these interactions, because I called myself straight. I was not allowed to know myself as queer.

    I asked Megan if they felt a sense of loss for the years that heteronormativity distorted their sense of self. They tell me: “I don’t think I missed out, and never did, really. I wouldn’t have some of the great friends in my life, had I come out early. Plus, the 80s and 90s were very homophobic still, it would’ve been harder in some ways.”

    Heteronormativity and cisnormativity (the assumption that everyone identifies as the gender they were assigned at birth) attempted to erase queerness from the narrative. Megan is in their 50s now, and non-binary. Being trans, they observe, wasn’t really spoken about in the ‘mainstream’ until about ten years ago. 

    Megan Munro as Sparklemuffin, ACT Finalist in the upcoming Mx Burlesque Australia competition. Photo credit: Nathan J. Lester.

    Megan Munro as Sparklemuffin, ACT Finalist in the upcoming Mx Burlesque Australia competition. Photo credit: Nathan J. Lester.

    While explicit homophobia and transphobia are very real dangers, Megan mentions how more subtle instances of heterosexism and cissexism can be just as harmful. We speak about how heteronormativity flattens out perceptions of ongoing oppression of queer communities. 

    Beyond queer people being suspended in a state of unknowing, broader communities do not see your lived experiences once you do know. They may not be able to identify the heteronormative structures that privilege them.

    When Megan came out for the first time in their 30s, they facilitated a Stepping Out program, “for women questioning their sexuality”. Through that they heard many stories from women who grew up under the suffocating blanket of heteronormativity. They often didn’t know they were interested in women until a lightbulb moment sparked something too bright to ignore. 

    Despite our differences in age and identity, I see how the weight of heteronormativity impacted myself, Megan, and the women they worked with in the Stepping Out program. I don’t remember clear lightbulb moments; there were small moments that poked at the edges of my unknowing, but never enough to completely disrupt it. 

    I then reached out to my friend, Imogen, a graphic designer and visual artist based in Meanjin/Brisbane who is a couple of years younger than me. She reflects: “When I was younger [I] just assumed heterosexuality was normal and the only other option was being gay.” 

    Imogen: “Took ages for me to realise that I could be attracted to multiple genders, and having some kind of awareness or visibility around bisexuality then would have helped me to realise that a lot sooner, but I had just never heard of it.”

    Here, Imogen touches on how ‘unknowing’ is not always ignorance of your own feelings. Unknowing is not the absence of knowledge, it may also be a suspension and negotiation. We recognise that something is different, but are unable or unwilling to name the difference. 

    Heteronormativity depends on placing people in precise boxes, on strict binaries and identities. Bisexuality (the capacity for romantic or sexual attraction to more than one gender) blurs these boundaries, so even knowing that straight is not the only option left Imogen feeling untethered for a time. 

    Queer people may feel adrift in a state of unknowing and knowing. The expectation that I was straight meant I was constantly reaching for ways to affirm this projection. Falling in love with boys and repressing my own identity felt like learned behaviours, and became muscle memory. 

    To lift the blanket, stretch your closeted limbs, and let yourself see whatever you want to see is not something we are all in the position to do. Imogen and I know how lucky we are in this. 

    My conversations with Megan and Imogen revealed to me the state of unknowing as one way that heteronormativity impacts the lives of queer people. Examining this unknowing has allowed me to identify the contours and boundaries of heteronormativity, as a structure that has shaped much of our lives. 

    Heteronormativity and cisnormativity leave queer people tightly wound, perhaps convinced of our perceived ‘straightness’ or gender because the world held up a mirror and told us what to see. 

    This is why representation in media that combats heteronormativity is so important. TV shows like Heartstopper, which I wrote about here, are entering the mainstream. My hope is that this representation will help end the state of ‘unknowing’, because young queer people are finally seeing their true selves reflected back at them.

    • Feature image is a stock photo. Jacob Lund/Shutterstock. 

    The post The suffocating blanket of heteronormativity appeared first on BroadAgenda.

    This post was originally published on BroadAgenda.

  • “Mental Health Units” in Prison Are Solitary by Another Name, Activists Say

    Christian Hill has been diagnosed with borderline personality disorder and major depressive disorder. In the New York State prison system, this classifies him as having a serious mental illness and confers a “1-S” designation upon him.

    Under the newly implemented HALT Solitary Confinement Act, people with this mental health designation cannot be punished by being placed in the Special Housing Unit, or SHU, where they would spend at least 17 days alone in their cells. Instead, Hill and others with this designation must be sent to a Residential Mental Health Unit, a prison unit for incarcerated people with serious mental health needs. Jointly operated by the state’s prison agency and its office of mental health, these units are supposed to be therapeutic rather than punitive.

    But despite its therapeutic intention, Hill still spends 20 hours in his cell on weekdays and 24 hours on weekends and holidays. For one hour each day, a door at the back of his cell is opened remotely, allowing him to go into a fenced-off pen adjoining his cell for recreation. “I do a lot of sleeping out of boredom,” Hill wrote in a letter from his Residential Mental Health Unit to Truthout.

    Hill says he’s being punished because of his mental health needs. According to a new report, he’s one of hundreds who are punished despite the state’s laws designed to protect them.

    Residential Mental Health Units Appear No Better Than Solitary

    In April 2022, Hill spent four days in the Intermediate Care Program, a nonpunitive residential mental health treatment unit at Sullivan Correctional Facility. On the fourth day, he was feeling suicidal and asked officers to contact mental health staff so that he could be placed on suicide watch.

    This was not the first time that Hill had expressed suicidal ideation during his 10 years in prison. “This was one of over 300 times I have been in need of or placed on suicide watch,” he wrote, adding that two of his suicide attempts had nearly succeeded. Because of this history, his requests to be placed on suicide watch are usually taken seriously.

    This time, however, Hill said that officers told him, “Go fuck yourself.”

    Hill repeatedly requested mental health staff, but said that officers continued to ignore his requests, eventually telling him to kill himself. Only after Hill threw water out of his cell was he taken to suicide watch, where he was stripped of all his clothing and belongings and placed under 24-hour observation for four days.

    After those four days, staff charged him with several rule violations: assault on staff, violent conduct, engaging in an unhygienic act, threats, creating disturbance and interference with an employee. He was sentenced to 180 days in the SHU. But because of his mental health classification, he is serving his SHU sentence in a Residential Mental Health Unit instead, which offers several hours of programming, including 20 hours of group therapy each week, individual counseling once every 30 days, and a medication review every 90 days.

    Prison officials also punished him with 180 days’ loss of access to commissary, packages and phone calls. This means that, during his time in the Residential Mental Health Unit, he cannot order items from the prison’s commissary (the prison store), receive packages from loved ones, or use the phone.

    Just before he was transferred from Sullivan to the Residential Mental Health Unit at Marcy Correctional Facility, he says he was assaulted during the pre-transfer strip search. When he arrived at Marcy, he was placed in the Residential Mental Health Unit there and charged, separately, with an additional six rule violations, including assault on staff, violent conduct, threats, creating a disturbance and interfering with an employee.

    He was sentenced to an additional 365 days in isolation on those charges and an additional 365 days’ loss of commissary, packages, phone calls and tablet use, which would have allowed him to utilize the prison’s e-messaging system to communicate with loved ones and advocates. For the next 545 days, he can only communicate by writing letters.

    In 2008, four years before Hill entered prison, New York passed the SHU Exclusion Law, limiting solitary for people with serious mental illness. Under the Act, people who have been diagnosed with serious mental illness, such as schizophrenia, major depressive disorder, bipolar disorder and/or active suicidality, can only be placed in the SHU for up to 30 days if they have broken a prison rule.

    After those 30 days, prison officials must divert them to a Residential Mental Health Unit. In these units, separate from the rest of the prison population, people must receive four hours of structured therapeutic programming and mental health treatment five days a week, and disciplinary sanctions for acts such as refusing medication and self-harm are prohibited. The 2008 law also prohibited punishing people in these units with additional isolation except if their conduct “poses a significant and unreasonable risk to the safety of [incarcerated persons] or staff, or to the security of the facility.”

    But, according to a new report by the HALT Solitary and the Mental Health Alternatives to Solitary Confinement campaigns, isolating people as punishment happens fairly frequently. Residential Mental Health Units “essentially have failed to provide an effective and humane therapeutic environment for a large percentage of its residents,” charges the report, entitled “Punishment of People with Serious Mental Illness in New York State Prisons.”

    Reviewing data from January 2017 through May 2019, the report concludes that New York’s state prison system and its Office of Mental Health have not been following the law’s limits on punishment.

    “Although these units are supposed to be therapeutic, they are frequently punitive,” said Jennifer Parish, who is director of criminal justice advocacy at the Urban Justice Center and a founding member of the Mental Health Alternatives to Solitary Confinement campaign. She noted that she has heard frequent complaints from people who have cycled through the SHU and various Residential Mental Health Units and many, she said, “felt they were treated worse than people in the SHU. This is not how this is supposed to work.”

    Hill agrees. He notes that, under the HALT Solitary Act, if he were in typical solitary confinement (i.e., the SHU), he would be allowed his personal property, including his radio, fan, calculator, lamp, hot pot for cooking and prison-issued tablet on which he can send e-messages to family members. But in the Residential Mental Health Unit, he has none of these to help him pass the hours that he spends alone inside his cell.

    Adding Hundreds of Days in Isolation

    In the 1974 case Wolf v. McDonnell, the United States Supreme Court ruled that people in prison have the right to due process under the 14th Amendment — even for hearings involving internal prison rules violations. That same right applies to those in the Residential Mental Health Units, but according to the report, 94 percent of the 1,925 disciplinary hearings held between 2017 and mid-2019 resulted in guilty findings — and the vast majority of people were punished with additional time in isolation. The report also found that the most frequent sanction was for disobeying a direct order (15.2 percent), followed by creating a disturbance (12 percent) and interfering with staff (10 percent).

    Both charges are vague and can encompass behaviors such as shouting or yelling, noted Tyrell Muhammad, a senior advocate at the Correctional Association of New York, a nonprofit that monitors New York’s prisons. The charges can also encompass actions such as watching staff extract a cellmate despite orders to face the wall, or yelling for staff when someone attempts suicide, explained Muhammad, who spent 27 years in New York State prisons, including seven in the SHU.

    “The above are actual incidents that I have experienced and was given disciplinary tickets and a Tier III for,” he said, referring to the highest-level infraction for prison rule violations that carries the most severe penalties. “Many would believe that if one is charged with these types of infractions that [it] is serious to the point where violence was used, [but that] is very rare. These infractions are a form of retaliation. It is usually because someone witness[ed] something and these disciplinary tickets are a way of intimidation.” He and other advocates have noted that staff make the decision on what actions constitute creating a disturbance or interfering with staff.

    In contrast, the report found that fewer than 4 percent of people in Residential Mental Health Units were charged with assault on staff, and fewer than 1 percent were charged with assault on another incarcerated person.

    Despite the lack of severity of the charges, hundreds have been punished with additional isolation. According to the report, of the 399 people in a Residential Mental Health Unit during that time, 99 percent were punished with solitary confinement. Eight-five percent were sentenced to six months or more of additional isolation time. Their total amount of time in isolation came out to more than 823 years with an average of 753 days (or more than two years) for each person.

    In addition to the punitive nature of being confined to their cells for 20 to 24 hours each day, most people in these units are handcuffed when they are escorted to therapy and counseling and, once at their destination, shackled to the floor with leg irons. If they remain free of misbehavior reports or infractions known as “negative informational reports” for 120 days, they are allowed to leave their cells without handcuffs and attend programs without being shackled. They are also moved to a cell with a television mounted on the wall, allowing them to watch TV to break up the monotony. But, Hill says, staff members at the Residential Mental Health Unit frequently write negative informational reports, which do not require a hearing or allow an incarcerated person to defend themselves against allegations of negative behavior. Instead, they must begin their 120 days again.

    The report also charges that people in these units — who are primarily Black and Latinx people with serious mental health needs — have been punished at much higher rates than others in the prison system and frequently because of behavior caused by their underlying mental health conditions.

    Over 80 percent in the Residential Mental Health Units were Black and/or Latinx. Black and Latinx people make up 72 percent of those incarcerated in New York State prisons and 37 percent in the state at large.

    In contrast, white people, such as Hill, comprised 14.5 percent of people in Residential Mental Health Units compared to 24 percent in all New York prisons and nearly 62 percent of the state at large. They also made up nearly 26 percent of people in the Intermediate Care Program, the nonpunitive mental health unit (or, as the report notes, 77 percent higher than white people in the more punitive Residential Mental Health Units.)

    Jack Beck, the report’s author and a member of the HALT Solitary campaign, noted that people sent to the nonpunitive Intermediate Care Program and to the Residential Mental Health Unit have the same serious mental health classifications. “There’s tremendous racial bias in the disciplinary system — and in the whole [Department of Corrections],” he said.

    Punitive Residential Reentry Units

    In 2021, 13 years after the passage of the SHU Exclusion Act, New York’s legislature passed the HALT Solitary Confinement Act, limiting solitary confinement to no more than 15 consecutive days (or 20 days within a 60-day time period).

    The law went into effect on March 31, 2022. It required the creation of Residential Reentry Units where people sentenced to more than 15 days in SHU will be transferred on Day 16. According to the Department of Corrections and Community Services, these units too are meant to “be therapeutic and trauma-informed and aim to address individual treatment, rehabilitation needs, and underlying causes of problematic behavior.”

    People who have serious mental illnesses are not placed in SHU at all and, like Hill, are sent directly to a Residential Mental Health Unit, where they still spend at least 20 hours each day alone in their cells.

    Now, Parish, Beck, and other advocates are concerned that these new Residential Reentry Units will replicate the problem of alternatives that are still punitive rather than therapeutic. “This is a cautionary message,” Beck said of the report and its findings. “If you’re going to have people in these treatment units but you’re going to constantly discipline them, it doesn’t work. It doesn’t change behavior. It’s totally ineffective.”

    The Department of Corrections and Community Supervision did not respond to Truthout’s queries about these units or its policy regarding suicidal ideation.

    The report concludes that the ongoing punitive approach to imprisoned people with mental health needs, even in units designated for these more vulnerable populations, “indicate that prison is not an appropriate environment for people with mental health needs.”

    Its first recommendation exhorts the state to stop incarcerating people with mental health needs. Instead, it urges legislators and policy makers to expand and enhance community-based mental health care, diversion programs, crisis response, and alternatives to incarceration.

    “Jails and prisons can’t provide effective treatment,” Beck told Truthout.

    This post was originally published on Latest – Truthout.

  • Why women are breaking up with the news

    Despite huge and seemingly compelling news events –  the Black Summer bushfires, the global pandemic and a hard-fought election campaign interest in news continues to fall.

    The proportion of those who say they have a high interest in news has dropped, with interest among women falling more than men. Now, more than half of women (54%) in Australia say they have low interest in news. This increases to 67% among women under the age of 25.

    Why are women – particularly young women – turning off from the news? The Digital News Report: Australia 2022, produced by the News & Media Research Centre at the University of Canberra, is an online survey of 2,038 adult Australians conducted in January and February this year, offers some intriguing insights into the differences between what men and women want from news media.

    Since 2016, the proportion of women who have high interest in news has fallen 14 percentage points compared to a 10-percentage point drop among men.

    Furthermore, the number of people avoiding news increased markedly over the years. Now, more than two-thirds (70%) of Australian women say they avoid news. compared to 66% of men.

    Women avoid news because they feel there is too much coverage on subjects like politics and coronavirus (51%) and because it has a negative impact on their mood (47%).

    They are also worn out by the volume of news (34%). Too much newsroom attention going toward topics like conflict-driven party politics may be pushing women away from news altogether. These factors affect younger women more than their male counterparts.

    Figure 1. Reasons for avoiding news (%)

    DN Figure 1

    In anticipation of publishing this article, BroadAgenda Editor Ginger Gorman threw out a tweet asking women why they were avoiding the news. The response was astounding and individual responses frequently mirrored our research findings. Within 24 hours, the tweet gained more than 20-thousand impressions and 200 replies.

    In the tweets, those identifying as women cited numerous reasons for their disillusionment with news, including (but not limited to): distrust in the balance of media reporting, distrust in journalists themselves, sensationalism, bad news fatigue, mental health implications and wanting to protect themselves or their children from upsetting topics.

    Back to our study.

    The reason why women are lighter news consumers compared to men may partly be because mainstream news media are not fulfilling their needs.

    We found considerable differences in the types of news women and men are interested in. Women are more interested than men in news about mental health/wellness, lifestyle, entertainment, coronavirus, and crime/personal security. Men are more interested in news about sport, business/financial/economics, politics, science/technology, and international affairs.

    While women are lighter consumers of national and mainstream news brands, they read their local or regional print newspaper more than men (15% women vs 12% men). They are much more interested in news that affects the local community and have the highest interest in local news among different news topics.

    When it comes to the reasons for consuming news, Australians say it’s their duty to be informed and that they want to learn about new things, men and women alike.

    However, women are less likely to say news is fun and entertaining, or say that it gives them something to talk about with others.

    Figure 2: Reasons for keeping up with news (%)

    DN Figure 2

    Women are generally more concerned about climate change compared to men but younger women are the most concerned; 82% of Gen Z and 83% of Gen Y women are concerned about this issue.  Interestingly, the concern level remains high among older women, whereas for men, the concern drops considerably among those 76+.

    Another interesting finding relates to whether people want journalists to take a position on climate change. On this issue, more than half (58%) of Gen Z women say they would like to see news media taking a clear position rather than reflecting a range of perspectives and leaving it up to people to decide. This indicates a strong demand among younger women for news to play an advocacy role in relation to the environment.

    The #MeToo movement and climate change protests attest to the fact that young women are passionate about community issues that they think are important. They pay attention to those issues and want to see more action from the news media.

    Figure 3: Concern about climate change and beliefs about news media taking a clear action (%)

    DN Figure 3

    Gen Z women are also much more likely than others to say they talked face-to-face with friends and colleagues about a news story (40%) compared to men in the same age group (34%). News stories that are relevant to their social context are more appealing to them.

    This year’s report shows that women have a greater desire for diverse news agendas and topics, particularly around issues that are related to their local communities. Recognising this diversity in tastes and preferences for news is yet another challenge for news outlets. To reach female audiences, particularly the younger cohorts, news media may need to broaden their coverage, and connect with topics that women care about.

     

    • Digital News Report: Australia is produced by the News & Media Research Centre (N&MRC) at the University of Canberra and is part of a global annual survey of digital news consumption in 46 countries, commissioned by the Reuters Institute for the Study of Journalism at the University of Oxford. The survey was conducted by YouGov in January/February 2022. In Australia, this is the eighth annual survey of its kind produced by the N&MRC.

     

    Please note: Feature image is a stock photo.

     

     

    The post Why women are breaking up with the news appeared first on BroadAgenda.

    This post was originally published on BroadAgenda.

  • Towards a Leftist Psychotherapy

    Millions of Britons are suffering from stress-related mental disorders. The number of people with anxiety has been steadily rising for years. According to NHS statistics, more than six million people in the UK are taking antidepressants.

    There is an acceptance that wide-scale mental distress is an unavoidable part of modern life. The general response to the crisis by government bodies and the media is to call for more treatment. While increased support is necessary, the focus on treatment hides the extent to which society is often responsible for personal distress.

    The cause for much of this depression is social and political. Under neoliberal governance, workers have seen their wages stagnate and their working conditions and job security become more precarious. The individualising and privatising forces that underpin capitalism have led to the breakdown of communities and social bonds, leaving millions of people lonely.

    Given the increased reasons for anxiety, it’s not surprising that a large proportion of the population diagnose themselves as chronically miserable. Converting that depression into a political anger is an urgent political project. This should be the job of the left, who are the natural critics of capitalism. I believe that we should develop a kind of ‘leftist psychotherapy’ in which mental distress is explained in relation to the power structures of society.

    In this endeavour the work of British clinical psychologist David Smail (1938-2014) is instructive. His writings provide a searing critique of the psychology establishment, and a social constructivist model for how to better understand mental distress. I believe that building on his work could have a tremendous impact.

    The Role of the Psychology Establishment

    In his seminal text Power, Interest and Psychology, Smail explains how mainstream psychology reinforces the status quo. It does this by diverting us from connecting mental distress to the material circumstances that condition our lives. ‘The psychology establishment has nothing to say about how to apparatus of power and interest that so clearly operates at the level of society comes to be reflected in the subjectivity of individuals – or even whether it does’.

    Psychology has become a technical profession, like chiropody or dietetics, which focuses on the pragmatics of relief rather than on any more abstract intellectual or scientific enterprise. The dominant forms of treatment in mental illness are drugs and therapy.

    Antidepressants contain people’s depression rather than actually deal with the causes of depression. The focus on brain chemistry creates a horrible loop whereby massive multinational pharmaceutical companies sell people drugs in order to cure them from the stresses brought about by working in late capitalism. In this context, the message to patients is cruel; if you’re depressed because of overwork, that’s between you and your brain chemistry!

    Smail was critical of therapy. He suspected that it is only effective to the extent that the therapist becomes a true friend to the client, involved in their world. The supposed process by which people are ‘cured’ of mental illness once they gain ‘insight’ into their problems is illusory, and therapists are to a large extent involved in wishful thinking.

    He argued that therapeutic psychology gives patients a false understanding of reality. The focus on the individual turns ‘the relation of person to world inside out, such that the former becomes the creator of the latter. If the story you find yourself in causes you distress, tell yourself another one’.

    Counsellors and therapists have a stake in maintaining an individualist and idealist account of emotional distress, for only such an account can legitimate the role of professional practitioner. ‘Psychology tries to be objective like a science – explanations of activities or interests undermines the ‘scientific’ rationale for our practice’.

    This is not to say that drugs or therapy are harmful. Being able to talk to someone for an hour in therapy or having something which will take the edge of things via anti-depressants can make people feel better, but it doesn’t get to the sources of that sort of misery in the first place.

    A Sociomaterialist Explanation of Mental Distress

    Smail argued that feelings of well-being fundamentally arise from a public world. And in a society in which the concept of the public has been so viciously and systematically attacked – it’s no surprise, he argues, that distress has increased.

    Interest and power are what determine events in our lives more than we are allowed to acknowledge. ‘The strength and integrity of the subject is determined not (as therapeutic psychology would have us believe) by efforts of individual will, but by the adequacy or otherwise of the environment (including, crucially, the public societal structures) in which it is located.’

    It follows that where public structures are stable, supportive and nurturing, the individual may blossom and flourish; where they disintegrate the subject becomes demoralised and depressed.

    To solve the mental health crisis we must ask broader ethical questions about how we treat each other. ‘We are bodies in a world: of course, in a physical world, but also a socially structured, material space-time in which what we do to each other has enormous importance’.

    A Way Forward

    To solve the mental health crisis it is necessary to critique the social conditions that we live in. Widespread mental illness is a hidden cost of neoliberal capitalism. Market forces have created heightened instability and alienation which has resulted in mass psychological distress.

    The medical establishment reinforces the status quo by privatising stress. Those who struggle to meet the expectations of society are told that the problem is their family background or in the chemical make-up of their brain. There is a case to be made that anti-depressants and therapy are now the opiates of the masses.

    As a collective, there is an urgent need for us to connect mental distress to systems of power and interest. If someone struggles to meet the cost of living, or to cope with the instability of working in the gig economy, it is vital that they understand that millions of other people are suffering for the same reasons.  Those incapacitated by depression and anxiety often feel tremendous guilt and self-loathing.  By connecting their illness to broader social forces, they may apportion less blame to themselves.

    We need to challenge the idea that wide-scale mental distress is an unavoidable part of modern life. The kind of world we want is an ethical choice. We are not bound to accept that the ‘real world’ is one in which the ‘bottom line’ defines what is right and wrong. The ruthless world may be chosen, as it is by the current rulers of the globalised neo-liberal market. It can also be rejected.

    The awareness that neoliberal governance is causing wide-scale mental distress can be a catalyst for social change. The left can drive this process by developing a ‘leftist psychotherapy’ that provides a theoretical framework for how the material conditions that we live in cause mental illness.

    The post Towards a Leftist Psychotherapy first appeared on Dissident Voice.

    This post was originally published on Dissident Voice.

  • I’ve Been in School Mental Health for 10 Years. My Heart Is Breaking Right Now.

    For much of the spring of 2020, I sat on a pink armchair in my bedroom and desperately tried to support the kids and families at the school where I was employed as a part-time social worker. I was armed with a lot, or very little, depending on your perspective: a phone; a laptop; consistent wi-fi; years of graduate school and work experience; compassion, more or less; and a working knowledge of children and the city in which I lived, more or less.

    Many of the families on my caseload spoke of their desperation in the face of new and intensified problems, and the fear, conflict, stress and cloistered chaos that entered their lives in mid-March and then simply remained. Others were unreachable; my calls and emails went unanswered, and teachers reported students who seldom appeared on class Zoom calls, or appeared only as black squares, worryingly silent.

    I remember parents crying as I met their pixelated faces with what I hoped was an expression of empathy and support, itself blurry. Sometimes children themselves articulated their difficulties, choppily, as the connection ebbed. These families spoke of food scarcity; constant strife; schoolwork that was never done; paid work that could not be completed; younger siblings who must be supervised; relatives who were sick or dying; children who wept, raged, or cowered, consumed by worry.

    Sometimes I could offer solutions to these ills, but often I could not; my own children jangled at the doorknob, and I was forced to say, as I ended the conversation, “I’ll make some calls, and let you know,” or “I’m so sorry; that’s so hard.” It hurt, every time, but there was, ultimately so little I could do. It was an intensification of a sensation I’ve had for years: For every student whose life has been improved by my labors, there are those whose challenges are too deeply entrenched for me to help much at all, given the limited resources attached to my role and the tenuousness of the infrastructure our country has to support families — parents, children — facing addiction, mental illness, medical challenges, undiagnosed learning disabilities, poverty, intergenerational trauma or some combination of all of these factors.

    My own school returned to in-person learning a few months later, in September 2020, much to my relief. Some of the problems vanished, seemingly overnight. Some seemed like ripples that died out slowly; some challenges simply stayed. Many other schools remained remote, in some form or another, until fall 2021. (According to the National Center for Education Statistics, only 35 percent of 4th and 8th grade students were fully in person in February 2021.)

    In May of 2022, I spoke to school social workers, counselors and psychologists across the country. I wanted to know about the shape and texture of their working lives during the pandemic. They told me things that were hard to hear, about fundamental shifts in their work.

    “Usually I turn my phone off, but my phone has been really on all the time because I’m worried about this one student,” Marsha Carey, a social worker in a charter high school in a large northeastern city told me, speaking to a dissolution of boundaries that would have been unimaginable to her before the pandemic. “One of my student’s moms died [of COVID-19]…. Sometimes my phone rings at 1, 2 o’clock in the morning, [and I answer because I’m] scared that my student can’t handle it anymore, where she’s suicidal. She doesn’t have a mom anymore, she doesn’t have a dad, her support system is not that great. [I’m] on call 24/7. That’s been very hard. You take it home to your family.”

    I have worked in school mental health for nearly 10 years, and throughout most of the pandemic. So much of what these workers told me — many of whom asked that I use only their first names, or share only general geographic information about their schools, given the sensitive nature of their work — resonated with my own experiences. The workers I interviewed for this piece range in focus from elementary to high school, and they come from public, charter and independent schools. But there was a striking sameness to their observations, as they described the effects of the harm wrought by the twin traumas of COVID-19 (by which I count both disease and economic fallout) and extended remote schooling.

    School counselors and social workers described schools full of children who were, as a group, experiencing developmental delays: “The 9th grade class as a whole is having all these large-scale social issues that are just usually more common in middle school or elementary school,” Kira, a counselor at an independent high school in a mid-Atlantic suburb told Truthout.

    Meanwhile, elementary practitioners told me their children were grappling with developmental struggles typical of preschoolers, and middle school practitioners told me their children were navigating the social, emotional and behavioral terrain of elementary schoolers.

    Students struggle simply to be in class after remote learning. Jamie Spiro, a therapist based in a high school in a large city in Washington State, described the current landscape of her adolescent clients. “I have some students who wear a mask but not because of COVID; they have anxiety around showing their faces.… Doing school by Zoom provided an opportunity to have their screens off. Returning, they had a lot of anxiety about their face being shown, and also some students got used to being in a Zoom class and exiting when they wanted. They’re surprised when they can’t just … leave class.”

    Teachers were ill-equipped to support these challenges. Zoe, an elementary school social worker from central Wisconsin told Truthout that, “Any time a student experiences anything sort of emotional, the teacher takes the approach of ‘I’m maxed out; can you just fix it?’”

    Many people I spoke to were the only counselor or social worker in their school. They all served hundreds of students. As a culture, we have unceremoniously dumped the aftershocks of fear, loss, economic stress, uncertainty and isolation into the laps of thinly stretched professionals.

    Like many, I have worked hard in my time as a social worker to manage my own and others’ expectations of my work. I do not “fix” children; I meet children and caregivers where they are, and support them — perhaps through change, perhaps not. I connect them to outside services and supports when they are available; sometimes such resources do not exist, or are geographically, financially or logistically inaccessible. I can go above and beyond on some days but not all. But when the problems become larger, more numerous, more entrenched, what becomes of your carefully constructed limits, your sense of efficacy?

    Heather Findley, director of mental health services for Holt Public Schools, a suburban and rural district in Michigan, wondered aloud about the impact of the pandemic on Holt’s students and, as a result, on its mental health staff: “How do you ultimately know that it’s not you not doing your job; it’s everything else that’s going on around it that’s impacting that, and how do you not then take that personally and be like ‘I’m not servicing the way I should be?’”

    Breanne, a school counselor in a mid-sized city in Washington State echoed this. “It’s been hard to even just take a day off to take care of yourself because you come back and students are like ‘Where were you,’ and ‘I tried to see you’ and ‘I needed this’ and ‘my family is getting evicted.’… You just feel that sense of responsibility for them but also, you’ve got to take care of yourself because everybody knows you can’t give from an empty tank.”

    Breanne is leaving her role to become an assistant principal, and had a keen understanding of the ways in which the challenges of this moment extended beyond the walls of her school.

    “We feel like we’re on our own in these situations, and even in our district we’ll talk and be like, ‘Maybe it’s just our population,’” she said. “Then we get to statewide events or national conferences online, and hearing these exact same things…. This isn’t isolated, this isn’t just a me thing; it’s not just my population, this is all over the country.”

    And then on the day of my last scheduled interview, a teenager with an AR-15 murdered 19 schoolchildren and two teachers at Robb Elementary School in Uvalde, Texas. The high school social worker in Chicago with whom I had arranged to speak that evening messaged me in the afternoon. “I’m struggling,” she wrote. She was very sorry, and sent me multiple apologies for canceling.

    The day after the shooting in Uvalde, Texas Gov. Greg Abbott — who in April slashed $211 million from the department that oversees mental health programs in his state — said: “We as a state — we as a society — need to do a better job with mental health. Anybody who shoots somebody else has a mental health challenge. Period.”

    These words require some scrutiny as we try to make sense of what this country’s frontline mental health workers have been tasked with over the past 27 months.

    The pandemic followed years of budget cuts to educational institutions and an increasingly frayed infrastructure (if it can even be called that) for addressing youth behavioral health. I absolutely believe in the power of mental health support. Researchers who highlight the value of identifying depressed and potentially violent young men are surely not wrong that the threats these teenagers pose to themselves and others are preventable. But I am increasingly wary of this notion — popular across party lines — that therapy is the tool that will rescue us from pain and dysfunction. (“Counselors not cops!” has become a popular rallying cry in progressive movements to defund the police, and while I agree that counselors are more useful to students than cops, I also have an intimate awareness of the structural barriers that stymie even the best counselors, and the ways that they are often inaccurately presented as a panacea.)

    Introducing mental health into a conversation about patriarchal violence and access to militarized weaponry seems to be a dangerous splinter off of a large, long-held confusion: the idea that counselors, therapists and social workers can fix things. We cannot. We cannot fix the harms wrought by a starkly unequal, violent society. We cannot fix the harms wrought by racism and patriarchy. We can only listen, support, connect, and move those willing closer to change, or toward whatever it is that they seek.

    I am reminded of another delusion of our culture. For years, this country has traded in the lie that the harms of inequality could be erased by fostering grit and resilience within schools. In the absence of a safety net — of universal health care; consistent poverty relief; access to quality, affordable and consistent mental health care; subsidies for families; or even sufficient programs to combat food insecurity — the school reformers of the ’90s and today have tasked educators with meeting needs, and repairing damage, of preposterous proportions.

    Those who wish to avoid the reality that deep, systemic change is needed will push the fallout of the pandemic and the epidemic of gun violence onto the laps of overworked and underpaid school mental health workers. But the current reality crushes even the ambitions of those who are trying to exert change beyond the walls of their counseling rooms.

    “There are a lot of instances of racism — student-to-student, teacher-to-student, at this school,” Sara, a school counselor in a Philadelphia charter high school, told me, her words slow and agonized. “Because everyone is at their [wits] end, to try to address those types of issues that need to be addressed, and as the counselor it is my job to do that … that becomes increasingly difficult.”

    She, too, is leaving her job, to work in private practice.

    We must shout the truth to those in power: They have abandoned this country’s children, and we cannot clean up their mess, however much our failure to do so might break our hearts.

    This post was originally published on Latest – Truthout.

  • Profile in Persecution: Mahmood AbdulJabbar Nooh

    Updated: Mahmood AbdulJabbar Nooh was a 17-year-old minor when Bahraini authorities arrested him on 13 November 2019, after chasing him in the streets of AlKarranah Town without presenting any arrest warrant. During his detention, he was subjected to torture, electric shocks, and burning. He was interrogated without the presence of his lawyer and faced an unfair trial based on confessions extracted under torture. Additionally, he suffered from medical neglect. He is currently serving his sentence of 10 years in prison on politically motivated charges. He was transferred from the new Dry Dock Prison, designed for inmates under the age of 21, to Jau Prison after turning 21 years old.  

     

    On 13 November 2019, Mahmood was arrested by plainclothes officers who pursued him in civilian vehicles. They approached him in the street without presenting an arrest warrant or notifying him of the reason for his arrest. Although he was allowed to contact his family the same night of his arrest, any sort of contact was cut off from 8:30 P.M. onward. Throughout this period, his family continued to search for him in various centers and hospitals, only discovering later that he was being held at the Criminal Investigation Directorate (CID) building.

     

    At the CID, Mahmood was interrogated for around seven to nine days without the presence of a lawyer. Throughout the interrogation period, CID officers subjected Mahmood to torture in the form of electric shocks and burning, aiming to extract a confession from him. Despite having sustained injuries during the interrogation, Mahmood was denied treatment. The examining doctor asserted that the burn, located in a private area, was not a result of torture but rather occurred at the “crime scene” during Mahmood’s arrest. This explanation seems unrealistic, considering the absence of marks on any other part of his body. Mahmood’s coerced confession was subsequently used against him in court.

     

    Following his interrogation, Mahmood was brought before the Public Prosecution Office (PPO), which subsequently ordered his detention for two months. He was then transferred to the Dry Dock Detention Center. It wasn’t until a week after he arrived at the detention center that he was finally permitted to meet his family for the first time since his arrest. Throughout the initial months of Mahmood’s detention, his parents were kept uninformed of the charges of which he was accused.

     

    On 30 November 2020, the First High Criminal Court sentenced Mahmood to 10 years in prison, charging him with joining a terrorist cell. Despite the presentation of evidence in Mahmood’s defense, the court did not consider it.  Following unsuccessful appeals, both the Court of Appeal and the Court of Cassation upheld the judgment. Mahmood was then transferred to the New Dry Dock Prison to serve his sentence. Upon reaching the age of 21, he was later transferred to Jau Prison. 

     

    Mahmood suffers from sickle cell anemia and G6PD deficiency, and experiences pain in his feet and bones. The intensity of the pain increases in cold and wet climates. On 15 May 2022, he initiated a hunger strike in protest against the medical negligence practiced by the prison administration. He has consistently been denied treatment and is only taken to the clinic to take painkillers to stop the strong pain without being offered further treatment. Although the prison authorities have scheduled appointments for Mahmood at Salmaniya Hospital to receive proper medical attention, he was not taken to these appointments. On 18 May 2022, the public prosecutor met with Mahmood and promised to respect his right to treatment and transfer him to the hospital. Based on those promises, he decided to end his hunger strike. On 9 June 2022, the Ministry of Health website revealed Mahmood’s infection with COVID-19 while incarcerated in Dry Dock Prison among other prisoners.

     

    Mahmood is still suffering from severe pain and serious health complications since his arrest in 2019, as a result of the severe torture and brutal beatings he endured during ten days of interrogation. He was subjected to kicking, punching, and electric shocks all over his body, particularly in sensitive areas. These actions caused him intense pain, leaving him unable to urinate normally and experiencing blood in his stool. After enduring prolonged suffering and making repeated demands during his time in the Dry Dock Prison, Mahmood was taken to the prison clinic on several occasions. At one point, he was transferred to the AlQalaa clinic, where a forensic pathologist examined him. Despite informing the doctor of his suffering, Mahmood did not receive proper treatment or any medication. Mahmood’s suffering persists even after his transfer to Jau Prison, where he continues to experience medical neglect and a lack of proper diagnosis for his health condition.

     

    On 19 January 2024, Mahmood experienced a health setback due to the policy of medical neglect. Consequently, he was transferred to the Jau Prison clinic. Facing challenges with the responsiveness of the clinic’s physician, Mahmood was urgently transferred to Salmaniya Medical Complex due to his deteriorating condition. X-ray images revealed that he had testicular torsion, requiring immediate surgery. The doctor asked him to inform his father due to his young age as he was only 21 years old, given the impact of this process on his life. Mahmood requested the police officers accompanying him to make a phone call to his father to obtain his opinion, because he was unaware of the seriousness of the surgery and its consequences and whether it would be beneficial for him or not. Also, he had no experience with surgeries and the healthcare system. However, Mahmood’s request was forcefully rejected by the police, compelling him to make the decision alone despite his young age and the impact of this surgery on his future life. Mahmood informed the doctor of his consent to undergo the surgery. Initially, the doctor hesitated to perform it because Mahmood was alone and needed his family’s presence during this period. However, due to the seriousness of his condition and the inability to delay the procedure, the surgery proceeded. As a result, Mahmood experienced psychological pressure during the surgery and his time at Salmaniya Medical Complex, as his family was unaware of his condition and the authorities refused to allow them to be informed about his deteriorating health.

     

    Despite the necessity for accurate follow-up regarding his health condition, Mahmood continues to suffer from medical neglect. He remains unaware of any updates regarding his health status post-surgery and has not been provided with the necessary medications. Instead of providing a wheelchair to assist him in walking, considering his inability to move long distances, he was sometimes forced to move through either a food distribution cart or on a makeshift bed for sleeping.

     

    Mahmood’s warrantless arrest on politically motivated charges, torture, and unfair trial constitute clear violations of the Convention against Torture and Other Forms of Cruel, Inhuman or Degrading Treatment or Punishment (CAT), the International Covenant on Civil and Political Rights (ICCPR), and the International Covenant on Economic, Social, and Cultural Rights (ICESCR), to which Bahrain is a party. Furthermore, the violations he endured as a minor contravene the Convention on the Rights of the Child (CRC), to which Bahrain is also a party. 

     

    As such, Americans for Democracy and Human Rights in Bahrain (ADHRB) calls on the Bahraini authorities to immediately and unconditionally release Mahmood. ADHRB also urges the Bahraini government to investigate the allegations of arbitrary arrest, torture, denial of access to legal counsel during the interrogation phase when he was a minor and medical neglect. ADHRB further advocates for the Bahraini government to provide compensation for the injuries he suffered due to torture and hold the perpetrators accountable. At the very least, ADHRB advocates for a fair retrial for him under the Restorative Justice Law for Children, leading to his release. Additionally, ADHRB urges the Jau Prison administration to immediately provide Mahmood with the necessary health care to address the injuries resulting from torture, holding it responsible for any additional deterioration in his health condition.

    The post Profile in Persecution: Mahmood AbdulJabbar Nooh appeared first on Americans for Democracy & Human Rights in Bahrain.

    This post was originally published on Americans for Democracy & Human Rights in Bahrain.

  • First Nations psychologists are decolonising the health system one yarn at a time.

    The post First Nations psychologists are decolonising the health system one yarn at a time. appeared first on IndigenousX.

    This post was originally published on IndigenousX.

  • Doctors spent less time and energy ‘triaging poverty’ while parents received the monthly child tax credit

    By: RACHEL FLEISHMAN. 

    See original post here.

    I’m a Pediatrician Caring for Families in Poverty. Here’s What’s Been Happening at My Hospital Since the Child Tax Credit Expired.

    When it’s my turn to be the pediatrician in the well-baby nursery at my hospital, my job is to counsel new parents about healthy newborn behaviors and assure them their babies are capable of basic survival. Breathing. Eating. Pooping. The rhythm and routine of newborn assessment are rote: look, listen, feel. Healthy babies have commonalities that allows doctors like me to decipher illness from health. When I look, I note each infant has one mouth, two eyes, four limbs wiggling about. I place my stethoscope atop each tiny chest, listening for crisp, clear breaths between rapid, steady heartbeats. I feel each baby’s bones as I run my fingers across clavicles, along spines, atop skulls. I identify with the pure affection manifest as mothers cuddle their children against their chests.

    My pediatric colleagues and I apply this same rhythm and routine daily to parse the implications of poverty. I work at a safety-net hospital in Philadelphia. The median household income in the neighborhood outside our hospital’s manicured lawns is $36,572. Most of our insured patients qualify for Medicaid. We have always listened for insecurities related to poverty. Some abated last year when the child tax credit was in effect. Since its expiration in January, however, these stresses have crept back in.

    Essentials are again inconsistently attainable. Parents in our clinics increasingly need assistance procuring diapers. Parents in our neonatal intensive care unit (NICU) increasingly request referrals for cribs, for food, for bus passes.

    Requests for car seats come in the clinic, the nursery, and the NICU. We replenish the pile of newborn clothes in our hospital’s donation closet each time the pile dwindles, the bins labeled not by what they contain, but by the names of the churches who provided their contents. I again hear parents telling me about taking three buses each way, every day, to visit their hospitalized premature babies, because they cannot afford an Uber. 

     This is all on top of the nationwide formula shortage, which has the nurse manager in the NICU calling our formula representative constantly, hoping she can source rare formulas for our most fragile patients.

    We are buoyed by the village of agencies, policies, public programs, donors, nonprofit organizations, and community members, but it is tempting to feel devastated by the depth of need. That our social worker can provide temporary breast pumps and that our nurse manager can source funds for transportation belies the point. We can find these and other solutions because the rhythms and routines we hear are predictable. But for a while, we did not have to. For months, I did not meet a single new mother pumping breast milk, drop by drop, with her own hands as she waited for her health insurance to deliver an electric pump.

    As I walk from room to room, my patients’ bodies appear indistinct. But a study out in April taught me that if I were to look deeper, with tools more sensitive than my own eyes, I might see effects of poverty imprinted inside those bodies. These researchers examined newborn brains with magnetic resonance imaging and found alterations in how brains form and develop in the face of maternal social disadvantage. Put another way, poverty impacts fetal brain growth. Overcoming those effects is certainly possible. Examples abound. But I do not believe any baby should have to try.

    Discussing research that differentiates fetuses based on lived experiences of pregnant women can be problematic. Many may be tempted to blame pregnant mothers for the adverse outcomes their children suffer. Mother blaming is not a new concept. The idea that women should be virtuous vessels, capable of perfect pregnancies in the face of societal stressors and systemic racism is a fallacy. No one chooses to live in poverty. Not pregnant women, not children. No one.

    And this new data is not surprising.

    The link between adverse health outcomes and poverty in pregnancy, infancy, and early childhood is irrefutable.

    The seminal report “From Neurons to Neighborhoods” provided cogent and coherent content about poverty’s effect on newborns and young children in 2000. What is surprising is that, in the 22 years since this report, and all the years since the reports that came before it, the pace of progress has been slow.

    Slow progress is not no progress. The moral imperative to support all citizens to birth healthy babies and raise healthy children is also a financial imperative to ensure healthy adults, healthy citizens. Healthy workers. Pilot programs to provide funding for pregnant women are under way in California. The child tax credit was a cost-effective federal policy that successfully reduced child poverty and uplifted the lives of mothers raising children while pregnant.

    I am not an expert on poverty. I have lived my whole life fed and housed. I do not research poverty’s effects like the study authors in St. Louis, nor am I an expert in early child development like those who authored “From Neurons to Neighborhoods.” But I have spent my pediatric career listening to my patients’ parents share their stories after I remove my stethoscope from my ears. Their stories taught me to see beyond what my own eyes may capture, to do all I can to support those I serve.

    Not everything improved in the wake of the child tax credit. The early-morning ritual on our postpartum unit of fathers, mindful of disturbing their partners’ sleep, leaving for jobs in warehouses, factories, retail stores, and then returning each evening to participate in newborn bonding they missed while working, never ceased. My colleagues who staff our pediatric and teen clinic serve patients increasingly victimized by gun violence. But in hindsight, we spent less time last year sourcing necessities for our families and could care for our patients in other ways. For a while, our patients’ families spent less energy triaging poverty.

    Toward the end of every newborn assessment, I elicit the common reflexes babies require to survive. A startle, a suck, a grasp. When I press my pointer finger atop a newborn’s palm, he predictably grasps my finger. If I do not pull my hand away, his grip persists. Babies, people, are resilient. Our bodies are predestined to grip and grab and hold on to all we are offered. I only wish our nation would place more in each palm.

    The post Doctors spent less time and energy ‘triaging poverty’ while parents received the monthly child tax credit appeared first on Basic Income Today.

  • Gun Lobby Intervened Against a Republican’s Gun Law. Then He Lost His Seat.

    Cole Wist was a Republican state House member in Colorado with an A grade from the NRA. Then, in 2018, he supported a red flag law, sponsoring a bill to allow guns to be taken away — temporarily — from people who pose an immediate threat to themselves or others.

    Wist lost his seat in the legislature that year in the face of an intense backlash from Rocky Mountain Gun Owners, a gun rights organization in Colorado that boasts it accepts “no compromise” as it battles “the gun grabbers.” The group campaigned against him, distributing flyers and referring to him on social media as “Cole the Mole.”

    Wist, an attorney, doesn’t regret trying to enact what he considered a measured response to an epidemic of gun violence in the United States. He acted after a mentally ill man in his Denver suburb killed a sheriff’s deputy. The bill didn’t pass until after Wist was out of office and his successor, Tom Sullivan, shepherded it through. Sullivan is a Democrat who lost his son in the Aurora theater massacre.

    Wist left the Republican Party this year, citing the Jan. 6, 2021, insurrection as the reason, and is now unaffiliated with any political party. Days after the slaughter of 19 children and 2 adults in an elementary school in Texas, ProPublica talked to Wist about the challenges ahead as proponents once again work to enact gun reforms.

    Colorado is one of 19 states, including Illinois, Florida and Indiana, that have red flag laws, sometimes called extreme risk protection orders. Texas does not. After the Robb Elementary School murders on Tuesday, a bipartisan coalition in the U.S. Senate agreed to negotiate over possible anti-violence measures, including expanding red flag laws.

    In Colorado, a spokesperson for the Rocky Mountain Gun Owners called Wist “a sellout” on Friday and said the organization had no choice but to work against him. “At the end of the day, my goal is to hold politicians accountable regardless of whether they’re a Republican or a Democrat,” said RMGO’s Executive Director Taylor Rhodes.

    Rhodes called the assault on the elementary school a “massive terrorist attack” but said gun control is not the answer.

    “We protect everything in our nation that’s valuable with guns. We protect our banks with guns, courthouses … our homes. We protect them with guns.” The group’s logo includes an image of a firearm that resembles an assault rifle.

    This interview with Wist has been edited for length and clarity.

    Tell me about why you introduced the legislation in Colorado.

    Every time we have an incident like this, people tend to go into their camps. We’ve got some folks who say we should ban certain kinds of guns or expand universal background checks or any other number of policy proposals to try to eliminate guns from society. On the other hand, you have folks who say no, these are mental health issues, this is an indication of a larger mental health crisis in the country. But you know, I don’t really hear a whole lot of policy solutions from those folks. So in an effort to try to pair concerns about mental health and the combination of mental health crisis with access to firearms and weapons, I started investigating extreme risk protection orders and how they’ve been passed in other states. And one of the first states in the country to do this was Indiana. And I don’t think you’d really think that Indiana is a hard left state, by any means. … And ultimately, I decided to sponsor legislation relating to extreme risk protection orders.

    When you served in the state legislature, the Republicans controlled the state Senate and Democrats had the House. What was the makeup of your district?

    I represented a district that at that time was predominantly Republican. It had historically elected Republican legislators, but it was a suburban district becoming more purple. And, you know, look, when you’re elected to represent a district in the legislature, you’re not just elected by the people that voted for you, you’re elected to represent everyone in the district, and that includes unaffiliated and Democratic voters.

    Who opposed you when you ran for reelection in 2018?

    So there’s a group called the Rocky Mountain Gun Owners, a very active gun rights organization. They targeted me or targeted my race for campaign activity and actively worked against me. … They put flyers on people’s doors, including my own door, and used their resources to campaign against me.

    Are the Rocky Mountain Gun Owners similar to the National Rifle Association?

    I think they characterize themselves as being the no-compromise gun rights organization. So I would characterize them as certainly more aggressive on gun rights issues than the NRA, and the NRA is the more well-known organization, the one with more resources. But in Colorado, Rocky Mountain Gun Owners is the gun rights group that seems to have the most sway. They’ve been successful in recalling a couple of legislators here.

    Did it seem like they sacrificed your seat to send a message to other lawmakers to stay in line?

    I guess that’s a fair interpretation, that you either stay in line and vote the party line on this issue, or they will remove you. And that’s what they did. I mean, there were other factors in play in 2018. That was also the midterm election of Donald Trump’s first term in office or his only term in office. … So there were more issues in play than gun policy. But it was certainly a group that worked against my reelection and didn’t help. … It might have been enough to suppress turnout on the Republican side for me.

    What was the reaction from the GOP leadership to your sponsorship of the red flag bill?

    I was the assistant minority leader in the state House at that point. There was an effort to strip me of that leadership post. That effort failed. I think there’s some reluctance in Republican circles here to take on groups like the Rocky Mountain Gun Owners for fear of getting primaried, for fear of having them work against you. And I suppose people may look at my experience as being something that deters them from even having conversations. I introduced a bill that was very controversial. In those circles, even being open to conversations about gun policy or gun safety legislation creates risk for folks in Republican circles here. So, if your objective is to stay in office for a long time and continue to get reelected … you don’t cross that line.

    In the aftermath of Uvalde, what does your experience suggest about the likelihood of our politicians enacting some measures to prevent future atrocities?

    I see some of the same signs happening again, in the aftermath of this event, where everyone sort of retreats to the corners. And some people are calling for banning certain kinds of guns and changing the purchase age for certain kinds of guns. If you try to ban AR-15s, I think that’s a policy solution that some people think is something we should do. I don’t agree with that. We’ve got millions of guns already in the possession of gun owners across the country. How much of an impact are you going to have if you ban certain kinds of guns at this point? I think a better discussion is to talk about why people commit these kinds of violent acts with guns and other weapons. … And so I think red flag laws and legislation that focuses on trying to reduce risk and talking about why these kinds of events happen is the most productive conversation for us to have. Let’s give law enforcement and families tools that they can use.

    But one of the things that’s lost in this conversation is that — I’ll talk specifically about Colorado — we have one of the highest suicide rates in the country. We also have one of the highest percentages of gun ownership in the country, and the highest percentage of suicides here are committed by guns. So when folks are going through a severe mental crisis, yes, there’s a risk that they might go commit a homicide, but there’s probably a greater risk that they’re going to hurt themselves. So I think there’s this way of characterizing red flag laws as confiscating guns and trying to hurt someone’s constitutional rights. But instead, I think it’s something that’s being used to help protect that person, to prevent them from harming themselves and prevent them from harming family members.

    Can you describe the toll this experience took on you and your family?

    I received threats as a result of going through that process. And that was very stressful for my family. I don’t miss that part of public life. And, you know, social media and other things have made being in office very difficult. And folks can say just about anything and do say just about anything. So I can choose to do a couple of things. As a private citizen, I can kind of retreat from this and not talk about it, or try to do what I can to raise awareness and just try to encourage folks to come together. I don’t know that you’re ever going to change everyone’s minds. But we don’t solve problems unless we talk to each other and not talk past each other. And every time we have an incident like what happened in Texas this week, there’s sort of the initial, let’s talk, let’s come together, let’s talk about this. But I’m just amazed at how quickly everyone just sort of retreats to the same old political position. I hope this time is different.

    This post was originally published on Latest – Truthout.

  • Police Can Make a Crisis Worse. The Public Needs Alternatives in an Emergency.

    “They’ll just end up arresting me.”

    “I’m just scared they’ll ask for my papers.”

    “What if they think my boy is an adult and rough him up?”

    We’ve heard various versions of these fears many times in our personal lives, as a Latino man and Black woman, and in our professional roles as professors who teach about race and racism in society. While the fear that causes someone to avoid the police — whether a fear of racism, deportation, homophobia, sexual violence or some combination thereof — may vary between our communities, the underlying question is always the same: If I call the police, will the outcome be worse than the problem I am trying to address?

    Many people fear calling the police for legitimate reasons. In immigrant communities, many worry that a call to the police is a quick way for them or someone in their home to wind up deported. Others, often in African American communities, fear that calling the police could result in their own victimization by police. Survivors of domestic violence may fear that police could escalate an already violent situation, if their story is even believed in the first place. Amid national discussions of racism and police-perpetrated violence, many bystanders worry that calling the police could make them an accomplice to race-based law enforcement violence. And sometimes, folks are so worried about the police showing up first to an emergency that they won’t even call 911 when other services — like EMT services after a vehicle accident — are needed.

    Research has continued to provide evidence of what communities have been saying for decades, and health organizations have continued to speak out. The American Public Health Association, the largest organization of public health professionals in the United States, released a statement in November 2018 citing law enforcement violence as a critical public health issue that results in more than a thousand deaths a year, with disproportionate losses among people of color.

    But fearing the police should not mean that you have no one to call in an emergency.

    In response to the growing awareness of the biases in the policing system, non-police response programs have emerged, with examples in Austin, Texas; Eugene, Oregon; San Francisco, California and Edmonton, Canada. While these programs differ in some ways, they all work to divert individuals away from law enforcement, reduce emergency department admission and provide services such as conflict mediation, welfare checks, and non-emergency care and referrals.

    Ann Arbor, Michigan, hopes to develop its own program to be added to the list. On April 4, Ann Arbor City Council approved $3.5 million in funds from the American Rescue Plan Act to develop an unarmed, non-police response to emergencies. The city council’s decision was inspiring — a testimony to the desire of our community to have a care-based response at the core of our city services. Among those who presented public comment in support of unarmed response was Kaveh Ashtari, a public health student and medical assistant, who told councilors:

    One of the lasting effects of the COVID-19 pandemic is this challenge of trust. I’ve worked with individuals who don’t feel comfortable accessing emergency services during critical times due to fear of escalation, due to fear of violence, due to fear of their own safety. This fear is real. It is for this reason an alternative is needed that can ensure that an individual is able to feel safe, one that is unarmed, one that the community can trust.

    Much of the effort for unarmed response in Ann Arbor has been led by the Coalition for Re-envisioning Our Safety (CROS), with whom we organize. CROS is a multiracial group of community members including social workers, public health experts, faith leaders, community builders, and others who have drawn on research, advocacy and community organizing to develop a plan for an unarmed, non-police response.

    Among the key components of the plan are that the unarmed response program be supported politically and funded by city government, be separate from law enforcement and the criminal legal system, expand beyond a sole focus on providing mental health care in times of crisis, and include a public phone number separate from 911. Notably, this is not a plan that replaces 911 (or policing) but is instead additive, offering another option for those who fear that a 911 call may result in unnecessary police presence. The CROS plan, like other successful plans, draws on empirical research and prioritizes community-driven leadership.

    President Joe Biden’s 2023 budget allocates an additional $30 billion to new police spending, and reports show an increasing number of cities using American Rescue Plan Act (ARPA) funds to increase their police forces. These are dollars that could have been spent supporting child care, reducing student loan debt or even providing additional COVID-19 tests to those without insurance. Instead, these funds will support further surveillance, bias trainings or community policing — all practices that have already proven to be unsuccessful at addressing racial inequities in policing. What’s needed is not more funding for policing but more funding for alternatives to police responses. For example, instead of using ARPA funds to expand a city’s police department, cities could opt to use ARPA funds for planning grants to apply for mobile crisis intervention services, mental health support in place of campus police for students, affordable housing to reduce recidivism, or other community-based services.

    The data are convincing: Care-based safety programs aren’t just more humane, they create significant cost savings in health care, policing and legal fees, and reduce ambulance and emergency room services — costs that often otherwise fall on taxpayers. But moreover, non-police alternatives could prevent violence, deportation or ensnarement in the legal system. Everyone, no matter their relationship to the police, should have someone available to call in times of crisis.

    This post was originally published on Latest – Truthout.

  • We need to question the NHS mental health services

    We need to have an open and honest conversation about how the NHS deals with mental health. Amplify participant NJ takes a look at the current state of mental health services and what can be done to improve them.

    By NJ Desu

    This post was originally published on The Canary.

  • 1,500 deaths investigated in England’s first public inquiry into mental health

    The deaths of 1,500 people are being investigated by the first public inquiry into mental health to be held in England.

    Each of the 1,500 people died while they were a patient on a mental health ward in Essex, or within three months of being discharged, between 2000 and 2020.

    Dr Geraldine Strathdee is chair of the Essex Mental Health Independent Inquiry. She said she wants to gather evidence about mental health inpatient deaths in the county over the 21-year period.

    Strathdee also said she wants to see how Essex compares to other areas in England, and whether the issues identified are unique to Essex or evident elsewhere too.

    A report published by the Trade Unions Congress described mental health services at “breaking point” in 2018, mostly due to lack of funding under Tory leadership.

    A lack of basic information

    Strathdee said that so far “there are some areas of concern that I have consistently heard”. These include a lack of basic information being shared with patients and their families about their care and treatment.

    Patients and their families have serious concerns about patients’ physical, psychological and sexual safety on the ward. And there have been “major differences in the quality of care patients receive both in staff attitudes and in the use of effective treatments”, she said.

    She added:

    Right now, we have very limited information on the 1,500 deaths we’ve been made aware of…

    Our investigations are ongoing, and we expect to be able to provide a fuller breakdown of this number in the future.

    But as it stands, for example, we have only been given the cause of death for around 40% of these deaths.

    A series of deaths

    Nadine Dorries announced the inquiry in 2020, when she was a health minister, following a series of deaths at an NHS mental health unit in Essex.

    Strathdee said the inquiry started to gather evidence in December 2021 from the families of those who have died as well as former patients. In the coming months, the team also hopes to speak to current and former staff.

    Afterwards, she will be “making recommendations to the Government on what changes must be made to keep patients safe in mental health inpatient care and to improve the experiences of their families and loved ones”.

    Richard Wade
    Richard Wade, 30, who took his own life in 2015, shortly after he had been admitted for the first time to a mental health unit in Essex (Family handout/PA)

    ‘They didn’t care’

    Robert Wade, 66, lost his 30-year-old son Richard Wade to suicide in 2015, shortly after he had been admitted for the first time to a mental health unit.

    His son, who lived in Chelmsford, had completed a PhD and had a high-flying job at accounting firm PwC in London. Mr Wade said:

    He went in (to the mental health unit in Essex) just after midnight…

    He was dead by midday.

    He was there for less than 12 hours before the injuries he inflicted on himself.

    Mr Wade continued:

    It boils down to something really quite simple.

    They didn’t care.

    They didn’t care for him, they didn’t seem to care for their professionalism, the consequence was he paid a big price.

    The mother, Linda Wade, said:

    There’s got to be change.

    We can’t bring Richard back but that was a young man that went into the Linden Centre for safety and there was no safety.

    To me, from the inquiry there’s got to come change, but it probably needs change right across the UK.

    The inquiry has so far heard from 14 families of those who have died and from people who have been inpatients themselves.

    They want more people to come forward and book evidence sessions. See www.emhii.org.uk or search on Twitter @EssexMHInquiry .

    By The Canary

    This post was originally published on The Canary.

  • Julian Assange: Extradited to the US?

    Julian Assange is one step closer to being extradited to the US has the court received ‘assurances’ that the US will offer adequate prison conditions. Listen to Curtis Daly’s reaction.

    By Curtis Daly

    This post was originally published on The Canary.

  • Dying to get treatment, part three: eating disorder treatment in the US is different

    Content warning: this article contains mentions of eating disorders, disordered behaviours, and other content. It may be triggering to those in recovery or who are currently suffering from an eating disorder. Reader discretion is advised.

    Eating disorder services in the UK are failing the thousands of sufferers seeking treatment. Throughout this four-part series, I will be investigating the reasons why the services are unable to provide the help so many people desperately need

    The NHS is failing people suffering from eating disorders across the UK. But what about treatment options in other countries? Some people, if they are fortunate enough to be able to afford it, even travel overseas to access treatment. In the US, despite the inequalities and issues its privatised system creates, there appear to be greater options and more effective treatment schemes.  Are medical professionals’ approaches to treating conditions like binge eating disorder (BED), bulimia, and anorexia better? If so, what could the UK’s health service learn from its American counterparts?

    This is part three of a four-part series. Part one, which you can read here, explored the state of eating disorder treatments under the NHS with insights from Ann McCann, the head of Eating Disorders Association NI (EDANI). In part two, which you can read here, I spoke with a friend who suffers from anorexia. She candidly and frankly explored her experience of NHS services and how they often fail to help those most in need. In part three, I look at eating disorder treatment in the US. I also speak with the doctor who helped me recover about his treatment methods and lived experiences with disordered eating.

    We could take a leaf out of the US’s books when it comes to treatment

    Over in the US, there is a great deal more success and creativity in terms of treatment offered. There are inpatient programs for bulimia and BED, such as Timberline Knolls in Illinois, where Demi Lovato received treatment for their bulimia. Inpatient programs offer a high level of care. Patients get a structured meal plan, group and individual therapy, psychiatric medication, and nutritional education. There is a set follow-up treatment plan when a patient is discharged. Facilities such as these enable the development of better behaviours and coping mechanisms. The constant access to psychological and medical professionals supports a person’s recovery significantly. With all these factors, inpatient programs are highly successful in helping people recover fully.

    US treatment is certainly better, for those who can afford it, than in the UK. Inpatient treatment for bulimia and BED isn’t an option on the NHS.  Although there are private options for treatment in the UK, few of them are tailored to bulimia and BED. However, even with the greater number of options in the US, accessibility is a very real issue, especially if someone cannot get health insurance.

    Even if someone has health insurance, that doesn’t guarantee it will cover the fees to attend a treatment centre. Although there have been improvements in terms of insurance coverage, barriers still remain. Oftentimes, insurers won’t authorise residential treatment until a person has undergone a medical assessment at the facility. Astonishingly, even if a facility determines that a person will require inpatient care, the insurer can still deny the admission. Although California recently adopted a law requiring insurers to cover all medically necessary mental health services, this isn’t the case across all states. Insurance coverage still remains a huge barrier for people seeking the treatment they desperately need.

    Licensed and approved medication for bulimia and BED is readily prescribed

    Another difference between the UK and the US is the psychiatric medication offered to eating disorder patients. Psychiatrists in the US can prescribe medications tailored specifically for eating disorders, not just general antidepressants. Lisdexamfetamine dimesylate, also known as Vyvanse in the US and Elvanse in the UK, is prescribed for BED treatment. It has been proven to be effective in reducing urges to binge and aiding in recovery. It is the first FDA approved medication to treat moderate to severe BED.

    Whilst many doctors have started prescribing Vyvanse, it doesn’t come without its issues and health risks. As Vyvanse is a type of amphetamine, it is a stimulant and can be addictive. As such, Vyvanse is a Schedule II controlled substance due to its high potential for abuse and dependence. Even with its positive impact in terms of reducing binge eating, it carries serious side effects such as cardiovascular and circulatory complications. Due to this, its use needs to be regularly monitored and it cannot be prescribed as a long term option for people with BED.

    Despite this evidence, the NHS will not prescribe it to anyone with BED. It is only prescribed for ADHD, which it also treats. In addition to more options for psychiatric medications, the psychological treatments on offer are more varied. Options range from holistic approaches to interpersonal psychotherapy. Individuals can more readily find a treatment approach that works for them.

    Unconventional but effective addiction treatments also helps those with an eating disorder

    As I mentioned earlier, there is a huge variety of psychological treatments which can be used for treating eating disorders. One such example comes in the form of Dr. Glenn Livingston, a psychologist based in the US. He has written several self-help books and offers coaching for those suffering from disordered binge eating. He takes an approach used in substance addiction treatment rather than traditional therapy. This is based upon the concept of ‘separating’ the urge to binge from your own conscious thoughts. It was his treatment method that finally helped me to recover. Despite having to pay for my treatment, which I acknowledge I am lucky enough to be able to do so, the benefits and freedom it brought me made it worth it. Unlike other services, his treatment does not require people to have health insurance.

    In an interview with Livingston, he candidly described to me his own personal struggles with binge eating. He noted that for many people with BED or bulimia, shame plays a huge role in the mental stress of having an eating disorder:

    People are really ashamed… take myself. I was going through several different Drive-Thrus a day to make sure nobody knew what I was eating

    How a simple ‘mind trick’ proves to be empowering and effective

    From his own struggles with binge eating, Livingston came across a simple ‘mind trick’. This allowed him to dismiss urges to binge quickly. By creating clear ‘rules’ about what, when, and how much to eat, the urges become easy to spot. Every thought suggesting you break a rule is your lower brain sending a misguided survival impulse. These impulses are urges to eat whilst food is plentiful. His method is simple to enforce and can help people get their bingeing issues under control rapidly.

    Livingston described his method as “a thinking game”. This ‘game’ involves “thinking about your constructive versus destructive thoughts about food in a different way”. Through his book and coaching, he aims to teach people to “rationally disempower a destructive food thought”. By learning “how to relax and switch nervous systems at the moment the impulse is firing”, you can stop acting on urges.

    Although there is an opinion that any restriction of food, even mental restriction, will trigger a binge, Livingston disagrees. He notes that provided the rules a person sets do not deprive them of adequate calories and nutrients, rules can successfully stop bingeing.  By self-regulating what you eat, a person can avoid or limit the number of trigger foods they eat. For some, total avoidance proves to be more freeing than trying to juggle moderating certain foods.

    Tackle urges to binge FIRST, then look at underlying causes

    Livingston also stressed that addressing underlying trauma or past issues of past trauma first can actually hinder a person’s recovery. He suggests tackling the urge to binge first to recover more quickly:

    It takes years to work through those emotional issues. Whereas you could identify the destructive thoughts and disempower them within a couple of months

    Recognising that you do have control over whether you act on urges or not often empowers those who struggle with binge eating. It removes feelings of powerlessness, where bingeing feels ‘automatic’ or that they can’t stop. However,  addressing trauma is also a hugely important step. Therapy for trauma can be massively beneficial for anyone with any kind of mental illness and can greatly improve a person’s quality of life. Livingston stresses that getting the urges to binge under control first frees up more mental space in order to undergo the difficult process of addressing trauma or other co-morbidities. Trauma should never be ignored and, without the stress of bingeing, a person may be more able to cope with the long-term task of going through trauma therapy.

    The food industry has a big role to play in contributing to binge eating issues

    Livingston also mentioned a factor that is often overlooked in regard to binge eating: the role of food companies. They make fast food and processed food highly palatable, due to a combination of sugar, salt, and fat. These foods are nutritionally lacking yet incredibly stimulating. When consumed, people will not feel satisfied by them, leading to overeating in order to try to become satiated. Food companies are highly attuned to how to psychologically and biologically get people to eat their products. Companies use this knowledge to increase sales. The colours used in food packaging, the excessive additives (mostly sugar and salt, the two most addictive), and the cheap price persuades people to buy these products. Livingston described how food companies put hugely varied artificial flavours in processed foods to make people eat more:

    on an evolutionary basis, when you sense variation in flavour… you are probably sensing a variation in micronutrients… So we are hardwired to keep eating when we find something that tastes a little different… The big companies know this.

    This manipulation results in the loss of the ‘hunger and fullness’ meter in people. An upset in the meter causes them to have urges to eat large amounts of these foods to satiate themselves. In an attempt to lose weight, they may over restrict their food intake or begin purging after eating. “A big part of the bingeing problem is the restriction also”, Livingston commented. The ‘feast and famine cycle’ only fuels the fire of an eating disorder.

    The hyper-palatability of food is a serious public health risk

    Even those without a diagnosable eating disorder struggle with overeating due to the hyper-palatability of these foods. Again, Livingston noted that:

    2.8% of the [US population] is diagnosable as a binge eater but 40% of the population is obese… there’s a problem there.

    Considering that 28 % of the UK’s adult population is obese and 36.2% are overweight, it would be foolish to overlook that a huge majority of people have issues regulating their eating due to the strategies food companies use. Boris Johnson’s woeful attempt to tackle the obesity crisis by putting calorie counts on restaurant menus is like sticking a plaster over a bullet wound. Tighter regulation on additives, accessibility to whole foods in deprived areas, and better education on diet are the solutions needed. These preventative measures could save many from developing an issue with overeating or binge eating.

    You can listen to my full interview with Livingston here:

    In part four, I’ll explore my personal reflections on the situation with the NHS, the food industry and our approach in the UK to eating disorders more broadly.

    Featured image via Envato Elements and Sardaukar Blackfang – Wikimedia, under licence CC0 1.0

    By Eileanor Crilly

    This post was originally published on The Canary.

  • Dying to get treatment, part one: eating disorder services fail to save lives

    Content warning: this article contains mentions of eating disorders, disordered behaviours, and other content. It may be triggering to those in recovery or who are currently suffering from an eating disorder. Reader discretion is advised.

    Eating disorder services in the UK are failing the thousands of sufferers seeking treatment. Throughout this four-part series, I will be investigating the reasons why the services are unable to provide the help so many people desperately need.

    A lack of resources and funding has left NHS eating disorder services across the UK “floundering”. They abandon sufferers of an eating disorder on months or year-long waiting lists for treatment. The NHS prioritises treatment in terms of physical symptoms, not mental distress. The vast majority of sufferers receive next to no help as they don’t meet the physical requirements for immediate treatment.

    Waiting lists and the focus on physical symptoms aside, my experience and research have revealed many factors contributing to why the services are failing. Often, these factors are over-looked when media outlets report on cases of the NHS eating disorder services failing. Across four articles, I aim to pull back the curtains and reveal all.  Internal factors like the continued use of debunked and ineffective therapies will be examined. Commonly ignored external factors, like the role of ‘big food’ companies and widely accessible hyperpalatable food, will also be considered. Along the way, my voice will be joined by the head of a charity, a renowned psychologist, and a recovering anorexic. Each of them has deep insights into why the NHS is failing.

    To fix a system, you need to know why it’s failing. Only then can you find a solution.

    Eating disorder services are inaccessible to the majority

    Trying to access treatment for a mental health condition after getting a diagnosis is incredibly difficult. It’s well documented that the NHS’s mental health services have hit a crisis point, and its eating disorder services are no exception. Unless you’re a ‘severe case’ (i.e. having a BMI under 15), you’re unlikely to get any attention or help. Those who eventually receive treatment often find it to be inadequate, so many never fully recover from their eating disorder.

    As a recovered bulimic, I can speak from experience that I was one of the unlucky ones. Like many, the NHS placed me on a waiting list for close to six years. Those with bulimia, binge eating disorder (BED), and eating disorder not otherwise specified (EDNOS) are the least likely to get treatment. This is in spite of these disorders being more common than anorexia nervosa.

    Eating disorder services have been “cut off by the knees” by underfunding

    I interviewed Ann McCann, the head of Eating Disorders Association NI (EDANI). She revealed the shocking state of eating disorder services in the north of Ireland, which has the highest level of multiple deprivation in the UK. In her words, funding cuts have left NHS services “cut off by the knees”, and they have been “floundering ever since”. McCann stated that this has resulted in a strict hierarchy in terms of who gets treatment:

    services just don’t have the capacity to see many more patients than those suffering from [severe] anorexia… there’s long waiting times even for the ones with anorexia (…) the ones with bulimia and binge eating disorder in particular just feel abandoned (…) they feel totally forgotten about

    For an eating disorder sufferer, these feelings of abandonment will worsen their mental state. EDANI offers a 24-hour helpline, which receives constant calls from concerned parents, partners, or individuals themselves. The vast majority of those calling for help are those with bulimia who have been unable to access NHS treatment. McCann said:

    for every one patient we would see with anorexia (…) there would be five or six with bulimia so there’s a far greater number of people suffering from bulimia (…) they are badly let down

    She expressed similar views to my own; the eating disorder services in the UK are in desperate need of updating and funding. McCann also emphasized that better education about nutrition and a healthy body image for young people would be hugely beneficial. Additionally, GPs need to develop a greater understanding and awareness of eating disorders. Rather than focusing on BMI criteria, they must recognise the behavioural and mental symptoms.

    You can listen to my full interview with McCann here:

    Physical criteria for a mental illness?

    On the notes of GPs, they still diagnose based on physical symptoms, going against the NICE guidelines for diagnosis protocol. They primarily use factors such as BMI and the loss of menstruation in women. In doing so, they are utterly ignoring the mental turmoil anyone with an eating disorder experiences. With bulimia and BED, individuals rarely become underweight. This means their GP may not recognise their disorder. Due to this, they may not even be diagnosed, let alone receive treatment.

    A healthy or overweight BMI doesn’t mean there isn’t severe mental distress or a risk of serious and fatal physical complications. Cardiac arrest, gastric ruptures, Ketoacidosis, oesophageal cancer and suicide are all common causes of death in eating disorder sufferers. The lack of immediate intervention for someone can result in them succumbing to health complications. If they eventually receive treatment, they may be in an even worse state than when they first got diagnosed. Recovery is a far harder process when an eating disorder is not treated early on.

    ‘One size fits all’ treatment relies on ‘guided self-help’ and 20 sessions of CBT

    According to the NHS website, the treatment for bulimia nervosa and BED is “a guided self-help programme”. It also includes around 20 sessions of cognitive behavioural therapy (CBT). Considering the fact that, on average, it takes around four years to recover from bulimia or BED, does 20 sessions cut it? Will they really be able to provide practical coping mechanisms and methods for dealing with urges to binge or purge? How about all the underlying and complex psychological issues which coincide with an eating disorder, such as trauma, body dysmorphia, low self-esteem, or other comorbidities? Although self-help can certainly aid a person’s recovery, psychological treatment and professional guidance must occur first. A person trapped in their disorder cannot rationally begin to tackle their habitual behaviours and thought patterns on their own.

    Moreover, everyone is an individual. What works for one person in addressing a mental illness will not work for another. The NHS method of treating eating disorders is ‘one size fits all’; it doesn’t incorporate personal nuances. The statistics show that less than half the people suffering from an eating disorder will fully recover and that interventions for bulimia and BED fail to save a substantial number of patients.

    An ineffective system

    The NHS already offers bulimia and BED sufferers an ineffective treatment programme. Its anorexia treatment isn’t much better. The NHS’s failings in terms of anorexia treatment in the UK have been brought to the public’s attention multiple times. The tragic death of Averil Hart and the case of Fiona Hollings, who was sent 400 miles from home to get treatment, have shown the system is ineffective.

    Surely it’s high time the NHS was given the funding and experts it needs to create effective treatment plans.

    For the second article in this series, I speak with a friend of mine who suffered from anorexia nervosa and got treatment on the NHS. She reveals that even when she accessed treatment, it wasn’t effective.

    Featured image via Envato Elements 

    By Eileanor Crilly

    This post was originally published on The Canary.

  • Dying to get treatment, part two: the reality of NHS eating disorder services

    Content warning: this article contains mentions of eating disorders, disordered behaviours, and other content. It may be triggering to those in recovery or who are currently suffering from an eating disorder. Reader discretion is advised.

    Eating disorder services in the UK are failing the thousands of sufferers seeking treatment. Throughout this four-part series, I will be investigating the reasons why the services are unable to provide the help so many people desperately need.

    While it’s easy to debate the pros and cons of eating disorder treatments from the outside looking in, often the most enlightened and important views comes from people with lived experience. They are the ones living with the illness, day in, day out. And they’re the ones at the sharp end of overstretched NHS services.

    This second article in a four-part series follows on from part one, where I looked at the issues with our underfunded and mismanaged NHS services. You can read that here. In part two, I speak to my friend who suffers from anorexia nervosa. I interviewed her and she talked candidly and frankly about the chaos and neglect she faced when accessing NHS eating disorder services.

    Her dire physical state luckily guaranteed her almost immediate attention

    My friend received her diagnosis on 3 March 2021. Her diagnosis came after going to the hospital because of stomach complications. Due to the nurse checking her blood, height, and weight, she was underweight enough to warrant pretty immediate treatment. She told me:

    During the blood test I just said to the nurse ‘oh don’t worry if I pass out after this, that’s pretty normal for me’. She looked at me puzzled and just said ‘what do you mean’? So I elaborated and simply replied ‘well I just don’t eat’. She was lovely. We had a chat and decided that she would talk to the doctor after I had left; run the blood tests for eating disorder and that the doctor would call me that same day with a separate appointment for us to talk. However, this wasn’t until she had noted down my height and weight proving that I was underweight. I fear that if I hadn’t been underweight my struggles would have been dismissed.

    “It felt like we were back in school just sitting in lessons trying to learn theories”

    Due to coronavirus (Covid-19), she attended a 40-week eating disorder outpatient programme. This consisted of a small group therapy session for an hour a week. Later, this evolved into a larger group session for two hours a week. She revealed that the group sessions were incredibly unhelpful. The therapy used was based upon the Maudsley model of anorexia nervosa treatment for adults (MANTRA). This has proven to be largely unsuccessful in helping people recover. In a small study of 33 people with anorexia, only 30% of patients achieved a ‘good’ outcome. That’s only 7 people out of the 33 who underwent treatment following the Maudsley model.

    The treatment I received was cognitive interpersonal group therapy that followed the Maudsley model. Unfortunately, I don’t feel like we were given any methods to deal with triggers, urges or any difficult food-related situations… It says a lot that two groups of six started and they were meant to combine into a group of 12. But only four of us managed to finish it… Many people who struggled with more bulimic symptoms left the group. There was such a large focus on anorexic symptoms that they found it really triggering… [They] were offered absolutely no additional support other than being given self-help resources.

    Most poignantly, she commented that the group therapy:

    didn’t provide any coping mechanisms or ways to actually get out of destructive habits. It felt like we were back in school just sitting in lessons trying to learn theories… It was most definitely ineffective, inadequate, and lacking… All they did was tell us what we had and why we had it but not how to fix it.

    A disregard for the complexity of underlying mental health issues

    In terms of a focus on physical symptoms rather than mental ones, she added that:

    I have struggled with depression and anxiety since 2016/17. So [I] definitely had other mental health complications while going through treatment… I wasn’t really asked either if I had any other issues. They would just repeat that our mood would increase as we gained weight. It really felt like they just ignored the other issues and just focused on us gaining weight… When people needed more psychological support for other mental health conditions, they were often kicked out of the group for ‘not engaging’ if they weren’t making physical recovery.

    Even the monitoring of physical symptoms was severely lacking. Of course, this is incredibly dangerous, especially for those with a low BMI. Deterioration can be rapid and needs immediate action to prevent health complications or a fatality. Shockingly, my friend described a negligent and blasé attitude to monitoring adequate food intake:

    there was an initial goal we had to aim for of a 0.5kg gain per week. But I never managed this. No one contacted me when I continued to lose weight. And no one contacted me when I showed on my weight and weekly behaviour tracker that I had been having a rough time… Even after all 40 weeks I was still only eating one meal a day. And they didn’t seem to notice or ask me how much I was actually eating… In the middle of each session, we were also encouraged to have a snack. After the fourth week of going, most people were having a snack. But I never had one. If I did… it would… [be] a black coffee just so they wouldn’t pick on me for not having something in my hand.

    Little attention was paid to how patients were eating in recovery

    Additionally, a nutrition plan was non-existent. There was no given meal plan or structure, which is vital for allowing someone to establish a regular eating pattern. For my friend, this led to her continuing to eat in a disordered manner. There was no guidance or attention paid to how each specific patient needed to eat:

    I was actually very surprised that we were never given a meal plan or anything similar to follow. All the guidance we were given was that we should be having three meals and three snacks a day. I had gone into the support expecting to get one… I felt that the only way I would eat more was if I was being forced to eat it. After I brought this up in my first 1:1 session she said I could make my own if I wanted but it wasn’t something they did. For me, creating one for myself completely defeated the point of having one in the first place… It would no longer be someone making a decision for me. So I found it easy enough to avoid the three meals and three snacks.

    Eating disorder services: discharged and disregarded

    After discharge, there was no follow up and no additional meal plan to use for weight maintenance. The NHS did not offer education about developing a non-disordered relationship with food either. More concerning is the desperate lack of post-discharge care or monitoring. My friend told me:

    I don’t think we received any education on how to develop a healthy relationship with food or exercise… When I was discharged I still had no idea how to eat ‘normally’ apart from having three meals and three snacks a day [ingrained] in my head… I haven’t had anything since being discharged. In my meeting that I was discharged I was told that I should still be going to the doctors for blood tests etc every other week… as I was still underweight. But the last one I went to was on the 17 August 2021… No one has said anything to me or even noticed that I haven’t been going.

    After treatment, she is still “very much struggling”

    I asked her how the treatment made her feel. This was her response:

    I felt talked down to and patronised, it felt like we were back in school… I am still very much struggling.

    This was heart-breaking to hear, and certainly was something I empathised with deeply. Since her discharge, my friend made the brave decision to attempt recovery by herself. Currently, she’s doing well and is ‘all-in’ with her recovery.

    But there is another way. In part three I’ll look at how treatment in the US differs and speak directly with a leading medical professional there.

    Featured image via pxhere

    By Eileanor Crilly

    This post was originally published on The Canary.

  • “Dry” Month Campaigns May Reinforce Harmful Stereotypes About Substance Use

    Treating abstinence as a moral victory reinforces stigmatizing and negative stereotypes about alcohol and drug use.

    Campaigns that challenge people to abstain from alcohol for one month — often in support of a good cause — have emerged across the globe over the past decade. Dry January officially launched in 2013 with a public health campaign by British charity Alcohol Change.

    Other “month of abstinence” campaigns have included Dry July, Sober September, Sober October and “Dry February” — a few examples of campaigns from Australia, New Zealand, the United States, Canada and beyond. Dry campaigns have gained traction with people increasingly taking a time out from drinking alcohol for one month.

    Early research suggests alcohol use has increased during the COVID-19 pandemic, particularly among individuals who have mental health challenges. The pandemic may be contributing to the greater interest in dry month campaigns. Market research surveys have found an estimated one in five people participated in Dry January in 2022.

    On the surface, “dry” months are great — individuals set a personal goal to abstain from drinking, are publicly encouraged to achieve it and raise funds for a charity. It can be seen as supportive and positive, and many individuals tout the health benefits they experience as a result.

    Substance Use Is Complex

    As a substance use researcher and therapist, I certainly do not dispute the potential benefits of avoiding alcohol for a month to meet personal health goals. I also appreciate the peer support received by individuals doing these challenges.

    So, why was I so bothered as I listened to someone sharing the life-changing benefits of her four-week sobriety stint on the radio? Why am I irked when people express relief when their four weeks of Dry February are over, and they can get back to “wine time?”

    I’m troubled because while dry drinking campaigns benefit many, they do not help the individuals that I have worked with over the years. These attitudes and campaigns do not contribute to a more nuanced discussion about substance use. Instead, they perpetuate the idea that quitting drinking for a month is a choice, and an easy and positive one at that.

    Dry February and other associated campaigns are not intended for individuals struggling with the systemic inequalities, such as poverty, illness and racism, that lead to substance use issues. You will also note that these campaigns are only about alcohol — a socially acceptable substance.

    How would these campaigns be perceived if they were focused on other drugs? Dry campaigns support a harm reduction strategy — not drinking for a month for health benefits with no expectation of ongoing abstinence. However, they continue to separate alcohol as more socially acceptable than other drugs. This negatively affects people who use drugs.

    These attitudes marginalize other substances and only normalize alcohol use, which contributes to the ongoing War on Drugs and deadly drug supply. Further, these campaigns praise people for not drinking, which plays into the harmful idea that drinking (and using other drugs) is bad or subversive and should be controlled.

    Stigma and Inequality

    Arguably, these campaigns are directed at predominantly white, educated, middle class individuals who have the luxury of taking a time out from drinking, and the privilege of doing so without the risk of social stigma.

    In one 2020 study comparing individuals who participated in a Dry January with the general population, those who participated in Dry January, were more likely to be younger, women, had a higher income, had completed university education and had “significantly better self-rated physical health.”

    Celebrating predominantly middle/upper-class, educated women for publicly choosing to quit drinking for one month is potentially harmful. It perpetuates an all or nothing moralistic attitude towards substance use. It reinforces the myth that quitting substance use is a choice that anyone can (and should) make.

    Dry month campaigns are not directed at my clients who attend therapy for substance use issues. They do not see themselves as welcome participants in these campaigns. Their substance use or sobriety isn’t trendy, or worthy of a hashtag. It’s messy, it’s personal and it is often much more complicated than deciding to “just quit.” For them, drinking can be a needed self-medication tool, an endless obstacle, or an enjoyable friend.

    Policy and Privilege

    I continue to appreciate many aspects of dry month campaigns, including raising money for charity and bringing discussions of substance use into the limelight. At the same time, these months are worthy of more critical reflection.

    Substance use is complex. People often struggle with their use for reasons directly related to social inequalities, trauma, unsafe supply and poverty. Treating a four-week vacation from alcohol as a moral victory reinforces stigmatizing and negative stereotypes about people who use alcohol and other drugs. Alcohol and other drugs are not inherently bad; the policies we have made around them are what cause harm.

    In the midst of Dry February, my hope for dry campaigns would be that they offer not solely a chance to examine and limit one’s own drinking, but an opportunity to broaden the discussion around how privilege and policy impact one’s relationship with alcohol and other drugs.

    This post was originally published on Latest – Truthout.