News & Announcements

Hawaiian Nonprofit Focuses on Purpose and Peer Support to Improve Mental Health

Posted: November 16, 2018

Pupilla, 53, is homeless and is staying at Waikiki Health’s Next Step Shelter until he can find permanent housing, which he hopes will be soon. The Long Island, New York, native comes from an affluent background and was well-adjusted until he was 17.

“Then I began to hear voices, but I learned to cope with it. But when I’d encounter high-stress situations after joining the military in 1986, those voices would come back.

“I wasn’t honest with the doctors about it and tried to handle it on my own, and that became a dead end.”

It’s been a long journey to recovery, Pupilla says. The former military medic says he served hard time in prison, tried to commit suicide multiple times and was dishonorably discharged – all due to being undiagnosed with a mental illness for years. He’s been chronically homeless and in and out of institutions. He was finally diagnosed in 2010 with schizoaffective disorder and acute anxiety and depression.

After a huge fight with his brother just before Christmas 2017, Pupilla says he was “forced” to come to Hawaii, and within weeks friends hooked him up with United Self-Help.

“When we get new people, we first try to get them into a group,” explains Bud Bowles, 70, USH executive director. “Then we talk, put them on the mailing list, then try to get them involved in our activities. I give them small jobs in the office or get them to lead classes to build up their confidence.

“They get better because they’ve got some- thing to do. We give them hope.”

The nonprofit has 16 consumer-run programs, says Bowles, a former advertising agency owner who’s been diagnosed with depression. “We’ve got our Bridges class. We have a self-esteem class. We’ve got a writers group, a schizophrenia group and a depression/ bipolar group. We have tennis and golf classes. We peer-mentor prisoners and others in support groups.”


Disaggregating Data, Confronting Stigma to Understand Mental Health Service Gaps for Asian Americans

Posted: November 14, 2018

A new report lists multiple ways in which lawmakers and other thought leaders across the country can help Asian American communities obtain improved access to mental health services.

Nationally, about 37 percent of people of Asian descent indicate that they have poor mental health, according to a report just released by the Center for American Progress. This is defined by the Kaiser Family Foundation as having one or more of the past 30 days during which one’s mental health “wasn’t good.” Poor mental health includes depression, stress and emotional problems.

Moreover, Asians are three times less likely than Whites to seek and utilize mental health services.

Among the factors that result in such disparities is the misconception that Asian Americans are monolithic and don’t need such help, along with the pervasive Model Minority Myth.

The Center for American Progress report states that lawmakers should expand the collection and publication of fully disaggregated health data of the different Asian subgroups.

“Too many analyses currently rely on aggregated data that provide an incomplete picture of these diverse communities,” the report stated. “Collecting sufficiently large samples of data on Asian-American ethnic groups is difficult. However, it is essential for crafting truly responsive public policy, especially health policy.”

Because Asians come from a variety of socioeconomic backgrounds, there is a “harmful and inaccurate narrative of homogeneity” in these communities stemming largely from too little disaggregated data, the new report states.

Previous studies have found significant discrepancies among the mental health needs of different Asian populations. For example, 33 percent of Korean American adults experience symptoms of depression, compared with less than 16 percent of Chinese Americans. Among Filipino American women, 78 percent describe their mental health as excellent or very good, compared with just 45 percent of Chinese American women and 50 percent of Vietnamese American women.

Meanwhile, too many Asian Americans still lack affordable access to mental health services, the report stated.


Building Strength and Resilience After a Sexual Assault: What Works

Posted: November 13, 2018

Emily R. Dworkin, a senior fellow at the University of Washington School of Medicine in Seattle, studies how the social interactions of trauma survivors can affect their recovery. She was also the lead author of a paper published in the journal Clinical Psychology Review in 2017 that looked through more than 100,000 studies conducted in the last 50 years and found nearly 200 relevant ones on the relationship between sexual assault and mental health to analyze.

What she found, Dworkin says, is strong evidence that sexual assault is associated with an increased risk for multiple forms of psychological harm "across most populations, assault types and methodological differences in studies." Too many survivors still face stigma and internalize that blame, and that can make it harder to seek help. And while some types of therapy have been shown to be helpful, she says, more information on evidence-based treatments for survivors "is critically needed."

Dworkin talked with NPR about her research findings and offered her perspective on where society and science need to go next to prevent assaults and help survivors heal.

NPR: You looked at a lot of studies about the mental health impact of sexual assault, but it's not an area as well-studied as say, heart disease. So what do we know?

Dworkin: Sexual assault [any type of sexual activity or contact that happens without the consent of both people] began getting research attention in the '70s as society as a whole was going through a feminist awakening, and it kind of developed at the same time as PTSD [post-traumatic stress disorder], which was then known as "combat trauma." Many things can lead to depression or anxiety. People with PTSD relive the trauma in the form of intrusive memories, nightmares, or even flashbacks. They avoid things that remind them of the trauma.

The symptoms that people were showing when they were coming home from war were the same as victims of rape trauma — recurring memories and a wish to avoid triggering them.

These days, lots of people are doing research, but there's still a lot left to understand. What we do know is that sexual assault is associated with a higher risk for a lot of different mental health problems, including PTSD [and depression, anxiety, substance abuse and suicidality] ... especially PTSD.

NPR: What do we know about how ethnicity and education affects the mental health of survivors of sexual assault?

Dworkin: We need to know more. Some of my past research on queer women shows that ongoing forms of stress can compound stress. And we know that people from marginalized groups are just at greater risk for sexual assault [and a number of other health problems]. So it's likely that these groups experience more trauma — but I don't think we can completely say for sure.

NPR: How does sexual assault compare with other forms of trauma, in terms of effects on mental health?

Dworkin: We never want to have the Olympics of trauma. But compared to other types of life-threatening trauma, survivors of sexual assault do seem to be more likely to get PTSD. In my preliminary look at the data from 39 studies on this topic, it seems like 36 percent of survivors meet criteria for a diagnosis of PTSD in their lifetime, versus 12 percent of people who don't have a history of sexual assault.

My thinking is that sexual assault is a unique form of trauma. It is highly stigmatized, and when people go to seek help for it, unlike in a car accident — well, the police are not going to ask you if you've really been in a car accident.

NPR: What are the resources and treatments that work best for survivors who are experiencing PTSD or other mental health symptoms?

Dworkin: First-line options should be things that we know work well. What I recommend is prolonged exposure therapy [helping people gradually approach trauma-related memories and feelings] or cognitive processing therapy [a specific type of cognitive behavioral therapy that helps patients learn how to challenge and modify unhelpful beliefs related to the trauma]. Both have been around since the '80s and were developed to treat survivors of rape. They have really strong evidence of reducing symptoms or eliminating the diagnosis [of a mental health disorder].

For resources, look for a good therapist who offers cognitive processing therapy. Also, you can check out the Association for Behavioral and Cognitive Therapies [for more information about the treatment].


They’ve Given Us Their Best – It’s Time to Give Veterans Our Best

Posted: November 09, 2018

The following was written by and from the perspective of Jeannie Campbell, Executive Vice President & COO of the National Council for Behavioral Health.

On November 11, Veterans Day, we honor our heroes – the men and women who answered the call to military service. We remember their achievements, their courage and their dedication and say thank you for their sacrifices.

As a 22-year Navy veteran, I can tell you how much this day of remembrance means to veterans and their families. But as we celebrate, I urge you to take a few minutes to remember those vets who are struggling with mental health and substance use disorders. They are facing their own personal battles and we owe them the best we can provide.

But getting help isn’t always easy for veterans and their families. We know that approximately 50 percent of returning service members who need treatment for mental health conditions seek it, but only half of them receive adequate care. A study we recently released with the Cohen Veterans Network revealed that lack of access to mental health services is the root cause of the mental health crisis in America.

Our veterans and their families deserve more than they are getting. And, I know we have the will to provide it.

Too often, veterans fly under the radar and we miss the opportunity to connect with them, inform treatment planning decisions and help them access care and benefits. Five years ago, the American Nurses Association launched their “Have you ever served in the military?” campaign that not only encourages health care providers to ask the question; it provides guidance on how to ask and what to ask. I urge you to implement this dynamic program in your organization without delay.

One of our Strategic Partners, Relias Learning, in partnership with us and the Department of Defense Center for Deployment Psychology, is also working to ensure that providers are equipped to provide veterans and their families the level and quality of services they deserve with the Behavioral Healthcare Certification for Veterans Care Providers program. This series of 15 self-paced online courses is specifically designed to train civilian behavioral health and primary care providers about the nuances of military orientation and specific issues affecting veterans and their families.

We can start with a commitment to change how we talk to veterans and families and ensure that we’re equipped to recognize and respond to their needs – and that’s a good start, but much more needs to be done within our flawed system.


Meeting Unmet Mental Health Needs of Black People

Posted: November 08, 2018

There is a mental health crisis in the black community, which calls for improved cultural competency training for all psychiatrists as well as more openness among blacks to talk about these issues, said APA President Altha Stewart, M.D. She spoke on Thursday at a session on mental health at the 48th legislative conference of the Congressional Black Caucus Foundation (CBCF), an organization aimed at advancing the global black community by developing leaders, informing policy, and educating the public.

Cultural competency training is aimed at helping health care providers understand patients’ values, beliefs, and behaviors so they can customize treatment to meet patients’ social, cultural, and linguistic needs. For black Americans, this means becoming more aware of the impact of community stressors and how these factors are contributing to their mental health problems, said panelists at the first-ever CBCF panel devoted to mental health in the black community. These factors include violence and trauma, racism, implicit bias, poverty, and limited access to educational, recreational, and employment opportunities, said Stewart, who is also the director of the Center for Health in Justice Involved Youth at the University of Tennessee Health Science Center. “Just being a black person in America can keep you in a constant state of rage,” she said, quoting James Baldwin.

There are only about 2,000 black psychiatrists nationwide, Stewart pointed out. “There are not enough black psychiatrists in America to serve all the black people who need mental health care.” She called for all psychiatrists to become more culturally competent, and for all to encourage young blacks with an interest in STEM (Science, Technology, Engineering, and Mathematics) to enter the mental health field. “Medicine needs their voice. We need their presence.”


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