Harris: Mental Health as a Social Justice Issue

NYAPRS Note: The following interview with the extraordinary Leah Harris delves more deeply in what trauma informed care and suicide prevention should be and assails systems where ‘meds and beds’ are the immediate default.

In particular, Leah’s call for an analysis of poor behavioral health and healthcare that looks beyond the biological to the social and to the impact of housing instability and homelessness, of poverty and isolation and of various forms of institutionalized discrimination.

These latter points were very powerfully advanced at a highly lauded joint plenary presentation by Dr. Ruth Shim and Jeff Olivet at our recent Executive Seminar. The attached presentation transcend the usual limitations of PPTs, leading with insight and crackling with outrage. You can also see it also at http://www.nyaprs.org/conferences/executive-seminars/executive-seminar-2016/documents/TheSocialDeterminantsofBehavioralandPopulationHealth_000.pdf.

Leah Harris on Mental Health as a Social Justice Issue

On the future of mental health

By Eric R. Maisel Ph.D.

Rethinking Mental Health Psychology Today May 1, 2016

The following interview is part of a “future of mentalhealth” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress.

Interview with Leah Harris

EM: You believe in redefining health (and mental health) as a social justice issue. Can you share your thoughts on that?

LH: The prevailing “mental health” paradigm is largely disease and pathology-focused, which is a convenient way to enforce and reinforce the status quo, placing the blame squarely on individuals’ “faulty” brains. As noted byGabor Mate, M.D., this paradigm is dangerous for many reasons, because it:

  • Separates the mind/brainfrom body in artificial and arbitrary ways.
  • Separates the person from theirenvironment, depoliticizing their experiences.
  • Focuseshundreds of millions of dollarson research into discovering the genetic causes of “mental illnesses,” while little is spent on research to improve the quality of and access to psychosocial services and treatments.

What is needed instead of a reductive approach to mental health is a political, intersectional analysis that highlights the connections betweenrace,gender,socio-economic statusand health outcomes.

People of color who experience mental disability or addictions are more likely to experience coercive “interventions” than their white counterparts -- whether in the form of police violence, mass incarceration, forced inpatient and outpatientpsychiatric commitment, as well as suspension and expulsion from school, which feed the school-to-prison pipeline. Mental health is a civil rights issue.

Mental health also hasclear social determinants: access to housing,education, employment, economic security, and social support. Yet far too often, people of color, gendernon-conforming folks, and people with mental health and other disabilities are systematically denied these things. A social justice approach to mental health would focus on ensuring equitable access to the social determinants of health for all. It’s impossible to regain your health if your basic needs are going unmet.

EM: You have done a lot of training and advocacy around “trauma-informed care.” What is meant by this term?

LH: “Trauma-informed care” is the newest buzzword that is thrown around in a variety of settings – from education to juvenile justice to mental health. I’ve known a lot of systems and agencies that claim that because they screen for trauma or have tossed in an evidence-based intervention, that they have “done” trauma-informed care.

Trauma-informed care is about so much more than that. It’s the recognition that the vast majority of people who encounter all of our systems have likely experienced multiple forms of trauma – whether in their home or in the community, as children and as adults.

Systems and society need to recognize that practices such as institutionalization and incarceration, seclusion and restraint, suspension and expulsion, solitary confinement, forcedmedication, and other practices serve to re-traumatize people they are supposed to be “helping” or “rehabilitating.”

Providers of services also need to recognize their own trauma histories, breaking down the us/them dichotomies between those who serve and those using services.

True trauma-informed care is about changing the culture of all of our systems to do everything possible to avoid re-traumatizing people, and to create the conditions where people feel empowered to heal and live their best possible lives.

EM: What do you mean by “trauma-informed suicide prevention?”

LH: Usually, suicide is discussed uncritically and reductively as being caused by “mental illness,” full stop. The high rates of trauma andadverse childhood experiences(ACEs) amongsuicidalpeople are rarely acknowledged in research or practice in the suicide prevention world.Researchers foundthat ACEs were a factor in nearly two-thirds (64%) of suicide attempts among adults and 80% of suicide attempts during childhood/adolescence.Traumaticexperiences in adulthood are also highly correlated with suicidal thoughts and actions.

The 2015 Access Denied: Washington, DCTrans Needs Assessment Report,the largest survey oftransgenderpeople in U.S. history, found that the prevalence of suicide is very high among transgender people, and that suicide attempts are highly correlated with experiences of assault anddiscriminationin adulthood. It makes sense then, if we'd like to reduce the suicide rate, that we focus on preventing childhood and adult trauma, and ensuring that people receive care and support that does not create further trauma and pain.

Sadly, often the only option available in mental health crises is to call 911 on people, leading todistressing or deadlyencounters with law enforcement. We have a long way to go to ensure that suicide prevention and crisis care are compassionate, culturally attuned, and trauma-informed.

EM: What are your thoughts on the current, dominant paradigm of diagnosing and treating mental disorders and the use of so-called psychiatric medication to treat mental disorders in children, teens and adults?

LH: We currently have a one-size-fits all approach to “mental health” in this country, which can essentially be summed up as “meds and beds.” I have some friends and loved ones who find the voluntary use of psychiatric medication helpful. They have a collaborative relationship with their psychiatrists, who listen to them about what is working and isn’t working. They are in charge of their own treatment choices and options. But most people are not in that situation.

My mother,who was diagnosed with schizophrenia,was so heavily drugged for most of her life that she could hardly function. She had no say over her medications whatsoever; any objection was viewed as “noncompliance” and a symptom of her “illness.” She died at the age of 46, and I am certain this was in large part due to the toxic effects of a lifetime of extreme overmedication on cocktails of antipsychotic and other drugs.

The key when it comes to medications or any other treatment is voice and truly informed choice. Many communities are demanding that “treatment” be redefined in a way that is responsive to their issues and needs.They are often less focused on cookie-cutter solutions such as “meds and beds,” and advocate instead for culturally and gender-responsive, holistic approaches to care. This is the critical direction for advocacy, now and in the future: to fight back and collectively reclaim our lives and health.

Leah Harrisis a mother, storyteller, survivor, and activist. She is a collaborative action facilitator and co-founder of Trauma-Informed DC (TIDC), a community-level effort to prevent and address sources of trauma and adversity affecting the residents of the District of Columbia. She is also founder of The Shifa Project, a woman-owned social enterprise focused on healing trauma and toxicstressthrough the expressive arts and holistic, mind-body approaches. Her writing has been published at The Huffington Post, Truthout, Mad In America, Off Our Backs: a Women’sNewsjournal, Adbusters, and CounterPunch.

http://leahidaharris.com/

**

Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, RethinkingDepression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel atericmaisel@hotmail.com(link sends e-mail), visit him athttp://www.ericmaisel.com, and learn more about the future of mental health movement athttp://www.thefutureofmentalhealth.com

To learn more about and/or to purchase The Future of Mental Healthvisit here

To see the complete roster of 100 interview guests, please visit here:

http://ericmaisel.com/interview-series/

https://www.psychologytoday.com/blog/rethinking-mental-health/201605/leah-harris-mental-health-social-justice-issue