Topic Expert Roundup: What Does Mental Health Awareness Mean to Therapists?

May is Mental Health Awareness Month, a time to recognize a range of issues—depression, bipolar, and schizophrenia among them—and the effects they have not only on the people personally experiencing and struggling with them, but on society at large. But what does it mean to be aware of mental health, exactly, and how does that awareness manifest?

Events in the news regularly challenge our perceptions of mental health, or what we may perceive as a deficit thereof. From the marathon bombings in Boston to the Newtown tragedy to the discovery of three women held in captivity in Cleveland for nearly a decade, some of the most compelling stories in recent times have been widely associated with mental health concerns. In some cases these concerns relate to victims, in others to perpetrators of violent acts. In almost all cases, though, an initial wave of outrage gives way to apathy and disconnect as the story fades from public consciousness.

While dedicating a month to mental health awareness is nice, it’s clearly not enough. We wanted to know what our Topic Experts had to say about the matter, so we asked them the following questions: What does mental health awareness mean to you as a mental health practitioner? Is awareness, in your estimation, on the rise or decreasing in recent years? Why? What obstacles do therapists and nontherapists alike face in their efforts to increase awareness of mental health issues? What can be done to combat stigma?

Their responses follow:

• Sarah Swenson (autism spectrum): “I work as a psychotherapist with gifted children and adults. This is one of the most underserved populations in the entire area of mental health. Gifted children are routinely misdiagnosed with ADHD, OCD, impulse control disorder, and even disorders of the personality. Often, these children are medicated. This creates a chain of events with effects that extend well into the future. … It is not only to the general public that the topic of mental health awareness is significant. It is also of importance to our health care providers and the medical schools that train new practitioners. Only through the addition of coursework in the identification and clinical presentations of intellectual giftedness will the tide turn. If physicians know what they are looking at, their diagnoses and referrals will change, and children who need no medication in the first place will benefit because they will no longer be medicated into altered states that create negative environments for their giftedness to blossom and grow.”
• Tom Wooldridge (systems theory / therapy and family-of-origin issues): “What is mental health awareness? For me, it has two components. First, we pay attention to our own mental health. What is the legacy of mental illness in my own family-of-origin and how does it affect my day-to-day life? How am I dealing with the experiences—both positive and negative—that I had growing up? What is my attitude toward my own emotional difficulties? Am I able to relate to them nonjudgmentally and with compassion? Second, we recognize the impact of mental illness and emotional suffering on those around us—friends, family, and the larger community—and begin to struggle with the question of how this awareness can inform our day-to-day lives. What are our attitudes toward those we encounter who are struggling with severe mental illness? Over time, we hope to find ways to support them in their struggles and to recognize our ultimate interconnectedness.”
• Stephen L. Salter (values clarification / eating and food issues): “The efforts of the mental health awareness project, while coming from a caring place, can do more to obscure awareness than promote it. Sure, it might be useful to understand ‘bipolar’ and ‘depression,’ but the effort becomes counterproductive if it is not contextualized within the much larger question, ‘What does it mean to be human?’ Perhaps we’d be better served to offer a month contemplating that question. We assign some really strange names to people—like ‘schizophrenic.’ More often than not, it further exiles the ‘mentally ill’ into a class of otherness. To truly understand mental health, the first diagnosis must always be human.”
• Deb Hirschhorn (relationships and marriage): “The stigma must come out of ‘mental health’ in people’s minds. The recent mass murderers needed help long before they became adults—and the help came too little, too late if it came at all. Here is what should happen instead: School counselors should be vigilant and then call parents in to discuss their children when something seems not right about a child. However—and this is a big however—it should be handled in a way that does not make the parents feel ‘one-down,’ but rather with great humility and kindness on the counselor’s part. The message should be sympathetic to whatever the parents and child may be experiencing. After all, if the child is being bullied at school or excluded from cliques, the child may need help with social skills and the parents may themselves not be strong in this area. This is nothing to be ashamed of: We all have our strengths and our weaknesses, and that point should be made to them. I, for example, can’t sing on key to save my life, and these parents may be great musicians. Not everyone is great in the social area, parents included, and even ones who have those skills may not have the skill of passing it on to their children. School counselors should be referring such children as soon as the problem becomes evident, even as early as kindergarten, and the referral should be geared toward handling difficult social and academic situations, dealing with abuse at home, and self-esteem building. It should not automatically include a prescription for medication. Therapists of all stripes must recognize the inherent value in talk therapy so that we can promote that message to the public.”
• Deborah Klinger (eating and food issues): “I believe that mental health awareness is increasing. High school counselors whom I’ve come in contact with are knowledgeable and concerned about students’ mental health issues, and the universities in my area have excellent campus counseling services that liaise with psychotherapists in the community. None of this was the case when I was in high school or college. The National Association of Mental Illness (NAMI) holds local family-to-family support groups for family members of mentally ill persons. And I hear mention and discussion of depression, bipolar, eating disorders, etc., everywhere—in national news media, online, and in day-to-day conversation. Not only has awareness of mental health issues increased, but so has understanding and acceptance.”
• Lynn Somerstein (object relations): “Thanks for asking about mental health awareness. I am sad people remain largely uninformed about mental health issues and are often reluctant to seek help because of the stigma that still comes with the territory. Treatment should be made more available, too, to those who want help but can’t afford it. Many therapists make private, sliding-scale arrangements for those without health insurance, but what we really need is better government health care and education about the many different avenues available—from talk therapies to medication.”
• Olga Gonithellis (creative blocks): “Reflect, talk, act! This month is an excellent opportunity for every one of us to reflect upon the importance of mental health, to start talking, and to take action. One of the common misconceptions is that talking about it creates it. There is an irrational fear that by sharing knowledge and information about mental illness, one will reinforce its existence. However, opening up communication and sharing facts and experiences are helpful tools in dealing with all sorts of psychiatric conditions, from depression to panic and from body dysmorphia to schizophrenia. Using my area of interest as an example, there is growing scientific research regarding the prevalence of psychiatric issues in performers and creative individuals. By encouraging a genuine curiosity about this topic, we are able to dispel myths and to discover realities. Artists have been able to receive help and guidance on concerns such as performance anxiety, low self-esteem associated with stress in the entertainment industry, the connection between mood and creativity, and more. Similarly, there are many other topics related to what impacts mental health that need to be addressed in our homes, our schools, and our communities. However, without awareness and a nonjudgmental approach, we will not get very far. Let us use this month as a chance to reflect, talk, and act!”
• Andre S. Judice (posttraumatic stress / trauma and energy psychology): “Mental health awareness is the recognition that our psychological well-being is an important part of our own health, productivity, and happiness, as well as the well-being of our communities. In my opinion, mental health awareness is on the rise in our country. Certainly, recent events across our nation have called this issue to the forefront as we are forced to consider the motivations of people who set out to harm others. Unfortunately, it seems that to this day in our culture too few people understand the factors that contribute to or hamper good mental health. On the other hand, our efforts to increase people’s awareness of these factors, as well as the various ways that we can each be more psychologically well, seem to be taking hold. … I believe that one obstacle to increasing mental health awareness is in the various belief systems (be they entrenched family beliefs, religious beliefs, or other beliefs held by a given group) that lead people to adhere to ineffective and antiquated value systems in which others are told that they don’t need outside assistance but merely willpower to be better and help from within the group itself. In these situations, people needing more effective ways to improve their mental well-being miss important assistance and opportunities. Certainly, stigma associated with reaching out for help is another obstacle which seems best resolved with increasing numbers of people being open about their own utilization of mental help support systems.”
• Shannon McQuade (addictions and compulsions): “It would be helpful to simply acknowledge that we all have a nervous system that, like anything else in the body, can break down. We are all at risk for mental health issues. Like cancer, some are more vulnerable than others. Many people have been rushed to the emergency room believing they were having a heart attack, only to discover that they were actually having a panic attack. A mental assessment should be part of a regular doctor visit, with referrals made to specialists as needed. If everyone was being screened as though it were no big deal, we would see attitudes change. Additionally, an increasing number of mental health professionals are ‘coming out of the closet’ and risking exposure to put a face on mental health issues, letting people know that we (myself included) who struggle with these issues can lead full, happy, productive lives if we have the right resources. Dr. Marsha Linehan, developer of dialectical behavior therapy, announced in 2011 that she had struggled with borderline personality issues, a diagnosis that carries a very heavy stigma and is difficult to treat. Though she had been apprehensive in sharing this (with good reason) early in her career, she decided that sharing her experience and recovery would bring hope to others. I think this a great example of self-disclosure that is helpful to our clients and to the public in general.”
• Marian Stansbury (imago relationship therapy): “It appears the awareness of mental health has been increasing over the years, especially influenced by people like Oprah. Being aware of not only what we’re feeling in our bodies, but also in our emotions and in our thoughts, is critical for good mental health. An obstacle to this is when we judge ourselves as having something wrong with us and then have too much embarrassment or shame to ask for the support we need. Or, we worry about what others would think if they found out. Just as we go to medical doctors when we have pains in our bodies, it’s important to seek out mental health professionals when we’re having disturbing emotions and/or relationships. A quick quiz to assess our mental health: (1) Do we scan our bodies for tension and ask what might be causing us to tighten up? (2) Do we use the principles of rational thinking that will lead to more positive emotions? (3) Do we check our emotional levels each day? (4) Do we ask ourselves how we’re treating others? How we’re treating ourselves? These aspects all comprise good mental health. Meditation and exercise are two important ways to be more mentally aware and to assess these different aspects.”
• J. D. Murphy (drug and alcohol addiction): “Tragedies such as that seen in the recent Newtown school shooting that continue to make the headlines over recent months and years leads this therapist to conclude that the progress needed in the treatment of mental illness is far from where it needs to be! This despite the growing availability of effective treatment, mental health professionals, and treatment facilities. One would have to question if this escalation is due, at least in part, to the stigma that many place upon the thought of being considered to have a mental illness, or, for that matter, to even have a family member or close friend who is challenged by such. Undoubtedly, recent cutbacks in the funding of programs designed to provide treatment for those struggling with a mental or addictive disorder has and continues to have an adverse impact on these populations. Schools, communities, organizations, churches, and, yes, even governmental entities must begin to work together in more effective efforts to raise awareness, normalize, destigmatize, provide funding for and treat such individuals.”
• Angela Lee Skurtu (relational psychotherapy and sexuality / sex therapy): “Mental health awareness includes both awareness of the number of people affected by mental health issues and the need for affordable interventions. For example, major depression affects approximately 14.8 million American adults every year. The National Institute of Mental Heath (NIMH) reports that it is the leading cause of disability in the U.S. for adults and teens. However, many insurance plans will not provide a minimum number of therapy sessions for mental health. … Other obstacles include public perceptions of therapy and a tendency for bad therapy to have wide ripple effects. When clients experience bad therapy, they share that information with others. This further reinforces the stigma already attached to mental health. Compound this with images of therapy in the media, and we have further misunderstandings. … To combat stigma, we need to improve our field. We need to increase funding for research and consistently publish new research in magazines aimed toward the public. We need to put that research into practice in our daily treatment. When we get better at treating mental health issues, people will see the value of what we do and mental health diagnoses will be seen as what they are: health issues that benefit from treatment.”
• Kelley Garry Marschall (worry): “Part of therapy is meeting people ‘where they are at.’ And these days, people are incredibly busy. Folks worry they’re not doing enough at home, work, and in their communities. Mental health clinicians hanging on to the gold standard of workday office appointments as the only way to help people is no longer meeting people where they are. It just creates more stress. We can email, Skype, and talk on the phone with our physicians about our physical health; why not talk to our clinician about our mental health? If practitioners can be less ‘couch bound’ and more open, with a client’s permission, to using multiple modes of communication to help people, the more accessible, open, and everyday mental health becomes. Tossing the couch may help the stigma fade away in the bright sunshine of everyday accessibility.”
• Tonya Lapido (relational psychotherapy and multicultural concerns): “In 2004, none of my clients referred their friends or family to me. People said the same thing over and over: ‘You’re a great therapist but I’m not telling anyone that I’m in therapy.’ Previously, our society equated mental health with ‘being crazy.’ While some maintain that perspective, it is also countered with the understanding of mental health as part of health. The discussion of wellness and work/life balance brings mental health to the forefront as an aspect of life that needs attention. … I recently attended a large business luncheon. I was the only therapist, and as I described my services the conversation quickly turned to the stigma associated with therapy. Three people stood up and said that they had previously been in therapy and found it useful. They weren’t shunned but applauded. Everyone literally applauded them for being open about their experience with mental health. … Though some stigma remains around mental health and its treatment, our society is moving in the right direction. In 2013, I have seen a rise in word-of-mouth referrals in my practice. People are telling others not only about the benefits of therapy but also that they themselves are in therapy!”
• Irene Hansen Savarese (communication problems): “Awareness of self is essential for change. May is Mental Health Awareness Month. As a marriage counselor and a relationship specialist, awareness of self in my work with couples and families stands out. … When clients ask a therapist for help, they are very much aware that something in their relationship isn’t right. Often partners are focused on what the other is doing wrong or not doing right. They’ll tell me that they don’t feel understood and that they don’t feel respected by their partner. Most partners feel that they have tried everything to fix their partner in the hope of fixing their relationship. … In my initial sessions with partners, I talk about the importance of each partner developing an awareness of himself or herself rather than focusing on what the other should be doing differently. I also look at how they react to each other in conflict situations and whether they manage to keep connected and engaged. These are important first steps to ensure an attitude conducive to partners being able to reach out to each other and work as a team.”
• Sarah Noel (person-centered / Rogerian therapy): “As I see it, mental health awareness is about educating the public on mental health issues, treatment options, and success stories. The more information people have about mental health issues, the better able they will be to recognize signs and symptoms, in both themselves and others. Further, the more information people have about treatment options and success stories, the more hope they will have. Hope is a powerful thing and often leads people to therapy. … Like many issues, I think the stigma associated with mental health issues has declined as awareness has increased. I think one way to continue the decline of stigma is to look at ‘mental illness’ in context. For example, a child who is raised by neglectful, unloving parents may become fiercely independent, requiring little from anyone. This is incredibly adaptive behavior that will allow this child to survive; however, taken into adulthood this behavior can create myriad personal and professional relationship issues. Failure to succeed personally and/or professionally might lead to depression. Understanding ‘mental illness’ as something that was once adaptive but simply no longer works is empowering, not stigmatizing—if you were able to adapt in the past, you can do so again.”

What do you think about what our Topic Experts shared? What does mental health awareness mean to you? Let us know your thoughts in the comments section below.

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