World Mental Health Day

This past Tuesday, October 10th was World Mental Health Day, which focuses on raising awareness about mental health concerns around the world to ultimately mobilize efforts to support mental health. While I know I don’t have to state the obvious, we are nearly in 2018—a time in history where technology is at a forefront and medical procedures are becoming much more advanced. Regardless of the progression taking place in certain fields such as technology and medicine, mental illness is still a concept that remains stigmatized in many, if not most countries across the globe—including ours.

According to the National Alliance on Mental Illness, 1 in 5 adults in the U.S. (43.8 million, or 18.5%) suffer from a mental illness each year and approximately 450 million people around the world are currently suffering with a mental health issue (NIMH, 2015). Only 41 percent of adults with a mental health condition received help and just over half (50.6 percent) of children ages 8-15 received mental health services in the previous year (SAMHSA, 2014).

In 2010, the CDC reported that 57 percent of all adults believed that people are caring and sympathetic to persons with mental illness. However, only 25 percent of adults with mental health symptoms believed that people are caring and sympathetic to persons with mental illness. While efforts have been made to reduce and eliminate the stigma towards mental health, as a society, we are far from attaining this goal.

Time and time again, I have heard individuals say that people “should” be able to deal with “tough times” on their own. The response is simple. If you were to fall and sprain or break your leg, would you seek medical care or “should” you be expected to deal with this “tough time” on your own? Should you just walk it off until everything is better? That’s not a viable or realistic solution, and if we can understand and accept the significance that mental health plays in our daily lives, similarly to medical health, we can each work to break this stigma.

In life, we often find that the act of being vulnerable (to an extent) leads to the attainment or accomplishment of goals. Or at least, it puts us in the direction of doing so. For example, when searching for jobs, we find ourselves engaging in a state of vulnerability as we partake in job interviews—often a scary process for many. Asking somebody out on a date requires a level of vulnerability, as you cannot ensure the outcome you would like. Trying a new restaurant when you already have your top three go-to places also involves being vulnerable because you have no idea whether or not you’ll enjoy the food and dining experience.

So just what happens when we take this step into vulnerability? Well, for starters, you find out in the job interview if the company is the right fit for you, and vice versa. You have the opportunity to analyze the interview and note what went well and how you can improve for future job interviews. When you engage in vulnerability and ask somebody out, there’s the possibility that the person will say yes. Of course, there’s the possibility that the person will say no, but you may never know what their answer is unless you ask. And as for the restaurant, you may end up with a new favorite dish and/or dining spot, or you may realize you never want to go back there again. But we won’t be able to attain these answers and knowledge if we don’t at least try something new.

So when we look at mental health and discussing our own personal mental health, yes, this is another experience in which vulnerability may likely be required. It can be uncomfortable to openly discuss what has been going on in our lives and how that has been affecting us. It can be challenging to freely discuss how we are feeling when it seems as though preconceived notions on the part of others may constantly be present. And it can seem impossible to honestly discuss when we aren’t doing too well. But this is how we break the stigma. We have to start somewhere, and that somewhere is playing our part and finding the courage to be more open regarding our mental health.

Promoting a greater level of mental health starts by speaking up. We cannot expect to break a stigma that has been around for centuries if we don’t practice what we preach. While I can attest that at times, this is easier said than done, what is it that we have to lose? By confiding in a confidant, we allow ourselves the opportunity to be heard. We give ourselves a change to really explore how we are doing without censoring ourselves. And we let ourselves be supported—another act of vulnerability.

Can we overcome “tough times” on our own? Honestly, who cares? Strength can be found within each of us, and overcoming challenging life obstacles by oneself doesn’t define personal strength. Personal strength can often be found in reaching out for a helping and supporting hand. There is strength in numbers, and if we can create and foster a support system and find the courage to open up, we can begin to break the stigma of mental health, while working on and maintaining our own mental health as well.

By no means is this a clinical perspective for anyone dealing with mental health concerns. This is more along the lines of what we can do to break this stigma. Should an individual find themselves in need of help, open up to a confidant and let them know what is going on. If they don’t listen, find somebody else. And if it is an emergency, do not hesitate to call 9-1-1. Know there is a plethora of mental health professionals who are here to listen. Collaborating with a mental health professional to receive treatment and accomplish any goals one sets for themselves is always going to be an option. We just have to be vulnerable by taking the first step.

There is one designated day in the calendar set aside to focus on mental health. (Granted, I missed that day, but I guess it’s better late than never). It is up to us to ensure that we focus on mental health everyday so that being vulnerable and honestly discussing how we are doing is something people can take pride in. We will be the ones who set the standards for how future generations view mental health. But in order for any change to happen, it must start with us.

 

Below are just a few of many available mental health resources:

https://www.nami.org/Find-Support
https://www.mentalhealth.gov/get-help/index.html
https://suicidepreventionlifeline.org
https://www.nimh.nih.gov/index.shtml
https://www.goodtherapy.org

 

PASEO Program Adventure: Final Thoughts

I wanted to be sure to end on an important note before I officially conclude writing about my experiences in Peru. Throughout the past two months, I spent a lot of my time working in El Porvenir—an impoverished city in northern Peru. This past March, Peru experienced an awful huaico, or flash flood, attributed to the phenomenon of El Niño. As I mentioned in posts throughout the past few months, we heard firsthand accounts from locals who live in El Porvenir and other cities in northern Peru about how the huaico affected their daily lives, and I spoke with various faculty members and school administrators about students whose participation in school has decreased due to having lost their homes in the flood. As I wrote about earlier, one student in particular was trapped underwater as the flood tore apart his home.

Just days after this particular flood (because keep in mind, there are many), the Peruvian government stated that the death toll had reached 94, while estimates reported that 700,000 individuals were left homeless in 12 of the country’s 25 regions. Nearly six months later, there are still so many individuals affected by the flooding whose lives have been changed ever since. When driving into El Porvenir, one can spot the zona de las damnificadas (pictured below), or the area of the victims. In this designated area, temporary housing (tents) have been set up alongside the street for families who lost their homes in the flood.

While living in a country filled with resources and opportunities for all (ideally), it can be easy to forget just how fortunate we are. I wanted to dedicate this post to those who have seemingly been forgotten, and to those who have been impacted by the devastating natural disaster that changed the lives of so many. From the children who cannot focus in school because they continuously re-live the scene of being trapped underwater to the parents who lost the homes they spent years saving up to afford, and everyone in between.

This post won’t help any of the affected individuals currently living en la zona de las damnificadas. This post also won’t change the stigma associated with mental health in Latin America, and more specifically, Peru (which is another concern). This post won’t help individuals realize the importance of seeking out mental health care, and it won’t make any difference whatsoever in changing the way the public hospital systems work when caring for individuals without resources. This post won’t increase the number of resources in Peru regarding mental health care like there being 1 psychiatrist per every 300,000 people within the country.

As I mentioned a few weeks ago, statistics show that nearly 5 million people (11.8%) in Peru suffer from some type of mental illness. 700,000 out of 1 million Peruvians suffer from depression, while 200,000 out of 1 million Peruvians suffer from some type of anxiety disorder. Less than 4 percent of these individuals receive services in specialized centers. Why, you may still ask? Fifty percent of such individuals believe they can overcome their mental illness on their own. Thirty percent don’t believe in treatment, and thirty percent don’t know where to go to receive services. So no, this post won’t help increase the number of individuals who receive services in specialized centers, and it most definitely will not decrease or eliminate the sense of shame that so many people associate with mental illness within the country. 

Realistically speaking, my words and my blog post can’t accomplish any of that. But what we can do is this: we can work together to appreciate what we have. As soon as we can learn to find gratitude and accept the term in its entirety, we can seek out ways to help those around us. There are so many people in need of help and assistance everywhere you turn, but when we become engulfed in our own lives, we often turn a blind eye to situations around us, and understandably so. But if we don’t help those in need, who will? 

It has to start with us. As for finding a solution to problems throughout the world, well, I haven’t gotten that far yet, and frankly, I doubt that I ever will. But if we can each find a way to work together and use the resources at our disposal to try and make the slightest difference—whether in somebody else’s life, in the community, in a different country, or on a global scale, that slight difference will hopefully make a lasting impact that will better the lives of those in need. Yes, I understand that this is much easier said than done, and it’s just a bunch of words written on a page that probably won’t be read by many. But we have to start somewhere with something. And I guess this is that starting point.

As I conclude writing about my experiences in Peru and the incredible opportunity that I have been given, I kindly ask that we work together to not forget those who have seemingly been forgotten. Mother Teresa once said, “Not all of us can do great things. But we can do small things with great love.” If you ask me, I think that’s the perfect starting point for all of us. 

PASEO Program Adventure—Day 56: Trujillo Alto, Huanchaco, y Lima, Peru

On Friday morning, we hosted another workshop with a different group of Líderes Escolares. Similar to what I mentioned in yesterday’s post, today’s workshop focused on mental health, including psychoeducation regarding the difference between sadness and depression, the difference between stress and anxiety, how to spot signs of suicidality, and resources that the students can use in the case that a peer is experiencing any of the aforementioned topics.

The students who participated in today’s workshop were younger than most of the other students we worked with thus far, but their interest and participation in such serious topics was great to see. Following the workshop, one of the students stood up and thanked us for the work we have been doing in Peru, and for the information and support we have provided the Líderes Escolares with. You can never know if you are making a difference in the surrounding community, and even though we still don’t know whether or not we have been and are making a difference, it was truly rewarding to hear such young students thanking us for working with them. After working with such inspiring, young leaders, one can’t help but feel a great sense of hope for the future.

After our workshop, some of the social workers we have been working with took us out for a delicious lunch, consisting of ceviche mixto and chicharron de pescado. As soon as we finished lunch, I had to get back to Huanchaco for my last Spanish grammar class.

Once our class ended, another student and I ran over to facilitate our last group with adolescent males that I spoke about throughout the past few weeks. Today’s group focused on support systems and evaluating the different types of support we each have in our lives (including practical support, social support, emotional support, and advice-based support). This activity helps you realize the types of support you may or may not have, which is useful in thinking about who one’s main confidants may be. We then focused on TIPP, which I wrote about on Monday.

During times of crises, TIPP is a useful tool that one can utilize to take a step back from the crisis to de-escalate the situation. TIPP can be used when one is about to engage in dangerous behaviors during a crisis, when an individual needs to make an important decision, but is too overwhelmed to think/make a decision, the individual is not processing information effectively, the individual is emotionally overwhelmed, and/or the individual isn’t able to use his/her abilities. TIPP stands for Temperature, Intense Exercise, Paced Breathing, and Paired Muscle Relaxation—all of which are techniques one can utilize during a time of crisis. As we finished the session, we celebrated our time together and the group members’ participation throughout the past few weeks with a chocolate cake.

Following the group, we ran over to the beach to watch the sunset one last time, before having to leave Huanchaco later that evening. After enjoying the sunset, some of the other students and I went for dinner, and returned back to our house to pack, before leaving for the airport. Since I won’t be returning to the States until Tuesday, I took a cab to San Isidro (where I will be staying for the next few days) once I arrived in Lima at around midnight. 

PASEO Program Adventure—Day 55: El Porvenir y Huanchaco, Peru

On Thursday afternoon, we had our second workshop with Líderes Escolares from three different schools. Today’s workshop focused on mental health, including psychoeducation regarding the difference between sadness and depression, the difference between stress and anxiety, how to spot signs of suicidality, and resources that the students can use in the case that a peer is experiencing any of the aforementioned topics. It was truly incredible to see so many adolescents participate in todays workshop, especially given the intensity of the topics we discussed.

Many of the adolescents mentioned knowing someone with a mental illness and/or knowing someone who has contemplated or attempted suicide. As I mentioned before, seeing so many young individuals take the initiative to learn about mental health in general and ways to help others as leaders in their schools has been, and continues to be refreshing and inspiring.

Following the workshop, we made sure to enjoy the sunset once again, before having a Cena Familiar at a local pizza restaurant with everyone from the program, seeing as it was my last night in the program, as well as the last night of a few other students as well. On our way back to the house, we stopped for picarones (the delicious fried dessert that one could only dream of.) After dinner, we played cards to officially end our last night in Huanchaco.

PASEO Program Adventure—Day 17: El Porvenir y Trujillo, Peru

This morning (Monday—yes, still behind), I completed my final observation at another school in El Porvenir. It was definitely an interesting experience because the school I observed is a Catholic school (considered more private than the others), as opposed to a national school (or public school, which is what every other school I’ve observed so far is considered). Since students from the secondary school were on a field trip to local historic sites for the day, I was only able to observe students in primary school.

Upon speaking with a local social worker, I was informed that there is a lot of crime among the students, including extortion and theft. When I spoke to the director of the school, she mentioned that a lot of the children have difficulties at home that influence their behaviors, including lack of parental support and/or parents having to work long hours, leaving their children unsupervised upon returning from school. This recurring theme seemingly continues to make its way into every school that I observe. There are so many challenges that these children face both inside and outside of school, but especially once they leave school grounds each day. The risk factors are substantial, and we have to focus on fostering more protective factors in order to provide these children with substantial support so they can have the futures they deserve.

In the afternoon, we had our weekly meeting with a group of local women and family members in El Porvenir that I briefly discussed last week. Each week, two students from the program are responsible for teaching the group members relaxation and emotional regulation techniques for them to utilize at any given moment and teach others in their community. This week, one of the other students and I were in charge of working with the group members’ children—some of whom have physical disabilities and/or difficulties with motor skills and/or verbal communication deficits. We had each child write their names and draw something that corresponds with each letter of their name. The creativity and abilities in these children are truly incredible.

After our group, we went back to Trujillo for our Psicología en Peru course. Tonight, we focused on statistics within the country, all of Latin America, as well as throughout the world. When we look at a global scale, depression happens to be the most common mental illness. However, in Latin America, only five percent of the adult population reportedly suffer from Depression. According to the NIH, “In 2015, an estimated 16.1 million adults aged 18 or older in the United States had at least one major depressive episode in the past year.” If so many people in the United States alone have experienced depression, why is the percentage so low in Latin America? It’s because so many people do not seek or receive mental health services. This number is merely what is reported.

Among so many other challenges, stigma is the biggest problem pertaining to bringing attention to mental illness in Latin America, and especially Peru due to discrimination against mental health. If you seek any type of help or treatment, you’re considered “weak” or “crazy.” You’ll likely be asked, “Are you weak? You’re not strong enough to deal with this?” Alongside stigma, shame and misconceptions about having a mental illness come into play as well.

Even if we were to put stigma aside, psychoeducation is another challenge. If someone does in fact have a mental illness, many times, they’ll go to the local clinic with the belief that it’s a physical illness as opposed to a mental illness. In a perfect world, hypothetically speaking, of course, let’s say that someone does in fact go to the hospital for an issue pertaining to their mental health. As I mentioned the other week, you would have to wait days in the hospital before getting an appointment, and when you finally do get one, your appointment would only last a few minutes, and would consist of being asked a few “yes” or “no” questions to determine if you have depression.

There isn’t enough time to converse with the patient, so the odds of someone actually getting the help he or she needs and deserves are slim to none. But first, you’d have to overcome the stigma and shame in order to even make it to this point. And you’d have to hope that your family wouldn’t abandon you due to shame as well. Now if you want to talk about services, there is about 1 psychiatrist per every 300,000 people in Peru. If we were to look at another country, let’s say Colombia for example, there, you would find 2.1 psychiatrists per ever 10,000 people. Pretty significant difference, right?

The following statistics have been taken from Según el Instituto Nacional de Salud Mental (INSM) (2014): Nearly 5 million people (11.8%) in Peru suffer from some type of mental illness. 700,000 out of 1 million Peruvians suffer from depression, while 200,000 out of 1 million Peruvians suffer from some type of anxiety disorder. Less than 4 percent of these individuals receive services in specialized centers. Why, you may still ask? Fifty percent of such individuals believe they can overcome their mental illness on their own. Thirty percent don’t believe in treatment, and thirty percent don’t know where to go to receive services. (Yes, the percentages overlap.)

This is why education is so important. We must spread the word about mental health because until we can do so, millions of people will not receive the necessary services they require.

PASEO Program Adventure- Day 10: El Porvenir y Trujillo, Peru

If I could fast forward one day (in real time)… My phone fell out of my pocket today in a shared taxi cab, which explains why this post is picture-free. I’ll explain what happened in tomorrow’s post (which is today in real time). I just figured I’d let you know you’ll have to use your imagination for the next few days with regards to what I’m talking about. And for those of you who just look at the pictures and don’t read the post (which I imagine is most everyone), well, it doesn’t really matter since you wouldn’t have made it this far in the post anyways.

Today, we traveled to El Porvenir, where we met with a group of local women and family members. We will undoubtedly learn a great deal from those in the group, but the goal is to help teach these individuals relaxation techniques for them to utilize at any given moment. More importantly, these individuals will be able to teach these learned skills to others in the town, so that the cycle of knowledge can continue to be passed along.

Our evening was spent learning about Psychology in Peru, which focused on healthcare throughout the country. We watched various videos that showed the lack of resources and services that public hospitals are able to provide. People wait days in public hospitals before being able to be seen by the general doctors on site. Specialists are rare to come by, so you have to wait to see one of the few general doctors. When it comes to important procedures of surgeries, you may have to wait days before being seen, but being seen just means that you’re given an appointment to return months later. You’re also given a list of supplies that need to be purchased for your procedure or surgery—all of which you must pay for and supply yourself.

Hospitals receive government funding, but tend to find themselves on the side of corruption, as they have deals with local clinics. If someone needs an appointment, the hospital will likely send them to a private clinic. Regardless of whether or not it is an emergency, the individual will have to pay for his or her own transportation from the hospital to the clinic. Now add on the cost of whatever the private clinic will charge as well.

If you want to see someone for a mental health concern in the hospital, you’ll likely see a nurse because mental health professionals are just as scarce as good public healthcare. Imagine having a serious medical condition, all while having to wait days in a hospital (no exaggeration)—in a wheelchair (if you are lucky), on a chair (if you can find an available one), on the floor (if there is room), or outside on the street. Now imagine having said serious medical condition, alongside a mental illness. With or without a mental illness, you will likely come out of the hospital worse than when you went in.

While medical care is short-staffed and completely behind, you can only imagine what mental healthcare is like. For this reason, oftentimes the solution for those with mental illnesses is to go to the church, talk to a friend (if you’re fortunate enough to do so), turn to alcohol and/or drugs, or commit suicide.

It’s difficult and frustrating to discuss the corruption, mismanagement, and maltreatment that takes place for those without financial resources, which ultimately affects the lives of so many. How do you make a change from the bottom upwards, when real change needs to start from the top and work its way downwards? Unfortunately, I don’t have the answer just yet, but we have to start somewhere. And seeing local individuals gather together to try and help those in their community is definitely a start in the right direction.

Snapshot Challenge Saturday

Last weekend, I had the opportunity to volunteer at the NEDA walk in Miami. Eating disorders have the highest mortality rate out of any mental illness, and if we can help bring additional awareness to this important cause, more individuals can receive the help and support they need to overcome this awful disorder. Seeing so many individuals come together for a wonderful cause was truly beautiful, but knowing that even more individuals will receive the medical attention they deserve is even more beautiful.