Mental Health in a Changing World

Today, instead of working on my memoir or baking that apple strudel I have been promising my husband for weeks, I have been engrossed in reading the recently published "Profiles in Mental Health Courage" by Patrick J. Kennedy (and Stephen Fried).

The son of Senator Edward (Ted) Kennedy, Patrick Kennedy experienced serious personal and family struggles with mental illness and addiction. While in the Senate, he sponsored the landmark Mental Health Parity and Addiction Equity Act and eventually left Congress to become more involved in mental health advocacy.

His book movingly tells the stories of twelve individuals who have lived with mental health disorders, portraying the many challenges and showing readers what it's like to manage a chronic and at times overwhelmingly difficult illness. Echoing the theme of his uncle President John F. Kennedy's book "Profiles in Courage," Kennedy writes, "We hope to make people understand how much courage it takes to endure the daily struggles for continued or improved mental health. Because, trust me, it takes courage ..."

May is the 75th anniversary of Mental Health Awareness Month, sponsored by the Mental Health America organization, previously known as the National Association for Mental Health. Mental Health America (MHA) is the nation's leading community-based nonprofit, whose mission is to promote mental health as a critical part of overall wellness and to raise awareness and educate the public about the prevention and treatment of mental illness including conditions like depression, schizophrenia and bipolar disorder.

This year's theme, "Where to Start: Mental Health in a Changing World," illuminates the ways that external pressures of work, relationships and societal stressors intersect with our emotional and sometimes genetic vulnerabilities to impact our mental well-being.

The organization's website offers educational resources, statistics and information about advocacy and public policy, as well as an extensive user-friendly toolkit with quick reads about ways to cope with difficult emotions, find online support, meditation apps and relaxation exercises, talk to family or friends about your struggles, and ways to access mental health services.

For more immediate help with suicidal, overwhelmingly upsetting feelings or just the need to talk with someone, people can call or text 988 or chat at 988lifeline.org.

Shannah Mulvihill, Executive Director and CEO of Mental Health Minnesota, says that "The observance of Mental Health Awareness Month is a way to normalize mental health issues and help people understand just how common they are. We provide positive and accurate information to correct misperceptions which contribute to stigmatization. With our focus on the voice of lived mental health experience, our organization's aim is to create a stigma-free community where individuals and family members can feel safe in expressing concerns and reaching out for help."

Mental Health Minnesota and other nationwide affiliates of Mental Health America offer supports such as a warm line staffed by certified peer specialists, education and advocacy and confidential online screening tools with provision of resources and referrals.

Devoted to inclusivity and equity, they follow the #B4Stage4 proactive approach to mental health, which includes preventing, assessing and intervening when people first begin to experience symptoms such as feeling low, having anxiety or hearing voices, which might presage the onset of a disorder such as clinical depression, Post Traumatic Stress Disorder (PTSD) or psychosis.

Even before the COVID pandemic, mental health challenges have been ubiquitous. Although numbers jumped during the early years of the pandemic, statistics over time have generally remained consistent. According to the Centers for Disease Control and Prevention (CDC) more than one in five US adults live with a mental illness, and about one in 25 struggles with a serious mental illness such as schizophrenia, bipolar disorder or major depression.

The National Council on Aging says that up to 25% of people aged 65 and older are living with a mental health condition. The State of Mental Health in America 2023, a report released by Mental Health America, found that 4.8% of adults reported serious thoughts of suicide, with the number rising to 11% of adults who identified with two or more races.

A number of factors can contribute to the risk for mental illness or poor mental health. The CDC says some of these include:

• Adverse childhood experiences such as trauma or a history of abuse
• Biological factors or chemical imbalances in the brain
• Drug or alcohol dependence or abuse
• Experiences related to ongoing, chronic illness

There has also been an increase in the number of people who are not struggling with a clinical, diagnosable mental illness (as categorized in the DSM-5-TR, the American Psychiatric Association's guide for mental health providers,) but whose mental health, which includes emotional, psychological and social sense of well-being, is poor.

"We are working to de-medicalize mental health issues," says Mulvihill. "Mental illness and poor mental health are not black and white issues. It is not always true that you have a particular disorder or you don't. There is definitely a continuum."  

According to Mental Health America, there are four things that can profoundly affect our mental health even if there is not "illness" per se. The organization points out that:

• Current events have a huge impact on the way we feel. Anxiety about climate change, political strife, crime and gun violence, socioeconomic issues and increases in identity-based hate is rampant. The 2022 Stress in America Survey conducted by the Harris Poll on behalf of the American Psychological Association found that 76% of adults reported that the future of our country is a significant source of stress to them. Many agreed that constant worrying has led to declines in their physical and mental health, eating and sleep habits and interest in hobbies and activities.
• Technology and the pervasiveness of social media perpetuates our constant awareness of news coverage and contentious political campaigns, increasing our stress, anger and anxiety. Mental health clinicians advise limiting media exposure and avoiding doomscrolling.
• Many people are suffering from loneliness which can profoundly impact both mental and physical health. In May 2023, the Surgeon General’s Advisory on our Epidemic of Loneliness and Isolation called our lack of connection a public health crisis and laid out a framework for a National Strategy to Advance Social Connection.
• Social drivers (social determinants) of health, the conditions in which we live, work, learn and play, include economic status, access to resources (food, health care, green space) social inclusion and community. Deficits in these areas cause significant challenges to well-being.

What can we as concerned citizens do to commemorate Mental Health Month and spread the word? Mental Health America makes a number of suggestions, some of which include:

• Run, walk or bike green. As the official color for mental health awareness, green represents renewal, hope and vitality. Many buildings and more than 200 iconic landmarks in the country, including NFL stadiums and Niagara Falls, will light up in green during this month.
• Reach out to your email contacts asking them to download the toolkit and disseminate resources through newsletters and social media.
• Include information and links about Mental Health Month in your Facebook, Twitter, Instagram and other social media posts.
• Take a mental health screening and share that you “took a checkup from the neck up,” and encourage others to do the same.
• Create a personal, professional or community fundraiser, in-person or virtual, to raise money to support the work of Mental Health America.

Barbra Williams Cosentino RN, LCSW, is a New York-based psychotherapist and writer whose specialties include chronic illness, health, aging and parenting. Bylines include HealthCentral, the New York Times, Today's Geriatric Medicine, Forward Magazine (Fox Chase Cancer Center), BabyCenter and many others. Read More