The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.
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 by Gabor Mate, M.D., this paradigm is dangerous for many reasons, because it:
+ Separates the mind/brain from body in artificial and arbitrary ways.
+ Separates the person from their environment, depoliticizing their experiences.
+ Focuses hundreds of millions of dollars on 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 between race, gender, socio-economic status and 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 outpatient psychiatric 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 has clear social determinants: access to housing, education, employment, economic security, and social support. Yet far too often, people of color, gender non-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, forced medication, 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 and adverse childhood experiences (ACEs) among suicidal people are rarely acknowledged in research or practice in the suicide prevention world. Researchers found that ACEs were a factor in nearly two-thirds (64%) of suicide attempts among adults and 80% of suicide attempts during childhood/adolescence. Traumatic experiences in adulthood are also highly correlated with suicidal thoughts and actions.
The 2015 Access Denied: Washington, DC Trans Needs Assessment Report, the largest survey of transgender people 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 and discrimination in 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 to distressing or deadly encounters 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 Harris is a mother, storyteller, survivor, and activist. She is founder of The Shifa Project, a woman-owned social enterprise focused on healing trauma and toxic stress through 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’s Newsjournal, Adbusters, and CounterPunch.
This post was previously published on Psychology Today.
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