Mental Health Care in Minoritized Communities – Episode 48

In honor of Bebe Moore Campbell National Minority Mental Health Awareness Month, NAMI’s CEO Daniel H. Gillison, Jr., is joined by Harold Turner, Executive Director of NAMI Urban Los Angeles, and Tracy McMillan, a relationship expert and television writer. In this episode, Dan and our guests explore mental health equity in minoritized communities, navigating mental health crises, the upcoming second season of Hulu’s “UnPrisoned,” and more. 

You can find additional episodes of this NAMI podcast and others at nami.org/podcast.

Transcript

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There’s a lot of need in all cultures out there. It took me a lot to understand how both of those systems work, the mental health system and the criminal justice system. We have a lot of people of mixed immigration status. They're at risk when they share with you. I can only imagine what it's like trying to go through that and not being able to speak the language. A fear that bringing it up or confronting the powers that be could lead to your being deported from the country. There's a lot to be sensitive to when you're trying to do outreach to people who have not been exposed to mental health and the mental health system and getting over a lot of the, you know, old prejudices and stuff that have been out there, cultural misunderstandings about mental illness. You want to dispel people's beliefs, but explaining to them how maybe trying a different method could be helpful. Welcome to Hope Starts With Us, a podcast by NAMI, the National Alliance on Mental Illness. My name is Daniel H. Gillison Jr. and I'm NAMI’s CEO. We started this podcast because we believe that hope starts with us. All of us. Hope starts with us talking about mental health. Hope starts with us making information accessible. Hope starts with us providing resources and practical advice. Hope starts with us sharing our stories. And hope starts with us breaking the stigma. If you or a loved one is struggling with a mental health condition and have been looking for hope, we made this podcast for you. Hope starts with all of us. Hope is a collective. We hope that each episode with each conversation brings you into that collective. So you know, you are not alone. Today, I'm joined by two incredible guests. But before I introduce our guests, I'd like to take a moment to honor July as Bebe Moore Campbell National Minority Mental Health Awareness Month. Bebe Moore Campbell was a mental health trailblazer who used her words, voice and experience to address the profound impact of mental health on culture, community and connections. She asked all of us to end the stigma surrounding mental health and to provide mental health support for minoritized communities. At NAMI, we have taken on this important work aiming to help communities of color share their lived experiences with mental health while reducing prejudices against being open about mental health challenges and care. Our first guest today is Harold Turner, executive director of NAMI in Los Angeles. Before joining NAMI, Harold worked with Fortune 500 organizations as an information technology professional. Since then, he began working with NAMI, starting in 2007, becoming the director of programs for NAMI Urban Los Angeles before becoming their executive director. He has also served on the NAMI California Board of Directors and as a commissioner on the Los Angeles County Mental Health Commission. We are also joined by Tracy McMillan, a relationship expert and television writer. Most recently, Tracy has worked on UnPrisoned, a Hulu and Onyx Collective series she created based on her experiences as a daughter navigating the impacts of her father's incarceration. So as I set this up, if you'll hang in there with me, audience. Unfortunately, I think all three of us in this podcast are sitting here, are all too familiar with the connections between the mental health system and the incarceration system. These systems are intertwined in America. Minoritized communities in America, Black and brown folks, non-English speaking community members, and more often have less access to mental health care and are more likely to be impacted by incarceration. It's a core priority at NAMI to unlink these systems by getting people help early and expanding access to care. We've worked closely with federal institutions and local communities to push for changes like 988 to reimagine crisis response and our current Crisis Can't Wait campaign through the Community Health Equity Alliance. The Community Health Equity Alliance prioritizes community informed solutions that address serious mental illness care at the state and local levels in select geographies. Bringing together thought leaders in mental health advocacy, faith, civic and health care professional services, particularly from Black and African ancestry adults through the Crisis Can't Wait campaign. We are sharing resources about common warning signs for serious mental health concerns using 988 and knowing your care journey. As we begin this, can each of you tell us about ways that your life has been impacted by incarcerations, our mental health systems? And then do you think that tools like 988 and Crisis Can’t Wait resources would have helped those journeys? Tracy, let's start with you. I've definitely been impacted by my contact with incarceration and that system. My mom gave me up when I was three months old. I went into foster care for 18 months and when I came out, my dad became my primary caregiver. And then 18 months after that, when I was about three, he got arrested and got a ten year sentence, federal sentence around-- I don't even remember what his crime was. I think it was like some kind of forgery. At that time, I went back into the foster care system and I'm told I was in more than 20 homes and I don't remember. I ended up in the home of a Lutheran minister, his wife and their five kids. This is all in Minneapolis, Minnesota. And what's interesting is because I was from Minneapolis, Minnesota, and it was in the years in the war on poverty. And there's a very strong social service vector in Minnesota. I actually had mental health care the entire time I was in foster care. I remember every six months I was brought to a place called Washburn Child Guidance Center. I was given every kind of possible test counseling, and basically I was also evaluated quite a bit. I look back on it, I'm like, wow, I was probably part of a lot of people's master's degree programs. But I'm going to say with my nine out of ten adverse childhood experiences, the fact that I'm living the life that I'm living today, and then I've been in therapy essentially my entire adult life, so many different modalities and they're all amazing as far as I'm concerned. I'm not an adherent to one over or over any other one. I do think certain things are very-- more technologies, I think EMDR is like a technology. It works sort of with or without you. It's not like you have to get lucky or hope that it works. It just does what it does because you're rewiring your brain. So yes, would I be where I am without all the mental health care that I've received in my life? I'm going to say the answer is probably not. Certainly statistically not. And I'm very, very grateful. Very grateful for it. You know, thank you for sharing your journey. And it sounds like you received early intervention. And that early intervention has really helped with your navigation. How would you look at that for a child without that early intervention, having navigated what you did in terms of your mother after three months and then your dad and then the family that they brought you in. For another child that doesn't have that experience, what would that have looked like for them from the standpoint of that lack of early intervention? I mean, I'm going to say it looks like the normal outcomes of somebody who has had the risk factors I've had. So the usual outcome for somebody with nine out of ten ACES is, I mean, not great. I'm not a person who's the facts and figures person in that way. I just know that--that I don't have a lot of company in my background in the plACES that I get to move through and the job I get to do. Usually people, even if they have one or two of my risk factors or even four of my risk factors, you know, I think we do the best we can with what--what they have. But your question is almost like asking somebody who's born into a family with $10 million. Well, what do you think your life would be like if you hadn't had the $10 million? So you're like, well, it wouldn't be--it wouldn’t have been my life. So I don't think there's any way to say what would happen. I am a very lucky combination of early intervention, great education. I was in a place where I got a great public education and I have a certain natural temperament, still resilience, I would say that allows me to have had a lot of very happy things happen and somehow they didn't crush me. And I don't know why. It's more like I'm--my temperament. You know, you have nine elements of temperament. They're inborn. I think I just have a certain amount of optimism and ability to deal with novel situations. I mean, there's just a certain number of things that I know I just have that I got lucky. But what we want is to not, you know, you shouldn't have to be as lucky as I am, really. We want people to be not have to win the lottery on top of having all these things that happen to you, you know, we want it to be where we just have the services and they're there. I was on a panel actually at the White House last fall about this very topic and my whole thing was we can say whatever we want as television creators, as social media or content. But the system itself, the delivery system has to change. Managed care has to shift to accommodate and build and give people more access to more mental health care. So well put, Tracy, and thank you and kudos to you and your resilience. And you mentioned a couple of things there. Terms of every six months that speaks to continuity of care. And I think that continuity of care is so critically important. Thank you for sharing that and also your resilience and your adaptability. So, you know, thank you. And also bringing up ACES are critically important and critically important to our community because it gets overlooked, because what happens is we address the symptom and we don't get to call it in. A lot of times the root causes are right there inside of ACES. We're all starting with at least one or two, you know, I mean, as people of color in America, especially, people descended from slaves in America. Absolutely. Thank you, Harold. Coming to you. Can you tell us about ways that your life has been impacted by incarceration or mental health systems? Yeah, I can't hardly imagine a life where that wasn't the case these days. My daughter was diagnosed with paranoid schizophrenia in her junior year in college. She was 21 years old. Prior to that, I knew very little about mental illness. Thanks to a great education system, you had some sort of health or science in every grade, but never any talk about the brain. So I was not prepared at all. To complicate it further, I was on the road traveling at the time. My daughter experienced her first break and it was significant. She attacked and injured a family member. She was arrested. She was charged with premeditated attempted murder. Like that was even possible. But my goal then was to get her help. We admit she actually did it. We don't have to go through that. They were the only two people home, but they wanted to go through the whole scenario trying to get her help, you know, during the incarceration phase was tantamount to impossible. It must've been two years to get her into court. The case itself lasted like another two years. You know, there was very little in the way of treatment for her during those months of incarceration. My daughter had been ill for some time before I could find any resource at all. So actually when I walked in the doors to NAMI or more properly, when I was dragged through the doors of NAMI by my by my spouse and it was the first place I found where people were finishing my sentences. I said, I can't believe this, you know, over that, that period when I my daughter was ill and not getting any better, I mean, I collected a lot of statistics about mental illness, but none of that translates into a support net that I needed and the guidance that I needed. My second time coming I-- I realized they were for real. Our flagship class, we offer NAMI Family-to-Family I took that class and that was transformational. It was amazing what I learned about the illness and explained so much of what I was going through and something I have to work with families on now is understanding that mental illness is not a disease of the intellect. And my daughter had this very intricate system of denial she had built around her academic success. She was going to school and doing well, so couldn't convince her she was ill. Then trying to navigate the criminal justice system was a whole other challenge. They don't come serial. They all happen at the same time. And it took me a lot to understand how both of those systems work, the mental health system and the criminal justice system. And it's one of the reasons you're now why NAMI Urban Los Angeles provides special support for criminal justice involved families. Teach them how to survive that system, and one of the unique areas of our community, too, mostly African-American and Latino and we have a lot of people who have mixed immigration status, which makes it difficult to try to reach out to people and have them be vulnerable when it involves so much of their family and they're at risk when they share with you. We've worked with that quite a bit to build trust in the Latino community. We offer everything we do in English. We offer in Spanish. We recruited heavily from the Latino community and more recently the Korean community as well. Communities sit right next to each other. So we are reaching out there. We also cover a lot of the African immigrant communities who deal with a lot of the same issues, and there are a lot of cultural misunderstandings about mental illness. So you have to be aware of that when you talk to them. You don't want to dispel people's beliefs, but explaining to them how maybe trying a different method could be helpful. So we just have to be aware of that. And it's something that that we've done and we're building now a cohort of family support group facilitators that are from the Ethiopian community. So there's a lot of need in all cultures out there and we just have to be sensitive. How things could have been different for me, I recognize and I know what I went through and I can only imagine what it's like trying to go through that and not being able to speak the language. A fear that bringing it up or confronting the powers that be could lead to your being deported from the country. It's a lot to be aware of. There's a lot to be sensitive to when you're trying to do outreach to people who've not been exposed to mental health and the mental health system and getting over a lot of the, you know, old prejudices and stuff that have been out there, I imagine it would have been different for me in a lot of ways. We went through the court system, the state mental hospital system in California, which is forensic in nature. Everybody that’s there is there by court order. You know, you don't check yourself in and out of there and one of the things, no matter how well you do, that's where I really had to advocate for my daughter and fight for her rights and beliefs is trying to navigate that system. It's something that a lot of our community members struggle with as well. And we work with them to teach them how to interface and work with the system. And I can say, you know, what keeps me at this work is I know recovery is possible and ain't easy. I've been over-- been through it over 20 years in totality. But, you know, I've seen my daughter do better, you know, get better, see her working in managing a job, seeing her go back to school and work on her second masters. She could be the poster girl for that. But I'm always aware of relapse can be a part of the landscape. Always has been. So I don't allow myself to get too high or too low, you know, enjoy the moment, you know, this is where we are now sharing talk with her, you know, which is amazing now, because she's at that point in recovery, which she can talk about that. She was diagnosed at 21. You know, one conversation I asked her, you know, when was the first time you started to, you know, experience psychosis? She told me she was 15. It shocked me at the moment. You know, that's six precious years we could have used to great effect had we known. Had she trusted enough to share. But that wasn't the case. And that's what ended up making the journey a lot more laborious than it had to be. And delayed her getting on the road to recovery. First of all, congratulations. And I want to say to both of you all, thank you for sharing your stories because you're going to help so many others. And we say often people don't care how much you know, until they know how much you care. But you all are sharing your stories. You're showing that you care. Tracy, my wife was in a foster home for the first six years of her life. There's all kinds of things that she navigates, so I can relate. Harold, I can relate to what you have been saying because we talk about early intervention at NAMI and Nothing About Us Without Us. And when you talked about the first time you found NAMI, you're looking across at someone that is experiencing something similar to what you're experiencing. Like, wait a minute, I've found a community. I have found a community. We have something we do here where we say we need help, not handcuffs. And we know that person. If they get into the justice system before they get into what we call the mental health system, it's so much more difficult. And we want them in the mental health system versus the criminal justice system. So, you know, what you've shared is so important. And even that six years, we know that a young person can actually be experiencing mental health symptoms as early as is ten, 11, 12, and it takes 11 years before they get any type of treatment. So thank you. You helped so many more just by sharing this story. And Tracy, I want to come to you now and--UnPrisoned is a story about a woman, a mother and a therapist who is navigating her father's new freedom from incarceration. Although therapists are experts on mental health, our families can often become an area where even the most prepared of us falter. The saying do as I say, not as I do might be appropriate here. Can you tell us a little bit about the inspiration behind UnPrisoned and your experiences with mental health as it relates to the story? So I am an influencer and I've written books on relationships and I have a TED Talk. But meanwhile, you know, my day job, my main thing is I'm a television writer for 17 years now, so when it came time to write a show--I always knew when my dad was in prison, his last sentence was 19 years and nine months. And I would think about what's going to happen when he gets out. As an influencer, the closest way, the most accurate description of what I do is really, I'm a jailhouse lawyer. It's like, you know, I had to do so much work on my own case. Now I can help you with yours. So I've been doing that informally for people for many years, just learning about attachment, learning all sorts of different therapy systems, participating in therapy systems. So when it came time to create a character whose dad gets out of prison after 17 years and comes to live with her and her teenage son, which is--my dad didn't come to live with us, but everything else about the setup is basically accurate to my life. I thought, well, I'm not going to make her a television writer in Los Angeles as I was. But what would I be if I had never left Minneapolis, my hometown? And I imagined, you know, if I had never left Minneapolis, I would be a marriage and family therapist right now, because that's kind of what my side hustle is. So that is how I decided to make this character a therapist. So one thing I want to talk about is the difference between emotional health and mental health. Like sometimes people have a brain based thing going on and sometimes people have an emotional thing that is organized in their brain. You know, it's a brain based thing, but it's your nervous system and your emotions and things that are less concrete than a biological, brain based illness. And I didn't have that, but I did have lots of emotional things going on. And I feel like we're a little iffy about the emotional stuff. I mean, we just don't have as much research on it. We don't really know that much about how emotions work. So sometimes I think we just mash up those two things and I would actually like to see us unhook them a little bit because they kind of are two different things. Doesn't mean they don't co-occur. So I'm not a doctor and that's not really my area. All I know is I probably don't have a diagnosis. I mean, maybe I had ADHD as a kid, although I wouldn't say that's what I'm living with. I would say I had really intense things, traumas that I carried that I wanted to explore how do we come back, walk through, carry those kinds of traumas, how do they affect us emotionally and how do we heal them? And then season two is really about how do we heal the family? How does a family heal itself? How do you go about that work? And if I get blessed enough to get a season three, it's really going to be about okay, once everything's cool at some kind of equilibrium, let's call it. How do you then create a positive primary attachment relationship in adulthood? I mean, honestly, it's been my life's work. I'll be 60 in like a month and it has taken me this long to get to something like--and I would say it's more of a percentage than a than a toggle switch. It's not like the light is on or the light is off. Really. It's more like about 90% of the time I am operating in what would be called from a secure base and secure functioning. And that is very far up after a lifetime of really you know, I've actually been married now four times, divorced three times. I'm not proud of it, but it's direct result of the the traumas that I experienced and that my attachment system, my attachment and wounding was so profound. Part of it is that I, I took 20 years off of being married after my third marriage. I was like, alright, this isn't just like we're going to make a little tweak here. We're not going to make-- do a little something different. We're going to need to take the whole house down to the studs. And so for 19 years, I was in relationships, but I wasn't. If they weren't right, I wasn't going to just like, marry the person anyway, you know what I mean? Which is when I was young, that I would-- I just wanted security. I was just like, who is going to take care of me? You know, I was very anxiously attached. You don't really see a lot of people like me out in the world because anxiously attached people are scared. And I didn't really want to take a lot of risks. But little by little, I have gradually had a healing of that and it's allowed me to go out into the world and now carry this message. So, you know, I'm obviously super grateful for that. But I think what people need to hear is that it's a life's work, It's a path. It's almost like having a disability, an emotional disability. It's more like that's something I live with. That's how I view it. I mean, I don't know, I'm not an expert in that way, but I view it as something that I have and it's just how am I going to carry it? How much of a burden is it going to be? How much will it preclude me from taking risks in life and reaching my full potential as a human being? To me, the work is about getting free, which is why I called the show UnPrisoned because we all have our types of prisons that we are in and we are all trying to set ourselves free. And so much of it does start with our mental and emotional health. It really does. And kudos to you on the title UnPrisoned. And here's to putting out front right now for year three for that. And also happy birthday. And I get it. And I appreciate you sharing your story in the detail that you are because it is about helping others by telling your story. So, Harold, I want to come to you about Bebe. And, you know, I got to meet Bebe before I actually got into this work at a book signing with a with a very good friend and one of her good friends. We know she was a ground breaking woman who co-founded NAMI Urban, L.A. Can you tell us about her legacy and what she means to NAMI Urban L.A. today? She left some big shoes and we're aware of that. You know, her legacy looms large in Bebe Moore. Campbell National Minority Mental Health Month. And we want to be sure that it's perceived that way and not just as the African-American Mental Health Month.‘Cause our community is very diverse and we want to include everybody in that. We want everybody to know what she was and how many of the things they have access to. now, we exist here because of her and because of her vision. It's pretty amazing. I mean, she was an accomplished woman and a woman of means who could have very easily taken that family to family class that I took and went on about her life. But she felt that was something that this community needed. That's led to the founding NAMI Urban Los Angeles. And we continue to do that, you know, So when we celebrate the month, we include activities from across the community. We have Mexican folklorico dancers and singers. You know, we have Korean drummers, you know, we want to include everyone, you know, African dancers and drummers. We want everybody to know and be involved in honoring that legacy and to know that they are welcome here and they are an integral part of this. It's our guiding light here. You know, it's always, you know, how does it affect the community? You know, we're always looking at the community. So one of the reasons why we put the spotlight on advocacy, that's where policies are made and we've all recognized what bad policy looks like and how it translates in the community. So we have to advocate for something better, you know, a better way of providing services to people who so desperately need them. I'm thankful to be here, you know, and we've embraced the challenge. We want to keep it going that way because it is so crucial in this community that so many unserved, underserved and inappropriately served community members. Who need that support and guidance that we're here to provide. And I can't thank NAMI enough. That's been wonderful. Well, thank you, Harold. And as you speak about NAMI and Bebe and having had the chance to actually interact with her in a very small setting with six, seven other couples, one long evening that we shared was wonderful and just a prolific writer, very accomplished poet, and two of her books, 72 Hour Hold, and sometimes Mommy Gets Mad are two great reads. And I would just offer to you that thinking about Bebe as a mom, as a colleague and having the chance to meet some of her college community, if you will, at that event was really very cool and it just showed how humble she was and at the same time how strong she was as an advocate. So thank you for sharing that. And I'm going to wrap this up in regards to one last question, and that is something that we do before we conclude, and it's a question that we ask every guest, and I want to make sure I get it right. So let me set it up. We know that the world can be a difficult place and sometimes it can be hard to hold on to hope. And that's why at the end of each episode, we dedicate the last couple of minutes of our podcast to asking our guests, what has you hold on to hope? Tracy, Harold, can you tell us what helps you hold onto hope? Tracy? So I was told that hope gets you up to the door, but knowing opens it. So that's what helps me maintain hope, is knowing that it can happen. Whatever it is that needs to happen can happen right here. It can happen right here, right now with me. It doesn't have to be some day tomorrow. Growth for me-- what helps me with hope is that growth is my own commitment to my own expansion, and then that spills over into helping others. I'm not trying to get anybody out there to change. I'm only demonstrating as much as I can with my own life what is possible and willing for whatever growth represents the next phase of my own development. And then naturally, you just bring up everyone around you to whatever degree the good Lord has you work. You know what I mean? Wherever the good Lord has you working, where if that's like one on one at Target, in line at Target, or whether that's it with a mass audience and a television show. Thank you. Thank you. Thank you, Tracy. Very powerful. Harold, what has you hold on to hope? You know, I go back to a passage I read in the family-to- family book when I first arrived at NAMI. And they pointed out that virtually everything we know about mental illness, we only know since the 1980s. And that struck me. And I think I've thought about it every day since then. That gives me hope to know that in just 40 years we have come further than in the rest of time combined. And I believe knowledge increases exponentially. And what we've learned, you know, the decoding of the human genome, knowing where a person's own DNA can help determine which medications are liable to be effective, you know, in helping them. All of this progress we've made, you know, in my own lifetime, having been being diagnosed with a mental illness, was tantamount to a death sentence. You know, you maybe had a choice of two medications, Haldol or Thorazine, and you got drug off somewhere, and you sit and grimaced and rocked your life away. Nothing could be further from the truth today. You know, people literally 70% of people with the first and second round of treatment go on to live useful, productive lives. That was unthinkable in my own lifetime. And we've come this far in having experienced it myself in my daughter's situation, who was seriously ill, and to come where she's come from to where she is in her journey continues, gives me every reason for hope, gives me every reason to stay committed to the cause. Because I think progress is the experience that I think it will increase in pace and effectiveness for people. Many of these illnesses will probably be curable in my own lifetime, and I'm not a puppy. So that's looking forward to that. I want to see as much of that as I can. Well, thank you and I appreciate both of you are actually speaking with us today and sharing what gives you hope. One of the things that gives me hope is knowing that the work does continue. And as long as there are advocates like this, like the two of you that are willing to share your stories and to share your your skills and your assets to actually help others, it's really helping the community at large. So really do appreciate it as we close this out. This has been Hope Starts With Us, a podcast by NAMI, the National Alliance on Mental Illness. To learn more about the Crisis Can't Wait resources on the Community Health Equity Alliance head to chea.nami.org. And if you are looking for mental health resources, as we said before, you are not alone. To connect with the NAMI helpline and find local resources, visit nami.org/help or text ‘HelpLine’ to 62640 or dial 800-950-6264 or if you are experiencing an immediate suicide, substance use or mental health crisis, please call or text 988 to speak with a trained support specialist or visit 988lifeline.org. I'm Dan Gillison. Thank you for listening. Be well.