A Critical Age: Ending Stigma and Keeping Young People Healthy in Mind and Body
Every year, the field of public health sees growing interest in studying and improving mental health. Public health’s focus on preventive interventions means this work can help people avoid suffering from mental illnesses well before they might take hold.
“Public health recognizes the total person and the total community,” says Kyle L. Grazier, Richard Carl Jelinek Professor of Health Services Management and Policy at Michigan Public Health and Professor of Psychiatry at Michigan Medical School. “Mental health conditions affect the person, family, friends, and the community and with early intervention can be treated or prevented. Prevention is one public health approach, and behavioral health can learn from this and other public health strategies.”
Grazier is currently a Fulbright Scholar in Croatia researching public stigma and its effects on integrating mental health in public health. She and a growing number of colleagues are at the leading edge of changing academia’s approach to mental health, addressing both the way they do research and the way we live with and acknowledge mental health problems. At the heart of much of their work is the idea that youth play a key role in improving prevention, recognition, and treatment of mental illness.
Stigma is a major concern for anyone working on mental health research. And prevention of mental illness is an urgent priority on university campuses, where stigmas are slowly being conquered. Sara Abelson, a PhD candidate at the School of Public Health, calls adolescence “a critical time for talking about mental health—when many disorders emerge for the first time.” Fortunately, she says, progress is being made. “Mental health was in the shadows ten years ago. Now, we see entire campus communities embracing the issue. Some university presidents and deans speak openly about mental health, recognizing its relationship with student persistence and retention. And many student organizations now exist to promote mental health.”
“Mental health was in the shadows ten years ago. Now, we see entire campus communities embracing the issue.” -Sara Abelson
For many years, Abelson created programs for one of those student organizations as vice president at Active Minds, a national nonprofit with hundreds of campus chapters (including one at Michigan) that raises mental health awareness among college students. Abelson now studies how colleges and universities can improve mental health outcomes for students and how they can reduce inequities that can lead to student isolation. “Schools have a broad role in preventing mental health disorders,” she says. “An interdisciplinary approach is critical. Student affairs, academic affairs, health services, and state and national entities should all be involved.”
Active Minds in particular creates peer-to-peer empowerment. Young people share their personal stories in order to reduce stigma, increase knowledge, and change the culture around mental health. Active Minds works with the entire student body to strengthen prevention approaches and help identify and connect underserved students to care.
As Marc Zimmerman, Marshall H. Becker Collegiate Professor of Public Health, points out, “Young people’s mental health also affects their education. They may be offered great opportunities but are depressed or alienated and can’t bring themselves to pursue them.” Doctoral candidates may suffer anxiety or depression and become stuck with their dissertations, sometimes for months. Graduation and student retention are now understood as mental health and public health issues.
College athletics, a world many see as full of physically strong, mentally tough achievers, can look much different below the surface. These young people put tremendous pressure on themselves, and many of them do not sleep and rest enough. One result is that many suffer from mental health problems. Two Michigan Public Health students have prioritized mental health after traumatic experiences related to their own successful sports careers.
While on the Michigan Women’s Rowing Team, Traci Carson suffered from an eating disorder and anxiety. “I thought the anxiety was normal for a student balancing demands,” she says. “Then I suddenly lost 15 pounds. There was no concern from my trainers or doctors. I got compliments for how great I looked.” Carson ultimately sought nutritional counseling and saw a therapist for the anxiety.
“Stigma kept me from reaching out. Now I try to be transparent with others, hoping they will share, reach out, and get help early.” —Traci Carson
Now with an MPH from Michigan Public Health and as a pre-candidate in its doctoral program, Carson wants to challenge the stigma of mental health issues. “Stigma kept me from reaching out,” she says. “Now I try to be transparent with others, hoping they will share, reach out, and get help early. In public health, you intervene before medication or hospitalization is required.”
Carson’s work on stress and women’s reproductive systems, especially those of female athletes, relates mental to physical health and underscores the value of prevention. “High stress can mean low energy,” she says. “Then a woman’s reproductive system can shut down. She might also lose bone density. A female runner gets a stress fracture, you backtrack and find an eating disorder. You want early intervention and prevention of that disorder.” Some strides have been made since Carson’s rowing days. Michigan Athletics now distributes eating disorder questionnaires to players. “That’s a beginning,” Carson says. “But we must change the whole culture around body image. That is a public health issue.”
In 2014 Carson saw that the University was creating Athletes Connected, a mental health resource for athletes, and asked to be on the advisory board. “They do wonderfully, raising consciousness about mental health in a setting where you’re supposed to be tough and strong and emotions are not always welcome,” she says. “But for athletes, strong mental health means strong performance. Asking for help makes you strong.”
Erin Finn, an MPH candidate in Epidemiology, also cites stigma as a central issue in addressing mental illness and advocates for early intervention. “We are doing a better job here at Michigan, presenting the reality of mental health issues and providing resources,” she says. “Everyone is susceptible and everyone can be helped—in advance,” she emphasizes.
As an undergraduate at Michigan, Finn ran track and field and cross country. “It was my passion and my joy,” she says. But when injuries sidelined her, “it ripped my world apart. I identified myself with running but I was not running.” Today Finn advises student athletes to join a community or activity outside of their sport. Her friends got her involved in a national Christian organization, Athletes in Action, “which helped me put my identity into something that was not my sport,” she says. Finn subsequently made a video for Athletes Connected, telling her story and helping to educate other students about one of the many mental health care options available to them.
Finn ultimately plans to become a physician, in order to “close the gap between clinical priorities and public health and to care for patients before they are sick. I have learned from public health how to care for patients preventively, even if in a clinical setting,” she says.
Kyle Grazier agrees that community health and clinical settings are a place to innovate. “Are pediatricians looking at kids’ stresses?” Grazier asks. “Do they screen for suicidal behavior?”
Grazier advocates one-stop health-and-social-service shopping for everyone. “Seniors are being screened at a local church for blood pressure—are they being screened for depression, too?” Grazier believes our primary care system “is robust enough to do this. One could arrange for multiple services through the same site, so you’d go to your primary care practitioner, get screened for depression, get bus fare, job counseling, even arrange for housing support. Total costs and costs to the person are less, and access to those parts of life that improve mental and physical health are much greater.”
Tomorrow’s Michigan students are today’s underserved middle schoolers, and they are at the heart of Marc Zimmerman’s research. Zimmerman involves these young people in community change to increase their sense of belonging and connection to adults. Called Youth Empowerment Solutions (YES), Zimmerman’s program began in Flint, now operates in Wayne County, and has been implemented nationwide. YES kids create murals, community gardens, and other public projects that connect them to their neighborhoods and help put them on a trajectory to be contributing members of their communities. Zimmerman has done trainings around the country, and international colleagues have taken YES back to their home countries.
“Poverty and lack of resources can lead to mental distress,” says Zimmerman. “Those feelings can result in violent behavior. Fewer resources may also translate to local schools that don’t have the means to help students reach their full potential. Economic stress in families creates stressors that may result in violence and increases the kids’ chances of engaging in violent behavior. These are all public health issues.”
Zimmerman studies empowerment and resilience, aspects of a child’s development that help us understand how some children exposed to violence are not themselves violent. Identifying positive influences means we can reinforce them and prepare young people for setbacks, stress, anxiety, and loss.
Like Zimmerman, Cleopatra Howard Caldwell, professor and chair of the Health Behavior and Health Education Department, works in Flint and Chicago, where she promotes family bonds as a proven way to prevent youth violence and improve mental health. With CDC funding, Caldwell, her team, and community partners developed an intervention that brings together fathers and sons to strengthen entire family systems. Improving family health also improves the health of communities.
“Nonresident African American fathers can be effectively engaged in health interventions,” Caldwell says. “Responding to your child’s needs enhances your sense of being a parent, which improves a father’s mental health. These men contribute to their own development and well-being—for example, reducing depressive symptoms and substance abuse—while strengthening their relationships with their sons, who also benefit from having their fathers involved in their lives.”
Young people are not only our future but are active members of our communities today. And for all of our advances in understanding mental health, they still suffer not only from mental illnesses but from the social stigmas that accompany them. In our clinics and classrooms, on the playing field and in our families, mental illness can indeed be prevented. We must support the total person and the total community in order to better serve our youth.
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