About the language of mental health “You can know the name of a bird in all the languages of the world, but when you’re finished, you’ll know absolutely nothing whatever about the bird… So let’s look at the bird and see what it’s doing ‐ ‐ that’s what counts. I learned very early the difference between knowing the name of something and knowing something.” – Richard Feynman Studies show that a significant number of Americans will experience a diagnosable mental health condition sometime in their lives. However, despite commonality of the conditions, the language of mental health is a tricky issue. While it is important to use terminology that is respectful and encourages positive, person‐centered attitudes, it must be acknowledged that language is shaped by setting, audience and purpose of the communication. Over the years, mental illness has been defined through clinical research and discovery as well as various pieces of legislation. For related reasons, the terminology used has tended to focus on things like diagnosis and categorical grouping. More recently, advocacy and empowerment groups have stirred movements which have voiced concerns that older verbiage has been too ‘clinical’ and focused on a person’s illness rather than their recovery from illness and can negatively serve to de‐emphasize a person’s unique skills, abilities and character. Throughout this informational packet and in presentations from the stage, you will find a mix of terminology. The mixed use of terms is reflective of these historical changes in our nation’s understanding, approaches and feelings about what is often collectively called ‘mental health.’ The language used is not intended to ‘label’ or to limit any person’s or group’s choice to self‐identify. It is our hope that through this discussion, our nation’s ideas and the language we use will continue to develop in a way that respects diverse perspectives and helps to further our national dialogue toward finding community solutions. The Creating Community Solutions-KC Planning Team
Session One: Mental Health
1 | P a g e Session One:
The Importance of Mental Health Definition Mental health is a state of well‐being in which every individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.  Mental health is the foundation for individual well‐being and the effective functioning of a community.  Mental health and mental illness are not polar opposites but may be thought of as points on a continuum. Mental health continuum Everyone experiences occasional stress and difficulties. Without effective treatment tailored to the individual, they can grow from moderate to marked distress to disabling and chronic impairment. Usually, occasional stress and transient difficulties don’t require any special attention. When stress is prolonged or the difficulties persist and begin to interfere in some way with a person’s occupation, relationships, health or other aspects of their wellbeing, effective treatment tailored to the individual may help to prevent a progression to marked distress or disabling and chronic impairment. Cultural differences Many cultures do not have a definition for mental health or mental illness. “Culture” refers to race, ethnicity and other characteristics such as age, gender, religion, income level, education, immigration status, geographical location, sexual orientation, disability, or profession. There is a move in the mental health field to deliver services in a culturally competent way that recognizes strengths of different cultures. Diverse mental health perspectives A mental health perspective is a point of view. There are many different perspectives in mental health because there are no clear answers. Mental illness is not well understood. It is hard to define and measure, and there are many different approaches in addressing mental illness.  Mental health perspectives can be different based on: o Roles in the system (mental health professional, family member, person with lived experience, or a person who was harmed by their mental health treatment) o Ideas about the nature of mental health problems (causes, diagnosis) o Views about rights (forced treatment) o Views about treatment (medical model, alternatives) Attitudes and beliefs  Positive attitudes about mental health can result in support and inclusive behaviors (e.g. willingness to date a person with mental illness, rent a house or hire a person with mental illness).  Negative attitudes may lead to avoidance, exclusion from daily activities and, in the worst case, exploitation and discrimination. 2 | P a g e Effect of mental health problems Mental health problems affect a person’s thinking, feelings and behavior.  Some problems occur for a short period and some last longer.  Emotional distress is a real health condition that affects functioning of the brain and other organs of the body like the kidney, liver or heart. Signs of mental health challenges  Prolonged anxiety, depression, hopelessness and isolation  Lack of eating or binge eating  Regular overuse of drugs and alcohol  Thoughts and actions about suicide  Inability to focus or pay attention  Problems from birth and development, such as autism  Difficult personality issues  Breaks from reality  Problems with impulse control and aggression Mental illness usually begins at a young age. Half of all diagnosable lifetime cases of mental illness begin by age 14, and three‐fourths of all lifetime cases start by age 24. Factors that contribute to mental health challenges  Life experiences, such as trauma or childhood adversities.  Possible biological factors, such as genes or chemical imbalances in the brain, although the research is still inconclusive.  Family history of mental health problems or unhelpful stress‐handling behaviors passed down to children. Treatment of mental health challenges Most people who experience mental illnesses can improve if they receive appropriate services, support and treatment. What these services should be is a matter of debate.  The first step to getting the right treatment is to seek professional health care and review your symptoms and life circumstances.  An alternate first step might be to find someone who has been there before and talk to him or her.  Treatment options are best when tailored to each specific person and health condition.  “Wait and watch” is another option. Watching is not the same as doing nothing. Mental health challenges are common An estimated 20% of Americans ages 18 and older – about one in five adults – will experience a mental health problem this year.  Most people with mental health problems who are appropriately treated get better, and many recover completely. Treatment gap Almost two‐thirds of the more than 45 million adults with any mental illness and almost 90% of the more than 21 million adults with substance use disorders go without treatment in the U.S. every year.  In metro Kansas City, about one in every 10 adults or some 225,000 adults, has a serious mental illness including major depression, schizophrenia, bipolar disorder and anxiety disorder. While treatment is generally effective, about 40% of people in our area are untreated. 3 | P a g e Untreated mental illness Untreated mental illness can become more serious and cause huge suffering to individuals and families.  Limits ability to reach social and educational goals.  Can seriously impair productive lives and life expectancy. In metro Kansas City, untreated serious mental illness is associated with 67 suicides annually, 11,000 incarcerations and more than 15,000 unemployed adults.  Leads to expensive costs to communities in terms of health, welfare and criminal justice costs. Medication In the last 60 years, studies have shown that specific medications can be helpful for some people with certain mental illnesses.  Because medications were available, doctors recommended them and people wanted them. Sometimes they helped, and sometimes they didn’t.  Today, the majority of prescriptions for medication for mental illness are written by providers who are not mental health specialists.  One in eight Americans, including children, is now taking a psychotropic medication. Psychiatric survivors’ movement A psychiatric survivor is a person who has rejected the current disease‐based mental health paradigm and views him‐ or herself as surviving the treatment, not the illness. The psychiatric survivor movement says that there are many reasons for extreme emotional states or biocognitive challenges. These often come directly from life situations that over‐
whelm a person’s social supports. The movement says that a model that views all emotional distress as a chemical illness which is best chemically treated has scientific limitations. While a disease model and treatment with drugs has been shown to help some people, it may harm many others and may be increasing the amount of disability in our country. The movement instead wants people who have recovered from mental health crises to share what was effective for them. These advocates ask for a focus on helping people strengthen social supports and find their personal power. Community impacts Serious mental illness cost the U.S. an estimated $193.2 billion in lost earnings per year and an estimated $247 billion in annual costs overall. 
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In metro Kansas City, the annual cost of untreated serious mental illness is estimated to be $624 million. Almost 90% of those costs are indirect costs to employers and individuals; about 10% are direct costs of medical expenses, criminal activity, disability and social welfare administration. By preventing a child from becoming dependent on alcohol, we can save about $700,000 over the course of his or her lifetime. By helping a child graduate from high school that would otherwise have dropped out, we can save as much as $388,000 over the course of his or her lifetime. What we know works  Promotion: Enhancing the ability to cope and provide positive sense of well‐being.  Prevention: Identifying early indicators of problems and promoting behaviors to reduce them.  Treatment: Providing proven methods that reduce or eliminate problem behaviors.  Recovery: Sustaining positive behaviors and hope. 4 | P a g e Session Two:
Challenges Myths and perceptions About 24% of the U.S. population believes that a person with a mental illness is dangerous and 39% believe he or she is unpredictable.  Less than half (44.3%) believe that someone with a mental illness can be successful at work.  Slightly more than half (55.2%) believe that treatment can help people with mental illness lead normal lives.  Around 30% believe that a person with mental illness can eventually recover. Dispelling the myths People with mental illness commit only 3‐5% of violent acts and are much more likely to be victims than perpetrators of violence.  Individuals who received treatment for mental illnesses in the community (outpatient, day and residential treatment) were 11 times more likely to have been the victims of violent crime than the general population in the past year.  Most people who have mental illness and receive appropriate treatment recover and lead healthy lives. Stigma Stigma refers to attitudes and beliefs that lead people to reject, avoid or fear those they perceive as being different. Like any type of discrimination, stigma related to mental health may come from outside, but it also has an internal impact on people who are its target. In fact, many people prefer not to use the term “stigma” because it can seem to place responsibility on people who are stigmatized. 
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Fear of discrimination and prejudice prevents up to 60% of those with mental health challenges from seeking treatment. Some also fear forced treatment and loss of rights. The mental health system itself is the biggest source of stigma according to a survey of recovered individuals done by MindFreedom International. It is hard to make progress on mental health when it is difficult to address the underlying fears, discrimination and inaccurate scientific information that are common in our communities. Bullying Bullying can have significant mental health consequences for both victims and bullies.  Compared to individuals who were not bullied, people who were bullied were nearly three times as likely to have issues with generalized anxieties as those who were not bullied, and 4.6 times as likely to suffer from panic attacks or agoraphobia.  Children who reported being both bullies and victims showed a nearly five times greater risk of depression as young adults, compared to those who had experienced being a bully or being a victim.  Social media today such as Facebook and Twitter plays a big role in bullying and violence – “digital disrespect” is a contributor to suicide and depression. 5 | P a g e Cultural biases Cultural biases against mental health professionals and health care professionals in general prevent many groups from accessing services.  African‐Americans tend to rely on family, religious and social communities for emotional support rather than turning to health care professionals.  Latinos use mental health services less than the general population.  Asian and Pacific Islanders tend to delay help‐seeking, which may be due to language barriers or mistrust of the system. The role of peers Peer support occurs when people provide knowledge, experience, and emotional, social or practical help to each other. Peer support was the most effective mental health intervention, according to a 2002 study by the National Association of State Mental Health Program Directors. A robust array of peer‐supported programs can bridge the gap between diverse populations and the help they need. Peer programs can also provide help at lower cost than many programs that use the medical or disease‐based model. Within the traditional mental health system, though, peers may be sidelined. Instead, peers seek increased input, including peers as board and staff members at community mental health centers, and on research funding and forced treatment review boards. Trauma and toxic stress When young children are exposed to repeated traumatic experiences (e.g., child abuse, witnessing violence), they are at increased risk of developing mental health problems, substance abuse and chronic health problems like heart disease and diabetes.  The negative effects of these early experiences, sometimes called “toxic stress,” can be prevented or reversed when a child has a relationship with a supportive, responsive and caring adult at an early age. Sexual orientation Social attitudes regarding sexual orientation can also affect how we view people with mental health problems. The rejection of lesbian, gay, bisexual, transgender and queer (LGBTQ) youth by their families or by their peers and community can have a profound and long‐
term affect, including depression, use of illegal drugs and suicidal behavior. Suicide Suicide is the third leading cause of death among people ages 15‐24. One survey found that in a 12‐
month period, almost 13.8% of high school students had seriously considered suicide, 10.9% had made a suicide plan, and 6.3% attempted suicide at least once. However, psychiatric survivors point out that some medications can increase the risk of suicide for youth, so it is essential to offer many different treatment choices, especially to young people. Substance abuse and mental health Individuals with substance abuse conditions often have a mental health condition at the same time, and persons with mental health problems often abuse substances or experience addiction at the same time.  In 2011, an estimated 10.6 million persons (8% of the population aged 12 or older) were classified with substance dependence or abuse in the past year.  Approximately 8 million adults have co‐
occurring disorders. 6 | P a g e Criminal justice There are high rates of mental illnesses and substance abuse problems among people in the criminal justice system.  In 2005, individuals who experienced mental health problems accounted for 56% of state prisoners, 45% of federal prisoners and 64% of jail inmates.  67% to 70% of youth in the juvenile justice system have a diagnosable mental disorder. Providing earlier intervention and treatment could significantly reduce public costs of jails, courts and corrections, and employer costs associated with lost productivity as a result of mental health and substance abuse problems of employees and their families. Homelessness From the January 2010 HUD Point‐in‐Time (PIT) counts, Continuums of Care reported that:  26.2% of sheltered adults who were homeless had a severe mental illness; and  46% of sheltered adults on the night of the PIT count had a chronic substance abuse and/or a severe mental illness. The growing scarcity of affordable housing, combined with the prejudice and discrimination associated with mental and substance use disorders, creates enormous housing challenges. Poverty and mental illness Mental health is closely correlated with poverty, with common mental disorders twice as common among the poor.  Highest estimates of mental disorders are among those with the lowest education levels, those who are unemployed and facing large amounts of debt. Poverty and unemployment increase with severity of the disorder.  Among those with severe disorders, those receiving disability benefits are most likely to be poor. Fragmentation of services Metro KC includes two states and from three to 18 counties, depending on who you ask, which poses distinct challenges when it comes to providing mental health services.  The state line serves as an artificial barrier. People who need help move back and forth across the state line, but services don’t move with them.  The metro area needs to better coordinate services to improve outreach and engagement. Initiatives are fragmented and it would be helpful to bring people together across boundaries to redesign the services that are provided, from housing to inpatient services. 7 | P a g e Session Three: Services for Young People
Needs & Services for Youth
Session Three:
Why focus on young people? Young people experience some of the highest rates of mental health challenges:  Lowest rates of seeking help  Can be the most costly of all illnesses if not identified and treated early  Delays in receiving treatment after first symptoms can lead to more severe consequences such as dropouts, suicide, etc. Symptoms surface early  Hyperactivity and lack of impulse control can surface before age 5  Significant anxiety before age 10  Major depressive episodes and substance abuse before age 15  The onset of psychophrenia typically occurs in the late teen years. Mental health influenced by development The brain develops to age 25, with the greatest development occurring in the first five years.  Brain development affects behavior among different age groups.  Paying attention to social and emotional learning from earliest years is important. Assessing youth needs is important A key challenge is in identifying needs that young people have at different stages of development.  It is often difficult for young people to verbalize and share problems.  It requires relying on behavioral indicators such as suffering, isolation, changes in eating patterns, etc.  Creating trust between service providers and young people is challenging. 
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Stigma and discrimination can make young people less willing to reveal issues. Children and youth listen to people their own age. Very few decision‐makers have good youth input into their planning. Youth and adolescents ages 12‐17 Middle‐ and high‐school youth face strong social pressure for approval and success.  Puberty and physical development are strong influences on behavior and the ability to control conduct.  Family conflicts, violence, trauma and negative environments affect development. Unique NEEDS for youth ages 12‐17  Ability to safely identify and respond to individual student mental health needs.  Access to counseling and crisis services.  Culturally relevant programs that reduce bullying, stigma, bias and discrimination.  Creating positive development settings, role models and support groups.  Academic support and after‐school programs.  Understanding that medications work differently on young people than adults. Typical SERVICES for youth 12‐17 The types of services below are intended to meet the unique needs of young people in this age group.  Student mental health and wellness  Anti‐bullying efforts  Positive juvenile justice  Integrating health and mental health programs in schools  Suicide prevention 8 | P a g e Transition age young adults ages 18‐24 Transition‐age young adults have:  The least access to care and the highest uninsured rates.  A low perception of risk.  Highest rate of homicide, motor vehicle injury and death, mental health problems, sexually transmitted infections and rates of substance abuse. Transition‐age young adults fall through the cracks  They age out of government insurance programs like Medicaid and out of foster care.  Transition into more restrictive adult programs at age 18.  More limited family and system support especially for young mothers and families.  Difficult to get help meeting social development milestones. Unique NEEDS for transition‐age young adults  Specific services for those at risk of homelessness.  Services for sexually exploited straight and LGBTQ teens.  Culturally and linguistically tailored for Latino, African‐American and immigrant communities.  Trauma and intergenerational dynamics regarding trauma and acculturation.  Jobs. Typical SERVICES for transition‐age young adults  Specialized and basic support services for specific communities and populations.  Appropriate crisis services.  Future‐oriented programs for work skills and employment.  Information and referral services and peer support groups.  Flexible services for homeless young adults and families. Affordability and access to care Not being able to afford care is among the top reasons that people with unmet needs reported they didn’t seek treatment.  People with mental and substance abuse disorders have historically had higher rates of being uninsured.  Alternative methods of providing care, such as involving lay people, can reduce cost.  Affordable Care Act will enable many uninsured people with mental health and substance abuse problems to become available for health coverage. Mental health and substance abuse services will be required to be covered equally with medical and surgical benefits. 9 | P a g e What is working in metro Kansas City The following are examples of innovative solutions that are working in our community. Of course, this does not attempt to be a complete list. Most, but not all, of these solutions apply to people ages 14‐
24. They are listed in no particular order. Mental Health First Aid is a public education program that helps the public identify, understand, and respond to signs of mental illnesses and substance use disorders. The 12‐hour course includes a 5‐step action plan encompassing the skills, resources and knowledge to help an individual in crisis connect with appropriate professional, peer, social and self‐help care. Strong peer support programs such as offered by nonprofits and community mental health centers. The programs are staffed by people in recovery from mental illness. Increasingly, they are serving as first contact for people whose first contact with the mental health system might be an emergency room. The SED waiver in Kansas, for youth with Serious Emotional Disturbance (SED) age 4 to 22, may provide Kansas Medicaid based on standardized assessment scores, the youth being deemed eligible for the State Hospital, and the child’s income, rather than on the family income. It also makes children and families eligible for six other services at community mental health centers, such as short‐
term respite care and parent support services. Outreach programs with faith‐based communities and programs offered by nonprofits. Decriminalization of mental illness  Crisis Intervention Training (C.I.T.) is a community partnership that provides training for law enforcement officers and effectively changes the way mental illness is addressed in the community. C.I.T. officers 
are trained to understand mental illness and can help people in crisis get the assistance they need. Mental Health Court in Kansas City, Mo., is a specialty court that sees defendants who have been diagnosed with serious mental health issues. The first in the area, it was established in 2002 with funding from the mental health levy and the COMBAT anti‐
drug tax, and was designed to identify, treat and monitor offenders whose behavioral problems are medically treatable. Exercise and the arts can help people with mental health challenges find their personal power and keep themselves physically and mentally healthy. Metro Kansas City has an abundance of the types of exercise teams and programs which are ideal for people with diagnoses, such as disc golf, cycling and martial arts. The area also offers strong arts programs at mental health centers, including both art therapy and literature. Trauma‐informed care recognizes the role of childhood trauma – physical, sexual and/or emotional abuse, neglect, violence in the home ‐ in health and health‐related outcomes. A growing number of local trauma‐informed organizations create environments that reduce the odds that an individual will be retraumatized – will again experience overwhelming feelings of hopelessness – and react in ways that create barriers to their recovery. Missouri allows citizens and counties to approve various taxes to support social services including a mental health property tax levy. In Jackson County, the Mental Health Levy resources support 40 agencies who provide mental health services to 15,000 people per year. 10 | P a g e Session Four:
Action Planning Building an action plan The goal is to create an action plan that is innovative and community‐based, and that helps to improve the mental health of children and young adults.  There is no one right action plan. Instead, the people in this room today will consider what is most important to them, the resources they have available, and the energy and enthusiasm they bring to bear.  Mental health touches all aspects of our communities, so we expect that action will be required across many sectors and organizations. Some of them may include: o Schools, including colleges and universities o The faith community o Businesses o Media o Health care providers o Mental health and substance abuse service providers o Social services, including youth‐serving agencies and peer groups o Law enforcement o Juvenile justice & foster care o Government o Philanthropic funders Roles and responsibilities of the Creating Community Solutions‐KC Planning Team  Review the detailed data and recommendations from the community conversation.  Convene regularly in full group and potentially in smaller working groups to develop the plan.  Build shared agreement around the final plan including key tasks, responsibilities and target outcomes.  Review the plan with those who attended the community conversation and the public.  Mobilize support and resources for the plan.  Track progress and inform the community. 11 | P a g e