Author Archives: Katti Gray

About Katti Gray

Katti Gray (@kattigray) is AHCJ's core topic leader for behavioral and mental health. A former Rosalynn Carter Mental Health Journalism Fellow, Gray is providing resources to help AHCJ members expand their coverage of mental health amid ongoing efforts to de-stigmatize mental illness and to place mental health care on par with all health care.

Following Africa, Asia into community mental health care

Photo by Chloe Capture via Flickr.

While organizing the “Building a mental health workforce from the grassroots up” panel for Health Journalism 2022 in Austin, I searched for weeks for a community health worker certified in mental health to join the discussion. That type of frontline worker seems critical to any parsing of how to fill critical gaps in a U.S. mental health matrix that the American Psychological Association and American Psychiatric Association describe as persistently short of clinical social workers, psychiatric nurse practitioners, psychologists and psychiatrists.

I’ve recently observed more advertisements or announcements regarding community mental health workers. City of College of San Francisco, for example, is offering a certification in mental health for community health workers, which, as a general group, has a more than 60-year-history in the United States. And the National Council for Mental Wellbeing trains community mental health workers largely through organizations requesting that training of their own laity.

During AHCJ’s Mental Health Summit last fall, India-born Vikram Patel, Ph.D. M.B.B.S, a professor in Harvard Medical School’s department of social medicine and global health, noted that in parts of Africa, South Asia and other exceedingly less-resourced nations, grandmothers, for example, are trained to help neighbors suffering from, say, post-partum depression navigate that terrain.

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Mental health disorders soar, but psychiatric bed count remains low

Photo by Jo Naylor via Flickr.

Mental and behavioral health disorders have reached a historic peak. And once again, the nation’s lack of inpatient psychiatric beds has become a major point of concern, a renewed focus of researchers and an important story for journalists to follow.

Reporters should note that even before the pandemic, those who had championed community-based rather than hospital-based care for people with mental illness had been heavily rethinking the wisdom of closing  psychiatric hospitals. A system of community-based care has yet to be built out. 

During the pandemic, a record number of patients have sought mental and/or behavioral health care for the first time; the mental health of the severely mentally ill, including those who couldn’t get in-person medical appointments, often suffered. And the number of children needing psychiatric care increased, though the tally of pediatric psychiatric beds is particularly low. 

In the last few months, newly published studies have cited everything from an accelerating decline in psychiatric beds that began roughly a half-century ago to difficulty accurately estimating just how many such beds the nation needs but doesn’t have.

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Addressing “national emergency” in youth mental health

Photo by ketan pics via Flickr.

A pandemic-fueled surge in mental illness among children and teens, including some disorders driving youth violence and disruptions at school, has been the subject of several news headlines.

This October 2021 Washington Post article cited a string of assaults, including against school security officers, after schools reopened last fall to what educators and other experts say is an extraordinary level of mental distress among youth. (That same article cited National Association of School Resource Officers reports of 97 gun-related incidents in schools from August 1, 2020, to October 1, 2020; up from 29 such incidents during the same period in 2019.)

This June 2020 Voice of America article spotlighted a United Nations report about global spikes in online bullying, harassment and such during remote learning, and the anxiety, depression and other mental health disorders that those assaults triggered. (Conversely, this July 2021 paper, published by the Brown University Annenberg Institute for School Reform but not in a peer-reviewed journal, suggests that bullying and cyberbullying declined during COVID-19.)

The situation is so severe in the collective eyes of the American Academy of Pediatrics, American Academy of Child & Adolescent Psychiatry and Children’s Hospital Association that those organizations, in October 2021, jointly declared the worsening state of youth mental health a national emergency. They especially noted, among other realities, that “more than 140,000 children in the United States lost a primary and/or secondary caregiver, with youth of color disproportionately impacted.”

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Busting myths about people with mental illness and criminal activity

Photo by Ricky Shore via Flickr.

One of the most widespread misconceptions about people with mental illness is that they are more likely to commit crimes than people without mental illness. Several studies have shown that the opposite is true. Overall, most crimes are committed by people who have no mental illness diagnosis; and people with mental illness are more likely to be crime victims than perpetrators.

The misconceptions, policymakers, reformers and researchers in this sphere say, are at least partly driven by news headlines about crimes committed by those with mental illness, especially the severest diseases. Schizophrenia is one of those severe illnesses. And, indeed, those with schizophrenia and related psychotic disorders are the likeliest of all people with mental illness to commit crimes.

That latter reality is at the center of a recently published JAMA Psychiatry study, “Association of schizophrenia spectrum disorders and violence perpetration in adults and adolescents from 15 countries: A systematic review and meta-analysis.” It newly spotlights the complicated, complex problem of crimes perpetrated by mentally ill people, even as it cautions against stigmatizing mental illness.

Study authors contend that the psychiatric needs of people with mental illness at risk for committing crimes go unmet precisely because the medical, law enforcement, and patient advocacy sectors — and the general public — have not confronted the facts. And, they argue, that news coverage of, say, those guilty of mass shootings sometimes has overstated the role/potential role of mental illness in those crimes. 

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Homelessness may drive extended hospitalizations among people with severe mental illness

Photo by Michael Tefft via Flickr.

Recent years have seen an uptick in the nation’s count of homeless people, a population with a greater portion of people with mental illness than in the general population.

The Substance Abuse and Mental Health Services Administration’s still widely referred to 2011 estimate suggests that 26% of unsheltered persons had severe mental illness compared with roughly 5% of people with housing. And when the tally of homeless people with less debilitating mental disorders is added to that equation, the rate jumps as high as 45%.

Published online last fall in Psychiatric Services, a University of California, Los Angeles analysis concluded that homeless people in court-ordered in-patient psychiatric care wound up in psychiatric hospitals for months longer than other involuntarily admitted psychiatric patients.

Mental Health Conservatorship Among Homeless People With Serious Mental Illness,” an observational study, analyzed hospital administration data for 795 patients, 18 and older, admitted involuntarily to one Los Angeles safety-net hospital between 2016 and 2018. While involuntarily committed patients comprised 6% of the sample population, they accounted for 41% of inpatient days spent hospitalized.

In-patients without housing spent an average of 154.8 days involuntarily in the hospital, while in-patients with homes were hospitalized for an average of 25.6 days.

What’s more, researcher Kristin Choi, Ph.D., M.S., R.N., said, according to a Jan. 2 University of California, Los Angeles (UCLA) press release, “There are very few long-term housing options for people who are disabled by mental illness and in need of supportive housing in Los Angeles. When these individuals are stabilized and ready for a lower level of community-based care, there is no place for them to go.”

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