This piece is part of the Times’ ongoing series on women in Arkansas politics called “That’s What Girls Do.”
The normal she knew no longer exists. Change had always been difficult for her, and then COVID-19 popped up and reared its ugly head. She had no warning to adjust her thought process, so now she’s stressed, anxious and reaching a state of depression. She has never been diagnosed with a mental illness but something is just not right. She thought about calling her friends and family but they are overwhelmed with their own fears and issues. She’s ashamed to reach outside her circle because she fears someone will call her crazy. What does she do? Where does she turn? She has no mental health coverage and cannot afford to pay out of pocket for mental health care on her minimum wage salary. She has to take care of her two children, pay rent and put food on the table. If she finds a place to reach out for help, she would have to take off from work without pay because she has no sick-leave benefits. She stays silent. She decides the shame associated with her illness is not worth discussing. She hopes that maybe it is just stress and will soon go away. Six months pass, and the symptoms persist. She is agitated and losing patience with her children.
Now what? For many Arkansans, there is no good answer.
Mental illness affects everyone directly or indirectly. If not you, it may be a family member, friend, coworker, church member or neighbor. It affects home life, entire families, marriages, careers and communities. In order to fight the stigma, we must educate the public on mental illness through awareness and education. According to the National Association of Behavior Health, approximately 1 in 5 adults in the U.S. — 43.7 million people — experience mental illness in a given year. Approximately 70 percent of youth in our juvenile-justice system have a least one mental health condition, and at least 20 percent live with a serious mental illness. Suicide, almost three years ago, was the tenth leading cause of death in the U.S. These statistics are just a few to ponder over so that everyone can realize the importance of breaking the stigma and tearing down barriers that prevent anyone from seeking help.
When I was young, I always heard grown-ups describe family members or neighbors who showed abnormal behavior as, “they are just different” or “they are a little slow” or “that’s just the way they are.” In my immature mind and curiosity, I knew that the behavior had a deeper meaning. It was such a hushed subject; no one would explain exactly what was going on or talk about why the behavior continued year after year. One day, when I was supposed to be in the room with the other children because we were not allowed to listen to grown-up conversations, I overheard the adults say that an absent person was in the State Hospital. When I tried to sneak back into the room with the other children, I tripped and made a loud noise. I was summoned back to stand before the adults and was told that I better not repeat the conversation. What was said in this house stays in this house, they admonished. I eagerly agreed and left the room without the answers I needed. After that day, I begin to find all I could read about mental health. I was deeply curious about what caused the brain to alter and why we couldn’t talk about it.
I wish I could say that attitudes have changed since the day that my elders sternly warned me in hushed whispers never to speak of this taboo subject. Sadly, though, the same shame and naivety that colored that experience for me is still prevalent due to lack of knowledge and understanding. Mental illness does not discriminate. It happens to the best of us, regardless of social and economic status, education, gender, race or age. We have made great progress in treatment availability, access to services and increase in professional staff but we still have a long way to go. We are, for example, still actively advocating for parity for mental health care; it should be treated the same as physical health care. The body must be treated holistically, which includes the mind, body and spirit.
In 2020, we still lack appropriate funding for mental health services. Persons with insurance coverage usually have high deductibles and still can’t afford the service as often as needed, which is determined by their diagnosis and treatment plan goals. Medicare clients usually have to wait longer for services due to the limited professionals approved to bill for Medicare services. Indigent clients, those without a funding source, can only receive services if public or charitable funding is still available. Funding for Community Mental Health Centers comes from federal and state dollars, which are appreciated but limited, to meet the total need of those seeking services. Beyond that, the services are billed on a sliding fee scale, which the majority of patients simply cannot afford. When in a crisis, waiting 3-4 weeks to be seen only makes the crisis worse, and sadly many patients who truly need mental health care never come back after the initial phone call or intake assessment. I talk to mental health professionals and providers across Arkansas, and their message has been clear: the need for mental health services is so much greater than what we can provide. Professionals suffer burnout due to the complex and severe cases that are presented, limited number of sessions we may offer, and reduced funding. These barriers must be addressed totally in order to meet the great demand for services.
Now, we are also facing the COVID-19 pandemic, which has increased the stressors on everyone regardless of whether there is a history of mental illness or not. I receive calls regularly from those who express an increase in symptoms of anxiety and depression. They are overwhelmed with all of the uncertainties that are being discussed on the news and social media. Below are 10 top stressors that have been expressed by many on a daily basis:
- Loss of job and the only household income.
- Pre-existing health conditions and scared of being diagnosed with COVID.
- Small business owner with no savings to maintain.
- School closed and children home 24/7, some with no food, some with ADHD.
- Quarantined with an abusive spouse or parent.
- Essential worker with no sick leave, so must work.
- Elder parents in nursing home and can’t have family visits.
- Family member dies and can’t hold proper funeral services.
- High school senior and can’t have prom and graduation.
- Parent/spouse of a front line worker who may be at higher risk.
We must immediately re-evaluate the resources we allocate toward mental health treatment in Arkansas. We must increase funding and expand access to mental health services. I am asking legislators, leaders, fellow mental health professionals, community advocates, and pastors to join me in pushing our elected officials for adequate mental health care for all Arkansans. Together, we can break the stigma associated with mental illness. We owe it to our children, grandchildren and future generations to smash these taboos and start talking about these issues out in the open.
I don’t want my life and my life’s work to have been in vain, so I will continue to be a voice for those who suffer with a mental illness. I visualize a brighter future where anyone needing mental health treatment, psychotropic medications and support services will get them without having to choose between those needs and paying their rent, mortgage or grocery bill. If you agree, I need you to join this fight. COVID-19 is stressing every part of our medical system, and for a mental health system that was already strained, it may be catastrophic.
The very first step in saving the lives of Arkansans who need critical mental health services is to speak up and use your voice. Call the governor and your state legislators. Call you congressmen and senators. Urge them to make funding of mental health services a high priority. And in the meantime, share this article with a message breaking the taboo around mental illness. Share your story, and share these tips for immediately dealing with the stress and fear caused by this pandemic:
- Stay connected to others.
- Journal your thoughts and keep a record of your emotional well-being.
- Take deep breaths.
- Try to exercise.
- Seek professional help if you need it.
If you need help, please do not suffer in silence. Reach out and let someone know you are hurting. Contact one of the national mental health resources that are available by phone or internet. And if you are having suicidal thoughts, call the National Suicide Prevention Hotline at 1-800-273-8255.
Jannie Cotton is a licensed professional counselor, retired CEO and mental-health policy leader and advocate. For over 40 years, she has fought to break the stigma associated with mental illness, served on several health care reform and legislative committees and task forces for juvenile justice reform. Jannie is an advocate for children and adult services, including education, Medicare for seniors and veterans’ access to mental health care. She is running as a Democrat to represent District 41 in the Arkansas House of Representatives.