Hope Starts With Us: Stigma & Mental Health Equity

AUG. 09, 2023

Hope Starts With Us: Episode 27

In this episode of NAMI’s podcast, NAMI CEO Daniel H. Gillison Jr. talks with Dr. Devika Bhushan, Dr. Napoleon Higgins and Angelina Hudson about stigma and mental health equity.

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

We hope this podcast encourages you, inspires you, helps you and brings you further into the collective to know: you are not alone.  

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[background music]

Devika Bhushan: What serves to break that stigma down is to humanize our own stories. It doesn't mean you have to get up on a platform and say it out to hundreds of people you don't know.

Angelina Hudson: Someone needs to deal with the stigma that is not from the outside in, but from inside out. Sometimes we shame our own family member. We shame ourselves.

Napoleon Higgins: The way to get involved is to go where the people are at. Don't wait for them to show up to see you. You've got to step out of your comfort zone. You've got to walk into places that you haven't been seen, so that the people in the community can be willing to come and see you.

Dan Gillison: Welcome to "Hope Starts With Us," a podcast by NAMI, the National Alliance on Mental Illness. I'm your host, Daniel H. Gillison, Jr., NAMI's CEO. We started this podcast because we believe that hope starts with 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. 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 to know you are not alone.

Today, I'm joined by Dr. Devika Bhushan, Dr. Napoleon Higgins, and Angelina Hudson to talk about stigma and mental health equity. Dr. Bhushan is a pediatrician who is passionate about equity. She has lived experience with bipolar disorder and speaks about it publicly to help break stigma. Dr. Bhushan is a former Acting California Surgeon General and a newly elected NAMI national board member.

Dr. Higgins is a psychiatrist in the Houston area, as well as President and CEO of Bay Pointe Behavioral Health. He is also a past President of the Black Psychiatrists of America and past President of the Caucus of Black Psychiatrists of the American Psychiatric Association.

Angelina Hudson has been Executive Director of NAMI Greater Houston since 2022, where she previously served as Vice President of Programs and Partnerships. She is active in the Community Health Equity Alliance, a broad partnership spearheaded by NAMI to improve access to mental health services for Black/African ancestry adults living with serious mental illness.

Thank you all so much for being with me today. While we're now in the month of August, July was Bebe Moore Campbell National Minority Mental Health Awareness Month, a time to focus on how we can break down harmful stigmas and systematic barriers that perpetuate mental health inequalities in communities of color.

Because this is such an urgent and timely issue, not just now but every month of the year, we wanted an opportunity to dive deeper into the causes of these inequities and possible solutions. Today, only one in three Black adults with mental illness receives treatment.

People in the Black/African‑ancestry community are also less likely to receive guideline‑consistent care, less frequently included in research, and more likely to use emergency rooms or primary care rather than mental health specialists.

These inequities are both caused and compounded by deep‑rooted factors like institutionalized racism, intergenerational trauma, and economic barriers. At the same time, stigma and cultural attitudes can make finding solutions even more complicated.

I'd like to start by asking all three of you if you could talk a little bit about stigma. What exactly is it? Why does it often disproportionately affect communities of color? How does it impact mental health equity?

Devika: There's so much to say about this topic. I'm really, really privileged and thankful to be joining in this conversation with my esteemed colleagues. I'll start us off by just saying I think stigma comes about because of something that we don't understand and therefore fear.

If we take the example of epilepsy or seizures, back in the day where we didn't understand what caused seizures, they were hugely stigmatized and attributed to causes like, for instance, spirits.

Now, when we actually can pinpoint specifically where in the brain specific seizures arise from, they are no longer stigmatized or feared because we have language and an actual, pinpoint‑able reason for what they are all about and, corollary, well‑honed treatments to be able to treat them.

Interestingly, as seizures went from the domain of psychiatry to the domain of neurology, where things are much more precise and knowable...

As that as an example, communities of color are in a position where, often, the way in which we experience mental illnesses can look quite different. It becomes another reason for us to be discriminated against.

That has led to the closeting of mental illness as well in communities of color. I'll pause there and see what my colleagues have to add.

Angelina: I only have one thing to add to that. I often refer to stigma as the blame, shame, and guilt. It's the feeling that we have that deters us for reaching out for help for anything. Most of all, mental health conditions because we taboo them. We make them something that is either spiritual or demonic.

Because what Dr. Bashan mentioned, we don't understand them. Then we try to either pray it away, wish it away. We look the other way and don't reach out for help. My message when I go out into the community is that education uncovers all of the fear.

It dispels the fear and anxiety that we have when we learn better. It's hard for many of our communities to believe that talking to someone for two and a half hours, once a week for eight weeks, it's going to make a difference.

It makes the difference between life and death. It makes the difference between a quality life and one that is shrouded in fear and disbelief, and sometimes leads to what I call dual diagnosis. Where there's not only the mental health condition, but also the self‑medicating that goes with it.

I use myself and my story as a poster child for what it means to have the right type of information, the right support from the clinical community, and then the support along the journey through NAMI, to make life a greater success or at least the best life we can have.

Dan: Then thank you very much both of you. We'll go to Dr. Higgins next, but I want to make sure I come back to you, Angelina, for you to share a little bit more about your story because I think it's very profound. In each one of us telling our story, we help so many others from the standpoint of what your experience has been.

You mentioned the speaking to someone every two hours for eight weeks. I want to come back to that. then Dr. Bhushan, you talked about the neurology. We'll examine that a little bit in this conversation. We'll go to Dr. Higgins now.

Napoleon: Exactly what Angelina and Dr. Bhushan has spoken to the issue of fear the issue of a lack of understanding. Then also the issue of just a lack of education. I know I was out at a community event this past week and at a black community event.

I was explaining an issue about depression and children. I had a book on that. The person that walked by said, "I don't want my kids to know about depression." In the frustration, when I try to contain myself as a child psychiatrist, I'm like kids face depression as well. They face anxiety as well.

Just as Dr. Bhushan has spoken up, you can teach children about the mind, just like you've got fingers and toes, your brain has parts to it and it can have pathology as well. It's the lack of education, lack of understanding, which I think helps to drive this issue of stigma and fear in the community that...

We have to really push and battle against that.

Dan: Thank you for what you just shared in terms of the event that you just went to Dr. Higgins and being a psychiatrist. We have this other item that we have in the nomenclature called ACES, Adverse Childhood Experiences.

How have you seen that from the standpoint of the examination of stigma, and the realization of what a young person is navigating and experiencing?

Napoleon: Definitely. With the ACES, which is a study referring to looking at, as it states, at first childhood experiences, we clearly see that you have worse outcomes, the more traumas that you go through.

Right now, and now across the world, but right now in the black community, you're seeing an increased rate of depression, anxiety, and completed suicides from the ages of five, all the way through young adulthood.

That's why it's so important to make sure that we're educating individuals about this, but also make sure that we're screening for it. Then I will go and say that across the board, and this is for the world, we're seeing anxiety and depression higher in kids, and we're looking at the trauma of what occurred with COVID, where essentially the world was shut down.

It's difficult to understand as an adult, but imagine as a child, when you haven't seen that much life and all of a sudden life changed. I remember my daughter said to us once, she said, "Dad, one day I went to school, came home from spring break, and the world was completely different.

The people I had grown up with, the people that I knew, the school, the schools that I knew, because I've lived in the same area my first 16 years of my life, all of a sudden, all of those people were missing.

"There were no goodbyes. There was no prom. There was no signing of yearbooks. That was no last day. There was no graduation. All of a sudden missing. You're not sure when the world will restart or if this is now permanent."

The sense of loss and the sense of trauma can occur and people will say the kids don't know about depression. Kids don't know about mental health. Whatever happens inside the home happens to the child. No one's paying attention to the 3‑year‑old, the 4‑year‑old, or the 15‑year‑old.

We're all paying attention to our own internal issues, but the issues of loss as far as a grandparent, the issue of loss as far as what they had with school, but also the issue of trauma. One out of four girls and one out of six young boys will be sexually traumatized before the age of 18.

That's a lot of people that when you look at the ACEs study are going to have a shortened lifespan because of the stress of that on their mental health. It's something that we cannot escape. We have to talk about it.

The kids can have an understanding and arm themselves and recognize when there's a problem and know when there's time to go and get help. We can teach this at a very early age. You can teach start teaching this in kindergarten.

"This is your head. There's a brain inside. This is how it works. This is when it's good. This is when there's a problem. If we started that early and made that a part of our regular education nomenclature, I think that we could do a lot to stop some of the stigma that is going on.

Dan: Thank you so much. We're going to segue to Dr. Bhushan now. Then this is just an incredible conversation. Thank you for that. Dr. Higgins and Dr. Bhushan, as I mentioned earlier, your own experience with stigma is a deeply personal one.

While you were serving as Acting Surgeon General in California, you very publicly disclosed that you live with bipolar disorder. Could you talk about how that affected your own view of stigma, and anything it taught you about inequities in what we casually say mental health systems?

Devika: Yeah, absolutely. Big set of topics and happy to dive into those. One quick corollary to what Dr. Higgins was mentioning around ACEs, as I was serving as acting Surgeon General and then previously Chief Health Officer at the Office of the California Surgeon General, one of the things that we put into place was something called the ACEs Aware Initiative in California.

Which really helps to transform the way in which we think about healing from childhood trauma, right? We know, as Dr. Higgins was saying, that it's two thirds of the population who will end up having one of the conventional 10 ACEs, like abuse or neglect, or growing up in a household with somebody with an untreated mental illness or substance use disorder.

It's holistic, right? It can affect our physical health, it can affect your growth, your development, your immune system, the ends of your chromosomes that are called telomeres which then can affect how long you live.

The equally important set of messages are that there is power to be had in knowing what your story has been, and how then it can impact your health in the future to be able to prevent those health impacts. Ranging from heart disease to cancer.

We know that re‑regulating your stress response using things like an anti‑inflammatory diet, exercise, good sleep, mental health supports can really mean the difference in preventing all of these outcomes that are given to us in terms of the associations in the literature, but by no means are ACEs going to be destiny.

There's a lot that we can do after we've had ACEs to relearn stress biology in our bodies and in our brains, to prevent us from suffering those health consequences at an early age. Then to transition a little bit to the stigma question.

At the point at which I decided to share my journey, it was August 2022. At that point in the pandemic, as Dr. Higgins has alluded to, we had all gone through something deeply traumatic together, and some of us had suffered more than others.

It felt like it was the right time to let people know my small part, in this conversation. Number one, to let people know that they weren't alone if they were struggling through something really traumatic and difficult, and number two, to let them know that there was a way forward that just like hypertension, high blood pressure, diabetes, a thyroid condition.

A chronic mental health condition is also extremely treatable and something with which you can live and live well. As long as you're careful about integrating lifestyle changes and treatments into your day to day life, you can start to think big and you can live out your dreams. I really wanted people to hear that.

I'm not the only person in the public eye with bipolar disorder, but I felt that it was important to share my piece of it. Because I wanted people to know that you can be in a public position like California's Acting Surgeon General.

You can aspire to being a parent. A caregiver, a partner. I've been with my partner now for almost two decades and we've been through a lot of ups and downs together, including when I was first diagnosed. The role that NAMI played in that for us was really pivotal, really helping my husband understand how to support me in those early years.

As far as learning about the systems, I think that my lived experience was very formative to who I became as a person, both professionally and personally. It definitely shaped the lens with which I approached policymaking for the ACEs aware initiative, for example.

When we were thinking through the supports we needed to put into place for folks to really heal from childhood trauma and all of its sequelae, and to be really resilience focused and strengths based in the way that we were offering interventions, referrals, and linkages.

As somebody who's been through the system, both as a pediatrician trying to make sense of the different options for my patients who were suffering from specifically mental health conditions, being unable to refer to psychiatry and really having to learn a lot of the tools myself to support my patients.

Then also as a patient, and subsequently a family member, really helping folks to navigate the care system that is the mental health system. We know that there's many gaps. It can take months to years before somebody is hooked up with the right kinds of treatment, before we get the right kinds of diagnoses.

My diagnosis, my correct diagnosis of bipolar disorder took three years, and that's lucky, actually, for bipolar disorder. Bipolar II ends up having an 11‑year gap between the first onset of symptoms and the correct diagnosis and set of treatments being offered. That is much too long. We have a lot of work to do.

Dan: Thank you very much, first of all, for your leadership. Your public and a very profound leadership at the government level and then personally, your authenticity and you sharing your story. It really is helping and will continue to help so many.

August of 2022 was an inflection point in terms of you providing us with a view into your success and your success in your journey. I wanted to ask a question here. You mentioned your husband and how NAMI helped. We began this by talking about, "We need to do a better job in educating."

Is there anything that you could share with us, Dr. Bhushan, about what NAMI did in helping your husband as a family member that could help our audience with the education that NAMI could possibly provide to them?

Devika: It was pivotal. At the moment which I was diagnosed, so just briefly, that three‑year period, essentially, consisted of me having symptoms of depression, to begin with.

Because I didn't have a family history of bipolar disorder at the time and I didn't personally have my own history out of mania, hypomania, I was diagnosed with unipolar depression or straight conventional depression and started on antidepressants.

Which end up meaning for the bipolar brain, basically, a dysregulation and activation where you can become triggered to experience hypomania or mania, which is when your brain is in an elevated state.

Essentially, three years of lots of different kinds of antidepressants were in the mix, and what at the time was being diagnosed as anxiety plus depression was actually hypomania layered on top of depression induced by the antidepressants, 20 different antidepressants in that span of time.

Finally, I was on three different activating medications that induced a manic episode. Then suddenly, it was very clear that this was not anxiety. This was actually hypomania now verging on mania. Now I had a bipolar spectrum diagnosis and needed to be on mood stabilizers rather than antidepressants on their own.

When we got that diagnosis, it was both a relief, but also it took us all by surprise. For my husband who was not in medicine, I was in medical school at the time. I'd studied these different models of how the brain can go awry.

For him, it was really pivotal to hear from family members who have been through that journey, to understand what does this diagnosis entail? What does it mean when your loved one has a hypomanic period of time or a manic period of time, when they may be doing and saying and believing things that you've never known them to say and do or be or say? How do you deal in those moments?

Because it's a very different paradigm than depression, right? It's a very different set of experiences for family members, more so than even for the person who's experiencing it. Because the family members will live with the memories of what's happened during those periods, which might be fuzzy or nonexistent really for someone who's going through it themselves.

To not only know specifically how to support me as I was coming through on that unwell period, but also to hear from so many families that it is possible to walk through this really stigmatized and difficult to hear diagnosis, and emerge on the other side with tools and stories that will really help buffer you from getting sick again, potentially in the future.

That was really meaningful to him to be able to understand that from people who had walked for decades alongside somebody who had the same illness, even though it can look different, obviously, in every person's life depending on who they are and what's going on for them.

Just to gather that collective wisdom of a family members was really powerful. I know Angelina has lived that same kind of an experience. I wonder if you have anything that you'd like to share there.

Angelina: Absolutely. To your question, Dan, how did NAMI help? It saved our lives. It saved my mind as I was thinking about checking into Spring Shadows Glen, which is no longer open. It also saved my marriage and my family.

During the time that the pediatrician was really asking me to wait, at first, they were like, "Give him another year. Let's see if he'll develop. You're comparing him to your daughter. Boys and girls are different." I really knew at seven months that there was something really wrong. No one was listening.

My husband was saying there's nothing wrong. My parents were saying there's nothing wrong, but I just knew it. Finally, the pediatrician said, "You know what? I don't have a lot of experience with this case. I'll refer you to someone that you think might be more specialized in treatment of children with brain disorder."

I didn't know anything about mental health at that point. We were just thinking that there was something wrong with the brain. I found out about NAMI because I was going from school to school asking what type of programming they had for students like my child.

I would just go to the chair of these departments, and when they would show me devices, interventions, or curricula, I would take pictures. One of the chairs of the special ed department...My children were not old enough to be in these programs yet. My son was four, but I was just so hungry for information.

He said, "What are you doing?" I said, "Oh, you've caught me. I'm trying to collect information to take back to my pediatrician because something's wrong. He doesn't mimic me. He's not developing." Then I started researching on brain development. It was just a shot in the dark. I didn't know what I was doing.

Until he said, I'm a NAMI teacher. We teach a class in Texas called Visions for Tomorrow. That is now NAMI Basics across the country. He said, "If you and your husband." and I'm like, "Oh, I'm I've given up on him." Because my family was saying there's nothing wrong with my child."

I remember Holly Robinson Pete once said that she was ready to divorce her whole family because they wouldn't get with the program. That's what I was going to do. I was going to divorce my parents, my husband, my siblings, everyone, because I knew that there were some answers.

In my very first class of NAMI, they introduced the emotional stages of response to trauma. The predictable, that was the first word. The predictable emotional response. They explained that when families are dealing with one family member who has some sort of mental health crisis or behavioral crisis, that many times the family members will be at different levels of response.

I had moved into the second level where I wanted to cope with it. I wanted to face it. I was angry at the world. I wanted someone to give me answers. My parents and my husband were still in phase one. They were in shock, they were in crisis, they were in disbelief.

They shared with me in that very first class, that if I just stick with it, they would eventually move to the second and third stages, or we might cycle up and down, back and forth, and begin to help one another, which is what happened.

Because NAMI said that to me in the very first week, I felt like it saved everything. I'm married 30 years now, and it's because of that NAMI class. Because I really felt an affront to my family, and I was in so much grief and pain that I was pulling the children into myself.

It was one year later after that first class, my second child was diagnosed, and five years later, my third child. Now you would think I'd be running for the hills and let's change my name, and somebody else you can have these children. The thought crossed my mind.

I just kept going back to that same class. It's funny how you can take a NAMI class multiple times, but your ears hear something different. I've read somewhere that relational trauma can only be healed relationally. That's what NAMI does.

You're in a group session, you're with other families. My first class had 22 parents in it, all different ages, but we were all hurting and desperate for answers. The class taught us how to talk to not only our nucleus family, but they taught us how to talk and explain what was going on to our extended family.

They gave us American Psychological Journal entries that we could take, and share with our pediatrician and say, "This is what I think I'm seeing. This is what..." So we can open up a conversation that seemed more educated, for lack of a better word. I took the class five times before I became a NAMI member and then a NAMI teacher.

I volunteered with NAMI for 10 years as a teacher and trainer before the local affiliate hired staff. As soon as they opened the staff position, I applied for it because I had been going to hospitals. I was trying to bridge, I felt that no one ‑‑ I'm going to finish the sentence right now ‑‑ I felt that no one should go through what I went through.

I was educated, two degrees, married, we had great insurance, and I couldn't get answers and I couldn't get help for four, five, six years. I'm like, "Why is it that I had to drive 40 miles to find a NAMI class? There were no classes inside the loop of this huge metropolitan area."

I started going to Mental Health America meetings and NAMI board meetings. I just started rallying. I got on the advisory board for Texas Children's Hospital who I thought should have been the first people to give me the answers I found in this NAMI class. I said, "Why aren't you doing this?"

I immediately moved into this advocacy role that led to my journey as a NAMI affiliate staff member. I promote now the bio psycho social approach, right? I do this in Latino and Black communities. My mother's Latina. My father is African American. My husband's family is all African American.

When the doctor, and Dr. Napoleon, you know this, when you first start with some sort of neurological journey, they want you to do an inventory with your family. They gave us these questions to go back and get our family history.

Surprise, surprise, my husband's family said, "Oh, you think it's us? No, that's her people." Then we went to another reunion, and we went and talked, I think it was around Thanksgiving time. We tried to talk to my family, and they said, "We told you not to marry him. You married into that family, and now you brought these illnesses into our family."

Of course, it was in both families, undiagnosed, untreated. We had all kinds of names for it. We had pet names for the loved ones that we loved. They kept introducing themselves to us every time we saw them. There was a history there, but it was not documented, and it was not called anything clinical. It was not treated.

When people couldn't keep a job, we just shamed them and put them on the back burner. We invited them to the family barbecue, but then they had to go home because they didn't thrive in society. That's where my commitment to the Black community came from.

The CHEA project is just such a breath of fresh air because someone needs to deal with the stigma that is not from the outside in, but from the inside out and throughout. Sometimes we shame our own family members, we shame ourselves, and we don't reach out for help.

We're worried about labels, we're misinformed about what eligibility and special ed is. That's not something that's going to prevent you from having a successful life if used properly. It's a service, it's not a location.

You said something earlier, Dr. Bhushun, you said that the ACEs should not determine your fate. I came from not the ACEs part and the trauma part, Dr. Higgins, but just plain organic mental illness that runs on a spectrum throughout my family's genealogy on both sides.

That's how I found NAMI, Dan, and that's how I got involved. While I really appreciate the attention that we're getting, and so sad that it took a pandemic or a spike in suicidal numbers in teenagers, I'm sad that, and I agree with the fact that's what it took for, at least our county, our city to get really on top of, "Let's open up this conversation with our youth."

I still champion and hero for the families that go to church every Sunday. They've got two family headed households, they're doing the best they can to make ends meet. They don't know about mental illness because no one's ever talked about it.

At the same time, they struggle with criminal justice issues. They have people with substance abuse disorder, and you have people in and out of jail or prison and they don't know why. They need to be brought in as well when it's just in their genealogy, it's just in their genetics they don't know about ACEs and the trigger of trauma.

Because that's the understanding or the language of clinicians and providers. We understand that on this side, but when you're just locking yourself in your bedroom at night, afraid of your son, or sleeping in your car, so you don't have to listen to your spouse go on and on about it.

Those are the real life issues that families are going through. When I go into the community, I start identifying the behaviors and not the clinical names or signs and symptoms, but just, "Are you...?"


Dan: You meet people where they are. That's what you're talking about, meeting people where they are, not where we want them to be. That's what your conversation has been about in terms of what you've seen.

That's what Dr. Bhushun was saying about her partner, her husband, in terms of him coming into the conversations and family to family, peer to peer, and some of the other learnings at NAMI and to be informed. Combating stigma is just incredible.

One of the ways, and thank you so very much for what you're doing in community, meeting people where they are. I really do appreciate Angelina, how you've talked about it because you're helping our audience very much.

To what Dr. Higgins said earlier about our young people and what's happening across the world, we've got our young people in a lot of communities are feeling hopeless and helpless. We want them to feel hopeful. We want to make sure we're doing the right things to do that.

Part of that is combating stigma. I want to talk about one of the things that we're doing in the adult community, and that is in addressing and combating stigma and inequity through the Community Health Equity Alliance, or what we fondly call CHEA, which we have been spearheading since early this year.

It brings together a diverse group of stakeholders, including advocacy organizations, support groups, academia, practitioners and the faith community. Angelina, you just spoke about it. You've been especially involved through NAMI Greater Houston's role as a CHEA partner.

What roles can communities and partnerships play in finding solutions that can be scaled more broadly? Then I want to start with you and then get the perspectives of Dr. Bhushun, and Dr. Higgins. Angelina?

Angelina: I think what we uncovered in the Houston area is that there were already just a great number of pastors, youth ministers that were already engaged. They were already working to raise awareness in their churches.

They were already preaching, sharing their own mental health conditions or those in the membership that were open and willing to share. What CHEA provided, an opportunity in the Houston, Harris County area through Dr. Higgins, was an ability to lasso all of these efforts together, and use our voice to make a difference in how we place a demand on clinics, hospitals.

I've never seen so much attention, quite frankly. I'm from Houston, born and raised, and I've never seen so much attention to the African American community like I see now. I even received a survey this morning from the city of Houston on how to repurpose historical black church and a historical, of one of the boards, third board in our area.

They want to know how to reuse that building to serve the community. I think that a part of that movement to receive information from us to help us as a community has come from initiatives like CHEA because we were able to pull together fraternities, sororities, businesses, corporations, churches, faith leaders, even social organizations, CBOs, community‑based organizations that impact historically Black, underserved areas.

Because our voice now is so unified, it's making a difference. We are very much sought after for what can we do, how can we serve, what can we do to make equity and open access to services in the Houston area.

Dan: Thank you. Very good. Dr. Bhushan, what are your thoughts? Then Dr. Higgins.

Devika: The kind of work that Angelina is spearheading, that CHEA is all about, is exactly what we need from a stigma reduction standpoint. Because it is truly about going to the community, with the community, in the community, and those really pivotal stories that are shared, that really help to break down stigma and help understand that.

It is not this one/two‑dimensional caricature of who it is that's ill with a mental condition or can be well after that period of illness. It's really sharing those nuanced, multi‑layered stories that we each have in our own lives, of family members, of ourselves, that help to unravel stigma in the long run.

Dan: Thank you very much. Dr. Higgins, can you speak to CHEA? Would you also include your thinking on 988?

Napoleon: The fact is that we developed a, actually, roadmap of how the community can engage the mental health system, depending upon where you are, anywhere from emergencies all the way to "Hey, I'm looking for a therapist."

We actually built out a website that also connects you with those services. We put 988 dead center in the middle of the map itself. It's dead center in the map, 988, which is the hotline that we use for all mental health concerns.

Sometimes people will call...especially with suicidal thoughts or they're having difficulty in their home, they don't know what to do with their family or their loved one. You can call the number, but also, you can text the number.

We've seen a huge uptake in the community of calls and responses to find a mental health person. Then also, sometimes you may need to have emergency services. We found that the majority of phone calls did not require intervention by an individual.

When you do have an intervention and someone needs to show up to your home, many times someone other than the police or the police person will show up with a mental health professional, or maybe even show up without having a gun on them so that it's not continuing a fear of a threat.

The individual understanding that person at the home who's suffering is not mentally well. Then the police themselves can be very triggering, especially from the community where I come from. The point is to make sure we have these access to resources that are outpatients, substance abuse treatment, inpatient, and emergency services, and 988 is written in the top front.

I think we have 911 to the left and 311, which is for community services in the Houston, Harris County/Area to the right so that people know they can access the care. As Angelina spoke about, the importance of community, but also the importance of family, and one place that psychiatry in itself misses that we so often focus on the individual.

I tell people if your pinky toe is broke and hurting, I can guarantee you your entire body reacts to that one pinky toe because it is at the bottom of your foot, but it's very much either stabilizing or unstabilizing to the entire family. Nobody who it is, if somebody's hurting that's a part of your body it's going to hurt you.

Too often we're focusing on the person in front of us, realizing there's the entire family and say, "Can I bring my spouse, my husband, my daughter, and my niece, my cousin?" Listen, the bigger the party the better the party, so if we can have as many people engaged as possible.

Another issue that we're running into in psychiatry is if I get admitted to the hospital I get completely disconnected from my entire family. That in itself, we clearly have to look at, only looking at a different way to approach these things so that we can be better received in the community because so often people fear things that are actually true.

There are certain things we're not doing well that we definitely need to improve so that people can better engage in the work that we do.

Dan: Thank you so much. This goes to that old adage, "If we do what we've always done, we're going to get what we've always got." CHEA is the opportunity for us to look differently and do differently. It goes back to how we opened our conversation, saying that we are a collective. That's what all of you have been describing.

On a related note, what can we as individuals do to combat stigma and inequity? How can we get involved or become advocates, whether in our communities, our homes, or our social circles? Dr. Higgins, let's start with you.

Napoleon: I'm a psychiatrist. I work every day. I see patients every day. This is where I see them, inside of this room right here. It's also important for me to go out into the community. I need to go out to where the people are because I can only see or treat or hear one person at a time inside of these four walls here.

When I go out to the churches or I go out ‑‑ me and Angelina spoke at a large fraternity event here in Houston a few weeks ago ‑‑ when I go out and I meet the people, it's easier to communicate the information.

Also, I'm from this area. There's about 1.6 million Black people in Houston. I can guarantee you I'm about one degree separated from 1.5 of them. I didn't just show up here yesterday. I've been here my whole life. If I don't know you in the room, I can guarantee you we're probably Facebook friends. If I saw you in a room and you're Black in Houston, we are connected in some manner or form.

Because I'm from the community, because I do show up, because I've been showing up ‑‑ I've been out here for years ‑‑ it's a lot easier to be in the community, but it's also easier to be accepted in the community. Even though I have MD behind my name and I sit in four walls, the people know me.

The way to get involved is to go where the people are at. Don't wait for them to show up to see you. How are they going to believe you when they finally show up to see you?

If they've known me and somebody referred me and you're a good friend that I've seen or somebody from your hometown knows who I am and then they refer you, it gives a different level of engagement because you've been out there in the community and people know that you care.

You've got to step out of your comfort zones. You've got to walk into places that you haven't been seen, so that the people in the community can be willing to come and see you.

Dan: I like the word "care" because we often say here, "People don't care how much you know until they know how much you care." What you're demonstrating, like you just said, about the MD behind your name, when you go out in the community, that's not what they're focused on first. They're focused on the fact that they can see you care. Then becomes the MD. Thank you for sharing that.

I'd like to go to Angelina next. Then we will wrap up this question with Dr. Bhushan. Angelina?

Angelina: I've long said there's only one way to combat stigma. That's to take the unveiling. Share your story. A face, a voice, a personal story. No one can ridicule or hide or shame someone who's just sharing how they feel and what they've experienced.

In every community where I've seen someone share their story, all of what they thought, all of the misinformation they had about the issue related to mental health, it disappears because you put a face on it. We go to school. We go to corporation. We go to churches. We go to synagogues. We've been to the mosques. We're about to go to a Hindu temple in Montgomery County.

We do this, and we share the stories along with someone from that community. Instantly, everyone who's sitting in a chair or a pew, it resonates with them when it's them too. I say, if you want to do one thing to reduce stigma, share your story.

Not only your story, but the story of your friends or family members, but don't use their name if they didn't give you permission to do so. Share these stories, because the more we talk about it...I think it was Dr. Higgins who said, "Even in elementary school, they brought in a big set of teeth, and they taught us how to brush our teeth."

They had germs, where you turn off the light. They show a blue light. It illuminates how many people have touched it and moved the artificial germs all over the room.

Why not come into grade school and just talk about your mental well‑being and how to maintain that, that your brain is built in such a way that if we don't take care of it, if we don't manage stress, guess what? We can have emotional or mental instability.

How do we prevent that? I think starting to talk about it in general terms, but also share your story. Those are the two best ways to reduce stigma.

Dan: Thank you so much, Angelina. Dr. Bhushan?

Devika: I love what Dr. Higgins and Angelina have just shared, and I want to underline it. The word stigma comes from the Greek for tattoo, right? Back in the day, we had certain marks, literally brands on people's skin that would serve to mark them as "other".

These would be people who would live over here because they were marked as slaves or as criminals, right? When we think about what stigma does today, it really serves to otherize somebody and make them feel excluded and discriminated against and marginalized.

Exactly as we were just talking about, the words that Angelina used were so beautiful. What serves to break that stigma down is to humanize our own stories. It doesn't mean you have to get up on a platform and say it out to hundreds of people you don't know.

It could be as easy as talking to an old friend of yours who maybe doesn't know that part of your story, or talking with a neighbor, a cousin, a colleague. These are experiences that are so universal, and when we hide them away, it not only serves to isolate us, shelter, and really make those experiences full of shame.

It also gets in the way of us moving forward as a society where we start to think of these conditions as common and as treatable as high blood pressure.

Dan: Wow. Thank you. Thank you, Dr. Bhushan. I want to thank all three of you. Before we conclude, I'd like to ask you a question that we ask every guest.

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Dan: The world can be a difficult place and sometimes it can be hard to hold on to hope. That's why each episode we dedicate the last couple of minutes of our podcast to a special segment called hold on to hope.

Dr. Bhushan, Dr. Higgins, and Angelina can you tell us what helps you hold on to hope?

Devika: I think that learning to see myself as a whole and complicated person for whom bipolar disorder has been an integral, but a part of my overall journey has been really important in terms of my own resolution of my own self stigma around it.

I think what gives me hope that I can be well, and I can stay well, just as we use that individual lens for the moment, is a deep recognition of what my struggles have taught me and what my struggles have allowed for me to do and be in this world.

I think when I look around and I see so many people committed to this cause of stigma reduction, of increasing access, of decreasing inequities as we look around that, too, gives me hope on a collective scale.

I feel that the commitment to bettering mental health and equity has never been greater than it is today. I think that also gives me a great deal of hope.

Dan: Thank you. Dr. Higgins?

Napoleon: I would say what gives me hope is the work that we're doing right here, where, we're explaining the information, talking about the information. Everybody who hears this will get will be a bit better.

I would say hope, continuing to push the information, to continue to keep up the fight, and also continuing to help individuals. Knowing that when you make a breakthrough when you help somebody, when you see the light come on, where you see that the better day, the brighter day for the individual in front of you that you were able to help.

Then that to me, that helps yourself, which gives me just increasing hope, to reach out, to help people, and help them attain and be a problem solver. This is the issue, let me give you the answers. Some of that can be seeing a psychiatrist, some of that can be seeing a therapist, some of that can be lifestyle changes, and sleep, and sunshine.

How do you naturally boost the dopamine in your brain by having a good laugh with some good people around you. All of those things to me help to build the hope, and I appreciate being a part of this fight.

Dan: Thank you so much. Angelina?

Angelina: The tagline for NAMI it's "Find Help, Find Hope." All those years ago, 23 years ago when I was looking for that hope, I found it in an NAMI class that I went on the tape five more times.

Back then hope for me was I wished internally that it would all go away. I really wanted all of this to be moved out of my life. What I found through the hope that NAMI provided me is that better days could come. That if I just held on to what I was learning and applied it to my life in the way that I designed.

Because NAMI just gives you options and you pick and choose how you're going to use this information. Then the hope was actualized, I now have an adult family and I feel like we made it, when I thought at one time we definitely would never make it. I found my hope that way, and that gave me hope.

I believe NAMI psychoeducation support provides hope. Where I have hope now, people ask me, "Why are you still doing this 23 years later?" I will always be affiliated with NAMI, in some form, shape, or another. Because I still find families that are looking for that hope.

As I find people that are still looking for hope, I can only point them in the direction of where the hope can be found. When they take that hope, sometimes they get a glimmer of hope just like you mentioned, Dr. Higgins, because you listened to them. Because you cared about them. Because you sat and made space for them.

That's what encourages me today. The hope that I still find in the eyes of new people that bump into NAMI. Because they are then opened up to the possibility that things will get better. Then they do.

Dan: Thank you so much. This has been an incredible podcast and I will tell you that I hope you will join us again. Because we need to keep this conversation going and make sure that we dig into the conversation from the standpoint of equity, what that looks like as well.

[background music]

Dan: I just want to say to you all, Dr. Devika Bhushan, Dr. Napoleon Higgins, and Angelina Hudson. Thank you so much for being with us today. From the bottom of NAMI's heart to yours. Thank you. This has been Hope Starts With Us, a podcast by NAMI, the National Alliance on Mental Illness.

If you are looking for mental health resources, you're not alone. To connect with the NAMI helpline and find local resources, visit nami.org/help text helpline to 62640, or dial 800‑950‑NAMI, 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.

To learn more about the Community Health Equity Alliance, visit chea, C‑H‑E‑A.nami.org. That's C‑H‑E‑A.nami.org. I'm Dan Gillison. Thanks for listening and be well.


About the Host:

Dan Gillison

Daniel H. Gillison, Jr.

Follow on Twitter: @DanGillison

Daniel H. Gillison, Jr. is the chief executive officer of NAMI (National Alliance on Mental Illness). Prior to his work at NAMI, he served as executive director of the American Psychiatric Association Foundation (APAF) in addition to several other leadership roles at various large corporations such as Xerox, Nextel, and Sprint. He is passionate about making inclusive, culturally competent mental health resources available to all people, spending time with his family, and of course playing tennis.

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