Selected Podcast
Ep. 29: Breaking the Silence About Mental Health
On this episode of Inspiring Health, we’re discussing a topic many people find difficult to talk about: mental health. What we understand about mental and behavioral health has increased tremendously in recent years. It can affect so many aspects of our life, yet it is an area of health many of us are afraid to talk about. Our discussion will take a closer look at existing disparities and why Black mental health is different than "Majority Mental Health".
Featuring:
Francis Sparrow, M.D.
Dr. Francis Sparrow is vice president and medical director for WellSpan Philhaven. Dr. Sparrow has been providing Behavioral Health care and services for more than 35 years and is a child psychiatrist Board certified in General and Child and Adolescent psychiatry. Transcription:
Roxanna Gapstur (Host): On this episode of Inspiring Health, we're discussing a topic many people find difficult to talk about, mental health. What we understand about mental and behavioral health has increased tremendously in recent years, and it can affect so many aspects of our life, yet is an area of health many of us are afraid to talk about.
Joining me today is Dr. Francis Sparrow, Vice President and Medical Director for WellSpan Philhaven Haven. located in Mount Gretna. Dr. Sparrow has been providing behavioral health care and services for more than 35 years and is a child psychiatrist, board-certified in general and child and adolescent psychiatry. Dr. Sparrow, thank you so much for being here today.
Dr Francis Sparrow: Thank you for the opportunity to be here to talk about mental health and why we need to have more open and honest conversations about this in our communities today.
Roxanna Gapstur (Host): Absolutely. Dr. Sparrow, as I look around, I'm seeing commercials and advertisements talking about mental health. Professional athletes, famous icons, all sharing their own experiences and encouraging others to talk about mental health. The public messaging seems to be more prominent now than at any time I can remember. How did we get to this point where mental health is such a monumental challenge to talk about, whether it's with your family, your friends, or even your healthcare provider?
Dr Francis Sparrow: Yeah. It is a big issue these days, mental health and mental wellness is something that we all live with. We all have our feelings of anxiety, sadness, hopelessness at times, guilt and grief. And to some degree, we all fear it. And as a result of that, we try to avoid and not deal with it. This is something that historically has been dismissed, negated, misused, and stigmatized, and the stigma is a big issue for our society and for the world at large.
So stigmas can be understood in four different domains. Stigma can be public where we have negative or discriminatory attitudes towards the illness or the person suffering from the illness. Stigma could also be institutional where we have policies or practices that unintentionally or intentionally limit access to care or impact negative awareness about the illness. We also can have self. That's where individuals internalize their feelings that are negative about their attitudes, their guilt or sadness about their situation. Also there's cultural stigma. Many times communities, especially communities of diversity, have their own experiences that shape their respect of stigma in the black community. There's a distrust of mental healthcare, healthcare systems and institutions at large.
Roxanna Gapstur (Host): Yes. I imagine it may take several more years to remove the barriers and walls that have been built up over decades, especially if there's deep rooted distrust. Unfortunately, that can lead to disparities in health equity. As with many facets of healthcare, there are disparities in mental and behavioral health. Can you talk more about disparities that exist around mental health and the barriers to care?
Dr Francis Sparrow: Absolutely. I think we all know that disparity in healthcare is a huge problem for us in our communities, our nation and worldwide. We know the common factors associated with disparity, obviously access to care, affordability, stigma, and cultural and language competency in our services and among our providers. These become really barriers to us really getting the care folks need.
Just some general things about disparity in black mental health care, so one out of three black Americans are experiencing some significant form of mental health diagnosis or challenge. That's compared to one out of five of folks in the general population. Black Americans are 20% more likely to experience mental health problems than the general population. Twenty-five percent of black American seek treatment compared to 40% of the general population. And when black Americans do seek treatment, the treatment they receive is not the best practice standards of either the national standards or local standards.
Black mental health is different than majority mental health. This is critical to our understanding, our treatment and our approach as a society and healthcare providers. As we know, in addressing any problem, and understanding the root causes and solving to root, we're not going to have realistic and positive outcomes without that intentional effort.
Roxanna Gapstur (Host): Yes. absolutely. Well, we've certainly touched on the negative connotations associated with mental health. I recently read a study from the NIH, National Institute of Health that said that 63% of black men and women believe a mental health condition is a sign of personal weakness. Where does that stigma come from, Dr. Sparrow?
Dr Francis Sparrow: Well, we know mental health conditions are often viewed as a sign of personal weakness. You know, we come from a community and a society that believes in pulling yourself up by your bootstraps. But because people in more vulnerable positions already feel vulnerable, they don't like to expose themselves to being more vulnerable and a risk for many other factors. So one does not want to put oneself in a situation where they feel more vulnerable and more precarious. Addressing this part of stigma is really a challenge. Both for individuals and communities and requires a comprehensive multi-pronged approach to resolving this.
Roxanna Gapstur (Host): Yeah. It's really such a complex topic. I know that we're learning more about factors such as genetics that affect mental health. However, recent studies are also identifying the role that social determinants have on mental health, including inequality related to healthcare, education, social status, and economic resources. Can you talk more about how the environment is triggering mental health crises?
Dr Francis Sparrow: Environmental factors are composite of social, economic, educational, vocational, cultural and institutional experiences. This fundamentally defines who each of us are, how we see the world and how we navigate it. These collective experiences shape and define the community's perception. This is generally true of all persons, but especially those of varied cultures and diverse ethnic backgrounds.
In the African American community, black mental health is the individual and collective experiences of the community, which then influences the wellness of the entire community. Trauma is the biggest influencer of black wellness and mental health. Trauma can be thought of in these domains. There's historical trauma that black cultures have experienced, slavery, civil rights, et cetera. There's also personal, past and present trauma, that people experienced directly or passively.
And there's also anticipatory trauma about events yet to happen or things that could happen. If we think about this for a moment and extrapolate from what we know about ACEs, adverse childhood experiences, to the idea of adverse cultural experiences, we can begin to understand some of the trauma burden that people experience. This can lead to an individual having a significant trauma burden resulting in increased morbidity and mortality that is manifested in physical, mental, and relational health issues. This is seen in the black community as well as other communities of diverse backgrounds and of color.
Roxanna Gapstur (Host): Dr. Sparrow, in addition to the factors that you just discussed, there are numerous myths tied to the negative stigma of mental health. Could you touch on what some of the common myths are in relation to mental health diagnosis?
Dr Francis Sparrow: Absolutely. There are many myths. Black Americans and persons of color do not experience nor do they respond to mental healthcare and treatment. Children and adolescents don't experience mental health problems. Persons with mental health problems and conditions are violent and unpredictable. There's no hope for persons with mental health problems and they can never recover. As individuals, we cannot not do anything to help a person with a mental health problem. There is no preventing mental health problems. Persons with mental health conditions are not employable. These are just a few, however, there many more myths associated mental health, more than we have time for today.
Roxanna Gapstur (Host): Yes. I think there's many of us who've heard some of those myths and it's good to hear you say that many of those things aren't true. Well, I know we're getting close to the end of our time together, Dr. Sparrow, but I have one final question I'd like to ask. Among the barriers to care are the costs and convenience to see a mental health provider. Can you talk a little bit about how health insurance has changed related to coverage and out-of-pocket costs for mental health?
Dr Francis Sparrow: Yes. Things have changed significant, particularly with the Affordable Care Act and other initiatives. Employers and payers have recognized the value and benefits of behavioral health care for their employees, families, and dependents. Most plans have behavioral health benefits. These benefits include behavioral health outpatient and inpatient services and substance use disorders are essential components of health benefits. The actual details of the coverage and available services in each community vary. Many payers and employers have wellness programs that incorporate behavioral health. Unfortunately, access to care and culturally competent care remain barriers at this time.
Roxanna Gapstur (Host): Dr. Sparrow, I know that WellSpan Philhaven and all of the folks who work with you day to day have worked really hard on many of these barriers and they continue to work on them each and every day. I'd like to thank you for being with me today and helping to break the silence about mental health and shedding some light on the disparities that exist in our community. I'm so glad we had an opportunity to talk today and share this with our listeners.
Dr Francis Sparrow: Thank you very much. I appreciate it.
Roxanna Gapstur (Host): That's all the time we have for today. We hope you'll join us for the next episode of Inspiring Health.
Roxanna Gapstur (Host): On this episode of Inspiring Health, we're discussing a topic many people find difficult to talk about, mental health. What we understand about mental and behavioral health has increased tremendously in recent years, and it can affect so many aspects of our life, yet is an area of health many of us are afraid to talk about.
Joining me today is Dr. Francis Sparrow, Vice President and Medical Director for WellSpan Philhaven Haven. located in Mount Gretna. Dr. Sparrow has been providing behavioral health care and services for more than 35 years and is a child psychiatrist, board-certified in general and child and adolescent psychiatry. Dr. Sparrow, thank you so much for being here today.
Dr Francis Sparrow: Thank you for the opportunity to be here to talk about mental health and why we need to have more open and honest conversations about this in our communities today.
Roxanna Gapstur (Host): Absolutely. Dr. Sparrow, as I look around, I'm seeing commercials and advertisements talking about mental health. Professional athletes, famous icons, all sharing their own experiences and encouraging others to talk about mental health. The public messaging seems to be more prominent now than at any time I can remember. How did we get to this point where mental health is such a monumental challenge to talk about, whether it's with your family, your friends, or even your healthcare provider?
Dr Francis Sparrow: Yeah. It is a big issue these days, mental health and mental wellness is something that we all live with. We all have our feelings of anxiety, sadness, hopelessness at times, guilt and grief. And to some degree, we all fear it. And as a result of that, we try to avoid and not deal with it. This is something that historically has been dismissed, negated, misused, and stigmatized, and the stigma is a big issue for our society and for the world at large.
So stigmas can be understood in four different domains. Stigma can be public where we have negative or discriminatory attitudes towards the illness or the person suffering from the illness. Stigma could also be institutional where we have policies or practices that unintentionally or intentionally limit access to care or impact negative awareness about the illness. We also can have self. That's where individuals internalize their feelings that are negative about their attitudes, their guilt or sadness about their situation. Also there's cultural stigma. Many times communities, especially communities of diversity, have their own experiences that shape their respect of stigma in the black community. There's a distrust of mental healthcare, healthcare systems and institutions at large.
Roxanna Gapstur (Host): Yes. I imagine it may take several more years to remove the barriers and walls that have been built up over decades, especially if there's deep rooted distrust. Unfortunately, that can lead to disparities in health equity. As with many facets of healthcare, there are disparities in mental and behavioral health. Can you talk more about disparities that exist around mental health and the barriers to care?
Dr Francis Sparrow: Absolutely. I think we all know that disparity in healthcare is a huge problem for us in our communities, our nation and worldwide. We know the common factors associated with disparity, obviously access to care, affordability, stigma, and cultural and language competency in our services and among our providers. These become really barriers to us really getting the care folks need.
Just some general things about disparity in black mental health care, so one out of three black Americans are experiencing some significant form of mental health diagnosis or challenge. That's compared to one out of five of folks in the general population. Black Americans are 20% more likely to experience mental health problems than the general population. Twenty-five percent of black American seek treatment compared to 40% of the general population. And when black Americans do seek treatment, the treatment they receive is not the best practice standards of either the national standards or local standards.
Black mental health is different than majority mental health. This is critical to our understanding, our treatment and our approach as a society and healthcare providers. As we know, in addressing any problem, and understanding the root causes and solving to root, we're not going to have realistic and positive outcomes without that intentional effort.
Roxanna Gapstur (Host): Yes. absolutely. Well, we've certainly touched on the negative connotations associated with mental health. I recently read a study from the NIH, National Institute of Health that said that 63% of black men and women believe a mental health condition is a sign of personal weakness. Where does that stigma come from, Dr. Sparrow?
Dr Francis Sparrow: Well, we know mental health conditions are often viewed as a sign of personal weakness. You know, we come from a community and a society that believes in pulling yourself up by your bootstraps. But because people in more vulnerable positions already feel vulnerable, they don't like to expose themselves to being more vulnerable and a risk for many other factors. So one does not want to put oneself in a situation where they feel more vulnerable and more precarious. Addressing this part of stigma is really a challenge. Both for individuals and communities and requires a comprehensive multi-pronged approach to resolving this.
Roxanna Gapstur (Host): Yeah. It's really such a complex topic. I know that we're learning more about factors such as genetics that affect mental health. However, recent studies are also identifying the role that social determinants have on mental health, including inequality related to healthcare, education, social status, and economic resources. Can you talk more about how the environment is triggering mental health crises?
Dr Francis Sparrow: Environmental factors are composite of social, economic, educational, vocational, cultural and institutional experiences. This fundamentally defines who each of us are, how we see the world and how we navigate it. These collective experiences shape and define the community's perception. This is generally true of all persons, but especially those of varied cultures and diverse ethnic backgrounds.
In the African American community, black mental health is the individual and collective experiences of the community, which then influences the wellness of the entire community. Trauma is the biggest influencer of black wellness and mental health. Trauma can be thought of in these domains. There's historical trauma that black cultures have experienced, slavery, civil rights, et cetera. There's also personal, past and present trauma, that people experienced directly or passively.
And there's also anticipatory trauma about events yet to happen or things that could happen. If we think about this for a moment and extrapolate from what we know about ACEs, adverse childhood experiences, to the idea of adverse cultural experiences, we can begin to understand some of the trauma burden that people experience. This can lead to an individual having a significant trauma burden resulting in increased morbidity and mortality that is manifested in physical, mental, and relational health issues. This is seen in the black community as well as other communities of diverse backgrounds and of color.
Roxanna Gapstur (Host): Dr. Sparrow, in addition to the factors that you just discussed, there are numerous myths tied to the negative stigma of mental health. Could you touch on what some of the common myths are in relation to mental health diagnosis?
Dr Francis Sparrow: Absolutely. There are many myths. Black Americans and persons of color do not experience nor do they respond to mental healthcare and treatment. Children and adolescents don't experience mental health problems. Persons with mental health problems and conditions are violent and unpredictable. There's no hope for persons with mental health problems and they can never recover. As individuals, we cannot not do anything to help a person with a mental health problem. There is no preventing mental health problems. Persons with mental health conditions are not employable. These are just a few, however, there many more myths associated mental health, more than we have time for today.
Roxanna Gapstur (Host): Yes. I think there's many of us who've heard some of those myths and it's good to hear you say that many of those things aren't true. Well, I know we're getting close to the end of our time together, Dr. Sparrow, but I have one final question I'd like to ask. Among the barriers to care are the costs and convenience to see a mental health provider. Can you talk a little bit about how health insurance has changed related to coverage and out-of-pocket costs for mental health?
Dr Francis Sparrow: Yes. Things have changed significant, particularly with the Affordable Care Act and other initiatives. Employers and payers have recognized the value and benefits of behavioral health care for their employees, families, and dependents. Most plans have behavioral health benefits. These benefits include behavioral health outpatient and inpatient services and substance use disorders are essential components of health benefits. The actual details of the coverage and available services in each community vary. Many payers and employers have wellness programs that incorporate behavioral health. Unfortunately, access to care and culturally competent care remain barriers at this time.
Roxanna Gapstur (Host): Dr. Sparrow, I know that WellSpan Philhaven and all of the folks who work with you day to day have worked really hard on many of these barriers and they continue to work on them each and every day. I'd like to thank you for being with me today and helping to break the silence about mental health and shedding some light on the disparities that exist in our community. I'm so glad we had an opportunity to talk today and share this with our listeners.
Dr Francis Sparrow: Thank you very much. I appreciate it.
Roxanna Gapstur (Host): That's all the time we have for today. We hope you'll join us for the next episode of Inspiring Health.