A town that takes care of its own

Monday, April 24, 2023

By Don Sapatkin

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A radical old idea for mental health care

In Geel, Belgium, townsfolk take in people with mental illness. The tradition dates to the 13th century, when locals built a church honoring St. Dymphna, the patron saint of mental illness, and pilgrims flocked to Geel (pronounced “hail”). Now the city of 41,000 has about 120 boarders in local homes (down from 2,000 at the end of the 19th century). The New York Times sent a reporter, photographer and psychologist to tell the story (perhaps to make up for an 1891 article that called it “a colony where lunatics live with peasants” producing “misery and evil results.”)

Boarders include people with schizophrenia and other serious conditions who have settled into treatment and can function well with families who are paid $25 to $30 a day by the state. Families and children often form deep attachments to the “aunties” and “uncles” who live with them. Case workers from a nearby state psychiatric hospital are available 24/7 to help when problems emerge, creating the trust that is key to the program. Police know how to de-escalate a situation when they encounter a boarder behaving strangely, and to call the hospital immediately. It’s a far cry from the U.S., where police responses to public mental health crises often lead to violence.

Ellen Baxter, who spent a year in Geel in 1975, thinks that core elements of Geel’s approach can be replicated and has spent the last 35 years trying to do so. The closest she’s come, as founder and director of Broadway Housing Communities, is a development in Harlem that is home to families and single adults, some of whom live with mental illness. She says it’s a sort of “vertical Geel.”

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New Apple app to enable journaling as a mental health tool

Apple will soon introduce a journaling app for the iPhone – code-name: Jurassic – that will let users tap the apparent mental health benefits of regularly logging thoughts and activities, the Wall Street Journal reports. Apple will introduce its latest operating system, iOS 17, in early June, and the new app will eventually come pre-loaded on every iPhone that runs on it.

The journaling app is designed to help users keep track of their daily lives and will take data from other apps, including text messages, phone calls and physical proximity to other people. The app will analyze a user’s behavior to determine what a typical day is like, including how much time is spent at home compared with elsewhere, and whether a certain day included something outside the norm. The app will also suggest topics for the user to write about.

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How “weathering” forecasts racial health disparities

Three decades ago, a young public health researcher at the University of Michigan proposed an unconventional idea: that the constant stress of living in a racist society could lead to poor health. In 1990, Arline Geronimus presented evidence on Black infant mortality, showing that the babies of teen mothers were less likely to die during their first year of life. She posited the younger moms gave birth to more robust children because they’d endured fewer years of racism-induced stress.

Geronimus called this form of chronic stress “weathering” – like a rock eroded by endless exposure to the elements. Attacked from all directions, she retreated into her work, bolstering her theory in 130 published papers involving Latina mothers, Mexican immigrants and Appalachian whites. Her work, described in a new book, “Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society,” provides a framework for understanding health inequities, the New York Times reports. It was also the basis for policy decisions by the White House Covid-19 Health Equity Task Force, said its chair, Marcella Nunez-Smith, a Yale professor. The panel worked to reduce the stress of the pandemic on vulnerable groups with strategies like hiring community health workers to provide outreach and support to vulnerable populations.

The disproportionate numbers of deaths among people of color during the pandemic became a stark example of the effects of weathering – and a key reason Geronimus reentered the fray. The numbers also present an opportunity for policy changes, she says, such as paying for doulas to reduce maternal mortality among Black women and restoring child tax credits that were ended by Congress at the end of 2021. “There are so many leverage points,” she says. “You just have to be committed.”  

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John Fetterman tell his story

His wife Gisele broached the subject of mental health early in their marriage – and tried to get him to read books about depression – but he shrugged it off. She also learned that she didn’t have the power to fix her husband’s mental health. “You could do everything to support someone, but you can’t get them through the door,” she told People. “He had to do that hard part himself.”

Fetterman’s stroke last May accelerated his depression. A further decline came with a nationally televised October debate with his Republican opponent, Mehmet Oz, and the negative, sometimes vicious, reviews that followed. His election victory paradoxically made things worse. He sank to his lowest place – rarely leaving bed, hardly eating or drinking, often missing doses of vital medication.

On Feb. 16, his office announced that he would get inpatient treatment for clinical depression at Walter Reed hospital. “I took a sigh of relief,” Gisele says of the moment he checked himself in. “I was really happy.” Said Fetterman: “One of the happiest days of my life was when [my doctor] said to me in one of the sessions, ‘I believe that your depression is in remission.'” He decided to leave the hospital on March 31 when he felt, for the first time, that life was a joyful thing, not just “back to bearable” like it had been before.

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In other news…

More public figures speak out about their mental health: Michigan Supreme Court Justice Richard Bernstein, the first blind person to be elected to the court, said he’s seeking short-term mental health treatment out of state “while working remotely on active cases,” Deadline Detroit reported. Oakland A’s relief pitcher Trevor May is stepping away from the team, citing his struggles with mental health. He is the third major league baseball player this season to take time off for mental health, according to OutKick. And the rapper Desiigner conceded that he has been struggling with his mental health. He checked into a facility for treatment after allegedly exposing himself on an international flight, TMZ reported.

Suicide by poisoning increased 73% among children 10 to 12; 49% among adolescents 13 to 15; and 11% among teens 16 to 19 from 2019 to 2021, the CDC reported. Girls accounted for most of the 30% increase across age groups.

Costs of eliminating the IMD exclusion: For years, mental health advocates have pushed for an end to Medicaid’s so-called IMD exclusion. Intended to prevent states from shifting the cost of large state mental hospitals onto the federal government, it bars federal reimbursement for psychiatric facilities with more than 16 beds. The law has led to severe shortages of psychiatric beds. An analysis by the Congressional Budget Office says eliminating the IMD exclusion would increase net Medicaid expenditures by $38 billion over the next decade. An opinion piece in The Hill put it all into English.

The six-week abortion ban that Gov. Ron DeSantis signed last week includes exceptions when the life of the pregnant woman is at risk, but not if the danger stems from a psychological condition – such as a personal or family history of postpartum depression that increases the risk of suicide. NPR has the story.

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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