An Interview with New York City’s Health chief

Tuesday, June 20, 2023

By Don Sapatkin

Plus: A digital nonprofit places itself squarely between mental health web searches and the platforms’ responses, recruiting young users to something better. Dozens of websites with connections to the 988 mental health and suicide lifeline shared user data with Facebook, an investigation found. And a MindSite News interview with New York City’s health commissioner.

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MindSite News Interview: Ashwin Vasan, New York City’s Doctor, on Trying to Fix a ‘Broken Mental Health System’

In an interview with MindSite News, New York City Health Commissioner Ashwin Vasan outlines his plans and priorities for elevating mental health as a crucial element in New York City’s health policies.

Read the full interview here.

Black mental health experts on how to deal with racial trauma

Trauma lives in the body. And that includes the trauma of being subjected to racism, Capital B reports:

As Black people, we are bombarded by instances of racism every day: Images of police and self-deputized citizens killing Black people. Hospitals shutting down in our communities. Negative stereotypes in media, microaggressions at work, suspicious treatment by store clerks and neighbors. All based on the color of our skin. 

The story, part of a special issue about pervasive racial discrimination produced in partnership with Vox, notes that constant exposure to racism can increase the risk of chronic disease like heart disease and blood disorders, which disproportionately affect Black people. “When you add racialized stress, it leads to this form of weathering on the body that shows up physically, physiologically, and emotionally,” Atlanta psychologist Ayanna Abrams told Capital B.

Experts offered five practical tools that Black people can use to heal racial trauma:

• Build racial pride: “Display African artifacts in your home or hang up the ‘Good Times’ painting,” which graced the cover of a Marvin Gaye album and the credits of the 1970s sit-com.
• Find a safe space focused on your identity: “From reading to skating to gardening, Black hobbyists have built communities to support one another’s creativity and passions, free from microaggressions and racial stress.”
• Limit your use of social media: Ongoing cycles of news coverage about killings of Black people traumatizes Black viewers well beyond the original reporting of the horrific events. Stay off social media, especially at times like these.
• Take mental health breaks: Racist microaggressions in the workplace and daily life can bring on stressful hypervigilance. Walking, being in nature and activities like meditation offer a respite. Just “stepping into the sunlight” can be “extremely helpful,” Abrams said.
• Explore affordable therapy options: Black people are much less likely than whites to seek mental health care, partly because of availability and cost. Ask therapists if they charge on a sliding scale depending on income.

Last year, MindSite News convened a live conversation with Black psychologists from Hurdle Health about vicarious racism and its impact on the mental health of Black people. You can view the recording here.

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A book about Depression-era quadruplets asks intriguing questions about schizophrenia’s causes

To the outside world, the Morlock sisters − identical quadruplets born in 1930 who quickly became a public phenomenon − were depicted in newsreels and newspapers as an upbeat and smiling antidote to the Great Depression. Inside, they suffered grievously: Their father, a Nazi sympathizer, sexually abused them. Their mother failed to protect them from her husband’s predations. Their classmates bullied them.

“Was it, in part, the conflict between the idealized way the outside world saw them and the awful way they were treated at home that led all four Morlok sisters − Edna, Wilma, Sarah and Helen − to develop schizophrenia as young women?” Rebecca Onion writes in her Washington Post review of a new book by Audrey Clare Farley.

The debate over the cause of schizophrenia has centered on the relative contributions of nature and nurture, genes and environment. “Farley wants to propose a third culprit: culture, society, what she calls ‘milieu,’” according to the review. The Morlok sisters’ story “is the story of a society professing great concern for its children, while actually exploiting them,” Farley writes in her book.

Onion gives a mixed review to “Girls and Their Monsters: The Genain Quadruplets and the Making of Madness in America.” (“Genain,” from the Greek for “dire birth” or “dreadful gene,” was how government scientists referred to the sisters.) Still, Farley’s ideas – especially that “madness might come to take root in a person via society” – are fascinating.

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This nonprofit helps teens find reliable mental health help online

These days, algorithms used by search engines and social media platforms are trained to spot cries for help and direct users to crisis hotlines and reputable sources of information. Even if the algorithms don’t screw up by offering a dangerous response, however, they miss a lot of keywords. It also is unclear how many people follow through on the suggestions.

Enter Koko, a digital nonprofit that helps various kinds of internet platforms, from social media to telehealth services, support the mental health of their users. “Koko meets young internet users at the crossroads between risk and harm reduction,” according to GoodGoodGood, a news site that focuses on upbeat stories.

Koko, which says it is embedded all over the internet (including TikTok) and engaged with two million users over the past year, spots many more keywords than traditional algorithms. The tool initially steps in with an active response when, say, it detects a query that hints at suicidal ideation. “’Everything okay?’ the message asks, according to the story. “’If you or someone you know is struggling, you are not alone. For peer support, self-help courses, and other resources, please try Koko.’ Users are then redirected to a number of mental health options, all of which are free.”

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Statistics you should know (unfortunately)

Three major government reports were released last week. Here is a summary of some of their key findings.

1. Violent deaths − suicides and homicides − have increased sharply among children and young adults (aged 10 to 24), according to a CDC National Center for Health Statistics Data Brief that examined trends back two decades. Key points:

•Among people ages 10 to 24, suicide deaths rose 62% from 2007 to 2021.
•For ages 10 to 14, the (far lower) suicide rate tripled from 2007 to 2018 and remained steady through 2021, while the homicide rate doubled from 2016 to 2021.
•Among ages 20 to 24, the suicide rate ticked up during most of the 2001-2021 period analyzed, while the homicide rate increased from 2014 through 2020 and remained unchanged in 2021.

2. About 18.5% of adults ages 18 and older reported being diagnosed with depression during their lifetime, according to a CDC Morbidity and Mortality Weekly Report, which relied on data from the agency’s 2020 Behavioral Risk Factor Surveillance System. Rates of depression were:

• highest among people 18 to 24 (21.5%) and lowest for those 65 and above (14.2%).
• higher among women (24%) than men (13.3%)
• higher among whites (21.9%) than Blacks (16.2%), Hispanics (14.6%), Native Hawaiian/Pacific Islanders (14.6%) and Asians (7.3%)

• higher among people with less than a high school education (21.2%) than those with a high school education or equivalent (18.5%) or college degree (15.4%).

Geographically, depression rates were highest in the Appalachian region but also varied widely elsewhere from state to state and county to county.

3. Lesbian, gay, and bisexual adults are more likely than straight people to use substances, experience major mental health conditions, and have serious thoughts of suicide, according to a 19-page report from the Substance Abuse and Mental Health Services Administration, based on the 2021 and 2022 National Surveys on Drug Use and Health.

Key points:
•About a third of bisexual females, bisexual males and gay males had a substance use disorder (SUD) in the past year, as did a quarter of lesbian females.
• Bisexual females were six times as likely to have attempted suicide in the past year than straight females.
• Bisexual males had rates of serious mental illness more than three times higher than straight males and more than twice as high as gay males.

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In other news…

Despite promises of anonymity, multiple websites connected to the 988 crisis hotline share visitors’ information with Facebook. An investigative report from The Markup, republished by MindSite News, found that several dozen websites connected to 988, the national mental health crisis hotline, have been sending user data to Facebook via a tool called the Meta Pixel. The data provided to Meta includes scrambled, but easily decipherable names and email addresses, in addition to signals that tell Facebook when website users click call buttons seeking help with mental health emergencies. The findings have piqued concerns among users and crisis websites, many of whom told The Markup that they assure visitors of anonymity.

The Markup tested 186 locally based crisis center websites that receive calls from the national 988 line and found 33 use Meta Pixel, a free and widely used piece of code that can be embedded into web pages to enable targeted Facebook ads.

In an emailed response, Meta spokesperson Emil Vazquez told The Markup “advertisers should not send sensitive information about people through our Business Tools.” Most of the 33 organizations found to be employing Meta Pixel didn’t respond to The Markup after the publication reached out. Some, including Contra Costa Crisis Center and United Way of Connecticut, responded that they had removed the pixel.

–Courtney Wise

Annual drug overdose deaths could jump 50% in three years without policy changes, White House drug czar Rahul Gupta predicted at Politico’s Health Care Summit, rising to 165,000 fatalities in 2025 from an estimated 110,000 in 2022. Deaths could be cut in half, he said, if President Biden’s initiatives, such as funding treatment in prison and expanding telehealth treatment, are implemented. Gupta also co-authored a New England Journal of Medicine perspective piece about the “medical and public health imperatives” of xylazine, the large-animal tranquillizer that is more and more frequently being mixed with street fentanyl by cartels or dealers  to produce tranq dope, an even more deadly combination.

Nearly 75% of people receiving mental health treatment said they’d faced obstacles with their insurance coverage, the New York Times reported. The Kaiser Family Foundation’s extensive survey of consumers’ experiences with four kinds of health insurance − employer-provided, Obamacare, Medicare and Medicaid − found big problems in all areas of medical care, such as coverage denials, high bills and a lack of providers in their plans. But responses to the few questions about mental health coverage were most disturbing to us.

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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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