tag:theconversation.com,2011:/fr/topics/counseling-16777/articlesCounseling – The Conversation2023-12-12T23:58:25Ztag:theconversation.com,2011:article/2185082023-12-12T23:58:25Z2023-12-12T23:58:25ZProgram at Hamilton Public Library shows how libraries can expand the social services they provide<figure><img src="https://images.theconversation.com/files/565206/original/file-20231212-29-g6jmfe.jpg?ixlib=rb-1.1.0&rect=0%2C44%2C2500%2C1613&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A new program at the Hamilton Public Library is making on-site social workers available to the public.</span> <span class="attribution"><span class="source">(Hamilton Public Library)</span>, <span class="license">Author provided</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/program-at-hamilton-public-library-shows-how-libraries-can-expand-the-social-services-they-provide" width="100%" height="400"></iframe>
<p>When we need help or advice, it’s not always clear where to go, what resources are available to us, or who to turn to when we need support. Public libraries are often easily accessible and free to the public. That means the <a href="https://thewalrus.ca/future-of-libraries/">local public library is often the first port of call</a> for people looking for help or advice.</p>
<p>This is changing how community members engage with their library and how staff engage with community members entering their doors. While libraries often act as an informational resource for folks looking to access community and social services, the public’s intensifying needs necessitate an expansion of the library’s role in our communities.</p>
<p>Staff at <a href="https://hpl.ca/">Hamilton Public Library</a>’s (HPL) 23 branches and two bookmobiles increasingly encounter people with a range of complex health and social issues in their library spaces. They include individuals with housing and food insecurity, newcomers to Canada, those dealing with mental-health challenges, substance use and addiction, and individuals who struggle with technology, face language barriers, and income pressures, among other challenges. </p>
<p>Given these growing and varied needs, having social workers in libraries is vital. Library staff often do not have the knowledge or expertise to effectively offer crisis and mental-health support people need. </p>
<h2>What’s happening at Hamilton Public Library</h2>
<p>In November 2022, HPL responded to this challenge. In partnership with Hamilton Public Health Services’ <a href="https://www.hamilton.ca/people-programs/public-health/mental-health-services/mental-health-street-outreach-program">Mental Health and Street Outreach Program</a>, HPL developed a program to provide <a href="https://www.thespec.com/news/hamilton-region/hamilton-public-library-to-hire-a-social-worker-at-its-downtown-branch/article_ec6348b6-22bb-5b31-8911-a98ab38bf12b.html">on-site social work services</a> at its downtown central library, with two part-time social workers being present, visible and accessible on the first floor. </p>
<p>In partnership with Hamilton Public Health Services, HPL staff and social workers working at HPL voiced a need to document and study their social work program. the aim is to identify short- and long-term outcomes, engage with different library members to explore how the social work program is understood and to make these findings available to other public libraries who may be considering their own social work program. </p>
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<a href="https://images.theconversation.com/files/564559/original/file-20231208-23-8jod9n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man gives advice to a woman in a library." src="https://images.theconversation.com/files/564559/original/file-20231208-23-8jod9n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564559/original/file-20231208-23-8jod9n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564559/original/file-20231208-23-8jod9n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564559/original/file-20231208-23-8jod9n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564559/original/file-20231208-23-8jod9n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564559/original/file-20231208-23-8jod9n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564559/original/file-20231208-23-8jod9n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The public library is increasingly the first place people go when they need support or advice.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>With colleagues, I partnered with HPL and Hamilton Public Health Services to take a deeper look at the program from multiple stakeholders’ perspectives. Over the next year, interviews with different community stakeholders (library members, library workers, and social workers) will help make visible how these different stakeholders understand and use social work activities and services at HPL. </p>
<p>Social workers working in public libraries is a recent but growing partnership practice across North America. <a href="https://www.pbs.org/newshour/show/library-social-worker-helps-homeless-seeking-quiet-refuge">The first social worker in a public library</a> was in San Francisco in 2009. <a href="https://publiclibrariesonline.org/2019/01/providing-social-service-resources-in-a-library-setting/#.XDtQqGtmscY.wordpress">In that case</a>, library members experiencing homelessness were accessing the library to seek refuge and meet their basic needs.</p>
<p>Since this first program, there have been many variations of social services offered in public libraries across North America. Taken together, this is signalling a shift in how we think about and use public libraries — from book repositories to community anchors and social infrastructures. </p>
<h2>Expanding the library’s role</h2>
<p>Social workers in libraries take on multiple roles, including helping people access resources, offering supportive listening and brief counselling and providing training to library staff on how best to deal with crises when they arise.</p>
<p>Social workers also support access to services like housing, harm reduction, employment counselling and food security, and they provide crisis intervention and the de-escalation of disruptive behaviours on-site. </p>
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<a href="https://images.theconversation.com/files/564562/original/file-20231208-27-wxkgs2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="The glass entrance of a library building." src="https://images.theconversation.com/files/564562/original/file-20231208-27-wxkgs2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564562/original/file-20231208-27-wxkgs2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564562/original/file-20231208-27-wxkgs2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564562/original/file-20231208-27-wxkgs2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564562/original/file-20231208-27-wxkgs2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564562/original/file-20231208-27-wxkgs2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564562/original/file-20231208-27-wxkgs2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">More public libraries are hiring in-house social workers to provide the kinds of help and advice members of the public are searching for.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>Library social workers aim to remove systemic barriers to make their services more accessible. They can do this by offering preventative support in their role as community collaborators and advocates, and by helping people access services that offer longer-term solutions to their problems. </p>
<p>Social workers in the library are also crucial; they are trained and able to support trauma, mental-health issues, challenges and complex needs in a way that meets the person where they are at emotionally, physically and/or cognitively.</p>
<p>Ultimately, this project at HPL will help ensure the social work program meets its intended outcomes and will inform decision-making about the program’s future design and sustainability. This work is especially important as HPL is piloting a <a href="https://www.thespec.com/news/hamilton-region/library-expands-use-of-social-workers-to-barton-branch/article_47e845d3-9267-5e45-a0e2-ca09c18333ee.html">second social work program at its Barton branch</a>.</p>
<p><em>Sarah Gauthier, a Manager of Central Information Services with HPL, and Kianosh Keyvani, a Clinical Resource Co-ordinator with the City of Hamilton’s Mental Health and Street Outreach Program, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/218508/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Dalmer receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Bridget Marsdin and Leora Sas van der Linden do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The public’s intensifying needs necessitate an expansion of the library’s role in our communities.Nicole Dalmer, Assistant Professor in the Department of Health, Aging and Society, McMaster UniversityBridget Marsdin, PhD student, School of Social Work, McMaster UniversityLeora Sas van der Linden, Program Manager, Community Research Platform, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2151322023-10-26T12:31:24Z2023-10-26T12:31:24ZPublic schools and faith-based chaplains: Texas’ new combination is testing the First Amendment<figure><img src="https://images.theconversation.com/files/555647/original/file-20231024-15-yneqdd.jpg?ixlib=rb-1.1.0&rect=3%2C0%2C2114%2C1409&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When public school counselors are in short supply, should chaplains be allowed to fill the gap?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/unhappy-young-girl-at-the-psychologist-royalty-free-image/1327949832?phrase=chaplain+counsels+a+child&adppopup=true">Vladimir Vladimirov/E+ via Getty Images</a></span></figcaption></figure><p>In 1996, a school board in eastern Texas created a program called Clergy in Schools. Beaumont Independent School District recruited volunteer clergy <a href="https://www.chron.com/news/houston-texas/article/beaumont-school-district-target-of-lawsuit-over-2023594.php">to counsel K-12 students</a> on topics such as self-esteem, peer pressure and violence. The goal, officials said, was to create volunteer opportunities, encourage conversation about civic values and morality, and enhance safe learning environments.</p>
<p>Clergy in Schools didn’t last long. A federal trial court in Texas <a href="https://law.justia.com/cases/federal/district-courts/FSupp2/224/1099/2490192/">invalidated the program</a> in 2002. The judge found that the program violated <a href="https://constitution.congress.gov/constitution/amendment-1/">the First Amendment</a>, according to which, “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof.” More specifically, the court held that the program was unconstitutional because it was not neutral with regard to faith and conveyed the message that religion is preferable to a lack of religion.</p>
<p>But now, schools across the state are debating whether to open their doors to clergy. </p>
<p><a href="https://legiscan.com/TX/text/SB763/id/2686268">Senate Bill 763</a>, enacted in September 2023, allows school officials to hire unlicensed chaplains, either as staff members or volunteers. Those who can pass background checks will be allowed to perform duties typically provided by counselors, such as mental health support. Local boards have until March 1, 2024, to choose whether to allow chaplain programs in their schools.</p>
<p>SB 763 generates significant questions around the First Amendment. These questions are all the more high stakes given that the Supreme Court has recently <a href="https://theconversation.com/why-the-supreme-courts-football-decision-is-a-game-changer-on-school-prayer-184619">signaled shifting views</a> about the limits on religious activity in public schools – themes I teach, write and speak about regularly as <a href="https://udayton.edu/directory/education/eda/russo_charles.php">a faculty member</a> specializing in education law.</p>
<h2>Lone Star State</h2>
<p>Across the nation, local boards have difficulty <a href="https://www.tasb.org/services/hr-services/hrx/recruiting-and-hiring/national-school-counselor-shortage-rates.aspx">filling counseling positions with qualified staff</a>. In fact, Texas ranks 23rd in the nation <a href="https://missoulian.com/news/national/most-states-have-a-school-counselor-shortage-heres-where-theyre-needed-the-most/article_1169c039-88da-5f13-8489-3ed8cdf09b76.html">in student-to-counselor ratios</a>, with almost 400 students for every counselor.</p>
<p>However, SB 763 was also enacted amid a seeming push to allow religion to <a href="https://www.expressnews.com/politics/article/republicans-push-christianity-texas-schools-17915163.php">occupy a greater place</a> in Texas’ public schools. </p>
<p>One bill <a href="https://www.texastribune.org/2023/05/24/texas-legislature-ten-commandments-bill/">requiring officials to display</a> a 16-by-20-inch copy of the Ten Commandments in <a href="https://www.washingtonpost.com/politics/2023/04/21/texas-bill-ten-commandments-public-schools-religion/">every public school classroom</a> was passed in the state Senate but died on the floor of the House in May 2023. <a href="https://capitol.texas.gov/tlodocs/88R/billtext/pdf/SB01396E.pdf#navpanes=0">Another bill</a>, passed by the Senate and sent to a House committee, would allow boards to require schools to provide students with <a href="https://www.dallasnews.com/news/education/2023/04/21/ten-commandments-and-prayer-in-public-schools-texas-senate-approves-religious-bills/">time to pray</a> or read religious texts.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/555649/original/file-20231024-23-l229tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="The multistory dome of a large building is seen between trees, with two flags flying in front." src="https://images.theconversation.com/files/555649/original/file-20231024-23-l229tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555649/original/file-20231024-23-l229tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555649/original/file-20231024-23-l229tg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555649/original/file-20231024-23-l229tg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555649/original/file-20231024-23-l229tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555649/original/file-20231024-23-l229tg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555649/original/file-20231024-23-l229tg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The Texas legislature has debated several proposals over the past year to give religion more of a role in public schools.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-exterior-of-the-texas-state-capitol-is-seen-on-news-photo/1661520774?adppopup=true">Brandon Bell/Getty Images</a></span>
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<h2>Shifts at SCOTUS</h2>
<p>The Supreme Court, too, has displayed a friendlier attitude toward prayer and religion in public education, as reflected in <a href="https://www.law.cornell.edu/supremecourt/text/21-418">Kennedy v. Bremerton School District</a>: its 2022 decision upholding the right of a Washington state football coach <a href="https://theconversation.com/why-the-supreme-courts-football-decision-is-a-game-changer-on-school-prayer-184619">to pray on the field</a> at the end of games.</p>
<p>In so doing, the justices acknowledged that the Supreme Court abandoned the tests it used over the past 50-plus years to assess whether government actions appeared to endorse religion, and therefore whether they violated the establishment clause of the First Amendment.</p>
<p>The most famous of these was often called “the Lemon test,” referring to the court’s 1971 decision in <a href="https://www.oyez.org/cases/1970/89">Lemon v. Kurtzman</a>. In order to be permissible, the court ruled in Lemon, an activity involving religion and state had to <a href="https://supreme.justia.com/cases/federal/us/403/602/">meet three criteria</a>: that it have a secular legislative purpose; that its principal or primary effect neither advance nor inhibit religion; and that it not result in “excessive entanglement” between religion and the state – though the court did not define “excessive.”</p>
<p>The court also abandoned what was known as the “endorsement test,” which stems from 1984’s <a href="https://supreme.justia.com/cases/federal/us/465/668/">Lynch v. Donnelly</a>, in which a man <a href="https://www.oyez.org/cases/1983/82-1256">challenged a Rhode Island city</a> over its Christmas display and Nativity scene – and lost. According to the endorsement test, a policy is permissible if a “reasonable observer” would not think it was endorsing or disapproving of religion. </p>
<p>Finally, in 1992, the court abandoned a test it applied only once, in <a href="https://www.law.cornell.edu/supct/html/90-1014.ZD.html">Lee v. Weisman</a>: coercion. The justices invalidated prayer at a public school graduation ceremony on the basis that it coerced people present into listening.</p>
<p>Instead of these tests, the court wrote in 2022’s <a href="https://www.supremecourt.gov/opinions/21pdf/21-418_i425.pdf">Kennedy v. Bremerton</a> that “the Establishment Clause must be interpreted by ‘reference to <a href="https://www.law.cornell.edu/supremecourt/text/21-418">historical practices and understandings</a>.’” However, it remains to be seen exactly what this means.</p>
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<span class="caption">People kneel and pray as Christian singer-songwriter Sean Feucht performs outside the U.S. Supreme Court after the Kennedy v. Bremerton ruling on June 27, 2022.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-kneel-and-pray-as-christian-singer-songwriter-sean-news-photo/1241572598?adppopup=true">Bill Clark/CQ-Roll Call, Inc via Getty Images</a></span>
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<h2>Crossing the line?</h2>
<p>Even so, SB 763 raises at least three thorny issues about how to assess whether a policy violates the First Amendment.</p>
<p>Initially, assuming the lower courts apply the new test enunciated in Kennedy v. Bremerton – that the First Amendment must be interpreted in light of “historical practices” – there do not appear to be traditions supporting the presence of faith-based chaplains as staff members or volunteers in public schools, regardless of whether they were formally credentialed.</p>
<p>Second is the question of endorsing religion. As noted, the Supreme Court repudiated its earlier tests about whether a policy appears to “endorse” a particular religion or no religion, or coerced people into participating. But the fundamental principle still holds: The First Amendment prohibits government from making any law “respecting an establishment of religion.” It thus appears that SB 763 straddles, if not crosses, the line into establishment. Having faith-based chaplains – a move <a href="https://bjconline.org/wp-content/uploads/2023/08/LETTER_-Texas-Chaplains-Say-No-to-Public-School-Chaplain-Programs.pdf">many Texas chaplains themselves oppose</a> – arguably puts the power of the state behind their actions.</p>
<p>Third is the question of which faiths will be represented and whether the chaplain program would appear to endorse some religions over others. Even if SB 763 were to survive a challenge on establishment clause grounds, one must question whether having chaplains from only some faith traditions is wise in an increasingly pluralistic American society, in which the number of <a href="https://www.pewresearch.org/religion/2021/12/14/about-three-in-ten-u-s-adults-are-now-religiously-unaffiliated/">people no longer identifying with religion</a> is growing.</p>
<h2>Votes ahead</h2>
<p>Not surprisingly, SB 763 has its supporters and critics. A board member in one Texas district <a href="https://www.texasstandard.org/stories/north-east-independent-school-district-san-antonio-tx-chaplains/">described the bill</a> as “a great opportunity to bring some spiritual guidance into the schools.” Another supporter, without offering a rationale, suggested that affording religion a greater place in public education could help to make schools safer, including <a href="https://www.expressnews.com/politics/article/texas-republicans-tout-christianity-campus-deter-18073417.php">reducing the risk of mass shootings</a>.</p>
<p>Conversely, <a href="https://www.washingtonpost.com/religion/2023/08/23/texas-school-chaplains-letter/">more than 100 chaplains</a> from various Christian denominations – including the Catholic Church, United Methodist Church and Seventh-day Adventist Church – as well as Jewish and Buddhist leaders signed <a href="https://bjconline.org/wp-content/uploads/2023/08/LETTER_-Texas-Chaplains-Say-No-to-Public-School-Chaplain-Programs.pdf">a public letter</a> opposing the bill. “It is harmful to our public schools and the students and families they serve,” the signatories wrote, because it neither prevents individuals from proselytizing in schools nor insures that they would have the necessary qualifications to serve students.</p>
<p>Boards have begun to vote on whether to allow chaplains in their schools. So far, boards <a href="https://www.keranews.org/education/2023-10-20/dallas-isd-wont-employ-chaplains-as-counselors">including those in Dallas</a> and <a href="https://www.kvue.com/article/news/education/schools/san-marcos-cisd-rejects-school-chaplains/269-026bbf9c-285c-4db5-be3d-14c09b40e678">San Marcos</a> have chosen not to do so, while others such as <a href="https://communityimpact.com/austin/round-rock/education/2023/09/26/round-rock-isd-officials-choose-volunteer-policy-for-local-chaplains/">Round Rock</a> <a href="https://www.ketk.com/news/local-news/mineola-isd-approves-chaplains-as-counselors/">and Mineola</a> have decided to allow chaplains in their schools.</p>
<p>SB 763 raises serious questions about what crosses the line toward establishing religion that, I believe, will likely result in litigation. Thus, both sides – whether in favor of or opposed to having chaplains in schools – should be mindful of the aphorism to “be careful what you wish for.”</p><img src="https://counter.theconversation.com/content/215132/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charles J. Russo does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Recent Supreme Court decisions have signaled a shift in how the country’s highest court interprets the limits on religion in schools.Charles J. Russo, Joseph Panzer Chair in Education and Research Professor of Law, University of DaytonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2091792023-09-18T12:21:16Z2023-09-18T12:21:16ZRacial trauma has profound mental health consequence – a Black clinical psychologist explains and offers 5 ways to heal<figure><img src="https://images.theconversation.com/files/548126/original/file-20230913-34443-83m8wu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Racial trauma can cause feelings of isolation among Black people. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-employee-working-overtime-in-the-evening-royalty-free-image/1496339990?phrase=black+woman+corporation&adppopup=true">Taiyou Nomachi/Getty Images</a></span></figcaption></figure><p>Since European expansion into the Americas, white people <a href="https://www.cnn.com/2021/11/25/us/ahmaud-arbery-racist-rhetoric-trial-takeaways/index.html">have demonized</a> Black people and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004736/">portrayed them</a> as undesirable, violent and hypersexual. Originally, the <a href="https://jimcrowmuseum.ferris.edu/brute/homepage.htm">intent of this demonization</a> was to legitimize the <a href="https://doi.org/10.1177/1532708616634769">conquest and sale</a> of African people.</p>
<p>One consequence of this negative portrayal has been the documented psychological impact on Black people themselves. It includes <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2611247/pdf/jnma00538-0053.pdf">self-hatred</a>, <a href="https://doi.org/10.1177/009579847900500201">internalized racism</a> and an <a href="https://virginiahistory.org/learn/civil-rights-movement-virginia/rising-black-consciousness">erosion of Black consciousness</a> within the Black community.</p>
<p>During the 1960s, <a href="https://www.youtube.com/watch?v=voV9ld-Qooc">Martin Luther King Jr.</a> recognized the consequences of racist stereotypes and tried to change the language and symbols of racism. </p>
<p>“Somebody told a lie one day,” King said. “They couched it in language. They made everything black ugly and evil. Look in your dictionaries and see the synonyms of the word black. It’s always something degrading and low and sinister. Look at the word white and it’s always something pure. …”</p>
<p>Though King longed for the day when the word “black” would be associated with beauty, Black people are still coping with feelings of alienation as a result of what is known as <a href="https://doi.org/10.1177/0011000006292033">racialized trauma</a>, the emotional impact of racism, racial discrimination and violence on mostly Black people.</p>
<p>I am a psychologist and professor of counseling. In our <a href="https://doi.org/10.17744/mehc.44.2.01">2022 peer-reviewed article</a>, mental health counselor <a href="https://www.waldenu.edu/why-walden/faculty/janee-steele">Janeé M. Steele</a> and <a href="https://und.edu/directory/charmeka.newton">I</a> detail the mental injuries caused by encounters with racial bias, hostility, discrimination and harassment. </p>
<p>More important, our research has shown that healing from racialized trauma can help reduce the negative impacts of racism and provide the emotional resources necessary to challenge racial injustices.</p>
<h2>Racialized trauma and mental health</h2>
<p>The <a href="https://dictionary.apa.org/trauma">American Psychological Association</a> defines trauma as “any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior, and other aspects of functioning.”</p>
<p>Common ways people are exposed to racialized trauma include everyday slights such as a store owner following a person of color around the store, racial slurs, denied opportunities, racial profiling and hate crimes.</p>
<p>These encounters, <a href="https://doi.org/10.1037/trm0000217">known as race-based events</a>, may occur directly between individuals or groups of people, or they may happen indirectly – for example, as a result of watching <a href="https://theconversation.com/how-black-communities-cope-with-trauma-triggered-by-police-brutality-199039">a video of police brutality</a>.</p>
<p>Whether they occur directly or indirectly, race-based events have a negative <a href="https://doi.org/10.1037/trm0000306">psychological effect on people of color</a> and often leave them feeling wounded. Some of these wounds include increased rates of <a href="https://www.webmd.com/mental-health/what-is-hypervigilance#:%7E:text=Hypervigilance%20%E2%80%94%20the%20elevated%20state%20of,a%20wide%20variety%20of%20incidents.">hypervigilance</a>, <a href="https://www.ptsd.va.gov/understand/related/depression_trauma.asp#:%7E:text=Depression%20often%20occurs%20after%20trauma,depression%20are%20often%20seen%20together.">depression</a>, <a href="https://adaa.org/understanding-anxiety/trauma">anxiety</a>, <a href="https://www.ptsd.va.gov/publications/rq_docs/V32N1.pdf">post-traumatic stress disorder</a> and <a href="https://doi.org/10.1111/j.1532-7795.2007.00540.x">low self-esteem</a>.</p>
<p>During our research, we interviewed a 29-year-old Black woman who grew up in a lower-middle-class neighborhood near Detroit. She attend predominantly white private schools and went on to become the first in her family to graduate from college and later earn a master’s degree in counseling. </p>
<figure class="align-center ">
<img alt="Two women are sitting at a table and one of them is using a pencil to take take notes." src="https://images.theconversation.com/files/518819/original/file-20230331-18-ohzuti.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518819/original/file-20230331-18-ohzuti.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518819/original/file-20230331-18-ohzuti.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518819/original/file-20230331-18-ohzuti.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518819/original/file-20230331-18-ohzuti.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518819/original/file-20230331-18-ohzuti.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518819/original/file-20230331-18-ohzuti.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Black social worker listens to a client.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/social-worker-meeting-a-client-royalty-free-image/532120326?phrase=black%20social%20workers&adppopup=true">Silvia Jansen/Getty Images</a></span>
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<p>But when she started her first full-time job, she noticed that it was dominated by white males in a work environment where the voices of people of color were not regularly heard. For instance, the woman told us that during staff meetings she was often ignored, except on rare occasions when issues of race were discussed.</p>
<p>As a result, the woman explained that she felt that she was devalued and began to feel anxious, sad and hopeless. Her self-esteem also suffered. </p>
<h2>How to heal</h2>
<p>Healing from racialized trauma is possible. </p>
<p>Yet current incidents of social injustice combined with centuries of violence, poverty, undereducation, mass incarceration, family dysfunction and health disparities have made it difficult for some Black people to maintain hope, a necessary element in undertaking the work to overcome this trauma. </p>
<p>Nevertheless, by learning new ways of thinking and coping, it is possible to find hope and overcome the wounds of racialized trauma. </p>
<p>Based on research and nearly 20 years of clinical experience, we have found tangible tools to address these wounds in five holistic ways.</p>
<p>As we write in “<a href="https://www.routledge.com/Black-Lives-Are-Beautiful-50-Tools-to-Heal-from-Trauma-and-Promote-Positive/Steele-Newton/p/book/9781032117423">Black Lives are Beautiful</a>,” a first step is identifying and understanding the psychological impacts of racialized trauma, as well as knowledge of strategies for wellness. </p>
<p>A second step in healing is the active promotion of higher self-esteem. </p>
<p>In our research, we learned that affirming one’s personal strengths and replacing negative beliefs can help individuals deal with racialized trauma. </p>
<figure class="align-center ">
<img alt="A Black man looks hopeful as he sits near a window and looks outside." src="https://images.theconversation.com/files/548165/original/file-20230913-29-nf968m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548165/original/file-20230913-29-nf968m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548165/original/file-20230913-29-nf968m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548165/original/file-20230913-29-nf968m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548165/original/file-20230913-29-nf968m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548165/original/file-20230913-29-nf968m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548165/original/file-20230913-29-nf968m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Boosting self-confidence is one way to minimize the impact of racialiized trauma.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/thoughtful-young-man-looking-through-window-royalty-free-image/1170998728?phrase=black+man&adppopup=true">Klaus Vedfelt/Getty Images</a></span>
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</figure>
<p>The third is developing resilience. Tenacity during adversity is important. The ability to bounce back and persevere can come from connecting with individuals, family and community.</p>
<p>For some Black people, this work is especially powerful, as <a href="https://doi.org/10.1037/11752-000">research indicates</a> that spending time engaged in activities that focus on cultural strengths can increase feelings of personal control and lead to higher self-esteem. </p>
<p>The fourth way is to promote empowerment. Finding strength in one’s personal choices is fundamental to achieving a higher self-image. Those choices could include supporting Black-owned businesses, attending cultural events and developing a strategy to gain financial independence. </p>
<p>The last way of healing is found in promoting a sense of community. By doing so, an individual can increase a sense of belonging and counter the feelings of isolation triggered by racialized trauma.</p><img src="https://counter.theconversation.com/content/209179/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Char Newton does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Whether experienced directly or indirectly, racial incidents can trigger numerous psychological impacts on Black people, including lower self-esteem and anxiety.Char Newton, Clinical Assistant Professor, University of North DakotaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2027942023-04-18T12:59:46Z2023-04-18T12:59:46ZHow hip-hop has enhanced American education over the past 50 years, from rec rooms to classrooms<figure><img src="https://images.theconversation.com/files/521377/original/file-20230417-1010-ebsf2l.jpg?ixlib=rb-1.1.0&rect=0%2C23%2C8010%2C5276&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Educators are increasingly turning to hip-hop to engage young people in school.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/smiling-young-male-college-student-wearing-royalty-free-image/1438969575?phrase=young%20black%20male%20wearing%20headphones&adppopup=true">Goodboy Picture Company/E+ via Getty Images</a></span></figcaption></figure><p>One of my most heartwarming memories from elementary school was the day my gym teacher tossed the planned activities, turned on some hip-hop music and just let us dance. I smile thinking of us all jumping around wild, crazy, happy and free. </p>
<p>Today, as a professor of higher education, I still carry the fondness I had for hip-hop as a child into my professional work. I have spent over two decades developing hip-hop cultural initiatives on college campuses. Hip-hop has made my jobs feel like house parties and turned co-workers and students into homies. But its impact in education is more than personal. </p>
<p>The year 2023 marks the <a href="https://theconversation.com/as-the-global-musical-phenomenon-turns-50-a-hip-hop-professor-explains-what-the-word-dope-means-to-him-200872">50th anniversary</a> of the <a href="https://www.npr.org/podcasts/1152139160/50-years-of-hip-hop">birth of hip-hop culture</a>. People around the world are taking time to reflect on and celebrate hip-hop’s accomplishments.</p>
<p>Educators are not only remembering the obvious ways hip-hop has influenced language and fashion or provided the soundtrack to our study sessions and sports events, but we are also acknowledging how hip-hop has changed education. Drawing from my research <a href="https://scholar.google.com/citations?user=7BZ3GM8AAAAJ&hl=en">exploring the educational benefits of hip-hop culture</a>, what follows are four ways that hip-hop has changed education in America.</p>
<h2>1. Made the classroom more engaging</h2>
<p>In the early 2000s, <a href="https://brichislitspot.files.wordpress.com/2018/07/hhbe_bettinalove.pdf">hip-hop-based education </a> surfaced in mostly English and language arts classrooms. Some teachers started incorporating hip-hop into lesson plans by using music and rhymes to teach subject matter. The goal was to make learning more stimulating while allowing students to feel culturally connected to the lessons.</p>
<p>An example was educator <a href="https://www.edutopia.org/blog/sparking-engagement-hip-hop-joquetta-johnson">Joquetta Johnson’s</a> having her students conduct a comparative analysis of Sojourner Truth’s <a href="https://www.nps.gov/articles/sojourner-truth.htm">“Ain’t I a Woman”</a> and Queen Latifah’s “<a href="https://genius.com/Queen-latifah-ladies-first-radio-edit-lyrics">Ladies First</a>.”</p>
<p>Hip-hop scholars now refer to this style of teaching as hip-hop pedagogy. <a href="https://files.eric.ed.gov/fulltext/EJ1071416.pdf">Hip-hop pedagogy</a> is the practice of incorporating the elements and values of hip-hop culture into the full educational experience. This includes not only the classroom environment, but also teaching techniques, student-teacher relationships and subject matter.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/521395/original/file-20230417-18-tdrp2q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="With full-length mirrors in the background, a group of hip-hop artists, in sweats and stockings, practice in a dance studio." src="https://images.theconversation.com/files/521395/original/file-20230417-18-tdrp2q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521395/original/file-20230417-18-tdrp2q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521395/original/file-20230417-18-tdrp2q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521395/original/file-20230417-18-tdrp2q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521395/original/file-20230417-18-tdrp2q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521395/original/file-20230417-18-tdrp2q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521395/original/file-20230417-18-tdrp2q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Private dance studios, public schools, community groups and colleges have incorporated hip-hop classes and culture into their curricula.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/hip-hop-dance-group-dancing-together-in-studio-royalty-free-image/1016801430?adppopup=true">Thomas Barwick/DigitalVision via Getty Images</a></span>
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<h2>2. Inspired new schools and community organizations</h2>
<p>Not only has hip-hop been integrated into school curricula, but an entire high school was established in St. Paul, Minnesota, to solely focus on hip-hop culture. The <a href="https://www.hsra.org/">High School for Recording Arts</a> is a public charter school that teaches dance, music, art and entrepreneurship to students who have been expelled or pushed out of other schools.</p>
<p>Several new hip-hop community organizations have also been developed. <a href="https://www.solhot.com/the-visionary">Saving Our Lives, Hearing Our Truths</a> is an Illinois-based community space where girls can rap and write, make friends, dream, draw, think critically, dance, create, speak up, be loud or just be quiet. </p>
<p>In New York City, <a href="http://iume.tc.columbia.edu/projects">Cyphers for Justice</a> engages high school youths, incarcerated youths and teachers in a <a href="https://www.academia.edu/49200110/Cyphers_For_Justice_Learning_from_the_wisdom_of_intergenerational_inquiry_with_youth">15-week program</a> in which they learn to use hip-hop creative practices like spoken word and dance performance to research and tackle social issues such as racial justice and school discipline policies. </p>
<h2>3. Expanded academic fields and jobs in higher education</h2>
<p>In 1991, Howard University became the <a href="https://carolinanewsandreporter.cic.sc.edu/from-djing-to-discussions-how-hip-hop-culture-has-graced-colleges">first university to offer a hip-hop course</a>. Since then, colleges across the country, including Harvard, Duke and New York University, have developed hip-hop-related courses. In 2012, the University of Arizona began offering a <a href="https://africana.arizona.edu/undergraduate/prospective-students/minor-hip-hop-studies">hip-hop studies minor</a> – the first of its kind at a four-year public university in the U.S. </p>
<p>The creation of hip-hop graduate courses has influenced the scholarship that students produce. For example, <a href="https://music.virginia.edu/people/profile/acarson">hip-hop professor A.D. Carson</a> wrote, performed and produced the 34-song rap album “<a href="https://www.youtube.com/watch?v=4W3LrHlRnHw&t=2s">Owning My Masters: The Rhetorics of Rhymes & Revolutions</a>” in 2017 as his doctoral dissertation at Clemson University. The groundbreaking dissertation received international praise and led to the <a href="https://news.virginia.edu/content/ad-carson-his-first-ever-peer-reviewed-rap-album-spring-shift-and-fall-courses">first peer-reviewed rap album</a>. </p>
<p>Hip-hop scholars are expanding the boundaries of what qualifies as rigorous research, how research is conducted, and what formats should be used for sharing this research with the public. Harvard University’s <a href="http://hiphoparchive.org/">Hiphop Archive & Research Institute</a> supports hip-hop research and scholarship. There are also hip-hop research conferences hosted at <a href="https://wgss.osu.edu/events/hiphop-literacies-conference">The Ohio State University</a>, <a href="https://www.tc.columbia.edu/events/info/hip-hop-ed-conference-8417633">Columbia University</a>, <a href="https://globalracialjustice.rutgers.edu/event/hip-hop-youth-research-activism-conference">Rutgers University</a> and the <a href="https://ed.buffalo.edu/black-history-ed/programs/conference.html">University of Buffalo</a>, to name a few. These conferences build on the legacy created by the students at Howard University who planned the <a href="https://www.theculturalinitiative.com/">first university-based hip-hop conference</a>, back in 1991. </p>
<p>These new hip-hop-related professional opportunities allow many scholars to develop academic careers without the pressure to discard their identities as artists or cultural curators. A.D. Carson is now an assistant professor of hip-hop and the Global South at the University of Virginia. At Harvard, the <a href="https://hutchinscenter.fas.harvard.edu/faq/nasir-jones-hiphop-fellowship">Nasir Jones Hiphop Fellowship</a>, named after the legendary New York rapper Nas, funds exceptional hip-hop scholars and artists. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/521396/original/file-20230417-26-qp2wra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="With their backs to the camera, a group of college-age students listen to a lecture from a smiling professor." src="https://images.theconversation.com/files/521396/original/file-20230417-26-qp2wra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521396/original/file-20230417-26-qp2wra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521396/original/file-20230417-26-qp2wra.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521396/original/file-20230417-26-qp2wra.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521396/original/file-20230417-26-qp2wra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521396/original/file-20230417-26-qp2wra.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521396/original/file-20230417-26-qp2wra.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">From elementary schools to universities, hip-hop culture has become a topic for discussion.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/smiling-professor-teaching-students-in-classroom-at-royalty-free-image/1374490613?adppopup=true">Maskot via Getty Images</a></span>
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</figure>
<h2>4. Fostered new mindsets</h2>
<p>Hip-hop has always addressed the social issues of the day, from <a href="https://www.loc.gov/static/programs/national-recording-preservation-board/documents/TheMessage.pdf">poverty</a> to <a href="https://news.harvard.edu/gazette/story/2020/07/hiphops-long-history-of-exposing-police-brutality/">police brutality</a>. With mental health now <a href="https://www2.ed.gov/documents/students/supporting-child-student-social-emotional-behavioral-mental-health.pdf">a priority in education</a>, some experts are exploring how to use hip-hop culture to support <a href="https://theconversation.com/the-healing-power-of-hip-hop-81556">student mental health</a>.</p>
<p>The University of Cambridge recently developed the <a href="https://www.cam.ac.uk/research/news/hip-hop-psych-initiative-aims-to-tackle-mental-health-issues-through-hip-hop">Hip-Hop Psych Initiative</a>, which aims to use hip-hop lyrics and music to help young people dealing with depression develop more positive images of themselves and their situations. <a href="https://manhattan.edu/campus-directory/ilevy01">Ian Levy</a>, an associate professor of school counseling at Manhattan College, developed a <a href="https://www.hiphopadvocacy.org/dr-ian-levy-hip-hop-education-hip-hop-counseling-therapy/">hip-hop-based counseling framework</a> for schools and other educational settings.</p>
<p>Hip-hop culture is also expanding beliefs about academic achievement, success and professionalism. University of Southern California education professor <a href="https://rossier.usc.edu/faculty-research/directory/christopher-emdin">Christopher Emdin</a> wants educators to rediscover their “ratchet” self. While being ratchet, which originally meant being uncultured, is often rejected within academic settings, Emdin explains that being a “<a href="https://www.tc.columbia.edu/articles/2021/august/christopher-emdin-wants-your-students-to-see-you-struggle/">ratchedemic educator</a>” is not about acting out, but acting authentically.</p>
<p>I have spent the past two years researching the ways that hip-hop culture produces its own set of professional practices that encourage drive, creativity, authenticity, honor, community, confidence and commanding attention. These characteristics are valued in many different settings, but hip-hop culture adds a unique flavor and intensity. I call this the <a href="https://digitalcommons.fiu.edu/communityliteracy/vol16/iss1/5/">Hip-Hop Mindset</a>.</p>
<h2>Continuing to evolve</h2>
<p>While hip-hop has left an indelible imprint on the field of education, it is not done yet. Hip-hop continues to evolve and gift us with possibilities for what culturally relevant education might look like in the next 50 years. As the saying goes, “Can’t stop, won’t stop.”</p><img src="https://counter.theconversation.com/content/202794/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Toby Jenkins does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Once considered a novelty in school, hip-hop has spawned an array of educational programs and initiatives that are reshaping the way educators teach and how students learn.Toby Jenkins, Associate Professor of Higher Education, University of South CarolinaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1883342022-09-21T12:36:19Z2022-09-21T12:36:19ZWhen you’re questioning your faith after being hurt by your religious community, here are 3 ways to cope<figure><img src="https://images.theconversation.com/files/480988/original/file-20220825-12-7fen2u.jpg?ixlib=rb-1.1.0&rect=12%2C3%2C2106%2C1404&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You don't have to work through trauma on your own.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/christian-group-of-people-holding-hands-praying-royalty-free-image/1360520573?adppopup=true">Khanchit Khirisutchalual/iStock via Getty Images Plus</a></span></figcaption></figure><p>For the past few months, religion has never been far from U.S. headlines.</p>
<p><a href="https://theconversation.com/roe-overturned-what-you-need-to-know-about-the-supreme-court-abortion-decision-184692">The Supreme Court has overturned constitutional abortion rights</a>. Congress is debating whether to codify <a href="https://www.washingtonpost.com/business/what-the-same-sex-marriage-bill-in-congress-would-and-wouldnt-do/2022/09/09/3f6a8298-3049-11ed-bcc6-0874b26ae296_story.html">protections for same-sex marriage</a>. Courts have been asked to decide whether religious schools and business owners have to <a href="https://www.npr.org/2022/09/13/1122477006/seattle-pacific-university-lawsuit-lgbtq-hiring-practices">hire</a>, <a href="https://theconversation.com/supreme-court-to-revisit-lgbtq-rights-this-time-with-a-wedding-website-designer-not-a-baker-187584">serve</a> or <a href="https://www.nytimes.com/2022/09/09/nyregion/yeshiva-university-lgbt-sotomayor.html?searchResultPosition=1">acknowledge</a> LGBTQ members and organizations.</p>
<p>Meanwhile, the U.S. Department of Justice is <a href="https://religionnews.com/2022/08/17/the-department-of-justice-is-investigating-the-sbc-abuse-fbi-what-does-it-mean-kathleen-mcchesney/">investigating the Southern Baptist Convention</a> after a consultant’s report revealed a history of sexual abuse and cover-ups – and <a href="https://kdvr.com/news/local/archdiocese-denver-lawsuit-sex-abuse-marshall-gourley/">new lawsuits</a> alleging abuse in the Catholic Church continue to appear.</p>
<p>As <a href="https://apps.tamusa.edu/course-information/Profile/Faculty/106?=Christine-Wong">an assistant professor of counseling</a> who <a href="https://doi.org/10.1002/cvj.12155">studies spirituality</a>, I have seen how controversies like these can activate memories and symptoms of religious abuse. They can also be challenging for people who have not experienced abuse but have difficult relationships to religion – especially those who have seriously questioned or left their faith.</p>
<p>People may have built their world around a church or church leader, then discovered their trust was misplaced. They may have been pressured to participate in activities that went against their values, or felt blamed for their story of abuse, gender identity or sexual orientation. They may have been told to stop gossiping when they reported mistreatment.</p>
<p>Religious rejection can be especially painful if it seems as though it’s <a href="https://doi.org/10.1007/s11089-008-0187-1">not only a community rejecting you, but God</a>. These experiences can evoke feelings of anxiety and depression – but there are steps you can take to begin healing. </p>
<h2>Many kinds of questions</h2>
<p>Therapy often helps people who are wrestling with aspects of their religious lives, whether or not they’ve experienced abuse. For example, people may reflect on the <a href="https://theconversation.com/patriarchy-and-purity-culture-combine-to-silence-women-in-the-southern-baptist-convention-and-are-blocking-efforts-to-address-the-sexual-abuse-scandal-183799">gender roles</a> they were expected to perform, or why they were told not to question leaders’ decisions.</p>
<p>Some, especially evangelical Christians, refer to the process of <a href="https://www.dallasnews.com/opinion/commentary/2022/07/17/evangelicals-are-deconstructing-heres-what-that-means-and-where-it-took-me/">rethinking their beliefs and religious identity</a> as “deconstruction.” <a href="https://gravityleadership.com/deconstruction/">Deconstruction</a> involves reflecting upon one’s beliefs, the way they were developed, and determining what values and beliefs one desires to maintain.</p>
<p>In cases in which people question their beliefs <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9780429330353-10/religion-hurts-supervising-cases-religious-abuse-craig-cashwell-paula-swindle">because of a painful experience</a>, it can be difficult for them to separate their higher power from the people who hurt them through religious teachings and practices. In my experience as a counselor, I’ve observed individuals blame themselves; experience confusion about their faith, identity and place in the world; and wonder whether God abandoned them.</p>
<p>For some people, <a href="http://hdl.handle.net/10504/64291">these experiences may result in leaving their faith</a>. This process can be difficult, as family, friends and faith community members may disapprove of this decision, <a href="https://doi.org/10.1007/s10615-021-00822-y">resulting in strained or severed relationships</a>. </p>
<h2>Recognizing abuse</h2>
<p>Spiritual experiences become abusive when they include emotional or financial manipulation, physical or sexual abuse, discrimination, humiliation or mistreatment. The abuse may be systemic, and perpetrators may have <a href="https://doi.org/10.1080/13552600.2021.1943023">used their authority or Scripture</a> to defend their actions.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1569989342612684800"}"></div></p>
<p>For some survivors, abuse can result in religious trauma, when they experience lasting symptoms. According to the latest revised edition of <a href="https://psychiatry.org/psychiatrists/practice/dsm">the diagnostic manual for mental health professionals</a>, signs of a traumatic response include recurring dreams, flashbacks, avoidance of activities related to the event, negative beliefs about oneself and the world, feelings of betrayal or detachment from others and hypervigilance. </p>
<h2>Counseling</h2>
<p>If you believe you or a loved one may have experienced religious abuse or trauma, or are in the deconstruction process, it is important to consider how you can support your mental health and well-being, especially given <a href="http://dx.doi.org/10.1037/trm0000183">the complex relationship between faith, identity and trauma</a>. For example, if you have felt harmed <a href="https://doi.org/10.1080/07325223.2018.1443305">in the name of a higher power</a>, it is common to experience confusion or even an existential crisis, in which you might question your purpose and basic assumptions about the world. </p>
<p>First, seek professional help. Licensed professional counselors are trained to identify symptoms of abuse and trauma and can help you process experiences and create an action plan.</p>
<p>Religious communities often stigmatize mental health treatment <a href="https://doi.org/10.1177/13634615211065869">and treat mental health issues as though they are purely spiritual</a>. They may treat the decision to seek professional help as a sign of a lack of faith in God. However, going to counseling does not necessarily mean you have to abandon your beliefs at the door.</p>
<p>A licensed professional counselor should be able to incorporate your faith to whatever level you find helpful. However, not all mental health professionals are comfortable <a href="https://doi.org/10.1002/j.2161-007X.2013.00024.x">addressing religious issues in counseling</a> – although there are efforts to improve this through training, <a href="https://www.counseling.org/resources/aca-code-of-ethics.pdf">ethical codes</a> and updating <a href="https://aservic.org/spiritual-and-religious-competencies/">professional competencies</a>.</p>
<p>To see if prospective counselors can provide appropriate care, you can ask what experience they have integrating spirituality into treatment, and whether they have experience working with religious abuse or with issues that led you to question your religious identity.</p>
<h2>Connection and community</h2>
<p>Second, connect with others who are going through similar experiences. You may have <a href="https://theconversation.com/patriarchy-and-purity-culture-combine-to-silence-women-in-the-southern-baptist-convention-and-are-blocking-efforts-to-address-the-sexual-abuse-scandal-183799">been shamed</a> for telling your story, or you may have left your religious community feeling alone and betrayed. You are not alone. </p>
<p>Religious trauma support groups like <a href="https://www.sacredwilderness.org">Sacred Wilderness</a> and <a href="https://www.reclamationcollective.com/">Reclamation Collective</a> can connect you with others who can identify with your experiences, online or in person. If you are not ready to share, you can read about the experiences of others on Twitter, with hashtags such as #ChurchToo and #ReligiousTrauma, or listen to a podcast like “<a href="https://open.spotify.com/show/10b0rbS8MNB7UjNIlWUAmf?si=cc70c7fb5eea4e77">Bodies Behind the Bus</a>.” However, if you find that your symptoms worsen reading these experiences, take a break.</p>
<p>Finally, find community outside of religion. If you decided to leave your house of worship, you may be grieving that loss of community, and a <a href="https://www.penguinrandomhouse.com/books/212681/social-by-matthew-d-lieberman/">sense of connection is crucial to mental health</a>. Individuals in isolation <a href="https://doi.org/10.1177/1745691614568352">have higher levels</a> of anxiety and depression, weakened immune systems and even higher risk of early death.</p>
<p>Community means finding people where you can connect with others authentically and encourage one another. This can come from fitness groups, book clubs, art classes or other interest groups. Take the opportunity to explore what you are curious about and learn more about yourself – and know that recovery is possible.</p>
<p><em>If you live in the U.S. and are in immediate crisis or having suicidal thoughts, you can call or text 988 or go to <a href="https://988lifeline.org/chat/">988lifeline.org/chat/</a> to chat with someone 24/7. Outside the U.S., you can visit <a href="https://findahelpline.com/">findahelpline.com</a> to find support.</em></p><img src="https://counter.theconversation.com/content/188334/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christine D. Gonzales-Wong does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A professor of counseling explains how to find therapists and support communities that can help work through these unique challenges.Christine D. Gonzales-Wong, Assistant Professor of Counseling, Texas A&M University-San AntonioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1874132022-07-27T11:55:57Z2022-07-27T11:55:57ZThe power of short breaks, movement and other practices on improving mental health – 4 essential reads<figure><img src="https://images.theconversation.com/files/475914/original/file-20220725-15-unq819.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4800%2C3858&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Exercising with loved ones is one way to support mental well-being. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mother-and-son-practicing-yoga-at-home-ground-view-royalty-free-image/200265184-002">Commercial Eye/The Image Bank via Getty Images</a></span></figcaption></figure><p>As of July 16, 2022, people have only to <a href="https://theconversation.com/whats-the-411-on-the-new-988-hotline-5-questions-answered-about-a-national-mental-health-service-178974">press three digits, 988</a>, to reach the U.S. National Suicide Prevention Lifeline when they need help during a mental health crisis. </p>
<p>Mental health issues such as anxiety and depression were a leading cause of global health problems <a href="https://doi.org/10.1016/S0140-6736(21)02143-7">even before the spread of COVID-19</a>; however, they’ve gotten worse. Since the first year of the COVID-19 pandemic, anxiety and depression rates worldwide have <a href="https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide">increased by an overwhelming 25%</a>. In the U.S., <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/">4 in 10 adults have reported symptoms</a> of anxiety or depression during the pandemic, compared with <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/">1 in 10</a> from January to June 2019. </p>
<p>Among the most affected are <a href="https://doi.org/10.1177/0004867414533834">young</a> <a href="https://doi.org/10.1007/s10964-020-01332-9">adults</a> and <a href="https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide">women</a>. The surge in people struggling with mental illnesses has coincided with <a href="https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide">gaps in mental care services</a> as well. </p>
<p>Research suggests that the pandemic has <a href="https://doi.org/10.3122/jabfm.2022.03.210461">exacerbated the impacts of loneliness</a>. Additionally, people’s <a href="https://doi.org/10.3390/ijerph18041974">fear of missing out</a>, also known as FOMO, hasn’t decreased even since in-person social gatherings became less frequent. But small daily actions – such as a short walk, break from social media or even a catnap – can add up to have an impact on mental health. Separately, counseling, therapy and medication prescribed by health care providers are <a href="https://doi.org/10.1007%2Fs13311-017-0549-4">effective treatments for those experiencing mental illness</a>.</p>
<p>The Conversation U.S. gathered four essential reads that explore some daily habits and practices that have been shown to improve mental health. These are food for thought, not guidelines or medical advice, but reading these articles could be the first steps toward a healthier lifestyle.</p>
<h2>1. A short break goes a long way</h2>
<p>Reducing screen time can alleviate feelings of isolation, loneliness and envy, which <a href="https://www.sciencedirect.com/science/article/pii/S2352250X15002535?via%3Dihub">may arise from scrolling through social media</a>, according to <a href="https://theconversation.com/profiles/jelena-kecmanovic-472294">Jelena Kecmanovic</a>, adjunct professor of psychology at Georgetown University.</p>
<p>“Several studies have shown that even a five-day or weeklong break from Facebook can lead to lower stress and higher life satisfaction,” she writes. “You can also cut back without going cold turkey: Using Facebook, Instagram and Snapchat just 10 minutes a day for three weeks resulted in lower loneliness and depression.” </p>
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Read more:
<a href="https://theconversation.com/6-ways-to-protect-your-mental-health-from-social-medias-dangers-117651">6 ways to protect your mental health from social media's dangers</a>
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<h2>2. Exercise is like medicine for the brain</h2>
<p><a href="https://theconversation.com/profiles/arash-javanbakht-416594">Arash Javanbakht</a>, associate professor of psychiatry at Wayne State University, shares the science behind the connection between exercise and mental well-being as well as his personal experience with the positive impacts of physical activity.</p>
<p>“Working out regularly really does change the brain biology, and it is not just ‘go walk and you will just feel better,’” he explains. “Regular exercise, especially cardio, does change the brain. Do not see it as all or none. It does not have to be a one-hour drive to and from the gym or biking trail for a one-hour workout vs. staying on the couch. </p>
<p>"I always say to my patients: ‘One more step is better than none, and three squats are better than no squats.’ When less motivated, or in the beginning, just be nice to yourself. Do as much as possible. Three minutes of dancing with your favorite music still counts.”</p>
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Read more:
<a href="https://theconversation.com/the-exercise-pill-how-exercise-keeps-your-brain-healthy-and-protects-it-against-depression-and-anxiety-155848">The exercise pill: How exercise keeps your brain healthy and protects it against depression and anxiety</a>
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<h2>3. Think therapy is navel-gazing? Think again</h2>
<p>People in need of therapy and counseling have long suffered from social stigma around mental illnesses, but these services are vital to protecting and improving our health. </p>
<p>“Decades of research show psychotherapy is effective for alleviating the most common forms of psychological suffering, such as anxiety and depression. But wellness is about more than reducing suffering,” writes <a href="https://theconversation.com/profiles/steven-sandage-1297183">Steven Sandage</a>, professor of the psychology of religion and theology at the Boston University School of Theology. “Counseling informed by positive psychology can be effective in improving well-being and increasing such qualities as forgiveness, compassion and gratitude.”</p>
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Read more:
<a href="https://theconversation.com/think-therapy-is-navel-gazing-think-again-173312">Think therapy is navel-gazing? Think again</a>
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<h2>4. Doing ‘nothing’</h2>
<p>Though it may not always feel plausible or even comfortable, slowing down and allowing yourself a dedicated moment of rest can do wonders for mental well-being, especially when speed and efficiency seem to have become integral to our lives.</p>
<p>“In this 24/7, ‘always on’ age, the prospect of doing nothing might sound unrealistic and unreasonable. But it’s never been more important,” writes <a href="https://theconversation.com/profiles/simon-gottschalk-471776">Simon Gottschalk</a>, a professor of sociology at University of Nevada, Las Vegas.</p>
<p>“To equate ‘doing nothing’ with nonproductivity betrays a shortsighted understanding of productivity,” he explains. “In fact, psychological research suggests that doing nothing is essential for creativity and innovation, and a person’s seeming inactivity might actually cultivate new insights, inventions or melodies.”</p>
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Read more:
<a href="https://theconversation.com/in-praise-of-doing-nothing-95998">In praise of doing nothing</a>
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<img src="https://counter.theconversation.com/content/187413/count.gif" alt="The Conversation" width="1" height="1" />
Researchers suggest it is important to build daily habits that support mental well-being and seek care when necessary.Michelle McAdams, University Relationship + Internship ManagerJacqueline Kim, Editorial internLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1733122022-02-22T13:42:41Z2022-02-22T13:42:41ZThink therapy is navel-gazing? Think again<figure><img src="https://images.theconversation.com/files/443113/original/file-20220128-23-183a6zz.jpg?ixlib=rb-1.1.0&rect=31%2C6%2C2086%2C1403&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many clients come to therapy wanting to look beyond themselves – talking about relationships, values and even spirituality.</span> <span class="attribution"><span class="source">SDI Productions/E+ via Getty Images</span></span></figcaption></figure><p>Midway through a recent lecture <a href="https://www.bu.edu/sth/profile/steven-j-sandage/">about my psychology research</a>, a bright graduate student voiced a familiar question.</p>
<p>“I have heard <a href="https://www.mayoclinic.org/tests-procedures/psychotherapy/about/pac-20384616#:%7E:text=Psychotherapy%20is%20a%20general%20term,%2C%20feelings%2C%20thoughts%20and%20behaviors.">psychotherapy</a> makes people more self-absorbed,” they said. “So how can you encourage a practice that has such a negative social impact?”</p>
<p>I am often struck by these negative stereotypes, despite <a href="https://www.apa.org/news/press/releases/2021/10/mental-health-treatment-demand">growing demand</a> for counseling – particularly amid the pandemic. The well-entrenched image seems to be that psychotherapy is an indulgent, narcissistic cocoon where therapists enable patients to “navel-gaze” and <a href="https://www.theguardian.com/commentisfree/2021/aug/23/is-it-your-mothers-fault-and-your-dads-how-psychotherapy-excavates-the-past-to-free-the-present">blame others for their problems</a>.</p>
<p>Full disclosure: I have seen examples of this during my 27 years in practice. But most patients are genuinely trying to improve close relationships, recover a sense of meaning and purpose and live consistently with their core values.</p>
<p>Mental health care often focuses on reducing patients’ symptoms. However, a growing body of research, including <a href="https://www.virtueandflourishing.com/">a project</a> I co-lead with <a href="https://sites.google.com/view/rap-lab/rap-lab/dr-jesse-owen">psychologist Jesse Owen</a>, investigates therapeutic approaches that also focus on increasing patients’ overall sense of well-being, or “flourishing.”</p>
<p>In many times and places, these kinds of concerns would be considered part of character development, or ethical or religious in nature. In fact, <a href="https://doi.org/10.1037/scp0000108">a large body of research</a> shows that most people want to engage <a href="https://www.apa.org/pubs/books/relational-spirituality-psychotherapy">spiritual, religious or existential issues in mental health treatment</a>, and that psychotherapies that engage patients’ spiritual practices <a href="https://onlinelibrary.wiley.com/doi/10.1002/jclp.22681">are effective for both mental and spiritual health</a>.</p>
<h2>Dual-factor treatment</h2>
<p>Decades of research show <a href="https://www.wiley.com/en-us/Bergin+and+Garfield%27s+Handbook+of+Psychotherapy+and+Behavior+Change,+7th+Edition-p-9781119536581">psychotherapy is effective</a> for alleviating the most common forms of psychological suffering, such as anxiety and depression. But wellness is about more than reducing suffering. </p>
<p>Over the past three decades, the field of <a href="https://theconversation.com/explainer-what-is-positive-psychology-and-how-can-you-use-it-for-yourself-75635">positive psychology</a> has grown, emphasizing how people can foster their strengths, virtues and well-being. Many thinkers, such as psychologist <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674932258">William James</a> and minister and author <a href="https://www.simonandschuster.com/books/The-Power-of-Positive-Thinking/Dr-Norman-Vincent-Peale/9780743234801">Norman Vincent Peale</a>, explored similar ideas in the 20th century. But now, empirical research has <a href="https://doi.org/10.1037/pst0000285">demonstrated that counseling informed by positive psychology can be effective</a> in improving well-being and increasing such qualities as forgiveness, compassion and gratitude.</p>
<p><a href="https://www.virtueandflourishing.com/overview">The project</a> I am co-leading with Professor Owen, funded by the <a href="https://www.templeton.org/?gclid=Cj0KCQiApL2QBhC8ARIsAGMm-KE9eSOY0DrPO1P7HNcMldVCDDHz5_a1ANwoPf9MJwVrNj6tt_Bx0RMaAhSgEALw_wcB">John Templeton Foundation</a>, is part of a growing trend of researchers seeking to integrate practices of positive psychology, spirituality and holistic well-being into mental health care, with careful attention to individual patients’ different needs. </p>
<p>For example, <a href="https://www.mcleanhospital.org/profile/mary-zanarini">Mary Zanarini</a>, an international expert on <a href="https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237">borderline personality disorder</a>, is testing a group therapy that develops skills in such virtues as forgiveness, humility and gratitude alongside other strategies, such as reflecting on and regulating emotions.</p>
<p>In a <a href="https://guilfordjournals.com/doi/10.1521/pedi_2019_33_395">2020 study</a> with patients diagnosed with borderline personality disorder, she found that patients’ ability to forgive and accept was correlated with their long-term ability to sustain work or education and a close relationship, in addition to their symptom remission.</p>
<p>In a separate <a href="https://doi.org/10.1002/jclp.22185">clinical study</a> with patients also suffering from borderline personality disorder, my colleagues and I also found that as patients developed a greater capacity to forgive, they experienced fewer mental health symptoms and less anxiety and frustration in close relationships.</p>
<p>These projects reflect a move toward what psychologists call <a href="https://doi.org/10.1016/j.brat.2017.01.008">dual-factor approaches</a>, which reduce symptoms of mental distress while also trying to increase flourishing.</p>
<p>Dual-factor frameworks recognize that experiencing mental health symptoms and well-being are not mutually exclusive. For example, in a study with <a href="https://doi.org/10.1002/jcad.12396">patients 18-29 years old</a>, our team at Boston University identified a subgroup of patients we labeled “resilient.” They showed the highest rate of symptoms, the lowest levels of life satisfaction and multiple serious stresses. Yet this resilient group functioned better in relationships, work or school than would be expected. Over the course of treatment, many moved into the category of “flourishing.”</p>
<h2>Cultivating strengths</h2>
<p>So what contributes to resilience in the face of suffering? A few months into the pandemic, we looked at that question in <a href="https://doi.org/10.1002/capr.12503">a follow-up study</a> with adults. </p>
<p>Similar to the previous study, people in one group scored more highly on well-being than would be expected, given their mental health symptoms. They demonstrated <a href="http://dx.doi.org/10.1037/scp0000267">fortitude</a>, finding opportunities for growth even amid stress. Those in another group, who also functioned better than expected given their mental health symptoms, demonstrated active forms of coping, such as deepening relationships or developing new hobbies, spiritual practices or creative interests.</p>
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<img alt="An older man trims a bonsai tree as a child watches." src="https://images.theconversation.com/files/446668/original/file-20220216-15-1s9ieat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/446668/original/file-20220216-15-1s9ieat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/446668/original/file-20220216-15-1s9ieat.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/446668/original/file-20220216-15-1s9ieat.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/446668/original/file-20220216-15-1s9ieat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/446668/original/file-20220216-15-1s9ieat.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/446668/original/file-20220216-15-1s9ieat.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Active forms of coping include working on new hobbies, like gardening.</span>
<span class="attribution"><span class="source">Karen Moskowitz/The Image Bank via Getty Images</span></span>
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<p>Philosophers across many different cultures have suggested humans move toward flourishing by <a href="https://plato.stanford.edu/entries/aristotle-ethics/">cultivating virtues</a> amid hardships. <a href="https://www.wiley.com/en-us/Virtue-p-9780745649542">The word “virtue”</a> can imply rigidity or perfectionism, yet its original meaning is about drawing on human strengths and practical wisdom to navigate life – such as the fortitude participants showed in our study.</p>
<p>Humility, gratitude and forgiveness are what some psychologists call “relational virtues,” ones that support healthy relationships. <a href="https://www.virtueandflourishing.com/our-team">Our team</a> is investigating how these three virtues might contribute to positive mental health over time.</p>
<p>Our initial evidence across two clinical studies is that patients generally tend to become <a href="https://doi.org/10.1002/capr.12199">less narcissistic</a> and <a href="https://doi.org/10.1002/capr.12389">feel less superior to others</a> over the course of psychotherapy. As patients develop more humility, their relationships improve and they report fewer symptoms of anxiety and depression.</p>
<p>For many people, relational virtues tie in with their spiritual or religious practices – which are themselves important to these patients’ well-being. Among those who value spirituality, a sense of being connected to the sacred <a href="https://doi.org/10.1080/19349637.2020.1791781">was positively related</a> to their overall functioning.</p>
<p>Based on <a href="https://www.virtueandflourishing.com/">our research</a>, a key factor linking virtue and positive mental health appears to be growth in emotion regulation, such as learning skills in mindfulness and processing complicated emotions such as shame, envy or pride. Our theory is that relational virtues often emerge in therapy when patients experience a balance of challenge and support and their core values are taken seriously. </p>
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<p>We need much more research to further validate these connections among relational virtues, emotion regulation and flourishing. But there are already enough data points to paint a more complicated and constructive public image of psychotherapy than the cynical stereotype.</p>
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<p><a href="https://www.ats.edu/">Boston University School of Theology is a member of the Association of Theological Schools.</a></p>
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<p class="fine-print"><em><span>Steven Sandage received funding from the John Templeton Foundation - grant #61603 - "Mental Healthcare, Virtue, and Human Flourishing." </span></em></p>Our research investigates the connections among mental health, holistic well-being and relational virtues – ideas that many people think of as ethical or religious.Steven Sandage, Professor of the Psychology of Religion and Theology, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1738182022-02-07T13:21:07Z2022-02-07T13:21:07Z5 strategies employers can use to address workplace mental health issues<figure><img src="https://images.theconversation.com/files/443888/original/file-20220201-23-1o2r30f.jpg?ixlib=rb-1.1.0&rect=0%2C22%2C4748%2C3350&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many workers are stressed out. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/business-woman-lying-on-exercise-ball-in-office-royalty-free-image/200566862-002">Symphonie/The Image Bank via Getty Images</a></span></figcaption></figure><p>COVID-19 has inflicted a <a href="https://www.shrm.org/resourcesandtools/legal-and-compliance/state-and-local-updates/pages/coronavirus-ongoing-pandemic-worker-mental-health.aspx">serious mental health toll on many U.S. workers</a>. </p>
<p>Like other Americans, workers have lost loved ones, connections to friends and family, and the comforts of their daily social rhythms. The pandemic has also imposed a unique set of stresses on workers, including the <a href="https://www.cbpp.org/research/poverty-and-inequality/tracking-the-covid-19-economys-effects-on-food-housing-and">risks of losing their job</a>, <a href="https://theconversation.com/how-remote-working-can-increase-stress-and-reduce-well-being-125021">rapid adjustments to working from home</a> and <a href="https://www.nber.org/papers/w27612">additional workloads</a>. And workers on the front line must face an <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2772328">increased risk of infection</a> and <a href="http://www.doi.org/10.1001/jamainternmed.2020.6249">increasingly aggressive customer interactions</a>.</p>
<p>As a result, many of these workers – especially those like <a href="https://doi.org/10.1016/j.psychres.2020.113441">nurses, doctors</a> and <a href="https://doi.org/10.3390/brainsci11091172">teachers</a> – are reporting elevated levels of anxiety, depression and sleeping problems. Americans are also <a href="http://www.doi.org/10.1001/jamanetworkopen.2020.22942">drinking a lot more alcohol</a> and <a href="https://doi.org/10.1016/j.appet.2020.104853">overeating, and engaging in less physical activity</a>. <a href="https://doi.org/10.1002/oby.23066">One-third of them have gained weight</a> since the start of the pandemic. </p>
<p><a href="https://profiles.arizona.edu/person/thaynes">I research the negative effects of stress</a> on health and sleep. I also see many of these issues firsthand in my work as a clinical psychologist treating local firefighters for stress and other issues they encounter on the job and in their lives. </p>
<p>I’ve learned workers are better able to <a href="https://www.cdc.gov/workplacehealthpromotion/planning/index.html">navigate mental health issues</a> when their employers have a plan in place. Based on my own work as well as other research, I believe there are five key strategies that companies could adopt. </p>
<h2>1. Creating clear policies</h2>
<p>With the increased stress levels brought on by the pandemic, managers may see more employees <a href="https://ckapfwstor001.blob.core.usgovcloudapi.net/pfw-images/borden/combat-operational/CBM-ch7-final.pdf">experiencing personal crises or disruptive behavior</a> that is affecting their work performance. </p>
<p>Psychological distress can lead to <a href="https://www.doi.org/10.1037/ocp0000293">disruptive behavior</a>, such as yelling at colleagues or throwing objects in anger. At the other extreme, employees may isolate themselves or avoid collaborations. Some workers may express suicidal thoughts over social media or by other means. </p>
<p>Managers may be at a loss for how to address these types of disruptive behavior, which is often unintentional. </p>
<p>A good first step for a company is to <a href="https://www.cdc.gov/workplacehealthpromotion/model/index.html">craft a clear workplace policy</a> that describes the specific types of disruptive behaviors that signal an individual is not currently capable of performing their job. This policy can discuss the process of temporary release, evaluation and treatment requirements, and conditions for a return to work. A policy like this provides clarity to both employees and managers.</p>
<p>For example, suicidal or violent thoughts might necessitate immediate intervention followed by a referral to an occupational health provider. The provider can ensure that the employee completes the required treatment plan prior to returning to work. Workers experiencing grief from a recent loss or flare-up of a mental health disorder might benefit from paid family medical leave or a temporary job reassignment.</p>
<p>It should be noted that under the <a href="https://www.ada.gov/">American with Disabilities Act</a>, employers are required to make reasonable accommodation for mental health disorders unless it results in undue hardship for the company. </p>
<p>The main thing is that managers need policies and procedures on how to respond to behavioral issues, with specific measures that correspond to the severity of a problem and its effects on colleagues and overall workplace performance.</p>
<h2>2. Partnering with mental health providers</h2>
<p>Many workers suffering as a result of the pandemic may not be exhibiting clear mental health problems. Rather, they could be experiencing a disruption in their personal lives that is bleeding into their work.</p>
<p>An example of this might be an employee who spends a significant amount of time at work talking about a marital conflict that occurred during home quarantine, thus interfering with workplace productivity.</p>
<p>In this case, a key mitigation strategy by a manager or colleague would be to refer that employee to a mental health provider or other supportive resource for help. In these cases, it’s useful to have an established partnership with a local provider and for employers to become familiar with the resources that are available.</p>
<p><a href="https://www.bls.gov/ncs/ebs/benefits/2021/employee-benefits-in-the-united-states-march-2021.pdf">Over half of civilian workers</a> have access to an <a href="https://www.opm.gov/faqs/QA.aspx?fid=4313c618-a96e-4c8e-b078-1f76912a10d9&pid=2c2b1e5b-6ff1-4940-b478-34039a1e1174">employee assistance program</a>, which provides free, confidential counseling to employees. Some larger companies may have their own in-house programs that provide direct access to mental health providers. But even smaller companies can set up partnerships that give workers access to counseling on an ad hoc basis.</p>
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<img alt="Women stretch as they do yoga standing on matts" src="https://images.theconversation.com/files/444409/original/file-20220203-21-9p1gp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/444409/original/file-20220203-21-9p1gp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/444409/original/file-20220203-21-9p1gp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/444409/original/file-20220203-21-9p1gp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/444409/original/file-20220203-21-9p1gp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=525&fit=crop&dpr=1 754w, https://images.theconversation.com/files/444409/original/file-20220203-21-9p1gp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=525&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/444409/original/file-20220203-21-9p1gp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=525&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Many companies offer employees wellness programs such as yoga.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/group-of-women-stretching-in-yoga-class-arms-raised-royalty-free-image/200398759-001">Andrea Wyner/DigitalVision via Getty Images</a></span>
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<h2>3. Preventing illness with wellness programs</h2>
<p>Workplaces can also take a more proactive stance. </p>
<p><a href="https://www.cdc.gov/workplacehealthpromotion/index.html">Workplace wellness programs</a> help prevent mental health problems by teaching employees new skills that support resiliency, which <a href="https://www.doi.org/10.2147/NSS.S344042/">can act as a buffer</a> from the negative effects of stress.</p>
<p>Workplace wellness programs for mental health typically teach stress management skills. Programs that <a href="https://doi.org/10.1146/annurev-orgpsych-012119-044908">promote positive emotions</a> may also improve productivity. </p>
<p>While these programs can have a meaningful, positive impact on health, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4945172/">employee participation is often limited</a>. To increase participation, it is very important to <a href="https://www.doi.org/10.1186/s12889-019-6578-7">include workers in decisions</a> about which programs to adopt. </p>
<p>Participation also improves when <a href="https://www.doi.org/10.1177/0890117118764856">managers support the program</a>, which typically requires managerial training on the program and how to promote it among workers.</p>
<h2>4. Fighting mental health stigma by changing norms</h2>
<p>People experiencing mental illness or just mental health struggles often face <a href="https://www.doi.org/10.1037/sah0000104">substantial stigma</a>. They might avoid treatment because they are concerned about losing their job or being viewed differently. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/books/NBK384914/">Employers can tackle stigma</a> at the structural level by <a href="https://www.nami.org/blogs/nami-blog/october-2017/9-ways-to-fight-mental-health-stigma">thinking and talking about mental health concerns</a> the same way they deal with physical ones and also by increasing mental health literacy within their company.</p>
<p>Another way to do that is to train dedicated employees to assist colleagues in need and become advocates for mental health and wellness services. Since some workers may feel more comfortable reaching out to a colleague than a mental health provider, these internal advocates can provide a bridge between employees and mental health care. </p>
<p>Companies can also <a href="https://www.doi.org/10.1016/S0140-6736(15)00298-6">develop programs</a> in which workers can hear people with mental illness describe their own challenges and how they overcame them. Research shows creating these social contacts <a href="https://www.doi.org/10.1007/s00127-017-1341-9">can reduce stigma</a>, at least in the short term. </p>
<h2>5. Nurturing social support through teamwork</h2>
<p>Finally, a large body of research demonstrates that <a href="https://doi.org/10.1037/0033-2909.98.2.310">social support buffers the impact of stress</a>. </p>
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<p>Social connections to the people around you can inspire what psychologists call “<a href="https://www.ascd.org/el/articles/the-power-of-collective-efficacy">collective efficacy</a>,” or a shared belief in a group’s ability to work together and overcome challenges to accomplish goals. Collective efficacy improves <a href="https://www.doi.org/10.1037/a0015659">group performance</a> and is also a <a href="https://www.doi.org/10.1521/psyc.2007.70.4.283">key ingredient in trauma recovery</a>. </p>
<p>The COVID-19 pandemic has fueled what <a href="https://www.nytimes.com/interactive/2021/12/16/well/mental-health-crisis-america-covid.html">some describe as</a> a mental health crisis. Employers are in a strong position to help curb it.</p><img src="https://counter.theconversation.com/content/173818/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patricia L. Haynes has received research funding from the National Institutes of Health, the Department of Defense, the Institute for Mental Health Research, the American Sleep Medicine Foundation, and the University of Arizona Canyon Ranch Center for Health Promotion and Treatment. Through her University of Arizona appointment, she engages in a professional services agreement with the City of Tucson to provide clinical services to employees. She is a member of the American Psychological Assocation, Sleep Research Society, Society for Behavioral Medicine, Society for Behavioral Sleep Medicine, and Society for Occupational Health Psychology.</span></em></p>Two years of pandemic have put a severe strain on the mental health of America’s workers. Employers with a plan in place will be best equipped to help them cope.Patricia L. Haynes, Associate Professor of Health Promotion Sciences, University of ArizonaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1678712021-10-01T12:12:46Z2021-10-01T12:12:46ZAmericans are in a mental health crisis – especially African Americans. Can churches help?<figure><img src="https://images.theconversation.com/files/423910/original/file-20210929-22-3d6wqk.jpg?ixlib=rb-1.1.0&rect=121%2C82%2C4128%2C2739&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The 160-year-old John Wesley AME Zion Church is one of the few predominantly African American churches that still exists in downtown Washington, D.C.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-160-years-old-john-wesley-ame-zion-church-is-one-of-the-news-photo/141796246?adppopup=true">Marvin Joseph/The Washington Post via Getty Images</a></span></figcaption></figure><p>Centuries of systemic racism and <a href="https://doi.org/10.1080/13811118.2019.1660287">everyday discrimination</a> in the U.S. have left a major <a href="https://doi.org/10.1111/1475-6773.13115">mental health burden</a> on African American communities, and the past few years have dealt especially heavy blows.</p>
<p><a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html">Data from the Centers for Disease Control and Prevention</a> indicate that Black Americans are twice as likely to die of COVID-19, compared with white Americans. Their communities have also been <a href="https://www.cbpp.org/research/poverty-and-inequality/tracking-the-covid-19-economys-effects-on-food-housing-and">hit disproportionately</a> by job losses, food insecurity and homelessness as a result of the pandemic.</p>
<p>Meanwhile, racial injustice and high-profile police killings of Black men have <a href="https://www.usnews.com/news/healthiest-communities/articles/2020-08-13/black-mental-health-threatened-by-coronavirus-george-floyd-killing">amplified stress</a>. During the summer of 2020, amid both the pandemic and Black Lives Matter protests, <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm?s_cid=mm6932a1_w">a CDC survey</a> found that 15% of Black respondents had “seriously considered suicide in the past 30 days,” compared with 8% of white respondents. </p>
<p>For a variety of reasons, many African Americans face barriers to mental health care. But <a href="https://oneill.indiana.edu/faculty-research/directory/profiles/faculty/full-time/fulton-brad.html">as a sociologist</a> who focuses on community-based organizations, I find that strengthening relationships between churches and mental health providers can be one way to increase access to needed services. In research with my collaborators <a href="https://www.rand.org/about/people/w/wong_eunice_c.html">Eunice Wong</a> and <a href="https://www.umass.edu/sphhs/person/kathryn-p-derose">Kathryn Derose</a>, I analyzed data on <a href="https://doi.org/10.1176/appi.ps.201600457">the prevalence of mental health care provision</a> among religious congregations and found that many African American congregations offer such programs.</p>
<h2>Need versus access</h2>
<p>Roughly <a href="https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf">1 in 5</a> Americans experience mental illness in a given year. Yet fewer than <a href="https://www.nimh.nih.gov/health/statistics/mental-illness#part_154785">half of adults</a> with a mental health condition receive mental health services. </p>
<p>African Americans utilize mental health services at about <a href="https://www.samhsa.gov/data/sites/default/files/MHServicesUseAmongAdults/MHServicesUseAmongAdults.pdf">one-half the rate</a> of white Americans. In part, this underuse may stem from African Americans’ <a href="https://doi.org/10.1016/S0140-6736(20)32032-8">often fraught relationship</a> with medical establishments in the U.S., given their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2593958/">histories of racial bias</a> and malpractice against people of color. Part of the reason may also derive from <a href="https://dx.doi.org/10.22229/afa1112020">stigma</a> among some African Americans perceiving mental illness and seeking help as signs of weakness. <a href="https://doi.org/10.1007/s10488-016-0743-4">Treatment “deserts”</a> where mental health providers are scarce may also be a factor.</p>
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<img alt="Students participate in an activity about mental health and suicide prevention at Uplift Hampton Preparatory School in Dallas." src="https://images.theconversation.com/files/423917/original/file-20210929-16-1inibqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423917/original/file-20210929-16-1inibqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423917/original/file-20210929-16-1inibqj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423917/original/file-20210929-16-1inibqj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423917/original/file-20210929-16-1inibqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423917/original/file-20210929-16-1inibqj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423917/original/file-20210929-16-1inibqj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Students participate in an activity about mental health and suicide prevention at Uplift Hampton Preparatory School in Dallas in 2018.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/MentalHealthEducation/b4c5b8b9fc494820ac1dd3f98f7d39c5/photo?Query=%22mental%20health%22&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=3980&currentItemNo=121">AP Photo/Benny Snyder</a></span>
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</figure>
<h2>Care at church</h2>
<p>One often overlooked resource for mental health care, however, are churches. For the past decade, the <a href="https://sites.duke.edu/ncsweb/">National Congregations Study</a> has documented the prevalence of mental health care provision among places of worship in the U.S. Based on data from the <a href="https://www.thearda.com/ncs/ncs2018/year_millness.asp">NCS’ 2018 survey</a>, 26% of congregations provide mental health programming, and 37% of people who attend religious services attend one of these congregations. Such programming can include support groups, meetings and classes focused on addressing mental health concerns.</p>
<p>Previously, my co-researchers and I <a href="https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201600457">analyzed 2012 NCS data</a> to better understand mental health resources within religious congregations. One of our goals was to identify factors that contribute to a congregation offering mental health care. These factors include having more members, employing staff for social service programs and providing health-focused programs. Other significant predictors include conducting community needs assessments, hosting speakers from social service organizations and being located in a predominantly African American community. </p>
<p>Based on the new <a href="https://www.thearda.com/ncs/ncs2018/trad3_millness.asp">2018 survey</a>, 45% percent of African American congregations offer some form of mental health service and nearly half of all African American churchgoers attend a congregation with such programs. These rates show an increase since 2012, and are roughly 50% greater than those among predominantly white congregations.</p>
<p>This research supports <a href="https://www.dukeupress.edu/the-black-church-in-the-african-american-experience">longstanding observations</a> about African American congregations as critical sources of spiritual, emotional and social support for their communities. Many religious people see their spiritual health and mental health as intertwined, and <a href="https://doi.org/10.1037/11872-000">research indicates</a> that spiritual practices, such as prayer and meditation, can also support mental health. </p>
<h2>Strengthening support</h2>
<p><a href="https://doi.org/10.1176/appi.ps.201600457">Our research</a> suggests that building collaborations between African American congregations and the mental health sector is a promising strategy to increase access to needed services. Given that 61% of African Americans say <a href="https://www.pewforum.org/wp-content/uploads/sites/7/2021/02/PF_02.16.21_Black.religion.topline.pdf">they attend worship services</a> at least a few times a year, congregations may provide an accessible resource. </p>
<p>At times, pairing religion and mental health may prove harmful. Some congregations see mental health problems as a product of <a href="https://doi.org/10.1080/13674670600903049">personal sin</a>, for example, and stigmatize people suffering from mental illness.</p>
<p>[<em>This week in religion, a global roundup each Thursday.</em> <a href="https://theconversation.com/us/newsletters/this-week-in-religion-76/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=religion-global-roundup">Sign up.</a>]</p>
<p>But congregations can also be helpful environments. When clinical treatment is <a href="https://doi.org/10.1146/annurev.publhealth.28.021406.144016">supplemented with social support</a>, the likelihood of successful outcomes is greater, and houses of worship often provide built-in social networks. People participating in a congregation-led grief recovery group, for example, can be involved in the congregation beyond their weekly meeting. In addition, some <a href="https://doi.org/10.1093/acrefore/9780190228613.013.226">mental health professionals</a> provide pro bono services for congregation-based programs. </p>
<p>Social worker <a href="https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilities-and-substance-abuse/victor-armstrong">Victor Armstrong</a>, the director of North Carolina’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services, <a href="https://afsp.org/story/the-role-of-the-church-in-improving-mental-wellness-in-the-african-american-commu">asserts</a> that African American faith leaders can play a “pivotal role” in mental wellness. He suggests shifting language to focus on “wellness” rather than “illness” in order to decrease stigma, among other recommendations.</p>
<p>Greater collaboration between congregations and mental health providers could help stem the growing mental health crisis, particularly within African American communities.</p><img src="https://counter.theconversation.com/content/167871/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Translational editorial assistance was provided by Emily Mace.</span></em></p>More houses of worship are offering mental health programs, especially African American congregations.Brad R. Fulton, Associate Professor, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1655892021-09-22T12:59:59Z2021-09-22T12:59:59ZTherapy dogs help students cope with the stress of college life<figure><img src="https://images.theconversation.com/files/420900/original/file-20210913-17-1u0oaz5.jpg?ixlib=rb-1.1.0&rect=14%2C0%2C4853%2C2909&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Therapy dogs are an effective way to reduce stress among college students.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/great-dane-therapy-dog-group-was-invited-to-csulb-to-news-photo/1034881044?adppopup=true">Scott Varley/Digital First Media/Torrance Daily Breeze via Getty Images</a></span></figcaption></figure><p>At a private college in the Northeast, a first-year student said it was the highlight of her day whenever she would lie on the floor of her adviser’s office and cuddle with a therapy dog, a Leonberger named Stella.</p>
<p>At a large public university in the Midwest, a graduate student spoke of how a therapy dog there provided some much-needed relief.</p>
<p>“What stands out for me is how comforting it felt to pet the therapy dog, especially when I started to miss my family and my own dog at home,” the student, who is in a demanding health professional program, told me for my <a href="https://www.proquest.com/openview/ce433fb1f134aef3b61f0ab32d30ee12/1?pq-origsite=gscholar&cbl=18750&diss=y">study of therapy dog programs for graduate students</a>. The student spent about 35 minutes a week with three other students who all got to spend time with the therapy dog, petting her and giving her treats.</p>
<p>Another student in the same program said spending time with a therapy dog helped her prepare for high-stakes tests. “It was always really nice to spend time with the therapy dog before big exams,” the student said. “I felt like it gave me time to relax before the stressful test.”</p>
<p>Such scenes are becoming more and more common at college campuses throughout the U.S. as college students <a href="https://brill.com/view/journals/soan/28/5-6/article-p489_3.xml">increasingly turn</a> to therapy dogs for comfort and to cope with the <a href="https://doi.org/10.1016/j.jadohealth.2009.08.008">challenges of student life</a> – such as <a href="https://ecommons.udayton.edu/cgi/viewcontent.cgi?article=1164&context=uhp_theses">increasing workloads</a>.</p>
<p>And as the <a href="https://www.apmreports.org/episode/2021/08/19/under-pressure-the-college-mental-health-crisis">demand for mental health counseling</a> on campuses <a href="https://abcnews.go.com/Lifestyle/wireStory/colleges-struggle-soaring-student-demand-counseling-67286699">continues to soar</a>, colleges are using therapy animals as a way to improve student mental health. Therapy dog programs are provided to colleges and their students <a href="https://www.forbes.com/sites/jillcastellano/2015/07/06/pet-therapy-is-a-nearly-cost-free-anxiety-reducer-on-college-campuses/?sh=488fc3727c59">largely free of charge</a>.</p>
<p>As an <a href="https://cphs.wayne.edu/profile/az5998">expert on therapy dog programs</a> – more formally known as canine-assisted interventions – I’ve <a href="https://www.proquest.com/openview/ce433fb1f134aef3b61f0ab32d30ee12/1?pq-origsite=gscholar&cbl=18750&diss=y">studied</a> how the programs can <a href="https://doi.org/10.1080/08927936.2021.1944558">improve student well-being</a>. Among other benefits, therapy dogs can help students <a href="https://doi.org/10.1080/08927936.2021.1944558">achieve a stronger sense of belonging</a> and <a href="https://doi.org/10.1080/08927936.2021.1944558">better deal with being homesick and lonely</a>, while also <a href="https://www.proquest.com/openview/ce433fb1f134aef3b61f0ab32d30ee12/1?pq-origsite=gscholar&cbl=18750&diss=y">lessening their anxiety and stress</a>. </p>
<p>Some of this can be explained by how human bodies respond to pleasant interactions with therapy animals. A 2019 study found that college students who spent even just 10 minutes petting a dog or cat saw <a href="https://journals.sagepub.com/doi/10.1177/2332858419852592">significantly decreased cortisol levels</a>, which are known to indicate stress.</p>
<h2>Animals on campus</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/415733/original/file-20210811-19-1vvpyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A dog sits next to a sign on a yard." src="https://images.theconversation.com/files/415733/original/file-20210811-19-1vvpyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/415733/original/file-20210811-19-1vvpyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415733/original/file-20210811-19-1vvpyl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415733/original/file-20210811-19-1vvpyl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415733/original/file-20210811-19-1vvpyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415733/original/file-20210811-19-1vvpyl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415733/original/file-20210811-19-1vvpyl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">College students interact with therapy dogs as a way to relieve stress.</span>
<span class="attribution"><span class="source">Christine Kivlen</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>In 2017, a survey of over 150 institutions found that <a href="https://doi.org/10.1007/s10755-017-9392-0">62% of schools had an animal-assisted intervention program</a>.</p>
<p>Dog therapy programs tend to look different at each institution. Some programs may involve a few therapy dogs and their handlers casually <a href="https://yaledailynews.com/blog/2015/12/09/yales-therapy-dog-program-spreads/">visiting the library a few times throughout the semester</a>.</p>
<p>In this setting, students may approach the therapy dogs one on one or in small groups. The time students spend with the therapy dog can vary from a few minutes to 45 minutes. </p>
<p>Other programs are more structured and involve scheduled times with a certain number of students being paired with an assigned therapy dog and handler. </p>
<h2>Inexpensive for dog owners</h2>
<p>The cost of having a dog registered as a therapy dog is relatively low for the owner.</p>
<p>The programs are typically coordinated by college personnel or faculty members in various departments, such as occupational therapy, psychology or counseling, or by an activities coordinator in student services. The dogs are typically pets with a good temperament and training. The handler pays any fees required for the dog-and-handler team to be registered through a company that provides therapy dog registration. The handlers pay the fees because they enjoy providing animal-assisted intervention.</p>
<p>Through the company Pet Partners, a widely used animal-assisted intervention company, it <a href="https://petpartners.org/volunteer/our-therapy-animal-program/fees/">costs the handler $15 to $30</a> for a dog/handler team to be evaluated, $95 to register the therapy dog team and $70 to renew each subsequent year. </p>
<h2>Calming effects</h2>
<p>In <a href="https://www.proquest.com/openview/ce433fb1f134aef3b61f0ab32d30ee12/1?pq-origsite=gscholar&cbl=18750&diss=y">my dissertation</a> on animal-assisted interventions, I asked a series of open-ended questions of graduate students who were participating in therapy dog programs.</p>
<p>Several students related how pleasant it was to have a scheduled break from schoolwork. “The experience forced me to take time out of my day and dedicate it to not studying,” one student wrote. </p>
<p>“The therapy dog is so calm,” another student wrote. “Her energy/mellowness helped me to calm down each session.”</p>
<p>Not only did the students enjoy their time with the therapy dogs, the therapy dogs seemed to enjoy spending time with the students as well. Many handlers told me about their dogs being much more excited on the morning of their designated day to go to the college. They also reported that their dogs were even more excited when they arrived on campus.</p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>.]</p><img src="https://counter.theconversation.com/content/165589/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christine Kivlen works for Wayne State University.</span></em></p>Colleges and universities are using therapy dogs as a low-cost way to improve their students’ mental health.Christine Kivlen, Assistant Professor (Clinical) of Occupational Therapy, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1363742020-05-26T12:17:50Z2020-05-26T12:17:50ZOnline therapy having its moment, bringing insights on how to expand mental health services going forward<figure><img src="https://images.theconversation.com/files/329860/original/file-20200422-47815-hmf6rw.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C8617%2C5766&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Therapists are discovering that tele-health counseling is effective.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/she-doesnt-need-a-prescription-for-this-tablet-royalty-free-image/1062130130?adppopup=true">Getty Images / AJ Watt</a></span></figcaption></figure><p>The coronavirus has resulted in stress, anxiety and fear – symptoms that might motivate a person to see a therapist. Because of social distancing, however, in-person sessions are less possible. For many, this has raised the prospect of online therapy. For clients in need of warmth and reassurance, could this work? Studies and my experience suggests it does. </p>
<p><a href="https://www.usf.edu/student-affairs/counseling-center/about-us/joyce-nick.aspx">I am a psychologist</a> and counselor at the University of South Florida. When <a href="https://www.usf.edu/student-affairs/counseling-center/">our center</a> named me its online assisted therapies coordinator, many of the staff initially pushed back at the notion of providing services through the screen. These negative attitudes toward telehealth should have surprised me. After all, its antecedent, telephone crisis lines, have been <a href="https://doi.org/10.1521/suli.2007.37.3.338">accepted and effective</a> for decades. </p>
<p>But my field of therapy <a href="https://www.psychologytoday.com/us/blog/over-simulated/201003/be-warned-online-therapy-is-not-therapy-not-really">has often been disdainful</a> of telehealth, opposed to “warm” psychotherapy work performed via a “cold” screen. Its resistance to the concept <a href="https://www.vice.com/en_us/article/gy344w/a-psychologists-take-on-why-online-therapy-isnt-as-effective-as-the-real-thing">has changed little</a> over the years.</p>
<p><a href="https://doi.org/10.1176/appi.ps.201100206">Research suggests</a>, however, that online therapy works just as well as traditional face-to-face therapy. Studies, looking at outcomes for clients and the quality of their relationships with therapists, found them equal across telehealth and in-person conditions. Since this <a href="https://doi.org/10.1080/15228830802094429">meta-analysis</a> (92 studies and 9,000 clients), <a href="http://dx.doi.org/10.1080/87568225.2014.854675">many other studies</a> have confirmed the value of teletherapy.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/329863/original/file-20200422-47820-1ria4nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329863/original/file-20200422-47820-1ria4nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329863/original/file-20200422-47820-1ria4nc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329863/original/file-20200422-47820-1ria4nc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329863/original/file-20200422-47820-1ria4nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329863/original/file-20200422-47820-1ria4nc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329863/original/file-20200422-47820-1ria4nc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Patients are reporting positive experiences with telehealth.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-woman-talks-with-a-doctor-online-royalty-free-image/1184631116?adppopup=true">Getty Images/SDI Productions</a></span>
</figcaption>
</figure>
<h2>Telehealth versus traditional therapy</h2>
<p><a href="https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf">Private insurance companies</a> like Cigna and Aetna, have come around; they now provide coverage for what they see as a “legitimate” service. And <a href="https://www.prnewswire.com/news-releases/american-wells-2019-consumer-survey-finds-majority-of-consumers-open-to-telehealth-adoption-continues-to-grow-300906438.html">surveys show</a> consumers are receptive to telehealth counseling: no driving to an appointment, no searching for a parking space, no worries about childcare while they’re away, no need to switch providers if they move, and no problem if the specialist happens to be far away. </p>
<p>Online therapy opens doors for clients who wouldn’t otherwise seek help, <a href="https://www.worldcat.org/title/empirical-examination-of-the-influence-of-personality-gender-role-conflict-and-self-stigma-on-attitudes-and-intentions-to-seek-online-counseling-in-college-students/oclc/941976505">particularly patients</a> who feel stigmatized by therapy or intimidated by a stranger sitting across the room from them. Often, <a href="https://doi.org/10.1089/1094931041291295">people open up</a> more easily in telehealth sessions. Firsthand accounts have detailed <a href="https://www.romper.com/p/i-tried-online-therapy-for-a-month-this-is-what-happened-13630">positive experiences from consumers</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/329866/original/file-20200422-47826-1ipsq2m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329866/original/file-20200422-47826-1ipsq2m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329866/original/file-20200422-47826-1ipsq2m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329866/original/file-20200422-47826-1ipsq2m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329866/original/file-20200422-47826-1ipsq2m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329866/original/file-20200422-47826-1ipsq2m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329866/original/file-20200422-47826-1ipsq2m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID-19 is forcing many reluctant therapists to give telehealth a try.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/focused-older-80s-patient-consulting-with-doctor-royalty-free-image/1189748859?adppopup=true">Getty Images / fizkes</a></span>
</figcaption>
</figure>
<h2>Overcoming prejudices about online counseling</h2>
<p>Now COVID-19 is forcing most traditional psychotherapists to adapt their practice to <a href="https://www.psychologytoday.com/intl/blog/expressive-trauma-integration/202003/covid-19-etherapy-in-times-isolation">online counseling</a>. After experiencing the medium, they are <a href="https://www.wecounsel.com/blog/why-every-therapist-in-private-practice-needs-a-telehealth-option/">overcoming their prejudices</a>. Many will convert some or all of their caseloads to telehealth after the pandemic ends. Most of our clients seem to be good with it: responding to a satisfaction survey, 85% of USF students strongly or somewhat agreed their telehealth experience was comparable to an in-person visit.</p>
<p>All this allows a continuity of care for clients that before was impossible; there is, however, a caveat. Because of the coronavirus, some of my clients at USF who live out-of-state have moved back home. That means, legally, I can no longer serve them. Even though they are still USF students, my license is valid only in Florida. </p>
<p>For telehealth to work effectively, our national system of licensing and regulation law needs to adapt. Although the federal government temporarily halted HIPAA regulations to promote telehealth during this time, not all states are allowing out-of-state practice. The coronavirus may not be here forever, but spring break and Christmas holidays always will. We need seamless telehealth across state lines. </p>
<p>That said, my own counseling center quickly transitioned to remote-only. Although most of the therapists can’t wait to get back into the office, they are appreciative they can serve students in need. Certainly many clients and therapists will gladly return to face-to-face sessions, but now they know the tool of telehealth will always be available, if and when needed. </p>
<p>So much is changing. Now, consumers can easily access online therapy. Free e-books are available; one dealing directly with the pandemic is “<a href="https://drive.google.com/file/d/117HY4z4mY5izJpR44ejuZ8rhTyoWEGEG/view">FACE COVID</a>,” by Russ Harris. Apps are around too – some free, some paid. Check out <a href="https://www.psyberguide.org/">the website psyberguide.org</a> to vet them. Asking for suggestions online will help as well. </p>
<p>Your insurance may allow you to talk to a licensed professional who does online therapy. Most major insurers have a list of them on their website. If you’re uninsured, most communities have free or low-cost mental health clinics. Many universities have them too. Also, <a href="https://openpathcollective.org">online directories</a> can point you to places that <a href="https://www.coronavirusonlinetherapy.org">offer services</a> on a sliding scale, depending on your income, from pro bono to US$60 a session. </p>
<p>After years of dismissing telemedicine, practitioners are getting past their biases in barely a few weeks. Telehealth has allowed psychotherapy to continue unabated. More people who need help will now get it. I’m sad our profession needed COVID-19 to address telehealth, but the benefits will last for generations. </p>
<p>[<em>You need to understand the coronavirus pandemic, and we can help.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-help">Read The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/136374/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Joyce is affiliated with USF and his private practice.</span></em></p>Because of COVID-19, more and more therapists are turning to telehealth counseling and finding help. Could this be the wave of the future?Nicholas Joyce, Psychologist, University of South FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1374552020-05-14T12:03:47Z2020-05-14T12:03:47ZWhat the coronavirus crisis reveals about vulnerable populations behind bars and on the streets<figure><img src="https://images.theconversation.com/files/333735/original/file-20200508-49550-ud4oca.jpg?ixlib=rb-1.1.0&rect=142%2C95%2C7797%2C4404&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Inmates work in the laundry room at Las Colinas Women's Detention Facility in Santee, California, on April 22, 2020.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/inmates-work-in-the-laundry-room-at-las-colinas-womens-news-photo/1210676403?adppopup=true">Sandy Huffaker/AFP via Getty Images</a></span></figcaption></figure><p>The notion that COVID-19 is an <a href="https://www.latimes.com/opinion/story/2020-04-08/coronavirus-racial-disparity">equal opportunity killer</a> has <a href="https://www.nationalgeographic.com/history/2020/04/coronavirus-disproportionately-impacts-african-americans/">crumbled</a>. The health and economic fallout from the crisis has disproportionately hit lower-income areas and communities of color. Nowhere is this discrepancy more evident than in prisons, jails and homeless shelters – made up <a href="https://qz.com/1233966/new-data-clearly-illustrate-the-poverty-to-prison-pipeline/">disproportionately of poorer</a>, <a href="https://www.pewresearch.org/fact-tank/2019/04/30/shrinking-gap-between-number-of-blacks-and-whites-in-prison/">black and Latino men and women</a>. </p>
<p>Here, COVID-19 cases have <a href="https://www.nytimes.com/2020/04/26/world/americas/coronavirus-brazil-prisons.html">mushroomed</a> due to <a href="https://www.bostonglobe.com/2020/03/13/nation/city-officials-scramble-stop-potential-spread-coronavirus-among-homeless/">dormitory-style living conditions</a> and the inability of people, often with underlying health issues, to practice social distancing. As the virus rages on, comprehensive COVID-19 testing for these populations remains elusive. </p>
<p>As <a href="https://socialwork.wayne.edu/profile/ao1692">experts on jails</a>, <a href="http://medpeds.med.wayne.edu/profile/ar3897">health disparities</a> and <a href="https://clasprofiles.wayne.edu/profile/gr2312">how to help former prisoners reintegrate into society</a>, we believe that missteps in how we transition incarcerated individuals back to the community would only put this vulnerable populace at greater risk of getting and transmitting COVID-19.</p>
<p>Health officials agree that incarcerated individuals and correctional staff are at <a href="https://www.vox.com/policy-and-politics/2020/3/17/21181515/coronavirus-covid-19-jails-prisons-mass-incarceration">high risk of contagion</a> due to crowded settings. But while both prisons and jails have curtailed visitations, they have fared differently amid the pandemic. </p>
<p>In prisons, where diversion and early release are often elusive, inmates with COVID-19 are quarantined in <a href="https://www.themarshallproject.org/2020/05/07/the-cruel-irony-of-social-distancing-when-you-re-stuck-in-solitary">solitary confinement</a>. However, this measure, more commonly used as punishment, may spur individuals with symptoms to skirt testing and <a href="https://www.healthaffairs.org/do/10.1377/hblog20200324.784502/full/">avoid these conditions</a>.</p>
<p>Though prisons have also become <a href="https://www.cnn.com/2020/05/07/us/coronavirus-cases-prisons-nursing-homes/index.html">hot spots for COVID-19</a>, they should be better placed than jails to limit exposure to outside diseases. That’s because they are efficient at confining their populace, and the flow of individuals in and out of prisons is tightly monitored. Prisons have larger medical units, more comprehensive assessment and release planning protocols including parole supports for <a href="https://www.prisonpolicy.org/virus/virusresponse.html">individuals returning to their communities</a>. </p>
<p>Jails are not designed for long-term stays. And they have flexibility with releasing individuals due to special circumstances like overcrowding. Thus, they have been a focus of calls for decreased admissions and the release of nonviolent inmates to keep incarcerated numbers low <a href="https://www.npr.org/sections/coronavirus-live-updates/2020/05/05/850513762/as-covid-19-fears-grow-10-000-prisoners-are-freed-from-overcrowded-philippine-ja">amid COVID-19</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/333736/original/file-20200508-49573-481k9l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/333736/original/file-20200508-49573-481k9l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/333736/original/file-20200508-49573-481k9l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/333736/original/file-20200508-49573-481k9l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/333736/original/file-20200508-49573-481k9l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/333736/original/file-20200508-49573-481k9l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/333736/original/file-20200508-49573-481k9l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Signs pleading for help hang in windows at the Cook County jail complex on April 9, 2020 in Chicago, Illinois.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/signs-pleading-for-help-hang-in-windows-at-the-cook-county-news-photo/1217892115?adppopup=true&uiloc=thumbnail_more_from_this_event_adp">Scott Olson via Getty Images</a></span>
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<p>Michigan’s 81 jails, for example, with 20,000 beds, <a href="https://www.freep.com/story/news/local/michigan/2020/03/26/advice-jails-michigan-coronavirus/2919375001/">have decreased incarceration levels</a> by more than half due to reductions in bookings, posting of bonds and <a href="https://www.mercurynews.com/2020/03/19/bay-area-courts-authorities-ramp-up-release-of-inmates-to-stem-covid-19-risks-in-jails/">limiting bookings to violent offenders</a>. Other measures such as eliminating bench warrant arrests – typically issued when an individual fails to make a fine payment or appear in court – and the early release of individuals at risk of COVID-19 <a href="https://www.freep.com/story/news/local/michigan/2020/04/25/coronavirus-cases-michigan-prison-surge-widespread-testing-prisoners/3002811001/">have also helped</a> bring down the populace.</p>
<p>Still, it’s important to recall that individuals who are jailed differ from those in state prisons in that they are often coming straight from the street. Many are experiencing <a href="https://www.who.int/bulletin/volumes/89/9/10-082842/en/">financial, health and behavioral health issues</a>. Others may be navigating substance misuse issues like withdrawal symptoms and intoxication. Scores suffer from <a href="https://www.healthaffairs.org/do/10.1377/hblog20140401.038180/full/">psychosis or depression</a>. </p>
<h2>Jail diversion and public health</h2>
<p>This poses a problem for states: Where will individuals with these behavioral health needs, with few financial and social resources, and possibly COVID-19, go?</p>
<p>In Michigan, inmates are being released with a signed, written promise to not engage in illegal activities and to appear in court when mandated. But these promises are hard to keep when you are <a href="https://www.npr.org/sections/coronavirus-live-updates/2020/05/05/850513762/as-covid-19-fears-grow-10-000-prisoners-are-freed-from-overcrowded-philippine-ja">struggling with addiction</a> or mental health problems. </p>
<p>It is dangerous to release people into the community without first testing them for COVID-19 and providing them with access to public health and treatment services. <a href="https://journals.sagepub.com/doi/abs/10.1177/0887403403255064">Our research</a>, informed by the <a href="https://www.samhsa.gov/gains-center">Gains Center</a>, which expands access to services for those with mental health and substance abuse disorders, shows that extensive transition planning, led by multidisciplinary teams, results in better outcomes for those reentering society. That includes giving them access to detox beds, housing and connections to day treatment. </p>
<p>The pandemic, however, has upended all norms. It has resulted in skeleton social service crews, restricted access to medical facilities and remote care requiring access to technology that homeless and recently incarcerated people often lack. People in jails have limited access to <a href="https://www.the-hospitalist.org/hospitalist/article/220860/coronavirus-updates/life-jail-made-worse-during-covid-19">mental health services</a>. This might make it harder for inmates to continue receiving the same medications when they leave jail, especially when it comes to treating psychiatric and <a href="https://www.healthaffairs.org/do/10.1377/hblog20200331.557887/full/">opioid use disorders</a>.</p>
<p>In worst-case scenarios, individuals attempting to stave off withdrawal may obtain drugs without <a href="https://www.health.harvard.edu/blog/recovering-from-addiction-during-a-time-of-uncertainty-and-social-distancing-2020040319381">maintaining social distancing</a>. We have anecdotal evidence of suicide rates increasing among opiate addicts awaiting treatment. Other <a href="https://www.northjersey.com/story/news/coronavirus/2020/04/24/nj-coronavirus-recovering-substance-abuse-amid-virus-outbreak/2998309001/">substance abusers</a> are refusing treatment all together. </p>
<p>Similarly, individuals with <a href="https://www.healthaffairs.org/do/10.1377/hblog20191022.281887/full/">mental health disorders</a> who need medications and housing need to be connected with providers who can assist them. But <a href="https://www.health.harvard.edu/blog/a-tale-of-two-epidemics-when-covid-19-and-opioid-addiction-collide-2020042019569">COVID-19 has disrupted</a> many of these services. The result is <a href="https://mentalillnesspolicy.org/consequences/homeless-mentally-ill.html">often homelessness</a>. </p>
<h2>Homelessness in the age of COVID-19</h2>
<p>To beat COVID-19, we believe it is essential to secure housing for the homeless. “Staying at home,” for instance, is impossible when you don’t have one. And how do you social distance when you live in a shelter with <a href="https://www.wvxu.org/post/its-impossible-keep-social-distance-homeless-shelters-so-groups-ask-help#stream/0">no access to private quarters</a>? </p>
<p>Cities like <a href="https://sf.curbed.com/2020/4/15/21221245/san-francisco-covid-coronavirus-hotels-homeless-sf">San Francisco</a> and <a href="https://ny.curbed.com/2020/4/13/21218888/nyc-coronavirus-homeless-hotel-rooms-shelters">New York</a> are attempting to reduce the homeless population by using hotel rooms. Other communities are erecting <a href="https://www.citylab.com/equity/2020/04/homeless-shelter-coronavirus-testing-hotel-rooms-healthcare/610000/">tent cities</a> or getting people into permanent housing.</p>
<p>Despite these efforts, individuals in unstable housing are <a href="https://apnews.com/43720a6c5d49e8c62950a2aab9e00ec2">vulnerable to the coronavirus</a> as well as food insecurity, violence and victimization. Some homeless people visit emergency rooms for health care and social needs – warmth, food, shelter and human touch. This renders them susceptible to contracting COVID-19 in the ER if they are negative or transmitting it if they are positive. </p>
<h2>A coordinated national strategy</h2>
<p>A coordinated and structured strategy, through a health equity approach, would likely interrupt the significant <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html">impact on marginalized communities</a>. </p>
<p>For instance, while <a href="https://www.journalofhospitalmedicine.com/jhospmed/article/220018/hospital-medicine/keep-calm-and-log-telemedicine-covid-19-pandemic-response">telehealth holds promise</a>, it’s not ideal for people without access to technology. And <a href="https://www.wfyi.org/news/articles/public-health-agencies-struggle-to-find-covid-19-resources">social service providers</a> do not have adequate staff, technology or finances. Consequently, they lack the capacity to plan for care during this unprecedented crises – because they are always operating in crisis mode. </p>
<p>The inability to plan, coupled with <a href="https://qz.com/1848836/funding-public-health-schools-could-help-us-covid-19-response/">disinvestment in a robust public health</a> and social safety net infrastructure, magnify health disparities. These shortfalls remind us that the structural and social health determinants for vulnerable populations need to be addressed. To not do so suggests that the value of life is not equally distributed.</p>
<p>[<em>You need to understand the coronavirus pandemic, and we can help.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-help">Read The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/137455/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephanie Hartwell received funding from NIH 2012-2014 to study prisoner reentry.
</span></em></p><p class="fine-print"><em><span>Sheryl Kubiak receives funding from Michigan Department of Health and Human Services; Foundations, SAMHSA. </span></em></p><p class="fine-print"><em><span>Ijeoma Nnodim Opara does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Amid the COVID-19 pandemic, missteps in transitioning the incarcerated back to their communities places this already vulnerable populace at greater risk of getting and transmitting the virus.Stephanie Hartwell, Dean of the College of Liberal Arts and Sciences, Professor of Sociology and Adjunct Professor of Psychiatry, Wayne State UniversityIjeoma Nnodim Opara, Assistant Professor of Internal Medicine and Pediatrics, Wayne State UniversitySheryl Kubiak, Dean and Professor of Social Work, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1096212019-01-23T11:48:08Z2019-01-23T11:48:08ZWhy it’s wrong to label students ‘at-risk’<figure><img src="https://images.theconversation.com/files/254420/original/file-20190117-32807-1skekoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The term "at-risk" is frequently used to describe students from challenging circumstances. Some educators are working to change that.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-people-education-group-hispanic-students-583892335?src=ATrTAJnT0I6cVrwmvHbO2g-8-27">Diego Cervo/www.shutterstock.com</a></span></figcaption></figure><p>Of all the terms used to describe students who don’t perform well in traditional educational settings, <a href="https://eric.ed.gov/?id=ED493702">few are used as frequently</a>– or as casually – as the term “at-risk.”</p>
<p>The term is regularly used in <a href="https://nces.ed.gov/pubs92/92042.pdf">federal</a> and <a href="https://www.kob.com/new-mexico-news/lawmakers-plan-to-provide-a-better-education-for-at-risk-students/5214101/">state</a> education policy discussions, as well as <a href="https://abcnews.go.com/beta-story-container/US/lebron-james-opening-school-risk-kids-culmination-decade/story?id=56913186">popular news articles</a> and <a href="https://www.apa.org/monitor/2012/02/at-risk-students.aspx">specialty trade journals</a>. It is <a href="https://www.childtrends.org/wp-content/uploads/2006/01/DefiningAtRisk1.pdf">often applied to large groups</a> of students with little regard for the <a href="https://www.nwp.org/cs/public/print/resource/2513">stigmatizing effect</a> that it can have on students.</p>
<p>As education researcher <a href="https://naeducation.org/our-members/gloria-ladson-billings/">Gloria Ladson-Billings</a> <a href="https://www.nwp.org/cs/public/print/resource/2513">once said of the term “at-risk,”</a> “We cannot saddle these babies at kindergarten with this label and expect them to proudly wear it for the next 13 years, and think, ‘Well, gee, I don’t know why they aren’t doing good.’” </p>
<p>My most recent encounter with the term “at-risk” came when I was tapped to review and <a href="http://dls.maryland.gov/pubs/prod/NoPblTabMtg/CmsnInnovEduc/2018_12_06_ToldsonFinalRecommendations2.pdf">critique</a> a draft report for the Maryland Commission on Innovation and Excellence in Education, also known as the “<a href="http://dls.maryland.gov/policy-areas/commission-on-innovation-and-excellence-in-education">Kirwan Commission</a>.”</p>
<p>The Kirwan Commission, chaired by <a href="https://www.agb.org/bios/william-e-kirwan">William E. Kirwan</a>, a longtime higher education leader, was <a href="http://mgaleg.maryland.gov/2016RS/chapters_noln/Ch_702_hb0999T.pdf">created in 2016</a> to make recommendations for improving education in Maryland. The initial draft of the Kirwan Commission report included a working group report called, “More Resources for At-risk Students.”</p>
<p>Fortunately, in this instance, commission members were aware of some common objections to using “at-risk” to categorize students and <a href="https://www.aclu-md.org/en/press-releases/race-equity-expert-delivers-highly-anticipated-second-address-kirwan-commission-what">publicly discussed</a> the <a href="https://www.edglossary.org/at-risk/">limitations</a> of using the term. Some of those objections included risk of social stigma to students and <a href="http://www2.ncte.org/blog/2017/02/redefining-risk-new-times-call-new-ground-rules/">lack of a uniform definition</a> of “at-risk.”</p>
<p>However, when it came to finding a better way to describe students who show lower levels of academic success because of nonacademic factors, such as poverty, trauma and lack of English proficiency, commission members were not sure what term to use.</p>
<p>As an <a href="http://www.qem.org/presidentbio/">outside consultant</a> for the commission, I was asked to come up with an acceptable alternative word or phrase. As I argue in my forthcoming book, “<a href="https://brill.com/view/title/54716">No BS (Bad Stats): Black People Need People Who Believe in Black People Enough Not to Believe Every Bad Thing They Hear about Black People</a>,” three things are essential to good decision making in education: good data, thoughtful analysis and compassionate understanding. What I have to say about the term “at-risk” will be based on those three things.</p>
<h2>Practical uses exist</h2>
<p>First, let’s acknowledge that, paired with good data, “<a href="https://journals.sagepub.com/doi/abs/10.3102/01623737015004380?fbclid=IwAR0hGmYiFL93HcnHT2SUCfCYcDBQvR_ZmqfuahwFO_TnIY3dIhx4uvqWiac">at-risk</a>” is practically useful and generally accepted in professional and academic settings. Used <a href="https://www.jstor.org/stable/25608745?seq=1#page_scan_tab_contents">effectively</a>, identifying risk and protective factors can help mitigate harm to students.</p>
<p>For example, dating back to the 1960s, research about how <a href="http://pediatrics.aappublications.org/content/90/6/855.short">exposure to lead</a> placed children at risk for cognitive impairments helped educators create <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240871/pdf/ehp0110-000563.pdf">safer learning environments</a> for students by removing lead from paint, toys and drinking water.</p>
<p>Today, in educational <a href="https://www.emeraldinsight.com/doi/abs/10.1108/S1479-3644(2009)0000007009">research</a> and <a href="https://www.fdschools.org/departments/student-services/at-risk-programs">practice</a>, educators <a href="https://eric.ed.gov/?id=ED493702">routinely use “at-risk”</a> to classify students who do not perform well in traditional educational settings. However, the factors that determine “at-risk” are often either unknown or beyond the control of the student, caregiver or educational provider.</p>
<p>As a scholar of counseling psychology – and as one who specializes in <a href="https://books.google.com/books?hl=en&lr=&id=i9M5DQAAQBAJ&oi=fnd&pg=PA143&dq=Ivory+Toldson+counseling+psychology&ots=mwAv76j3Ea&sig=MBU-X3J5lMJkQKaVyz-LuvWdFvE#v=onepage&q=Ivory%20Toldson%20counseling%20psychology&f=false">counseling persons of black African ancestry</a> – I believe that to designate a child “at-risk” for factors such as growing up in a single-parent household, having a history of abuse or neglect, or how much money their families make or their race or ethnicity – adds more chaos and confusion to the situation. Instead, compassion and care are what are needed.</p>
<h2>Never use ‘at-risk’ as an adjective</h2>
<p>Using “at-risk” as an adjective for students is problematic. It makes “at-risk” a category like honors student, student athlete or college-bound student. “Risk” should describe a condition or situation, not a person. Therefore, “More Resources for At-risk Students” might more appropriately be “More Resources to Reduce Risk Factors for Students.”</p>
<h2>Be specific</h2>
<p>Assessments of risk should be based on good data and thoughtful analysis – not a catch-all phrase to describe a cluster of ill-defined conditions or characteristics. If the phrase “at-risk” must be used, it should be in a sentence such as: “‘This’ places students at risk for ‘that.’” If the “this” and “that” are not clearly defined, the “at-risk” characterization is useless at best, and harmful at worst. But when these variables are clearly defined, it better enables educators and others to come up with the solutions needed to reduce specific risk factors and improve outcomes.</p>
<h2>Skip the alternatives</h2>
<p>Common alternatives to “at-risk” include “historically underserved,” “disenfranchised” and “placed at-risk.” These indicators acknowledge that outside forces have either not served the individual student or population well, or have assigned the at-risk label to unwitting subjects.</p>
<p>These phrases move the conversation in the right direction. However, using these phrases still comes up short because they obscure the problem. For example, research suggests that <a href="https://www.tandfonline.com/doi/abs/10.1080/10509674.2010.519666">child abuse</a>, <a href="https://www.tandfonline.com/doi/abs/10.1080/10911359.2013.747407">poverty</a> and <a href="https://www.jstor.org/stable/25608729?seq=1#page_scan_tab_contents">racism</a> can place students at risk. However, different strategies can lessen each risk. When the risk factors are more clearly identified, it puts educators and others in a better position to strategically confront the issues that impede student learning. It also better enables educators and others to view the individual student separately and apart from the particular risk.</p>
<p>Some have suggested replacing the term “at-risk” with “<a href="https://books.google.com/books?hl=en&lr=&id=fQX2czepcW8C&oi=fnd&pg=PR9&dq=%22at-risk%22+%22at-promise%22&ots=yLkU8c1_8q&sig=Jf5h6Ya_p9gIh-p7n0RP7OmRNlM#v=onepage&q=%22at-risk%22%20%22at-promise%22&f=false">at-promise</a>.” While well-intended, the problem I see with that is it could easily be seen as a condescending euphemism for the term it was meant to replace.</p>
<h2>The best alternative for ‘at-risk’</h2>
<p>In my book, I describe an in-service training for staff members of a public high school, in which I asked the participants to describe the neighborhoods of their students. I heard phrases like “crime-ridden,” “broken homes” and “drug-infested.” I then asked if anyone grew up in neighborhoods that had similar characteristics. After several raised their hands, I asked, “How did you grow up in such a neighborhood and still become successful?” This question spurred a more meaningful discussion about the neighborhoods where students are from. It was a discussion that considered community assets – such as hope and resilience – against a more thoughtful examination of community challenges.</p>
<p>Every student has a combination of risk and protective factors among their friends, in their homes, schools and neighborhoods. These factors can help or hurt their academic potential. Students who live in poverty, or have been assigned to special education, or have a history of trauma, or who are English learners, may or may not be “at risk” depending on their respective protective factors. But when students are labeled “at-risk,” it serves to treat them as a problem because of their risk factors. Instead, students’ unique experiences and perspectives should be normalized, not marginalized. This reduces a problem known as <a href="https://www.edglossary.org/stereotype-threat/">“stereotype threat,”</a> a phenomenon in which students perform worse academically when they are worried about living up to a negative stereotype about their group.</p>
<p>For all these reasons and more, I believe the best alternative to describe “at-risk students” is simply “students.” For what it’s worth, the Kirwan Commission agrees. The commission recently <a href="http://dls.maryland.gov/pubs/prod/NoPblTabMtg/CmsnInnovEduc/2019_01_18_PolicyArea4.pdf?fbclid=IwAR2rCDkWkBSdXnbfQely6FiUiUoGU2aupfmXrxPVm360veL_VVceEa4KBXc">revised its call</a> for “More Resources for At-risk Students” to “More Resources to Ensure All Students are Successful.”</p><img src="https://counter.theconversation.com/content/109621/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ivory A. Toldson is affiliated with Howard University and The QEM Network. </span></em></p>Using the term ‘at-risk’ to describe students from challenging circumstances often creates more problems than it solves, a professor of counseling psychology argues.Ivory A. Toldson, Professor of Counseling Psychology, Howard UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1040982018-10-01T10:37:37Z2018-10-01T10:37:37ZWe provided psychological first aid after the Las Vegas shooting – here’s what we learned<figure><img src="https://images.theconversation.com/files/238505/original/file-20180928-48631-1uj3rr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Evacuees arrive at the UNLV Thomas & Mack Center after a gunman opened fire Oct. 1, 2017 in Las Vegas.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Las-Vegas-Shooting/5a1657648bdc48d3a5ffe6a8f939f72f/2/0">Al Powers/AP</a></span></figcaption></figure><p><em>Editors’ note: In the aftermath of the Oct. 1, 2017 <a href="https://www.usatoday.com/story/news/nation/2017/10/06/here-all-victims-las-vegas-shooting/733236001/">shooting massacre</a> that claimed the lives of 58 people, several psychology and counseling scholars at the University of Nevada, Las Vegas sprang into action to offer trauma counseling to victims and witnesses of the <a href="https://www.cnn.com/2013/09/16/us/20-deadliest-mass-shootings-in-u-s-history-fast-facts/index.html">deadliest mass shooting</a> in recent U.S. history. The UNLV scholars helped provide aid and comfort to <a href="https://www.unlv.edu/news/article/hundreds-gather-campus-candlelight-vigil">hundreds of evacuees</a>, mostly noninjured, who were driven by bus from the strip to the UNLV Thomas & Mack Center soon after the shooting. The Conversation recently connected with those scholars to hear what they learned from the experience.</em></p>
<p><strong>What is “psychological first aid”? How do mental health experts like you work side by side with traditional first responders?</strong></p>
<p>The goal of <a href="https://www.nctsn.org/resources/psychological-first-aid-pfa-field-operations-guide-2nd-edition">psychological first aid</a> is to sooth, assist and help people function and cope in a healthy way in the wake of a traumatic event. </p>
<p>It’s employed in the hours and days following the event, when people’s immediate needs, including medical care, as well as basic needs like food, shelter and water, must be met, along with their psychological and physical safety needs.</p>
<p>The point is not to push people to express emotion or describe in detail what they experienced. Rather, mental health professionals can help first responders by offering survivors practical assistance, comfort, safety, good compassionate company and emotional support.</p>
<p>For example, in the hours following the Oct. 1 mass shooting in Las Vegas, nonwounded victims and evacuees from the Strip needed basic things: blankets to cut the chill of the evening hours and psychological shock, cellphone chargers so they could stay in touch with loved ones, rides home and reliable news updates to reduce chaos and control rumors. By helping provide these simple needs, our team of mental health professionals was able to free up first responders and law enforcement to do their jobs.</p>
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<span class="caption">Police run toward the scene of the Oct. 1, 2017 shooting near the Mandalay Bay resort and casino on the Las Vegas Strip in Las Vegas.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Las-Vegas-Shooting/712f54b9ef2548d1aaf427b517783224/46/0">John Locher/AP</a></span>
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<p><strong>What tools and treatments can mental health clinicians offer in the wake of this kind of almost unimaginable tragedy?</strong></p>
<p>In the immediate aftermath of the shooting, people needed to know how this stressful event would affect them. For example, potential effects may have included trouble sleeping, increased nervousness or feeling easily upset or agitated.</p>
<p>People also needed guidance to pursue healthy coping strategies. They needed to know where to find support services then and in the future, as well as information regarding the signs that someone might need a higher level of professional care. Such signs include persistent anxiety.</p>
<p>Unfortunately, we heard from victims who were initially given ill-informed treatment by poorly trained providers. Some were “debriefed” in a group setting for hours, encouraged to share their stories and describe the trauma in detail. As psychology and counseling researchers, we know this <a href="https://www.ptsd.va.gov/professional/trauma/disaster-terrorism/debriefing-after-disasters.asp">outdated treatment approach</a> is harmful and can retraumatize people who are already vulnerable and hypersensitive.</p>
<p>In the days, weeks and months after an event like this shooting, people are often hyperaroused – that is, in a ramped-up jittery state – and hypervigilant – that is, overly aware and reactive to everything in their environment. They’re expecting danger and feeling unsafe, fearful, angry or distressed. Others may keep thinking about the traumatic event. Memories of the event can intrude on their day. They may have difficulty sleeping because the memories keep running through their mind. Or they may have nightmares. Others may experience emotional numbing or avoidance.</p>
<p>We helped victims build resilience skills such as problem-solving and engaging in positive activities, like spending quality time with loved ones and participating in activities that they enjoy. We educated people on how to manage emotional and physical reactions through things such as breathing exercises or identifying and planning for triggers. Mental health professionals also promote helpful thinking and identify opportunities for establishing a sense of community and belonging. Perhaps more importantly, professionals trained in psychological first aid are prepared to identify and assist those who won’t recover on their own.</p>
<p>When the skills-building approach isn’t enough, mental health professionals know how to identify those who will need a higher level of care.</p>
<p><strong>What did you learn in the heat of disaster response that’s applicable now a year later and on into the future in terms of mental health?</strong></p>
<p>Different people need different things. Some of the people we worked with following the Oct. 1 shooting needed to talk. Some needed to sit quietly. Some needed to get busy and find something to do to feel helpful. Some needed to take a day to themselves. There are typical human stress responses to an abnormal event, but there is no one prescribed journey toward healing.</p>
<p>We also know that people are naturally wired to <a href="https://www.psychologytoday.com/us/blog/in-the-name-love/201403/why-we-all-need-belong-someone">need a sense of belonging and human connection</a>. And, in this sense, personal and community healing go hand in hand. One cannot exist without the other.</p><img src="https://counter.theconversation.com/content/104098/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Paul is the Director of The PRACTICE: A UNLV Community Mental Health Training Clinic, housed on and sponsored by the University of Nevada, Las Vegas.</span></em></p><p class="fine-print"><em><span>Heather Dahl, John A. Nixon, and Noelle Lefforge do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>One year after the Oct. 1 shooting massacre in Las Vegas, a team of scholars from the University of Nevada, Las Vegas offers insights into how to best help those affected by the violence.Michelle Paul, Associate Faculty-in-Residence in Psychology, University of Nevada, Las VegasHeather Dahl, Assistant Professor, Dept. of Counselor Education, School Psychology, and Human Services, University of Nevada, Las VegasJohn A. Nixon, Assistant Professor-in-Residence of Counselor Education and Assistant Director of Clinical Services, The PRACTICE, University of Nevada, Las VegasNoelle Lefforge, Assistant Professor-in-Residence in Psychology and Assistant Director of Clinical Services and Research at The PRACTICE, University of Nevada, Las VegasLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/922472018-03-01T11:41:02Z2018-03-01T11:41:02ZSchools shouldn’t wait for red flags to address student mental health needs<figure><img src="https://images.theconversation.com/files/207908/original/file-20180226-120971-6yhnkf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Students who need mental health services rarely receive them.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-little-boy-being-bullied-school-793798384?src=bZz2xbyPo-XeNZnVrgqQnQ-1-31">Africa Studio/Shutterstock.com</a></span></figcaption></figure><p>One out of every 4 or 5. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2946114/?_escaped_fragment_=po=2.63158">That’s how many students</a> will display a significant mental health problem over the course of their lifetime.</p>
<p>Such students can be identified early with considerable accuracy if educators are given the right training and tools. Unfortunately, most schools rely on reactive methods, like office discipline referrals, to figure out which students need behavioral and mental health services.</p>
<p><a href="https://experts.umn.edu/en/publications/comparison-of-measures-to-screen-for-social-emotional-and-behavio">Research</a> shows this approach of waiting until students act out in school is inefficient and leads to as many as 80 percent of those with mental health needs to fall through the cracks. </p>
<p>Such concerns have heightened in the wake of the Parkland high school massacre. News reports indicate the alleged shooter exhibited a number of troubling behaviors, raising questions about his mental health status and whether more could have been done to help him sooner.</p>
<p>To address the issue of students falling through the cracks, more schools should adopt proactive, universal <a href="https://www.researchgate.net/profile/Nathaniel_Von_Der_Embse/publication/285370762_Evaluating_the_Applied_Use_of_a_Mental_Health_Screener_Structural_Validity_of_the_Social_Academic_and_Emotional_Behavior_Risk_Screener/links/5665980608ae15e74634a06e.pdf">screening tools</a>.</p>
<p>Universal screening typically occurs three times throughout the school year: fall, winter and spring. Screeners are brief assessments that take no more than a few minutes to complete. They include approximately 20 questions and are given to each student in the elementary classroom. These tools ask students to indicate things such as “I lose my temper” or whether they are “adaptable to change.” The questions are purposefully broad and are meant to identify students who may be at risk for either internal problem behaviors, such as anxiety or depression, or external problem behaviors, such as aggression toward others. The screenings are scored and used to prioritize which students need intervention.</p>
<p>Screeners are typically administered without parental consent if they are embedded into the general school curriculum. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0022440506001026">Research</a> shows that screening tools can help educators identify students with mental health needs with far greater accuracy and speed, rather than waiting for a severe problem behavior, such as a school fight. </p>
<p>I <a href="http://news.usf.edu/article/templates/?a=8239&z=232">developed</a> one such tool – the Social, Academic and Emotional Behavior Risk Screener, or SAEBRS – with the help of several grants, including <a href="https://ies.ed.gov/funding/grantsearch/details.asp?ID=2071">$1.4 million</a> from the Institute for Educational Sciences in the U.S. Department of Education. </p>
<p>If society is serious about preventing severe mental and behavioral health problems, it must take a critical look at the current state of mental health supports in the nation’s schools. Doing so will bring the value of screening tools into sharper focus.</p>
<h2>School mental health stretched thin</h2>
<p>First, let’s consider the service provider side of the equation. The National Association of School Psychologists <a href="https://www.nasponline.org/standards-and-certification/nasp-practice-model">recommends</a> a ratio of 1 school psychologist for every 500-700 students. However, the reality is that states on average have ratios of nearly <a href="https://www.nasponline.org/Documents/Research%20and%20Policy/Research%20Center/Ratios_by_State_2005_and_2010.pdf">twice that amount</a>. Simply put, <a href="https://link.springer.com/article/10.1007/s12310-016-9184-1">schools rarely have the staff necessary</a> for comprehensive mental health services.</p>
<p>Second, only a small number of students who need mental health services <a href="http://psycnet.apa.org/record/2003-04925-006">will receive intervention in a timely manner</a>. Due to the amount of time that teachers spend with students, teachers are the critical link to identify which students need help and to refer students to school psychologists, counselors and social workers. The question is: Do teachers know what to look for?</p>
<h2>Silent issues overlooked</h2>
<p>Consider a typical elementary classroom with 30 students. Approximately 6 students, on average, will have a critical mental and behavioral health problem such as anxiety or aggression, yet <a href="https://www.ncbi.nlm.nih.gov/pubmed/24233052">less than half</a> will receive timely intervention. Who are those students? Typically those that exhibit more outward types of problems, such as aggression, problems paying attention and disruptive behavior.</p>
<p>Students with harder-to-see issues, such as withdrawal, anxiety and social isolation <a href="https://www.sciencedirect.com/science/article/pii/S002244050600104X">often get overlooked</a> and rarely receive essential services. Teachers often <a href="https://www.tandfonline.com/doi/abs/10.1080/13540602.2011.580525">lack the training</a> or tools necessary to know which students may need help, beyond those that are disruptive to instruction.</p>
<p>These screenings are not part of the process for comprehensive special education evaluations, so the concerns about schools having to offer special education services as a result of the screening do not come into play. </p>
<p>While screening tools can help identify troubled students sooner, it is important not to oversell the usefulness of these tools. To be clear, there are no research-validated tools that can reliably identify which students may commit violent acts.</p>
<h2>Toward universal screening</h2>
<p>Currently, <a href="https://eric.ed.gov/?id=EJ1070185">less than 15 percent</a> of schools engage in some form of behavioral or mental health screening. However, more schools are adopting universal screening. </p>
<p>As the developer of a screening tool, I have seen rapid adoption of the tool over the last four years from two elementary schools in rural North Carolina to <a href="https://www.ncbi.nlm.nih.gov/pubmed/26619092">hundreds of schools</a> across 28 states. As schools consider how best to meet the behavioral and mental health needs of their students, screening can provide crucial information to guide the way.</p><img src="https://counter.theconversation.com/content/92247/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathaniel von der Embse receives funding from the Scattergood Foundation, Institute for Education Sciences, and the National Institute for Justice.</span></em></p>In order to prevent future mental health problems among at-risk students, schools must do a better job of screening for mental health problems earlier.Nathaniel von der Embse, Assistant Professor of School Psychology, University of South FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/923332018-02-27T11:28:33Z2018-02-27T11:28:33ZIf you want to know how to stop school shootings, ask the Secret Service<figure><img src="https://images.theconversation.com/files/207893/original/file-20180226-140200-s1smdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The U.S. Secret Service released a study of school shootings in 2002.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-secret-service-agent-listening-his-172646540?src=AbGHYtpa5xGj_wEp4QmTtw-1-2">David Stuart Productions/Shutterstock.com</a></span></figcaption></figure><p>While President Donald Trump has not shied away from offering suggestions on how to prevent school shootings – including <a href="https://www.cbsnews.com/news/trump-listening-session-florida-school-shooting-students-parents-today-2018-02-21-live-stream/">one controversial idea</a> to arm teachers – what often gets overlooked in the conversation is research on the subject that has already been done.</p>
<p>This research includes <a href="https://www.secretservice.gov/data/protection/ntac/ssi_final_report.pdf">one major study</a> of school shootings conducted in part by the very agency charged with protecting the president of the United States himself - the U.S. Secret Service.</p>
<p>Has this research been ignored or just forgotten? I raise the question as one who has studied averted school shootings and the news coverage that followed.</p>
<p>Two months after the Columbine tragedy in 1999, experts from the U.S. Department of Education and the U.S. Secret Service collaborated to study the “school shooter” phenomenon. They published <a href="https://www.secretservice.gov/data/protection/ntac/ssi_final_report.pdf">the study</a> on their findings in 2002. The study focused on examining the thinking, planning and other behaviors of students who carried out school attacks. Particular attention was given to identifying pre-attack behaviors and communications that might be detectable – or “knowable” – and could help prevent future attacks. </p>
<p>The team studied 37 school shootings involving 41 attackers that took place from December 1974 through May 2000. Data included investigative, school, court and mental health records. In addition, 10 school shooters were interviewed to gain their perspectives from “conceptualization to execution” of the attacks. A series of findings emerged. In light of the Florida school shooting massacre and the fact that the alleged shooter <a href="https://www.rollingstone.com/culture/news/nikolas-cruz-alleged-florida-school-shooter-w516801">drew a lot of attention</a> prior to carrying out the shooting, those findings bear repeating here. </p>
<ol>
<li><p><strong>“Incidents of targeted violence at school rarely were sudden, impulsive acts.”</strong> Most attackers progressed through a process that started with an idea, to a plan, to accessing weapons and ending with the attack. If noticed, this process may be interrupted at any time before the attack.</p></li>
<li><p><strong>“Prior to most incidents, other people knew about the attacker’s idea and/or plan to attack.”</strong> The implication is that schools must develop a culture that promotes student sharing of concerns about others. In studying schools that averted a shooting, I and other researchers <a href="https://scholar.google.com/citations?hl=en&user=s2KaqBMAAAAJ">found</a> that a key factor was establishing trusting relationships with students. We also found that the notion of “snitching” needed to be reframed to being helpful. Unfortunately, it seems that in the case of the Parkland shooting, multiple people did come forward with concerns. The alleged shooter was on several different radars, but unless he was posing an imminent danger to himself or others, he couldn’t be jailed or forced to receive psychological services. It therefore becomes an issue of individual versus collective rights. Unless we are ready as a society to lock people up for disturbing communications, there will be some individuals who will fall through the proverbial cracks.</p></li>
<li><p>Along similar lines, <strong>most attackers “engaged in some behavior prior to the incident that caused others concern or indicated a need for help.”</strong> Some of these behaviors included talking about bringing a gun to school, or warning friends to avoid a certain area of the school on a given day. The Parkland shooter had a history of violent and aggressive behavior, including Instagram posts about becoming a “<a href="https://www.cnn.com/2018/02/25/us/nikolas-cruz-warning-signs/index.html">professional school shooter</a>.” </p></li>
<li><p>While most attackers – 96 percent – were male, the report found that <strong>there “is no accurate or useful ‘profile’ of students who engaged in targeted school violence.”</strong> Three-quarters of the attackers were white; one-quarter of the attackers came from other racial and ethnic backgrounds, including African-American (12 percent), Hispanic (5 percent), Native Alaskan (2 percent), Native American (2 percent) and Asian (2 percent). Most came from intact families, were doing well in school and were not loners, according to the report.</p></li>
<li><p><strong>“Most attackers had difficulty coping with significant losses or personal failures. Moreover, many had considered or attempted suicide.”</strong> Knowing the students and what they are dealing with in their lives, such as parental divorce, ending of a relationship or other failures is important for getting help in a timely manner. The Parkland shooter’s adoptive mother died of pneumonia just three months prior to his <a href="https://nypost.com/2018/02/15/moms-flu-death-may-have-sent-florida-massacre-suspect-over-the-edge/">deadly attack</a>. And at age 5, he also <a href="https://nypost.com/2018/02/25/accused-florida-school-killer-watched-his-father-die/">witnessed his father die</a> of a heart attack. </p></li>
<li><p><strong>“Many attackers felt bullied, persecuted or injured by others prior to the attack.”</strong> Almost two-thirds reported being targeted by others prior to the attack, with some claiming to have withstood severe bullying for a long time. There is evidence that Nikolas Cruz was often mocked for his <a href="http://www.miamiherald.com/news/local/community/broward/article200754714.html">odd behavior.</a></p></li>
</ol>
<p>Following the publication of the Secret Service study on school shootings, <a href="http://journals.sagepub.com/doi/abs/10.1177/0011000009344774">my research on averted school shootings</a> found that schools that prevented a shooting had done some of the things recommended by the Secret Service.</p>
<p>The case in Florida shows that many of these recommendations were followed and people spoke up when they saw something wrong. The issue is whether authorities need more power to intervene once they have been made aware of a potential threat, or whether they just need to do a better job with the power they already have.</p><img src="https://counter.theconversation.com/content/92333/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeff Daniels does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As the nation searches for ways to prevent the next school shooting, one scholar says answers can be found in a forgotten study the Secret Service did after the Columbine massacre.Jeff Daniels, Professor of Counseling, West Virginia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/906122018-02-23T11:42:21Z2018-02-23T11:42:21ZA former prosecutor reimagines how the criminal justice system can serve victims of domestic violence<figure><img src="https://images.theconversation.com/files/207577/original/file-20180222-152357-2wxdve.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Victims of domestic violence may not get the services they need.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-psychologist-feeling-hopeless-depressed-619742600">Shutterstock</a></span></figcaption></figure><p>For nearly a decade, I believed I was helping improve victims’ lives by prosecuting people who committed domestic violence in Seattle, Washington.</p>
<p>I aimed to advance the goals of the criminal justice system: Stop the violence, hold the defendant accountable and enhance the survivor’s safety. </p>
<p>Then, in 1996, I met a woman whose case would eventually shatter my view of what prosecution means for domestic violence victims. I’ll call her Marina, a pseudonym to protect her identity.</p>
<p>Over the past several years, I have spent hours reconnecting with Marina and a few other victims from the cases I prosecuted. I wanted to learn from victims how to reform the criminal justice system to better serve them.</p>
<p>Here’s what I learned.</p>
<h2>The case that changed everything</h2>
<p>Like many victims I met, Marina suffered gruesome violence at the hands of her boyfriend. Marina testified at trial that her boyfriend tried to rip out her tongue and that she believed his threats to kill her and her 10-year-old daughter. The jury agreed and convicted him.</p>
<p>At sentencing, I asked for prison time. Marina told the judge that she still loved her boyfriend, he was a good dad, and the violence was her fault. She begged that he not be incarcerated. The judge sentenced her boyfriend to five years and prohibited him from any contact with Marina or her daughter. To me, the prosecution was a complete success. Marina viewed it differently. Furious, she screamed at me, saying I had ruined her life.</p>
<p>Believing I was doing good, I brushed off Marina’s accusation. Later, it haunted me. Had I ruined her life, or had I helped her? I did not know because I did not see Marina again after sentencing. Twenty years later, I sat down with her and later with her daughter.</p>
<p>Today, Marina is afraid and alone. She is still dealing with her trauma and still hiding from her boyfriend who has since been released. She shuns intimate relationships for fear of more violence. Her daughter, now 31, lives in another state with two small children and has no contact with Marina. She has been in many abusive relationships, became addicted to meth and has tried to kill herself. Marina and her daughter are both alive, but the prosecution hardly looks like a success to me now.</p>
<h2>Dumped by the system</h2>
<p>Talking to Marina led me to contact a handful of other victims, and several themes emerged from those conversations.</p>
<p>Yes, I had done my job: Often the violence stopped and the victims survived. However, for all of these victims, trauma – not love – endured. Worse yet, every victim felt abandoned by the prosecution and left to manage that trauma on their own. For example, one victim told me she felt “dumped” after the trial.</p>
<p>Across the country, domestic violence survivors have access to a <a href="https://vawnet.org/sites/default/files/materials/files/2016-08/MeetingSurvivorsNeeds-FullReport.pdf">wide variety of services</a>. The majority of the victims I spoke with accessed services after the prosecution and felt those services helped them. Marina, for example, found temporary housing for her and her daughter through a domestic violence organization. Other victims got counseling or mental health medications. </p>
<p>Unfortunately, these services are provided by a network of <a href="https://nnedv.org/content/domestic-violence-counts-11th-annual-census-report/">underfunded nonprofit organizations</a> that the victim <a href="https://vawnet.org/material/difference-between-surviving-and-not-surviving-public-benefits-programs-and-domestic-and">needs help to navigate</a>. Meanwhile, courts only have control over defendants – they cannot order victims into treatment. That means current criminal justice reform efforts focus primarily on <a href="https://www.clasp.org/sites/default/files/public/resources-and-publications/publication-1/2016.10.27_fromincarcerationtoreentry.pdf">improving services for defendants</a>. </p>
<p>The victims I spoke with were only able to access a portion of the services they needed and only through their own initiative. Often crucial needs, such as civil legal assistance, went unmet. Helping victims recover after the trial was never part of my job as a prosecutor. After each trial, I immediately moved on to the next case, the next defendant and the next victim. </p>
<p>Marina, and all the victims I talked to, told me that what they wanted but did not get was an ongoing relationship with the prosecution to help them heal.</p>
<h2>Another way</h2>
<p>Another victim I interviewed, someone I’ll call Steve to protect his identity, showed me how things might change.</p>
<p>Steve was one of my more challenging cases. Steve’s boyfriend smashed Steve’s head with a bottle. Several months later, he slit Steve’s throat. Even though Steve nearly died, he tried everything to avoid testifying, including committing himself to the psych ward during the trial – in response to his boyfriend’s manipulative mix of threats and expressions of love.</p>
<p>When his evasion efforts failed, Steve testified that he had cut his own throat. Fortunately, the jury saw through Steve’s ruse and convicted his boyfriend. I wasn’t sure Steve – who as a disabled alcoholic with AIDS, left homeless after his boyfriend’s violence caused his eviction – would have survived the years between his court appearance and when I tracked him down for an interview. Instead, I learned Steve’s AIDS actually saved him.</p>
<p>When he sought treatment for his condition after the trial, the AIDS clinic assigned Steve a doctor and a social worker who identified his needs. Over the next 15 years, they helped him with meals, medication, counseling, job training, substance abuse treatment, housing assistance and finding community. This <a href="https://www.doh.wa.gov/portals/1/Documents/Pubs/430-023-StatewideStandardsHIVMedicalCaseManagement.pdf">case management approach</a> is considered best practice response to the AIDS epidemic and is <a href="https://hab.hrsa.gov/about-ryan-white-hivaids-program/about-ryan-white-hivaids-program">largely funded by the government</a>. These are precisely the resources every domestic violence survivor deserves.</p>
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<p>Prosecution and victim services should consider a case management model for victims after trial in which each victim would be assigned to a team. The team would include a prosecutor, victim advocate and social worker to assess needs and coordinate services. This could fulfill victims’ desire for continued contact with the prosecution and help victims recover from the trauma. Today, <a href="https://www.familyjusticecenter.org/about-us/history/">family justice centers</a> are a step in this direction by locating a variety of service providers in a single location. What they are lacking is connecting victims with a specific team of individuals who are responsible for their care during and after their criminal case concludes.</p>
<p>This model will also have another benefit. Prosecutors must consider what happens after the gavel drops, not just for victims of domestic violence, but for their own sake.</p>
<p>Through this process, I discovered that <a href="https://www.researchgate.net/publication/223981411_The_Effect_of_Attorneys'_Work_With_Trauma-Exposed_Clients_on_PTSD_Symptoms_Depression_and_Functional_Impairment_A_Cross-Lagged_Longitudinal_Study">I too carried</a> the victims’ trauma. Because I had no contact with victims post-trial, they remained forever ingrained in my memory as they were in the courtroom. Reconnecting with the victims and learning about their lives after the prosecutions allowed me to relinquish some of their trauma. It helped me heal as well.</p><img src="https://counter.theconversation.com/content/90612/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew King-Ries was a deputy prosecuting attorney with the King County Prosecutor's Office in Seattle, Washington. He is a member of the ABA Commission on Domestic and Sexual Violence.</span></em></p>Years after their trials, he got in touch with the victims he thought he had helped. They described feeling ‘dumped’ by the system.Andrew King-Ries, Professor of Criminal Law, University of MontanaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/889252018-01-04T23:21:20Z2018-01-04T23:21:20ZThe hidden homelessness among America’s high school students<figure><img src="https://images.theconversation.com/files/200852/original/file-20180104-26139-11q3q4p.jpg?ixlib=rb-1.1.0&rect=232%2C0%2C2391%2C1288&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In 2016, James Edwards, right, poses with fellow residents at the Plymouth Crossroads youth homeless residence in Lancaster, N.Y., as he prepares to leave for college. Edwards finished high school while homeless. </span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Back-to-School-Homeless-Students/58bbbcdc20464d39bc84abecc54e04ae/5/0">AP/Carolyn Thompson</a></span></figcaption></figure><p>One in 30.</p>
<p>That’s what a <a href="http://voicesofyouthcount.org/wp-content/uploads/2017/11/ChapinHall_VoYC_NationalReport_Final.pdf">new first-of-its-kind study</a> found was the number of students ages 13 to 17 who have experienced homelessness in the past year. The figure represents about 700,000 young people nationwide.</p>
<p>When a student is homeless in high school, it can cause high levels of stress and anxiety. While other students are able to focus on getting good grades and planning for college, students who are homeless often worry about basic necessities, such as food, clothing and shelter.</p>
<p>In order to turn things around and help homeless students succeed and have a decent shot at college, school counselors should be seen as our first line of support. I say that based on years of experience as a researcher who has focused on the <a href="https://link.springer.com/article/10.1007%2Fs11162-013-9297-4">critical role</a> that school counselors play in helping low-income and first-generation college students make it to college.</p>
<p>Unfortunately, what I have found through <a href="http://professionalschoolcounseling.org/doi/abs/10.5330/1096-2409-21.1.47?code=asca-site">my research</a> is that school counselors often feel helpless despite their desire to help students who are experiencing homelessness. They also feel underprepared to support the needs of such students. With increased preparation and knowledge on homelessness, school counselors would be in a much better position to help homeless students succeed.</p>
<p>School counselors may meet homeless students’ basic needs by collecting school supplies, clothing or food items for students in need. This can be done by coordinating community or school donation programs, collecting monetary donations from the community, or applying for grants through the Department of Education. They may also identify resources in the community and collaborate with stakeholders, such as social workers and teachers to form a supportive system. But <a href="http://tpcjournal.nbcc.org/wp-content/uploads/2015/03/Pages%20200%E2%80%93216.pdf">my research</a> has found that school counselors often lack knowledge about students who are homeless, and have limited training to support their needs. This in turn puts the educational future of students experiencing homelessness in jeopardy.</p>
<p>One of the reasons homeless students can be difficult to identify is because homelessness is often thought of as individuals living on the street or in a shelter. The reality is that homelessness can also take many other forms. In fact, the federal definition of homelessness includes those who lack a “<a href="https://www2.ed.gov/policy/elsec/leg/esea02/pg116.html">fixed, regular, and adequate nighttime residence</a>.” This includes individuals and families who are living with others due to a loss of housing, often referred to as “doubling up.” Those living in shelters or locations such as motels, hotels, trailer parks or campgrounds because they lack other consistent housing options may also be considered homeless. Individuals who are under 18 and living without a parent or guardian and lack consistent housing are considered “unaccompanied homeless youth.” Through having a clear understanding of the various definitions, school counselors can identify students experiencing homelessness quickly and educate others so that if there is a housing loss, students can be provided with the supports they need. </p>
<h2>Counselor contact is critical</h2>
<p><a href="https://doi.org/10.1007/s11162-013-9297-4">Research indicates</a> that students from low-income backgrounds are more likely to go to college after they graduate when they have a series of contacts with their school counselors, as opposed to seeing their counselor only once. Unfortunately, <a href="https://doi.org/10.5330/1096-2409-21.1.47">my work suggests</a> that school counselors are often forced to focus on meeting homeless students’ basic needs. This leads counselors to offer homeless students the kind of <a href="https://doi.org/10.1177/0002764206289140">general college support</a> that they would give all students. Consequently, many counselors may neglect the highly specialized college planning needs of students who are homeless. Further, <a href="https://secure-media.collegeboard.org/digitalServices/pdf/nosca/true-north.pdf">one report</a> suggests that although school counselors are in a position to positively impact students’ career and college readiness, they need more extensive graduate and in-service training on college and career counseling.</p>
<p>Generally speaking, students who are homeless face emotional distress in the form of <a href="https://doi.org/10.1023/B:JOYO.0000032641.82942.22">anxiety or low self-esteem</a> and lower <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3566371/">academic</a> achievement. School can be a place of <a href="https://nche.ed.gov/downloads/briefs/introduction.pdf">consistency</a> that can support their postsecondary planning, but only if schools are mindful of the unique needs of high school students experiencing homelessness. Schools must provide individualized support that focuses on enhancing students’ expectations of <a href="https://nche.ed.gov/downloads/res-summ-sch-couns.pdf">college attendance and their belief in their ability to attend</a>.</p>
<p>When they are identified, students experiencing homelessness can be supported through the <a href="https://www2.ed.gov/policy/elsec/leg/esea02/pg116.html">McKinney-Vento Homeless Assistance Act</a>. The federal law includes provisions meant to remove barriers, such as by providing transportation for students who move out of a district because they became homeless. It also allows for quick enrollment for students experiencing homelessness regardless of the required paperwork, and funding for programming such as academic support or afterschool programs. It also allows for a local liaison to ensure students are identified and receiving supports they need. Further, when McKinney-Vento was recently revised under the Every Student Succeeds Act, it <a href="https://nche.ed.gov/legis/essa.php">specifically stated</a> that school counselors and local liaisons must provide “individualized” college support for students who are homeless. But ultimately, the federal law by itself won’t do anything to help students experiencing homelessness. It’s all about how well the law is executed at the school level.</p>
<h2>Information is crucial</h2>
<p>Schools should also include information about McKinney-Vento and college planning that would be directly beneficial to homeless youth on their websites. Unfortunately, <a href="https://doi.org/10.5330/prsc.18.1.8015445n7034xr36">few schools are doing so</a>.</p>
<p>Schools can also develop systems of support in the community to support homeless students’ basic needs. This will allow them more time to focus on other things, such as college planning.</p>
<p>When advising about college, counselors must determine things such as whether students need campus housing during breaks, if the school has affordable meal plans and if the university has support systems in place for additional counseling, advising, mentoring or tutoring. Directing students to apply to universities that are a good fit will help them to be more successful.</p>
<p>With intentional planning, schools can be a resource for students experiencing homelessness that helps them to stay on track, graduate and go on to college. But if we continue to neglect the specific needs of homeless students, we run the risk of consigning them to lives of uncertainty and placing their college dreams further out of reach.</p><img src="https://counter.theconversation.com/content/88925/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stacey Havlik does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Roughly 700,000 students ages 13 to 17 have experienced homelessness in the last year. An education researcher says the obstacles that these students face can threaten their college dreams.Stacey Havlik, Assistant Professor of Education and Counseling, Villanova UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/750892017-06-15T14:43:40Z2017-06-15T14:43:40ZAre Africa’s ‘men of God’ preserving injustices against women?<figure><img src="https://images.theconversation.com/files/171335/original/file-20170529-25241-h7rpbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Churches in the global South, especially Africa are growing. </span> <span class="attribution"><span class="source">Reuters/Akintunde Akinleye</span></span></figcaption></figure><p>Adoley and her husband Mike (not their real names) attend one of Ghana’s <a href="https://yen.com.gh/65552-race-heaven-largest-churches-ghana-photos.html">mega churches</a>. Both are university graduates. She is a seamstress and owns a small retail shop. He is an accountant. The couple live with Mike’s family, where Adoley sometimes feels she’s blamed for the couple’s childlessness after having three miscarriages.</p>
<p>When they visited our home in Accra one Sunday in December 2015, Adoley complained about a few things, such as Mike refusing to carry her handbag in church while she went to the bathroom, because – as he explained – “a man doesn’t carry a woman’s bag”.</p>
<p>This anecdote points to a bigger story about the church in Africa today, and the messages that some of its influential male leaders promote about masculinity, marriage and gender roles in society more broadly.</p>
<h2>“Men of God” are powerful</h2>
<p>While churches in the economic north are <a href="http://www.bbc.com/news/world-33256561">emptying out</a> those in the Global South – and especially Africa – are <a href="http://magazine.pewtrusts.org/en/archive/trend-summer-2016/how-africa-is-changing-faith-around-the-world">growing</a>. Pentecostal and charismatic churches have mushroomed, many influenced by a wave of American-exported evangelicalism in the 1970s and 1980s.</p>
<p>Churches also carry out important <a href="https://cruxnow.com/africaund/2017/03/24/cardinal-says-african-church-substitutes-failed-states/">social functions</a> the state has neglected. They are involved in addressing <a href="https://link.springer.com/article/10.1007%2Fs10624-004-3589-1?LI=true">HIV/AIDS</a>, <a href="http://www.cihablog.com/the-gospel-of-public-image-in-ghana/">building hospitals</a> and <a href="https://ejournals.bc.edu/ojs/index.php/ihe/article/view/9692">establishing universities</a>. This kind of work – sometimes called the “social gospel” – makes the church much more than simply a religious space. The modern African church promises a life that is <a href="https://www.youtube.com/watch?v=Gk7slNftZuc">abundant and prosperous</a> – both spiritually and materially.</p>
<p>African church leaders – the bishops and archbishops, prophets and overseers, pastors and deacons, benignly referred to as “men of God” – are powerful. Their teachings have a wide reach that is not limited to Sunday mornings and mid-week services. There are TV and radio programmes, audiotapes and books, international branches and YouTube videos that reach a wide audience beyond their own congregations.</p>
<p>They are also influential voices on gender issues. Jesus’ social gospel subverted gender cultures – and actively sought to challenge <a href="https://peacetheology.net/restorative-justice/6-jesus-and-justice/">injustice</a> in general. There are several examples of Christ’s counter-culture behaviour when it comes to his relationship with women. Women were generally viewed as the cause of men’s sexual sins. To prevent Jewish men from yielding to temptation, they were instructed not to speak to women in public, including their own wives. Not only did Jesus <a href="https://www.biblegateway.com/passage/?search=John%204:27">speak</a> to a woman in public he dared to <a href="https://www.biblegateway.com/passage/?search=Mark+5%3A41&version=NIV">touch</a> them in public.</p>
<p>These perspectives are not sufficiently evident in the messages preached from mega church platforms across the continent today. When it comes to the question of gender, injustice seems to have intensified in the church</p>
<h2>Problematic messages about marriage</h2>
<p>Much of the current discourse from church platforms in Africa focuses on marriage. Subjects include the breakdown of marriages, preparing women to be good wives, and the “unsuitability” of certain types of young women for marriage.</p>
<p>Archbishop Duncan Williams, founder of Ghana’s Action Faith Chapel International, <a href="https://www.modernghana.com/news/577248/until-a-man-proposes-youll-rot-in-your-beauty-intelligen.html">caused a stir</a> in 2014 when he told women:</p>
<p>it’s a privilege to be married… Sister when you get married, be thankful and stop misbehaving… It doesn’t matter how pretty and beautiful and intelligent you are; until a man proposes to you, you are going to stay beautiful, pretty, intelligent, nice and whatever, and rotten.</p>
<p>Not long afterwards Bishop Dag Heward Mills, founder of Ghana’s Lighthouse chapel, <a href="https://www.youtube.com/watch?v=XPudqyDeY0A">mocked Ghanaian girls</a> for their inability to cook, saying that they were “less than 10% of what we want”.</p>
<p>In his book <a href="http://azaliabooks.com/index.php?route=product/product&product_id=135">Till Death Do Us Part</a>, Bishop Charles Agyin-Asare, founder of one of Ghana’s mega churches, responded to the issue of abuse in marriage, writing:</p>
<p>You are not the first woman to be beaten by your husband, and you will not be the last… Rise up with the Word of God and use your spiritual weapons… Keep going to church, listen to tapes, pray, notice the blessings around you, keep your vows.</p>
<p>Women, in this discourse, have no value outside of marriage. And they have no value within it beyond providing domestic services. Women carry the responsibility for keeping the marriage intact, even at the cost of their personal well-being and safety.</p>
<p>These pronouncements can have a profound impact on women’s position in marriage and, given the importance of marriage in African cultures, on gender relations more broadly.</p>
<h2>A particular brand of masculinity</h2>
<p>The male gender, just like the female gender, is <a href="http://repository.brynmawr.edu/cgi/viewcontent.cgi?article=1007&context=soc_pubs">culturally constructed</a>. And as the church defines and redefines the roles and positions of women in marriage and society, it does the same for men.</p>
<p>The church has always been a male-dominated institution. Beyond this, my research into the gender discourse of the Pentecostal and charismatic churches shows how they promote a particular <a href="https://www.google.com.gh/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwjr1YWslfXTAhXIuY8KHfGPDRAQFggpMAE&url=http%3A%2F%2Fwww.mission-21.org%2Fno_cache%2Fservice%2Freader-zu-africa-and-switzerland%2F%3Fcid%3D3980%26did%3D4541%26sechash%3Df1e06e97&usg=AFQjCNHerGzcljzx4nLQk7HoGOesJA38rA">brand of masculinity</a>.</p>
<p>By “<a href="https://newafricanmen.wordpress.com/tag/kopano-ratele/">masculinity</a>”, I <a href="https://books.google.co.za/books/about/Men_and_masculinities_in_modern_Africa.html?id=fXMpAAAAYAAJ&redir_esc=y">refer to</a> “a cluster of norms, values, and behavioural patterns expressing explicit and implicit expectations of how men should act and represent themselves to others”.</p>
<p><a href="https://www.google.com.gh/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwjr1YWslfXTAhXIuY8KHfGPDRAQFggpMAE&url=http%3A%2F%2Fwww.mission-21.org%2Fno_cache%2Fservice%2Freader-zu-africa-and-switzerland%2F%3Fcid%3D3980%26did%3D4541%26sechash%3Df1e06e97&usg=AFQjCNHerGzcljzx4nLQk7HoGOesJA38rA">On the one hand</a>, the brand of masculinity espoused by the “men of God” encourages behaviour that can be advantageous for many women in relationships: they generally eschew violence, advocate monogamy and companionship between spouses, and underscore the responsibilities of fathers and husbands.</p>
<p>On the other hand, the “Men of God” portray women as the “weaker sex” emotionally and intellectually, who need protection and guidance. Sometimes they emphasise women’s “limitations”. This leads to a devaluing of women, re-inscribing male domination and undermining female autonomy.</p>
<h2>A different approach</h2>
<p>Pre-martial counselling has been suggested as part of the problem. But, there are churches that foster a more gender-sensitive approach.</p>
<p>One is the Family Life Ministry at Calvary Baptist church in Accra. They work with a network of professionally trained lay counsellors across several churches in Accra to offer couples practical social and spiritual guidance using an alternative approach to “family life”.</p>
<p>Gender issues are tackled from social, medical, legal and cultural perspectives. Couples are encouraged to see men and women as created equal in the image of God, and to see the development of their partners as a positive investment in their own lives, and those of their families and society.</p>
<p>Only when approaches like this become the norm will the church become a place where women as well as men, wives as well as husbands, the single as well as the married, can experience comfort, well-being and true freedom from bondage.</p>
<p>Until then, in our deeply religious context, we can expect some fraught gender relations at best, and many unhappy wives especially.</p><img src="https://counter.theconversation.com/content/75089/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I have received several grants over the course of my 28 year career in the academy. However, I didn't receive any external support for this work, nor do I stand to benefit from this work in any way, financially or in kind.
I am a volunteer counselor with the Calvary Baptist church Family Life ministry mentioned in the article. This work is unpaid. We volunteer our time and resources to support individuals in Calvary Baptist and other churches. </span></em></p>The particular brand of masculinity promoted by Africa’s influential male church leaders tends to devalue women, re-inscribe male domination.Akosua Adomako Ampofo, Professor of African Studies, University of GhanaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/670332017-01-13T02:04:23Z2017-01-13T02:04:23ZHelping universities combat depression with mobile technology<figure><img src="https://images.theconversation.com/files/152170/original/image-20170109-29708-axnfji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A smartphone could help people fight depression.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/pic-532074958/">Woman with phone via shutterstock.com</a></span></figcaption></figure><p>Depression is the <a href="http://dx.doi.org/10.1016/j.apnu.2011.03.003">leading mental health issue</a> on college campuses in the U.S. In 2015, a <a href="http://www.acha-ncha.org/docs/NCHA-II_WEB_SPRING_2015_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf">survey of more than 90,000 students</a> at 108 American colleges and universities found that during the previous year, more than one-third of them had felt so depressed at some point that it was difficult to function. More than two-thirds had felt hopeless in the preceding academic year.</p>
<p>Today’s college students are dealing with depression at an <a href="https://theconversation.com/depression-common-on-college-campuses-graduate-students-more-at-risk-41324">alarmingly high rate</a>, and are <a href="http://www.aucccd.org/assets/documents/aucccd%202015%20monograph%20-%20public%20version.pdf">increasingly seeking help</a> from on-campus mental health services. Depression is also an <a href="http://dx.doi.org/10.1016/j.jadohealth.2009.08.008">underlying cause of other common problems</a> on college campuses, including alcohol and substance abuse, eating disorders, self-injury, suicide and dropping out of school.</p>
<p>But university counseling centers, the primary sources for students to get mental health care, are struggling to meet this rising demand. First, it can take a long time for clinicians to gain a full picture of what students are experiencing: Depressed students’ accounts of their symptoms are often inaccurate and incomplete.</p>
<p>In addition, budget constraints and limited office hours mean the number of clinicians on campus has not grown, and <a href="http://www.aucccd.org/assets/documents/aucccd%202015%20monograph%20-%20public%20version.pdf">in some cases has shrunk</a>, despite increasing demand. There simply are not enough university clinicians available to serve every student – and few, if any, at critical times like nights and weekends. The number of students on counseling waiting lists <a href="http://www.apa.org/monitor/2014/09/cover-pressure.aspx">doubled from 2010 to 2012</a>. This can leave students waiting long periods without help. In the worst cases, this can have lifelong – or life-ending – consequences. </p>
<p>Using <a href="https://www.newscientist.com/article/mg22329863-300-failing-students-saved-by-stress-detecting-app/">mobile technology for mental illness diagnosis</a> and treatment is becoming a <a href="http://doi.org/10.2196/jmir.4273">hot research topic</a> nowadays because of the pervasiveness of mobile devices and their behavior-tracking capabilities. Building on others’ work, we have found a way to enhance counseling services with mobile technology and big data analytics. It can help students and clinicians alike, by offering a new tool for assessing depression that may shed increased light on a condition that is challenging to study.</p>
<h2>Measuring well-being</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/152157/original/image-20170109-23482-bzs6qy.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/152157/original/image-20170109-23482-bzs6qy.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/152157/original/image-20170109-23482-bzs6qy.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=947&fit=crop&dpr=1 600w, https://images.theconversation.com/files/152157/original/image-20170109-23482-bzs6qy.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=947&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/152157/original/image-20170109-23482-bzs6qy.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=947&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/152157/original/image-20170109-23482-bzs6qy.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1190&fit=crop&dpr=1 754w, https://images.theconversation.com/files/152157/original/image-20170109-23482-bzs6qy.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1190&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/152157/original/image-20170109-23482-bzs6qy.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1190&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The iSee app’s main screen shows activity trends.</span>
<span class="attribution"><span class="source">Mi Zhang and Jingbo Meng</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>We are developing a system for tackling this campus mental health crisis, called <a href="http://www.egr.msu.edu/news/2016/09/07/isee-counseling">iSee</a>. When it’s ready to be deployed, students who participate in the program will need to carry a smartphone and a smartwatch. Data collected by those devices are transmitted to, and analyzed by, a computer system. This lets the relatively few counselors keep better track of more students – extending service to more students in need.</p>
<p>The smartphone and smartwatch have several built-in sensors:</p>
<ul>
<li>a GPS sensor, to track geographical locations,</li>
<li>a light sensor, to measure ambient light levels,</li>
<li>an accelerometer, to capture physical movements, and</li>
<li>a touchscreen, to monitor the frequency and duration of users’ interactions with their phones, such as browsing social media.</li>
</ul>
<p>These sensors capture many of the students’ daily activities that <a href="http://dx.doi.org/10.1176/appi.books.9780890425596.dsm04">can help indicate mental well-being</a>, including walking or other physical exercise, sleeping habits, social interaction and how often they go to class or local businesses – or whether they stay home or in a dorm room all day long.</p>
<p>iSee can offset the inherent inaccuracies and incompleteness in patients’ self-reporting of their depression. It can even observe symptoms students themselves don’t notice or think to mention to a counselor. And because the data are continually collected, it can identify moments of vulnerability and resilience and provide a picture of a student’s progress over time. That can help not only monitor but also treat depression.</p>
<h2>Improving counseling service</h2>
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<a href="https://images.theconversation.com/files/152163/original/image-20170109-23453-123xi1l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/152163/original/image-20170109-23453-123xi1l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/152163/original/image-20170109-23453-123xi1l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=493&fit=crop&dpr=1 600w, https://images.theconversation.com/files/152163/original/image-20170109-23453-123xi1l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=493&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/152163/original/image-20170109-23453-123xi1l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=493&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/152163/original/image-20170109-23453-123xi1l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=619&fit=crop&dpr=1 754w, https://images.theconversation.com/files/152163/original/image-20170109-23453-123xi1l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=619&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/152163/original/image-20170109-23453-123xi1l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=619&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Counselors can keep an eye on their patients, without even needing to make direct contact.</span>
<span class="attribution"><span class="source">Mi Zhang and Jingbo Meng</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Our work builds on the algorithms we have designed that <a href="http://dx.doi.org/10.2196/jmir.4273">analyze mobile device data to detect depression</a>. In a 2015 study, we showed that the severity of a person’s depression can be predicted by monitoring their GPS locations and how often they use their phones: People with more severe depression symptoms tended to move from place to place less and stay at home more than people with fewer depression symptoms – or none at all. The movements of more severely depressed people also tended to be less regular, and were more likely to use their phones frequently and for longer durations. For iSee, we will incorporate data from the other sensors, translating the raw measurements into models of how the students are behaving.</p>
<p>Then iSee will look for behavior patterns that can relate to mental health problems – such as staying home all the time or getting irregular sleep. By sharing this information with both the patient and the counselor, iSee will help better describe, and more accurately portray the severity of, an individual’s symptoms.</p>
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<a href="https://images.theconversation.com/files/152161/original/image-20170109-23464-7bte5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/152161/original/image-20170109-23464-7bte5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/152161/original/image-20170109-23464-7bte5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=464&fit=crop&dpr=1 600w, https://images.theconversation.com/files/152161/original/image-20170109-23464-7bte5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=464&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/152161/original/image-20170109-23464-7bte5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=464&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/152161/original/image-20170109-23464-7bte5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=583&fit=crop&dpr=1 754w, https://images.theconversation.com/files/152161/original/image-20170109-23464-7bte5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=583&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/152161/original/image-20170109-23464-7bte5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=583&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A mental health counselor can see when a student’s behavior suggests a change in their depression.</span>
<span class="attribution"><span class="source">Mi Zhang and Jingbo Meng</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Treating depression</h2>
<p>In addition, iSee can sense in real time when a student’s behavior matches certain symptoms of depression – such as being socially isolated for three days. If that happens, the app can automatically deliver in-the-moment therapies to help, without relying on the patient, or even the clinician, to initiate. For example, if iSee notices a socially isolated person is alone at home on a sunny Saturday afternoon, it might suggest calling some friends or going out for a walk. </p>
<p>That is exactly the sort of suggestion a counselor would make. Unfortunately, counselors usually can only make these suggestions in hindsight during therapy sessions. The smartphone can provide that assistance in the moment when help is needed.</p>
<p>By finding ways the many sensors on smartphones and smartwatches can shed light on people’s daily lives and habits, and by analyzing that data in ways that highlight potential mental health problems, we can help college students stay healthier and reduce the workload on overtaxed professionals at the same time.</p><img src="https://counter.theconversation.com/content/67033/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mi Zhang works for Michigan State University. He receives funding from the National Science Foundation (NSF).</span></em></p><p class="fine-print"><em><span>David Mohr works for Northwestern University. He receives funding from the National Institutes of Health.</span></em></p><p class="fine-print"><em><span>Jingbo Meng works for Michigan State University. She receives funding from the National Science Foundation (NSF).</span></em></p>Using sensors on smartphones and smartwatches can shed light on patients’ symptoms of depression, even identifying ones they didn’t notice or share with counselors.Mi Zhang, Assistant Professor of Electrical and Computer Engineering, Michigan State UniversityDavid Mohr, Director, Center for Behavioral Intervention Technologies (CBITs) Professor of Preventive Medicine (Behavioral Medicine), Medical Social Sciences and Psychiatry and Behavioral Sciences, Northwestern UniversityJingbo Meng, Assistant Professor of Communication, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/562392016-07-06T01:05:04Z2016-07-06T01:05:04ZHelping ex-prisoners keep out of prison: what works<p>In California, about 74 percent of people who leave prison return within <a href="http://www.cdcr.ca.gov/Adult_Research_Branch/Research_documents/Outcome_evaluation_Report_2013.pdf%22">12 months</a>. Considering that the California prison system paroles about <a href="http://www.cdcr.ca.gov/Reports_Research/Offender_Information_Services_Branch/WeeklyWed/TPOP1A/TPOP1Ad140611.pdf">45,000 people each year</a>, this recidivism rate presents serious problems for policymakers and correctional agency administrators. It’s a revolving door – one that needs to be stopped.</p>
<p>Transitioning back into society presents real challenges for male offenders. During their time in prison or jail, they often lose contact with their families and support networks, creating <a href="http://canatx.org/rrt_new/professionals/articles/SEITER-WHAT%20WORKS.pdf">insurmountable odds</a> for successful reentry into the community. On top of that, these men often have <a href="http://www.rand.org/pubs/technical_reports/TR687.html">limited access to health care</a>, housing, education and employment, disadvantages that can lead to homelessness and rearrest.</p>
<p>With the deck stacked against parolees in so many ways, my colleagues and I wondered what sort of interventions could help keep them from returning to the life that put them in prison in the first place. </p>
<p>Five years ago, with a grant from the National Institute on Drug Abuse, my colleagues and I enrolled 600 men who were recently released from prison or jail and were currently residents at the Amistad de Los Angeles residential drug treatment program in a study. All of the parolees had been homeless prior to being incarcerated, which places them at risk for rearrest.</p>
<p>We wanted to assess what sort of post-release coaching and health assistance program would help them with stay healthy and and avoid <a href="http://dx.doi.org/10.1097/NNR.0000000000000083">the kinds of behavior</a> that could lead to rearrest.</p>
<h2>Preventing parolees from falling into old habits</h2>
<p>We divided the 600 parolees into three groups. One group received both intensive peer coaching and case management. The second group received intensive peer coaching but only brief counseling from nurses about hepatitis and the hepatitis vaccine. The third group received limited peer coaching and an even shorter session about hepatitis and the vaccine.</p>
<p>We found that each combination helped to reduce drug use and risky sexual activity and to lower recidivism rate. We also found that the third group, the model with limited peer coaching and support from nurses, was the most cost-efficient and just as effective as the other two, more intensive models.</p>
<p>Within 12 months of release, <a href="http://dx.doi.org/10.1080/10550887.2016.1147796">62.1 percent of parolees</a> in our study were rearrested. That might seem high, but keep in mind that one-year reincarceration rate for all California parolees in 2013 was 74.1 percent. So parolees who went through any of the three combinations of nursing care and peer coaching were less likely to be back in prison one year after release.</p>
<p>We also found that 12 months after starting the study, parolees reported using fewer drugs and engaging in fewer risky sexual activities than they had before being incarcerated. </p>
<p>That all three variations succeeded in lowering the rearrest rate, and in reducing drug use and risky behaviors, suggests that there is something beneficial about combining nurse case management with peer coaching.</p>
<h2>Nurses provide critical health assistance</h2>
<p>Nurses believe that improving one part of your life can have ramifications in lots of other parts. For example, seeking a healthier lifestyle can lead one to become motivated to seek job skills or employment and end the cycle of drug use and reincarceration. In this study, the nurse case manager performed health assessments, and provided health education regarding the dangers of injecting drugs and having unprotected sex.</p>
<p>Parolees, and particularly those with a history of homelessness, are at high risk for hepatitis B and C virus and HIV. We tested all participants for hepatitis B virus, which is vaccine-preventable. If he tested positive, the nurse provided speedy access to vital health services and arranged appointments for further examinations and treatment. If the test was negative, eligible participants received the HBV vaccine, which protects against hepatitis A and B. </p>
<p>In our study 73 percent of participants completed the HBV vaccination series.</p>
<p>This vaccine completion rate, in particular, is important because only <a href="http://link.springer.com/article/10.1007/s11524-008-9305-8">12 percent</a> of <a href="http://dx.doi.org/10.1097/NNR.0000000000000083">incarcerated populations</a> complete the three-dose vaccine series.</p>
<p>Two-thirds of those arrested in the U.S. <a href="http://www.nejs.gov/nij/adam/ADAM2003.pdf">test positive for drugs</a> and over half the men exiting jail and prison have sex on the <a href="http://www.ncbi.nlm.nih.gov/pubmed/16219588">first day of release</a>. Risky sexual behavior is not an independent risk factor for rearrest, but it may be a sign that these parolees may be returning to old habits that got them in trouble in the first place</p>
<p>Other risky activities, such as ongoing drug use, are easily adopted by ex-offenders who have difficulty coping with life post-incarceration. This can often lead to criminal behavior – either while under the influence of drugs or to support their drug habit. </p>
<p>While nurses can provide critical support, parolees need more than that to cope with life after prison. That is where the peer coaches come in. </p>
<h2>Peer coaches know the road that parolees are on</h2>
<p>The peer coaches were all former inmates who were trained about the needs and challenges faced by parolees discharged to the community. As a role model who has served time in prison and successfully transitioned back into the community, the peer coach makes a powerful difference for parolees. They know what it’s like to be released from prison and to try and start over. In fact, several of the peer coaches had actually been treated at the residential treatment facility where our study was based. The parolees were also impressed by the fact the peer coaches were employed on federally funded grant through a prestigious university.</p>
<p>The coaches went through several weeks of training covering the research process, ethical conduct, social justice, organizational skills, coping behaviors and information about hepatitis. Most importantly, the peer coaches learned about the resources available in the community to help parolees.</p>
<p>We found that peer coaches had a real ear for listening and a talent for providing advice to parolees on how to cope with life after incarceration. Peer coaches guided recently released ex-offenders in direct pathways to seeking jobs. They warned against returning to old neighborhoods and old friends who might still be using drugs and involved in gang activity. Most importantly, they reminded the ex-offenders to seek advice and support when in need. </p>
<p>They also reminded parolees to receive all three doses of the HBV vaccine, reinforcing what the nurses in the program had told them.</p>
<h2>Where do we go from here?</h2>
<p>Our research suggests that support for residential treatment facilities along with peer coaching and nurse-partnered care can result in long-term success of community reentry. </p>
<p>While the original study focused on male offenders, we found there was a real interest from women parolees and probationers to be part of the study. Therefore, we are currently conducting a three-year study of women parolees.</p><img src="https://counter.theconversation.com/content/56239/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adeline Nyamathi receives funding from NIDA.
National Institute on Drug Abuse</span></em></p>Case management from nurses combined with peer coaching from ex-offenders helps recently released parolees avoid the behavior that got them locked up in the first place.Adeline Nyamathi, Professor and Associate Dean for International Research and Scholarly Activities, School of Nursing, University of California, Los AngelesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/413242015-05-08T09:53:32Z2015-05-08T09:53:32ZDepression common on college campuses; graduate students more at risk<figure><img src="https://images.theconversation.com/files/80736/original/image-20150506-10961-mkprvt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Suicides are the second leading cause of death on college campuses. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&search_tracking_id=PXYBTGr-noxxRYHvoh47xg&searchterm=depression&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=197995073">Girl Image via www.shutterstock.com</a></span></figcaption></figure><p>Graduate <a href="http://www.ncbi.nlm.nih.gov/pubmed/24711096">students experience significant stress </a> and are more prone to depression and anxiety than other groups of students. They report greater levels of eating disorders, substance abuse and feelings of hopelessness.</p>
<p>A recent report from the University of California, <a href="http://ga.berkeley.edu/wellbeingreport/">found</a> 47% of doctoral students and 37% of master’s degree students, who were surveyed, to be depressed. Furthermore, 64% of graduate students in arts and humanities <a href="http://ga.berkeley.edu/wellbeingreport/">showed higher levels</a> of depression and suicidal thoughts. Based on the university’s <a href="http://grad.berkeley.edu/admissions/rankings-stats/">enrollment data </a> from 2013, we can estimate 2,800 of the 6,000 PhD students to be clinically depressed.</p>
<p>This is a high number and not limited to the Berkeley campus. Other studies, too, have shown high rates of student depression. As a researcher working on suicide prevention programs, I have found this to be true for our own campus.</p>
<h2>Stressed students</h2>
<p>On a single day last fall, we randomly stopped students on our campus and administered a depression questionnaire. Of the approximately 250 students we contacted on this one particular day, no fewer than eight were having active suicidal thoughts. </p>
<p>While the students with suicidal thoughts received emergency counseling, another 12 scheduled appointments voluntarily after seeing their scores. Ten more students presented themselves over the next few days, saying that the questionnaire helped them realize they needed counseling. </p>
<p>This meant that 30 students, or 12% of the students we stopped, were experiencing depression serious enough to need intervention. </p>
<p>Relative to the total campus enrollment, these are small numbers, but in terms of the number of students we contacted, <a href="http://www.sprc.org/collegesanduniversities/scope-problem">they are higher than previously reported percentages</a> and quite probably more in line with reality. </p>
<p>Suicide is the <a href="http://www.suicide.org/college-student-suicide.html">second leading cause of death</a> for college students after <a href="https://www2.nami.org/Content/NavigationMenu/Find_Support/NAMI_on_Campus1/Mental_Illness_Fact_Sheets/Suicide.pdf">traffic accidents</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/80737/original/image-20150506-10937-fgpbif.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/80737/original/image-20150506-10937-fgpbif.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80737/original/image-20150506-10937-fgpbif.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80737/original/image-20150506-10937-fgpbif.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80737/original/image-20150506-10937-fgpbif.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80737/original/image-20150506-10937-fgpbif.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80737/original/image-20150506-10937-fgpbif.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Students have a great deal of anxiety over job prospects after college.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&search_tracking_id=PXYBTGr-noxxRYHvoh47xg&searchterm=depression&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=94267417">Pencil image via www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>We do not have adequate data that separates the suicide rate of graduate students from that of under-graduates. But studies among graduate students show that a substantial percentage suffer from depression, anxiety and have suicidal thoughts. </p>
<p>According to <a href="http://www.ncbi.nlm.nih.gov/pubmed/24711096">one such study</a> where an email questionnaire was sent out to 301 graduate students nationally, 22% were found to be on medication for depression or anxiety and nearly 19% were in counseling. </p>
<p>At the University of Michigan, researchers <a href="http://psycnet.apa.org/psycinfo/2007-19519-005">found</a> nearly 2% of graduate students were having suicidal thoughts in the four weeks preceding a survey they conducted in 2007. </p>
<p>Other studies, too, have reported that <a href="http://psycnet.apa.org/psycinfo/2009-08599-001">4% of graduate students </a> and <a href="http://annals.org/article.aspx?articleid=742530">11% of medical students</a> having serious suicidal thoughts in the year prior to the studies. </p>
<h2>Anxiety over life after college</h2>
<p>The most common risk factors, as reported by researchers at the University of Michigan, for depression in graduate students include financial concerns, post-graduate job prospects, isolation and lack of social support. </p>
<p>We don’t know what makes the arts and humanities graduate students more vulnerable to depression and suicide. Since there are no other studies that point to these fields of study as having greater risk, it may be that this is simply coincidental or specific to the Berkeley campus, or their fears about post-graduate employment are realistic. </p>
<p>This is not to say that undergraduate students are not at risk. Data from the <a href="http://www.sprc.org/">Suicide Prevention Resource Center</a>, a federally-supported program, shows about 8% of college students (undergraduate and graduate) as <a href="http://www.sprc.org/collegesanduniversities/scope-problem">having</a> suicidal thoughts, about 2% making a suicide plan and about 1% making an attempt. </p>
<p>As not all universities respond to surveys about student suicide and in many cases suicidal thoughts or attempts go unreported, actual numbers are likely to be higher. </p>
<p>A university can be a stressful place. Students might feel <a href="http://www.sprc.org/sites/sprc.org/files/library/SuicideAmongCollegeStudentsInUS.pdf">overwhelmed</a>, hopeless, isolated and not able to cope at college. Under such circumstances, they may perceive suicide to be the only way out.</p>
<h2>Depression on campus</h2>
<p>So, what can colleges and students do?</p>
<p>University administrators and counselors should focus on <a href="http://www.ncbi.nlm.nih.gov/pubmed/24711096">developing mental health and wellness interventions</a>. College students in general and graduate students in particular need to be encouraged to seek help. </p>
<p>Additionally, students need to know there are a number of online resources available. </p>
<p>These resources include the <a href="http://www.sprc.org/">Suicide Prevention Resource Center</a>, the <a href="http://www.jedfoundation.org">Jed Foundation</a>, <a href="http://www.thetrevorproject.org">The Trevor Project</a>, <a href="http://www.nimh.nih.gov/index.shtml">The National Institute of Mental Health</a> and <a href="http://www.samhsa.gov">The Substance Abuse and Mental Health Services Administration</a>. Information can also be found on the <a href="http://www.apa.org">American Psychological Association</a> and the <a href="http://www.psychiatry.org">American Psychiatric Association</a> websites. </p>
<p>It is important to break the silence and to bring to public attention the problem of student depression, anxiety and suicide. The larger issue of lack of resources on some campuses needs to be addressed urgently.</p>
<p>Otherwise, the numbers will continue to rise.</p><img src="https://counter.theconversation.com/content/41324/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeannie D DiClementi receives funding from a Garrett Lee Smith suicide prevention grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) that is referenced in the article.</span></em></p>Suicidal thoughts among college students are more common than we think. Graduate students, especially those in the humanities, are at a greater risk.Jeannie D. DiClementi, Associate Professor of Psychology, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/305262014-09-28T23:53:00Z2014-09-28T23:53:00ZCost of love: will subsidising couples counselling actually work?<figure><img src="https://images.theconversation.com/files/57430/original/kmfnvbxz-1409098354.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Social Services Minister Kevin Andrews believes couples counselling will ultimately save Australia money.</span> <span class="attribution"><span class="source">Lukas Coch/AAP </span></span></figcaption></figure><p>Social services minister Kevin Andrews claims his A$20 million <a href="http://www.dss.gov.au/our-responsibilities/families-and-children/programs-services/stronger-relationships-trial">Stronger Relationships Trial</a> will <a href="http://www.theaustralian.com.au/national-affairs/kevin-andrews-wedded-to-divorce-cut/story-fn59niix-1226839936170">save the government money</a> in the long run by reducing family breakdown. But will it work?</p>
<p>The trial, which began on July 1, provides a $200 subsidy per couple for up to 100,000 couples to access counselling or education. Its stated aim is to <a href="http://kevinandrews.com.au/latest-news/2014/07/01/stronger-relationships-trial-begins/">strengthen committed couple relationships</a> by making relationship counselling and education easier to access. </p>
<p>But factors such as financial stress, the extent of unhappiness and the low quality of many counselling services all come into play when considering whether counselling will be effective.</p>
<h2>The cost of separation</h2>
<p>Family separations do <a href="http://www.aifs.gov.au/cfca/bibliographies/separationdivorcefinance.php">cost the public money in all sorts of ways</a>. These include the costs of increased child support, running the Family Court or loss of work productivity. But not all separations are bad. For example, leaving a violent relationship is often the wisest path to follow. </p>
<p>On the other hand, about <a href="http://www.aifs.gov.au/institute/pubs/WP20.html">half of all separations</a> are not highly troubled relationships. Instead one or both partners feel a loss of energy in the relationship. </p>
<p>So can people be helped to have the sort of relationship that they choose to stay in?</p>
<h2>Pros and cons of counselling</h2>
<p>There is lots of evidence that high-quality counselling works quite well to re-energise relationships. About 60-70% of unhappy couples who get such <a>counselling improve their relationship.</a> </p>
<p>Some of the remaining 30% to 40% negotiate lower-conflict separations than they might have without counselling. </p>
<p>That is the good news about couple counselling. The bad news is that relatively few couples try counselling. Probably <a href="http://sccn612final.wikispaces.com/file/view/Marital+Therapy,+Retreats,+and+Books.pdf">less than 25% of separating couples</a> have sought any sort of help for their relationship. Making counselling cheaper might get more couples to try it. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/57425/original/vx9hmdb3-1409094976.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/57425/original/vx9hmdb3-1409094976.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/57425/original/vx9hmdb3-1409094976.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1086&fit=crop&dpr=1 600w, https://images.theconversation.com/files/57425/original/vx9hmdb3-1409094976.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1086&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/57425/original/vx9hmdb3-1409094976.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1086&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/57425/original/vx9hmdb3-1409094976.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1365&fit=crop&dpr=1 754w, https://images.theconversation.com/files/57425/original/vx9hmdb3-1409094976.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1365&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/57425/original/vx9hmdb3-1409094976.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1365&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Early intervention can prevent the long-term resentments that destroy relationships.</span>
<span class="attribution"><span class="source">shutterstock</span></span>
</figcaption>
</figure>
<p>One limitation of counselling is that most couples who attend do so after <a href="http://www.ncbi.nlm.nih.gov/pubmed/22304874">years of unhappiness.</a> The longer couples have been unhappy, the less likely the counselling is to work, so getting couples to seek counselling early is important.</p>
<p>A second limitation is that much of the counselling available to couples on Australia is, in my 30 years of observation, not high quality. Quality counselling involves couple being <a href="http://aboutfamilies.files.wordpress.com/2013/01/erb-relationship-counselling-dec12-final.pdf">carefully assessed</a> to screen for problems that often co-exist with relationship problems, such as depression, alcohol and drug misuse, gambling and parenting problems. </p>
<p>Many - or in my opinion, most - Australian marriage counsellors do not have the mental health training to conduct this screening. Sometimes treatment for the individual’s problems can be <a href="http://psycnet.apa.org/psycinfo/1993-30389-001">more appropriate than couples counselling</a>, or is needed in conjunction with couples counselling. </p>
<p>Quality counselling also means applying approaches that have been shown to work by well-conducted psychological research. Too often, in my experience, Australia counsellors provide what they are familiar with, rather than what has been shown to work.</p>
<h2>Is it better to prevent or cure?</h2>
<p>Relationship education is different to counselling. Education is briefer and is focused on teaching happy couples how to strengthen a good relationship. Most education tries to help couples build relationship commitment and develop key relationship skills like good communication.</p>
<p>There are limits to the effects of couple education. <a href="http://www.buildingstrongfamilies.info/">The Building Strong Families trial</a> in the US evaluated couple education with poor unmarried parents. It found only <a href="http://www.mathematica-mpr.com/%7E/media/publications/PDFs/family_support/BSF_36month_impact_fnlrpt.pdf">very small benefits for the couples</a>. </p>
<p>The least likely to benefit were those who were in severe poverty. Learning relationship skills does not ease the enormous stress of <a href="http://www.mdrc.org/sites/default/files/shm%20impl%20full%20pdf_1.pdf">not being able to pay the rent</a>. </p>
<p>But for those of us not in poverty, education looks promising. More couples are willing to attend relationship education than attend counselling, but <a href="http://www.theatlantic.com/education/archive/2014/03/government-funded-relationship-education-can-work/284405/?single_page=true">less than one-third of couples</a> do any sort of relationship education. </p>
<p>There is a lot of evidence that just <a href="http://www.aifs.gov.au/institute/pubs/fm2005/fm71/rp.pdf">ten to 12 hours</a> of relationship education produces benefits for couples that are evident years later. A 2012 University of Queensland <a href="http://espace.library.uq.edu.au/view/UQ:288950">study</a>, which I co-authored, found that relationship education for at-risk couples doubled the chance those couples would maintain happy relationships in the first three years of parenthood. </p>
<p>The benefits of education are strongest for couples who are reasonably happy, but who have indicators of future risk for problems. Indicators of risk include couples in which the partners’ parents divorced when they were young, or partners who have suffered from depression or anxiety, or people with children from a prior relationship.</p>
<h2>What delivery method works for you?</h2>
<p>Couples who don’t attend relationship education often say that attending education is <a href="http://www.blackdoginstitute.org.au/search/index.cfm?q=curtin+university+media">hard to fit into a busy lifestyle</a>. Educators are gradually responding to this criticism by offering education programs couples can complete at home, or online. </p>
<p>Religious organisations pioneered relationship education in Australia and continue to be major providers. Some couples see relationship education as too religious or conservative for them. However, secular providers are seeking to broaden the appeal of education to the less religious. </p>
<p>The Stronger Relationships Trial will include independent evaluations of the effects of the services offered. This increased accountability is likely to nudge service providers to increase innovation. </p>
<p>If providers do improve the quality of counselling and the accessibility of education, more couples are likely to have happy, stable relationships. It’s a big “if”. The next year will clarify if the $200 per couple subsidy is an effective way to promote this innovation.</p><img src="https://counter.theconversation.com/content/30526/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kim Halford is lead author of the Couple CARE relationship education program, which is widely used in
Australia. He derives royalties from the use of that program.</span></em></p>Social services minister Kevin Andrews claims his A$20 million Stronger Relationships Trial will save the government money in the long run by reducing family breakdown. But will it work? The trial, which…Kim Halford, Professor of Clinical Psychology, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.