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I am Apolonia Crawford a graduate student attending Angelo State University working my way through their Licensed Professional Counseling Bridge program.
As I work through the class one of my personal goals is to take time to put myself first.  I have found that I have not been doing that and it has taken a toll on me physically and mentally and I cannot help putting myself through what I have been.
A professional goal I have is beening able to identify the triggers in my life before allowing that to have a negative impact on my professional life.
Not only am I a graduate student, I am also the proud mother of two teenage girls and five fur babies. Yes five, a chi-weenie, a pomeranian, two husk-weenies (husky and dachshund), and an Australian Kelpie.

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Mental Health Disorders Reference Guide- Apolonia Crawford

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Mental Health Disorders Reference Guide- Apolonia Crawford

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REFLECTION
I enjoyed this assignment because it opened up my eyes to some of the possible disorders that all under the overarching disorder. Although the assignment did not all of the possible disorder it was interesting to see which disorder where under each one.  It was also interesting to compare the definition the actual research definition of what a disorder is to what society or myself believes that disorder is.  In creating this reference guide I believe that it will help me in the future as I continue to add to it and expand my knowledge under each overarching catagory.

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Reference Guide for Mental Health Disorders- Crawford

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REFLECTION
There is a vast range of problems that fall under the umbrella of mental illnesses, such as depression, bipolar disorder, schizophrenia, substance use disorder, anxiety disorders, eating disorders, obsessive compulsive disorder, and post-traumatic stress disorder. The severity of any of these illnesses can range from mild to severe (significantly interfering with key everyday activities), and they can also co-occur.

However, these depressing figures show that these difficulties really exist. The prevalence of mental illness, which affects 46.6 million Americans or one in five people, has been rising recently, particularly among young adults. Significant disparities also exist: Communities of color are frequently provided with lower-quality mental health care, have less access to mental health services, and are less likely to receive a diagnosis and treatment for their mental illness, according to the U.S. Department of Health and Human Services.

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American Counseling Association Code of Ethics

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American Counseling Association Code of Ethics

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REFLECTION
Counselors must make extra efforts to accurately identify mental issues by conducting personal interviews, according to the American Counseling Association's (ACA) Code of Ethics, which is included in Section E Evaluation, Assessment, and Interpretation. These personal interviews are used as one of the assessment techniques to determine the client's care, including the kind of treatment, where it will be provided, and any recommended additional therapies that may be required (E.5.a.). Counselors are required by the ethics codes to understand how culture affects how clients describe and approach their problems. Therefore, it's crucial to consider the client's socioeconomic and cultural experiences when evaluating mental health issues (E.5.b.).

American Counseling Association. (2014). 2014 ACA code of ethics. https://www.counseling.org/docs/default-source/default-document-library/2014-code-of-ethics-finaladdress.pdf

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Find information on key laws and resources for Texans living with a mental health diagnosis. This page provides information on both resources and contacts that can help when looking for mental health services in the state. Additionally, this page includes a summary of laws by topic that may impact individuals living with mental illness. This section is not intended to be used for legal advice.
On This Page:
Resources

Contacts for Urgent Services

Contacts for Non-Urgent Services

The first step when seeking help for non-emergency mental health or substance use challenges is to find local services. Call the local referral line for confidential help 24 hours a day, 7 days a week.

File a Complaint

To file a complaint with the U.S. Department of Justice (DOJ):

(800) 514-0301 (voice)

(800) 514-0383 (TTY)

Additional Resources

State and Federal Law

Patient's Rights

( Texas Health and Safety Code, Chapter 576)

A person living with mental illness has the rights, benefits, responsibilities, and privileges guaranteed by the constitution. A patient of an institution has:

the right to register and vote at an election;

the right to acquire, use, and dispose of property, including contractual rights;

the right to sue and be sued;

all rights relating to the grant, use, and revocation of a license, permit, privilege, or benefit under law;

the right to religious freedom; and

all rights relating to domestic relations.

Providing court-ordered, emergency, or voluntary mental health services to a person is not a determination or adjudication of mental incompetency and does not limit the person's rights as a citizen, or the person's property rights or legal capacity. A person is presumed mentally competent unless a court has determined otherwise.

An individual who is a patient in an inpatient mental health facility has the right to:

receive visitors;

communicate with a person outside the facility by telephone or mail; and

communicate by telephone or mail with legal counsel, the state agency, the courts, and the state attorney general.

A patient must be informed in writing, at the time of admission and discharge at an inpatient facility, of the existence, purpose, telephone number, and address of the protection and advocacy system in Texas under the Protection and Advocacy for Mentally Ill Individuals Act of 1986.

A patient receiving mental health services has the right to:

appropriate treatment in the least restrictive appropriate setting available;

not receive unnecessary or excessive medication;

refuse to participate in a research program;

an individualized treatment plan and to participate in developing the plan; and

a humane treatment environment that provides reasonable protection from harm and appropriate privacy for personal needs.

A person may not administer a psychoactive medication to a patient receiving voluntary or involuntary mental health services who refuses unless:

the patient is having a medication-related emergency;

the patient is younger than 16 years of age, or the patient is younger than 18 years of age and is a patient admitted for voluntary mental health services, and the parent, managing conservator, or guardian consents to the administration on behalf of the patient; or

the refusing patient's representative authorized by law to consent on their behalf has consented to the administration.

A patient receiving inpatient mental health services is entitled to obtain at the patient's cost an independent psychiatric, psychological, or medical examination or evaluation by a psychiatrist, physician, or no physician mental health professional chosen by the patient. The facility administrator allows the patient to obtain the examination or evaluation at any time.

If the patient is a minor, the minor and the minor's parent, legal guardian, or conservator is entitled to obtain the examination or evaluation. The cost of the examination or evaluation will be billed by the professional who performed the examination or evaluation to the person responsible for payment of the minor's treatment.

Least Restrictive Appropriate Setting for Treatment

( Texas Health and Safety Code, Section 571.004)

The least restrictive appropriate setting for the treatment of a patient is the treatment setting that:

is available;

provides the patient with the greatest probability of improvement or cure; and

is no more restrictive of the patient's physical or social liberties than is necessary to provide the most effective treatment and to protect adequately against any danger the patient poses to themselves or others.

Continuing Care Plan

( Texas Health and Safety Code, Section 574.081(c))

The physician responsible for a patient's treatment will prepare a continuing care plan for a patient scheduled to be furloughed or discharged unless the patient does not require continuing care.

The plan must address the patient's mental health and physical needs, including:

the need for outpatient mental health services following furlough or discharge; and

the need for sufficient psychoactive medication on furlough or discharge to last until the patient can see a physician.

The physician shall deliver the plan and other appropriate information to the community center or other provider that will deliver the services if:

the services are provided by:

a community center or other provider that serves the county in which the patient will reside and that has been designated to perform continuing care services; or

any other provider that agrees to accept the referral; and

the provision of care by the center or provider is appropriate.

A patient who is to be discharged may refuse the continuing care services.

Guardianship

( Texas Probate Code, Sections 770A and 770(b))

The guardian of an adult may expend funds of the guardianship as provided by court order to care for and maintain an individual who has been determined to be incapacitated. The guardian may apply for residential care and services on behalf of a person who has decision-making ability if the person agrees. The guardian must report the condition of the person to the court at regular intervals, at least annually, unless the court orders more frequent reports. If the person is receiving residential care in a public or private care facility, the guardian must include in any report to the court a statement as to the necessity for continued care in the facility.

A guardian may not voluntarily admit an incapacitated person to a public or private in-patient psychiatric or residential facility for care and treatment. If care and treatment in a psychiatric or a residential facility are necessary, the person or the person's guardian may apply to a court to commit the person or transport the ward to an inpatient mental health facility for a preliminary examination.

A guardian of a person younger than 16 years of age may voluntarily admit an incapacitated person to a public or private inpatient psychiatric facility for care and treatment. A guardian of a person may voluntarily admit an incapacitated person to a residential care facility for emergency care or respite care.

Read more about State and Federal Laws for Guardianship.

Disease Management

( Health and Safety Code, Section 533.0354)

A local mental health authority (LMHA) must ensure the provision of assessment services, crisis services, and intensive and comprehensive services using disease management practices for adults with bipolar disorder, schizophrenia, or clinically severe depression and for children with serious emotional illnesses. The LMHA must ensure that individuals are engaged with treatment services that are:

ongoing and matched to the needs of the individual in type, duration, and intensity;

focused on a process of recovery designed to allow the individual to progress through levels of service;

guided by evidence-based protocols and a strength-based paradigm of service; and

monitored by a system that holds the local authority accountable for specific outcomes, while allowing flexibility to maximize local resources.

An LMHA ensures the provision of assessment services, crisis services, and intensive and comprehensive services using disease management practices for children with serious emotional, behavioral, or mental disturbance and adults with severe mental illness who are experiencing significant functional impairment due to a mental health disorder that is defined by the DSM-5, including:

major depressive disorder, including single episode or recurrent major depressive disorder;

post-traumatic stress disorder;

schizoaffective disorder, including bipolar and depressive types;

obsessive-compulsive disorder;

anxiety disorder;

attention deficit disorder;

delusional disorder;

bulimia nervosa, anorexia nervosa, or other eating disorders not otherwise specified; or

any other diagnosed mental health disorder.

Each LMHA is required to incorporate jail diversion strategies into the disease management practices for managing adults with schizophrenia and bipolar disorder to reduce the involvement of those client populations with the criminal justice system.

Court-ordered Mental Health Services

( Texas Health and Safety Code, Sections 574.004 and 574.102)

An attorney representing a proposed patient during a hearing for court-ordered mental health services must interview the proposed patient within a reasonable time before the date of the hearing.

The attorney must thoroughly discuss with the proposed patient the law and facts of the case, their options, and the grounds on which the court-ordered mental health services are being sought. A court-appointed attorney must also inform the proposed patient that they may obtain personal legal counsel at their own expense instead of accepting the court-appointed counsel.

Before a hearing, the attorney must:

review the application filed for court-ordered mental health services, the certificates of medical examination for mental illness, and the relevant medical records;

interview supporting witnesses and other witnesses who will testify at the hearing; and

explore the least restrictive treatment alternatives to court-ordered inpatient mental health services.

The attorney must discuss with the proposed patient:

the procedures for appeal, release, and discharge if the court orders participation in mental health services; and

other rights the proposed patient may have during the period of the court's order.

Minors

( Texas Health and Safety Code, Section 572.004)

Minors (under age 18) may not refuse psychoactive medication authorized by a parent or guardian, or discharge themselves from a voluntary mental health facility if guardian or parent objects.

Restraints and Seclusion

( Texas Health and Safety Code, Chapter 322)

A person may not administer to a resident of an inpatient facility a restraint that:

obstructs the resident's airway, including a procedure that places anything in, on, or over the resident's mouth or nose;

impairs the resident's breathing by putting pressure on the torso; or

interferes with the resident's ability to communicate.

The executive commissioner of the Health and Human Services Commission (HHSC) will ensure that each resident at a facility and the resident's legally authorized representative are notified of the rules and policies related to restraints and seclusion.

A facility may not discharge or otherwise retaliate against:

an employee, client, resident, or other person because they files a complaint, present a grievance, or otherwise provide in good faith information relating to the misuse of restraint or seclusion at the facility; or

a client or resident of the facility because someone on their behalf files a complaint, presents a grievance, or otherwise provides in good faith information relating to the misuse of restraint or seclusion at the facility.

Detaining a Mental Health Patient

( Texas Health and Safety Code, Section 573.021)

A peace officer, without a warrant, may take a person into custody, regardless of the age of the person, if the officer:

has reason to believe and does believe that:

the person is a person with mental illness; and

because of that mental illness there is a substantial risk of serious harm to the person or to others unless they are immediately restrained; and

believes that there is not sufficient time to obtain a warrant before taking the person into custody.

A peace officer who takes a person into custody must immediately:

transport the person to:

the nearest appropriate inpatient mental health facility; or

a mental health facility deemed suitable by the LMHA, if an appropriate inpatient mental health facility is not available; or

transfer the person to emergency medical services personnel of an emergency medical services provider.

A jail or similar detention facility may not be deemed suitable except in an extreme emergency.

A physician shall examine the person as soon as possible within 12 hours after the time the person is brought into a facility by the peace officer or transported for emergency detention by the person's guardian.

A person may be admitted to a facility for emergency detention only if the physician who conducted the preliminary examination of the person makes a written statement that:

is acceptable to the facility;

states that after a preliminary examination it is the physician's opinion that:

the person is a person with mental illness;

the person evidences a substantial risk of serious harm to themselves or to others;

the described risk of harm is imminent unless the person is immediately restrained; and

emergency detention is the least restrictive means by which the necessary restraint may be accomplished; and

includes:

a description of the nature of the person's mental illness

a specific description of the risk of harm the person evidences that may be demonstrated either by the person's behavior or by evidence of severe emotional distress and deterioration in the person's mental condition to the extent that the person cannot remain at liberty; and

the specific detailed information from which the physician formed the opinion.

A person transported by a peace officer for emergency detention, or detained will be released on completion of the preliminary examination unless the person is admitted to a facility.

This same individual has the right to:

a reasonable opportunity to communicate with and retain an attorney;

a reasonable opportunity to communicate with a relative or other responsible person who has a proper interest in the person's welfare;

be advised of the location of detention, the reasons for the detention, and the fact that the detention could result in a longer period of involuntary commitment;

be transported to a location if the person is not admitted for emergency detention, unless the person is arrested or objects;

be released from a facility; and

be advised that communications with a mental health professional may be used in proceedings for further detention.

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Find information on key laws and resources for Texans living with a mental health diagnosis. This page provides information on both resources and contacts that can help when looking for mental health services in the state. Additionally, this page includes a summary of laws by topic that may impact individuals living with mental illness.

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The Mental Health Parity and Addiction Equity Act

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The Mental Health Parity and Addiction Equity Act

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The Mental Health Parity and Addiction Equity Act | Guidance Portal

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ContentsIntroductionSummary of MHPAEA ProtectionsKey changes made by MHPAEAMHPAEA RegulationFact Sheets & FAQsRegulations and Guidance IntroductionThe Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law t

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Prevalence of Mental Health Conditions in Specific Populations

Black/African American Community

Percent of African Americans with Mental Illness: 16% [Source]

Number of African Americans with Mental Illness: 7 million

Latinx/Hispanic American Community

Percent of Latinx/Hispanic Americans with Mental Illness: 16% [Source]

Number of Latinx/Hispanic Americans with Mental Illness: 10 million

Asian American/Pacific Islander Community

Percent of Asian Americans with Mental Illness: 15% [Source]

Number of Asian Americans with Mental Illness: 2.9 million

Native American/Alaskan Native Community

Percent of Native Americans/Alaskan Natives with Mental Illness: 19% [Source]

Number of Native Americans/Alaskan Natives with Mental Illness: 827,000

Multiracial

Percent of people who identify as being two or more races with mental illness: 25% [Source]

People who identity as being two or more races are most likely to report any mental illness within the past year than any other race/ethnic group.

LGBTQ+ Community

Percent of Individuals who Identify as LGBTQIA+ with Mental Illness: 39%

Number of Individuals who Identify as LGBTQIA+ with Mental Illness: 5.8 million [Source]

Mental Health America released a report on LGBTQ+ mental health using data gathered from our online screening tools here.
Treatment

Percent of adults with mental illness who did not receive any mental health treatment: 56% [Source]

Number of adults with mental illness who did not receive any mental health treatment: 27 million [Source]

Percent of adults with mental Illness who report they try and can't get treatment: 24.7% [Source]

Number of adults with mental Illness who report they try and can't get treatment: 12.2 million [Source]

Percent of youth with depression who did not receive any mental health treatment: 60.3% [Source]

Number of youth with depression who did not receive any mental health treatment: 2.17 million [Source]

Percent of youth with severe depression who received some consistent treatment: 27.2% [Source]

Number of youth with severe depression who received some consistent treatment: 661,000 [Source]

Ratio of individuals in a state to available mental health providers: 504 to 1 [Source]

Insurance Coverage

Percent of US Adults with Mental Illness who are Uninsured: 11.1% [Source]

Number of US Adults with Mental Illness who are Uninsured: 5.5 million [Source]

Percent of youth with private insurance that did not cover mental or emotional problems: 8.1% [Source]

Number of youth with private insurance that did not cover mental or emotional problems: 950,000 [Source]

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Quick Facts and Statistics About Mental Health

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Prevalence of Mental Health Conditions in Specific Populations Percent of African Americans with Mental Illness: 16% [Source] Number of African Americans with Mental Illness: 7 million Percent of Latinx/Hispanic Americans with Mental Illness: 16% [Source] Number of Latinx/Hispanic Americans with Mental Illness: 10 million Percent of Asian Americans with Mental

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Mental Health America (MHA) is committed to promoting mental health as a critical part of overall wellness. We advocate for prevention services for all, early identification and intervention for those at risk, integrated services, care and treatment for those who need them, and recovery as the goal.

We believe that gathering and providing up-to-date data and information about disparities faced by individuals with mental health problems is a tool for change.
FILL OUT THE FORM BELOW TO DOWNLOAD THE PRINTABLE VERSION OF THE REPORT.
2023Key Findings

In 2019-2020, 20.78% of adults were experiencing a mental illness. That is equivalent to over 50 million Americans.

The vast majority of individuals with a substance use disorder in the U.S. are not receiving treatment. 15.35% of adults had a substance use disorder in the past year. Of them, 93.5% did not receive any form of treatment.

Millions of adults in the U.S. experience serious thoughts of suicide, with the highest rate among multiracial individuals. The percentage of adults reporting serious thoughts of suicide is 4.84%, totaling over 12.1 million individuals. 11% of adults who identified with two or more races reported serious thoughts of suicide in 2020 - 6% higher than the average among all adults.

Over 1 in 10 youth in the U.S. are experiencing depression that is severely impairing their ability to function at school or work, at home, with family, or in their social life. 16.39% of youth (age 12-17) report suffering from at least one major depressive episode (MDE) in the past year. 11.5% of youth (over 2.7 million youth) are experiencing severe major depression.

Over half (54.7%) of adults with a mental illness do not receive treatment, totaling over 28 million individuals. Even in Montana (ranked #1), over 4 in 10 adults with a mental illness did not receive care.

Almost a third (28.2%) of all adults with a mental illness reported that they were not able to receive the treatment they needed. 42% of adults with AMI reported they were unable to receive necessary care because they could not afford it.

10.8% (over 5.5 million) of adults with a mental illness are uninsured. Hispanic adults with AMI were least likely to have health insurance, with 19% reporting they were not covered by insurance.

6.34% of youth in the U.S. reported a substance use disorder in the past year. That is equivalent to over 1.5 million youth in the U.S. who meet the criteria for an illicit drug or alcohol use disorder.

22.87% of adults who report experiencing 14 or more mentally unhealthy days each month were not able to see a doctor due to costs. In Georgia (ranked 51), over one-third of adults experiencing frequent mental distress are unable to afford a doctor's visit.

59.8% of youth with major depression do not receive any mental health treatment. Asian youth with major depression were least likely to receive specialty mental health care, with 78% reporting they did not receive mental health services in the past year. In South Carolina, the lowest ranking state, nearly 8 in 10 youth with depression do not receive care.

Nationally, only 28% of youth with severe depression receive some consistent treatment (7-25+ visits in a year). Most (57.3%) youth with severe depression do not receive any care.

Nationally, 1 in 10 youth who are covered under private insurance do not have coverage for mental or emotional difficulties - totaling over 1.2 million youth. In Arkansas (ranked 51), nearly one-quarter of youth with private insurance do not have coverage for mental health care.

Only .718 percent of students are identified with emotional disturbance for an individualized education program (IEP). IEPs, with sufficient resources for schools and teachers, are critical for ensuring that youth with disabilities can receive the individualized services, supports, and accommodations to succeed in a school setting.

In the U.S., there are an estimated 350 individuals for every one mental health provider. However, these figures may actually be an overestimate of active mental health professionals, as it may include providers who are no longer practicing or accepting new patients..

Explore the web-based report using the links provided on the left or download the printable report.
The State of Mental Health in America
In the above links you will find a Collection of Data across all 50 states and the District of Columbia answering the following questions:

How many adults and youth have mental health issues?

How many adults and youth have substance use issues?

How many adults and youth have access to insurance?

How many adults and youth have access to adequate insurance?

How many adults and youth have access to mental health care?

Which states have higher barriers to accessing mental health care?

Our Goal:

To provide a snapshot of mental health status among youth and adults for policy and program planning, analysis, and evaluation;

To track changes in the prevalence of mental health issues and access to mental health care;

To understand how changes in national data reflect the impact of legislation and policies; and.

To increase dialogue and improve outcomes for individuals and families with mental health needs

Why Gather this Information?

Using national survey data allows us to measure a community's mental health needs, access to care, and outcomes regardless of the differences between the states and their varied mental health policies.

Rankings explore which states are more effective at addressing issues related to mental health and substance use.

Analysis may reveal similarities and differences among states in order to begin assessing how federal and state mental health policies result in more or less access to care.

This publication was made possible by the generous support of Alkermes and Otsuka America Pharmaceutical Companies.
The content of this webpage is the property of Mental Health America. MHA grants a limited license to use the webpage, or portions thereof, only if, whenever the webpage is used in written or electronic form, it is clearly stated that the website was created by and is the property of Mental Health America and a link is provided to www.mhanational.org. Under no circumstances may the website be used for any commercial purpose without the express written permission of Mental Health America. For permission to use the content of this webpage, please contact info@mhanational.org.

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Mental Health America's annual State of Mental Health Report ranks all 50 states and the District of Columbia based on several mental health and access measures.

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National Institute of Mental Health (NIMH)

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Mental illnesses are common in the United States. It is estimated that more than one in five U.S. adults live with a mental illness (57.8 million in 2021). Mental illnesses include many different conditions that vary in degree of severity, ranging from mild to moderate to severe. Two broad categories can be used to describe these conditions: Any Mental Illness (AMI) and Serious Mental Illness (SMI). AMI encompasses all recognized mental illnesses. SMI is a smaller and more severe subset of AMI. Additional information on mental illnesses can be found on the NIMH Health Topics Pages.

Definitions

The data presented here are from the 2021 National Survey on Drug Use and Health (NSDUH) by the Substance Abuse and Mental Health Services Administration (SAMHSA). For inclusion in NSDUH prevalence estimates, mental illnesses include those that are diagnosable currently or within the past year; of sufficient duration to meet diagnostic criteria specified within the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); and, exclude developmental and substance use disorders.

Any Mental Illness

Any mental illness (AMI) is defined as a mental, behavioral, or emotional disorder. AMI can vary in impact, ranging from no impairment to mild, moderate, and even severe impairment (e.g., individuals with serious mental illness as defined below).

Serious Mental Illness

Serious mental illness (SMI) is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. The burden of mental illnesses is particularly concentrated among those who experience disability due to SMI.

Prevalence of Any Mental Illness (AMI)

Figure 1 shows the past year prevalence of AMI among U.S. adults.

In 2021, there were an estimated 57.8 million adults aged 18 or older in the United States with AMI. This number represented 22.8% of all U.S. adults.

The prevalence of AMI was higher among females (27.2%) than males (18.1%).

Young adults aged 18-25 years had the highest prevalence of AMI (33.7%) compared to adults aged 26-49 years (28.1%) and aged 50 and older (15.0%).

The prevalence of AMI was highest among the adults reporting two or more races (34.9%), followed by American Indian / Alaskan Native (AI/AN) adults (26.6%). The prevalence of AMI was lowest among Asian adults (16.4%).

Figure 1

*Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic. NH/OPI = Native Hawaiian / Other Pacific Islander | AI/AN = American Indian / Alaskan Native

Mental Health Services - AMI

Figure 2 presents data on mental health services (including virtual services) received within the past year by U.S. adults aged 18 or older with any mental illness (AMI). NSDUH defines mental health services as having received inpatient treatment/counseling or outpatient treatment/counseling, or having used prescription medication for problems with emotions, nerves, or mental health.

In 2021, among the 57.8 million adults with AMI, 26.5 million (47.2%) received mental health services in the past year.

More females with AMI (51.7%) received mental health services than males with AMI (40.0%).

The percentage of young adults aged 18-25 years with AMI who received mental health services (44.6%) was lower than adults with AMI aged 26-49 years (48.1%) and aged 50 and older (47.4%).

Figure 2

*Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic. Note: Estimates for Native Hawaiian / Other Pacific Islander and, American Indian / Alaskan Native groups are not reported in the above figure due to low precision of data collection in 2021.

Prevalence of Serious Mental Illness (SMI)

Figure 3 shows the past year prevalence of SMI among U.S. adults.

In 2021, there were an estimated 14.1 million adults aged 18 or older in the United States with SMI. This number represented 5.5% of all U.S. adults.

The prevalence of SMI was higher among females (7.0%) than males (4.0%).

Young adults aged 18-25 years had the highest prevalence of SMI (11.4%) compared to adults aged 26-49 years (7.1%) and aged 50 and older (2.5%).

The prevalence of SMI was highest among AI/AN adults (9.3%), followed by adults reporting two or more races (8.2%). The prevalence of SMI was lowest among Asian adults (2.8%).

Figure 3

* Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic. NH/OPI = Native Hawaiian / Other Pacific Islander | AI/AN = American Indian / Alaskan Native.

Mental Health Services - SMI

Figure 4 presents data on mental health services received within the past year by U.S. adults 18 or older with serious mental illness (SMI). The NSDUH defines mental health services as having received inpatient treatment/counseling or outpatient treatment/counseling or having used prescription medication for problems with emotions, nerves, or mental health.

In 2021, among the 14.1 million adults with SMI, 9.1 million (65.4%) received mental health treatment in the past year.

More females with SMI (67.6%) received mental health treatment than males with SMI (61.3%).

The percentage of young adults aged 18-25 years with SMI who received mental health treatment (57.9%) was lower than adults with SMI aged 26-49 years (67.0%) and aged 50 and older (71.0%).

Figure 4

*Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic. Note: Estimates for Asian, Native Hawaiian / Other Pacific Islander, and American Indian / Alaskan Native groups are not reported in the above figure due to low precision.

Prevalence of Any Mental Disorder Among Adolescents

Based on diagnostic interview data from National Comorbidity Survey Adolescent Supplement (NCS-A), Figure 5 shows lifetime prevalence of any mental disorder among U.S. adolescents aged 13-18.¹

An estimated 49.5% of adolescents had any mental disorder.

Of adolescents with any mental disorder, an estimated 22.2% had severe impairment and/or distress. DSM-IV based criteria were used to determine severity level.

Figure 5

Data Sources

1. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9. PMID: 20855043

2. Substance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report .

Statistical Methods and Measurement Caveats

National Survey on Drug Use and Health (NSDUH)

Diagnostic Assessment:

The NSDUH AMI and SMI estimates were generated from a prediction model created from clinical interview data collected on a subset of adult NSDUH respondents who completed an adapted (past 12 month) version of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (Research Version, Non-patient Edition) (SCID-I/NP; First, Spitzer, Gibbon, & Williams, 2002), and was differentiated by level of functional impairment based on the Global Assessment of Functioning Scale (GAF; Endicott, Spitzer, Fleiss, & Cohen, 1976).

The assessment included diagnostic modules assessing the following: mood, anxiety, eating, impulse control, substance use, adjustment disorders, and a psychotic symptoms screen.

The assessment did not contain diagnostic modules assessing the following: adult attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, schizophrenia or other psychotic disorders (although the assessment included a psychotic symptom screen).

People who only have disorders that are not included in these diagnostic modules may not be adequately detected. However, there are known patterns of high comorbidities among mental disorders; these patterns increase the likelihood that people who meet AMI and/or SMI criteria were detected by the study, as they may also have one or more of the disorders assessed in the SCID-I/NP.

Population:

The entirety of NSDUH respondents for the AMI and SMI estimates were the civilian, non-institutionalized population aged 18 years old or older residing within the United States.

The survey covered residents of households (persons living in houses/townhouses, apartments, condominiums; civilians living in housing on military bases, etc.) and persons in non-institutional group quarters (e.g., shelters, rooming/boarding houses, college dormitories, migratory workers' camps, and halfway houses).

The survey did not cover persons who, for the entire year, had no fixed address (e.g., homeless and/or transient persons not in shelters); were on active military duty; or who resided in institutional group quarters (e.g., correctional facilities, nursing homes, mental institutions, long-term hospitals).

Some people in these excluded categories had AMI and/or SMI, but were not accounted for in the NSDUH AMI and/or SMI estimates.

Data regarding sex of the respondent was assessed using male and female categories only. Gender identity information was not collected in the survey.

Survey Non-response:

In 2021, 53.0% of the selected NSDUH sample of people 18 or older did not complete the interview. This rate of non-response is higher than in previous years. Please see the Background on the 2021 NSDUH and the COVID-19 Pandemic section below for more information.

Reasons for non-response to interviewing include the following: refusal to participate (30.1%); respondent unavailable or never at home (18.8%); and other reasons such as physical/mental incompetence or language barriers (4.2%).

People with mental illness may disproportionately fall into these non-response categories. While NSDUH weighting includes non-response adjustments to reduce bias, these adjustments may not fully account for differential non-response by mental illness status.

Data Suppression:

For some groups, data are not reported due to low precision. Data may be suppressed in the above charts if the data do not meet acceptable ranges for prevalence estimates, standard error estimates, and sample size.

Background on the 2021 NSDUH and the COVID-19 Pandemic:

Data collection methods for the 2021 NSDUH changed in several ways because of the COVID-19 pandemic: the 2021 NSDUH continued the use of multimode data collection procedures (both in-person and virtual data collection) that were first implemented in the fourth quarter of the 2020 NSDUH. Overall, 54.6% of interviews were completed via the web, and 45.4% were completed in person. In 2021, the weighted response rates for household screening and for interviewing were 22.2% and 46.2%, respectively, for an overall response rate of 10.3% for people aged 12 or older.

Given the use of multimode data collection procedures throughout the entirety of the collection year and the rate of non-response, comparison of estimates from the 2021 NSDUH with those from prior years must be made with caution.

Please see the 2021 National Survey on Drug Use and Health Methodological Summary and Definitions report for further information on how these data were collected and calculated.

National Comorbidity Survey Adolescent Supplement (NCS-A)

Diagnostic Assessment and Population:

The NCS-A was carried out under a cooperative agreement sponsored by NIMH to meet a request from Congress to provide national data on the prevalence and correlates of mental disorders among U.S. youth. The NCS-A was a nationally representative, face-to-face survey of 10,123 adolescents aged 13 to 18 years in the continental United States. The survey was based on a dual-frame design that included 904 adolescent residents of the households that participated in the adult U.S. National Comorbidity Survey Replication and 9,244 adolescent students selected from a nationally representative sample of 320 schools. The survey was fielded between February 2001 and January 2004. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview.

Survey Non-response:

The overall adolescent non-response rate was 24.4%. This is made up of non-response rates of 14.1% in the household sample, 18.2% in the un-blinded school sample, and 77.7% in the blinded school sample. Non-response was largely due to refusal (21.3%), which in the household and un-blinded school samples came largely from parents rather than adolescents (72.3% and 81.0%, respectively). The refusals in the blinded school sample, in comparison, came almost entirely (98.1%) from parents failing to return the signed consent postcard.

For more information, see PMID: 19507169 and the NIMH NCS-A study page.

Last Updated: March 2023

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An overview of statistics for mental illnesses. Mental illnesses are common in the United States. One in six U.S. adults lives with a mental illness (43.4 million in 2015). Mental illnesses include many different conditions that vary in degree of severity, ranging from mild to moderate to severe.

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Mental Health First Aid USA - Mental Health First Aid

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Mental Health First Aid is a national program to teach the skills to respond to the signs of mental illness and substance use.

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American Foundation for Suicide Prevention

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American Foundation for Suicide Prevention

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Call or text 988 or text TALK to 741741

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American Foundation for Suicide Prevention

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Learn about suicide, how you can help prevent it, and resources for those affected, from the American Foundation for Suicide Prevention. Our mission: save lives and bring hope to those affected by suicide

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REFLECTION
The complex topic of suicide has an influence on those who have died by suicide as well as survivors, family members, friends, and members of the greater community. Suicide is typically influenced by a wide range of interconnected factors, including social, physical, situational, psychological, economic, and cultural issues, according to experts.

Despite the efforts of academics, the vast effects of suicide and its ties to different aspects of our lives remain poorly understood and stigmatized. Suicide sufferers and organizations working to prevent it are seriously threatened by the widespread stigma linked with it. If attempts to prevent and treat suicide are to be successful, public health measures must be given top priority in order to improve the health and safety of those who would be most impacted.

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Suicide is a complex issue that can affect everyone, including those who have died by suicide, survivors, family members, friends, and members of the wider community. Further, experts recognize that suicide is often rooted in a broad net of interconnected factors, including social, physical, circumstantial, psychological, economic, and cultural issues.

Nevertheless, in spite of the work of today's leading suicidologists, suicide's far-reaching effects and its links to various different aspects of our lives remain poorly understood and highly stigmatized. In particular, the widespread stigma around suicide is extremely harmful both to the people who are affected by it and to suicide prevention initiatives. For suicide prevention and treatment efforts to succeed, public health efforts including policy, funding, and research efforts need to be prioritized to improve the health and safety of those impacted most.

What Does Stigma Around Suicide Look Like?

According to the American Psychological Association (APA), stigma is defined as "the negative social attitude attached to a characteristic of an individual that may be regarded as a mental, physical, or social deficiency. A stigma implies social disapproval and can lead unfairly to discrimination against and exclusion of the individual."

The stigma around suicide takes a variety of different forms. Often, it manifests as negative beliefs or stereotypes about suicide and the people affected by it. Those individuals (including those who have died by suicide, survivors, and their families) may also experience distrust and avoidance from other people, and may even receive differential treatment from professionals or social institutions.

What Contributes to the Stigma Around Suicide?

Historically, suicide has long been associated with immorality. Many religions (including Christianity, and especially Catholicism) consider suicide to be a sin. To this day, suicide remains illegal in many countries.

Broadly speaking, stigma is almost always the result of ignorance or false beliefs, and the stigma around suicide is no exception. There are many myths attributed to suicide, many of which are perpetuated by media and social media, and have reinforced existing stigmas around suicide. As a result, they become even more entrenched in our social consciousness.

What is the Impact of Suicide Stigma?

These beliefs are not just untrue (and in many cases, unfair) - they are also actively harmful to anyone who has been affected by suicide. For example:

Stigma may impede the healing and recovery process for people who have attempted suicide. In some cases, the care they receive from healthcare professionals might be inadequate; that is, it might address their physical needs without taking care of the emotional or psychological needs that caused the attempt in the first place.

Individuals who are suicidal might hesitate to reach out for help because they are afraid of being perceived as weak or a failure if they admit to contemplating suicide. This may result in any mental health issues they are experiencing being exacerbated.

The families and loved ones of individuals who have died by suicide may experience feelings of self-blame of guilt, or may feel judged by other people. This, in turn, can impede their mourning process and make it difficult for them to find support in their grief.

How To End the Stigma of Suicide

Fortunately, the stigma around suicide and mental illness is decreasing, but there is still a long way to go. There are things that each of us can do in our daily lives to promote suicide prevention and foster a supportive environment for people who have been affected by suicide.

In particular, normalizing mental health treatment and combating myths about suicide are arguably the most important actions we can take to destigmatize suicide. This starts with widespread education efforts around the causes of suicide and effective prevention techniques. In addition, access to resources and support for those affected by suicide is important in helping individuals who are thinking about suicide, those who have attempted it, and the families and loved ones of those who have died by suicide and survivors alike.

The American Association of Suicidology (AAS) is dedicated to promoting the understanding and prevention of suicide, as well as providing support, hope, and healing to those who have been affected by it. AAS promotes the study of suicide as a research discipline, public awareness programs, public education, and training for professionals and volunteers. AAS membership includes mental health and public health professionals, researchers, suicide prevention and crisis intervention centers, school districts, crisis center volunteers, survivors of suicide loss, attempt survivors, and a variety of laypersons who have an interest in suicide prevention.

By joining the AAS, the largest and oldest suicide prevention membership organization in the U.S., you will be among the ranks of the world's leading suicidologists and suicide prevention experts. Ready to join? Individual and Organizational Memberships are available!

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Suicide is a complex issue that can affect everyone, including those who have died by suicide, survivors, family members, friends, and members of the wider community. Further, experts recognize that suicide is often rooted in a broad net of interconnected factors, including social, physical, circumstantial, psychological, economic, and cultural issues.

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Find facts and statistics sheets, shareable graphics, specific resources for demographics and much more. You can also find information about your local AAS Accredited Crisis Center in the links bel...

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1 in 5 of Us Lives With a Mental Illness

The Latest Research Discoveries

Donate Now

Awarding Grants for scientific research

100% of every donation for research goes to research

World-renowned scientists

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1 in 5 of Us Lives With a Mental Illness The Latest Research Discoveries Awarding Grants for scientific research 100% of every donation for research goes to research World-renowned scientists

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The National Child Traumatic Stress Network

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Childhool Traumatic Grief: Information for School Personnel

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Childhool Traumatic Grief: Information for School Personnel

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Substance Abuse and Mental Health Services Administration

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Tips for Survivors: Coping with Grief after a Disaster or Traumtic Event

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Tips for Survivors: Coping with Grief after a Disaster or Traumtic Event

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REFLECTION
Everyone copes with grief in their own manner, and in their own time.  For some this is a swift process that with support from loved ones they are able to forward with their loss and  take the steps necessary to gain back a sense of balance, during a turbulant time.  However for some this process may take longer and additional community support is needed. That's why it's important to know how to cope with grief. When I first saw this handout, I thought "okay, I'm pretty sure I know how to cope with grief. I've been through so much of it, I'm a pro!" However, as with anyone who thinks they know it all, I was wrong and I learned some things about coping that I didn't know before and search for resources in my community that would be benefical for me to reach out to.

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Racial violence and discrimination are woven into the fabric of the United States. The way policies and laws are implemented. The weaponization of Whiteness and privilege. Disparities in education and health care. The horrible and senseless killings of Black people throughout our nation's history and into the present day.

How do daily acts of racial violence, injustice and discrimination affect the mental health of Black Americans? What is it like to work and live beside people who don't value you as a human being? What is it like to live in a country where your rights are frequently threatened?

DominiqueHammonds, an assistant professor and testing coordinator in the Department of Human Development and Psychological Counseling at Appalachian State University, provides a quick glimpse into the complexities of being a Black woman and counselor in a racist society. Hammonds, wearing a shirt that read "Black and Educated," was shopping in Walmart recently when a White woman passed by her and casually said, "You're disgusting." In that moment, Hammonds felt powerless. She feared the consequences of saying or doing anything in response.

Hammonds left the store and shortly thereafter went into a counseling session where her client recounted feeling powerless, angry and upset because of injustices they were experiencing in their life. Hammonds had to compartmentalize her own feelings of powerlessness to help the client.

Counselors play an important role in helping Black Americans cope with and heal from racial stress and trauma, but they can do more. Namely, they can also take steps toward changing an unjust and racist system that powerfully and negatively affects the mental health of Black Americans.
A distrust of mental health
Research indicates that Black Americans are 20% more likely to report serious psychological distress than are White Americans, yet they are less likely to use mental health services.

LoniCrumb and Janeé Avent Harris, who are both assistant professors of counselor education at East Carolina University (ECU), examined, along with two of their colleagues, the negative perceptions of mental illness and treatment among Black Americans. They found that stigma, a lack of trust in mental health care and a mislabeling of Black people's presenting concerns make this group more apprehensive to seek counseling. Financial constraints and a lack of access to culturally responsive mental health care are additional barriers, explains Crumb, a research and innovation associate with the Rural Education Institute in the College of Education at ECU. (See their article " African Americans' perceptions of mental illness and preferences for treatment" in the Journal of Counselor Practice for a more detailed discussion of their findings.)

This distrust is not unfounded. Black Americans have been misdiagnosed and overdiagnosed with schizophrenia for decades, for example. (For more, read " The historical roots of racial disparities in the mental health system " by Tahmi Perzichilli at CT Online.)

Angie D. Cartwright, an associate professor of counseling at the University of North Texas (UNT), stresses the importance of looking at how and why the mistrust of mental health began in the Black community. "Institutional and systemic racism is the foundation of a lot of our medical treatments, including mental health counseling," Cartwright says. "And, historically, when [Black people] invite others into [their] homes and communities, then problems happen."
Sitting with discomfort
Counselors, not clients, should be the first to broach issues of racism. This isn't necessarily easy or comfortable.

Counselors often conflate comfort and safety, but they are two different things, insists Cartwright, a licensed professional counselor and licensed sex offender treatment provider who is the clinical director and owner of North Texas Counseling and Wellness.

As she explains, being comfortable enough to broach the topic does not mean the topic itself will be comfortable. "It's not comfortable to say, 'I was discriminated against,' 'I had a gun pulled on me' or 'I was fired because my boss is racist,'" she continues. "There are some conversations we will always feel some discomfort talking about. And that's OK." But clients should feel safe enough to share their experiences - ones that will often be uncomfortable for counselors to hear, she adds.

"You have to get comfortable with being uncomfortable," says Hammonds, a licensed clinical mental health counselor (LCMHC) in North Carolina. "Part of the [counseling] skill set is learning how to have these discussions in a way that feels comfortable." For example, can counselors say the word Black, acknowledge their own ethnic identities or discuss racism knowledgeably? If not, then clients know they won't be able to go beyond a surface-level discussion with them, Hammonds explains.

What counselors say doesn't even have to be overly complicated, notes Hammonds, an American Counseling Association member. They can simply say, "I just want to check in. There's a lot going on around us right now. What's that been like for you?" or "I'm curious how you as a Black American might be affected by racial violence and oppression."

Being open and brave about this topic will likely result in some missteps. That's part of the process, says Hammonds, who encourages counselors to use those mistakes as opportunities to learn.

One misstep may be getting defensive when clients express anger, distrust or sadness about their experiences. "If you find yourself getting defensive - trying to explain away the client's experiences or identifying with client experiences and feeling like you have to apologize ... on behalf of the system - don't," Hammonds says. "All you're doing [in getting defensive] is communicating to the client that you're still not comfortable and haven't done your own personal work around this." And apologizing just puts clients in a position where they feel obligated to say, "Oh, it's OK," she adds.

Instead, she advises counselors to reflect on their own internal experience and to tune in to what might be prompting that response. Perhaps it's a case of the counselor wanting to protect their own ego, or maybe they are masking their own discomfort or lack of knowledge. If counselors find themselves becoming defensive in session, they can tell the client, "I feel like I'm reacting to something right now, and I recognize that I need to do some self-reflection. But I don't want to heap that on you." But do this briefly, Hammonds says, or else the session becomes about the counselor rather than the client.

Building trust and rapport also becomes critical to creating a sense of safety for these clients. Too often, counselors jump to diagnosis and treatment because the mental health system encourages them to have a solid plan and work toward a goal fairly early in treatment, Hammonds points out. She encourages counselors to slow down and first invest time in establishing good relationships with their Black clients.
Context matters
As Avent Harris, an ACA member, points out, counselors won't be aware of needing to broach the topic of racism unless they understand its historical and political context. Put simply, they have to know what to look for and ask about.

"You don't learn this context or gain this cultural awareness by just reading the DSM [ Diagnostic and Statistical Manual of Mental Disorders]," says Avent Harris, who specializes in multicultural considerations in counselor education and the role of spirituality in Black mental health help-seeking behaviors. She advises counselors to move beyond reading only counseling texts to explore the works of Black scholars, theologians and authors.

Counselors may also need to adjust a technique or approach to better fit with their clients' experiences. For example, the thought of going for a run in the evening sounds straightforward, but for many Black people, and Black men in particular, it can evoke a sense of fear. They question whether they will be safe or if their choice to run could cost them their life.

If a client brings this fear up in session, it could be dangerous for the counselor to use a thought-stopping technique, with the aim of interrupting, removing and replacing the client's "problematic thoughts," Hammonds explains. Suggesting that the client simply stop thinking that running could harm them ignores their experiences and the existence of the racism embedded in society, she says.

Instead, Hammonds, president-elect of the North Carolina Counseling Association, says the counselor should consider the context around the client's fear of running alone at night. Where does that fear come from? How does society contribute to or perpetuate this client's fear and anxiety?

"Those are the types of discussions that we need to be making space for," she says.
Self-awareness and honesty about biases
Hammonds stresses the importance of counselors reflecting - honestly - on their own experiences and biases. As she points out, counselors often like to think, "I took this multicultural course, or I've worked with clients from diverse backgrounds, so I'm doing OK." But it may not mean that at all, she emphasizes.

This self-awareness starts with counselor training. Working with diverse clients is the best way to learn to appreciate differences and to examine one's own biases and beliefs, says Crumb, an LCMHC in North Carolina.

This diversity should also extend to counselors' consultation groups. Avent Harris, an LCMHC associate in North Carolina, looks for colleagues who will provide honest feedback and challenge her own thoughts and beliefs. She says that if she has an uncomfortable moment in session, these colleagues would ask, "So, what made you uncomfortable in that moment? What questions do you need to ask yourself to reflect on that moment?" They wouldn't just echo her thoughts or tell her "not to worry about it," Avent Harris says.

Hammonds recommends that counselors continue to record and watch themselves in session just as they did during graduate school and supervision. "There's so much value in replaying your words and listening from that outsider's perspective," she says. The process affords counselors a chance to (re)consider their words, think about the purpose of their statements or actions, and evaluate whether they really listened to and heard their clients.

Counselors should also get their own counselor. "Some of this stuff is deep-rooted. It takes time to dig up those roots, to understand them, to untangle them and to repot them," Cartwright says.

She jokes that her mother always told her, "Never trust a beautician with bad hair." This same principle applies to counselors, she says. They have to make sure they take care of their own mental health before working with clients on their well-being. "And clients will be able to tell if you ... have done your work," she adds.

Cartwright, the project director for UNT Classic (a program that addresses disparities in mental health services for Black and Hispanic populations in the Dallas-Fort Worth metro areas) and UNT ICBH Project (a program that supports graduate students during clinical training), suggests that her colleagues, especially those who hold identities associated with privilege, work with a counselor who identifies with a marginalized group or with intersections with which the privileged colleague struggles.

They should also intentionally put themselves in a position in which they are the minority, continues Cartwright, a member of the ACA Advocacy Task Force and president of the International Association of Addictions and Offender Counselors, a division of ACA. For example, she suggests that White counselors attend a Black church one Sunday. "If you are uncomfortable for that short time that you're there, imagine what your Black clients feel like on a daily basis when they are constantly in spaces dominated by White people," she observes.
Finding voice and value
Black clients report to counseling with the same common presenting concerns that other clients have. But in addition, Hammonds says, they often seek counseling because of issues of "voice and value." They have experiences that either minimize their voice or communicate - overtly or covertly - that their ideas, opinions and problems don't matter or don't matter as much as those of others, she explains. Feeling undervalued, dismissed and unheard can lead to anxiety, depression and other mental health issues, she adds.

Cartwright specializes in underserved populations in counseling and counselor education, mentorship in counselor education, and offender and addictions counseling issues. She once worked with a client who was experiencing racism and discrimination at her job. The former client was the only Black woman on a large corporate team, and she noticed that meeting times would suddenly change without anyone alerting her. She also got the sense that her co-workers were talking about her behind her back. At first, she internalized this discrimination and started thinking that she must be bad at her job. She felt like an impostor.

But after another colleague confirmed the woman's suspicions of racial discrimination, the former client filed a lawsuit and won. The win came at a cost, however. She learned that co-workers had purposely changed meeting times without letting her know. Other colleagues whom she had thought were well-intentioned had made racist and hurtful remarks about her that were uncovered during the lawsuit and investigation.

As a result, the client began to question her judgment and worth. Cartwright helped the client learn to feel valued and trust herself again. They worked on challenging the client's thoughts that she wasn't good enough. For instance, they used self-affirming techniques such as daily affirmations and "I" statements that allowed the client to identify and acknowledge her strength and resilience.

Even if counselors can't relate to being discriminated against at work, they probably can identify with feeling like their voice hasn't been heard, Hammonds says. With that perspective, counselors can take intentional steps to empower these clients in session.

For example, Black clients often feel like they can't or shouldn't tell counselors if they didn't like the way the counselor phrased something or if a moment in session made them uncomfortable, Hammonds notes. But they should be made to feel comfortable voicing those thoughts, she continues, and it's up to counselors to create a space that invites that feedback.
Hidden struggles
A May 31 article in the Washington Post reporting on protests in the wake of the killing of George Floyd described a less visible impact of racial violence: "the private weariness and anguish felt by many [B]lack people in the country." In other words, many Black people are exhausted.

Emotional exhaustion is another reason that Black individuals often seek counseling, Hammonds says. Besides being fatigued from the discrimination and injustices that they experience daily, they often find it necessary to code-switch - changing the way they talk and express themselves when they are outside of their homes and Black communities.

To help explain this concept, Hammonds uses the analogy of counseling professionals switching their "hats" or roles. They may go from teaching to supervision to having a counseling session with a client and back to teaching again, all in the same day, which can be taxing.

"Switching roles, having to constantly pause and reconsider how much you can share and what is your role in this new context, and always being aware of what you can and can't say and what you can and can't do is exhausting," Hammonds says. "And that's an emotional labor that many White Americans aren't required to do."

Black women often face an extra burden. As Avent Harris explains, "Black women are expected both inside and outside their community to not be vulnerable, to not share emotions and to carry the weight of everything on their shoulders."

This unrealistic expectation can take a toll on mental health. In fact, many of Cartwright's clients struggle with the " Black superwoman syndrome " - the myth that Black women are impermeable. They feel pressure to do it all and to do it well. Although this isn't really a syndrome, it does help explain the chronic stress these women endure while trying to juggle multiple roles and keep up with the daily demands placed on them by family, work and community.

Cartwright's clients often discuss feeling misunderstood at work and how co-workers minimize their experiences. Cartwright normalizes these experiences for her clients, but she also expresses how sad it is that this is their "normal."
The trauma of racial violence
Instances of brutality and violence against Black people are not new, and neither are the racial disparities that regularly confront them. The main difference today is the ability to easily document such instances, says Hammonds, whose research interests include technology in counseling, multicultural counseling and community determinants of mental health. Almost everyone today has a smartphone in their pockets, and more people are using them to record acts of race-based violence and to demand justice and accountability.

These videos also continually expose others to these traumatic and heinous acts. This can be particularly traumatizing for Black people, who often internalize the traumas they witness because they know it could have easily happened to them, Hammonds says.

The disparaging comments on social media can also be traumatizing and triggering for Black Americans, Crumb adds. For instance, they may read a racist comment made by a supervisor or colleague. Then they have to return to work and sit beside that person, knowing how that person really feels about them.

"And so often, [Black people] are expected to move through the world, to hear all this, to see all this, and have no emotional reaction or response," Avent Harris says. Counselors can help change this by validating clients' emotional reactions to racial violence and discriminatory remarks, she adds. This involves letting them know that it's OK to feel disappointed, sad, angry, scared, anxious or whatever else they are feeling.

The trauma of being exposed to racial violence and remarks also has a collective effect. "Collective trauma is exposure to stressful events that threatened a sense of safety on a group level," Hammonds explains.

On a recent episode of The Thoughtful Counselor podcast, Hammonds described how repeated exposure to racial violence and discrimination operates like a wound that won't heal: "That spot's been nicked so many times. We can go about the process of healing, but before you know it, there is another nick. Then you're walking around doing your best to cope, shielding that spot, anticipating situations that might nick you again. ... You are always on edge. You're withdrawing. Your trust is slow to build in other people and situations. You feel angry and sad. And you start to think, 'Is there something wrong with me? Why can't I get out of this cycle?'"

This collective trauma correlates with symptoms of depression and posttraumatic stress disorder such as avoidance, reexperiencing, numbing and hyperarousal, she adds.

If a community experiences stress together, then counseling approaches that draw on the power of relationships are helpful, Hammonds says. These approaches include relational therapies, psychodrama, drama therapies, creative approaches and group therapy.

Hammonds often incorporates music into her sessions with clients. She describes music as being akin to a picture book because it connects people to a certain memory, place, emotion or experience in their life.

When clients can't easily describe their thoughts, feelings or perceptions in their own words, she asks them to think of a song that best captures their emotions or that represents what they see around them. She then pulls up the song and plays it in session, asking the client, "What is powerful about this song? How do the lyrics or beat affect you?"
Impacts on Black children
In the summer of 2016, Philando Castile was fatally shot in his car by a Minnesota police officer during a traffic stop. Castile wasn't alone. His girlfriend, Diamond Reynolds, and her 4-year-old daughter witnessed the entire incident.

After the shooting, Reynolds, who was now in handcuffs, was understandably distraught and emotional. Her daughter tried to comfort her, exclaiming, "Mom, please stop saying cusses and screaming 'cause I don't want you to get shooted." A few minutes later, the girl said, "I wish this town was safer. ... I don't want it to be like this anymore."

The girl's words illustrate how racism and racial violence affect children even at a young age. "Black youth are just as affected as their Black parents are by systemic racism and injustices," says Crumb, an ACA member whose research interests include rural and school-based mental health services. Black children are affected directly and indirectly. They witness racial violence and discrimination themselves, and they hear adults talking about it at the kitchen table. "Then, they assume these thoughts, these fears ... [and] this distrust," Crumb adds.

Again, counselors should take the initiative to broach the topic of racism with these youth. Crumbs calls it "taking the temperature of the room" because counselors can check in to see how children are doing. For example, a counselor could say, "This has been a tough summer with COVID-19 and a lot of people getting harmed and dying. How are you feeling?"

Then counselors should let the children guide the conversations, Crumb says. Some may verbalize their feelings. Others may use play or draw a picture to express their emotions.

Crumb points out that school settings are often the only access that some Black communities have to counselors. But because of mistrust and fear, they may not view counselors and schools as "safe spaces." Crumb advises counselors to be mindful of current and historical racial inequities within school systems and to alter their approaches accordingly in attempting to connect with these children.

Younger children may not have the vocabulary to easily communicate their feelings. They often "speak" through play and toys. So, Cartwright recommends that counselors keep an assortment of toys, dolls and activities that will allow children to communicate in the way in which they feel most comfortable. If they want to use a brown doll, counselors should make sure it is available to them, she adds.

But as Reynold's 4-year-old daughter demonstrated, some Black children possess an early awareness of racism and a vocabulary to discuss it. They often have little choice. Black children will be exposed to inequities earlier than their White peers because of their parents' lived experiences and the conversations they overhear, Avent Harris explains.

Crumb encourages counselors, especially school-based counselors, to be courageous in advocating for Black youth. Black youth are often overlooked academically and are disproportionately suspended, she says. Counselors can be vocal in questioning why that is the reality. Likewise, if diagnoses of attention deficit/hyperactivity disorder and conduct disorders are disproportionate toward one ethnicity, counselors can ask questions and press for answers.

More than that, counselors can do something about such disparities. For example, they can lead professional development trainings for teachers, Crumb says.
Partnering with the Black community
Black people may rely on informal networks of support such as family, friends and their church communities when it comes to issues having to do with their mental health, Crumb says. She add that counselors should encourage clients to continue using these supportive networks because it is imperative that they have trusted individuals to whom they can turn to discuss their experiences of race-based trauma.

Counselors should also reach out and form relationships with stakeholders in Black communities. Crumb and Avent Harris recommend partnering with community organizers, historically Black Greek-letter organizations, those involved with the juvenile justice system, law enforcement personnel and faith leaders.

Faith leaders are often both spiritual and political leaders in the Black community, Avent Harris says, so collaboration with them is crucial. "A lot of times, how [Black Americans] conceptualize events, crises, pain and suffering is coming from [their] spiritual beliefs systems," she adds.

In an article written for CT Online after the 2015 church shooting in Charleston, South Carolina, that took the lives of nine Black people, Avent Harris suggested that counselors could meet with Black pastors and offer to speak in their Sunday morning services, co-sponsor a mental health day or provide referral resources.

Counselors should also think of these partnerships as a preventive measure. Counselors need to be invested and involved with Black communities before crises happen, Avent Harris stresses. She challenges her colleagues to name five contacts they have a working relationship with in the Black community and could reach out to immediately. If they can't name five, she says, then they have some work to do.
Less talk, more action
The words diversity and inclusion have steadily gained prominence in the counseling profession, but Avent Harris believes this has allowed counselors to largely become complacent and not move past thinking of "change" as simply including and hiring diverse individuals.

"It's not just diversity and inclusion. It's how we're doing equity work, how we are doing anti-racism work," she emphasizes. "What are our actions behind the words that we say? And do our actions align with what we say and who we say we are as a profession?"

Avent Harris, like many other Black people, is exhausted from having the same conversation over and over again about what the Black experience is like. "It's time to move beyond that talk and really implement action," she says.

Taking action doesn't mean that all counselors have to hit the streets and protest, but they can commit to influencing the spaces they are in, Crumb says. Maybe that's writing an article. Maybe that's offering a training. Maybe it's working to inform policy. Maybe it involves working toward making positive change in their communities or within themselves.

Cartwright also suggests one small step counselors could take that would have a huge impact: making their services more accessible to communities of color by offering one pro bono slot a week or having a sliding scale.

Although 2020 hasn't been the year we wanted, it may be the one we need. Every day, we hear the global rallying cry, "Black Lives Matter." Behind that cry are Black people who are suffering and dying because of systemic racism. We hear the refrain: Trayvon Martin, Tamir Rice, Eric Garner, Philando Castile, Charleena Lyles, Atatiana Jefferson, Breonna Taylor, Ahmaud Arbery, George Floyd, Tony McDade, Rayshard Brooks, and countless others who have died.

These are the tragic killings that make the news. But how many others die daily without drawing widespread attention? How many more face daily injustices or discrimination?

Yes, their lives matter. And their mental health does too.
****
On June 22, the ACA Governing Council issued a statement on anti-racism. As this article was being written, ACA leadership was listening to a cross section of members and volunteers to develop an action plan that would give life to the statement. For more, see tinyurl.com/ACAAntiRacism.
****
Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.
**** Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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Black mental health matters - Counseling Today

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Racial violence and discrimination are woven into the fabric of the United States. The way policies and laws are implemented. The weaponization of Whiteness and privilege. Disparities in education and health care. The horrible and senseless killings of Black people throughout our nation's history and into the present day.

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Supporting Children with Traumatic grief: What Educators need to know

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Supporting Children with Traumatic grief: What Educators need to know

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Psychological First Aid Online Certificate

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Psychological First Aid Online Certificate

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REFLECTION
Completing the PFA was a daunting task, I thought that I would never finish, however I learned so much while working through it. In the process of going through the online course I learned how to properly respond to a crisis and what type of supports are needed for those who are impacted, to include my self. Overall I learned that the main purpose of PFA is to reduce the stress levels and assist in the recovery efforts of those who are impacted by a traumatic event. Although it was a long train, I felt it was one that was benefical and I appreciated that it was interactive so that I could maintain interest in what was going on, instead of just clicking through, to get it over with.

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REFLECTION
When starting this assignment I was completely confused, Crisis Prevention and Threat Assessment?  How are we supposed to make one of those and make it about domestic violence for the school environment?  I spent hours, days, weeks trying to wrap my head around it. Then it finally hit me domestic violence is about the whole family unit and that includes children AND adults, so that made my life so much easier.  After finally letting the stress of trying to figure out what to do dissipate I was ready to go full speed ahead.  I began working on the slideshow and found that I knew a lot more about domestic violence then I thought I did. At one point I had to stop and take a few days because I remembered why I know so much.  I spent time during those days talking to my "favorite" brother and he was able to get me to the point where I could continue to work without completely losing it and falling apart.  Overall this assignment helped me grow and face truths that I had long ago forgot or repressed.

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Key Ingredients for Successful Implementation

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Key Ingredients for Successful Implementation

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More about Baylor Scott & White EMS

Fleet of 15 ambulances and three wheelchair vans

State-of-the-art communications center

Serving approximately 1,100 square miles, including most of Bell County

The exclusive ambulance provider for the city of Temple, Texas

Also providing non-emergency transportation for patients of Baylor Scott & White Medical Center - Temple and surrounding nursing facilities.

Baylor Scott & White EMS offerings

Our state-of-the-art communications center is staffed by a team of highly trained emergency medical dispatchers. We are able to quickly and efficiently assign the closest, most appropriate vehicle to respond to your needs.

Baylor Scott & White EMS emergency medical dispatchers are trained and certified by the National Academies of Emergency Medical Dispatch, a nationally-recognized course of study. Our dispatchers are also trained in customer service, system resource management and the National Academy of Emergency Medical Dispatch (NAEMD) protocols.

Specialty Care Transportation (SCT)

Baylor Scott & White EMS SCT units are the vehicle of choice for transporting critically ill or injured patients. Each unit is staffed with a critical care paramedic who follows advanced protocols for the management of critically ill patients.

Equipped with state-of-the-art technologies for long distance transports:

Ventilator

Cardiac monitoring with 12 lead EKG

External pacing

Three-channel IV medication pump

Continuous Positive Airway Pressure (CPAP)

ETCO 2 monitoring

Advanced Life Support (ALS)

Baylor Scott & White EMS ALS units are staffed with a paramedic and an emergency medical technician (EMT). ALS paramedics can perform:

Manual defibrillation

Synchronized cardioversion

Transcutaneous pacing

Cardiac monitoring and interpretation, including 12 lead EKG

Paramedics can also execute a host of advanced procedures in the field, including:

Advanced airway management

Medication monitoring and administration

Intraosseous needle placement

Advanced pharmacology and IV pump management

Multiple IV medication infusions

Baylor Scott & White EMS BLS units are used for basic medical transportation of stabilized patients.

The vehicles are equipped with an automated external defibrillator (AED) and staffed by two basic emergency medical technicians who can perform basic airway management.

Bariatric patient transport

BSWEMS offers the only bariatric patient transport service from Dallas to South Austin.

Our Bariatric Unit is fully equipped with patient transfer devices and a true bariatric stretcher capable of handling up to 1,600 pounds. This enables us to provide obese patients with comfortable transportation that has their dignity and care in mind.

If your community group is interested in a demonstration, please contact BSWEMS at 254.724.7476.

Baylor Scott & White EMS is able to provide medical stand-by coverage and public service appearances for your special event, staffed at any level of service that we offer.

Our ambulances are especially popular at community events where our staff is pleased to educate the public about the roles of emergency medical personnel and the equipment that they use. BSWEMS is also actively involved in public safety education within local school districts.

Interested in scheduling our EMS team for an event? Call us at 254.724.8080, Monday-Friday, 8:00 AM - 5:00 PM CST for more information.

Education, research and outreach

Our trauma center near you here in Temple is committed education, research and outreach through:

Enhancing the skills of medical professionals involved in the care of injured patients through the training of medical students and residents

Being a leader in developing new technologies and treatments

Educating the community through outreach

Actively participating in the Texas Department of State Health Services Central Texas Regional Advisory Council

Providing support for facilities seeking trauma center designation

Providing continuing education course and seminars

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Fleet of 15 ambulances and three wheelchair vans State-of-the-art communications center Serving approximately 1,100 square miles, including most of Bell County The exclusive ambulance provider for the city of Temple, Texas Also providing non-emergency transportation for patients of Baylor Scott & White Medical Center - Temple and surrounding nursing facilities.

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Now accepting applications for the Spring 2023 Temple Fire and Rescue Fire Academy. The deadline to submit an application is March 20, 2023. Click HERE to learn more. Overview History Connect With Us Become A Firefighter

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Free Community Classes

Our free community classes are here to help educate you in a variety of topics. Based on the eight principles of our CREATION Life wellness philosophy, we want to make sure you have the information you need to live your life to the fullest. Offerings include free fitness classes as well as childbirth, breastfeeding, and infant care, to name a few.

State-of-the-Art Technology

Open MRIs, hyperbaric medicines, low does CT scans that can detect lung cancer sooner - there was a time when these technologies were only offered at a few hospitals that were usually located in a "big city." Today, you don't have to leave Central Texas. We have the latest technology and follow industry best practices to help you feel whole faster.

Nationwide Network

Did you know that we are a part of AdventHealth - a network of 46 faith-based facilities focused on providing wholistic care in the communities we serve. We are honored to be your community hospital and we are proud to be part of a network that allows us to use our expansive network to bring you high quality healthcare.

If you're looking for a way to enrich your community, consider sharing your time and talents. When you volunteer, you become a part of a legacy of kindness, caring and the healing ministry of Christ. Where do you feel led to serve? You could work in our gift shop, drive a shuttle or help at a nurse's station. Whatever you choose, you're a valued part of our team. Help us surround patients and their families with uncommon compassion.

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Get on the path to whole-person health with medical care from AdventHealth Central Texas, formerly Metroplex Adventist Hospital

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At AdventHealth Central Texas, formerly Metroplex Adventist Hospital, our compassionate experts and advanced care can help you to start leading a happier, healthier life today. The medical care services at our Killeen hospital and in our network of care include surgery, cancer treatments, women's care, sleep studies, a 24-hour ER and more.

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Cedar Crest Hospital & Residential Treatment Center

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Situated on over 30 acres in the beautiful rolling hills of Central Texas, Cedar Crest provides innovative behavioral health and substance abuse treatment for children, adolescents, and adults. Our private campus includes walking trails, picnic areas, outdoor swimming pool, full-size gym, and state-of-the-art exercise equipment; providing opportunities for leisure, therapeutic recreation, and team building skills. Cedar Crest provides a full continuum of care including adolescent residential, inpatient, outpatient, and partial hospitalization/intense outpatient treatments.

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Cedar Crest Hospital & Residential Treatment Center | Belton, TX

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Situated on over 30 acres in the beautiful rolling hills of Central Texas, Cedar Crest provides innovative behavioral health and substance abuse treatment for children, adolescents, and adults. Our private campus includes walking trails, picnic areas, outdoor swimming pool, full-size gym, and state-of-the-art exercise equipment; providing opportunities for leisure, therapeutic recreation, and team building skills.

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Blood donors report feeling a sense of great satisfaction after making their blood donation. Why? Because helping others in need just feels good. Donate blood today to help those in need.

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Make a Donation

As a not-for-profit organization, Love of Christ Food Pantry relies solely on the generous donations.
Read More

Volunteer with Us

Individuals and community groups of all ages are welcome to join us as we serve our community.
Read More

Find a Service

Love of Christ Food Pantry offers groceries, hygiene and clothing items as well as classes and support.
Read More

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As a not-for-profit organization, Love of Christ Food Pantry relies solely on the generous donations. Read More Individuals and community groups of all ages are welcome to join us as we serve our community. Read More Love of Christ Food Pantry offers groceries, hygiene and clothing items as well as classes and support.

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Advent Health Central Texas. (n.d.) Retrieved March 5, 2023, https://www.adventhealth.com/hospital/adventhealth-central-texas

American Association of Suicidolgy. (2023). Stigma and Suicide. https://suicidology.org/2023/01/19/stigma-and-suicide/

American Counseling Association. (2014). 2014 ACA code of ethics. https://www.counseling.org/docs/default-source/default-document-library/2014-code-of-ethics-finaladdress.pdf

American Red Cross. (n.d.) Retrieved March 5, 2023, from https://www.redcross.org/.

Cedar Crest Hospital & Residential Treatment Center. (2022). Retrieved March 5, 2023 from https://www.cedarcresthospital.com/.

Crawford, A. (2023). Reference guide for mental health disorders. Angelo State University.

Cardona, H. and Crawford, A. (2023). Domestic violence. Angelo State University.

Helping Hands Ministry. (n.d.). Rooted in the community, growing in faith. Retrieved March 5, 2023, from https://www.helpinghandsbelton.org/

Red Cross. (n.d.). https://www.redcrossblood.org/

Love of Christ. (n.d.) Love of Christ Pantry. Retrieved March 5, 2023, from https://locfoodpantry.org/

Marbut, R. (2022). Operation: RISE robust interagency strategic engagement.

Menschner, C. and Maul, A. (2016). Key ingredients for successful trauma-informed care implementation. Center for Health Care Strategies. https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf

Mental Health America. (n.d.). Quick facts and statistics about mental health. Mental Health America. https://www.mhanational.org/mentalhealthfacts

Mental Health America. (n.d.). The state of mental health in America. Mental Health America. https://www.mhanational.org/issues/state-mental-health-america

National Alliance on Mental Illness. (2021). 2020 mental health by the numbers. NAMI. https://www.nami.org/mhstats

National Alliance on Mental Illness. (2020). Mental health facts in America. NAMI. https://www.nami.org/mhstats

National Institute of Mental Health. (2022). Mental illness. National Institute of Mental Health, U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/statistics/mental-illness.

Office of the Governor. (n.d.). Mental health protections. Office of the Governor | Greg Abbott. https://gov.texas.gov/organization/disabilities/mental_health_protections

US Department of Health & Human Services. (2011). The mental health parity and addiction equity act: Guidance portal. US Department of Health & Human Services. https://www.hhs.gov/guidance/document/mental-health-parity-and-addiction-equity-act.

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Crisis Intervention: Issues and Challenges

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Crisis Intervention: Issues and Challenges

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Key Ingredients for Successful Implementation

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Key Ingredients for Successful Implementation