Schizophrenia in Minoritized Communities (Ep. 115)

Guest: Regina Graham, MD (she/her)

Medical Director of Early Psychosis Programs,

Health Sciences Clinical Professor

UC Davis School of Medicine

According to the National Institute of Mental Health, nearly one in five U.S. adults live with a mental illness ( 52.9 million people in 2020). While People of Color (POC) have rates of mental health disorders similar to Whites, these disorders are more likely to last longer and result in more significant disability for POC. Most mental illness goes untreated, especially in communities of color. Fifty-two percent of Whites with AMI received mental health services in 2020, compared to 37.1% of Blacks and 35% of Hispanics.

Dr. Graham is a child, adolescent, and adult psychiatrist, with expertise in intensive mental health settings -- including inpatient, residential, and emergency interventions -- working with vulnerable populations. She has a passion for prodromal, early and first-episode psychosis and its management utilizing specialized care models to optimize outcomes for patients, their families, and communities.

Definition of Minoritized Communities:

• Groups who have experienced systemic discrimination and marginalization due to factors like race, ethnicity, gender, sexual orientation, or socioeconomic status
• Groups excluded from opportunities and power structures in our society

Questions:

• How does cultural background impact the experiences of schizophrenia for the individual and their loved ones?
• How could trauma impact members of minoritized communities with schizophrenia?
• How are members of minoritized communities with schizophrenia being served in mental health services, and what are the barriers to treatment?
• Specific story about how individuals from minoritized communities with schizophrenia hesitate in seeking treatment during a crisis?

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Mindy and her book: https://mindygreiling.com/

Randye and her book: https://randyekaye.com/

Miriam and her book: https://www.miriam-feldman.com/

Hosts:

Who:

Randye Kaye - was a morning Radio Personality bringing humor to CT families when her own son was diagnosed with schizophrenia. Now she is still a Broadcaster, Actress, Voice Talent, Speaker, and Author (Ben Behind his Voices, Happier Made Simple)

Miriam Feldman -  is an artist, writer, and the mother of an adult son with schizophrenia. Her book, He Came in With It chronicles her family's story and was released to rave reviews on July 21st, 2020.

Mindy Greiling - Mindy Greiling was a member of the Minnesota House of Representatives for twenty years. She helped found the nation's first state mental health caucus, which successfully lobbied for a significant increase in Minnesota's mental health funding Her acclaimed memoir is Fix What You Can.

Transcript

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SPEAKER_02 0:00

Definitely like racial discrimination, you know, is one form of trauma that would affect certain minoritized communities specifically. And it's a balance of if someone is has some paranoia about something that's related to how they appear physically, that probably buttresses that belief.

SPEAKER_03 0:19

That's Dr. Regina Graham. While most mental illness goes untreated, it is especially true in minoritized communities. We explore why and give advice for anyone with a loved one with severe mental illness. Welcome to our podcast, Schizophrenia. Three moms in the trenches. From the place where schizophrenia and real life collide. East Coast, West Coast, Middle America. With Miriam Feltman, Mindy Gryling, and Randy Kaye. Welcome back to Schizophrenia Three Moms in the Trenches. It's been about a month because we've been busy with things, but we have a lot of exciting things lined up for you. I'm Randy Kaye, author of Ben Behind His Voices, here with Mindy Gryling, author of Fix What You Can, and Miriam slash Mimi Feldman, author of He Came In With It. We're three moms. We each have sons with schizophrenia. And we're kind of deep in the trenches because we've been at this a couple of decades. So whether you're new to the schizophrenia family community or you're deep into it like we are, we're just here to share information and support. So thank you. And tonight, today, whenever you're listening, this episode is about something we've mentioned as we're very aware, three middle-class white women in America, but we have tried to be an ally and be very aware of the specific challenges of schizophrenia in minoritized communities. But rather than try to talk about it ourselves, we have brought on an expert. And she'll be joining us, Dr. Regina Graham, who is medical director of early psychosis programs at UC Davis School of Medicine, will be joining us in a few minutes, and I'll tell you more about her in just a moment. So since it's been about a month, um Mindy, I know a lot of listeners have asked on our Facebook group about Jim and how he's doing. I know he's just moved into housing and had a bit of a glitch.

SPEAKER_01 2:24

That is that kind of covers it. I had Jim moved in, and unfortunately, a week after he was there, uh Roger and I traveled and then we came back for a week, and then we traveled for another week. And one of those weeks, by the way, was the Treatment Advocacy Center um AOT implementation symposium, and that was an incredible experience. But for Jim, it was very inopportune time for us to be gone. And, you know, I just I think I mentioned on our last podcast that I felt like a weight was lifted off of my shoulders when I knew Jim was going there and we were so relieved. And I think I went overboard thinking, no, they're gonna do everything. So I just want to advise our listeners if you get to have your child go into wonderful supportive housing like Jim has, don't do that. You still have to be the mom and you still have to be involved. And at least while you're living and healthy, I think you'll always have to do some of that coordinating. But Jim didn't eat. He got depressed, he got lonesome, you know, he really has never lived alone. He's always lived with somebody. And if he ever, the small times he's lived alone, he's had relapses. So he's not alone there, but he's all by himself in his apartment. He's used to, you know, having people around. So he just got lonely, got depressed, and stopped eating, and he lost 14 pounds in two weeks' time, despite the fact that he's on Mujaro and other things to help him not eat too much. So he the uh the housing place had to call an ambulance and send him to the hospital. So that's what we came home to was Jim in the hospital for about a week, and they just basically fed him. Unfortunately, they also kept him in bed, like hospitals tend to do. So he got really weak, couldn't walk um again, and had to go home with a walker. And so, fast forward to now, um things are getting coordinated. Jim has lots of people to do lots of things, but the mental health system, as we know, doesn't communicate very well. So here's my tip, and I will end with this for now and keep people posted as I go along. But my tip is the mental health system is not coordinated. So the mama bears or papa bears have to do it. And so I have made an e-group. I've got 11 people on it, all people that are helping Jim, including Jim. And I just throw out whatever we need that's going wrong. Like today, he his lift money ran out. He has money from the county that he can use for transportation, and all of a sudden there isn't any more, and he's got half the month left to go. So, what can we do about that? Or his the place where he gets his UAs, year analysis, um, and blood draws is closing. What to do about that? I mean, all these things, it's a wonderful thing that we have lots of minds and heads to do things. But without this coordination, um, it just wasn't working for Jim. Nothing was happening. And also he was saying, I'm fine, we know that drill. And then um the people would were just taking him at his word that it wasn't, it wasn't working. So don't give up, stay involved, don't be afraid to be a hovering mom for a bit longer, even when they do get into great supportive housing.

SPEAKER_03 6:19

Thank you for that tip. That's uh, you know, it's all about the coordination of care. And I've often found with Ben his dream was to live alone and it has yet to work out. So it there's, and if you're a practitioner who runs housing, be aware that just because someone's moved in doesn't mean they're emotionally moved in. And you know that uh the transition is difficult. So um, Mimi, how about you? I I can I just say I saw a picture, it was on Facebook, so I guess it's public, of your son Nick, with a a drawing pen in his hand making some art. That just made me so happy.

SPEAKER_00 7:00

Yeah, it's been a it's been a good couple weeks. Well, one thing I want to say apropos of what Mindy was saying is that you know, Nick with his act team also has all these people, this wraparound care. But again, if I just leave it to them to communicate, and you know, they meet every week, all of them and everything, but so many things fall through the cracks. I made also a group text with all his people on it, and we call it Team Nick, and that's where everybody communicates. And since we've done that, it's communication just is the big, big deal. And and again, they'll ask, like they would ask your son, how is he? And he he'll say, Fine, and he's not fine. And if you had heard that, you would know because you're the mom. And that's what I go through with Nick a lot, too, is the doctors or the the clinicians will ask him, you know, how's this, how's that, and he'll always give them the answer that he thinks that they want to hear. And I have to stand behind him and go.

SPEAKER_01 8:02

Um but great minds think alike. That is exactly what I learned. I should have talked to you first.

SPEAKER_00 8:08

Yeah, well, it's very helpful. And um, as far as Nick, I took Nick, you know, when when we had New Year's is 2025, I decided that I my commitment was that I was gonna take Nick to visit his sisters a you know, a couple times a year, each sister at least. Because um, Nick, um and this is again how how Dr. Latman says that all our kids, it's it's so homogeneous. Is you know, Nick lives alone and he loves it and does great alone and refuses to even consider living in any kind of group housing. And luckily we can afford it because he has the subsidized housing, but he does well on his own. But we took him on this trip, and it was the best trip yet. And um we um we went to Nick and I went with my youngest daughter, Rose, to a live drawing class, and we sat for three hours and drew a live model, all three of us, and it was just it was terrific. It was great.

SPEAKER_03 9:10

That's fantastic. And real briefly, did you tell your story to an organization in South Africa? Did I hear that?

SPEAKER_00 9:16

Yes, I was asked to speak at a um uh support group in South Africa. Turns out Dr. Leitman also spoke with them a while back.

SPEAKER_03 9:28

And Dr. Leitman, if you don't know, is someone we've had on the podcast a few times, and he's a strong advocate for the proper use of closeril. You can uh check out our episodes. I'm not sure of the number right now, it might be episode 18, but just do a search on Leitman when you have our podcast and you can hear uh what he talks about. Go ahead.

SPEAKER_00 9:48

Yeah, so it's very interesting. You know, I did a little research ahead of time about the system there, and and what I found after interacting with these people is that a lot of similar problems, housing is a big issue. Um they don't have as many of the clause pine specific problems that we have. Um, but um but it it was just all very interesting. And you know, to go to another culture and talk to other people, it was it was fascinating.

SPEAKER_03 10:19

That's wonderful. And just to be clear, you didn't get to fly there. This was virtual. I zoomed. Zoom. We were so jealous until we heard it was Zoom, but anyway, but but to talk to another culture is amazing. And um, I'm gonna be very brief here. Uh if you're new to the podcast, my son Ben has had quite a lot of ups and downs since my book came out, which was 10 years ago. Uh Mindy and Mimi's were more recent during COVID. Uh, but uh at the moment, he's um sobering up. And you know, Knockwood, he's he's been passing all his urine tests and he's been sober, but he's refused medication since like eight months. And so talking to his voices is starting to annoy his housemates, and he's in danger of losing his housing. So that's where we are, and and and just to show you again, we talk a lot about the cognitive deficits when someone has schizophrenia. I I didn't hear from him for 10 days, and of course, where do we go? Is he alive? Like, you know, but like you, I'm pulling strings in the background. I'm like backstage pulling strings, nobody can know. And I contacted the house manager who said, Oh, yeah, I think he told me he lost his charger. And I'm like, he has this boy. I'm sorry, he's a man, but he's a boy with 144 IQ, can't figure out how to contact me or his conservator to get somebody to send him a charger. And so he just lives without a cell phone. It's like, oh, I'm at the bottom. I guess it's pretty good down here. So anyway, I contacted his conservator and said, please send him a charger. And she did, and then I started hearing from him again. But it's like, how are you? Fine, cool, you know, just stuff like that. However, um, during all this, while I'm compartmentalizing, I got to go to an amazing conference called Changing the Narrative of Neuropsychiatric Brain Disease. And we are going to have Dr. Rock Almirata and his wife Lisa Mann on the uh on the podcast and when their book comes out called Reimagining Lives, and it's about the techniques that he's been using at Silver Hill Hospital and translated into actionable steps for other people to use. So it's very exciting. It was very exciting to be there. Um, a lot of fans of the podcast who said that they just love us and the grassroots, you know, as much as there's a lot of podcasts with experts, they love the grass-rootedness of us. So um, you're welcome and thank you. And just as a reminder before we bring on Dr. Graham, is this we love hearing from you. And what I need to remind all of our wonderful listeners that we are exactly what the title says. We're three moms in the trenches. Yes, we have other skills. Yes, Mindy was the state legislator for 20 years. Like, you know, we've been we've been in the trenches a while and we're experienced, but we're not experts. So recently we've had people go, What do you think of the keto diet? What do you think of this doctor that does brain scans for $5,000? You should know about this. And what I want to say to you is this we're not going to speak about anything we don't know about. So even if we're aware of these things, a really good thing for you to do is to join our Facebook group. We have a community there. Just search Schizophrenia Moms and you'll find us. And you can talk to each other and ask each other about your experiences with these people because you know we are what we are, and we we can't just um we don't bring on people to to further their businesses. We just try to bring you information as we see it and share our experiences because you've told us you like to see it, so you don't feel alone. But you are welcome to join our community and bring up questions like that, and you can talk to each other. Uh, so we're not here, we're not sponsored by any anybody. This is why some of the people told us they love our podcast because we're not sponsored by we make no money on this, we are just doing this as a labor of love. So there are things out there, but if we don't have personal experience with it, as we have had with Clauseril, and right now my son's on another med. We're not here to talk about any particular med. All we're doing is sharing our stories. So I thank you so much for your interest. I thank you so much for your suggestions. If it's something we're not qualified to talk about, we're not going to talk about it, which brings us to something we're not qualified to talk about, which is schizophrenia in minoritized communities. So to do that, I will read you some um statistics, though. And this is the National Institute of Mental Health. Now, we know nearly one in five U.S. adults live with a mental illness. Uh, people of color have rates of mental health disorder similar to whites, but they're more likely to last longer and result in more significant disability. Because even though most mental illness across the board goes untreated, this is especially true in communities of color. 52% of whites with mental illness received mental health services in 2020, compared to 37.1% of blacks and 35% of Hispanics. So, in order to talk about this, we brought in a wonderful expert, Dr. Regina Graham, who is medical director of early psychosis programs and a clinical professor at the UC Davis School of Medicine. She has expertise in intensive mental health settings, including inpatient, residential, emergency interventions, and especially working with vulnerable populations. She has a passion for prodromal early and first episode psychosis and its management. So please enter and sign in, please, Dr. Graham.

SPEAKER_02 16:27

Thank you for that wonderful introduction.

SPEAKER_03 16:30

Well, you're welcome and welcome to the podcast. Um we want to just hand this over to you know to talk about what you'd like us to know a bit about what got you interested in this, what you have noticed, and um for instance, how does how does cultural background impact the experiences of schizophrenia for the individual and their loved ones and the care they get?

SPEAKER_02 17:01

So I think um the statistics that you brought up in the beginning um about the delay for treatment for people in minoritized communities that um has such an effect um uh for all illnesses, but particularly things like schizophrenia, which we know the earlier you can intervene, it really can change the trajectory of prognosis. And so um even things like um we have all of these early psychosis programs. I work in one of them, um, and they're wonderful. And also um there are statistics showing that these programs are less um, they're less they're being utilized less by people in minoritized communities such as um white blacks and Latinos. Um, and so you know the longer you wait to get treatment, you know, the the harder it is to get people back to their baseline.

SPEAKER_03 17:59

Why do you think why do you think that is?

SPEAKER_02 18:01

Do you have any theories about um I mean I think just in general, uh information about mental health and what it looks like is um not um equally distributed. Um I think particularly um things like schizophrenia can be confusing in the beginning because it can be the pro-dromal symptoms can look like things like depression, um, or if someone's having problems concentrating, someone might think, oh, maybe they're having DHD and then they're misdiagnosed. Um I think just knowing that you have a issue and what to attribute it to is like a problem. And then um, once you do know, then you have to deal with everything like stigma, getting access to care, and then having your team who's treating your family member and the individual to understand their background. And I really think of you know, everyone has a culture, and um but for the minorities minoritized communities, they might be coming with specific things in their culture that make it um harder to access mental health or feeling the stigma about what they might think either other family members, other people in their community, and or the mental health system might be thinking about them that might keep them away from participating um and trying to seek treatment.

SPEAKER_01 19:37

I was just at in uh New York, uh one of the times I was gone when my son was falling apart in his supportive housing. I was on a road scholar trip for uh Broadway, and we saw three Broadway plays. One of them was named Purpose, and it was about a black family, African-American family, and it was kind of loosely based on Jesse Jackson. The father was had another last name, but he was you know, pretty much looked and sounded, and the play was written as if you had been uh Jesse Jackson and his family. And there were uh one son was the junior to the father, and as part of the story, he had bipolar disorder, and the family just you know danced around that, but particularly the father did not want to hear that about his son, that he just needed to buck up and move on and quit, you know, not doing well in life. And it was just complete denial. And then there was this young character who came in, a young um African-American woman who is a social worker, and she was trying to deal with the family and get them aware of things, and but she also uh failed to do that. It was a it was a very funny play, it was had a lot of poignant things, and this bipolar denial was just a subplot. But to me, having uh Jim in our family, um, I just resonated so to that whole family and how they were not dealing with the son with bipolar disorder, which was very clear that he had it as you watch the play.

SPEAKER_02 21:20

I think it's it's such a journey, right, for both the individual with the illness who hopefully accept it to some degree, um, and also the family members. And um I like to think of it as like you have to walk side by side. Um, like you can't go ahead of them where they're at. Um, and then you can't not give them information that could be helpful. So if you, you know, if you see the person clearly has my polygons or you have to say it, even if even if that's upsetting. Um and I think that you know, sometimes it's helpful to learn the language that the individual in their Family wants to use to describe the illness. They might know other family members who have similar things and they have words or terms they use for it, and that might feel less stigmatizing than using something like bipolar. And then I think the other part is um not losing hope. So, like saying, okay, someone has something like bipolar or schizophrenia, um, and it's a treat it's treatable and there's things that can help improve things. It's not I'm just telling you this diagnosis to you know slap on a band-aid of like stigma and saying this is hopeless, but I'm the reason why we're diagnosing is because we want to like have the correct intervention and that there could be improvement. Um, and a lot of people don't know that, they just hear these words and it's just like, oh, everything's gonna be terrible forever.

SPEAKER_03 22:55

Right. And and so far everything you're saying, I think is applicable, whatever whatever culture you have. Do you find in your work that there is additional stigma or additional you you mentioned lack of education, like in the minoritized communities, do you feel that the access to treatment, the access to a diagnosis, the ex that is different, is more difficult than it is for your average white person?

SPEAKER_02 23:32

I think on average, I think people have other, I think people minoritized communities have their own way of dealing with symptoms. Um, so that could, but that don't involve the mental health system. And so, you know, even the idea of who gets treatment there might be like depend might be very extreme. Like, you know, you don't go to a mental health provider unless, you know, you're homeless walking on the streets and you're unhoused and you're talking to yourself, that's the someone who gets mental health treatment. Um, or someone who had a recent suicide attempt in their mind that they might think that. And so I think just education about like what it involves. I mean, and sometimes um there's also misperception, particularly with people who are immigrants, um, that if you go to a hospital, that means that, or you go to emergency room, that means you're gonna be like locked up forever. Um, I've definitely dealt with that um quite a bit with families that wherever they came from, if someone needed mental health, that means you're like locked someplace forever. Um, whereas like we have the opposite problem in this country, like people are begging for hospitalization. Um, but just you know, explaining explaining that. Um, and I think just like education, um, I always talk about um being ready to take medication, like just little things that you might think are like um you don't have to say, such as if you're traveling, bring medication with you and continue to take it. Some people like, oh well, if I go to a happy place, a different place, I don't need medicine because my problems were contained to wherever I'm living or whatever situation that is. Um, so I think, you know, I think we can't assume we have to ask, you know, each family, each individual, like what their um understanding is. Um, because some people also have other family members in their family who have mental illness and they may have dealt with it in different ways. And so that also might be an impairment. So they might know about it, but the way they think that it's treated or dealt with could be very scary.

SPEAKER_01 25:55

And that's my son entered the mental health system when I had to call the police because we could not get him to go to the doctor to take medication, and then he got so sick we ended up having to call the police. And I know the history, just you know, not personally, but I certainly have read a lot and heard a lot about the history of the police. And I'm from Minnesota, so we had the George Floyd incident right here in Minneapolis. So I would imagine that's adds to the barrier if people are have someone in their family who's that sick, but would be afraid to call the police.

SPEAKER_02 26:33

Yeah, that's always like um, I've dealt with that many times that um both black parents and um family members and um Latinx families for different reasons don't want to call the police. Um, and um every state is different how you get involuntarily hospitalized, but in California, law enforcement is like a huge gateway, sadly. Um calling 911 and having the police respond is a way to get to a hospital. Um there are that we are trying to change it and have some mobile response teams, but um, by and large, a lot of times if you're not outside, if you're outside the hospital and you need involuntary treatment, law enforcement is involved. And um it's really scary. And you know, I try to coach parents who are who will say, well, I'm afraid they're not gonna, they might maybe they'll seem like they're gonna be aggressive and then they're gonna get shot and die. And isn't that worse than like staying inside the house and having whatever symptoms they're having? Um and so it takes a lot of convincing, a lot, a lot of convincing. Um, and I would say that fear is like regardless of socio economic status. I've heard parents say that very, very often.

SPEAKER_03 27:53

Really? So it's the the socioeconomic status has less to do with it than just the culture, like Yeah. I I mean, I teach um uh NAMI, NAMI family to family classes, and one time I was the only white person in the room, and it was and uh I loved it, and I had a I had to just say, hey, I know I'm I know I know what I am, you know. So, but we all got along great, but I found there was a cultural difference, and for me, and this is just an observation because I don't know, a lot of the families told me that they wanted to keep it inside the family as long as possible, and that, you know, I think that's true in a lot of cultures, but that that was a barrier to getting the early treatment that they wanted. And you know, you're in the early psychosis program, so you probably see people when they've come in. But do you have dealings with the people who have yet to kind of bite the bullet and come in for help?

SPEAKER_02 28:56

Yes, yes. I mean, especially um uh in other situations. Well, now I work outpatient, so someone voluntarily coming in, but particularly an ER or an inpatient, um, you have people who don't want anything to do with it. And um, I think again, you just have to try to give as much information as possible. Um, and even also, I mean, honestly, even things education about things like um HIPAA and mental health information, um, which a lot of people don't know that like it's even more protected than your your general health. Um, you have to give an extra layer of approval to release that information. Um, and so even letting people know that like like just because you're seeking help doesn't mean it's gonna be like announced on the radio or like you know, on Facebook Live. Um and just trying to like help them understand that, or people think also in in terms of um someone who's in school, that like everyone in school is gonna know that you're seeking mental health treatment. Um and that's not, I mean, if you just if you choose to disclose that, um, but it's it's not a it's not a guarantee that they're gonna find out.

SPEAKER_01 30:12

I would like to know um about your clientele of patients. Um, are they all black? You know, when I was or all people of color or not, when I was in high school, I'm a tall person. If you met me, I've shrunk an inch or so, but I was almost 5'9. And so whenever I saw, you know, the basketball players with a girlfriend who was five two, I thought, how dare they, you know, those tall basketball players should be safe for tall women like me. And so um, you know, it's such there's such a dearth of uh providers of color, especially psychiatrists. And so how how do you manage your patient load so that you help the people who need you the most? Or do you just take who comes and work just as well with other cultures?

SPEAKER_03 31:04

And I guess we should add, if you're listening to this and you're not watching it on Facebook, Dr. Graham is a person of color, just in case. Right. I thought that was obvious, but yeah, you know, so um uh yeah, so go ahead.

SPEAKER_02 31:19

Um so our program takes whoever is referred, um, and we have um individuals from all different races and um uh ethnicities. And um, you know, I mean I think as you know, just dealing with early psychosis is such a rare thing, and you know, people are desperately seeking treatment of any culture. Um and I in our clinic um we also see like a a range um both of like private insurance and also some um Medicaid. So um it runs the gamut.

SPEAKER_00 32:03

And I'm I'm sorry. I said I have a question about um about trauma. How does how could trauma impact members of minoritized communities with schizophrenia? Is trauma a bigger issue there, do you think? I mean, we've already talked about the police and the relationship with the police, and it is fraught. Um, I've been afraid to call the police myself, and I'm just uh you know, another middle class white woman, but um, but trauma I'm interested in that.

SPEAKER_02 32:38

I think um definitely like racial discrimination, um, you know, is one form of trauma that would affect certain minoritized communities um specifically. Um and I think that, you know, um it's a balance of if someone is has some paranoia about something that's related to how they appear physically, um of both acknowledging like there is a reality um and some lived experience that probably um buttresses that belief and also um possibly it's extreme for you and it's um you know you're adding to what does exist and it's making your your life even more hard and impaired. Um but I think you know um I always try to like find the seed of like what is actually happening to kind of validate that part, um, but also not say, okay, well, everything that you're paranoid about that could be related to race, like assume that it's 100% happen exactly the way someone is is is you know describing it. Um and then I think you know it can be like very depending on the situation, um unfortunately um there's over um well number one, I'll just say the largest provider of uh mental health services in our country, including in California itself, is the um incarceration system, prisons and jails, and um minoritized communities, black and Latinos are overrepresented in that um system um and getting some degree of care um there. Um and so you know if you're associating mental health treatment with prison, that's not that doesn't lead to like a very positive um um feeling about getting involved in the system.

SPEAKER_03 34:53

Thank you. You know, bringing it back to I'm hearing so so much so much in common. Like, you know, all the families go through the does he have it or she does our loved one have it? I'll try not to use gender, but you know, does our loved one have this illness? What can I do alone until people don't know? Like we all go through this, and and the according to the statistics, the same percentage of people get mental illness regardless of the culture. It's the um lack of treatment in the minoritized minoritized communities that that gets in the way. And what summing up what I think we've discussed so far is part of it is perhaps increased stigma, uh, lack of education, uh needing to know more about it, to know about it further. And but some studies that I've read, and I I can't recall where right now, but you have talked about the effect of city living versus rural living and poverty versus having a lot of money. Certainly, listen, uh a lot of a lot of people at this conference I went to have $40,000 a month to send their kid to a farm, and and that's great, but I don't, and a lot of people don't. So, yes, certainly I think money has something to do with the, but money is no cure because I know a lot of very rich people who still struggle. When when your loved one has schizophrenia, it's a cross-the-board grief for everybody. But the rates of poverty, cultural influence, um, do you and you know, defining minoritized communities, it's any groups excluded from opportunities and power structures in our society. So if you were to have the power to right the wrong of people in minoritized communities getting care later and less frequently, what would you love to change about things? That's a big question, but that's a good question.

SPEAKER_02 37:05

Yeah, um, I mean, I think in terms of like really doing the outreach, so um, wherever these communities are, so schools, um I think you know, churches, mosques, um and I think just giving information that these things exist, there's treatment. Um, and it doesn't mean you don't you can't do the other treatment that you might have that's outside of the medical system, depending on what it is. But also we want you to do this other mental health system treatment. Um, I think that would make a big deal. I mean, a lot of people don't they don't even think they think also there's an age where someone gets a mental illness, you like, you know, you have to be like 25 and above or whatever. Um, and say, well, it's isn't someone too young. Um, and so just getting that information, I think it's just, you know. I think a lot of people don't know, and if they do know, I mean, and and I've also heard this a lot too of someone who maybe their loved one has been sick for a while. And yes, maybe they were stigma, yes, maybe they were denial, but also they're like, well, I didn't, if I really knew what was going on, I would have presented this person to try to get them help sooner. But I actually really I had a thousand other reasons why what I to explain what I thought was going on, um, and I didn't know.

SPEAKER_03 38:34

So definitely making education and awareness available so that is it's less stigmatized. Do you think schools are part of the solution as well?

SPEAKER_02 38:43

I think schools, yeah. I mean, I I mean, young people, they also advocate for themselves. You know, they'll tell their parents like I need help. Um, you know, take me here to get help.

SPEAKER_03 38:54

And so that never happened to me, just saying. So I was like, I'm fine, I'm fine, I don't need school, I don't need a job. Good job is a government plot. I don't need so that would be like a miracle for my son to say I need help, but some do, yes.

SPEAKER_00 39:10

You know, I've been um in recent years uh somewhat critical of all the money that is being spent on these glossy, splashy stigma campaigns when what, in my opinion, we really need are more hospital beds and housing and and um education and access to doctors and all these things. But at the same time, do you think that maybe um this specific area actually more of an outreach of that kind of a campaign about stigma and about the culture around it directed specifically to Hispanic culture and those, you know Muslim, Muslim culture, you know, everything that we have here. You know, maybe it's time to fine-tune the stigma approach because just this constant talk about, yeah, you can have feelings and you can talk about it. And yeah, I think we need to get more specific because I think there's very specific areas and groups who aren't getting the message.

SPEAKER_02 40:24

Um I think that you know, um having a stigma anti-stigma campaign um that someone from a minoritized community saying, like, you know, I mean, best would be lived experience, um, and um talking about it, I think that would go a really long way. I mean, even something, for example, um Simone Biles um leaving the Olympics um and saying that you know she had to take care of her mental health, that was huge.

SPEAKER_01 40:58

That was huge. But about the oh, go ahead.

SPEAKER_02 41:02

Oh, and just you know, it was huge in many ways. Number one, some people also, well, does she have mental health issues? Like, you know, the criticism, but then also people just saying, Oh my god, thank you for saying that. Um, and we never had anyone like you, a black woman, say that, you know, I I I have I have to stop because I need to take care of my mental health. Um, so I think just even like big in her life, but I think that also had like a huge uh impact globally.

SPEAKER_01 41:33

You mentioned um black churches, and there's research that shows that that's often the first place any person goes from any culture is their church and the pastor or the IMAM or whatever. Um, are you making any um inroads yourself, or is anybody into some of the attitudes in some of the black churches anyway that um other guests that have been on our podcast has have talked about that the idea that you know you would pray harder about it, or you know, it didn't necessarily end up with being referred to you or somebody that could help the person if they also needed medication or more than the church could provide. So is that a place where you're educating and is that are we getting any further in 2025?

SPEAKER_02 42:26

Um that's a hard question. Um me personally, I I have I have I don't do outreach there, but I've definitely had a number of um patients who because of religious reasons, um, they and or their family didn't want to take you know psychiatric medication. Um and we had to, we did involve their religious leader um in the treatment plan. So um, you know, personally I like to say things like, you know, God created if you believe God created the world and all of these things, then that person is also part of creating medication. Um and you know, it's not a selling either-or thing. We want to use all everything that's available to us. Um and um I I mean personally I found that a lot of I guess the the religious leaders who are or providers who are willing to join in the treatment team um are actually pretty good of saying, like, I know you know you have this belief, but it's okay to also use these kind of treatments. Um so I think, you know, it is as much as you can bring those people in or at least at least and at least let the individual in the family know you're not anti that thing, whoever whoever their leaders are, um, because then it just like leads to keeping secrets. Yeah, you've touched on a really going on.

SPEAKER_03 44:03

Yeah, that's a really important aspect. I know when I spoke at uh a health conference at in a state where a lot of the state is rural, the city practitioners were like, Yeah, yeah, yeah, let's get the pamphlets, and the rural people were like, our pastors are just going pray harder. And so, you know, that was uh in a way, that's a minoritized community as well, no matter what color your skin is, right? So, you know, we we're trying to address a lot of issues. Um, but I we only have a few minutes left, and I I I the story of Simone Biles was so powerful. Do you have any other specific stories about how individuals from minoritized communities with schizophrenia might hesitate in seeking treatment and what you did about it?

SPEAKER_02 44:59

I mean, I I I hope.

SPEAKER_03 45:01

Without mentioning names, obviously.

SPEAKER_02 45:03

I know, I know, I know. I'm trying to I'm trying to choose one story. Okay. Um I mean, I think in terms of I just want to go back to like um like if there's a crisis and when you do have to coach someone around um you know, you need to call 911 um to try to get assistance. Um that I did have um um a family member, uh page I was working with who um, you know, he um stopped taking medication, became increasingly um disorganized and paranoid. Um and the family couldn't get him to do anything. And so um we, you know, like kind of let them know that they have to take him to the hospital. Um that's the only option. Um and because they could not get him to go to the hospital voluntarily, they had to um actually um call 911. Um and unfortunately, um it was somewhat of the worst case scenario, despite trying to coach them to say it was a mental health crisis. Um, when they called 911, the police did come and they had, you know, almost like a SWAT team type of situation. Um but they did not um physically harm um anyone. Um and the young man was taken to the hospital and hospitalized and treated and improved a lot after getting medication. Um, and afterwards the family was like, well, that was really scary. I don't know if I'm gonna like do that again in terms of calling the calling 911 um because I felt like it was almost like over too much response. Um, but at the same time I saw everyone lived. My son got traded. Um so I mean, some and of course there's no guarantee about the next time if that has to happen, but I think you know, just more of the experiences you can have that are positive with the mental health system, the better. Um, and I think it's just really the most important thing is that um the patient got better after this whole ordeal. Um but you know, it takes a lot of coaching.

SPEAKER_01 47:30

You know what? I'm just amazed at the way you do your practice. I I it's a very rare psychiatrist that would be doing this coaching and educating with the parents. I have until we got Dr. Leitman, I never came close to anybody that gave me that kind of counsel. So I have to compliment you on your hands-on approach and educating and in a specific example, um, you know, getting down to exactly what they need to do. I think that's incredible. So your patients are very lucky. I hope they know that.

SPEAKER_03 48:06

Thank you. Yes, and and it to kind of sum in a minute, I'm gonna give you a minute to think about this, Dr. Graham. I'm gonna ask you to kind of just share the top few tips for families and practitioners that you would like to share. Uh, but I will say I also in the last month I spoke to the um Connecticut Alliance to Benefit Law Enforcement, and they were all CIT trained officers. And I was presenting the family point of view, uh, and my son has been hospitalized 12 times and probably should have been hospitalized 25 times, but it's very difficult to get permission to get them hospitalized, as many of us know. And we have spoken about loved ones living with us who do get violent, and how safe is that for the family? And there's a lot of issues here to continue to unpack. But I spoke about the many, many times when having been coached to say the right thing, they did not come like a SWAT team, and they came with a mental health practitioner or CIT training, crisis intervention training, and got my son gently to the hospital by persuading him, or some once in handcuffs, to be fair, but without fear on his part. They were and and and then the and the other speaker was someone who is somebody with bipolar herself, and she actually showed video of her own psychosis, and every symptom that she was showing, because her crisis team was trained, they brought her to the hospital and she told the story of a woman one county over who exhibited the same symptoms and was brought straight to jail for two years. So that for two years. Well, because look, my son was in jail 10 months waiting for a bed. Yeah, you know, it's not a pretrial. You can be there, it depends on the state. I'm not gonna say, but you know, we all know that. So when you say reaching out, if families aren't lucky enough to have a practitioner like you, I'm gonna recommend uh some of the resources we have uh on this podcast, uh Nicole Drapo Gilman's uh Lillian's book about resources for families, NAMI Family to Family, which teaches you and gives you a sheet of what to do in a crisis. Families can educate themselves once they're aware. And uh, you know, not everyone is as great as Dr. Graham. We know that. So, families, if you feel there might be an issue, educate yourself of what to do in a crisis beforehand. And NAMI has a lot of that information right there on their website, NAMI.org. And I'm sure the schizophrenia and psychosis alliance, also Action Alliance, has that information as well. So there are resources out there. Dr. Graham, do you have any particular resources that you recommend to your families?

SPEAKER_02 51:05

I mean, I would say it's kind of more nuts and bolts in terms of our local area about where to go and who to call. Um, and then as time goes on, if there's more reading they want to do, you can give them that. But I would say in the beginning, it's really the nuts and bolts. Call this person, go here if XYZ happens. Um, but I will look into some um resources and see to add it to the website.

SPEAKER_03 51:30

All right, thank you. Any any final words of the the question I asked you? Like, what would you most like people to know about schizophrenia in minoritized communities? What would you most like people to understand and do?

SPEAKER_02 51:43

I would say um for the for the practitioners um and the providers to um be curious um in terms of not making assumptions about what do you think this person and or their family believes, um, and trying to reflect their language that they're using to describe um symptoms. And um lastly, to always keep in mind like what's top of their mind in terms of priority because there might be something that they think is problematic and they want to address that might be different than what you're thinking isn't is the main issue. Um and doesn't mean you can't work together, but it's good to keep track of that um and the type of language they're using to describe um certain symptoms or behaviors because it could be different than what we might be using as clinicians. Um I would say um for the um individual in the family, um, particularly with something like schizophrenia, which I know you've spoken before um on your podcast about um the lack of insight a number of people have who have schizophrenia sometimes, um, especially when they're not doing as well. Um, so it's really important that um as much as you can include family members or support person in the treatments um with your provider so they can get more than one perspective about what's going on. Um we love that. And also you, you, your the the individual seeking treatment might be overwhelmed or confused or whatever, and maybe they're not the best person at the time to convey what's been going on, and it's good to have someone to help you out see that.

SPEAKER_03 53:33

All right, and uh that's that's good advice, no matter what your culture, no matter what your religion. If we are all families struggling with severe mental illness and someone we love, we all have that in common. So, Dr. Graham, thank you so much for joining us today. Thank you so much for tuning into this episode of Schizophrenia Three Moms in the Trenches. You can help out the podcast and help others by sharing the podcast and by subscribing wherever you get your podcasts and or on YouTube. And remember, you can reach us at mindygryling.com, randy k.com, or MiriamHeifenfeldman.com