Introductions

1. Summary of Prevention, Early Intervention (PEI) DataCity of Berkeley Mental Health Department Community Meetings& Focus Group DiscussionsPrepared by Health & Human Resource Education Center

2. Introductions • Total Meetings Conducted – 8 • Consumer Group • 0-5 years Advocates • Youth Advocates • LGBT Advocate Group • African American Group • Elders and Adults • Asian Pacific Island Group • Youth

3. Who We Talked To Berkeley Alliance, BUSD, School MH Planning Process, Pacific Center, Fred Finch Youth Center, BMH Adult Services (TAY Programs), Through the Looking Glass, Alameda County Child Counsel, Albany Project FYC, Berkeley Schools Homeless Educational Program, Rosa Parks Collaborative, Rosa Parks Elementary, Jones MH, The Better Way, Brothers Supporting Brothers, City Manager’s Office, Local 1021, Black Infant Health, Berkeley Drop-In Center, City Employment Coordinator, Progressive Baptist Church, MH Commission, Peer Counseling Collective, Radical MH Collective, Consumer Liaison City of Berkeley, AC Network of MH clients, BMH Mobile Crisis Team, Longfellow Middle School

4. PEI State Identified Community Mental Health Needs Disparities in Access to Mental Health Services Psycho-social Impact of Trauma At Risk Children, Youth and Young Adult Populations Stigma and Discrimination Suicide Risk

5. Overall Findings MH services are not culturally responsive regardless of age, gender, race, sexual orientation; socio-economic status; minimizing the potential impact on the mental well being of the citizens in the City of Berkeley. The scope of existing PEI programs and funding for them is sorely inadequate for children, adolescents, and young adults; with limited accessibility for adults and older adults

6. Common Themes Across Focus Groups MH issues and services are isolated and not seen as community or system wide concerns School-based climates are generating MH issues for teachers, students and families There is fear and distrust of the MH system’s ability to meet the needs of the diverse cultures in Berkeley Language and cultural barriers limit access Physically accessing services is difficult (location, time, facilities, transportation) Poverty presents a significant challenge to MH

7. Common Themes Explored Reported Reasons for FEAR in Accessing Services • Potential consequences and recrimination from seeking treatment • Loss of children (single parents, elders caring for grandchildren, disabled) • Loss of job and or career • Teachers in particular fear seeking help in the mental health system; question confidentiality; fear loss of job/livelihood • Immigration Problems (deportation, loss of visa/student over-stays) • Elders fear losing independence • Being mis-understood and and mis-diagnosed - Language and Cultural Barriers - Impact of Historical Racism • Fear of forced treatment • Confidentiality • Loss of reputation, humiliation • Trust of clients, colleagues, family members and friends • Professional standing • LGBT issues

8. Common Themes Explored Reported Language and Cultural Barriers • Semantics of “Mental Health” terminology • Alienates people and keeps them from seeking services • Information presented in non accessible language and format • Diversity of Cultures and Languages in Berkeley • Impacts inability of system to provide information and services in timely manner • Impacts the general tone and attitude of feeling “welcomed” and “heard”

9. Common Themes Explored Physical Access is Difficult • Disabled • Lack of mobility and support to assist in transportation • Elders • Physical and mental challenges for negotiating transportation • Often housebound due to illness or lack of assistants • Single Working Parents • Lack of centralized or neighborhood services • Youth • Need for dedicated youth centered and friendly facilities

10. Common Themes Explored Poverty Low income populations get less medical care • Especially pre-existing conditions that are not properly diagnosed • Working poor become isolated • Few mental health prevention services in general • Lack of awareness of what prevention services are available • Homelessness • Youth and all generations • MH waiting lists discriminate against homeless when restricted by residency requirements • Transitional Age Youth (TAY) lose support and services • No income to pay for services • No follow through with previous existing services and medications

11. Common Themes Explored “What ever early intervention you put in place, psycho-social issues are under-girding everything: housing costs, pay, hunger, what we call low-income. It doesn’t matter what you do, if you don’t address these issues families will continue to be under tremendous stress.”

12. Disparities in Access to Mental Health Services

13. Disparities in Access to Mental Health Services Consumers Unaddressed issue: MH Medications can cause weight gain; creating or exacerbating other life threatening conditions such as diabetes, hypertension and obesity Low income populations get less medical care, limiting access to prevention information Children are pulled into a mental health profile because parents couldn’t access mental health services

14. Disparities in Access to Mental Health Services Age 0-5 Advocates Berkeley’s early childhood facilities do not offer sufficient support for children from at risk homes Most “at risk” families and the disabled have no medical coverage for pre-natal training or care; and lack awareness of services they can access for free. There are limited services for teen parents

15. Disparities in Access to Mental Health Services Youth Advocates (elementary through high school) There is a disparity of access to services for youth depending on their medical coverage There are gaps between City services and County services, and a lack of clarity regarding which are appropriate and available Some youth and transitioning age youth aren’t in school and need community access to PEI services in places other than schools

16. Disparities in Access to Mental Health Services LGBT Problems getting to and paying for services are complicated by the need for confidentiality Visibility of services is very low – they are hard to find Staffing and funding is sorely inadequate Latino and/or Spanish speakers have few services Queer kids of color are marginalized even in LGBT community and lack specific services Transgenders also marginalized and lacking services

17. Disparities in Access to Mental Health Services African Americans Many experience school sites as “white institutions” and not places of support for Black families School systems fail to recognize the role of the extended family, particularly the grandmother, in the child’s life The “attitude” and “tone” of many service providers shuts down communication Family members experience staff who are culturally/linguistically insensitive

18. Disparities in Access to Mental Health Services Adults and Older Adults Information about MH is not in circulation Many elders are isolated and not in communication with much of the outside world; they have no knowledge of services or transport options Berkeley Adult School students lack MH access due to language difficulties, cultural barriers, and limited onsite MH staff Many services require eligibility for Medi-Cal & Medicare

19. Disparities in Access to Mental Health Services Asian Pacific Islanders In Berkeley, many Asian students “don’t look like an immigrant”- primary issue is over staying visa expiration, creating stress and fear of deportation, and lessening likelihood of accessing MH services Limited capacity of MH providers who understand MH issues for refugees and war-related trauma

20. Psycho-Social Impact of Trauma

21. Psycho-Social Impact of Trauma Consumers Police play a part in on-going trauma (they symbolize force, or potential for force) Vets returning from wars (present and past) with PTSD are in increasing numbers There are no safe places for students to talk about witnessing traumatic events, problems, and fears for their safety Trauma gets passed from parents to children

22. Psycho-Social Impact of Trauma Age 0-5 Advocates Young children with substance abusing parents, abused or very depressed moms are high risk Low-income kids are starting school way behind kids who are more advantaged Psycho-Social trauma increases issues of non-attachment for parent and child

23. Psycho-Social Impact of Trauma Youth Advocates Transitional age youth have lifetime of trauma and need multi-faceted PEI services, including safe housing and continuation of support African American boys are not doing well in school and in society in general and need a systems-wide approach Youth in group homes often get recruited for sex work

24. Psycho-Social Impact of Trauma Youth Advocates Under the umbrella of other diagnoses, trauma, is at the root of conditions and problems

25. Psycho-Social Impact of Trauma LGBT Youth are targeted and traumatized (especially in high school) Safety is a constant concern; Local community center has to keep door locked Youth stressed by coming out issues and lack of family acceptance Schools are not well trained to give support to outand questioning youth

26. Psycho-Social Impact of Trauma LGBT There are no services and limited support in place for children with LGBT parents Youth having two mommies or daddies are experiencing external homophobia resulting in gay bashing and fights Internalized homophobia exists and goes unaddressed

27. Psycho-Social Impact of Trauma “…coming out about having two mommies and daddies, it’s so strong and courageous but it takes a toll on these kids and the issue doesn’t get addressed. There’s no support.”

28. Psycho-Social Impact of Trauma African Americans Racism is a historical trauma that Black people live with today; impact of “bussing” in Berkeley still exists Trauma is minimized in Black clients by attitudes that suggest a person should just “get over it” Trauma is compounded by inadequate, insensitive, unaffordable MH services Many African Americans inappropriately served within the current MH system

29. Psycho-Social Impact of Trauma Adults and Older Adults Elders suffer daily trauma from “invisibility” and grief that comes with the loss of independence Many Berkeley Adult School students have trauma related to immigration and language; home situations are often abusive There is a growing veteran population in need of MH services Chronically homeless have physical problems in addition to MH

30. Psycho-Social Impact of Trauma Asian Pacific Islander Many immigrant women face domestic violence issues Recent immigrants have a difficult time adapting and fitting in, causing a great deal of stress Immigrant parents expect children to be happy aboutbeing in America, when it’s likely their children are suffering from confusion and anxiety

31. Psycho-Social Impact of Trauma Asian Pacific Islander (con’t) Asian populations tend to somaticize their MH issues and aren’t comfortable “talking out” the problem. MH services that include bodywork are very limited or non-existent Most first generation immigrants do not identify as API, instead identifying with their specific country of origin Class issues must be considered; traditional socio-economic class distinctions play a part in MH

32. Psycho-Social Impact of Trauma Youth • Children can experience something at a very young age that was never dealt with. This can affect their behavior and attitudes (fears) growing up • “Abusive contact” wears on the personality • Many youth are forced to contribute to their family income that pushes them into adulthood before their time, causing great stress • Many youth use sports as an outlet for their emotions

33. At Risk Children, Youth and Young Adult Populations

34. At Risk Children, Youth and Young Adult Populations Consumers Childhood behaviors may be related to side affects of medication for physical conditions (ex: asthma) “At-risk” children are more often put into treatment prematurely Early diagnoses ‘type-cast’ students causing them to be tracked unfairly during school years College age youth are at high risk of first onset during exam time

35. At Risk Children, Youth and Young Adult Populations Age 0 – 5 Children’s Advocates Studies show state-subsidized pre-K programs have expulsion rates 3 times of all K-12 Expectant mothers suffering from abuse, medical trauma, or disabilities need information and support in baby care and relationship building with their child Some children are identified with learning disabilities when the root of their issues may be problems at home

36. At Risk Children, Youth and Young Adult Populations Youth Advocates(elementary through high school) Continuum of school based MH services is limited and fragmented Lack of PEI services is contributing to mental health issues in the school system Teachers need more MH consultants to support PEI classroom activities Schools need to be more welcoming to parents in a culturally competent manner

37. At Risk Children, Youth and Young Adult Populations Youth Advocates-(con’t) Parents need schools to take better measures to ensure their children’s safety Transitional age Youth (TAY) lose MH services when housing ends with no immediate carry-over for support TAY is a high risk time for first breaks; often MH crisis demands high end adult services

38. At Risk Children, Youth and Young Adult Populations • Youth Advocates-(con’t) • Transitional Age Youth (TAY) life-skills building services are not billable • Billing doesn’t support social integration activities that are crucial for the MH of all youth, especially those returning from jail or hospital

39. At Risk Children, Youth and Young Adult Populations LGBT LGBT youth are targeted and traumatized (especially in high school) Youth experience internalized homophobia Children and youth with gay/lesbian parents feel stigma early and need support for the challenges of alternative family structures Tolerated derogatory language (ex: “that’s so gay”) contributes to unsafe environments

40. At Risk Children, Youth and Young Adult Populations African Americans Black children singled out for unjust disciplinary action causes MH issues at an early age It is reported that 70% of Black youth in BUSD are in Special Ed, or said to have serious emotional problems – and there appears to be no alarm?

41. At Risk Children, Youth and Young Adult Populations African Americans Incidences of racial discrimination contribute to MH problems Black youth ages 16-18 have deep despair regarding their future prospects Black children are discouraged from free play and self-expression; Black children are overrepresented in MH diagnoses.

42. At Risk Children, Youth and Young Adult Populations African American Pain and anger in Black clients is addressed negatively and not therapeutically Poverty impacts the MH of Black families, especially women who are single heads of households Youth (and adults) are overrepresented and inappropriately served in existing MH services

43. At Risk Children, Youth and Young Adult Populations Asian Pacific Islanders MH is a westernized concept and psychology is very new to API youth and their families API ages 15-25 have the highest depression rates of all people of color Immigration issues can look different; often related to “overstays” Young adults who “get MH” and want group services cannot find API counselors

44. At Risk Children, Youth and Young Adult Populations Asian Pacific Islanders (con’t) Many Asian students do well academically so MH issues go unaddressed; only acting out students are identified Expectations of parents causes a great deal of stress along with transition and acculturation issues of immigrant youth Extreme difficulty in matching dialect language services to client needs

45. At Risk Children, Youth and Young Adult Populations Youth • Youth first turn to each other • Turn only to adults, counselors if friends won’t talk or not helpful • Usually go first to a school adult (counselor) • Some youth believe that just going out to party will overcome their depression or worries • Romantic relationship problems can deeply affect teens

46. At Risk Children, Youth and Young Adults Populations Youth (cont’d) • Many youth put off going home after school • Teens feel not listened to, like they are not trusted • Feel they don’t get to spend enough time with their parents

47. At Risk Children, Youth and Young Adults Populations “I think part of understanding youth culture is understanding that there is new culture everyday. Youth define themselves different everyday, and we need to incorporate that and ask them what is your culture.”

48. Stigma and Discrimination

49. Stigma and Discrimination Consumers Mental health diagnoses create discrimination within medical healthcare system; the “at risk” term is used in only certain ethnic and/or socio-economic areas “At risk” labeled youth may be put into treatment before necessary and/or un-warranted Family members feel stigmatized when one of them is diagnosed or treated

50. Stigma and Discrimination Consumers (con’t) Internalized stigma works on children and adults: marginalization and isolation Media attention on people with mental illness makes the general public afraid of individuals with MH issues Media attitudes discourage fostering of community, but rather encourage stigma and alienation