Reclaiming the California Dream
Episode 6 - Mental Health Without Wealth
Reclaiming the California Dream is a limited podcast series featuring amazing stories from deeply rooted California community members and what their community means to them. By working together to pass the Schools and Communities First Act, we can sustain our culture, provide stability for our families and build a future where all Californians have access to quality health care and education we deserve.
Reclaiming the California Dream is brought to you by AAPIs for Civic Empowerment Education Fund (https://aapiforce-ef.org) and Project by Project San Francisco (https://projectbyproject.org).
Produced by Raymond Luu.
Hi, everyone. Welcome to our limited podcast series, Reclaiming the California Dream. We’ll be hearing stories from some amazing individuals, and how much their community means to them. The Schools and Communities First Act, also known as Proposition 15, will restore $12 billion a year in funding for our roads, parks, and libraries; health clinics and trauma centers; local schools and colleges. By working together to pass the Schools and Communities First Act, we can sustain our culture, find stability for our families, and build a future where all Californians have access to quality healthcare and the education we deserve. Today, I’ll be talking with Huanvy who sat down with a medical student, who shares some of the issues they faced based on the research that they’ve done. Enjoy.
Just gonna record… You might get a message on your end saying (in high-pitched voice) “You’re being recorded!” Hey Huanvy. So thanks for taking this call with me today. So you spoke with medical student Sherwin and they definitely gave a unique perspective when it comes to health services and its relation to the community. So could you just start with just your relationship with Sherwin?
So Sherwin is my partner, so it was pretty convenient when for my internship they wanted a podcast with someone who worked in the healthcare industry.
So I guess just to start off, can you introduce yourself with like name, pronouns if you want, and the work that you’ve done in the past in the general field of healthcare, and what you’re up to now?
Hi, my name is Sherwin. My pronouns are they/them. I’m 24 years old and in undergrad did some mental health advocacy and like the undergrads here doing you know, campus events, things like that. And then after undergrad, I got a job for a couple of years doing schizophrenia research at Stanford with Dr. Jong Yoon, great guy, great medical school. So to say what we were doing we were looking at the mechanism of schizophrenia because although it’s a really debilitating, widespread mental illness, it’s responsible for something like 1-2% of—up to like 10% of hospital bedtime, despite being like 1-2% of the population at most. But we have no idea what causes it. And so our research was trying to figure out what does cause it, there could be like eight or nine different, good theories that seem plausible about what causes schizophrenia and our lab was looking into two of them. And my research focused on one of them.
Can you also share a bit about your experience with mental health advocacy too?
Yeah. The primary goal of the organization I worked with—this was at Pomona College in SoCal. It was called Mental Health Alliance, its original name when it was founded 10 years before I got there, it was just called We Should Talk About This. Because at the time, that was the problem was that no one was talking about mental health, and so the organization, our primary thing is we put on events. Our big one was called Student Speak where we have a panel of five students from different walks of life, different backgrounds, different races, ethnicities, gender, and sexualities, and so on. And they just tell their story in 10 minutes or so to tell the story of mental health and mental illness. And then eventually people would take questions, but we both saw it as a platform for people to like really share their story and own it. And also as a way to build awareness and community that, you know, someone who like is a good friend of yours, just someone you may not even know that well, but you see around, maybe have dealt with psychosis or dealt with, you know, something really difficult and they’re human. They’re just like you, they’re not someone who should be stigmatizing or looking down upon. And I really enjoyed those. Our other thing was advocating to the administration for changes to support students’ mental health, things like modifying hospitalization policies or improving resources at the school. That was harder and definitely less successful there because we’ve got a lot of administrative pushback. If we didn’t get all of the changes we made that we wanted, we at least, I think, inspired the next generation of students to keep up the fight and hopefully succeed where we failed.
So Huanvy, Sherwin talks about folks nowadays having a platform to share their stories about mental health. We often think about awareness being the prerequisite or precursor to change. And it seems like a lot of Sherwin’s work so far has brought about a lot of awareness, yet they mentioned that when it comes to hard-coded structural change, that’s when it seems to get exponentially harder.
It’s a lot easier to talk about things and just to like raise awareness and then when it comes to actually implementing policy or like fighting for really tangible change, that’s when it gets really hard because you get a lot of that institutional pushback. And it’s because like actually implementing change requires things like funding and all the stakeholders to agree on like all the policy decisions. So I think I’m very lucky where I’ve been able to hear a lot about Sherwin’s experience with activism and mental health advocacy in undergrad.
So college mental health is a really interesting thing because my observation of it was that a lot of college students have just made it to college by clamping down on whatever is going on with them. With that like “I just got to get to college, just got to get to college.” So just like pushing down whatever, like depression or anxiety, or like darker things that are troubling them. And they arrived at college and suddenly like you lose all of your, most of your support networks, you have to make new friends, your parents aren’t around. If that was a positive or a negative thing, everything in your life that told you this is who I am is pretty much gone. And it’s a time for a lot of reinvention and growth, but it’s also a time when there’s a lot of risk for mental health and mental illness, especially with things like college being difficult and it can be induced depression, lots of deadlines can induce anxiety, et cetera, et cetera. Dining halls are a fun trigger for eating disorders and so on and so forth.
And I think that a lot of the times too, teenagers get dismissed when they’re trying to tell their parents or tell authority figures in their life about mental illness. I remember struggling a lot with depression since I was, I think middle school was when it started really becoming an issue for me. And I remember trying to tell my parents that, you know, there’s something going on and like, I literally feel like I don’t want to be alive. Can you share about what drew you to this field of healthcare?
Yeah, this is difficult because part of the things that drew me to mental health, I didn’t know until a good like four years after the fact, but the main thing is my father and my mother both are immigrants to the United States. They both immigrated in like the late seventies after the revolution in Iran and the trauma of that immigration impacted them both in really deep and difficult ways. My father suffers from PTSD and my mother is also grappling with the trauma and the difficulty of being cut off from her family, thrust into a new country and trying to survive. And so I very much grew up in the shadow and being effected by mental illnesses, and their struggles and likewise other people close to me like my brother, at times myself, I’ve struggled with depression, have dealt with, you know, these difficult patterns of thought. And especially in early college, one really close friend of mine who I got to know pretty well for our first three months was like dealing with something that I didn’t fully know. And they eventually disclosed to me that they were had a pretty severe eating disorder. And we became really close. But I just like really wanted, they were a dear friend, I wanted them to live in a world and go to a school that was a good and a safe place for them and not a place that was harming them. And you know, the roommate was talking to them and so on and so forth. And yeah, and I saw how even little changes like they got a dog and that was the first emotional support animal on campus. And it really did have a huge effect on their mental health, even little changes like that really spirit, a huge change in quality of life. And I just thought like, this is what I would want to do. I wanted to help people to share their stories and help people understand themselves. I want to help them get access to resources and like put a very short—people who are harmed the most by societal systems have one of the least access to mental healthcare to alleviate the harm of the systems. And that to me is enormous injustice and something that I wanted to work to alleviate.
Yeah. I think I would love to hear you talk more about that, about like these injustices that you see in the medical field, the ways that you’ve seen the system fail people, especially people of marginalized identities, coming from marginalized communities and like ways that you would like to see this field improve.
Yeah. A few things come to mind. One was from college and one was from my work experience. So in college I had a friend who, they were the first in their family to go to college and they were, they were Latinx, most all of the therapists we had available were white therapists. You could go into town and find a therapist that cost a lot of money and your parents would see your insurance building. So a lot of students who couldn’t afford otherwise would go to the school therapists. And the issue people kept running into, including my friend was that a lot of mental health symptoms manifest differently by culture. I don’t want to go too much into my friends, like specific symptoms just for privacy sake, but basically they were dealing with a very, you know, common readily diagnosable mental illness. But the problem was that the particular manifestation of it was deeply tied to their cultural experience. And so the intrusive thoughts, they were getting to not match up with what the therapist was looking for. And so the therapist was just like, “Oh, you’re just, you know, you’re just having a bad time, but this isn’t a mental illness when it very much was.
Second experience was, so there is a person who we’re working with relatively young, and their mother was an immigrant to the States in our schizophrenia study. And they participated in the study. They were a good participant. We were having to work with them, but they also asked for our help, they were making a little bit too much to qualify for Medicaid, but they weren’t making enough money to afford good healthcare because schizophrenia requires often very expensive drugs. And so they asked us for help and they ended up, you know, my boss was like, yeah, go for it. I spent some time researching, calling around trying to find, you know, a treatment option that was accessible to them. What I got was just like, every psychiatrist is full. There are like, no one is really free. There’s a county line that can get you to a psychiatrist, but it’s understaffed and difficult to reach. And so it was frustrating that after all this time and research, the best I could say was like, here’s the phone number that you’ve probably already called for the county hospital. They don’t have enough psychiatrists. They don’t have enough social workers. Here’s a phone number, I hope it helps. But that was the reality of it.
It was schizophrenia, you know, it’s just, it’s a very difficult condition. It’s very hard to take care of yourself living with schizophrenia. I know people who have done it. We had patients who did, were living good, well adjusted lives, but to get there almost always, you need really strong support. You need a sibling or a parent or a friend who’s going to be really there for you. We had stories of patients who were out on the streets for months at a time, and their parents found them, you know, unable to take care of themselves and able to feed themselves properly.
We had stories of friends doing the same thing. It’s just like, if it wasn’t there I’d always wonder what would have happened to this person. There was no other social safety net. The county is already overstretched. They don’t have the money. They don’t have the funding to really take care of these folks who really, really need that care. In the first case, an immigrant mother who doesn’t know the U.S. healthcare system very well. In other cases, low-income folks who can’t afford medications or can’t afford good health insurance are the ones who are harmed the most by schizophrenia. And I think the same is true of most other severe mental illnesses, and even like non-severe mental illnesses. It was something that really, really impacted me. And I really just felt was a deep injustice of it. And we did our best to help. You know, we’re, we’re a small lab. We don’t have a lot of funding. We still tried to get people to resources.
Huanvy, what was your reaction when you heard about the case of the immigrant mother?
It was so heartbreaking because there was literally like this group of medical researchers at Sherwin’s lab, trying to find resources like, you know, people who know the right words to look up and know the right resources to turn to. And they still couldn’t find accessible healthcare for this person.
In research, maybe the tragedy of it is like, if you discover a really cool drug, you discover a really powerful treatment or, you know, a new way of thinking about the thing. You really, really need to hope it’s cheap because if it’s 300, 400, 500 dollars a treatment and they need a treatment every month, most people with schizophrenia, unless they have like very rich family members that are willing to pay for this, the reality is they can’t afford that. Most people with schizophrenia have difficulty maintaining an income, have difficulty like attaining employment until they’re stable, and to be stable, you need medication and you see the problem here alright, I’m sure. You don’t need medication, but it definitely helps. And more than just medication, having access to a psychiatrist who will work with you, we’ll try different medications, we’ll modify your doses. And that requires good healthcare. And so it’s this awful little trap of who gets harmed the most by schizophrenia.
Yeah, definitely. What, like what do you see as the biggest needs of like the healthcare industry? Like especially the mental healthcare industry, and what would it mean to have those needs be met? Like what would that world look like?
Yeah. I (laughs) am going to go with the regular answer and then I’m going to go into a somewhat spicier answer. So the regular answer is like with mental healthcare, especially on a societal level, we really need to stop criminalizing and harming and start caring about people who are suffering from mental illness. Cause right now, if you have schizophrenia, oftentimes, unless you’re very lucky your best hope of getting like a good warm place to sleep is to be thrown into jail. And the police are horrifically under equipped. They’re just not the right sort of people you want dealing with some of the severe mental illness, their tools are gun and nothing else. And what you’d really want to see is some kind of dedicated mental health first responder program. An example, when I was living at my house in the Bay, you know, it’s the San Francisco Bay, it’s one of the most resourced wealthy places in the country.
And I was living in my house and outside my house, there was someone who was clearly having a mental health crisis. They were screaming, they were loud, they were clearly distressed. And we’re like, what do we do? Well, if you call the cops, that’ll make things worse. If we could—and our only other option, this is the best we had was a suicide hotline because that’s the only mental health resource easily accessible we could get. And that is not what someone like that needed. What they needed was the equivalent of a firefighter. You want to train first responders, someone who’s got a toolkit. Someone who has done this a lot. Someone who is employed by the city, who comes to them, who knows how to deal with these situations, calms them down, you know, helps them find a quiet place, you know, checks in with medications, checks if they’re dehydrated, see what things are exacerbating their condition, finds family members or loved ones who can help take care of them and resolves that situation.
And you want it to be as easy as calling 911 saying, “911 What’s your emergency?” There’s someone having a psychiatric crisis, can you send someone to help right away?
So there’s definitely been a lot of talks across the country about police not being the best at handling every situation, especially when it comes to those who may be having an episode in public or some sort. So, you know, let’s say that there is a mental health first responder hotline. Wouldn’t that put the onus on the general public though, to be able to assess and call correctly the 311 number, let’s say if it was 311. Cause you know, I guess my concern would be that there would be mistakenly called 311 calls when maybe the person having an episode doesn’t want to be helped.
I think that’s definitely a possibility and I think that’s something that would happen. But I think the difference is that, you know, these people don’t have guns on them. They’re not like trigger happy, like they’re not on like trigger happy power trips. Ideally these first responders would be trained in deescalation tactics because like deescalation is significantly more effective than a gun. And the consequences of mistakenly calling 311 on someone are significantly lower than mistakenly calling the cops on someone I think. And I think that’s the key difference.
I think a shift in the attitude towards mental health care, from a stigma, from a harm-based thing to more trust and more care put in these patients. I was listening to a psychiatrist doc, about why they do their job and what they do. And they say a psychiatrist job is to go into a room with someone experiencing mental health crisis and be present with them. That’s the most important thing you can do is be present with someone. You’ve listened to them when no one else has listened to them. You care for them when no one else is caring for them. Everything else, the medications, the treatments, the diagnoses, that’s all extra. And that I think is really impactful.
And now for the broader U.S. healthcare system, this is a similar space that you take. The U.S. spends a lot of money on healthcare, which is not a secret to anybody in the U.S. healthcare system. Yet we cannot really treat people the way they need treatments. The first thing is just that a lot of people do not have consistent access to health insurance or preventative healthcare. And so they put off treating things until they get really bad. And then they have to go to the emergency department. They have to have difficult procedures, they have to have surgeries. And if you had a regular access to a primary care physician to say like, “Hey, you know, your blood pressure is a little high.” Maybe it would be good to, you know, change up your diet a bit or, you know, put you on a blood pressure medication or even just change your work life so that you’re not working somewhere that stresses you out all the time. That would be really effective instead of, you know, going hundreds of thousands of dollars into med debt on post heart attack. And you know, the easiest way to do this is just to make healthcare free or affordable. And their efforts to do that in California has Medi-Cal, which is lovely. There’s, you know, statewide Medicare and Medicaid, there’s proposals to dramatically expand or even universalize Medicare and Medicaid. And a lot of policy wonks who are much smarter than me have been talking about how to—am I allowed to endorse political candidates on this podcast? (laughing)
You know, I’m not sure? You can say whatever you want.
I’ll just say then that there’s a taskforce of the folks from the Bernie Sanders campaign and the Joe Biden campaign, who have been working on trying to create a universal healthcare proposal that is cost effective, that doesn’t cause dramatic shock and damage to people who are currently on insurance, but the transitions to the U.S. towards a single payer system, or at least a public option, such that everyone has access to quality affordable healthcare.
And now for the second, slightly spicier take. Americans don’t know how to die. Most money we spend on healthcare is something like 50% of the money we’ll spend in a lifetime. That’s just, it could be wrong, it could be higher, honestly. It’s spent in the last year or last two years of life, it’s spent on treatments that do not have very high efficacy because family members don’t want to be the one who pulled the plug on their grandparents, where people are lunging for these miracle cures. They’re like, it’s got a 10% chance to save me. It’ll cost 300 hundred thousand dollars, screw it, let’s do it. And I think it’s in large part because doctors don’t know how to talk to their patients about death. Again, there are much better proposals here than I can really throw at you. And end of life care is a huge, huge, hot button issue in medical care right now in the industry. But one of these big things is just helping patients accept that they’re dying so that they don’t spend tons and tons of money and take up tons and tons of physician time and hospital time on these low efficacy treatments that will provide you with very little in the way of quality of life anyways,
You know, when I heard Sherwin’s spicy take of Americans not knowing how to die, I really couldn’t help but think about how it’s sort of ingrained in American culture to live as long as possible. Right?
Yeah. And yeah, I think it’s like very much a cultural thing. Like the way we treat death is very final. You know, it’s like this person’s gone forever. And I can think of a lot, a lot of other cultures where there is a lot of beliefs that address that, whether it’s like reincarnation or an afterlife or something. I think that there’s definitely shifts that can be made like some combination of like a cultural shift and making preventative healthcare more accessible. And I think people would be more okay with dying. If they had more access to preventable health, to preventative healthcare throughout their life.
The first proposal, the broader access to healthcare is the more important one. And, you know, please fund more psychiatry things. We need the money, but I think the second thing is important to, so I’m saying it,.
Thanks for saying that. That is definitely spicy, and—
I would say it’s not that spicy in the medical community. It’s just something that, isn’t something that is really easy. Like it’s hard to tell the general public that, “Hey, you suck at dying. Please get better at that.” Like that’s not, no one is campaigning on that message.
Americans are so scared of the concept of death. There is no way that’s happening.
But thank you for sharing that. I think that is a very important point to make. You know, if you imagine, and you touched on this already, too with when you were giving the example of that experience with the person near your old house who was having the, like going through a mental health crisis. And like also just as a side note, like I remember that, and I remember being there, and this was especially at the peak of when everyone on social media was sharing resources to like things to do other than call 911 during a mental health crisis or like alternatives to police. And people were posting a lot of local resources and this was like at the height of that. And even with all of that research, I remember spending like at least 30 minutes to an hour, trying to find just a hotline we could call. And there was not a single hotline we could call that was both relevant to the situation and like appropriate for the situation, and also did not involve police. And you talked about like what the ideal situation would have happened there, if there was a dedicated emergency crisis, like mental health crisis team that could respond. And I’d love to just hear more expanded version of that. Like, you know, if we had all the funding and the resources that we needed, and we weren’t grappling with all of this scarcity, like what would an ideal world look like?
So when I was at Stanford, we had some medical students or like psychiatrists, psychiatric trainees come through, some psychologist trainees. And one of them was talking about, this is an MD-PhD, brilliant woman. And she was talking about the state of mental healthcare in California prisons. And as I’m sure you can guess, it’s not good. They do not have nearly the amount of resources they need. The primary emphasis of push on them is to sedate people rather than to heal people. The goal of the prison is just make sure they’re not wilding out or causing disturbances other than how do we help this person get better. Prisons are also a terrible place for people’s mental health in general with all this isolation. There’s lack of freedom. There’s all these, you know, there’s all of the, it’s really just a pressure cooker for making a mental illness worse.
It’s very, very difficult. And so if I had unlimited resources, I would want more dedicated psychiatrists. I mean, really, I would want to change the entire prison system and get rid of it and replace it with something that was more functional. But if we’re sticking to medium sized goals, more psychiatrists and psychologists and therapists who work with people who are incarcerated, who give them access to treatments, who give them access to socialization and give them access to things like, you know, acting or art or music or sports or things that they can make their lives a bit better, because these are things that are preventative against mental illness. And then second would be, and this would hopefully avoid so many people who are just, who are mentally ill getting thrown into prison in the first place, would be that kind of mental health field responder program, where you have a dedicated system to help people who due to mental illness or having difficulty in some aspect of life, whether they’re like houseless or whether they’re just really having a rough time and, or someone’s in psychiatric crisis.
I, something that was actually kind of wild to me leaving the research world was just that most people don’t know how to deal with someone who is in psychiatric crisis at all. And I’m currently at the age, you know, 22 to 23, 24, when psychiatric crisis, psychotic breaks are really common among young folks. In the last year, I’ve had maybe three or four different people ask me like, “Hey, someone I know is having a psychiatric, a psychotic break, do you know what to do?” And I’d be like, I actually do, but that really, we shouldn’t be reliant on, you know, two years out of college research assistants do the reservoirs of that knowledge and the public. We should have dedicated resources, trained first responders whose primary work is dealing with these kinds of situations, because this kind of work and this kind of resource—putting money there helps with keeping people out of prisons. It helps with keeping people from being stuck in a cycle of houselessness, and it makes the community a better place to live where people know that when things are hard for you, there are people that are there to care for you. You’re not going to be pushed down. You’re not going to be hurt.
So Huanvy, I think I certainly understand the benefits of these services that you and Sherwin mentioned when it comes to having the resources and funding to provide it. However, I guess I’m wondering on the, “How” Part of it, like walk me through, on some of the changes that would need to be made.
I think it’s like at every level, you know, it’s like you got to build the literal infrastructure, like the building of where the clinic’s going to be housed, and then you can hire more people. And with that, you can have more people working more hours, because without being like totally overstretched and with more capacity, it means more access. Maybe then people won’t have to wait seven months just to get a diagnosis.
On a societal level. That’s such an important thing to be able to say, this is a community that cares after people who are hurting. This is a community that cares for people who are at their lowest points.
Wow. I think that was a really beautiful way to like wrap this all up. And I don’t know, I’m like a little bit speechless at how well you put that.
Aw, thank you so much. That’s very flattering.
But I am in complete agreement with all of it. And also you are so incredibly well-spoken and probably more well-spoken than someone two years out of college should have to be about these issues.
That’s very kind of you to say.
Yeah. Well, thank you so much for taking the time to do this interview. I’m gonna stop the recording now.
Reclaiming the California Dream is brought to you by AAPIs for Civic Empowerment Education Fund and Project by Project San Francisco. If you’d like to learn more about us, visit our website at aapiforce-ef.org and projectbyproject.org. Thanks for listening. Ad paid for by Chinese Progressive Association, nonprofit 501(c)(3). Committee Major Funding by Chinese Progressive Association, San Francisco Foundation.