Suicide Prevention Has Nothing to Do with Suicide Prevention

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Description

It turns out, there’s more to suicide prevention than crisis hotline numbers and inspirational memes. This week, we’re looking at the concept of upstream intervention – because the most effective way to convince someone to live is to help them create a life worth living. We explore the toll of historical trauma for American Indians and Alaska Natives, communities currently experiencing an unprecedented rise in suicide while also coping with some of the highest rates of COVID infection in the country.

 

We’re joined by Dr. Billie Jo Kipp of the Blackfeet tribe and Shavaughna Underwood of the Quinault tribe, who both work at the Center for Native American Youth. We also chat with Patrick Kennedy about Mental Health Parity and holding insurance companies accountable.

 

Season 2 of Last Day is created in partnership with The Jed Foundation. The Jed Foundation (JED) empowers teens and young adults with the skills and support to grow into healthy, thriving adults. You can find tips, tools and resources for taking care of your emotional health available at: www.jedcares.org/lastday

 

Resources from the episode:

 

 

If you or someone you know is struggling emotionally or feeling hopeless, it’s important to talk to someone about it now. Contact one of the resources below for a free, confidential conversation with a trained counselor anytime.

 

National Suicide Prevention Lifeline: 1-800-273-8255

Crisis Text line: Text “Connect” to 741-741

The Trevor Project: 1-866-488-7386

 

To follow along with a transcript and/or take notes for friends and family, go to http://lemonadamedia.com/show/last-day shortly after the air date.

 

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia.

Click this link for a list of current sponsors and discount codes for this show and all Lemonada shows.

Transcript

SPEAKERS

Dr. Billie Jo Kipp, Shavaughna Underwood, Patrick Kennedy, Jackie Danziger, Stephanie Wittels Wachs

Stephanie Wittels Wachs  00:00

If you are just tuning in, I encourage you to go back and start listening from Episode 1, it’ll make more sense. As for what you’ll hear today, we have worked hard to ensure that our storytelling around suicide is as safe as possible. But we can’t address this issue by tiptoeing around it. Instead of warning, who should and shouldn’t listen before each episode, we want to encourage you to press pause if and when you need to. We’ll be here when you’re ready to press play.

Stephanie Wittels Wachs 

I recently heard a story told by Dr. Donald Warren. He’s a member of the Oglala Lakota tribe, and an associate dean at the University of North Dakota. He’s got an MD from Stanford, an MPH from Harvard. And he comes from a long line of traditional healers. Anyway, the story was the parable of the river. Long ago, there were three sisters walking along a river. And all of a sudden, they see all these tiny babies in the water struggling to stay afloat. So the first sister says “This is an emergency” and jumps in to save them. The second sister thinks about that, and says “No, we’ll never keep up with it. We need to teach the babies how to swim so they can survive in the water on their own.”

Stephanie Wittels Wachs 

And the third sister just starts walking upstream. And the other two get really upset. They’re like “Where are you going? Why aren’t you helping.” And she says “I’m going to find out who’s throwing these babies in the water. And I’m going to make them stop.” This story perfectly, literally illustrates an idea we’ve been obsessed with for a while now that we’re finally ready to dig into upstream interventions. The idea that we can reimagine suicide prevention beyond crisis intervention. We’ve been fascinated with it. Ever since Janis, our JED advisor said this in one of our earliest meetings,

Dr. Billie Jo Kipp 

Suicide prevention, it has nothing to do with suicide prevention. It’s really about just making sure that people have adequate access to the things that promote wanting to live like, obviously health care, but jobs and education and the kinds of things that get people up in the morning and get them excited about life. That’s like the best form of suicide prevention that exists on the planet.

Stephanie Wittels Wachs  02:39

This blew our ever-loving minds, and it is something that we’ve been thinking about ever since. I mean, we’ve heard almost every guest this season, say some version of “I wish I’d gone to therapy sooner” or “I wish they’d gone to therapy sooner.” And this isn’t the episode where we’re going to be like “gotcha” therapy isn’t actually something we all need, because it is. But if I could take a magic wand, and automatically grant free therapy to everyone in this country, it wouldn’t actually solve the rising rate of suicide overnight, it would be a lot better. But it still wouldn’t address all the things that bring people to therapy in the first place.

Stephanie Wittels Wachs 

Even when you’re going to see a mental health professional for one hour a week, that still leaves 167 hours left to live on your own. So it matters if you’re spending those hours hungry, or isolated or out of work. So this week, we are walking upstream, away from the moment of crisis to focus on the basics, like the food we eat, or the roof over our heads, things that contribute to our overall quality of life. And to do that, we are talking about American Indians living on reservations, a population that represents what happens when you try to exist with only the bare essentials. Because this is a little woo woo but stick with me. The goal is not simply to survive. It’s to thrive. Not just to live, but to create a life worth living.

Stephanie Wittels Wachs  04:18

I’m Stephanie Wittels Wachs and this is LAST DAY.

Shavaughna Underwood 

Okay, so I kind of just want to give a little bit of a trigger warning to anyone listening, that I talk about abuse a lot, because it’s something that I lived through, and I’m dealing with the outcome of that to this day.

Stephanie Wittels Wachs

This is Shavaughna Underwood. She comes from the Quinault people. She’s a 2020 champion for change at the Center for Native American youth where she also works as Administrative Assistant helping people get into therapy. She’s the secretary of the Quinault Society and the Vice President of the culture committee. In short, she is very accomplished.

Shavaughna Underwood

So I am born and raised in Taholah, which is a fishing village on the Quinault reservation. It’s my ancestral homelands. Some ways that our homelands are described as it’s the beginning of a world. We have the ocean, we have the river, we have a rain forest, we have mountains, it is gorgeous. You smell the ocean. We have our fish house, a school and a post office. Not really a whole lot here. But it’s everything to us.

Stephanie Wittels Wachs

The Quinault are 1 of 574 federally recognized tribes in the US, they have a rich multi tribal heritage that evolved over a century, as people from nearby tribes made a home on their beautiful coastal land. But within this pristine landscape, Shavaughna experienced a lot of ugliness, as a kid

Shavaughna Underwood  06:04

It’s not that happy to story. So I was raised in the system. The foster care system, I was in a couple of foster homes, and it wasn’t a very good childhood. So I’m healing from that. My mother dealt with addiction a lot. And she was very abusive. And this was a long time ago, she’s a completely different person now. She is clean, and the most loving human on Earth. But what I endured as a child was something no one should ever go through. And so in therapy, we’re talking about how at times, like my five-year-old self is kind of striving the boat. And that comes with self-harm, suicidal ideation. That’s something that I live with.

Stephanie Wittels Wachs 

When she says her five-year-old self was striving the boat, what she’s talking about, is that at five, she tried to end her life.

Shavaughna Underwood 

So this was when my mom was dealing with addiction, I was still in her care. And she was very, like, I felt a lot of rejection. I internalized that rejection. And I was like “if my mom doesn’t love me, nobody will.” So didn’t want to deal with that anymore. And I took a knife and I tried to kill myself. And that was my first attempt that I remember.

Stephanie Wittels Wachs

As the mom of a six-year-old, this is really hard to hear. I just need to express that out loud. Okay, so she was eventually taken out of her mom’s house bounced around several foster homes, but no matter where she went, No one was really talking about the reality of what was going on. So she felt isolated, and tried to soothe herself any way she could.

Shavaughna Underwood  08:01

I developed horrible coping mechanisms, I dealt with a lot of like alcoholism and drug addiction at a very young age. So I cooked very unhealthy when I was a child. And nobody paid attention. Nobody really cared. I kind of just got off drugs on my own. As I got older, and I was very lonely.

Stephanie Wittels Wachs

Shavaughna was essentially the baby floating down the river. And when you’re just trying to keep your head above water, it’s hard to build healthy coping mechanisms.

Dr. Billie Jo Kipp 

When you’re growing up in a poor economy, and all the social ills are around. You don’t know that there’s anything different.

Stephanie Wittels Wachs 

This is Dr. Billie Jo Kip. She’s the Associate Director of Research and Evaluation at the Center for Native American Youth, where Shavaughna works. They are generations apart, but share very similar journeys. Dr. Kip is a member of the Blackfeet tribe and was born and raised on their reservation, located in a remote area of Montana.

Dr. Billie Jo Kipp 

My experience growing up on the reservation, was watching my dad.

Stephanie Wittels Wachs

Her father was on the tribal council all his life. She remembered him frequently getting up in the middle of the night, traveling miles away and helping people get gas to visit their families in the hospital. If we go back to the parable, her dad was jumping in the river helping every single baby that he could. And it always felt like an emergency.

Dr. Billie Jo Kipp 

I hated it. It was a selfless kind of love, but I hated it and I thought I never gonna do that. So I went on the other direction. I went into the helping direction of becoming a clinical psychologist. That way I could give back.

Stephanie Wittels Wachs

and when she said she could give back it was in a second sister type of way. She wanted to teach people to swim. And while training to become a child psychologist, she started to look at her own childhood differently.

Dr. Billie Jo Kipp  10:09

My awareness level really didn’t happen until my journey through education. And then I realized that I was quite different. And I realized the inequities of funding of access to resources of education, and tribal communities, but it was, you know, nobody let you know you’re poor, until somebody tells you, you’re poor, right? And so you don’t know that there’s a label for this. This is life. This is how we live. And nobody lets you know that things like Alcoholism and Substance Abuse and Mental Health are issues that can be resolved or be worked on. And I’ve been through all those as well. And so I’m very fortunate to have education, to help me see, and juxtapose the differences in tribal communities in the national level.

Stephanie Wittels Wachs

And when you say you’ve been through all of those as well, do you mean personally been touched by addiction?

Dr. Billie Jo Kipp 

Yeah, I’m in recovery about 35 years now, I think.

Stephanie Wittels Wachs 

Congratulations.

Dr. Billie Jo Kipp 

Thank you. And I’ve struggled with depression. It’s one of the reasons I went in to use drugs and alcohol. And so my husband and I both we’ve been married 46 years. And so we are very fortunate to be able to come through those things and to go on and to contribute to the greater good.

Stephanie Wittels Wachs 

Dr. Kip doesn’t just connect the dots between her depression and her struggle with alcohol. She traces it back to the history of her tribe.

Dr. Billie Jo Kipp

If you come and are raised and born into a culture that has been oppressed and has been a product of genocide, you start to see your worth less than. You can see the over representatives of native in Substance Abuse and Alcoholism and mental health. Those are clear examples of long history of oppression and violence. And it’s much like an abused child. You know, when you come through recovery, when you come through understanding what happened, then you get better. Collectively, collectively, we have to understand how this contributes to our overall wellness. And collectively, we have to understand how our systems may impact that.

Stephanie Wittels Wachs  12:42

Systems like health care.

Dr. Billie Jo Kipp 

The health care of tribes and tribal reservations is funded by the Indian Health Service. The Indian Health Service is severely underfunded. They’re funded at maybe a level of 50% to the number of native patients and clients. And so access to health care is incredibly difficult. And oftentimes, like on my reservation, our hospital is sometimes on trauma only. And all the funding goes that. So, no preventative care, no systematic, ongoing care of mental health issues. And so our access to quality mental health care and quality health care is really limited by the funding levels of Indian health, which we are so and I hate to say sorely dependent on.

Stephanie Wittels Wachs 

The Indian Health Service, or IHS grew out of the relationship between the federal government and Indian tribes that was established in 1787. Fun fact, federally recognized tribes are the only people in this country who are actually guaranteed health care. But it’s so underfunded, it’s all crisis management, very little preventative care. Forget about upstream. For example, if you’re living with diabetes on a reservation, it’s easier to get a ramp installed outside your house to accommodate a wheelchair than it is to get preventative care to avoid having to use a wheelchair in the first place. And this quote unquote “free healthcare” isn’t actually free at all. They basically got it in exchange for their land.

Dr. Billie Jo Kipp  14:31

We’re provided health and education and welfare per treaty. However, when we a became a ward of the government, and that’s what we were called early on. The government always only gave us what we need. So there were times that the government said that when they moved us to reservations sent rancid meat and that’s what we got. That’s what we ate, we had a starvation winner. That role wiped out multiple people.

Stephanie Wittels Wachs 

The American Indians were given the bare minimum to survive. And even that was difficult. The concept of thriving was entirely off the table. With each treaty, the US got greedier and crueler.

Dr. Billie Jo Kipp

So in the eyes of the government, they struggle to understand our needs, they struggle to see us as a contribution and only a I believe, and this is my belief, and only something to be dealt with. And we were called throughout history, called the “Indian Problem.” Well, if we’re a problem, we’re not going to be treated as human. And that became the dehumanization of Native people.

Stephanie Wittels Wachs 

The US government literally use the phrase, the “Indian Problem” to refer to Native Americans in the 1950s. As they tried to dismantle the very reservations that they created, communities were torn apart, resources were stripped away. And the results are still very much felt today.

Shavaughna Underwood  16:11

I grew up very poor. And I didn’t have access to food. So I have access to very unhealthy processed food. We kind of just ate whatever we could. So it was usually like I ate a lot of white rice. That’s all I remember my entire childhood. And I think any red kid can relate to that. So rice with either hamburger gravy or fried rice, poor man’s fried rice, which is just bacon, eggs, and rice. And that is all I ate my entire childhood, because it was available.

Shavaughna Underwood 

So I was extremely overweight, because of what I ate. And that was out of my control. I didn’t play sports, I was bullied. They didn’t understand that I was poor, and didn’t have access to food like them. And they made fun of me for the way I looked. And that gave me a lot of the issues that I deal with around suicidal ideation. So today, studying food sovereignty and making sure people have access to food that is good for our bodies is something that I care very deeply about.

Stephanie Wittels Wachs 

Food sovereignty is the right to healthy and culturally appropriate food produced through ecologically sound and sustainable methods. It’s not a fad diet catchphrase like clean eating and whole Foods. It’s a response to an historic health concern for Native people.

Shavaughna Underwood

Our bodies were not made to consume processed foods, sugar, all of that stuff that’s causing diseases in our communities.

Stephanie Wittels Wachs 

When native tribes were displaced and forced to relocate hundreds of miles away, the new land couldn’t easily support the traditional staple vegetables and beans that it sustained their people for 1000s of years. To prevent the indigenous people from literally starving, the government gave them commodity foods like canned goods along with white flour, processed sugar and lard. This is how you end up with frybread one of the most iconic indigenous dishes that is both a symbol of resilience and a response to colonization. commodity foods are partially responsible for today’s alarmingly high rates of diabetes and heart disease. Shavaughna’s story just illustrates that this threat to physical health has a very real impact on mental health. For her, food sovereignty is a way to heal trauma.

Shavaughna Underwood  18:45

Once I reached the age where I could take care of myself, I realized I deserve better. I realized I deserved veggies, I deserved through and water. So I make sure that I have access to that. I worked very hard to have the life that I do. And I told myself, you are giving yourself the love that you always deserve.

Stephanie Wittels Wachs 

Growing up, Shavaughna didn’t know the history behind the hunger she experienced every day. She was just a kid living in a food desert, being bullied for the way she looked. Reclaiming her roots gave her a path forward.

Dr. Billie Jo Kipp 

When you are able to name things in a collective way, like historical trauma, many clients had that “aha” moment. And it took away the shame of their difficulties. It took away the shame of their behaviors and not to excuse it, but to understand it in a more deeply historical level.

Stephanie Wittels Wachs

Like Dr. Kip, Shavaughna didn’t learn about historical trauma until she was in school.

Shavaughna Underwood 

The term came into my life when I was in college and my Professor said, if we’re going to be professionals in this world, we have to face our traumas. And she says she doesn’t want to raise us. And to have this go on the road and cause harm because we didn’t deal with our traumas yet. So I had to look at my traumas, sit with them, go through years of therapy, just because I wanted to be a better person for the people that I want to help.

Dr. Billie Jo Kipp  20:24

We do trauma, because we’re traumatized. And we have a history of trauma. But if you remind them, we have a history of strength, and resilience, and look what our ancestors overcome, our ancestors froze. We had ancestors who were massacred, but yet they believed that we deserved better.

Stephanie Wittels Wachs 

We hear a lot about resilience. But it comes at a cost. Learning about historical trauma was an “aha” moment for Shavaughna. But a painful one.

Shavaughna Underwood 

It was definitely a new wound that I didn’t know existed, that was 1000s of years old. And I’m learning that it’s going to take so much more than Western medicine to actually heal that. Because it’s not something that we were supposed to go through.

Stephanie Wittels Wachs 

This is the struggle of approaching the health concerns of a community like American Indians and Alaska Natives. Today’s problems were forged centuries ago, when the government forcibly severed the connection between people and their indigenous practices. The resulting statistics are staggering. Death rates from preventable diseases among Native people are significantly higher than among non-Indians. According to recent data in North Dakota, the average age of death in the white population is 77.4 years old.

Stephanie Wittels Wachs

In the AI community, it is 56.6 years old. They experience higher rates of suicide compared to all other groups. Since 1999, the rate of suicide amongst native women has gone up 139%. So how does your community approach suicide prevention?

Dr. Billie Jo Kipp  22:21

You know, I think every tribal community struggle, I think they try to do a lot of the information. We’ve had so many suicides recently. And just recently, I had a nephew suicide and I know is becoming more common.

Stephanie Wittels Wachs 

Was this a recent loss?

Dr. Billie Jo Kipp

About maybe four weeks ago? Yeah.

Stephanie Wittels Wachs 

Oh, my goodness.

Dr. Billie Jo Kipp 

Yeah. And the sad fact is, I think it may have been a reaction to his aunt and uncle both died of COVID within days of each other, and those are my sister and my brother.

Stephanie Wittels Wachs 

Oh, my goodness, I am so sorry for your loss, that is a lot.

Dr. Billie Jo Kipp

That is a lot of loss. It is, it is. It is, and I hate to say this, but that’s kind of more than no more on the reservation. I live in Seattle now and I can’t even get back home. At this point, we can’t ceremoniously bury our people. Our people die alone in COVID. And that is so anti-cultural for us when, when our people are on their journey to the Sandhills. Everybody is around them. And we can’t do that. And so this has been a disruption of our cultural system.

Stephanie Wittels Wachs

When Dr. Kip told me that she lost her nephew just four weeks ago to suicide. It was like a bomb went off on our Zoom call. The fact that she had also lost her sister and brother to COVID left me speechless, which is hard to do. But it makes sense that I’m shocked and she’s not. Because this isn’t just bad luck or getting struck by lightning three times. None of this is accidental. When you look at the most common health concerns for Native communities, they just so happened to mirror the negative potential health outcomes associated with what ACES or Adverse Childhood Experiences.

Stephanie Wittels Wachs  24:33

They’re more likely to smoke, experience obesity, hypertension, diabetes, heart disease, and chronic lung conditions. And you know what all these things are? Pre-existing conditions that increase your risk of dying from COVID. How reservations coped with the pandemic on top of a rising rate of suicide, when we come back.

Dr. Billie Jo Kipp 

I think if you look at a lot of reservations, look at Navajo Nation, how many people they’ve lost? They still don’t have the basic elements of water and phones, and homes. They don’t have the basic needs. So if we’re always trying to get our basic needs met, food for the day, something like that, how can we think of being well? Being healthy?

Stephanie Wittels Wachs 

When COVID first became a national issue in the US, it was talked about like a great equalizer. Suddenly, we were all in the same boat, fighting against a common enemy. But the virus ended up highlighting the preexisting health disparities already present on reservations. By the spring, the Navajo nation had a higher infection rate than New York City. In New Mexico, indigenous Americans make up only 8.8% of the population, but accounted for over 60% of deaths. And for people who were intentionally handed blankets carrying infectious diseases, COVID has opened up a lot of old wounds.

Dr. Billie Jo Kipp  26:21

If we look at COVID today, it’s a severely anxiety provoking disease.

Stephanie Wittels Wachs

It seems like the long-term ripples of that are going to be so profound. And I’m, you know, when we talk about historical trauma and trauma that sort of keeps going, are you able to sort of look at this a moment and think, is there fear there that this is creating more of that?

Dr. Billie Jo Kipp 

Oh, most definitely. Most definitely. I think that tribes are really fearful. One of the things I keep writing about is the children because I’m trained as a child psychologist, is the lack of access to their peers, the lack of access sometimes to food, because when you’re in the poverty community, school is where you get your food. And now they’re all doing the Zoom thing. However, we don’t have a strong internet on the reservation. Many of our children don’t have access.

Stephanie Wittels Wachs

I’m not sure that I would have considered access to Wi-Fi suicide prevention before this. But of course, it makes sense when you think about what the internet represents. Information, community, connection. Now with the pandemic, that resource is an essential need. COVID has isolated Native youth at a time when the suicide rate was already rising. And this problem isn’t isolated to the US. A first nation tribe in Canada declared a state of crisis in 2019, after three suicide deaths occurred over three weeks, including a 10-year-old girl. The stakes are too high to just stop outreach services during the pandemic. So Shavaughna and others have had to get creative.

Shavaughna Underwood  28:17

My dad is a fisherman. And he would catch fish and fillet it and I would go and deliver it to elders who were hungry in the village. There’s this one grandma, who I delivered fish to. I was like “Do you want some fish?” And she got really excited and said yes, and I dropped that on her porch, and she stood at the door. And she was like “I love you.” And there’s some reason that I love you. This meant the world to me. And I told her I loved her too. And I hope she loves her fish. So I don’t want to be selfish, but it was just so gratifying to hear an elder fill joy right now in a time where everyone is scared, upset, doesn’t know what’s coming next. It was just a really special moment.

Stephanie Wittels Wachs 

A special moment that revolved around key pieces of her culture, food sovereignty, respect for elders, tribal connectedness. Those things are hard to come by right now.

Shavaughna Underwood 

Our oldest traditions just sitting down and talking and we don’t get to do that. We don’t get to tell stories or sing our songs. And it just feels traumatizing, I guess? Because our ancestors weren’t allowed to practice their culture. And right now it feels like we aren’t allowed to even though it’s much different circumstances. It’s still very painful.

Dr. Billie Jo Kipp 

The culture is a resource for our people. The holdings, the underpinnings of the culture is that we care for one another. We love one another. We do good. We follow a straight path we follow what our ancestors want us to do. So we’re always checking in with our elders and our ancestors to make sure that we’re following the path and when we get away from our core values, of our culture and of our being, then we struggle with issues of the world. And so the culture is really a place we go to in a place that we incorporate in our daily lives, to give us strength, to give us hope, but also to give us direction.

Stephanie Wittels Wachs  30:37

For Native communities, rebuilding after the pandemic has to happen holistically, placing equal weight on physical, emotional, mental, and spiritual well-being. Taking this approach is itself an upstream intervention, trying to force a Western approach to mental health on this community won’t cut it.

Dr. Billie Jo Kipp 

One of the biggest barriers, I believe, is lack of culturally appropriate interventions. And I as a native person, and I’ve worked in several tribes across the nation, and one of the things I did as a, as a native psychologist is to learn what are the resources in their culture that they can incorporate into their treatment plan. And so we always worked from that lens.

Stephanie Wittels Wachs 

When Dr. Kip first mentioned cultural resources, I imagine something like connectedness, an important factor, but one that is highlighted in many treatment models. But talking to Shavaughna, I realized it’s more concrete than that.

Shavaughna Underwood

So speaking from a quantum person, we have a lot of different medicines, we have cheese, singing our songs and dances that’s really good for not only our physical health, but our mental health, you’re connecting to your identity. And that gives us strength, a strength that you didn’t even know existed.

Stephanie Wittels Wachs  32:01

Right now, Native people are separated from most care, culturally appropriate or otherwise, because not all states have nationally recognized tribes, mostly because they were all relocated elsewhere. They are an easy target for budget cuts, voters aren’t going to complain if their representative votes against the rights of a tribe located halfway across the country. Why would they? Doesn’t impact them. But if you saw a bunch of little babies floating down the river, wouldn’t you want to save them? This is what we mean, when we talk about upstream interventions. Health care is a critical one. But just to give you a sense of how severely underfunded the Indian Health Services, funding would have to nearly double to match the level of care provided to inmates in our federal prisons. Enter Dr. Billy Jo Kipp, and the Center for Native American youth.

Dr. Billie Jo Kipp 

So we really proposed programming and curriculum, and facilitate our Native youth at a higher level. We introduce them to Congress; we introduce them to ways to advocate because we need that. We need people who can interact and who can develop initiatives that are critical to Indian country.

Stephanie Wittels Wachs

For Shavaughna, these programs offered a way out of the darkness.

Shavaughna Underwood 

Having more opportunities to actually gain knowledge for life skills, like I got to go meet President Barack Obama, I got to go meet Michelle Obama. So I think giving youth those opportunities, and letting them shine is really important. Not just giving them a voice, but actually letting them shine, show their skills. Because they’re all talented, meaningful, and important.

Stephanie Wittels Wachs

Shavaughna recalls this one day that this Quinault tribal leader singled her out to acknowledge her hard work, and all the promise he saw in her.

Shavaughna Underwood  34:07

And I was like “Me?” Like, in my head, I was still an addict. I was suicidal. I was all these things and but he gave me those kind words. And they brought me to where I am today. So having someone just give you like the smallest bit of light. Can really turn your life around. And it turns my struggle into a passion and into a career. I was inspired and motivated and took those words and ran with them.

Stephanie Wittels Wachs 

It turns out Dr. Kipp has had her own journey building resilience with the help of community support.

Dr. Billie Jo Kipp

I struggled with suicide and had an attempt as I went down my journey through drugs and alcohol and I am lucky that we had on our reservation, a non-native clinician who sat with me who cried with me who helped move me towards treatment to something better, was having that one person who believe I could be better. And you know, there are other people around me and they would say it, but I couldn’t hear it. Because I was so ashamed of what I was doing. I was so ashamed for my life. So I’m not ashamed to tell you I’m a teen mom, I’m not ashamed to tell you I’m in recovery, because it strengthens me. It makes me who I am. Every experience I have gone through has strengthened me for this moment.

Stephanie Wittels Wachs 

I love that. That is so powerful and so important. How are you approaching your own mental health during this COVID time?

Dr. Billie Jo Kipp

You know, I’d be remiss if I didn’t say struggle, I do struggle. Every day I struggle, every day I tell my husband, I hate COVID because it’s taken many people, my sister died in the middle of this. And so it’s been hard. It’s been hard, I cry. And that’s good, that’s healing. Tears are aren’t about the pain. Tears are the healing from the pain. And I work and I work knowing that if I stay connected, and do these things, and do the things for CNA, why? That somewhere down the line, there’s going to be somebody like me, who’s going to do the same thing. So I reach you teach one, you reach one, you’re always as you climb the ladder, you reach back and you pull others up.

Shavaughna Underwood  36:48

I have come a long way. And much different than I was five years ago, on my journey, like no self-harm, no eating disorders. I’m like in recovery. It’s something I live with and struggle with at times. But it’s not as strong, I don’t have a strong tendency to not be alive anymore.

Stephanie Wittels Wachs 

Recovery has been possible because consciously or not, Shavaughna has taken an upstream approach to her own well-being.

Shavaughna Underwood

I felt like it kind of goes back to psychology like the hierarchy of needs. I was able to get a job and take care of myself. I decided to go to college and get a degree and become the first generation in my family to get a college degree. And I just decided I wanted to end that intergenerational trauma for my lineage, it’s going to stop with me. I decided I wanted to have a better quality of life. And I wanted to live my life because my ancestors didn’t get to.

Stephanie Wittels Wachs

Today, Shavaughna lives right on the ocean, where she hears the waves all day and feels a connection with her ancestral land. Also, if you’re not familiar with Maslow’s Hierarchy Of Needs that she mentioned, think of a pyramid. The bottom two layers are your basic physiological and safety needs, food, water, shelter, security, meeting those leads to the next two layers, psychological needs, belonging and love. The ability to form intimate relationships, building self-esteem by feeling accomplished and recognized.

Stephanie Wittels Wachs  38:37

And at the very top is self-actualization. Achieving one’s full potential, including creative activities. This should be the goal for all humans. And this is a useful framework for demystifying this idea of how to build a life worth living. You can’t just skip to the top of the pyramid through sheer perseverance. You need a strong base to build upon. After the break, we talk to a policymaker who’s applying this strategy on a national level.

Stephanie Wittels Wachs 

back so far, we have been focused on a community that illustrates the most extreme example of a system that was built without a third sister with no focus on upstream interventions. But just in case you’re feeling comfortable, because you’re not dependent on the Indian Health Service. Rest assured the health care system serving the general population is its own tangled mess.

Patrick Kennedy

I mean, this is the Wild West. I find that I’m kind of an operator. I’m like an old-fashioned switchboard operator. I plug this person into that treatment and this person into that treatment. I counsel them, what is your payer cover? What’s in network?

Stephanie Wittels Wachs  40:08

That guy comparing himself to an old timey cable girl is Patrick Kennedy. We talked to Patrick last season because he knows what it’s like to struggle with addiction. We brought him back this season to talk about his continued work with the Federal Mental Health Parity and Addiction Equity Act. He’s the one who passed it back in 2008. Reminder, the grand idea behind Parity is..

Patrick Kennedy 

The brain is part of the body.

Stephanie Wittels Wachs 

Which sounds almost laughably obvious until you consider the fact that the Parity law was passed almost 13 years ago. And yet mental health care still sucks pretty hard for most Americans. Because it turns out, making a rule and getting people to follow a rule are two very different things.

Patrick Kennedy 

I’m sorry to say we didn’t get this law, kind of fully enforced at the get go. But there’s a long story to that. The bottom line is we in the mental health and addiction world, we’re very disorganized. And that’s to our detriment. And one of the reasons why we don’t have enforcement, is we don’t muster the kind of political pressure that comes close to the power that insurers have.

Stephanie Wittels Wachs

Yeah, it’s just so interesting, as a lay person, you know, you think, oh, the bill is passed. So that means it’s gonna work now. And it doesn’t, you know, it’s just..

Patrick Kennedy

But it’s an important tool. And, you know, like civil rights, you know, it didn’t get rid of racism. But what it did do is it said, there’s an infrastructure to prosecute, discrimination. You can’t prosecute what’s inside someone’s heart. But you can say they can’t act on it. And that’s our tool. But like the 64 Civil Rights Act, 65 Voting Rights Act, Fair Employment, Fair Housing, all of those pieces of legislation, they’re only as good as we make them, work for us. And that takes constant vigilance, constant advocacy, and constant political pressure.

Stephanie Wittels Wachs  42:13

So we can’t prosecute insurance companies for wanting to make as much money as possible. But we can hold them accountable for offering plans that are designed to make money by denying care. Or at least we could, if enough people applied pressure in the right places. It’s kind of like the funding for the Indian Health Service, politicians can get away with a lot of cruel behavior, if it flies under the radar. And with both systems, that cruelty is backed by a lot of history.

Patrick Kennedy 

While there is a major legacy of discrimination, there is a consequence to us, marginalizing and segregating this care forever. And while there is an urgent need for us to rectify that and get to treating this like we would other conditions, because keep in mind, it is a physical health condition. It’s more genetic than any other set of illnesses. This is about brain chemistry, not character. No one chooses a life where they alienate their friends and family, jeopardize their own safety, that of others, and being arrested being fired from a job. So we have to get around these old images, but there are inherent biases in everything we do. And it takes a lot of work to undo that.

Stephanie Wittels Wachs 

This is usually where we talk about fighting stigma by sharing stories and shedding light on the things we keep in the dark. You know, our whole shtick. Patrick’s approach is a bit more pragmatic.

Patrick Kennedy  44:11

Most importantly, we have to reimburse for treatment so that we have the kind of fidelity to best practices that can be reimbursed. And we have a pipeline of available providers ready willing and participating in networks. So there are no barriers for people to get care, frankly, before they get in trouble.

Stephanie Wittels Wachs 

Coverage is meaningless if there aren’t any in network providers in your area, or if your claims keep getting denied. Because the insurance company thinks you’ve had enough therapy to be all better now. As a patient, these barriers can be extremely frustrating. But they’re also the way big insurance companies have historically tried to sidestep the law. And the wild part is, you’d think this would make society more suspicious of the insurers. But it also contributes to the stigma that helps insurance companies get away with this.

Patrick Kennedy 

Well, it’s a self-fulfilling prophecy. You will find these illnesses are just as successfully treated as other illnesses. Problem is, people’s experience is very negative, because the current system doesn’t model that treatment and recovery is possible. And that’s what fuels these biases that once you have these illnesses, you’ll never get better. Because everybody has it in their own experience with a loved one. That they never were able to get through it.

Stephanie Wittels Wachs  46:01

And a bad experience can leave the impression that there isn’t a better option, rather than the reality, which is, the best options for patients aren’t always the best options for profit margins. So the problem gets swept under the rug until someone hits a crisis, like Dr. Kip said about Native communities, it’s all emergency care and no prevention.

Patrick Kennedy 

And we don’t have a mental health perception of hygiene, like we put a lot of stock in wearing masks and washing our hands. But we need to take that template and apply it to what’s our mental hygiene in terms of getting enough sleep, eating right, not spending too much time on technology. How do we connect with our family and friends in meaningful ways? How do we practice? In addition to exercise on your physical front to stay healthy? And diet? How do we do mental exercises to help mediate our emotions and cope with life stressors? These are things I believe in years to come, are going to be second nature to us. But the question is, how quickly are we going to get there? And how many people have to suffer before we do?

Stephanie Wittels Wachs 

That is the kind of question that really stings for everyone who hears it. So why aren’t we doing more now?

Patrick Kennedy

Our budgets, and therefore our financial incentives are misaligned, in order to get the long-term return on investment. So if you have to post quarterly earnings as an insurance company, it doesn’t incentivize you to do the things that you know, will reduce lifetime disability dramatically. Because you’ll never see the upside on that. If your government and your budgets are annual, and the health care budget doesn’t care what the housing budget is, and the housing budget doesn’t care what the health care budget is.

Patrick Kennedy  48:14

Then there’s never going to be an alignment that if you increase the housing budget, for people with severe and persistent mental illness, you provide one of the most important medical interventions for the healthcare budget that you can provide. But people can’t worry about treatment if they’re worried about dangerous living conditions and being shuffled around from one shelter to the next.

Stephanie Wittels Wachs 

This goes back to Maslow’s hierarchy of needs, which by the way, was inspired by his work with Blackfeet Nation tribes. The pyramid rests on top of the critical bottom layer, access to basic needs like food, water, and shelter. Without those things, it is very difficult to build that life worth living. Treating every budget separately ignores the fact that it all works together. So it’s important to let our lawmakers know that we see the invisible lines between these sectors. If they’re promising to fight the opioid crisis, while slashing housing budgets. Call them out on it. It is truly the only way we will start to get anywhere on a systemic level.

Stephanie Wittels Wachs 

How do we do that? How do we start to change public health messaging? It seems like a huge thing to do. Where do we start?

Patrick Kennedy

Well, these are, needless to say unprecedented times. And I think that they provide an opportunity for us to change everything and to do it all at once. I literally think the COVID crisis is a mental health crisis. I believe that it’s going to take COVID, for us to change our perceptions about mental health and addiction. Because COVID affected every single person in one way or another, to allow them the perspective that they may not have had previous to COVID. Where even healthy [people have suffered, increases in anxiety and depression. So that is going to be a new reality, which I think is going to create the impetus for a policy change.

Patrick Kennedy  50:39

And if their workplace doesn’t address it, it’ll lead as we know, to higher health care costs, higher disability costs, and clearly lower productivity. So this is now a major business issue. And I think that will put political pressure and what you have is a real opportunity for fundamental change. And they’re ultimately will need to be the beginning of a political movement. And that’s not going to happen without citizens stepping forward and saying, I’m going to make sure I ask local candidates, what are they going to do about this and that.

Patrick Kennedy 

And by the way, I now know what questions to ask because for each office that a candidate is running for these are the things that we need them to do, in order to make the system better. More affordable and accessible housing, stable places for people to live, so they don’t have to cycle in and out of the criminal justice system, or the health care system. These kinds of things. And in education, if you’re not helping our kids build resiliency through coping mechanism development and social emotional learning, problem solving skills, you’re just letting down a future generation who as we know from indicators, is suffering much higher rates of suicide, ideation and attempts, and tragically deaths. So we have to do this failure is not an option here.

Stephanie Wittels Wachs  52:25

It is 2021. New year, new administration, new beginnings. It’s time to decide what kind of future we want to build. Being healthy should not be a luxury. And you shouldn’t have to choose between feeling sane, and putting food on the table. But we can’t begin to talk about true mental well-being while people are still living paycheck to paycheck. And for many Americans, those paychecks stopped back in March.

Stephanie Wittels Wachs

If you look at the history of American Indians and Alaska Natives, you can see how systemically removing services has directly resulted in poor health outcomes. And that’s true for physical and mental health. So it’s time. We know better. And we are at the edge of that river right now. And we can each choose which sister we want to fight for. Better crisis management, better access to preventative care, or better public health policy that builds a fairer system for all.

Stephanie Wittels Wachs 

Like Patrick said, there’s a part for each of us to play. Or we can do nothing, in which case we are the people throwing the babies into the river, turning a blind eye and hoping they can swim.

Stephanie Wittels Wachs

Next week, we are taking a surprise turn to talk about self-harm with a member of the LAST DAY team. Our apparently not so stone-cold producer, Jackie.

Jackie Danziger  54:06

Like there’s something sort of tragic to me about imagining myself as an angsty teen that like to journal and cut myself. Do you know what I mean, I’m like “Oh” That’s exactly who I was. I don’t want to be that person. But I totally am.

CREDITS

LAST DAY is a production of Lemonada Media. Our supervising producer is Jackie Danziger. Associate producers are Giulia Hjort and Claire Jones. Technical Director is Kegan Zema. Music is by Hannis Brown. Executive producers are Jessica Cordova Kramer and me Stephanie Wittels Wachs. We are thrilled to partner with the JED foundation this season and grateful for all their wisdom and support. You can find them online at @JEDfoundation. And you can find more mental health resources at jedcares.org/lastday. If you want to hear more LAST DAY, we have an entire first season. Please go listen to that wherever you get your podcasts. And while you’re there, please write us a review, rate the show and subscribe if you have not done so already. You can find us online at @LemonadaMedia, and you can find me at @wittelstephanie. I will see you, next week.

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