Policy is Mental Health Care

Recently, I watched “Inside a Suicide Prevention Center in Puerto Rico,” a short January 2018 New York Times Youtube documentary done a few months after Hurricane Maria.

The workers said that, since the hurricane, they’d gotten busier. Puerto Rico’s top mental health official said that they were already seeing signs of severe mental health crisis. Over a month in, many were still without electricity, water, and in some cases, a roof over their heads. Three months after Hurricane Maria, more than 1.5 million people, nearly half of Puerto Rico’s population, were still without power. For me, the most jarring and memorable moment of the documentary was near the end, when a crisis line worker said, “Sometimes I can’t find the words. Because how can I tell someone to keep calm when they don’t have a place to sleep?”

I work on a suicide hotline, and have had similar experiences. There are many callers for whom our work is effective. But there are many more who, similar to the callers in Puerto Rico, have fallen through the cracks in our societal systems, have seemingly exhausted all possible options for help, and still can’t get back on their feet. People who are homeless and the shelters are full. People who can’t find jobs and are ineligible for many programs that provide help because of past felonies. What do you say to someone whose mental health problems are created, either partially or totally, by a lack of tangible, physical resources to improve their lives? A lack that can’t be fixed with simply a phone conversation?

I am in school to become a mental health counselor. I believe deeply in the efficacy and importance of mental health work, and I think it’s vital that we fight to make therapy affordable, accessible, and free of stigma for all. But it’s hard to process past trauma when you don’t know where your next meal is coming from. It’s hard to have hope for the future when you don’t have access to resources and opportunities. While watching the video, I remembered that if I truly want to support the mental health of my future clients, I need to be much more than a mental health advocate. I need to be an activist and an advocate in much broader senses of those words.

Ensuring people have a roof over their heads is mental health care. Ensuring people have clean water and food to eat is mental health care. Ensuring people have rights and can be themselves in the world without discrimination is mental health care (#TransRightsAreHumanRights) . Ensuring people can walk, drive, and sit in schools without fear is mental health care (#BlackLivesMatter). Ensuring everyone has access to physical health care is mental health care. Ensuring people are paid a living wage is mental health care. Ensuring we take care of our earth for the generations after us is mental health care. Ensuring people have a ladder to climb back up after they’ve fallen down is mental health care (in the beautiful words of musician Gregory Alan Isakov, “If it weren’t for second chances, we’d all be alone”). Ensuring people can see possibilities and a path forward is mental health care. Ensuring people’s basic needs are met is mental health care. Policy is mental health care.