You can’t pick and choose with mental health

October is mental health month. It’s the busiest time of year for mental health professionals as most groups and establishments scramble to put up talks and seminars to promote mental health awareness. In a way, it’s a sign of progress that so many have recognized the need to prioritize our mental health, even for one month. Sometimes though, as the exhaustion of October sets in, I wonder if it made any difference or if it just made schools and companies feel happy that they’ve “done something” for mental health enough to forget about it the rest of the year. Did establishments increase their funding for mental health care and services? Did they even set up any structure for mental health care? Did they take an honest look at their work policies and rules to ensure that these do not exacerbate a sense of meaninglessness? Did schools learn to embrace accommodations as a PWD’s right rather than think of it as an unfair advantage? Honestly, has anything changed after so many years of webinars and talks?

Mental health, like other advocacies, has to compete with other priorities. It even has to compete with the different priorities inside it—do we fund for awareness campaigns or try to raise funds big enough to offer services? Most organizations focus on the awareness side of the advocacy because it requires much fewer resources to do so. Anyone can be a mental health awareness advocate. Diversity of experience and perspectives are very much welcome in the cause. People with lived experience help to humanize the issue. People who care for people with mental health issues also provide a critical voice—in that this problem claims multiple victims, not just one. We also need people who advocate on the well-being side since too much of the spotlight has been on problems and disorders. They remind us that the spectrum of mental health isn’t just limited to illness but that it also covers hope, joy, a sense of meaning, and enhancing the quality of life.

In contrast, providing quality mental health services and programs is much harder to initiate and sustain. It is resource intensive and time-consuming. Unlike a medical mission, where a great number of patients can be served in a day, providing mental health care requires that a specialist provides continuous care, meaning that one professional can only handle a small number of clients at any given time. We certainly cannot drop in and out of a town as follow-ups make or break the success of a mental health intervention. Providing an in-house mental health specialist or contracting out requires significant funds from a school or company. Most of the current advocacy work that provides services rely on a pool of volunteer psychologists. Volunteering to do psychotherapy takes a considerable portion out of one’s income capacity, which can lead to financial insecurity (Those who say otherwise must have a partner or household member that can compensate for the lack of income being brought in). This can lead to a high burnout rate or eventually a decision to cut down their caseload significantly. We’ve graduated only a few at a time and even fewer commit to a full-time practice due to the exhaustiveness of the work.

Then there’s the panda problem. Similar to the challenges in wildlife preservation, most funding go toward the “cute” problems. In mental health, the problems that people can sympathize with are the ones that get the most attention. And it is the least threatening problems that get the most sympathy. It is relatively easy for people to understand that we need to comfort those who are suffering. What is hard for them to grasp is that suffering doesn’t always come in a huggable form. For example, one of the most common misconceptions is that depression looks like sadness, preferably with tears. However, the hallmark of depression is not necessarily sadness but the loss of capacity for joy. When there is no capacity for joy, the meaningfulness of goals—and life—disappear. Demotivation and lethargy sets in. When life is meaningless, being polite and caring for others just sound excessive and so that gets thrown out.

Real depression is not always a crying child in the corner. Real depression can sometimes look like anger and irritability. It can look rude and messy. Real depression can get ugly. We can’t pick and choose which displays of mental health are acceptable or worthy of help. Sharks need help, too.

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