Youth Mental Health Learning and Strategies

Diana Chao's Handout Youth Mental Health Learning and Strategies

Awaken What's Possible.

2022 Youth Theology Network Gathering

Letters to Strangers (L2S) is the world’s largest grassroots youth-for-youth mental 50% of all lifetime cases of mental health nonprofit, seeking to destigmatize mental illness and increase access to illness begin by age 14. 75% by age 24. affordable, quality treatment particularly for those aged 13 to 24.

Suicide is the 2nd leading cause of death in the world for young people 1

10% or less of those with depression

Letter-Writing

Writing is humanity distilled into ink. We want the human connection to foster empathy, one letter at a time. Our campus and local Chapters exchange letters anonymously with each other and community partners. The public uses our free custom online platfom. Overall, we exchange 20000+ letters a year.

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Suicide rates have increased by over

60% in the past 45 years—and it’s still going.

Peer Education

We create science-informed, culture-aware workshops and curricula. Our world’s first youth-for-youth mental health guidebook is an illustrated 80,000-word deep-dive & is complemented by our Teachers’ Handbook curriculum guide.

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receive effective treatment in most countries

Grassroots Policy-Based Advocacy

We foster reform from the ground up with student task forces focusing on community-based demands that emphasize diversity and needs. Examples include our pioneering 24/7 pan-African toll-free mental health hotline at 9898.

At 13-years-old, Diana Chao learned that she had bipolar disorder. After surviving a series of suicide attempts, Diana began writing letters to strangers. Those letters paved her healing journey, and for once, she could believe she wasn’t alone.

In late 2013, Diana established the first Chapter of Letters to Strangers in her Southern Californian high school as a sophomore. The rest is herstory.

We support 35,000+ people in over 20 countries on six continents worldwide every year. Highlights of our network include: the first student mental health task force at Rutgers University Honors College (NJ, USA); the first mental health professional ever brought to speak at the Karachi high school Chapter (Pakistan); the first peer mental health resource center in Zimbabwe; a short film series created with the Screen Actors Guild of New York.

We have been recognized by the National Alliance on Mental Illness, Mental Health America, Active Minds, Oprah Magazine, L’Oréal Paris, Vice, Viacom, Yahoo, The Washington Post, the Shawn Mendes Foundation, Google, Facebook, Born This Way Foundation, the Smithsonian Institute, YouTube, Unilever, and more.

www.LetterstoStrangers.org hi@LetterstoStrangers.org 2115 Aviation Dr. Upland, CA, USA 91786

501 (c)(3) Tax-Exempt Number: 83-0837546

@L2SMentalHealth

(YOUTH) MENTAL HEALTH: LEARNINGS & STRATEGIES DIANA CHAO, LETTERS TO STRANGERS

© Letters to Strangers

TRUE OR FALSE? 1 IN 5 CHILDREN AGES 13-18 HAVE OR WILL HAVE A SERIOUS MENTAL ILLNESS

© Letters to Strangers

TRUE. • 50% of all lifetime cases begin by age 14 and 75% by age 24 • 37% of students aged 14+ with a mental health condition drop out of school - the highest dropout rate of any disability group • Among those with severe depression, 80% of American youths have no or insufficient treatment.

• Suicide is the 2nd leading cause of death in the U.S. for ages 15 to 34.

• The estimated cost of untreated mental illness in the U.S. is $100,000,000,000 (includes unemployment, unnecessary disability, substance abuse, etc.)

• 70-90% of individuals with mental illness saw improvement in their symptoms and quality of life after participating in some form of treatment.

© Letters to Strangers

MENTAL ILLNESS CAN AFFECT ANYONE AT ANY TIME, ANYWHERE AT ANY AGE. THIS IS NOT A MORAL DILEMMA.

© Letters to Strangers

That’s why I’m here. Together, we must erase the stigma & increase access to quality, affordable care.

Stigma (n): A distinguishing mark of social disgrace

© Letters to Strangers

EMPATHY “FEELING WITH PEOPLE. In order to connect with you, I have to connect with something in myself that knows that feeling.” -Brené Brown © Letters to Strangers

WHAT IS MENTAL HEALTH?

“Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.” www.mentalhealth.gov

© Letters to Strangers

WHAT CAN AFFECT MENTAL HEALTH?

Biological factors

Sociocultural factors

The illnesses that are most likely to have a genetic component include autism, bipolar disorder, schizophrenia, and ADHD

Severe parental discord

The level of the neurotransmitter serotonin is lower in individuals who have depression. This finding led to the development of certain medications for the illness.

Cultural repression

Epigenetics also play a role.

Exposure to violence

© Letters to Strangers

Death of a family or close friend Parent's mental illness & criminality Overcrowding Economic hardship Abuse & neglect

Environmental factors Head injury, poor nutrition, and exposure to toxins (including lead and tobacco smoke)

All ACE questions refer to the respondent’s first 18 years of life

Abuse

ACEs (ADVERSE CHILDHOOD EXPERIENCES)

• Emotional • Physical • Sexual

Household Challenges • Domestic violence • Substance abuse / mental illness / incarceration in the family • Separation / divorce of parents

Neglect • Emotional • Physical

© Letters to Strangers

WHY ACES MATTER Almost 2/3 of study participants reported at least one ACE, and more than 1/5 reported three or more ACEs.

ACE score 4+

ACE score 7+

NOT because of likelihood

to conduct bad behavior. © Letters to Strangers

Chronic obstructive pulmonary disease: 2.5x of those with no ACEs

Hepatitis: 2.5x / Depression: 4.5x / Suicidality: 12x

Lifetime risk of lung cancer: 3x Coronary heart disease: 3.5x Measurable biological difference and neurologic differences Even if don’t engage in any high-risk behavior, body’s stress system changed Adaptive → maladaptive. Children esp. sensitive. Affects developing immune systems, etc.

INTERGENERATIONAL TRAUMA IS REAL.

© Letters to Strangers

WHAT IS MENTAL ILLNESS? © Letters to Strangers

WHAT WE KNOW: Anxiety Disorders Major Depressive Disorder OCD (Obsessive Compulsive Disorder) Bipolar Disorder PTSD (Post-Traumatic Stress Disorder)

Schizophrenia and other Psychotic Disorders Personality Disorders* ADHD (Attention Deficit Hyperactivity Disorder)* Eating Disorders* *sometimes these are categorized separately from mental disorders, such as via learning disorders and other names © Letters to Strangers

MYTHBUSTERS AKA WHY KNOWLEDGE IS POWER

© Letters to Strangers

© Letters to Strangers

LET’S DEBUNK. True • People with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population

• Culture, family background, religion, and other factors that make up our story can impact our understanding of mental health • Youth are especially vulnerable to mental illness, especially today. Suicide has increased by over 60% in the past 45 years.

False • I feel sad, moody, or burnt out. I must be depressed • Mental illness is a choice. They need to get over it • People with a mental illness are dangerous or “crazy” • People w/ a mental illness are dependent upon others • People with a mental illness have no friends • Mental illness disables someone for life • Some ethnicities and races are more prone to mental illness than others

• Eat • Mind distractions (personal, social)

• Pride (ego, denial, affirmation) • Anger

WHAT ARE THE SYMPTOMS? OUR PAIN LANGUAGES

• Tears • Hurting Self (verbal, physical) • Insomnia/Hypersomnia

• Zany (humor, character, façade – emojis!)

• Imprudent behavior

• Not present (silence, absences, drifting) • Gross productivity © Letters to Strangers

PROTECTIVE FACTORS • Preventative screenings • Family & Community • Access & participation in fun/recreational activities • Access to ongoing, effective care • Restricted access to means of harm • Skills in conflict resolution, problem solving, and nonviolent handling of disputes

• Learning to feel good about one’s own actions in the face of danger • Cultural & religious beliefs that discourage suicide • Practicing Strengths

• Meditation/Yoga • Preventative safety measures - Being able to act and respond effectively despite feeling fear •

Make a Safety Plan •

Things you can do yourself

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People you can reach out to who aren’t professionals/Places you can go to decompress

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Mental health professionals/hotlines/numbers/addresses (national & local) – put these in your phone!

© Letters to Strangers

Positivity Portfolio

Joy/Gratitude/Serenity & Calm/Interest/Hope/Pride/Amusement/Inspiration/Awe/ Love

Gratitude journal

Writing letters!!!

COPING SKILLS & SELF-CARE

Healthy, productive distraction: art/music, pets Focusing: sub-vocalization, deep slow breathing, rational responding, schema work Meta-cognitive: acceptance, compassion

Break down large tasks into small ones

Emotional glossary

© Letters to Strangers

WHAT ARE THE TREATMENTS? Medication, Hospitalization

Psychotherapy/Teletherapy

Non-Healthcare Professionals • Friends • Family • Meditation, yoga, exercise • Reflection, journaling, art

© Letters to Strangers

• Different types for different disorders • Change thought or behavior patterns • Understand how past experiences influence current behaviors • Solve other problems in specific ways • Learn illness self-management skills.

• SSRIs (Selective Serotonin Reuptake Inhibitors), etc.

• Trial and error, can take time to find fit • Inpatient care

CULTURE, IMMIGRATION, & STIGMA HOW DO OUR IDENTITIES AFFECT OUR PERCEPTION OF MENTAL HEALTH?

© Letters to Strangers

HOW DOES IDENTITY AFFECT MENTAL HEALTH?

Culture

Religion

Immigration Status

© Letters to Strangers

Language

Diet

Gender Economic Reality

WHAT ARE SOME POSSIBLE REASONS WHY PEOPLE DON’T SEEK PROFESSIONAL HELP? © Letters to Strangers

“It’s a White Person Thing” Honor / fear of gossip

“Men don’t cry” Respect the family Betrayal of faith / “Just go pray” Accusations of ungratefulness Lack of knowledge

WHAT CAN WE DO? NO ONE WALKS THIS EARTH ALONE

© Letters to Strangers

TO BEGIN… • Watch your language!

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Die by suicide, NOT committed suicide

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Completed suicide, NOT succeeded in suicide

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People with…. NOT Mentally Ill people or Bipolar people

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Avoid trivialization or unnecessarily pathologizing

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Avoid sensationalizing or unnecessarily mentioning means

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Avoid glamorization or idolization of those who passed from suicide

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If you are a student journalist, watch your reporting ethics – do NOT publicize method!

•

•

Copycat suicides

When you talk about a stressful event, ask not just what happened but what happened leading up to it and the person’s thoughts for possible ways to address the situation. Ask them how they think you would feel about their solutions, and what would happen if their approach was followed? How do they think you would approach the situation?

• Let them help you.

• Take them seriously. If you’re thinking about it, they’ve probably already thought about it. © Letters to Strangers

IT’S SIMPLE

© Letters to Strangers

Self-Advocate Increment Meditate Patience Listen Educate

SELF-ADVOCATE How do you talk to those who might not believe you?

• • • •

Be honest Do your research Be prepared for what they might say Reassure them that you are not disagreeing with their point of view, but that your own experience is leading you to a new conclusion • Show your emotions—be human • Ask questions • This is not a zero-sum game. You’re not in it to win. You’re in it to accept yourself.

Being a self-advocate means knowing your own limits, too. If you need rest, don’t be afraid to do so. If something makes you uncomfortable, say so.

© Letters to Strangers

INCREMENT • One step at a time • Embracing change, understanding emotional complexity, internalizing new knowledge, and creating new habits don’t happen overnight • Make bite-sized, achievable action items • Breach the topic gently, incrementally, and ease into it. But be direct when you do ask. You cannot make someone suicidal simply by asking.

• It’s easy to rush into solutions and what-ifs. Increment instead: step-by-step, what does the next step look like? Be there. Don’t just say you’ll be there.

• You’re not fixing people’s problems for them; you are helping them get to where they can solve it themselves. © Letters to Strangers

MEDITATE • Reflect critically: • What do I feel?

• Why do I feel this way?

• How does this feeling affect the way I act or think?

• Do I want to feel this way?

• What can I do to avoid feeling this way in the future?

• What/who else I care about? Does this experience change the way they add worth to my life?

• Discover quiet: • Locate the present: what are your sensations?

• Let thoughts flicker by, pick them up, and gently lay them down • This moment of peace, paused in time, is a safe space you can always return to

© Letters to Strangers

PATIENCE Beware of boundaries

Note nonlinearity What, not why

Empathize

Persist

W.A.I.T.

Know when you need help

ANOGSTOSIA. Avoid judging. Avoids aying there’s something wrong with them and asking them why they won’t accept it. Be gentle.

Do not lose sight of who they are. © Letters to Strangers

© Letters to Strangers

LISTEN • Echo • Ask questions • Confirm • Speak in the “I” • Who is this for? What would you want?

(THE RSA, BRENE BROWN)

EDUCATE Know your • Resources • Definitions • Facts

• Stereotypes • Assumptions • Identity

© Letters to Strangers

THANK YOU! QUESTIONS? www.LetterstoStrangers.org Facebook, Instagram, Twitter, and Tik Tok: @L2SMentalHealth @Dizzodin diana@letterstostrangers.org

© Letters to Strangers

LETTER WRITING Diana Chao, Letters to Strangers

INTRODUCTION demonstrations

Storytelling ◦ Storytelling is the singular connection between time and space. The universal human connector ◦ Words force you to summarize the indescribable ◦ You have to let yourself go before you can let other people in. And to let other people in is to write. Because when you write, you are sharing the most intricate, delicate, intimate part of you: your thoughts. ◦ When you put your emotional image into words, there is no longer ambiguity in what YOU saw and felt. Now your mindset is borne to the world, and that’s what makes writing so intimate and therefore powerful. Wield that power wisely.

Emotions ◦ Writing is the way we tell the truth ◦ Writing brings back the dead and the memories and the things we run away from ◦ Writing remembers. ◦ Words carry emotions because you choose what word you use ◦ Stories help us escape and ease back into the locomotive of reality ◦ Writing is a way of both easing the truth into memory and easing ourselves out of reality. Writing is an escape, and give us a quieter, kinder, gentler way of telling our story within our constraints. All of this is innately emotional. ◦ Doesn’t have to be intense – humor evokes emotions too! Joy is an emotion!

Vulnerability “There is nothing to writing. All you do is sit down at a typewriter and bleed” – Ernest Hemingway ◦ People are drawn to the emotional, the beautiful, and the conflicted ◦ Art is an emotional exchange. That’s why it creates empathy. ◦ This means a reflection of your own emotions. Capturing something without believing it renders it empty

“Why do you stay in prison when the door is so wide open?”

– Rumi

DETAILS The teaspoons of how

Verbs ◦ Verbs > adjectives ◦ Make new connections - observe ◦ “Slow like molasses” or “slow like December”? ◦ “Fast as a cheetah” or “fast as falling in love”? ◦ Be specific, show vs. tell “I was so happy to see her” vs.

“I ran to her, jumped up and clung to her shoulders. She laughed and asked me to let her go. I’ve grown too heavy now, she said, a boy bigger than her body could hold. But how could I let mama go?” // “She grinned so hard the corners of her lips touched the moon” vs. “she was happy.” ◦ You also want to have some sort of conflict - it could be physical (war) or emotional (someone crying) - conflict makes the person read on because people always want solutions. Unresolved, though, conflict is haunting.

CHALLENGE Now it’s your turn!

Guidelines ◦ Always begin by addressing a stranger and sign off as a stranger. ◦ If you wouldn’t want to read what you wrote, then chances are, a stranger wouldn’t, either.

◦ Speak in the “I.” Don’t assume, accuse, or make generalizations, such as with advice. ◦ It is okay to be personal. Just know, this is not a pen pals system, so you will not hear back from the stranger who read your letter.

◦ Share information, but avoid condescension. Share experiences, but avoid blatant self-promotion. ◦ Avoid pushing your beliefs. ◦ Write like your reader is a friend. Write while envisioning positivity. ◦ Don’t be afraid to be vulnerable. However, do include trigger warnings at the top of your letter. ◦ Stay creative! Just write as who you are. ◦ The best way to up your letter-writing game is by committing yourself to the principles behind these letters: empathy, connection, growth, love, and vulnerability.

Imagine/look at an object o Write down more and more words that associate with it, until you reach a concept/theme/emotion o Connect the dots o Now cut it down

Guidelines ◦ Always begin by addressing a stranger and sign off as a stranger. ◦ If you wouldn’t want to read what you wrote, then chances are, a stranger wouldn’t, either.

◦ Speak in the “I.” Don’t assume, accuse, or make generalizations, such as with advice. ◦ It is okay to be personal. Just know, this is not a pen pals system, so you will not hear back from the stranger who read your letter. ◦ Share information, but avoid condescension. Share experiences, but avoid blatant self-promotion. ◦ Avoid pushing your beliefs. ◦ Write like your reader is a friend. Write while envisioning positivity. ◦ Don’t be afraid to be vulnerable. However, do include trigger warnings at the top of your letter. ◦ Stay creative! Just write as who you are.

◦ The best way to up your letter-writing game is by committing yourself to the principles behind these letters: empathy, connection, growth, love, and vulnerability.

SUBMIT! www.letterstostrangers.org/letterexchange