Why the NAMI + Google mashup is not the best

Why our Director Wouldn’t Take Google’s New Depression Test


At the end of August, Google decided to make available directly on its site (through a “knowledge panel”) the ability to take a depression screening quiz. We know a thing or two about online depression screening quizzes, because back in 1996 I put one of the first interactive depression screening quizzes online, long before Google even existed.

Here’s the thing… Depression screening tests — like the PHQ-9 that Google is now offering on its website — are super helpful tools to give a person a little more insight into the possibility of having a serious mental illness. 

What’s NAMI Doing Here?

I guess to make people feel better about taking a quiz that’s been available online for more than a decade, Google partnered with a non-profit that works in the area of mental illness, the National Alliance on Mental Illness (NAMI).

This is no dig on NAMI, but NAMI is not a scientific organization, nor does it have much to do with the PHQ-9. It is an organization that does great, amazing work from a family perspective of mental illness. But why only NAMI specifically? Why didn’t Google reach out to more than just one non-profit in mental illness to contribute to this effort?

There are literally hundreds of non-profits dedicated to ending the stigma of mental illness, and many who have done really great work in the past few years. For instance, Bring Change to Mind has really changed the modern conversation, in my mind, about mental illness. And Mental Health America Chapters and the Mental Illness Policy Org. has also worked very hard in this area of education and helping to reduce the stigma of mental illness. And that’s to name just two out of hundreds.

But only NAMI was chosen to help with Google’s effort, which seems a little unfair to me.

The rise in student mental health problems – ‘I thought my tutor would say: deal with it’

Students starting university face different pressures from earlier generations.
What are the potential troubles and how can young people be prepared?

It was at 3am that film student Nicola Gee finally managed to confess, in an anonymous text to Samaritans, how depressed she had become at university. “By then, I felt isolated and shut off from my friends. I had put myself under a lot of pressure to achieve, and then would get annoyed with myself for feeling low and stressed. I had this constant feeling of being a failure, like nothing I did was ever good enough.”

She started closing herself away in her room for hours to study, and stopped eating regular meals. Her sleeping pattern became disrupted and she struggled to get up in the mornings. Then she’d tell herself it was her fault she wasn’t coping: “Everyone else seemed to be managing, and meeting their deadlines.” That belief put her off from seeking help. “I thought if I went to the doctors and said I was stressed, they’d laugh at me. And if I asked my personal tutor for help, I’d be told: just deal with it, like everyone else.”

Her mother and sisters were going through a difficult time following the breakup of her parents’ marriage, and she felt guilty she wasn’t there. “Getting a first was the only way I could validate my decision to live so far away.”

Gee, who was studying at Leicester University, eventually sought help. “I was lying awake, feeling depressed and alone. I remembered hearing that Samaritans have a 24-hour number you can text.”

Writing her feelings down in a text message proved a relief and within five minutes she had a helpful reply.

Thanks to regular support from Samaritans, she worked up the courage to talk to her tutors and got extensions on her deadlines, and then began running regularly to help release stress.

“I used that time to wind down and have a break from thinking about my degree and my family. I’d come back from a run relaxed and able to sleep.” She graduated with a first and, over the past 18 months, has run 24 races to raise money for Samaritans.

Sadly, many university students like Gee will fail to get the help they need. The Higher Education Statistics Agency recently revealed the number of students who drop out of university with mental health problems has more than trebled since 2009-10, with a record 1,180 university students with mental health problems abandoning their studies in 2014-15, the most recent year for which data was available.

How can those starting university this academic year avoid this? Do today’s students find university more of a struggle than their predecessors and, if so, why?

Dr Fredrik Johansson, a consultant psychiatrist for Camden and Islington NHS Foundation Trust, thinks they do. Around 5% to 10% of his caseload at any one time are university students, studying at, for example, nearby UCL, LSE or the University of the Arts. Their numbers have significantly increased recently, he says.

“Those who would have suffered in silence may now be accessing help. However, I do think the students I see feel under a lot more pressure and they have more extreme reactions to stress. They are less resilient than in the past.” He fears that the students he treats represent “the tip of the iceberg”.

Helicopter parenting and over-monitoring are partly the reason some undergraduates struggle to cope, he thinks – “they haven’t experienced making mistakes by themselves” – but he also blames financial pressures. “They take university more seriously than we did. They are very aware they will owe a lot of money when they graduate and they feel they absolutely have to do well as a result.”

Dr Aleksej Heinze, senior lecturer at the University of Salford Business School, has noticed the vast majority of his students now have a part-time job. “They feel under immense financial pressure.” For some students he sees in his capacity as a personal tutor, this can create what he describes as the perfect storm: having to meet work commitments as assignment deadlines pile up.

“Sometimes these students are tempted to take shortcuts like plagiarism, even though our plagiarism detection rates are very high nowadays. Others will get into strange sleeping and eating patterns because they are working shifts and don’t know how to look after themselves.”

Studying and working has replaced studying and socialising. “As a result, it’s not as easy for students today to make close friendships, and some think their existing relationships on social media are enough for them. That tends to make them less resilient if things do go pear-shaped, because they don’t have a support network at university.” He typically refers at least one student a month for counselling.

Homesickness is another common reason freshers struggle, says Dr Hinnah Rafique, a lecturer in public policy at Oxford University and a director at Generation Medics, which helps young people from all backgrounds access medical and health careers. “Some students are still unprepared for university and, especially if they are the first in their family to do a degree, don’t know what to expect.”

The good news is that university pastoral staff are better trained nowadays, she says, and recognise how overwhelming homesickness can be. “It can rear its ugly head at any time, and it tends to be triggered by really small things that seem completely insignificant to someone from the outside looking in. Students should seek help early.”

Meanwhile, Dr Ewan Jones, director of studies in English at Downing College, Cambridge, has noticed many more freshers struggling to make the transition from school, where they are frequently measured and tested, to a different form of thinking, where they are encouraged to explore ideas and try them out.

Some obsessively compare themselves to their peers, especially on social media. “Our first year students are used to being big fish in small ponds. They can’t all be the smartest kid in the room at Cambridge. Many find that difficult.”

Freshers are routinely asked if they have previously experienced any mental health problems and, over the past 10 years, Jones has observed greater numbers reporting these problems, both before and after they arrive at Cambridge. He believes this may be partly because the support services for students have increased.

“We encourage our students to feel there’s no stigma in speaking out and deliberately give them personal tutors who do not teach the subject they are studying. That way, they don’t have to put on a brave face.”

Last year, just before exams started, the college also offered students meditation sessions and puppies to stroke. “The puppies in particular proved very popular.”

Statement on Trump TransBan

Griffin Ambitions Ltd. condemns in the strongest terms President Trump’s executive memo banning transgender individuals from enlisting in the United States military and denying medically necessary care for transgender individuals already serving. As a mental health organization, we are all too aware of the trauma and pain caused by this kind of discrimination and the disproportionate mental health needs of the LGBTQ community, stemming in part from this discrimination. We stand with all trans service members.   

Personality disorders

The term “Personality Disorder” implies there is something not-quite-right about someone’s personality. However, the term “personality disorder” simply refers to a diagnostic category of psychiatric disorders characterized by a chronic, inflexible, and maladaptive pattern of relating to the world. There are many subset of personalities, all identifiable by their patterns. Personality disorders in particular are subsets that use maladaptive patterns of functioning, causing distress or problems integrating into society. This maladaptive pattern is evident in the way a person thinks, feels, and behaves. The most noticeable and significant feature of these disorders is their negative effect on interpersonal relationships. A person with an untreated personality disorder is rarely able to enjoy sustained, meaningful, and rewarding relationships with others, and any relationships they do form are often fraught with problems and difficulties.

 

To be diagnosed with a “personality disorder” does not mean that someone’s personality is fatally flawed. In fact, these disorders are not that uncommon and are deeply troubling and painful to those who are diagnosed. Studies on the prevalence of personality disorders performed in different countries and amongst different populations suggest that roughly 10% of adults can be diagnosed with a personality disorder (Torgersen, 2005).

 

Many types of disorders are evidenced by a complete and total deviation from normal and healthy functioning (e.g., epilepsy). However, personality disorders cannot be understood independently from healthy personalities.  Since everyone has a personality (but not everyone has epileptic seizures), personality disorders reflect a variant form of normal, healthy personality. Thus, a personality disorder exists as a special case of a normal, healthy personality in much the same way as a square is a special case of the more general construct of a rectangle. Therefore, it is useful for us to begin our discussion of personality disorders by first discussing the broader, more general construct of personality.

Resources:

http://www.mayoclinic.org/diseases-conditions/personality-disorders/home/ovc-20247654

https://medlineplus.gov/personalitydisorders.html

https://www.psychologytoday.com/basics/personality-disorders

https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders

https://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder

Personality Disorders: Crash Course Psychology #34

https://www.mentalhealth.gov/what-to-look-for/personality-disorders/index.html

http://www.nhs.uk/conditions/personality-disorder/Pages/Definition.aspx

Substance Abuse/Addiction

Very generally, substance abuse and addiction occurs when an individual compulsively and uncontrollably seeks out a substance or action despite the consequences associated with it. It is possible to be addicted to anything that activates the pleasure center of the brain. Dopamine is released in the reward pathway and triggers the pleasure response. Normally, this rewards you for doing behaviors that are essential for survival, like eating or socializing. But in addiction, the substance or action overloads the reward pathway with dopamine and the person then attempts to have the same “high” as the first time they experienced it. Addictions can be physical, where the body has adapted to the drug existing in the body and tolerance is developed. Sometimes cues related to the substance, such as walking into a bar, increase the desire for it. Psychological dependence occurs when the search for a high is related to coping with stress or other negative emotions. Someone who is addicted, no matter what the addiction is, will have a number of characteristics associated with the addiction. They do not have control over their substance use. They likely take more of the substance than planned or for a longer period of time than intended. They may make multiple attempts at lowering their intake of the substance or quitting use altogether with no success. Addicts spend much of their time obtaining substances, taking them, and recovering from the effects. They may have physical symptoms of craving and withdrawal. Use typically interferes with family and other role obligations, though the addict will continue to use the substance despite these social or interpersonal conflicts. Addicts may only realize they have a problem when they hit “rock bottom”. Treatment takes into account the individual and the type of addiction itself. Individuals are encouraged to quit with the help of a medical professional. Alcohol, benzodiazepine, and opiate withdrawal can be deadly and should not be quit “cold turkey”. Relapse, even years after successful treatment, is still possible. The structures in the brain and new circuits created from the addiction remain even after use is stopped. Recovery is completely attainable and maintainable with consistent treatment.

Resources:

http://americanaddictioncenters.org/withdrawal-timelines-treatments/dangers/

http://americanaddictioncenters.org/withdrawal-timelines-treatments/

https://www.psychologytoday.com/blog/all-about-addiction/201001/alcohol-benzos-and-opiates-withdrawal-might-kill-you

https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction

https://www.psychologytoday.com/basics/addiction

https://www.nytimes.com/2017/07/15/business/lawyers-addiction-mental-health.html

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) consists of excessive worry around a variety of situations and functions. Most people are worried about something, but the worry of GAD is extreme and unwarranted by the specific situation. Normal worries may escalate to something beyond the individual’s control. These excessive worries must last most days for the 6 months and be around a variety of activities. There also has to be three or more physical symptoms, such as sleep disturbances, restlessness, and irritability, along with the anxiety. These symptoms cause significant distress and cannot be explained by any substance or other mental illness. GAD affects about 3.1% of Americans. Treatments for GAD involve medication and psychotherapy, usually in tandem. Medications can target the feelings of anxiety as well as the physical symptoms. Psychotherapy works on the behaviors and thinking surrounding the anxiety, developing new habits around the anxiety. This can help in coping with the anxiety and reduce its effect.

 

The nature of GAD is that worry is about anything and everything, and most likely the sufferer knows that it is. But they have no control over what they have anxiety around or how great it is. And sometimes this can prevent the individual from performing tasks, sleeping, and drain all energy. Part of college is to be efficient with time and energy, and anxiety makes it very hard to do that. The college environment in general is stressful, which exacerbates the problem. The majority of those with GAD have other mental illnesses as well, compounding the difficulty. They are more likely to have substance abuse problems. Someone with GAD in college can contact the disabilities office to set up accommodations that may aide in reducing anxiety and fostering success. This may include more time on exams, changes in housing, and more flexibility in course work. Medications and therapy are effective as well as likely essential. When untreated, GAD can lead to many other health problems, so it is important to address it. However, it is completely treatable and success in college is very possible.

Resources:

https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

http://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/basics/complications/con-20024562

https://www.psychologytoday.com/conditions/generalized-anxiety-disorder

https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml

Social Anxiety disorder

Social anxiety, also known as social phobia, is a fear, anxiety and avoidance surrounding normal social situations. This is different from shyness, as there is an intense fear that cannot be controlled rather than discomfort. Symptoms of social anxiety include: anxiety or fear surrounding social interactions, being observed, and performing in front of others; fear that anxiety will be apparent to others; social situations almost always provoke fear or anxiety; situations are avoided or endured with intense anxiety; anxiety or fear is disproportionate to the actual threat posed by the situation. This must cause significant distress that lasts six months or longer without being attributable to any other substance or mental disorder. It is estimated that about 7% of Americans suffer from social anxiety at any one time. Treatment involves typically a combination of psychotherapy and medication. Psychotherapy can be in the form of cognitive-behavioral therapy or group therapy. Medications like anti-anxiety, antidepressants, and beta-blockers can be helpful in reducing symptoms. Beta-blockers, instead of targeting the brain, target the physical symptoms that appear while anxious. This may help sufferers with panicking about being anxious or panicking that others can see they are anxious.

 

Much of the college experience is about navigating differing social situations. Someone with social anxiety has almost an inability to do this. They have such intense fear and anxiety surrounding the situation that they cannot enjoy the interaction or take anything away from it. Going to class, speaking up in class, and doing presentations cause so much fear and anxiety that they are avoided, which can cause academic decline. Social situations like going out with friends or even meeting new people are difficult. College is all about thriving in these interactions and getting the most out of these experiences, and someone with social anxiety will try to avoid all of that even if it would be beneficial to them. Some people will attempt to use drugs or alcohol to cope with the anxiety, which can lead to a substance abuse problem and does not actually relieve the anxiety. The best thing for someone with social anxiety is to go to therapy and/or take medication. This will help them navigate social situations better and lead a more fulfilling life.

References:

http://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/basics/complications/con-20032524

https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml

https://socialanxietyinstitute.org/what-is-social-anxiety

Panic disorder

Panic disorder is characterized by recurrent panic attacks. These panic attacks cannot be explained by any other means (like PTSD, drugs, etc.) and are follow by a period of at least a month where the individual performs behaviors to prevent panic attacks or is generally intensely afraid of having another panic attack. Panic attacks consist of sudden feelings of fear or dread, an overactive fight or flight response when there is no reasonable risk. Panic attacks, along with the intense emotions, have many physical symptoms like shortness of breath, chest pain, shaking, feelings of numbness, or sensations of unreality. Because panic attacks do not typically have a specific cause, they can happen at any time. This simply perpetuates the fear around even having a panic attack or having someone see you have a panic attack. Intensity and frequency can vary by person. About 2-3% of the US population has panic disorder, and it is 2x more prevalent in women than men. Treatments include psychotherapy, like cognitive behavioral therapy, and medications, like antidepressants and beta-blockers.

 

As stated previously, panic attacks can happen at any time. This makes life very difficult for a college student with panic disorder. They live in constant fear of having another attack or having someone witness an attack. This avoidance gets in the way of what you’re really supposed to be doing: school. Many school environments cause lots of anxiety for any student, but a student with panic disorder is more likely to have a panic attack when already anxious or stressed. Avoiding that stress can simply look like avoiding school in general. Sometimes it can be so debilitating that sufferers prefer to stay locked inside rather than go out. Students miss out on college experiences. Those with panic disorder have a higher risk for drug or alcohol abuse. It’s hard to achieve when you are afraid of something you have no control over. But therapy and medications can help dramatically. Medications can lessen the load while going through therapy, or may be used long term. Therapy works by training your brain to react to stress in healthy ways, recognize panic attacks and stop them before they can fully develop, and be able to enter into situations where panic attacks have previously happened. It can become completely manageable with treatment.

Resources:

https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml

http://www.apa.org/topics/anxiety/panic-disorder.aspx

http://www.mentalhealthamerica.net/conditions/panic-disorder

https://psychcentral.com/disorders/anxiety/panic-disorder-symptoms/

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) consists of excessive worry around a variety of situations and functions. Most people are worried about something, but the worry of GAD is extreme and unwarranted by the specific situation. Normal worries may escalate to something beyond the individual’s control. These excessive worries must last most days for the 6 months and be around a variety of activities. There also has to be three or more physical symptoms, such as sleep disturbances, restlessness, and irritability, along with the anxiety. These symptoms cause significant distress and cannot be explained by any substance or other mental illness. GAD affects about 3.1% of Americans. Treatments for GAD involve medication and psychotherapy, usually in tandem. Medications can target the feelings of anxiety as well as the physical symptoms. Psychotherapy works on the behaviors and thinking surrounding the anxiety, developing new habits around the anxiety. This can help in coping with the anxiety and reduce its effect.

 

The nature of GAD is that worry is about anything and everything, and most likely the sufferer knows that it is. But they have no control over what they have anxiety around or how great it is. And sometimes this can prevent the individual from performing tasks, sleeping, and drain all energy. Part of college is to be efficient with time and energy, and anxiety makes it very hard to do that. The college environment in general is stressful, which exacerbates the problem. The majority of those with GAD have other mental illnesses as well, compounding the difficulty. They are more likely to have substance abuse problems. Someone with GAD in college can contact the disabilities office to set up accommodations that may aide in reducing anxiety and fostering success. This may include more time on exams, changes in housing, and more flexibility in course work. Medications and therapy are effective as well as likely essential. When untreated, GAD can lead to many other health problems, so it is important to address it. However, it is completely treatable and success in college is very possible.

Resources:

https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

http://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/basics/complications/con-20024562

https://www.psychologytoday.com/conditions/generalized-anxiety-disorder

https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml