Breaking The Stigma: You Are Not Alone

NEW YORK - Talking about mental health can be an uncomfortable, but it's an important topic. 

Last year, our colleague Cindy Hsu sat down with Dana Tyler to share her personal battle with depression in hopes of helping others who might be going through similar situations. 

We are continuing that conversation with another CBS2 special, focusing on difficult discussions and the resources available to everyone. 

A warning: This conversation covers some sensitive topics involving mental health and suicide. 

DANA TYLER: Hi, I'm Dana Tyler, here with my friend, longtime friend and coworker Cindy Hsu, and we're here to get uncomfortably candid and helpful and hopeful with you. We're all in this. Last summer, Cindy shared her very personal story of mental illness. She was so open talking about her journey through depression, a suicide attempt, and the steps she took to get healthy again. A raw conversation that we turned into a half hour special called "Breaking The Stigma." That phrase is so important, breaking the stigma.

CINDY HSU: And we're talking about breaking the stigma around even talking about mental illness, because it seems to be such a - 

TYLER: I don't want to talk about it!

HSU: Exactly. Exactly. And it's something that affects everyone. Maybe you know somebody. Maybe it's yourself. And this is a special to reach you. 

TYLER: You said how people reached out through emails. They were sharing stories, they were also thanking - 

HSU: Right, after the special that we did last year, so many came in. You know what really touched me was when people would say "it made me go get help." 

TYLER: We'll have a conversation here, and we have all kinds of resources on our website, and you can watch the special too. But let's get started. 

Let's introduce our guests. We're so glad that you're here. Dionne Monsanto, a mom. Your daughter took her own life 11 years ago. We appreciate you being here, because not only are you sharing your story, but you're also talking about today. We'll get into what you're doing to help other parents, other loved ones, because you're very involved as a volunteer. So thank you for being here, Dionne. 

DIONNE MONSANTO: Thank you. 

TYLER: We also have Dr. Jennifer Hartstein, a child and family psychologist, and we know that involves the whole family. Yes, so thank you, Dr. Jen for being here. 

And Dr. Jill Harkavy-Friedman, vice president of research with the American Foundation for Suicide Prevention. And we look forward to hearing what you have to say, research-wise, you know, who this is happening to, and just helping us, emergency resources. And we will call you Dr. Jill, if you don't mind. 

We're good with names, but let's just make it as comfy as possible. 

RESOURCES AND ASSISTANCE

HSU: Dionne, I'd like to start with you. You are such an advocate. And you speak to so many people, sharing your story and having very uncomfortable conversations as well. What what do you tell them?

MONSANTO: Most often, when I'm speaking with someone, it's another parent, and if their child has attempted suicide, or if they've lost someone, I always start off with "it's not your fault." Because there's such a feeling of guilt. There's such a feeling of shame and embarrassment. So mom to mom, or mom to dad, just parent to parent, I think it's not your fault. We're always doing the best we can with the information we have at the time. 

And then for, I'm thinking of a family, it was a daughter. And she was really concerned because she'd had multiple attempts, and just say, you know, keep your eyes on her, keep loving her. And therapy. Like, always, a big fan of therapy. A big fan of talk therapy, art therapy, dance therapy - like, anything you can do to keep involved and get engaged with them. Because sometimes as they get older and they want to separate, they need us more. 

I'm a parent of adult children now. And I feel like there's a little more work with that. So staying involved, I think makes a tremendous difference.

HSU: Your daughter Siwe, beautiful, beautiful daughter. She was 15 when she took her life. Were there any signs leading up to this that she was in crisis?

MONSANTO: Because she had multiple attempts, you know, what I learned is that that's one of the signs, if someone has attempted, they will probably attempt again. And that's a risk factor. 

She had also been a victim of sexual violence. And that's a risk factor, you know, the abuse in the past that she had endured. 

But in terms of immediate things, I thought I was clear. Now looking back, one of the big things she had done was give me special items. I didn't know that until I took "Talk Saves Lives" and went through training. And she was such a brilliant- we're performing family. She's an actor, was an actor. And so when she gave me this dress, I thought, like, what are you giving me this dress for? You begged me for this dress? And she goes well, mom, you know, my room is always a mess. You'll know, you're organized, you know where you where it is. So when I want to wear it, you'll have it. 

You know, so the fact that she cleaned up her room and had everything prepared and gave me her favorite dress, that she begged and lobbied for. In retrospect, with what I've learned now, I could see she was preparing. But I didn't know.

HSU: You know, that brings up something, When I was contemplating suicide. I gave one of my best friends her watch back. You know, and that is, that's something - you, you just want to give back to those who are going to be left behind.

TYLER: Putting things in order. 

HSU: Yeah. 

RESOURCES AND ASSISTANCE

TYLER: I'm wondering about Siwe, Dionne. Breaking the stigma is what we're talking about, to encourage people to talk. I know she was a teenager, but in just speaking in a sort of a bigger picture of people of color, and the want, or are they embarrassed - how do we speak about that?

MONSANTO: That's a hard one. I was talking about my grandmother to the ladies earlier, and I can hear - my family's from the Caribbean, and it's like, you know, you can't put your business in the street. You cannot put your business in the street. You cannot discuss these things. 

So I think little by little, even as we talk about, like, I'm in therapy. I'm going to see my therapist, and making that statement. 

You know, when I was coming up... you'd get a negative response. So just having the conversation and encouraging people. Like, I am having challenges when I'm in parent groups, speaking out to someone. You know, I'm having some troubles with my son, you know, I'm concerned about my son. Even if they're like, you know, would you pray on my son? I was like, absolutely we'll pray. Have you thought about therapy as well? Can we do both?

HSU: Dr. Jen, what have you seen in your practice with people coming in that maybe you haven't seen before? We have COVID, we have so many things. 

DR. JENNIFER HARTSTEIN: I think in my practice, what we have really seen is all of this skewing younger. So, whereas, my practice really focuses on kind of 13 to 25-year-old, self-harming suicidal individuals, is our hotspot. 

All of a sudden, 11- and 12-year-olds are being referred at greater rates, that kind of middle school age range, and girls especially, than we've ever seen. And so I think that was a big eye opener for us during COVID that's just like, what are we missing in that middle school age range? And what kind of signs are we needing to look at? And I think that that was a big deal and really important. 

And I just had a thought about the warning signs that you were talking about with your daughter, I think that's an important thing that we don't think about enough. And, kind of, what are those little - we think big red flags of all of this stuff  - what are those yellow flags? You know - the giving away of things, or any change in behavior: The room is clean, when it's always messy, or small, baby things that your antenna is kind of like, wait, what's that about? And we don't dig deeper. 

And I think that that that's been a big deal is that we're getting calls for services based on "There's something not right, there's like something that just feels off to me about my kid." And, and they're usually right.

TYLER: Isn't that too, just go with your gut. And just talk more about the red flags.

HARTSTEIN: There are the red flags we know about, right? Giving away of possessions is a big red flag. Talking about wanting to die is a big red flag. Major changes in behavior. So, used to love playing sports, no longer playing sports. The depressive symptoms, we kind of think of hallmark symptoms, staying in bed, more crying, maybe their biological clock is the opposite so they're staying up all night and can't get out of bed in the morning. 

So those are like the big ones. We started major behavior changes. But we also need to funnel it down to the little ones. Are they staying closer to you? Are they wanting more of their favorite things? Like more comfort things? Are they changing some of their relationships with their friends? Are there like just subtle things that you're kind of tilting your head, and kind of being like, "Are they okay? Yeah, they're fine. That's just teenage stuff." 

But I think when you have that moment of like, "Are they okay?" That one step further of - something doesn't seem okay. Are you okay? And really listening to the answer, I think is an important moment. Your gut as a parent, gives you so much valuable information. You can't diminish that at all.

HSU: And it's so much catching those yellow flags early. And we talked that it's never too early to talk to your child about, I don't know if you'd call it mental health at that age, but there are things you can do now, no matter how small they are.

HARTSTEIN: Right. And I want to highlight that all of us have mental health. Not all of us have mental health issues, but everybody has mental health. So we need to stop thinking that you have it, and I don't, right? 

We kind of put mental health and mental illness as synonymous things, and illness and health are not synonyms. They are just by naturally not. So we all have mental health, mental health and so we can always talk to our kids about mental health. What self care, how are you taking care of yourself? How are you expressing your emotions? 

Feelings can start conversations often and early and as young as babies. 

TYLER: That's what I was going to ask. So you're saying, you know, the toddler on the ground, how are you feeling? Are you happy? Or tell me what's bugging you? Right?

HARTSTEIN: Absolutely. We can label emotion early and often. We can express it. Or, you know, kids are great at expressing emotion. And oftentimes the reason they get shut down is we, as the adults in the lives of those kids, are uncomfortable. So we want to fix it. But the best thing we can do is sit with them and their emotion, help them learn how to regulate, help them understand that being angry, sad, disappointed, is really okay. What can you learn from it? And where do you take that learning? 

And I think that those questions can start teeny, teeny. And the more we have those questions, by the time they get to 15, or 16, they have the skills to be able to come to you and say, hey, I'm really feeling awful.

MONSANTO: And they have the vocabulary.

TYLER: That's a good point Dionne. That's a really good point. 

RESOURCES AND ASSISTANCE

HSU: Dr. Jill, I was going to ask you, one of the messages that we've been talking about is that mental health and physical health are really the same. But that's not how people often see them.

HARKAVY-FRIEDMAN: Yeah, you know, that idea that somehow your mental health happens magically, independent of your body. If we really stopped to think about it, it really doesn't work that way. 

We all know, when we feel anxious, we feel it in our gut. When we feel something in our gut, we feel anxious. You know, it's one system and and the brain is an organ. And all those things are related. 

How you take in information, how you process information, how you experience things like anxiety, and depression. It's all one system. And the more we can talk about it as a whole person, instead of different body parts, I think, the more we can address concerns about mental health.

Watch: Dana Tyler and Cindy Hsu's original "Breaking The Stigma" special

TYLER: On the other hand of that, when you put them separately, you would take care of that broken leg. You know, take care of your heart, your soul, or your head.

HARKAVY-FRIEDMAN: Exactly. And that's how we think about something like mental health, and suicide, like heart disease, right? 

First of all, you may be at risk for heart disease, and there are some things you can do to take care of it. And if you try to do the diet, exercise, all those things, you might reduce the rate of heart disease. Unfortunately, we can't save every life from heart disease. 

We can't save every life from suicide, either. But if you had a risk of breast cancer in your family, what would you do? You'd start mammograms early, you would monitor carefully, you would do something right away. But we don't think about mental health that way. But it's exactly the same. Early intervention has a tremendous impact. 

And it often is about learning skills, changing behavior, and guess what your brain is really, we say plastic. In other words, it can change. Just because you have a family history, or you've had a head injury doesn't mean that you're destined to something.

HARTSTEIN: So the idea that two things that are opposite can be true at the same time, and so a lot of therapy pushes you to change, but then it doesn't look at the fact that you're suffering. 

So [dialectical behavior therapy, or DBT] is this dance between accepting you where you are - hey, life is really hard, you're struggling, you're doing the best you can right now - and you need to do better, try harder, be more motivated to change, and the kind of tango in that, and the push pull of that is, wow, I'm going to validate how you're feeling, because validation is hugely important. 

Life is really hard right now. I'm really sorry, you're struggling. And - What are we going to do about that? How do we help you make a different choice? Do something different? 

So DBT is really a cognitive behavior therapy that is built on this idea that we kind of can accept and change at the same time.

HARKAVY-FRIEDMAN: So it works on things like learning to be mindful, learning to be present. Emotion regulation. And language is really important for that. 

You know, people in my practice tease me, because I'm always saying "good is not a feeling, bad is not a feeling." 

HARTSTEIN: Upset is not a feeling. 

HARKAVY-FRIEDMAN: Even anxiety can be broken down into feeling, so you can address them. One person I worked with actually bought me a feeling chart.

HARTSTEIN: I love my feeling chart.

RESOURCES AND ASSISTANCE

HARKAVY-FRIEDMAN: Learning to say those words, and acknowledge them, and know what your patterns are. 

You know, people, for instance, tend to get anxious before they go to a party, right? Probably most of us. But what do we do? One person goes straight to the bar. One person goes straight to the corner... and very few people, just sort of over time, they kind of relax. But we're all feeling the same feeling. What we do with it is different. 

And that's part of suicide prevention, also, is knowing what you're doing and what you're experiencing, and then trying to figure out how to do it in a way that doesn't leave you feeling pain, loneliness, feeling like you're a burden, and to really - you feel what you feel. But then what do you do with those feelings?

HARTSTEIN: I think all feelings are valid, right? I think we have to remember that we are entitled to every feeling we have. The work is what do you do with the feelings? Because if we could change feelings easily, I would be out of business happily. But we could snap our fingers and feel better. And that's just not how life works.

So when it comes to how do we change how we think about something, how do we change our behavior, and if we kind of think of it in a triangle, change one part of the triangle, the other pieces of the triangle change. And feelings are the hardest thing to do in that.

And I think that's, we all are like, "I just want to feel better." And I have so many clients who are like, "I don't want to do the work. It's too hard." And I'm like, "Sorry."

HARKAVY-FRIEDMAN: To get back to your original question about physical and mental health, it's no different in physical health, right? You could know you have a risk for something and do nothing about it. Or you could do something about it. And the more you know about what to do, and you find the benefits of it, the more you're going to do it. 

And, let's face it, we often have lapses where we go back, but if you have the connections that help to keep you connected to your own well being. And I think that's what happening in COVID, is that from the start people were talking about well being. And I think people are feeling crummy, there's no doubt there's more depression, more anxiety, more thinking about suicide.

TYLER: Isolation, social media, fueling everything.

HARKAVY-FRIEDMAN: But fortunately, it doesn't seem to be translating into suicide rates.

TYLER: Because Dr. Jen, Dr. Jill, it can be the cheerleader, the football captain, and the the person who's falling through the cracks at school, the very successful business person. We've seen celebrities. It's just each individual's complexities.

HARKAVY-FRIEDMAN:  That's right. And then, it's in the context of stress. Yeah. But what happens is we see the stress, and we say, oh, they died, they killed themselves because they got divorced, or they lost their job, or they got bullied. 

But, you know, it doesn't work that way. There are so many of them at that moment in time. And then of course, when we're talking about death by suicide, there has to be access to lethal means. And we know one of the most powerful things to prevent suicide is limiting access to deadly means when someone is in a crisis. Or it doesn't have to be a crisis, but just not feeling well. 

So it's that constellation of the risk factors, the stressors, and access to means, that come together. Fortunately, those moments of actual action can often be very quick. And if we can help people through those moments, we can help save their life.

MONSANTO: You were talking about using your words. And when you have that gut feeling to say to them, like, you know, Dana, I'm really concerned about you. You haven't been yourself. What's going on? Can we talk about it? And you know, just being direct, Because I think the uncomfortable aspect of the conversation prevents some of us from listening to that gut feeling.

RESOURCES AND ASSISTANCE

TYLER: I'm one of those people who will tell you, I'm fine. So I can change it and turn it to you. I do that all the time. So in that conversation, Dionne, also to all of you, are you going to use the phrase? Are you going to say the words - 

MONSANTO: I would, absolutely. And this is what we teach people... in Talk Saves Lives, you know, the AFSP training, that you should be direct. Are you thinking about killing yourself? You know, you're using words like, do you feel like you're a burden? Do you feel uncomfortable? You feel like a foreigner in your body? Are you thinking about ending your life?

HARTSTEIN: You're not giving anybody the idea. I think there's a myth that if I bring up suicide, and I put it on the table, that I'm giving you the idea. And the truth is, is that no, you're not. If someone is looking at suicide as the best and only option because life feels so painful, and they're so underwater, that they just can't see a way to break the surface. You're not giving anybody any ideas.

HARKAVY-FRIEDMAN: And I think being non-judgmental is really important. Even if you're terrified inside. It's OK to be afraid, because we don't want anybody to die. But they're not going to suddenly, like, kill themselves right then in that second, but they will feel relief. 

The more specific you can be about what you see: I noticed you haven't been to class in weeks, I noticed that you're not going and hanging out with us. The more you can articulate that and say what you see, the better. 

The other thing is, some people, like Dana, will say, no, I'm fine. And you say, OK, but I'm here for you, you matter to me. 

HARTSTEIN: Or help somebody identify who they might feel comfortable going to. 

I think that, if I'm worried about what my mom might say, but I'm really close and comfortable with my coach, then the coach can be that person. Who's the person? Can they identify the person? And it might not be a parent for a lot of different reasons.

MONSANTO: And I think an aspect of talking about it is the storytelling. 

Use this show. Use a story. Use something as an example. You know, you came to this presentation, you know, I heard this lady talking and she said she lost her daughter to suicide. And you know, do you know anybody that's felt that way? Have you ever felt that way before?  

So there's this conversation starter, where you're like, so storytelling, it's like, OK, I'm not concerned about you, Dana. I just heard about somebody else. Like, oh, that's interesting. So now, you know, well, this person has some awareness,

TYLER: Maybe that will evoke... .

HARKAVY-FRIEDMAN: That's the reason we're training people to understand the risk factors, warning signs, how to have that conversation. For that very reason. The more you feel comfortable with it, the more you can open up and help other people open up.

TYLER: But some people... I had no idea. If [Cindy was] giving a cry for help, I missed it. We work in two different parts, here. And so when this happened, I was like, "How did I miss that?" You know, why wasn't I there? 

HSU: I'm like you, and so many people, so good at masking. 

You know me, I'm that I'm the happy one. I'm gonna put my arms up in the picture, and that sort of thing. 

But it was somebody, one of my colleagues, who came to me and asked, are you OK? And finally, it was like, no, and then tears came. And I left work, and everything. I started getting honest with myself, you know? 

And I asked her later, what did you see in me that made you ask, are you OK? And she said she saw the light go out of my eyes. So the person is different. The person who was like this, is like this.

TYLER: You still tried?

HSU: Yes, yes. And I'm so grateful I'm here. 

TYLER: I am too. 

HARKAVY-FRIEDMAN: When a person's in that state, they don't have access to their usual coping. So us expecting people in the in the depth of pain to say, oh, by the way, I'm not feeling great, you know ... it often doesn't happen. 

Because the way the brain works in that moment is, you know, people can say things like, I love my family, my family loves me, but they'll be better off without me. That's completely illogical. But that's how the brain is.

You don't see the other options that are out there. It's not that there are no options. It's that you don't see them. And also there's a possibility you might act more on impulse. 

And when someone is trying so hard to look like they're fine, that cognitive flexibility isn't there to say, I really need help.

TYLER: It's important to, I've learned this from Cindy, that you go through this time. Cindy's daughter is now in college. But the family involvement. Not only pre, during, 

Yes, you know, not only pre during, and in your case, after. I mean, this just doesn't end, you know, there's a lot of examination and, and even more openness that needs to happen. 

HSU: That's true. And then the whole family also, in a sense, needs to be treated. Because it's not just the person who's suffering, because so often you you focus on the person who's suffering and you don't take care of yourself. 

So what are some - I know there are group meetings, I know there are different things you can do if you or someone who knows someone who is suicidal, or as a mental illness. What are what would you say to family members and friends?

HARTSTEIN: So one of the things we recommend, certainly, since since I specialize in working with young people, is do their families need to be in their own treatment? Do they need parenting support? Because there is a lot of guilt and shame about not being able to do the right thing, or preventing it or protecting them, or what could they have done differently? So a lot of parenting support we offer. 

We have a group for families to come together so they can learn skills and strategies on how to talk to each other differently, or use emotion regulation strategies, or just, you know, all the different skills that the family learns together. 

So I think that if we're talking about one person needing treatment, why not look at the system and where the system might need treatment? 

TYLER: What if i don't have insurance? What are the rates now? Dr. Jill?

HARKAVY-FRIEDMAN: There are some services where people can find free or low cost care. Of course, they have long lines and waiting lists like everybody else. 

But we have some places on our website. You can also call your local hospital, go to maybe counselors in the school, if you have a child. Local VA, if you're involved with the VA, or you're a veteran and you don't know where to go, they can tell you outside services, it doesn't have to be at the VA. So use the local resources.

I'll say, in all honesty, it is not easy to find mental health care whether you can pay for it or not. And so the problem is you have a person who's feeling terrible, doesn't have access to thinking flexibly, and then they're supposed to make 15 phone calls to people they don't know, to get therapy. 

So I would say that the whole system is kind of broken.

TYLER: And then there are the meds. 

HARKAVY-FRIEDMAN: And then the medications. Often if you contact the pharmaceutical companies, they will help you to get funding.

HARTSTEIN: They'll give you, you can get discounted medications, if you can, you know, you call and you say I can't afford whatever this is they will give you access for up to a year or two years of decreased fees. 

And to add on to what you're saying, Dr. Jill, I think that there's an important thing that if someone is in crisis, I think there is also a stigma of taking someone to the emergency room. And you get faster access to care for anything if you go to the emergency room. And so if you're really worried about someone safety, call 911 Take them to the emergency room, because you will get faster access to care and emergency rooms can't turn you away. They have to treat you. 

And so there is there's kind of expedited care, it might not be long term, but at least gets you in the door. And they might be able to help get you on a waitlist for treatment center or for therapy someplace that I think that's important.

MONSANTO: I also want to add what Dana said, because I was in corporate America, when all of this was happening, and the EAP services, the employee assistance programs. And because of the whole stigma, and concern about privacy, I was in financial services and people - those services are underutilized. So I'm always saying it's a different number at every company. But if you are employed, 90% of the companies have some sort of employee assistance program ... that has to stay confidential. 

And what I tell people when I'm training, I -  because I worked there, and before I was in HR - I was like, it's not confidential, my name is gonna be on a list. Like, I was a naysayer, nobody believed that, my colleagues didn't believe it. 

Then when I worked in HR, I can personally say, I saw the reports, and you pay the bill. But it just gives you a number of people and departments and that's it. So it is confidential, and people need to utilize it. 

HSU: Thank you so much for this conversation. I just wanted to see... any final thoughts? Dionne?

MONSANTO: I always come back to the parents. The parents, the siblings, the grandparents. Enjoy your family. Talk to them. But if you're facing this crisis, and someone has attempted suicide, or someone has completed suicide, I always want to leave them with it's not your fault.

TYLER: So sorry for the loss of your daughter. 

HARTSTEIN: I think we have to remember that mental health and physical health are on the same plane, and all of us have mental health. And if we start to make it more of a priority across the board, I think that we will see rates continue to decrease, which is such great news. 

And hopefully, you know - we did this with cancer, we did this with heart disease. It's time kind of mental health be the next public crisis that we really start to address. And I think that we're starting baby steps to head in that direction. And hope we can continue to do that. Programs like this will certainly help.

HARKAVY-FRIEDMAN: Yeah, and I would like to say something, actually, Dr. Jen, you said something. And I always say which is that we all have mental health. And so taking away the idea that that that mental health means mental illness is really important. And that having those conversations, if you're not feeling well, or you're worried about somebody, there's every reason to hope and to connect, and you could save a life just by being there.

HSU: And I will just say that there is hope. You know, I've been to the bottom of the bottom of the bottom, where I didn't want to live anymore. Then I got the help I needed. Still getting the help I need: Therapy, medication. And this is part of my healing, having these conversations to help others.

TYLER: Breaking the stigma, Encouraging other people. And that's I would add to that, saying it's OK if it's a cry for help. It's a scream for help. Don't be afraid. You are loved.

RESOURCES AND ASSISTANCE