Connections between Mental Health and Poverty

By Akiksha Chatterji, College of Wooster (2017)

The summer has been an intense to say the least. Frontline Service, in Cleveland, Ohio, the agency at which I interned, was created in response to the increasingly pressing issues surrounding underprivileged individuals in need of mental health aid. Frontline’s mission statement states: “Reaching out to adults and children in Northeast Ohio to end homelessness, prevent suicide, resolve behavioral health crises, and overcome trauma.” Frontline aims at helping clients who face mental health issues. Poverty is not a perquisite for aid from Frontline. Nevertheless, the majority of Frontline clients are underprivileged and cannot afford help.

Akiksha (Wooster 2017) interned in Cleveland with Frontier Services. The organization helps people suffering from mental health issues who lack material means to seek help elsewhere.

Akiksha (Wooster 2017) interned in Cleveland with Frontier Services. The organization helps people suffering from mental health issues who lack material means to seek help elsewhere.

Clients are referred to specific departments and programs depending on their diagnosis. For example, within the trauma department, four separate programs treat distinct causes: the traumatic loss response team (TLRT), children who witness violence, defending childhood, and Exodus. This service, targets specific populations that fit the criteria required to get aid from Frontline. After referral, Frontier Service employees provide appropriate aid. I devoted my summer in the Trauma department, to serving ‘Children who witness violence.’ The violence occurred in their home, neighborhood or school and lead to traumatic stress that could bring about depression or substance abuse. Fortunately for my education, I experienced other sections of the trauma department as well, and I was impressed that the team is a highly united group, probably the most united of all the departments at Frontline. This unity contributed to its success. I learned that professional collaboration is a key to effective mental healthcare.

On my second day, my supervisor sent me on a TLRT call with one of the employees. TLRT targets the needs of families of homicide, suicide, and accident victims. As I read the case files, I was shocked. The intensity of these family problems made me realize the good fortune of feeling safe in my own home. These initial cases were only the tip of the ice-berg; I came to understand how much emotional and mental strength doing this job, on a daily basis, requires. For this reason alone, the Trauma Department employees need an amazing sense of humor and must remain connected and do their job well. Staff well-being, both mental and physical, is extremely important for this work, especially because the clients are so vulnerable, and the Trauma Department works as a team. It exchanges ideas, discusses matters that the team is facing, and considers how it can reach out to other agencies. I witnessed no disruptive disagreement as staff talked from their cubicles to share stories and arrive at innovative solutions. The Trauma Department certainly functioned as an integrated network, and I learned how important this teamwork was for successful mental healthcare in a high pressure work assignment.

I also learned about mental health for children from a revealing panel discussion on CASA in Cuyahoga County. CASA (court appointed special advocates) provides legal aid (and much more) to children within hostile family environments. Hostile is a euphemism for what I heard about. These children faced horrific violence. Not only did I learn in detail about CASA but was also exposed to eye-opening facts about generational poverty. This presentation covered aspects of why it is hard to combat poverty. For example, I had never considered how persons’ conceptions of time can keep them in poverty. People in poverty typically do not have a future orientation because they live in a survival mode. Their lives are divided into moments represented by separate circles; each circle is an emotional event in their lives. Time equals the present and is assigned on the basis of emotional significance. This phenomenon prevents planning for the future. The absence of a future orientation creates a huge barrier to change. As my internship progressed, I applied this presentation to my work and found that perceptions of time served as a barrier to overcoming present coexisting problems such as addiction, mental illness, and a sense of victimization.

I also experienced language and culture as barriers to change. One of the calls I went on with a co-worker was to a supposedly ‘Indian’ family. It was somewhat ignorant of the agency to assume the family was Indian; I discovered they were Nepalese and spoke neither English nor Hindi, despite the referral sheet indicating that family said it speaks ‘Indian,’ There is no Indian language! In this instance, the language was a barrier to good mental healthcare and escaping poverty. The family could not understand the important information my co-worker futilely tried to convey and did not seem to realize the gravity of what she was saying. My co-worker did not seem to understand, at the moment, how to better communicate with the family. Sharing a common language is extremely important in order to communicate successfully, and neither my agency nor the family could surmount this barrier. My co-worker said that she would try to find an interpreter. I speak Hindi, but that was of limited help. I communicated a little with her but soon realized that she spoke as much English as Hindi. Their small house was an utter mess, and apparently the children were not attending school. With another pregnant lady in the house, it was hard to imagine how they could support themselves. Although some of these challenges were evident for other families, in this case the cultural and language differences compounded the difficulty of surmounting these more typical challenges to provide for the family the help they needed and deserved. How would the family be able to get the information it needed? The family needed an interpreter, which we did not provide. We did our best to inform them of their options and left. There is only so much Frontline could do without increasing personnel resources, and thiese language and cultural barriers were distinctive. Yet the challenge that remained for Frontline was that it had to address other families with different but similarly challenging language barriers. I do know that they have a language bank with translators to help; I simply do not understand why they did not think this necessary from the beginning. I also learned the importance of a support system. In working with these families, I recognized that I have a support system anddo not provide for all of my basic needs.Some of the clients we dealt with have no shelter or food, and they have no support system. Without support, there was little they could do for themselves. . Recovering addicts, incarcerated parents, and traumatized patients all need support to actually move forward and make changes. Some had no family support. Who do such people turn to? It is comforting to know that numerous services in Cleveland are available to deal address many of these needs. Frontline collaborated to create an integrated network in order to best serve those in need. The Exodus program, within the Trauma department, offers an example. It collaborates with over six other agencies.

Collaboration is crucial for Frontline to provide its clients the aid they need. I discovered that promoting mental health requires support for multiple needs and requires collaboration with many different agencies. Each relationship, each child, and each mother with multiple needs should be addressed, and no one agency alone can do it. A network, with ongoing collaboration is key.

When my supervisor introduced me to a judge at the juvenile court, my confidence in Frontline’s resourcefulness grew. I was able to shadow this judge for a day. Law school is among my post-undergraduate options and I saw this as the perfect opportunity to experience what might be in my future. The cases that Judge Sweeney dealt with were definitely intense. Most important, I learned how charges are levied and how intentionality figures into determining the charge. Intentionality isn’t exactly observable evidence; in this sense, it is subjective and can quite easily be falsified without any empirical means to determine otherwise. I found that the intensity of criminal law would be interesting to me and that criminal justice bears heavily on the mental health of both the victim and the accused.

As my internship came to a close, I began to integrate poverty into the analysis of my experience. As I have noted in discussing support systems, I realize the importance of material deprivation in mental health. My internship with Frontline went beyond alleviating material deprivation. I have seen poverty in India and in the U.S., although it is different from what ‘poverty’ is considered to be here, the fundamentals remain the same. Some of the families suffer from conditions (both mental and physical) that inhibit them from escaping material deprivation. Frontline’s philosophy is not limited to reducing material deprivation; rather, it includes helping people suffering from mental health issues who lack material means to seek help elsewhere.

My internship at Frontline revealed the importance of teamwork in treating mental health, especially in the context of intense family situations. I learned how ingrained perceptions of time can affect mental health, and how language and cultural barriers that an agency lacks the resource to address can diminish the effectiveness of mental healthcare. I also learned how we need support systems for effective mental healthcare and that Frontline had to collaborate with many agencies in order to support desperate families facing mental health challenges. Finally, I learned about connections between criminal justice and mental health, and even discovered that I might have a future role in this area.

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