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Can a Psychiatric Research Project Further Mental Health Education in Harlem?

Article Reposted from The Eye – The Columbia Spectator By Victoria Li 

Dr. Sidney Hankerson sits in a circle with reverends, pastors, social workers, public health professors, clinical doctors, and government officials from the Department of Health and Mental Hygiene. Everyone seated finishes tossing and catching a ball of yarn across the circle to form a web that spans the entire room. They are instructed to loosen their grip on their piece of yarn, causing the interlocked threads to slacken and drop to the floor. This, according to the paper in which Hankerson and his co-authors describe their research project centered around mental health awareness programming in Harlem churches, is what happens when some individuals within a community neglect to uphold their responsibilities: The entire community suffers.

This gathering in 2015 was the beginning of Community Coalition for Mental Health, a loose alliance of community partners brought together by Hankerson tasked with addressing the need for mental health resources in African-American faith-based communities in Harlem. Not long after this gathering, the early members of CCMH suggested the implementation of Mental Health First Aid, a well-known mental illness education program, trainings in West Harlem faith-based communities.

Hankerson, an assistant professor of clinical psychiatry at Columbia, is now the inaugural co-director of the Zuckerman Institute Community Wellness Center at Columbia’s Manhattanville campus, along with Dr. Olajide Williams, an associate professor of neurology at the University. The first MHFA trainings took place before the Jerome L. Greene Science Center building, which currently houses the Wellness Center, was opened in February 2018, but today those trainings are coordinated by Hankerson’s staff and funded by the center. The CCMH, one of Hankerson’s research projects, predated the Wellness Center’s opening and was integrated as a program that the center supports after Hankerson was appointed co-director. The Wellness Center, on the other hand, was provisioned in the Community Benefits Agreement, a 2009 contract between Columbia and the West Harlem Development Corporation. The center, as outlined in the agreement, offers free cholesterol screenings, blood pressure tests, and stroke education to local residents—all community benefits, not research endeavors. Today, the center also publicizes “improving access to quality mental health services in Upper Manhattan” as part of its offerings, and the MHFA trainings are the core of this programming. It’s important, however, to note that the center is not a clinical practice and doesn’t offer counseling.

MHFA is an internationally renowned public education program that introduces participants to the risk factors and warning signs of mental health problems, emphasizes early treatment, and connects people to needed support. In other words, it’s a risk management program, a public health initiative meant to promote awareness. In 2015, New York City First Lady Chirlane McCray launched ThriveNYC (the parent initiative hosting MHFA trainings), and since then the city government has provided free and readily available MHFA trainings in all five boroughs of the city. Under Hankerson’s leadership, MHFA is currently run in the First Corinthian Baptist Church and the Parish of St. Charles Borromeo, both in Central Harlem.

But the MHFA run by the Wellness Center and CCMH isn’t just a community education program: It has doubled, at least until this past September, as a study environment in which Hankerson (thanks to funding from National Institute of Mental Health) surveys the efficacy of MHFA trainings in faith-based communities for mental health awareness education. In light of this, the question of whether the Wellness Center contributes substantially to the local community—whether it fills a niche of its own in the web of Harlem service organizations—becomes more difficult to answer. On one hand, there are more robust programs, even some with a clinical focus: The Emma Bowen Community Center, located within walking distance of the Wellness Center, is a center that integrates mental health with primary health care and services 15,000 people every year. The HOPE Center, meanwhile, provides free counseling services at First Corinthian Baptist Church, and ThriveNYC pledged to train 250,000 New Yorkers in MHFA by 2022.

But from Hankerson’s perspective, the research component of the Wellness Center is itself a form of community service, contributing to the public good in its own right. He believes that it will increase awareness about mental health problems and support advocacy for more services in under-resourced communities in the future, particularly those services which engage faith-based communities. The center’s programs also bolster existing outreach and infrastructure in the area.

Today, the Wellness Center’s commitment to expand mental health awareness in West Harlem seeks to be guided by community voices. The nature and goals of the center’s mental health programming, however, are complicated by the fact that both the CCMH and its MHFA program began as clinical research projects. While Hankerson’s research successfully invites community members to collaborate with and contribute to his research project, it remains unclear what plans exist for the future of Columbia’s involvement in West Harlem mental health education. To complicate matters, this delicate balancing act is based on a relationship between those community voices—Columbia, other research-focused entities, the New York City government, and faith-based communities—that continues to evolve. While MHFA is now funded by the Wellness Center, CCMH is currently in search for new sources of funding, because its initial research funding has terminated. So where does Columbia’s role in supporting local mental health education go from here?

The son of a deacon, Hankerson grew up in Fredericksburg, Virginia, and his professional career has specialized in the intersection of mental illnesses like depression in predominantly African-American faith-based communities. At CCMH meetings, you can find Hankerson—always sharply dressed in a well-pressed blazer or a vest—hugging each attendant as they walk in the door, addressing them by their first name, and asking about their families. As someone who has long advocated that physical and spiritual health are inextricable elements of mental health, Hankerson had first proposed training the clergy of faith-based communities in West Harlem so that they could incorporate mental health education into their counseling and religious services. This approach, however, was rejected by early CCMH participants in favor of the MHFA training run by the center today: still with a focus on religious communities, but not directly engaging leaders. One of the original yarn-holders, Teena Brooks, the assistant director of the Office of Consumer Affairs at the NYC Department of Health and Mental Hygiene, proposed that the group adopt MHFA.

Since it opened last year, Columbia’s Wellness Center has become a holding place for Hankerson’s projects—the office spaces and conference rooms where phone checkups with MHFA training participants are dialed, where monthly CCMH meetings are held, and where all the training manuals gather in storage. When I attended a CCMH meeting last December, the sleek white walls of the center were covered with holiday decorations. A Christmas dinner was set up for the 24 participants who came.

Over the course of that meeting, it became clear that while CCMH is grounded in the goal of bringing out community voices, the group was not yet in the position to propose incisive and enactable steps to move toward that goal. When I ask her about the mission of CCMH, Brooks begins, “that’s an interesting question… I think the vision remains strong. There’s a lot of thought about how to continue to build on some of the work” that CCMH initiated at its inception. The goal of the meeting I attended had been to set a vision for 2019, yet the vast majority—about 90 percent—of the attendants were attending a coalition meeting for the first time, and aside from Hankerson, only one participant had held the yarn in March 2015. The evening became a free-form brainstorming session, with the conversation skirting from the negative impacts of substance abuse to the importance of addressing family dynamics in children’s therapy.

MHFA trainings provided by the city government, which are available free to the public, are no different in substance from the ones offered in two Harlem churches by Hankerson’s team. The distinguishing factor between MHFA trainings offered by the city government and those affiliated with the Wellness Center are that the latter exclusively take place in faith-based settings and its participants double as participants in a clinical research project. Each participant consented to completing pre- and post-training surveys about their demographic and socioeconomic backgrounds, which asked them to identify their own attitudes and perceptions of mental health, as well as the state of their mental well-being at the time of the training. A phone follow-up three months later asked similar questions to measure the “efficacy” of MHFA training.

I decided to register for a NYC-sponsored MHFA training—not the one offered by Hankerson, but the version offered by the city government to the general public—and experience for myself the promises made in the glossy brochures on the MHFA website. The first thing that struck me after a quick Google search was the ready abundance of the trainings. There were least a dozen trainings in English, Spanish, and Chinese available that very same weekend across the five boroughs in all sorts of venues—YMCAs, middle schools, churches, public libraries, even within residential apartments. I followed a few simple steps to sign up for the “adult Mental Health First Aid course,” and, on a sunny winter morning a few days later, walked into the half-empty Greater Holy Tabernacle Church in the Bronx.

Over the next eight hours, though it never strayed from the topic of mental health, MHFA training felt more like the orientation at a summer camp. A warm, effusive yet commanding MHFA trainer, Egeria Bennett, stood at the podium where sermons are delivered every Sunday and asked the 30 or so participants to sit in the front rows. Bennett began by laying out the ground rules—the Aretha rule (establishing mutual respect) and the Vegas rule (requiring confidentiality). At one point participants were asked to yell out and complete an alphabetical list of words related to depression and anxiety, popcorn style. At another point, every participant was given crayons to draw on a large sheet of poster paper what they think anxiety looks like. The result was a wall full of colorful posters of stick figures in school, or on the subway, or going through otherwise mundane, ordinary motions, depicting the feeling that anxiety pervades everyday life for many of the participants.

At times, the boundary between informative training and group therapy blurred. In the first 30 minutes of the training, Bennett was interrupted twice by long accounts of a participant’s family member’s history with substance abuse or anxiety, which she had to courteously cut short by invoking a special rule: ELMO (Enough, Let’s Move On). Nevertheless, whenever someone began sharing a personal anecdote at the MHFA training, the other participants listened with their entire bodies, with a slight lean forward and intent faces, nodding heads and murmurs of agreement found throughout the group. This handful of strangers demonstrated an immense vulnerability to one another in that church on that random Saturday morning.

The same phenomenon also appears in Hankerson’s MHFA trainings. Emely Santiago, the project coordinator for the Manhattanville Wellness Center, observes that, despite an explanation at the beginning of the training that “this isn’t supposed to be a therapy session,” sometimes the participants dip into a tone of group therapy. Santiago thinks this phenomenon is understandable given that it takes place in the communal embrace of churches, which she describes as “a pretty beautiful thing for the community to experience.”

This tension may bring to bear a broader challenge between teaching and listening in mental health education, between disseminating information as a public service and listening as a public service. MHFA trainings, meant to give information, spontaneously transformed into a space where listening as a public service was demanded. One challenge facing the Wellness Center today is the balance of these two competing commitments in the service of the community, and how CCMH, designed as a platform to listen to diverse community partners, will play a part in its future.

The Rev. Kyndra Frazier, director of the HOPE Center, points out that the most concerning challenge that the center faces is having a wait period of 2-3 months for anyone seeking counseling service. Hankerson himself admits that “finding creative ways for people to receive treatment sooner [is] one of the challenges that we are working on,” though the center is not a clinical practice.

After all, Harlem is arguably in need of more programs addressing mental health, like the HOPE and Emma Bowen Centers. Community District 10, of which Central Harlem is the primary neighborhood, has an adult psychiatric hospitalization rate of 1,038 per 100,000 adults, ranking the ninth highest in New York City, while Community District 9, which includes Morningside Heights, Manhattanville, and Hamilton Heights, has a lower rate of 726 per 100,000 adults, still higher than the New York City average of 676 per 100,000 adults.

“We really want the community to drive what some of the solutions should look like,” Brooks says. Later, she adds, “We want these solutions to be really meaningful and enduring. … It isn’t always just about coming in and providing money.” She sees the relationship between the community and Columbia as a question not just of sponsorship, but of gaining understanding of local needs and priorities.

Hankerson’s research projects for CCMH and MHFA trainings have ended as of September 2018. The future of CCMH currently hangs in the balance: Hankerson plans to seek funding from Columbia, While the MHFA trainings will be funded by the Wellness Center, Hankerson is still looking for additional sources of funding for the community group that brought MHFA trainings to him in the first place.

The mental health initiative of the Wellness Center is trying to live up to the spirit of partnership—balancing services of value to the community with those of value to the city government and to research scientists.

“I think we’re still trying to figure out what the long-term relationship and partnership is for CCMH and the Wellness Center. There’s real potential there for further exploration and growth,” Brooks says. “It’s one that’s beginning to take shape and one that I have a lot of hope for for what it will mean for the Harlem, Morningside Heights community.”

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