Gabe Howard Bipolar Speaker & Writer

It is my job, goal and life’s work to have more conversations surrounding mental, mental illness, and psychology because people experience this, yet most people aren’t talking about it 
— Gabe Howard

GABE HOWARD

 Award-Winning Writer | Mental Health Activist | Sought-After Speaker| Educator

It is my job, goal and life's work to have more conversations surrounding mental, mental illness, and psychology because people experience this, yet most people aren't talking about it. When a mental crisis or a mental health illness issue occurs, we're sort of behind the A ball as a society because we don't know how to react. I'm looking to flip the script on that and get people to the knowledge before they need it rather than after.

I was formally diagnosed in 2003. I was admitted to a psychiatric hospital and I really speak from experience when I say that I had to learn all of this after the fact. The day before I was diagnosed, I knew nothing about mental illness, nothing about mental health. I thought I was interested in physiology but I wasn't. Then, I'm diagnosed I'm in a hospital, in a locked psychiatric ward and I needed to learn everything instantly.

I really wished that I would of had a lot of knowledge ahead of time, because I think if I would of been diagnosed sooner, I probably wouldn't have been suicidal and in crisis. Thankfully, I ended up in a physiatrics hospital. I could of easily ended up in jail, or in a morgue, it could of turned out a lot worst.

Whats interesting is people are like "you were in a locked psychiatric ward, thats literally the worst case scenario". Interestingly, its not! Thats like the best case scenario for somebody that has untreated mental illness that their unaware of and that their doing nothing about, a psychiatric ward is the best case.

The worst thing about being in a psychiatric ward is, its a complete lack of control. Its locked, the doors are locked. Everything is controlled, and regimented. When I checked in they took stuff from me. The things that I brought in from home to make myself feel better in the hospital they were like "you can't have that". My girlfriend at the time brought me, my favorite drink and they were like, "no that has caffeine in it, he can't have it".

At the end of the first visit I wanted to walk her to the elevator, and they were like "no you can't". Thats kind of devastating to your psyche a little bit, because I'm like GROWN! their like "NO". It was for my own good, they were trying to keep me alive, I was there because I was suicidal. But from my perspective in that moment I just felt weak. Those are the things that I remembered; just how little agency I had.

I'm lucky for an incredible number of reasons. 1st, I'm lucky that I had money, my care over the next four years was a couple hundred thousand dollars. I was able to be hospitalized, I was able to see a psychiatrist every 4-6 weeks. I was able to try the best medications on the market. I was able to go to intensive outpatient treatment. I was able to go to the hospital for 8 hours a day 5 times a week. I was able to do that twice. I was able to go to support groups led by psychologist and psychiatrist, there wasn't really any sort of care that I wasn't able to afford. That was so important to me.

Secondly, I did have a good family, while they made a ton of mistakes they were there for me. They didn't run away from me, they were there for little things. My whole family helped me move out of my house into a smaller apartment when money got tight and when I lost my job. When I did lose my job, I had plenty of people to talk to me and say "Hey you're more than just a job, you're going to focus on wellness" and that pumped me up. Of course I had my number one (then girlfriend now wife), who was there for those really low points. Lastly, I worked very hard.

Somebody who doesn't have all those resources, they only can have one of those things, and that is to work really, really hard. Maybe, they can have two of those things, because they can work really, really hard and they have a really good family but if they don't have the money they are not going to have access to the same amount of care that I did.

Then even that fractures out, theres plenty of people that have good health insurance but maybe they live in rural America where these programs are not there or they can't afford these programs. Maybe they have the money but they don't have an number one, or a good family. If you don't know what to buy the amount of money isn't going to be helpful. You need to find a way to pay for treatment because treatment is so important. You need to take your medications as prescribed and get the right medications. You need to have a support system because thats so important.

There are things that you can do if you're not as fortunate as I was;

  1. Support can come from many different places, find peer support groups.

  2. Find consumer operated drop in centers.

  3. Find a sponsor.

  4. Find people who have been there; Theres lots of free support groups sponsored by mental health charities all over.

  5. Find a buddy, who is willing to help you and be respectful of their boundaries.

  6. Ask questions,

  7. Go to all of the appointments, even when you don't want to, even if you've been in the same clothes for five days and you haven't showered, find a way to get to that appointment. The people there will understand more than you think.

  8. If you don't have health insurance you have to find health insurance.

  9. Apply for disability, welfare, medicare, social services: some people that I talk to are like "I don't want to do that, I don't want to be a mooch". Listen, its a social safety net, for a reason. You're going to use that safety net to get well and then when you're well, you'll be happy, you'll go back to work, and your work and earnings will help fund these social nets for the next person

  10. Fight really hard for a better future, and find the things that you need.

As much as I hate to say it, it does boils down to advocacy, you're now sick and you have to advocate for yourself, this is an overwhelming task, but it is not an impossible one

Contact Information: Website | Youtube | Twitter 


Danny van Leeuwen | E-patient | Caregiver | Nurse | Informaticist | Leader

"The cost of care needs to me more transparent, more predictable and more reasonable. There is nothing like the fear of not being able to afford what you need, or going bankrupted" Danny van Leeuwen, RN, MPH, CPHQ. 

 


How does an individual figure out what works for them?

"I think you learn what works by trying things. The life journey for an individual, for me, for you, is an experiment. The way I look at it is, that I'm trying to accomplish something with my health journey. I have multiple sclerosis, its a progressive disease and I want to progress as slowly as possible.

I'm also a person that's pathologically optimistic, and I don't want to mess with that. Its a real strength to be optimistic, I feel better having a positive attitude. I also play the baritone saxophone, and I don't want to mess with that. Those are the three things that I want to accomplish, so I need to experiment with the things that are going to help me accomplish those health goals.

I can and I do go to research and try to learn what works for populations, or groups of people. Just because something works for groups of people or is likely to work for groups of people doesn't mean it will work for me so I feel like I need to try stuff. If it doesn't work then I need to adjust and try something else, so I think its experimentation".

Suggestions for improving empathy in health service delivery?

"You don't create empathy. There are people who have no empathy, there are people who have lots of empathy and then there are people in between. I think what you can do is foster the situation where empathy can exist and grow. Its very challenging to be empathetic when you have 8 minutes as a clinician, to spend with someone when theres this whole list of things to do.

You're consumed with checkin all the boxes and its hard because empathy requires listening and reflexion, which means you have to pause and think about; what do I see here in-front of me, whats the story I'm hearing, whats behind what their saying. That takes a moment, and when you're really rushed its really hard to do that".

Appeal to policy makers?

"The cost of care needs to me more transparent, more predictable and more reasonable. There is nothing like the fear of not being able to afford what you need, or going bankrupted. The next thing is the availability of information. My information about me, is mine. Right now information is so silo, its so dependent on the platform, i.e electronic record, the setting. Its very difficult to share that information amongst settings.

As a patient I want to have access to all the information there is about me, I'll pick and choose whats important and whats not. But, I want to be able to have access. I also think that the way healthcare is setup is by episode and diagnosis. An episode is a snapshot, its a moment in time. A diagnosis is a label about some aspect of my dis-health. I think policy makers should focus on longitudinal care over time, thinking about me a person, rather than a diagnosis".

Advice to clinicians that are new to healthcare environment?

"It would be good for people who go into the healthcare profession to spend a day in the shoes of people who are living in the setting their in. If their a patient, spend the day in the bed. When I was a young nurse I went to the Rusk Institute in New York City to learn about physical rehabilitation; I spent the day in a wheelchair.

That was a transformative experience, gaining some lived experience, I think that would be one thing. I would encourage networking as a young clinician. Finding people who care about the patients in this manner. Finding out who they are and then meeting with them regularly to share what works and what doesn't. Having that support system outside of the work environment I think is really important".

Contact Info: Twitter | Website | Youtube


Heather Corini Aspell | Visual Storyteller | Artist | Patient Advocate

"The government can continue to provide better services for transportation for disabled people, to actually advertise those services in a way that people are going to see them. That would make a huge difference" Heather C. Aspell


Suggestions for healthcare providers:

Having the providers have more time with patients. I'm not really sure what in the system needs to change in order to make that happen but I know that its not the physicians themselves are not creating the limitations on time. I know doctors who want to spend more time with their patients and they can't, so theres clearly something higher up in the system that needs to change.

Suggestions for government:

 The government can continue to provide better services for transportation for disabled people, to actually advertise those services in a way that people are going to see them. That would make a huge difference. So many people don't know of the services that are already there because they are being marketed more toward the senior population. 

Suggestions for decision makers:

I think we need to have more collaborative discussions between people who advocate for the current insurance system, that we have here in the U.S and a system like they have in Canada and say ok what are the problems with both systems and how can we create some kind of new idea that we haven't come up with yet thats going to allow people with serious chronic illness to get access to specialist without long wait times but also allow people with common ailments to have regular access to preventative healthcare that is affordable.

Unfortunately anyone can ill or disabled so these issues about healthcare, their important, they affect everyone. You may be healthy right now but unfortunately you or someone you love may not be that way. It doesn't matter how old they are, it doesn't matter what their race, gender, ethnicity is you can be affected. Don't pass judgement on those that you encounter who may be chronically ill or disabled. Be mindful of the fact that it could affect anyone, when you're thinking about issues related to healthcare or insurance. and the political area as well.

Overall message to society:

I think the number one thing patients that are chronically ill can do is to start sharing their stories. I think that individual stories are the most persuasive thing that we have. If everyone begins to share a little bit about themselves and their experience with just one person or with thousands through a social media account, then people will begin to get a little bit of a window into what life is like for people like us. Gradually we'll be able to create a shift in what society thinks it means to be disabled or chronically ill.


Advancing Health Equity In The United States

V1: Director of Health and Wellness, Ginny Mantello, MD discusses social determinants of health, health initiatives and polices implemented to advancing health outcomes on Staten Island.

 

We want to make sure and be mindful that every individual deserves the right to be healthy. Health is a fundamental right and how do we help people regardless of income and race attain their highest level of health. Theres a big push from the city and state departments from the CDC to the borough presidents office. The key is for residents to be engaged but also understanding what in their community is lacking and then reaching out and engaging with  their local governments, also perhaps with the city and state governments, whether it be by phone or social media or in person Ginny Mantello, MD. 

 

V2: Assistant Commissioner, Bureau of Systems Partnership - Javier Lopez, MPA discusses food policies, strategic partnerships and other initiatives taken by the NYC Department of Health to advance health outcomes in NYC.

We as government have to be technical assistants, thought partners and leaders because we have expertise in areas that our colleagues and neighborhoods may not have the time to invest in. If we're really thinking about long term a lot of the funding and a lot of the work has to reside with the communities and neighborhoods that we serve Javier Lopez MPA.

 

V3: Deputy Director CUNY Urban Food Policy Institute, Craig Willingham, MPH discussing " The CUNY Urban Food Policy Institute Guide to Food Governance in New York City".

 

Often times the distribution of certain types of stores and by extensions, certain types of foods really comes down to both the market perception; In the case of supermarkets, supermarket operators or in the case of whole sale distributors those people who go around to have a sense of what they think folks in a given neighborhood would to want to buy Craig Willingham, MPH.

Article Link | Guide to Food Governance in NYC

 

V4: Brooklyn Borough President Eric L. Adams discussing his role in both advocating and allocating resources to advancing health outcomes in Brooklyn

When you go to some of the health issues and you dig deeper into the report that Dr. Bassett put out, you must really look at the report and separate it from those issues that are beyond our control, theres not much that we can do about and those issues that are not within our control. It doesn't matter who's the borough president, major, or the commissioner of health is; we want to empower people to deal with their health issues. When you do that you begin to empower people to take control, to move away from the old way of thinking. When you look at the major 15 reasons Americans die, 13 of those 15 are clearly preventable; health disease, diabetes, colon cancer, high blood pressure etc. all of those items are preventable.

If we empower people to have lifestyle changes. In the process, they will be ensuring that they have, preventative health care and not so much focus on adequate healthcare, to give them a pill or a needle or injection, or an operation that will treat the symptoms and not the underlining cause. We're not doing that, we're not doing that city wide, we're not doing it and really educating people on how the things they put in their mouths are the things that are causing them to be placed in a hospital at a earlier rate. That is my focus. My focus is to really use my personal victory over diabetes, to turn around, how we think about health care and truly move towards a more proactive health care system Eric L Adams.

 Link: Community Health Profile Report

 

 

V5: Bronx Borough President Ruben Diaz Jr. discussing advancing health equity in the Bronx.

About 100,000 more Bronxites are working today than the day that I took office. Last year the crime rate was the lowest since the early 1950's in our borough. 2017 was actually our 5th straight year of under 100 homicides, we're down to 72. I don't really know how you celebrate that, as 1 death is one too many. If you use the national metrics system of 1 homicide per every 100,000 residents, when compared we're safer than Philly, Baltimore, Dallas, Boston, D.C, Chicago.

You don't even have to compare us to Detroit, that was what we used to be 30/40 years ago. Because of that we've seen an increase in our tourism, development, job creation, etc. I give you that overview because there's been a tremendous, body of work done by the elected officials, both present and past. Community leaders, community activist and advocates, non profit organizations, etc. It feels good, and theres a lot to brag about but the one area I cannot brag about is health" Ruben Diaz Jr.

 

V6: Aletha Maybank, MD, MPH, Deputy Commissioner and Director of The Center for Health Equity, discusses the Health Department’s work to eliminate health inequities in New York City.

I think its a very important to really recognize the role of government, organizations, institutions and policies and how all of that, a lot of times makes it very difficult for folks to fully harness the power that they have, in order to create health that is good in one community such as Brownsville as compared to the financial district. When you have investments that you don't have as control over what are you supposed to do? Thats frustrating for people, they have to worry about their day to day Aletha Maybank, MD, MPH.

Links: One NYC Report | TCNY 2020

 

V7Melanie Ferris | Research Manager discusses "Community engagement to advance health equity: Strategies and tips".

 

One of the initiatives that I've been working to evaluate is one thats funded by the Center for Prevention of Blue-cross Minnesota. The initiative is their health equity and prevention initiative. An important and critical part of their work has been community engagement, about half way through the initiative, we asked representatives from each of the agencies to come together and really talk about what community engagement is, how to use it in their work, and to help us put together a list of tips and strategies about authentic community engagement and how that can be used to advance health equity.

The seven key ingredients; 

  1. A focus on relationships

  2. Transparency in goals scope and expectations

  3. Listen to understand 

  4. A goal of fostering community capacity

  5. Activities that bring people together

  6. Strategic partnerships that bring people together

  7. Awareness of organizational capacity

 Link: Strategies & Tips Article 

 

V8: Sheryl Weir, MPH | Section Manager | Health Disparities Reduction and Minority Health Section | Michigan Department of Health and Human Services. discussing advancing health equity in Michigan.

Unless we understand this broader concept of systems and social determinants, then we will just be putting bandages. For us I think one of the things that is pretty interesting in this department is that three years ago we were Department of Community Health, and there was a Department of Human Services, we rarely interfaced. We were merged about three years ago, and as you can imagine it was pretty major. Department of Community might of been 2300 strong, and Human Services was much bigger and so you're merging two cultures.

I'm really encouraged because what its given us an opportunity to do is to say, well here are multiple determinants that we can impact; human services, services to children, and those kinds of things. Connect those to health services. We can have a bigger impact of addressing social determinants by being one department. We have to work together and I'm so pleased to say theres been some interesting collaborations in this department around issues of racial justice, social justice and how do we use what we have and what we know in our resources together to really try to improve the life experience for our most vulnerable populations Sheryl Weir, MPH.

 

V:9 Tari Hanneman,MPA | Director of the Health Equality Project at the Human Rights Campaign Foundation discusses advancing health equity for LGBTQ population.

 

The big difference in rural verses urban is obviously going to be access to care and the number of providers that are available; and then whether or those providers are going to be LGBTQ friendly. If you have a huge menu of providers to choose from you're likely to find some that are going to be LBGTQ friendly, culturally competent and aware, but, if you have a very small slice thats going to be a lot harder. In some places you may only have one hospital in town and it may be a critical access hospital, its the smallest of the hospitals there are and it may not have the capacity to really invest in the best policies and practices around LGBTQ competencies.

In some places there are no providers we work with a lot of youth gender clinics, working with transgender youths and a lot of times we hear of families having to travel hundreds of miles to go to a clinic". In regards to policy "The Equality Act would provide consistent and explicit non discrimination protections for LGBTQ people, across all key areas of life; employment, housing, public spaces, public accommodation services, federally funded programs and jury service Tari Hanneman.

 

V 10  Noel Brathwaite, PhD, MSPH, Director | Stephanie Slowly, MSW, LCSW-C, Deputy Director | David Mann, MD, PhD, Epidemiologist | Kimberly Hiner, MPH, Program Administrator | Office of Minority Health and Health Disparities, Maryland Department of Health.

The office has a multi part mission. When we look at the mission there are five aspects to our mission. 1. We leverage resources of the department. 2. We also want to provide some guidance to the department relative to policy decision. 3. Strategic initiative influencing the strategic direction of the department. 4. We want to engage in what we call health equity consultation. As well as 5. external communication. Our vision is to really ensure that health across all population groups in Maryland is equal and that people are enjoying their daily life and enjoying wellness in Maryland" Noel Brathwaithe, PHD, MSPH.

From the perspective of how we approach understanding minority health disparities, it comes from the way we look at the data. We can think about four layers, in which we can use data to kind of understand the flow from health to disease within any population. We can track the disparities on all of those four levels. The end point level is essentially, things like death rates and hospitalization rates, the kind of pain, suffering and disability that people experience from having different disease and other bad health outcomes"  David Mann, MD, PhD.

The Diabetes Prevention Program DPP, is a national program provided through the CDC, the state of Maryland has been really champions of this where they've deployed this program throughout the state. We have within our office, the Minority Outreach Technical Assistance program. That is a program where we fund local community based organizations. If you look at the structural level of government, we're the state and most times the state funds the local health departments. What we've decided to do is to bypass the local health department, in this particular initiative, and really fund those community based organizations" Stephanie Slowly, MSW, LCSW-C.

Language and language barriers play a role in health disparities in Maryland. Understanding that Maryland has a very diverse population, we need to meet our clients where they are. In addition to providing medically trained interpreters during medical appointments and translating medical information our office has specially undertaken several projects and initiatives that will work with healthcare providers and those that are working with these communities i.e our MOTA program" Kimberly Hiner, MPH.

Links: MOTA | Health Equity Internship Program | Cultural & Linguistic Competency | Data