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Richard Helppie Â
Hello, welcome to The Common Bridge. I'm your host, Richard Helppie. We've covered a lot of important topics on The Common Bridge and none more pervasive as mental health and the treatment of mental illness. Today we continue to pursue that topic. We've got an expert with us who's doing some wonderful things in the field so I'd like to welcome to The Common Bridge Mr. Kevin Fischer. Kevin, welcome to The Common Bridge.
Kevin Fischer Â
Thank you for having me.
Richard Helppie Â
Very, very good to see you. Our audience likes to know a little bit about our guests so maybe a little bit on you; where did you grow up, what were some of your early experiences and what's brought you to this point today?
Kevin Fischer Â
Of course. I'm a native Michigander. I grew up in Highland Park, Michigan, which is a little city surrounded by Detroit. I came to this work, really - I'm an advocate and an activist, I'm not a psychiatrist or social worker; I always like to get my disclaimers out - I came to this with personal experience. I'm a retired businessman. I spent 20 years in transportation logistics, and then I spent some time buying for Kmart, Sears and Meijer. But in 2007, my oldest son Dominique was diagnosed with serious mental illness. He was 20 years old, sophomore at John Carroll University. And by all means just an all American kid, three sport athlete, great social skills, good academic skills, never gave his mom and I much troubled at all, came home for Thanksgiving break, and was just rambling about God working for him and taking over the world for the better. We had never seen symptoms of mental illness in him before. So his mom and I quickly assumed that maybe he'd gone off to school and experimented with drugs so we took him to the hospital to be drug tested. After a lengthy exam, the doctors explained to us that there were no drugs or alcohol in his system, but that they were going to put him on a 72 hour psychiatric hold, which was like hitting a brick wall at one hundred miles an hour because, again, we had seen no symptoms of mental illness with Dominique. He was initially diagnosed with schizophrenia and later, they added the diagnosis of bipolar disorder. We learned very quickly how little we knew about mental illness treatment, really what his prognosis was going to be. So for about two and a half years we floundered, trying to understand the behavioral health care system. Unfortunately, that journey came to an end on June 27th of 2010 when we lost Dominique to suicide, so it was worse than you can imagine. And frankly, as a father, I felt a tremendous sense of not only grief, but failure. I felt like I failed to protect my son. So I went through this grieving process but I did it in probably the most unhealthy manner possible because I internalized everything. Dominique's mom and I had divorced about a year prior. I was in a new relationship and I ultimately remarried but two younger children were bought into that relationship. I was trying to be a strong dad; protector, provider, silence is strength, show them what I thought they needed. But what I was doing by internalizing my own grief and guilt was killing me inside. It wasn't long after - probably six months after I lost Dominique - that I started experiencing suicidal ideation myself. I had literally, frankly, planned to take my own life on the year anniversary of Dominique's passing; I planned to go visit his grave site and I didn't plan to come home. I'm blessed with a wonderful wife, my wife always allowed me to grieve in my own way and I always visited Dominique's grave site alone unless I [made] separate visits for her. But for me, it was very private and personal. The day that I planned to take my life, she decided that she was not going to allow me to spend that day alone. I noticed she wasn't getting dressed for work and when I asked her why she said, well, I'm going to spend the day with you. I said, no, today is going to be a really bad day. And she said, no, I know what today is and I can't allow you to spend it alone. So without knowing that I was experiencing suicidal ideation, she really intervened and saved my life. Once I got past that, it was what's next? What was next for me was...I had gone to therapy, I had hired a therapist, I joined a national grief organization for parents who lost children. I was doing things that I thought were good for my self-care but I was just sinking and sinking. So my wife, my current wife, Sonia, said, well, maybe if therapy's not helping you maybe you can help yourself by helping others. She Googled everything and she happened to come across NAMI, the National Alliance on Mental Illness.
Richard Helppie Â
That's N-A-M-I, the National Alliance for Mental Illness.
Kevin Fischer Â
Correct. So I said, sure, I'll try it. When I went to my first family to family support group meeting, it just resonated. I was with people who understood what I'd gone through, I was with people who didn't make me feel like I failed my son, because there's a stigma associated with mental illness. There's a stigma for people who've lost loved ones to suicide. I just felt at home and one thing led to another and I was a volunteer for NAMI. In 2014, I assumed responsibility as the State Executive Director, supposedly on an interim basis and ten years later, I'm still here and I love the work that I do.
Richard Helppie Â
I offer my condolences for the horrible tragedy that you've experienced and I'm very impressed that you've energized toward helping other people through NAMI. Is the website NAMI.org?
Kevin Fischer Â
No, that's the national website. The Michigan website is NAMImi.org. just added the Michigan [abbreviation].
Richard Helppie Â
So if you're in Michigan, NAMImi.org. If you're anyplace else - our audience is international - NAMI.org. What does NAMI do?
Kevin Fischer Â
NAMI is the nation's largest grassroots mental health advocacy organization that is purely dedicated to improving the lives of anyone impacted by mental illness, not just people who live with the diagnosis, but their family members, their caregivers, and literally the community at large because there's a ripple effect to when a person is diagnosed with mental illness. We as a society, not just in Michigan, or the United States, but literally around the world, we don't really understand the mental illness, because we're afraid...it's taboo to talk about it. We really need to change that. NAMI is really dedicated to changing that, to making mental illness, that conversation, a household conversation because that's how we overcome it.
Richard Helppie Â
Well, I know that when someone has a cancer diagnosis or a cardiac diagnosis or they've been a stroke survivor, people say, oh, we don't hide that and we know how to talk with people that are in treatment. But now that you've said that, it occurs to me that we don't know how to say, look, my family member has a diagnosed mental illness. What do we do differently? That is a huge challenge. Is our mental health treatment ecosystem responsive to that?
Kevin Fischer Â
The ecosystem is responsive, but we've got so much further to go because we have such a shortage of resources. Again, that's internationally, that's not a US thing, that's not a Michigan thing. Internationally there's a tremendous shortage of behavioral health care professionals. But even before we get there, the whole reason I wear this "Everybody versus Stigma" is because stigma is the leading barrier to the early diagnosis and treatment that leads to better outcomes. If we don't de-stigmatize mental illness, it doesn't matter how many hospitals we build, doesn't matter how many psychiatric beds, it doesn't matter how many professionals, doesn't matter how much money we throw at it, if people are afraid or ashamed to pursue mental health treatment, they simply won't. We can throw all the money at it that we want to and it just won't make a difference.
Richard Helppie Â
Do you see any difference among segments of the population - teens or elderly, suburban versus urban versus rural versus big states, little states, any differences there?
Kevin Fischer Â
I love young people, I love all people but I absolutely love young people - not in a creepy way. Young people...we talk about stigma, we adults are more the perpetrators of stigma than young people. I spend a lot of time in junior and senior high schools and on college campuses and young people are very open to having this conversation. I will give an hour presentation and immediately after Q&A I will have students - boys and girls, and I'm starting to see as many young men as girls - come to me and they'll tell me about their experience with mental illness, substance abuse disorder, being survivors of suicide attempt, they'll tell me what medications they're on, they'll tell me that they're in therapy. But what scares me the most is they tell me that their parents are not comfortable having the conversation and in many cases, not receptive to them receiving treatment. I've had young people tell me, yes, I'm diagnosed, but my parents won't allow me to get treatment, because they don't want the neighbors, the co-workers, the people we sit next to a church, to know. So we're denying these young people the help that they need. And coming out of this pandemic, COVID has had a tremendous impact on our behavior health.
Richard Helppie Â
I know that there's been much written but very little detail about the mental health impacts of the COVID shutdowns. Also we don't talk about the social indicators of health status; housing stability, food security, and the like. How do all these factors come together?
Kevin Fischer Â
I'm going to answer the last part first, because it's really important that we address that. If people don't have the social supports that they need; if I'm homeless, if I'm cold, if I'm hungry, if I'm worried about taking care of my children, if I don't have a place to sleep at night, you can't expect me to come to therapy, you can't expect me to keep that appointment. We have to make sure people have all of those social supports that they need to take care of themselves. In many cases, when we talk about suicidal ideation, those are the triggers. As I mentioned before, when I lost Dominique, I did what I thought society expected me to do; I grieved internally, I put on a brave front for my wife and my children. That is a huge mistake. Very similar to if an individual or loved one has mental illness, we need to make sure that their basic needs are met before we can expect them to engage in an effective treatment plan. They're just not able to do it. I mentioned before, COVID had a tremendous impact on our behavior health. I believe if I were able to sit down with Dr. Fauci - I believe I've actually heard him say this in interviews before - using the term "social distancing" was a mistake. We have to be really careful about the language that we use. That social isolation had a huge impact on our mental health. 55% of children and 45% of adults that we've interviewed in the last three years said that the COVID pandemic had a tremendous impact on their well-being. They're engaging in more illicit alcohol and drug use, [have] more depression, more anxiety. All of those things have been triggered by the COVID pandemic because COVID was traumatic and trauma can trigger mental illness. So there are huge ramifications. Then we also have to understand that...we always say mental illness doesn't discriminate, doesn't care if you're black, white, rich, poor, Republican, Democrat, urban, suburban, rural. It doesn't discriminate. Neither does stigma but stigma does vary by community and culture. The stigma of mental illness in the African American community is much different than it is in the Caucasian community, is different than it is in the Muslim community, is different in the Latino community. It even varies between men and women, people who are religious and not. There are huge variations. We can't take for granted the phrase "meeting people where they are," we have to be intentional about that. My conversation with students is very different than my conversation with adults, is different than my conversation with seniors, is different when I'm engaging with law enforcement, military veterans. I have to tailor my conversation to meet their needs and not be so general.
Richard Helppie Â
You mentioned law enforcement. My understanding is you're doing some work with officers about de-escalation. That officer arrives at the scene and doesn't know if they're going to be a counselor, a warrior or something else. How do you prepare that law enforcement person for the interaction? What kinds of things are you doing?
Kevin Fischer Â
I happen to have the privilege of serving as the president of CIT International, which is Crisis Intervention Team training. CIT International was actually started by NAMI in the late 80s - 1988 - as a result of a situation in Memphis, Tennessee, where an unarmed man who was experiencing a behavioral health crisis was shot and killed by law enforcement. The local NAMI affiliate went to the police chief and the mayor and said, look, you can't execute people because they're mentally ill, you have to learn and understand how to relate to us. Because they don't get that training in the academy, they just don't, they don't have the lived experience. So what we do at CIT International, it's a 40 hour training. It's five days, eight hours a day, where not only we have classroom work where we help them identify people who are experiencing behavioral health crisis, versus - I guess what you might call - the common criminal who's being defiant. We teach them about medication, we teach them about what resources are available in the community so we're not taking them to jail and we're not harming them but they're getting help. Most importantly, we teach them how to verbally de-escalate, we teach them that time is on your side. This is not like a drive thru; very often law enforcement officers are trying to quickly resolve one situation so they can go to another. When a person is in a mental health crisis you can't put them on the clock because to be able to verbally de-escalate you have to slow everything down. You have to talk to me at my level; I learned this very much from my son Dominique, I learned that my expectation of him as a 23 year old man - that he would know to get up in the morning to take a shower, brush teeth, make the bed - all of that changed for him. Well, very similar to law enforcement, very often law enforcement may go - as they call it - hands-on because they may interact with a person like my son. Officers give commands, they say stop, talk to me, put your hands up, that kind of thing. Well, the person who's in a mental health crisis is not able to respond to those commands. So the untrained officer may think you're resisting or being defiant. No, I'm schizophrenic, I'm not able, I've got voices in my head that that are competing with the commands. So we train officers to do that. But equally as important, we train officers on officer wellness and self-care because we have to remember that law enforcement officers are people first. They're coming home where they may have children that are experiencing behavioral health issues of their own, or they're struggling in school, they may have marital problems, they may have money problems, they may have problems on the job, and we expect them to come out on the street and treat us as competently as they can. Well, they've got all that other stuff going on too. There's a stigma among law enforcement officers; many officers are afraid to disclose that either they're challenged with the behavioral health care issue or family member because they don't want to be taken off the service, they don't want to be thought less of by their partners, they want to be trusted. So we have to break down that stigma as well.
Richard Helppie Â
I'm really being enlightened here about that central stigma; folks understanding what they're dealing with and how to do it. Are there particular policies or institutions that are responding well in your work with NAMI? Are you finding things still kind of back in that old stigmatized way or are more people becoming enlightened?
Kevin Fischer Â
More people are becoming enlightened but it's not happening fast enough, quite frankly. First of all, we need to normalize the conversation about mental health in our homes. Then when we think about professions, whether it's law enforcement, first responders, dentists, any profession, we need to have that conversation. Most people don't realize that in the United States, corporate America loses almost $200 billion in earnings annually - $200 billion annually - directly attributed to mental illness. Corporations need to understand the impact that is having on their bottom line, if for no other reason. I was having a conversation just a couple of days ago where a young lady who works for large corporation said, my company employee assistance program - EAP program - they talk to us about money management, they have resources for us if we have a substance use problem, marital problem, but they never talk about mental health. Mental health is hitting us for $200 billion a year.
Richard Helppie Â
When you think about some of the societal factors...we've had a couple of men on the show - Adam Coleman and Zoe Kennedy - and one of the things that they talked about is the presence of fathers in the home. I hear loud and clear from you that you were good dad, strong man, and you still dealt with a son with a tragic mental illness. Is there a linkage between the fathers in the home and mental stability or better behavior, particularly with young men?
Kevin Fischer Â
Yes, yes and yes, there is serious linkage between the absence of a father in the home and mental illness, because again, remember, we're talking at the very least about trauma. If you're in an unstable home environment there is something called ACEs - Adverse Childhood Experiences. Adverse Childhood Experiences is a quiz that basically highlights indicators of trauma that can lead to mental illness and it has a lifelong effect if it's not dealt with. An absent father is one of those traumas; again, homelessness, if there's violence in the home, if there's sexual or emotional abuse, those are traumas. We think about PTSD in terms of active military and veterans but we've all experienced PTSD and that is ACEs. What's interesting about Adverse Childhood Experiences is that studies show us if we don't get treatment, if we don't address that trauma from childhood, the lifelong effect is not just mental illness, it's not just a negative impact on relationships but it rears its head in heart disease, stroke, diabetes, cancer. So it has a tremendous physical effect on us. My parents, my grandmother used to always say, either you deal with your issues or your issues will deal with you. That trauma going unaddressed and untreated will have, can have, very serious physical consequences.
Richard Helppie Â
When you're driving to work and you're musing about the state of the world - I know you're a deep thinker - what kind of society would we have if there was adequate mental health services and treatment for mental illness and de-stigmatization? What would our society and our world look like?
Kevin Fischer Â
One, I think we'd have a much safer society - and I want to be careful so I'm going to explain that comment - and I think we'd have a happier society. Unfortunately, the United States has experienced more mass shootings in recent years than we'd like to talk about. Unfortunately, whenever there's a mass shooting, it is very common to connect that with mental illness. People will say, well, to carry out such a horrific crime you must have been mentally ill. The fact is - and this is not my opinion, the fact is - people with a diagnosed mental illness are responsible for less than 4% of all violence in this country, less than 4%. Most people with mental illness - and again, I'll use my experience with my son - most just want to be left alone. They want to be, they need to be heard but they want to be left alone. Now, I would not be a good advocate if I didn't admit this as well, I'm very protective of people with mental illness but untreated mental illness can be dangerous. That's where it's really important that we have adequate resources available and that we encourage people to get the help that they need before they become a danger to themselves or others. After is too late. Worldwide we are too reactive to mental illness and again, I attribute that mostly to stigma. We hope that people who live with mental illness, it'll just go away - it won't be so bad today, he'll be better tomorrow - we can't [do that]. Mental illness is a medical diagnosis so like any other medical diagnosis, the longer you ignore it, probably the worse it's going to get. The earlier we intervene, the better the outcomes. So we need to encourage people to get help when they need it and we need to make sure that help is available when they are ready. Because, again, drawing on my experience with Dominique, I used to tell him, I would do this for you, I prayed to do this for you, I pray to God let us switch positions. But it doesn't work that way, he had to get help when he was ready, I couldn't force him to get help. So when a person is ready, we need to have adequate resources available to them. But beyond that, people who live with serious mental illness sometimes commit petty crimes. If we go back to the late 90s when there was an explosion across the country - people like to pick on in Michigan and say the late 90s is when Governor Engler closed the state hospitals, that's true but that didn't just...and I'm not defending the governor at all - but that happened across the country. What happened was we closed a lot of those mental health facilities, we sent people home or to communities that were ill-prepared to manage them. So we ended up with an explosion of homelessness because either - and again, using my experience - Dominique becomes frustrated with me because he doesn't understand why dad, who loves him, is yelling at him - make your bed, take a shower, do this, take your medication - so he decides I'd rather live on the street than be yelled at every day, or me as a parent or caregiver may come to the conclusion, well, you're just not listening to me, so get out of my house. But either way, we had that explosion of homelessness. Now people [who are] out in the street in the cold and are hungry, what are they going to do? If they need to they're going to steal food, they're going to steal clothes, they're going to do the things to keep them warm...
Richard Helppie Â
They are going to self-treat with whatever narcotics, alcohol they can get on the street. We had on Dr. Victor Hong from the University of Michigan Health System, who is a psychiatrist in emergency medicine and he spoke about the closing of the mental hospitals without having the community-based services. We've had on Judge Milton Mack twice and he talked about the jails being the largest mental health facilities and then chapter and verse about how inadequate those are. Kevin, you're very steeped in this from a deeply personal place and from a professional place, and I can hear your business background coming in and you can solve this problem. If you had a call today from the president of the United States and you were invited to go to Washington and maybe sit with a couple of cabinet secretaries, what would you tell them?
Kevin Fischer Â
My first ask would be let's do everything in our power to de-stigmatize mental illness. That has to be where we start. And if that's marketing campaigns, whatever that needs to be, we have to de-stigmatize mental illness. Then we need to make sure we have the resources available. I give the current president credit because he has invested more in the behavioral health care system, I think, than has ever been invested in this thing. I could say the same thing here in the state of Michigan, that the Whitmer administration has invested more money to behavioral health care than we've ever seen. But it's not enough. It's not enough. We need to educate more behavioral health care professionals. We are eight to ten years behind developing what I call a batch of behavioral healthcare professionals that can meet the need. And the need is unfortunately only getting worse. In 2022 we experienced the highest rate of suicide or loss by suicide in our country's history - 49,499 people died by suicide last year. Unfortunately, the experts are predicting that it'll be even higher for '23. We have to change that and the way we change that is first by normalizing the conversation. In the end, it has to be simultaneous; we have to invest in resources again so when people are ready for help, there are good places for them to go and receive help. But we're making some progress. I am cautiously optimistic. We have something - and I don't know if Judge Milton Mack or Dr. Hong talked about it - Senator Stabenow in partnership with Senator...I knew I was going to forget his name since I got ready to say it...out of Missouri, created something called Certified Community Behavioral Health Centers, which is game changing, in my mind. But they created - we call them CCBHC - Certified Community Behavioral Health Clinics - and it is game changing from the perspective that high quality behavioral health care is now available to anyone. Anyone can go to a Certified Community Behavioral Health center, regardless of the severity of their diagnosis, regardless of their insurance status, and regardless of their ability to pay. So where many people won't seek behavioral health care treatment because of stigma, lack of knowledge of what resources are available, and they're concerned about affordability, this legislation takes it off the table. There are over 500 CCBHCs across the country and growing, and we need more of them. It's high quality behavioral health care. It's not back door back alley, these are some of the best providers in our communities. But it's the best kept secret in the country; Certified Community Behavioral Health centers have been around for seven years now and even mental health professionals are unaware of it.
Richard Helppie Â
Well, it seems to me very cost effective because the cost of one police run...there was a situation in Wixom last night with a barricaded gunman so lots of law enforcement resources out there for hours on end...any time we can prevent a public event like that, will prevent a personal tragedy is, I think, cost effective. Helping people cope because times have been stressful since COVID. The country is very divided, there's more stress there. People are wondering if they can trust our institutions, can they trust the people that we elect, can they rely on the value of the dollar. I mean, there are fundamental things that I would imagine really stress vulnerable people to the point they have an event. Kevin, this has been a really thoughtful conversation today and I really appreciate that you're here. What didn't we talk about today that you'd like the listeners and the readers and the viewers of The Common Bridge to hear?
Kevin Fischer Â
So two things. First, make mental health a dinner table, breakfast table conversation in your family. This is something that we need to talk about. Again, if we normalize the conversation we can de-stigmatize mental illness. The second is, if you or a loved one lives with mental illness, please don't wait until a person is a danger to themselves or others before you get them help. We want to prevent crisis and the way we prevent crisis is to intervene early. I know that's not easy. Sometimes - again, speaking from personal experience - there were times that I would have to take my son to a crisis center proactively, because I feared that it may become a physical confrontation or maybe I would need to call the police and I don't want the police involved. Anytime you can resolve a situation proactively, the better; and to your point, it saves money. It costs us ten times more to house an individual in jail than it does to provide them with effective behavioral health care from the community mental health system. So it saves money and improves the quality of life and it saves lives.
Richard Helppie Â
Very important things to think about. Any closing thoughts for our audience that you'd like to wrap up with?
Kevin Fischer Â
Self-care is not selfish. As we enter the holiday season a lot of people like myself struggle. Dominique's birthday is New Year's Day so the holidays are always a really tough time for me. Protect your mental health and don't be apologetic about that. If you're not comfortable going to the company office party, Christmas party, family gatherings, if you know those are not good spaces for you and a good time for you to be there, don't go. If you or someone you know...me, for example, you know that this is a tough season for me, acknowledge that and allow me the space and grace to say I understand why you don't want to come to the company party, maybe I can take you for coffee. A lot of people are uncomfortable because they don't know how to talk to me about my son. As a matter of fact, there are some people who won't mention his name and they do it - not for malicious reasons - they do it because they think they're being protective. But I miss him and I enjoy hearing his name and I actually appreciate even when somebody says, Kevin, I know it's a tough time for you, I don't know what to do, how can I help? It means the world to us.
Richard Helppie Â
We've been talking today with Kevin Fischer, the Executive Director of the Michigan chapter of the National Alliance for Mental Illness, a deeply personal conversation about his dearly departed son, Dominique, who was stigmatized and victimized by mental illness. We can do better as a human race, we can do better as a country. I hope that everybody that is listening, reading or viewing this will understand that this is not a Republican issue, a Democrat issue, a Right or a Left issue; we need to come together on the common bridge and solve these problems. Our human heart needs that to happen. Our families need that to happen. With our guest, Kevin Fischer, this is your host, Rich Helppie, signing off on The Common Bridge.
From Personal Tragedy to Advocacy: A Father's Quest for Mental Health Reform and Understanding.