For the past 18 years I have been working in Camden, New Jersey, a city that has been called America's poorest and most violent city of its size. During that time, I helped to found Hopeworks, an organization that works with youth ages 14-23 year old, focusing on getting them back into school. Working with these youth, many of whom have dropped out of school and are encountering difficulty transitioning to productive jobs with a living wage, I have encountered many "mental health issues.”
I don't like the term "mental health." It puts the cause of problems entirely on the backs of the youth and ignores the role of the toxic stress-filled environment they live in. In fact, the phrase comes from the early 20th century term "mental hygiene," with associations of a lack of cleanliness. Such terminology leads to shame and blame--that "what has happened to me" really isn't as important as "why don't I simply modify my Ünclean" behavior instead of acknowledging the powerful impact that toxic-stress play in the role of brain health.
I found the Helping Families in Mental Health Crisis Act (H.R. 2646), introduced by Representative Tim Murphy(R-PA), of Pennsylvania, to be problematic because it misses the importance of context and brain health in the lives of the youth I work with. At a time when so much pain is happening in our c
ountry around racism, wealth inequality, abuse and neglect, here in Camden we created a community of healing and hope. Hopeworks is not rooted in shame and blame. We have a saying at Hopeworks - "Hope Is Sweaty" - and for all these years, we did just that. Hope is not some pill you take, or a whimsical ideal. It is a choice to be present, even when the future seems muddled and unsure. Hope is a daily decision to draw near to others, who are often in extreme pain, and to be willing to share that space with them. Sharing the space is the beginning of hope. My profound concern is that the bill clearly misses the importance of context and brain health in outcomes for our youth.
Innovation is what has set Hopeworks apart from many other "programs." From our inception, we have seen ourselves not as a program to find work for youth, but as a youth development program that is working for the future of our youth. A key discovery we have made in our work is about toxic stress and the traumatic impact it has on the human brain. About five years ago, we shifted our program to focus on "brain health" as it is clear that the exposure to toxic-stress has a dramatic impact the health of our youth's brains. Neuroscience studies make it increasingly clear that such exposure leads to poor health outcomes. Using the Adverse Childhood Experiences (ACEs) study we have adapted our program to helping youth understand "what happened to them." This shift from "why"to "what happened" has had a profound impact.
Toxic-stress is much like radiation: You don't see it, but the impact is evident. In a city like Camden, toxic stress makes our city a hot zone. People are impacted daily by trauma, which affects them physiologically. We can now measure this impact on health better than ever using tools such as the ACES questionnaire. We strive to be a healing organization, one that responds to the injury and understands trauma so that the people in the organization can be trauma-responsive in their work. Concretely, this means shifting the framework from "punitive/behavior coercing" methods to a framework that asks "How is a behavior helpful for a person?" If we realize that we are dealing with individuals who are adapting and adroitly surviving a great deal of "radiation poisoning," we will recognize that efforts to simply motivate them or to provide resources without addressing the impact of trauma will fail.
This responsive framework also means that the organization itself must grapple with how it is impacted by the toxicity of the abuse, neglect, violence and poverty around it. Organizations are collections of brains, working in a context. If that context is toxic, the unprepared organization will be affected. A number of years ago, this is exactly what happened at Hopeworks. We came to a place where we basically stopped liking our youth. We increasingly saw their behaviors--being late, their aggressiveness and inconsistency - as "bad behavior" (unclean)--and that we needed to fix. Our organization, our system, had become overwhelmed and reacted with predictable survival behavior. We call this reaction vicarious trauma--it is when an organization itself becomes “irradiated” with toxic stress.
We now understand that the behavior of our youth "makes sense" to them and their own perceived lack of safety, and we now understand the importance of realizing how that behavior works for our youth. In fact, their behavior is a way for a Hopeworks youth to survive. Of course, we want them to thrive, not just survive. In order to move from surviving to thriving, we have had to work with our own and their brain health. The good news is that our brains are resilient; its neural plasticity is well documented. When we focus on the how the brain works, our responses to stress and the health of this important organ, healing can happen. It is a true healing, not simply a behavior change but a resilience that gives rise to amazing things.
Many programs seek out the youth who can make the program work. At Hopeworks, we have adapted our program to meet our youth where they are and to help them first heal, so that they can take advantage of opportunity and move towards a future of thriving. We have done that because we have taken serious the impact of toxic-stress on our brain health. What happens to us matters. We need a new approach to mental health policy. Instead of treating symptoms – as the Murphy bill does - we need a comprehensive approach to brain health that acknowledges and addresses the toxic environments in which so many of our children and families live.
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