For almost 40 years, National Alliance on Mental Illness Metropolitan Baltimore (NAMI Metro) has been dedicated to advocacy, education, support and eradicating stigma so that all individuals and families affected by mental illness can build better lives.

Never before has our work been more relevant. The coronavirus pandemic wrought unemployment, isolation and disruption. It increased conditions such as anxiety and depression. The need for effective resources for those living with these conditions has never been greater and with that need comes an incredible opportunity.

Until recently, those living with mental health conditions often struggled in private. Today we have a greater awareness that our mental health is nothing to hide. Now is the time to make the most of this groundswell of compassionate understanding. Let’s break down stigma. Let’s talk about our mental health. We have the tools to provide those in need with the resources required to live fulfilled, productive lives.

A hallmark of NAMI Metro is our peer-led support network. Our volunteers bravely share their stories to help others. As the area leader for mental health awareness and education we’ve provided 9,000 touch points of service to people in the Baltimore Metropolitan area in the last year alone. While we work with individuals and their families, our mission includes outreach and training with some of the most influential people in businesses, colleges and universities, and emergency services.

Whether our work brings us to a classroom or a corporate boardroom, NAMI Metro and our many community partners are committed to removing the stigma of mental illness. We are proud to share in these pages just a few stories of how our work is building healthy lives for those living with a mental health condition and our community as a whole.

Let’s raise our voices,

Kerry Graves
Executive Director, NAMI Metropolitan Baltimore

I WILL LISTEN

David K. Wilson

PRESIDENT OF MORGAN STATE UNIVERSITY

➜ College is a time of critical development for young adults. It’s a time of important milestones that can also be deeply stressful. Studies show anxiety and depression are on the rise among college students and suicide remains the leading cause of death on campuses. Seventy-five percent of mental health conditions develop by age 24.

Understanding the importance of student mental health, Morgan State University allied with NAMI Metro four years ago to create campus-wide programs to destigmatize mental illness and promote wellness. As part of that commitment, Morgan participates in NAMI Metro’s “I Will Listen” program, a weeklong campaign to engage college students in conversation about mental health.The 2021 initiative included a chapel service, an open mic night, and a final “day without headphones” where everyone on campus was encouraged to wear “I Will Listen” t-shirts.

“We’re making a statement to our students that we’re here to listen and share your concerns,” says Danny Molock, PhD, interim coordinator for student life and development.

The pandemic makes this work more relevant than ever, explains David K. Wilson, president of Morgan State University.

“Covid has exacerbated the normal mental and psychological challenges that we see on our campus, as it has on college campuses across the nation,” he says. “But it is further exacerbated here at Morgan because so many of our students come from communities that have been disproportionately impacted by Covid.”

Wilson created a mental health task force to engage every aspect of the university in support of mental health. The university is proactive in its programs, bringing therapeutic pets to campus at exam time, sponsoring outdoor “Yoga on the Yard,” to promote relaxation, physical wellness and a sense of community, and offering depression screening.

Importantly, Wilson led by example, asking the counseling center to give a presentation on self-care and stress management to the university’s leadership team during the worst of the pandemic shutdown.

“It’s important for us in leadership to model this and we realize that we, too, need self-care,” says Wilson.

Morgan’s “I Will Listen” week attracted record attendance in 2021. Molock says they’re expanding into more collaborations with NAMI Metro, including a walk for mental health in the spring.

“This generation of students is more willing to share and more willing to listen,” he continues. “They want to be advocates in support of one another.”

Michael Harrison | Derek Loeffler | Joann Wallace

BALTIMORE CITY POLICE DEPARTMENT

➜ Officers of the Baltimore City Police Department (BPD) interact with people experiencing mental health crises every day. From those who experience homelessness and substance use disorders to typical 911 calls, an officer may never know when a situation might be exacerbated by mental illness.

Through training organized by Behavioral Health System Baltimore and community partners, the BPD is training cadets and seasoned officers on how to better identify individuals in crisis so interactions can end in compassion, not handcuffs.

“Crisis intervention trains officers to deal with a person in crisis in a very different way that now uses de-escalation techniques, time, spatial distance and the tools available to them other than force to get people the care they need, rather than taking them into physical custody and making arrests,” said Baltimore Police Commissioner Michael Harrison.

NAMI Metro facilitates multiple training sessions as part of the mandatory three-day behavioral health training given to all cadets and helped create new curriculum and experiential learning for the specialized Crisis Intervention Training (CIT) provided to officers on a voluntary basis. NAMI Metro expanded its training to 911 operators in 2021 and has trained nearly 2,000 emergency service personnel since 2016. The program includes partnerships between police officers, social workers and community services.

“An officer might be driving down the street and witness someone in crisis, or they may get a call to a home where there’s a potential family disturbance where the family is having trouble with a loved one,” explains Major Derek Loeffler. “The more training we can give [officers] to understand and respond to those situations, the better equipped they are to serve the residents of Baltimore.”

Not only does CIT provide vital information and tools to officers, Captain Joann Wallace explains that officers enjoy the coursework, especially the role-play that concludes the 40-hour training. Officers like Wallace act out scenarios so trainees can test their skills in a controlled environment before taking it to the street. “It’s a lot of fun and interesting and we’re able to give real-time feedback and the officers can ask questions so that when they take this training out on the street it’s become real for them,” she states.

Much of the training gets to the heart of strong community policing, where communication and relationships play an important role in public safety.

“Understanding crisis and responding to it appropriately without force reduces injury to both community and officers,” says Commissioner Harrison. “It also reduces emotional harm and litigation, which in turn builds trust.”

The greatest take away for officers is that regardless of the situation, don’t rush to a judgement or action.

BREAKING the silence

Patrick Sutton

INTERIOR DESIGNER

➜ It’s impossible to miss the artistry of interior designer Patrick Sutton, whose work graces public spaces, restaurants and private homes in Baltimore and around the globe. He recently released his first book, Storied Interiors, about the stories our spaces tell about our lives and our dreams.

Sutton has his own story to tell, one that influenced the person and designer he is now. In her early 20s, Sutton’s mother began acting erratically. This was the early 1970s, a time when mental illness was simply not discussed. His mother was eventually diagnosed with schizophrenia and her condition became a family secret.

“As a little boy, you don’t know what’s going on you just know something is wrong. It was awful for a child such as myself because there was no support network,” says Sutton. “My mom’s illness was swept under the rug when what she needed was care. It was like living with a ticking time bomb.”

It wasn’t until later in life that Sutton understood the family secret was nothing to be ashamed of. In fact, it defined him as an individual. Lacking an adult role model for “normal” life given his mother’s condition and his father’s absence due to his career as a travel journalist, Sutton grew up being a student of other people, an observer. That skill, and his desire to create beautiful healing environments, informs his work today as a preeminent designer.

“Since I couldn’t heal my mother I’m constantly trying to create environments where I can heal others through design,” says Sutton.

When Sutton took his story public he shared his experience in a speech at a Design Leadership Network conference, an international gathering of designers. At that event he offered a candid view of how his mother’s illness shaped his life and design. “Over the next two days people came up to me individually —not just one or two people, but like 25—and shared their stories from their lives,” he recalls. “Sharing what happened to me gave them license to share what happened to them. That’s what awareness does. It gives people the freedom to know they are not alone.”

When Sutton shared his story publicly, an alliance with NAMI Metro came naturally. He explains that NAMI Metro’s mission to remove the stigma from mental illness is dear to him. His hope is that through his outreach others will learn that not only is mental illness nothing to be ashamed of, sharing one’s experience candidly can be empowering.

“It’s okay to seek help, it’s okay to seek therapy, which is a powerful tool,” Sutton concludes. “What NAMI is doing is shining a light on this, making people realize this isn’t something to be hidden, it is a part of life.”

TOGETHER we support each other

Tchernavia Rocker

Chief People and Administrative Officer Under Armour

➜ As Chief People and Administrative Officer at Under Armour (UA), Tchernavia Rocker ensures that everyone from retail salespeople to executive leaders have a healthy, positive work life. To support that, UA has all the programmatic pieces in place—an employee assistance program, global mindfulness sessions, and No Meeting Friday afternoons in corporate offices, for example. While tools and programs are necessary, Rocker says creating an environment where conversations about mental health are supported has been an important shift.

“We’re creating an environment where it’s okay to engage and we talk openly about taking away stigma,” she says.

UA’s commitment to mental health is closely tied to its Teammate Resource Groups, small groups created within UA’s larger Diversity Equity and Inclusion strategy. These include Black and Latina employees and parents. UA partnered with NAMI Metro in 2019 to learn how to better support employees. Rocker can still recall the first listening session.

“It was the first safe space conversation we had,” she recalls. “We brought teammates together who, maybe for the first time, were talking about mental health. It was one of the most impactful moments of my professional career because I understood, deeply, what it meant for teammates to have a space where they didn’t need to hide anymore about the challenges they might be having…NAMI helped us facilitate those conversations, creating the runway for us to talk about how we can support psychological safety in the workplace.”

Rocker explains that storytelling and the willingness of leadership to guide from a place of their own vulnerability is critical. Rocker experienced this intimately when her husband died unexpectedly in 2021, understandably sending her life into a tailspin. When she told her boss, rather than just ask what she needed, he reached out to UA’s mental health providers to educate himself on how he could best support her.

“A month later when I returned to work he and I told that story to the workforce, of how I could go to my boss and tell him I was struggling,” she recalls. “By telling our story collectively, it opened up the door for other leaders to tell their stories and it was like freedom just ran through the door after that. It just takes one moment of vulnerability by leaders to create a safe space.”

UA advocates storytelling across its entire brand, supporting not only its employees but also its athletes, from the professional to those in youth sports, to be open about their experiences. The partnership with NAMI Metro helps the organization bring evidence-based expertise to help UA navigate this landscape in a meaningful way.

“Mental health is a broad spectrum including acute traumas and diagnoses that require a level of care,” says Rocker. “It comes down to storytelling and making sure that when people tell their story they feel supported and have the resources available to move forward. The focus has to be on creating the space and place to have these conversations.”

[Editor’s Note: This story was published in our May 2021 issue as part of our annual “Excellence in Nursing” package. See the full list of winners online on May 17, or pick up a copy of our May issue at your local newsstand.]

 

The face still haunts her. It was a busy day in the intensive care unit at Ascension Saint Agnes Medical Center, a community hospital in southwest Baltimore, and Muna Jeter stepped in to help her understaffed team of nurses transport a coronavirus sufferer. The patient looked scared and alone.

“I couldn’t get the patient’s face out of my head for days,” recalls Jeter, who generally oversees a team of 400 nurses as director of critical care and respiratory therapy at Saint Agnes. “I can’t imagine how they do this day in and day out.”

And then there are the faces of her co-workers: More than a year into the pandemic, Jeter can see the toll the experience has taken on her colleagues when they report for their shifts.

“I almost feel they’re like veterans,” Jeter says of the nurses on her team. “Some mornings when I look at their faces, it’s like they could be going to war.”

By early March of this year, COVID-19 patient volumes at Saint Agnes were at 87 percent of capacity—near their lowest since the disease first appeared, although by later in that month it was back to 96 percent, according to a New York Times study.

“Now is when they’re finally processing and responding to the trauma of not seeing patients get better—seeing patients dying—for so long,” Jeter says. “Just last week, a nurse said to me, ‘I spent all of Sunday crying because I knew that when I came in on Monday, I would have to take care of patients again. And I don’t know how much longer I can do it.’ And this is the most positive nurse in the world. She came in that Monday to another shift. And she immediately started to cry in the middle of the unit.”

Over time, the challenges faced by nurses on the frontline of COVID-19 care shifted. Worries over insufficient personal protective equipment and fears of contracting the virus or spreading it to family still lingered, but as PPE became more readily available—and safety protocols more sophisticated—those fears were eclipsed by the long-term fatigue of working short-staffed shifts with surging numbers of critically ill patients.

Add to that the heavy emotional toll of witnessing suffering and death on a scale that is unprecedented for even the most experienced nurse, and it’s a nearly unbearable burden.

“And it was just so much—I think suffering is the word, it’s not so much the deaths, it’s the prolonged ventilator, it’s seeing the 39-year-old person that can’t come off the ventilator with little children at home,” Jeter says. “The trauma is multidimensional.”

 

WORRIES OVER INSUFFICIENT PERSONAL PROTECTIVE EQUIPMENT AND FEARS OF CONTRACTING THE VIRUS OR SPREADING IT TO FAMILY STILL LINGER.

 

An April 2020 survey of health care workers in the U.S. found that nearly half of them reported serious psychiatric symptoms during the COVID-19 pandemic, including thoughts of suicide, with 14 percent screening positive for post-traumatic stress disorder.

The International Council of Nurses, a Switzerland-based federation of more than 130 nursing associations from across the globe, found that nurses working on the COVID-19 frontlines were experiencing unprecedented levels of stress and were at “high risk for full-blown stress response syndromes, anxiety, depression, post-traumatic stress disorder, chronic illness, and burnout.”

The pandemic has compounded challenges in an industry that was already stretched too thin. Not only are hospitals overwhelmed with sick patients, but there is a shortage of nurses available to take care of them, leading to longer shifts and higher patient-to-nurse ratios.

By 2022, the nation will need an additional 1.1 million new nurses, according to the U.S. Bureau of Labor Statistics. However, the gap between available jobs and people graduating from nursing school continues to expand.

“Many of these issues have been challenges for nurses for a long time,” says Alison Trinkoff, a registered nurse and professor in the University of Maryland School of Nursing’s (UMSON) family and community health department who studies nurse wellness. “Nurses were already tired and having issues with schedules. Anytime you have a 24/7 type of job, those kinds of issues can come up.”

The pandemic, however, has exacerbated those problems. For one, there’s just more work and fewer people to do it. An increase of nurses hitting retirement age or taking early retirement has added to staffing issues, while the need for nurses who have been exposed to COVID-19 to isolate or quarantine makes staffing less predictable.

“Nurses who are working through the pandemic have a lot of additional responsibilities,” Trinkoff says. “And as you can imagine, such a physically exhausting and emotionally exhausting combination is challenging.”

Trinkoff began her research into nurse work-life and wellness in the 1990s with the first nationwide survey of substance use among nurses. Today, she leads a team at UMSON as they survey 4,000 registered nurses across 10 states to determine physical and psychological job demands, work schedules, healthy lifestyle behaviors, and the availability of wellness offerings through the workplace.

The survey aims to measure the pandemic’s impact in several areas—passion for nursing, ability to relax, and more—by asking if they have increased, decreased, or stayed the same during COVID-19.

Perhaps the most difficult part of the pandemic is its prolonged nature and uncertain end date, Trinkoff adds.

“Having a lot of exposure to so many people dying in such a short time is wearing on anyone’s endurance,” she says. “That sort of ‘grit our teeth and dig down’ becomes difficult if the situation continues for an extended period of time. The longer it goes on, it’s really wearing on people.”

The specific long-term effects nurses will experience from working on the frontlines of the pandemic remain to be seen, but the fallout from previous outbreaks can serve as a guide.

A recent review of psychological impacts of pandemics and endemics—including SARS, MERS, COVID-19, Ebola, and influenza A—found that depressive symptoms were reported in more than a quarter of health care workers, with insomnia in more than 34 percent and severe anxiety in 45 percent. Of those who reported post-traumatic stress symptoms, 10-40 percent reported the symptoms persisting one to three years after the outbreak ended.

 

PERHAPS THE MOST DIFFICULT PART OF THE PANDEMIC IS ITS PROLONGED NATURE AND UNCERTAIN END DATE.

 

“The majority of us who come through this pandemic are going to bounce back from this very negative experience. But there is a significant minority who will continue to have long-term struggles with anxiety, stress, PTSD,” says Dr. Aliya Jones, deputy secretary of behavioral health at the Maryland Department of Health.

“Some of them will use substances to cope, including those in the health care industry. Some will incur long-term problems with substance abuse or symptoms of suicidal thoughts. Some are going to act on those thoughts. We think that the long-term outcome for any of these behavioral health conditions warrants being as proactive as we can to help those who are helping us.”

That’s why, in January, the Maryland Department of Health launched Operation Courage, a support services program designed to address the growing and long-term mental health care needs of frontline workers and first responders amid the COVID-19 pandemic, offering assessment and therapy as needed.

“Health care workers are wonderful at taking care of other people, but they’re not always so great at taking care of themselves,” Jones says. “There’s a stigma around mental health—period—and certainly more so as a health care worker.”

“We need leadership to create environments that sup- port people reaching out for assistance, not stigmatizing someone’s proactive and brave decision to reach out for the help they need,” Jones says. “Awareness is not the problem. Stigma continues to be the problem. The stigma against mental health issues runs very deep, and it’s going to take a long time of proactive support in order for us to really embrace the reality that mental health issues are common, no one is immune, and that treatment works. We will continue to fight that fight.”

At Saint Agnes, leadership offers a variety of wellness and self-care resources designed to help nurses heal from the trauma of the past year, from meditation and yoga to virtual brunch with the hospital’s chaplain and inviting a psychologist to come in and sit in the break room.

“As a leader, I’m concerned about what the workforce will look like after this,” Jeter says. “I don’t know how nursing is going to recover. It’s not just the trauma of the pandemic, it was the sustained level at which we were expecting them to perform.”

As a faith-based hospital, the Saint Agnes staff takes comfort in pastoral services with each other and with patients and their families.

“It’s good being in a faith-based hospital, because we do a lot of prayer and moments of silence before every meeting, even on the unit floor at huddles,” Jeter says.

In the end, she says it’s nurses’ support for their colleagues that keeps them going and motivates them to continue to get up and come to work each morning or to pick up extra shifts when the team is short-staffed. “They come in for each other.”

Like so many hospitals across the nation during the COVID-19 outbreak, colorful letters stuck in the grass outside Saint Agnes spell out “Heroes Work Here.”

“It’s wonderful to think of nurses as heroes, and, in many ways, I love seeing the recognition not just as people, but of the essential role they play in the health care system,” says Alison Trinkoff. “But you have to recognize even heroes are human. And we certainly want to make sure that their human needs are taken care of, because if there’s one thing we’ve learned, it’s how precious nurses are in this pandemic. So whatever we can do to help them be their best selves and practice as effectively as they can, it benefits all of us.”