Changing the Conversation

Human connection is an integral part of social and emotional health and well-being. Think about the many connections, friendships, and relationships that shape your daily life. When you are in need of support, these relationships are key to providing guidance, happiness, and stability.

Social supports act as a crucial determinant for shaping health outcomes. Research suggests relationships are a significant factor in determining substance use and recovery outcomes. Studies of adolescents suggest that family support and involvement acts as a protective factor against substance use. A study of women experiencing homeless found that those who had less social support were more likely to engage in illicit substance use. A common affirmation in the recovery community— people, places, things—points to how important people can be in impacting one’s journey to recovery. Social networks, including family, friends, community and kinship ties, can act as risk or protective factors in determining an individuals’ path toward recovery.

Recovery outcomes are valued goals of services throughout the nation. Relationships that empower and encourage choice and self-direction are hallmarks of all activities that support recovery. 

It is a beautiful Sunday morning. A friendly visitor is coming to my house today. She is a young person studying at a university in Boston. I am looking forward to our meeting. She is just starting out in life. I am in the older stages of life. When we are having coffee, I realize we are speaking the same language. The generation gap is not evident in our communications. She reminds me to be energetic and hopeful. She makes me laugh. She is a bright spot in my day. I trail off in my thinking…I wish I had family and children in my life. I am alone most of the time. I actually like my company, but occasionally I lament that along the path to recovery I did not construct my own family. I realize the importance of relationships and quality of life in promoting recovery.

My kids have known about homelessness since the moment they knew about things. They are currently 5 and 8 years old and were gestated, born, and grew up while I was running a drop-in center for homeless young adults. In addition to constantly hearing about my work and people with whom I worked, they came to picnics, holiday parties, talent shows, and many other community events connected to the drop-in center.

They knew by name some of the young adults who lived or panhandled on the streets of Harvard Square. They made pictures for my clients who moved into housing “so they have something pretty on the wall." Their room is decorated with artwork created by homeless young adults; they say “I hope I can be that good at art one day.” One rainy and cold fall morning, my oldest – who was 6 at the time – looked at me over breakfast and said “Rain, rain, go away. Mama’s friends have nowhere to stay.” My children are aware of homelessness, poverty, and injustice – understanding this is part of understanding their mother.

Research on “health care disparities,” the euphemism for unnecessary deaths and adverse outcomes among people from low socioeconomic groups and from communities of color, often attribute them to individual characteristics and structural barriers within mental health systems. Most often an individual’s use of services as well as the way services are arranged and delivered are cited as causes.

I want to begin by commenting on what is going wrong and then discuss what is hopeful in the provider-client relationship. Although research is taking place, there is little agreement about best practices and ethical standards in minority mental health care. The issues of staff bias, racism, institutional racism, prevailing practices, and methods of prioritizing who gets time and attention are omitted from the discussion. Also, questions of discrimination that stem from preconceived notions and racial profiling of African American people and/or questions of how stigma influences medical decisions are absent, if not actively avoided, in discussions of healthcare disparities.