Healing A Broken Mental Health System: Dr Gary Howell Of National Louis University’s Florida School of Professional Psychology On 5 Things That Can Be Done To Fix Our Broken Mental Health System
An Interview With Stephanie Greer
Tackle systems of power and privilege head-on to address the implications on mental health and the perpetuation of oppressive practices that further marginalize people.
The current state of the mental health system is a conversation that echoes in the halls of policy-making, the corners of social advocacy, and within the private struggles of individuals and families. As we continue to witness an unprecedented need for robust mental health support, the shortcomings of the existing system become more glaring. It is within this backdrop that we seek the insight of those who are at the forefront of behavioral health. In this interview series, we are talking to behavioral health leaders, policymakers, mental health practitioners, advocates, and reformers to share their perspectives on healing our broken mental health system. As a part of this interview series, we had the pleasure of interviewing Dr. Gary Howell.
Dr. Gary Howell is an associate professor and the director of practicum training at National Louis University’s Florida School of Professional Psychology. He has dedicated himself to advocacy and support of the LGBT community for over 20 years now. As an openly gay psychologist, educator, and LGBT expert, Dr. Howell strives to shed light on bullying, suicide, and homophobia.
Thank you so much for joining us in this interview series. Before we start, our readers would love to “get to know you” a bit better. Can you tell us a bit about your background and your childhood backstory?
I am a clinical psychologist who specializes in working with the LGBTQ+ community. I am an Associate Professor and the Director of Practicum Training at the Florida School of Professional Psychology in the Clinical Psychology doctoral program. I am the incoming President of the Florida Psychological Association as well. I completed my undergraduate education at Austin College and my doctoral education at Adler University (formerly Adler School of Professional Psychology) in Chicago.
I moved to Florida after completing my postdoctoral training in Chicago at an agency that worked primarily with patients struggling with severe mental health problems. I was fortunate to train and supervise clinical students, develop programs, grow the group practice, and learn how to run a successful clinical practice. As I was wrapping up my fifth year at the agency, I was given an opportunity to teach and run my own practice and moved from Chicago to Tampa in 2011. I quickly discovered how much I missed working in my own community, so I set up my practice in Ybor City, the LGBTQ+ neighborhood in Tampa.
In 2017, I founded a Tampa nonprofit called Institute for LGBT Health and Wellbeing intending to expand the services I already provided in my private practice. Prior to my move from Chicago, I was involved in the Illinois Psychological Association and chaired the Sexual Orientation and Gender Identity section of the organization. This led me to further leadership at the national level within the American Psychological Association where I was able to continue my work with other LGBTQ+ psychologists.
I grew up in a very rural community in Texas with a population of around 40,000 when I moved away. I worked at a local HIV/AIDS clinic while I was completing my undergraduate degree. During this difficult work, I found my love of advocacy and social justice, which made Adler University a perfect fit for my doctoral training. It was challenging being a young gay male in such a rural place where identifying as LGBTQ+ was not always safe outside the bubble of Austin College. I was fortunate to have amazing gay mentors who shared with me an invaluable history lesson on being gay in the South and allowed me to appreciate the storied and violent path that was paved so I would have more freedom to be openly gay. I was fortunate to learn this in my early 20s and make it a point to train future clinical psychologists to be aware of these stories as well.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My favorite quote by Gandhi is “Be the change you wish to see in the world.” I shared this quote as the student speaker at my doctoral graduation in 2008 and the following year the university started a campaign around being a change agent. I have spent most of my adult life endeavoring to embody this quote to the fullest extent possible.
As I was doing HIV prevention work at the age of 19, I hit many roadblocks, met many bigots, and was frequently told my existence as a gay man was not valued. Unfortunately, I live in a state where so many years later I am bearing witness to the same bigotry we fought so hard to escape and eradicate. Hearing Jeanne White at a convention talk about the death of her son, Ryan White, was the spark for me. Only a few years later, I spent hours watching the news in the days leading up to October 12, 1998, as the world watched Matthew Shepard eventually die after being beaten and left for dead in Wyoming–this was the fuel that ignited my passion for advocacy. I vowed that day to always be intentional with my efforts to be a catalyst for change and keep the voices of my LGBTQ+ community centered and amplified with any chance or platform I was given.
Over the years, this has shifted in centering Black and trans lives. The intersections of these identities are connected to an epidemic of dehumanization, violence, and racism toward transgender women of color (TWOC); however, Black TWOC are most impacted by these senseless acts of violence. Whether in a training workshop I am providing to clinicians or the community, in my classroom, or when interviewed by media, I make space to speak their names and advocate for systemic change. I am a fighter, a social disruptor, and an accomplice in the fight against racism and anti-Blackness. Advocacy and activism are in my blood, and I recruit my students and colleagues to join my efforts to be the change in our world.
Let’s now shift to the main part of our discussion. It is often said that “the mental health system in America is broken”. What does that statement mean to you? From your perspective what is “broken” today?
The mental health system is extremely broken in our country. Suicide rates are alarmingly high, and lack of access to quality care is a healthcare disparity and a social determinant of care. Mental Health is rarely the top priority of our elected officials who often view it as a target when discussing budgetary restrictions and funding cuts. To me, this statement means millions of people are affected by systems that do not work and have been designed in some instances to oppress minoritized groups.
For many years, substance abuse treatment and eating disorder treatment were not often covered by some of the top insurance companies. The fight for mental health parity laws should have never been a fight to begin with. We have a shortage of quality mental health providers in this country, especially in rural areas and communities that rely on Medicaid. So much is broken today, and unnecessary barriers and lack of training exacerbate underlying mental health conditions for minoritized communities. We need to do better as a profession and society to tackle these issues because we are armed with data, research, and evidence that so much is preventable.
Our mental health system is broken and glorifies resiliency for those faced with challenges often beyond their control. Why do we expect children to be resilient in order to survive sexual abuse, trafficking, and kidnapping? What happens in situations where one is not resilient? Children should not have to be resilient; they should not be subjected to these situations in the first place. This mindset places the onus on children to be resilient and deal with abuse. The mental health system is broken because we focus so little on prevention and have an opportunity to improve mental health services and redefine societal attitudes.
What about any bright spots? Do you think there are any elements that we get right in today’s world that we wouldn’t want to reverse unintentionally?
We are making some progress about stigma around mental health. Celebrities and other influencers sharing their own experiences with mental health treatment certainly encourage more people to seek help but much more work is needed. We can erase the stigma more if more faith-based community leaders and medical providers encourage and integrate mental health treatment. Alternative approaches to treating mental health have offered hope for some patients who once believed they would never find relief (e.g., Ketamine treatment and Transcranial Magnetic Stimulation (TMS). Mind-body approaches have helped address pain disorders, anxiety, and cancer treatment and have been used in some cultures more regularly than any medical approach.
In your opinion, what are the 5 most impactful things that could help heal the broken mental health system? These could be on any level including training, workforce, policy, culture, equity etc.
1. Increased workforce of trained and competent clinicians (knowledge, skills, awareness of intersectionality, minority stress, impact of racism on mental health, etc.).
2. Reimbursement rates for clinicians whose work often is not reimbursed on par with their medical counterparts, which means fewer providers taking insurance and another barrier to care.
3. Tackle systems of power and privilege head-on to address the implications on mental health and the perpetuation of oppressive practices that further marginalize people.
4. Policy to support access to mental health services.
5. Overhaul of inpatient psychiatric treatment.
If all of the items on your list were magically implemented tomorrow, what change might we see in the world? What are the signs (big and small) that would show us that the system is being healed?
People would feel more comfortable seeking mental health support as a reduction in stigma would mean that discussing mental health issues would be as normalized as physical health issues. These conversations about mental health in workplaces, schools, and social settings would be more open and frequent. Clinicians would be more in touch with the communities they serve, and patients would be more likely to find clinicians who understand their nuanced struggles. The mental health community would unite more to correct and challenge the dangerous misinformation on apps like TikTok.
With increased access to care and higher quality of treatment, it is quite likely a decrease in overall mental health crises, a reduction in suicide rates, and improved general well-being across all populations would be noted. Improved mental health care would lead to better productivity, which is likely to correlate to better attendance on the job. Healthcare costs associated with untreated or poorly managed mental health conditions would improve.
Overall, we would see more inclusive communities that support individuals with mental health challenges. There would be broader policies aimed at supporting mental health at local, national, and global levels, which would be reflected in governmental budgets and initiatives. Mental health would be more seamlessly integrated into general healthcare, which means routine/regular mental health check-ups would be comparable to physical health check-ups. There would be a greater emphasis on preventive measures and self-care. These changes would create a paradigm shift toward a more empathetic, culturally inclusive, efficient, and equitable mental health system, ultimately supporting a healthier and more resilient future for our country.
What is a project you or others are working on today that gives you hope? How can our readers learn more about this work?
I am working on a seed grant project with a current and former graduate student, and three trans people from the community on a Participatory Action Research study on evaluating and addressing the experiences of transgender and nonbinary people in the United States. We are at the beginning of the second phase and will be conducting 30–40 comprehensive interviews with transgender and nonbinary people all over the United States in January 2024. We hope to have data collected and analyzed by late May with submission for publication shortly thereafter.
Ultimately, we hope to create a documentary highlighting these experiences.
I also spent some time in Santiago, Chile consulting with a school for transgender youth. Children from all over Santiago attend the Selenna Foundation school which is run by two moms with transgender girls. I had the privilege of meeting with the parents of several children in December 2018 and providing education and resources. Given the school is not an accredited educational system, it is challenging to find teachers who will dedicate their time to the cause and leaves the school to rely on donations and other foundations for support. They do not qualify for funding from the government but do have relationships with universities to create a pipeline to college for trans youth. Since 2018, the school has grown from just under 20 students to over 70. Their work is inspiring and would love to film a documentary to bring awareness and funding to their efforts.
How do you see technology shaping the future of mental health care and its accessibility?
Technology is an ever-changing tool for improving accessibility and shaping the future of the mental health industry. The profession underwent a major shift when the COVID pandemic began and continues to utilize telehealth services to expand our ability to reach patients who have never had access to mental health services in rural areas. Providers have more opportunities to offer group therapy and support groups in a virtual or hybrid modality as well.
Additionally, more partial hospital and intensive outpatient programs offer a virtual component now.
As the approval for PSYPACT (psychology compact) continues to gain traction, psychologists can now practice across state lines with limited barriers to offer supportive treatment. This is especially important for diverse people who may not live in areas where providers are competent to treat them. The use of clinical apps also allows providers to work closely with patients to track their symptoms or provide interventions between sessions.
In your view, how do social factors like poverty, education, and culture affect mental health care and its effectiveness?
Poverty, education, and culture are social factors that have a significant impact on mental health care. These interconnected social determinants of care have far-reaching clinical implications for the communities that are excluded from accessing services or encounter barriers that limit access. These factors are intersectional and create unique vulnerabilities where each identity overlaps.
Minority stress is affected by external and internal factors that can trigger mental health challenges and exacerbate depression and anxiety, sense of belonging, and other identity concerns. Poverty contributes to educational deficiencies in areas where funding is not available to provide the most current textbooks or fund salaries for more qualified teachers. Chronic stress is rampant among impoverished communities. Education and cultural beliefs can positively influence understanding and perception of mental health. Education is a tool for having a better understanding of healthcare, which the CDC refers to as health literacy. Individuals with higher health literacy are likely to understand ways to better manage mental health which leads them to seek services. Cultural-informed care benefits diverse patients more and provides a space to adequately address the challenges of intersectional experiences.
In light of the growing mental health crisis among young people, what innovative approaches or interventions have proven most successful for children and adolescents?
Early intervention services support the integration of mental health in educational settings to increase awareness, knowledge, and skills. An emphasis on mind-body practices (e.g., mindfulness programs, peer support groups, yoga) has become mainstream with seemingly unlimited access to free tools (e.g., cognitive games for memory and attention problems, cognitive behavioral apps, meditation apps, etc.). Play therapy and art therapy are useful tools in reaching young patients. For LGBTQ+ youth, platforms like Trevor Space have saved many lives and connect kids and teens with local agencies to support them.
We are very blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might just see this if we tag them. 🙂
Sadly, some of the most important people I would want to meet are no longer with us (Sylvia Rivera, Marsha P. Johnson, and Harvey Milk). However, Cindy Lauper and Lady Gaga are icons and allies in my community. Their efforts in support of LGBTQ+ rights place them at the top of my list of celebrities I would like to meet. Their music, their foundations, and their devotion to advocacy would make for a beautiful conversation and a once-in-a-lifetime breakfast or lunch. They have both touched the lives of my patients, my friends, and myself over the years. I know in some of the darkest times, they have a way of connecting with the pain of those who have been bullied and those we have lost to suicide and/or murder. The work of True Colors and Born This Way Foundation is important to my fight.
I have been in the same room as President Obama before he was elected, but the work he did to support the LGBTQ+ community will never be forgotten, and something I would love the opportunity to tell him in person. His presidency was pivotal in forcing us to address and have difficult conversations about making our country a better place for diverse people.
How can our readers further follow your work online?
Florida School of Professional Psychology at National Louis University
Institute for LGBT Health and Wellbeing
Queer Folx Megaphone Podcast on most platforms (I have recommitted to dusting this off in 2024)
Thank you for your time and thoughtful answers. I know many people will gain so much from hearing this.
About The Interviewer: Stephanie Greer, PhD is the Co-founder and CEO of Akin Mental Health — a company dedicated to guiding families on their journey supporting a loved one with mental health challenges like bipolar disorder, schizophrenia and severe depression. Stephanie is passionate about this topic from her own personal experience growing up with a mother who struggled with bipolar 1 disorder and found a path forward to overcome the obstacles and live well. Stephanie’s professional experience includes a doctorate in neuroscience as well as design research roles at Hopelab and Apple. Stephanie brings this personal passion together with her world-class science and technology background to support families across the US in their personal journeys supporting loved ones with mental illness. To learn more about Akin Mental Health and join our community, visit us at akinmh.com.
Healing A Broken Mental Health System: Dr Gary Howell Of National Louis University’s Florida School… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.