This article was originally published by WireTap magazine

Graham Danzer

September 8, 2008

Twenty-year-old San Francisco resident Darrin Harris is a survivor. Like too many African-American men growing up in a city with a reputation for progressive politics, Harris was shuffled between foster care and jail for years before receiving the mental health care he needed. Thankfully, for this resilient young man, much of this trauma is now in the past.

These days, Harris makes a strong first impression with his graceful manners and upright posture, reflecting a composed and self-assured young man. He wears colorful striped dress shirts tucked into crisply ironed dress pants. His future is hopeful, as he searches for work and considers going back to school with help from state scholarships.

This wasn’t always the case.

For many young people growing up in neglected communities, there are systemic social and personal barriers to getting adequate mental health care. In my role as Harris’s social worker, I watched him overcome personal struggles, social stigmas, and a juvenile system that frequently fails to identify psychiatric illnesses.

Dark Days

Darrin Harris’s birth parents were both poor and addicted to drugs. Unable to care for themselves or their son, Darrin was placed in foster care as an adolescent, an all too common fate for youth from his community. While rates of childhood neglect are similar across color lines, African-American youth are more likely to become caught up in the foster care system.

According to a 2005 Adoption and Foster Care Analysis and Reporting System report ( AFCARS), African-American children represent 15 percent of the youth population in the U.S., but make up 30 percent of youth in the foster care system. For many foster care youth, this unstable housing can have negative repercussions.

Darrin moved from foster care to group homes following a spate of disruptive, volatile incidents due to his sudden radical shifts in mood. When his outbursts continued, he was sent to psychiatric hospitals, and finally juvenile hall. Juvenile detention is a frightening place for any youth, but hardened by a lifetime of institutionalization, it was nothing new to Harris.

“Group homes are just like being in jail,” he said during one of our counseling appointments. “They tell you what to do, where you can go, where you can’t, just like jail.”

As he transitioned through different housing environments over the course of a decade, Darrin’s chaotic and frightening mood swings had his friends on edge, fearing what he would do next. At his most manic, Harris was effusive, bursting with energy and talking in a frantic, unintelligible diction. He was easily irritated, paranoid and reckless. The behavior would go on for days until a sudden crash would leave Harris crying and suicidal.

Harris was suffering from bipolar disorder, an illness characterized by alternating periods of mania and depression, impulsive behaviors and sleeplessness, followed by a collapse into despair, guilt and crying. While the disorder is dangerous, fear-inducing and chaotic for the individual, as well as those around them, it’s also highly treatable.

Given appropriate medications, therapy and life structure, people with bipolar disorder can lead stable lives. According to the Annenberg Adolescent Mental Health Initiative, anti-depressant drugs and psychotherapy are effective in 80 to 90 percent of cases. But with side effects like weight gain, tremor and nausea, determining the right prescription can take time and make medication compliance difficult.

Challenges and History

Staying consistent with a course of medication is absolutely necessary for people with bipolar disorder, though it’s often difficult given the stigma associated with taking psychiatric medications. Harris, like others with mental health issues, feared that taking medication or going to counseling would confirm that he was “crazy.” This is a common belief, particularly in the African-American community where historical medical maltreatment, such as the Tuskegee Syphilis Experiment, has fostered legitimate distrust for medical professionals. It’s also common for many young people needing psychiatric care to be misdiagnosed with other conditions–further delaying relief and fueling distrust of the medical institution.

A 2007 San Francisco Chronicle article profiled youth exhibiting symptoms of Post Traumatic Stress Disorder (PTSD) who had been misdiagnosed with Attention Deficit Disorder (ADD). PTSD is not uncommon in urban communities with high rates of violence and trauma. PTSD has similar symptoms to ADD but can be differentiated through follow-up care and more thorough examination. But such necessary differentiation can only happen if a young person is receiving adequate care to begin with.

Despite similar rates of mental illness among both white and non-white populations, a 2000 surgeon general’s report found that African-Americans often do not receive adequate evidence-based mental health care, including accurate diagnosis and treatment.

The remnants of institutionalized racism impact mental health issues in urban communities of color, contributing to ailments often going undiagnosed and untreated. As one client told me, medications and therapy were “white folk shit.” Psychiatric illness is frequently hidden in the African-American community and its sufferers are too often left untreated until a series of major crises, or pressure from friends and family, sends the person into a city clinic. This was exactly the scenario that brought Darrin and his younger sibling to my office.

How Families Cope

I first met Darrin Harris after he stormed into our city clinic yelling with arms flailing and panic in his eyes. His 13-year-old brother, looking battle-weary, trailed behind him, his beanie pulled low over his head. His pants were drooping at the waist more from exhaustion than style and he was too worn out even to speak.

Harris’s girlfriend was similarly overwhelmed and had been begging Harris to get help. At the time, his most recent foster mother, who loves him very much, had kicked Harris out following several days of violent outbursts and threatening behavior.

Although Harris had many compassionate people in his life, they didn’t understand the root causes of his behavior. Harris’s friends would often demand that he “get over it” or “just calm down,” not realizing that he wasn’t able to control what was happening. Bipolar disorder can’t be willfully controlled any more than cancer or heart disease.

While friends and family may have good intentions when they make demanding statements, they actually harm the suffering person who may feel responsible for their mood swings and erratic behavior. Given the right care, those with psychiatric illnesses can learn that they’re not unwell by choice and that they are able to regain control of their lives.

Harris was relieved to hear this information when he arrived in my office. Clinic staff initially feared that he might be a danger to himself and others, summoning police while Darrin was escorted to my office. I spent nearly two hours with him in a back room, listening as Harris’s energy and volume dropped by the minute.

By the time the police had arrived, Darrin had stabilized and began to grasp that something beyond his control had happened. I explained that he had been through a lot and that the clinic was there to help; he no longer had to suffer alone. I informed him that medications would help him feel better and didn’t mean that he was “crazy,” but rather that he cared for himself enough to receive treatment. I told him that he deserved to feel better after all he and his family had been through. After a decade of uncertain living situations, hospitalizations and juvenile hall stays, Darrin Harris was finally receiving the help he needed.

Moving Forward

Grateful to see the police sent away and a team of professionals at his side, Darrin opted for medication and counseling. As I learned through our frequent follow-up interviews, personal freedom was very important to him. Maintaining autonomy was a priority after a life in institutions and forced living arrangements. Understandably, Harris was suspicious of the rehabilitation programs that social workers had been offering over the years.

These services included counseling and job training to ease the transition into a structured daily work life. But as his moods and thought processes became more stable, he saw why he had been distrustful of group homes and other public services. Eventually, he found the right program for his needs, enrolling in transitional housing services.

Things are looking better for Harris every day. He has a place to live, hasn’t had a serious argument with his girlfriend in three months, has better relationships with his friends and family and is prepared to go out on job interviews. It’s hard to imagine that he’s the same person who was nearly taken to a psychiatric emergency center by the police months earlier. Darrin’s eyes glisten with hope as he sits relaxed in a chair in my office, discussing his prospects for school and work.

The iPod earbuds that dangle around his neck play a familiar hit by 50 Cent, but it’s as if Harris’s nodding is more in tune to his own rhythm than 50’s. He’s been through stressful times but is now stronger, aware of the effects of mental illness. Darrin’s continued improvement depends upon his ongoing dedication to treatment. His progress and poise are promising traits. He has not only learned to help himself, he has also learned how he can share his experience with others in his community, shedding light on a problem that all too often goes undiagnosed.

For more information, read:

Darrell Steinberg’s and Miriam Aroni Krinsky’s article on mental health and foster care youth.

US News & World Report’s article on youth incarceration and psychiatric disorders.

Foster care facts at Foster Care Month.

One youth’s story:

Graham Danzer, MSW PPS, is a social worker in San Francisco at Westside Crisis Clinic.