Thrilled to announce our new grant!
Women in poverty dealing with domestic violence face two terrible choices:
A: Leave. Struggle without financial/social support.
B: Suffer in silence, wait for husband to die.
We want to test a third way for those who can’t/won’t divorce. (1/x)
🎉 Big news! 🎉
Thrilled to share that Sabitri Sapkota Devkota &
@BibhavAcharya
have received a 5-year R01 grant from
@NIMHgov
for a study on reducing intimate partner violence & depression in Nepal. 🇳🇵 (1/4)
After failing to control human
#trafficking
,
#Nepal
lays the blame on women and proposes limits to their movement.
#Women
under 40 must travel with an insurance of $14000 & a recommendation from local officer, unless she's under the 'protection' of family.
We just received a 5-year
@NIMHgov
research award to test an intervention for diabetes, high blood pressure, anxiety, and depression in Nepal.
Testing something like this has been a long-standing goal for me since we trained our first CHWs in rural Nepal 16 years ago...
(1/n)
📚 An Academic’s Guide to the Nepali 5-day holiday of Tihar:
Day
#1
. Kaag (crow) Tihar. Crow brings messages from the god of death.
Academics, feed your local crows so your reviews and summary statements don’t bring the news of death of your grant proposals.
Our book is finally here! 🚨
If are a student, teacher, or practitioner of global mental health, we’ve curated wonderful insights from 70 contributors.
Many thanks to
@routledgebooks
and to my (twitter-shy) co-editor Anne Becker
@harvardmed
.
@AllenFrancesMD
I've seen plenty of people with untreated severe depression in Nepal (because of lack of meds/ECT). They don't "get better naturally"; they become catatonic. I think people in the US haven't seen catatonia and now have a romanticized idea of severe depression.
@tylerblack32
@eclecticherbal
I appreciate your patience in highlighting things that are wrong. I had trouble finding things that are right!
Meds for BPAD/psychosis in kids if you CAN'T rule it out (vs. only if you can rule it in)?
I can't believe they're is a licensed clinician. Hope they get investigated.
Residents/attendings are often in awe of Nepali IMGs. A resident said "he ran the whole floor as an intern. He had run a whole hospital before residency!"
@TheUSMLE
named Nepal and this has the unintended consequence of unfairly hurting honest Nepali applicants. See/sign below:
Few concerns with the USMLE
@TheUSMLE
statement:
1) promotes collective punishment and humiliation
2) the mention of “Nepal” is shaming the entire country and casting shadow over supermajority of Nepali physicians in US and abroad who are honest, intelligent and diligent.
(1/3)
Most days you wonder if anyone even reads your academic papers.
Then you learn that your 2021 paper was included in "50 Studies Every Global Health Provider Should Know" from
@OxUniPress
!
We had described our model for mental health care in rural Nepal:
We recently tested a mental health program in rural Nepal and achieved results similar to those from well-resourced research studies in the US.
A thread on the highlights of bringing mental health care to rural Nepal. (1/n)
(free)
@BMJ_Open
@ucsf
has
-set up temporary COVID screening clinic
-made is easy to telecommute and see pts (
@UCSFPsychiatry
moved 95%+ of clinic visits online within a week, even if insurance didn't cover it)
-canceled elective procedures
It's losing a lot of $$ but doing the right things!
As I was writing this, my big fear was in sending any kind of message that we are out of the woods in SF. The takeaway here is that sheltering in place early can help flatten the curve. KEEP STAYING HOME for our frontline medical workers.
Nepali healthcare workers have asked burnout resources.
While we advocate for better systems, here are two videos in Nepali to recognize and address burnout.
Thanks to
@UCSFPsychiatry
global mental health fellows Eva Studer+Tula Gupta.
#COVID19nepal
नेपालमा उपलब्ध कोभिशिल्ड खोपको बारेमा अनावश्यक त्रास फैलिदैछ। खोप पाएका झन्डै २ करोड मध्ये जम्मा ३७ जनालाई यो समस्या देखिएको हो। खोप नपाउदा पनि यो समस्या प्राय: यति नै मात्रामा देखिन्छ। त्यसैले यो समस्याको बारेमा चिन्ता लिनु पर्दैन।
@AnupSubedee
@AgyaMahat
@smadixit
@AnupKaphle
Only 37 reports of clots from 17 million people. Not worse than people without vaccines.
This is bad timing because many LMICs only have AZ available (unlike these countries that are overreacting by banning AZ but can access other vaccines).
Still in shock to hear about the passing of Paul Farmer.
Here is one story of how he inspired and supported a whole generation of people working in global health and social justice.
Like many, I first learned about his work through this article:(1/n)
After getting 4 rejections last year, finally received funding for an
@NIH
study in rural Nepal with
@possiblehealth
@UCSFPsychiatry
@ArnholdInst
. We will be studying a technology-enabled service to improve care engagement for HIV-positive youth in Nepal.
We recently tested a mental health program in rural Nepal and achieved results similar to those from well-resourced research studies in the US.
A thread on the highlights of bringing mental health care to rural Nepal. (1/n)
(free)
@BMJ_Open
1 one out 3 people will experience a panic attack in their life. If you do not know what they are, they can be terrifying and can negatively affect your life. In this video (in Nepali) I explain what they are and what to do if they are a problem for you.
I realize some IMGs are worried about this news hurting their credibility but taking action against cheaters is essential to build credibility for honest applicants.
I expected another lawsuit from Nepali IMGs whose scores have NOT been invalidated.
@USMLE
must act against potential cheating. But there was no need for them to name Nepal in the initial release. They've tainted the credibility of all applicants associated with Nepal.
UPDATE:
Last week, a Nepali doctor filed a class action lawsuit against the National Board of Medical Examiners, alleging discrimination based upon national origin and requesting that invalidated USMLE scores be restored while examinees appeal.
Today, the NBME responded.
(🧵)
Very excited to be able to expand a small but promising pilot study to an expanded pilot intervention to address domestic violence and depression in Nepal.
We are thrilled to share that Possible’s "Family-based intervention to address domestic violence against women and mental health - a single arm trial" is among the nine winners of
@TheSVRI
2023 Research Grant. Congrats to all our fellow awardees!
🇳🇵Exploring solutions to intimate partner violence in rural Nepal:
We've been testing an intervention that brings in the husband + mother-in-law.
Understanding that many women can't leave their husband, our focus is on enhancing relationships.
Insights from Counselor Aratiji👇
I made some short Nepali videos to address general stress and anxiety. Videos require no literacy and are appropriate for people who prefer to receive educational and health materials in Nepali and would like to learn to manage stress
"Can you really build a career in 'global health' if you focus on the country where you were born?"
Join us for a webinar on the challenges/opportunities to build a global health career (teaching, research, programs) as part of the diaspora.
Thanks
@nepali_diaspora
for hosting
Digital tools are everywhere! Our new paper includes lessons from testing them in healthcare settings:
🕰️1. Be patient with your fancy idea. Start simple:
We wanted to use a cloud-based tracker but doctors loved paper. We said, ok, let's start with paper.
Soon they.. (1/n)
After years of feeling helpless, not knowing how to support women experiencing domestic violence but unable to divorce, we finally have promising results from a family-based intervention.
Looking forward to
@NIMHgov
@gchallenges
@wellcometrust
@iamhrf
conference
Our team will be presenting findings from our innovative family-based intervention to reduce intimate partner violence and depression in Nepal.
Join us at the Global Mental Health Conference organized by
@HHSGov
@NIMHgov
@gchallenges
@wellcometrust
@iamhrf
Massive construction at Bayalpata Hospital in rural Nepal.
Overheard from a visitor: "This is the only construction in Nepal that is completed on schedule!"
Invest in logistics! If forced to unreasonably minimize "overhead" costs, we are rewarded with delays and inefficiencies.
🌍Just 10 years ago, many well-intentioned mentors cautioned me that it's practically impossible to build a career in global mental health. Not enough money, not enough interest, not enough clarity about what to do even do etc.
But something else was also "not enough"... 1/n
Lower to middle-income countries face a staggering 90% treatment gap in mental healthcare. The work of professionals like Bibhav Acharya, MD (
@BibhavAcharya
) aims to make quality mental health services more accessible.
Growing up, a neighbor used to get drunk and beat his wife. Everyone knew/knows this is a common problem with few effective interventions.
Very excited to start this
@NIH
@NIAAAnews
study on alcohol and IPV in India with
@UCSFPsychiatry
@StJohnsResearch
Doctors interrupt patients within 11 seconds
When uninterrupted, a patient will talk for 30-90 seconds
Community Health Workers
@possiblehealth
doing one of my favorite exercises: listen to someone for 90 secs without interrupting
Part of our
@NIMHgov
study in rural Nepal
Congrats to the recipients of the NIMH Global Mental Health VISTA Awards! 👏The scientific contributions of early career researchers are essential for addressing our most pressing global mental health challenges.
#globalmentalhealth
This is one of many examples of Paul Farmer reaching people in all corners of the world.
He pushed us to imagine a better world.
My reflections and transformation from organizing small mobile clinics to building health systems in rural Nepal.
🙏
People aren't getting mental health care because of 1) lack of mental health professionals; 2) stigma against seeking care
@healinitiative
fellow
@rimal_pragya
presents our model to address both by integrating mental health into primary care
@USEmbassyNepal
's American Center
If you build, will they come?
Yes, but they need to *experience* the benefit.
Context: we built a 24-hr delivery center. It was unused for 6 wks, until a woman with post-partum hemorrhage arrived in an emergency, and was saved.
After that, there was an influx of deliveries!
Who says doing mental health work in rural Mexico, rural Nepal, and Navajo Nation can't be fun?
Always a joy to hangout with our
@UCSFPsychiatry
@healinitiative
global mental health fellows. 😊
Those who suffer are powerless and those with power do not suffer the consequences of inaction
Why stress isn't always bad and why we continued to build a hospital in Achham even when people threatened to beat me up
Thanks
@mahatsujit
@ukaalonews
for this longform interview 🙏
जसको कामै ग्रामीण क्षेत्रमा स्वास्थ्य सेवाको अनुमति दिने हो, त्यही निकायले हामीलाई अछाममा अस्पताल सञ्चालनको अनुमति दिन वर्ष दिन कुराइदिए। हेर्नुस्, पहिला त काठमाडौँ बसेर अछाममा के दिने-के नदिनेबारे अधिकार प्रयोग गरिएको छ।
@BibhavAcharya
@ukaalonews
Many women face violence from their husbands, but are unable to divorce. How can we help?
Next week at
#CUGH2024
, we will be sharing our findings from an innovative study that brings the mother-in-law, husband, and daughter-in-law together to reduce domestic violence. Come by!
Are you a US psychiatry resident interested in global mental health?
Join our 1-2 year fellowship starting July 2024. You will learn how to build and improve mental health care delivery systems via rotations in Nepal, Mexico (Spanish speakers), and Navajo Nation.
Apply/share!
@shristijoshi
@tirimiridai
@ranju_darshana
Few thoughts/tips.
Short/immediate term:
1. Avoid if possible/desirable. Like any external stimulus, see if you can adjust the dose (how much), frequency (how many times a day/week), or intensity (reading about something vs. watching a video). (1/n)
Just received the good news that our symposium has been accepted at this GMH conference!
Our Nepal-US team will present results from a pilot study to simultaneously reduce intimate partner violence + depression among young married women in Nepal
@UCSFPsychiatry
@possiblehealth
Join 700+ researchers at the Global Mental Health conference in Washington, D.C.
Dates: Mon 30 Oct - Wed 1 Nov
Co-sponsors:
@NIMHgov
@gchallenges
@wellcometrust
@iamhrf
Registration will close once the remaining spaces have been taken.
You want to help someone quit smoking.
Making them feel guilty only works temporarily. So what do you do?
Motivational interviewing!
But isn't used much in global health. Main reason: it is considered "too Western." We tried to address that.
🧵1/n
Motivation interviewing (MI) has been around since the 1980s and works very well for encouraging patients to engage in healthy behaviors (taking meds, regularly following up with their doctor).
Pay attention to independent studies saying B cells will keep us immunized for years.
Ignore the statements from pharma CEOs saying that we need boosters every few months. This is unscientific and promotes more vaccine hoarding by rich countries.
Always a treat to hear from Vikram Patel and his team about scaling up psychological treatments by lay counselors in India and now in Texas!
And how fitting that he holds Paul Farmer's named professorship
@NIMHgov
#globalmentalhealth
conference
Remembering Paul Farmer today.
He wrote this message almost 10 years ago. Thank you for your mentorship, guidance, and unrelenting work to improve health worldwide. 🙏
Link to a tribute I wrote after his death:
When people can't make a valid counterargument against your beliefs/behaviors, they attack everything else.
.
@iihtter
protested for street vendors' right to conduct business in peace+not have their property violently confiscated.
Trolls are obsessed with his shorts and sandals!
Wherever I go in Kathmandu these days, vendors greet me (& other friends who campaigned) with warm smiles & hugs. Nothing beats that familial feeling; there is an incomparable satisfaction in standing with working people. I will stand with them again, if it comes down to that.
Looking at Charikot Hospital through a new window.
Always inspiring to witness and participate in the work and expansion of high-quality healthcare in Nepal with
@possiblehealth
and
@Nyaya_Health
What an incredible stroke of luck!
While in Janakpur for our research project to reduce intimate partner violence, met the legendary
@chefsantoshshah
at his restaurant. 🙌
The food was an absolute delight, perfectly balancing flavors without overwhelming the senses. 😋
Professors are STILL telling students: global health=flying to multiple countries to build your portfolio (vs. "just" working in one country, esp if are an immigrant)
Please stop.
GH=improving health among underserved people (vs. collecting airline miles/visas on your passport)
Our Nepal team is growing! Check out the 4 job openings.
I will be closely working with the mental health research coordinator to implement our mental health programs, trainings, research, and services.
Please share/send referrals.
This is the challenge that USMLE now faces: how to ensure credibility in the test scores?
Of course social media is quickly turning this into a country- or IMG-specific issue. The real issue is ensuring that the test measures actual competence vs. access to old questions.
@BibhavAcharya
What worries me more is that the image has been tainted forever.
Even honest applicants will be rejected immediately after the PD's see Nepal in the CV.
Always an honor to work alongside our
@possiblehealth
team on-site in Nepal.
Weekly update meeting for our
@NIMHgov
study with
@UCSFPsychiatry
on addressing hypertension, diabetes, anxiety, and depression by training community health workers to deliver brief psychotherapy. 😊
We're looking for an implementation research coordinator to join our team in Dolakha, Nepal, as part of a new NIH-funded research study on suicide prevention. Please share/apply below:
The sound technician who helped with our presentation said they were deeply moved by listening to our work.
That’s not something you hear every day!
It can take a whole generation to stigmatize domestic violence, change gender norms, and increase access to educational...
It has been both heart-breaking and inspiring to see yet another wave of
#MeToo
stories in
#NepaliTwitter
.
If you are feeling overwhelmed, here are some tips to take care of your mental health:
@shristijoshi
@tirimiridai
@ranju_darshana
Few thoughts/tips.
Short/immediate term:
1. Avoid if possible/desirable. Like any external stimulus, see if you can adjust the dose (how much), frequency (how many times a day/week), or intensity (reading about something vs. watching a video). (1/n)
I once had an "Is there a doctor on the plane?" moment on a local flight in Nepal. Crew too scared to let "a paralyzed person" board.
Turns out they had catatonia. Convinced the crew it was safe. Explained to family that it was treatable. Family cried in relief. Lorazepam indeed
Lorazepam, lorazepam, rule out medical/WD or need to remove antipsychotics if malignant catatonia or lorazepam not working => ECT and do all this promptly :) and don’t forget the lorazepam and not 0.25mg either. 🙏🏻
💬 We encourage people to "talk about mental health," but what if they actually do??
Often missing from
#WorldMentalHealthDay
🌍 messages is what to do if someone DOES talk to you about their mental health... 1/n
Will be talking about mental health impact of COVID, especially on healthcare workers at Good Morning Nepal (
@GMNAP1
) with
@smadixit
and
@SareetaShree
May 24, Nepal time 7:30-8am.
Thanks for making space for mental health
"An obsolete government facility is now one of the most modern and eco-friendly hospitals in Nepal, providing accessible and affordable health care to the most underserved part of the country."
Thank you,
@nepalitimes
for sharing the story.
Hospital with a view! 🇳🇵
Pic: Looking out from Dolakha Hospital, the site for
@UCSFPsychiatry
@healinitiative
global mental health fellows. Miss spending time with the fellows and soaking in this view.
I will be talking in a webinar about emotional and mental health issues during COVID for Nepali-speaking communities. Please share with those who may benefit.
(in partnership with
@HealthySCC
but relevant for Nepali speakers anywhere)
April 12th, 3pm PT
In 2007, I was working in New York when trans fats were banned
We know it takes 17yrs for evidence from studies to change policies
Turns out, it takes 17 more yrs for evidence-based policy in one location to reach another
Thank you to people patiently working to change policy!
.
@WHO
congratulates
#Nepal
for restricting levels of industrially produced trans-fatty acids in the food supply through a legislation, a move aimed at promoting health and saving lives.
To know more:
📸: WHO Nepal/A.Maharjan
We need mandatory training on:
- how to not Reply All
- how to not email thousands of staff when you need to tech support
- how to not Reply All with "Please don't reply all"
- how to not Reply All with "PLEASE DON'T REPLY ALL!!!"😅
🚨Are you a US-trained psychiatrist seeking advanced training in global mental health? Want to join a like-minded network to build/improve care in Nepal, Navajo Nation, and Mexico?
Applications open for July 2023 cohort
@healinitiative
@UCSFPsychiatry
Spending some time at Bayalpata Hospital in rural Nepal to strengthen our mental health program. The view from my room is just the bonus!
@possiblehealth
Happening tomorrow!
Great catching up with some of the presenters already
@KripaSigdel
@DG_Nep
@sauhardarai
.
Our symposiums will not be streamed but the keynotes and plenaries will.
Day 1:
Day 2:
After years of feeling helpless, not knowing how to support women experiencing domestic violence but unable to divorce, we finally have promising results from a family-based intervention.
Looking forward to
@NIMHgov
@gchallenges
@wellcometrust
@iamhrf
conference
@wendyburn
@mirandarwolpert
@ProfDavidNutt
This resonates with what I see in clinical practice. Many SSRIs help people "feel less bad". Psilocybin seems to help people who feel stuck/rigid become more open to newer perspectives/build mental flexibility
Psychiatry is one of the few fields where you can still get to know your patient.
My mentor Rohrbaugh
@YalePsych
used to say "growing up, our family physician inspired me to become a doc. In medschool, I realized it's the psychiatrist who gets to know the patient+their family"
One of the remarkable things about this generation of medical students is their ability to shake off old stereotypes about specialties.
The surge in interest among US allopathic med students in
#psychiatry
over the last decade has made it an increasingly competitive Match.
Home visits is one of my favorite things to do with GMH fellows.
It's "inefficient" as it can take hours to visit one patient, but you see how they live and learn how tough it is for them to come to see you, and they get to share their story in a space where they're in charge.
I keep seeing "exercise is as effective as meds/therapy" but that conclusion is incorrect.
Think about who would agree to 3 hours/week at the gym?
Depressed people who agree to an exercise-based study are VERY DIFFERENT from people who choose just meds/therapy.
For some people with depression, exercise can be just as effective as conventional mental health treatments like therapy or medication.
But exercise is rarely prescribed.
That’s one thing Professor
@jonroiser
hopes his new research project will change👇
So great to see
@vivek_murthy
and of course Marcella Nunez-Smith from
@YaleMed
. Was lucky enough to have her as my teacher 12 years ago.
Congratulations America on helping bring science back to the COVID response.
Breaking: Biden is announcing a COVID task force, which will be chaired by 3 scientists: former Surgeon General
@vivek_murthy
, former FDA Commissioner
@DavidAKesslerMD
and
@Yale
epidemiologist Dr. Marcella Nunez-Smith.
Breaks my heart to read about this but also gives me hope that a major newspaper outlet is devoting resources to investigative journalism on issues that truly are in social interest. Great job!
Just finished reading
@tednaiman
's book.
Perhaps the most accessible book on diet and exercise for overall health. Will be using the principles with my patients (+friends/family), who are utterly confused by the garbled messages from other sources.
Just made a short video on grief/loss in Nepali. Please share.
#covid19nepal
आफ्नो नजिकको मान्छे बित्दा आफूलाई के हुन्छ र शोकमा पर्दा समस्या बढ्यो भने के गर्न सकिन्छ भन्ने बारेमा जानकारी दिन बनाइएको भिडियो।
@ankitkhadgi
@Devkota_Sabina
@basantabasnet
Is this a serious newspaper or a tabloid?
This is the problem with "lets talk about X" campaigns. Yes, we are "talking about mental health" but to serve a regressive agenda, and by not including the perspective of the person enduring pain
Maybe that gives us the answer: tabloid
We are still looking for a mental health researcher in Nepal.
It's very difficult to reverse the high-income country-based decision-making on which projects to pursue and we want to do whatever we can to support a Nepal-based principal investigator.
Please share/apply:
🚨Job alert
We are looking for a mental health researcher (PhD or MPhil) in Nepal to oversee + drive the MH portfolio (intimate partner violence, collaborative care, community health and more) at
@possiblehealth
.
AND will work closely with me! Pls share
Scapegoating people with mental illness is a sign of a society incapable of accepting that it is protecting and supporting rapists and murderers.
Fact: people with mental illness are much more likely to be the victim, rather than perpetrator, of violence.
Dr. Sushil Koirala argues that rapists do not have sound mind or may be suffering from some kind of mental delirium that is why they do not spare their own mothers and sisters |
#Rape
#mentalillness
A non-profit media outlet does an investigative report leading to arrests high-profile crony capitalists in Nepal.
Support
@ukaalonews
as they keep scaling the nearly impossible mountain of bringing accountability and fighting impunity. Congratulations!
As a non-profit independent media, public’s financial support is the only way to keep doing what we do. Every bit helps, so please support 🙏🏼
It’s not just a donation, but an “investment” that sustains this collective effort to see a just, fair, & well functioning society of ours
@AllenFrancesMD
When diagnosing someone with BPD, I often bring her book out, go through the diagnostic criteria together with the patient, and if it matches, tell them Linehan's story.
Find this to be less stigmatizing for what is a very stigmatized label, and often empowering for patients.
A must-read for anyone interested in mental health. OCD can look and feel like psychosis, leading to misdiagnosis, fear, shame, and incorrect treatments. Every time I've diagnosed OCD, the patient is relieved to get an explanation that helps them go from self-blame to recovery.
‘With OCD, it’s often a secret illness. The person who is struggling can hide it well, and appear ‘okay’ where in fact the mental torture is incredibly painful’.
Another poignant article by
@AshCurryOcd
Paternal OCD: Ashley’s story
If you are attending the
@APApsychiatric
annual meeting in San Francisco, come by our two presentations:
1. Using visual aids to address burnout in Nepal during COVID (1:30, May 21st)
2. Lessons from implementing collaborative mental health care in Nepal (1:30, May 24th)
#APAAM23
Had no idea that hearing loss is the biggest modifiable risk factor to prevent dementia.
Huge potential to address this with hearing aids. Perhaps a neglected topic in
#globalhealth
?
In 2006, Einstein was 1 of only 8 schools that let me apply to their program despite me being an international student.
They have been a pioneer in inclusion. Back when schools had quotas to restrict Jewish students,
@EinsteinMed
had a no discrimination policy.
Well-deserved!
NEWS
Bronx medical school, the Albert Einstein College of Medicine, is now tuition-free thanks to a $1 billion gift from Dr. Ruth Gottesman, a former professor.
Gottesman, whose late husband was an early investor with Warren Buffett, has made it a condition of the gift that
The highest yield ~3 mins on why our "modern" diet is bad for you.
Refined carbs and fat are driving metabolic syndrome (not just obesity, especially for Asians/S. Asians who don't gain as much weight but still have cardiovascular problems/metabolic syndrome).
Thanks
@tednaiman
My three minute rant on the cause of the obesity epidemic. 😅
Thanks
@drkerrygelb
for the interview!
[FYI you can watch the entire thing here on Twitter/X/TwiX on Dr. Gelb’s feed or on his YouTube channel — ]
➘
This is an important challenge in mental health. People read a list of symptoms and trivialize it: "I felt like that this morning! This is not a real illness"
Only way to understand the gravity:
a) experience the horrible symptoms or
b) bear witness to someone who is suffering
Severe OCD causes most suffering among psych disorders (up there with severe schizophenia, mood & eating disorders)- every waking hour a misery of thought &/or action.
Vast majority of Nepali IMGs take a year off and work very hard on USMLE, spend a lot money on exam fees and forgo earnings for many years to secure a US residency position.
USMLE specifically named Nepal while left it up to everyone else to speculate how programs should ...
Someone with a mental illness is more likely to be a victim rather than a perpetrator of violence.
Mental illnesses are universal, but the US has the most mass shootings.
Don't use mental illness as a scapegoat for outcomes of racism + poor gun control policies.
I am mentally ill and yet I have never had the desire to target an entire group of people and massacre them.
Racism is not a mental illness. It is a choice of hatred and violence.
Do not further demonize and stigmatize mental health in order to avoid the dealing with racists.