This article is part of a series about mental health in Washtenaw County. It is made possible with funding from Washtenaw County's Public Safety and Mental Health Preservation Millage.
Ann Arbor resident Stephanie Ratovonarivo, who lives with bipolar disorder, was 18 and living in her native Madagascar when she experienced her first manic episode.
"There was a shooting not far from my apartment," she says, "and when I started to hear the bullets, I rushed outside with my father and I wanted to save everybody."
For years, Ratovonarivo was ashamed of her mental illness and wanted to keep it a secret. But she started sharing her story when she became involved with the Washtenaw County chapter of the National Alliance on Mental Illness
(NAMI Washtenaw County). NAMI Washtenaw County's Ending the Silence program features 50- to 90-minute presentations by volunteers, intended to educate audiences on the early signs of mental health conditions.
NAMI Washtenaw County leaders say funding from Washtenaw County's Public Safety and Mental Health Preservation Millage has been a godsend for their organization, making Ending the Silence and other programs possible.
"We're based on donations and some small grants, so this opportunity was huge for us," says NAMI Washtenaw County Executive Director Judy Gardner.
Maria Alfonso, NAMI Washtenaw County project manager, agrees.
"On the one hand, the millage funding helps us continue the work that we've been doing for a long time now in the community and … allow[s] us to really rev up a lot of what we were doing and grow our programming," she says. " … The other prong is, we've had some new projects that we were able to pursue because of it."
Mental Health 101
NAMI Washtenaw County is primarily a volunteer-run organization that offers support groups and educational classes to families and individuals with mental illness, or to those who care for an individual with mental illness, at no cost.
"I like to describe [the classes] as Mental Health 101 or like a crash course on mental illness," Alfonso says.
The classes go over basic information, like what a mental illness is. Alfonso says they also cover practical topics, like what mental health care looks like, how to advocate for your mental health, and ways to support mental well-being in your lifestyle.
Because the millage funding came through in early 2020, at the beginning of the COVID-19 pandemic, Alfonso and Gardner say they were able to move their classes and support groups online relatively quickly.
But since the world has shifted back toward in-person events, the funding has also allowed NAMI Washtenaw County to increase its staff, expand its outreach efforts, and publish a booklet providing readers with basic information on how and where to find treatment for mental illness.
NAMI Washtenaw County Project Manager Maria Alfonso.
The millage funding has allowed Gardner and Alfonso's team to expand their outreach efforts in areas like Ypsilanti and Whitmore Lake – "communities that were what folks may call underserved and weren't getting a lot of our information and had just some disparities in health care based on what the public health record showed," Gardner says.
"We were very excited about being able to take our work on the road," she says.
Other outreach efforts include programs like Ending the Silence, which have empowered people like Ratovonarivo to open up about the difficult stories surrounding their mental health. Just before her first manic episode, Ratovonarivo had been living with her family in France, where her father, who had kidney cancer at the time, could get better medical treatment. But when Ratovonarivo was deported, she had to leave behind friends, a boyfriend, and her family, and return to Madagascar. There, she says, her uncles and cousins criticized her for becoming "too Westernized."
"I was having a hard time fitting in and I was really depressed," Ratovonarivo says.
At the same time, the political situation in Madagascar had become unstable, and the country was on the verge of a coup d'état. Both internally and externally, things felt precarious.
NAMI Washtenaw County Executive Director Judy Gardner.
Now, Ratovonarivo recognizes that she had all the symptoms of mania. She wasn't sleeping; she was overactive. When the shooting started, she says, "I remember the adrenaline pumping in my veins, like, 'I can do this, I can take people, let's go, let's go, let's go.'"
She says she and her father spent hours outside, "hiding and running," before they could make their way back to the apartment. But over the next few days, Ratovonarivo found herself in encounters with mercenaries.
"I put myself in danger by recording the conversations and taking notes on what they were doing because I thought I was a reporter and I was going to expose them all," she says.
She only narrowly managed to avoid arrest, and struggled long after with feelings of shame about the entire situation. But Ending the Silence gave her an outlet to come to terms with her illness and her actions.
"It was really empowering for me because I felt free of judgments," Ratovonarivo says. "And that felt like I was finally owning my own story."
The whisper network
Gardner and Alfonso are also working to undo what they call a "whisper network" around mental illness.
"There's definitely a language that is spoken that you have to almost learn when … you're just first experiencing a mental illness symptom," Alfonso says. "You know, there's so many little questions that are going to be asked of you and such a steep learning curve."
For many, that language — which can include terms as widely varied as "bipolar disorder," "inpatient treatment," or "therapy" — can be utterly mystifying when first encountered, and can be a major obstacle to seeking out treatment in the first place.
"We call it the whisper network because it's almost like a secretive language that you don't learn until you're in the system for a longer period of time," Alfonso says. "So we really wanted to make that as accessible as possible, as transparent as possible, so that there isn't this gatekeeping to care."
Gardner coined the term years ago following an experience that, coincidentally, first introduced her to NAMI. She had a loved one who was experiencing symptoms of mental illness. When a colleague heard about it, Gardner says, she took her aside to recommend looking into NAMI's services.
"This colleague of mine literally whispered. She was trying to protect my privacy," Gardner says.
NAMI Washtenaw County's Judy Gardner and Maria Alfonso.
Gardner links the idea of the whisper network to the sense of stigma that is still attached to mental illness for many.
"Either for cultural reasons or just their own private reasons, there's a lot of shame around that," she says.
As a result, many of the available resources go unused because "there's a lack of understanding of how to take advantage of them," according to Alfonso.
In many cases, the people who most need resources simply haven't heard of them.
"I can't tell you how many times I've mentioned the [Washtenaw County] Mental Health Treatment Court
and no one knows what I'm talking about," Alfonso says. "Now, that's a huge resource that everyone should know about because if you or a loved one commits some sort of a minor crime while they're ill, and it's due to their illness, they shouldn't go to serve a sentence for that. Most likely, they should just go and get treatment. So you have this alternative that's wonderful."
To combat that sense of stigma — and that lack of awareness about existing resources — Alfonso says NAMI Washtenaw County has been focusing on "bringing all this knowledge and information into the light so that people can take advantage of it and they don't have all these hoops they have to jump through."
A guide to "Taking Care"
According to Alfonso, "the largest project" that emerged from the millage funding was a booklet that NAMI Washtenaw County produced, entitled "Taking Care."
"We wanted a guide that would be there for someone who has little to no mental health experience, and to have it be so accessible that they can read the guide and be able to navigate the system and get themselves to care," Alfonso says.
According to Gardner, the NAMI team had put together focus groups to troubleshoot common questions and concerns about obtaining care.
The questions that emerged, she says, had to do with basic matters, like how to know when you need help, who to call for help, what therapy entails, or what to do for someone in crisis.
"We were finding that [those were] the same general questions that folks have. So we would lead them to our educational programs and, of course, our support groups. But people need to have something that they [can] hold onto and have a resource in their households with phone numbers and access lines to help them even get started," Gardner says.
"Taking Care" provides information on those basic questions and NAMI's services — and it's less than 20 pages long.
Alfonso says the booklet is "made to look eye-catching and yet not conspicuous because there still is that stigma" attached to mental illness and obtaining care.
NAMI Washtenaw County distributes the booklet at community health events and general locations like corner stores, grocery stores, and libraries. Alfonso says those common locations are chosen "in the hopes that someone might see it and maybe they're not ready to have that conversation … out in the open about their mental illness, but they might be willing to at least read the booklet."
A digital version of the booklet is also available for free download on NAMI Washtenaw County's website.
According to Alfonso, approximately 3,400 printed copies of the booklet have been given out, and 100 PDF copies have been downloaded, to date.
"People love it," Gardner says. Her team spent a year and a half working on the booklet. "A labor of love, I really call it."
Looking ahead, both Gardner and Alfonso are hoping to focus even more of their attention on outreach efforts.
"I would like to see an expansion of our educational programs to reach a broader cross-section of the community. We're still not reaching people. And our biggest barrier is stigma," Gardner says.
Alfonso says, "Our goal as we continue is to show that not only did we take the feedback and data from the community, but we're really trying to give them something that they can use, that makes it worthwhile for them — because it is an investment. The millage dollars, at the end of the day, are something the community pays for, so we want to be sure that what they get out of it is valuable."
Natalia Holtzman is a freelance writer based in Ann Arbor. Her work has appeared in publications such as the Minneapolis Star Tribune, the Los Angeles Review of Books, Literary Hub, The Millions, and others.
All photos by Doug Coombe.