Peer Leaders Making a Difference in Mental Health

Talking about mental health can be tricky territory for anybody. If you're a kid, it can be even more difficult to find the words, let alone to ask for help for what is often a silent struggle.

And then there's the stigma associated with mental health disorders — a stigma that is often heightened in the socio-economically and racially diverse communities served by the Arthur Ashe Institute for Urban Health (AAIUH) of Brooklyn, New York.

UNICEF USA teamed up with AAIUH in 2020, amid rising concerns about the mental health impacts of the COVID-19 pandemic on young people, to develop Beyond the Stigma: A Collective Conversation on Youth Mental Health and Wellness. The program aims to equip youth — as well as supportive adults — with the tools and knowledge needed to recognize signs of anxiety, depression and emotional trauma and then proactively address them, by seeking help for themselves or providing support to others who may be experiencing something similar. 

A mission to empower and enable youth around mental health support

"Our mission is to empower and enable youth, families and communities to proactively address the mental health and psychosocial support needs of youth, especially as those needs intensified during COVID," says Kenya Kirkman, AAIUH Senior Program Coordinator.

According to the National Alliance for Mental Illness, 1 in 5 teens and young adults in the U.S. lives with a mental health condition. More than 64 percent of youth who suffer from major depression do not receive any mental health treatment, according to Mental Health America. And while emerging data has begun to highlight the adverse effects of the pandemic on mental health and wellness, less is understood about the impact on communities of color — including the diverse communities AAIUH serves and where social determinants and other factors have long contributed to disproportionately poor health outcomes.

Briana, a high school senior in Brooklyn, New York, trained with the Arthur Ashe Institute for Urban Health to be a peer mentor for youth struggling with their mental health. "I want to be a person that someone could rely on if they're ever not feeling okay — to be that ray of sunshine that people need sometimes." © Photo provided courtesy of Briana

After conducting a thorough needs assessment, the partners concluded that innovative strategies to reach more people of color with culturally-tailored health information focused on mental health were sorely needed.

"We want to de-stigmatize mental health, something that is extremely prevalent in communities of color," says Faven Araya, AAIUH Community Engagement & Relations Manager. "The other added layer is that a lot of the folks who we deal with are coming from immigrant households, where culture and tradition and beliefs play a heavy role in how mental health is discussed or not discussed ... The idea is for this to just be the first step of many."

A slide from the Beyond the Stigma workshop presentation designed to educate youth about how to help themselves and others recognize and deal with mental health impacts of COVID-19. "UNICEF USA helped us establish a process for doing a community needs assessment, then developing the content," says Faven Araya, Arthur Ashe Institute for Urban Health Community Engagement & Relations Manager. "It was collaborative, and that's the way we always do our work." © Image provided by AAIUH

As part of the initial assessment, AAIUH surveyed young people and adults between ages 14 and 30 (mean age: 18) in North and Central Brooklyn, the Institute's geographic catchment area and where the population is 75 percent Black or African American and 13.5 percent Latino. The goal was to gauge the prevalence of certain emotions over the past year related to life during COVID-19. Many of the over 130 respondents reported feeling unmotivated, experiencing stress or anxiety, loneliness or isolation, anger or irritability and depression. These findings plus a literature review, informant interviews and focus groups informed the program's curriculum and overall approach.

Working with other community-based organizations and community members with well-established ties to youth, AAIUH has since reached hundreds of young people with information and training through workshops and other enrichment activities, including an introduction to art therapy as a different way to connect. 

"When youth were asked who they went to for support, the majority said their peers or friends," Araya says. "That was the impetus behind establishing these peer-to-peer trainings and workshops."

Josh, 18, of Flatbush, Brooklyn, is one of 21 individuals who trained with AAIUH to be a peer leader.

The other day, two of my friends came to school crying. I used the stuff I learned [from the program] to try to comfort them, and it actually worked. Helping someone feel better, that's very satisfying. — Josh, 18

"I was the type of person who, if someone's going through something, I wouldn't really know what to do — I'd feel uncomfortable when someone was upset, I wouldn't know how to approach them, so I would just leave it alone," Josh told UNICEF USA during a recent phone interview. "But the other day, two of my friends came to school crying. I used the stuff I learned [from the program] to try to comfort them, and it actually worked. Helping someone feel better, that's very satisfying." 

Soon after completing the Beyond the Stigma training, working in teams of four or five, Josh and other peer leaders helped moderate larger group discussions that drew dozens of participants from schools all around New York City. 

One of those peer-led talks took place on a September afternoon on Zoom. More than 70 kids tuned in. Some took turns speaking on camera, while others commented in the chat box — a virtually non-stop stream of engagement for over 90 minutes. 

The workshop curriculum that Arthur Ashe Institute for Urban Health developed in collaboration with UNICEF USA includes active listening skills — a strategy for peer-to-peer mental health support. The stigma that is so often attached to mental health conditions is a major hurdle, AAIUH Senior Program Coordinator Kenya Kirkman explains. "The training is designed to make it easier to have difficult conversations." © Image provided by AAIUH

"It's really important that we come together, especially now as we're transitioning back to in-person learning," Sanan, one of the peer leaders, said to the group. "We might be facing the same struggles or issues. By being here, you're taking the first step toward solving them. That's actually the purpose of this workshop, to create that community where we can share our experiences and really begin our mindfulness and mental health journey — and to show our peers they aren't alone." 

Kirkman was present too, along with a handful of experts and consultants who had contributed to the program's development, standing by to answer any questions.

"We want to make this as safe a space as possible," Kirkman said to the young participants. "We want you to feel comfortable in sharing your lived experiences or your experiences with mental health. And if you don't feel comfortable in sharing, we understand that as well. But we want to make sure that everyone understands that their views are valued and are important to the conversation."

The chat box blew up. Plenty of sharers here, posting about their experiences during quarantine, losing family members to COVID-19, the isolation of virtual school and being cut off from friends, watching the news on TV reporting more and more deaths. "Mentally, it was honestly really terrible," said Briana, another peer mentor co-leading the session, a senior at a Brooklyn high school. Others said they have been feeling overwhelmed, helpless or scared about the future.

"I've learned that it's okay not to be okay," offered Chloe, 16. "It took me a while to come to that."

I've learned that it's okay not to be okay — Chloe, 16

The group explored the meaning of mental health ("includes emotional, psychological, spiritual and social well being") and defined some common mental health challenges, including depression (“a young person is sad, lacks energy and desire”), anxiety ("feelings of fear, helplessness, disappointment and excessive worrying"), insomnia ("problems going to sleep, staying asleep or may experience bad dreams”) and anger (“difficulty controlling your temper and easily upset and annoyed by others”).

Many comments were read aloud by peer leaders or by AAIUH staff. "I really liked the response that talked about mental health as accepting yourself for who you are, especially now as social media has made standards of how you look so high," Sanan said.

Debunking mental health myths and addressing stigma 

A significant amount of workshop time was spent debunking common falsehoods and misconceptions — myths like, it's a sign of weakness to ask for help; that therapy and counseling are only for 'crazy people;" that talking about suicide or asking someone if they feel suicidal will encourage a suicide attempt.

That last one triggered many questions, prompting an expert to weigh in. "Generally, if you feel that someone or think that someone is thinking about suicide, it's always good to ask and to listen — It doesn't encourage the person to do it," Wayne Bleier, a child protection specialist and UNICEF USA consultant on the project, told the group. "Most people who are suicidal want help. So it's really important that if you sense one of your friends is feeling suicidal, that you ask them. And then listen to them."

Stigma that's associated with mental health provoked a lot of input from workshop attendees. Araya pulled highlights from the chat thread: "'As a Nigerian, I was always taught that mental health issues were a weakness of the mind and that seeking help for it would only make me or anyone seem crazy...' Wow. That's powerful. How many of you guys can relate to that? Samantha can: 'I can relate to that coming from an immigrant household as well. It makes you feel less than or inferior.' Yes. We have a couple echoes on that."

A framework for helping someone take action for their mental health

Moderators talked through a framework for taking action known as the P.A.U.S.E. model, a set of practical, tangible steps for supporting oneself and for supporting others, based on a tool developed by BEAM (Black Emotional and Mental Health Collective) based in Culver City, Calif.: 

• Practice active listening without judgment 
• Assess for distress and harm
• Understand and acknowledge the experiences/affirm their feelings are valid
• Seek productive support
• Encourage self-help and other supportive strategies

A key takeaway: Once a young person experiencing mental health challenges feels that they have been heard, it can be easier to offer support and information. More importantly, when providing support to a peer, "don't ever think it's your responsibility to be the guide for that person. What you can do is help them get help."

The "E" portion of P.A.U.S.E., a five-part strategy for how to support someone who may be experiencing stress, anxiety, depression or anger, part of the curriculum developed by the Arthur Ashe Institute for Urban Health in collaboration with UNICEF USA. During peer-moderated workshops, participants discussed what it means to practice self-care and the different forms it can take — specifically mental self-care (“taking care of your mind”) and emotional self-care. © Image provided by AAIUH

AAIUH offers a version of Beyond the Stigma for adults as well, which covers a lot of the same ground but is framed as an effort to strengthen community-based support for young people by enlisting the grownups as important drivers of that support. 

Barbers and hair stylists  playing a key role

Edwin Martinez, a barber in the Brownsville neighborhood in central Brooklyn, has been working with the Arthur Ashe team on various community health initiatives for years — hosting info sessions inside his shop on breastfeeding and other topics, helping to raise awareness about COVID-19 prevention and distribute PPE once the pandemic hit. He was among the first to sign up for training in "how to help a young person in your life," and has since helped recruit others to do it as well. 

"The cool thing about being a barber is, everybody stops at the barbershop," Martinez told UNICEF USA during a recent interview outside the Hair Creations salon on Mother Gaston Blvd. where he works. "In our community, it can be hard to get people to connect, but people come here and they connect to their barber or their stylist. People want to look good. Trust is built here."

Being well known in the neighborhood and having that trust, Martinez says, creates an opportunity for him to help. "Mental health is super stigmatized, and it's easy to write someone off or ignore them if they're angry all the time," he says. "I can help direct people, if they ask. I can make suggestions, tell people about Arthur Ashe — the Institute is awesome! — and their resources. I see myself as a mediator between professionals and a community that trusts me. You trust me because you’ve known me for years, I trust them because they bring accurate information, helpful information, information that is tailored to our community's needs."

According to the guidance from AAIUH, the role of the youth mental health supporter is to provide a listening ear, and to provide accurate, up-to-date information on available services and let the individual make their own choices. As the workshop presentation puts it: "When providing mental and emotional support, our duty is to respect and protect the rights and needs of all persons, not make assumptions or judgments."

Edwin Martinez, a barber in the Brownsville neighborhood of Brooklyn, New York, helped recruit others for AAIUH's youth mental health support training. "Everybody stops at the barbershop," Martinez says. "Trust is built here." © Photo by Maryanne Buechner for UNICEF USA

For UNICEF USA, Beyond the Stigma is part of a broader undertaking aimed at strengthening resilience and building capacity for mental health and well-being of children and families in vulnerable communities in response to the effects of COVID-19. UNICEF USA has invested in a number of initiatives in the U.S., including partnering with Johns Hopkins Center for American Indian Health to develop a psychological first aid training guide for frontline and essential workers adapted for indigenous communities.

"From UNICEF USA’s perspective, the opportunity to engage youth in addressing the mental health of their peers is very significant and core to our domestic engagement strategy,” says Edison Sabala, UNICEF USA's Director of Humanitarian Response & Impact Partnerships. “It is our mission to empower young people to be part of the solution — in this instance, having youth engage in responding to the needs of their peers as a consequence of COVID. The Arthur Ashe Institute serves a population that has been disproportionately impacted by the pandemic — ethnic communities where there are often barriers to accessing health care and mental health care services. We are really proud to be able to help vulnerable children in New York.” 

UNICEF USA's efforts align closely with UNICEF's global humanitarian work, where mental health and psychosocial support for children has long been a pillar of emergency response — including the global COVID-19 response — and health and social system strengthening. Meanwhile, evidence of the pandemic's impact on children's emotional well-being continues to mount: a new study published in The Lancet found that the pandemic was responsible for 53 million more cases of major depressive disorder — a 28 percent increase — and 76 million additional cases of anxiety disorder — a 26 percent jump — across 204 countries in 2020.

A comment posted during a recent virtual youth mental health workshop co-moderated by a group of peer mentors trained by the Arthur Ashe Institute for Urban Health with curriculum developed in collaboration with UNICEF USA. © Image provided by Maryanne Buechner 

With the first cohort of peer mentors trained and a round of workshops completed, Kirkman says AAIUH is planning to expand its curriculum and its program activities around youth mental health and psychosocial support, including additional workshops with other community groups, including churches and other faith-based organizations. Closer collaboration with schools is another goal.

“We've essentially provided a platform for kids to talk about their mental health, and hopefully they will continue to talk about these issues, and to more proactively engage with their peers and support each other using skills they've learned," she says. "Now we need to figure out how best to keep pushing it forward — to keep the conversation going."

Juzette, 15, a peer leader, photographed outside her school in The Bronx, New York. After a "sad, lonely and hectic" time quarantining with her two younger sisters, Juzette says she jumped at the chance to participate in the Arthur Ashe mental health support training. "I felt like I could really use some strategies to move me forward." © Photo provided courtesy of Juzette

Briana, for one, is taking her role as a peer leader seriously. "I want to be a person that someone could rely on if they're ever not feeling okay — to be that ray of sunshine that people need sometimes."

Fifteen-year-old Juzette is also committed to doing her part. "I want to be the person I needed when I was going through my own mental struggles," she says. "I want to be the person I needed for myself." 

Beyond the Stigma: A Collective Conversation on Youth Mental Health and Wellness, is an initiative co-developed by UNICEF USA and the Arthur Ashe Institute for Urban Health and implemented by AAIUH in partnership with several New York City-based community and youth organizations. To learn more about AAIUH, visit arthurasheinstitute.org

Learn more about how COVID-19 has impacted youth mental health globally from the 2021 edition of UNICEF's State of the World's Children report, On My Mind: Promoting, protecting and caring for children's mental health.

Support UNICEF's crosscutting work in children's and adolescent mental health — a critical part of UNICEF's mission to save and protect vulnerable children around the world. Donate today. 

Top photo: Josh, 18, of Brooklyn, New York, is one of 21 peer leaders trained by the Arthur Ashe Institute for Urban Health using a new curriculum developed in collaboration with UNICEF USA. Training focused on teaching mentors how to engage and empower their peers as a way to proactively address mental health in their own communities. The Institute recruited youth from various neighborhoods in Central Brooklyn and elsewhere, mainly high school students already involved in other community-based programs run by three local organizations: Flatbush Leadership Academy, a community service organization; Health Science Academy, an afterschool science enrichment program; and Kings Against Violence Initiative, a nonprofit that specializes in youth violence interventions. When it comes to connecting with youth and building youth-oriented networks of support, AAIUH Senior Program Coordinator Kenya Kirkman says, "these partnerships are essential."© Photo by Kenya Kirkman for UNICEF USA