The handwritten doctor’s order was just eight words long, but it solved a problem for Dundee Manor, a nursing home in rural South Carolina struggling to handle a new resident with severe dementia.
David Blakeney, 63, was restless and agitated. The home’s doctor wanted him on an antipsychotic medication called Haldol, a powerful sedative.
“Add Dx of schizophrenia for use of Haldol,” read the doctor’s order, using the medical shorthand for “diagnosis.”
But there was no evidence that Mr. Blakeney actually had schizophrenia.
Antipsychotic drugs — which for decades have faced criticism as “chemical straitjackets” — are dangerous for older people with dementia, nearly doubling their chance of death from heart problems, infections, falls and other ailments. But understaffed nursing homes have often used the sedatives so they don’t have to hire more staff to handle residents.
one in 150 people.
Schizophrenia, which often causes delusions, hallucinations and dampened emotions, is almost always diagnosed before the age of 40.
“People don’t just wake up with schizophrenia when they are elderly,” said Dr. Michael Wasserman, a geriatrician and former nursing home executive who has become a critic of the industry. “It’s used to skirt the rules.”
refuge of last resort for people with the disorder, after large psychiatric hospitals closed decades ago.
But unfounded diagnoses are also driving the increase. In May, a report by a federal oversight agency said nearly one-third of long-term nursing home residents with schizophrenia diagnoses in 2018 had no Medicare record of being treated for the condition.
hide serious problems — like inadequate staffing and haphazard care — from government audits and inspectors.
One result of the inaccurate diagnoses is that the government is understating how many of the country’s 1.1 million nursing home residents are on antipsychotic medications.
According to Medicare’s web page that tracks the effort to reduce the use of antipsychotics, fewer than 15 percent of nursing home residents are on such medications. But that figure excludes patients with schizophrenia diagnoses.
To determine the full number of residents being drugged nationally and at specific homes, The Times obtained unfiltered data that was posted on another, little-known Medicare web page, as well as facility-by-facility data that a patient advocacy group got from Medicare via an open records request and shared with The Times.
The figures showed that at least 21 percent of nursing home residents — about 225,000 people — are on antipsychotics.
The Centers for Medicare and Medicaid Services, which oversees nursing homes, is “concerned about this practice as a way to circumvent the protections these regulations afford,” said Catherine Howden, a spokeswoman for the agency, which is known as C.M.S.
“It is unacceptable for a facility to inappropriately classify a resident’s diagnosis to improve their performance measures,” she said. “We will continue to identify facilities which do so and hold them accountable.”
significant drop since 2012 in the share of residents on the drugs.
But when residents with diagnoses like schizophrenia are included, the decline is less than half what the government and industry claim. And when the pandemic hit in 2020, the trend reversed and antipsychotic drug use increased.
A Doubled Risk of Death
For decades, nursing homes have been using drugs to control dementia patients. For nearly as long, there have been calls for reform.
In 1987, President Ronald Reagan signed a law banning the use of drugs that serve the interest of the nursing home or its staff, not the patient.
But the practice persisted. In the early 2000s, studies found that antipsychotic drugs like Seroquel, Zyprexa and Abilify made older people drowsy and more likely to fall. The drugs were also linked to heart problems in people with dementia. More than a dozen clinical trials concluded that the drugs nearly doubled the risk of death for older dementia patients.
11 percent from less than 7 percent, records show.
The diagnoses rose even as nursing homes reported a decline in behaviors associated with the disorder. The number of residents experiencing delusions, for example, fell to 4 percent from 6 percent.
A Substitute for Staff
Caring for dementia patients is time- and labor-intensive. Workers need to be trained to handle challenging behaviors like wandering and aggression. But many nursing homes are chronically understaffed and do not pay enough to retain employees, especially the nursing assistants who provide the bulk of residents’ daily care.
Studies have found that the worse a home’s staffing situation, the greater its use of antipsychotic drugs. That suggests that some homes are using the powerful drugs to subdue patients and avoid having to hire extra staff. (Homes with staffing shortages are also the most likely to understate the number of residents on antipsychotics, according to the Times’s analysis of Medicare data.)
more than 200,000 since early last year and is at its lowest level since 1994.
As staffing dropped, the use of antipsychotics rose.
Even some of the country’s leading experts on elder care have been taken aback by the frequency of false diagnoses and the overuse of antipsychotics.
Barbara Coulter Edwards, a senior Medicaid official in the Obama administration, said she had discovered that her father was given an incorrect diagnosis of psychosis in the nursing home where he lived even though he had dementia.
“I just was shocked,” Ms. Edwards said. “And the first thing that flashed through my head was this covers a lot of ills for this nursing home if they want to give him drugs.”
Homes that violate the rules face few consequences.
In 2019 and 2021, Medicare said it planned to conduct targeted inspections to examine the issue of false schizophrenia diagnoses, but those plans were repeatedly put on hold because of the pandemic.
In an analysis of government inspection reports, The Times found about 5,600 instances of inspectors citing nursing homes for misusing antipsychotic medications. Nursing home officials told inspectors that they were dispensing the powerful drugs to frail patients for reasons that ranged from “health maintenance” to efforts to deal with residents who were “whining” or “asking for help.”
a state inspector cited Hialeah Shores for giving a false schizophrenia diagnosis to a woman. She was so heavily dosed with antipsychotics that the inspector was unable to rouse her on three consecutive days.
There was no evidence that the woman had been experiencing the delusions common in people with schizophrenia, the inspector found. Instead, staff at the nursing home said she had been “resistive and noncooperative with care.”
Dr. Jonathan Evans, a medical director for nursing homes in Virginia who reviewed the inspector’s findings for The Times, described the woman’s fear and resistance as “classic dementia behavior.”
“This wasn’t five-star care,” said Dr. Evans, who previously was president of a group that represents medical staff in nursing homes. He said he was alarmed that the inspector had decided the violation caused only “minimal harm or potential for harm” to the patient, despite her heavy sedation. As a result, he said, “there’s nothing about this that would deter this facility from doing this again.”
Representatives of Hialeah Shores declined to comment.
Seven of the 52 homes on the inspector general’s list were owned by a large Texas company, Daybreak Venture. At four of those homes, the official rate of antipsychotic drug use for long-term residents was zero, while the actual rate was much higher, according to the Times analysis comparing official C.M.S. figures with unpublished data obtained by the California advocacy group.
make people drowsy and increases the risk of falls. Peer-reviewed studies have shown that it does not help with dementia, and the government has not approved it for that use.
But prescriptions of Depakote and similar anti-seizure drugs have accelerated since the government started publicly reporting nursing homes’ use of antipsychotics.
Between 2015 and 2018, the most recent data available, the use of anti-seizure drugs rose 15 percent in nursing home residents with dementia, according to an analysis of Medicare insurance claims that researchers at the University of Michigan prepared for The Times.
in a “sprinkle” form that makes it easy to slip into food undetected.
“It’s a drug that’s tailor-made to chemically restrain residents without anybody knowing,” he said.
In the early 2000s, Depakote’s manufacturer, Abbott Laboratories, began falsely pitching the drug to nursing homes as a way to sidestep the 1987 law prohibiting facilities from using drugs as “chemical restraints,” according to a federal whistle-blower lawsuit filed by a former Abbott saleswoman.
According to the lawsuit, Abbott’s representatives told pharmacists and nurses that Depakote would “fly under the radar screen” of federal regulations.
Abbott settled the lawsuit in 2012, agreeing to pay the government $1.5 billion to resolve allegations that it had improperly marketed the drugs, including to nursing homes.
Nursing homes are required to report to federal regulators how many of their patients take a wide variety of psychotropic drugs — not just antipsychotics but also anti-anxiety medications, antidepressants and sleeping pills. But homes do not have to report Depakote or similar drugs to the federal government.
“It is like an arrow pointing to that class of medications, like ‘Use us, use us!’” Dr. Maust said. “No one is keeping track of this.”
published a brochure titled “Nursing Homes: Times have changed.”
“Nursing homes have replaced restraints and antipsychotic medications with robust activity programs, religious services, social workers and resident councils so that residents can be mentally, physically and socially engaged,” the colorful two-page leaflet boasted.
Last year, though, the industry teamed up with drug companies and others to push Congress and federal regulators to broaden the list of conditions under which antipsychotics don’t need to be publicly disclosed.
“There is specific and compelling evidence that psychotropics are underutilized in treating dementia and it is time for C.M.S. to re-evaluate its regulations,” wrote Jim Scott, the chairman of the Alliance for Aging Research, which is coordinating the campaign.
The lobbying was financed by drug companies including Avanir Pharmaceuticals and Acadia Pharmaceuticals. Both have tried — and so far failed — to get their drugs approved for treating patients with dementia. (In 2019, Avanir agreed to pay $108 million to settle charges that it had inappropriately marketed its drug for use in dementia patients in nursing homes.)
‘Hold His Haldol’
Ms. Blakeney said that only after hiring a lawyer to sue Dundee Manor for her husband’s death did she learn he had been on Haldol and other powerful drugs. (Dundee Manor has denied Ms. Blakeney’s claims in court filings.)
During her visits, though, Ms. Blakeney noticed that many residents were sleeping most of the time. A pair of women, in particular, always caught her attention. “There were two of them, laying in the same room, like they were dead,” she said.
In his first few months at Dundee Manor, Mr. Blakeney was in and out of the hospital, for bedsores, pneumonia and dehydration. During one hospital visit in December, a doctor noted that Mr. Blakeney was unable to communicate and could no longer walk.
“Hold the patient’s Ambien, trazodone and Zyprexa because of his mental status changes,” the doctor wrote. “Hold his Haldol.”
Mr. Blakeney continued to be prescribed the drugs after he returned to Dundee Manor. By April 2017, the bedsore on his right heel — a result, in part, of his rarely getting out of bed or his wheelchair — required the foot to be amputated.
In June, after weeks of fruitless searching for another nursing home, Ms. Blakeney found one and transferred him there. Later that month, he died.
“I tried to get him out — I tried and tried and tried,” his wife said. “But when I did get him out, it was too late.”
In 2010, Accenture scored an accounting contract with Facebook. By 2012, that had expanded to include a deal for moderating content, particularly outside the United States.
That year, Facebook sent employees to Manila and Warsaw to train Accenture workers to sort through posts, two former Facebook employees involved with the trip said. Accenture’s workers were taught to use a Facebook software system and the platform’s guidelines for leaving content up, taking it down or escalating it for review.
What started as a few dozen Accenture moderators grew rapidly.
By 2015, Accenture’s office in the San Francisco Bay Area had set up a team, code-named Honey Badger, just for Facebook’s needs, former employees said. Accenture went from providing about 300 workers in 2015 to about 3,000 in 2016. They are a mix of full-time employees and contractors, depending on the location and task.
The firm soon parlayed its work with Facebook into moderation contracts with YouTube, Twitter, Pinterest and others, executives said. (The digital content moderation industry is projected to reach $8.8 billion next year, according to Everest Group, roughly double the 2020 total.) Facebook also gave Accenture contracts in areas like checking for fake or duplicate user accounts and monitoring celebrity and brand accounts to ensure they were not flooded with abuse.
After federal authorities discovered in 2016 that Russian operatives had used Facebook to spread divisive posts to American voters for the presidential election, the company ramped up the number of moderators. It said it would hire more than 3,000 people — on top of the 4,500 it already had — to police the platform.
“If we’re going to build a safe community, we need to respond quickly,” Mr. Zuckerberg said in a 2017 post.
The next year, Facebook hired Arun Chandra, a former Hewlett Packard Enterprise executive, as vice president of scaled operations to help oversee the relationship with Accenture and others. His division is overseen by Ms. Sandberg.
Ms. Whittome, whose father is of Punjabi heritage, has been an outspoken advocate for many causes, from social justice to women’s rights, a role that has sometimes drawn criticism from those on the other end of the political spectrum. After activism during widespread protests against a controversial policing bill earlier this year and the Black Lives Matter protests last year, she detailed a torrent of abuse.
In an interview with the news outlet The Independent last year, she spoke of the hate mail and racist abuse on social media that had become the norm, and of having to report a series of death threats to the police.
The abuse she detailed, particularly on social media, has become typical for many women in Parliament. Female lawmakers, and in particular women of color in Parliament, have long faced abuse, both online and in person, at a disproportionately higher rate than their male counterparts, reports have shown. Before the last general election in 2019, in which Ms. Whittome won her seat, some women chose not to stand in the election, citing the abuse.
Her office is still open and staff are still working while she takes leave.
And while the details behind Ms. Whittome’s trauma were not given, her frank discussion of her mental health struggle also highlights a broader issue, mental health experts said.
David Crepaz-Keay, the head of applied learning at Britain’s Mental Health Foundation, a charity that has been carrying out a nationwide study of the pandemic’s impact on mental health since early last year, said it was also indicative of a shift in public discourse.
“We’ve noticed a huge change in the kind of broader public willingness to engage in talking about mental health, even over the last five years,” he said, pointing to society’s long history associating shame and disgrace with mental illness.
But more recently, public acknowledgment of mental illness — including by other members of the British Parliament and lawmakers elsewhere like Kjell Magne Bondevik, who took a leave of absence as prime minister of Norway in 1998 and spoke openly about his depression — has helped to normalize the struggle.
“I’m going to be vulnerable,” he said about sharing details on his mental health. “If I get attacked for it, let’s see who’s attacking me.”
In the interview with Ms. Winfrey in March, Meghan also shared her mental health battles, saying that she had struggled with suicidal thoughts when she was part of the royal family. Last year, she shared the trauma of miscarriage in an essay published in The New York Times.
Symptoms of depression and anxiety have been on the rise in many countries since the beginning of the coronavirus crisis, and Harry said that it was important to talk about the feelings caused by the pandemic.
“We’re now in the emotional phase,” Harry said, making reference to a Times article about the feeling of languishing. “You just feel flat. It’s not depressed, it’s definitely not flourishing,” Harry said. “You lack the energy and the will, your motivation, because you sit and wonder, ‘What happens next?’”
Harry said efforts like founding the Invictus Games, a sports event first staged in 2014 that showcases the talents of wounded servicemen and women, had helped him deal with his own mental health problems. “If we’re looking after our body and our body gets injured, what do we do when our mind gets injured?” he said.
About moving to the United States, Harry said “that wasn’t the plan.”
But, he added, “Sometimes you have to make decisions and bring your family first, and put your mental health first.”
And, once again, Harry was asked if he had seen the Netflix series “The Crown.”
CVS, which merged with the insurance provider Aetna three years ago, aims to reduce overall health costs with its mental health pilot program, Dr. Knecht said. Mental health issues that are not addressed become crises, he added, “so our aspiration is to make mental health services accessible and locally available so we can address these issues before they continue to expand and result in substantial morbidity and poor outcomes.”
Removing obstacles to mental health care by making providers more accessible is helpful, said Vaile Wright, senior director of health care innovation at the American Psychological Association, “but they are never the No. 1 barrier to accessing treatment,” she said. “Cost is.”
Psychiatrists are less likely to take insurance than other types of physicians, and many psychologists, social workers and others who offer therapy likewise decline insurance because they say payments by insurers are relatively low and managed care companies sometimes subject them to intrusive audits.
The mental health services provided by the CVS MinuteClinics are covered by many major health insurers and Employee Assistance Program plans, a spokeswoman said.
“Pricing options without insurance range between $129 for an initial assessment to $69 for a 30-minute session, with many options in between,” she added.
At Walmart, the initial therapy session is $60 and the 45-minute follow-up sessions cost $45, according to the company’s website.
If you’re considering using a retail location to receive therapy, be sure to ask the same questions you would of any new therapist, experts advise. Some examples include:
Where were you trained?
What kind of license do you have?
What is your specialty?
How will we monitor my progress?
How long will my session last, and how many sessions are available to me?
Is there follow-through if I need a referral?
How much will this cost?
How will my data be stored and shared?
In addition, if you identify as L.G.B.T. or are a member of another minority group — or if you already know that you suffer from a particular condition like anxiety or depression — it’s helpful to know whether the therapist has worked with similar populations in the past and whether they have had cultural competence training, said Alfiee Breland-Noble, a health disparities researcher and founder of the AAKOMA Project, a mental health nonprofit for teenagers and their families.
Inside a state-of-the-art lab, tucked in an industrial neighborhood on Vancouver Island in British Columbia, employees wearing protective suits move around two clear boxes, careful not to disrupt the tubes and sensors that keep temperature and humidity constant. Inside the boxes are mushrooms.
But not just any mushrooms. They are psychedelic — “magic” — mushrooms that the start-up Numinus Wellness believes one day may be used to treat mental health conditions as varied as depression, substance abuse and anxiety.
Welcome to the ’Shroom Boom. While Numinus is using mushrooms to make mind-altering therapies, other mushroom growers are promising other benefits, like strengthening immune systems or reducing inflammation. Mushrooms are showing up in all sorts of wellness products, pushing them into the mainstream and making mushrooms a major force in the flourishing, multibillion-dollar wellness market.
legalize psilocybin, the main active ingredient in “magic” mushrooms, for the treatment of certain mental health conditions in supervised settings. In March, the New York City mayoral candidate Andrew Yang said New York State should legalize psychedelic mushrooms, a stance he raised in 2019 when he was a Democratic presidential candidate.
Regulators in the United States and Canada are taking baby steps toward allowing limited use of psychedelic mushrooms, which produce visual and auditory hallucinations over a few hours after ingestion, for the treatment of certain mental health conditions. Popular as part of the counterculture in the 1960s, magic mushrooms were deemed illegal in the United States in the 1970s.
public offering. Another psychedelic company, MindMed, has financial backing from Kevin O’Leary of “Shark Tank.”
New York in March. But some analysts and many of the companies themselves caution that the path for psychedelics will most likely be very different.
study by researchers at Johns Hopkins Medicine that found use of psilocybin relieved anxiety and depression in people with a life-threatening cancer diagnosis. A second, small study involving 24 participants conducted by Johns Hopkins researchers that was published in JAMA Psychiatry found that those who received psilocybin-assisted therapy showed improvement as well.
“The magnitude of the effect we saw was about four times larger than what clinical trials have shown for traditional antidepressants on the market,” Alan Davis, adjunct assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, said in an announcement about the study’s results.
The Food and Drug Administration has put at least two psychedelic mushroom compounds on the fast track for approval to treat depression.
Last year, Canada began allowing a limited number of people with terminal illness to use psychedelic mushrooms. Currently, Numinus is working toward a psilocybin-assisted therapy trial for patients with substance abuse disorders.
And while regulators in the United States are taking a new look at psychedelic mushrooms, psilocybin is still a Schedule 1 drug and would need to be reclassified by regulators.
Despite those hurdles, though, Mr. Nyquvest sees the potential for a broader use of psychedelic mushrooms around wellness, beyond what he called “treating really heavy indicators” of substance abuse and depression.
“The same way you go to the dentist to take care of the teeth, we need to think about taking care of the brain and mental well being.”
PARIS — The highest court in France has ruled that the man who killed a Jewish woman in 2017 in an anti-Semitic frenzy cannot stand trial because he was in a state of acute mental delirium brought on by his consumption of cannabis.
Kobili Traoré, who has admitted to the killing and is in a psychiatric institution, beat Sarah Halimi, 65, before throwing her out the window of her Paris apartment to cries of “Allahu akbar,” or God is great, and “I killed the devil.”
Mr. Traoré, who was 27 at the time, had been troubled by Ms. Halimi’s mezuza, which “amplified the frantic outburst of hate,” according to one psychiatric report.
The verdict, more than four years after the killing, ended judicial proceedings in France for the case. The verdict came after a lower-court ruling rejected a trial, and the Halimi family appealed. President Emmanuel Macron made an unusual personal intervention by calling for the case to have its day in court. Outrage in the large French Jewish community has accompanied the long failure to try Mr. Traoré.
Mireille Knoll was stabbed to death in her Paris apartment in what the prosecutor’s office called a killing tied to the “victim’s membership, real or supposed, of a particular religion.” In this case, the nature of the killing — a hate crime — was quickly recognized.
French Jews have been repeatedly targeted by jihadists over the past decade. In 2012, an Islamist gunman, Mohammed Merah, shot dead three children and a teacher at a Jewish school in the southern city of Toulouse. In 2015, Amedy Coulibaly identified customers as Jews at a kosher Paris supermarket before killing four of them. He declared he was murdering the people he hated most in the world: “the Jews and the French.”
Mr. Macron, sensitive to anger in the Jewish community at lone-wolf explanations of the violence, and at hesitation in some French media to use the words “anti-Semitic” in describing the crimes, said in January last year that the Halimi case “needs a trial.” He was widely rebuked for failing to respect the independence of the justice system.
Criticism has mounted over the law that has allowed Mr. Traoré to avoid trial. “It is possible to consider that the current law is unsatisfactory,” said Sandrine Zientara, one of the public prosecutors in the case. “Its application has led here to complete impunity.”
The outcome in the Halimi case, she said, had been met by “a great deal of incomprehension.”
Dozens of senators, reacting to the case, have proposed a revision of the law to the effect that psychic disturbance cannot exonerate someone whose troubled mental state is induced by a narcotic.
Of three psychiatric reports on Mr. Traoré, two said he could not appear in court because his capacity for discernment at the time of the crime had been “eliminated” by his delirious mental state. The third, by Daniel Zagury, said his mental state had only been “altered” and so he could be tried.
“The crime of Mr. Traoré is a frenzied, anti-Semitic act,” Mr. Zagury wrote.
Shimon Samuels, the Simon Wiesenthal Center’s director for international relations, called the verdict a “devastating blow,” which, he argued, “potentially creates a precedent for all hate criminals to simply claim insanity or decide to smoke, snort or inject drugs or even get drunk before committing their crimes.”
LONDON — Sunny, driven and with a new engineering master’s degree in hand, Joshua Morgan was hopeful he could find a job despite the pandemic, move out of his mother’s house and begin his life.
But as lockdowns in Britain dragged on and no job emerged, the young man grew cynical and self-conscious, his sister Yasmin said. Mr. Morgan felt he could not get a public-facing job, like working at a grocery store, because his mother, Joanna, had open-heart surgery last year, and Mr. Morgan was “exceptionally careful” about her health.
He and his mother contracted the coronavirus in January, forcing them to quarantine in their small London apartment for over two weeks. Concerned by things he was saying, friends raised the alarm and referred him to mental health services.
But days before the end of his quarantine last month, Mr. Morgan, 25, took his own life. “He just sounded so deflated,” his sister said of their last conversation, adding that he said he felt imprisoned and longed to go outside.
Japan saw a spike in suicide among women last year, and in Europe mental health experts have reported a rise in the number of young people expressing suicidal thoughts. In the United States, many emergency rooms have faced surges in admissions of young children and teenagers with mental health issues.
Mental health experts say prolonged symptoms of depression and anxiety may prompt risky behaviors that lead to self-harm, accidents, or even death, especially among young people.
weigh the risks of depression if they impose new virus restrictions. And public health officials in some areas that have seen a surge of adolescent suicides have pushed for schools to reopen, although researchers say it is too early to conclusively link restrictions to suicide rates.
June CDC survey found that younger adults, along with ethnic minorities and essential workers, experienced increased substance use and suicidal ideation.
“Imagine a young person in a small room, who takes their course online and has limited social life due to restrictions,” said Fabrice Jollant, a professor of psychiatry at the University of Paris. “They may be tempted to consume more drugs or drink more alcohol, and may have less physical activity, all of which can contribute to symptoms of depression, anxiety and poor sleep.”
For Pepijn Remmers, such temptations had tragic consequences.
Pepijn, 14, greeted lockdown restrictions last spring with positive energy. An adventurous and sociable teenager, he picked up piano playing and would slip under the fence of the local soccer pitch on the outskirts of Amsterdam in the afternoons to play with his best friend, Thijs.
But as the pandemic dragged on, Pepijn struggled to focus and online classes became too “booooring,” he told his parents. New restrictions in the fall stopped the soccer.
He began to take drugs in October, according to his father, Gaston Remmers, and his exercising routine waned in December. As his sleep patterns began to change, his parents took him to a therapist.
Papyrus, saw its calls increase by 25 percent, in line with an increase of about 20 percent each year.
It is unclear, the organization says, whether this is a sign of more people experiencing more suicidal thoughts or symptoms of mental health issues, or if people now feel more comfortable reaching out for help.
Lily Arkwright confided in her friend and housemate Matty Bengtsson. A 19-year-old history student at Cardiff University, Lily was self-confident, outgoing and charismatic in public, her friends and family said, but as she went back to school in September, she began to struggle with the effects of lockdown.
She also became more withdrawn, Mr. Bengtsson said.
One evening in October, as Mr. Bengtsson and Ms. Arkwright were getting ready to see some friends, she grew upset and called her mother to say that she was coming home, Mr. Bengtsson said.
Ms. Arkwright took her own life there, a day after the birthday of her brother, one of her closest confidants.
“Lockdown put Lily in physical and emotional situations she would never have in normal times,” said Lily’s mother, Annie.
Ms. Arkwright said she hoped that growing concerns about young people’s mental health during the pandemic would prompt more of them to share their struggles and seek help.
“It’s OK for a young child to fall over and let their parents know that their knee hurts,” Ms. Arkwright said. “This same attitude needs to be extended to mental health.”
But though stigma around discussing mental health has lessened, society, too, needs to normalize talking about suicide, said Ged Flynn, chief executive of Papyrus, adding that the more comfortable people were with the subject, “the less we need help lines like us.”
People should be praised for adapting and finding resilience during these difficult times, Mr. Flynn said. “Even the need to reach out to a help-line shows resilience,” he said, adding that considering the circumstances, many people were doing “really well.”
For Mr. Morgan’s friends, the loss of a man they called confident and kind has given them a resolve. “Josh always said: One day he’s going to make it,” said his friend Sandy Caulee, 25. “At least we will — for him.”
This is not news to those who are prominent in beauty culture. After all, they’re often famous because of social media, and when they choose to make a beauty line, it’s not just about cashing in — most of the time they feel insecure, and they use cosmetics to help themselves feel better and want to share those to make others feel better too. But this becomes a vicious cycle, and it’s hard to step back.
Michelle Phan, an early influencer and Ipsy co-founder, confused the beauty community when she stopped posting online in 2015. Two years later, she restarted her makeup line, Em Cosmetics, which she bought back from L’Oréal, and sold her stake in Ipsy. “Once, I was a girl with dreams, who eventually became a product, smiling, selling and selling,” she said in a 2017 video explaining her departure. “Who I was on camera and who I was in real life began to feel like strangers.” She added: “My insecurities got the worse of me. I became imprisoned by my own vanity and was never satisfied with how I looked. The life I led online was picture perfect. But in reality, I was carefully curating the image of a life I wanted, not had.”
Working within the system, Rae was trying to address the way that she was also torn apart by a lot of the same concern over her looks that other people had. She even built vulnerability into the branding of her makeup line. Last year, Rae and Item sold a round, orange-colored compact, and when you opened it, it had a mirror with the words “I love you say it back.” This was a riff on a popular meme, a standard-issue message of girlboss empowerment but also an acknowledgment of widespread insecurity that Rae, and the person buying the compact, might feel.
I thought that was sweet, but an intimate relationship with the idol was also what the consumer was demanding. A display of insecurity from Rae, or at least an acknowledgment that Rae might look in the same mirror and need a jolt of confidence the same way the consumer does, may be part of that. “Relatability is the No. 1 thing that makes people click ‘check out,’” Sarah Brown told me.
It was hard to tell whether Rae was truly insecure or simply using a marketing tactic to gain fans. “Everybody is insecure about their bodies, and the more our culture gets visual, the more insecure we’ll all get, and it doesn’t matter how you look objectively one bit,” Widdows, the philosopher, told me. “So it’s not implausible to think even the most beautiful celebrities might also be insecure. In fact, it’s very plausible to think they are. But to say that they suddenly stopped being insecure because they put their own lipstick on, I find much less plausible.”
Still, the psychological flytrap in this kind of rhetoric — “I want you to know your body is perfect even though you’re buying this product to look like me, and I am insecure about my looks” — was powerful, and stars other than Rae were gesturing to it as well. When I asked Camberos, the beauty executive, where he saw beauty culture today and where it was going, he said it was connected to the issue of mental health. Rae told British Glamour that she felt she was in a good place regarding her appearance lately and quoted the saying “Comparison is the thief of joy.” When asked about what she was proudest of, though, Rae said, “Just staying mentally healthy has been a really big accomplishment for me.”
It was a bit chilling to think about linking these two things, a beauty brand and mental health, especially as our era of global pandemic comes to a close and we emerge in the light, blinking, looking to create new idols. In September, Selena Gomez, who has been open about her bipolar disorder, introduced her own line, Rare Beauty. In marketing efforts, the company, which offers soft concealers, foundations and blushers, vowed that “we will use makeup to shape positive conversations around beauty, self-acceptance and mental health.” And shortly before the musician Halsey began promoting her new makeup line in early 2021, she chose to post an old photo of her emaciated body on Instagram, explaining that she suffered from an eating disorder. Kylie, too, recently put a saying from a self-help author on her Instagram — “may the dark thoughts, overthinking, and doubt exit your mind right now,” it read in part — along with a photo of a bathtub and naked legs, slightly covered in suds, against which rested a clear pink bottle from her skin-care line.
Oprah Winfrey’s interview with Meghan and Harry has clearly become a spark for international discussions about racism and the state of Britain’s royal family. And it has brought new attention to another issue as well.
Meghan’s revelation of her mental anguish during and after her first pregnancy, including thoughts of suicide so significant that she feared being left alone — and that the palace had been a barrier to the help she needed — sounded painfully familiar for many.
The experience of life-threatening pregnancy complications, mental as well as physical, is strikingly common. If it has not happened to you, it has almost certainly happened to someone you care about, though you may not know it.
Twitter was soon filled with people sharing their own stories of depression, anxiety and suicidal thoughts during and after pregnancy.
2017 survey of 1,000 British women, nearly 50 percent of respondents reported experiencing a mental or emotional problem, but half of these had not had this problem identified by a health professional.
Meghan did not say whether she had been diagnosed with peripartum depression or any other condition. But experts increasingly advocate extending specialist care to women who experience serious distress during or after pregnancy, whether or not they fit a specific diagnosis.
“Some researchers have suggested that we should, rather than looking at particular diagnostic categories, refer instead to ‘perinatal distress’ to encompass the complexity of the difficulties experienced at this time,” Dr. Svanberg said.
The stakes, after all, are extremely high. Pregnant people risk stroke, hemorrhage, infection and other complications that can be deadly for parent and baby. But mental distress is one of the most serious risks of all. In developed countries, suicide “is a leading cause of death in the perinatal period (The leading cause of death in 2003),” Dr. Svanberg wrote.
Discussions of pregnancy and mental health often focus on pregnancy hormones’ effect on mood. But while that is a factor, there is substantial evidence that other stressors play a role as well — so much so that approximately 10 percent of fathers also experience postpartum depression.
four times higher than for white women, and studies have shown that medical workers tend to underestimate Black women’s pain during birth, which can deprive them of the medication and care they need.
The popular image of pregnancy as something happy and straightforward, troubled only by cute problems like wanting to put pickles on ice cream, or brief ones like a painful natural delivery, can mean that those who have more difficult pregnancies can face stigma and dismissal if they ask for help.
“At the root of barriers to maternal mental health care are gender stereotypes that promote the idea that women should be ‘self-sacrificing mothers,’ who ought to prioritize the purported needs of their families and children even over their own survival and well-being,” said Ms. Shah, who has worked on reproductive and maternity rights issues around the globe. “These stereotypes lead to stigmatization of health care for pregnant women or mothers who experience depression or anxiety, rather than only joy or contentment.”
“There is also an assignation of blame, that there must be something wrong in what we are doing if we are not feeling 100 percent,” Dr. Agarwal said. “Women are also made to feel guilty about being frail, overemotional and nervy.”
Although some in the British news media have criticized Meghan for claiming victimhood despite her wealth and privilege, many of those with more firsthand experience saw her story as a sign that these problems could happen to anyone, no matter the circumstances.
Ms. Molyneux said that she was moved to hear Meghan speak so frankly during the interview. “I felt a big wave of relief wash over me to see this incredibly accomplished person admit she’d had mental health struggles,” she said.
“For people who are less privileged than me, women in jobs where it’s less safe to admit you are struggling, they can point to this person who has wealth and privilege — a literal duchess — and say, ‘This isn’t my fault, it can happen to anyone, and I need help.’”