Curbing the Toll of Mental Illness

Across the disciplines, researchers seek to ease human suffering 

Anthony Fulginiti remembers when a family member, struggling with mental health in a challenging environment, attempted suicide. Fulginiti, an assistant professor at the Graduate School of Social Work, was just a boy then. But the memory never faded.

“It’s always something that’s stuck with me,” he says. “Probably more traumatic than the actual suicide attempt is that nobody talked about it again. 

“It was like nothing ever happened.”

The stigma that stifles discussions of suicide has been around for centuries, rooted in moral, philosophical and religious objections to taking one’s own life. But for Fulginiti, the silence was deafening.

He is one of several University of Denver faculty members from across the disciplines leading a push to shift the conversation around mental health and to better the lives of people confronting everything from suicidal thoughts to depression to traumatic brain injuries.

That’s no small task. After all, nearly 1 in 5 American adults—51.5 million people in 2019—live with some sort of mental illness, reports the National Institute of Mental Health. And, the American Psychiatric Association notes, more than half of those diagnosed worry that they will be treated differently or lose their livelihood because they don’t get the help they need.

Research catalyzing social networks

The average person contemplating suicide tells one or two people about their painful thoughts, Fulginiti says. So how those one or two people respond to those disclosures is critically important.

“We’ve all been to many mandated trainings,” he says. “When you leave the training, you know more than when you went in. But if I tracked you down a week later or a month later, you’re likely to know less and less and less, unless you practice it. And we know that engaging with someone who is in a suicidal crisis is not something that happens every day.”

Fulginiti’s research at the Graduate School of Social Work centers on social networks. In a campus community, for example, who are the best people to train as “gatekeepers,” equipped with empathic listening and communication skills, compassion and the knowledge to direct vulnerable students to resources? How many people need that training to create an environment where every student in crisis is connected to someone prepared to effectively support them? And how often should they be retrained to ensure they’re ready when confronted with a crisis?

Instead of trying to train everyone, Fulginiti is working with computer engineers to develop an algorithm that targets the right people to train—trusted individuals who are most likely to have contact with vulnerable students and most able to steer them to resources that best meet their needs.

Fulginiti is also teaming with DU’s Health and Counseling Center to explore ways to deploy Campus Connect in the college environment. More than 450 students, faculty and staff have volunteered to become gatekeepers since the program started in 2015.

“I’d like people to know that we’re all inherently capable of being an advocate for and working toward making suicide less common,” Fulginiti says. “We’re all valuable in terms of the support we give one another, whether we listen to one another … making eye contact, [paying] someone a compliment, giving someone a smile. I don’t want people to undervalue those things. We all have a role to play.”

Illustrations by Vincent Comparetto

Separating mind and brain

Kim Gorgens has accomplished plenty in her career as a clinical psychologist and researcher. She’s delivered a pair of popular TED Talks, been interviewed by Anderson Cooper and headed several prominent boards in her field. But July 7, 2021, might have topped them all.

On that day, Gov. Jared Polis signed Senate Bill 138 into law, requiring the Colorado Department of Corrections to create a pilot program that will screen people entering the prison system for brain injuries. Those who are suffering will receive additional support from CDOC.

“I think it was a highlight of my entire career,” says Gorgens, a professor in DU’s Graduate School of Professional Psychology. “The work we’ve done in criminal justice has taken on a life of its own, driven by the people touched by the work.”

After assessing nearly 5,000 people in Colorado criminal justice, Gorgens’ team reported that an average of 47% of that population (including in county jails and on probation) suffer from a significant traumatic brain injury (TBI). In some places, the rate was as high as 97%. In contrast, the community prevalence rate is less than 8.5%. People in criminal justice with TBIs were also found to suffer from mental illness and substance abuse, and to have a history of trauma, attempted suicide or some combination.

“By no means is it a straight shot from brain injury into criminal justice,” Gorgens says, “but there are ways that the injury is related to behavioral problems, cognitive problems, a risk for substance abuse, a risk for mental illness. It starts people on that trajectory that, in an overwhelming number of cases, lands them in the criminal justice system.”

The most common TBIs affect the frontal lobe, which is involved in sophisticated thinking such as reading ambiguous social situations, forecasting consequences and inhibiting impulses, especially when under stress—all abilities that can deter commission of a crime, Gorgens says.

TBIs impair those abilities and make it extraordinarily difficult for a person to ever exit the criminal justice system, her research shows. People on parole or conditional release often face extensive paperwork and appointments, with penalties imposed for tardiness or absence.

“Even things like managing a calendar or remembering to do a certain thing at a certain time is a pretty robust executive function that we take for granted,” Gorgens says. “But for someone whose brain isn’t working as well, it’s like a nonstarter.”

Perhaps as a result, Colorado reports a recidivism rate of about 50%. A stronger support network, Gorgens and her partners believe, could alleviate some of the burden on the corrections system and lead to better outcomes for people on the inside. The Brain Injury Alliance of Colorado (BIAC)—a longtime DU partner—has trained its staff to help those in the criminal justice system get benefits, job skills and support for their families. A clinician and care coordinator take over when those people are released. BIAC is also building housing for people with brain injuries that will benefit returning citizens.

These programs, Gorgens says, go a long way toward destigmatizing conversations about mental health.

“We think of the brain and mind as different things,” Gorgens says. “[But] depression causes changes in the structure and, really importantly, in the function of the brain. Brain injuries do the same thing. That doesn’t excuse bad behavior, but people [can better] understand [the] behavior.”

The postnatal impact of prenatal depression

During 40 weeks of pregnancy, a single cell mushrooms into trillions of cells. Fingerprints and footprints develop alongside eyebrows and eyelashes. Babies establish sleeping patterns and become sensitive to sound.

Indeed, a baby’s mental and physical health outcomes might take shape before they even take their first breath, according to research by Elysia Davis and Jena Doom, psychology faculty in the College of Arts, Humanities and Social Sciences. 

“Most people are aware of postpartum depression, and I think there’s this general impression that depression is higher postpartum than in pregnancy,” Davis says. “In fact, that’s not the case. Levels of depression are as high or higher during pregnancy.”

In a new study, Doom and Davis are widening the spectrum on both ends: examining a mother’s mental health before a baby is born and looking for the impact when that baby reaches preschool age, when behavior begins to solidify. Denver Health and the Anschutz Medical Center are joining DU undergraduate and graduate students at the Stress Early Experience & Development (SEED) Research Center to conduct the research.

Past research has linked prenatal depression to depression in children, antisocial behavior, conduct disorders and conditions such as Attention Deficit Hyperactivity Disorder in youths as old as 16. Davis’s work examines whether intervening during pregnancy to improve maternal health can benefit not only the mom, but also the baby. Inspired by Davis’s research, Doom wondered whether improving prenatal maternal mental health could also improve a child’s nutrition and cardiovascular health.

Mothers share nutrients and communicate with their unborn children through biological processes, Doom says, and stress can affect how our bodies absorb nutrients. If a mother is stressed, Doom hypothesized, “these early experiences might program the brain and then our offspring to eat more of these high-calorie, high-fat foods when they’re stressed, which might lead to poorer cardiovascular health later on.”

What’s more, Doom says, prenatal depression often continues after the child is born, which may make it difficult for a mother to establish healthy eating, physical activity or sleeping habits.

“If you have a mom who is experiencing a lot of stress, she might not be getting a lot of sleep or [she may be] experiencing depression,” Doom says. “She may not be getting much physical activity, maybe eating high-calorie, high-sugar foods.”

Postnatal experiences and behavior can promote good health too. Positive, sensitive, responsive parenting can compensate for potentially detrimental experiences before a child is born, Davis says. This research will offer insight into whether offering a mother mental health services during pregnancy can reduce a child’s risk for cardiovascular disease later in life.

“Prevention is so much more effective than treatment,” Davis says. “This is really a window of opportunity where we can really benefit and help at least two people, the mother and her baby.”

Doom agrees: “A lot of times we focus on cardiovascular disease in adulthood, which is really important to do. But if we can prevent some of these new cases or reduce risk early on, that can really pay dividends in the cost of health care, in human suffering and the number of people who have to deal with mental and physical health problems.”


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