Erin Fitzgerald, a staff member of HDI is wearing a blue flannel and holding a washboard to make music. they are on a blue background with HDI's logo in the top left.

“All people offer perspective that is valuable to the rest of the world.” HDI Staff Erin Fitzgerald speaks on their experience with Neurodiversity and mental health

The following article discusses suicide, which some readers may find distressing. 

Erin Fitzgerald could always see the signs that she was different growing up – the tools to recognize how simply didn’t exist yet.  

“I grew up in an era where mental health was talked about very differently from how it is talked about today. There are some similarities and holdovers, but a lot of differences too,” Fitzgerald, who also identifies as queer and uses she/they pronouns, said. “In the 70s and 80s, I do not remember any conversation around mental health or counseling that did not feel totally pathologized. I do not remember myself or anyone else getting referred to talk with someone or getting assessed for something based on how we were doing or how we were feeling inside. I would only hear about mental health if someone were seen as causing a problem for other people, or seen as a problem themselves.”  

Fitzgerald also grew up in a household with a parent who was diagnosed with a severe mental illness, who did not have the same options for support and resources that exist today. “It makes me sad to think about this, because my dad struggled quite a bit and had a hard time finding the right kind of support,” she shared. “He ultimately died by suicide, which is an all-too-common scenario when people do not have the support that they need to address their mental health issues. I cannot help but wonder if he were living in a different time, and if he could have found the kind of support that exists now, how things might have gone differently.”  

Fitzgerald, who works with HDI as the CTP Coordinator with HDI’s Supported Higher Education Partnership, has had her own journey with mental health. She has had family that struggled, has worked as a support provider, and has sought support from the system as well. She was given multiple diagnoses before finally being assessed for autism and sensory processing disorder as an adult.  

“It wasn’t until some years later that I even heard the term ‘Neurodiversity,’” Fitzgerald said. “That really clicked some things in place for me. It was a turning point for me to think about the way I was wired as being a neurotype and an identity, and not a problem to be solved or a thing to be fixed.”  

For Fitzgerald, this was a revelation – and a total reversal of how anything related to mental health was treated in the past.  

But the signs were always there, and looking back, Fitzgerald sees them clearly – both in how it’s affected her view of the world at large, and how it’s affected her view of something deeply important to her – art.  

“It is interesting – I think that way my brain is wired has always affected my view on the world as well as my art. But I have not always been in good touch with what that wiring was,” Fitzgerald said. “So only in recent years do I feel that I am able to understand the degree to which that affects my view of the world, and how that is portrayed in art.”  

comic from spectrum with four squares. the top left has a person wearing a hospital gown holding their head with text reading, "Sometimes it takes a crash..." the next square show a person laying face down with text that says, “…to find a landing…” the next shows that person crouching on the ground with one foot on the floor, with text that says “…to find your footing…” the final square shows that person wearing a grey t-shirt and pants standing an a podium with a rainbow flag behind them with text reading, “…find your place.”

That’s a big part of how Fitzgerald relates to the world. Art, she said, is an essential part of her life.  

“When it comes down to it, art is the primary way that I process information and emotions. This has always been true, and not just with visual art. Music, writing, theater, any kind of creative expression – it all helps me to process things,” Fitzgerald said. “Consuming it, creating it, engaging with it, talking about it – all of these actions are extremely important to me. I can’t imagine life without being swirled up in the arts on a regular basis.”  

Today, Fitzgerald creates a cartoon called SPECTRUM that explores the multiple aspects of her journey and identity. She started the project after attending a class with Lynda Barry – somewhat accidentally, she noted.  

“I did not go there to learn cartooning specifically, but after the workshop I started drawing cartoons every day. I did not set out to draw a cartoon called SPECTRUM, or to cover specific topics such as Neurodivergence and Queerness. But that is what kept coming out on the page, so that is what I went with,” Fitzgerald said. “I have been drawing SPECTRUM cartoons ever since, and it has been a great tool for me to further process the world around me and to think more deeply about my interactions within it. It has also turned out to be a good tool for having conversations with other people around those subjects.”  

Cartoons like SPECTRUM are relevant to an emerging field known as Graphic Medicine, one that Fitzgerald says is still finding its identity. But it’s one she finds exciting for its diversity in application and accessibility. Graphic Medicine is, explained simply, the intersection between the realms of graphic arts (such as illustration and comics) and health and medicine. This can take many different forms, which is part of the appeal. It also does something that is central to a lot of work that Fitzgerald does – gives a voice to more people to share their experiences.  

“I was drawn to this field for many reasons,” Fitzgerald said. “The part of this field that is most appealing to me is the fact that engaging with and creating graphic works can increase understanding of topics such as overall health, medicine, mental health, identity, and community engagement. It can intersect and therefore help connect people and ideas from all different disciplines and perspectives.”  

Fitzgerald also notes that the principles of graphic medicine are in line with those of Universal Design and Universal Design for Learning in a few key ways – in giving people additional tools to communicate and understand concepts related to health and medicine, and in giving a voice to people receiving supports – allowing everyone the chance to learn together. In addition, graphic formats provide context and color to raw data, adding images and stories to the numbers.  

Fitzgerald is also working on a wordless graphic memoir called InQuest, which documents her perspective about the mental health system. She hopes the project will help increase understanding of that system from the perspective of people who have navigated it from the other side. “The message I find most important from that project is this: the perspective of a person experiencing a mental health crisis is valid and meaningful, and should not be dismissed,” she said. More information about that project can be found here

A spectrum comic that has someone not in frame ask, “So…can you tell me about your strengths?” A person that looks nervous responds, “Well I don’t mean to brag…but my amygdala is huge.”

Today, Fitzgerald works with people with intellectual and developmental disabilities (IDD) as they attend college – something that has only recently become an option for many. That, Fitzgerald says, is because people have historically not included the voices of people with IDD in conversations about higher education.  

“I think this is partly because of that tendency in our society to separate people into categories based on what we are told they do or don’t know, or can or can’t do,” she said. “If we want to be truly inclusive, we need to see everyone else as a partner in this journey, and not only in a specific role of expert or learner. That is how we got here, so we need to expand our own perceptions as we continue to build the way forward.”  

In general, that is a uniting factor in a lot of what Fitzgerald does – working to ensure that voices of all people are heard and valued in the process.  

“One of the main things I want people to understand about mental health and IDD is that all people offer perspective that is valuable to the rest of the world. In our society, we tend to put certain perspectives up on a pedestal as being more important, and putting other perspectives in a category as being less valued,” she said. “We tend to separate people into categories of those with expertise to share, and those who need that expertise. That is oversimplified and can be quite dangerous. It is important for us to recognize the value in all human perspective, and to stop pathologizing everything that is outside of the norm. I think we have come a long way in this, but we still have a long way to go.”  

Read Fitzgerald’s ongoing comic, SPECTRUM, here

“I hate being treated like an emergency waiting to happen.” UK student Bailey Patterson speaks on her experience with suicide and wanting to help others

The following article discusses suicide, suicidal ideation, miscarriage, and sexual abuse, which some readers may find distressing. 

Bailey Patterson was 4 or 5 when she began struggling with suicidal thoughts. 

“Things like ‘I wish I’d never been born,’ ‘I don’t want to be here,’ ‘I wish I would die,’” Patterson, a senior Interdisciplinary Disability Studies major at UK who identifies as multiply disabled, said. “Those thoughts progressed as life threw me more curveballs, where I was pretty actively having suicidal thoughts probably every day of my life when I was in middle school and high school. Still, I would never have a plan, it was just pretty aggressive thoughts.” 

That lasted until she was 16, when a friend had experienced a traumatic event for which Patterson felt responsible. Her mother interrupted her first suicide attempt shortly after that.

Patterson is not alone in struggling with suicidal thoughts. According to the American Foundation for Suicide Prevention, suicide is the 11th leading cause of death in the US. The World Health Organization reports that it is the fourth leading cause of death among 15 to 29-year-olds. The CDC reports that 12.3 million American adults have serious suicidal thoughts and 1.7 million attempt suicide. In 2022, 49,449 people died by suicide. 

Patterson considers herself chronically suicidal, but stresses that suicide is a complex issue. Mental illness is often a component of it – according to the National Alliance on Mental Illness, 46 percent of people who die by suicide have a known mental health condition – but Patterson stresses that there are other extenuating circumstances. She remembers her first stay as an inpatient in a mental health facility. The only other patients in her ward were girls, ages 12 to 17.

“There was a really common thread about gender-based violence,” she said. “Several of the girls on the ward had been sexually abused by older men.” 

Patterson noted that she thinks this ties into a major factor in suicide that is commonly overlooked.

“There’s this narrative in popular culture that if someone is suicidal, it’s because they don’t see the value in their lives or they’re depressed, and you can do this that and the other to make it go away. You can take long walks and you can eat healthier and you’ll feel less depressed,” she said. “For many people, the cause of the suicidal thoughts or the depression is the situation they’re living in. There are people living in current abusive situations that they feel they have no way of escaping from, there are people who are dealing with interpersonal violence or abuse, there are people who are homeless, there are people who are in poverty, there are people who are experiencing systemic interpersonal racism and sexism and bigotry. Those things are not things that you can walk and eat better to get rid of.”

That means that addressing those issues will help also help address the risk of suicide among marginalized populations. Patterson believes that addressing those issues while promoting mental health will do a lot to solve the problem.  

“I feel like if we understood that and worked towards those goals while also keeping in mind personal wellness and self-care and things like that, that would be a big help,” she said. “A lot of people are overlooking some of the greatest causes of distress that are leading people to be suicidal.”

She also remembers difficult times and experiences for both her and the others she met during her two inpatient stays. Among them, she particularly recalls a patient with a fear of needles being given medication by injection against her wishes when that patient felt there were other ways to administer similar medication and another woman on her second trip to inpatient services who had been pregnant when she was checked in and miscarried after being given a medication early in her stay.

That experience awakened in Patterson a desire to help others with the same struggles. Now, she channels that into standing against abuse and the loss of autonomy in psychiatric settings. Currently, Bailey is a Student Informatician with SPHERE at HDI, Officer of the Disabled and Ill Student Coalition, and an activism and research advocate in the Mad Pride and Psychiatric Survivors movements.

“The feeling of solidarity with these other with these other people who were also experiencing something similar to what I was in the moment, being there, hearing their stories changed my life,” she said. “That was the first moment where I thought ‘this is important and I want to do something about this for the rest of my life.’”

Helping others is one of the ways in which she deals with the frequent thoughts of suicide that she still experiences – and feels like she will always experience. 

“I manage, like a lot of us do,” she said. “Take it one day at a time and try to take care of myself as best I can, but I do not foresee a life for myself where I do not feel suicidal in some degree most days of my life. That’s probably just the way it is for me. That’s something that I’m going to have to continue to manage for the rest of my life, and I think that’s ok.”

She’s found a few coping mechanisms that can help when the thoughts get particularly bad. 

“One of the things that I do is I try to imagine a time in the future where I am happy,” she said. “That can be really hard, especially when you’re very depressed, but I have a couple of things in my mind, scenarios where I could be doing this thing that would be a happy moment for me. I try to really picture it and stay in that moment…then I try with all my might to believe that could happen for me one day. That’s my best coping mechanism thus far.” 

And if someone close to you is struggling with suicidal thoughts, Patterson stressed that one of the best ways to help is to keep treating them like a human being. 

“Anyone who hears that their loved one is going to have emotions that come up for them, but I think the number one thing you can do is not freak out,” she said. “You should be there, and you should attend to the problems…I sometimes get the feeling that we are treated like a danger. I hate being treated like an emergency waiting to happen. I think the best thing you can do is just be calm and present for that person and realize that the person speaking to you is the person you’ve known.”

Warning signs of suicide may include: 

  • No longer participating in things they enjoy
  • Feeling sad all or most of the time
  • Talking about dying or wishing not to be alive
  • Feeling hopeless or feeling like one has no purpose
  • Withdrawing from social groups or saying goodbye
  • Giving away important items

If you are struggling with suicidal thoughts, help is available. You can call the suicide and crisis lifeline at 988 or text SAVE to the Crisis Text Line at 741741. Both services are free and available 24/7. If someone is in immediate danger call 911 or go to your local Emergency Room.

This article represents the opinions of the author and interviewee, not that of the University of Kentucky. 

HDI’s Lisa Amstutz is Second in Kentucky to Earn Special Credential for Mental Health ASL Interpreting

Lisa Amstutz earned her Qualified Mental Health Interpreter Certification earlier this month, making her the second American Sign Language interpreter in Kentucky to do so. The credential is part of a crucial effort to bridge the gap between Deaf mental health care needs and barriers to access.

The certification is typically held by experienced interpreters who have already demonstrated particularly high competence in general interpreting. A progeny of Alabama’s Mental Health Interpreting Project, the certification is earned through practicum experience focused on broadening the interpreter’s knowledge of mental health conditions and treatments so that the most effective interpretation can be made in crisis and mental health care settings.

A common misconception about American Sign Language (ASL) is that it is simply English on the hands, when in fact, ASL is a full language with its own grammar, syntax, idioms and means of expression. A question asked in English may need to be altered to make conceptual sense in ASL, and likewise, a sentiment expressed in ASL may need to be altered from a direct translation to hold true to its intended tone in English. Because of this, a qualified ASL interpreter is a non-negotiable requisite to effective mental health care for those who use ASL as their primary language.

An estimated one in five adults in the United States is living with a mental illness, and research repeatedly shows that this rate is significantly higher among Deaf and hard-of-hearing individuals. A statement from the National Association of the Deaf cites that “mental health disorders for deaf signers, including depression and anxiety, occur at a much higher rate, usually in the magnitude of two times higher than what is typically seen in the hearing population.”

Amstutz explains that one cause of this is related to language deprivation, which occurs when a child is not given full access to language in the first few years of life. Language deprivation has long-term effects on neurological development, affecting the child’s ability to develop language skills needed for fluent communication later in life, oft in turn leading to emotional distress and behavioral health issues.

Over 90% of deaf children are born to hearing parents, and the vast majority of those parents do not learn sign language. Language deprivation research indicates that assistive hearing devices such (hearing aids and cochlear implants) are “insufficient as a stand-alone approach for language acquisition in deaf children,” sign language is scarcely proposed to parents as a solution for language acquisition.

According to a Boston University article, “The developing brain responds to language no matter how it is presented, so exposure to ASL is equivalent to exposure to a spoken language.” Still, the article goes on, “Perhaps as many as 70 percent [of deaf children] are deprived of language.”

Another major factor affecting the prevalence of mental health conditions among ASL users is the barrier to accessing mental health care at all, along with fears of communication barriers leading to undesirable outcomes such as misdiagnoses or involuntary admission to psychiatric units.

This Verywell Mind article illustrates an example of how a deaf person may pound on the floor to get another person’s attention, which is an accepted action within the Deaf community but may be perceived as aggressive by a hearing person.

According to Amstutz, ASL interpreters are trained to routinely “clean up” one language to make it make sense in the other. But what if, say, the patient is experiencing psychosis, and by cleaning up the language as the interpreter typically would, the clinician in turn misses key indicators of the condition? In mental health interpreting, Amstutz explains, interpreters have a unique role in ensuring the clinician has all information needed to make a diagnosis or set a treatment plan.

“We bear a great responsibility, because we are, a lot of times, the only person in the room that knows something here is not right,” Amstutz said.

Amstutz says her new certification will be helpful in establishing herself as a core part of the ASL user’s care team in settings with other professionals “who have long viewed us as ‘helpers.’”

Amstutz has long demonstrated her passion for mental health care access, even predating her work as an interpreter. When she first began college, she intended to become a child mental health therapist. Later, she realized her best fit as a crucial advocate in mental health as an ASL interpreter.

“Working on this credential has stretched me professionally and is helping me realize a lifelong dream, “Amstutz said. “I’ve worked in mental health settings for most of my 29 years of working as an ASL interpreter, and since my first mental health interpreter training experience in 2018, I knew pursuing the [certification] was something I wanted to do.”

Amstutz is a part of the Kentucky Office of Vocational Rehabilitation ASL Interpreting Team which is employed by the UK Human Development Institute to serve its Deaf and hard-of-hearing consumers.

Please join the Human Development Institute in congratulating Amstutz on her new credential as a Qualified Mental Health Interpreter.

HDI Celebrates Developmental Disabilities Awareness Month 2023 with Amanda Stahl

HDI Celebrates Developmental Disability Awareness Month

This month (March), HDI celebrates Developmental Disability Awareness Month. For some people, that may lead to questions about what defines a developmental disability. Developmental disabilities are conditions that begin during development and usually last throughout a person’s life.

For Amanda Stahl, LCSW, it’s a wide spectrum. 

“It’s a disability that happens before the age of 18,” Stahl said. “A disability that affects your daily life skills. It affects your development, how you become who you are as a person.” 

But at the same time, Stahl stresses that there is a human being behind every label and every diagnosis. 

“In my work, I don’t focus only on definitions. I focus on people’s stories,” she said. 

As part of her work with Merge, an HDI project focused on improving mental health access for individuals with mental health conditions and developmental disabilities, she’s helping ensure those stories are told. 

Merge seeks to improve the mental health systems that support people with co-occurring mental health conditions, and intellectual and developmental disabilities. Stahl is one of the researchers interviewing people with lived experience for Merge. 

“Some of the work that I’m doing is going around Louisville and going around to different parts of the state and collecting people’s stories around their experiences with mental health and disability,” she said. “What were the good experiences they had, what were the negative experiences they’ve had, what would they want to recommend to other direct support professionals and providers?” 

Stahl thinks that isolation, loneliness, and societal expectations placed onto some people with disabilities can have a tremendous negative impact on the mental health of individuals with disabilities. 

“It’s not done on purpose,” she said, adding that some have difficulty find more positive ways to think about themselves until they find ways of building community and experiencing inclusion. “People with disabilities may be isolated from other people with disabilities, including older people with disabilities,”

She also noted that she sees patterns in the interviews she’s completed. For example, she finds that even experienced mental health providers can have difficulty working with people with developmental disabilities, especially those who are in more controlled environments. Sometimes individuals, she says, may not feel like they have the space to feel or process their emotions. Another thing that she noted is that a lot of individuals with lived experience feel like outsiders. 

“Knowing my own story, a lot of their stories are very similar,” Stahl said. “I felt like I was the only one until I met this one person.” 

Stahl hopes soon to do more research on individuals in day programs to get an even wider view on what the community’s needs are. From there, the information will be used to develop training that will be designed for individuals and providers around the state. 

“I’m trying to get stories from the most impacted people,” she said. Ms. Stahl stressed that people often underestimate others due to disability – something she says is a mistake. 

“There may be limitations to what someone can do,” she said. “But always assume people can do more than you think they can.”

Amanda Stahl, LCSW, is a Disability and LGBTQ+ Activist from Louisville, Kentucky. Amanda is the lead organizer and director of a non-profit organization called the Independence Seekers Project (ISP), organized and developed by people with intellectual and developmental disabilities.

Merge Logo.

HDI introduces new mental health project: Merge

The University of Kentucky Human Development Institute introduces a new project: Merge. The project will strengthen the existing training framework serving Kentuckians with co-occurring mental health, and intellectual and developmental disabilities (MHIDD). By evolving current training, Merge aims to increase and improve the application of person-centered services and referral systems. 

Merge hopes to build stronger connections across systems in Kentucky, including state agencies, medical providers, medical service providers, LEND trainees, families, and individuals with MHIDD.

Merge will work with a team of state partners that includes people with lived experience. This team will identify existing resources, needs, gaps, and priorities. Existing resources will be strengthened and will address racial, health, and economic inequities in underserved communities. Once gaps and needs are identified, universally-designed supports will build a trauma-informed, and recovery-oriented framework for application. These efforts help fulfill Merge’s goal to increase understanding and improve the implementation of person-centered, culturally relevant services and referral systems.

For more information, contact Kristen Dahl at