It’s 9 a.m. on a Saturday morning just after the Fourth of July, and Nancy Cleveland is on the move.
She joins a group of about 20 Macon residents in Central City Park to help them harness the power of nature as a healing force. They’ve come to participate in a program called Walk With A Doc, bearing ailments from major depression to hypertension. Cleveland — a 2019 recipient of the annual Emerging City Champions (ECC) grant — walks with them.
One in six Georgia residents lives with mental illness, including substance abuse disorder, and about 20% of them are uninsured. About 80% will never receive treatment due to costs, lack of access and social stigma; in fact, mentally ill Georgians are more likely to go to prison than receive treatment for their conditions. That’s why Mental Health America, a nonprofit organization, ranks Georgia 47th nationally for mental health access.
Walk With A Doc
“Macon, which was once referred to as ‘a city in a park,’ can be a place that we live and heal in,” she said.
Cleveland helped bring Walk With A Doc to Macon last year by partnering with Navicent Health Center and Park Prescriptions, an initiative that recommends nature as a supplemental form of treatment.
Each walk begins with a quick information session with a medical professional. This month, Dr. Harry Strothers, a family medicine doctor at Navicent Health, discusses skin cancers, explaining how to identify different types before the group breaks to walk. He joins them, hears their concerns and helps answer health questions.
As she walks, Cleveland brainstorms. She muses about hosting future Walk With A Doc sessions near homeless shelters or senior living facilities to help bring services to the most vulnerable. When she spots a group of homeless men charging cell phones at a public charging station, she wonders whether Walk With A Doc could use a smartphone app to better reach them.
The success of the program inspired her, in part, to apply for the ECC award. As a recipient, she’ll receive funding to design and implement her own project in Macon over the next year: a series of mental health pop-up gyms called Head Space. It will fall under the umbrella of Park Prescriptions as well.
“A pop-up gym is really the creation of a space that puts mental health issues at the forefront,” Cleveland said. “You’ll have mini therapy sessions, so I’ll have actual therapists there, hopefully on site, that will give you five to 10-minute mini-therapy sessions, and they’ll be available for treatment. So you’ll see kind of what therapy is like, break the stigma of therapy if you’ve never done it before and maybe even meet your new counselor if you so choose.”
Based in local parks and community centers, Head Space will offer workshops in alternative and natural care, such as how to use St. John’s Wort to alleviate depression symptoms, lavender to release stress and cannabidiol (CBD) oil to relieve anxiety. Cleveland also plans to construct a “zen garden,” a nod to Walk With A Doc, but it will also include complimentary tea, guided meditation and yoga instruction.
Cleveland’s goal is to show Middle Georgia that therapy and self-care aren’t just for those with diagnosed mental health conditions.
“I’m trying to fill the gap before you even get there, hopefully prevent you from even going there at all, by destigmatizing the concepts of mental health but then offering concepts that will address stress and anxiety and depression,” she said. “Not everyone is depressed, but you might be suffering from a depression. Not everyone has anxiety and stress, but you might be going through a period in your life that is causing those issues. I want this program to address those moments.”
Returning to Macon
Cleveland is no stranger to those moments. She was born in Macon but was taken from her mother by the Division of Family and Children Services at the age of 2 months due to her mother’s severe mental illness and drug addiction. She left Georgia and moved in with family in the Bronx, New York. Throughout her life, she has experienced situational stress, anxiety and periods of depression.
She returned to Macon in 2014 to obtain adult legal guardianship of her mother, who was still struggling with her mental health.
“That was the only way to stop her from being able to check herself out (of residential treatment facilities), because although she had those issues, she still had her rights to leave any type of treatment center,” Cleveland said. “But once I had that kind of control, I was able to put her in the treatment center, and I just started thinking, ‘How could I have made this easier?’”
When Cleveland arrived back in Macon, she found that her mother was experiencing homelessness — as up to 12% of mentally ill urban residents do, according to the National Coalition for the Homeless. She was able to enroll her mother in a treatment center in Dublin, Georgia, where she is receiving care today.
Her mother’s struggles planted the seed for Head Space, but it was Middle Georgia’s history of providing insufficient mental health services that kept Cleveland’s idea alive.
She pointed to Central State Hospital in Milledgeville, which was once the largest mental health institute in the world. There are 25,000 unmarked graves around it, she said. Neglect and mistreatment fueled by stigma and misinformation about mental illness prompted a high rate of patient deaths during its operation in the 1800s through the early 20th Century.
These issues are not ghosts of the past: in Georgia, there are 10.9 psychiatrists per 100,000 people, and almost half of the 159 counties have no psychiatrists at all, according to a study by William M. Donald, professor of psychiatry at Emory University.
Social stigma hits close to home for Cleveland and her mom. She said women, people of color and those living in poverty – especially the homeless – suffer disproportionately from judgment in their communities, and her mom has “fit in all of those boxes” in her lifetime.
“(Therapy) just seems like it’s something that’s not even for you, it’s not marketed to us,” she said. “And in our own culture, if you do have an illness, it’s either brushed off or we’re scared. So you either have like, ‘oh, take a nap and wake up, you’ll be fine,’ or ‘oh, why is that girl acting so funny?’ So I want to introduce more of that education to our community especially here in Macon-Bibb, where the county is predominantly African American, and throughout Central Georgia.”
Mental Health Pop-Up
While looking for a solution that became Head Space, Cleveland researched how other U.S. cities have addressed the crisis. In San Francisco, California, Alexa Meyer launched Mental Health Pop-Up to introduce self-care in a casual, comfortable space.
Meyer said that while searching for a therapist to help treat feelings of anxiety, she identified the same stigmas and lack of access in her area that Cleveland saw in Macon. And like Cleveland, she knew she had to make a change.
“I wanted therapy and mental health care to feel really as easy and modern as going to the yoga studio that I go to down the street,” Meyer said. “If you’ve never been to therapy before, if you’ve never been to a therapist’s office, it’s hard to imagine what that might be like, and I think that contributes to the stigma of ‘well, it’s really tucked away, so it must be really serious. It must be really clinical. It must be for people who are really, really, really struggling.’”
Meyer hosts pop-ups in different cities across the country. She said that overall, participants appreciate the ease of access to services and the understanding that they aren’t alone in their struggle.
“People often feel like they’re the only ones feeling a certain feeling, but when people come to the pop-ups, they see that there’s all sorts of people there taking care of their mental health and well-being,” she said.
Back in Macon, Cleveland’s dreams of expanding access to mental health treatment don’t end with Headspace. Eventually, she wants to either establish a permanent wellness center or turn the pop-up program in an adaptable model that she can bring directly to community centers, schools and businesses. This design will help her reach communities that face additional barriers to access treatment—especially low-income families, people of color and children—and promote self-care as a preventive measure.
While facilitating the most recent Walk With A Doc, Cleveland met a Macon woman, Sheila, who said she knew Cleveland’s mother and had spent time with her while she was struggling with homelessness after the housing project where they had both lived was torn down.
“Even going through what she’s going through, she still was a nice, friendly person. You could always still talk to her,” Sheila said. “And when you talk to her, you really relate to her.”
Hearing the stories of her mother’s impact on others resonated with Cleveland’s goals in promoting preventive care.
“That’s why I think, again, it all rolls back to trying to do programs like this. Not to say that if she ‘walked with a doc’ she would’ve changed her life, but I just think that if we have more things in place, we can avoid losing such a bright spirit like that. Because I never got to meet her (growing up), but when I hear stories like that, it seems like she was such a wonderful woman,” she said.
“Yes, she was,” Sheila replied. “She is.”