Students celebrate their admission to YouthBuild Charter school in September.

Each of the students who got into the one-year program has worked hard to get there:

Sidhu: This is as much about you choosing us, as us choosing you.

Youthbuild executive director Simran Sidhu says motivation is key in being admitted to this school, which caters to people between the ages of 18 – 21. About 900 people apply every year. Applicants have to show up for an interview, then go through an in-depth orientation, and finally, complete what's known as "mental toughness" training:

Sidhu: It's 8 days of you have to be there on time every day, you have to go by the school's rules. Really, the most important thing is that it starts students off with a feeling of success, that yes, they CAN do it.

That's something the 214 students in this year's incoming class will have to continue to prove every day – as they complete a challenging curriculum split evenly between academics and practical job training.

Sidhu: Our students for example in the building trades training track rebuild abandoned houses in the city, so that when they leave, they have the sense that they have a trade, I have something to prove that I did this, and I built this house, and nobody is ever taking that away from you.

YouthBuild Executive director Simran Sidhu

Mornings at YouthBuild on Broad Street begin with an assembly. Dean Ameen Akbar discusses what's on the agenda for the week, and leads the students in their school pledge, which reinforces concepts like dedication, and respect.

The students wear YouthBuild t-shirts and khakis. Many are covered in tattoos – but they are as eager as first-graders to be called on by Akbar.

Akbar says his relationship with students is built on mutual respect:

Akbar: There's a reason why we don't have metal detectors and never will have metal detectors. There is a reason why we don't have school police, and will never have school police. People have told our students that yeah, I respect you. But when they see us play it out, when we say thank you to them, when we make a mistake, we apologize to them – these are things that they haven't gotten by and large in their communities, in their families, and quite frankly, in school.

Gregory Jefferies, YouthBuild student

Jefferies: I couldn't focus, because you had guys in the back of the classroom, rolling up blunts, marijuana, smoking with the windows open, it was like the teachers were inferior to the students, they were not showing any discipline whatsoever.

After a several-year hiatus, Jefferies is now determined to get his diploma:

Jefferies: You can't really move on in life without your diploma, having your diploma is they key to unlock another door in life.

Jefferies is 20, and has two young children. About half of all students at YouthBuild have children, and face a myriad of other challenges. Many become homeless over the course of the year, their families struggle with drug and alcohol addictions, and then, says Ameen Akbar, there is the ever present specter of violence:

Inspirational messages and letters from students in the hallways.

The graduation rate at Youthbuild is between 75 and 80 percent, and executive director Simran Sidhu says her staff is working hard to keep everybody enrolled

Sidhu: You know, you miss three days of school you get called by a case manager by your mentor, by your teacher, by me, so they come back with this "oh my god, five people called me, I better show up."

The school year at YouthBuild is still young, and even with so many odds stacked against his students, Ameen Akbar is full of energy and optimism.

Akbar: I get an opportunity and we get an opportunity here to touch and feel change every day. It's not a word, we can touch it.

Activist Jeff Bohen wants other people affected by mental illness to get out and vote. He says otherwise, politicians won't take them or their issues seriously:

Bohen: They listen to us with that sympathetic ear as opposed the ear of – hm, we should be concerned about how they are going to vote.

Bohen works to get people interested and registered and to get them to the polls on Election Day.

Temple University professor Mark Salzer studies community integration of people with severe mental illnesses. He says the places where people come for treatment should be part of this effort:

Salzer: Service providers and residential programs do not provide the supports to their residents to get out there and vote.

Salzer says Pennsylvania providers that receive state and federal funding are required to encourage voter participation, but rarely do so.

For Julie Pinto and her husband, the nightmare started on Father's Day weekend. Her 25-year-old son, a college student, came to visit, and was clearly delusional. He said he was a psychic, and could read other people's thoughts. Pinto says he also was behaving erratically:

Pinto: He would not take a shower, because he thinks there are chemicals in the water, which is going to kill him, and also, he wrote this essay, 14 pages, writing about government how they were after him, and trying to kill him

The Pintos eventually had him committed to a hospital – but after three days, he was out, and getting worse. After two failed family interventions, they went through the same process, this time, a judge ordered him to get outpatient treatment once released from the hospital – but Pinto said nothing happened:

Pinto: Nobody followed up on it, he never took any medication, neither did he go to any doctor to be seen.

The legislation pending in Harrisburg would make it easier for families to get loved ones into treatment, and also assure follow-up by adding oversight, says Jeanette Castello. She is an advocate and mother who has been in the same position as the Pintos.

Castello: What we are really talking about are the individuals who lack insight, who have something called anosognosia, which means they have total unawareness of their need to be in treatment, and this would assign a treatment provider much more quickly, and assure that the individual remains in treatment.

Castello is hoping the bill will get a vote next month.

Julie Pinto says she has been spending her days on the phone trying to get help for her son. While many organizations are willing to help – none can force him into treatment.

It's called the "Ugly Meter" – a cheap download that scans people's faces, measures how symmetrical they are, and then scores them accordingly. An "ugly" score is accompanied by a nasty message, like – you are so ugly, you could be a scarecrow."

Jonathan Singer is a professor of Social Work at Temple University. He says this application could be very hurtful to teens, who often struggle with self-esteem issues, and put so much value on the opinions of their peers.

Singer: “If a peer says you are ugly that is something that really means a lot, because developmentally, peer groups are very important. And if you have a belief that you are ugly, and then somebody takes a picture and says well the computer program confirmed that, then that's just a lot more information that this fear is correct.”

He says parents can play an important role in persuading their children NOT to use technology to taunt others:

Singer: “One of the things you need to do developmentally is to turn it around for the kid, so that they can imagine what it would be like for themselves, to have that happen.

Singer says an ongoing and open conversation about the issues is the best defense for parents in preventing their children from being or becoming a bully.

ECT machine.

Jack Nicholson as Randle Patrick McMurphy, strapped helplessly onto a gurney. Detached psychiatrists administering electro shocks, as his body twitches in agony.

Carol Kivler says that's the first image of "shock therapy" that came to mind when doctors suggested she try what is today called "electroconvulsive therapy" or ECT. She reacted accordingly:

Kivler: NO WAY!!! I will never be able to go to work again, what will my neighbors think? What will my colleagues think? No way, there is no way I am having shock therapy.

Kivler was in her forties then, and had been hospitalized for several weeks with a severe depression. She wasn't responding to medications or therapy. She thought about suicide all the time:

Kivler: Can I take that picture and break it and slash my wrists. Or can I get the liner of the garbage pail and smother myself. 24-7, nothing but suicidal ideation.

During ECT, doctors stimulate the skull with a quick electric current.

Kivler: I said – what are you crying about? He said – you actually have some life in your face for the first time, you are smiling, your eyes look clearer, your face looks brighter. You look different.

Psychiatrist Dr. John O'Reardon at the University of Pennsylvania says ECT stimulates the production of neurons, which send and receive signals from the brain and nervous system

O’Reardon: Depression, on a persistent basis, causes neurons to die in the brain, so depression if you will can be toxic to the brain. And ECT, instead of what we fear it to be, can restore normal health and function to that circuit including that extraordinary process of generating new neurons

Carol Kivler has used the treatment ever since. She's written a book about her experience, titled, "Will I Ever Be the Same Again?" She speaks out about her positive experience with ECT because she believes too many people shun it due to its terrible reputation.

The anesthesia team and psychiatrist Dr. John O'Reardon make sure patient is stable and doing well

Rogers: It is a hugely controversial treatment, because there are people who claim it has saved their lives, and other people who say it has damaged their lives, blighted their lives, ruined their lives.

Rogers says many patients who try the procedure lose their memory, and their brains are permanently damaged:

Rogers: I have a letter from somebody who received ECT in the 80s. Her name is Barbara, and she said: “There is no amount of money on the face of this earth that could pay or reimburse me for what they took from me through their slipshod, careless, negligent medical techniques. I want them to know that they took Barbara, lost her somewhere in the electrical currents. If they know where she is, tell me and I will get her now."

On a recent Wednesday morning, Dr. O'Reardon is administering ECT to patients at Pennsylvania Hospital.

They have about ten minutes of full anesthesia, and the stimulation of the brain lasts only seconds…

Robert Cronin has been coming in from the suburbs for over a year – and says ECT has only had positive effects on his life, especially his brain function:

Dr. O'Reardon with Robert Cronin, who has experienced great benefit from ECT

O'Reardon says that today's ECT is effective and says the chances of memory loss are slim.

O’Reardon: we have figured out how to avoid it completely for most patients, that that no longer has to be a burdensome side effect.
But mental health advocate Susan Rogers says patients also need to hear about the patients WHO SUFFER LONG-TERM DAMAGE FROM ECT.

Rogers: I'd let them know that they are taking a huge risk here, and that it may work out really well, or it may not and there's no way to know it IN advance

She urges people to fill out a psychiatric advance directive when they are doing well. That's a document that specifies which treatments they are willing to accept.

Yet acceptance is exactly what Carol Kivler hopes to promote, when it comes to ECT.

Kivler: I often say if we could just change the image of ECT to a defibrillator of the brain – when we have a heart attack, they shock us with electricity. Well, when you have a depression your neurons need to be shocked, yet people don't look at it that way. It's no different!

WHYY’s Behavioral Health reporter Maiken Scott spoke with psychologist Dan Gottlieb about this group:

Delaware Valley Community Health is a partner in this project. CEO Patty Deitch says her staff will provide basic health services:

Deitch: Physicals, treating acute primary care illnesses, flu shots, treating chronic conditions, having people come back so that we can monitor if they have diabetes or blood pressure, teaching them about how to take care of themselves and monitoring their progress.

Offering primary health care services in a place where people usually go for mental health services is a new approach in dealing with chronic health issues in people with severe mental illnesses, who die on average 25 years younger than their peers.

They suffer from obesity, diabetes and high blood pressure. Some of these problems are related to side-effects from medications. Others are caused by sedentary life styles or lack of access to care.

Mark Salzer is a professor of rehabilitation sciences at Temple University. He says many severely mentally ill people feel uncomfortable at general primary care clinics:

Salzer: Those centers might view these problems as mental health problems, or that people are too much of a hassle, or too difficult to work with, so people were falling through the cracks.

Salzer says this clinic, a collaboration between Horizon House and Delaware Valley Community Health, is an important step in improving access to health care for people with severe mental illnesses. He says many of their problems can be treated effectively if they are caught early on and monitored.

It's a display of 1100 backpacks called "Send Silence Packing" – the backpacks represent how many lives are lost to suicide on American college campuses every year.

Each pack is dedicated to the memory of a specific person.

The traveling exhibit is organized by "Active Minds" a national network of college groups promoting mental health and awareness.

Executive director Alison Malmon lost her brother to suicide when she was a freshman at the University of Pennsylvania. She says 1100 backpacks lined up elicit powerful reactions:

Malmon: It's such a visual representation of such tragedy. Time and time again we hear from individuals that they didn't realize that this was such an issue. Or they even sometimes have to step away from the display because it is so impactful, but then they always come back

Malmom says students can learn about suicide warning signs and prevention at the display.

Several very popular blogs have been written by people who were dying from cancer or other illnesses.

WHYY's Behavioral Health reporter Maiken Scott talked with psychologist Dan Gottlieb about our online relationship with death and dying: