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When she was 22, Rachel Star Withers uploaded a video to YouTube called “Normal: Living With Schizophrenia.” It starts with her striding across her family’s property in Fort Mill, S.C. She looks across the rolling grounds, unsmiling. Her eyes are narrow and grim.

She sits down in front of a deserted white cottage and starts sharing. “I see monsters. I see myself chopped up and bloody a lot. Sometimes I’ll be walking, and the whole room will just tilt. Like this,” she grasps the camera and jerks the frame crooked. She surfaces a fleeting grin. “Try and imagine walking.”

She becomes serious again. “I’m making this because I don’t want you to feel alone whether you’re struggling with any kind of mental illness or just struggling.”

At the time, 2008, there were very few people who had done anything like this online. “As I got diagnosed [with schizophrenia], I started researching everything. The only stuff I could find was like every horror movie,” she says. “I felt so alone for years.”

She decided that schizophrenia was really not that scary. “I want people to find me and see a real person.” Over the past eight years, she has made 53 videos documenting her journey with schizophrenia and depression and her therapy. And she is not the only one. There are hundreds of videos online of people publicly sharing their experiences with mental illness.

In her early videos, Withers glowers. She tried to give off an aura of toughness befitting the daughter of a Hell’s Angel biker. But there’s also a sense that terror is a deep undercurrent in her life. “All right, let’s go,” she says in the video “Watch If You Forget,” where she documents getting electroconvulsive therapy for depression. Then, in the next few seconds, “I’m about to start the electroshock therapy and, yeah, I’m pretty nervous.”

Things have changed a lot since then. Now, almost all her videos open with Withers flicking her black curls, arms raised with swagger: “Hey, what’s up! I’m Rachel Star!”

That public sharing of mental illness might be making a huge impact on the way our society views these disorders, especially for those of us who are digital natives. Millennials tend to be more comfortable talking about mental health issues, according to a poll released Jan. 14 by the Anxiety and Depression Association of America, along with two national suicide prevention foundations.

When it came to seeing a mental health professional, for instance, 48 percent of survey respondents between the ages of 18 and 34 said that it was a sign of strength. About 35 percent of all prior generations felt the same way.

“Our young people are accepting that mental health problems exist, and they want help for it, and they are not looking at these things as something to be ashamed of,” says Anne Marie Albano, a clinical psychologist at Columbia University who is on the board for the ADAA.

She thinks that social media and videos like Withers’ have helped lower stigma around mental illnesses. “Young people take advantage of this,” Albano says. “It gives the opportunity for people to tell their stories and post images. This allows them to feel more hope than prior generations.”

There might be other reasons young people are less concerned about stigma surrounding mental illness. Perhaps as you age, your outlook becomes more pessimistic, says John Naslund, a Ph.D. candidate at the Dartmouth Institute for Health Policy and Clinical Practice who studies social media and mental health. He notes that the ADAA poll found that a higher percentage of older adults than young people didn’t believe that something like suicide could be prevented. “Maybe they’ve been through this before and have had people close to them take their own lives.”

He hopes things really are getting better. “It’s very possible. That would be a very exciting change in the way society views mental illness,” Naslund says. But the problem has not been solved. Even if information moves quickly, change is slow. “It’s really important to acknowledge that people who have serious mental disorder still face a lot of stigma,” he says.

When she was younger, Withers struggled with a lot of shame and humiliation over her disorders. “For so many years, I felt like a freak,” she says. Part of that was the religious community she had joined. “Think militant Christian. Like a militaristic type,” she says. When she was 17, she graduated from high school early to attend the former Teen Mania Ministries Honor Academy in Dallas. “I honestly thought that’s what God wanted me to do.”

At the same time, her mental condition was deteriorating. She says her schizophrenia was starting to emerge and transform into something unmanageable. The counselor at Honor Academy diagnosed her with depression and prescribed pills. They didn’t help. Eventually she told them about her hallucinations. “This being a Christian place, they decided I was possessed by demons.”

For three days, Withers fasted. Each morning, she met three of the school’s spiritual advisers, and they spent the day performing an exorcism in a closed room. They read Bible verses, and Withers confessed to everything she could think of that might be construed as a sin — even watching demon-related TV shows like Buffy The Vampire Slayer.

At the end of the crucible, Withers was on the floor, exhausted. “I was young and here are these people who you know, I’m told, are close to God. I was like … OK. It must be right,” she says. “Surprise! It didn’t work. I spent six more months there as an outcast.”

Reducing this kind of stigma is a fundamental reason Withers continues making videos. She wants others to see those struggling with mental disorders with more compassion, and she wants people with a mental diagnosis to see themselves more positively.

After she posted her first video, Withers says, “People just come out of the woodwork emailing me, messaging me. The friends I’ve had the longest time, even people I’ve never met in real life with schizophrenia and like disorders. We just started talking.” She got invited to mental health forums and to mental health support groups on Facebook.

“Thank you for these videos. They really help me to better understand my sister,” YouTube user Kathryn Hatzenbuhler posted under one video.

These online communities are an important part of Withers’ life now. “Whenever I’m posting on Twitter, I’ll put #schizophrenia and #schizophrenic. I’m hoping to find other people who are having problems,” she says.

Withers ended up making a coloring book for kids with schizophrenia, and she shares ways she has figured out to deal with her visions and voices.

Via webcam, she showed me two askew mirrors in her room that can be angled away from the viewer. “People with mental disorders don’t do well with mirrors. I just start hallucinating,” she says. “It’s real hard putting on makeup, you have to imagine. Having the mirrors at an angle helps.”

In one video, she talks about walking up to one of her hallucinations to touch it, and that alone took away some of the fear. “It’s kind of something to help you get used to your hallucinations, so you know how to respond, because the voices are always horrible. The voices are never like, ‘Oh my God, you look so good today.’ “

There’s no hiding her disorder from anybody on Facebook, so people she knew in real life started finding out. It caused her pain at some jobs (“This one girl was like, ‘Oh she’s crazy. I’m not working with her’ “), but it also led some people to talk about their own or their family’s experiences with mental disorder. “They’ll be like, ‘So … I saw your post, Rachel. I had a question.’ “

Researchers think there’s a potential gold mine of mental health benefits in exchanging messages and encouragement online like this. “Social support is always the No. 1 variable that predicts a better prognosis and better care management of anyone’s illness,” Albano says.

It’s a small leap from there to think that participating in mental health-focused communities on YouTube and Facebook might actually be making people healthier and preventing suicides. “That’s probably absolutely correct,” says Patrick Corrigan, a professor of psychology at the Illinois Institute of Technology. But scientists are only just now beginning to measure the effect social media might have on clinical outcomes. “It’s quite a new area of thinking, online peer-to-peer support for mental illness,” Naslund says.

But there’s an obvious downside to being public on social media about mental health problems. “Say I have a network of friends and I have a breakdown one day. It will spread through social media, maybe in negative ways,” says Michael Lindsey, a professor of social work at New York University. That could be through someone’s real social groups, like at work or school, or it could be anonymous, via Internet trolls. For those already depressed, anxious or paranoid, cruel comments and messages could have a terrible impact.

But in Naslund’s research, he says that problems with online attacks have been extraordinarily rare. “If someone did post a derogatory comment, seemed a little harmful, other people would come to the defense and say, ‘Don’t listen to that,’ ” he says. “[Social media are] way more supportive than we imagined.”

According to Naslund, the benefits seem to vastly outweigh the harms. “That’s clear in the literature,” he says.

And Withers agrees. She doesn’t think that people with mental health problems usually go on social media and spiral out of control even more. “I’m sure it happens somewhere on some area of the Internet,” she says. “But I think usually when I’m feeling depressed and stuff, but then I see someone else thinking of hurting themselves, the opposite kicks in. It’s like, no. You have so much to live for. You’re able to pull yourself out in a way to help someone else.”

When Withers does get trolls, she blocks them. “Anything remotely violent towards me gets blocked,” she says. “Like — I’m not going to respond to that. Don’t call me that word.”

Still, she cautions others to think carefully before coming out to the world about their mental illness. It can be dangerous, she admits. She says she gets phone stalkers and death threats. But she is still glad that she did it. It’s uncomfortable for her to think what might have happened if she never went online about her depression and schizophrenia. “I see myself being a lot more closed off,” she says. “I hope I would have found other people’s videos.”

Withers attributes a lot of her transformation to electroconvulsive therapy. She says it knocked out a lot of her deep depression. And Withers thinks sharing on the Internet has also helped. “It helps me to vocalize it and put it all out there,” she says, and it makes her feel like she is less “broken and sick” when other users empathize with her online.

Recently, she posted a video to YouTube called “There Will Be Beautiful Days.” It’s short, reaching just past a minute long. Withers smiles and says she knows things are hard now. Maybe harder than they’ve ever been. But it’s going to be OK. And at some point, you’ll have some good days. Maybe even just one great day, but it’ll be enough. It will make life worth fighting for.

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My 14-year-old patient grabbed my hand and told me that he was going to die.

Just seconds before, the nurse had wheeled him into the resuscitation room. His blood pressure and heart rate were more than twice the normal levels. He was pale, clammy and gasping for breath.

The nurses and doctors with me in the ER worked to stabilize him. We put an oxygen mask on his face. We inserted two IVs and began pumping fluids into his body. When his oxygen level dropped, we inserted a breathing tube.

In the meantime, we observed that there was no sign of trauma or active infection. The electrocardiogram showed that this wasn’t a heart attack. His blood tests were unrevealing.

What was causing his symptoms? It was his friends who told us what happened. They were experimenting with what they said they thought were “totally safe” and “natural” drugs — substances called Spice or K2 that are often referred to as synthetic marijuana.

In the past, the drugs had given the teenagers a quick high. This time, they experienced hallucinations. Some threw up. My patient was the one who got the sickest.

This would be a frightening scenario for any friend or family member, but what makes it worse is that this isn’t an isolated incident. In the last two years, cities across the U.S. have seen surges in ER visits and hospitalizations tied to an evolving category of chemical substances known as synthetic drugs.

In Baltimore, where I serve as the health commissioner, we have seen a marked increase in the use of these drugs, along with a spike in adolescents seeking urgent medical care.

Patients present with a range of symptoms, from agitation, hallucinations and psychosis to dangerously high blood pressure and seizures. Most recover with supportive therapy. Some, however, experience irreversible heart, brain and kidney damage. A few die.

How is it that these dangerous drugs can be so widely accessible?

One reason is that they encompass a large of number of compounds. Some are similar to amphetamines; others have ingredients similar to cannabinoids (the active ingredients in marijuana) and are referred to as synthetic marijuana. Since the Drug Enforcement Administration first ban on some synthetic drugs in 2011, more than 250 similar compounds have surfaced in their place.

Another reason is misleading advertising. Sold in gas stations, corner stores, and online, these drugs are marketed as room fresheners, herbal incense, bath salts or potpourri. In fact, they consist of chemicals sprayed onto dried plants and are intended solely for human consumption.

Many young people falsely believe that these synthetic drugs provide a safe and legal alternative with the same high as illicit drugs. However, some synthetic cannabinoids can be up to 100 times more potent than marijuana. Moreover, users don’t know which of thousands of chemical combinations they may be taking. Scientists have equated taking synthetic drugs with a game of Russian roulette.

If federal regulation of these substances is so challenging, what can be done to reduce the harmful effects on our youth?

First, local legislative efforts can be effective. New York City and Washington, D.C., are among major cities that passed legislation in 2015 to ban the sale of synthetic drugs. In Baltimore, we introduced a bill to impose civil as well as criminal penalties to sellers. It also allows inspectors to remove these drugs from stores at time of discovery, and provides a mechanism for citizens to anonymously report stores selling these substances.

Second, businesses themselves can take action. After we sent 1,300 letters to local stores, many have posted “Not a Drug Dealer” signs in their windows. Some havde voluntarily reported distributors that are illegally selling synthetic drugs.

Third, parents, teachers, pediatricians and others who work with teens should be aware of the dangers of synthetic drugs and speak with children and adolescents. In Baltimore, we launched a public education campaign called “Don’t Roll the Dice With Spice.” Similar efforts exist in Minnesota, New York City and Washington, D.C.

My 14-year-old patient regained consciousness and recovered without long-term damage. He said that he had no idea that what he took would make him so sick. I hope that other young people will not require a near-death experience to prompt them to avoid these dangerous synthetic drugs.

Dr. Leana Wen is the Baltimore City Health Commissioner. Follow her on Twitter: @DrLeanaWen and also @BMore_Healthy.

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Maybe it was last January’s big measles outbreak at Disneyland that scared more California parents into getting their kids vaccinated. Or maybe health campaigns have become more persuasive. Or maybe schools getting stricter about requiring shots for entry made a difference.

Whatever the reasons, childhood vaccination rates last fall went up in 49 of 58 counties in California, according to data released Tuesday by state health officials.

The California Department of Public Health annually reports vaccination data for kindergartners from nearly all public and private schools statewide. For the 2015-2016 school year, 92.9 percent of kindergartners were up-to-date on their shots — an increase of 2.5 percentage points from the previous term.

In California, as in the rest of the nation, 2015 was a year of heated debate around vaccines. It started last January with the first reports of a measles outbreak tied to Disneyland. Then, in early February, state lawmakers introduced a bill to eliminate the personal belief exemption, which has allowed California parents to easily refuse vaccines on behalf of their children.

The repeal of that exemption became law, to take effect in July 2016. But the percentage of parents citing personal belief exemptions is already declining in California, the newly released data show — from 2.54 percent of incoming kindergartners in 2014-15 to 2.38 percent this year. In addition, the percent of children receiving both doses of the vaccine against measles, mumps and rubella — or MMR — has increased from 92.55 percent to 94.59 percent statewide.

“I can only assume that this is in part a response to … the measles outbreak and the publicity that that received,” says Dr. Art Reingold, head of epidemiology at the University of California, Berkeley School of Public Health. “It’s unfortunate that fear or outbreaks of disease are necessary to get people to do what we’d like them to do, but I think that’s human nature.”

Even Marin County, a hotbed for the anti-vaccine movement, saw its personal exemption claims drop — from 6.45 percent last year to 5.97 percent this year. The county’s public health officer, Dr. Matt Willis, calls the decline in Marin’s rate “great news,” and notes that this is the third year in a row of increasing vaccination rates. “We haven’t seen this many children vaccinated in Marin County since 2007,” he says.

Still, a decline in the number of parents formally refusing to vaccinate their kids isn’t the only reason for the statewide improvement in vaccination rates, according to James Watt, chief of the division of communicable diseases in the state’s department of public health. Another big factor, Watts says, is a decline in what are known as “conditional admissions” to schools.

These are kids who show up on their first day of school having received some — but not all — of the required immunizations. Often, schools go ahead and allow these children to start class, with the understanding that their parents will make sure the students get the remaining shots as soon as possible. But that’s not what the law demands.

“If those children could get a dose ‘today,’ they’re not supposed to be admitted to school,” Watt says. The problem, he explains, is that lots of kids have been enrolling with “conditional entry” who don’t go on to get the rest of their shots.

By working with parents and school districts to explain and enforce the rules — and vaccinate more kids — the state was able to reduce the overall number of conditional admissions from 6.9 percent of all enrolled kindergartners in 2014-2015 to 4.4 percent this year.

“The outbreak of measles was a real wake-up call for all of us around this issue,” Willis says. “It gave us a chance to speak openly as a community about what vaccination does for us. It gave us a chance to understand vaccination as a matter of community responsibility.”

Dr. Olivia Lang, a Berkeley pediatrician, said she’s seen a change in her practice, too. “There were a lot of families who had been waffling on vaccines, but perhaps were not strong believers in anti-vaccination ideals,” she says. “But now they’re saying, ‘Well, I guess we’re going to have to do it,’ ” and so they are getting their children vaccinated.

Starting with the 2016-2017 school year, all kindergartners and seventh-graders in California will need to be up-to-date on their immunizations to enter school. Only those children who cannot be vaccinated for medical reasons will be exempt.

A version of this story first appeared on KQED’s State of Health blog.

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If you fall off a curb, bop your head and go to the ER to make sure you’re OK, there’s a good chance you’ll be trundled off for a CT scan.

That might sound comforting, but people with injuries minor enough that they get sent home are increasingly being given computed tomography scans, a study finds. That’s despite efforts to reduce the unnecessary use of CTs, which use radiation and increase the lifetime risk of cancer.

There’s been a lot of focus on excess use of CTs in children, but much less on adults who go to the emergency department for things that turn out to be no big deal.

So researchers at the University of California, San Francisco looked at data on every single emergency department visit in the state from 2005 through 2013. They looked at people who had relatively minor injuries, focusing only on those who were sent home after being evaluated and treated. That could include people with fractures, sprains, strains and concussions.

Out of those 8,535,831 people with injuries that didn’t appear to be serious, 5.9 percent got at least one CT scan while they were in the emergency department. That number rose over time, from 3.51 percent in 2005 to 7.17 percent in 2013. The study was published Monday in the Journal of Surgical Research.

“There is a lot of awareness about overuse of CTs,” says Renee Hsia, a professor of emergency medicine and health policy at UCSF who was the senior author of the study. But patients and doctors both have reasons for wanting a scan.

“Patients tend to want to be safe, which is not a bad thing,” Hsia says, “but sometimes they want more rather than less. It’s a very American thing. Also doctors don’t want to miss anything.”

But safety comes with a price. The 72 million CT scans that Americans got in 2007 will cause 29,000 excess cancers, according to a 2009 study from the National Cancer Institute. Nearly 15,000 of those cancers could be fatal.

Efforts to get doctors to cut back on use of CTs may have caused the little downward blip in Hsia’s data from 2009 to 2011, but the numbers then continued to rise. CTs of the head were most popular. The pelvis and abdomen was the only body area that got scanned less often.

People who went to Level I and II trauma centers were more likely to get CTs, the authors found, which may reflect the culture of institutions used to dealing with severely injured patients.

As a practicing ED doctor, Hsia says there’s a lot pressure to scan patients and get them out the door rather than keep them in the hospital overnight for observation, as they would have done in the past. “There’s a lot of pressure for earlier and earlier diagnosis,” she says. “And there are consequences.”

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