In 2012, 986 mass shootings ago, I wrote these words: “”In the wake of another horrific national tragedy, it’s easy to talk about guns. But it’s time to talk about mental illness.”
Now it’s time to talk about guns.
In the wake of the Umpqua Community College shooting, I had the unenviable task of appearing on CNN to defend the shooter’s mother, Laurel Harper, for sharing an entirely legal interest in firearms with her son.
Legal, but stupid.
Should Harper be blamed for her son’s actions? Of course not. Millions of parents share an interest in guns with their children. Harper did not have a crystal ball that could predict her son would become a mass shooter; in fact, it could be argued that mothers are the worst people to ask about their children’s weaknesses, because we prefer to focus, like Harper did, on our children’s strengths. Harper, who is grieving the loss of her son, the tenth victim of the shooting, couldn’t predict a mass shooting any better than anyone else can.
But was Harper irresponsible in how she owned and stored her guns? The clear answer is yes. Not because her son had a mental illness. Because all parents who own and store guns in their homes are irresponsible, regardless of whether anyone in the family has a mental illness.
What causes mass shootings? The same thing that causes 61% of all deaths by gun violence (suicides): easy access to guns. If no one in your family has suffered the negative effects of gun ownership, it’s not because you are a “responsible gun owner.” You are just lucky.
The research on guns and gun ownership is clear. Having firearms in your home makes everyone who lives there more likely to be a victim of gun violence, period. That’s irresponsible parenting.
In the wake of other clear public health risks, Americans have acted rationally. For example, seat belts save lives, so we pass laws that require car drivers to buckle up, and accident-related deaths go down.
But guns? Pry them from our cold, dead fingers.
I live in Idaho, a state where the Second Amendment is revered only slightly less than the Bible. I have enjoyed shooting as a sport; in fact, my brothers taught marksmanship at Boy Scout camps for years. I also enjoy hunting, and many of my friends provide food for their families by heading to the hills with their .22s each October.
But as I’ve learned more about the risks of storing guns in the home, my views on gun control have evolved.
I've avoided talking publicly about guns for this simple reason: I am afraid one of my Second Amendment-worshipping, gun-toting neighbors will shoot me. As I wrote this essay, my husband, reading over my shoulder, said, “Let’s update our wills before you publish.”
But our fear speaks volumes about why we need to talk about guns. In fact, we all are afraid—to go to the store, to the movie theater, to school. It’s time to face that fear head on and do something about it.
I believe that Americans should be allowed to own any type of gun they want to—as long as they are stored in locked cases at gun clubs. Want to shoot a semiautomatic and feel like an action movie hero? Knock yourself out—at the gun club. Want to take your kids hunting for the weekend? Check out your hunting rifles—from the gun club.
If Adam and Nancy Lanza had bonded over guns at a club instead of at home, 20 children would likely be enjoying fourth grade this fall. If Laurel Harper and Chris Mercer had bonded over guns at a club instead of at home, 10 people would likely still be alive today and turning in their midterm writing assignments. If guns were stored at a gun club instead of at home, more than 19,000 people who died by suicide in a single year might have had a chance to get the mental healthcare they desperately needed.
Our Founding Fathers were reasonable men. They surely never imagined a country where an amendment designed to keep the British from invading, at a time when guns could only fire one shot at a time with questionable accuracy, would lead to weekly mass shootings of innocent citizens.
I hope that Laurel Harper will join moms across America in demanding action from Congress on gun control. I’m one of those moms. Please don’t shoot me.
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Liza Long, aka the Anarchist Soccer Mom, is a writer, educator, mental health advocate, and mother of four children. She loves her Steinway, her kids,and her day job, not necessarily in that order. Her book "The Price of Silence: A Mom's Perspective on Mental Illness" is now available in bookstores.
It is with a fair amount of sadness and more than a bit of nostalgia that I bring you the news that Georgetown University will no longer be hosting the Training Institutes. For many involved in the children's mental health field, the Georgetown Training Institutes has always been an important conference to attend. The conference provided a unique opportunity to connect with colleagues, learn about the latest practice modalities, and get energized about important and innovative work being done in children's mental health.
I had the pleasure of attending all but one of the Training Institutes, beginning with the first, held in Breckenridge, Colorado in 1986. At that time, I was working for Dr. Lenore Behar, who headed up children's mental health services for the state of North Carolina. She sent me to the Institutes, and for that, I will always be grateful to her. As a young aspiring system of care evangelist, that first meeting in Breckenridge opened my eyes to a national network of extremely dedicated and committed children's mental health professionals, that until then, I didn't even know existed.
I have so many wonderful memories of that first meeting, but one that stands out for me was meeting Harry Schnibbe, the founder of the National Association of State Mental Health Program Directors. Harry swore like a sailor, and would call out bullshit before the words could leave the offenders mouth. I remember seeing him stroll into a meeting full of suits, dressed in an old polo shirt and khaki's, completely owning the place with a "you got a problem?" look on his face that instantly told you who was in charge.
I was in the first hours of my first time attending the Georgetown Training Institutes and I was sitting across from Harry Schnibbe in a small meeting room, not sure who he was, but knowing I was liking what I was seeing. "You hungry?" he growled at me. Without waiting for an answer, or caring, for that matter, he continued, "Wanna get some good rainbow trout? Not that cheap shit you get in North Carolina, but some real fresh, good shit - I know a place." Harry had drank whiskey with Ernest Hemingway and had felt the wrath of Lyndon Johnson as a young legislative chief for Senator John Carroll. There was not a chance in hell that I was going to say no. I was in love.
And just like that, I was off to dinner with Harry and a group of his friends. I didn't know a soul, but Harry, without hesitation, instantly folded me into this strange mix of wildly passionate people who all shared a deep commitment to improving children's mental health in America. I was hooked.
If not for the Georgetown Training Institutes, I would have never had that unique encounter with Harry. A moment in time where I got to meet and interact with a larger than life figure who would inspire me for decades to come. My memories of Harry Schnibbe continue to inspire me today.
And that, Network faithful, was the magic of the Georgetown Training Institutes. Sure, there was much to be learned at the Institutes, but for me, the greater gift was the opportunity to meet and interact with amazingly inspiring individuals from across the country. Advocacy is hard work. Advocacy is draining work. And if you are going to sustain, you have to find ways to re-energize. The Georgetown Training Institutes provided a forum where I could always count on getting re-energized to continue doing the work I do.
If you have a memory of the Georgetown Training Institutes, take a moment to share it below.
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Scott Bryant-Comstock President & CEO Children's Mental Health Network
In light of the terrible shooting at Umpqua College in Roseburg, Oregon, I am reposting my June Morning Zen article about Representative Nina Lowey's (D-N.Y.) failed attempt to include an amendment that would have reversed a nearly 20-year-old ban on funding for the Centers for Disease Control and Prevention (CDC) to conduct research on gun violence. Specifically, the amendment would have struck Section 216 from the bill (Section 216 prohibits funds from being used to advocate or promote gun control).
We have a Congress that continues to stop any effort to allow the CDC to conduct research on the gun violence. For those in Congress who speak of "doing something now" to stem the tide of mass shootings, I have an idea for you – Reverse the nearly 20-year-old ban on funding for the Centers for Disease Control and Prevention (CDC) to conduct research on gun violence. Anything we can do to develop a better understanding of the root causes of gun violence would qualify as a worthy investment of federal dollars, don't you think?
Hold your representatives feet to the fire on this issue, Network faithful. Over the past two years, we have seen a dramatic uptick in the political debate about mental health reform. The debate has at times blatantly, and other times, more subtly, made the connection between mental illness and violence. This connection continues to be made, in spite of the research showing that people with mental illness are far more likely to be victims than perpetrators of violent crime. Using the fear tactics inherent in connecting mental illness and violence while simultaneously blocking funding for research to understand better gun violence is not only disingenuous, it is unforgivable.In June of this year, the House Appropriations Committee voted 19-32 against ranking member Rep. Nita Lowey's (D-N.Y.) amendment to a bill that would fund health, education and labor programs in the next fiscal year. Representative Lowey's amendment would have reversed a nearly 20-year-old ban on funding for the Centers for Disease Control and Prevention (CDC) to conduct research on gun violence. Specifically, the amendment would have struck Section 216 from the bill (Section 216 prohibits funds from being used to advocate or promote gun control) and this section of text from the accompanying report(page 47-48):
Gun Research.—The Committee continues the general provision to prevent any funds provided from being spent on gun research, to include collecting data for potential future research, such as was proposed in the budget request for the National Violent Death Re- porting System. The Committee notes the budget request for Gun Violence Prevention Research is not funded and would be contrary to the prohibition. The Committee reminds CDC that the long- standing general provision’s intent is to protect rights granted by the Second Amendment. The restriction is to prevent activity that would undertake activities (to include data collection) for current or future research, including under the title ‘‘gun violence prevention’’, that could be used in any manner to result in a future policy, guidelines, or recommendations to limit access to guns, ammunition, or to create a list of gun owners.
For readers who have congressional representatives that continue to invoke a mental illness - violence connection, yet pride themselves on being forward thinking about mental health reform, time for a gut check.
Put on your advocacy hat, pick up the phone and call your representatives office. Ask them what they think about the wisdom of blocking a proposal that would have reversed a nearly 20-year-old ban on funding for the Centers for Disease Control and Prevention (CDC) to conduct research on gun violence. Ask them if they think this action falls in line with their publicly-held position on the connection between guns, violence and mental illness. Ask them, regardless of their position on gun violence and mental illness, if they think it would be a good idea to get a better handle on understanding the increasing gun violence in America. Ask them if they are committed to designing mental health legislation that incorporates sound research on gun violence. Remind them that the current mental health reform proposal in the House (H.R. 2646) “requires” family members of mentally ill individuals who have committed violent acts to be involved in decision-making around government grants focused on mental illness. Then ask them again, if they think it would be important to include sound research to better understand gun violence in America.
Hold your representatives feet to the fire on this issue, Network faithful. Over the past two years, we have seen a dramatic uptick in the political debate about mental health reform. The debate has at times blatantly, and other times, more subtly, made the connection between mental illness and violence. This connection continues to be made, in spite of the research showing that people with mental illness are far more likely to be victims than perpetrators of violent crime. Using the fear tactics inherent in connecting mental illness and violence while simultaneously blocking funding for research to understand better gun violence is not only disingenuous, it is unforgivable.
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Scott Bryant-Comstock President & CEO Children's Mental Health Network
Those of us who have lost a pet know how heartbreaking this can be. According to a recent survey, approximately 70 percent of Americans have a companion animal and around 63 percent of these pet owners consider their pet to be a member of the family. With cat and dog life expectancies reaching into the teens and 20s, animals often become integral parts of our daily lives for many years, thereby creating meaningful, dependable and loving relationships.
When a loved one passes away, grieving is a natural response that is expected as a social norm. Unfortunately, the same doesn’t always hold true when an animal dies. Neighbors or friends may say, “She was JUST a dog.” Many people may not understand the emotional effects and devastation of losing an animal companion.
Below are some tips on coping with the loss of your pet:
Acknowledge that healing takes time. Your pet was loyal to you for many years, offering constant love and happiness whenever you needed it most. Your pet may have slept with you at night, sat by your feet at the kitchen table or followed you around the yard. Your pet’s loss will certainly be palpable (and your home may be quieter), and it is necessary to give yourself days, weeks or even months to adjust to the change and process the emotions you may face day-to-day.
Be open to closure. Honoring the life of a pet is a great way to process the death and pay tribute to the many memories you had together. Having a small funeral process can offer a sense of comfort. Whether through burial, spreading ashes or even a small memorial service, having a special, sentimental commemoration can provide a dignified celebration of the life of your pet.
Be honest with yourself (and others). Viewing your pet as part of your family means you will most likely grieve your pet as the loss of a family member. Recognizing and discussing the loss is an important stage in the healing process. Journaling, talking with a friend and taking care of yourself are necessary in order to stay emotionally healthy during this difficult time. In addition, it is important to be honest with children. Losing a pet is sometimes hard for a child to grasp. Saying, “Fluffy has gone to live somewhere else,” or “We are putting Lucky to sleep,” can be confusing and upsetting. Offering age-appropriate explanations about the death of the pet will provide better understanding for your child. Honestly expressing your feelings will also help your child process the nature of the loss and see that it’s okay to be sad - a healthier strategy for you and a helpful alternative for others.
Be thoughtful about getting another pet. Many families often think that getting another pet may offer a good distraction from the mourning process. Alternatively, some pet owners feel that getting another pet would be replacing the previous pet and would therefore be insensitive and upsetting. Although your beloved pet is certainly not replaceable, this does not mean that you can’t ever again experience the joy of pet ownership. Weigh the emotional, physical and financial pros and cons before thinking of becoming a pet owner once again. Be cognizant of your grief process and how another animal companion may affect you and your family. If you are feeling the significant loss within the home, try framing a picture of your cat or purchasing a Labrador plush toy for your toddler. Little reminders around the home may offer the temporary “replacement” you need. In time, you may be able to once again provide a loving home for a pet.
Ways to remember your pet: Donate to a rescue organization in your pet's name. Create a pet photo album or memorial book. Make a piece of jewelry out of your pet's ID tags.
There are many ways to cope and help yourself and others deal with the grieving process. Celebrate the life of your pet, give yourself time and take comfort in the many loving memories your animal companion has provided you over the years.
Co-authored by Alex D’Auria
This article originally appeared on psychbc.com. Check them out!
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Rae Speaker received her master's degree in social work from Case Western Reserve University and her bachelor’s degree from Baldwin-Wallace College. She has extensive post-master's training in cognitive therapy, addictions, structural family therapy, sexual issues and mood disorders. A board certified Diplomate in clinical social work, she served in clinical and supervisory positions in both inpatient and outpatient settings, including the Child Guidance Center of Cleveland and Lorain Community Hospital, for more than 40 years. She also has served as an adjunct instructor for graduate students at both Case Western Reserve and Cleveland State Universities. She offers outpatient psychotherapy for a wide range of clinical issues, including marital issues, addictions, mood disorders and sexual dysfunction. She has a specialty interest in stress management issues and has taught classes in this area at St. John West Shore Hospital.
When my son was nine, ten and then eleven, we lived at high alert. He talked about how he wanted to die almost every day and many days, he hurt himself. He had meltdowns several times a week that lasted 30 or 45 minutes, sometimes more than an hour. His behavior was bizarre at times, at other times he was profoundly sad. Once, he ran away from school at recess (some classmates joked that whoever ran the slowest would have to stay after school and he couldn’t tell if that was true and panicked). I got a terrifying call saying the police were searching a nearby pond, fearful he had tried to drown himself.
At ages 7 and 8 he had been hospitalized (several times) and that didn’t seem to be the answer. His doctor said regularly, “He could be admitted right now, you know.” But we didn’t do that. He had weekly therapy, medication trials, special education and more. He also had a mom who never gave up. Somehow we wove a safety net and got through it day by day.
Everyone understood how serious his mental health problems were, but I had no vocabulary to describe how acute they were. His psychiatrist and I created a chart to measure his outbursts, his self-harm, his bizarre thinking and his fears and anxiety, which I faithfully filled out each day. On a scale of 1 to 10, he was often a 9 or 10 for one, two or most of these things. He had the same serious mental illness every day, but his acuity shot up and sometimes down.
Paul Gionfriddo, the CEO of Mental Health America, has started a campaign called B4Stage4. He believes that we need to use a framework of Stages 1 to 4 as we do with other illnesses. He writes that the way we determine Stage 4 for mental illness in this country is by using the “imminent danger to self and others” standard. We wouldn’t wait until Stage 4 to treat illnesses such as cancer, heart disease or diabetes, he argues. He makes the case that we need to offer care for mental health issues early on, at Stage 1 – when early symptoms show up — or better still, focus on prevention.
Paul Giondriddo sees mental illness as having 4 stages, as chronic diseases such as cancer do. There is a progression from a less severe stage to more severe one, if the mental illness is left unidentified and untreated. I wonder, though, if this model fits as neatly for child and teen mental health issues. Children are different from adults in lots of ways. For mental health issues, they often appear to have episodes (not chronic) and can become acute, sometimes even when they are getting treatment and services. Often, what worked at age 10, doesn’t work at age 14 and you try new approaches. For some children, the illness is revealing itself symptom by symptom as the child gets older. Children can be initially diagnosed with anxiety or attention problems, then mood swings show up and the diagnosis changes.
I do think this framework of Stages 1 to 4 is intriguing. As parents, we need a vocabulary to describe how intense, how acute our child’s symptoms are. This could be the way to do it.
Sometimes parents are told that their children are considered too acute or difficult to manage for certain settings, even for some psychiatric hospital units. They might require a one-to-one staff person, someone to have their eyes on them and be ready to act. But it sounds odd to hear that phrase: too acute. Does that mean that this bipolar disorder is worse than that bipolar disorder? They are the same illness after all.
At one point state and federal programs used the term “serious emotional disturbance” to describe children and teens with significant mental health issues. It’s an awkward term at best. Sometimes I like the “serious” part of it but cringe at calling children disturbed. But that term is also used in special education (slightly different definition) and often the criteria are focused on the impact of the mental health issues on the child’s life and leaves acuity up for grabs.
Mental health issues for children and teens hurt. The youth hurts and often the family hurts too. But there are two kinds of hurt – the long term kind where the impact of the day to day care, support, advocacy takes its toll and the hurt when things zoom up and up into high intensity. We need a vocabulary to talk about them differently.
Parents know when their child’s acuity is in Stage 3 or 4. The burden of care becomes enormous and at times, unmanageable and overwhelming. Parents know the difference between the adjustment to your child’s new normal, the recognition that certain behaviors are part of the illness or trauma and out of your child’s control and then finding ways to work around that. That’s an adjustment to the illness or disorder and what it brings with it. Parents also know when new normal changes and the intensity rockets up like a NASA space launch. We just don’t have the vocabulary to distinguish between them.
Using a framework of Stages 1 to 4 could even help in our discussions with schools. Many schools, to be honest here, have become pretty unimpressed when they hear a depression or bipolar diagnosis. But what if they heard that this child with bipolar has been in Stage 3 for the last 2 months and all the medications, therapy and services haven’t really brought his acuity down to Stage 2? It could change the discussion.
When my son was nine and ten, I knew he had a serious mental health issue, even though his diagnosis hadn’t landed in one place yet. But when his acuity zoomed up, sometimes overnight, and stayed at Stage 3 and 4 for days and weeks at a time, I needed a way to talk about that too. Could this be a way to do that?
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Lisa Lambert is the executive director of Parent/Professional Advocacy League (PPAL) and a Children's Mental Health Network Advisory Council member. Lisa Lambert became involved in children’s mental health as an advocate for her young son in 1989 through the CASSP family network in California. After moving back to Massachusetts, she began supporting families whose children and youth had behavioral health needs. Her areas of expertise include mental health policy, systems advocacy and family-driven research. Lisa is a nationally recognized blogger on family advocacy for children's mental health. You can read her blog posts here.
Jose was one of the calmest, quietest, most peaceful boys in the classroom. The kind of boy everybody loves.
Jose had thick, coal-black hair and matching black-marble eyes. He was always in an immaculate, crisp school uniform, often with a warm sweater around his sturdy frame. Jose’s family never adjusted to the cool northeastern temperatures in winter. They were from a small town in Panama, emigrated here shortly before Jose’s birth and now live in a quiet, clean, working class neighborhood.
Jose lived with two cousins, an uncle, an aunt, Mom, baby brother and sometimes Dad. He had been an only child until October of second grade, when his brother was born.
Jose is very proud of “his country”, Panama. His passion is soccer. He loved everything about soccer. If there was a televised soccer game involving Panama, Jose knew all about it.
Jose’s strong academic performance had begun in first grade. His reading level in September, at the start of second grade, was about half-year ahead, in the top 10% of the class and his math results were in the top quarter of the class.
Looks great so far, right ?
When you look inside a classroom there are some things you can not see A few weeks into the new school year Jose’s reserved social traits began to intensify. He was always polite and respectful, but at that point he became unusually silent, a moody silent: frowning. He began ‘forgetting’ his glasses about half the time. He stopped participating in class. When called on to answer a question, Jose often hadn’t heard the question. Inattentive and forgetful, he sometimes completely checked-out with his head in his arms, down on the desk. He was unresponsive and avoidant with classmates. At first, I thought sleep-deprived, which usually resolves itself after adjusting to new school year routines. Now that the calendar reached into October I began to suspect something more.
As the year continued on into late October/November, Jose’s academic pattern emerged to be wildly inconsistent. A student’s literacy results are usually in a narrow range. There aren’t usually wild swings between ‘A/B’ and ‘D/F’, week by week, which was Jose’s pattern.
Jose’s behaviors were more than ‘daydreaming’: he was detached, forgetful, ‘stunned’ even, with muted responses, low energy, easily fatigued and more – all in context of fluctuating academics.
Public Health Data Childhood trauma is the response of overwhelming or helpless fear, or terror. Specifically, it is a response to abuse, neglect, to a missing parent, or a household which includes violence, mental illness, or substance abuse. Other childhood traumas can include experiences with community violence, or ethnic oppression, and more.
See more detail at “Common Sense” on varying rates of trauma (3+ “Adverse Childhood Experience” or ACEs) from 22% to 45+% of all children. From idyllic middle class suburbs, to rough urban settings. Childhood trauma is no respecter of demographics.
The child who is hyper-aroused, hypervigilant, aggressive and disruptive is the ‘Poster Child’ for abused or neglected experience. They get the attention in a classroom setting where learning for 30 students is the goal. See “Jasmine” at “Peek Inside a Classroom“.
Students like Jose can be overwhelmed by the same life-altering fears as “Jasmine” and yet, may react with totally opposite behaviors: compliant, but “disconnected”, “in a fog”.
Dissociating students are much more likely to be unsupported, or even completely unnoticed. Even when teachers (I have been guilty too) are trained and are able to notice “Jose”, it can be tempting to ignore him, and take advantage of the calm classroom to teach the other 30 children. Simultaneously, it’s very frustrating, because Jose gets absolutely no learning. “Roberto” was another student in dissociation, while “Danny” exhibited behaviors of both hyperarousal and dissociation.
I had suspicions about deeper, life issues for Jose, but my goal was to hear directly from Jose. I started by sharing that I was surprised at his score on the latest reading test, because I knew from his other tests that he was able to do the work. In an empty classroom, in private I reassured him that he was not in trouble (the location and the message and tone were all part of establishing “safety”). I mused that sometimes when things change at school, that’s because they had changed at home first. I wondered out loud if everything was okay?. . .
Jose hesitated, but eventually shared that he “missed dad”. “He doesn’t come home any more”. Instead dad goes to Jose’s aunt’s (dad’s sister’s) house in the evenings “because dad says ‘it’s more fun there. He thinks it’s boring at home’”. Jose believed final divorce was near.
Jose, head hung low and he broke into tears at this point. At first he was turned away and “hidden”. A confused, powerless, embarrassed posture. I hugged him lightly and said ‘it must be hard’. He nodded and went silent. I decided to wait to talk with Mom till we could talk in person. I knew that children’s versions of their parent’s lives can be hazy and incomplete.
Dissociation: One more thing you can not see when you look in a classroom Two days later, on a gray rainy day, Mom came to school to pick up Jose. When I shared what Jose had said to me, she had the same response as Jose: very soft and fragile emotionally, with quivering lip and almost immediate tears. It was clear that they were both suffering deeply from the broken marriage. I suggested that it might help Jose to have someone to talk to outside of school. She took Jose home, promising she would find someone.
Relation-based, on-going, or “Complex”, trauma is the most heinous type of trauma (versus ‘environmental-based trauma, and one-time events). Complex trauma occurs during childhood, within the family system. The trauma originates from caregivers who are accountable for protection and love. Instead, chronic, overwhelming fear and pain, and no escape: incest, physical abuse, witness to intimate partner violence, are examples. As another example, Divorce, no matter how “friendly”, rocks the child’s world. It is a terrifying loss of security and love to young children. Results of Complex Trauma impair least seven domains, as detailed at Cook, et al,(2005).
Back to Jose: his mom returned the following week and abruptly announced that “all that stuff we talked about” last week was “fine” now: the father was not an issue. Jose was “incorrect” according to her. She was curt, did not want a discussion, turned and left quickly. It happens too often. Guards are down, things are shared, but then later denied.
I planned to be exceedingly clear at upcoming Report Card conferences about what I was still seeing at school, in spite of Mom’s denial. I had every intention of being brief and crisp (and probably too cold). I was frustrated about lack of attention to Jose, and his pain and the secondary status of his learning, after all, I was his teacher, and (I felt), his advocate.
Some adults dismiss the impact of adverse events (ACEs) on children, thinking “they’re too young to understand anyway, or “they’re young, they’ll get over it”.
Actually, this common adult perspective is exactly wrong. It is precisely BECAUSE the child is “too young” that their ability to defend against intense stress and trauma is far weaker and the results are far worse than an adult exposed to the same event.
Children’s brains are still developing: 1) Their brains are not fully ‘wired’. The immature brain is “use-dependent”, meaning it develops in areas that are used, and therefore more vulnerable to mis-wiring from chronic defensive usage. See …early brain development p.3-6, 2) The chronic, powerful chemical baths of cortisol and adrenaline during “fight or flight” cause direct damage to still-developing brain cells, and 3) children’s frontal cortices are not yet experienced in processing and logically understanding the source of fear. Their immature coping mechanisms are easily undermined and their sense of helplessness or powerlessness is relatively greater than an adult. So, over time, unaddressed trauma causes changes the physical structure and functioning of children’s brains and will lower the quality of their lives and likely result in early death. Levine and Kline p.4, Perry p.245, and the CDC Adverse Childhood Experience (ACE) research.
Mom arrived for our conference cuddling a new infant, Jose’s 5 month old brother. I shared preemptively, and somewhat formally, that Jose’s academic performance was now distinctly below average.
I had struggled to give him “C”s. I also shared that Jose’s performance continued to be wildly erratic. I described the swings as clear evidence that he still has very high ability. Students don’t just have ability ‘on occasion’.
Erratic academics often mean there is “something ‘inside him’ troubling the student”. I wondered aloud if there was anything she could think of?
I stopped. The room was silent.
A dependent, child can not be known in a vacuum. The child is an integral, dependent member of a family system. See summary of M. Bowen (in Louis Cozolino; Chapter 3). When one person in the system is impacted by trauma, all others are impacted in relation to that member. Jose (and mother) were impacted by a variety of insecurity and abandonment issues, related to his father. The divorce was a pending fracture to their system, and even more in Jose’s eyes, a pending earth-splitting re-definition of his entire world.
Warning: It suddenly became overpoweringly emotional. An intense, flooding release. Mom struggled to share through heaving sobs. Her wounds were obviously still open and tender. First she shared that, yes, there was something bothering Jose “inside”. The phrase ‘inside of him’ had seemed to translate powerfully. Suddenly, Mom blurted “Yes, ‘inside’ Jose is still dealing with the death of his aunt, Maria, his Dad’s sister”. Maria had died about only 8 or 9 months ago, in the summer right before school. She had been Jose’s favorite aunt. Apparently their love and affection were mutual.
Dissociation: One more thing you can not see when you peek in a classroom It got more intense. Mom continued: Maria suffered painfully and ultimately died from burns covering 100% of her body. . . the result of a gas leak, explosion, and fire. Maria’s brother, Jose’s dad, was working on the same street, heard the explosion which caused the fire, heard his sister’s screams and was completely powerless to help.
Mom shared that Dad then went “deep inside himself”, completely shutting out the entire family. Mom described dad as ‘totally unavailable’ for two to three months – increasing insecurity and abandonment fears for the rest of the family.
Yet, to this day, Jose has never made mention of Maria or her death to me.
Mom herself was close to Maria. Grieving and preoccupied, she tried to disconnect by wrapping herself in preparations for her baby-to-come. The baby came in October, a brand new “attraction” in the family. Mom acknowledged that she also dramatically cut time and communication with Jose. Her words, translated; “ignored”, “forgot”.
Even so Jose never mentioned his little brother to me. He seems to have no affect for him. If Jose refers to him at all, it is only by his ‘position’, “my baby brother”. He doesn’t speak his name.
At this point in the report card conference (yes it was still the same conference). We were all weeping.
I asked Mom if she would be willing to see the School Counselor (yes, there is one at our school) with Jose. Mom agreed, at the time.
Successful education is centered on Jose — not on Jose’s test scores
Trauma Informed Education Jose must be understood holistically and helped personally.
Jose, defending himself “invisibly”, in dissociation, needs every bit as much support as Jasmine, on the “front page”, in hyperarousal. They simply defend themselves differently in “fight, or flight”.
Neither defense allows trauma-impacted children to access their education.
Conversely, a trauma-informed education paradigm requires: a) explicit acknowledgement of childhood trauma, b) screening students, c) training teachers and staff, and d) creating “safety” across the learning environment.
Crucial investments towards safety include appropriate class-sizes, with limits on trauma-impacted children per classroom. Additionally, dedicated appropriate space for children to de-escalate is needed, as well as on-site nurses and counselors; counselors, who build safe, trusting relationships with the children and families. (See “Common Sense” and here and here and here for more detail on some “beginnings”).
Presently, the education “reform” environment has resulted in the opposite — disinvestment — in Public Education. In our own city the total local/state/federal funding is described as an “Empty Shell” Budget. How long will we keep trying to do what can’t be done? The emperor has no clothes. The children have a right to more than ’empty shells’.
Further, reformers’ paradigm which focuses on education as a single ‘silo’ of only one (testing) dimension, blocks our view of the whole child. See “Failing Schools or Failing Paradigm?”. Their system generates wrong decisions, life-changing decisions, based on uninformed, misleading (test) data — it’s not ACE-adjusted data – it’s without any perspective on wide differences in trauma rates.
Daun Kauffman has been teaching in Philadelphia public schools for 14 years. "I live, and work, and worship in the Hunting Park neighborhood of north Philadelphia, with students we’ve served. The Philadelphia Inquirer has described the neighborhood as 'a gritty, drug infested barrio'. Nevertheless, my neighbors and students are steadfast, creative and inspiring in the way they wrestle with many life challenges. They have taught me much."
Oh my, the next few weeks are going to be interesting for supporters and detractors of the various mental health reform bills floating around in the halls of the House and Senate. As faithful readers know, the Network welcomes opinions on all sides of the mental health reform debate, and we have been blessed to have blog post contributions from a diverse group of thought leaders. Only on these pages will you read opinion pieces from the likes of Liza Long, Dennis Embry, Lisa Lambert, Leah Harris, Dottie Pacharis, Will Hall, and so many more. It is our continual bounty of diverse opinion that is one of the things I love so much about the Children’s Mental Health Network. Never a dull moment around here!
Time to crank up the mental health reform dialogue We are approaching the month of October; recess is over, and the Pope has completed his visit to Washington, DC. Heck, if we avoid a government shutdown, maybe we can roll our sleeves up and get busy with pending mental health legislation. In fact, mental health advocates on both sides of the mental health reform debate are picking up the pace, beginning with two important events taking place on October 7th.
Mental Health Reform: Improving Access to Care & Reducing Incarceration If you find yourself in favor of the Murphy bill and want to hear from both Representative Murphy and Senator Murphy (who is pursuing a similar bill in the Senate), there is an event taking place in Washington, DC that will interest you. On Wednesday, October 7, 2015, from 8:30 – 10:30 AM Eastern Time, The National Journal and Janssen Pharmaceuticals are sponsoring an event in Washington, DC on mental health reform. The event, Mental Health Reform: Improving Access to Care & Reducing Incarceration will include a number of speakers, including:
Rep. Tim Murphy, Sen. Chris Murphy (D-CT), Mary Giliberti, Executive Director, National Alliance on Mental Illness, John Snook, Executive Director, Treatment Advocacy Center, Fred Osher, M.D., Director of Health Systems and Services Policy, Council of State Governments Justice Center, Kathleen Nolan, Director of State and Policy Programs, National Association of Medicaid Directors, and Renée Binder, M.D., President, American Psychiatric Association.
That is quite a lineup, boding well for a robust discussion, to say the least. Unfortunately, there is no consumer or young adult voice on the panel. Ouch!
Hey, organizers, there is still time. Let us know if you want some recommendations for incorporating young adult voice into the mix. After all, much of your conversation will be focused on this population. We are happy to help!
Day of Action for REAL Change in Mental Health Policy Also on Wednesday, October 7th, the Campaign for Real Change is initiating a “Day of Action for REAL Change in Mental Health Policy.” The Campaign for REAL Change in Mental Health Policy was initiated in opposition to The Helping Families in Mental Health Crisis Act (H.R. 2646), introduced by Representative Tim Murphy (R-PA). Here is how they describe themselves on their website: “We are a diverse group of professionals, psychiatric survivors, researchers, policymakers, citizens, family members, and people in recovery who don’t necessarily agree on all points, but who are united in our effort to stop the Murphy bill. We are also united in the belief that we can do better than what this bill proposes.”
For the October 7th event, the Campaign is encouraging people to call, write, or use social media to contact their members of Congress and tell them that the Murphy Bill is bad for America. Their Twitter campaign is: Tell The National Journal “Nothing About Us, Without Us!” #RealMHChange
The Campaign website includes resources individuals can use to help with their advocacy efforts. Regardless of where you land on the Murphy bill, if you are an advocate in search of resources, check out their landing page for the Day of Action.
Bottom line for Network faithful Same as always – Do your homework and try to listen, even when it hurts. Stay focused on the end goal – improving the lives of individuals and families in ways that support and strengthen a community-based approach to helping each other be as successful as possible.
Whew! I told you it was gonna get busy!
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Scott Bryant-Comstock President & CEO Children's Mental Health Network
Sharing with CMHNetwork readers my Call to Action letter to Drs.Torrey, Embry and Representative Murphy on a very doable strategy for preventing first episode psychosis. We can make significant change – today. But we can only do this if these three individuals – two esteemed scientists, one from the treatment end of the continuum, one from the prevention end of the continuum and a member of Congress who has made mental health reform his mission – take the lead. This is what it will take to begin preventing first episode psychosis – today.
Dear Dr. Torrey, Dr. Embry, and Representative Murphy:
I was most excited to read in the Treatment Advocacy Newsletter about the positive results from the study recently published in Nature Communications (Amminger, et al.) that showed impressive benefits for the use of Omega-3 fish oil for the prevention of psychotic disorders. More impressive was learning that Dr. Torrey’s organization, the Stanley Medical Research Institute, not only funded this study, but is also actively involved in funding additional studies of Omega-3 in Australia and Europe and a trial of the use of omega-3 for individuals with bipolar disorder.
Over the past month, the Children’s Mental Health Network has been focusing on the important benefits of Omega-3 fish oil and have called publicly for the three of you to come together to help promote the promising research supported by Dr. Torrey’s organization on the use of Omega-3 fish oil to prevent psychotic disorders.
There has been much turmoil over the past few years in the mental health community about the best approaches to meeting the needs of individuals with serious mental illness. The debates will continue, but the three of you have the opportunity to do something very unique – bring together scientists from prevention and treatment backgrounds together with a Congressman who brings with him the advantage of a national speaking platform to do something that could absolutely make a difference in the lives of individuals with mental illness today. Not sometime in the future, but today. Better yet, the cost of this prevention effort would be exceedingly low, something politicians and advocates on all sides of the mental health debate could get behind.
I know you are aware of the scientific data regarding the positive effects of Omega-3 fish oil as a preventive treatment strategy for first episode psychosis, but both the looming challenge of the incidence of first episode psychosis and the scientific data regarding Omega-3 (in addition to the study funded by Dr. Torrey’s organization) is worth repeating:
The problem According to Dr. Thomas Insel, each year, about 500,000 young people in this country seek help for symptoms that resemble the prodrome of a psychotic illness. Approximately 100,000 adolescents and young adults in the United States will experience first episode psychosis each year (calculated from McGrath, Saha, Chant, et al., 2008). The time for action is now. We cannot wait for further replication studies of the use of Omega-3 fish oil before taking action – the potential damage to human lives would be staggering. For example, a follow-up study requiring a seven-year tracking period would mean 700,000 young adults would have had a first episode psychosis in the time it took to complete the study. Theoretically, the results of the Amminger study might avert 30% or a 210,000 cases of first episode psychosis for about $15 to $20 each if we implemented a national effort to use Omega-3 fish oil as a preventive strategy with individuals who have a mental illness. Even if first episode psychosis was reduced by 10%, that would be a tremendous gift to the nation. Congressman Murphy is right to remind us all that we must do something. The three of you rallying together is the “something” I think people would be hard-pressed to disagree with.
The scientific evidence is in, and it points to a low-cost, effective solution There are many published examples of the positive impact of Omega-3 on mental illness, including:
In 2006, a consensus paper by a committee of the American Psychiatric Association published a recommendation that all individuals with a DSM diagnosis should be taking at least 1 gram per day of Omega-3. Freeman, M. P., Hibbeln, J. R., Wisner, K. L., Davis, J. M., Mischoulon, D., Peet, M., . . . Stoll, A. L. (2006). Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. Journal of Clinical Psychiatry, 67(12), 1954-1967.
Role of omega-3 fatty acids in the treatment of depressive disorders: a comprehensive meta-analysis of randomized clinical trials. PLoS One, 9(5), e96905. doi:10.1371/journal.pone.0096905
Most exciting is the consensus that now exists between the Department of Defense and the National Institutes of Health about using omega-3 to protect military service members. Examples of published studies include:
Coulter, I. D. (2014). The response of an expert panel to Nutritional armor for the warfighter: can omega-3 fatty acids enhance stress resilience, wellness, and military performance? Mil Med, 179(11 Suppl), 192-198. doi:10.7205/milmed-d-14-00189, Lewis, M. D., & Bailes, J. (2011).
Neuroprotection for the warrior: dietary supplementation with omega-3 fatty acids. Mil Med, 176(10), 1120-1127. Lewis, M. D., Hibbeln, J. R., Johnson, J. E., Lin, Y. H., Hyun, D. Y., & Loewke, J. D. (2011).
Suicide deaths of active-duty US military and omega-3 fatty-acid status: a case-control comparison. J Clin Psychiatry, 72(12), 1585-1590. doi:10.4088/JCP.11m06879
The time for action is now Drs. Torrey, Embry and Representative Murphy – we can make significant change – today. But we can only do this if the three of you take the lead. Two esteemed scientists, one from the treatment end of the continuum, one from the prevention end of the continuum and a member of Congress who has made mental health reform his mission. This is what it will take to begin preventing first episode psychosis – today.
Will you take this challenge? I look forward to hearing from you and sharing your thoughts with our readers. As always, please let me know how we can be helpful. We can do this, but it begins with the three of you joining hands and leading the way.
Scott Bryant-Comstock President & CEO Children’s Mental Health Network
When someone shines a spotlight on a clandestine affair, does our silence become voyeurism? Are we sideline participants - part of a newly created menage a trois that relies on all partners to support the new status quo? Do we then all share equally in the blame for what has become of the Federation of Families for Children's Mental Health?
I watched the indiscreet descent of our Federation from a robust, raw, angry, intense and utterly dedicated culturally pluralistic gathering of parents and family members to a meeting of largely "professionalized parents" who, despite their many strengths and skills have been molded to become part of the system itself. This is not what any of us envisioned!
Trepidation over continuing funding for the Federation led us onto a dance floor where we not only had to follow the lead of our funders, but pretend that we liked it.
Whatever happened to our role as David in the biblical tale of David and Goliath? We were small and without great weaponry, but we had right on our side and on the job learning about how to bring down a non-system of services for our children. Once we were expected to become more "professionalized," we were assigned a new and potentially equally important role - to carve up the beast from the inside. It was to be our responsibility to identify gaps in services and to build support for all families to place demands on the system so that it could become more responsive. Of course we were to be unfettered, and our voices, however strident, were to be honored. Is that not why parents were hired in the first place? There is an enormous disconnect between our one-time expectations and the reality of today.
Who do we blame? Funders, who knew from the outset that who controls the money controls those who receive it? The Federation, that spent countless hours chasing the dime, redefining their expectations of and for families and handholding with the bureaucracy to sustain itself? Or ourselves, that we believed the exhortations that becoming part of an impersonal and largely intractable service system whose movement was as slow as molasses in January was the only way that the voices of parents would be heard?
When I expressed disagreement with the direction of the Federation, not because I felt that "training" parents was a bad idea, but because I feared that ultimately, a paycheck has immense power over one's voice, the notion was pooh-poohed by both Federation leadership and by funders. I am hardly surprised but greatly dismayed by what has become of an organization to which I dedicated years of my life and all of my trust. Something MUST be done so that families once again receive the support and education they need to ensure the best services for their child.
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Dixie Jordan is one of the nations foremost experts in understanding the reauthorization of the Individuals with Disabilities Education Act (IDEA). She has developed a practical training that offers specific techniques for developing positive Individualized Education Plans for children and youth with mental health needs that is used throughout the United States. Dixie has been involved with the National Federation for over twenty years, having served on the Board of Directors as well as having provided countless hours of individualized consultation on IDEA for parents attending the annual national conference.
What would happen if the mental health system fully recognized the pervasive and profound impacts of trauma on their clients? How might a deeper appreciation of the multi-faceted sequelae of childhood maltreatment and toxic stressors reshape mental health services? While the implementation of trauma-informed care in mental health programs has made significant inroads, the dominant bio-reductionist model continues to constrain and undermine progress.
As readers of this website well know, the seminal ACE study (Felliti & Anda) continues to enhance our understanding of the correlations between childhood trauma and both psychological distress, as well as physical illness. These correlations are striking in their dose-dependent nature – the higher the ACE score, the greater the probability of being diagnosed with a wide spectrum of mental health disorders, including depression, anxiety and psychosis. The ACE studies give credence to the straightforward proposition that when bad things happen to us at vulnerable ages, physical sickness and extreme distress is frequently the result. In addition, people exposed to high ACEs commonly adopt a host of risky behaviors such as substance abuse, overeating, and unprotected sex in an attempt to cope with their overwhelming experiences.
Acknowledging ACEs and implementing a trauma-informed perspective threatens to blow up the fictitious diagnostic boxes that mental health systems currently employ to categorize human suffering. The DSM's nosological approach focuses on describing the disparate surface symptoms of distress (depression, anxiety, psychosis) while ignoring their known etiology in childhood adversities. By disease-ifying distress, the DSM pathologizes adaptive, normal responses to abnormal experiences.
Take, for example, the diagnosis of Intermittent Explosive Disorder. A child is labeled with this when it is noted that from time to time, for unknown reasons, s/he becomes enraged and verbally abusive, destroys property, or hurts others. The DSM naively names these de-contextualized behaviors as a disorder, and dismissively overlooks the role of chronic, unpredictable toxic stressors that are frequently playing out in the traumatized childs’ life. It is akin to diagnosing someone who has a urinary tract infection (UTI) with a fever disorder (FD), co-morbid low back pain disease (cm-LBPD), and frequent urination illness (FUI). ACEs can be likened to an infection that manifests itself in myriad ways in survivor’s bodies and minds. Etiology matters.
When people become overwhelmed with an unrelenting sense of fear, emotional dysregulation, and alienation brought on by cumulative traumatic exposures they often seek help from mental health programs. The help seekers’ signs and symptoms will be duly documented, and myopic diagnoses assigned. Bessel van der Kolk observes in his recent book, The Body Keeps the Score, that a “mislabeled person will be a mistreated person.” Van der Kolk adds that mental health providers frequently focus treatment on the traumatized person’s solutions rather than their underlying problems.
Due to the deeply ingrained medical model, we heavily medicate problems: we saturation-bomb them with neuroleptics. A pill for every ill; and if one does not work – another is added. When traumatized people do not respond well, we call them "treatment-resistant" and "non-compliant." Psychiatry’s magic bullets, aimed at mythical chemical imbalances, can offer temporary relief and tamp down some distressing symptoms – but they cannot heal the wounds inflicted by ACEs. Not all traumatized people develop mental health problems, and not all mental health problems are readily attributable to trauma; but most are, according to ACEs research.
If the impact of ACEs was fully recognized, help-seekers could be invited into an ongoing exploration of what’s happened to them, rather than a code-ification of what’s wrong with them. Baffling and troubling behaviors could be seen as the ingenious survival strategies they often represent. A traumatized person can begin to make meaning out of realizing there are comprehensible reasons for their seemingly incomprehensible feelings of despair, inability to relax and feel joy, and distrust of others. Understanding that one’s behaviors makes sense in the context of ACEs, rather than seen as some random neuronal static, or discombobulated dopamine receptors, can be as life-changing as it is challenging. Recovery will require hard work and active participation by the traumatized person and their support system, but healing can and does happen, whereas passively taking pills will not overcome these barriers to health and well-being.
Not only can an in-depth understanding of the effects of ACEs better support trauma survivors' recovery, it can also increase providers’ empathy towards help seekers. (Lebowitz 2014) Mental health professionals express more empathy towards people when they hear a story, rather than a diagnosis accompanied by tales of life-long brain diseases. Recent studies point out the failure of ongoing efforts to dispel stigma by promoting the notion that mental illnesses are diseases like any other (Read 2007). In addition to the lack of supporting evidence for this trope, actual evidence shows that stigma reduction campaigns using this message may actually increase stigma. Apparently sharing one’s experiences of being subjected to heart-breaking parental abuse, unpredictable episodes of terror, or feeling unloved, engenders more empathy and emotional support than being told that a person has a defective brain.
What if ACEs were the basis of mental health treatment? Perhaps there would be more compassion from mental health professionals and from the public. Most importantly, there would be more compassion by traumatized people toward themselves. Many returning war veterans receive well-deserved support, respect and admiration when seeking help for PTSD. We will take a significant step forward in trauma informed care when we extend that same support and respect to the survivors of unseen wars at home.
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Wayne Munchel, LCSW is a leader in mental health programs designed for transition age youth. He was also a founding staff member of The Village, an innovative recovery program located in Long Beach, CA. Mr. Munchel provides trainings and consultations for services to young people, including trauma informed care and supported employment. This post originally appeared on the Mad in America website, August 26, 2015