Questioning elements in HR 2646 does not make you "the enemy"

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We received a sober reminder a few weeks ago that many in Congress involved in mental health reform efforts still all too quickly fall into the fatal trap of "us versus them."

Reacting to a sign-on letter from the Center for Democracy and Technology opposing HIPAA changes in Rep. Tim Murphy's mental health bill (H.R. 2646), Murphy's Chief of Staff, Susan Mosychuk outlined the Congressman's strategy for addressing dissent with stark clarity. In an interview with Politico, Mosychuk is quoted saying "Those who oppose the reform [HR 2646] are 'the enemy'. I challenge anyone opposing this life-saving reform to talk to someone who loves and cares for an adult family member experiencing schizophrenia."

Those who provide mental health services at the local level will tell you that describing mental health providers with different viewpoints as the "enemy" is a quick recipe for community-wide failure. For many years, I have had the opportunity to visit communities across America deeply involved in working to create service delivery systems that honor both the needs of a community and the individuals and families seeking services. It is a complicated dance, but those communities that do well share in their commitment to honor difference, create opportunities for dialogue and challenge gross generalizations about what works or what does not.

Members of Congress involved in discussions about mental health reform would do well to keep this in mind as they move forward in creating mental health legislation. If they are sincere in wanting to do what is best for families (and I believe that they are), then there is no place for making broad statements that effectively say that any disagreement with "reform" (as they define it), puts you in the camp of  "the enemy."

I expect more from our elected leaders. If Congressman Murphy wants to be a champion of mental health reform, the only way to do so is to abandon the bullying tactics utilized in the creation of the original Helping Families in Mental Health Crisis Act. Our task as advocates and politicians involved in the creation of a mental health bill is to approach difference with respect and a willingness to listen.

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scott

Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

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scott

Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

- See more at: http://www.cmhnetwork.org/media-center/morning-zen/the-murphy-bill-fails-its-own-home-inspection#sthash.Y44NiLyE.dpuf

Senate HELP Committee brings reason, civility and comprehensiveness to mental health reform

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On January 20th, 2016, something remarkable happened at the US Senate Committee on Health, Education, Labor & Pensions Committee Hearing on Improving the Federal Response to Challenges in Mental Health Care in America. Civility, respect and a desire to be comprehensive were ever present at this hearing. The Senators allowed breathing space for the expert witnesses to expand on their answers to questions put forth to them, illustrating their understanding that mental health reform is complicated and needs to be addressed from a variety of perspectives. The witnesses in this hearing consistently spoke of the need for broad-ranging prevention efforts across the age spectrum to help address mental illness in America.

The tone of this congressional hearing on mental health reform was what I have longed to see, especially when contrasted with the vitriol and pettiness that has dominated similar hearings in the House of Representatives, where the simplistic and misleading pairing of mass shootings and mental illness has dominated the conversation.

Witness Testimony
Brian M. Hepburn
, MD, Executive Director, National Association of State Mental Health Program Directors (NASMHPD) provided thoughtful analysis of the issues his organization sees in states across America. Responding to Senator Alexander's opening remarks seeking guidance on how the federal government could support state efforts, Hepburn used the example of the funding that has been set aside for First Episode Psychosis programs. Dr. Hepburn encouraged the Committee to consider changing the allocation methodology so that states with smaller consumer populations, and thus smaller block grants, can receive an amount sufficient to implement an effective FEP program. Changing FEP allocation methods to more accurately reflect what is needed to create quality programming is a critical point that advocates need to champion.

Penny Blake, RN, an Emergency Room Nurse, and a member of the Emergency Nurses Association, brought instant credibility to the dilemma Emergency Rooms across America face when dealing with mentally ill individuals. She spoke of the lack of community mental health services in many parts of the country that put emergency rooms in a bind if the services needed are not available. She stressed that communities must have the health care infrastructure and funding to provide the resources to keep this population healthy. She pointed out that a high-quality, community‐based mental health system would include acute and longer‐term care, access to community mental health clinics, inpatient and outpatient treatment, the availability of 24-hour crisis psychiatric care and services that would allow for integrating the patient more fully into society.

William W. Eaton, PhD, Professor, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, was the next expert witness to speak. There is nothing better than a researcher who knows what he is talking about to lay out the facts succinctly and clearly. Bottom line? There is a plethora of prevention programs for mental and substance abuse disorders with proven positive outcomes. Most of these programs are social intervention programs that can be put in place before a disorder emerges. Dr. Eaton stressed that these resources were unused and often overlooked. (Readers may want to check out the recent Morning Zen post by Dr. Dennis Embry on the power of prevention.)

Dr. Eaton went on to discuss the exciting work being done in genetics, to help us better understand the root causes of mental illness. He stressed that genetic studies would increase their focus on the social, environmental interaction to help identify triggers for the onset of mental illness. Once again, all roads lead back to prevention. Dr. Eaton reminded the committee that a person with schizophrenia will die 20 years early – not because of disease, but because we are not paying attention to them.

  • Amen, Dr. Eaton. If your testimony can help the Senate Committee increase emphasis on proven prevention efforts that not only head off the development of psychosis but will save untold amounts of money that would need to go to treating mental illness after the fact, then how can this Senate Committee not pay attention? Advocates take note – It is our job to keep this Committee's feet to the fire on the importance of prevention.

Hakeem Rahim, EdM, MA, CEO, Live Breathe LLC, Let’s Talk Mental Illness, National Alliance on Mental Illness, was the final witness to speak. Mr. Rahim spoke eloquently of the importance of both medication and support groups in his recovery. He stressed to the committee that "the power of being able to confide in and relate to others going through similar experiences cannot be understated. Engaging with peers has shown me that even in my darkest times I am not alone. Along with peer support groups, programs like NAMI’s In Our Own Voice, have given me platforms to share my story with communities and other people struggling with mental illness."

An enlightening discussion promoting the benefits of prevention
After the opening statements, there was a wide-ranging discussion of proven practices and strategies that could directly reduce incidences of mental illness. Dr. Eaton stressed the importance of stigma reduction classes in high school and reiterated that it was "more important to move upstream to more prevention." Ms. Blake called for a comprehensive approach, from high-intensity services to the types of services that integrate individuals more fully into society. Dr. Hepburn reminded the Committee that 30 years ago we waited until someone developed a serious mental illness. Now, the emphasis needs to be on moving "upstream toward prevention and early intervention", citing as examples both the promising work being done in first episode psychosis programs and the need for a more robust approach to children's mental health. Dr. Hepburn also gave the Committee a sobering reminder of the state of the mental health service delivery system in America when he pointed out that the average age of a mental health provider is 58. Never was training and education more important than it is now.

One of my favorite quotes from the question and answer portion of the hearing was from Senator Collins, who said: "The practices of the past are dictating the services of today." Truer words were never spoken, Senator Collins!

I encourage you to watch the Senate HELP Committee hearing on mental health. Their commitment to honor the effectiveness of treatment strategies across the continuum represents a welcome approach to addressing the challenging issue of mental health reform.

We have work to do!
Make no mistake, there is much work to be done with the plethora of mental health bills in the legislative pipeline, but watching the Senate HELP Committee hearing provided a glimmer of hope that our nations politicians are heading in the right direction on mental health reform.

Next week, I will share my comments on the new  bill in the House of Representatives, the Comprehensive Behavioral Health and Recovery Act of 2016. This bill presents a significant advancement beyond the approach taken in the Helping Families in Mental Health Crisis Act (HR 2646).

Stay positive Network faithful, Spring is coming, and the opportunity for meaningful mental health reform is at hand.

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scott

Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

 

Youth peer support now part of the service array in Michigan - Young voices lead the way

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Morning Zen Guest Blog Post ~ Krissy Dristy

"Loneliness is the most terrible poverty" – Mother Teresa (1910-1997)

I believe that Mother Theresa had it right when she shared this poignant and meaningful insight with the world. This quote has held great significance and meaning to me throughout my life. Artfully displayed in a painting by the entryway of my parents’ home, I read the words daily on my way out the door each morning. There was something powerful about Mother Theresa's reminder of the pervasive effect that loneliness has on the human condition. It blew my mind to think that with so many people in the world, we can still feel alone on our paths in life.

As a youth dealing with anxiety and depression, I was no stranger to loneliness. When explaining this part of my story to others today, I have often been met with a look of shock and disbelief. It is true that I had a supportive family, awesome friends and positive school and work experiences. In fact, for the most part, life seemed pretty great. Underneath it all, I often felt isolated in my mind.  Depression can be a dark place, and while I was holding it together on the outside, the pain I felt inside was gripping. Of course, I had my friends and family to support me, but they didn’t understand how it felt to be in my shoes. I just wanted to talk to someone who had been down this path before and had come out on the other side. Someone who understood how hard it could be; someone who wouldn’t judge or look down on me. What I was longing for was Youth Peer Support.

I did not know it at the time, but peer support for youth and families was on the rise in my home state. The partnership between the Michigan Department of Health and Human Services (MDHHS) and the Association for Children’s Mental Health (ACMH) had supported Parent Support Partner (PSP) since 2010. With the Department and statewide family organization working together, a successful training model was created for PSP, and parents and caregivers could access PSP through Medicaid. This was a great triumph for families who, through the public health system were now able to receive support from parents who could directly identify with their challenges. Parents no longer had to feel quite as lonely in the hardships that can come with raising children with SED (severe emotional disturbances).

With Parent Support Partner creating positive outcomes for families, the need to extend peer support to youth with SED was clear. In 2014, DHHS and ACMH worked with a national consultant to collect stakeholder input and began creating a curriculum for State Plan Medicaid Youth Peer Support. By the summer of 2015, ACMH hired for the positions of Statewide Youth Peer Support Coordinator and Lead Trainer. This past November, the first cohort of Youth Peer Support Specialists went through the state approved YPS training. With the hard work and invaluable contributions of many, we are beyond pleased to announce that Youth Peer Support is now officially a part of the service array in the Pre-Paid Inpatient Health Plan/Community Mental Health Service Provider system for youth and families in Michigan.

Youth Peer Support Specialists (YPSSs) are young people between the ages of 18-26 with lived experience who have received mental health services as a youth. YPSSs serve as an integral member of the treatment team and use their voice of experience to help create positive outcomes for youth. They are young adults who have “been there” and used their challenges to build resiliency, and are now leading their own paths to a life of recovery. By connecting with YPSSs, youth peers are less likely to experience stigma and isolation and more likely to feel engaged in services and experience hope for the future. When youth experience positive outcomes from YPS, families, caregivers and the system as a whole benefit too!

I truly believe in the great impact that Youth Peer Support will have for Michigan Youth. Having been lucky enough to co-facilitate Cohort One of YPS, I had the opportunity to meet the amazing group of young people who will pioneer this service in our state. Their courage and willingness to share their stories was inspiring to me, to say the least. I know that had I been able to connect with someone like them, I would have been able to get on the road to recovery sooner. I am so thankful that youth today will not have to wait as long.

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krissyKrissy Dristy is theYouth Peer Support Statewide Coordinator for the Association for Children’s Mental Health (ACMH), a statewide youth and family advocacy organization based in Lansing, MI. Krissy describes her role at ACMH this way - "I support youth and families by training young people with SED to provide support to their peers. Navigating the system while managing a mental health challenge can be a scary and lonely experience at times. Youth Peer Support Partners can relate and can help by providing direct support and assisting with information and skill building."

Documentary film exposes heroin addiction; Congress debates; CDC stymied in abuse prevention efforts

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heroin
I just finished watching the new HBO documentary, Heroin: Cape Cod. It is a raw, up close and personal account of the heroin epidemic currently gripping our nation, as told by those who know addiction best - active users.

I encourage you to watch this film, which is currently playing on HBO. If you do not have a subscription to HBO, you will need to find someone who does. Take the extra step and figure out a way to watch this film.

Steven Okazaki, the director and creator of Heroin: Cape Cod tells the story of heroin addiction today, through candid interviews with eight young heroin addicts, law enforcement and family members attending a parent support group. You should know going in, that all of the heroin users in the film will draw you into their lives. You will feel every bit of the anguish, love, anger and desperation that is constantly swirling in their lives and the lives of those around them. You should also know that some of the people in this film that you will develop a bond with, die of a drug overdose during filming.

Then why watch such a depressing movie?
Our nation needs a wake-up call to the rampant abuse and overprescription of opioid painkillers. Addicts, who may have begun their opioid journey through painkillers such as oxycontin or oxycodone, tend to gravitate to cheaper heroin, readily available on the streets. The result is a rising tide of needless overdose deaths.

Here are some stark statistics from the recently released CDC Opioid Prescribing Guidelines fact sheet.

  • In 2012, health care providers wrote 259 million prescriptions for opioid pain relievers – enough for every American adult to have a bottle of pills.
  • Prescription opioid sales in the United States have increased by 300% since 19992, but there has not been an overall change in the amount of pain Americans report.
  • Almost 2 million Americans, age 12 or older, either abused or were dependent on opioid pain relievers in 2013.
  • In 2013, more than 16,000 people died in the United States from overdose related to opioid pain relievers, four times the number in 1999.

What are Congress and the White House doing about the epidemic?
There have been a host of bills introduced in the 114th Congress that address opioid abuse in one way or another. The White House has pledged to continue the fight against painkiller addiction and the abuse epidemic leading to an increasing number of overdose deaths. Clearly, something needs to be done, and I am hopeful, will be done.

CDC stymied in efforts to provide guidance on opioid prescriptions
But trouble looms in the fight to set guidelines for prescribing opioids. Recently, the CDC was forced to delay issuing voluntary guidelines aimed at reducing the use of the drugs, after complaints that they based their results on thin evidence and that the recommendations were crafted quietly with a small set of specially chosen advisors. Due to the intense criticism from some advocates and political leaders, CDC is holding off distributing the guidelines, and instead, opening up the draft to public comment — despite support from at least 14 senators and many addiction advocacy groups.

In a recent Politico article, Andrew Kolodny, co-founder of Physicians for Responsible Opioid Prescribing, is quoted as saying, "Many are calling this a victory for the opioid lobby. That decision will tack months on to the process [and also] increases the likelihood that the guideline may never be released. This is an enormous win for the opioid lobby.”

What to do?
Here are three things you can do now:

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scottScott Bryant-Comstock
President & CEO
Children's Mental Health Network

Well, Network faithful, was I right about Wilton? We are indeed in good hands. We are fortunate to have a host of young adults like Wilton Johnson doing strong advocacy work across America. Take a moment to celebrate the Wilton Johnson in your life and let them know that you appreciate what they do.

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scott

Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

- See more at: http://www.cmhnetwork.org/media-center/morning-zen#sthash.ZlnxSpOD.dpuf

 

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scott

Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

- See more at: http://www.cmhnetwork.org/media-center/morning-zen#sthash.ZlnxSpOD.dpuf

 

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scott

Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

- See more at: http://www.cmhnetwork.org/media-center/morning-zen#sthash.ZlnxSpOD.dpuf

 

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scott

Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

- See more at: http://www.cmhnetwork.org/media-center/morning-zen#sthash.ZlnxSpOD.dpuf

Preventing Stage 4 Mental Illness—Call your congressional representative and let them know it is possible

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Morning Zen Guest Blog Post ~ Dennis D. Embry

What is Stage 4 mental illness? Surprisingly, the answer to that question had not occurred to me until Paul Gionfriddo spoke at the national conference of the Federation of Families for Children’s Mental Health—just before Thanksgiving. For those who don’t know, Paul is the CEO of Mental Health American and the father of a child with a serious mental illness. There were no dry eyes as Paul spoke, unless their eyes were made of stone.

I know what Stage 4 is. I am a cancer survivor. I had Stage 1 of a rare and dangerous melanoma, and it scared the crap of me. And I know all about mental illness from my own family and my professional life as a psychologist.

A giant zap went through my brain as Paul spoke. “YES! We can prevent Stage 4 mental illness. The gold-standard prevention science for that is published and easily available at www.pubmed.gov.”  The science has been funded by the National Institutes of Heath. I’d never thought about it that way, even though I am a prevention scientist and a psychologist. I wanted to shout at the top of my lungs, “Paul, we can prevent Stage 4 mental illness!” We probably cannot in every case of mental illness, any more than we can prevent every case of Stage 4 cancer.

How do I know we can prevent Stage 4 mental illness? Well, the work of my colleagues at Johns Hopkins shows that a simple first-grade preventive strategy that teaches self-regulation and peer cooperation prevents suicide 10 to 20 years later (1-4). Amazingly, the same first-grade preventions strategy averts really violent, anti-social behavior associated with homicides 10-20 years later (2, 5). Check these out www.pubmed.gov.

Ah, maybe that strategy is a fluke. Well, it’s not. The next day after Paul Gionfriddo told his heart-wrenching story, Dr. Joseph Hibbeln from the National Institutes of Health told the same prevention-science story, except it involved a completely different mechanism—dietary intake of fatty acids. He called his presentation, Oiling the Brain. You can read that science by Hibbeln and other researchers at pubmed. Dr. Hibblen and his colleagues absolutely show that reducing omega-6 fatty acids in the brain and increasing omega-3 increase mental health, reduce violence and reduce suicide.

The world should be celebrating that two completely different methods are absolutely proven to prevent Stage 4 mental illness. This should be headline news on the front page of every newspaper in America, and the focus of every TV news program. When the first returns of the Salk vaccine showed it could prevent polio, the world rejoiced. So after, the nation and the world mobilized to eradicate polio—which we’ve almost done 50 years later. We have the caliber of science to prevent Stage 4 mental illness, though we cannot do that overnight.

Could everyone reading this please, please, please start telling everyone you know: “We don’t just have to focus on treatment of serious mental illnesses after the have a crises that requires forced treatment for people like so many of the shooters. We don’t have to have legislation just focused on iron lungs, braces and wheel chairs for people’s broken brains.

What to do? Start by calling (202-225-2301), faxing (202-225-1844), emailing or writing Congressman Tim Murphy to tell him he can be the nation’s hero by preventing Stage 4 mental illness rapidly and inexpensively—based on gold-standard science funded by the National Institutes of Health and described in the 2009 Institute of Medicine Report on Preventing Mental, Emotional, and Behavioral Disorders Among Young People.  And, please, share this same message with your Congressional representative, Senators, Governor and State Legislature. And call your Mayor and city council, too. Tell you’re your local hospitals to hold grand rounds about preventing major mental illnesses. We have good enough science to start preventing Stage 4 mental illnesses. Let’s do it. #SaveAllKids

References

1. H. C. Wilcox et al., The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug & Alcohol Dependence, 14 (2008).

2. S. G. Kellam et al., The good behavior game and the future of prevention and treatment. Addict Sci Clin Pract 6, 73-84 (2011).

3. C. Katz et al., A systematic review of school-based suicide prevention programs. Depression and anxiety 30, 1030-1045 (2013).

4. A. R. Newcomer et al., Higher childhood peer reports of social preference mediates the impact of the good behavior game on suicide attempt. Prevention Science, No Pagination Specified (2015).

5. H. Petras et al., Developmental epidemiological courses leading to antisocial personality disorder and violent and criminal behavior: Effects by young adulthood of a universal preventive intervention in first- and second-grade classrooms. Drug & Alcohol Dependence, 15 (2008).

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embryDennis Embry, President/Senior Scientist at PAXIS Institute – Dennis D. Embry is a prominent prevention scientist in the United States and Canada, trained as clinician and developmental and child psychologist. He is president/senior scientist at PAXIS Institute in Tucson and co-investigator at Johns Hopkins University and the Manitoba Centre for Health Policy. His work and that of colleagues cited in 2009 the Institute of Medicine Report on The Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. Clinically his work has focused on children and adults with serious mental illnesses. He was responsible for drafting of the letter signed by  23 scientists, who collectively represent scores of randomized prevention trials of mental illnesses published in leading scientific journals. In March 2014, his work and the work of several signatories was featured in a Prime-TV special on the Canadian Broadcast Corporation on the prevention of mental illnesses among children—which have become epidemic in North America. Dr. Embry serves on the Children's Mental Health Network Advisory Council.


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enbry

Dennis Embry, President/Senior Scientist at PAXIS Institute – Dennis D. Embry is a prominent prevention scientist in the United States and Canada, trained as clinician and developmental and child psychologist. He is president/senior scientist at PAXIS Institute in Tucson and co-investigator at Johns Hopkins University and the Manitoba Centre for Health Policy. His work and that of colleagues cited in 2009 the Institute of Medicine Report on The Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. Clinically his work has focused on children and adults with serious mental illnesses. He was responsible for drafting of the letter signed by  23 scientists, who collectively represent scores of randomized prevention trials of mental illnesses published in leading scientific journals. In March 2014, his work and the work of several signatories was featured in a Prime-TV special on the Canadian Broadcast Corporation on the prevention of mental illnesses among children—which have become epidemic in North America. Dr. Embry serves on the Children's Mental Health Network Advisory Council.

- See more at: http://www.cmhnetwork.org/media-center/morning-zen#sthash.fceVtweH.dpuf

Is a digital device in your child's future this holiday season?

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Morning Zen Guest Blog Post ~ Amy Williams

kidscellphonesWhether you are dusting off your stockings to hang by the chimney with care or perfecting the art of frying golden latkes, giving gifts is a staple of the holiday season for many people. As families draw together, cherish traditions, and celebrate their beliefs it is easy for our children to devise a wish list of gadgets and toys they dream of unwrapping. For many parents, they are noticing that at the top of the present list is often a form of technology in the guise of a digital device.

Unwrapping Technology: Is My Child Ready?
Smartphones, tablets, gaming consoles, and more might be a pixelated holiday dream for your child. It is believed that 75 percent of children aged under eight have access to devices classified as “smart” and 78 percent of teens possess their own cell phones. Unfortunately, many children and teens are not developmentally ready or responsible enough to have the world at their fingertips via wi-fi and social media.

If a child is not ready for the responsibility that comes with receiving digital devices this holiday season, their anticipated gift might download a whole new set of problems and heartbreak during the new year. Before gifting a new device, ask yourself the following questions:

  • Is my son or daughter able to be responsible for their belongings?
  • Does my child understand social media and the permanence of the Internet?
  • Can he or she make sound or reasonable judgments?
  • Have we addressed social media etiquette in our family?

6 Ways To Ring In A Happy Holiday Season
If you were able to say “yes” to the above questions with little hesitation, then your child might be ready to handle a new digital device. For many parents, it is important to understand the impact of allowing our kids a passport to digital citizenship. We need to realize that high levels of connectivity open our children up to a world of online predators, disappearing messages, cyberbullies, and sexting opportunities.

Here are six tips to help our children enjoy their digital devices this holiday season:

  • Create a contract for the family that lists all expectations and consequences of using technology.
    This is important, because it allows parents and children to discuss digital responsibilities which will eventually prevent arguments and disagreements down the road.
  • Avoid allowing digital devices in bedrooms.
    Besides the obvious benefit of deterring risky online behaviors, this step can ensure a child is able to get adequate sleep or enjoy time away from a glowing screen.
  • Sit down with children and walk them through the process of choosing their privacy settings. It sounds relatively simple, but many of our teens are not protected. Don’t let your child suffer, because they forgot to add a password or turn off their location tracking.
  • Begin an ongoing discussion regarding digital etiquette and how to behave online. Start simple and as a child grows, be sure to include topics like online predators, identity theft, and cyberbullying.
  • Don’t leave a child’s well being up to chance- take advantage of monitoring software. You wouldn’t give a 16 year old the keys to a car without a few driving lessons. Why would you allow a child to use the Internet or technology without parental guidance? Go high-tech and use convenient programs to track a child’s phone and Internet activity. As a child demonstrates good choices, scale back this process.
  • One of the best ways to protect our children is to have a firm understanding of the dangers lurking behind our children’s technology. Did you know that sexting is considered a normal part of development? How about the facts that cyberbullying rates are rising and have tripled within the last year? By knowing the facts, you can help bully proof your child or take measures to avoid heartbreak.

All parents, regardless of what holiday we celebrate, want their child to safely chat and snap selfies with their friends long after the dreidels and decorations are packed away. If your child is begging for a new digital device this holiday season, taking a few precautions today will ensure many more happy celebrations to come.

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tonko

Congressman Paul Tonko represents New York’s 20

- See more at: http://www.cmhnetwork.org/media-center/morning-zen#sthash.SvhQiqNg.dpuf

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amyAmy Williams is a journalist and former social worker, specializing in teen behavioral health. She believes that, in our digital age, it's time for parents and educators to make sure parents and students alike are educated about technology and social media use. You can follow her on Twitter.

Why equating mental illness with violence harms us all

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Morning Zen Guest Blog Post ~ Congressman Paul Tonko (D-NY)

We too often forget that those struggling with mental illness are constantly forced to fight a battle on two fronts. Not only do they have to grapple with themselves—with their own thoughts and mind—but they also have to contend with the negative assumptions made about those with mental illness, which are pervasive in our society.

Those stereotypes, though, are hardly a figment of their imagination. Public opinion suggests that people with mental illness and violent tendencies go hand in hand. In fact, at least half of the American public believes that individuals with mental illness are inherently more violent.

These claims are unfounded and they are completely unacceptable. Attitudes like this do nothing but aggravate the stigma that so many have spent decades trying to overcome.

But any progress we have made to change attitudes is incrementally undone every time there is an incident of mass violence in this country and politicians or pundits take to cable news to tout mental health reform as the solution. These repeated claims are re-stigmatizing mental illness and they can no longer be our reaction to isolated and extreme events.

To be clear, I am not suggesting that a person with a mental illness is incapable of committing a crime. But the fact is that people with mental illness are an order of magnitude more likely to be victims of a crime than perpetrators.

Violent crimes are committed by violent people. Plain and simple. Study after study has shown that there is no connection between those with mental illness and violence. Violence is not a characteristic of one particular demographic and, while it may be seductive to believe otherwise, these terrible episodes of mass violence cannot be predicted.

The need for meaningful reforms that better serve the needs of patients and families experiencing mental illness is clear, but we cannot make unsubstantiated claims in order to scare the public into supporting reforms. That will only create a false sense of security, while ignoring the real issues and demonizing a community in the process.

Members on both sides of the aisle and passionate advocates across the country desperately want to see real improvements made to strengthen our mental health system. In response, we should put in place forward looking and inclusive policies that offer the necessary services, supports, and treatments to individuals so that recovery is an option. Likewise, we must build on the historic gains that the Affordable Care Act made for mental health coverage by expanding Medicaid and better enforcing our mental health parity laws. We also have to acknowledge that our current dysfunction stems in part from decades of broken promises and a chronic underinvestment in community based mental health services.

Unfortunately, when our national discourse is based upon the false premise that mental health reforms are the solution to mass violence, we end up with regressive proposals that, if enacted, would do more harm than good. Policies that, in the name of public safety, restrict patients’ civil rights, infringe on their privacy, or use the courts or law enforcement to force individuals to receive health care services take us in the wrong direction as a country and would reverse decades of progress. No credible witness believes that the fundamental problem ailing our mental health system is that individuals have too many rights.

At its core, these policies would take us back to outdated and biased treatment of those with mental illness by rolling back critical patient protections that would deter individuals from getting the support and medical care that they need. Perpetuating the harmful stigma that those with mental illness are more inclined to be violent is exactly what keeps people from seeking treatment when they need it most.

We are better than this. We need to make advancements on mental health issues in this country, but in so doing, we cannot advance a harmful and false understanding of these disorders.

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tonko

Congressman Paul Tonko represents New York’s 20th Congressional District, including the communities of Albany, Schenectady, Troy, Saratoga Springs and Amsterdam. He represents all of Albany and Schenectady Counties and parts of Montgomery, Rensselaer and Saratoga Counties. He is serving his fourth term, after first being sworn into Congress in 2009.

Paul serves on the Energy and Commerce Committee, the oldest standing committee in the House, created in December of 1795. He is the first upstate New York Democratic member of the committee since Leo O'Brien, who resigned the post in October 1966. Additionally, as a member of the Science, Space and Technology Committee, Paul serves on the Subcommittee on Research and Technology, which has jurisdiction over non-defense federal scientific research and development.

Paul previously served on the Natural Resources Committee, Education and Workforce Committee and the Budget Committee.

Children’s mental illnesses are socially contagious…

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Morning Zen Guest Blog Post ~ Dennis Embry

surprise
What? Our kids are catching mental illnesses? Yes, but not typically by germs. This will take a bit of flexible thinking to understand what people intuit and good science confirms.

Consider most humans recognize many diseases are contagious. Many in my generation lived through the polio epidemic, whose virus crippled or killed kids and adults when we were growing up. Before the discovery of the Salk vaccine, we knew how the disease was spread. That’s why we were forbidden to go swimming—a terrible constraint for kids like me growing up in hot Phoenix. Some communities even had quarantines. Families had lots of fear.

On November 21, this year, Dr. Joseph Hibbeln from the National Institutes of Health gave an amazing presentation for nearly two hours at the annual conference of the National Federation of Families for Children’s Mental Health. I’ve known him and his work for 15 years, and it keeps getting better and better. His talk was stunning, and you can capture the breadth of his scientific work just by going to the National Library of Medicine at www.pubmed.gov.  Search his name, Joseph Hibbeln, and you’ll start to get the drift of my reasoning.

Few people realize that most mental disorders—even serious ones—are socially contagious. I know you’re thinking: “What? Is he crazy? It’s a genetic or biological disorder.”  And the TV ads only Americans see, and hear the drill about this biological inevitability, many times per day with a strange caveat: “…of unknown origin” or some other waffling statement. So what do I mean by socially contagious? Here are a few examples of the social contagion of mental illnesses, which can be modified—if we as society choose to act like we did when polio contagion threatened our children:

  • Social Contagion Example #1, Children’s Diet. Too much omega-6 (soybean oil, corn oil, etc.) and too little omega-3 (mostly in fish) in our modern diet predicts lifetime mental illnesses in children, youth and adults [1, 2]. Dr. Hibbeln carefully traced rapid increase in omega-6 consumption after World War II to increased the risk of mental illnesses of children born after the late 1950s, illustrated by a mound of research [3-8]. A recent consensus [8] concludes: “nutrition…should now be considered as mainstream elements of psychiatric practice, with research, education, policy, and health promotion reflecting this new paradigm.” 

    That our children “choose” to eat what is widely advertised to children should be obvious to any parent or grandparent. This I know first hand because of my earlier work Children’s Television Network and McDonald’s, but you can read a sample of such social contagion on the National Library of Medicine, http://bit.ly/food-choices-kids. New studies show that changing the dietary ratios of omega-6 and omega-3 in children, youth and adults can prevent or reduce mental illnesses.
  • Social Contagion Example #2, Children’s Classrooms. Not far from DC is Johns Hopkins Center for Prevention and Early Intervention, where some of the best studies on how early exposure to peaceful, positive classrooms versus classrooms filled with misbehavior have lifetime impact on children’s mental illnesses, including the ultimate Stage 4 consequence of serious mental disorders, suicide. My colleagues and I at Hopkins have significantly shown that experimentally reducing classroom problematic behaviors and creating a joyful, positive classroom filled with self-regulation and prosocial peers creates mental health and reduces current and lifetime psychiatric disorders.
  • Social Contagion Example #3, Children’s Sleep Patterns. Sleep disturbances among children are increasing because of electronic media in children’s bedrooms, especially now because of cellphones and tablets. Sleep disturbance causes mental illness that just a small selection of articles in PubMed reveal. What is most interesting is that sleep deprivation and drug use among teens is contagious across their social networks.

As you might imagine, the combination of two or more of these social contagions really accelerates the risk of serious mental illnesses. A child growing up in a “bad neighborhood” will be likely exposed to all three of these socially contagious vectors of mental illnesses. Almost every middle-class or upper class kid is exposed to one or two of these socially contagious vectors on average in the United States. Hmm, that might well be why the United States has an epidemic of mental illnesses (suicide, anxiety, ADHD, depression, etc.) among our children, which is becoming more and more evident in very diverse data sets: pharmaceutical sales reported by the Wall Street Journal, by military authorities, by Medicaid data, and scientific epidemiological studies such as the National Comorbidity study. If you’d prefer to see the evidence in a video, checkout my Congressional Briefing on December 3, 2014 to see the graphs and other tidbits.

Families reading this might have negative reaction: “Here we go again blaming the parents. ”I understand the history of blaming families for children’s mental illnesses, which still is a thriving notion among the public, political leaders, and at countless IEP meetings I’ve been to. No, this is really about a contagion, in many ways like the polio epidemic—a contagion we have much better science to prevent than we did when Salk’s vaccine was proven to affect antibody expression in 1954, before the large-scale study directed by Thomas Francis that actually prevented polio in 1955. There are scores of well-designed longitudinal studies now about actual primary prevention of mental illness by different scientists around the world; we’ve just not taken the leap to prevent mental illnesses at a population level in the U.S. like the Thomas Francis polio study.

Can we prevent the social contagion of mental illness at a population level? Yes, I think we can because of the existing prevention science is much better than Salk’s original study on polio contagion. How that might happen rapidly—like the Thomas Francis study proved—will be my next essay.

References

  1. Hibbeln, J.R., et al., Healthy intakes of n-3 and n-6 fatty acids: estimations considering worldwide diversity. American Journal of Clinical Nutrition, 2006. 83(6 Suppl): p. 1483S-1493S.
  2. Nieminen, L.R., et al., Relationship between omega-3 fatty acids and plasma neuroactive steroids in alcoholism, depression and controls. Prostaglandins Leukot Essent Fatty Acids, 2006. 75(4-5): p. 309-14.
  3. Iribarren, C., et al., Dietary intake of n-3, n-6 fatty acids and fish: relationship with hostility in young adults--the CARDIA study. European Journal of Clinical Nutrition, 2004. 58(1): p. 24-31.
  4. Kitajka, K., et al., Effects of dietary omega-3 polyunsaturated fatty acids on brain gene expression. Proceedings of the National Academy of Sciences of the United States of America, 2004. 101(30): p. 10931-6.
  5. Levant, B., J.D. Radel, and S.E. Carlson, Decreased brain docosahexaenoic acid during development alters dopamine-related behaviors in adult rats that are differentially affected by dietary remediation. Behav Brain Res, 2004. 152(1): p. 49-57.
  6. Liu, J., et al., Malnutrition at age 3 years and externalizing behavior problems at ages 8, 11, and 17 years. American Journal of Psychiatry, 2004. 161(11): p. 2005-13.
  7. La Guardia, M., et al., Omega 3 fatty acids: biological activity and effects on human health. Panminerva Medica, 2005. 47(4): p. 245-57.
  8. Sarris, J., et al., International Society for Nutritional Psychiatry Research consensus position statement: nutritional medicine in modern psychiatry. World Psychiatry, 2015. 14(3): p. 370-371.

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enbry

Dennis Embry, President/Senior Scientist at PAXIS Institute – Dennis D. Embry is a prominent prevention scientist in the United States and Canada, trained as clinician and developmental and child psychologist. He is president/senior scientist at PAXIS Institute in Tucson and co-investigator at Johns Hopkins University and the Manitoba Centre for Health Policy. His work and that of colleagues cited in 2009 the Institute of Medicine Report on The Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. Clinically his work has focused on children and adults with serious mental illnesses. He was responsible for drafting of the letter signed by  23 scientists, who collectively represent scores of randomized prevention trials of mental illnesses published in leading scientific journals. In March 2014, his work and the work of several signatories was featured in a Prime-TV special on the Canadian Broadcast Corporation on the prevention of mental illnesses among children—which have become epidemic in North America. Dr. Embry serves on the Children's Mental Health Network Advisory Council.

Replace labels with love

1 Comment | Posted

scott3Every once in awhile I meet someone who reminds me that the advocacy movement for children's mental health is in good hands with the up and coming generation. This past week, while walking through the lobby of the hotel where the Federation of Families for Children's Mental Health conference was being held, a young man named Wilton Johnson approached me and asked if I would pose for a picture holding a sign that said "Replace labels with love." He clearly knew the quickest way to my heart. The unfortunate stigmatizing labeling of the past has roared back with a vengeance on the coattails of the buzz around mental health reform in the halls of Congress. I am all for anything that helps stem the cancerous tide of stigmatizing language!

wiltonWilton Johnson is a dynamo, pure and simple, and we need more people like him. The campaign that he is promoting, "Replace Labels with Love," is an Anti-Stigma Campaign launched in May of 2015 by M.O.V.E. Wisconsin during Children’s Mental Health Awareness Month. The premise behind the campaign is to remind people that labels put people in boxes and dismiss capabilities. Love empowers and promotes growth because everyone needs to be loved and not labeled. By replacing labels with love, we are reminding our community to use first person language when engaging and interacting with other members of our community.

move2Sounds pretty darned good to me. Contact MOVE Wisconsin to learn more about their efforts and maybe even score a cool button like I did!

Want to learn more about Wilton Johnson?
You can start by watching this video of a speech by Wilton Johnson from the Wisconsin Family Impact Seminar in February 2015. As well, read the article by Jabril Faraj of the Milwaukee Neighborhood News Service, on Mr. Johnson's participation in an innovative housing program for homeless young adults:

  • New housing program provides ‘optimism and hope’ for homeless young adults
    June 11, 2015, by Jabril Faraj, Milwaukee Neighborhood News Service

    Wilton Johnson walked into his new home for the first time last week. Johnson, 24, lived in foster care from ages 9 to 14 and was homeless, off and on, for a period after that. Until recently, he worked at the airport assisting wheelchair-bound passengers get to their destination.

    “We all know that housing for young adults is a huge need,” Johnson told a crowd gathered at a grand opening event for the six-unit house, part of Journey House’s Campus Housing Initiative. The initiative provides housing for “motivated youth” — young people ages 18 to 25 who have aged out of foster care and are going to school or working.

    “This initiative reaffirms my faith in my city and my county,” Johnson said, adding that the program will provide “optimism and hope for me and many of my peers.” Milwaukee Mayor Tom Barrett and Milwaukee County Executive Chris Abele also made remarks at the event.

    In addition to Johnson, who will serve as a peer advisor for the program, five other youths between the ages of 18 and 22 have been identified by Milwaukee County Wraparound to fill the property at 741 S. 23rd St. Brian McBride of Project O-YEAH, which provides services to young people transitioning out of foster care, said the program identified individuals who “showed motivation, who stayed engaged within their treatment plans … and have struggled with the housing piece.”

Well, Network faithful, was I right about Wilton? We are indeed in good hands. We are fortunate to have a host of young adults like Wilton Johnson doing strong advocacy work across America. Take a moment to celebrate the Wilton Johnson in your life and let them know that you appreciate what they do.

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scott

Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

Innocence Lost: Tooth Fairies and School Lockdowns

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Morning Zen Guest Blog Post ~ Eliot Brenner

fatherwalkingdaughterschool
The Truth About the Tooth Fairy

My 9 year-old daughter ran into the kitchen, shouting, “Mommy is the tooth fairy. Look, it’s Mommy’s handwriting on this note.”

I looked away from her. I am a lousy liar and I knew that if I looked my daughter in the eye I would have to tell the truth.

She persisted: “Mommy is the tooth fairy, isn’t she?”

She had me. I put my index finger to my lips. “Shhh,” I said, “don’t let your brother and sister hear you.” At 8 years old and 4 years old, they did not need to have their bubble burst any sooner than necessary.

Later that night, as I tucked my daughter into bed, she had more questions for me. “Does this mean that for all of my friends their parents are the tooth fairy, too?”

“Yes,” I replied. “But I think it would be best if you kept that secret and let them find out on their own. ”

She agreed. That evening she had grown wiser and more mature. Now she was keeping an “adult” secret.

I realized that night that my daughter had begun the process of losing her innocence. Next would be Santa Clause, then the Easter Bunny. There was no turning back.

Little did I know just how quickly her innocence would unravel.

Our First Lockdown
A month later my wife and I received text messages from our children’s elementary school. A series of ‘credible threats’ were made toward several schools in our town. All 17 public schools serving 10,000 students were placed in lockdown.

My wife and I waited for additional information. All we could think of was Sandy Hook. After two hours, we were told that although schools were still on high alert, all students were safe and would be dismissed early. Several schools had received bomb threats and threats of someone showing-up with a gun.

How are our children doing, we wondered?  How would we explain this to them?

Of course, being mental health professionals, we were well versed in the recommended advice following any scary or potentially traumatic situation:

  • Ask your child for her understanding of what happened.
  • Ask your child how she is feeling. 
  • Reassure her that teachers, police, and parents will be there to keep her safe
  • Make sure she does not repeatedly overhear television news, which can inadvertently prolong the event or make her feel as if the event is happening again.

We knew all of this, but we still weren’t sure how our children – who did not know about the tragedy of Sandy Hook - would react to the lockdown.

The Reunion
When my wife picked-up our son and daughter at school, their reactions could not have been more different. He was nonplussed and his mood was upbeat because he got out of school early; she was shaky, tense, and preoccupied.

At home, my son was well aware of how frightened some of his classmates were, but he seemed unaffected by the event. My daughter, on the other had, repeatedly retold the event, emphasizing how she was “shaking for two hours until the police came.”

How, I wondered, could my daughter who just stopped believing in the tooth fairy, make sense of someone wanting to bomb her school or shoot her classmates? How could we, as parents, help her make sense all of this?

“Why would anyone do this?” my daughter asked.

“Because,” I said, “there are some people in the world who do bad things. And that is why the school went into lockdown today – to make sure that you will be safe if someone tries to hurt you.”

She listened, asked more questions, and we tried to reassure her that the world was safe and that the adults in her life would do everything possible to protect her.

The Aftermath
As parents, we reassure our children who are facing school lockdowns that they are safe, but we know that is not entirely true.

Because lockdowns are relatively new, we don’t know much about their lingering effects on children, parents, and teachers. Following a 2014 school shooting, a New York Times Headline read “In The Age Of School Shootings, Lockdown Is The New Fire Drill.” But is it? Growing-up in the Midwest, I endured plenty of fire and tornado drills and warnings – evacuating the school or kneeling against the wall with my classmates while waiting for the siren to end. These just don’t seem the same as the uncertainty and horror of a murderer with a bomb or a gun.

The day after our school lockdown, children were offered access to crisis counselors. Did the children that most needed support see the counselors? When children did see counselors, was it helpful? More importantly, is offering counseling the best way to help fearful children following a lockdown?

It would be reassuring if we could turn to the research literature to help us design school lockdown procedures and mitigate their potentially traumatic effects. Unfortunately, there is almost no mental health research to guide our efforts. One qualitative study of middle and high school teachers found that while teachers had a thorough knowledge of lockdown procedures, they were not trained in how to adjust their implementation of procedures to account for “the human response to crisis.”

Given the paucity of research about the effects on children’s mental health of school lockdowns, it behooves us as parents and citizens to advocate for greater resources for this area.

For a week following my children’s school lockdown, police roamed the hallways and playgrounds. My daughter was nervous and did not sleep well. My wife and I continued to reassure her. Within two weeks, my daughter’s nervousness had passed. But how about the other 10,000 children in our town?

The Future
This month, my daughter stopped believing in the tooth fairy and experienced her first school lockdown. She started to grapple with the idea that somewhere out there, someone might be trying to hurt her. This month, she surrendered a bit of childhood innocence.

As a parent, I was powerless in the face of someone threatening to harm my children. I did what I could to support my children following a potential trauma, but I do not know if it was enough. And I have no idea about how other children in the community are faring.

Like fire and tornado drills, lockdowns aren’t going away. We may be powerless, but we must not forget our responsibilities as citizens to advocate for research into finding better ways to mitigate the traumatic effects of lockdowns on the mental health of our children, parents, and teachers.

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eliot brennerDr. Eliot Brenner is a nonprofit executive with 15+ years’ experience leading program operations and change management in child welfare, mental health, healthcare, and philanthropy.  He is also a licensed clinical psychologist with a private practice. Most recently, Dr. Brenner was Type 1 Diabetes Program Director at the Helmsley Charitable Trust, which is the largest private foundation funder of type 1 diabetes research, treatments, and support programs.  At the Trust, he led staff and strategy for a portfolio of 200+ grants totaling more than $200 million. Prior to joining the Trust, Dr. Brenner was Deputy Executive Director at Casey Family Services, the direct service agency of the Annie E. Casey Foundation. At Casey Family Services, he directed all program operations and training, and led a staff of 290 that served more than 4,000 children annually. Dr. Brenner also worked in the public sector, where he was Chief Consulting Psychologist for the Illinois Department of Children and Family Services. He has published peer-reviewed articles in children’s services and mental health. Dr. Brenner currently serves on the Children's Mental Health Network Advisory Council.

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