Social-Emotional Learning is having an impact in urban schools!

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Morning Zen Guest Blog Post ~ Kevin Dwyer

clevelandCleveland Metropolitan School District was highlighted in Education Week (Evie Blad, June 10, 2015) for its system-wide, yes, system-wide, social-emotional learning (SEL) instruction combined with other best-practice interventions that address school climate and positive conditions for learning. The Ed Week article, Urban Districts Embrace Social-Emotional Learning is a must read for school leaders and education stakeholders to best understand that system-wide SEL and multiple interventions can address real world needs of students to be academically successful. 

Evie Blade’s Ed Week article also focused on the evaluation of these SEL interventions by the American Institutes for Research (AIR) in 8 urban school districts from Anchorage Alaska to Nashville, Tennessee.

I have talked about Cleveland’s innovative multi-interventions in previous Morning Zen posts on specific topics like alternatives to suspension, including last week’s on improving attendance. I noted their efforts in developing alternatives to suspension in establishing “planning centers” also noted in the Education Week article as well as regular school student support team problem solving for addressing what we sometimes call “early warning signs of academic and behavioral problems.”

Blade noted that these multi-year systemic SEL initiatives are taught as a curriculum in primary grades and also “…infuse social emotional concepts into the teaching of traditional subjects like history.”

Cleveland’s efforts are continuously evaluated for fidelity to the researched best-practice guidelines so that each school can look at its implementation grade and compare that to its student outcomes. What was reported by AIR in its presentation at the American Education Research Association conference in April titled: Results from an evaluation of a demonstration program to build systemic social emotional learning in eight urban districts, (Kimberly Kendziora, PhD, et.al.) was that student outcomes were positive when implementation had high fidelity. Cleveland showed higher math and reading scores, higher GPA and fewer suspensions. Cleveland also informally reported higher attendance in elementary schools (personal communication with Lori Hobson of CMSD). Nashville, showed higher math scores, attendance and fewer suspensions, although lower in Algebra 1. Students SEL competencies were highest in grade 3 and lowest in secondary grades. This may be related to the stage of implementation since most systems started with primary grade SEL curriculum. Surveys of school staffs and system administration showed positive associations with student social and emotional competence and some student achievement, attendance, and disciplinary outcomes. AIR concluded that “Implementation matters.”  

Communicating the effectiveness of SEL instruction encourages other systems to implement real SEL initiatives. Evaluating implementation fidelity continuously as we do academic instruction ensures we are doing our best for our students. Connecting SEL to early and intensive mental health interventions creates the synergy and assurance that our students get the support they need to succeed. 

My hat is off to Education Weeks reporter Evie Blade for her comprehensive article!

  • You can read Evie Blade's article here.

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dwyerKevin P. Dwyer, M.A., a Nationally Certified School Psychologist, is an education and child mental health consultant.  He recently served as a principal research associate for the American Institutes for Research. For over 30 years he practiced school psychology in public schools and held several local, state and national leadership positions in the fields of mental health and education, being responsible for the design, development, implementation and evaluation of programs and practices, for improving school climate, safety, and wellbeing for the education, and mental health of children.  He has helped school staff in many districts use data to inform decisions on improving caring and connectedness with students and professional peers.  His work, publications, presentations, and practices have influenced public policy and the development of efficient, family-focused collaborative child service systems.  During his 30 years as a public school psychologist, he worked directly with over 10,000 children and their families as well as trained over 6000 educators. He provided psychological services to children, including those with disabilities and those whose anxiety and mental health problems blocked learning and adjustment.  He assisted teachers and staff in supporting a caring, inclusive school climate for all children.  In 2007, the Maryland Coalition of Families awarded Mr. Dwyer and his wife for their work in making schools more family friendly.  He served as president of the National Association of School Psychologist and was given its highest honor, the Life-time Achievement Award.  In 2000, he received the Tipper Gore “Advocacy award for improving the lives and mental health of America’s children” from the National Mental Health Association.

VA report on decrease in suicide a "smoke screen" deflecting from the real truth

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Morning Zen Guest Blog Post ~ COL (Ret) George Patrin, M.D., CMHNetwork Advisory Council Member

The VA just released a report stating that suicides are down among Vets who are accessing their care vs. Vets who aren't. Here is an excerpt from the press release:

  • In the past eight years, VHA has enhanced mental health services across its system and supplemented it with specific programs for suicide prevention – like the Veterans Crisis Line. However, until recently information on suicide among all Veterans was not available. Earlier this month, a study on the changes in suicide rates for Veterans and non-Veterans was published that included indications that VHA patients were experiencing positive outcomes from care.

    “Going into this study, we thought we would see a higher rate of suicide among VHA users,” Dr. Robert M. Bossarte said. “This is because sickness is a risk factor for suicide, and the basic assumption was that those seeking care would be at a higher risk than those who weren’t. The data showed the opposite was true: VHA users had a lower suicide rate than non-VHA users.”

Sounds great, right? Before you celebrate this finding, let's look a little bit closer and talk about what this really means.

Is it a surprise to anyone that “VHA users had a lower suicide rate than non-VHA users?” The VA starts up a program(s) or service not offered before this (and why not?), and some Vets who had no options before go to the VA. Great. Those who still don’t trust the VA stay with what they had…and the suicide rate is higher without care than those getting any level of care at the VA.

This is nothing to boast about. The comparison needs to be VA care vs. other quality network care, whether DoD or civilian.

This report is distracting us from the reality of the lack of quality programs and processes, beginning with access to care problems in the National News, but more importantly the lack of true preventive services and poor continuity and integration of behavioral health, emergency care, and the primary care provider.To give the VA credit, our entire nation is stuck with a crisis-oriented sick-care system, especially for mental health issues. The whole system needs to be turned on its ear. The VA started this brand of holistic healthcare delivery years ago with the invention of Primary Care Teamlets, but seems to have lost that direction. (I know this because I’m enrolled to one, and it’s not what it’s advertised to be.)

What is more maddening is why the VA and entire DoD aren’t looking to repeat successes of other organizations, like the Henry Ford Health System in Detroit, who have figured out how to achieve zero suicides among those they are responsible for serving. While “one size doesn’t fit all,” the model works. To be sure, the VA does provide wonderful care in places, not due to their regulations, but due to exceptional employees who go the extra mile day in and day out. Thanks to those people for what they do.

But let’s not throw up smoke screens with reports like this to make ourselves feel better, deflecting us from the real truth. We are better than this…and our Vets and their Families deserve a better level of care!"

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george patrinCOL (Ret) George Patrin, M.D., spent over 23 years as an Army Pediatrician and Healthcare Administrator concentrating on Family Advocacy and Healthcare Process Improvement. His final assignment was as Northern Regional Command Special Projects Officer for Patient-Family Centered Healthcare assisting in writing DoD Patient Centered Medical Home (PCMH) Guidelines and Training. He has been a staunch advocate for both soldier and family member readiness throughout is military career. He is a sought after speaker on parenting education, child abuse prevention, school learning and behavior problems, and healthcare administration optimization. Dr. Patrin is a member of the Children's Mental Health Network Advisory Council. He can be contacted at patrin.george@gmail.com.

Education equity: failing funding or fair funding?… Be part of the solution!

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Morning Zen Guest Blog Post ~ Daun Kauffman

Grateful thanks
A heartfelt tip of the hat to the Basic Education Funding Commission (BEFC) of Pennsylvania! They have led us, the nation, to a place in history where we get to be part of the “tipping point” of a dramatic turn toward educational equity.

No doubt that the task was daunting. Education funding-concerns are very weighty and very high-profile in Pennsylvania. House Bill 1738 set up the BEFC and tasked it to “develop a basic education funding formula and identify factors that may be used to determine the distribution of basic education funding among the school districts …”

No doubt BEFC research and analysis, coupled with focus, persistence and thoroughness have produced a historic recommendation.  A recommendation worthy of equally profound action from each of us.

Education Equity
The BEFC recommended factors required for fair funding. Eight factors are included in a proposed ‘formula’ and eight factors are recommended for consideration by the full General Assembly.

The most pivotal equity-factor is found on page 69 of the document entitled “BEFC Report and Recommendations” (June 18, 2015):

  • “The [PA] Department of Education should consider devising protocols and measures to identify students in trauma.”
The BEFC recommendation continues with:
  • “The Commission recognizes that students in trauma may be more costly to educate and the application of weights to this factor based on reliable data may be merited.”

Childhood trauma is the “most pivotal factor” in education equity because of both its wide scope and its deep impact on children’s ability to learn. It will be historic for any state to attack this  inequity, via  an explicit funding mandate, statewide, across five-hundred school districts. . . quite amazing when you think about it !

Legislator contact info is linked at the end of this blog, for those who are immediately ready to lobby for implementation.

Definition
Childhood Trauma is not “poverty”. Research shows that about half of those living in poverty do not experience debilitating trauma. Poverty does have a myriad of impacts on learning to be sure, but they are not necessarily traumatic impacts.

Childhood Trauma is a response of overwhelming, helpless terror to event(s) some call “Adverse Childhood Experience” (ACE): Physical Abuse, Emotional Abuse, Sexual Abuse, Physical Neglect, Emotional Neglect, Single Parent Home (due to any: separation, divorce, incarceration), Household violence, Community violence, Household substance abuse, Household mental illness, and more.

Deep Impact
The impact of childhood trauma changes children’s physical brains, and impairs their cognitive and social functioning and ultimately their life trajectories. The children are not bad or sick, they are injured.  The neuroscience is compelling. Childhood trauma connects directly to education via its toxic stress effects on development of the physical brain. When children live in a  chronic, traumatic state of survival, the unresolved toxic stress damages the function and structure of their still-developing brains. These injuries relate specifically to the prefrontal cortex and academic processes, especially crucial executive function, memory and literacy.

The physiological process also leads kids to distorted perceptions of social cues, which alter their social behaviors in response. Eminently logical defenses in the midst of trauma (hyper-vigilance, dissociation) become ingrained habits, and then destructive, once the threat is extinguished, but the defense pattern remains. A detailed anecdotal narrative called “Danny goes to school” provides more insight.

Wide Scope
The wide scope is stunning! Based on research in the USA, childhood trauma rates vary in a range from 22%  to 45+% of children impacted by 3 or more categories of trauma — in many districts the scope is greater than English Language Learners (ELL) or those with an Individual Education Plan (IEP). In some urban locations (pg. 17 map) the prevalence is greater than ELL and IEP students combined! Researchers including our own Department of Justice report the scope as massive, “an epidemic”, or a “national crisis”, particularly in urban areas.

Findings from public health research are convincing. The groundbreaking “Adverse Childhood Experiences (ACE) Study” by Felitti and Anda/CDC found a “strong correlation between the extent of exposure to childhood ACEs and several leading causes of death in adulthood. . .”

This study uncovered devastation that is no respecter of demographics, zip code or socio-economic status. CDC researchers found roughly one-fourth, of beautiful suburban San Diego’s, mostly middle class, mostly white, working folks with medical insurance had experienced 3 or more ACEs!

Three or more ACEs is significant because experiencing 3 or more ACEs correlates with doubled risk of depression, adolescent pregnancy, lung disease, and liver disease. It triples the risk of alcoholism and STDs.  There is a 5X increase in attempted suicide. It doesn’t just go away.

Today, at best, trauma-impacted children are stll invisible (see “What’s Missing?”) in the data and analyses (Try asking for ACE-adjusted, test scores). At worst the data is outright misleading, especially for our understanding of academic results including “standardized test” results.   .

Evolving precision
Several members of the BEFC rightly raise crucial questions about how we can get to specific measures of scope and the cost factors for trauma.  Follow-up papers here will provide detail regarding screening measures and cost factors. However, a key perspective is that we are leading the way, the front line of equity for trauma-impacted children. A poignant awakening for us all. We can choose to start with best-estimates and adjust as we go. Conversely, delaying for every detail to be precisely quantified is too costly and too inequitable.

A starting point for screening can be as simple as the “ACE score” derived by counselors as part of annual school registration or re-registration. A wide range of other screening measures is available at the National Child Traumatic Stress Network website.

A starting cost-priority in addressing the learning impacts of trauma is training of teachers and staff. The most efficient approach is through the “first responders” already seeing the children every day. Training must be an on-going requirement for all adults in a district, as part of a priority to: 1) deliver “safety”, 2) understand complexity of teaching trauma-impacted children, and 3) respond appropriately, including avoiding re-triggering old trauma. Training options include “Institute for Family Professionals” (IFP), a division of Lakeside Education Network, right here in Pennsylvania, and Sanctuary Institute, a division of ANDRUS.

Other crucial incremental costs will include smaller class-sizes, with limits on trauma-impacted children per classroom. Also, dedicated appropriate space(s) for children to de-escalate, and on-site counselors, that is District counselors, who build on-going relationships with the children and families in the school community. These are all starting points, to be refined as we go.

Immediate priority
What remains is the immediate priority for the full General Assembly to act formally. We need them to explicitly acknowledge the power of childhood trauma by acting to include it in a “fair” funding formula as per the BEFC recommendation (weighting and costs to be estimated and then refined as we go). The kids are waiting.

Join the movement: Be part of the solution!

Please take a moment to write to your own legislators now, whether in Pennsylvania or elsewhere. Sample below.

Pennsylvanians: Please write or call now. Simply click on this link, or search “find your legislator, PA General Assembly”, then click on a single legislator’s name.  (Most have an email link.  Many have a Facebook page.) Thirdly, cut and paste the short note below (or compose your own)  into their contact form with your name/address. Please add your voice today!

Those from out-of-state can write the Co-chairs of the BEFC  here. Equally important, those from afar can further expedite ‘tipping’ by raising nationwide visibility of trauma-impacted children and Pennsylvania’s dramatic and comprehensive shift in equity (share this post widely). We all have the chance to participate in the tipping point toward equity for trauma-impacted children. It’s an exhilarating time.  Join us as we all together make history.

  • Sample note to General Assembly legislators:

    Dear ____________,


    Thank you for helping establish the Basic Education Funding Commission (BEFC) and charging them with the daunting task of creating a fair funding formula!


    Please continue the profound work the BEFC started by adding childhood trauma as an explicit factor to the “Fair Funding Formula” (page 69 of their Report). Please authorize a high priority effort to identify screening protocols and weights for the costs of educating trauma-impacted students. Meanwhile, please endorse best-effort estimates of those measures (to be refined as we go).


    Again, thank you for your part in getting us to this exciting tipping point toward Pennsylvania’s new leadership in educational equity.       

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Be sure to follow Daun Kaufmann at lucidwitness.com

daun

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." 

 

Members of Congress continue to stick their heads in the sand on gun violence

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Morning Zen Blog Post ~ Scott Bryant-Comstock

head in sandOn Wednesday, 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

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

Firearms availability and mental health

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Morning Zen Guest Blog Post ~ Kevin Dwyer

Firearms & mental illness comparison to comparable nations
Trained as a social scientist in examining cause and effect one looks for similarities and differences among variables that have a logical relationship to the variation in outcomes. When looking at death by firearms one can examine accidents, homicides and suicides. For example it might be hypothesized that the numbers of accessible firearms might increase the number of human deaths by firearms beyond those directly related to legal self-defense or policing. You might make comparisons between our country and comparable countries such as England, Canada or Australia whose language and social-ethnic strata are similar & who have stable, democratic governments. These countries have identifiable differences in firearm access laws. They also keep statistics on important variables of access to firearms and lethal outcomes. 

The findings are clear (as reported by advocacy groups and government agencies). Among these comparable countries:

Firearms and fatalities

  • The number of privately owned firearms is highest in the USA
  • The number of all deaths by firearms is highest in the USA
  • The number of suicides by firearms is highest in the USA
  • The number of homicides by firearms is highest in the USA
  • The number of firearm tragedies involving 4 or more victims is highest in the USA
  • The number of children killed by firearms is highest in the USA
  • Most firearms deaths occur among persons who have legal access to the firearms, most frequently firearms from their home

According to the Washington Post’s Mark Fisher (December 14, 2012) U.N. data shows an American is 20 times more likely to be murdered by a firearm than a person living in any other developed country. 

Mental illness

  • All 4 countries have similar incidence levels of persons with mental illness.
  • Only 3 of the 4 have full parity health care coverage for treatment of mental illness. Even with the Affordable Care Act, the USA does not have universal parity for mental health treatment.
  • All 4 countries agree that persons with mental illness should not have access to or be able to purchase firearms. However, in the USA, persons with serious mental illness can purchase firearms thru private sales where no “background check” is required. 

Conclusion:
Easy access to abundant firearms in the USA by persons with and without mental illness can be associated the higher death, tragedy and firearm violence in our country making our schools, malls, streets, houses of worship and our homes more lethal than comparable settings in the other 3 similar countries. The data speaks for itself, more accessible firearms, more tragic deaths, more murders, and suicides with firearms. One may conclude:

  • Lower the number of privately owned firearms you will lower the number of deaths by firearms.  Seems logical. It is very clear that if you lower the availability of firearms to persons with mental illness you will reduce the number of violent acts, particularly suicides.

Recommendations
Given the conclusion, there are other interventions that can be made. If we are not going to support reducing privately owned firearms we must block access to those firearms by angry, depressed, or other family members with mental illness.

Another thing we can do is help people better address anger, stress and, yes, mental illness. An untreated schizophrenic with paranoid inner voices can have those voices shut off or toned down with medication. The voices are neurochemical and can be treated neurochemically with psychotropic drugs, psychotherapy and supports. If a teen is despondent, anxious and bullied, that teen can be helped and supported by counseling and caring peers/family. All children and youth can be taught social skills to improve problem solving and coping skills.              

What we have learned about addressing early warning signs preventing firearms tragedies in schools
Since the school shooting at Jonesboro, Arkansas, and more critically after Columbine, schools have been improving prevention and intervention initiatives to reduce peer violence and tragedy. One very effective prevention mechanism has been to provide easier access to school mental health staff to respond to student’s reports of concerns about their friends, about shared sadness, about stress and anger. We have successively taught students to share worries. Some of these efforts have focused on suicide threats, others on bullying some on scary facebook chatter. The results have been many thousands of supportive interventions for school children and their families. Few keep records of these interventions so no one can tell if these interventions prevented killings but the general data shows reductions in both completed youth suicides and in school violence since the 1990’s. School security officers and metal detectors and other hardware may be helping but “humanware,” caring connections and mental health services are more vital in developing this improved safe school climate.  

Importantly, students themselves are critical in preventing violence. Students now feel that “warning signs” they see or hear from a friend can be shared with trusting adults and that help will be the result rather than punishment or adults discounting their shared concerns.

Furthermore, when teachers and school staff are supported in raising concerns about a student’s stress and observed functional changes in behavior, children are saved from acting on suicidal or violent thoughts and plans. 

Teaching & supporting mental health promotion, early and intensive intervention is successful in schools
There are numerous effective mentally healthy things that schools are doing with success that can be applied to all ages. If children can be taught positive coping skills and self control strategies so can adults. Employers, community organizations can communicate and teach these constructs. Warning signs can be publicly broadcast to improve awareness. And we need to do more to help the adult and youth who may be burdened by mental illnesses. Improvements in treatment and interventions are not sufficiently publicly understood. Access to help is not sufficiently supported. 

Mental health workers ask about firearms in the home
One positive intervention by mental health professionals working with children and youth has been to routinely inquire about the availability of firearms in the home of persons receiving mental health services, particularly for those who are suicidal, depressed, paranoid or angry and impulsive. We all do this now. Most therapists will drill down to insure that if firearms are in the home families are made aware of the danger and are urged to remove those firearms or at a minimum secure them. Complacency or discounting the danger is generally not tolerated. Even securing firearms in the home is not fool-proof. Children and youths have broken locks, found combinations, even bought bullets to use in unloaded family firearms to kill themselves and sometimes others. 

Mental health treatment works to reduce tragedies
Proven mental health treatments have been supported through training and professional best-practice guidelines. The best-practice constructs we have used with children can be generalized for the public across the life-span. Adults, family and friends can be supported in sharing their concerns about their stressed loved ones with mental health professionals, clergy or others who are or can be trained to listen and support in confidence the shared “warning signs” that may require interventions. Connection to crisis centers is now common. People can be given ways to approach a friend or family member who is in distress to seek mental health help. To make this more universal will require a responsive and effective mental health system. We know that professionally supported family interventions that are used effectively for substance abuse and can also be used to get a person into treatment and prevent tragedy. It takes planning, communication, training and changes in our view of friends helping friends to get mental health treatment. It requires a general understanding that firearms are a serious danger when available to persons with early and imminent warning signs of mental illness.     

Gun security measures in homes are important
Even without new controls gun owners should routinely be given information about the dangers of having weapons in the home when a family member is in distress, has a mental illness or a history of impulsivity or rage. Gun clubs and others could support firearm storage for persons who know that removing the firearms is a preventive measure during a time of family stress.

Policy recommendations

Address Early Warning Signs to prevent firearm tragedies

  • Establish a national Presidential public health initiative to assist the public in recognizing and helping family members and friends to seek mental health treatment services for functional mental illnesses, particularly depression and thought disorders. Using the Center for Disease Control & Prevention along with the Substance Abuse and Mental Health Services Administration, NIMH & the Justice Department in conjunction with professional, mental health consumer and advocacy groups, establish an Presidentially tasked advisory council to quickly produce an array of technologically current materials for public information to make it easy for worried family and friends to know what to look for and what to do to contact and receive best-practice mental health advice on helping effectively reach those with signs of mental illness, particularly those talking about their thoughts or plans for suicide or violent acts. Ensure a service system is in place to provide the necessary diagnosis and treatment for those found to need immediate mental health interventions. This initiative should be at the Presidential level and not be given to a specific agency!
  • Using the same advisory group (possibly expanded to include other agencies - FBI) establish an information system to address the clear understanding that firearms access is extremely lethal for persons with mental illness, including persons expressing thoughts of suicide, persons with rage behaviors, impulsivity and anyone who shares disturbing thoughts concerning the use of firearms. These public messages should focus on both actions and words of friends and family members. Ideas and direction should be focused upon gun owners to increase their awareness of the extreme danger access to firearms present for persons with diagnosed and undiagnosed mental illness. Gun clubs should be supported and encouraged to provide free storage of firearms for families requesting that service. Clear do’s and don'ts about firearm security in the home should be provided to gun owners on a regular basis.  Legislation might also be needed to affirm liability for lax firearm security in homes. Trigger locks (or other technology) could be mandated for all firearm sales.   
  • Provide statistical data to all news media regarding the daily numbers of persons who die by firearms and the connection of that to firearm access of the diseased. 
  • Provide public information and reminders to the general public about techniques for interpersonal problem solving, conflict resolution and symptoms listeners/viewers may have warranting self-referral for help.  Resources for such wellness services should be funded and encouraged. Mental wellness tips could be part of advertising for various industries to encourage positives.  

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dwyerKevin P. Dwyer, M.A., a Nationally Certified School Psychologist, is an education and child mental health consultant.  He recently served as a principal research associate for the American Institutes for Research. For over 30 years he practiced school psychology in public schools and held several local, state and national leadership positions in the fields of mental health and education, being responsible for the design, development, implementation and evaluation of programs and practices, for improving school climate, safety, and wellbeing for the education, and mental health of children.  He has helped school staff in many districts use data to inform decisions on improving caring and connectedness with students and professional peers.  His work, publications, presentations, and practices have influenced public policy and the development of efficient, family-focused collaborative child service systems.  During his 30 years as a public school psychologist, he worked directly with over 10,000 children and their families as well as trained over 6000 educators. He provided psychological services to children, including those with disabilities and those whose anxiety and mental health problems blocked learning and adjustment.  He assisted teachers and staff in supporting a caring, inclusive school climate for all children.  In 2007, the Maryland Coalition of Families awarded Mr. Dwyer and his wife for their work in making schools more family friendly.  He served as president of the National Association of School Psychologist and was given its highest honor, the Life-time Achievement Award.  In 2000, he received the Tipper Gore “Advocacy award for improving the lives and mental health of America’s children” from the National Mental Health Association.

Good intentions, sense, science, and dollars: Improving the new Murphy Bill

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Morning Zen Guest Blog Post ~ Dennis D. Embry, Ph.D.

So many people, including Congressman Murphy, are saying things like, “my son, daughter or spouse would have been saved by the Murphy Bill.” Having lost my parents and brother to the complications of mental illness and addictions, I can empathize with that. Perhaps that is why I became a first-rate psychologist and first-rate scientist for preventing mental, emotional, and behavioral disorders. Mr. Murphy believes so much in his bill that he’s commented that it would have stopped Adam Lanza (CT), James Holmes (CO) and Jared Laughner (AZ) in my hometown of Tucson. We will consider the good intentions in light of sense, science, and dollars.

Sense and Good Intentions
The bill contains honorable and hopeful aspirations, yet that evokes a quote from Thomas Edison that merits mindfulness: “A good intention, with a bad approach, often leads to a poor result.” So here is the Murphy bill, full of good intentions. When you consider the sense, science, and dollars, the bill will almost certainly lead to a bad result. 

With both successes and failures in results of major policy projects under my belt by co-writing two bills with good intentions, one worked well, and the other was sinkhole that swallowed money with mixed effects. A first principle of trying to do a good is to own and measure the possibility of failure, and own failure when it happens. This is why I am a scientist who demands that the results good or bad or in-between be published. That is wise when thinking about the future of our children and society.

In politics, however, errors and failures get buried and obscured, regardless of political party. How many political leaders in America have gone before cameras, saying? “My policies failed.” How many political leaders have demanded that their pet peeve policy and legislation be subjected to a rigorous scientifically valid evaluation, and sanctioned the publication of results if it failed? Perhaps the advocates of the Murphy Bill might want to read the web page of the Coalition for Evidenced-Base Practices in DC:

  • …the Coalition [a nonprofit, nonpartisan organization} seeks to increase government effectiveness through the use of rigorous evidence about what works. In the field of medicine, public policies based on scientifically-rigorous evidence have produced extraordinary advances in health over the past 50 years. By contrast, in most areas of social policy – such as education, poverty reduction, and crime prevention – government programs often are implemented with little regard to evidence, costing billions of dollars yet failing to address critical social problems.

Sense and Science
Section 2 of the revised Murphy bill states, “The term ‘‘evidence-based’’ means the conscientious, systematic, explicit, and judicious appraisal and use of external, current, reliable, and valid research findings as the basis for making decisions about the effectiveness and efficacy of a program, intervention, or treatment.”

Only one practice is actually named in the revised Murphy bill—assisted outpatient treatment—out of a treasure trove of better evidence-based practices that could be deployed and should be deployed to save our country from the growing tragic epidemic of mental illnesses documented by several Institute of Medicine Reports [1, 2].

The single strategy proposed in the Murphy Bill does not meet the Top-Tier or Near Top Tier criteria of the Coalition for Evidence-Based Practices, nor meets the standards of Cochrane Review—another independent arbiter of evidence-based practices in medicine and psychiatry. Here’s what the Cochrane Review says about the golden boy that is supposed to prevent all the terrible events across America, including my city of Tucson:

  • …no significant difference in service use, social functioning or quality of life compared with standard voluntary care. People receiving CCT were, however, less likely to be victims of violent or non-violent crime. It is unclear whether this benefit is due to the intensity of treatment or its compulsory nature. Short periods of conditional leave may be as effective (or non-effective) as formal compulsory treatment in the community. Evaluation of a wide range of outcomes should be considered when this legislation is introduced. However, conclusions are based on three relatively small trials, with high or unclear risk of blinding bias, and evidence we rated as low to medium quality.

We helped the Treatment Advocacy Center to get AOT on the National Registry of Evidence-Based Practices (NREPP), with the clear caution that the science was not strong and that the strategy required much more research, given there were alternative practices that had more robust, scientifically-proven results. The AOT research scores are on the low side for a submission, with an overall of 2.5 out of 4.

How does that compare to some well-studied strategies for serious mental illnesses like Dialectic Behavioral Therapy? DBT ratings range from 3.2-to-3.7 out of 4, and DBT has been widely scaled and evaluated.  Similarly, NIDA’s vast investment on testing prize contingency management for treating very serious addictions (which happens a lot with folks with serious mental illnesses) has research ratings of 3.4 to 3.6 out of 4. Betting the nation’s future on research score of 2.5 is like placing a bet on a pair of cards at Vegas; the House or entropy in the case of policy will likely win. How do I know that?  Well for one, my colleagues and I have taken a bunch of good quality prevention and intervention strategies to scale (including whole states and provinces) in the United States and other countries, with successes and challenges. In all three cases, these strategies have much better research scores, and still there were challenges—even-though one of those achieved population-level effects using federally collected data across states. Indeed, there is a whole level of experimental research on these issues called, Implementation Science.

The “evaluations” outlined in the bill are weak, and don’t meet any reasonable standards of finding out scientifically if the bill achieves the advertised purposes of averting future Newtown’s, Aurora’s, or Tucson’s—let alone making sure no parent or family has to wait for a psychiatric bed for seriously mentally ill loved one, as hyped to pass the bill. None of my colleagues with the proven, published studies for evaluating such large-scale prevention, intervention, or treatment practices and policies have been invited to testify or consult, and the bill really doesn’t factor in such talent in the advisory boards. Is it possible to design a sensible scientific strategy to evaluate this massive experiment with the Nation’s Mental Health? Absolutely. I can rattle of practical ways in minutes, but what will Congress do if this governmental reorganization fails?

Let us be sensible: there is absolutely no high-quality, well-controlled peer-reviewed scientific publications that remotely suggest the Murphy Bill would have, or will stop future horrific events that happened in Newtown (CT), Aurora (CO), or Tucson (AZ). That’s simply good intentions. That said, the bill’s opponent often equally tout their good intentions, with similar emotional appeals and weak evidence.

Let us be equally sensible, forced treatment has horror stories—which I know first hand as a family member and clinician. Just letting very troubled patients decide to seek treatment has equally horrific stories. Both shades of grey are abundant in the press. 

The recommended best implementation of AOT I visited in Hamilton, OH was exemplary as promised but is not presently scalable in the county let alone the nation or state of Ohio to handle all the potential patients who need it. You can read my report about this terrific exemplar in a previous posting on the CMHNetwork website.

I get and honor the good intentions of both Congressman Murphy and his detractors. The revised bill cannot achieve the hoped-for goals when it pivots on a weak strategy and is not crafted based on good science of prevention, intervention, treatment or their implementation. Our current policies and practices are not working, as well documented by the rise in morbidity and mortality from neuropsychiatric disorders in the United States by diverse sources [1-13].

One thing absolutely missing from testimony and the bill is a serious discussion the prevention of mental illnesses long before events in Newtown, Aurora, and Tucson. In 1994, when the Institute of Medicine reviewed the evidence, there was a hint of possibility but no solid science. In 2009, the Institute of Medicine revisited that issue after the publication of hundreds of well-designed randomized, longitudinal trials that concretely proved it was possible to prevent such serious problems.

Sense and Dollars
The promise of the bill cannot be practically achieved, when it only appropriates a fraction of the funds spent in New York to achieve its statewide results with AOT. To achieve the result in New York across the United States would require $4 billion in new treatment money. And if all the money from the mental health block grant (about $480 million) each year were diverted just to patients with first-episode psychosis (for which there is both good prevention and treatment research) that would be only about $900 per patient for the 500,000 cases per year—not even one night for a psych bed. Further, the bill lacks a credible way to scientifically evaluate the outcomes of this vast “policy experiment” with the minds of our most fragile citizens. I speak this caution from both successes and utter failure of my own good intentions trying to better lives with science, dollars, and policy.

There are better ways to achieve the good intentions of all the parties, with better sense, science, and dollar value. I wish we could have that adult discussion: millions of lives hang in the balance.

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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. 

References
1. O'Connell, M.E., T. Boat, and K.E. Warner, eds. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults: Research Advances and Promising Interventions. 2009, Institute of Medicine; National Research Council: Washington, DC. 576.

2. Woolf, S.H. and L. Aron, U.S. Health in International Perspective: Shorter Lives, Poorer Health, in Board on Population Health and Public Health Practice, Division of Behavioral and Social Sciences and Education, R.M. Martinez, Editor. 2013, The National Research Council and Institute of Medicine: Washington, DC.

3. Soni, A., The Five Most Costly Children's Conditions, 2011: Estimates for U.S. Civilian Noninstitutionalized Children, Ages 0-17, A.f.H.R.a. Quality, Editor. 2014, Agency for Healthcare Research and Quality: Washington, DC.

4. Merikangas, K.R., et al., Comorbidity of Physical and Mental Disorders in the Neurodevelopmental Genomics Cohort Study. Pediatrics, 2015.

5. Kessler, R.C., et al., Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry, 2012. 69(4): p. 372-80.

6. Patton, G.C., et al., Health of the world's adolescents: a synthesis of internationally comparable data. The Lancet, 2012. 379(9826): p. 1665-1675.

7. Thomas, J.R., Panel looks to tackle skyrocketing special education costs, in The CT Mirror. 2012, The Connecticut News Project, Inc: Hartford, CT.

8. Copeland, W., et al., Cumulative Prevalence of Psychiatric Disorders by Young Adulthood: A Prospective Cohort Analysis From the Great Smoky Mountains Study. Journal of the American Academy of Child and Adolescent Psychiatry, 2011. 50(3): p. 252-261.

9. Twenge, J.M., et al., Birth cohort increases in psychopathology among young Americans, 1938-2007: A cross-temporal meta-analysis of the MMPI. Clin Psychol Rev, 2010. 30(2): p. 145-54.

10. Smith, J.P. and G.C. Smith, Long-term economic costs of psychological problems during childhood. Soc Sci Med, 2010. 71(1): p. 110-5.

11. Merikangas, K.R., et al., Prevalence and treatment of mental disorders among US children in the 2001-2004 NHANES. Pediatrics, 2010. 125(1): p. 75-81.

12. Mathews, A.W., So Young and So Many Pills: More than 25% of Kids and Teens in the U.S. Take Prescriptions on a Regular Basis, in Wall Street Journal. 2010, The News Corporation: New York.

13. McMichael, W.H., Most U.S. youths unfit to serve, data show, in Army Times. 2009: Washington, DC.

CMHNetwork 'walks the walk' on the Alternatives Conference

3 Comments | Posted

The Alternatives Conference, now entering its 29th year, was at the center of controversy last year in the often heated debate around the Helping Families in Mental Health Crisis Act (for brevity, we will refer to this as the 'Murphy bill'). Comments about the conference were often vitriolic, and the name 'Alternatives' was highlighted as an example of wasteful spending by SAMHSA. Conference workshops were chastised for being irrelevant to the needs of individuals with mental illness, and a poor excuse for the sharing of far-fetched treatment and support options for individuals with mental illness.

The Children's Mental Health Network has passionate followers who are firmly for the Murphy bill and those who are firmly against the Murphy bill. This dynamic is what makes the Network unique. We encourage the sharing of differing views in the hope that we can find consensus on issues impacting families who have children with mental health challenges. The emails I received last year referencing the Alternatives Conference were just as polarizing as the debate around the Murphy bill. Some emails would say, "See, I told you so, Murphy is right." and others would say, "They just don't get it, Murphy is wrong."

Alternatives Conference dragged through the mud in Wall Street Journal article
I have never been to the Alternatives Conference. In fact, I had never heard of the Alternatives Conference until a little over a year ago when the Wall Street Journal published a scathing Op-Ed article that slammed the conference as an example of why SAMHSA needed to be reorganized and the Helping Families in Mental Health Crisis Act needed to be passed.

The examples in the Op-Ed piece came across as so egregious as to make anyone wonder how in the world public dollars could be invested in such an endeavor. Of course, after doing just a bit of digging, the truth of the matter became crystal clear. You can read my detailed analysis of the accusations made here.

I'll put this simply - If the Alternatives Conference activities that were described as wasteful spending in newspapers around the country and on the floor of the House of Representatives all of last year are good enough for the Veteran's Administration to endorse and use with our returning wounded warriors with PTSD, then they are good enough for me.

CMHNetwork walks the walk on AOT
Juxtaposed against the accusations of wasteful spending was a call by supporters of the Murphy bill to require Assisted Outpatient Treatment in all 50 states. As with our careful analysis of the charges made about the Alternatives Conference, the Children's Mental Health Network hosted a number of dialogues on the topic of AOT with both supporters and those in opposition.

Our investigation into AOT uncovered a wide range of approaches to the use of civil commitment across the country. This led us to question what exactly the Murphy bill was asking to be put in place. I asked E. Fuller Torrey's organization, Treatment Advocacy Center (TAC) to give us what they would consider to be an excellent example of AOT so that we could do a site visit to learn more about what they did. TAC is one of the primary architects of the Murphy bill and has been involved with the Network in all of the dialogues last year.

Supporters and those in opposition of AOT were invited to attend the site visit. Just like the review of the Wall Street Journal article, what we found on the site visit went way beyond the sound bites that you hear in the press or by politicians who are either for or against AOT. You can read about our visit here.

It is our responsibility as advocates to not just accept as gospel what any politician tells us, regardless of what side of the issue you are on. We must do our homework. For when we do, we can change the conversation about what is most helpful for youth and families, not what is most helpful for politicians.

CMHNetwork walks the walk on the Alternatives Conference
I am a firm believer that if you are not willing to embrace and experience what concerns you most then you probably shouldn't be talking about it. Which leads me to the finale of this Zen post: We are going to the Alternatives Conference! Gotta practice what you preach, Network faithful.

I want to invite all of our colleagues and supporters who participated in bemoaning the use of federal funds to help support the Alternatives Conference to attend this year. Let's see what all the fuss is about. Let's dialogue with presenters at this conference and hear from them how they are using alternative approaches to treating and supporting those with mental illness. If you are not willing to do this, then frankly, you shouldn't be using it as an example of what you see as wrong with the mental health system in America.

alternatives

October 14 - 18, 2015
Memphis, TN

  • Learn more about the Alternatives conference here and sign up!

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scott

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

Choke

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Morning Zen Guest Blog Post ~ Zoë Hooley

“I’ll be locking up your possessions. In a few days we’ll see about putting you back in your own clothes. Cell phones are not permitted on the unit; get out any numbers you may need. There are payphones in the common area that you can use after breakfast and before dinner. There are walk-throughs every fifteen minutesfor your safety.” The monotony of the nurse’s voice showed that she had given this speech countless times. “Do you have any questions?”

I mutely shook my head. I did have a question: Could I get out of here? But I already knew the answer. We sat in a tiny room, just big enough for two chairs and an old metal desk that looked as worn as I felt.

“Before I take you to your room, I need to do a skin check.”

“A what?”

“I need to check for any existing marks or wounds. If you can stand up?” she coaxed, clicking her pen.

I rose and reluctantly lifted my hospital gown as she dutifully noted my scars on the genderless diagram on her clipboard, a personal paint-by-number. She scribbled a mark for the bird tattoo on my ribs, the scar from the mole I’d had removed from my arm when I was fifteen, the birthmark on my left calf.

“Turn around.”

I complied, feeling a twinge of shame as she marked down the phoenix tattoo I’d gotten three years earlier, after I’d almost killed myself. (The first time, my planned defenestration. Not to be confused with when I almost killed myself this time.) Wings spread wide in flight, as if about to soar off my shoulder, it symbolized how suffering begets rebirth. Where was resurrection now? I felt nothing but the flat pile of ashes, smelled nothing but smolder.

“All done,” she said with a reassuring smile.

The nurse took me down the hall, past the many whiteboards affixed to doorways like placards. She paused at one with a vacancy and wrote in my namemy first name, the one only my grandma calls mealong with the names of my assigned nurse and social worker.

“I’ll give you a few minutes to get settled,” she said, gesturing toward the bed and nightstand that together occupied half of the room; a curtain separated them from an identical arrangement on the other side. The built-in furniture reminded me of the dorms in college, the ones in the old residence hall. “I’ll check on when the doctor will see you.”

I sat tentatively on the bed, numbness and emotion vying for dominance. They’d been playing tug-of-war for the last several days, but I could feel that emotion was going to win this one. Which is to say, I could feel. Anxiety and fear and frustration bumped into each other in my stomach, looking for a way out. I searched in the paper grocery-turned-duffel bag I’d used to carry my things from the downstairs crisis unit, rummaging for my journal and a pencil. Pens, for reasons as inscrutable as my breakdown, were considered potential weapons and weren’t allowed.

I was interrupted as a short, middle-aged woman with a wide face and wider smile shuffled into the room on the blue socks that everyone wore in the unit. I was sniffing back my tears as she noticed me sitting on the bed.

“Are you in my room?”

I nodded shyly, not trusting that my voice would be clear of tears.

“I’m Cynthia.” Her guilelessness and my self-doubt did a tango around the room.

“Hi, Cynthia.”

“We’re watching TV.” It was an assumption more than an invitation. Of course everyone wants to watch TV.

“I think I have to wait for the nurse.”

“Oh, okay.” She started to leave the room, then turned back. “I’ve got grapes.”

A grin punctured my numbness. “I’m okay.”

***

Five days ago, I’d been rushed to the ER with a dangerously high blood alcohol level.

A break up on the heels of a move on the heels of a job-change—to think about it made my head spin and my stomach ache. So I tried not to.

I came home from work to my Chicago apartment, empty except for Raymond, the beta fish, who wasn’t much of a conversationalist. I started drinkingjust to take the edge off. But the edge was deep and jagged and I slipped into it. Alcohol was a recent addition to my strategies for quelling my chronic, throbbing anxiety. Running too much, cleaning too long (and then cleaning again), eating too little: I’d tried my hand at them all. But none had been able to stop the pulsing dread more than whiskey. A lightweight, I quickly outpaced myself, and by the time my roommate got home, I was breathing threats—wishes, perhaps—of suicide.

“I slapped you. I’m sorry,” she told me later. “I wanted you to snap out of it.” But I’d already snapped.

***

The ambulance clattered and howled through the streets of Chicago, me in its belly. They wouldn’t let my roommate ride in the ambulance; they wouldn’t let me leave the hospital. Involuntary commitment is called “C&P” in Illinois: Certificate and Petition. As much as I petitioned, they wouldn’t let me leave.

I spent the next several days in the crisis unit, waiting for an open bed in the psychiatric ward six floors above. They answered the phone by saying, “Crisis.” It was the ward’s official greeting. Emergencies were standard.

My first morning upstairs in the psych unit, they woke me at 6:10 a.m. to take blood. I rubbed the sleep out of my eyes as the nurse rubbed an alcohol swab on my forearm.

“There will be a little poke,” she narrated as she lifted the needle. I barely noticed, my drowsiness serving as an anesthetic.

“That wasn’t so bad, huh?” she said cheerily, removing the tourniquet. I smiled absently as she gathered her supplies and left the room, calling, “Breakfast will be up soon!” as she departed.

I caught sight of myself in the mirror as I made my way to the bathroom. My curly hair looked as if it had been practicing gymnastics all night, and my eyes had a glassy pre-coffee blankness. The baggy blue hospital gown drifted around me as if it wasn’t sure what to do, either. I hesitated for a moment, listless, before impulsively burrowing in my bag for my lipstick, dabbing on the color quickly and decisively. I nodded at my reflection before heading down the hallway to the dining room.

My eyes scanned the three rows of tables with all the certainty of a new kid who’d just walked into an unfamiliar cafeteria. On the far side of the room, Cynthia was motioning to me. When she caught my eye, she patted a spot beside her at the table. I angled my way there. When I sat down, she introduced me to her neighbor.

“This is Zoë. She’s my new roommate.” I tried to focus, to absorb their names, but my brain was such a tangle, and nothing sunk in. Bill? Marsha? Or was it Martha?

We groggily waited in silence for the staff to distribute the food. Our meals came up to the unit in a big capsule of molded plastic, which made a sound like the opening bay doors of a spaceship when they unlatched it. The trays were covered with plastic domes resembling flying saucers, orbited by tiny satellites of orange juice and reduced-sodium margarine.

I scooted the breakfast sausage to the outskirts of my plate. They remembered I was a vegetarian about 45 percent of the time. No matter: they had sent coffee. I slurped it as eagerly and gingerly as if it were real coffee—from one of the upscale boutiques in the Gold Coast that I passed every day on my way to work—and not bland, burnt Folgers.

As I sipped, my gaze roamed around the room. The other patients were trading items from their trays like baseball cards.

“Ronald, you can have my juice.”

“Anyone want my biscuit?”

“Give your jam to Gina, she always likes it.”

The patients whose medication made them prone to dizziness wore yellow socks—bright yellow—cluing in the staff to the fact that they were unstable. But weren’t we all? Wasn’t that why we were in the psych ward?

Later, I lay in my bed, trying to clear space in my head for sleep. I wondered if my brother was trying to get ahold of me. I wondered how I would explain my absence to my boss. I had called into work, earlier that day, and made as vague an excuse for my hospitalization as I could muster. Brian answered the phone. We call him The Beast. After I’d broken up with my boyfriend, Brian offered to beat him up. (He then went on to relate tales of all the people he’d beaten up alreadythere were many.) Brian sounded so scared, saying he was worried sick about me. Why hadn’t I called? He spoke quickly and nervously, like a child. I was one of Brian’s favorites, the only girl in the back stock crew. He’d chosen me because he thought me capable and strong. But here I was in the psych ward. Regret and shame frayed the edges of my thoughts.

Feet could be heard making their way down the tiled hallway.

“Just a safety check.” Came a cheerful voice from the doorway. “Everything okay?”

“Yeah,” Cynthia piped up from the far side of the room. “I’m gonna choke her when you leave though,” she said around giggles.

Stillness returned to the room after the nurse left.

“I wasn’t really going to choke you, you know,” Cynthia said from the darkness on the other side of the curtain.

***

Three days later, my gathered things—a drawing by my friend’s three-year-old, sent to cheer me; the wilting flowers my friend Joseph had brought; the social worker’s card—jutted out of the grocery bag, now torn at one corner from use.

Cynthia had left the day before. I had suggested that maybe we could swap addresses and write. It’s what I’d learned to say to departing cabinmates at summer camp.

“I’m not too good with words,” she hedged, taking the pencil. Her face wrinkled with concentration, the paper wrinkling under her measured hand, she made up with force what she lacked in finesse. I slipped the address into my journal alongside other valuables: a pressed flower, my prescription for antidepressants.

“Would you help me fill this out?” Cynthia asked, holding out a form. I nodded quickly—too quickly—eager to jump over any gap where embarrassment might insert itself. I read the questions to her slowly, slipping into the voice my mother used for story time.

***

The next day, I answered the questions for myself:

  • During this hospital stay, how often were your room and bathroom kept clean?
    D. Always
  • During this hospital stay, how often did nurses treat you with courtesy and respect?
    C. Usually
  • During this hospital stay, how often did doctors listen carefully to you?
    B. Sometimes
  • Would you recommend this hospital to your friends and family?
    B. Probably no. (It depends on their roommate.)
  • In general, how would you rate your overall mental or emotional health?
    Fair, gathering wind.

It would take days and weeks and years before I could use “health” to classify my emotional state, but I could hear in the distance the rustle of wings. A plume from the pyre, the phoenix flies.

* * * * *

Zoë Hooley is the author of one of the essays in the book Writing Away the Stigma.

A letter from the heart

2 Comments | Posted

Morning Zen Guest Blog Post ~ Laura Humphreys

To Those I Love,

If I cannot come to see you, or to see you if you come to see me, know that it’s not personal; it’s never you.

If I try and I fail, it is better to be happy for me that I tried than to be sad or frustrated that I failed. Every attempt, no matter how far I get, is a step I am taking back to you. If I am able to reach you physically yet cannot meet your eyes, speak, stay or seem to be comfortable in your company, it’s not personal; it’s never you.

If I try and I fail to be there emotionally, please try to remember that it is because my demons are taking my attention away from you and making me uncomfortable.

If I seem selfish in my behaviour, it is because I am trying so hard not to be selfish. I am trying to find myself and reclaim my mind from my demons so that I can be there, in mind and body, for you.

If I become so uncomfortable to the point my behaviour screams that I want to get away, know that it’s not because of you. Sometimes I have to leave in order to redeem myself and to protect you from feeling uncomfortable or from worrying about me quite as much. Sometimes I have to say to myself, “I’ve done all I can for now. I will try again another day.” I will come back to you. If not that day, then another day.

I came to be this way because of life experiences that imprinted into my young and influential brain that certain situations are not safe for me to be in. Years of seeking help and failing to get it meant that the longer I went untreated, the more ingrained my behaviours, thoughts and fears became. By the time someone listened and I did receive help, my demons had become so deep-rooted that even twelve years on, I haven’t been able to fix all the things that went so wrong.

Anything that reminds me of those experiences encourages the demons to come forwards, and it often takes all my energy to hold them back until they relent.

And they do relent. It is possible for me to put them in their place and to live life just as me, without my demons. But to bounce back from a time when they got the better of me, from a time they have ruled my life, it’s the hardest thing in the world to do. Sometimes it feels like a constant fight. I am told that one approach to recovery is to stop fighting. Yet to stop fighting means to fight against the urge to fight. There is no easy way for me to recover and live the life I want to, and it will take time. It might take weeks, months, or even years. No-one can know how long it will take. Matters of the brain and mind are complex. All I can do is keep trying. Some days will be better than others.

My mental illnesses do not care for social or personal etiquette or for what I want. They are selfish and they want to be an entity in themselves, to exert themselves vicariously through my body. They demand to be heard and to have control over my mind. They do not like to be ignored.

The level of truth in this is disputed by some who have recovered and others who claim to be experts in the field of mental health; they state that your mental illness is never your identity. They might say that what I am saying in this letter [that my behaviour implies a lack of control or will to overcome, that my mental illness has any identity] is taking a “victim attitude”, which is not conducive to recovery. The reality is that accepting your boundaries and working with them and explaining them to those you love is not the same as acting like a victim of your own mind. To act like a victim would be suggested by something more along the lines of the abdication of all responsibility of illness and recovery and disregard for any understanding, or attempted understanding, of the illness.

I have boundaries, but I am not a victim.

I have written this to you because you are one of a select group of people who have loved and supported me through the tough times. You have also seen me at my best and therefore have the belief and knowledge that I can be fully present and safe in life, no matter where I am. Your belief in me gives me hope and faith and reminds me that I can get back to living my life as I was, with you as an important and regular feature, enjoying your company and love and sharing days and life experiences with nothing to get in the way. No-one can understand how much I am missing that freedom right now.

I am more grateful than anyone can ever know for those people who love and have loved me. I am not an easy person, and knowing that makes me appreciate and love you all the more for the fact that you have accepted me as a part of your life, whether directly or by association.

Thank you for celebrating the good times with me, and for supporting me through the difficult times. I hope one day to be able to return the kindness, stability and love you have given me when you also need it most.

With much love,

Me  x

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lauraMy name is Laura Humphreys and I'm a mental health advocate in Cambridgeshire, UK. Having suffered with mental illness for 19 out of my 26 years, I write a blog about life with mental illness and have appeared in various forms of media speaking about different mental health conditions. My day job is as assistant editor of Guinea Pig Magazine but I'm also studying Psychology with The Open University.

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