August 17, 2009
Letters
Young, Mentally Ill and Behind Bars
To the Editor:
Re “Mentally Ill Offenders Stretch the Limits of Juvenile Justice” (front page, Aug. 10):
Solitary confinement is among the harshest legal punishments that American society inflicts on its adult inmates. To inflict it on children is cruel and immoral.
I studied suicides in New York State’s prisons over a six-year period and found that half occurred in solitary confinement units even though just 7 percent of the population was housed there. In 1890, the United States Supreme Court observed that prisoners in solitary confinement “fell, after even a short confinement, into a semifatuous condition, from which it was next to impossible to arouse them, and others became violently insane.”
If adults are unable to endure the tedium and psychological torture of round-the-clock confinement, imagine what it does to young, developing minds — and what it does to those with mental illness.
Mary Beth PfeifferStone Ridge, N.Y., Aug. 10, 2009
The writer is a journalist and author of “Crazy in America: The Hidden Tragedy of Our Criminalized Mentally Ill.”
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To the Editor:
In response to rallying cries of “get tough on crime” in the 1980s, many policies were put in place that have led to skyrocketing prison populations. The most troubling, with profound effects, is in the juvenile justice system.
The systematic use of and reliance on the criminal justice system to deal with mental health problems of our youth have been misguided. Not only is this a waste of taxpayer money, but it is also tragic for the youth, families and communities in which they reside. The juveniles who are imprisoned because of mental illness are often without adequate treatment and without hope of recovery. They will be doomed to a life of crime and their victims will suffer. The economic crisis has worsened the situation, as it has resulted in a reduction of support for treatment of mental illness.
Congress should address the policies and revisit laws that result in an extraordinary number of youth with mental health disorders landing in prison. Instead, when possible, home-, family- and community-based care that addresses the underlying disorders should be used.
Greater collaboration is also needed among everyone involved in the lives of youth. Earlier detection of mental health and substance abuse disorders of juveniles in the justice system; increased training for juvenile court, corrections and law enforcement personnel; and expanded services and programs that have been proved to reduce recidivism and improve outcomes for juvenile offenders are needed in order to improve the likelihood that juveniles with mental health disorders will get the help they need to become productive members of the community.
As Attorney General Eric H. Holder Jr. told the American Bar Association during its annual meeting this month in Chicago, while we need to be tough, we also need to be smart on crime.
Carolyn B. LammPresident, American Bar AssociationWashington, Aug. 12, 2009
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To the Editor:
Your article accurately portrays the devastating consequences of cutting state and community mental health programs. Cutting publicly financed programs does a disservice to the mentally ill, costs more in the long run and worsens human suffering.
A 2004 study showed states with intensive community treatment programs had fewer arrests, jail days and hospitalizations of people with mental illnesses. One state saw an 83 percent reduction in jail days. States and communities that effectively carry out community mental health programs will reduce costs and, more important, help the mentally ill get effective treatment and keep them out of prisons.
Laurence H. MillerChairman, Assembly Committee on Public and Community Psychiatry American Psychiatric AssociationLittle Rock, Ark., Aug. 11, 2009
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To the Editor:
Research demonstrates that delinquent youth with mental health issues can be far more effectively helped by home-based and community-based treatment than in correctional institutions. That is why in 2007 the Bloomberg administration began the Juvenile Justice Initiative, which provides treatment at home as an alternative to incarceration for juvenile delinquents.
Treatment for these youth, many of whom have been diagnosed with mental illness, is provided by trained clinicians with small caseloads who help families with obtaining appropriate psychiatric services. This reduces recidivism by 30 to 70 percent (far better than the 90 percent re-arrest rate for youth placed in juvenile prisons), and provides treatment for a fraction of the cost, while more successfully addressing antisocial behavior and teaching caregivers for these youth how to manage the symptoms of their children’s mental illness.
By wrapping services around the youths and their families in the community, therapeutic gains can be sustained after treatment ends.
John B. MattinglyCommissioner, New York CityAdministration for Children’s ServicesNew York, Aug. 11, 2009
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To the Editor:
While thorough in describing the plight of mentally ill youth, your article does not describe emerging innovations.
For example, juvenile mental health courts and legal services lawyers in California have joined together to divert mentally ill youth from detention. These nonadversarial courts offer intensive case management and link youth to community-based mental health services so they can safely return home. The legal services lawyers expand access to critical resources like Medicaid, special education and disability benefits by enforcing existing legal rights to adequate mental health treatment and supports. Providing intensive treatment in the home is cheaper, more effective and more humane than detention.
Juvenile mental health courts are an important innovation to reduce detention of youth with mental illness, but they are not a solution. Only by providing adequate mental health services to every child in America will we end the practice of using juvenile jails to warehouse mentally ill youth.
Patrick GardnerFiza QuraishiOakland, Calif., Aug. 11, 2009
The writers are, respectively, the deputy director and a legal fellow at the National Center for Youth Law.
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To the Editor:
The crisis in our juvenile corrections system will only worsen unless we reverse course and aggressively put in place early identification, prevention and effective treatment programs for mental health conditions.
We have a strong research base that shows that these programs can reduce antisocial behaviors and help young people succeed. Yet we fail to invest in these proven approaches. The plight of children in these facilities demands that we change course.
The health reform plans now being debated improve access to prevention programs that can avert the current downward spiral. Effective implementation of the 2008 insurance parity act contained in economic bailout legislation will help assure equitable access to mental health services.
We must change policies that permit mental health services to be the first cut. Continuing on our current path is expensive, ineffective and inhumane.
David L. ShernPresident and Chief ExecutiveMental Health AmericaAlexandria, Va., Aug. 11, 2009
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August 20, 2009
Letter
Help Without Confinement
To the Editor: NEW YORK TIMES
“Mentally Ill Offenders Stretch the Limits of Juvenile Justice” (front page, Aug. 10) illustrates the problems with using juvenile justice systems to meet the mental health needs of youth. Fortunately, there are growing efforts to better serve youth while ensuring public safety.
When mental health services are not available, or are poorly coordinated, youth land in the juvenile justice system, which worsens underlying conditions and contributes to re-offending.
Many jurisdictions are breaking with these failed approaches. Eight states participating in the MacArthur Foundation’s Models for Change, a juvenile justice systems reform initiative, are coordinating with law enforcement, schools and probation officers to divert youth with mental health needs away from juvenile justice placement and toward expanded treatment services.
When more states keep youth from being unnecessarily confined in order to gain access to treatment, everyone benefits. Rather than burdening overstretched systems, we can strengthen them while better providing for youth, families and communities.
Joseph J. CocozzaDirector, National Center for MentalHealth and Juvenile JusticePolicy Research AssociatesDelmar, N.Y., Aug. 11, 2009
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A dangerous label for children
Boston Globe
As a pediatrician who has listened to countless stories from distraught parents, I have no doubt that there are children who, even from infancy, are chronically unhappy. But to label them as having a ‘‘major depressive disorder’’ serves only one purpose: to provide a new market for the pharmaceutical industry.
Claudia Meininger Gold
August 16, 2009
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CLAUDIA MEININGER GOLD
A dangerous label for children
By Claudia Meininger Gold August 16, 2009
AS A PEDIATRICIAN who has listened to countless stories from distraught parents, I have no doubt that there are children who, even from infancy, are chronically unhappy. In documenting her struggle with depression in a recent New York Times Magazine article, Daphne Merkin wrote, “It is an affliction that often starts young and goes unheeded - younger than would seem possible, as if exiting the womb I was enveloped in a gray and itchy wool blanket instead of a soft, pastel-colored bunting.’’ My concern, however, with the study in the August issue of Archives of General Psychiatry describing preschool depression is that by saddling these young children with a major psychiatric diagnosis, our thinking will stop. Under the pressure of the powerful pharmaceutical industry, a direct line from diagnosis to drug will be the path of least resistance.
My sense is that these children process the world differently. One mother described carrying her screaming son for hours until she realized that he didn’t want to be held. Another mother said her daughter was “not cuddly’’ and difficult to feed. As they become toddlers, the issues change. I hear about what I call “sock bump anxiety,’’ where many changes of socks are required to find the one with the right seam in the toes. “Fun’’ family outings to a county fair can end in disaster as kids become overwhelmed by all of the sights and sounds. Intense tantrums and meltdowns are frequent.
When I talk with parents of these young children, I often discover that Mom, or Cousin John, or some other relative was just like this as a child, and now has a diagnosis of depression or bipolar disorder. They fear their child will have the same fate. Certainly I cannot claim to know what the future holds for these children.
However, I do have ideas about how to help these families in the present, ideas that are informed by contemporary research at the interface of developmental psychology, neuroscience, and behavioral genetics. This research shows that a child’s mind grows and develops when the people who are most important to the child are able to think about the child’s experience without becoming overwhelmed or shutting down. A parent’s capacity to “hold a child in mind’’ can help that child learn to manage difficult emotions and may actually change the way his brain handles stress.
To help parents with this task, which is more difficult than is generally acknowledged, I first validate their experience. One mother was beaten down by the constant comparisons to her sister’s angelic, easygoing child. “You are not a bad parent,’’ I tell them. “Life is really more challenging for you and your child.’’ If one parent suffers from depression, the strain of such a child can be particularly intense, and that parent will need help for him- or herself.
The normal stress that a child places on a marriage is significantly magnified. One mother of a 6-month-old felt a transformation in her relationship with her daughter simply because her husband came to the visit with me. He finally appreciated what she was experiencing at home while he went to work. With his support she had more energy to be fully present with her child.
All of the burden need not be on the parents. As these children get older, certain types of activities can be particularly helpful. These include martial arts, music, swimming, and horseback riding. I guide parents in finding what is right for their child. One boy at the age of 6 discovered a love for the stage. I joked with his parents that he might grow up to be a great actor, if they could just survive his childhood!
It is quite possible that if I were to list these children’s symptoms, or administer a standardized assessment tool, as was done in the recent study, they would meet diagnostic criteria for “major depressive disorder.’’ But such an approach is oversimplified and misses the nuances and complexities of human relationships. I would offer the same help with or without the label. In my opinion, labeling these young children serves only one purpose: to provide a new market for the pharmaceutical industry.
Claudia Meininger Gold, MD, is a pediatrician in Great Barrington.
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New Center for Cooperative Parenting Launched! The National Cooperative Parenting Center
Dr. Debra K Carter, Director of the National Cooperative Parenting Center, announced the launching of the center’s new site www.TheNCPC.com and the 2009-2010 training schedule for legal and mental health professionals.
FOR IMMEDIATE RELEASE
PRLog (Press Release) – Aug 20, 2009 – Bradenton, Florida — “As the emerging field of Parenting Coordination becomes a growing alternative dispute resolution process in cases of parental separation and divorce being instituted throughout many state Family Law systems, it is important that parents, legal prossionals, and mental health professionals understand the purpose of Parenting Coordination”, notes Dr. Debra K Carter, CEO of the newly launched National Cooperative Parenting Center. Dr. Carter reports, “The National Cooperative Training Center is committed to assisting parents, legal professionals, and mental health professionals in managing the difficult process of separation and divorce, so that those most vulnerable during this time, the children, are provided the objective support and advocacy they need.” The National Cooperative Parenting Center’s main office is located in Bradenton, Florida, although services and trainings provided will reach the national landscape. Dr. Carter is committed to the center’s mission of, “Promoting the welfare of children and the stability of their families”. The center’s staff will accomplish this through providing services and training for parents, mental health professionals, and legal professionals in a number of vital areas associated with parental separation and divorce including: Parenting Coordination, Parenting Plans, Parenting Assessment, Family Law Mediation, Clinical Mentorship, Forensic Consultation and Expert Testimony. For more information on the center’s services and upcoming trainings visit the website at www.TheNCPC.com or any of the following contacts: Toll Free Telephone: 877-571-NCPC (6272) Local Telephone: 1-941-855-0255 e-mail: contact@TheNCPC.com
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About National Cooperative Parenting Center: The National Cooperative Training Center is committed to assisting parents, legal professionals, and mental health professionals in managing the difficult process of separation and divorce so that, those most vulnerable during this time, the children, are provided the objective support and advocacy they need.
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Back-to-School Resource From American Public University For Teachers, Counselors: 'Tips' Cards On ADD/ADHD, Bullying, Child Abuse, Teen Depression
21 Aug 2009 [Click to Print] "Tips for Teachers" cards on key behavioral and student wellness issues are available at no cost to teachers, counselors, principals and other school-based personnel, thanks to a program by American Public University, a member institution of American Public University System, an accredited, online university system that serves more than 50,000 working adults studying worldwide. Laminated, 6" x 8" cards are available featuring information from expert sources on how to recognize and help students who may be suffering from these conditions and/or situations: - Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD) - Bullying - Child abuse and neglect - Teen depression and suicide The "Tips for Teachers" cards have many uses, including as a classroom resource, for professional training, as part of "welcome back" teacher packets, as a resource for parents, and as a resource to help satisfy school district- or state-mandated training requirements. Teachers, administrators and schools may order the cards at no cost by visiting studyatapu.com/tips-for-teachers. SourceAmerican Public University
Article URL: http://www.medicalnewstoday.com/articles/161358.php
Main News Category: ADHD
Also Appears In: Depression, Mental Health, Psychology / Psychiatry,
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latimes.com/news/opinion/la-oe-shimizu24-2009aug24,0,1748835.story
latimes.com
Opinion
The trauma of mental illness
One mother shares her fear, anger and anxiety as she fights the disease afflicting her son.
By Julia Robinson Shimizu
August 24, 2009
Aweek ago Sunday, my husband and I spent the day knocking on doors and apologizing to our neighbors. The night before, I had called 911 for an ambulance to transport our schizophrenic son to the hospital. Again. He didn't want to go. Again. He pushed me away from the phone and began raging at the 911 operator as we ran from the house. Almost immediately, there were two police officers on our front lawn. Our son stood in the kitchen, shouting at them to leave. They called for backup; four, then six officers on the front lawn. Patrol cars blocked traffic on the narrow street in front of our North Hollywood home. Our son called 911 again, screaming, shouting: "There are police officers here, make them go away!" I tried to reason with the police: "We just need an ambulance." But by this time, it was out of my hands.Two more officers arrived and ordered me to the edge of my yard, away from the view of the kitchen window. Another pair of officers pulled me aside, asking me what had happened. "I called an ambulance," I said, watching two more officers stride across the brown lawn. One, her dark hair pulled back in a tight bun, carried a shotgun wrapped in what looked like bright green cloth. She paused to smile at me, "Just bean bags, not lethal," and stood at the ready under the mulberry tree. We could see our son pacing back and forth in the kitchen, his long hair flying. By now there were more than a dozen police officers on the front lawn. They asked if there was an entrance in the rear. We directed them to the back patio, warning them not to trip over our elderly dog asleep in the breezeway. We have been through this so many times before. We've heard all the arguments from well-meaning people about how Big Pharma is bad and that we should try diet or therapy or other things. But from here in the mental health trenches, the reality is very simple. When our son takes his prescribed psychotropic medications, no one would ever suspect the depth of his illness. But when he is off his meds, he is unable to eat, sleep, bathe or make sense. He is overtaken by delusions: The Red Hot Chili Peppers have used his name without his permission; sitting on his guitar case is the same as playing the guitar. He regularly becomes violent when we suggest he should resume his medication or stop smoking pot. Oh, yes, pot. Research has shown that marijuana use is toxic to schizophrenics, that it exacerbates psychosis. It was an astounding surprise to me that marijuana could be so dangerous. But it sets our son into a blink-of-an-eye downward spiral that starts with the idea that he should set his prescribed medications aside. He then starts dressing in rags and refusing to bathe. He becomes increasingly incoherent -- responding, as one doctor put it -- to "unseen stimuli." The cycle generally ends with an involuntary hospitalization. His newly minted "medical marijuana" card has complicated everything. As more and more officers arrived, my cellphone rang. Our son. I held the phone away from my ear so my husband and I could both hear it. "How could you do this to me? I hate you! Stop being my mom!" There was still no ambulance, but now officers had pulled the screen from the dining room window and climbed inside. There were shouts, thumping and thrashing as they tackled our son. Four officers carried him down the front steps, howling and spitting. They pulled a hood over his head, handcuffed him, hobbled him with an ankle leash of thick webbed nylon and set him on the curb.Finally the ambulance arrived. Firefighters in yellow reflective coats stood watch as a pair of paramedics struggled to place monitors and a blood pressure cuff on our son."I need help. I need to get to the hospital!" he wailed as they muscled past his resistance to get a pulse. The ambulance pulled away from the curb and a police officer gave us directions to a local hospital emergency room where he was to be evaluated. Our son had his first psychotic break in his freshman year of college, and he has been in and out of hospitals ever since. It is always the same. We follow the ambulance, wait to see him admitted or transferred, worry over him. This is his sixth hospitalization in less than a year and comes just eight days after his previous discharge. At 24, he is no longer covered by our insurance, but this may be to his advantage. We've been told he can now access services through the Los Angeles County Department of Mental Health, and we're hopeful there may be more options for him now.With severe mental illness, nothing is certain. Except that we owed our neighbors an apology for the disruption. It felt odd, standing on doorsteps of neighbors we hardly know, telling them we were sorry. All those who answered their doors were quick to wave our apology away: "No, no, no problem."For all of them, including those who did not answer, we left a note. We were hesitant to share our story with our neighbors, but giving up the pretense of privacy offers us a chance to be free of the burden and shame of this mystifying illness.By being open, we may even be able to help someone. Our letter to our neighbors included information about NAMI, the National Alliance on Mental Illness, an all-volunteer grass-roots organization dedicated to helping individuals and families living with mental illness. NAMI has helped us understand we are not alone. Millions of Americans, an estimated one in five families (22%), are living with mental illness. As a matter of fact, two of the responding police officers on Saturday night, including the blond female officer assigned to keep me company, told us that they too had family members with serious mental illness. Our odyssey has taught us many things, but none more important than these: Mental illness is no one's fault. Treatment works. There is hope.Julia Robinson Shimizu serves on the board of the National Alliance on Mental Illness, San Fernando Valley. Website: www.nami.org
Copyright © 2009, The Los Angeles Times
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