Monday, March 18, 2013

All Things New

We made it! Spring is here with  birds singing and flowers blooming and animals playing....and  mental illness continues its march across the country and the world, leaving a wake of devastation and confusion. Just  yesterday, I was  with family in Kerrville and an email came  through to my cousin announcing a school mate of hers had committed suicide. His father  met the same fate several years before.  It is interesting to listen to non-professional folks discuss a suicide. "Such a waste", "he was always a little off" "you know his Dad was wierd too", "guess it does run in the family". Suicide remains a  very frequent answer to the question  of  what's the use? Adolescents and  young adults are resorting to suicide in record numbers. The   incidence in our military is astounding. Most of the mass shootings we have all witnessed have been about suicide. Yet we  are intent upon solving this crisis with a plethora of  laws regarding gun ownership.  Guns are not the problem. The  stigma  around health  is the issue. The stigma or fear creates an environement where people are ashamed to seek help even when they know they need it. They are afraid if people find out they will be treated  like they are "crazy". And they would be right. They are treated differently. There are many ways to kill oneself besides guns.  Some of them also put  others at risk as well.  Death by cop comes to mind. Or all those single car accidents....I know a friend who  has had the passing thought every time she is on a long trip to just pull the wheel to the right and see what happens... the only thing that keeps her from doing that at the moment is what she has learning in therapy, the picture of her little girl she keeps taped to her steering wheel and the fact she may take our a bunch of people with her. Spring is a time of  renewal, of growth and beauty. Wouldn't it be nice if that growth and  renewal could extend to  our cultures attitude towards mental health? I followed  an anti stigma blog and will be following a new campaign as soon as it is released. My hope, my prayer is through campaigns and blogs and postings we can change the way mental health issues are  viewed and make  getting help easier than getting  help for allergies. The new campaign's website is
I invite you all to go there, check it out and take the pledge to become an advocate. It costs nothing but your time and your commitment to be a voice for those who have none. Won't you join us?

Wednesday, January 30, 2013

Lost in the Battle

It is almost the end of January. It is time for me to address the Sandy Hook tragedy that took the country by agonizing surprise in December. After all the speculation of who the shooter was, and photos of parents and kids who were forever changed, we are in the middle of a huge battle over guns in our country. The nation is extremely divided on this lone issue and it will likely get the l;ion's share of the public attention.It is fact that more kids die in this country from car accidents and many hundreds of thousands of children die from abuse every year. The later of these causes is at epidemic proportions. Yet we do nothing to prevent this from happening. Then there is the issue of the mentally ill in our society. All of the shootings have been attributed to some mental illness on the part of the shooters. So do we need to keep all people who have ever been treated for a mental illness from legally owning a gun? How do we track this without violating HIPPA. So many questions. One thing that has not been discussed is the fact that most if not all of the shooters were suicidal at the time of their assaults. those of us in the "business" know that a great way to commit suicide is death by cop, which is forcing an officers hand. Making them shoot you. What chance would a shooter who tried to kill several hundred people have to live in  a gun battle? What is behind the decision to take a life, even if it is your own? Suicide is very preventable according to experts in preventative medicine. These same experts agree that funding is not the issue keeping people from seeking help. It is the stigma of being seen as mentally ill. So logically, making it impossible for a person who has ever been treated for mental illness from legally owning a gun would add to that stigma. So back to the  current debate over guns in America. Will making assault weapons and mega clips stop gun violence? Some of the most restrictive gun laws in this country are in Chicago which has the highest death by homicide using guns than anywhere else. Guess not. Will universal background checks and agovernment data base of gun owners keep this from happening? Criminals who get guns, I don't think get them legally for the most part.  Fast and Furious showed the black market gun trade in the US. I have no great insight into these issues only to say that until children are regarded as precious and valued, and until those precious kids are taught the value of any life and of living a life of respect and dignity for each other,all of the laws we pass are just to make us feel better in my opinion.

Tuesday, December 4, 2012

Do You Believe?

This time of year always reminds me of magic. The magic of Christmas. Magic sleighs and reindeer, and elves and an awesome guy in a red suit that lives at the north pole who flies all over the world in a single night delivering toys to all the good little boys and girls. Childhood seems to ripe with magic, or it used to anyway. The tooth fairy was this magical creature that was invisible to kids, who collected teeth when placed under a pillow, and replaced the tooth with money. The economy obviously has impacted fairy land as well. A tooth used to be worth a quarter, now I hear they are going for upwards of $2.00! The Easter Bunny, the Sandman, and all the  creatures that live in that far off place of magic and  wonder, have they been forgotten? Adults seem to be too busy to play those kid games anymore. The only time you can see an adult really get into magic is around the holidays. Santa is at the mall. There is reindeer food for that fateful Christmas eve run along with cookies and milk for a hungry chief elf. I believe in magic, always have. And I believe in miracles.
Magic makes childhood what we as adults think it is. Adults tend to fantasize about what a childhood should be about. Happiness, fun, and innocence. That is what we all remember as the childhood we all want for our kids. Ask any kid if that is what they have. They will probably think you are  completely out of touch with reality. Maybe we are. The day to day life of a child includes stress, pressures,awkwardness, ridicule, fear, uncertainty, confusion, and pain both emotional and physical.
Those wonderful days of  playing with friends in sun streaked  yards, riding bikes, building forts and secret clubs with no girls allowed does not exist in the modern world. A lot of the  magic of childhood that was fueled by their imagination is slowly being eroded by technology. Whatever you can imagine can be  done through computer generated images on a screen as big as a football field in ear splitting sound... and 3 D. There is little left to the imagination. So back to my original question...Do you believe? Magic or miracles or both? Somewhere are there still fairies and elves that dance around in a wondrous land where kids are protected and taught the beauty and magic of imagination? I wonder.  

Sunday, September 30, 2012

How Do You Cook A Frog?

Friday, I attended the Congress For Children here in San Antonio. This is an event that talks about issues impacting kids in Bexar County. We heard about the Pre-K for SA bill coming up in November that would add about $7.86 to the taxes for each family to provide free Pre K for the kids here. We heard about the impact of poverty on kids. We heard from some of our legislators on what was their main focus this session.  We heard a very small amount about the mental health of our kids. We heard a lot about nutrition, obesity, foster care and healthcare. Nothing was more impactful than a presentation done by Clarissa Zamora from Childsafe.
Clarissa followed suit with statistics. Everyone seems to think numbers are the key to getting people to make changes. But she also offered a personalization of the kids who are abused and tortured in Bexar County each year. The chair person for Voices for Children was emotionally destroyed by the video she showed. The numbers we all hear, 26 kids died in Bexar County from abuse and neglect, were suddenly real kids. They all had names and horrifying stories. They screamed for help. They screamed for their abuser to stop, promising anything. For those too tiny to be able to promise, they simply screamed until they no longer could.
26 kids died in Bexar County this year. 26 kids were murdered. If there had been a single gunman that had murdered 26 people in one day, the city would be relentless in bringing that person down. Things would be done to prevent that from ever happening again. We have seen it repeatedly all across the country and right here in river city.
But because we hear the stories one at a time, over and expanse of a year, we seldom hear an outcry of outrage.It is kind of like the old saying about boiling frogs. If you put a frog in boiling water, it will jump out. But if you put it in water and slowly raise the heat, it will sit there and cook to death.
We are the frogs. Child abuse is the water in the pot. The cases of adults hurting kids is the heat. The heat is being turned up and we are still sitting. We hear the stories and think "how sad and tragic".

We can create free pre-k, free health care and great schools for our kids. Unless we can protect them from those who are supposed to protect them and teach them, all is lost.

We can judge any society by the way it treats it's kids and it's animals. We fail on both counts.
However society treats it's kids is how they will treat society when they are in charge.

From this perspective it looks like our priorities are in the wrong place. Stop asking for funds to build new sports arenas and convention centers and school programs. Lets start asking for money to protect our kids.

Friday, July 20, 2012

Prevention of Self Injury

Recently, at an advisory board meeting at a behavioral health hospital, a participant recounted her experience involving seeking treatment for self injury. The story left the members of the board shocked. She stated she had received treatment via the emergency department was humiliating and the medical professionals were cold and hostile. One instance included an emergency physician suturing her arm without benefit of anesthesia.
To those of us who work in behavioral health, this is not surprising. In this setting nurses often sue restraints and continuous staff monitoring to manage the severity of the self injury. This puts the staff in control, are the most restrictive in nature and place a huge financial burden on the facility, which can result in negative feelings from both the staff and the patients.
To understand this issue it is important to know individuals who struggle with self injury have difficulty managing their lives and use this behavior as a way to cope with stressors. Over 50% of self injurers have a history of abuse, neglect, or chaotic family lifestyles. They generally range in age from 13-30 but can be seen in children as young as 6. Adolescence is usually the prime time for emergence of self injury as a coping skill. The highest age range shown to experience self injury on a routine basis is between 18 and 24 years old. The primary reason for self injury is for emotional release, with combating dissociation a close second. Additionally, avoidance of suicidal impulses, for distraction and to gain a sense of control were also reported.
Treatment for self injury can include family and individual therapy, group work, and medical attention to any wounds to avoid infection and scarring.
The practice of continuous monitoring by staff can costs hundreds of thousands of dollars over time. Approximately 10% of psychiatric patients are using self injury at some point in their illness. Over time this adds up. In an effort to change how self injury is treated and regarded a study was conducted in the northwest involving consultation with experts in the field and a focus group. The program that emerged included a training effort to increase staff understanding and empathy for people who self injure. Additionally it is vital that staff evaluate each other as frustrations can mount over time. At no time should financial considerations take precedent over quality patient care and the well being of the patients we serve. The addition of sensory tools to the treatment protocol is important. Weighted blankets, stress balls, sand,clay music,etc can help the patients use other methods to self soothe. Sensory tools are very effective in addition to impulse control logs, skill cards and educational materials. Information  for parents in a format that is easily understood is vital. The biggest part of any successful self injury protocol is the staff. They must be engaged and passionate about the impact their interactions can have for their patients. A caring accessible staff that checks in periodically just to see how your day is going adds a sense of security  while allowing the patient freedom and choice.
Self injury is a coping skill used by many people with a multitude of psychiatric issues. It is nothing more than a way to cope, just like running, smoking or drinking. It just happens to leave lasting scars. It also horrifies people who do not understand the pain the person is carrying with them. Perhaps if more programs like this are accessible to people across the country, self injury will be regarded as a valid psychiatric issues that responds well to treatment. We can then add it to the growing list of psychiatric illnesses that can be managed with continued appropriate care.