Category Archives: bipolar disorder

Troubled Teen Industry – Legislation to stop abuse in boarding schools and camps

Troubled Teen Industry – Legislation to stop abuse in boarding schools and camps
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There is good news about stopping abuses in the Troubled Teen Industry.  Today, February 11, 2009, a committee in the House of Representatives voted to present a bill, H.R. 911, to the House for a vote.  You may be interested in the remarks made by the committee chair below.

 

SEE MY PREVIOUS POST ON THIS SUBJECT FROM JAN 26, ’09:

with tips for how to check if a program is legitimate.

 

(excerpt)  Remarks of the Honorable George Miller Chairman, House Education and Labor Committee regarding the Stop Child Abuse in Residential Programs for Teens Act Wednesday, February 11, 2009.  H.R. 911

 

Today, our committee considered legislation to stop child abuse in residential programs for teenagers and ordered it reported to the House.  It builds on a two year investigation into the shocking abuse and neglect of teens at residential programs across the country.  The Government Accountability Office uncovered thousands of cases and allegations of child abuse in recent years at teen residential programs, including therapeutic boarding schools, boot camps, wilderness camps, and behavior modification facilities.  A number of these cases resulted in the death of a child. Our committee heard stories about program staff members forcing children:

 

–  to remain in so-called “stress” positions for hours at a time;

 

–  to undergo extreme physical exertion without adequate food, water, or rest;

 

–  to stand with bags over their heads and nooses around their necks in mock hangings;

 

–  and to eat foods to which they are allergic, even as they get sick.

 

Bob Bacon, whose son Aaron died after being deprived of adequate food and water at a wilderness therapy program, told this committee last year, “The stories of Aaron’s death and the others who have died, or survived the abuses of these programs, are chilling reminders of the dangers of absolute power, and point out the extremely high risks we take in allowing these programs to operate without strict regulation and oversight.”

 

We heard from parents of children who died preventable deaths at the hands of untrained, uncaring staff members.  We heard from adults who attended these programs as teens about the physical and emotional abuse they witnessed and suffered.  We also learned about the weak patchwork of regulations governing teen residential programs.

 

Parents often send their children to these programs when they feel they have exhausted their alternatives.  They trust that these programs and their staff will be able to help children straighten their lives out.  In far too many cases, however, the very people entrusted with the safety, health, and welfare of these children are the ones who violate that trust in some of the most horrific ways imaginable.  The GAO informed us about programs’ irresponsible operating practices that put kids at risk, and about the deceitful marketing practices that programs use to lure parents desperate for help for their kids.  We know that there are many programs and people around the country who are committed to helping improve the lives of young people and who do good work every day.  But unfortunately, it can be extremely difficult for parents to tell the good programs from the bad.

 

H.R. 911 requires the U.S. Department of Health and Human Services to establish minimum standards and to enforce those standards. Ultimately, however, states will be responsible for carrying out the work of this bill:

 

–   within three years, set standards and enforce them at all programs, both public and private.

–   standards will include prohibitions on the physical, sexual, and mental abuse of children.

–   …will require that programs provide children with adequate food, water and medical care.

–   …require that programs have plans in place to handle medical emergencies.

–   include new training requirements for program staff members, including training on how to identify and report child abuse.

–   set up a toll-free hotline for people to call to report abuse at these programs.

–   create a website with information about each program, so that parents can look to see if substantiated cases of abuse have occurred at a program that they are considering for their kids.

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Call 911 – Make a crisis plan for your troubled child

Call 911 – Make a crisis plan for your troubled child
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Don’t let your family become emotionally battered when your troubled child or teen goes through one crisis after another.  It’s the last thing your family needs—more stress and exhaustion!  Since your main job as a parent or caregiver is to reduce stress, you must manage the inevitable emergencies in a way that quickly settles down your family, as well as get help for your child.  Are you prepared to head off a crisis when you see one coming?  Does your family have a crisis plan for when (not if) your troubled child has a mental health emergency that puts everyone or everything in danger?

 

Never be afraid to call 911 when there’s a danger of harm. You will NOT be bothering them!

I got my crisis plan idea from the “red alert” scenes on Star Trek, when red lights flash and an alarm sounds, and crew members drop everything and run to their stations with clear instructions for protecting the ship.

 

Think of your family as crew members that pull together when someone sounds the Red Alert because your child is becoming dangerously out of control.  Each family member should know ahead of time what to do and have an assigned role, and each should know they will be backed up by the rest of the family.  This will be tremendously reassuring to everyone.  Together, you can manage through a crisis, reduce the dangers, and ensure everyone is cared for afterwards.

 

Have a crisis plan for the home, the workplace, and the school

…and start by asking questions.  Here are some examples:

 

o        Who goes out and physically searches for a runaway?  This person should be able to bring the child back to school or home without mutual endangerment, and they should know how to work with police or community members.

 

o        Who gets on the phone and calls key people for help?  Who do they call, the police or a neighbor or a relative?  Does your town or city have a crisis response team for kids?  Some do.

 

o        Who should be appointed to communicate with the child?  This should be a family member or friend that the child trusts more than the others.

 

o       Can a sibling leave to stay at someone else’s house until things cool down at home?  Which house?  An escape plan for a sibling can protect them and help them manage their own stress.

 

o       Who should step in and break up a fight?  And what specifically should they do or say each time to calm the situation?  Believe it or not, your troubled child can often tell you what works best and what makes things worse.  Listen to them.  It doesn’t have to sound rational to you if it works to calm them down quickly.

 

o       How should a time-out work?  Who counts to 10, or who can leave the house and go out for a walk?  Where can someone run to feel safe and be left alone for a while?

 

o       What should teachers or co-workers do to calm down a situation and get their classroom or office back to normal as quickly as possible? 

 

Experiences and evidence has shown that a rapid cooling down of emotions and rapid reduction of stress hormones in the brain supports resilience—the ability to bounce back in a tough situation.  Your entire family needs resilience, not just your troubled child.  A simple crisis plan makes all the difference.

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The Troubled Teen Industry – A warning about boarding schools and outdoor camps

The Troubled Teen Industry – A warning about boarding schools and outdoor camps
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This is a young adolescent, not an adult military recruit who’s there by choice.

There is a troubled teen industry out there—boarding schools, outdoor programs, and “boot camps” that are not licensed, not certified, and not experienced with youth with disorders.  Maybe you’ve seen the ads that promise to improve your teen’s behavior in the back of some magazines.  They promise that their program will “fix” your child.  They promise that your teen will learn important lessons about respect and about following your rules.  There are quotes from satisfied parents about how the program saved their teen’s life, but you can’t contact them.  The ads claim that staff are highly trained, strict, and caring.  The location is usually too far to check out easily, an airline flight away from home, often in a rural area.  The cost is outlandish.  To help with payment, the program provides financial advice to parents about getting loans and 2nd mortgages.

It’s a red flag if they >promise< to ‘fix’ your child.

You’re a desperate parent and you’ll do anything you can to stop the craziness and get a break.  You tell yourself it must be a nice place, especially if it advertises a religious approach*, even though you haven’t seen it in person.  The representative on the phone seems to know exactly how you feel and what your teen needs.  If you’re desperate, you may not think to ask if the organization is a legitimate behavioral health treatment facility.  Many are not!

*Claiming a religious affiliation is no guarantee of a genuine, effective faith-based program.

 What to ask:

 

What is the training and licensure of staff?  You want to know if they have therapists with MSW degrees, registered nurses, psychiatrists or doctors, and if a professional is available on site 24/7.  Mental health programs are about treatment and stability through medication or therapy, and positive activities with lots of emotional support.  Safety must be paramount.  Staff must be aware of the types of things that can go wrong and how crises should be handled.

 

Does the camp or school have a business license in their state?  Are staff licensed to practice behavioral health?  Do they have grievance procedures?

 

Is the camp or school accredited as a treatment facility, and by whom?  Does it have mental health agency oversight?  Are emergency services (hospital, law enforcement) a phone call away?  If your child’s mental health is a concern, read “What to know about psychiatric residential treatment.”

 

Can you call and talk to your child when you request?  Can you visit?  Can your child call you when they request it?  Some of these programs limit or disallow parental contact. Why? According to a testimonial at a children’s mental health conference, a young man was used as slave labor at a camp. The staff kept communicating to his mother that he was misbehaving, that he hated her and didn’t want to talk, and that they recommended he stay another 6 months.  In this way, they drew out his stay for 3 years.

 

Seriously? This makes troubled kids ‘tough?’ This isn’t appropriate for normal children.

I’ve heard personal testimony from parents and troubled young people whose condition was worsened by the camp or school, or who felt betrayed by their families.  On rare occasions, children have died at the hands of young, untrained staff who thought they were just disciplining the child.  Other stories included teens being offered drugs by staff or other campers, or sexual relationships with staff or campers.

 

Check out the article below.  The problems in the “troubled teen industry” are significant enough such that an advocacy group has formed to change state laws to protect youth.

 

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Unlicensed residential programs: The next challenge in protecting youth. –excerpt-

By Friedman, Robert M.; Pinto, Allison; Behar, Lenore; Bush, Nicki; Chirolla, Amberly; Epstein, Monica; Green, Amy; Hawkins, Pamela; Huff, Barbara; Huffine, Charles; Mohr, Wanda; Seltzer, Tammy; Vaughn, Christine; Whitehead, Kathryn; Young, Christina Kloker

It’s understandable if you’ve “had enough!” and want your child punished, but excessive punishment does not work.  (Text reads: “If I can’t make a kid puke or piss in his pants on his first day, I’m not doing my job.”)

American Journal of Orthopsychiatry. Vol 76(3), Jul 2006, 295-303.

 

According to this article, many private residential facilities are neither licensed as mental health programs nor accredited by respected national accrediting organizations.  The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) is a multi-disciplinary group of mental health professionals and advocates that formed in response to rising concerns about reports from youth, families, and journalists describing mistreatment in the unregulated programs.  There is a range of mistreatment and abuse experienced by youth and families, including harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions, medical and nutritional neglect, rights violations and death.

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Spirituality and mental health, some research

Spirituality and mental health, some research
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Scientists worldwide have been studying the effect of religion and spirituality on mental health and addiction recovery in children, teens, and adults.  Below are research findings that show religion and spirituality improve adult and adolescent mental health, including recovery from mental crises and substance abuse, when the spiritual approach carries messages of love, kindness, tolerance, and moral responsibility.  But when religion had a punitive or unforgiving message to those with mental or substance abuse disorders, the results were disheartening: a worsening of psychotic symptoms; inability to sustain recovery from substance abuse; and physical abuse.

If you look at the dates of some of these studies, you’ll see that researchers have been measuring of the value of spirituality for mental health and addiction for ~30 years, and results have consistently shown positive benefits which are statistically significant.  It’s hard core research–dense reading–so key findings and conclusions are in red in case you don’t want to scan through lengthy writing and jargon.

Enjoy,  Margaret

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God Imagery and Treatment Outcomes Examined
Currier JM, Foster JD, Abernathy AD, et al. God imagery and affective outcomes in a spiritually integrative inpatient program. [Published online ahead of print May 5, 2017]. Psychiatry Res. doi:10.1016/j.psychres.2017.05.003.

Patients’ ability to derive comfort from their religious faith and/or spirituality emerged as a salient mediating pathway between their God imagery at the start of treatment and positive affect at discharge, a recent study found. Drawing on a combination of qualitative and quantitative information with a religiously heterogeneous sample of 241 adults who completed a spiritually-integrative inpatient program over a 2-year period, researchers tested direct and indirect associations between imagery of how God views oneself, religious comforts and strains, and affective outcomes.

FINDINGS

When accounting for patients’ demographic and religious backgrounds, structural equation modeling results revealed:
(1) overall effects for God imagery at pre-treatment on post-treatment levels of both positive and negative affect;
(2) religious comforts and strains fully mediated these links.

Secondary analyses also revealed that patients generally experienced reductions in negative emotion in God imagery over the course of their admissions.

“[Spirituality] enables neurotic conflicts typical for adolescence to be more easily overcome.”

The influence of religious moral beliefs on adolescents’ mental stability.
Pajević I, Hasanović M, Delić A., : Psychiatry Danub. 2007 Sep;19(3):173-83

University Clinical Centre Tuzla, Trnovac b.b, 75 000 Tuzla, Bosnia & Herzegovina. zikjri@bih.net.ba.
This study included 240 mentally and physically healthy male and female adolescents attending a high school, who were divided into groups equalized by gender (male and female), age (younger 15, older 18 years); school achievement (very good, average student); behaviour (excellent, average); family structure (complete family with satisfactory family relations), and level of exposure to psycho-social stress (they were not exposed to specific traumatizing events).  Subjects were assessed with regard to the level of belief in some basic ethical principles that arise from religious moral values.

CONCLUSIONS: A higher index of religious moral beliefs in adolescents enables better control of impulses, providing better mental health stability.  It enables neurotic conflicts typical for adolescence to be more easily overcome.  It also causes healthier reactions to external stimuli.  A higher index of religious moral beliefs of young people provides a healthier and more efficient mechanism of anger control and aggression control.  It enables transformation of that psychical energy into neutral energy which supports the growth and development of personality, which is expressed through socially acceptable behaviour.  In this way, it helps growth, development and socialization of the personality, leading to the improvement in mental health.

Religion, Stress, and Mental Health in Adolescence: Findings from Add Health

Nooney, J. G. 2008-10-23 from http://www.allacademic.com/meta/p106431_index.html

 A growing body of multidisciplinary research documents the associations between religious involvement and mental health outcomes, yet the causal mechanisms linking them are not well understood.  Ellison and his colleagues (2001) tested the life stress paradigm linking religious involvement to adult well-being and distress.  This study looked at adolescents, a particularly understudied group in religious research.  Analysis of data from the National Longitudinal Study of Adolescent Health (Add Health) reveals that religious effects on adolescent mental health are complex.  While religious involvement did not appear to prevent the occurrence of stressors or buffer their impact, some support was found for the hypothesis that religion facilitates coping by enhancing social and psychological resources.

 

Study Links Religion and Mental Health

David H. Rosmarin and Kenneth Pargament, Bowling Green State University, Ohio

(IsraelNN.com) 2008

A series of research studies – known as the JPSYCH program – reveals that traditional religious beliefs and practices are protective against anxiety and depression among Jews.  The research indicates that frequency of prayer, synagogue attendance, and religious study, and positive beliefs about the Divine are associated with markedly decreased levels of anxiety and with higher levels of happiness.  “In this day and age, there is a lot to worry about,” Rosmarin notes, “and the practice of religion may help people to maintain equanimity and perspective.”

 

The Once-Forgotten Factor in Psychiatry: Research Findings on Religious Commitment and Mental Health (excerpt)

David B. Larson, M.D., M.S.P.H., Susan S. Larson, M.A.T., and Harold G. Koenig, M.D., M.H.Sc.

Psychiatric Times.  Vol. 17 No. 10, October 1, 2000

 

“The data from many of the studies conducted to date are both sufficiently robust and tantalizing to warrant continued and expanded clinical investigations.”

 

Treatment of Drug Abuse

  • The lack of religious/spiritual commitment stands out as a risk factor for drug abuse, according to past reviews of published studies.  Benson (1992) reviewed nearly 40 studies documenting that people with stronger religious commitment are less likely to become involved in substance abuse.
  • Gorsuch and Butler (1976) found that lack of religious commitment was a predictor of drug abuse.  The researchers wrote:  “Whenever religion is used in analysis, it predicts those who have not used an illicit drug regardless of whether the religious variable is defined in terms of membership, active participation, religious upbringing or the meaningfulness of religion as viewed by the person himself.”
  • Lorch and Hughes (1985), as cited by the National Institute for Healthcare Research (1999), surveyed almost 14,000 youths and found that the analysis of six measures of religious commitment and eight measures of substance abuse revealed religious commitment was linked with less drug abuse.  The measure of “importance of religion” was the best predictor in indicating lack of substance abuse.  The authors stated, “This implies that the controls operating here are deeply internalized values and norms rather than fear or peer pressure.”
  • Developing and drawing upon spiritual resources can also make a difference in improving drug treatment.  For instance, 45% of participants in a religious treatment program for opium addiction were still drug-free one year later, compared to only 5% of participants in a nonreligious public health service hospital treatment program-a nine-fold difference(Desmond and Maddux, 1981).
  • Confirming other studies showing reduced depression and substance abuse, a study of 1,900 female twins found significantly lower rates of major depression, smoking and alcohol abuse among those who were more religious (Kendler et al., 1997).  Since these twins had similar genetic makeup, the potential effects of nurture versus nature stood out more clearly.

“lack of religious commitment was a predictor of drug abuse”

Treatment of Alcohol Abuse

  • Religious/spiritual commitment predicts fewer problems with alcohol (Hardesty and Kirby, 1995).  People lacking a strong religious commitment are more at risk to abuse alcohol (Gartner et al., 1991).  Religious involvement tends to be low among people diagnosed for substance abuse treatment (Brizer, 1993).
  • A study of the religious lives of alcoholics found that 89% of alcoholics had lost interest in religion during their teen-age years, whereas 48% among the community control group had increased interest in religion, and 32% had remained unchanged (Larson and Wilson, 1980).
  • A relationship between religious or spiritual commitment and the non-use or moderate use of alcohol has been documented.  Amoateng and Bahr (1986) reported that, whether or not a religious tradition specifically proscribes alcohol use,those who are active in a religious group consumed substantially less alcohol than those who are not active.
  • Religion or spirituality is also often a strong force in recovery.  Alcoholics Anonymous (AA) invokes a Higher Power to help alcoholics recover from addiction.  Those who participate in AA are more likely to remain abstinent after inpatient or outpatient treatment(Montgomery et al., 1995).

“…adolescents [who were] frequent church-goers with high spiritual support had the lowest scores on the Beck Depression Inventory.”

Suicide Prevention – Surging suicide rates plague the United States, especially among adolescents.  One in seven deaths among those 15 to 19 years of age results from suicide.

  • One study of 525 adolescents found that religious commitment significantly reduced risk of suicide(Stein et al., 1992).
  • A study of adolescents found that frequent church-goers with high spiritual support had the lowest scores on the Beck Depression Inventory(Wright et al., 1993).  High school students of either gender who attended church infrequently and had low spiritual support had the highest rates of depression, often at clinically significant levels.
  • How significantly might religious commitment prevent suicide?  One early large-scale study found that people who did not attend church were four times more likely to kill themselves than were frequent church-goers (Comstock and Partridge, 1972).  Stack (1983) found rates of church attendance predicted suicide rates more effectively than any other evaluated factor, including unemployment.  He proposed several ways in which religion might help prevent suicide, including enhancing self-esteem through a belief that one is loved by God and improving moral accountability, which reduces the appeal of potentially self-destructive behavior.
  • Many psychiatric inpatients indicate that spiritual/religious beliefs and practices help them to cope. Lindgren and Coursey (1995) reported 83% of psychiatric patients felt that spiritual belief had a positive impact on their illness through the comfort it provided and the feelings of being cared for and not being alone it engendered.

Potential Harmful Effects – Psychiatry still needs more research and clearer hypotheses in differentiating between the supportive use of religion/spirituality in finding hope, meaning, and a sense of being valued and loved versus harmful beliefs that may manipulate or condemn.”

 

Read my article “Faith can help, & harm, a family’s mental health,” for potential harmful effects on families. –Margaret

  • Alcoholics often report negative experiences with religion and hold concepts of God that are punitive, rather than loving and forgiving(Gorsuch, 1993).
  • Bowman (1989).  In assessing multiple personality disorder, children in rigid religious families, whose harsh parenting practices border on abuse, harbor negative images of God.  Josephson (1993),Individual psychopathology is linked with families whose enmeshment, rigidity and emotional harshness were supported by enlisting spiritual precepts.
  • Sheehan and Kroll (1990).  Of 52 seriously mentally ill hospitalized patients diagnosed with major depression, schizophrenia, manic episode, personality disorder and anxiety disorder, almost one-fourth of them believed their sinful thoughts or acts may have contributed to the development of their illness.  Without the psychiatrist inquiring about potential religious concerns, these beliefs would remain unaddressed, potentially hindering treatment until discovered and resolved.  Collaboration with hospital chaplains or clergy may help in some of these instances of spiritual problems or distress.

Conclusion

Religious/spiritual commitment may enhance recovery from depression, serious mental or physical illness, and substance abuse; help curtail suicide; and reduce health risks.  More longitudinal research with better multidimensional measures will help further clarify the roles of these factors and whether they are beneficial or harmful.

–Margaret

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How to work with police once you’ve called 911.

How to work with police once you’ve called 911.
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Q: When is it time to call 911?  I’ve been told many times that I should call the police or mental health hotline when there’s a crisis, but how do I know when it’s a real crisis?


A:  If your child is doing something dangerous to him or herself, or others (including a pet), or property, and if you can’t manage it or stop it, call for help.  “Dangerous” means threatening, harmful, or abusive.  Emergency 911 dispatchers, police, and mental health crisis workers all encourage anyone to call, anytime.  You will not bother them.  I once visited a 911 facility and got a chance to ask to speak with the staff and this was their message.  They described the many ways they can respond when a child or teen “blows out,” runs, or becomes suicidal.


Once you call the police:

Advice from the Federation of Families for Children’s Mental Health (www.ffcmh.org).

  

1.   Remain as calm as you possibly can.

 

2.   Provide only facts as quickly and clearly as possible.

EXAMPLE:  I am calling from [address].  My 13 year old son is threatening to cut his sister.  He has [diagnosis] and may be off his medication and under the influence of alcohol.  There are 4 of us in the house: my mother, my son and daughter, and myself.

 

3.   Identify weapons in the vicinity or in your child’s possession and alert the dispatcher

 

4.   Be specific about what type of police assistance you are asking for.

EXAMPLE:  We want to protect ourselves and get my son to the emergency room for a psychiatric evaluation, but cannot do that by ourselves.  Please send help.

 

5.   Answer any questions the dispatcher asks.  Do not take offense when you are asked to repeat information.  This is done to double-check details and better assist you.

 

6.   Offer information to the dispatcher about how an officer can help your child calm down.

 

7.   Tell the dispatcher any addition information you can about what might cause you child’s behavior to become more dangerous—suggest actions the officer should avoid.

EXAMPLE:  Please don’t tell him to stand still.  He cannot hold his body still until he calms.  If you can get him to walk with you, he can listen and respond better.  He is terrified of being handcuffed.  Please tell him what he needs to do to avoid being handcuffed.

 

REMEMBER:  Your primary role in this situation is to be a good communicator.  Your ability to remain calm and provide factual details is critical the outcome of this situation.” 

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What is your local police force like?  Call the non-emergency line and check, ask questions about how police typically respond to situations where a child or teenager is diagnosed with a mental disorder and out of control.

 

In many parents’ experiences, including mine, the police were very helpful.  Others have had poor experiences.  Some said their child calmed down and appeared normal once the police arrived, and they felt the police assumed they were exaggerating.  Some said the police only aggravated the crisis, and in a very few cases, the encounter lead to tragedy.

In 2007, I attended the national conference of the Federation of Families in Washington DC, and learned from the President of the National Association of Chiefs of Police, Ronald C. Ruecker, that the NACP has made a commitment to promote police training in crisis response to children with mental disorders, including information about the disorders and their manifestations.

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