Category Archives: suicide

What to know about psychiatric residential treatment

What to know about psychiatric residential treatment
3 votes

residential centerHave you been searching for psychiatric residential treatment for your child?  Do all the programs sound wonderful?  Ads include quotes from happy parents, and lovely photos and fabulous-sounding activities.  But what’s behind the ads?  Residential treatment programs are diverse, but there are important elements they should all have.  Here’s how to avoid low quality residential treatment.

Psychiatric residential treatment is serious stuff–it’s difficult to do–especially when troubled children and teens are put together in one facility.

Should you ask other parents for their opinion of a program?  In my experience with a child in psychiatric residential care, and as a former employee of one, word-of-mouth is not the best way to assess quality or success rate.  There are too many variables: children’s disorders are different; acuity is different; parents’ attitudes and expectations are different; length of time in the facility is different; what happens once a child returns home is different…  It’s most helpful to ask questions of intake staff and doctors or psychologists on staff.  Quality psychiatric residential care facilities have important things in common.

What to ask about the staff:

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  • What is the training and licensure of staff?  Are there therapists with MSW degrees, registered nurses, psychiatrists and psychiatric nurse practitioners, and is a medical professional available on site 24/7?
  • There should be a high staff to patient ratio, and a physically comfortable environment with lots of emotional support.
  • Do the staff seem mature to you?  Do they support each other, are they a team?  There is often heavy staff turnover at residential treatment centers because the work is emotionally draining, so staff cohesion is as important as the qualities of each individual.
  • Safety is paramount.  Staff must be able to safely manage the things that can go wrong with troubled kids.  They should be trained in NCI (Nonviolent Crisis Intervention), “training that focuses on prevention and offers proven strategies for safely defusing anxious, hostile, or violent behavior at the earliest possible stage.”

What to ask about programs:

  • Does the program specifically identify parent/family involvement as part of treatment?  Does it emphasize parent partnership with staff?  Ask.  Whether you live close or far from the center, even out-of-state, you should be regularly included in conversations with staff about your child’s treatment.  You should also be included in a therapy session with your child periodically; some facilities can connect with you over Skype.  Your child’s success in psychiatric care depends on their family’s direct involvement.
  • The program should coach you in specific parenting approaches that work for child’s behavioral needs.  While your child is learning new things and working on their own changes, you must also.
  • You should be informed why your child is getting the treatment or behavioral modifications he/she is receiving.

Body health is mind health, and vice versa.

  • residential programsMental health treatment will include medication and therapy, but must also include positive activities and an educational program.  The whole body needs care:  exercise, social activities, therapeutic activities (art, music, gardening), healthy food, restful sleep, etc.

Is your child emotionally safe as well as physically safe?

  • You should be able to visit the unit or cottage where your child will live, see their bedroom, and see how the other children interact with staff and how staff interact with each other.

What to ask about the business itself:

  • Can you take a tour ahead of time?  Can your child or teen visit too if appropriate?
  • Are emergency services nearby (hospital, law enforcement) that can arrive quickly?
  • Does the facility have a business license in their state?  Do they have grievance procedures?  Is the center accredited as a treatment facility, and by whom?  In the U.S., the main accreditation authority is called JCAHO (Joint Commission on Accreditation of Healthcare Organizations).

Psychiatric residential treatment works miracles, but it doesn’t work for all children.  Some need to go into treatment more than once to benefit. Some fall apart a few weeks or months after discharge.  These are common.  What’s important is that you and your child are taught skills for managing his or her unique symptoms, communicating well, and committing to staying well together.

Good luck.

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Filed under autism, bipolar disorder, borderline personality disorder, borderline personality disorder, cutting, depression, mental illness, mental illness, oppositional defiant disorder, parenting, psychiatry, PTSD, schizoaffective disorder, schizoaffective disorder, schizophrenia, suicide, teenagers, therapy, troubled children, troubled children

Helping your troubled teen after they turn 18

Helping your troubled teen after they turn 18
3 votes

Most young people aren’t ready for adulthood by 18 years of age, but your troubled teen is especially unprepared. By 18, their legal status instantly changes to “adult” and they are free to fail at life’s countless tests. Your hands are tied and you can’t keep your son or daughter safe from themselves any more.

Pace yourself for a marathon

Your job as parent is far from over.  Not surprisingly, parenting an 18+ year old will feel the same as when they were 17 years 11 months old.  They’ve been behind their peers for a long time–emotionally or socially or academically. You’ve done everything possible to get them ready for adulthood, but they simply aren’t!  For troubled teens, the teen years last into the mid-20’s or longer. And this is really scary; suicide rates across all age groups are highest for people aged 16-24.  It’s the period of greatest stress, whether the person is suicidal or not.

Many people with disorders aren’t able to take full responsibility for themselves until their early 30’s.

Over the past 16 years, I’ve asked this question of people with mental health disorders, their parents and siblings and children, and their friends:  “At what age did (you, your loved one) make the conscious choice to take responsibility for themselves: treatment, income or job, living on their own, choosing to associate with healthy people. I asked dozens and dozens of people. Their answer? Every single one told me they or their loved one didn’t turn things around until they were between the ages of 29 – 34.

True story: a co-worker once shared about his bipolar disorder and his years of substance abuse and hardships. I would never had guessed this grounded stable person had a troubled past. I asked when he turned his life around; it was 30. I asked what motivated him.  His answer? “I couldn’t avoid it anymore. I ran out of excuses. I hit rock bottom too many times.”

The questions to ponder are how much to sacrifice and how much to let go.  There needs to be a balance.

Parents have a tendency to rescue their adult son or daughter when a crisis befalls because  it’s so hard for the child to recover from set-backs.  But rescuing too much makes them more dependent on the parents (or adult siblings).  Pressuring a troubled teen to be an “adult” when they are not ready may lead to their dependence on others who might make their lives worse.  Or they’ll cope with drugs or alcohol, or risky choices, or give up.

I know of a couple in their 70’s who’d rescued their troubled 34-year-old daughter her entire life, and faced cutting her off because they couldn’t manage anymore.  They were heartbroken to let her go, painfully afraid she would become homeless or suicidal, and deeply regretful they unwittingly undermined her capacity for independence.  Don’t let this happen to you.

The first challenge is deciding where they’ll live.

As with any troubled teen, they must become independent eventually.  It may be a tough call for you:  bear the stress if they live with you? or worry when they leave your protection, possibly forever?  Ironically, your adult child must be better than ‘normal’ young people at managing life because they have so much more to worry about.  Besides the usual adult responsibilities, add self-monitoring for mental and emotional stability, taking meds or obtaining therapy, and disciplining themselves to stick with dozens of choices that support their well-being (diet, exercise, healthy friendships, education or work, financial stability…).

If your troubled teen of 18 must live at home full or part-time, change your rules and expectations. Rules can include a requirement for ongoing mental health care. Your troubled teen must transition to becoming your guest who stays at your invitation and a renter who contributes to the household and follows the landlord’s rules.  You’ll need discipline to step back and respect their privacy and (reasonable) choices and activities.  This may not be easy to achieve–you’ll make many compromises.

In the eyes of the law, you are not responsible for them anymore.

You really aren’t.  In fact, you have the right to banish your 18-year-old from your home and change the locks on the doors.  The parents who do this are usually in fear for their physical and emotional safety–not because they don’t care.  If this describes you, it’s understandable and forgivable if you feel forced into this step.  But know this, things change.  Your adult child will change; banishment is not forever.

There’s good news. Adults have more options for support.

Ironically, your troubled teen, by 18, will have more access to services than ever, and you’ll both get the support you’ve desperately needed.

  • In the U.S., people with mental health problems are protected from job/housing/educational discrimination by laws that protect the disabled.
  • insurers are required to provide mental health care on par with all other treatments and services.
  • Mental health advocacy groups support adults by offering support groups, referrals to safe housing or appropriate job opportunities, social connections with safe accepting peers, and legal and legislative advocacy.
  • Educational institutions have special departments solely for supporting students with disabilities, and that includes troubled young adults.

This is what your troubled teen needs to function after 18, listed in order of value:

  1. A constant, supportive family (that sets boundaries and asserts high-as-possible expectations)
  2. Support from peers and mentors or counselors
  3. A job or continuing education
  4. Ongoing mental health care
  5. A safe living situation

Adjust your expectations for how quickly they’ll progress.

Parents with ‘normal’ 18 year olds gradually revise their relationship with them, becoming a mentor and peer rather than a parent.  You can’t do that yet; your challenge is to flow between the role of parent, disciplinarian, social worker, and therapist until they are ready.

You can do this.  Stay patient.  Keep a bridge built.  They’ll eventually grow up.

–Margaret

 

Please rate this post and comment.  Your thoughts and experiences will help others who read this article.

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Filed under adult, mental illness, parent rights, parenting, suicide, teenagers, teens, troubled children

Coping with grief when a child attempts (or completes) suicide

Coping with grief when a child attempts (or completes) suicide
3 votes

In the US military, the Purple Heart medal is awarded to a soldier who is wounded in battle, or who later dies of those wounds.

In the years of writing this blog, I have shared practical information on behavior and treatment, and offered encouragement and hope for parents.  But hope and information cannot soften the impact of this horrible statistic:  The mortality rates of teens with mental disorders are 3 to 4 times more deadly than most childhood cancers, and the statistics only measure those deaths by suicide:  Mental illness more deadly than cancer for teens, young adults.

Death by suicide seems especially tragic because it appears to be a choice, and while we tell ourselves that mental illness is the cause, it’s not the same as a car accident being the cause or a tumor being the cause.  Unsuccessful suicide attempts are no less traumatic, like a cancer that keeps returning, because you can’t come to terms with a “maybe.”  A parent is held hostage by the anticipation of loss, a relentless moment-by-moment fear that your child will attempt again in the future until they are successful.  It’s an emotional ride one’s subconscious never ever forgets, and it becomes your PTSD.  You can carry it quietly with you for decades, until a sneak attack, when you find yourself overreacting to a news story, a scene in a movie, or a conversation with a friend.

My PTSD ambushed me recently.  I was attending an evening class when suddenly a person next to me slammed down her cell phone, exclaimed “Oh my God!” and quickly grabbed up her things and dashed out.  I followed to check on her and see if I could help with something.  As she speed-walked to her car, she said her daughter had texted that she swallowed a poison because she was upset, but is now sorry and wants help.  I got back to the classroom in shock, trembling, and completely unable to focus.  It had been many years since I had received a similar message, but it felt like it had just happened again that moment.

You are not alone if you’ve ever secretly felt it would be a relief if your child ended their life, bringing peace to you both.  (And you wouldn’t be a bad parent, either)

But death is more than self-inflicted suicide.  You face a death of hope when child with a serious mental disorder that takes a long slow trajectory through addictions, high risk behaviors, and unstable reactions to life’s many insults.  Families like ours bear witness but can’t intervene, or interventions don’t work.  All we can do is wait and hope and do what we can for our child, day by day, and banish thoughts of a different future.  I consoled myself with the knowledge that my child was getting by, and getting by was enough.

Another type of death caregivers face is the loss of their child’s “self” as they knew it, and their future as they imagined it.  A mentally ill child or teen can morph from a fresh young person in a world that is wide open to them, to a scary being we don’t recognize as our own and cannot understand–a stranger, a changeling, a flame snuffed out too soon.  It should not be this way.  It is unfair.  It is a tragedy.  You start healing the grief when you are able to make the commitment to do the best you can anyway.  YOU HAVE EARNED YOUR PURPLE HEART.

Any serious medical condition can devastate and traumatize a child’s family, but those with mental disorders impose a complicated trauma that’s hardly possible to resolve.  The following stories are actual examples.  Ask yourself:  how does one be a loving responsible parent in these situations?

–  When her daughter attempted suicide, an overwhelmed single mother discovered that her son had been sexually abusing and cutting her for 3 years, right under her nose.  The guilt she felt was quadrupled by the guilt laid on her by others.  She didn’t know how to go forward as a mother from here, after loving but failing both children.

–  A teen girl attempted to hang herself in a very public place, and many found out about it before her parents.  Their first trauma was the call from the emergency room, their second was from the shower of doubt others laid on them:  Where were you?  Why didn’t you help her before it got this far?  What did you do to drive her to this?  And it was unending.  The daughter threw these doubts back at her parents repeatedly.  There were several inappropriate people in the community who wanted to “rescue” the daughter, including a teacher, but undermined the parents’ authority completely, and their ability to get treatment for the girl.

–  One couple devoted themselves to raising a difficult boy they adopted when he was 2.  At 9, after years of problems, he sexually assaulted a playmate, and they found themselves disgusted and repulsed.  The brokenhearted mother said she had long ago accepted that her boy would never be normal, but this was different.  She didn’t want him anymore.  (I’ve heard parents talk half-jokingly about taking their offspring to Nebraska. *)

You are not alone if you’ve ever secretly wanted your child to be taken away to never live with you again. You are not alone if you feel you’re DONE.  (And you would not be a bad parent for thinking this.)

Consciously keep the good things alive.  Display photos of the real child you know or knew, the one without the brain problems.  Keep their writing or artwork or tests scored A+.  Other parents experiencing a loss do this, whether the losses are from death by disease, or death of self due to brain damage from an accident.  Speak often of the good things they were or are, as any proud parent might, keep the memories alive.

Get out of your trance and take yourself back to here and now.  When you notice yourself caught up in a train of thought and obsessing on your fear or paranoia, get back in the room—get back to driving that car or attending that meeting or straightening the house.  Get back to noticing the people you love, get back to making those helpful plans.  Central to the philosophy of dialectical behavioral therapy (DBT) is the concept of “Mindfulness.”

Remember this wisdom: take one day at a time.  You can handle one day, you can keep cool, do what must be done, feel accomplishment, in one day. Don’t think farther ahead.  Since you are the linchpin, the one holding up the world, you probably don’t have the luxury of taking a break, and may have to hold things together until there is time for your own healing.  The one-day-at-a-time approach is imperative.

When you’re leg is broken, you need a crutch.  When you’re heart and mind are broken, use the “crutch” of a medication for depression, anxiety, or sleep.  Do other healing things for yourself, whether exercise or therapy or asking for comfort from friends.  Acknowledge your wounds and admit this is too much handle.  You have earned your scars from bravery, so wear them as the badges of a hero.

A tragic event does not mean a tragic life.  I know a mother whose son completed suicide as a young adult in his 20’s.  She seemed remarkably cheerful and at peace with this.  She spoke lovingly of him often, and her email address comprised his birth date.  She continually did her grief work, was active in a suicide bereavement group, and often offered to visit with families facing such a loss.

— Margaret

How am I doing?  Please rate this article at the top, thanks.

*  In the United States, in 2008, the state of Nebraska enacted a “Safe Haven” law to reduce the tragedy of infant child abuse and neglect.  The law allowed anyone to anonymously leave a child at a hospital with the promise that child would be cared for.  But something unexpected happened.  Parents from around the nation drove hundreds and hundreds of miles to leave their troubled older children instead.  Nebraskans eventually amended the law with strict age limits for infants only.

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Filed under Grief, mental illness, mental illness, parenting, PTSD, suicide

Brace yourself for borderlines

Brace yourself for borderlines
15 votes

Are you ready to bang your head on a wall?  Do you want to abandon your child in the wilderness?  Are you praying for the day they turn 18, when you can change the locks on your doors?  Children with borderline personality disorder (BPD) bring out the worst in everyone around them.

A borderline child or teen is not a “drama junkie” on purpose.  There brain is primed to overreact.

Yes, BPD kids really believe that others are out to get them, and that all their problems are someone else’s fault.  They are appalled that others mistreat them horribly.  They are insulted and defensive when they detect criticism, even when there isn’t any.  They can never be pleased, and it’s always about them.  Most exasperating for you, they turn from monstrous, to sweet and charming, and back to monstrous in an instant.

“Does this explain why I can go from 0 to 60 in two seconds?”
–17-year-old girl when told she was diagnosed with borderline personality disorder

Especially confusing, a borderline teen can be very engaging and affectionate… sometimes at random, and sometimes when they want something.  They will also turn on the charm to embarrass you in front of others (such as in family therapy).  Since they seem so wonderful to other people, you are asked why you get upset at your clearly wonderful child.  People often recommend that you take care of your own issues instead.

Even though their manipulation and upheaval is relentless, strive for compassion.  Trust me, your borderline child will suffer more than you in every important aspect of life.  They make a mess of their relationships because of their anger, instability, substance abuse.  Their clingy behavior is annoying.  They drive away good friends, hate them for leaving, and then suffer from loneliness and depression.  They make a mess of their jobs, often fired or forced to resign, and bounce from one to another… and they don’t understand why it happens to them.

For goodness sakes, why?

When playing a game that requires teamwork, the brain of a normal person shows activity in the bilateral anterior insula.

 

The brain of a borderline person, when playing the teamwork game, showed no activity whatsoever.

A study published in 2008 in Science showed that brain activity in people with borderline personality disorder was abnormal—their brains lack activity in the ‘cooperation’ and ‘trust’ regions, called the bilateral anterior insula.  Borderline personality patients do not have an internal, natural sense of fairness and social norms, and little to no level of trust.

Statistics

One research study reported that borderline personality disorder occurs as often in men and women, and sufferers often also have other mental illnesses or substance abuse problems.  (In my personal observations over many years, teenagers with borderline personality disorder are often diagnosed with bipolar disorder.) Another study reported, “The disorder occurs in all races, is prevalent in females (female-to-male ratios as high as 4:1), and typically presents by late adolescence.”  It is estimated 1.4 percent of adults in the United States have this disorder.

In infants:  the children who were later diagnosed with borderline personality were more sensitive, had excessive separation anxiety and were moodier. They had social delays in preschool and many more interpersonal issues in grade school, such as few friends and more conflicts with peers and authorities.

In teenagers:  they are more promiscuous, aggressive and impulsive, and more likely to use drugs and alcohol. Cutting and suicide are more common.  “…research shows that, by their 20s, people with the disorder are almost five times more likely to be hospitalized for suicidal behavior compared to people with major depression.”

 

Evidence for hope

“Trying to Weather the Storm” (excerpt)
Shari Roan, September 07, 2009, Los Angeles Times

“Borderlines have the thinnest skin, the shortest fuses and take the hardest knocks.  In psychiatrists’ offices, they have long been viewed as among the most challenging patients to treat.

“But almost 20 years after the designation of borderline personality disorder, understanding and hope have surfaced for people with the condition and their families.  Advances have been made in recent years.  Researchers from McLean Hospital in Massachusetts studied 290 hospitalized patients with the condition over a 10 year period:  93 percent of patients achieved a remission of symptoms lasting at least two years, and 86 percent for at least four years. Published in The American Journal of Psychiatry, the research argues that once recovery has been attained, it appears to last.

“Having a relative with BPD can be hell,” says Perry D. Hoffman, president of the National Education Alliance for BPD http://www.borderlinepersonalitydisorder.com.  “But our message to families is to please stay the course with your (child) because it’s crucial to their well-being.”

Treatment

“What Therapy Is Recommended for Borderline Personality Disorder in Adolescents (13-17 years)?”(excerpt)
Mary E. Muscari, PhD, August 9, 2005, http://www.medscape.com/viewarticle/508832

Psychotherapy is the primary treatment of BPD, specifically long-term dialectical behavior therapy (DBT), which helps the person attain and maintain lasting improvement in their personality, interpersonal problems, and overall functioning.  DBT appears to be the most effective.  It focuses on coping skills, so patients learn to better control their emotions and behaviors. This may be complemented with medications that help with mood stability, impulsivity, psychotic-like symptoms, and self-destructive behavior.

There are several appropriate therapies in addition to DBT, and all share common elements:  1. The bond between the patient and therapist is strong.  2. Therapy focuses on the present rather than the past, on changing one’s behavior patterns now regardless of how patients feel about the past or if they see themselves as victims.

On DBT:  I recommend this straightforward self-help lesson to get started learning the concepts and skills:  http://www.dbtselfhelp.com/html/dbt_lessons.html.

When to hospitalize

  • In an emergency – when your child has serious suicidal thoughts or an attempt, and/or is in imminent danger to others.
  • In long-term residential care – when your child has persistent suicidal thoughts, is unable to participate in therapy, has a life-threatening mental disorder (e.g. bipolar), continued risk of violent behavior, and other severe symptoms that interfere with living.

Other treatment a borderline may need:

  • Treatment for substance abuse.
  • Therapy that focuses on violent and antisocial behaviors, which can include emotional abuse or physical abuse, baiting, bullying, and sexualized behaviors.
  • Therapy that focuses on trauma and post traumatic issues when an adolescent loses their sense of reality.
  • Reduce stressors in the young person’s environment.  Most adolescents with BPD are very sensitive to difficult circumstances, for examples: an emotionally stressful atmosphere at home; teasing in school; pressures to succeed or change; consistent rules; being around others who are doing better than them, etc.

What parents and caregivers can do

With a partner or spouse:  Maintain a united front.  Communicate continually to stay on the same page when managing your child and setting limits.  Have each other’s back even if you’re not in full agreement.  Always take disagreements out of earshot of your child.  Any disagreement they hear will be used against you.

Maintain family balance.

Keep your energy in balance so you can maintain your family's foundation.  Too much spent on your child affects everything else your family needs to survive.

Keep your energy in balance so you can maintain your family’s foundation. Too much spent on your child affects everything else your family needs to survive.

 

Keep things relaxed.  If you need to set boundaries and apply pressure, do it only to maintain  appropriate behaviors and reminders for self-calming.  Let other things go.

Use praise proactively.  Borderlines crave attention and praise.  When they deserve it, pour it on thick.  And pour it on thick every single time they demonstrate good behavior and positive intention.  One can’t go too far.  When an argument or fight comes up, search your memory banks for the most recent praiseworthy thing they did or said, and bring it up and again express your gratitude and admiration.  This does two things:  it reinforces the positive;  and it redirects and ends a negative situation.

Become skilled in DBT and help your child stay in the here and now.  Keep up the reminders that enable them to stay in the moment, to take those extra few seconds to think things through before reacting.

  • Did your friend really intend to upset you?  It sounds like they were talking about something else.
  • The delay wasn’t planned just to make you mad, perhaps you were just frustrated by being asked to wait, and it was no one’s fault.
  • The tear in your jacket isn’t a catastrophe.  It is easily fixed and I can show you how.

Prevent dangerous risk taking – Teens with borderline personality are exceptionally impulsive and prone to risky behavior.  Consequently, parents should consider:

  • Tightly limiting cell phone use, email, texting, and access to social networking sites
  • Using technology to track their communications (this is legal), or disabling access during certain time periods
  • Reducing the amount of money and free time available
  • Searching their room (this is also legal)

A couple I know fully informed their borderline teen that all internet activity would be tracked, as well as cell phone calls.  The father also installed cameras in the home, at the front and back doors, in plain sight.  Nevertheless, his son continued with bullying and hurtful behavior towards siblings right in front of those cameras, and he would get caught and pay consequences repeatedly.  His persistence in the face of obvious monitoring became a great source of private amusement for his parents–humor really does provide relief.
–Margaret

Be patient – You are unlikely to receive the child’s respect, love, or thanks in the short-term.  It may take years.  But be reassured that your child will thank you for your firm guidance and limits once he or she matures to adulthood.

Other characteristics of BPD

Signs and symptoms of BPD may include significant fear of real or imagined abandonment; intense and unstable relationships that vacillate between extreme idealization and devaluation; markedly and persistently unstable self-image; significant and potentially self-damaging impulsivity (spending, sex, binge eating, gambling, substance abuse, and reckless driving); repeated suicidal behavior, gestures, or threats; self-mutilation (carving, burning, cutting, branding, picking and pulling at skin and hair, biting, and excessive tattooing and body piercing); persistent feelings of emptiness; inappropriate anger or trouble controlling anger; and temporary, stress-related severe dissociative symptoms or paranoid ideation.

  • Chronic depression: Depression results from ongoing feelings of abandonment.
  • Inability to be alone: Chronic fear of abandonment also leads to these adolescents having little tolerance for being alone. This results in a constant search for companionship, no matter how unsatisfying.
  • Clinging and distancing: Relationships tend to be disruptive due to the adolescents’ alternating clinging and distancing behaviors. When clinging, they may exhibit dependent, helpless, childlike behaviors. They over idealize he person they want to spend all their time with, constantly seeking that person out for reassurance. When they cannot be with their chosen person, they exhibit acting-out behaviors, such as temper tantrums and self-mutilation. Distancing is characterized by anger, hostility, and devaluation, usually arising from discomfort with closeness.
  • Splitting: Splitting arises from the adolescents’ inability to achieve object constancy and is the primary defense mechanism in BPD. They view all people, including themselves, as either all good or all bad.
  • Manipulation: Separation fears are so intense that these adolescents become masters of manipulation. They will do just about anything to achieve relief from their separation anxiety, but their most common ploy is to play one individual against another.
  • Self-destructive behaviors: The behaviors are typically manipulative gestures, but some acts can prove fatal. Suicide attempts are not uncommon yet usually happen in relatively safe scenarios, such as swallowing pills at home while reporting the deed to another person on the telephone.
  • Impulsivity: Poor impulse control can lead to substance abuse, binge eating, reckless driving, sexual promiscuity, excessive spending, or gambling. These behaviors can occur in response to real or perceived abandonment.

 

Drawn from:
Risk taking adolescents: When and how to intervene (excerpt)
David Husted, MD, Nathan Shapira, MD, PhD , 2004
University of Florida College of Medicine, Gainesville

– – – – – – – – – –

How am I doing?  Please rate this article at the top, thanks!

–Margaret

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Filed under bipolar disorder, borderline personality disorder, Bullying, cutting, suicide, teenagers

Bullies, like their victims, are also at risk.

Bullies, like their victims, are also at risk.
1 votes

It’s easy to understand what it’s like to be a victim, but don’t be surprised if your understanding of bully behavior is off base.  There are many myths about who bullies are and what makes them behave the way they do.

Profile of a young bully:  this is a child or teen with a positive self-image, strong self-esteem, and little anxiety.  They are driven by a desire to be in control and they cherish power.  They also have little empathy for their victims, and appear to derive satisfaction from inflicting physical or psychological suffering on others.  A bully will defend his or her actions by blaming the victim, saying that their victims provoked them.  A bully may also have poor self-control, and be depressed or stressed in some way.  They have difficulty making friends.  It’s not black and white however–victims can become bullies–any child, boy or girl, can be a bully or be bullied if the circumstances are right

If you and your child have been a bullying victim, you may hope bullies get their just desserts.  Well, they do.

Without intervention, bullying can lead to serious academic, social, emotional and legal difficulties, which can continue into adulthood.  Bullies are even at higher risk of suicide.(see the research studies at the end of this article).

What if your child is the bully?

Think about it.  Your child may be strong and motivated, they’re active, and yet they get into trouble a lot.  They complain how others make them mad or pick on them, and yet they don’t appear to have the fears and anxieties that their victims have.  If a teacher or parent tells you that your child is a bully, it can be huge shock, and your first reaction might be to defend your child.  Perhaps you can’t imagine the child you love is hurting others, or perhaps you’ve even encouraged your child to defend themselves against others.

If it’s hard to accept, take a moment and step back and think things through.  It may not be your fault, but as a parent, you have a responsibility to both your child and to their classmates (and their parents) to intervene to stop the behavior, and make it clear that bullying is not acceptable, and that it will not be tolerated or ignored.

What parents of bullies can do

Find out if anything is bothering your child and aggravating their internal nature to act out against others.  Is there something making them feel insecure or unhappy?  Are they being ignored at home?  Picked on?  Are there other family troubles they can’t cope with?  Ask them.  Then ask yourself two important questions:

  1. What can you and your family do to reduce stress in your child’s life;
  2. What values do you want your child to learn from you, such as respect for others and empathy for others’ feelings.

Maintain an atmosphere of love and calmness at home.  Don’t allow older siblings to tease a younger child, and don’t allow destructive criticism.  Work toward an ideal home environment that is a “haven of love” for all the family.  Yes, a haven of love, that’s what it says.

Have a plan before you talk with your child, and prepare to have an open conversation and to listen closely to your own child’s point of view.  Your job is to design some disciplinary action that fits the context of your lives.

Make it very clear that bullying and aggression will not be tolerated, and spell out the consequences for all bullying behavior.  It is important to be completely consistent so that the child understands exactly what will happen if he or she repeats this behavior.

Consequences could include the loss of privileges, and especially freedoms that allow them to bully others.  For example:  if your child is allowed out to play in the evening, and is bullying other children at this time, keep them indoors for a day or a week depending on how serious the behavior is or the age of the child.  Whatever you decide on, make it extremely clear and consistent.

Next, teach your child or teen different responses to things that make them aggress against others.  They probably don’t have social skills, or options, for handling situations that make him or her upset or angry.  Some examples:  avoid kids that irritate them, or “storm out” of a situation that’s escalating instead of fighting, or write down insults and keep them hidden instead of speaking them aloud, leave a situation and get physical exercise…

Then teach your child empathy, which can be learned.  Say to them: “All people deserve respect even if you don’t like them,”  “All people have value and feelings”, “All people are different, and they don’t have to be like you or act the way you want them to.”  Remind them of others who show kindness and respect to them.  If your child can be trusted, taking care of a pet is a good way to help him or her develop the skill of empathy.

Praise and positive reinforcement are actually crucial.  Catch your child being good and offer praise as immediately as possible.  Being “good” might be about being kind, but it might also be about avoiding confrontation even if they get angry or aggressive in their thoughts but not their actions.

Allow your child or teen to earn rewards and privileges.  For a child, keep track with a calendar and stickers so that you and your child can measure each positive behavior, and then celebrate and reward it accordingly.

Let the school know what you are doing to work with your child, and ask for staff help and ideas for consistent consequences at school.  Let other parents know as well.

If bullying or other aggressive behaviors persist even after working with your child or teen, seriously consider professional mental health treatment.

Some statistics on risks to bullies

One study showed that 60% of boys who were identified as bullies in grades 6 through 9 had at least one criminal conviction by age 24 years, and between 35% and 40% of these children had three or more criminal convictions by that same age.

Much bullying occurs in schools.  Dr. Joyce Nolan Harrison, assistant professor of psychiatry at the Johns Hopkins School of Medicine said, “Studies show [bullying is] particularly common in grades 6 through 10, when as many as 30% of students report they’ve had moderate or frequent involvement in bullying,” she says.

According to international studies, bullying is common and it affects from 9% to 54% of all children.  In the United States, many believe bullying can push victims to acts of violence, such as the Columbine High School massacre.

Children with attention deficit hyperactivity disorder are almost 4 times as likely as others to be bullies.  And, in an intriguing corollary, the children with ADHD symptoms were almost 10 times as likely as others to have been regular targets of bullies prior to the onset of those symptoms, according to the report in the February 2008 issue of the Journal Developmental Medicine & Child Neurology.

If you are the parent of a victim

If schools don’t have the resources to deal with bullying, parents need to take matters into their own hands.  Enlist the help of all the other parents of bullied children.  “Parents have to work as a group,” explains Dr. William Pollack, professor psychiatry at Harvard Medical School.  “One parent is a pain in the [butt].  A group of parents can be an educational experience for school authorities.”

One thing you shouldn’t do, Pollack says, is call up the bully’s parents.  “You have no idea of what is going on in that kid’s home,” he says.  “He may get hell for bullying your kid — or he may be told to keep it up.”

Armor your child by describing ways they can protect themselves.  Avoid the places where bullying happens (bathroom, lunch, playground) or always bring a friend.

Help the bullied kids find each other.  “If there are a bunch of them together, they can stand the bully down,” Dr. William Pollack says.  “They don’t have to beat the bully up.  They just have to say, ‘Why are you treating my friend this way?’  The bully will often move on.”

Inform teachers and school staff in writing of your concern, or volunteer in your child’s classroom(s).

– – – – –

Bullying and suicide. A review.  (excerpt)
Authors: Kim, Y.S.; Leventhal, B. International Journal of Adolescent Medical Health; pp: 133-54;  Vol(Issue): 20(2), 2008

Researchers at Yale School of Medicine believe they’ve found a connection between bullying, being bullied, and suicide in children.  Bullying, the most common type of school violence, has been frequently associated with a broad spectrum of behavioral, emotional, and social problems.  This paper provides a systematic review of 37 studies, from 13 countries, that were conducted in children and adolescents, and that examined the association between bullying experiences and suicide, with an emphasis on the strengths and limitations of the study designs.  (Suicide is third leading cause of mortality in children and adolescents in the United States of America and around the world.)  Despite methodological and other differences and limitations, it is increasingly clear that any participation in bullying increases the risk of suicidal ideations and/or behaviors in a broad spectrum of youth.

Not just the victims were in danger: “The perpetrators who are the bullies also have an increased risk for suicidal behaviors,” said lead author, Dr. Y.S. Kim.

Many adults scoff at bullying and say, “Oh, that’s what happens when kids are growing up,” according to Kim, who argues that bullying is serious and causes major problems for children, and that it should be taken seriously and addressed.

Email: young-shin.kim@yale.edu

– – – – –

Kids with ADHD more likely to bully  (excerpt)
By Linda Carroll, MSNBC contributor Jan. 29, 2008 URL: http://www.msnbc.msn.com/id/22813400/

For one year, a study followed 577 children in the 4th grade, in a community near Stockholm.  The researchers interviewed parents, teachers and children to determine which kids were likely to have ADHD.  Children showing signs of the disorder were then seen by a child neurologist for diagnosis.  The researchers also asked the kids about bullying.

“The results underscore the importance of observing how kids with ADHD symptoms interact with their peers,” says study co-author Dr. Anders Hjern, a professor in pediatric epidemiology at the University of Uppsala in Stockholm.  These kids might be making life miserable for their fellow students.  Or it might turn out that the attention problems they’re exhibiting could be related to the stress of being bullied.

“You can’t learn if you’re being bullied, if every day you’re frightened of how you’re going to be treated,” says William Pollack, an assistant clinical professor of psychiatry at Harvard Medical School.

As for the bullies, they often need help with other issues, Pollack says.  “It’s not uncommon, for instance, to find that the aggressor is acting out because he’s depressed.  And often, the kids who are doing the bullying have been bullied themselves,” he adds.

Unfortunately though, treating ADHD won’t remedy bullying because “drugs for the condition impact a child’s ability to focus in school but not the aggression that could lead to bullying,” says Kazdin, a professor of psychology and child psychiatry and director of the Parenting Center and Child Conduct Clinic at Yale University, and president of the American Psychological Association.

Bullying happens most at school.  The best solution for bullying is for schools to develop programs that help both the bullies and the bullied, experts say.

– – – – –

Hyperactive Girls Face Problems As Adults, Study Shows (excerpt)
by Nathalie Fontaine, René Carbonneau, Edward Barker, Frank Vitaro, Martine Hébert, Sylvana Côté, Daniel Nagin, Mark Zoccolillo and Richard Tremblay, March 2008, Journal Archives of General Psychiatry, and ScienceDaily (Mar. 20, 2008).

A 15-year longitudinal study found that girls with hyperactive behavior (restlessness, jumping up and down, a difficulty keeping still or fidgety), and girls exhibiting physical aggression (fighting, bullying, kicking, biting or hitting) were found to have a high risk of developing adjustment problems in adulthood.

Young girls who are hyperactive are more likely to get hooked on smoking, under-perform in school or jobs and gravitate towards mentally abusive relationships as adults, according to a joint study by researchers from the University de Montréal and the University College London (UCL).

The study followed 881 Canadian girls from the ages of six to 21 years to see how hyperactive or aggressive behavior in childhood could affect early adulthood.  The research team found that one in 10 girls monitored showed high levels of hyperactive behavior.  Another one in ten girls showed both high levels of hyperactive and physically aggressive behavior.

According to UCL lead researcher, Dr. Nathalie Fontaine.  “This study shows that hyperactivity combined with aggressive behavior in girls as young as six years old may lead to greater problems with abusive relationships, lack of job prospects and teenage pregnancies.”

“Our study suggests that girls with chronic hyperactivity and physical aggression in childhood should be targeted by intensive prevention programs in elementary school…  Programmers targeting only physical aggression may be missing a significant proportion of at-risk girls.  In fact, our results suggest that targeting hyperactive behavior will include the vast majority of aggressive girls,” said Dr. Fontaine.

“We found that about 25 per cent of the girls with behavioral problems in childhood did not have adjustment problems in adulthood, although more than a quarter developed at least three adjustment problems,” researcher Richard Tremblay said, noting additional research is needed into related social aggression such as rumor spreading, peer group exclusion.  “We need to find what triggers aggression and how to prevent such behavioral problems.”

– – – – –

Bullying and Suicide
Psychiatric Times. Vol. 28 No. 2   February 10, 2011

Childhood and adolescent bullying is recognized as a major public health problem in the Western world, and it appears to be associated with suicidality. Recently, cyberbullying has become an increasing public concern in light of recent cases associated with youth suicides that have been reported in the mass media.  Victims of bullying consistently exhibit more depressive symptoms than nonvictims; they have high levels of suicidal ideation and are more likely to attempt suicide than nonvictims.  Studies show that bullying behavior in youth is associated with depression, suicidal ideation, and suicide attempts. These associations have been found in elementary school, middle school, and high school students. Moreover, victims of bullying consistently exhibit more depressive symptoms than nonvictims; they have high levels of suicidal ideation and are more likely to attempt suicide than nonvictims.

The results pertaining to bullies are less consistent. Some studies show an association with depression, while others do not. The prevalence of suicidal ideation is higher in bullies than in persons not involved in bullying behavior. Studies among middle school and high school students show an increased risk of suicidal behavior among bullies and victims. Both perpetrators and victims are at the highest risk for suicidal ideation and behavior.

 

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

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

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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RED ALERT – Crisis plans for troubled kids

RED ALERT – Crisis plans for troubled kids
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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 plan for when (not if) your troubled child has a mental health emergency that puts everyone or everything in danger?

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

 

Think of your family as crewmembers 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, just a little, 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?  Which room can someone run to 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.

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Spirituality and mental health, some research

Spirituality and mental health, some research
10 votes

 

Our “winter holidays” are of primarily religious origin and focus, so it seemed appropriate to look at the effect of religion and spirituality on mental health and well being.  Below are research results that show religion/spirituality improves adult and adolescent mental health, including recovery from mental crises and substance abuse, when it (and believers) carries the message 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 could be 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 for at least 30 years, and have consistently shown positive benefits that are statistically significant.  I’ve tried to simplify scanning through the lengthy studies and jargon by highlighting results and conclusions in red.

 

Enjoy,  Margaret

– – – – – – – – – –

 

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 thatfrequency 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 ninefold 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.

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/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/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).

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) reported83% 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.”

 

  • 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.

 

 

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

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

 

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 to help 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.” 

– – – – – – –

 

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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Mental illness more deadly than cancer for teens, young adults

Mental illness more deadly than cancer for teens, young adults
2 votes

Why isn’t everyone more upset?  A disease is killing our children and it’s worse than cancer and leukemia.  Why is pychiatric research 30-40 years behind cancer, as well as the development of pharmaceuticals and other treatment modalities?

We don’t get casseroles when our child is hospitalized for a mental health crisis

Out of curiosity, I did some research on child mortality rates from various causes, because I wanted to know how death from mental illnesses compared with other fatal illnesses of childhood and adolescence. The results were astonishing, unexpected, and disturbing.

Childhood Illness Age Range Annual Deaths per 100,000 Children
Cancers, leukemia: 5-14 yrs 2.6
Cancers, leukemia: 15-19 yrs 3.6
Childhood diabetes: Avg. 15 yrs 2.2
Anorexia: 15 – 24 years 6
Suicide ** 10 – 14 years 1.6
Suicide ** 15 – 19 years 9.5
Suicide ** 20 – 24 years 13.6

(The chart columns are in the order listed in the box, somehow I couldn’t get the right grays!)

* The starting point for the data on the medical illnesses was the website for the Center for Disease Control and Prevention www.cdcp.gov  in Atlanta; the starting point for the mental illnesses was the website for the National Institute for Mental Health, www.nimh.gov.

** The suicide data was from those with depression, bipolar disorder, schizophrenia, and psychotic disorders-unspecified.  (Suicide from other mental health causes, such as borderline personality disorder and co-morbid substance abuse, is also prevalent but I could not find data for young adults.)

This screams out for a changes in attitude, policy, and investment in children’s mental health treatment!  I had no idea that death rates from mental illness were 3 to 4 times higher than the feared cancers and leukemias.  It is imperative that young people with mental health issues receive aggressive and sensitive treatment as would be expected and demanded of medical doctors treating cancer.

The data was difficult to find, requiring searches in many different medical journals and numerous articles, as nothing like it was compiled in one place.  I chose to use the cancer, leukemia, and diabetes data because deaths from all other causes were insignificant by comparison.  The death rates for cancer and leukemia are averages for the different forms of each, and in the journals they were presented together.

I welcome additions or corrections of this data from any other sources, and encourage readers to investigate this for themselves.

 

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Filed under bipolar disorder, borderline personality disorder, depression, mental illness, mental illness, parenting, psychiatry, schizoaffective disorder, schizophrenia, suicide, teenagers