Category: schizoaffective disorder

Call 911 – Make a crisis plan for your troubled child

Call 911 – Make a crisis plan for your troubled child

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.

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

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

This is a troubled teen in a military-style camp, 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 ‘correct’ 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.”

 

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

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.

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.


 

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

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.

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

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

 

Q: Should I call 911?  I’ve been told 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.  “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.” 

– – – – – – –

 

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.

Support Your Child or Teen’s Recovery From a Disorder or Addiction

Support Your Child or Teen’s Recovery From a Disorder or Addiction

What recovery looks like – A person with a mental or emotional disorder who is in “recovery” lives a normal life and aren’t affected by their disorder.  They look and act normal.  At the very least, they have stable relationships, a steady job, a place to live, a regular diet, cleanliness, and regular mental health check-ins.  Recovery is maintained when the person pays attention to themselves and notices if their symptoms are starting, and then takes action to stop the symptoms.

Recovery is like the alcoholic who stops drinking–they still have an addiction, but they stop using.

What your child will need to sustain recovery as an adult:

INSIGHT  +  STABILITY  +  RESILIENCE

Insight – self awareness

Insight allows a child to recognize they have a problem, and choose to act to avoid the problem.  If insight is not possible, they need a toolbox of options that help them to respond appropriately, instead of reacting to chaotic messages in their brain. Knowing and admitting they have a problem, or knowing techniques for avoiding problems, are very powerful skills they need as adults.

Stability– fewer falls or softer falls

Your child is like a boat that’s easier to tip over than most other boats; any little wave will capsize them, and everyday life is full of waves, big and small.  Your job is to notice when the troubled child is starting to capsize and show them how to right the boat, or if that doesn’t work, how to use the lifesaver.  Eventually, your child will learn how to sense when trouble is coming on, avoid the thing that causes problems, and ask others for help.  Sense it.  Avoid it.  Ask for Help.

Resilience– bounce back when they fall

Troubled children have a much harder time bouncing back from problems.  They have extreme responses to simple disappointments like breaking a toy, or poor grades, or something as serious as the parents’ divorce.  Some even fall apart in joyous times because the emotional energy is too much!  You must be acutely aware of this–they will not get back on track by themselves.  Don’t worry that helping them will spoil them or “enable” them.  Eventually they will learn from you how you do it.

“…We are all born with an innate capacity for resilience, by which we are able to develop social competence, problem-solving skills, a critical consciousness, autonomy, and a sense of purpose.”

“Several research studies followed individuals over the course of a lifespan and consistently documented that between half and two-thirds of children growing up in families with mentally ill, alcoholic, abusive, or criminally involved parents, or in poverty-stricken or war-torn communities, do overcome the odds and turn a life trajectory of risk into one that manifests “resilience,” the term used to describe a set of qualities that foster a process of successful adaptation and transformation despite risk and adversity…”   http://www.athealth.com

Your troubled child’s recovery and how you help them achieve it

Your troubled child’s recovery and how you help them achieve it

What recovery looks like – A person with a mental or emotional disorder who is in “recovery” can look and act like anyone else.  They have:

  • stable relationships
  • a steady job or in school
  • a place to live
  • a proper diet
  • cleanliness
  • regular mental health check-ins.
Their mind is unstable. It’s like they stand on a beach ball that can topple them at any moment.

Recovery is maintained when your child can pay attention to themselves and notice if their symptoms are starting up, and then take action to stop the symptoms.  You teach them what to look for, and how to do a personal check-in.  It’s just as if they are monitoring any other problem in order to stay healthy such as: blood sugar, body temperature weight gain or loss, digestive system function (gut microbes).  In mental disorders, their signs and symptoms are not steady.  Anything can lead them from “OK” to “out of control” in an instant, and problems can last minutes to weeks to months.

What your child will need to sustain recovery as an adult:

INSIGHT  +  STABILITY  +  RESILIENCE

INSIGHT– self awareness

Insight allows a child to recognize they have a problem, and choose to act to avoid the problem.  If insight is not possible, they need a toolbox of options that help them to respond appropriately, instead of reacting to chaotic messages in their brain. Knowing and admitting they have a problem, or knowing techniques for avoiding problems, are very powerful skills they need as adults.

STABILITY – fewer falls or softer falls

Your child is like a boat that’s easier to tip over than most other boats; any little wave will capsize them, and everyday life is full of waves, big and small.  Your job is to notice when the troubled child is starting to capsize and show them how to right the boat, or if that doesn’t work, how to use the lifesaver.  Eventually, your child will learn how to sense when trouble is coming on, avoid the thing that causes problems, and ask others for help.

  • Sense it.
  • Avoid it.
  • Ask for Help.
Life throws punches. Vulnerable brains need to be more wary and resilient than the average person.

RESILIENCE – bounce back when they fall

Troubled children have a much harder time bouncing back from problems.  They have extreme responses to simple disappointments like breaking a toy, or poor grades, or something as serious as the parents’ divorce.  Some even fall apart in joyous times because the emotional energy is too much!  You must be acutely aware of this–they will not get back on track by themselves.  Don’t worry that helping them will spoil them or “enable” them.  Eventually they will learn from you how you do it.

“…We are all born with an innate capacity for resilience, by which we are able to develop social competence, problem-solving skills, a critical consciousness, autonomy, and a sense of purpose.”

     “Several research studies followed individuals over the course of a lifespan and consistently documented that between half and two-thirds of children growing up in families with mentally ill, alcoholic, abusive, or criminally involved parents, or in poverty-stricken or war-torn communities, do overcome the odds and turn a life trajectory of risk into one that manifests “resilience,” the term used to describe a set of qualities that foster a process of successful adaptation and transformation despite risk and adversity…”   http://www.athealth.com

–Margaret

 

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Mental illness is more deadly than cancer for teens, young adults

Mental illness is more deadly than cancer for teens, young adults

Why isn’t everyone more upset?

A disease is killing our children and it’s more deadly than cancer and leukemia!  Did you know it was mental illness?

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.

Look at the highest bars in this graph. They are 3-4 times the height of average cancer and diabetes rates in children. There are gaps in the available data, but this simple comparison is disturbing.

* The starting point for the mortality rates of 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 children to young adult age ranges.)

On suicide:

  • It’s often normal for children and young people to think about suicide, but just in their imagination. They might consider it during some painful time in their lives, but there are no plans made or steps taken.  When the difficult times are over, they don’t think about it any more.
  • Young people with early onset mental illness can’t endure much stress; thoughts of suicide recur over time, starting as early as age 6 or 7.  These children are vulnerable to repeated intrusive suicidal thoughts because they live with a combination biological, psychological, and social/relationship causes (called “biopsychosocial”).  More about this is explained here: “Use the “S” Word: Talk with your Child about Suicide.”
  • There are ‘fast’ and ‘slow’ suicides in young people.
    • The ‘fast’ ones are 1) direct self-harm that has been planned, or 2) spur-of-the-moment suicide due to an extreme emotional reaction to a single intolerable event (examples: a boyfriend/girlfriend or best friend dies; a teen has a serious fight with a parent and (without planning) wants to ‘get back’).
    • The ‘slow’ suicides result from a persistent pattern of harmful behaviors that eventually lead to death.  Young people struggling with anorexia can die by heart failure or other causes due to their weakened body.  Others abuse substances and/or participate in extremely risky activities that expose them to multiple lethal situations:  overdose, criminal environments, disease.

The chart above screams out for a changes in attitude, policy, and investment in children’s mental health treatment and suicide prevention.  I had no idea that death rates from mental illness could be 3 to 4 times higher than most cancers and leukemia.  It is imperative that young people with mental health issues receive as aggressive and sensitive treatment as is expected and demanded of medical systems that treat cancer in children.

 

Parents: talk about this. Talk to your child; share it on social media; and talk to mental health organizations about what you can do.

The data on mortality rates for mental illnesses was difficult to find, and it required searches in many different medical journals and websites.  I chose to use the data on cancer, leukemia, and diabetes because the mortality rates from these are high and because deaths from all other causes were insignificant by comparison (motor vehicle accidents are the one exception).  In this graph, the death rates for cancer and leukemia are averages for the different forms of each, and in the medical 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.

–Margaret