Category: psychology

Welcome to the 911 Club for Parents of Troubled Kids

Welcome to the 911 Club for Parents of Troubled Kids

Let’s start a 911 Club, a community for parents who depend on emergency services for managing their mentally ill child. Our T-shirts would be black and blue like bruises. Only people raising a mentally ill child or young adult could join. Club rules would be simple:  1. No one is ever judged. 2. We keep things confidential. 3. Everyone is made to feel like a hero. 4. Everyone accepts that they are not guilty or failures, and neither are their children.

Every day, an emergency is just around the corner.

Parents with troubled children, no matter the age or diagnosis, are forced to make difficult decisions and take extreme actions… like calling 911.  It’s not something they choose, and they’ll avoid it if possible.  They are like any other parent with a severely disabled or physically ill child—they will do anything to help their child, but instead of wheelchairs or chemotherapy, they need emergency responders.

Most parents with normal children will never need to do the following 10 things that parents of troubled children often do:

  1. Call police
  2. Call an ambulance
  3. Or call a crisis line repeatedly
  4. Search a child’s room, especially if the child is a teenager or may be suicidal
  5. Spy on their child: read their email, texts, social media or search histories, read their journals
  6. File criminal charges or get a restraining order
  7. Lock up common household items (matches, knives, scissors, fuel, and anything conceivably dangerous in the wrong hands)
  8. Participate in endless meetings, appointments, and therapy sessions. Complete dozens of forms and continually pursue financial or community mental health resources
  9. Block out people who used to be friends
  10. Never share our stories with ‘normal’ people lest we get bombarded with uninformed and unsolicited opinions.


Parents can see an emergency coming, but can do little to prevent it.

All parents of troubled children have barriers to getting help, even when it’s blatantly obvious that the child needs it.  Why?  The aftermath of a recent high school shooting in Florida by provides details:

  1. The tragedy has to happen first: “A neighbor warned the sheriff’s office …and begged them to intervene. She was told there was nothing deputies could do until Cruz actually did something.”
  2. Mental health professionals don’t take history into account; and they are ignorant that children can behave well in their presence: “An investigator … spoke to Cruz, and advised that he was “not currently a threat to himself or others” and did not need to be committed.
  3. Family and other eyewitnesses are ignored by the people and institutions they depend on. “Lynda Cruz’s cousin warned deputies Cruz had rifles and pleaded for them to “recover these weapons.”


Policymakers, mental health professionals, and emergency responders out there:  fix this!

Part of the reason parents or family of the mentally ill person can’t get timely help is because of civil rights laws.  To those in the mental health community, start talking about how to handle this.  The present situation is unacceptable!  Stop protecting an acknowledged dangerous person’s rights over those of innocent victims.  It’s not OK.  This is just like some gun advocates who think it’s more important to sell assault rifles to protect their personal rights over those of innocent victims.

True Story

An upsetting thing happened in my city about 10 years ago that could have been my story. A man took his grown son to the emergency room because the son had been insisting he was going to stab someone—he suffered from untreated schizophrenia. When there, the staff found no reason to hold the son despite his history of violence and his father’s testimony. The father pleaded with them to put his son in a 72-hour hold and they refused.

Within minutes, the son ran off into the surrounding neighborhood, and within an hour, had stolen a steak knife from a restaurant, and ran out and stabbed a man walking on the sidewalk. (The victim lived, fortunately.) The father told the reporter that he’d been trying every possible means to stop this from happening in the hours before the event. Getting the son to go with him to the ER was an extraordinary feat in and of itself. He was beside himself with frustration and sadness and anger.  Now his son had aggravated assault and attempted homicide charges, and faced prison instead of a hospital.

–Margaret

 

U.K. needs to be a “999 Club”; Germany needs a “112” Club; a “110 Club” in China…

On child psychiatry and stigma

On child psychiatry and stigma

When parents complain about psychiatrists, it’s often because the psychiatrist treats them as being the cause for child’s problems.  Doctors often do not understand what life is like in the family’s home, and how impossible it is to follow through on their recommendations.  Interestingly, psychiatrists who themselves have a troubled child are keenly aware of the challenges.  In fact, they too can go crazy with grief, and guilt, and a sense of failure… just like parents who aren’t medical doctors.  A doctor’s negative attitude towards parents has huge emotional consequences for them.  If parents aren’t listened to, or if they are talked down to, it adds a load to their emotional baggage and is debilitating.  It weakens their capacity for caring for their incredibly stressful child, and for themselves.  To be fair, the medical field has lots of practitioners who aren’t helpful or people-friendly.  What’s different about psychiatry is that The Rest Of The World stigmatizes anything related to mental health or brain health… it’s as if brains are always healthy, and if someone has a behavior problem it’s their fault.  Many also think mental health treatment itself is sinister and evil, and that psychiatrists and psychologists themselves are provide fake or harmful treatments to unsuspecting people.

Our Own Worst Enemies
Nada Logan Stotland, MD, MPH

“Oncology manages to cloak the most primitive possible treatments—poison and burning—with elaborate protocols. Yet the mention of psychiatry conjures ECT, and ECT conjures images of the snake pit.  …We are the only specialty with our own dedicated hate group. We shouldn’t be our own worst enemies.”  May 18, 2010, Blog @ www.psychiatrictimes.com

o        Dr. Stotland, above, mentions ECT  (electroconvulsive therapy), or “shock therapy.”  It reboots the brain and is the only thing that keeps some people alive and eases their suffering.  So how is ECT worse than shocking a stopped heart with a defibrillator–two paddles on the chest and BOOM!  Which is more barbaric?

o        In the TV medical dramas, there’s this common scene:  a patient is in a hospital bed surrounded by doctors, and the patient is bleeding, or screaming in pain, or convulsing.  Somehow this is acceptable in prime time.  What if the scene was different.  Instead, an agitated, hallucinating patient is being restrained, and injected with a drug that immediately calms and relaxes them.  My guess is the public would find it sickening and unethical.

o        When a sweet-looking child loses all of his or her hair after being poisoned by chemotherapy, it evokes sympathy and compassion.  But if this same  child’s hair was lost while taking a psychiatric medication, then it would be seen as a barbaric side-effect of forcing drugs on children to send them to zombie-land.  Cancer treatment is forgivable; treatment for brain diseases is not.

This public attitude must change.   It victimizes the victims who live with mental disorders, and the confrontations and insinuations families experience is emotionally debilitating.   Mental health treatments are no more barbaric than those of other medical illnesses, but the stigma unique to mental health manifests itself in blame, prejudice, and the cruel insensitive comments of others.  Let the public dialogue discuss improving lives instead of finding fault with doctors, sufferers, and their families.

–Margaret

Use IQ sub-scores to guide your child’s future

Use IQ sub-scores to guide your child’s future

The IQ of a child or teen does not predict their success or failure in the world, nor their chances for a meaningful life that’s full of wellbeing.  But in very practical terms, your child will need to function as an adult someday, and take care of themselves, which means getting a job and getting a life.  What’s the best job or future path?  What isn’t?  If you know how your child scored on different parts of the battery of IQ tests, you can guide them to a future that rests on their best scores, and this is especially important for young people with behavioral disorders.  Let me explain.

A person’s IQ is the average of the scores from tests for different types of intelligences, and each test can be scored from a range of 0 to ~200.  From the Wechsler IQ Scale, used most widely in schools, there are six intelligence types. (There are many other IQ tests in use today besides the Wechsler Scale.)

  • Verbal comprehension  Ex:  Measures the ability to write, work crossword puzzles, use words creatively or convincingly, tell interesting stories or funny jokes, debate an issue, explain things clearly, and use a large vocabulary.
  • Perceptual Reasoning  Ex:  Measures the ability to put puzzles together, appreciate of art or photography, use geometry, learn best with charts and pictures, draw, notice details.
  • Working Memory  Ex:  Measures the ability to remember strings of numbers or letters, lists, and subjects just observed or subjects recalled from a much earlier time.
  • Processing Speed   Ex:  Memory recall, speed of problem solving, recognition, and correlation.
  • Reading   Ex:  Measures the ability to read and understand different types of writing, to learn and draw conclusions from reading, reading speed, comprehend the meaning in written material.
  • Math Reasoning  Ex:  Ability to solve mysteries, solve logic and math problems, organize things, figure out how things work, use technology, appreciate and apply science.

Your child’s individual intelligence scores are better indications of your child’s strengths and weaknesses.  You should support interests that take advantage of where their best intelligence is, their high scores, to prepare them for schooling or a job.  On the other hand, if you know where they score low, you can arrange extra support for them before they become adults–or you can guide them away from a future choice (such as a career) where they won’t or can’t thrive.

Introduce your child to experiences they are predisposed to master.

The philosophy here is to help your troubled child use the best of what they have, and not require them to be well-rounded.  Pressuring them to do well in everything isn’t helpful for two reasons:

  1. Troubled children commonly have a wider range of low to high scores, and they aren’t or can’t be well-rounded;
  2. Your effort goes into weaknesses they struggle with, instead of strengths that should be nurtured and celebrated.  Troubled children and teens really need a good dose in self-esteem.

A hypothetical case –  Take two very different children with very different IQ scores, yet both with the same behavioral problems in school.  They act out, pick fights, hit others and damage others’ things.  Sean is a 15-year-old boy with an IQ of 83, diagnosed with ADHD and Fetal Alcohol Effect (FAE); Katy is a 10 year girl with an IQ of 122, diagnosed with PTSD and ODD.  In the graph below, Sean’s scores are in red, and Katy’s are in blue.

 Sean’s score of 83 is misleading because his overall functioning is much lower.  In fact, three of his test scores are below 75, the level designated as developmentally disabled.  His special education teachers are surprised he does so poorly in school because he seems so normal on the surface thanks to his above average verbal skills.  He has lots of friends.  He communicates clearly, he listens to others, and he likes to tell good stories. What should Sean be when he grows up?

Half of Katy’s scores are above gifted, ~130, but her below average verbal ability prevents her from mastering essential social and communication skills.  Because she’s so intelligent, people are surprised that her grades are low. The problem is her behavior in class and how it distracts from learning. But Katy’s behavior comes from an early trauma.  And with lower verbal skills, she has a harder time communicating her needs and perceiving the little social interactions that help us mature.  Katy can do anything, but what shouldn’t Katy do when she grows up?

To help people understand the implications of IQ, psychologist Dr. Arthur Jensen created a chart that he believed matched IQ scores to careers:

  • 89-100 would be employable as store clerks
  • 111-120 have the ability to become policemen and teachers
  • 121-125 should have the ability to excel as professors and managers
  • 125 and higher demonstrate skills necessary for eminent professors, executives, editors

“What is an IQ?” http://homeworktips.about.com/od/homeworkhelp/a/IQ.htm

From this chart, Sean’s IQ of 83 is too low for a store clerk, and yet Sean is able to function pleasantly and helpfully around people in structured situations.  He might do fine helping customers in the right kind of store.  He’s also good at tackling one day projects with groups of people.  Maybe landscaping or neighborhood clean-up is is meaningful to him and he thrives.

Katy could easily become the professor or executive in Dr. Jensen’s chart, yet her verbal skills might limit her to careers that don’t require nuanced interactions with people.  She might do best working semi-independently, possibly in technology, science, or engineering.  She might love a summer science camp where her intelligence would get the challenges it needs and shine.

What will your child do when he or she grows up?  You can’t make their decisions, but you can influence their choices.

“No IQ score should be considered an exact measure of intellectual ability…  It does not measure creativity, leadership, initiative, curiosity, commitment, artistic skill, musical talent, social skills, emotional well-being, or physical prowess – all components which can be included in definitions of giftedness.”
National Association of Gifted Children http://www.nagc.org/

— Margaret

Youth with mental disorders demand rights!

Youth with mental disorders demand rights!

Troubled young people have rights, and a national organization is there to support them. Youth ERA (Mission:  “Youth ERA works to empower young people and create breakthroughs with the dedicated systems that serve them.”)  Youth ERA offers peer support, social and educational support, and advocacy for youth with brain disorders.  The Oregon Chapterin  partnership with Portland State University, wrote a Youth Bill or Rights for teens to young adults between ~16 to mid 20’s.  As you can see in the Rights document below, they believe youth should be allowed to guide their mental health treatment, and receive respectful, humane care.

“YOUTH ERA BILL of RIGHTS  –  We believe that all youth should have the following rights in their mental health care:

1) Youth have the right to be leaders of their psychiatric treatment plans.

Youth should be informed of the possible side effects of medications, how long recommended medications take to go into effect, and the possible long-term effects of recommended medication. Service providers should work with youth to explore possible alternatives to using psychiatric medication before medication is given. Communication between youth and all medical providers should be collaborative, clear, and with limited use of medical terminology.

2) Youth have the right to evaluate their mental health services.

Mental health counselors, social workers, psychologists, and other service providers should provide opportunities for youth to evaluate the satisfaction of their services throughout the duration of care in a respectful and non-threatening manner. This includes evaluation of the relationship with the provider, counseling plans, and implemented treatment models.

3) Youth have rights to services that are as noninvasive as possible.

When youth are transitioning into new services, mental health programs should strive to make the transition as accommodating as possible for the youth. Youth should be consulted on the ways they would like to end their relationship with the current provider and whether they would like the current provider to share their file with their new provider. Providers should share if there will be any changes in the costs of services and/or insurance coverage.

4) Youth have rights to get treatment from trained, sensitive providers.

Youth should have access to mental health professionals that are familiar with the unique needs and challenges of youth with mental health needs. All mental health professionals should have specialized training that fosters positive youth development and support. Youth mental health service consumers should be included in the creation and implementation of these trainings.”

This document was created and signed in 2009 by 30 mental health service-experienced youth gathered in Portland, OR, from the following states: California, Hawaii, Idaho, Illinois, Kentucky, Maine, Massachusetts, Missouri, Michigan, New York, North Carolina, Oregon, Texas, and Washington.

Youth ERA rights are similar to the “Mental Health Consumer Rights” developed by adult mental health consumers, which is appended at the end of this article.

Parents should support these rights

I say “bravo,” these are appropriate and necessary–anyone receiving treatment must be comfortable and safe with care providers, and treated with dignity and respect, period  But I’d like to see something similar for parents and caregivers, too, who also participate in treatment and need to feel respected and heard.

 – – – – – – – – – –

Adults with mental illness had already developed a bill of rights for the same reasons as the youth–to receive sensitive, humane services and participate in all aspects their treatment.

Adult Consumer Bill of Rights – for adults in mental health service systems

  1. Information Disclosure:  Consumers have the right to receive accurate, easily understood information and may require assistance in making informed health care decisions about their health plans, professionals, and facilities.
  2. Choice of Providers and Plans:  Consumers have the right to a choice of health care providers that is sufficient to ensure access to appropriate high-quality health care.
  3. Access to Emergency Services:  Consumers have the right to access emergency health care services when and where the need arises.
  4. Participation in Treatment Decisions:  Consumers have the right and responsibility to fully participate in all decisions related to their health care.
  5. Respect and Nondiscrimination:  Consumers have the right to considerate, respectful care from all members of the health care system at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality health care system.
  6. Confidentiality of Health Information:  Consumers have the right to communicate with health care providers in confidence and to have the confidentiality of their individually identifiable health care information protected.
  7. Complaints and Appeals:  All consumers have the right to a fair and efficient process for resolving differences with their health plans, health care providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review.
  8. Consumer Responsibilities:  In a health care system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume reasonable responsibilities.

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) established the Consumer Bill of Rights Workgroup to promote and implement the Presidential Advisory Commission’s Consumer Bill of Rights and Responsibilities in health care. http://mentalhealth.samhsa.gov/consumersurvivor/billofrights.asp

 

–Margaret

My son has the problem, yet the therapist focuses on me, huh?

My son has the problem, yet the therapist focuses on me, huh?

Question:   My son’s therapist keeps telling me what to do, or that I’m not doing the right things at home.  But my son is the one with the problem, why all this focus on me?

Answer:
   You could be the problem or the therapist could be the problem.  You are working hard to manage a difficult situation, and you clearly care about your son because you are bringing him to therapy, but your own stress and exhaustion may look like you’re the one with the behavior problem.  My guess is that the therapist is trying to tell you how to change your parenting or communication style to reduce your son’s stress and better manage his issues.  This is a hard message to take when you know you’re doing everything you can, and you’ve been put through a lot by a difficult child.

Someone who doesn’t know me is telling me I’m not good enough?  What?

How can you tell it’s the therapist with the problem?

  • One problem I’ve seen with therapists is that they often don’t know how to talk to parents about parenting issues without sounding like they are making presumptions and blaming the parent for the child’s problems.  Everyone loves to blame the parents.
  • Some therapists put themselves in the child’s shoes.  That’s why they got into child therapy in the first place, they love children!  Yet pro-child therapists put their emotional biases in the mix to protect your child from you.  This ridiculous attitude is changing, thankfully. The mental health profession has begun to realize how critical the family is for the child’s treatment.
  • The worst situation is when a therapist embarrasses you or blames you in front of your child.  That’s grounds for firing them!  You may indeed need parenting guidance, but you should never have someone undermine your authority.
  • Another problem is when a therapist doesn’t have children, or doesn’t have troubled children.  They feel too confident in their abilities and don’t know what it’s like living with a troubled child 24/7, so they make assumptions and you constantly feel you need to defend yourself.

A good therapist or doctor will show compassion for a stressed parent, listen to their side of the story, and help the parent feel understood and believed.  Then they will take the time to explain exactly what the parent might do differently at home and why.

You should leave every meeting feeling better about yourself and child.

Try giving this therapist a chance first, and ask him or her if you can meet them without your son, and request that they fully explain their advice.  Let them know that this has been hard for you and you’ve felt blamed, and that you need their support.  Then listen carefully.  If you’re still not convinced of their point, ask them if there’s a book or a website or support group for you (it’s easier to accept advice from other parents who’ve learned from their mistakes).  If you feel that you can’t work with this therapist, consider finding someone who takes a better approach to you and your situation.

You and your child have to “click” with a therapist or doctor, or they can’t help you.