EBD Blog

Sometimes folks lose sight of the fact that disability and mental health issues are international in scope. They’re not confined just to one’s own neighborhood, locality, geopolitical area, etc. Fortunately, there are groups that transcend borders (you can probably think of the names of some well-know organizations that function internationally), and there are some in EBD, too. The Open Society Mental Health Initiative is an example:

The OSI Public Health Program’s Mental Health Initiative aims to ensure that people with mental disabilities (mental health problems and/or intellectual disabilities) are able to live as equal citizens in the community and to participate in society with full respect for their human rights. The Mental Health Initiative focuses on ending the unjustified and inappropriate institutionalization of people with mental disabilities by advocating for the closure of institutions and the development of community-based alternatives. The initiative works in Central and Eastern Europe and the former Soviet Union (read more about the history of mental health policies in this region).

The OSI initiative is more than a one-trick pony. It’s about a lot of things, and its foci include children with Autism, mental health issues, and more. I encourage readers to check the site. Here is a link to the OSI MHI home page.

Lord Jones of Cheltenham, a member of the the UK Parliament, has formally asked “what measures are planned to improve services for (a) children with serious emotional disturbance, and (b) adults with mental health illnesses.” The request is in response to recent UK report, Keeping Children and Young People in Mind – Full Government Response to the CAMHS Review that, in turn (and as the title shows), was a response to the government-sponsored review of child and adolescent mental health services (CAMHS).

Keeping Children and Young People in Mind calls for a system of universal services, targeted services, and specialist services accompanied by support for them from local and national government agencies. Get a copy of Keeping children and young people in mind: the Government’s full response to the independent review of CAMHS and visit the Web site of the UK Department of Children, Schools, and Families for more about “services supporting the emotional wellbeing and mental health of children and young people.”

See the Parliamentary records for a written version of the request by Lord Jones.

Right here in my home commonwealth of Virginia last week, Mira Signe, Vicki Hardy-Murrell, John Morgan, and Margaret Nimmo Crowe explained why it is important that government and private organizations attend to and address issues in children’s mental health. By explaining that Virginia has inadequate services and that one in every five children or youths experience mental health problems at some time during their lives, they made the point that that there is a tremendous need for public focus on these issues. This was the kick-off event for the Campaign for Children’s Mental Health.

The Campaign for Children’s Mental Health is a 3-year sustained effort to make mental health services more available and accessible to Virginia children in need. It will strongly endorse Governor-elect McDonnell’s call for system improvements; urge the General Assembly and state and local government to work collaboratively with the administration to address system deficiencies; and conduct a high-profile three-year advocacy and education drive to build public and political support for improved mental health services for children.

Only about one in 20 of Virginia’s children have access to the key services listed in the accompanying box. So, four out of five children who need these services do not have access to them.

No, Virginia, this is not an acceptable way to treat our children. Let’s do better.

• Down load the press release (source of the excerpt quoted here).
• Read coverage in these newspapers:
  • Lynchburg News and Advance—Coalition pushes mental-health care for children
  • Washington Examiner&mdash:Advocates start bid to expand children’s mental health services under bleak budget;
  • Richmond Times Dispatch— Coalition advocate mental-health care for children
  • Washington Post (blog)—New coalition has AG’s support for mental health reforms
• Visit (and support) the Web site of the Campaign for Children’s Mental Health.
• Download pdfs of “Survey of Community Services Board Child and Adolescent Services” and “Review of Community Services Board Child and Adolescent Services“; these are report by James W. Stewart, Inspector General for Virginia’s Mental Health, Mental Retardation & Substance Abuse Services (now called Behavioral Health and Development Services). The list of key services comes from these reports;
• Visit the < href="http://www.facebook.com/pages/The-Campaign-for-Childrens-Mental-Health/183467424796?v=wall" target="_blank">Facebook page;
• Listen to a brief (3+ min) interview with Ms. Crowe from WMRA: Pushing for Children’s Mental Health Reform.

Writing under the headline “Pros and cons of screening teens for depression,” Brendan Borrell examined some of the issues that sometimes roar around surveying youths to identify those who are depressed or at risk for depression. Mr. Borrell’s article, which is one in a series of articles about depression appearing in the Los Angeles Times, addressed concerns such as parental reservations about testing of their children without permission, false positive identification of a high percentage of students, and the absence of adequate treatment for many who need help.

Mr. Borrell established the importance of the issue in his lead:

By the time a teenager graduates high school, about one out of nine of his or her peers has attempted suicide. Suicide is the third leading cause of death among young people, behind car accidents and homicide, and 10% to 12% of teens ponder suicide every day.

Continue reading ‘Screening teens’

“Hold Me Tight, Let Me Go,” a movie about a UK school for children with Emotional and Behavioral Disorders, will air on US television 28 July 2009 on P.O.V. The film, made by Kim Longinotto (pictured at right), features the children and staff at Mulberry Bush School in the Oxfordshire village of Standlake. P.O.V. (Point of View) provides “documentaries with a point of view.”

Variety describes it as a film “mixing ferocity with tenderness, delicacy with tenacity”–exactly like the unusual school it explores. In Hold Me Tight, Let Me Go, one of Britain’s leading documentary filmmakers takes a verité look at Oxford’s Mulberry Bush School for emotionally disturbed children. Mulberry’s heroically forbearing staff greets extreme, sometimes violent behavior with only consolation and gentle restraint. Kim Longinotto’s unblinking camera captures an arduous process and a nearly unhinged environment, but it also records the daily dramas of troubled kids trying to survive and the moments of hope they achieve with Mulberry’s clear-eyed staff.

Watch on YouTube

Link to the US PBS site, where one can learn when the entire film will be available in different areas. Visit the Mulberry Bush organization’s Web site. See the UK’s Office for Standards in Education, Children’s Services and Skills (Ofsted) listing for the Mulberry Bush School. Link to an extended piece, “Inside the home for angry infants: It costs £123,000 a year to send a child to this special school — because nobody else will have them,” by Caroline Scott in the Times Online (11 May 2009). Learn about other P.O.V. shows.

The Substance Abuse and Mental Health Services Administration, which is a part of the US Department of Health and Human Services, maintains a Web site where users can search for and learn more about methods for preventing or treating some Emotional and Behavioral Disorders. It’s called the “National Registry of Evidence-based Programs and Practices” (NREPP) and, for those who are concerned about employing or recommending evidence-based practices, it’s worth reviewing.

The National Registry of Evidence-based Programs and Practices (NREPP) is a searchable online registry of mental health and substance abuse interventions that have been reviewed and rated by independent reviewers.

The purpose of this registry is to assist the public in identifying approaches to preventing and treating mental and/or substance use disorders that have been scientifically tested and that can be readily disseminated to the field. NREPP is one way that SAMHSA is working to improve access to information on tested interventions and thereby reduce the lag time between the creation of scientific knowledge and its practical application in the field.

NREPP is a voluntary, self-nominating system in which intervention developers elect to participate. There will always be some interventions that are not submitted to NREPP, and not all that are submitted are reviewed. In addition, new intervention summaries are continually being added. The registry is expected to grow to a large number of interventions over the coming months and years. Please check back regularly to access the latest updates.

Although NREPP originally focused on substance abuse, its coverage is broader now. Look for resources about, for examples, Across Ages; Aggressors, Victims, and Bystanders: Thinking and Acting To Prevent Violence; Al’s Pals: Kids Making Healthy Choices; All Stars; Caring School Community; CASASTART; Children’s Summer Treatment Program (STP); Coping Cat; Creating Lasting Family Connections (CLFC)/Creating Lasting Connections (CLC); Early Risers “Skills for Success”; Families and Schools Together (FAST); Guiding Good Choices; Incredible Years; Keep A Clear Mind (KACM); Keepin’ it REAL; Lions Quest Skills for Adolescence; Multisystemic Therapy (MST) for Juvenile Offenders; Multisystemic Therapy With Psychiatric Supports (MST-Psychiatric); Positive Action; Primary Project; Project Northland; Project Towards No Tobacco Use; Project Venture; Promoting Alternative THinking Strategies (PATHS), PATHS Preschool; Protecting You/Protecting Me; Right Decisions, Right Now: Be Tobacco Free; SAFEChildren; Second Step; SMARTteam; Storytelling for Empowerment; Strengthening Families Program; Strengthening Families Program: For Parents and Youth 10-14; Success in Stages: Build Respect, Stop Bullying; Too Good for Drugs; and Too Good for Violence;

Children and youths with ADHD and their families ought to know about systems of care. Systems of care are networks of services that are coordinated across different agencies and groups within the community. A system of care focuses on the needs of individuals and should be designed so that it takes advantage of that person’s strengths (i.e., is “strengths based”) and unique characteristics (e.g., ethnic background and native language).

Systems of care have been studied extensively in the disciplines focused on Emotional and Behavioral Disorders. They are not just for kids “lost to the streets.” The coordination of services can be beneficial for individuals with ADHD, too.

Learn more about ADHD and systems of care from the SAMHSA, the US Substance Abuse and Mental Health Services Administration. Download a PDF.

Summer in the US finds children and youths out of school and, perhaps, less vulnerable to some of the problems that are associated with the social and academic demands that are part of schooling. As a result, perhaps fewer of the familiar problems illustrated in this poster are apparent during summer.

If summer seems like a relief from such problems, though, that could be an important indicator that those very problems need to be addressed. A few weeks away from school probably will not cure them. Those same difficulties may still be occurring, just less obviously, and they are likely to recur soon.

Individuals or the families of children who experience the kinds of problems noted in the poster should consult the resources available from the US government’s Substance Abuse and Mental Health Services Administration. One will not find easy cures there, but by carefully perusing the resources available one can learn what signs to monitor and where to go to get help.

The image is hot. Click it to get to a good starting place.

Even though many schools in the US have closed for the summer or are about to do so, I want to remind folks that this is not a good time to take a break from considering the mental health needs of children and youth. Although they are likely to wax and wane over time, mental health problems don’t take many vacations.

Learn more about US resources for individual children and youths who have emotional and behavioral disorders by surfing the rich resources assembled by the Substance Abuse and Mental Health Services Administration (SAMSHA) of the US Department of Health and Human Services. Although some of the materials may be a tad out of date (e.g., prevalence figures have been updated for some disorders such as Autism), there are still plenty of valuable materials available from SAMHSA.

Go there! Compare what you see learn there with what’s available at other trustworthy sites. Learn what to do and from whom help is available.

No, sorry. It’s not a briefing about the mental health of the US Senate. It’s about a briefing held in the US Senate regarding the looming problems in mental health in the US. Ordinarily I focus on issues in children’s mental health, and this may appear to be more about adults’ mental health. However, note that in many situations where adults’ mental health is an issue, there are children who are affected and who may be at increased risk because of the adults’ mental health needs.

Thanks to US Senator Debbie Stabenow for helping make this briefing happen.

ON THE FRONT LINES OF AMERICA’S PUBLIC MENTAL HEALTH CRISIS

Mental illness is the leading cause of disability in our nation. While Community Mental Health Centers and other front line safety-net providers are doing their best to respond to the needs of low-income persons with mental health disorders. They are confronted by both short term and continuing crises.

Our public mental health system is facing an immediate fiscal challenge: media reports this year indicate that as many 32 states are contemplating mental health funding cuts, including hiring freezes and community-based service reductions.

The ongoing challenge is to provide a response delivery system that allows persons with mental illness to access both the behavioral and physical health care they so urgently need. Adults with serious mental illness are dying, on average, 25 years earlier than the general population. In early March, for example The New York Times reported that hospitalized person with bipolar disorder have mortality rates that are 35% to 200% higher than other hospital patients.

On Tuesday, March 31, from 12:00 – 1:30 pm in Room SVC 208/209 of the Capitol Visitor Center, Senator Debbie Stabenow will host a briefing titled “On the Front Lines of America’s Public Mental Health Crisis,” to discuss challenges facing community mental health and efforts to address them – often through programs that integrate mental health and primary care services.

>>snip…< <

Panelists:

Linda Rosenberg, President and CEO
National Council for Community Behavioral Healthcare

Cindy Kaestner, Vice President
Abbe Center for Community Mental Health, Cedar Rapids, Iowa

Patrick Barrie, Interim Director
Washtenaw Community Mental Health Organization, Ypsilanti, Michigan

Helen Royal, Grant Coordinator, Advancing Colorado's Mental Health Care Initiative for Summit County Colorado and Behavioral Health Services, Frisco, Colorado

Karen Wyatt, MD, Medical Director
Summit Community Care Clinic, Frisco, Colorado

Malkia Maisha Newman, Community Educator
Community Network Services, Farmington Hills, Michigan

Although insurance carriers in California must pay for some services, in a memorandum to insurers Monday 9 March 2009 insurance regulators in California indicated that insurance coverage does not have to extend to applied behavior analytic (ABA) treatment for children with Autism. According to Lisa Girion, the memorandum from the Department of Managed Health Care requires insurers to pay for speech, occupational, and physical therapy, but not for educational services aimed at improving daily living skills.

The letter is focused on “ensuring that individuals with Autism Spectrum Disorders (ASD) receive the care they are entitled to under the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act) and accompanying regulations.” It requires that insurers maintain a network of services for evaluation and referral of individuals with ASD that conforms to, Knox-Keene Act. This part addresses screening, diagnosis, qualified providers, and so forth. Under the head “Part B: Treatment for Persons with ASD,” the letter reads

Health plans must do the following:

Cover all basic health care services required under the Knox-Keene Act, including speech, physical, and occupational therapies for persons with ASD, when those health care services are medically necessary.

>>…snip….< <

2. Provide mental health services only through providers who are licensed or certified in accordance with applicable California law.

3. May not categorically exclude any particular health care treatment or therapy for Autism Spectrum Disorder.

So, ABA cannot be expressly denied. As Ms. Girion reported, it must be that the focus of the treatment (e.g., self-care, head banging) that are not considered legitimate targets for mental health. One has to wonder whether speech therapy predicated on behavior analytic principles—and most of the effective speech therapies for children with Autism are based on ABA principles—will become a target.

I have little trouble considering healthy living a mental health issue. Of course, I’m biased, but that might be the path to take. As Ms. Girion notes and the memorandum reads, the Department of Managed Care still requires a process for review of appeals by independent medical providers.

Links to Ms. Girion’s story, “Autism patients in California are dealt insurance setback,” and to the CA Department of Managed Care memorandum.

The US National Academies Press announced the publication of a book entitled Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities that discusses prevention of problems during childhood, adolescence, and young adulthood. Edited by Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, the book represents the work of the Board on Children, Youth and Families. It is available in hardback, as a PDF, or online (the last option is free).

Mental health and substance use disorders among children, youth, and young adults are major threats to the health and well-being of younger populations which often carryover into adulthood. The costs of treatment for mental health and addictive disorders, which create an enormous burden on the affected individuals, their families, and society, have stimulated increasing interest in prevention practices that can impede the onset or reduce the severity of the disorders.

Prevention practices have emerged in a variety of settings, including programs for selected at-risk populations (such as children and youth in the child welfare system), school-based interventions, interventions in primary care settings, and community services designed to address a broad array of mental health needs and populations.

Preventing Mental, Emotional, and Behavioral Disorders Among Young People updates a 1994 Institute of Medicine book, Reducing Risks for Mental Disorders, focusing special attention on the research base and program experience with younger populations that have emerged since that time.

Researchers, such as those involved in prevention science, mental health, education, substance abuse, juvenile justice, health, child and youth development, as well as policy makers involved in state and local mental health, substance abuse, welfare, education, and justice will depend on this updated information on the status of research and suggested directions for the field of mental health and prevention of disorders.

Link to the press release or the ordering page.