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A Quick Guide on How to Talk to Children About Mental Health

Posted: February 12, 2018

The following guide was written by Louise Theodosiou, a child and adolescent psychiatrist.

The parents and care takers I meet through my job as a child and adolescent psychiatrist often tell me about young people in their lives who are suffering from anxiety or low mood. I can sometimes hear an element of desperation or hopelessness in their voice, which may come from the fact they have no idea what to do or how to seek help. They want to be able to support the young person in their life, but without having the tools to do so, their confidence as care-givers diminishes and that can have an enormous impact on the whole family unit. 

Schools and community centres have taken steps to ensure that children and parents recognise the value of physical health, from the promotion of fresh fruit and vegetables to the need for regular exercise. But where are the messages about mental health?

This Children’s Mental Health Week we need to do several things: advocate for ways to improve child mental health, encourage children to have time to talk to parents and care takers, as well as encourage them to make friendships and develop interests. There is also a need to understand the signs that children may be experiencing mental health issues in the first place.

These might include feeling anxious or unhappy, concerns about eating or weight and struggling to manage one’s behaviour. Age and maturity are obviously important factors, but signs to watch out for at any age include behaving like a younger child, withdrawing socially, losing interest in activities, struggling to learn or complete schoolwork, tearfulness and not eating or drinking. We know that children need to be safeguarded at all times, and providing a space for a child to say that they are experiencing neglect, bullying or abuse is a key part of maintaining wellbeing. 

Each child has unique strengths and needs that can impact on how they function at home or at school. If a child or young person is displaying signs that they are struggling, it is helpful to consider several different dimensions. Addressing these difficulties at an early stage can reduce secondary difficulties, for example, an impact on self-esteem, learning or school attendance.

Can the child explain that they feel sad or anxious? Listen when they talk to you. These are sensitive topics and words are important. Children may talk about feeling stressed or “not right”: use the language they do to show that you understand. Talking to a teacher, a parent or carer about emotions can be a great relief. There is information available about anxiety and low mood for teachers, parents and care takers in sources such as MindEd, which offers free online training, or the free information sheets on the Royal College of Psychiatrists website. 

If difficulties remain, parents can talk to GPs and teachers. Schools are working increasingly closely with mental health and wellbeing services. Often there are counsellors in school, and teachers and GPs can signpost families to voluntary sector counselling and to child and adolescent mental health services if difficulties are severe. Signs that children may be more unwell include struggling to leave the house, losing interest in their appearance, losing weight, hurting themselves or talking about not wanting to be alive. 

Does the child have a specific difficulty with learning or concentration or social understanding? 

There are situations where learning needs are not picked up and children can develop coping mechanisms that may stop working as they move into high school. The same is true for children who struggle to concentrate or who are very active. Children with social communication difficulties may manage in primary school but struggle as they get older and relationships become more nuanced. 

For difficulties with learning there are often educational psychology services to assess the needs a child may have in school. Many schools and GPs will now have training in how to recognise problems with concentration, overactivity or social communication difficulties. This will include when to refer to paediatrics or child mental health services for a more detailed assessment.

Parents, care takers and teachers know the children in their lives well and will be instinctive in their caring through years of experience. Often, they will know when something is not right and should feel empowered to act on their instincts.

Learn more at Independent.co.uk.



People Of Color And Mental Illness Photo Project Tells The Stories That Aren’t Being Told Enough

Posted: February 09, 2018

Some of us avoid openly discussing mental health issues, but talking about it isa necessary conversation to have. And while there have been some strides made to destigmatizing mental health issues, campaigns and advocates aren't always so inclusive of people of color with mental illness, even though Mental Health America (MHA) estimates 8.9 million Latinx or Hispanic identifying people in the United States are diagnosed with a mental illness every year.Enter Dior Vargas, who started the People of Color And Mental Illness Photo Project in 2014 in response to the lack of representation of mentally ill Latinx people in mainstream media.  “I was raised to believe that mental health and mental illness was a white person thing. So, I wanted to create a space where people could share their photos stories. I wanted to create a resource where people of color could go to for hope and a sense of community,” Vargas tells Bustle.

Now, just a few years later, Vargas is planning to release a book version of her popular art project. “Mental illness affects everyone in some way, and it is doing a disservice to the experiences of people of color by showing only white people as those who deal with these conditions. I thought this project and overall conversation was a necessity,” she tells Bustle.

The idea behind the project is simple: it features photos of people of color holding signs with their name and mental illness(es) written on them. Not only does mental illness affect 8.9 million Latinx people, but the National Alliance on Mental Illness (NAMI) estimates Black American are 20 percent more likely to be diagnosed with a serious mental health issue than the general population. Moreover, MHA predicts over 2.2 million Asian Americans and Pacific Islanders live with mental illness, and over 21 percent of the entire U.S. Indigenous population is diagnosed with a mental illness. These statistics only further stress the need to make sure people of color struggling with mental health issues don't feel isolated or alone.

Not only is there a lack of representation in mental health, but the Latinx community in particular faces large disparities when it comes to seeking and receiving mental health treatment. Despite the fact that the Latinx community has a similar susceptibility rate to mental illness as the rest of the population, NAMI reports that only 10 percent of mentally ill Latinx people actually seek out a mental health professional. Though stigmas surrounding mental health exist in every culture and community, there are certain stigmas that are unique to Latinx culture, Vargas explains. “The stigmas I have found most challenging is the idea that those who experience mental health struggles are being dramatic, that it is un castigo de dios [a punishment from God], or that the person is being weak [for having a mental illness,"] says Vargas. “Being questioned what you have to be depressed about or to think about what you have is also invalidating. It makes you feel awful about yourself — I know that from personal experience.”

Vargas adds that is it important to note “language and immigration status really complicates things” when it comes to receiving proper mental health care. “Xenophobia has always been rampant, but even more so now. This exacerbates mental health conditions. Undocumented people are afraid to get help because they think that might heighten the risk of being deported,” she says. Given the current climate around issues such as DACA and the DREAM Act, it’s no surprise that immigration status is impeding on accessibility of mental health care for undocumented people. Undocumented people of any background are more susceptible to mental health issues due to the sheer stress of being undocumented.

Vargas, who identifies as queer, also warns that “the intersection of race, ethnicity, gender, and sexuality compounds the oppression that people experience.” NAMI estimates that LGBTQ individuals of all socioeconomic classes and races are three times more likely to be diagnosed with a mental illness than their straight peers. Additionally, a 2016 survey from the National Center for Transgender Equality found 40 percent of transpeople have attempted to commit suicide in their lifetime. “Homophobia and transphobia is taking people’s lives and people who are part of these communities are shown that their lives are disposable. That’s detrimental to one’s mental health and self-worth," Vargas says. She points to the recent murder of transgender Latina Victoria Ramos Gutierrez to show how transphobia impacts the mental health of the queer, Latinx community.

Overall, Vargas believes organizations and individuals that are focused on mental health advocacy need to expand the conversation to include more marginalized communities — because, intersectionality is key. “[Mental health] programs need to think about who is missing in the conversation. They need to be cognizant that people’s experiences with mental illness is not the same. When organizing, who is sitting at the table?” Vargas tells Bustle. “If you truly care about the experiences of people of color, educate yourself about the unique stigmas and disparities. Don’t use people to fill a quota — we’re human beings, and we need to be valued. I’ve worked for mental health organizations who feign interest in our experiences when actually they really care about numbers and how it makes them look. It needs to be genuine and sincere. We aren’t pawns or tokens.”

Mental health is an already challenging topic, but those of us who are engaged in improving the current understand of mental health issues must be inclusive and intersectional. Expanding the conversation to center marginalized voices, is not just important — it is essential to creating long-lasting change.

Read more at Bustle.com.



Inside the Native American Foster Care Crisis Tearing Families Apart

Posted: February 08, 2018

Elisia Manuel remembers when she and her husband Tecumseh received their first foster child. “We had to go buy the boy some clothes,” she told Vice. “We had to get him everything, because he came with nothing. The agency even had to lend us a car seat to bring him home.” Elisia, who comes from the Mescalero Apache and Yaqui tribes, and Tecumseh, an Akimel O’odham from the Gila River Indian Community located just south of Phoenix, were thrilled to get a Native child to care for—even if it meant completely outfitting the little boy, purchasing a heavy-duty washer, and finding other supplies.

But state and tribal child welfare agencies say that Native foster families like the Manuels are hard to find. And that shortage can cause havoc when non-Native foster families wishing to adopt a Native child try to circumvent a law designed to keep tribal kids in their communities. Nationwide, American Indian and Alaska Native children are placed into foster care at a rate 2.7 times greater than their proportion in the general population, according to the National Indian Child Welfare Association (NICWA). With a disproportionate number of Native kids removed from their homes each year, the need for Native foster homes is huge—and there aren’t enough to meet the need. That shortage leads to non-Native foster parents taking in kids from tribal communities. Sometimes, those foster parents decide they want to adopt the foster child even though the law is supposed to prevent virtually all such non-Native adoptions.

This has led to nasty fights over custody; one highly publicized dispute was over Lexi, a young Choctaw girl whose foster parents sued to prevent her being given to the girl’s paternal family. The case stretched over four years and attracted international media attention until 2016, when the case was resolved in favor of her father’s family. In 2013, a little girl known as Baby Veronica was at the center of yet another maelstrom, this time after her non-Native mother turned her over for adoption leaving her Native father to fight for her return. This time, the outcome was different: The non-Indian adoptive family got to keep the girl.

To understand these disputes, you have to know the painful history behind them. Before the enactment of the 1978 Indian Child Welfare Act (ICWA), the law that governs removal and placements of Native kids, 25 to 35 percent of Native children nationwide were being removed from their families, according to NICWA.

Montana’s Department of Health and Human Services’ Child and Family Division found that prior to ICWA’s enactment, nearly 80 percent of all Native families had lost at least one child to the foster care system, thus posing the real risk of tribal extinction. Minnesota’s Department of Human Services found that the children who were removed were “at great risk for experiencing psychological trauma leading to long-term emotional and psychological problems as adults” due to losing cultural and family connections.

Eighty-five percent of those children removed from their homes were placed outside of their families and communities by state courts, welfare agencies, and private adoption agencies, despite many “fit and willing relatives” who could have taken in those children. In fact, family fostering is the norm in Indian Country, but states did not realize, or recognize, that fact. This can still be an issue, although after 40 years of educating state child welfare workers, it’s starting to change. Over the past decade, the federal government has finally issued compliance guidelines for ICWA for states and other entities. That’s helped to reduce the number of placements outside tribal communities, although more needs to be done, according to author Shanna Knight in the publication ABA Child Law Practice.

But now, with a perceived increase in legal challenges to ICWA, including a challenge by the Goldwater Institute that the US Supreme Court declined to hear last year, the need for tribal foster homes to prevent these agonizing battles grows ever greater.

The Manuels, who now have six kids in their home—three of whom they’ve adopted—are one of just a few foster homes in tribal communities.

The lack of Native foster families across the nation is “a serious issue,” David Simmons, the director of government affairs and advocacy for NICWA, told Vice. “Recruitment and retention of foster parents isn’t there.”

Simmons regularly advises state child welfare systems, “Don’t assume mainstream methods will work with Native American families—you need a cultural approach, based on relationships.” Care by kin is “very big” in tribal communities, Simmons said.

Then, there’s the matter of trust. “There’s a historic distrust [of state and federal government] in Native communities,” Simmons told me.

Native families also can have trouble meeting strict care home standards. “For example, the child’s room must be a certain size to qualify the home as a foster home,” Simmons said. But ICWA contains a provision that states should treat tribal foster homes according to the tribes’ standards of cultural norms, such as extended families raising children. Also, the law trumps state regulations such as the home structure or how many people reside in the home. Arizona is home to 22 tribal communities, and nearly 28 percent of the state is tribal lands.

Despite this, Kenneth Poocha, the tribal liaison for the Arizona Department of Child Safety, told Vice that there is a shortage of Native foster homes in Arizona for the 1,500 Native kids in the state’s system—about 10 percent of the state’s current total foster child population. “There are a variety of reasons as to why this may be,” Poocha, a member of the Hopi Tribe, said. For one thing, “Many Native American families that may be willing to be a foster home are simply not aware of the process or even how to begin.”

Poocha and his office are actively recruiting foster families, but it’s not an easy proposition, even though families operating homes licensed by the Arizona Department of Child Safety receive payments up to nearly $29 a day, and more for children requiring more medical and/or behavioral care. Poocha also says that in Arizona, tribally certified foster homes are considered to meet state regulations.

When Native foster families can’t be found, state child welfare staff must place them with non-Native parents, creating a complicated situation for the foster and birth families and the child’s tribe. A non-Native foster mother living in Phoenix Vice spoke to requested that her name not be used because she’s fearful of harassment from Native activists upset that non-Indians are caring for tribal children. The single working mom has had the boy, now nearly four years old, for a year.

“I was his third home in two months,” she told Vice. “I wouldn’t have taken him if I had known how many needs he had.” But she added that after some time, she realized that “this is the child I was meant to have.”

The boy had been severely neglected and “completely deprived of attention,” she told Vice. His separation anxiety is so bad, “I go to the bathroom, and his fingers go under the door.” The boy had no words when he first came to the mom’s home, he was suffering from post-traumatic stress disorder from witnessing domestic violence, he had severe social and behavioral issues and developmental delays, and his immune system wasn’t well developed. “He had chronic fevers,” the mother told Vice.

All these issues are symptoms of toxic stress caused by adverse childhood experiences, which if not corrected by putting the child in a better environment can result in cognitive and health deficits that last a lifetime. The Phoenix foster mom thinks that the boy’s birth mother “probably suffered from adverse childhood experiences herself.”

The mom said that the child’s tribe, which is peripherally involved, would like for him and his three siblings to be reunited. However, “there are no placements that can handle all four of them,” the foster mom told Vice. “I think it would be cool to do cultural things with him, but we’ve been in survival mode all this time.” The foster mom supports eventually sending the boy home, once the birth mom “gets her act together,” she said.

There’s widespread agreement that the best solution would be to place Native children in Native homes, but there are material obstacles in the way that the ICWA can’t solve.

One of those obstacles is supplies. Recalling their early struggles with obtaining needed supplies for their first foster child, Elisia and Tecumseh Manuel decided that other Native foster parents needed support with basic needs like diapers and clothing. The couple established a nonprofit called Three Precious Miracles in the hopes of making it easier for Native families to foster children.

Today the organization provides clothing, cribs, car seats, and a support group for parents. Elisia says she’s received calls for help from as far away as South Dakota, although most of her work is done in Arizona.

Read more on VICE.com



February 7th is National Black HIV/AIDS Awareness Day

Posted: February 07, 2018

The following is an article written by Phill Wilson, the president and CEO of the Black AIDS Institute:

My colleagues and I marched in the Kingdom Day Parade last month, and toward the end of the route, a group of 10-15 men and women began heckling us. “All Black people don’t have AIDS,” they said, referring to the Black AIDS Institute banner we were marching behind. “You need to take that sign down. It offends us.”

We tried to explain we were raising awareness to help prevent the spread of HIV within the black community, but our efforts were not exactly effective.

Today is National Black HIV/AIDS Awareness Day (NBHAAD). Many believe the AIDS epidemic is over, in part because HIV does not get the media attention it used to. But nothing could be further from the truth, especially for black Americans.

Black communities disproportionately bear the brunt of the HIV/AIDS epidemic in America. Almost half of all new HIV diagnoses in the U.S. in 2016 occurred within the black community alone, and in the year prior, black Americans accounted for 52 percent of HIV/AIDS-related deaths in our country. These numbers are alarming on their own but carry additional weight when considering black Americans make up only about 12 percent of the total U.S. population. And when looking at the black LGBTQ community specifically, the results are even more grim: The Centers for Disease Control and Prevention predicts black gay and bisexual men in the U.S. have a 1 in 2 chance of HIV infection over the course of their lifetime.

These statistics ― and the parade hecklers ― prove comprehensive HIV/AIDS awareness is as needed today as it was back in 1999 during the first-ever National Black HIV/AIDS Awareness Day. All black people don’t have AIDS, and all people with AIDS are not black; however, AIDS in America is absolutely a black disease.

The question of whether we can end the overall AIDS epidemic in the U.S. has been asked and answered; we have the diagnostic, surveillance, treatment and biomedical prevention tools necessary to eradicate our country of this disease. The real question is whether we have the political and moral will to use these tools effectively, humanely and in an inclusive manner. We cannot end the HIV/AIDS epidemic in America if we don’t address the unique ways this disease affects the black community. National Black HIV/AIDS Awareness Day takes place during Black History Month for a reason. It is a reminder to black people that, as Martin Luther King Jr. said, “Of all the forms of inequality, injustice in health is the most shocking and inhuman.”

AIDS in black communities does not happen in a vacuum separate from the many social determinants of health, and efforts to end the HIV/AIDS epidemic in America absent of a social justice lens are destined to fail. As King said, “In a real sense, all life is inter-related ... Whatever affects one directly, affects all indirectly.”

This year’s National Black HIV/AIDS Awareness Day is especially bittersweet for me, because I recently announced I am soon stepping down as the Black AIDS Institute’s president and CEO, where I’ve had the privilege of serving for the last 19 years. When I started doing this work in 1983, I couldn’t have imagined this mysterious new disease, first identified at UCLA Medical Center, would become the defining health issue of my generation. I’ve been fighting the AIDS epidemic nearly my entire adult life.

HIV/AIDS is a critical part of any discussion about black survival. If black lives really matter, the lives of black people living with HIV/AIDS ― and those at risk for HIV infection ― must matter, as well. HIV/AIDS activists must learn to appreciate and understand the intersectionality of this disease. Though we’ve made progress on overall infection and death rates, HIV/AIDS continues to disproportionately affect black Americans.

As I contemplate my last National HIV/AIDS Awareness Day in my current post and think about what the next act of my life will include, I wonder what we’ll say when future generations ask (and they will ask), “What did you do to fight the AIDS epidemic?”  

We cannot let the answer be, “Not enough.”

Read more on HuffingtonPost.com.

Links to Resources:

  • Visit the National Black AIDS Day website to find events, explore toolkits, learn more about the awareness day, and more
  • Read the blog post NBHAAD 2018: Taking the HIV/AIDS Fight To the Future from the Black AIDS Institute
  • Learn more about NBHAAD Awareness Day at HIV.gov
  • Find HIV testing near you
  • Read HIV.gov blog posts over the years on resources, programs, and policies that inform the way our nation addresses the impact of HIV on black Americans
  • Read the blog post National Black HIV and AIDS Awareness Day: Stay the Course, the Fight is Not Over from the Human Rights Campaign
  • Learn about the Human Rights Campaign 2017 HIV 360° Fellows amplifying Black voices and leadership in LGBTQ and HIV spaces



How U.S. Mosques are Dealing with Rise in Mental Health Issues

Posted: February 06, 2018

They meet in a conference room on the second floor of the Islamic Association of Raleigh, a therapist and a member of the mosque experiencing emotional distress.

Sitting around a table in the windowless room, they talk for an hour, during which the therapist draws up a list of referrals to outside experts who can offer specialized help for marital conflict, children's behavioral problems, depression, substance abuse or other issues.

In the United States, many Muslims are reluctant to seek out mental health professionals because of the stigma attached to mental illness or because they fear that a Western-trained therapist will not understand their culture or religion. Instead, they turn to imams and other community leaders, who often quietly refer them to mental health professionals. But leaders of the Raleigh mosque, which draws thousands of worshippers a week, realized that mental health issues needed to be dealt with in a more professional and organized way and that the requests were inundating its two religious leaders.

"Our imams get hundreds of requests every week," said Azleena Azhar, a trained Muslim chaplain and one of the leaders of the referral initiative. "It's been very overwhelming for them. People are slowly finding out that if they don't need to get advice from a religious scholar - they can come to the team and talk to someone there instead."

A year ago, a group of mental health experts who also are mosque members agreed to volunteer their services. Members can go online and pick from six mental health experts - including a family therapist, chaplain and a substance abuse counselor - for a free and confidential session. This new referral initiative started here in September and is part of a growing menu of social services nationwide aimed at addressing the needs of American Muslims, which have never been stronger.

Muslims in the U.S. are racially and ethnically diverse, with nearly 60 percent born abroad. As a minority - making up 1.1 percent of the U.S. population - they have suffered assaults and intimidation.  They have faced a rise of nationalist rhetoric, which views immigrants as "other," have contributed to feelings of being bullied, harassed and otherwise treated with suspicion.

"There's this collective feeling of being under siege," said Dr. Hamada Hamid Altalib, a psychiatrist and neurologist who is president of the Institute for Muslim Mental Health and chief editor of the Journal of Muslim Mental Health.

Yet, many Muslims are wary of talking with outsiders about domestic violence or behavioral issues, for fear that may cast a bad light on the faith generally, said Kameelah Mu'Min Rashad, founder and president of the Muslim Wellness Foundation in Philadelphia. "There's an ambivalence about sharing these challenges outside of the community because it reinforces the stereotype we're trying to counteract about who we are," he said.

Providing mental health services through the mosque may provide cover as well as permission to access care, said Heather Laird, a psychologist who directs the Center for Muslim Mental Health and Islamic Psychology at the University of Southern California. Laird is one of a growing number of Muslims working to empower adherents to take advantage of mental health services. Laird is working on a developing a 24-hour mental health hotline for Muslims living in Southern California and has been instrumental in several initiatives to extend culturally compatible mental health services to Muslims through education, treatment and referrals. 

"There's a lot of intergenerational trauma in our community - a lot of issues that come up that have gone unaddressed: depression, marital issues, suicide among youth, LGBT sexuality," she said. "Our community is suffering."

That kind of cultural sensitivity is critical because Muslims won't seek out mental health services if they fear that their religious identity might be threatened, said Shaykh Suhail Mulla, resident scholar at the Islamic Society of West Valley in Los Angeles and the Muslim chaplain at UCLA. For example, a woman wearing the hijab and seeking out psychotherapy may not want to be told "You just need to take off your hijab and assimilate and be like everybody else and then you'll be able to find a job," he said.

Read more on HoustonChronicle.com.



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