News & Announcements
The Challenges for Doctors Treating Migrant Children Separated From Their Parents
Posted: August 09, 2018
Clinicians at public hospitals in New York City who have started seeing children separated from their families at the border are concerned about the psychological impact of the separation as well as the practical challenge of treating children whose medical history is unknown.
At a news conference, officials announced that at least 12 such children had been seen at public hospitals, brought in by their new caretakers. Dr. Mitchell Katz, president and chief executive of NYC Health & Hospitals, described the children “being brought in by loving foster families struggling to take care of these children,” but aware that they have been traumatized by the separation. The announcement took place in the atrium of Bellevue, the oldest public hospital in America, founded in 1736 — a reminder that these institutions have a long history of providing front-line care to the marginalized, the dispossessed and struggling new arrivals.
Dr. Daran Kaufman, the director of pediatric emergency services at NYC Health & Hospitals/North Central Bronx, said that she had reached out to Dr. Katz because “all of us in our emergency department have been touched so deeply by this issue and the patients we’ve seen.” The foster parents who have brought the children in, she said, “have been very caring, but they’ve also felt quite unsure how to address the needs of these children.”
The children who come in with medical issues such as asthma are without adult family members who can provide medical history, Dr. Kaufman said. In some cases, doctors have asked for details of past illness and treatment from older siblings who may themselves not even be teenagers.
And then there are the children’s emotional needs, which are far more difficult to address. Dr. Jennifer Havens, the director and chief of service of the department of child and adolescent psychiatry at Bellevue Hospital Center, said that in the pediatric emergency room, doctors are accustomed to seeing adolescents who came to the United States without their parents, and have been placed by the government in the care of social service agencies. But now they have started seeing much younger children who were separated from their families at the border.
Dr. Ruth Gerson, director of the Bellevue Hospital Center Children’s Comprehensive Psychiatric Emergency Program, said that helping these children presents special difficulties. “Typically as child psychiatrists, we’re helping children deal with trauma, whatever it is, after it’s over and they’re in a safe and secure environment,” she said. “These kids are in the midst of ongoing trauma. They don’t know if their families are O.K., and we as therapists are also in a much harder position — we don’t know how to help, we don’t know the facts, it just makes trauma treatment so much more complicated.”
Young children who have suffered trauma may regress developmentally, she said, losing skills that they had mastered. Or they may have behavioral symptoms like severe tantrums or difficulty sleeping. “It’s important for people to remember that young children can experience pretty severe depression and suicidal thoughts, even preschool children,” she said, and caretakers should take any such statements from children seriously.
And children suffering from post-traumatic stress may describe their symptoms in terms that adults may misinterpret, she said.
“How do we understand a child who says they’re hearing voices after a severe trauma?” Dr. Gerson said. In an adult, the diagnosis might be psychosis, but this may be how a child describes flashbacks or intrusive thoughts, common symptoms of PTSD.
In older school-age children and adolescents, she said, “depression can often look like irritability, a child who seems angry all the time, not necessarily sad and mopey.” Caretakers should watch for any evidence of self-injury, and again, be alert for behavioral changes as well as any expressions of despair. And all of this is more complicated if there are language barriers.
Gov. Andrew M. Cuomo toured a residential facility housing some of the children, where an official said: “They have trouble sleeping, sometimes they’re anxious, depressed, crying, primarily.”
The doctors speaking at Bellevue said that there are probably more of the children separated from their families coming in for care than have been identified. “We don’t ask about people’s immigration status here because we want families and children who are concerned about their immigration status to feel safe coming here,” Dr. Gerson said, “because our mission is to provide treatment.”
At the news conference, Dr. Katz called providing care for these children “a phenomenal use of Health & Hospitals” to “be here for people, whatever the crisis,” and Chirlane McCray, the first lady of New York City, thanked the clinicians at the city’s hospitals who are treating these children “how every child should be treated.”
“We’ve just tried to show these kids kindness,” Dr. Kaufman said. That means language and cultural competency — they are able to speak to the children in Spanish — but it also means trying to do a little extra for both the children and their caretakers. “We let them know they are welcome here, even though they’ve experienced such trauma, we have toys and books and gifts and we give as much as we can to the children and to the families caring for these children.”
“My biggest priority is to have people realize that developmental regressions, giant tantrums, sleep problems, hearing voices, can be a totally natural response to trauma,” Dr. Gerson said. “We need to get these kids back with their families.”
Read more on NYTimes.com
Request for Comments: Drafted Indian Health Service Strategic Plan Fiscal Year 2018-2022
Posted: August 09, 2018
The Indian Health Service (IHS) is developing an Agency-wide Strategic Plan to guide the work and strengthen partnerships with Tribes and Urban Indian Organizations.
The IHS is seeking public comment on its Draft IHS Strategic Plan fiscal year (FY) 2018-2022 (Draft IHS Strategic Plan FY 2018-2022). Additionally, notice is given that the IHS will conduct a Tribal Consultation and Urban Indian Confer regarding the Draft IHS Strategic Plan FY 2018-2022. In addition to the virtual town hall sessions, the IHS will seek other opportunities to solicit input from Tribal and Urban Indian programs on the Draft IHS Strategic Plan FY 2018-2022 during the comment period. For IHS Strategic Plan events during the comment period, please check the IHS Event Calendar.
The strategic goals of the IHS are:
Deadline for comments is August 23, 2018.
Suicide Risk among Pacific Islander, American Indian, and Multiracial Youth
Posted: August 08, 2018
A national study found that Native Hawaiian and other Pacific Islander (NHPI), American Indian/Alaska Native (AI/AN), and multiracial adolescents have an increased risk of illicit substance use, depressed mood, and suicidality compared to their non-Hispanic White peers.
Small population sizes of NHPI, AI/AN, and multiracial adolescents make it difficult to measure their substance use and mental health needs in national surveys. To address this issue, researchers pooled 1991 to 2015 data from the nationally representative Youth Risk Behavior Surveillance System. They used these data to develop national prevalence estimates of depression, substance use, and suicidality among NHPI, AI/AN, and multiracial youth, and then compared the estimates to non-Hispanic Whites.
The analysis found that NHPI adolescents had rates of attempted suicide two times higher than non-Hispanic Whites, and that current cigarette use predicted greater odds of attempted suicide. Among AI/AN adolescents, rates of attempted suicide were three times higher than among non-Hispanic Whites, and current alcohol and cigarette use both predicted greater odds of attempted suicide. Rates of attempted suicide among multiracial adolescents were similar to those of AI/AN adolescents.
The authors suggested that higher risk for substance use, depressed mood, and suicide attempts among NHPI, AI/AN, and multiracial adolescents may stem from socioeconomic and health disparities. Culturally relevant screening, prevention approaches, and interventions are needed to address the substance use and mental health issues of NHPI, AI/AN, and multiracial adolescents.
#BeTheDifference This Back-to-School Season
Posted: August 07, 2018
Mental illness and substance use disorders are prevalent. And that’s true for young people, too: one in five youth aged 13-18 will experience a mental illness in their lifetime. That means that in a classroom of 25 students, five will have a mental illness.
To address mental health and substance use in school settings, The National Council's Mental Health First Aid USA (MHFA) #BeTheDifference focus this month is Back-to-School: Why Mental Health Matters at School.
Here are 5 ways you can #BeTheDifference this back-to-school season:
Mental Health First Aiders are making a difference in communities across the country every day.
Read more on MentalHealthFirstAid.org.
Mental Health Advocates Share Stigmas They Face as a Person of Color with Mental Illness
Posted: August 06, 2018
In the world of mental health awareness, there are myriad stigmas that make it harder to get treatment. For people of color who live with mental illness, those stigmas can be compounding. Whether it's the dangerous myth that Black men are "too strong" to seek mental health treatment, or that only certain women can experience an eating disorder, these stigmas are incredibly damaging, and often render people of color who experience mental health issues invisible.
But, of course, mental health issues affect people of any race or identity. According to Mental Health America (MHA), 8.9 million Latinx people in the U.S. live with a diagnosable mental illness, but, as the American Psychiatric Association (APA) found, only 36 percent of Latinx people with depression received care. And the National Alliance of Mental Illness (NAMI) reported that Black Americans are 20 percent more likely to be diagnosed with a serious mental health issue than the general population, but only 25 percent of Black Americans with mental illness receive treatment. What’s more, the APA reported that Indigenous Americans and Alaskans “experience serious psychological distress 1.5 times more than the general population," and the rates of post-traumatic stress disorder (PTSD) in Indigenous communities are twice that of the general U.S. population.
Long story short, mental illness is far from being a health issue that only affects some people, and for people of color, the particular stigmas around mental health they face can create a uniquely isolating experience. These mental health advocates tell Bustle the unique stigmas they face as a person of color who lives with mental illness, and how they combat them.
Alison Mariella Désir-Figueroa
"I think that the myth of the strong black woman plagued, and continues to plague me as an Afrolatina woman who suffers from anxiety and depression. The burden of typically always being seen as resilient, tough and a 'boss' doesn't leave much room for vulnerability," says Alison Mariella Désir-Figueroa, an entrepreneur, athlete, activist, and mental health counselor in training.
"After not being on medication for several years, I recently started taking an anti-anxiety medication again, and I had to wrestle myself away from the line of thinking that this was somehow a personal failure or a step back in the wrong direction," she says. "The messages we receive about mental illness, and the negative stigmas associated with it are ones that we all must continue to speak openly about because, even as a mental health professional and mental health advocate, I am affected. Through my work and advocacy, I hope to create spaces and communities that normalize mental healthcare, particularly for people of color."
Elyse Fox, a filmmaker and the founder of Sad Girls Club, tells Bustle, "In the past, society has made me feel the most displaced as a woman of color with a mental illness. Growing up, I never had any examples of people of color striving through life while living with depression, anxiety, etc. Representation truly matters in making mental health conversations normal, and shameless to discuss."
"As a person of color with mental health issues such as depression and anxiety, people made me feel as if what I was going through wasn’t real. Specifically coming from Latinx households, my family made me feel like I needed to be at an 'extreme' point in order to access the care that I needed, which was therapy," says Amy Quichiz, a writer, activist, and the co-founder of Veggie Mijas. "I believe there are still many stigmas such as not wanting to talk about it, dismissing it by saying, 'ella está loca' [she's crazy], instead of acknowledging mental health. It took me a while to believe that taking medication for my mental health was OK, and to talk about depression and anxiety without it being a 'private issue that stays within family.'"
Quichiz adds, "I think the more we talk about it, the more we have other folks of color to acknowledge the truth, and face their vulnerabilities — which is a good thing and part of the healing process."
Chamique Holdsclaw, an Olympic gold medalist and former WNBA player who's now a vocal mental health advocate, and star behind the documentary Mind/Game, tells Bustle, "A unique stigma and discrimination I’ve faced as a person of color with mental illness is the expectation of praying away my illness. From others' stories that have been shared with me, minority groups are faced with not being right in their religion or spirituality as to why they are experiencing mental illness, which to me is a dangerous point of view and keeps people from speaking up and seeking help.”
Gloria Lucas, the founder of Nalgona Positivity Pride, says that "One of the unique struggles I faced as a brown womxn with an eating disorder was no advocacy for me in the professional eating disorders world, and no language to talk about unhealthy relationships with food in my own community. Considering how eating disorders are portrayed as mainly affecting white, thin, and affluent women, I was never able to see my own reflection — which only increased my isolation, and the severity of my eating disorder.
"As a Latinx woman who struggles with multiple mental illnesses, it saddens me to admit that the most stigma I have received towards my mental health has been from my own family," says Deb Blake, a mental health advocate and activist with Utah Against Police Brutality. "I grew up in a "no se habla de eso" [we don't talk about it] culture. I was constantly told that I was just being dramatic, and that my illness wasn't real. Trips to mental health facilities were 'vacations.'"
"I was in a session with a therapist at college, and after explaining the dynamics and challenges with my family, she told me that I needed to stand up to my mother and fight against how she raised me. I felt attacked, and I also felt like my mother was being attacked," says Dior Vargas, a mental health activist who founded the People Of Color and Mental Illness Project, which has since been transformed into a full-length book titled The Color Of My Mind. "The therapist wasn’t understanding that this was my [Latinx] culture. Family is extremely important, and things aren’t done that way in my household. I stopped seeing her after that because I knew I couldn’t be comfortable and open with her again."
Our conversations surrounding mental health awareness need to keep expanding by making space for people of color to safely voice their experiences and to share their unique experiences of mental health discrimination. It's time to get rid of the mental health stigmas that have kept people of color with mental illness from either seeking treatment, or receiving quality care.
Read more on Bustle.com.