Early 'mental health first aid' should be a priorty for everyone
By Steve Smith - Staff Writer
Statewide - posted Mon., Nov. 25, 2013
The U.S. is celebrating the 50th anniversary of mental health care legislation that President John F. Kennedy signed into law in 1963. The Community Mental Health Act of 1963 happened to be the last piece of legislation Kennedy signed. Yet, many people, including children and teens, are still having difficulty finding the care they need, in part because of incorrect perceptions that persist.
One of the speed bumps to receiving help is that more caregivers, social workers and even first-responders need to recognize the signs that help is needed - and be able to refer people needing mental health care properly. Better systems of early detection and proper referrals need to be in place (and are being worked towards), but it may indeed "take a village" to identify those children and teens who need help and get it to them.
Meagan Allen is a 21-year-old Madison resident and a student at Mt. Holyoke College in Massachusetts, who has suffered from OCD and has fought the stigma, as well as ignorance, on her way to finding treatment.
"I don't remember the first time I displayed my symptoms," Allen said. "What I do remember - and what I will always associate with OCD - is fear. It's an all-consuming fear, one that becomes almost paralytic," she said. Allen explained that her obsessive thoughts make her entire body tense up, and the thought will play over and over in her head. These thoughts could be so obsessive that she could not remember doing menial tasks, including school work.
Allen frustrated teachers, who did not know how to deal with her. She was evaluated by a psychologist, who, after extensive testing, said she had “OCD-like symptoms,” but refused to officially diagnose or medicate her, because medical literature said most people with OCD don't display symptoms until their late teens. She suffered through what she described as a "never-ending stream of gruesome nightmares," and thoughts of death (including thoughts of finding all of her family and friends decapitated). One psychiatrist prescribed Zoloft to Allen when she was 10, and declared her cured, although she noticed no change in her condition.
"Throughout middle school and high school, certain administrators would refuse to acknowledge my OCD, despite having all of the appropriate documentation. Their responses ranged from, 'You don't need any help, you do fine in schools' to, 'You clearly don't have a problem' to, 'What is OCD anyway? Can't you just get over it?'"
Allen said people often tell her it is "not a real problem" and that the medication she's taking is "just poisoning her body."
Eventually she found a psychiatrist (one that she still sees today) who tried talk therapy and carefully helped her confront her fears as they arise.
"This doesn't bother me anymore," she said. "Instead of being ashamed of having OCD, I am proud, because it has made me who I am. I will always have obsessions."
Dr. J. Craig Allen (no relation to Meagan) said that a national 2010 study found that 20 percent of youths had suffered from some mental disorder throughout their entire lifetime, including mood disorders, which are most-common, followed by behavioral disorders like ADHD and anxiety disorders. That percentage is higher than that of physical disorders, he said, yet only one in three receive any type of treatment. Of those who do, 70 percent receive six or fewer sessions with a professional.
The importance of finding disorders early, and intervening, is of utmost importance, the doctor said, adding that some can be stopped, and others can have their severity greatly reduced.
An adolescent's brain – particularly the part that contains judgment and risk-assessment – is still developing, Dr. Allen said, adding that any introduction of substances that stimulates the reward pathway can result in a brain being changed forever, making intervention for substance abuse far more critical than is commonly believed.
"These interventions are available," he said. "There are barriers to making them available in all communities. That is one part of the dialogue that we'd like to have."
Barbara Ward-Zimmerman, a clinical and school psychologist, said she feels that caring for every child and adolescent's mental health is a community affair that should incorporate parents, caregivers, grandparents, school personnel and athletic directors, as well as mental healthcare professionals. The question, Ward-Zimmerman said, is "when should worry prompt action?"
"I think the message is that we need to seek help as early as possible," she said, adding that pediatric primary care should be the "first line of defense."
"The nice thing is, it's very early on," she said. "Primary docs can't be left holding the bag themselves. We need to support them. We can ask them to do mental health screenings from the get-go, all the way through development. We can also help them to learn great interventions... and when it is appropriate to triage. What we all need to do as mental health providers, is to develop a system of primary care along with the education system. It will take all of us working together to address the needs of all of our kids."
Steve Larson, who oversees behavioral health services for Hartford Healthcare, said that after the tragedy in Newtown in December of 2012, it was clear that there needed to be more dialogue about mental health, and that many more community-type conversations are taking place in eastern Connecticut, as well as better training in mental health "first aid."
"If you really think about it, it is like first aid," Larson said. "It's not meant to be treatment, it is really meant to help people to recognize mental health issues, help reduce the stigma, enable people to talk about it, and to know what to do about it."
Rushford (a mental health and substance abuse treatment facility) President and CEO Jeff Walter said that youth mental health is a very important topic, but "not always at the forefront of what we talk about in the community."
Rushford and Hartford Healthcare have been active in community forums and other ways of educating the public to try to build that ground swell of across-the-board awareness and support, in conjunction with local-based social services.
Sheryl Sprague, prevention manager at Rushford and recent president of the Glastonbury Alcohol and Drug Council, said that there is an eight-hour course on mental health first aid available to identify disorders, refer those who need further care and to help reduce stigma. The course is offered to parents, teachers, caregivers – literally anyone. Those courses can be found at mentalhealthusa.org, or are also offered through Rushford.
"Another call to action is to get involved with your local prevention council," Sprague said, adding that local social services agencies are also some of the best resources.