The Child Mind BlogBrainstorm
Mental Health Care: Who Needs It and Who’s Getting It
May 26, 2015 Caroline Miller
The New York Times got a lot of attention last week with a dramatic headline: "Severe Mental Illness Found to Drop in Young, Defying Perceptions." The article was a report on a study, published in The New England Journal of Medicine, about trends in kids (6 to 17) getting treated for mental health issues from roughly 1996 to 2012.
Over that period of time the percentage of kids getting some kind of outpatient mental health care rose, from 9.2% to 13.3%. So who, wondered researchers, was that care going to? Was it, as some would argue, going to kids who don't need it?
To get at an answer, they divided the kids into two groups—more severely impaired and less severely impaired—based on parents filling out scales on 13 kinds of impairment. And they found, as the Times headline points out, that there was actually a decline over that period in reports of kids in the severe category, from 12.8% to 10.7%.
What does that mean about who's getting the increased care? Here's where it went:
• Services to kids with more severe impairment rose from 26.2% to 43.9%.
• Services to kids with less severe impairment rose from 6.7% to 9.6%.
So the percentage of kids getting services who have severe impairment is more than four times that of less impaired kids, and the percent increase over the period is greater, 67.5% compared to 43%.
And here's the thing: The increase in care is impressive, but still, less than half of kids with severe impairment and less than 10% of kids with less severe impairment are getting treatment.
The Times also notes the fact that the number of kids with severe impairment in this study are lower than other studies which have put the prevalence of severe impairment in kids at around 22%. Here's where it gets confusing, because the scale these researchers used for impairment, called the Columbia Impairment Scale (CIS) is different from the criteria used by other researchers.
Many other prevalence studies are based on diagnostic criteria—either via parent reports of a diagnosis by a health care provider or direct diagnostic interviews by a professional of a sample population of kids.
As Kathleen Merikangas, a National Institute of Mental Health researcher who has conducted some of the most significant prevalence studies of children and adolescents, tells the Times, "Right now we have all these different agencies doing surveys, each using a different method. It's a nightmare. We need to do better."
And what of the decline in severe impairment? The study's lead author, Dr. Mark Olfson of Columbia University, offers several possible explanations for this trend: prevention (maybe parents are doing something that's protecting kids) and increased treatment.
But here's Dr. Olfson's final conclusion in the study results: "Despite the increase in treatment, many young people with severe mental health impairment received no care. In schools and primary care settings, improvements in the identification and referral of young people in the greatest need of treatment could provide community benefit."
Speaking of perceptions of mental health, as the Times is, it's important not to ignore the obstacles—including, frequently, stigma—that prevent kids from getting the care they need. Recognizing this would have made for a different and more challenging headline.View Comments | Add Comment
Change Maker Awards: Chirlane McCray, for Fighting for Access to Mental Health Care for All New Yorkers
May 22, 2015 Caroline Miller
One of the toughest things about mental illness is how lonely it can be. When you're struggling emotionally, you need allies and advocates who will do research, make phone calls, find the most appropriate care, and offer support while you do the work it takes to get better.
No one knows this better than Chirlane McCray, who is the First Lady of New York. Chirland has been that ally and advocate for her daughter Chiara, and now she's is trying to do it for the whole city.
Chirlane's daughter Chiara struggled with anxiety, depression, and substance abuse as a teenager. "Our child was in a great deal of pain, terrible pain, but because it originated in her mind, and not another part of her body, there was no established series of steps for us to follow," Chirlane said at the Change Maker Awards ceremony, as she accepted the Activist Award.
And Chirlane and her husband, New York Mayor Bill de Blasio, were acutely aware that they had the connections and the resources many other parents in the city don't have.
"All the time I was looking for someone to help her, all the time I was talking with people, I wondered, what about families who don't have the advantages that we have? Like, how do they do it?" she said. "And how can we create a mental health system that works for every New Yorker?"
So this past January, Chirlane announced that under her guidance the city will be crafting a new "road map" to address mental health issues and create a more inclusive mental health system. City agencies will work with community groups to investigate the scope of the problem, the number of people affected, and their demographics, including race and socio-economic status. Then they will make recommendations that cut through bureaucracy to get children and adults quality mental help faster.
The mental health road map won't be ready until this summer. So in the meantime, Chirlane and Chiara together have launched NYC Teen Text, an initiative that enables students at high schools throughout the city to to receive confidential help and emotional support via text when they need it. And she's tweeting up a storm, with hashtag #ShatterTheStigma, to open up honest discussions about mental health care needs.
When the Germanwings flight went down in March, she wrote a letter to the editor of the New York Times. "Mental health care must be as accessible as getting a flu shot," she wrote. "We must seek to change the culture so that people realize that seeking treatment for mental illness is an act of strength, not weakness."
Chirlane has been both a poet and an activist all her adult life. We applaud her for using the platform she enjoys as First Lady to offer her support to all New Yorkers who struggle with mental illness. And we were delighted to hear her report: "Our family was lucky; we eventually found enough of what we were looking for. And Chiara is now kicking butt at recovery."View Comments | Add Comment
Change Maker Awards: Bloomingdale's, for Promoting Mental Health Awareness
May 20, 2015 Rachel Ehmke
When you think about Bloomingdale's, most people think about shopping, but at the Child Mind Institute we have a slightly different perspective. That's because Bloomingdale's happens to be one of our founding partners, and if you think that sounds unique for a retail store, you're absolutely right.
As anyone who has ever been diagnosed with a psychiatric disorder knows, there is stigma attached to mental illness. It is something people often prefer to ignore or keep hidden, and it takes courage to acknowledge mental illness and speak up about it.
The same holds true for corporations, so when Bloomingdale's came on as a partner five years go, we knew from the start it was going to be a very important and meaningful relationship. And it has been, so we were very pleased to give the Corporate Advocate Award to Tony Spring, the CEO of Bloomingdale's, at our Change Maker Awards ceremony.
In the years we've been working together Bloomingdale's has sold numerous limited-edition products that have raised funds to benefit patients and research at the Child Mind Institute. Through this partnership they've also been promoting awareness about mental health, in their catalogues and signage, which is perhaps even cooler. An estimated 17.1 million children have or have had a psychiatric illness, which is more than the number of children with cancer, diabetes, and AIDS combined. Yet families often report feeling alone in their struggle and sometimes even delay getting care because stigma has made them afraid or ashamed.
For those famililes we need reminders that mental illness is as universal as physical illness, and when Bloomingdale's puts the cause front and center throughout the year in their stores, they are getting those families' attention in a way we never could without their help.
At the Change Maker Awards Spring talked about the importance of tackling that adversity head-on, and not being ashamed. Citing the many brilliant people who were dismissed early on—including Beethoven, Charles Darwin, Walt Disney and Albert Einstein—he said, "While not every child will be famous or extraordinary, doesn't every child deserve the opportunity to be happy, and achieve their very best?"
We certainly think so, and we're glad Bloomingdale's does, too. No other national company has made the kind of commitment to children's mental health care that Bloomingdale's has, but we hope more companies will follow in their footsteps.View Comments | Add Comment
Mindfulness: How and Why It Works
May 19, 2015 Caroline Miller
The path that led Dan Harris to mindfulness meditation started with a panic attack on national television. It was Good Morning America, to be specific, which means it was witnessed, he notes, by an estimated 5.019 million people.
Harris spoke about his experience at the Child Mind Institute's 2015 Spring Luncheon yesterday, headlining a panel on the benefits of mindfulness that was moderated by psychiatrist Gail Saltz. An ABC News correspondent, Harris is the author of 10% Happier: How I Tamed the Voice in My Head, Reduced Stress Without Losing My Edge and Found Self-Help That Really Works-a True Story. Panelists explained mindfulness in both scientific terms and practical terms.
"Mindfulness is the ability to see what's going in your head, " Harris said, "combined with the ability to not get carried away with it."
Dr. Allison Baker explained the role of mindfulness in managing anxious or negative thoughts. "It helps you step back and look at that thought as just a thought, as opposed to a reality," she said. "That in turn is allows you to have a little distance and not necessarily engage in that thought and get agitated about it, or have your sleep disrupted because of it."
Over time it means that you have choices in terms of how you engage in or react to that thought, she added, and that sense of control is very powerful.
Cameron Craddock, the Child Mind Institute's Director of Imaging, described research he and others are doing that shows that there's a brain network—they call it the default mode network—that is constantly active when you are having recurring, repetitive thoughts. "This is a network that is turned off when we are performing an external, goal-driven task. And we've shown that if that network doesn't go off, you actually can't perform that task."
The research shows, Dr. Craddock said, "that people who practice mindfulness meditation over time end up being much better at turning off this network and holding it off, as well as being able to turn it on in times when it's appropriate to turn it on."
Added Harris: "What the good doctor calls turning off the default mode network, I call getting out of your own way. "
Dr. Craddock described mindfulness mediation as exercising that part of your brain that modulates, or turns that network on and off. Harris used the same metaphor: When you're practicing mindfulness meditation, every time your thoughts wander from the present moment, and you bring them back, "that's a bicep curl for your brain."
The reason to practice mindfulness, he noted, is that "most of the things that you are most embarrassed by in life come from mindlessness: Finding yourself with your hand in the refrigerator when you're not hungry. Checking your cell phone when your kid is trying to talk to you. Losing your temper when it's strategically unwise."
Bottom line: "Meditation is a pretty common sense way to see what's happening in your head," he said, "so you're not yanked around by it. "View Comments | Add Comment
Change Maker Awards: Tim Murphy, for Championing Mental Health in Congress
May 15, 2015 Harry Kimball
US Representative Tim Murphy is a clinical psychologist, but his first experience of mental illness came long before he decided on his first profession. "I remember when I was ten or eleven years old, growing up in Ohio, there was this railroad track in front of the house," he told us in Washington, DC. "And one time when the train was supposed to come, it didn't—and all I saw was this light. I asked my Dad about it, and he said someone had escaped from the local psychiatric hospital and laid on the tracks."
"How could that be?" he remembers thinking. "How could someone do that?" That formative memory and his years working in the mental health field have led to a political career committed to making change for people and families struggling with psychiatric disease. Congressman Murphy is co-chair of the Congressional Mental Health Caucus and sponsor of landmark mental health reform legislation, the Helping Families in Mental Health Crisis Act, which he hopes will bring real, transformative change to a broken system.
Murphy has not forgotten that childhood thought—"How could that be?"—and brings it to bear on the state of mental health care in the US, which he has called "immoral" and "embarrassing." He is confident that his bill can work to address the problem legislatively-but he also knows that this issue is deeply personal, and that change begins with each of us.
People and families struggling with mental illness exhibit "courage under fire," Rep. Murphy told the crowd at the Change Maker Awards. They face a complicated, confusing system—and illnesses that are so misunderstood and maligned that most people would rather ignore the problem. But the bravery of these families must be matched by our own resolve.
"That's what we need to do when it comes to dealing with mental illness, to have courage," he said after accepting the Champion Award. "To have the courage to say, 'We will stand up for this. We will work for this. We will forget all the barriers that divide us, and see that this is something that must unite us.'"
Rep. Murphy's thinking follows a clear line—from that speechless 11-year-old boy to the Pennsylvania psychologist all the through to the politician and Naval Reserve officer who treats patients at Walter Reed. "Mental illness doesn't know income level, or race, or gender, or preference, or party," he said. "Let's work together." We couldn't agree more.View Comments | Add Comment
Change Maker Awards: Active Minds, for Fighting Stigma on Campus
May 13, 2015 Caroline Miller
For Alison Malmon, the more than 1,100 college students who commit suicide in this country every year are much more than a statistic. Her brother was one of them.
When she was a freshman at Penn, her older brother Brian took his own life. Alison and Brian had been so close people thought that they could be twins. But when Brian found himself plunging into psychosis and a deep depression, he'd hidden his symptoms. "He was ashamed. He was scared. He thought it was his fault," Alison explains. "He thought he was the only one not having the best time of his life in college, and that's why he kept it quiet."
And that's why Alison founded Active Minds—so that other college students who are struggling emotionally will know they're not alone. Active Minds encourages students to speak openly about mental health, to dissolve the stigma and secrecy around mental illness.
"Brian needed to hear from his peers, from his friends, from people who had graduated from his university and were successful, that they too had struggled, and yet they were okay, and they were living with and managing their disorder as part of their everyday life," Alison adds. "But he never got that message."
Now more than 10 years old, Active Minds involves 10,000 students a year in student-run chapters on 400 college and high school campuses across the country. These groups promote awareness of mental health, support students who are struggling, and help connect them to counseling. They are changing the environment on campuses by welcoming students to share their suffering and seek help.
Research shows that 60 percent of young people with depression and 80 percent of those struggling with anxiety don't get treatment. Untreated anxiety and depression are major risk factors for suicide.
And as Lucy Ingram, who was diagnosed with bipolar disorder when she was a Connecticut College student, discovered, isolation is a huge barrier to getting effective treatment.
"In addition to the depression and anxiety I was experiencing, I distinctly remember how lonely, isolated and confused I felt during that time," Lucy writes on the Active Minds web site. "I felt intensely embarrassed and ashamed, and was scared to tell my friends, family and teachers about the difficulties I was experiencing. I had no idea what was happening to me, and did not have an adequate understanding of what mental illness was and where I could go to seek help."
Active Minds was a life saver for Lucy. "While it remained challenging to be a college student with mental illness, reaching out for help and sharing my experience with those around me proved invaluable to my recovery."
So the role of Active Minds is to fight that isolation, explains Alison, now the organization's executive director, by building a community of young adults who know what to say to friends who are distressed, and who know how to connect with the on-campus counseling services, or the crisis text line, or whatever it may take to get to people help as soon as they need it.
"Had Brian gotten support earlier," she said, "I think his life would have been different.View Comments | Add Comment
Spotting Moms' Depression at Kids' Checkups
May 12, 2015 Harry Kimball
Depression screening at the doctor's office is familiar to most adults. A new study out of UC Davis gives it a twist: screening moms for symptoms of depression when they bring their kids for a checkup. And why not? "Pediatricians are in a position to talk to moms about the effects of depression on their children and use that as a motivation to get their symptoms evaluated," the lead author tells ScienceDaily.
The study tested the effectiveness of a very specific intervention, composed of a questionnaire and then "targeted education that focused on removing the stigma associated with depression and how treatment could improve their children's health" for mothers with symptoms. Nearly 74% of them sought help, compared with 54% of controls who were simply screened and given more general information,
That seems like a win-win, and suggests that whether you stick to a specific intervention or not, pediatricians talking to moms about mental health is a good idea. And it certainly makes sense that emphasizing the powerful effects of a mother's wellbeing on her child's health is a good motivator. "If I can give pediatricians an efficient intervention to implement in their practices," the lead author says, "we can really increase our ability to identify women with depression."
This all just begs the question—why not also give pediatricians the tools and education they need so they can also identify kids with depression?View Comments | Add Comment
More Kids Experiencing Mental Health Disorders
May 6, 2015 NBC Illinois
The Children's Mental Health Report is featured.View Comments | Add Comment
CMI Honors Change Makers From City Hall to DC to PS 59
May 5, 2015 Caroline Miller
Last night the Child Mind Institute celebrated five great people and organizations that are changing the way we think about and treat kids struggling with mental illness.
The Change Maker Awards, as we're calling them, were the kickoff of our annual Speak Up for Kids campaign, held each May. As the host for the evening, actress and comedian Ali Wentworth, put it: "Raising our voices lets struggling young people know that it's okay to ask for help and that help exists."
Here are the evening's honorees:
The Advocate Award: New York First Lady Chirlane McCray knows from personal experience what a struggle it can be to find the right help for an adolescent wrestling with mental illness. She helped her daughter Chiara get treatment for depression, anxiety and substance abuse. And now she's trying to help the whole city get better access to care. Chirlane is leading the creation of New York City's first "road map" to construct a more inclusive mental health system. Its recommendations will cut through bureaucracy to deliver quality care faster.
The Corporate Advocate Award: Everyone knows Bloomingdale's, but not everyone knows the courage Bloomingdale's has shown in the causes it supports, from AIDS prevention and treatment back in the 1980s to fighting the stigma around mental illness. Bloomingdale's has supported the Child Mind Institute since its inception with fund-raising events and products, and has helped spread the word that it's important to talk openly about psychiatric and learning problems so kids can get the care they need. The award was accepted by Bloomingdale's CEO Tony Spring.
The Local Hero Award: Angela Renz is a social worker in two New York City schools who is known for moving mountains to help kids get attention for emotional and family problems. Angela is alert to the impact of trauma on kids, and she connects them to the services they need. Whether they lost a home in Hurricane Sandy or they face stress and violence on a daily basis, she is there. Angela also helps teachers at risk of burning out, getting them the support they need so they can remain a consistent force of good in her kids' lives.
The Community Builder Award: We know that isolation is one of the most destructive and painful aspects of mental illness—something Alison Malmon learned first hand in college, when her older brother Brian took his own life. Brian had struggled with depression and psychosis, but he hid his symptoms, even from his sister. After Brian's death, Alison founded Active Minds to help other college students get the support they need to get treatment and get better. Now in 400 colleges, Active Minds empowers students to speak openly about mental health: with each other, with their school administrations, with government officials. They run mental health first aid training and a suicide prevention campaign.
The Champion Award: Congressman Tim Murphy, a Republican from Pennsylvania, has committed his life's work, twice, to getting help to people with mental illness. For the first half of his career, he was "Dr. Tim," a clinical psychologist. These days, he is co-chair of the Congressional Mental Health Caucus and the most outspoken advocate for mental health care in Washington. In December, Rep. Murphy unveiled the Helping Families in Mental Health Crisis Act to create meaningful changes in the US health care system.
George Stephanopoulos, host of ABC's This Week and Good Morning America, gave the award to Rep. Murphy. Stephanopoulos noted that the congressman "talks loudly and with great authority about the fact that millions of Americans-many of them children-have severe mental illnesses that go untreated because their families struggle to get them access to good care. Tim Murphy won't stop until we ALL feel better."View Comments | Add Comment
Mental Illness Affects 17 Million Under 18: CMI Children's Mental Health Report
May 5, 2015 Harry Kimball
Last night at the inaugural Change Maker Awards, the Child Mind Institute released its first annual Children's Mental Health Report. Founder and President Harold S. Koplewicz, MD, mentioned just a few of the findings:
• An estimated 17.1 million US children and adolescents now have, or have had in the past, a diagnosable psychiatric disorder
• Two thirds of children with a mental illness do not get treatment
• Anxiety is the most prevalent mental illness among children
• 80% of kids with an anxiety disorder don't get treatment
• The cost to society of untreated mental illness in young people is hundreds of billions of dollars a year
"These numbers defy the imagination," Dr. Koplewicz said. "They are unacceptable." But they do make it more clear what we can do to change things for the better. Dr. Koplewicz hit on three major takeaways. "Access to care is a huge problem," he said, "and public awareness is lacking." Furthermore, "we do far too little research into psychiatric disorders in kids, particularly in the youngest people, where intervening can be so transformative."
The report synthesizes the most reliable data available on the prevalence of mental illness in children and adolescents, the gap between the need and care, and the efficacy of treatment. All numbers include sourcing. The report attempts to gather what we know—but also call attention to what we don't.
Dr. Koplewicz pledged to continue producing the report annually in the hope that "it will raise awareness both of the magnitude of the problem and of the clear benefits of confronting it head on," including the "research dollars, training programs, and public education efforts we need to bring these kids out of the shadows."
But childhood mental illness is not just a public health problem—it's a very personal, family-based struggle, too. We want to assume that our kids are healthy, so sometimes we look the other way when there are signs of trouble, Dr. Koplewicz tells Web MD in an interview about the Children's Mental Health Report. "But this is really one of those times when looking the other way can be detrimental to the child."View Comments | Add Comment