Laura Zera

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Mental Health Treatment and Mass Shootings

By Laura Zera 10 Comments

After each mass shooting in the United States, there are calls for increased gun control, better access to mental health services, or both. Fuelled by emotion, we seek solutions; I have been right in there, too, simultaneously grieving those lost and asking for system changes to prevent reoccurrences.

A bit ago, I came across an article which hypothesized that improved mental health treatment won’t impact mass shootings or school killings. The author, Dr. John M. Grohol, founder of website PsychCentral.com, focuses on school shootings in this piece, and posits that what will help most is restricted access to household guns, and more involved parenting.

Two pieces of a puzzleWhen I re-read this piece today, I pondered whether I agreed or not (and then I veered off to something about the Paul Simon and Edie Brickell arrests for disorderly conduct, and then I saw a Jennifer Aniston story that I just had to read—love her—and then I came back to this mental health piece. And so it goes. Sometimes it helps to break the tough topics into bite-size pieces.).

Like I said, I’ve let my emotions lead me into the debate before. After Sandy Hook, I was annoyed that some people focused on gun control, when for me, the shooter so clearly needed mental health services. “That’s what it’s about,” I said, “because a person with a mental illness can always find a weapon.” Then I read a comment on Dr. Grohol’s piece, which reminded me how complicated each and every case is. The commenter wrote:

I love how everyone thinks they have the answer to this problem. Intellectual humility seems to be in limited supply. “It’s the drugs,” “it’s mental illness,” “it’s the provision of inadequate services.” There are so many imponderables involved in human behavior, our point of departure for any enquiry into its determinants… …should be both skepticism and an acknowledgment of the limitations of human understanding.

As humans, we’re very good at pointing a finger and assigning blame. It deflects our own icky feelings. However, those getting pointed at and blamed feel shame, and shaming someone gets us nowhere.

So, can we do any better than we are now to prevent them? Yes, I still believe we can.

For starters, I agree with Dr. Grohol – locking down guns in a household is common sense. As for parenting, well, I can’t speak from personal experience, but I’ve seen troubled parents turn out well-adjusted kids, and vice versa, but I agree with his assertion in principle.

But kids grow up and move out. Then what?

Hand Over Hand I don’t want to oversimplify, but for treatment of both kids and adults with severe mental health issues, doesn’t a lot of it come down to communication and collaboration? Parents and doctors and lawmakers and community health nurses and hospital psychiatry teams and teachers and the child/adult in question all working together? Long-term relationships, not revolving-door appointments. Courage. People who aren’t afraid to talk, to question, and to course correct. To have some intellectual humility, rally all of our resources and push the limits of our human understanding. Or, rather, our understanding of one human.

What are your thoughts and practical considerations?

P.s. Here’s a story about parents of a son who had bi-polar depression, and who was killed by Seattle police. They’re lobbying for a bill that allows family members to request a judicial review if emergency in-patient psychiatric treatment has been denied to their loved one with a mental illness. I support this, because it’s another avenue for conversation and collaboration between parties, as opposed to decisions made in a vacuum, often due to cost or expediency.

Mental Health Resources for Kids

By Laura Zera 14 Comments

Teenagers on school stepsHaving just spent a morning speaking to AP Psychology students at a local high school this week, I thought it would be a fitting time to highlight a few mental health resources for children and youth. When I was growing up, there were few to no places for me to go to talk to a qualified adult or peer counselor about my turbulent home life, so I find it incredibly heartening when I learn of the variety of programs that are out there now. I hope their posters are plastered all over the doors and walls at every school in the communities they serve!

Events

First up, because it’s coming up soon, and is always the kick-off to Mental Health Week in Canada, is the Walk So Kids Can Talk. Planned for May 4, 2014 at locations all over Canada, the Walk is a fundraiser for the Kids Help Phone (see below). You can join a team, walk individually, donate online – it’s your choice!

The National Children’s Mental Health Awareness Day will be May 8, 2014 in the United States. Events are organized by community groups and health organizations, and while I don’t see anything posted for 2014 yet, here’s a list of the events held across the country in 2013, and by whom.

Teenage girl with depressionHelp Phones

Kids Help Phone is a 24/7 free, anonymous and professional counselling service supporting the mental and emotional well-being of kids ages five to 20 across Canada. If you want to understand why a line like this is so important, here’s an example of a recent (and real) call: Kevin Helps a Friend Being Bullied.

Australia has a similar resource, called Kids Helpline. It’s also available seven days a week, 24 hours a day.

In the U.S., both of the kids help lines I found are faith-based (when I was a teenager, this would have been enough to dissuade me from calling). The one run by Covenant House is called the Nineline Crisis Hotline, and is not currently operational (calls are being rerouted to the National Runaway Safeline).  The other is run by Boys Town, a Catholic organization, and is still in service.

The U.S. also has the National Suicide Prevention Lifeline for people of all ages, and TXT 4 Help, where teens who feel they’re in danger can send a text, and in return will be sent location details of the nearest designated “Safe Place” (fire stations, libraries, fast food restaurants, YMCAs, Boys and Girls Clubs, convenience stores, and other businesses all serve as Safe Place sites in different communities). There, a Safe Place volunteer or agency staff member will meet them to talk.

Programs

It has been a couple of years since I ran across the Kids in Control and Teens in Control programs, run by the British Columbia Schizophrenia Society as a resource for children who have a parent with schizophrenia. I hope to write more about this program in the future; it looks quite amazing.

Teenage boy on skateboardIt’s the 21st century, and resources have to be designed to meet teens where they already go. OK2Talk.org has done that by creating a unique Tumblr site. Although geared toward teens and young adults who suffer from mental illness, anyone can add their voice by sharing creative content such as poetry, inspirational quotes, photos, videos, song lyrics and messages of support in a safe, moderated space.

Another organization that is utilizing the digital world for its delivery of services is WesForYouthOnline.ca. A recent Aviva Community Fund grand prize winner in the At-Risk Youth category, this Ontario-based organization was recognized for its efforts in using an online counseling model, as well as for plans to build a local center that will offer face-to-face services and meet-ups. It’s a fantastic example of community members who saw a need and then went to work creating the solution themselves.

The U.S. federal government is behind Caring For Every Child’s Mental Health, and while I’m not sure about the availability of interactive resources, they have published a number of topical papers and links for young adults to help with the transition into adulthood.

I spent a bit of time looking for a youth-oriented program offered through the U.S.’s National Alliance on Mental Illness, but everything I found mentioned that it was for those who are 18 and over. What they do have, though, is a two hour in-service program for teachers (and parents, presumably those who help out in the classrooms), aimed at helping them identify and respond to early warning signs of mental illness in children. It’s called Parents & Teachers as Allies.

That’s my start to a round-up of mental health resources for kids. I will try to keep this list updated on an annual basis by checking that these resources are still available and adding new ones.

If you know of any other resources, anywhere in the world, that are targeted to children, teens or young adults, please share them in the comments section below. 

Mental Health: Mobile Technology Use in Developing Countries

By Laura Zera 15 Comments

Cell phone image courtesy MicrosoftIn developing countries, almost everybody has a cell phone, and sometimes two or three to take maximum advantage of network coverage across different carriers. Not all phones are operational all the time; the predominant use of prepaid plans means that sometimes people let their minutes run out until they can afford to reload the phone. But where personal computers are still an anomaly, mobile handsets have become ubiquitous, and for good reason: they’re less expensive than other (computing) devices, increasingly “smart” and multifunctional, and both durable and portable for long and dusty trips from village to city and back again.

Erecting cell booster antenna - Northern Cameroon
Erecting cell booster antenna – N. Cameroon

For these reasons, problem solvers in the Global South turned to mobile technology before it had even caught fire in the North. In the banking industry, mobile payment operations started as far back as 2000, for example. Soon, ideas for mobile solutions for agriculture and education and health care were all popping up, and I’m pleased to see that this is now extending into the mental health arena.

Some of this momentum is being driven by dollars from the Government of Canada. Through an agency called Grand Challenges Canada, it was announced last week that more than seven million dollars has been allocated for 22 global mental health projects worldwide. These projects are delivered by local in-country agencies and institutions (a very important aspect, in my opinion).

Of the initiatives that were chosen for a grant, 13 of them include deployments of mobile phone technologies. Uses will include things such as screening and referral tools, and training and support for lay health workers (defined as those who carry out functions related to healthcare delivery, but have no formal professional or paraprofessional certificate or tertiary education degree).

Port-au-Prince, Haiti
Port-au-Prince, Haiti

The practical reality of mental health care delivery in the developing world is that the majority of services will come through lay health workers. As Grand Challenge’s press release states, there are fewer than 30 psychiatrists for 10 million people in Haiti, and data from other countries would reflect similar ratios. Ramping up the number of professionals in specialty areas takes too long, so community health care workers are the most available and direct way to create a greater availability of services. With mobile technology, these generalists will have more specialized resources at their fingertips, via a device that they probably already own.

The entire list of projects and related links and contacts is available on this Global Mental Health Media Information Sheet. It’s an interesting mix, and the geographic diversity is sure to lead to some unique challenges and results. I plan to follow up on some of them in the future.

Have you run across a mobile application that is designed specifically for mental health? Do you have field experience delivering mental health services in the Global South? All thoughts and feedback is appreciated!

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Haiti photo: Wiki Commons by Marcello Casal Jr, ABr

 

You and Mental Health: Countering the Pathology View of Hearing Voices

By Laura Zera 15 Comments

There’s a t-shirt–you may have seen it– that says, “I do whatever the voices in my head tell me to do.” My guess is that the person who decided that particular expression should be screen printed on cotton had never experienced auditory hallucinations, just as the person who came up with the “Kiss me, I’m Irish” t-shirt was probably Latvian.

Voice to earWe quip about hearing voices because we don’t think it’s normal. You’ll never see a t-shirt that says, “I respond when asked a question,” or “I sleep laying down.” If we’ve never heard voices, though, then who are we to deem it (and damn it) as abnormal?

In my last mental health post, I wrote about empowering the mental health consumer by engaging them and their families more meaningfully in decisions around their treatment protocol. When working with those who deal with psychosis, however, if we pathologize the experience of hearing voices, we’ve instantly set boundaries on the discussion–and attached a certain stigma–as we dive into contemplation of ways to eradicate the voices.

A different philosophy bears consideration. Started 26 years ago as the Hearing Voices Movement and now operating as INTERVOICE, it holds that voice hearers can develop their own personal narrative around the experience, including tools for accepting and coping with the voices. Instead of labeling voice hearing as abnormal, it applies recognition of voices as meaningful and related to the hearers’ lives, possibly even linked to unresolved trauma or a difficult event. Thus, an environment is created where voice hearers are encouraged to talk about their experiences without shame and stigma.

The approach is supportive and respectful. The result is empowerment.

While many voice hearers are leading the way in changing perceptions around voice hearing (take the wonderful Eleanor Longden, for example), I’m also thinking about this with a more all-encompassing mental health shift in mind. Movement toward more meaningful mental health care, for any symptoms and illnesses, require that we approach with an open mind and suspension of some of our usual labels for what’s normal and what’s not. Stay human-focused. Try new things. Engage in deep dialogue with mental health consumers to come up with new policies. And then, one happy day, the t-shirt designers will have to respond to a savvy market and retire some of their classics.

 

What do you think about this philosophy? And are there any risks or other considerations that I’ve missed?

 

Let Me Give You a Quarter for the Shoes

By Laura Zera 27 Comments

Image by © Royalty-Free/Corbis

He stood on a street corner, the local KFC his theater backdrop, a worn and dirty “Help Needed” sign in his hands. The traffic lights supplied a captive audience of people in cars, and he shuffled back and forth, 15 feet south or west, as instructed by the lights’ color. Well, that and probably a substance dependency issue or a mental illness. Something had led him to this spot.

I kept my car windows up and my gaze angled enough to keep him in my line of vision without making direct eye contact. He wasn’t a very big or threatening man, just unkempt, his hair having a crazy, clown-like quality to it. As the light turned green and I sped off, I noticed that the soles of his boots flapped as he walked, as detached from the rest of his shoes as his soul from society.

“Everybody should have warm, dry feet,” I remembered Janie saying. Janie owned a local thrift shop where she gave away socks for free. I was only a few blocks away from her shop, and they sold men’s shoes there. Or I could keep driving. But if I went straight home, what would that say about my own soul?

I turned right at the next light, looped back around and swung into the KFC parking lot. Now my window was down. “What size are your feet?” I called out.

“Nine.” He hopped over decorative shrubs to get to my car. “Are you going to buy me shoes?” I told him that was my intention, and he wanted to know where I would be shopping and how long it would take for me to come back (I estimated 15 minutes in case I had to hit two thrift shops to find his size). “I should be here,” he said, after thoughtful consideration. “I might have gone to the bathroom, but then I’ll be back.”

Ten minutes later, back at his corner, I handed him a lightly used pair of Skechers. “Thanks,” he said. “Do you want to have lunch?”

“Aw, no, sorry, I have to get home.”

He was smoking a cigarette that he’d hand-rolled into some strange origami, and his teeth bore the stains of tobacco and tough breaks. “You’re my friend now. If you ever want to hang out, I’m here every day, usually between 10 and 12.”

I checked that the traffic light was still red so we could continue the conversation, and then, trying to ascertain if he was independent or ‘in the system,’ asked, “Do you live alone?”

“Oh, well, I’m doing a lot better these days,” he blustered. “The devil and his legion aren’t coming after me anymore.” His eyes widened as he said this, and he nodded his head, as if I had previous knowledge about Satan’s antics as they related to him and this was just my status update. “They were trying to get at me, you know, coming in everywhere and following me around.”

He’s delusional. This, I understand, I thought, and relaxed. “Okay, well I’m glad to hear you’re doing better. What’s your name, by the way?”

Image courtesy of Microsoft“Here, let me give you a quarter for the shoes.” He fumbled in his denim shirt pocket without telling me his name.

“No, no, that’s okay, really. They’re my gift to you. To start your weekend off right.”

“Really? Thanks! You’re my friend, so you’re protected from everything.” He took a couple of steps back until he was on the sidewalk again. “Are they lace-ups?”

“Yup, they’re lace-ups. Will that work for you?”

“Oh yeah, that’ll work. I just have to bend down more.”

I couldn’t suppress my smile. “Okay, good.” The light turned green. I put my car into gear and waved as I set off.

Everybody should have warm, dry feet.

 

Mental Health: My, What a Pretty Brain You Have

By Laura Zera 14 Comments

It’s true, we really are wired, and now we have gorgeous, multi-colored images to prove it. Okay, wait, our brains aren’t multi-colored, but the scientists who are creating these brain mapping images figured it’d be easier to sort out what goes with what, kind of like Garanimals, but for bundles of fiber. On a side note, does anyone else think that not making Garanimals for adults is a total missed opportunity? I do, and so does Ellis D. He asked this *exact* question seven years ago on Yahoo! and got nowhere, but I think it deserves far more consideration than it’s thus far been granted.

And THAT, people, is a prime example of why we need this kind of color coding to figure out what the heck is going on in our complex (and in my case, often tangential) brains. This mapping process is made extra tricky by the popular belief that our brain wiring changes after each experience. It’s no wonder people have been having a hard time understanding the causes and treatments for mental illness—we’re presenting researchers with a rapidly moving target!Continue Reading

Mental Health: Schizophrenia Diagnosed by Eye Test

By Laura Zera 14 Comments

The practice of mental illness diagnosis has long been less than scientific, as few biological markers have been identified for any of the mental illnesses. This month, a study published in the academic journal Biological Psychiatry states that a simple eye movement test can detect schizophrenia, and with an astonishing 98% accuracy.Continue Reading

When Someone You Love Has an Untreated Mental Illness

By Laura Zera 52 Comments

“Are they a threat to themselves or others?”

It’s the question you will be asked if you are trying to get help (through involuntary commitment) for a loved one with a mental illness. And in many states, provinces and countries around the world, it’s your answer to that question that will determine whether help will be forthcoming or not.

For a person’s illness to progress to the stage of potentially harming themselves or others is very serious and obviously not desirable, yet the flip side of that coin is that if someone hasn’t reached that stage, and won’t voluntarily accept treatment, there is little a family member can do. It can be an excruciatingly difficult and heart-wrenching position to be in, as I learned some years ago.Continue Reading

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