In Defense of Mental Wellness

A work in progress..

2011-10-18T09:24:00.001-05:00

I have never wanted to be a leader. I believed you had to have charisma, be willing to take on more responsibilities that you could possibly handle and be a self-absorbed, power-mad jerk. At least, that was my experience with leaders in my youth. Less-than-angelic nuns, frustrated teachers and incompetent bosses seem to be expected in most arenas. In school, I wanted to help things run smoothly and efficiently and ran for student council secretary and vice-president. I was asked at a fraternity pledge interview if I was a follower or a leader. I confidently stated "reluctant leader," explained my position of not wanting the attention, glamor or glory but looked forward to the challenge and responsibility. Needless to say, I am not an Alpha.

One of my college buddies convinced me to run for student body president in the mid-eighties after I managed his campaign a year before. He lost but ran that year as my vice-president and we won. Little did I know that he saw something in me that I didn't. The following election, he parlayed his vice-presidential post to run again and won. Ah, the machinations of the power-hungry.

Since then, I have tiptoed through increasing and varied levels of leadership and management, trying not to step on those landmines common to supervisors. I have tried to keep things simple in what I do and say to balance what must be done to support my staff and what is expected of someone in my position. I strive to be as good a leader as I can and take comfort that I try harder than most. I believe I should be ready, willing and sometimes able to do anything and everything I expect from those I manage.

Being liked is swell. Being respected is great. But being appreciated is the best. Thanks to: Tracy, Kathy S, Anna, Janet, Toni, Emily, Andrea, Diondria, Vic, Eric, Sharon D, Afua, Sophia, Octavia, Connie and Rachel for making my managerial journey worthwhile.

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Simple musing . . .

2011-06-14T21:12:00.001-05:00

His baloney has a first name
It's A - N - T - H - O - N -Y
His baloney has a last name
Of W - E - I - N - E - R
He loves to tweet it every day
And if you ask me why I'll say
Because politicians have a knack for
A - B - U - S - I - N - G - P - O - W - E - R

Where could he possibly go and how long does it take to wash the stupid off?

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Truer words best spoken by another ...

2011-01-25T10:16:00.000-06:00

I have struggled to start out the year with optimism, determination and drive and wanted to post something with heft. Then I received this from my colleague and could not have stated anything better.

The goal for this year is to continue to inspire HOPE.

Families are in such an economic crisis. Many parents are without jobs. Many homes are in foreclosure. The state has seen a rise in food stamps and Kidcare benefits provided to families. It is amazing, discount stores, second hand shops and smaller grocery chains like ALDI; business is booming. Families are more in need of social service support than ever before. Parents are depressed, children are depressed, lifestyle changes are everywhere. Families are going from having home life, to apartment life and living out of hotels and with other family members.

Families are showing up at the doors of hospitals. Partial hospital programs are in high demand. Alternative school placements are on the rise. All are looking for additional support from SASS.

Gone are the days of treating PTSD for DCFS wards with the need of SASS services. Today we provide services for the many with Conduct Disorder, Bi Polar Disorder and yes, Autism. Today is all about good case management support.

I am committed to offering families supportive services in their time of crisis. The challenge is to walk in the door and bring HOPE to what many families describe as highly dangerous and hopeless situations. I may walk into the crisis and meet a family in total shock and trauma, when I walk out the door I want to of had inspired HOPE. To say to families you are not alone, along with your new resources for food and medical benefits your state, this State of Illinois had provided to you supportive services for your family in this time of crisis.

My goal is to not stop providing that HOPE that life does go on and it is possible for it to get better. No matter what conflicts arise after the initial crisis. I cannot be distracted by the many outside conflicts of others who may not share the same principal as I in providing the best services using the best practices. I cannot be discouraged from inspiring each family with HOPE. I must stay focused on the challenges that we are faced with in today's culture where so many are in economic crisis. I want to continue to inspire HOPE.

This will also include taking better care of myself, staying healthy to deflect the stress of providing crisis services. Eating right, working out, ha ha, getting sleep. Most of all remembering that I also have a family and life to enjoy.

This month I began my 16th year as a SASS worker, along this journey I can recall many families saying thank you as I walk away from their crisis. Let this year be the year I inspire the most HOPE.

Melissa C.
SASS since 1996

They're Not Just Playing!

2010-10-17T23:26:00.000-05:00

I was called to an area elementary school to perform a psychiatric screening on a 12 year old male threatening to harm the school staff. I was familiar with Alfonzo (not his real name) as a current client that I have screened and worked with over several years. Upon my arrival, I met with Alfonzo and his dad as well as his homeroom and special education teachers and the assistant principal.

As we entered the conference room, Alfonzo sat down and immediately started spinning in his seat. I was quickly reminded of his hyperactivity and my need to direct that energy. I gave him paper and a pencil and asked him to write, draw or fold something for me.

According to the special education teacher, Alfonzo kicked open the front door, flew down the hall into his classroom and dove into his seat. When confronted, he went back out, gently opened the door, walked to the classroom and sat in his seat. The homeroom teacher reported that as Alfonzo was given scissors for a craft project, he told her he would cut her like he did a teacher last year but then said he was “only playing.” And the assistant principal added that at the start of the school year when she asked Alfonzo to remove a straw from his mouth, he complied but only after telling her about the plate in his neck after being shot multiple times.

I asked Alfonzo about these behaviors and he readily admitted to each. I asked him to show me what he had done. One side of the picture was four figures with firearms and the other side eight figures with arms outstretched. I asked him to tell me about the picture. He described the scene as zombies versus the survivors, each zombie with differing characteristics and the survivors as he and his friends.

Being an avid gamer, I knew he was describing the zombies from Valve’s Left 4 Dead series. And I know these are games rated as Mature by the Entertainment Software Ratings Board (ESRB). But what I also remember about Alfonzo is that his father is a former gang member, his brother is incarcerated for a drive-by shooting and several other family members as victims and/or perpetrators of urban violence. The horrors in his front yard have been much worse than what he has witnessed in a video game.

I asked what he likes to do in his free time. He said “go outside to play basketball and tag or play video games.” I asked him what are his favorite video games and he mentioned Grand Theft Auto, Saints Row and Left 4 Dead.

The picture that Alfonzo drew is but one example of creative expression that has sent many school kids to psychiatric facilities around the globe. Too often, it is misinterpreted as a precursor to violence or a cry for help. In this case, Alfonzo’s picture represents his attempt to overcome and conquer his circumstances.

As he chooses and engages in his video game play, we can use that to develop rapport, assess strengths and weaknesses, explore sensitive areas and modify his thoughts, feelings and actions. As therapists are able to integrate music, art and movement into their therapeutic skill sets, video games should be seen as an evolutionary tool for multisensory engagement and behavior change.

It's ALIVE!!

2010-05-19T22:26:00.018-05:00

One of my colleagues called me on Tuesday and asked me to look online to see if was true?

“If what is true,” I asked cautiously as I did not want to seem oblivious to everything.

“Universal Health Services just bought Psychiatric Solutions!” I had not heard this news, did a search and confirmed the information. For those of us behavioral health providers in the metropolitan Chicago area, this is huge news. This will consolidate three of the largest freestanding psychiatric hospitals under one corporation. And as a clinician who started my career during the dominance of psychiatric corporate giants like Psychiatric Institute of America (PIA), National Medical Enterprises (NME) and Charter Medical Corporation, I am having flashbacks about why these juggernauts all but disappeared.

During the early 1990’s, I worked at Charter Barclay Hospital in Chicago, one of a chain of premier freestanding psychiatric facilities throughout the country but predominantly in the western and southern regions. Many remember the Charter commercials below that aggressively targeted individuals and families with offers of “free” assessments.

We were trained at the front end to convert calls to assessments and assessments to admissions. We were told never to ask about insurance over the phone. Just get them in, and the service would sell itself.

What we weren’t told was that, once patients were admitted, they would be treated as long as their benefits would cover. The 28 days model was seen as the treatment of choice for rehabilitation from alcohol and drug addictions. Customers were involuntarily hospitalized just because they walked into the locked lobby and realized that they could not just leave when they wanted. Oh, and they had benefits to be exhausted.

Before the turn of the second century, the abuse, fraud and waste began to coagulate into fines and lawsuits and corporations learned that they could no longer exploit the mentally ill and chemically impaired population.

In 2000, I consulted with one of the premier freestanding hospitals to train and develop processes for the front end systems to increase profitability from patient admissions. After six months, I realized that the owner was nostalgic and wanted to recreate the same flawed business model so I bailed before he could resurrect his monster.

As much as I enjoy consultant work and would love to assist in developing real community mental health alternatives offered by private corporations, I realize that profit and greed are enticing and prefer to give helpful advice now before the monster is unearthed.

Don’t:

pickpocket families and shovel them into medically unnecessary treatments under the guise of providing “free” assessments;
abuse involuntary commitment procedures that violate basic human rights, freedoms and dignity;
ignore the continuum of care;
promise referral sources interventions you cannot support or provide, especially as it conflicts with the needs and wishes of the consumer.

Do:

provide actual and tangible services useful to the community – employment, consumer education, crisis consultations, level-of-care screenings, referral and linkage;
develop effective and collaborative networks of referral agents, health providers, educators, payors and others who benefit from an expanded customer base;
offer accessible treatment options from inpatient to support groups;
recognize that word-of-mouth can make or break any health care provider; and
hire and train front-line workers to do clinical work with administrative responsibilities, not the other way around.

It is imperative that behavioral health providers like Universal Health Services offer contextual, responsible and truly community oriented care or join the automobile, banking, oil and insurance corporate entities in putting profits before people. And risk that when angry consumers appear with pitchforks and torches, they will not come looking for them.

Stop Backing Out of Driveways!

2010-05-05T13:02:00.000-05:00

In 2007, the National Highway Traffic Safety Administration (NHTSA) of the United States began collecting data about motor vehicle accidents off of public roads and highways. And, in that year alone, 14,000 persons were injured in back over incidents, 2000 of which were children, 221 fatalities and 99 were children.

Advocacy groups have called for driver education, teaching kids not to play in driveways, reversing cameras and parking sensors. In the realm of keeping it simple, I advocate an uncomplicated remedy – back in and pull out.

Backing into a parking spot, driveway or car port creates several conditions:

You have to drive past and initially view the area you’re backing into and
When backing up, you must slow down to avoid hitting another vehicle or the residence.

Personally, I have always preferred to back into spaces because I take greater care in the process and do not like backing into major thoroughfares.

Do yourself, your friends and family a favor. Spread the word! Back In and Pull Out! Start today!

How the Video Game Industry Can Save Our Streets

2010-04-29T09:44:00.009-05:00

I woke up this morning to a news report of kids using kids for target practice on the southeast side of Chicago. Each time, I am sickened and the only relief I feel is when I hear that they’re in stable condition. Our streets are under siege and our children are the insurgents.

Our children have too much unstructured time. Families have limited resources to connect to meaningful activities. And what outlets do kids who are not athletes, musically inclined or aloof have?

As a youth, I spent many days hanging out at the video game arcade. I only developed proficiency at foosball but enjoyed the sights, sounds and watching others compete and bring those machines to their electronic knees. But now, all of the technology that amazed me then exists in the current generation home console units.

It is time to bring back the neighborhood arcades, version 2010.3. Storefronts and mini-malls remain vacant in these troubled areas and could be quickly modified into a technological drop-in community center. Donations from video game and computer industry corporations would provide hardware, software, consultation and technical assistance needed for start-up. Once locations have been set-up and established, the community impact would be immediate and resonant:

Area residents hired and trained to manage sites, provide guidance in using the equipment, monitor activity in and around the facilities, etc.
After-school, weekend and school holiday access for families,
Multipurpose use for school-sponsored field activities, structured mentoring and tutoring areas, kiosks for product demonstrations, appearances by industry professionals and game celebrities, corporate-sponsored healthy eating café, gross motor activity sections,
Corporate-sponsored areas with featured hardware and software, opportunities for training, certification and continuing education geared toward video game industry, and
Support for learning styles and intellectual strengths.

Once established, these educational and entertainment centers can provide needed family and community supports. Students and parents could earn credits through scholarship, stewardship and volunteer efforts; local law enforcement personnel can include the centers as part of their patrol routes and possible off-duty work; legislators and community leaders can show evidence of working and flourishing community-corporate partnerships and educators can encourage game developers to include learning standards in game design.

These are a few benefits of the video game industry directly investing in communities for immediate results. While this will not solve all community ills, it would be a start. And I do not believe we will see news reports of shootings by children with a gun in one hand and a game controller in the other.

Parenting is no game ...

2010-04-24T15:40:00.000-05:00

We picked up my seventh grade son from a math competition where he placed second for individual and third for the group. I asked him to what he attributes his success and he said he didn't know. I asked him if he stuck his fingers in his nose to keep the thoughts from escaping and, wisely, he did not answer.

I think I have a fairly good idea of how he spends his time. He attends school and performs pretty well in terms of grades, test scores, behavior and citizenship; does chores, watches television, reads a great deal outside of school requirements and spends about thirty hours playing online computer games. For the past few months, it has been League of Legends. Before that, it was Team Fortress 2. Next, I think it will be Monster Hunter Tri. He had an opportunity to play that at the Nintendo booth of the comics convention we attended last weekend.

Most parents would think that this is too much time for computer gaming for children, one of which would be my wife. My thoughts are that he is not hanging out, tying up a phone or burning up minutes or bringing over hoodlums to eat up the food and tear up the place. Most of the time, I sit right next to him, on my computer, writing, surfing, working or playing while we talk, joke and interact throughout the evening.

We have an adult son as well and I am still trying to figure out this parenting thing. But I continue to follow certain principles. I provide structure so they know where the boundaries lie, what they are allowed to do and warnings that certain choices they make can place them outside of my ability to help. I give them support to do the things they want to do after they've done what they have to do first and provide whatever resources I have or sacrifices I need to make to support them. And they get supervision as I inform them what they can do, make certain that they are able to do it and watch them as they do it. It is no easy task.

Children, especially young black males, need to be surrounded by many layers of protective factors. As a student of my surroundings, I watch and listen and see that most of the time, we are the architects of our own chaos and engineers to our own destruction. Early on, I learned that engagement in technology would keep me out of a lot of trouble and, so far, it's done OK by me and mine.

When you’re smiling … the whole world aims at you.

2010-03-11T09:19:00.002-06:00

My wife and I went to a neighborhood popcorn shop this week. I held the door for her, walked in and looked around at their offerings. There was a slice of red velvet cake that I gravitated towards. Thoughts of the exercise I should be doing and the calories presented before me prevailed so I continued to just look. Karen found what she wanted, made her purchase and we left the store.

She then asked me what was wrong. I told her nothing was wrong. She informed me that a store clerk looked at me cautiously and told me that I could be that I don’t smile. I agreed, I don’t smile much but I do make it a point to smirk several times daily and guffaw at least three times daily.

What followed was a lecture from her about how I don’t look happy, others say I don’t look happy, my scowl is so unattractive, ad nauseam. I explained that, in the several times that she mentioned this, I have made great efforts to present a cheerful countenance throughout the day.

And then I began to reflect. I used to smile a lot until third grade when Henry Crawford punched me and knocked out my tooth. I didn’t smile as much but I tried until after I ran a foot race with fifth grade classmates, Lance Campbell tripped me and I chipped a front tooth which needed capping.

No more smiling for me. What I needed was a game face that I would don before I leave home every morning. Throughout the years, I made some adjustments here and there but I still carry it around.

Now I know that I don’t really need the game face as much. I also know that it takes more muscles to frown than smile; people gravitate toward others that have a “winning smile” and smiling releases endorphins which help to prolong life spans. My personal experiences are with others who smile while they sharpen their blades, probe and stab at soft spots and tell you “this will only hurt a little bit.”

“Do as you would be done by” is the Golden Rule and creed that I live by and I believe that everyone is capable of doing kind and noble acts. But as we know, many live by “he who has the gold makes the rules” and run over the disenfranchised, dejected and depressed among us. I believe this is what I carry around on my face.

I want my share of endorphins. I want to live longer. But I will not be a victim to the conquerors and tyrants among us.

Gather up thy sword and shield ...

2010-01-13T21:40:00.003-06:00

I love crisis work. In the workplace, whenever I hear any kind of commotion, instead of going in the opposite direction, I stroll into the hornet's nest, offer help where I can or get out of the way, careful not to get stung.

Personally, I greet conflict like a herd of buffalo. I sidestep the thundering issues or retreat from the stampeding situations until the other party stops advancing. I pull out my vast mediation and negotiation skills to manage the confrontation but forget that 1) I cannot be impartial if I am one of the aggrieved parties and 2) others don't necessarily fight fairly. I'll take a non-aggressive stance and take a verbal sucker punch, emotional low blow or rehashed body slam. In the back of my mind, I know I am capable of giving as good as I get by shouting, cursing, stomping, name calling and saying hurtful things but know that things have a tendency to boomerang and I strive to treat others as I would want to be treated. Regardless, sidestepping or retreating is frequently seen as surrender or cowardice.

Crises and conflict usually appear when there are power and control issues, even if those issues are only perceptual. Power and control has always been low on my list of needs or desires. Alas, as I grow grayer and hopefully wiser, I now realize that many things you must fight for in order to protect your peace-of-mind. I stand my ground for those things that are important, even if only to me. At this point, I don't necessarily expect to win every skirmish but will resist valiantly.

You Can't Have Your Cake and Hide it Too.

2009-12-03T13:16:00.002-06:00

Although Rick Telander of the Chicago Sun Times put the Tiger Woods' situation better than anyone I've heard or read so far in this article, I gonna offer my two pence anyway.

The majority of us live simply and are consequential only to our friends, families, colleagues and the Master Planner. We all have public and private faces that we manage with whatever moral or ethical codes we carry. Others aspire to greatness in various forms of public displays for the fame, wealth, influence or any combination of the former.

Any investment manager will tell you, the greater the risk, the greater the reward. If you choose the public life for the rewards, you also choose the risks.

The difference between those in the public eye and those of you like me is when we screw up, there is a plop and a ripple affecting those in our relatively small spheres of influence. Public figures, when they choose poorly, make a huge splash and everyone ends up getting wet.

In Tiger's case, everyone but Elin. She is a smart one and clearly understood her investment. Seven figures immediately transferred to her sole account, a renegotiation of her 10 year, $20 million marriage/ prenuptial contract so that she earns more to stay married for less time. Make no mistake, when your life is linked to a public figure, you have so much more to lose than they do unless you have your own thing detached and independent of your public cash cow.

Do the right thing, Tiger. Be contrite, be wiser, be the image you're well paid to be or begone.

Tragedy and Closure, Part Three

2009-11-17T11:57:00.003-06:00

In the spirit of keeping things simple, I have only two words about the Fort Hood tragedy - workplace violence.

And moving along, we Chicagoans have lost a powerful and spirited voice in Michael Scott. He had been fighting the good fight and I had been privileged to work with him in the early nineties in North Lawndale as a member of the Westside Association for Community Action (WACA). He truly will be missed.

What deeply concerns me is the coroner's report, decided quickly and, to me, without adequate investigation, that he committed suicide. Many of the signs make that likelihood improbable.

First, it is important to understand that people have tendencies to do what is expedient and convenient before they will consider what is right or just. Suicides, from a criminal investigation perspective, are expedient and convenient. Victim and murderer at the crime scene, all tied with a yellow ribbon. Case closed.

But here is a man who was deeply committed to his family and his community and, had organized an event that he would host in two days. Suicidal folks generally do not plan or thing about their future, unless planning to make sure that those left behind are cared for. There are too many inconsistencies to ignore.

Why such a public place? Why now? Was this a message to someone?

My thoughts and prayers go out to his immediate family. But, to many, the westside of Chicago is brother Scott's family.

Do you work in a barn?

2009-10-14T15:00:00.000-05:00

As they say, first impressions are lasting. Most will attest to the fact that customer services can be the most pleasant and helpful or abrasive and frustrating experiences known to man. There is usually little gray area. From the employee perspective, either you enjoy what you do, what you provide and respect customers or you don't and won't attend to their needs because you can't keep your eyes off the clock.

Most of us know how to behave when we get poor customer service - we ask for a manager, file a grievance, get loud or give back what we received. Those who are vulnerable and have difficulty managing themselves,their families or their immediate situations do not have the knowledge, energy or ability to advocate for themselves and end up being steamrolled by the very systems established to help -iatrogenic care.

As an intake worker for four non-profits, three for-profits and one governmental agency and, of these, three community mental health agencies, three hospitals, one addiction treatment center and a county probation department - front-end service delivery winds up dead last in importance. Without exception, it is most poorly run, underutilized, understaffed, exploited and inadequately funded department found in organizations. The reasons are many and simple - intake functions do not fit neatly into clinical, administrative or financial domains and do not consistently produce billable activity that can be pored over or bean counted. Not recognizing its value is akin to leaving your front door open because it doesn't wash your clothes, chill or heat your food, entertain your guests or feed your family. But a good, solid front door helps with heating and cooling expenses and provides some measure of privacy and security, not to mention a host of other supports.

I have spent my entire career advocating for greater support for front line workers in mental health settings and have been largely ignored. A few years ago, a group of university professors at the University of Wisconsin-Madison got a clue and established the Network for the Improvement of Addiction Treatment (NIATx) to reduce waiting times and no-shows while increasing admissions and treatment retention. Organizations and providers would do well to check out the great work they have been doing with applying process improvement to the helping profession and utilizing proven solutions to identified challenges.

Now, go show your front door some love. Unless you've decided you didn't need it after all.

What Doesn't Kill You Makes You ... Injured.

2009-09-21T21:53:00.000-05:00

Each of us is scarred in some form or fashion. Me, I kind of pick at my wounds daily to open up the old wounds and remind myself how I made it this far. Don't get me wrong, I am not miserable. In fact, far from it. I realize that things are not as they seem. It just gets hard convincing others that there is more to life than pushing things off your lap on to another's plate.

Healthy doses of fantasy keeps me sane. Reading and daydreaming help me to manage insane tasks in an insane world. And I can thank my parents for recognizing the benefits of interactive media.

As a shy child, I preferred books, video gaming and computers to social outings. Interactive media, as opposed to non-interactive media like books, movies, music and the like, gave me opportunities to go where I've never been, do what seemed impossible and create in limitless ways. I still have fond memories of the political intrigue in Spycraft and CyberJudas, time travel in Millenia: Altered Destinies, dungeon adventuring in Darkstone and the car combat of Interstate '76.

That was so long ago and the platforms, technology and sophistication of interactive media is now so impressive and affordable. And I understand some of the concern about the objectionable content that appears in a lot of interactive media products.

But, in the grand scheme of things, I would much rather for my child to be using interactive media at home, school or in the community, with friends or responsible adults, in a safe setting rather than hanging out on the sidewalk attracting lead mosquitoes. Drive-bys would be more challenging if there is no one to shoot at.

What we need are community centers, arcades and recreational venues for children and adults to play, learn and have fun sponsored by corporation dollars. If families have opportunties to use interactive media and want products for their home, they should be able to purchase them as subsidized or for a sliding scale. Anything we can do to encourage adults to spend fun and quality time with children should be encouraged, rewarded and subsidized.

Not only will killings, maimings and interrupted futures be reduced, but families will experience realities beyond their neighborhoods, doorsteps and their own noses.

Retrospect

2009-07-08T12:30:00.000-05:00

As many of us mourn the loss of one of the greatest entertainers ever, I can't help but realize that I have some Michael Jackson in me and, probably, always will. I came to this realization after viewing a 360 panoramic view of his arcade room at the Neverland Ranch. I saw the X-Men game, Jurassic Park: Lost World, Terminator and gobs of Star Wars memorabilia. It was after I saw the poster of the Marvel Universe when it hit me like a sack of Sacajaweas.

Michael was not the picture of mental wellness and, in fact, seemed to have a tenuous grasp on this earthly plane with ordinary mortals. He was a genius, but a scarred and flawed genius nonetheless. He had a painful upbringing and did his best to recapture what he felt was lost - his innocence, naivety and sense of wonder. But he did his best to remain a child.

I, too, had a difficult childhood, for different reasons. Being bullied leave scars that stay with you long after abusers have ceased their terror campaigns. I have decided that I will remain childlike because living as an adult ain't all that. Sure, I realize that I need to take care of my family, contribute to my community and pay my taxes but these responsibilities do not preclude, gut-laughing whenever I can, playing after a job well done, singing off-key and not caring who hears and dreaming of adding value to the world.

Thanks, Michael, a job well done.

Tragedy and closure continued

2009-02-19T10:03:00.000-06:00

The more I read, the angrier I get about how far people will go to protect their jobs and the BS they will feed others in order to do so. This family will never after closure after burying their ten year old shining star but the least that the school district and the police can provide to them is the truth.

Reports now say that he did not tell a school official about his thoughts of suicide but told one or more other students. Could one of these students been one who was suspected of bullying him?

Listening to the 911 calls, I noted that he was found in a third floor boys bathroom. If I was an angry, unstable, troubled and impulsive pre-teen boy, I would probably stab myself with a pencil or throw myself down the stairs or off the railing before I would hang myself from a hook in the bathroom until I bled from my nose. And why did the medical examiner not mention this as well in the report?

As hard as they may try, this will not go away under a pile of rapidly shifted papers. I was always told by my elders, the more lies you tell, the more you have to tell and the more you have to keep up with. Look at Illinois politics and you'd have to agree.

Tragedy and closure

2009-02-18T16:51:00.000-06:00

OK, so I'm trying to teach my fifth grade students and one boy is giving me a hard time. I scold him, he gets upset and says he going to kill himself. I send him to his gym class. The next thing I know, he is found dead hanging in the boy's bathroom.

OK, so I'm the police officer called to the scene where the boy was found. I'm taking statements, I'm looking at the torn clothing from where the boy hung from a hook in the stall and a footprint on the toilet seat. I give my information to the medical examiner who determines that the boy committed suicide. Case closed.

Looks like a few juicy bits for the next blockbuster detective series, doesn't it? Only thing is that this really happened, in a suburb of Chicago, in the first part of 2009. And, although the information is factual, the explanations are most likely fictional.

OK, so the teacher has been placed on administrative leave. Probably because he/she did not follow proper procedures and, basically, they need someone to burn at the stake. But let's look at what really happened, thoughtlessly or not.

Most people who find an unresponsive person and do not panic, will attempt to render lifesaving measures such as checking, pulse, respiration and rending CPR. They will not think about the fact that they may be compromising a crime scene and destroying evidence.

Other people who have responsibilities for supervising and monitoring children will immediately go into CYA mode - "I just turned my head for a second," "He said he'll be right back," or "I was attending to a more urgent matter."

How about the commonly held ideas about suicide such as a person will make several statements and even attempts before they successfully kill themselves, they will choose a location where they will, more than likely, not be found until it is too late, they will attempt less painful methods first and they may have had a plan and let someone else know.

Or even the school's responsibility to respond to a crisis. If anyone says they will kill themselves, act like it. Call an emergency contact person, place them in a secure location with constant line-of-sight monitoring, engage the emergency response plan that is in place.

A tragedy such as this creates many more questions than answers? Why were officials so quick to determine that this young boy killed himself? Because it is easier. Easy for the police because they can close their investigation. Easier for the school because they can chalk it up as another troubled kid from an unconcerned family. But there is nothing easy about sending your child to school in the morning and identifying his body that evening because of gross negligence.

Other thoughts to consider, most ten year old boys are not impulsive enough to decide to kill themselves while in line for gym class, not inventive enough to think of the hook in the bathroom stall, not strong nor agile enough to lift their weight on to the hook and not resolute enough to stay on the hook until they pass away.

The family said that he had plans for the future, was a happy child and got along well with others, all contra-indicators for suicidal behaviors. They did report that he was being bullied at school which is not difficult to believe. All school districts have policies against bullying but most do not follow them, at least most of the ones that I have worked with. Many children in psychiatric crisis at school have been provoked by bullies and we end up addressing the symptoms and not the source.

If he had said he would kill himself, where was it documented? Teachers know to keep anecdotal records, especially for students with behavior learning challenges and parents who want proof of their child's disruptive behavior. Why was he not held in the classroom or taken to someone's office for constant monitoring and observation? Did someone call his parent about what he said? Unfortunately, they may have waited and called to say what he did.

Heal thyself, o helper of others

2009-01-06T04:18:00.000-06:00

I did not realize how difficult it is to maintain an online blog. I have traditionally only been able to pump out the text when depressed or ached, don't like to talk just to hear the sound of my own words as I think I sound kind of nasally and don't like to blahblahblahblog. My goal has always been to inspire, educate and minimally inform. By the way, did you know that women on their monthly cycle can have a positive lab result for urinary tract infection? Unfortunately, I learned it this past weekend attempting to transfer a young adult to a psychiatric bed. After eighty and a half hours and fourteen hospitals refusing, it was done and her mother called to say how she appreciated the work I had done.

I should be asleep, one, because I'm exhausted and two, it's four in the morning. But after rolling around so much and realizing that I didn't want to disturb my wife, I figured it'd be a good time to put my finger down my creative throat and spit out whatever I have trouble keeping down.

It has been a difficult start to the ninth year of 2000. I have a good friend rehabbing his broken bones after arguing with a slippery sidewalk and losing and another friend who just lost his father in a horrible fire and is supporting his mother who dealing with being unable to save him. I pray that things this year will not be a syndication of 2008 as it was not a good year for many. I lost a niece and a cherished cat but gained a brother. And I believe that I have learned not to question as things unfold that I may think are unfair or unjust. And I know that all things will be revealed in the end. But, sometimes, faith can be a little slippery in my season of discontent.

I now pronounce you ... medically cleared.

2008-12-20T11:34:00.000-06:00

Emergency room (ER) staff hold a special fondness for psychiatric patients. Overt psychosis, statements to kill self or others, inability to care for one basic needs or imminent risk do not classify as serious enough to be treated before minor physical maladies. And, even though mentally ill patients do not appear to be in distress, they require the same basic diagnostic procedures as all other patients.What does it mean to be "medically cleared?"

I screened a "medically cleared" 10 year old on stimulant medications in an ER and recommended transfer to a freestanding psychiatric hospital. When the receiving hospital asked for the patient's results from the lab screens, they were informed that no lab tests were done.
A few days ago, a crisis worker met with a "medically cleared" young adult who ingested 25 to 30 ibuprofen tablets a few hours before presenting to the ER. Fifteen minutes into the screening, the patient began vomiting uncontrollably and asked that the interview end because she was in too much discomfort.
An adolescent patient "medically cleared" from an ER vomited eight times in route to a freestanding psychiatric facility. He arrived dehydrated and was sent to another emergency room and medically admitted to a telemetry unit for two days.
I have been asked to assess "medically cleared" patients from pediatric intensive care units (PICU) prior to transfer and admission to other psychiatric hospitals. The most recent lab results were from tests taken 2 days prior to the request for assessment.

Medically clearing a patient is largely based on where the patient will be in the next few days and what supports will be immediately available during that time. Most hospitals require basic lab screens including blood alcohol level (BAL) and drug for adolescents and adults, pregnancy screens for females and others tests to address a patient's history of diabetes, hypertension or other chronic illnesses. In cases of drug ingestion, a period of 48 hours observation on a medical unit is required prior to transfer. Intoxicated patients cannot be interviewed until their BAL is below 100 as they are medically compromised and may be hallucinating, delusional, aggressive, suicidal or homicidal because of an alcohol-induced acute episode. Patients with acute eating disorders frequently present not only as underweight but as dehydrated and fluid imbalances which may require monitoring on a telemetry or intensive care unit. Self-injury patients may present with wounds at risk for infection, inflammation or damage to major arteries, tendons or organs.

The purpose of medical clearance is not for CYA; it is to increase the patient's chances in being able to successfully engage in the next level of prescribed care.

taking care of our youth

2008-12-17T21:30:00.000-06:00

Here in the great state of Illinois (governor not included), we have a community crisis stabilization program for Medicaid and unfunded families of children and adolescents. The SASS (Screening, Assessment and Support Services) program originated in the early 90's as a grant-based program primarily for wards of the state and lower income families seeking treatment.

As most behavioral health providers can agree, our work improves consumers functioning in at home, school, and in the community as well as job retention, overall general health, crime reduction and a host of benefits to society at large. We can also agree that we have done a poor job of showing how that grant money is spent. As a result, the feds decided to go after the non-profit providers and established a fee-for-service model for reimbursement. Early on, we heard rumblings about it as well as the institution of mandatory hospital prescreenings for all Medicaid and unfunded families. What we did not know was that Governor Blagojevich, in his infinite wisdom, would roll out the model with the crisis program.

Try to imagine providing a face-to-face emergency screening within 90 minutes, determining a need for psychiatric hospitalization or community-based crisis stabilization services and writing up an invoice.

The state of mental wellness

2008-12-17T21:04:00.000-06:00

There are a lot of good things happening in mental health service delivery. Consumers taking responsibility for their recovery, motivational interviewing, practice guidelines and the use of technology permit us to work smarter. But some of us rely on the old ways of treating patients with illness and maintaining dependencies on the programs that have withered away or disappeared for lack of funding. How our government justifies taking money from non-profit community programs and giving it to for-profit corporations who have squandered enough resources from greed and ecomonic strip-mining.

We need to support families and communities by holding us all to the highest standards. Let us not settle for less from each other. Set examples that our politicians would envy. Insist on enriching opportunties for our children and places where they can be safe from gunfire and predators. Treat others as we would be treated.

And so it begins ...

2008-12-17T15:44:00.000-06:00

As a seasoned frontline clinician who has seen a lot of things, I realize that I have worked with many who are well -intentioned but logically clueless. I am using this as an opportunity to address issues that, in the greater scheme, seem inconsequential to those who do not deliver or receive behavioral health services. Believe me, there are much larger ills that face us. But for some of us, who paint our little mental health corner and want our neighbors and consumers to benefit from our efforts. For 23 years, I have consistently told families that my goal as a mental health worker is to put myself out of a job. In order to do this, we need to do a lot of things differently. Details to follow.