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Giving Kids a "Sip" of Alcohol Can Send the Wrong Message About Drinking


That little sip of wine or beer that some parents offer
their kids at a wedding or on New Year’s Eve may muddle messages about alcohol,
according to a new study by researchers at the Center for Alcohol and Addiction
Studies at Brown University. The scientists surveyed middle school students for
three years to learn whether even a taste in early childhood was a predictor of
risky behavior in high school.





The Internet-based study, published in the April 1st
issue of the Journal
of Studies on Alcohol and Drugs, included more than 500 Rhode Island school
students. More than one-third of the kids surveyed reported trying their first
sip of alcohol by the sixth grade, and most said that their first taste took
place at home. Wine and beer were the most commonly tried beverages, usually at
a special occasion, such as a wedding or a holiday, and adults were the primary source of the alcohol. Nearly three-quarters
of the children were offered sips by their own mom or dad.





The study also showed that
kids who sipped alcohol by the sixth grade were five times more likely to down
a full alcoholic beverage by the time they reached 9th grade—26% of
sippers consumed a full drink versus 5.5% of non-sippers. The earlier sippers
were also four times more likely to get drunk or binge drink by early high
school, and trying alcoholic beverages earlier in life also raised a child’s
risk for trying other substances.





Even when the researchers
controlled for other factors, such as risk-taking behavior, the drinking habits
of parents, and a history of alcoholism in a parent, kids who’d sipped before
sixth grade had higher odds of alcohol use by their freshman year of high
school.


The take-home message:
Offering a child a sip of your beverage may send the wrong message, says study
author Kristina Jackson, Ph.D., associate professor in the Department of
Behavioral and Social Sciences at Brown School of Public Health.





"Parents should provide
clear, consistent messages about the unacceptability of alcohol consumption for
youth,” Jackson advises. “Younger teens and tweens may be unable to understand
the difference between drinking a sip and drinking one or more drinks.
Certainly there are exceptions, such as religious occasions,
so the most important thing is to make sure that children know when drinking
alcohol is acceptable and when it is not.”





The context of alcohol use is important, says Oscar G. Bukstein, M.D., M.P.H., medical director at DePelchin
Children’s Center and a clinical professor of psychiatry at Baylor College of
Medicine and the University of Texas Health Science Center-Houston, who was not
involved in the research. “Often, by allowing children to sip or try alcohol on
‘special occasions’, the message delivered may be one of ‘this is how we
celebrate’, we drink,” Buckstein says.





He says that sipping may be associated with increased access to
alcohol, too, or more lax parent attitudes and that undermines any anti-drinking
messages kids hear.





April 21st is the national day to talk with your kids
about alcohol. Visit Mothers
Against Drunk Driving’s (MADD) Power of Parents
page to learn more.





by Mary Brophy Marcus, health writer, APA






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Autism Awareness Month: Learning more about a complex condition







You probably know someone with
autism—in your neighborhood, in your workplace, in your school, in your family.
  In fact, an estimated one in 68
children in the U.S. has been identified with autism spectrum disorder,
according to the Centers for Disease Control and Prevention.   The data on adults is less clear, but the
numbers are growing. 



April is Autism Awareness Month – a chance to raise awareness and learn a
little more about this complex condition affecting so many.  Here are just a few sources that might help
answer some questions.


Want a good quick overview of what autism is?  Check out the CDC’s main autism page.



Looking for a good app to help someone with autism function better?  There are many apps available to help people
with autism with communication, behavior, organization, creative arts, and
more. In fact, there are so many apps that it can be hard to know where to start
or what might be useful for a particular person. Check out Autism Speaks’ searchable
resource on autism apps –
with information on function, device, target age, and the research data that’s
been gathered to evaluate or inform the app.


 One resource you may be familiar with already is Siri, the personal assistant
on the iPhone. See a New York Times
column by a mom of a child with autism who has made good use of Siri, “To
Siri, With Love: How One Boy With Autism Became BFF With Apple’s Siri.”  Siri is not only tirelessly patient in
responding to repetitive questions (common among some with autism) but lets you
know she doesn't understand (leading to practice with phrasing and enunciation)
and will gently encourage polite language.



Want to know how to talk with parents of children with autism?  See a recent Today.com article on “11
things never to say to parents of a child with autism (and 11 you should).”

Want to know a
little about what it’s like for some people with autism and sensory
sensitivity issues to experience their environment? (Note of caution:  Every person with autism is different. No two
experience sensory sensitivity in the same way.) View the short video from the
UK-based National Autistic Society, Experience For 60 Seconds How The World Looks, Sounds, And Feels To
Someone Who Has Autism.” Some people
with autism have difficulty processing multiple sensory experiences at once. An
animated video by the Interacting with Autism project gives a glimpse into sensory overload and how sensory experiences intertwine in everyday
life.






Want to know more about the latest
research on autism spectrum disorders or the latest clinical trials? Find out how your family can participate
in research  or find out about clinical
trials.







Have more questions? Visit national organizations, such as Autism Speaks and the Autism Society of America, or federal
agencies, including the CDC
and the National
Institute of Mental Health.  Join the conversation #autismawareness, #autism, #mentalhealth.

by Debbie Cohen, health writer, APA





For more news and wellness info from APA, follow us on Twitter and Facebook.








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Are Some Jobs More Stressful Than Others?



Everyone has bad days on the job—a project that you put hours into bombs or a task you need to accomplish is difficult and stressful. But are some jobs harder overall on our mental health than others? Depression may be more likely to occur in some professions, research suggests. And according to a new study by researchers at the National Institute for Occupational Safety and Health, suicides in the workplace, while not commonplace, are on the rise. Their research, published in the March 16 online edition of the “American Journal of Preventive Medicine,” showed that 270 people committed suicide in the workplace in 2013, a 12% increase over 2012.




Men and those over 65 were more likely to commit suicide in the workplace than others. Law enforcement jobs -- police officers, firefighters, and detectives -- had the highest rate of workplace suicides with 5.3 suicides for every 1 million workers. Farmers, ranchers, fishermen, and forestry workers came in next with 5.1 suicides per one million. The authors also noted that minorities may be at a greater risk for workplace suicide compared to non-workplace suicides. Their research did not include military jobs.




This month’s “JAMA Psychiatry” also addressed the topic in a “Viewpoints” op-ed co-authored by two medical interns from New York who said that being a physician, especially a young intern, may leave some people vulnerable to mental illness and suicide. Doctors are twice as likely to kill themselves compared to non-physicians, and female doctors are three times more likely to do so than their male counterparts, according to the American Foundation for Suicide Prevention (AFSP). According to AFSP, though, the workplace can be an ideal place for suicide prevention programs. Their Interactive Screening Program (ISP), for example, is an anonymous online survey that IDs at-risk people and connects them with support. The NFL and the Boston Police Department have used the program. The authors of the “Lancet Psychiatry” op-ed say some work programs, like one at the U.S. Air Force, have successfully addressed workplace depression and mental illness in a variety of ways. One initiative: The USAF designates certain supervisors as mental health “gatekeepers.” Their job is to identify at-risk employees and channel them to screening and mental health services.



Want more info on managing workplace stress? Read about APA’s Partnership for Workplace Mental Health. Learn more about the American Foundation for Suicide Prevention’s ISP program by contacting the Program Director at isp@afsp.org. Read Mayo Clinic’s article: Work-Life Balance: Tips to Reclaim Control.



by Mary Brophy Marcus, health writer, APA



For more news and wellness info from APA, follow us on Twitter and Facebook.

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A Psychiatrist’s Take on “Fifty Shades”

This summary is not available. Please click here to view the post.

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Black History Month – African Americans and Mental Health


Ranna
Parekh, MD, MPH






As we celebrate Black
History Month, we reflect on African Americans’ place in US history. At the
APA, we give thanks to psychiatrists – such as Jeanne Spurlock, MD, Solomon
Carter Fuller, MD, Chester Pierce, MD, and a long list of Solomon
Carter Fuller Award recipients--whose great contributions continue to
influence our medical field.  It is also
a time when we are reminded of the unique mental health challenges facing the
black community and the importance in working together toward improved access,
assessment and treatment.  






The history of African
Americans predates slavery; however, its legacy and the ongoing discrimination
continue to impact the lives of African Americans today. Emotional strength, strong social connections, and
determination have enabled many African Americans to overcome adversity.
 Yet African Americans, just like people of all racial/ethnic backgrounds,
experience mental illness.





While rates of mental
illness in African Americans are similar to those of the general population,
African Americans receive less care and poorer quality of care and often lack
access to culturally sensitive care. For many reasons, African Americans face
particular obstacles in getting help for mental health concerns. Racism,
discrimination, cost or lack of health insurance, or distrust of the health
care system may prevent some African Americans from getting the help they
deserve. Stigma about mental illness can also pose a barrier, and blacks are
much less willing than whites to use medicines for a mental illness.














Also, African Americans
sometimes express mental illness and emotional distress differently than
others.  For example, among people with depression, blacks are more likely
than whites to complain of body aches or other physical symptoms. 





Racism
and discrimination have multiple effects on mental health.  Victims of
discrimination experience feelings of unfairness when dealing with mental
illness and those feelings make it difficult for them to do anything about it. 
In addition, the anticipation of discrimination, the perception of being in an
environment of discrimination, or seeing others being victims can contribute to
greater ongoing stress and anxiety.  


Chester M. Pierce, MD, emeritus
professor of education and psychiatry at Harvard Medical School and founder of
the eponymous Division of Global Psychiatry at the Massachusetts General
Hospital is to receive APA’s 2015 Human Rights Award. His life’s work included
studying people living in extreme conditions. In 1970, he coined the term microaggessions to help people
understand the continuing stain of racism experienced by African Americans.
Microaggressions are brief, everyday exchanges
that send denigrating messages that are not overt discrimination – the person
may not even be aware of the denigrating action. Being continually subjected to
these microaggressions takes a toll on physical and mental health. 





This is also
compounded by the economic effects—blacks have much higher unemployment and
poverty rates than whites.  In January 2015, the unemployment rate for black
 men over 20 was more than twice that of
white men (11.4% vs 5.2%) and the unemployment rate for black youth age 16-19
was significantly higher than white youth (30% vs 17%). 




Also, African-American men are less likely to seek help for medical problems and
mental health concerns often become secondary to any medical concerns. Physical
conditions and conditions affecting the mind are connected in many
ways--problems that first affect the mind can later increase one’s risk for
physical problems, such as diabetes, high blood pressure, or malnutrition. And
physical conditions, such as a disease or an accident, can affect the mind
(i.e., emotions, thinking, and mood). African Americans have a much higher
risk than white Americans for many types of chronic diseases, such as diabetes
and heart disease.






The California Mental Health Services Authority has developed a 

video and discussion guide about young black men and
mental health. 






Beyond the Beat and the Lyrics --
Understanding the Impact of Stigma and Discrimination on the Mental Health
Status of Transition-Aged African American Males,"  is intended to raise
awareness and stimulate conversation.





Mental disorders are
nothing to be ashamed of. They are real medical problems, just like heart
disease or diabetes. As with these illnesses, there is help available and much
you can do to support or improve your health. Like all people with mental
illness, African Americans, do recover and go on to lead productive and
fulfilling lives.








Ranna
Parekh, MD, MPH, is the director of the Division of Diversity and Health Equity
at the American Psychiatric Association







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Eating Disorders Awareness Week 2015: Speak Up and Speak Out


By Deborah R. Glasofer, PhD


Reviewed by B. Timothy Walsh, MD





This
week marks Eating Disorders Awareness Week. It is a
time to speak up about eating disorders, including anorexia nervosa, bulimia
nervosa and binge eating disorder. Many of us fall prey to messages about what
is and is not beautiful or healthy. For people with eating disorders, however,
the problem extends far beyond any messages heard from the outside world.
Individuals with eating disorders struggle – perhaps because of their biology,
or as a result of persistent behavioral patterns – with critical messages from
within that define health or beauty narrowly or with great distortion.





Eating
disorders do not discriminate. They impact women and men of all ages, races,
and sizes, although they most often affect girls and women between 12 and 35
years old.



Eating
disorders do not tread lightly. These are dangerous illnesses characterized by
behaviors (e.g., severely restrictive eating, purging) with potentially
life-threatening physical consequences. They can negatively impact
psychological health – obsessing about food, eating, or body size, rigidity in
thinking, overall anxiety and mood – and carry an
increased risk of suicide.



Listen
to learn more about the latest
breakthroughs in eating disorders understanding and treatment, including
cognitive neuroscience and pharmaceutical research. Read up to learn more from
the Columbia Center for Eating Disorders, a part of the New York State
Psychiatric Institute, about spotting an
eating disorder and approaching a
child
(of any age), a teammate, friend, or
loved one
about whom you are concerned. Listen in to learn more about who’s who on an
eating disorder treatment
team,
and differences between treatment
setting options.




Deborah R. Glasofer, PhD, is a clinical
psychologist at the Columbia
Center for Eating Disorders and an
assistant professor of psychology in the Columbia University Department of
Psychiatry.










Wear Red Day: Promoting Healthy Hearts and Healthy Minds 


Erik R. Vanderlip, MD, MPH 







Researchers today are putting together what it means to truly have a “broken heart.” As we adorn our favorite red apparel for “National Wear Red Day” to raise awareness of the untold stories of millions of women experiencing strokes or heart attacks in our country, we must consider the contribution of poor mental health to this burden. 





Clinical depression has repeatedly been linked with accelerating the onset of heart attacks and strokes and severely complicating recovery. People with depression often lack the concentration and energy to effectively exercise, eat healthfully, and engage in rehabilitation to optimize recovery. Several studies 1,2 have suggested significant reductions in heart attacks and improved rehabilitation after stroke with proper depression treatment, yet these practices are not yet standard care. Proactively managing our moods and emotions should be granted the same time and effort as lowering our cholesterol, losing weight or dieting. From taking a daily aspirin to taking a walk, keeping tabs on our emotions and addressing them head-on should be an essential part of heart and brain health. 


There are a number of reasons this hasn’t caught on. Cardiologists and primary care physicians are happy to roll up their sleeves to manage cholesterol and lower blood pressure, but when it comes to emotions, many lack the training and expertise to feel confident in diagnosing mental illness, much less manage it. Mental illness is often seen as very subjective, making it challenging to measure or assess. 


Furthermore, mental illness is too often stigmatizing, and many people are embarrassed to admit they’re struggling to cope. Or they may feel as if the overwhelming hopelessness they’re feeling is a natural consequence of having a heart attack or stroke. While it may be common, we know it’s not healthy. Solid, effective treatments exist that we know can help improve our quality of life as well as, perhaps, extend longevity. 


We’re not scared to talk to our doctors about high blood pressure or aspirin, and we shouldn’t be scared to talk to them about our mood. It may be one of the only ways we can begin to mend our broken hearts. 



More information from the American Heart Association:







References: 

1. Jorge RE, Acion L, Moser D, Adams HP, Robinson RG. Escitalopram and enhancement of cognitive recovery following stroke. Arch Gen Psychiatry. 2010;67(2):187-96. doi:10.1001/archgenpsychiatry.2009.185.

2. Stewart JC, Perkins AJ, Callahan CM. Effect of Collaborative Care for Depression on Risk of Cardiovascular Events: Data From the IMPACT Randomized Controlled Trial. Psychosom Med. 2014;76(1):29-37. doi:10.1097/PSY.0000000000000022.
Detail:

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You want to do what?!?! The importance of informed consent in treatment





By Gail  A. Edelsohn, MD, MSPH





We come across ads in print, on television
and on the Internet for medications and therapies that promise to make your child
do his homework without a screaming match, behave better and generally restore
harmony to home life. Not so easy, taking a medication raises a host of
questions:  How long does the therapy
take? Should I as the parent sign off on this? What about the possible serious
side effects, such as significant weight gain, thoughts about suicide, risk of
diabetes or a life-threatening condition?








Parents and legal guardians make
decisions about psychosocial therapy and medication treatment for children and
adolescents every day. But who should give permission and sign informed
consent?  What should parents, advocates,
guardians be looking for or consider before signing informed consent? Is
signing a form enough?  What about the child
or teen - do they have a voice regarding their own treatment?


What is Informed Consent?


Psychiatric informed consent
involves a parent or legal guardian giving
permission for his/her child to undergo evaluation and treatment.  It is a
process which partly involves receiving sufficient relevant information about
the condition, prognosis, risks and benefits of treatment to be given and other
types of treatment available. Informed consent is NOT simply a signed and dated
form. Parents and guardian should expect informed consent to include:




  The purpose of the treatment


  • To address a specific condition or diagnosis?



  • To lessen symptoms?



  •  To change behaviors?


  The effects of treatment


  • How will you know if it is working?



  •  How long till you see an effect?


  Risks of treatment


  • Side effects of medications



  • Consequences of psychosocial treatment (e.g., therapy
    can be emotionally difficult)


  Risks of NO treatment


  • Will symptoms improve over time without
    treatment?



  • Will things get worse or lead to other
    consequences? (e.g., Untreated individuals are more likely to use substances,
    get into legal trouble)


  What alternative treatments are available?
  

For medication


  • Is it FDA approved for this age and condition?
    (i.e., prescribed FDA on label)



  • If it is prescribed off-label, why?



  • Are there any FDA warnings about the medication
    and what do they mean?



  • What is the plan for stopping or phasing out the
    medication?









     Parents and legal guardians are
asked to give legal permission or informed consent for treatment.  If a child is in foster care, it may be the
parent or it may be child welfare service or court that can give consent.   Where a child is living (home, out of home
placement) does not tell you who the legal guardian is.  In some states an adolescent may give
informed consent for psychiatric treatment depending on the state’s legislation
about mental health procedures. Ideally the parents/guardians and the child
should be involved in treatment decision making.



Children also have a voice in
this process.  Children and youth should
be involved in giving assent.  Assent involves providing the child or teen
with information about the therapy or medication in terms appropriate to their
age and stage of development. The assent process should include opportunities
for the child/adolescent to ask questions and have their concerns addressed.






Gail A.
Edelsohn, MD, MSPH, is senior medical officer with Community Care Behavioral
Health, clinical professor of psychiatry and human behavior,  Jefferson
Medical College, and clinical professor of psychiatry and behavioral science,
Temple University School of Medicine.

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The Power of Words: Addressing the Stigma of Mental Illness


Jenna Bowen, medical student, University of Wisconsin


Reviewed by Claudia Reardon, MD







Crazy.  Insane.  Deranged. Mad.  Lunatic. —Misused as nouns, adjectives and
lay-diagnoses, their use perpetuates stereotypes of the wide variety of people
who experience mental illness.


Maybe you know someone or, more likely, a number of people who
experience depression, anxiety, bipolar disorder or other brain disorders.  According to the National Institute of Mental
Health, 1 in 4 American adults and 1 in 5 American youth experience a form of
mental illness every year. People with mental illness are teachers, accountants,
neighbors, sisters, fathers and friends. Anyone you know could be experiencing
mental illness, but afraid to come forward and be treated. Maybe that person is
you.


People living with mental illness continue to have an identity
that is beyond a diagnosis, similar to other medical conditions. While managing
mental illness may be challenging at times—similar to challenges faced by
people with diabetes, high blood pressure, or other medical illness— there is
greater difficulty in getting the treatment needed because of feelings of shame
and stigma surrounding mental illness. However, treatment for mental illness
works. Research shows the majority (65 percent to 80 percent) of individuals
with mental disorders will improve with appropriate treatment and ongoing
monitoring. People with mental illness need to know that they will continue
to be seen as people – your brother, best friend, daughter —and not “crazed” or
“insane” if they appropriately seek help for a treatable medical condition that
they happen to be experiencing.



Bring Change 2 Mind, an organization aimed to end stigma and
discrimination surrounding mental illness, offers recommendations to reduce
your impact on the stigma surrounding those with mental illness.




  • Use "person first" vocabulary. When we say a person is
    schizophrenic, we make their mental illness fully define their identity.
    Instead, be clear that this is a disease that individuals manage and live with—
    "He is living with schizophrenia."

  • Avoid the verb "suffers" when discussing mental illness.
    Instead, choose, "lives with mental illness" or "is affected by
    mental illness."

  • There are many phrases and terms; "crazy,"
    "nuts", "psycho", "schizo", "retard"
    and "lunatic" that may seem insignificant, but really aren't.





Be an advocate for those that you know, and the many that you
don’t know, who are living with some form of mental illness by breaking down stigma,
and being conscious of language surrounding brain disorders. To learn more check
out:


·        
Bring
Change 2 Mind


·        
NAMI
– Stigma Busters


·        
Resource Center to Promote Acceptance, Dignity and
 Social Inclusion Associated with Mental Health (SAMHSA)


·        
Mental
Health Terminology:  Words Matter






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Study highlights lack of access to mental health care

By Arshya Vahabzadeh,MD 

 @VahabzadehMD



A new study from the CDC’s National Center for Health Statistics once again highlights that too many people living with mental health conditions are not getting needed care.



Study authors Laura A. Pratt, PhD, and Debra J. Brody, MPH, found that nearly 8% of Americans aged 12 and up had depression (moderate or severe depressive symptoms in the past 2 weeks). The rate of depression was twice as high among people living below the poverty level, 15%.



 Far more alarming, the study showed yet again that people with depression are going untreated. While nearly 90% of people with severe depressive symptoms reported difficulty with work, home, or social activities related to their symptoms, only about one-third (35.3%) had seen a mental health professional in the past year, according to the study. Among those with moderate depressive symptoms, only 1 in 5 had seen a mental health professional.



While there are many reasons people don’t get needed mental health care, including mental health stigma and lack of access, discrimination in mental health coverage by insurance companies shouldn’t be among the reasons. Federal law now requires that insurers cover mental health illnesses the same as physical ailments, such as heart disease, diabetes and cancer.





However, many people don’t know their rights when it comes to getting mental health treatment. To address this glaring problem, the American Psychiatric Association has released a new poster --

available to mental health professionals -- that explains in simple terms your rights under the law and what to do if you think your rights are being denied. Download a copy at www.psychiatry.org/parity.


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World AIDS Day





By Annelle Primm, MD, MPH



World AIDS Day

December 1, 2014


Focus, Partner, Achieve:  An AIDS-Free Generation




World AIDS Day is a key opportunity to raise awareness and to commemorate those who lost their lives to this often deadly disease. But, today, we can also be hopeful about achieving an AIDS-free generation.  Increased access to treatment, new and better prevention services and care, and advances in treatment are all reasons for hopefulness.  And that amounts to greater peace of mind.

 


An estimated 35 million people worldwide have HIV and more than 39 million people have died from the virus since the first cases in 1981. In the U.S., more than 1.2 million people live with HIV, but nearly 1 in 7 of those don’t know they have the virus.


An estimated 50,000 people in the U.S. are newly infected each year.  It’s why I continue to tell people the importance of getting tested.  There’s no shame, just a need for information.




What is the Connection Between HIV and Mental Health?



Mental and neurological disorders have an intertwined and often complex relationship with HIV and AIDS. Yet mental health issues are often overlooked in HIV interventions and treatment.







  • About 60% of people with HIV also have depression.  Sometimes one may be tempted to “blame” depression on their HIV status, but the reality is that depression can happen to anyone and treatment works

  • Pre-existing mental disorders (including substance use) can complicate HIV-related illness.  It’s important for physicians to know all they need to know about your health, and for you to be comfortable sharing  

  • Nearly 50% of people with HIV experience impaired motor skills, trouble with memory and poor concentration.  If you experience such changes, those are important to inform your doctor about

  • Mental illness can make it more difficult for people to adhere to HIV-medication regimens

  • New antiretroviral treatments and combination therapies can affect the central nervous system and/or have psychiatric side effects

  • Mental illnesses can be especially challenging to recognize and diagnose in people with HIV/AIDS.  That’s why the APA works to educate and provide tools and training to physicians.





Unfortunately, both HIV and mental illness still carry a significant burden of stigma and discrimination.



As HIV/AIDS increasingly becomes a chronic disorder with the improvement of treatments, the need for mental health care and services is rising.  World AIDS Day is also a day to recognize the many psychiatrists and other mental health clinicians working with HIV patients who also have complicated psychiatric or substance use comorbidities.





Looking for ways to take action?  Here are a few simple, powerful, and engaging ways you can take action:







Annelle Primm, MD, MPH is the Deputy Medical Director of the American Psychiatric Association







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Native Americans and Suicide



By Arshya
Vahabzadeh, MD & Brad Zehring, DO





 Mental illness does not discriminate - it affects every age, sex, religion, and ethnic group.




The Indian Health Service conducted a study in 2008 that noted that the rate of suicide for American Indians and Alaska Natives is higher than any ethnic group within the United States. The study reported that suicide in these populations is up to 70% higher, especially in ages 10 to 24. Sadly, this statistic is not decreasing. Mental health professionals and society need to recognize the etiology of the despair that leads to suicide so that treatment and appropriate allocation of resources can be made.



The statistics are alarming, but possibly more alarming is the silence around this tragedy. Since suicide is taboo on most reservations - there are reports that a death by suicide often is not reported or legal authorities classify it as an accident. Due to the silence and misrepresentation, the numbers could be even greater.



It is important to break the silence on the troubling trends within Native American reservations. Native Americans must be willing to discuss their stressors and be open to getting education necessary to cope, deal, and treat their stressors. Mental Health professionals must be willing to understand their culture and adapt. Alex Crosby, MD, MPH, medical epidemiologist of the CDC has been recorded as saying that Native American suicide is so prevalent that it has become acceptable practice when tensions build up. Suicide should never be an acceptable option.



Reasons for troubling trends among Native Americans



There are a lot of thoughts on why mental illness and suicide have increased in the Native American population. There has been a lot of discussion of generational trauma due to the disempowerment and oppression of Native Americans and Alaska Natives. It has been discussed that this has caused adverse childhood experiences that lead to high rates of depression and other mental illness that are precursors to suicide.




While disempowerment and oppression could very well be contributing factors - poverty seems to be a growing problem on reservations. Poverty tends to put stress on educational standards decreasing the educational opportunities for those on the reservation – leading to a viscous cycle. There are few jobs on the reservation causing adolescents and young adults to leave their families and move to where there are jobs. However, parents age and get ill causing tension between the traditional Native American family structures where youth takes care of the elderly and providing for the immediate family.




In addition to poverty, substance abuse is a big problem on the reservation. Substance abuse can affect mood, often negatively, which increases the tension and is a risk factor for suicide. Domestic violence and sexual assault are also known problems on the reservation. These stressors have led to unstable environments for children growing up. Add untreated mental illness to the mix and it is easy to see how hopelessness and despair thrive often leading to the belief that suicide is the only way out.




The Way Forward

Recently, the American Foundation for Suicide Prevention joined a Native American Mental Health panel sponsored by Congressional Native American Caucus and Center for Native American Youth. The panel focused on ways of improving mental health resources and suicide prevention. The IHS and the Substance Abuse and Mental Health Services Administration (SAMHSA) collaborated on targeted suicide prevention programs. The IHS established the Suicide Prevention Initiative and SAMHSA provided funding to the IHS to address youth suicide and provide suicide prevention for high-risk populations.




As we move forward as Mental Health professionals, it will be important to continue to collaborate with the Native American population, especially with Mental Health professionals with experience with the population and their culture. Understanding their culture and etiology of stressors will go a long way in providing the appropriate resources and treatment.

Resources for Help

In the US:

·         Suicide help

·         1-800-273-TALK



Outside the US:

·         International Association of Suicide Prevention (IASP)

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15 Tips for Talking to Kids about Ebola


By David Fassler, M.D.


Child and adolescent psychiatrist 


Parents and teachers may find themselves faced with the challenge of
discussing the evolving Ebola epidemic with children. Although these may
be difficult conversations, they are also important. There are no “right” or “wrong” ways to talk
with kids about Ebola, but here are some suggestions if you need help. 


1. Provide an open and supportive environment where children
know they can ask questions. At the same time, it’s best not to force children
to talk about Ebola unless and until they’re ready.


2. Answer questions honestly. Kids will usually know,
or eventually find out, if you’re “making things up." It may affect their trust in you or your reassurances in the future.


3. Use words and ideas children can understand. Gear
your explanations to the child’s age, language, and developmental level.


4. Help kids find accurate and up to date
information. Print out Fact Sheets from
the CDC, CNN, WHO and kidshealth.org.


5. Be ready to repeat information and explanations
several times. Some information may be
hard to accept or understand. Asking the same question over and over may also
be a way for a child to ask for reassurance.


6. Acknowledge and validate the child’s thoughts, feelings,
and reactions. Let them know that you think their questions and concerns are
important and appropriate.




7. Remember that kids often personalize situations.
For example, they may worry about their own safety and the safety of family members. They may also worry
about friends or relatives who travel or live far away.


8. Be comforting, but don’t make unrealistic promises. It’s
fine to let children know that they are safe in their home or at school. But you can’t promise that there will be no cases of Ebola in your state or
community.


9. Let kids know that there are lots of people helping
the families affected by Ebola. This time is a good opportunity to show children that when something scary or
bad happens, there are people to help.


10. Children learn from watching their parents and
teachers. They will be very interested in how you react to news about Ebola. They also learn from listening to your conversations with other adults.


11. Don’t let kids watch too much television with
frightening images. The repetition of such scenes can be disturbing and confusing.


12. Children who have experienced serious illness, loss, or other traumatic events in the past are particularly vulnerable to graphic
news reports or images of death. These children may need extra support and
attention.


13. Watch for physical symptoms including headaches and
stomachaches. Often times, kids express anxiety through physical aches and pains.
An increase in such symptoms without apparent medical cause may be a sign that
a child is feeling anxious or overwhelmed.


14. Children who are consumed with questions or worry about Ebola should be evaluated by a trained and qualified mental health professional. Other signs that a child may need additional care include:
ongoing sleep problems, frequent fears
about illness or death, or reluctance to leave parents or go to school. If such
behaviors continue, ask your child’s pediatrician, family physician, or school
counselor to help you contact a mental health professional. 


15. Although parents and teachers may follow the news and
the daily updates with interest and attention, most kids just want to be kids. They may not want to think about what’s happening across the country
or elsewhere in the world. They’d rather play ball, climb trees, or ride bikes.


Public health emergencies are not easy for anyone to
comprehend or accept. Understandably, many young children feel frightened and
confused.  As parents, teachers, and
caring adults, we can best help by listening and responding honestly and comfortingly. Fortunately, most children, even those who have experienced loss or illness, are quite resilient.  However, by creating an open environment where
they feel free to ask questions, we can help them cope with stressful events
and experiences.





David Fassler, M.D., is a child and adolescent psychiatrist
practicing in Burlington, Vermont. He is also a Clinical Professor of
Psychiatry at the University of Vermont.









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