0 Tips for Talking to Children about Aurora Shooting

By David Fassler, M.D.

Parents and caretakers are faced with the challenge of discussing the recent tragic shooting in Aurora, Colorado with children. Although these may be difficult conversations, they are also important. There are no “right” or “wrong” ways to talk with children about such traumatic events. However, here are some suggestions that may be helpful:

• Create 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 things unless and until they're ready. 

• Give children honest answers and information. Children will usually know, or eventually find out, if you're “making things up.” It may affect their ability to trust you or your reassurances in the future.

• Use words and concepts children can understand. Gear your explanations to the child's age, language, and developmental level.

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

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

• Remember that children tend to personalize situations. For example, they may worry about their own safety or the safety of friends when going to the movies or other public areas.

• Let children know that lots of people are helping the families affected by the recent shooting. 

• Children learn from watching their parents. They are very interested in how you respond to local and national events. They also learn from listening to your conversations with other adults.

• Don't let children watch too much television / news coverage with frightening images. The repetition of such scenes can be disturbing and confusing. 

• Children who have experienced trauma or losses in the past are particularly vulnerable to prolonged or intense reactions to news or images of violent incidents. These children may need extra support and attention.

• Children who are preoccupied with questions or concerns about safety should be evaluated by a trained and qualified mental health professional. Other signs that a child may need additional help include ongoing sleep disturbances; intrusive thoughts or worries; recurring fears about death, leaving parents, or going out to public areas. If these behaviors persist, ask your child's pediatrician, family physician, or school counselor to help arrange an appropriate referral.

• Although parents may follow the news with close scrutiny, most children just want to be children. They may not want to think about or discuss violent events.  They'd rather play ball, climb trees, or ride bikes.

A senseless, violent crime is not easy for anyone to comprehend or accept. Understandably, some young children may feel frightened or confused. As parents and caring adults, we can best help by listening and responding in an honest, consistent, and supportive manner.

Fortunately, most children -- even those exposed to trauma -- 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 and reduce the risk of lasting emotional difficulties.

David Fassler, M.D., is a child and adolescent psychiatrist practicing in Burlington, Vermont.  He is also a clinical professor in the Department of Psychiatry at the University of Vermont College of Medicine.

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0 When Divorce Happens

By Gariane Gunter, M.D. 



A recent study was published in Health Day that discusses the mental health of children of divorced parents. While I am not in the position to support or deny the findings, the topic of divorce when children are involved is often a difficult one. Every family is different, but the following are some general tips for divorcing parents that can be helpful.



1. Attempt to keep a positive attitude during the point of separation. This is often a very trying time for the family. Stick to a routine and embrace the activities your children have always enjoyed.

2. Don’t forget to nurture yourself. Going for a walk, having coffee with a friend, or reading a good book are ways to rest and regain energy. It’s normal to feel exhausted when separating; and possibly for many months to follow.

3. Encourage kids to openly discuss their feelings, positive or negative, about what's happening.

It's important for divorcing, as well as already divorced parents, to sit down with their kids and encourage them to say what they're thinking and feeling. But you'll need to keep this separate from your own feelings. Most often, children experience a sense of loss of family and may blame you, the other parent, or both of you for what is going on in their lives. You really need to be prepared to answer questions your kids might raise. They might feel guilty and imagine that they "caused" the problem. Kids and teenagers may feel angry or frightened, or worried about their future. Counselors can assist with this difficult conversation and provide a safe environment if safety is a concern.

4. Although very tempting, try not to speak negatively about your former spouse when your children are present. This issue, often called “parental alienation” can be a problem. Doing things such as putting your child in the middle, saying negative things about the other parent, and using your child as a messenger puts your child in a “no win” situation and creates lifelong relationship issues for all involved. The reasons include the following:



• The comments may confuse and frighten children.

• Many of your concerns about your former spouse are difficult for you to express. It is very important that you keep these concerns to yourself. Children just do not have the emotional maturity to withstand information/situations that adults find stressful.

• Your child’s identity and self concept is based on parental behavior. Even if it is next to impossible to say anything good about your former spouse, try to do so. If this is impossible then don’t say anything.

• Children love to eavesdrop. Telephone conversations are their favorite snooping ground. Make all effort to not discuss your divorce-related difficulties on the telephone when your children are around.

5. During the crisis point of separation try to remember that your children need you both parents more than ever. This is not a time to deny access unless a professional deems it necessary to do so for safety related reasons.

6. It is important to accept the fact that a separation involves feelings of loss for children. Try not to panic if the following behaviors occur during the first few months of separation:

• Sleep difficulties like disrupted sleep, an inability to sleep, exhaustion etc.

• Social isolation

• Anger, intolerance, grumpiness

• Avoidance of divorce related conversations

• Obsessing about the divorce

• Appetite changes

• Feelings of worthlessness

• Tears and feelings of overwhelming sadness

7. Although many children do not ask to see a counselor when their parents separate, they usually find counseling very helpful.

8. It is important to acknowledge that children are very loyal and protective of their parents. If children are placed in loyalty binds they can experience anxiety. Try to alleviate their anxiety if they decided to “pick a side.” This is a coping skill which teens in particular use. If your child engages in “picking a side” try not to feel rejected.



9. Think of yourself as a survivor not a victim. And be patient. Everyone takes different times to heal.

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0 Lessons Learned in the Wake of Tragedy

By Gina Newsome Duncan, M.D.





Dr. Molly McVoy recently blogged about the horrific shootings of Representative Gabrielle Giffords and others on Saturday, January 8, 2011. This tragic incident has sparked widespread national debate about all aspects of the case, including mental health treatment in this country and links between violence and mental illness.



The fact is that most people with mental illness are not violent, and that violence is most often caused by those who are not mentally ill. However, this incident does provide an opportunity for us as a nation, to seriously consider the state of our mental health services. If we examine it carefully, we can possibly prevent further acts of violence, and also think about how we help those who are in need of mental health treatment.



It is an unfortunate reality that mental illness remains largely shrouded in stigma, and tragic events such as this often help to only deepen that stigma in the minds of the public. As a result of this stigma, many people live with unnecessary shame and suffering, not seeking the help that they need. Most often, the primary victim is the person living with the illness, and by extension, their loved ones. Very rarely, however, untreated illness can lead to tragic consequences that reach far beyond the person with the illness and his or her family.



Like physical illness, mental illness has the best outcome when recognized and treated early. We should let this tragedy be a call to become more proactive in addressing issues of mental illness in our communities.

There are several important steps that can be taken:



1) As a public, we can become more informed about the signs, symptoms and treatment of mental illness.



2) We can all work to  destigmatize mental illness. The American Psychiatric Association’s Council on Communications is actively involved using this blog and with other activities.



3) Educate yourself on how mental health is funded in your community and let your vote count when issues of mental health funding are on the ballot.





It is true that there are rare situations in which a person with a severe mental illness may become violent. In most cases, this violence will be self-directed in the form of suicidal acts, but in rare instances, it may be directed toward others as well. What can be done in those situations?



1) If you are personally experiencing a mental illness and are having thoughts of harming yourself or others, it is important that you seek help from a doctor, therapist, or 911 immediately.



2) If you are the friend or family member of a person experiencing a severe mental illness and you are concerned due to actions or statements they have made that they may be a danger to themselves or others, it is important that you seek help from a doctor, therapist, or by calling 911 immediately.



a. Be as detailed about your concerns as possible.



b. Do not let your concern go unheard, put it in writing.



c. Firearms and weapons should be kept sealed and locked, or ideally, removed from the home.



d. Unfortunately, many communities do not have adequate crisis prevention resources. Familiarize yourself with the procedures your community does have for involuntary hospitalization. You can get this information by calling your local health department, hospital department of psychiatry, emergency room, community mental health center, family physician, or police department.

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0 Shootings Stir Emotions, Call for Access to Affordable Care

By Molly McVoy, M.D.



The tragic shooting in Arizona has spurred many emotional headlines and provocative stories in the news. News stories have used the words “insane,” “coldblooded,” “bizarre,” “evil” and “troubled.”



Whenever tragedies such as this occur, emotions are stirred and people often look for clear answers. Unfortunately, tragedies like this do not have easy answers. Whether or not mental illness is involved in this case, this may be a moment to look at every way to reduce the risk of another tragedy such as this in the future.



Rep. Giffords



U.S. Rep. Gabrielle Giffords, currently in an Arizona hospital as a result of the shooting, is a friend to the National Alliance for Mental Illness (NAMI) and has served as co-chair of several fundraisers for NAMI in Southeast Arizona.



There are so many ways in which the mental health system in the United States is broken. Treatment is often hard to access and expensive. Consistent treatment is often nearly impossible for those with severe mental illness. Advocating for improved access to quality mental health care is critically important at a time like this.



In addition, it is also important to remember that the likelihood of violence from those who struggle with mental illness is very low. Most of the violence perpetrated in this country is by individuals without mental illness. Most individuals suffering from mental illness are not violent.



No matter the cause, a time like this calls for reflection and action: examining all the factors that can be changed to minimize the risk of something like this happening in the future.

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0 “What do I tell my kids?” Tips for talking to children about the Gulf Oil Spill

By Molly McVoy, M.D.





I did a quick Google search of kids and the Gulf oil spill, and I found everything from “Why are they killing all the birds and sea turtles?” to resources for environmentally minded children on how to start an environmental action plan of their own.





The oil spill in the gulf coast has many worried, from children through adults. The resources for how to talk to them are varied and sometimes confusing. Below are some basic tips for talking to children about the oil spill threatening the gulf coast.





Talking to your children about disasters can be challenging. Children ask tough questions and it can be difficult to know how best to answer them. However, times like this, during disasters, can be a golden opportunity with your children. When current events are scary or confusing, it can be a great opportunity for parents to show their children that there are people to help them and the country get through them.





The best advice I can give for talking to children about anything, but disasters in particular, is this - be honest, be simple and repeat, repeat, repeat. Don’t force your child to talk about the oil spill, but, if they ask, tell them the truth in language that fits with their age. Children know if they’re being told the truth, so answer them as simply and straightforwardly as you can. But, being a child, they will likely ask again and again (and again!). It’s okay if you have to repeat yourself, it’s the open dialogue and the reassurance that children are looking for during times of crisis.





So, as Bill Cosby said of fatherhood “You just need a lot of love and luck - and, of course, courage.”

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