IN THE WAKE OF SANDY HOOK - SIX MONTHS LATER

In the Wake of Sandy Hook - Six Months Later

by Andrew Malekoff

On June 3, 2013, at a White House conference on mental health, President Obama urged Americans to “help bring mental illness out of the shadows” and pledged that his administration will provide new resources to support the effort. He called for an open dialogue on mental illness. He said a lack of public understanding about mental illness leads to a lack of treatment. These are timely and encouraging words.

On April 3, 2013, I participated as a panelist in a National Public Health Week event, organized by Hofstra University School Health Sciences and Human Services, on mental health issues in the wake of Sandy Hook. My emphasis was on eradicating stigma and improving access to quality mental health care and child care.

The American reality today is one out of five children has a serious emotional disturbance and more children suffer from psychiatric illness than from autism, leukemia, diabetes and AIDS combined. Yet, we continue to treat illnesses above the neck differently than those below the neck. 

People with mental health problems, and their families, often feel a sense of shame and suffer in silence; while people with physical health problems evoke the sympathy, support and comfort of others. It is shameful that the editors of major metropolitan newspapers exploit and discredit people suffering with mental illnesses with malicious name-calling that reinforces fear, mistrust and stigma, causing labeled persons to lose status and experience discrimination.

We know that the most violent acts are not committed by people with mental illness. In fact, people with mental illness are disproportionately the victims of violence. New gun laws require that the names of designated individuals with severe mental illness be recorded in a national data-base. Whether this will improve public safety or generate a witch hunt that further stigmatizes the mentally ill remains to be seen. In any case, what it does not do is address the problem of better access to quality mental health care.

Here are the facts: seventy-five percent of all serious mental illness occurs before the age of 24; and 50% before the age of 14. Yet, only one out of five children who have emotional disturbances receive treatment from a mental health specialist. We must do more to identify mental health problems early and then, when indicated, provide ready access to quality community-based mental health care.

Early screening by schools and pediatricians is a promising development. Yet, New York State has implemented a "clinic reform" plan that assures continued access to care only to children and families with Medicaid insurance coverage. This leaves a significant number of children and adults in the lurch. 

What’s more, New York State does not support universal access to quality child care, which is critical to a child’s healthy emotional development. By lowering income-eligibility levels for child-care subsidies, thousands of Long Island children are now being denied quality child care, leaving parents to either curtail work or leave their children in unlicensed child-care settings.

When elected representatives and appointed officials champion early mental health screening in schools and pediatrician’s offices, while denying universal access to child care and community-based mental health care, there is only the illusion of caring, political sleight of hand and insult to the children and adults who died at Sandy Hook.

 

SIXTY YEARS OF INSTILLING HOPE, RESTORING MORALE AND MORE

Sixty Years of Instilling Hope, Restoring Morale and More

Andrew Malekoff© March 2013

This year marks the 60th anniversary of North Shore Child and Family Guidance Center. I wonder if its founders, a small group of parents, could have imagined in 1953 that six decades later the Guidance Center would be taking more than 100 calls a week from parents concerned about their children’s emotional well-being. The callers tell stories about children and teens who are troubled, in trouble or causing trouble. Handling their first call sensitively is a hallmark of the Guidance Center. That first person-to-person contact makes all the difference in whether a parent chooses to take the next step forward towards hope or retreats into a sense of despair.

In the early 1950’s, the north shore communities of Long Island were experiencing rapid change. What was once a bucolic landscape peppered with small villages and large estates was being converted into a vast array of suburban developments. The last remaining farms were leveled as roads. Housing developments and schools suddenly popped up, many clustered near the most prominent new roadway, the Long Island Expressway.

According to Bob Smith, who penned a reflection on the first 50 years of the Guidance Center, “In the beginning there were the parents; a generation of mostly young professionals and middle-class workers who had come of age in the great depression, been tempered by the crucible of war, and then came marching home to an increasingly troubled urban environment. These young men and women came to the suburbs in search of a safer, healthier place to raise their children.” The new residents had come with little children or the expectation of children. They came as a single generation, not as an extended family. The priority of the suburbs became raising children.

The Guidance Center’s beginnings were rooted in a community-based model, where progressive-minded suburban activists organized to establish a children’s mental health clinic for members of the community in need of such services. The message to new suburbanites was that, despite their relocation into more affluent communities, mental health problems were not confined to the underprivileged and poor.

Smith recalled that the founders, “made it understood that the oft repeated remark – ‘wherever you go – there YOU are’ was, in fact, true; that the need for services crossed financial, educational, ethnic and class barriers. And that the suburban environment, because of its isolation, might even be more stressful for these young families than the urban environment might have been, with its close-knit neighborhoods and extended families for support.” This remains true today, despite dramatic changes in the intervening years.

Sixty years later, we are blessed to have modern technological innovations such as the Internet and cell phones that provide us with the capacity to make connections anywhere and anytime. Yet, instant access and social media are no replacements for more intimate face-to-face interaction, the essential medium of a community-based agency.

The 100-plus calls we receive every week tell different stories, yet are similar with characteristics of demoralization such as a sense of helplessness and hopelessness, inability to cope, self-blame, feelings of worthlessness and a sense of alienation. Perhaps the most enduring quality of the Guidance Center, over 60 years, is its ability to connect with struggling families of all backgrounds, up close and personal, and to instill hope and restore morale.

Happy 60th Anniversary North Shore Child and Family Guidance Center!

SHORTSIGHTED CUTS TO DRUG TREATMENT

http://www.newsday.com/opinion/letters/letter-shortsighted-cuts-to-drug-treatment-1.4809203

Shortsighted cuts to drug treatment

Andrew Malekoff

March 14, 2013

Regarding the escalating drug problem on Long Island ["Deadly turn to heroin," News, March 11], six months ago, County Executive Edward Mangano held a news conference on the growing heroin and prescription pill problem in Nassau County. He stood with the mothers of children who died from drug overdoses.

To remedy this he announced that Nassau had been certified by the New York State Department of Health to train its employees, as well as families of at-risk individuals, in administering the overdose-reversal agent Narcan to anyone who has ingested large amounts of opioids like heroin.

Any step to save lives is welcome. However, at the news conference there was no mention of $7.3 million in human services funding that was cut on July 5, 2012, which included $1.75 million for outpatient drug treatment.

I am reminded of the parable about the small village on the edge of a river. One day a villager saw a baby floating down the river. He jumped in the river and saved the baby. The next day he saw two babies floating down the river. He and another villager dived in and saved them. Each day that followed, more babies were found floating down the river. The villagers organized themselves, training teams of swimmers to rescue the babies. They were soon working around the clock.

Although they could not save all the babies, the rescue squad members felt good and were lauded for saving as many babies as they could. However, one day, one of the villagers asked: "Where are all these babies coming from? Why don't we organize a team to head upstream to find out who's throwing the babies into the river in the first place!"

Mobilizing county resources to pull babies from the river while simultaneously cutting back on activities to prevent the babies from being tossed into the river in the first place makes no sense.

Andrew Malekoff

Editor's note: The writer is the executive director of the nonprofit North Shore Child and Family Guidance Center in Roslyn Heights.

THEY LOBBY FROM THEIR GRAVES

THEY LOBBY FROM THEIR GRAVES

by Andrew Malekoff © 2013

It was not necessary for the slaughter of innocents at Sandy Hook Elementary School to validate what we are reminded of daily - that there is evil in the world. But what it did do is to affirm that if the massacre of six- and seven-year-old children is not off limits, then nothing is.

Immediately after the murderous rampage in Newtown, CT, mental health experts offered tips to speechless parents about how to soothe their children. The advice sounded like this: Be available emotionally, be compassionate, limit media exposure, reassure safety, offer distractions to prevent obsessive worry, monitor for angry outbursts and depression and, if symptoms persist, seek professional help.

Can you imagine how the advice might have sounded if parents spoke from their guts instead of their heads and hearts? The advice might have sounded like this: It’s a cruel world, evil is everywhere, toughen up, watch your back, be vigilant, don’t trust anyone and (for older children) just because you’re paranoid doesn’t mean that they’re not out to get you.

In the last 30 years, America has mourned at least 61 mass murders. After some time passes, the latest homegrown massacre will become another tombstone in our collective psyche, alongside Columbine, the World Trade Center, the Long Island Railroad, Virginia Tech, Oak Creek, Aurora and more.

We seem always to move forward believing that we have seen the last and worst of it; until the next time. Denial is a healthy defense when the alternative is all-consuming, paralyzing and debilitating fear. We do all we can to protect our children emotionally, as well as physically. And, so we support their denial, using psychological bromides to seal their emotional scars.

The two major talking points since Newtown are preventing gun violence and promoting mental health. On the issue of gun violence, I wholeheartedly support the right to bear arms and taking steps to get certain guns out of uncertain hands. On the issue of mental health care, the chronic under-funding of children's outpatient community-based mental health services in Nassau County and New York State, is a disgrace.

New York State has ensured easy access to community-based mental health care for Medicaid recipients and neglected the needs of underinsured middle class and working poor families. Their answer is always that the marketplace will take care of it. It won’t. They know full well that private practitioners often do not accept private insurance and will not provide the labor-intensive services that licensed community-based mental health agencies do.

The gun lobby is formidable and well-heeled. Children, on the other hand, don’t have a voice until they are in the ground. Children are killed, grieving parents become tireless advocates and laws are passed. Timothy’s Law (mental health parity), Megan’s Law (making information available to the public regarding registered sex offenders) and Katie’s Law (making aggravated vehicular homicide a crime) come to mind.

Think about it. After the Newtown shootings there was not one parent in the United States who was able to escape the tyranny of imagining their child being murdered in their neighborhood school. How many more children will be taken from us before lawmakers devote the same energy and resources it takes to launch their re-election campaigns, to safeguarding our children?

Wake up lawmakers, elected and appointed officials, and government bureaucrats. Our children are suffering and dying, families are struggling and desperate. Support the constitutional right to bear arms, take steps to prevent gun violence and provide adequate funding for community-based mental health centers to support the emotional well-being of all of our children.