DEPRESSION, SUICIDE, DISCRIMINATION AND PARITY

In the immediate aftermath of the suicides of Kate Spade and Anthony Bourdain Gov. Cuomo issued a press release about new funding to address the rising rate of suicide.

He stated: "Two high-profile suicides this week put mental illness front and center, but while those names were the ones in the press, every day there are thousands of New Yorkers who struggle with suicidal thoughts, and we must do everything we can to support them. Depression does not discriminate. It affects every part of society and people from all walks of life."

I applaud the Governor for bringing this matter to light. He stated, “Depression does not discriminate.” Nevertheless, health insurers that do not comply with federal parity law, denying timely access to care, do discriminate. When New York State government does not enforce this law, they aid and abet discrimination against the “thousands of New Yorkers,” who the Governor referred to as those “who struggle with suicidal thoughts”.

The difficulty people have accessing mental health and addiction care is not simply a matter of stigma. It is a matter of discrimination. This is a civil rights issue that an announcement of new funding alone will not solve.

On December 15, 2017, North Shore Child and Family Guidance Center held a press conference at its headquarters in Roslyn Heights and issued the results of a research study – Project Access that we conducted in collaboration with LIU Post Department of Social Work. 

In this year-long study, hundreds of Long Islanders were surveyed about their experiences attempting to obtain help for mental health and addiction problems.

Of the 650 Long Islanders who took part in the survey, almost half said that it was more difficult finding help for mental health or substance abuse problems than finding help for physical illnesses, nearly 40 percent said that their insurance company did not have an adequate number of providers and two-thirds said that their insurance company was not helpful to them in finding a suitable provider for themselves or a loved one.

NY State Senator Todd Kaminsky, who attended the December 15th press conference, stated that the findings were “Damning.”

In a bipartisan effort, Kaminsky and Senator Elaine Phillips wrote to the Department of Financial Services (DFS) on January 9, 2018 citing the Project Access study and requesting “a thorough investigation to determine why insurance companies are not being held accountable for network adequacy.” Network adequacy is the part of the federal parity law that states that health insurers who cover mental health and addiction care must have an adequate number of providers in their network. Many more people wrote directly to Gov. Cuomo, requesting the same.

Almost five months later Scott Fischer, Executive Deputy Superintendent for Insurance, a division of DFS, responded in writing to the Senators. Fischer wrote: “DFS’s review of the various networks has confirmed that each of the insurance companies in Long Island exceeds the standards for mental health and substance use providers, for the purpose of the commercial products sold outside of NYSOH.”

Translation: There is no problem. There is nothing more to do. This does not square with the results of Project Access.

Health insurers and government ignoring federal parity law is discrimination. When it comes to suicide prevention: access delayed, is access denied.

Discrimination deserves a place alongside stigma when the conversation turns to access to care.

It’s a matter of civil rights.

Long after the tragic deaths of Kate Spade and Anthony Bourdain fade from the front pages, the lack of compliance and enforcement of federal parity law will persist and the thousands of people that the Governor spoke of in hispress release will still be unable to access care.

Andrew Malekoff

This article was published in the NYS Behavioral Health News, Summer 2018

Andrew Malekoff is the Executive Director of North Shore Child & Family Guidance Center, which provides comprehensive mental health services for children from birth through 24 and their families. To find out more, visit www.northshorechildguidance.org. To read more about Project Access go to: https://www.northshorechildguidance.org/wp-content/uploads/2017/12/north-shore-project-access.pdf

KIDS IN CAVES AND KIDS IN CAGES

By Andrew Malekoff© July 12, 2018

The daring cave rescue in Thailand was breathtaking. For a few moments the world stood still.

Skilled divers, medical personnel and others united and prevailed to save the lives of 12 children and their soccer coach.

It was a time when thoughts and prayers were a welcome sentiment, as opposed to the cliché often uttered by politicians in the aftermath of a school shooting.

Meanwhile, one of the more disturbing and divisive stories in recent memory—the forcible separation of thousands of migrant children from their parents after crossing the southern border into the United States—remains.

What makes the migrant children story disturbing is obvious. Although some people may be put off by the term “kids in cages,” the reality is that many of them are confined to chain-link pens that they are not permitted to leave.

Not so obvious are the nuances contained in the widely divergent and often politically motivated opinions about what brought them here in the first place.

Many believe the migrants were seeking asylum from violent gangs and terror.  Others say they were escaping poverty and looking for a free ticket into the U.S. Still others insist that the bulk of the children were brought here not by parents but by human traffickers posing as parents and that they haven’t been separated but put into protective custody.

Whatever the reason they undertook the arduous and dangerous journey, the result is the same: Who is welcome here and who is not have become political flashpoints in post-truth America.

The juxtaposition of migrant children trapped in cages and children trapped in caves symbolizes a troubling paradox: Some children count and some don’t.

Thailand is a well-known destination for forced labor and sex trafficking of children.  Yet we are not riveted to the plight of these children, whose daily peril is not as well-exposed as the kids in caves.

The kids in caves made for great reality TV. It evoked Survivor, the reality show where contestants are stranded in an isolated location and a lone survivor takes home a cash prize. Cave Rescue was more compelling must-see TV, with life and death at stake.

When the kids in the cave were losing oxygen, tanks of air were delivered to them. One man, a Thai Navy SEAL Saman Gunan, gave his life for the boys to breathe easier. These kids also had each other and a surrogate parent for emotional support. There were volunteers from around the world pitching in and well-wishers everywhere.

But what of the kids in cages who are experiencing inconsolable grief and a prolonged stress response that is likely to derail their healthy development for many years to come? Who is there to rescue them?

What they are missing cannot be found in a metal canister. What they long for is human touch and a sense of hope.

The daring rescue in Thailand was a blessing for its exhilarating outcome and for what it made us feel about ourselves, if only for a moment. We all cared together.

If only there was some way to sustain that feeling and good will toward all of God’s children.

Note: The following column will be appearing in Blank Slate Media.

CONTEXT COUNTS IN CARING FOR CHEMICALLY DEPENDENT KIDS AND FAMILIES

By Andrew Malekoff©

Despite feeling blindsided, many of us now know that we are living in the midst of an unprecedented drug epidemic. According to the U.S. Department of Health and Human Services, since 1999, the rate of overdose deaths including prescription pain relievers, heroin and synthetic opioids such as fentanyl, nearly quadrupled.

In the intervening years, many steps have been taken to help save lives. These include improving prescribing practices and expanding access to medication-assisted treatment and the use of Naloxone. 

Medication-assisted treatment combines behavioral therapy and medications such as methadone or buprenorphine to treat opioid addiction. Through affordable, accessible and quality care people can recover and go on to live productive lives.

Naloxone is used to treat a narcotic overdose in an emergency situation by reversing the effects of opioids, including slowed breathing or loss of consciousness.

Notwithstanding the increased attention to lifesaving measures, there is relatively little focus on the devastating impact of addiction on children living in families where a parent is addicted to drugs or alcohol.

There are more than 8 million children under 18 years of age that are growing up in homes with alcohol and other drug-abusing parents. These young people are likely to become alcohol or drug abusers themselves without intervention.

Parental alcoholism and drug addiction influence the use of alcohol and other drugs in several ways. These include increased stress and decreased parental monitoring that contributes to adolescents’ joining peer groups that support drug use.

Children who grow up with an addicted parent learn to distrust to survive. When unpredictability dominates one’s life, he or she is likely to be wary, always sensing disappointment lurking nearby.

Children growing up with an addicted parent become uncomfortably accustomed to living with chaos, uncertainty and unpredictability. When a child grows up under these conditions, they learn to guess at what normal is.

Denial, secrecy, embarrassment and shame are common experiences of children who live with an addicted parent. Even seeking help outside of the family might in itself be seen as an act of betrayal, a step toward revealing the family secret. The stigma of addiction can leave chemically dependent persons and family members feeling utterly alone in the world.

Children who grow up with an addicted parent live with the unspoken mandate - don’t talk, don’t trust, don’t feel.

Growing up with an addicted family member leaves children with little hope that things will ever change. I am reminded of a 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 resources to pull babies from the river, while neglecting the ones left behind makes no sense.

Published in Behavioral Health News, FALL (2) 2017 Issue, Volume 5, Number 2, p. 20

ANIMAL ASSISTED THERAPY FOR VULNERABLE YOUTH

By Andrew Malekoff©, Summer 2018

For almost two decades, my agency, North Shore Child & Family Guidance Center has been utilizing Animal Assisted Therapy (AAT) in outpatient mental health work with youths and their families, working in partnership with local canine and equine organizations.  An adjunct to traditional therapy, AAT relies on the human-animal bond in goal-directed interventions as an essential part of the therapeutic work. 

According to leading AAT expert Cynthia Chandler some of the reasons to include animals in therapy are:

1.     Consumers may be more motivated to attend and participate in therapy because of a desire to spend time with the therapy pet.

2.     Consumers may receive healing nurturance and affection through physical contact with the therapy pet.

3.     Consumers may experience genuine acceptance by the therapy pet.

4.     In many instances . . . consumers may be able to perform activities and achieve goals that would not otherwise be possible without the assistance of a therapy pet.

Following is an illustration of animal assisted group work using a therapy dog to build social competencies and self confidence in group members.

In a group that was composed of early adolescents who were identified as painfully shy or socially awkward, the group members were all drawn to the therapy dog Elvis, who was introduced as a new “group member.”

Everyone wanted to pet Elvis, a Basset Hound, and feed him treats. The norm in groups like this is to earn time with Elvis by taking steps forward in skill development. For example, speaking up and talking about one’s experiences in the previous week could earn time with Elvis. In addition, the work is metaphorical in the sense that the group members are directed to notice things about Elvis. 

For example, one group member says, “Elvis looks a little shy.” To which the worker asks, “How can you tell?” This ignites a process in which members begin to build their powers of observation and reading non-verbal cues, for example.

In animal assisted groups the group worker must work closely with a co-facilitator, the animal handler. The handler is like an interpreter who can teach about his or her dog. For example, “This is how Elvis will show you if he is a little shy and here is how you can approach him.” The group members transfer learning by observing and learning about and interacting with the animal. They can then practice without being hit over the head with it by being lectured to.

Success comes by noticing the animal or by failing to do so. For example, if an animal shies away, group members learn that maybe he needs some quiet time. In other words, the members discover that there are lessons learned from not having their wishes fulfilled all the time.

Having an animal handler as a co-leader is not very complicated since their role is circumscribed. The handler is an interpreter who loves to talk about the personality of his or her dog and its uniqueness. They can humanize how the dogs speak and keep appropriate boundaries (e.g. not rushing at someone socially). Using dogs are a little easier to arrange for logistically, but there are a growing number of settings that offer equine facilitated therapy, which add another dimension to group work for shy and awkward youths.

According to my North Shore Child & Family Guidance Center colleague social worker Lee Holtzman, Animal Assisted Therapy is a viable alternative to work with children and youths who have a history of trauma. Expanding research in the area of how trauma affects the brain has highlighted the role of adjunct therapies such as yoga and animal assisted therapy, for example, to help people safely regain the ability to feel their bodies and to uncover and release painful memories stored in the body.

Finally, two guidelines to keep in mind when planning to use animals are: (1) Seek parental permission. This is particularly relevant to culturally sensitive practice. There are certain cultures that may have strong attitudes towards human-animal interaction that might preclude practice with animals. In any case, engaging parents in the process is a must; and (2) Screen for proper credentialing and training. Carefully screen animals and handlers to be sure that they are properly trained and credentialed.

Published in the New York State Behavioral Health News, Summer issue 2017

DEPRESSION, SUICIDE, DISCRIMINATION AND PARITY

Depression, Suicide, Discrimination and Parity

By Andrew Malekoff© Summer, 2018

In the immediate aftermath of the suicides of Kate Spade and Anthony Bourdain Gov. Cuomo issued a press release about new funding to address the rising rate of suicide.

He stated: "Two high-profile suicides this week put mental illness front and center, but while those names were the ones in the press, every day there are thousands of New Yorkers who struggle with suicidal thoughts, and we must do everything we can to support them. Depression does not discriminate. It affects every part of society and people from all walks of life."

I applaud the Governor for bringing this matter to light. He stated, “Depression does not discriminate.” Nevertheless, health insurers that do not comply with federal parity law, denying timely access to care, do discriminate. When New York State government does not enforce this law, they aid and abet discrimination against the “thousands of New Yorkers,” who the Governor referred to as those “who struggle with suicidal thoughts”.

The difficulty people have accessing mental health and addiction care is not simply a matter of stigma. It is a matter of discrimination. This is a civil rights issue that an announcement of new funding alone will not solve.

On December 15, 2017, North Shore Child and Family Guidance Center held a press conference at its headquarters in Roslyn Heights and issued the results of a research study – Project Access that we conducted in collaboration with LIU Post Department of Social Work. 

In this year-long study, hundreds of Long Islanders were surveyed about their experiences attempting to obtain help for mental health and addiction problems.

Of the 650 Long Islanders who took part in the survey, almost half said that it was more difficult finding help for mental health or substance abuse problems than finding help for physical illnesses, nearly 40 percent said that their insurance company did not have an adequate number of providers and two-thirds said that their insurance company was not helpful to them in finding a suitable provider for themselves or a loved one.

NY State Senator Todd Kaminsky, who attended the December 15th press conference, stated that the findings were “Damning.”

In a bipartisan effort, Kaminsky and Senator Elaine Phillips wrote to the Department of Financial Services (DFS) on January 9, 2018 citing the Project Access study and requesting “a thorough investigation to determine why insurance companies are not being held accountable for network adequacy.” Network adequacy is the part of the federal parity law that states that health insurers who cover mental health and addiction care must have an adequate number of providers in their network. Many more people wrote directly to Gov. Cuomo, requesting the same.

Almost five months later Scott Fischer, Executive Deputy Superintendent for Insurance, a division of DFS, responded in writing to the Senators. Fischer wrote: “DFS’s review of the various networks has confirmed that each of the insurance companies in Long Island exceeds the standards for mental health and substance use providers, for the purpose of the commercial products sold outside of NYSOH.”

Translation: There is no problem. There is nothing more to do. This does not square with the results of Project Access.

Health insurers and government ignoring federal parity law is discrimination. When it comes to suicide prevention: access delayed, is access denied.

Discrimination deserves a place alongside stigma when the conversation turns to access to care.

It’s a matter of civil rights.

Long after the tragic deaths of Kate Spade and Anthony Bourdain fade from the front pages, the lack of compliance and enforcement of federal parity law will persist and the thousands of people that the Governor spoke of in hispress release will still be unable to access care.

Published in the New York State Behavioral Health News, Summer 2018 issue

WHAT IS TODAY'S AMERICA MAKING OUR CHILDREN SUSCEPTIBLE TO?

By Andrew Malekoff© June 22, 2018

There are a few great films that have lingered in my consciousness; images are seared in, memorable lines are indelible and feelings evoked are still close to the surface. 

The White Ribbon (2010) is one such film that has left a lasting residue. It depicts the residents of a northern German village, dominated by a baron, sometime before World War I.

Inhabitants of the village young and old are sliding down a slippery slope of moral decline. A number of men in leadership positions are despicable, especially in their treatment of women and children.

The cruelest scene of the movie was not one that showed physical violence, but verbal abuse towards a woman that served faithfully as caretaker and more for the town's widowed physician.

As for some of the children, although it is only suggested it appears that they are budding sociopaths that perform serial acts of meanness.

Movie reviewer Mike LaSalle wrote about the film, “No child is trained to become a martinet, and no one says anything about a master race. Rather, the kids, from their elders, get quiet lessons in moral absolutism, sternness, emotional violence and heartlessness.”

Weeks after seeing the film, I started thinking more deeply about the children in this pre-World War I town. I realized that they would become young adults during the time Hitler would rise to power.

They lived an incubator in which they adopted the brutality that they experienced, often against unsuspecting victims. They were being unwittingly primed for carrying out the atrocities that later came to characterize their future lives in Nazi Germany.

Seeing this film has led me to wonder about what the times we live in today are a prequel for.

As LaSalle remarked, “It didn't have to be Nazism that took hold a generation later. It might have been any ideology that encourages blind devotion that flatters people's vanity by telling them they're intelligent for not thinking and that they're virtuous for believing themselves better than their fellow citizens.”

The White Ribbon begs the question: What is today’s America making our children morally susceptible to?

Published in the Blank Slate Media in June 2018

SETTLING IN, CHICKEN-STYLE

By Andrew Malekoff©, July 2018

It’s a common refrain heard in classrooms and at dinner tables all across the country: “Why won’t you just sit still?” Sometimes, with kids who seem especially hyperactive, there is an all-too-quick leap to giving the “problem” a psychiatric label and pulling out a prescription pad.

Although I’m a clinical social worker by training, I find that alternative sources of knowledge (what some may refer to as old-fashioned common sense) sometimes fit best. Here’s an example:

I recall a meeting with my colleagues regarding a newly formed after-school program for teenagers. A shared frustration was getting things started on time. After some conversation, it became clear that the kids eventually settled down, but it always took more time than the adults deemed necessary.

One of the women, my longtime colleague Dr. Nellie Taylor-Walthrust, an alcohol and substance abuse counselor and pastor, asked her colleagues, “Did any of you ever live on a farm?” They all signaled that they hadn’t. She smiled knowingly and responded, “Well, I did. And when you grow up on a farm you notice certain things.”

She went on to explain, “I’ve been watching closely, and in the after-school program I’ve noticed certain behavior by a number of the youngsters each time they come to the group.

Whether they arrive early or after the group has already begun, they perform a certain ritual before connecting more consciously with what is going on in the group. It goes something like this: They move the chairs several times, place certain objects—coat, sweater, book bag—in a certain position on or near the chair, collect objects from their pockets or begin to crumple paper and place it in the waste basket, and so on. When confronted about their distracting behavior, they often reply, ‘Okay, just one minute,’ meaning that they hadn’t quite completed their settling-in process.

“After weeks of observation, I was reminded that I had seen chickens perform similar rituals before laying eggs. I often wondered why they didn’t simply walk in, lay their eggs, and walk out. But instead, they would survey the nest, scratch and peck some more, and sit down again.

This behavior continued until they felt settled in. When the process was interrupted, I observed, they would start the ritual all over again. Now, I’m not suggesting that some youngsters are like chickens, but there seems to be a similarity in their need to release a certain amount of energy in order to focus on the task before them.”

Nellie’s “down home” observations captured the essence of the young people’s waking moments. The milling process seemed to be a normal resistance brought on by the daily residue of feelings either about home or school, perhaps intended to sidestep the work at hand.

For most kids, milling is a natural and normal process to be respected and left alone, as opposed to a manifestation of a disorder or some form of pathology. The kids eventually settled down and attended to task, as did the chickens.

This tale of the chickens had a soothing effect on Nellie’s colleagues, whose patience increased as a result.

What does this story about restless kids and chickens preparing to lay eggs mean? Sometime a kid is just a kid. That’s not to say that, for some, careful examination, diagnosis and specialized care are necessary and should be sought.

But for the others? Well, sometime they’re just being chickens. I mean kids. 

Published in the Long Island Weekly in July 2018

THE LIVES OF BLACK MOTHERS AND BABIES

By Andrew Malekoff© May 2018

In a report issued by Nassau County’s Department of Health - Community Health Assessment and Community Health Improvement Plan (2016-2018) – there is no mention of maternal mortality or information on social and environmental risk factors for women and infants of color. Consequently, no initiatives to address maternal and infant mortality disparities are recommended, yet overall Nassau County health data indicates that it ranks at the top of all counties in New York State.

To address this “invisible injustice,” maternal and child health advocates convened at Hofstra University on March 23, 2018 for a Birth Equity Breakfast organized by the Nassau County Perinatal Services Network.

Birth equity refers to the assurance that all human beings have the best possible births, buttressed by careful attention to racial and social disparities. 

Keynoter Dr. Martine Hackett, assistant professor at Hofstra University’s School of Health Professions and Human Services, presented data from the NYS Department of Health that showed the disparate outcomes for Black mothers and babies as compared with their White counterparts.

Infant mortality refers to the death of children before their first birthdays, which is a key indicator of the overall health of a population. According to the United Nations International Children’s Fund (UNICEF), Japan is the number one ranked country for newborn survival, while the United States ranks only 22nd in the world.

Among the eye-opening data that Dr. Hackett cited are the differences between the infant mortality rates in contiguous communities in Nassau County. For example, in Roosevelt there were 11.1 infant deaths per 1,000 births from 2012-2014, while neighboring Merrick had zero deaths. Overall, in Nassau County the Black infant mortality rate is more than four times that of the White infant mortality rate and even higher than in New York City.

Dr. Joia Creer-Perry, President of the National Birth Equity Collaborative, spoke about the perception of Black mothers and the barriers to receiving holistic care by the health care system. If a woman is living under great stress she will have trouble carrying her baby to term. Premature birth to underweight babies is a leading cause of infant mortality.

Social justice activist and attorney Fred Brewington condemned the institutional racism prevalent in healthcare that has resulted in infant mortality figures today that are no different than they were almost a century ago.

Just weeks after the Birth Equity Breakfast, Tasha Portley, a nurse living in Tyler, Texas, spoke at a similar forum halfway across the U.S. In a report published in the April 16th edition of the Tyler Morning Telegraph, Portley stated that “Pregnant Black women often experience casually degrading remarks from White people when they seek maternal health care.”

Portley shared the story of a Black woman who had some difficulty acquiring a breast pump from a local social services agency and, in the process, was the target of demeaning remarks by an employee. Portley went on to say, “We are dying because we are Black and we are living in a country where there is inherent racism. It is systemic. It is the thread; it is the fiber of everything that exists.”

Dr. Hackett highlighted what needs to happen in order to turn the corner on disparities in Nassau County. Among her recommendations were to inform women after childbirth of warning signs for hemorrhage, embolism or infection, especially when there are preexisting conditions; to enhance service integration for women and infants; and to treat women of color with dignity, respect and culturally relevant care.

Bringing birth inequities to light is an important step forward. When this issue is not identified in Nassau County health data, people don’t know about it and it cannot be addressed. The breakfast concluded with the unveiling of the Birth Justice Warriors, an initiative envisioned by Dr. Hackett, to train birth advocates with the hope of ameliorating the birth inequities in Nassau County.

Published in the Long Island Weekly in May 2018

AMERICAN IN EVERY WAY EXCEPT ON PAPER

By Andrew Malekoff© April 2018

Imagine being American in every way except on paper and knowing that if you are the victim of violent crime you cannot report it out of fear of being deported. This is the sad reality for nearly 800,000 young immigrants who found hope in DACA. 

If you’ve heard the acronym but are not familiar with DACA, it refers to Deferred Action for Childhood Arrivals, a federal program that began in 2012 permitting any person who was brought into the U.S. before the age of 16 the temporary right to live, study and work legally in America, providing they meet certain criteria including no criminal record and attending in high school or college, or serving in the military.

According to the Pew Research Center, two-thirds of current DACA recipients are 25 or younger, many of whom were brought to the U.S. as children so they might escape persecution, violence and poverty for the promise of a better life.

One young immigrant, Rodrigo Trejo, shared his story with United We Dream, the largest immigrant youth-led organization in the country: “When I was in the 11th grade my step dad was deported to Mexico, but he had a conversation with me before he was sent back. He told me that I was going to have to be the man of the house because he didn’t think he was ever coming back. I didn’t know what he was trying to say at the time, until he passed away crossing the U.S border. He couldn’t bear to be away from his family.”

Although Rodrigo became depressed and dropped out of school he bounced back. He reenrolled and graduated at the age of 20. Soon thereafter he applied for DACA in order to continue his education. “I plan to continue my studies and want to help others who have the potential of becoming someone great but because of similar life circumstances, don’t believe in themselves,” he said.

On September 5, 2017, U.S. Attorney General (AG) Jeff Sessions pronounced, "I am here today to announce that the program known as DACA that was effectuated under the Obama administration is being rescinded [effective March 5, 2018].”

On January 9, 2018, four months after AG Session’s announcement, a U.S. District Judge temporarily blocked the Trump administration from ending DACA, thus allowing recipients to renew their protected status for two years, re-affirming their legal legitimacy to remain in the U.S. A subsequent appeal of the judge’s ruling to keep DACA going failed.

If DACA were to be permanently rescinded it would prevent young immigrants like Rodrigo from applying for deportation protections and work permits, exacerbating the isolation, uncertainty, hopelessness and terror that preceded DACA becoming law.

If you follow national news, there is a cat-and-mouse game being played with DACA recipients in our nation’s capital. Let’s not lose sight of the fact that what is at stake is the physical and emotional well-being of young people like Rodrigo who came to the U.S. as children by no fault of their own.

In addition to the shifting sentiments expressed by the president, there is an organized anti-immigrant movement underway in the U.S. led by groups such as the Federation for American Immigrant Reform (FAIR), Center for Immigration Studies and Numbers USA. These nativist groups advocate for white European power and political control, and paint undocumented immigrants with a broad criminalized brush.

The issue of immigration in the U.S. is much broader than DACA. Nevertheless, we need to stand up to protect these young people from being rounded up and sent away. If you believe in human rights, doing nothing is not an option.

Published in the Long Island Weekly in April 2018

THE STRUGGLE TO ACCESS MENTAL HEALTH AND ADDICTIONS CARE

The Struggle to Access Mental Health and Addictions Care

By Andrew Malekoff© February 2018

It’s a heartbreaking scenario that is far too common: Someone makes the difficult decision to seek out professional help for a mental health or substance abuse problem for themselves or their loved one and is faced with a myriad of roadblocks. They start calling providers on their insurance plan and find that they are not taking new patients, or they no longer accept insurance and only want cash. And the cost of paying out of pocket is too much for many to afford.

Here is the reality: Health insurers are required by law to offer an adequate network of providers for their beneficiaries to choose from, and not just for physical illnesses. This requirement is known in the health insurance industry as network adequacy.

Along with the difficulty of finding a provider who will accept your insurance, the problem is often complicated by a family’s reluctance to seek help for a mental health or drug problem, as opposed to physical illnesses like cancer or diabetes. Despite progress in public education, stigma still looms large.

Once someone takes the leap of faith to ask for help, he or she is too often told, “I’m sorry, I don’t accept your insurance any longer.” When this happens there is a chance they will give up.

It is this reality that spurred North Shore Child & Family Guidance Center to launch a research initiative called Project Access. This entailed creating a survey that was completed by almost 650 people across Long Island. Here is some of what we found:

·       Almost 50% of the participants said that it was more difficult finding help for mental health or drug problems than finding help for physical illnesses, especially when they were in crisis.

·       Nearly 40% said that their insurance company did not have an adequate number of providers.

·       66% reported that their insurance company was not helpful in finding a suitable provider for themselves or a loved one.     

·                                                                  

One survey respondent wrote: “A  family member within my household required therapy and we had difficulty finding a provider; when we did, scheduling was a nightmare because so many patients were trying to see him. I believe it was because he was one of the few willing to accept multiple insurance policies.” This was a familiar refrain.

Health insurers reimburse mental health and addictions care providers at such low rates that they flee health insurers in droves. This is a civil rights issue and a situation that puts lives at risk.

The NY State agency that Gov. Cuomo has charged with monitoring and enforcing network adequacy is the Department of Financial Services. We are using the Project Access data to demand that Governor Cuomo and the Department of Financial Services launch a full scale investigation of access to care in New York State and to hold commercial health insurers’ feet to the fire.

If you agree, clip this column, add a note saying “I agree” and include your name and address. You can write to the governor at: The Honorable Andrew M. Cuomo, Governor of New York State, NYS State Capitol Building, Albany, NY 12224; email him at Press.Office@exec.ny.gov; or call him at 518-474-8418.

Published in Long Island Weekly, February 28 2018

PARKLAND YOUTH, ACTIVISM AND TRIUMPH OVER HELPLESSNESS AND DESPAIR

By Andrew Malekoff© February 19, 2018

The 2018 Valentine’s Day massacre at Douglas High School in Parkland, Florida has elevated beyond cliché status the oft-stated sentiment about a loss of innocence in childhood. For many, the events of that day evoked painful memories of the 2012 Sandy Hook Elementary School shooting and scores more in recent decades. Schools, movie theaters, concert venues and more have become American killing fields.

After “thoughts and prayers” are paraded around by politicians from all sides, what happens next? 

Many gun rights advocates, refusing to allow for the fact that our forefathers were talking about the right to bear arms such as muskets and had no conception of guns that could shoot down dozens in an instant, stand in the position that it’s not about guns but rather mental illness.

As the Executive Director of North Shore Child & Family Guidance Center, which serves children and their families facing issues such as depression, anxiety and substance use disorders, I have seen the many faces of mental illness and addictions for more than 40 years. It is incredibly rare for those who are labeled as mentally ill to be violent. In fact, they are far more likely to be the victims of violence than the perpetrators.

Nevertheless, we do need to have a discussion about mental illness at times like these. That discussion, however, needs to be about how health insurance companies and the elected officials who count on their donations are failing miserably at having adequate numbers of providers on their lists who take insurance.

Over and over again, we hear that, before they found North Shore Child & Family Guidance Center, which never turns anyone away for inability to pay, they made numerous calls to the mental health providers on their insurer’s list and found that they no longer take insurance or are booked for months.

Aside from receiving emotional first-aid, the surviving students from Douglas High are demonstrating that they need to take action; action that represents triumph over the demoralization of helplessness and despair. 

Noted trauma expert Bessel van der Kolk said that “talking about the trauma is rarely if ever enough.”  Survivors have a need to create symbols such as memorials or participate in action that “enable them to mourn the dead and establish the historical and cultural meaning of the traumatic events.”

The surviving students from Parkland are turning their heartbreak and rage into activism by demanding a new look into America’s gun laws, as Emily Witt wrote in the New Yorker (Feb. 17). In her encounters with some of the surviving students she reported that “Their grief was raw, their rage palpable.”

“Emma Gonzalez, a senior at Douglas, had the most searing indictment:

“The people in the government who were voted into power are lying to us. And us kids seem to be the only ones who notice and are prepared to call B.S.

“Companies, trying to make caricatures of the teen-agers nowadays, saying that all we are self-involved and trend-obsessed and they hush us into submissions when our message doesn’t reach the ears of the nation, we are prepared to call B.S.

“Politicians who sit in their gilded House and Senate seats funded by the N.R.A., telling us nothing could ever be done to prevent this: we call B.S.

“They say that tougher gun laws do not prevent gun violence: we call B.S.”

From Columbine to Parkland, there have been so many shocking events in between. Too many have faded from consciousness.

As Journalist Gary Smith, who wrote about a lesser known 2012 shooting at Chardon High School in Ohio, stated: "The clock is already ticking in the land of amnesia."

How long before Parkland, too, is gone? If it is up to the young activists in Parkland, never.

Published in Blank Slate media February 2018       

ONE GOOD PARENTAL TURN

By Andrew Malekoff© Published February 7, 2018

Remembering without awareness is a phrase I really like. It suggests the retrieval of a memory that escapes conscious awareness.

Recently, I passed the 20-year mark without either parent, and many more years without grandparents. One grandmother, Annie, died before I was born. I was named after her. The other, Jenny, died when I was too young to remember her. My grandfathers, Harry and Joseph, died a few years later, still during my childhood years, but I have memories of both of them.

Each had disabilities and prostheses. Both of Grandpa Harry’s legs were amputated as the result of diabetes. Grandpa Joe lost his eye as the result of a carpentry accident. Their disabilities were never hidden from me. I went with my dad and Grandpa Harry when he had his prosthetic legs fitted.  Grandpa Joe regularly took his eye out and showed it to me on request. I used to wonder if I would have artificial parts when I got older.

In my first year of graduate school in 1976, I was assigned to intern in a program called “Aged in Distress.”  It was a crisis intervention program for older people. I made home visits to people with physical and mental disabilities, as well as one woman who was bedridden and terminally ill.

Although my primary interest in becoming a social worker was to work with children and teenagers, I was surprised at how much I liked working with older people. I was 25 at the time. Thinking back, it shouldn’t have come as such a surprise to me. Sometime after the internship, 

I realized that I was remembering without awareness the short time I had with my grandfathers.

Now I know that my early memories and recollections, whether I am consciously aware of them or not, influence how I feel about and relate to others in the present. As a child who experienced my grandfathers’ lives and deaths, I wasn’t conscious of the fact back then that one day I would be dealing with my parents’ aging, illnesses and deaths.

My father had cancer and my mother had heart and kidney problems. I traveled often from my home on Long Island to New Jersey to help care for them, some of that time at the same hospital in Newark where I was born in 1951.

One memorable evening—which also happens to have involved artificial body parts—was the time my mother fell and was taken to the hospital. She called me at 2 a.m. and said, “Andy, will you bring my Polident to the hospital?”  Broken arm and bruised face, all she could think about was what she needed to keep her dentures in place so that she would look good.

I took the 90-minute drive from Long Beach to Newark at 2:30 am, retrieved her tooth powder from the medicine cabinet in her home, headed to Beth Israel hospital, spent a few hours with her and drove back to Long Island with enough time to make it to my office for work.

Although the trip was inconvenient, I was aware all along that one good turn deserves another. 

Both my mother and father took time caring for their parents when they aged while also caring for me and my brother. It is these kinds of life lessons that seep into your unconscious and define the person you become, with many generations to thank.

Long Island Weekly: https://longislandweekly.com/one-good-parental-turn/

WHEN YOUR CHILD RELATES BETTER TO SCREENS THAN HUMAN BEINGS

By Andrew Malekoff© November 2017

On Friday, October 20 North Shore Child & Family Guidance Center hosted psychotherapist, author and parenting expert Sean Grover for a workshop titled “When Your Child Relates Better to Screens than Human Beings.” We were pleased to offer this program to help fortify parents during these difficult times.

As tech-dependence increases, many kids move through the world in a self-centered bubble, separated from their own thoughts and feelings, as well as the thoughts and feelings of others. As conversation skills and positive interactions crumble, technology even starts to change kids’ sense of humanity; they are less compassionate and sensitive to others. The workshop explored these vital issues and offered advice about what parents can do to help.

“Everywhere you look, children are staring into cell phones, screens, computer screens, tablets, iPads and more,” said Grover, who has appeared on the Today Show, in the New York Times and in many other media outlets. “While some kids use technology as a pastime, others are absorbed by it.

Technology devours their lives. They can’t put it down or turn it off. These kids tend to be more isolated and anxious, have poor people skills, difficulty maintaining friendships or an unstable sense of self.”

In his workshop, Grover gave parents guidelines on how to take back control and help their offspring wean off their technology addiction. Here are some of his tips:

1. Tech Blackouts

Set aside specific times at home when no one (parents included) uses technology. Cell phones, computers, iPad...everything is off. If you want your kid to be less tech-addicted, you must lead the way. Tech-free time can be spent reading, talking, playing games, cooking, making art...anything creative or social will do.

2. Tech Hours

Kids resist structure — but fall apart without it. Technology needs limits. For instance, I often recommend that families establish tech hours; time for homework, gaming or surfing the Internet. Scheduling tech time will help to limit battles by setting clear guidelines. For instance, when it comes to gaming, many parents may allow thirty minutes a day during the school week and two hours a day on the weekends.

3. Tech Spaces

When possible, keep all technology in a common space like the living room — not in a child’s bedroom. Establish communal places for tech time; try to avoid allowing your kid to disappear for hours behind a closed door.

4. Tech Limits

There are plenty of online services that can filter out inappropriate or violent material. These services can also limit Internet access by scheduling times that the Internet is available and times when it is not. One example of such a service is Net Nanny.

If you haven’t already read between the lines, you should know that how you use tech devices influences your ability to effectively guide your kids. Although your example is not the sole factor, keep in mind that as distant as some kids become from adults as they are moving through their teen years, they continue to observe you, and more closely than you know.

As the lyrics from the 1970s-80s new wave rock band the Police advise: “Every breath you take, Every move you make, Every bond you break, Every step you take, I'll be watching you.”

Published in Long Island Weekly, November 2017

IN THE COMPANY OF ONESELF

By Andrew Malekoff©  2017

In New York it is illegal to use a hand-held cell phone while driving. Although drivers have the option to use hands-free devices, studies show that talking or texting on any cell phone while driving is so mentally distracting as to suggest it is a serious safety hazard. Nevertheless, not a day goes by that I do not see drivers talking on both hand-held and hands-free devices. Safety aside, what does all this chatter in the car portend about one’s ability to be alone?

More than 50 years ago Clark Moustakas, a psychologist and the author of the existential study Loneliness, wrote, “Being alone, for me, usually means an opportunity to think, imagine, plan. I choose to be alone because I desire to be quiet for awhile to consider aspects of my life. It is usually a tranquil time of self-expression and self-renewal.”

Can you remember a time when a solitary ride in the car offered such an opportunity, to simply be alone with your thoughts, feelings and sensations—maybe with your favorite soundtrack playing in the background?

We now live in an era when, because we are plugged in 24-7, the simple pleasure of being alone is something that we avoid. For many people, young and old, aloneness is a source of discontent. Why? Are we afraid that it might lead to loneliness?

Loneliness is not just about a lack of companionship but an inner sense of being alone, regardless of the external circumstances—of feeling lonely even when with friends or family. 

I believe that the recent popularity of mindfulness—a mental state achieved by directing one's awareness on the present moment, while calmly noticing and accepting one's feelings, thoughts and bodily sensations—is a counterforce to the busy-ness of our perpetually plugged-in lives.

As if to foreshadow the current era of mindfulness, Moustakas said, “Loneliness anxiety is a widespread condition in contemporary society. The individual no longer has an intimate sense of relatedness to the food he eats, the clothing he wears, the shelter which houses him.”

According to Maria Gonzalez, an author and corporate executive whose most recent book is Mindful Leadership, 9 Ways to Self-­Awareness, Transforming Yourself, and Inspiring Others, “The daily commute is a great opportunity to train the mind.” She recommends practicing simple techniquies repeatedly, to train the mind in three areas:

1. To be more focused and better able to concentrate;

2. To experience more clarity in our thinking and decision-making; and

3. To approach all of life with a sense of balance, whereby we can “go with the flow” when a situation cannot be changed in the moment.

“The idea,” Gonzalez says, “is that you are continuously aware of three things: your body, what you see and what you hear. This is what it is to be mindfully present as you drive. Do your best to stay present for the entire commute.”

Although it seems elementary, it’s not as easy it sounds. As your mind wanders you may have the impulse to check your phone, or give in to some other distraction. When that happens, intentionally pull yourself back.

Like all things worth mastering, being mindful takes practice. As you do this you are preparing yourself to be present, to be at ease in your own company and, at the same time, you’re making the road a safer place for us all.

Published in Long Island Weekly, October 2017