ACTIVE SHOOT PREP A SAD COMMENTARY

Violence—random, sudden, illogical, and lethal—has become a fact of life. Years of social and economic injustice have resulted in large numbers of people who are frustrated and without hope for the future, people to whom bravado is everything, and anything that seems the slightest bit threatening—a put-down, a disagreement, a dirty look—­demands immediate retaliation.  As I write these words, this kind of violence almost seems old school to me.

I’m not quite sure when my consciousness shifted about the kind of violence we now all face. I wonder if it was during the six year period beginning in December 1993 when the Long Island Railroad massacre occurred, followed by the Oklahoma City bombing in April 1995 and then Columbine school shooting in April 1999. The targets: public transportation, a federal building and a public school.

I think it was during that period of time when it started to sink in that something dramatically different was happening that was more than a fluke. I remember thinking, in one of my more morbid moments, that all Americans were secretly entered into a daily national lottery that wouldn’t result in fortunes gained from pooled funds, but instead in body counts delivered at the hands of deranged strangers.

And now, as two additional decades have unfolded, churches, synagogues, concert halls, nightclubs, workplaces and more have been added to the pantheons of mass murder.

This past Election Day, during our annual staff development day, I participated in an Active Shooter Preparedness Training at North Shore Child and Family Guidance Center. It was presented by police officer Ken Murray and paramedic Rich Husch from Nassau County Police Department Homeland Security division. The training was engaging and informative.

Before 1993 I don’t believe I could have imagined participating in such a workshop. Today it is essential for workplaces, schools and houses of worship.

In a staff development day just few years earlier, the theme was mindfulness. Mindfulness, originally a Buddhist concept founded centuries ago, refers to a practice of paying attention and staying in the present, moment-by-moment, to feelings, thoughts, bodily sensations, and surrounding environment without being judgmental. Mindfulness is often taught as a meditative approach to calming or soothing oneself.

After the active shooter preparedness training I thought about the commonalities and contrasts of the two, both of which emphasize paying attention to the environment, one to luxuriate in the richness of what might otherwise pass one by and the other to be hypervigilant to threats and escape routes.

Mindfulness is taught for the benefits of stress reduction, improved focus and reduced emotional reactivity. Active shooter preparedness is taught so that, In the midst of chaos, anyone can play an integral role in mitigating the impacts of a potentially deadly incident.

On reflection, I’m struck by the emotional flexibility required to absorb both into one’s consciousness, requiring fluidity and many-sidedness.  Robert J. Lifton is an American psychiatrist and author, chiefly known for his studies of the psychological causes and effects of wars and political violence.

In a review of Lifton’s book, The Protean Self: Human Resilience in an Age of Fragmentation, the reviewer sums up the concept of the protean self by stating that “life is not a straight line. Instead, it is, and ought to be, experienced as a collage.”

The sad reality today is that the collage is becoming overcrowded by images of carnage that more sensible gun regulation can go a long way to changing.

Published in theislandnow.com: https://theislandnow.com/opinions-100/kids-first-preparedness-mindfulness-and-the-protean-self/

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. 

EVERY FIGHT NEEDS A VOICE

When tragedy strikes, the grief can be overwhelming. One way that some people choose to deal with their pain is to try to make something good come out of a horrible situation. That’s what the parents of Timothy O’Clair did when their 12-year-old son died by suicide on March 6, 2001 after mental health benefits provided by their insurance company ran out.

The O’Clair family fought tirelessly for years for New York State to pass a law requiring health insurance policies to provide access to timely and affordable mental health care in the same way they cover physical illness. The legislation, called Timothy’s Law in honor of their son, was finally signed in December 2006.

Timothy’s Law helped to blaze the trail for a much broader federal law that passed two years later which requires health insurers to provide access to mental health care on par with medical and surgical care.

Now, what would you think if I told you that despite these hard-fought state and federal laws, in New York State national insurance companies are continuing to prevent children like Timmy O’Clair from accessing care and that New York State regulators are assisting them in doing so?

This is precisely the case. As health law expert Brian Hufford stated, “Timothy’s Law appears effective. In 2009, the state reported an increase of 4.5 million people with plans promising comprehensive mental health coverage. But that number is almost certainly a mirage.” Hufford goes on to say that New York’s insurance regulator, the Department of Financial Services, has a shallow history of enforcement that suggests it lacks the interest or resources to adequately protect New Yorkers.

One year ago North Shore Child & Family Guidance Center issued the results of a groundbreaking study known as Project Access, which surveyed 650 people across Nassau and Suffolk Counties.

The results revealed conditions similar to what the O’Clair family fought against in the early 2000s and showed that discrimination against people living with mental illness and substance use disorders persist.

An immediate follow-up to the Project Access study exposed the reality: the New York State Department of Financial Service is stonewalling demands to further investigate this civil rights issue.

In a letter to DFS Commissioner Mary Vullo citing the Project Access study, state Senators Todd Kaminsky and Elaine Phillips requested a thorough investigation into the persistent problem New Yorkers were experiencing when trying to access timely and affordable mental health care.

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 the New York State of Health,” the official health plan marketplace.

In other words, this DFS official is stating that there is no problem and nothing more to do, which is contrary to the evidence.

Fischer’s response belies the reality that DFS does little if anything to verify reports from health insurers indicating that they have adequate networks of providers available to their beneficiaries.

I had the privilege of meeting Timothy O’Clair’s dad Tom at a National Alliance on Mental Illness event in Albany in October.

Tom was the driving force behind the passage of Timothy’s Law. We shared a stage in recognition of our mutual efforts to advocate for effective and enforceable parity laws so insurers do, in fact, cover mental health care the same way they do physical illness.

We spoke briefly. I told him that although I never met his son, I keep Timothy close to my heart in the continued fight. He responded, “Keep doing what you’re doing.”

Although it was only the two of us in this fleeting interchange, I’m sure that Tom’s entreaty was meant for all people of good will that know firsthand the devastating impact of untreated mental illness and addiction. We all must keep fighting so Timothy’s Law is a reality and not just mere words on paper.

To find out how you can join this effort, contact Andrew Malekoff at (516) 626-1971, ext. 302, or email amalekoff@northshorechildguidance.org.

Published in theislandnow.com: https://theislandnow.com/opinions-100/kids-first-every-fight-needs-a-voice/

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

FIGHTING BACK FROM CHILDHOOD SEXUAL ABUSE: KAYLA'S STORY

By Andrew Malekoff

I recently attended a seminar led by Dr. Cynthia Kaplan, Director of Trauma Training & Consultation within the Child and Adolescent Services at McLean Hospital of Boston. Dr. Kaplan addressed the issue of childhood sexual abuse (CSA). She incorporated the story of a young woman, Kayla Harrison, a survivor of CSA and a two-time Olympian Gold medalist in judo for the United States.

Many years ago CSA was only heard about in whispers as opposed to in depth reports by investigative journalists. Today, reports on CSA perpetrated by what seem like otherwise model citizens – religious leaders, coaches, teachers, seem commonplace.

Dr. Kaplan made a strong point about how we caution children in the strongest terms to “stay away from strangers,” yet 90 percent of children and adolescents, who are sexually abused, know their abuser.

Kayla’s book, Fighting Back: What an Olympic Champion’s Story Can Teach Us about Recognizing and Preventing Child Sexual Abuse - and Helping Kids Recover,  co-authored with Drs. Kaplan and Aguirre, contains excerpts from Kayla’s personal journal. She wrote about her experiences throughout the course of her abuse, including about how she was groomed by her coach.

“By the time I was 9 or 10 I started traveling with the team to local tournaments. At night when the whole team would watch movies I would snuggle up next to him. He would put a blanket over us and then one day things went further and he guided my hand to touch him.”

About one in 10 children will be sexually abused before their 18^th birthday. The impact of CSA can be felt by survivors throughout their lifetime. According to Dr. Kaplan, what complicates the healing is that CSA is not visible, not transparent. Consequently, survivors may not get the support they need and are often left to struggle and mourn alone.

When film director Steven Spielberg created the Shoah Foundation, which strives to capture the testimony of Holocaust survivors, he discovered that many of them had never told their stories before. They often avoided doing so because they had a deep sense of shame and distress which they often believed could or would not be understood by others. After the filming they reported feeling a sense of relief at finally having told someone. They finally felt heard.

Being truly heard requires another person to bear witness. Living with the hurt in silence can compound traumatic stress and lead to destructive and even fatal behaviors including drinking, drugging, self-harm and suicide.

Disclosures of CSA require professional support. When survivors lose their ability to control disclosures, the emotional impact can be devastating. Even in the best of circumstances, says Dr. Kaplan, following disclosure individuals often feel more distressed and have trouble managing emotions. They may begin to lose faith in the world and can feel re-traumatized by the disclosure experience itself.

It is significantly more likely that a child will disclose if they know they are likely to be believed and do not feel blamed and also if they are helped to anticipate the potential legal repercussions of breaking their silence. 

Believing that they will be protected by the adult they disclose to goes a long way. Particularly when they are able to maintain at least some control over the disclosure process, preserve their anonymity to the extent possible and sustain a level of confidentiality.

Surprising as it may seem, children also need to feel free to express their concerns about what will happen to the offender, as it is a complicated relationship with the victim having mixed feelings that survivors need time to process.

There is hope. As Kayla said, after many years and support from her new coaches, parents and mental health professionals, “I began to see my way out of the darkness and towards the light until I could again see the flame of the Olympic torch shining with my very own eyes.”

Published in Blank Slate Media’s TheIslandNow.com, Oct. 23, 2018, link: https://theislandnow.com/opinions-100/kids-first-fighting-back-from-childhood-sexual-abuse-kaylas-story/

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.  The book Fighting Back can be found at: https://www.guilford.com/books/Fighting-Back/Harrison-Kaplan-Aguirre/9781462532971

END RAPE CULTURE

by Andrew Malekoff

In the 1980’s I held a part time job as a psychiatric crisis counselor for an emergency room nearby my home in Long Beach. I carried a beeper and was on call nights and weekends. I handled some of the crises over the phone. Many calls required my presence at either the ER or, in some cases, the police station.

The calls involved people with thoughts or actions related to suicide; substance use issues; family conflicts; or people with mental illness experiencing disturbing symptoms such as hallucinations or delusions.

Sometimes crisis calls were more benign. They included people seeking advice or referrals, or people who simply wanted to make human contact in the middle of the night to combat their loneliness.

A few of the crisis calls have not escaped my memory. One of them involved a young Black woman who told me that she had been raped. She said she came to the ER to request an  examination.

In the course of my intervention in the ER I asked the on duty nurse if the woman was given a “rape kit,” a sexual assault forensic exam to preserve potential DNA evidence and receive important medical care. The nurse said she had not. When I asked why not, she gestured with her head towards the chief emergency room physician and rolled her eyes.

I approached him and asked him the same question, “Why not?” With no change of expression he said matter-of-factly, “Because she’s crazy.” I said, “What has that got to do with it.”  He did not respond.

I returned to the woman and asked her again, “Would you like to be examined?” She nodded yes.

I circled back to the doctor and said, “If you’re telling me that you are refusing her a “rape kit,” I am including that in my crisis note which will be read by government officials that support this hospital. I will state that the patient reported being raped, requested a rape kit and that you denied her the examination.”  He appeared surprised to be challenged and finally said, “I’ll give her a kit but don’t ever question my authority again.”

As I was following the proceedings leading up to the most recent Supreme Court nomination and the protests led by women, I found the term “rape culture” popping up repeatedly on social media.

Emilie Buchwald, author of Transforming a Rape Culture describes rape culture as “a complex of beliefs that encourages male sexual aggression and supports violence against women. A rape culture condones physical and emotional terrorism against women as the norm.”

Women Against Violence Against Women (WAVAW) Rape Crisis Centre in Vancouver, BC, Canada further states that “rather than viewing the culture of rape as a problem to change, people in a rape culture think about the persistence of rape as just the way things are.”

Perhaps the most disturbing aspect of rape culture is that, to a large extent, it is accepted as inevitable when, in fact, it is an “expression of values and attitudes that can change.”

Parents can teach their children not to condone sexual violence in everyday language and reject the sexual denigration of women and girls. Schools can teach comprehensive sex education that includes values and attitudes. The justice system can punish rapists and not their victims.

And, medical personnel who perform forensic exams can be properly trained.

Published in Blank Slate Media’s TheIslandNow.com on Oct. 9, 2018, link: https://theislandnow.com/opinions-100/kids-first-end-rape-culture/

   

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.

BEYOND WORDS: TRAUMA AND THE ARTS

by Andrew Malekoff

Powerful images that depict disturbing events in ways that literature alone cannot can be illuminating and healing. Following are three descriptions of different media that capture recent man-made disasters still very close to the surface for many of us.

The first, Please Stand By, is an example of cartoon art in the aftermath of 9/11. The second, The Last Lockdown, is about a sculpture created after the mass school shooting in Parkland, Florida. Both illustrate the fear-inducing paralysis of traumatic events. The last, Memorial Rock Garden, describes bereaved children painting stones to memorialize their deceased dads.

Please Stand By

In the immediate aftermath of the September 11, 2001 terrorist attack on America, several artists joined together to produce a soft cover book entitled 9/11: Artists Respond.  It is a collection of art, sequenced to showcase the artists’ response to the terror that befell the world.

One nine-frame piece entitled “Please Stand By…”, by Jeph Loeb and J. Scott Campbell, features a girl of about eight years old watching cartoons on television. By the third and fourth frames, the image on the screen changes to a live feed of the Twin Towers ablaze.

As the little girl stands transfixed, stuffed animal in hand and her face less than 12 inches from the screen, the commentator announces, “We interrupt this program to take you live…”

The little girl turns away and cries out, “Mommy!” The next three frames begin with her mother dropping a basket of laundry. Then, with her face contorted in anguish, she embraces her daughter to shield her from the unrelenting televised images.

The final frame is a close up of the little girl asking, “Mommy, when are the cartoons gonna come back on?”

The Last Lockdown

The next image is a haunting statue, as described by journalist Josh Hafner, of a “small girl cowering beneath an open school desk, clutching a leg as she gazes into the distance with a look of fear in her eyes.”

The sculpture was created by Manuel Oliver, an artist who lost his 17-year-old son Joaquin in the Parkland, Florida, mass shooting earlier this year. As Oliver said, “It’s too late for us to save Joaquin from gun violence, but through art my family and I are making sure that we protect the rest of the kids out there.”

“Talking about the trauma is rarely if ever enough,” advises noted trauma expert Bessel van der Kolk. He points to the Holocaust Memorial in Jerusalem and the Vietnam War Memorial in Washington, D.C., “as good examples of symbols that enable survivors to mourn the dead and establish the historical and cultural meaning of the traumatic events to remind survivors of the ongoing potential for communality and sharing.”

Memorial Rock Garden

          In 2002 at North Shore Child & Family Guidance Center, a group of boys and girls who lost fathers in the attack on the World Trade Center decorated stones to be placed in a memorial rock garden.

The kids in the bereavement group sat together around a table covered with newspaper. In front of each of them was a large smooth oval-shaped stone. They decorated the stones with unique designs of paint and glitter, each one a personal remembrance of their fathers.

“Mine is painted gold,” beamed Mack. “I painted it gold because my dad is like gold to me.” A heart framed Jenny’s design, “because my dad will always be in my heart.” On Seth’s stone were two intertwined hands, a small one and a larger one that showed “me and my dad were best friends.” Victoria painted a fire hat and said, “My dad is my hero.”

We might do well to remember that when funding cuts threaten to decimate arts programs in schools there is more at stake then we might imagine. The impact of the arts is not measured by standardized tests and its value is incalculable.

Published in Anton Media's Long Island Weekly, Oct. 23, 2018, link: https://longislandweekly.com/beyond-words-trauma-and-the-arts/ 

Bio: 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.

SEEKING HUMANE SOLUTIONS FOR YOUNG REFUGEES

By Andrew Malekoff

In a recent story in the Albany Times Union, reporter Mallory Moench paints a different picture about juvenile asylum seekers as compared to recent stories about caravans purportedly composed of gang members and Middle Eastern terrorists.

In the report we meet Rosa, who left El Salvador as a young adolescent after being targeted by a gang intending to prostitute her. To prevent becoming sexually exploited, she left her parents and crossed the border. She has been living in the Capital Region of New York for the past two years.

Rosa, now 17, is undocumented and is seeking special immigrant juvenile status that would enable her to apply for a green card which permits a foreign national to live and work permanently in the U.S.

Rosa understands that she could be denied and deported. More than 12,500 undocumented young people have participated in immigration court this year alone. For those without a lawyer, the odds of deportation are much greater.

According to the Albany Times Union report, “If juveniles [under the age of 21] have a relative who is a U.S. citizen or green card holder, they can apply for a family-based petition. If they are victims of trafficking, domestic violence or another crime they can apply for crime victim visas. If they’re fleeing persecution like Rosa, they can apply for asylum. If they’re missing one or more parents they’re eligible for special immigrant juvenile status.”

Attorney General Jeff Sessions has taken measures to fast track deportations. Consequently, many juveniles may be sent back to their homelands—and the dangers and threats that await them—before legal proceedings are implemented.

Many of the young people living in New York’s Capital Region, ages 12 to 19, came from El Salvador, Guatemala, Honduras or Mexico after being confronted with gang violence. The profile and numbers of refugees on Long Island is similar. It is ironic that with the incendiary political rhetoric of the day, many asylum seekers have been labeled gang members, when it is gangs that they are trying to escape from. 

Many young migrants endured trauma in their passage to the U.S. They faced starvation, violence and abandonment.

There are only two immigration courts in all of New York. One is located in New York City and the other is in Buffalo. For many asylum seekers, the cost for transportation to court hearings prevents them from following through. For example, for those living in the Capital Region, a bus ride can be as much as $100 and more than $500 for private transportation. This is especially daunting when they are living in poverty.

Furthermore, there is a cap on the number of visas given each year and also each month. This contributes to inordinate delays in court.

For most of these juveniles the fear and anxiety of being deported as they await a final legal determination can be unbearable and impacts their ability to heal from the traumatic journey to the U.S.

Immigration laws do need to be enforced as open borders with endless flow of refugees is unsustainable.

The challenge is how to enforce the law, dial down the divisive and hateful rhetoric, demonstrate compassion and seek humane solutions for young migrants simply looking to live without fear.  We’ve strayed from that ideal. I hope we can find our way back.

Bio: 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.

WORDS REALLY DO MATTER

Andrew Malekoff

Words matter. Today, this is no more evident than in the incendiary rhetoric – spoken and tweeted - that has contributed to American citizens being pitted against one another.

There is a growing sentiment that the mass shooting in a Pittsburgh synagogue that took the lives of 11 congregants was fueled by hate speech that ignited the shooter’s growing rage.

Although that subject is being abundantly covered in the media, it is the words associated with another kind of shocking death that I wish to draw attention to here. 

When someone takes their life they are most frequently reported to have “committed suicide.” Commit is a word that connotes a criminal act. Yet, suicide is not a crime.

Desiree Woodland, a mom who lost her son to suicide shared her experience in a NAMI (National Alliance on Mental Illness) publication. “My son did not commit a crime. He believed the only way to end the unbearable pain was to end his life. He died because he didn’t have the words to express the deep psychological/biological turmoil he was experiencing.”

If not a crime, is suicide an immoral, depraved or sinful act? It isn’t if it is the consequence of mental illness, unbearable stress, or trauma.

Nonetheless, family members who are survivors of suicide loss report the experience of others speaking in hushed tones around them. Some people refer to suicide as a selfish act, the result of poor parenting, a deficit in the family or all of the above.

At the same time that there is a growing demand to tone down divisive and hateful rhetoric in order to prevent interpersonal violence, there needs to be discussion about mental illness and suicide. 

According to Denver psychotherapist Dr. Stacy Freedenthall, “If changing our language can help suicidal people to feel safer asking for help, then changing language can save lives.” 

In academic journals there appears to be an inclination to use the term “completed suicide.” However, committed and completed are terms that advance the stigma and shame related to suicide and should be avoided.

Increasingly there is preference to the expression “died by suicide” which avoids the judgmental undertone of “committed suicide.” 

Perhaps a contributor to The Mighty, a digital health community created to empower and connect people facing health challenges and disabilities, said it best: “By shifting our language around suicide, we have the power to reduce some of the massive shame carried by survivors of suicide. If you feel scared or helpless about what to say to someone who’s lost someone to suicide, take comfort in knowing that, by changing your language about suicide, you’re offering an act of kindness.”

To be published in Blank Slate Media’s – TheIslandNow.com

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.