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Dear Colleagues,

As pediatric providers dedicated to providing high-quality care for children and adolescents, many of us have experienced an unprecedented surge in mental health needs among our patients. The COVID-19 pandemic has exacted an enormous toll on children’s mental health: exacerbating social isolation, depression, anxiety, and trauma, and further straining our already fragile mental health care system.

The American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry jointly declared the soaring rates of child mental health conditions a national emergency and have identified pediatric providers as critical gateways for expanded access to mental health screening and care.

In my pediatric practice, many of the children and adolescents I care for are also contending with significant social needs including poverty, food and housing insecurity, exposure to violence, and racism. These experiences are often traumatic and contribute to high rates of mental and physical health disorders as well as to disparities in needed care.

My team and I have implemented universal screening for both mental health conditions and the social determinants of mental and physical health that place children at high risk for mental illness. We see universal screening for these risks as a critical step to early identification and ensuring access to and engagement in care and support.

Younger children have not been spared from this crisis—more than 20% of 5-12-year-olds report worsened mental health since the start of the pandemic. As a pediatrician, a large part of the role I play in mental health prevention and care is giving our youngest patients—and their caregivers—the language and tools needed to express their feelings and emotions.

Finding the right mental health educational tools to share with parents and younger patients can be challenging. That is why I was excited to learn of the Depression and Bipolar Support Alliance (DBSA) Mood Crew®, a program of ten emotion-based characters created to support children’s mental health and help parents, caregivers, educators, and clinicians start conversations about emotions with children ages 4 to 10. Each character comes with a biography and various activities to encourage better understanding of emotions. As the child and adult explore the interactive Mood Crew activities together, young ones will begin to build a basic emotional vocabulary that can support lifelong mental health.

We can turn the tide on the children’s mental health crisis by supplying our families with building blocks for resilience. Learning how to communicate “big” feelings is often the first step in prevention, and for children with more serious needs, to healing.

Sincerely,

Nicole Brown, MD, MPH, MHS
Chief Health Officer, Pediatrician
Strong Children Wellness Medical Group, PLLC

Nicole Brown, MD, MPH, MHS is a general pediatrician and health services researcher and is the founder and Chief Health Officer of Strong Children Wellness. Her research and professional interests center on enhancing care and service coordination for children who have experienced trauma and those with chronic mental health needs in the pediatric primary care setting.

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The current relationship between law enforcement and the mental health community requires immediate change.

The media headlines and news feeds today seem to be constantly filled with stories of people living with a mental health condition who die, become injured or suffer emotional trauma as the result of a police interaction. Last fall, the death of Walter Wallace, Jr. spurred riots in Philadelphia.  Daniel Prude died in Rochester, New York[1] police custody earlier last year, but it was recently announced that no officers will be charged. In January, an unarmed Patrick Warren, Sr. was shot outside his Texas home during a mental health wellness check.

These deaths, though tragic on their own, are not isolated occurrences. According to a study from the U.S. Department of Health and Human Services, 22% of deaths due to the use of lethal force by law enforcement were mental health related. Much of the explanation for this stems from the fact that many law enforcement policies and training do not adequately include crisis intervention and de-escalation training.

Black Americans are at an even higher risk of being caught in the crosshairs of a potentially lethal encounter with law enforcement. The National Institutes of Health notes that Black Americans are 20% more likely than White Americans to experience serious psychological distress. That statistic, when paired with the over-policing of Black communities as a whole, which increases the likelihood of police interactions, led the Bazelon Center for Mental Health Law to note unequivocally that “Black people with mental illness are at great risk of dying at the hands of the police.” 

Although it is not a crime to exhibit symptoms of a mental health condition, police are often called involving a person in this situation. Depending on how a mental health crisis is handled, it may lead to a violation of that person’s civil rights. Unless an individual represents an immediate threat to their own safety or that of another individual or property, a police response using force is not the appropriate solution. Even when officers are called and notified that a person has a mental health condition, they often may not have the training or resources to effectively de-escalate the crisis, as was the case for Patrick Warren, Sr.

We must demand a change. Across the country at the federal, state, and local levels, we continue to underfund or shutter programs that provide access to mental health treatment and wellness. Meanwhile, the pandemic has reduced treatment options, increased joblessness, created extended isolation, and produced a secondary mental health crisis as many experience episodes of depression or anxiety for the first time.

As the number of people impacted by mental health conditions grows, our law enforcement agencies have become a catch-all resource for responding to all types of crises though some lack the understanding or tools to respond appropriately. This system continues to fail.

At the Depression and Bipolar Support Alliance, we call on all of our legislators at every level to reinstate and increase funding for mental health treatment and improve access to care.

Along with improving mental health wellness journeys, we call for law enforcement agencies to improve training in at least two areas:

  • Expand civil rights training to respect the rights of people with mental health conditions, while providing protection to the community. Living with a mental health condition, even when exhibiting symptoms of illness, does not eliminate a person’s civil liberties.
  • Require de-escalation and Crisis Intervention Training for all officers who engage with the community and appoint staff liaisons tasked with building community partnerships to aid in this effort.

There are programs proven to work. Communities across the country have shown that there are more effective solutions. Most prominently, Crisis Intervention Training (CIT) is a certification course that provides training in de-escalation, understanding of how mental health conditions can present, and promotes respect by creating opportunities for police officers to talk with community members who live with mental health conditions. The training is most effective when law enforcement officers create partnerships with local organizations: hospitals, behavioral health centers, libraries, schools, and other local resource organizations.

Illinois has launched several successful programs. In Orland Park, officers have a partnership through their CIT program with a local treatment center that will get in touch with a referral within 48 hours of officer contact. Additionally, police officers follow up after that introduction has been made to ensure that the person in crisis has access to the resources they need, and to cultivate a relationship between police and local families.

In suburban Chicago, the municipality of Park Ridge’s program has been used as a model across the country, noting within their report that “CIT training across ranks and divisions has planted the seeds for a culture in which de-escalation and compassion underlie officers’ expectations of one another in the field.”

Indianapolis, Indiana has also seen success with its Behavioral Health Services Unit. Most police districts have a behavioral health detective who partners with a mental health clinician for support during non-emergency events. Ideally, individuals with mental health conditions should decide whether they require such services.  At times, however, a family member will be called upon to make such judgments.

Indianapolis has also led the way with its internal police peer support and mentoring program, designed to reduce stigma and employment penalties, while addressing mental health concerns early for officers.

It cannot be overstated how effective these training programs can be when also complemented by adequate resources provided for those living with mental health conditions. After the 2018 police shooting of Marcus-David Peters in Virginia, Richmond’s police chief commented, “I look at what it would take to become a psychologist, psychiatrist, mental-health counselor — five to eight years of training. Our police department gives our officers 40 hours. Five to eight years, and we get 40 hours.” The Bazelon Center notes that “while increasing police training can improve police responses to people with mental illness, the Richmond police chief’s main point must not be ignored: the fundamental problem is having police, rather than mental health personnel, address the situation.”

At the Depression and Bipolar Support Alliance, we call on all our legislators at every level to increase funding for mental health treatment and improve access to care, and to invest more funding to ensure every law enforcement agency offers adequate training related to civil rights and crisis intervention.

[1] An early version of this document stated that Daniel Prude was in the custody of the New York Police Department instead of the Rochester, New York City Police Department. – 4.27.2021 Source: https://www.nytimes.com/article/what-happened-daniel-prude.html

Young Adult Council members understand how challenging it can be to choose a career that is a good match for you. YAC member Christine provides a list of questions to ask yourself, and other YAC members weigh in on how those questions impacted them personally. 

Remember that your career choice isn’t set in stone. You don’t have to retire from the first company that hires you. If you start a job and find out that it isn’t a great fit for you, it is okay to step back, assess what does and does not work, and make a change. 

Here are some areas to consider.

Fulfillment

  • Is your job meaningful to you? 
  • Is it enjoyable? A job can include “important” work but not personally fulfilling.
  • Do you want a job that gives you emotional fulfillment or just one that pays the bills?

YAC Member Lauren: Fulfillment has been incredibly important to me in finding a career, so I knew that I wanted to work in healthcare to heal and care for others. It took me time after college to figure out, but eventually I settled on pursuing my doctorate to become a clinical psychologist. Although I am still in training, the work has been so enriching, and I am always learning something new. It has been a privilege to be introduced to the intimate parts of people’s lives, as well as their struggles. Of course, this comes with its challenges, so self-care has been essential for me to continue to provide quality treatment. Knowing my limitations is also part of the job, so I try to be mindful of this and establish boundaries where I can. What keeps me motivated, and ultimately fulfilled, is how inspiring it is to see how therapy improves the quality of someone’s life and empowering others to realize their worth.

Personality

  • Are you easygoing or more ambitious? 
  • Do you prefer to work alone or in a group? 
  • Are you more hands-on or theoretical? 
  • Are you introverted or extroverted? 
  • Do you have a soft touch or a firm hand?

YAC Member Mason: I am definitely more ambitious than easygoing, but whether that’s me or the GAD (generalized anxiety disorder) is hard to tell. Unlike most people, I prefer to work alone, and then share, and then revise, rather than work collaboratively. When I work independently, I have to motivate myself to do it because there is nobody there to do it for me. I can be both hands-on and theoretical, depending on the task. As far as extraversion goes, my Meyers Briggs suggests that I am 51% introvert – so I guess that clears that up. I can definitely have both a soft touch and a firm hand depending on the scenario and how much confidence I have. I have been working on myself, trying to become a little more confident and independent. My primary occupation is as a sound designer for live theatre. I am often the head, if not the only member of my department, so learning to be more decisive and fostering personal growth are very important. Additionally, I try to keep a sense of humor because in these hard times, everybody needs a laugh. 

Personal Strengths

  • What are you good at? 
  • What skill sets, training, or hobbies do you have that may be useful in finding a job? 
  • What is your past job experience?

YAC Chair MJ: I started freelancing as a designer after college, and I learned early on that it relies on some traits that I don’t have. I’m a good multitasker and a clear communicator, but I’m also a fairly introverted person, and setting firm boundaries with my clients proved to be difficult for me – nt to mention maintaining the stamina it takes to be constantly searching for new leads and partnerships. I burnt myself out pretty quickly, but then I found a job that plays to my strengths in a way that freelancing doesn’t. I had to know the Adobe Creative Suite inside and out, which I had learned in school and further developed in my freelance work. I had to clearly express design and technical issues to coworkers who aren’t familiar with the work, and my communication skills helped with that. The benefit of my current position is that the work is brought to me, and I don’t have to seek it out. There’s more design work than socializing involved with the role, which plays better to my introversion; plus, when I talk to my coworkers and clients the communication is mostly written, and I’ve found that it doesn’t drain my energy in the same way that phone calls with my freelance clients did. It was a very slight shift in terms of the work I’m doing, but it’s made all the difference in my mental health and work/life balance!

Balance/Flexibility

  • How many hours a week do people normally work at this job? 
  • Will your employer be flexible with hours and/or sick days? 
  • Do those you know in the field have time for personal obligations, and is their work flexible if they need to take a sick day or go on maternity leave? 
  • What kind of life do you want outside of work, and will you be able to achieve this with the job you’re thinking about pursuing?

YAC Secretary Olivia: This is something I wish I had taken into more consideration before choosing my career. I work as a television news producer. Television news is a 24 hour affair; there is always a producer in the newsroom. I anticipated taking the least desirable shift as a new hire; I figured it was only fair that the new person would get the “worst” shift. However, I didn’t fully consider how the hours I work would impact my family and social life. I work nights and weekends, which makes it difficult to maintain a sense of social wellness. I’m able to cope with the situation for the time being, because I know I will be moved to a “better” shift eventually. However, I have definitely thought about how much easier it would be to maintain healthy relationships if I had chosen a career where everyone works 9-5. 

Difficulty of Path

  • How much training is required for this job, and what might it cost? 
  • Will the journey to this career be high stress and/or physically taxing? 

YAC Member Christine: I am in my last year of medical school, training to become a physician. The cost, both emotionally and financially, of this chosen path has been high, but after careful consideration I decided it was worth it for the fulfillment that my job brings me. I think that it’s okay to choose a high stress path, as long as you are sure you want it and you go in with your eyes wide open. Make sure you do your research, so you have an idea of what obstacles you may face, and make sure you have a great support system and set of coping skills for when things get rough. The items in this list are things to consider when searching for occupational success and wellness, but no job is perfect, and you have to decide for yourself which factors are most important!

Financial Security

  • Are you looking for an hourly job or a salaried job? 
  • Will you be making enough money to cover living expenses or, if you want one, a future family? 
  • Does the industry have a high turnover rate?
  • Is the degree you are pursuing versatile? 

YAC Chair MJ: After I graduated college, I moved to New York City with a friend. We didn’t have jobs or anywhere to live yet, but we knew we wanted to be in New York. For a while, I just worked freelance design for nonprofit organizations, and found other ways to make extra cash when the freelance work was slow. At times, I was a bartender, server, paid television audience, and a dogsitter. I quickly got exhausted from always hustling different jobs and trying to plan where I’d be able to make money next, and realized that I’d prefer a full time position with a single company in the design industry. New York is expensive, though, and I wouldn’t be able to make rent as an in-house designer for nonprofits, so I turned to the tech industry. I found a low-intensity design job at a large software company, and it provided me with the financial security I wanted, a singular source of income, which I preferred, and in my industry of study. I make enough now to save a little money for the future, too!

Physical and Emotional Limitations

  • Are there physical or mental health conditions that may limit the type of work you can do? 
  • Is a high stress job or a night shift job right for you and your mental health? 
  • Is it important that your bosses are supportive? 
  • Will you have insurance and paid time off benefits? 

YAC Secretary Olivia: For a short time in college, I thought I might want to become a licensed counselor or social worker. I wanted to use my personal experience to help others living with mood disorders. After I added psychology as a second major, one of my close friends experienced a mental health crisis. I’m glad I was able to help my friend and direct them to treatment, but I realized that I couldn’t commit to doing that on a regular basis; it was simply too taxing on my own mental health to feel responsible for others in crisis. I reevaluated my career options and decided to pursue television news. Now in my career, I can help share the stories of others living with mood disorders and help educate the public without putting my own mental health at risk.