Action on mental health needs global cooperation


Mental-health disorders are the leading causes of disability worldwide. Nearly 30% of people around the world experience a mood, anxiety or substance-use disorder in their lifetime1. The resources required to address these conditions are inadequate, unequally distributed, inefficiently used and static2. The widespread incarceration of people with mental-health disorders persists.

The need and demand for mental-health care is increasing as vulnerable populations expand. Notable are the tens of millions of migrants fleeing persecution, conflict and violence, as well as the survivors of Ebola and other recent threats. Yet there are only 9 mental-health providers per 100,000 people globally; an extra 1.7 million mental-health workers are needed in low- and middle-income countries alone.

Mental health does not lack political support. This month, the World Bank and the World Health Organization (WHO) will together address the broader development community to make the case for investment in mental health. In the past three years, the importance of mental health has been highlighted by the WHO, in its Mental Health Action Plan for 2013–20; by leaders of countries in the Asia-Pacific Economic Cooperation (APEC); and by the health ministers of the Commonwealth nations. In September 2015, mental health was incorporated into the United Nations’ Sustainable Development Goals.

Five years ago, we, as members of the Grand Challenges in Global Mental Health initiative, called for an equitable and global approach to reducing the burden of mental disorders3. The visibility of the issue has come a long way since then. And although there continue to be problems with the delivery of mental-health services, funding for research and innovation in mental health in low- and middle-income countries has increased substantially (albeit from a small base). Since 2011, new investments estimated at US$79.3 million have been made by the three largest funders of mental-health research in low- and middle-income countries (Grand Challenges Canada, the UK Department for International Development and the US National Institute of Mental Health).

Researchers in such countries are tackling the dearth of mental-health professionals by testing the delivery of care by non-specialists — such as peers, community health workers or primary-care providers. Others are developing and testing applications on smartphones and tablets to extend access to screening and treatment4.

Now, clinicians, patients, caregivers and researchers need to learn from each other. The knowledge gained in all countries must be evaluated, disseminated and adapted for local use everywhere. Crucially, everyone involved must start with the same mindset: when it comes to mental health, all countries are developing countries.

Of course, the resources available are drastically different in the developing and developed worlds: a teenager in Afghanistan seeking mental-health care does so in a country that has 1 psychiatrist for every 10 million people, not 1 per 5,000, as in, for instance, Belgium. But no country has sufficient numbers of trained mental-health-service providers. Nearly one-third of the US population lacks adequate access to mental-health-care providers. There are similar shortages in parts of countries as diverse as Australia, Canada, Finland, France, Japan, New Zealand and Slovakia. Even in wealthy countries, 40–60% of people with severe mental disorders do not receive the care they need5.

Across all settings, those with the fewest social and economic resources are least likely to receive quality mental-health services, be they in Arctic areas of Canada, inner-city Glasgow or rural Sierra Leone. Today’s global mental-health research must lead to interventions developed in and for such underserved communities.

Moving forward

Mirroring the global community’s commitment to sustainable development, the world needs a global commitment — financial as well as moral — to mental health that supports the translation of ideas and interventions between poor and rich settings while taking into account local needs. If an intervention shows great promise in Iran, for instance, can it be adapted for Poland or Indonesia?

In the 1980s and 1990s, global collaborative research led by the WHO enabled cross-national comparisons of the incidence, prevalence and long-term course of mental disorders, as well as cross-cultural conceptualizations of mental illness and traditional modes of understanding and management. Over the past 15 years, many of the efforts in global mental health have focused on introducing high-quality research in low- and middle-income countries to establish an evidence-base for the delivery of services in these nations.

More-recent research has focused on efficacy, effectiveness and implementation in low- and middle-income countries. Local research teams frequently collaborate with colleagues in rich countries. Yet, the relevance of this work to underserved populations in high-income countries is not routinely part of the global conversation. In low-income countries, the limited infrastructure for community mental-health care and the dismal budgetary allocations for mental health are significant obstacles to implementing research findings.

The status quo is not working — and innovations are needed urgently. The following case studies are exemplars of the approaches we advocate.

South–south learning. The Programme for Improving Mental Health Care (PRIME) is a consortium of research institutions and ministries of health funded by the UK government. PRIME aims to scale up mental-health services in Ethiopia, India, Nepal, South Africa and Uganda by integrating these into primary care. Together, these countries have developed locally relevant mental-health plans informed by community advisory boards that include district health administrators, service users, traditional healers and police. The consortium observes cross-country differences and similarities in the evolving mental-health-care systems.

The shared framework for developing and implementing plans with local adaptations is a powerful tool. Adaptations included change-management interventions for district managers in South Africa, a mental-health case manager in India, and new assessment tools in Nepal. All country teams have recognized the need for systemic changes. The next phase of the study is evaluation, to assess whether and how these changes affect disease burden.

North–north learning. The Arctic Council, an intergovernmental forum for the circumpolar states, has emerged as an avenue for launching collaborative efforts to reduce suicide rates in those countries. Young Alaska Native men experience the highest rates of suicide of any demographic group in the United States. Similarly high rates also occur among some indigenous Arctic communities in Canada, Greenland and Russia. Local responders can benefit from what has been learned and shown to be effective elsewhere.

“If an intervention shows great promise in Iran, for instance, can it be adapted for Poland or Indonesia?”

An Arctic Council initiative that ran between 2013 and 2015, led by Canada, identified promising practices for suicide prevention and mental-health promotion, and mapped the evidence across circumpolar communities, noting what interventions were acceptable where. Teams identified common threads that made a programme scalable and adaptable across the region. These included having sustained funding and dedicated physical spaces for services; easy access for community members; having skilled workers who were based in and were knowledgeable about the community; and creating forums for talking about suicide. Crucially, the effort continues in the US-led RISING SUN initiative, which engages researchers, community-members and decision-makers to identify shared tools.

South–north learning. BasicNeeds is a global mental-health charity, established in 2000 in Britain, that facilitates access to employment and mental-health care for people with mental illness. The organization refined a model for helping people into care and work and to advocate for their problems in African and Asian countries, including Ghana, Tanzania, Nepal, China and Vietnam.

In Nepal, for example, a local charity that specialized in community-based rehabilitation adopted the BasicNeeds model. Working closely with government-funded mental-health clinics, the programme conducted community outreach and facilitated access to mental-health-care services. It reduced expenses for families with ill members. Eligible families received training and financial support for developing and implementing a business plan for income generation. People who received support were all earning money 6–12 months later. BasicNeeds received funding last year from the Robert Wood Johnson Foundation in Princeton, New Jersey, to translate the model to a deprived, inner-city environment in the United States.

This kind of translation of practices is just beginning. Technology is increasingly enabling innovators to make their ideas and projects public. One venue for sharing ideas is the Mental Health Innovation Network (MHIN), funded by Grand Challenges Canada and managed by a research team at the London School for Hygiene & Tropical Medicine and the WHO’s Department of Mental Health and Substance Abuse (of which S.S. is director). Another virtual community is the WHO’s Global Clinical Practice Network. This online platform allows thousands of clinicians from around the world to contribute to and benefit from mental-health research. Through it, more than 12,000 clinicians from 139 countries have participated in field trials, testing diagnostic guidelines in a wide range of settings. Such networks also break national, professional and linguistic boundaries to facilitate global conversation and learning.

Next steps

To meet the mental-health needs of vulnerable people everywhere, we must develop, study and practise the translation of knowledge and ideas in all directions. How? Here are six suggestions.

Determine which innovations will scale up. Sometimes local application is enough. The community must distil guiding principles that enable practitioners to decide what is right for which contexts. This requires health planners to consider system-level issues (such as human resources and financing) and community-level needs (including acceptability and feasibility of care practices). In all contexts, cost, complexity and fragmented services can curtail wider implementation.

Train scientists to translate research findings. A new cadre of global mental-health researchers is needed to adapt treatments to fit local health systems. They must be able to assess needs and must be equipped with the collaborative skills to engage decision-makers, clinicians and community members. They need to generate knowledge that informs cross-cultural translation.

Use the community’s knowledge. The growing evidence base on effective low-cost mental-health treatments is underused. Scientific knowledge is often inaccessible to practitioners, because they lack the time and resources to review information. We need to develop ways to synthesize new global mental-health findings routinely, and present this information so that users can apply it. The global fight against HIV/AIDS presents one model to draw from: networks of funders, researchers, clinicians and patients have been able to achieve standardized care protocols by sharing information through international working groups, society representatives and UNAIDS, the UN programme for HIV/AIDS. Similar networks exist in vaccine and contraception research.

Sustain effective mental-health treatments. A major problem is that research funding does not support continued delivery of services on the ground — this requires a greater commitment from local and national governments and aid agencies to invest in mental health. The WHO Mental Health Action Plan specifically calls for stronger leadership and governance for mental health at the national level, including adequate funding. Around $1.6 billion is needed in low-income countries, and between $6.6 billion and $9.33 billion in lower-middle-income countries, to provide a basic package of mental health services; this is eight and six times more, respectively, than current investments6. The message that poor investment in mental health is costly for all countries must be communicated to leaders with the power to invest7.

Evaluate the outcomes of treatments. Globally, we lack adequate information on the impact of services because clinics and health systems often lack the funding, capacity, motivation and protocols for monitoring and evaluation. Rarer still is a mechanism for using the results of evaluation to improve services. So people need to be trained to monitor and evaluate new and established approaches. Collaborative research networks can facilitate this kind of capacity building. The WHO Mental Health Action Plan sets out six global targets to achieve by 2020. For example, it calls for a 20% increase in service coverage for severe mental disorders and a 10% reduction in suicide rates globally. Mental-health advocates, clinicians and patient groups in each country must track progress towards these targets.

Disseminate successes and failures. The risks that result from sharing information about programme weaknesses must be minimized. Researchers rely on journal publications to disseminate information, but it is much harder to publish unsuccessful trials or evaluations. We need options beyond research databases. Online platforms such as the MHIN could be used here, especially by those who are not researchers who develop new solutions to local problems.

In a world where mental-health innovations cross borders as people do, a mother migrating from Khayelitsha in South Africa to New York could meet a community health worker who delivers a depression treatment in her home, much like the community counsellor at her maternal health clinic in South Africa. People move because of needs and opportunities — so, too, must knowledge.

The above article was written by Pamela Collins & Shakhar Saxena and published on Nature.com 

 

 

 

Keeping Our Promise to Foster Youth: Holding Systems Accountable while Implementing the Strengthening Families Act


On February 23, 2016, Rochelle Trochtenberg, a former foster youth who grew up in Los Angeles, was named the foster care ombudsman for California, home of the country’s largest child welfare system. The ombudsman receives and investigates complaints about the child welfare system and identifies systemic issues for remediation and improvement. By naming an ombudsman, California has positioned itself to effectively implement groundbreaking new federal child welfare legislation, the Preventing Sex Trafficking and Strengthening Families Act of 2014 (SFA). The SFA is our country’s most recent piece of federal legislation impacting child welfare systems, with the potential to touch almost every area of child welfare policy and practice. The law holds particular promise for older foster youth who are often forgotten by the child welfare system.

Without good enforcement mechanisms, however, even the best law has little chance of success…especially laws that impact vulnerable children.

For example, the law seeks to prevent foster youth from becoming involved in sex trafficking and address the circumstances – abuse, neglect – behind running way. It also promotes access to everyday extracurricular and community activities as an important priority for foster youth who are often prevented from participating in routine childhood experiences. Finally, and maybe most importantly, the law requires states to redouble their efforts to find families for all youth in care. This is especially important for older youth who, like all kids, need supportive and permanent family connections in order to avoid adverse outcomes – homelessness, dropping out of school – and successfully transition into adulthood.

Without good enforcement mechanisms, however, even the best law has little chance of success. This is especially true of laws that impact vulnerable children. Ensuring strong enforcement and accountability systems as states implement the SFA will be crucial to its success. Luckily, there are many ways to hold systems accountable. States can:

  • Name ombudsmen, as California has done, to ensure that the law’s promises become realities. Few states have ombudsmen, despite the widespread acknowledgement that youth and families have limited voice in how the child welfare system works.
  • Support Youth Advisory Boards and require that Boards have opportunities to report to policy makers, including legislators, about the status of implementation of laws.
  • Create client feedback loops through regular surveys of youth and accessible grievance procedures that are reported to the legislature and child welfare agency for response.
  • Collect and analyze data to track to the progress of implementation initiatives.
  • Require child welfare case plans for youth to include the important aspects of the SFA, such as documenting a youth’s participation in extracurricular activities and the agency’s work to connect youth to family.
  • Support courts in ensuring implementation. Courts, which review child welfare cases at least twice a year, play a pivotal role in making sure the law is being followed and that youth voices are being heard.

For more tips on how the court can play an important role in implementing the SFA and engaging youth, see Issue Brief: The Role of the Courts in Implementing the Strengthening Families Act.

The above  article was posted by Juvenile Law Center

Cities Begin To Count The Scars Of Childhood, And Try To Prevent The Damage


LOS ANGELES — Kimberly Cervantes has spent much of her young life learning to outwit the perils of Compton. At 19, she’s street smart and savvy, but Cervantes’ maturity was born out of a violent childhood.

In high school, she was assaulted on a public bus. In middle school, she witnessed the deaths of two students. Her mother and younger brother were once robbed at gunpoint at a convenience store. The steady exposure to violence has led Cervantes to some dark places — including crippling anxiety and thoughts of suicide.

“There’s so many people out there acting out,” she said. “Drug abusers on almost every corner. It’s hard to maintain the whole happy-go lifestyle.”

In an unprecedented move, Cervantes and four other students are suing the Compton Unified School District, arguing that the trauma they have faced makes it difficult to learn and demanding that the district offer them additional support, in much the same way schools must accommodate students with autism, dyslexia and other disabilities.

Students who’ve suffered multiple traumatic incidents are six times more likely to have behavioral problems; five times more likely to skip school; and two-and-a-half times more likely to repeat a grade.

 

Kathryn Eidmann, a staff attorney at Public Counsel in Los Angeles who is on the legal team representing the students, says researchers have shown that sustained stress alters brain development and, if ignored, trauma can derail academic achievement.

“Under federal anti-discrimination laws, schools have an obligation to take kids as they find them, to provide them the accommodations necessary, so that they have equal access to education,” Eidmann said. “The children who have been injured, through no fault of their own, by these types of adverse experiences, need intervention and support from the schools in order to be able to learn.”

In Los Angeles last October, Judge Michael W. Fitzgerald ruled that the case could move ahead in federal court and signaled that the physical and mental consequences of trauma could trigger similar protections as other disabilities.

A shocking number of Americans experience abuse, neglect and violence during childhood. Apioneering study of more than 17,000 people in the 1990s found one in four had been physically abused; one in five, sexually abused; and one in four grew up in households with substance abuse. Others witnessed domestic violence or had a parent die or go to prison.

These “adverse childhood experiences” — or “ACEs” — were found to predict a raft of health and social problems from adolescent pregnancy to depression and heart disease in adulthood. And ACEs appeared to have a dose response: the more traumatic incidents a child experienced, the greater the risk of poor outcomes.

While cities across the country have begun to measure the prevalence of childhood trauma, local leaders in Memphis — a city marked by violence and racial strife — were stunned at the results of their own survey: 37 percent of adults in Shelby County, which encompasses Memphis, during their youth had witnessed someone being shot or stabbed; 23 percent reported being emotionally abused; and 25 percent grew up amid drug addicts or alcoholics.

For Barbara Holden Nixon, a longtime social worker in Memphis and Shelby County, the solution for reducing childhood trauma needed to center on the next generation of Memphians.

“People say, ‘Where do we start?’” Nixon said. “And it’s an easy answer. We start at the beginning.”

While other groups focused on reducing gun violence in Memphis, Nixon decided to focus primarily on parenting to try to prevent trauma from the earliest ages. She founded the ACE Center Task Force of Shelby County, a who’s who of state and local government and community leaders.

Nixon turned to Robin Karr-Morse, a Portland, Oregon-based national expert on childhood trauma who argues that parents who themselves suffered wrenching childhoods need help learning better ways to raise their children.

“We’re putting no blame on the parents. The whole idea is just the opposite,” Karr-Morse said. “It’s not ‘What’s wrong with you?’ It’s ‘What happened to you?’ And, then, giving them tools to help offset whatever that is.”

Memphis has started by opening free drop-in centers called “Universal Parenting Places” that offer arts therapy, music classes and individual counseling for parents.

Kimberly Lawston sought help after a bitter divorce to explain the breakup to her children, but the counseling sessions led Lawston to reflect on her own childhood.

“My mother was a holler-er, and I didn’t want to be that way where you were afraid to come to me,” she said. She didn’t want her children to feel like they were “dumb or stupid. Your behavior may have been a bad at that point in time, but that doesn’t mean you’re a bad person.”

At the parenting center in Memphis, Lawston is learning alternative ways to parent and talk with her children. But she says her family has resisted the new approaches, often responding, “No, that’s not how we do it. We do it this way. There’s nothing wrong with us the way we raised you. You have to do what I say!”

Patrice Bibbs has been learning about how to use time-outs when her 2-year-old daughter is upset “instead of trying to spank them.” But her family, too, has been critical of her efforts.

“I’ve heard that I’m bourgeois, that I think I’m uppity because I’m trying to teach her something different and it’s not the norm for us,” Bibbs said. “But I just want something different for her that I didn’t have.”

Alicia Norman, principal of Perea Preschool in North Memphis, which is opening a new Universal Parenting Place later this year, says as the number of preschoolers being expelled shows interventions are urgently needed: “They’re angry. They are out of control, three- and four-year-olds! And it breaks my heart to see that a child has been broken so early in life.”

In school surveys, Norman says parents report spanking their children, in some cases with belts and electrical cords, up to five days a week.

“For a lot of our families, their first option sometimes, and their only option, is to spank their children, where research shows now the adverse effects of spanking, especially spanking gone wrong,” Norman said. “They want their children to be the best that they can be, but these are the only tools that they have.”

Local law enforcement officers say children living in turbulent homes whether they’re wealthy or poor are more likely to end up in the criminal justice system. But Stephen Bush, Shelby County chief public defender and a fervent member of the ACE Awareness Task Force, says the ACE research is changing how cases are prosecuted here.

“The use of adverse childhood experiences and the language around that has given us a new common language when we’re advocating on behalf of kids in front of the courts,” he said. “It helps explain some of the behaviors that might not seem understandable if you’re just looking at it without understanding the history of this child’s life.”

Support for this new awareness reaches to the top of county government.

Shelby County Mayor Mark Luttrell Jr., also a task force member, calls the ACE research a basic philosophy of county government.

“We’ve tried to make it the common thread that runs through our public safety agenda, through our public health agenda, through our community services agenda, through our education agenda,” he said. “Every portfolio that we have within county government has a component in there for, ‘How do you address the younger generations at that formative stage?’”

Luttrell says he doesn’t expect change to come quickly and it will likely take decades to measure if the approach Memphis is taking reduces violence in the community.

But civic leaders here say doing away with the stigma of getting parenting help is a good start.

This article was originally posted in PBS Newshour

10 Ways to Build Resilience


“The best way to find yourself is to lose yourself in the service of others.” —Gandhi

Resilience is defined as “the capacity to recover quickly from difficulties.” And if ever there was a profession facing “difficulties” it is physicians. The “recover quickly” part is no slim accomplishment either.

Wayne Sotile, PhD, “one the world’s most seasoned clinicians specializing in life coaching for physicians,” says that today’s healthcare system faces unrelenting change and the mismanagement of that change along with the fatigue it brings is causing an epidemic of costly burnout for health professionals. Sounds pretty bad.

But the medical profession must do much more than just endure. It must flourish. Doctors have a great trust. When it comes to the dealing with the stress of today’s medical profession—adapting, coping, adjusting, and managing—some doctors are better at it than others.

My physician-dad was a fine model for resilience. He knew how to compartmentalize things. Maintaining control, being positive, and seeking support were skill sets I observed in him. In fact, it wasn’t until he retired from medicine that I felt he lost his coping skills.

According to an American Psychological Association report, The Road to Resilience, “being resilient does not mean that a person doesn’t experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity in their lives (e.g., doctors).

In fact, the road to resilience is likely to involve considerable emotional distress. Resilience is not a trait that people either have or do not have. It involves behaviors, thoughts and actions that can be learned and developed in anyone.”

The APA offers these 10 ways to build resilience:
1. Make connections. “Accepting help and support from those who care about you and will listen to you strengthens resilience.”

2. Avoid seeing crises as insurmountable problems. “Try looking beyond the present to how future circumstances may be a little better.”

3. Accept that change is a part of living. “Accepting circumstances that cannot be changed can help you focus on circumstances that you can alter.”

4. Move toward your goals. “Do something regularly—even if it seems like a small accomplishment—that enables you to move toward your goals.”

5. Take decisive actions. “Rather than detaching completely from problems and stresses and wishing they would just go away, act on adverse situations as much as you can.”

6. Look for opportunities for self-discovery. “People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss.”

7. Nurture a positive view of yourself. “Developing confidence in your ability to solve problems and trusting your instincts helps build resilience.”

8. Keep things in perspective. “Even when facing very painful events, try to consider the stressful situation in a broader context and keep a long-term perspective.”

9. Maintain a hopeful outlook. “Try visualizing what you want, rather than worrying about what you fear.”

10. Take care of yourself. “Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing.”
– See more at: http://www.hcplive.com/physicians-money-digest/columns/the-doctor-report/04-2016/10-ways-to-build-resilience/P-2#sthash.3yCwwtFo.dpuf

 

The box that stops some college applicants in their tracks


Even though 95% of all youth arrests are for nonviolent offenses, records of the children’s court involvement can follow them for their entire lives. Youth who are working toward getting their lives back on track after their involvement with the juvenile justice system are often stalled by the negative consequences of having a record.

Barriers to education, including higher education, severely limit a young person’s opportunities to succeed in adulthood. Educational obstacles also disproportionately affect youth of color, who are more likely to face involvement with the juvenile justice system than their white peers. Over 600 colleges and universities use the Common Application, which includes a check box asking applicants about any past juvenile crimes. Although research shows that most schools don’t deny admission based on this information, the vast majority of youth with records who see this check box will not complete the college application.

Some colleges, however, use this information to conduct official background checks of students. Two-thirds of colleges and universities collect criminal justice information during the admissions process. Of those, about 20% of colleges have denied admission based on the young person’s record and the wrongful assumption that rejecting youth with records will make campuses safer.

Juvenile Law Center supports the call to “ban the box” from college applications so that youth with records can go to college, obtain employment, and contribute to their communities and the economy. Removing the check box asking about past offenses means that more young people will be able to move on from their mistakes and get their lives back on track. Learn more about the collateral damage caused by juvenile records at jlc.org/future-interrupted.

4 Facts About LGBTQ Youth Homelessness That Show How Badly Action Is Needed


While LGBTQ rights have definitely made a lot of progress in recent years, there are still major issues affecting the LGBTQ community. One example of these often under-discussed issues is that of LGBTQ youth homelessness. In general, our society doesn’t give a ton of air time to conversations about homelessness or outreach for the homeless population. Sadly, this is no different when it comes to homeless youth, or homeless LGBTQ youth. Though it’s difficult to get a precise number when it comes to counting the homeless population, sources estimate that between 320,000 and 400,000 of LGBTQ youth experience homelessness each year according to the Center for American Progress, making them between 20 and 40 percent of the overall youth homeless population.

Studies show that across the board, there are serious long-term effects of experiencing homelessness as a youth. For example, studies show that homeless youth have a higher chance of developing certain mental illnesses, higher rates of substance abuse, higher likelihood of participating in criminal activity, and greater risk of unsafe sexual behaviors. For LGBTQ youth, who are already part of a minority population, these risks can be heightened, as the LGBTQ population faces additional vulnerabilities. While it’s important that we continue to combat homelessness on a large scale, it’s also important we familiarize ourselves with the populations most directly affected, including LGBTQ youth — because as these facts show, it’s long past time we took action to alleviate the problem.

1. Rejection From Families Makes A Big Impact

While non-LGBTQ youth certainly face struggles with their families, for LGBTQ youth, the thought of coming out to family can be terrifying not just on an emotional level, but also on a practical one. While emotional rejection can definitely leave long-term effects, the reality is that many LGBTQ youth either must leave their homes after their families ostracize them for being gay, or choose to flee to escape confrontation or violence. For these LGBTQ youth, not only are they reeling from the loss of their family’s emotional support, but also their financial support and living security.
2. Few LGBTQ Youth-Specific Homeless Shelters Exist

Luckily, there are some homeless shelters in existence which specifically service the LGBTQ youth population. However, in the overall big picture, there are relatively few places LGBTQ youth can go where they feel safe and respected and still be out about their sexual orientation or gender identity. In fact, while LGBTQ youth make up roughly 40 percent of the population in youth homeless shelters, they’re also at the highest risk of experiencing violence, abuse, and exploitation.

3. LGBTQ Youth Experience Higher Rates of Mental Illness

Studies show that LGBTQ youth are at a higher risk for depression and anxiety than their non-LGBTQ identified peers. Furthermore, according to the Youth Suicide Prevention Program, 30 percent of LGBTQ youth attempt suicide once per year on average, while 50 percent of all transgender people will attempt suicide at least once before their 20th birthday. When LGBTQ youth are homeless, they often lose their health insurance or access to healthcare providers, making it a challenge to receive mental health help or guidance.

4. Transgender Youth In Homelessness Have Additional Needs
While there are many overlapping needs within the LGBTQ community, there are some needs which are particular to the transgender population. The same sentiment is accurate for LGBTQ youth who experience homelessness. For example, according to data reported from The True Colors organization, roughly one quarter of all reporting transgender homeless youth request assistance for gender transition, including medical assistance, legal name change, access to healthcare specific to transgender youth, etc. In shelter situations where transgender youth aren’t accepted because their gender identity does not match the sex listed on their identification, or because the staff isn’t trained on transgender issues, transgender youth often have few options except to live on the streets — which is terrifying for anyone, but especially for a young person in a vulnerable state.

The issue of youth homelessness is definitely a big one, and not everything is covered here. When discussing youth homelessness, it’s important to keep intersectionality in mind in all aspects, such as race, socioeconomic background, education level, and more. For LGBTQ youth, coming out is too often met with being cut from family or community ties, and that removal can lead to homelessness faster than one might think. While the experience of being homeless can be traumatizing in itself, studies show it can have long-term negative impacts on LGBTQ youth. In my opinion, the best way to tackle the issue is to continue bringing attention to it and calling for advocacy, better resources, and more outreach to help those LGBTQ youth suffering in silence.

the above article was written by Marissa Higgins of Bustle Magazine

Alternatives for Justice-Involved Youth with Mental Health Needs Finally Start to Appear


Last week I stood in my swivel-based office chair attempting to hang a picture. It had been bothering me all week and surely using this approach would be successful and quick.

Just as I stretched as far as I could and began to loop the latch on the back of the frame to the nail, the chair I was standing on shot out from under me. Sprawled in the middle of my office with every part of my body in pain, I began to contemplate my ability for complex decision-making.

Here I am, with a couple advanced degrees, and I virtually knocked myself out hanging a picture. Surely I know better, so I should have chosen a ladder or at least a stable chair. Either one would have increased my level of success and decreased my level of pain.

With that image in mind, I couldn’t help but think about the concept of balancing care and control in the juvenile justice system. Often the tool of choice in juvenile justice is the hammer — a tool that is driven with power and accountability, monitoring compliance and wielding authority.

Although the hammer is useful for its intended purpose, it doesn’t work very well in circumstances where other tools are a better fit. Just as you wouldn’t use a screwdriver to hammer in a nail, a hammer wouldn’t tighten a screw.

For juvenile justice, the system often overpromises the versatility of the hammer, ignoring the other tools in the box needed to build bridges for youth, families and communities. In doing so our probation officers are often underequipped to prevent youth from becoming funneled deeper into the system, especially youth with untreated or undiagnosed mental health needs.

Most estimates of prevalence range from 50 to 75 percent, with approximately 20 to 25 percent of youths having a serious emotional disorder. When compared to the estimates among the general population, 9 to 20 percent of youth indicating a mental health need, it is obvious youth with mental health challenges are disproportionately represented within the juvenile justice system.

In fact, in 2004, the U.S. House of Representatives found two-thirds of juvenile detention facilities across the country reported holding youth in detention not because of the seriousness of their offenses but because they were awaiting mental health care.

These youth enter a justice system that is ill-equipped to respond to and support the complex and multisystemic issues facing them. Youth with mental health challenges present symptoms of their problems in multiple settings, including the school, community and home.

Subsequently, they pose a challenge to the traditional model of supervision. It’s no surprise that officers who supervise justice-involved youth with mental health challenges identify the most daunting issue regarding successful supervision as accessing and coordinating social services.

When unsuccessful under supervision, youth will often be charged with a violation of probation and placed in out-of-home settings. This is especially true for youth who are court-ordered to treatment or other services and supports.

Recidivism studies indicate the rates of rearrest for juvenile offenders who have returned from residential treatment and/or juvenile correctional settings range from 40 percent and 65 percent to as high as 85 percent. These findings suggest that when justice-involved youth return to the community from placement, including placements with mental health treatment, there is a very high likelihood that they will cycle back through the system or become engaged in the adult criminal justice system.

Fortunately, states across the country are beginning to look at effective alternatives and diversion models from the juvenile justice system for youth with mental health needs. In Texas, diversion from the system took shape as theFront-End Diversion Initiative (FEDI), a preadjudicatory model that focuses on the use of specialized juvenile probation officers (SJPOs) — essentially probation officers who also take on the role of a case manager.

With specialized supervision, exclusive caseloads facilitate the linking of youth with mental health needs to appropriate services, improve their level of functioning and reduce the number of noncompliance revocations of probation. These officers are extensively trained in adolescent mental health, crisis intervention and family involvement, and serve as a broker between youth and community resources and supports. While working toward supervision goals, specialized supervision also works on treatment goals.

Preliminary data suggest that by rethinking the model of traditional probation, youth were significantly less likely to be adjudicated and more likely to receive needed mental health supports. Youth who had specialized supervision were also more likely to access community services such as individual therapy, family counseling and other community resources than those under traditional supervision. However, despite the data, many states, including Texas, do not implement statewide policies that encourage the adoption of this more successful approach.

When we look at the data, it is clear that the specialized supervision model is promising. In any given year more than 1 million juveniles are arrested across the country. Probation departments initially see most of those youth, and more than half of their cases receive court-ordered supervision.

If you only have a hammer, you see every problem as a nail. Given the disproportionately high number of juveniles who enter the system with an unmet mental health need, states and local jurisdictions must change the tools they make available to supervising juvenile probation officers.

Rethinking probation will require more than just buy-in from any one department or county. Rather, systemic change through state-level policies has more potential to effectively replace the hammer of traditional probation with specialized supervision, linking youth to effective services and supports to reduce recidivism and promote better long-term outcomes.

Erin Espinosa, Ph.D., is a research associate at the Texas Institute for Excellence in Mental Health in the School of Social Work at The University of Texas at Austin. Reach her at erin.espinosa@austin.utexas.edu.

Use data to challenge mental-health stigma


The US National Institute of Mental Health considers stigma to be the most debilitating aspect of a mental illness. It is easy to see why. Stigma increases mental distress and leads to shame, avoidance of treatment, social isolation, and, consequently, a deterioration in health.

What form does this stigma take? Is it decreasing for mental illnesses such as depression, as claimed by some media articles? How can it be combated? We don’t know the answers to those questions. That is partly because not enough people have asked them — and partly because not enough people have answered them. Surveys are expensive, and funds, especially for research on mental illness, are limited.

Surveys in the old days saw pollsters with hand-held clipboards quizzing shoppers in department stores. This gave way to the ubiquitous telephone survey. Today, the Internet affords ever more ways to collect survey data. Some years ago, I developed a way to ask questions in an efficient and global manner. It is called Random Domain Intercept Technology and it relies on people — like you — making mistakes while browsing the Internet. Mistyped URLs and broken web links trigger the survey, and invite the user to participate.

Unlike surveys in which people are given cash or rewards to answer questions, this method does not allow for a long-form questionnaire, although it can break down long surveys into shorter mini-surveys. It permits brief questions — often 8 to 15 of them — to be asked, and answered on a voluntary, non-incentivized basis by large numbers of random and anonymous people using the Internet. And that means almost everywhere in the world.

From September 2013 until May this year, we used the technology to ask some simple questions about mental illness and stigma. More than 1 million people from 229 territories responded. Their responses offer a unique and real-time snapshot of how the globe thinks about the estimated one-quarter of its population who will experience mental ill health (N. Seeman et al. J. Affect. Disord.190, 115–121; 2016).

The survey requested age and gender, and then asked two specific questions. First, is there someone you interact with every day who suffers from mental illness? (This may include psychosis, depression or addiction.) And second, are people who suffer from mental illness any of the following: more lazy, more violent, suffering from a condition as serious as physical illness, the victims of bad parenting, or able to overcome their challenges through ‘tough love’?

“The anonymity of the survey facilitated consistent answers.”

In developed countries, only 7% of respondents thought that people with mental illness were more violent than the general population. In remarkable contrast, about 15% of those in developing countries thought that people with mental illness were more violent. Although 45–51% of respondents from developed countries believed that mental illness is similar to physical illness, only 7% of the same people thought that mental illness can be overcome. It seems that the understanding that mental illness has a biological cause makes the public more, rather than less, pessimistic about outcome. This has been reported previously, and is, at first glance, counterintuitive. Attributing illness to genes takes away blame, but at the same time, takes away hope for change.

Although the identity of individual respondents is unknown, the overall reproducibility of responses from any one region is high. When the same questions were posed every month in India for 21 months running, 10% of respondents each time reported that people with mental illness are more violent than others.

And despite the fact that mental illness is often a taboo subject, the anonymity of the survey facilitated consistent answers. In China, for example, people with mental illness are often viewed as bringing shame on their family. The ‘loss of face’ associated with mental illness there and in many developing countries attaches not only to the ill person, but also to family members. In this context it makes sense, therefore, that people with mental illness are kept at home, and this may explain the high proportion of people in China who reported having daily contact with a mentally ill person.

The approach I describe can uncover views on any topic held by those in Internet-enabled areas, currently 43% of the planet. And it can allow for ‘before and after’ surveys, assessing the effectiveness of population-wide interventions.

For instance, it would be of immense value to repeat this stigma survey in a region that has introduced a public-education anti-stigma campaign. The tool is not limited to stigma — in the field of mental health, for instance, it can probe suicidal ideas and, again, evaluate a suicide-prevention intervention. It can probe symptoms of post-traumatic stress disorder in the wake of a disaster (such as a hurricane or the Paris terrorist attacks) and test ways to mitigate these traumas.

Measuring a social problem on the scale of mental-illness stigma does not make it go away. But at least it shows us the size of the challenge — and could very well help to find ways to fix it.

The above article was written by Andrea Armstrong and posted to Nature.com 

Gallery

2016 Children’s Mental Health and Well-being Celebration

This gallery contains 4 photos.


I was once just another youth in foster care


Too often, youth in the child welfare or justice systems are excluded from discussions about how to reform these systems, yet they have personal experiences that would inform these discussions. To amplify their voices, Juvenile Law Center developed two Philadelphia-based youth engagement programs, Juveniles for Justice and Youth Fostering Change, which create opportunities for these youth to advocate directly for systemic reforms.


I was once just a youth in foster care who also had a run in with the juvenile justice system. During my time in both systems, I felt like I never had a voice because I never was given a chance to give my opinion or say what I wanted or needed. I felt helpless. Then, I heard about Juvenile Law Center and its youth advocate programs. I ended up being a youth advocate in Youth Fostering Change for two years and an advocate in Juveniles for Justice for one year. Suddenly, as a youth advocate I was able to do everything I couldn’t do before, and not only did I have the liberty to advocate and voice things for myself, I was able to help create a voice for hundreds and hundreds of youth like me.

But, because I was an older youth in foster care, my stability was shaky as I began aging
out of the system and having nowhere to go. I enrolled in a medical assistant school the same year I became an alumni of Juvenile Law Center’s youth advocate programs, and that’s also the same year I became homeless. But, I still believed that, down the line, there was hope.

Nine months later, in February 2013, I was working an externship. During that time, I was arrested for a fight, incarcerated for a whole month, and sent to court three times. When I came home from jail in April, I was still homeless and my graduation from the medical assistant program was pending. I was able to graduate that June; none of my family was present, but Juvenile Law Center was there.

I wasn’t able to find a job right after graduation, but I’d heard about an employment opportunity called PowerCorps PHL from Juvenile Law Center staff. PowerCorps employs young people ages 18-26 to help them better themselves and help beautify the city under the Green City Clean Waters Act. The six-month program also offers fellowships and the chance to be an assistant crew leader, if your crew leader finds you fit and able to lead. Eager to work, I jumped at the job opportunity, and that same week, I found another job opportunity working at Eastern State Penitentiary once a week. By August, I was looking forward to working two jobs in September: PowerCorps PHL and Eastern State Penitentiary.

I’ve been working at Powercorps since September, 2014, and in this month I’m returning to the program working full-time as an assistant crew leader. Everything I’ve learned as a youth advocate, from advocacy skills and the way that I interact with people to my ability to help and understand people, paid off. I will be working more hours with PowerCorps now, and being in that leadership position is going to help pursue my long term goal: starting my own nonprofit advocacy organization. I want to help people just like Juvenile Law Center helped me advocate for myself.