Pediatric PsychiatryNov 04, 2019 11:48AM ● By Jenna Gallagher
Many in Omaha remember Dec. 9, 2007. On that day, at 1:42 p.m., 19-year-old Robert Hawkins of Omaha opened fire in Westroads Mall, leaving eight dead and five wounded, before turning the gun on himself. Hawkins had been taking antidepressants and was hospitalized at Richard Young for mental illness twice—once at age 4, and again at age 13.
Hawkins was one of the 20% of people with mental health issues in the United States who had received treatment.
“About 80 percent of children in the United States who need mental health treatment don’t ever receive it,” says Dr. Joan Daughton, who specializes in child and adolescent psychiatry at Omaha’s Children’s Hospital & Medical Center. “And, there’s an average of eight to 10 years between the onset of mental health issues and the beginning of treatment. As a culture, we’re so accustomed to being reactive, but when it comes to health care—and mental health care is no exception—we need to be proactive.”
Most mental health issues children face are not headline news, which may be why they don’t get the attention they need. Daughton says that the majority of her patients are being treated for issues such as ADHD, anxiety, depression, PTSD and disorders on the autism spectrum. “Things like bipolar disorder are way lower on the list,” she says.
Supriya Bhatia, Ph.D., of Boys Town Child and Adolescent Psychiatry, agrees. “Children and adolescents deal with [things] including bullying, navigating social situations, depression and anxiety, struggles with substance abuse, and learning what is a good relationship and what isn’t.”
What puts a uniquely 21st-century spin on things is round-the-clock virtual connectivity. With people glued to their smartphones and increased professional demands and other obligations that can distract parents, many families have lost touch with their ability to connect with each other in real life.
Social media has also been linked to mental health problems, as it helps rumors spread faster, increases avoidance of negative interactions, potentially removes a level of empathy, and is relentlessly accessible.
“It can be a struggle for kids, especially adolescents in the 13-to-15-year-old range, to learn how to manage when everything in their world shifts to social media,” Bhatia says.
Resilience, Good Habits, and Communication
Michael Vance, Ph.D., the director of behavioral health at Children’s says that one of the most important ways adults can help young people navigate their world in a mentally healthy way is by emphasizing resilience—including modeling it ourselves. “Children need to fail sometimes,” Vance says. “When they see us screaming at other cars in traffic or being irrationally angry after a hard day at work, they’re not learning how to appropriately handle the fact that things won’t always go their way.”
He advises challenging them with opportunities such as extracurricular activities where there may not be a 100% chance of success, and complimenting them when they handle disappointments well, or behave in an emotionally healthy way.
Vance says that community involvement and part-time jobs help young people learn to be comfortable in their own skin, and that they are part of something larger than themselves or their challenges.
Self-care also plays a key role. “Children need their parents just as much, if not more, as teenagers than they do when they are younger,” Daughton says. “We need to help them remember to get good nutrition and enough sleep and exercise. But we also need to be able to talk about sexual education, substance use, and our expectations within the family. And if they aren’t comfortable talking to us about those things, we need to let them know where else they can go to talk to someone.”
While Daughton is a firm advocate for early intervention, she wants people to know that help is available at every stage.
Arming our kids with the skills to communicate what they’re going through and how they’re feeling can impact every facet of their lives. “Kids don’t automatically know what everything means when it comes to emotional perception,” Bhatia says. “We can help them learn how to express their emotions in a healthy, productive way. For them to be able to do this is a strength.”
Meeting Kids Where They Are
Today, young people have more opportunities to do that than ever before. Schools across the metro, including Westside, are being proactive in looking at students’ mental health.
“Westside Community Schools relies on a comprehensive, multi-tiered approach to mental and behavioral health prevention, identification, and intervention for all learners,” Brandi Paul, director of Communications & Engagement at Westside Community Schools, said via email. “Students at all levels participate in mental/behavioral health screenings conducted three times each year as part of our PK-12 Positive Behavior Intervention and Supports model. In addition, general and special educators directly instruct students at all levels in areas of social-emotional learning and school/campus-wide behavioral expectations.”
“We’re always looking at different ways to reach kids where they’re at,” says Vance. One way they do this at Children’s is through a service called telehealth that enables doctors to provide the same psychiatric care in a virtual visit that they could in person—an essential option for some patients who don’t have as much access to care or who are dealing with certain anxieties, depression, or trauma. Vance says that the team at Children’s is also using virtual reality technology—such as helping an anxious child or youth get more comfortable with an MRI procedure.
Additionally, Children’s is reaching kids in the classroom. “We’re spending a lot of time training teachers and school staff to recognize when a child might need an intervention,” says Daughton, noting that counselors in Omaha Public Schools, for example, spend about half their time teaching social and emotional skills such as sympathy and empathy.
Many districts have partnered with Children’s Behavioral Health in an effort to address the needs of their students and families through more onsite services and resources. Families can work with school counselors to establish the connection and facilitate the appointment, either at school or at the facility.
“We have…expanded our partnership with Children’s Behavioral Health to address mental and behavioral needs of our children by offering more onsite services at Westside Middle School, Westside High School, and Westside West Campus,” Paul says. “We also work to continuously spread awareness of the Westside Safe Schools Hotline [through Boys Town], allowing 24/7 access to professionals for students or families with concerns about all issues from bullying, to safety, to suicidal thoughts, and anything else that could threaten someone’s physical and emotional well-being.”
According to Kara Neuvarth, media relations director at Boys Town, Safe Schools Hotline is available to several metro school districts—Omaha, Millard, Ralston, Bellevue, Papillion-La Vista, and Plattsmouth Public Schools, Brownell-Talbot, and Westside Community Schools. Students in those districts can call a number anonymously if desired and talk with a trained crisis counselor at any time. They also have a telehealth service.
The newest program at Boys Town is the The Child and Adolescent Psychiatric Inpatient Center, which opened Sept. 12. This new 16-bed facility, connected to Boys Town National Research Hospital-West on the Boys Town campus, provides care and safety for children ages 5 to 18 who need psychiatric hospitalization. It includes classrooms, a gymnasium, living spaces, and recreational areas. Patients receive treatment and care from board-certified child and adolescent psychiatrists, pediatricians, pediatric specialists, highly trained psychiatric nurses, and social workers.
Even campaigns such as the #BeKind movement that has been adopted by many Nebraska school districts in recent years can be a less formal version of cognitive behavioral therapy, in which patients learn to be mindful of how their thoughts and feelings impact their behaviors and the patterns that creates. “This message of #BeKind can stimulate more positive thoughts and make kids more mindful of how these thoughts affect their actions,” Bhatia says.
In many ways, schools are the front line—because they’re where the battle is won or lost, and they can be scary places. In addition to traditional stressors like bullying and academic and peer pressure, today’s students have active shooter education—including realistic drills—starting in kindergarten.
It’s hard not to assume that the necessary evil of an active shooter drill would be anxiety-producing. “Schools are doing the best they can to be prepared and to support children in managing their fears,” Bhatia says. Still, that requires more outreach from mental health professionals, more teacher education, and, frankly, more resources.
“Mental health awareness is improving, but Nebraska still ranks 49 out of 50 states when it comes to delivering quality mental health care in schools,” Daughton says. “We need elected officials to decide that it’s a priority and to support it.”*
Vance says that without the right resources in place, all too often, intervention will be put off until a problem has escalated to the point of self-harm, violent behavior, or hospitalization. “The earlier we can get kids the help they need, even before they need it, the bigger the impact we can have.”
*Update: According to mhanational.org Nebraska ranks 35 out of 50 for 2020.click here to subscribe.