I didn’t attend many funerals in my childhood. One that I recall was for the father of a close childhood friend. He died of a heart condition during our first year of high school.
In the intervening years I have paid my respects on numerous occasions, including a disturbing number of times after the untimely deaths of young people. Conversations at funerals inevitably lead to the circumstances of the death and the conditions leading up to it. Talking about the cause of a loved one’s death is never easy. But these conversations are especially difficult, even taboo, in the aftermath of a drug overdose or a death by suicide, when grieving is complicated by circumstance.
In most cases when someone dies, the feelings of loss and numbness ease incrementally, enabling the bereaved to process the experience and gradually return to a new state of normal. In contrast, when grief is complicated and survivors are inconsolable, accepting the loss and moving forward is far more difficult.
The stigma, shame and discrimination that accompany living with a mental health or substance-use disorder often have the effect of silencing not only those who have the disorder but also their family members. And after losing a loved one to one of these illnesses, surviving family members are often rendered voiceless once again.
Matt Shapiro, associate director of public affairs for the Albany-based National Alliance on Mental Illness New York State, shared that “The impact that mental illness had on me and my family led me to shame, silence and masking who I really was. [Becoming an advocate for] the National Alliance on Mental Illness has given me the ability to take off that mask, end the silence and speak about my issues.”
Shapiro is one of a growing number of those fighting to ensure that people with a mental health or substance-use disorder have timely and affordable access to treatment and care in accordance with the federal Mental Health Parity and Addiction Act. The passage of that bipartisan law in 2008 aimed to prevent health insurers from imposing less favorable benefit limitations on such care than on medical and surgical coverage.
But having a law on the books doesn’t guarantee compliance or effective enforcement. Millions of dollars in fines imposed on violators have had little impact on the trillion-dollar behemoth that is today’s health insurance industry.
Bad publicity doesn’t seem to work, either, because tens of thousands of New Yorkers continue to have difficulty accessing timely and affordable in-network care. Still, advocates like Shapiro battle on with unwavering determination.
Also fighting to make a difference are larger-scale advocacy efforts like Parity at 10, a three-year campaign to unite local and national advocates in 10 states, including New York, to pursue full enforcement of the Parity Act. Achieving full enforcement of parity compliance and enforcement, however, remains highly problematic.
It’s about time to ask Gov. Andrew Cuomo and the commissioners of the state Departments of Health and Financial Services, which are responsible for enforcing parity, questions such as, what will it take for you to suspend the licenses of serial violators in the health care industry and to put them out of business if they fail to reform?
Corporations have no empathy, and are unencumbered by conscience and shame. What do they care about? The profits they accumulate from the misery of people living with untreated mental health and substance-use disorders whose access to care they deny. If fines alone won’t work, only the real threat of putting them out of business will.
Do Cuomo and the State Legislature have the nerve to take on the health care insurance industry when it comes to parity enforcement, beyond passing nominal legislation for funding to add staff to the DOH and the DFS for monitoring and trouble-shooting, as they have done this year?
Increasing staff in those departments to enhance surveillance of parity compliance is a good step forward. But without impactful enforcement when persistent deficiencies that impede access to care are identified, the benefits are questionable.
Greedy health insurers and neglectful government regulators have two things in common: They count on stigma and our silence — in life and death.
Andrew Malekoff is executive director of the North Shore Child & Family Guidance Center, a nonprofit children’s mental health center. For more information, go to www.northshorechildguidance.org.
Each year, May 9th is designated as National Children’s Mental Health Awareness Day. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), National Children’s Mental Health Awareness Day shines a national spotlight on the importance of caring for every child’s mental health and reinforces that positive mental health is essential to a child’s healthy development.
This year’s theme is “Suicide Prevention: Strategies That Work.”
According to the Centers for Disease Control and Prevention (CDC), suicide is the third leading cause of death among individuals between the ages of 10 and 14, and the second leading cause of death among individuals between the ages of 15 and 34. It is far more rare—though not unheard of—for children younger than 10 to commit suicide, but it does happen. About four out of every 500,000 children below the age of 12 commit suicide annually, reports the CDC.
At North Shore Child & Family Guidance Center, 20 percent of all admissions come to us as crisis situations, including kids who talk and act as if they don’t want to live.
“Both children and teens are at risk of depression and suicide when they experience traumatic events in their lives, such as divorce, death of a loved one, abuse or illness,” says Elissa Smilowitz, LCSWR and Coordinator of Triage & Emergency Services at North Shore Child & Family Guidance Center.
Parents must be open to believing the risk of suicide is real and not assume that their child or teen’s behavior is just a normal part of adolescence, adds Smilowitz. “Parents say, ‘Teenagers are supposed to be moody, aren’t they?’ Yes, but it is the severity of the mood that parents need to look at.”
Smilowitz points out some of the warning signs: “Look for changes in their behavior that aren’t typical for them.”
She cites:
Withdrawing from friends and family
Sleeping all day
Being depressed and crying often
Posting suicidal thoughts on the Internet
Talking about death and not being around anymore
Cutting themselves
Increasing aggressiveness or irritability
So, what do you do if you suspect your child or teen may be suicidal? The first step is to consult a mental health professional. The Guidance Center has a Triage & Emergency Services program that offers a rapid response to psychiatric emergencies. Our team will assess if the situation appears urgent and will make an appointment to see the child within 24 to 48 hours (if it’s deemed extremely urgent, we do advise you go to the Emergency Room).
It’s very important that you communicate your concern to your child in a loving, non-judgmental way, says Smilowitz. “Talking about suicide will not make your child more likely to act upon it,” she says. “The opposite is true. Also, let them know that you believe that getting help is not a weakness, but rather shows their strength.”
If you or a member of your family is in crisis, call North Shore Child & Family Guidance Center at (516) 626-1971. You can also call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week
What does it take for a group with a strong ethical foundation to stray from its ethical convictions? This is a vital question for anyone affiliated with an organization that espouses human rights — and it’s also relevant to anyone of any age who feels reluctant to speak out in our increasingly divided culture.
The American Psychological Association, founded in 1892, offers a case in point by demonstrating how even the best of intentions can go awry in dire circumstances. It is a situation that all of us may face in our lives.
To set the stage, although there has been much debate in recent years as to whether “enhanced interrogation” constitutes torture, it has been determined to be so according to international standards set forth in the 1949 Geneva Conventions and the 1984 United Nations Convention Against Torture.
Nevertheless, in the aftermath of 9/11, the APA supported this practice in the interrogation of detainees held in Guantanamo Bay in Cuba, Abu Ghraib in Iraq and in a number of so-called “Black Sites” across the globe, including Lithuania, Thailand, Romania, Afghanistan and Poland.
How did the APA, whose mission is to apply psychological knowledge to benefit society and improve people’s lives, come to support torture? One possibility, according to psychologist Dr. Nina Thomas, who has served on an APA ethics panel, was for APA members to take the position: “We didn’t know about it.”
Thomas wrote about this matter in an article entitled, “We didn’t know: Silence and silencing in organizations,” which was published in the International Journal of Group Psychotherapy in 2016.
Thomas says that a full understanding of context is critical to unraveling how the APA became involved in enhanced interrogation. She notes that soon after the 2001 attack on America, “national security was uppermost in the minds of government officials and private corporations and organizations.” No one living in the vicinity of the attacks at that time would doubt that there was growing fear and insecurity. Any sense of American invincibility was replaced by paranoia.
Living on Long Island, just about 25 miles from the World Trade Center, I was hesitant to travel by way of bridges or tunnels for a time. Was I being cautious, irrational or paranoid? Whichever it was, there was a visceral sense of something profoundly different. It was my sense that most people, especially in the areas directly affected by the attacks experienced this feeling.
Historically, according to Thomas, psychologists assisted the U.S. military in “analyzing propaganda and countering its effects as well as boosting morale during protracted war.” They also provided research on “learned helplessness” that was used to prepare captured American soldiers to resist interrogation during times of war.
This history of collaboration contributed to a growing relationship between the APA and the U.S. Department of Defense and the Central Intelligence Agency. At a time when there was a pervasive sense of acute fear, the APA was positioned to be a vital asset in helping to extract information from detainees that might protect American lives from further attacks. And perhaps by any means possible.
Thomas says some of the APA members who directly or tacitly supported the role of psychologists in the interrogations later reported taking issue with the international standards and their definition of torture.
Consequently, in a context of immense fear and hyper-vigilance, interrogation practices that overrode the APA’s ethical standards were excused or perhaps ignored by conveniently distorting the conventional standards used to define torture.
Potential dissenters — essentially bystanders — were then faced with the challenge of being silent (“We didn’t know about it”) or speaking out and being ostracized and marginalized. Apparently a good number chose the option of “going along to get along.”
In any group that strays from its ethical standards, according to Thomas, “when personal interests hold sway over ethical concerns, the group runs the risk of self-destructing,” particularly when an impression of “we were just following orders” prevails.
Some APA members (and others) may have felt that psychologists’ role in the interrogations were justified as they were used in their entirety for what was perceived as the greater good.
Perhaps the lesson for members of all organized groups, as articulated by Dr. Thomas is, “when self-interest trumps ethics, no one is served.”
This story offers a good lesson for children (and for all of us) growing up in an increasingly divided America. The bottom line: Citizenship involves being active participants in community affairs, even when it may place you at odds with your friends, neighbors, colleagues or others. It is vital that we teach young people that dissent is a cornerstone of democracy. They need to know that their voices will make a real difference in changing the world where others have failed.
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.
A sellout crowd of 245 people recently joined together for North Shore Child & Family Guidance Center’s annual spring luncheon. This year’s event, which supports the Guidance Center’s mission to restore and strengthen the emotional well-being of children and their families, was a record-breaker, raising more than $87,000.
The luncheon, which took place at Glen Head Country Club, began with a morning round of Mahjong, Canasta and Bridge, along with unique shopping boutiques from some of Long Island’s trendiest and most charitable small business owners, including Buy the Bag, Club & Country, Dash, I Thrive, Transitions and RFC Fine Jewelry, among others.
After a delicious luncheon buffet, Vanessa McMullen, who is the supervisor at the Guidance Center’s Marks Family Right From The Start 0-3+ Center in Manhasset and also head of the agency’s Diane Goldberg Maternal Depression Program, introduced the day’s speaker, former client Katherine. The audience was completely engrossed as Katherine shared her experience with postpartum depression and talked about the lifesaving treatment she received at the Guidance Center.
She told the crowd, “I was desperately seeking someone who could tell me that I could get through this and convince me that it would get better. When I was finally connected with North Shore Child & Family Guidance Center, my life and my daughter’s life were changed forever. The Guidance Center has not only given me back my life, it has given my family a future.”
“Katherine’s story was incredibly moving,” said Nancy Lane, who is the Guidance Center board president. “When she spoke about the dedication of the Guidance Center staff to both her and her family, I was incredibly proud. Our dedicated team of professionals gives their all to bring hope and healing to each and every client.”
The luncheon couldn’t have been so successful without the hard work of the co-chairs, Jan Ashley, Amy Cantor and Alexis Siegel.
“The enormous success of this year’s event is largely due to the incredible dedication of our three co-chairs,” said Andrew Malekoff, executive director of the Guidance Center. “They have put so much time and energy into the luncheon for several years, and we are truly grateful to them for continuing to make each year more special than the last.”
—Submitted by North Shore Child & Family Guidance Center
