Mental Health Care in 2021 in the United States

Mental Health Care in 2021 in the United States

The month of May is dedicated to mental health awareness. I decided to use this opportunity to frankly discuss the mental health care system in the United States and what many families and patients have to go through and often not receive any help. Unfortunately, this is very common that many teenagers and adults fail to receive mental health care or receive inadequate mental health care.

Many people assume that the United States provides the best physical and mental health care in the world. However, this is not the case. One example of this fact comes from the ABC News Show 20/20. An Olympic Athlete had been living with Bipolar Disorder for over 20 years and never diagnosed. She had been reporting difficulties with depression for years, but her complaints were dismissed. The alarming fact is that even though her brother committed suicide due to being Bipolar her symptoms were dismissed. We know that Bipolar Disorder is inherited and suicide tends to run in families. In other words, if a family member committed suicide it puts you at a higher risk for suicide. The family never discussed the brother’s suicide due to shame associated with suicide and mental illness. Therefore, clinicians treating her may never have been told that her brother committed suicide. The Athlete and her husband asked for help for 10 years and despite the fact she had all the symptoms and a family history of Bipolar, no one diagnosed her. She lives in the United States, her brother committed suicide because he was Bipolar and it still took 10 years for her to be diagnosed with Bipolar Disorder and not dismissed by psychiatrist as someone who was over reacting. Now that she is diagnosed she is dealing with the shame of being Bipolar. However, the shame associated with mental illness and suicide might have contributed to her not being diagnosed earlier. Often patients come in to my office for help, but I may not get all the vital information for months because the patient is embarrassed and worried how I might react to their family history.

We often hear parents complain that their teenager is driving them crazy or a teenager complaining how unfair their parents are to live with on a daily basis. Many people assume this is normal life with a teenager. However, according to the CDC, one out of five teenagers have a diagnosable mental health condition and would benefit from psychotherapy. The parents of these teenagers are begging for help, but they are ignored. Many people assume they are over reacting. Furthermore, there is a strong negative stereotype about mental health in our Country and people prefer not to be associated with someone who has a mental health issue. Many people act like mental health issues are catchy and a sign of weakness and lower intelligence. None of these ideas are true. In fact, many very famous people have mental health issues themselves or in their families.

Therefore, you have some parents begging anyone who will listen for help. You also have teenagers who are crying out for help by cutting themselves or acting out trying to get people’s attention. Many of us assume if the parents are begging or the teenager is cutting themselves that they will receive mental health care. Unfortunately, this is not how our world works. I have been working as a psychotherapist who treats teenagers for over 20 years. There have been many times I could not have a suicidal teenager hospitalized because the hospital had no beds for a suicidal teenager or the insurance refused to authorize the admission to the hospital.

This is a very important point for people to understand. As the psychotherapist, I do not determine the treatment plan for a teenager or child. Your insurance company dictates the treatment plan. They have decided what diagnosis they will cover and what treatment modalities they will pay for. Additionally, they decide how much they will pay. I have seen some teenagers and the insurance would only allow $25 per session. Many people assume the insurance company pays psychotherapist or hospitals their entire fee. They pay the psychotherapist or hospital the rate they decide. If the psychotherapist wants to work with that insurance company they must agree to accept the insurance company’s rate. This is why health care providers always ask for your copay. The copay is part of the rate. If the insurance rate is $50 and your copay is $25, if the provider does not collect your copayment, the insurance only pays $25. This is why many providers do not accept insurance. They dictate the course of therapy even though they no nothing about the teen and they under pay the provider. Insurance companies make a great deal of money by charging high premiums and refusing to pay for treatment. This is not fair or appropriate.

Therefore, parents are seeking help, but they are told they need to contact someone else, they have contacted the wrong place. For example, one Thanksgiving I had a mother have my answering service page me and she was begging me for help because her teen was suicidal. I referred her to the County hospital because based on what she said the teen needed to be hospitalized. She told me the County hospital gave her my telephone number because they had no more beds for anyone who was suicidal. The parents tell me they feel like no one cares. She did everything she should have, but she could not get help. Her son needed to be hospitalized for his safety, but the hospital refused to admit him.

Again, some people might believe this is an isolated case. Sadly this is not an isolated case. As I said, I specialize in treating suicidal, bipolar and teens who are trauma victims. There have been a number of times I have sent a suicidal teen by ambulance from my office to the County hospital only to have the teen released in less than an hour because the hospital had no beds. I had one person on the Psychiatric Crises Unit tell me on the telephone unless the person had a shotgun in their mouth not to send them to the Hospital because they had no beds for suicidal teens. The hospital only has a couple of beds for suicidal teenagers based on the State budget. Anytime cuts need to be made to the State budget, mental health is always the first area to be cut.

As a result of budget cuts and insurance companies denying treatment, the therapist in a difficult position. Do you just discharge the teen or do you continue to treat the teen for a low fee or for free? Remember 1 out of 5 teens have a psychological condition that needs treatment, what do you do when treatment is denied or there are no treatment options? Besides 1 out of 5 teens needing mental health care, the CDC has recently moved suicide from the third leading cause of death to the second leading cause of death for children 10 to 18 years old. Therefore, there are many teens who desperately need mental health care and may die without it. Also, when you examine the results further you find that teens who need therapy but fail to receive it are more likely to get involved with drugs, crime, are more likely to drop out of school, more likely to get pregnant or father a child and that child is more likely to become a foster child. These teens are also more likely to end up on probation, homeless and on welfare.

As a society we do not place much emphasis on mental health care. Mental health care programs are always some of the first programs cut when the budget is cutback. Our priorities need to be examined. I find I t very interesting that Contra Costa County had enough money to build a new Juvenile Hall, which is three times the size of the old Juvenile Hall, but there was not enough money to fund a large number of mental health services which had to be cut.

We often look at teens who are acting out and blame their parents. We ask why don’t they get their child the help they need? What stops them from helping their teenager? Why is the teen always getting involved with drugs or not going to school? The answer could be because the teen needs mental health care and the parents have been and continue to try to get their teen help but their is no help. The teen may be acting out because they are tired of asking for help and being in pain so they start looking for the easiest way out of pain.

If we want our teenagers to grow up to become productive members of society then we need to provide them with the mental health care they need. If we want parents to be responsible parents, then we need to provide parents options for how to get their teens help when they ask for it.

With the number of mass shootings, the significant increase in the number of children with anxiety disorders and the epidemic of teenagers cutting and teenage suicide, I am surprised we have not made it easier and more affordable for teenagers to get adequate mental health care. In addition to the issues I stated above, the Coronavirus has created a number of mental health issues for children and teenagers. Grief due to the death of family members, drug use and overdoses have increased and so have anxiety and depression increased due to the pandemic. However, I don’t see any plans to deal with the large number of teenagers who are going to need help. I have seen a significant increase in the number of teenagers needing mental health care since the Pandemic started. I have also seen insurance companies refusing to cover mental health, so what do we do?

I have been treating teens for over 20 years and it is still a problem to get a teenager residential care if they need it. Also it is still difficult to get teens medication at an affordable price. I had a teen the other day who needs medication but they had no medical coverage to see a psychiatrist. The parent made an appointment but the fee for the visit was $450 and they would not reduce the fee. So again what do they do?

We can write our Congressmen and Senators and demand that they fund community mental health centers. We can also demand that private insurance companies be required to offer teenagers and their families adequate mental health benefits based on what professional therapists are recommending. The professional treating the child knows what the child needs not some clerical worker with a Bachelors degree who is answering phone calls at the insurance company.

In short, if we want our teenagers to survive their teen years we all need to act together and demand that our children receive the treatment they need and deserve. Mental health care is not a dirty word. There is no difference between mental health and physical health. Therefore, they needed to be treated the same and we need to eliminate the stigma associated with mental health issues.

Finally, private insurance companies make huge profits and drive the cost of health care up based on how they do business. If we don’t start to speak up for our kids, they will never receive the care they need. Look at your next pay stub and look at how much you pay for health insurance and compare that to the benefits you receive. When you take your teenager to a psychotherapist most insurance companies only pay the therapist $75. Your copay is part of the payment. Your premiums are high, but they do not pay it out to providers they keep it.

Dr Michael Rubino has over 20 years experience treating children and teenagers dealing with anxiety, depression and trauma. To find out more about Dr Michael Rubino and his private practice visit his website at www.RubinoCounseling.com or his Facebook page www.Facebook.com/drrubino3 or his podcasts on Spotify and Apple

Leave Your Divorce at Home and Don’t Take it to Your Teen’s Graduation

Leave Your Divorce at Home and Don’t Take it to Your Teen’s Graduation

Last year due to the Coronavirus most graduations either were canceled or occurred virtually. This year due to the the success of the vaccines, many schools are having graduation ceremonies. This is fantastic for High School students and college students. However, if a High School Senior’s parents are divorced, their High School Graduation can create a number of problems. This article address the issues associated with divorce and High School Graduation and provides some solutions to the issues.

Divorce brings a lot of new situations in to a people’s lives especially if you have children. Hopefully, when you and your spouse divorced it was done in a civil manner and the children were not put in the middle of the divorce. This is the ideal situation, however, we do not always get the ideal situation. Very often divorces are high conflict and the two of you argue over everything and anything. Usually in these high conflict divorces, the children are put in the middle and used as weapons. The children feel they have to choose between their mother and their father. This is a very sad situation.

This conflict usually interferes with visitations and holidays too. Parents argue about pick up times and drop off times, how long they have the children for holidays and there is often arguments about can a child bring toys or clothes from Dad’s house to Mom’s house. In short, parents argue about everything and the children become sick and tired of the arguing.

The other factor that adds to this is grandparents saying negative things about the ex wife or ex-husband. This only increases the pressure and stress the children are dealing with after a divorce.

The final stressor is when one or both parents remarry or have a long term boyfriend or girlfriend. Then the arguments about she is not my child’s mother or he is not my child’s father and I don’t want them involved in my child’s life start. Also a new girlfriend or boyfriend can cause teens to argue with their parents because they want their parents back together.

In short in a high conflict divorce, children live in a war zone. They become use to arguing about everything and often feel they must choose sides. At times some children do choose sides hoping to end the fighting or because they are so confused. This type of divorce creates a great deal of issues for children and I cannot cover all the issues in this blog. I would need a book to cover all the issues. Most the time, teens become sick and tired of the fighting and wish that their parents would stop fighting so they could at least not have to worry about what will cause the next argument.

Graduation is one of those issues. Parents will often start arguing about issues such as, “I paid for everything you needed for high school and now your father wants to come.” Or “if your mother shows up, after everything she has done, I won’t be in the same room as her.” And of course there is always the issue of “he better not bring her to my child’s graduation.” What is a teenager to do?

They have spent the last four years working very hard in high school and graduation is a day for them to celebrate their accomplishment. They also usually want the people who they love and care about to be there with them to celebrate their accomplishment. However, how does this happen when Mom and Dad and grandparents are stating their terms about who can attend graduation and how graduation day will go because of the divorce.

Your teenager did not get divorced. You and your spouse divorced and even though you are no longer married, you are both still parents for your teenager and you need to act like parents and adults. This means putting aside all your feeling and issues so your teenager can truly celebrate their day, their graduation. Most parents have told their teens to stop being selfish and to think about someone else, at some point during High School. Well isn’t it time that you followed your own advice. Stop thinking about yourselves and your divorce and think about your teenager and how you can make your teenager’s graduation a happy day for them.

What you need to do is you and your ex spouse need to sit down together or email each other and discuss how the two of you can put your issues on hold for one day so your teenager can have what they deserve, a happy graduation. The two of you need to talk with grandparents too and other extended family and inform them what will be allowed and what will not. This doesn’t mean you have to act like best friends. You simply need to be civil to each other. If you don’t think you can sit next to each other at the graduation, then one of you sits on the left and one sits on the right. You don’t have to have a joint party either. You can decide to have separate parties. The key is communicating with each other before the graduation and decide how you can do it civilly. This will be the best graduation present that you can give your teenager. If you can allow them to have their graduation day to celebrate their accomplishment without having to worry about what fight there will be. You are also teaching them a lesson about love, being parents and relationships.

The most important thing to do is remember this is a celebration. So let your teenager celebrate and allow yourselves to celebrate with your teenager as their mother and father. Remember the divorce ended your marriage not your relationship together as parents. Do not allow your divorce to deprive you from enjoying your child’s High School graduation day with them. They only graduate from high school once.

Dr. Michael Rubino has 20 years experience working with teenagers and families coping with divorce. He is an expert in providing psychotherapy treatment for children and teenagers. For more information about Dr. Rubino or his private practice visit his website at www.RubinoCounseling.com or his Facebook page at www.Facebook.com/drrubino3 or his podcasts on Spotify or Apple.

As Schools Reopen the Issue of Bullying Returns Too

As Schools Reopen the Issue of Bullying Returns Too

As more people in the United States are vaccinated for the Coronavirus, we are seeing the number of cases and deaths significantly decline. While we have not over come the Coronavirus yet, we are able to start to resume many everyday activities. One of these activities is reopening schools and children and teenagers returning to school.

Before the pandemic most kids and teenagers complained how they hated school and wanted to stay home. However, after a year of remote learning most kids and teenagers want to go back to the classroom and also see their friends again. However, as kids return to school a common issue will return. The issue is kids being teased and bullied. In the 21st century bullying doesn’t just happen at school it now occurs on line and via texting too.

Often when a child is being bullied they do not say anything to their parents until the bullying is really bad. They are afraid, especially boys, that you will see them as weak. They are also afraid that you will be disappointed in them for not defending themselves. Parents it’s important that you understand that you have not said anything or done anything to create this feeling in your child. Our society teaches children these messages, especially boys. Children receive these messages about being strong and solving their own problems from television, music, and video games. This is what the documentary “The Mask You Live In”, is trying to address. It is on Netflix and it might be helpful if you watch it.

It is very important to take bullying very seriously these days. It is no longer just one kid calling another kid names. The bullying today occurs at school and may include threats of being killed and it goes beyond school. Now bullies can continue their bullying via text messages, emails, Facebook, Twitter, Instagram and Snapchat. So the bullying becomes non-stop. It can really make someone feel worthless and that they would be better off dead. One example of a child being overwhelmed by bullying is a 13 year old boy, on the east coast, who committed suicide because he could not tolerate the bullying any longer. The boy committed suicide to escape the bullying. He is not the first child to commit suicide due to bullying. One 15 year old girl committed suicide due to bullying and she left a note to be placed in her obituary. In the note she asked kids to be kind to each other. Some kids are turning to drugs and alcohol to numb the pain and we are seeing a significant number of accidental overdosages resulting in teenagers’ deaths. We assume they were accidents, they could also be suicides staged to look like accidents. Also suicide has recently been moved from the third leading cause of death for kids 10 to 18 years old to the second leading cause of death for kids. Therefore, if kids have been commuting suicide to escape bullying, the rate of bullying has most likely increased significantly.

Bullying is not just an elementary school issue. It occurs in High School and College too. A few years back a college student committed suicide because his roommate secretly filmed him in his dorm room with another guy having sex. When the tape was posted on the college’s email for others to see, the boy was so ashamed because he had not made it publicly known that he was gay. He was so upset and humiliated that he ended up committing suicide.

As the rates for bullying in middle schools increase so do the number of suicides and drug use increase. However, this issue also occurs in elementary school and elementary students are committing suicide or starting to use alcohol and marijuana. We know it is a very serious problem in Elementary schools because suicide it is no longer the third leading cause of death for 10 year old children. Suicide is now the second leading cause according to the CDC statistics. Also fifth graders are beginning to use alcohol and marijuana.

Additionally, I am seeing more and more elementary students in therapy because they are being bullied on line or at school as schools reopen. Many of these children are embarrassed because they feel they should be able to stop the bullying. They are also embarrassed and often don’t want me to tell their parents because they believe they must of done something to deserve being bullied. I explain to them they do not deserve it and they should not have to stop it on their own. I also explain that their parents would want to know so they can help them. I need to emphasize that Mom and Dad won’t blame you or be ashamed of you. It is amazing to see how relaxed these children become when I tell them this about their parents.

What should a parent do? One thing is parents should watch for the following warning signs that your child is a victim of a bully:

Avoiding activities they used to enjoy

Loss of friends or avoiding social situations

Problems sleeping

Complaining of stomachaches or headaches

Loss of appetite

Declining grades

Missing or damaged clothing or belongings

Self-destructive behaviors like running away from home

If you notice any of these or just have a sense something is wrong then talk to your child. However, when you talk to your child reassure them they did nothing wrong, there is nothing wrong with them and you are not upset or disappointed with them. Try to develop a game plan of how you are going to deal with it together and ask how you can be supportive. Also ask your child to promise you if they feel really sad like they want to hurt themselves that they will talk to you before they do anything. You may think this is ridiculous, but I use a no suicide contract with many children that I work with and they honor it. The contract lets them you know that you care about them and it is okay to talk about their feelings.

The other thing you can do as a parent is go to your child’s school and ask what is the school’s policy on bullying. You can also ask how the school watches for bullying, how is the policy enforced and what is being done to prevent bullying. You may ask the school to contact or you can volunteer to contact a group such as Challenge Day. This is an international organization that addresses bullying and they are located in Concord, California. I have seen their work and it is fantastic and kids love it.

Another thing you can do as a parent is start talking to your child about bullying on an occasional basis. This gives you a chance to let them know it’s not their fault and to develop a plan of action if it does occur. You should also discuss drugs and alcohol at the same time. I work with kids all day long and at times I am still shocked at how young kids are when they are starting to get involved with drugs and alcohol.

Keeping an open line of communication with your child is very important if you want them to come to you. Research still indicates that children are more likely to turn to their friends when they have a problem. This is good that they have this emotional support, but their friends don’t have the answers or solutions that they need. Remember it is best to speak to your child when you are in a calm environment and no one else, such as brothers or sisters, are around. Also remember the word HALT. It stands for:

Hungry

Angry

Lonely

Tired

If you sense your child is experiencing any of these feelings it is not a good time to talk. When you talk with your child you want it to be productive and for your child to feel like they are not being judged. Therefore, sometimes it is better to put off a conversation so you don’t end up in an argument. This is more likely to close the line of communication with your child.

I have mentioned several times that being bullied is not their fault. What I have seen from working with children who are bullies, abusive men and reviewing the research is that bullies really have very low self-esteem. In fact many times they lack a sense of themselves. The only way the feel important or alive is by putting someone else down. They do this because they are afraid the other kids might be able to figure out how lousy they feel about themselves. It is often said the best defense is a good offense. They hope that by acting like the big guy on campus that other people will see them as the big guy and they are able to keep their secret. Kids usually do this because it was done to them too.

Therefore, we need to remember the bully is usually a kid who has been abused too and is crying out for help. If we are going to stop the problem of bullying we need programs to help the bullies too. They are only repeating what they have been taught.

One last comment, I saw a school install a “buddy bench.” If anyone had been bullied, having a bad day, feeling lonely, all they had to do was sit on the buddy bench. Another student or teacher would then go over and ask how they could help. There was no shame associated if you sat on the buddy bench. It was presented as a brave choice. The school was using it as part of their program to stop bullying at school. This fantastic idea came from a 10 year old student. Children often have fantastic answers and we need to listen.

Dr. Michael Rubino specializes in working with children and teenagers. He has over 20 years experience working with children and teens especially those who are victims of trauma. For more information about Dr. Rubino’s work or private practice visit his website at http://www.rubinocounseling.com or his Facebook page at facebook.com/drrubino3 or his podcasts on Spotify or Apple.

What We All Need to do to Fix a Divided Nation

What We All Need to do to Fix a Divided Nation

Unfortunately we are living in a divided nation and people are getting hurt or killed due to their beliefs or the color of their skin. For example, people are getting attacked because they are asking customers to wear masks in their stores. In addition, Asian Americans are getting attacked and killed just walking down the streets because they are Asian. There are people who are blaming Asian Americans for the Coronavirus. We also continue to have African Americans being shot by police officers. All of these incidents are creating a divided nation. It has become so bad that people stormed the United States Capital building and were trying to over turn the results of the 2020 election.

We are living in a country where many people are afraid to go outside because they might be attacked. Additionally, in public people are being rude to each other and no one feels safe. This feeling is severally impacting children and teenagers.

Prior to all of this hate, children and teenagers were reporting increased depression and anxiety. Since the beginning of 2021, more children and teenagers are reporting depression and anxiety. The number of teenagers dying from drug overdoses and suicide continues to rise (CDC). Some teenagers are taking things into their own hands and are carrying guns and knifes so they can protect themselves or others. Remember the teenager who went from Iowa to Minnesota with a gun and killed two people during the riots. He felt he had a responsibility to stop the chaos. Teenagers should not have to stop the chaos occurring in the United States. This is placing too much pressure on them resulting in teenagers feeling depressed and anxious and seeing no future for themselves.

The United States is supposed to be the “great melting pot.” The Statue of Liberty says, “Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore.” We are all supposed to be equal and live together in a Country where we can be ourselves and have a chance at making a decent life for our families. However, we are losing that dream quickly especially if we allow those who are spreading hate and lies to continue to spread hate and lies.

The Harlem Globetrotters developed an anti-bullying program for school children in order to stop bullying. The United States belongs to everyone who is a citizen. Yes there are people who are not citizens, but according to the saying on the Statue of Liberty, we still need to treat them with respect and dignity because they are fellow human beings. Therefore, we are all in this together and we all have to fix the problems together. Or, would we prefer that the children continue to live in an environment which is creating depression and anxiety for them and causing thousands of children to commit suicide every year. We are talking about children as young as 8 years old who are committing suicide and the number of children committing suicide is increasing every year (CDC).

The Harlem Globetrotters program is not that hard. All you have to do is remember is A, B, C. A is for action, B is for bravery and C is for compassion. To make it easier let’s use an example, if you see an Asian American being attacked on the street, (B) be brave and don’t ignore it, (A) act by calling the police with your cellphone and screaming for help, (C) stay around and show the person some compassion asking if they need anything or reporting what you witnessed to the police. We can do this, we have done it before. This is exactly what happened in the George Floyd case and by everyone working together a bad police officer is now off the streets. If we had not acted together, that officer would still be on the streets chocking people.

If adults are willing to take action, we can teach children and teenagers the same A,B,Cs and if they see their parents and grandparents getting involved they will follow your example. Additionally, if they see adults working together for the common good, maybe we may see a reduction in the number of teenagers feeling depressed and anxious. If that occurs we would most likely see a decrease in the number of teenagers cutting and overdosing on drugs. We would also see a reduction in the number of teenagers and children committing suicide because they would feel a sense of hope for their futures.

Finally, if we all work together we would be worthy of what is inscribed in the Statue of Liberty. We also would stop being a joke to the world. We are the United States, the most powerful nation in the world! However, how can we say that if we allow stereotypes and racism to decide how we treat each other?

Dr. Rubino is a psychotherapist with over 20 years experience treating children and teenagers. If you would like to learn more about his work visit his website at www.RubinoCounseling.com or his Facebook page at www.Facebook.com/drrubino3 or his podcasts on Spotify or Apple.

Teenagers Continue to Experience Vicariously Trauma Daily

Teenagers Continue to Experience Vicariously Trauma Daily

Many people tend to assume only people who were directly exposed to a trauma will experience issues related to the trauma and may develop Post Traumatic Stress Disorder (PTSD). However, this is not the truth. Many people may not have lived through the trauma, but they may know someone who did or they were exposed to very explicit images of the trauma or have been hearing about the trauma a lot on the news. It may also trigger memories of a trauma they experienced in their lives or in their family. This can cause what is referred to as vicarious trauma. Vicarious trauma is when someone is traumatized by an event but they did not experience the event themselves. Simply knowing about or hearing about the event is traumatizing to them. This is happening to many children and families in the United States. However, when are we going to pay attention to the way children in the United States are being traumatized over and over?

If this sounds confusing, let’s look at what children and teenagers have been dealing with and living through the last few years. This last year teenagers and children have been living with the trauma of the Coronavirus. Their schools were closed without warning and so were the sports and other after school activities stopped suddenly. In addition they were not able to hang out with friends and had to go to school remotely.

In addition to these changes, many children and teenagers had family members they could no longer see, such as grandparents and many had family members who died due to the Coronavirus. However, they were not able to attend funeral services and say goodbye. Over 525,000 Americans died to the Coronavirus. All of those people had family members and friends who are grieving for them still. A fact we tend to overlook. However, children and teenagers are dealing with it daily especially if they lost a parent, grandparents or a sibling.

While children and teenagers are still dealing with how poorly the Pandemic was handled by the government, now many are being told we are reopening states including schools. Therefore, they no longer have to deal with remote school now they will be back in their classrooms. This brings up anxiety about how school will be because they still need to be cautious so they don’t contract the Coronavirus. Many children and teenagers have told me they are very worried about being exposed to the Coronavirus or their parents being exposed to the Coronavirus.

In addition to the Coronavirus, children and teenagers now have to worry again about mass shootings. We just started opening the Country and already there have been two mass shootings. This brings up the anxiety and vicarious trauma children have been exposed to regarding school shootings for years. They have been increasing every year since 2010 (CDC) and in 2019 by November there had been 336 mass shootings averaging out to a mass shooting every 1.2 days (Gun Violence Archive). These are overwhelming statistics for adults and we are expecting children and teenagers to cope with them. The students know there have been no changes to the gun laws. Therefore, they are having to return to school and worry about mass school shootings.

Look at what they are returning to when they return to school. Today in most United States schools, the classroom doors are kept lock while class is in session and no one can enter a school campus without checking in with the main office and they must wear an identification badge while on campus. In fact, all school employees must wear official school identification badges while at work. Many elementary students noticed these changes and have asked why the door must be locked? Students are told it is for their safety. The school is preventing any people who do not belong at the school from getting near the students. No one mentions someone with a gun, but children have heard about and remember all the mass shootings and they know why the door needs to be locked. I have many elementary students mention this to me during their therapy sessions.

Now when we were in school we had fire alarm drills in case there ever was a fire in the school. No one thought much about them. Some students felt the fire alarm was too loud but no one really worried about a fire happening at school. We never worried about it because we never heard about any school fires and people dying.

Today students face more than fire alarm drills. Schools routinely have active shooter drills. During these drills students are taught to shelter in place and to remain very quiet so the shooter will not enter their room. Therefore, besides having heard about and remembering mass school shootings, school students know they are returning to a place where they could be killed. They know they are practicing what to do in case there is a shooter at their school trying to kill them. Therefore, they worry about could a shooting happen at their school and could they die. As a result of these fears, the CDC has documented that anxiety disorders and depression had significantly increasing in children since school shootings increased and they have documented a further increase in anxiety and depression due to the Coronavirus.

To add to the trauma students now face, if there is an incident, such as a bank robbery, involving someone with a gun near a school, the police put the school on lock down. The students must shelter in place and they don’t know if the person with the gun will come to their school or not. This creates a significant amount of anxiety for children and many are traumatized by the incident. Here is another incident causing trauma for children and teenagers. How many do we expect them to cope with at their ages? When will we provide mental health care for the children, teenagers, their parents, the school staff and the first responders? All of these people are being exposed to trauma regarding the Coronavirus and mass shootings on a regular basis. This creates traumatic reactions and exacerbates old traumatic reactions.

Another issue which adds to this trauma is gun control. Since the shooting in Florida many students have been actively campaigning for sane gun control. However, nothing has been done to enact sane gun control laws. High school students know nothing is being done and elementary children are hearing nothing is being done about guns. This makes them worry because they know guns are still out there that can be used to kill them. The shooting which occurred in New Zealand cause high school and elementary students to wonder why our Country does nothing about gun control. Our government has done nothing even though students and parents are demanding safe gun laws. While our government debates the issue, more students were killed and may be killed. Just look at the two mass shooting this past week. However, New Zealand in a matter of 3 weeks after a shooting banned all assault weapons. This makes students wonder why we have not done anything when we have a bigger problem with mass shootings. Also it doesn’t make them feel safe at school because they do not feel like a priority. Some people will say children and teenagers are not aware of such issues. However, remember with their Smartphones they have instant access to the news and this generation of teenagers are politically active.

Working with teenagers and children I have seen that anxiety and trauma reactions have

increased significantly for children. Also children are afraid of returning to school because they might be killed. These are responses to the mass shootings. Every time there is a mass shooting children become more anxious and afraid. We had two mass shootings this last week and as I am writing this article another mass shooting is occurring in the Florida Keys. We have just started to open the Country and we already have had 3 mass shootings. This will exacerbate previous traumatic reactions and create new ones. We are expecting children and teenagers to cope with the Coronavirus and mass shootings at the same time. For those children and teenagers not directly effected by the virus or shootings, they still have to cope with the issues which results in vicarious trauma.

Furthermore, if we want to reduce the vicarious trauma children and teenagers experience, we must be honest and not lie to children and teenagers. Remember, they have their smartphones phones and easy access to news and videos clips of the news. The best example is when the US Capital building was attacked by people trying to prevent President Biden from winning the Presidential Election. There have been Republican Congressmen and Senators saying they were safe and down playing the event. However, police were killed and injured and people were chanting “hang Pence”. To me that doesn’t sound safe. Additionally, despite the video showing these protesters breaking windows, spraying police with pepper spay and beating officers with flag poles, the former President Trump went on television saying the protesters were hugging the police, waving hello and walking calmly into the Capital. This type of blatant lie causes teenagers not to trust authority figures because they may be lying and it can cause them to second guess what they saw in the video. This creates a situation where teenagers do not know who to trust and this exacerbates their fear and traumatic reactions because they feel they have no one to trust. Children and teenagers need the truth in age appropriate terms. The truth is easier to handle than their emotions.

Summing up, children and teenagers in the United States have been traumatized and vicariously traumatized by mass shootings and the Coronavirus. As we start to open up the Country, they continue to have to deal with the Coronavirus and mass shootings. Therefore, they continue to be traumatized and vicariously traumatized. Many will need psychotherapy to help them with these issues. The American Association of Children and Adolescent Psychiatry has put out the following guidelines. If you notice any of these signs or symptoms in your child or teenager it explains how to start to talk to your child or teenager and how to find the appropriate psychotherapist for your child. It is important to get a therapist who specializes in anxiety disorders and trauma issues http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Talking-To-Children-About-Terrorism-And-War-087.aspx.

One final aspect about vicarious trauma that has emerged regarding mass shootings and the Coronavirus is suicide. Family members and survivors of mass shootings are feeling survivors guilt and as a result committing suicide. There was a report of 3 people who committed suicide who either survived a mass shooting or their child died in one. This has been occurring for a long time. It has been occurring since Columbine. Family members feel they can no longer cope with the pain. Survivors can’t cope with the guilt of surviving. Family and friends of some one who was killed or injured in a mass school shooting have had their lives changed forever! People, family members and first responders, especially hospital workers dealing with the Coronavirus are also committing suicide. They are dealing with depression, anxiety and trauma reactions on a daily basis. However, we do not have adequate mental health resources to help these people. Also people assume after a few months, most people may be grieving but can handle their situation. This is not true. They are experience anxiety and trauma that for many of them is very confusing. This only increases the anxiety and trauma. The children experiencing the shooter drills are also confused by their anxiety and traumatic reactions. They do not know what to do and this causes isolation and the feelings increase.

We must eliminate the stigma associated with mental health issues. We also need to make sure that anyone who is even remotely exposed to a mass shooting (including first responders and emergency room physicians) or anyone who has had to deal with the Coronavirus have access to mental health care. Not just for a month or two but for as long as they need psychotherapy and they should be able to receive the therapy without worrying about the cost.

We have a generation of children growing up with anxiety and traumatic reactions. If we don’t help them now, they will only get worse as time goes on. May be we need to take a lesson from New Zealand and how they responded to a mass shooting. They banned assault weapons after one shooting. We have been having shootings for 20 years and have done nothing, why? We have a great deal of information about the Coronavirus and we are arguing about wearing masks. Why?

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers and specializes in treating trauma. For more information about his work or private practice visit his website www.RubinoCounseling.com or his Facebook page www.Facebook.com/drrubino3 or his podcasts on Spotify or Apple.

Teenagers Respond Better to Discipline

Teenagers Respond Better to Discipline

As a psychotherapist who works with children and adolescents, I often hear how their parents are too strict and unfair. Many children and adolescents feel their parents punishments are not appropriate and their parents are out of touch with today’s world. I also hear parents tell me no matter what rules or punishments they impose that their children refuse to follow the rules. While this disagreement has been going on for many, many years, I would imagine with the Coronavirus and teenagers doing school remotely and not able to spend time with friends that the argument has become unbearable for some families by this time.

From my experience, one of the major issues in this situation is the difference between discipline and punishment. Many people may feel there is no difference between the two concepts. However, there is a major difference between the two terms. The difference can determine how many arguments you and your teenager have regarding the issue.

Discipline is used to teach a child or teenager about rules and life. Punishments are used to tell a child or teenager they did something wrong such as breaking a house rule. However, punishments often have no association to the broken rule and often make a child feel like they are bad and they often don’t know which rule they broke. Punishments do not teach they only make a child feel bad or angry. For example, if it was the child’s turn to take out the garbage and they forgot and played their video game online with friends. Discipline would be having them take out the garbage and clean the dinner table for a week and they could not play their online game. A punishment would be that they were grounded and had to stay in their room for two weeks without any electronics. What connection does the grounding have to forgetting to take out the garbage?

Research has shown that discipline is a more effective way to teach children\teenagers about rules and appropriate behavior. The discipline needs to have some association with the rule that was broken. A punishment which tends to make a child think they are bad and has no association to the rule they broke typically teaches a child nothing. What it typically does is make a child feel like they are a bad person and they often don’t understand why they are being punished. All punishment tends to teach some children and teenagers is that they are worthless and they feel unlovable.

I had a fourth grader ask to come to therapy because they were tired of getting in trouble at home. They felt like they were a bad person and he had no idea why he was doing bad things at home on a regular basis. Therefore, the punishments taught him nothing except it did lower his self-esteem. Research also has shown that children and teenagers who feel they are bad people are more likely not to graduate high school and to get involved with drugs and alcohol. They feel they are bad so they feel they should be doing things associated with “bad kids.” They give up trying because they don’t believe anyone will see them as a lovable person who is worth something.

As I stated discipline has been shown to be more effective with children and teenagers. However, before a parent imposes discipline there are important steps for the parent to take:

1. First, the parent needs to let the child\teenager know that they love them and that the child\teen is not bad, but they made a mistake.

2. The parent needs to explain to the child when they made a mistake and what was the mistake. Additionally, emphasizing to the child that they are not the mistake, their choice was a mistake.

3. Explain that they are imposing the discipline to help the child learn from their mistake and hopefully they won’t make the same mistake again.

4. Let the child know when the discipline starts and ends. Also do not make it too long or severe. It should be in proportion to the mistake. It should also needs to be age appropriate.

5. Finally, ask the child if they understand and if they have any questions.

One thing that makes disciplining a child or teenager easier is having a behavior contract. It is important that parents sit down with their child or teenager and develop a behavior contract regarding house rules and expectations a parent has for them and consequences if the child violates the contract. Therefore, if your child makes a mistake, the consequence is already known because it is in the contract. Therefore, it is less likely that the child will feel like a bad person or confused about the consequences because everyone in the family agreed to them. This also makes it easier the mistake was the choice they made not them.

I recommend contracts on a regular basis. The contracts help reinforce the discipline and that choices have consequences. Therefore, the parent is teaching a child to think before they act. Thereby, significantly decreasing the odds that they will make a bad choice. It can also help a child deal with peer pressure because you have already discussed what you feel is appropriate and inappropriate. A contract also help to reduce arguments at home. If everyone agrees to the contract and a teenager violates the contract they cannot blame Mom and Dad for the consequences. Mom and Dad are only enforcing the agreed upon contract. The teenager needs to take responsibility for their choice.

Dr. Michael Rubino is a psychotherapist with 20 years experience treating children and teenagers. For more information about Dr. Michael Rubino’s work visit his website at www.RubinoCounseling.com or his Facebook page www.Facebook.com/drrubino3 or his podcasts on Spotify or Apple.

Looking at the Issue of Teenagers Cutting

Looking at the Issue of Teenagers Cutting

Today’s teenagers are under a great deal pressure. In fact, according to the CDC, 1 out of every teenager has a diagnosable mental health issue. In addition, depression, anxiety, drug overdoses and suicide are currently at epidemic rates for teenagers. In fact, suicide was the third leading cause of death for teenagers and now it is the second leading cause of death (CDC). Furthermore, cutting or self-harming behaviors are also at epidemic rates for teenagers (CDC). Self-harming behaviors include teenagers cutting themselves with knives or scissors in addition to scratching themselves severely and sometimes teenagers may even use erasers to erase their skin and cause sores. These are only a few examples.

Ten years ago if I asked a teenager if they were cutting or had ever cut, once in a while I would get an answer of yes. Today when you ask teenagers about cutting most teenagers answer yes. In fact, it’s no longer just teenagers. Children as young as 8 or 10 years old often respond yes to this question. This is alarming, but it is evidence of the amount of emotional pressure these kids have to deal with today.

When you ask a teenager about cutting behavior, they usually respond it was easier to deal with the physical pain than the emotional turmoil they were dealing with inside. Others will say the cutting takes their mind off of the emotional situation and others even say it makes them feel human. So as you can see there are numerous reasons, but teenagers are also very embarrassed and ashamed about the cutting behavior. If I am treating a teen who is engaging in cutting I must be very sensitive and non-judgmental about the behavior if I’m going to help. In addition, the family needs to be non-judgmental as well. Teenagers do not cut for the attention and as I stated above they are embarrassed about their behavior. If they sense that someone is viewing them in a negative way, they will not talk about it. Additionally, teenagers who are engaged in cutting hide their cuts so no one will know about their behavior.

Therefore, when treating or dealing with a teenager who is cutting you need to be patient and non-judgmental. Remember they are resorting to this behavior because it is the only way they are able to deal with the emotions they are feeling and the situations they are facing. Life today can be very overwhelming and often teenagers are not prepared for what they have to face in life and they are embarrassed to ask for help too. Often they are embarrassed because our society looks down on people dealing with mental health issues. I recently had a 13 year old ask me, why don’t we place more emphasis on mental health so people can get the help when they need it? A very good question to ask. Our society has a very strong negative stereotype regarding mental health and therapy. As a result, it is very difficult for teenagers to ask for and receive the mental health care they need.

After being treated for cutting, many teenagers are still embarrassed and feel awkward about their past behavior. Many times teenagers are left with scars on their bodies from cutting. Most families cannot afford plastic surgery and insurance will not cover it, even though it is a mental health need and in my opinion should be covered. The point is many teenagers continue to feel embarrassed and ashamed of the scars years after they have stopped cutting. Below is a blog from a teenager who discusses how they feel about their scars and people’s reactions. It also may help give you some insight to what teenagers are going through these days and how many of them are feeling overwhelmed by life. Instead of ignoring their cries for help we need to figure out how we can help them without making them feel embarrassed or crazy.

My self-harm scars are “hideous.” I’m covered in them. Head to toe. No amount of time, no amount of fading will make them unnoticeable. That doesn’t mean I hate them. It doesn’t mean I’m embarrassed by them. I am aware that they make other people uncomfortable and there are times, when out of respect for others, I will cover them. There are other times when I won’t cover them. Whether I choose to cover them or not, I don’t feel that I should have to explain my choice. If I choose to cover them, it doesn’t mean I’m ashamed or feel forced to cover them. If I choose not to cover them, it doesn’t mean I want attention.

I regularly see people comment on social media saying, “If you make a public post people have the right to say whatever they want.” Apparently this entitles people to be nasty and judgmental. It excuses them from filtering what they say and think. It exempts them from extending basic decency and courtesy to others.

I’ve heard the same said about people who walk around with self-harm scars exposed. No. Just because you can see my scars doesn’t give you a free pass to say what you want. You don’t get to say, “You’re too pretty for that.” You don’t get to say, “You’re too smart for that.” It doesn’t matter whether you know me or not. They are my scars from my battles. Even if you know me, I can guarantee you won’t know all about my battles. You won’t know my darkest moments or thoughts. If you’re a stranger? What could you possibly think you know about my life? You don’t get a say on what my scars look like. You don’t get a say on whether or not I’m too pretty, too smart or too strong for that. You don’t get a say on whether or not I cover them.

Yes, you can see them. Yes, they are “hideous.” Look away. Walk away. Think about it by all means. Talk to someone else about it. If you’re game, educate yourself on it. Take responsibility for what you are doing. Take responsibility for what you are saying. Yes, you can see my scars but that doesn’t make me responsible for your reaction.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. In addition, he specializes in treating victims of trauma and first responders. For more information about his work or private practice visit his website at www.RubinoCounseling.com or his Facebook page at www.Facebook.com/drrubino3 or his podcasts on Spotify or Apple.

Three Years After the Park Side Shootings and What has Changed?

Three Years After the Park Side Shootings and What has Changed?

Today, February 14, 2021, will mark the three year anniversary of the at the high school in Parkside, Florida. On that day 17 people were killed and 17 people were injured. The lives of these students, teachers and staff and families were changed forever. Additionally, the lives of the first responders, paramedics and police, were also changed forever. A family never fully recovers from the death of a child. Furthermore, these statistics do not account for how many students at the school, teachers and family members are suffering from grief and Post Traumatic Disorder. Remember, this is Valentines Day and students and families were expecting a day of fun not a day of horror that has changed them for life.

Additionally, this year will be the nine year anniversary of the tragic shooting at the Sandy Hook Elementary school where many children and adults where senselessly killed. Again the students and families’ lives were changed forever on that day. Since the Sandy Hook shooting more than 500,000 people in the United States have been killed by senseless gun violence. This means over 500,000 families have been changed forever and we have no idea how many children and adults continue to suffer with PTSD. The research shows people associated with these shootings do suffer from PTSD afterwards and many survivors have committed suicide (CDC).

In reviewing the subject of school shootings, I read an article by Cody Fenwick regarding children and gun violence. His article was very alarming. Since it is the three year anniversary of the Park Side shooting and the nine year anniversary of the Sandy Hook shooting, Fenwick’s article about children and guns is very important. His article also outlines a strong connection to guns and the senseless shootings and to the alarming numbers of teenagers who commit suicide with a gun. The article by, Fenwick, confirmed what I am hearing from teenagers and children in psychotherapy. Additionally, other school shootings, such as the one in Nashville, or the shootings in the Synagogue in Pennsylvania or in the Texas Church, confirm the need for gun control. A point the statistics in Fenwick’s article support.

Many of us feel because we live in Pleasant Hill, Walnut Creek or Lafayette that our children and teenagers do not have to worry about gangs or gun violence. Unfortunately, this is not the truth. According to a new research study in the Journal of Pediatrics, guns continue to be the third-leading cause of death for Americans younger than 18 years old, killing around 1,300 children and teenagers a year in the United States. In addition, almost 6,000 children and teenagers are injured per year by guns. Many teenagers are permanently disabled from these gun injuries too.

The study examined data from the Centers for Disease Control and Prevention and the Consumer Product Safety Commission between 2002 and 2014. The study found that boys, especially older boys such as teenagers and minorities, were much more likely to be the victims of gun violence. The study did not say anything about where the boys lived. The facts are children who are male and teenagers, are at a higher risk for becoming a victim of gun violence. Therefore, teenagers in our area are at risk of becoming a victim of gun violence.

The study does indicate there has been a decrease in accidental deaths such as boys cleaning a gun. However, the rate as a method for suicide has increased. I have mentioned before in other articles that suicide is the third leading cause of death for 10 year old boys. However, since the article was published, the CDC states that suicide is the second leading case of death for children 10 to 18 years old. This study confirms that the preferred method of suicide for boys and teenagers are guns. According to Katherine Fowler, one of the lead researchers at the CDC, “Firearm injuries are an important public health problem, contributing substantially to premature death and disability of children.” Understanding their nature [guns] and impact is a first step toward prevention.”

When we look at these numbers, can anyone argue against taking steps to protect our children? Can you imagine a 10 year old boy using a gun to kill himself? Can you imagine a 10 year old boy feeling that his life is so bad at the age of ten that death seems like a better option than living?

The study indicates that in recent years guns were responsible for a large number of adolescent, males who were murdered. The study documented that deaths in the category of murder for boys under the age of 18 years old decreased to 53 percent. This is a decrease yet the rate is still 53%. The other causes of gun-related deaths include:

• 38 percent — suicides

• 6 percent — unintentional deaths

• 3 percent — law enforcement/undetermined cause

The study found 82% of those killed due to a gun were boys. This means 82% of gun deaths were boys who were children or teenagers. Putting it another way, this means these boys were not even 18 years old yet at the time of their deaths. The study also found that white and American Indian children have the highest rate of suicide using a gun.

We also like to think that the United States in one of the most advanced nations in the world. However, the statistics show that the United States has the highest rate in the world for children under 14 years old committing suicide. Again, the United States has the highest rate of children under 14 years old using a gun to commit suicide. That number scares me and is appalling to me. However, as an adolescent and child psychotherapist, I do not doubt it. I have heard 6 year old boys seriously discussing suicide.

Furthermore, I hear teenagers routinely talking about needing to carry a knife or gun with them for protection. They tell me you never know when you will be jumped and you need to be able to protect yourself. In fact, a few years ago a teenager was shot on his front door step in Danville over a marijuana deal. When I mention to teens the risks they are taking by caring knives or guns, the boys tell me there is no guarantee they will live until 30 years old. They would rather die protecting themselves than doing nothing. Violence in our society has become so severe that many teenagers do not expect to live to the age of 30. Think about that fact.

As a society, we need to look at these numbers and ask ourselves some questions. What are we going to do in order to improve gun safety? Most importantly, why are children as young as 6 years old thinking about suicide? Also what are we going to do so that children who are suicidal have access to mental health care? This is our problem because it does happen in Pleasant Hill, Walnut Creek and Lafayette.

The students at the high school in Park Side and the parents from Sunny Hook have marched and petitioned for sane gun control laws. Senators and former President Trump both promised to improve laws so children would be safe going to school. They are becoming angry and discouraged and how can you blame them? It is now 3 years after Park Side and 9 years after Sandy Hook, but there have been no changes. These students and families have been marching, holding rallies and speaking to Congressmen and Senators who have promised changes. However, nothing has happened so far. How long do these students and families need to wait for sane gun laws. Also, why should children and families believe us when we say we will keep them safe?

Dr. Rubino has 20 years experience as a psychotherapist working with children and teenagers. For more information about his work or private practice visit his website at www.RubinoCounseling.com or his Facebook page www.facebook.com/drrubino3 or his podcasts on Spotify or Apple.

The Toll the Pandemic is Taking on Teenagers’ Mental Health

The Toll the Pandemic is Taking on Teenagers’ Mental Health

The pandemic has reached a frightening point and a point where many teenagers feel the Coronavirus will never end. Over 475,000 Americans have died from the coronavirus and daily there are approximately 3,000 Americans dying from the Coronavirus. In addition we are discovering new stains of the Coronavirus and we race to get everyone vaccinated. We are starting to see a drop in the number of people being hospitalized, but all of this may be temporary according to the CDC. The CDC is warning if we do not wear masks on a regular basis and continue to social distance, the numbers will start to increase again.

Today’s teenagers have access to all this information via their smartphones. News updates pop up on their phones and once again their see that nothing in their lives is stable yet. It will be a while before we return to anything looking like normal life.

As a result, teenagers are losing hope and wondering what type of life they will be living. Teenagers have had their lives turned upside down and they are feeling overwhelmed and very stressed about how their lives have changed. Many college students and high school students are continuing to have to attend school remotely. Additionally, events such as sports, the prom and graduation ceremonies have already been cancelled for this school year. The high school experience they have heard about and have been waiting for no longer exists. Many teenagers are feeling depressed and angry about how their lives have changed. Furthermore, they have no control over the situation and have no idea what to expect from life.

Prior to the pandemic depression and anxiety rates were increasing for teenagers (CDC). Additionally, the suicide rate for teenagers had gone from the third leading cause of death to the second leading cause of death for teenagers. Since the Pandemic has started teenagers have had to shelter in place for months, attend school remotely and have not been able to hang out with their friends. This has caused depression and anxiety to reach epidemic levels for teenagers (CDC). The number of teenagers cutting (self-mutilating behavior) have increased significantly because they feel out of control and are having significant difficulties processing all the feelings they are experiencing. Also suicide rates and drug overdoses have increased in teenagers. Again because they feel helpless and are having significant difficulties processing their emotions. Suicide and drug overdoses have increased so much that there are now numbers in communities that teenagers can text for help if they are feeling suicidal or severely depressed.

Furthermore, besides their school experience changing significantly and not being able to hang out with friends, many are living in families who are worrying about paying the rent or having enough money for food. Unemployment is at a record high so many teenagers are living in a family where both parents have lost their jobs. This is a huge amount of stress for a child or teen to experience and have to cope with daily. Additionally, many of these teenagers are coming from families who never had to worry about money before. Having to stand in a line for food daily is something they thought only occurred in third world countries, they never thought it occurred in the United States or could ever happen to their family.

As a result, many teenagers are struggling with severe mental health issues due to the Coronavirus. As a result, the Mayo Clinic has been studying the impact that the virus and quarantine have on us and our mental health. Here is what they found and their recommendations:

Stress is a normal psychological and physical reaction to the demands of life. Everyone reacts differently to difficult situations, and it’s normal to feel stress and worry during a crisis. But multiple challenges daily, such as the effects of the COVID-19 pandemic, can push you beyond your ability to cope.

Many people may have mental health concerns, such as symptoms of anxiety and depression during this time. And feelings may change over time.

Despite your best efforts, you may find yourself feeling helpless, sad, angry, irritable, hopeless, anxious or afraid. You may have trouble concentrating on typical tasks, changes in appetite, body aches and pains, or difficulty sleeping or you may struggle to face routine chores.

When these signs and symptoms last for several days in a row, make you miserable and cause problems in your daily life so that you find it hard to carry out normal responsibilities, it’s time to ask for help.

Get help when you need it

Hoping mental health problems such as anxiety or depression will go away on their own can lead to worsening symptoms. If you have concerns or if you experience worsening of mental health symptoms, ask for help when you need it, and be upfront about how you’re doing. To get help you may want to:

• Call or use social media to contact a close friend or loved one — even though it may be hard to talk about your feelings.

• Contact a minister, spiritual leader or someone in your faith community.

• Contact your employee assistance program, if your employer has one, and get counseling or ask for a referral to a mental health professional.

• Call your primary care provider or mental health professional to ask about appointment options to talk about your anxiety or depression and get advice and guidance. Some may provide the option of phone, video or online appointments.

• Contact organizations such as the National Alliance on Mental Illness (NAMI) or the Substance Abuse and Mental Health Services Administration (SAMHSA) for help and guidance.

If you’re feeling suicidal or thinking of hurting yourself, seek help. Contact your primary care provider or a mental health professional. Or call a suicide hotline. In the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or use its webchat at suicidepreventionlifeline.org/chat.

Continue your self-care strategies

You can expect your current strong feelings to fade when the pandemic is over, but stress won’t disappear from your life when the health crisis of COVID-19 ends. Continue these self-care practices to take care of your mental health and increase your ability to cope with life’s ongoing challenges.

In addition to the facts above, people who have had the virus have been reporting feeling anxious and depressed. They have also reported the virus has impaired their ability to make decisions. This is being referred to as “the long haul syndrome.”The bottom line is the virus is creating mental health issues for those dealing with the quarantine, first responders, medical personnel and people with the virus. We are focusing on getting the virus under control which we must do. However, as we struggle to get control of the virus, we also need to address the mental health issues created by this pandemic. At this point, we have no idea how many will need mental health care and for how long. Therefore, as we focus on finding a cure, we may want to start to prepare for the mental health issues which are occurring and will after the quarantine.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating trauma victims and teenagers. For more information about his work or his private practice visit his website www.RubinoCounseling.com or his Facebook page www.Facebook.com/drrubino3 or his podcasts on Spotify or Apple.

The Pressure Teenagers Face to be Sexually Active

The Pressure Teenagers Face to be Sexually Active

It’s Valentine’s Weekend and a major issue for many teenagers is if they have a boyfriend or girlfriend. Having a girlfriend or boyfriend is very important to many teenagers. Often teenagers feel defective if they do not have a girlfriend or boyfriend. Many people are familiar with this line, “you complete me,” from the movie, Jerry McGuire, starring Tom Cruise. A deaf couple signs this message to each other in an elevator and Tom Cruise’s character assumes they must really be in love. However, this may not be the reality. In reality it may be an unhealthy relationship.

As a psychotherapist with over 20 years experience treating couples and teenagers, I have observed a common mistake that many people make regarding relationships and love. Many people tell me they feel an emptiness inside themselves and describe it as a “big empty hole.” They assume that a relationship will fill this emptiness. In other words, they are relying on their partner to eliminate the empty feeling they are experiencing.

This is a mistake. The only person that can fill that emptiness you feel is you. When I work with couples or an individual who is experiencing this emptiness, they usually are upset with their partner. They are upset because their partner is not filling the emptiness. Also the other partner is frustrated because they are tired of having to constantly reassure their partner. They report they are tired of always having to worry about meeting their partner needs and that their needs are constantly being pushed aside.

This type of pattern is very common in relationships where there is domestic violence or a substance abuse problem. Also jealousy is a major issue in these relationships. The person who is experiencing the emptiness is very sensitive to feeling rejected or abandoned. This is usually a result from childhood issues that have never been addressed. However, as an adult, if they sense these feelings in their relationship they tend to over react to them. The person may drink excessively to reduce their fears and men often result to verbal or physical abuse. Anything that will keep their partner in the relationship and continue to fill the empty space.

This tends to occur because as we grow up there is a great deal of pressure for people to be in relationships. You see this in children in first grade or kindergarten when adults jokingly ask children if they have a boyfriend or girlfriend. If a child doesn’t they often feel there is something wrong with them.

I see this issue a lot with teenagers. I have teenagers who feel they are defective because they never had a girlfriend or boyfriend. This defective feeling increases significantly, if the teenager never has been on a date. They believe if they are going to be a “normal” teenager, they must at least be dating. Boys tend to believe they must be sexually active too in order to be normal. I have had teenagers tell me they felt suicidal or were using drugs because they did not have a girlfriend or boyfriend. They are willing to risk their lives using drugs or believe they are better off dead, if they don’t have a girlfriend or boyfriend. They are so tied up trying to live the stereotype, they can’t believe that many teenagers do not have a girlfriend or boyfriend and do not date in High School.

This pattern continues into adulthood. Many women feel defective if they are 30 years old and not married. Men feel as if they are not men if they do not have a girlfriend. Both men and women often settle for anyone as long as they can say they are in a relationship.

As children, we never learn how to love and care for ourselves. Ask someone if they would go out to dinner by themselves and most people look terrified by the idea. They have no idea what they would do and they are afraid about what other people with think. This is a sad state that we cannot love ourselves. If we always need someone to reinforce we are lovable, we turn our power over to strangers. If someone says something nice about us we feel good, if they say something hurtful, we feel unworthy as a person. But, why should someone else determine our value? We should be the one who judges if we are lovable or not. A relationship should add to our life like a bottle of wine adds to a meal. A relationship should not define us as a person.

As a result of this problem, many couples end up divorcing because a partner is tired of having to reassure their spouse daily. I have seen these divorces become very nasty and costly. So both parties are hurt even more and so are the children. They only people benefiting are the attorneys.

We also have this same issue with teenagers. However, when they break up it tends to be more dramatic. A teenager may start to use drugs, develop an eating disorder, start cutting, become depressed and may attempt suicide. The behaviors are not uncommon after teenagers break up.

We see this acting out behavior more in teenagers and children. Teenagers and children are desperate to feel that they are loved by their parents especially. If they don’t feel they are loved, there is a tendency to act out. Disney’s movie, Frozen, has a segment where the trolls explain that if someone doesn’t feel loved they may act out in pain or make poor decisions in an attempt to find love. Oprah, during her last show, had a very good way of expressing this need. She stated, “everyone wants to know: ‘Do you see me? Do you hear me? Does what I say mean anything to you.” The program Challenge Day, which Oprah recommends, states what teens are looking for this way: every teenager wants to feel safe, loved and celebrated. I see it every day, when teens don’t feel loved, they act out. Negative attention is better than no attention.

How do we handle this issue? We need to start to acknowledge as a society that a relationship doesn’t make you a complete person. Only you can make yourself feel complete as a person. Also we need to remove the stigma of seeking mental health care. We need to encourage adults who feel incomplete without a relationship to seek psychotherapy and deal with their issues. Parents, if you notice that your teenager is desperate to be in a relationship, help them get psychotherapy so they can deal with the pain they are feeling. Remember this emptiness feeling typically begins in childhood. Therefore, if we show children and teens that they are loved or get them help when they are acting out, we can prevent them from dealing with this emptiness for years.

Again, please remember a relationship should add to your life, it should not make you a person or define you as a person.

Dr. Michael Rubino has over 20 years experience working with families and teenagers. If you would like more information about his work or private practice visit his website at www.rubinocounseling.com or his Facebook page www.Facebook.com/drrubino3 or listen to his podcasts on Spotify or Apple.