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

Yes, You can Take Your IEP to College

Yes, You can Take Your IEP to College

Working with children and adolescents I have had many parents ask about 504 plans and Individual Educational Plans (IEP). Parents tend to focus on the assistance their child may need in elementary or high school due to a learning disability or mental health issues. Working over 20 years as a psychotherapist, what I have observed is that children who need assistance in elementary and high school typically need assistance in college. However, many students are not aware that they are entitled to assistance in College too. Now that schools and colleges are reopening many college students are planning on returning to campus and high school seniors who are graduating are preparing to leave for college. Parents are trying to anticipate what their child will need at college, such as laptops etc. However, do not forget their Individual Educational Plan (IEP) so they can arrange for accommodations at their college.

From my experience, most families assume there is no assistance in college. However, typically if a child has an IEP, they are also entitled to assistance in college. Most colleges in their Counseling departments have people and programs designated to help disabled students. A student with a physical or learning disability or mental health issue such as ADHD or depression would qualify for assistance by the Disabled Students Program at a college. I have recently been receiving many questions from Parents about what happens to their child’s IEP when the go to college and questions from parents who have college freshmen asking about their child’s IEP. Therefore, I thought it would be beneficial to provide information about how IEPs are handled by colleges. In addition to an IEP, any student with a learning disability or mental health issue is entitled to accommodations by their college because they are covered by the Americans with Disabilities Act of 1991.

Additionally, if you live in California and you have a physical or learning disability or a mental health issue and if you had or did not have an IEP while in school, you may qualify to be a client of the California Department of Rehabilitation. This Department is responsible for assisting people in California, with a disability, find a job and get the education they may need to find a job. The Department may assist their clients by providing tuition assistance for community or state colleges and provide financial assistance to buy text books and school supplies. What they are able to do depends on the State budget.

This is another reason for parents to insist when their child does need an IEP that the school district places the child on an IEP. The lies schools tell parents that an IEP will prevent their child from getting into a college, the military or getting a job are not true. Another reason to insist on the IEP, if your child qualifies for an IEP, as a result of having an IEP, your child can be granted accommodations on the SAT or ACT. These are tests seniors typically need to take when they are applying to four year universities. The common accommodation most students require is additional time to complete the tests. I have had many teens with ADHD come to me seeking accommodations on the SAT or ACT. A common requirement that the testing boards require is that a student needs to have had an IEP if they are seeking accommodations on these tests.

Therefore, many students who have disabilities or mental health issues can receive assistance in college. While many people may be surprised, it is true. However, for many college students finding the assistance can be confusing and overwhelming. For a Freshman in college, dealing with heath or mental health issues, the confusion and embarrassment the feel at times because of society’s stereotypes can cause students to give up. The best place for a college freshman to start is the student counseling center. They can then direct them to the correct department and they can avoid some of the embarrassment and confusion.

Also I was contacted by bettercollege.com with a resource guide they developed for college students with mental health issues. While their guide was created for students with mental health issues, it can also be used as a guide for students with physical or learning disabilities. This guide can help a student not feel so overwhelmed or embarrassed too.

Since I feel this is a valuable guide to Freshman students and their families, I am including a link to this resource guide below:

Guide to College Planning for Psychiatrically Impaired Students – https://www.bestcolleges.com/resources/college-planning-with-psychiatric-disabilities/

Dr. Michael Rubino is a psychotherapist with over 20 years experience working with children, teenagers and college students. For more information about Dr. Rubino’s work and private practice visit one of his web sites www.RubinoCounseling.com or www.rcs-ca.com or his Facebook page www.Facebook.com/drrubino3.

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.

Is it stress or a mental health issue?

Is it stress or a mental health issue?

With all the stress teens have in their lives now, how do parents determine the difference between stress and a mental health issue and the need for therapy? Stress Response or Mental Health Disorder? How to Tell the Difference https://www.healthgrades.com/right-care/mental-health-and-behavior/stress-response-or-mental-health-disorder-how-to-tell-the-difference

The Pandemic has Exacerbated Teenage Camouflaging Behavior

The Pandemic has Exacerbated Teenage Camouflaging Behavior

There is a behavior that is becoming common in teenage and tween girls that has been identified by an adolescent psychologist who specializes in treating teenage girls. The behavior that has been identified is called “Camouflaging.” This behavior left unidentified can lead to low self-esteem, depression, cutting, abusive relationships etc. It is becoming very common in teenagers right now. When I was a guest co-host on the Street Solider Radio Show on KMEL, and the teens were talking about how they change the beliefs and how they change how they dress because they are afraid of being rejected by their friends is Camouflaging. Covering up their outside person so no one can identify the true person inside. Friends are a very important issue for teenagers right now. Remember due to the Coronavirus most teenagers have not had contact with their friends in over a year. Many teens are worried about how their friends have changed over the year and are afraid of losing their friends.

Therefore, Camouflaging is when an adolescent girl changes how she looks in terms of make up and how she dresses, her opinions and things about herself she is willing to deny or things she will start doing in order to be accepted by her friends. The real problem occurs when the girl is changing so much about herself or does it for so long that she forgets or losses track of her real self. Besides changing how she feels, she may forget her core beliefs and do things she doesn’t believe in.

While this behavior has been identified in girls and the research appears correct, I believe this behavior applies to boys too.

Many adolescent boys change the way they dress, their beliefs and the way they act to be accepted by their friends. I hear many of these boys telling me in therapy that they feel lost. They tell me they no longer have an idea of who they really are or believe in or feel. These boys often turn to alcohol, drugs, sex and cutting. They usually turn to these behaviors to numb out their lost feeling or to try to remember their real selves. Often they turn to these in order to forget the shame and guilt they have due to something they did in order to fit in with their friends.

As a result, many teens start acting like someone they are not just to be accepted. This fear of not being accepted and forgetting their real self because they has been covering their true self up for so long or denying their true feelings for so long can result in boys and girls having low self-esteem and/or feeling depressed. It can also result in girls or boys getting involved in emotionally or physically abusive relationships because they don’t feel they are entitled to anything more. They no longer love themselves so how could anyone else love them.

As I stated this behavior can result in low self-esteem and depression in addition to behaviors as cutting, eating disorders, drug use, becoming sexually active etc. Often boys and girls cut just so they can feel as I stated above. The constant denying of their emotions or values can cause boys and girls to lose a sense of their true feelings. Therefore, cutting can occur so boys and girls feel or can cope with denying themselves. Denying their feeling or who they are can result in boys and girls feeling very confused or lost. Therefore, they look for behaviors that help them remember who they are or will numb out the list and confused feelings. They also seek behaviors that help them deal with changing their beliefs. Again this can trigger eating disorders, drug abuse or other self-destructive behaviors. This helps numb out the confusion and disappear of denying their feeling and trying to forget their true self. This can cause feelings of depression and anxiety too.

What should parents look for in their teens? If your son or daughter tries to stop wearing his or her glasses or if he or she all of a sudden changes how he or she dresses or acts these are possible warning signs. Another change could be not doing as well in their classes because they are afraid of looking too smart. Basically, if you see signs indicating that your teenager is trying to deny who they are so they will be accepted by others. It’s more than the common issue of trying to be accepted by friends, they are forgetting themselves and beliefs to fit in.

While it is normal for teenagers to make changes in their attitudes or how they dress, we are talking about something that goes far beyond normal self-expression. We are referring to changes where a teenager is trying to deny who they are because they feel they are unacceptable.

This is what we are talking about. If teenagers are changing their hair or how they dress as a way to express themselves that is normal teenage behavior. However, if teenagers are doing it just to fit in and they end up losing a sense of their true self this is camouflaging.

As I stated, Camouflaging results in depression or low self-esteem because the teenager is forgetting their true self. If they are doing it as a way of trying to experiment with their self expression, the teenager is happy and confident as stated above. This is the main point to understand. Experimenting with their dress and beliefs etc. is normal for teens and helps teenagers identify themselves, however denying or camouflaging their feelings results in teens losing themselves and many behavior problems. This is the main thing for parents to watch for in their adolescents behavior.

If you go onto Yahoo and look up Camouflaging you will find a segment on Good Morning America about Camouflaging. In fact, here is the link to the GMA segment https://gma.yahoo.com/video/parents-worry-tween-teen-camouflaging-122935763.html?soc_src=copy. Also if parents look at the February issue of Teen Vogue, you will find an article about Camouflaging.

Dr Michael Rubino has over 20 years experience working with teenagers and their families. Dr Rubino is considered an expert psychotherapist in the treatment of teens. For more information about Dr Rubino and his private practice visit his website at www.rcs-ca.com, www.RubinoCounseling.com or www.RubinoCounseling.com or his Facebook page at 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.

Teenagers are Using ADHD Medications to get High

Teenagers are Using ADHD Medications to get High

Working with teenagers, I often have parents who are concerned about their teenager using marijuana or alcohol. Besides the concern that their teenager may be using drugs or alcohol, they are concerned about their teenager becoming addicted. Besides marijuana and alcohol, parents are concerned about methamphetamines and heroin. Currently there is an epidemic of teenagers addicted to methamphetamine, heroin and opioids in the United States (CDC). While parents worry about opioids, methamphetamines and heroin addiction in teenagers, there is another drug parents need to be concerned about. Parents need to be concerned about the drugs children and teenagers take for Attention Deficit Hyperactivity Disorder (ADHD).

Methamphetamine is a very popular drug because it is easy to get and there are a number of ways to use it. Also many teenagers like the effect that they receive from methamphetamine. They get an adrenal rush and can stay up for days at times. Therefore, it makes it easier for them to get all their work done. Many teenagers are involved with numerous school activities, trying to maintain a good grade point average and want to spend time with their friends. They often find out that they don’t have enough energy to keep up with their schedule. The boost they receive from the methamphetamine helps them keep up and get everything done. However, buying methamphetamines can be a dangerous thing to do and if they are caught with methamphetamines, they are in a lot of trouble.

Many teenagers do not want to run the risk of being caught with or buying methamphetamines. Therefore, teenagers have found away around the risk, medications for Attention Deficit Hyperactivity Disorder (ADHD). Most medications for ADHD such as Ritalin or Concerta are stimulant based. In other words, they contain a form of methamphetamine. Therefore, if a high school student who does not have ADHD takes Concerta, they experience the same effect as if they took methamphetamine such as cocaine. They get a burst of energy and can stay up all night so they can finish their work.

During finals, I hear many teenagers talk about taking Concerta or other ADHD drugs so they have the energy to study. Some teenagers will tell their parents they are having difficulties concentrating hoping their parents will take them to the physician so they can get a prescription for ADHD medication. On the other hand, teenagers who are suppose to be taking medication for ADHD often sell their medication. They can sell it very easily to friends at school and they can make good money too. Many of these teenagers feel they don’t need their medication so they are happy to sell it.

The buying and selling of ADHD medications on high school campuses is a daily occurrence. Most research studies indicate it starts in 8th grade and continues in high school. Many teenagers rely on ADHD medications to help them when they feel they are falling behind in school. Many teenagers see no problem using the ADHD medications because they were prescribed by a doctor. However, they were not prescribed to them. Therefore, the dosage they are taking may be too much for their body. Also I have seen teenagers combine these medications with energy drinks which have very large amounts of caffeine. I have had teenagers report they felt like their heart was going to come out of the chest because it was beating so fast. In addition, they also report not being able to sleep for days because they are wired.

This is a major danger when teenagers use ADHD medications to stay awake. They can become wired the same way as if they used cocaine or smoked methamphetamine. Also taking these ADHD medications opens the door to teenagers experimenting with such drugs as cocaine. They like the effect of the ADHD medication and wonder how other drugs may feel or may be they can no longer get the ADHD medication so they start experimenting. In fact, research indicates that teenagers who abuse ADHD medication are more likely to use methamphetamine or heroin.

In addition to opening the door to other drugs, they are risking their health and life. If they heart rate is racing and their blood pressure is rising they can induce a heart attack. Also parents may notice there is something wrong, but if they do not know their teenager has been taking ADHD medication, there is no way for a parent to tell a physician. Therefore, the teenager may not get the medical help they need. In addition to the physical symptoms, using too much methamphetamine can cause psychotic symptoms and the teenager may need to be hospitalized. The bottom line is just because the ADHD medication came from a pharmacy does not make it safe for everyone. I have included a link for parents which discusses the dangers and symptoms that parents need to be aware of regarding teenagers abusing ADHD medications https://drugabuse.com/library/adderall-abuse/#effects-of-adderall-abuse.

Hopefully, parents can take this information and discuss the situation with their teenagers. Encourage them that if they are feeling overwhelmed by school and life to talk to you not to turn to a drug. A drug will never solve the problem and more likely create more problems. Also let your teenager know all you expect is the best they can do naturally. You do not expect perfection.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers and children. He is a founding member of the National Advisory board for the Alive and Free program. For more information regarding Dr. Rubino’s work or private practice visit his website www.RubinoCounseling.com or his Facebook page www.Facebook.com/drrubino3.