Alabama Department of
Child Abuse and Neglect Prevention
Children’s Trust Fund of Alabama

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Alabama Department of
Child Abuse and Neglect Prevention
Children’s Trust Fund of Alabama

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Stigma

It is time to talk about something tough—help.  How many times have you ever lamented if only so-and-so had gotten help we may have avoided a tragedy?  Less seriously, we may kick ourselves for failing to ask our teacher about extra credit too late in the semester.  Or what about the time we thought we could carry all the groceries into the house in one trip only to stumble our way to a mashed loaf of bread and broken carton of eggs?  It is amazing how hard it can be to find help or ask for it when we find it…in the helping profession.

When I started out in the helping profession, I had my share of judgments about clients who cannot meet their children’s most basic needs or abused illegal substances knowingly.  How could someone let their financial situation get so bad that they are evicted?  Why did they wait so long for help?  Why would someone knowingly engage in an illegal activity that could endanger their children at the same time?  That was the first wall that came down for me.

Let’s consider the following concern facing our children today.  Suicide ranks as the third leading cause of death among children ages 6 to 18 years old in the United States from 1999 to 2015—25,055 suicides compared to 26,741 homicides (Centers for Disease Control and Prevention, 2017).  However, children ages 9 to 14 years old were more likely to die by suicide than homicide during that same period.  Instead of asking, “Why did those kids not ask for help?” or opining, “Those deaths were avoidable,” we need to start asking how we can encourage others to ask for help.

Why does preventing the avoidable seem so impossible? Adolescents with suicidal ideation associate with lower levels of help-seeking in general (Carlton & Deane, 2010; Evans, Hawton, & Rodham, 2005; Wilson, Deane, & Ciarrochi, 2005; Wilson, Deane, Marshall, & Dalley, 2010). Additionally, adolescents who reportedly attempted suicide are less likely to receive help from any source (Cotter et al., 2015; Wyman et al., 2008).  If they decide to disclose these feelings, children are more likely to inform a friend or schoolmate regarding their suicidal ideation than a trusted or responsible adult (Pisani et al, 2012).  When these peers learn about their friend’s suicidal ideation, it is unlikely they will encourage a suicidal peer to notify a parent or to report to an adult themselves (Gould et al., 2004).  Though adolescents may seek help, they often seek help from sources who are unprepared, unable, or unwilling to link them with appropriate interventions.

At least anecdotally, this seems consistent with our expectations for children.  Socially, we share our lives with our peers because we may be too emotionally immature to identify an appropriate adult.  But we share it with another peer who may be too emotionally immature to handle the gravity of the situation.  Additionally, children may fear retaliation and judgment from adults.  Moskos, Olson, Halbern, and Gray (2007) found surviving family and friends of adolescents who committed suicide in Utah believed suicidal youth felt mental illness was a “weakness” and the belief that nothing would help.  This notion of preserving honor from the disgrace of admitting weakness is a sentiment echoed among parents in Southern states. Brown, Moreover, Gould et al. (2006) found that the most seriously impaired of their surveyed adolescents held greater beliefs of self-reliance.

There are several ways to help someone struggling with mental health issues especially suicidal ideation.  The National Alliance on Mental Illness suggests creating open, honest dialogue about mental illness and treatment and empowering others to obtain help (Greenstein, 2017).  Educational programs for parents of children with suicidal ideation can focus on managing parental expectations for their child’s mental illness and the treatment process (Olin et. al, 2010).  Community programs while not designed to address mental illness can nonetheless help parents cope with the additional social and financial demands of navigating the mental health system.

While parents’ frustrations about the mental health system may seem trivial in the grand scheme, it is important to consider how agency policies may unnecessarily convolute service delivery.  Some agencies have extensive waiting lists.  Parents may be unable to send their child to treatment consistently due to transportation or work issues.  Fees for services may be difficult.  Medicaid may have lapsed.  As a support system to families, it is important to see how a gap can be filled.  Simple advocacy on behalf of the client can build that therapeutic alliance between the agency and client and successful link them to needed services.

that social connections are a key ingredient to preventing abuse and neglect. Advancing human connection is not easy in an increasingly social media driven age.  Our kids seem more interested in their “apps” and less interested in face-to-face interaction.  Dialogue and repartee are now replaced by emojis and acronyms.  Gifs are now used to describe our complex emotional state and physical situation.  The Child Mind Institute connects increased social media use by adolescents with interferes with development of social skills to make friends and maintain relationships, lowers self-esteem, and increases anxiety (Ehmke, n.d.).  Parents should limit social media use and engage with their child about their own well-being.  Many grantees work through rebuilding the parent-child relationship.  Removing the smart phone from the conversation could be a means to moving the needle in the right direction.

The Child Mind Institute is an excellent resource for families and grantees as it stores many different resources for parents and educators.  Grantees should develop relationships with mental health providers and become aware of each resources limitations and business practices.  Sending a new client to a provider on a day they are not seeing new patients could create tension and reduce their chances of getting help.  You can reach out to the school systems regarding any protocols they may have for suicidal behavior.  If the school system does not have a policy, you should ask how one can be developed or introduce a protocol from another school system. Suicide crisis lines can be accessed at the following web address:  http://www.alabamapublichealth.gov/suicide/crisis-numbers.html.  Lastly, explore how you can help build connections for clients in the community so they do not feel like they are living in the margins of their own life story.

John Richards, MSW

 

References: 

Brown, R. P., Imura, M., & Mayeux, L. (2014). Honor and the stigma of mental healthcare. Personality And Social Psychology Bulletin40(9), 1119-1131. doi:10.1177/0146167214536741

Carlton, P., & Deane, F.P. (2010). Impact of attitudes and suicidal ideation on adolescents’ intentions to seek professional psychological help. Journal of Adolescence, 23(1), 35-45. http://dx.doi.org/10.1006/jado.1999.0299

Centers for Disease Control and Prevention. (2017). [data table of 10 leading causes of death United States, 1999-2015, all races, both sexes]. Web-based Injury Statistics Query System.   Retrieved from https://www.cdc.gov/injury/wisqars/fatal.html

Cotter, P., Kaess, M., Corcoran, P., Parzer, P., Brunner, R., Keeley, H., & … Wasserman, D. (2015). Help-seeking behaviour following school-based screening for current suicidality among European adolescents. Social Psychiatry And Psychiatric Epidemiology, 50(6), 973-982. doi:10.1007/s00127-015-1016-3

Ehmke, R. (n.d.). How using social media affects teenagers. Retrieved March 30, 2018 from https://childmind.org/article/how-using-social-media-affects-teenagers/

Evans, E., Hawton, K., & Rodham, K. (2005). In what ways are adolescents who engage in self-harm or experience thoughts of self-harm different in terms of help-seeking, communication and coping strategies? Journal Of Adolescence, 28(4), 573-587. doi:10.1016/j.adolescence.2004.11.001

Gould, M. S., Velting, D., Kleinman, M., Lucas, C., Thomas, J. G., & Chung, M. (2004). Teenagers’ Attitudes About Coping Strategies and Help-Seeking Behavior for Suicidality. Journal Of The American Academy Of Child & Adolescent Psychiatry, 43(9), 1124-1133. doi:10.1097/01.chi.0000132811.06547.31

Greenstein, L. (2017, October 11).  9 Ways to Fight Mental Stigma. https://www.nami.org/blogs/nami-blog/october-2017/9-ways-to-fight-mental-health-stigma

Hari, J. (2015, June). Johann Hari: Everything you think you know about addiction is wrong [Video file]. Retrieved from https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

Moskos, M. A., Olson, L., Halbern, S. R., & Gray, D. (2007). Utah youth suicide study: Barriers to mental health treatment for adolescents. Suicide And Life-Threatening Behavior, 37(2), 179-186. doi:10.1521/suli.2007.37.2.179

Olin, S. S., Hoagwood, K. E., Rodriguez, J., Ramos, B., Burton, G., Penn, M., & … Jensen, P. S. (2010). The application of behavior change theory to family-based services: Improving parent empowerment in children’s mental health. Journal Of Child And Family Studies19(4), 462-470. doi:10.1007/s10826-009-9317-3

Pisani, A. R., Schmeelk-Cone, K., Gunzler, D., Petrova, M., Goldston, D. B., Tu, X., & Wyman, P. A. (2012). Associations between suicidal high school students’ help-seeking and their attitudes and perceptions of social environment. Journal Of Youth And Adolescence, 41(10), 1312-1324. doi:10.1007/s10964-012-9766-7

Wilson, C. J., Deane, F. P., & Ciarrochi, J. (2005). Can hopelessness and adolescents’ beliefs and attitudes about seeking help account for help negation?. Journal Of Clinical Psychology, 61(12), 1525-1539. doi:10.1002/jclp.20206

Wyman, P.A., Brown, C.H., Inman, J., Cross, W., Schmeelk-Cone, K., Guo, J., et al. (2008). Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. Journal of Consulting and Clinical Psychology, 76(1), 104–115 http://dx.doi.org/10.1037/0022-006X.76.1.104.