Mental Health Resources for Adolescents
The topic of today’s rant, er, blog is something that’s been on my mind for many months: the availability of mental health hospital beds – actually, the unavailability of mental health hospital beds.
Yes, I know, in general, mental health resources across the board are insufficient. But, I want to focus here on critical care, and even more narrowly, on critical mental health care for adolescents.
The feds say there are approximately 42 million adolescents in the U.S. Up to .28% of them, that’s almost 118,000 children between the ages of 13 and 18, have early-onset schizophrenia. According to the National Institute of Mental Health, approximately 2.6% of adolescents experience severe impairment from bipolar disorder. That’s more than a million children age 13-18. A study completed in 2019 estimated that 18.8% of adolescents contemplate suicide, with 8.9% of them attempting it, due to depression. That’s almost eight million kids who contemplate it, and almost four million who attempt it. (It’s probably worse: It is generally accepted that the pandemic has increased the incidence of suicidal depression in all age groups.) Granted, many of those children may overlap with the children diagnosed with bipolar disorder. The UNC Health Center in North Carolina estimates that nationwide, approximately 100,000 adolescents experience unspecified psychosis.
Okay, let’s assume that at any given time 5% of the adolescents with mental health issues will experience crisis so dire as to require inpatient treatment. That’s 260,900 mental health beds needed for adolescents. How many total mental health beds are there in the U.S.? Well, in state-run facilities there are fewer than 40,000. I was unable to find a number on private facilities, but all the information out there indicates that it’s certainly not 230,000. Even if it were, most of those beds are filled with adult mental health patients.
Critical mental health care in the U.S. is a disaster, but, in my opinion, the worst impact of that particular disaster is upon the adolescents needing care and their families. The impacts, in order of severity, are:
- Death – of the child or someone else
- Serious injury – to the child or someone else
- Destruction of the family
- Incarceration of the child
- Drug abuse
- Financial calamity
In my opinion, the parents of adolescents with significant mental health issues additionally suffer immeasurable impacts when they are unable to acquire critical care for their children. Oftentimes, the adolescent may be as large or larger physically than their parent(s). If the child is out of control, the potential physical threat exacerbates raw emotions, increasing the likelihood of tragic outcomes. The parents’ fear of their child is not only for themselves, but for other family members and the community, as well. The stress level is out the roof, leading to mental and emotional crises within the family as well as the mentally ill child. In addition, parents face stigmas as being the parents of “that child,” and hear, directly and indirectly, uninformed criticisms of their performance as parents. “If he’d been present in his kid’s life instead of running around, this wouldn’t be going on.” “If she’d made him behave when he was younger, he wouldn’t be so out of control now.” “They’re just trying to put her away so that they don’t have to deal with their child anymore.”
Perhaps even worse, because these people with mental health issues are legally minors, the parents can be held legally accountable for their actions. It puts parents in untenable positions and destroys families. Years ago, when I worked for a social services agency, I saw situations where one child in a family acted out due to mental health issues, and social services removed all the children from the home, essentially accusing the parents of failing to keep the children safe. All the children, and the parents too, were irreparably harmed as a result.
Families wait weeks, and in some instances, months to get their child the care they need. Sometimes because the treatment the child needs is unavailable, the child is shuffled off to generalized alternative care placements euphemistically referred to as “group homes” where physical, emotional, and sexual abuse by other adolescents occurs. NO ONE is helped by such haphazard placement, and at-risk children are substantially harmed.
What’s the answer? I wish I had a magic solution to offer. As with nearly everything, money is part of the answer. But, just indiscriminately throwing money at this problem will not address it. There needs to be comprehensive planning involving input from mental health experts, child development experts, parents, and adults who, as adolescents, were recipients of mental health services. And, there needs to be adequate follow-up care to help prevent the need for repeated crisis care.
Clearly, the mental asylums of the previous centuries are not an option, but adequate beds for adolescents in mental health crisis must be made available. Not knowing what else to do, I wrote to my legislative representatives. I received very nice form emails in response. Perhaps if more people wrote to their representatives about this failure to serve the children, the response would be more, well, responsive. Perhaps.
Book Review: Inherited by Cathleen Maza
Inherited by Cathleen Maza traces an inherited psychic gift through a family from the 1700s to the present day. The gift is only passed down to female family members who receive it when the previous holder passes away. Elise McGregor and her older sister Sarah were primed to receive the gift from their Aunt Ronnie. Sarah eagerly hoped to receive it; Elise didn’t want it. They were both disappointed.
Sarah aids her sister with research and moral support, and Elise makes the best of the situation, doing what’s expected of her, until she runs into a particularly malevolent spirit. Spirits cannot kill, she’s been told, but her experience with that particular spirit shows her that they can influence situations so that unwary people do die. After that experience, Elise decides to hide away in an apartment above Sarah’s garage, which is spirit free.
Still trying to help her sister, Sarah arranges a chance meeting with an eligible young man, and as Sarah had expected, sparks fly. Fast forward a couple of years, and Elise has married Mike, they have an infant, and they’re living in Mike’s spirit-free home – or rather his almost spirit-free home. There are some “sprites” that Sarah and Elise hypothesize are unborn children. Then one day, a dark spirit, as strong or stronger than the one that had turned Elise from her inherited responsibility, invades their home. To get her family and her life back, Elise, with the help of Sarah, must learn who the dark spirit is.
Cathleen Maza has delivered another wonderfully written tale in Inherited. The brief glimpses into life during earlier time periods and other countries were colorful and set the scene for what occurs in present-day Michigan. Clever and subtle foreshadowing is resolved in a very satisfying series of plot twists toward the end. Some minor editing issues, but not enough that it seriously detracts from the story. I wholeheartedly recommend this book to anyone who loves a bit of a ghost story!
Short Story: You Get What You Pay For
Don saw him pull into the lot. The truck was distinctive with its custom orange fleck paint, chrome package and backlit running boards. He remembered it and its owner vividly.
He hadn’t been the one to deal with the guy the last time he came in for a sunroof estimate, but he’d heard enough to know he was a jerk. That designation was confirmed when he pulled up to the service bay and honked his horn when the door didn’t immediately open.
But, Don greeted him with a smile after he pulled the truck in and stepped out. Actually, the guy in his wannabe Wranglers had to jump out because of his stumpy legs. Don thought to himself, “What is it with little guys and overblown lift kits?”
Aloud, he said, “What can I do ya for today?”
The man looked Don over, from his grey hair needing a cut, down his paint speckled overalls, to the paint paper booties covering his shoes. Then, he brusquely answered, “Where’s the manager, Tim? I always deal with him.”
Don crossed his arms and said, “Vacation.”
The man pursed his lips and grunted. He looked at Don. Don looked at him. Finally, the man said, “My sunroof is leaking.”
Grinning, Don replied, “That truck doesn’t come with a sunroof. Confucius say man who cut hole in roof gets wet.”
“Are you some sort of funny guy? I don’t have time for jokes. Can you fix it or not??
“I’ll be glad to take a look.,” Don said. “Let’s step over to the desk and writecha up.”
“I just told you I don’t have time. Can you just fucking look at it without all the bullshit?”
The friendly smile froze on Don’s face. He could’ve taken a quick look, but this guy — Don was pretty sure his name was Mitchell — had just used up everything in Don’s goodwill bucket. In a take-it-or-leave-it tone, he said, “No sir, I cannot touch your vehicle without you signing an authorization.”
Without a word, Mitchell stomped his little feet in their drugstore cowboy boots – red and black — over to the service desk. Don followed behind, and wordlessly signed into the terminal. He asked the guy his name (indeed, it was Mitchell), address, phone number and vehicle year, make and model. Then, he printed out the work order and slid it silently across the countertop for Mitchell’s signature. Mitchell scribbled something that might’ve been his name; it could just as well have been Martian curse words. Don didn’t know and didn’t care.
“Okey dokey,” Don said. Motioning to the doorway to his right, he continued, “If you’ll just have a seat in the waiting room. . .”
“Absafuckinglutely not,” Mitchell said. “I’m not gonna have you take my truck somewhere and make the problem worse. I’m staying with the truck.”
Don wanted to quote his grandaddy and say to the younger, much shorter man, “You are really chappin’ my ass, you little peckerhead.” But, he didn’t. Instead, he said, “Sure, suit yourself. But that means the inspection will have to happen here, and that means you’ll have to help me do it, because our technicians only work in the shop.” It was complete hogwash intended to further irritate the insufferable little jackass. It worked.
“Why should I have to help you do your job?” Mitchell spat back.
“It’s not my job,” Don responded.
Mitchell waited futilely for Don to continue. Finally, grasping that Don wasn’t going to offer any more, he asked, “What do you mean it’s not your job?”
“I’m sorry, but I don’t really know how else to tell you that assessing your leak and estimating what it’ll cost to fix is not my job.”
“If you can’t do it, why the fuck am I even talking to you?”
Don’s eyes narrowed, but his tone was even when he replied, “I never said I couldn’t do it – just that it’s not my job.”
Tiring of the game, Don said, as if speaking to a child, “You have choices. One choice is that you can let us take the truck back to where the technicians will evaluate it. The other choice is that you stay with the truck, I do the assessment and estimate here, and you help me.”
“Or, the third choice is that I fucking leave,” Mitchell snapped.
“You’re right,” was Don’s even reply.
Mitchell glared at Don. Don looked back at him.
“That’s all you’re going to say?” Mitchell demanded.
“What else would you have me say? You’re very right: you do have three choices.”
“Goddamn it,” Mitchell said. “How do I need to help you?”
Don clenched his teeth, and then raised a finger and said, “You wait here – I’ll be right back.”
He returned a few minutes later carrying a five-gallon bucket full of water. He set it down before Mitchell, and said, “Okay I’m going to get inside the truck and make sure the sunroof is fully closed, and then you’ll slowly pour water around the edges of the sunroof.”
Mitchell looked at him dubiously and said, “Are we really going to need five fucking gallons of water for that?”
Don took a deep breath. Then, he said, “Probably not. But better to have too much than not enough. Now, don’t just dump it – pour it slowly all around the edge of the sunroof.”
He looked at the bucket and then pointedly back at Mitchell. He held up a finger again, walked around them both to the back of the truck, and lowered the tailgate. Then he hurried back, picked up the bucket and said, “Here, I’ll put this up in the bed for you.”
After he put the bucket in the truck without spilling a drop, he turned to Mitchell and said, “Okay, hop on up there, and we’ll get this thing done.” He made a show of having a concerned frown play across his face. “”Uhm, do you need a stepladder?”
Mitchell exploded, “No, I don’t need a fucking stepladder!”
He strode to the back of the pickup, put his left hand on the tailgate and attempted to jump in. He ended up in a quasi-reclining position on the tailgate, and in scrambling to his feet, he kicked the bucket, jostling water into the truck bed.
Don turned away and choked down the guffaw welling up inside him before Mitchell got to his feet. He didn’t really need water poured onto the sunroof to assess the problem. But, he was so going to enjoy watching that little buffoon try to hoist that bucket and carefully pour the water. He climbed up into the cab and yelled back to Mitchell, “Okay, I’m all set in here – start pouring the water – carefully.” He turn and watched out the rear window as Mitchell picked up the bucket. “No way he can lift that above the cab,” he thought to himself.
As Don watched, Mitchell lifted the bucket by its handle with both hands. When he got it about chest high, he stood like that for an interminable moment. Don assumed he was trying to figure out how he put an arm around the bucket without dropping it. Don was right because suddenly Mitchell let go of the handle with his left hand and tried to catch the bucket’s body before his right hand dropped it entirely. He was mostly successful, but in the course of catching the bucket, he sloshed water all over himself.
Don chuckled to himself and thought, “Uh oh, those precious boots got wet.” Aloud he yelled, “You okay back there?” In response, he heard a string of obscenities.
“I’ll take that as a yes,” Don said and chuckled again. More loudly he said, “Okay start pouring the water slowly along the edges of the sunroof.”
Even with the water that had soaked into Mitchell’s clothes, Don figured the bucket was still heavy enough that it would be impossible for a man of Mitchell’s size to have any control of how the water poured out. He was right. As Mitchell lifted and tipped the bucket, a wave of water splashed on the pickup’s roof and ran down the windshield. It also flowed backward onto Mitchell as he leaned against the cab for stability.
“That wasn’t what I had in mind,” Don yelled at Mitchell. “In order for me to pinpoint exactly where the leak is, you need to pour the water slowly around the edge of the sunroof.”
“Goddamn it!” was Mitchell’s reply. But, he picked up the bucket and tried again. And again. By the time the bucket was empty, it was raining inside the cab – Don stepped out – and Mitchell was soaked to the skin. He threw the empty bucket down and walked to the tailgate. Then, with his right hand on the bed wall, he attempted to jump down. He would’ve been fine except that it turned out that his precious boots were slicker than snot when wet. As soon as his feet hit the smooth concrete, they flew out from underneath him, and as he went down, the gold link bracelet on his arm cut a scratch marking the path of his fall into the paint of the rear quarter panel.
Mitchell littered the air with expletives as he got himself up (he refused Don’s hand), and caught sight of the scratch in the quarter panel. Don stood silently, waiting for Mitchell’s verbal fit to subside.
Finally, Mitchell growled, “So did you fucking figure out what’s wrong?”
Don treated Mitchell to a sardonic smile, “Yes, you have a very leaky sunroof,” he said.
“Still the funny guy. I fucking knew that before I came in here. What’s wrong with it?”
Don continued smiling, “Well for starters, the sunroof itself is crap quality. But the leak is because the people you had install it cut the hole too big. They tried to rectify that problem by putting the gasket in upside down, but that just guaranteed it would leak.”
“Can you pull it out and flip the gasket?”
Don replied, “I could, but I won’t. It might stop leaking for a while, but like I said the hole’s too big, and I can’t believe you haven’t noticed this: it wasn’t even cut plumb with the cab. The driver side is at least an inch closer to the windshield. And, like I said, the sunroof itself is crap. We won’t touch it. I’d suggest you take it back to where you had it installed.”
Mitchell rolled his eyes.
Don nodded, “I’m guessing they told you that the price they gave you offered no warranty on workmanship, and you’d have to prove the sunroof was defective.”
Mitchell didn’t indicate whether Don’s guess was right. But it was confirmed when he asked, “Can you put a new sunroof in?”
Don smiled his sardonic grin again and replied, “I absolutely could get you outfitted with a high-quality sunroof, correctly installed.” He pointed to the service desk. “Do you want me to write you up a detailed estimate?”
Mitchell snapped, “Just fucking ballpark it for me.”
Don looked to the ceiling for a moment, and then looked Mitchel directly in the eye. “Ballpark, I’d say $13,400.”
The small man’s eyes bulged. “What the ever-loving fuck? That’s more than $10,000 more than what you’d estimated to fucking put one in before!”
Don nodded understandingly, “Yeah, yeah it is because now we have to replace the roof and match the color to the rest of the truck, and that color’s not cheap. Plus, there’s the blue surcharge that currently sits at $1300.”
Arms waving furiously, Mitchell yelled, “What the fuck is a blue surcharge?”
“It’s $100 for every time you’ve dropped the f-bomb and $150 for each GD. I gave you a break while you were dealing with the water, and I didn’t add your last few. From here on out, though, it’s $250 per.”
Mitchell opened his mouth, but Don interrupted him, “Before you let another streak fly, let me tell you this: Any reputable shop’s gonna tell you that you’ve ruined the cab roof, and it has to be replaced. Few of them, however, will take on that job. And, the thing with the mess you have going on there, is that it’s just a matter of time before the sunroof falls in on you, or most likely, goes flying off as you’re driving down the road.”
“You can’t f…charge me for cussing! I’ll talk with Tim, and I’ll have your fucking job!”
“The surcharge is now $1550,” Don said calmly. “And, Tim’s gonna go along with me on this.”
“We’ll see about that,” Mitchell said smugly. “Tim and I go way back.”
“Doubtful, but it doesn’t matter,” Don replied.
“And why the fuck is that?”
Don grinned down at the tiny, red-faced man. He said, “$1800, and my name’s on the sign out front. Now, you have a good evening – better mind the weather report; I think they’re calling for a lot of rain.”