Saturday, February 28, 2015

MPPC: Champion of Teen Mental Health

Reflections on Menlo Park Presbyterian's "Parenting Teens Through the Challenges of Life" Conference 

Today I attended “Parenting Teens Through the Challenges of Life” at Menlo Park Presbyterian Church (the church where I'm a member, but not a leader). I wanted to get involved with mental health issues at my church for some time, but haven’t found the time until today. So I decided to go to the event.

Overview of the Day

The conference was a nice blend of expert opinion and personal experience. One child psychologist masterfully weaved in theory with his professional experience caring for teens, and his own experience and strategies in raising his own teens. The experts, by and large, were speaking both from professional and personal experience, which gave an authenticity to the advice. There was even a resource fair where local providers of services and organizations were able to talk to parents and professionals, from NAMI to AA, and both secular and Christian treatment centers.

The first keynote speaker was the Executive Director of Adolescent Counseling Services in Palo Alto, Philipe Rey. He gave a talk answering, “What’s wrong with kids these days?” with “Nothing: Society has changed.” He cited lack of social engagement, changes in the family structure, and technology as some of the contributing factors to the new problems. He engaged the audience well with personal anecdotes, exaggerated stories, and the occasional statistic from San Mateo and Santa Clara County; he got so into it at times, he seemed to forget his audience: his occasional use of profanity fell quite flat before the stained glass. While some of what he said was platitudes (we were frequently reminded that “Teenagers experiment” and “It’s normal”), most of the presentation was a good set of concrete tips for engaging with teens, from encouraging family dinner to going for long car rides.

The second keynote speaker, Amy Simpson, was an author at the flagship evangelical magazine, “Christianity Today”  delivered a powerful message. She told of the struggles of herself and her family as they struggled to wrestle with their mother’s schizophrenia. After her heart-wrenching story of being ostracized and stigmatized, she gave a set of great advice for taking care of those who are mentally ill and their families. I think the most memorable line was her description of mental illness as the “no casserole illness”; if you get cancer, or go to the hospital for surgery, members of the church bring you food, but not if it’s a mental illness. Her message was one of empowerment to help those who are sick: “Do what you’re already doing” (just don’t forget to do it to those who are mentally ill, too). She seemed nervous and unvarnished, but I think this added to the authenticity of her message. It was one of the heavier talks I’ve ever heard, effectively communicating the burden. I was used to stories of schizophrenia ending dramatically in suicide, as a warning to take it seriously. This one ended on a note of hope. With treatment, though still sick, “Mom is doing really well.”  

Overall, it was a very down-to-earth set of presentations. I must admit, it was somewhat jarring for me, who feels a sense of comfort when there’s journal references at the bottom of every slide. I was mostly able to suppress my priggishness in noting a minor statistical error here or there, or an improperly used psychiatric term, but overall, the presentations were informative and accurate. Most importantly, it seemed to be exactly what parents needed. In conversations I had, parents were grateful and found the lessons helpful.

The material was also very timely and specific to the issues faced by local parents. Cutting was discussed twice; in fact, this topic (not yet discussed in any of my formal training) was mentioned in a session on “risky behaviors,” and inspired three of the four questions, leading to a good discussion on this apparently very common behavior. Also, perhaps it’s inevitable in Silicon Valley, but one of the more commonly blamed factors for the new problems was technology and ways to limit it, from texting late into the night to pornography. One pediatrician giving a lecture on sexuality, while emphasizing that parents can continue to encourage children to wait until marriage, also stressed the importance of talking about contraception for those teens that choose differently, even modelling how to talk about contraception; a secular doctor could find little to object to.

It was shocking was what parents knew and what they learned. I am a psychiatrist who spends a good amount of my time doing intakes on, by and large, mostly suicidal patients. It wasn’t me but a parent who pointed out that 100% of Palo Alto Police are specially trained to manage mental health crises; another contributed that San Mateo county was making great strides in that direction as well. On the other hand, many parents found out (and were probably horrified) about “sexting,” Snapchat, Tinder, and “hooking up” in the same hour. Some things that were commonplace for me as a doctor and psychiatrist (e.g. talking to psychotic people, talking about sexual organs) I discovered were really intimidating to parents; one very good thing parents could walk away with was some context, and examples of places to start with these conversations.

One of the things that came through loud and clear was well-modeled examples of ways to talk to kids. Parents were encouraged, exhorted, chided, pleaded with, and instructed to talk to their kids about drugs, alcohol, sex, depression and even suicide. A multitude of example conversations were given, some of them even role-played by awkward, earnest, geeky parents.

My Impressions

I went to the conference with some apprehension. I had heard that the Church and mental health were opposed. Part of me was dreading that professional mental health would be maligned, and part of the reason I attended was to be able to speak to church leaders I know about these issues. But there was none of that. The only criticisms of the system were criticisms I make myself: critiques of the complexity and lack of access. Many churches discourage their members, implicitly or explicitly, from seeking help (according to statistics presented in the conference, such attitudes are much rarer than I expected). But MPPC does not have the “pray it off” attitude toward mental illness. Coming away from the conference, I found that my church puts enormous faith put into mental health professionals (or at least those who we invite to speak to our members). In fact, if I had to offer one very small criticism of the conference message, I would say that too much faith was placed in mental health professionals.

One member I talked to was going to join a support group at the church, but was told that he would need to get “clearance” from a professional before he participated in the group. One of the keynote speakers seemed to think that the support of friends and community had only the effect of making it more likely that patients see professionals: “Loving friendships are the best context for helping people get the help they need.” The belief that a person can be supported no matter what their diagnosis is, or that community support itself can be therapeutic seemed to not be considered. We heard that treatments of mental illness have “grown by leaps and bounds over the past decade” and that they are “90% effective” (perhaps the statistic where my desire for a reference was most salient).

I know what we can do and what we can’t do as mental health professionals. I know the effect size of SSRIs, and, though good, ain’t great. I know how a hospitalization can help, and how it can’t. I know how our diagnostic categories are useful, and how they arose by consensus. And for many of my VA patients, often isolated, lonely veterans, I am more hopeful about the effects of joining a strong community than of the drug that I prescribe.

Perhaps the biggest gap in the program was the lack of presence of psychiatry. Today, I heard from psychologists (including John Ortberg, our executive pastor), pastors, MFTs, a drug and addiction counselor, and even a pediatrician. But not a single psychiatrist. I was there with my co-resident, but we didn’t manage to shake hands with another psychiatrist. And when I introduced myself as a psychiatry resident at Stanford, the other clinicians immediately begged for a card, hoping I had some availability, crestfallen to discover that interns don’t take new outpatients.

There is a huge need. One of the biggest take-aways for me was this: kids are in big trouble. On the adult side, I’ve heard strong arguments on both sides: that depression incidence is higher now than it was decades ago, or just that our awareness has increased. With hundreds of parents and community members showing up for most of a Saturday to talk about teen mental health, there is clearly a big demand for this. The three recent suicides of Gunn High students have been on my mind, and correspond to the increased incidence of suicide in this age category nationally; perhaps this was one of the reasons why so many attended.

The other lesson from the conference is that we’re doing something about it. One of the things I love most about my church: we do things. As a small example that makes the point, I’ll tell you about a problem of handouts. One of the breakout speakers had a thick stack of handouts that people had not taken. Right before he started speaking, one of the audience members, stood up, grabbed his stack of papers, and started handing them out to the room. She had the boldness and even presumptuousness to see a problem, not ask permission, and solved it almost reflexively. And so with mental illness and teens: there are new problems and new challenges, from cutting to sexting; suicide is a clear and present danger in the Valley. But parents and providers showed up to do something. This was not a small event, nor a short one. The sanctuary was about two-thirds full at the keynote session, about 700 people, and went from 8:00am – 3:30pm. With the amount most of the parents in the area can bill for their time, it represents an enormous opportunity cost. I can make various complaints about polish or rigor. But the most important thing about this event is that it happened: a well-attended tactical briefing on the problems and what to do. Like soldiers fighting a war, hundreds of parents showed up, and were strengthened. I hope and pray that this would not be the last event of its kind.