Allison Kilkenny: Unreported

Children in the Mental Health Void

Posted in health by allisonkilkenny on February 20, 2009

Judith Warner

Protesters of Nebraska's safe-haven law hold signs in front of the Creighton University Medical Center

Protesters of Nebraska's safe-haven law hold signs in front of the Creighton University Medical Center (Nati Harnik /AP)

Remember the Nebraska law meant to keep desperate new mothers from abandoning their babies in dumpsters by offering them the possibility of legal drop-off points at “safe havens” like hospitals?

As was widely reported last year, the law neglected to set an age limit for dropped-off children, and eventually led to 36 children – mostly between the ages of 13 and 17 – being left with state authorities. Most of these children had serious mental health issues. Some were handed over to the state by relatives who had no other way of securing for them the heavy-duty psychiatric care they needed. Seven of the children came from out of state, including one who’d been driven 1,000 miles to Lincoln, Neb., from Smyrna, Ga.

Recently, The Omaha World-Herald acquired 10,000 pages of case files concerning these children from the state’s Department of Health and Human Services. They paint a portrait of desperation – of out-of-control kids, overtaxed parents and guardians, and an overstretched health care system – that really deserves more widespread national notice.

Because even though the mentally ill “safe haven” children had extreme needs, and some of their parents and guardians had extremely limited capabilities (one grandmother said her charge had “demons inside of him”; a mother who dumped her two teenagers in an emergency room said they were “mouthy,” “too much work” and “need to be voted off the island”), what their stories have to say about children’s mental illness, parental limitations and the paucity of care available in our country is altogether typical. They illustrate how a lack of good care early on can create much bigger problems, for families and for society, in the long run.

Their example also serves as a necessary corrective to the popular view that children being labeled mentally ill today are just spirited “Tom Sawyers” who don’t fit our society’s cookie-cutter norms, with parents who are desperate to drug them into conformity.

The children abandoned in Nebraska had big-deal problems. An 11-year-old boy, hearing voices since the third grade, had punched his fist through a glass door and smeared another child with his feces; other children had started fires, tortured pets, sexually abused younger children and made murder and suicide threats. Some of the adults charged with their care had problems, too, mental health issues that made them incapable of properly seeking help. Some parents and guardians had blocked earlier efforts by the state to provide care for their children, by not taking their children to Medicaid-funded therapy sessions or not picking up free psychiatric medications.

Others had tried hard to get help for their children; Matthew Hansen and Karyn Spencer, reporters for The World-Herald, noted that the 29 Nebraska “safe-haven” children alone had received nearly $1.1 million in state-financed mental health services. But these services “were not provided in a coordinated and cohesive way,” Kathy Bigsby Moore, executive director for the advocacy group Voices for Children in Nebraska, told me. She reviewed the state case records and found that some children received too little care too late and some, in desperate straits, were spending months on waiting lists for spots to open in residential treatment programs.

One Oklahoma woman who had been frustratedly trying to get her adopted son into a residential treatment program phoned a Nebraska official and threatened to bring the boy to his state unless she received help. The boy was admitted to a psychiatric program almost immediately.

“Why on God’s green earth does it take all that to get help?” she asked The World-Herald.

This problem of lack of access to care – and lack of access to truly good care – is the real mental health “epidemic” affecting children in our time.

Insurance companies will no longer pay for long-term inpatient care for mentally ill children; as a result, psychiatric hospitals have been steadily closing, and residential treatment programs for the most difficult children, whose tuition is most often paid with public funds, are packed.

And yet the care available for children at home with their parents is severely lacking. Outside of big cities, where even under the best of circumstances there can be a two- to three-month wait to see a child psychiatrist, there is a severe shortage of children’s mental health specialists.

In 1990, the Council on Graduate Medical Education estimated that by 2000, the United States would need 30,000 child psychiatrists; there are now 7,000. Many rural areas have no child psychiatrists or psychologists at all. Often, pediatricians end up providing mental health care, but they aren’t trained for it and often aren’t reimbursed for it by health insurance. The American Academy of Child and Adolescent Psychiatry is currently working with the American Academy of Pediatrics to try to formalize ways to collaborate on caring for children with mental health needs, but models for such joint care are scarce. And doctors have no financial incentives to talk to one another on the phone.

Programs that could help support mentally ill children and their families – therapeutic after-school care, community-based outpatient services, transitional care for children with chronic mental illness who sometimes suffer dramatic flare-ups of symptoms that send them to emergency rooms or to adult psych wards unequipped to help them – are also very poorly developed around the country, and generally not reimbursed by health insurance.

The result of all this fractured, fragmented, chaotic or non-existent care, said Christopher Bellonci, a psychiatrist who is the medical director of the Walker School, a nonprofit residential treatment program in Needham, Mass., is that children with psychiatric problems get steadily worse, and eventually “fail up” through repeated trials of medication and short-term hospitalizations until they can no longer be kept at home. Getting these children into good treatment programs requires “significant advocacy on the part of parents who have to be extremely sophisticated,” he said. And the cost of those programs is so great that, as was the case in Nebraska, some parents are actually forced to make their children wards of the state in order to get the child welfare system to pay for their care.

“Parents who have not been abusive or neglectful are put in the untenable situation of having to surrender custody,” Bellonci told me. “It’s criminal, frankly.”

In Nebraska, where access to child mental health services is particularly poor, child advocates had hoped that last year’s headline-making child abandonments would shock lawmakers into spending more money to develop better child mental health services. But that isn’t happening.

So far, Moore says, the only legislation likely to win passage would create a uniform state hotline and provide “navigators” to help parents find mental health services for their children. There isn’t, however, any increased funding for actual care. And without access to services, she said, “We fear it’ll be a hotline and navigators to nowhere.”

“Navigation to nowhere” perfectly sums up the experience of many parents I have interviewed about their attempts to secure mental health services for their children. As a country, it’s really in our interest to provide them with a compass.

GM: Twittering ‘Til The Bitter End

Posted in Economy by allisonkilkenny on February 19, 2009

General Motors and Chrysler’s requests for $21.6 billion in federal loans have a lot of citizens up in arms. GM has already asked for (and received) $13.4 billion in loans under the auto industry bailout, and the company claims it would need another $100 billion in government financing if it goes bankrupt.

But the good news is that the auto giant has a comprehensive, full-proof business model to confront the worsening recession:

1. Cut 47,000 American jobs

2. Close five North American plants

3. Drop several brands, including the lightweight, more fuel-efficient Saturn, and to counterbalance that, the “Why Jesus?!” Hummer brand

4. Hope the UAW doesn’t raise too much hell over GM’s inability to pay retirees’ health care costs

5. Twitter

I learned of step five in GM’s Vision of the Future when I twittered the following innocuous (or so I thought) comment:

allisonkilkenny: sees GM is phasing out the small, fuel efficient Saturn. Oil companies: 1, Earth: 0.

Seconds later, I received a reply tweet from something called GMBlogs:

@allisonkilkenny we don’t have indiv trash cans at ofc cubes at hq, just an ex, not sure total $ saved from small ideas, but likely large

picture-1In other words, GM is still environmentally-friendly because interns have to share trash cans. Shaky reasoning aside, I was surprised that I had popped onto the radar of GM with my casual mention of their brand, especially when the company should theoretically be preoccupied with, ya know’, going out of business.

I contacted Christopher Barger, GM Director of Global Communications Technology, about this weird prioritizing. Barger quickly responded to my questions, and he explained that GM is using TweetDeck to just search for mentions of GM, as well as interacting with the people who were already following the company. It’s not unusual for a corporation to use Twitter to monitor customer reactions to its products, and Barger equated the practice to customer service, though he seemed to take offense when I pointed out the slim differences between corporate acts of “good will” and propaganda.

I responded that, unlike customer service, I didn’t approach GM with a question or complaint. They specifically searched Twitter for mention of their product and then sent a messenger my way to post some talking points about The Corporation. 

An entire department devoted to the cause of Tweeting and blogging may seem like a strange choice for budget allocation considering their economic turmoil, but GM has burst onto the technological scene with great gusto. GM is quick to rationalize, claiming this is totally 100% normal because corporations need to keep their fingers on the pulses of clients and customers, and GM is hardly the only corporation to engage in the magic world of Twitter.

“We knew that when [the loan request] was submitted last night, there would be a lot of people reacting to it — on Twitter, on Facebook, in the blogs.  We wanted to be out there answering as many questions as possible about the viability plan itself, the progress we’ve made in its execution since December 2, the impact of the restructuring on our brands and upcoming vehicles, trying to let people know that Saturn still may have life after GM, trying to gauge how people were reacting to the plan,” said Berger.

Of course, gauging customer reaction shouldn’t take a back seat to providing actual products and services, say cars and health care. If GM is looking for a reaction from American citizens about their billions of dollars in requested loans and mistreatment of their employees, I can save them a lot of time and Tweeting:

It’s not good. It’s very bad. Less people want to buy your heavy, fuel-inefficient cars, and almost no one is thrilled that taxpayers are paying you billions of dollars to close domestic plants and ship jobs across our borders. Few people like that you mistreat unions. No one likes that in your rush to modernize and embrace the technology of the internet (complete with Twitter experts,) you forgot how to compete with foreign car companies.

It is possible to make tweets private and avoid the watchful eye of corporations, though that protection has already been hacked. For now, know that while you may never again own a good American car, you’re sure to get a prompt reply whenever you Twitter about GM.

Demand Candidates Answer Vets’ Questions

Posted in Barack Obama by allisonkilkenny on October 18, 2008

On Wednesday, October 15th 2008, a peaceful protest outside the third Presidential Debate at Hofstra University on Long Island was met with violence and misconduct by police.

Iraq Veterans Against the War had a clear mission that night: to ensure that the issues most important to Veterans would be at the forefront of the debate. With over 4,183 service members having been killed in Iraq (at the time of the protest), it’s unforgivable that the candidates have been allowing the Occupation of Iraq and it’s casualties to fall into avoidable talking points instead of focused attention.

At 7:00pm the night of the debate, IVAW members led a contingent of a few hundred peaceful protesters to the main gate of Hofstra University. As per our letter to Moderator Bob Scheiffer, because we hadn’t received notice that two of our Veterans would be allowed to enter the debate to address the candidates, a small, uniformed contingent of Veterans physically attempted entry.

Immediately police began arresting those who “crossed the line”. They then began using horses to physically knock protesters back away from the Hofstra gates.

As the order to get back on the sidewalk was being complied to at least one officer charged his horse up the curb, and onto the sidewalk- directly resulting in at least three injuries- including two Iraq Veterans.

Nick Morgan, a former Army Sergeant was trampled, knocked out, and had his face crushed by the hoof of a horse.

Witnesses say that police left him unconscious on the sidewalk for up to ten minutes before arresting him. Nick, disoriented and obviously suffering a concussion, was initially refused medical treatment beyond a simple piece of gauze taped to his face.

###

Supporters of the Hofstra 15 are now asking that you contact Back Obama and John McCain and demand they answer the vets’ questions posted below. Please support the brave men and women that demand nothing but some answers regarding their health care,

See the following websites to contact each candidate!
http://my.barackobama.com/page/content/contact/
http://www.johnmccain.com/Contact/

————————–——————
The Questions which we, the Veterans, wished to ask
————————–————————–——————

Senator McCain, on July 9th 2008 you were quoted saying “I’ve received every award from every major veterans organization in America but the reason why I have a perfect voting record from organizations like Veterans of Foreign Wars, the American Legion, and all the other Veterans Service Organizations is because of my support of them.”

However, there are non-partisan Veterans Organizations such as the Disabled American Veterans (DAV), Iraq and Afghanistan Veterans of America (IAVA), and the Vietnam Veterans of America (VVA) who’ve noted that you’ve consistantly voted against important issues such as increased VA funding in 2004, 2005, 2006, and 2007. This summer, another Veterans Organization, Veterans for Common Sense filed suit against the VA and discovered that approximately 1000 Veterans under their care are attempting suicide each month, with an average of 17 succeeding every 30 days. Government surveys conclude that over 300,000 21st Century Warriors are currently suffering from Post Traumatic Stress Disorder, while only 67 thousand have been diagnosed with with PTSD, and less than half of those are collecting disablity benefits. Doctors and Nurses at the VA are struggling to treat the 2 million American Troops who’ve deployed to Iraq and Afghanistan. What promises are you willing to make, as a Veteran, as a Senator, as a Presidential Candidate, to the Veterans of the United States to prove that you will ensure the VA is fully funded, staffed, and capable of preventing Troops from suffering as they are now, after they’ve served our great nation overseas?

-Sergeant Kristofer Goldsmith
Operation Iraqi Freedom III Veteran

———————
Senator Obama, you have said that the War and Occupation of Iraq is illegal. If by your words, it is illegal, then it is not only the right of service members such as myself to refuse deployment and participation in Iraq, it is also our responsibility. Sir, as President, are you willing to go by your own words and back them up, and support servicemembers refusing to participate in what you have, in your own words, termed an “Illegal Occupation”?

-Sergeant Matthis Chiroux
Operation Enduring Freedom Veteran