As an Adolescent Support and Counseling (ASACS) Counselor, it has always been a passion of mine to provide counseling and prevention serves to teens and their families. I’ve been very fortunate to fulfill that calling and having a platform to make an impact at Daegu Middle High School in Daegu, South Korea.

In supporting and working with the Daegu students, I developed a year-round leadership club called the Role Model Club. The goal of this club is to develop middle and high school students so they serve as peer leaders for younger students in elementary school.

All Role Model Club candidates are selected by their teachers and are interviewed for entry into the Club.  Once selected, students participate in several field trips, planned by ASACS, to the elementary school and school-age services for Red Ribbon Week (an awareness week that raises awareness on the importance of a drug-free, healthy youth) and Military Children’s Month. The club members also assist fifth graders as they being their transition into sixth grade.

Role Model Club members also participate in the planning and facilitating of various campaigns and serve as a positive advocate for youth in the community. Role models learn to act as ambassadors through positively influencing their peers and learn important skills to engage and connect with peers that are graduating to the next grade level. 

Through weekly meetings, students create educational skits to promote healthy decision-making skills. We focus on a variety of topics such as: drug refusal, fire and bullying prevention, developing interpersonal skills, technology management, positive body image and many others.

Throughout the school year, I actively engage with parents of Role Model Club students, making sure they are informed of activities, fieldtrips, contests, and various campaigns that students plan and implement throughout the school year and summer months.

The positive feedback that this program has received from both students and their parents truly reaffirms my belief that the Role Model Club is a unique and enriching experience for teens to learn leadership skills that will last a lifetime.

About Jasmin Coty

Ms. Jasmin Coty has been an ASACS Counselor since December 1989 helping military and civilian families throughout Germany for over 20 years and in the last five years assisting teen and their families at Daegu MHS in Daegu, South Korea.

In 1989, one survey of the general public found that more than half of respondents believed lack of discipline was a possible cause of mental illness. The survey found that, at that time, Americans were more likely to receive information about mental illness from mass media than from medical providers or psychologists. Thirty years later, with the availability of information on the internet, the public should theoretically have a more accurate and balanced perspective of mental illness. But is the public obtaining their information from science-based sources? While there is still much to learn about mental illness, scientists have identified several factors that can play a role in mental health, including genetics, environmental exposure, altered brain chemistry, significant stress, and comorbid medical conditions. With the availability of misinformation on the internet and on social media websites in particular, are we really any better educated on mental health than we were 30 years ago?

The National Institute of Mental Health (NIMH) reports that approximately 1 in 5 adults experiences mental illness annually, with approximately 1 in 25 experiencing mental illness that substantially interferes with or limits 1 or more major life activities. Based on data from the 2018 National Survey on Drug Use and Health, approximately 19% have an anxiety disorder, 2.8% live with bipolar disorder, and fewer than 1% have schizophrenia in the United States (US) adult population. In addition, 7.2% of adults have experienced at least 1 major depressive episode in the last year. Unfortunately, only about 43.3% of adults with a mental health condition received mental health services within the past year, and of those with a serious mental illness, only 64.1% received mental health services within the past year. Even the indirect costs of mental health have a significant impact. Serious mental illnesses have been estimated to cost over $193.2 billion in lost earnings per year in the US, and mental illness has been predicted to cost the global economy $16 trillion by 2030.

Much has changed in the treatment of mental illnesses in the past 30 years. Key treatments for depression, such as selective serotonin reuptake inhibitors (SSRIs) and newer serotonin-norepinephrine reuptake inhibitors (SNRIs), have mitigated some of the limitations of earlier antidepressants (e.g., drug-food interactions or select adverse effects). Even in the past year, novel approvals for treatment-resistant depression (TRD) and postpartum depression (PPD) have emerged. For those with schizophrenia, the availability of newer generation antipsychotics has significantly altered care as well. Although testing for genetic alterations to better identify the best medication choice for a patient is in its relative infancy, the role of pharmacogenomics is rapidly expanding, too. These advances offer promise for individuals with mental illness, but no medication is without risks, and a discussion with a licensed medical provider is essential to establish an appropriate treatment regimen. In addition to medications, the role of nonpharmacologic treatment has expanded in the past 30 years as well, with additional treatment modalities beyond the advancements in psychotherapy alone (e.g., modern cognitive behavioral therapy, interpersonal therapy). A more holistic approach, incorporating lifestyle changes (e.g., diet, exercise) and non-traditional medicine (e.g., meditation, acupuncture), is also gaining in popularity; however, it is critical to understand that herbal or “natural” treatments can have adverse or toxic effects and drug interactions. These should only be used in consultation with a healthcare provider.

Mental illness can contribute to the risks for suicide. Unfortunately, the Centers for Disease Control and Prevention (CDC) reports that suicide rates have increased by approximately 30% from 1999 to 2016. Notably, suicide is rarely caused by a single factor, and the National Alliance on Mental Illness (NAMI) reports that approximately 54% of those who die by suicide do not have a diagnosed mental health condition. Regardless, this leaves a significant portion of patients with known mental health conditions where intervention may have been helpful. Moreover, NAMI also reports that approximately 90% of those who die by suicide show symptoms of a mental health condition. The CDC includes several warning signs on their website and offers advice to several groups ranging from laypersons to the government to healthcare providers. One component the CDC emphasizes to healthcare systems is the need for affordable and effective mental and physical healthcare where people live. In addition, the Zero Suicide Institute provides a framework for continuous quality improvement in health and behavioral healthcare systems aiming to prevent suicide.

Of late, the public seems particularly concerned with the risk of violence in those with a mental illness. A 2006 survey found that 32% and 60% of Americans thought people with depression and schizophrenia, respectively, were likely to act violently toward someone else; however, research has demonstrated that there are several factors that contribute to violence, and that when accounting for these additional factors, the presence of a mental illness is only a modest contributor (at best) to violence. According to the 2018 National Survey on Drug Use and Health, approximately 19.4% of those over 12 years of age have used an illicit drug in the past year and 3% had at least 1 illicit drug use disorder. Additionally, 3.7% of adults reported dual diagnosis (both any mental illness and substance use disorder). Studies of patients with substance abuse or dual diagnosis have found higher correlations with violence compared to mental illness alone. Most importantly, adequate treatment has demonstrated improved outcomes.

With the discussion of mental health in the press and the plethora of inaccurate information on mental health online, it is difficult for the public to develop a truthful foundation on mental illness. While public access to information and scientific discovery have advanced in the past 30 years, the most critical component for the proper diagnosis, effective treatment, and safety of those with mental illness remains consultation with a healthcare provider and/or team.

If you or someone you know may be at risk for suicide, contact the free and confidential Suicide Prevention Lifeline at 1-800-273-TALK (8255). It is available to anyone 24 hours a day, 7 days a week.

Children with attention deficit hyperactivity disorder (ADHD) may have difficulty in school, because their symptoms—inattention, impulsiveness, and hyperactivity—get in the way of learning.

Success in school is important for the development of healthy self-esteem and confidence.

You can help your child succeed in school by:

• Working with teachers and other school personnel.
• Educating yourself about ADHD.
• Helping your child control his or her symptoms.

How can you help your child be successful in school?

You can help your child have the greatest chance of success in school by educating yourself, building relationships, maintaining open communication, working with your child, and keeping good records. Preschool or kindergarten is the best time to start using these techniques. But it is never too late to help a child improve his or her school performance.

Education                                                          

Learning as much as you can about ADHD and your child’s education rights will help you work with the school system more effectively.

• Learn about ADHD. Use the Internet to locate national organizations, ask your doctor, or visit your local library or bookstore for information about ADHD.
• Know your child’s symptoms and treatment plan. Talk with your doctor about your child’s behaviors that may interfere with learning and about ways to control those behaviors. Develop a record of your child’s treatment plan.
• Learn about your child’s education rights. Laws exist ensuring education rights for children who have conditions that interfere with learning. These laws also stipulate that parents have a right to be informed about and participate in educational decisions concerning their child. Contact your state and local education departments for information about ADHD in the schools and your rights to educational accommodations.
• Talk with other parents of children with ADHD. Join a support group for ADHD families. Find out how others have effectively worked with school systems.

 Build relationships

A positive relationship with teachers and other school personnel will improve your child’s chances of being successful in school.

• Start early. Before a school year begins, get to know the principal and other appropriate school personnel. Find out as much as you can about the school policies and rules, especially how behavior problems are handled. Find out if there are other children with ADHD in the school and how their behavior is being handled in the classroom.
• Share what you have learned. Find out if the teachers and other personnel need information about ADHD. Look for ways to help them get that information, such as suggesting books, pamphlets, or any local educational programs.
• Get to know your child’s teacher. Before the school year begins, talk with your child’s teacher about his or her style of teaching and discipline in the classroom. Find out whether the teacher has experience teaching children who have ADHD. Share with the teacher information about your child’s symptoms and what behaviors may interfere with his or her ability to learn. You may want to share your child’s treatment plan with the teacher.
• Make a school plan. Work with the teacher to design a plan to help your child perform to his or her potential. Address how to minimize misbehavior and how to react to it. Your plan will change as your child grows and develops. You may need to work with the school to develop an individual education plan (IEP) for your child. An IEP is a tool for classroom and homework adaptations for a child with a disability. For children with milder symptoms, the school may suggest a plan that is used for medical conditions that do not meet the IEP standards (called a 504 plan).
• Ask school personnel for help when needed. Tutoring or services that help with study or organizational skills are sometimes provided through the school. If not, school personnel often have a list of local resources that can help your child.

Keep communication open

Open communication with your child’s teacher can help resolve problems that may occur throughout the school year. The following are suggestions for working and communicating with your child’s teacher:

• Understand the demands upon your child’s teacher. Most children with ADHD can be taught in a regular classroom, although adjustments are sometimes needed. Not all teachers are trained to do this. Also, teachers are stretched to their limits by large numbers of children in the classroom, making it difficult to give each child personal attention. Ask the teacher what he or she needs from you to help assimilate your child.
• Keep the teacher informed. Share with the teacher any relevant changes in your child’s treatment plan. Help facilitate the sharing of information among you, your child’s teacher, and your child’s doctor.
• Visit the classroom. If possible, volunteer for school activities and parties. This will let the teacher know that you are interested in your child’s education and willing to help.
• Request progress reports. Children with ADHD often lose or forget their assignments. Ask the teacher to complete regular progress reports of your child’s performance and behavior.
• Have a final conference. Meet with the teacher at the end of the school year to discuss your child’s overall progress and the teacher’s suggestions for the next year. Ask him or her about possible teachers for the next year and how to help your child get the best chance for success in school.

Work with your child

• Use treatment methods as recommended by your child’s doctor. This may include medicine and/or behavior management techniques. This will help your child control symptoms of ADHD at home and school.
• Keep your child involved. Let your child know that you support his or her teacher. Clearly outline your expectations and the consequences of misbehavior. Talk with your child about how the teacher will let him or her know that a behavior is becoming inappropriate.
• Link school and home. Use the same signals (such as hand signals) that the teacher uses at school to indicate when a behavior is becoming inappropriate. Also, you can reward your child with privileges for remembering to bring home school progress reports. You can further reward him or her if the report is positive. If your child fails to bring a progress report home, you may treat it as if he or she had an unsatisfactory report and withhold a privilege.
• Help your child organize. Even young children can learn to use lists, daily planners, or calendars to keep up with homework assignments, tests, and activities. A young child may need a teacher’s help in writing down assignments.
• Use learning aids, such as tape recorders or computers. Teach your child how to take notes and to underline important information. If your child seems to learn best visually, ask about books that have helpful pictures and diagrams or workbooks.
• Have short sessions. Keep homework sessions to no more than 20 minutes without a break.

Keep good records

Health and school records can help monitor your child’s academic and behavioral progress as well as help identify when treatment adjustments are needed. You should keep and update the following records:

• ADHD evaluations. Collect copies of any records that are used to evaluate your child for ADHD. These records often identify the type of ADHD that your child has, which helps with treatment.
• Evaluations for any other conditions with similar symptoms.
• History of medicines. Record all medicines that your child has taken or is taking to treat ADHD.
• School progress records. Keep copies of any school plans, daily school progress reports, and formal progress reports throughout the year. Also, keep your child’s final grades and any achievement test results. You may find them helpful as you develop school plans for the following year.
• Individual education plan. If your school developed an individual education plan (IEP) for your child, ask for a copy. You may need to share that information with the health professionals working with your child.

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This document is for your information only. It is not meant to give medical advice. It should not be used to replace a visit with a provider. Magellan Health does not endorse other resources that may be mentioned here.

Children who are socially withdrawn, shy, and appear to lack self-esteem are more likely than other children to be targets for bullying. Children who appear confident and strong are better able to discourage children from harassing them.

Parents and other important adults in a child’s life can use these suggestions to help boost a child’s self-esteem:

• Encourage your child to participate in extracurricular activities such as sports or drama, which can raise a child’s confidence and sense of mastery. Sports, in particular, also help build strength, which can level the imbalance of physical power between children. Some children may prefer individual sports (such as karate, gymnastics, and swimming) over group sports (such as soccer or baseball). Drama classes can help children project strength and confidence, even if they don’t feel it at first.
• Help children become involved socially with other children through school, church, or community activities. This way, children will build social skills and learn to be at ease with others. Children who have friends and “hang out” with them at school are less likely to be targets for bullying than lonely children who have no social support.
• Role-play with children to show them how to appear confident and how to handle encounters with children who harass them. Help children learn to look people in the eye and to speak with a strong voice—but not shout—when talking to would-be bullies.

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Magellan Health Insights: Dr. Ghani, thank you for chatting with us today. Why do you think it’s important to be aware of minority mental health?

 Dr. Shareh Ghani: Many psychological conditions have a connection to the individual’s perception of themselves. How comfortable do we feel in our environment? How well do we fit into what is seen as the norm? It’s human nature to want to fit in. Being a minority myself as an immigrant to the U.S. from Pakistan, I can see that there is extra pressure when you may be uncertain about fitting in or what is expected.

Seeking treatment for mental health unfortunately carries a degree of stigma for everyone and minorities are much less likely to seek or receive treatment for mental health conditions. For those who don’t speak the primary language or do not speak fluently, it can be even more difficult to seek these services and treatment. In addition, there may not be bilingual providers available or covered in the network, if the patient has insurance coverage – which is less likely for minority members. We are starting to see improvements, but for immigrants and members of other minority groups, it can be even more difficult to ask for help.

Magellan Health Insights: Why wouldn’t a minority member seek out care for mental health?

 Dr. Shareh Ghani: There are many reasons. Fundamentally, these members are often challenged by the complications of poverty and social determinants of health (SDOH). Language, i.e. communication and or comprehension, can be a barrier. Beyond language, it may not be culturally acceptable to ask for help. It may seem embarrassing. Which leads us to stigma. The person’s community at large, the clinicians and physicians providing care, and even the patients themselves may see it as stigma. People openly discuss their diabetes but not their depression.

 In addition, these patients are less likely to be routinely screened. They also may not be able to specify that their symptoms are symptoms of a behavioral health condition. In the U.S., patients come to me and say they think they may be depressed. In India, my patients would describe physical symptoms – like gastrointestinal problems. This means they may go through a battery of tests to eliminate physical diseases before behavioral health is addressed.

Magellan Health Insights: How can providers best support minority mental health?

Dr. Shareh Ghani: Paying extra attention and being aware of the cultural needs of every individual is key. In order to come up with a successful treatment plan, providers need to be knowledgeable about cultural factors. And they need to ask about what their patients preferences are related to care. Unless and until we talk to each person about their comfort level working with a provider of a particular gender, someone from their own culture or sexual orientation, or even age group, we can’t provide the best treatment. We, as patients, are most likely to speak openly when we feel comfortable. Being able to speak openly with a therapist or provider will make it more likely that the member will be accurately diagnosed and that treatment will be more successful.

Providing culturally competent care is critical – all care must be culturally competent care. What does that mean? We must be able to provide care to patients with diverse values, beliefs and behaviors and meet patients’ social, cultural and linguistic needs. We must acknowledge the importance of culture, recognize the potential impact of cultural differences, and adapt services to meet culturally unique needs. By taking training and educating ourselves on cultural competence we can reduce the racial and ethnic disparities in healthcare and give all of our members the best care. 

Magellan Health Insights: We couldn’t agree more! Thank you, Dr. Ghani!

Read more about Minority Mental Health Here

As we observe National Minority Mental Health Awareness Month, we sat down with Dr. Rakel Beall-Wilkins, a former Magellan Healthcare medical director.

 Magellan Health Insights: Dr. Beall-Wilkins, thank you for speaking with us today. Of course, everyone’s mental health is critical, but why is it important to pay particular attention to the mental health of Black, Indigenous and People of Color (BIPOC)?

Dr. Rakel Beall-Wilkins: We know that mental health conditions can be successfully treated. However, BIPOC are significantly less likely to receive treatment for mental health conditions, including substance use. And it’s reaching crisis levels, especially among our young people. For example, suicide is now the third leading cause of death among African American males who are 15-24 years old.

Magellan Health Insights: What are the barriers to BIPOC receiving high quality mental health treatment?

Dr. Rakel Beall-Wilkins: BIPOC are less likely to seek treatment, both for their physical and mental health. However, when they do reach out for assistance, they are less likely to receive consistent, high-quality treatment.

There are many contributing factors to these barriers. The high costs of care can be a deterrent. Most BIPOC in the U.S. (with the exception of Asians) have higher than average rates of poverty. BIPOC are more likely to lack insurance coverage, and may only seek emergency care, which costs more and is less effective than sustained treatment. Medications or diagnostic procedures may be viewed as too expensive. Or reliable transportation for follow-up care may not be available.

There are also what are called the social determinants of health (SDoH). These include factors such as consistent transportation, the availability of healthy food, safe and affordable housing, access to education, public safety and working conditions. BIPOC are more frequently negatively impacted by the SDoH. For example, these members are more likely to be homeless or move frequently, which interferes with maintaining consistent treatment. They may lack adequate nutrition and are at greater risk for having associated medical conditions like hypertension or diabetes.

Further, the stigma around mental health conditions, while improving, is still a deterrent to seeking treatment—for everyone. Some cultures may see it as taboo to request help or be seen as someone who needs help.

When BIPOC patients do seek treatment, there may be no one available who speaks their language. In some clinical settings I’ve been in, it could take a week to arrange for an interpreter or a therapist who was proficient in the patient’s language. They may not have a primary care physician (PCP) to help with screening for mental health conditions or provide follow-up care. In addition, the community clinics where BIPOC are more likely to receive care may be understaffed, overcrowded and have long wait times. Understaffing may lead to inadequate screening or even misdiagnosis. And, frankly, the clinic also may not be in a place where the member feels safe traveling so, they may hesitate to go in the first place or return for continued treatment.

Magellan Health Insights: How can everyone, including healthcare professionals, best support minority mental health?

Dr. Rakel Beall-Wilkins: Everyone can help eliminate stigma. Be open to talking and hearing about mental health conditions, and make it clear that you know that having a mental health condition is nothing to be ashamed of. When someone you care about is going through a difficult time, encourage them to get help, and learn ways you can support someone who coping with a mental health challenge.

As healthcare providers, we personally can help by:

• Ensuring we are taking into account each person’s wishes when referring them to other providers: We should ask every patient whether they prefer to see someone of a specific race, ethnicity, gender or sexual orientation.
• Educating ourselves to be more culturally competent and making cultural training a priority for our staff.
• Expanding our workforces with staff from various backgrounds, sexual orientations, cultures and with varied linguistic skills particularly for the unique cultures that are most prevalent in the community.
• Screening for psychiatric conditions during routine visits. Many patients will report physical symptoms instead of talking about the underlying mental health concerns. PCPs and others see many cases of mild or moderate depression during routine care, and screening every patient can help prevent costly emergency visits and admissions. Self-screening tools can also help.

Beyond what we can personally do to educate and equip ourselves and our staff, I believe that the best solutions come from an integrated, collaborative approach. Everyone can help eliminate the disparities. If we work with leaders in the community, for example in churches and schools, we can raise awareness of mental health conditions, destigmatize treatment seeking, help address the social determinants, and improve the lives of everyone in our communities.

Overview

Post-traumatic stress disorder (PTSD) is a mental health disorder. Many people believe things about mental health disorders that aren’t true. Here are some myths about PTSD.

Myth: PTSD is in your head. It does not exist.

PTSD does exist. It is a recognized mental health problem that has been studied for many years. You may get PTSD if you have lived through a traumatic event that caused you to fear for your life, see horrible things, and feel helpless. Strong emotions caused by the event create changes in the brain that may result in PTSD.

PTSD has not always had the same name. It also has been called combat fatigue or shell shock.

Myth: Only soldiers or people in war zones get PTSD.

Anyone who sees or goes through a traumatic event can develop PTSD. A traumatic event is a horrible and scary experience. During this type of event, you think that your life or others’ lives are in danger. You feel that you have no control over what is happening. These events include violent crimes, sexual assaults, childhood neglect or abuse, and natural disasters such as hurricanes or earthquakes. Your job also could expose you to traumatic events. First responders at a traumatic event, such as firefighters and police, can develop PTSD.

Myth: You should be able to move on after a traumatic event.

The strong emotions you may feel during the traumatic event can create changes in your brain that result in PTSD. You may not be able to “move on” because of this. It’s important to remember that PTSD is a medical condition. People with other health conditions, such as cancer, deal with the condition as best they can. The same is true for PTSD.

Myth: PTSD always happens right after the traumatic event.

PTSD symptoms can develop at any time after a traumatic event. Your symptoms may start soon after the event, or you may not have them until months or years later. They may come and go over many years.

Myth: People with PTSD cannot function.

PTSD can cause severe symptoms, but counseling, medicines, and support all help people adjust. People with PTSD have jobs and relationships. They enjoy life and are active members of their communities.

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When the whole family is involved in physical activities together, children learn that being active is fun and makes you feel good. And busy parents can combine family time with exercise time.

Try these tips for getting everyone in the family up and moving together:

Getting started

• As a family, make a list of activities you’d like to do together.
• Make sure the activities are things everyone can do and enjoy.
• Keep a family physical activity log, or hang a calendar on the wall.
• Try to plan one or two family activities a week. For ideas, see the suggestions below.
• Once a month, plan something special that involves being active, like a trip to the zoo, a day hike, or camping.
• Use a safe backpack, stroller, or bike trailer so that smaller children can be included in family activities.

Walking

When family schedules get really busy, going for a walk may be the easiest thing you can do together.

• Start with short walks that everyone in the family can do. Add more distance gradually. Younger children can ride a bike or a tricycle. You can pull a wagon in case little ones get tired.
• Scavenger hunts can keep children from being bored on a walk. Keep in mind a list of “treasures” they can find, such as a red leaf, a blue house, a black dog, or an out-of-state license plate.
• Use a phone app or get pedometers, and work on increasing the number of steps you take on your family walks. Start with a goal of 10,000 steps a day.
• Register the whole family in a family fun run/walk in your community. If the event is for charity, have your family walk through your neighborhood to collect pledges.

Outdoor activities

• Go for a bike ride.
• Join your children in old-fashioned games like hopscotch, tag, jump rope, and hide-and-seek.
• Get involved in family-friendly sports like skiing, skating, swimming, and tennis.
• Play a daily family basketball game in the driveway or at a playground.
• Take up miniature golf or flying-disc golf.
• Fly a kite.
• Pick up trash at a local park.

Indoor and rainy-day activities

• Have a family dance night. Share dances from each generation, and teach each other to do them. Or learn folk dances.
• Create a new dance or exercise routine to a favorite song. Have a different child choose the song each week.
• Go to the mall, and count how many laps you can walk as a family.
• Have a hula hoop contest.
• Set up a fun obstacle course in the basement, garage, or spare room.

General rules

• Limit TV, video games, and computer time.
• Don’t use food as a reward for meeting activity goals.
• Make physical activity a priority. Don’t let things get in the way of family activity time.

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