Perspectives - Vol. 6, No. 1 - Just One Man's OpinionThomas Cox, MS Updated: Jan 1st 2001 "The problem is not telling a person something they don't want to hear,
it's telling them in such a way that they hear you." Kids' mental care found lacking; Children's Mental Health 'Crisis' in U.S. These are the headlines that led me to the Report of the Surgeon General's Conference on Children's Mental Health (RSGCMH), released January 3rd. Fortunately it's not as voluminous as its predecessor, the Surgeon Generals Report on Mental Health (SGRMH, 1999), but it's comprehensive, completely validates my experiences and beliefs, and more importantly it offered solutions; The RSGCMH produced a National Action Agenda designed to improve the system. "This report provides a blueprint for change," said Dr. Satcher, "and presents an overarching vision aimed at fostering social and emotional health in children. The burden of suffering by children with mental health needs and their families has created a health crisis in this country. Growing numbers of children are suffering needlessly because their emotional, behavioral, and developmental needs are not being met by the very institutions and systems that were created to take care of them." I must admit when I first read that the system wasn't meeting the needs, my defenses immediately kicked in. I am the system, the Trifecta, I have provided services in, have administrated and provided training to, and been a consumer of "the system". As such the Surgeon General just pointed out my ineffectiveness and futility. Then I remembered that I already knew the existing system was ineffective. Dr. Satcher was simply stating the obvious, validated by "the reflected the voices of youth and family" who contributed heavily to the Action Agenda. As such this report is a consumer satisfaction report. Who best to comment on needs not being met than those who represent the needy? Now the obvious question is, defensiveness aside, what are we going to do with this Action Agenda? There was a sense of urgency to the report. It stressed the need for the public to become fully aware of the impact the inadequate system is having on our society. The children's system, or lack of, is a consistent feeder for the adult mental health system which has it's own issues. The impact is also felt in the criminal justice system and many other areas; divorce, domestic violence, unemployment or underemployment, and a perpetual high poverty rate. There is no shortage of reasons to get energized to fix the system, and it's not like it's a new problem. Over 50 years ago Father Edward Flannigan, of Boys Town renown, charged that delinquent parents and outmoded laws were feeding 100,000 children annually into an "Army of Crime". His experience extended from the turn of the last century, when he was working with "human derelicts" that were products of "the broken homes of yesteryears". We have the same problem today. Broken homes definitely contribute their share to an already overburdened mental health system, that includes the juvenile justice system. Whatever happened to the Good ole Days? I've led hundreds of parent groups, where parents want to relate back to the Good ole Days. Back when kids knew there place and respected authorities. I have found those "Good ole Days" are often referring to the days prior to the pressure and responsibility of being a parent. Unfortunately the "Good ole Days" are the days that required the formation of the current institutions and systems that have been identified as not meeting the needs. The past has produced the need for the system. Now it's time to fix it. For the most part the system is already in place. To speak of "overhauling the system" inspires dread because of the generalization and enormity. Rather, I propose we view it as a matter of fine-tuning and problem solving to plug the holes and fill the gaps. But, for the most part I submit we already have a system that is not far from viability. Why aren't the institutions and systems meeting the needs? There are many effective services and resources available through the existing systems and institutions. To start the discussion I offer the following: There is a consumer demand that is analogous to trying to hold the ocean back with a broom. Historically we simply produce more brooms, but because we need new brooms fast, the standards are lowered to speed up production. The present system perpetuates the problem by creating more brooms with improved quality, but after a while those brooms get weaker, and the need to create more, faster, lowersyadda, yadda, yadda. That is the problem in a nutshell. This situation contributes significantly to the stigma that the Surgeon General claims overrides the problems with the system as a whole.  Before I proceed, I want to acknowledge that, without a doubt, the overwhelming majority of mental health professionals that staff the agencies and institutions within the overall system are dedicated, committed, compassionate, undertrained, overworked, and incredibly underpaid people. I say this with no hesitation because it is an accepted industry standard. That having been said, any adjustment to the system must begin with us, the providers at all levels of the mental health care system. There needs to be a consistent message that we provide our consumers. We contribute to the stigma because often times we provide opinion as fact, and that produces confusion. One example of a mixed message we present to the public is when we provide parenting information in regards to corporal punishment, "spanking". Having led hundreds of parent groups, many with parents that have had negative experiences with local children protective service workers, a favorite discussion starter is to ask for a show of hands of all those who knew "Spanking" was illegal? The uninitiated raise their hands and then blame the very agencies designed to protect their children, because they have revoked their parental authority. "If you just let me light his behind up with a belt he'll follow orders". To this parent I'm reluctant to tell him that spanking is legal because the point needs to made that if the only way you can gain compliance is to beat your kids into submission, that is a significant problem that spanking is only going to escalate. Yet we as an industry often advocate against spanking by promoting the dangers to young Timmy's psyche, via the behind. At that point we loose credibility. When the parent who is concerned with their child's safety and well-being, applies a couple of thought out, well targeted swats to the backside of their out-of-control child, or to emphasize the importance of compliance is told that spanking is child abuse, we are dismissed. We are viewed as impractical, propagated by the stereotype of a young, childless social worker passing judgement on frustrated parents who want help not blame. I'm sure many of my peers will view this as inviting rampant child abuse. Granted many times a child has been abused, and the parent has claimed they did little more than apply a stern measure of corporal punishment. That is no different than the parent who locks a child in a closet for hours, and claims they simply put the child in time-out. They are both wrong, yet as a field, we don't advocate against time-out. We must be logical and put our own issues aside. If not, the consumer views it as "our" issue and we are dismissed. I say "we" and "our" because this is a major source of the stigma associated with my industry. When a parent hears the message that spanking a child is harmful, causing permanent physical and/or emotional damage. I Imagine the thought process of that parent who was spanked as a child, and in hindsight considers they aren't damaged, ergo you are wrong, and what do you mean I'm damaged! My father is a retired, 27 year, career Marine. He had 15 years in the military police and two tours in Vietnam, and I was more leery of my mother, the kindly, compassionate, nurse mom. I never needed the juvenile courts to keep me in line I would never have considered approaching the level of defiance and disrespect which is common amongst the population I work with. I can only remember being spanked by my father twice, no idea what I did, but I remember my behind was hot and sore. There was no yelling or screaming, no punches thrown, no belt or other weapons used. I take that back, my mother occasionally used a terrycloth housecoat belt or open-toed terrycloth half slipper. My recollection is more of it being used to herd my sisters and I in a certain direction. As my two older sisters and I sit around laughing about those childhood memories, we all acknowledge there was no real pain associated with it. We also knew compliance would ensure that the lack of pain would continue. We didn't want to escalate her to the hand. We also laugh at the assertions that corporal punishment as a parental tool, appropriately used, is harmful. Again, I'm confident the motivation of those who perpetuate any confusion are well intentioned, albeit misguided. I say it with confidence because I want those who disagree with my stance to afford me the same benefit of any doubt as to my motivations and intentions. I simply ask that we present a consistent message. In a parents group for families involved with the Juvenile Courts, we established a Philosophy of Parenting that would provide a consistent standard to reference. We had to address the spanking issue, but I was a contract therapist for a community mental health agency for kids and families and the issue had to be addressed to the satisfaction of the agency clinical director, that I imagine to this day continues to disagree with me, but respects my right to be wrong. We have the same goal, to better educate parents in an effort to improve their parenting skills and attitude. We agreed to the following compromise as one component to the groups Philosophy of Parenting. - Effective parenting can be accomplished without using corporal punishment. If necessary, corporal punishment should never be administered in anger, and never use a stick, paddle, belt or any object to apply corporal punishment. If your hand hurts, so does their bottom.
I offer this as a start, to generate consensus. Do you agree or disagree with my position? What will it take to make it palatable, while maintaining legal and practical considerations. The Surgeon General recognized that the task ahead will not be easy, but he emphasized the need to take advantage of "golden opportunities" which can often be "disguised as irresolvable problems". I offer one mans perspective on one issue. There are many other issues such as medication for children that we can address another time. The Surgeon General provided the Blueprint, now we must provide the building materials and the willingness to make it work. I am open and invite your constructive feedback. What do you think? References Reference
Cox, Thomas (2000). Just One Man's Opinion. [Online]. Perspectives. [2001, January 1]. |
