Child and adolescent psychiatrist Dr. Meenakshi Suman says she recognizes the stigma of mental health fading away as she continues in her fourth year at Sheppard Pratt Health System in Howard and Baltimore counties.
While some Howard County families are open to getting their children help for illnesses like depression, mood disorders, stress and anxiety, Suman believes furthering mental illness education through collaboration with the county and public schools can alleviate false beliefs that there are quick fixes to these rising, long-term struggles.
"Howard County is generally a resourceful population as compared to Baltimore City, where parents don't have resources," said Suman, an Ellicott City resident. "On the flip side, in Howard County, there's more of a stigma attached to mental health because there are more people who come from different ethnic backgrounds and not all of them are keen on having a child get mental health treatment."
Based on her work as a psychiatrist, Suman said more than 60 percent of all children in Howard County requiring inpatient mental health care received treatment from Sheppard Pratt, with the majority of admissions resulting from mood disorders.
Sheppard Pratt has two inpatient facilities, Sheppard Pratt at Ellicott City and Sheppard & Enoch Pratt Hospital in Baltimore, that provide psychiatric care to people with mental and behavioral issues. Outpatient and community services are also available throughout Howard, Baltimore, Harford, Frederick and Montgomery counties and Baltimore City.
Dr. Harsh K. Trivedi, CEO and president of Sheppard Pratt Health System, said he will help moderate a discussion on the subject through the Horizon Foundation's mental health film festival Oct. 25 at UA Snowden Square Stadium movie theater in Columbia.
The best way to talk about mental health is to provide exposure to the community, Trivedi said, and sometimes, the media gives people a false view into the world of psychiatry.
"Even in folks who have good intentions, they unknowingly continue to cast the same stigmatizing images because that is their perception of what psychiatric illness and treatment is," Trivedi said. "Having a mental health film festival allows people who are curious and want to learn more information get a sense of what really is going on."
Trivedi will explore the issue after the viewing of festival film, "Inside Teen Suicide."
Sometimes, parents don't know how to respond or address a child with a mental illness, Trivedi said. He said that for parents, information is power.
"One of the hardest things is being a parent," he said. "As a parent, you try to make the best decisions possible. What I usually deal with is the parent who is kicking themselves, saying, 'If I had just done this three months ago, maybe something different would've happen.' You always have to make the best decision based on the limited set of data points that you have at any given moment."
Children are more willing to address the problem head-on, Suman said, but some parents treat the illness as though it were physical rather than psychological. For example, in a recent case, the psychiatrist said parents of a young child with suicidal thoughts came to her office, expecting a fast-acting solution.
Survivors of Suicide, a support group at Grassroots Crisis Intervention Center in Columbia, has evolved into a place of solace, free of judgment, shame and secrecy — characteristics often suppressed by the stigma surrounding suicide and mental illness.
"They just thought [the child] would come and talk to the doctor for 15 minutes and that would be the end of the treatment," Suman said. "We see that kind of scenario quite often."
According to Nancy FitzGerald, executive director of special education and student services in Howard County Public Schools, school administrators, teachers and staff are working to break down the barriers of addressing students' mental and emotional wellness.
The school system currently provides counseling, character education and school-based crisis teams for students, FitzGerald said, as well as suicide prevention overview and threat management procedures for staff.
"We recognize that the needs are getting greater," FitzGerald said. "We're seeing more and more students coming in who are experiencing depression and anxiety and other mental health issues."
In the 2014 Maryland Youth Risk Behavior Survey, 18.2 percent of Howard County Middle School students reported feeling sad or hopeless within a year, with 15.7 percent seriously considering a suicide attempt.
Meanwhile, nearly a quarter of high school students in the county reported feeling sad or hopeless throughout one year, while 13.5 percent of females and 9.4 percent of males made plans to attempt suicide.
Jacqueline Dougé, child mental health medical director at the Howard County Health Department, said that, nationally, one in five children are diagnosed with a mental health illness.
"It's a matter of people understanding that it's a common issue," Dougé said. "In a recent Howard County health assessment, 11 percent of parents said that their child has either been diagnosed with depression or anxiety. It's more prevalent than diabetes."
The health department also works with the school system, she said, continuing to provide a mental health clinician at Bollman Bridge Elementary School, while adding a clinician this year to Patuxent Valley Middle School. Dougé said the health department currently has a contract with the University of Maryland, who provides both the licensed professional counselors.
Grassroots, Howard County's only crisis intervention center, has launched a new suicide prevention app, joining a nationwide trend to integrate technological advances with crisis intervention, a form of counseling that lies on traditional communication like face-to-face or over-the-phone conversations.
Bollman Bridge was the first school-based wellness center, she said, which began its services in the 2013-2014 school year.
"We have two models of school-based wellness centers in Howard County," Dougé said. "We have our traditional model, where there's actually a nurse practioner onsite and we have the mental health provider. Then, we have the telemedicine sites that are only for medical care, like cough and cold, ear infection. [Both schools] share the same campus, so it was just an opportunity where we tried to expand, knowing that some of the kids who receive services at Bollman could potentially continue to have services as needed as they transition into middle school."
The need for trained staff is necessary, Dougé said. Mental illness is no longer a "silent disease," but one that is recognized openly. Stress, family history, trauma and adverse childhood experiences increase the risk of a mental health diagnosis, she said, but no underlying cause is always definitive.
In partnering with the county's Mental Health Authority, Howard County General Hospital and public school system, Dougé said the health department urges families to address their concerns during routine doctor appointments and screenings.
"For pediatricians, there are standardized surveys and questionnaires that providers can ask parents and even adolescents about depression and anxiety and coping issues," she said. "There are even screenings pediatricians and OBGYNs can do for mothers, like maternal depression screening."
At a Howard County mental health symposium last month, Howard County General Hospital physicians Drs. Meng Choo and Eric Crawford agreed that stress is the initiating factor in mental health issues commonly seen in the pediatric emergency room.
For students in Howard, stressful situations range from conversations through texting to a parent's unrealistic expectations, Choo said.
"When you send a text, you can interpret it any way you want," Choo said during a panel at the symposium. "There's no emotion involved. That becomes a stressor, which can cause a patient to spiral."
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Parents then insist on a "quick fix," perhaps through medication.
"'My child is depressed. If they take a pill, will they be better tomorrow,'" Choo said parents ask him. "[Parents] need to understand that mental health is a long-term problem that needs to be dealt with on a long-term basis."
Part of the problem can and should be discussed in the classroom, Crawford added. Maryland officials must recognize the need for facilities for mental health education and treatment just as they did for shock trauma with the University of Maryland Shock Trauma Center.
As the county and school system explore mental illness and work to spread more awareness, high school students Jacob Lampf and Patrick Keefe said they'd like resources to be more openly discussed.
Lampf and Keefe, both seniors, were among the six Howard County students to talk about mental health during a symposium in September.
"I don't know a lot of the resources that are available to us," Keefe said. "For a lot of us, we call it the silent war. You don't really want to share your experiences, you don't talk about it and you don't know who to talk to about it."
The Marriotts Ridge High School student said he still sees the negative stigma in his school setting, which he described as a challenge.
"When a child is diagnosed with cancer or diabetes, everyone takes a step forward to help them to show their support," he said. "But when a child is diagnosed with depression or anxiety, people take a step back."
Lampf agreed. A member of the Howard County School Health Council and a student at Atholton High School, Lampf said over-testing has become one of the biggest causes of stress among his peers. Lampf said students have "become data points" and "upward-sloping graphs" as schools focus more on students' academic success over mental well being.
"We need to look at these tests and ask ourselves, 'Are they worth taking time out of the classroom day, which will in turn end up with more homework or stress at home away from instructional time?'" he said. "We're treated as part of a collective rather than individuals. I strongly disagree with that."
Howard County is making progress in the eyes of Dr. Harsh K. Trivedi, but there's always room for improvement.
"For the number of kids who are going through these types of thoughts and having these types of exposures, we all can do a better job of readily providing data in the hands of parents so when things come up, they can better spot issues that are there and also have meaningful resources and advice."