Pediatric health care is by its very nature holistic. Not only do we have the opportunity to treat acute illnesses, we can guide and support child development. We often think of the physical or cognitive stages of development but we must also remember to nurture the emotional aspects of a child's growth. There is no curriculum to teach, there is no single instructor. Rather, these are lessons learned at the hands of society. In the world today, civility is one of the most important of these tutorials. But it seems as if it's slipping away.
The true meaning of civility is somewhat in the eye of the beholder but several scholars have attempted to define it. At its simplest, it is courtesy and politeness. Many have described it as the outward expression of the value of others, a straightforward recognition of humanity. Or, simply stated, putting the common good above our self-interest. Whatever definition we use, it seems that civility is amorphous subject matter that relies on the world as a classroom.
Interestingly, children are hard-wired to be kind when they are born. As early as toddlerhood, they will show empathy, for example lending a peer their blankie when they perceive an injury or sadness. By school age, when children are able to understand their own emotions, they begin to show compassion by both action and word. Then we hit middle school, the denizens of which are commonly known as the "mean girls," and the kindness once so evident seems much harder to find. As time goes on, the hard-wired kindness from birth may reappear, but not always. Where does it go? Why is it so hard to conjure up with age?
Many factors seem to contribute to the demise of civility over time. Children are incredible observers and mimics. If the prominent figures in their lives, which can change with time, act with disregard for others, kids will emulate that behavior. After all, children do learn what they live. It starts with the inner circle of nuclear family but over time includes peers, teachers, public servants and celebrities. As these role models erode their civil behavior, the humanity that is inborn begins to dissolve.
In addition, television, video games and social media are huge teachers in life lessons for all of us, children included. These venues can be very valuable but if not monitored closely, they can change the course of social development very quickly. In the worst-case scenario, this can lead to increases in violent behavior, societies in conflict and political division, all of which are not hard to demonstrate in the world today.
So can we change this shift away from civility and preserve the innate kindness that people are born with? There are many things we can instill in our behavior to nurture humanity in each other, and most of all, in our children.
First, we start at home. By thinking, speaking and acting with an open mind, we can set the frame of reference for children that can persist throughout their lives. We can teach the concept of always looking out – seeing others first and not expecting anything in return. This will breed awareness of things beyond the self and foster tolerance and acceptance, critical elements of civility. It will grow the innate seeds of empathy and kindness and eventually, teach respect for others both like and unlike ourselves.
We can model restraint and self-control. We can still allow human discourse and debate – in fact that is paramount to our ability to continuously improve the human condition. But we must listen and respond thoughtfully instead of just dominating the conversation. We must hear other opinions and adopt the best ones. The ones that do not elevate the human condition can be disposed of as long as it is done with respect.
We can apologize when we are wrong and we can change. We can share stories of events that helped shape us and taught us kindness throughout our life. Social media can promote acts of kindness and joy in 140 characters or less. We can write better stories and better blogs that lead to conversations about preservation of the ideal human situation. We can hold ourselves to the highest standard of compassion and civility. We can emulate societies that really do subscribe to the "it takes a village" concept when it comes to raising children to be responsible and caring human beings. The entire society takes on the child rearing and demonstrates in daily activity and interaction how to live a compassionate and caring life.
For us to do that in all societies, we must first demand civility in our public servants and politicians. We must take a stand against incivility and let others know it is not the way for a thriving society to exist. Our media must stop lauding those with celebrity status who have histories of behaviors that are antonyms of the desired, such as domestic violence and illegal behavior. Rather, let's hold up those who do charitable work and make the world a better place. Ignore the rogues and they will cease to be relevant.
Maybe civility is not such a vague concept at all. Recently it was described as standing up and taking responsibility for the feelings of others. Maybe we don't need to teach our children the lesson. Maybe they have the answer and the grownups of the world, especially those of high influence, should be the ones taking the notes.
By Elaine Cox
15 August 2017
School-based mental health programs can reach large numbers of children, with increasing evidence of effectiveness in improving mental health and related outcomes, according to a research review in the September/October issue of the Harvard Review of Psychiatry.
"This review provides evidence that large-scale, school-based programs can be implemented in a variety of diverse cultures and educational models as well as preliminary evidence that such programs have significant, measurable positive effects on students' emotional, behavioral, and academic outcomes," write J. Michael Murphy, EdD, of Massachusetts General Hospital and colleagues.
An estimated 13 percent of children and adolescents worldwide have significant mental health problems such as anxiety, disruptive behavior disorders, attention-deficit/hyperactivity disorder, and depression. Especially if left untreated, these disorders often persist into adulthood, with lasting effects on many aspects of life.
Over the years, many programs have been designed to deliver preventive mental health services in schools, where children and teens spend so much of their time. Substantial research now shows that school-based mental health interventions can be widely implemented and can lead to population-wide improvements in mental health, physical health, educational, and social outcomes.
Dr. Murphy and colleagues identified and analyzed school-based mental health programs that have been implemented on a large scale and have collected data on specific mental health outcomes. The authors estimate that the eight largest programs have reached at least 27 million children over the last decade.
The interventions vary in their focus, methods, and goals. The largest program, called "Positive Behavior Interventions and Supports" (PBIS), focuses on positive social culture and behavioral support for all students. The second-largest program, called "FRIENDS," aims to reduce anxiety and to teach skills for managing emotions and coping with stress – not only to children, but also to parents and teachers.
Most of the school-based mental health interventions were designed to focus on mental health promotion or primary prevention for all students in the school; some programs also target students at high risk of mental health problems. Most of the programs have been implemented across school districts, while some have been introduced on the state or national level.
Available research provides "moderate to strong" evidence that these interventions are effective in promoting good mental health and related outcomes. For example, studies of FRIENDS have reported reductions in anxiety, while PBIS has shown improved reading scores and fewer school suspensions. Other programs have shown benefits such as reducing bullying at school; one intervention has even been linked to lower rates of substance abuse in young adulthood.
The authors point out that school-based mental health interventions have been studied almost exclusively in high-income countries – despite the fact that about 80 percent of the global population of children live in low- and middle-income countries (LMICs). But there's evidence that this may be changing, since three of the eight largest programs have been implemented "to scale" in LMICs. One of these, called "Skills for Life," has been running on a national basis in Chile for more than a decade.
"Data sets of increasing quality and size are opening up new opportunities to assess the degree to which preventive interventions for child mental health, delivered at scale, can play a role in improving health and other life outcomes," Dr. Murphy and colleagues conclude. With ongoing data collection and new evaluation frameworks, they believe that school-based mental health programs have the potential to "improve population-wide health outcomes of the next generation."
10 August 2017
In 2014, Rehana (name changed), a 15-year old from a school in West Bengal’s Sunderbans region, was rescued from a red light area in Delhi. The Class IX student had been ensnared by traffickers who then sold her off in Kolkata. After being brought back, the local administration and a non-governmental organisation (NGO) re-enrolled her in school. They feared she would drop out in months. Her script ran differently though. Rehana is today training to become a nurse.
Activist Rishi Kanta, whose NGO Shakti Vahini in Delhi aids in the rescue of trafficked girls and women, believes it is the West Bengal government’s girl child welfare scheme, Kanyashree Prakalpa, that has helped Rehana and others like her make a new life.
“Not only has the scheme prevented schoolgirls vulnerable to trafficking from dropping out, it has also offered a lifeline to girls like Rehana who did not have much institutional support after being rescued,” says Rishi Kanta. In June, Kanyashree Prakalpa was awarded the United Nation’s Public Service Award at The Hague.
Instituted in 2013, Kanyashree Prakalpa is a conditional cash-transfer scheme aimed at improving the status and well-being of the girlchild. Official statistics say there are around 41.2 lakh beneficiaries (as of July 25, 2017) of the scheme, implemented through 15,826 institutes and schools. “We want to ensure that every eligible person gets the benefits of the scheme,” says Shashi Panja, Minister of State for Women & Child Development and Social Welfare.
West Bengal was a ripe case for such a scheme. Although child marriage is prohibited by law, the State was among the top five when it came to early marriages. Further, in districts such as Murshidabad, Birbhum, Malda and Purulia, every second girlchild was found married off before 18. These are also districts where trafficking of girls is fairly common.
Now, National Family Health Survey statistics show that the number of women married before 18 has dropped from 53.3% in 2004-05 to 40.7% in 2015-16, though still above the national average of 26.8%.
Experts says the launch of the cash incentive scheme has convinced many families to send their daughters to school and also delay their marriage (the scheme offers a one-time grant of Tk 25,000, apart from annual scholarships, when the girl turns 18 and if she is studying in school or undergoing vocational training).
In April 2015, when Lakshmi Gorai from Raipur in Bankura district was pulled out of school to be forcibly married off, the district administration intervened and stopped her parents. When the family claimed they had no means to keep the 15-year-old in school, the authorities enrolled Gorai and other school-going girls from the neighbourhood in the Kanyashree scheme.
Ayesha Sultana, a first-year B.A. student at Women’s Christian College in Kolkata, was enrolled in the Kanyashree scheme by her school when she was in Class VIII. The yearly scholarships, she says, helped her continue studies, and subsequently encouraged 20 other girls from her lower-middle-class neighbourhood in Mominpur to join school.
“The scheme has come as encouragement to pursue higher studies. The Tk 25,000 grant will help me complete my graduation,” Sultana says. Officials say the scheme has also helped girls stay ahead of boys in the board-level examinations. This year, girls accounted for 69% of the candidates in the West Bengal Madrasah Board Examination.
The tangible benefits aside, officials say the scheme has motivated young girls, especially in the rural and semi-urban areas, and encouraged them to stand up for themselves. In many places, Kanyashree Sanghas (associations) have been formed and according to reports, these are now the first line of defence against child marriages. The sanghas also help identify girls who have dropped out of school.
Recently, West Bengal Chief Minister Mamata Banerjee announced that the scheme would soon be extended to cover postgraduation studies as well.
By Shiv Sahay Singh and Indrani Dutta
5 August 2017
Worried Adelaide parents and educators are turning to psychologists for
advice about a “graphic” new Netflix movie about anorexia that is aimed at
The film "To The Bone" tells the “confronting” story of a young woman with anorexia nervosa, and should have carried a “trigger warning” according to the national voice on eating disorders, The Butterfly Foundation.
There are fears the film – which stars a waif-thin Lily Collins alongside Hollywood star Keanu Reeves – glamorises the potentially dire eating disorder.
Butterfly Foundation chief executive Christine Morgan says: “My concern is, that while this film might cast a spotlight on the reality of eating disorders, it needs to come with clear warnings at the start. There are two groups who are particularly vulnerable – those who already have an eating disorder as well as those in ‘pre-stage’ who are really concerned about their own body image.”
Internationally, there have been calls to ban the film because experts are worried it might incite eating disorders.
The Butterfly Foundation has created a “fact sheet” that schools can use to provide as a guide for parents and staff that includes safe viewing tips. Local psychologists and eating disorder specialists also say they are being contacted for advice by parents as well as schools. Some teachers are concerned about conversations they’re hearing in the schoolyard.
The film’s release comes less than two months after the controversial series on suicide "13 Reasons Why", also created for Netflix.
Researchers from the San Diego State University found there was a spike in internet searches about suicide, including phrases such as “how to kill yourself”, in the wake of that show.
Adelaide clinical psychologist Kirrilie Smout says while the film has some positives as a “conversation starter”, it contains “unhelpful messages” and parents need to be wary.
“(It) underestimates the suffering involved in eating disorders, doesn’t accurately portray treatment and may make eating disorders seem attractive or interesting,” the director of Developing Minds Psychology and Education said. “I believe that for some kids and teens who either have, or who are at risk of developing an eating disorder, it could quite feasibly trigger jealousy, anxiety about current weight, desire for weight loss and disordered eating behaviour.”
Ms Smout, who has written a blog on the issue, says the movie isn’t suitable for young children. “It is entirely appropriate to say to a 13-year-old ‘no, you are not watching this’, and to provide the reasons why and suggest another film to watch instead.
“If you have an older child (16-plus) who wants to watch it and won’t be distracted by another suggestion, ask them if you can watch it together so you can talk about it afterwards ... then monitor and watch what’s going on later.”
If a young person has a negative body image:
1. NEVER ignore and dismiss concerns as, “this is
just a phase”
2. DON’T forget the importance of role-modelling (be careful about your own language and how you refer to yourself)
3. DECOUPLE size and shape with value as a person (remind young people while it is important to be healthy, a body is there to help live life, it doesn’t define them)
By Rebecca Baker
4 August 2017
These findings emphasize the need for early detection and intervention.
Adolescent depression increases the risk of violence, suggests a study published in the August 2017 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).
The study examined the longitudinal association between depression and subsequent violence from three representative samples in the Netherlands, United Kingdom and Finland. Researchers for these three cohorts used complementary measures of depression, including self-report and clinical diagnoses, and different measurements of violence including informant reports of violence and official convictions for violent crimes.
The research team, led by Professor Seena Fazel, from the Forensic Psychiatry Group at the University of Oxford, United Kingdom, found modest increases in risk of violence in depression. In absolute terms, for instance, in the Finnish sample, 7.1% of individuals with depression were convicted of one or more violent crimes, compared with 3.6% in the general population without depression.
In relative terms, across samples and measurements, the study shows a consistent pattern of increased relative risk of later violence. In the Dutch and UK samples, an increase in depressive symptoms was associated with a significant elevated risk of later violence. In the Finnish sample, the odds of violence in individuals with a diagnosis of depression were increased two-fold, compared to those without depression. These findings highlight the need for active and early treatment of depression in adolescents and young people. The mechanisms behind this link need further investigation, and may involve increased impulsivity, hostility and poor self-regulation.
"We know that high rates of depression have been reported among adolescents in juvenile detention and correctional facilities (e.g.,11% in boys and 29% in girls)," said Dr. Rongqin Yu, lead researcher at the Forensic Psychiatry Group at the University of Oxford, United Kingdom. "However, the longitudinal link between depression and violence was unclear. Our longitudinal design allowed us to take into account previous violence, enabling us to test whether adolescent depression is associated with changes in violence over time. We found a consistent pattern of increased risk of later violence across samples. Both depression and violence are prevalent in adolescents and young adults; our findings indicate the importance of early detection and treatment of depression."
Professor Fazel said: "This research is important for two main reasons. First, it adds to the evidence of the many potential harms of untreated depression in young people. Second, it suggests that closer liaison between criminal justice and mental health might prevent violence in high-risk individuals."
1 August 2017
Resilience programmes should be introduced into primary schools for children as young as 6 and 7, as part of plans to reduce New Zealand's high youth suicide rates.
There was "clear evidence" that behaviour programmes focused on primary school children contributed to reducing "later adolescent suicidality as well as other unwanted behaviours", the prime minister's chief science adviser has told ministers.
In a discussion document released on Wednesday, Sir Peter Gluckman delved into the risks associated with growing up in the 21st century and points to the need to better develop the resilience of children "to the inevitable stressors of growing up".
With young people hitting puberty earlier right across the Western world, analysis showed "compelling evidence" that children who enter puberty at a younger age, were at "far greater risk of behavioural, psychological and emotional disorder".
There was "unequivocal evidence" that children who entered puberty early were "more likely to indulge in alcohol and drug abuse" and often demonstrated more impulsive behaviours. Boys, in particular, showed greater impairment in the quality of their relationships.
Adolescence was a period of "relatively poorly developed self-control and heightened impulsive behaviour", Gluckman said.
"So, rather than resilience, which might be expected – and needed – we see severe and harmful (including self-harm) responses."
In fact, the rates of hospital admissions for self-harm were 50 to100 times higher than those for suicide. Many more than that again had suicidal thoughts, although that was difficult to quantify in statistics.
But a further possible factor in increasing rates of youth suicide was a "substantial change in the way we raise our children", Gluckman said.
"They now tend to be under tight control in the pre-pubertal period but less control post-puberty (as reflected in school subject choice, parental controls on time, place and behaviour, access to credit cards and the internet etc).
"In contrast, 50 years ago Western child-rearing practice followed a loose-tight pattern in which pre-pubertal children had more freedoms – especially to undertake risky play – but adolescence was much more constrained.
"This reversal may have resulted in a reduction in the capacity to self-assess risk in adolescence."
As well as changes in family structure and parenting practices, children were also growing up with different levels of parental engagement, and technology had changed the nature of their social networks and communication.
Meanwhile, media, celebrities and other social factors were combining to create "unrealistic expectations and pressures on young people".
"Compared to previous generations, youth face many more choices at an earlier age, but at the same time may have less clarity as to their path ahead," Gluckman said.
New Zealand's youth suicide mortality rate in 2010 was 15.6 per 100,000 adolescents aged 15-19 – the highest among reported OECD rates.
But National rates should be treated with caution, Gluckman advised. "There were reasons why many countries may under-report," he said.
From July 1, 2014 to June 30, this year, there were 238 suicides among New Zealanders aged 12-24. Rates were significantly higher for Maori youth aged 15-24, and had not lowered. But the Maori youth population was smaller, meaning the total number of Maori youth suicides was low and it was hard to pinpoint a trend.
Suicide prevention was hard, because causes were not understood well enough at the individual level.
"Completed suicide is a rare event, so it is difficult to study in the way we can study influenza or diabetes."
But primary prevention, with the right programmes placed early on in schools was "strongly suggested". But some formal programmes that had been implemented were likely not helping.
"Indeed, some programmes may actually increase the risk of suicidality."
Reducing access to alcohol, further education to enhance the skills of young people growing up in a digital world and whole-school cultural changes in positive messaging and cultivating media literacy, self-control and social skills were among the most effective early prevention methods.
Programmes that focused on young teens and young adults in their adolescence had seen some successes. But some of those programmes were "distressingly ineffective".
But a focus solely on youth mental health, "although important, is not sufficient", Gluckman said.
"Rather, we conclude that the high-priority need is to introduce and reinforce programmes focused on primary prevention starting early in life and developing secondary prevention strategies involving well-trained and engaged mentors, including peer mentors."
Earlier on Wednesday, Health Minister Jonathan Coleman announced the Government would extend funding for the Suicide Mortality Review Committee to continue its work, beyond its trial period.
"Our suicide rate is too high, particularly the rates for youth and specifically Maori and Pacific young people," said Coleman.
"Although wider interventions and support have been made available, there is always more we can do."
The review committee was established under the New Zealand Suicide Prevention Action Plan 2013-16 and operated on a trial basis under the Health Quality & Safety Commission. It will now receive $750,000 annually, reprioritised from Ministry of Health baseline funding.
In line with international trends, there had been a significant increase in demand for mental health and addiction services in recent years.
"To help meet this increase, the Government's funding for mental health and addiction services has lifted by $300 million. In addition to this, Budget 2017 committed an extra $224m, including $124m for new approaches.
"Cabinet is in the process of considering new mental health initiatives, and the details of these are expected to be released in the next few weeks."
By Stacey Kirk
26 July 2017