Schools often first line of defense in identifying, treating kids with mental illness
by Barbara Jones
They teach kids to read, write and solve math problems, and to work and play well with others.
And along with those lessons, educators are increasingly being trained to spot depression, anxiety and other troubling behaviors in their students, with administrators and teachers forming the first line of defense against mental illness.
"We provide psychiatric first aid," said Ailleth Tom, who coordinates crisis counseling and mental health services for the Los Angeles Unified School District. "We really listen, protect and connect students with services.
"We don't ask, `What's wrong with you?"' she said. "We ask, `What's happened to you?"'
Speculation about the mental health of the 20-year-old gunman in the Connecticut school shootings has focused attention on the need for the early treatment of troubling behavior in the nation's adolescents and teens.
Los Angeles Unified has long partnered with local law enforcement agencies and mental health experts in Los Angeles County, where crisis- and threat-assessment teams evaluate student activity that could potentially lead to violence.
Within Los Angeles Unified, experts train principals and faculty to watch for early warning signs so kids can get help before more serious conditions develop. Any new insights that develop from the Sandy Hook Elementary tragedy will be incorporated into future professional development sessions, officials say.
"We all are very aware of the school's role in identifying problems a student may be having. We do feel that responsibility," said Judith Perez, president of Associated Administrators of Los Angeles, which represents about 3,000 principals and assistants principals in LAUSD.
With 600,000 students, LAUSD has a cadre of 300 psychiatric social workers who refer students to mental health professionals or, in some cases, hold group or individual therapy sessions on campus for kids struggling with emotional traumas like divorce, death, illness or abuse.
"They're completely busy all of the time," Superintendent John Deasy said. "There are not enough of them to deal with the problems."
Mental health services are also offered at eight clinics operated jointly by LAUSD and Los Angeles County. Sites include clinics next to Daniel Pearl High School in Lake Balboa, and at Cabrillo Elementary in San Pedro.
Christine MacInnis, a counselor at North High in the Torrance Unified School District, said counselors do not wait for students in distress to come to them.
"Half come to me on their own, and the other half are referred through a parent, teacher, coach or administrator," she said. "Teachers are probably our first line of defense, because they are the ones with them all day."
The most common warning signs are sudden changes in behavior or appearance. A strong student may lose interest in his studies, for instance, or a snappy dresser may start coming to school looking disheveled.
If Torrance High counselors suspect that a student is a danger to himself or others, they call in a Los Angeles County psychiatric evaluation team. In the extremely rare event that a child is perceived to be a threat to others, law enforcement is also notified.
In 2011-12, the Los Angeles County Department of Mental Health conducted more than 4,200 threat assessments involving the region's school districts, a spokeswoman said. The agency's Emergency Outreach Bureau also held some five dozen training sessions for educators, law-enforcement, parents and students.
The Sandy Hook tragedy unfolded as many school districts were preparing for winter break. Nevertheless, officials began reviewing their own operations to determine whether they needed to do more to keep campuses safe.
San Bernardino City Unified, for instance, formed a task force that includes officers from the San Bernardino and Cal State San Bernardino police forces, along with members of local churches and service clubs. They'll be looking at all aspects of student safety, including support for youngsters with mental health issues.
According to the National Alliance on Mental Illness, more than 20 percent of U.S. kids ages 9-17 are struggling with a mental disorder that disrupts their lives, with symptoms appearing by age 14 in half of those cases.
However, only 20 percent of these youngsters begin treatment each year.
Experts say parents may be reluctant to seek treatment for their child because of the long-held stigma about mental disorders. Others may be in denial about troubling changes in their child's behavior, dismissing extreme mood swings, or episodes of panic, defiance or excessive hostility as just a passing phase.
This may create a delay that experts say could allow the disorder to worsen and become more difficult to treat.
"Adolescents and teens are in the midst of achieving their education, making friends and developing their identity," said Dr. Daniel Grosz, director of adolescent psychiatry at Northridge Hospital Medical Center's Behavioral Health Unit.
"If their mental illness started early in life, it's harder for them to achieve these goals. The longer we delay, the more resistant these conditions become."
Researchers from the National Institute of Mental Health studied more than 10,000 kids with mental disorders and found that panic and anxiety were the most prevalent issues, followed by ADHD, depression and drug or alcohol abuse.
Grosz said youngsters coping with these kinds of issues may display flashes of anger or aggressive behavior, but not the type of violence unleashed at Sandy Hook Elementary, where 20 children and six adults were gunned down.
"It's important after a tragedy like this to strike the right balance between investing in awareness and resources and referrals without going to the other extreme of suspecting any kind of unusual behavior," he said.
Nevertheless, he advised against keeping guns in a home where there are concerns about the mental health of anyone - adult or child.
While the Sandy Hook shootings shook the entire nation, they had an even stronger impact on the parents of children with mental and behavioral disorders.
Rosa Morales, who lives in San Bernardino County, has sought psychological help through the school system for her 10-year-old son because of the sudden, angry outbursts that seem to come out of nowhere.
"Once he had a screaming fit when he couldn't pass a level in a reading computer game," she said. "He yelled and screamed that he was a dummy, that all the kids in his class had already passed the level and that he was too dumb to get it right," she said.
Morales fears that her son's tantrums may one day escalate to violence.
Administrators said schools can play an important role beyond recognizing students in distress. They can help parents find low-cost counseling, support groups and other services.
In the wake of the Sandy Hook Elementary tragedy, school districts in the Southland and around the U.S. have been reviewing security procedures and looking for ways to improve student safety.
However, Las Virgenes Superintendent Dan Stepenosky, who wrote his doctoral dissertation on the gunmen in two high-profile school shootings, said the best way to protect students is to get to know them well and to address their mental health issues as soon as they surface.
Warning signs of mental illness
Each mental illness has its own symptoms, although there are some general signs that might alert you that someone needs professional help. These include:.
Marked personality change
Inability to cope with problems and daily activities
Prolonged depression and apathy
Marked changes in eating or sleeping patterns
|Thinking or talking about suicide or harming oneself
Extreme mood swings - high or low
Strange or grandiose ideas
Abuse of alcohol or drugs
Excessive anger, hostility, or violent behavior.
Mexico: Report lists more than 20,000 people missing over the past six years
by E. Eduardo Castillo
MEXICO CITY - Federal police officer Luis Angel Leon Rodriguez disappeared in 2009 along with six fellow police as they headed to the western state of Michoacan to fight drug traffickers.
Since then, his mother, Araceli Rodriguez, has taken it into her own hands to investigate her son's disappearance and has publicized the case inside and outside Mexico. She's found some clues about what happened but still doesn't have any certainty about her son's whereabouts.
As Mexican troops and police cracked down on drug cartels, who also battled among themselves, Leon was just one of thousands of people who went missing amid a wave of violence that stunned the nation. A new report by a civic participation group has put a number for the first time on the human toll: 20,851 people disappeared over the past six years, although not every case on the list has been proven related to the drug war.
With at least another 70,000 deaths tied to drug violence, the numbers point to a brutal episode that ranks among Latin America's deadliest in decades. In Chile, nearly 3,100 people were killed, among them 1,200 considered disappeared, for political reasons during Augusto Pinochet's 1973-1990 dictatorship, and at least 50,000 people disappeared during 40 years of internal conflict in Colombia.
The new database is shedding needed light on Mexico's unfolding tragedy. It's also sparking angry questions about why it doesn't include all of the disappeared. Neither Rodriguez's son nor his six colleagues who went missing on Nov. 16, 2009, are in the database, which was allegedly leaked by the Attorney General's Office to a foreign journalist. The group Propuesta Civica, or Civic Proposal, released the data on Thursday.
Rodriguez's mother said she's been in touch with authorities investigating the case and has spoken about it in several public forums about the missing.
"I don't think any government entity has a complete database," she said.
A spokesman for federal prosecutors, who would not allow his name to be used under the agency's rules, said the Attorney General's Office had no knowledge of the document.
As compiled by Civic Proposal, the report reveals the sheer scope of human loss, with the missing including police officers, bricklayers, housewives, lawyers, students, businessmen and more than 1,200 children under age 11. The disappeared are listed one by one with such details as name, age, gender and the date and place where they disappeared.
Some media in Mexico have reported that the number of missing could be even greater, at more than 25,000, with their estimates reportedly based on official reports, although media accounts didn't make the reports public.
"We're worried because several of the people gone missing in the state of Coahuila, and that we have reported to authorities, don't appear on the database," said Blanca Martinez of the Fray Juan de Larios human rights center in that northern border state. She's also an adviser to the group Forces United for Our Disappeared in Coahuila, made up of relatives searching for loved ones.
Martinez said that between 2007 and 2012 the group registered 290 cases of missing people. The database released Thursday lists 272 cases in the state since 2006.
"We have no doubt that the authorities have done absolutely nothing" to solve them, she said.
Public attention to Mexico's disappeared has grown especially since 2011 when former President Felipe Calderon publicly met with members of the Movement for Peace with Justice and Dignity, a human rights group led by poet Javier Sicilia. His son was allegedly killed by drug traffickers that same year.
Sicilia's movement demanded that the thousands of killed and missing should be treated as victims of the drug war, even if they were criminal suspects. Calderon's government responded that it would create a missing persons database, but authorities have not made it public so far. Calderon also ordered the creation of a special prosecutor in charge of assisting crime victims and supporting the search for the missing.
"There is nothing worse for me than having a missing relative. Not knowing where the person may be is very serious and so ... in every case that comes to us, we try to find a solution, to find the person," said Sara Herrerias, the head of Provictima, the office established by Calderon to help crime victims.
Herrerias, however, was cautious talking about the number of missing and said she could only discuss the cases that her office has dealt with.
In 14 months, she said, Provictima has handled the cases of 1,523 missing people, most of them allegedly taken by members of organized crime but with some cases also reportedly involving government authorities. Of the total number, 150 people have been located, 40 of them found dead.
Herrerias declined to talk about the possible magnitude of disappearances. "I don't like to talk when I don't have hard data," she said.
Estimates of the missing vary. The National Human Rights Commission, which operates independently from the government, has said that some 24,000 people were reported missing between 2000 and mid-2012, in addition to some 16,000 bodies that have been found but remain unidentified.
The government of President Enrique Pena, who took office Dec. 1, estimates the number of unidentified bodies at about 9,000 during Calderon's previous six-year administration.
Civic Proposal director Pilar Talavera said that although her group saw inconsistencies in the database, they decided to disclose it not only to help the public understand the scale of the violence, but also to pressure authorities to disclose official information on disappearances.
While the numbers help, what the relatives of the missing need most, of course, is to just learn what happened to their loved ones.
Since the disappearance of Rodriguez's then-23-year-old son, a dozen alleged members of the La Familia drug cartel have been arrested as suspects in his case. Rodriguez said she has interviewed four of them, who have told her that her son and the other six officers were killed and their bodies "disintegrated."
She said that so far no one has given her any clues about where her son's remains are.
"If it's true what the criminals say ... even with that, my heart asks to find Luis Angel," Rodriguez said. "For me Luis Angel is still missing."
Predicting events such as Connecticut school shooting not easy
by Lindsey Tanner
CHICAGO - It happened after Columbine, Virginia Tech, Aurora, Colo., and now Sandy Hook: People figure there surely were signs of impending violence. But experts say predicting who will be the next mass shooter is virtually impossible - partly because as commonplace as these calamities seem, they are relatively rare crimes.
Still, a combination of risk factors in troubled kids or adults including drug use and easy access to guns can increase the likelihood of violence, experts say.
But warning signs "only become crystal clear in the aftermath, said James Alan Fox, a Northeastern University criminology professor who has studied and written about mass killings.
"They're yellow flags. They only become red flags once the blood is spilled," he said.
Whether 20-year-old Adam Lanza, who used his mother's guns to kill her and then 20 children and six adults at their Connecticut school, made any hints about his plans isn't publicly known.
Fox said that sometimes, in the days, weeks or months preceding their crimes, mass murderers voice threats, or hints, either verbally or in writing, things like `"don't come to school tomorrow,"` or `"they're going to be sorry for mistreating me."` Some prepare by target practicing, and plan their clothing "as well as their arsenal." (Police said Lanza went to shooting ranges with his mother in the past but not in the last six months.)
Although words might indicate a grudge, they don't necessarily mean violence will follow. And, of course, most who threaten never act, Fox said.
Even so, experts say threats of violence from troubled teens and young adults should be taken seriously and parents should attempt to get them a mental health evaluation and treatment if needed.
"In general, the police are unlikely to be able to do anything unless and until a crime has been committed," said Dr. Paul Appelbaum, a Columbia University professor of psychiatry, medicine and law. "Calling the police to confront a troubled teen has often led to tragedy."
The American Academy of Child & Adolescent Psychiatry says violent behavior should not be dismissed as "just a phase they're going through."
In a guidelines for families, the academy lists several risk factors for violence, including:
Previous violent or aggressive behavior
Being a victim of physical or sexual abuse
Guns in the home
Use of drugs or alcohol
Brain damage from a head injury
Those with several of these risk factors should be evaluated by a mental health expert if they also show certain behaviors, including intense anger, frequent temper outbursts, extreme irritability or impulsiveness, the academy says. They may be more likely than others to become violent, although that doesn't mean they're at risk for the kind of violence that happened in Newtown, Conn.
Lanza, the Connecticut shooter, was socially withdrawn and awkward, and has been said to have had Asperger's disorder, a mild form of autism that has no clear connection with violence.
Autism experts and advocacy groups have complained that Asperger's is being unfairly blamed for the shootings, and say people with the disorder are much more likely to be victims of bullying and violence by others.
According to a research review published this year in Annals of General Psychiatry, most people with Asperger's who commit violent crimes have serious, often undiagnosed mental problems. That includes bipolar disorder, depression and personality disorders. It's not publicly known if Lanza had any of these, which in severe cases can include delusions and other psychotic symptoms.
Young adulthood is when psychotic illnesses typically emerge, and Appelbaum said there are several signs that a troubled teen or young adult might be heading in that direction: isolating themselves from friends and peers, spending long periods alone in their rooms, plummeting grades if they're still in school and expressing disturbing thoughts or fears that others are trying to hurt them.
Appelbaum said the most agonizing calls he gets are from parents whose children are descending into severe mental illness but who deny they are sick and refuse to go for treatment.
And in the case of adults, forcing them into treatment is difficult and dependent on laws that vary by state.
All states have laws that allow some form of court-ordered treatment, typically in a hospital for people considered a danger to themselves or others. Connecticut is among a handful with no option for court-ordered treatment in a less restrictive community setting, said Kristina Ragosta, an attorney with the Treatment Advocacy Center, a national group that advocates better access to mental health treatment.
Lanza's medical records haven't been publicly disclosed and authorities haven't said if it is known what type of treatment his family may have sought for him. Lanza killed himself at the school.
Jennifer Hoff of Mission Viejo has a 19-year-old bipolar son who has had hallucinations, delusions and violent behavior for years. When he was younger and threatened to harm himself, she'd call 911 and leave the door unlocked for paramedics, who'd take him to a hospital for inpatient mental care.
Now that he's an adult, she said he has refused medication, left home, and authorities have indicated he can't be forced into treatment unless he harms himself - or commits a violent crime and is imprisoned. Hoff thinks prison is where he's headed - he's in jail, charged in an unarmed bank robbery.
American Academy of Child & Adolescent Psychiatry: http://www.aacap.org
FY 2012: ICE announces year-end removal numbers, highlights focus on key priorities and issues new national detainer guidance to further focus resources
WASHINGTON – U.S. Immigration and Customs Enforcement (ICE) Director John Morton today announced the agency's fiscal year (FY) 2012 year-end removal numbers, highlighting trends that underscore the administration's focus on removing from the country convicted criminals and other individuals that fall into priority areas for enforcement. To further focus ICE resources on the most serious criminal offenders, ICE today also issued new national detainer guidance . This guidance limits the use of detainers to individuals who meet the department's enforcement priorities and restricts the use of detainers against individuals arrested for minor misdemeanor offenses such as traffic offenses and other petty crimes, helping to ensure that available resources are focused on apprehending felons, repeat offenders and other ICE priorities. It is applicable to all ICE enforcement programs, including Secure Communities.
"Smart and effective immigration enforcement relies on setting priorities for removal and executing on those priorities," said Director Morton. "In order to further enhance our ability to focus enforcement efforts on serious offenders, we are changing who ICE will issue detainers against. While the FY 2012 removals indicate that we continue to make progress in focusing resources on criminal and priority aliens, with more convicted criminals being removed from the country than ever before, we are constantly looking for ways to ensure that we are doing everything we can to utilize our resources in a way that maximizes public safety."
Department of Homeland Security (DHS) Secretary Janet Napolitano has directed ICE to focus its resources on key priorities in all aspects of its immigration enforcement efforts. ICE's implementation of this directive includes today's new national detainer policy, as well as the continued use of investigations and programs like Operation Cross Check that target criminal aliens and ICE's expanded collaboration with U.S. Customs and Border Protection to remove recent border crossers.
ICE priorities include the identification and removal of those that have broken criminal laws, threats to national security, recent border crossers and repeat violators of immigration law. Overall, in FY 2012 ICE's Office of Enforcement and Removal Operations removed 409,849 individuals. Of these, approximately 55 percent, or 225,390 of the people removed, were convicted of felonies or misdemeanors – almost double the removal of criminals in FY 2008. This includes 1,215 aliens convicted of homicide; 5,557 aliens convicted of sexual offenses; 40,448 aliens convicted for crimes involving drugs; and 36,166 aliens convicted for driving under the influence.
ICE continues to make progress with regard to other categories prioritized for removal. Some 96 percent of all ICE's removals fell into a priority category – a record high.
To support DHS' efforts to secure our nation's borders, ICE prioritizes the identification and removal of recent border crossers and conducts targeted enforcement operations with the U.S. Border Patrol. The historic results along the Southwest Border are attributable to the joint efforts of U.S. Border Patrol agents and ICE officers and agents, and the emphasis ICE places on the removal of recent border crossers.
As part of the effort to ensure that the immigration system can focus its resources on priority cases, ICE has also implemented policies and processes that ensure that those enforcing immigration laws make appropriate use of the discretion they have in deciding the types of individuals prioritized for removal from the country. In addition, ICE has also decided not to renew any of its agreements with state and local law enforcement agencies that operate task forces under the 287(g) program. ICE has concluded that other enforcement programs, including Secure Communities, are a more efficient use of resources for focusing on priority cases.
ICE will continue to analyze its policies and the results of its programs, making improvements where necessary to meet our priorities.
Visit our immigration enforcement Web page for more information.