Dr. Henry Paul, MD

Psychiatrist, Author and Educator

MENTAL ILLNESS AND THE ADA

March 31st, 2015

Did you know that Mental Illness is among the illnesses and disabilities covered by the Americans with Disabilities Act? Not many people know it. The United States government covers a lot under the ADA. It includes mental health disorders that fall within the guidelines of the ADA but it does not list specific mental illnesses.

Under the ADA, a person has a disability if they have a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment.

It is great that the ADA can cover mental illness, but the scary part is that you have to tell others that you have it. Telling your co-workers or your boss can be the hardest. There is no right or wrong answer about telling your boss or others that you have a mental disorder. Although, if suddenly you are unreliable, your work drops off, and you no longer are the team player you used to be, then your boss will notice.

The ADA protects you from being fired from your job or rejected for employment. It also provides accommodations at work. Again, this is helpful, but you have to be willing to reveal your diagnosis. It most likely will depend on the overall benefit to you at work. Some people with mental health impairments will have a disability under the ADA and some will not.

The World Health Organization predicts that by 2020, mental illness will be the second leading cause of disability worldwide, after heart disease. Right now major mental disorders cost the nation at least $193 billion annually in lost earnings alone, according to a new study funded by the National Institute of Mental Health, and the direct cost of depression to the United States in terms of lost time at work is estimated at 172 million days yearly.

Here is a list of the possible mental disorders that could fit under the ADA. Notice I said “could” because the decision is based on your symptoms and the effect they have on your ability to do your job.

I want to see a national dialog about mental health that helps employers to understand the importance of having an employee who is both physically and mentally well. In order for employees to benefit from the ADA they have to be willing to share their diagnosis. Sadly, it is still a reality in America today that people with mental illness are somehow labeled or looked upon differently. I am proud to say that we are making strides in this country to change those stereotypes. I only wish it could happen faster. Putting mental health problems on an equal footing with physical illnesses will, in the end, benefit all.

Click here to read one woman’s struggle to decide to reveal her Bipolar Disorder diagnosis.

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

SHOULD I WORRY ABOUT THE MUSIC MY TEEN LISTENS TO?

March 30th, 2015

“Music lyrics have undergone dramatic changes since the introduction of rock music more than 40 years ago. This is an issue of vital interest and concern for parents and pediatricians.” American Academy of Pediatrics

As an adolescent psychiatrist for over thirty years, I have been asked over-and-over about the influence that music has on teenagers. The concerns that parents have about today’s music are very real. Parents worry about the suggestive nature of the lyrics and the influence it will have on their children. Even worse, parents are scared that the music might be harming their children.

For the most part, listening to music is a healthy, relaxing and very natural thing. Teenagers listen to music for a host of reasons. For many of them music is at the center of their lives socially and culturally and listening to music is important to fitting in.

I think music reveals a lot about a person and can be a window to one’s soul. It can help quieter teenagers to express themselves, and it can express emotions that tempestuous adolescents may not be able to voice.

It is difficult for parents to hear songs about drugs, nirvana, suicide, gangs, racism, sexism, and sex. It is scary to think that your child is taking those lyrics to heart. Teenagers experiment with different types of music, and often much of it is just a phase. Remember, the songs that you listened to in high school that your parents thought were suggestive? Most likely your parents weren’t happy when you were listening and singing those lyrics either.

As with many other trends, the music phase will pass without any lasting damage. Music only becomes a concern when your teenager is manifesting other emotional difficulties and is using music-listening to get away from problems, to substitute for real-life activities, or to accompany a depressive withdrawal. In these cases, the music is giving your teenager a message about depression, severe social problems, drug use, and even suicide plans and parents must intervene. Parents should not turn off the music. Instead, learn about the music. Today you can find the lyrics to almost any song on the Internet, so GOOGLE the artist and the song. That is the best way to assess the lyrics. Then have a discussion about it with your son or daughter. You will get a glimpse of what is bothering your teenager and then, if necessary, you can seek required help. Click here for recommendations from Common Sense Media to help you talk with your teenager about the music they are choosing to listen to.

WHY MEDICATION?

March 24th, 2015

I do not believe that every child with a mental disorder needs medication, but I do feel strongly that some do. To withhold these important therapeutic agents can be harmful and, in some cases, tragic. However, I fully understand why parents are often anxious, hesitant, and concerned about their children’s welfare. All too often, such feelings arise from the biased, misleading, and even fabricated stories that are conveyed through the media and on the Internet.

I have experience prescribing almost all of the current psychotropic drugs and have treated children and teenagers with all the varied disorders listed in the diagnostic manuals. I have seen the therapeutic effects of medication when administered properly, the harmful effects when they are abused or prescribed incorrectly, and have observed the side effects that very rarely occur.

In my book, When Kids Need Meds, I try to alleviate some of the misconceptions and the fears. I discuss the mental disorders, explain the process of psychiatric evaluation, answer the many questions, and talk about stimulants, antidepressants, antipsychotics, mood stabilizers, sleep medications, and anti-anxiety drugs. I focus on the importance of non-medication therapies, too. I also provide references for readers to obtain more information.

Friendly and easy to use and read, this guide covers almost every aspect of an extremely important and very prevalent topic to educate, comfort and provide support. I believe parents will find it invaluable.

Now through the month of April I am offering free copies of my book. If you are interested in a copy please email me at drpaul@henrypaulmd.com.

Here is a link to an excerpt from the book.

HEROIN AGAIN!

March 19th, 2015

“New York City is now the “nation’s most significant” heroin hub,” according to city Special Narcotics Prosecutor Bridget Brennan. NY Post, 3/16/15, NY is now heroin central: narcotics prosecutor

I have been writing about heroin now for over a year in my blog, and the heroin situation just continues to get worse. Heroin is an epidemic that has taken America by storm. I cannot impress enough on parents that they need to educate themselves about the dangers of prescription painkillers and the rising use of heroin. These threats are particularly dangerous to our teenagers and young adults.

Here are some facts on Heroin from the DEA’s Prevention4teens:

Narcotics (such as heroin, morphine, OxyContin, etc.) are used to dull the senses and reduce pain. Narcotics can be made from opium (from the opium poppy) or created in a laboratory (synthetic and semi-synthetic narcotics).”
Heroin is a narcotic which can be injected, smoked or snorted. It comes from the opium poppy grown in Southeast Asia (Thailand, Laos and Myanmar— Burma); Southwest Asia (Afghanistan and Pakistan), Mexico and Colombia. It comes in several forms, the main ones being “black tar” from Mexico (found primarily in the western United States) and white heroin from Colombia (primarily sold on the East Coast). In the past, heroin was mainly injected. Because of the high purity of the Colombian heroin, many users now snort or smoke heroin. All of the methods of use can lead to addiction, and the use of intravenous needles can result in the transmission of HIV.
Heroin Effects: Euphoria, drowsiness, respiratory depression, constricted pupils, and nausea.
- Overdose Effects: Slow and shallow breathing, clammy skin, convulsions, coma, and possible death.
- CSA Schedule: Heroin has no legitimate medical use: Schedule I.
- Street Names: Horse, Smack, Black Tar, Chiva, and Negra (black tar).
Denial Can Make the Problem Worse: Some parents may be afraid to confront the realities of drug use, so they may deny the truth, even to themselves. You may have heard some adults say: “My kid doesn’t use drugs.” “It’s not a problem for our family.” “I used drugs and survived.” “Drug use is a normal part of growing up.” “We’ll never solve the drug problem.” “Alcohol is more dangerous than marijuana.”

I recommend that you attend a forum at your local high school or a community coalition awareness forum to learn more about the substance and heroin abuse in your community. Many local coalitions are forming around the country to educate the public, parents and teens about the dangers of heroin and the painkillers that often are the “gateway” drug to it.

Some of the latest newspaper stories about the heroin epidemic:
Schumer Moves to Reverse President’s Cut in Critical Drug Trafficking Program
Man accused of stashing heroin in daughter’s diaper
4-year-old hands out heroin at daycare
Cops seize $2.5M worth of heroin in Bronx raid
Schumer slams Obama’s proposed cuts to anti-drug program

Disclaimer

This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

PSYCHOTROPIC MEDICATION USE AMONG ADOLESCENTS

March 18th, 2015

I came across an interesting study this week that I want to share. Although, it has been out about a year, the information provided in it is quite interesting and still relevant. At the end of 2013, it was reported that more than six percent of adolescents were taking psychotropic medications. These medications are to help treat the symptoms of a mental disorder. Depression and ADHD are the most common mental health disorders among adolescents.

I have often stated that these drugs are not a cure-all but rather aid in alleviating symptoms. Suppressing the symptoms provides a child the opportunity to develop better life-skills and strategies to deal with their disorder. The hope is that, with time and teaching, they will develop the ability to manage their disorder without medication.

Remember, a mental disorder is a group of signs or symptoms the psychotropic drugs treat. Many psychiatrists, myself included, see these signs and symptoms as only part of the overall problem. Much like a fever – signs and symptoms are an indicator of an underlying and not so obvious condition. I believe, as do many of my peers, that the underlying condition is as important to diagnose and treat, as are the signs and symptoms.

So what are underlying conditions? To believe in the concept of “underlying”, you must be open to another concept: the unconscious mind – the belief that we have thoughts and feelings of which we are unaware. Freud’s discovery of the unconscious mind entered mainstream psychiatry over a century ago. My clinical experience, as well as that of my thousands of colleagues who work every day in the curious world of underlying issues, makes it clear that signs and symptoms have their origins deeper in the personality.

What is their cause? In a nutshell, I believe that stresses in early life can lead to unresolved conflicts and anxiety. Many of us outgrow these difficulties as we mature. For others, the underlying tension leads to signs and symptoms that we call mental disorders. Which signs and symptoms we develop are based mostly on our genetic makeup. We can treat the symptoms very well with psychotropic medication, but it is almost always necessary to explore the underlying issues to free a person to develop to their full potential.

I believe that parents should not be afraid to give their adolescent medication when it is recommended by a medical professional. I almost never prescribe medication without a recommendation for psychotherapy, too. For many children and teenagers, the symptoms are so bad that therapy can’t even take place until the medication brings some relief.

After treating children and adolescents for more than 30 years, I can tell you first-hand that medication is most helpful to symptom relief. It will often give an adolescent enough of a reprieve from their symptoms to gain from other therapies. From talk therapy to special educational settings, these therapies can lead to a better quality of life for the adolescent and the family.

Click here to read the report.

When Kids Need Meds; Everything a Parent Needs to Know About Psychiatric Medication and Youngsters

A VERY SAD STORY

March 17th, 2015

Suicide is every parent’s nightmare. On an ongoing basis, there are pressures in teenager’s lives that we know about, and we don’t know about. It’s never simple. In the case of 13 year-old Cayman Naib who was found near his home with a self-inflicted gunshot wound last week, I am sure there are a lot of questions that friends, teachers, and family are asking themselves.

According to the CNN story, Naib left shortly after receiving an email from the school about overdue homework. Most likely that was not the trigger for his suicide. As an adolescent psychiatrist, I know that these stories are usually far from complete. I believe there might have been signs of pre-suicidality that were missed. A suicide rarely happens out of the blue after an email about homework, although sometimes a suicide does appear to come out of nowhere. More often some social rejection or another stressor is present.

Psychological testing of all students is not practical, but the good education of teachers (see our recent blog) and parents to signs of depression or other mental disorders is best.

I think it needs to be pointed out that suicide does not discriminate. The best defense against these situations is knowledge, and the courage of parents to ask the right questions. Here is a list of warning signs that I posted for parents in an earlier blog.

I want to make it clear that knowing the warning signs of suicide can save lives, but it certainly is no guarantee. Hopefully, families that are faced with the suicide of a loved one can eventually find peace, and they need to know that this is not their fault.

Click here for more on Cayman Naib’s story.

“FREE RANGE” PARENTING

March 11th, 2015

A Maryland couple who was being investigated for allowing their two children to walk home alone from a neighborhood park have been “found responsible for unsubstantiated child neglect” by the state’s Child Protective Services. ABC News, ‘Free Range’ Parents Found Responsible for Child Neglect After Allowing Kids to Walk Home Alone, By Candace Smith and Lauren Efron, 3/3/2015

First we heard about “helicopter parents” — those parents who “hover” around their children to protect them from the dangers of growing up. Now we hear about “free range” parents. The complete opposite of helicopter parents, these parents believe that their children must experience life to learn its valuable lessons.

There are more and more stories in the news every day analyzing parenting styles – too protective or too lax. When it comes to “free range” parenting it is a little harder to understand the underlying reasons why a parent might want to give their child more responsibility than might seem appropriate for the child’s age, because we hear so many stories of children being hurt, abducted and so on.

I think when it comes to this parenting style there is an over-play of publicity that does not have a lot of facts to substantiate the hype. The important piece of “free range” parenting is to make sure that parents train their child, educate them, and know what level of responsibility the child truly can handle. Freedom has to be partnered with the ability to be responsible.

In the case of Danielle and Alexander Meitiv they believe that the best way to raise children is to give them the freedom to play, walk and explore without parental supervision – much how they were both raised.

In an interview today with WBUR Radio’s “Here & Now” Danielle said, “We’re just doing what our parents did and their parents did and that’s letting children have some freedom and independence in their local neighborhood. So far they’ve gone about a mile, that’s the area we’ve shown them and taught them about, but as they get older they can go a little further on their bikes, but for now it’s within a few blocks to a mile from our house.”

Her husband added, “This is child-directed. They ask for more independence and we evaluate whether they’re ready for that level of independence. First, we train them. We train them to cross streets, we tell them how to avoid dangers and when we judge that they’re ready for that level of independence we give it to them.”

I want to emphasize that each family has do what is right for them based on their knowledge of their child. It seems that the Meitiv’s were working on doing just that. There are no hard and fast rules for “free range” parenting or parenting, in general. If children came with directions, it would be easier, but they don’t. They come with something better – loving parents who want the best for their children. It would be presumptuous for us to judge these parents for choosing this parenting style and for us to recommend universal practices for parenting.

Here is a link to the WBUR interview. Make sure to check out the comments.

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

YOU CAN MAKE A DIFFERENCE IN THE GROWING HEROIN EPIDEMIC

March 2nd, 2015

“What we’re seeing now is the pendulum swing from the legislation that was developed around prescription medications,” said Mark Gilmore, senior investigator with the Putnam County sheriff’s office. “The e-prescription program went into effect and cut off the supply line of falsified prescriptions. And that,” he said, “has made addicts turn to a quick, cheap fix in the form of heroin.” Senator Murphy pitches plan to combat heroin. Amanda Purcell, Poughkeepsie Journal, 2/27/2015

For the past year, I have been blogging about the growing heroin epidemic in the United States. This growth is in large part due to the “gateway drugs” known as painkillers.

Elected officials in New York State have turned up the heat on the heroin epidemic (and it is an epidemic!) by forming coalitions and doing community education and outreach. Through awareness campaigns targeted at educating parents about the drug dangers facing their children, and at educating the children and the community at large, it is believed that we can fight this growing epidemic.

Heroin does not discriminate. From the wealthy to the poor, the cities to the suburbs, and the college campuses to the streets – heroin is big a problem.

Senator Terence Murphy (40th District) representing the New York City suburb communities in Westchester, Putnam and Dutchess counties said in a recent interview with the Poughkeepsie Journal (the Gannett daily newspaper) that, “I campaigned on this. I’m three weeks into my tenure here and I want to get out of the gate swinging,” Murphy said. The article went on to say, “Statewide, there were 89,000 heroin and prescription painkiller treatment admissions in 2013, 25,000 more than in 2004, according to Gov. Andrew Cuomo’s office. Locally, treatment facilities are full, or near to full, and recently, federal, county and local law enforcement arrested 21 and seized $1 million worth of the drug.”

After one of the biggest heroin drug busts in Westchester County in January, Westchester County Police Commissioner George Longworth said during a press conference announcing the arrests, “Some people may think that heroin is only an inner-city problem, but it’s not, Heroin is being sold on tree-lined streets. It is being used by — and sold by — young people who live in comfortable homes and circumstances. No community is immune.”

Senator Murphy is taking his message on the road saying that he intends to hold a forum every two to three weeks in his district. He held his first last week. If you have the opportunity to go to Senator Murphy’s forum or a forum in your district or at the local high school – GO! The more ALL of us understand this epidemic the better equipped we will be to stop it.

The specifics of Murphy’s plan include:

Sponsoring legislation to require insurance companies to cover drug treatment and rehab up to ninety days;
Using drug seizure proceeds to provide funding for NARCAN, a potentially life-saving overdose treatment, to all first responders;
To help with prevention, state funding for school resource officers (Police SROs) and Drug Abuse Resistance Education (DARE) in all area schools by restoring the Gap Elimination Adjustment school aid cuts made by Senate Democrats in 2010;
Forming an federal-interstate-local joint, inter-agency law enforcement counter-narcotics proliferation task force and removing legal barriers to data sharing, aspects of which are already underway;
A state grant program for a local narcotics units to provide stepped up enforcement against drug distributors;
Increasing penalties for major narcotics traffickers; and
Restoring funding cuts enacted by Senate Democrats to the NYS Office of Alcoholism and Substance Abuse Services (OASAS) to fund peer recovery advocate, addiction services and treatment programs.

Ten years ago, most people never knew a person who died from a heroin overdose. Today, most people know of someone – a friend of a friend, the girl up the road, the son of a friend at work, their niece, son, brother or sister – and the list goes on. More awareness outreach and more money for law enforcement are needed to combat the “heroin epidemic” on the streets. Find out how you can help in your community. We all can make a difference.

Previous blogs on heroin:

GOVERNOR CUOMO RECOGNIZES THE HEROIN EPIDEMIC AND IS DOING SOMETHING ABOUT IT

THE GROWING HEROIN PROBLEM IN AMERICA

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.