How to cover mental health - and abide by the moral imperative

To paraphrase Bob Woodward, journalists – and their readers – should seek the truth or, more realistically, the “most obtainable version” of it.

But in its coverage of crime that involves people with mental illness, the media has consistently produced information that is incomplete, inconsistent and, as a result, untruthful to the point of outrageousness.

In such matters, the media needs to grasp the complexity of mental illness – which would include developing an understanding of the background, symptoms and effects of schizophrenia, bipolar disorder and other illnesses – before going to print or doing a broadcast.

But the media has too often chosen the low-road and typically gone for the fear-mongering, consumer-driven components of a story rather than promoting a profound understanding that – if they tried – could attract the same amount of readers they normally get, as well as perform a public service.

The media also have failed to provide a consistent balance in the form of an alternative viewpoint that could help explain – and lend clarity to – such issues. Providing balance in crime news could help shape a new understanding of mental illness and, perhaps, help people better understand why certain crimes are committed.

Perhaps the biggest culprit is the tabloid media, which has developed its own vocabulary of terms to paint people with mental illness as less than desirable. These news outlets routinely dehumanize people by labeling them with derogatory terms such as “wacko” or “loon” – even if the story has a remote connection, or even lacks any association, with mental illness.

Language is, perhaps, the media’s sharpest weapon, and it’s allowed The New York Post, The New York Daily News and many papers like it to be seduced by the need to condense, shock, outrage and, ultimately, demean those with mental illness. A search of newspaper headlines through the Lexis-Nexis online research site, for example, revealed that, since March 1995, the word “wacko” has appeared in articles published by The Daily News and The Post more than 500 times (The same term was used in The New York Times, which has shown more sensitivity toward mental health issues, 238 times, but not one appeared in a headline). The term was sometimes used to describe some cases where mental illness was not necessarily an issue – but, because of the headline, it’s either unfairly implied or alleged that mental illness was connected to crime, or it was even the direct cause of it.

One such Daily News headline on April 20, 2004 read thusly: WEB HATE SITES LURING SICKOS, WACKOS, WEIRDOS. Toward that end, Michael Jackson is always an easy target, such as this example from the Daily News on April 1, 2004: JACKO GOES MUM BUT STAYS WACKO. On March 14, 2004, this headline appeared in The New York Post: STANDOFF; WACKO HOLDS GRANNY HOSTAGE.

None of these stories, however, produced any evidence that the people described as “wacko” were ever diagnosed with a mental illness. Has Michael Jackson ever even visited a psychiatrist?

Sometimes, these editorial headline decisions are made BEFORE the facts of a particular case come to light. The Feb. 7, 2007 issue of Columbia Journalism Review, for instance, cited the reporting of the bizarre adventures of Lisa Nowak as an example, noting the former astronaut “soared” across newspaper front pages earlier this year not for her recent shuttle mission to the international space station, but for the details surrounding her arrest and subsequent charges for attempted murder and kidnapping.

As CJR noted, Nowak had recently separated from her husband of 19 years, with whom she had three children. She graduated from the U.S. Naval Academy and worked at NASA for more than 20 years. Many news reports, however, focused not on her accomplished background or her recent marital troubles, but on the sensationalistic case evidence produced by police: Nowak allegedly wore adult diapers so she wouldn’t have to stop during her 900-mile road trip to confront Air Force Capt. Colleen Shipman, whom Nowak allegedly considered a rival for the affections of another astronaut, William A. Oefelein, according to CJR.

Twenty-four hours after the story broke, it was still unclear whether Nowak suffered from any illnesses related to mental health. Still, the news media jumped on this story and immediately applied derogatory mental health terms to describe the disgraced astronaut and her adventures – none more so than The New York Daily News, which displayed a front page, bold-type, black-and-white headline that said: “Dark Side of the Loon.” To this day, it’s still unclear whether Nowak suffers from any type of mental illness, but it didn’t matter: The Daily News had effectively dehumanized her before she even had a diagnosis from a psychiatrist.

In some ways, television news – particularly Fox News – has adopted the same kind of shock-and-awe philosophy as The Post and The Daily News. The 24-hour news outlets have helped promote that approach by employing commentators who offer strongly worded diatribes that strike a nerve with a public that’s weary of random, unexplained kidnappings and killings in today’s society.

Bill O’Reilly, host of “The O’Reilly Factor,” has, perhaps, taken this approach a step further than most commentators, making it his regular practice to use the word “loon” to describe anyone who is undesirable or, more accurately, anyone who disagrees with him. In the process, he’s reinforced his obvious bias against people with mental illness more often than he promotes his line of clothing. Just three months ago, a quick search of "Bill O'Reilly" and "loon" on You Tube yielded no more than 10 video-clip entries. Now the list is endless - page after page shows O'Reilly equating "loons" with pedophiles and people who exhibit other forms of inappropriate behavior – as well as the “far left” peace advocates who protest against the Iraq war. Other talk-show hosts who imitate him have caught on, too, and they've made continuous references to "left-wing loons" and other groups.

Here is an example of one such O’Reilly diatribe, taken from his nationally syndicated newspaper column published on Nov. 12, 2007 and entitled “Never mind the far-left loons, the war on terrorism is real.” Notice how “lunacy,” in O’Reilly’s mind, essentially boils down to stupidity:

“So now the far-left loons in the media are saying there really isn’t an organized terror threat in the world and this whole war on terror deal is a hype job,” he wrote. “That must come as great comfort to the thousands of families who lost loved ones on 9/11. They must really appreciate the St. Louis Post-Dispatch editorializing: ‘After nearly six years of hearing the Bush administration make assertions about the war on terrorism that turn out – to put it kindly – overblown.’ I’m just wondering how ‘overblown’ the terror war is for the five thousand individuals injured when al-Qaida blew up two U.S. embassies in Africa, not to mention the 257 human beings who were murdered in that attack. But it might be hard to comprehend ‘overblown’ when you’re dead.

“The nutty professor Paul Krugman, who teaches at Princeton and writes op-ed lunacy for The New York Times, is also on the diminish-terror bandwagon. This is from his desk: ‘There isn’t any such thing as Islamofascism – it’s not an ideology; it’s a figment of the neocon imagination.’ That’s like saying there is no such thing as stupidity, right, professor?”



The gotcha headlines, some media have argued, attract people who otherwise wouldn’t give a damn about what’s going on in the world around them. In a Dec. 20, 2001 article published by the Asia News Network, Fox News chairman Roger Ailes defended his network’s overall approach to news and how it deals with crime and terrorism stories by saying: “Look, we understand the enemy... They want to murder us. We don't sit around and get all gooey and wonder if these people have been misunderstood in their childhood. If they're going to try to kill us, that's bad.”

But all that is beside the point. To quote Albert Brooks in the movie “Broadcast News,” they’re burying the lead, and not reporting on the root cause of the murder or what can be done to prevent such horrific acts from happening again.

In a June 16, 1995 New York Times article, reporter Lisa Foderaro noted: “Language is such a sensitive area in the mental health field because it can reflect an individual's very notion of what mental illness is – whether a serious disease or merely a psychiatric label put on an emotional crisis or an altered state of consciousness – and because it can be belittling or empowering.” She then quoted Nora Weinerth of the National Stigma Clearinghouse in New York, who said: “When language is used to devalue, it shapes attitudes that, in turn, become public policy.”

Having balanced coverage would perhaps counteract against the stereotypes. In criminal matters, reporters could give mental illness awareness efforts the same kind of respect they give to police departments who want to inform a public about a suspect who’s on the loose. If a reporter discovers that a suspect is schizophrenic, or obsessive compulsive, or bipolar, maybe he or she should call up psychiatrists or the National Alliance on Mentally Illness to learn more about the illness, and then report on it. Psychiatrists, psychologists or advocates could be on the same “call list” – right alongside the police – when a murder takes place and the evidence is clear that the suspect has a mentally illness.

The New York Times is, perhaps, one of the few who “get it” and explore what happens in criminal cases involving people with mental illness as well as revealing the so-called “dark side” of the suspect. It was, in fact, one of the first publications to explore what happened to Andrew Goldstein before he pushed Kendra Webdale to her death on a subway track in New York City. The man was diagnosed with schizophrenia, and he had failed numerous times to get treatment before he killed the 32-year-old woman eight years ago.

In a May 23, 1999 New York Times Magazine article, the newspaper explained how there were numerous attempts to get Goldstein help before he committed murder. But the system failed him like it failed many others. According to the Times: “They knew he was dangerous. In the two years before Kendra Webdale was instantly killed on the tracks, Andrew Goldstein attacked at least 13 other people. The hospital staff members who kept treating and discharging Goldstein knew that he repeatedly attacked strangers in public places. They knew because he had attacked them -- two psychiatrists, a nurse, a social worker and a therapy aide in two years' time. Over and over, his hospital charts carried warnings.”

The Times continued: “They knew. Long before this subway push … the state of the nation's shattered mental-health system all but assured such calamities. Yet for each hospitalization – there were 13 in 1997 and 1998 alone – Goldstein was given medication, then discharged, often after just a few days, to live on his own in a basement apartment. And now the consequences were front-page news: ‘Horror on the Tracks,’ read the tabloid headlines, ‘The Face of a Madman.’ ”

Editor's note: This blog entry was originally submitted as an assignment for Richard Wald's Critical Issues class at Columbia University.

Badlands
By Bruce Springsteen

Lights out tonight
trouble in the heartland
Got a head-on collision
smashin' in my guts, man
I'm caught in a cross fire
that I don't understand
But there's one thing I know for sure girl
I don't give a damn
For the same old played out scenes
I don't give a damn
For just the in betweens
Honey, I want the heart, I want the soul
I want control right now
talk about a dream
Try to make it real
you wake up in the night
With a fear so real
Spend your life waiting
for a moment that just don't come
Well, don't waste your time waiting

CHORUS
Badlands, you gotta live it everyday
Let the broken hearts stand
As the price you've gotta pay
We'll keep pushin' till it's understood
and these badlands start treating us good

Workin' in the fields
till you get your back burned
Workin' 'neath the wheel
till you get your facts learned
Baby I got my facts
learned real good right now
You better get it straight darling
Poor man wanna be rich,
rich man wanna be king
And a king ain't satisfied
till he rules everything
I wanna go out tonight,
I wanna find out what I got
Well I believe in the love that you gave me

I believe in the love that you gave me
I believe in the faith that could save me
I believe in the hope
and I pray that some day
It may raise me above these

CHORUS

mmmmmmmm, mmmmm, mmmmmm

For the ones who had a notion,
a notion deep inside
That it ain't no sin
to be glad you're alive
I wanna find one face
that ain't looking through me
I wanna find one place,
I wanna spit in the face of these badlands

CHORUS

From WSJ: In case of a psychiatric emergency, read this:

Before there were living wills, people were just left to die.

And if they had a mental illness, they were left to suffer.

Now - as noted in this entry from the Wall Street Journal's Health Blog - there is a movement to prevent either situation from reaching a crisis point.

And, as the blog noted, it was the Terri Schiavo case that highlighted the importance of giving family directives on what to do when patients are unable to communicate their wishes.

The piece, entitled, "In Case of Psychiatric Crisis, Read This," talks about Psychiatric Advance Directives, or PADs.

It notes: "PADs are legal documents that patients can prepare to state in advance of an acute psychiatric crisis what medications, hospitals and other treatments they would prefer or like to avoid.

Twenty-five states have laws allowing PADs. In North Carolina, a sample form includes such items as preferences about electroconvulsive therapy, or ECT, and tips for medical personnel on how to minimize the use of restraints or seclusion. A model form in Texas lays out details on a patient’s consent, or lack of it, for specific medications. A Michigan form guides a patient in legally designating a personal advocate in case of crisis.

But how are PADs actually used? And what happens if, in the breach, a doctor’s judgment clashes with the stated wishes of the patient? The Health Blog asked medical sociologist Jeff Swanson from Duke University, who’s been active in research on mental health policy and treatment options for people with serious mental illness.

First, Swanson laid out a key difference between the advance directives for psychiatry and those typical for medical care. A living will focuses primarily on “forgoing unwanted treatment,” Swanson said. “The goal of the psychiatric advanced directive is to [help you] recover. You’re trying, in a way, to protect yourself from decisions you might make when you’re ill.”

Swanson explained that an advance directive helps people to maintain some autonomy when they otherwise lose their ability to decide. But there can be legitimate questions about whether patients are thinking clearly when they create PADs, or what to do if they say later that they don’t want to follow their PADs, he said.

Though PADs are legal documents, most state laws on the subject contain override clauses, Swanson said. In a crisis, a doctor can invoke his or her clinical judgment to act in the best interest of the patient, essentially ignoring the PAD. Empirical data are hard to come by. But “clinical experience and anecdotal reports suggest that overrides occur with some frequency,” according to a commentary Swanson published last year in the Journal of the American Academy of Psychiatry and Law.

Are PADs worth the trouble then? Some psychiatrists have wondered if it would make more sense to draw up a crisis plan, rather than a legal document, to guide treatment.

Swanson, who has conducted quantitative and qualitative research on the topic, said that some patients say that even if their directives aren’t followed, they still feel the documents give them respect within the mental health system. “Just the fact that someone needs a legal document for respect is telling,” Swanson said."

PTSD is not just a "war thing."

Post-traumatic stress has a long reach.

But one of its most misunderstood qualities is that it only applies to soldiers who have served in the battlefield.

In fact, it can affect people of any age and stripe - including teenagers and young adults who live in the peaceful fields of suburbia.

And anyone can encounter the kind of heartache and mental anguish that many soldiers feel when they struggle in their return to civilian life.

This is the story of Jill Manges, as reported by insidehighered.com:

Jill Manges guesses that if she’d suffered an epileptic seizure that day in class, she’d still be enrolled at Eastern Illinois University. But Manges, who has post-traumatic stress disorder, instead suffered a flashback during French history that led her to shout and sob uncontrollably.

“I can’t deny the fact that what happened was disruptive,” says Manges, who was sentenced to a year-long suspension by the university judicial board last month for violating two sections of the student conduct code barring the disruption of university functions and the academic environment in particular (see standards Id. and IVa. of this document).

“But I wonder if they would do this to someone who had an epileptic seizure in class or had a hangover in class or had an asthma attack, because that’s disruptive too.”

In a letter to Manges dated September 17, Eastern Illinois’ assistant director of judicial affairs writes that given Manges’ admission that she violated the two code of conduct standards prohibiting disruptive behavior during the September 5 “incident” (in other words, the in-class flashback), and “the seriousness with which the board viewed this incident, it is their recommendation that you be suspended from the university, effective immediately, for a minimum of an academic year through the Spring Semester, 2008, during which you would be prohibited from being on the campus without prior permission of the vice president for student affairs or his designee.”

“This was a very difficult decision for the board because they recognize that you have made progress in dealing with the situation but the board is concerned about your well-being as well as the well-being of the greater EIU community. Therefore, the board encourages you to seek a medical withdrawal from the university,” the letter continues, indicating that should that be Manges’ choice, the board would not submit its suspension recommendation to campus leadership.

“In consequence, as a condition of your readmission to the university,” the letter says, “you will need to provide documentation as evidence of your continued improvement and ability to keep your condition under control....”

Eastern Illinois officials won’t comment on the specifics of Manges’ case. But speaking more broadly about how they handle mental health issues on campus, they stress that they always have students’ best interests at heart.

“Since we’re in such a rural area and some of our services are limited, we realize this may not be the best environment to really serve all students and we also recognize that sometimes a student may not be good in this environment for other students,” says Heather Webb, director of judicial affairs at the university.

“Everything is done on a case-by-case basis,” says Sandra Cox, the director of the counseling center. “Usually when information goes out there, [people] only have a very small portion of the truth, they have a very small portion of the behaviors that are brought up. They have a very small portion of the whole picture.”

A Flashback and its Fall-Out

While enrolled at Eastern Illinois, Manges says she saw a private counselor off campus to deal with her diagnosis of PTSD — a result of the sexual abuse she experienced from 1999 through 2000, when someone she knew not only abused her but also collected money from other men who did the same.

She was sitting in French history class September 5 when she could feel a flashback coming. Trying to leave but unable to exit the room in time, she collapsed before reaching the hallway.

“I don’t remember what happened because I was disassociating, but what witnesses said, what my professor said, is that I started sobbing uncontrollably, shouting, screaming. I was unresponsive; I was just lying on the floor,” Manges says.

For the 10 to 15 minutes the episode lasted (of the 50-minute Wednesday afternoon class), the other 15 students “responded by sitting quietly and letting those of us who needed to act do so,” says David Smith, the professor teaching the course. “I was extremely proud of how the students responded.”

An ambulance came, and Manges declined to go to the hospital. She says it’s her understanding that at least two classes, including her French history class, were canceled, and one other was moved. There were six or seven classrooms on the hall, Smith says, and other professors came into the hallway to see what was going on.

Manges experiences such severe flashbacks – which she describes as akin to reliving a traumatizing event – once every two weeks or so. This was the first time one happened in a public academic setting at Eastern Illinois, she says, although she had a similar experience in a classroom at a community college that she previously attended (she transferred to Eastern Illinois in January of this year).

Upon returning to her room on September 5, Manges says she had two voice-mail messages waiting: one from judicial affairs, asking her to see a campus counselor, and one from the counseling center. Wanting to comply, she called the judicial affairs official, who met Manges to walk her over to the counseling center. The next day, Manges met with judicial affairs for a meeting, and her parents came to the university for a second meeting the day after. “Pretty much the gist of it was she told me how much of a disruption I had caused,” Manges says.

Smith, who says that he was interviewed by several college officials about the incident, adds that in his conversations, judicial affairs staff focused on the flashback and the disruption of classes.

After a hearing September 13, Manges says she learned of the year-long suspension and her option to accept a medical withdrawal. She chose the latter so her family could get her tuition money back. Because of that, she says she can’t appeal the judicial board’s decision. She’s living in her off-campus apartment, with plans to get a job, move to Boston in January and apply to finish college there. She was a junior history major and writing minor at Eastern Illinois. She has no plans to sue, saying she has neither the money nor the time.

Manges says she had come up on judicial affairs’ radar screen once previously, back in the spring when she spoke with a professor about experiencing suicidal thoughts. Manges says she was asked by college officials at that time to sign a behavioral contract agreeing to continue psychological treatment and keep up her academic coursework. Manges, who says she is not suicidal now, signed the contract.

She says that she upheld it and that the contract — and the suicidal ideation she experienced in the spring — did not come up during her judicial board hearing, which focused on the PTSD. She says that a letter from her therapist certifies that she is not a threat to herself or others.

And as Gary Pavela, author of Questions and Answers on College Student Suicide: A Law and Policy Perspective (2006: College Administration Publications), points out, “Research indicates that the odds that a student with suicidal ideation will actually commit suicide are 1,000 to one.” Several national reports following the 1999 Columbine High School shooting show that “it is inadvisable to create the impression that there is some kind of automatic, hair-trigger response to behavior that is viewed as disruptive or that falls outside of the area of disruptive into suicidal ideation,” Pavela says, as the perception of harsh penalties can prevent students from seeking help.

“I don’t know what we can do except to make students aware that this is happening at the campus,” says Manges, who describes a general lack of awareness of mental health issues. “Honestly, because there’s not a lot of knowledge about mental illness, mental illness still has a huge stigma. People don’t understand it; people are scared of it because they don’t understand it.”

“I was certainly disappointed at the outcome,” says Smith, the professor of the French history course. He testified on Manges’ behalf at the judicial board hearing.

“I certainly hoped that the student would be returning to the class, wanted her to come back” — as, he says, did the other students in the course.

“I would hope that in the wake of terrible tragedies like at Virginia Tech that universities don’t close themselves off as places where students can deal with difficult issues.”

Psychology and Behavior

Eastern Illinois administrators say they make a concerted effort to help students deal with their problems while staying on campus. “Whenever possible, we try to work with the student to help them through their mental illness,” says Webb, the judicial affairs director. She mentions the behavioral contracts cited by Manges as one example. A number of situations, including excessive alcohol consumption and suicidal ideation, could result in students being asked to sign a contract, which outline a set of expectations.

“It doesn’t say we expect you not to experience mental health issues. We expect that,” Cox of the counseling center says. “What we look for are changes in behavior.”

Webb says that, whenever it’s appropriate, she contacts the counseling center to see if a voluntary withdrawal might be an option for a student facing charges in the judicial system. In fact, when asked whether there were any inaccuracies in a student newspaper story outlining Manges’ take on what happened, officials clarified a policy stipulating that when mental illness is impacting student behavior, the possibility of a voluntary medical withdrawal is always discussed prior to judicial proceedings.

“[What’s been] put out there is that Eastern has suspended students based on mental health reasons. And that is incorrect,” says Cox. But, she adds, “if there are long-term or consistent behaviors that are in violation of the student conduct code…then we have to look to see, do we have the services for someone who is struggling to a significant extent?”

While Cox says she processes a handful of voluntary withdrawals per week at the university of about 12,000 students, not once in her 11 years at Eastern Illinois has the university had to complete its mandatory withdrawal process for psychological reasons, reserved for the most extreme cases involving threats to the self or others and an inability to take care of oneself.

Yet, while Manges technically signed a voluntary withdrawal form, to her it might as well have been mandatory. “I was between a rock and a hard place. I chose a hard place,” she says. “I’ve always been under the impression that people who take a medical withdrawal do it for themselves. For me, it was something that I was pretty much forced into doing.”

The Bigger Picture

While what Manges says happened at Eastern Illinois may not be common, nor are such experiences uncommon, says Karen Bower, a senior staff attorney at the Judge David L. Bazelon Center for Mental Health Law. Bower says she routinely (more than once a month) gets calls from students who are forced to leave college for mental health reasons.

“They all feel very betrayed by the school and say that being out of school isn’t going to help them,” says Bower, who was involved with recent lawsuits on similar issues against George Washington University and Hunter College of the City University of New York that both ended in settlements.

“We have urged that schools not use disciplinary action for behavior that’s a result of mental illness,” Bower says — echoing Professor Smith’s sentiment that a judicial board hearing didn’t seem like an appropriate venue for addressing his student’s situation.

“I am concerned that judicial affairs as a body is designed to handle certain kinds of cases that this kind of event — when someone is not operating in a voluntary manner — they’re not well-equipped to deal with,” says Smith.

In its model policy, the Bazelon Center recommends that involuntary leave only be used in a situation where an individualized assessment determines that a student is a direct threat to the self or others. Under the Americans with Disabilities Act, Bower adds, colleges are required to provide reasonable accommodations for students. That could mean, in this case, she says, waiving the rule about class disruptions for Manges, or mitigating any sentence.

“I think they think it’s objective, but discrimination based on conduct that’s the result of disability is the same as discrimination based on disability,” Bower says. “The use of the disciplinary system as a whole is really a way of removing students from an environment instead of finding out what kinds of supports and services they need to stay in school and be successful.”

Although college leaders say they have the students’ interests at heart — in addition to the interests of other students — when advocating medical withdrawals, Manges says in her case, at least, the time off won’t be helpful.

“Being in school is extremely important to me and it is part of the healing process. It is my way of reclaiming my life; it is my way of getting back what was stolen from me when I was younger,” says Manges.

“I can’t do anything right now. I can work, I can go to therapy, but I was going to therapy while I was in school.”

Who's "crazy," and is that such a bad thing?

It would be cliche' to say that, to bloggers, Bill O'Reilly is the gift that keeps giving. It would also be inaccurate.

He's more like the cold that won't go away, the rash that won't stop itching or the headache that can't be cured by a double dose of extra-strength Tylenol.

Once again, our favorite target recently used mental health stereotypes to attack people on a personal level. But, as this Miami Herald columnist writes, it's not necessarily a bad thing.

Sometimes, it helps the cause when the repeat offenders continue to perpetuate stereotypes and promote hysteria. It allows people like myself, and Andres Oppenheimer, to expose their ignorance.

Who’s crazy, me or Bill O’Reilly?
By Andres Oppenheimer

On Nov. 8, I had the distinction of being called “a crazy columnist” and a “nut” on prime-time television by conservative Fox News anchorman Bill O’Reilly for a column I had written about the urgent need for a comprehensive solution to America’s immigration crisis.

I’m not going to disqualify O’Reilly — or the CNN anti-immigration crusader Lou Dobbs — as a Hispanic-phobic hate monger. Rather than trying to smear him, as O’Reilly did to me, I will focus on how deceiving his arguments are. You judge.

First, the facts. In my Nov. 4 column, “Angry migrant underclass might erupt in U.S.,” I argued that the rapid escalation of the U.S. anti-immigration hysteria is a dangerous trend. It will create an underclass of nearly 13 million people who won’t leave this country, who can’t realistically be deported and who — if deprived of a path to earned legalization — will become increasingly frustrated and angry, I said.

I even used the word “intifada” — granted, I wanted to grab your attention — to describe the worst-case scenario of what could happen if undocumented immigrants are given absolutely no legal path to earned upward mobility. In that context, I cited the examples of the Palestinian youths’ riots in Israel in the 1990s and the 2005 riots by Muslim youths in the suburbs of Paris.

My main point was that the estimated 1.8 million U.S.-raised undocumented youths — who were brought to this country as toddlers, often speak no other language than English and don’t even remember their countries of origin — will soon be thrown into the U.S. labor market with zero chances of getting a legal job.

What is going to happen with these youths? Most are barred from applying for in-state college tuition and will grow up on the streets. Many of them will join the gangs that are already terrorizing many U.S. cities. Undocumented kids, especially the brightest ones, need to be given an opportunity to gain U.S. citizenship, as was contemplated in the Dream Act that was recently defeated in the U.S. Senate.

As soon as my column was published, I was flooded with e-mails from all over the country. By Wednesday, MiamiHerald.com Web site had a whopping 93 pages of comments on the column. Many of them were openly hostile against Hispanic immigrants and claimed — wrongly — that my column was inciting violence.

On Nov. 8, O’Reilly said in an on-air conversation with Fox News analyst Laura Ingraham that “there is a crazy columnist in Miami, Miami Herald, who says that the Hispanics are going to rise up.”

Ingraham said I was “intimating something akin, Bill, to a race war. ... It’s insane.” He responded, “He’s a nut. He’s a nut, this guy.” She added that I am part of “a crazy far-left anarchist wing” of the immigration debate.

My opinion: For the record, I never called for violence, nor would I. Suggesting that I was endorsing violence, as was done in the O’Reilly show, is irresponsible journalism.

But even more irresponsible is what O’Reilly and other cable television anti-immigration crusaders are doing every day: inciting Americans to rebel against “illegal immigrants” — most of whom are Hispanic — without offering any realistic solutions to America’s immigration problem.

As long as the income gap between the United States and Latin America continues to be as wide as it is, as long as U.S. employers keep welcoming undocumented immigrants to do low-paid work and as long as U.S. consumers continue to prefer paying less for services performed by undocumented workers, the immigration flow will continue, no matter how many stretches of fence we place along the 2,000-mile border.

If we want to reduce illegal immigration, we will have to allow greater legal immigration and at the same time increase economic ties with Latin America to help our neighbors grow and reduce their people’s pressures to emigrate.

Above all, we need to give the 1.8 million U.S.-raised undocumented children an earned path to legalization. Otherwise, we will be creating an underclass of social pariahs, many of whom will end up joining street gangs.

Are these fears crazy? Am I nuts? You decide.

Andres Oppenheimer is a Latin America correspondent for the Miami Herald. E-mail: aoppenheimer@miamiherald.com.

From Marlboro man to PTSD

From the San Francisco Chronicle:

The photo of the "Marlboro Man" in Fallujah became a symbol of the Iraq conflict when it ran in newspapers across America in 2004. Now the soldier has returned home to Kentucky, where he battles the demons of post-traumatic stress.

The photograph hit the world on Nov. 10, 2004: a close-cropped shot of a U.S. Marine in Iraq, his face smeared with blood and dirt, a cigarette dangling from his lips, smoke curling across weary eyes.

It was an instant icon, with Dan Rather calling it "the best war photograph in recent years." About 100 newspapers ran the photo, dubbing the anonymous warrior the "Marlboro Man."

The man in the photograph is James Blake Miller, now 21, and he is an icon, although in ways Rather probably never imagined.

He's quieter now -- easier to anger. He turns to fight at the sound of a backfire, can't look at fireworks without thinking of fire raining down on a city. He has trouble sleeping, and when he does, his fingers twitch on invisible triggers.

The diagnosis: post-traumatic stress disorder.

His life in Kentucky, before and after the clicking shutter, says as much about hundreds of thousands of new American war veterans as his famous photograph said about that one bad day in Fallujah -- a photo Miller cannot see as an icon.

"I don't see a whole lot," he said. "I see a day I won't care to remember, but that I'll never forget."

Miller was assigned to the 1st Battalion, 8th Marine Regiment of the 2nd Marine Division, based in Camp Lejeune, N.C.

"Right before we got ready to leave for Iraq, I guess I was a little nervous. I started smoking more -- I went from about a pack-and-a-half a day to 2 1/2 packs a day," he said. "When we got to Iraq ... I was smoking 5 1/2 packs."

For a while, Iraq didn't seem all that bad. Miller and his fellow Marines settled into a routine in Anbar province in western Iraq, setting up hiding places among the palms and sand, and watching for the white pickups that insurgents would use to plant bombs and fire mortars.

There also was time for candy and laughter with the Iraqi children who came running to see the American troops. Miller felt like he was helping.

Then, on Nov. 5, 2004, in the middle of a sandstorm, the Marines got the word that they might be heading for an assault on Fallujah -- at the time, the capital of the Iraqi insurgency.

No American forces had gone inside the city in months. And now Miller would be among the first. He had been a Marine for less than two years.

"It puts butterflies in my stomach right now," he said. "I don't know if you can describe it. I don't think words can."

The night before U.S. forces went into the city, Miller gathered with his fellow Marines and led them by memory through a passage from the Bible, John 14:2-3.

"In my Father's house, there are many mansions: if it were not so, I would have told you. I leave this place and go there to prepare a place for you, so that where I may be, you may be also."

The assault on Fallujah began Nov. 8, 2004, when U.S. planes, using a combination of high explosives and burning white phosphorus, hammered the city in advance of the artillery push. Miller was under fire from the moment he stepped out of the personnel carrier.

It lasted into Nov. 9 -- the day that, for a while, would make Miller's face the most famous in Iraq.

As Miller remembers that day, he was on a rooftop taking fire and calling for support on his radio - a 20-pound piece of equipment that he had to lug around along with nine extra batteries, hundreds of extra rounds of ammunition, and a couple of cartons of cigarettes.

As insurgent bullets from a nearby building pinged off the roof, a horrified Miller heard footsteps coming up the stairs behind him. He raised his rifle -- and barely had time to halt when he saw it was embedded Los Angeles Times photographer Luis Sinco.

Miller returned to his radio, guiding two tanks to his position. When they opened fire, he said, the thunder left his body numb -- but the building housing the attackers had collapsed. Later, he said, they would find about 40 bodies in the rubble.

"I was never so happy in all my life to take that handset away from my head," Miller said. "I lit up a f -- cigarette."

His ear was bleeding from the sound of the tank firing -- Miller still can't hear out of his right ear. His nose bled from a nick he took when his rifle scope and radio got tangled up midfire. He looked at the sunrise and wondered how many more of those he would see.

He was vaguely aware that elsewhere on the rooftop, Sinco was taking pictures.

At a briefing the next day, Miller's gunnery sergeant walked up to him, grinning, and said: "Would you believe you're the most famous f -- Marine in the Marine Corps right now? Believe it or not, your ugly mug just went all over the U.S."

The Marines wanted to pull him out of Fallujah at that point, Miller said, not wanting the very public poster boy to die in combat. But he stayed.

He won't talk about the weeks that followed. He only mentions moments, like still frames from a film. The day his column barely survived an ambush, escaping through a broken door as bullets struck near their feet. The morning he woke up to discover that a cat had taken up residence in the open chest cavity of an Iraqi body nearby, consuming it from within.

The day he discovered that Demarkus Brown had been killed.

"When we found out, I told a couple of my buddies who were close to him, too. We just sat around, and we didn't say much at all," Miller said. "You didn't have the heart to cry."

But it wasn't those terrible benchmarks that affected him the most, Miller said. It was the daily chore of war: the times he had to raise his rifle, peer through the scope and squeeze the trigger to launch a bullet, not at a target, not at a distant white truck, but at another human being.

"It's one thing to be shot at, and you shoot a couple rounds back, just trying to suppress somebody else," Miller said. "It's another thing when you see a human being shooting a round at you, knowing that you're shooting back with the intent to kill them. You're looking through a scope at somebody. It's totally different. You can make out a guy's eyes."

When Miller returned to America, he brought back a big duffel bag packed with numerous letters and gifts from those who had seen his photo. It was only later that he discovered he'd brought home some of the war, too.

None of the Marines talked much about the strain that war puts on one's emotions, Miller said.

The "wizards" -- military psychologists -- gave the returning troops a briefing on the subject, but nobody paid much attention. Even guys who were taking antidepressants to help them sleep didn't think much about the long-term consequences.

"What the hell are those people going to do once they get out? They ride it out until they get an honorable discharge, and then they're never diagnosed with anything," Miller said. "How the hell are you going to do anything for them after that? And that's how so many of these guys are ending up on the damn streets."

Miller dismissed the early signs, too. When he and his buddies reacted to a truck backfire by dropping into a combat stance and raising imaginary rifles, well, that was to be expected. And when his wife, Jessica -- the childhood sweetheart whom Miller had married in June -- told him he was tightening his arm around her neck in the night, that was strange, but he figured it would pass. So would the nightmares he began to have about Iraq, things that had happened, things that hadn't.

Then one day, while visiting his wife at her college dorm in Pikeville, Miller looked out the window and clearly saw the body of an Iraqi sprawled out on the sidewalk. He turned away.

"I said, 'Look, honey, I just got to get out of here.' I couldn't even tell her at the time what had happened," he said. "(I thought), 'Well, that's it. That's my little spaz I'm supposed to have that the psychiatrists were talking about ... I'm glad I got it out of the way."

But he hadn't. Jessica, a psychology student, tried to help with a visualization technique. But when he looked inside himself, Miller found a kind of demonic door guarded by a twisted figure in a black cloak. Under the cloak's hood, he spotted the snarling face of the teufelhund, a Marine Corps icon -- the devil dog.

"So I come out again, without closing the door," he said. "After all this happened, my nightmares started getting a lot f -- ing worse."

Finally, Miller went to a military psychiatrist, who diagnosed him with signs of post-traumatic stress disorder. Miller thought that meant he could not be deployed. But in early September, he joined a group of Marines headed to police New Orleans in the wake of Hurricane Katrina.

"I really didn't want to go. ... There was a possibility we would be shooting people," he said. "We could be going into another (urban warfare) environment just like Iraq, except this would actually be U.S. citizens.

"Here we go, Fallujah 2, right here in the states."

Not long after they arrived, as Hurricane Rita bore down on them, the Marines were packed into the amphibious assault ship Iwo Jima to wait out the storm offshore. And one day, as Miller headed for the smoke deck with a Marlboro, a passing sailor made a whistling sound just like a rocket-propelled grenade.

"I don't remember grabbing him. I don't remember putting him against the bulkhead. I don't remember getting him down on the floor. I don't remember getting on top of him. I don't remember doing any of that s -- ," Miller said. "That was like the last straw."

On Nov. 10, 2005 -- the Marine Corps' 230th birthday and one year to the day after the Marlboro Man picture appeared in the Los Angeles Times, Miller was honorably discharged after a medical review. His military career was over.
Miller returned to eastern Kentucky, the place he had spent years trying to escape. He wanted the familiarity and safety of the people and land he'd known since birth.

"Maybe it made me think twice about what I had lost," he said. "What I was really missing."

In a way, though, his family is still missing Blake Miller -- the Miller who left Kentucky for Iraq a couple of years ago.

The man who left was easygoing, quick to laugh, happy to sit in a relative's house and eat and smoke and talk. The man who came back is quick to anger, they say, and is quiet. He still smiles often but does not easily laugh.

And when he takes a seat in his adoptive grandmother's home, amid her collection of ceramic Christ figurines, it is in a chair that faces the door.

Mildred Childers, who owns those figurines, sees Miller's difficulties as a crisis of faith. She still remembers Miller's call just before the assault on Fallujah, and his terrible question: "How can people go to church and be a Christian and kill people in Iraq?"

"He was raised where that's one of the Ten Commandments, do not kill," she said. "I think it's hard for a soldier to go to war and have that embedded in them from small children up, and you go over there and you've got to do it to stay alive."

Recently, some of his Marine buddies have been calling Miller up, crying drunk, and remembering their war experiences. Just like Papaw Joe Lee used to do when Miller was a boy.

"There's a lot of Vietnam vets ... they don't heal until 30, 40 years down the road," Miller said. "People bottle it up, become angry, easily temperamental, and hell, before you know it, these are the people who are snapping on you."

Jessica interrupted. "You're already like that," she said.

She recalled her own first glimpse of the Marlboro Man -- an image seen through tears of relief that he was alive, and misery at how worn he looked.

"Some people thought it was sexy, and we thought, 'Oh, my God, he's in the middle of a war, close to death.' We just couldn't understand how some people could look at it like that," she said. "But I guess for some people it was glory, like patriotism."

She looked at her quiet husband through the smoke drifting from his right hand.

"But when it comes out and there's actually a personality behind that picture, and that personality, he has to deal with all the war, and all he's done, people don't want to know how hard it actually is," she said.

"This is the dark side of the reality of war. ... People don't want to know the Marlboro Man has PTSD."

Miller stood outside his father's home in Jonancy, looking over the beaten mobile homes, the rows of corn, potatoes and cabbage. For a change, he wasn't smoking - he's down to a pack-and-a-half a day.

"There ain't a goddamn thing around here," he said. "My whole life, all I did was watch my old man bust his ass."

It was why he joined the Marines -- why part of him wishes he could go back.

"My whole life, all I've ever known is working on cars, doing body work, cutting grass, manual labor, you know? It was something different," he said. "You always hear those commercials -- it's not just a job, it's an adventure. It was, you know?"

On the other hand, Miller isn't sure he'd want to go back to combat -- nor sure he'd ever let any kid of his enlist. He has mixed feelings about the oversize copy of the Marlboro Man picture proudly displayed in the lobby of the Marine recruiting station in Pikeville.

Some of his relatives and friends are against the war; others see it as a fight against terrorism.

Miller himself seems torn -- proud of the troops fighting for freedom, but wondering whether there was a peaceful way, to find terrorists in Iraq without invading.

There was no time for such questions in Fallujah. But now, at night, when he can't sleep, Miller thinks of the men he saw through his rifle scope, and wonders: Were they terrorists fighting against America? Or men fighting to protect their homes?

"I mean, how would we feel if they came over and started something here?" he asked. "I'm glad that I fought for my country. But looking back on it, I wouldn't do it all over again."

It helps, sometimes, to talk about it -- last week, Miller did what he hopes other veterans do: He had his first visit with a Veterans Administration counselor.

"I've got my whole life ahead of me," he said. "I'm too young to lay down and quit; too young to let anything beat me."

Down the road, Miller hopes to start a business. For now, he is waiting for his disability benefits to kick in. Maybe then, he and Jessica can afford the big wedding they had always wanted. She already has her white wedding dress. He still intends to wear his Marine Corps blues.
Veterans and stress

Post-traumatic stress disorder is an ailment resulting from exposure to an experience involving direct or indirect threat of serious injury or death. Symptoms include recurrent thoughts of a traumatic event, reduced involvement in work or outside interests, hyper alertness, anxiety and irritability.

About 317,000 veterans diagnosed with the disorder were treated at Department of Veterans Affairs medical centers and clinics in fiscal year 2005. Nearly 19,000 veterans of the wars in Iraq and Afghanistan were seen for the disorder in veterans' medical centers and Vet Centers from fiscal year 2002 to 2005.

A recent study of soldiers and Marines who had served in Iraq and Afghanistan found that about 17 percent met criteria for post-traumatic stress disorder, depression, or generalized anxiety disorder. Of those whose responses were positive for a mental disorder, 40 percent or fewer actually received help while on active duty.

For more information, contact your local veterans facility, call (877) 222-VETS or visit one of the following Web sites:

U.S. Department of Veterans Affairs National Center for Post-Traumatic Stress Disorder: www.ncptsd.va.gov/

San Francisco Chronicle Guide for Returning Veterans: http://www.sfgate.com/returningvets/

Wake Me Up When September Ends/Green Day

Summer has come and passed
The innocent can never last
Wake me up when September ends

Like my fathers come to pass
Seven years has gone so fast
Wake me up when September ends

Here comes the rain again
Falling from the stars
Drenched in my pain again
Becoming who we are

As my memory rests
But never forgets what I lost
Wake me up when September ends

Summer has come and passed
The innocent can never last
Wake me up when September ends

Ring out the bells again
Like we did when Spring began
Wake me up when September ends

Here comes the rain again
Falling from the stars
Drenched in my pain again
Becoming who we are

As my memory rests
But never forgets what I lost
Wake me up when September ends

Summer has come and passed
The innocent can never last
Wake me up when September ends

Like my fathers come to pass
Twenty years has gone so fast
Wake me up when September ends
Wake me up when September ends
Wake me up when September ends

For people with eating disorders, now is the time to "get high" on their bodies

As Sara Evans (left) might sing it, people with eating disorders shouldn't feel like they're "nailed to the ground."

Not when the National Eating Disorders Association is around to raise them to new heights - and spread awareness of their plight.

That's why the NEDA's 2007 Every BODY is Beautiful Auction has opened for bidding, with the goal of raising $30,000 to support the organization.

The auction items include:

- a California Dreamin' Weekend in Malibu
- two tickets to a Sara Evans Concert, as well as "meet & greet" passes (Evans is the honorary chair of the auction).
- a David Ortiz hand-signed official Boston Red Sox jersey
- a Hope Star necklace

Registering for the auction is easy. Check out the NEDA's auction website at www.nationaleatingdisorders.cmarket.com and click on “Register” in the upper right corner.

In less than a minute, you'll be ready to "fly."

"Born To Fly" by Sara Evans (Sara Evans/Marcus Hummon/Darrell Scott)

I've been tellin' my dreams to the scarecrow
About the places that I'd like to see
I say 'friend, do you think I'll ever get there?'
Aww, but he just stands there smilin' back at me

So I confess my sins to the preacher
About the love I'd been prayin' to find
Is there a brown-eyed boy in my future, yeah
He says 'girl, you got nothin' but time.'

(But) (Oh) (So) how do you wait for heaven
And who has that much time
And how do you keep your feet on the ground
When you know
That you were born, (you were born, yeah), you were born to fly

My daddy he is grounded like the oak tree
My momma she is as steady as the sun
Oh, you know I love my folks, but I keep starin' down the road,
Just lookin' for my one chance to run

Hey, 'cause I will soar away like the blackbird
I will blow in the wind like a seed
I will plant my heart in the garden of my dreams
And I will grow up where I want, wild and free

Using "loon" as a weapon - and turning it into a whole new language

When a public figure slurs a group of people, what usually follows is an apology or some other public demonstration of humility.

But the more he's cornered, the more Bill O'Reilly fights back.

Now that he's under attack for his repeated use of the word "loon," O'Reilly appears to be using the word more often than he was before. It seems like he's reinforcing his obvious bias against people with mental illness more often than he promotes his line of clothing - and that's no small feat for a self-promoting egomaniac like O'Reilly.

Just three months ago, a quick search of "Bill O'Reilly" and "loon" on You Tube yielded no more than 10 entries. Now the list is endless - page after page shows O'Reilly equating "loons" with pedophiles, violence and other forms of inappropriate behavior. Other talk-show hosts who imitate him have caught on, too, and they're speech is riddled with references to "left-wing loons" and other groups who, in their minds, are crazier than they are.

So, Coping with Life resumes its occasional role as mental health media monitor by providing yet another example of O'Reilly's "unhinged" behavior casting a negative light on people with mental illness - and asking readers to protest against this behavior by emailing oreilly@foxnews.com.



Teach Your Children
Crosby, Stills, Nash and Young

You who are on the road
Must have a code that you can live by
And so become yourself
Because the past is just a good bye.

Teach your children well,
Their father's hell did slowly go by,
And feed them on your dreams
The one they picks, the one you'll know by.

Don't you ever ask them why, if they told you, you will cry,
So just look at them and sigh and know they love you.

And you, of tender years,
Can't know the fears that your elders grew by,
And so please help them with your youth,
They seek the truth before they can die.

Teach your parents well,
Their children's hell will slowly go by,
And feed them on your dreams
The one they picks, the one you'll know by.

Don't you ever ask them why, if they told you, you will cry,
So just look at them and sigh and know they love you

Identify the mental illness before the tragedy takes place

It doesn't usually happen with physical illnesses. Before the problem becomes severe, there's a diagnosis.

But time and again, mental health issues aren't discovered until the worst effects appear. They're issues that not often - but sometimes - lead to tragedy.

Recently, an 18-year-old opened fire at Delaware State University; a 14-year-old in Ohio shot four students and teachers before committing suicide and another 14-year-old was arrested for allegedly plotting a shooting spree at a Philadelphia high school.

And then, of course, there was Virginia Tech.

Cho Seung Hui, the shooter in the mass killing that took place earlier this year, may not have had a serious mental illness relative to other diagnoses, as the National Alliance on Mental Illness pointed out. But the possibility opens the door for reflection on the nature of mental illnesses, how to deal with them and what can be done in the future to prevent such tragedies, mental health experts say.

In New Jersey, the Safe Schools and Communities Violence Prevention and Response Plan Act outlines a comprehensive strategy for addressing a range of needs to help students cope with tragedies, and to identify and treat mental illness before violent incidents take place.

Debra Wentz, chief executive officer of the New Jersey Association of Mental Health Agencies, Inc., said the legislation is long overdue: It was introduced immediately following the 1999 Columbine killings in Colorado.

“There have been several wake-up calls — too many — that point to the critical need for this bill to be passed with the necessary funding to ensure that every school district can achieve the goals set forth in the legislation,” said Wentz.

The Safe Schools and Communities Violence Prevention and Response Plan Act calls for each county superintendent to hire a violence prevention specialist, who would work with local community mental health providers, school professionals and parents to develop a plan to identify at-risk students.

It would also ensure they receive early intervention with mental health services and to coordinate a mental health response in the event of an incident.

“This Safe Schools and Communities Violence Prevention and Response Plan Act outlines a comprehensive plan for addressing a range of needs to help students cope with tragedies and to identify and treat mental illness before violent incidents take place,” Wentz said.

Mental health blogs surge to the top of their class

There are many ways to rate a blog. If you scroll down the side of this one, you'll see more rating systems than you'll ever see in TV Guide.

But, whether its "Bloggernity," "Topblogarea," "Blogger's Choice Awards" or "Fuel My Blog," they're all saying the same thing: Mental health blogs have become the most popular health blogs in cyberspace.

Postpartum Progress, for instance, is number one on one list - and the blog recently sponsored the "Blog for MOTHERS Act Day" which resulted in a flood of emails and telephone calls to Congress demanding action on postpartum depression treatment.

Coping with Life only started two weeks ago, but this blog has recently averaged between 700 and 1,200 hits a day, largely because of its support for postpartum depression treatment and other causes. Many thanks to everyone.

What we're trying to do is fill a niche. Perhaps no area of healthcare demands a "clearinghouse" - where people can find websites, telephone numbers and programs that can refer them to services - more than the mental health field.

We got involved because many of us have had personal experiences with various mental illnesses, and we felt like we could fill the void (see Coping with Life's first entry: Trapped by Mental Illness ... and a healthcare system that failed her).

Many thanks to Thomas Wright-Piersanti at 41 Miles to Freedom for providing inspiration.

NOTE: If you scroll down on the right side of this blog, you'll see labels for Blogger's Choice Awards and other rating systems. Help support Coping with Life and please rate this blog. You can also get it on your mobile phone by clicking on the logo on the lower right side, or here. Thank you.

Coping with Life's performance (views per day:)

Adam Raised a Cain
By Bruce Springsteen

In the summer that I was baptized
my father held me to his side
As they put me to the water
he said how on that day I cried
We were prisoners of love, a love in chains
He was standin' in the door I was standin' in the rain
With the same hot blood burning in our veins
Adam raised a Cain

All of the old faces
ask you why you're back
They fit you with position
and the keys to your daddy's Cadillac
In the darkness of your room
your mother calls you by your true name
You remember the faces, the places, the names
You know it's never over it's relentless as the rain
Adam raised a Cain

In the Bible Cain slew Abel
and East of Eden he was cast
You're born into this life paying
for the sins of somebody else's past
Daddy worked his whole life for nothing but the pain
Now he walks these empty rooms looking for something to blame
You inherit the sins, you inherit the flames
Adam raised a Cain

Lost but not forgotten, from the dark heart of a dream
Adam raised a Cain

Copyright © Bruce Springsteen (ASCAP)

New data on youth suicide rates underscore need for mental health care

Recent news of increased rates of suicide among individuals between 10 and 24 years of age illustrate the need for and value of mental health care, mental health professionals say.

In just one year, the number of suicides in this age group increased by 8 percent (from 4,232 in 2003 to 4,599 in 2004), which is the greatest increase in more than 15 years. In addition, the most pronounced increases were evident among adolescent girls: a 76 percent increase among girls aged 10 to 14 years and a 32 percent increase among girls aged 15 to 19 years.

Mental health treatment — both pharmacologic and psychotherapeutic — has been proven to be highly effective in reducing depressive and other symptoms, thereby reducing the risk of suicide.

Debate continues about whether the increase in suicides resulted from physicians’ reluctance to prescribe antidepressants to youth in response to “black box” warnings of suicide risk associated with these medications, as the Food and Drug Administration has required since late 2004.

Other possible reasons for the higher suicide rates are increased prevalence of mental illness and greater use of alcohol and other drugs. However, research indicates that the risk of suicide is commonly highest just before treatment begins and that this risk declines once therapy is under way.

“Treatments for mental illness have been proven effective and can help individuals achieve a fulfilling life of recovery. However, there are many barriers, including inadequate funding and stigma, that prevent children and adults from receiving the therapy and other support services they need,” said Debra L. Wentz, chief executive officer of the New Jersey Association of Mental Health Agencies, Inc.

Dr. Wentz said it is critical that family members and friends be alert to the signs and symptoms of mental illness and the warning signs that individuals may be considering suicide (see lists of signs following

With this critical knowledge, a family member or friend will have a greater opportunity to encourage loved ones to seek assistance.

“Recognizing signs and symptoms is a critical first step. In addition, we must erase the stigma that presents a tremendous barrier for these individuals to obtaining the care they need,” said Dr. Wentz. “It is time for us all to recognize that mental illness should be treated as any other disease.”

What to do if there is a concern that someone might try to commit suicide?

▪ Take it seriously: 75 percent of individuals considering suicide give a warning to a friend or family member.

▪ Be willing to listen: Ask the person what is bothering him. Persist to overcome reluctance to talk about it. Ask if the person is considering suicide, but do not attempt to argue him out of suicide. Rather, show that you care and understand, and say that depression can be treated and problems can be solved.

▪ Seek professional help: Be actively involved in encouraging the person to locate and go to a physician or mental health professional. A complete listing of local community mental health agencies throughout New Jersey may be found by visiting NJAMHA’s website.

▪ In an acute crisis: Take the person at risk to an emergency room or walk-in clinic at a psychiatric hospital. Stay with him until help is available. If these options are unavailable, call 9-1-1 or the National Suicide Prevention Lifeline at 1-800-273-TALK.

▪ Follow-up on treatment: By continuing to show support, you can increase the likelihood that your friend or loved one will continue with treatment.