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Show Notes
Note: This episode discusses mental health crises and mentions suicide. If you or a loved one are experiencing thoughts of suicide, know that you are not alone and help is available. You can call or text “988” – the National Crisis/Suicide Hotline. They are available 24 hours a day, 7 days a week.
Dr. Shivana Naidoo is a child and adolescent psychiatrist with a broad range of experience working in various settings including inpatient, outpatient, emergency, partial treatment, and private practice both virtually and in person. She joins Jo-Ann and Candida to discuss communication when a child or teen (or anyone) is in a difficult mental health situation or crisis in a school or healthcare setting.
Dr. Naidoo emphasized that parents and teens are empowered in most situations to ask questions, to get more information from other sources, and to not agree to anything that doesn’t seem right. She acknowledges that the available care options vary depending on where you live – state by state, county by county as well as the type of place you live in such as rural, suburban, or urban settings. However, in general, there are protocols for schools and hospitals to follow when a student of any age presents behavior or symptoms that indicate the need for further evaluation. If there is a situation at home in which parents/caregivers may question whether to inform the school, the risks of survival and health of the child should be considered.
Unless it is a medical or psychiatric emergency, avoiding the emergency room is best, if at all possible. Most hospital emergency rooms are not well suited to dealing with mental health situations or crises, especially for children and teens. If that is the best or only option at the time, and if you can choose which hospital to go to, an academic medical center or larger hospital will often provide the most resources. If a school has reached out to you about your child needing to go to the emergency room, Dr. Naidoo explains that, when possible, the parent/guardian should first make phone calls to the child’s pediatrician and mental health providers to get more information and consider if there are options besides emergency rooms, such as Mobile Crisis Teams.
Dr. Naidoo advises that once the child is being evaluated in an emergency room or other acute care setting, the caregivers ask questions and write down the names and responses. This ensures that the information will not be lost and often encourages hospital personnel to be more attuned to the patient and parent/caregiver. If there is a decision being made between hospital admission or discharge to home a parent/caregiver can take several steps to ensure that, if the child is discharged, they will have appointments as soon as possible with the appropriate providers (therapist, psychiatrist, pediatrician). If the parent/caregiver can assure the hospital staff that the home setting is safe, that information will be included in the decision making about whether a child goes home or is admitted.
In terms of home safety planning Dr. Naidoo recommends using the GOSECURE acronym to remove or secure hazards in the home and make a safety plan:
- Guns
- Overdose options
- Sharps
- Electric cords
- Car keys
- Underage drinking
- Reattempt [likely to be the same method]
- Exits/Entrance [elopement]
The best decisions about how to help a child experiencing a mental health crisis will grow out of honest conversations with everyone on the team – the child, parent/caregivers, outpatient treatment providers, and hospital staff. School personnel are also often involved, especially if the crisis occurred at school. Communication between all of these parties is essential for successfully navigating these difficult situations.
Resources
Do Better MD – Dr. Naidoo’s website
Bradley REACH – virtual partial hospital program
Orchid Exchange – online therapy and support groups
American Academy of Child and Adolescent Psychiatry
Youth Risk Behavior Surveillance System (YRBSS) | CDC
CAMS-care -(Collaborative Assessment and Management of Suicidality)
The Hope Institute – Assessment and treatment
National Suicide Prevention Lifeline (Now 988) 988 Lifeline
Crisis Text Line (741741) Crisis Text Line
Episode 13 AI-Generated transcript, lightly edited for clarity
E13: Dr. Shivana Naidoo – Talking it Through
Note: This episode discusses mental health crises and mentions suicide. If you or a loved one are experiencing thoughts of suicide, know that you are not alone and help is available. You can call or text “988” – the National Crisis/Suicide Hotline. They are available 24 hours a day, 7 days a week.
Jo-Ann Berry: Good morning, Candida.
Candida Fink: Good morning, Jo. How are you?
Jo-Ann Berry: I’m pretty good. How are you?
Candida Fink: You know, snow in here a little bit, which feels like winter. That’s a good thing. Well, it is winter, so there you go.
Jo-Ann Berry: Snowing here, too, so welcome. I’m Jo-Ann Berry, special educator.
Candida Fink: And I’m doctor Candida Fink, child and adolescent psychiatrist.
Jo-Ann Berry: This is Mental Health Goes to School. And today, our guest is Dr. Shivana Naidoo. Candida, why don’t you go ahead?
Candida Fink: So, Dr. Naidoo and I met, at the, AACAP (Association of Child and Adolescent Psychiatry), our professional annual meeting, and found we had so much to talk about that we really wanted to have you on our podcast, and you had me on your podcast. So let me tell our listeners a little bit about you. You’re a child and adolescent psychiatrist, board certified in child and adult psychiatry. You’ve worked with thousands of youth in mental health crisis and their parents. You’ve done specialty training, which I think is really cool, in nutritional psychiatry and autism assessment. You’re currently working at the Bradley REACH Partial Hospitalization program, an acute care setting for high risk youth. You have worked in an outpatient community mental health care for a long time, over a decade, and you have a small private practice. I know you as a passionate and gifted communicator about children’s mental health, and you’re building broader awareness and reducing stigma through all the work you’re doing. Your website, dobettermd.com, and podcast, Thinking it Through with Dr. Naidoo.
You are providing important education and engaging conversation about child and adolescent mental health for families and interestingly, also for pediatric providers, other pediatric providers, like pediatricians who often first see and manage mental health challenges in kids. Dr. Naidoo, you are the mother of two young boys, Gavin and Dylan. You volunteer your time as a board member in the parent teacher organization at their elementary school. You’re living in Chandler, Arizona, but you remain a New Yorker at heart, spending your childhood and most of your young adulthood and all of your psychiatric training in Queens and Brooklyn. You studied cello at the Juilliard School of Music. That is so interesting. You remain a singer songwriter and you enjoy writing music and playing guitar.
Your parents and grandparents were teachers, and I love how you continue this tradition by teaching residents, patients and their families. And you love to learn. And you have said your most important teachers are your children and your parents. What a bio in all the amazing things you’re doing. So thank you, really, for being here. We really appreciate it.
Shivana Naidoo: Well, you know, I think we, any mom has, a fantastic bio, right? Any mother, anyone that has children. I mean, I shouldn’t just say mom, but any parent, when you go through just a little bit of parenting, there’s so many things you have to develop to become just, a parent who’s surviving, right? Like multitasking. Organization, like, anyone’s bio, once they’re a parent, is, like, elevated in my opinion.
Candida Fink: An excellent point. And important to remember for parents who often can feel pretty overwhelmed and feel like they’re not doing enough or don’t know what they’re doing, but they are skill building and learning. Right, Jo? We’ve been there. Jo-Ann and I have much older kids, so our resume is a little longer on that one.
Shivana Naidoo: Yes, it is. Yes, it is.
Candida Fink: So, you are doing this great communication work, and we wanted to focus today on how you’re working to some of the ways you can educate parents and families about the interface of mental health needs, and how they appear in school. When there are evaluations needed or placements needed to fill some of that gap so that families don’t feel as overwhelmed, when they have to seek mental health care for their kids, Particularly when the school has asked for it, and to know their rights about it as well, to know what they can ask for, what they can share or not share. So tell us a little bit about how to start, anywhere in that chain, because that’s a lot.
Shivana Naidoo: Yeah, well, I think I want to first start off, and maybe this has already been covered in your podcast, but just a reminder that there are many different types of schools. Public, private, charter, specialty schools, and based on what type of school it is and what age range they are addressing, elementary, middle, high school, transition age, preschool, the access of mental health within that system may be very, very different. Very different.
So, for example, my children, go to public school in Chandler, which is one of its very, a very good public school system within Arizona. Arizona in general is kind of is the lowest paid salary teachers in all of America. It’s always near the bottom, last, or second last. So, our teachers work really, really hard and are terribly underpaid and we know that’s actually in every single state, they’re underpaid for the work that they do. So the counselors are also very different based on where you are. So in our school, there is a counselor, but she has a very small amount of kids because the socioeconomic grouping around our school is, you know, is a very small area. I think the more that you go into larger areas with greater socioeconomic diversity and stronger, stressors on family systems, counseling demands increase. Where I went to high school in New York City public school, I went to an excellent, also small liberal arts public high school, Townsend Harris High School in Flushing.
Candida Fink: Yay.
Shivana Naidoo: In grade, school I did not realize that I actually kind of fell into therapy while I was in school. There was a woman who is a social worker, a licensed clinical social worker. I didn’t know who she was. And, you know, I was a straight A student. I went to UPenn. I was a gunner. So I was always in the other counselor’s office, the guidance counselor’s office, talking about colleges and where am I going to go? And, you know, because I’m a straight A student. So the last day of my freshman year of high school, my dad had passed away. So he had cancer, he had leukemia. He struggled with that for about two years, so that was within middle school to high school. But with my finals, it was in the middle of my finals. So I met this woman. I didn’t ask for it, but they knew he passed away. So they introduced me to her. You know, I said hi, we chat a little bit, and then they’re like, oh, maybe you should check in with her over the next year or so. Yeah, that wasn’t so bad. She seemed nice, so I ended up using my lunch hour once a week to go in and see her. So I didn’t even realize I was engaging in therapy. I was like, I like this lady. I’ll spend lunch with you. We can chat. And, I think that positive other adult in my life at that time is good.
My mom is a teacher. I have two younger siblings at that time. My sister was 13, my brother was six. She taught in elementary school, you know, so she was going through her own stuff. Her whole family was. But I found this, the social worker to be so incredibly helpful to ground me in kind of processing what grief was and processing what it meant to be the oldest sibling in this family who just lost the parental figure and kind of, figuring out what I wanted, what I wanted to do versus what I felt I had to do because my dad died of cancer or because I live in this particular cultural construct. so I think I bring that up because in a lot of places, there is access to mental health care through the school, and you as a parent or may not even realize what is accessible through the school. And there are also just maybe in high school, depending on the school. Like, my school everyone was very driven, very, very resourceful. Other schools are different. You know, our local public schools. Jamaica High School is a huge school. I mean, I can’t even imagine how the guidance counselors and social workers in that school functioned. You know, fights every day, you’re walking home, people are getting beat up in the street, like, It’s a mixed bag, right?
Candida Fink: And how much mental health resource they have with so many kids and so many needs.
Shivana Naidoo: Yeah. In Arizona, our school district, we’ve had a rash of suicides in high school. So what they have done is they have partnered with an organization called the Hope Institute, which has actually created this, not a clinic. They use the CAMS method, the collaborative assessment and management of suicidality, which is a structured, assessment and then protocol, for how to work with suicidal people, adults and children. So it’s pretty evidence based to help with adults, and there’s emerging, strong, emerging evidence to help with teenagers. So they use this modality and they’re kind of testing it out in our school district. So, I’m very excited about that and hope that can be helpful because we know, as, kind of having contact with the schools. Even if there’s contact, you don’t know what to do after that.
You know, for these counselors and, teachers that are in school, when someone comes to you with a mental health care concern, it’s very hard to connect them to care. So having resources like that, is really important. And, oftentimes the school is the first point of contact for any mental health awareness, whether it is that all teachers are mandated reporters. If there’s any concern for a child having some form of abuse, they have to report. This is every state. all kids see caring, compassionate adults in school and may want to share.
You know, I know my six year old tells his teacher every day about what happens at home over the weekend, every single night. So I think that, the school can really be such an important place to start that intervention. and I think that, one thing I wanted to mention was, early last year, the reports from the youth risk behavior survey came out, and it shows how we really have a need to help children, and teenagers in particular. This is a survey that’s been done over the past ten years, and what’s cool about it is that it is done in school. So, this survey is a survey done nationally, reaches kids in school, in high school, to help understand what the risk behaviors are. So they do the survey for not just mental health, but also for, sexual activity, for substance use, for many different things. And what they really found, from the most recent data, which is from 2021, which is post, COVID, is that close to 60% of girls are really struggling with depression, that suicide continues to be on the rise, and that for the first time ever, females are using more substances than boys. So the fact that they gather this data in school just speaks to us about how the school is this hub. It’s a community where we can bring resources, we can connect them, but it’s just where to connect them to and how do we do that?
Candida Fink: Absolutely. I mean, I think that’s why Jo and I started this podcast, because we’re so aware of how crucial school is in terms of how it’s affecting kids and as a place where mental health issues are seen and identified, and a place potentially to gather resources. That CAMS program sounds like there’s some research attached to it, as well as the clinical sort of training. It’s a training component. Is that what that is?
Shivana Naidoo: Yeah. CAMS is an evidence based treatment that was designed by Dr. Jobes He’s a psychologist, so he’s done, a lot of work, kind of showing how this kind of like CBT or DBT could be a method to help prevent and reduce actively suicidal people, and addresses their thoughts. How do you think through suicide? How do you work on modifying, risk factors for yourself? How do you build the will to live, to be stronger than the will to not? So, they are doing research in teens, and right now, the hope project is one method that they have here in Chandler that they are trying to implement to really address, the rising need for mental health care for kids.
Candida Fink: Got it.
Shivana Naidoo: But it’s suicide specific versus mental health. And I think that’s one of the things that school mental health care counselors have to deal with all of mental health. Right. So,whether the child has anxiety, they have selective mutism, they’re acting out in school, and physically aggressive, and educational needs. They’re behind in school, and they’re stressed out because of that. They have a learning disability. So I think the school counselor has a very broad, spread of needs to address.
But I think, for me, what I think is helpful for parents listening to this podcast to understand is that when it comes to things like self harm and suicide, everybody’s guard is up, right? Everybody’s guard’s up in the school. Everybody’s guard is up outside of school. So, very often, depending on the school systems, they may have different ways of addressing that particular, concern, and it can spiral. So I think that, I just wanted to speak a little bit about how I’ve seen that play out in my role as a psychiatrist, in emergency rooms, in outpatient care, on the inpatient setting.
I think that very often, school is the first place to catch such a high red flag. and that may be because that’s where kids feel most comfortable to share with their peers and the peer shares with a teacher. Like how so many times in the emergency room, the story is, a 14 year old kid comes in to see me. How did you get to me? Well, I told my friend at school that I was thinking, like, I didn’t really want to be here anymore. And then my friend was worried. So my friend told my teacher, and my teacher told my counselor. My counselor called me into their office, and I didn’t want to talk because I was embarrassed. And then they called my parents and said, I have to go to the emergency room right away. And here I am. And, that’s the story. I know where I trained at Northwell, which is kind of a big hospital on the border of Long Island in Queens. In their emergency room, they have this special protocol just for kids who are referred from school, because it’s almost like these particular kids from school are a different level of acuity because they haven’t been able to have a full assessment.
Candida Fink: That’s right. That’s right.
Shivana Naidoo: Because, again, those counselors in school are dealing with so many things. Their specialty is not self harm and suicide in general. It’s very hard for them to do that kind of assessment, not only because of training, but because of time. It takes time to do a risk assessment and to really weigh, the positives and negatives. And I think, the school has a lot of responsibilities. Throwing the responsibility on them to determine which child is safe is a whole other question, because oftentimes kids are sent from the school to the emergency room because they need a letter saying this child is safe to return to school.
And I will have to mention in this group, too, it’s infrequent, but I think we have to think about it. Are risks of threat to school, school shooters, violent images, things drawn, in books. All of these can also raise concerns for teachers, for schools, and they want to make sure this child is safe to remain in the school. And I think risk assessment for a threat is very different than for suicide, but I think it raises the same concerns. All hands on deck. Oh, my God. I don’t know what to do. And I think also, I don’t want to be the one responsible for saying they are safe.
And I think it is not just schools that have that fear. I also think that is the same for a lot of outpatient counselors. I think a lot of pediatricians, even the emergency room sometimes does not like to provide those letters and say, yes, they’re clear for school, because there’s a concern for liability. And I think it’s more often than not, when parents get this call, it’s out of the blue. Nine times out of ten, they had no idea their child was dealing with anything mental health related. They had no idea they were self harming, no idea they were suicidal. And here I am told I have to bring them to the emergency room. And then it’s like, where do I go? Who do I talk to? And then once you’re there, you’re waiting and waiting and waiting and waiting to see somebody. Because depending on which emergency room you go to, you may or may not have a psychiatrist there. A child psychiatrist may not be there.
So I think our system of mental health care is also still turning its wheels on how to really help address the mental health care needs in youth, which we know have been there forever, right? Any teacher will tell you, kids have had mental health care challenges, anxiety, sadness. Absolutely. Has always been there. And, I think society wants us to believe that COVID caused all of this. But I really don’t think that COVID is the main factor here or that social media caused all of this. And still, I don’t think it’s just social media. I think that we are living in a more stressed environment. In general, I think parents are more stressed. I think there are more demands on our time. I think it has been harder for parents to find time to connect to their children and get a better read on them because life is so much more stressful and, we’re constantly on the go, honestly. That’s part of why I left New York and the east coast, because that’s what it is, right? That’s what the life is like in the east coast. So I think that it really, there’s a need for us to kind of be more attentive and look at our systems and really how to fix them. I feel like I just rambled.
Jo-Ann Berry: That’s okay. That’s all good information, but it does prompt the question. So a parent at home gets the call from the school. We think your child is, needs to be assessed and they need to go to the ER to do this. What then? What sorts of resources or rights do the parents have in this situation? And like you said, all hands on deck. We want to make sure everyone’s okay and that they are or are not safe to return to school and then what the appropriate steps are. What resources and questions should parents be asking in this situation?
Shivana Naidoo: So there are a couple things. I think it’s kind of hard. if you’re a listener and don’t know the system, it might be hard. So let’s just talk through an example, let’s say, because I also think that changes what to do.
Let’s say again, you have a 14 year old, a freshman girl, never had any mental health care issues, and you are the parent picking up the phone, hearing that your child, we have concerns. She’s self harmed. She’s saying she doesn’t want to be here. you need to take her home. So you could. So there could be a couple of things. It could be possible for the school to call for a crisis team to come into the school and do an assessment. That is one option. Not every school will do this, but sometimes they will.
So different states, different counties have something called a mobile crisis team. And what that is, is that is a team of a seasoned, licensed mental health counselor, of some degree, social worker, very often, and then also a peer support, and they come to the place where that person is to meet their need and ensure safety. The goal of a mobile crisis team is to prevent going to the emergency room and to prevent going to a hospital. Why is that important? Because the ER is not the best place for kids to go if they’re in mental health care crisis. That is why we’re focused on kids. But really, mobile crisis teams are really preventative from clogging up the emergency room, which is really for medical concerns.
With mental health care concerns and some schools, that’s their protocol already. They already have that in place where if there’s a mental health care issue, we’re going to call in the troops. We have our own crisis team, or we are connected to a crisis team and they will come as long as it’s during school hours. But there’s no guarantee they can come during school hours, right. Because they have a couple other people to see. So you could ask for that. Is there somebody in the school who can do an assessment for them? You could ask, as a parent, can I take them home? You can ask, do I, can I take them home to have them see their pediatrician? That’s another option. Pediatricians are always an option.
Now it again depends on the pediatrician. Let’s say you have a pediatrician that you barely know. You barely see them. She’s 14, right? This is a child who’s 14 years old. Hopefully you’ve had a pediatrician that you’re regularly seeing every single year, right. And you have a relationship with them. Hopefully that pediatrician knows your family and has seen a couple of the kids in your family. Hopefully that pediatrician has already done screenings like the PHQ-9 (Patient Health Questionnaire-9), which is a part of their annual screening, especially once you hit age 12. They should be doing screening for mental health care.
So you can ask the school, can I have another doctor like my pediatrician see my child and do an assessment? And the school may say, sure, you can take them home, have them see their pediatrician, because that’s a doctor, right. A licensed medical doctor, and they can do an assessment. Some schools may say, no, you need to bring them to the emergency room or they cannot go home. They may say that legally, though, there is no requirement for you to actually have to take them to the emergency room. Right. This is still your child. It’s still your choice what to do with them. But if there’s a mental health concern, any concerned parent should be feeling okay.
If the school saw concerning my child, I need to follow up. This is not something I can wait on. So I don’t advise any parent listening to this to take their kid home and do nothing, right? That’s not the message. The message is, what are the steps to get further assessment? So if your pediatrician knows your child, that may be a great place to go. But what if you haven’t seen the pediatrician in a while? What if you don’t have a relationship with your pediatrician? What if you don’t like your pediatrician? What if you feel like you can’t trust them, then they may not be the best place to go. But it is also possible maybe your 14 year old has actually been in some form of mental health care. Maybe they’re seeing a counselor. Maybe you’re in family therapy. That may be another option. You can say, hey, you know what? My kid has actually been seeing a counselor for a while. I’m going to take them to see her. Is that okay? Because that’s a professional. It’s a mental health care professional. And that might be sufficient as well, because the counselor hopefully has a rapport with your child and can know, okay, is this baseline? Is this something different? And because they have that understanding of your child, they can get a better sense of whether they should escalate it or not.
I will say in my experience, though, it takes a seasoned and experienced counselor or therapist to make that call, and a seasoned and experienced therapist who knows your child and family and, and trusts you as parent. If the counselor, pediatrician, whoever, does not trust you as a parent, that makes or know you as a parent, it makes a big difference, a world of difference. So parental involvement really can make or break where things go in terms of higher levels of care or escalating the situation.
And then the last thing may be saying, okay, we’ll go to the emergency room. I think that’s what you’re saying to do. I’m going to follow through. I’m going to go to the emergency room. Now the question is, where do you go? Right. There are all types of emergency levels of care. There are regular medical, emergency rooms, small emergency rooms. There are urgent care centers that have popped up all over the place. There are walk in clinics that can treat you urgently. That’s popped up all over the place. Different states may also have 24 hours urgent psychiatry care.
Where I trained in residency, I feel like training in New York City I’m so spoiled because there’s so many things in New York City that is not anywhere else. Where I trained in New York, at Kings county, the Kings county downstate, there were two sets of hospitals. One hospital was just kind of a general, run of the mill emergency room, medical emergency room. And there was a curtain, dividing pediatrics and adults, and then another curtain dividing pediatrics, adult psych, so not much there. And then the other side of the street, literally, you had an entire psychiatric emergency room for adults, and then a separate entire emergency room for kids. Just mental health. And then you had this whole other medical emergency room.
So I would figure that out before you go anywhere I would figure out before you go to the emergency room if this is a mental health care concern, depending on where you go, it affects who you see and how long you will wait. If you go to a very small medical emergency room, they may not see kids. My son, actually, one day, he had a shortness of breath. He has asthma, and I was frightened. I took him right down the street to Dignity Health emergency room. No pediatrics. They don’t do pediatrics, but because it was a breathing issue, they took care of him, and thankfully, we were discharged. But they don’t typically take care of kids, so they don’t have the right equipment, the right size, the right people. Same thing with mental health. but it’s even harder to find mental health care professionals.
Very often in the medical emergency rooms, they either don’t see kids, and if they do, they don’t have a psychiatrist. But almost always there’s a social worker who save the day. Right? Social workers save the day everywhere. They are the ones that really will do these assessments. But in an ideal world, you would like to have a big center because big means more and oftentimes more resources, more people, more staff, and less waiting because you have more opportunity to find the right person.
In an ideal world, if there is an academic medical center that is nearby you, that is where you should go. Because at an academic medical center, you will have trainees, residents, doctors in training, social workers in training, psychologists in training, and almost always some form of psychiatry residency or child psychiatry fellowship. That is where you should go. you know, there are like, Boston Children’s ideal place to go. If you’re in New Rochelle, it’s slim pickings depending on where you are. Right. and you can’t go directly to Four Winds. You have to call in advance, and that’s a whole other level.
So in Phoenix and in Arizona, there are various areas where you can actually go just for a mental health care assessment before deciding whether to go into a higher level of care, which is what everybody wants to avoid. But I think sometimes there is a benefit to considering going to one of those places that have a pediatric psychiatric emergency room, which I think most places in the country do not have access to. But if you are in that realm, if you can do that, that’s where you should go, because then, they know what to do. They have people available, they can do that assessment. Good to go.
Jo-Ann Berry: So I just want to point out, it seems like it might be worth making a couple of phone calls before you head over to wherever. And like you said, it’s going to be completely variable in different areas of the country, in different states, whether you’re in a urban or rural setting. Like, if you’re in a rural setting, you might not have any options, but calling ahead is also, if possible, probably a good idea, because then they can tell you, oh, the social worker comes in at this time, maybe you should wait a couple hours or something like that.
Shivana Naidoo: Right? And, another option, too, could be telling the school, hey, I know that they need assessment. If there is a mobile crisis team that takes care of peds in your county, maybe they will also, you can tell them, I’m going to go home. I’m going to call the mobile crisis team, let them come to my home and do an assessment. Because again, the goal is to not have an escalation, have the child be admitted. But again, not every place has that ability.
Now, if you are in your own home as a parent and you become concerned that something might be up, you see the cuts, right? Not the school. Let’s say that happens and you’re worried, oh, my God, what if they go into the school and this teacher sees them? What should I do? I think that might be important to address, too. What are your options? You can always call the National Suicide hotline, which is now 988. 988 has replaced the prior 1-800 number. What I think is important to remember is that when you call 988, the area code on your phone, your phone that you’re calling from, dictates who responds. So it is by state that there is a response. So I bring this up because I’m from Arizona. Arizona is full of transplants like me. I have a 718 phone number, so if I call for myself or my child, New York City is responding, right. It’s going to be patched the New York State district, but I need an area code for the area that I’m in. Ideally now, New York can still respond to me.
They are absolutely wonderful counselors, but if something happens where they do an assessment on the phone for you or your child that has these cuts, and they feel like they need a higher level of care, or they think they need to be assessed in person, they may have to, have you hang up and call 911, or they may or may not be able to patch you to the right person, because, again, they’re addressing your call based on where your area code is, but 988 is a great resource.
741 741 (Crisis text line) is also another great resource, the texting hotline that you can text back and forth that can give you guidance and counseling on the phone. What’s nice about 988 is very often they will do follow up calls, but in general, 988 is not the best place to go for an actual assessment. They’re kind of like a crisis intervention to really help sort out what you need to do, what the next steps are. but then that brings up the question of, well, do you tell the school, what if your child has mental health concerns or did something at home? Do you let the school know? And I think, it’s a really important question because, I’m making broad, sweeping generalizations here. But, my mom’s a teacher, right? And my mother in law is a teacher. teachers care about their kids. They really care about their kids. And even teachers that don’t teach your child, if your child stands out for some reason, any reason, they care about your child, and they know your child.
So I think that also, it’s a kind of a double edged sword, because if your child is self harming, I think that there is some valid concern for parents to worry that people will find out that don’t need to find out, because we’re human, right? And people care. Of course they shouldn’t. Right. They’re not supposed to speak about anything like that. But inevitably, I think it is a risk. And what’s a greater risk? Your child hurting themselves and dying and not getting help or teachers knowing about it and actually caring and keeping an extra eye out for them. Right. What is the risk, really?
So I tend to advise parents, especially if school is the stressor, let’s say that child’s self harm. Because I’m stressed out about math. I hate math. I don’t want to go to math. I’m failing. I can’t go. That’s why I self harm, because my test is in two days and I’m going to flunk it. I think you absolutely should have a conversation with not just that math teacher, but the counseling, whatever counseling resources are there in the school. I think they should have a heads up. Now, let’s say it’s a, medication issue, right? Should the teachers be aware that they’re on a new medication for ADHD, for example? Sometimes. Actually, I will tell you frankly most times I say no. I say don’t tell the teacher about it, because teachers can be a check. You start a child on a medication. If I started a child on medication, parents agree to that medication for ADHD, which is a focusing thing, right. Which is going to affect schoolwork. I typically tell parents, don’t tell the teachers, because if they come back and tell you, wow, today was a great day, I don’t know what happened, it’s working.
Candida Fink: They’re blinded to it, right.
Shivana Naidoo: They’re blinded, right. A real eye and a real check for what is going on. If they say, no, this is exactly the same. And you feel, parents, something’s different. I feel, doctor, it’s different. We should be questioning that, because if it’s not coming out in school, and that’s really the reason for giving them the medication to begin with, maybe we need to think of a different tactic. So I really like having teachers be that double check when it comes to those kinds of things. but in terms of safety, suicide, depression, especially anxiety that is being provoked by school situations, I really encourage the family to have an open dialogue with that school. And that’s really one of the reasons why, I’m very grateful working at the job that I work at right now.
I work at Bradley REACH which is a partial hospitalization program, which is kind of a foreign language for a lot of people. And in the systems of care that I have been rambling about, I’ve talked about clinic, which is outpatient care. I’ve talked about the emergency room, which is acute care, and the goal is to always prevent going up the ladder. So the bottom is going to be outpatient care, really. Actually, the bottom is pediatric care, pediatric care, with some mental health in there. Then outpatient care or clinic, which I’ve done, which is where my heart really is. I’ve been doing that for many, many years in private practices in this realm too.
Then above that is something like a day treatment program, maybe in the schools. Then above that’s going to be an intensive outpatient program where a kid will go to care for a couple of hours, a couple of times a week. Then there is a partial hospital program, which is where I work, which is where it’s kind of like a hospital, but just during the day. So the kids are in this program for mental health, which is really just mental health for a school day, essentially. And then after that, the highest level is inpatient care, which I’ve also worked in, which is where kids are in a locked unit because their mental health concerns are so grave that they need to be there for their safety.
So what can happen in the school setting is a, child self harms or raises the concern for suicide. The school raises a concern. Parents are called, they’re frantic. The kid ends up in the emergency room. The person in the emergency room cannot determine whether this kid is safe, so they decide to admit them. But there are no beds at that highest level of care. Right. See how they jump from the emergency room all the way up to inpatient if you don’t know what is in between? And then what ends up happening for most cases is these kids wait in the emergency room for days, sometimes for weeks, and they’re waiting and waiting and waiting to go inpatient, in part because the assessment in the emergency room may not be clear enough or they may not be aware of other resources to send them to. Then they end up in the emergency room. Then, they end up in the, inpatient hospital. And this is a terribly traumatic experience. From the time the parents get that call on the phone from the school counselor all the way through to the inpatient unit, where they come back, really, for me, they would be stepping down to partial hospital, but that is very rare. Very few places have a partial hospital. Most often, they would end up back in clinic.
Where I worked prior to this current job was really community mental health care. And there was a requirement that if they were admitted to a hospital within seven days, they had to see a doctor. So we had slots for hospital discharges, which were about 60 minutes, which sounds like a lot of time, not that much time in psychiatry, but so much of my time was spent in those post hospital visits, having them tell the story of this trauma, bearing witness to how horrible this was, how powerless they felt. And in that building, the alliance to say, okay, now you’re here, now we work. Now we got to do the work. But that took almost the entire 60 minutes.
So what I would do is I would have my lunch break right after that visit, because I always went over. I always went over when I had those patients, because the parents were traumatized, the kids were traumatized, everyone felt like they had no control. And this is what we really want to avoid, right? So that’s why I wanted to kind of talk about the system. So parents are aware, but of, I think there’s a sense that there’s an inevitability all along this chain, right? That once the school counselor knows they’re going to go to the ER, they’re going to be hospitalized. Oh, my God, my kid does not deserve to be in a psych ward. So what I want parents to be aware of is, let’s say you get to the emergency room. The school sent you, you got to the emergency room, you’re here. Anyone that talks to your child, you’re not being a bother. Ask for their name, ask for their credentials, and write it down. Yes, write it down. Why would I say to write it down? Because it makes a difference if your child is seeing. well, first of all, so many people come at you, you don’t know.
Candida Fink: Who’s who in the ER. It’s crazy, right?
Shivana Naidoo: Who is who? Are you a nurse? Are you a medical student? Are you the person getting insurance information? Right. So knowing who’s talking to your child and to you is really, really important. And writing it down is helpful so that if you need to recall their name or recall what their position was, that can be helpful, too. And on the flip side, as an emergency room person, if I know you are the parent writing things down, I’m already going to be like, okay, I got to up my game. I got to be on top of this because this parent knows what they’re doing. And, I think that’s important. I do think that there is bias within treatment, and I think that when we know there’s a parent who’s informed, who is going to advocate, we treat them with a different level of respect and attention. That’s how you have to advocate, unfortunately, yeah. So I would write it down, and, let’s say that you saw a psychiatrist, a social worker who did an assessment and said, you know what? I think this kid needs an admission. And then you saw a psychiatrist who says, I think I need an admission.
Have a conversation with that person who is telling you they have to go to inpatient help. Understand, what are the reasons why are you advising this? And if you have spent sometimes hours in the emergency room just on this piece with parents, talking, giving them space, coming back, giving them space, because, in the consult service, determining where kids are going, and in the emergency room, sometimes it takes time for parents to really wrap their head around the need for their kids to really be safe, because, again, this could have hit them out of the blue.
And you have opportunities as a parent to say, you know what? You’re concerned about her self harming. I can take away all the knives. I can remove all the sharps while she’s here in the emergency room. I’m going to go home, I’m going to sweep the house. I’m going to make sure nothing. There are no guns in the house. No overdose options in the house. I tell parents to, when they’re concerned about suicide risk, to go SECURE. It’s an acronym to think about lethality, because that’s really what parents can do to be empowered to prevent suicide.
They can try to reduce any access to lethal means in the home to keep their home safe, because when kids are upset and emotionally fueled, they get impulsive and they do things they don’t mean to do. So this go secure acronym is for guns. G is for guns. No guns in the home or in a gun safe. O is for overdose options. This means anything. This means medications you take. Medications the kid takes. over the counter pills, vitamins. All of these things could be lethal in overdose. S is for sharps, right? For this child we’re talking about this. A child that’s self harmed. So, x acto blades, art. Art supplies. Knives. the inside of pencil sharpeners. I don’t know. Kids love that. So many kids cut by opening up their, pencil sharpeners and taking those out. That’s for s remove that. E is for electric cords or things people can hang with. Oftentimes, kids will consider tying things to a ceiling fan. C is for car keys. So oftentimes kids who have maybe passive suicidal thoughts or,they could drive off in the middle of the night, they could turn the car on and leave the garage closed. So I always advise parents who have a kid who they’re concerned about suicide for to take the car keys and keep it with them and not have kids have easy access to that. U is for underage drinking. Over 50% of kids that come into the emergency room who’ve had a suicide attempt also have alcohol on the brain. And we know alcohol in the brain and impulsive kids is not a good combination on all fronts.
Candida Fink: Bad mix.
Shivana Naidoo: R is for a re attempt. Maybe in the emergency room, you find out from the psychiatrist or the, the social worker that this child has attempted already. They made an attempt a year ago, and never again. Whatever that attempt was, now that you parent are aware of that, you take action. Whatever that was, that is the one thing you really focus on. If it was an overdose option, you try to remove everything they can overdose from. If it was thinking about hanging, you focus on that. Because kids who attempt one way typically re attempt the same way. Oftentimes that risk is greatest in the first 30 days of that attempt, and then 90. But 60% of kids who make an attempt, re attempt in that same year. So if you find out about this information in the emergency room for the first time, you want to protect against that reattempt. And last is going to be things (E) like exits, doors, entrances. If your child has thoughts about elopement or running away, you want to keep guard of these things.
So these are the things you can go in to the emergency room doctor and say, listen, these are the ways I am going to keep my child safe. I can keep my child safe. And if you truly believe parent that you can keep your child safe, and you say, I’m going to keep them safe, I’m going to get them to see their pediatrician tomorrow or in three days, I’m calling right now to make the appointment and I’m going to get a referral for a counselor. And that’s also what a lot of emergency rooms can do. They can actually help connect you to care by giving you numbers, giving you resources within your area, and that maybe even are taken by your insurance. And it could even be that emergency room maybe is connected to an outpatient service, which is why again, an academic medical center is the ideal thing, because then your child may be able to get into counseling or therapy through that center. And you can say, hey, if I can do all this stuff and keep my child safe, can I take them home? and that may really change that psychiatrist’s opinion and decision making.
Because if they see a parent who’s involved, who’s invested, who is adequately concerned, who is not dismissive that their child cut or has suicidal thoughts, who is going to address it without delay, that makes me, psychiatrists feel better about sending this child home because I know their parents going to do the right thing. So all along the way, even if you feel that they’re advising to do something, you can always show as a parent that I can step it up and I’m going to do the right thing. Please don’t send them to the hospital. Now, if your child has actually made an attempt recently, recently, I’m talking about a month. If your child’s made an attempt in the past month, or past day, then it’s really difficult for the emergency room to say, okay, you can go home with your mom, okay, you can go home with your dad. But still, and I will tell you, I have made that decision several times. I have made the decision several times, brought something up in school. I do an assessment, I find out they actually made an attempt pretty recently. But if I’m able to engage with that parent and get them an outpatient, an appointment and safety plan appropriately in the emergency room, which is also key. Right. Planning for worst case scenario. Best case scenario, and everything in between. I, have sent them home.
Candida Fink: But it’s planning and communication.
Shivana Naidoo: Absolutely.
Candida Fink: And commitment from the parent.
Shivana Naidoo: Absolutely. Right. It really depends on the engagement from that parent and that child. Right. The child being talking to me, that makes a big difference, too. But I bring up the parent component partially because that’s what I feel we need to do better at my private practice called DoBetterMD. Cause I feel like I want to do better as a doctor. And I think very often our current system of care needs to do a better job for parents. I feel like we are not educating our parents enough about what they can do to really help keep their child safe, what they can do to connect them to care, and what they can do to keep their own self safe. Because it’s rattling as a parent to hear that your child’s going through this. It’s not a fun experience at all. Parenting already is stressful. As we started with, our parents do so many jobs, and when you throw in a mental health care component for that child, it takes a toll on.
Candida Fink: You and on the whole family, too.
Shivana Naidoo: Right.
Candida Fink: Like siblings. Right. It’s a family. It’s a family condition, for sure.
Shivana Naidoo: But I think that, there are some states where, And I think it depends on the provider, too. So I used to work at Albany Medical Center on the consult service and teaching residents doing outpatient care. But there were a few child psychiatrists there, and we each had very different opinions about what to do regarding these kinds of cases. I believe in parents. I believe that if you’re a parent that cares about your child, you will do the right thing. If I tell you what to do, if you don’t know what to do, it’s hard. But there were other doctors that felt like, this is a situation where I have to escalate it. I have to go against what they want and recommend this particular thing. And that’s why we spend all this time training. Right.
Jo-Ann Berry: Right.
Shivana Naidoo: It’s not an easy decision. I hope that people listening are not, thinking that it’s an easy decision. It’s not an algorithm, it’s not a protocol. It’s a lot of nuance. But big players in that conversation, are parents and our children. So, if your kid’s in the emergency room and they’re not talking, encourage them. Encourage your child. Say, hey, the more you tell them, the more you’re honest, the more we can get you the right help. There’s nothing you can say that is wrong. We are here to get help. I’m concerned, your school’s concerned. We’re here to help you.
Encourage that child to cooperate and encourage that child to ask for what they need. Because so often, and I’m sure, Dr. Fink, you’ve had this experience too. When you see parents and children together, the child presents so differently than was just the child themself. And we want to be able to give kids that opportunity to share what they really need. And I think that’s why schools are also a place where kids can be who they are. When a kid has a special teacher, it’s just such a wonderful relationship that kids have. I mean, now that I’m on the parent teacher association organization board and I’m in school and I see the 6th graders go back to their kindergarten teacher and give them a hug right on the playground, it’s just, those bonds, are so powerful to help kids know that there are trusting adults that will listen to them, see them, hear them, appreciate them, because they will go to them for help they need. That’s who they’re going to go to. The person that has listened to them.
Candida Fink: And seen them validated who they are. Well, validation over and over and over.
Jo-Ann Berry: Well, and teens, regardless of their mental health status, often behave differently with their parents than they do with other people. It’s just part of the nature of growing up in, and establishing yourself as an individual and stuff like that. So I agree, the more a parent can be the advocate for the child and know that they need to. Like, I like how you say, tell them, work with them and I will step out of the room so that you can do that. And I love the part, just write stuff down just because you’re never going to remember. You think you’re going to, you don’t remember is even under non stress situations. So you’re completely stressed in that situation. So write stuff down and then step away and let the, child and the professionals do their thing. Because like you said, oftentimes when the, parent is in the room or in the situation, they’re going to behave differently. So let’s let the truth come out.
Shivana Naidoo: Yeah, and the other thing I would say is, let’s say again, you’re in that position in the emergency room as a parent, and you’re out of the room, and your kid is now in the room with the doctor or the, social worker. I would call the pediatrician again. Right? Let’s say you have no relationship with them. Fine. You have the pediatrician call them, say, hey, this is the situation here. My kids in the emergency room, I don’t want them admitted. Do you have any access mental health care? Because now, since there’s such a paucity of Dr. Fink and myself, oftentimes, pediatric offices will have behavioral health embedded. They’ll have a counselor, they’ll have a nurse practitioner. They’ll have somebody and say, please, is there any way I can get them an appointment? Can they see you tomorrow? Can they see you today? Because that way, let’s say I’m, the doctor. I saw your kid, and I say, I think she needs admission. You, parent can say, no, no, no, listen, I already talked to the pediatrician. I got an appointment tomorrow. You’re gonna see the behavioral health, specialist the next day. You’re gonna see the nurse practitioner the next day. I’m gonna keep them safe. I’m gonna do the go secure. Please, let’s not traumatize this kid. So if you come up with a plan that can also help the psychiatrist and the decision making body say, okay, this is a with it parent. We can trust them. They care. Let’s let it go.
Candida Fink: I wanted to just, come back to the partial hospital notion, and it sort of help our listeners understand, because I know when I, when we’re in the situation of determining if a child needs to be hospitalized, the idea of partial hospitalization often comes up, and people don’t understand what that is. and certainly, I find that sometimes it’s helpful as a way to prevent inpatient care. We also use it as a step down from inpatient care. Help us understand a little bit about that.
Shivana Naidoo: Absolutely. So, since I’ve worked in many different, states and settings, I know partial hospital level, of care is not accessible to a lot of people. But in the northeast, this is pretty common. There are lots of partial hospitals programs in the northeast, and I think, on the coasts. Right? The coast, the big cities.
So what a partial hospital is, and honestly, I don’t like the name. I wish it could be something different. I don’t know how that name got stuck, because it really. So I work in a very unique partial hospital program as well. I work in a virtual partial hospital program, so most traditional partial hospital programs are actually at the hospital. So kids will, go into the hospital around 08:00 a.m. They will go through a full day of almost school, and then they go home at the end of the day.
While they’re in that program during the day, there are a variety of things that happen. One, they’re not by themselves. They’re with several other, teenagers. Teenagers are, twelve and above, typically, that are dealing with similar issues of mental health. And they’re learning skills by doing certain groups that are skill based and then other groups that are more social based. And they also, additionally go to these different groups, will be assigned various individual team members.
So in my program, every patient has a psychiatrist like myself, whether or not they’re on medication. Every patient will have an individual therapist who’s doing individual therapy or counseling. And then every patient will also have a family therapist who’s a separate person. Not all partial hospitals work the same, but that’s how mine does. And the Bradley system works. So I will meet with a child at least three times a week regarding medication issues, if they are on medications. If not, I meet less frequently. The individual therapist and the family therapist will do at least two sessions a week. And the goal of this really intensive intervention is to be preventative.
We have a very short span of time. Partial hospitals can typically run between two weeks to maybe six or eight weeks, but usually is not beyond two months of treatment. That kind of treatment is really to jumpstart, some active critical thinking and really catalyze some changes that can be implemented when they step down to outpatient care. Where I am is pretty unique because it is not a physical hospital. REACH is, the Bradley partial hospital program that is in the virtual setting. So they have spearheaded this really cool initiative, about working in a setting where we’re all in different states. I’m in Arizona, but I take care of patients in Rhode Island, Connecticut, Massachusetts as well as Florida, depending on where they’re coming from. A lot of patients I have seen have stepped down from inpatient settings and they’ve stepped up from an ER. So that’s typically where we get our patients. They’ve gone to the emergency room, and I’m talking about this parent that’s advocating because these are the kids that come to see me in the partial hospital and not in the hospital. And they’re able to do this program from the luxury of their own home, their computers, because these are parents who’ve said, no, I can do everything I can to keep my child safe. And again, we have this unique opportunity in the northeast area, to have this ability to do virtual. I think it is a model that they’re really trying to grow and expand. But I think that, as you asked, Dr. Fink, I think sometimes it’s hard to think about a hospital where you’re not 24/7 like kind of an oxymoron.
Candida Fink: Right.
Shivana Naidoo: That’s why I wish the name would be a little different. Like, I think it should have been a day treatment program, really.
Candida Fink: I think that’s a better, better name.
Jo-Ann Berry: Yeah, I agree. When I first heard of partial, because we have students frequently who, it’s a step up for them, and they go for two or three or four weeks, and then they come back to us, oftentimes very much, in better space than they were when they left. But when I first heard of this, I’m like, what?
Shivana Naidoo: So, yeah, why set a thing, agree, and then partial? The word partial just sounds incomplete. Right? Like, part of the reason why I chose to work here now versus do outpatient, is because I wanted to provide exceptional care. you know, one of the sad things about, working in community mental health care is you realize, or a clinic, how stressed out people are. you are seeing patient back to back to back to back to back. There’s no wiggle room. And I took that job because I wanted case management help. So I looked for a job specifically for case managers. But then there weren’t enough therapists and there weren’t enough doctors. And actually there were only NP’s. And me, I was the one doctor there, and that was it. So I was burning out doing that kind of care. And I also feel like I give exceptional care. So I want all of my kids to get exceptional care, and I want them to see a therapist and family therapists that give exceptional care. And I do feel that Bradley. Bradley REACH provides that. So I’m grateful for who I am right now.
Candida Fink: Yeah.
Shivana Naidoo: And there’s still more to be done.
Candida Fink: There’s still so much, m so much, so much.
Shivana Naidoo: What’s also great about this program, if you are in the northeast and you are a listener, is that we also work with the schools.
Candida Fink: So when we’re full circle, yeah.
Shivana Naidoo: Transition kids from our higher level of care down to outpatient, we always have the family therapists do school meetings. So because after parents being the number one stressor. It’s school. It’s school. Parents and school, those are the two things stressing kids out. Everything else, social media, substance use. No, it’s parents and it’s school. So if we can get at the school piece that can really help kids feel comfortable and confident, react, limiting. So we will have a meeting with the school counselor, with the, teachers that are needed to be spoken with. We will advocate if they need a 504 or an IEP, and why, we’ll share diagnoses. And it’s a collaborative visit, so that way we can have all the players at hand to really help that child ask for what they need. Because we also want the child, the child who’s not a child, who’s a teenager. Right. And almost an adult, speak what they need. Right. That’s also a part of growing up, being your own advocate. We can model, but then we also want you to kind of grow into your own shoes. Right.
Candida Fink: Help them learn how to do that.
Shivana Naidoo: Yeah. And that it can be done. I think that’s the part that so many parents are not aware of, that you can advocate, you can ask, you can stand up for your child, you’re not being a bad parent, by asking questions.
Candida Fink: Absolutely. I mean, that’s crucial. I think that point is just so important for parents to understand they’re not a bother. Ask questions, get information. It’s so critical to caring, providing good mental health care.
Jo-Ann Berry: And I would say so, just coming full circle, what you’ve just said in the past few minutes said is pretty much what almost all of our guests on the podcast we’ve talked about is how important communication is between the parents, the providers, the school, whatever that combination might be. And you could always ask, and it might be the school will say, well, we can’t actually do this, but here’s what we could do that will come close to that. Or maybe what your child needs is not what we can provide in this setting. And here are some options, and you can always come back. We always say that when we leave IEP meetings, if something occurs to you, once you read this, have some time to think about it, definitely come back to us with further questions, suggestions, and we can incorporate that or talk about it, as seems appropriate. And also, encouraging young people to be their own advocates. We work on that a lot at our school, is encouraging students to self advocate, and sometimes it starts out very small. It’s like, oh, I can’t do this assignment by Friday. Can I give it to you on Monday? That’s the first step in self advocacy, and then hopefully it works up into bigger things.
Shivana Naidoo: And I guess I also want to say with, with schools, taking care of patients who may be on medications, parents, you don’t have to tell the school if your child has a mental health care challenge, if your child is taking medications for anxiety, if your child has, even tried to end their life, you do not have a requirement or obligation to tell your school. I do think it would be a good idea, to let the school be aware, but you should not feel like these are things you have to divulge.
And I say that because, there are many cultures who want to keep things very private, and they are really worried about stigma, and they’re very worried about their child being labeled or branded. but I think the school, more often than not, serves as this extra layer of security and protection. Almost always, even if it’s not the direct teacher, even if your child feels that the teacher does not like them or doesn’t hear them or get them, there’s somebody else at the school who wants to. There’s somebody else at the school who can. And if your child does not, especially if your child does not feel connected to you or you feel like there’s a rift, school is the next best bet to find a caring adult to look out for your child. So although you don’t have to, we can use the schools to our advantage, too. Right? You can. You can develop that relationship with the school. Honestly, that’s part of why I volunteer is on the board, because, I want to develop a relationship with these teachers. I want them to know my children, know myself, know I’m putting effort and energy into developing them, and not just them, but the school.
Candida Fink: Right.
Shivana Naidoo: I care about other kids, too, not just my own kids. And I want to be in an environment that is enjoyable for everybody. Secretly, I’m trying to be best friends with a school counselor, but don’t do anything.
Candida Fink: Okay. Mum’s the word here. Listening. We didn’t hear that.
Shivana Naidoo: Because it starts in elementary school.
Candida Fink: Yeah, of course it does. Absolutely.
Shivana Naidoo: It starts there. It starts at a place where kids, are still developing their skills.
Jo-Ann Berry: Right. Well, it’s a lifelong project, and it takes a village. That’s what we always say. It takes a village. If a student, doesn’t quite click with me, then they do with somebody else and vice versa. I mean, sadly it does happen in public schools and big public schools, but mostly you cannot go to work every day if you don’t like being with the age group. I get comments like you’re hanging out with teenagers all day? I’m like, yeah, it’s so fun, most of the time anyway.
Shivana Naidoo: Yeah.
Jo-Ann Berry: So yeah, you can’t do it if you don’t want to be around the kids and help them, and help them become their best selves.
Candida Fink: Yeah, yeah. I mean the idea of communicating with school I think, is such an important ongoing conversation and there is a nuance to it, as you brought up, Dr. Naidoo, that I always tell parents my default is the ideal is an open communication loop because the school can be part, first of all, may be part of the challenge or triggering stressors, and also can be an important part of the healing of the connection. Finding an adult or creating the right accommodations modifications. Finding the right placement.
So ideally that’s, the loop is open. but there are certainly situations where that is not going to be okay for one reason or another. And certainly situations where you describe culturally families where that feels very, very difficult to them. Unfortunately, I run into that way too much. Even you out here in the suburbs, I think it’s a little different in the city, but even just something as basic as language, not having a translator to be able to do testing or not a translator, but a person who speaks the family’s primary language to be able to communicate. And that can be a huge challenge. That’s the kind of thing I think we can help families understand, that they can ask about, that they, if they don’t understand what’s happening, if part of it’s a language issue that they can ask and that that may not be immediately available, but they, they have the right to ask for that. And find either, they can use a translation service if needed, but they don’t have to be having these meetings and not understand what’s going on. So that’s just one specific example, I think, of ways that families may feel really apart from things and not feel comfortable sharing.
Shivana Naidoo: And I think some parents, again, culturally, may not, may not want to challenge the teachers or may not want to challenge the school. They may not want to bring up a concern, even if it is academic, purely academic. They just may not want to bring that to the table because they feel like, there’s a power, hierarchical difference. so there’s a lot that comes into being comfortable communicating and comfortable asking fo for things.
Candida Fink: Yeah, absolutely. None of it is black and white. It’s all complex and nuanced. I mean, the hit parade that we talk about, the top hits are communication and connection. Those come up, continuously in every interview we’ve done and certainly in our work. But that’s never as simple as it sounds. But they’re goals. They’re always goals, and they’re always things to be thinking about as fundamental towards supporting kids, with mental health needs in school. I feel like we could keep talking because there is there is so much here, but we will refer people to your resources to continue to learn more from you. So just tell our listeners again, sort of how they find you and what that’s about.
Shivana Naidoo: So you can visit my website. It is a work in progress. I’m working on it. so it’s, dobettermd.com. If you want to listen to my podcast, you put a backslash and then podcast, and you can listen to my podcast, which is called Thinking It Through with Doctor Naidoo, Child Psychiatrist. And there will be an episode featuring Dr. Fink on there as well, coming to you soon, and hopefully also featuring Jo-Ann Berry
Candida Fink: All right, very good.
Jo-Ann Berry: Yeah, we’ll put that in the show notes. so people can just click on that.
Candida Fink: Yeah, yeah.
Shivana Naidoo: Social media. And I’m on Instagram and do reels here and there, but everything’s a work in progress. It is.
Candida Fink: And when you’re working full time, as Jo-Ann and I have found, we’re working a lot of hours. This work is hard, and, so it’s hard to find the time. But this type of advocacy and education, we think is important. Clearly you do. And, so, trying to find the time, piecing it together, work in progress. We’ll take it, and, So, yeah, so these will be in the show notes, right. We’ll have any resources you mentioned, I think we’ll try to find links and that kind of thing.
Shivana Naidoo: The REACH website also is very good. They have a great, blog where all the different, Oh, great professionals on, on the team. Do you write blogs? I’ve written a couple blogs also about I’m interested in suicide prevention. So about suicide prevention and, mental health care. So you can visit our website. And if you have a child who you think could benefit from this in any of these states, I mentioned Rhode Island, Massachusetts, Connecticut. we’re happy to be to be helpful. We’re expanding into Florida. We’re reaching out to other states as well. so you can look on our website, Bradley REACH website. And, if anyone’s interested in thinking about me as a psychiatrist, for them, you can also contact, me via, my website, or, the website. The medical record platform is, orcid exchange. I am taking a few select patients.
Candida Fink: Excellent.
Shivana Naidoo: But as you can hear, it’s a little bit of work. If you work with me. Right. I’m going to make you work.
Candida Fink: outstanding. Outstanding. All right, well, thank you very much. Yes, thank you. Any closing thoughts?
Shivana Naidoo: I want to say if you are a parent listening to this, you have choices, you have options. Do not let our mental health care system, which has its limitations, make you feel like you’re stuck in a corner. You can always ask for help. You can always reach out, at least at bare minimum, to your pediatrician, which will point you in the right direction. If you were a child or a teenager or a young adult and you are in school, even if the school does not have enough resources, if you feel comfortable telling someone, anyone there, it can be the custodian. It doesn’t matter, anyone in the school, that you need help. I promise you, the school will help rally the troops to get you that help. And hopefully you’ll end up in the lap of someone like me or Dr. Fink to help you through the rest of the way.
Candida Fink: That’s right. Having options and knowing you have options and things you can do when you feel afraid and overwhelmed, I think those are perfect closing thoughts. All right, thank you, Dr. Naidoo Thank you so much. And to our listeners, we’ll catch you, on the next episode. All right, thanks.