Violence in our Lives: What to do?

Several ideas have been swirling around in my head for this week’s blog post. The one that emerged today wins, hands down. I am a believer in Carl G. Jung’s concept of synchronicity. When three or four separate but related items come across my desk or inbox at one time, I believe they are connected in some fashion and should be addressed.

This morning I received an email from the Office of Civil Rights listserv on HIPAA Privacy and Security. It contained a link and reference to a letter of clarification written by Leon Rodriguez, Director of OCR.

In light of recent tragic and horrific events in our nation, including the mass shootings in Newtown, CT, and Aurora, CO, I wanted to take this opportunity to ensure that you are aware that the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule does not prevent your ability to disclose necessary information about a patient to law enforcement, family members of the patient, or other persons, when you believe the patient presents a serious danger to himself or other people. 

The HIPAA Privacy Rule protects the privacy of patients’ health information but is balanced to ensure that appropriate uses and disclosures of the information still may be made when necessary to treat a patient, to protect the nation’s public health, and for other critical purposes, such as when a provider seeks to warn or report that persons may be at risk of harm because of a patient. When a health care provider believes in good faith that such a warning is necessary to prevent or lessen a serious and imminent threat to the health or safety of the patient or others, the Privacy Rule allows the provider, consistent with applicable law and standards of ethical conduct, to alert those persons whom the provider believes are reasonably able to prevent or lessen the threat.

Given all the discussion about mental health interventions related to the perpetrators of the recent violence, Director Rodriguez clearly felt it was necessary to remind healthcare providers of all stripes that the law does not prevent them from involving the authorities when they believe an individual is potentially dangerous.

I was educated in the Tarasoff era. It was controversial, but clear, that mental health providers have a clear duty to protect the intended victim of a violent action to be committed by one of their patients. That protection may well include the duty to warn the potential victim. Given the occurrence of mass killings in recent years, it is easy to wonder if we all ought to behave as if we have at least a moral responsibility to notice and to notify the authorities about the potentially dangerous behavior of others.

As a former mental health provider, I worry about the tendency of our country to blame violent behavior on mental illness. As research in the area indicates, the relationships among mental illness, drug abuse and violent behavior are complicated, at best. Social factors such as ‘poverty, family history, personal adversity, and stress’ also feed into this complex equation.

On January 15, 2013, President Obama presented proposals to control the sale of certain kinds of guns and the ammunition they use. He also proposed a whole raft of other actions that will hopefully make our awareness and ability to intervene before violence occurs an easier job.

The knee jerk reaction of the NRA and other defenders of the ‘right to bear arms’ has been loud, and people seem to quickly line up in one camp or the other. That is why I was so struck by the post of a Friend of a Friend on Facebook that I shared his statement on our SOS page. You may not be able to get to it unless you are a registered user of Facebook, but if you are, please take a look. This is a well thought out, rational, and personal reaction to some of the responses to the President’s proposals.

One of those proposals is that teachers and others who interact with young people need to learn more about the mental health issues that might help them identify youngsters who are in need of assistance. Linda Rosenberg, President and CEO of The National Council for Community Behavioral Health shared her take on President Obama’s proposals.

As part of his recommendations to protect our communities from gun violence, President Obama today rightly called for Mental Health First Aid training to help teachers and staff recognize the signs of mental health disorders in young people and find them appropriate care.

The youth version of Mental Health First Aid is an evidence-based training program to help citizens identify mental health problems in young people, connect youth with care, and safely deescalate crisis situations if needed. The program, focusing on youth ages 12 to 25, provides an ideal forum to engage communities in discussing the signs and symptoms of mental illness, the prevalence of mental health disorders, the effectiveness of treatment and how to engage troubled young people in services.

Mental Health First Aid has become a major push for The National Council. Information and resources are readily available.

After all is said and done, we get to the bottom line. What should people do if they find themselves in an active shooting situation? This is not a thought most of us want to entertain, but first-responder agencies have always believed that being prepared for an emergency greatly increases a person’s chances of surviving a dangerous situation. With a grant from the Department of Homeland Security, the Houston Police Department has prepared an excellent video about surviving an active shooter event.  

Events like the Sandy Hook School shootings stir up primal reactions for most of us. It is important that we not shut those reactions down. Instead, we need to open ourselves to many possibilities of how we and our communities need to intervene to assure that we and our children are as safe as is reasonably possible.

Please share your comments, experiences, concerns below.



Brain 2013

Several years ago, I stopped making New Year’s resolutions. I had always been pretty good at accomplishing goals I set, but I was starting to find it harder and harder to follow through on something like those annual resolutions. I was also finding it hard to locate particular words when I was looking for them; and I long ago decided that if something is not written down, it does not exist…at least not for me and my overburdened memory.

My proposed solution to the challenges facing my aging brain is something Seth and I named ‘Google Brain’. It is the chip that will be implanted into our brains to be augmented by Google’s outrageous computers and search capabilities. While I have no advance knowledge of Google working on such a project, I have hope that they are doing so…and that it will be available while I can still benefit from it. They are even welcome to the name I have chosen for their project!

Several things have popped into my awareness lately to make me hope my fantasy will one day be a reality.

At the beginning of January, some psychology colleagues on a technology listserv of which I am a member mentioned an episode of 60 Minutes in which a young man successfully participated in a stair-climbing event in a 103-story Chicago building. This man has a prosthetic leg that he controls by his thoughts.

Another colleague responded indicating that there are many projects in the works that extend that same technology. Neuroscience has become the ‘hot’ research field related to mental health and behavior. It has many practical applications, but can seem so complicated as to be off-putting to some. That is why a video explaining some of the technology and research tools being used is so delightful. This is a clear and visually appealing explanation of semantic mapping in the brain, something that has fascinated me since the very early brain research demonstrated the storing of memories in particular regions of the brain, and their recall through electrical stimulation during brain surgery. The use of fMRI to advance this purpose is very exciting. These are important arenas for behavioral health providers to be informed about. It might well be the future of this field.

We certainly are approaching what many of us thought might be the distant future. Verizon together with cellphone producer HTC has started to communicate the image of humans enhanced by technology with their Droid DNA phone and ads. Google released their new Google Glasses in 2012. These are glasses enhanced with computer, camera, and internet connectivity. When I wrote about two books that used these glasses and fMRI in 2011, I knew the technology was available somewhere but did not know it would soon be here for the rest of us to start to access.

I love finding out about technologies like this that may be available to all of us in my lifetime. Maybe I will even be able to make and carry out New Year’s resolutions again with the help of some of these tools-in-the-making. Are there things in your world that provide the same kind of  excitement and hope for you? New tools, new toys, new ideas? Please share your comments below.



Add Newtown, CT to the Very Sad List

The horrible shootings in Newtown, CT this past week have again reminded us of how fragile human life is. Others have more eloquently addressed this tragic loss than I am able to do.

Often in  a circumstance like this, it becomes clear that the perpetrator experienced mental health issues that were inadequately addressed. The behavioral health community jumps to the defense of the mentally ill immediately citing the very low incidence of violence caused by the mentally ill. Rather than become defensive, I think we need to be open to hearing and acting upon other perspectives on such tragedies.

My niece is an educator. Yesterday, in her blog, she posted a take on these events that we should all consider. Please take a look at her post, One Educator’s Response to the Sandy Hook School Shooting.

Please feel free to share your comments here and at Kami’s blog.

Caregiving and Caregivers

I have recently been struck by the number of people in my immediate circle who are primary caregivers for someone other than their children. I am not sure how I had not noticed this earlier in my life. I have always had friends older, younger and the same age as me, so I thought I had a wide spectrum of life experiences on my radar. Not so at all. Only in the last several years as I have focused on my own needs as a caregiver have I really started to notice just how common this state of life is.

According to, nearly 66 million Americans are caring for an elderly, seriously ill or disabled friend or family member. Within our organization, 1/5 of us work full-time and are also primary caregivers. I was surprised to learn that we are exactly representative of the rest of the U.S. The 66 million indicated above is about 21% of the approximately 315 million people living in this country. Just look around you. If you are not the one-in-five yourself, one of the four people who sits near you at work is likely to be.

Medicare is concerned enough about this state of affairs that it has dedicated a section of its website to providing information and resources for caregivers. This includes documents and videos as well as links. If you are caring for someone who is on Medicare, knowing what services Medicare covers can be most helpful, and having access to additional resources can be a lifesaver!

One of the links on the site takes you to a Department of Health and Human Services Eldercare locator. This is aimed at helping you find specific kinds of services near to your home when the person you care for is elderly. Many caregivers never look for assistance because they assume none is available. That is not necessarily the case. Learning to reach out and ask for help is an essential survival skill.

Those of us who currently work in the behavioral health field or have done so in the past are always attuned to mental health issues in our clients. Unfortunately, we often overlook those same issues in our own family members, friends and co-workers. According to the National Family Caregivers Association, family caregivers often experience major depression.

Family caregivers suffer from major depression much more frequently than the rest of the population. That’s a fact. When a family caregiver suffers from depression, there are two people at risk – the family caregiver and the family member or friend for whom she or he cares.

Learning to identify depression and deciding to seek assistance is essential to self-care. Just as you would assure that a client is getting appropriate services to treat depression, it is important that you reach out to the caregivers in your life who may be in need of support and similar services.

As baby-boomers become ‘senior’ citizens, the numbers of those needing assistance and of caregivers providing that help will increase dramatically. Now may be the time to learn about available resources and to provide them to those caregivers you know.

Please share your experience. Just enter your comments below.

Thanksgivings: First and Current

Our book club is reading 1491: New Revelations of the Americas before Columbus by Charles C. Mann. While the book is a fascinating account of relatively new research on the state of the Americas before Columbus and the meeting of Americans and Europeans, I was also struck by Mann’s description of what that harvest celebration we think of as ‘The First Thanksgiving’ between the Pilgrims and the local Indians likely actually included. It was certainly nothing like what we celebrate!

We have created all sorts of traditions that are based more on the ideas of Sarah Josepha Hale, the 19th century editor of Godey’s Lady’s Book and a well known trend setter. According to Elizabeth Armstrong’s article in the Christian Science Monitor in November 2002, the three day harvest festival that occurred in the fall of 1621 included 52 English colonists and 90 Wampanoag Indians. According to Mann’s account, the Indians and their leader Massasoit were likely present to enlist the support of the colonists against a neighboring competing tribe.

A 1999 version of the web site of Plimoth Plantation included in a K-12 curriculum of the state of Wyoming shares details and hypotheses about the development of the Thanksgiving holiday Americans celebrate. A visit to the current web site of Plimoth Plantation reveals significantly more information and tracks the development of the holiday over time. President Abraham Lincoln declared the fourth Thursday in November to be a national day of thanksgiving.

As a behavioral health specialist, holidays and how we handle them have always been interesting to me. How they came to be, which aspects of the celebrations we have adopted, and how we incorporate holiday traditions into our own lives speak volumes about us as a culture and as individuals.

In this year when many are beginning to experience recovery from a very difficult economic time, we hope that a community-wide expression of gratitude for the many privileges we share will help us all move past a bitter and hard-fought election cycle.

We are grateful for our new and our long-time customers. We are indebted to our readers who come back regularly and share their experiences with us and with one another. We appreciate your feedback and your encouragement. Thank you for sharing your journey as behavioral health providers with us.

Happy Thanksgiving!