Puer Natus Est

How Do They Grow Up So Fast?

The future president of Mars at the zoo, age 4

I dropped my oldest son off at college last weekend. All week, I had been busy planning for a semester start of my own, putting the final touches on my English Composition fall syllabus for first-year students, a class I love to teach because it opens students' eyes to the possibilities of writing, to the power of communication. And then, my phone buzzed with a text message from my son: “It is really hard to say goodbye to everyone.”

I remember that feeling.

Parenting is hard. This oldest child of mine, like all oldest children, was an experiment, a very wanted child, but also an unknown.  I was in graduate school when I learned that I was pregnant. I thought I would just deliver my first baby over spring break and return immediately to school a week later. He was born just six hours after I turned in my grades for the History of Rome section I taught as a UCLA teaching assistant, just six days after I successfully defended my academic work in comprehensive written examinations, struggling with Braxton-Hicks contractions as I labored (figuratively and literally) to translate difficult Greek passages and apply them to theoretical contexts.

For me, motherhood changed everything. Puer natus est, the Roman poet Virgil wrote in his 

Fourth Eclogue about the birth of Augustus Caesar, destined to be the first Emperor of Rome. “A child is born.” Is there a pronouncement more existentially profound?

My first child was obsessed with the space shuttle before he was two. He built rockets, first from Legos, then with real rocket fuel he cooked in my kitchen with sugar and cat litter. From an early age, he studied everything he could find about the Titanic, informing me as a preschooler that he would only watch documentary films, because “fiction is not true” (I beg to differ: sometimes it seems to me that fiction is more true than so-called facts).

When he was four, he swallowed a quarter because he wanted to know what it tasted like and earned his first (and last) ambulance ride. When he was 14, he broke both arms in a frightening parkour accident: My first and most urgent question to the emergency room doctor: “How is he going to wipe his own bum?” His younger brother had been in the same emergency room just two weeks earlier, transported by ambulance after a violent behavioral episode associated with mental illness.

I did not follow the plan and return to graduate school the week after my oldest son was born. I stayed home for 12 years to raise him and his 3 siblings. Nor did I plan on his father divorcing me. But when that happened, I gradually picked up the pieces and moved on. A few years later, I started an online doctoral program in Organizational Leadership (my kids describe what I study as “Advanced Manipulation Techniques”), and now, as my first son prepares to start his first year of college, I am preparing to defend my own doctoral dissertation proposal on mental health advocacy and leadership. We put many of our personal goals on hold when we become parents, but I'm glad I've returned to mine.

The family jokes that my oldest son is the future president of Mars. It might not turn out to be a joke. He certainly has the drive, the talent, the ambition.

But in so many ways, I feel like I have failed him.

His younger brother’s struggles with then-undiagnosed mental illness, coupled with a difficult divorce, defined our family in ways that I wish, as a writer, I could revise. Mental illness affects the whole family, and I think the sibling experience has not yet been adequately chronicled or supported.

And at age 18 as commencement speaker at his high
school graduation.

Still, as Dante said, we are a part of all we have met. My oldest son has met and conquered many challenges in his formative years, and I know that he will continue to achieve at a high level as he begins his college experience.

For my part, as I loaded up the Suzuki with boxes of his clothes and books and Star Trek models, I just wanted him to have fun. To be safe. And to learn to be happy.

Right before I left him to begin his new phase of life, I gave my son a journal inscribed with this message: 

“I’m not sure whether this means I’m a good parent or a bad parent, but I am really ready for this day—the day I officially get to hand your future off to you. I’ve watched you grow up to be brave, capable, and incredibly talented. Now is the time to be curious, to explore the world of ideas. I went to a relatively crappy college in a crappier town than your school, and I ended up loving every minute of it. The books I read in college are still my favorite books. The friends I made are still close. But most important, college made me the person I am today. Be curious.
P.S. Keep a journal! You’ll laugh really hard at what you wrote when you’re my age.”

As I turned to walk away, my cheeks were wet with tears. I blamed the moisture on the smoky air from all the Idaho wildfires. But my son and I both knew differently. His future is now his.

Knock Knock, Who's There?

Law enforcement officers are first responders
for  mental illness.
Photo by leila haj-hassan, freeimages.com

When your child has a mental illness, too often it’s the police

Last night, I was abruptly awakened at 4:00 a.m. by the sound of my doorbell ringing. Confused with sleep, I struggled to pull on a pair of jeans as the doorbell rang again, followed by an insistent knocking.

“Who is there?” I said as I stumbled to the door.

“The police,” a firm male voice responded. “Open up please, ma’am.”

My heart froze. “Where’s my son?” I thought, panicked.

I slowly opened the door to see two police officers. “Can I help you?” I asked.

“Is that your car, ma’am?” the female officer asked, gesturing toward my grey Suzuki.

“Yes,” I replied.

“The door is open,” the male officer said. “Will you check inside and see if anything is missing?”

My heart started beating again. It wasn’t anything serious; my son had just forgotten to close the car door behind him, like he forgets so many things: dishes on the table, cupboard doors open, sometimes even the refrigerator or freezer gaping wide, sending my electric bill sky high.

My 14-year old son has bipolar disorder. For years, he experienced unpredictable, violent rages. The police have been frequent visitors to our modest suburban townhome. Sometimes they have taken him to the emergency room. Sometimes they have taken him to juvenile detention. Every time, my family has been afraid.

This morning, I read a poignant post on helicopter parenting of adult children with mental illness—one that I am afraid will be my experience in a few years. Karen Easter, a Tennessee mom-advocate, wrote this about  her son:

[O]n bad days, when it is apparent he hasn't been taking his meds, I have no other choice but to put on my helicopter mom hat.
In fact, I have never liked this hat.
Did I mention I really, really despise hats?
Hey, wait just a minute ... I should NOT have to be wearing this hat AT ALL!
But I wear it because right now this very minute, I must hover to keep him safe--only because the system has failed him and our family miserably. I don’t really want to wear this hat.

For so many parents of children with serious mental illness, this last week of August is a nail-biter as we wait to see whether Congress will do the right thing and pass Representative Tim Murphy’s proposed “Helping Families in Mental Health Crisis” Act. Here are some of the critical reforms that Representative Murphy’s bill provides:

Revising HIPAA Laws and Medicaid Reimbursements

Privacy laws in healthcare prevent parents from getting crucial information that they need to help their adult children in crisis. And the Medicaid IMD exclusion has directly caused an acute shortage of inpatient psychiatric beds for patients with mental illness who need treatment. Today, there are only 40,000 psychiatric beds available in the nation. If my son required longer term care, he would have to go hours away from my home. This is true for many families.

Providing Alternatives to Institutionalization through AOT

Assisted Outpatient Treatment (AOT)  is a proven alternative to keep people stable and productive in their communities. The opposition to Rep. Murphy’s bill has labeled this provision as “forced treatment.” It is not. AOT laws are already on the books in 44 of 50 states and “require mental health authorities to provide resources and oversight necessary so that high-risk individuals with serious mental illness may experience fewer incidents and can live in a less restrictive alternative to incarceration or involuntary hospitalization” 

A few weeks ago, I spoke with a young woman who opposed my views on AOT. She had been in a psychiatric hospital for more than a month and felt that the care she received was “horrible.”

“Have you been to jail?” I asked. She admitted that like many people who have mental illness, she had.

“Which did you prefer?” I asked.

“The hospital,” she responded without even hesitating. But she made a good point: our current in-patient hospitalization practices, while not as horrible as the psychiatric institutions of yore, could still use some serious makeovers in terms of both physical facilities and therapeutic practices. One of my friends with bipolar disorder has envisioned a therapeutic hospital that would feel more like a spa, where people could stabilize in safety while also continuing to work remotely or go to school—to do the things that give everyone’s life meaning and purpose. Similarly, AOT aims to keep people in their communities, not force them into institutions.

Restructuring SAMHSA funding

I have already expressed my frustrations with SAMHSA and how they fail to provide assistance to the most critically ill patients and their families.  Representative Murphy’s bill restores accountability by tying funding to evidence-based practices that actually help people with mental illness to manage their conditions and live productive, healthy lives. Far from discouraging innovation, as the opposition warns, this provision will actually encourage organizations to build program evaluation into their practice, providing data about what works—and what doesn’t—so that we can focus on helping people to make their lives better.

Let me give you an example from my own state. In an effort to save money, Idaho contracted with Optum to manage its Medicaid mental health care. Optum looked at one service, psychosocial rehabilitation, or PSR, and decided that it was overused and often not medically necessary, especially in children. 

PSR had historically been used as a “catch-all” for children with serious emotional disturbances or behavioral issues. The result of this abrupt PSR denial was that families suddenly found themselves without a service they felt was necessary to their children’s health.

What did the evidence say? Because there were never any requirements to track outcomes, the state merely logged hours and made reimbursements. It turns out that no one really knows what PSR is in Idaho, let alone whether it is effective. Every agency essentially acted independently, developing their own model in the absence of standards for care. Two researchers did find significant clinical improvements for kids on PSR. But they only looked at one of many models. 

Tying outcomes to funding would have provided much-needed data on whether PSR works in children. If the data had been positive, we might have an additional valuable tool to help children function better in the community, a tool we could share with other communities to improve everyone’s care.

Representative Murphy’s bill was forged after the tragedy of Newtown, which also sparked my own desire to advocate for my son. As I researched the myriad problems that plague our system for my forthcoming book, I repeatedly found the same tragic story: poverty, mental illness, and prison. America’s incarceration rates when compared to other so-called first world countries are quite literally off the charts, with more than 2.4 million people in prison. 

If ever there was a truly bipartisan cause, it’s mental health. Fixing our broken mental healthcare system promises to ameliorate so many of the other social ills that harm children, families, and communities. A new advocacy organization, Treatment Before Tragedy, is sharing stories of families like mine, whose children are suffering.  If you are a family member of someone who has mental illness, I encourage you to join this organization and to share your story on Twitter, using the hashtag #Tb4T.

And if you haven’t, please call your representative personally and ask him or her to cosponsor Representative Murphy’s bill. Right now, if your child is in mental health crisis, your only options are to call the police or to go to the emergency room. We can and must do better for our children and families. No family of a child with mental illness deserves that dreaded knock in the middle of the night.