When those in a high school in Oakland County, Michigan watched the Netflix series 13 Reasons Why, the premise and themes it focused on hit close to home as the school had also lost one of their students to suicide back in 2013.

While the show has been criticized, many feel it accurately and excellently portrayed present day issues that teens face today including bullying, body-shaming, social media use, abusive relationships, as well as consent and sexual violence, and even the increased risks associated with having access to weapons such as guns in the home. 

Despite this, many at the school including the dean felt the show portrayed little hope, and depicted suicide as the only way out, without highlighting the many mental health resources available and the care/support family and friends frequently provide. This sparked an idea for a project called "13 Reasons Why Not" ...

The project involved 13 recordings from students at the school being played over morning announcements. Each day, on the recording one teen would share a problem they had been struggling with, whether that would be bullying at school or issues in their home life. However, rather than placing blame, at the end of the recording, the student would thank someone, such as another classmate who has helped them and thus provided a sense of hope and encouragement to carry on.

​Since the project has been in place, students who have volunteered recordings have found an outpouring of love and support from their classmates, and have found that their school has become a community where individuals feel safe and comfortable sharing their mental health struggles. A bright idea not only to raise awareness and encourage ongoing discussions on these issues, but to show what 13 Reasons does not ... that help, hope, and support do exist. 

"“I watched the series. I thought it accurately depicted the problems that teenagers in high school are facing now. But it was incredibly troubling to me that suicide was portrayed as being, almost, inevitable, like she had no other option,” said Fine.
​
“The idea was to come up with 13 reasons why not, because that was not portrayed in the show. … Even though it can get very dark, there is always hope. Our message is that there are no 13 reasons why. Suicide is not an option."

To find out more, visit:
"Oxford High School students begin project called '13 Reasons Why Not'" by Monica Drake (Oakland Press News)

The Netflix original series 13 Reasons Why has received considerable attention over the last few months since its initial worldwide release on March 31. The feedback has been mixed however, and has generated a fair bit of controversy over the portrayal of suicide and self-harm, leading Netflix to post advisory warnings. Many mental lhealth organizations and advocates, along with mental health professionals, have since been speaking out about their concerns regarding the show.

Psychiatrist Dr. Stan Kutcher in Halifax, has been working with the IWK Health Centre and Teenmentalhealth.org to generate an online resource for teens, parents, and educators on how to address concerns regarding the show and discuss mental health issues with young people. 

The resource (link below) specifically highlights concerns such as how the show glamorizes or romanticizes suicide/self-harm raising the concern that there may be an increase in such behaviours by vulnerable youth, presents adults/others as unknowing or unhelpful, and most importantly does not address mental illness which often underlies suicidal thoughts and behaviours. 

However, more importantly, the website provides visitors with a "set of talking points", an important document that should be provided to those who watch the series as it both addresses the above concerns, but also guides discussions between youth and their caregivers/educators, and highlights how hope and help are available to those in need.

To find out more, visit:
http://teenmentalhealth.org/news-posts/responding-13-reasons-considerations-schools/

Put your knowledge and skills to the test with the case of patient A, a 6 year old child, who is brought to your office due to a repetitive self-injurious behaviour in which she repeatedly jams her finger into her nose, leading to multiple nosebleeds per day.

Based on additional history, you determine that these symptoms began at age 3, and are associated with multiple fears (vomiting, storms, public bathrooms, parents' dying), bedtime checking rituals, and involuntary motor and vocal tics such as facial grimacing and throat clearing. She has recurrent UTIs, but is otherwise healthy. There is no history of trauma/abuse. She has been receiving CBT for the last year, and is not on any meds. 

What diagnoses are on your differential? What further information would help you distinguish between these diagnoses? What treatment would you suggest?

"A girl repeatedly jabs her finger up her nose: Compulsion or self-injury?" by Butkus M and Vinch J (Current Psychiatry). 

We now understand better than ever how exposure to early adversity affects the developing brains and bodies of children. It affects areas like the nucleus accumbens, the pleasure and reward center of the brain that is implicated in substance dependence. It inhibits the prefrontal cortex, which is necessary for impulse control and executive function, a critical area for learning. And on MRI scans, we see measurable differences in the amygdala, the brain's fear response center. So there is concrete neurologic evidence why those exposed to high doses of adversity are more likely to engage in high risk behaviour and suffer worse health outcomes. 

To learn more about this enlightening research see Dr. Nadine Burke Harris' TED Talk: 

https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en

Filmmaker and radio producer Bianca Giaever sought out to make a film on ‪anxiety‬ from a child's point of view. In her interviews with these young people, Giaever asked each of them to tell a story that they could make into a movie. What resulted, was a delightful and heartwrenchingly cute short film inspired by one of the 6 year old girls Giaever spoke with, who at the end of the film demonstrates some pretty powerful insight and advice for us all in how to deal with negative feelings like anxiety and disappointment. A must watch!

"I was curious to see if a six year old could relate to emotions like anxiety at such a young age. I didn't know that this advice would necessarily come from Asa — I interviewed a few different six year olds for this project by offering free babysitting or just asking. I asked some parents and figured that six years old is the perfect age, when kids can coherently tell a story but aren't self conscious or inhibiting themselves at all yet."

Catch up on all the news related to mental health and psychiatry!

Catch up on all the news related to mental health and psychiatry from last week!

In this poignant short video by Swedish filmmaker Erik Rosenlund, we get a unique glimpse into the reality of living with ‪‎ADHD‬ from a child's perspective. The beautiful film demonstrates many of the struggles these children face including difficulties in the classroom to their social relationships and how they may be seen by other youth.

The film which aims to promote greater understanding of youth living with ADHD, also movingly demonstrates the importance of having a supportive parent who provides both ‪‎love‬ and ‪patience‬.

Check out all the news related to mental health and psychiatry from the last few weeks!

Surfacing data has identified a growing trend of prescribing ‪‎antidepressants‬ and ‪antipsychotics‬ to toddlers and ‪children‬ under the age of 2. For many physicians and experts in the field, the use of psychotropics to address violent or withdrawn behaviour in our youth is worrisome, particularly due to the fact that these medications were originally designed for adults and have not been researched on young children to determine efficacy and risks on young people with rapidly developing brains.

The data also raises the question of whether as a society we are pathologizing certain child behaviours that are variants of normal or are seeking a quick fix rather than being willing to spend the time and money to explore the more deeply rooted causes of the child's mood and actions. It also brings to light the shortage of child psychiatrists and gaps in the training of our pediatricians which likely perpetuate the issue.

"In interviews, a dozen experts in child psychiatry and neurology said that they had never heard of a child younger than 3 receiving such medication, and struggled to explain it. They presumed that parents and doctors, probably desperate and well meaning, were trying to alleviate thrashing temper tantrums — the kind that get children kicked out of day care — or an overly depressed disposition, like being strikingly inhibited, nonverbal or lethargic.

“People are doing their very best with the tools available to them,” said Dr. Mary Margaret Gleason, a pediatrician and child psychiatrist at Tulane University School of Medicine. “There’s a sense of desperation with families of children who are suffering, and the tool that most providers have is the prescription pad.”

But Dr. Gleason said that children with ages measured in months had brains whose neurological inner workings were developing too rapidly, and in still unknown ways, to risk using medications that can profoundly influence that growth. She said the medications had never been subject to formal clinical trials in infants and toddlers largely because of those dangers."

For the full story, click here: http://www.nytimes.com/2015/12/11/us/psychiatric-drugs-are-being-prescribed-to-infants.html?ref=todayspaper&_r=1