The challenges families face in finding the right help…

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May 1-7, 2016 is Children’s Mental Health Awareness Week. We’re sharing this post a day early to begin calling attention to the challenges many families experience finding the right help for their child when their child experiences a mental health crisis.

Parents of kids with emotional, behavioral or developmental disorders frequently experience great frustration negotiating the confusing maze that constitutes our system of mental health care in many communities across the U.S. They often turn to pastors and ministry leaders as trusted resources in times of crisis. My own professional society (the American Academy of Child and Adolescent Psychiatry) encourages parents to seek recommendations from their spiritual leaders. In honor of Children’s Mental Health Week, I want to help ministry leaders appreciate the challenges families face in finding the right help for their kids, and offer resources to share with parents when they look to the church for help.

Among the challenges families face are…

Access to professionals with the training and experience to effectively treat kids. I’m a child and adolescent psychiatrist by training…after medical school, I did a three year residency in general psychiatry at Cleveland Clinic prior to two additional years of training with kids at University Hospitals of Cleveland. There are approximately 8.000 child psychiatrists actively practicing in a country with approximately 75 million children and teens. The vast preponderance of child psychiatrists are clustered in major cities, and are especially rare in large areas of the South or Midwest…areas where the church tends to have more influence.

Finding professionals who will see kids and know what they’re doing can be a challenge. One difference between child psychiatrists and other clinicians who see kids involves the variability of training experiences and supervision prior to entering practice. Child psychiatrists have a minimum of five years of training and supervision following med school. In contrast, psychologists have the option of doing a one year internship in child psychology. Counselors in our state (Ohio) who identify children as an area of concentration would have a minimum of 1500 supervised contact hours of treatment with kids before entering independent practice.

Finding professionals who effectively provide evidence-based treatment. Here’s an example…Cognitive-Behavioral therapy (CBT) has been shown to be an effective alternative to medication in the treatment of kids with anxiety disorders or depression. In a city/region generally accepted to be among the top ten in the U.S. for medical resources, there are a handful of psychologists or counselors therapists in whom I have confidence when it comes to offering therapy of the quality received by the kids who participated in the published research studies.

Getting appointments in a timely manner. Because professionals with the training and experience to work with kids are in short supply, getting an appointment with the best people (assuming you have people in your area) can take a very long time. Even in large cities such as Boston and Washington D.C. with a relatively larger supply of professionals, appointment wait times have reached crisis proportions. In areas such as rural Wisconsin, waits for an appointment can reach two years!

shutterstock_282803315Finding affordable care of high quality. In Northeast Ohio, we have a three-tiered healthcare system. Kids who qualify for Medicaid can access services through our teaching hospitals and community mental health centers. In some counties the available services for kids are outstanding and far exceed anything families with private insurance can access. In other counties, services are available, but child psychiatry access is limited to very brief appointments focused entirely upon prescribing of medication and counseling provided by inexperienced trainees. Sadly, the trend in our public mental health system is headed in the wrong direction. Within the last year, our state issued administrative rules limiting kids in the public system to two hours of psychiatric assessment in a given year. A typical psychiatric assessment of a child or teen takes around three hours in our practice.

The most highly regarded clinicians in private practice (child psychiatrists, psychologists, some counselors) are able to practice without having to join insurance networks for payment. This is our practice model. Waiting lists are shorter, but such practices are becoming fewer and fewer in number as the hours spent in uncompensated tasks (phone calls, emails, paperwork, coordinating care with other professionals, working with schools, dealing with pharmacy benefit managers) have become so great that many clinicians have had to close their practices and accept salaried positions. Economic factors in recent years (markedly higher health insurance costs, higher insurance deductibles, limitations on contributions to flexible spending accounts, increased costs involved with raising children when salaries remain relatively flat) have resulted in our business model becoming unsustainable outside of a few very affluent cities.

shutterstock_410689672Middle class families who depend upon their health insurance benefits may be in the most difficult situation of all. From a psychiatry perspective, the only way a physician can earn a salary comparable with those offered by public agencies while accepting insurance is to run an “assembly-line” practice composed of seeing high volumes of patients for very brief appointments. The large teaching hospitals in our area who contract with the big insurance companies won’t hire an adequate supply of clinicians to see kids with mental health issues because it’s impossible for those clinicians to see enough kids to generate the revenue necessary to cover the costs of their salaries, benefits and overhead on the reimbursement rates they get from insurance. Parents frequently get names of clinicians who are allegedly “in-network” from insurance company websites only to find that they’re not taking new patients, they don’t see kids, their offices are closed, they don’t accept the insurance in question, or that they’re scheduling six months in advance. Appointment times may not be available outside of work or school hours.

These are just a few of the struggles experienced by the parents of the kids who are acting out in Sunday School. What can the church do?

  • Pastors and ministry leaders can become familiar with the resources available in their immediate communities to help kids and families in crisis. Many churches will have members and attendees who are pediatricians, psychologists or counselors who might make recommendations as to local resources for families in need. The local chapter of NAMI may be an excellent resource for church leaders in search of resources for kids and families.
  • One way in which a church could provide a much-needed service to families in their immediate area would be to make available advocates who would help parents in search of mental health care connect with resources offered through community agencies, schools, private clinics and their health insurer.
  • Families may need some short-term financial assistance from a deacon’s fund or other benevolence fund to obtain a competent assessment in a timely manner when they have a child or teen in crisis.
  • The church can also provide a powerful demonstration of the love of Christ by creating ministry environments in which families of kids with mental health disorders are welcomed and valued.

shutterstock_257468587Editor’s note…AACAP developed Facts for Families to provide concise and up-to-date information on issues that affect children, teenagers, and their families. The AACAP provides this important information as a public service and the Facts for Families may be duplicated and distributed free of charge as long as the American Academy of Child and Adolescent Psychiatry is properly credited and no profit is gained from their use. Here are links to information on When to Seek Help for Your Child, Where to Find Help for Your Child and Understanding Your Mental Health Insurance.

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shutterstock_291556127Key Ministry encourages our readers to check out the resources we’ve developed to help pastors, church leaders, volunteers and families to better understand the nature of trauma in children and teens, Jolene Philo’s series on PTSD in children, and series on other mental health-related topics, including series on the impact of ADHD, anxiety and Asperger’s Disorder on spiritual development in kids, depression in children and teens, pediatric bipolar disorder, and ten strategies for promoting mental health inclusion at church.

Posted in Advocacy, Families, Key Ministry, Mental Health, Resources | Tagged , , , , , , , , , , | Leave a comment

The joy of the Lord and clinical depression…Sergei Marchenko

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Editor’s note: Sergei Marchenko, pastor and husband of Gillian Marchenko is blogging for us today. Sergei looks at how we can make sense of the “joy of the Lord” in the context of depression. Here’s Sergei.

It is admittedly difficult to preach about the joy of the Lord to those who struggle with mental illness, particularly clinical depression. When a person for whom feeling happy is a medical impossibility hears biblical commands to rejoice always (and again I say, rejoice!) they often feel even more guilty over their lack of joy or ashamed of their failure as a Christian or angry at the preacher who doesn’t understand what they are going through. Should churches avoid such preaching? If we mean preaching that provides superficial answers to profound struggles, then my answer is yes. And here is a good place for me to ask those who struggle with mental illness to forgive me as a preacher for minimizing or misunderstanding your pain, for the lack of sensitivity and compassion, and for sometimes not even considering how a particular message might affect you. I am sorry. However, if we mean preaching on one of the dominant themes that is at the center or periphery of almost every promise or command in Scripture, well, I don’t think we should avoid it at all. I would like to share two things I am learning about the joy of the Lord.

First, our joy as commanded in Scripture is not merely an emotion. Joy is a disposition of the soul that often results in emotion but does not depend on it. Joy is an affection, to use an old Puritan term. A Christian has been so transformed that her heart has been reoriented toward God through the supernatural and mysterious work of the Holy Spirit. She is able to see God for who he is, even though that vision is still imperfect. She is moved to respond to that vision with reordered holy emotions, thoughts, and actions, even though the follow-through is never totally consistent while we are still part of the broken world. Clinical depression is part of the disintegration of creation which includes the human body. As a person with a broken foot cannot dance in worship, so a person with depression may not be able to express the emotion of happiness in the Lord’s presence. While we await complete restoration at Christ’s return, when our emotions, actions, and thoughts will be fully consistent with who God is and who we are as his redeemed creation, we can still experience the reality of the new orientation or disposition of the soul even now, however incompletely expressed. In other words, every Christian should be able to say truthfully that they are joyful in the Lord and at the same time that they do not feel joyful in the Lord. Both can be and often are true. Going back to my analogy of the would-be dancer with a broken foot, he can say that he is joyful in the Lord and that he is not able to dance joyfully.

shutterstock_394503922As a person struggling with mental illness reads Bible passages or hears sermons about being joyful, my encouragement is to take those commands as relating to a basic disposition of the soul toward God. Perhaps, it might be helpful to replace joy with such theological synonyms as satisfaction or rest or security or peace or acceptance. Do you have joy in the Lord? Do you believe God is on your side? Do you look to him for comfort? Are you turned toward him or away from him? Are you resting in his embrace? I think that even in the midst of depression Christians might answer yes to those questions.

Second, our joy in the Lord is a reflection of the Lord’s joy in us. You see, the Lord rejoices, delights, exults in us. Like a father who cries and laughs at the birth of his baby, who claps at her first steps, who cheers her on from the stands, who brags about her to his friends, so does God feel about his children. The great news of the gospel is that broken people like us, confused, disobedient, forgetful people have been adopted into God’s family through Christ. Anyone who is in Christ, who has identified with him as their Redeemer by simple faith, is an adopted child with whom the Father is perfectly pleased. Not because of our virtues or moral achievements or religious commitments, but because of the Son’s sacrifice and victory on our behalf. And so it is biblically and theologically correct to say that God is as pleased with us as he is with his perfect Son Jesus. That kind of over-the-top joy of God in us can cut through our guilt and shame and pain and despair and isolation. The joy of the Lord (in us, through Christ) is our strength.

If we understand and accept this divine delight in spite of our very real struggle, something we call grace, we can be sure that our affections have been reordered and the soul’s disposition has been changed by his Spirit. And so we now have the joy of the Lord, however limited by mental illness might be its expressions. We can be joyful without necessarily feeling joyful because God delights in us through Christ.

Sergei Marchenko was born in Kyiv, Ukraine and grew up in a non-religious post-Soviet family. At 16 he was converted to Christ under the influence of American missionaries who lived next door and his call to full-time ministry came a couple years later during his first year of college. He currently serves as Lead Pastor of Chatham Bible Church in Hazelwood, MO. Sergei is married to Gillian (a writer and speaker), and they have four daughters: Elaina, Zoya, Polina and Evangeline. Polina and Evangeline, who was adopted from Ukraine, both have special needs.

In the midst of so many hormones at home, Sergei attempts to preserve his masculinity by following the National Hockey League, talking theology and history with friends, and finding interesting podcasts to download for afternoon runs. He also enjoys music, church, cooking and seeking out fun public parks to enjoy with his family.

Sergei graduated from Moody Bible Institute and Trinity Evangelical Divinity School, and is ordained in the Evangelical Free Church of America.

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Still LifeFor Gillian Marchenko, “dealing with depression” means learning to accept and treat it as a physical illness. In Still Life she describes her journey through various therapies and medications to find a way to live with depression. She faces down the guilt of a wife and mother of four, two with special needs. How can she care for her family when she can’t even get out of bed? Her story is real and raw, not one of quick fixes. But hope remains as she discovers that living with depression is still life.

Still Life is available here in paperback and e-book from IVP Press. The Kindle edition is available at Amazon.

Posted in Depression, Key Ministry, Mental Health, Spiritual Development | Tagged , , , , | 1 Comment

Six reasons people with disabilities don’t know we love them

13062155_10153374161451008_7625398875489313501_nEditor’s note: Shannon’s post was inspired by a talk she heard from Jen Hatmaker this past weekend.

When Jesus spent time with people, he didn’t choose the powerful or privileged. Jesus loved the poor. The sick. The powerless. Widows. Lepers. Orphans. Traitors. Women. Immigrants. Those with mental illnesses and disabilities.

In the words of Jen Hatmaker, who I heard speak this weekend, “Jesus loved all the unsanctioned people.”

And today? Some of those same groups, as well as a few more, are still treated as unsanctioned by some of our churches. Often, they don’t know we love them. Why?

  1. We haven’t told them.

The Great Commission calls us to go and make disciples of all peoples. If we say yes to sharing the good news of Christ in distant places around the globe, we’re heeding that command. But we’re also doing so when we show that same love to people here. As people with disabilities are less likely to attend church and those with autism are more likely to be atheists, are we fulfilling our responsibility to go and tell this group about Jesus?

  1. We doubt our shared humanity.

Shepherds College TNT Ellen Cook Photos 2010 005When we talk about us and them, as we often do with people with disabilities, we’re drawing lines. We wouldn’t explicitly say “we’re more human than they are,” but sometimes we say that in how we treat our friends with special needs. We say it whenever we repeat the myth that kids with Down syndrome and other conditions are sweet angels who are just happy all the time. If humans experience a range of emotions, so when we pretend like some people can’t, then we’re calling them less than human. Treating others in a condescending matter doesn’t show love.

  1. They doubt our willingness to do hard things.

Listen, I’m a mom of kids with special needs. I know including my family at church can be hard. Accommodating for disabilities present at church is extra work at times. We’ll be visiting a friend’s church in the coming weeks, and I’ve emailed the children’s ministry coordinator there in advance. I said, “Let me tell you about my family… What would it look like for us to come on [insert date]?” But I might as well have said, “Are you willing to do hard things?” Saying yes to that question is the ultimate demonstration of love to families like ours.

  1. They believe the lies of the world.

After reviewing the medical records for a child I love, one medical professional said directly, “she will be horribly devastating” and advised against her adoption. This is an example of how the world views people with disabilities. We’re quick to define ourselves or others by our abilities and accomplishments and accolades. That worldview tells lies to people with disabilities, saying that their deficits outweigh their many strengths. When someone hears that they aren’t valued enough times, then they believe it. If we in the church aren’t intentionally offering a different narrative about disability, then how will these precious friends know that they are loved?

  1. They’ve been rejected too many times.

shutterstock_228077539Why risk being treated as unloveable again after the first time it’s happened? In my daughter’s dance class, another little girl refused to hold her fisted hand. Cerebral palsy made my child’s hand muscles tighten, but rejection was what made my eyes watery. This moment hasn’t been the first time and won’t be the last. Sometimes it’s easier to not even chance the rejection.

  1. We’ve said no before.

In leading the special needs ministry at our church over the past several years, almost every new family has arrived with the story of at least one church before us that has said no. Some have explicitly been told, “I’m sorry, but we can’t bring your child back.” Others have peeked into the classroom each week to see their son ignored in the corner while teachers engage the rest of the class. Every story has broken my heart anew.

This post might seem gloomy, but nothing in it is meant as an indictment of any church. Instead, let’s view each of these as opportunities for us to do better. We can say yes. We can accept instead of reject. We can offer a biblical worldview on disability. We can do hard things and affirm common humanity. And we can tell people of all abilities how much God loves them.

Let’s say no more to treating any group of people as if they are unsanctioned by God or us. As Jen pointed out this weekend, Jesus loved others with presence, with touch, with proximity, and with dignity. Let’s go and do likewise to our friends affected by disabilities.

Shannon Dingle is a Key Ministry consultant. She’ll be presenting at the Christian Alliance for Orphans Summit in Orlando, FL on May 5th and 6th. 
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Dingles SpringCheck out Shannon Dingle’s blog series on adoption, disability and the church. In the series, Shannon looked at the four different kinds of special needs in adoptive and foster families and shared five ways churches can love their adoptive and foster families. Shannon’s series is a must-read for any church considering adoption or foster care initiatives. Shannon’s series is available here.

Posted in Advocacy, Inclusion, Shannon Dingle, Special Needs Ministry | Tagged , , , , , , | Leave a comment

A community for families impacted by mental illness

shutterstock_339787181Our new ministry division for families will seek to provide encouragement and support for families of kids with disabilities through several types of online gatherings; large group communities (housed on Facebook and organized around a specific condition, disability or area of interest), special interest study groups organized around a topical study (Bible study, book study or shared media, housed on Facebook but including opportunities for real time interaction via videoconferencing) and more intimate small groups.

We’re pleased to announce the launch of our first large group community on Facebook… the Key for Families Mental Health Community.

We’ve established a place for families of kids and young adults with common mental health conditions to find encouragement, resources and support from a decidedly Christian perspective.

shutterstock_326764691Our Facebook communities will be:

  • Broadly organized around common interests (child and adolescent mental health, trauma, Asperger’s Disorder, parents in ministry, homeschooling and disability are examples of a few communities that will be starting at launch)
  • Directed by a team of hosts responsible for overseeing the content and membership of the community.
  • “Closed” groups…any member can invite a new member, but members need to be registered with Key for Families and approved by a community host. Membership is NOT confidential…anyone can find the group on Facebook and see who belongs to the group.
  • Typically feature links to articles or content of interest to the group shared to promote awareness or discussion.
  • Open-ended.

Within our Facebook communities, members will have opportunities to join smaller, more intimate studies and discussions…

shutterstock_104902844Special interest study groups are:

  • Organized around a study/discussion of a book, Scripture or other media easily shared with all participants in the group.
  • Housed on Facebook as “secret groups.” Only current and former members can see the group’s name and description on Facebook, and only current members can see links and comments posted to the group. Any member can invite a new member, but (as with Facebook communities) members need to be registered with Key for Families and approved by a community host. Comments and discussion inside the group is confidential.
  • Are offered under the sponsorship of one or more Key for Families Facebook communities.
  • Led by an assigned host.
  • Are limited to a maximum of fifty participants.
  • Are typically time-limited, with exceptions made upon approval of Key for Families leadership.
  • May involve a requirement for group members to purchase resources or materials.

We encourage the development of friendships outside of our communities. We especially encourage group members from churches intentional about welcoming families impacted by mental illness to let us know so we might help find “a church for every child.”

Interested in joining our online mental health community? Let us know a little bit about you, and we’ll activate your membership.

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shutterstock_291556127Key Ministry encourages our readers to check out the resources we’ve developed to help pastors, church leaders, volunteers and families to better understand the nature of trauma in children and teens, Jolene Philo’s series on PTSD in children, and series on other mental health-related topics, including series on the impact of ADHD, anxiety and Asperger’s Disorder on spiritual development in kids, depression in children and teens, pediatric bipolar disorder, and ten strategies for promoting mental health inclusion at church.

Posted in Advocacy, Families, Groups, Key Ministry, Mental Health | Tagged , , , , , , , , | Leave a comment

Why are we witnessing an epidemic of mental illness in kids?

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As a child and adolescent psychiatrist, I frequently encounter parents and skeptics who freely share their opinions that much of the reported crisis in children’s mental health is fabricated…a marketing scheme of the pharmaceutical industry, a consequence of poor parenting or misplaced priorities on the part of families.

Opinions such as these endure because anecdotal data in support of them can be relatively easy to find. There’s an argument to be made that drug company marketing in support of long-acting ADHD medications led to a spike in the number of kids being diagnosed in the early years of the last decade. I see parents who come looking for the “magic pill” to fix their child’s problems and recoil when family-based or behavioral interventions appear more appropriate. I spoke to a colleague recently who quit her job in a publicly-funded clinic because she was sick of parents who needed her to declare their kids sick so that they could obtain disability payments from the government. But these situations are by far the exceptions as opposed to the rule. I spend my days dealing with kids with real disabilities accompanied by well-meaning parents who more so than anything desire the best for their kids and are willing to try the strategies our practice team recommends.

In an earlier post, I shared data from a study examining the prevalence of mental health disorders among kids entering the first grade. Here are some of my hypotheses as to why over 20% of U.S. kids meet criteria for at least one mental disorder:

  • shutterstock_409637815Rates of mental illness are a reflection of the struggle kids and families face in responding to the external demands placed upon them by our culture. I have a very hard time with the concept of first graders carrying planners. One of the biggest changes I’ve seen in my 30 years as a doc is the increase in the productivity expectations schools place upon kids. My youngest daughter had about the same volume of homework in the first grade that I had in the seventh grade in what was then an elite public school system in Ohio. Most kids that I see with ADHD come to my office because of problems with organizational skills and work completion. Kids getting diagnosed with the condition have genuine difficulty keeping up in school. The biggest change I’ve seen in the composition of my practice involves the number of kids struggling with anxiety. The pressures to succeed both academically and socially are unprecedented.
  • The general breakdown of the family…the maladaptive choices parents make in seeking to fill the emptiness in their lives have consequences for kids. This is the primary reason I quit doing community mental health. My typical referral when I worked in a public mental health center…Single mom comes in (she has five kids by four different guys and is currently living with a boyfriend unrelated to any of her children who beats her on a nightly basis in front of her kids) with her seven year old who was suspended for fighting on the playground. I was far more overwhelmed by the level of spiritual poverty working in the city than the economic poverty our families experienced. I concluded that many of the families I was working with needed a pastor more than they needed a psychiatrist. That observation also holds true with lots of affluent families from the suburbs.
  • The consequences of a post-modern culture with an emphasis upon relative values and the lack of moral absolutes. I spend much of my talking to kids and teenagers who may be anxious, depressed or suicidal. Just to be clear, I’m absolutely convicted that God’s way works and the rules and standards for living in the Bible exist for our own protection. With that said, I’m probably not going to get very far making that argument with a teenager, even (in most instances) kids from Christian families. The destruction accepted standards of right and wrong behavior make things worse for kids with vulnerabilities to anxiety or impulsive behavior.

shutterstock_363166763This comes into play when kids fail to appreciate the intensity of emotions they’ll experience when sexual boundaries are crossed. Many don’t yet have the necessary emotional maturity to manage the intensity of feelings when relationships become sexual. Kids who think too much or have a difficult time letting things go often become depressed or exhibit self-injurious behavior in response to the ups and downs of relationships. The breakdown of standards of absolute right and wrong has resulted in kids (and parents) exposed to problems and situations that they’re not equipped to deal with…a situation that frequently precipitates symptoms of mental illness in teens who are vulnerable.

  • The interplay of environment and genetics. We know that kids exposed to alcohol and tobacco in utero are likely to develop ADHD and experience learning disabilities. A landmark study demonstrated that exposure to tobacco smoke during the third trimester of pregnancy appears to be especially toxic for children with two identical copies of a specific gene associated with ADHD, resulting in an 8-fold greater risk of the condition. 

Here’s what I do know:

  • Every kid and every family needs to know Jesus
  • The church is called to make disciples
  • As the church, we’re called to share God’s love with kids with mental illnesses and their families, REGARDLESS OF THE CAUSE.

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shutterstock_291556127Key Ministry encourages our readers to check out the resources we’ve developed to help pastors, church leaders, volunteers and families to better understand the nature of trauma in children and teens, Jolene Philo’s series on PTSD in children, and series on other mental health-related topics, including series on the impact of ADHD, anxiety and Asperger’s Disorder on spiritual development in kids, depression in children and teens, pediatric bipolar disorder, and ten strategies for promoting mental health inclusion at church.

Posted in Advocacy, Controversies, Hidden Disabilities, Key Ministry, Mental Health | Tagged , , , , , , , , | 3 Comments

Life with depression is not a waste

shutterstock_367518008One thing I struggle with most regarding my major depressive disorder is the notion that my life is a waste. There are weeks, sometimes months in the past lost to me. I look back and can’t remember what my children were like at certain ages or if we had a good time on our 2008 vacation.

Even recently, in what I would define as ‘a season of health,’ I lose track of time. “It’s been pretty good these last few weeks, right?” I casually mention to my husband and he’ll look at me quizzically. “Gilly, don’t you remember? You spent two days in bed last week.”

Moments in my life are forgotten, lost, dark. How can whole, omitted days not be a waste?

In my recent book, Still Life, A Memoir of Living Fully with Depression, I describe it this way:

“When you are depressed, time becomes an enemy. You either have too much of it, like a sprawling Nebraska cornfield, or you’ve wasted it, your moments thrown into a heap and lit with a match. Burned up. Irretrievable. Each second holds an exorbitant amount of pain. It traps you. You feel each beat. Minutes are full and long as they crawl toward the new hour, and you do nothing but try to hold still and live through them. Time is wasted because you concentrate on living through each moment. You look back, you search your memory, but all you see is a heavy cloud of hurt, confusion and black.”

 —Adapted from chapter three, “Major Depressive Disorder.”

file7481240231358_1But even within collected black moments in life, God keeps bringing me to the Psalms of David. His hymns ease my wreaked mind and provide a moment of peace while I consider his role in the overarching theme of God’s plan of redemption. Here is a man with a tortured life, both outwardly as he is chased ruthlessly by his nemesis Saul and inwardly with the lure of another man’s wife is too much for his sinful heart to ignore. If you read David’s lyrics recorded in the Bible, you see a man familiar with darkness and yet pleading for the light, and grabbing and holding on to the moments they exist.

The other day I read one of the most famous of the Psalms;  139. Immediately in the first verse, the theme emerges:

“O Lord, you have searched me and known me! He goes on, “You know when I sit down and when I rise up.”

This inescapable truth is staggering. God intimately knows the days I can’t function. Regardless if they are lost to me, they are not lost to him. He is not unaware of my numbed mind and aching limbs crawling towards the next minute. No, he is right there with me. He is sovereign. He is the one providing the next patch of light in my life. Even if his purpose escapes me, purpose exists nonetheless.

Verses 11-12:

“If I say,”Surely the darkness shall cover me, and the light about me be night,” even the darkness is not dark to you; the night is bright as the day, for darkness is as light with you.”

In my ongoing illness I begin to understand the confusing need for darkness. If there is no darkness, why would I crave the light?

My life is not a waste to God and it is not a waste to my family. It’s not a waste to others who know my story and breathe a sigh of relief that they are not the only people in the church fighting depression. And in the extension of this line of thinking, I realize my life is not a waste to me.

I guess that’s why I wrote a book about depression; a vulnerable, at times embarrasing story about my inner most thoughts, struggles, and shame. I wrote it because this is what the Lord continues to write on my heart: Life with depression is not a waste. Life with depression is Still Life, and valuable to God.

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Still LifeFor Gillian Marchenko, “dealing with depression” means learning to accept and treat it as a physical illness. In Still Life she describes her journey through various therapies and medications to find a way to live with depression. She faces down the guilt of a wife and mother of four, two with special needs. How can she care for her family when she can’t even get out of bed? Her story is real and raw, not one of quick fixes. But hope remains as she discovers that living with depression is still life.

Still Life is available here in paperback and e-book from IVP Press. The Kindle edition is available at Amazon.

Posted in Depression, Gillian Marchenko, Hidden Disabilities, Key Ministry, Mental Health | Tagged , , , , , , , , | 4 Comments

Should kids with ADHD take their medication for church?

shutterstock_216207223We’re going to plunge headfirst into a topic this week that I’ve never seen addressed anywhere in books, articles or seminars on working with families of kids with ADHD…the use of medication for the specific purpose of helping kids function better during church-based programs and activities.

There are several reasons why I referred to today’s discussion as a “taboo topic.” Parents of kids with ADHD who do make their way to church are often very uncomfortable sharing information about their child’s diagnosis or treatment. Church staff and volunteers should (appropriately) avoid speculation about a child’s diagnosis or  treatment needs. Physicians and other professionals involved with treating kids with ADHD are likely too uncomfortable broaching the need for medication at church or too oblivious to the reality that some parents would desire treatment in support of their child’s spiritual development.

First, my two cents: If your child’s experience at church is as important as their experience at school, the need for effective treatment at church is as great as their need for treatment at school.

Because medication is the single most effective stand-alone treatment for ADHD and the therapeutic effects of the medications used to treat ADHD are very short-lived, the child’s experience in church on a day to day or week to week basis may be highly contingent upon their medication status.

Why would a parent not give their child medication on the weekend that would help them have a better experience at church? Here’s data from a study I presented ten years ago at the American Academy of Child and Adolescent Psychiatry looking at prescription fill rates for children and adults with ADHD:

Bottom line: The “average” kid with ADHD who has been prescribed medication isn’t on their medication on any given day.  I suspect parents avoid medication whenever they can get away without it. Appetite suppression is common. Some kids have more difficulty sleeping on medication. Kids with ADHD who also have anxiety disorders (30%) often become moody or irritable on stimulants. Parents administer medicine because…

(A) Their child wouldn’t make it through school without it

(B) Without medication, their child’s behavior would be too disruptive to family life and peer relationships.

Parents haven’t been conditioned to think about the impact of ADHD on their child or family’s church participation because I suspect most clinicians don’t ask. In the last 25 years, I can count on the fingers of one hand the number of times a parent spontaneously volunteered concerns about their child’s ADHD at church before I raised the question. Talk about don’t ask, don’t tell!

shutterstock_65137348Scheduling of activities for children and youth can create challenges for medication administration. There’s a big pool of kids out there for whom their needs for support in church will vary from activity to activity. The parent who gives their kid his medicine two hours before leaving for church may not send medication along for a weekend retreat. If your church offers AWANA (or similar midweek programming) and has a high percentage of kids with ADHD, it’s important to keep in mind that the three most commonly prescribed medications for ADHD (Adderall XR, Concerta and Vyvanse) typically wear off around dinnertime when kids take medication before leaving for school.

The only time I’ve needed to have a parent sign a release of information so I could talk to my wife occurred when she was serving as AWANA group leader. A patient of mine with ADHD was in her group and got into a fight with another kid who probably should have also been a patient. Understanding this boy’s challenges in the evening led to a medication adjustment and a successful year in AWANA.

There’s a big pool of kids out there for whom their needs for support in church will vary from activity to activity. The parent who gives their kid his medicine two hours before leaving for church may not send medication along for a weekend retreat.

shutterstock_379214836The other side to this discussion involves the perspective of the child’s prescribing physician/clinician. Why wouldn’t the kid’s doctor instruct parents to use medication on Sundays or for evening church activities?

  • Maybe the physician felt uncomfortable asking about family religious practices? In our ultra-PC world, more and more physicians are likely to avoid any discussion of religious practices altogether for fear of offending parents.
  • The physician is so busy typing into an electronic record during the all too brief appointments the insurance companies pay for that they don’t have time to ask about church.
  • The physician may not have the cultural competency to understand the importance of church in the life of the child’s family.
  • The physician may recommend withholding medication on weekends to minimize the impact of side effects: It’s not uncommon for kids to have difficulty eating or fail to gain weight while taking medication for ADHD. Appetite and growth concerns are probably the most common reason physicians suggest to parents that they withhold medication on weekends.
  • The physician may not have the depth of understanding about ADHD that would lead them to individualize the child’s treatment for evening or weekend activities.  Some docs have a greater level of sophistication in understanding ADHD and the nuances of the medications used to treat it. Educated parents who have done their homework and make well-reasoned suggestions to their child’s physician often get what they want.

In a nutshell, it should be possible to find a solution for church for kids who benefit from medication at school. Short-acting versions of extended-release ADHD medications are readily available that may be very helpful when kids with ADHD can benefit from improved symptom control for several hours for a church activity with a minimal impact upon their side effect burden.

My hope would be that parents would become as comfortable addressing the need for medication at church with their child’s physician as they would discussing the impact of their child’s ADHD in school or at home, and physicians would routinely ask about the impact of ADHD on the child’s church participation and spiritual development. We’ve got a long way to go before those conversations become routine.

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shutterstock_291556127Key Ministry encourages our readers to check out the resources we’ve developed to help pastors, church leaders, volunteers and families to better understand the nature of trauma in children and teens, Jolene Philo’s series on PTSD in children, and series on other mental health-related topics, including series on the impact of ADHD, anxiety and Asperger’s Disorder on spiritual development in kids, depression in children and teens, pediatric bipolar disorder, and ten strategies for promoting mental health inclusion at church.

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