About Suicide & LGBT Youth

Suicide is the act of taking one’s own life and continues to be a serious problem among young people. Some youth may experience strong feelings of depression, stress, confusion, self-doubt, pressure to succeed, financial uncertainty, and other fears while growing up. These can be very unsettling and can intensify self-doubts. For some, suicide may appear to be a solution to their problems and stress. Research has shown that lesbian, gay, bisexual, transgendered, and/or questioning (LGBTQ) youth are more than twice as likely to attempt suicide than straight peers. However, sexual orientation is not noted on death certificates in the U.S. so exact completion rates are difficult to report. Studies have also confirmed that
LGBTQ youth have higher rates of suicidal ideation than their straight peers and often have more severe risk factors. It is important to note that being LGBTQ is not a risk factor in and of itself; however, minority stressors that LGBTQ youth encounter - such as discrimination and harassment - are directly associated with suicidal behavior as well as indirectly with risk factors for suicide.

How does it affect my child?

Warning signs specific to LGBTQ Youth may include: - Previous suicide attempts - A diagnosable mental illness and/or substance use disorder - Relationship issues - A high rate of victimization/bullying - Difficulties in dealing with sexual orientation - Lack of family acceptance - Expressing hopelessness or helplessness - Having a plan

How can we help?

Some factors which may help to lower a youth’s risk of considering suicide are: - Programs and services that increase social support and decrease social isolation among LGBTQ youth (support groups, hotlines, social networking) - Access to effective, culturally competent care - Support from medical and mental health professionals - Coping, problem solving and conflict resolution skills - Restricted access to highly lethal means of suicide - Strong connections to family - Family acceptance of one’s sexuality and/or gender identity - A feeling of safety and support at school - Connectedness at school through peer groups - Positive connections with friends who share similar interests - Cultural and religious beliefs that discourage suicide - Positive role models and self-esteem If you are worried that a youth may be thinking about suicide ask him/ her directly if he/she is considering suicide. Ask whether he/she has made a specific plan and has done anything to carry it out. Explain the reasons for your concerns. Listen openly. Be sure to express that you care deeply and that no matter how overwhelming his or her problems seem, help is available. All suicide threats should be taken seriously. Immediately seek professional help from a doctor, community health center, counselor, psychologist, social worker, youth worker or minister if you suspect a suicide attempt. In Maryland, call 1-800-422-0009. You can also call 1-800-SUICIDE or look in your local phone book for suicide hotlines and crisis centers. If the youth is in immediate danger, do not leave him/ her alone and seek help immediately. You can call 911 or take him/her to the emergency room. If the youth has a detailed plan or appears acutely suicidal and will not talk, he or she could be in immediate danger and it is important to get help right away. Do not leave the youth alone and seek help immediately. Learn warning signs, risks, and other factors associated with suicide especially if the youth has made suicidal attempts or threats in the past. Offer support!

Important!

Some youth may exhibit many warning signs yet appear to be coping with their situation and others may show no signs and yet still feel suicidal. The only way to know for sure is to ask the youth and to consult a mental health professional.

About Substance Use and Young People

Many people don't understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to. Fortunately, researchers know more than ever about how drugs affect the brain and have found treatments that can help people recover from drug addiction and lead productive lives.

What Is drug addiction?

Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug addiction is considered a "relapsing" disease—people in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug. It's common for a person to relapse, but relapse doesn't mean that treatment doesn’t work. As with other chronic health conditions, treatment should be ongoing and should be adjusted based on how the patient responds. Treatment plans need to be reviewed often and modified to fit the patient’s changing needs.

What happens to the brain when a person takes drugs?

Most drugs affect the brain's "reward circuit" by flooding it with the chemical messenger dopamine. This reward system controls the body's ability to feel pleasure and motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. This overstimulation of the reward circuit causes the intensely pleasurable "high" that can lead people to take a drug again and again. As a person continues to use drugs, the brain adjusts to the excess dopamine by making less of it and/or reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug, trying to achieve the same dopamine high. It can also cause them to get less pleasure from other things they once enjoyed, like food or social activities. - Learning - Judgment - Decision-making - Stress - Memory - Behavior Long-term use also causes changes in other brain chemical systems and circuits as well, affecting functions that include: Despite being aware of these harmful outcomes, many people who use drugs continue to take them, which is the nature of addiction.

Why do some people become addicted to drugs when others do not?

No one factor can predict if a person will become addicted to drugs. A combination of factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction. For example: • Biology. The genes that people are born with account for about half of a person's risk for addiction. Gender, ethnicity, and the presence of other mental disorders may also influence risk for drug use and addiction. • Environment. A person’s environment includes many different influences, from family and friends to economic status and general quality of life. Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person’s likelihood of drug use and addiction • Development. Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction risk. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to addiction. This is particularly problematic for teens. Because areas in their brains that control decision-making, judgment, and self-control are still developing, teens may be especially prone to risky behaviors, including trying drugs.

Can drug addiction be cured or prevented?

As with most other chronic diseases, such as diabetes, asthma, or heart disease, treatment for drug addiction generally isn’t a cure. However, addiction is treatable and can be successfully managed. People who are recovering from an addiction will be at risk for relapse for years and possibly for their whole lives. Research shows that combining addiction treatment medicines with behavioral therapy ensures the best chance of success for most patients. Treatment approaches tailored to each patient’s drug use patterns and any co-occurring medical, mental, and social problems can lead to continued recovery. More good news is that drug use and addiction are preventable. Results from NIDA-funded research have shown that prevention programs involving families, schools, communities, and the media are effective for preventing or reducing drug use and addiction. Although personal events and cultural factors affect drug use trends, when young people view drug use as harmful, they tend to decrease their drug taking. Therefore, education and outreach are key in helping people understand the possible risks of drug use. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

Points to Remember

• Drug addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. • Brain changes that occur over time with drug use challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease. • Relapse is the return to drug use after an attempt to stop. Relapse indicates the need for more or different treatment. • Most drugs affect the brain's reward circuit by flooding it with the chemical messenger dopamine. This overstimulation of the reward circuit causes the intensely pleasurable "high" that leads people to take a drug again and again. • Over time, the brain adjusts to the excess dopamine, which reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug, trying to achieve the same dopamine high. • No single factor can predict whether a person will become addicted to drugs. A combination of genetic, environmental, and developmental factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction. • Drug addiction is treatable and can be successfully managed. • More good news is that drug use and addiction are preventable. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

Learn More

For information about understanding drug use and addiction, visit: • www.MDDestinationRecovery.org • www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-abuseaddiction • https://teens.drugabuse.gov/drug-facts/brain-and-addiction • https://easyread.drugabuse.gov • For more information about the costs of drug abuse to the United States, visit: www.drugabuse.gov/related-topics/trends-statistics#costs • For more information about prevention, visit: www.drugabuse.gov/related-topics/prevention • For more information about treatment, visit: www.drugabuse.gov/related-topics/treatment • To find a publicly funded treatment center in your state, call 1-800-662-HELP or visit: https://findtreatment.samhsa.gov/

About Bullying

Bullying is a common experience for many children and adolescents. Teasing, ignoring or intentionally hurting another child are all types of bullying. Harassment and sexual harassment are also considered forms of bullying. Bullies may be large and aggressive, but they also could be small and cunning. Victims of bullying have poor self–confidence and typically react to threats by avoiding the bully. Both bullies and their victims make up a fringe group within schools. Those children who bully want power over others. Both bullies and their victims feel insecure in school. Boys typically bully by using physical intimidation. Girls bully in a less obvious manner by using social intimidation to exclude others from peer interactions.

How does it affect my child?

Children who are bullied by their peers are:

• more likely to show signs of depression and anxiety, have increased feelings of sadness and loneliness, experience changes in sleep and eating patterns, and lose interest in activities they used to enjoy
• more likely to have health complaints
• less likely to do well in school, miss, skip or drop out of class

What are the types of bullying?

Verbal bullying is saying or writing cruel things about another person. Verbal bullying includes: - teasing - name-calling - inappropriate sexual comments - taunting - threatening to cause harm Social bullying, sometimes referred to as relational bullying, involves hurting someone’s reputation or relationships. Social bullying includes: - leaving someone out on purpose - telling other children not to be friends with someone - spreading rumors about someone - embarrassing someone in public Physical bullying involves hurting a person’s body or possessions. Physical bullying includes: - hitting/kicking/pinching - spitting - tripping/pushing - taking or breaking someone’s things - making mean or rude hand gestures Cyberbullying is bullying that takes place using electronic technology. Electronic technology such as cell phones or computers as well as social media sites, text messages, chat, and websites. Examples of cyberbullying include: - cruel text messages or email - rumors sent by email or posted on social networking sites - embarrassing pictures, videos, websites, or fake profiles

What can we do about it?

Know your child’s routines and pay attention to any changes to that routine. Does your child arrive home later than usual, take alternate routes to school (in order to avoid confrontation with abully), or appear more overwhelmed or sad? Maintain close contact with teachers to see if your child avoids certain classes or school settings. This may also help you to understand bullying. Empower your child by showing how much you value him/her. Spend time talking with him/her personal self-worth and the importance of sticking up for himself/ herself. Help your child understand the difference between aggression and passive communication by showing different examples of each. Ask your school psychologist or social worker to explain the different forms of communication: aggressive (typical of bullying), passive (typical of bullying victims) and assertive (most effective means of communication). Discuss with your child the impact of being a bully and how bullying is hurtful and harmful. Model how to treat others with kindness and respect. If you suspect your child is being bullied at school, talk with your child’s teacher or principal. Children should not be afraid to go to school or play in their neighborhood. If your child sees another child being bullied, help your child report the bully to a teacher or another adult. Saying nothing could make it worse for everyone. Become familiar with the bullying prevention curriculum at your child’s school. For example, in Maryland, state law requires that all public schools include a bullying prevention component within their curriculum. See Maryland State Department of Education website for more information: http:// www.marylandpublicschools.org/MSDE/divisions/ studentschoolsvcs/student_services_alt/bullying/

What is trauma?

A trauma is a dangerous, frightening, and sometimes violent experience that is often sudden. Trauma is a normal reaction that occurs in response to an extreme event. It can happen to one family member or a whole family. Examples of a trauma are: - Violence - Fire - Homelessness - Natural Disaster After experiencing a trauma, children, teenagers and families may feel traumatic stress. Feelings of traumatic stress include: - Feeling scared or anxious - Feeling numb

How does it affect my child?

Many people who go through trauma will having trouble adjusting to life after the event. The brain of children and teenagers may be harmed and they may not develop needed skills. After trauma, some children suffer from Post Traumatic Stress Disorder (PTSD), Child Traumatic Stress (CTS) or depression. PTSD usually happens after a major trauma that was life-threatening. CTS happens after trauma is over. It is important to get help for a child or teenager after going through a trauma so he or she can continue to grow. For more information, refer to the Anxiety Disorder Fact Sheet included in this kit.

Signs & Symptoms

There are lots of reactions to trauma including: - Thinking about what happened - Aggression or irritability - Body aches - Having trouble at school - Nightmares or difficulty sleeping - Trouble concentrating - Refusing to go to school

What can we do about it?

It’s important to get help if children or teenagers are having signs or symptoms after a trauma. Caregivers and relatives can help children in two important ways: 1. Talking to children about what happened 2. Getting professional help Recommendations for families - Learn what trauma is - Get help from trauma experts - Be involved in your child’s health What can caregivers say and do? - Tell children they are safe - Let children talk about feelings and fears - Go back to a daily schedule - Spend extra time with family and friends

Resources and Links

Children’s Mental Health Matters! Facts for Families — First Steps in Seeking Help www.ChildrensMentalHealthMatters.org American Academy of Child & Adolescent Psychiatry This site contains resources for families to promote an understanding of mental illnesses. www.aacap.org Helping Children after a disaster– Information for parents about trauma, PTSD, and behavioral changes to look for. http://www.aacap.org/publications/factsfam/ disaster.htm Posttraumatic Stress Disorder (PTSD) – Defines PTSD and gives symptoms. http://www.aacap.org/publications/factsfam/ ptsd70.htm Talking to Children About Terrorism and War http://www.aacap.org/publications/factsfam/87.htm The Family-Informed Trauma Treatment Center (in Maryland) http://www.fittcenter.umaryland.edu Maryland Coalition of Families for Children’s Mental Health http://www.mdcoalition.org National

How Do I Know if I or Someone Else Needs Mental Health HELP?

- You cannot cope with daily life - You feel sad, stressed or worried - You are not sleeping or eating well - You want to hurt yourself or others - You are troubled by strange thoughts (e.g., hearing voices) If you are not sure what to do, just call Parker Psychiatric Services (410) 777-8710.

Getting Help for a Substance Use Disorder (SUD)

A range of Substance Use Disorder Services are available in Maryland through your Local Health or Human Services Departments for individuals with Medical Assistance or who are uninsured. There may be a sliding fee or co-pay required for individuals non-eligible for Medicaid. All services within the public system are provided based on eligibility and medical necessity criteria. Maryland Crisis Connect SUD Services Call 211, Press 1 Maryland Crisis Connect is available 24 hours/7 days a week to provide support, guidance and assistance on how to access SUD services, in addition to the current mental health crisis services provided by this hotline. Callers will also be given information about naloxone, recovery support and family services as available/appropriate in the individual’s local area.

How Do I Know if I or Someone Else Needs Substance Use Disorder Help?

You may need help if you are: - Feeling that you have to use the drug regularly — this can be daily or even several times a day - Having intense urges for the drug - Over time, needing more of the drug to get the same effect - Making certain that you maintain a supply of the drug - Spending money on the drug, even though you can't afford it - Not meeting obligations and work responsibilities, or cutting back on social or recreational activities because of drug use - Doing things to get the drug that you normally wouldn't do, such as stealing - Driving or doing other risky activities when you're under the influence of the drug - Focusing more and more time and energy on getting and using the drug - Failing in your attempts to stop using the drug - Experiencing withdrawal symptoms when you attempt to stop taking the drug

About Early Childhood Mental Health

Learning doesn’t begin when children start school, it begins at birth. By the time children turn three, they have already begun to lay the foundation for the skills and abilities that will help them succeed in school. Problem solving, toleration frustration, language, negotiating with peers, understanding routines, and self-control are all skills that are developed early in life. The pace of brain development in this stage of life far exceeds growth in subsequent life stages. Research tells us that early experiences can, and often do, impact brain development. Supporting a child’s social and emotional development is a critical component of school-readiness. Parents and caregivers can help children to identify and express emotions, foster secure relationships, encourage exploration, and provide a secure base for the child.

Behaviors that warrant concern

Infants and Toddlers (birth to age 3) - Chronic feeding or sleeping difficulties - Inconsolable “fussiness” or irritability - Incessant crying with little ability to be consoled - Extreme upset when left with another adult - Inability to adapt to new situations - Easily startled or alarmed by routine events - Inability to establish relationships with other children or adults - Excessive hitting, biting and pushing of other children or very withdrawn behavior Preschoolers (ages 3 to 5) - Engages in compulsive activities (e.g., head banging) - Throws wild, despairing tantrums - Withdrawn; shows little interest in social interaction - Displays repeated aggressive or impulsive behavior - Difficulty playing with others - Little or no communication; lack of language

What is Traumatic Stress?

Research has shown that exposure to traumatic events early in life can have many negative effects throughout childhood and adolescence, and into adulthood. Children who suffer from child traumatic stress are those who have been exposed to one or more traumas over the course of their lives and develop reactions that persist and affect their daily lives after the traumatic events have ended.

What Is Resilience?

Resilience is the ability to adapt well over time to life-changing situations and stressful conditions. While many things contribute to resilience, studies show that caring and supportive relationships can help enhance resilience. Factors associated with resilience include, but are not limited to: - The ability to make and implement realistic plans - A positive and confident outlook - The ability to communicate and solve problems

Factors that contribute to childhood trauma:

- Caregiver’s competencies - Neglect - Witnessing domestic violence - Witnessing community violence - Emotional, physical, or sexual abuse - Loss of caregiver

Symptoms of Traumatic Stress:

- Re-experiencing the event, reenacting - Avoidance and general numbing of responsiveness - Increased arousal

What does it look like?

- Changes in play - New fears - Separation Anxiety - Sleep disturbances - Physical complaints - Distress at reminders - Withdrawal, sadness, or depression - Easily startled - Difficulties with attention, concentration, and memory - Acting out, irritability, aggression

Suggested Activities to Promote Social Emotional Development:

- Read books and help your child identify emotions. - Allow your child to control the book and take ownership of reading activity. - Use pictures of a range of faces (happy, scared, sad, mad, silly, tired, etc.) and have your child practice making those faces. - Follow your child’s lead in play. - Narrate your child’s actions and continuously describe your own actions and surroundings.

What is Grief?

Grief is a natural response to a death or a loss, such as a divorce, an end to a relationship or a move away from friends. Grief may produce physical, mental, social or emotional reactions. Physical reactions can include change in appetite, headaches or stomach aches, sleeping problems and illness. Emotional reactions can include anger, guilt, sadness, worry and despair. Social reactions can include withdrawal from normal activities and the need to be near others or to be apart from others. The grief process also depends on the situation surrounding the death or loss, the relationship with the person who died and the person’s attachment to that person. Grief is normal, but when the symptoms are very intense or last a long time, professional help may be needed.

How does it affect my child?

The way in which children are communicated with and managed at the time of a loss will affect how they are able to grieve and how they manage loss in the future. Children are often confronted with both natural death and death through unnatural means such as murder or suicide. The media may bring this issue to life for children, and they need an outlet to deal with the grief of unsettling images and thoughts. Children who grieve may display many symptoms that impact their functioning. Some examples include: - Young Children - Bedwetting - Thumb sucking - Clinging to adults - Exaggerated fears - Excessive crying - Temper tantrums - Older Children - Physical symptoms (headaches, stomach aches, sleeping and eating problems) - Mood swings - Feelings of helplessness and hopelessness - Increase in risk-taking and self-destructive behaviors - Anger, aggression, fighting, oppositional behavior - Withdrawal from adults and /or peers and activities they enjoyed prior to the loss - Depression, sadness - Lack of concentration and attention

What can we do about it?

Be a constant source of support in your child’s life. Research shows that maintaining a close relationship with a caring adult after the loss can help. Provide a structured environment that is predictable and consistent. Limit choices; introduce small, manageable choices over time. Contain “acting out” behavior. Insist that children express their wants, needs and feelings with words, not by acting out. This is also true for teens, who have a tendency to act out in anger rather than expressing how they feel directly. Encourage children to let you know when they are worried or having a difficult time. Crying can help children release their feelings of sadness and help them cope with the loss. Let your child know that she/ he is safe. Often when children are exposed to trauma they worry about their own safety and the safety of their family members. It is a good idea to keep them from seeing too many pictures of the event. Encourage your child to ask questions about loss and death. Children often have many questions about death and may need to ask again and again. Be patient and answer these questions as openly and honestly as possible. Talk to your child about death in a way he/she can understand. Give your child affection and nurturing. Attempt to connect with them. Help your child maintain a routine. It is helpful for your child to continue with daily activities. Offer suggestions on how to eat and sleep well. Be patient with regressive behaviors such as thumb sucking and bed wetting. Put together a memory book. This is a good exercise to help your child experience his/her emotions in a positive way. Be aware of your own need to grieve. Parents have often experienced the same loss as their children, and should allow themselves to experience grief and get support.

Resources/ Links

Children’s Mental Health Matters! Facts for Families — First Steps in Seeking Help www.ChildrensMentalHealthMatters.org American Academy of Child & Adolescent Psychiatry This site contains resources for families to promote an understanding of mental illnesses. www.aacap.org Children and Grief http://www.aacap.org/publications/factsfam/grief.htm Children’s Sleep Problems http://www.aacap.org/publications/factsfam/sleep.htm Helping Children after a Disaster http://www.aacap.org/publications/factsfam/disaster. htm Child and Youth Health illustrates how children grieve and their level of understanding per age group. http://www.cyh.com/HealthTopics/HealthTopicDetails. aspx?p=114&np=141&id=1662