A crisis results when that critical incident/traumatic stress overwhelms a person’s coping mechanisms, resulting in:
1. disruption of psychological balance
2. usual coping mechanisms/abilities fail to re-establish that balance
3. the distress yields some signs of functional impairment
[International Journal of Emergency Mental Health, 2000, 2(2), 119-125]

A crisis is a traumatic event that seriously disrupts our coping and problem-solving skills. Crises are unpredictable, volatile, and may even threaten your safety and survival.

He said that suicide has two components. The first one is “What’s the message that the suicidal person is trying to convey?” And the second is “To whom is this message intended?”

Our task as helper is: (1) To find out what this message is, and (2) To see how we can help the suicidal person make the connection(s). Our role is to help facilitate the communications and connections that the distressed person wants to make.

Dr. Hipple encouraged us to not be afraid to reach out to people in distress.

“You’re offering connections. As we have conversations with the distressed or suicidal person, the chances for a dramatic outcome decreases.” — Dr. John Hipple

The parents of a young boy who was described as “all over the place” came in to see Dr. Ackerman. The mother was a housewife and the father a top corporate executive who made lots of money. When the psychiatrist would ask a question, the mother had all the answers. However, when asked, the boy’s father gave the same responses each time, “I don’t know, I’m never around.”

After the session, the man confessed to his wife that he felt ashamed that he didn’t know the answers to the simplest inquiries about his own son because he was always working and never home. Shamefaced, he came in to work the next day and asked for a demotion.

Over the course of the next few weeks, the boy stopped his disruptive behavior and eventually was fine.

Obviously, this doesn’t happen in every instance of children being cured of behavior/acting-out problems just by having their dads spend more time with them. But what this wonderful and encouraging story does say is that no matter how advanced our society becomes, no matter how much money a parent makes, no matter how effective the medication, nothing can replace the innate bond and the yearning for that connection that a child has for his mother and father.

Despite the notion of Asian Americans as the “model minority”, studies show that “not all Asian Americans are as uniformly educated, acculturated, and financially successful as the myth of the “model minority” would suggest.” Source: http://www.cacf.org/mythsfacts/index.html

In the course of research, I came across The Southeast Asia Resource Action Center (SEARAC), a national organization “advancing the interests of Cambodian, Laotian, and Vietnamese Americans through leadership development, capacity building, and community empowerment.”

People from the Southeast Asian countries of Cambodia, Laos, and Vietnam constitute the largest group of refugees ever to build new lives in the United States. Nearly all Southeast Asian Americans — whose main ethnic groups are Cambodian, Hmong (from the northern mountains of Laos), Lao, and Vietnamese — entered the U.S. as refugees or as relatives of refugees at various times after the end of the Vietnam War. They began to relocate to this country in 1975, when the American-supported South Vietnamese government succumbed to the military pressures of their Communist neighbors to the north. In that same year, the Communist Pathet Lao defeated the US-supported government in Laos, and in 1976 the US-supported Cambodian government was toppled by the infamous Khmer Rouge. Southeast Asian arrivals to this country increased dramatically in the late 1970s and 1980s, with the influx of Vietnamese “boat people,” the flight across the Mekong River of hundreds of thousands of Hmong and Lao refugees from Laos, and the escape of hundreds of thousands of Cambodians from the Khmer Rouge government in Cambodia. Current estimates are that 1,342,532 Southeast Asian refugees entered the United States between 1975 and 1998.

Source: http://www.searac.org/commun.html

Another excellent resource is the Suicide Prevention Resource Center (SPRC).
In “Suicide Among Asian American/Pacific Islanders”, the Suicide Prevention Resource Center (SPRC) shared the following:

General Statistics
The Centers for Disease Control and Prevention report that, between 1999 and 2004, in the Asian American and Pacific Islander population:

• The suicide rate was 5.40 per 100,000, approximately half the overall U.S. rate of 10.75 per 100,000.¹
• The highest rate, 27.43 per 100,000, was found among adult males 85 and older.²
• Suicide ranked as the 8th leading cause of death for all ages (compared to 11th for the overall US population).³
• During the 1980s, the Asian and Pacific Islander population more than doubled in the U.S., making it the fastest growing racial/ethnic group, followed by Hispanics. Three fourths of the Asian and Pacific Islander population growth has been due to immigration. This rapid growth is predicted to continue, with another doubling by 2009.⁴
• Elderly Asian American/Pacific Islander women have higher rates of suicide than whites or blacks. For women aged 75 and older, the suicide rate for Asian Americans/Pacific Islanders was 7.95 per 100,000, compared to the white rate of 4.18 and the black rate of 1.18.⁵

Youth Statistics

• In the 12 months preceding the Youth Risk Behavior Survey, Asian American and Pacific Islander high school students were as likely as their black, Hispanic, and white counterparts to have attempted suicide.⁶
• Suicide ranked as the second leading cause of death for those ages 15 to 24 years old.⁷

Mental Health Considerations

• One study found that Asian Americans and Pacific Islanders are significantly less likely than Caucasians to mention their mental health concerns to:
  1. a friend or relative (12% vs. 25%),
  2. a mental health professional (4% vs. 26%),
  3. or a physician (2% vs. 13%).⁸
• Asian Americans do not access mental health treatment as much as other racial/ethnic groups do, perhaps due to strong stigma related to mental illness. Emotional problems are viewed as shameful and distressing and this may limit help-seeking behaviors. Asian Americans also tend to rely on family to handle problems.⁹
• Asian American concern about negatively affecting their social network and expectations of low effectiveness keep them from seeking help.¹⁰

Ethnic and Cultural Considerations

• For nearly half of Asian Americans and Pacific Islanders, access to the mental health care system is limited due to their lack of English proficiency and to a shortage of providers with appropriate language skills.¹¹
• Many Asian American and Pacific Islander cultures view the psychological and physical as highly interconnected, unlike the common view in Western cultures. Asian Americans and Pacific Islanders may be more likely to express emotional distress through physical problems and to believe that physical problems cause emotional disturbances.¹²
• In Asian Americans, suicide risk increases with age. Some explanations for the increase are related to difficulties adapting to the U.S. culture. Elders are not treated with the level of respect of their native cultures and may feel burdensome. Many Asian American men who are in the U.S. without their families are isolated not just from family but also culture.¹³

See references at http://www.sprc.org/library/asian.pi.facts.pdf.

Finally, the third resource I discovered was “Mental Health: Culture, Race, and Ethnicity (A Supplement to Mental Health: A Report of the Surgeon General), 2001.”

Many Southeast Asian refugees are at risk for post-traumatic stress disorder (PTSD) associated with the trauma they experienced before they immigrated to the United States…

Studies document high rates of mental disorders among these refugees. A large community sample of Southeast Asian refugees in the United States (Chung & Kagawa-Singer, 1993) found that premigration trauma events and refugee camp experiences were significant predictors of psychological distress even five years or more after migration. Significant subgroup differences were also found. Cambodians reported the highest levels of distress, Laotians were next, then Vietnamese. Studies of Southeast Asian refugees receiving mental health care uniformly find high rates of PTSD. One study found 70 percent met diagnostic criterion for the disorder, with Mien from the highlands of Laos and Cambodians having the highest rates (Kinzie et al., 1990; Carlson & Rosser-Hogan, 1991; Moore & Boehnlein, 1991).

See references at http://www.surgeongeneral.gov/library/mentalhealth/cre/sma-01-3613.pdf.

“It was God’s will.”
“If it was meant to be, it’s meant to be.”
“If God had wanted you to have the boys, then you’d have them.”
“I know how you feel, when I was…”
“Oh, you’ll get over it.”
“Everything is going to be okay.”

…and on and on it went.

Please know that I am not disrespecting church goers, their faith, or their character. What I am trying to do is to illustrate that sometimes, even with the best intentions, people say inappropriate things to those in mourning.

From a mental health’s perspective here’s why those statements are not suitable for comforting someone experiencing trauma and/or grief & loss.

“It was God’s will.”

>How do you know that it’s really God’s will? And even if you did know, this statement does nothing to help comfort and console those in emotional pain or extreme grief.

“If it was meant to be, it’s meant to be.”

>This statement shows a lack of concern for the person in that it carries the “c’est la vie” (French: that’s life!) attitude.

“If God had wanted you to have the boys, then you’d have them.”

>This statement sends the message that you don’t deserve these babies yet.

“I know how you feel, when I was…”

>This attempt to sympathize with the person in mourning seems like the “right thing to say.” However, no two people are exactly alike and thus each person’s loss and trauma is unique to him/her. A more acceptable statement might be: “I am so sorry for your loss. I’m here for you if you need me.”

“Oh, you’ll get over it.”

>This statement is insensitive and minimizes the person’s level of pain.

“Everything is going to be okay.”

>The reason why this statement is inappropriate is that it attempts to predict the future for this person. How do we know that she will be ok? The answer is we don’t. A more appropriate statement might be: “I’m glad that I had the opportunity to be here with you during such a difficult time.”

Trauma experts have shared that it takes 1 to 6 weeks following a crisis (e.g. grief & loss) for strong emotional reactions to subside (A Practical Guide for Crisis Response in Our Schools) and that overall recovery from symptoms such as fear, anxiety, and nervousness can take up to three months (Diane Myers, Disaster Mental Health Consultant & Trainer).

Furthermore, coping with loss is a process that involves a series of tasks carried out over time. The passage of time is a necessary but not a sufficient component of successful grieving. People grieve differently and at different pace (A Practical Guide for Crisis Response in Our Schools).

Sometimes when we’re not sure what to say, the best thing might just be…to not say anything at all. A comforting pat on the back or a hand on the shoulder with an empathetic nod might be what’s needed at that moment.

There are many types of mental health providers. Some strictly manage your medications, some offer psychotherapy, and some help you find services in the community, for example. They may have different licenses, degrees and certifications. States generally license mental health providers and set requirements for training and skills. These requirements can vary widely, so consider reviewing your state’s regulations before treatment. The terms that describe mental health providers are used broadly and can mean different things in different states.

Psychiatrists

Psychiatrists are medical doctors (M.D.) or doctors of osteopathy (O.D.) who specialize in the diagnosis, treatment and prevention of mental illnesses. After medical school, they complete at least another four years of residency training. A psychiatrist who passes certain exams can be certified by the American Board of Psychiatry and Neurology. Some psychiatrists seek further training to specialize in certain areas, such as geriatric or addiction psychiatry.

Because they’re medical doctors, psychiatrists can prescribe medications. They also offer psychotherapy. They may work with you on everyday problems like stress or more complex issues like schizophrenia. Psychiatrists work in private practice, hospitals, medical centers, schools and other settings.

Psychologists

Psychologists are specialists in psychology — a science that deals with the mind, mental processes and behaviors. There are many types. Those who treat mental illnesses are generally clinical or counseling psychologists. The title “psychologist” is usually used for those who have a doctoral degree (Psy.D. or Ph.D.), advanced training, and certain licensing and certification. However, it’s sometimes used for someone who has only a master’s degree.

Psychologists provide psychotherapy for a range of issues, from marriage problems to personality disorders. They work in private practice, hospitals, schools, community agencies and other settings. Psychologists can’t prescribe medications except in New Mexico and Louisiana — the only states with privileges for specially trained psychologists.

Psychotherapists

Psychotherapist is a general term for a mental health provider. Psychotherapists may be psychologists, social workers, psychiatric nurses, marriage and family therapists, pastoral counselors, or others who provide psychotherapy.

Be aware that some people who set up shop as therapists have no formal training and aren’t subject to any state laws or regulations.

Social workers

Social work is a broad profession. In general, social workers help people overcome social and health problems. Most have a master’s degree in social work (M.S.W.), but training and education vary widely. To provide mental health services, they must have advanced training and be licensed by their states.

Licensed clinical social workers (L.C.S.W.) may provide therapy in private practice, psychiatric facilities, hospitals and community agencies. Others may work in employee assistance programs or as case managers who coordinate psychiatric, medical and other services on your behalf. They may specialize in certain areas, such as domestic violence or chronic illness. They can’t prescribe medications or order medical tests.

Psychiatric nurses

Psychiatric nurses are licensed registered nurses (R.N.) who have extra training in mental health. They may have an associate degree or a bachelor’s, master’s or doctoral degree. Their level of training and experience determine what services they can offer. Under supervision of medical doctors, they may offer mental health assessments and psychotherapy, and they may help you manage your medications.

Advanced practice registered nurses (A.P.R.N.) have at least a master’s degree in psychiatric-mental health nursing. In general, they can diagnose and treat mental illnesses, and in many states they’re authorized to prescribe medications. They also may be qualified to practice independently, without the supervision of a doctor.

Licensed Professional Counselors and Mental health counselors

Licensed Professional Counselors and Mental health counselors are therapists who are trained to diagnose and provide individual and group counseling. They often provide general psychotherapy. Most have at least a master’s degree in counseling, counseling psychology or a related field, have several years of supervised work experience, and are licensed or certified.

Counselors may specialize in certain areas, such as career counseling, marriage issues or substance abuse. They may work in private practice, community agencies, hospitals, employee assistance programs or other settings. They offer help for a range of problems, from anxiety to depression to job stress to grief.

[I've edited this section to reflect the more than 100,000 professional counselors in the U.S. In 38 states, these professional counselors are referred to as Licensed Professional Counselor (LPC) and in 10 states they are called Licensed Mental Health Counselors (LMHC)].

Marriage and family therapists

Marriage and family therapists evaluate and treat disorders within the context of the family. They typically have a master’s or doctoral degree. After additional experience under supervision, they may go on to take an exam to become licensed or certified. Not all states require licensing or certification, however.

Marriage and family therapy is usually brief, averaging about 12 sessions. It focuses on specific problems and solutions. You may meet with a therapist one-on-one, with a partner or with your whole family. These therapists provide help with a range of problems, such as depression, parent-child conflicts and eating disorders.

Pastoral counselors

Pastoral counselors are trained mental health providers who also have in-depth religious or theological training. They provide psychotherapy and other support in a spiritual context. Certification and licensing varies. There are several levels of certification, each with its own requirements stipulating such things as religious activity, coursework, research, publication and experience.

Pastoral counselors provide a variety of services, such as treatment of mental illnesses, wellness programs, spiritual direction, group therapy, and family and couples therapy. They may work in pastoral counseling centers, schools, religious communities or other settings.

Psychoanalysts

The term “psychoanalysis” is often used loosely. But it refers to a specific treatment that explores unconscious factors that influence relationships and behavior. It was developed by Sigmund Freud. Virtually anyone can call himself or herself a psychoanalyst, since it’s not a legal term. However, many psychoanalysts seek extensive training or certification. Those who train at accredited psychoanalytic institutes are typically medical doctors, psychologists or social workers. They generally undergo at least four years of psychoanalytic training, coursework, their own psychoanalysis, and perform supervised psychoanalysis of others.

Treatment is intensive, with several sessions a week for five to 10 years. During this time, you generally lie on a couch and talk about whatever comes to mind.

For more information on the educational backgrounds of these mental health providers, please see “Mental Health Practitioners: Who’s Who?”

If someone like me who is a therapist/counselor/mental health professional (or whatever “label” is suitable) has trouble keeping up with all the different types how can we expect clients or people seeking assistance to be able to understand all of this? (This is a rhetorical question by the way). I would love to get some comments from mental health professionals themselves as well as community members. What do you think? Confusing or not, if so why or why not?

I want to share four suggestions from LD Online (called First Year Teacher Essay) that might make for a smooth transition into the school system and to ensure that your school year starts off well.

1. Get to know your students before the first day of school. Ask around. Find out who the previous teachers were. Look over their files, especially if they have an IEP (Individualized Education Plan). What are the things they had trouble with last year and what were they good at?
2. Start building relationships with parents. They can be your best source of information about your student as well as help you help the child at school. By building and maintaining an open line of communication with parents you communicate a message that says, “I care and I’m willing to work together to help your child.”
3. Develop a method to monitor and assess your students. This allows you to pinpoint areas that the child may struggle with. It also gives you feedback about your teaching efficacy. In other words, if you don’t assess and monitor, how will you know whether or not the students are learning anything at all, and if so how much?
4. Find a mentor teacher. This is very important, but one that tends to be pushed aside. Mentors can help answer questions, offer support and encouragement when you need it.

This next one is my own suggestion based upon what I’ve seen and experienced during my time in Saipan.

• Teaching = Friendly Attitude + Acculturation. No where else is this more pronounced than in Saipan and the CNMI. I have seen some very unhappy non-local teachers and I have watched them struggle in their jobs here. My take on the whole thing is that they had a difficult time adjusting to the mindset of the island. As outsiders, we must be careful to balance two dichotomies - that is, helping others vs. imposing our ideologies on them.

In contrast, the successful “outsiders” are the ones who have embraced the island and the way of life here. In order to be effective, you must get to know your students, their families, their background and their struggles and triumphs. For it is only through that perspective can you truly help.

Good luck and have a great school year. Please let me know if I can be of service.

Many first-year teachers feel fairly competent in their content areas and comfortable in instructional techniques. It’s classroom management that has them concerned.

I came across a nice article offering classroom management suggestions for new teachers as I was surfing the ERIC (Education Resources Information Center) website. It’s called, “For the Uninitiated: How to Succeed in Classroom Management.”

As part of the Novice Teacher Induction Program (NTIP) implemented at all universities in The Texas State University System, Sam Houston State University faculty members work with novice teachers in four public school districts. They serve as mentors—observing, advising, encouraging, celebrating, and commiserating with the teachers. In addition, teachers participate in seminars that provide opportunities for sharing experiences and discussion.

During each seminar, novice teachers write their concerns or questions on exit slips. This feedback helps to determine topics for future seminars. In the first year that Sam Houston State University conducted its NTIP, nearly 1,200 slips were collected. Of these, more than 50 percent cited two aspects of classroom management as the most problematic: procedures and behavior management.

Even though educator preparation programs typically provide instruction in classroom management, more often than not, students fail to comprehend the complexities until they are solely responsible for a classroom. This article examines procedures and behavior management and offers suggestions that have proven effective.

I’ve also included it here on BeyondBehaviors.Com in PDF format, For the Uninitiated: How to Succeed in Classroom Management.pdf.

A few days ago, I received this nice letter via email from Crisis Prevention Institute’s Executive Director, Robert S. Watters. Here is the letter re-formated verbatim from his email:

Thanks Robert! What wonderful praises.

But that wasn’t all. Because a day or so before that, I received this email from Crisis Prevention Institute’s Associate Director of Quality and Standards, Erik L. Larson. Erik mistakenly wrote Saipan Times, instead of Saipan Tribune:

Via email June 28, 2007

Dear Mr. Nguyen,

I had come across the article from the Saipan Times about your upcoming move back to Texas, and I thought I’d just send you a quick note. Congratulations on the work that you have done while in Saipan; the article is very nice and recognizes a number of important accomplishments you have made while in Saipan. Additionally, it was nice to see that note that you have been able to deliver Nonviolent Crisis Intervention® training while overseas. Good luck with the move back and with getting settled back in, in Texas. I’m not sure what your plans are for employment and if you will be delivering Nonviolent Crisis Intervention® training, but I’m attaching a Base of Employment Change Form that you could complete and submit when you are able, so that we can update your records. Again, welcome back and best wishes with the move, please let me know if we can provide any assistance.

Sincerely,

Erik L. Larson

Associate Director of Quality and Standards
Crisis Prevention Institute
3315-I North 124th Street
Brookfield, WI 53005

Thank you Erik for those kind words.

I’m sharing these things with the CNMI community not to boast (although some may see it that way), but rather to inspire! Those who know me and who have worked alongside me know that I have held true to my words and followed through with what I have set out to do. They also know that I do not work for glory or recognition, but that these accolades are by-products of a job well done.

Thanks again Robert Watters and Erik Larson of CPI for their letter and email.

Photo: Group photo with members of the Mental Health Planning Council.

Photo: Tee Abraham (Director for NMC’s Rehabilitation & Human Services Program), presented me with this tea leaves necklace which she made!

Photo: Here I am holding the plaque given by the Mental Health Planning Council (MHPC) honoring my contributions to serving and advocating for individuals with mental health disability and children with special needs.

Thank you so much again for the beautiful plaque. It is truly validating to have my colleagues and members of the community acknowledge my efforts. So it is with the utmost appreciation that I humbly accept this award.

Thank you Tee Abraham for the thoughtful and meticulously crafted tea necklace. I have preserved it as instructed and will proudly show my family the beautiful plaque and the wonderful tea necklace.

Si Yu’us Ma’ase (Thank You) and God bless.