 Well, welcome. Today's event is a children's mental health salon. Where are the casseroles? We'll share the meaning of that title with you shortly. But first, welcome and thank you so much for joining us today. A day that promises to be engaging, informative, and hopefully entertaining. My name is Chuck Oro and I'll be your emcee this afternoon. Before we begin, we'd like to take a moment to thank TedEx San Antonio and One in Five Minds for hosting this wonderful event. Let's hear it for them. Now, please also join me in acknowledging our sponsors today, Baptist Health Foundation of San Antonio, the Bear County Health Collaborative, NAMI Child, excuse me, Clarity Child Guidance Center and Laurel Ridge. A round of applause for those wonderful folks. And finally, thanks to each and every one of you for taking time today to learn more and take action. You're going to hear that all day today. Take action in regarding to children's mental health. It's estimated, check this out. It's estimated that one in five children suffer from a mental, emotional, or behavioral disorder. And fewer than 20% of those children receive help. That equals nearly 80,000 children and adolescents right here in our own backyard, right here in Bear County alone, who do not receive treatment. And there are barriers to the treatment. There's knowledge of where to get help and a lack of funding or insurance to pay for help. But most often, the primary reason families don't seek help for their children is stigma. What happens if a child is not treated? Well, I'll tell you 50% with a serious mental illness will drop out of high school. Untreated children are twice as likely to abuse drugs and alcohol. And one in two juveniles incarcerated have an undiagnosed mental illness. Now, those are sobering statistics. We have identified a problem. But today, we explore solutions. Today is a take action day. Today is a what can we do about it day? Share your thoughts throughout the event on Facebook and Twitter with the hashtag TedXSA salon. That's how we can one way that we can take action. Now, today is all about learning, being inspired, and taking action on that inspiration and to assist you. We've got a large manila envelope labeled goals guide on each of your tables. So go ahead, pull those out. I'll wait for you. Pass them around. Now, the goals guide is designed to help you frame up what actions you will take today and in the future. Keep this goal guide with you when you go on the breaks to keep track of how you are making progress. We'll then mail you a copy as a reminder after the event is over in a couple of weeks or couple of months. Now, friends, as we start the program, please know that the restrooms are right outside the doors to the right, right where you came in, which is also where you can have your story videotaped. Folks, we encourage you to share your thoughts in order to eliminate that stigma. Silence creates stigma and your voice, your voice is an important part of the solution. Now, speaking of silence, we know we live in a technologically advanced society, so take a minute to silence your phones as we are live streaming this event, and you will also be recording our speakers for TEDx San Antonio. Now, folks, we've got a full afternoon of fast-paced activities and events, and if you've looked over the agenda, you see that we've got parent conversations, presentations, and activities. You may have also noticed that the next three hours are broken into sections, the parent's view, the child's view, and family and society's response. Now, parenting a child with a mental illness can be difficult, but it also has moments of joy and moments of hope. Now, are you still wondering where the title, where are the casseroles came from? Anyone? Anyone? Well, I'm going to tell you what it is. It was inspired by a 60-minute story earlier this year about a mom's support group in Connecticut. Now, one mom commented how her child had broken their arm, and the community responded with this outpouring of support that they had so many meals and casseroles brought to them that they didn't have to cook for two weeks. But when that same child was hospitalized with a mental illness, they didn't receive one casserole. Not one. Where was the support? Where was the action? Well, today, my friends, we're taking action, and we are going to cook up some casseroles, if you will. Right now, we're going to hear from some local parents and their perspectives. Joining me, please join me in welcoming mom's Lisa Sanchez, Kim Rice, and Michelle Jenkins, and our moderator, former president of our local to introduce three ladies who have stepped forward to share their family's journey with mental illness and healing. I appreciate their willingness to and unselfishness to openly share their stories. Through your sharing, these brave moms can help others who are on the same journey. Our first panelist is Lisa Sanchez. Lisa is a registered nurse with University Health Systems in the administration. She serves as the executive director for patient services. Lisa is also a mom of three and will discuss her son's journey through mental illness. Next, we have Kim Rice. Kim will also share her story of her son's journey. And Kim is the mother of three boys and one girl. Kim's husband, Matt, is also the senior pastor of one of our local churches here in San Antonio, San Antonio First Church of the Nazarene, over here on West Avenue. And our third panelist is Michelle Jenkins, who will share her story about her daughter's journey. After working 22 years with a small entity here in San Antonio called USAA, Kim and her husband decided that she would leave her career and return home to devote her time towards her family and raising her children. Now Lisa, my first question. Where are the casseroles? Is the topic of this panel and this event? So can you tell us what this means to you and your family? When I first saw this topic, it just took me about two seconds to figure it out because my grandmother back in Northeast Texas, as I was a young girl, took a casserole to everyone that had any kind of situation, whether it be a death in the family or someone with a sick or had surgery. So I was raised with the casserole theory, I guess. Having a son with mental illness, however, there have been no casseroles. There have been no visitors on our worst days. There's been no phone calls on our worst days. And it's almost as if at that time in your life there's no true existence. Certainly no one reaches out to say, how are things going? Can I run to the grocery store for you? Can I get anything? Can I pick anything up? Or certainly do you have dinner planned or can I help you with dinner? So what we do as parents with our very sick children is go and do our regular day at work, go home, face what we have to face at home, and then cook our own dinner. So there are no casseroles brought to us. Being a pastor's wife, I've cooked a lot of casseroles, and my son having cancer, we had a lot of casseroles. But when we realized that my son had a mental illness, the phones, there were no phone calls, it was a very awkward time in our life. I wished for casseroles. Michelle. Well I'm the person who doesn't cook on the panel, so I really did not understand the title, where are the casseroles when I first heard this event. But even though I did not know what the title meant, I knew what it felt to have a child with mental illness and not have any support. So what this title really means to me and what hit home is there's such a disparity in services and support for children and their families with mental illness. Such a disparity. Mental illness is the invisible disability. And I think that's why people don't think about casseroles with mental illness because they can't see it. So that's really how it hit home with me. Thank you, Kim. Michelle, while I'm sure it is difficult to discuss your family's journey, can you give us a summary of what your child's diagnosis has been and how is he doing now? How is she doing now? Thank you, Ed. You know that should be such a simple question to answer. What is your child's diagnosis? But when I was thinking about how to answer this particular question, I really didn't know how to answer. Because when I think about my daughter, I don't think of her diagnosis per se. I don't think of that label. And we don't share that label in our household because we don't want her to label herself either. But I will share you that with children, it is so difficult because it may change over time with regards to what their diagnosis is. So initially early on, we were dealing with a mood disorder, anxiety, and depression. And now five years down the road, we're calling it more of a bipolar disorder. But again, it's a hard question to answer. But that would be the most accurate description. Thank you, Kim. My son has a mood disorder. And it is a pretty rocky road sometimes with that disorder. And many people don't understand the disorder because on the outside, everything appears to be just fine and normal. And times when they do see the mood disorder, it is an interesting and they think it's a behavior issue. So, Lisa. My son has Tourette syndrome. He's 21 years old and was diagnosed when he was nine with Tourette syndrome. For those that knew that may know Tourette syndrome or may not know, it comes with several other pieces to Tourette syndrome. He has anxiety, depression, actually school phobia and obsessive-compulsive disorder, which is probably the worst of all of those combined. He's a hopeful person. He's a happy person. And so when you ask how is he doing now, like Michelle, we go through day by day and every day is different. And I don't even know what will happen when I get home today. But we're always hopeful. And I would like to say I appreciate this forum today. And thank all of you for being here because it's a blessing for us to be able to be here and talk about this to you. And I hope it helps. Thank you, ladies. Now that we have kind of a baseline of understanding, can you tell us when you first realized something was amiss here? When or what event perhaps triggered your mom radar, knowing that something was different? Kim? My son was diagnosed with a rare bone cancer. And we first were dealt with this death sentence, per se. But God was so good in sending us the right doctors to help him with his cancer. Then came an amputation of his leg. And you know, just it was a grieving time for me as a mom. And so I can't imagine the grieving time for my son. But as time progressed, we began to realize that my son was in deep despair, emotionally in deep despair. And he hit sixth grade. And it was our son that we did not know anymore. And we began the journey of really a very dark time in our life. And I want to say that we had this light shown upon us. And it was clarity and the doctors. And the facility was incredible. So I'm so grateful that I can sit here today with a big word of hope that we all can raise our kids and know that there is something out there that can help them. Thank you, Kim. Michelle, was there any particular situation that turned your mom's radar on? Yes. And never underestimate intuition or mom's radar. And I would definitely say that's a big takeaway as you sit here and listen to this today and you go talk about what you heard. Yes, what I noticed initially with my daughter was a change in her appearance, her attitude and the music she was listening to. And even though my mom radar had started to go up, I wasn't sure what was going on because this also happened at a period of time where she was in middle school. And middle school is hard enough. And so as a parent, you try to discern, okay, is this, you know, quote unquote normal middle school behavior? Or is there something else going on? So I did see those signs. But I didn't think too much about it. I thought it was a phase she was going through. I am really fortunate that a friend of mine called me. This was when I was still working. And I got a call one day at my desk. And this person said, Michelle, can you meet for coffee? And it was really unusual because we didn't go have coffee together at work. But this one particular person as a parent had the courage to reach out to me as another parent and share what her child had told her, which was my daughter was actively cutting at middle school. So I was fortunate. I had someone who had the courage to come find me and tell me something I did not know was happening. So I saw some signs, but then I was fortunate that I had someone to tell me. Wow. Thank you so much, Michelle. Lisa? Well, with Tourette syndrome, it was a little bit easier to know that part that we knew something was going on with him. But probably the most significant to me is remembering his anxiety and his depression that hit really hard. I'm a nurse. And so I always thought they had everything you could imagine to begin with. And I had even diagnosed them with all kinds of things before all three of my children. I was always diagnosing them with something. So I was always on the lookout and aware. But my instinct, my instinct said something's just not right with this kiddo. And I remember even calling my mom and saying, you know, I think he's got something neurological. And they're always saying, oh, you always say that. But for this instance, I was right. So the depression is like, you know, you see the changes. You see the no friends coming over going to bed and sleeping 20 hours out of 24 hours, not eating or eating a lot. So, you know, your mom, your mom radar really keys in on those. And so those, like she said, as soon as you can and to see it, it's to take them in and have them checked as soon as you can. Very good. Thank you, Lisa. What do you as parents suggest to other families that they do if they're experiencing concerns with their children concerning mental health? Lisa? Well, I would say have them checked. Have your pediatrician check them and don't stop. If you feel like something's not right, if you feel like your child is sleeping too much or their eating has changed or their friends have changed or you may wonder if, gosh, is he doing drugs or someone like Michelle had the fortune of someone telling her. If the pediatrician says, don't worry about it, worry about it. The neurologist says there's no medication for this. We'll just write it out. Don't listen. Listen to go to someone else and to you as a parent, feel like your questions have been answered. Because so many times it's so easy for someone to say it'll pass. Or this is just a nervous habit. Don't worry about it. Worry about it. Before it's too late. And don't worry too much, but you know what I mean. I would suggest that you talk to your friend or another family member that maybe has a teenager that maybe is having issues. But issues are one thing. But when your child is acting out in anger or being disrespectful, wanting to hurt, punch holes in walls and stuff like that, it's not normal. This isn't normal behavior. And I would just encourage you to not want to hide, close the door and make everybody think that your world is okay. But to seek help. And I have a great place that you can go if you if you need help. And I can't, you know, I want to just keep telling you there is hope for your child. For a friend that you know, for an adult in your life, there is hope. And we felt totally hopeless. I was telling Mr. Ed that when Drew was, my son was in middle school, we really, we just didn't feel like that we had anyone that we could even turn to to say, what is this about? And finally, we had someone in our life that said there's nothing else we can do. And we looked at each other. There's nothing we can do. But there was something that we could do. And we went to Clarity and we went to wonderful doctors that that was able to help us on our journey, not only my son, but my husband and I, and my kids. And I'm so grateful for for the hope that we we all have in this room and in our society today. Thank you, Michelle, your comments. I can't agree more with Lisa and Kim. Just don't give up. Ask for help. Reach out. I know for me personally, the best help I received for my daughter and my family is when I spoke to a neighbor. I had finally opened up that something was going on inside our house. Because as we opened up the program, there's such a stigma about mental health. As a parent, I was nervous to expose that part of our family to other people. Because what would they think? What would they think of me? What would they think of my parenting skills? Because often, that's what people think is the root cause of the problem is parenting. So parent to parent, I would say, trust your gut instinct, trust your intuition, speak out. Because with children, they don't have the insight yet or the ability to necessarily voice what's going on within side of them. So the only cues you have as a parent is to see their observations and their behaviors. So be their biggest advocate and keep talking because there is help. And there will be days when you feel you can't do it another day. And that's when you need your support system even more. So also, I would say, think of me and my story about a friend whose child did not have mental illness, but they still took the time to help. So if you're a parent who has a child who has a mental illness, speak up. If you're a parent who has a child who doesn't have a mental illness, speak up. Get involved. It is your place to help. Wow. Great advice, Michelle. Thanks. Okay, ladies. What can we as a community do to be supportive to you and your families? Lisa? I want to preface this by saying my son has tried to start writing a journal about his journey throughout the years. And I was just sharing with Michelle some of his thoughts. And so, very powerful words to see these after all these years of thinking, I know what's in his mind and how could I really know that. But when he writes that, you know, he would go sit in the cafeteria at the high school at a table by himself facing the wall because he didn't want to look at, see people staring or laughing at him. Or when he would go out in the grounds to try to be part of the click when there wasn't a click for him to be in. Those words are very powerful. Coming from a beautiful 21-year-old young man. And so it really brought me back to think about, I looked at the brochures I'm sitting there before this and all those things inside you can do today. All of those things. But more than that, teach your children, teach those around you inclusion, acceptance, and just love for each other. That's the most powerful thing we can do. What can you do as a community? You're already doing it. You're here. So I ask you when you leave today, share this talk today with someone else. Share it with everybody else. Tweet about it. Put it on Facebook. Put it on Instagram. Take a photo of this. Do something. Just share the information because I can't tell you. You don't know who you're going to help just by starting a conversation. Make this your dinner conversation tonight because I really know that once people know more, they do more. So just help educate other people and be compassionate in the struggles that we have with our children. They're no different than what anyone else has. Well, they're a little bit different, but you know, they're still our children and just give us compassion and share this discussion. Thank you, Kim. I think as a community, if we can not pass judgment, there's so much in the world today that, you know, we judge people. I mean, everything, not just mental health, but everything. And I really believe with all of my heart that it just takes one person to share your journey, your struggle. It takes the next person to pass along what maybe you learned as an individual about mental health. Mental health doesn't mean that that they're weird. My son had cancer and we were quick to take care of him. And when it comes to mental health, it seems like we just shy away from wanting to help. And our schools, you know, if our schools could just be educated and educate our kids and teachers, and I believe we could do so, so much in our community. Very good. Ladies and gentlemen, please join me in a round of applause for our brave parents who have openly shared their stories today. By speaking up, these bombs are showing us a model of action that can change the way we view and support mental illness. Thank you. Some of you here today may have children struggling with mental illness. Some of us here might struggle with mental illness ourselves. But if you don't, the following interactive video is going to provide you some perspective because it's sometimes hard to understand what they're going through. Let's take attention deficit disorders as, for example, a child's ability to pay attention and focus on a teacher's instructions can mean the difference between success or failure in education. So for a moment, let's be a child and experience a teacher's instructions amidst a sea of interruptions from other students. Can we be successful in this activity? Listen closely to this PBS simulation that's also available online. Watch as the technician tries to follow along and you try to follow along as well. Let's take a look. On your desk, you should have shapes and a grid. We're going to play a game now with shapes and colors. When we're done, we'll all have formed a secret picture. Make sure you listen to my instructions or your picture won't look like it's supposed to. Are we doing art? No, Freddie. Art class was yesterday. Here we go. I'm only saying the directions once, so don't ask me to repeat them. Listen carefully. Ready? Everyone take the yellow triangle and put it on the yellow circle in the grid. I don't have a yellow triangle. Is that yours on the floor? Now find the green square. It belongs on the red square. Look at the blue triangle on the grid. Put the green circle on it. Which circle? Don't put the red square on the yellow triangle. But I already used the blue triangle. Arthur and the green triangle on the red couldn't swim and Mrs. Smith had to go in and square out the shape. And I think the kids are going to get the yellow triangle. Arthur had to go to the nurses on there. Hey, everyone needs to settle down and pay attention or no one's going to get this right. Who cares? Cover the no square with the red circle. Put the blue triangle on the spot below the green square, you can see. Put the red triangle over the yellow shape. Is that a trick question? Put the yellow circle on the last empty space. Is everyone done? Flip your cards over. Does yours look like this? So the question is, how does any child complete their work with that kind of distraction going on? That was a good example that gave us a better perspective. Now to continue our focus on the child and their perspective, our first presenter is Dr. Soad Mitchelson. You're going to like her. She is a child and adolescent psychiatrist which are in critical demand across the United States. She serves as President and Senior Medical Director of Southwest Psychiatric Physicians and is an adjunct clinical associate professor, Department of Psychiatry at the University of Texas Health Science Center right here in San Antonio. She teaches residents and fellows as they rotate through a local psychiatric hospital. Dr. Mitchelson is often interviewed by local media outlets including print, radio and TV stations and she'll be speaking from over a decade of experience working with children and families in desperate need of psychiatric care. Her strong belief is that with children, there is always hope. Ladies and gentlemen, please help me welcome Dr. Mitchelson. Thank you very much Chuck. And good afternoon everyone. I would like to see who has ever felt hope. Please, a show of hands. For anything, I hope my child makes a goal at a soccer game. I hope I can get up late today. Well, I'm here to tell you that with children, there is always hope. And with children with mental health challenges, there is certainly hope. And I hope to be able to get through this talk too. So, the wonderful aspect of working with children is that we are at the beginning of a journey. So I can assure you, we have not exhausted all the resources and we have not exhausted all the therapeutic interventions. So let's review some concepts. Hope. Hope as a noun. It means an expectation. But hope as a verb means desiring, expecting, pursuing an outcome. And the word prognosis, prognosis means an expected outcome of a medical condition. So, as we can see, hope and prognosis do go hand in hand. But we can't just sit in front of the TV and watch daily tragedies with ooze and oz and expect to change the lives of children with mental health conditions and those that are affected by it. To be able to hope for a better prognosis, we must be proactive. We can not be passive. That one in five child, hope does not start with them. That might be a bizarre comment, but actually it starts with us. The one in five child should be our inspiration. They initiate this journey of hope. We can begin by dismantling, taking apart. For example, this role that we have sometimes of being an audience, of being onlookers, of being just judgmental. We have to break that down and actually rebuild ourselves. And what do we rebuild ourselves as? We rebuild ourselves as educated and empathic catalysts to mental health. People that are invested in these children and the children that are actually with our own children. So, let's further our education. This is a very important concept we have to understand. That all those intense emotions, the mood swings, the voices, all that mental psychosis, that is all a product of a medical condition. Kids don't just come up one day and say, I want to feel this. It's a medical condition. It's a neurological condition and it is a brain disorder. And this has been presenting and progressing, developing much, much, much sooner and before we even saw the symptoms. So it is very important to be empathic with these children with mental health conditions because they have actually been feeling the despair and feeling the pain way before it ever bothered anyone else. Children want to do well and always remember that. Kids do want to do well. Even if your own kids are driving you up the wall, they really do want to do well. They want to please. So we really have to ask questions, all of us. We have to ask questions if this is not exactly what we see. So let me share with you a snapshot. And I mean it is a tiny little snapshot of a child with a mental health condition. So Frankie. Frankie is not his real name. His real name is actually perfect for him. But he was two years old. His parents started questioning things when he was two years old because he was tremendously hyperactive. Now when we're talking hyperactivity, we're talking about a child that runs 24-7. Gets himself in various dangerous situations. Climbing furniture, climbing trees, impulsive. And impulsivity is a very important concept because it's not physical impulsivity only. It's verbal impulsivity. So they say things that are not necessarily something that is very socially appropriate. And besides that, he started being a little bit aggressive. So what did his parents think? They thought what most parents think when they have a two-year-old with behavioral problems. They felt as well as other people would tell them that because Frankie was actually the fourth and youngest child, he was the only boy after three girls. What else could it be but bad parenting? He was spoiled. But actually, he was not spoiled. That was not the case. As time went by, Frankie's temper tantrums became much more intense, more frequent. And his family felt his parents that they did not understand him. And so at that point, because they felt they couldn't control him, they couldn't change his behaviors, they actually brought him to see a psychiatrist, which was a big deal for that family. They had never seen any mental health issues in their family. Well, that was not true either. But not because it wasn't a truth, but because no one spoke about it. So Frankie comes in. We met when he was three years and 10 months old. And yes, he was a handful. It was very difficult to have him even sit still for more than 10 seconds in the office. But his parents came in. They were exhausted. They were defeated. And they were hopeless. But they were willing to do whatever was recommended to them. And for the next six painful months, because they were very painful, the non-medication intervention was tried, which is very appropriate in a child that age. The family went to family sessions with their three daughters. They also went to individual for Frankie. So he had play therapy. And they also went to parenting skills. But unfortunately, the behaviors did not improve. Actually, Frankie became much more violent. And when he came into the office one day, he stated, the shadows are telling me to kill. And I'm very scared. So at this point, medication was indicated. He was started on a low dose of an antipsychotic. He's a little guy, right? So he was started on a low dose of an antipsychotic, but that was just enough. He was too unsafe at this point. And when I say unsafe is that he felt he needed to do what the voices said to him. And his parents couldn't keep him safe at home and couldn't keep him safe with his sisters. So then what was the next step? Frankie was to have his first hospitalization. And it was the first hospitalization of 16 hospitalizations he was going to have in eight years. One of those hospitalizations was longer than three months. So you answer the question, where is the hope? Well, actually, through hospitalizations, through tons and very intense therapy, throughout patient appointments, Frankie was beginning to progress. His mood got better. The voices went away. His family learned to cope with Frankie. But better yet, and this is the most important part, is that Frankie learned that he was not bipolar. Frankie learned to understand he was a normal boy with a condition called bipolar disorder that needed to be treated. So his identity changed completely. He was now empowered. And he continues to be empowered. His last hospitalization was in October of 2012. I've been working with Frankie for about 10 and a half years. And Frankie was my inspiration. My inspiration to bring the word hope into a treatment plan, to make sure that that was part of what needed to be reached when working with families. Now, Frankie has many challenges ahead of him. He has continued treatments, continued psychiatric care, and continued therapy. But he is 14 years old now, is in the eighth grade. He struggles with homework. He struggles with understanding girls. Now, is he not normal, right? So again, what can I say to you is that Frankie is one in five. He can be your child. He can be your child's classmate. He can be a family member that no one is spoken of. But the bottom line is that with children, there is always hope. And that with children, with mental health conditions, there is certainly hope. Thank you very much. And thank you for being here. And of course, thank you very much, Dr. Mitchelson, for that inspiring story. I mean, just gives you chills up your back. We're so grateful that she is a part of that solution. Now, to encourage you and the audience to take action on what we've been hearing thus far, let's all agree that we've been touched by children's mental health, even if it's, today's the first day that we're becoming aware of it. The stories of hope and healing, they're out there, whether it's our own story, that story of that of a sibling, a friend, or your own child. Now, research tells us that writing is therapeutic. In fact, the mere act of writing allows us to process the emotions in a different part of the brain that actually reduces trauma. In this day and age of clicks and 140 characters on Twitter and a fast-paced electronically based life, let's turn back the clock to when we expressed ourselves through penmanship. You remember those days, right? On each table, there's a manila envelope that is labeled story. In it, you'll find blank colored forms. Once you take them out, we're going to pass them around. We're going to practice our penmanship today. Now, we're going to give each of you the next five minutes to think of something that you would like to share. What will you write to age yourself or others in healing? Will you tell the story of a friend that you might have lost, a painful moment in a family experience, or maybe even a joyous one? Did a mentor change the direction of your life when you were struggling, or did words or actions cut through you that have yet to be fully healed? We're asking that you take the next five minutes to write down what comes to your mind. So, I was supposed to add lib or tell jokes or something while the crowd congregated and got back. I was supposed to buy some time while people wandered back in, but obviously, didn't need to do that. There's so much meat. There's so much casserole here that we're hungry for, and it's nice. It's awesome. I'm learning so much. Next up, we'll start back up the program. We're going to start with Dr. Joseph Blader. He's a child and adolescent clinical psychologist. He received his undergraduate education at Tufts University and obtained his doctoral degree in psychology at Queens University in Ontario, Canada. He completed clinical training at the Children's Hospital of Eastern Ontario in Ottawa, and he has held clinical and faculty positions at North Shore Long Island Jewish Medical Center, New York University School of Medicine, Albert Einstein College of Medicine, and the State University of New York at Stony Brook. Quite impressive. Dr. Blader's work is focused on the needs of children with severe behavioral and mood problems, particularly when it leads to impulsive aggression. That is, the title of his presentation is, Will Neuroscience Ever Provide Anything Useful for Children's Mental Health? Ladies and gentlemen, please help me welcome Dr. Blader. Thanks, Chuck. Unless you've been hiding in a cave, you've heard the steady drum beat proclaiming that we live in the age of the brain, where unraveling its mysteries and its afflictions are the next great frontier in biomedical research. Way back, President George H.W. Bush proclaimed that 1990 to 1999 was the decade of the brain. Well, shortly after the decade of the brain officially ended, we had another President Bush in the White House who taught us that it was actually the gut that was the seat of human reasoning and other mental faculties. Well, the brain may have gotten a little bit of a demotion in a certain sense during the Bush administration, but nonetheless, research in neuroscience and expanding our capabilities to provide high-quality treatment progressed. In February of this year, President Obama announced major federal support for a new brain science initiative. The theme of this initiative is to understand how neurons in the brain are connected and function together. Some say that the model for this approach was the human genome project. One nice thing about the human genome project was that its aims were very clear. When we started, we knew that at the end, what we were going to have was a list, very long list, of the amino acids of the location and sequences of the amino acids that are the backbone of DNA in the human cell. Ten years later, when the first draft of the human genome project became available, that's exactly what we got. Connections in the human brain are maybe even more mind-boggling than that. For starters, we have neurons, have billions of connections in the brain, and even that number probably doesn't convey the complexity of the task because it's not just a matter of the connection itself, but the type of connection is probably even more important. So we have long neurons that link up spot A in the brain with spot B in the brain. Well, that neuron may carry a signal from A to B. It may carry a signal from B to A. Very often, there are neurons going in both directions and that interact so that feedback in one direction turns up the volume or lowers the volume of the other signal. Wow. So I'm not sure what the end product of this comprehensive mapping of brain connectivity is going to look like, but we have to start somewhere. And since, after all, the brain is basically neurons connecting and signaling to one another, it's bound to be an important undertaking and will probably produce some very exciting discoveries. But the question for today is when will that and other efforts in neuroscience meaningfully improve the quality of life for people that suffer with brain disorders and still better prevent the development of these conditions among people who are otherwise vulnerable to them? Well, as it stands, we have some intriguing clues about what might be different about brains of among people who have a specific psychiatric disorder from people who don't have that condition. But what we really want to know is what's the mechanism, what's the, what is actually going on step by step that leads those differences to produce very specific symptoms and that hopefully that might show us where we could intervene more effectively. Well, I have to tell you that right now we don't have the neural equivalent of the leg bones connected to the thigh bones connected to the hip bone that X leads to Y, Y leads to Z and symptom A is the obvious and unavoidable result of that process. What's the underlying physiology that gives rise to hallucinations, schizophrenia? I don't know, you know, nobody knows. What causes the soul-crushing despair, the feeling that your very being is like a towel soaked in worthlessness, filth and self-disgust so that just being awake is being conscious is a torment? No one knows. For that matter, because depression is often an episodic condition, how come a week later the same person looks back on those feelings and says, well, that didn't make any sense. Why on earth did I feel that way? Even more puzzlingly, how does that person go from depression to mania and now feels like God's gift to humanity and so full of bliss and perfection that just wants to share with the whole world? No one knows. This, you know, that the brain is unlike other organs in the body in ways that make figuring these things out really hard. It doesn't have moving parts, it's awfully hard to see in action and the exception of a few hormones, most of its outputs are kind of transitory things like thoughts, feelings, behavior. This opaqueness and this complexity has led some people to say that the human brain is evolution's cruel joke on human beings, that for all the things in the universe we can comprehend, the brain can comprehend, remains so obscure to itself. I want to share with you today my belief that when it comes to many of the major brain disorders, evolution or luck, fortune, whatever has actually been exceptionally kind to us in 2014. Even though we're not clever enough to have figured out what step by step produces the symptoms of many psychiatric illnesses, somehow we have so many effective treatments that now relieve suffering in ways that even 50 years ago it would not have been realistic to imagine. For that reason I think that the real human tragedy in mental health care today is not a lack of scientific understanding but the failure to use what we already have effectively and equitably. Let's take for example the explosion in the use of multiple medications to treat children who have pretty severe out of control behavior. They lose their cool and their composure over any little thing it often seems. They're explosive, emotionally volatile, impulsive and that leads to quite severe aggressive behavior at times. It's not unusual to find children in the absence of any evidence that shows that it really doesn't a good on three, four or more medications at the same time, largely in desperation to try to help these problems. Well, I've been doing treatment trials for children with these sorts of difficulties in which we're trying to learn whether two medicines are really any better than one. Now the fact of the matter is most of these children, the vast majority of fact, have attention deficit hyperactivity disorder as at least a part of their difficulties for which we already have some very effective treatments and whose side effect burdens are not too bad. So the first thing we do in our trials is work hard to optimize that first line treatment for ADHD which involves frequent contact with families, rating scales, other assessments and in a trial what's essentially a trial and error process take the time to find the optimal medication and the optimal dose particularly youngster. Then if it turns out that we're still having a lot of problems with aggression, explosiveness, emotional volatility and so on, well then we start our controlled trial where we're looking at the benefits or side effects of additional medicines. The children we enroll have already had in community care long histories of treatment, substantial exposure to stimulant medications for ADHD. A fair number have had hospitalizations in the past. Some have even had antipsychotic medication treatment earlier on and even greater number have at some point had emergency room visits for their out of control behavior so we're targeting fairly severe group of youngsters. Well what do you suppose is the most important thing we learned in this research? I'm still surprised at how often just our first line treatment taking the time to systematically and rigorously implement the first line treatment for ADHD leads to remission of aggressive behavior, the irritability, the explosiveness, the volatility dissipate and we're in a much better place. Nearly two-thirds of the children who come to our trial don't need any additional medication so I consider this an example of well be honest part of our study involves neuroimaging, brain scanning to try to learn about what's different about kids who have such a good response and those that don't but the fact is we don't need the answer to that question to help far more children than we are at the moment. We don't need to develop a new drug to help more children than we're helping at the moment. We need to do the first part of our treatment well and the nice bonus in this context is that this is a sort of care that we can deliver in primary care pediatrics and in fact we're partnering with a number of pediatric providers throughout San Antonio to do just that. Besides medication we know an awful lot about what life is like in families where a child has a severe behavioral disorder. Not always but very often life becomes this cauldron of antagonisms and anxieties. Now you don't need a PhD or advanced medical training to see that any person who goes through life with that amount of grinding constant interpersonal conflict is going to have problems. Never mind the psychiatric issue that ignites those conflicts in the first place but we already know so much about how to lower the emotional temperature, how to help families lower the emotional temperatures in their homes, how to break out of this cycle of corrosive interactions but any professional or family member will tell you that the biggest problem is finding therapists who are suitably trained and that the wait lists are months and months long. So I want to tell you today that we should be burning the candle at both ends and then maybe the future will be twice as bright. By all means let's continue our hard work and investment in understanding the brain and behavior so that real breakthroughs in treating and preventing mental illness are possible. But let's not squander the good fortune that we already have. We have to do a better job in using the treatments imperfect as they are, our good treatments may be imperfect but we have to do a better job making them available and skillfully and optimally implemented and the sooner the better. When Frederick Douglass said about 150 years ago that it is easier to build strong children than to repair broken men, he essentially articulated the main imperative in children's mental health today. We have the tools at our disposal to help before rejection, social marginalization, loss of developmental opportunities and disability leave their scars. If it's any consolation you can count on me to be your loyal partner in meeting that challenge and from what I've seen and heard today it's humbling as well as a great privilege to have such wonderful partners in that process. Thank you. Dr. Joseph Blader, thank you sir. I don't know about you guys but I am inspired and I am feeling blessed to be in the company of such educated professionals who are taking action and it just feels great. I'm being filled today. I'm being fed today. Let's hear from Dr. Marcella Palanca who is the director of the master's in psychology program with a concentration in family couple and individual psychotherapy at our Lady of the Lake University. She's also the director of the psychological services for Spanish speaking population certificate. She is a licensed family therapist and professional counselor with years of experience working with young people and their families from a narrative therapy framework. A native of Bogota, Colombia, she migrated to the United States in her mid 20s and has lived, studied and worked in New York, Florida, Louisiana and more recently right here in Texas. Her personal lens as an immigrant in this country is featured in her research interest and published work on the development of culturally relevant and restorative practices conceived from Latin American paradigms. Today she's going to present did we all get, did we get it all wrong? Please help me welcome Dr. Palanco. I would like to talk today about what the idea of mental illness or mental disorders due to the dignity of our children, their families and our communities. It was 10 years ago when I met Alicia and Sophia. Alicia was an immigrant minority single mother and Sophia was her four-year-old daughter in preschool. I've changed both of their names in order to protect their rights or privacy. I was assigned to be their therapist and this was at a time when I was trying out my newly provisioned out license as a counselor. I was working for an agency that provided in-home counseling to children and their families. It was 10 years ago, but I still remember that when I was driving to their home, I was thrilled. Alicia and Sophia were among the first families that I worked with so you can imagine my excitement. I was eager to get started. I feel very confident about my rather expensive training. So I go to their home, knock at the door. Alicia welcomes me in. While I shake her hand, I realized that I had forgotten something really important that my counseling professors had taught me. Read the clinical history beforehand. Clearly a novice therapist. There it was. It was too late. I had Sophia's clinical history under my arm. I just didn't want to reveal how inexperienced I was by having to excuse myself. Tell the family, sorry, I forgot to read your clinical history. I have to step out for a minute. So all the information I had about them were their names, which gladly I cared to check, and their address. I introduced myself to Sophia. Sophia felt imperative that I made her toys, dolls, and stuffed animals. We talked in great detail about the life that Sophia had shared with her toys, mostly well dolls and stuffed animals, and also about the extraordinary worlds in which these lives had taken place. Some of which had already been documented in Sophia's drawings that were hanging on each one of the walls of their apartment. They were beautiful, colorful, very creative. During our conversation, Sophia seemed to experience how it was like to fly like a bird. She would jump from chair to chair. Then she would experience how it was like to turn invisible. When she would try to trick her toys so that they could not, from her vantage point, see her hiding under the table. It was really very hard not to be impressed and amazed by her creativity and imagination. Alicia told me that she was like well acquainted with Sophia's toys, companions, and even from time to time, she had even served them breakfast, lunch, and dinner at the table, of course, per Sophia's request. At night, for Sophia, it was urgently required that she would go to bed in the company of her toys. She needed to be protected. Alicia saw no problem whatsoever and wholeheartedly agreed with this every single night. Sophia explained to me that she needed to be protected from some of the kids from her preschool who managed to get into her dreams to torment her, much like they did during the day. They made fun at her and they humiliated her due to her accented English and her dark skin color. They were relentless, according to Sophia. Most recently, they started calling her crazy when they learned that therapists will go to the preschool to pull her out from their activities to provide services. My heart dropped to my stomach. At four years old, Sophia's peer relationships had become a window to the world of racism. During her dreams, then Sophia told me that her toys will help her when somebody will try to hurt her. They would even fly away from the situation or they will use their animal powers. During the day, however, since she was not allowed to bring her toys with her, she had to resort to other means to protect herself. She resorted to her fists and her pencils because she knew that she had to protect herself. After all, this is what she learned from her mother, Alicia, who protected herself and Sophia when Sophia's father tried to hurt both of them with his fists. Our time came to an end and I, of course, thanked them both for being so open, allowing me in into their homes and into their lives. I reflected a bit of the sort of things that I learned from Sophia that evening. Of course, make an allusion to her creativity and imagination, her kindness, her care and thoughtfulness towards her toys, but I also expressed how disconcerted I was having learned about Sophia's pain by others trying to hurt her. But I felt reassured that she had created friends and allies to be there to look out after her. So I prepared myself to say goodbye. I walked to the door. Alicia walks with me. She thanks me for my visit. And then in a tone of desperation, she tells me, we're going to need all the help that you can give us. Then she continued. My daughter has child onset schizophrenia, ADHD or attention deficit hyperactivity disorder, a post-traumatic stress disorder and a learning disorder for psychiatric diagnosis that had been given to her within the last year by different psychiatrists and therapists. This has been isolating and devastating for the family. When relatives and neighbors learned about this diagnosis, cousins and neighbors children stopped coming to their home to play with Sophia. It was quite isolating. Once again, my heart fell to my stomach. Four psychiatric diagnosis for a young person experiencing the pain and humiliation of racism and domestic violence. So of course, I left go to my car. And as you may imagine, what is the first thing that I do? Of course, read the clinical history only to confirm Alicia's descriptions. I found the four psychiatric diagnosis listed under which there was a long list of symptoms. All of these taken from the diagnostic and a statistics manual of mental disorders published by the American Psychiatric Association. That was all I found about who Sophia was. This didn't tell me anything in any way shape or form about the Sophia that I had just met few minutes ago. So I wonder, have I read the file beforehand? Would I have had the opportunity to meet Sophia as a creative, caring, thoughtful, talented young person? Or perhaps I would have approached her much like neighbors and relatives as a dysfunctional person with a disordered or ill mind. Would I have made any reference whatsoever to the undignifying experiences such as living with racism and domestic violence? Did you change your mind about Sophia after I told you about her diagnosis? I wonder. Perhaps I was shaking a bit as a new practitioner in this country, but I knew for a fact that there was something much more to the lives of Alicia and Sophia that these psychiatric diagnosis would have had me known about them and the circumstances of their lives. Arthur Klayman, American physician and anthropologist and professor of psychiatrists at Harvard University, wrote that the professionalization of human problems as psychiatric categories causes people to lose a world, to lose a world of relationships, local context, cultural categories, to understand what life means and what is at stake in living. The professionalization of human suffering as psychiatric categories in authenticates us. It makes illegitimate our own representations of experience. It infringes in the rights that people, young people, their families and their communities have to tell their own stories in their own terms. It robs us from meaningful relationships that dignifies us and deletes relationships that cause pain and humiliation by making them unavailable for accountability. The mental health professions may have been originally conceived as a means to better understand and address social suffering and to work collaboratively with communities for the better care of humanity to use homie Babba's term. The recent trend of psychiatric diagnosis in the U.S. and it's rather very unsettling and unfortunate export worldwide tells me, however, that as professionals we got it all wrong. We have created these psychiatric categories to understand families in single ways, impoverishing our own moral responsibility. It has been put forward mostly to the benefit of a pharmaceutical economy at the expense of its devastating effects. As professionals we have a long road ahead of ourselves to undo the wrong, but it is possible if we re-engage in practices of morality from a place of humanity and solidarity with this room for the imagination like Sophia's imagination, with this room for families like Alicia and Sophia, like your families, like my family, where we can take back our neighbors, our relatives, our allies, our worlds by exercising the rights that we have to our own cultural stories. Thank you. And good afternoon everybody. I appreciate everybody being here today and taking the time to listen to us. I want to tell you who I am. I am a police officer, unlike any other city, any other state, any other corner of the nation. I want to tell you who else I am. Prior to 9-11, not trained to help you, couldn't do anything for you. I am your stigma. I am the one that couldn't do anything for you, didn't have the training. Somebody broke into your home. I could help you. If somebody, you're involved in a major accident because of a drunk driver, I'm your guy. But I'll tell you who else I am. I wasn't the guy that you wanted to come talk to your 12-year-old who was in crisis, going through a bad time. But something happened. Something changed or whatever. Right after 9-11, a little circulation went around. They requested us to attend a class called crisis intervention. And now remember, this is right after 9-11. So of course, in my mind, this is going to be how to catch terrorists, capture the bad guys that are trying to blow you up or whatever. And then I went to the class and sat down. They said, oh, this is about mental illness and de-escalation and how not to use force. I'm in the wrong room. I'm not supposed to be here. And then something happened that week too. It was a week-long class. And on Thursday, this young lady, I say young lady, she was in her 70s, came up and spoke to us. And she started telling us about her son. Now, I understand this young lady is about this tall. And she said her son is 6 foot 4. All the siblings have moved out, have nothing to do with her. She's on her own. She's very frail. And she said that her son becomes very violent when you talk about the police. You talk about doctors. You talk about medication. And then she said her reality. She said her reality is that everyone in this room is a police officer. Correct? And of course, we all shook our head. Yes, we are. We're here to help. And she said, I understand that one day, one of you will have to come to my home after my son hurts me. And one of you will have to one, arrest him. One of you will either maybe even have to, based on how bad he hurts me, maybe even kill my son. And I'm a father. And I heard that. And that touched me. And her last statement as she walked down the aisle amongst all these officers, she said, I want to thank you all of you for being heroes, just as your MC said. And I said, what kind of hero am I that I can't even help her? But then I realized it's not even in the dictionary, but hero is somebody that's not made. It's not somebody goes to a police academy. A hero is somebody that's moved. And that day that moved me and me and my partner. We created the first mental health unit on San Antonio Police Department. And from that day on, we decided at that point, we're not going to be the guy that shows up and arrest your son. We're not going to be the one that's going to shoot somebody's son who's going through a crisis. And one thing we will do, I can tell you this now is we are your first responders. And what that really means is, you're not going to hear it on the news. We are your first responders. If you call me because you have a broken leg, you're in a car crash or your son or your family member has a broken mind, I will be responding and I will stay until that person or your family member gets help. That's exactly what we'll do. And one thing our chief said he wants everybody, Chief McManus said that he wants everybody on this department trained to learn how to do escalation techniques and not use force, use communication and help and not hurt. That we are a sword, we are the sword that defends in the night that we don't need to be polished. We need to be sharpened, sharpened with skills, sharpened with techniques that will show that we are here to help. And one thing we would like to do is we want to show you what that looks like. If you call me in the middle of the night and say, I don't know what else to do. Just as you heard one of the speakers say, we call the police. We want to show you what that looks like. San Antonio 911, what's your emergency? Hi, it's my sister. I need police here real quick. I just saw her walk into her room with my razor blades and she's told me she's been getting bullied on Facebook a lot recently. I just need police here really quick. I'm worried. Okay, what's your name? It's Robert. Okay, Robert police are on their way. All right, thank you so much. Are you okay? Hey, my name is William. This is my partner, James. What's your name? Caitlyn. You look really upset today. Can you tell me about what's going on with you today? Well, Caitlyn doesn't seem like everything's fine. Your brother called. He was really worried about you. You know, I may not understand Caitlyn, but I want you to walk with me. I want you to walk with me and help me to understand, explain what's going on with you today. Well, your family is really worried, Caitlyn, and you seem so upset. And I want you, I know you don't know us, but we're going to show you that you can trust us. Just give us a chance and tell me what's going on with you today. Well, Caitlyn, we can't leave until we know that you're okay and that your family is being taken care of. Caitlyn, I couldn't imagine what you're going through, but I want you to understand that we are here with you and we want to help you. Are you seeing a doctor right now? What about sleeping? You look really tired. Have you been sleeping at all? And Caitlyn, I could tell that these people are hurting you. Have you done anything to hurt yourself? Okay, and I need to know about that. That's going to be very important for me to know because I want to know how to best help you. Would you go with this and let us help you? We want it. We want to try to help you. Hey, Caitlyn, again, I can't even imagine what you're going through. You know, you're telling us that you're being bullied on Facebook and that's a huge concern for us. Also, your brother's concerned because you went into the bathroom with a razor blade and you're thinking about possibly hurting yourself. You know, I have a daughter and if my daughter was going through what you were going through right now, I couldn't even imagine leaving her here to deal with this by herself. So I would treat you like I treat my daughter. And what we'd like to do is we'd like to take you somewhere to speak to some really nice people and we'd encourage you to be honest with them and let them know what's going on with you and maybe they can set up a plan for you, okay? Because we don't want to see anything happen to you, Caitlyn, okay? And what we'll do is we'll give your parents our phone numbers. So if there's a concern in the future, they can give us a call directly. You don't have a dad? Okay, well, I'm sorry to hear that, Caitlyn. What I'll tell you this, okay? You come with us, we're going to be with you from start to finish, okay? We'll get down into the hospital with you and I'll tell you what, if there's any questions you have, you can ask us or we can ask the doctor and we can do whatever it takes to make you more comfortable, okay? But we are concerned about you and we'd really like for you to at least give us an opportunity to take you and talk to somebody. Would you at least like to try that? Okay. You don't have to be scared, Caitlyn. We're going to be with you. We're going to walk through with you and we'll make sure that you get all the help that you need and your family needs, okay? Just give us a chance. Would you like to come with us? Thanks, Caitlyn. Okay. I'm coming to you from Boise, Idaho because I had to be at the soccer fields all morning and I can't tell you how happy that makes me feel because two years ago my son was in an acute care psychiatric hospital. Today he's playing soccer and he's in a mainstream high school and that's why we're here today and I've got to tell you guys, you're so lucky there in San Antonio. You have a world-class police department who sets a model for the entire United States in how to handle mental illness but it's not fair that they have to be the first responders. We've got to do better for our kids. I'm so grateful to all of you for being here today because you are taking the first steps to end stigma by coming together, sharing your stories and speaking out for kids. We're going to change this world and we're going to make it a better place for all of our kids. Thank you so much for letting me speak to you earlier today and then Skype in. I really wish I could be there with you today and thank you for everything that each one of you is doing. Thank you, Liza. It's amazing. It's amazing. It's amazing. Can you hear me? Yeah, here we go. It was amazing, Liza, saying that she's inspired and thanking you for taking steps and of course she was the one that took the step because of her bravery that a lot of things are taking action. So now it is time for you to even go more into this and to take more action. We'd like for you to pull out the gold's guide again and the Manila envelope on your table that is labeled envelopes. Now make sure your gold's guide is filled out then self-address the envelope so that we can mail it to you in the upcoming months and then take the yellow copy and place it in that self-addressed envelope. Take the white copy with you as a reminder and then leave the pink copy on the table. We'll use the pink copy to report how many of you took action today as one of our performance metrics. So once again, yellow copy goes in the self-addressed envelope. The pink copy stays on your table and the white copy goes home with you. And we've got volunteers roaming around to help you if you need some assistance and we'll mail you a copy in a few months as another way of reminding you of the actions that you said you wanted to take today on behalf of children, children in our community. This has been an amazing and informative day. Let's have another round of applause for our speakers and our participants. And as a surprise to them, we actually have a gift for all of them. It's a unique, one-of-a-kind, handcrafted item from a child in treatment for mental illness. I think it's up on the screen there and here's another one that I have right here. So that's awesome. Made by a child with mental illness. It's awesome. We'd also like to thank the community organizations here providing resources for you to take action. They're the ones giving us the ingredients for those casseroles. Thank you to our sponsors, Baptist Health Foundation of San Antonio, the Bear County Health Collaborative, NAMI, Clarity Child Guidance Center, and Laurel Ridge. Let's give them a round of applause. Others also step forward to help us. We can't forget the guys who provided the refreshments, Heavenly Gourmet and HEB. Yes, thank you very much. Feeding our tummies as well as our minds. And of course, to our Lady of the Lake University, they presented our Theater of the Oppressed. And of course, we are here on the beautiful grounds of Morgan's Wonderland. Let's say thank you to those wonderful folks making a difference in our community. And they are so kind as to extend an invitation for every single one of you to go out and visit the rest of the park for the rest of the evening there. So if you haven't visited Morgan's Wonderland and seen all the great stuff that they do, please after this event is over, you can roam the grounds and enjoy it. That's awesome. And finally, a big thank you to TEDx San Antonio for ideas worth spreading and to one in five minds in their efforts to end the stigma of mental illness for hosting this event. There's still time, my friends, to record your story and take action, visit a take action table before you leave. Be sure to share with others what you've learned today. And if there's a family you know who needs a casserole, why don't you be the one to make one for them? Ladies and gentlemen, thank you for being with us. Have a blessed day.