January 12, 2024

By Courtney Wise

Plus: Tik Tok teen influencer Kate Speer is working with Harvard’s school of public health to expand her campaign against the sale of weight supplements to minors.

It’s rare that we include an article that isn’t explicitly about parenting in our Thursday edition of the Daily, but I missed distilling a deeply researched and engrossing article about palliative care in psychiatry that the New York Times published last week. It offers the public more to consider as our society wrestles with calls from several psychiatrists for a patient’s right to end medical treatment of “intractable” anorexia.

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Minnesota strengthens Black parents’ wellbeing, enhancing whole families’ mental health

The wellbeing of children is deeply affected by their parents’ health and wellbeing. That’s why behavioral health professionals in Minnesota have focused a new initiative on parents and caregivers to grapple with the youth mental health crisis, MPR News reports. Their focus is on Black parents and children, in particular, due to the systemic inequalities they face as a result of racism. 

“Black youth in Minnesota are at risk of experiencing toxic stress that contributes to depression and anxiety due to long-standing structural racism,” reads a statement from Reimagine Black Youth Mental Health, a collaboration between the Brooklyn Bridge Alliance for Youth, the Minnesota Department of Health and a coalition of local governments that seek to improve the wellbeing of Black children. “These systemic inequities have resulted in negative, disproportionate outcomes for homeownership, income, incarceration, and physical and mental health in Black populations in Minnesota.” Organizations supporting the collaboration include the African American Child Wellness Institute, Minnesota’s Follow Along program, the Minnesota Integrated Care for Early Childhood Initiative and the state’s Department of Human Services.

While Black youth may sometimes avoid feeling the impact of systemic inequality, their Black parents can rarely do the same. And the stress those parents endure can affect the way they show up at home. It might sound like harsher tones in conversation, offering less leeway to a child who’s not following directions, or general low patience rooted in a fear that, if their children don’t immediately and always do what their parents order them to do at home, they’ll be hurt (or worse) in the outside world. “We believe that we are protecting them, because we love them,” said Eva Marie Shivers, founder of Indigo Cultural Center which conducts research on racialized generational trauma in the Black community and how it affects the way kids are parented. 

“I’m very conscientious about making sure that I take care of my mental health so that I am able to show up better as a parent,” said parent Monica Jones. She and her husband, Brandon, who also happens to lead the Minnesota Association for Children’s Mental Health, practice healthy social-emotional strategies in front of their children so that they know what a good model looks like. She hopes their ability to draw on those techniques “can help them regulate their emotions and understand the importance of mental health down the road as they get older.”

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Anorexia, when treated, isn’t a fatal illness. But should our adult children who no longer want treatment be allowed to opt out?

Some illnesses are incurable. It’s something we understand implicitly, but rarely say aloud. We know Grandpa’s congestive heart failure is going to kill him, but rather than acknowledge death is near, we hand him a blanket to warm his legs outside on the 4th of July. The love and concern we have for Grandpa’s humanity inspires our willingness to provide comfort care, the last remaining balm we have in abundance. But psychiatrists “aren’t allowed to acknowledge futility,” says Joel Yager, making it tough for them to accept that some patients just can’t get better, he told the New York Times.

Yager was once among them. In the mid-1980s, when he worked as a psychiatrist treating patients with severe eating disorders at the University of California, Los Angeles, his best medical sources taught him to exert his will over patients unresponsive to treatment. People with anorexia nervosa starved themselves again and again; his job was to help them regain weight. That’s what professional guidance instructed him to do. But then he noticed that the very patients in a cycle of despair stopped showing up. They disappeared, only for Yager to learn they had often died at home, alone. Whether by starvation or suicide, he can’t say. He only knows he felt like a failure. In compelling his patients to be saved, he felt that he “rescued them to death.” Diseases of the mind have limits too, Yager decided, just like those of the body.

Yager didn’t invent the concept of terminal mental illness, though he did coauthor a paper in 2022 that suggested a new clinical psychiatric disorder: “Terminal Anorexia Nervosa.” In it, Yager and lead author Jennifer Gaudiani, an internal-medicine doctor who founded an outpatient eating-disorders clinic in Denver, asserted the diagnosis be reserved for the rare patients for whom “recovery remains elusive.” They’re patients like Naomi who, now in her early 40s, has been starving herself since she was 11 years old. “I’ll either die of anorexia or I’ll die of suicide,” Naomi has said. “I’ve accepted that.”

Gaudiani has since rejected the title “terminal anorexia,” but she and Yager have proposed palliative and hospice care as a last resort for people with anorexia nervosa who, like Naomi, are determined to stop treatment. Their criteria is that they be at least 30, have received high-quality care for severe and long-lasting anorexia, be able to make sound decisions, are prepared to die and “understand further treatment to be futile.”

Naomi fits the criteria for “terminal” anorexia as defined by Yager and Gaudiani, the Times notes. The insistence that further treatment would be of no use distresses Yager’s colleagues, but it enables patients like Naomi access to palliative care. His critics, who are many, worry that accepting a terminal diagnosis for anorexia would open the floodgates for other people with serious mental illness to die with a doctor’s help, even before they’ve tried all other avenues for relief. In Naomi’s case, after four years of palliative care for anorexia, she still sees no future for herself. However, there’s been a role change: As her parents age, she has become more and more involved in helping them, including cleaning, keeping up the yard and cooking dinner – even though she doesn’t eat the meals she prepares for them.

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As COVID funds dry up, Houston schools decide whether or not to cut mental health staff

Sometimes I wonder if the trauma inflicted upon humanity by COVID-19 can ever be quantified. Its impact will never cease to reverberate in the lives of Laura Ortega and her two young children. Their world crumbled when their beloved husband and father, Eliberto, died two summers ago, on the same day he tested positive for the virus. Wanting to help her children navigate the stress of being asked how their summers went, Ortega reached out to their Houston school to connect them to mental counseling help. But none was available, she told The Texas Tribune. Reaching out to the providers listed by Medicaid was no better. “They will just say, ‘Well, you can call this place, and you can call this place, and you can call this place,’” Laura said. “And you call them, but they never call back.”

It was six months before Ortega was able to secure counseling for her children. That lag time can be harmful to children, said Bradley Smith, director of the graduate program in the University of Houston’s Department of Psychology. They need swift trauma-informed care. “The saying, ‘Time heals all wounds,’ that doesn’t really apply to trauma. Just the passage of time doesn’t automatically take care of things. And so I think we have a lot of kids walking around that are still experiencing [deep grief and fear] from the pandemic that haven’t been worked out.”

Worse yet, it’s likely the number of students needing help will only grow as schools face budget cuts. Federal COVID funds will end this fall and, despite a near $33 billion surplus, Texas legislators directed no mental health funds to its public schools to cover the loss. That leaves school leaders with the terrible choice of cutting teacher salaries  cutting vital mental health services. Both decisions undermine student learning, said Brian Woods, deputy executive director of advocacy for the Texas Association of School Administrators.

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In other news…

In a read that many a parent will relate to, Vanessa Barbara writes in the New York Times that telling tales to her daughter – political, mythological, and otherwise – helped her survive “an unhinged far-right presidency and a devastating pandemic.”

Want to resolve harmful “youth trends”? Provide a safe place for teens to build community, and talk about their emotional and mental health needs, writes Chicago teen Lakaya Knight in an op-ed published by the Chicago Tribune. Teens have mental and emotional struggles that adults fail to take seriously by not providing safe places for them to talk, gather, play, and “escape their difficult realities,” Knight says. As a result, teens create their own spaces without the adult support they need, she explained. “We are not trying to spark social disruption. We are trying to build community given the limited resources we have access to,” writes Knight. “If the city wants to ease youth trends, it must invest in mental health resources and programs that promote youth wellness, such as the Healing Through Justice model. It focuses on youth leadership and our ability to address inequity and mental health challenges.”

LGBTQ+ advocates filed a lawsuit earlier this week to block enforcement of Louisiana’s new ban on gender-affirming health care for anyone under 18. They called the law “unconstitutional,” PBS NewsHour reports. The filing prepared by Lambda Legal reads, in part, “The Act’s prohibition on providing evidence-based and medically necessary care for transgender adolescents with gender dysphoria stands directly at odds with transgender adolescents’ right to obtain the medical treatment they need, as recommended by their medical providers and with the support of their parents,” the lawsuit states.

Last fall, we noted a collaboration between Harvard’s T.H. Chan School of Public Health and TikTok influencers to correct misinformation about mental health. It involved researchers from the university briefing influencers on popular mental health topics, including, closing the mental health care gap, intergenerational trauma, the connection between physical and mental health, and addressing climate grief. Some influencers even participated in special Zoom training with researchers. Initial results of the relationship prove positive; social media posts created by Harvard-trained influencers received 500,000 more views compared to the posts they made before the partnership. As the project reaches its one-year anniversary, influencer Kate Speer hopes to extend the relationship into funded posts that promote mental wellness, NPR reports. 

In October, Speer used her TikTok platform to campaign against the sale of over-the-counter weight loss supplements to minors in the state of New York. She received no pay or incentives for the posts, but since then has worked with Chan School researcher Amanda Yarnell and social and behavioral scientist Bryn Austin to write a grant requesting funds to support similar efforts in other states. “When influencers can only survive by taking money from predatory companies to put disinformation out, that’s bad for public health and that’s bad for society,” Austin says. “We need to be able to create an opportunity for them to make a living, use their gifts for storytelling and communication, but for good….That’s the direction I see us in public health and in academic research needing to go.”

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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