ONE: ok guys here’s an arc about mob, in his growth as a person, being confronted with an ideology he’s unfamiliar with, and he has to learn from it but also understand why it’s unhealthy and bad to properly grow from it and choose kindness in the end, albeit in a more nuanced way than before, and this will make mob more able to confront later problems in the season that can’t be solved with mere kindness and require a deep understanding of loneliness and solitude, something he hasn’t had much room to speak on until now. To express mob being shown this villain’s ideology we have a sequence where we see how mogami views the world and by extension how he sees mob, by putting mob in the kind of sad fucked up world he thinks exists, but mob will overcome it with the knowledge that in the real world he has people he cares about and that even the people who make the world bad sometimes can change and nobody is a static evil and kindness and courage when you’re going through hardship goes a long way. despite the darkness this is ultimately a very uplifting experience for him and a show that life is always more than its darkest moments, and also how picking yourself up instead of wallowing in your own suffering and trauma is hard but a very courageous act and what makes mob stronger than mogami

mp100 fans with tunnel vision: Oh so mob was tortured for six months and is sad? He’s literally so sad and traumatized and nobody is talking about this?

Podcast: Children’s Treatment for Mental Health Issues

Today’s guest is Okpara Rice, CEO of Tanager Place, a mental health facility for children in Cedar Rapids, Iowa.  Unlike adults, children are not in control of their own environment, and anything that affects a child will affect their families, and vice versa.  So, what is the best way to help these kids?  Join us as Okpara and Gabe talk about the importance of a holistic approach to mental illness in children, approaches which may or may not include medication.

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  Guest information for ‘Children’s Mental Health’ Podcast Episode

Okpara Rice joined Tanager Place of Cedar Rapids, Iowa in July 2013, and assumed the role of Chief Executive Officer in July 2015. Okpara is the first African American to hold executive office at Tanager Place in its more than 140-year history.

Okpara is active in the field and his community and currently serves on a wide number of boards and advisory committees locally, regionally, nationally and internationally. The issues that fuel his passion include juvenile justice, access to services, health equity, education and leadership development.

Okpara has presented internationally in Europe and Canada on issues that affect children. He holds a Bachelor of Science in Social Work from Loyola University, Chicago, Illinois, and a Master of Social Work from Washington University, St. Louis, Missouri. He also holds an Executive Management certification from Georgetown University, Washington DC, and an Executive Scholar Certificate from the Kellogg School of Management at Northwestern University, Evanston, Illinois.

Okpara lives in Marion, Iowa with his wife Julie and sons Malcolm and Dylan. To learn more about Tanager Place of Cedar Rapids please visit www.TanagerPlace.org.

  Computer Generated Transcript for ‘Children’s Mental Health’ Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: Welcome to the Psych Central Podcast, where each episode features guest experts discussing psychology and mental health in every day plain language. Here’s your host, Gabe Howard.

Gabe Howard: Hello, everyone, and welcome to this week’s episode of the Psych Central Podcast. Before we get started, I want to give a big shout out to our sponsor, Better Help Online Therapy, where you can get one week of free, convenient, affordable, private online counseling anytime, anywhere, just by visiting BetterHelp.com/PsychCentral. They help keep the show free, so please check them out. And speaking of shows, calling in today, we have Okpara Rice, the CEO of Tanager Place of Cedar Rapids, Iowa. Okpara, welcome.

Okpara Rice: Hey, thanks, Gabe. Great to be with you today.

Gabe Howard: Well, we’re really glad to discuss children and mental illness, children and mental health. Nobody wants to talk about children. I mean, people just aren’t talking about mental illness at all and children are vulnerable. So I really appreciate all you do and being willing to have this discussion. The first question that I want to ask you is what is Tanager Place?

Okpara Rice: Well, yeah, we’re in east central Iowa pretty much, and we’re a behavioral health organization, and we see about five thousand kids a year. We have a large outpatient mental health clinic, inpatient services, in-home services. We also do a great deal of training on trauma and resilience. We host a symposium every year. And really, you know, our mission is to inspire, empower and heal. That’s really the three things that we are trying to do with kids in our state. The other thing, though, that I’m really involved in a lot of advocacy, both on the state level, the national level. I’m also involved in some international work as well. And so this discussion around children’s mental health and what is proper mental health for children has been something that I’ve been working with really since the last few years. I think it’s a conversation that has finally started to kind of hit the national media. I think people are starting to pay a little bit more attention. I think even when you look at what’s happening right now at the border and what’s happening with those kids. People are talking about the trauma. I’ve talked to CNN some. I was talking about the trauma that they’re facing. And I said, oh, OK, we’re finally starting to get it all over the country. So it is a good conversation to have. And because really, it’s about where we’re going to put resources for the future. So it’s not cliche when we say that children are our future, that is literally the truth. But it’s a hard thing to do.

Gabe Howard: One of the things that I think that’s interesting is you’re saying that trauma is part of mental health and it’s bad mental health. A lot of people, when they think of mental health and, you know, unfortunately we use that word wrong all the time. You know, he has mental health. Everybody has mental health. They’re really speaking of mental illness. But when we’re speaking of negative mental health, you see the trauma scale is being very valuable. Can you explain that a little bit? Because so many people don’t see trauma as mental illness or mental health at all.

Okpara Rice: Yes, because I think that what we’re trying to do, I think what has happened in movies and other things, I think people have had the vision of what is someone who is mentally ill and then what is somebody who is struggling with their mental health. What is somebody who is in struggle with mental health challenges and what we have learned and what we really know is that all of us at some point have had some type of mental health challenge. Right. And some of us have had different resilience factors and different interventions that helped us over those humps. And I think that we are starting to know more and really speak to. And I think that people are like, oh, yeah, you know, I think I’m gonna go get some help. Or maybe a child is looking a little bit more sad than I remember. They’re not talking as much. Maybe we should get some consultation. I think that what we’ve known the discussion around trauma and ACES, the Adverse Childhood Experiences Survey that Kaiser Permanente had done, had really kind of pushed across the nation. And people start to think like, God, how many? What were those things that kids have been exposed to that could affect their physical outcomes later in life? And that’s where the discussion has changed over the last few years. People are making the connection of these traumatic events. And they don’t have to be that you witnessed a shooting. There could be things like people hollering in your house or bullying situations that happen at school or divorce. It could be a multitude of things that are traumatic to a child. So there is no one like, you know, major traumatic event. It could be small little things that adds up, that erode the child’s sense of self over the years. And so what are those things that help the child to try and build themselves back up? What are those things that helps the child feel strong? What are those supports that the community has to foster those resilience factors in children? That’s what we’re talking more about. That’s the part that’s exciting. We kind of know what really deteriorates a child’s resilience factors, but we have to do in invest in the things that actually help build those resilience factors.

Gabe Howard: And when it comes to children, they’re vulnerable for a couple of reasons. One, they’re children, but two, they’re completely dependent on the adults who are around them. For example, if I feel that I am in harm’s way as an adult, I am empowered to do something about it. But children don’t have that. They’re stuck with whomever their parents are. And that can be a positive. But it could also be very negative.

Okpara Rice: Absolutely, I mean, but when you think about it, all children have to go to school. Right. So we know and we as a country know where our kids are going to be mainly especially doing the school month. We have to build on support there. Parents are doing the best job they can. Some parents are better than other parents, right. Depending on how you look at what parenting is. Some days, I have two sons, I feel like I’m a really good parent and sometimes I feel like, boy, I’m really struggling to handle that situation well. So parents are also a tremendous amount of pressure. And I think when we look at the complex issues of our society, all those things factor in. However, parents still need backup. Right. You know, we need to make sure that our school systems in that are also trauma informed, resilience, focused solutions focus to help kids who may be struggling. And what we find is that more and more resources have been pulled out of schools for mental health and for positive mental health than has been a year in years past. Because everybody is trying to do the best they can with the budgets they have. We also need to make sure there are enough community support. I grew up in Chicago and I remember I spent my summers basically almost unsupervised, you know, on the streets of Chicago running with my friends. You know, there were no community centers. There were no real organized activities in my neighborhood. And so how can we invest in our community? Especially our communities that are more at risk? And we know that there are higher traumatic events and lower socio economic status to make sure that those kids are still getting positive influences, that we’re still intervening in a positive way, preventing kids from having further mental health crises later on in life and also strengthening their resilience. There are a lot of things that we have to do as a community, and it’s not, and again, I don’t mean to be cliche, but we have to look at it as a whole village that we have to care about what’s happened with all kids, regardless of who lives in my neighborhood or who doesn’t live in my neighborhood. These are things that we need to have.

Gabe Howard: It’s an interesting concept that you raise, Okpara, that there are things that we can do to give kids a better chance and improve their mental health. That children won’t even see as preventative medicine for it, for lack of a better word. You take a child to a doctor, you give them a physical or you give them vaccines, that the child knows that it’s preventative medicine. But having structured activities, having supervision, getting them involved in sports, theater, music or things like this, it improves their mental health. And I would say that the average child is completely unaware that this is improving their mental health.

Okpara Rice: Absolutely. They’re building blocks of life. Is that this is what we know kids need and that kids know it’s that holistic view of a child. And we also have to you said it. We have to care as much about the mental health as we do their physical health. That is as crucial. I said something controversial at a meeting maybe a year ago right after the Parkland shooting and that tragedy of that young man and all those children that died. This was also a child who committed this act, because this was a young man who had gone through therapy and had been in therapy. And so therapy is not a magic bullet. Medication is not a magic bullet. And sometimes I think what gets portrayed is that these things are like so magical. Know what the journey is, the journey that we need to start as early as possible for children and to make sure we’re intervening as early as we possibly can and hopefully preventing tragedies like that. But there are many, many children who struggle with mental health issues who never become violent. There are many people who have struggled with mental health issues as children who’ve grown up to be very successful adults. What it is is that you find those things that help center, you find those things to help you recover when you have crises, you find those supportive adults, supportive community around you that helps you when you have some of those low points. The use of psychopharmacology has also been something that we have gotten much better at knowing. But the types of medications that might help a child and when children shouldn’t be on medication as a field, we have gotten much more sophisticated. We tend not to focus on the positive things that are happening to the many, many programs around the country that are doing positive things. That for whatever reason, the things that always hit the paper are things we always hear the most about other negative things that are happening. That’s something that I think is really, really unfortunate. And we have got to have portrayals out there, people who are getting healthy. It’s OK to have setbacks. It’s OK to have challenges. We all have that. And that’s the part we have to realize. None of us have gone through life without having some type of mental health challenge or issues of low self-esteem or issues of depression or issues of self-doubt or doubt about the world. These are things that we just have to come to acknowledge. And I think that helps reduce the stigma and a lot of ways, because you know what? It can be any one of us. I mean, each of us are such different, unique creatures. We all have different resilience factors. We all have different lives that we live. And then that journey has taught us how to deal with different stresses. And so I am very much glass half full about this because I think that there are so many amazing people out there trying to do work with kids that it that it does my heart well. And I know at Tanager Place, that’s one of things that we do. And I get to do that work every day.

Gabe Howard: We’re going to step away to hear from our sponsor.

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Gabe Howard: And we’re back speaking with Okpara Rice, the CEO of Tanager Place. Let’s talk about some controversy for a moment, because something that you said there is we need everything. We need psychopharmacology, which is, you know, medication and we need therapy and we need community supports. And we need we need lots of things. Like you use the cliche, which is one that I really like, is that it really does take a village. But like you said, the controversies are what hits the news. And one of the big ones that people talk about all the time is, oh, you have a hyper child or a child who’s hard to handle. Let’s medicate them and make it easier on the parents. What do you have to say about that from your viewpoint as the CEO of Tanager Place, who works with a lot of children who are in crisis?

Okpara Rice: Yeah, I think that’s a fallacy. I think that sometimes we think that a pill can solve everything. Psychopharmacology is just a part of treatment that usually is tied to therapy and other interventions. It’s just a part of the treatment process. It is not meant for every child. It is not the most appropriate thing for every child. But there are a large segment of kids where it is. We are very lucky here. We have two psychiatrists, two psychiatric nurse practitioners, a psychologist. We have a great medical team here and I see them and the work they do everyday. Parents are not coming in saying, hey, just give me some medication. My child needs to calm down. That is not what’s happening. We don’t do that type of work. We’re not operating in isolation that way. You need to really, first of all, understand the diagnosis of that child, what’s happening with them in school and at the home and their social interactions. And then you’re making a treatment plan. Psychopharmacology may be part of that treatment plan or may not or may be for a small amount of time. The thing is that we are doing the right intervention at the right time and the right dosage. That’s what the most critical thing and medical providers that help. But we do it in very interdisciplinary team environment. So you have the psychiatrist, you have the therapist, you have the caseworker all talking with the parents. This is in lockstep with the parent. I think that sometimes in society we think, oh, yeah, there’s a pill for that, that will be, that’s fine. That’s not really reality. And most medical providers are not trying to do that either. In all fairness to the psychiatrists I’ve known around the country and people I’ve talked to, people take that very seriously, because what we know is that some of these medications are very strong and there are long term studies around how they may impact children’s physical health. Years down the road. So people are very careful about what they prescribe.

Gabe Howard: It’s interesting to hear your perspective on it, Okpara, because you say things like psychopharmacology, and interdisciplinary team, and wrap around services, and that’s a very medical approach. And I think that is what’s happening in the field. I think that is the average way that a child is prescribed medication and services, etc. But it doesn’t quite have the umph of, oh, we’re just medicating annoying kids. And I think  that’s why that information kind of goes out there, because that’s kind of a fascinating conversation. Like, hey, your child is a pain. Let’s give him drugs. Like that that has that hook.

Okpara Rice: Yeah. I don’t want to give the impression that it’s only a very medical model, I should say it is a much more holistic model. I mean, because what the other pieces that we do in this part of our conversation are how we look at kids as you’re looking at all the social determinants of health that the CDC put out. So you understand housing, you understand employment, you understand all the societal factors that go into what happens in that household. What happens with those adults also then happens to that child. So I’m speaking from a professional standpoint that using the big words or whatever. But the reality is, I’m also a dad of a 13 year old and a 9 year old. And when I think about if my children are having challenges, what would I want them to have? And the fact that their dad is the CEO should not matter. We want kids who whose parents are not CEOs or whose parents are single parents. We have to be able to get the same quality of care and that same holistic view of that child. So there is no shortcut to proper treatment. And that’s what we have as a society. I think we’re starting to get there. I am hopeful we are getting there now that we see that the holisticness of the child again, medication is not a cure all. It’s gotta be part of a treatment continuum that involves therapy that may involve physical health. And there’s a lot of other pieces that go along with it. But we have to look at the child holistically. Otherwise we’re not really doing a service because children are not, they don’t operate in isolation. So if you’re not looking at all those pieces, you’re not going to be effective. And then no medication is going to be effective. We’re not trying to have kids who are zoned out, you know, walking around the city. That’s not productive. That’s not healthy.

Gabe Howard: There’s an interesting thing that you said there, where you said that the things that are happening to the adults in the household are happening to the children in the household. And I want to touch on that for a moment, because adults really have this idea that children are you know, they’re bullet proof from the ways of the world. They don’t have mortgages and jobs and children and all of these things. But I think if we all reflect back when mom and dad are stressed out about money that is felt and reverberated throughout the household and absolutely impacts the children. Now, it may impact them in a different way. And in fact, I think it’s reasonable to say that it absolutely impacts children in a different way. Can you sort of speak on that idea that, oh, you’re just a kid, don’t worry about it and how that needs to evolve because the kids are worried about it. But because you told them not to worry about it. That means you’re not a source of support.

Okpara Rice: Right. And I’ll say a couple of things. You know, one, first of all, anybody who’s been around any type of child knows children pick up on everything. First of all, there is nothing that seems to get past them, which is remarkable. But I must think of my own experience a little bit. You know, I grew up in a household. My father was a drug addict. My mom was very clinically depressed. And I know for a fact, when I look back on my wife, the effect that those two things had on me and what happened when you are wondering if you’re going to have a home the next day? We were homeless for a little bit. You know what that’s like? Or you don’t know what’s happened. What’s your next meal? Or when your mom can’t get out of bed for two days because she doesn’t have the strength to do that. You know, so I know what those things did to me made me think about throughout my life. I mean, those are extreme in that I would hope nobody has ever had to experience that. I know there are children who experience that every single day. And that’s the extreme. But there are small things, just the pressures of maintaining the household, the pressures around making sure there are gifts at Christmas time. That’s one of the things that my role and all the roles I’ve had that’s always so important to me, because guess what? As a parent, I know when it gets to Christmas time and how expensive toys are and people want to give their kids things. And that stress and that pressure of trying to make that happen. But God, do you pay this bill or do you go get this toy, right? You know, we try to make sure all our kids through our program get some Christmas gifts or families get some gifts. So that’s one less thing that they have to worry about. But all those pressures, of course, filter down to the child. They can feel that tension. And again, each child responds to that tension in a different way. But we have to acknowledge that tension is there. They’re not oblivious. As a matter of fact, they’re picking up on way more than you think. And sometimes it’s good just to have a conversation with your child, if they’re old enough to to have a dialogue, to make them feel reassured that, hey, things are OK, we’re going to be fine. Things may be tight right now, but this is what we’re doing. You know, you don’t have to talk to them like an adult, but acknowledge that the tension is there. That’s going to help them feel safer.

Gabe Howard: Let’s move on to when everything goes wrong. The worst case scenario, what people unfortunately think about more often than not when they think about mental illness and that’s crisis. You said that at Tanager Place, you have inpatient and outpatient services and that’s crisis treatment. Can you talk about that a little bit, how you take somebody from crisis to wellness?

Okpara Rice: Yeah, I mean, it’s again, it’s a journey because each child is different and so our children in our impatient program, they’re not able to be in their home for various reasons. So we have kids who come us who have severe depression. We have kids who may just come out of a psychiatric hospitalization. And so that journey for them is gonna look different, for each family is going to look a little bit different. You know, I don’t look at it necessarily as crisis. I think that they may have had this episodic situation, but it’s really about how do you help them avoid that situation? Go on into the future? How do you build their resilience so they don’t do any self harm or they don’t think about suicidal ideation or contemplate not being on the planet? How do you help young people do that? And there is no easy way. I wish it was an easy fix, but it’s not because each child responds to treatment in such different ways. And also what we learn now that, not what we’ve learned, but what we really acknowledges that, you know what, if you’re not helping the family at the same time, a child may be an inpatient care, that you’re really not doing quality treatment. And that is something that has absolutely moved across the country. And I think people are much more family engaged and family driven because we get that child may be with us for six months, eight months. They’re going to go back to that home. They’re gonna go back to their home community. So we not only build the resilience factors in that child, and we don’t do that in that family. And in that community, then they’re not going to be successful going back. And so I think that what we know, again, is moving away from that medical model, treat the child, treat the child, treat the child to now much more of a systematic, holistic view of that family unit. That’s what makes for good treatment. And it takes time. Unfortunately, we live in a managed care environment and insurance sometimes dictates certain things and each state is very different how that’s done. And so not only you have to have a really quality patient program. We’ve got to get also really quality community based support for that child to understand that there may be setbacks along the way. And that’s part of the journey, right? Nobody one day is like, oh, boy, I mean, you know, I’m having this episodic crisis. I’m perfectly fine. Doesn’t work that way. That’s not life. But we have to have things in that community where that child may not need that highest level of care, that most restrictive level of care.

Gabe Howard: How do the families respond to this? Because I imagine that given our limited knowledge of mental health that exists in society, when they knock on your door, they probably believe that the issue is entirely with the child. And then you’re saying, no, no, no, there’s things that you can do as well. Is there pushback on that?

Okpara Rice: Oh, sure. I mean, there’s some but, you know, really a lot of people when they come to our door, they just want help. They want help. The thought of a parent, any parent, losing their child is terrifying. They do. They want help. Look, OK. And I’m not saying it is all pie-in-the-sky, that everybody comes so open to that. It’s not necessarily true. Each treatment program is different and treatment programs unique. Each. Each family is unique. Some people are ready to engage in that change making process. Some people are ready to do some self reflection. Some people are not. It just really depends. And that’s where there are other programs that people can find that fit what their family may need. But for the most part, honest to God, I must admit, a lot of parents who are in crisis and who feel like it because they don’t want to lose their child. And our job is to help give them hope that we’re going to help be a part of this journey with you. And so a lot of people that’s it’s just hard. It’s humbling and scary. And so, again, you acknowledge that, you validate those feeling, but then you set a course of action. You set a plan together to help their child and to help their family again. If the family isn’t healthy part of that is our encouraging people to be healthy, then it’s not. Treatment is not going to be successful long term. And there are a lot of families who have themselves wound up in therapy, who seek additional things or who have had events in their past that have changed how they parent. So, again, if you’re open and you’re engaging with people, people come to you for help. And that’s the most profound thing. Once that door is open on this and they help us help this family, there are a lot of things you can do. We just have to come with the right spirit or philosophy around this. It’s not victim blaming. We don’t have people say, oh, it’s your fault, your child is struggling. It’s your fault your child has thought about committing suicide. That’s not what you do. You look at what are those factors that led to that child thinking about that? What are those stressors in that child’s life that has led them to think about that? What can we do? What are those supports you can build in? How can we build on supports for that parent as well, that even hearing that about your child is traumatic? So those are things that we do.

Gabe Howard: That’s the final thing that I want to touch on, Okpara, so many people believe that mental illness only exists in children that have bad parents more often than not bad mothers or come from broken homes or there’s just a lot of, like you said, victim blaming that the child would be fine if it wasn’t for their awful family. We know that that’s not true.

Okpara Rice: Oh, absolutely. Let’s just be straight. Children’s mental health challenges cover every socio economic spectrum. I don’t care. We have kids who come who are seen in our outpatient clinic and our inpatient programs, whose families are extremely wealthy, whose families are extremely poor, whose families are middle class. It covers every gambit. So we have to put that out. We have to just say that’s just a myth. And you know what? Even families that are very, very poor, they want the best care for their child, too. That’s the other myth that we have a society which is a whole different conversation too. Being poor doesn’t mean you don’t care about your kids. So everybody’s trying to get the best care they can. They just have limited resources that they can turn to to get that care. That’s where wealth gives you that opportunity. But better believe it, wealthy, poor, middle class, everybody has the same level of mental health struggles.

Gabe Howard: That is excellent. Okpara, thank you so much. What’s the Web site for Tanager Place if people want to check it out across the country?

Okpara Rice: You’ve got it, www.TanagerPlace.org.

Gabe Howard: Awesome, thank you so much for being on the show, we really appreciate your time and for enlightening us on all of these subjects. You’re just, you’re just awesome.

Okpara Rice: Thanks so much for having me. I really appreciate it.

Gabe Howard: You’re very welcome. And hey, everybody, do you want to interact with me on Facebook, suggest topics, comment on the show, and be the first to get updates? You can by joining our super secret Facebook group, which I’ve now said publicly at PsychCentral.com/FBshow. Have any topics but don’t have Facebook? There’s got to be one out there. E-mail us at [email protected], and tell us what you think. And don’t forget to review our show on whatever podcast player you found us on. Tell a friend. Thank you so much, and we will see everybody next week.

Announcer: You’ve been listening to the Psych Central Podcast. Previous episodes can be found at PsychCentral.com/Show or on your favorite podcast player. To learn more about our host, Gabe Howard, please visit his website at GabeHoward.com. PsychCentral.com is the internet’s oldest and largest independent mental health website run by mental health professionals. Overseen by Dr. John Grohol, PsychCentral.com offers trusted resources and quizzes to help answer your questions about mental health, personality, psychotherapy, and more. Please visit us today at PsychCentral.com. If you have feedback about the show, please email [email protected]. Thank you for listening and please share widely.

  About The Psych Central  Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar and anxiety disorders. He is also one of the co-hosts of the popular show, A Bipolar, a Schizophrenic, and a Podcast. As a speaker, he travels nationally and is available to make your event stand out. To work with Gabe, please visit his website, gabehoward.com.

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Podcast: Children’s Treatment for Mental Health Issues

Today’s guest is Okpara Rice, CEO of Tanager Place, a mental health facility for children in Cedar Rapids, Iowa.  Unlike adults, children are not in control of their own environment, and anything that affects a child will affect their families, and vice versa.  So, what is the best way to help these kids?  Join us as Okpara and Gabe talk about the importance of a holistic approach to mental illness in children, approaches which may or may not include medication.

SUBSCRIBE & REVIEW

  Guest information for ‘Children’s Mental Health’ Podcast Episode

Okpara Rice joined Tanager Place of Cedar Rapids, Iowa in July 2013, and assumed the role of Chief Executive Officer in July 2015. Okpara is the first African American to hold executive office at Tanager Place in its more than 140-year history.

Okpara is active in the field and his community and currently serves on a wide number of boards and advisory committees locally, regionally, nationally and internationally. The issues that fuel his passion include juvenile justice, access to services, health equity, education and leadership development.

Okpara has presented internationally in Europe and Canada on issues that affect children. He holds a Bachelor of Science in Social Work from Loyola University, Chicago, Illinois, and a Master of Social Work from Washington University, St. Louis, Missouri. He also holds an Executive Management certification from Georgetown University, Washington DC, and an Executive Scholar Certificate from the Kellogg School of Management at Northwestern University, Evanston, Illinois.

Okpara lives in Marion, Iowa with his wife Julie and sons Malcolm and Dylan. To learn more about Tanager Place of Cedar Rapids please visit www.TanagerPlace.org.

  Computer Generated Transcript for ‘Children’s Mental Health’ Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: Welcome to the Psych Central Podcast, where each episode features guest experts discussing psychology and mental health in every day plain language. Here’s your host, Gabe Howard.

Gabe Howard: Hello, everyone, and welcome to this week’s episode of the Psych Central Podcast. Before we get started, I want to give a big shout out to our sponsor, Better Help Online Therapy, where you can get one week of free, convenient, affordable, private online counseling anytime, anywhere, just by visiting BetterHelp.com/PsychCentral. They help keep the show free, so please check them out. And speaking of shows, calling in today, we have Okpara Rice, the CEO of Tanager Place of Cedar Rapids, Iowa. Okpara, welcome.

Okpara Rice: Hey, thanks, Gabe. Great to be with you today.

Gabe Howard: Well, we’re really glad to discuss children and mental illness, children and mental health. Nobody wants to talk about children. I mean, people just aren’t talking about mental illness at all and children are vulnerable. So I really appreciate all you do and being willing to have this discussion. The first question that I want to ask you is what is Tanager Place?

Okpara Rice: Well, yeah, we’re in east central Iowa pretty much, and we’re a behavioral health organization, and we see about five thousand kids a year. We have a large outpatient mental health clinic, inpatient services, in-home services. We also do a great deal of training on trauma and resilience. We host a symposium every year. And really, you know, our mission is to inspire, empower and heal. That’s really the three things that we are trying to do with kids in our state. The other thing, though, that I’m really involved in a lot of advocacy, both on the state level, the national level. I’m also involved in some international work as well. And so this discussion around children’s mental health and what is proper mental health for children has been something that I’ve been working with really since the last few years. I think it’s a conversation that has finally started to kind of hit the national media. I think people are starting to pay a little bit more attention. I think even when you look at what’s happening right now at the border and what’s happening with those kids. People are talking about the trauma. I’ve talked to CNN some. I was talking about the trauma that they’re facing. And I said, oh, OK, we’re finally starting to get it all over the country. So it is a good conversation to have. And because really, it’s about where we’re going to put resources for the future. So it’s not cliche when we say that children are our future, that is literally the truth. But it’s a hard thing to do.

Gabe Howard: One of the things that I think that’s interesting is you’re saying that trauma is part of mental health and it’s bad mental health. A lot of people, when they think of mental health and, you know, unfortunately we use that word wrong all the time. You know, he has mental health. Everybody has mental health. They’re really speaking of mental illness. But when we’re speaking of negative mental health, you see the trauma scale is being very valuable. Can you explain that a little bit? Because so many people don’t see trauma as mental illness or mental health at all.

Okpara Rice: Yes, because I think that what we’re trying to do, I think what has happened in movies and other things, I think people have had the vision of what is someone who is mentally ill and then what is somebody who is struggling with their mental health. What is somebody who is in struggle with mental health challenges and what we have learned and what we really know is that all of us at some point have had some type of mental health challenge. Right. And some of us have had different resilience factors and different interventions that helped us over those humps. And I think that we are starting to know more and really speak to. And I think that people are like, oh, yeah, you know, I think I’m gonna go get some help. Or maybe a child is looking a little bit more sad than I remember. They’re not talking as much. Maybe we should get some consultation. I think that what we’ve known the discussion around trauma and ACES, the Adverse Childhood Experiences Survey that Kaiser Permanente had done, had really kind of pushed across the nation. And people start to think like, God, how many? What were those things that kids have been exposed to that could affect their physical outcomes later in life? And that’s where the discussion has changed over the last few years. People are making the connection of these traumatic events. And they don’t have to be that you witnessed a shooting. There could be things like people hollering in your house or bullying situations that happen at school or divorce. It could be a multitude of things that are traumatic to a child. So there is no one like, you know, major traumatic event. It could be small little things that adds up, that erode the child’s sense of self over the years. And so what are those things that help the child to try and build themselves back up? What are those things that helps the child feel strong? What are those supports that the community has to foster those resilience factors in children? That’s what we’re talking more about. That’s the part that’s exciting. We kind of know what really deteriorates a child’s resilience factors, but we have to do in invest in the things that actually help build those resilience factors.

Gabe Howard: And when it comes to children, they’re vulnerable for a couple of reasons. One, they’re children, but two, they’re completely dependent on the adults who are around them. For example, if I feel that I am in harm’s way as an adult, I am empowered to do something about it. But children don’t have that. They’re stuck with whomever their parents are. And that can be a positive. But it could also be very negative.

Okpara Rice: Absolutely, I mean, but when you think about it, all children have to go to school. Right. So we know and we as a country know where our kids are going to be mainly especially doing the school month. We have to build on support there. Parents are doing the best job they can. Some parents are better than other parents, right. Depending on how you look at what parenting is. Some days, I have two sons, I feel like I’m a really good parent and sometimes I feel like, boy, I’m really struggling to handle that situation well. So parents are also a tremendous amount of pressure. And I think when we look at the complex issues of our society, all those things factor in. However, parents still need backup. Right. You know, we need to make sure that our school systems in that are also trauma informed, resilience, focused solutions focus to help kids who may be struggling. And what we find is that more and more resources have been pulled out of schools for mental health and for positive mental health than has been a year in years past. Because everybody is trying to do the best they can with the budgets they have. We also need to make sure there are enough community support. I grew up in Chicago and I remember I spent my summers basically almost unsupervised, you know, on the streets of Chicago running with my friends. You know, there were no community centers. There were no real organized activities in my neighborhood. And so how can we invest in our community? Especially our communities that are more at risk? And we know that there are higher traumatic events and lower socio economic status to make sure that those kids are still getting positive influences, that we’re still intervening in a positive way, preventing kids from having further mental health crises later on in life and also strengthening their resilience. There are a lot of things that we have to do as a community, and it’s not, and again, I don’t mean to be cliche, but we have to look at it as a whole village that we have to care about what’s happened with all kids, regardless of who lives in my neighborhood or who doesn’t live in my neighborhood. These are things that we need to have.

Gabe Howard: It’s an interesting concept that you raise, Okpara, that there are things that we can do to give kids a better chance and improve their mental health. That children won’t even see as preventative medicine for it, for lack of a better word. You take a child to a doctor, you give them a physical or you give them vaccines, that the child knows that it’s preventative medicine. But having structured activities, having supervision, getting them involved in sports, theater, music or things like this, it improves their mental health. And I would say that the average child is completely unaware that this is improving their mental health.

Okpara Rice: Absolutely. They’re building blocks of life. Is that this is what we know kids need and that kids know it’s that holistic view of a child. And we also have to you said it. We have to care as much about the mental health as we do their physical health. That is as crucial. I said something controversial at a meeting maybe a year ago right after the Parkland shooting and that tragedy of that young man and all those children that died. This was also a child who committed this act, because this was a young man who had gone through therapy and had been in therapy. And so therapy is not a magic bullet. Medication is not a magic bullet. And sometimes I think what gets portrayed is that these things are like so magical. Know what the journey is, the journey that we need to start as early as possible for children and to make sure we’re intervening as early as we possibly can and hopefully preventing tragedies like that. But there are many, many children who struggle with mental health issues who never become violent. There are many people who have struggled with mental health issues as children who’ve grown up to be very successful adults. What it is is that you find those things that help center, you find those things to help you recover when you have crises, you find those supportive adults, supportive community around you that helps you when you have some of those low points. The use of psychopharmacology has also been something that we have gotten much better at knowing. But the types of medications that might help a child and when children shouldn’t be on medication as a field, we have gotten much more sophisticated. We tend not to focus on the positive things that are happening to the many, many programs around the country that are doing positive things. That for whatever reason, the things that always hit the paper are things we always hear the most about other negative things that are happening. That’s something that I think is really, really unfortunate. And we have got to have portrayals out there, people who are getting healthy. It’s OK to have setbacks. It’s OK to have challenges. We all have that. And that’s the part we have to realize. None of us have gone through life without having some type of mental health challenge or issues of low self-esteem or issues of depression or issues of self-doubt or doubt about the world. These are things that we just have to come to acknowledge. And I think that helps reduce the stigma and a lot of ways, because you know what? It can be any one of us. I mean, each of us are such different, unique creatures. We all have different resilience factors. We all have different lives that we live. And then that journey has taught us how to deal with different stresses. And so I am very much glass half full about this because I think that there are so many amazing people out there trying to do work with kids that it that it does my heart well. And I know at Tanager Place, that’s one of things that we do. And I get to do that work every day.

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Gabe Howard: And we’re back speaking with Okpara Rice, the CEO of Tanager Place. Let’s talk about some controversy for a moment, because something that you said there is we need everything. We need psychopharmacology, which is, you know, medication and we need therapy and we need community supports. And we need we need lots of things. Like you use the cliche, which is one that I really like, is that it really does take a village. But like you said, the controversies are what hits the news. And one of the big ones that people talk about all the time is, oh, you have a hyper child or a child who’s hard to handle. Let’s medicate them and make it easier on the parents. What do you have to say about that from your viewpoint as the CEO of Tanager Place, who works with a lot of children who are in crisis?

Okpara Rice: Yeah, I think that’s a fallacy. I think that sometimes we think that a pill can solve everything. Psychopharmacology is just a part of treatment that usually is tied to therapy and other interventions. It’s just a part of the treatment process. It is not meant for every child. It is not the most appropriate thing for every child. But there are a large segment of kids where it is. We are very lucky here. We have two psychiatrists, two psychiatric nurse practitioners, a psychologist. We have a great medical team here and I see them and the work they do everyday. Parents are not coming in saying, hey, just give me some medication. My child needs to calm down. That is not what’s happening. We don’t do that type of work. We’re not operating in isolation that way. You need to really, first of all, understand the diagnosis of that child, what’s happening with them in school and at the home and their social interactions. And then you’re making a treatment plan. Psychopharmacology may be part of that treatment plan or may not or may be for a small amount of time. The thing is that we are doing the right intervention at the right time and the right dosage. That’s what the most critical thing and medical providers that help. But we do it in very interdisciplinary team environment. So you have the psychiatrist, you have the therapist, you have the caseworker all talking with the parents. This is in lockstep with the parent. I think that sometimes in society we think, oh, yeah, there’s a pill for that, that will be, that’s fine. That’s not really reality. And most medical providers are not trying to do that either. In all fairness to the psychiatrists I’ve known around the country and people I’ve talked to, people take that very seriously, because what we know is that some of these medications are very strong and there are long term studies around how they may impact children’s physical health. Years down the road. So people are very careful about what they prescribe.

Gabe Howard: It’s interesting to hear your perspective on it, Okpara, because you say things like psychopharmacology, and interdisciplinary team, and wrap around services, and that’s a very medical approach. And I think that is what’s happening in the field. I think that is the average way that a child is prescribed medication and services, etc. But it doesn’t quite have the umph of, oh, we’re just medicating annoying kids. And I think  that’s why that information kind of goes out there, because that’s kind of a fascinating conversation. Like, hey, your child is a pain. Let’s give him drugs. Like that that has that hook.

Okpara Rice: Yeah. I don’t want to give the impression that it’s only a very medical model, I should say it is a much more holistic model. I mean, because what the other pieces that we do in this part of our conversation are how we look at kids as you’re looking at all the social determinants of health that the CDC put out. So you understand housing, you understand employment, you understand all the societal factors that go into what happens in that household. What happens with those adults also then happens to that child. So I’m speaking from a professional standpoint that using the big words or whatever. But the reality is, I’m also a dad of a 13 year old and a 9 year old. And when I think about if my children are having challenges, what would I want them to have? And the fact that their dad is the CEO should not matter. We want kids who whose parents are not CEOs or whose parents are single parents. We have to be able to get the same quality of care and that same holistic view of that child. So there is no shortcut to proper treatment. And that’s what we have as a society. I think we’re starting to get there. I am hopeful we are getting there now that we see that the holisticness of the child again, medication is not a cure all. It’s gotta be part of a treatment continuum that involves therapy that may involve physical health. And there’s a lot of other pieces that go along with it. But we have to look at the child holistically. Otherwise we’re not really doing a service because children are not, they don’t operate in isolation. So if you’re not looking at all those pieces, you’re not going to be effective. And then no medication is going to be effective. We’re not trying to have kids who are zoned out, you know, walking around the city. That’s not productive. That’s not healthy.

Gabe Howard: There’s an interesting thing that you said there, where you said that the things that are happening to the adults in the household are happening to the children in the household. And I want to touch on that for a moment, because adults really have this idea that children are you know, they’re bullet proof from the ways of the world. They don’t have mortgages and jobs and children and all of these things. But I think if we all reflect back when mom and dad are stressed out about money that is felt and reverberated throughout the household and absolutely impacts the children. Now, it may impact them in a different way. And in fact, I think it’s reasonable to say that it absolutely impacts children in a different way. Can you sort of speak on that idea that, oh, you’re just a kid, don’t worry about it and how that needs to evolve because the kids are worried about it. But because you told them not to worry about it. That means you’re not a source of support.

Okpara Rice: Right. And I’ll say a couple of things. You know, one, first of all, anybody who’s been around any type of child knows children pick up on everything. First of all, there is nothing that seems to get past them, which is remarkable. But I must think of my own experience a little bit. You know, I grew up in a household. My father was a drug addict. My mom was very clinically depressed. And I know for a fact, when I look back on my wife, the effect that those two things had on me and what happened when you are wondering if you’re going to have a home the next day? We were homeless for a little bit. You know what that’s like? Or you don’t know what’s happened. What’s your next meal? Or when your mom can’t get out of bed for two days because she doesn’t have the strength to do that. You know, so I know what those things did to me made me think about throughout my life. I mean, those are extreme in that I would hope nobody has ever had to experience that. I know there are children who experience that every single day. And that’s the extreme. But there are small things, just the pressures of maintaining the household, the pressures around making sure there are gifts at Christmas time. That’s one of the things that my role and all the roles I’ve had that’s always so important to me, because guess what? As a parent, I know when it gets to Christmas time and how expensive toys are and people want to give their kids things. And that stress and that pressure of trying to make that happen. But God, do you pay this bill or do you go get this toy, right? You know, we try to make sure all our kids through our program get some Christmas gifts or families get some gifts. So that’s one less thing that they have to worry about. But all those pressures, of course, filter down to the child. They can feel that tension. And again, each child responds to that tension in a different way. But we have to acknowledge that tension is there. They’re not oblivious. As a matter of fact, they’re picking up on way more than you think. And sometimes it’s good just to have a conversation with your child, if they’re old enough to to have a dialogue, to make them feel reassured that, hey, things are OK, we’re going to be fine. Things may be tight right now, but this is what we’re doing. You know, you don’t have to talk to them like an adult, but acknowledge that the tension is there. That’s going to help them feel safer.

Gabe Howard: Let’s move on to when everything goes wrong. The worst case scenario, what people unfortunately think about more often than not when they think about mental illness and that’s crisis. You said that at Tanager Place, you have inpatient and outpatient services and that’s crisis treatment. Can you talk about that a little bit, how you take somebody from crisis to wellness?

Okpara Rice: Yeah, I mean, it’s again, it’s a journey because each child is different and so our children in our impatient program, they’re not able to be in their home for various reasons. So we have kids who come us who have severe depression. We have kids who may just come out of a psychiatric hospitalization. And so that journey for them is gonna look different, for each family is going to look a little bit different. You know, I don’t look at it necessarily as crisis. I think that they may have had this episodic situation, but it’s really about how do you help them avoid that situation? Go on into the future? How do you build their resilience so they don’t do any self harm or they don’t think about suicidal ideation or contemplate not being on the planet? How do you help young people do that? And there is no easy way. I wish it was an easy fix, but it’s not because each child responds to treatment in such different ways. And also what we learn now that, not what we’ve learned, but what we really acknowledges that, you know what, if you’re not helping the family at the same time, a child may be an inpatient care, that you’re really not doing quality treatment. And that is something that has absolutely moved across the country. And I think people are much more family engaged and family driven because we get that child may be with us for six months, eight months. They’re going to go back to that home. They’re gonna go back to their home community. So we not only build the resilience factors in that child, and we don’t do that in that family. And in that community, then they’re not going to be successful going back. And so I think that what we know, again, is moving away from that medical model, treat the child, treat the child, treat the child to now much more of a systematic, holistic view of that family unit. That’s what makes for good treatment. And it takes time. Unfortunately, we live in a managed care environment and insurance sometimes dictates certain things and each state is very different how that’s done. And so not only you have to have a really quality patient program. We’ve got to get also really quality community based support for that child to understand that there may be setbacks along the way. And that’s part of the journey, right? Nobody one day is like, oh, boy, I mean, you know, I’m having this episodic crisis. I’m perfectly fine. Doesn’t work that way. That’s not life. But we have to have things in that community where that child may not need that highest level of care, that most restrictive level of care.

Gabe Howard: How do the families respond to this? Because I imagine that given our limited knowledge of mental health that exists in society, when they knock on your door, they probably believe that the issue is entirely with the child. And then you’re saying, no, no, no, there’s things that you can do as well. Is there pushback on that?

Okpara Rice: Oh, sure. I mean, there’s some but, you know, really a lot of people when they come to our door, they just want help. They want help. The thought of a parent, any parent, losing their child is terrifying. They do. They want help. Look, OK. And I’m not saying it is all pie-in-the-sky, that everybody comes so open to that. It’s not necessarily true. Each treatment program is different and treatment programs unique. Each. Each family is unique. Some people are ready to engage in that change making process. Some people are ready to do some self reflection. Some people are not. It just really depends. And that’s where there are other programs that people can find that fit what their family may need. But for the most part, honest to God, I must admit, a lot of parents who are in crisis and who feel like it because they don’t want to lose their child. And our job is to help give them hope that we’re going to help be a part of this journey with you. And so a lot of people that’s it’s just hard. It’s humbling and scary. And so, again, you acknowledge that, you validate those feeling, but then you set a course of action. You set a plan together to help their child and to help their family again. If the family isn’t healthy part of that is our encouraging people to be healthy, then it’s not. Treatment is not going to be successful long term. And there are a lot of families who have themselves wound up in therapy, who seek additional things or who have had events in their past that have changed how they parent. So, again, if you’re open and you’re engaging with people, people come to you for help. And that’s the most profound thing. Once that door is open on this and they help us help this family, there are a lot of things you can do. We just have to come with the right spirit or philosophy around this. It’s not victim blaming. We don’t have people say, oh, it’s your fault, your child is struggling. It’s your fault your child has thought about committing suicide. That’s not what you do. You look at what are those factors that led to that child thinking about that? What are those stressors in that child’s life that has led them to think about that? What can we do? What are those supports you can build in? How can we build on supports for that parent as well, that even hearing that about your child is traumatic? So those are things that we do.

Gabe Howard: That’s the final thing that I want to touch on, Okpara, so many people believe that mental illness only exists in children that have bad parents more often than not bad mothers or come from broken homes or there’s just a lot of, like you said, victim blaming that the child would be fine if it wasn’t for their awful family. We know that that’s not true.

Okpara Rice: Oh, absolutely. Let’s just be straight. Children’s mental health challenges cover every socio economic spectrum. I don’t care. We have kids who come who are seen in our outpatient clinic and our inpatient programs, whose families are extremely wealthy, whose families are extremely poor, whose families are middle class. It covers every gambit. So we have to put that out. We have to just say that’s just a myth. And you know what? Even families that are very, very poor, they want the best care for their child, too. That’s the other myth that we have a society which is a whole different conversation too. Being poor doesn’t mean you don’t care about your kids. So everybody’s trying to get the best care they can. They just have limited resources that they can turn to to get that care. That’s where wealth gives you that opportunity. But better believe it, wealthy, poor, middle class, everybody has the same level of mental health struggles.

Gabe Howard: That is excellent. Okpara, thank you so much. What’s the Web site for Tanager Place if people want to check it out across the country?

Okpara Rice: You’ve got it, www.TanagerPlace.org.

Gabe Howard: Awesome, thank you so much for being on the show, we really appreciate your time and for enlightening us on all of these subjects. You’re just, you’re just awesome.

Okpara Rice: Thanks so much for having me. I really appreciate it.

Gabe Howard: You’re very welcome. And hey, everybody, do you want to interact with me on Facebook, suggest topics, comment on the show, and be the first to get updates? You can by joining our super secret Facebook group, which I’ve now said publicly at PsychCentral.com/FBshow. Have any topics but don’t have Facebook? There’s got to be one out there. E-mail us at [email protected], and tell us what you think. And don’t forget to review our show on whatever podcast player you found us on. Tell a friend. Thank you so much, and we will see everybody next week.

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  About The Psych Central  Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar and anxiety disorders. He is also one of the co-hosts of the popular show, A Bipolar, a Schizophrenic, and a Podcast. As a speaker, he travels nationally and is available to make your event stand out. To work with Gabe, please visit his website, gabehoward.com.

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