Strung Out: An Interview with Erin Khar

Erin Khar is an award-winning writer known for her deeply personal essays on addiction, recovery, mental health, parenting and self-care. “Ask Erin,” her weekly Ravishly column, attracts more than 500K unique readers per month. Her work is published in SELF, Marie Claire, Redbook, and anthologies including Lilly Dancyger’s Burn It Down: Women Writing About Anger. Her first full-length memoir, Strung Out: One Last Hit and Other Lies That Nearly Killed Me (Park Row Books, February 25), will be released this month.Khar's intro to opioids came in pill form at age eight. It was the year her parents split up. In Strung Out she writes, “My Dad had moved out and my mother drifted from room to room in our old Spanish house with a weightlessness that I could tell threatened to take her away.”Khar suffered from overwhelming feelings that she didn’t understand. “A panic spread across my chest, filling my body with heat, trapping me. I ran to the bathroom and locked the door. As I reminded myself to breathe, some instinct led me to the medicine cabinet.”With anxiety pounding, the third grader fumbled past Band-Aids and Tylenol and found her grandmother’s bottle of Darvocet, which warned: “May Cause Drowsiness and Dizziness.” She wanted so badly to stop hurting, she popped a big red pill into her mouth, then gulped from the faucet to wash it down. The burning heat of anxiety soon gave way to a “lightness of little bubbles.” Erin felt like she might float out of her body; this was the escape she’d yearned for.Strung Out depicts one person’s journey against the backdrop of America’s opioid crisis. The book is written in gorgeous, accessible prose. Candor and vulnerability come through in a natural, believable voice, conveying what many trauma survivors know intimately: pain, anxiety, rage, depression.Khar tried heroin for the first time at age 13. Her boyfriend described it as a much better high. It also proved to be the quickest route to forgetting: When Khar was four, a teen boy began molesting her. The abuse continued for years. Like many survivors, Khar told no one and desperately tried to block it from her mind. “I needed to be somewhere else, someone else,” Khar told The Fix. Strung Out is a page-turner that follows the progression of addiction: Narcotics seem like a magical solution until the relief morphs into a monster roaring for more. Opioids are now responsible for 47,000 deaths per year—that’s nearly two-thirds of all drug-related deaths in the U.S. Reading Khar’s book felt like listening to a confidante, a kindred spirit who “got me.” We sat down in a New York City garden to talk about the hell of addiction and colossal relief of long-term recovery.What idea sparked this book?I wrote Strung Out because it was the book I wish I’d had when I was younger. I want to open up the conversation. Why do people take drugs? And why can’t they stop? The more we talk about it the more we can get rid of the stigma and shame surrounding it. Many people still don’t seem to understand addiction. I want to encourage empathy and compassion and give people hope.I love that your then 12-year-old son asked if you ever did drugs. Can you tell me about that?At first, I pretended I didn’t hear him. [Laughs] I tried not to cringe at my deflection.I stalled by saying, “That’s a complicated question.” I didn’t know what to say. I did use drugs. A lot of them. Heroin was on and off from 13 to 28. That’s when I got pregnant with him. But how much should I tell him? I’d smoked crack, done acid, taken Ecstasy.You describe childhood guilt and shame vividly. Looking back, do you think that was rage turned inward?Oh yeah. It definitely had to do with early trauma. All I knew then was a nagging feeling. It wasn’t until I was 19 that I came to terms with everything. Before that, I minimized what happened to me, trying to shove [memories] aside. It took a long time for me to see that my therapist was right: my anger had sublimated into guilt.Do you look back now and understand your feelings of shame?Yes. I took responsibility for things because it gave me the feeling that I was in control. Can anyone process that kind of childhood trauma all in one go? I don’t know. Maybe it takes a lifetime to process? Maybe I’m still processing it.Do you get triggered due to PTSD?Yes. Even though I’ve done a lot of work on myself, I still have hypervigilance. My body reacts strongly to some situations, like if I’m startled by something, and especially if I’m asleep.Can you describe things that helped? Especially for anyone who is trying but can’t stop using.The first thing was accepting that I wasn’t going to be fixed overnight. Then it was forgiving myself for relapsing constantly. For me, whatever I’m dealing with, if I break it down into small, digestible increments, it’s a lot easier to handle. Focusing on the big picture is not helpful. That’s why they say a day at a time.How did you stop relapsing?By being honest about relapses. When I was in a 12-step program, I had so much shame. It was detrimental to worry about being judged at meetings. [Some] people in AA seemed pissed off when you relapsed. I get that it’s upsetting but have a little fucking compassion. [So] I hid relapses, which made it a lot easier to do it again. Finally, I was honest about [chronically] relapsing and that helped me stop. You do not have to relapse. It’s not a requirement of recovery but I don’t think that we unlearn things in 30 days or 60 days or 90 days or a year. I don’t think it happens that quickly. For anyone who struggles with addiction, we want immediate relief. Like pushing a button?Yes. I wanted to be numb. Stop thinking. In recovery, my biggest life lessons were learning to have patience, be honest, and work on accepting things I have no control over.Did you find things easier when you began opening up?First, I had to get through my fear that people were always judging me. It took work. I wouldn’t say it was easy but yes, I did get better. How do you feel about your upbringing now?I definitely don’t blame my parents for any of the choices I made. Even the choices when I was really young. I hid the sexual abuse and my depression from them. I hid my suicidal feelings. If my parents had stayed together and everything had been perfect, I may still have hid things. It may be a function of my personality.Today I have a really good relationship with both of my parents and they have a really good friendship with each other. I will forever be grateful that no matter what happened, through everything I did, they never turned their backs on me. I have a very different idea about tough love than I used to. When I was first trying to get sober, the general idea of interventions and dealing with somebody who was addicted was this hard line of tough love. I used to deal with people that way. But now, I really don’t think it works. That doesn’t mean that you should enable people. But, for me, I was lucky. Despite everything I had done to my parents—years of lying and stealing—our family connection remained. That door was still open when I finally asked for help.Erin Khar talks hope, shame, and recovery: Order Strung Out: One Last Hit and Other Lies That Nearly Killed Me 

A Jail Increased Extreme Isolation to Stop Suicides. More People Killed Themselves

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.BAKERSFIELD, Calif. — Shackled at the wrists and ankles, Christine Taylor followed a red line on the basement floor directing her to the elevator at Kern County’s central jail. She heard groans and cries from among the hundred people locked above, a wail echoing through the shaft.It was minutes before daybreak on a Monday morning in May 2017 as the elevator lifted her toward the voices. Jail staff had assigned Taylor to something called “suicide watch,” a block of single cells where she’d be alone 24 hours a day. The sound of other people would soon become a luxury.What a stupid mistake, Taylor fumed.Earlier, she had argued with jail staff during her booking at the downtown jail. Have you ever attempted suicide, a deputy asked. Taylor glared back, her hands trembling. She had never been in serious trouble with law enforcement, and she considered her arrest that night a gross misunderstanding.“Do you think I’m going to try to kill myself with my shirt?” Taylor responded, flippantly. “Maybe.”Her answer got her a glimpse of how the jail handles people it perceives as suicide risks.Within minutes, deputies moved Taylor into a changing room on the third floor and had her strip naked. They handed her just two items: paper-thin clothes that come apart under pressure and a blue yoga mat.Exhausted and scared, she followed orders, walked down a hall and stepped into a bathroom-sized isolation cell. The door slammed behind her. The floors felt colder inside, and a mold smell came up from the toilet-sink fixture. A bed was mounted to the brick wall. Hazy fluorescent lights reflected off the ash-white paint. And, as Taylor soon learned, jail staff never turned them off.To shield herself, she crawled under the bed and put the yoga mat over her torso like a blanket.She pressed her eyelids shut but couldn’t block the glare or the rush of tears.“Cruel and Unusual” Punishment; No LimitsEach year, the Kern County Sheriff’s Office sends hundreds of people into this kind of suicide watch isolation. Inmates awaiting trial spend weeks and sometimes months in solitary, according to state and county records. When those cells fill up, deputies place people into “overflow” areas, rooms with nothing more than four rubberized walls and a grate in the floor for bodily fluids. They receive no mental health treatment, only a yoga mat to rest on.Kern County sheriff’s officials say they turned to isolation rooms to help prevent deaths after a spate of jail suicides that started in 2011.This wasn’t what state lawmakers envisioned when they undertook a sweeping criminal justice overhaul nearly a decade ago to alleviate what the U.S. Supreme Court deemed the “cruel and unusual” conditions for people in overcrowded state prisons. Those prisoners, the court found, would languish for months, even years, in “telephone-booth-sized cages” without treatment, resulting in “needless suffering and death.”California’s reforms, dubbed “realignment,” diverted thousands of offenders to county jails so, among other things, the corrections system could see to basic health needs and meet minimum constitutional requirements. That shift also transferred billions of dollars to local sheriffs to better run jails.Some, like Kern County Sheriff Donny Youngblood, have rejected warnings from the state to improve the outdated and often brutal forms of isolation that helped trigger the state’s prison crisis.The state can’t do much about it, a McClatchy and ProPublica investigation found. The California Board of State and Community Corrections, which is supposed to maintain minimum jail standards and inspect local facilities, has no legal authority to force local lockups to meet those standards or ensure inmates are physically safe and mentally sound.Last year, for instance, a state board inspector called out the Kern County Sheriff’s Office for 27 violations, a majority of them for using yoga mats instead of mattresses in suicide watch cells. But his letter read more like an invitation than a warning. “If you choose to address the noncompliant issues,” he wrote, “please provide your corrective plan to the BSCC for documentation in your inspection file.”The sheriff’s office disregarded the findings and bought more than 100 additional mats this year, agency records show.“It’s completely unethical, and counter to clinical evidence for what people need,” Homer Venters, the former chief medical officer of New York City jails, said of Kern County’s suicide watch. “For any human, that represents punishment and humiliation.”Isolation practices save lives, Kern County officials argue. But records show the strategy didn’t work; inmates continued to kill themselves.In one case, an inmate hanged himself in a suicide watch cell, after grabbing an extension cord that guards left within reach. Since 2011, 11 others have taken their lives in other parts of the jail. During the past four years, Kern County had the highest suicide rate of the state’s 10 largest jail systems, with 5.61 deaths per 100,000 bookings, close to twice the statewide rate, an analysis by ProPublica and McClatchy found. Overall, inmate suicides declined slightly in California county jails over that period.The state’s board has no authority to investigate deaths in local lockups. The agency answers to the Legislature, which has not held a single hearing about jail inspections or the dozens of gruesome deaths in facilities across the state in the past eight years.Texas and New Jersey, meanwhile, have boards that regularly examine such deaths.“California is flying blind without a state regulatory agency that has meaningful enforcement authority. It’s time to correct this institutional failure,” said Ross Mirkarimi, the former San Francisco sheriff who is now a jail consultant. “It is a perfect opportunity for the governor to arc from the era of realignment into a new period of reform for California jails.”Sen. Nancy Skinner, D-Berkeley, chairs the California Senate Public Safety Committee. She voted in support of realignment in 2011, when she was in the Assembly. Skinner said “there’s a lot of frustration” about how passive the state board has been in overseeing county jails.“The sheriffs do have the authority here, and they could do the right thing,” Skinner said in an interview. “We as the state definitely have to improve our oversight.”Gov. Gavin Newsom’s office, in a written statement, said Kern County’s jail practices are unacceptable, and local officials should reform their policies.“County jails should not hold people in their custody in isolation indefinitely, no matter what the situation is,” the governor’s statement reads. “This is troubling, and it is this Administration’s hope that the findings in the reports issued by the Board of State and Community Corrections will catalyze change and reforms at the local level, where authority to make those changes ultimately resides.”Many local jails across the country use variations of suicide watch to remove hazards and increase monitoring of vulnerable inmates. But Kern County uses isolation far more aggressively, and often exclusively, to prevent suicide deaths. “In my career, this is how suicide watch is done,” said Chief Deputy Tyson Davis, the jails’ top administrator. “They go into a cell by themselves with as few points to hurt themselves on as possible.”That runs counter to best practices advocated by mental health experts, who are increasingly critical of isolating and stripping people considering suicide. A growing body of research shows the practice can harm a person’s mental health and actually increase their suicide risk once they are released from watch.Youngblood, the sheriff, declined multiple interview requests, and his office declined to discuss specific cases, including Taylor’s.After McClatchy and ProPublica asked questions about Kern County’s isolation practices and its use of yoga mats, the sheriff’s office replaced the mats with blankets that are resistant to rips. And Davis said in September that he is working to add mental health specialists to inmate screening, which deputies alone have long conducted. The new clinical positions are not funded yet.Bill Walker, Kern County’s behavioral health director, is in charge of mental health care in the jails. When asked in August if isolation without clinical treatment is harmful, Walker replied, “I would be the first to agree with you.” However, he continued, Kern County’s suicide watch is better than the indifference institutions inflicted decades ago on the people they detained.“We used to bury people in the state hospitals in unmarked graves,” Walker said. “The humanity of safety is to keep them alive.”This account is based on interviews with Kern County’s top jail administrators and deputies, county behavioral health directors, former inmates and families of the deceased. The sheriff’s office took reporters on tours of its jail facilities and to see the suicide watch cells. McClatchy and ProPublica also reviewed and analyzed state inspection documents, autopsy reports, court filings, jail purchasing records and state data on in-custody deaths.An Uptick in Suicides, Then Yoga MatsIn 2011, Lorena Diaz tried to end her life by jumping off a highway bridge. She survived, and a county mental health clinic released her, apparently no more stable than before.Desperate, her mother called Diaz’s parole agent to ask for help, to find a place where her daughter would be safe. The agent alerted local police, who promptly arrested and booked Diaz into the downtown Bakersfield jail, according to sheriff’s office records. But within two days of her arrival, staff found the 29-year-old mother hanging from a bed sheet tied to a wall vent.The death was the first in a string of suicides over the next year: A 42-year-old man charged with crashing into a sheriff’s patrol car cut his wrist with a razor and bled out while his cellmates slept. A 20-year-old murder defendant who told deputies he heard voices hanged himself in an isolation cell.In response to the suicides, Youngblood and his jail staff began sending far more people to suicide watch cells, records show. The practice continues to this day.“The tripwire to get on suicide watch is fairly light,” said Lt. Ian Silva, who oversees many of the jails’ day-to-day operations. “We don’t want to take any chances.”The sheriff’s office also added a new feature to its suicide protocol. In March 2012, the agency purchased 25 blue yoga mats, finance records show, and ordered 109 more in July of that year. The mats are a half-inch of foam designed to cushion people doing floor exercises.They became the only thing Kern County’s suicidal inmates got to sleep on, besides the cement floor or metal bunk. They were also a signal that isolation was no longer a fleeting experience. People began spending longer periods of time on suicide watch.In state prisons, at-risk inmates receive mattresses. Silva said the sheriff’s office chose to give yoga mats instead to ensure inmates cannot impede deputies from entering cells. “Our big concern with full mattresses is barricading,” Silva said.Because people with suicidal thoughts often spend their time searching for methods to end their lives, jail experts say suicide watch cells should not contain anything a person can use to asphyxiate or cut themselves.Kern County deputies violated that rule in August 2013, after deputies booked Luis Campos on a stack of domestic violence charges. Campos had tried to kill himself before, so deputies put him in the watch cell closest to their desk.The aging facility’s air-conditioning system regularly faltered in the summer, internal investigation records show. So deputies rigged up a portable fan with an extension cord and duct tape to blow air at their watch station as the afternoon heat topped 90 degrees.They found Campos dead during morning rounds two days later, dangling from the cell bars, an extension cord noosed around his neck.Until last year, the sheriff’s office had only 11 specialized suicide watch cells across its three jail facilities, and they were always full. So deputies began using what are called safety cells as suicide watch overflow.Safety cells are closet-sized rooms with nothing but four walls and a grate in the floor. No bed. No water fountain or toilet. They’re temporary storage boxes for people who’ve lost control.California jail standards say safety cells should only hold inmates who are damaging the building or showing an active intent to hurt themselves or others. Medical staff members are required to evaluate each inmate within 12 hours, and a jail administrator needs to reapprove holding them in the safety cell every 24 hours thereafter.By early 2015, Kern County’s jail deputies were sending nearly three dozen people a week to suicide watch, a 29% increase from a year earlier. Some were removed from watch in hours. Others stayed for days.Still, elsewhere in the jails, the suicides continued. That January, a 31-year-old man hanged himself. He’d first tried to kill himself days earlier, a nearby inmate later told detectives. The following September, a 25-year-old man with a history of depression died the same way in a group cell after telling his parents he would kill himself if they did not bail him out.Deputies said they were unaware that either posed a suicide risk, according to autopsy records.Meanwhile, state inspectors from the corrections board made their routine tours of Kern County’s jails and reviewed their internal records every two years. By the time an inspector arrived in June 2016, 10 inmates had taken their lives in 5 1/2 years. The inspector did not mention the deaths in the reports. And in evaluating safety cells, one of the reports simply noted “documentation for the use of those cells were good.”Two more men hanged themselves in January and February 2017, as deputies sent upward of 36 inmates a week to isolation cells.Christine Taylor was soon among those on suicide watch.“When Am I Going to Get Out?”Keys banging on the door woke her that first morning.“Taylor!” the deputy making the morning rounds shouted. She crawled from underneath the cell bed, where she had been hiding from the lights, and moved toward the metal door. She looked out the smudged plexiglass window. It was like peering through a porthole on a space shuttle, she said.The person on the other side wouldn’t open the door. Kern County jail staff almost never do during these routine cell checks and brief behavioral health evaluations. So Taylor crouched on her knees and spoke to the specialist through the food-tray slot in the door. She said she was not suicidal. She was only on suicide watch, she pleaded, because she hadn’t cooperated with deputies during intake.“When am I going to get out?” Taylor asked as the staffer walked away.“Well,” she heard, “we’ll see.”Police had arrested her on suspicion of elder abuse. Her father, who suffers from Alzheimer’s disease, claimed that she attacked him during a middle-of-the-night disagreement. But Taylor, then 47, had video showing the opposite; in fact, officers had responded to similar calls at their home before, for offenses imagined or badly misunderstood. This time, deputies refused to watch the tape.Now Taylor was alone, a dozen yards from the deputy desk. She tried to sleep. It was the only thing to do — inmates on suicide watch in Kern County don’t get books to read or recreation time to interact with other inmates because even that could be too dangerous, sheriff’s officials said.So she covered her eyes from the light with her clothes and rolled up her yoga mat to use as a pillow. About four hours crawled by after she entered the jail when staff returned to the door and said they were moving her.For a moment, Taylor felt a rush of excitement. She thought about all the things this might mean: a pillow, a toothbrush, a shower, maybe even a cellmate, someone to talk to.Deputies instead led her around the corner to another suicide watch cell, next to a deputy’s desk. The furnishings were the same: bed, toilet and yoga mat. But the move shortened the distance the deputies had to walk as they signed off on the required twice-every-30-minutes checks. And she could see staff and inmates walking out of the elevators past the window. There were people around, Taylor thought, people to hear about how she’d been wronged.“Innocent until proven guilty!” she screamed, calling out to other inmates to join her protest. No one did. “I didn’t get my phone call! I didn’t get my phone call!” Taylor chanted.Her confusion had given way to resentment. There was nothing the jailers could do to her that would be worse than being in that cell, she thought, so Taylor vowed to make everybody in earshot hear her outrage. She’d become part of the collective wail that greeted her just hours earlier.Jail staff ignored her.Taylor tried another tactic: She ripped a piece of material from her paper-thin shirt and fashioned it into a small nooselike loop. She said she dangled it in the porthole window. (Jail staff wrote that she put it around her neck, sheriff’s office records show.) Deputies stormed the cell and restrained her, Taylor said, and records show staff replaced the clothes with a hunter green, tear-resistant suicide smock.The following day, around noon on Tuesday, jail records show deputies transferred her to a punishment cell, known as administrative segregation.“If They’re Committed, It’s Hard to Stop Them”Kern County’s behavioral health department doesn’t provide treatment to inmates on suicide watch, aside from dispensing medication for previously diagnosed conditions, said Walker, the department’s director. Last year, the county agency doubled its jail staff, which now employs about 40 caregivers.Counties usually have a written agreement with the behavioral health provider working in the jails. The contract — among the most foundational parts of jail-medical operations — dictates what the provider will do, as well as the consequences for failing to deliver services. But in Kern County, the jail has had no such agreement for “several years,” Walker said. That means there’s no written accountability for when things go wrong. County officials maintain a contract isn’t necessary.The behavioral health department does not reliably track how many people have attempted suicide in the cells, why people were placed in isolation or how long they stayed, he said. It also does not keep data on inmates sent to outside hospitals because of mental illness.After every death of a mentally ill inmate, behavioral health and jail staff meet to review the case and determine if there are ways to prevent similar fatalities in the future. However, officials have not examined the jails’ suicide deaths as a whole at any point since 2011, Silva and Walker confirmed.During an interview in August, the county’s top behavioral health officials demurred when asked why Kern County’s jail suicide deaths had increased dramatically.“I don’t think I have an answer I could give you at the moment,” Walker said. Deputies don’t send all suicidal inmates to behavioral health staff. Greg Gonzales, head of correctional care, said suicide prevention cannot keep all inmates safe. “If they’re committed, it’s hard to stop them,” he said.At the sheriff’s office, Silva partly attributed the increased deaths to “bad luck.”The behavioral health department provides inmates the best care it can afford, Gonzales said.Over the past two decades, researchers have examined suicides in local jails, where death rates are often higher than among the general public and in prisons. They’ve consistently opposed the use of isolation, saying it increases the likelihood that inmates will attempt to hurt themselves. A guide from the World Health Organization states, “Prisoners at risk should not be left alone, but observation and companionship should be provided.”The key to keeping people safe in local jails is paying attention, said Sheriff Tom Dart from Cook County, Illinois, whose Chicago-area jails are increasingly a model for humane practices. Dart said he eliminated isolation as punishment when his department’s data showed the practice actually led to more rule violations and security problems.“If you value something as a society, you study it,” Dart said. “You analyze it. You spend money on the data. If you don’t care about something, you don’t study it.”A 2014 statistical analysis of New York City’s jail inmates found serious mental illness and solitary confinement were the strongest factors in suicide attempts.Lindsay Hayes, a national expert on correctional suicide prevention, said jails use isolation with good intentions. “I truly believe that correctional officials and mental health and medical officials and leadership are not intentionally trying to punish people, to create tortuous types of environments,” Hayes said. “They’re just being extremely careful and, in many ways, over-protective and over-reactive.”A “Lonely Cell” and Endless DaylightTaylor felt worlds away from another human being. In the punishment cell, around the corner from suicide watch, no one walked by. She couldn’t hear voices or the clatter of activity. Distance muted everything.“It was the loneliest feeling I’ve ever had,” she said. “That feeling is what made me decide that I wanted to be good and go back to the cell behind the deputies.”The “lonely cell,” as she called it, broke her in less than a day. She apologized. She told deputies she’d learned her lesson. More importantly, Taylor said, “I was just being quiet.”Deputies moved her back to the suicide watch cell by the desk that Wednesday morning, two days after being booked into the facility, according to jail records.She tried to measure the hour by watching how much sunlight streamed onto the jail hallway floor. Peering through the window, she learned to tell time by making mental notes about when one deputy’s shift ended and another person’s began.She marked the hours with scraps of food and shreds of a paper plate, but it was all guesswork. The constant light triggered sleep deprivation and confusion. Taylor had lost track of just how long she’d been in Kern County’s jail.Bedbugs, Yoga Mats and a ShrugIn California, this kind of isolation is entirely permissible.To bolster oversight of county jails and distribute funds in the realignment era, state lawmakers created the corrections board. Every two years, it sends an inspector to each facility to make sure sheriffs and their officers are following the rules.Steven Wicklander, an inspector for the state board, arrived at the Kern County jails in June 2018, a year after Taylor’s arrest. The central receiving jail was in the midst of a bedbug infestation. The sheriff’s staff was not regularly cleaning cell mattresses, Wicklander wrote in his notes. They handed out dirty beds and only washed them when the mattresses were “contaminated.”Conditions weren’t much better in the newest jail, opened last year and built with $100 million in state funds to cope with an influx of inmates serving longer sentences in county facilities under realignment. Its expansive infirmary is primarily for suicide prevention, and its 14 isolation cells were constantly full.Over three days, Wicklander toured the suicide watch halls at each jail facility. He saw maxed-out cells and deputies putting suicide watch inmates in safety cells for more than a week straight.“The safety cell cannot be used as a substitution for treatment,” Wicklander wrote in his final report in August 2018.There were violations at every stop. Kern County jails are so understaffed the sheriff’s office requires deputies to work overtime to cover the shifts, causing deputies to fall behind on safety and security checks. Suicide watch and safety cell practices, particularly the yoga mats, were against the rules.Agency officials do not have authority to make county leaders change and generally see themselves as partners, not regulators, said Allison Ganter, deputy director overseeing the inspection team.“We are not enforcement,” she said.Youngblood and his staff waited eight months to respond to Wicklander’s report.They wrote back this April and rejected the board’s findings that yoga mats violated the standards. The sheriff’s office spent $4,500 to buy 60 more mats the same month, finance records show.Yoga mats, they wrote, provide people on suicide watch “the comfort of padding, albeit minimal, in an environment which is uncomfortable by design.”A New Caregiver, and a Long Walk HomeAs the week went on, Taylor tried to talk to anyone who walked by her cell. Once, a woman sat near her window, and they chatted briefly about being arrested and their legal cases. “She was telling me her story, which was almost like my story,” Taylor recalled.She tried to get the staff talking. Taylor said she noticed a picture of a puppy on a deputy’s monitor and complimented the pet’s cuteness. The deputy scolded her and turned the screen away.“The most exciting part of the day was when they would give me my food because there was actually somebody there,” Taylor said.Saturday marked her sixth day in the jail. That morning, a different behavioral health specialist met with Taylor and decided that her suicide risk — however deputies calculated it initially — was gone. She moved to a space with the rest of the inmates in the jail’s general population ward, where she was thrilled to receive a toothbrush, soap, clothes and a mattress.Deputies also gave her access to a phone for the first time since she’d been put on suicide watch early Monday morning. Taylor called her mom, who helped arrange for her to post the $35,000 bond. (Two weeks later, prosecutors dropped the charges. Taylor sued the county for wrongful detention, but the suit was dismissed.)The sheriff’s office said it is not permitted to discuss her case under state law and would not answer reporters’ questions about her time in jail.It can take hours to be formally released from custody, and oftentimes inmates are released in the middle of the night without reliable transportation. Late Sunday, the doors of the downtown Bakersfield jail swung open for Taylor. A 4-mile walk in the dark awaited her.She had been in sweats when police arrested her and didn’t have a bra to wear for the trek home. Taylor asked if she could borrow one of the jail-issued ones.“It’s bad luck to take anything home from here,” a deputy replied.“Good advice,” she said. If you or someone you know needs help, here are a few resources:Call the National Suicide Prevention Lifeline: 1-800-273-8255Text the Crisis Text Line from anywhere in the U.S. to reach a crisis counselor: 741741This originally appeared at ProPublica 

5 Habits that Will Help You Stay Sober Through Hard Times

Anyone who is clean and sober will undoubtedly experience periods or moments in which the desire to drink or use comes back. This is to be expected. Experiences such as using dreams, emotional highs/lows, and emotional landmines set off by life experiences are par for the course. Someone who is newly sober may experience these things so often they wonder if life will ever normalize. Rest assured, the ups and downs of life become less intense the longer you stay sober, but life still happens! Generally speaking, as someone begins accruing more sober time they are able to get through the struggles more gracefully. The path we travel is turbulent at first, but it does smooth out.So how does someone who is living a sober life prevent themselves from being derailed when these inevitable difficult life situations occur? Every person is different, and what works for one may not for another, but there are some general things a recovering person can do that are considered effective for sustained sobriety. Let’s list four practices out.Reaching out to someone you trust who understands what you’re going through.Redirecting your attention to something/someone else.Reframe the way you look at a situationRecognize what you can do to better the situation or take care of yourself. 1. Reaching OutThis is hands down the most important step someone with an addiction issue can take! Most of the time it is also the most difficult. It may be less difficult for someone who has been sober for a long time then it is for someone who is newly sober, but that doesn’t mean it’s easy. Reaching out for help to get perspective on a life situation invites a more objective party into the situation. Connecting with another human being who has dealt with a similar issue is invaluable!2. Redirecting AttentionThis is an action that may well be the crux of maintaining sobriety. Step out of your world and into someone else’s. Do so with no conditions! Just listen to someone else and what kind of help they might need. Do so with the sole intention of seeing how you can be helpful. Sometimes this may be helping someone else who has issues with addiction, but this can be practiced in every aspect of life from family and work to our social lives!ea3. Reframing PerspectiveMany people with addiction issues have a tendency to catastrophize things. Defaulting to spinning life situations in a negative light is common. A helpful practice is to reframe the way we look at things. Shedding a positive light on something can work wonders for the energy we bring into a situation that is difficult/depressing/overwhelming. This doesn’t mean we just think happy thoughts, or wear a smile all the time! Changing perspective is hard! It may be as simple as looking at challenges or setbacks as temporary situations that are opportunities to grow stronger. 4. Recognizing What You Can DoIn any situation there are things we can and can’t control. Those of us with addiction issues frequently swing from extremes of thinking we need to control everything to believing we can change nothing. This is something that most of us struggle with to some degree. There is a balance between these two extremes that is not easy to find, and frequently we must go back to Reaching Out for some assistance in determining what is in our power and what is not. If we have not done our part to change something we should take that action. If we already have, and are not satisfied, then we should probably just let it go. Letting go of the things we can’t change is not easy, and if this is especially difficult then Reaching Out one more time could be useful. The Bottom LineBy no means does getting sober mean we are exempt from the ups and downs of life. Everyone is still subject to experiencing the struggles, hardships, successes, celebrations and moments of malaise that come with being a human being. The gift of sobriety is that WE GET TO EXPERIENCE THESE THINGS, and we grow from them in ways we couldn’t when actively using! Sobriety allows us the opportunity to start over, and to have a new experience with life. When we list the problems have now and compare them to the problems we had before getting sober we see that they are quality problems. Certainly there are exceptions, but most of the day to day struggles/triggers we experience pale in comparison to the ones we dealt with in active addiction. Utilizing all four of these practices can help us to get through the inevitable struggles that come with living a sober life. It should also be noted that you cannot touch one without touching the others! Someone who puts them into practice will find that they rely on one another. They are tools that can be especially helpful for those of us with addiction issues, but they can be useful for anyone struggling with a life situation. The most important thing to remember is that regardless of what you are going through, you can get through it sober!To learn more, visit Ardú Recovery Center’s website. Reach the facility by phone at (801) 823-6832 or by email. Find Ardú Recovery Center on Facebook and Instagram

Resolution: Getting and Staying Sober in 2020

For many of us, the end of a year or the beginning of a new one signifies renewal and change. The tradition of making resolutions for the year to come is common to many of us. For the person struggling with addiction or problematic substance use, it could be a resolution to stop engaging in the behavior that is having a negative impact on their life.Changing a behavior is hard! Resolving to get more exercise or finding time for an old hobby is difficult enough. How on earth is someone who is addicted to a substance or behavior expected to make a lasting change? Where do they even begin?Letting go of an addictive behavior is definitely possible, and the beginning of a new year is as good a time as any to make this change! If you are still on the fence, it may be helpful to take a really objective, practical look at the pros and cons of stopping an addiction. For someone who has not struggled with addiction, it may be obvious that it’s worth stopping, but an addicted person’s thinking can be distorted when it comes to the substance or behavior that is causing them problems. Sometimes, writing out the ways a behavior is damaging and why it should stop is helpful for someone who is unsure of whether they are ready to make a lifestyle change. One of the best things someone who wants to change an out of control behavior can do is reach out for help. This initial action is one of the most important steps in directing someone with an addiction toward lasting positive change. Making the DecisionThere are a multitude of ways in which people achieve sobriety. Choosing a residential facility, withdrawal management/detox centre, sober living, or a support group can feel overwhelming. This is one of the benefits of reaching out to someone for help. Having support during the process of making these decisions early on can make it a smoother, less stressful experience.Withdrawal ManagementOnce you’ve made the decision to stop using alcohol or other substances, you should determine whether or not withdrawal management (e.g. medical detox) is necessary. For those addicted to alcohol, opiates/opioids, benzodiazepines, or barbiturates this is usually a good idea. Getting through the physical detox period of these substances is difficult and can be fatal depending on the duration and quantity of the drug being used. An assessment should be made by a medical professional if one of these substances is being used.Residential TreatmentOnce detoxed, many find that entering a residential treatment center is the best idea. A residential treatment center can offer guidance and structure that may be crucial for someone who has recently stopped engaging in their addiction. Underlying mental health issues can be addressed, and reestablishing positive habits, behaviors, and routines can make a big difference in achieving lasting sobriety. This is also the period that many people begin exploring options for maintaining sobriety. There are multiple options available. The 12-Steps are the most well known program for maintaining a recovery-oriented lifestyle, but they are not a good fit for everyone. SMART Recovery is a newer recovery program that has been very effective in helping people achieve long-term recovery. With its roots in Cognitive Behavioral Therapy, SMART meetings are held internationally. They offer a program that deals with addictions of all types, from gambling and food to drugs and alcohol. Many find the logical, non-faith based approach that SMART takes to be one of it’s biggest attractions. These may be the two most popular support organizations for those with addiction right now, but that doesn’t mean that they are essentials to a recovery lifestyle. There are a variety of ways that people maintain recovery. The most important thing to remember when checking out these options is to just keep an open mind. If there is something that seems useful or makes sense, hold on to that piece. You can discard what is not applicable or useful. Deciding to seek help at a residential treatment center is another exercise in reaching out. It means you have a treatment team ready to provide support as you begin your new life. It also means you will have other people who have chosen a sober life to interact with. The relationships people build with one another while in treatment offer another type of support that frequently extends beyond residential care.Meaning and Purpose - What NowOnce unintoxicated, many people find they are missing a sense of meaning and purpose. So many feel like they are coming out of a fog and are without direction or hope. Even those who managed to retain a strong sense of self, duty, or obligation may find themselves questioning these things once they are no longer actively using. This is a unique and personal experience for everyone. While these feelings and thoughts can be unsettling, they should be explored, not avoided. This is a key part of establishing a solid footing on the new road you are walking; deciding which direction you are headed!Regardless of what direction you choose to go on your sober journey, it is important to keep an open mind. It’s a journey of exploration and discovery! Learn more at www.sunshinecoasthealthcentre.ca or reach Sunshine Coast Health Center at (866) 487-9010 or by email at info@schc.ca

The 5 Most Common Myths About Faith-Based Addiction Treatment Programs

Whenever the topic of faith comes up, there are almost always variations of opinions and strong viewpoints.Let’s look at dispelling five of the most common myths about faith-based addiction treatment programs.Myth #1: Patients Are Not Interested in Faith ProgrammingDr. David Rosmarin is a psychology professor at Harvard and the Director of Mental Health and Spirituality at McLean hospital, ranked number one in psychiatric hospitals for adults in the county by Healio Psychiatry. Dr. Rosmarin was a guest on my Faith in Recovery radio show in June 2018. What’s interesting is that of the top ten psychiatric hospitals throughout the country, McLean hospital is the only one that has a spirituality program. McLean conducted a study on the significance of spirituality as it relates to mental illness.In a study on the significance of spirituality as it relates to mental illness, 58.2% of patients coming into McLean’s psychiatric unit requested to have spirituality/faith programming as part of their treatment. According to an article McLean published on April 25, 2013, “Our work suggests that people with a moderate to high level of belief in a higher power do significantly better in short-term psychiatric treatment. The study concludes belief in God is associated with improved outcomes in psychiatric treatment.” This brings us to the obvious question! Why is McLean hospital the only one of the major psychiatric hospitals who offers faith programming? I believe it has much to do with the increased politically correct environment. People are afraid to offend anyone, in particular regarding the topics of religion and mental illness. People may feel as if they are walking around on egg shells, which results in overlooking programs that are proven to be effective. Let’s not put political correctness over the many people afflicted with mental illness or substance use dependency who are in desperate need of help.Myth #2: Faith Programs Are Judgmental and Condemning As a Chaplain in our Faith in Recovery program, the three things I hear the most are: “Why does God allow suffering?” “How do I know what God’s will is for my life?” And the last one is a statement: “I stopped going to church because I was forced to go when I was young and all I felt when going was guilt, shame and judgement, so I stopped going.”According to the 2017 Lifeway research survey, “66% of Americans between 23 to 30 years old stopped attending church on a regular basis after turning 18.” It’s a sad commentary on the Church, especially since it’s supposed to be a place of healing and acceptance. I experienced the same thing growing up and as soon as I was old enough to stop going, I did just that.Not all churches have a judgmental environment. There are some incredible churches out there, but the damage has been done and it’s difficult to turn the perception around. What is disturbing is the fact that the teachings of Christ and all that He did were the exact opposite of guilt, shame and judgement. Apparently somewhere during the past two thousand years some churches didn’t get the memo.A faith-based program in a treatment setting at its core must be non-judgmental. The majority of our patients are coming in with tremendous guilt and shame. The last thing they need is to have more of that directed their way. In fact, one of our groups is called “Overcoming Guilt & Shame.” When coming into treatment for substance use dependency or mental health disorders, patients need to be treated with respect, and they need to know that God loves them. He wants to forgive them and has a plan for their lives. It must be emphasized that they have value and a purpose and most importantly God values them. When people truly begin to realize these things, the light begins to open their eyes and the seeds of hope emerge. It’s an incredible sight to witness and I am blessed to have a front row seat on a daily basis.Myth #3: I Won’t Fit In, I’m Not Very ReligiousI think this is similar to any topic that we do not feel we are well-versed in or do not know much about. In general, we tend to shy away from the things we are unfamiliar with or which we associate with a bad experience. Not fitting in is simply not the case. We meet every client right where they are at on their spiritual journey, even if they have no spiritual journey at all. We have patients who grew up in the Church and fell away, those who never stepped foot in a church, devout atheists, agnostics, Jewish, Muslim, Buddhist, and those coming out of the occult. All are welcome and treated the same. Often times in 12-step treatment, the default setting is “I already heard this.” This contrasts with the faith programming most patients have never heard. This is all new information to them, which gives us a fighting chance to keep their attention. More importantly, our patients begin to face their fears. They realize they are much stronger than they think they are. Myth #4: They Will Force Me to ConvertOne of the things we hear in our faith program is: “I liked it because beliefs were not forced on me.” As one of our former patients, Richard, said in his testimonial video, “One of my biggest things is there’s a connection with God, but I don’t want Him shoved down my throat all day long… it’s so far from that, but it’s so connected it’s amazing.” I believe the reason so many feel this way relates back to what we discussed earlier: They were forced into attending church. We all know when forced into something--especially in our adolescence--we tend to rebel against it.The reality is God gave us the gift of free will. He never forces us to do anything, so why should we force Faith on someone? All we can do is plant the seeds and water them. God is the one who transforms people’s hearts. We do not have the capacity to change someone’s heart. Myth #5: We Will Not Be Allowed to Share Our ViewsThis point actually came from a group in our Faith in Recovery program after I asked for their feedback on myths about faith programming. A few patients stated that one of the concerns they had prior to coming into the program was that they would be talked down to and their opinions would not be heard. After experiencing the group, the consensus was that it was the opposite of this concern; that they were actually encouraged to share their thoughts and perspectives on their faith and to always ask questions. When patients feel that they are not being heard, they tend to shut down completely. This is the exact opposite of what we are trying to have them accomplish in treatment. Transparency and being completely open is an essential part of getting better. Most patients have been suppressing things for far too long so the last thing we want them to do is shut down.It’s not surprising that people have this preconceived notion of faith programming as they may be associating it with the years of sitting in the pews being preached to with little opportunity to ask questions. We focus on who our patients are becoming, not on who they were in active addiction. What I witness on a daily basis is patients encouraging one another, praying for each other and providing a listening ear to someone who is struggling.If those who are in treatment are given the opportunity to speak, you will be surprised at the profound and insightful things they have to say.

Treating the Growing Trauma of Family Separation

Q&A with Developmental Psychologist Hirokazu YoshikawaThe US immigration policy that has separated more than 5,400 children from their parents had spurred psychologists and pediatricians to warn that the young people face risks ranging from psychological distress and academic problems to long-lasting emotional damage. But this represents just a tiny part of a growing global crisis of parent-child separation.Throughout the world, wars, natural disasters, institutionalization, child-trafficking, and historic rates of domestic and international migration are splitting up millions of families. For the children involved, the harm of separation is well-documented.Hirokazu Yoshikawa, a developmental psychologist at New York University who codirects NYU’s Global TIES for Children, recently looked into research on the impacts of parent-child separation and the efficacy of programs meant to help heal the damage. Writing in the debut issue of the Annual Review of Developmental Psychology, he and colleagues Anne Bentley Waddoups and Kendra Strouf call for an increase in mental health training for teachers, medical doctors or other frontline service providers who can help fill the gap left by the lack of mental health providers available to cope with the many millions of children affected.Knowable Magazine recently spoke with Yoshikawa about the crisis and what can be done about it. This conversation has been edited for length and clarity.Are there any good estimates of the number of children throughout the world who’ve been separated from their parents? Exact numbers are hard to pin down, especially because several of the categories involved — like child soldiers and child-trafficking — aren’t well reported. What we know for sure is that the number of people around the world being displaced from their homes is at a historically high level. In 2018, some 70.8 million individuals were forcibly displaced due to armed conflicts, wars and disasters. That’s a record, and given that these phenomena often result in family separations and that more than half of these individuals were children under the age of 18, it suggests that historic numbers of children have been separated from their parents.Why have such family separations become more common? Many factors are driving it, but climate change is playing an increasing role in displacement and armed conflict all over the world. Climate change reduces access to dwindling resources and contributes to natural disasters, like floods, droughts, crop failures and famine. All of this increases conflicts, drives migration and breaks up families. This is not a blip in history; it’s a trend we will have to live with for generations to come.What’s most important to know about the damage that comes from children being separated from their parents?There are thousands of studies on the power of disruptions of children’s early attachments to their parents to cause longstanding problems. We’re talking about cognitive, social-emotional and other mental health impacts.The developmental study of the mechanisms that may explain why these separations are so harmful goes back to before World War II, with the work of psychoanalysts and scholars such as Anna Freud, John Bowlby and Mary Ainsworth. In 1943, Anna Freud and Dorothy Burlingame studied children who’d been evacuated from London and learned that in many cases being separated from their mothers was more traumatic for them than having been exposed to air raids. When families left London but stayed together, the children behaved more or less normally. But when children were separated from their mothers, they showed signs of severe trauma, such as wetting the bed and crying for long periods of time.Later on, Bowlby and Ainsworth published their more well-known studies of how infants form attachments with their mothers, and how sensitive and responsive parenting is key to forming secure attachments both with parents and later on with others. Researchers have found that this process can be disrupted in prolonged separations — say of more than a week — before the age of 5.More recently — for example, in the ongoing and high-profile studies of Romanian children who were raised in abysmally low-quality orphanages — researchers have shown how children in institutional care have suffered from poorer learning and social and emotional behavior due to the lack of intellectual and emotional stimulation and the opportunity to engage in relationships with caregivers.How seriously children are affected can depend on factors such as whether the separation was voluntary or not, how long it lasts and what kind of care exists in its wake. Permanent loss of parents can create some of the most severe consequences, while long periods of parent-child separation, even if followed by reunification, can seriously disrupt a child’s emotional health. Children are generally more vulnerable to long-term harm to their social-emotional development in early childhood, up to five or six years, but no period of development is immune.One major problem we see is that most children who are separated from their parents have already experienced some other trauma along the way, which then makes the separation even harder. When parents are present, they can often help buffer the impact of extreme adversity from bad experiences.What did you learn that most surprised you as you reviewed the scientific literature?The sheer range of outcomes was surprising to me — beyond learning and achievement and mental health outcomes, they include very basic human functions like impaired memory, auditory processing and planning. They also include a range of physiological outcomes related to stress that are themselves related to long-term disease and mortality. So parent-child separation as it is currently experienced can shorten lives and increase the chances of physical disease.Meanwhile, something that didn’t surprise me because I’m immersed in this literature all the time, but will probably surprise your readers, is that there are now about 8 million children in the world living in institutional care. This is a problem that reflects the lack of robust foster care and capacity of governments to facilitate placement with relatives, who will generally give more stable care than strangers. As we state in our review, even in otherwise good-quality institutional care, children suffer due to the high turnover of caregivers.  What relevance does your work have for US policies that have led to many parents and children being separated at the border? US officials should know that there’s a global consensus, expressed in the UN Convention on the Rights of Children, on how to respond to children’s needs in this context. Primarily that means avoiding separating children from parents whenever possible and, when it must happen, keeping it as short as possible. An overwhelming amount of research, going back to Bowlby, supports these guidelines.Unfortunately, we don’t have a lot of research findings on children separated from their parents while awaiting detention. And it doesn’t make it any easier that the Department of Homeland Security has had so much trouble keeping track of the kids involved.Yet there are hints of the kind of negative effects you might expect to see if you look at the research on children whose parents have been detained without warning, for example in large workplace raids to arrest undocumented workers. In these cases, researchers have found that children have missed school and suffered behavior problems and depressive symptoms.This brings up the fact that, in the United States, we’re talking about many more than 5,000 children being separated from parents. While the separations at the Mexican border have gotten a lot of media attention, millions of other children across our country are affected by the relatively recent harsher, sweeping policies resulting in more detentions and deportations of immigrants already living in the US. This has created a climate in which the threat of family separation is omnipresent.We’re particularly concerned that many children separated from their parents stop going to school, perhaps from lack of supervision or from the need to support themselves or family members. The humanitarian sector tends to focus on basic needs and that’s understandable — they want to save lives. But from a developmental perspective, we have to focus on whether children thrive, not just survive.Unaccompanied children who are trying to migrate are an increasing part of this global problem. What kind of special risks do they face? It’s true that there has been a significant increase in recent years in unaccompanied minors trying to migrate internationally. At the US border, this increase has been happening since the 1990s, due to both economic crises and increases in urban violence in Mexico and in Central American countries. But the trend is now accelerating. From 2015 to 2016, there were five times as many children estimated to be migrating alone than from 2010 to 2011. In 2017, more than 90 percent of undocumented children arriving in Italy were unaccompanied.Compared with refugee children who flee with their families, unaccompanied children are at greater risk for trauma and mental illness. One study of refugee children attending a clinic in the Netherlands found that the unaccompanied children were significantly more likely than those traveling with their families to have been victim to four or more traumatic events in their lives, including during their travels. They also had a higher rate of depressive symptoms and even of psychosis than refugee children living with their families.What are some of the best ways that governments and nonprofit organizations can help these children? Whatever can be done to avoid the separation from parents in the first place and to avoid detention and institutionalization of children whenever possible is in the children’s best interests. (That’s the guidance from the Global Compact for Refugees, Article 9 of the Convention on the Rights of the Child, and other global rights documents.) After that, it’s a matter of limiting the time away from parents or other caring adults as much as possible. The earlier and younger that children leave institutional care for stable foster care or adoption, the better it is for them.You can see this in some of the follow-ups of the study of children in Romanian orphanages. Children who left the orphanages for foster care by 15 months of age had trouble speaking and understanding in early childhood, but not later. Children placed before 30 months showed growth in learning and memory so as to be indistinguishable from other children by age 16. So recovery from early institutionalization is possible, but it may take longer if a child spent more time in the orphanage.What kinds of programs for children, if any, can help lessen the impacts of being separated from their parents?In general, programs that help equip children for their daily lives can be useful. That includes education in decision-making, problem-solving, communication and stress management.Teachers and doctors can play a major role, at minimum by identifying children who need mental health services and directing them to programs. The fact is we’ll never have enough mental health providers, so it makes sense to train members of the education and basic health systems that are already in place.In the review, we describe a few of these efforts. One that stood out for us took place in two schools in London where children on average aged 12 to 13 had been separated from one or both parents due to war or migration. They came from Kosovo, Sierra Leone, Turkey, Afghanistan and Somalia. Teachers identified children who needed services, and who then spent one hour a week for six weeks with a clinical psychology trainee doing cognitive behavioral therapy. The treatment helped reduce PTSD symptoms, and the children’s teachers later reported that the children were behaving better in the classroom.Granted, this was a very small study with no longer-term follow-up, so you can’t draw very strong conclusions, but it hints that even such a short-term intervention can be helpful in addressing children’s traumas. Studies have shown that even as few as 12 sessions of counseling from people trained in cognitive behavioral principles can help many people.Do we have any idea of how many kids are being helped by these sorts of interventions? Are we still mostly talking about small experiments?We’re not anywhere close to meeting the need for services. Unfortunately, health systems worldwide continue to overlook all kinds of mental health needs, particularly in low-income countries, even as depression and other mental illnesses take an economic toll, leading to reduced lifespans and reduced economic activity. The economic costs of mental health problems are huge, yet this may be one of the most underinvested areas in terms of health care.The largest program you describe is in China, which isn’t that surprising, given how many internal immigrants China has. Yes, there are potentially tens of millions of Chinese children and youth whose parents travel to cities to work and leave them behind, in the care of grandparents or other relatives. Between one-third and 40 percent of children in rural areas of China are in this situation. And there’s a lot of research documenting that these children are doing less well than children who are being raised by parents.We describe one community-based program involving 213 rural villages with nearly 1,200 left-behind children. For three years, each village designated a space for after-school activities for the youth and hired a full-time employee to provide welfare services. The findings suggest the approach helped reduce disparities between the left-behind and non-left-behind groups.What if anything gives you hope that this situation may improve?The outcry over the US policies has increased awareness about a very vulnerable population of children. That could be a silver lining of the crisis. These parent-child separations are going on not only at the border, but also all over the country. The hope is that the attention will increase support for organizations, such as the national Protecting Immigrant Families Coalition, that are working to make a difference.When it comes to children throughout the world who’ve been separated from their parents, we need a lot more people to be aware and concerned so as to provide the attention, stimulation and care that can help them recover.Editor's note: This article was updated on January 24, 2020, to clarify that in addition to teachers and medical doctors, Dr. Yoshikawa and his colleagues also recommend mental health training for all frontline service providers. 10.1146/knowable-012320-1 Katherine Ellison is a journalist, author and mother with a keen interest in issues related to parenting. Her latest book is Mothers & Murderers: A True Story of Love, Lies, Obsession … and Second Chances.This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

These Homes for Mentally Ill Adults Have Been Notoriously Mismanaged. Now, One Is a Gruesome Crime Scene

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.On the afternoon of Dec. 3, workers at the Oceanview Manor Home for Adults found resident Ann McGrory, 58, lying on the floor, lifeless, with her pants down around her ankles. She had cuts and bruises on her hands, head and face. By her side, seated atop his bed in Room 512, was resident Frank Thompson, 64, her sometimes-boyfriend who had a reputation at the home as a heavy drinker with a short temper. The aides called police. Thompson was brought into custody for questioning later that day and placed under arrest on Wednesday.He is charged with second-degree attempted murder rather than murder because the medical examiner has not yet determined the cause of death to be a homicide, according to a law enforcement source. McGrory also had serious preexisting medical issues, including brain cancer. The criminal complaint, however, lays out evidence that McGrory was severely beaten. She was found with a bruised, swollen eye, blood on the back of her head, broken fingernails and what appeared to be blood beneath them. Thompson has not yet entered a plea. Brooklyn Defender Services, which is representing him, declined to comment because the case is in such an early phase.The incident is the latest in a decades-long string of controversy at Oceanview Manor and other adult homes throughout New York City, which are occupied primarily by impoverished adults with mental illness but are gradually taking on seniors in need of assisted living.In the spring of 2017, a ProPublica reporter spent parts of several weeks at Oceanview, where ill and unkempt residents could be seen eating from garbage cans and using outdoor dumpsters as toilets. They complained among themselves of thievery and predation, as well as failed intervention from state regulators. There were two deaths in a matter of weeks and police responded to several emergency calls there, including one related to a resident who had slashed another. At the time, an attorney for the home denied any stabbing, attributed the deaths to natural causes and said that comparing the current state of the homes to their scandalous history was unfair.In 2002, a New York Times investigation found that adult home residents had been exploited for profit and received subpar health care. Disability rights advocates sued the state, arguing that mentally ill people had been warehoused in Oceanview and other adult homes in New York City, violating their rights under the Americans with Disabilities Act. After more than a decade of litigation, a federal judge ordered the state to assess and move out residents capable of living independently.In 2017, lawyers representing the adult home industry sued the state on behalf of a single former resident at Oceanview, who allegedly decided to move into his own apartment under the new state program and then changed his mind, wishing to move back into Oceanview because he missed life there. Rather than allow the man alone to move back, the state agreed to temporarily suspend a rule limiting the number of mentally ill adults who can live in the homes. The state has reinstated that rule.In spite of its problems, the home, like at least a dozen others, is moving into a state-sanctioned business model to care for the elderly and infirm. ProPublica reported this year that hundreds of mentally ill residents have been certified as assisted living recipients, which allows home operators to bill more for their care.According to the complaint against Thompson, video surveillance footage at the home shows him and McGrory entering his room together at 2:35 p.m. At 2:50 p.m., McGrory opened and then closed the door to his room, but no one else entered the room. At 3:48 p.m., workers entered the room and later told police that they saw Thompson trying to remove McGrory’s pants. It is unclear whether McGrory was asking for help when she opened the door or what prompted the workers to ultimately enter the room.McGrory was pronounced dead by Emergency Medical Services at 4:57 p.m.“We are shocked and saddened by these horrifying allegations and are investigating,” said Jonah Bruno, a spokesman for the New York Department of Health, which oversees the home. He would not say whether the home’s administration had properly reported the incident, which would be part of the department’s investigation.Asked what McGrory’s fate says about the home’s ability to care for people with such extensive medical and psychiatric needs, Bruno said, “Adult homes are capable of providing varying levels of care based on levels of need and are required under state law and regulation to only accept residents for whom they can provide appropriate care.”Lisa Vider, the home’s administrator, did not return a phone call for comment on this story. But Jeffrey Sherrin, an attorney who represents Oceanview, said, “The incident is under investigation, and so far as we know, no cause of death has been determined. We are unable to comment, and we must also respect resident privacy.”Fellow residents say both Thompson and McGrory had recently struggled at the facility.Patricia Rosetti, 68, said she had shared a room with McGrory in the group home since 2014. “She was so lonely all the time,” Rosetti said. “She was divorced and had a son and it drove her nuts that she couldn’t see her family.” ProPublica made efforts to reach her next of kin but was unsuccessful.Rosetti said McGrory had been repeatedly hospitalized for a variety of psychiatric and physical issues. Over the summer, Rosetti said McGrory had gone to the ocean wearing nothing but her underwear and came back scratched and bruised by the rocks. She spent the next couple of months in a mental hospital and was scheduled for an operation on her brain in January.Rosetti said that McGrory had struck up a kind of relationship with Thompson, which worried the roommate because of his drinking. “I told her not to hang around with him,” she said.Thompson’s roommate, Rufus Lane, 74, and his friend Johnny Lide, 69, sat across from Rosetti on a bench in a smoking section outside the home. They nodded as a fellow resident described Thompson’s temper but then came to his defense. “He would talk shit to me all the time,” Lide said, “but I never paid him no mind.”Lane and Lide said that Thompson liked to drink but was not a violent person. They were surprised that he had been accused of hurting McGrory.“That girl was his heart and soul,” Lide said. “I can’t see him doing no shit like that. That shocked the shit out of me.”After about 30 minutes last Wednesday, workers at the adult home asked a reporter to leave the premises, saying it was private property.“Nothing happened here last night,” one said.Filed under:Criminal JusticeHealth CareThis story was originally published by ProPublica.