Dr. Zakia Alavi, Consulting Psychiatrist for MC3, was featured on the Pediatric Meltdown podcast titled “School Shootings: The Aftermath and Prevention.”

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MC3 Consulting Psychiatrist Dr. Joanna Quigley offered tips on how to talk with kids about a school shooting in a Michigan Advance article, “How should you talk with kids about a school shooting?”.

“Parents obviously don’t want to burden their kids with more fear and worry based on what they are experiencing, yet I also think it’s important for parents to name their own feelings to some degree,” Quigley said.

This article, written by Kara Gavin, originally appeared on the M Health Lab website.

Raising or educating kids in a pandemic with cases surging and the winter holidays approaching was already hard enough for Michigan parents and school staff.

And then the school shooting in Oxford, Michigan happened on Nov. 30, 2021 – the first one in the state in decades, and the first one to claim multiple young lives in the U.S. since the start of the pandemic.

Now, parents and educators find themselves having to help children and teens process the news and navigate the trauma.

That may take days or weeks, but resources from local and national organizations can help, says Joanna Quigley, M.D., a child psychiatrist at Michigan Medicine, the University of Michigan’s academic medical center.

“The biggest things that adults and our communities can do right now are to provide consistency and structure, to keep open lines of communication, and to find time each day to check in with one another,” she said. “Make it clear you’re available to answer questions about what happened, but make sure the child isn’t overexposed to the media coverage of the event, or to social media posts about it.”

Stepping away from news and posts on screens large and small is important for avoiding an effect called retraumatizing, which brings up the negative emotions that the initial shock of the event prompted.

She highly recommends giving older children and teens a resource from the National Child Trauma Network called “When Terrible Things Happen”, which can help young people recognize the effects of major traumatic events and work to reduce them or avoid making them worse.

For parents, she recommends the disaster, violence and trauma resources from the American Academy of Child and Adolescent Psychiatry, the Resources for Families site from the federal agency known as SAMHSA, as well as the resources developed for coping during COVID-19 by the U-M Department of Psychiatry.

Routines, communication

The stress of a sudden major trauma on top of the underlying stress of living through a pandemic – especially at this time in Michigan – makes it especially important for families to spend time together, focus on healthy eating, sleeping and activity habits, and keep regular schedules.

School is an important part of that, giving kids a safe and familiar environment and keeping their minds and bodies active. With teachers, school counselors and school nurses already stretched thin by the stress of educating during a pandemic, this may be especially hard, but she recommends the tips contained in this resource from the NCTN.

Even though it may be tempting, kids, teens and adults shouldn’t try to avoid thinking about or talking about what has happened or how they’re feeling.

In fact, says Quigley, “Grownups should name the emotions they’re feeling about this situation, especially with teens. Sometimes older children and teens aren’t ready to name the emotions they’re feeling or discuss them proactively, but if they hear that others are feeling them, they may.”

This may take some time, she added. “Even if say they don’t have questions or don’t want to talk right now, let them know you have an ‘open door policy’ if they do want to talk, which could be a week or two from now, or may be prompted by more information coming out about the incident. It’s important for them to know that the adults in their lives are available to them on an ongoing basis.”

If you suspect or see a problem

For both children and adults, it’s important to recognize when stress, feelings and emotions have started to interfere with normal relationships, ability to enjoy favorite activities, and regular daily tasks.

Today’s children and teens are more equipped than previous generations to talk openly about their mental health. But some may still bottle it up for fear of being labeled or stigmatized.

Teen and young adult years are peak times for the start of many mental health conditions, from depression to schizophrenia, Quigley notes.

Adults and peers who notice someone’s behavior or personality has changed should speak up and try to guide them to help.

Anyone in Michigan, including students, who is concerned about a school safety issue should contact the OK2SAY Tip Line at 1-855-565-2729, text to 652729, or email to [email protected].

Parents with concerns about their own children should start by expressing their concern to their child’s pediatrician, family physician or nurse practitioner, Quigley emphasized.

She and colleagues help these primary care providers care for the mental health needs of their young patients through the MC3 program.

For families that own guns, it’s always important to follow safe practices to keep lethal means from being readily available to anyone during stressful times. The U-M Injury Prevention Center’s resource for families is a good one to refer to, Quigley says. She emphasizes that gun violence is a public health issue, not strictly a mental health issue. 

If someone has urgent concerns that someone might hurt themselves, the National Suicide Prevention Lifeline is available at 1-800-273-8255 or through web chat on its site. Each county in Michigan also has a crisis line; they’re listed here.

MC3 Consulting Psychiatrist Dr. Joanna Quigley was quoted in a Medscape article about the recent declaration of a pediatric mental health emergency by the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association:

“It’s very powerful that these three groups came together and made a joint effort and statement to really highlight how serious this problem is across the country.”

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The following article was written by Dr. Richard Dopp, a Consulting Psychiatrist for MC3. It was published by the bphope magazine.

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Balancing the benefits and risks of taking psychotropic medications during pregnancy is a hard but necessary task.  You should always discuss treatment decisions thoroughly with your psychiatrist or other prescribing practitioner, as well as your obstetrician, to make the best personal choice.

Should I continue my bipolar meds if I’m pregnant?

First and foremost, any changes to your medication regimen must be worked through with your practitioners for the safest outcome. Raising the topic early on—preferably when still considering getting pregnant—is the best plan. And it helps to be proactive: Read up on your medications and bring any concerns to your care providers.

Recent research suggests that risks associated with continuing your pharmacotherapy during pregnancy have been overstated. Several studies over the past five years have found no significant differences in newborn health between mothers with bipolar who remain on meds and mothers without a psychiatric disorder.

Lithium, a mood stabilizer that is among the “first line” of medications prescribed to treat bipolar disorder, has a reputation for affecting fetal development. Findings from large-scale studies in the U.S. and Europe now indicate that negative outcomes are lower than previously thought.

However, treatment guidelines suggest lowering doses of lithium during the first trimester, when risk of miscarriage is generally higher and much of fetal heart development occurs.

With second-generation antipsychotic medications, also commonly used to treat bipolar disorder, recommendations call for lowering dosage in the third trimester. Nursing mothers should also consult with their prescribing practitioner about the likelihood of medication passing into breast milk.

What are the risks of not taking my meds?

Going off your prescribed medications increases the likelihood of having a depressive or manic episode. Depression and mania impose their own consequences for self-care during and after pregnancy, as well as for providing the attentive, 24/7 care required by a newborn.

An extensive review of previous studies, published in 2019, reported that 70 percent of women who discontinued treatment with lithium during their pregnancy experienced recurrence of mood episodes. Among women who continued on lithium while pregnant, that figure dropped to 23 percent.

Higher risk of depression, mania and psychosis continues after the baby is born, often complicated by hormonal changes and sleep deprivation.  Postpartum mood episodes may affect the process of mother-child bonding, which is important to long-term child development.

Dutch researchers found that nearly 60 percent of new mothers admitted to the hospital for postpartum depression reported impaired bonding. Over the course of treatment, however, decreases in both depressive and manic symptoms correlated with improved bonding.

What else should I consider?

Create a treatment team.
You should strongly encourage your obstetrician, prescribing practitioner, and psychotherapist to connect. A team approach, known as “collaborative care,” is the best way to get all your questions answered and your concerns addressed while keeping everyone on the same page regarding medications, supports, and reasonable monitoring.

Seek counsel(ing).
If you are not already in psychotherapy, give some thought to recruiting that extra support while you’re pregnant or considering pregnancy. Talk therapy gives you a dedicated opportunity to parse all the practical or emotional issues that come up along the way.

Respect your changing body.
The usual interventions and self-care strategies for bipolar management apply during pregnancy. However, you may want to adapt your activities over the months as your ligaments soften, lung volume decreases, and center of gravity shifts.

If you do yoga, for example, be aware that some poses should be modified during pregnancy. It’s a good idea to find a yoga instructor with training in prenatal yoga, or at least research this topic online.

Whether you are continuing or starting an exercise regimen—a vital contribution to both physical and emotional health—it’s wise to check in with your care providers over the months to assess personal safety levels for aerobic exercise and weight training.

If you don’t get the go-ahead for vigorous types of physical activity, walking can be an excellent substitute. If you have access to a pool, water walking or swimming at a gentle pace provides a lower-gravity alternative as your belly grows.

MC3 Pediatrics Director Dr. Sheila Marcus was quoted, along with MC3 Consulting Pediatrician Dr. Lia Gaggino, in this article from the Michigan State University School of Journalism. “‘The emergence of COVID-19 flooded emergency rooms with people afflicted with mental illnesses,’ Marcus said. Reports of suicidal thoughts increased 124%, and there was a 158% increase in depression and anxiety cases.”

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Dr. Dayna LePlatte, an MC3 Psychiatrist, was featured on WXYZ-TV Detroit | Channel 7, sharing her insights about the stress women are under during the COVID-19 pandemic.

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