I wouldn’t say never.

If family therapy hasn’t helped the child settle down, if the psychotherapy for him or her hasn’t turned things around, if vigorous exercise hasn’t lifted the depression – then I might say go ahead and try an antipsychotic drug for the child.

But when you consider that over 300,000 kids in this country are on some kind of psychotropic medication, I suspect things have run amok.

I’m not alone.  Indeed, there’s a group of public health officials from 16 states who’ve formed a group looking at the problem.  They’ve named this effort, “Too Many, Too Much, Too Young.”

These officials are on to something.  For one thing, their worry is legitimate given results of the new study comparing the use of drugs for poor kids and those given to kids whose families have private insurance.

Here’s this storyl.  Researchers from Rutgers and Columbia found that poor kids are four times more likely to get the drugs than other kids.

What accounts for the disparity?   The researchers speculate that it comes down to money.   Private insurance reimburses more dollars for therapy and does Medicaid. That’s the health insurance most poor children are on.

There’s probably more to it than that.

Primary care doctors do most of the prescribing of psychotropic drugs.   Poor families are less likely to seek out therapists or psychiatrist than other families. And middle-class families likely are more apt to seek counseling or other services from mental health professionals.

For my part, I have several objections to drugging any kids with anti-psychotics willy-nilly.

The drugs have powerful side effects.  They  can cause weight gain.  Lots of it.  They can cause agitation – or lethargy.   If they help at all – often they don’t – many must be taken for a year or more to avoid relapse.   Recent evidence shows the drugs raise the risk of suicide in young people.

In addition,  the drugs often serve as a substitute for therapy and other activities than offer a more permanent answer.

Finally, when you hand a child or teen-ager a drug, you also hand them a diagnosis.   For many kids, that diagnosis becomes a label, even a lifelong label.   That person then naturally internalizes the label.  It’s his or her identity, a handicap than can limit one’s ambitions, talents and dreams.

“Depressed,” “bipolar,” “schizophrenic” becomes “I’m disabled,” “I’m not up to it,” “I won’t try,” “I can’t.”

That’s my quarrel with automatically  treating behavior and mood problems in kids with antipsychotics.

Mental Illness and Your Town is a map showing the way, potentially, to mental illness help and healing.  The author, Larry Hayes, has a professional background encompassing extensive work as an editorial page editor (of the Fort Wayne Journal Gazette).  Hayes is also an ardent advocate for the mentally ill.  And a cascade of ideas, associated possibly with mental health improvement, pours forth copiously from the lay reader friendly writing pen of Hayes.  Effectual ways, at the community level, to help and heal mentally ill persons are especially of interest to Hayes.  The impassioned advocacy efforts of Hayes may, indeed, kindle flames of community interest to actively engage  mental health issues.  The bluntly edifying writing of Hayes may contribute also to erasing any lingering societal stigma enshrouding mental illness.

As an advocate for the mentally ill, Hayes is thoughtful with regard to his criticisms, and practical oriented regarding his many suggestions for change.  Currents of thoughtful criticisms and practical suggestions flow dually and powerfully through the pages of the text.

The ideas put forth by Hayes are not supported by a bedrock of referenced research data.  The lack of referencing, linking particular ideas of Hayes (for mental illness help and healing) to specific research materials, may be displeasing to readers seeking academic style writing discipline.

In another vein, the book, substantively, is suffused with anecdotal information.  Some of these anecdotal data pertain specifically to Hayes, and to his family.  More generalized discourse is also mixed into the textual composition.

For some, the anecdotal nature of the book’s substance may be animating in a pleasing way.  For others, however, insistent on academic rigor, the suffusing of the book’s substance with anecdotal matter may be cause for critical concern.

The overarching substantive emphasis of the book is on the elucidation, by Hayes, of an expansive gamut of ways for communities to help and heal mentally ill persons.

The following are some of the textually described mechanisms which, in the view of Hayes, may be conducive to mental health betterment in communities:  the forming of local suicide prevention councils; suicide “hotlines”; community “clearinghouses” (established to assist mentally ill persons); the preparation of community directories, identifying comprehensively available mental health services; the creating of “self test” brochures (for example, for depression); news mediums (as a way to inform the public about mental health issues); the “clubhouse” model, for mental health rehabilitation; the “Memphis” model, for police response to a mental health crisis; and ombudspeople, for the mentally ill.

A “Recommended Reading” structural section, following the text, provides citations for some mental health associated research materials, together with pithily annotated comment.

There is a further structural appendage (“Internet Resources”) which gives an alphabetized listing of mental health associated websites, accompanied by brief annotation.

Critical readers may opine that Hayes presents his sundry ideas, for mental health improvement, by means of discourse which, in style, is quite informal; and, in substance, is generalized in nature and superficial in academic depth.

Some may question also the real life practicality of particular suggestions advanced by Hayes.  Ear to the financial ground readers may question, for instance, whether, in real life, there are sources of money sufficient to fund ideas, of Hayes, dependent on adequate funding.

But plainly, Hayes does a very good job, overall, of traversing the challenging path (towards mental health betterment) in doggedly determined pursuit of ways for communities to help and heal mentally ill persons.

The contents of this very fine book should be quite appealing to lay readers.  The considerable efforts of Hayes, to achieve mental help improvement, may, additionally, greatly pique the professional interest of a vast range of groups, including:  advocates for the mentally ill, psychologists, psychiatrists, social workers, psychiatric nurses, psychotherapists, behavioral therapists, mental health rehabilitation specialists, family medicine doctors, emergency room doctors, pediatricians, local government officials, mayors, city council members, county council members, police officers, judges, juvenile justice professionals, school teachers, school superintendents, public health professionals, sociologists, clergy members, legislators, and health policy makers.

He just writes a syndicated newspaper column.  But this doc raises a critical issue when it comes to treating a mental health problem.

Peter Gott, M.D., isn’t a psychiatrist.  But in a recent column, a reader had been advised by his family doctor to take an antidepressant.  The reader worried about serious side effects.

Yes, Dr. Gott said, these medications, while generally safe,  have side effects, some unpleasant.    But before taking an antidepressant, the he advised the reader to consult a psychiatrist.  Why?  Because that specialist has lots more experience dealing with the side effects of these medications.

Maybe that’s not always the case.  After all, family doctors do regularly prescribe psychotropic medications.   Lots of them.  And people with depression, for example, more likely seek out the family doctor for help first.  So the family doctors aren’t lacking in experience.

There are two problems, though.   One is they don’t have the extensive training in a field that’s highly complex.  More important, they’re often so rushed, they don’t spend enough time with the patient to fully understand a patient’s mental health problems.

Research shows that family doctors miss a diagnosis of mental illness in about half the cases.  And when they get it right, they prescribe the wrong medication.  But the answer isn’t for the family doctor to routinely ship every person who seems depressed off to a psychiatrist.

A better approach comes from the University of Michigan’s Depression Center.  For the past year, the center has been overseeing a pilot program for family doctors in Flint, Michigan.   The program takes as a given the rush the typical general practitioner is to see each patient.  So this pilot program has assigned a nurse specialist to advise the family doctor and follow the patient’s treatment throughout its course.

If there’s a shortcoming to this program in Flint, it’s that so many people still fail to discuss mental health problems with the family doctor.  And they sure don’t want talk to a psychiatrist.   This powerful stigma means lots of people suffer when they could be helped.

But Dr. Gott’s open discussion of mental health is the sort of thing that can overcome the stigma.   Truly, there is help.

We never got around to telling Obama what we thought.

But that’s the way it often goes in our Unitarian church forum.

We’ve got lots of opinions.  But no easy answers.   Indeed, when I asked whether the country had some other option than invading Afghanistan,  Jim, whose son had served two tours in Afghanistan,  said we should start earlier.  He was thinking of how our country had supported repressive regimes in the Mideast.

Well, yes, I allowed as how that history helps explain the hostility some Muslims feel toward our country.   But back to the issue, should we have invaded Afghanistan in the first place.

My thought was to encourage my class to engage in some moral reasoning.  After all, I had bill the series “Living the moral life.”

Once I brought up morality, Steve pounced and declared that morality had nothing to do with President Obama’s decision to send 30,000 more troops to Afghanistan.

Nothing?    Yes, Steve insisted, it’s all politics.

Several others agreed with Steve.   Don, who tries to follow Norse ethics, reminded us that our country had been attacked so we had every right to retaliate.  An eye for an eye.

So for nearly two hours,  my lively little class debated the pros and cons of injecting morality into a discussion on military strategy.

Meantime, I got the distinct impression several folk hadn’t listened to the president’s speech Tuesday.   In fact, one newscast on PBS went from city to city to get reaction and found only one or two people who had heard the speech.

Are we that disconnected from the two wars the country is still waging?

Some critics have complained that President Obama isn’t asking any sacrifices of Americans.   To be sure, he’s proposed no new taxes, while promising that the increase in troops won’t raise the deficit.

Other critics wonder aloud whether we need to reinstate the draft.  The idea is to spread the burden, spread the pain of these wars.    Hmm.  Bring that up in Congress and see how far it gets you.

But if my class at church ducked the immediate question of this troop surge for Afghanistan, I’ve noted that the columnists and editorial writers don’t seem to have much of an answer, either.

In The Washington Post, one noted, correctly, that the Islamic terrorists don’t need Afghanistan or Pakistan as a base.  They can set up shop in Somalia or someplace else.  Even the United States.    But right now, Bin Laden and his followers remain in that mountainous border between those two countries.

Another writer listed half dozen false assumptions in the president’s decision.

I can’t argue with either criticism.   But frankly, I’ve yet to read or hear any plausible alternative to beefing of allied forces and stick it out.

If President Obama announced a withdrawal now rather than a surge, he would be turning Afghanistan back over to the Taliban.   Not only would the Republicans assail such a decision.   It would betray the Afghans who have been our allies.  They didn’t ask us to invade their country.  We could have construed 9/11 as a major crime and not a war.   That’s how the country dealt with the Oklahoma City bombing.

Imagine that U.S. and allied troops had met more resistance than expected on D-Day, retreated to their boats off the Normandy coast and sailed back to England.  We would have left the French to mercies of the Nazis.

So back to my moral question.  And in my mind, it is a moral question.  What’s the right thing to do here?   I don’t think it’s to abandon the Afghan people to the mercies of the Taliban.

Will the surge allow the president to begin withdrawing U.S. troops by July, 2011?

Well, of course, nobody can say.   If you read the accounts in the New York Times and Washington Post of the debates within the administration, you can see that the president and his top civilian and military officials examined every possible option. In the end, it was unanimous.  Give the surge a fighting chance.

We’re there.  And we’re not leaving any time soon.

The red-colored flier was there this morning when I opened the door to get the paper off the porch.

“Hello, neighbors,” the flier announced.

We were instructed to collect canned goods and anything else we’d care to donate to poor families.  We’re to set out these food stuffs on the porch Dec. 5.

It’s the 25th annual Christmas Food Box, which serves 1,000 families in our town each year we’re told in the cheery message.   St. Mary’s soup kitchen, the Bishop Luers High School Key Club and St. Johns Elementary School sponsor this seasonal food drive.  And catching the spirit, I noticed that by mid-day my wife had already filled a shopping bag with canned goods.   It’s amazing what middle class people can live without.

I don’t recall any church or civic group dropping off canned goods at my house when I was a kid.   I imagine that because my parents belonged to bridge clubs, the Elks and the country club in our northwestern Ohio town people wouldn’t have guessed that my family couldn’t always pay the grocery bill.

I knew it , though.  I knew it because I answered the door when the butcher  announced to me, age 10, that he was taken possession of our 1937 Chevy because Dad hadn’t paid his bill.

It was humiliating.  But my folks didn’t offer to tell their side of the story.  People have their pride you know.   I was left to suffer the shame alone.

For me today, it’s hard to imagine what it’s like not to have enough money to put food on the table for the family.   Yes, there are food stamps.  Yes, Congress recently increased the food stamp allowance.  That’s now up to an average of $133 a month.  Yet for many households, that only gets you through three weeks of the month.  If that.   Then the family turns to food banks – providing one is available in your community.

It’s the story of a very tattered safety net.

The other day, the Department of Agriculture put out some grim figures.  It seems that within the last year or so, the number of households in which children face “very low food security” has jumped from 323,000 to 506,000.   (In the 1960s, we called it hunger; now it’s food insecurity, a way to pretty up human suffering.)

Well, those figures reflect what’s happened with food stamps.  Within two years, we’ve had a 40 percent increase.   That translates into 36 million Americans relying on this bare bones program for their daily bread.

Most of us won’t be surprised that these numbers, in turn, follow the recent increases in unemployment, now over 10 percent throughout the country.

But the families most likely to be in this fix for the long haul, even when jobs are plentiful,  are those headed by single moms.

President Obama wants to end hunger in America by 2015.  That’s his promise. So let’s all write him a letter or send him an e-mail to tell him to be sure and do that.

Meantime, put your canned goods on the porch.  And send a fat check to your local food bank.