Dr. Jeff Rowe, Supervising Psychiatrist, San Diego County Mental Health Services
San Diego County Mental Health Services -Children Services
CAVANAUGH: This is KPBS Midday Edition. I'm Maureen Cavanaugh. It's Tuesday, January 17th. Our top story on Midday Edition, the head sideline almost inconceivable. The San Diego County sheriff's department is holding a 10-year-old El Cajon boy. Deputies say the boy stabbed his 12 year-old friend to death in the driveway of the victim's home. My guest is doctor Jeff Rowe, he's supervising psychiatrist with San Diego County mental health services. Doctor Rowe, welcome to the program.
ROWE: Thank you. Maureen.
CAVANAUGH: First of all, here's what we know about the incident from the sheriff's department. The paramedics were called to a home in unincorporated El Cajon yesterday afternoon. Of the 12 year-old stabbing victim died at the hospital. The 10-year-old suspect was taken into custody. The names of both boys have not been released. Now, most of the rest comes from news reports and neighbors who are saying the 10-year-old was had-known to have anger issues. My question for you, doctor Rowe, is can you tell the difference between simple anger issues and a child who has a real problem?
ROWE: Well, sorry to disappoint, but it'll be kind of a complicated answer.
ROWE: Anger issues usually are a sign of something else. Simple anger usually is a cover for fear or hurt. Other anger mostly has to do with other kind of mental health problems. If there's ongoing, frequent anger, it could be a sign of a mood disorder or some other kind of behavioral disorder.
CAVANAUGH: Neighbors reportedly say they all knew this suspect was a volatile kid, but he would yell and scream and not act out. Is it usual if a child has violent outbursts for those outbursts to escalate?
ROWE: Well, it's not usual. So much is dependent know the situation and what is provoking the situation, what is sustaining it, what's decreasing it. Of and so in this situation, we don't know exactly what happened. And in other situations where children go from yelling and shouting to more violent behavior, you always need to know the particular details of what happened at that time.
CAVANAUGH: Now, it's hard for people, especially parents to believe that a young child is even capable of stabbing or seriously injuring someone. Have you ever seen that in your practice?
ROWE: Yes, I am the supervising psychiatrist for kids in juvenile hall, and over the past ten years, I've had the chance to deal with, unfortunately, several kids who've done these kind of things. The
CAVANAUGH: When you encounter a child who has had an outburst like that and wound up in juvenile hall, are there some patterns of circumstance? Or is it widely different? Does it usually happen from child abuse or are there many different causes?
ROWE: There's many different causes. And it's actually hard to figure out who will do the violent behavior, and who's at risk to do the violent behavior. Many of the kids in our county, we have 750,000 kids here, a lot of kids underidge here. And right now, there are probably 12,000 kid who is have anger issues or could be volatile. But it turns out they don't. Very infrequently does this happen, and it's very hard to predict.
CAVANAUGH: What kind of mental health conditions might lead to a violent outburst by a child that injures someone?
ROWE: There's. One would be post traumatic stress disorder. You mentioned before,ing a victim of abuse could set someone up for that kind of risk. Also having difficulty with your mood. Bipolar disorder, or a similar kind of condition could set someone at risk. Being depressed could, having ADHD with impulses could as well. There are a variety of disorders. My experience is, it's never just one disorder for the person who ultimately does this. It's a combination of difficulties in situations.
CAVANAUGH: When should a parent get help? 'Ll for their child?
ROWE: Well, Chargers help should be sought if someone is worried about injuries. If you feel like you're about to be injured or the child is about to be injured, don't mess around. That's 911. And we have a lot of good experienced physicians to deal with these situations. We have emergency screen think unit, which is down in Chula Vista, which is where we take most of our kids who are emergency kind of situations. So 911 is the best thing to do. If you're having not quite a dangerous situation but an annoying or difficult or problematic situation, we recommend that people call the axis and crisis line. Do you want the number for that right now?
CAVANAUGH: Sure, do you have it?
ROWE: Well, I've memorized it.
ROWE: It's 1-800-, four seven nine, three three three nine. And we have trained professionals on the line. And two one one will do it too. We have professionals on the line ready to help people particular out what they need and how to get it.
CAVANAUGH: I think speaking with doctor Jeff Rowe, supervising psychiatrist with San Diego County health issues. Suppose you make an emergency phone call to 911, because your child is violent in some way. What happens to the child?
ROWE: Well, the police will come. 911 is for police. They'll come and they'll assess the situation and determine how serious is it today. Is there something that has to happen today in and they have the rights and the responsibility to then take that child for an evaluation. In our county, that would be to the emergency screening unit. Once there, trained professionals would evaluate the situation and determine, does this person need to stay here for the next 23 hours and 59 minutes? Or do they need to go to the hospital? And we have a hospital unit that's available for us all the time F. They don't, they could have the person go up and do follow-up the next day or the day after. If the child already has a mental health provider, then the next day, ESU can contact that provider as well.
CAVANAUGH: How about if indeed injure child is expressing violent words? It's all verbal, acting out in a verbal sort of a way and you don't dial 911 but you feel the child is out of control and you use one of those auxiliary numbers. What then happens to the child? Is there any kind of wait time for a child to be seen by a mental health professional?
ROWE: Well, there can be. Of what will hatch is the person on the line with the axis and crisis will line will give you some referrals, most likely in your neighborhood. Also depending upon your funding worry mental health. If you have private insurance, we recommend you use that. But if you have Medi-Cal or you're not funded, a referral will be made to a local clinic. And many of those clinics have walk-in hours. And each clinic that day may have a bit of a backup, but it's fairly certain that you should be able to get in within seven-days. If not, I would suggest a call back to the axis and crisis line. You're not stuck with your regional clinic. You can go to any of the outpatient clinics in our county.
CAVANAUGH: Do they sometimes work with the child's school?
ROWE: Well, I may not get it all right. But we have 42 school districts. So there's I variety of ways the school districts handle things. Some of the districts have ded skated mental health R health staff that are providing treatment in the schools and doing prevention kind of work and treatment kind of work. The school system itself has district counselors. There used to be more before budget cuts. But now district counselors may have to cover a couple different schools. But they're still available. Of and the backup for all of that is the emergency screening unit. There's another set of providers. County mental health is funded. Mental health specialists on campuses at over 200 campuses in your county. So there's a couple different ways people can get service.
CAVANAUGH: There are a whole lot of people in our county who do not have private insurance but do not qualify for Medi-Cal. These are the people in the middle who are not insured and might be very concerned about starting a program like that for their child who perhaps needs mental health services because they can't afford it.
ROWE: Yes, and there's a couple different options for that. Each of our outpatient clinics have the ability to do something called umdapping. I forget what all the letters stand for. But they'll do an interview in which they find out what your financial situation is. They'll assign a number of dollars that you need to pay for that year, and that gets you in. And you can get whatever service the county decides you need. Without people insurance can be seen for a reasonable amount of money. Some of our contract clinics have sliding fee scales, some of the Catholic charities and others have funding fee scales as well. So there's a variety of ways to get services in our county if you don't have insurance.
CAVANAUGH: Now, it seems to me, doctor Rowe, that there are -- you feel that there's very little reason why kids can't get help. But are there reasons that they don't get help?
ROWE: Yeah, there's a couple. And this is always the conundrum for us child psychiatry and mental health people. One of the factors is that there's stigma involved still. We don't like it, but there's stigma involved with getting mental health services. Sometimes people don't want to let their neighbors know they need help. It's embarrassing to them. Another problem can be false or iniat information. Someone may think, hey, my kid needs help, and another person might say, don't get help, they'll just mess you up further. I actually have been following some of the comments on your -- the KPBS website, and I can't believe how, I'll just say it, how ignorant some of the responses are about children's mental health. It's a vital service and can provide a lot of good for people. I wish people would just keep pushing and trying to get access to it.
CAVANAUGH: Well, I think part of that problem probably is that it's hard to understand how a child as young as ten or 11 or eight can actually be treated within the mental health services. What kind of services can you provide a child that young?
ROWE: Maureen, you'd be surprised at who our youngest patient is. I think we had a patient who was at 18 months. You need to do specialized care. And we have locations of early childhood mental health special care. One is kids' start, it's for kids who've got medical, mental health issues. Also healthy developmental services is a first five funded service throughout all the regions in the county in which any child under the age of five can get health service. So we have the services for the really young kids there. One thing that people might not know is our ability to regulate our moods and our arousal and our fear and our aggression develops in the first six years of life. And if kids don't have proper care taking and nurturance, and guidance in the first six years of life, they could end up kind of off the charts. Now, people can get that too with proper nurturance. They could be born with parts that aren't connected correctly. There's a couple ways to have trouble with a temper and aggression. But the earliest sign of it can be fixed. We're just not used to do thatting.
CAVANAUGH: There were reports that the 10-year-old suspect who was just put on a new medication, and we have heard stories in the past about kids on medication and we're not really comfortable with knowing all the side effects involved and some of those side effects in rare instances can be anger. Do we know anything more about how effective medications are, psychiatric medications are for kids?
ROWE: Well, there's another complicated subject for you. We can't talk about this young man, but in January psychotropic medication, used to manage people's behavior, moods, thought patterns, have not been very well studied in young children, and have been kind of studied in teenagers but more in the way of most adults. And at first, you might think well, that's terrible. We shouldn't be using medications in kids this young out the retch. The problem is, who would volunteer their unmentally ill child for this project? I wouldn't. It's hard to do research to get that kind of information. The clinical experience have 8 of importance about how to use the different treatments. Almost no one would prescribe medicines before other treatments are tried. So the treatments are tried, individual therapy, family therapy, group therapy, speech and language assistance, learning disability therapies, and if those aren't successful, or if the safety concerns are too high, then you start thinking about medicines.
CAVANAUGH: Now, doctor Rowe, we don't even know where this child will be held, what charges if any he will face. Is there a mental health counseling or evaluation in this round for this suspect 10-year-old?
ROWE: Well, we don't know where he's going to be. But we will say that they have a full mental health staff available. If he were to end up in a juvenile hall, there would be mental health staff there. Therapists, psychiatrists, nurse, medical staff, school staff, very closely cared well, very well-followed. The same is true if you were to end up in another place. Mental health teams, medical team, school teams. Each of our institutions for both dependency which is children who have been neglected or done body thing, which is the delinquency system, have full team available, 24 hours a day.
CAVANAUGH: You've worked with children who have issues of violence. What's the prognosis for kids like this?
ROWE: Oh, it's very good. The prognosis is very good. I've seen children who were completely psychotic at a time, and others who just were really, really mad and didn't have good impulse of impulse control. But the treatments available are very effective, guidance and support that can be provided is very effective. So getting them into treatment is really great. It can be very effective.
CAVANAUGH: This whole incident, and the tragic loss of this 12 year-old child in this stabbing death, can this tragedy in any way serve as a warning sign for other parents who might be concerned about the outbursts of their children?
ROWE: Well, this is a very sad and tragic situation, no doubt. And all of us will have to examine ourselves. How are we doing things? How friendly and inviting are we to people to come get help? Does the family have access to this help? Those are things we want to make sure we privately find out about. But I think there's a bit of a misunderstanding that you have to wait until things are really bad before you get help, and I wish people wouldn't do that. I wish they would come in earlier, it's easier to treat when you get it in earlier stages. And I hope that the stigma goes down, and the availability of resources is better promoted so people know they can get help, and it's not a bad thing.
CAVANAUGH: Well, you've given us a lot of information, and a lot of that will be on our website at KPBS.org, if you want to check out these links and that phone number. I've been speaking with doctor Jeff Rowe, supervising psychiatrist with San Diego County mental health services. Doctor Rowe, thanks a lot.
ROWE: Thank you, Maureen.