This is the second episode featuring child psychiatrist, Dr. William Dikel. Dr. Dikel pulls back the curtain on the often overlooked role that education systems play in addressing the mental health needs of children and youth. Dr. Dikel helps unravel the complexities facing schools that are caught between scarce resources and the pressing need to collaborate with external agencies. We challenge the myth that mental health is solely a special education concern, urging parents and communities to come forward and support the broader network that our children and youth need. With compelling stories, we highlight how outdated methods linger in our systems and why a leap towards comprehensive mental health assessments is crucial for change.
We delve into the unique challenges that teachers and educators face, especially those dealing with Emotional and Behavioral Disorders (EBD). The staggering turnover of special ed EBD teachers speaks volumes about the pressures they endure and underscores the necessity for a cooperative effort involving multiple agencies. Dr. Dikel stresses the importance of a clear understanding of mental health and disorders for delivering effective support and simplifying the complex landscape they present.
We share a moment of musical connection through African drum rhythms and the poignant performance of "Mi Voz" by Serenade, underscoring the power of artistic expression.
This is the second episode featuring child psychiatrist, Dr. William Dikel. Dr. Dikel pulls back the curtain on the often overlooked role that education systems play in addressing the mental health needs of children and youth. Dr. Dikel helps unravel the complexities facing schools that are caught between scarce resources and the pressing need to collaborate with external agencies. We challenge the myth that mental health is solely a special education concern, urging parents and communities to come forward and support the broader network that our children and youth need. With compelling stories, we highlight how outdated methods linger in our systems and why a leap towards comprehensive mental health assessments is crucial for change.
We delve into the unique challenges that teachers and educators face, especially those dealing with Emotional and Behavioral Disorders (EBD). The staggering turnover of special ed EBD teachers speaks volumes about the pressures they endure and underscores the necessity for a cooperative effort involving multiple agencies. Dr. Dikel stresses the importance of a clear understanding of mental health and disorders for delivering effective support and simplifying the complex landscape they present.
We share a moment of musical connection through African drum rhythms and the poignant performance of "Mi Voz" by Serenade, underscoring the power of artistic expression.
Welcome to Stories in Life. You're on the radio with Mark and Joe. We share stories that affirm your belief in the goodwill, courage, determination, commitment and vision of everyday people.
Mark Wolak:
Our goal is that through another person's story you may find connection. No matter your place in life. The stories we select will be inspiring and maybe help you laugh, cry, think or change your mind about something important in your life.
Joe Boyle:
Join us for this episode of Stories in Life.
Dr. William Dikel:
You can't expect the schools to do all this. The schools can play a role in partnership with corrections, social services etc. Medical mental health. Then, you've got most of the kids who have serious mental health problems are not even in special ed. But if I go to a superintendent anywhere in the country and I'll say, do you want to do some mental health stuff? Who should I talk to? They'll always say the special ed director and the problem with that is the person who's before Special education, is a pre-referral issue might be the one to talk to, not the special ed one. But what I found is very interesting is that individuals who are in the system who are trying to address mental health issues some of them feel like they're under a gag order because you're just not supposed to talk address mental health issues. Some of them feel like they're under a gag order because you're just not supposed to talk about mental health in schools because you might have to pay for it.
Mark Wolak:
I'm listening to our conversation today. It makes me believe that those parents really need to have connections in the community outside of the school to help with that children's mental health issue.
Dr. William Dikel:
If you look at the big picture, you'll find that most people with mental health disorders get no treatment whatsoever. The ones that do get treatment the vast majority of them, never see a mental health professional. They're going to the family doctor, the pediatrician or whomever medication. They're not getting therapy. And the people who are getting therapy from mental health professionals are a very small percentage of the people who need treatment. So the dilemma is if you don't see somebody who knows what they're doing, you can end up on all kinds of medication misadventures and kids who are put on medication when they don't, when medication is not indicated. But it's a quick way to do something but it might not work. It might make you worse. People need to learn how to expect good, qualified, comprehensive mental health assessments. You can't just go into a mental health person and talk for 10 minutes and have a complete diagnosis. You have to look at the nature of the mental health system. And the nature of the mental health system. It's always underfunded. It's always not addressing the issues appropriately. When I was president of the Minnesota Psychiatric Society, we did an analysis of how much doctors were being paid for treating depression and what we found was that the clinics and the funders put the mental health system in a different box than the medical system. What that means is that a psychiatrist with much more training in mental health than a family doctor was actually being paid 40% less than the medical doctors for treating depression. I'll say it again the psychiatrist was getting 40% less than the family doctor for treating depression. Go figure that one out.
Dr. William Dikel:
Or I found another issue. I was asking people why is it that if this kid is schizophrenic in the hospital, you diagnose him as attention deficit, high productivity disorder something that's much milder than schizophrenia. And what I was told was Department of Human Services decided that we'll pay more for child psychiatry. So what are we going to do? We'll find the disorders in the DSM that are usually started in childhood, and then we'll pay more for it. Well, adhd usually started in childhood, and then we'll pay more for it.
Dr. William Dikel:
Well, ADHD usually starts in childhood, and schizophrenia usually doesn't start in childhood. So because of some arbitrary rule that some bureaucrat came up with, it created a completely "bass-ackward" kind of situation where it made no sense. But if you look around, you'll find that this happens in most systems. I can tell you my three things that have led me to be a consultant and know how the system works. If you'd like to hear Sure, okay, it's typewriters, basketball and hunting Typewriters. Uh, have uh letters on them. And do you know how the letters got to be on a typewriter? Uh, yes.
Mark Wolak:
Actually I learned this from you.
Dr. William Dikel:
Yes, Uh, it was to slow down the typist. Right People think that the typewriter Q, w, e, r-t-y, the way they came up with it, was because it must be better, more frequently used letters, etc. But the truth is it's the exact opposite. When you first had the typewriters, if you type too quickly it would jam up. So they came up with the worst possible arrangement and we're stuck with it. But we don't even know that we're stuck with it. If you look at like I have a Macintosh laptop, it's got a Dvorak keyboard that's what it's called. Mr Dvorak figured out how to make the right setting for the right letters and it's 30% faster right Than the QWERTY keyboard. But who's going to use the Dvorak keyboard once they learn the QWERTY keyboard? So the QWERTY syndrome is when you're in a system and you don't even realize how dysfunctional it is and you don't even realize that at one point it really was useful but now it's not useful. Welcome to the world of social services, education, etc. The second example is basketball. Basketball was invented on the east coast for college students who wanted to get exercise in the winter and they tried to figure out how to do it so that nobody would get hurt. And the coach nailed a peach basket at 10 feet high. And that's how basketball was born. Well, for the first year, nobody actually cut a hole in the bottom of the basket, so you had to climb up a ladder to get the, to get the ball out of your basket. Okay, um, how many of us are working with creating better ladders rather than cutting the hole in the bottom of the basket? And it's interesting because the second year they had a situation where they switched to a net but you had to climb up a ladder or pull a thing because the net didn't have a hole in the bottom. It makes you stop and think.
Dr. William Dikel:
The third example is hunter. So I was looking in the Farmer's Almanac and in the last page it said ask the Farmer's Almanac. So somebody wrote it and said can deer see those bright orange colors that hunters are wearing? If so, is there a better color? And the answer was yeah, deer can see the orange. The best color for hunters because it's not a visible spectrum for deer is bright, shocking pink. Now you go try to sell bright, shocking pink hunter's outfits and see what happens. So consultants can come up with all kinds of ways to solve problems, but people are not culturally ready.
Joe Boyle:
So Will, are you saying that 5% of our population needs mental health services?
Dr. William Dikel:
It depends what kind of mental health thing you're talking about, but the 5% is identified as not just having some mental health issues, but really it's affecting them to the point that mental health problems are very problematic and affecting them at school, at home, etc. And one of the other things is people can make it worse, just like people can make it better. Other things is people can make it worse, just like people can make it better. And I think one of the issues for educators is how do you teach this population of kids who have very serious mental health issues? I personally would not last more than a day or two as a special ed EBD teacher, because I am aware that EBD muscle behavioral disorder special ed teachers spend more time training to become a special ed EBD teacher than they spend actually being one, because the turnover is about three and a half years. It's an incredibly complex and difficult field and I think, if you know anybody who's been in it for a while, they really are saints because they can really do what most people can Most teachers can't and work with kids who have very serious issues, and the families too. Families often have a lot of issues that they need to work on and I think, mark, you hit the nail on the head. You can't expect the schools to do all this. The schools can play a role in partnership with corrections, social services, et cetera, medical mental health, but the schools shouldn't be expected to do the be all and end all. I've taught for a long time and I do see good examples of good stuff happening, and some people are really trying to do good work, which is great to see.
Dr. William Dikel:
The question is how much of that has to do with school responsibilities. So let's say you co-locate some services in a district and a kid who's not in special ed is feeling suicidal. Should they be seen by the co-located mental health clinician from the clinic that sends people into the school to see kids with mental health problems in school if the kid does not have any academic difficulties? We see straight A students commit suicide when nobody would have identified them as having special ed needs. So then you're asking some very tough questions, which is number one do you have to wait until a kid is eligible for special ed before you get the mental health services? Number two what would be the liability of having a clinic in your school and have it be open to anybody, not just special ed kids, and then how would you deal with that? You don't have enough people to provide services. So what you have is you've got the co-located clinicians in the school. Their caseload fills up, it's completely full. By, oh, let's say, by February they can't get any more referrals in and they keep seeing the kids who they have on their caseload. There's no supervision necessarily regarding when it's enough enough and you can create all kinds of problems if you don't have appropriate boundaries. So it is very complicated.
Dr. William Dikel:
But that's why I wrote the book and the different articles that I wrote, so that if somebody who's seriously interested in this and save themselves a lot of time and effort by looking at what actually works and trying to do that, what do I mean by that? Well, if you look, for example, at the Minnetonka report that I did, or in the book, and you say, okay, you've got a co-located service and you have a therapist here on Wednesday and you also have the school social worker, you have a psychologist, et cetera, what happens if a kid in that condition says they want to kill themselves? Who assesses them? Do you try to find the therapist who's co-located in the school and ask them to do it? What if it's not a Wednesday and they're not there. Would it be the school social worker? Would it be the police liaison? Would it be the school counselor? Would it be the school psychologist? Would it be whoever happens to be free at the moment? What kind of protocol are you using for suicide threats in this school and are you using for suicide threats in this school and are using the same protocol in this school?
Dr. William Dikel:
When I consulted in the state of Hawaii, that was about 20 years ago, the state said we think that the education system should get mental health funding because that's where the kids are with mental health problems. But then, when they got the funding, they switched things from the mental health perspective to the behavioral perspective. And the problem is, if you're on the island of Kauai or Oahu or whatever, or Oahu or whatever, and somebody's talking suicide and the response is that's the behavioral planning we have to do Somewhere else on the islands, the issue is that it's more of a mental health issue. You've got yourself a real problem liability-wise, and so if you talk to people about mental health issues, I think it's very helpful to back up and just say what do we mean by mental health? And I think that the real problem. One of the real problems is it's too broadly defined. People say, well, we don't want to just talk about negative stuff for mental health, because mental health is so important and it's really a thing that we have to encourage. That's all true. But unless you really can narrow down some to what there are actual disorders, where people have actual obsessive-compulsive or autism spectrum or other types of disorders then if you can't address the disorders you're going to have some problems, but at the same time you can't just talk about disorders. So, yes, it's very complicated and I think that the idea is to make it simpler. So here's a simple way to wrap your mind around it.
Dr. William Dikel:
Some mental health problems are due to the environment that you're in. If you have a person who's being physically abused, by their spouse, for example, and they are feeling depressed, anxious, et cetera, they don't need Prozac, they need to get out of that house, they need to get away from the situation that's causing them constant pain and suffering. Then there's another category of somebody who might be in depression. That is, somebody who is having a toxic effect, for example, a side effect from a medication. Example, a side effect from a medication. Many medications cause side effects, of mood, of impotence, of different types of mental health issues that are actually caused by the medication they're taking to save for their blood pressure.
Dr. William Dikel:
Here's a word for you today iatrogenic, you know what that means?. iatrogenic, you know what that means? No, no, the doctor does not want you to know what iatrogenic means because you have a problem caused by the medical system. So next time you go to the doctor, throw that word in and see what happens. Yeah, ooh.
Dr. William Dikel:
So there are a lot of people who are having serious side effects to medications, Adderal, for example. I've seen kids become suicidal who are on Adderal. If you have somebody who is a nicotine addict and they go to school and they can't smoke, they're going to get agitated and antsy and nicotine can have that effect. As withdrawal, you can have toxins in your environment. I believe that some of the cases of autism spectrum are due to neurotoxins in the environment, and that's because I've looked at the literature on where kids are living and what kind of exposure they have.
Dr. William Dikel:
There's also other issues related to medical problems that manifest as mental health If you're an alcoholic, if you are a meth addict, etc. So this category is mental health problems caused by medical issues or by medications or toxins caused by medical issues or by medications or toxins. Okay, so that's the second category. The third category is one that is disorders which, when we figure out what they are, they won't be mental health at all. And what I mean by that is you know, 100 years ago the number one cause of psychosis was probably syphilis. Right, things change and people understand that what you really might have is not a mental health issue at all.
Dr. William Dikel:
Who have obsessive-compulsive disorder, panic disorder, major depression, bipolar disorder, schizophrenia, autism. These disorders really have a very strong biological basis. Autism has a huge percentage, for example, of individuals who in a situation where their genetics have a very strong role in developing autistic symptoms. Well, that's not a problem relating to stress. That's an issue related to an individual who has a disorder which someday we'll have a better understanding of what that disorder is. So, what we're calling depression today, Aristotle called it melancholia, which, if you look at what that means, it means bile, black bile, because people used to think there's a chemical imbalance whereby a black bile I think another colored bile, sanguine was blood. If you hear that word Sometimes you'll hear sanguine, and it's interesting to know that now, if you fast forward to now we're saying well, it's a chemical imbalance, that's why you're depressed. It's exactly what they were saying in Aristotle's time. They just had a different name for it.
Mark Wolak:
That part is really, really helpful, because I think that people do not realize how complex the sorting and the diagnosing and the evaluating really is. You know, I mean people want simple answers. They want things fast really is. You know, I mean people want simple answers, they want things fast and we have a culture that medicates pretty much everything. So you know, I really appreciate that what's your favorite type of music?
Dr. William Dikel:
Well, I can tell you what kind of art I'm into, including music. Okay, I play the djembe, which is a drum for an African dance troupe, and I very much enjoy African rhythms. West Africa.
Joe Boyle:
And now it's time for stories in life. Art from the heart, deep thoughts from the shallow end. Each episode.
Mark Wolak:
We bring you a poem, a song or a reading just for you.
Joe Boyle:
I will not shy away, for now is my time. Es mi voz, es mi voz. Es mi voz, es mi voz. It's my voice, it's my voice. It's my voice. It's my voice. I can say whatever I want in my own way. It's my voice, it's my voice.
Mark Wolak:
What do I have to give To find life for free? This world of hurtful people? I won't let you break me, so I'm here to stay. I will not run and hide. Accept me as I am. It's my time to shine. Es mi voz, es mi voz. Es mi voz. Es mi voz. Voy a decir lo que quiera.
Joe Boyle:
That song was Mi Voz, which translates to my Voice, from the artist Serenade, off the 2013 album named West African Drumming Mix.
Dr. William Dikel:
I have fun doing consultations around mental health in schools because the people I end up working with number one are willing to admit that what they're doing isn't working. That's what you did, Mark, 30 years ago, and so the courage of the people that I work with is inspiring to me, because people really find the uphill battle to be problematic. So I really enjoy writing mental health plans for school districts. I also enjoy working as an expert witness because, for one thing, expert witness work and court cases are the last vestige of combat. If you're an extra witness on the witness stand and you're being cross-examined, it's combat in its own special way, and it's a challenge to know when you're being tricked the trick questions but if you know what's happening, it's very enjoyable.
Joe Boyle:
Any cases you could share with us, or is that all confidential?
Dr. William Dikel:
Let's say the attorney says come on,Dr. Dikell, can't you just say this because he is a jerk? Why are you making him a brat? Why are you using all these big words to talk about this behavior? Which then you say yeah, I know how it is, because you lawyers have all kinds of et cetera, et cetera.
Dr. William Dikel:
Or they'll say do you consider the comprehensive textbook of psychiatry to be the last word on something or other? And if you say yes, then anything you say outside of that book doesn't count. So it's very interesting to see how they try to trap you, but I think you should pause before you say anything and if all else fails, keep a smile on your face. They'll think well, maybe I misunderstood him. Looks like he thinks he did the right thing.
Dr. William Dikel:
So you never know with forensic work and people don't recognize that if you suffer from depression, that's as bad as suffering from cardiac or other issues, and people need to take these seriously and understand that help is available. So I think that whether you're talking about children's mental health in schools or in other systems, what you'll find is a very universal sense that not enough is being done and how can we help these kids and families better? So that's really what I'm focusing on. I'm always looking for new consultations, and so I think it's great that you're on the same boat as far as trying to figure out what we can do that can really help these kids and families.
Mark Wolak:
Yeah, Thank you Will. It was courageous on your part to reply to my query a few months ago about doing a podcast because, I mean, we hadn't talked for a couple years. But thank you for that because you added a lot of value and we're going to make a great story with this. I'll give you a heads up when we've got it edited and ready to go.
Joe Boyle:
That's great. Nice to meet you Will.
Mark Wolak:
Thank you very much, Take care. Thank you very much.
Joe Boyle:
Dr Dikel brings a wealth of knowledge on psychiatry man. He's an impressive guy to listen to.
Mark Wolak:
Yeah, very knowledgeable. You know, first about medicine and then the psychology of medicine with children and adults, and I'm really glad that he's so outspoken about the systems that we have and whether or not they're serving the very needs that we're trying to pay attention to.
Joe Boyle:
He takes the stigma away from it.
Mark Wolak:
He does, doesn't he? He kind of says, look, it's a big factor in our lives and we ought to be all learning more about it. And you're right. We ought to be all learning more about it, and you're right. Remove the stigma of mental health issues in children and in adults and be curious about what would make a difference and be better.
Joe Boyle:
I give him so much credit for trying to simplify the guidelines of how to discover a problem and deal with it and navigate it through the whole system.
Mark Wolak:
Yeah, really a great episode. Thank you, Joe. That was a lot of fun to do with you. Thanks, you will find more resources at Dr Deichel's website williamdeichelcom D-I-K-E-L WilliamDykelcom. Again, thank you for listening.
Joe Boyle:
We hope you enjoyed this episode. Please join us again next time on Stories in Life on the radio with Mark and Joe, and visit our website at storiesinlifebuzzsproutcom or email us at storiesinlifepodcast at gmailcom.