In Lisa Sanchez’s darkest days, she hid her family behind closed window blinds. She avoided friends and family.
She was embarrassed by the mental illness that caused her preteen son to uncontrollably shout out obscenities. Embarrassed when that son was treated poorly at grocery stores, church and school.
She was embarrassed that she didn’t know that bipolar disorder ravaged her daughter, leading to alcohol and drug abuse when the girl was in middle school. That the same daughter, her oldest, the one she always called “the strong one,” would wake up from a drunken stupor on the side of the road, so drunk she couldn’t get home. She was embarrassed that she never knew that daughter had a plan to kill herself until it was almost too late.
She’s not embarrassed anymore.
When Lisa talks of her three children, all of whom battled decades of mental illness, she cries, the pinwheel medallion that she wears around her neck catching the sun as she wipes away her tears.
“I’m happy. It’s a happy sadness that we made it,” she clarifies quickly.
They’re tears of relief. And pride.
“I’m blessed. God has blessed me with three children with mental illness. And we made it,” she said. “There’s light now.”
Jacob Sanchez was just 4 years old when his mother first noticed something was different about him. He made it through four days of pre-kinder before she got the call saying he wasn’t ready for school. He screamed continuously. He needed to be carried by a staff member all day long. He was disruptive.
Once he began staying with his grandmother, Lisa began noticing other things. The constant throat clearing. The repetitive motions that started at his face: first touching one cheek, then the other, before going to his chin. Beginning again. Increasing in frequency and speed as he grew agitated, nervous or excited. Then the barking began. Spitting. Whistling. Shouting.
Jacob was diagnosed with Tourette Syndrome, a neurological disorder characterized by motor and vocal tics, sometimes obscenities. Then came the potentially crippling triad that so often develops with Tourette: obsessive compulsive disorder, anxiety and depression.
By the time he was in middle school, he had been admitted to Clarity Child Guidance Center for emergency inpatient care twice, and had two intensive partial admissions. After two failed attempts at high school, he was withdrawn and homeschooled.
Those years were marked by constant fits of screaming and crying. It seemed endless, and for Jacob’s two sisters, it was unbearable.
One sister turned to drugs and alcohol. The other began displaying signs of obsessive compulsive behavior in elementary school.
“I was so overwhelmed with Jacob that I never picked up on it,” their mother said. “‘Dear God,’ I remember thinking, ‘How did it get to this?’”
A nation in crisis
They call it a crisis. San Antonio, along with the rest of the country, is facing an epidemic.
Across the country, one in five children has a mental illness. In Bexar County, that translates to 80,000 kids who are struggling with behavioral, emotional or mental illness.
Lisa had three in her small family. She never saw it coming. There was no family history of mental illness, no substance abuse problems. She, like many parents, was unaware of the prevalence of mental illness in children.
“If one in five kids in Bexar County had leukemia or some kind of cancer, we’d be having bake sales, and doctors and researchers would be working diligently to find cures,” she said. “But we have one in five kids who could potentially end up suicidal or in jail or dropping out of school or using drugs and alcohol, but the concern is not there.
“There is a stigma about mental illness, and that has led to a lack of resources.”
Nationally, there’s a “severe shortage” of practicing child and adolescent psychiatrists, according to the American Academy of Child and Adolescent Psychiatry. In Texas, there are eight psychiatrists for every 100,000 children.
“There is a huge need,” said Rene Olvera, M.D., M.P.H., division chief of child and adolescent psychiatry at the Health Science Center and outpatient medical director of Clarity Child Guidance Center, where the university’s child and adolescent psychiatry program is housed.
About 5 percent of medical students nationwide continue fellowships in child psychiatry. At the university, that number hovers around 4 percent, with the program capped to allow four fellows a year.
Before they leave medical residency, child and adolescent psychiatry fellows spend months in mandatory rotations at Clarity, as well as the San Antonio State Hospital, Bexar County Juvenile Detention Center and the Cyndi Taylor Krier Juvenile Correctional Treatment Center. They also train at area schools, an emergency shelter and neurology clinic, and offer pediatric consultations for University Health System.
“What we’ve tried to do is create an environment that allows our residents to see a full breadth of child psychiatry. And at the same time, we’re filling that gap for our community,” Dr. Olvera said.
Mental illness can start as early as when a toddler takes its first steps. The most common illnesses are attention deficit hyperactivity disorder, depression, bipolar disorder and anxiety. Suicide is the second leading cause of death in children in Texas, and the third nationwide.
“I think society forgets or they don’t like to think about the fact that kids do kill themselves,” said Brigitte Bailey, M.D., training director of child and adolescent psychiatry.
But every appointment is an opportunity to save a life, said William Lee, M.D., a child and adolescent psychiatry fellow at the Health Science Center. In medical school, he decided to change his specialty from pediatrics to child psychiatry when he realized his favorite part of a patient appointment was asking how that patient was doing, how school was going, how things were at home—the questions that a physician doesn’t have much time to explore, but that he felt were the most critical.
“To hear a child articulate their problems to you and what they are struggling with, I think that is a very powerful moment,” he said. “When we think about childhood, it’s all the innocence, the fun, the play. If they cry, we think we can give them some ice cream and they’ll feel better. But that’s not always the case. And to be able to have someone sit across from you and tell you that they’re really struggling, they can be 8 or 9 years old, but their problems are real. That’s a real moment.”
It’s not sad, he said, though the circumstances that bring a child to the point of needing help often are.
“What I feel is hope,” he said. “When a child comes to you for help, you have the opportunity to make a difference for the rest of their lives. You have the chance to change their trajectory. That is something that is both a very powerful responsibility and an important responsibility.”
Lisa spent years visiting different neurologists, running every kind of medical test to determine the cause of Jacob’s muscle and vocal spasms. She didn’t feel hope until she arrived at Clarity. Like the name promises, a sense of clarity overcame her, she said.
“We shouldn’t be so stigmatized and so worried about what people are going to think and get the help our children need,” she said. “Just like you worry about your child getting the flu or meningitis, worry about your child having mental health issues. And don’t be afraid to question doctors if you feel something is wrong with your child and no one is listening. Because no one knows better than you.
“I waited too long.”
It wasn’t that Lisa didn’t know there was a problem—she was working so hard to fix it herself. She thought if she was a better parent, the problems would go away.
“I just didn’t think I was doing it right,” she said.
The night Jacob was admitted to Clarity was the first night in years that Lisa got a full night’s sleep. She was at peace.
With new eyes
Lisa’s home is a different place these days. It’s been a decade since her darkest days of hiding. Mental illness doesn’t go away, but it can be managed. Jacob, now 22, still spits. He still barks and has other noticeable motor tics. But he also has a full-time job at a local hospital as a transport tech in the emergency room. He goes to movie theaters again, something he stopped doing at the height of his illness. Years of psychotherapy, behavioral interventions, medications and electroconvulsive therapy got him this far.
Through psychiatric care, his oldest sister learned how to manage her bipolar disorder. She no longer self-medicates with drugs and alcohol. She now travels around the world on mission trips and hopes to someday join the Peace Corps. She’s 24. Their younger sister is 19, and has devoted her life to helping fellow students with special needs. Her hope is to become a psychiatric nurse practitioner.
They’ve all been touched by mental illness, their futures shaped by it. Jacob says he’s blessed with it.
Just before the Easter holiday, Lisa saw her family with new eyes. Her daughters were home for the holiday. Jacob had taken time off from work. They all sat together on the oversized sectional in their living room, the evening light filtering through their open window blinds. There was laughter as they swapped stories. And she thought, it’s taken us a long time to get here, but finally we have arrived.
A difficult path
Becoming a child and adolescent psychiatrist isn’t fast and it isn’t easy. Following medical school is a grueling five-year residency program, with three years spent in adult psychiatry and a two-year child and adolescent psychiatry fellowship. That’s the same number of years required to become a general surgeon, said Brigitte Bailey, M.D., training director of child and adolescent psychiatry.
“There has always been a shortage of child psychiatrists,” said Dr. Bailey. “It’s a lengthy road.”Once they’re out of school, they face other challenges: Insurance reimbursement rates are notoriously low. Unless you work in private practice, it isn’t lucrative. And it’s a lot of work.“You need to wake up loving your field of medicine because you’re going to spend long hours and you’re going to invest a lot to do it,” Dr. Bailey said. “We need that idealistic spirit to come into this because we want to work with families and do good work.”
The average wait time for a child to see a psychiatrist in the city is more than three months. Community assessments estimate San Antonio is 45 beds short on any given day.
Still, the city is better off than other areas of the country, said Dr. Bailey.
“Our program here has an overwhelming impact,” she said. “We’re quiet, but we’re everywhere. And our trainees are everywhere in San Antonio.”
Those trainees tend to stay in the area after residency, helping keep the psychiatrist-to-child ratio lower.
“Not only do we train them, but because we’re in the community, that commitment continues long after they leave here,” said Rene Olvera, M.D., M.P.H., division chief of child and adolescent psychiatry at the Health Science Center and outpatient medical director of Clarity Child Guidance Center. In April, Clarity opened an outpatient therapy facility that now houses the Health Science Center’s child and adolescent psychiatry program.
Dr. Olvera estimates that 90 percent of Clarity’s staff was trained at the Health Science Center.
“It’s a dual function while they’re here, as our fellows are learning while providing patient care,” he said. “The beauty is that the payoff to the community goes on for decades.”