When depression goes to camp

When depression goes to camp

Jewish sleepaway camps struggle to get ahead of mental health challenges

Staff Writer, New Jersey Jewish News

When a rising sixth grader joked about jumping off the railings of her cabin at URJ Camp Harlam last summer, her counselor, Casey Quinto of Metuchen, sprang into action. She went to speak with the camper, whom she described as “generally happy” and who had “plenty” of friends. 

But even though the camper’s offhand comment didn’t appear, at least on the surface, to be serious, “She wasn’t giving straight answers. Her body language was off, and she wasn’t making eye contact,” said Quinto, 21. Finding the incident “alarming,” especially given that just a short while earlier the camper had been quiet and seemed angry with her friends, Quinto called in someone with more expertise to take over. 

“I wanted to make sure she was safe,” said Quinto. She knew what to do — assess the situation, listen to the camper, give reassurances, encourage self-help, but if necessary, seek out a mental health professional — because she had been trained in Mental Health First Aid (MHFA). 

Adapted from a curriculum developed in Australia in 2001 by Betty Kitchener, a nurse specializing in health education, and Tony Jorm, a mental health literacy professor, the training is designed for lay people — rather than clinicians — to use in a crisis until professional help arrives. It is managed and distributed in the United States by the National Council for Behavioral Health.

URJ Camp Harlam became the first Jewish camp to utilize MHFA, having offered the training to a select group of its staff four years ago, and it has continued to do so in the three subsequent summers. Thanks to the Foundation for Jewish Camp (FJC) and a grant from UJA-Federation, 30 counselors from three other Jewish sleepaway camps — Camp Ramah in the Berkshires, URJ Crane Lake Camp, and Young Judaea’s Camp Tel Yehudah — have been trained for the first time in MHFA this summer.  

“The training has made me more confident with the campers, speaking about things they are going through,” said Quinto, now in her fourth year on staff, and her 11th at camp (she started as a camper). “It has made me a “better listener, and given me ways to approach and guide [difficult] conversations.”

That’s exactly what URJ Camp Harlam’s executive director, Aaron Selkow, was hoping for when he instituted the training with social worker Cori Miller, URJ Camp Harlam camper care and enrollment manager. Both are now certified to teach the course.

“We wanted to arm our staff with more tools to help mental health issues the same as how we address physical matters or social health,” he said. “We’re seeing a crisis of mental health challenges in this country,” and if kids are struggling with anxiety, depression, social challenges, or other difficulties at home, those struggles come with them to camp. 

The idea behind MHFA is to teach counselors how to listen to their campers and pay attention to their behavior. This is crucial, as counselors at sleepaway camps interact daily with the campers and are the ones most likely to notice behavioral changes. 

The training helps the counselors understand when to be on the lookout for signs of concern, and how to ask questions in a non-judgmental way that will elicit deep, meaningful responses, and how to validate campers’ emotions and help them find ways to problem solve their own issues. It also enables counselors to identify when to bring in a third party who has more expertise. MHFA is not intended to provide skills for diagnosis or clinical treatment.

According to Tom Rosenberg, president and CEO of the American Camping Association, MHFA is becoming more common at camps — Jewish and non-Jewish — nationwide. “Five years ago, it was relatively unknown. Now it’s really taking off.” He attributes it, in part, to camps trying to be more inclusive, welcoming children with disabilities, medical disorders, and mental health concerns. It’s part of a continuum of mental health care at camps that often entails having staff inclusion coordinators and psychologists, according to Rosenberg. 

“Camps want to provide not just a physically safe environment, but one that is emotionally safe, as well,” he said. “When kids feel safe, connected, and like they belong and are included, they are ready to take positive risks and really participate in camp, and that’s the special sauce where they start to contribute and develop collaboration skills and leadership skills.” The training offered to camp staff is developed for use with young people, ages 13-18, and is known as Youth Mental Health First Aid (YMHFA).  

One in five children ages 13-18 lives with a mental health condition, according to the National Alliance on Mental Health. And according to a recent Centers for Disease Control Youth Risk Behavior survey, “persistent feelings of sadness and loneliness” rose “significantly” among adolescents between 2007 and 2017, as did suicide attempts. Additionally, adolescents experience anxiety disorders at a higher rate than adults, 31 percent for adolescents compared to 19 percent of the adult population, according to the National Institute for Mental Health.

As Rabbi Eliav Bock, director of Camp Ramah in the Rockies, the site for Bamidbar, the first Jewish wilderness program for young adults, put it, “Just Google teens and anxiety.” 

Summer camps, with their 24/7 immersive environment, are often on the front lines dealing with these issues. While some cases are more serious than others, Miller, the Camp Harlam social worker who was behind the effort to implement YMHFA, said the most common mental health challenges at camp are Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, depression, anxiety, and autism. 

Not only are kids dealing with more emotional disorders than ever, but at sleepaway camp, unlike during the year, they don’t have their own private space to relax and decompress after a stressful day. “It’s different from years ago, when camp was the remedy,” Miller said. 

Camp, said Bock, is like a “playdate that never ends,” and it can put stress on some kids and surface behaviors not seen at home.

Because the training is taking off at summer camps around the country, the American Camping Association has been working with the National Institute of Behavioral Health to develop scenarios for YMHFA training particularly relevant to the camp experience. Miller was part of that effort, and one of the scenarios now being approved for general use — and was presented for the first time at the URJ Camp Harlam training on June 22 — came from an incident that occurred there several years back: 

Carrie (not her real name), a 12-year-old camper who struggles to fit in, often walks behind other girls in the first days of camp and says she feels different from the other kids. Her behavior becomes increasingly concerning — from Carrie declining to participate in activities, distancing herself from her bunkmates, and wondering aloud if anyone would notice if she were missing — until a counselor overhears Carrie say she doesn’t know why she is living.

Camps, like schools, are playing catchup as they try to integrate emotional intelligence into their culture. 

“Everyone has mental health [issues],” said Rabbi Avi Orlow, vice president of program and innovation at FJC. “We’re not always attuned to it. We don’t know how to talk about it without stigma.” 

He acknowledged that his organization is only at the “beginning” stages of thinking about this issue. “It’s on our agenda,” he said. “It’s part of our strategic plan to figure out how to make camp a caring community.”

Mental health issues at camp are not a new phenomenon, but the way camps are approaching them is.  

“The reality is that mental health is something that has always been beneath the surface at any camp,” said Rabbi Ethan Linden, director of Camp Ramah in the Berkshires located in New York. “The question is what we are willing to talk about and acknowledge as being part of our community.” 

In the past, camps have been in reactive mode, responding in the aftermath of trauma or tragedy, such as after a freak accident or illness, or at some camps this summer, to the mass shooting at Marjory Stoneman Douglas High School in Parkland, Fla. But until recently, summer camps weren’t expected to take more than a relatively laissez-faire approach.

When Miller first arrived at URJ Camp Harlam in 2012 not having had much experience in summer camps, she looked at the environment through the lens of a social worker. She recognized the “beauty of the natural relationship building” that occurs between campers and their peers, and with counselors. But she also noticed that the interactions between the young adults and campers had room for improvement. 

“These young counselors mentoring young kids did not have the skills I’d hope they have to say and do the right things,” Miller said. “It’s not that they were doing anything wrong. It’s just that I knew the power of doing things better.” As she considered how best to equip them with some basic tools, she stumbled over the MHFA curriculum. It was “a simple solution to a complicated problem,” she said.

And she believes it has had “a tremendous impact” on the camp environment, especially when it comes to what she calls the art of noticing: becoming aware of what is happening around you.

Seventeen new staff members participated in the URJ Camp Harlam training on June 22. Miller and Selkow teamed up to teach the material, which included basic information about mental health conditions, first-person testimony from someone facing bipolar disorder, a five-step approach to helping someone in need, and hypothetical scenarios based on actual incidents so the staff could practice their skills. 

Throughout, Miller stressed the impact of using certain words. For instance, the statement, “I noticed you weren’t participating today,” could elicit a more honest reaction than the seemingly more judgmental, “Why weren’t you participating today?” 

Even though there’s a push to educate counselors and staff to look for warning signs with regard to mental health difficulties, not everyone agrees that MHFA is the ideal tool. For one, MHFA was not developed to address situations that could specifically arise in sleepaway camps.

Orlow of FJC called it “a very regimented training program with no flexibility to deal with the idiosyncratic nature of camp life.” He added, “It seems like a great intervention, but too rigid for most camps to jump into right away.” As an alternative, he said, FJC is considering developing its own training program. 

Also, the eight-hour training can be offered in one or in two days, which Miller said is “a lot of information” to throw at 18- to-20-year-olds, some of which may be “scary” and unnecessary. And she noted that the training alone, without regular follow up, would not be particularly effective, a point Rosenberg made as well.

Miller holds weekly meetings with the trainees at URJ Camp Harlam, and they are required to report every day on a situation they noticed and explain how they worked through it. But Harlam is a “well-resourced” camp, said Orlow, with a sophisticated and layered camper-care program that not all camps have the tools to replicate. At Camp Ramah in the Berkshires, for example, the initial MHFA training stands on its own, although staff is “encouraged” to check in with supervisors should they want to follow up, according to Linden.

It’s hard to overstate the potential impact of training gone well. In the case of Casey Quinto’s camper whom she noticed making flippant comments about not wanting to live, it turned out that camper had a serious underlying mental condition that required her to leave.

Thanks to Quinto’s reporting — and other feedback provided by the camper-care team after their intervention — the girl’s family sought help from a therapist. The camper won’t be at URJ Camp Harlam this summer but Miller hopes she will return next summer, able to participate in all the fun camp has to offer.

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