Au Pairs Who Have Psychiatric Disorders
Au pair agencies are required to screen all prospective au pairs for mental disorders: depression, bi-polar, schizophrenia, etc. The tests the agencies use vary - there is no one test required by the Department of State. All the tests vary along types (some are personality tests, some are cultural adaptability inventories). There are no statistics available to the consumer regarding the results of the psychological scores, for example, how many au pairs pass; how many fail; how many are accepted if they have marginal results and what are the criteria by which the agency accepts or rejects an au pair using these methods?
Therein lies the problem - where is the reliability of a U.S. government sanctioned test that has passed muster?
Secondly, not all tests can rule out all mental health issues. Only a few psychological profiles flag a potential child abuser and there is no indication that the tests used by the au pair agencies include this feature. It can be very time consuming and expensive to screen for pedophilia (adults who are sexually aroused by young children). In the case of Cultural Care's Swiss au pair (who took at least one pornographic photo, of a child touching her genitals) did the test she apparently "passed" screen for Pedophilia? Probably not.
Who gathers and processes the test data? Who reads the results and consults with the agencies regarding potential red flags? What are the person's qualifications interpreting test results? Au pair agencies do not hire licensed psychologists to interpret tests that are supposed to screen for psychiatric problems. Why not? Money, of course. It would really cut into their bottom line.
On the other end of this problem, once your au pair has matched and is now in America, what do these agencies do if the au pair presents with psychiatric symptoms? Usually, agencies drag their feet assessing potential problems, mostly because the front line staff and supervisors are poorly trained in psychiatric illness and do not recognize the warning signs.
How widespread is this problem? How many families have had to deal with au pairs suffering from a mental breakdown who eventually needed a psychiatrists' care?
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Comments
good article
Hi there = very good comments on psychiatric issues, as a professional in the mental health field, it is very common for young people between ages of 18 - 25, to suffer from Schizophrenia (first onset of disease usually occurs during this time period) and yes, a stressor usually precipitates the eruption of the symptoms, such as hallucinating, hearing voices, seeing things that are not there.
For a host family dealing with this situation, it can be a nightmare! All au pair agencies, who deal with parents, children, and young women (and men who come as au pairs) MUST have a program in place to handle these psychiatric emergencies quickly and efficiently.
The very first thing to do is to remove the au pair (who needs to be hospitalized immediately). How can an agency act fast on this score? Education of frontline staff of course. All counselors, LCCs must be educated and trained in the identification of a possible psychiatric breakdown. Once the signs are identified, then the LCC can get approval to have the au pair seen by a professional (psychiatrist or clinical psychologist).
Then, a diagnosis can be determined. The agency has to support this by active involvement in the situation and a policy and procedure that is set up not only to recognize and remove ill au pairs, but to care for them as quickly and professionally as possible.
There is no difference between an au pair who is suffering from hearing voices to an au pair who just broke her hip falling down a flight of steps - both girls should be taken to a hospital, get diagnosed and treated as quickly as possible. Then, the agency can arrange for their transport home while looking for a replacement au pair for the unlucky host family.
It is not that difficult to execute, but I feel many agencies will drag their feet on the physicatric front and try to avoid costly interventions and just either ignore it or send the girl home without a proper diagnosis and treatment plan. They may also not want to invest the time and money to train their counselors or LCCs. I think this is a major stumbling block in getting host parents the tools they need to deal with an au pair who is going through a mental breakdown.
What the agencies do not know is that the incidence of mental health issues present in adolescents and young adults (the very population they are recruiting from) is rising at an alarming rate in this country and in Europe, etc. Depression rates have skyrocketed and with that, suicide.
It is not the same world as it was in 1980's when agencies first started recruiting and I think that most agencies have not caught up with the times.
Is there a way to review these medical procedures here on the website (probably not since most agencies do not have them in place or they do not want to reveal what they are).
my au pair was diagnosed with schizophrenia
I had a 18 year old au pair arrive and 5 months later she began to act strangely. She would stay in her room and became suspicious of me and my husband. She would say strange things at the dinner table and then she forgot (or refused) to pick up my son from soccer practice. He called me at work and I came home to find the au pair locked in her room. The police had to break down the door. The EMTs took her to the hospital and we never saw her again. My counselor told us she was diagnosed with schizophrenia. She was hallucinating, hearing voices. She was eventually sent back home to Sweden.
The agency explained that is was the shock of a new environment that caused her illness. Do you think this is possible? We always suspected she was prone to having a mental breakdown as she had no friends and kept to herself, always, and was, well, a bit unusual in her behavior and outlook on life, etc.
We didn't know anything about mental disease and we certainly didn't think the agency would not screen properly for this. We have since switched agencies, but I don't think that is matters as I don't think any agency can screen properly since one has to be interviewed by a clinical doctor or psychiatrist to rule out mental disease.
What I don't understand is why the US government doesn't have a standard test that all agencies must use. This way it is easier to monitor each agency and the au pairs they let in (or don't).
Your au pair who was diagnosed with schizophrenia
Hi Patty,
First, it sounds like your au pair has signs of a mental disorder even before she arrived to your home. You say she didn't have any friends and was a loner and her behavior was a "bit unusual". These can be signs of schizophrenia. Certainly, hearing voices is a main symptom of this disorder. The fact that she had her breakdown in a new environment could have been the stressor that caused the disorder to manifest itself (stressors such as this can precipate the onset of schizophrenia).
Secondly, it is difficult to say if the agency was able to catch these signs with their psychological assessments. They are not sophisticated enough to pinpoint these disorders before they emerge. Should they be? Yes, I think so. The tests for these disorders would be expensive and therefore not cost effective for au pair agencies to administer them.
I do agree that there should be standardization of psychological testing of all au pairs across the board and that the U.S. Dept of State should be the office to initiate this process. Without this, host parents can and do match with au pairs who may have a predisposition for mental disorders and coming to the United States is often the key stressor that causes the disease to erupt.
There are steps parents can take to decrease their odds of matching with an au pair who may have a history of mental disorder in their family: you can assess their mental health by reviewing their family letter and quality of their phone interview.
What to look for? Signs of depression would be fatigue, lack of interest in hobbies and activities with others, poor self-esteem issues and low energy. Signs of more serious mental disease, such as schizophrenia are: social isolation, strange stories or ideas in the family letter or odd conversations during the phone interview. For example, one host mom reported a prospective au pair telling her that she (au pair) wanted to come to America to find her father, who was the President of the United States. She told the host mom it was a secret and no one knew this fact, but the 'voices' told her she had to come to America and meet him and then all would be fine. The host mom called her counselor and the counselor told her to not to call the au pair again and not to match with her. The au pair's belief that her father was the president is called a delusion and typical of schizophrenia.
Fortunately, these cases are uncommon but all host parents should be aware of the possibility and they need to assess all prospective au pairs for potential mental health issues.
au pairs get sick too
Yes, it is a very sad situation for these very young girls to be so far away from home and to get a serious mental problem, I feel for them, really I do! One of my former au pair's friend (another au pair) had a breakdown and you could see it coming. She was very distraught and anxious all the time and then she got very depressed and could not take care of the children. She forgot them in the A&P once and then she had a car accident and when she was in the hospital the emergency doctor diagnosed her with manicdepressive disorder.
No one else caught it! Not even her LCC. And she should have! I know the host mom called and spoke to the LCC about it and all she said was "give her time to adjust, it is just cultural shock." Who has cultural shock for 8 months??
I do agree with you, these LCCs should be mandated to learn about these disorders! maybe the government should requite them to get a license or workshop credit hours. Does it happen frequently? I think so. It happens enough to have this training put into place.
This poor au pair suffered for many months with the advantage of medicine and therapy. She could have killed herself! The children could have been harmed also!
The au pair agencies should be doing this on their own - should they wait until there is a crisis and a death and then they do something? Why not do something proactive, and now?
Au pairs who become mentally ill
Yes, very sad situation and absolutely no excuse for any au pair agency to pretend these conditions do not arise or even exist in a new au pair recruit. I have had some experience with this (past au pairs and agencies) and each contact person, from different agencies, seemed out of their element when it came to mental health issues.
I didn't expect my counselor to know what my au pair was suffering from, but I certainly did expect her to take some action based on symptoms we witnessed and that she herself observed!
We had one girl who was extremely depressed, crying all the time and unable to get up in the morning (she would sleep for hours, well into the day, past dinner, etc.). We felt this was unusual and called the agency, they sent the counselor over and she made the au pair get up and shower. She took the au pair out for lunch and after 2 hours, returned her and announced "Here, she is fine!"
The very next morning, we could not get the au pair up. After many attempts, we became alarmed and called 911. The au pair had taken a whole bottle of baby aspirin! The EMTs said it was a suicide attempt. Our counselor felt all she needed was a good, hot shower and a nice lunch out! How utterly ridiculous. If this counselor had been given even the most rudimentary facts of depression and suicide, this au pair's attempt to take her life could have been avoided.
We fired the program and in less than a month, we were with another, better agency. We matched with a well-adjusted young woman from Germany and have not looked back since, or, should I say, until now, when I read this post and people's comments about au pairs and mental disorders.
Free advice: if you see any signs of mental instability, call the counselor and the agency at the same time. Call your doctor and share the symptoms. If you doctor thinks there is something amiss, take her there yourself. If the doctor feels she needs psychiatric care, make sure the agency arranged this ASAP and not on "Monday" or the next day.
Edina, you make excellent sense and points about the au pair industry and the training they should be putting into place for both families and au pairs' sake.
They are responsible for these young women and they need to step up to the plate and get it done.
Au Pairs and Mental Disorders
Thank you Updike,
I agree, au pair agencies can do more in preparing their local representatives in recognizing psychiatric disorders. When I was working in the au pair industry, many times counselors would call a manager to report strange or erratic behavior on the part of an au pair, stating a concern about an au pair who may be suffering from depression or bipolar disorders, and the managers would say "it is not your job to diagnose mental problems!"
This defensive reaction was very off putting for the local representatives who were trying to report accurate observations and real concerns from the field as they sought appropriate and prompt medical attention for the au pairs in question. Often they did not receive assistance until something actually happened to demand immediate medical intervention, and that was not effective management or leadership! To be fair, many of these managers were just as uneducated regarding psychiatric symptoms as their local counselors were!
So the training needs to be two-fold, on the managerial level and on the local representative level. The training needs to focus on identification of specific symptoms which is easy enough to do.
For example, what are the symptoms of depression? Low energy levels, body aches and pains, inability to perform routine tasks, crying, sleeping too much or not sleeping at all,overeating or not eating, not caring for self (not showering, washing hair - overall appearance becomes compromised) and verbalizations that represent depression, such as "I don't care anymore," "I feel sad, blue or tired all the time," or worse, suicidal ideation, "I want to end it all," or "I wish I were dead."
These symptoms are easy enough to recognize and you do not have to have an advanced degree in either psychology or social work to see identify these signs of depression. Local representative, LCCs, counselors are not required to have a background in psychology or social work, so they are unfamiliar with psychiatric disorders, but they can benefit from basic training in the identification of common psychiatric disorders that can plague young people: depression, mania, suicidal ideation, eating disorders, anxiety disorders and schizophrenia.
Most au pair agencies do have yearly training conferences for their all of their staff (and including the local representatives). I have attended many of these conferences over the past 10 years and I have never seen any mental health workshops listed on their training agendas.
Au pair agencies have wasted valuable training time to discuss such trivial topics as "How to Use Your Local Community Newspaper To Increase Your Cluster Size, or "How to Scrapbook with Your Au Pairs" instead of "How to Identify 5 Major Psychiatric Disorders Young Adults Can Suffer From" or "Recognize the Top 5 Signs of Depression & Suicide," etc.!
In addition, many au pair agencies are reluctant to hire professionals to run training and educational workshops and instead ask for "volunteers" among their own staff. As a result, many workshops are poorly run and lack the essential tools local representatives need to carry out their responsibilities working with host families and au pairs.