MR. KOJO NNAMDIWelcome back. Inner-city neighborhoods that see daily violence are often compared to war zones. And for people in those communities, the psychological toll of urban violence may actually be similar to what soldiers endure after combat. That, according to growing research in cities around the country, showing a startling number of civilian Americans are suffering from Post Traumatic Stress Disorder. It's affecting people who've been assaulted, who witness shootings or experience abuse in their homes. But the vast majority are not getting diagnosed and they're not getting treated.

MR. KOJO NNAMDIAnd with the U.S. still struggling to address the PTSD crisis among veterans of war, it's unclear how our healthcare system will care for the number Americans coping with trauma in their own neighborhoods. Joining us to talk about this is Thomas Mellman. He's a professor of psychiatry and vice dean of research in the College of Medicine at Howard University. He joins us in our Washington studio. Dr. Mellman, thank you for joining us.

PROF. THOMAS MELLMANGood morning.

NNAMDIAlso with us is Penny Griffith and she's a social worker and executive director of the Columbia Heights/Shaw Family Support Collaborative. Penny Griffith, good to see you. Thank you for joining us.

MS. PENELOPE GRIFFITHWelcome.

NNAMDIAnd Maxwell Manning is a clinical social worker and consultant. He's currently CEO for the Institute for Human and Business Development and New Life Counseling Center. Maxwell Manning, thank you for joining us.

MR. MAXWELL MANNINGThank you.

NNAMDIJoining us from studios at the Argo Network in New York is Lois Beckett, a reporter for ProPublica, which recently conducted a survey of trauma centers and cities with the cities homicide rates and highlighted the prevalence of civilian PTSD. Lois Beckett, thank you for joining us.

MS. LOIS BECKETTThank you.

NNAMDIYou, too, can join the conversation. Give us a call, 800-433-8850. Have you or someone you'd known endured a traumatic experience and suffered from its effects? Did you or that person get treatment? If not, how did you cope with the trauma? 800-433-8850. You can send email to kojo@wamu.org or send us a tweet @kojoshow. Lois Beckett, posttraumatic stress disorder first entered the American vocabulary in the years following the Vietnam War.

NNAMDISince then, much of our understanding of trauma's harmful aftermath is still associated with veterans of war. And while treating soldiers remains a huge challenge for U.S. policymakers, in your reporting, you found another population of Americans also suffering from the effects of trauma. Were you surprised by the rates of PTSD among civilians here in the U.S.? And how high exactly are those rates?

BECKETTSo, doctors across the country in trauma centers have started to measure rates of posttraumatic stress in their patients. In Chicago's Cook County Hospital, it was 43 percent of patients with all different kinds of injuries were showing signs of posttraumatic stress in the months after their injuries. In Los Angeles, one of the early studies found that 27 percent of young men with gunshot wounds were exhibiting signs of posttraumatic stress three months after their injuries.

BECKETTOverall, I would say, it's between 20 and 30 percent among the studies are showing those are the levels of posttraumatic stress among civilians who have been injured.

NNAMDIOne trauma surgeon that you interviewed said everyone thought that PTSD in violent neighborhood -- just quoting here -- "young black men's disease." Why do you think there's so little awareness of high rates of PTSD in our very own cities?

BECKETTI think there's a really powerful myth out there that people who are exposed to violence, you know, by participating in crimes, people who are in gangs are going to become hardened to violence. That it doesn't affect them anymore. It's one of the early PTSD researchers on gang members told me. But, in fact, the reality is just the opposite that the more trauma you're exposed to, the more vulnerable you become to posttraumatic stress.

BECKETTSo you have doctors or people in the general population thinking, you know, this guy is a gang member, he's tough, you know, he's not going to get PTSD. And, in fact, on the other hand, you have these young men who, just like soldiers don't want to admit that they're vulnerable, there's a huge stigma about talking about mental health. So on both sides here, you have people who don't want to admit that there's a problem going on when, in fact, young men who have been in and out of jail, young men who have committed crimes or have been victims of crimes before are tremendously vulnerable to posttraumatic stress.

NNAMDIThomas Mellman, as a professor of psychiatry at Howard University, you have research trauma exposure and PTSD in communities right here in Washington, D.C. To what extent did you find that people locally were dealing with trauma? And how often did you find that it developed in PTSD?

MELLMANWe have conducted a couple of surveys. One was in the primary care clinics of Howard University. That study was led by my colleague Tanya Alim. And we found that on the order of 70 percent of what was predominantly African Americans attending several of our primary care clinics at Howard University have been exposed to significant trauma. And the overall rate of current PTSD, fulfilling the diagnosis was 16 percent.

MELLMANSo -- and almost none of these individuals had received specific mental health treatment or any intervention that was really designed for PTSD. And much more often than not, the diagnosis was not recognized. I'm currently conducting research that focuses on young healthy adults from urban environments, the majority of whom are African American. And we've been recruiting from both college campus and community settings.

MELLMANNow, it's not a representative sample, but the figures are strikingly similar to what I just quoted. As many as 80, 90 percent, depending on how you calculated had been exposed to the type of trauma that can engender PTSD. One of the major themes of PTSD research is why some people who are exposed to violence develop posttraumatic stress and others seem to be more resilient.

MELLMANThat's a big important problem that we're trying to understand in our research as well as other people are trying to understand it. But we found the similar rate of PTSD, 16 percent. But that's meeting the full criteria for the diagnosis. We also found that an equal number of individual has symptoms of intrusive preoccupations of disturbed sleep. And we're particularly interested in the toll that exposure to violence and living in a threatening neighborhood environment.

MELLMANThe toll it takes on people's sleep, which we think has both immediate and long-term consequences for people's adjustment and even their physical health.

NNAMDIMaxwell Manning, we often associate PTSD with violence or the violence of war. But when we're talking about our own neighborhoods, what kind of events or environments are causing psychological trauma?

MANNINGThere are several environments -- several environmental things that are causing trauma. Some of them are related to such things as domestic violence, dating, date violence. We have bullying in schools. We have just a general environment of poverty, where people are losing their jobs, people are feeling stressed out by the kind of things that are going on in the environment nowadays, which really puts stress on the family, which in turn put stress on the children.

MANNINGThe families are really under a lot of pressure given the economic situation that we're in nowadays. We're also in an environment where it's information driven. So there's not as much closeness in families and social relationships. So sometimes there's a disconnect which causes bullying over the internet, it causes bullying in the school. And even in our social environment. So you just go to the store sometimes there's an intense reaction that people are having difficulty dealing with that related to the trauma that we're all experiencing.

MANNINGMany of us have people in our family that are experiencing mental health problems and we don't know what to do. Some of them are related to trauma. In my experience, many of the families that I interact with, there's at least one or two other people in their family that are experiencing some form of trauma.

NNAMDILois Beckett, we've identified events and situations that can be traumatic. But at what point does exposure to trauma trigger PTSD? Yeah.

BECKETTSo some of the reactions to...

NNAMDII'm sorry, I meant Lois Beckett and that's who've answered.

BECKETTYeah, that's me.

NNAMDIYes, I am sitting across from Penny Griffith also and I was pointing at her as I was asking you the question. So, Lois, you respond first and then Penny.

BECKETTGotcha. So some of the common reactions to trauma, if you're having trouble sleeping, if you're thinking obsessively about the event. If that happens right after the trauma and then that goes away, that's normal. It's when those symptoms linger over months or even years when you're still thinking about the traumatic event every day, when you can't sleep, when you're waking up from nightmares, having flashbacks. That's PTSD.

NNAMDIPenny, your organization works to support families and young people here in Washington, D.C. How frequently do you find yourself and your organization and the people you serve dealing with trauma or even PTSD?

GRIFFITHSo my organization work a lot with the (unintelligible) in the Washington, D.C. area. So we see that quite often, more so than anything else. And we see a lot of the behavior or the aggression involving young people who are involved in gangs. But we also see the depression. We also see the disconnect from the education relationship disconnect. We see a lot of the sense of isolation from our young people.

GRIFFITHAnd again, as Lois said, there's a masking of this tough guys and tough girls as if they got it together when they're the most vulnerable population that we have right now. There's a masking of this toughness because they have to protect themselves in the street. They got to go -- get from one corridor to the next. It takes a lot of guts to go from one street to the next and survive that transition to and from school.

GRIFFITHSo kids are -- they're in their own warzone. I always say we have our own little war going on in the D.C. area. And we have those young people who are struggling to survive in the best way they know how. But when we work with them and we bring them into the office and we bring them into our group support and we start talking about those things that they don't want to talk about, yes, you may be afraid.

GRIFFITHAnd let's talk about the fear of walking to school or leaving school or going to school. And we begin to have open discussions with them and put it out there. Then you see the response in a different way. The kids open up. They want to have a private meeting. And so, if we make ourselves available and really understand what the fears are, I see the results of kids being transparent and available and wanted to change and asking for help.

GRIFFITHYou know, help me not to be able to stay here or get me out of this gang, because they really want to survive. They want something different for themselves.

NNAMDIPenny Griffith is a clinical social worker and the executive director of the Columbia Heights/Shaw Family Support Collaborative. She joins us in our Washington studio along with Thomas Mellman. He's a professor of psychiatry and vice dean of research in the College of Medicine at Howard University. Maxwell Manning is a clinical social worker and consultant, currently CEO for the Institute for Human and Business Development and New Life Counseling Center.

NNAMDIAnd Lois Beckett who joins us from Argo Studios in New York as a reporter for ProPublica, which recently conducted a survey of trauma centers in cities with the highest homicide rates and highlighted the prevalence of civilian PTSD. We're inviting your calls at 800-433-8850. Were you aware that many civilians also suffer from posttraumatic stress disorder? Give us a call, 800-433-8850.

NNAMDIMilitary hospitals like Walter Reed routinely screens soldiers for depression and signs of psychological trauma. But what about civilians? Thomas Mellman, under what circumstances would they get screened for trauma exposure?

MELLMANWell, in my view, that should be a part of routine primary care screening. There are very -- at least screening for posttraumatic stress disorder symptoms. There are very efficient ways of doing that. And when you're running through the usual health screening about exercise, diet, smoking, et cetera, I think assessments can very efficiently and very meaningfully address sleep and posttraumatic stress.

NNAMDILois, your report on a number of recent studies at trauma centers around the country where researchers find 20 percent, 30 percent or even 40 percent are showing -- of patients are showing signs of PTSD, how are those studies changing the way that trauma centers and hospitals and primary care clinics look at PTSD among civilians? And is the sheer number of cases causing them to reevaluate their screening procedures?

BECKETTI talked to trauma surgeons across the country, I heard from a lot of them that their awareness of this issue has completely transformed over the past couple of years. And I talked to trauma surgeons who said, you know, I didn't really think civilian PTSD was real. And then this research has just built and built. And now, you know, the only people who don't believe it's real are people who have not been keeping up.

BECKETTBut the level -- growing awareness among trauma centers has not been matched by action. I spoke to people at Cook County in Chicago where they found that 43 percent of patients with posttraumatic stress, they really want to be doing something about it. They want to be doing more routine screenings, helping, providing more followup. And they asked to spend a couple of hundred thousand dollars a year which, for a big trauma center, is not that much.

BECKETTBut, you know, hospitals are really struggling financially. And what I heard over and over again from trauma surgeons was we want to be doing something about this but we don't have the money.

NNAMDIWas that the main reason why those trauma centers did not dedicate resources to PTSD screening?

BECKETTNot having the resources, not having the money is a big part of that. And, you know, not having the money fits into a lot of things -- hospital administration, Medicaid, not sure how they could get reimbursement for it. And also, along with the problem of not having money for screening, a lot of doctors say they're afraid that if they diagnose people with PTSD, and these are patients who don't have their own health insurance, who don't have a lot of money, they're worried they won't be able to get mental health treatment because there's such a shortage in many places of the country.

NNAMDIIndeed. I was just about to ask you about that, Maxwell Manning. Physicians don't think it's ethical for them to diagnose someone with PTSD if they can't connect that person to treatment. What does it take to treat PTSD?

MANNINGWell, it takes a number of different approaches. More recently they're talking about revisiting the whole psychodynamic approach, which you also have CBT and you have a number of other (word?) spaced approaches that were very effective in treating PTSD. The problem really has to do with the disconnect in the medical system. And that's what's being worked on. The primary care physician is usually the first stop.

MANNINGThat they -- where the -- it can be identified and the person can be referred to mental health services. But there's an equity in terms of the value of mental health services versus medical services. And particularly in African American community, many African Americans are treated for mental illnesses by their primary care physician. It depends on the -- how chronic the PTSD is, how long it's been gone -- how long it's been untreated.

MANNINGAnd if it's been untreated for a long period of time and the person is still in an environment where they continue to experience trauma or trauma-related circumstances, it's going to take a long time for that trauma to be helped or the trauma to be addressed.

NNAMDIThomas Mellman, I was going to ask you the same question. But I'm going to ask you to hold your response for a while because Kamar (sp?) in Manassas, VA also wants to talk about treatment. Kamar, you're on the air, go ahead please.

KAMAROh, thank you, Kojo. This is very exciting. I'm a first-time caller into any radio show.

NNAMDIThanks.

KAMARHi. I'm from New York and I transplanted myself to Manassas and I just want to tell you that there are three things that I find quite effective with PTSD. I'm a psychotherapist, an LCSW. And when I was in New York, I happened to be interested in hypnotherapy. And I had taken a course. And one of the things that I noticed as I was practicing the hypnotherapy and speaking out loud to other therapists was that it took them to a different space. And I don't want to sound new agey or anything, but it (unintelligible)...

NNAMDIToo late.

KAMARI'm sorry, go ahead.

NNAMDIGo ahead. No, please go ahead. I was just (unintelligible).

KAMARIt causes respiration to slow down, the body relaxes, the brain relaxes. It's no longer focused on hyper-vigilance and fear. And because that is a constant. I'm someone who has PTSD. It doesn't ever go away, but it can be treated. Yes, cognitive behavioral therapy definitely helps. But that, in conjunction with hypnotherapy as well as yoga, which relaxes and teaches you how to control your body, your breathing and puts you in a different state.

KAMARAll of those things are so beneficial. And my thoughts on this are -- and pardon me I'm pacing, I'm out of breath, but my thoughts on this are, if like in the '70s we could get lots of people with grants to get out there and do yoga, it doesn't have to be a diagnostic situation. It can be simply...

NNAMDIWell, allow me to have Thomas Mellman weigh in on that. Thomas Mellman?

MELLMANOkay, thank you. We know a lot more about how to help people with posttraumatic stress than we used to. There's a lot of information that's come in, research and clinical experience. And as my colleague here mentioned, cognitive behavioral therapy, it's been shown to be very effective approach. And a common theme of cognitive behavioral therapies that are the most effective is they deal directly with the trauma, with the memory of the trauma in some direct way.

MELLMANThis can be through techniques that are called prolonged exposure, cognitive processing therapy. But people with PTSD are in kind of a mental tug-of-war where they are intruded upon by these disturbing memories and they try to avoid them, they try to avoid being reminded, they try to push it out of their mind. And in doing so, it just gives the memory more power. And, therefore, it's a rather straightforward principal.

MELLMANGetting someone to talk about it, to recount it. And in our experience, also writing about it can be a very powerful and efficient intervention. So most experts are, you know, I have to say, would not consider hypnosis per se a treatment for posttraumatic stress disorder. Although certainly the relaxation techniques the caller mentioned can be very helpful in people coping with their anxiety as they're processing their trauma.

MELLMANBut as far as -- I think you hit the nail on the head in terms of why screening for PTSD can be threatening because when you identify a problem, you're obligated to do something about it. And I think many systems and practitioners feel helpless in that regard. But I do think that recognition is better than nothing and education is also very important first line just for a person to be able to identify the nature of their problem and to have some idea about what can be helpful.

MELLMANSome of which can be addressed in not necessarily a formal treatment setting because we don't have the mental health system to address the scope of this problem. Although for many, mental health intervention can be critical.

NNAMDIPenny Griffith, soldiers may leave the warzone. They return home. But civilians who suffer from PTSD may regularly walk past the very places where traumatic events occurred. What challenges does that present for a person's recovery?

GRIFFITHI think it really impacts the recovery in a tremendous way, especially for the young people, as I mentioned, that we talk about. If you live in the same block area that your brother or your cousin or your friend died, and you have to go back and forth in that area and never talk about it, never have the opportunity to talk about it. Our mental health system in D.C. has emergency crisis that goes into the school and meet with those kids. A lot of times the kids do not see the mental health provider after an incident.

GRIFFITHBecause that's a taboo. It's still a taboo in our culture that I'm not crazy, and not that they understand that they're in PTSD mode. So they see themselves as not being crazy so I don't need to see a mental health provider. But we see the symptoms later on with poor school attendance, the self-medicate into drugs, marijuana, the explosive behavior, unresponsive behavior, for many different things. And you see that. So that recurrent experience of having to be in the same neighborhood where you've just had a traumatic experience, and in the same school probably, the kids have to live through that day in and day out.

GRIFFITHAnd don't understand that they have the means to get some help for that. And so we see their behavior as out of control kids, but there's a lot of underlying issues that need to be addressed. And it has nothing to do with the fact that I don't want to be good, do the right thing. They do. When you get a kid into your workspace and you work with them, they really want something good for themselves and that's giving the opportunity, they do.

NNAMDIGot to take a short break. When we come back we'll continue this conversation on trauma and PTSD in urban neighborhoods. If you have called, stay on the line. We'll get to your call. If you haven't and would like to, the number's 800-433-8850. Of course you can shoot us a tweet @kojoshow. Do you think our policymakers in the healthcare system are doing enough to treat people with PTSD? You can also send email to kojo@wamu.org. I'm Kojo Nnamdi.

NNAMDIWelcome back to our conversation on PTSD and trauma in urban neighborhoods. We're talking with Lois Beckett. She's a reporter for ProPublica, which recently conducted a survey of trauma centers in cities with the highest homicide rates and highlighted the prevalence of civilian PTSD. Thomas Mellman is a professor of psychiatry and vice dean of research in the College of Medicine at Howard University.

NNAMDIPenny Griffith is a clinical social worker and executive director of the Columbia Heights/Shaw Family Support Collaborative. And Maxwell Manning is a clinical social worker and consultant. He is currently CEO for the Institute for Human and Business Development and New Life Counseling Center. I'd like to go directly to the phones, where Kay, in Derwood, Md., awaits us. Kay, you're on the air. Go ahead, please.

KAYHello there. Thanks very, very much. I am thrilled with this sad theme. I have a son, in fact, who was in a car accident a few years ago. And they said that he had a concussion. And I was curious to know what the symptoms of PTSD are and the links with anything like a head injuries or wounds that folks may have had.

NNAMDIThomas Mellman?

KAYThank you.

MELLMANThank you. I used to work intensively in trauma surgery care settings and we encountered such cases. And it's become a very important theme because of the difficulties experienced by the current group of veterans who are often exposed to blast injuries, as well triggers of PTSD. So the main difference between PTSD and post concussive syndrome is the divergent effects on memory. So PTSD is kind of a strengthened memory of a traumatic event.

MELLMANAnd people with concussions have gaps. But there are also similarities. And a lot of the so-called non-specific symptoms overlap, such as difficulty getting to sleep, trouble staying asleep, poor concentration, being vigilant and easily startled. The other thing I would say about -- so car crashes can trigger both concussive syndromes, as well as post-traumatic stress disorder, either or both. And in the case of post-traumatic stress disorder, the most common sequelae would be fear and anxiety about driving.

MELLMANAnd that can be quite disabling for some people. And it's treatable. In the absence of other PTSD symptoms, we might just call that a driving phobia, but that's often very prominent but can be overcome through graded exposure and coaching and relaxation techniques.

NNAMDILois Beckett, did any of the surgeons that you interviewed talk about the fact that when we think about PTSD we still only think about it in terms of violent confrontations, often involving firearms? Did they talk about things like car crashes?

BECKETTAbsolutely. When they did the study in Chicago and also in Baylor Medical Center in Dallas, they were looking at patients with all different kinds of injuries and found that oftentimes people with a sort of assaultive violent injuries might be more likely to get PTSD, but people with car crashes, absolutely.

NNAMDIWe got an email from one who wanted to remain anonymous, who said, "I've not heard rape and sexual abuse related to PTSD mentioned here, and wonder if the treatment is somewhat different for people who must live with this daily. What do your guests find?" Maxwell?

MANNINGIt's very similar, except that when you're talking about something as interpersonal as rape, the trauma, sometimes people are not willing to talk about it. The exposure sometimes is a traumatic experience in itself. We've heard of situations where women have gone to police departments and they've talked about being raped. And their experience with the police department is a traumatic experience. And so the sensitivity about rape, about abuse, is not there on the same level as it is with other trauma experiences.

MANNINGSo the treatment has to be a lot more delicate and more specific in dealing with some of the environmental, some of the social issues that are related to the trauma. I know that there are people that I've come in contact with who have been raped and they haven't really talked about it in treatment until maybe two, three years down the line where they feel more comfortable, where they feel like it's a safe place for them to begin to talk about that experience.

MANNINGSo we really need more services related to rape and trauma. There are a lot of situations with the younger population where this is happening and it's not being talked about, it's not being exposed. And we need to become more sensitive about that as a society.

NNAMDIPenny Griffith, the National Center for PTSD estimates that as many as 43 percent of all children will go through trauma and, of those kids, as many as 15 percent of girls, 6 percent of boys will develop PTSD. You mentioned schools. What role do you think schools can play more effectively in helping children to cope with that trauma? And do you think a lot of schools are screaming for signs of trauma exposure and PTSD right now?

GRIFFITHI would say no. Schools are not screening for that right now. And the schools, I know, have tremendous financial crisis, as we all are going through right now. But I think something that has changed drastically is that we don't provide the kind of mental health support for the school system as we used to years ago. And so you may have one counselor to an entire school population. Again, how many of the young people will say, "I need to go see my therapist. I need to go see the mental health provider in the school."

GRIFFITHSo the schools have to get creative in the way that you educate the teachers to look for those signs and behaviors. Everyone should be educated around that. But there also needs to be information sharing with the young people about the signs and symptoms of PTSD. That should be part of some kind of sharing in the school system to educate the young people about behavior changes. If you're experiencing this, this could be the reason why you're experiencing behaviors like this.

GRIFFITHAnd I think if we kind of wrap ourselves around the young people, by providing them with the education -- kids want to learn and they want to understand things as well as adults do. And so if we can provide a system in the school that would educate and that would train our teachers and our professionals to look for those behaviors and educate the young people, as well, inform them about those behaviors.

GRIFFITHAnd then make the mental health provider process a more friendly approach, where they could go to the kid's home to do the therapy with him in the home, than have the young person come to the therapist's office to see the therapist -- which is a stigma of itself -- maybe providing home visitation therapy for them to have it on a larger scale then what we have right now.

NNAMDILois Beckett, you, I think, mentioned that Education Secretary Arne Duncan mentioned PTSD in a speech last year.

BECKETTYes. Sec. Duncan is from Chicago, and obviously is very concerned about this, and has a long history of himself knowing the effects of violence on kids. And so they asked for $125 million to help schools develop programs to deal with PTSD and other kinds of violence in the 2013 budget. Some of that money has come through. And I'm still waiting to hear from the Department of Education to what extent that will be funded. But there are going to be funds available after several years of gap for schools who want to implement these kinds of programs.

NNAMDIChildren is what Mary, in Arlington, Va., wants to talk about. Mary, you're on the air. Go ahead, please.

MARYHi. I have two young adult daughters who suffer from PTSD due to very early childhood trauma. And they're both at various stages of treatment. But my question -- which I realize is multi-faceted, so I'll just ask if very basically and you can take in any direction you want. But there seems to be, in the literature, growing evidence of an overlap between early childhood trauma and PTSD and subsequent mental illness, in particular bi-polar, which one of my daughters was recently diagnosed with.

MARYAnd the literature seems to indicate that very early childhood trauma, because of the neurological development and the brain chemistry that's taking place, that the early childhood trauma can actually affect neurological development, perhaps triggering what may be a predisposition to the bi-polar or other mental illness. And I'd be very interested to hear any comments or input about that.

NNAMDIGlad you brought that up because Thomas Mellman, you can explain, how do children and young people process traumatic events? And, as Mary was pointing out, what effect do you think they can have on a child's development?

MELLMANWell, early life exposure to trauma can have profound impact, profound deleterious impact on children's development and predispose them to a host of adult problems, including both mental disorders and physical conditions. There's increasing evidence to find. It's a complicated relationship and I don't want to imply that a maltreated child or a traumatized child is fated to a life of either disability or continuous suffering. There's also resilience that is manifested in both adults and children, and we need to understand that, as well.

MELLMANIn my view and based on the data I'm familiar with, the main determinate of particularly bi-polar mood disorders is heredity. It's a very difficult condition that seems to have biological determinates. I think even more so than unipolar depression or PTSD itself, obviously. But there is an increase in really the whole spectrum of mental conditions in relation to early-life trauma, as well as probably risks for diabetes and cardiovascular disease that we're still trying to understand. So early detection and intervention is very important.

NNAMDIA lot of schools, Maxwell Penny (sic), have young people who act out aggressively and teachers and principals might just think they're, well, bad kids. In what cases do you think they might be misinterpreting those kids' actions and their behavior is really a response to whatever psychological trauma they might be experiencing?

MANNINGI think in a lot of cases there's a disconnect. Because there's not a lot of education in the school system about mental health issues. There's also a disconnect around the generational disconnect. The millennials, the Generation Y, they process things differently. Their exposure to the environment is different. They're more connected to the digital age, which causes a disconnect. And sometimes that's interpreted as them acting out, as them being bad children.

MANNINGSo we need more education in the education system about mental health, what that is, and how they can refer these children to get other services. We also need that in the general public. There needs to be more of an effort to -- like this particular show -- to inform people about what are some of the challenges around mental health and how can we refer people. I think about the number of incidents that are happening in our society that are children-related or adolescent-related, like the incident in Columbia, where I don't know whether they still found out why it happened -- where the two people were shot at the mall.

MANNINGOr whether it was mental-health related or was there some other situation. And these situations continue to happen, where we're unaware of the connection between mental health, post-traumatic stress, acute stress disorder and some of these violent incidences that are happening in the public,

NNAMDIRebecca, in Baltimore, Md. Rebecca, you are on the air. Go ahead, please.

REBECCAYes. Hello. Thank you for having me. A lot of what I wanted to talk about actually has already been brought up and discussed.

NNAMDIThat's good because we only have about two minutes left.

REBECCAOh, great. Okay. Well, real quick, cut to the chase. I have PTSD and I'm also a professional physical therapist. And I've been working in physical therapy for 13 years. And the discrepancy that I see is sometimes that there's a lot of emphasis being put on PTSD as a mental disorder, but not enough emphasis being put on how to treat it from an inter-disciplinary approach, how the physical body is very much connected to the mental body and how the brain and the physiological phenomena need to be reprogrammed and then…

NNAMDIAllow me to have Thomas Mellman respond to that.

REBECCASure.

MELLMANWell, thank you for making that point. I think I have in my remarks emphasized the connection between post-traumatic stress and physical health conditions, including cardiovascular problems, diabetes. PTSD often occurs and is triggered by situations that involve physical injury. And having PTSD certainly complicates the pain and disability that can arise from the physical limitation. So I couldn't agree more that interdisciplinary efforts are needed and are optimal. And that includes people on the so-called medical side of the spectrum, as well as the mental health side.

NNAMDIAnd I'm afraid that's all the time we have. Thomas Mellman is a professor of psychiatry and vice dean of research in the College of Medicine at Howard University. Penny Griffith is a clinical social worker and executive director of the Columbia Heights/Shaw Family Support Collaborative. Maxwell Manning is a clinical social worker and consultant, currently CEO for the Institute for Human and Business Development and New Life Counseling Center.

NNAMDIAnd Lois Beckett is a reporter for ProPublica, which recently conducted a survey of trauma centers in cities with the highest homicide rates, and highlighted the prevalence of civilian PTSD. Thank you all for joining us and thank you all for listening. I'm Kojo Nnamdi.