Cheryl Platzman Weinstock, Author at KFF Health News https://kffhealthnews.org Mon, 03 Feb 2025 13:12:28 +0000 en-US hourly 1 https://wordpress.org/?v=6.6.2 https://kffhealthnews.org/wp-content/uploads/sites/2/2023/04/kffhealthnews-icon.png?w=32 Cheryl Platzman Weinstock, Author at KFF Health News https://kffhealthnews.org 32 32 161476233 Little Tracking, Wide Variability Permeate the Teams Tasked With Stopping School Shootings https://kffhealthnews.org/news/article/threat-assessment-teams-school-shootings-secret-service-fbi/ Mon, 03 Feb 2025 10:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1977295 Max Schachter wanted to be close to his son Alex on his birthday, July 9, so he watched old videos of him.

“It put a smile on my face to see him so happy,” Schachter said.

Alex would have turned 21 that day, six years after he and 16 other children and staff at Marjory Stoneman Douglas High School in Parkland, Florida, were shot and killed by a former student in 2018. In the years before the shooting, that former student had displayed concerning behavior that elicited dozens of calls to 911 and at least two tips to the FBI.

“Alex should still be here today. It’s not fair,” Schachter said.

After two weeks of grieving Alex’s death, Schachter, propelled by anger and pain, began advocating for school safety. In part, he wanted to ensure his three other children would never be harmed in the same way. He joined the newly formed Marjory Stoneman Douglas High School Public Safety Commission to improve the safety and security of Florida’s students. And he launched a nonprofit bearing Alex’s name, which advocates for school safety.

Doing that work, he learned about threat assessment teams, groups of law enforcement and school officials who try to identify potentially dangerous or distressed kids, intervene, and prevent the next school shooting. Florida is one of about 18 states that require schools to have threat assessment and intervention teams; a national survey estimates 85% of public schools have a team assigned to the task.

The teams, whose mission and operational strategies often are based on research from the FBI and the Secret Service’s National Threat Assessment Center, or NTAC, have become more common as the number of school shootings has increased. Despite their prevalence for almost 25 years, some of the teams have developed systemic problems that put them at risk of unfairly labeling and vilifying children.

States vary widely in their requirements of threat assessment teams and there isn’t a nationwide archetype. Few school districts and states collect data about the teams, little is known about their operations, and research on their effectiveness at thwarting mass shootings and other threats is limited. But a 2021 analysis by the NTAC of 67 plots against K-12 schools found that people “contemplating violence often exhibit observable behaviors, and when community members report these behaviors, the next tragedy can be averted.”

“School shooters have a long thought process. They don’t just snap. They have concerning behavior over time. If we can identify them early, we can intervene,” said Karie Gibson, chief of the FBI’s Behavioral Analysis Unit.

Yet, Dewey Cornell, a forensic clinical psychologist who in 2001 developed one of the first sets of guidelines for school threat assessment teams, said there have been problems. In many cases, he said, threats have been deemed not serious “but parents and teachers are so alarmed that it is difficult to assuage their fears. The school community gets in an uproar and the school administrators feel pressured to expel the student.”

And in other cases, a school doesn’t do a threat assessment and assumes a student is dangerous when somebody else reports them as a threat, and they may take a zero tolerance approach and remove them from the school, said Cornell, the Virgil S. Ward professor of education at the University of Virginia.

A task force convened by the American Psychological Association found little evidence that zero tolerance policies have improved school climate or school safety and said they may create negative mental health outcomes for students. The task force cited examples of students who were expelled for incidents or school rule violations as minor as having a knife in their lunch box for cutting an apple.

Marisa Randazzo, a research psychologist and the director of threat assessment for Georgetown University, said she has also seen “hyperreactions,” especially among school communities that have experienced a mass killing.

“It’s understandable. People who have been close to an event like this are on higher alert than other people,” said Randazzo, who previously worked for the Secret Service and co-founded Sigma Threat Management Associates.

Threat assessments are supposed to be a graduated process calibrated to the seriousness of a problem, since the majority of student threats are not credible and can be resolved through supportive interventions, according to research from the Secret Service.

Stephanie Crawford-Goetz, a school psychologist and the director of mental health for student support services in the Douglas County School District in Colorado, where a shooting occurred at a charter school in 2019, said her district’s threat assessment process emphasizes a proactive, rehabilitative approach to managing potential threats, as the NTAC suggests.

Crawford-Goetz said her district interviews students before convening the team to assess whether a threat is a misguided expression of anger or frustration and if the student has a plan and means to carry out violence.

Students whose threats are deemed transient receive support, such as help with coping skills, and they may meet with a mental health provider.

If the threat is credible, a student may be temporarily removed from the classroom or school.

Randazzo said the vast majority of kids who make threats are suicidal or despondent: “The process is designed primarily to figure out if someone is in crisis and how we can help. It is not designed to be punitive.”

Crawford-Goetz tells parents about her district’s threat assessment team at the beginning of the school year. Some districts report keeping their teams a secret from parents, which is not how they were designed to operate, said Lina Alathari, chief of the NTAC. Her team encourages schools to educate the whole community about the threat assessment process.

Some advocacy groups contend that threat assessment teams have perpetuated inequities. There has also been widespread concern that children with disabilities can easily get swept into a threat assessment.

In a 2022 report, the National Disability Rights Network, a nonprofit based in Washington, D.C., said some threat assessment teams have become “judge, jury, and executioner,” going beyond assessing risk of serious, imminent harm to determining guilt and punishment.

Expanding their scope allows threat assessment teams to get around civil rights protections, the report says.

Cornell disputed the disability rights group’s conclusion. “This has not been corroborated by scientific studies and is speculative,” he said.

Some states, such as Florida, mandate that threat assessment teams determine whether a student’s disability played a role in their behavior and recommend they include special education teachers and other professionals in their evaluation.

In Texas, which has mandated threat assessment teams, a third of students subjected to threat assessments in the Dallas Independent School District receive special education services.

Yet, the district doesn’t have a special education staff representative on its threat assessment team, according to a March 2023 report by Texas Appleseed, a nonprofit public interest justice center.

Many school districts are developing their own models in the absence of national standards for threat assessments.

Florida revamped its threat assessment system in January 2024 to improve response times, provide consistent data collection, and build in more checks and balances and oversight, said Pinellas County Sheriff Bob Gualtieri, who is also chair of the Marjory Stoneman Douglas High School Public Safety Commission.

The new model requires the teams to work quickly and file uniform, electronic summary reports of threat assessment findings. Those results follow students throughout their school years.

The adjustments are intended to eliminate the risk of not knowing about a student’s past troubling behavior if they change schools, as occurred with the Parkland shooter and a student who shot and killed classmates at a high school near Winder, Georgia, in September, said Gualtieri.

“As parents, you never stop worrying about your kids,” Schachter said.

Virginia mandates that all public schools and higher education institutions, including colleges, have threat assessment teams. In Florida, where one of Schachter’s daughters attends college, threat assessment teams are mandated in all public schools, including charter schools.

“There’s more work to be done,” Schachter said.

Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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]]> 1977295 Décadas de programas nacionales contra el suicidio no han frenado estas muertes https://kffhealthnews.org/news/article/decadas-de-programas-nacionales-contra-el-suicidio-no-han-frenado-estas-muertes/ Mon, 16 Sep 2024 12:58:41 +0000 https://kffhealthnews.org/?post_type=article&p=1916438 Si tú o alguien que conoces pudiera estar pasando por una crisis de salud mental, comunícate con la línea directa de suicidio y crisis 988, marcando o enviando un mensaje de texto al “988”.

Cuando el hermano menor de Pooja Mehta, Raj, murió por suicidio a los 19 años en marzo de 2020, ella se sintió “inesperadamente sorprendida”.

El último mensaje de texto de Raj fue para su compañero de laboratorio en la universidad sobre cómo organizar las preguntas de una tarea.

“No dices que vas a tomar las preguntas del 1 al 15 si planeas estar muerto una hora después”, dijo Mehta, de 29 años, defensora de salud mental y prevención del suicidio en Arlington, Virginia. Había recibido capacitación en Primeros Auxilios de Salud Mental, un programa nacional que enseña cómo identificar, comprender y responder a las señales de enfermedad mental. Sin embargo, dijo que su hermano no mostró signos de problemas.

Mehta dijo que algunas personas la culparon por la muerte de Raj porque los dos vivían juntos durante la pandemia de covid-19, mientras Raj tomaba clases por internet. Otros dijeron que su capacitación debería haberla ayudado a reconocer que su hermano estaba en crisis.

Pero Mehta dijo que “actuamos como si supiéramos todo lo que hay que saber sobre la prevención del suicidio. Hemos hecho un buen trabajo desarrollando soluciones para parte del problema, pero realmente no sabemos lo suficiente”.

La muerte de Raj ocurrió en medio de décadas de intentos fallidos para reducir las tasas de suicidio a nivel nacional.

Durante los últimos 20 años, funcionarios federales han lanzado tres estrategias nacionales de prevención del suicidio, incluida una anunciada en abril.

La primera estrategia, de 2001, se centró en abordar los factores de riesgo del suicidio y se basó en algunas intervenciones comunes.

La siguiente, pidió desarrollar e implementar protocolos estandarizados para identificar y tratar a personas en riesgo de suicidio, con seguimiento y el apoyo necesario para continuar el tratamiento.

La iniciativa más reciente se basa en las anteriores e incluye un plan de acción federal que llama a implementar 200 medidas durante los próximos tres años, incluidas priorizar a las poblaciones desproporcionadamente afectadas por el suicidio, como los jóvenes negros, los nativos americanos y de Alaska.

A pesar de estas estrategias en evolución, desde 2001 hasta 2021, las tasas de suicidio aumentaron la mayoría de los años, según los Centros para el Control y Prevención de Enfermedades (CDC). Los datos provisionales de 2022, los más recientes disponibles, muestran que las muertes por suicidio aumentaron un 3% adicional con respecto al año anterior.

Funcionarios de los CDC proyectan que el número final de suicidios en 2022 será aún mayor.

En las últimas dos décadas, las tasas de suicidio en estados rurales como Alaska, Montana, Dakota del Norte y Wyoming han sido aproximadamente el doble que en áreas urbanas, según los CDC.

A pesar de esas cifras persistentemente desalentadoras, expertos en salud mental sostienen que las estrategias nacionales no son el problema. En cambio, argumentan que las políticas, por muchas razones, simplemente no se están financiando, adoptando y poniendo en marcha.

Esa lenta adopción se vio agravada por la pandemia de covid-19, que tuvo un amplio y negativo impacto en la salud mental.

Un grupo de expertos nacionales y funcionarios gubernamentales coincide en que las estrategias simplemente no han sido adoptadas de manera generalizada, y dijeron que incluso el seguimiento básico de las muertes por suicidio no es universal.

Los datos de vigilancia se utilizan comúnmente para impulsar la mejora de la calidad de la atención médica y han sido útiles para abordar el cáncer y las enfermedades cardíacas. Sin embargo, no se han utilizado en el estudio de problemas de salud conductual como el suicidio, dijo Michael Schoenbaum, asesor principal de servicios de salud mental, epidemiología y economía en el Instituto Nacional de Salud Mental (NIMH).

“Pensamos en tratar los problemas de salud conductual de manera diferente a como pensamos en los problemas de salud física”, dijo Schoenbaum.

Sin estadísticas precisas, los investigadores no pueden averiguar quién muere con mayor frecuencia por suicidio, qué estrategias de prevención están funcionando y dónde se necesita más dinero para la prevención.

Muchos estados y territorios no permiten que los registros médicos se vinculen a los certificados de defunción, dijo Schoenbaum, pero el NIMH está colaborando con otras organizaciones para documentar estos datos por primera vez en un informe público y una base de datos que se publicarán antes de fin de año.

Además, las estrategias enfrentan obstáculos en el hecho de que la financiación federal y local sube y baja, y algunos esfuerzos de prevención del suicidio no funcionan en ciertos estados y localidades debido a la geografía desafiante, dijo Jane Pearson, asesora especial de investigación sobre suicidio para el director del NIMH.

Wyoming, donde unos cientos de miles de residentes viven dispersos en un paisaje extenso y desigual, consistentemente se ubica entre los estados con las tasas más altas de suicidio.

Los funcionarios estatales han trabajado durante muchos años para abordar el problema del suicidio en el estado, dijo Kim Deti, portavoz del Departamento de Salud de Wyoming.Pero desplegar servicios, como unidades móviles de crisis, un elemento central de la estrategia nacional más reciente, es difícil en un estado grande y escasamente poblado.

“El trabajo no se detiene, pero algunas estrategias que tienen sentido en algunas áreas geográficas del país pueden no tenerlo en un estado con nuestras características”, dijo.

La falta de implementación no es solo un problema de los gobiernos estatales y locales. A pesar de la evidencia de que examinar a los pacientes en busca de pensamientos suicidas durante las visitas médicas ayuda a evitar catástrofes, no se obliga a los profesionales de la salud a hacerlo.

Muchos médicos dicen que hacer las preguntas sobre el suicidio es desalentador porque tienen poco tiempo, una formación insuficiente y no se sienten cómodos hablando de suicidio, dijo Janet Lee, especialista en medicina adolescente y profesora asociada de pediatría en la Escuela de Medicina Lewis Katz de la Universidad Temple.

“Creo que es realmente aterrador y sorprendente pensar que si algo es una cuestión de vida o muerte, alguien no pueda preguntar sobre ello”, dijo.

El uso de otras medidas también ha sido inconsistente. Los servicios de intervención de crisis son fundamentales para las estrategias nacionales, pero muchos estados no han construido sistemas estandarizados.

Además de ser fragmentados, los sistemas de crisis, como las unidades móviles de crisis, pueden variar de un estado a otro y de un condado a otro. Algunas unidades móviles de crisis utilizan telemedicina, algunas operan las 24 horas del día y otras de 9 a 5, y algunas recurren a la policía local en lugar de buscar a trabajadores de salud mental.

Y la incipiente línea 988 de prevención del suicidio y crisis también enfrenta problemas graves.

Solo el 23% de los estadounidenses están familiarizados con el 988 y hay una brecha significativa de conocimiento sobre las situaciones en las que las personas deberían llamar al 988, según una encuesta reciente realizada por Ipsos y la Alianza Nacional sobre Afecciones Mentales.

La mayoría de los estados, territorios y naciones indígenas aún no han financiado de manera permanente al 988, que se lanzó a nivel nacional en julio de 2022 y ha recibido alrededor de $1,500 millones en fondos federales, según la Administración de Servicios de Salud Mental y Abuso de Sustancias (SAMHSA).

Anita Everett, directora del Centro de Servicios de Salud Mental de SAMHSA, dijo que su agencia está realizando una campaña de concientización para promover el sistema.

Algunos estados, como Colorado, están tomando otras medidas.

Allí, funcionarios estatales lanzaron incentivos financieros para implementar esfuerzos de prevención del suicidio, entre otras medidas de seguridad para los pacientes, a través del Programa Estatal de Pago por Incentivos de Calidad Hospitalaria.

El programa otorga alrededor de $150 millones al año a los hospitales por su buen desempeño. En el último año, 66 hospitales mejoraron su atención a los pacientes que tuvieron conductas suicidas, según Lena Heilmann, directora de la Oficina de Prevención del Suicidio del Departamento de Salud Pública y Medio Ambiente de Colorado.

Los expertos esperan que otros estados sigan el ejemplo de Colorado.

Y a pesar del lento avance, Mehta ve puntos positivos en la última estrategia y plan de acción.Aunque es demasiado tarde para salvar a Raj, “abordar los factores sociales que impulsan la salud mental y el suicidio e invertir en espacios para que las personas busquen ayuda mucho antes de una crisis me da esperanza”, dijo Mehta.

El reportaje de Cheryl Platzman Weinstock cuenta con el apoyo de una beca del National Institute for Health Care Management Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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]]> 1916438 Decades of National Suicide Prevention Policies Haven’t Slowed the Deaths https://kffhealthnews.org/news/article/national-suicide-prevention-strategy-action-plan-rising-rates-deaths/ Mon, 16 Sep 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1908647 If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

When Pooja Mehta’s younger brother, Raj, died by suicide at 19 in March 2020, she felt “blindsided.”

Raj’s last text message was to his college lab partner about how to divide homework questions.

“You don’t say you’re going to take questions 1 through 15 if you’re planning to be dead one hour later,” said Mehta, 29, a mental health and suicide prevention advocate in Arlington, Virginia. She had been trained in Mental Health First Aid — a nationwide program that teaches how to identify, understand, and respond to signs of mental illness — yet she said her brother showed no signs of trouble.

Mehta said some people blamed her for Raj’s death because the two were living together during the covid-19 pandemic while Raj was attending classes online. Others said her training should have helped her recognize he was struggling.

But, Mehta said, “we act like we know everything there is to know about suicide prevention. We’ve done a really good job at developing solutions for a part of the problem, but we really don’t know enough.”

Raj’s death came in the midst of decades of unsuccessful attempts to tamp down suicide rates nationwide.

During the past two decades federal officials have launched three national suicide prevention strategies, including one announced in April.

The first strategy, announced in 2001, focused on addressing risk factors for suicide and leaned on a few common interventions.

The next strategy called for developing and implementing standardized protocols to identify and treat people at risk for suicide with follow-up care and the support needed to continue treatment.

The latest strategy builds on previous ones and includes a federal action plan calling for implementation of 200 measures over the next three years, including prioritizing populations disproportionately affected by suicide, such as Black youth and Native Americans and Alaska Natives.

Despite those evolving strategies, from 2001 through 2021 suicide rates increased most years, according to the Centers for Disease Control and Prevention. Provisional data for 2022, the most recent numbers available, shows deaths by suicide grew an additional 3% over the previous year. CDC officials project the final number of suicides in 2022 will be higher.

In the past two decades, suicide rates in rural states such as Alaska, Montana, North Dakota, and Wyoming have been about double those in urban areas, according to the CDC.

Despite those persistently disappointing numbers, mental health experts contend the national strategies aren’t the problem. Instead, they argue, the policies — for many reasons —simply aren’t being funded, adopted, and used. That slow uptake was compounded by the covid-19 pandemic, which had a broad, negative impact on mental health.

A chorus of national experts and government officials agree the strategies simply haven’t been embraced widely, but said even basic tracking of deaths by suicide isn’t universal.

Surveillance data is commonly used to drive health care quality improvement and has been helpful in addressing cancer and heart disease. Yet, it hasn’t been used in the study of behavioral health issues such as suicide, said Michael Schoenbaum, a senior adviser for mental health services, epidemiology, and economics at the National Institute of Mental Health.

“We think about treating behavioral health problems just differently than we think about physical health problems,” Schoenbaum said.

Without accurate statistics, researchers can’t figure out who dies most often by suicide, what prevention strategies are working, and where prevention money is needed most.

Many states and territories don’t allow medical records to be linked to death certificates, Schoenbaum said, but NIMH is collaborating with a handful of other organizations to document this data for the first time in a public report and database due out by the end of the year.

Further hobbling the strategies is the fact that federal and local funding ebbs and flows and some suicide prevention efforts don’t work in some states and localities because of the challenging geography, said Jane Pearson, special adviser on suicide research to the NIMH director.

Wyoming, where a few hundred thousand residents are spread across sprawling, rugged landscape, consistently ranks among the states with the highest suicide rates.

State officials have worked for many years to address the state’s suicide problem, said Kim Deti, a spokesperson for the Wyoming Department of Health.

But deploying services, like mobile crisis units, a core element of the latest national strategy, is difficult in a big, sparsely populated state.

“The work is not stopping but some strategies that make sense in some geographic areas of the country may not make sense for a state with our characteristics,” she said.

Lack of implementation isn’t only a state and local government problem. Despite evidence that screening patients for suicidal thoughts during medical visits helps head off catastrophe, health professionals are not mandated to do so.

Many doctors find suicide screening daunting because they have limited time and insufficient training and because they aren’t comfortable discussing suicide, said Janet Lee, an adolescent medicine specialist and associate professor of pediatrics at the Lewis Katz School of Medicine at Temple University.

“I think it is really scary and kind of astounding to think if something is a matter of life and death how somebody can’t ask about it,” she said.

The use of other measures has also been inconsistent. Crisis intervention services are core to the national strategies, yet many states haven’t built standardized systems.

Besides being fragmented, crisis systems, such as mobile crisis units, can vary from state to state and county to county. Some mobile crisis units use telehealth, some operate 24 hours a day and others 9 to 5, and some use local law enforcement for responses instead of mental health workers.

Similarly, the fledgling 988 Suicide & Crisis Lifeline faces similar, serious problems.

Only 23% of Americans are familiar with 988 and there’s a significant knowledge gap about the situations people should call 988 for, according to a recent poll conducted by the National Alliance on Mental Illness and Ipsos.

Most states, territories, and tribes have also not yet permanently funded 988, which was launched nationwide in July 2022 and has received about $1.5 billion in federal funding, according to the Substance Abuse and Mental Health Services Administration.

Anita Everett, director of the Center for Mental Health Services within SAMHSA, said her agency is running an awareness campaign to promote the system.

Some states, including Colorado, are taking other steps. There, state officials installed financial incentives for implementing suicide prevention efforts, among other patient safety measures, through the state’s Hospital Quality Incentive Payment Program. The program hands out about $150 million a year to hospitals for good performance. In the last year, 66 hospitals improved their care for patients experiencing suicidality, according to Lena Heilmann, director of the Office of Suicide Prevention at the Colorado Department of Public Health and Environment.

Experts hope other states will follow Colorado’s lead.

And despite the slow movement, Mehta sees bright spots in the latest strategy and action plan.

Although it is too late to save Raj, “addressing the social drivers of mental health and suicide and investing in spaces for people to go to get help well before a crisis gives me hope,” Mehta said.

Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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]]> 1908647 Federal Panel Prescribes New Mental Health Strategy To Curb Maternal Deaths https://kffhealthnews.org/news/article/postpartum-mental-health-federal-strategy-maternal-deaths/ Thu, 16 May 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1852717 For help, call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262) or contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.” Spanish-language services are also available.

BRIDGEPORT, Conn. — Milagros Aquino was trying to find a new place to live and had been struggling to get used to new foods after she moved to Bridgeport from Peru with her husband and young son in 2023.

When Aquino, now 31, got pregnant in May 2023, “instantly everything got so much worse than before,” she said. “I was so sad and lying in bed all day. I was really lost and just surviving.”

Aquino has lots of company.

Perinatal depression affects as many as 20% of women in the United States during pregnancy, the postpartum period, or both, according to studies. In some states, anxiety or depression afflicts nearly a quarter of new mothers or pregnant women.

Many women in the U.S. go untreated because there is no widely deployed system to screen for mental illness in mothers, despite widespread recommendations to do so. Experts say the lack of screening has driven higher rates of mental illness, suicide, and drug overdoses that are now the leading causes of death in the first year after a woman gives birth.

“This is a systemic issue, a medical issue, and a human rights issue,” said Lindsay R. Standeven, a perinatal psychiatrist and the clinical and education director of the Johns Hopkins Reproductive Mental Health Center.

Standeven said the root causes of the problem include racial and socioeconomic disparities in maternal care and a lack of support systems for new mothers. She also pointed a finger at a shortage of mental health professionals, insufficient maternal mental health training for providers, and insufficient reimbursement for mental health services. Finally, Standeven said, the problem is exacerbated by the absence of national maternity leave policies, and the access to weapons.

Those factors helped drive a 105% increase in postpartum depression from 2010 to 2021, according to the American Journal of Obstetrics & Gynecology.

For Aquino, it wasn’t until the last weeks of her pregnancy, when she signed up for acupuncture to relieve her stress, that a social worker helped her get care through the Emme Coalition, which connects girls and women with financial help, mental health counseling services, and other resources.

Mothers diagnosed with perinatal depression or anxiety during or after pregnancy are at about three times the risk of suicidal behavior and six times the risk of suicide compared with mothers without a mood disorder, according to recent U.S. and international studies in JAMA Network Open and The BMJ.

The toll of the maternal mental health crisis is particularly acute in rural communities that have become maternity care deserts, as small hospitals close their labor and delivery units because of plummeting birth rates, or because of financial or staffing issues.

This week, the Maternal Mental Health Task Force — co-led by the Office on Women’s Health and the Substance Abuse and Mental Health Services Administration and formed in September to respond to the problem — recommended creating maternity care centers that could serve as hubs of integrated care and birthing facilities by building upon the services and personnel already in communities.

The task force will soon determine what portions of the plan will require congressional action and funding to implement and what will be “low-hanging fruit,” said Joy Burkhard, a member of the task force and the executive director of the nonprofit Policy Center for Maternal Mental Health.

Burkhard said equitable access to care is essential. The task force recommended that federal officials identify areas where maternity centers should be placed based on data identifying the underserved. “Rural America,” she said, “is first and foremost.”

There are shortages of care in “unlikely areas,” including Los Angeles County, where some maternity wards have recently closed, said Burkhard. Urban areas that are underserved would also be eligible to get the new centers.

“All that mothers are asking for is maternity care that makes sense. Right now, none of that exists,” she said.

Several pilot programs are designed to help struggling mothers by training and equipping midwives and doulas, people who provide guidance and support to the mothers of newborns.

In Montana, rates of maternal depression before, during, and after pregnancy are higher than the national average. From 2017 to 2020, approximately 15% of mothers experienced postpartum depression and 27% experienced perinatal depression, according to the Montana Pregnancy Risk Assessment Monitoring System. The state had the sixth-highest maternal mortality rate in the country in 2019, when it received a federal grant to begin training doulas.

To date, the program has trained 108 doulas, many of whom are Native American. Native Americans make up 6.6% of Montana’s population. Indigenous people, particularly those in rural areas, have twice the national rate of severe maternal morbidity and mortality compared with white women, according to a study in Obstetrics and Gynecology.

Stephanie Fitch, grant manager at Montana Obstetrics & Maternal Support at Billings Clinic, said training doulas “has the potential to counter systemic barriers that disproportionately impact our tribal communities and improve overall community health.”

Twelve states and Washington, D.C., have Medicaid coverage for doula care, according to the National Health Law Program. They are California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, Oklahoma, Oregon, Rhode Island, and Virginia. Medicaid pays for about 41% of births in the U.S., according to the Centers for Disease Control and Prevention.

Jacqueline Carrizo, a doula assigned to Aquino through the Emme Coalition, played an important role in Aquino’s recovery. Aquino said she couldn’t have imagined going through such a “dark time alone.” With Carrizo’s support, “I could make it,” she said.

Genetic and environmental factors, or a past mental health disorder, can increase the risk of depression or anxiety during pregnancy. But mood disorders can happen to anyone.

Teresa Martinez, 30, of Price, Utah, had struggled with anxiety and infertility for years before she conceived her first child. The joy and relief of giving birth to her son in 2012 were short-lived.

Without warning, “a dark cloud came over me,” she said.

Martinez was afraid to tell her husband. “As a woman, you feel so much pressure and you don’t want that stigma of not being a good mom,” she said.

In recent years, programs around the country have started to help doctors recognize mothers’ mood disorders and learn how to help them before any harm is done.

One of the most successful is the Massachusetts Child Psychiatry Access Program for Moms, which began a decade ago and has since spread to 29 states. The program, supported by federal and state funding, provides tools and training for physicians and other providers to screen and identify disorders, triage patients, and offer treatment options.

But the expansion of maternal mental health programs is taking place amid sparse resources in much of rural America. Many programs across the country have run out of money.

The federal task force proposed that Congress fund and create consultation programs similar to the one in Massachusetts, but not to replace the ones already in place, said Burkhard.

In April, Missouri became the latest state to adopt the Massachusetts model. Women on Medicaid in Missouri are 10 times as likely to die within one year of pregnancy as those with private insurance. From 2018 through 2020, an average of 70 Missouri women died each year while pregnant or within one year of giving birth, according to state government statistics.

Wendy Ell, executive director of the Maternal Health Access Project in Missouri, called her service a “lifesaving resource” that is free and easy to access for any health care provider in the state who sees patients in the perinatal period.

About 50 health care providers have signed up for Ell’s program since it began. Within 30 minutes of a request, the providers can consult over the phone with one of three perinatal psychiatrists. But while the doctors can get help from the psychiatrists, mental health resources for patients are not as readily available.

The task force called for federal funding to train more mental health providers and place them in high-need areas like Missouri. The task force also recommended training and certifying a more diverse workforce of community mental health workers, patient navigators, doulas, and peer support specialists in areas where they are most needed.

A new voluntary curriculum in reproductive psychiatry is designed to help psychiatry residents, fellows, and mental health practitioners who may have little or no training or education about the management of psychiatric illness in the perinatal period. A small study found that the curriculum significantly improved psychiatrists’ ability to treat perinatal women with mental illness, said Standeven, who contributed to the training program and is one of the study’s authors.

Nancy Byatt, a perinatal psychiatrist at the University of Massachusetts Chan School of Medicine who led the launch of the Massachusetts Child Psychiatry Access Program for Moms in 2014, said there is still a lot of work to do.

“I think that the most important thing is that we have made a lot of progress and, in that sense, I am kind of hopeful,” Byatt said.

Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management Foundation.

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]]> 1852717 Proponen estrategia federal de salud mental para frenar muertes maternas https://kffhealthnews.org/news/article/proponen-estrategia-federal-de-salud-mental-para-frenar-muertes-maternas/ Thu, 16 May 2024 08:59:00 +0000 https://kffhealthnews.org/?post_type=article&p=1854431 Bridgeport, Connecticut.- Milagros Aquino buscaba un nuevo lugar para vivir y estaba intentando acostumbrarse a la comida después de mudarse a Bridgeport, desde Perú, con su esposo y su hijo pequeño en 2023.

Cuando Aquino, que ahora tiene 31 años, se quedó embarazada en mayo de ese año, “de repente todo fue peor que antes”, dijo. “Estaba muy triste y me pasaba el día en la cama. Me sentía realmente perdida y me limitaba a sobrevivir”.

El caso de Aquino no es único.

Según estudios, la depresión perinatal afecta a un 20% de las mujeres en Estados Unidos durante el embarazo, el posparto o ambos. En algunos estados, la ansiedad o la depresión afectan a casi una cuarta parte de las madres primerizas o de las embarazadas.

Muchas mujeres en el país no reciben tratamiento porque no existe un sistema generalizado de detección de enfermedades mentales en las madres, a pesar de las recomendaciones. Expertos afirman que la falta de detección ha provocado un aumento de las tasas de enfermedad mental, suicidio y sobredosis de drogas, que ahora son las principales causas de muerte en el primer año después que una mujer da a luz.

“Se trata de un problema sistémico, médico y de derechos humanos”, afirmó Lindsay R. Standeven, psiquiatra perinatal y directora clínica y educativa del Johns Hopkins Reproductive Mental Health Center.

Según Standeven, entre las causas profundas del problema figuran las disparidades raciales y socioeconómicas en la atención materna y la falta de sistemas de apoyo para las nuevas madres.

También apuntó a la escasez de profesionales de salud mental, la insuficiente formación en salud mental materna de los proveedores y el insuficiente reembolso por estos servicios. Por último, Standeven señaló que el problema se ve agravado por la falta de políticas nacionales de licencia por maternidad y el acceso a las armas.

Estos factores contribuyeron a un aumento del 105% de la depresión posparto entre 2010 y 2021, según el American Journal of Obstetrics & Gynecology.

En el caso de Aquino, no fue hasta las últimas semanas de su embarazo, cuando empezó a hacer acupuntura para aliviar su estrés. Una trabajadora social la ayudó a recibir atención a través de la Emme Coalition, una organización que conecta a niñas y mujeres con ayuda financiera, servicios de asesoramiento en salud mental y otros recursos.

Las madres a las que se diagnostica con depresión o ansiedad perinatal durante o después del embarazo corren un riesgo tres veces mayor de comportamiento suicida y seis veces mayor de suicidio que las madres sin un trastorno del estado de ánimo, según estudios recientes, estadounidenses e internacionales, publicados en JAMA Network Open y The BMJ.

Las consecuencias de la crisis de salud mental materna son especialmente graves en las comunidades rurales que se han convertido en desiertos para la atención de la maternidad, ya que los pequeños hospitales cierran sus unidades de parto por la caída de las tasas de natalidad o por problemas económicos o de personal.

Hace pocos días, el Grupo de Trabajo sobre Salud Mental Materna —codirigido por la Oficina de Salud de la Mujer y la Administración de Servicios de Salud Mental y Abuso de Sustancias, y constituido en septiembre para dar respuesta a este problema— recomendó crear centros de atención de maternidad que pudieran servir como núcleos de atención integrada, e instalaciones de parto, aprovechando los servicios y el personal ya existentes en las comunidades.

Según Joy Burkhard, miembro del grupo de trabajo y directora ejecutiva de la organización sin fines de lucro Policy Center for Maternal Mental Health, el grupo de trabajo determinará en breve qué partes del plan requerirán la intervención del Congreso y financiación para su puesta en práctica, y cuáles serán “las opciones más factibles”.

Para Burkhard, es esencial un acceso equitativo a la salud. El grupo de trabajo recomendó que los funcionarios federales determinen las zonas en las que deben ubicarse los centros de maternidad basándose en datos que identifiquen a las desatendidas. “La América rural”, dijo, “es lo primero y lo más importante”.

Hay escasez de atención en “zonas poco probables”, como el condado de Los Angeles, donde recientemente se han cerrado algunas maternidades, explicó Burkhard. Las zonas urbanas desatendidas también podrían er elegibles para los nuevos centros.

“Lo único que piden las madres es un atención de la maternidad que tenga sentido. Ahora mismo no existe nada de eso”, añadió.

Se han diseñado varios programas piloto para ayudar a las madres con dificultades, que consisten en formar y equipar a comadronas y doulas, personas que orientan y apoyan a las madres de recién nacidos.

En Montana, las tasas de depresión materna antes, durante y después del embarazo son superiores a la media nacional. De 2017 a 2020, aproximadamente el 15% de las madres experimentaron depresión posparto y el 27% experimentaron depresión perinatal, según el Sistema de Monitoreo de Evaluación de Riesgos del Embarazo de Montana.

El estado tuvo la sexta tasa de mortalidad materna más alta del país en 2019, cuando recibió una subvención federal para comenzar a capacitar a las doulas.

Hasta la fecha, el programa ha capacitado a 108 doulas, muchas de las cuales son nativas americanas. Los nativos americanos representan el 6,6% de la población de Montana.

Según un estudio publicado en Obstetrics and Gynecology, las nativas, sobre todo las de zonas rurales, tienen el doble de morbilidad y mortalidad maternas que las mujeres blancas no hispanas a nivel nacional.

Stephanie Fitch, gestora de subvenciones de Montana Obstetrics & Maternal Support en la Clínica Billings, afirmó que la formación de doulas “tiene el potencial de contrarrestar las barreras sistémicas que afectan desproporcionadamente a nuestras comunidades tribales y mejorar la salud general de la comunidad”.

Doce estados y Washington, DC tienen cobertura de Medicaid para la atención de doulas, según el National Health Law Program. Son California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, Nueva Jersey, Oklahoma, Oregon, Rhode Island y Virginia.

Medicaid paga alrededor del 41% de los partos en Estados Unidos, según los Centros para el Control y Prevención de Enfermedades(CDC).

Jacqueline Carrizo, la doula asignada a Aquino a través de la Emme Coalition, desempeñó un papel importante en su recuperación. Según dijo Aquino, nunca podría haber pasado por un “momento tan oscuro sola”. Con el apoyo de Carrizo, “pude salir adelante”, afirmó.

Los factores genéticos y ambientales, o un trastorno mental previo, pueden aumentar el riesgo de depresión o ansiedad durante el embarazo. Pero los trastornos del estado de ánimo pueden afectar a cualquiera.

Teresa Martínez, de 30 años, de Price, Utah, había luchado contra la ansiedad y la infertilidad durante años antes de concebir a su primer hijo. Pero la alegría y el alivio de dar a luz en 2012 duraron poco.

Sin previo aviso, “una nube oscura se cernió sobre mí”, dijo.

Martínez tenía miedo de decírselo a su marido. “Como mujer, te sientes muy presionada y no quieres el estigma de no ser una buena madre”, explicó.

En los últimos años, se han puesto en marcha programas en todo el país para ayudar a los médicos a reconocer los trastornos del estado de ánimo de las madres y poder asistirlas antes de que se produzcan daños.

Uno de los programas más exitosos es el Massachusetts Child Psychiatry Access Program for Moms, que comenzó hace una década y desde entonces se ha extendido a 29 estados. El programa, financiado con fondos federales y estatales, proporciona herramientas y formación a médicos y otros profesionales para detectar e identificar trastornos, clasificar a los pacientes y ofrecer opciones de tratamiento.

Pero la expansión de los programas de salud mental materna se está produciendo en medio de la escasez de recursos en gran parte de la América rural. Muchos programas a lo largo del país se han quedado sin fondos.

El grupo de trabajo federal propuso que el Congreso financie y cree programas de consulta similares al de Massachusetts, pero no para sustituir a los que ya existen, dijo Burkhard.

En abril, Missouri se convirtió en el último estado en adoptar el modelo de Massachusetts.

Las residentes con Medicaid tienen 10 veces más probabilidades de morir en el primer año de embarazo que las que tienen seguro privado. De 2018 a 2020, un promedio de 70 mujeres de Missouri murieron cada año durante el embarazo o dentro del año posterior al parto, según las estadísticas del gobierno estatal.

Wendy Ell, directora ejecutiva del Proyecto de Acceso a la Salud Materna en Missouri, calificó su servicio como un “recurso que salva vidas”, gratuito y de fácil acceso para cualquier proveedor de atención médica en el estado que atienda a pacientes en el período perinatal.

Unos 50 profesionales de salud se han inscrito en el programa de Ell desde su puesta en marcha. En los 30 minutos siguientes a la solicitud, los profesionales pueden consultar por teléfono a uno de los tres psiquiatras perinatales. Pero mientras los médicos pueden recibir asesoramiento de los psiquiatras, los recursos de salud mental para las pacientes no son tan fáciles de conseguir.

El grupo de trabajo pidió financiamiento federal para formar a más profesionales de la salud mental y ubicarlos en zonas con grandes necesidades, como Missouri. El grupo de trabajo también recomendó formar y certificar a una plantilla más diversa de trabajadores comunitarios de salud mental, asesores de pacientes, doulas y especialistas de apoyo a colegas en las zonas donde más se necesitan.

Se ha diseñado un nuevo plan de estudios voluntario sobre psiquiatría reproductiva para ayudar a los residentes, becarios y profesionales de la salud mental con escasa o nula formación sobre el tratamiento de las enfermedades psiquiátricas en el periodo perinatal.

Un pequeño sondeo reveló que el plan de estudios mejoraba significativamente la capacidad de los psiquiatras para tratar a las mujeres en el período perinatal con enfermedades mentales, afirmó Standeven, que contribuyó al programa de formación y es uno de los autores del sondeo.

Nancy Byatt, psiquiatra perinatal de la Facultad de Medicina Chan de la Universidad de Massachusetts, que dirigió el lanzamiento del Massachusetts Child Psychiatry Access Program for Moms en 2014, dijo que todavía hay mucho trabajo por hacer.

“Creo que lo más importante es que hemos avanzado mucho y, en ese sentido, tengo cierta esperanza”, señaló Byatt.

Los informes de Cheryl Platzman Weinstock cuentan con el apoyo de una subvención del National Institute for Health Care Management Foundation.

Para ayuda, se puede llamar o enviar un mensaje de texto a la National Maternal Mental Health Hotline al 1-833-TLC-MAMA (1-833-852-6262) o contactar a 988 Suicide & Crisis Lifeline marcando o texteando “988”. Hay disponible servicios en español.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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]]> 1854431 Native American Communities Have the Highest Suicide Rates, Yet Interventions Are Scarce https://kffhealthnews.org/news/article/native-american-suicide-interventions-scarce/ Thu, 25 Jan 2024 10:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1802915 If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.” To reach the Native and Strong Lifeline, call “988” and press 4.

Amanda MorningStar has watched her children struggle with mental health issues, including suicidal thoughts. She often wonders why.

“We’re family-oriented and we do stuff together. I had healthy pregnancies. We’re very protective of our kids,” said MorningStar, who lives in Heart Butte, Montana, a town of about 600 residents on the Blackfeet Indian Reservation.

Yet despite her best efforts, MorningStar said, her family faces a grim reality that touches Native American communities nationwide. About a year ago, her 15-year-old son, Ben, was so grief-stricken over his cousin’s suicide and two classmates’ suicides that he tried to kill himself.

“Their deaths made me feel like part of me was not here. I was gone. I was lost,” said Ben MorningStar.

He spent more than a week in an inpatient mental health unit, but once home, he was offered sparse mental health resources.

Non-Hispanic Indigenous people in the United States die by suicide at higher rates than any other racial or ethnic group, according to the Centers for Disease Control and Prevention. The suicide rate among Montana’s Native American youth is more than five times the statewide rate for the same age group, according to the Montana Budget and Policy Center. Montana ranked third-worst among states for suicide deaths in 2020, and 10% of all suicides in the state from 2017 through 2021 were among Native Americans, even though they represent only 6.5% of the state’s population.

Despite decades of research into suicide prevention, suicide rates among Indigenous people have remained stubbornly high, especially among Indigenous people ages 10 to 24, according to the CDC. Experts say that’s because the national strategy for suicide prevention isn’t culturally relevant or sensitive to Native American communities’ unique values.

Suicide rates have increased among other racial and ethnic minorities, too, but to lesser degrees.

Systemic issues and structural inequities, including underfunded and under-resourced services from the federal Indian Health Service, also hamper suicide prevention in Indigenous communities. “I worried who was going to keep my son safe. Who could he call or reach out to? There are really no resources in Heart Butte,” said Amanda MorningStar.

Ben MorningStar said he is doing better. He now knows not to isolate himself when problems occur and that “it is OK to cry, and I got friends I can go to when I have a bad day. Friends are better than anything,” he said.

His twice-a-month, 15-minute virtual telehealth behavioral therapy visits from IHS were recently reduced to once a month.

Mary Cwik, a psychologist and senior scientist at the Center for Indigenous Health at Johns Hopkins Bloomberg School of Public Health in Baltimore, said the systemic shortcomings MorningStar has witnessed are symptoms of a national strategy that isn’t compatible with Indigenous value systems.

“It is not clear that the creation of the national strategy had Indigenous voices informing the priorities,” Cwik said.

The cause of high suicide rates in Indigenous communities is complex. Native Americans often live with the weight of more adverse childhood experiences than other populations — things such as emotional, physical, and sexual abuse, intimate partner violence, substance misuse, mental illness, parental separation or divorce, incarceration, and poverty.

Those adverse experiences stack upon intergenerational trauma caused by racial discrimination, colonization, forced relocation, and government-sanctioned abduction to boarding schools that persisted until the 1970s.

“There’s no way that communities shaped by these forces for so long will get rid of their problems fast by medical services. A lot of people in Indian Country struggle to retain hope. It’s easy to conclude that nothing can fix it,” said Joseph P. Gone, a professor of anthropology and global health and social medicine at Harvard University and member of the Gros Ventre (Aaniiih) tribal nation of Montana.

Most tribal nations are interested in collaborative research, but funding for such work is hard to come by, said Gone. So is funding for additional programs and services.

Stephen O’Connor, who leads the suicide prevention research program at the Division of Services and Intervention Research at the National Institute of Mental Health, said, “Given the crisis of suicide in Native American populations, we need more funding and continued sustained funding for research in this area.”

Getting grants for scientific research from NIMH, which is part of the National Institutes of Health, can be challenging, especially for smaller tribes, he said.

Officials at the NIMH and the Substance Abuse and Mental Health Services Administration said that they continue to build research partnerships with tribal nations and that they recently launched new grants and multiple programs that are culturally informed and evidence-based to reduce suicide in tribal communities.

NIMH researchers are even adjusting a commonly used suicide screening tool to incorporate more culturally appropriate language for Indigenous people.

Teresa Brockie, an associate professor at Johns Hopkins School of Nursing, is one of a small but growing number of researchers, many of whom are Indigenous, who study suicide prevention and intervention strategies that respect Indigenous beliefs and customs. Those strategies include smudging — the practice of burning medicinal plants to cleanse and connect people with their creator.

Without this understanding, research is hampered because people in tribal communities have “universal mistrust of health care and other colonized systems that have not been helpful to our people or proven to be supportive,” said Brockie, a member of Fort Belknap reservation’s Aaniiih Tribe.

Brockie is leading one of the first randomized controlled trials studying Indigenous people at Fort Peck. The project aims to reduce suicide risk by helping parents and caregivers deal with their own stress and trauma and develop positive coping skills. It’s also working to strengthen children’s tribal identity, connectivity, and spirituality.

In 2015, she reported on a study she led in 2011 to collect suicide data at the Fort Peck reservation in northeastern Montana. She found that adverse childhood experiences have a cumulative effect on suicide risk and also that tribal identity, strong connections with friends and family, and staying in school were protective against suicide.

In Arizona, Cwik is collaborating with the White Mountain Apache Tribe to help leaders there evaluate the impact of a comprehensive suicide surveillance system they created. So far, the program has reduced the overall Apache suicide rate by 38.3 % and the rate among young people ages 15 to 24 by 23%, according to the American Public Health Association.

Several tribal communities are attempting to implement a similar system in their communities, said Cwik.

Still, many tribal communities rely on limited mental health resources available through the Indian Health Service. One person at IHS is tasked with addressing suicide across almost 600 tribal nations.

Pamela End of Horn, a social worker and national suicide prevention consultant at IHS, said the Department of Veterans Affairs “has a suicide coordinator in every medical center across the U.S., plus case managers, and they have an entire office dedicated to suicide prevention. In Indian Health Service it is just me and that’s it.”

End of Horn, a member of the Oglala Lakota Sioux Tribe of the Pine Ridge Indian Reservation in South Dakota, blames politics for the discrepancy.

“Tribal leaders are pushing for more suicide prevention programs but lack political investment. The VA has strong proactive activities related to suicide and the backing of political leaders and veterans’ groups,” she said.

It is also hard to get mental health professionals to work on remote reservations, while VA centers tend to be in larger cities.

Even if more mental health services were available, they can be stigmatizing, re-traumatizing, and culturally incongruent for Indigenous people.

Many states are using creative strategies to stop suicide. A pilot project by the Rural Behavioral Health Institute screened more than 1,000 students in 10 Montana schools from 2020 to 2022. The governor of Montana is hoping to use state money to expand mental health screening for all schools.

Experts say the kinds of strategies best suited to prevent suicide among Native Americans should deliver services that reflect their diversity, traditions, and cultural and language needs.

That’s what Robert Coberly, 44, was searching for when he needed help.

Coberly began having suicidal thoughts at 10 years old.

“I was scared to live and scared to die. I just didn’t care,” said Coberly, who is a member of the Tulalip Tribes.

He suffered in private for nearly a decade until he almost died in a car crash while driving drunk. After a stay at a rehabilitation center, Coberly remained stable. Years later, though, his suicidal thoughts came rushing back when one of his children died. He sought treatment at a behavioral health center where some of the therapists were Indigenous. They blended Western methodologies with Indigenous customs, which, he said, “I was craving and what I needed.”

Part of his therapy included going to a sweat lodge for ritual steam baths as a means of purification and prayer.

Coberly was a counselor for the Native and Strong Lifeline, the first 988 crisis line for Indigenous people. He is now one of the crisis line tribal resource specialists connecting Indigenous people from Washington state with the resources they need.

“It’s about time we had this line. To be able to connect people with resources and listen to them is something I can’t explain except that I was in a situation where I wanted someone to hear me and talk to,” said Coberly.

Amanda MorningStar said she still worries about her son night and day, but he tries to reassure her.

“I go to sleep and wake up the next day to keep it going,” Ben MorningStar said. “I only get one chance. I might as well make the best of it.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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]]> 1802915 As Younger Children Increasingly Die by Suicide, Better Tracking and Prevention Is Sought https://kffhealthnews.org/news/article/pediatric-children-suicide-screening-prevention-risk/ Thu, 21 Sep 2023 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1746728 If you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 988 or contact the Crisis Text Line by texting HOME to 741741.

Jason Lance thought Jan. 21, 2010, was a day like any other until the call came.

He had dropped off his 9-year-old son, Montana, at Stewart’s Creek Elementary School in The Colony, Texas, that morning.

“There were no problems at home. He was smart. He wore his heart on his sleeve and he talked and talked and talked,” said Lance. It was “the same old, same old normal day. There were kisses and goodbyes and he said, ‘I love you, Daddy.’”

A few hours later, school officials called to say Montana had died by suicide while locked in the nurse’s bathroom.

“I knew he had some issues going on in school, but I never seen it coming,” said Lance. His shock and grief were complicated by the realization that there may have been more signs his son was struggling.

As children across the country step back into school routines this fall, it is important to pay attention to their mental health as well as their academics. Suicide ranks as either the seventh- or eighth-leading cause of death among children ages 5 to 11, according to the Centers for Disease Control and Prevention and recent studies. And numbers show the rates among younger kids appear to have increased in the past decade, especially among Black males.

A growing body of research shows that “historically we thought that suicide is a problem of teens and adults, but younger children are expressing similar thoughts that may have been ignored before,” said Paul Lipkin, a pediatrician at the Kennedy Krieger Institute in Baltimore and a specialist in developmental disabilities such as autism.

This has many experts calling for lowering the screening age for suicide ideation in children and moving to develop more effective early suicide risk detection and targeted prevention strategies. The broad approach includes pediatricians, teachers, and parents working with children at a young age to build their resilience and identify and manage their stress.

Studies have found that young children gain an understanding about death and killing oneself from TV or other media, discussions with other children, or exposure to death from a family or community loss.

“Pediatric suicide wasn’t on our radar decades ago and maybe was underreported,” said Holly Wilcox, president of the International Academy of Suicide Research and a professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore. “The truth is that now we can do stuff about it.”

It is quite likely the 136 reported suicides from 2001 to 2021 among 5- to 9-year-olds were an undercount.

“Counts are often incomplete, and causes of death may be pending investigation resulting in an underestimate relative to final counts,” said Margaret Warner, a senior epidemiologist at the CDC.

The problems with those numbers are important because, Warner said, “if we are missing deaths, or don’t have all the information leading to them, we can’t properly develop programs to prevent future deaths.”

That’s why there’s also an ongoing national effort by coroners and medical examiners to improve the quality and consistency of pediatric death investigations.

Leaders in suicide prevention hope this wide spotlight on pediatric suicide will also help curtail the rising suicide rate among people ages 10 to 24 in the U.S. since suicide is the second-leading cause of death in that age group, according to the CDC.

Some of the increase in mental health issues among children has been attributed to the isolation and lack of school structure during the pandemic. Beginning in April 2020, pediatric emergency room visits for children 5 to 11 increased approximately 24%, according to a CDC report from November 2020.

Other factors, such as being neurodivergent or having a psychiatric disorder, can make a child more vulnerable to suicide.

A study published in February in Frontiers in Public Health also found that being the victim or perpetrator of bullying is a risk factor for suicide, even when researchers controlled for other risk factors.

Montana Lance was diagnosed with attention-deficit/hyperactivity disorder, as well as dyslexia, and often was the target of bullying at school.

Officials at the Lewisville Independent School District declined to comment on Montana’s death. His parents filed a lawsuit against the school district, but it was dismissed, and the district was found not liable for his death.

Suicide is complex, but recent studies have found that there are things parents, teachers, pediatricians, and caregivers can do to help protect children from it.

Lisa Horowitz, a pediatric psychologist and staff scientist at the National Institute of Mental Health, said, “It’s never too early to start a conversation with kids about recognizing mental health distress and doing what we can do to help them have better coping strategies and foster resilience.”

Building resilience in children can help buffer them in times of stress, according to a study published in 2022 in Frontiers of Psychiatry.

“I don’t want people to panic but just want them to be vigilant about their children,” said Horowitz.

Sometimes that vigilance can be “tricky” because depression may look different in younger kids. They may act out, be more irritable, and not manifest their symptoms in the same way as teens and adults, Wilcox said.

“We don’t have enough studies on how best to identify preteens and children at risk for suicide. Oftentimes you just have to trust your gut about these things,” she said.

If a child is upset, parents should ask them questions about what they’re experiencing, said Tami D. Benton, psychiatrist-in-chief, executive director, and chair of the Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children’s Hospital of Philadelphia.

“Parents shouldn’t talk kids out of their feelings or give them examples of when it happened to them, or minimize their feelings. It puts them down,” she said.

Parents and children should come up with a plan together, but also teach their children that they can master these situations, said Benton.

When parents get stuck about what to do in difficult situations, they should consult with their child’s pediatrician.

In March, the American Academy of Pediatrics recommended universal screening for suicide risk in all children 12 and older and when clinically indicated for kids 8 to 11. There aren’t any screening tools validated for use in children under 8. But Horowitz said younger children can still be assessed and evaluated for suicide risk.

Schools can also play an important role in suicide prevention.

Meghan Feby, a school counselor in the Colonial School District in New Castle, Delaware, said, “I am the sole school counselor in my building. It is a daunting task. That’s why there are supports in place that have eyes where I can’t have eyes … on school computers. Employing software strategies like GoGuardian Beacon can really help fill in gaps and supports.”

The software captures keywords and phrases that might indicate a child is thinking about suicide and has already been used to intervene when children using district computers displayed concerning behavior. It is monitoring activities on school computers used by more than 6.7 million public school students in kindergarten through 12th grade.

Some schools said they are having problems implementing software like this because some parents find it intrusive.

Many schools use the Good Behavior Game, a decades-old behavior management intervention for kids in first and second grades, and it has been used in higher grades. The team-oriented classroom curriculum uses peer pressure to stimulate students to be attentive and engaged and work together. Researchers such as Wilcox have studied the extensive participation of thousands of students and found it reduced suicidal thoughts and behaviors.

Children who have played the game were half as likely as young adults to report suicidal thoughts and about a third less likely to report a suicide attempt.

Lance said that the day Montana died by suicide changed his life forever.

“You’re not supposed to bury your children. They’re supposed to bury you,” he said. “All this attention on the mental health status of children these days is not going to bring my child back, but it can stop another family from suffering.”

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]]> 1746728 Mental Health Respite Facilities Are Filling Care Gaps in Over a Dozen States https://kffhealthnews.org/news/article/mental-health-respite-facilities-care-gaps/ Tue, 11 Jul 2023 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1715501 If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

Aimee Quicke has made repeated trips to emergency rooms, hospitals, behavioral health facilities, and psychiatric lockdowns for mental health crises — including suicidal thoughts — since she was 11.

The 40-year-old resident of Le Mars, Iowa, has bipolar and obsessive-compulsive disorders. “Some of the visits were helpful and some were not,” she said. “It was like coming in and going out and just nothing different was happening.”

Then she heard about Rhonda’s House, a rural peer respite program that opened on the other side of the state in 2018, through acquaintances in her community.

That facility, and dozens of others like it established nationwide over the past 20 years, offers a short-term, homelike, nurturing environment for people who are experiencing a mental health crisis but don’t need immediate medical attention. At respites, patients are treated like guests, proponents say, and can feel heard and keep their dignity without having to relinquish their clothes and other belongings.

During her weeklong stay at Rhonda’s House, which founder and executive director Todd Noack referred to as “a bed-and-breakfast facility for emotional distress,” Quicke made many breakthroughs, working on her self-esteem and gaining better coping skills. If she hadn’t found the program, she said, “I don’t think I would have come out of 2020.”

Public health professionals say respite facilities can potentially play a big role in addressing a national mental health crisis that accelerated dramatically during the covid-19 pandemic, especially when it comes to suicide prevention.

“It’s a really important piece of the larger puzzle of how to improve health care and reduce suicide risk, because there is a ‘traffic jam’ in suicide prevention,” said Jane Pearson, chair of the National Institute of Mental Health Suicide Research Consortium.

Respites rely on trained peers to provide care, and often serve patients who might otherwise visit overburdened ERs, psychiatric institutions, and therapists. Today there are 42 community-based respite programs spread across 14 states, including new ones opened recently in Tacoma, Washington, and Grand Rapids, Michigan. Most are nonprofits governed by a patchwork of state guidelines, and they’re funded by a mixture of local, state, and federal grants.

Experts say the programs fill a void, though there is little hard data on their effectiveness. Paolo del Vecchio, director of the Office of Recovery at the federal Substance Abuse and Mental Health Services Administration, said peer-run respites have proven themselves as an “evidence-based model of care,” with positive effects including reduced hospitalizations and increased engagement with community support services.

A 2015 study published online in the journal Psychiatric Services found that people who sought respite were 70% less likely to use inpatient emergency services than non-respite users.

Still, del Vecchio said, more research is needed to analyze how the programs are working and troubleshoot problems. SAMHSA is conducting a cost-benefit analysis of respite programs that officials hope to release this summer.

Pearson said she would like to see more research on who uses respites, how they are advertised, clients’ reasons for seeking them, and whether they deliver what they promise.

Respites can be especially important in rural America, where suicides increased 46% from 2000 to 2020, compared with 27.3% in urban areas, according to the Centers for Disease Control and Prevention. Rural residents also have 1½ times the rates of ER visits for self-harm as urban residents.

Del Vecchio hopes greater awareness can help bring the promising respite approach to the states with the highest suicide rates, including Wyoming, Montana, Alaska, and New Mexico.

Rhonda’s House, in Dewitt, Iowa, has provided care to 392 people over the past five years, and recently moved into a three-story, five-bedroom house with two baths. Peer specialists in Iowa must complete 40 hours of training plus six hours of ethics counseling, and then work 500 hours to become eligible to take a state certification test.

For Quicke, Rhonda’s House was a lifesaver during a brutal 2020. The pandemic had isolated her from her support system, her brother-in-law died, her long-term partner moved out, and her mother had open-heart surgery.

“There was a lot of chaos. A lot of family fights broke out. That’s when I took off — packed a bag and left for respite,” said Quicke. “There was nowhere else closer to go.”

She drove six hours from her home to Rhonda’s House, where she found 24-hour help that you “just can’t get from an emergency room or hospital.”

Unlike traditional hospital staffers, peers are available to speak with guests whenever they are needed, which Quicke appreciated since she has “a lot of panic and anxiety in the night and it’s frightful.” She also found it easy and comforting to speak with peers with “lived experience,” or firsthand experience with mental health challenges.

Allowing people to reach out for help without being judged is a crucial feature of the respite model, said Paul Pfeiffer, a psychiatrist at the University of Michigan’s medical center. He cautioned against regulations that would make them more like hospitals, noting that many people in trouble avoid getting help because they fear being locked up in a psychiatric facility.

Quicke said she learned a lot during her stay at Rhonda’s House. “I always thought I was co-dependent. I learned I just need me and my dogs. I learned wellness tools and that I can be strong and resourceful and resilient,” she said. She described being more conscious of her triggers and said she had “more routines to help with sleep hygiene.”

When Quicke left, respite staffers connected her with community resources close to her home, near the Nebraska border. They also encouraged her to call if she needed help again and told her she could return for another stay after 60 days — giving her time to work through her challenges and freeing up space for others in the meantime.

“Peer respite works 8 out of 10 times,” said Noack, the executive director. “Some people do have to leave to get another level of care, but nothing is ever perfect.”

The average cost of staying at Rhonda’s House is $428 a day — far less than the thousands of dollars a hospital stay typically costs. Noack’s respite does not bill insurance but covers the cost with state and regional contracts, as well as donations, like many other respites.

Some respites receive Medicaid funding. As this type of care grows, more states will explore Medicaid and other funding sources, said del Vecchio.

A few weeks ago Quicke became discouraged after a job rejection. She thought about going back to Rhonda’s House but said she channeled what she learned there during her stay.

“I was able to use my coping skills to get through it,” she said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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]]> 1715501 In Hard-Hit Areas, COVID’s Ripple Effects Strain Mental Health Care Systems https://kffhealthnews.org/news/in-hard-hit-areas-covids-ripple-effects-strain-mental-health-care-systems/ Thu, 04 Jun 2020 09:00:25 +0000 https://khn.org/?p=1110976 In late March, Marcell’s girlfriend took him to the emergency room at Henry Ford Wyandotte Hospital, about 11 miles south of Detroit.

“I had [acute] paranoia and depression off the roof,” said Marcell, 46, who asked to be identified only by his first name because he wanted to maintain confidentiality about some aspects of his illness.

Marcell’s depression was so profound, he said, he didn’t want to move and was considering suicide.

“Things were getting overwhelming and really rough. I wanted to end it,” he said.

Marcell, diagnosed with schizoaffective disorder seven years ago, had been this route before but never during a pandemic. The Detroit area was a coronavirus hot spot, slamming hospitals, attracting concerns from federal public health officials and recording more than 1,000 deaths in Wayne County as of May 28. Michigan ranks fourth among states for deaths from COVID-19.

The crisis enveloping the hospitals had a ripple effect on mental health programs and facilities. The emergency room was trying to get non-COVID patients out as soon as possible because the risk of infection in the hospital was high, said Jaime White, director of clinical development and crisis services for Hegira Health, a nonprofit group offering mental health and substance abuse treatment programs. But the options were limited.

Still, the number of people waiting for beds at Detroit’s crisis centers swelled. Twenty-three people in crisis had to instead be cared for in a hospital.

This situation was hardly unique. Although mental health services continued largely uninterrupted in areas with low levels of the coronavirus, behavioral health care workers in areas hit hard by COVID-19 were overburdened. Mobile crisis teams, residential programs and call centers, especially in pandemic hot spots, had to reduce or close services. Some programs were plagued by shortages of staff and protective supplies for workers.

At the same time, people battling mental health disorders became more stressed and anxious.

“For people with preexisting mental health conditions, their routines and ability to access support is super important. Whenever additional barriers are placed on them, it could be challenging and can contribute to an increase in symptoms,” said White.

After eight hours in the emergency room, Marcell was transferred to COPE, a community outreach program for psychiatric emergencies for Wayne County Medicaid patients.

“We try to get patients like him into the lowest care possible with the least restrictive environment,” White said. “The quicker we could get him out, the better.”

Marcell was stabilized at COPE over the next three days, but his behavioral health care team couldn’t get him a bed in one of two local residential crisis centers operated by Hegira. Social distancing orders had reduced the beds from 20 to 14, so Marcell was discharged home with a series of scheduled services and assigned a service provider to check on him.

However, Marcell’s symptoms ― suicidal thoughts, depression, anxiety, auditory hallucinations, poor impulse control and judgment ― persisted. He was not able to meet face-to-face with his scheduled psychiatrist due to the pandemic and lack of telehealth access. So, he returned to COPE three days later. This time, the staff was able to find him a bed immediately at a Hegira residential treatment program, Boulevard Crisis Residential in Detroit.

Residents typically stay for six to eight days. Once they are stabilized, they are referred elsewhere for more treatment, if needed.

Marcell ended up staying for more than 30 days. “He got caught in the pandemic here along with a few other people,” said Sherron Powers, program manager. “It was a huge problem. There was nowhere for him to go.”

Marcell couldn’t live with his girlfriend anymore. Homeless shelters were closed and substance abuse programs had no available beds.

“The big problem here is that all crisis services are connected to each other. If any part of that system is disrupted you can’t divert a patient properly,” said Travis Atkinson, a behavioral consultant with TBD Solutions, which collaborated on a survey of providers with the American Association of Suicidology, the Crisis Residential Association and the National Association of Crisis Organization Directors.

White said the crisis took a big toll on her operations. She stopped her mobile crisis team on March 14 because, she said, “we wanted to make sure that we were keeping our staff safe and our community safe.”

Her staff assessed hospital patients, including Marcell, by telephone with the help of a social worker from the emergency room.

People like Marcell have struggled during the coronavirus crisis and continue to face hurdles because emergency preparedness measures didn’t provide enough training, funds or thought about the acute mental health issues that could develop during a pandemic and its aftermath, said experts.

“The system isn’t set up to accommodate that kind of demand,” said Dr. Brian Hepburn, a psychiatrist and executive director of the National Association of State Mental Health Program Directors.

“In Detroit and other hard-hit states, if you didn’t have enough protective equipment you can’t expect people to take a risk. People going to work can’t be thinking ‘I’m going to die,’” said Hepburn.

For Marcell, “it was bad timing to have a mental health crisis,” said White, the director at Hegira.

At one time Marcell, an African American man with a huge grin and a carefully trimmed goatee and mustache, had a family and a “pretty good job,” Marcell said. Then “it got rough.” He made some bad decisions and choices. He lost his job and got divorced. Then he began self-medicating with cocaine, marijuana and alcohol.

By the time he reached the residential center in Detroit on April 1, he was at a low point. “Schizoaffective disorder comes out more when you’re kicked out of the house and it increases depression,” said Powers, the program manager who along with White was authorized by Marcell to talk about his care. Marcell didn’t always take his medications and his use of illicit drugs magnified his hallucinations, she said.

While in the crisis center voluntarily, Marcell restarted his prescription medications and went to group and individual therapy. “It is a really good program,” he said while at the center in early May. “It’s been one of the best 30 days.”

Hepburn said the best mental health programs are flexible, which allows them more opportunities to respond to problems such as the pandemic. Not all programs would have been able to authorize such a long stay in residential care.

Marcell was finally discharged on May 8 to a substance abuse addiction program. “I felt good about having him do better and better. He had improved self-esteem to get the help he needed to get back to his regular life,” Powers said.

But Marcell left the addiction program after only four days.

“The [recovery] process is so individualized and, oftentimes, we only see them at one point in their journey. But, recovering from mental health and substance use disorders is possible. It can just be a winding and difficult path for some,” said White.

Seeking Help

If you or someone you know is in immediate danger, call 911. Below are other resources for those needing help:

— National Helpline: 1-800-662-HELP (4357) or https://findtreatment.samhsa.gov.

— National Suicide Prevention Lifeline: 1-800-273-TALK (8255).

— Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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