November 20, 2019

Editor's Page

Safe Places

Mark R. Howard | 7/26/2019

Young Floridians are committing suicide in larger numbers and at a higher rate than they did a decade ago: From 2007-09, according to data from the Florida Department of Health, 245 people between ages 12 and 19 killed themselves — a rate of 4.3 per 100,000 people in that age range. Between 2015-17, the number of suicides in that age range rose to 347 — a rate of 6.2, nearly a percentage point above the national average.

Florida shouldn’t have needed those statistics — or the staggering number of opioid-related deaths or the Parkland school shooting — to pay more attention to the availability of behavioral health services. Few states spend less than Florida on mental health, and we rank 43rd in the availability of mental health services.

The lack of behavioral health services isn’t confined to smaller, poorer counties. Consider the experience of Jason Barrett, CEO of the Flagler Health in St. Johns County, which has taken a smart approach to dealing with the problem by carving out a role for itself both as a provider and coordinator of services.

St. Johns (home to Ponte Vedra and St. Augustine) is one of the healthiest counties in Florida and has one of the state’s top school systems. But Barrett says when his health system began looking at health data on the county from the Robert Wood Johnson Foundation in 2018, “some specifics were glaring,” including the fact that the county’s teen suicide rate was twice the state’s average.

Then, during the early weeks of last school year, five local children killed themselves. Flagler Health, formerly Flagler Hospital, has a 130-year record of service to its community, and Barrett says it was “our responsibility to address these issues.”

Through information provided by the school district, Barrett learned that fewer than half of the children identified as being in crisis had contact with a counselor or other professional. Nationwide, the ratio of patients to counselor is 300 to 1, he says. “In Florida, it’s 700 to 1, and in St. Johns County, it was 880 to 1.”

Barrett also says he quickly came to appreciate the stigma that still attaches to mental health issues — when Flagler and other mental health providers staged forums to talk about the suicide rate, no one showed up.

In exploring how to make help more effective and more available, “a lot of the work we’ve done is talking to teenagers. They’re real advocates for mental health,” says John Eaton, Flagler’s administrator of community health improvement. Flagler also hired a consulting firm called Juv, based in Brooklyn, that’s run by high school and college kids and uses networks of teens to gather information.

Some insights from Flagler’s research reflect the fact that not all big-picture problems play out the same way in every community: It turned out that one of the biggest stressors for kids in St. Johns County wasn’t social pressure or abuse or poverty, but academics. Many kids said they’d never seek help from the most likely resource — a guidance counselor at school — because they worried that seeking help might affect the counselor’s recommendation letter to colleges they wanted to attend.

Second: Parents and students had radically different perceptions about how well they communicated about mental health issues. In one survey, 90% of parents reported they had spoken with their children about mental health issues within the last 30 days; only 10% of kids reported having those conversations.

Flagler’s strategy involves creating as many avenues as possible for kids to seek help, removing the stigma associated with needing help — and then coordinating all the services that may be required, from traditional behavioral health counseling to substance abuse counseling and even help with medical problems, housing, transportation and food. The coordination is handled by a group called Care Connect, created and funded by Flagler and private donors. “It’s all about access and affordability,” Barrett says.

Some referrals will come through a network of “navigators” associated with the school system. A school-safety bill passed by the Legislature this year includes funding to help create those teams. It’s a start.

Other referrals will come via another important player, the Crisis Text Line. The text line, founded in 2013, provides free support for people in crisis, 24/7, in all 50 states, using trained volunteers. The text medium, which allows for private, anonymous communication, has proven particularly popular with young people. The crisis line — text HOME to 741741 — has received more than 105 million messages and has become one of the biggest sources of mental health data anywhere in the country. For a quick education in the dynamics of crisis, see crisistextline.org/blog/100-facts-we-learned-from-100-million-messages.

The crisis line provides an additional avenue into Care Connect, along with the school-based navigators. Communities like St. Johns County that formally partner with the crisis line by making a financial contribution receive detailed data on utilization patterns in their regions. Starting this fall, the crisis line number will appear on all student IDs at St. Johns County high schools. Those who text the line — or seek help through the schools — can choose to be referred to Care Connect. “We wanted to create a one-stop shop for students and their families” to avoid bureaucratic barriers, Eaton says. The formal rollout for the system will start with the beginning of this school year.

The teenage years have always been tough, but figuring out why more kids today lose all hope is its own mystery. Eaton says some kids indicated that — perhaps as a function of social media — the pressures of teenage life are somehow more unrelenting today. “They say you can’t turn it off any more, you can’t put it behind you and just go somewhere and be in a safe place.”

 

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