US

Number of youth suicides a shock
More than 100 tried in the first 4 months of the year

State officials have turned to the Centers for Disease Control and Prevention for help to understand why more than 117 youths 13-20 years old attempted suicide in Kent and Sussex counties in the first four months of this year.

Speaking to a conference of mental health, medical and social service professionals, Susan Cycyk of the state Division of Prevention and Behavioral Health Services, said the attempts occurred within a 25-mile radius. Through April, nine of the 117 youths died by suicide, she said, and Jim Lafferty, executive director of the Mental Health Association of Delaware, said the number of deaths has risen to 11 since then. Cycyk said in a typical year, that area might see seven to nine suicides.

"We wanted to find out if there were any trends," she said.

Four CDC epidemiologists, led by Dr. Alex Crosby of the Division of Violence Prevention, spent 10 days in Delaware conducting interviews and investigating the available data, Lafferty said. They completed their research on May 4 and their preliminary report is expected in a few weeks. The final report will not be complete for about six months, Cycyk said.

Early recommendations include increased training to recognize signs of mental health challenges and increasing the amount of "positive" opportunities available to youth after school, she said.

The Department of Services for Children, Youth and their Families took the lead in responding to the reports and the state departments of Education and Health and Social Services also have been involved.

The CDC's experts brought the right knowledge and protocols to the question, DHSS Secretary Rita Landgraf said.

"Because this is such an emotive situation, it's easy to apply assumptions," she said. "We needed to apply science and research. ... We want to understand the root causes and the historical perspective -- as we do for any type of epidemic. At face value, it felt as though we were reaching an epidemic. That is why the state elected to reach out to the CDC."

Cycyk released the information during an address to the Rural Health Conference, which drew more than 150 people to Rehoboth Beach Country Club.

The event was sponsored by the Delaware Rural Health Initiative and included a broad assessment and update on the state of Delaware's mental health services in Kent and Sussex counties, which are considered vastly underserved.

Delaware officials are working to expand those services, partly in response to mandates from the U.S. Department of Justice, which sued the state for violating the rights of people with serious, persistent mental illness by warehousing them at the Delaware Psychiatric Center and not providing enough community-based services to support people in their own residences.

Robert Bernstein, the court-ordered monitor, applauded the "remarkable things going on structurally" as the state addresses problems in its mental health system.

Updates from Dover Behavioral Health System, La Red in Georgetown, and Steven Dettwyler of Community Mental Health & Addiction Services, sketched out a broad array of increasing resources -- from expanded acute care to additional crisis response experts, a growing peer network, and the introduction of "telepsychiatry," which allows psychiatrists to consult with patients from afar using videoconference technology. Medicaid will start to reimburse Delaware providers for telemedicine services starting July 1, Landgraf said, which will make that technology available to many more.

Child and adolescent psychiatric services remain thin in Kent and Sussex, though, areas that were the focus of the General Assembly's Study Group on Child Mental Health Needs in the two counties. Among the group's recommendations: recruiting two child and adolescent psychiatrists to Sussex County, expanding bilingual resources, and providing traumatic stress intervention training to child mental health professionals.

The juvenile suicides occurred too late for the group to include that issue in its study, but in concluding remarks the group urged the state to address the matter in a formal way.

"The study group members believe strongly that a formal review of the state's efforts in this area is appropriate given recent events."

Lafferty urged parents to be aware of how their children are doing.

"If an 'A' student all of a sudden is racking up D's and F's, something is going on," he said. "Maybe they were very involved with friends, very social, in sports -- and then they are staying home, starting to isolate. That's something to be explored -- any changes you see in a child's behavior. Parents have to be attentive and find a way to talk. If someone says 'I wish I were dead,' take it seriously."

The American Foundation for Suicide Prevention says 90 percent of those who die by suicide have a psychiatric disorder and experts list these risk factors for youth: suicidal thoughts, depression, impulsive aggressive behavior, bipolar and anxiety disorders, drug and/or alcohol abuse, and previous attempts.

Beth Miller
5 June 2012

http://www.delmarvanow.com/article/20120605/DW01/206050304