COOS COUNTY — Suicide attempts and other psychological crises among Coos County children as young as 4 are on the rise, and Bay Area Hospital isn't equipped to deal with them.
In 2011, Bay Area Hospital logged 27 child psychology consultations and six admissions. By 2014, the last year for which statistics are available, those numbers had grown to 101 consultations and 62 admissions.
“Our community is suffering from a lot of higher risk youth, and the hospital is not the best place to put a child with pediatric behavioral psych issues," said Kera Hood, BAH's manager of psychiatric services. "We're not treating them, we're housing them.”
Oregon ranks 11th in the United States for youth suicides, with the majority of attempts made by those between the ages of 10 and 24. White males are at the highest risk. Suicide is the second leading cause of death for ages 10-24 (after accidental injury), according to the Centers for Disease Control. In 2014, 5,504 U.S. youth 10-24 killed themselves.
Locally, the problem is particularly acute because Bay Area Hospital is not licensed to treat children with severe mental illness. When youth come in having harmed themselves or threatened suicide, the hospital can only isolate them in a room with a 24-hour sitter until they can either be transferred or otherwise safely discharged. Hood described the experience as “traumatizing” for youth, an event that often labels them rather than helps them. Not only that, but it costs the hospital $865 per day to house a child.
“It's a really big issue, and it's a serious issue,” said Kelly Barnett, North Bend School District's school nurse. Of the reported 400 percent increase over the past few years, she said that percentage is “realistic just in the last year.”
“On a regular basis, pretty much daily, we are dealing with students in the middle school and high school with serious mental health crisis,” Barnett said.
Local mental health professionals haven't pinned down a cause for the explosion. But Hood said that Coos County isn't alone in this issue, which is shared across the nation.
“Everyone is looking for psychiatrists,” Hood said. “There is a huge need for them nationwide, and what we're finding here is the lack of ability for people to find treatment and providers. Here at the hospital, we're doing the best we can with getting help more available to people.”
Hospital has reached out for help
Bay Area Hospital has reached out to Coos Health and Wellness and Kairos, which provides pediatric psychiatric services in the region, seeking help.
“We brought together some brilliant minds, put them in the same room and we researched what to do,” Hood said.
At the hospital's request, Coos Health and Wellness and Kairos created the Pediatric Psychiatric Crisis Response Team, a pilot project. The team responds during the early stages of a child's crisis. It can facilitate in-home and community prevention, a stay at Pony Creek Crisis Respite Home, admission to the hospital, and use of “crisis beds” out of the community “when absolutely necessary,” according to a press release.
The PPCR team has two measurable objectives, which will be evaluated by a steering committee that oversees the project. After the pilot year ends in 2017, there must be a significant decrease in the hospital's emergency room behavioral health services, with no more than 75 visits for the entire year. Also, at the end of the first year, there must be an increased follow-up after an emergency room appearance, with at least 7 percent of youth being provided quality wraparound services for families, along with a preventive model that includes peer and family supports.
“Over time, it is anticipated that the steps taken, combined with successful implementation of the project, will reduce appearances, reappearances, and time spent in the hospital,” the press release said.
The PPCR team is to be officially launched in July. Shawna Schaar, children's behavioral health program manager at Coos Health and Wellness, said her agency's protocol is to encourage people, whether individuals, families, or police officers, to call the team's hotline when a youth is threatening suicide or has even attempted it. The team will send in family or peer supports to homes or the hospital.
“The Bay Area Hospital asked us to do this,” Schaar said. “What we're seeing is that teens usually have their crisis in the evening, so our teams will roll out to the hospital and intervene, sit with them, and assist the hospital staff. We also go to their homes and keep teens from going to the hospital if we can. We might even stay for some time to help deescalate the situation.”
Schaar said the Coos Bay Police Department is excited about the PPCR team because when its officers respond to mental health scenarios, they often are unsure what to do. The team will go on calls with police officers, both for the team's safety and to show officers what to do if more than one call comes in and the team is unable to respond.
“When we open the hotline,” Schaar said, “it is going to be a soft rollout just in Coos Bay and North Bend for the first year. We will cover the whole county if we see numbers and that the team is being used. I hope it helps and we can intervene.”
Schaar said that Coos Health and Wellness works with about 300 kids on average throughout Coos Bay and North Bend, ranging from ages 4 to 17. They treat suicidal kids on a daily basis, and the hospital has a case almost every weekend.
“There's a lot of kids that aren't getting services,” Schaar said, “so the number of kids out there is a lot higher than 300.”
Karla Bertolini, a school-based mental health therapist for the Coos Bay School District, said that the county has been identified as a high need population, that “we have a higher rate of suicide and mental health issues.” A state grant was provided to put mental health first aid trainers in as many of these counties as possible.
School districts respond to crisis
The Coos Bay School District is responding to the youth suicide crisis by training its teachers, as well as community members, in mental health first aid. The district is working in collaboration with Coos Health and Wellness to put on four 8-hour courses for up to 30 people. It is the first year for the training, something that the district's special programs director, Lisa DeSalvio, said is necessary.
“We have significant mental health issues in our schools,” DeSalvio said. “We really felt this is an area where we needed training for staff. It is identified as a need since we have kids that are receiving mental health services, and a number of students that have been suicidal. They need help, and when they go to a counselor or a teacher, or anyone, the question is whether or not these people know how to handle the situation.”
Bertolini explained that the training is mainly for people working with youth, teaching them how to assess for suicide, and create more awareness.
“Since starting the training,” Bertolini said, “we've seen a lot of excited people sign up. We've had full workshops each time.”
DeSalvio said training is just the first step, and that the training will continue next year.
“Youth mental health first aid is a valuable tool that we can share with community members and teachers,” said Heidi Luckman, the second school-based mental health therapist for Coos Bay Schools. “These tools that we teach can be used to assist youth that might be struggling.”
North Bend School District school board chairman, Bob Adams, said that when people talk about attempted suicide they need to take out the word “attempted” and replaced it with “contemplated.”
“That's the problem we need to address,” Adams said. “'Attempted' leaves too much to risk, so let's get there ahead of time.”
He said the district has recently added an additional counselor to help handle the problem, which is mostly seen in the middle and high schools.
“This was done because of a request coming primarily from teachers and leadership of the school,” he said. “They say we need this and that there are issues we need to deal with. It's a hard world out there, and there are family issues. The point is, we have to help these children."