Mind and Body

“A sharpening of the already present”

Reframing the story about growing mental health needs in a time of pandemic and climate apocalypse means disrupting the dominant narrative and upsetting the status quo

Image courtesy of R.I, Kids Count

The graphic introducing the "Health" section in the 2020 Rhode Island Kids Count Factbook.

By Richard Asinof
Posted 2/15/21
A deep dive into why the data in Rhode Island showed a surprising “decrease” in the number of suicide deaths for teens in Rhode Island, challenging the dominant narrative of the medical establishment.
Why has Hasbro Children’s Hospital failed consistently to provide ConvergenceRI with news releases and new data regarding mental health service demands in Rhode Island? What would the R.I. Coalition Against Domestic Violence learn from participating in the Healthy Minds, Healthy Bodies conversation about teenage angst that might change its approach in how it works with teens? What are the best metrics around sadness that could be incorporated as longitudinal indicators in future Rhode Island Kids Count Factbooks? What kinds of peer programs exist for students working on mental health and behavioral health issues in schools in Rhode Island? Will pediatric practices consider screening for toxic stress as part of an integrated behavioral health primary care best practices? Instead of asking about pain as a fifth vital sign, what would happen if there was a question instead that looked at “sadness” in people’s lives?
One of the undercurrents that has been accelerated as part of the response to the coronavirus pandemic has been the undercutting of the role of primary care providers, nationally and locally. Instead there has been a promotion of corporate partnerships with big box pharmacy stores to deliver testing and vaccines, with numerous performance problems in delivery, data, and management oversight.
Finally, the Biden administration is moving ahead with supplying community health centers with access to vaccines, acknowledging that the health centers have been on the front lines of providing health care during the pandemic, particularly for the hardest hit communities.
The opportunity for Rhode Island to carve out its own health care priorities during this time of flux depends on the leadership of the R.I. General Assembly, which will require a major pivot from the priorities of the Raimondo administration, under whose direction private consulting firms took over most design and implementation of health care policy decisions. Will the R.I. General Assembly have the gumption to audit the performances of Deloitte and Boston Consulting Group, among others, particularly in the managed Medicaid arena? Stay tuned.

PROVIDENCE – What happens, to borrow a Star Wars’ analogy, when the empire of the dominant narrative strikes back?

Last week, ConvergenceRI published a story, “Bridge over troubled waters; data on teen suicide in RI,” which explored the most recent data around suicides in Rhode Island for children under 18 for 2019 and 2020, looking at the kinds of interventions and preventions that were occurring in response to the mental health stresses and demands precipitated by the social isolation conditions imposed by the pandemic. [See link below to ConvergenceRI story.]

The context for the news story was the continuing debate swirling around the relative risks of in-person versus remote learning as a catalyst for increasing behavioral health and mental health issues for children in Rhode Island, which, of course, is part of a much larger conversation happening nationwide around what constitutes “safety” parameters around the reopening of schools. The national efforts to dispense vaccines as quickly as possible to protect communities against the spread of the virus has only exacerbated the debate around school safety and the yet unanswered question of where teachers fit into priorities around who is first on line to get the vaccine.

The “surprising” data results, which were revealed after ConvergenceRI spoke with Jeffrey Miller, who directs the R.I. Department of Health’s six suicide prevention programs, is that Rhode Island led the nation for the lowest number of suicide deaths reported in 2019 and 2020 for children under the age of 18.

ConvergenceRI had also spoken with Susan Orban, the director of “Healthy Bodies, Healthy Minds,” the collaborative Health Equity Zone in Washington County, to capture her insights concerning on-the-ground efforts with children and families, focused on improving the mental and behavioral health of teenagers, including a suicide prevention program begun in 2018, funded by the federal Centers for Disease Control and Prevention.

High anxiety
Orban said that while the isolation and disconnection that had occurred during the pandemic had served up a predictable recipe for increased levels of anxiety and despair, she lamented the lack of investment in prevention and, in particular, the failure to invest, at the community level, in fostering mental wellness in students. What was lacking, Orban argued, was a “robust mobile crisis system.”

Orban’s observations did not break new ground; they have formed the backbone of most findings from studies detailing the unmet needs in Rhode Island when it comes to mental health and behavioral health services for much of the last decade.

The priority for Orban was to renew the focus on prevention – on action steps that can take place before conditions spiral out of control, with the need for crisis interventions, such as emergency room visits and hospitalizations. Toward that end, to help teens and families to find common ground to talk together about increasing levels of anxiety, Orban’s coalition is holding an online screening of a documentary on anxiety, “Angst,” on Tuesday, Feb. 23, to be followed by a facilitated discussion.

Anxiety disorders are the most common mental health challenge in the U.S., a disorder that afflicts some 54 percent of females and 46 percent of males, Orban explained in a news release. “Sadly, while anxiety disorders are highly treatable, only one-third of those suffering receive treatment,” she said. The goal of the screening, Orban continued, is to “encourage young people to ask for help if needed – and to be ready to provide it.”

Reality check
ConvergenceRI had planned to do a follow-up story, reaching out to other key players in the landscape around children, mental health, and the pandemic, including Rhode Island Kids Count and the R.I. Coalition Against Domestic Violence, to capture their perspectives.

But then, it seemed, the long arm of the health care empire struck back, in a long-form story in The Providence Journal, to reinforce the dominant narrative around the growing emergency crisis intervention, instead of upstream prevention.

What had first been envisioned as a follow-up story had now morphed into something larger, more important [and written with a heightened awareness of the greater risk involved in challenging the status quo].

It was an insight offered by Cynthia Roberts, an evaluator at the R.I. Coalition Against Domestic Violence, that most resonated, during an interview with her about the need to focus on centering the conversation about mental health and behavioral health needs and domestic violence in the context of a larger, community-driven perspective.

In looking at the current crises in mental and behavioral health and domestic violence in Rhode Island, Roberts said that there was a need to acknowledge, borrowing a phrase from Kim Tallbear, an Indigenous scholar, “a sharpening of the already present.” [See link below to YouTube presentation by Kim Tallbear.]

Translated, the new tidal wave of mental health trauma afflicting young people in Rhode Island was not so much a new phenomena caused by COVID-19, but rather the “sharpening” of the continued, existing crises, coupled with an apparent ongoing failure to address them.

Perverse metrics, predictable responses
For sure, the data around teen suicide is a perverse metric, much like attempting to measure the impact of the opioid epidemic by counting the number of escalating deaths by overdoses in Rhode Island, or the number of murder/suicides by guns in domestic violence incidents. Any such death is tragic: the numbness around the number of deaths – from ODs, from domestic violence, from suicides, and from the coronavirus – is symptomatic of a much larger societal malaise: the lack of connectedness in our lives.

For the record, the lack of an integrated statewide database to track the diseases and deaths of despair – from alcohol, from suicide, from drugs, and from gun violence related to domestic violence, all tied to economic conditions – has translated into a continuing, intentional policy “blindness” that afflicts and hinders most state efforts, despite the best of intentions, in ConvergenceRI’s opinion.

Similarly, the coronavirus pandemic has “revealed” the prevalence of pre-existing social disparities and systemic racism that “already existed” within our health care delivery system. [it is not just “Black Lives Matter” but “Black Moms Matter,” too.]

It should not have been “surprising” to anyone to learn that the ZIP codes most ravaged by COVID-19 correlated directly with the poorest, most vulnerable, highest density and racially diverse communities and neighborhoods in Rhode Island, where the gaps in life expectancy rates are the greatest. [Yes, ZIP codes may prove to be more important than genetic codes in predicting health outcomes, as Kim Keck, the former president and CEO of Blue Cross Blue Shield of Rhode Island, pronounced, in her introduction of the findings of the RI Life Index, but the question remains: What are we going to do about it?]

And, when it comes to mental health and behavioral health issues, it should have surprised no one that the COVID pandemic would be construed as manifesting itself as “a massive pandemic of mentally ill adolescents [emphasis added],” with many of them admitted to Hasbro’s Children’s Hospital, according to Dr. Brian Alverson, the director of the Division of Pediatric Hospital Medicine at the Lifespan facility, as quoted by G. Wayne Miller in his story in The Providence Journal published this past weekend.]

The problem with such pronouncements, in ConvergenceRI’s opinion, is that Rhode Island had already been experiencing “a massive pandemic of mentally ill adolescents” that had been ravaging the state for years – an onslaught that had been identified, studied, researched, and documented for much of the last decade – and ignored.

Willful ignorance?
The evidence has been well known – and ignored – for years:

• What is known as the Truven Report, four analytical studies conducted by Truven Health Analytics and released in September of 2015, provided an in-depth look at Rhode Island’s behavioral health care landscape, from a cost, supply, demand, and infrastructure analysis.

At the time the studies were released six years ago, the hope was that they would serve as the framework to develop a new coordinated system of behavioral and mental health care in the state, looking to create a continuum of care, focused on population health. [See link below to the ConvergenceRI story, “Looking for a sanity clause in Rhode Island.”]

• As reported by ConvergenceRI at the time, the Truven studies found:
 Children in Rhode Island faced greater economic, social, and familial risks for the development of mental health and substance use disorders than children in other New England states and the nation.

• Unemployment among parents in Rhode Island is higher than in other New England states: more children live in single parent households, more children have inconsistent insurance coverage, and one in five children in Rhode Island is poor.

• “These socio-economic challenges help explain why children and adolescents in Rhode Island experienced higher rates of adverse childhood events and subsequent behavioral health conditions such as ADHD, major depression, and illicit drug use than children and adolescents in other New England states and nationally,” the study said.

• Further, the study continued, such “higher risk factors are expressed in adulthood as higher prevalence rates of disease.” Adults in Rhode Island have higher rates of drug abuse and dependence and serious psychological distress than other New England states and the national averages.

Translated, the early stressors in childhood and adolescence often blossom and flower into higher rates of depression and substance use disorders.

The most recent Mental Health America’s 2021 report documented the predictable consequences and health outcomes of the policy failures of Rhode Island’s mental health and behavioral health delivery systems: “[Some] 50,000 Rhode Island adults experiencing a mental illness were not able to receive the treatment they need,” the report said. As a predictable result, Rhode Island had the highest prevalence of untreated adults with mental illness of any state in New England.

The question is: Why would anyone be surprised that the pandemic, with its dramatic increases in economic, social, and health stressors, would exacerbate an already over-taxed system?

Continuing the conversation
In reporting on the story in last week’s edition, ConvergenceRI had reached out to a number of sources, including Dan Fitzgerald, MPH, ICPS, the executive director of the Chariho Youth Task Force, in order to get as broad as perspective as possible on how best to frame the conversation.

Fitzgerald had responded but too late for inclusion in last week’s story. His answers were insightful enough to convince ConvergenceRI to plan to do a follow-up story.

ConvergenceRI: How would you characterize the increases in demand for mental health and behavioral health services during the pandemic, in terms of what you have seen?
FITZGERALD: Anecdotally, the middle school, high school, and college-aged students we work with report feeling way more overwhelmed since March 2020. In October 2020, we launched a resource where we have wooden signs around our community with a QR [quick response] code on our website, and we have had more than700 unique devices scan this code and access these resources.

The majority [of folks responding] clicked the stress reduction button, and the second-highest [number of] clicks was on the “I need help now” button.

ConvergenceRI: Has there been an increase in suicides or suicide ideation in Rhode Island in 2019 and 2020, from the population that you have been working with?
FITZGERALD: To my knowledge, I do not have any concrete data pointing to an increase during this time period.

ConvergenceRI: How much of the apparently increased levels of anxiety are related specifically to the situation regarding schools?
FITZGERALD: From a youth perspective, a large amount is related to the schools. For some, home is not the safest place and attending school virtually for much of the spring was a real challenge, especially letting their peers and educator look into their homes via virtual meetings. For others, the stress from isolation has been the most difficult aspect.

ConvergenceRI: A former director of a high school health clinic described her work with teens as being about “sadness, sex, and substances.” Is that accurate?
FITZGERALD: For some, I think that is accurate. For many, I fear we collectively do not know. School and community support staff are having a hard time reaching students they previously knew were in need. There are so many students falling through the cracks that we as support professionals and organizations are unable to currently reach.

ConvergenceRI: The other somewhat problematic part of the discussion is the idea that schools represent a “safe” place, as distinguished from homes, and that there are services available for students at schools. From your expert position, what resources are available at schools for students who are experiencing mental health and behavioral health issues?
FITZGERALD: In our school district, we do have incredible support professionals who are still providing services. For some students, there is less [of a] barrier to access these services because they do not have to walk to a physical office and face that stigma. For some, they are not comfortable or able to access due to their home life.

ConvergenceRI: Can you describe the work that you are currently engaged in with the Chariho Youth group?
FITZGERALD: Our primary work is substance use prevention and mental health promotion. We work to provide resources to our entire community and offer a virtual support group for adults who have a loved one in active addiction or have lost someone to overdose. We also work with the school district to provide education proactively and reactively to those who have initiated use.

ConvergenceRI: What questions haven't I asked, should I have asked, that you would like to talk about? Better yet, how would you like to see the conversation framed around mental health and behavioral health issues for students in Rhode Island?
FITZGERALD: There will be long-term impacts from the isolation and negative mental health experiences of our young people, our educators, our first responders, our parents, etc. We need to invest in community-wide approaches that arm our friends, families, and neighbors with adequate resources, and incorporate trauma-informed approaches at school, at work, and in the home.

Pretending this never happened and moving forward when we “get back to normal” will not be possible for all our students.

Keepers of the data
ConvergenceRI next sought out Rhode Island Kids Count, which produces its annual Factbook each year that serves as a veritable encyclopedia of data on the health and well being of children in Rhode Island.

In the section entitled “Children’s Mental Health,” to be found on Pages 58 and 59 of the 2020 Rhode Island Kids Count Factbook, children’s mental health is defined as follows: The number of acute care hospitalizations of children under age 18 with a primary diagnosis of a mental disorder. Hospitalization is the most intensive type of treatment for mental disorders and represents only one type of treatment category on a broad continuum available to children with mental health concerns in Rhode Island.

In the data presented, the Factbook, looking backward at data from 2014 through 2018, based upon data from the R.I. Department of Health Hospital Discharge Database, said: “Twenty-five children under the age of 20 died due to suicide in Rhode Island between 2014 and 2018.”

ConvergenceRI spoke with Elizabeth Burke Bryant, the long-time executive director of Rhode Island Kids Count, to get her perspective on how best to frame the conversation around mental health and behavioral health needs for children and families in Rhode Island.

ConvergenceRI: I was curious what you thought about the story. Were you surprised by the data that showed Rhode Island had the lowest rate of teen suicide in the nation for 2019 and 2020?
BURKE BRYANT: This is something that we track carefully in the Rhode Island Kids Count Factbook. And, I know that the data you used was from a new source of data.

ConvergenceRI: When you say it is a “new source of data,” Jeff Hill is seen as the go-to-person in Rhode Island around suicide prevention data, and he has been doing this work for six years.
BURKE BRYANT: I meant new data, I didn’t mean new source.

ConvergenceRI: The data results were surprising to me. I was wondering if they were surprising to you. In general, did you think I did a good job of covering the story? Were there things that I should have included that I left out?
BURKE BRYANT: Rather than give you feedback on the story, I would rather just dive in and say: We really need a lot of attention on children with mental health concerns, because we know that families are under a great deal of stress right now with the pandemic.

And, there have been a lot of national reports on the increased mental health needs of children and youth as a result of the pandemic. So, it is an issue that we are always concerned about, because we know that there has been a shortage of mental health treatment for children and youth who need it.

That’s been the case nationally and in Rhode Island, so it’s really important to keep a focus on what the needs of children and youth are so that we are able to make sure that their needs are being met.

ConvergenceRI: What types of additional resources do you think are needed to do that?
BURKE BRYANT: Well, I think, more mental health professionals in schools. We know that many children find it easier to access mental health services at schools.

And, we have reported in our student-centered learning issue brief, it was a data point that students are many times more likely to use school-based health centers for mental health services. It is also an issue when we are facing a pandemic.

ConvergenceRI: You cited national studies. I was wondering whether you had any local data that you can cite about the increases in demand for mental health services for children and families.
BURKE BRYANT: We have hospitalization and death data in our Factbook, but the latest data we have for hospitalization and deaths is from 2018, and that [can be found] on Page 59 of our Factbook. It shows that in 2018, there were 2,865 emergency department visits and 1,864 hospitalizations of Rhode Island children with a primary diagnosis of a mental disorder. We don’t have a trend to show yet from back data to 2020 through the pandemic.

We also rely, as I now that you are well aware of, the YRPS [Youth Risk Behavior Surveillance] data conducted by the Centers for Disease Control and Prevention, and that data is from 2019, and that only comes out every two years.

But I think we can get some more recent hospitalizations and death data in Rhode Island. I have asked Stephanie [Geller, the deputy director at Rhode Island Kids Count] that question, and she thinks we might be ale to get a little bit more [information].

ConvergenceRI: In talking with Susan Orban, she very clearly said that the goal should be to keep children out of the emergency department, that it wasn’t the most appropriate way to treat children, and that it was often counter-productive.
BURKE BRYANT: Yes, absolutely. It’s not where we want mental health services to be provided. That is absolutely the case. We want preventive services. We want services that are community-based and school-based for children and their families to access. And the goal is always to keep kids from having to go to emergency rooms when mental health crises escalate.

It’s far better to get in early and make sure that there are preventive services and services that will prevent emergency room use. That’s why we do a careful charting of emergency department visits and hospitalizations, because they are indicators that we want to see decreases in both.

We want to make sure that mental health services are available in the early stages of mental health issues as they [become evident]. I think that is what Susan Orban was stressing as well.

ConvergenceRI: Do you think too much pressure is being placed on schools to pick up the pieces of a safety net that has been torn apart?
BURKE BRYANT: I think we’ve known in this country and in Rhode Island for a long while that we have a shortage of mental health professionals and child psychologists and child psychiatrists for our children in Rhode Island. It is a national problem as well.

We need to continue to work on that issue. I think that I’ve given you this statistic before, but only about one in five youth with a mental health condition in Rhode Island is able to access services.

On Page 58 of the 2020 Factbook, we state: “One in five children, ages 6-17, has a diagnosable mental health problem, and one in 10 has a significant functional impairment, so that just shows the prevalence of this issue when it comes to mental health.

We further indicated, in Rhode Island, that an estimated 36 percent of children, ages 3-17, who needed mental health treatment or counseling, had a a problem obtaining needed care.

ConvergenceRI: What’s the solution?
BURKE BRYANT: And, then, more recent data, because I know you like more recent data, is in Fiscal Year 2019, there were 437 children and youth awaiting psychiatric inpatient admission, and the average wait time in 2019 was 3.3. days, up from [a wait time of] 1.4 days in 2018.

But what you are asking about and focusing in on, and what I’m talking about, is trying to further upstream before mental health conditions escalate, with more access to preventive health services for children and teens.

ConvergenceRI: A few years ago, you honored the work of the  Central Falls High School health clinic director. In my interview with her about her work, she identified three key health needs for the students she was seeing: sex, sadness and substances.
One of the biggest needs, she said, was the need to talk about sadness, beyond what she could provide. In talking about the mental health and behavioral health needs for kids, would it make sense for the Rhode Island Kids Count Factbook to develop some kind of longitudinal metric to measure “sadness?”
BURKE BRYANT: That would depend on the availability of data, data that would actually measure it. In the Factbook, we have to go with the best available data. We definitely want to put as much data as we can into [our indicators].

There may be studies that monitor the incidence of depression. There may be other metrics that get closer to “sadness,” but I would need to look further into what data we would be able to get in order to measure that over time.

ConvergenceRI: Where do you think the future investments in resources need to be directed?
BURKE BRYANT: I think we need to see a range of access points; community-based mental health organizations that work with children and families are one place. Another opportunity for investments is in school-based health centers.

We need to make sure that we are attracting professionals in this area [of practice] to Rhode Island, so that there is an increase in the number of practitioners that can readily see children and teens in need of mental health services.

Because it is very cost effective if you can get in earlier with preventive mental health treatment, it can often times prevent escalation to what then becomes an emergency circumstance that would need emergency care or inpatient care.

I think another key resource that has been augmented has been Kids Link, as a number to call about children’s mental health issues.

[Editor's Note: Late on Sunday night, Burke Bryant sent an addendum to her interview. She wrote: First,  I re-read last week's story and I agree with with Jeffrey Hill when he said: “I think it's really important for schoolchildren to know where to reach out and how to reach out, if they are feeling sad - and certainly if they feel that they cannot reach out to a parent.”

Children are suffering from social isolation. loneliness, and the changes in their routines. Some children are dealing with the anxiety of parents losing jobs, and the economic stress that results. And some children are coping with health concerns and losses of loved ones due to COVID.

Second, I think the additional data that was released by the R.I. Department of Health and mentioned in  the recent Providence Journal story is very relevant to our conversation about youth suicide. In that article, according to R.I. Health Department spokesman Joseph Wendelken, his office had not observed an increase in the number of suicides to date, but the “proportion of emergency-department visits among Rhode Islander’s ages 10 to 17 relating to suicidal thoughts and actions was approximately two times higher during March to June 2020, when compared to (the same three-month data slice) from March to June 2019.”

So while it is good news that  the data from Jeffrey Hill shows that there was no increase in suicides for kids under 18 in (2019 and) 2020, and that Rhode Island has the lowest rate of suicide for kids under the age of 18 in the nation, the above data reflecting suicidal thoughts and actions was approximately two times higher is worrisome.

And, as you and I discussed, focusing on prevention and reaching kids earlier is key. As Susan Orban said, we need a mix of approaches to reach kids including in schools, at homes, or through community programs.]

Teen dating violence
ConvergenceRI also reached out to the R.I. Coalition Against Domestic Violence, with a specific set of questions, including:

• How important is it to develop a database for Rhode Island that connects the diseases and death of despair – suicide, drugs, alcohol, and gun violence involving domestic violence, tied to economic disparities?

• Is there an opportunity to develop better screening at the pediatric and emergency room level around toxic stress, childhood adverse experiences, and domestic violence in Rhode Island?

• How would the Coalition suggest reframing the story about data on teen suicide and mental health in Rhode Island?

Cynthia Roberts, an evaluator with the Coalition, provided a wide-ranging response of how the work around domestic violence, grounded in evidence around key indicators for equity and racial disparities, focused on a sense of “connectedness.”

Further, in response to the specific questions, Tonya Harris, executive director of the R.I. Coalition Against Domestic Violence, chose not to respond specifically to any of the questions asked, but instead, sent in a statement that focused on her own reframing of the issues, through a lens looking exclusively on domestic violence.

Harris wrote: “Prevention of domestic violence is possible. The RICADV and the network of member agencies continues to work toward ending domestic abuse and preventing violence before it starts.”

Further, Harris said: “We have to stop accepting domestic violence as a fact of life, as ‘just the way it is,’ and continue working toward change on many levels. We must also shift the attitudes and behaviors that perpetuate this violence and make sure our communities are vibrant, healthy places for everyone. This breaks the cycle, this stops the violence before it has a chance to start – this is primary prevention.”

Harris continued: “February is national Teen Dating Violence Awareness and Prevention Month, and educating teens and young adults about healthy relationships is vital. This year, our public awareness campaign aims to do this by spreading the word that we all deserve healthy relationships.”

For this year’s campaign, Harris said, the Coalition is “collaborating with Rhode Island students to hear what healthy relationships mean to them, and answering their questions about safe, respectful dating. Our goal is to create an open space for youth, teens and young adults to learn more about how identifying healthy relationships is important in the prevention of teen dating violence.”

Harris added: “A common misconception is the idea that domestic abuse is limited to physical violence, when in reality, domestic violence takes on many forms, like emotional, psychological and financial abuse as well as digital abuse - with cyberstalking as an example.” Harris urged that teens recognize the signs of what is involved in a healthy relationship – including mutual respect for one another’s time, privacy and boundaries. “It’s also critical young adults know support is available if they have questions, aren’t sure if they’re in an abusive relationship or not, or are looking for services,” she said.

In conclusion
Talking about mental health during a time of pandemic, where the stresses and anxieties are magnified, provides a number of different narratives – some of which connect, while others remained steadfast in their hardened silos. Still others tilt toward maintaining the status quo of the current health care delivery system.

One major problem is the lack of an integrated statewide database that can connect what is known as the diseases of despair, which could be seen as a first necessary step for creating convergence in the conversation, instead of four or five different approaches that are constantly competing against each other for scarce funds and resources.

Clearly, there is no lack of data; there is no lack of insights; there is no lack of ongoing unmet needs in the mental health arena, for children, families and adults.

One overarching solution, identified in legislation now before the R.I. House, H5546, introduced by Rep. Robert Craven, would increase the rates of reimbursement for outpatient, in-network, mental health and substance use disorder services and treatments by 23.4 percent over the next five years, with a minimum increase of four percent per year, to be completed on or before July 1, 2027. This would help to increase the number of mental health practitioners.

There is no doubt that we are in the midst of a mental health and behavioral crisis, exacerbated by the pandemic and the continuing health and economic fallout. Instead of pointing out the obvious – that there is an enormous demand for services that is inundating the current health care delivery system’s capabilities, perhaps a better response would be to look at the reasons why the current data reflects no major increase in suicide deaths by teens in Rhode Island, to better understand what part of the upstream approaches of prevention are working and to invest in them.

© convergenceri.com | subscribe | contact us | report problem | About | Advertise

powered by creative circle media solutions

Join the conversation

Want to get ConvergenceRI
in your inbox every Monday?

Type of subscription (choose one):

We will contact you with subscription details.

Thank you for subscribing!

We will contact you shortly with subscription details.