Delivery of Care

Bridge over troubled waters: data on teen suicide in RI

Did you know that Rhode Island has the lowest rate of suicide for kids under 18 in the nation, according to preliminary data for 2020?

Image courtesy of Healthy Bodies, Healthy Minds website.

The Health Equity Zone in South County, "Healthy Bodies, Healthy Minds," has developed a collaborative community suicide prevention program, funded by the Centers for Disease Control and Prevention.

By Richard Asinof
Posted 2/8/21
A look at the data on teen suicide in Rhode Island revealed some surprising statistics: Rhode Island led the nation in the lowest number of suicides for youth 18 and younger for 2019 and 2020. The strategic push for in-person schooling to relieve the state’s mental health exigencies for schoolchildren may need to be re-examined.
How can schools better integrate mental health programs around suicide prevention being developed by Health Equity Zones in South County, in Newport, and in Bristol? Is there a need to do toxic stress screenings as part of pediatric best practices in Rhode Island, looking at adverse childhood events? Does Commissioner Infante-Green need to tone down her inflammatory rhetoric around mental health concerns for remote learning students? Do the new SMART Clinics need to do a better job in conducting outreach to existing mental health programs operating in Providence? What is the current status of EMS diversion at hospitals in Rhode Island?
Members of the R.I. General Assembly are raising some serious questions around the way in which the new SMART Clinics have been coordinating their services with existing school nurses. From afar, the new school-based clinics, supported by corporate donations from Aramark, CVS, and Partnership for Rhode Island, and sponsored by the GINN Foundation, represent a plug-in-and-play model for delivering services, which may or may not meet the existing community needs.
The medical needs of students will be managed by the Providence Community Health Centers with culturally appropriate care as well as the integration of behavioral health staffing. However, many of the families of students do not have access to health insurance coverage, and the question remains unanswered: who will pick up the tab for uncompensated care delivered by the health clinic.
There are also reported to be problems regarding preserving the privacy of health data for students and how that is being shared.

PROVIDENCE – One of the crucibles of current state education policy in Rhode Island, as advocated by outgoing Gov. Gina Raimondo and by R.I. Education Commissioner Angélica Infante-Green, has been the belief, repeated again and again in strong emotional appeals, that in-person learning in the state’s public schools was a scientific, data-driven choice to prevent an avalanche of mental health problems, including suicide, from overwhelming Rhode Island’s schoolchildren.

For months, both Raimondo and Infante-Green have warned repeatedly that remote learning would precipitate a dire flood of mental health problems if students did not return to in-person classrooms, which they deemed to be a safe sanctuary from the coronavirus pandemic.

Throughout the fall, Raimondo had used the bully pulpit at her weekly news briefings to publicly call out and berate superintendents in local school districts, such as Pawtucket and Warwick, that chose not to follow the Governor’s call for an in-person regiment for students, instead of opting for a hybrid system of in-person and remote learning.

Many teachers, in turn, have consistently pushed back against the Raimondo administration, arguing that safe, in-person learning necessarily involves expanded testing for teachers and students, increased supplies of personal protective equipment, installation of better air filtration systems in the schools beyond just opening windows, and the inclusion of teachers as a higher priority population to receive a vaccine, particularly as the community spread of the virus kept reaching higher and higher levels in November, December, and January. Further, the Providence Teachers’ Union has called out Infante-Green for what they describe as her bullying tactics around the current contract negotiations.

Not surprisingly, the definition of “safety in schools” has emerged as a key political football of 2021, one that has now been tossed into the lap of incoming Gov. Dan McKee as a policy hot potato. In addition, the R.I. General Assembly is considering placing a temporary moratorium on expansion of all charter schools in Rhode Island, certain to become another flashpoint in state educational policy.

Prevalence of suicide?
A recent New York Times story, published on Jan. 24, with the headline, “Surge of Student Suicides Pushes Las Vegas Schools to Reopen,” brought to the forefront once again the issue surrounding the mental health of students in Rhode Island, related to the emotional burden that COVID-19 had been placing on students.

The story, written by reporter Erica Green, painted a dire situation in Nevada: “The reminders of pandemic-driven suffering among students in Clark County, Nev., have come in droves. Since schools shut their doors in March, an early-warning system that monitors students’ mental health episodes has sent more than 3,100 alerts to district officials, raising alarms about suicidal thoughts, possible self-harm or cries for care. By December, 18 students had taken their own lives.”

The story continued: “The spate of student suicides in and around Las Vegas has pushed the Clark County district, the nation’s fifth largest, toward bringing students back as quickly as possible. This month, the school board gave the green light to phase in the return of some elementary school grades and groups of struggling students even as greater Las Vegas continues to post huge numbers of coronavirus cases and deaths.”

Further, Green wrote: “Superintendents across the nation are weighing the benefit of in-person education against the cost of public health, watching teachers and staff become sick and, in some cases, die, but also seeing the psychological and academic toll that school closings are having on children nearly a year in.”

What the data in Rhode Island revealed
To be transparent, ConvergenceRI has always been a bit skeptical about the way that data had been weaponized by the Raimondo administration when it came to promoting in-person attendance in public schools. [See link below to ConvergenceRI story, “A deadly experiment in RI?”]

Particularly after the Raimondo administration had consistently cited studies put out by the Centers for Disease Control and Prevention, apparently “edited” and “doctored” by political appointees of the Trump administration, saying that in-person learning in schools was safe and claiming that there was limited transmission of the virus by students in schools. There were also questions that had been raised about the role that Dr. Deborah Birx had played in promoting the CDC study with its altered findings.

Yet, given the alarming story about the rash of suicides by students in Nevada, ConvergenceRI wondered: what would the data in Rhode Island around suicides reveal for 2019 and 2020? In particular, what did the data have to say about incidence of suicide in Rhode Island in students under the age of 18? Had there been a similar kind of tragic upswing in suicides as had been reported in Las Vegas? And, what other kinds of data existed about the mental health demands created by COVID-19?

To find out the answers, ConvergenceRI interviewed Jeffrey Hill, who has served as the manager of Youth Suicide Prevention Project at the R.I. Department of Health since 2016.

The answers were surprising: Rhode Island has the lowest rate of suicide for kids under the age of 18 in the nation, according to Hill, according to the data from 2019 and the preliminary data from 2020.

When asked by ConvergenceRI if there had been an increase in suicides in teenagers during the past year, Hill, who administers six suicide prevention programs, answered with a firm “No.”

Preliminary data, he continued, “shows that we didn’t experience any increase in suicides for kids under 18 in 2020,” destined to be remembered as the year of the plague in Rhode Island, where the number of COVID-19 deaths in Rhode Island has reached 2,212, with 117,891 confirmed cases, as of Feb. 6.

The success in suicide prevention in teens in Rhode Island, Hill explained, was due to “the efforts of everyone who is involved in children’s mental health. I don’t know that I could attribute it to any one thing.”

Hill continued: “I think that we worked very hard on a prevention program with a number of school districts to increase access to mental health services.”

Hill said he was speaking specifically around the issue of suicide prevention, which was the core of his work. “We are fortunate to see that there were no deaths [from suicide] that we know of in 2020 for children under the age of 18.”

Further, Hill said: “We didn’t see an increase in deaths in the demographics under age 24 in 2019 or in 2020.” According to American’s Health rankings, Hill continued, “Rhode Island had the lowest suicide rate in the country. I think we have a lot to be proud of.”

The tools of prevention
In discussing Rhode Island’s apparent successful approach to preventing suicide by teenagers, Hill cited a number of tools focused on prevention, including: teacher trainings, school crisis teams training, promoting access to hotlines such as Kids Link, and, most importantly, “helping schools to screen kids, hopefully getting them to the right place, rather than the emergency room.”

Hill shied away from making any judgments about comparisons of virtual learning as opposed to in-person learning, with regard to mental health needs, saying it was way to early to draw any conclusions from the data.

In trying to evaluate any findings about in-person learning and its benefits for better mental health outcomes, Hill said that it could cut both ways. “I think it can be helpful for kids who may have difficulty in accessing mental health services. Schools may have been the place where they were accessing them before the pandemic,” he said, where they had found a trusted adult that they felt they could reach out to.

On the other hand, Hill continued, “Students may feel more comfortable reaching out for help online.”

In talking with the former director of the high school health clinic at Central Falls High School, I told Hill, she had identified the top three key issues facing teenagers as: sadness, sex, and substances. Did Hill feel that was an accurate description? And, what were the best ways to measure the metrics of sadness, beyond self-reporting analyses?

“I think it’s 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.”

Further, Hill stressed the importance of peers serving as part of the educational process around mental health, knowing how to look for signs with each other that someone is struggling and needs help, particularly for middle-school students.

“That is an important link in the chain of prevention,” Hill said, adding that it was also important to know that there were professionals out there that students could reach out to as well – and to educate parents that there were professionals that they in turn could reach out to.

SMART health clinics in Providence
While Hill said that he was aware of the two new school SMART health clinics that have been established in Providence, he said that no one had yet reached out to him to talk about his potential involvement with the health clinics around suicide prevention.

In terms of accessing mental health services through schools, Hill said that he was aware of programs involving The Providence Center and Family Service of RI where there were behavioral clinicians on site at the schools to see students after school.

In terms of suicide prevention programs, Hill said that the Health Equity Zone in Washington County, “Healthy Bodies, Healthy Minds,” had created programming, as had the Bristol Health Equity Zone.

Bridge over troubled waters
After talking with Hill, ConvergenceRI reached out to Susan Orban, who is the director of the Healthy Body, Healthy Minds initiative. Under her leadership, the HEZ has also developed a “Zero Suicide Initiative” having received $2 million in competitive CDC funding in 2018. [See link below to ConvergenceRI story, “New bridge over troubled waters.”]

Orban apologized for not being able to pull together any data, because she had a grant report due the next day. Instead, she offered her overview of what she saw happening on the ground in regard to teen suicide rates in Rhode Island in her neck of the woods.

Orban wrote: “I was alarmed by the news stories coming out of Nevada recently about the significant up tick in youth suicides since COVID. I feel like we have to knock on wood in Rhode Island. Jeff Hill has done an amazing job working on prevention efforts in Rhode Island, and fingers crossed they are paying off for our youth.”

Orban continued: “Not to say all is rosy, although numbers were down early in the pandemic as everyone stayed away from Emergency Departments [EDs] Locally, the number of people going to EDs has been rising again. EDs are no places for people in crisis to be getting care, especially children and youth.”

Further, Orban wrote: “Spending hours waiting for an evaluation, dressed in a johnny in a cold sterile exam room is no way to calm down in a crisis. A robust mobile crisis system is needed in our state to respond to mental health crises, wherever they are – in schools, at homes, or through a community program.”

The situation in schools around behavioral health issues needs to have more money invested in resources, Orban argued. “As for schools, with only part-time behavioral health staff available, crises often occur on days when staff are not working in the building. Managing behavioral health issues cannot fall solely to behavioral health staff. All staff in schools need to have an understanding of common mental health issues and how to de-escalate crises.”

Orban said that while isolation and disconnection contributed to feelings of despair, she believed that not enough was being done to invest in prevention strategies. “I agree isolation and disconnection are a set up for despair among us social beings. But, I also believe we do not invest enough in prevention. Be sure to ask the question as you explore your story: What are schools doing to foster mental wellness in their students in the midst of the pandemic?”

Orban also stressed the need for additional training: “I believe strongly all staff in schools need to be trained in Youth Mental Health First Aid. This should be a prerequisite for hire, just like it is a state mandate now for police officers and EMS personnel to be trained in Mental Health First Aid.”

Here are suggested links to access mental health services around suicide prevention, as recommended by Jeffrey Hill:

•  Families can reach the National Suicide Prevention Lifeline operated in Rhode Island at BH Link at 1-800-273-8255.

•  Kids’ Link RI is a behavioral health triage service and referral network. The program is offered in collaboration with Gateway Healthcare, Lifespan, Hasbro Children's Hospital and Bradley Hospital. Kids’ Link RI is available 24 hours a day, seven days a week, to help triage children and youth in need of mental health services and to refer them to treatment providers.

Call 1-855-543-5465 if your child is: feeling excessive anger or sadness; lashing out at siblings, friends, and adults; having behavior problems at school; having severe worries, or hurting himself/herself or others.

The free, confidential phone line connects parents and caregivers to an experienced clinician that can help them access children’s services in Rhode Island, and determine the best place to go for treatment and counseling.

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