TRURO — A forum on youth suicide at the community center on March 16 attracted more than 50 people, many of whom talked about a broken mental health care system, poor insurance coverage, and a lack of providers. But there were also hopeful notes, including a new “navigator” at the high school.
The forum was organized by the Cape & Islands Suicide Prevention Coalition in response to the recent deaths of three teenagers on the Lower and Outer Cape.
“People do not like to talk about youth suicide,” said facilitator Maura Weir, a clinical psychologist and director of wellness and counseling at Cape Cod Community College. “But I actually do like to talk about it. And I want everyone else to feel the same way.”
An informed conversation, Weir said, does not give teens self-destructive ideas. In fact, many are already thinking of it. Ten percent of teens seriously considered suicide in the past year, according to the Massachusetts Youth Risk Behavior Survey. For LGBTQ adolescents, the number is 31 percent.
“Just think about the adolescent brain,” said Weir. “Their prefrontal cortex is still developing, so they have a little bit more risky behavior and more impulsive behavior than supposedly we have as grown adults.”
Research on suicide-attempt survivors shows that most simply wanted their pain to end, she said.
“I see a lot of people who attempted suicide and lived,” said Weir. “The minute that they do the act of suicide, 99.9 percent of them wish they hadn’t done it. All the research says most suicide-attempt survivors realized they didn’t want to die as they were performing the act of suicide.”
The forum included panelists from human service organizations and the Nauset Regional Schools. Experts discussed how their groups provide resources to Cape families in crisis. It became clear from audience questions, however, that insurance companies’ refusing to cover mental health treatment has left wide service gaps, especially for adolescents.
Beth Cook of Truro said she knows that from personal experience. About three years ago, her daughter, then 16, suffering a breakdown, and Cook contacted a Cape-based mobile crisis team, only to discover that it is restricted to those with the state’s public insurance, known as MassHealth.
Because the crisis team could not come to Cook’s home, she took her daughter to the emergency room at Cape Cod Hospital, where the girl spent six days in a hallway, untreated, waiting for a psychiatric inpatient bed to be available. Cook eventually took her home, she said, and drove her every day to outpatient treatment in Pembroke, 80 miles away.
Nurses from the local schools and providers from Outer Cape Health Associates who were in the audience in Truro agreed that they, too, had trouble finding care for patients in crisis and that teenagers can spend days in the emergency room waiting for treatment.
Panelist Rebecca Stanley, the director of emergency services and crisis stabilization for Bay Cove Human Services of Cape Cod, said her agency provides that mobile crisis care. Now they do offer the service to anyone under age 21, regardless of insurance coverage. For adults, most private insurance remains a barrier, she added.
Insurance, said panelist Meghan Robitaille, program director at the Justice Resource Institute, “is the worst problem I have. I hate it. This is not how it should be. If someone needs help, they should get help.”
Regina Broz of Wellfleet asked how adolescents can get credible information if they refuse to talk to parents, teachers, or other adults. She asked if the Nauset schools have suicide prevention curricula.
Nauset Regional Middle School offers SOS, or Signs of Suicide, said panelist Jessica Newell, a social worker and counselor at the school. The program, for students ages 13 to 18, has produced evidence that it reduces suicide attempts.
But Nauset Regional High School stopped offering SOS about four years ago, said Dee Smith, head of the school’s guidance department. Smith said the administration is now trying to design programs offered during the school day rather than a one-time assembly or class. Smith said seniors need suicide awareness before college, where they will be unsupervised and far from people they love and trust. They need the skills to prepare for the isolation, Smith told the Independent.
There is one new development at the high school. Outer Cape Health Services (OCHS) has “embedded” a navigator — that is, a guide to the treatment labyrinth — at Nauset, said panelist Kim Mead-Walters, whose son Jeremy died by suicide in 2016.
Starting in February, the navigator, Jennifer Ferron, moved into an office on the school campus and is now introducing herself to students, said Robin Millen, Nauset’s director of curriculum, instruction, and assessment.
Ferron works in the school but is a staff member of OCHS, which funded the position with a $200,000 grant from the federal Health Resources & Services Administration (HRSA). The grant is designed to improve students’ access to primary care, behavioral health, dental, vision, and “enabling services” like transportation, outreach, translation, and telehealth, according to an announcement from HRSA.
The navigator can help connect students with therapists or, theoretically, find psychiatric inpatient beds — of which there are currently none on Cape Cod for teens, Weir said.
Holes in the treatment web are problems, but not a reason to give up hope, said Weir. Call state Sen. Julian Cyr, who attended Nauset High himself and is “very interested in this,” Weir said. He is working on legislation to increase mental health parity. Also, she said, look to each other as parents and clinicians.
“Maybe insurance is not always the answer, but community is,” Weir said. “Turn around and look at everyone who is here tonight. You guys are a community. You have the strength to come here tonight. You have the strength together to help make mental health issues something that doesn’t have this stigma we see now.
“This is how change happens,” she continued. “It happens at the community level.”