This forum, hosted by Renee Shaw, discusses suicide – the second leading cause of death for teens and young adults in Kentucky – and talks with students, educators, and mental health professionals to examine the root causes of anxiety and depression and to learn how to help young people in crisis.
Mental Health Concerns for Youth Increase During Pandemic
Dr. Allen Brenzel is a child psychiatrist who works at the Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities. He says the latest Kentucky Incentives for Prevention (KIP), a statewide survey conducted every two years with about 50,000 students, revealed several troubling trends.
“One in five students reported that they experience significant psychological distress during 2021, and one in seven reported that they seriously contemplated suicide,” Brenzel says. “One in 14 reported that they attempted suicide. Those numbers are disturbing and staggering.”
Alissa Briggs, Ph.D., a licensed psychologist specializing in adolescent medicine at the University of Kentucky, says that research conducted by her team has found similar statistics. About 30 percent of students she’s surveyed report feeling anxious and depressed most days at school. Both Brenzel and Briggs note that mental health issues among Kentucky youth were already rising during the mid- and late-2010s, prior to the onset of COVID-19 in the spring of 2020.
While some statistics, such as youth suicides, have not spiked because of the pandemic, Brenzel says that self-reporting by adolescents of mental health problems, emergency room visits, and hospitalizations have all increased in the state. Children statewide were abruptly removed from classrooms over two years ago, and remote instruction became the norm for much of the 2020-21 and 2021-22 school years.
“So often, with many of our students, there are two anchors in their life,” says Joe Bargione, Ph.D., a retired psychologist at Jefferson County Public Schools who currently works with the Bounce Coalition. “One is their family, and the second is their school.”
Only recently have most schools in the state returned to normal, pre-pandemic operations, Bargione says. But for many students, the stable social environment of school was further affected by tornadoes in western Kentucky last December and flooding in eastern Kentucky in July. These students in impacted areas need extra counseling and care from school staff, he says, and funding for this support should be for the long term.
How Schools are Responding, and a Student’s Perspective
According to Damien Sweeney, Ed.D., director of diversity, equity, inclusion, and belonging at the Kentucky Department of Education, school administrators, teachers, and staff are making a sustained effort to prioritize mental wellness as an essential part of education. Many districts are implementing the Trauma-Informed School model that creates a welcoming environment for students by encouraging discussion of mental health issues by all staff, from teachers to cafeteria workers, janitors, bus drivers, and administrators.
“What this really boils down to is having a relationship with students,” says Sweeney. “Understanding their lived experience, trusting yourself enough to ask pertinent questions about their background, if you feel that they are at risk.”
Building on the trauma-informed care approach, Sweeney says the state board has a toolkit for teachers and staff specifically designed to reach out to students who identify as LGBTQIA (lesbian, gay, bisexual, transgender/transsexual, queer/questioning, intersex, and asexual). Students from this group are at higher risk for developing mental illnesses, Brenzel notes: one in three LGBTQIA youth reports having considered suicide compared with one in seven overall.
Sweeney acknowledges that race-based trauma is also widespread among students in minority groups, and he believes that more programs need to be developed in Kentucky’s education system to assist these at-risk kids. One solution is for schools to offer psychologically safe spaces where children can express their feelings about any event involving race that occurred at school, in their community, or around the world, Educators are there to offer guidance and support.
“When we create these opportunities, kids learn and they feel seen and heard and valued, and they also feel that adults are not shying away from truly hard conversations,” he says. “We used to call these conversations courageous. Now we call them necessary…. I don’t think that our educators need to have a moment of bravery to talk about something that must be talked about, that’s at the top of the minds of our students.”
Panelists praise state legislators for passing a law in the 2022 General Assembly that requires school districts to allow students to take absences due to mental health issues. The push for such a law came from several parties, including the Kentucky Education Commissioner’s Student Advisory Council, a group of students from around the state that meets several times a year to address topics important to their peer group.
Alexandra Perry is a member of the council and a senior attending school in northern Kentucky. Perry observes that many of her fellow students are still getting re-acclimated to the in-person school routine. Isolation brought about by the pandemic had negative effects on many of her friends, she says, leading to anxiety and depression.
Mental health, Perry says, “is a rough zone in school. A lot of times, it’s difficult to talk about mental health in school because it’s never brought up, it’s such a sensitive topic.” However, she has seen an increased effort by teachers and staff to discuss students’ emotional problems once in-person attendance resumed. She hopes those conversations will continue as she says it will help reduce the lingering stigma surrounding mental illness.
The QPR Model
Molly Jones became a committed advocate for helping people with mental health challenges after her son Pete died by suicide in December 2016 at age 23. Pete had struggled with depression for more 10 years.
Jones and her family formed The Pete Foundation to connect young people who have considered suicide as well as their parents and caregivers to clinical services. The organization was featured in KET’s You Are Not Alone series in 2018.
Part of The Pete Foundation’s outreach consists of instructing adults in the QPR approach to suicide prevention. QPR stands for Question-Persuade-Refer, and Jones says, “It’s a life-saving technique. The best way to think about it is, it’s a CPR for mental health.”
The first part of QPR – asking the question – is the hardest, but Jones says that adults, be they parents, caregivers, teachers, or mentors, must overcome their fear and ask the young person struggling with depression, stress, or another condition whether they are considering taking their own life. If the answer is yes, then the next step is to persuade the youth to get professional help, and then to refer them to a local clinic.
“We embrace it because it solves that problem that so many people feel they suffer from: ‘I didn’t know what to say, I’m afraid I was going to say the wrong thing,’” Jones says. “Knowing QPR solves that, 100 percent.”
“Be present, be available, and don’t be afraid, because kids will sense your discomfort with the subject, and they don’t want to make other people uncomfortable at times,” Brenzel says. “My experience with young people is that they’re ready – they are so ready to talk about this. We have to get over our hesitancy.”
Bargione concurs, saying, “We have to dispel the myth that talking to a child about their emotional wellbeing, if they’re having thoughts of suicide, will lead them to act upon that – that you’re putting those thoughts in their head. It’s actually just the opposite.” Many young people are relieved when the topic is stated out loud because they realize that someone cares about their mental health, he explains.
Effective Therapies and Proactive Measures
Briggs and her colleagues at UK treat children with mental illness using cognitive behavioral therapy, which teaches action strategies (such as relaxation or role playing) and techniques that help kids recognize the sources of negative thoughts and then change the pattern. She explains that teenagers have difficulty regulating their emotions due to biological changes as they grow into young adulthood.
“What’s going on in their emotional processing system is churning and firing on, and the system that helps them manage and regulate those emotions is lagging a little behind,” she says. “So adolescents really do feel emotions more intensely and quickly sometimes.”
Still, applying cognitive behavior therapy is successful in helping many children move away from a state of constant depression or having thoughts of suicide, Briggs says. She also recommends apps like MindShift, which can help kids deal with anxiety, and Finch for and self-care.
On a broader scale, Bargione stresses that the importance of promoting mental wellness can’t be overstated. In particular, he says more resources should be devoted to help children who experience an abundance of adverse childhood experiences (ACEs). ACEs were examined in detail in KET’s Healing Childhood Trauma special report.
ACEs have negative impacts on a child’s mental and physical health that can last their entire life. Many of them are actions and events specific to the individual and his/her family, such as parental or caregiver abuse and neglect, drug use, divorce, or incarceration of a parent. But they also include social and environmental conditions that affect wellbeing, such as neighborhood crime, food and housing insecurity, environmental pollution, and poverty.
Bargione says that a recent study from the U.S. Centers for Disease Control and Prevention examined what are called positive childhood experiences (PCEs). The research found that creating social support for PCEs through specific government policies – such as introducing social and emotional learning at the preschool/Head Start level – builds feelings of connection and belonging and creates long-term benefits for youth.
“Everybody needs to be at the table and work collaboratively to address ACEs,” says Bargione. “They impact kids 24-7, 365.”
