Helping Kentucky’s Youth with Mental Health Problems

By John Gregory | 9/29/18 8:00 AM

According to the U.S. Centers for Disease Control and Prevention, nearly 15 percent of Kentucky high school students have seriously considered committing suicide in the past year.

That means tens of thousands of the state’s youth thought about ending their lives before they even reached graduation.

“So what we need to be thinking about [is] how do we support those young people and get them access to services to ensure that they don’t think about suicide again,” says Dr. Joe Bargione, a retired school psychologist with Jefferson County Public Schools.

Bargione appeared on KET’s Connections to discuss suicide and suicide prevention strategies as well as other youth mental health issues.


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Risk Factors for Suicide and Other Mental Health Problems
While the risk of suicide cuts across all demographics, the CDC reports a significant rise in recent years in the suicide rate among students as young as 10 years old. Suicide is also the second leading cause of death among youth and young adults.

Bargione attributes the increase to teens feeling unable to cope with greater demands at home and school. They may also face what are called “adverse childhood experiences,” such as abuse and neglect at home, food insecurity or homelessness, bullying, or exposure to violence in their communities. He says many teens often feel like they have no one to turn to for help when they face these situations.

Students may also suffer from anxiety or toxic stress, which occurs when a young person endures prolonged exposure to a threatening situation.

“Anxiety may be situation-specific,” says Bargione. “For example, I might have a fear of tests, but then the rest of the day or the rest of the week I’m OK. But with toxic stress, you never get away from it.”

To move from emotional distress to a crisis point like considering suicide usually takes a triggering event. Bargione says for young people such events can include the death of a loved one, a relationship break-up, or being rejected for a college admission.

There are signs that indicate a young person may be thinking about suicide. Bargione suggests watching for behavior changes, like sleeping too little or too much, or a sudden change in academic performance. The child may also isolate themselves from friends and family, stop participating in favorite activities, or they may give away prized possessions.

“If we can just recognize those signs,” Bargione says, “then we can intervene earlier.”

Asking a Simple Question
Bargione says a positive relationship with an adult is the top factor that can help a child who may be thinking about suicide. Such a relationship can make the child feel cared about, provide them someone they feel comfortable talking to, and can create a sense of connection and belonging.

“So with the overwhelming number of children in Kentucky, that’s mom, dad, grandma, and granddad,” Bargione says. “But there’s a bunch of young people where the parents, for whatever reason, they’re not able to be that positive adult, and that’s where the rest of us around the state have to step in.”

That could be a family friend or neighbor, someone at church, or a teacher, bus driver or lunchroom worker at school. Legislation passed by the General Assembly earlier this year requires all Kentucky middle and high school teachers and administrators to receive one hour of suicide prevention training every other year.

But since there are relatively few teachers and school counselors compared to the 650,000 public school students in Kentucky, Bargione says important for all adults to learn how to intervene with children at risk of harming themselves. One such program is QPR, which stands for question, persuade, and refer. The 90-minute training teaches people to recognize a child who is distress and to ask them a simple but very important question.

“Are you thinking about suicide?” says Bargione. “You must ask the question, and be direct and be empathic.”

The next step is to connect the child with the appropriate professional resources in their school or in the community who can evaluate their situation and get them the help that they need. A number of mental health organizations offer QPR training in Kentucky. In September alone, more than 2,200 people received QPR training in Louisville, according to Bargione.

A New Response to Inappropriate Behavior
An increasing number of schools are taking a trauma-informed approach to responding to children with behavioral or mental health issues. This technique encourages teachers, administrators, and staff to discern and respond to traumatic factors that may drive a child’s inappropriate behavior at school.

Bargione says Instead of simply disciplining a student for acting out in the classroom, the adult would first try to learn the backstory to the behavior. Is the child experiencing abuse or neglect at home, or the threat of crime and violence in their neighborhood, for example.

“I may have to be physically aggressive towards others to survive,” Bargione says. “But then when we display that same behavior in an organized setting such as a school or like an afterschool program, that’s an inappropriate behavior. So the young people have problems shifting from that.”

The impacts of such trauma can go far beyond short-term behavioral issues or thoughts of suicide. Bargione says sustained exposure to adverse experiences in childhood can lead to lifelong health problems, including anxiety, depression, substance abuse, diabetes, chronic pulmonary disease, and cancer.

“If you can take care of those traumatic events, not only are you helping that young person right now, but you’re also avoiding some of those long-term health implications,” he says. “So the person can live longer, they’re going to have healthier lives, they’re going to have better relationships with people around them.”

Bargione says the trauma-informed approach gives schools an option beyond discipline to help troubled students correct behavior issues and restore crucial relationships. He says it’s also important to teach children how to be resilient in the face of life challenges as they grow older.

“You’re going to feel terrible that my parent died or I didn’t get the job, but what are those skills we can teach you to be able to bounce back from that and being able to rationalize what happened and what can I do differently?” he says.

Long-Term Care after a School Shooting
In the wake of a shooting in January that left two Marshall County High School students dead, state lawmakers formed a special working group to explore ways to make schools safer. Bargione is a member of that group, which is traveling the state to hear testimony and collect ideas from students, school officials, and the public.

Bargione also served on the crisis response team that went to Benton just after the shooting to support survivors at the school and in the community, and to help them plan for their long-term needs. He says certain milestones like the first anniversary of the shooting may cause people to reconnect with initial trauma they experienced at the time of the incident.

“The long-term planning is what do we for next January,” Bargione says, “because one of the things you want to avoid in those kinds of situations is contagion effects or copycatting.”