Missouri Department of Mental Health Director Valerie Huhn told the State Board of Education that in the last three years, the U.S. Surgeon General has issued advisories about the mental health of children, instead of about drugs, tobacco, and exercise.

“This feels different. Mental health is just like a broken arm for kids,” said Huhn. “We would never let them walk around with a broken arm. We need to start making sure we are addressing the things that are impacting mental health and that we are talking about mental health. We literally talk about this as a generational issue and it may be a two generational issue, to be honest. I just don’t want to say that yet because we’re talking about it. I think that’s really, really, really important.”

Huhn said multiple studies show rates of depression and anxiety among children jumped by more than 50% between 2010 and 2019.

The advisories say nearly one-third of teenagers report using social media almost constantly, with that figure doubling since 2015. They also say that children who spend more than 3 hours a day on social media face double the risk of mental health problems, including depression and anxiety.

Huhn said children need more healthy social interactions that drive people to connect.

“Among people ages 15 to 24, time spent in person with friends has declined by nearly 70% over the past two decades, from roughly 150 minutes a day in 2003 to 40 minutes a day in 2020. So, we are not talking to each other face to face,” she said.

Board member Kim Bailey, a mental health specialist from Raymore, said there should be a training element for teachers to educate students about the importance of face-to-face interaction.

“We are seeing a significant increase in our higher-level mental illnesses. I do feel that if we can get more healthy social connection, we’ll see those numbers come down,” said Bailey.

Board member Pamela Westbrooks-Hodge, of the St. Louis area, said she’s glad to hear discussions at the federal level about regulating social media use among children.

“I have not heard those same conversations at the state level,” she said. “And so, as you talk about solution sets and we talk about reining this in and preventing it, what role does policy play in helping parents regulate this? I mean, we know parents need to put kids in seatbelts, but it’s also a law that you have to wear a seatbelt.”

The state Departments of Elementary and Secondary Education and Mental Health plan to work together to address the mental health needs of children. Missouri Board of Education President Charlie Shields, of St. Joseph, said things must change if we want different results.

“We help with nutrition services, children experiencing homelessness. We have schools that have washing machines in them, said Shields. “We’ve had school nurses for 100 years. We don’t tell parents you take your kid to school; we send a bus by. All those services are designed to help parents. But somehow, we talk about mental health, behavioral health, values. That’s the third rail we can’t touch and we’ve got to get past that.”

Another conversation centered around the need for additional mental health professionals. Dr. Cla Stearns, with the Missouri Department of Mental Health, said not all of these jobs need to be people who are licensed, or have a master’s degree or doctorate.

“Missouri is 39th in the country on per capita mental health workers,” he said. “If you look at a map of the United States, and they show where there are areas where there’s considered to be an adequate mental health workforce, that’s about five states. And we’re 39. So, even with a massive push, we’re not going to get enough master’s level LPCs, LCSW, doctorate level folks in this to solve this issue. So, one of the things that we’re trying to do is some parent education because honestly, that’s probably your best avenue towards really improving the situation – is to give parents better skills and better information so that they can be kind of your frontline mental health workers.”

The U.S. Surgeon General recommendations for parents and caregivers include:

• Create tech-free zones and encourage children to foster in-person friendships.

• Model responsible social media behavior.

• Work with other parents to help establish shared norms and practices and to support programs and policies around healthy social media use.

U.S. Surgeon General recommendations for government include:

• Establish a dedicated leadership position to work across departments, convene stakeholders, and advance pro-connection policies.

• Study and support research on the causes of social disconnection.

• Develop age-appropriate health and safety standards for technology platforms. Standards may include designing technology that is appropriate and safe for a child’s developmental stage; protecting children and adolescents from accessing harmful content (e.g., content that encourages eating disorders, violence, substance use, sexual exploitation, and suicide or discusses suicide means).

• Develop tools that protect activities that are essential for healthy development like sleep; and regularly assessing and mitigating risks to children and adolescents.

• Support integration of screening and treatment into primary care. For example, continue expanding Pediatric Mental Health Care Access programs, which give primary care providers teleconsultations, training, technical assistance, and care coordination to support diagnosis, treatment, and referral for children with mental health and substance use needs.

• Provide resources and technical assistance to strengthen school-based mental health programs.

• Expand and support the mental health workforce. Example opportunities include investing in training and hiring individuals from a broader set of disciplines (e.g., peer supports, community health workers, family counselors, care coordinators) and accelerating training and loan repayment initiatives.

• In the school setting, governments should invest in building a pipeline of school counselors, nurses, social workers, and school psychologists.

• Expand and strengthen suicide prevention and mental health crisis services.

Source: Missouri Mental Health Director: “Mental health is just like a broken arm” – Missourinet

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SPRINGFIELD, Mo. (KY3) – A bold move to save lives.

Signs with the number 988 Suicide and Crisis Lifeline have been posted at Busiek State Forest in Christian County.

Francis Skalicky with the Missouri Department of Conservation said, “There was a suicide here last year. One is too many.”

Officials say there have been some suicides that have happened over the past few decades in the forest.

“Before they do what they came here for hopefully, these signs will give them a thought to reconsider,” said Skalicky.

There are three signs posted around the park. They are designed to get people the help they need when they need it.

“I think it could potentially save a lot of lives. Usually, when you’ve made that decision, you think, okay I can’t take this anymore. I’m going to make a permanent decision for what could possibly be just a temporary issue,” said Stephanie Appleby with the National Alliance on Mental Illness.

She says people in crisis often isolate themselves.

“I know, just from statistics, and just my family alone. Five members of my family have completed suicide. They’ve all gone out and done it outside or in a rural area,” explained Appleby.

She says having the 988 Suicide and Crisis Lifeline posted at Busiek State Park gives those in need the resources they need.

“I think having those signs in those areas are so important because it gives someone just a nugget of hope to think okay, there’s my sign. I think a lot of us who are dealing with mental health conditions are looking for a sign,” said Appleby.

Skalicky said, “We want our areas to be known for all the good things but if people come here for a despairing reason well there’s help for them too. There’s is help. There is hope. That’s what these signs are there for.”

Source: 988 Suicide and Crisis Lifeline signs posted at Busiek State Forest in Christian County (ky3.com)

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Construction has the 2nd highest rate of suicides among all occupations. It is a high-stress job that has high rates of alcohol and drug use.

Brandon Anderson is the Vice President of Safety for the Missouri chapter of Associated General Contractors of America (AGCMO). He talked with Show Me Today about the steps the industry is taking to address mental health concerns.

If you or someone you know is experiencing a mental health, suicide, or substance use crisis, or if you just need support for emotional distress, call or text 988 or chat online.

Source: Construction industry vows to tackle mental health issues head on (LISTEN) – Missourinet

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Davidson and his colleagues started by training practitioners in the basic essentials of psychiatric rehabilitation and developing relationships with community partners who would employ some of the program’s clients. “The program quickly grew.” The aim was to infuse the clubhouse with hope and provide support and connection to resources.

He notes that Fellowship Place had many older members who had been there for years; however, it wasn’t tailored to address the needs of young people. This was around the same time the field of psychiatry had started developing early or first-episode psychosis intervention. In 2019, Dr. Lisa Dixon shared with #CrisisTalk that the longer the duration of untreated psychosis, the poorer short and long-term outcomes. Davidson says both psychiatric rehabilitation and first-episode psychosis intervention were part of a shift in thinking regarding the quality of life a person with serious mental illness could expect to have. “Before that, people were basically told to give up all hope of ever having a life,” he says. 

Psych Rehab is part of the Yale Program for Recovery and Community Health, a program Davidson and colleagues started in 2000. “It’s primarily a research and policy program.” The program is part of the Connecticut Mental Health Center and focuses on rehabilitation and community living and works in conjunction with the Connecticut Department of Mental Health and Addiction Services. “We try to shift the priorities and the practices of staff within the larger behavioral health system and away from a chronic maintenance model of, ‘You’re never going to have a life again, so don’t bother us.’” Instead, the program focuses on areas of remaining function as a launching platform to further develop and help people live healthy and fulfilling lives. 

Community provider agencies performed the actual rehabilitation work. However, Psych Rehab did the research, training and tried out new interventions through randomized trials, establishing evidence-based practices. “We ended up expanding statewide.”

What Davidson found most troubling was the continued narrative that people diagnosed with a serious mental illness needed to “resign themselves to impoverished, lonely, empty lives.” “That was the message said to everyone across the board, no matter if they were young or old — that was very distressing.” However, he also realized people couldn’t just be removed from the hospital setting and into the community without transitional support.

In a study conducted by Psych Rehab, researchers interviewed people in the aftermath of a state hospital downsize. Long-term patients who had lived in the hospital for a decade had been relocated back into the New Haven community. In terms of quality of life, Davidson was surprised to discover little difference between the two, except people felt lonelier than they had in the state hospital. “They were sitting in their apartments alone, feeling isolated and despairing, with empty time on their hands.” The assumption had been that once back in New Haven, they’d become part of the community, but that hadn’t happened on its own. “We quickly discovered more needed to be done.”

Loneliness continues to be an ongoing challenge in the Covid pandemic aftermath. While it’s unsurprising that people felt lonely during physical distancing requirements, many, especially those facing mental health challenges, have continued to feel so even as they’ve toggled back to day-to-day in-person living. For instance, the percentage of youth who contacted YouthLine — a peer-to-peer support helpline at Lines for Life in Oregon — because of loneliness increased slightly between March 2020 and June 2022. The percentage of youth outreaching the line over mental health concerns more than doubled in that time frame, from 17 percent to 35 percent. Davidson says people who experienced inpatient hospitalization have expressed loneliness and not feeling welcome or included in the community once they left the hospital. Peer connection, informal and formal, can help people feel less lonely in the pandemic aftermath. “It’s a core rehabilitation strategy.” 

As people began reentering in-person living and new normalcy, there wasn’t a guidebook, and for many, it was a bumpy transition marked by repeated closures and uncertainty. In January 2021, Dr. Robert Roca shared that even more devastating than the continued pandemic and isolation for older people would be if the virus waned and then there was another peak. “That’s going to be a real test of resilience for us all if we find ourselves more intensely locked down and having to adapt our lives yet again.” He said the continued uncertainty and adjustment would wear on people’s patience and fray their defense mechanisms. “When people’s confidence in the future wavers is when the most dire psychiatric events happen,” he said.

Davidson says he hasn’t seen a sense of community fully rebound in New Haven, a shift similar to hospital closures that can’t be expected to happen without deliberate efforts to facilitate connectivity. People who lacked sufficient support before the pandemic, or who had support fall away during it, especially need transitional assistance. “If they were estranged from families and friends before Covid, that’s going to make it all the harder for them to have any kind of support now,” he says. “They were already at a disadvantage and are disparately affected.” Davidson believes communities can learn from the peer movement to help support people reintegrate to post-pandemic living. 

When Davidson helped develop peer support programs in New Haven, the concept was to provide social contact in a relationship where one person was doing a bit better than the other. “That would help the person struggling and create credibility because the peer had been there themselves.” They’d go to baseball games, go hiking and sip iced coffee or tea on a hot summer day. “One interviewee described spending time with their peer support person as long conversations and bottomless iced tea.”

At that point, peer support was primarily informal. Davidson and his peers worked to develop evidence-based, peer-led peer support specialist training. “We learned a lot along the way.” 

He highlights that many environments — whether schools,  churches, and other community organizations — have established frameworks to develop and further expand peer support and connectivity. “Most of us get our peer support on a daily basis from the people in our lives but we don’t think of it as peer support.” 

What he’s found is that peer support services foster joy in daily living, helping people regain or restore everyday activities that may seem trivial but give life meaning and purpose. “It’s also motivational — people find gainful employment, further their education and begin reclaiming their life in all the ways people might do so.” 

Source: Combating Loneliness With Peer Connection – #CrisisTalk (crisisnow.com)

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In October, Missouri 988 received 5,311 phone calls, 94% of which were answered locally with the average wait time being about 14 seconds. The crisis line also responded in very quick fashion to the influx of text and chat messages received as well.

“We’re trying to figure out how, we’re doing a great job messaging 988, we’re getting some of the most calls in the country because of our efforts, but how do I reach the person who doesn’t necessarily think this service is for them? That’s really what I want to focus on next,” she said.

Despite the quick response times, Huhn said it’s not enough.

“I am troubled everyday when I hear about a suicide that’s occurred in our state,” said Huhn. “I’ve had, I think we had three young women, just in the last month, die by suicide. Young women don’t die by suicide. What is going on, here?”

She still hears and reads reports of suicide happening in Missouri.

“How do I find the person who has had that traumatic event, who just needs, maybe six months or a year of support, but doesn’t think the service is for them because this is exactly who this service is for,” she said. “So, I will continue to push on 988. Suicide will continue to be something that we talk about a lot at the department.”

You can call or text 988 or chat virtually by going to 988lifeline.org.

Source: Missouri emerges as leader in 988 crisis hotline response times  – Missourinet

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While the crisis line has offered text and call services via the 988 phone number for more than a year now, the organization recently announced the launch of a new video phone service that will offer crisis counseling in American Sign Language.

As of right now, the service can be accessed by calling 1-800-273-8255 on a phone with video capabilities, or by pressing the ASL NOW button on 988lifeline.org. The 988 Lifeline is working to make videophone services reachable via the 988 phone number in the coming weeks.

Columbia-based DeafLEAD, an organization that currently offers crisis services for Deaf and hard of hearing people, will be one of two nationwide providers of this service.

Sol Romero, the videophone crisis line operations manager for DeafLEAD, attended and spoke at the event with other members of the DeafLEAD team.

He highlighted the importance of having a crisis line where Deaf and hard of hearing people can communicate in the language of their choice without the need for an interpreter – especially in a world where accessibility is limited.

“It’s going to make a profound impact in our community,” Romero said. “It’s history happening, in the making for Deaf individuals and their mental health.”

Romero became deaf at 23 years old and speaks ASL. He emphasized ASL is not English – it is its own separate language many Deaf and hard of hearing people speak as their primary or native language. Because of this, he said it’s important for people to have access to culturally competent care from someone who speaks their language – especially in times of crisis.

“Deaf people do die by suicide, as well, and Deaf people are in crisis, as well. We’re all humans. We raise children, we have families, the only difference between you and myself is I’m Deaf. That’s the only difference,” Romero said.

A full ASL interview with DeafLEAD’s Sol Romero – captions and English interpretation provided.

The 988 videophone service is unique because it directly connects users who speak ASL with a crisis counselor who also speaks ASL, which is different from other services that require an interpreter for the caller and crisis counselor to communicate. Many advocates and partners at the event, including Tia Dole, stressed the significance of this as a step toward full accessibility.

Dole is the Chief 988 Suicide and Crisis Lifeline Officer with Vibrant Emotional Health, a non-profit that administers the 988 lifeline. She said the videophone is just one part of 988’s goal to make its services accessible to all people who may need them.

“We want everybody who lives in this country, regardless of immigration status, regardless of who they are, where they live, to feel comfortable using 988 and to be able to speak in their language,” Dole said.

In addition to a host of advocates and partners, the launch event was filled with people who came out to celebrate the new service and open up the conversation about mental health. There were also activities and events like chalk art, mural painting, live performances and a wellness walk.

Stationed across from the stage, local artist Adrienne Luther Johnson painted a colorful mural inspired by wellness and 988. As a millennial, she said she’s seen a rise in mental health awareness throughout her life and hopes to continue that conversation through her artwork.

“To be a part of it now where I have gone through all these lessons of depression and anxiety and my relationship with my mental health and self care – it’s just really nice to be able to have that present in my work, be able to have open and honest and vulnerable conversations with people,” Luther Johnson said.

John Ginwright, the deputy division director of the Missouri Department of Social Services, also attended the event. He spoke about the importance of making services like 988 Lifeline available to the younger generation, as well as the need for continued mental health education.

“There is a mental health crisis that our youth are experiencing, and a lot of times the older generation can’t relate to that because they did it a different way when they were growing up,” Ginwright said.

According to the U.S. Department of Health and Human Services, “mental health challenges are the leading cause of disability and poor life outcomes in young people.”

LaShawna Samuel also works with Missouri’s Department of Social Services. Near the plywood board where event attendees wrote messages of hope, Samuel said it’s crucial for people to know 988 Lifeline services are there for everyone to turn to in times of crisis.

“Don’t wait until there’s a crisis or you feel like you want to harm yourself,” Samuel said. “Even if you’re having a bad day and you want someone to talk to who’s maybe someone that hasn’t heard you a million times already. Go ahead and pick up the phone and call, text, video chat.”

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Historically, mental health crisis care in the United States has left people and family members without choice, making the emergency room the only place to go. In many cases, the experience is traumatizing. “Often people aren’t treated with respect and are subject to restraints and traumatizing procedures,” says del Vecchio. “What I felt from my own experience—and that of many of my peers—is that we need a major whole-scale transformation of how mental health and substance use urgent care is delivered in this country.”

Having experienced crises and the crisis system has made him poignantly aware of what most, if not all, communities lack: recovery-based and trauma-informed crisis care. “I’ve experienced crises from mental health, addictions, and trauma,” he emphasizes. “When in crisis, I’ve been responded to by police officers—restrained and taken in the back of police cars, feeling shame, fear, and pain.” 

On March 8, del Vecchio shared on the 988 Crisis Jam one of the worst moments of his life and the shortage of options for care.

…wanting to end my life

without hope, without friends, without a job,

feeling without a future

it was also without choices of where to go for help

The only option was a nearby mental health intake center. When del Vecchio arrived, the first person he saw was a uniformed police officer who told him to take a number. As he waited for hours, he took in the drab, institutional surroundings. Plexiglass separated the staff from everyone else. As he waited, his fears mounted, and he wondered if he’d be restrained again, hospitalized, and given medication he didn’t want. “Would I lose my housing?” he said on the 988 Jam. “Would I lose my family?

When his number was called, a staff member told him to “return in a month, the soonest there would be an opening.” The center never followed up to check on him. “I left more hopeless than when I came in, and I left through that gray door, never to come back.”

As the Center for Mental Health Services director at SAMHSA, del Vecchio was at “ground zero” for the legislation that became the National Suicide Hotline Designation Act of 2020, a collaborative, bipartisan effort designating 988 as the nationwide telephone number for the National Suicide Prevention Lifeline (now known as the 988 Suicide and Crisis Lifeline). However, he says 988 offers an opportunity to go beyond a three-digit number and transform the crisis care system meaningfully, “so people receive the care they need.” “Not only short-term but also longer-term recovery supports,” del Vecchio explains. 

For example, he highlights how follow-up—after someone has reached out to 988—is vital in crisis prevention. “A simple follow-up phone call to someone presenting in a crisis can be one of the most impactful things we can do to help prevent future crises,” he says. 

Dr. Madelyn Gould, a professor of epidemiology in Columbia University’s psychiatry department and a research scientist at the New York State Psychiatric Institute, has evaluated the SAMHSA-funded National Suicide Prevention Lifeline. Her studies have illustrated how vital follow-up is to crisis stabilization, data that influenced many accredited Lifeline call centers to integrate follow-up. “People are still incredibly vulnerable 2-3 weeks after a crisis,” she told #CrisisTalk in 2022.

Megan Stone, manager of Clinical Best Practices and Care Transitions at 988 Lifeline, said that follow-up also allows a person to share more about their challenges. It creates an opportunity for a 988 crisis counselor to fill in any gaps in care between the “initial 988 contact and what happens next.” “…whether that’s getting an appointment with a mental health provider or getting utilities restored,” said Stone.

To maximize the full potential of 988, del Vecchio says legislators, state and federal leaders, and partners must “keep an eye on the prize,” which is a full continuum of recovery-based and trauma-informed care. “That means care that’s person-centered, based on the individual choice of the people who receive care,” he emphasizes. “It’s where people are safe and feel welcomed, their rights are protected, and they have access to a range of care and support to address all of their needs, including peer and family support.” Most of all, del Vecchio says recovery-based and trauma-informed care gives people hope that they can get through a crisis and go on and live a full, happy life.

The Covid pandemic exacerbated mental health challenges among young people in the United States. As the father of three young adults, del Vecchio witnessed his children struggle firsthand. His youngest daughter, now a freshman in college, navigated high school during the pandemic. “It was difficult for her not to be able to interact with peers,” he says. She experienced mental health challenges. He highlights that his daughter isn’t alone. “Young women in the U.S. are experiencing depression and anxiety, often caused by trauma.” 

The Centers for Disease Control and Prevention’s Youth Risk Behavior Survey (YRBS) recently released a data summary and trends report, highlighting that female and LGBTQ high school students have experienced high levels of sexual violence, with American Indian or Alaska Native and multiracial high school students experiencing a disproportionate risk.

CDC data has also shown that more young people are presenting to emergency rooms, often because they lack access to other resources in their communities. Emergency room staff are more likely to restrain Black children. Del Vecchio says this highlights the dire need “for equity in healthcare responses and trauma-informed care.” 

The pandemic has heightened all stressors on our young people simultaneously, says del Vecchio. “While we are seeing more willingness for people to talk about mental health and addictions, perhaps like never before, we still have a long way to go,” he points out. “Shame, prejudice, and social distancing—from those experiencing challenges—continues to expand.” He sees 988 as an opening to scale evidence-based, holistic care and supports for children, youth, and families.

As states prepare to market 988, del Vecchio suggests they focus on the nexus between storytelling and developing a community safety net, going beyond mental health treatment by addressing quality-of-life challenges and social determinants of health. “We know the reasons why a person presents in crisis is often from social determinants of health—issues from problems with their social supports, housing, or job stress,” he points out. 

A robust community safety net can help prevent crises and meet the whole health needs of people in the community. “That’s what a 21st-century crisis care system should look like,” says del Vecchio.

He believes 988 marketing must focus on tailored messaging to ensure it reaches those who need it. “The best people to share messaging about the three-digit number are people within the community,” he says. “Self-disclosure is the most effective way to reduce negative attitudes—what we call stigma.” He notes it’s particularly impactful for those close to the person disclosing, such as a family member, friend, co-worker, neighbor, or faith community member. 

“The challenge is how can we share these stories more broadly so people build trust that 988 is an effective resource that can be helpful for people.” 

This article was originally published on May 9, 2023.

Source: Paolo del Vecchio Shares His Hopes for 988 – #CrisisTalk (crisisnow.com)

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The boys grew up on the same street in Winston-Salem, North Carolina, and supported each other as they developed as athletes—Middleton played football, and A.J. ran track. “We were just looking to chase our dreams and make it professionally, and we continued to work on that together,” he reminisced. When the New York Jets signed Middleton in 2016, A.J. was there to support and celebrate with him. 

By then, Middleton had already noticed changes in his best friend. His mother is a therapist, so he wasn’t a total stranger to mental health challenges. “My mom was my first entry point into learning about mental health and what she did on a daily basis to help others,” he said. He knew people suffered from anxiety, depression, and post-traumatic stress disorder. “It’s a lot different seeing your best friend battle and trying to fight through it.” 

As A.J.’s mental health deteriorated, Middleton witnessed the seemingly endless barriers in his friend’s way as a young Black man, including stigma and insufficient access to resources. Desperate to help, Middleton said he didn’t realize it could take a while to find the right therapist and the right medication. A.J. struggled with the adverse side effect of the medication he was on.“He felt like someone was controlling him, and he couldn’t be the person he once was.” 

Also in the way was a lack of patient-provider racial concordance. “There aren’t many providers who look like us. That was a barrier to treatment, too,” emphasized Middleton.

As a high-performance athlete, A.J. was extraordinarily goal-oriented and pushed to thrive in high-pressure environments. The problem was and is that the stigma against mental health is still very present among coaches and athletes, noted Middleton. “If an athlete pulls a hamstring or breaks their leg, everyone can understand and respect that, but if they say, ‘Hey, I’m having a tough day and wasn’t mentally in it,’ that’s far less understood.”

Three months after A.J. died by suicide in 2017, Middleton founded and launched Dream the Impossible in his honor. The nonprofit organization aims to destigmatize mental health and halt and reverse the suicide rate among Black youth and athletes. “So far, we’ve helped over 10,000 young people with mental health education and connection to resources,” he said. 

Reaching young athletes is personal. “A.J. was an athlete. I’m an athlete,” said Middleton. The nonprofit—which won the NFL Community MVP in 2017—is working to shift student and professional sports culture toward active listening, trust, and open communication about mental health. “Both student and professional athletes have long had to portray a certain image and maintain a type of perfection that may not reflect how we’re really doing.” 

Black athletes face specific challenges, like acclimating to life at predominantly white institutions. “You’re suddenly someplace with people who don’t look like you and might not see life in the same way,” said Middleton. “It takes time to adjust to that.” He’s working to address this issue as the special assistant to the Athletics Department at Appalachian State University, his alma mater and a predominantly white institution where he played safety in college. “It takes student engagement and support, community groups, student-athlete leaders, and counselors,” he said. “There’s a great deal of support here for student-athletes, but we need to continue to grow these resources.”

His hope, through Dream the Impossible and in his role at Appalachian State University, is to help young people excel, personally and in their sport. “We want them to find their passion, their purpose, and know how to maneuver through their pain, and connect them to services in the community, if needed.” While Middleton views 988 as a phenomenal resource and an opportunity for crisis care to be more accessible, he emphasizes that there continue to be crisis system barriers, especially for marginalized and small communities. “They often don’t have the resources or budgets for mobile crisis teams,” he said.

Young people today are facing novel challenges, ones that Middleton and A.J. didn’t have to navigate while growing up, like the Covid pandemic and social media. “The pandemic has amplified both the youth mental health crisis and people’s openness to talking about mental health,” said Middleton. According to NCAA student-athlete well-being studies, student-athletes have reported higher levels of anxiety, depression, and mental exhaustion when compared to pre-Covid. The percentage of athletes who self-reported “constantly” or “most every day” mental health challenges were highest among women, Black, Latinx, and other marginalized races and ethnicities, LGBTQ students, and those who reported family economic hardship.

Social media use during the pandemic has created what Middleton calls “the microwave effect,” where student-athletes witness someone else’s rapid ascent in the sports world and assume that’s how it should be. “They expect overnight success because they see other kids getting offers. Instead of moving them to work harder to get there, the comparison makes them sad and less motivated.” He believes social media’s impact has swelled because of the isolation youth experienced during the Covid pandemic. “They’ve been scrolling and accessing so much of this instant success content that young people have overvalued it.”

In 2021, many children and adolescents were also thrust back into in-person school and sports without much, if any, reintroduction, emphasized Middleton. During the pandemic, daily structure fell away for many young people and so too did learning, not only academically but also socially. Public schools (K-12) have reported the pandemic has had lingering adverse effects on students’ socio-emotional and behavioral development. Intermittent Covid-related closures and student and teacher absenteeism have created additional and ongoing barriers to identifying and referring students to mental health services. (Schools are often a primary referral source for mental health services.) 

Middleton shares that a critical component of mentoring and coaching kids is getting to know “their baseline.” With so many moments missed during the pandemic, it takes additional awareness and investment to catch up on the struggles students have faced that they didn’t know about, but he’s up to the challenge. “You need to take the time to learn what makes them tick and what makes them anxious and sad,” he said. “They won’t talk to you about everything, but it’s our job to be trustworthy and consistent, so we are there when they need to come to us.”

He taps into A.J.’s story and his own to reach young people who might be struggling. After losing his best friend, Middleton felt tremendous loss and became acutely aware of his own mental health challenges. “I’ve always battled with my mental health, but at the end of the day,” he said, “I’m more aware of how my body and mind operate and what helps me, like yoga, friends, family, peers, and therapists.” He shares with students what’s helped him stay well, including his self-care plan. “It’s better to be proactive than reactive,” he said. “We all handle pain and adversity differently, and we need to have a plan for when challenges arise in our life.”

Photo credit: Miami Dolphins

Source: After Tragedy, Veteran NFL Player Launches Mental Health Awareness Initiative – #CrisisTalk (crisisnow.com)

The post After Tragedy, Veteran NFL Player Launches Mental Health Awareness Initiative appeared first on Missouri 988.

According to Vibrant, it awarded up to $9 million in 988 planning grants to 46 states, the District of Columbia, and the territories of American Samoa, Guam, and Puerto Rico on January 25, 2021. The grants provided a clear roadmap for developing the infrastructure and operational readiness needed for when 988 went live on July 16. They focused on eight core areas, including coordination, capacity needs, funding, and messaging surrounding 988, according to Matthew Taylor, MA, director of Network Development at the National Suicide Prevention Lifeline. “Our goal was to assist states, territories, and Lifeline crisis call centers in the planning process for the nation’s first three-digit number for mental health and crisis response.” 

The grant allowed DBH to onboard Casey Muckler, MPH, as the 988 project director overseeing Missouri’s 988 implementation efforts. One of her first initiatives, and a key requirement of the Vibrant planning grant, was enhancing the structure of the 988 task force and bringing additional voices to the table. Stakeholder representation included the Lifeline-988 providers, Access Crisis Intervention (ACI) regional-based community service providers, Missouri’s Behavioral Health Council, 911 service board, first responders, Missouri’s Sheriffs’ Association, Missouri’s Crisis Intervention Team (CIT) Council, people with lived experience, LGBTQIA2S+ advocacy groups, substance use providers, suicide prevention advocates, and other essential community voices. 

According to Muckler, an early success of the task force was securing buy-in from community providers. She said it was instrumental to have Lauren Moyer, Compass Health Network Executive Vice President of Clinical Innovation, co-chair of Missouri’s 988 task forces (Muckler is also a co-chair). Given Compass Health’s history as a Lifeline and ACI provider, Moyer understood many providers’ concerns and pain points, helping to balance her co-chair role as the liaison between the state and providers. “Hearing a provider voice lead the 988 discussions rather than having the state telling them what to do has been very helpful,” said Muckler.

Another core grant requirement was to conduct a statewide needs assessment on Missouri’s current crisis care system. The evaluation and in-depth collaboration with crisis service providers revealed four areas for improvement—expansion of the backup routing system statewide; mobile crisis response consistency across the state; increased training and community-based services for people with intellectual developmental disabilities (IDD); and improved coordination between 911 and 988 systems.

Williams reported that the planning grant was integral to improving their backup routing process to ensure statewide coverage before July 16. The six 988 call centers—Behavioral Health Response, Burrell Behavioral Health, CommCARE, Compass Health, Ozark Center, and Provident Behavioral Health—provide primary regional call coverage to serve all 115 counties and the City of St. Louis. Provident Behavioral Health also provides statewide backup services. “We wanted a second opportunity for Missourians who contact 988 to receive a localized response and to also maintain our high in-state answer rate,” shared Muckler. Missouri launched its statewide 988 routing and backup coverage system in early February, thanks to collective participation from the six 988 call center providers.

Missouri also tapped into the expertise of DeafLEAD for statewide 988 text and chat services. DeafLEAD, a nonprofit organization in Columbia, provides mental health and crisis services for people who are deaf, hard of hearing, deafblind, late-deafened, and their families. “DeafLEAD has been a national Lifeline backup chat provider, and we wanted to use their strength and specialty. It was a natural fit for DeafLEAD to do 988 chat and text services for the state,” shared Williams.   

In working with the Vibrant 988 planning staff and consultants, Missouri projects 258,032 contacts via 988 phone, text, or chat options during the first year, at an estimated cost of over $16 million. “We anticipate a large text and chat volume increase over the coming years,” reported Muckler. Given the high projected demand for 988, DBH is working closely with DeafLEAD to launch its statewide 988 text and chat services this fall. 

The gap analysis confirmed that mobile crisis response was robust in portions of the state, but some rural communities had minimal mobile crisis access. “We are working to get mobile crisis response up to best practice standards statewide,” noted Williams. One barrier the task force identified was insufficient reimbursement rates for staffing mobile crisis teams, particularly in rural areas. In response, the behavioral health division secured $14 million in state funding to build up mobile crisis response in these areas. An added benefit for mobile crisis response is that MOConnect, the statewide bed registry, is being implemented by the Missouri Behavioral Health Council. This system will enable 988 providers to coordinate and dispatch mobile crisis teams and connect to crisis stabilization centers—known in Missouri as Behavioral Health Crisis Centers—and inpatient services for 988 contacts needing higher levels of crisis care.   

Lifeline-988 crisis counselors and behavioral health providers identified a need for further training to support the IDD population and their families experiencing a crisis. The gap analysis also identified a need to provide better support to people with IDD across the age spectrum. “Our goal is to do a better job of keeping the person supported in the community,” acknowledged Williams. The division of behavioral health plans to update its statewide crisis reporting form to collect data to better understand system-level gaps and help the state monitor the quality of care for the IDD population.   

The gap analysis also found that another critical need was to establish clear roadmaps for coordination among the 911 public safety answering points (PSAPs), law enforcement, and 988 providers. “We recognized an opportunity to enhance our crisis system to best support law enforcement and 911, so we are focusing on those system changes,” commented Muckler. In working with the 988 task force, the aim is to improve the response for those in crisis by using behavioral health staff as the responders, thus diverting from law enforcement and 911 operators.  

Missouri has over 185 locally funded, locally based PSAPs centers. Williams noted, “A big challenge is how our seven 988 providers can partner with 185 PSAPs across the state.” Some 988 providers are in the planning phase for pilot projects in both rural and urban areas to help shape future statewide 911 and 988 coordination efforts.  

Muckler shared her excitement about the rollout of 988 but acknowledged her concern about securing long-term funding to continue building out their 988 crisis care system. Missouri secured $16.7 million, a combination of state and federal funding, to support this year’s 988 implementation efforts. “We will need to request an appropriation every year in order to sustain 988 services,” she said. She further commented, “We are also concerned about whether our actual 988 volume will exceed the projected rate of growth because the projections were used to estimate a budget for implementing 988 and scaling up the crisis workforce.”   

Although there is some uncertainty surrounding long-term funding and projected 988 volumes, both Williams and Muckler look forward to the progress and challenges ahead as the state implements 988 and continues to expand its crisis system. 

Source: How Vibrant’s 988 State Planning Grant Helped Missouri Expand Its Crisis System – #CrisisTalk (crisisnow.com)

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Around this time was when I started experiencing passive suicidal thoughts. I faced intrusive thoughts of what it would be like to die or for someone to find my body. By college, these thoughts grew more active and serious in nature. I made my first suicide attempt during spring break of my freshman year of undergrad. This was the wake-up call that I needed more serious help. I started on the journey toward finding the right medication.

I managed fairly well for several years. I mostly lived a stable life, while still struggling with depression, episodes of mania/hypomania, and the occasional crisis accompanied by varying degrees of suicidal ideation. I survived graduate school thanks to the support of disability support services and vocational rehab. In my late 20’s, I was doing exceptionally well, and I stopped taking my medication.

However, in spring of 2018, my boyfriend at the time left me without warning for a job overseas. This started me on a spiral out of control: in a manic state, I broke up with him two months later, and moved on to someone new very soon after.

My new relationship was toxic, and fraught with fighting. I was cycling between depressive, manic, and mixed episodes on a monthly basis. In the summer of 2019, I was in as bad a state as I’d ever been. I didn’t feel that I belonged anywhere and I was contemplating almost every day. I then formulated a plan to kill myself.

It’s not uncommon to have someone dealing with suicidal ideation come up with a list of “why” they should stay alive, and “who” they want to avoid hurting. Basically, the motivation to keep trying. My why/who has always included my sisters, and currently includes my dog, Beau, and my cat, Moji. When I was a teenager, my logic was that I didn’t want my baby sisters to feel responsible – as though they could have done something to stop me. But as I’ve gotten older, that logic no longer works – they’re adults, they know the drill, they might still struggle with it to an extent, but not the way they would have when we were kids. And my family could always take care of Beau and Moji.

With my motivation to stay alive non-existent that summer, I was barely hanging on. I got into a huge fight with my boyfriend and he broke up with me. When I announced I would be attempting suicide after fighting it for so long, he begged me to get help and promised he would stay if I did. In an emergency session with my counselor, she declared that if I did not go to the hospital voluntarily, she would have the police take me. Together, we made a plan and my boyfriend agreed to supervise me for the evening before making our way to the hospital.

I arrived at the hospital bright and early in the morning. Set on a beautiful campus, it felt completely surreal that life had taken me here. We entered the waiting room, where I filled out paperwork and awaited an intake assessment. I met with a psychiatric nurse practitioner who did an assessment of my diagnosis and determined my level of suicidal threat.

My hospital room was bare except for a twin-size bed with one sheet and one blanket, a small bookshelf to function as a dresser, and a private bathroom. The rules were explained to me: two telephones were available to patients which could be accessed between certain times of the day, and were turned off when counseling groups were running. We were only allowed pencils under supervision in group; otherwise, we just used markers, and had access to a few books and some puzzles. I ended up doing a lot of journaling while in the hospital. It was cathartic.

There were several benefits for me going to the hospital. First, I was able to quickly and under close supervision adjust my medication. After leaving the hospital I still needed to tweak it, but I got back on track much more quickly than I otherwise would have. Secondly, I met several people like me: people with bipolar disorder, and people who had dug themselves into difficult situations. Finally, the break from technology and social media was amazing. I needed to reconnect with myself.

The hospital changed my life and really made a difference. Now that I’ve been there, it’s less scary to think about going back again if I need to.

It’s been two-years since the hospital, and I am still in somewhat of a recovery phase. I continue to experience occasional mild- to moderate- depressive episodes. But I haven’t had any serious thoughts about suicide in at least a year. It’s amazing how that has positively affected my ability to function in the world, and to view the world in a new light. To stand up for what I need, and fight to wake another day.

Since that time in the hospital, I’ve experienced so much. I’ve gone to escape rooms, taken hikes, made a road trip to see old friends, gone to my aunt’s wedding, come out, cuddled my pets, spent quality time with my sisters, made new friends, listened to music, celebrated my recovery, and been a bridesmaid for my best friend.

I’m so happy I’ve had these experiences. I’m so thankful to finally feel, and want to be, alive.


Source: https://afsp.org/story/the-other-side-of-hospitalization

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