- [Teresa] Mental health issues are accelerating at an alarming rate being called a national emergency.

- I started not wanting to do anything and just wanting to hibernate and wasn't liking the foods I was eating anymore, and it was just really weird and like I didn't feel like myself.

- [Teresa] Kids and adults are struggling, and now with the holidays here, coping may be even more difficult.

Right now on "Health Matters."

(melancholic music) (heart beating) - [Announcer] "Health Matters" is made possible with the support of Providence Inland Northwest, Washington.

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(upbeat music) - Good evening, and welcome to "Health Matters."

I'm Teresa Lukens.

The holiday season may be the most wonderful time of year, but for not everyone.

For some, it means more stress, isolation, and loneliness, and as we head into another pandemic winter, there's added concern for those already experiencing mental health disorders.

The news is even more distressing for kids.

Just days ago, the US Surgeon General issued an advisory calling for action to respond to a growing mental health crisis among kids.

Joining us tonight is Tamara Sheehan.

Tamara is regional director of behavioral health services at Providence in Spokane.

She leads inpatient and outpatient behavioral health programs across the region for Providence.

Claudia Miewald is director of behavioral health at Kootenai Behavioral Health in Coeur d'Alene which specializes in psychiatric and chemical dependency treatment services for all ages in North Idaho, Eastern Washington, and Montana.

Claudia is also involved with several behavioral health programs and initiatives across Idaho.

Dr. Breanna Barger-Kamate is the medical director for the pediatric emergency room at Sacred Heart Children's Hospital.

She regularly sees children in mental health crisis in the emergency room, and Dr. Dirk Dhossche is inpatient adolescent unit director at Inland Northwest Behavioral Health.

Prior to coming to Spokane last year, he served as adolescent inpatient psychiatric medical director at University of Mississippi Medical Center for nearly 20 years.

Thank you all for being here.

Let's talk about just how big of a crisis we are talking about, Tamara.

- I'll sat first of all, this is a crisis.

I think everybody's sitting at this table and people who worked in mental health in hospital situations, it was a crisis before COVID.

So I just want to mention that we've seen this trend occurring over many years, and it's just been exasperated by COVID and the decrease in resources that we have in our communities.

If I was to speak to what does a crisis look like from a Providence standpoint, that is numerous individuals coming to our adult and pediatric emergency rooms to seek services for mental health and being unsafe to leave that location and have to remain in the emergency room for days waiting for resources to open up.

Sometimes, it's an inpatient bed.

Sometimes, they stay long enough, we're able to get them stabilized and into some community resources.

I think we're more likely to do that for the adult population than the pediatric population.

That's a lot more sensitive, a lot fewer resources.

Our emergency room is overwhelmed.

Often in both the pediatric and the adults, over half of the individuals that are seeking care in the beds are mental health or substance use disorder as well, so that could be 35 adult patients and 15 adolescents and children's patients in the pediatric areas, which is pretty significant.

And we're seeing that in all of our emergency rooms in the community.

Obviously, Sacred Heart Medical Center has the psychiatric services in the children's hospitals, so we see the largest number of those, but we do see also adults and pediatrics going into other hospitals in Spokane.

So it's definitely trending up, and I think the biggest issue we have is they're coming in more sick than they were before, and that means that the resources they need are too too much for what can can be done in the community for them, so we're really holding on to people seven, 10, 12 days.

Pediatrics, I'll let Dr. Barger speak to that, even longer at times just trying to find a safe place for them to discharge to.

- Are you seeing the same thing, Claudia, in North Idaho?

- We're seeing a similar set of issues in North Idaho in terms of we have strong inpatient services, but outpatient services seem to be lacking in terms of being able to refer a patient, a client, to outpatient counseling or if they need a provider to be able to prescribe.

The wait lists are very long, sometimes up to six, nine months, that people are waiting for those types of services.

So it's definitely, I would consider it to be a crisis for this population, both youth and adults.

- And Dr. Barger, this is exactly what you've been seeing is what Tamara and Claudia are speaking to.

- Yeah, it's just kind of a growing surge that's really trended probably over the last 10 or 15 years, but we are unable to place a lot of the young people that come through our doors.

Exactly what Tamara was mentoring is often they're too acute.

They are in a lot of crisis situations.

Some of them have other medical and mental health and behavioral disorders such as autism and exposure to drugs or alcohol in-utero that can kind of sometimes make children harder to place because they require more services than what are really available.

One thing that we've noticed here is several years ago, we actually trimmed back on the under-12 beds that were available in Spokane, and so kids that are under 12 actually go to North Idaho for treatment, and because there's limited beds and resources there, children will frequently end up waiting several days, one, two weeks at a time, to either get placed at Kootenai Behavioral Health or eventually get stabilized and get transitioned either home or into foster care.

We're seeing children as young as seven stay for 10, 14 days, and while we are able to keep them safe in the emergency department, it's not an environment conducive to healing.

It's a 10-by-10 windowless room that they stay in.

They have a sitter that tries to keep them occupied during the day, but it's a rotating cast of characters, right?

It's not somebody that creates a long-term parental role model and bond for a child of that age, and I think that that's probably really the tip of the iceberg in terms of what's out there in the community because before these kids reach the ER, they're also decompensating out in the outpatient world.

So there's definitely a need both for the outpatient resources to increase, and then also inpatient bed capacity.

- And Dr. Dhossche, that's where Inland Northwest Behavioral Health comes in is that inpatient piece, and in fact, expanding beds here in the last year.

So talk about where the program is right now.

Are all those beds fall at this point, or is there a waiting list?

- We are very busy.

The unit, which is for 13 to 17-year-olds, so it's the older adolescents, has been busy.

We have a maximum capacity of 25, but with the circumstances of COVID infections, isolation, patients who need cannot have roommates for some reason.

We run about 17, 18, 20 maybe, and we opened in the midst of COVID in June, so we cannot really compare how it was before COVID, but I did hear you referenced the advisory of the Surgeon General.

I printed it out (women chuckling) just to give some numbers about this.

I mean, the increased rates of anxiety, depression, crises were increasing before COVID.

The report references between 2009 and 2019, there is a 40% increase in anxiety, depression, maybe emergency room visits, and this was pre-COVID.

2021, it seems to have doubled, so this is the advisory of the Surgeon General and an action plan.

and it's a good reference.

But you are right.

Once the adolescents or the older adolescents, they end up in the hospital, they are under our care, and we have a team of nurses, social workers, recreational therapists, mental health technicians to provide care for these kids who are in a crisis, and the most common issue is suicidality.

Suicidal ideations, they have done a suicidal gesture, often an overdose, run into traffic, or any other unsafe behavior basically.

So every child is screened for the appropriate criteria.

Can we be of help by providing a supportive environment, safety, 24-hour monitoring, and we gather as much information as we can at first.

I mean, I'm giving a little bit insight in the clinical mechanism of how this works, but the kids get better.

They all get better, and we can do this in a week or two, maybe longer for most of them.

So stabilization with the help of this team approach.

Intensive, I mean, every day counts, but the collaboration with the caretakers, parents, is essential.

We have to keep in touch with them because what often happened is there is a crisis.

Usually, it involves family conflict, familial circumstances, societal stress, which has been enormous in COVID.

Financial, social, school stress.

Some kids do well with online.

Others do not.

Most of them do not, but- - So, there's really nothing simple about this process.

There's a lot of moving parts.

- There are a lot of moving parts, but there are always moving parts.

It seems more to happen more often now because of the general stress situation.

The good news is people do leave the hospital.

Kids, they are improved.

They have a better perspective of what has happened to them.

They feel relieved often that they have a peer group who is experiencing similar problems, and they feel that they're not alone in this.

So a thorough evaluation, it's a bit of detective work.

I mean, every case is different.

The stresses are different.

We work with the parents.

We run groups to improve coping skills and tactics when there is a crisis, and when the time comes that we see that things are improving, aftercare, which is critical.

Treatment does not stop when they leave the hospital.

It has to continue.

- Treating kids with mental health disorders is just as difficult as diagnosing their condition.

Not many kids can find the words or are willing to open up about what they're feeling, but one Spokane teenager is not only speaking up, she's doing it in a very public way.

- I go to school at East Valley High School.

I'm a sophomore.

I like to play softball, go to the gym.

- [Teresa] By all accounts, Shylar Thompson is a typical teenager, but what makes her stand out from her peers is her ability to share what most would rather hide.

- I started to really notice when I started not wanting to do anything and always just wanting to hibernate and I wasn't liking the foods I was eating anymore, and it was just really weird, and I didn't feel like myself.

- [Teresa] At that time, she was just 10.

Now at 15, she's willing to step into the spotlight in hopes of helping others.

- I basically was saying I just really need some serious help.

- [Teresa] Therapy was starting to help until the pandemic and a breakup with a boyfriend.

- So, I was just really, really depressed.

It was all hitting me after the breakup super bad, and I actually tried to take my own life.

- [Teresa] Shylar spent several weeks in the hospital, then enrolled in RISE.

It's an outpatient program through Providence where she learned skills to help cope with her mental health disorder.

- [Shylar] I still use them to this day.

I just feel like they help so much.

- [Teresa] Keeping busy and working up a sweat also makes a difference.

- [Shylar] Something I like to do, and I don't have bad thoughts while I'm working out ever.

It's just something to get my mind off of reality.

- [Teresa] But by telling her story, her reality has already made a difference for some friends at school.

- [Shylar] They were like, "This really helped me."

Told my mom that I was depressed and I really needed help, and she got signed up for a few programs, and I just started crying.

That's what I wanna do really bad.

Knowing I did that just as young as I am, it was pretty amazing to hear.

- She is an amazing young girl.

Shylar hopes to become a teacher or a therapist.

She wants you to know to be kind to other people because you may not know what they're going through at any given time, and she says, "It's okay to speak up," and boy, is she speaking up and helping others, and Tamara, talk about the RISE program.

After she came out of inpatient treatment, she went into RISE which is kind of a what, a mid-level treatment?

- Yeah, actually it's the highest level of care before going to inpatient or it's a step down.

So it's called a partial hospitalization or intensive outpatient program.

Really, what defines a partial hospitalization versus intensive outpatient is whether you go two, three, four, or five days a week.

It's an all-day program.

As she had mentioned, we teach behavioral activation.

We teach coping skills.

Lot of people have that behavioral activation that the exercise.

We all know we're supposed to do it, and this one of the things that they teach.

There's a variety of evidence-based practice.

They make it both hard work and fun at the same time.

As Dr. Dhossche spoke of, it's really with adolescents.

It is a team effort, both on the side of our psychiatrists, our ARMPs, and our therapists, but also the family members or guardians or their support system.

And we also have that for the adult program as well.

We have the same type of program.

It's amazing to watch people come in.

People can self-refer, and they don't have to be on the midst of the end of their ropes.

They can come in when they know that things are changing.

They need they sometimes say tune-up.

We need a tune-up.

They can come in and they can enroll in the program.

We take all insurances, so that's really awesome because it's really rare to find a Medicaid program in our communities.

We are working with that with the legislature, Providence, and here actually at the RISE program and Seattle Children's because we don't have these programs for our Medicaid population.

So we do have that at RISE.

We also have a children's program, and I wanna make sure we mention the eight to 12-year-old program.

It's been around for 25 years.

It's called BEST, and a lot of people know about it, but we also use evidence-based techniques and help those children and their families where the children's behaviors often are how you can tell if they're suffering from mental health issues is someone becomes violent or impulsive, and it's out of character for them.

So that's how those young children also show that they're having mental health issues.

We also do see eight to 12-year-olds ever suicidal as well, so it is getting to be at younger and younger ages.

We have that for children.

We have it for adolescents and adults, and they're all evidence-based practice, and I say that because it's really important not to just go have fun.

It's important to make learning fun, but it's also important to teach those coping skills, teach people to be resilient, and sometimes we even have adolescents come in and their parents come into the program afterwards, or we'll have several sets of children throughout the last couple of years since we've been open.

It's a great program.

It is a commitment because it is every day, and your number of days are dictated by how much treatment you do need.

So it's a wonderful program.

You see people come in.

She's a prime example.

Head's down, not really feeling good about life and themselves, and even my front desk staff, they watch them blossom and change, and by the time they leave, we have a graduation, and it's really emotional and really exciting, and it's success in six weeks often.

So it's a great program.

- Yeah, she told us that she uses those tools on a daily basis.

Dr. Barger, you're generally the first person that these young kids, and they are getting younger.

She was 10 years old when she told her grandmother that she thought she needed help.

That's pretty insightful, but how do kids even voice that?

How do parents know to get them to the emergency room or to find them help?

- So frequently, it will manifest as behavioral outbursts: anger, unsafe behaviors.

I know you mentioned like running into traffic and things like that where basically, the child's just simply out of control and beyond what the parent is able to reorient and redirect and all the different things that we try to get parents to learn when their child does have these emotional outbursts, but you know, kids as young as seven or eight, they can communicate suicidal thoughts and share that.

A lot of times, they don't necessarily even understand at that age the permanence of what they're talking about or even have some magical thinking around that still, but we definitely have seen suicide attempts in children as young as nine, 10 and 11 years old.

So I think getting children into services early like when you start to see them have those early signs of decompensation or troubling behaviors is really important, and you can start just by talking with your regular doctor.

It doesn't have to always be all the way into the mental health system.

A lot of times, just talking with the regular doctor about behavioral and coping strategies early on, and even the school system is one of our biggest providers of mental health care and counseling.

And so getting them in contact with their school resources before a child enters the kind of crisis situation.

- You're also really concerned about the social media piece.

Why is that?

- Well, we see a lot of children getting exposed to images and groups that actually can encourage children in lines of self-harm and suicidality.

Also, the other piece is that kids can get bullied and be quite cruel towards one another online because there's little consequence when you send off a negative comment to a friend or an acquaintance, but that comment can land really hard on an adolescent that's searching for who they are and their identity and for a place in the world, and when those cruel words land on a kid, that can really throw them into crisis.

Something as simple as being made fun of, but because it's amplified through social media, can be really devastating to a child, and we have seen a lot of that.

So I would really urge parents to limit the social media exposure of their children and adolescents and to monitor that closely because we do see children thrown into crisis specifically because of social media.

- They're learning technique, suicidal techniques?

- That's right.

They will get on these social media groups and share methods of self harm, cutting, and even suicide attempts and advice, and unfortunately, sometimes they'll even egg each other on to increase the risk-taking behaviors that we see.

There's very little we can do to control that once your child's online because they can just link through SnapChat, WhatsApp, Facebook, even encrypted things where we can't even see what they're communicating between each other because they're encrypted apps.

So I would definitely encourage families to be really vigilant about social media use in our young people.

- We're now heading into the holidays.

That can be difficult for people with a pandemic on top of that, seasonal affective disorder.

Are you worried about what's to come here in the next few months?

- You know, the winter months are difficult on a lot of folks and especially around this holiday season, particularly with adults.

There's just a lot of stress, economic stress, worrying about the budget.

How much can we spend on Christmas?

Can we really do this well?

Should we have the big gathering?

We're still in the pandemic, so trying to navigate all those waters and also looking at trying to have that perfect holiday.

I think we need to give up on that Norman Rockwell kind of holiday and give ourselves a break this year and say you know, perfect doesn't really exist.

It's kind of an illusion in terms of the holiday, and good enough is good and really enjoy the holiday for what it's meant to be for connection with others and making sure that we're having some fun.

That, however, leaves a segment of the population who can experience some holiday blues.

There is a segment of the population that definitely experiences some depression, if you will, just increased sadness looking over the past year.

Maybe some grief is going on, and I would encourage people to look out among your coworkers, people that you know, people in your neighborhood, and reach out to them and try to help them with any isolation that they may be going through because isolation is a really big thing that goes along with holiday blues.

A lot of times, people who are experiencing those pieces of depression and those kinds of things really are not wanting to reach out, but sometimes, even just having a cup of coffee with someone can make a big difference in their lives.

Certainly, if it's interfering with your daily functioning, your job performance, that's the time to reach out even to your primary provider for a little bit of help to see what can you do.

Is this a bigger kind of thing in terms of what I need to be maybe treated for?

Seasonal affective disorder is a real disorder, and it affects about 9% of individuals in the Northern Hemisphere, maybe about 1% in the Southern part of the country.

So those of us up here in the Northern section, we are subject to it because we do have less light on a daily basis.

We get dark at four o'clock, 4:30, and so that natural light is really a factor, and there's some really nice strategies that can help with that.

Certainly, light boxes, one strategy.

Getting out in nature and taking that walk when you can is a really big thing to combat seasonal affective disorder, but if it's really severe, you should see a provider for some further assistance and check in with your doctor.

- And we are already running short on time, but Dr. Dhossche, how do we know what's normal and what isn't?

Everything is topsy-turvy and right now, and it's hard to recognize that, so I know there's a lot there, but what are a few things that we should watch for in ourselves, in our children, in our family?

- Yeah, I like the advice that you gave about what to watch for during the holidays, but this applies to doctors, too, and nurses and everybody- - [Teresa] Front-line workers who are stressed right now.

- Who works in the health field.

We have to keep our morale up, keep going to work, being on call, do night shifts (laughs), so we can use your advice very well ourselves.

Fortunately, there are services.

We keep all these services open, and we have schools.

School counselors can alert problems.

So we have a walk-in option in our hospital, so people, parents can bring their children.

School counselors can refer.

Emergency rooms, obviously, are a major source of referrals, but it's a low criteria entry for at least in the Northwest Behavioral Health.

They get screened, so use that option if... - Reach out I bet I think is really what, yeah.

- Better be safe.

Better be safe, have an evaluation, and have an informed opinion about what can be done, what is needed, and if there is a hospitalization, okay, well, can do that, too.

- We're starting to take the stigma off of mental illness.

So it's important to speak up, tell somebody that you're not okay and that you need help.

We could talk for a whole other hour or two about this topic, but unfortunately, we are out of time So appreciative that you were all here tonight, and that will do it for this edition of "Health Matters," and in fact, you will find some helpful information on tonight's topic on the "Health Matters" page at ksps.org, and be sure to join us in January on January 20th when we talk about opioid addiction, another crisis in this country.

Until next time, I'm Teresa Lukens.

Stay safe and good night.

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We know you live fully.

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