(light upbeat music) - [Announcer] This is a production of South Dakota Public Broadcasting.

(upbeat electronic music) - Hello and welcome to "South Dakota Focus."

I'm Jackie Hendry.

Mental health challenges impact people of all ages, but South Dakota's young people are at especially high risk.

For South Dakotans ages 10 to 29, the leading cause of death is suicide.

There are many reasons a child may die by suicide, but a leading risk factor is a feeling of isolation and loneliness.

In fact, earlier this month, the US Surgeon General released a report calling loneliness and isolation an epidemic, with serious risks to mental and physical health.

You may have already seen the statistic from that report that says the health impact of feeling socially disconnected is similar to the health risks of smoking 15 cigarettes a day.

But hope is not lost.

We'll hear a little later from a panel of mental health experts how you can support the young people in your life.

Before that, we're going to share a story produced by journalism students from Sturgis Brown High School.

Long before the Surgeon General's report, we asked them to pick a topic related to mental health that they would report on for us.

They chose isolation.

Here's what they found.

(upbeat electronic music) (students chattering) (bell ringing) - [Reporter] Many people deal with mental illness on a day-to-day basis.

According to the National Alliance on Mental Illness, 1 in 6 US youth aged 6 to 17 experience a mental health disorder each year.

The town of Sturgis, South Dakota is no different.

Though our community is rather small, the problems its youth faces are large.

- Me being alone in my room all the time.

- When you're by yourself.

- Not being able to express myself.

- Staying away from everyone.

- Cut off from the rest of the world.

- But no one's really acknowledging you.

- Doing everything by myself.

- Not feeling like you can talk to people about your problems.

- [Reporter] Isolation is defined as the process or fact of isolating or being isolated.

While many people immediately consider the physical state of isolation, it can also be a state of mind, existing only within an individual.

There are many factors that contribute to feelings of isolation and mental health issues.

These factors can include the relationships students have with their family, friends, other people, and even technology, among other things.

- Isolation leads a lot to mental health because I think we as people depend on human contact and we're very social creatures.

So without that, we become depressed 'cause we don't have those stimulants we get from conversation.

- People's relationships have a major impact on their mental health.

The people they surround themselves with often will relate to how they act and how they are, which could be great, 'cause you could have those people who bring out the good sides of you, but also the bad.

- It can cause anxiety, some depressive symptoms, and sometimes you're not sure which came first, if it's maybe some of the mental health concerns that's causing them to feel so isolated, feel very lonely even when they're around a lot of people.

- [Reporter] According to United Way of the Black Hills, Sturgis faces seven main problem areas within its community.

These include mental health, getting access to local, affordable, and diverse mental healthcare, as well as bringing attention to mental health in general, substance and alcohol abuse, getting access to diverse treatment and understanding prevention and awareness, birth to five childcare services, finding affordable and quality childcare, food security, accessing affordable, healthy food, as well as finding emergency food programs if needed, home and family life, accessing child abuse, neglect, and domestic violence education and support services, housing, finding affordable housing, housing assistance, or emergency housing, and finally, economic opportunities, finding diverse employment opportunities that offer proper job training.

Whether these factors affect the community's youth directly or as a trickle-down effect of the issues their parents are facing, these problems can lead to mental health issues in different ways.

In fact, the percentage of people reporting chronic depression at the Sturgis Hospital jumped from 22.5% to 31.1% in just three years.

- The causes of mental health issues are a lot.

There's a lot of different ones.

There's the biological aspect of, like, your brain is not working the way it's supposed to, but, like, a ton of environmental factors, of outside factors can also contribute to it.

For example, I know so many people that, had they not experienced what they had gone through, they probably would be in a lot better place because they just don't know how to cope with that.

- [Reporter] Students often have a lot of pressure from outside obligations, including accelerated or AP coursework, sports, clubs, and jobs that add stress to their lives and may cause them to experience mental health issues or escape into a state of isolation in order to cope.

Some, on the other hand, use these outside obligations as an opportunity to uplift their mental health.

- I do believe that having a job has given me more of a purpose.

Making money and kind of being more on my own now has made me not so much rely on other people, but I do feel like that is a positive mental health benefit.

- [Reporter] While mental health can often be a heavy topic to talk about, it's important to remember that there is always hope.

No matter your circumstances or the challenges you're facing, there are many methods and options available to uplift your mental health.

- My favorite way to uplift my mental health, my main outlet is, like, drawing and, like, physically making myself feel the emotions and kind of translating it onto paper.

But, like, there's tons of different outlets.

Like, I also recommend going outside.

It's kind of shocking what being under the sun and, like, touching some grass can do for your mental health.

It sounds dumb, but it's true.

- I find one of the most powerful ways to, like, help with your mental health and make it better and all that good stuff is finding a good community.

If you're around, like, a good group of friends that make you laugh, help you just see the positives in life, it really helps you with your overall mindset.

- We have mental health providers in our community.

In fact, we have two or three different agencies that are willing to even come right into the school to meet students where they're at, which helps so that parents don't have to provide transportation and fit it into their schedule.

And so we do have agencies that will come into the school.

We make referrals to them, and then they come right here to see the students.

- Don't give up trying to find happiness because I think that everybody truly deserves happiness.

- I would like people to know there's a lot of people who understand a lot of the pressures that they're going through, and that you're not dumb to try and reach out.

I think everyone deserves help.

(upbeat electronic music) - We wanna say thanks again to the members of Sturgis Brown High School's upper-level journalism class for their work on this project.

We're going to now continue this conversation with a panel of experts to discuss the overall trends of youth mental health in South Dakota and how we might better serve our state's young people.

First, I want to welcome Dr. Wallace Jackmon, a clinical psychologist with Avera Medical Group.

Dr. Jackmon, welcome.

- Thank you.

- Next, Dr. Kari Oyen.

She's a nationally-certified school psychologist and director of the school psychology program at the University of South Dakota.

Dr. Oyen, welcome.

- Thank you very much.

- And finally, Erik Muckey is the executive director of Lost&Found, a suicide prevention organization founded by South Dakota students.

Lost&Found focuses on young people ages 15 to 35.

Erik Muckey, welcome to you as well.

- Thank you.

- So we asked these students in Sturgis to report on a topic related to youth mental health, and they were the ones that chose the subject area of isolation.

And it just so happens we just got that report from the US Surgeon General about what he's calling the epidemic of and isolation in the United States.

So, Dr. Jackmon, I wanna start with you.

And if you would like to highlight some of your key takeaways as you reviewed this report on isolation.

What stood out to you?

- Well, one thing that stood out to me was the enormity of the issue that he addressed in his report.

And most of us as clinicians have seen this over and over again for the past decades.

There's a lot of research out there that supports much of what he's saying.

The isolation aspect, I think, has increased significantly since the COVID-19 epidemic and folks having to be isolated and spending more time at home, whether it be their inability to socialize versus a workplace environment of having to work from home versus going to their office.

- Mm-hmm, and I want to touch on how this matches with what we know overall about mental health trends in South Dakota, if there was anything that surprised you looking at this report or if this is par for the course for what we're seeing in South Dakota?

(Wallace laughs) - No, I can't say I was horribly surprised by any of it.

Research has supported that, again, for decades.

- Right, and the highlight of this report that stood out to me was the role of social media.

And we know this is a big topic for especially when we're talking about youth mental health and isolation.

The surgeon general references a Pew research study that says 46% of teens ages 13 to 17 self-report that they are online almost constantly, was the phrase that they used.

And that's nearly doubled since just 2015.

Less than a decade, we've jumped to 46% of young people.

Dr. Oyen, from an adolescence standpoint, what does this say to you about youth wellbeing?

- I think that it makes me think about a lot of things.

I've been studying a lot about the adolescent brain, and I think that there's a lot of incredible things happening in your adolescence.

What is really primarily happening is this social-emotional system is running rampant.

And we do a lot of what we call reward seeking.

So when you are beyond the age of 10, usually 11 and and beyond, there's kind of a dip in your dopamine.

Dopamine's that thing that really makes you feel good when you get rewards.

So, like, if you hit the penny slots and you hit it and you hit it big and you're feeling those rewards come on, you know, that's what's happening, right?

You get that reward seeking.

But what's so fascinating about adolescence is that you mostly feel those things in the presence of peers.

And it can be if we're physically near each other, it also can just be perceiving, you know, the presence of peers.

And so one of the things that really strikes me about that is that there is a lot of perhaps misperception that's happening for our adolescents and that they're really perceiving that they're feeling quite isolated.

And I do think it's a problem because it can really promote kind of lack of coping and really promote some pretty negative outcomes for our youth, especially our youth in South Dakota.

- Right, Dr. Jackmon, you had more to say about social media?

- I would piggyback on what you're saying is that there's a direct correlation between increased anxiety and depression and the amount of time folks spend on social media.

There's a lot of research that supports that.

We also know about 86% of adolescents sleep with their phone, and we know sleep problems can contribute to more anxiety, more depression.

And so there's a direct link between the amount of time folks spend on social media and their distress level, anxiety, and depression.

- And to that point about peer rewards and that relationship, Erik, I wanna bring you in because Lost&Found, my first interaction with the organization was as a college student and I know peer support is a big part of your organization.

What does some of that peer support training specific to mental health look like for Lost&Found?

- Yeah, you can look at it in two different ways.

Lost&Found has what's called a peer-to-peer mentorship program, which is a more true, I guess, dedicated one-on-one peer support relationship that we create in partnership with counseling centers and with counseling graduate-level programming on South Dakota campuses.

So you have an opportunity where a student can be trained, probably an upperclassman usually, it might not be the case in a technical college but there's differences you can address.

And you really are focusing on how do you create training for that mentor to say, "How do I help a peer who's struggling with coping skills?

How do I help a peer who's navigating isolation?

How do I help a peer who's navigating the many challenges that were already present in an academic setting where you're talking about finances, academics, relationships of all types?"

And so really what that peer support programming in a dedicated sense looks like is students meeting with peers on their campus over a period of six to eight times in a semester and really diving into those goal setting exercises to say we're gonna talk about isolation, we talk about some of these goals where, you know, a student may not want to be online all the time and they might wanna replace that with other behaviors.

But if they're not able to do so with a peer, how do they do it?

And so that's an environment where that one-on-one kind of peer support really can make a difference in a more I guess concentrated sense may be a word.

But there's also a flip side of this too where we're really trying to help students understand you can support your peers in a lot of ways and you can exhibit behaviors in ways that will help eliminate some of that isolation on your campus.

And so really what some of that training looks like is what's called our Lost&Found Advocates program, where we literally give students a blueprint of saying, "Here's what mental health is, here's what it looks like for me, here's how I might identify it in others, and here's how mental health conditions might impact our entire community."

And so giving not just the direct support skills needed to provide that peer support, but then also more of the educational components to say, "You can be a peer mentor, you can be that support for others just by learning and being aware of your environment and what contributes to a person's mental health."

- Absolutely, so that peer support is a big piece of the puzzle, but access overall, that umbrella term of access to mental health services is a struggle in so many places, but particularly in South Dakota.

And, Dr. Oyen, I know schools can be such a centralized access point when it comes to health services for students.

Outline for us the role of the school psychologist in this puzzle and how we're filling that need in South Dakota, because there is a need.

- Yeah, I think that, first of all, I was so impressed by the young people that made that video to talk about some of the risk factors and protective factors that surround them.

And I am very struck by all the things that schools are trying to do to try to address mental health, because we know that 1 in 5 kids have a diagnosable mental health disorder.

And a majority of those kids do not receive any help, but of the small proportion that do, they often receive it at school.

And so we know that schools in a lot of places in a lot of ways are kind of the de facto mental health providers.

And so what are we doing in those spaces to try to promote wellbeing?

I think that for school psychologists, again, I'm training school psychologists, we're the only training program in the state of South Dakota, I can't tell you how many emails that I receive looking for school psychologists to come meet the need, but we know that we have a problem and a shortage, a mental health workforce shortage.

The ratio that we have in South Dakota is one school psychologist for every 1,600 students.

The ratio that's recommended from our national association is 1 to 500.

The other thing I like to share is that the other thing that's fascinating about South Dakota is that we actually have one school psychologist for every 800 square miles.

And so the pure driving to be able to provide access to mental health services in schools is pretty profound.

And there's a lot of people doing this work every single day.

But I also think it says to us that not just one adult in a school can solve this problem.

We really need to equip the whole system to be able to talk with peers about what does mental health look like?

What do I do if my friend is having a hard time?

A lot of times students will hear it, but then they don't know what to do with it.

And then who do I tell?

And then what happens when I tell, or what happens when everyone has some training on how to cope?

It turns out that can really help with a lot of things that kids might be struggling with.

- Wow, Dr. Jackmon, that workforce piece only on the school psychology realms feel so astronomical of a challenge to address.

How is Avera Behavioral Health looking at ways to address some of that shortage and reach out to those areas that are underserved?

- Well, one is through telemedicine, in which we can reach out to folks through video portals or whatnot.

Obviously, increasing the workforce.

There's a shortage of clinical psychologists too.

- There are.

(all laughing) - But social workers, there's great social workers, there are great LPC counselors out there.

But in the rural areas, that's much more difficult and remote and finding clinicians that are willing to relocate is difficult.

So that's something I would hope that our state government or other entities would look to problem solve some of that in the rural areas.

But telemedicine would probably be the biggest outreach effort that we've done through Avera.

- Right.

How do we talk to our peers about mental health?

We've discussed this on this program before, but I'll pose it to you now.

If I ask a friend, "Are you thinking about hurting yourself?

Are you thinking about ending your life?

", is there a risk that that plants the idea in their mind and does harm, or how can I deal with that concern?

- That's a great question.

Often that myth, I think, is still floating out there, that that would cause the person to commit suicide or hurt themselves or harm themselves.

And actually, research supports just the opposite, that by asking folks those questions, it could be something as simple as, "How are you doing," or, "You seem different today.

What's going on with you?

You aren't interacting quite the same."

Just asking those questions and/or asking them, if you know they have a history of depression or suicide, are they feeling suicidal?

Actually, research has shown that decreases the likelihood that they will commit suicide because there's a caring individual that's intervening to help them and they might be more open to seeking help by someone asking them that question.

- Hmm, Dr. Oyen, you looked like you had more to add to that.

- Yeah, no, I just completely agree with that.

I think that there are some myths that surround what I would consider to be things that are hard to talk about.

It's hard to talk about youth suicide.

It's really hard that we are in a space and place where we have one of the highest rates of youth suicide.

We know that the number one cause of youth suicide is really a diagnosable, treatable mental illness plus a trigger plus some sort of overwhelmed coping system.

And so we have to know that talking about it matters.

And Dr. Jackmon is right on, when we talk about it, we can start to make some progress towards change.

And there are a lot of young people that are hurting, that don't know who to go to, or maybe I'm trying to reach out via social media or some sort of other means.

Typically there is a little bit of leakage, you know, whether it be like on social media or some sort of mechanism.

What I'd love to see is us find mechanisms for the people that hear about it, to be able to say, "Here's an adult that I can trust, that I can have someone help."

And so I think that's some of the things for us to be thinking about as the adults that surround kids at school.

- Yeah, Erik, the South Dakota legislature supported $2 million in grant funding allocated to the Department of Health that'll be put out through grants to support things like suicide prevention programs and other related things.

You testified in favor of that.

What are your hopes for that money?

what do you hope it supports?

- I think the intention of House Bill 1079 really echoes what my colleagues on the the stage with me today really are talking about.

And we're talking about, especially Dr. Oyen, not just making sure that we have enough clinicians in the field, 'cause I think there's efforts that are ongoing with the legislature to try to address that, but also recognizing that, while we exist and operate within a shortage, we're gonna have to train the whole system.

And so really what I'm hopeful for with House Bill 1079, and I think the bill sponsors who put this forward understand this very carefully, we really need a stronger commitment to peer support programming in our state, particularly if we're going to, again, navigate a mental health workforce shortage where folks in the community need to be able to talk about it.

Whether that's on a college campus or in a school-based setting, that needs to be a priority.

The other side of what that bill does and accomplishes is that it's also mental health the state better inform its needs as far as the needs of the community in terms of mental health workforce, particularly in a K-12 system where we may not always know or appreciate the numbers, like what Dr. Oyen shared, where, you know, we can see that statewide.

And I'm still kind of flabbergasted by the 1 in 800 square miles.

That's still- - I know, yeah.

(Kari laughs) - But I think what it gets back to the heart of us saying, community by community, how do we equip community leaders with the tools to understand their prevention capacity and then be able to measure and see change?

But then also I think what's important too is, ultimately, that bill does go back to things like suicide loss response planning.

It sounds maybe like a weird way to approach a problem where you'd say, "We need more prevention resources," and we do, and that bill accomplishes that, but that bill also accomplishes something really important, which is prevention in the face of a suicide loss.

And so being able to provide suicide loss response planning services, particularly for, again, schools and campuses, and emphasizing that youth and young adult population, that bill really is critical to put in really kind of in first terms for the state of South Dakota a state-funded initiative focused just on youth and young adult suicide prevention where it's probably needed more than ever.

- Right, then that's exactly our next topic is, we've talked prevention and now the term, some people call it postvention when a death has occurred by suicide.

We just got a press release today, the day that we're recording this from South Dakota Department of Social Services saying South Dakota youth aged 10 to 29, the leading cause of death is suicide.

Dr. Oyen, I'm thinking especially for that K-12 age young people, what does or what should postvention in a school setting look like in South Dakota in the face of these drastic shortages that we're talking about?

- Right, well, first of all, I do want you to know there's lots of efforts being taken, especially in school crisis prevention and response.

And so we're doing a lot of training to talk with school staff about how to prevent, but then how to respond.

Because we know that, especially when a young person dies by suicide, there is something that's called contagion, which is truly this idea that, when you are either physically close or emotionally close to someone who dies by suicide, that can make it at a higher risk, that you might also be someone who's at risk to die by suicide.

And so because of that, because we know that, there are some things that we wanna do.

There are some specific ways that we wanna respond.

There are ways that we wanna share information.

We wanna know facts.

We wanna do a lot of reassuring about how we share those facts.

Sometimes there's a lot of unknowns when a young person dies by suicide, meaning there's a lot of rumors that can be spread around.

And so we wanna equip school teams in how they're sharing information in a really positive way to make sure that kids know that school is a safe place for kids, that there are adults that care about them at school and that want them to be well.

I also would give the state of South Dakota a lot of applause for, when we are seeing things that are happening, we are trying to equip young people to know things like mental health first aid and school teachers to know mental health first aid.

And what that really means is that, if I have a young person that's in crisis right in front of me, even if I'm not a trained mental health professional, I know how to at least get them to one.

And I think that that's really powerful for us to consider.

And then one other small note that I wanna make is that we also have a lot of teachers that are really stressed out.

And I want us to be really mindful of teacher wellbeing too.

And so what are we doing to help teachers engage in things like self-care so that they can take care of themselves so they also then can notice if I have someone in my classroom having a hard time.

And then not only notice, but be able to help them, you know, get access to some additional supports.

But I do wanna say one other thing about the postvention, the best resource that I send to any school team that contacts me saying that, "I have had a child die by suicide in my school," is the After the Suicide toolkit.

And it is based for schools.

It helps you with things like messaging and things like memorials, things that we should consider as the adults that surround kids in schools.

- Erik Muckey, Dr. Oyen, Dr. Jackmon, I wanna thank all three of you for the service you've provided for South Dakota viewers today, and thank you for your work and your time.

- Awesome, thank you so much.

- Yeah, thank you very much.

(upbeat electronic music) - You can find links to the resources we talked about on tonight's program online at sdpb.org/news.

This is our last show of the 28th season of "South Dakota Focus," and you can help shape our next season.

This summer, we're gathering stories about parenting and childhood in South Dakota.

So what does childcare look like in your hometown?

What do you want to know about foster care?

How are young people deciding if they stay in South Dakota after they graduate?

Those are some of my questions, so send me some of yours and your ideas at sdfocus@sdpb.org.

You can also find me on Twitter @JackieHendrySD.

So until next time, I'm Jackie Hendry.

Thank you for watching.

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