Editor’s note: This is part one of a two-part report from the Hibbing Daily Tribune that looks deeper into the shortage of in-patient beds for teens experiencing mental health issues or are at risk for suicide. In part two of this report, the HDT will give an inside look into the care Iron Range teens are receiving at outside facilities.

HIBBING — Suicide is now the second leading cause of death among Americans ages 10-24. A report released last month by the Centers for Disease Control and Prevention revealed that national teen suicide rates increased 56 percent between 2010-2017. That’s an average rate of 10.6 suicides per 100,000 people in 2017, compared to 6.8 in 2007.

In rural cities like Hibbing, where police say they average six suicide-related calls a day, health professionals and school officials have been struggling with how to handle the growing mental health crisis among area youth.

That problem is amplified when considering the closest in-patient treatment for a young person at risk for suicide is 80 miles southeast in Duluth — and that’s if they’re lucky. More often, at-risk teens are transported 200 miles away from their immediate family and support systems in order to receive the professional care they need, all while families rack up bills for travel and hotel stays.

First stop: class to psychologist's office

Hibbing High School Principal Mike Finco has been with the local district for 15 years. He’s weathered countless trends throughout his time at the school, but the snowballing mental health issues he sees gripping students don’t seem to be losing steam. Finco told the Hibbing Daily Tribune in a recent phone interview that a drastic shift in family structure and the prevalence of social media has left students more susceptible to mental health challenges. Youth now live in an age when there is no safe haven to protect them from “instant bullying,” which can lay the early groundwork for fear and anxiety.

“It’s been an ongoing problem in all schools for a number of years,” Finco told the HDT. “I think that everyone knows there are shortages of caregivers in the area for teen mental health, so we do our best to identify kids early to get them the help that they need before it gets to be a serious problem.”

In Hibbing, that means not only paying attention to the students acting out, but also those who have “gone quiet.”

At HHS, Finco’s office is connected to the main office, which leads to the counseling area. It’s a busy place staffed with three counselors and a psychologist who oversees the non-stop flow of students. Some in crisis may land there after friends report their suicide-related texts or posts on social media. Others voluntarily self-report.

Anytime a counselor determines that a student is at serious risk for self-harm, that teen is sent to Bryan Ridgeway, a psychologist for the Hibbing School District. Back in August, he told the HDT that in those instances, he conducts a depression screening, asking direct questions, like “Have you thought about how you’re going to hurt yourself? Have you hurt yourself in the past?” If the teens’ answers suggest they are at risk, their parents or guardians are immediately notified and urged to bring them to the nearby Fairview Range Medical Center for further evaluation.

“In the 29 years I have been working as a school psychologist, the number of students requiring mental health services has definitely gone up,” Ridgeway said. While he sees many factors playing into “why,” he pointed to the increasing pace of society and the distraction of technologies as common culprits. But at the core is often something much simpler. He said he sees otherwise caring parents get so caught up in day-to-day stressors that they forget to check in regularly with their kids. And while parents are usually “shocked” to receive his call, the majority cooperate and agree to bring their child in for a professional evaluation at Fairview Range. If a parent refuses, Ridgeway coordinates with the school’s resource officer to determine if they should intervene and bring the student to the hospital directly.

“If someone says they want to die and have a plan to hurt themselves, our focus is their safety,” Ridgeway said.

Second stop: emergency department

Fairview Range in Hibbing does not have in-patient mental health beds for patients under the age of 18. That means teens who are determined to be at high-risk for suicide are sent to receive treatment off the Iron Range. “This has been occurring for several years now and is a real source of frustration to me and for most of the parents I have worked with,” Ridgeway said. “A parent finds out their child is having suicidal thoughts and then is sent halfway across the state to get help. It makes it very stressful for the family both emotionally and financially.” He said he doesn’t assign blame to the hospital or parents, and instead described the problem as a communitywide issue. “It puts an increased strain on families that are often already being stretched to their limits with existing home issues.”

Kelly Lawson, director of Emergency and Behavioral Health Services at Fairview Range, told the HDT in July that they have 34 in-patient beds for adults — that includes 28 regular beds and six intensive care beds. Lawson estimated that they quit providing in-patient mental health beds for youth about 15 years ago.

“It's just a completely different programming,” Lawson said. “Adolescent patients are quite vulnerable and their needs are much different than adults, so to maintain that, it just got to be overwhelming for the organization, so we just made the decision that we would focus on adults.”

When interviewed, Lawson mentioned the difficulty of recruiting people who specialize in pediatric care to work with youth. She also discussed the complication of navigating family dynamics. “It’s virtually impossible to find out who their legal guardians are,” she said, noting that HIPAA laws block staff from knowing if a child brought in for a mental health crisis was removed from a home due to abuse or sexual allegations. They also have no easy way of navigating the foster care system.

As Lawson explained, if a 16-year-old is brought into the hospital after expressing suicidal thoughts, that teen would be seen by an emergency room nurse and provider for a mental health assessment. Staff would then talk to the teen’s emergency contact for additional information, preferably a parent or legal guardian. Or if they were brought in by law enforcement or a school liaison, that person would also be contacted to help fill in the blanks. From there, Lawson said, hospital staff would determine where the “safest place” is for the patient. “Is it going back to the family, developing a safe plan, or is it in-patient admission?”

Third stop: outside facility

Last year, Fairview Range reported a 20 percent increase in youth coming in for mental health in the emergency department. That includes patients from Hibbing and neighboring towns such as Chisholm, Keewatin and Nashwauk. Between the beginning of April 1 and the end of June 30, hospital staff saw 20 youth for mental health issues, averaging 1.5 adolescent admissions a week. Of those, Lawson said about half were transferred out to other in-patient facilities while the other half were discharged and sent home. The demographics of young patients they treat for mental health issues are primarily 12-17 year olds, with the younger half being predominantly female, the older end being male.

The hospital’s youth admission rates aren’t far off from what they’re seeing with adults, Lawson noted. As to why, she listed a general sense of social dysfunction, a lack of healthy coping skills and teen drinking and drug culture, as well as a lack of social support systems. Teens who end up in the emergency department who have a strong desire to kill themselves often have other underlying mental health conditions. Couple those with “social dilemmas” like bad break-ups, bullying or social media strife, and Lawson said young people get pushed past their limit.

“Maybe their parents are working three or four jobs and they’re not home, so ‘latchkey’ kids,” Lawson said. “If they don’t have a lot of support systems at home, for a lot of them, that’s their family. That’s their people. That’s their culture, and when there’s dysfunction there, they just don’t have a lot of stability or family support to go to.”

Few youths who end up in the emergency department have tried to complete suicide. Those who have tried tend to be older, closer to age 17, and typically used drug overdosing as the means, Lawson said.

In those cases where in-patient care is required, that teen could remain in the emergency department overnight until staff secure an ambulance transport to an available bed somewhere in the state or on the Minnesota-North Dakota border for treatment.

•••

The free and confidential Suicide Prevention Lifeline is 800-273-8255. You may also visit ThriveRange.org for resources to use when feeling suicidal, or text "range" to the Crisis Text Line 741741.

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