Health Care

Depression, childhood trauma, suicide. As problems soar, here’s how to help KC kids

Teens and suicide: Adults should understand there’s usually not just one reason why

Courtney Costain, teen council member of Zero Reasons Why and a Spring Hill High School junior, talks about misconceptions adults have when it comes to teens and suicide.
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Courtney Costain, teen council member of Zero Reasons Why and a Spring Hill High School junior, talks about misconceptions adults have when it comes to teens and suicide.

Three years ago Gardner high school student Blake Burns fell into a deep depression.

Like many of his peers, Burns loved social media. But the weight of seeing others living what seemed like perfect lives eventually wore him down. He was dealing with a friend’s suicide and he felt like he wasn’t good enough — in school, in tennis, in anything.

“It was just the stressers and thinking that I had to be perfect constantly and that if I ever wasn’t perfect there wasn’t really a point of living. Which is a very skewed view of life,” said Burns, now 18.

Burns was hospitalized after trying to take his own life. For the first time, he got help with his mental health.

Now he’s part of a group of teens helping other kids in the Kansas City area. And there are plenty who need it.

A community health needs assessment recently completed by Children’s Mercy Hospital showed a striking rise in mental health problems for kids ages 5-17 across Jackson, Clay, Wyandotte and Johnson counties.

Among the findings:

The percentage of kids who have been diagnosed with depression doubled in three years, from 5.5% in 2015 to 11.7% in 2018.

The percentage of kids who have taken prescription medicines for mental health also doubled during those years, from 7.2% to 15.9%.

The percentage of kids who stopped doing their usual activities for two or more weeks in the past year because they felt sad or hopeless more than tripled, from 3.0% to 10.7%.

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All three rates are now above the national average. The data came from surveys of a random sample of 1,000 families in the four-county area with at least one child.

Children’s Mercy officials say that a greater willingness to talk about mental health and get a diagnosis may be driving some of the increases, but can’t explain all of them.

Sarah Soden, the director of the hospital’s behavioral medicine division, said Children’s Mercy is getting an average of about 1,000 mental health referrals a month from its outpatient clinics. More striking, perhaps, is that an average of more than 100 kids a month are landing in the hospital’s emergency rooms for mental health assessments.

”These are children who maybe have expressed suicidal ideation or other sorts of urgent mental health needs,” Soden said.

Fifteen teens in Johnson County died by suicide in a 13-month span over the past year.

There are many possible reasons for the increases in mental health problems, and the extent of their influences differ from county to county. Students and Children’s Mercy staff say social media is a part of it. But the health assessment showed that there is much more going on. Childhood traumas caused by things like violence and drug use are also on the rise and financial stresses continue to weigh on low-income and even middle-income families.

Something is clearly happening, Soden said, and not just in Kansas City.

“It’s definitely a national trend,” she said. “Children’s hospitals across the country are facing this.”

The good news, she and other experts say, is that children and young adults like Burns are more willing than ever to talk openly about their mental health struggles. And adults are starting to listen.

Bullying and social pressure

Scientific studies have shown mixed results about whether excessive use of electronics such as smartphones is detrimental to kids’ mental health. But bullying is, whether it occurs in person or online.

The Children’s Mercy health assessment found that bullying is up across the metro. It is highest in Johnson County, where almost 27% of kids said they had been targets.

Soden said that may be just the tip of the iceberg. Even more common than direct harassment, Soden said, is a sort of “broader social pressure” that comes with having everyone’s lives — or idealized versions of them — playing out publicly online.

She and Margo Quiriconi, the hospital’s director of community health initiatives, said that during the health assessment process they heard from teens who said they’ve been ranked online based on what they wear or how they look.

“All sorts of negative things were being put up and posted for the world to see in your school community,” Quiriconi said.

Kids are also increasingly comparing themselves not only to their school peers, but to people they haven’t met, like social media “influencers” who use posh-seeming lifestyles to hock products.

Mary Beth Karlin, an 18-year-old senior at Shawnee Mission West, said there’s increasing pressure to find a niche that can deliver that type of lifestyle.

“I feel like our generation is very stuck on, you need to make it big, or you’re not going to make it,” Karlin said. “... I feel like that pressure puts a lot on people, like, I need to become rich really fast and that’s how I’ll be happy and successful.”

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Gardner-Edgerton High School senior Blake Burns and Shawnee Mission West High School senior Mary Beth Karlin are part of a group of teens working to end the stigma around talking about suicide and mental health. Andy Marso amarso@kcstar.com

Karlin said some teenagers overextend themselves with tough classes and lots of activities to build college resumes.

Nadeen Alsalman was one of several students at Lincoln College Preparatory Academy in Kansas City who said they feel similar pressure.

“I feel like a lot of people they look at social media and they see like, influencers and people who are their age doing more than them or doing other things and they think, ‘Oh I’m not doing this or I’m not doing that’ and they feel like they need to change themselves,” Alsalman said.

Burns said deep feelings of anxiety and inadequacy are becoming more common among his peers, especially those who don’t know precisely what career they want to pursue.

“A lot of stress of just life,” Burns said. “Sometimes you feel like you’re not the best person you are and maybe there isn’t a place on earth for you. There needs to be things that show that there are places where you do belong.”

That sort of teenage angst is not new, but Soden and Quiriconi said the digital revolution may be heightening it, and preventing kids from developing the emotional IQ they need to cope with it. Smartphones and other devices provide constant distraction, which means people don’t take the time to sit with their feelings and work them out.

Jason Bohn, the director of adolescent services at Renew Counseling Center in Olathe, said demand for his programs on handling anxiety is soaring.

Kids today are hyper-aware of how many choices they have, he said, but they often don’t know how to navigate them. Many of the kids he sees have what he calls a “mean adviser voice” in their heads, telling them they’re failures.

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“They beat themselves up all the time,” Bohn said. “Telling them they’re not OK, that they shouldn’t be here. I personally believe that it can be changed. That filter and just that way of thinking about yourself, young people can unhook from it.”

Bohn said he’s increasingly engaging the parents in his program, explaining that kids need boundaries to help them make the right choices. Parents and schools can also help by emphasizing growth rather than achievement, he said, so kids feel comfortable trying new things and dealing with failure.

But the Children’s Mercy health assessment shows that many parents are going through their own challenges.

Childhood trauma

The Great Recession has technically been over for almost 10 years, but the assessment showed that a significant number of families in the Kansas City area are still struggling to pay basic bills as costs rise and wages don’t keep up.

More than 40% of respondents said they were worried or stressed about how to pay their rent or mortgage in the previous year. Another 29% said they ran out of food at some point.

The Children’s Mercy assessment included data showing more than 8,000 students in the area reported being homeless at some point during the 2017-18 school year.

“When parents have trouble with their rents and stuff like that, some of those kids are moving five or six times,” Kansas City child psychologist Shawn McDaniel said. “If you disrupt a kid’s school like that, they’re going to have all sorts of adjustment issues.”

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These are also national trends. A recent Gallup poll showed that levels of stress, anger and worry among U.S. parents has risen to levels not seen in decades, and it’s especially high among low and middle-income parents.

It’s hard for that not to seep into their parenting, Soden said. She noted with dismay that more than 8% of parents surveyed in the health assessment reported being either “usually” or “always” angry at their kids in the past month.

“It just goes to show you how much these families are struggling,” Soden said.

Soden and Quiriconi said one of the biggest takeaways for Children’s Mercy from the assessment is that the hospital has to partner with community groups to support parents so they can help their kids stay well emotionally.

Otherwise the Kansas City area risks having multiple generations that don’t know how to handle routine issues like tantrums, aggression, chores and social media in healthy ways.

“We’re expecting pre-school teachers and pediatricians in 15-minute visits to impart this knowledge on families in between the vaccinations and teaching the ABCs,” Soden said. “Don’t we want to help with these things upstream so we can teach a 7-year-old to manage her anxious feelings, so when she’s 17 and suffering heartbreak and school stressers she knows how to do it, rather than ending up in our ED (emergency department) because she’s expressing suicidal thoughts?”

Other societal factors that impact children’s mental health may be more difficult to address.

The Children’s Mercy health assessment found eight types of childhood traumas that had risen in the area since 2015, including domestic violence, household substance abuse and parental divorce or separation.

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But none had risen more dramatically than parental death. From 2015 to 2018, the percentage of KC-area kids who had experienced the death of a parent rose from 1.7% to 7.5%, a figure due in part to spikes in homicides and drug overdoses.

When Lincoln Prep students led a multi-school walkout to protest gun violence last year, several said they had seen it firsthand in their neighborhoods.

Lincoln Prep junior Assata Jihad said her class has bonded through a lot of adversity and generally knows how to support each other through the daily stresses of social media, academics and trying to find their places in a quickly changing world.

But the death of a loved one is an entirely different level.

“You can comfort them and make them feel better, coming from a loving place that you might understand,” Jihad said. “But someone losing someone else is like... I can’t help you. I hope that you do good, genuinely, but I can’t help you. Which is super-sad, but I feel like that’s the only thing we kind of don’t have figured out amongst ourselves.”

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Lincoln College Preparatory Academy students Nadeen Alsalman, left, and Assata Jihad discuss mental health issues at their school while Linda Bishop, the faculty adviser for the school’s Future Medical Professionals club, listens. Andy Marso amarso@kcstar.com

Steve Sewell, a former pastor and hospital chaplain from St. Joseph who co-wrote a children’s book about dealing with the death of a loved one, said depression is a natural consequence.

In addition to grief counseling, he said kids in that situation need to be given the time and space for self-care, whether that means spending time outside, listening to music or just sitting quietly with the memories of the person they lost.

In fact, people should take time for those things even when they’re not grieving, he said. But that can be difficult in an era that prizes busyness, striving and constant stimulation.

“When we lose someone, especially someone who’s very close to us, it really is a battle for us,” Sewell said. “But I think one of the reasons why it’s a battle for us now more than ever is I don’t think we have as much margin in our lives as we used to. We run on empty so much.”

Talking about it

Kids are starting to speak up about their mental health needs.

The string of suicides in Johnson County teens spurred a movement called Zero Reasons Why. It started with students and administrators from six school districts in the county and is now spreading to other parts of the metro.

It’s built around three pillars: removing the stigma associated with mental health problems and suicide so people can talk openly about it, building community support so teens and their parents know where to access help and educating students early about how to maintain their emotional well-being.

Burns and Karlin, who lost her brother to suicide, are part of a Teen Council that has been out front leading the campaign.

The overall goal is to teach kids to monitor their mental health and know that it’s OK to let people know when they’re feeling overwhelmed or depressed and need help — especially if they’re thinking about harming themselves.

“No one wants to admit that they’re hurting and struggling and they don’t want to do it alone,” Karlin said. “So we need to talk about it. Just like talk to your friends, talk to your family members and make sure it’s OK to talk about. It’s not something you should be embarrassed about. Years ago it’s not something that you wanted to talk about, but I feel like we’ve come such a long way.”

With that new openness to seeking help comes another challenge: finding it.

Soden said there are long wait times for some types of outpatient psychiatric help at Children’s Mercy and about half of the patients they get each month have to be referred elsewhere.

The glimmer of hope, she said, is that Kansas and Missouri have good telemedicine laws, which means that it’s easier for behavioral health professionals to counsel kids via videoconferencing. But there still just aren’t enough of them.

Some schools are adding social workers, but the superintendents involved in Zero Reasons Why have also banded together to ask the Kansas Legislature for more funding for community mental health centers.

It’s a recognition that the schools can’t do it themselves and they need a place to send kids who need help, before they end up in a hospital.

“Do we really have the capacity to help everybody who needs it?” DeSoto schools superintendent Frank Harwood said during a recent mental health symposium. “That’s a scary question for us.”

Blue Valley Schools superintendent Todd White said that if the world has gotten more complex and daunting for kids, then adults need to take some responsibility for making it that way and try to give their kids the emotional skills they need to cope.

That means being willing to talk to their kids about how they’re feeling — whether good or bad — and listen and support them.

But they don’t need their parents to clear all obstacles out of their way, he said. In fact, that’s counterproductive. Kids need to experience trying, coming up short and learning that they’re still valuable.

“Just walk beside them,” White said. “That’s all they need.”

Children’s mental health resources:

KidsTLC (Olathe): 913-324-3658

Research Psychiatric Center (Kansas City): 816-444-8161

Children’s Mercy Hospital (Kansas City): 816-234-3674

National Suicide Prevention Lifeline: 1-800-273-8255

Crisis Text Line: Text: START to 741741

American Foundation for Suicide Prevention: https://afsp.org/find-support/

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Kansas City Star health reporter Andy Marso was part of a Pulitzer Prize-finalist team at The Star and previously won state and regional awards at the Topeka Capital-Journal and Kansas Health Institute News Service. He has written two books, including one about his near-fatal bout with meningitis.

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