How One County is Working Together to Address Young People at Risk of Suicide

After St. Mary’s Medical Center in Victorville, California, found itself dealing with a growing number of youth with severe psychiatric issues, a discussion with local stakeholders yielded a new plan to help support these youth and their families.

In San Bernardino County, a largely rural, high desert community of about 21,000 square miles that boasts nearly 2.2 million residents, we really struggle to coordinate help for children and youth experiencing suicidal ideation due to the lack of psychiatric services available in our area.

Recently, our organization — a consortium of San Bernardino County school districts and charter schools that helps to provide behavioral health supports and professional development — was approached by a local hospital, St. Mary Medical Center, to enter into a discussion about how to support these extremely vulnerable children and youth. Located in Apple Valley, California, St. Mary’s shared the story that the number of children and youth exhibiting suicidal behaviors and thoughts has increased drastically. The rate of suicide among our children and youth in San Bernardino County is disturbingly high at 7.4 per 100,000 children.

Unfortunately, St. Mary’s is not equipped to provide psychiatric services to patients who appear in the emergency room due to the fact that they are designed to address medical issues, triage the emergencies as they enter the emergency room and absence of residential psychiatric resources in our region. The closest psychiatric facility for children and youth is at least an hour drive away and bed space is limited. As a result, children and youth coming to the emergency room at St. Mary’s are sometimes held there up to four days until a bed is available at the psychiatric facility, according to center administrator Kevin Mahaney.

When CAHELP talked to St. Mary’s about how to better assess children and youth for suicidal risk, we realized that there are many barriers to addressing the issue. For example, even though many programs run from 8 a.m. to 5 p.m., children and youth rarely showed up in the ER during those hours; typically they were admitted in the middle of the night. Also, it can be difficult for one agency to be able to provide an entire spectrum of services for youth in need of intervention.

As we brainstormed how to better serve children and youth, we started talking about all of the various contractors in the area and what part each organization could play toward a solution, especially when it comes to more robust services to prevent placing children in out of home care. The discussion revealed that there are several agencies in our community that hold contracts with the San Bernardino County Department of Behavioral Health to support children and youth in crisis.

CAHELP, specifically our member organization Desert/Mountain Children’s Center, holds the contract for the Children’s Intensive Services program, which are aimed at children and youth at risk of losing their home or school placement due to behaviors and psychiatric issues. Victor Community Support Services holds the contract for Success First/Early Wrap, a wrap-informed full service partnership program that offers up-front, time-limited services to children and youth who struggle with emotional disturbances and co-occurring disorders who are at risk for psychiatric hospitalization or losing their current residential placement.

And the Community Crisis Response Team — trained mental health professionals authorized to conduct suicidal assessments — operates directly from the county’s Department of Behavioral Health, while Valley Star operates a Crisis Walk-In Clinic that provides crisis intervention and stabilization treatment for up to 12 people at a time.

The Crisis Walk-In Clinic had previously approached administrators from St. Mary’s to discuss collaborating on assessing children and youth for suicidal risk. St. Mary’s was concerned about the lack of bed opportunities at the clinic and had delayed this effort. But we realized that it made sense for the Crisis Walk-In Clinic to provide the initial mental health assessment and when hospitalization was not deemed necessary, to then connect the child and family immediately to Desert/Mountain Children’s Center’s Children’s Intensive Services program or Success First/Early Wrap when appropriate. As an outcome of this initial discussion, we are now meeting with all the agencies involved and our three local hospitals to formulate a system of support for our children and youth exhibiting suicidal ideation.

Although the high desert area of San Bernardino County is a rural community, I believe the same issues occur in our urban areas. There may be more availability of mental health personnel to assess suicidal ideation in urban areas, but some of the same issues of bed capacity and referral coordination still apply.

This discussion generated interest in how a community with various providers for children and youth, could come together to reduce the need of psychiatric hospitalization, increase direct service in a timely manner and improve the lives of children, youth and their families.

Jenae Holtz is the chief executive officer of the California Association of Health and Education Linked Professions, Joint Powers Authority, which consists of the Desert/Mountain SELPA, Desert/Mountain Charter SELPA and the Desert/Mountain Children’s Center. 

Don’t miss the Breaking Barriers Symposium, a working conference that focuses on providing practical ideas to help break the barriers to care for California’s youth and their families. The fourth annual Breaking Barriers Symposium will be held November 20-21, 2019, in Sacramento. You can register here.

*This article has been updated to clarify services administered by the Crisis Walk-In Clinic.

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