Mental health screening

A recent survey found 41 percent of Montana high school students — the highest rate ever documented — self-reported symptoms of depression over the last year, and roughly one in 10 reported a suicide attempt in the past 12 months.

While state officials and mental health experts are alarmed at the findings, sustainable solutions remain elusive in Montana.

And while the global suffering from COVID-19 over the last year and a half may have played a role in recent numbers, the assembly of factors in a single student’s life that may develop into depression and anxiety are too complex to pin mental health struggles on the pandemic alone, the state suicide prevention officer said in a recent interview.

The Youth Risk Behavior Survey was developed by the Centers for Disease Control and Prevention and is conducted every other year among grades 7 through 12.

The 2020 survey found the highest rate of students ever to report feeling so sad or hopeless for two or more weeks in a row that they stopped doing usual activities, a metric researchers say is a symptom of depression.

The factors leading to such sadness are complex and, in some cases, specific to Montana.

“The most important thing is the survey reflects the students’ voice,” Superintendent of Public Instruction Elsie Arntzen said in an interview last week. “I think it’s imperative that adults listen to that student voice.”

Considering Montana’s longstanding ranking among states with the highest rates of suicides, the survey results may be a dull shock. For the last three decades, the state has been among the five worst nationwide for suicides across all age groups.

But a closer look reveals how dim the last 12 months were for some high school teenagers. Golden Valley County, for example, saw 60 percent or more high school students report symptoms of depression. In Petroleum County, one in 4 students reported attempting suicide in the last year. The Flathead Valley is reeling from nine suicides among students in the last 17 months.

Some have pinned mental health issues among students on COVID-19 measures like remote learning or mask mandates on campuses. Karl Rosston, the suicide prevention coordinator at the Montana Department of Public Health and Human Services, said the collective isolation students experienced last year may end up being a contributing factor, but it’s too soon to tell. The rate of students feeling hopeless for two weeks or more in a row has also been steadily rising since 2011.

“We definitely heard a lot more about mental health issues, more depression, more anxiety (related to COVID-19),” Rosston said. He added that the increase hasn’t translated to more suicides, at least for 2020.

“We really have to take a look at trends over a 10-year period because of our small sample size in order to get a more reliable and valid statistical analysis,” Rosston said.

Several factors are fastened to Montana, like sparse populations and elevation. Studies have found a “threshold effect” where suicide rates increase at a certain elevation, where less oxygen is available to the brain. But Rosston said other factors can be improved, like the stigma that often creates barriers to seeking help. Stigma appears to be a greater hurdle in rural Montana, Rosston said.

“One of the greatest fears around suicide is fear of being judged,” Rosston said. “You live and you work in these small rural communities where you know everyone and everyone knows you, and there’s a fear of being isolated and judged. I think the stigma is much worse in a rural communities than it is in our urban areas.”

A new approachOne possible solution tapped this year is a pilot project funded in part by a state Department of Public Health and Human Services grant and conducted by the Rural Behavioral Health Institute. The Livingston-based nonprofit’s project, currently underway in Madison, Gallatin and Park counties, provides a six-and-a-half minute mental health screening completed by 12-year-old students. The results of the screening are delivered through a web-based system to a designated school staff member who can connect the student with resources on the same day. If the school doesn’t have a contracted therapist, the nonprofit provides one, oftentimes remotely from Shodair Children’s Hospital in Helena.

The institute’s executive director Janet Lindow and implementation director Julie Anderson already conducted the screenings in Park High School in Livingston and found both buy-in and success. Screening isn’t a new idea, Lindow said, but connecting the student to a therapist the same day is.

“Once you identify a child with suicidality, you don’t want to leave them hanging, you want to connect them with care,” Lindow said. “We could not have better partners as far as therapists who are trained to deal with kids in crisis, and that’s what we’re offering to schools.”

Without gathering student’s personal information, the project is generating data that the Rural Behavioral Health Institute hopes can eventually help the state identify problem areas to address. More immediately, the screenings allow schools to be more proactive than reactive to crises, Lindow said.

Rosston said he’s going watch the project “very closely” over the next year, with hopes that if successful the state could bring those screenings to more counties.

Existing program at riskMental health resources already in schools, however, are facing some uncertainty. The Comprehensive School and Community Treatment program, which connects a licensed or supervised-in-training practitioner and behavioral health aides with children in school settings, came into jeopardy recently.

For years schools claimed providing physical space and technology like laptops as how they “paid” for their one-third of the cost for the program. The federal government, which covers the rest of the cost, objected to that approach years ago, but had allowed leeway until 2020. The state health department then stepped in with cash to keep the program going, but the Legislature rejected that earlier this year.

Lawmakers did approve stop-gap funding, allocated to the state Office of Public Instruction, to keep the program going while OPI and the state health department try to find a solution for schools’ new cash requirement. That pot of money was expected to run dry in September but is now on pace to last through mid-November, Arntzen said last week.

When that funding does run out next month, Arntzen is hopeful federal COVID relief dollars can refill whatever budgetary holes schools choose to dig in order to keep their CSCT program going.

“We need to make sure those services are rendered,” Arntzen said.

Arntzen also floated the idea of going a different route altogether from CSCT. Many students who use the program are in special education, Arntzen said, so perhaps schools can channel their resources there.

“That doesn’t mean we increase the number of students that are in special education by any means, or prop up the numbers bigger, but I think there’s multiple ways to look at this,” she said.

Arntzen was not particularly warm, however, to the idea of going to the Legislature in 2023 to ask for money to conduct statewide screenings like those done by the Rural Health Behavioral Institute and emphasized by Rosston.

“Remember, one size does not fit all,” Arntzen said, suggesting communities like Missoula and Bainville could see lopsided success through the program. Addressing the current workforce shortage, including paraprofessionals and bus drivers, is already taking up much of Arntzen’s attention, she said.

“My job is to talk about the beautiful and wonderful things in education in a positive aspect but also to ring the bell and say we need to do better,” she said, adding that the duty to push down the numbers from the Youth Risk Behavior Survey doesn’t fall to her office alone. “I’ve got to work with (the state health department) with this, with county health, I’ve got to work through so many different entities and it’s not just about a classroom teacher, it’s about all of us in a state working on this.”

Part of Rosston’s plan to bring more resources to communities is by training those who are already there, or en route. Rosston has been training primary care providers around the state and encouraging them to conduct risk assessments for all kids over the age 12. Rosston has also expanded assessment trainings to nursing students around the state, many of whom will go on to work in rural health care settings.

“That’s probably the most reliable thing that we can do,” Rosston said of the screenings. “It’s hard for me to imagine us having enough mental health services in our state just because of the rural nature, it’s just not economically feasible to have it. But primary care is one that we really are focusing on because most communities do have a health care clinic, or rural doctor or nurse. Getting them trained up is probably our best initiative.”

And in recent months, Rosston has gotten a hand in training new trainers, who can take that information to their regions. Jess Hegstrom, the suicide prevention health educator for Lewis and Clark County, is one of several new local trainers who can now bring that education to providers in the area. With additional grant funding, Hegstrom said these trainings will soon expand out to Broadwater and Jefferson counties, and beyond that before long.

The most important thing, Hegstrom said, is that people who are in contact with children are prepared when crisis happens.

“Making sure people know how to help means people won’t fall through the cracks,” Hegstrom said. “It means that if people get the help they need, they’ll probably never be suicidal again.”