Just before midnight one night in early September, a 17-year-old Free State High School senior parked her SUV on a dead-end road flanked by corn crops, intent on killing herself.
Amber had taken some of her father’s medication bottles from the tote where her parents stored them in the kitchen, turned her phone location settings off, and drove to a remote area where she thought no one would find her.
She’d suffered a string of recent losses — not only had a grandmother she was close to died, Amber had been the one to find her before medics arrived. And her girlfriend, her very first love, had just broken up with her. She felt she had two choices: take the pills, or drive as fast as she could through the cornfield until she hit something.
As Amber contemplated her decision, a figure emerged beside her car. The road’s seclusion regularly attracts teenagers in pursuit of illicit behavior, which is precisely why a police officer drove by, discovering Amber.
Amber stepped out of the car.
The officer asked if she was OK.
Amber — a pseudonym used to protect the girl’s privacy — wept.
No, she said. She was not OK.
It’s been a year since public health officials declared the state of pediatric mental health a national emergency, and signs suggest that the crisis is still underway.
More children between the ages of 5 and 18 are going to emergency departments for suicidal ideation, self-harm, and suicide attempts than ever before: In 2021, there was a 153% increase compared to 2016, according to the Children’s Hospital Association.
The crisis was exacerbated by the pandemic, according to Aihua Zhu, a senior analyst with Lawrence-Douglas County Public Health, who found that suicide ideation increased locally for those who are 18 and younger in 2020.
But the steep rise of adolescent suicidal ideation started before the pandemic.
“In Kansas, it was around 2015 that we really saw the suicide death rates for that under 18 population really, really spike up,” said Monica Kurz, vice president of Kansas Suicide Prevention Resource Center. “Talking with individual kids and teens tells us that folks are really struggling, and I would argue that that predated the pandemic … but that the pandemic focused us in on seeing just how much distress there is.”
Amber’s mother, whose first initial is J, noticed something was off when her daughter quit sports in the middle of her junior year.
“She had been playing since she was 5,” J said. “Our lives revolved around practices, games on the weekends, tournaments and traveling. She went from wanting an (athletic) scholarship to just quitting. Yes, I was concerned. Very concerned.”
In Douglas County, 37.8% of sixth, eighth, 10th and 12th graders reported feeling so sad or hopeless they’d quit activities in this year’s survey, according to the Kansas Communities That Care survey — up from 33% in 2020, the first year Douglas County has data available for the question. In 2019, 24% of sixth-graders — the youngest group surveyed — revealed they’d quit activities out of hopelessness; that number jumped to 34% this year.
More than 8% of Douglas County adolescents reported that they’d seriously thought about killing themselves in 2021, just as Amber had considered doing the night a police officer discovered her parked car.
That night, J got a welcome call from police. She had already been on the phone with dispatch, reporting her daughter missing. “Runaway” was the word the police had used, and hearing it put that way had caused her heart to sink.
Learning her daughter’s location — just a mile from home — J drove to the dead-end road, parked, and jumped out of the car, running to her daughter and sweeping her into a tight hug.
Amber thrust her car keys at J, saying she didn’t want access to any of the family vehicles.
That night, Amber slept in bed with her mother.
“I didn’t sleep,” J said. “I was awake every move. It was like having a newborn kid, you know? They cry once and you know you’re up and wanting to know what’s going on.”
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Assessing for severity
The next day, Amber still felt an immense and frightening sadness.
“I think I need help,” she told her mother. “Can you take me to the hospital?”
Recognizing that this would not be a quick process, J took a shower and drove her daughter to the emergency room.
After giving Amber a six-question survey, nurses shuffled J and Amber into the gold unit, a secluded part of the emergency department with its own rules, staff and a video monitoring system that observes patients at all times for their own safety. Amber, who wore sweatpants and house slippers, had to jettison the bag she’d packed to bring with her: inside it had a photo of her girlfriend, and her late grandmother’s perfume.
Once in their own room, J observed that the white walls had holes in them, ostensibly from being punched.
“You’re gonna have a hard time finding someone who tells you that those isolation rooms at LMH are ideal, right?” Kurz said. “You will find that (the) message from professionals and folks with the experience of being in the middle … we are all aware that the way that you have to set those rooms up so that they are physically safe is not conducive to folks feeling really wrapped up and cared for by their physical environment.”
Once in the gold unit, medical staff assess children for severity: can they be sent home with a personalized safety plan, or is the threat serious enough to merit hospitalization? LMH staff analyze the lethality of the plan; what resources, if any, the child is already plugged into; and protective factors that could motivate the child to want to live. Is the child looking forward to anything? Can the child imagine their family’s sadness at their loss?
“After talking with the parents, we start making calls to the hospitals, and then it comes down to what beds are available,” said Lynn Powers, director of inpatient case management at LMH. “Typically at this point … availability is the biggest issue and what we find is after the kiddo had maybe spent the night and slept, (and) parents have slept, the next morning that crisis may be gone … and we might be on a safety plan.”
The next day, Amber still felt too scared of what she could do to herself if she was sent home. A safety plan was off the table.
“She’s just a smart … intuitive girl in touch with her feelings,” J said of her daughter. “And she said, ‘I can’t do this on my own.’ So they started looking for a short-term behavioral and mental health facility for her to go to.”
‘How do you not know who’s in-network or who’s not?’
Because Lawrence does not have an inpatient mental health hospital, LMH sends children and teens suffering from a mental health crisis to one of five locations: Marillac, in Overland Park; Camber Children’s Mental Health, in Kansas City, Kansas; Crittenton Children’s Center, in Kansas City, Missouri; KidsTLC in Olathe; and Stormont Vail Health in Topeka.
The demand for more inpatient care has diminished bed availability.
“Our current state is that beds for kids are hard to come by,” Powers said. “It’s not unusual that we have a kid waiting 24 to 48 hours in the gold unit waiting for a bed.”
On top of an increased demand for inpatient beds, insurance coverage — or lack thereof — can further restrict access.
J wanted her daughter to go to Marillac because it was in-network and her insurance provider would pay for 80% of the bill. But Marillac didn’t have a bed for Amber. The closest place with an immediate opening was in Wichita, more than two hours away.
Was there a closer hospital that would also accept her insurance? J asked.
Hospital staff didn’t know.
How much per day would it cost if insurance didn’t cover the stay?
J started to cry.
“I wanted to get my daughter the help she so desperately needed and wanted and we were stuck in this small room with absolutely nothing in it waiting for news on a place,” J said. “At one point when my daughter saw me crying, she said she didn’t want to go because it was going to be too much of a financial hardship on our family.”
Eventually, J got on the phone with her insurance company and asked which facilities they would cover.
“I’ve got all these dollar signs running through my head and thinking, … we can’t lose … everything we have,” J said. “There’s got to be someplace in-network she can go, and I felt like the insurance company should have, I don’t know, given me better information, instead of transferring me and putting me on hold. … I can only imagine what they were doing. I mean, how many people did they go to and ask this question to? And it bothered me that they said they didn’t know. Like, how do you not know who’s in-network or who’s not? How am I supposed to know?”
After Amber and J had sat in the gold unit absent anything to do for nearly 19 hours, LMH found an opening at Stormont Vail, which served 67 pediatric patients from Lawrence in 2020 and 73 in 2021.
Unsure if it would be in-network, J agreed to send her daughter to Stormont Vail anyway, saying she would work it out.
J was not allowed to drive Amber there.
“They made her put on some hospital scrub-looking things,” J said. “I also remember her walking to the (van) and I was thinking she looks like a criminal being transferred to another prison.”
Amber’s stay at Stormont Vail was in-network. J got a bill for $10,954 for the three-day stay, but she only had to pay $960, plus about $100 for the ER visit.
“If it would’ve been out-of-network, we would’ve been responsible for the whole charge,” J said. “Imagine if she needed to be there for 30 days.”
Amber was prescribed a mood stabilizer and an antidepressant, and sent home on her third day.
Searching for outpatient resources
According to J, the short hospital stay mitigated Amber’s mental health crisis, but she still needs help — which isn’t easy to find.
“It seems everyone is either not in-network for our insurance or not accepting new patients,” she said.
J called Bert Nash Community Mental Health Center and secured an intake appointment for her daughter, but the earliest slot was more than a month after her discharge for a telehealth visit, and an extra week beyond that for an in-person appointment.
Amber chose in person, which meant her prescriptions would lapse before she could see someone. So J had to make another round of calls to ensure that the prescription stayed current.
“I feel like these appointments should be set before she leaves the mental hospital,” J said. “I also feel like I should be assigned a caseworker … to help me with all of this.”
Powers commiserates with parents who have to drive their children home after a mental health hospital stay, knowing the problems are still present.
“I wish that … (mental-health professionals) held appointments for us … but we run into the same roadblocks when we’re trying to find resources for (patients) as well,” Powers said.
“We make a lot of those phone calls … and we know we’re not any more successful in getting those resources and so that is challenging because … these parents are trying to work, trying to get their kids to school, trying to feed their kids and buy groceries and do those things and then trying to spend, you know, two or three hours a day on the phone trying to find somebody to see (their) kiddo. It’s challenging.”
Get mental health help in Lawrence
These resources are available 24/7 if you or someone you know needs immediate mental health help:
• Bert Nash Community Mental Health Center: 785-843-9192
• Kansas Suicide Prevention HQ (formerly Headquarters): 785-841-2345
• National Suicide Prevention Lifeline: Dial 988; veterans, press 1
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Chansi Long (she/her) reported for The Lawrence Times from July 2022 through August 2023. Read more of her work for the Times here.