As adolescent mental health crises have surged to new heights, some teens have used emergency services and inpatient hospitalizations as forms of temporary relief and stabilization.
One Lawrence teen was repeatedly thrust into the emergency department and regional mental health hospitals during the peak of her struggles. Her story is emblematic of what can happen when families feel desperate to help their teens.
As a 12-year-old seventh-grader in 2018, Renee — a name used to protect her privacy — made the honor roll, the year before she was hospitalized for a mental health crisis for the first time.
Renee’s infant niece died of SIDS during a normal afternoon nap that year. Renee was devastated by the loss. She held it together academically, but she developed an unhealthy way of coping with her pain: she sliced her arms and legs with household objects like scissors, knives and pencils.
“I got addicted to cutting,” she said, gesturing to her forearm, covered with a slew of orderly scars. “I got addicted to the feeling, the look of it. … I needed to feel that pain to be OK.”
Almost 1 in 5 adolescents have reported harming themselves to self-soothe, according to a meta-analysis by the American Association of Suicidology. Renee had several risk factors for nonsuicidal self injury, such as lower socioeconomic status, negative life events, parental divorce, adverse childhood experiences and exposure to bullying.
Renee’s urge to self-harm escalated after she was raped by a friend’s brother, she said.
One day after the rape, Renee was at her dad’s house when she pilfered a pocket knife from her brother’s room, planning to cut herself. She accidentally sliced through her thumb.
She said her dad, whom she lived with part-time, found her in the bathroom, rinsing the blood off.
“He’s like, ‘What did you do that with?’ … ‘why did you do that?’” Renee said. “I’m sitting on my bed at that point, and I’m still crying my eyes out. And he’s like, ‘If you do it again, I’m gonna whip you with the belt.’ … And then he went downstairs.”
Her dad, who had no idea that his daughter had been raped at the time, said he had not intended to use the belt. He just didn’t know what to do to get her to stop.
“I used the threatening of the belt quite a bit,” he said. “I never acted on it.”
Renee walked to the bathroom, drew a bath, and submerged herself in the water. She hoped to drown herself, she said.
“I felt like it was my time to go in the moment. And I felt that there was no more of a purpose for me in the world,” Renee said.
About this story
The demand for pediatric mental health services is on the rise. This article is part of a series examining the struggles some kids, teens and families in Lawrence and Douglas County have faced.
Renee’s dad told his other daughter to go check on her sister.
Renee’s older sister pulled her from the water.
That night, police escorted Renee to Lawrence Memorial Hospital, where she was admitted into the gold unit to be evaluated for suicidal risk. She was then sent to Stormont Vail Health in Topeka, which served 67 pediatric patients from Lawrence in 2020 and 73 in 2021.
The urge to use corporal punishment to eliminate behaviors is damaging for children’s mental health, regardless of the reason, said Brynne Schellenger, a co-founder of the DBT Center of Lawrence.
“What I recommend my parents do first is you gotta regulate yourself,” Schellenger said. “… You can still be scared while being in control. That’s one of those things where the research is actually showing that corporal punishment has the opposite effect, really. It has long-term negative effects for mental health regardless of the intention behind it.”
‘These are our children’
After a three-day stay, Renee was discharged and sent home with a prescription for a generic antidepressant. Shortly after, she went to live with her mother, whose first initial is M, full-time.
By then, Renee was regularly cutting her forearms with whatever sharp object she could find. Sleeping or eating more or less than usual are other signs of distress that Renee experienced. She struggled to get out of bed in the mornings, and she would comfort eat when she felt sad.
Parents sometimes miss serious distress in their children, thinking it will correct itself or that it’s a part of growing up, said Stacy Johnson, a children’s therapist who owns a private practice in Lawrence.
“It’s easy to miss because there’s not always a lot of warning signs, especially with kids that young, and sometimes it comes on really quickly,” she said.
Renee was also experiencing angry outbursts — throwing things, yelling and threatening to hurt her mother. She punched walls and screamed when someone used an authoritarian tone with her or took her cell phone away.
Other signs of her distress were so abject they were impossible to overlook.
“I used to have these manic episodes of just going off on my mom telling her I wanted to die, telling her I wanted to just take a whole bottle of pills and make it all go away,” Renee said. “[Once] I looked my mom in the eyes and I told her I wanted to slit my throat in front of her just so she could feel what I was feeling.”
Depression can disguise itself as anger, said Nicole Stafford, children and family services director at Bert Nash Community Mental Health Center.
“If there’s an increase in irritability or … an inability to control [their] anger, that can be a sign of depression,” Stafford said.
Renee, now 16, sometimes describes traumatic moments of her life in a flat, distanced way like she’s recounting the plot of a TV show she watched recently; this aligns with her eventual diagnosis of post-traumatic stress disorder (PTSD). She also sometimes exaggerates her own mistreatment by others, aligning with her other diagnosis of Borderline Personality Disorder.
In the eighth grade, Renee started seeing a private therapist who incorporated certified therapy dogs into her treatment. The therapist told M that Renee was rejecting the skills. M believed the therapy wasn’t trauma-based enough.
“I can’t tell you how many emails, how many phone calls I made [to Bert Nash, to the school, to her therapists], just saying this answer is not good enough, there’s got to be more help for my daughter, because what we’re doing is not working,” M said.
“There comes a point where a lot of people will look at you and they’ll say, ‘Well, … if they wanted to change, they’re ultimately going to have to be the one to change,’” M continued. “Yes. But these are our children. These are children who are still learning. They’re still developing their minds. … They’re seeing a crazier world by the day. And they don’t know what to do without us.”
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‘It’s a journey for you with your child’
Renee experienced another three-day hospitalization at Stormont Vail in 2020.
“[She] hated me when she had to go, but then … she’d be really good when she got back because she was scared to go back, but then it wouldn’t take very long and we’d be right back at the hospital,” M said.
M did some research. In the midst of the 2020 pandemic, she turned to the Dialectical Behavior Therapy Center of Lawrence so she and her daughter could seek therapy and learn distress tolerance and emotional-regulation skills together.
Schellenger commends M’s willingness to start therapy.
“I would say … go get yourself your own therapist because you’re gonna need it for the journey with your child,” Schellenger said. “This isn’t just a journey for your child. It’s a journey for you with your child.”
For a while, M and Renee engaged in weekly virtual sessions to learn coping skills.
Renee started at stage one of the DBT treatment model, which is circular, not chronological. It’s not uncommon for a patient to finish stage one, enter stage two and then go back to stage one again.
The ultimate goal is to get patients to feel like their lives are worth living.
“We start working to develop that life worth living even while in stage one,” Schellenger said. “This helps [them] to not lose hope while decreasing misery.”
At stage one, Renee and her therapist worked to reduce her problem behaviors and increase her skills-based responses. Schellenger described the DBT model like a house, which she sometimes draws for clients.
“The basement is on fire and that’s where we’re willing to die and we’re doing impulsive things. And I help people climb out through a metal ladder, which is horrendously painful — which skills are, because they’re something new — and then they lay on the floor of the first floor [stage 2] for a little while after having climbed out of hell. And the room is no longer on fire, but it’s not exactly a pleasant place to be,” Schellenger said.
Next, “They climb up the stairs, [for] emotional therapy, and then you’re on the second floor where it’s nicely furnished and it’s the way you want it to be and there’s a window. And then there’s stage four. … Personal freedom and spirituality.”
DBT helped Renee climb from the metaphorical fiery basement where she wanted to die.
Renee would sometimes use tipping, a DBT skill that involved placing her face in cold water to activate her parasympathetic nervous system to regulate her extreme emotions. She sometimes counted and breathed deeply when angry.
But Renee quit DBT before finishing her six-month program because “therapy [appointments] were never when she needed them,” her mom said.
Renee engaged in risky behaviors after terminating care.
“She got to where she was sneaking out of the house every night, leaving, hanging out with a very, very bad crowd. She stole my debit card one night,” M said. “I mean, it just … spiraled quickly. I didn’t know when I was gonna get a call that she was dead in a ditch somewhere.”
M took Renee to the emergency room a few days after Christmas in 2020. Renee was hospitalized at Marillac in Overland Park for three days, and released. A week later, she was hospitalized for three more days.
She was picked up as a runaway after being out all night that February 2021. A couple weeks later, she snuck out again.
“I used to be sort of addicted to sex … just to gain back my self-image, … because I have been raped,” she said. “I wanted to gain back everything that they had taken from me. I wanted to [gain] control of my own body for once.”
The kids who are ‘reckless with their lives’
M tirelessly searched for a place that could help her daughter beyond the three- to five-day stays that had yielded little improvement.
M found Kids TLC, a psychiatric residential treatment facility in Olathe, where 160 children from Lawrence have sought services in the past five years — and where more than 100 children in Kansas are now waiting for a bed.
Almost 90% of the children Kids TLC serves have a history of trauma. They are the kids who “yell and curse, throw and break things, hit and kick people, or cut and burn themselves,” according to the description on the Kids TLC website.
Kids TLC aims to help kids who have “become reckless with their lives,” and kids who distrust adults, have indiscriminate sex, and take drugs — kids like Renee.
When M petitioned Medicaid to cover the services she wanted for her daughter, it denied her request. She appealed the decision and was eventually approved to register her daughter into the residential program after months of waiting.
Renee packed a favorite blanket, a purple stuffed unicorn, and a stack of family photos she plastered on her room walls — among them, a close-up of her late niece, with perfect cupid’s bow lips and big blue eyes.
Renee went to Kids TLC in June 2021, shortly after her 15th birthday. It was two months before she saw her family in person again. She video chatted with her mother at night, and immersed herself in school work and activities — including therapy with horses, music and pets — during the day.
Renee was placed into a unit of about 10 patients with mental illnesses and traumas of their own. They attended lunch and participated in activities together. Youth care facilitators helped shuffle them through their day, prompting them to wake up, shower, and attend meals. (People hired for this position are not required to have postsecondary education or experience working in the mental health field.)
The environment at TLC was structurally stable but invariably unpredictable. Another teen might snap a rubberband on her wrist to hurt herself, or shove furniture across the room in frustration.
Tanese Jade, of Kansas City, who worked at Kids TLC from 2019-2021, said the unpredictability stemmed from the nature of the problems the children carried in with them.
“You really have to know these kids to actually realize that … maybe [they’re] not who [their] case says [they] are … because sometimes you have parents who are just trying to get their kids in and they’re gonna say that their kid is the end-all be-all most horrible kid ever just so they can have a place to stay,” she said. “But you do also get those kids whose case file is who they are. I’ve had a kid who literally pounced on a girl and choked her out (without provocation).”
The children at Kids TLC follow a structured routine that mimics a normal school day where children eat breakfast in their home classroom, then go to classes like math, science and gym.
Of all the activities available, horse therapy resonated with Renee. One week, she was assigned a horse named Little Bay, and she learned to ride him.
“If you’re stressed, the horse is going to be stressed,” staff members taught her.
On the last day of horse therapy week, Renee grew emotional.
“I just put my hand around my horse and I … cried into his neck and I sat there and just felt with him, you know?” she said.
In some ways, Renee’s anger softened. Her outbursts didn’t go away completely, but they diminished.
‘Get them back to their families’
Renee was discharged after being at Kids TLC for four months. That’s about two months less than the average stay of 190 days, according to Tracy Mattis, director of marketing and communications for Kids TLC.
“The goal [is] always to get them back to their families, get them to a secure, loving placement, [to] reattach to a family, because again, our end goal is to get kids back in loving homes,” Mattis said. “For some kids that takes the full 190 days, for some kids that takes a full year or two years, but that’s a conversation between the clinical team, the insurance company — the family’s an active partner.”
M said she believes her daughter would have benefited from a longer stay.
She wishes she could say that Kids TLC healed Renee’s trauma, that it eliminated her urge to hurt herself, that it motivated her to wake up early in the mornings for school. But mental health recovery is an ongoing process with improvements and setbacks, and lately there have been more of the latter.
“It did change my daughter’s life. She still has a lot of struggles” but there hasn’t not been one call to police since Renee came home in October 2021, M said. “She stays open with me.”
Able to come off her medications at Kids TLC, Renee reports better brain functioning.
She still struggles to wake up for school. She attends a therapeutic classroom that only requires attendance three days a week. To her dad’s frustration, Renee receives credit for attendance no matter what time she walks into the classroom.
Her dad believes the school is stifling Renee’s resiliency and hindering her chances of making it after high school. The real world will not restructure itself for Renee, he said. She has to learn to adapt.
“You’re the only one who can make a change and make the improvements you need to make,” he tells her.
One recent night, Renee felt brave enough to sing karaoke in front of a crowd of people — “Stay,” by Rihanna. Her voice, fueled by a genuine heartache, reverberated through the small bar, causing people to look up from their drinks to see whose mournful cry had captivated them:
“But I’m the only one who needed saving,” she sang. “’Cause when you never see the light, it’s hard to know which one of us is caving.”
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Get mental health help in Lawrence
These resources are available 24/7 if you or someone you know needs immediate mental health help:
• Douglas County Treatment and Recovery Center: 785-843-9192; 1000 W. Second St. in Lawrence; trcdgks.org
• Bert Nash Community Mental Health Center: 785-843-9192; bertnash.org
• HeadQuarters Kansas: 785-841-2345; hqkansas.org
• National Suicide Prevention Lifeline: Dial 988; veterans, press 1
• SAMHSA Behavioral Health Treatment Services Locator and Helpline: 1-800-662-HELP (4357)
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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.
