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Saturday, March 17, 2012


The Union


Section A


Strides made in suicide prevention, mental health care BY TRINA KLEIST Staff Writer


t Sierra Family Medical Clinic on Tyler Foote Crossing Road, patients are asked questions about their mental health along with the usual questions about physical ailments. Blood pressure? Heart condition? Diabetes? Paranoid delusions? Use meth? Feel suicidal? It’s a model called integrative care and has been practiced at the clinic for about nine years under the direction of Dr. Peter Van Houten, a pioneer in the field. The idea is that physical and mental Peter Van Houten health, including substance abuse, need to be treated together. One result of better treatment for all three, advocates argue, should be relief of the underlying causes that drive people to take their lives. Of those who die by suicide, 90 percent suffer a diagnosable mental illness, according to a 1999 report by the U.S. Surgeon General. The mental crises that lead up to suicide are costly to Nevada County in ways beyond the devastation to those left behind. Sierra Nevada Memorial Hospital in Grass Valley spends “in the millions” on unreimbursed care for people having mental crises, spokeswoman Debbie Plass said. On March 6, Van Houten and others trying to expand the integrative health model applied for a $6 million, three-year state grant that would fund the expansion of their research-proven practices. “We’re on the leading edge compared to other counties in terms of trying to use evidencebased practice,” said county Behavioral Health Director Michael Heggarty. “I think we’re very good at it.”

Sierra Medical Clinic Inc. (formerly Miners Clinic), Chapa De Indian Health Program Inc., all in Grass Valley, and Sierra Family Medical Clinic on the San Juan Ridge. Partners from the substance abuse side are Community Recovery Resources and Common Goals Inc., also in Grass Valley.

Many tools already in place to prevent suicide in Nevada County came about in the wake of the 2001 shootings by Scott Thorpe, a mentally ill man receiving treatment through the county’s Behavioral Health Department. Here are key advances so far in Nevada County in tackling the suicide-mental illness connection: Shift at Behavioral Health Services at Nevada County Behavioral Health are shifting to become more consumer-driven, said Lael Walz, president of the Nevada County chapter of National Alliance on Mental Illness — a group that works closely with Behavioral Health and advocates for treatment. One step in the early years of the shift was adding a medical director to the department’s staff; a board-certified psychiatrist works at the department four days weekly, Heggarty said. Another step was the Feb. 27 addition of a fourth mental health crisis worker to contract staff in the department, Heggarty said. Crisis workers answer the department’s crisis line and evaluate people who might be considered a danger to themselves or to others for forced hospitalization — known as a 5150 hold. Previously, two people worked the day shift Monday through Friday, and one person worked nights and weekends. A second person now has been added to the night-weekend shift, Heggarty said. On March 27 county supervisors will be asked to approve increasing the county’s contract with Sierra Mental Wellness Center to hire the new person, for a total cost of nearly $489,000, Heggarty added. Collaboration among agencies and doctors “The more we can collaborate and work together so the disease doesn’t take everyone

Photo for The Union by John Hart

Dr. Frank “J.R.” Lang, chief medical officer at Western Sierra Medical Clinic Inc., on Whispering Pines Lane in Grass Valley, is part of a group of clinics, the hospital, county agencies and substance abuse treatment centers trying to integrate their care of the same people. under, the better, because it’s really awful,” said Walz, who has family members who face mental illness. The goal is to arrive at complementary assessments and confer on diagnoses, so “we’re all working toward the same goals ... and we all have a similar starting point,” Heggarty said. While simple in concept, it has been challenging to practice, said Chief Medical Officer Frank “J.R.” Lang Jr. of Western Sierra Medical Clinic Inc. in Grass Valley. Partners in the $6 million grant application to the California Institute for Mental Health hope to expand what they already

are doing. They will focus on 50 adults, to start out with, who are the heaviest users of mental, medical and substance abuse treatment services, according to the plan. Goals include evaluating substance abuse clients for chronic physical ailments; reducing visits to the emergency room; improving health as measured by blood pressure, cholesterol, weight, smoking and level of exercise; and create a care plan that brings together treatment for drug and alcohol abuse, mental health and chronic disease. Partners include county Behavioral Health, Sierra Nevada Memorial Hospital, Western

Integrative treatment This approach connects physical and mental health and substance abuse treatment in the same clinical setting. Chapa De and Western Sierra clinics also have been using the model, Walz said. People with severe mental illness are more likely to develop serious health problems, dying 25 to 55 years sooner than their mentally healthy peers. They’re also more likely to abuse alcohol or drugs, research shows. At Western Sierra, licensed clinical social workers and a clinical psychologist provide onsite mental health care, director Lang said. “Physicians and therapists share the same (patient) medical records,” Lang said. Doctors use a simple, routine screening for depression, called the PHQ9, that can be a red flag that more probing and perhaps treatment is needed, Lang said. A mental health expert can be brought in right away, and a treatment plan can be worked up quickly, Lang said. It’s called a “warm handoff.” Instead of making another appointment the person likely won’t keep, contact is made right away and treatment can begin. Laura’s Law Nevada County is the only one in California to enact this unique tool, named after one of Thorpe’s victims, 19-year-old Laura Wilcox, of Penn Valley. The state law went into effect in January 2003 and permits county governments to provide court-ordered outpatient

treatment for people with serious mental illness who exhibit a recent history of hospitalization, violence or both. “If you’re suicidal and refuse to be treated, we can ask the court to order you into treatment,” Heggarty said. But many families facing mental illness in their midst don’t know about this recourse — or they fear it could make things worse, said one person touched by suicide in the family. Those committed to treatment under Laura’s Law receive an intensive array of services. Research shows high levels of success for people with serious mental illness if they have at least 180 days of such treatment, according to Assemblyman Michael Allen, of Napa County, who has introduced a bill that would extend the law. Calif. Mental Health Services Act Approved by voters in 2004 as Proposition 63, the Mental Health Services Act levies a tax of 1 percent on every dollar of personal income over $1 million. Nevada County will spend about $4.3 million in MHSA funds this year, Heggarty said. Some of that is for one-time training costs, he added. Much of it goes to working with other organizations supportive of the mentally ill, according to a department report. Funds collected through the act also have helped pay for treatment, Walz said. It also pays for training others to become more aware of mental illness and suicide risk, including the Sources of Strength program at schools in Nevada County (see “Sources of Strength” story) and mental health first aid training (see box). “With the money from the (act), we had opportunities we never had before ... because without resources, it’s not going to happen,” Walz said. To contact Senior Staff Writer Trina Kleist, email or call (530) 477-4230.

Pillars of strength sustain youth at risk BY TRINA KLEIST Staff Writer

It was 10 o’clock one night in January when Chris Espedal got a call from a student at Bear River High School. The teenager had seen a Facebook post from a fellow student that evening, had thought and thought about it, and finally decided a grown-up needed to know. The post didn’t sound right, the teen had said. It raised a red flag. Maybe, the poster might be in a mood to try a permanent solution to a temporary problem. “It was like, OMG, this person is saying that?” recalled Espedal, the school nurse who heads up the Sources of Strength program at Bear River. Immediately, Espedal got a parent involved. As it turned out, the Facebook poster was depressed. The caller had received training in Sources of Strength, a program to help teens see the red flags that often signal a coming suicide attempt. “The kids are recognizing the high-risk behaviors” that can lead to suicide, Espedal said. In Nevada County, 22 people died by suicide in 2011. Of those, two were high school students — one at Nevada Union High School and one at Truckee High School, said Kim Honeywell, Nevada County’s suicide prevention coordinator. Nationally, suicide is the third leading cause of death among people aged 15 to 24, according to the U.S. Surgeon General. “There is very little in the

way of mental health services for this group,” said Wendy Barnhart, chief of operations and compliance for Sierra Family Medical Clinic on the San Juan Ridge. Yet, at least at Bear River High, students carry surprisingly heavy burdens. They have friends who have died by suicide, in car wrecks, in crazy accidents and from medical conditions, they said. “Nobody really gets how much it affects students,” said Breanna Gatto, a senior who has lost several friends to untimely death. “I can’t fall asleep. That’s all I think about all the time. I just get stressed out.” Sources of Strength was brought to Bear River in early 2011, a few months after the accidental death of junior Justin Butler in September 2010. It is based on research into what makes young people resilient to life’s challenges, pulling together the best practices in the field, said Nevada County Suicide Prevention Coordinator Kim Honeywell. It has been introduced at four other campuses in Nevada County, but is most developed at Bear River, she added. Sources of Strength has trained about 225 students in Nevada County so far. They now know how to mentor fellow students who just need someone to talk to. It’s about changing a culture, Espedal said. “They’re spreading help and hope and strength,” Espedal said. A positive approach On a sunny day in front of

pillars, but even Stark’s friend at least had a few she could have relied on, had she known. The friend, a Bear River student, killed herself two years ago. The girl often was seen as a trouble-maker, but Stark knew her as a sensitive, caring person who would stand up for those being bullied by others, she said. The day students learned of the girl’s death, “I remember seeing two girls in front of me in class laughing, and I was bawling my eyes out and shaking with anger,” Stark recalled. The incident shows two sides of the cultural shift Espedal and students in Sources of Strength are trying to make happen: Learning not to judge others who are different, and learning how to reach out to those who need help.

Photo for The Union by Trina Kleist

Bear River High School senior Keleigh Casey writes the names of “positive friends” on a pillar in a courtyard at Bear River High School in southern Nevada County. the Bear River cafeteria, students in the Sources of Strength program put the finishing touches on pillars they had painted to symbolize the eight pillars of healthy living that, according to research, will help prevent youth suicide: Family support, positive friends, mentors, healthy activi-

ties, generosity, spirituality, medical access and mental health — they work together like spokes on a wheel, Honeywell said. On a brightly painted pillar with the label “positive friends” in big letters, senior Hannah Stark penned the name of her best friend. Not everyone has all eight

Caring peers, trusted adults Peer leaders from a wide range of social cliques were drafted for the training. SOS participants also thought about which grown-ups they would talk to if they had a problem. Those “trusted adults” were notified of their election, and their names were spread out among students as back-up resources if peer-to-peer advice isn’t enough. “We don’t tell on them, or rat them out, but sometimes we do need to bring in a trusted adult,” Gatto said of teens who have come to her with their problems. The job of the “trusted adult” is to connect youth to whatever they need in their moment of distress, Honeywell said.

“Knowing there’s now a group that, if someone felt they wanted to hurt themselves, there’s someone they can talk to, it’s a help,” Stark said. Maybe it would have helped her friend, she added. ‘No easy life’ SOS students draw on their training, shaped by their own pain, to help others. Like several students in the SOS program, senior Jack Tortorici was a friend of Justin Butler’s and was deeply wounded by his death. “The reason why we’ve joined SOS is because we don’t want to see other people hurt,” Tortorici said. “We can teach others that they can move on ... Talking it out really does help.” Sources of strength such as sports involvement, music, churches and mission trips have helped Ashleigh Higginbotham, Jenny Astwood and Nathan Karas Jr. in dealing with their own pain and in helping others, they said. Their experiences with all kinds of people have helped them become more compassionate, they added. “You never know what’s going on with other people,” Astwood said. Being a part of the program has helped her to “make a difference” as a mentor for other teens, Astwood added. “It’s for everyone who ever struggled,” Tortorici said. “No teenager’s life is going to be an easy life.” To contact Senior Staff Writer Trina Kleist, email or call (530) 477-4230.