Adding more youth mental health beds in central Oklahoma would be an asset to the state overall at a critical time, but it won’t help Tulsa gain ground in an area in which it’s sorely lacking.
According to a new report released this week, the Oklahoma City metro area is home to a disproportionate concentration of the state’s already limited number of psychiatric beds for youths.
The report comes at an eventful time, as officials are considering the use of federal COVID-19 relief money to increase youth bed capacity, including by adding more than 70 new beds at a planned OU Health facility in Oklahoma City.
“It’s wonderful to have the beds there because it’ll keep more children from going out of state,” said Zack Stoycoff, executive director of the Healthy Minds Policy Initiative. “But in terms of placing beds near the need, there’s certainly something to be said — if we have resources for inpatient services — for Tulsa and also rural areas being part of that conversation.”
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The report, available in full online, is the latest in a series from Healthy Minds on the state’s mental health care system for children.
A Tulsa-based mental health advocacy group, Healthy Minds is part of a coalition of area health care leaders who team up to find solutions.
The report notes that of around 915 youth mental health beds statewide, about 60%, or 556, are located in the Oklahoma City area.
At the same time, the area is home to only 36% of the state’s youth population, age 6-17.
Tulsa County, meanwhile, has 26% of the youths but only 12%, or around 115, of the beds.
Nonmetro areas have 27% of the beds and 37% of the youths.
Moreover, Tulsa has actually lost 116 youth beds since 2018. That’s about half its former capacity, with most of the losses coming from the closure of Shadow Mountain Hospital.
Bottlenecks in the mental health system created by the bed shortage have only been made worse by the COVID-19 pandemic, Stoycoff said.
“We’re seeing record numbers of children going to hospital emergency rooms in Tulsa where they are, frankly, warehoused, often for days or longer, as a bed is sought,” he said. “Children are really just sitting there and not receiving appropriate care.”
Of the 947 youths from Tulsa County who were placed in an inpatient, residential or crisis residential facility in fiscal year 2021, 27% were placed in a facility outside Tulsa, according to a Healthy Minds review of Medicaid claims data.
Stoycoff said: “Anecdotally, we hear from providers outside of the Tulsa area that they see quite a few Tulsa clients. When you put the data to that, you start to realize there are a number of Tulsa clients who are going across the state or even out of state, meaning families are driving many miles to receive appropriate care.”
One big reason for the geographical disparity in youth beds, Healthy Minds reports, is that 222 of Oklahoma City’s are operated by private general acute care hospital systems.
Tulsa lacks inpatient psychiatric beds in its general acute care hospitals, which is unusual for a city its size.
“Tulsa, we found, is really rather unique in the country in that,” Stoycoff said.
The OU Health mental health facility targeted for Oklahoma City is the most significant current proposal to expand bed capacity for children in Oklahoma.
It is to be a $115.8 million facility that would add 72 children’s inpatient beds, and project leaders have requested that a portion of it be funded by the state’s share of American Rescue Plan Act funding.
If the OU project is completed and the rest of the state’s beds remain at their current level, the Oklahoma City area would house 68% of the state’s youth inpatient beds.
The Healthy Minds report found that while the new beds would provide immediate relief, they won’t meet the need on their own.
Making the problem worse, the report notes, is the fact that Oklahoma already has an over-reliance on inpatient and residential beds due to the absence of home- and community-based care.
But while that larger issue needs to be addressed, more beds in the places that need them most, like Tulsa, would be a big help.
In addition to adding beds, Stoycoff said, another more immediate solution to “stem the tide at the emergency room” would be creation of a “front door triage center” for mental health.
“We have that in Tulsa for adults — a crisis care center operated by Family & Children’s Services. But we don’t have that for children,” he said.
Stoycoff said an ARPA request is pending with the city and county to renovate a facility that has already been funded operationally to provide those services.
To read the full report and the previous ones in Healthy Minds’ children’s mental health series, go to healthymindspolicy.org/children.
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Hiding in plain sight: Inside the online world of suicidal teens
‘I SHOULD FEEL SAD’
Martina Velasquez of Weston was 13 when she first became aware of secret societies for depressed teens on Instagram and Tumblr. “When you are in a position of absolute depression and hopelessness, you think you are completely alone,” she said.
“Girls like me were posting about devastating break-ups and romanticizing suicide,” Velasquez said. “After a while, you start thinking, I should give in to this. I should feel sad.”
Velasquez said she spent many after-school hours on her cellphone, looking at photos and videos of teens comparing who could cut themselves deepest and starve themselves more, or reading sad quotes about no longer wanting to live. “That negativity is definitely not good for your mental health,” she said.
“I am mature enough now to know I was feeding off of it and getting worse,” said Martina, now 16 and outspoken about keeping younger girls off these sites. “In that time period, I could have killed myself.”
Megan Moreno, a pediatrician specializing in adolescent medicine who conducts research about teen social media use, says young people tell her they use social media to feel connected with others just like them, using hashtags to unlock the doors to secret communities where they can bond over being depressed or suicidal. But at the same time, there is a lot of harmful glorification of suicide that adults either aren’t aware of or don’t know how to monitor, she said.
“I have been told about things online by patients that no amount of (searching) would pick up,” Moreno said. “Cryptic messages … like ‘Elvis has left the building’ … Only kids who are in that circle would know what that means.”
The teens that the South Florida Sun Sentinel spoke to said when deeply depressed or anxious, they go first to social media — rather than reaching out to adults or counselors who won’t relate to their pain.
Teens say they want to feel less alone, and sharing their pain gives them instant access to people who “get” what they are going through. A Boca Raton high school student said she posted in a suicide-related Instagram community that she felt sad and no longer wanted to live. Dozens of teens direct messaged; “if you ever want to talk, I’m here,” one wrote, and “can relate,” wrote another.
For all the empathy the teens share or receive, an element of toxicity can push someone over the edge, not only virtually but in reality. In some of these cyberspace worlds, self-destruction and suicide are not only normalized but encouraged.
‘YOU’RE BETTER OFF DEAD’
Jackie Feliciano, a Palm Beach County 2019 high school graduate, said she often felt alone and sad during her teen years and spent an entire summer without leaving her house. When she posted on Instagram about feeling like a loser, her post drew comments designed to humiliate her further.
“They said things like, ‘Why not kill yourself, you’re better off dead.’ The way teens treat each other online can be so cruel,” she said.
David Robinson, a Florida pediatrician, said his teen patients frequently talk about dealing with social media poison. “You know how mean girls can be in junior high,” he said. “Now they can be nasty 24/7 on social media. I think what’s posted on Instagram and Snapchat is one of the reasons we are seeing more depression. Some of these sites do get shut down when they are found, but new ones come up.”
In 2017, 14-year-old Molly Russell killed herself in London after looking at graphic content of suicide on Instagram. Her father, Ian, told the BBC his daughter likely looked to the internet for support but found something different.
“I think Molly entered that dark rabbit hole of depressive suicidal content. Some were as simple as little cartoons — a black-and-white pencil drawing of a girl that said: ‘Who would love a suicidal girl?’ Some were much more graphic and shocking,” he said.
After an appeal by Ian Russell, Instagram, one of the most popular sites for teenagers, banned graphic images of self-harm.
“In the three months following our policy change we have removed, reduced the visibility of, or added sensitivity screens to, more than 834,000 pieces of content,” Instagram CEO Adam Mosseri wrote on the website in October.
Adolescent mental health specialists want social networking sites to do more to hide or ban content that exacerbates suicidal thoughts or triggers self-harm. Currently, when somebody searches a term related to self-harm or sees a post in their news feed, sites like Facebook, YouTube, Instagram, Tumblr and others provide a method to report suicidal content. Phone numbers to get support are sometimes provided.
Even so, the warning screen or “content advisory” message doesn’t prevent anyone from getting to the graphic details. Users can simply choose to view the images anyway.
‘I WISH I HAD SEEN THIS EARLIER’
In the last two months, two South Florida teens, Alejandra Agredo and Bryce Gowdy, posted final public messages on Twitter or Instagram — “I bon voyage” and “to be or not to be” — before their suicides. In both cases, dozens of their teen followers “liked” the posts, while others commented long after it was too late, saying “I hope all is well” or “I wish I had seen this earlier.”
Alejandra’s father, Freddy Agredo, said he had spoken with his daughter just hours before she posted her farewell on social media and tried to cheer her up. “She had several accounts and I tried to monitor them,” he said. “We had talked about how people can be mean online and I told her ‘you have to learn to let it slip away.’”
Orion Zamparello, who worked closely with Agredo as part of the Miami Riders Alliance, said teens are “looking for someone to care. Social media is filled with cries for help.”
When Anthony Wolkin-Grudin put his cry for help on Facebook, his father, David, had been aware of his mental health struggles. “I did not see the post, but Anthony was in therapy and on medication. He had his highs and lows, but we were very much involved in is well being,” his father said. “Anthony wore his feelings on his sleeve. The next day everything could be fine, but he was impulsive. He had an obsession.
“I don’t know why (teens) put it out there on social media. It’s almost like you want to hear someone say you are loved,” David Wolkin-Grudin said. “I will tell you, suicide doesn’t end the pain it transfers it. Every day becomes a battle for the parent.”
As parents struggle with how to react, teenagers repeatedly told the Sun Sentinel when they see such messages, it puts them on the front line of prevention without the expertise to help.
“Basically, you are venting to another teen who has no background or education to counsel you,” said Nicole Yedra, 18, a Fort Lauderdale High School student who conducted a workshop to empower teens at a Broward Youth Leadership Institute Summit in June.
Moreno, the pediatrician, said no one knows how to react to the cries for help they see online, and that’s especially true with teens.
“They see this post that looks concerning and hope someone who knows (the person who made the comment) will do something. They typically will only intervene if the person is in their close social circle,” Moreno said. “It can be stressful not knowing if anyone did.”
For teens, going to an adult for help may not feel like an option. “The general population of high school students don’t want to seem like a snitch or offend their friend,” Yedra said. “It’s like it’s not your business to tell other people, but how else would counselors be able to get a hold of something they post?”
Another challenge: Teens may not know how to identify real threats of self-harm.
“Sometimes I will go up to them and ask, ‘Are you okay’ and they don’t want to talk about it,” Yedra said. “You never know if they are joking or serious.”
“Venting online about deteriorating mental health has become a part of teen culture,” said Jason Tache, 18 and a 2019 graduate of Cypress Bay High School in Weston. “Sometimes they post rants and it helps to get things off their chest, and sometimes it’s a sign of a downward spiral.”
Tache said social media has given his age group a platform to talk about mental health — even if they do so with strangers. Yet, he sees the drawbacks. “It’s a new era surrounding mental health and we don’t really feel like anyone gets it. We look for adults to help us, but we do kind of feel like it’s up to us to figure it out.”
For three years, Tache led the HOPE Sunshine Club at a middle school and recently sat on the board of the Florida Initiative for Suicide Prevention. He believes peer programs and clubs that empower students should receive some of the $144 million allocated in the last two years by the state of Florida to help teenagers with mental health issues.
“Teens need to learn the warning signs and feel comfortable and capable of effectively intervening to save lives,” he said, starting as early as middle school. “Doing that is more preventive. By high school, it is more is reactionary.”
The right reaction can be life-changing.
Broward County high school teacher Kelly Oddone said because a student shared a disturbing Snapchat post of a friend, Oddone was able to stop a suicide. The suicidal girl denied she needed help, but Oddone used a screenshot of the post to get her to open up and get help.
“A week later, her mother came to school and thanked me,” Oddone said. “Her daughter had a real plan.”
Moreno, the doctor who specializes in adolescent medicine and director of the University of Wisconsin Social Media Adolescent Health Research Team, has been studying how social media can be a better resource when it comes to mental health. So far, she has learned teens want a reaction to their online cries for help. “They want a friend to say, ‘I saw what you posted and I’m worried about you. What can I do to help?’ “
Bober, the Hollywood adolescent psychiatrist, sees dozens of teens a month struggling with mental health issues and believes encouraging teens to seek intervention for their friends should be a new focus of prevention strategy.
“I think we have to create a culture where it is more acceptable to speak out about friends who are crying out for help online,” he said. “We need to reframe it from being a snitch to being a hero.
“By not doing that,” he said, “We are seeing the consequences.”
— Suicide Prevention Lifeline: 1-800-273-8255
— Society for Prevention of Teen Suicide: sptsusa.org
— The National Alliance on Mental Illness: Nami.org
— The Jason Foundation Parent Resource Program and Parent Resource Library
— Survivors of Suicide Loss Support Groups fisponline.org/survivors-info/support-groups/
TIPS FOR PARENTS FROM TEENS
— Get to know your child’s friends so they feel comfortable coming to you if they see something
— Learn suicide warning signs
— Follow your teen on their social media accounts, but know they may have private accounts, too
— Ask your teen directly about a cryptic post or worrisome hashtag
Evidence shows that suicide is not inevitable for anyone, and that lives can be saved with mental health support. If you or someone you know is having suicidal thoughts, help is less than a moment away. Call 1-800-273-TALK (8255), text 741741 or visit suicidepreventionlifeline.org for free, confidential support 24 hours a day, seven days a week.