A6 | Saturday, March 17, 2012 | The Union | Section A

SUICIDE PREVENTION

BY TRINA KLEIST

Staff Writer

At Sierra Family MedicalClinic on Tyler FooteCrossing Road, patients

are asked questions about theirmental health along with theusual questions about physicalailments.

Blood pressure? Heart con-dition? Diabetes?

Paranoid delusions? Usemeth? Feel suicidal?

It’s a model called integra-tive care and has been practicedat the clinic for about nine yearsunder thedirection of Dr.Peter VanHouten, a pio-neer in thefield.

The ideais that physicaland mentalhealth, includ-ing substance abuse, need to betreated together. One result ofbetter treatment for all three,advocates argue, should be reliefof the underlying causes thatdrive people to take their lives.

Of those who die by suicide,90 percent suffer a diagnosablemental illness, according to a1999 report by the U.S. SurgeonGeneral.

The mental crises that leadup to suicide are costly to NevadaCounty in ways beyond the dev-astation to those left behind.Sierra Nevada Memorial Hospi-tal in Grass Valley spends “in themillions” on unreimbursed carefor people having mental crises,spokeswoman Debbie Plass said.

On March 6, Van Houtenand others trying to expand theintegrative health model appliedfor a $6 million, three-year stategrant that would fund the expan-sion of their research-provenpractices.

“We’re on the leading edgecompared to other counties interms of trying to use evidence-based practice,” said countyBehavioral Health DirectorMichael Heggarty. “I think we’revery good at it.”

Many tools already in placeto prevent suicide in NevadaCounty came about in the wakeof the 2001 shootings by ScottThorpe, a mentally ill manreceiving treatment through thecounty’s Behavioral HealthDepartment.

Here are key advances so farin Nevada County in tackling thesuicide-mental illness connec-tion:

Shift at Behavioral Health

Services at Nevada CountyBehavioral Health are shifting tobecome more consumer-driven,said Lael Walz, president of theNevada County chapter ofNational Alliance on Mental Ill-ness — a group that worksclosely with Behavioral Healthand advocates for treatment.

One step in the early yearsof the shift was adding a medicaldirector to the department’s staff;a board-certified psychiatristworks at the department fourdays weekly, Heggarty said.

Another step was the Feb.27 addition of a fourth mentalhealth crisis worker to contractstaff in the department, Heggar-ty said.

Crisis workers answer thedepartment’s crisis line and eval-uate people who might beconsidered a danger to them-selves or to others for forcedhospitalization — known as a5150 hold.

Previously, two peopleworked the day shift Mondaythrough Friday, and one personworked nights and weekends. Asecond person now has beenadded to the night-weekendshift, Heggarty said.

On March 27 county super-visors will be asked to approveincreasing the county’s contractwith Sierra Mental WellnessCenter to hire the new person,for a total cost of nearly$489,000, Heggarty added.

Collaboration among

agencies and doctors

“The more we can collabo-rate and work together so thedisease doesn’t take everyone

under, the better, because it’s real-ly awful,” said Walz, who hasfamily members who face mentalillness.

The goal is to arrive at com-plementary assessments andconfer on diagnoses, so “we’re allworking toward the same goals ...and we all have a similar startingpoint,” Heggarty said.

While simple in concept, ithas been challenging to practice,said Chief Medical Officer Frank“J.R.” Lang Jr. of Western SierraMedical Clinic Inc. in Grass Val-ley.

Partners in the $6 milliongrant application to the Califor-nia Institute for Mental Healthhope to expand what they already

are doing.They will focus on 50 adults,

to start out with, who are theheaviest users of mental, medicaland substance abuse treatmentservices, according to the plan.

Goals include evaluatingsubstance abuse clients forchronic physical ailments; reduc-ing visits to the emergency room;improving health as measured byblood pressure, cholesterol,weight, smoking and level ofexercise; and create a care planthat brings together treatmentfor drug and alcohol abuse, men-tal health and chronic disease.

Partners include countyBehavioral Health, Sierra Neva-da Memorial Hospital, Western

Sierra Medical Clinic Inc. (for-merly Miners Clinic), Chapa DeIndian Health Program Inc., allin Grass Valley, and Sierra Fami-ly Medical Clinic on the SanJuan Ridge.

Partners from the substanceabuse side are CommunityRecovery Resources and Com-mon Goals Inc., also in GrassValley.

Integrative treatment

This approach connectsphysical and mental health andsubstance abuse treatment in thesame clinical setting. Chapa Deand Western Sierra clinics alsohave been using the model, Walzsaid.

People with severe mentalillness are more likely to developserious health problems, dying 25to 55 years sooner than theirmentally healthy peers. They’realso more likely to abuse alcoholor drugs, research shows.

At Western Sierra, licensedclinical social workers and a clin-ical psychologist provide onsitemental health care, director Langsaid.

“Physicians and therapistsshare the same (patient) medicalrecords,” Lang said.

Doctors use a simple, rou-tine screening for depression,called the PHQ9, that can be ared flag that more probing andperhaps treatment is needed,Lang said.

A mental health expert canbe brought in right away, and atreatment plan can be worked upquickly, Lang said.

It’s called a “warm hand-off.” Instead of making anotherappointment the person likelywon’t keep, contact is made rightaway and treatment can begin.

Laura’s Law

Nevada County is the onlyone in California to enact thisunique tool, named after one ofThorpe’s victims, 19-year-oldLaura Wilcox, of Penn Valley.

The state law went intoeffect in January 2003 and per-mits county governments toprovide court-ordered outpatient

treatment for people with seriousmental illness who exhibit arecent history of hospitalization,violence or both.

“If you’re suicidal and refuseto be treated, we can ask thecourt to order you into treat-ment,” Heggarty said.

But many families facingmental illness in their midst don’tknow about this recourse — orthey fear it could make thingsworse, said one person touchedby suicide in the family.

Those committed to treat-ment under Laura’s Law receivean intensive array of services.Research shows high levels ofsuccess for people with seriousmental illness if they have at least180 days of such treatment,according to AssemblymanMichael Allen, of Napa County,who has introduced a bill thatwould extend the law.

Calif. Mental Health Services Act

Approved by voters in 2004as Proposition 63, the MentalHealth Services Act levies a taxof 1 percent on every dollar ofpersonal income over $1 million.

Nevada County will spendabout $4.3 million in MHSAfunds this year, Heggarty said.Some of that is for one-timetraining costs, he added.

Much of it goes to workingwith other organizations sup-portive of the mentally ill,according to a departmentreport.

Funds collected through theact also have helped pay for treat-ment, Walz said.

It also pays for training oth-ers to become more aware ofmental illness and suicide risk,including the Sources ofStrength program at schools inNevada County (see “Sources ofStrength” story) and mentalhealth first aid training (see box).

“With the money from the(act), we had opportunities wenever had before ... because with-out resources, it’s not going tohappen,” Walz said.To contact Senior Staff Writer Trina Kleist,email tkleist@theunion.com or call (530)477-4230.

Strides made in suicide prevention, mental health care

Photo for The Union by John Hart

Dr. Frank “J.R.” Lang, chief medical officer at Western Sierra MedicalClinic Inc., on Whispering Pines Lane in Grass Valley, is part of agroup of clinics, the hospital, county agencies and substance abusetreatment centers trying to integrate their care of the same people.

Peter Van Houten

BY TRINA KLEIST

Staff Writer

It was 10 o’clock one nightin January when Chris Espedalgot a call from a student at BearRiver High School.

The teenager had seen aFacebook post from a fellow stu-dent that evening, had thoughtand thought about it, and finallydecided a grown-up needed toknow.

The post didn’t sound right,the teen had said. It raised a redflag. Maybe, the poster might bein a mood to try a permanentsolution to a temporary problem.

“It was like, OMG, this per-son is saying that?” recalledEspedal, the school nurse whoheads up the Sources of Strengthprogram at Bear River.

Immediately, Espedal got aparent involved. As it turned out,the Facebook poster wasdepressed.

The caller had receivedtraining in Sources of Strength, aprogram to help teens see the redflags that often signal a comingsuicide attempt.

“The kids are recognizingthe high-risk behaviors” that canlead to suicide, Espedal said.

In Nevada County, 22 peo-ple died by suicide in 2011. Ofthose, two were high school stu-dents — one at Nevada UnionHigh School and one at TruckeeHigh School, said Kim Honey-well, Nevada County’s suicideprevention coordinator.

Nationally, suicide is thethird leading cause of deathamong people aged 15 to 24,according to the U.S. SurgeonGeneral.

“There is very little in the

way of mental health services forthis group,” said Wendy Barn-hart, chief of operations andcompliance for Sierra FamilyMedical Clinic on the San JuanRidge.

Yet, at least at Bear RiverHigh, students carry surprisinglyheavy burdens.They have friendswho have died by suicide, in carwrecks, in crazy accidents andfrom medical conditions, theysaid.

“Nobody really gets howmuch it affects students,” saidBreanna Gatto, a senior who haslost several friends to untimelydeath. “I can’t fall asleep. That’sall I think about all the time. Ijust get stressed out.”

Sources of Strength wasbrought to Bear River in early2011, a few months after theaccidental death of junior JustinButler in September 2010.

It is based on research intowhat makes young peopleresilient to life’s challenges,pulling together the best prac-tices in the field, said NevadaCounty Suicide PreventionCoordinator Kim Honeywell.

It has been introduced atfour other campuses in NevadaCounty, but is most developed atBear River, she added.

Sources of Strength hastrained about 225 students inNevada County so far.They nowknow how to mentor fellow stu-dents who just need someone totalk to.

It’s about changing a cul-ture, Espedal said.

“They’re spreading help andhope and strength,” Espedal said.

A positive approach

On a sunny day in front of

the Bear River cafeteria, studentsin the Sources of Strength pro-gram put the finishing toucheson pillars they had painted tosymbolize the eight pillars ofhealthy living that, according toresearch, will help prevent youthsuicide:

Family support, positivefriends, mentors, healthy activi-

ties, generosity, spirituality, med-ical access and mental health —they work together like spokes ona wheel, Honeywell said.

On a brightly painted pillarwith the label “positive friends” inbig letters, senior Hannah Starkpenned the name of her bestfriend.

Not everyone has all eight

pillars, but even Stark’s friend atleast had a few she could haverelied on, had she known.

The friend, a Bear River stu-dent, killed herself two years ago.The girl often was seen as a trou-ble-maker, but Stark knew her asa sensitive, caring person whowould stand up for those beingbullied by others, she said.

The day students learned ofthe girl’s death, “I remember see-ing two girls in front of me inclass laughing, and I was bawlingmy eyes out and shaking withanger,” Stark recalled.

The incident shows twosides of the cultural shift Espedaland students in Sources ofStrength are trying to make hap-pen: Learning not to judgeothers who are different, andlearning how to reach out tothose who need help.

Caring peers, trusted adults

Peer leaders from a widerange of social cliques were draft-ed for the training. SOSparticipants also thought aboutwhich grown-ups they wouldtalk to if they had a problem.

Those “trusted adults” werenotified of their election, andtheir names were spread outamong students as back-upresources if peer-to-peer adviceisn’t enough.

“We don’t tell on them, orrat them out, but sometimes wedo need to bring in a trustedadult,” Gatto said of teens whohave come to her with theirproblems.

The job of the “trustedadult” is to connect youth towhatever they need in theirmoment of distress, Honeywellsaid.

“Knowing there’s now agroup that, if someone felt theywanted to hurt themselves,there’s someone they can talk to,it’s a help,” Stark said.

Maybe it would have helpedher friend, she added.

‘No easy life’

SOS students draw on theirtraining, shaped by their ownpain, to help others. Like severalstudents in the SOS program,senior Jack Tortorici was a friendof Justin Butler’s and was deeplywounded by his death.

“The reason why we’vejoined SOS is because we don’twant to see other people hurt,”Tortorici said. “We can teachothers that they can move on ...Talking it out really does help.”

Sources of strength such assports involvement, music,churches and mission trips havehelped Ashleigh Higginbotham,Jenny Astwood and NathanKaras Jr. in dealing with theirown pain and in helping others,they said.

Their experiences with allkinds of people have helpedthem become more compassion-ate, they added.

“You never know what’sgoing on with other people,”Astwood said.

Being a part of the programhas helped her to “make a differ-ence” as a mentor for other teens,Astwood added.

“It’s for everyone who everstruggled,” Tortorici said. “Noteenager’s life is going to be aneasy life.”To contact Senior Staff Writer Trina Kleist,email tkleist@theunion.com or call (530)477-4230.

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 Schoolin southern Nevada County.

Pillars of strength sustain youth at risk