We Need to Provide Services that Young People Will Use

Dan Strauss, Executive Director
The Alex Project

Dan Strauss lost his 17-year old son, Alex, to suicide on October 11, 2010. Alex preferred communicating by text rather than by phone, and had texted friends and his counselor on the night of his death. Motivated to eliminate that communication barrier for young people in crisis, Mr. Strauss established The Alex Project, which supports crisis help line services by text. Care for Your Mind interviewed Mr. Strauss about youth suicide prevention and Alex’s experience with mental health care.

We Need to Provide Services that Young People Will Use
Crisis Intervention by Text Message for Preventing Youth Suicides

Care for Your Mind: While you were seeking treatment for Alex, what problems did you encounter in finding services and providers that were appropriate for him?

Dan Strauss: One of the biggest problems was the “hammer and nail” or silo syndrome. Understandably, treatment providers tended to have one area of expertise and one set of tools with little visibility to other areas and services. The implication was that when we were working with a psychiatrist, the key to Alex’s treatment was more medications. When we were working with a social worker, the key was for Alex to get a job. With a psychotherapist, the key was for Alex to sign a “No Harm Contract.” With a church counselor, the key was to take away Alex’s iPod. With an athletic coach, the key was to push Alex harder.

CFYM: What resources, if any, did you find helpful?

DS: In theory, an integrated approach could have been helpful. However, not surprisingly, you need to look beyond the program title to verify that the program really is a collaborative effort between different services and providers.

CFYM: You have identified an apparent gap in suicide prevention: the need for crisis support to be more available by text, particularly for young people. Can you explain why this gap exists and what you believe is a solution?

DS: Based on my interviews with crisis center directors, the gap exists because of “fear and funding.” With all good intentions, many crisis center directors are conservative with respect to new technologies, largely because they are literally dealing with life and death. Voice help line processes and technologies are familiar and comfortable.

The other understandable factor is funding. A crisis center executive is typically working with a very tight budget and substantial investments in voice-related help line assets such as staff training. It is not surprising that more than one director told me that the key was “simply to figure out a way to get the teenagers to call them” instead of text messaging.

A solution that seems to work is to find a few leaders who are doing pioneering work, establish some early successes with them, and then market the heck out of it until enough people notice and run with it. The Reno Crisis Call Center is a great example of a pioneering group.

CFYM: What role, if any, do you believe the government should have in making text-based crisis intervention available? Who else should be involved, and in what ways?

DS: Just as in the case with the National Suicide Prevention Lifeline, government can and should provide the funding for the network infrastructure for text-based crisis intervention. This would facilitate nationwide crisis center collaboration. Of course the existing players should be involved as well. There are currently a few early-stage nationwide networks such as Crisis Text Line and 121Help.me that can be brought together along with Reno Crisis Call Center to take advantage of their different strengths.

CFYM: What do you think should be the other priorities in youth suicide prevention?

DS: Short-term: we need to keep the focus on eliminating stigma. Shame leads to concealed pain and death.

Mid-term: we need to keep adapting how we listen; keep reducing hurdles to reaching help. Text messaging access to help lines works because it is familiar, discrete, and available to youth. In a few years there will be another technology that youth are using. In the interim, there is still a lot of work to do in simply helping youth know that they can reach help via text messaging.

Longer-term: it would be wonderful to see more integrated community-based approaches for working with youth at risk for suicide. Think of what we could do if we had collaborative safety networks comprised of well-informed high school volunteers, psychiatrists, therapists, counselors, coaches, social workers, law enforcement, and faith-based groups.

CFYM: What advice or suggestions would you give to a parent who is concerned about their child’s mental health?

DS: Don’t wait for the answer from the experts. No one cares as much as you do. Do your own homework. This is why the type of training, education, and support that Families for Depression Awareness provides is so vital. There are few more important roles for a parent to take than to advocate for their child’s mental health needs.

Your Turn

  • How can we overcome the “fear and funding” issues preventing text message crisis center services?
  • What are other communication barriers that need to be addressed in the youth suicide prevention effort?
  • Have you experienced collaborative care for you or a loved one? If so, did it help?

The Alex Project promotes texting access to lifesaving crisis center services: If you need help, text ANSWER to 839863. The Crisis Call Center will respond 24/7/365 and help get you through it.


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12 comments
careforyourmind
careforyourmind moderator

Less on my plate, you raise a very insightful challenge to all of us in the advocacy community. We are all stronger together, whether that is as individuals or as individual advocacy organizations. Your suggestion to use an advocacy blog such as CFYM to bring the key players together to discuss prioritization of the issues is sound. In our first post of this series, we challenged readers to contact their Congressional Representatives and Senators to do what they could to pass the Garrett Lee Smith Reauthorization Act of 2011. This would be a place to start. This is one issue that all of the advocacy groups generally agree is sound and worthwhile.

So how about it readers, in our first poll we asked: Should Congress pass the Garrett Lee Smith Reauthorization Act of 2011 to continue funding for youth and young adult suicide prevention programs?

Have you taken the poll? Have you contacted your elected officials? Have you shared the blog on facebook and other social media outlets? Have you asked your family, friends and co-workers to support you in your efforts to advocate for passage of this important bill that has the potential to reduce deaths by suicide among our youth?  Remember it only takes one to start a movement.

Less on my plate
Less on my plate

Since we are having a dialogue, can we focus for a moment on fragmentation. Dan raised it in terms of a lack of coordination that leads to worse outcomes and a poor patient experience. I suspect Dan's concerns are experienced by all of us, i.e., patient, families, and clinicians. Maybe systems can be put in place to enhance communications and care teams will find the time to digest them...assuming they can achieve a more manageable workload.

For a moment, I'd like to focus on the fragmentation mentioned in Cheryl King's post a week earlier. There are many well intentioned disease research and patient support groups out there in the mental health community. Unfortunately fundraising has become more challenging, in part because there are so many of us working in this space and sometimes shaking the same philanthropic trees. As a community, we have to figure out better ways of working with each other if only to do a better job of educating and advocating for our needs. And that requires big and small organization leaders to come together and figure out priorities and agree that we will all focus and apply collective pressure until our goals are met. Our failure to come together to develop and pursue the mood disorder's "agenda" will result in solutions that are not patient-centered. Witness House Representative Tim Murphy's federal legislative proposals. While many of us think Mr. Murphy's heart is in the right place and are grateful for long overdue Congressional attention, our community's fragmented nature prevents us from directing change from the patient up.

Let's talk about how we can work more effectively and efficiently TOGETHER.

StephenBonin
StephenBonin

1.  Disseminating the results of effectiveness helps convince skeptics and funding sources, such as governmental entities and private foundations. Also, people who have never heard of crisis texting definitely benefit from reading this article and its links. 2. According to Madeleine Byrne, Ph.D., Texas Director over incarcerated juveniles because of mental health AND crime issues, communication must spread the message that more group homes are necessary. She offered one example: a man in this system is graduating out because he is 19. He lives with Schizophrenia. He will be going into a nursing home, which is not good.  3.  Yes. When I was struggling with an issue for which my psychologist believed different medication could help, he, with my approval, talked with my psychiatrist on the telephone. Moreover, this same psychologist is our DBSA Chapter Advisor, so he gets a different perspective about me when he meets with our group the first Tuesday of each month.

StacyK
StacyK

Thank you Dan for sharing your story about the tragic loss of your son Alex to suicide and thus the creation and mission of The Alex Project. I'm so sorry. I was beyond touched when I read your interview responses with Care For Your Mind. Your strength, your love for Alex and consequent knowledge about suicide prevention and the direction we should head shines through and gives me great hope that we will succeed in preventing youth suicide. My daughter has attempted suicide twice and was in a medically induced coma due to the severity of the last overdose so I can understand your passion and drive to stop this from occurring again. Thank you for sharing the text based crisis intervention resources, Reno Crisis Call Center, the Crisis Text Line and 121help.me. I will share that information with those I know in an effort to create further awareness. Again, thank you. It's because of loving and caring parents as yourself who advocate for change that we will indeed see positive change. I plan on visiting The Alex Project website and learning all I can to help support texting access in crisis centers.

In response to the first question, How can we overcome the “fear and funding” issues preventing text message crisis center services? I think that it's critical that we continue to work at raising awareness in regard to youth suicide and how to prevent it. I think "fear and funding" go hand in hand. Therefore, the more people that are educated about the importance of crisis text messaging services the more people who will vote for the funding. To get past the fear we have to educate the public. It's time we catch up with our youth in regard to technology. I'd like to see PSA's about the need for crisis text messaging services. That's just a thought of course. Is anyone aware of such a campaign?

jules78
jules78

This is absolutely a fantastic project which should be implemented and made available to all youth. Education within the community is key, especially within schools. It seems the stigma of mental illness still exists on a large scale and there is not enough education of school staff and teachers. When our kids spend so much of their time at school, they need the continued support and understanding of those with whom they are surrounded. If the teachers are not educated, then how on earth do we break the stigma and show our kids that there is no shame in acknowledging that something is wrong and that they can talk about it?  I believe as a parent it is our duty to do everything we can to connect with our children and be educated about issues that can affect them so that we can hopefully recognise when something is wrong and get professional help, as well as know how to provide a supportive home environment for them. However, the barrier I have found is that no matter how good the support network you have, it seems to stop at the school gates. This is simply not good enough and needs to change. It creates a conflict within a youths mind and that's where the feelings of shame start. As a mum, I will continue to be an advocate for my daughter, because I have educated myself for many years and I know the reality of mental illness, and I will continue to break down the walls of ignorance that some teachers try to hide behind. It's time to get real. Our kids are killing themselves and yet they are the most precious human beings we will ever have in our lives. I lost my Step-son in an accident a year ago and I will not lose my daughter too.

Support services via text-message are an excellent idea and if it saves one life then it's worth it. Imagine if it was YOUR child who's life it saved. You can't put a price on that!

In the Burbs
In the Burbs

A "silo-ed approach" to therapy plagues many, if not most of us.  Communication and coordination challenges especially seem to worsen as our children get older and prefer to go unaccompanied to caregiver visits.  Despite our child's current care team (psychologist and physician) practicing in separate offices across town, each has shown a willingness to catch up on the progress and actions of the other.  They have also talked with each other when concerns arose (medication side effects, cost concerns, signs of worsening).  Contrast their actions with a prior care team located in the same office that rarely communicated.  Yes, we are lucky to be under the care of committed professionals.  However, after complaining about compartmentalized care for so many years, I made a conscious effort to interview prospective care team members and left practices that were unwilling to work with us. 



Portiaspeace
Portiaspeace

Read an article recently about text messaging as a way to support kids through a crisis. They can reach out even when in a friend group as everyone is used to seeing each other text, so the stigma barrier is reduced, confidentiality increased, and kids actually make use of the technology this way. Win/win.


Less on my plate
Less on my plate

Care for Your Mind Editors: an idea that might be cool, different, and of extreme value to us all who have family members and patients at risk of attempting and completing suicide. Bring together for an online dialogue as many willing organizations who are actively engaged in suicide prevention efforts, be they focused on education and awareness, prevention, treatment, advocacy, etc. See if the leaders of these organizations can reach consensus as to 3 priorities that need to be pursued at the federal level. Assuming agreement can be reached, then participating organizations can pool resources to develop a campaign that educates the mood disorder community on a common set of priorities and actions. Together we can be powerful and persuasive, alone we can be ignored.

StephenBonin
StephenBonin

@StacyK I agree with you about "the more people that are educated about the importance of crisis text messaging services, the more people who will vote for the funding." After finishing this response, I will write an information sheet to a member of the counseling staff of our community college. He is a reverend in the African American community, and in talking with him on the phone two days ago, I've realized as a journalist mental health advocate, I face a challenge to inform people in our county. The texting method, the backpacks on the campus lawn. . .these are two new methods of hope in addition to chat and phone crisis counseling for youth. On a basic level, he doesn't even know about the two clinics, our support group, and various counselors.

StephenBonin
StephenBonin

@jules78 I appreciate the passion in your tone. Your message compels me to believe in any and all methods that can enhance probability of success. Thank you for sharing.

StephenBonin
StephenBonin

@Portiaspeace Indeed, texting is of their generation. Goes without saying, I see so many with fast fingers!  Thank you for sharing.