It’s a small but alarming statistic. Among kids ages 10–24, suicide is the second-leading cause of death in King County. “We used to have a kid that we needed to hospitalize for suicidality at Seattle Children’s, maybe one kid every three months,” says David Downing, chief operating officer at Youth Eastside Services, a provider of behavioral health services in east King County. “Now, it’s not unusual that you could have three kids in a week.”
At a national level, there are other concerning signs. Depression and anxiety are increasingly showing up in students, including middle school students, says Kevin King, an associate professor of psychology at the University of Washington.
“Adolescence is a developmental period where you really start to see sharp increases in the prevalence in common mental health disorders.”
And while it’s hard to know exactly why this is happening, it’s clear that between the barrage of societal changes over the past decade, economic issues, increasing income inequality and the very real possibility of a school shooting (there have been nearly 200 since the Sandy Hook Elementary School shooting in 2012), American youth have plenty on their minds. Now a pilot program for middle school students in the Lake Washington School District is trying to make a difference.
The Screening, Brief Intervention and Referral to Treatment (SBIRT) program—part of a King County program to expand mental health support in middle schools—kicked off last fall. Since then, hundreds of middle school students in the Lake Washington district have been given the highly specialized questionnaire asking about a wide range of topics, including sleep habits, substance abuse, suicide and the person in the community who gives them the most support.
Depending on their answers, students received follow-up questions or health advice on topics such as sleep. And while answering the 39 questions takes only about 10 minutes, crucial information has been revealed.
Of the 200 students across six middle schools who took the survey, 30 showed symptoms of anxiety, and 40 reported incidents of harassment in the past year, says Matt Gillingham, director of student services for the Lake Washington School District. But the most alarming finding was that 13 students reported having thoughts of suicide.
“We’re trying to surface things that with middle school students might be internalized, so they’re not…necessarily outwardly obvious to the adults in their lives,” says Gillingham. “So if there are concerns, we can reach and connect with the kids earlier before that becomes problematic for the youth.”
The findings were reviewed immediately by counselors from the individual schools and by Youth Eastside Services, a partner in this program at the Lake Washington district, and counselors took immediate action for those students at risk for suicide.
There are 12 school districts in King County participating in SBIRT screening programs like this one, and at least half of those districts officially kicked off implementation in the fall. Although the program is still in the pilot stage, Margaret Soukup, the school-based SBIRT program manager for King County, says they expect more schools to start implementing it at a universal level in the next year.
The program is designed to provide schools with more information about their student body—from their challenges to their successes—while also giving students an outlet for reporting what they’re going through so they can get the help they may need.
School counselors have found the screening to be helpful when it comes to connecting with students and identifying those who may need extra help, says Soukup. “It’s been really important for the adults in the schools, and [for] students to actually feel like, ‘I’m seen, people know who I am, I’m not just a shadow in the school.’”
As the name suggests, SBIRT has three key parts: The screening questionnaire, developed by researchers at Seattle Children’s Hospital and the University of Washington, gives a broad overview of the mental health of the student body and identifies students with some risk factors. The brief intervention is meant to help students who have been identified to be at some risk. And the referral phase helps those high-risk students to get connected with specialized support and/or treatment.
At a time in their lives when these students may be dealing with the stress of grades, schoolyard crushes, online bullying and even the possibility of a school shooting, SBIRT works to remove communication barriers that can seem impenetrable at times, and to separate the needs of students from the adults able to help them.
SBIRT is funded and facilitated by the King County initiative Best Starts for Kids, which is focused on prevention and early intervention strategies for children, and King County’s Mental Illness and Drug Dependency behavioral health sales tax fund, which helps with services for those experiencing behavioral health conditions.
In May 2017, officials from the county reached out to 19 King County school districts to see if they were interested in implementing SBIRT. A dozen districts, including Seattle, Auburn, Kent, Bellevue and Lake Washington, signed on and were awarded funding.
The Lake Washington School District was awarded $300,000 for three years of program planning and implementation; it will be the first district to start administering the screening questionnaire to all of its middle school students.
Other districts have used it for specific groups of middle school students. Some middle schools in the Auburn School District have given the questionnaire to students who have had multiple absences or disciplinary actions; other middle schools in the district have given it to random groups of sixth-graders to test out the screening process, according to Rhonda Larson, assistant superintendent for the district’s Family Engagement and Student Success office. Results are confidential, and students can opt out, Larson notes. Recently, she says, counselors sat down with the parents of one middle school student who had indicated suicidal ideation through the survey. They were able to discuss the situation and create a plan to support the student.
Across the districts, responses to the questionnaire have revealed a wide range of information, says Soukup. There are the students who don’t know what marijuana is, and others whose biggest issue is not getting enough sleep. Sometimes the follow-up for a student who has been identified as having an issue has simply involved setting them up with a mentor or tutor, or reinforcing the positive things they are already doing.
But when there are signs of anxiety or depression, Soukup says, those symptoms are most often associated with social media, bullying or some kind of school-related anxiety.
Whatever the situation, when at-risk kids have been identified, schools are able to follow up and get them help, says Sheila Capestany, project lead for Best Starts for Kids.
As this school year winds down, the stresses kids face may not have changed. But when they begin school next September, they’re more likely to have a smoother ride thanks to more schools adding mental health screening to their lesson plan.
A Rising Tide of Mental Health Issues
Between 2003 and 2011, lifetime diagnoses of anxiety or depression for children increased from about 5 percent to 8 percent, according to the Journal of Developmental & Behavioral Pediatrics. A recent Pew Research Center study found that 70 percent of American teenagers consider anxiety and depression major problems for their peers. Major episodes of depression have also gone up, from about 9 percent to 11 percent between 2005 and 2014, according to the American Academy of Pediatrics.
King County has not been immune. In 2016, 26 percent of eighth-grade students had said they felt sad or hopeless for at least two weeks over the past year, a 4 percent increase from 2012, according to Washington’s Healthy Youth Survey, a biennial survey whose participants remain anonymous. More than half of those students surveyed in 2016 said they had felt anxious, nervous or on edge in the past two weeks.