'It really does get better': One teen's journey shows the hardship and hope of finding mental health treatment for youth in Spokane County

<p><p>Shylar Thompson was standing on a square podium on the football field in a floor-length fiery red gown when the announcer said her name: She had just won homecoming queen of East Valley High School’s sophomore class.</p></p><p><p>Thompson could see her family in the audience crying. She started crying. She never imagined being here. Not with the stress of the past two years. Not with where 2021 began.</p></p><p><p>The 15-year-old has struggled with depression since she was young, and the coronavirus pandemic only intensified it, starting with school closing.</p></p><p><p>Thompson loved school before the pandemic. After her older sister noticed her behavior changed with the initial shutdown, Thompson got connected to a counselor she began to see weekly in the summer of 2020.</p></p><p><p>But as she started her freshman year predominantly through a laptop screen, her depression didn’t go away.</p></p><p><p>By January , the then-14-year-old did n’t want to live anymore. One night when she thought everyone was asleep, she decided to act on her suicidal thoughts. Her sister walked in on her, beginning a year that has been both transformational and challenging for Thompson as she navigated the region’s stressed behavioral health resources for teens.</p></p><p><p>Thompson stayed up with her sister that night, crying and telling her everything she’d bottled up inside. In the morning, her sister took her to Providence Sacred Heart Medical Center.</p></p><p><p>Thompson would be stalled in the emergency department alone for two weeks, while she waited for an inpatient bed to open up at either Inland Northwest Behavioral Health or in Sacred Heart’s psychiatric unit.</p></p><p><p>Eventually, she got into Inland Northwest Behavioral Health, where she stayed for a little more than a month. She missed her family a lot. She would read books in her room and cry often. The group sessions and individual therapy offered there were helpful, but the isolation was difficult. Thompson talked to her therapist there about step-down programs that would enable her to keep working on her mental health but live at home. She referred her to the RISE program at Providence Holy Family Hospital.</p></p><p><p>Thompson was on the waiting list for six months.</p></p><p><h3>‘Crisis mode’</h3></p><p><p>Many kids and teens needing mental health treatment throughout the pandemic have had to wait, much like Thompson.</p></p><p><p>When she was leaving Inland Northwest Behavioral Health earlier this year, Gov. Jay Inslee was signing <a href=”https://www.governor.wa.gov/sites/default/files/proclamations/21-05_Children%E2%80%99s_Mental_Health_Crisis_(tmp).pdf” target=”_blank”>an emergency declaration</a> for the state’s strained mental health resources for youth and teens.</p></p><p><p>It is still in effect today.</p></p><p><p>The pandemic created demand in a system already understaffed and under-resourced before the pandemic hit, local and state providers say.</p></p><p><p>Dr. Tona McGuire, who is co-leading the Department of Health’s statewide behavioral health strike-force team, has been working in the field for more than 30 years.</p></p><p><p>She said behavioral health resources for youth have been underfunded for years in Washington state. There aren’t enough clinicians in the state to meet the demand for treatment.</p></p><p><p>The pandemic led to an increase in children and teens visiting the emergency department for psychological stress, and suicidal ideation among these kids also began to increase.</p></p><p><p>As the pandemic continues, the burnout among staff has only made it harder for families that need services, with programs limiting the number of patients they can accept.</p></p><p><p>“The whole system is struggling, and I think is really in a crisis mode,” McGuire told The Spokesman-Review in October.</p></p><p><h3>Perfect timing</h3></p><p><p>When the RISE program had an opening for Thompson, it was September, six months after she was added to the waiting list.</p></p><p><p>When she was discharged from Inland Northwest Behavioral Health, Thompson went back to school and saw her counselor weekly again. She returned to a phone flooded with messages of love and support.</p></p><p><p>But when summer hit, things got bad again.</p></p><p><p>Thompson’s home life can be stressful.</p></p><p><p>She was raised by her grandmother and lives with her and her two sisters. Her parents are in and out of the picture.</p></p><p><p>This summer, her home life got more stressful when the septic tank backed up and flooded their house and the family had to move into an apartment.</p></p><p><p>Thompson was away at summer camp during part of the move, where she got COVID again (she’d already tested positive earlier in the pandemic) and fell off a bike, a painful fall that led to no broken bones but made walking difficult.</p></p><p><p>“It couldn’t have been a better time,” Thompson said of the program. “That’s why I think it helped me so much because I was at my lowest (point). I really didn’t want to be here anymore, and then my grandma got that call.”</p></p><p><p>Thompson felt like God was saying things do get better, and she set her mind to putting in the work.</p></p><p><p>RISE is an intensive outpatient program, meaning patients spend several hours for multiple days a week in treatment during the day.</p></p><p><p>Unlike other programs in the county, however, RISE is only intended to last about six to eight weeks . Other outpatient programs can last much longer.</p></p><p><p>RISE is based at Holy Family, and there is a program for teenagers, as well as one for adults. Thompson went three times a week for the entire day, meaning she had to miss quite a bit of school to participate.</p></p><p><p>People with anxiety or depression, other mood disorders and personality disorders can be treated through the program.</p></p><p><p>Each day, there is a mix of group sessions and one-on-one therapy with a counselor, as well as appointments with a psychiatrist.</p></p><p><p>From the start, leaders in the RISE program are already thinking about transitioning a patient after their time spent in the program, especially with the local shortage of providers. Patients begin talking about their discharge plan, a potential physician to prescribe medications and where they can seek therapy or other treatment afterward, said Kristin Reiter, the program manager of RISE.</p></p><p><p>“There is such a shortage here in the community in general, we want to make sure there’s continuity of care,” Reiter said. “It’s common they come in without an existing therapist and prescriber, so that’s something we do regularly.”</p></p><p><p>School has always been Thompson’s favorite place. She loves her teachers, classes, the structure of the school days.</p></p><p><p>RISE felt structured like school, but for mental health, she said, a format she really enjoyed as she learned practical skills to take away with her.</p></p><p><p>One skill she finds herself using regularly is called opposite action, a common skill taught in dialectical behavioral therapy. It entails thinking of the opposite action to what your emotions are telling you and doing it. Thompson thinks about it like if she’s lying in bed, feeling lazy and unmotivated, with her thoughts telling her to stay put, she envisions herself getting out of bed, going to the gym, finishing her homework. And then she does it.</p></p><p><p>Naming that skill and putting it into practice during her time at RISE has helped her so far. Thompson is going to the gym regularly, committing to habits she knows are good for her mental health. For her, RISE helped enforce those skills and made them habitual.</p></p><p><p>For the first time in a long time, RISE has openings for teenagers and adults, and there is no longer a waiting list.</p></p><p><p>Whether patients are referred from the emergency department or an inpatient treatment program, they can get into the program fairly quickly, Reiter said.</p></p><p><h3>Talk about it</h3></p><p><p>While the pandemic has made it difficult to predict when surges may occur, Reiter expects that the number of people seeking treatment for mental health will increase in the holiday season and winter time.</p></p><p><p>Youth emergency department visits for suicidal ideation had dropped to the lowest point in the past three years earlier this summer, but <a href=”https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/821-135-YouthBehavioralHealthSitRep-October2021.pdf” target=”_blank”>state data show</a>s that number is on the rise again, as is the number of emergency department visits for suicide attempts.</p></p><p><p>Behavioral health providers <a href=”https://www.spokesman.com/stories/2021/oct/26/report-more-than-1000-kids-have-lost-a-caregiver-t” target=”_blank”>did not see a typical “summer slump”</a> in demand for mental health services for youth and teens. When COVID can pull a child out of school for two weeks with exposure, many students are experiencing an even less-regimented routine this school year.</p></p><p><p>Dr. Erik Loraas, a psychiatrist at the RISE program, said anxiety or depression in this age group usually will present as behavior changes become a trend.</p></p><p><!–[photo id=752424]–></p><p><p>If a child who is typically social begins to withdraw consistently from something they used to like, or if their grades start to fall with no explanation, these may be signs that a child or teen is stressed or anxious.</p></p><p><p>Loraas encouraged families to have an open communication line with their children and teens. He also said that asking a child or teen about suicide or suicidal ideation is not going to give someone that idea.</p></p><p><p>“There’s never been anything to support that talking about it makes someone more likely to do it,” Loraas said.</p></p><p><p>He encouraged guardians to approach these conversations with unconditional support and a nonjudgmental stance, to not overreact if a child discloses their struggles with depression or other mental health conditions.</p></p><p><p>Having open and honest conversations can leads the way to finding good treatment and solutions for teens, he said.</p></p><p><p>“Be understanding, and while you can be concerned, being frightened and scared to a point, you run the risk of your kid not opening up about this again,” Loraas said.</p></p><p><p>While hospitalization is necessary for children and teens at risk for harming themselves or others, other treatment options are available for mental health. Loraas encourages families to speak with their pediatricians or family care providers to find resources or referrals.</p></p><p><h3>‘It really does get better’</h3></p><p><p>Since Thompson graduated from RISE, she’s been back at school full time, catching up on her classes and reconnecting with friends.</p></p><p><p>When classmates ask where she’s been, she will tell them. Her close friends know how much time and energy she put into her mental health this fall. Thompson feels more happy and hopeful than she has in a long time. When she was at RISE, they talked about the program like a cast on a broken leg.</p></p><p><p>“It’s something to help fix you and put you back together and send you out to the world again,” Thompson said.</p></p><p><p>She knows life is going to keep throwing her challenges, but she has more skills now to cope. She also learned a lot about self-love in her time with her therapist at RISE.</p></p><p><p>From posting positive affirmations around her room to reminding herself she doesn’t have to be perfect, Thompson said RISE helped her work through some of her insecurities, which had been far worse earlier in the year.</p></p><p><p>Thompson was crowned homecoming queen in October. In April, she will turn 16 and be able to get her driver’s license.</p></p><p><p>For those in similar positions to where she was earlier in the pandemic, Thompson encouraged them to recognize that there is hope.</p></p><p><p>“You just have to keep walking toward it, and there is so much to live for if you just put in the work,” she said. “You’re enough, and it really does get better.”</p></p><p><p><em>If you or someone you know is contemplating suicide, please call the National Suicide Prevention Hotline at (800) 273-8255. Access a Washington county-by-county directory of mental health programs at</em> <em>doh.wa.gov/Portals/1/Documents/Pubs/606019-BHADirectory.pdf</em><em>.</em></p></p>