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The national statistics overall show that mood disorders among children, adolescents and young adults have increased significantly over the past 10 years. If you asked me in 30 seconds to describe the biggest challenge to us in the mental-health arena, it would be that area.
DDN: Describe this sort of disorder for us.
Ramey: The problem with mood disorders, unlike attention deficit disorder, conduct disorders or things like that, is that kids who are anxious or depressed sometimes do things that lead them to want to harm themselves. So that's what makes this issue in our community and nationally much more acute than anything else. Not to downplay alleged attention deficit disorder, but generally that's not something that results in someone's death.
But a youngster who is depressed, a youngster who feels that death is better than life, can end up dying. That’s the single biggest area that’s of concern to us.
DDN: What are some numbers?
Ramey: Last year, and these are government statistics, 7.4 percent of high school kids nationally indicated in the previous 12 months they tried to kill themselves.
Now, there’s some pretty significant racial and gender differences there. Among males it was 5.1 percent. Among females it was 9.3 percent. Among African-Americans it was 9.8 percent, among white teenagers it was 6.1 percent. Among what is called sexual minorities, it was 35 percent.
These are extraordinarily high numbers of our young people who have a couple things in common. No. 1, they generally feel as if they are a burden to other people.
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No. 2, they don’t have the relationships with caring individuals that get most of us through the tough times.
And then finally No. 3, they have come to some accommodation that death is better than life, generally because they feel that the pain that they are experiencing today will go on forever. (Most adults) know one thing: whether today is a good day or a bad day, it’s going to pass. Kids don’t feel that way, so the pain they feel, again with this anxiety and depression, they feel will go on forever. There’s no relief in sight, therefore I’d just as soon be dead.
DDN: What’s going on to cause this?
Ramey: You know, you can interview three different people and get four different answers. I'll give you my study on it — I think here's about two or three different trends going on.
The research on technology and social media is now complete. It is a major factor leading to mood disorders in teenagers. Period. We need not debate that anymore.
That’s not to say that all technology and all social media are bad for all kids. But it is to say beyond a tipping point, kids spending so much time in social media is significantly related to these mood disorders. And the way it works is almost common sense. The more time you’re spending on that, you’re not interacting in person. So you’re not building up the relationships that get us through our tough times.
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If you’re texting someone or you’re on social media or you’re getting support from a friend rather than a family member, it doesn’t have that same qualitative thing.
Not to say that we should suddenly take our kids away from technology, but we need to place limits on it and we need to teach them how to be responsible digital citizens. I think most people would agree that’s a factor. I think the question’s been answered. Other people are not quite so definitive. But my reading of the literature says that’s a major factor.
DDN: What else?
Ramey: I don't think that is the one and only thing. I think the second fault rests with parents.
I think well-meaning and loving parents have over-protected our kids and not allowed them the gift of dealing with failure and frustration at a younger age, leaving them ill-equipped as they enter the tougher teen years to deal with real-life situations.
The end result is, I’ve never learned to get up after falling because my parents never let me fall. When I do fall, I think, “Oh my goodness, the world’s coming to an end.”
So-called “helicopter parenting” … It may make parents and kids feel good in the moment. But it’s a harmful way of raising kids, because it doesn’t teach them the skill of resiliency.
And the third and final factor … there’s a fascinating increase, well-documented, in kids’ trait of perfectionism. Perfectionism meaning, I expect myself to be perfect, I expect you to be perfect and I think that you expect me to be perfect. And by definition since that’s an ideal we can never fully achieve, when things don’t reach that ideal, kids feel badly and act on those feelings.
So those are kind of the three things that I think are at work. And again, different people will rank those differently.
DDN: What can parents do?
Ramey: Every day at Dayton Children's we see a number of these kids, and this is a very busy time because suicide is a seasonal business, so to speak. What is evident in almost every case is that kids, like rest of us, they wear a mask. They appear one way to their parents and even their peers, and you know life is very different.
I get asked all the time what can parents do — and the answer is simple, but doing it is difficult. And that’s to stay engaged with your youngster. To raise them in such a way where you are an askable parent and kids feel like they can say things to you that reveal a little bit of who they are. So that when the times do get tough, they have you. It’s tough. And for some kids, frankly, it’s tougher than others.
For the most part it’s not a matter of bad parents or bad kids, it’s a matter of kids encountering normal situations but not being equipped to deal with them.
DDN: What is Dayton Children’s doing?
Ramey: I'm real proud and we should be proud as a community of what Dayton Children's is doing and there's about three or four things that really are noteworthy.
No. 1, we’ve added more mental-health professionals. So we have more psychiatrists, more psychologists, more social workers on staff today than ever before. So we recognize this as a significant community need and even though … these are not services that bring revenue to the hospital. They all result in a loss financially to Dayton Children’s, but we do it anyway because it’s the right thing to do.
So the first thing we’ve done is hire more people. The second thing we’ve done is establish three really, really cool programs. Program No. 1 is called Mental Health Resource Connection. … We have trained, licensed social workers. They’re going to be on the phone with the family. They are going to do an assessment on the phone. They are going to hook the family up with the right resource and then they are going to call back and say, were you able to keep your appointment? What can we do to help? And really try to reduce barriers. What the hospital charges for this is nothing.
And the program is growing. We started off the first year (five years ago) with just under 1,000 referrals. This year we’re going to see over 6,000 referrals through that program.
The second thing that’s pretty cool is we have a crisis center on the first floor. It’s designed in kind of a clever way. Rather than bringing a child to a traditional emergency department and you’re mixed in with kids with broken arms and asthma, we have a separate unit right next to the emergency department. Kids get in a little quicker. It’s a little cheaper. And most importantly, all of the rooms are designed with only one thing in mind — and that’s patient safety. This crisis center we just opened up in July, and we think that’s a great response to a significant community need.
And the third thing which is going to occur this summer is opening up the first-ever in-patient unit at Dayton Children’s for patients between 11 and 17 years of age. That will be a short-stay stabilization unit, average length of stay about four days. The intent there is for the kids who are not safe to send home, get them in, stabilize them and connect them with community resources.
The only local option (now) is Kettering and they are often filled so then we would reach out to Columbus, Cincinnati, Akron and then we refer a lot of kids to Kentucky. Hopefully, we can keep most kids in our area and provide them outstanding care right here.
DDN: What more can we be doing?
Ramey: We're investing millions of dollars at the back end but not enough money at the front end. Psychiatrists and this new inpatient unit … it's a $10 million project. What if we took some of that money and instead tried to figure out what the heck is going on and how do we equip kids at a young age, meaning beginning in kindergarten — how to begin to take care of their mental health like we're after them to try and take care of their physical health.
We know that when we focus on something – I use bullying as an example – bullying is at an all-time low today. All-time low. When we focus on something with a laser-like attention, we get things done. Maybe should start thinking about that with these mood disorders as well and put up fewer buildings, hire fewer people and redirect those resources elsewhere.