Palo Alto Weekly

Spectrum - June 11, 2010

Guest Opinion: A silver lining of collaboration has emerged from a dark cloud

by Meg Durbin, M.D.

Spring is often a bittersweet time for families, filled with celebrations, graduations, life transitions, separations. This has been particularly true the past two springs in Palo Alto, with the well-known losses of young people from our community.

In the wake of the second loss in close succession last June, several of us physicians and therapists (and Gunn High School parents) came together, bridging often rival health care institutions to form an alliance.

We recognized the importance of understanding where we fall short and formulating a coordinated response. We already knew that our health care system has many gaps and contrived distinctions between "medical" and "mental" health services.

Most immediately, we understood the urgency of overcoming barriers to care for teens needing emotional and psychiatric support. By the first week in June 2009 the two major medical facilities who see teens in Palo Alto opened their doors for urgent mental health needs related to the Gunn tragedies, regardless of insurance coverage.

In talks I've given on this topic in the past year to parent, community and professional groups I first show a picture of a dark cloud with a silver lining. The lining represents the outpouring of concern, generosity, thoughtfulness and collegiality displayed as doctors, psychotherapists, school personnel, city officials, even journalists all work together.

Traditional barriers between competing institutions and specialties have broken down. We have a common goal: to understand and improve how we identify teen emotional and psychiatric concerns and help them and their families cope.

It might seem obvious that all primary-care physicians would already be routinely checking their teens for depression. But this is not so. In the midst of a busy practice, and with uncertainty about how to deal with and refer those patients discovered as depressed, many physicians have not adopted broad mental health screening methods.

This is a national problem. The U.S. Preventive Services Task Force two years ago recommended routine depression screening for all adults and teens. But it also added a crucial caveat: that screening only be done when there are adequate systems in place to address the depression.

Yet in a timely publication out just this month the American Academy of Pediatrics Mental Health Task Force now recommends routine mental health screening, and we have begun educating our colleagues, sharing the tools to do this, and improving our systems of care and referral.

As the local tragedies recede in time, the work continues daily for many of us. We have spent this year learning from each other and from national experts about how to respond to suicide clusters, how to screen for depression, which questionnaires to use, and how to make sure that those identified with depression get the best support and treatment. We are compiling a family resource guide with community and Web-based organizations.

We are also creating a provider tool kit so doctors can address gaps in their own practices and learn how to readily diagnose and begin treatment of depression, and know when, how and where to refer.

We are working to create easier access to mental health care providers and to identify hospitals specifically tailored to help teens and children with mental health needs.

It's important to keep these kids out of emergency rooms whenever possible, and not traumatize them further when their emotional issues are coming to a crisis point. We are continually surprised to learn of the myriad community organizations already existing and willing to partner together to help our teens.

More poignantly, we realize there are solid medical studies backing up the intuition of those compassionate primary care docs who haven't shied away from dealing with their patient's emotional needs. Such front-line docs, while not technically mental health care specialists, have always known that a gentle inquiry, a hug and some words of encouragement can really make a difference to all but the most severely depressed teens. They don't all need a mental health referral; many can do with reassuring, consistent contact with their "regular" doctor.

It has been a hard year for Palo Alto, with the intentional and accidental deaths of some beloved youth.

But as we now celebrate this year's high school graduates I am encouraged by the many professionals and parents coming together.

Most of all, I am inspired by our young people. As my own 2010 Gunn graduate has said to me several times this year: "We who remain must live all the more fully to honor those who have died."

And witnessing these students' courage, compassion, support and embrace of diversity, I know that they are doing just that. Congratulations to our 2010 graduates. And a heartfelt thanks to all those who have supported them.

Meg Durbin is an internist and pediatrician at the Palo Alto Medical Foundation who has led the effort in the past year to ease details of sharing information (with parent approval) between health care providers, mental health professionals and school officials. She can be e-mailed at durbinm@pamf.org.

Comments

Posted by Paul Losch, a resident of Community Center
on Jun 12, 2010 at 12:18 pm

Thanks for a thoughtful editorial.

What I find missing in this whole matter is what are families doing or not doing that have led to the suicides. Is there a pattern? How well educated are parents about clinical depression, which is a physical disease that is presented in late adolesence through the mid 20's.

This an incredibly complex matter, and our community is doing a great deal to address it. Getting to it at a family level is another part of what we need to end the tragedies. I do not have the expertise to suggest how that gets done, but I do have the experience as a parent to set objectives.


Posted by KJ, a resident of another community
on Jun 13, 2010 at 11:02 am

An enlightened, and enlightening, article. Thank you for writing it.

If you can publish statistics on how many young people have been served because of these new collaborations and new outreach, people would learn that the need for mental healthcare is not unusual and should not be neglected, just as one would not neglect a physical healthcare need. We might also learn whether the "receding in time" of the tragedies is attributable to your success in preventing new ones.


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