Doctor seeks new approach to teen mental health

Fragmented, insurance-driven system leads to patchwork care, poor communication

Galvanized by a cluster of Palo Alto student suicides in 2009 and 2010, local physician Meg Durbin is challenging the medical bureaucracy to streamline mental health screening and treatment for teens.

Frustrated by what she calls a fragmented approach -- in which mental health is "carved out" of many insurance plans, leading to patchwork care, poor communication and poorly served patients -- Durbin, who also is regional medical director for managed care at Palo Alto Medical Foundation, aims to establish new procedures that could be used by thousands of doctors.

"We must start saving lives in our own communities now," Durbin said in a grant proposal to test new models of "collaborative care," in which mental health screening would become standard procedure, and patients at risk would be monitored.

Durbin cites the case of a teen with "profound sadness" and thoughts of suicide, who some years ago came to the Palo Alto Medical Foundation with her mother. The girl's primary-care doctor recommended hospitalization. After waiting for hours in the emergency room of a children's hospital, the girl was given an assessment with no privacy and sent to a different hospital that was licensed to admit teens with psychiatric issues.

The teen's experience was "humiliating and utterly distressing as her parents were not allowed to travel with her between hospitals," the teen's primary-care doctor said. "Her mother called me the next day, pleading that I help get her daughter released. As she was discharged from the hospital, I was told she had been connected with a therapist. Later, I found that this connection was tenuous."

The primary-care doctor received no communication from the therapist and never heard when the therapist stopped treatment.

"The teen could not bring herself to return to our clinic because of the traumatizing memories of the hospitalization," the doctor wrote. "I did have a few conversations with her mother, who reassured me that she was doing well."

But three years later, as she was about to graduate with honors from high school, the young woman died by suicide.

"I have often wondered whether events would have taken a different path had she not been so traumatized by the way our 'system' did not serve her," the doctor wrote.

Fragmented mental health care -- often driven by insurance reimbursements -- means there's not necessarily any coordination, or even the most basic communication, between a teen's therapist or psychiatrist and her primary health provider.

Durbin, whose three sons were Gunn High School students at the time of the suicides in 2009 and 2010, knew some of the families of the students who died and was deeply affected by the suicides.

Following the second student death in June 2009, she was among the physicians who organized the medical community's response to the events, launching HEARD (the Health Care Alliance for Response to Adolescent Depression).

In the three years since, HEARD has amassed a huge amount of medical data and guidance on its website and has removed password protection of the site so it's now freely accessible.

In her own Palo Alto medical practice, Durbin said, "I absolutely screen (for mental health) now -- not just with children but also with adults."

Even so, she said, it's not yet an "embedded guideline that everyone screen." Hence, her effort to change procedures more broadly within Palo Alto Medical Foundation and even throughout the vast Sutter Health Care System -- with 48,000 physicians in 100 Northern California cities and towns -- of which Palo Alto Medical Foundation is a part.

Durbin is seeking backers for a $3 million, five-year pilot program with the goal of establishing a nationally recognized model of care "that will transform the delivery of behavioral health care within our region, beginning with our adolescent population."

The pilot will test three primary-care approaches to mental health screening and care for teens and measure the results.

The results, she said, will yield "an effective, standardized protocol for identifying, treating and preventing behavioral disorders within the primary-care setting" -- a protocol she hopes will propel changes nationwide in approaches to teen mental health.


Like this comment
Posted by Bane, conquerer of worlds
a resident of Leland Manor/Garland Drive
on Jul 28, 2012 at 10:17 pm

Old news is old. Stop beating a dead horse and peeling scabs off healing scrapes.

Like this comment
Posted by Observer
a resident of South of Midtown
on Jul 29, 2012 at 9:33 am

Please stop bringing up the terrible events of the past. I'm all for improved teen mental health screening and better treatment, but using sad incidents to get people to read an article is wrong. It has been proven that the constant mention of it increases the possibility that it will continue. The Palo Alto Weekly is well aware of this. Why do you keep bringing it up in this blatant inconsiderate way?

Like this comment
Posted by Parent
a resident of Another Palo Alto neighborhood
on Jul 29, 2012 at 10:02 am

As someone who seriously considered suicide as a teen, I would like to say that for any teen who supposedly has mental health issues which may lead to tendencies to hurt themselves, that the parents must be examined to see if they are the cause.

I had very strict, authoritarian parents who made my life miserable. I could never reach their high standards no matter how hard I tried. I felt worthless and unloved, but more than that I had no idea that they were the problem and not me. As soon as I moved out and was away from their controls, I became a different person almost overnight.

My gut feeling is that teens are often driven by parents to the state of despair as I was. As a parent myself I have seen similar signs of parents pushing their kids too much and my heart goes out to anyone who is in the situation that I was in.

So please, please, please, look at how the parents treat the kids before diagnosing the kids with mental health issues.

Like this comment
Posted by Parent
a resident of Palo Verde
on Jul 29, 2012 at 2:57 pm

Sometimes it is the parents and other times the child. In any case the entire family needs help if any member is hurting.

Like this comment
Posted by patient perspective
a resident of Another Palo Alto neighborhood
on Jul 29, 2012 at 5:14 pm

Dr. Durbin,
In your position, I would like for you to hear that a great deal of medical care is stressful and humiliating for patients, not just mental health care. MOST healthcare is disjointed with very little follow through. Getting healthcare in our system is like having to fly a plane from the back seat. It is very common for people to stop seeking care for all kinds of difficult problems because they feel the medical profession is unhelpful at best, arrogant or patronizing (and unhelpful) at worst. The doctors involved usually never know the negative outcomes when that happens.

I'm not demonizing physicians, most of whom I believe are in the profession because they want to do a good job caring for people. I think most do no understand or appreciate just how hard it can be to seek care, nor how brutal it can be to be very sick (emotionally and/or physically) and dealt with in the way you described.

Like this comment
Posted by kk
a resident of Barron Park
on Jul 30, 2012 at 10:45 am

Suppose to be

This is the way we do it.

Throw it all out the window. They are kids and some kids come with parents with mental illness. Maybe there should be a class called "coping" so the kids have some sense of how to seek it themselves and the adults in the schools should start asking "how are you feeling today" and create a culture that self checks everyone.

Its not one simple solution, its layers of actions

Like this comment
Posted by parent
a resident of Gunn High School
on Jul 30, 2012 at 11:33 am

parent of a person who died by suicide

Thank you for working on the issue of teen and young adult mental health issues Dr. Durbin, and to the Palo Alto Weekly for keeping the issue of suicide in the news. We owe it to our children and young adults and adults.

As of January 1, 2012, HP chose SignatureValue HMO offered by United Healthcare of California. Although treating mental health issues is part of healthcare offered by Palo Alto Medical Foundation, the Psychiatry/Mental Health Department chose not to be part of the mental health carve out with United Healthcare West. After being in counseling since week 1 after the death of our son, we did not want to change counselors, but we have had to go less often as we pay out of pocket.

Other HP employees have had to pay out of pocket to continue with their mental health counselors. My husband and HP HR have been unable to get UHC West to make exceptions to choosing someone outside their Mental Health Plan.

As companies change health plan coverage yearly, it is extremely hard to continue continuity in seeing mental health providers.

Like this comment
Posted by Michele Dauber
a resident of Barron Park
on Jul 30, 2012 at 1:29 pm

This is an excellent article about an important effort to improve mental health care for the community. I think it is important to respond to those who anonymously wish that everyone would stop talking about "the terrible events of the past." "Observer" [portion removed by Palo Alto Online staff] even accuses the Weekly of somehow acting improperly by merely mentioning the fact of the suicide epidemic and mental health crisis that Dr. Durbin seeks to abate and treat.

Reporting on efforts to improve mental health care in the wake of a mental health crisis is not "peeling the scabs" off wounds, nor is it somehow "blatant inconsiderate" (sic). It is responsible journalism in which the community receives information about important issues and efforts to address them. [Portion removed by Palo Alto Online staff.]

As the parent of a child who died by suicide, I appreciate Dr. Durbin and the Weekly's effort to keep the community from slipping into the complacent amnesia that some appear to be seeking.

Like this comment
Posted by Maureen Simons
a resident of Duveneck/St. Francis
on Jul 30, 2012 at 3:59 pm

Bravo to Dr. Durbin! She is a true asset to the community and has worked tirelessly to make this happen. Dr. Durbin was one of the first people to step up and offer her help when we were going through this crisis. She spoke on a panel of physicians for Paly and Gunn parents and was extremely effective and well-receive. I know she was doing several other hands-on things to support our community as well. Even more impressive, she didn't drop the issue when it fell from the headlines - she persevered to create systemic changes.

This kind of change takes time and incredible patience - that is what is going on here, not resurrecting a bad memory. Ignoring how badly broken this system us could clearly lead to other tragedies - whatever the source of the depression and despair. Dr. Durbin has demonstrated real courage, compassion and leadership and we are very lucky to have her in our community.

And I second the notion that you should put your actual name with your posts.

Like this comment
Posted by Barbara Slone
a resident of Leland Manor/Garland Drive
on Jul 30, 2012 at 5:55 pm

Thank you Dr. Durbin and also to the staff at the Weekly for keeping us aware of this important work. Our community stands to benefit greatly by this program and we need to remember the "tragic events of the past" in order to move forward in assuring that none of our precious children fall through the cracks again. We are indeed lucky that Dr. Durbin has chosen our community for her pilot program. I am appalled at the insensitivity of the first two comments on this article. If you are going to remove content from these comments I certainly think that "Stop beating a dead horse and peeling scabs off healing scrapes" qualifies for removal.

Like this comment
Posted by Paly parent
a resident of Palo Alto High School
on Jul 30, 2012 at 6:18 pm

Just another attempt to waste a lot of money.

Like this comment
Posted by Chrisc
a resident of College Terrace
on Jul 30, 2012 at 7:29 pm

My previous ins also was not taken by pamf for mental health. Even though
I had blue cross for everything else but my company assigned
Mental health to ubh. Now on Medicare, I can go to
Pamf. I noticed there are things in obama's health care plan
Improving coverage for mental health,
So please don't vote for someone who will turn this
All back. It's time mental health is treated as the
Serious disease it is.

Like this comment
Posted by Sharon
a resident of Midtown
on Jul 30, 2012 at 7:44 pm

[Portion removed by Palo Alto Online staff.]

Stanford and PAMF in fact -implement an appropriate medical solution that worked and is working very well.

Like this comment
Posted by Ex-Teacher
a resident of Mountain View
on Jul 31, 2012 at 8:43 am

Thank you for attempting to make something understandable Dr. Durbin. I am an ex-teacher who saw so many abuses in the school system it was stomach turning. I saw teachers who were tenured have their own children taken out of their home for neglect and abuse. I saw administrators make fun of children. I saw children desperate for anything that made sense when they came from parents who were incompetent. Children have almost no voice. We must advocate for them.

By making an approach to mental health that includes something less fragmented, more consistent, and that applies to adults and minors, children can be part of a whole, not those who are having fingers pointed at them to take the blame. I completely support his effort!

Like this comment
Posted by Gunn Parent
a resident of Barron Park
on Jul 31, 2012 at 11:58 am

This is a very exciting development. If it works it will be much more effective than changing the school calendar. Thank you Dr. Durbin.

Sorry, but further commenting on this topic has been closed.

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