By Sarah Hall

Editor

David and Lisa Craig say that they’ll never have a bad day again, because the worst day of their lives has already happened.

On Oct. 30, 2006, their only child, Corey, completed suicide. She was 16.

“You get through it,” Lisa Craig said. “But you don’t get over it. I think about her every single minute of the day.”

Corey was a junior at Bishop Ludden Junior/Senior High School. She was beautiful, well-liked, even outside her large circle of friends. But Corey was also suffering from depression and anxiety, and in Central New York, where there has long been a dearth of mental health services, particularly for adolescents, the resources that could have helped her just weren’t available.

“When we started trying to find her help, we found out how hard it was to actually get it,” Lisa said. “There was really no vehicle to get her into any kind of mental health care.”

While Corey died more than 10 years ago, the situation for youths facing a mental health crisis has not improved. According to a July 2016 article in the Washington Post, the availability of psychiatric beds nationwide is at an all-time low, with New York showing the sharpest dropoff since 2010. The wait for an inpatient bed for adolescents admitted to the emergency department for a psychiatric crisis can exceed two weeks due to the shortage.

The decline in beds represents part of a much longer trend. The state’s Office of Mental Health (OMH) closed Four Winds Hospital in Syracuse in 2004, forcing families to seek intensive inpatient treatment in facilities as far away as Buffalo or Saratoga. The OMH also considered closing the Richard H. Hutchings Psychiatric Center’s Children and Adolescent Inpatient Service Units in Syracuse in 2013. The plan was ultimately scrapped, but it forced the further examination of youth mental health services in the area and ultimately prompted the creation of a Youth Mental Health Task Force, helmed by 129th District Assemblyman William Magnarelli (D-Syracuse) and 24th District Congressman John Katko (R- Camillus). The 22-member task force, formed in April of 2015, spent two years identifying the weaknesses of Central New York’s mental health care system and coming up with recommendations to improve it.

“People told us stories about their families and what they had gone through, extreme situations where young people committed suicide, and the feeling that there was nothing there to really help these families,” Magnarelli said. “It became clear to us that this was a bigger problem than most people admitted to.”

Scary statistics

Though mental health issues tend to be swept under the rug, the task force’s report, issued March 3, reveals that they are a major issue in Central New York. According to the New York State Department of Health, as cited in the report, the suicide mortality rate in Onondaga County between 2008 and 2011 was 10.7 per 100,000 people. Statewide, the average topped out at 8.2 per 100,000 in 2012.

“Suicide is the No. 2 cause of death in kids 24 years old and younger,” Katko said. “It’s the No. 10 cause of death of all individuals in the United States. The number 10 cause of death amongst all Americans, and the attention is nowhere near where it needs to be. That’s what we’ve got to change.”

Mental illness in youths in general is on the rise. The task force’s report compared studies published between 1980 and 1993 with studies published between 1993 and 2002 and found that observations of youths showing signs of mental illness had nearly quadrupled. By the year 2000, about 750,000 children and adolescents were at risk for suicide. However, just over a third of those were receiving treatment. About 60 percent of all youth with mental health issues, according to a Substance Abuse and Mental Health Services Administration Report cited by the task force, do not receive any kind of mental health services.

One of the biggest barriers to seeking help is the lack of providers available. Though more and more children and adolescents are going to their primary care providers with complaints about mental health — according to the report, more kids are making appointments for office visits seeking mental health care than adults — those primary care providers have few options as to where they can send young patients. The Health Resources and Services Administration reported in 2016 that there are only enough providers of psychiatric care to meet 47.74 percent of the need nationwide. The number is even more dismal in New York, where the percentage is just 44.12.

Where have all the doctors gone?

Magnarelli said many physicians are deterred from going into pediatric psychiatric care because it just doesn’t pay enough.

“Their reimbursement rates from the insurance companies and from Medicaid are small,” Magnarelli said. “People go into the more lucrative-type practices because they’d like to pay off their debts that they’ve run up to become a doctor. This thing goes around in a circle. The bottom line is, especially for mental illness, it’s not covered by many insurance companies, or not much is covered.”

The report also cites the absence of insurance coverage as a barrier faced by many families.

“… the issue of adequately funding youth mental health services must be addressed,” the report reads. “The federal and state government must provide additional funding to cover treatment and support services. Private health insurance companies must also provide adequate coverage for treatment.”

This is an issue New York was thought to have addressed with Timothy’s Law, passed in 2007, which requires health insurance plans sold in the state to provide coverage for mental health care comparable to what it provides for physical health care. The law is named after Timothy O’Clair, a 12-year-old from Schenectady who completed suicide after his family was unable to continue to pay for his treatment due to limits on their insurance.

Under Timothy’s Law, insurance companies are supposed to provide mental health parity. However, “they’re not,” Magnarelli said. “Or they cover certain things and they cover it for a certain amount of time. They come out with their protocols, and [they say] that’s all that’s needed.”

Once insurance runs out and people have to pay out of pocket, they often stop treatment, even for their kids, because the cost is prohibitive. Some rely on emergency services and crisis care — in Syracuse, St. Joseph’s Hospital Health Center has a Comprehensive Psychiatric Emergency Program (CPEP), a 24-hour psychiatric emergency room that provides evaluation and treatment for both children and adults in the midst of an acute mental health crisis. Patients can be admitted for a period not to exceed 72 hours. But that’s only a temporary solution.

“They can only stay there for 72 hours and then they’re back on the street, and often times there’s no follow-up treatment,” Katko said. “I know one child who has been to CPEP 20 times. Twenty times. Think about the burden on society for that. And he obviously has mental health issues that have not been addressed.”

Losing Corey

Another major issue is the lack of connection between primary care providers and their more specialized counterparts, creating a gap in the continuity of care. This is one of the issues the Craigs faced in Corey’s treatment.

“Being that she’s 16, your first point of entry medically is still the pediatrician,” Lisa Craig said. “They got us in on their lunch hour. But then I left the office that day with a list of people to contact on my own.”

It didn’t get easier from there. It took repeated calls before the Craigs could find someone who would even see Corey.

“They wouldn’t answer their phone, or they didn’t return my call, or they wouldn’t see a teenager, or they had a two-month waiting list,” Lisa said. “I was flabbergasted that I couldn’t get her in to somebody to talk to.”

They finally connected with a social worker, but it quickly became clear she couldn’t help Corey. She referred the Craigs back to their pediatrician, who had a policy not to prescribe antidepressants, so they found themselves back at square one. While they waited for another referral, Corey made her first suicide attempt.

The next morning, the Craigs met with a full team at Upstate University Hospital who assessed Corey. Among them was an adolescent specialist who prescribed antidepressants, talk therapy and exercise. She was also diagnosed with attention deficit disorder and put on a small dose of Adderall.

For the Craigs, it was like they had their daughter back.

“What a difference,” Lisa said. “She was working. She was doing stuff with her friends, and… she was doing great in school. … She was back, we thought.”

But in late October of 2006, Corey had a setback. She spend most of the last weekend of the month shifting from her bed to the couch and back again. But by Monday, she seemed better. She told her parents a friend was giving her a ride to school so they didn’t need to drive her. Neither David nor Lisa knew anything was amiss until after 10 a.m., when the school called David’s cell phone and told them a friend had received a goodbye text from Corey.

David raced home, calling 911 on the way. By the time he got there, it was too late.

“They wouldn’t let either one of us in [the house]. They put us in separate cars to go up to the hospital and they brought her up in an ambulance. Then she was pronounced deceased,” he said. “That’s why I will never have a bad day again, because we had our bad day.”

Erasing the stigma

While major changes need to be made to provide adequate care to children and adolescents facing mental illness, the first step is much smaller — we need to start talking about it.

“People don’t like to talk about mental illness,” Magnarelli said. “People don’t like to say anything about their children’s suffering and how the family is suffering as well. They like to keep it under wraps.”

All that does, the assemblyman said, is contribute to the unnecessary stigma surrounding mental illness.

“It’s like any other disease that people suffer from,” he said. “If someone comes down with cancer, we have no problem understanding what they’re going through and trying to be of help to them. When it comes to mental illness, the first thing is that nobody says anything and you don’t even know it’s happening. We have to get the word out that it’s okay to talk about these things, that it is an illness, that it is treatable.”

That’s where the Craigs have been directing their energy since Corey’s death. They’ve spoken at schools, given interviews and set up a fund at Upstate University Hospital in her name in the hopes of preventing more families from going through the same heartache they’ve endured.

“I think we were given a mission,” David Craig said. “I really do.”

Corey’s story has been shared with people as far away as Australia and the UK and, fortunately, has helped several young people see that suicide isn’t the answer. It brings great comfort to her parents, who, more than a decade later, are still struggling with their daughter’s death.

“I tried to help her and I couldn’t. That makes me feel like I failed. I failed at the job that I wanted more than anything. I just couldn’t make her happy,” Lisa said. “I know I did everything I knew how to do at that time. I know, but still, I’ll go to my grave blaming myself.”

Next week, part II of this report will address the task force’s recommendations on how to address the crisis and the logistics of implementing those recommendations.