St. Luke's leads work on mental illness and children
Jan 21, 2013 (Duluth News Tribune - McClatchy-Tribune Information Services via COMTEX) --
A new model of treating childhood depression that's playing out at St. Luke's hospital and clinics in Duluth emerged from soul-searching over the 2005 Red Lake High School shootings.
"At the time (of the Red Lake shooting rampage), there were only 18 ... adolescent psychiatrists in the state of Minnesota," said Jordan Kalm, clinic manager for St. Luke's. "That subspecialist was almost nonexistent in the state."
On March 21, 2005, 16-year-old Jeff Weise shot and killed his grandfather and his grandfather's girlfriend in their home, and then headed to his high school, where he shot and killed a security guard, a teacher and five students before turning the gun on himself.
Weise had been treated for depression and had been taking the antidepressant Prozac. He had exhibited warning signs in drawings given to classmates and in online exchanges. But the failure to prevent his shooting spree led state officials to wonder if there was a better way to deliver mental-health care to the young.
The result: The state Department of Human Services offered grant money to medical institutions willing to seek a fresh approach to pediatric mental-health care. Applications came from across the state, and two were approved, said Marilyn Odean, program director of the Whiteside Institute for Clinical Research, a collaboration of St. Luke's and the University of Minnesota Medical School at Duluth.
One went to South Lake Pediatrics in the Twin Cities, the other to St. Luke's.
The St. Luke's model, originally funded for two years, is now in its third year after earning an extension, and it will continue through a fourth year. The grant is for $150,000 each year.
It introduces a collaboration of community agencies, led by St. Luke's and the Human Development Center, with a goal of identifying and treating childhood depression and other mental illnesses early. The program covers children ages 6 through 17.
"It's pretty much known that depression that's not adequately treated has a much higher recurrence risk over a lifetime," said Dr. Heather Winesett, a St. Luke's pediatrician who spearheaded writing the grant after being approached by Dr. Steve Sutherland, then with the HDC and now medical director at Amberwing.
During the first two years of the program, HDC psychiatrists offered training to St. Luke's pediatricians, met with them in two-hour "curbside consultations" to discuss mental-health issues that had arisen, and were available to treat children with particularly complex cases. The pediatricians were also introduced to a pediatric symptoms checklist that allows them to detect possible mental-health problems that otherwise might go unnoticed.
Although called the Childhood Depression Project, in practice it quickly expanded to include other mental illnesses, such as anxiety and attention deficit hyperactivity disorder, said Winesett and Krista Harju, patient care coordinator for St. Luke's Pediatric Associates. It also has been expanded to family-practice physicians at St. Luke's clinics.
The model introduces the team approach to medicine favored by the Affordable Care Act, said Dr. Steve Bauer, a child psychiatrist with the HDC. It also equips
primary-care doctors to diagnose and treat manymental-health ailments,
freeing psychiatrists for the more-complex cases.
That's important, because it can be hard to get a child in to a psychiatrist, Harju said.
"It can take months and months to get into child psychiatry," she said.
More than 1,200 pediatric symptoms checklists were completed last year, Odean said. The number of children screened was less than that, because some were screened more than once. Almost 10 percent of the screenings revealed possible mental-health issues, Odean said.
The issues can go beyond depression, and they don't just involve older children. For example, thoughts of self-harm can begin at a very young age, Winesett said.
"If you ask a lot of these kids ... the question: Have you ever thought of hurting yourself Then you'll get 'yes' answers from kids as young as 7 and 8," Winesett said.
If the state adapts the model, much of the consultation in rural areas probably will take place via video links, Bauer said. That's already happening to some extent. For example, Bauer consults monthly with a family-practice group in Grand Marais by video.
One thing is clear, those involved with the Childhood Depression Project say: The problem hasn't diminished since Red Lake. "It only keeps coming to light over and over again, unfortunately, with the acts of violence," Harju said.
The Aurora, Colo., movie theater shootings last summer and especially the Sandy Hook Elementary School shootings in Newtown, Conn., in December made discussion about mental health as prevalent as the talk about gun issues, Kalm said. Some such episodes years from now could be prevented by effective treatment now, he said.
"If we can give you the tools now, when you're 5 or 6 or 7 or 8 or 10 or 12, we can hopefully keep you out of a situation when you're 50 or 60 that might be ... like Newtown."
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