A cluster of Iowa youth suicides worries health officials

Late last year, over a two-month period, five children in Polk County died by suicide.

In December 2021, the county medical examiner reported one child who died by suicide. Then January comes, and four more occur. Two were 12 years old, one was 13 and one was 16. The youngest was just 10 years old.

These five youth suicides alarmed mental health providers and advocates — and not just for Polk County.

“We were the canary in the coal mine. If it’s going on in Polk County, it’s going on everywhere,” said Liz Cox, executive director of Polk County Health Services.

The Iowa Department of Public Health, in partnership with Polk County public health officials, formally requested assistance from the U.S. Centers for Disease Control and Prevention to study patterns and offer insight on how to respond.

At the same time, officials involved with community-based mental and behavioral health services took a closer look at the state of Iowa’s crisis response services for youth at a regional and local level. Some gaps were identified, particularly around education and awareness for suicidal ideation among youth, Cox said.

Increased access to mental health care was identified in Iowa before COVID-19, but the pandemic has exacerbated that demand as more youth — as well as adults — grapple with the elevated stress, anxiety and depression during the pandemic.

“The increase in prevalence of behavioral health problems has coincided with severe disruptions in services, leaving gaps in care for those who need it most,” IDPH spokeswoman Sarah Ekstrand said. “From the state’s perspective, we are seeing both an increased need for services combined with young kids who need a more acute level of care or crisis stabilization.”

How did we get here?

Over the past two years, children were more socially isolated — missing out on school, sporting events and other activities — during a critical period of development. In addition, many faced added stress throughout the pandemic, concerned about a parent’s job loss or worried about loved ones who became seriously ill from COVID-19.

This has culminated in higher rates of anxiety and depression among those under the age of 18, as well as additional behavioral health challenges noted by parents and school districts across the state, said Peggy Huppert, executive director of the non-profit NAMI Iowa.

“There’s been a collective societal trauma,” Huppert said.

It’s clear the pandemic added stressors to American children. A 2021 federal survey showed nearly 20 percent of students reported they seriously considered suicide and 9 percent reported having attempted suicide in the past year. That’s on top of the 44 percent who reported persistently feeling sad or hopeless during the past 12 months.

The full scope of what may be happening in Iowa still is unclear. Data that could measure the pandemic’s toll is not yet available from state public health officials.

However, officials at the Eastern Iowa not-for-profit service provider Foundation 2 believe there’s a connection with the Polk County cluster and the increase in need for services locally.

“There’s been an increase in suicidal ideation in youth, but there’s no data yet that confirms suicides among youth themselves escalated,” said Lejla Ford, mobile crisis outreach and crisis stabilization community-based services, or CSCBS, program manager at Foundation 2.

Foundation 2’s mobile crisis unit, which dispatches counselors 24/7 to help those in need, saw a significant dip in mobile crisis clients during the first half of the pandemic, with totals reaching just 255 in 2020, Ford said. By comparison, the crisis line served 523 youth in 2019.

Ford said that’s likely because children had fewer eyes on them from other concerned adults, such as teachers or coaches. She said things are ramping back up, with 412 youth served by the mobile crisis unit in 2021.

However, experts have pointed out this trend of suicide-related behaviors among youth predated the pandemic. A 2018 Iowa Youth Survey showed thoughts of suicide and having a plan to attempt suicide increased 53 percent among young residents between 2012 and 2018.

Gov. Kim Reynolds signed a law in 2019 that created the state’s Children’s Mental Health System and established requirements for core services for young Iowans, including regional crisis stabilization and mobile response teams.

“It was just getting going when the pandemic hit,” Huppert said. “That slowed things down considerably, unfortunately.”

How is Iowa responding?

State officials say behavioral health was identified as a major focus in the effort to merge the state departments of public health and human services, according to IDPH’s Ekstrand. Part of that effort includes data and systems integration to “build a pathway toward equitable services for Iowans,” she said.

“We are invested in a future state, where we can analyze our data in real time and use it to drive resources, prevention and intervention to Iowans with behavioral health needs,” she said.

The state public health department also launched a campaign earlier this year with messaging tailored to young Iowans who are struggling and to the influential adults in their lives. The campaign is part of Your Life Iowa, the 24/7 text and chat helpline that offers access to counselors for immediate support and referrals to treatment options.

The East Central region of the state’s Mental Health and Disability Service regions recently hired a children’s coordinator and a children’s navigator, positions focused on ensuring response times and getting children to services seamlessly, said Mae Hingtgen, the region’s chief executive officer.

“Our perspective at the region is that it’s important that people of any age group realize that it’s OK to need help, and help is available,” Hingtgen said.

Much of the new children’s navigator’s work is connecting directly with school districts across the region’s nine-county area, educating officials on how to access regional funds to boost mental and behavioral health services within its schools. That region, which includes Linn and Johnson counties, is the state’s largest Mental Health and Disability region.

As students have returned to in-person classes, the Cedar Rapids-based crisis center Foundation 2 is working to address this increasing need through its J-FAST program — the Juvenile and Family Assistance and Stabilization program.

Since its launch in 2019, the program has diverted students from hospitals or long-term committal. Children at risk for suicide receive a mental health assessment within 24 hours of contact and receive follow-up appointments to get help, said Sydney Carpintero, youth services coordinator with mobile crisis outreach.

However, staffing continues to be a major challenge for mental health and behavioral health care, creating a major barrier for youth and their families seeking services.

“We have a lot of ground to make up for,” Huppert said. “We have a lot of ground to cover. We had it two years ago, and then the pandemic delayed us and made things worse. So now we have even more ground to cover.”

Illustration By Laurie Harker

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