LEWISTON — Thirteen children have been taken to St. Mary’s Regional Medical Center’s behavioral emergency department in less than 48 hours, a number that officials there call “a sharp increase.”

But while that worries medical staff — children and teens go to the behavioral Emergency Department for severe depression, suicidal thoughts and other mental health crises — staff members are just as concerned about the children they aren’t seeing.

They fear this week’s suicide of 13-year-old Lewiston middle school student Anie Graham may prompt other children to consider killing themselves.  

“I think this whole community’s in crisis. You can feel that. I felt it last night,” said Paul Rouleau, who is director of behavioral operations at St. Mary’s and Community Clinical Services in Lewiston and who attended Thursday’s community forum on teen suicide. “If it’s a real emergent thing, don’t be bashful. Come to the emergency department,” he said.

Anie killed herself Tuesday after what her parents said was a long battle with depression and a lengthy struggle to find help. Her death shocked the community and horrified her classmates and their parents.

On Wednesday morning, more than 30 students skipped class and gathered outside Lewiston Middle School to protest what they’ve seen as the school’s lack of response to bullying and students in crisis. On Thursday night, more than 200 people packed a community forum to share grief and personal stories about suicide and to plead for something to be done.

Anie’s parents said this week that they struggled to find help for their daughter for months, calling Maine’s mental health system “fragmented” and “broken.” They said the school didn’t help enough, St. Mary’s released her two months ago without admitting her and Tri-Country Mental Health Services in Lewiston couldn’t make an appointment for three weeks and then canceled the one it did schedule.

After Anie wrote a note in school Monday that read “I want to kill myself,” her parents said her pediatrician that day did little but chat with Anie, told them St. Mary’s teen program no longer existed and said he’d see if there was something in Brunswick that might help.

Her father found her dead in her room the next day.

On Friday, after “a very powerful evening” at the community forum, Lewiston Superintendent Bill Webster told the Sun Journal he plans to improve his schools’ anti-bullying efforts and review staff protocols around suicide threats.

“It wasn’t that (Anie’s) parents didn’t know that there were issues, and perhaps even risk, and then they left the school with that knowledge, then they made a stop at the doctor’s office,” Webster said. “Would there have been a different outcome here, or might there be a different outcome in the future, with a more integrated response? I don’t know enough of what that might be or what that could be, but I do want to ensure that we have a dialogue that explores those possibilities.”

Webster said it’s not uncommon for staff on Monday morning to spend time “taking care of some of the fallout that’s happened over the weekend from social media posts. That’s an issue for students, an issue for staff but also a big issue for parents. I’m hoping to get some information fairly soon so we can pursue something — that could be another community forum, sharing information, and it might also be some changes to how we do things in terms of student trainings in schools.”

Rouleau told the Sun Journal on Friday that St. Mary’s hopes to restart its shuttered intensive outpatient program for teenagers. The program, which is less restrictive than a hospital stay but more intense than outpatient therapy, provides hours of daily counseling and regular sessions with parents so that “if someone is not doing well, we can catch it ahead of time, intervene at the time.”

St. Mary’s runs such programs for children up to age 12 and for adults 18 and older. It has not had a teen program since about 2012, when it closed for a lack of child psychiatrists.

Rouleau believes there is no such program for teens now in the state. He said St. Mary’s has been considering restarting the program for at least a couple of years. A new doctor is starting in July and the hospital plans to talk with her about it.

“Oh, yes, we have a need,” he said. 

Rouleau said he wasn’t able to comment on specific situations, including Anie’s parents’ assertion that St. Mary’s failed to admit her two months ago even though she was threatening suicide.

Tri-County spokeswoman Nicole Pollock declined to comment on the Graham family’s claims related to their difficulty getting an appointment there.

“We’re just going to let the family grieve,” she said.

She would say that it’s typically pretty easy to schedule appointments with Tri-County counselors, even when the client is a teenager.

“It’s usually just trying to figure out the schedule between the client needs,” she said. “We have a pretty solid staff, over 400 people.”

Greg Marley, clinical director of NAMI Maine, moderated the community forum on Thursday night. He also provides training and support under the Maine Suicide Prevention Program.

On Friday, he gave the school credit for holding the forum and recognizing the power of listening.

“My takeaway is kudos to the school for having an open ear and not feeling they had to defend their stance or actions at that event,” Marley said. “I feel like they have some real openness to move forward and make changes based on what they hear and what they know, responding to the need. Last night’s conversation was the first step and the next steps are what’s important. There were some hard stories and hard feelings.”

It’s important to keep in mind while wading through the shock of a death like Anie’s that it’s easy to want to blame one thing or find one problem to fix, but “suicide is almost invariably more complex than that,” Marley said.

Rouleau said parents should be particularly vigilant in the coming days as children grieve Anie’s death and, possibly, deal with their own depression or feelings of suicide. Parents, he said, should watch for behavior that is out of the ordinary for their child and should make sure their child knows they are available to talk.

“You have to have a conversation about, ‘Are you safe?'” he said. “If somebody says they’re suicidal, I would take that at face value and have them assessed.”

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A family portrait hangs on the wall at the home of Rosie and C. Matt Graham. In the photo is their son, Moses, and daughter, Anie, who took her life Tuesday. The Grahams said area mental health services weren’t available to help their daughter.

More coverage:

The Lewiston School Department has sent letters to parents advising them about mental health resources and detailing the kinds of behavior they should be concerned about in their kids.

Some of the worrisome behaviors include:

• Dangerous risk-taking (climbing too high, driving too fast, not being afraid)

• Threatening to hurt self or others

• Self-destructive behaviors (drug use, promiscuity, hurting or hitting self)

• Violent play

• Total withdrawal from people and environment

• A dramatic change in personality or functioning over a long period of time

Behaviors that may mean a child is at risk for suicide:

• Saying “I want to kill myself” or “I wish I were dead.”

• Apathy about things they used to care about

• Drug or alcohol abuse

• Showing interest in violent acts or how others have killed themselves

• Writing notes to friends about suicide

• Giving away valued possessions

• Asking questions about guns or medications

• Asking a friend about a suicide pact.

Resources:

• Tri-County Mental Health crisis outreach: 783-4680

• St. Mary’s Psychiatric Emergency Department: 777-8700

• Maine Statewide Crisis Line: 1-888-568-1112

• Statewide community resources: 211 or visit 211.org

• National Suicide Prevention Hotline: 1-800-273-TALK (8255)


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