Jersey, 17, recalled when a taco on TV provoked his brain to spiral.
"Taco," he said to himself.
Followed by "Beef … Cow … Cow gets slaughtered … Cow dies."
"Oh, dang, so will I," Jersey said out loud. "I'm going to die, and I don't know when."
For eight years, Jersey's brain twisted his thoughts, connecting random, everyday objects to death. "Every night and a couple times a day, I'd get this same feeling of fear, of pure dread," said Jersey (not his real name).
He also suffered from debilitating chest pains and headaches. "I had no control when they'd happen. Anything - literally anything - triggered my bad feelings."
The lack of control he felt about death caused him to attempt suicide two times.
Jersey said he might have tried to kill himself again if he hadn't entered Adolescent Dialectical Behavioral Therapy for Adolescents in the Collaborative Network for Overcoming Emotional Challenges, Crisis and Trauma (CONNECT) in the WashU Medicine Department of Psychiatry's Division of Child & Adolescent Psychiatry.
CONNECT encompasses research-backed, holistic services and evidence-based practices for preteens and teenagers suffering from untreated trauma-related disorders, pervasive emotion dysregulation and suicidal behavior. "WashU Medicine is addressing a mental health crisis among young people in our community," said Cynthia E. Rogers, MD, the Blanche F. Ittleson Professor of Psychiatry and director of the Division of Child & Adolescent Psychiatry. "The need for adolescent psychiatric services is higher than ever and shows no signs of slowing. The good news is that these conditions are especially responsive to timely, evidence-based interventions like the ones we have in this program."
CONNECT provides swift patient care by streamlining the division's clinical services to a one-stop place to receive services ranging from short-term psychiatric care to comprehensive trauma treatment and evidence-based treatment for pervasive thoughts about suicide or self-harm and other high-risk behaviors for adolescents. It also provides case management and supportive services to caregivers.
Its debut parallels that of St. Louis Children's and KVC Health Systems new mental health hospital and intensive outpatient center slated to open later this year. St. Louis Children's, part of BJC Health System, is staffed by WashU Medicine physicians. The CONNECT program will integrate with the new center to provide a continuity of care for youth mental health.
A centralized place for the most current treatments
By all accounts, programs like CONNECT prove crucial in addressing what the American Academy of Pediatrics and the U.S. Surgeon General have called an unprecedented mental health crisis in young people. According to federal data, in 2021, nearly 57% of teenage girls and 29% of teenage boys reported feeling persistently sad or hopeless. Suicide is the second leading cause of death for people ages 10 to 14.
"Adolescent mood disorders present complicated, life-threatening consequences and, while they may seem insurmountable to patients and their families, they are very treatable, especially when high-quality treatment is started early," said Rogers, the child-psychiatrist-in-chief at St. Louis Children's Hospital, where many adolescents are initially treated for mental health disorders. "WashU Medicine clinicians have the tools to stop - or at least drastically alter - debilitating outcomes not just in the short-term but across the patient's life by decreasing risks such as suicide attempts and substance abuse disorders."
As a national leader in child and adolescent psychiatry, WashU Medicine is positioned to provide high-quality care unparalleled in the region by targeting the biological and environmental factors contributing to adolescents' emotional state and stability, said Eric J. Lenze, MD, the Wallace and Lucille Renard Professor of Psychiatry and head of the WashU Medicine Department of Psychiatry.
"Our clinical programs are among the best due to WashU Medicine's commitment to academic medicine, in which clinical care, research and education are inextricably linked to symbiotic relationships," Lenze said. "When families use our programs, they can be confident that they are receiving the most current, comprehensive and research-based treatments available. Our clinics leverage the cutting-edge research and medical resources of WashU Medicine and St. Louis Children's Hospital."
A multi-pronged approach
Private philanthropy has played a critical role in strengthening WashU Medicine's adolescent psychiatric services. An anonymous donor made a $10 million gift to establish and endow CONNECT, uniting three specialized programs into one coordinated effort: the Bridge Program, the Trauma Response Program and the Adolescent Dialectical Behavioral Therapy and Family Resiliency Program. Additional funding for CONNECT was provided by Jackie and Randy Baker, who created a spendable fund to address the program's immediate needs.
Often, outpatient psychiatric care starts through the Bridge Program, which offers transitional care to adolescents who have been treated for a suicide attempt or other mental health crisis in an inpatient center or, more commonly, a hospital emergency room. In the past year alone, the Bridge Clinic has treated adolescents from 30 counties in Missouri and Illinois.
While a hospital stay is often lifesaving for adolescents in crisis, it can lead to what health-care providers call "boarding." This occurs when patients remain in the emergency room for weeks or months because they may lack resources for the care they need. Health-care providers aim to avoid delays because research has shown that receiving treatment within two weeks of an emergency room visit can decrease the risk of repeated psychiatric stays and hospitalizations.
Via CONNECT, patients in the Bridge Program receive a dedicated interdisciplinary team of health-care workers who ensure timely care management and intensive treatment. Adolescents may participate in one, two or three of the programs, depending on their evolving needs.
"Many times, families and pediatricians know a child needs help, but they're uncertain what type of help or how to access it," said T. Eric Spiegel, MD, a WashU Medicine professor of psychiatry and associate division director of child and adolescent psychiatry. "CONNECT allows families to have one point of contact with WashU Medicine and St. Louis Children's, and the psychiatric services to eliminate delays and deliver the appropriate treatment." For psychiatric providers, the program encourages collaboration among team members, ensuring everyone is aligned and striving toward clear treatment goals.
The Trauma Response Program has served more than 2,000 patients and their families since before the pandemic, while the number of referrals has increased significantly during the same period. The American Psychological Association defines trauma as an emotional response to a one-time event, such as experiencing a car accident or natural disaster, as well as suffering chronic episodes like physical or sexual abuse, living in a violent or war-torn community or bullying. Living with trauma is a risk factor for multiple mental health diagnoses and mood disorders, including depression, post-traumatic stress disorder, psychosis and substance use disorders.
Similarly, the dialectical behavioral therapy program is in high demand. It started two years ago and already has received more than 400 referrals. As one of the best evidence-based treatments for suicide and self-harm, dialectical behavioral therapy helps teens experiencing severe mood disorders, including posttraumatic stress disorder, major depressive disorder and anxiety disorders.
Typically, the therapy consists of year-long treatment encompassing weekly individual therapy, the availability of 24/7 crisis coaching from therapists, and a skills group for the teen and one caregiver. The leading evidence-based treatment for suicide and pervasive emotion dysregulation, DBT provides skills in mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance.
Finding happiness
Dialectical behavioral therapy's focus on distress tolerance has proven to be a highly effective treatment for Jersey, said Josh Jones, a licensed clinical social worker and a dialectical behavioral therapist in the program who works with patients like Jersey.
Much of learning how to tolerate distressing emotions, situations, conversations and thoughts centers around being uncomfortable. "Part of what we teach in dialectical behavioral therapy is that pain is a part of being alive and how to learn to accept it," Jones said. "Accepting doesn't mean you have to like it. Rather, it's acknowledging the reality of it and adjusting our behavior to the reality."
The therapy entails many steps, conversations and unpleasant emotions. Jones said navigating the pain involves defining and distinguishing between facts and judgments, exploring the feelings associated with each one, and experiencing emotions - no matter how scary - and surviving the discomfort as a way to make peace with their feelings.
For Jersey, that meant acknowledging that he will die no matter what. Within that reality, Jersey learned to hold two truths in one space: his loss of control related to death and his ability to find joy in the activities he likes to do, such as foraging for edible mushrooms and berries in the woods; identifying flora and fauna, including insects; building a computer from scratch; or writing about his mental health struggles, which he hopes to turn into a children's book to help kids.
"I am still very afraid of having no control over my death," Jersey said. "But my therapy has helped me realize that death is fixed. I can't pray it away no matter how hard I try. And if I were to die by my own hands, then I wouldn't be able to feel happiness. It's such a relief to finally know happiness."
Originally published on the WashU Medicine website
