While every student in every school faces a different set of challenges, after visiting roughly 370 schools over the past six years, John Broderick, a former chief justice of the New Hampshire Supreme Court, has seen some recurring themes.
“What I’ve realized over time, six years, is how many kids, one in five at least, have a mental health challenge, and they want to share it with someone,” Broderick said. “And I happen to be the person there who’s willing to listen. Who won’t judge them or shame them or blame them. I validate to them that it’s OK not to be OK. It’s just not OK to pretend you’re OK.”
Barbara Van Dahlen, a world-renowned clinical psychologist, had just launched the “Campaign to Change Direction,” an effort to make the five signs of mental distress (withdrawal, agitation, hopelessness, decline in personal care and change in personality) as recognizable as those of a heart attack or a stroke.
She approached Bill Gunn, then a psychologist at Concord Hospital, and suggested the campaign launch in New Hampshire. Gunn reached out to Broderick and asked him to help lead the effort.
In his book, “Back Roads and Highways: My Journey to Discovery on Mental Health,” Broderick reflects that Gunn contacted him in part because his family had endured a very public mental health crisis in 2002.
As the Associated Press reported: “In 2002, Broderick’s 30-year-old son attacked him with a guitar while he slept. Broderick said his son had shown signs of mental illness as early as age 13, but it wasn’t until he spent three years in prison that he got the help and medication he needed to treat his depression and anxiety.”
In his book, Broderick writes that he had been in denial about his family’s trauma.
“It had been a long time since our family had begun its steep descent into hopelessness,” Broderick writes. “After agonizing years of struggle, self-doubt, despair, self-blame, and embarrassment we had re-emerged whole. We were weakened and vulnerable to be sure, but we had somehow survived. We were still a family. We had clawed our way back.
“But I knew in my attempt to return to my everyday life that I had papered over some of the toughest and most devastating memories of those years; memories of endless days and nights when our lives were held prisoner to worry and regret.”
Both Broderick and his wife, Patti, went forward with the project knowing it would unearth painful memories, because they believed that others might benefit from hearing their story.
“Maybe the campaign will bring purpose to our suffering,” Patti says in Broderick’s book. “Maybe our tale will be a wake-up call for other parents.”
Broderick wrote that both he and Patti thought telling their story might give them a chance to paint a more complete picture of their son “as the person he was and not just as some afflicted stick figure who had injured his father and gone to prison. I knew who he was and wanted others to know that person, too.”
‘We need to speak up’
Conquering self-doubts, in May 2016 Broderick launched the campaign in Representatives Hall at the State House in Concord.
To the state’s congressional delegation, governor, state legislators, judges, educators, medical professionals, law enforcement, religious leaders and other stakeholders, Broderick said: “Mental illness has taken many of us in this room and those we love on a journey none of us could have ever expected,” the Associated Press reported.
“I’ve learned the hard lessons as have my son and my wife and my family, and I don’t stand here today to be at all self-righteous, because if I could have, I would’ve hidden our family’s problems, too.
“We need to speak up,” Broderick said. “It’s about time, and we are here, and we are going to fight this fight very publicly.”
Van Dahlen, who also spoke at the kickoff event, asked that anyone whose life had not been touched by mental illness raise their hand. Not a single hand went up.
When Broderick asked her about this afterward, she told him: “‘It happens in every room where I ask the question, John. Just because people don’t talk about mental illness, doesn’t mean people and families aren’t dealing with it.’”
Shortly after the presentation, NEA-NH, a statewide teachers union, contacted Broderick and asked him to speak to a plenary session at a workshop for teachers of all grade levels.
Broderick writes that teachers are aware of student mental health struggles from firsthand experience as well as the Youth Risk Behavioral Surveys conducted since the 1990s by the Centers for Disease Control. Those surveys showed “an alarming number of high school students were depressed; engaging in non-lethal self-harm, and giving ‘serious consideration’ to suicide.”
“Similarly disturbing,” he wrote, “was the percentage of students who ‘had made plans in the last 12 months’ to take their own lives. The rate of teen suicide was also increasing at an alarming rate.”
U.S. Surgeon General Vivek Murthy offers similar statistics in his 2021 Advisory on Protecting Youth Mental Health.
“In 2019, one in three high school students and half of female students reported persistent feelings of sadness or hopelessness, an overall increase of 40% from 2009,” Murthy wrote.
Broderick writes that in the years to come: “The disturbing statistics I read about would, in time, have names, faces and dreams.”
As he heard students’ stories, he became determined to do something about it.
Those observations were made before the coronavirus pandemic. From the first lockdowns in March 2020 until this moment, the existing youth mental health crisis has grown worse.
‘More depression and anxiety’
Jodie Lubarsky, vice president of clinical operations for youth and family services at Seacoast Mental Health Center, reports seeing increased rates of depression and anxiety among young people served by the center.
“Prior to the pandemic, we would see the slow emergence of symptoms come on,” Lubarsky said. “You might see some slight changes in a young person not doing as well in school, isolating from friends, disengaging from preferred activities. And it’s almost as if kids in some ways have gone from 0 to 100. The symptoms just grow in severity incredibly fast. We’re seeing higher acuity and kids who just don’t know how to cope or manage with the feelings they’re having.”
Dr. William Torrey, who has seen a similar rise in cases at Dartmouth, points to several studies showing a correlation between the rise in adolescent mental health problems and the ubiquity of social media.
“Adolescents are struggling more with depression and anxiety than they were 10 years ago and (studies show) the jump in depression, anxiety and suicidal thoughts went up right at the same time as people started getting on social media a lot more,” Torrey said.
“What we have seen in clinical care is more adolescents in the emergency room and more adolescents looking like they are not safe to go home from the emergency room and requiring hospitalization,” Torrey said.
In an interview at the opening of the 99 Faces Project exhibit at Dover High School on May 11, a 16-year-old high school junior said she was sent to the emergency room at a local hospital by her primary care physician after expressing suicidal thoughts and feelings of severe depression.
“He basically said, ‘You can willingly go to the ER or I can section (involuntarily commit) you,’” she said.
She considered herself “lucky” because she was in the emergency department for just two days before a bed opened at Hampstead Hospital, the only hospital in the state that provides psychiatric services for children. Some children are held in emergency rooms for days and even weeks before a bed opens.
Here’s how the student described the emergency department room where she was held:
“Everything is very beige. It’s almost like they think the colors will harm you. All you have is a bed in the center of the room and you can see the ties where they can restrain you on the side and there’s a chair that probably weighs 80 pounds and there’s a bedside table that’s cemented to the floor. There’s a tiny, tiny TV with just two channels up in the corner inside a box and sometimes you can have a golf pencil.”
‘Their first change of life’
New Hampshire’s Department of Health and Human Services publishes “designated receiving facility data” on its website, which shows how many beds are available in the state for involuntary commitments on any given day. On May 11, for example, all 16 DRF beds at Hampstead Hospital were filled and six children were waiting for placement.
The state recently purchased Hampstead Hospital, which right now has 45 to 50 active beds, according to Jake Leon at the New Hampshire Department of Health and Human Services.
“Hampstead was licensed for 111 beds, but it has never been a realistic census since many of those beds are triples and quads, which are not as therapeutically appropriate as singles and doubles,” Leon said.
Leon said that once DHHS takes over operations at Hampstead, it plans to expand bed capacity, with a minimum 55 beds initially and a minimum 65 within a year.
Torrey acknowledged the state’s efforts while reiterating the lack of beds.
“They clearly want to do it (increase beds for children) and they are working toward that, but there has not been adequate capacity in Vermont or New Hampshire for children,” Torrey said.
While the pandemic also impacted the mental health of adults, Lubarsky said, children and young adults were hit particularly hard.
“For those of us with lived experience in our adult lives we had encountered some sort of change of life before,” Lubarsky said. “We had the opportunity to go through changes or adaptations or adjustments and we pulled from our tool boxes or had those supports that we could lean upon. For a lot of our young people, this was their first change of life.
“Going into a state of emergency in these unprecedented, unpredictable times, being isolated from peers, I think really put kids in a position of not being able to manage this unknown scenario.”
Lubarsky said the social isolation also deprived children of a school-based support system.
“For a lot of our kids, their supports were at school,” Lubarsky said. “They might not have had a trusted adult at home or support system in their home environment and so not being in school took them away from guidance counselors and social workers, coaches, mentors and teachers who maybe they were getting a lot of support from.”
Whether speaking to students or adults, Broderick ends all his talks with a simple request for help.
“If I could change it myself, I would, but I can’t,” he writes. “But we could. We could. I hope I can count on your help. Together we could change and save lives. So many people are depending upon us.”