Suicide is one of the three leading causes of death among adolescents behind accidents and homicide.
Many suicidal teens are successfully treated for depression and other mental disorders.
But in a few instances, outpatient care or even weeks in a hospital will not improve their condition.
They need a long term residential facility.
NHPR's Kerry Grens has the story of one family's discovery that in New Hampshire, these places don't exist.
The Blaine's picturesque farm house sits atop a hill in Plymouth, surrounded by acres of forest and views of neighboring mountains.
[birds and blaine talking]
[sounds walking into house]
It's dinnertime.
Inside the smell of baked ziti fills the kitchen - a meal one friend of Jane Blaine had brought over earlier.
Jane Blaine: I have a really good friend, one of my three generals as I call them. She said, look, we can't all send the food over all at once. So she coordinated this and like two or three times a week people bring food over. Still.
Friends of Jane and Larry Blaine have been bringing them meals for two months, ever since their daughter committed suicide.
She was seventeen.
Her death came after six years of eating disorders and depression.
Emily was anorexic by the time she was in seventh grade.
Her father, Larry Blaine, says in high school her condition worsened.
Larry Blaine: She just started to fall apart at about that time. It wasn't just her eating disorder, she began to fall apart in other ways, which at first we thought were typical early teenage behavior, but they became worse and worse and worse and we could not find any way to help her.
Jane Blaine: That whole summer prior to her junior year was not a good summer. It's hard now to remember, but again, she was basically isolated, wouldn't you say, Larry? She didn't call people, or wouldn't call them back if they called her. And it was in October that she came down one morning and said Mom I've just taken a bottle of aspirin.
It was clear to Mrs. Blaine how serious her daughter's condition had become.
After this first attempt, Emily spent five days in a psychiatric hospital.
She came home, and within a month she tried to kill herself again.
The hospital kept her for a few days and sent her home.
It was a pattern Mrs. Blaine would come to know well.
Jane Blaine: When we would object to her being released they would say, well, she's stabilized now. That seemed to be the word: stabilized, which basically means she's not throwing a fit.
The Blaines took on the unsuccessful task to find a place that could keep Emily for long term treatment.
But psychiatric treatment space of any sort for adolescents is scarce and becoming scarcer.
Dr. Kenneth Brown is the medical director at Hampstead psychiatric hospital.
Brown: In the ten years or so that I've been here I've seen in the east a child program close in Portsmouth I've seen to the West in Nashua a child program close'talking in patient hospitalization. So this is it for southern New Hampshire except for Keene.
And that's just for short term treatment.
For longer stays, there's nothing.
Dr. Eric Vance is a psychiatrist at Seacoast Mental Health Center in Exeter.
He provides outpatient care to adolescents, and he recognizes the holes in the system.
Vance: There are kids for whom those brief hospitalizations aren't sufficient and they have such severe depression or recurrent depression they would be better treated in longer term residential facilities. But it's not always possible to keep even a very severely depressed or persistently depressed person in the hospital for any significant length of time.
Dr. Vance and Dr. Brown say hospital stays are kept short by the stringent criteria a patient must meet for insurance companies to pay for in-patient care.
By these standards, if Emily wasn't immediately suicidal, she belonged in out patient care.
For most children, this works well.
But for Emily, the Blaines saw no progress.
Finding no long term care in New Hampshire, they broadened their search to Massachusetts.
They took out a loan, and paid thirty thousand dollars for four weeks of treatment at a hospital in Belmont.
Mrs. Blaine says even that hospital wasn't ready to keep Emily because her suicide attempts while she was there required medical attention only an acute hospital could provide.
By this point the Blaines had learned that not only was there no space to take someone like Emily, but no financial support either.
By most standards, the Blaines have a generous insurance plan through Cigna.
But it doesn't cover long term hospitalization.
Cigna officials wouldn't comment, but according to Anne Grossi at Behavioral Health Network in Concord, the Blaines couldn't have bought long term hospitalization coverage if they tried.
BHN manages mental health benefits for a number of companies, though not for Cigna.
Grossi: Insurance doesn't provide for long term care. No matter where you are, I'm sure probably no matter what state you're in, no matter what plan it is, there is nothing for long term residential care. Insurance provides for short term acute care.
Terry Sturke from BHN adds that insurance is expensive enough as it is without adding a long term component.
Sturke: And I think people need to move away from the perception that it's an entitlement. Unless we want to pay these unbelievable prices far beyond what we pay now for coverage of every possible thing.
Without insurance coverage, without a place to treat their daughter, the Blaines brought Emily home, where her condition worsened.
Larry Blaine: She was subject to violent and completely uncontrollable rages from time to time. We had the police come to the house I don't know how many times, probably a dozen times. And these rages became more and more serious.
In an odd way, Emily's violence actually opened the door to new options for residential treatment'through the courts.
The Blaines petitioned the court to intervene, and Emily was ordered to spend six weeks at a home for delinquent children.
But Mrs. Blaine says that home clearly wasn't up to the task.
Within a few hours of her arrival, Emily escaped.
When the police picked her up she attacked an officer.
Mrs. Blaine says the group home wouldn't take her back.
At home, there were more suicide attempts, and more attacks on her parents.
On March 25th this year, Emily was determined to complete her suicide.
Larry Blaine: She drove as far as she could down a logging road to make sure she would not be seen. Stopped the car there and that's all I'll say. She killed herself.
Jane Blaine doesn't know if any place, even one that could have kept Emily for months, would have saved her child.
All she knows is she never had a chance to find out.
Jane Blaine: I think there were very few people we encountered that we could say, you're not doing your job. They were doing what they could. What they were allowed to do. But what she needed wasn't there. And what a lot of girls need, and boys, isn't there.
For NHPR News this is KG.
