Crystal Wise
When they’re together, it’s difficult for them not to smile. After all, the two psychiatrists, Dr. Kristen Pyrc and Dr. Kia Carter, have been best friends since they started working together at Cook Children’s Medical Center in 2016. They josh around like a couple of old pals or siblings, frequently one-upping each other with quips and humorous self-deprecating remarks. So, the persistent grins are understandable.
But their expressions quickly straighten when I pose a specific question: “Why have the suicide rates among teens gone up?”
Few subjects are as difficult to discuss — or difficult to imagine. But the sudden serious looks on the doctors’ faces are not because of shock due to the subject matter. No, this is what this pair of psychiatrists do for a living. They don’t have to imagine anything. Both Dr. Pyrc and Dr. Carter are the co-medical directors of psychiatry at Cook Children’s — Pyrc leads the outpatient unit and Carter leads the inpatient unit (children admitted to the inpatient unit display an imminent risk to themselves or others). Talking about, combating, and even witnessing the aftermath of teen suicide and suicide attempts are a near everyday part of their lives.
At one point during our hour-long interview, Carter mentioned that she had received a text message about a kid who had just posted a video, a goodbye video, as Carter called it, on TikTok. This was the Friday before spring break.
I continue my earlier question with earnestness turned to a 10. “I mean, since the pandemic, [teen suicide] has been a real problem. It’s almost like its own pandemic, right?”
Suicide attempts among U.S. youth (aged 15 to 24) did increase 8% in the two years (2020 and 2021) during the pandemic, according to the American Foundation for Suicide Prevention. Even Cook Children’s saw a significant uptick in the number of kids they had admitted for suicide attempts, reaching 434 attempts in 2021 — the most in the hospital’s history by 140 attempts.
And it doesn’t take a leap away from logic for this to add up. After all, regardless of one’s age or geographic location, feelings of isolation, fear, and uncertainty became universal in the wake of COVID-19. The mental health of the world as a whole had seen better days.
But for those in the thick of growing, learning, and gaining an understanding of the world and one’s place in it, you know, teens, one could imagine the effects of the pandemic being even more severe.
“I’d like to correct that, though,” Carter responds to my question. “The suicide numbers were increasing before the pandemic.”
True. I fell for a common misconception and placed too much blame on the pandemic’s disruption of social development. The increase doesn’t fall squarely on the shoulders of COVID-19.
According to the AFSP, suicide rates have been on an upward trajectory since 1999, when they hit an all-time low. The trend is true for Texas, as well. And suicides among 13- and 14-year-olds doubled between 2008 and 2018. A 2023 study conducted by Pew found that 22% of high school students “said they had seriously considered suicide within the past year.”
So, I return to my earlier question. Why?
Well, according to Pyrc and Carter, there’s no one reason. Much like I was quick to place blame on COVID-19, it’s just as easy to point fingers at social media, bullying, access to disturbing content and guns, global unease, and absent parents, each of which can lead to feelings of hopelessness and despair and can result in suicidal ideation.
Progress and advancements in communication and feeding our economic machine have had their drawbacks. We now live in an era where triggers for mental health disorders are innumerable.
Add to this a lack of pediatric mental health resources and infrastructure, and you have a perfect storm. Mental health resources — psychiatrists, facilities, programs — in Texas are far from matching their increased demand.
“Child psychiatrists are in really short supply,” Pyrc says. “If your kid’s struggling, a parent may call, and the psychiatrist won’t be able to get them in for six months. When your kid’s struggling, they need to be seen in six days. This shortage is what’s led to so much of the deterioration in kiddos’ mental health. It’s a lack of mental health resources.”
According to the American Academy of Child and Adolescent Psychiatry, the country needs 47 child psychiatrists per 100,000 children aged 0 to 19. The U.S. currently sits at 9.75 child psychiatrists per 100,000.
Taking matters into their own hands, Dr. Carter has testified “two or three times now” at the Texas State Capitol in front of the appropriations committee advocating for an increase in mental health resources for pediatrics. Pyrc and Carter are also in the midst of planning and creating the Behavioral Health Assessment Center — “One of our ideas we hatched,” says Pyrc — a program aimed at drastically decreasing teen suicide attempts by improving Cook Children’s outpatient resources so they can see and assess more children. As Pyrc alluded to earlier, ensuring children are seen within six days, not six months.
Pyrc and Carter are both advocates and innovators, fighting for resources while simultaneously using their ingenuity to improve results regardless of those resources.
You can’t take away smart phones. Bullies will always exist. You can’t rid the world of the things that might cause suicidal ideation. But you can seek ways to better help those in need.
Perhaps I’m asking the wrong question. I shouldn’t be wondering why. I should be asking what can be done.
Crystal Wise
“Phones,” Pyrc says when asked what the biggest barrier is to a parent understanding their child’s mental health. And she’s not only talking about children on their phones, she’s talking about parents, too.
“Everybody’s on their phone. They’re distracted, and they’re distracted from their kid, as well. And their kids are on their phone, and they’re not really interested in what their kid is looking at on their phone.”
There’s a litany of studies that dive into how phone screen time impacts one’s quality of life, and they all come to the same conclusion: It does.
A Yale School of Medicine study from last year reported that, among children ages 9 and 10, digital technology directly correlated to the likelihood of developing depression and anxiety within a couple of years.
Despite this, according to a Common Sense Census report, phone usage is up 17% among teens between 2019 and 2021.
And what are they up to on these devices?
According to a 2023 Gallup poll, teens spend nearly five hours a day (4.8 average) on social media. That’s an hour longer than the running time of “Lawrence of Arabia.”
And a 2021 Youth Risk Behavior Survey from the CDC provides some insight into how that time on social media is impacting children.
According to the survey, 16% of high school students said they were bullied through text or social media in the past year. One in three girls said they felt bad about their bodies when using TikTok, Instagram, or Snapchat. And nearly half of teens surveyed blamed their overuse of social media on an increase in anxiety, stress, and depression.
On the flip side, mobile devices can be equally detrimental to parents and the parents’ parenting, which, by extension, is also detrimental to their kids. Pew Research Center reported in 2020 that 68% of parents say they are at least sometimes distracted by their phone when spending time with their children.
Both Pyrc and Carter are parents, Pyrc to a 9- and 5-year-old and Carter to a 14-year-old. So, they’re well aware of the hardships that come with parenting. And when they give advice, they often use experiences with their own children as examples.
Their main advice for parents is simple, but they’re also aware it isn’t always easy: talk to your kid and ask questions.
“So, I have a teenager,” Carter says. “When the pandemic hit, she’s dealing with social isolation. So, I start to wonder, is her hanging out in her room a concern? But, no, she was just being herself. But it’s important to have those conversations and being comfortable talking to your child about mental health. Ask them how they’re feeling. Are you having any sad thoughts? What are you watching on TikTok?
“As a parent, you won’t know unless you ask. You wouldn’t imagine how many kids get admitted to our inpatient unit for suicidal ideation, and the parent was clueless.”
Pyrc adds that a depressed teen won’t show the same signs as a depressed adult.
“Our heart attack in psychiatry is suicide. So, that’s the thing that we’re always trying to avoid,” Pyrc says. “Whenever an adult thinks about depression, they think about the person who can’t get out of bed, who’s really sad and crying. And that’s one way depression can manifest. Depression in a kid, however, would look different. They’re more likely to be really irritable and really grumpy. And the thing you look out for is loss of function. For instance, they really enjoyed playing soccer and were on the soccer team. And now, they don’t care if they do soccer anymore. And it’s not a big deal if they hang out with their friends or not. And for a teenager, that’s so important. Their friendships are often more important than their relationship with their parents.”
The difficulty, Pyrc admits, is that some of these behaviors come naturally to teenagers, making it difficult to distinguish between a moody teen and a youngster who’s battling depression. As a dear friend once told me, “Never in our lives do we experience more social pressure, and never are we more socially inept.” It’s easy to put up barriers during an awkward time.
“You want kiddos to be successful in school, in their relationships at home, and in their relationships in the community. And whenever those things aren’t happening, that’s when we get worried.”
The way Pyrc puts it, kids don’t exist in a vacuum. When a psychiatrist sees a child, they address what’s going on in the kid’s school and family. This is why powers that be will call them dependents; they very much depend on these things.
“You need all of those things working together to help the kid.”
Derek Gower
The Lone Star State can proudly claim the No. 1 spot when it comes to a lot of things. Barbecue, rodeos, oil and gas, overzealous and overreactive football fans, and heat and humidity. Well, Texans might hesitate to boast about the latter, much like they wouldn’t pride themselves on being tops in the nation when it comes to having an abysmal record on mental health care and resources for its residents.
In May 2023, Forbes published an article ranking Texas at the bottom of the barrel for mental healthcare. Not only did it “win,” but Texas also received the distinction of earning a perfect 100 out of 100 score — don’t be fooled, a 100 in this study is not acing the test.
One striking statistic from the study showed 73.1% of Texas youth who had a major depressive episode in the past year did not receive mental health services, more than any other state.
Texas has the fourth highest percentage of children with private health insurance that does not cover mental or emotional problems, clocking in at 13.8% of those insured. And the state also has the fifth lowest number of mental health treatment centers per capita in the nation.
While mental health is no longer a taboo phrase in the good ol’ cowboy land of the Lone Star State, it still has a way to go to catch up to other states. Perhaps, when it comes to this subject, Texas is just a few years behind. It’s as if it got held back in grade school and started college in its 20s.
When Carter spoke at the State Capitol, she spoke of witnessing the issue of limitations with Texans’ insurance coverage, declaring this issue an impediment for many seeking care.
“What we have observed and studied is that families with limited financial resources or limitations through their insurance coverage regarding mental health services limit their ability to access the most appropriate care that they may need,” Carter said before the appropriations committee in Austin. “What we feel would be beneficial is all insurance companies and payer sources offer the same access to care as well as reimbursement of care to the providers in order to allow easier access to all mental health services.”
For lower income families reliant on Medicaid — which, while a federal program, is administered by the state — the program in Texas only reimburses between $60 and $122 for a 50-minute therapy session. As you probably presumed, most other states have more robust mental health coverage through their Medicaid program. With such a low payout for sessions in Texas, those using the government provider, and who generally have no other choice due to an inability to afford private insurance through the marketplace, end up toward the rear of the line and waiting months to see a therapist.
But this isn’t to say no efforts are being made to curb this problem. The Fort Worth-based My Health Resources of Tarrant County, one of the state’s 37 mental health authorities and operates four clinics, is a state-subsidized entity that services only uninsured low-income families and, occasionally, those on Medicaid. According to an article published by the Texas Tribune on Dec. 22, 2023, one of the four outpatient clinics provides treatment to over 1,300 people per month. The wait time to see one of the clinic’s three healthcare providers: weeks or months. Even the fix can leave Medicaid users feeling hopeless.
In April 2023, the Texas Senate passed Senate Bill 26, which established a $15 million grant program to “provide support to eligible entities for community-based initiatives that promote identification of mental health issues and improve access to early intervention and treatment for children and families.” Of those qualified to receive grants include the local mental health authorities similar to My Health Resources of Tarrant County.
Today, 251 of Texas 254 counties are wholly or partially deemed “mental health professional shortage areas” by the federal government. Yes, Tarrant County is one of these areas. Not a fun club.
While Texas isn’t the only state whose mental health resources are inadequate, neither Carter nor Pyrc feels the state is adequately dealing with the problem.
“In Illinois, where I practiced before, I didn’t realize the mental health system they had was so great until I moved to Texas,” Carter says. “I’m like, ‘oh, they don’t have this’ or ‘they don’t have that.’ In Fort Worth, when people seek out for help, they can’t find the help. And I think [the state] struggles with that every day. I mean, there are six-month waits to go see a therapist.”
Another area where Texas falls behind is residential care. As Carter explains it to me, residential care is a step above inpatient care, where a patient remains in the hospital until they’re stabilized, in terms of the level of care and attention a patient requires.
“If we have a child who’s actively suicidal or actively psychotic, our goal is to admit them and stabilize them so they’re safe to leave to go back home,” Carter explains. “But that’s not fixing the problem. We’re not working through the trauma, and we’re not figuring out why mom is not able to help the kid. We’re just there to make sure the child is safe.”
Residential care is more of a rehabilitation clinic — where kids remain for two or three months to receive the care they need. This is where a child who’s actively attempting to do harm to him or herself can see improvement.
And, having zero state-funded residential services, Texas is, yet again, well behind the curve; it’s one of only a handful of states that currently does not.
“The reason that’s important is because insurance dictates treatment a lot of times,” Carter says. “If a kid has an insurance that does not contract with a certain residential facility or a parent is self-pay, the kid can’t get residential treatment. They can’t get the treatment they truly need. But a state-funded facility would provide them treatment regardless of the payer source and their ability to pay.”
Neither Dr. Pyrc nor Dr. Carter was pining for the position that had opened a few months ago — medical director of the psychiatry department. They’d both been approached individually and, well, according to Pyrc, no one wanted to do it. Pyrc was trying to have a kid, and the seemingly endless list of responsibilities wasn’t exactly appealing to anyone within the eight-person department.
At least, it wasn’t appealing to anyone on an individual level. But when presented with the idea of pairing Carter and Pyrc together came up, there was no hesitation. The two besties were in.
“I think we decided that we really work better as a team,” Carter says. “I think that since we’ve agreed to do it, it’s really been like this ebb and flow, and we don’t even talk about what our different responsibilities are. We’ll get an email and then one of us will just do it. We don’t say, ‘You want to do it, or should I do it?’ We just do it.”
Derek Gower
Sometimes, people just hit it off. There’s no rhyme or reason. It’s just a vibe, to use a little previous generation’s vernacular. Within 15 seconds of meeting, you’re thinking, “I’ve had some previous moments when I could’ve appreciated this person in my life.”
And it is an interesting pairing. It’s not like one’s strengths compensate for the other’s weaknesses or they see things from entirely different perspectives and have different ideas, which requires compromise. No, they’re a couple birds of a feather and on eerily similar wavelengths. The clothes they wear, the purses they buy, the things that go unsaid that remain entirely understood.
I considered jokingly bringing up clairvoyance but wasn’t sure how such a word lands with legit psychiatrists.
They’re both originally from Texas, Carter names Houston her hometown, and Pyrc is from the northeast Texas town of Hooks — “Don’t blink and you’ll miss it,” she says. They both have children, Carter has one teenage girl, and Pyrc has a couple grade schoolers. And they both live in Mansfield, where Carter moved after some persuasion from Pyrc.
Carter calls herself the miracle child, as her mom got pregnant with her after her tubes had been tied — her sisters are 16 and 14 years older than her. “Back in the day, they just tied the tubes. They didn’t clip and burn.” She’d go to school in New Orleans at Xavier University and attend medical school at Louisville followed by her fellowship training at Northwestern Lurie Children’s Hospital in Chicago. She admits to initially wanting to be an OB-GYN but found the field didn’t agree with her inability to sit still for long.
Pyrc grew up in the aforementioned rural part of northeast Texas with her parents, who are still together, and a brother. She would also attend college in Louisiana but calls Centenary in Shreveport her alma mater and would go on to medical school in Houston at the University of Texas. She’d then go to North Carolina for her residency and fellowship. Like Carter, she was also on the fence about entering psychiatry, initially thinking she wanted to be a pediatrician. But once they started doing their rotations, the field piqued her interest. “I was more interested in the ‘Why?’” she says. “I’d always wonder what happened to get [the patient] there. I was always more interested in the why and the social history.”
Sharing the helm of the psychiatry department, Pyrc and Carter’s big undertaking is the Behavioral Health Assessment Center, a new project within the psychiatry department that alleviates many of the issues families are contending with when seeking care. The center provides urgent evaluations for children not actively suicidal, but have perhaps had some self-harm, and uses an assembly line of intake workers, psychiatrists, and social workers to ensure the child is receiving the right treatments, medications, and therapy. It’s preventative care.
“Because the risk is if that child doesn’t get the treatment and doesn’t start medication, then in two weeks, we’re probably going to see that child in the ER from a suicide attempt,” Carter says. “Ultimately, it’s made to support the families who may not have access to the necessary care in the community.”
Education and raising awareness are other substantial parts of their job. Both regularly speak at local middle schools and high schools — having the difficult conversations with teenagers. And, sharing hosting duties with Wini King, Pyrc even has her own podcast, Raising Joy, which has aired for over two years and focuses on children’s mental health. Not steering away from the heavy topics, Pyrc discusses suicide prevention, coping with the loss of a pet, protecting women from abuse, and drug overdose.
“What’s tough about our job is that we talk about really terrible, hard things, but we have to find a way to keep going,” Pyrc says. “And I think that [Kia and I] do that with each other by laughing and being silly when we can.”
Crystal Wise
There was a headline I remember seeing last year stating that CDC data found that suicides had reached an all-time high in 2022. The rates, which had been rising since an all-time low in 1999, had soared past the previous peak, which occurred the year before.
Whether you trust the accuracy of any measurements from the early 20th century or not, the National Center for Health Statistics calculated the suicide rate in the United States during the early 1900s, which would give some insight into a world not dominated by computers, phones, televisions, or any screens at all. (NOTE: No data could be found specific toward teen suicides)
Unsurprisingly, 1932, the last full year of the Great Depression, had the highest suicide rate. What was surprising was its number — 22.1 per 100,000. Sixty-three percent higher than 2022, the year that suicide rates reportedly hit an all-time high.
The rate, according to NCHS, had surged since 1928, when the rate was 18 per 100,000. In fact, according to the data, during much of the 1920s, a time of great prosperity, the suicide rate was higher than it is today.
Again, no screens. No social media. Bullying … undoubtedly, but not in the same menacing way that dominates Facebook and TikTok. However, suicide, and its root causes, were still largely unexplored, misunderstood, and met with a suppression of feelings.
While mental health, as an idea and study, has existed since 1847, championing its awareness didn’t occur until 1949. Coincidentally or not, the suicide rate has remained fairly steady since, generally fluctuating between 11 per 100,000 and 14 per 100,000.
Mental health awareness, meanwhile, has only increased since the middle of last century, culminating in what it is today — films that regularly address the issue, celebrities candid about their experiences, and social media channels unironically devoted to the cause,
While I didn’t pose the question directly, Carter, for her part, believes that awareness and sharing experiences is one of the great deterrents of teen suicide.
“It’s important for people to talk about [mental health] and make it normal,” Carter says. “Just like we screen for blood pressure; it’s normal. You do it at every visit. We normalize to a point where people become more comfortable talking about it and seeking help.”
If you or someone you know is experiencing a mental health crisis, visit 988lifeline.org for immediate help.
