Mental Health and Suicide Prevention in McKinney, Texas

Community Demographics and Health Status

McKinney, Texas is "unique by nature." As one of the fastest growing cities in the United States, McKinney has a current population of more than 149,000, located 30 miles north of Dallas and is the seat of Collin County. The city ranks number 2 in CNN Money Magazine's Best Places to Live in America list. According to the U.S. Census Bureau (2010), McKinney experienced extraordinary growth, with a population of 54,369 in 2000 and 131,117 in 2010. The 141.7% increase over ten years led to its ranking as number one on the list of Top 10 fastest growing cities with a population of 50,000 or greater. In this 100% urban city, there is more than 2,300 acres of open space containing 47 parks, 50 miles of hike and bike trails, neighborhood centers, and sports complexes.

As of the 2012 census, McKinney had a population of 143,223 (49% male and 51% female) with a median age of 32.7 years. The racial and ethnic composition of the population was 64.5% non-Hispanic white, 10.2% non-Hispanic black, 0.7% Native American, 1.0% Indian (from India), 3.1% other Asian, 0.1% Pacific Islander, 0.1% non-Hispanic reporting some other race, 3.1% reporting two or more races, and 18.6% Hispanic or Latino of any race. The median household income in the city was $81,894 with a median family income of $92,868, with only 9% of local residents living in poverty. With 67.9% of McKinney's residents employed, the percentage of the population with a bachelor's degree or higher is significantly above the state's average. The cost of living index in McKinney is 94.6 (U.S. average is 100), falling marginally below the national average (U.S. Census Bureau, 2012).

In addition to published statistics on population and economic status, epidemiological data was obtained from the Collin County Health Department. The Windshield Survey and Community and Population Health Scavenger Hunt provided insight beyond surface observations of this prosperous town. Using the Windshield Survey allowed observations about the community that may be overlooked in daily life. The town is very well kept; shops and restaurants surround nice residential areas; and many people were observed walking, running, or riding bicycles—which supports why McKinney has the highest health ranking overall in the state of Texas. Personal observations of the community, combined with visits to one of the eight local Fire/EMS stations and the local hospital, informed understanding of neighborhood and community safety. Meeting with the local Emergency Management Director for Collin County and the Medical Director of Emergency Services at the local hospital provided additional assessment data through the Community and Population Scavenger Hunt.

Although McKinney is unique in its prosperity and growth, it is not immune to disaster risk. Severe weather, pandemic, hazardous materials, or terrorism could strike the community at any time. A critical finding during the Disaster Assessment and Planning Guide revealed that the city has recognized the need to provide additional training and emphasis around providing appropriate safety measures for vulnerable or at-risk behavioral health patients. In August 2013, Medical Center of McKinney conducted a comprehensive disaster exercise at the Behavioral Health hospital where staff worked with local EMS, Fire, and Emergency Management officials to practice evacuation of these specialized patients.

Mental Health Crisis and Leading Health Threats

In conclusion, McKinney is a finely honed community where the quality of life is perceived to be above average due to its highly educated, financially sound population. However, a concerning trend has emerged: mental health disorders related to drug and alcohol abuse are increasing within the community.

McKinney's Mayor Brian Loughmiller states, "Our community has a consistently high quality of life for our residents, no matter how we grow or change." Collin County is rated number one for overall health ranking according to the 2014 County Health Rankings, which average health outcomes including morbidity and mortality rates, health factors and behaviors, clinical care availability, social and economic factors, and physical environment.

Despite favorable overall health indicators, a troubling mental health crisis underlies McKinney's prosperous exterior. Although cardiovascular disease continues to be the greatest cause of death for this community according to the Texas Department of State Health Services, cancer and suicide are also among the leading causes of death. Healthy People 2020 reports that the suicide rate increased from 11.3 per 100,000 in 2007 to 12.2 per 100,000 in 2010 (age-adjusted), though the average for Collin County is 9.2. Suicide is the 11th leading cause of death in the United States and in McKinney alike.

Given the high incidence rate of behavioral health disorders and the significant impact on the community, a more strategic approach is needed. The National Institute of Mental Health (NIMH) reports that approximately 1 in 17 American adults have a serious debilitating mental illness, making mental illness the leading cause of disability in the United States. Since physical and mental health are directly connected, mental illnesses such as depression and anxiety can ultimately lead to heart disease. Therefore, research should examine how mental illnesses such as depression influence the risk of heart disease, stroke, obesity, and suicide rates.

Existing Mental Health Services and Gaps

The cause-and-effect relationship between mortality and depression is complex, as a decline in physical health can cause depression, and depression can cause a decline in physical health. However, a 1996 study by age group in the United States demonstrated that mental health disorders and substance abuse accounted for 30% of disability-adjusted life years (DALYs) lost by people under 25. Since this represents the greatest disease burden for this broad age range and correlates with decreased quality of life and increased morbidity, it poses a major threat to the youth and young adults of McKinney.

Economic pressures on families contribute to adolescent mental health risk. In McKinney, 58.4% of both parents are in the labor force in families with children ages 6 and under, and 67.4% in families with children ages 6–17. Although the percentages of divorced families in McKinney are reportedly low at 12.4% for women and 6.8% for men in 2012, divorce rates are nationally on the rise, and family disruptions contribute to mental disorders in adolescents as well.

McKinney is in alignment with Healthy People 2020 goals to improve mental health through prevention and by ensuring access to appropriate, quality mental health services. Medical Center of McKinney offers psychiatric and behavioral medicine services to residents of north Texas and southern Oklahoma. The goals of treatment at Medical Center of McKinney's Behavioral Medicine Services include intervening in the current crisis, preventing further escalation, and re-establishing coping skills while emphasizing short-term crisis stabilization, medication management, and planning for ongoing care.

However, McKinney faces a critical gap: behavioral medicine services focus on treatment rather than prevention. Dr. Scott Corcoran, Medical Director of Emergency Services, reports that over the past few years he has observed an increase in the number of patients seeking help for psychiatric services and an increase in attempted suicides within the community. He noted: "Because emergency departments are the safety net for the entire health care system, they tend to have spikes in volumes when outpatient resources are not adequate to satisfy the public need. Due to the lack of funding and reimbursement for outpatient psychiatric services, emergency departments have seen a boom in visits for psychiatric reasons over the past 15 years. These patients are often combative or require one-on-one safety monitoring, which also presents a big burden to emergency departments in general."

Prevention Strategies and Healthy People 2020 Alignment

The rising costs for treatment of mental health and substance abuse disorders have hindered healthcare organizations and imposed a crippling effect on individuals and families. This has stimulated increased interest in prevention practices that can impede the onset or reduce the severity of mental health disorders. The Texas Department of Health Services has recognized this need by launching Speak Your Mind Texas, a statewide conversation about mental health disorders, available resources, and the possibility of recovery. Additionally, the Texas Legislature allocated more than $300 million for mental health funding to expand services, decrease wait lists, and improve mental health hospitals.

Young people with mental disorders face obstacles to achieving critical developmental tasks, such as establishing healthy interpersonal relationships, succeeding in school, and entering the workforce. In McKinney, Job Corps—a program authorized by Title I-C of the Workforce Investment Act of 1998—provides no-cost education and career technical training through the U.S. Department of Labor to young people ages 16 through 24. Courses in independent living, employability skills, and social skills help students transition into the workplace. The wellness center also provides 24-hour emergency medical services including weight management, smoking cessation, pregnancy prevention, and other health-related programs.

Healthy People 2020's goals to improve mental health status include reducing suicide rates and adolescent suicide attempts by ten percent, reducing the proportion of adolescents and adults experiencing major depressive disorder, and increasing primary care physician screening for depression. If emphasis were placed on prevention of suicide and depression, a reduction in both rates and attempts would result. Prevention of depression could also inadvertently decrease overall mortality and morbidity rates within the community by maintaining individuals' ability to preserve good physical health.

Strategies for enhancing psychological and emotional well-being for young people at risk for mental disorders and substance abuse, as recommended by the National Research Council and Institute of Medicine study, include strengthening families and individuals, preventing specific disorders, promoting mental health in schools, and promoting mental health through healthcare and community programs. The complexity of implementation will require a process to identify families dealing with adversities such as parental depression or divorce in order to focus on specific audiences.

Healthcare providers need adequate training and resources to identify and pre-screen for mental disorders. They must have a clear understanding of the lasting effects that mental health disorders can cause and be educated on the warning signs of mental illness and substance abuse. A collaborative approach will be required not only among healthcare providers but within schools to heighten awareness among teachers and counselors. Community outreach will be vital to the success of depression and suicide prevention within the community.