Category: Health and Fitness

When You Think About Your Health, Don’t Forget Your Eyes

I vividly remember that late Friday afternoon when my eye pressure spiked and I staggered on foot to my ophthalmologist’s office as the rapidly thickening fog in my field of vision shrouded passing cars and traffic lights.

The office was already closed, but the whole eye care team was there waiting for me. One of them pricked my eyeballs with a sharp instrument, allowing the ocular fluid that had built up to drain. That relieved the pressure and restored my vision.

But it was the fourth vision-impairing pressure spike in nine days, and they feared it would happen again — heading into a weekend. So off I went to the emergency room, where I spent the night hooked up to an intravenous tube that delivered a powerful anti-swelling agent.

Later, when I told this story to friends and colleagues, some of them didn’t understand the importance of eye pressure, or even what it was. “I didn’t know they could measure blood pressure in your eyes,” one of them told me.

Most people consider their vision to be vitally important, yet many lack an understanding of some of the most serious eye diseases. A 2016 study published in JAMA Ophthalmology, based on an online national poll, showed that nearly half of respondents feared losing their eyesight more than their memory, speech, hearing, or limbs. Yet many “were unaware of important eye diseases,” it found.

A study released this month, conducted by Wakefield Research for the nonprofit Prevent Blindness and Regeneron Pharmaceuticals, showed that one-quarter of adults deemed at risk for diseases of the retina, such as macular degeneration and diabetic retinopathy, had delayed seeking care for vision problems.

“There is significantly less of an emphasis placed on eye health than there is on general health,” says Rohit Varma, founding director of the Southern California Eye Institute at Hollywood Presbyterian Medical Center.

Because eye diseases can be painless and progress slowly, Varma says, “people get used to it, and as they age, they begin to feel, ‘Oh, this is a normal part of aging and it’s OK.’” If people felt severe pain, he says, they would go get care.

For many people, though, it’s not easy to get an eye exam or eye treatment. Millions are uninsured, others can’t afford their share of the cost, and many live in communities where eye doctors are scarce.

“Just because people know they need the care doesn’t necessarily mean they can afford it or that they have the access to it,” says Jeff Todd, CEO and president of Prevent Blindness.

Another challenge, reflecting the divide between eye care and general health care, is that medical insurance, except for children, often covers only eye care aimed at diagnosing or treating diseases. More health plans are covering routine eye exams these days, but that generally does not include the type of test used to determine eyeglass and contact lens prescriptions — or the cost of the lenses. You may need separate vision insurance for that. Ask your health plan what’s covered.

Since being diagnosed with glaucoma 15 years ago, I’ve had more pressure checks, eye exams, eyedrops, and laser surgeries than I can remember. I should know not to take my eyesight for granted. And yet, when my peepers were filling with that vision-threatening fog last March, I felt oddly sanguine.

It turned out that those serial pressure spikes were triggered by an adverse reaction to steroid-based eyedrops prescribed to me following cataract surgery. My ophthalmologist told me later that I had come “within hours” of losing my eyesight.

I hope my brush with blindness can help inspire people to be more conscious of their eyes.

Eyeglasses or contact lenses can make a huge difference in one’s quality of life by correcting refractive errors, which affect 150 million Americans. But don’t ignore the risk of far more serious eye conditions that can sneak up on you. They are often manageable if caught early enough.

Glaucoma, which affects about 3 million people in the U.S., attacks peripheral vision first and can cause irreversible damage to the optic nerve. It runs in families and is five times as prevalent among African Americans as in the general population.

Nearly 10 million in this country have diabetic retinopathy, a complication of diabetes in which blood vessels in the retina are damaged. And some 20 million people age 40 and up have macular degeneration, a disease of the retina associated with aging that diminishes central vision over time.

The formation of cataracts, which cause cloudiness in the eye’s natural lens, is very common as people age: Half of people 75 and older have them. Cataracts can cause blindness, but they are eminently treatable with surgery.

If you are over 40 and haven’t had a comprehensive eye exam in a while, or ever, put that on your to-do list. And get an exam at a younger age if you have diabetes, a family history of glaucoma, or if you are African American or part of another racial or ethnic group at high risk for certain eye diseases.

And don’t forget children. Multiple eye conditions can affect kids. Refractive errors, treatable with corrective lenses, can cause impairment later in life if they are not addressed early enough.

Healthful lifestyle choices also benefit your eyes. “Anything that helps your general health helps your vision,” says Andrew Iwach, a clinical spokesperson for the American Academy of Ophthalmology and executive director of the Glaucoma Center of San Francisco.

Minimize stress, get regular exercise, and eat a healthy diet. Also, quit smoking. It increases the risk of major eye diseases.

And consider adopting habits that protect your eyes from injury: Wear sunglasses when you go outside, take regular breaks from your computer screen and cellphone, and wear goggles when working around the house or playing sports.

The Prevent Blindness website offers information on virtually everything related to eye health, including insurance. Other good sources include the American Academy of Ophthalmology’s “EyeSmart” site and the National Eye Institute.

So read up and share what you’ve learned.

“When you get together for the holidays,” says Iwach, “if you aren’t sure what to talk about, talk about your eyes.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

Biden Administration to Ban Medical Debt From Americans’ Credit Scores

The Biden administration announced a major initiative to protect Americans from medical debt on Thursday, outlining plans to develop federal rules barring unpaid medical bills from affecting patients’ credit scores.

The regulations, if enacted, would potentially help tens of millions of people who have medical debt on their credit reports, eliminating information that can depress consumers’ scores and make it harder for many to get a job, rent an apartment, or secure a car loan.

New rules would also represent one of the most significant federal actions to tackle medical debt, a problem that burdens about 100 million people and forces legions to take on extra work, give up their homes, and ration food and other essentials, a KFF Health News-NPR investigation found.

“No one in this country should have to go into debt to get the quality health care they need,” said Vice President Kamala Harris, who announced the new moves along with Rohit Chopra, head of the Consumer Financial Protection Bureau, or CFPB. The agency will be charged with developing the new rules.

“These measures will improve the credit scores of millions of Americans so that they will better be able to invest in their future,” Harris said.

Enacting new regulations can be a lengthy process. Administration officials said Thursday that the new rules would be developed next year.

Such an aggressive step to restrict credit reporting and debt collection by hospitals and other medical providers will also almost certainly stir industry opposition.

At the same time, the Consumer Financial Protection Bureau, which was formed in response to the 2008 financial crisis, is under fire from Republicans, and its future may be jeopardized by a case before the Supreme Court, whose conservative majority has been chipping away at federal regulatory powers.

But the move by the Biden administration drew strong praise from patients’ and consumer groups, many of whom have been pushing for years for the federal government to strengthen protections against medical debt.

“This is an important milestone in our collective efforts and will provide immediate relief to people that have unfairly had their credit impacted simply because they got sick,” said Emily Stewart, executive director of Community Catalyst, a Boston nonprofit that has helped lead national medical debt efforts. 

Credit reporting, a threat designed to induce patients to pay their bills, is the most common collection tactic used by hospitals, a KFF Health News analysis has shown.

“Negative credit reporting is one of the biggest pain points for patients with medical debt,” said Chi Chi Wu, a senior attorney at the National Consumer Law Center. “When we hear from consumers about medical debt, they often talk about the devastating consequences that bad credit from medical debts has had on their financial lives.”

Although a single black mark on a credit score may not have a huge effect for some people, the impact can be devastating for those with large unpaid medical bills. There is growing evidence, for example, that credit scores depressed by medical debt can threaten people’s access to housing and fuel homelessness in many communities.

At the same time, CFPB researchers have found that medical debt — unlike other kinds of debt — does not accurately predict a consumer’s creditworthiness, calling into question how useful it is on a credit report.

The three largest credit agencies — Equifax, Experian, and TransUnion — said they would stop including some medical debt on credit reports as of last year. The excluded debts included paid-off bills and those less than $500.

But the agencies’ voluntary actions left out millions of patients with bigger medical bills on their credit reports. And many consumer and patient advocates called for more action. 

The National Consumer Law Center, Community Catalyst, and some 50 other groups in March sent letters to the CFPB and IRS urging stronger federal action to rein in hospital debt collection.

State leaders also have taken steps to expand consumer protections. In June, Colorado enacted a trailblazing bill that prohibits medical debt from being included on residents’ credit reports or factored into their credit scores.

Many groups have urged the federal government to bar tax-exempt hospitals from selling patient debt or denying medical care to people with past-due bills, practices that remain widespread across the U.S., KFF Health News found.

Hospital leaders and representatives of the debt collection industry have warned that such restrictions on the ability of medical providers to get their bills paid may have unintended consequences, such as prompting more hospitals and physicians to require upfront payment before delivering care.

Looser credit requirements could also make it easier for consumers who can’t handle more debt to get loans they might not be able to pay off, others have warned.

“It is unfortunate that the CFPB and the White House are not considering the host of consequences that will result if medical providers are singled out in their billing, compared to other professions or industries,” said Scott Purcell, chief executive of ACA International, the collection industry’s leading trade association.

About This Project

“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.

The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country. 

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability. 

KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

KFF Health News’ ‘What the Health?’: Countdown to Shutdown

The Host

Health and other federal programs are at risk of shutting down, at least temporarily, as Congress races toward the Oct. 1 start of the fiscal year without having passed any of its 12 annual appropriations bills. A small band of conservative House Republicans are refusing to approve spending bills unless domestic spending is cut beyond levels agreed to in May.

Meanwhile, former President Donald Trump roils the GOP presidential primary field by vowing to please both sides in the divisive abortion debate.

This week’s panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat News, and Tami Luhby of CNN.

Among the takeaways from this week’s episode:

  • The odds of a government shutdown over spending levels are rising. While entitlement programs like Medicare would be largely spared, past shutdowns have shown that closing the federal government hobbles things Americans rely on, like food safety inspections and air travel.
  • In Congress, the discord isn’t limited to spending bills. A House bill to increase price transparency in health care melted down before a vote this week, demonstrating again how hard it is to take on the hospital industry. Legislation on how pharmacy benefit managers operate is also in disarray, though its projected government savings means it could resurface as part of a spending deal before the end of the year.
  • On the Senate side, legislation intended to strengthen primary care is teetering under Bernie Sanders’ stewardship — in large part over questions about how to pay for it. Also, this week Democrats broke Alabama Republican Sen. Tommy Tuberville’s abortion-related blockade of military promotions (kind of), going around him procedurally to confirm the new chair of the Joint Chiefs of Staff.
  • And some Republicans are breaking with abortion opponents and mobilizing in support of legislation to renew the United States President’s Emergency Plan for AIDS Relief — including the former president who spearheaded the program, George W. Bush. Meanwhile, polling shows President Joe Biden is struggling to claim credit for the new Medicare drug negotiation program.
  • And speaking of past presidents, former President Donald Trump gave NBC an interview over the weekend in which he offered a muddled stance on abortion. Vowing to settle the long, inflamed debate over the procedure — among other things — Trump’s comments were strikingly general election-focused for someone who has yet to win his party’s nomination.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The Washington Post’s “Inside the Gold Rush to Sell Cheaper Imitations of Ozempic,” by Daniel Gilbert.

Alice Miranda Ollstein: Politico’s “The Anti-Vaccine Movement Is on the Rise. The White House Is at a Loss Over What to Do About It,” by Adam Cancryn.

Rachel Cohrs: KFF Health News’ “Save Billions or Stick With Humira? Drug Brokers Steer Americans to the Costly Choice,” by Arthur Allen.

Tami Luhby: CNN’s “Supply and Insurance Issues Snarl Fall Covid-19 Vaccine Campaign for Some,” by Brenda Goodman.

Also mentioned in this week’s episode:

To hear all our podcasts, click here.

And subscribe to KFF Health News’ “What the Health?” on SpotifyApple PodcastsPocket Casts, or wherever you listen to podcasts.

California Officials Seek ‘CARE’ Without Coercion as New Mental Health Courts Launch This Fall

The first time Heidi Sweeney began hallucinating, the voices in her head told her Orange County’s Huntington Beach was where she would be safe. There, behind the bikini-clad crowds playing volleyball and riding beach cruisers, she slept in homeless encampments, then beside a bush outside a liquor store, drinking vodka to drown out the din only she could hear.

For years, she refused help, insisting to all who offered, “I’m not sick,” until police arrested her for petty theft and public drunkenness. A judge gave her an ultimatum: jail or treatment. She chose treatment.

“I’m so thankful that they did that,” said Sweeney, now 52. “I needed that. I think there’s others out there that need it, too.”

If she hadn’t been compelled to get care, Sweeney said, she wouldn’t be alive today, back at work and reunited with her husband. It’s why she supports California’s new civil CARE Courts that will launch this fall in eight counties, including San Francisco, Los Angeles, and Orange, followed by the rest of the state in 2024.

Under the new system, family members and first responders can ask county judges to order people with psychotic illness into treatment, even if they are not unhoused or haven’t committed a crime. A judge will then determine if a person meets criteria for the program and may oversee a care agreement or compel a treatment plan. That treatment plan could even include involuntary commitment.

The bill creating the program sailed through the state legislature with near-unanimous support last year amid growing frustration from voters over the state’s increasing number of homeless people, even as it drew vehement opposition from disability rights groups, who argued CARE Courts’ hallmark — compelling people who have done nothing wrong into mental health care — is a violation of civil rights.

That tension — between those who advocate for treatment being voluntary and those who say the status quo allows people to die in the streets “with their rights on” — is playing out all over the state of California. In Orange County, officials are threading a delicate needle: how to convince people to accept care without coercion, particularly when their illness causes them to believe they are not ill.

“We don’t want to punish people,” said Maria Hernandez, the presiding judge for Orange County Superior Court. “We want them to maintain their dignity.”

A photo of a judge sitting at their bench in a courtroom.
Orange County Superior Court Presiding Judge Maria Hernandez says Orange County’s CARE Court, launching this fall, will resemble the county’s other collaborative courts, like her young adult diversion court, where compassion and science drive her decisions.(April Dembosky/KQED)

Orange County is expecting between 900 and 1,500 residents will be eligible for CARE Court in any given year, according to the county public defender’s office. Local lawyers, judges, and health officials have all aligned in designing their program with a distinct patient focus, endeavoring to make the process as benign and nonthreatening as possible.

Hernandez said that means modeling the new civil court after the county’s other collaborative courts, where judges often lose the black robe and come down off the bench to work with people, eye to eye.

One prototype, she said, is her Young Adult Court, where, on a day in June, the mood was downright jovial. Defendants and their family members were chatting and laughing, munching on snacks laid out on a table in the back as three young men “graduated” from the diversion program.

“Judge Hernandez is so awesome,” said Abraham, 25, a graduate of the program, who asked to be identified only by his first name because he was charged with a felony that has since been expunged from his record. “I don’t even look at her as the judge. She’s just like a mom figure. She’s only trying to push you to be the better you.”

A minute later, Hernandez walked through the aisle of the courtroom and gave Abraham a hug.

Even if CARE Court is overseen by a judge like Hernandez, patient advocates object to the idea. Orlando Vera, who lives with bipolar disorder, said helping a vulnerable person heal from mental illness shouldn’t involve dragging them into a courtroom.

“It’s not a place you resolve your emotions. It is a very business-oriented environment. So I do feel that this is not the place for it,” Vera said, adding, “Can we stop it? I would say we can’t.”

After advocates failed to persuade the state Supreme Court to block the program on constitutional grounds, some started referring to gearing up for the rollout of CARE Court as “disaster preparedness,” equating it with a devastating earthquake or wildfire.

Peer Voices of Orange County, a group Vera co-founded and runs, plans to install patient advocates at the courthouse to attend all CARE Court hearings.

“Our focus is how do we support those that are going through the system,” he said. “We need to be their voice.”

A photo of a man sitting indoors.
Orlando Vera, a co-founder of Peer Voices of Orange County, says he and other people with lived experience of mental illness will attend CARE Court proceedings on behalf of patients.(April Dembosky/KQED)

Orange County behavioral health director Veronica Kelley is sympathetic to advocates’ concerns. She said CARE Court is not the program she would have created to improve the state’s mental health system. But she serves at the will of the governor and other elected officials who control her budget.

“So we end up building the Winchester Mystery House,” she said, referring to the 100-year-old mansion in San Jose known for its mazelike layout. “It is a structure that was OK, but then it just started adding hallways to nowhere and basements that are on top of the building. That’s what our system looks like.”

Kelley is trying to shape the new court process into something its critics can accept. This is why she wanted Orange County to go first: “so we can help craft it into something that’s not another colossal waste of time and funds, and that we don’t destroy the people we’re trying to serve at the same time,” she told a roomful of patient advocates during a meeting of the state Patients Rights Committee, held in Santa Ana.

This means social workers from her behavioral health department or the public defender’s office might visit people 20, 30, or 40 times to build trust, listen, and set goals.

Under the CARE legislation, county courts are allowed to fine public behavioral health agencies $1,000 a day if they can’t find a patient and enroll them in treatment by certain deadlines.

Kelley said her county’s judges have agreed to give her staff the time and extensions they need to do their jobs well. She also vowed that no one who declined services in her county would be institutionalized involuntarily, even though the new legislation allows it.

“If someone agrees to do something of their own accord, it is far more probable that there will be long-term success and long-term commitment to the services being provided,” she said.

Kelley pointed to the county’s success with another civil court process, established by Laura’s Law in 2002, in which, for every person involved in court-ordered outpatient care, another 20 accepted treatment willingly.

She said the county has the same goal for CARE Court, with the focus on finding a treatment plan people accept voluntarily, before a judge has to order it.

A photo of a woman sitting indoors.
Veronica Kelley, the behavioral health director for Orange County, will oversee mental health outreach and care provided through the local CARE Court, launching in October.(April Dembosky/KQED)

This article is from a partnership that includes KQED, NPR, and KFF Health News.

As Younger Children Increasingly Die by Suicide, Better Tracking and Prevention Is Sought

If you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 988 or contact the Crisis Text Line by texting HOME to 741741.

Jason Lance thought Jan. 21, 2010, was a day like any other until the call came.

He had dropped off his 9-year-old son, Montana, at Stewart’s Creek Elementary School in The Colony, Texas, that morning.

“There were no problems at home. He was smart. He wore his heart on his sleeve and he talked and talked and talked,” said Lance. It was “the same old, same old normal day. There were kisses and goodbyes and he said, ‘I love you, Daddy.’”

A few hours later, school officials called to say Montana had died by suicide while locked in the nurse’s bathroom.

“I knew he had some issues going on in school, but I never seen it coming,” said Lance. His shock and grief were complicated by the realization that there may have been more signs his son was struggling.

A photograph of elementary school student, Montana Lance. He is wearing a school backpack and smiling at the camera.
Jason Lance dropped off son Montana at Stewart’s Creek Elementary School in The Colony, Texas, on Jan. 21, 2010. The school called a few hours later saying Montana had died by suicide while locked in the nurse’s bathroom. “I knew he had some issues going on in school, but I never seen it coming,” Lance says.(Jason Lance)

As children across the country step back into school routines this fall, it is important to pay attention to their mental health as well as their academics. Suicide ranks as either the seventh- or eighth-leading cause of death among children ages 5 to 11, according to the Centers for Disease Control and Prevention and recent studies. And numbers show the rates among younger kids appear to have increased in the past decade, especially among Black males.

A growing body of research shows that “historically we thought that suicide is a problem of teens and adults, but younger children are expressing similar thoughts that may have been ignored before,” said Paul Lipkin, a pediatrician at the Kennedy Krieger Institute in Baltimore and a specialist in developmental disabilities such as autism.

This has many experts calling for lowering the screening age for suicide ideation in children and moving to develop more effective early suicide risk detection and targeted prevention strategies. The broad approach includes pediatricians, teachers, and parents working with children at a young age to build their resilience and identify and manage their stress.

Studies have found that young children gain an understanding about death and killing oneself from TV or other media, discussions with other children, or exposure to death from a family or community loss.

“Pediatric suicide wasn’t on our radar decades ago and maybe was underreported,” said Holly Wilcox, president of the International Academy of Suicide Research and a professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore. “The truth is that now we can do stuff about it.”

It is quite likely the 136 reported suicides from 2001 to 2021 among 5- to 9-year-olds were an undercount.

“Counts are often incomplete, and causes of death may be pending investigation resulting in an underestimate relative to final counts,” said Margaret Warner, a senior epidemiologist at the CDC.

The problems with those numbers are important because, Warner said, “if we are missing deaths, or don’t have all the information leading to them, we can’t properly develop programs to prevent future deaths.”

That’s why there’s also an ongoing national effort by coroners and medical examiners to improve the quality and consistency of pediatric death investigations.

Leaders in suicide prevention hope this wide spotlight on pediatric suicide will also help curtail the rising suicide rate among people ages 10 to 24 in the U.S. since suicide is the second-leading cause of death in that age group, according to the CDC.

Some of the increase in mental health issues among children has been attributed to the isolation and lack of school structure during the pandemic. Beginning in April 2020, pediatric emergency room visits for children 5 to 11 increased approximately 24%, according to a CDC report from November 2020.

Other factors, such as being neurodivergent or having a psychiatric disorder, can make a child more vulnerable to suicide.

A study published in February in Frontiers in Public Health also found that being the victim or perpetrator of bullying is a risk factor for suicide, even when researchers controlled for other risk factors.

Montana Lance was diagnosed with attention-deficit/hyperactivity disorder, as well as dyslexia, and often was the target of bullying at school.

Officials at the Lewisville Independent School District declined to comment on Montana’s death. His parents filed a lawsuit against the school district, but it was dismissed, and the district was found not liable for his death.

Suicide is complex, but recent studies have found that there are things parents, teachers, pediatricians, and caregivers can do to help protect children from it.

Lisa Horowitz, a pediatric psychologist and staff scientist at the National Institute of Mental Health, said, “It’s never too early to start a conversation with kids about recognizing mental health distress and doing what we can do to help them have better coping strategies and foster resilience.”

Building resilience in children can help buffer them in times of stress, according to a study published in 2022 in Frontiers of Psychiatry.

“I don’t want people to panic but just want them to be vigilant about their children,” said Horowitz.

Sometimes that vigilance can be “tricky” because depression may look different in younger kids. They may act out, be more irritable, and not manifest their symptoms in the same way as teens and adults, Wilcox said.

“We don’t have enough studies on how best to identify preteens and children at risk for suicide. Oftentimes you just have to trust your gut about these things,” she said.

If a child is upset, parents should ask them questions about what they’re experiencing, said Tami D. Benton, psychiatrist-in-chief, executive director, and chair of the Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children’s Hospital of Philadelphia.

“Parents shouldn’t talk kids out of their feelings or give them examples of when it happened to them, or minimize their feelings. It puts them down,” she said.

Parents and children should come up with a plan together, but also teach their children that they can master these situations, said Benton.

When parents get stuck about what to do in difficult situations, they should consult with their child’s pediatrician.

In March, the American Academy of Pediatrics recommended universal screening for suicide risk in all children 12 and older and when clinically indicated for kids 8 to 11. There aren’t any screening tools validated for use in children under 8. But Horowitz said younger children can still be assessed and evaluated for suicide risk.

Schools can also play an important role in suicide prevention.

Meghan Feby, a school counselor in the Colonial School District in New Castle, Delaware, said, “I am the sole school counselor in my building. It is a daunting task. That’s why there are supports in place that have eyes where I can’t have eyes … on school computers. Employing software strategies like GoGuardian Beacon can really help fill in gaps and supports.”

The software captures keywords and phrases that might indicate a child is thinking about suicide and has already been used to intervene when children using district computers displayed concerning behavior. It is monitoring activities on school computers used by more than 6.7 million public school students in kindergarten through 12th grade.

Some schools said they are having problems implementing software like this because some parents find it intrusive.

Many schools use the Good Behavior Game, a decades-old behavior management intervention for kids in first and second grades, and it has been used in higher grades. The team-oriented classroom curriculum uses peer pressure to stimulate students to be attentive and engaged and work together. Researchers such as Wilcox have studied the extensive participation of thousands of students and found it reduced suicidal thoughts and behaviors.

Children who have played the game were half as likely as young adults to report suicidal thoughts and about a third less likely to report a suicide attempt.

Lance said that the day Montana died by suicide changed his life forever.

“You’re not supposed to bury your children. They’re supposed to bury you,” he said. “All this attention on the mental health status of children these days is not going to bring my child back, but it can stop another family from suffering.”