Lewiston mental health providers are seeing a sharp increase in the number of young people seeking help in the weeks since 13-year-old Anie Graham, a seventh-grader at Lewiston Middle School, died by suicide at her home.

Tri-County Mental Health Services, which runs a hotline and provides emergency crisis counseling, has doubled its 24-hour staffing from three people to six in recent weeks, and remains “so busy” it hasn’t taken the time to tally how many calls it has responded to in the wake of Anie’s death, officials said.

“We expected there to be a significant response from the community. We prepared ourselves for that,” said Tri-County Executive Director Catherine Ryder.

At St. Mary’s Regional Medical Center’s behavioral emergency department, which treats people for suicidal thoughts or mental health crises, eight young people came in for help in a single day, compared with the usual two to four walk-ins. More than a dozen youths came in within 12 hours of Anie’s death, said department director Paul Rouleau.

“It was higher than we expected,” said Rouleau, noting that an increase is typical after a death. The emergency hospital visits are tapering off, he said, but there remains a concern about so-called “cluster suicides” that continues for six to eight weeks after a death.

“We’re still in a risk time here,” he said.

On Monday, the Lewiston school district is holding its second community forum since Anie’s death, focused on social media and bullying, which was one of the concerns raised by Lewiston Middle School students, the superintendent said. The forum will include anti-bullying experts and will begin at 7 p.m. at the Lewiston High School gym.

“We’re still very raw here,” said Superintendent Bill Webster, noting that students were still visiting the extra counselors posted at the school in the wake of Anie’s death. “I think the school has returned to some overall sense of normalcy, (but) there are still undercurrents that come up during the day,” he said.

Jenna Mehnert said she was glad more students are seeking help.

“That’s a positive outcome. Reaching out for assistance and for services is a big goal, especially with adolescents,” said Mehnert, executive director of the National Alliance on Mental Illness Maine.

Young people in crisis have “gone down a rabbit hole and they can’t see any options,” Mehnert said. “So being connected to resources is important.”

TAKING THE DIFFICULT FIRST STEP

Julia Hansen said she had to walk that path herself last year, when two of her closest friends at Waynflete School in Portland took their own lives within five months.

Hansen, a sophomore at the time of her friends’ deaths, said she herself started struggling with depression in the sixth grade, when she entered that “mess called middle school.”

It was four years later when her friend Payton Sullivan died.

“Before Payton died, I could barely talk about my depression. But after that, it was, like, mask off. I had to get help,” said Hansen, urging young people in crisis to take the step to talk to someone.

“Opening up is one of the bravest things. It is so scary,” said Hansen, now a junior at Casco Bay High School. “I think people don’t do it because of the stigma. We push it under the rug. We don’t approach it with the urgency of physical illnesses. But it’s an illness you can’t see, and we should be talking about it.”

Anie’s death came amid a national conversation around youth mental health and suicide, and as a high-profile criminal trial is underway in Massachusetts, where a teenage girl is accused of goading her boyfriend into taking his own life via texts encouraging him to do it.

Also, the Netflix series “13 Reasons Why” about a 17-year-old who dies by suicide was immediately controversial when it aired earlier this year, prompting the National Association of School Psychologists to send a notice to school mental health professionals offering guidance on how to talk to students about the show – the first time the group had ever taken such a step. The American Psychological Association warned youths who might have suicidal thoughts against watching the series. In Maine, school districts sent home letters to parents about it.

Experts say they walk a constant line between educating young people about mental illness and not glamorizing or overemphasizing a particular situation.

Ryder said the situation in Lewiston, while tragic, is an opportunity for parents to talk to their children and to spur broader community conversations.

Tri-County will be participating in Monday night’s forum and have tables set up with counselors and referral information. The agency provides hotline help and also goes on calls to homes, schools or wherever it is needed.

“Everyone is doing their best to have something positive come from this,” Ryder said. “Healing takes time.”

YOUTHS AND EMOTIONAL PRESSURES

Maine’s rate of suicide is consistently higher than the national average – 16.54 suicides per 100,000 residents in 2014, according to the U.S. Centers for Disease Control and Prevention – and has been slowly rising over the past 15 years. The national rate was 13.41 per 100,000 people in 2014.

Suicide is the second-leading cause of death among Mainers age 10-25, and the third-leading cause of death for the same age group nationally.

A self-reported survey of Maine high school students found 10 percent said they had attempted suicide at least once in the past year. The 2015 Maine Integrated Youth Health Survey also found that 15 percent had seriously considered attempting suicide in the past year and 18 percent reported at least one episode of self-injury in the past year.

The survey found that 6.2 percent of middle schoolers had attempted suicide at some point in their lives. Ten percent of eighth-grade girls said they had tried to kill themselves, double the 5 percent rate for eighth-grade boys.

More than 20 percent of middle schoolers said they felt “sad or hopeless almost every day for two weeks or more in a row (and) stopped doing some usual activities,” according to another survey question. For the girls, the figure was 29 percent, more than double the 14 percent for boys.

Mehnert, of the National Alliance on Mental Illness Maine, said a big concern is that the brain’s frontal cortex simply isn’t fully developed in middle and high school, yet students are dealing with a lot of emotional pressures.

“They don’t really have the capacity to process it all. And the scary thing is, we continue to have kids grow up faster. The things they used to struggle with in high school are now in middle school,” she said, such as issues surrounding sexuality and where to go to college or how to pay for college.

“This is stuff that’s not age-appropriate,” Mehnert said.

Webster, the Lewiston superintendent, said the district is privately meeting with mental health providers in the area to discuss general protocols and what happened specifically with Anie Graham.

The Graham family has been forthcoming in telling their story, saying that Anie first started showing signs of a problem about 18 months ago, including cutting herself and talking about death, and they actively sought help from doctors.

On the day before she died, the school called the Grahams because Anie had written on a class assignment that she wanted to kill herself. The family took her to a doctor that day, but when the doctor asked her about the note, Anie said she didn’t mean anything by it. Her mother, Rosi Graham, said the family had a meal that night, and next morning they found Anie’s body in her room.

The Grahams, who have criticized the resources available to their family, declined to comment for this story.

FINDING SOLACE AFTER A SUICIDE

Another Maine parent who lost a child to suicide said she also struggled to find mental health help for her daughter before she died.

“I couldn’t find a therapist for my daughter. No one with credentials higher than a social worker could see her,” said Victoria Vest, who said her daughter, Beata, was discharged after a 10-day hospital stay without adequate outpatient care. “It is the worst feeling in the world.”

In an awful irony, she said she hasn’t had trouble getting mental health help for herself since Beata, a sophomore at Waynflete School in Portland, died.

“It’s horrifying that after my daughter dies, I can find a fabulous psychologist, and so can my sister and my mother. But where were these appointments when my daughter needed it?” Vest said. “I feel guilty going to therapy.”

Hansen, the former Waynflete student, said she found solace by throwing herself into projects to increase mental health education. She helped arrange for mental health speakers to come to Waynflete and launched the “Yellow Tulip Project,” a way to draw attention to mental health issues and dispel the stigma and shame. More than 35 gardens have been planted at school community organizations and churches across New England.

“I think the most important thing to know is that as hard as it may get and as dark as you may be, always – always – hold onto hope and beauty in the world,” Hansen said.

And Hansen has a message for those students in Lewiston trying to make sense of Anie’s death:

“Know that you are not alone,” she said. “There are so many people who want to help you. And know that you are loved.”

Noel K. Gallagher can be contacted at 791-6387 or at:

ngallagher@pressherald.com

Twitter: noelinmaine