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For a myriad of reasons that experts say remain unclear, a state known for its mountains and fly fishing is one of the worst in the nation for youth.

Kids Count data from 2015 ranks Montana as 30th in the nation for overall child well-being and 47th for child health. Montana has one of the highest rates of suicide among teens.

Since organizations started ranking states in the late 1990s, Montana has always been at the bottom, Thale Dillon of Montana Kids Count said. The state consistently has high death rates for children and teens, high rates of traffic crashes, and high rates of substance abuse.

Cassidy “Cassie” Holt, a 17-year-old student at the Trapper Creek Job Corps outside Darby, could have been one of those statistics.

When she was just seven, Holt’s teachers noticed bruises and duct tape marks on her arms. When her teachers asked what the marks were from, Holt told them that on nights “when he wanted to,” her dad would use duct tape to restrain her.

“He duct taped my hands behind my back and duct taped my mouth to make me shut up and sent me to bed,” she recalled. “And then the next morning right before I went to school, he would cut the duct tape off of me and send me off to school.”

He would spank Holt with a cutting board. He would sexually molest her and say it was tickling.

Holt was taken away from her father and placed in a foster home. As she grew up, Holt developed an angry demeanor, sank into depression, and planned suicide.

As a teenager, she found help through mental health services available to Montana youth from low-income families.

She was a victim of the adversity of her childhood, and statistics show that she’s not alone.

Nearly a fifth of youth who qualify for Medicaid services receive some form of mental health treatment, and close to 30 percent of all Montana teens who responded to a statewide student survey said they had ongoing feelings of sadness or hopelessness. Almost 19 percent reported they had seriously considered attempting suicide.

Matt Kuntz, executive director of the National Alliance on Mental Illness Montana branch, said mental illness is a result of biological and environmental factors.

Everyone has varying biological susceptibilities to brain health, and environmental conditions weigh on how the brain develops.

“I think that we also have to be honest and say that there still is a lot of mystery in these conditions; we don’t understand all of the reason Montana is hit as hard as we are,” Kuntz said. “And that's a reason why it’s also probably not realistic for us to look at one fix but at a series of system tweaks and changes.”

One agency looking at change is Helena-based ChildWise Institute.

Created several years ago by youth mental-health treatment and therapy provider Intermountain, the ChildWise Institute works to educate Montanans about complex trauma known as Adverse Childhood Experiences. A comprehensive study done in the 1990s showed that people who experience ACE are more likely to suffer health complications later in life.

“The revelation is not that adversity in childhood creates emotional distress; that was something we all knew. Those of us in the mental health field would say ‘duh’ to that,” Elizabeth Kohlstaedt, clinical director at Intermountain, said. “But the revelation is that adversity is common, that it’s cumulative, and that it leads to physical illness and emotional illness in adulthood.”

Kohlstaedt said Intermountain operates under the idea of trauma-informed care. When youths walk into their clinic in need of mental health treatment, staff assume they may have a background of trauma.

And when youths do need treatment from Intermountain, it’s because their mental health conditions have reached a crisis stage.

Kohlstaedt said an understanding of trauma and knowledge of ACE creates the opportunity for people to intervene before an individual reaches crisis level.

“Montana in particular is rife for this kind of change. We have sort of a tough individual attitude of 'pull yourself up by your bootstraps' … and that doesn't work anymore,” Kohlstaedt said. “That created illness in adults, and it creates stress in children.”

It’s a familial cycle of trauma and stigma — one that many Montana organizations are trying to break. Those organizations are working hard not just with a moral imperative to improve the lives of the next generation but with an economic case to unleash the abilities of the next generation.

“If we remain at the bottom, that means teens don’t get better, so we’re trucking away at status quo,” Thale Dillon of Montana Kids Count said. “... But there are lives that are being lost completely unnecessarily and children who grow up without being able to realize the full potential that they have.”


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