BELMONT — At any given time, the rooms behind an unlocked steel door on the third floor of McLean Hospital's East House house 14 teenage girls who have tried to hurt or kill themselves. They've often been prescribed medications, gone through hours of therapy, and endured previous hospitalizations aimed at protecting them from themselves.
But in the program directed by Dr. Blaise Aguirre, the priority is not on medication or keeping patients locked up. The point is to cultivate a trust, self-respect, and mindfulness that will help these teenagers sustain themselves long-term.
Aguirre is quick to say that he can't work miracles. But of nearly 1,000 girls who've passed through the floor over the last nine years, he knows of only three who eventually committed suicide.
Over a period of about two months each, the staff convinces these teens that they are worthy of love from others and themselves.
"They feel they're understood by their therapist. They feel that the team, including their parents, want them to get better," said Aguirre, who is also an assistant professor of psychiatry at Harvard Medical School.
Aguirre bases their care on dialectical behavior therapy (DBT), an approach aimed at teaching how to regulate emotions, tolerate distress, get along with others, and act with self-awareness.
"This isn't kumbaya, sit around the campfire, feel good. It's about neuroscience," he said.
Dr. Bruce Perry, a child trauma expert in Houston, described McLean's program as a beacon in a world where adolescent mental health care is almost universally terrible. "To find high-quality, well-delivered, sensitive care that can be provided in a sustained way, in a center of excellence, is exceptionally rare," he said.
A lot of suicidal and self-destructive behavior is a cry for attention, Perry said, and at McLean, the teens are given the attention they crave, and a sense that their lives can improve.
"When they have even little moments when they feel regulated, heard, a bit of pleasure, it can serve to create a sense of hope," said Perry, a senior fellow at the nonprofit Child Trauma Academy. "The accumulation of these little moments over time can help shift the individual's sense of their own worth, that they have value."
Aguirre takes most of the kids off their medication and instead teaches them to meditate — to be present in the moment, rather than dwelling on the miseries of their past, or their fears for the future.
"We live in those moments and we miss the wonderfulness that is in the present moment," he said.
Aguirre said he uses the DBT approach in his own life, too. He meditates regularly, and when he's really annoyed at someone, he practices kindness to turn the emotion around.
"It's a way of taking care of myself," he said.