Featured Discussion 28

Preventing Youth Suicide

The prevalence of youth suicide

Suicide and risk and protective factors

Suicide is associated with a range of risk factors including mental health problems, substance abuse, trauma, social isolation, and experiences of abuse and adverse life conditions. The 2004 Healthy Youth Survey in Washington State found that about 30% of children in grades eight, ten, and twelve reported feelings of sadness or hopelessness, for two consecutive weeks or more, that were severe enough to interfere with their usual activities. Earlier identification and treatment of depression among young people is clearly an important part of efforts to reduce suicide rates. According to recent prevalence data on diagnosed mental health disorders, the first onset for many disorders is in childhood or adolescence. Despite early symptoms, treatment may not be provided for several years. There are also disparities in access to treatment. Longer delays are associated with sociodemographic factors, such as being male, having less education, and being a member of a racial or ethnic minority groups.

Research also indicates that the cultural context has an important influence on suicide risk and protective factors. Although historically, suicide rates have been lower in some groups, such as African Americans, these trends are changing. Some groups, such as American Indians or Alaskan Natives, are at significantly higher risk of suicide, in comparison to other populations in the United States. Understanding the cultural context is essential for suicide reduction efforts.

Reducing Suicide

A review of suicide interventions by the World Health Organizations identified about thirty different approaches, including both primary prevention approaches, and secondary interventions for at-risk group and individuals. The authors of this report concluded that it is not yet possible to determine which programs are the most effective.

One example of a school-based prevention program is Signs of Suicide (SOS), recently developed in the United States. The program adopts a two-pronged approach, combining screening for risk factors, such as depression, with educational activities to raise awareness of suicide and its correlates. Participants are taught a "first-aid" response, based on a three-step action plan - ACT - Acknowledge the signs, show Care and Tell a responsible adult. Evaluation of the program suggests promising outcomes. For example, students who had participated in the program were more likely to seek counseling either for themselves, or on behalf of friends. However, there have also been negative responses to school-wide screening programs because they are perceived as being too intrusive in a school environment. Although there is empirical evidence to the contrary, screening also raises concerns that exposing students to self-report questions about suicide may increase distress and have a contagion effect.

Please share your experiences and expertise by discussing the issues raised in this essay. Below are some questions that you might wish to address in your comments.

• What can be done to increase the protective factors against youth suicide?
• What can be done to reduce the risk factors for suicide among children and adolescents?
• How can culturally-based models of research and intervention be developed and implemented?
• Have you been involved in suicide reduction programs? What worked or didn't work?
• What is your view of screening as a strategy to prevent suicide? Are schools an appropriate venue for screening?
• What other prevention strategies should be implemented?
• What actions should be taken to reach children or young people who may not participate in a school setting?

We look forward to hearing your views. As always we appreciate your thoughts on this important issue.

Your thoughts…

Comments:

Although they don't disclose the connection, some of the sites posted above are by the Church of Scientology via their CCHR organization:
signsofsuicide.org
teenscreentruth.com
Both registered to Colleen House of the Buffalo Church of Scientology and CCHR. Posted Friday, December 28, 2007 by RonS at 03:25 PM

""To effectively combat suicide what is needed is a competent psychotherapist.... try and find one today when the only competency that matters to mental health is that one has accumulated thousands of hours.... doing what? James W. Patterson, Ph.D.""
*****This is self promotion on your part to sell your services, but your services tend to hurt more then they help in many ways. Of course you can say hurting people is helping them, but I have never really known a time that the pain was the thing that helped me. I do think that if more of the real needs were being met in a respectful and giving way that more things would change much quicker. I also think that what the system does is a form of bullying in and of itself much worse then any other form of bullying in many cases, so the bullying from the system and system providers needs to stop i.e. coercion and force. I do not see mental illness as a "personal" disease I see it as a sign of societal breakdown and a lack of compassion and empathy systemically. Posted Tuesday, May 29, 2007 at 04:07 PM

How does one effectively combat suicide if one does not know what the cause of it is? To the behaviroally trained individual of course we look at everything but the individual for the "cause". The reason for this type of thinking and painting everything physical and tangible as "responsible" is to avoid looking within... and this is due to an unknown fear of the unknown within each of us... unless one has removed it via competent psychotherapy.

The choice for suicide is a natural choice one's MIND gives one as an alterntive to facing what one fears within oneself [specifically the "monster" hidden within ones MIND realm]. To effectively combat suicide what is needed is a competent psychotherapist.... try and find one today when the only competency that matters to mental health is that one has accumulated thousands of hours.... doing what?

James W. Patterson, Ph.D. Posted Saturday, March 24, 2007 at 08:58 AM

My doctor has tried several anti-depressants and to my dismay, none of them are working. Someone told me about an anti-depressant with opiates and said it works really well. WBR LeoP Posted Sunday, March 11, 2007 at 03:55 PM

The highest cause of death in humans are doctors... WBR LeoP Posted Saturday, March 10, 2007 at 04:58 PM

Psychic pain doesn't kill you, it only makes you wish it did. Posted Tuesday, November 28, 2006 at 02:42 PM

Get the facts on mass mental health screening of American children:

Search the net for the phrase:
"TeenScreen petition"



Posted Tuesday, August 29, 2006 by David at 05:01 AM

While any loss from suicide is very tragic and we want to do all we can to stop a tragedy from happening, I question any program associated with the pharmaceutical companies who have heavily vested interests in their success. The Signs of Suicide Program is heavily funded by the pharmaceutical companies who stand to gain much financially from this program. http://signsofsuicide.org
PR companies, hired by the pharmaceutical corporations have worked hard to develop this "new market" for their drugs. Up until these programs the school market had been largely untapped. http://www.teenscreentruth.com/teenscreen_PR_firms.html TeenScreen and SOS were developed by the same group and funnel their product to the mental health industry, ONLY. http://www.signsofsuicide.org/funding.htm No physicals, blood tests, MRI's, CAT scans or lab tests, only a "diagnosis" based on observation of "symptoms". A recent survey showed that 9 out of 10 children who saw a psychiatrist ended up on drugs. Here is the result:
http://www.teenscreentruth.com/psychiatry_drugs_suicide.html Posted Thursday, May 18, 2006 at 08:40 AM

Here is a letter to an Editor from a friend about Teen Screen, if you read it you will see that this mothers child was screened, was being so called treated and then committed suicide any ways. Is it worth losing one more child to this unwillful act of so called authority just so that nothing ever really has to change? I just wanted to share this with the board. Janie
**********************************

Dear Editor,

I have read and re-read your recent article, “Science Tries to Find Secrets of Teen Brains”

Over the course of my review, I experienced many thoughts and emotions. To be quite frank, the overwhelming feeling was rage.

Experience has taught me that when rage raises its ugly head, it is usually best to walk away from the source and cool down. Hopefully, you will not take my response as a personal assault, but rather understand why there has been so much resistance to mental health screening of our youth.

Please allow me to explain, but first, I feel to express my sorrow in learning of the death of another child; such a terrible, painful and utter tragedy… I sympathize and I empathize with her mother; indeed with all who knew and loved this young lady.

My son, Kevin, was only fourteen when he died. His death certificate reads
“suicide” as cause of death.

He too was once full of life; a handsome, intelligent, straight A student, trained in the martial arts; a Life scout working toward his Eagle. He was loved beyond measure by his family and well liked by his friends. He will never know the thrill of holding a driver’s license in his hand, will never go on that first date or kiss his first love; will never graduate from high
school or college, will never marry, will never experience the joys and
challenges of being a parent himself… So, you see… I do understand. I
more than understand.

As you note – those adolescent years can be tumultuous. When you stop to
consider the many changes that are taking place at this time in their lives, not only physiologically, but also within their environment – hormones rushing in, new friends, new expectations and responsibilities – the sometimes overwhelming implications of moving beyond childhood and into adulthood…. Suffice it to say, we would all be wise to look back on our own
experience as we made our own way through those years – sometimes stumbling, sometimes racing to some perceived “finish” line, sometimes falling flat on our faces – yet we all came through, one way or the other.

I raised four children. With the exception of Kevin, they are all grown now and beginning families of their own. Kevin was my youngest, so I am no stranger to the challenges of the teen years. However, I did perceive that around the age of twelve, Kevin was struggling. Against what or over what, I couldn’t be sure, but when he began to withdraw from activities that he had always enjoyed, I felt he might need help beyond what I could offer as
his mother to come to terms with whatever he was feeling or experiencing that led him to withdraw.

I did not feel any need for his school to assist or intervene. The decision
to seek assistance was simply a decision we made as his parents. We made an appointment with our family doctor, who after speaking with me and my son in his private office, made the assessment that my son was suffering from depression. We were then given “instruction” on how depression is caused by a chemical imbalance that is often genetic, and that the answer was to “correct” the imbalance. There were marvelous new drugs on the market today that could correct the imbalance. Although I expressed hesitation, as our family had always been very mindful of using drugs sparingly, I was assured that this new generation of drugs were quite specific to the problem, and quite safe.

My son was prescribed a new generation drug, an SSRI antidepressant, quite
safe for children. We were not offered any other options. The diagnosis was made (depression = chemical imbalance) and treatment planned (chemical balancer = drugs). He experienced problems shortly after beginning this course of therapy, but our trusted family doctor again assured me that this was quite common, and encouraged me to make sure he took his dose every day at the same time. I was instructed on the knowledge that sometimes it took a few weeks for the drug’s effects to “kick in”. I dutifully followed the instructions.

So, here we have a very real case of a child who underwent screening, received a medical diagnosis and was receiving treatment – all under the
care of a medical professional.

To put it simply – screening didn’t work for him. In my own research, I
discovered the disturbing fact that many adolescents who committed suicide
were “screened” and were receiving treatment via drug therapy with these
newer, “marvelous” antidepressants.

What compels you to foster the idea that screening in the schools will work? Is there some educational secret that the medical professionals have
entirely missed? If the screening detects a child who is troubled, what
treatment will be offered? Will he receive counseling even if his parents
are uninsured, or even if insured, can’t afford counseling? If the
adolescent is troubled because his mother and father are getting divorced, can the problem be fixed with medication? If he is struggling
academically, and this leads to feelings of being overwhelmed, will a tutor be provided? Depression can stem from an inability to control one’s circumstances. Will he be empowered? By what? At what cost? Will he and his parents be offered a range of options that are within their means?

As I am certain is the case for any parent who loses a child, especially to sudden, traumatic, unexpected death – there begins an almost obsessive compulsion to examine and question and re-examine every fact, every memory, every tiny detail - to understand what “it” was that we missed.

I’ve been doing that for almost six years now. I’ve discovered where I went wrong –I trusted too much.

Sometimes you have to trust. When my children were old enough to enter
kindergarten, I had to trust they would be in good hands. When I take my car in for repairs, I have to pretty much trust the mechanic…. But, you can also trust too much.

I placed too much trust in the medical profession. I did not ask the right
questions. I didn’t even know then what questions I should have asked. I
am also learning to forgive myself.

But more importantly, here is where the medical profession has it wrong, and where you have it wrong – all summed up in two very important words: INFORMED CONSENT.

My son was suffering depression because a trusted medical professional told me it was so, not because of any scientific test which validated his
diagnosis. My son was not required to undergo any testing whatsoever. Had
he received the care he should have received, had I been better educated and less trusting, I would have demanded a complete physical, a blood work up, lab tests – to first rule out any underlying physiological reasons that might have been found. I have learned many things since his death
–information I should have had when he was alive.

In my estimation of the points you bring up in your article, what you are
suggesting here as a valid medical, scientific test is simply “wishful
thinking”. Where are your references to this “astounding new brain
research”? If you’re referring to brain imaging and brain scans, may I
introduce you to a range of neurologists and others within the medical and scientific fields who have completely debunked any notion that brain scans and/or imaging can properly diagnose a “mental illness”?

I know enough to know that “screening” did not help my child. I even wonder
if this is what ultimately led to his untimely death. I assure you that
many others share my thoughts. This is why the Teen Screen program or any
variation of mental health screening for our youth is being met with such
resistance. My experience is just as valid as anyone who claims that
screening works.

To those less educated in the field of mental health, your article suggests
an attempt to balance the pros and cons of this most important argument, but you do not convince me. Your article left me feeling as if someone was deliberately attempting to rub my nerves raw. There is no doubt which side of the issue you favor. Is this good journalism – to expose your bias in such a manner? It speaks of advertising clothed in the framework of journalism – truth blended with assumptions, some of which have already been proven to be false; propaganda at it’s finest.

We all do what we have to.

As for me, I intend to continue to work against mental health screening. I intend to help other parents understand the importance of educating
themselves on this very important matter and how to avoid the mistakes I
made. I also intend to help them understand that sometimes they just need to trust their own instincts.

Sincerely,

Cassandra Dawn Casey
(formerly, Dawn Rider)

President, A.S.P.I.R.E.
www.aspire.us

Mother to Kevin Neil Rider
10/02/85 – 06/3/00

Lehi, UT
Posted Monday, December 12, 2005 at 06:19 AM

TEE Productions in Cleveland Ohio has produced a Video, "Inside I Ache" that is geared to the friends of a potential Suicide. See description below. For More information please contact me, Dan Roberts at 216-831-1353
The video, Inside I Ache, is a conversation starter geared to friends of a depressed person to educate them as to the warning signs of suicide and then to encourage and give them permission to break a confidence and tell an adult in authority. With the video comes suggested lesson plans as well as follow up lessons on bullying, anger, coping/resiliency and the concept of choosing life and its importance. As an aside, this makes a great program for parents and youth to see the video together. The parents and the students can then be separated and social workers or trained teachers can discuss elements of the video with each. For the parents the concept would be the promise that if their child comes to them with an indication that a friend is in trouble, they would make a pact to tell the parent of that child as they would like others to tell them.

In case you are questioned about the efficacy of talking about suicide in the classroom, the video (included) You Can Do It, part I, is a 10-minute presentation by noted authorities who indicate that by talking about depression and suicide one might actually be preventing a death. This occurs by giving off the message that authorities are open and not threatened by the conversation. In case the person who is to teach this subject is nervous You Can Do It, part II, is a 20-minute presentation, again by noted authorities, about what preparations the person need to make before teaching this subject.


What People Are Saying About “Inside I Ache”….

“I have had an opportunity to preview both videos and review the accompanying guide and was immediately struck with the critical message conveyed so sensitively and informatively.” “…As a superintendent of a public school system, I believe the information in the videos should be shared with educational professions….”
Linda J. Williams, Ph. D., Superintendent of Schools, Richmond Heights Schools, Richmond Hts., Ohio

“I have viewed your video, and read your guide for professionals working with teens. It is an excellent resource to those who work with young people. The video talks openly about the warning signs of depression and how one can reach out to help a friend with suicidal thoughts. One of the most powerful points of the video, young people talking about their experiences will make it more real to those students who view the video.” Carol Loehr, survivor of a child who died by suicide

“Most importantly it (“Inside I Ache”) brilliantly breaks the silence that suicide can be a needless and preventable cause of death by talking to the children. “Inside I Ache” is the missing piece in the prevention of youth self-inflicted death.” Earl A. Grollman, DHL, DD, Author and lecturer in the field of Thanatology.

“I want to commend you on the quality of the video “Inside I Ache.” I believe this video has the potential to make an enormous difference in the lives of young people, both those at risk of depression and suicidal thoughts and others who might find themselves befriended by someone in emotional duress.” “…It deals intelligently with its subject; it does not talk down to students but rather treats them with great respect. It is direct, unsentimental, emotionally true and at times even surprisingly candid.”
Dr. Scott Miller, Theater Arts Program Director, Cleveland School of the Arts, Cleveland, Ohio

“I thought it was a great production. The thing that stuck out most to me (from an educational perspective) is that you kept to one theme. Suicide prevention can be challenged from many angles and messages can be lost if you give out too much information. I thought that it was great that you kept repeating your message, of ‘tell someone, don’t keep it a secret.’ I think that the audience I intend this for will certainly get the message.” Captain Sharon Low, Regional Human Rights Advisor Regional Cadet Support Unit (Northern Canada)

“I recently reviewed your video, “Inside I Ache and You Can Do It” and found the video to be an excellent classroom tool. I have been looking for a quality video on suicide for several years and could not find one that met my needs. I feel the student section of the video is superb. …I also plan to use several of the activities in the teacher’s guide to provide hands-on activities for the students.” Ms. Joan Ball, Menominee High School, Life Management Department

200+ copies already sold to: Cleveland Public School, Regional Cadet Support Unit (Northern)-Canada, Mental Health Agencies-State of Ohio, Regional School Districts-Minnesota

Posted Saturday, December 10, 2005 at 08:50 AM

As a clinician I have instinctive negative reactions to data that is associative and does not speak to the nature of the associations, i.e. is any risk factor directly causal, or perhaps a by product of a deeper issue or cause. Stomping out risk factors (i.e. drug intervention programs blind to the mental health issues of a kid) may actually precipitate more risk for suicide. So I would always apply the common sense test to such data and not swoon over raw data ever.

The SOS program passes the common sense test for me. My experience is that when youth are estranged from all adults in their environment, they may have worries about a friend's risk of suicide, but if they don't, or can't, tell ( the last letter in ACT) then the necessary interventions don't occur.

However the real devil is in the details. Creating a climate where teens can tell demands respect for them in what they developmentally should NOT tell adults. Some risk taking out of the watchful eye of caring adults is normative and growth promoting. What we have to assure is that youth in a school environment have the tools to decypher what out of the box behavior is relatively harmless, low risk and fun, and what is very high risk, or too deviant (from a kids point of view - just too screwed up and weird) to be comfortably tolerated in a peer context. Then there needs to be a person that is identified by peers as cool headed, non-hysterical and sensitive to the incredible politics of a youth social scene and can make a senstive and effective intervention.

Doing something programmatically would involve educating students in a school, staff generally, and creating a cadre of staff who have special status in the school and with the kids and are protected from the politics that swirl around issues of suicide and schools that lead to hysteria.

All this is quite complicated. The good news is that without research and programmatic activity by schools or MH professionals such intervention systems form naturally when the right combination of individuals are left to develop relationships over time in a school setting. Posted Thursday, December 8, 2005 by Charles Huffine, MD at 11:20 AM

Great discussion and useful info. My comments are that single focused prevention efforts are likely to not be effective in reducing the incidence of suicide. The research and evaluations that I have seen seems to support multi-modal approaches consistent with the US Air Force approach. Several very good school based evaluations have used multi-modal approaces as well. We have a lot to learn yet about prevention of suicide, but there are some approaches that have great possibilities and some evidence behind them.

SOS did the work to demonstrate positive results of a singular program approach and might be a very good program to consider; however, I would encourage planners to consider using programs like these within a broader context and approach to suicide prevention. My concern with the evidence based movement, is that very good programs that have not invested in research will be discarded as they do not carry the "seal of approval" ... and innovation may be squelched. We are not far enough along as a field to discard promising approaches.

Sure depression screening is intrusive and there will be those who fight against this. Seems like some schools try to fly below the radar on programs that could be politically toxic. Posted Wednesday, December 7, 2005 at 11:18 AM

Without looking at the impact of bullying, creating pressure to put into place anti-bullying measures, educating schools on the destructive effects of bullying on lives, attendance and test scores, no suicide prevention program will be effective, nor will it have any lasting effect.

Also, when advocating for anti-bullying measures and reviewing treatment of children in the schools, we must not overlook the gay-baiting which is systemic and pervasive in our schools. IT is the gay-baiting which is the most inflammatory most allowed bullying. The results influence the high suicide rates of LGBT children. 60% of all attempted suicides are LGBT, 30% of all committed suicides are LGBT youth.

Posted Wednesday, December 7, 2005 by Mika Major LGBT Community Cent at 10:18 AM

Post a Comment:

Return to Current Featured Discussions Page

Top