Suicide in Our Youth and What Is Being Done About the Epidemic!

unnamed-2I saw this article in nprEd by Kavitha Cardoza regarding teen and even younger suicide victims and was truly scared. Every day, thousands of teens attempt suicide in the U.S. — the most extreme outcome for the millions of children in this country who struggle with mental health issues.

As we’ve reported all week, schools play a key role, along with parents and medical professionals, in identifying children who may be at risk of suicide. And one of the biggest challenges: myths that can cloud their judgment.

“People are afraid of the whole topic,” says David Jobes, the head of Catholic University’s Suicide Prevention Lab. “It just feels like something that’s left unsaid or untouched.”

Jobes says one of the most common — and most dangerous — myths about suicide is that young children just don’t kill themselves.

It’s just not true.

Children as young as 5 take their own lives every year.

Another myth? Suicides are an impulsive decision, made in the heat of the moment.

Again, not true.

Jobes says kids can spend weeks thinking about and planning for their own deaths. And that, he says, is where schools have a role to play.

“They’re going to be letting their friends know, dropping hints, writing essays that their English teacher might pick up, telling coaches,” Jobes says. The one thing teens considering suicide won’t do are tell their parents.

Jobes was asked to walk the author through a few other common misperceptions of suicide.

Myth 1: Asking someone about suicide will cause him to become suicidal

“There’s already issues and struggles around mental illness within our culture and society. It’s highly stigmatized, and suicide is even more stigmatized. It feels like something that’s just best left unsaid or untouched, kept under the rug, and that’s a problem in terms of saving lives. Because we need to ask, and we need to intervene to actually save lives. You need to be direct. ‘Sounds like you’re really down, have you thought about taking your life?’ Just be very direct. The more direct the better.”

Myth 2: Depression causes all suicides

“That’s just not true. So, we have millions of Americans who are depressed. A small fraction of them take their lives, a very small fraction. So depression and suicide are not synonymous.

“On average, about a hundred and some Americans die each day [from suicide]. About 40 to 50 of them might be depressed. Other diagnoses are relevant — like schizophrenia, psychotic disorders, substance abuse, anxiety disorders. It’s not just all about depression.”

Myth 3: We cannot really prevent suicides

“We know very clearly that, with proper identification, proper support and treatments that are suicide-specific, we absolutely can make a difference and save lives. Most suicidal people who talk about suicide don’t really want to be dead. They’re giving other people lots of indications, lots of warning signs, lots of communications that this is something that they would like to not do, but it requires people identifying that and getting them the proper help.

“Some of the warning signs would certainly be depression and … loss of concentration. People not seeming like themselves. Insomnia can be a big risk factor. Other warning signs might include irritability, withdrawal. And the thing that’s really critical: Lots of people have those symptoms and are not thinking about suicide. It’s really when the symptoms add up in the mind of that person, where they think ‘The way I deal with this is to take my life.’ ”

Myth 4: Suicides always happen in an impulsive moment

“People contemplate, think about it, imagine it, fantasize about it, write suicide notes, post things on the Web. After many days or weeks, [they] then perhaps make a fatal attempt. There is a major theory in the field that says that no suicides are impulsive. That there is always a history if you dig deep enough.

“The idea that they come out of the blue may happen, but it’s actually quite rare. A small number of people, especially among adolescents or school kids, are not going to communicate their intent. But that’s the exception. They’re going to be mostly letting their friends know, dropping hints, writing essays that their English teacher might pick up, telling teachers and coaches. So when people say this, they’re not crying wolf. It’s something to take seriously.

“Kids telling other kids is really critical because that’s who they’re gonna tell. They are not going to typically tell their parents. They get oftentimes a very negative reaction, even a punitive reaction. So, schools are in a position to try to communicate to kids that talking to your friends is fine, but if you really are a friend of this person, keeping a secret about something as serious as suicide is not in their best interest. And they need to pass that information up to teachers or the principal or to guidance counselors who are in a position to get professional help involved.”

Myth 5: Young children, ages 5 through 12, cannot be suicidal

“Young children do take their lives. In the United States each year, about 30 to 35 children under the age of 12 take their own lives.

“It’s hard for a lot of us to imagine that a child that young — a 5-, 6-, 7-year-old — could actually know what it means to say, ‘I want to kill myself.’ But we do research with young children and know that kids are saying these words.

“They do intend it, and they do sometimes take their lives. Oftentimes, by running into traffic and getting hit by a car. We don’t know a lot about young children taking their lives. The suicide prevention literature kind of begins at age 12 to 14. It’s almost as if, even in the professional literature, young children can’t be suicidal. And it’s just not the case.”

Myth 6: When there has been a suicide, having a school assembly seems like a good idea

“There’s literature and a professional take on all this that in post-vention, which is intervening after a suicide has occurred in a school, you want to find a response that is not overreacting, which would cause other kids to copycat or to follow that behavior.

“Alternatively, you don’t want to underreact. And so there is a very useful literature out there, professional associations that provide guidelines where we try to find that sweet spot of attending to the fact that this happened, providing necessary information and then resources, but not letting the whole school out to go to the funeral. Or not having an assembly where everybody comes to hear from an expert about suicide.

“We really want to have these conversations in smaller groups, especially among those kids who were most affected by the suicide. So, just a wholesale didactic event is not necessarily in the school’s best interest and not necessarily the best way to prevent copycat suicides or additional suicides.

“The American Foundation for Suicide Prevention does have very useful guidelines that are specific to schools. The American Association of Suicidology has also had a task force. There is extensive literature that is accessed through those organizations about what is optimal, school-based post-vention.

“We certainly know that children and adolescents are heavily influenced, especially teenagers, by their peers. And that’s developmentally normal. So one of the things that we do worry about with kids is the idea of copycat effects, or modeling effects. That a child in a school system who may seem sort of invisible takes his or her life raises awareness and then suddenly everybody is abuzz about this horrific event.

“For other kids who look at that, they might say, ‘Wow, that’s something I could do, too.’ And that’s the nature of the suicidal mind in a child — to not really think about this in a rational way. And that’s where modeling effects are especially worrisome. And then we, of course, worry about clusters or contagion effects. And there is an extensive literature on how to manage that modeling effect so that there aren’t additional suicides to add on top of what is a tragic event in most school systems.

“High school guidance counselors are mostly focused on getting kids into college or getting them registered for courses. They don’t typically — in fact rarely do they — have a mental health background. So when a suicide does occur, a lot of these counselors are naturally approached assuming that they have a mental health background, and they don’t.

“That’s where school systems need to have access to mental health professionals and to people who really know what they’re talking about. And that’s where different guidelines [come in] — for example, the ones from the American Foundation for Suicide Prevention or Sources of Strength. There are different programs that are out there, especially Sources of Strength, which have an excellent evidence base that have been shown to be effective in adolescent populations.”

My question is why are kids as young a 6 or 6 attempting suicide. There must be some really difficult challenges for them or they don’t have the necessary skills to manage daily problems, which are thought to be minimal as compared to adult challenges. What are we missing in these kids? Do these children have underlying mental problems that are not being diagnosed or is their a hostile environment with physical or mental abuse, no role models or a living situation that none of us would even put an animal in?

Also, do we have the necessary man and womanpower and finances to search and find these “lost children” and care for them? Will the Affordable Care Act be able to support programs for these needy children?

But then I was encouraged by this article about some positive actions to help with firearms and suicide. John Daley wrote in his Public Health article about the Centennial Gun Club.

It’s ladies night at the Centennial Gun Club in a suburb of Denver. More than 80 women are here for safety instruction and target practice.

Tonight the club is offering more than shooting, though. The women rotate through the firing range, and in another large room, they hear a sobering presentation from emergency room doctor Emmy Betz. She’s part of a collaboration between gun shops and public health leaders in the state to help prevent suicide.

“If you’ve been touched by suicide somehow, if you could, raise your hand,” she asks. About half the hands go up.

Colorado has the nation’s seventh-highest suicide rate. In a typical year, more than half involve guns. Research suggests suicide is often an impulsive act, Betz says, and attempts are much more likely to be lethal when a firearm is used. If people survive a suicide attempt, they are far less likely to eventually die from suicide.

“Unfortunately, with firearms typically there’s not that second chance,” she says.

There’s a new push in the national conversation about gun violence that is attempting to sidestep the political rancor, to find common ground on one thing — guns and suicide. The campaign in Colorado is called the Colorado Gun Shop Project.

Centennial Gun Club is one of 46 on board. The project formally started in the summer of 2014, modeled after a similar one by the New Hampshire Firearm Safety Coalition.

During Betz’s talk, organizers hand out Life Savers candies to drive home the message. Gun owner Lily Richardson says she thinks the information could do just that: save lives. “I think those who are aware and taking the initiative to talk about it can help make the difference,” she says.

Nancy Dibiaggio, a new gun owner, agrees. “It’s a big issue, and I think it’s great Colorado is jumping on the wagon with this.”

Dick Abramson, Centennial’s owner, says he welcomes the opportunity to facilitate the discussion. “The difficulty is that it’s not a topic people want to just bring up and talk about over the cocktail table, right?”

He says workers at his store have refused to sell a gun to someone they’re concerned about or feel is having an especially bad day. “My honest feeling is this is a nonpartisan issue,” he says. “This is something that everybody can get behind. It should be a universal concern of everyone.”

In another Denver suburb, the Bristlecone Shooting, Training and Retail Center is also part of the project. At its range, shooters take target practice at bowling pins lined up on the far wall.

In the shop’s showroom, store owner Jacquelyn Clark shows off literature on display “that talks about suicide prevention and what to do if somebody you know or you yourself are in crisis,” she says.

A poster reads, Gun Owners Can Help! Under a photo of a lone elk in the mountains, it lists signs someone may be suicidal and a phone number for the National Suicide Prevention Lifeline.

Clark says there’s now an 11th commandment on gun safety rules: Consider off-site storage — family, friends, some shooting clubs, police departments or gun shops — if a family member may be suicidal. Clark says most people don’t realize that the majority of gun deaths are not homicides but suicide.

A survey of hospital emergency rooms by the Centers for Disease Control and Prevention in 2011 found an estimated 21,175 suicides involving firearms compared with 11,208 homicides involving guns.

“The gun community itself is more at risk than the regular community, not because gun owners tend to have more mental health issues but just because they have more access [to firearms],” Clark says.

Jarrod Hindman, director of the Suicide Prevention Resource Center in Colorado, says he appreciates that local gun advocates are taking the lead. “This is their project,” he says. “We’re just helping to facilitate the process.”

Look at these statistics: more than 500 Coloradans took their own lives with a firearm in 2014, says Hindman, but talking about the role of guns is hard.

“Obviously this is a very contentious topic, and we’ve found a way to find middle ground in a topic where we didn’t think there was a middle ground,” he says.

And now, a large trade association for the firearms industry, the National Shooting Sports Foundation, is teaming up with the American Foundation for Suicide Prevention to develop a suicide prevention campaign for the gun group’s 13,000 members. Their goal is to reduce the annual suicide rate by 20 percent in the next decade.

This topic of suicide is worrisome and it was my contention to pursue more discussion of physician involvement. Remember my discussion of the high suicide rate in physicians and in the medical students and the interns and residents training for their eventual medical practice. But suicide in teens and the children is chilling.

We need to become more aware of this severe problem and dedicate whatever finances necessary to save our children. I will, in another post, discuss the mental health problems in our children and our lack of support in the education and health care systems to care for these children.

Happy Labor Day!

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