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Silent
Epidemic
Grappling
with increasing rates of teen suicide.
by
Elizabeth Pownall
The Situation
The summer before his junior year in high school, Mark was depressed. He had considered
suicide before, but not to the extent where he actually planned to die. Until this
particular summer.
"I was home alone for the weekend, and I was thinking how
alone I was," Mark recalls. "The depression just built and built to the
extent that I got the gun case out. I had the gun in my hand and, as fate has it,
the phone rings. I put the gun down and answer the phone. It's my drama teacher and
he invites me to this musical in Portland."
The intervention saved Mark's life, but each year there are thousands
of teenagers who are not as lucky. The 2000 Surgeon General's Report states that
more teenagers and young adults die from suicide than from cancer, heart disease,
AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined.
Suicide is the second leading cause of death for Oregon youth ages
10-19, according to the 1999 Youth Risk Behavior Survey (YRBS). Oregon's teen suicide
rate is 29 percent higher than the national average.
Call to Action
In March, 2001, The Oregon Plan for Youth Suicide Prevention:
A Call to Action, was introduced by the Oregon Department of Human Services Health
Division. It recognizes youth suicide as a "silent epidemic" that needs
statewide recognition. A Call to Action is an attempt to break through the cultural
stigma surrounding death and end the shame around suicide by dealing with it realistically
through education.
Fifteen strategies are introduced, including the reduction of access
to firearms, educating youth and young adults on suicide prevention, reducing harassment
in schools and communities, and providing media education and guidelines to reporting
suicides so as not to risk "suicide contagion."
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What
To
Look For
Risk Factors: Depending on a person's
individual response, risk factors that may contribute to a person feeling suicidal
include significant changes in: relationships; well-being of self or a family member;
body image; job, school, location; financial situation; state of the world. Also,
significant losses including: death of a loved one; loss of a valued relationship;
loss of self-esteem or personal expectations; loss of employment; and perceived abuse,
including: physical; emotional/psychological; sexual; social; neglect.
Typical Warning Signs: These can include withdrawal from friends and family; depression, not necessarily
clinical depression, indicated by signs of: loss of interest in usual activities;
showing signs of sadness, hopelessness, irritability; changes in appetite, weight,
behavior, level of activity, sleep; loss of energy; making negative comments about
self; recurring suicidal thoughts or fantasies; sudden change from extreme depression
to being "at peace" (may indicate that they have decided to attempt suicide);
talking, writing, hinting about suicide; previous attempts; feelings of hopelessness,
helplessness; purposefully putting personal affairs in order: such as giving away
belongings, interest in wills or life insurance, "clearing the air" over
personal incidents from the past.
Source: Oregon Health Department Youth Suicide Prevention
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One of the more ominous statistics in the Surgeon General's report
is that suicidal adolescents are 75 percent more likely to commit suicide if they
have easy access to a gun.
"Guns are the most prevalent means for young people to complete
a suicide," says Ron Bloodworth, Coordinator for Oregon Health Department Youth
Suicide Prevention Program. Adolescence is an impulsive time, and a gun in the hands
of a depressed teenager, he says, "can be a permanent end to a temporary situation."
Yet the issue of youth suicide is much more complex than gun access,
according to Dan Close, Director of the UO's College of Education Family and Human
Service Program. "It's not a simple case of 'We have a bunch of depressed kids
and they're going to find a way to kill themselves'. Suicide rates among youth have
always been high," he says.
Suicide, Close contends, defies any socio-economic boundary. "The
common feature is the transition going into adolescence and going into adulthood.
It is when things stop working. When all those external trappings cease to function
for you any longer, then you become desperate."
The mental health needs of children and adolescents, nationwide,
are an increasing concern to specialists. According to the Surgeon General's Report,
12 to 15 million children and adolescents are in need of mental health services,
yet services are fragmented and underfunded. Rather than getting the help they need,
troubled youth are typically suspended from schools, thus exacerbating the problem.
"Kids that have serious depression or who aren't coming to
school because of terrible anxiety or family trauma -- these are the kids who are
at risk for violence, to themselves or to others," says Peter Schnabel, South
Eugene High School's Psychiatric Mental Health Nurse Practitioner. Suicide is not
only linked to depression, Schnabel notes, but it is also linked to complicated anxiety
problems or learning and attention disorders. If a student is failing, he says, that
student can become depressed and suicidal.
The adjustment from elementary or middle school is significant
for students who already have some psychiatric disorders, says Schnabel. While adolescents
seem to push their parents away for personal freedom, it is important for parents
to create a "holding environment." It's time for parents to be available
to talk and to provide extra support for their adolescents and to be attentive, he
says.
Research shows that students are more likely to be diagnosed with
mental health problems such as depression in school-based health centers than in
a doctor's office or medical clinic. As such centers increase in number, the possibility
of students falling through the cracks greatly decreases, says Schnabel, as the centers
are getting to a point where they can do evaluation and treatment. "There is
a nice relationship between the health care center and the school as well as with
the parent community. Parents see it as a place their children can get help,"
he says.
One physician who endorses the school intervention advantage is
Dr. Teresa Callahan, a physician at Prime Med Urgent Care and Family Medicine in
Cottage Grove. When she was a physician in a public school, Callahan says she got
much more information about the students than she did while working in a private
office setting. "In private practice, she said, "you just get this little
window of looking at someone. (At Willamette High School) I could talk with the teachers,
the parents; I got a whole community's input."
When she took her position at Willamette High School Health Center
in the Bethel School District in 1997, Callahan noted the high numbers of depressed
youth. She became especially concerned when the YRBS Report was released in 1999,
indicating that depression was a major factor for adolescents attempting suicide.
One of the primary factors leading an adolescent down a path of self destruction,
the report notes, is school harassment.
"Across the board," she says, "whether it was harassment
because of gender, race, ethnicity, or because of perceived sexual orientation, a
large number of kids reported they had been harassed and that led to the development
of their depression."
The Risk
The most important risk factor for suicide is a previous
attempt. This is followed by depression, substance abuse, loss of someone intimate
to suicide, access to firearms, a history of sexual assault and abuse, and harassment.
Nearly 30 percent of youth in Oregon reported being the target of racial, sexual,
or perceived sexual orientation harassment at school or on their way to and from
school during the past year, according to the YRBS study. Nearly 7 percent of high
school students and more than 10 percent of 7th and 8th graders reported that they
were targeted with harassment because someone thought they were gay, lesbian, or
bisexual.
"The suicide rate for gay teens is particularly distressing
and in my mind cannot be ignored," writes William Pollock in his book, Real
Boys, "When we hear these staggering statistics, when we begin to appreciate
how lonely and frightened so many gay youth feel, some of us may be quick to conclude
that being homosexual must be the primary cause of these problems...These problems
are not caused by homosexuality but rather by society's misunderstanding of homosexuality."
Whether parents, teachers and students feel homosexuality is wrong,
says Callahan, it cannot excuse harassment in schools, no matter what form it takes.
"It's clear when kids feel unsafe at school, when they feel
threatened, alienated, unwelcome, ostracized, they are not learning," says Callahan.
"They are watching their back, wondering who's going to be waiting for them
at their locker, who's going to beat up on them when they dress for gym, etc."
As the national spotlight turns to school harassment and school
bullying, the Human Rights Watch calls for action from all school districts to include
sexual orientation and gender identity in their anti-harassment and anti-bullying
policies. In Oregon, HB 3247, a bill calling for a statewide initiative that would
prohibit harassment based on sexual orientation, failed to make it through the 2001
Oregon legislative session.
Harassment is critical, says Patrick Fraleigh, Psychologist/Human
Resources Administrator for the 4J School District. "When you look at all the
school violence, almost all the perpetrators were significantly harassed or bullied
in one form or another -- they were always on the fringe. All of them, to my knowledge,
have described themselves as being victimized by their peers."
Every employee in Eugene's 4J School District has four obligations
regarding harassment. They must understand the many forms harassment can take, interrupt
students when they witness harassment, track students' incidents, and report persistent
harassment behavior to an administrator.
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Community Resources
Parents, relatives, friends, teachers, ministers and other
trusted adults should not be overlooked as valuable and vital resources.
24 Hours (Local)
-- 911/Sacred Heart Emergency Room
-- White Bird Crisis Line 687-4000
-- Looking Glass Station 7 (Information and referral) 689-3111
24 Hours (National)
-- 1-800-suicide
-- Hotline for GLBTQ youth 800-850-8078
Monday through Friday
-- School Nurse/Counselor/Mental Health Specialist in school health
center
-- Pat Norberg (Lane County Child and Adolescent Behavioral Health) 682-7588
-- Looking Glass Counseling Center 484-4428
-- Options Counseling 687-6983
-- ACES Counseling 344-2237
-- PFLAG/ GLSEN (parents and friends of lesbians and gays; gay lesbian straight education
network) 302-4422
-- GLBTQ (gay lesbian bisexual transgender questioning) Eugene Youth Group 684-3466
Web Resources
www.yellowribbon.org
www.befrienders.org/email.html
www.glesen.org
www.youthresource.com
Call to Action, Oregon Health Department Suicide Prevention Report
available at www.ohd.hr.state.or.us/ipe/suicide.htm
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This is a big change, says Fraleigh, from four years ago when the
only people involved in the harassment issue were administrators. The 4J School District
got involved in harassment prevention and now all levels, including parent volunteers
in schools, take harassment very seriously. "It is just as serious to harass
someone as it is to trip them or push them into a locker," he said.
Harassment is what led Mark to the brink of suicide. As a gay teenager,
he faced frequent jibes from classmates, which plunged him into deep depression.
"The heavy harassment made me feel weighed down," he says. "I have
received verbal harassment from students. I've had objects thrown at me, paperclips
shot at me in the halls, I've had graffiti on my locker." Mark credits his drama
teacher for saving his life, with that spontaneous call inviting him to see a play
in Portland.
Intimate Vigilance
In a recent speech, National Education Association President
Bob Chase cited research that shows 80 percent of teachers harbor negative attitudes
toward gays and lesbians, and 53 percent of prospective teachers feel uncomfortable
working with a gay or lesbian colleague. "These are the attitudes, fears, and
misconceptions that can permeate a school environment," he says.
Chase insists that beyond anti-discrimination policies and training
programs, everyone, including parents, teachers and students, must maintain an "intimate
vigilance," which means "paying attention. Reaching out to children who
seem distressed. Challenging their assumptions about people who are different from
them. Calling them on inappropriate behavior and bullying." It may mean asking
children how they are doing. "Small acts of engagement and compassion can make
a tremendous difference," he says.
The Aftermath
Those left behind in the aftermath of a suicide have a
lifetime of picking up pieces, sifting through memories, struggling with guilt, a
desire to replay events, trying desperately to understand what happened. The ripple
effect a suicide can have on a family, a school, and a community cannot be underestimated.
"Death by suicide," writes Kay Jamison in her book,
Night Falls Fast, "is not a gentle deathbed gathering: it rips apart lives
and beliefs, and it sets its survivors on a prolonged and devastating journey."
Why did she/he choose to die? What could have been done to prevent
his/her death? What is it about that person that sets them apart from everyone else,
that he/she would choose to die while someone else chooses to live? All are questions
that haunt those left behind.
When her best friend committed suicide in 1968, Eugene therapist
Barb Ryan wanted to die. She plunged into a tunnel of adolescent despair that was
not recognized by anyone around her. People asked Ryan why her friend commited suicide,
what she knew about it, while in the meantime Ryan, herself was lost in the process.
"The first three years after my friend died are not only a
blur to me, but are a total time warp; I pretty much shut down, stopped talking to
everybody, spent time in my room ... I had been a straight A student up until then
-- and I barely pulled through. No guidance counselors or teachers said, 'Oh we know
your best friend died, what do you need?'"
It was in the form of a household visitor that Ryan found her way
out. "She recognized me as a human in pain. I didn't even talk a lot, she just
held my hand."
Prevention
Of the 736 suicide attempts among Oregon minors in 1997,
the Oregon Health Division Annual Report shows: 364 youth reported they were unsure
whether they wanted to live or die, 211 didn't want to die, 28 had the idea, and
133 wanted to die. From a prevention perspective, says Jill Bishop, Safe Place Coordinator
with Looking Glass Youth and Family Services, "there's a lot of room to push
them in another direction. Often people don't realize it can mean only one connection
for a kid to prevent them from killing themselves."
Bishop's interest in suicide prevention grew when she noticed the
statistical connection between the high rates of adolescent suicide and lack of preventive
education. If adolescents have the right coping skills -- yoga, meditation, a support
system of friends, relatives and clergy -- they will consider options other than
suicide when they enter a low period in their lives, says Bishop. But she's quick
to add, "If they don't have these skills, suicide can be pretty appealing."
Bishop teaches suicide risk reduction workshops in the public schools,
through Project Safe Place funded by Lane County Health and Human Services. In her
workshops she goes over the signs of depression so students may recognize it in each
other. She also coaches them in how to assist a potentially suicidal friend. One
method is the ACT approach: Acknowledge that your friend is depressed. Care -- show
your friend you care, Tell -- tell a trusted adult. Students are also given a list
of resources at school and in the community where they can find help.
Unfortunately, many parents, educators, and peers do not know how
to approach the problem of suicide when it enters their lives. "If someone has
a plan and has made a previous attempt," Bishop says, "their risk increases."
Bishop plans on developing a parent workshop in the next year.
Parents have a responsibility, Bishop says, to educate themselves
on the signs and treatment of depression, to restrict their adolescent's access to
lethal weapons, and to advocate for the mental health needs of their children.
There are reasons parents do not seek help for their children,
Dr. Kirk D. Wolfe, President of the Oregon Council of Child and Adolescent Psychiatry
pointed out in a recent conference. Parents don't recognize the warning signs for
suicide. They believe that depression is a normal part of adolescence. They believe
their child has a good reason to be depressed. They are afraid of social stigma --
that they might be viewed as crazy or weak by others. They do not have adequate insurance
and are not aware of other resources available to them, or their child refuses treatment.
The best thing a parent can say and do for their adolescent is
"to say 'I love you no matter what' and do it," says Laura Phillips, Coordinator
of Eugene GLBTQ Youth Group. Parents can easily overestimate their adolescent's strength
and desire for independence. They can be hurt by their child's rebelliousness and
step too far away from their child, she says. In doing so, parents are "not
seeing in the midst of it all the young person's vulnerability." If an adolescent
is feeling rejection from their peers and alienation from their parents, she says,
"this is a recipe for depression and every possible risk: substance abuse, dropping
out of school, unsafe sex, and in particular, self harm."
The best thing parents can do, Phillips says, is to accept their
children, love them, and seek out the support their children need for issues they
may be struggling with.
In July, HB 3024 was passed, making it a requirement that every
county, statewide, develop a comprehensive mental health plan that includes suicide
prevention. "This is just a beginning," said C.A. Baskerville, Prevention
Coordinator for the Lane County Health and Human Services.
"Jill Bishop is championing the issue. She has really taken
it to the next level, pushing it and really making sure it is in people's minds,"
says Baskerville.
"Suicide prevention," Coordinator Bloodworth says, "is
everybody's business."
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