How Dayton region can stop record increase in teen suicides
Dayton Daily News - 6/16/2019
Jun. 16--A more proactive approach -- from parents, schools, anyone in contact with kids and even teens themselves -- is necessary to counteract the growing number of youth suicides in the Dayton area, experts say.
A Dayton Daily News investigation found that more consistent screening of teens and adolescents for mental health and suicidal thoughts is needed, as well as more training for anyone around youth on risk factors, warning signs and how to have ongoing conversations about suicide.
The Dayton Daily News' Path Forward initiative investigates solutions to the region's most pressing issues, including the Miami Valley's mental health, starting with the youngest victims. This story digs into what the community is doing to stop record increases in youth suicides and what else needs to be done.
Youth suicide has reached at least an 18-year high in Ohio, with 128 deaths by suicide in youth ages 8 to 19 in 2018.
Waiting for kids to approach a counselor isn't enough, said John Ackerman, suicide prevention coordinator at Nationwide Children Hospital's Center for Suicide Prevention and Research in Columbus.
"That's what we've relied on probably a bit too heavily," he said. "It probably doesn't go far enough to meet the needs."
Nationwide is one of a handful of children's hospitals across the country doing targeted suicide prevention research.
Discussions about suicide prevention also need to focus on ameliorating risk factors and root causes of depression, anxiety and suicidal thoughts, rather than debates about bullying, which has declined nationwide with no effect on youth suicide rates.
"Suicide rarely has a simple explanation," Ackerman said.
Several local school districts have taken steps to address the issue. Six districts partnered with the Montgomery County Alcohol, Drug Addiction and Mental Health Board to administer annual mental health screenings for all students, as well as providing teachers with mental health first aid or other courses. About 2,500 students were screened in the past year.
And at least seven districts have formed Hope Squads, a new approach to train students to help their friends.
At least two local high schools -- Oakwood and Kettering Fairmont -- lost students to suicide this past school year.
"A lot of kids feel like they're stuck, and they don't have anyone to go to," said Oakwood student Sam Nicholaisen. He survived a suicide attempt in 2015 and wants to share his story following the deaths of several friends by suicide in the past year, including fellow Oakwood student Jacob Polete in November.
"When Jacob died, everyone felt it," he said. "But we're just a few months later and everything is back to normal, like it didn't happen. No one talks about it. Nothing has come of it since then, and it's kind of sad."
Suicide prevention must be an ongoing effort, experts said, not just something talked about after a tragedy. And it can't just fall on the schools -- it must include parents, relatives, neighbors, coaches, clergy, friends or anyone around adolescents, according to experts.
A comprehensive approach also should involve teens themselves because only one in four suicidal teens will confide in a trusted adult, according to Ackerman. They are much more likely to turn to their peers, he said.
"The young people know themselves best. We need to empower them and show them that it's a sign of strength to talk about (mental health)," Ackerman said.
Attention in the aftermath of a suicide to the sensational aspects can be problematic when trying to prevent future suicides, experts said.
That can include speculation about what caused the young person to take their life, Ackerman said.
Bullying often is singled out for blame, with school leaders criticized for not doing enough. But that debate can obscure the real issues, Ackerman said.
He described bullying as a precipitating factor that could compound suicidal thinking in someone who already has risk factors. Risk factors include past trauma or a family history of depression. Precipitating factors would be more immediate circumstances like a rejection or death of a loved one.
For a grieving community, bullying can seem like the easiest answer, Ackerman said. "But most people who are bullied do not kill themselves," he said.
The percentage of U.S. teens who reported being bullied at school in the past year hit an eight-year low in 2017 and the percentage reporting cyber-bullying dropped 1.3 percent from 2011 to 2017, according to the Centers for Disease Control and Prevention.
Meanwhile the national suicide rate for 15- to 24-year-olds has risen every year since 2007.
"It is not accurate and potentially dangerous to present bullying as the 'cause' or 'reason' for a suicide, or to suggest that suicide is a natural response to bullying," according to the federal government's StopBullying.gov page.
'Root causes' of local suicides
The Montgomery County Prevention Coalition recently took a deep dive into the available data and research to understand the real main causes of suicide in the Dayton community.
"We have been working on defining these issues over the past few months, and we have narrowed it down to eight root causes," said Tristyn Eppley, manager of the coalition. The list applies to all age groups, including children.
Those causes include a lack of healthy coping skills in youth; various community barriers to receiving care, including stigma; high levels of stress and trauma due to loss of jobs, the addiction crisis and high rates of domestic violence; and a lack of community connectedness.
The coalition is developing solutions and policies to combat these causes and prevent more suicide deaths.
"We would want to see evidence-based programs happening in every school, (suicide) screenings happening in every school, Hope Squads in every school," Eppley said.
But the coalition recognizes that schools face financial constraints and must balance mental health programs with all the other mandates they must follow.
The Path Forward will examine the challenges for local schools in addressing student mental health in a future story.
Researchers want to know more about what causes suicide and how to prevent it, Ackerman said, but funding lags other public health issues that kill far fewer people.
The federal government spent about $100 million on research labeled suicide or suicide prevention in 2017 while $2.5 billion was spent on emerging infectious diseases, according to National Institutes of Health data. Emerging infectious diseases include things like Ebola and Zika. More than 45,000 Americans died by suicide in 2016 compared to two U.S. Ebola deaths during the most recent outbreak and one non-congenital death from Zika complications.
Prostate and breast cancer, which kill roughly the same number of Americans each year as suicide, receive three and six times as much government funding for research.
"We don't get the research dollars for suicide even though it's the second leading cause of death for 10 to 34-year-olds," Ackerman said.
Both U.S. Sen. Sherrod Brown, D-Ohio, and U.S. Rep. Mike Turner, R-Dayton, said they support more mental health and suicide prevention funding.
"If we're serious about addressing teen suicide, we need to get serious about investing in research, prevention efforts and mental health services," Brown said in a statement. "Too many families and communities have lost loved ones to suicide and it's time for Congress to do its job. By increasing funding and support for individuals, we can learn more about these terrible tragedies and hopefully prevent more from occurring in the future."
"Youth suicide prevention is critically important," Turner said in a statement. "Just this week, I supported three amendments to an appropriation bill to increase funding for youth suicide awareness, research and prevention efforts. We must continue to work to protect our children's lives."
U.S. Sen. Rob Portman, R-Ohio, did not respond to a request for comment.
Kids tell kids
A number of local schools are incorporating peer-led programs by creating Hope Squads.
The program teaches students to look out for signs that their classmates might be struggling, know how to start a conversation with them, and how and when to get further help.
Lakota East and West and Mason high schools had Hope Squads in place this past school year. Kettering and Springfield students just completed the training and will use the program next school year. Oakwood will start training in the fall.
Two Beavercreek middle schools are in the process of starting Hope Squads as well.
"Kids tell kids when they are struggling emotionally," said Jennifer Wright-Berryman, assistant professor of social work at the University of Cincinnati and lead researcher for Hope Squad. "They're already talking to their friends about suicide. It's not a taboo subject among kids anymore."
Young people increasingly share their intentions on social media and their friends are the most likely to see those messages. That includes lingo like "KMS" -- kill myself -- when kids are frustrated. Hope Squad members seek to turn those conversations in a healthier direction.
In 2017, a Moorefield Twp. teen live streamed a suicide attempt on Facebook, according to a report from the Clark County Sheriff's Office. Another teen called 911, deputies said, to report seeing her take a large amount of medication. Her parents intervened and got her to a hospital.
Students trained by Hope Squad become a type of first responder, Wright-Berryman said. They aren't counselors but shepherd their peers to appropriate care.
"(The Hope Squad) also do a lot of really cool activities to raise awareness around mental health and suicide prevention," she said, including hosting a Hope Week to focus awareness efforts.
Kettering-Fairmont High School was already in the process of starting a Hope Squad when a junior at the school died by suicide in March. That incident united the community to act, Principal Tyler Alexander said.
"We are believers that we need to talk about it," Alexander said. "If you don't do that then students don't think that people care for them, or they don't know that there are resources."
They've gotten positive feedback about the program.
"We are really, really excited," Alexander said. "We believe that it's not only going to save lives, but it's going to help us create even a better culture for our building."
Nicholaisen said he'd like to see a peer-to-peer program started at Oakwood and school officials confirmed they will begin training in the fall to hopefully launch a Hope Squad at Oakwood High School next spring.
"Peers and friends, people your age, are the best people to go to," he said. "They can relate most to you at the time. You'll listen to someone your age more than an adult."
At Lakota, students believe they already have improved their school culture and helped their peers after just one year using Hope Squad. School counselors saw a spike in referrals for mental health issues, which they anticipated, according to Lori Brown, director of student services.
"Overall the parents have been very supportive," Brown said. "They're saying, 'Yes, this is a conversation that we need to be having.'"
Students were skeptical at first, according to Hope Squad members at both Lakota schools, and some still joke about the project. But overall students bought in, used their peers as sounding boards and got help, they told the Dayton Daily News.
"Having an administrator talking to you about it seems like it's just a protocol thing and they have to talk about it," said Eliana Bishop, 15, a Hope Squad member at Lakota West. "Having people in your grade you can talk to and you won't feel judged by them, I think is what really made a difference."
"It's much easier for the students to talk peer-to-peer," said Gavin Mullen, a Lakota East Hope Squad member who will be a junior in the fall. "Adult life and student life are very different."
These youth face the highest risk
Some teens, including girls and African Americans, are at a higher risk of suicide than their peers. But teen suicide numbers remain highest for those who identify as lesbian, gay, bisexual, transgender or queer.
LGBTQ teens attempted suicide at rates more than four times higher than their peers nationwide last year, according to Greg Ramey, pediatric psychologist and executive director for the Center for Pediatric Mental Health Resources at Dayton Children's.
The suicide risk is so high for these teens that Public Health Dayton & Montgomery County's LGBTQ Community Health Alliance made it a top priority.
They have worked to strengthen gay-straight alliance groups at area high schools or create them where they don't exist. Research shows having a strong alliance group lowers rates of suicide ideation and attempted suicide -- even among students who don't identify as LGBTQ, according to Jerry Mallicoat, LGBTQ health initiatives project manager for the local public health department.
"Having these GSAs really matters because it helps the students feel safe and supported at school," Mallicoat said. "It just generally gives them a sense of belonging ... It helps with all sorts of the emotional and social issues they may be experiencing that can lead to them attempting suicide."
Devon Stephenson was out of high school when he attempted to end his life in 2018 but said his struggle with sexual identity was a factor in his depression and anxiety. Even when things seemed to go well for him, the current Wright-State student and Dayton resident said he feared it was all too good to be true.
"I felt that it was all temporary because you are expecting to not be accepted," he said.
Stephenson, now 26, is studying to be a social worker. He was active in suicide prevention and mental health work through the Montgomery County Prevention Coalition even before his attempt, which he said shows you can know a lot about this topic and still not be looking out for your own well-being.
"Check in on your strong friends," he said. "In Dayton we really need to focus on community connection that creates empathy."
The Youth Action Team of Public Health's alliance presented at the Ohio Association of School Nurses conference in Dayton in March. They trained school nurses from across the state on how to best interact with LGBTQ youth, and how to spot and intervene with students who might be suicidal.
Resources geared toward teens?
Local teens and parents said they'd like to see more resources be specifically aimed at youth and the ways they communicate and get information.
"What's out there now in terms of resources are not items that are particularly helpful to teenagers," said Debbie Kirschman Klopsch, Sam Nicholaisen's mom. "What's it going to take to really address it beyond reciting a phone number?"
Nicholaisen doesn't believe kids are likely to call a hotline and speak with a stranger. They don't even call their own friends and family on the phone, he said.
More awareness that many people are going through something and destigmatizing talking about mental health will help, Nicholaisen said, along with letting kids know that their peers and parents will listen.
"I don't think people understand that everyone around them is fighting their own battles," he said. "Which means you both can give empathy to each other."
'Have the hard conversation'
For parents, the research so far points to a deceptively simple answer -- talk to your kids about suicide.
But even parents who have been through the experience admit it's easier said than done.
"We don't want to give our kids ideas," said Leigh Ann Fulford, a local volunteer with the American Foundation for Suicide Prevention who lost her sister to suicide. "Parents don't want to talk about it."
A number of training classes available through ADAMHS and other agencies in Dayton include role playing for participants to practice asking direct questions about self-harm and suicidal thoughts.
"Let's not wait for the crisis to have conversations," Ackerman said.
So strike up a discussion at the dinner table, in a car, anywhere that parents have an audience with their kids. And not every conversation has to be about suicide.
"But if you're seeing warning signs, have a very direct conversation," he said.
Parents also need to be aware of the potential for increased risk of suicide with some psychiatric medications prescribed for teens. Ackerman doesn't want teens who need medication to not get it because of fears of side effects, but said parents need to be more vigilant when medication is involved.
"It's a really important time to check in more often," he said.
Medication for depression or anxiety, whether prescribed to a teen or a family member, can also become a lethal means in some cases, so parents should lock it up.
Kirschman in Oakwood saw some signs that her son was struggling but chalked it up to typical teenage stuff that would pass.
"Hindsight being 20/20, I probably would have taken more aggressive action earlier," she said.
She remembers asking Sam if he was OK the night he attempted to kill himself. He said, "Yeah," and that was the end of their chat. But he wasn't OK.
"Have the hard conversation," Kirschman said. "Face your fear."
A parent's instincts are probably correct, she said, but they must use a direct approach. Parents strategize for the sex talk, the drugs and alcohol talk, even the safe driving talk -- but there's no suicide talk.
That hesitancy can isolate kids even more.
"I thought my parents didn't know anything about what I was going through," Kirschman's son Nicholaisen said.
Parents need to know that their sons and daughters might be struggling more than they think, he said.
"This is a major thing affecting kids," Nicholaisen said. "Having the conversation could be the difference between life or death."
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