Preventing the forever decision.
This piece first appeared in The Vermont Standard.
In a video posted on a Myspace page, a Rutland teen hams it up. First she feigns surprise, then astonishment; she looks back at the camera with one eyebrow arched, shaking a finger to mockingly scold. She’s a girl with a thousand expressions and she’s using them all to goad her friends to laugh, and they do. Internet surfers who stumble on the page unaware soon realize the jarring truth, that the girl with the beautiful face and thick blonde hair tumbling down to the middle of her back, who wears a string of pearls with her tank top and jeans and sneakers, is a girl who is gone. And the page is a place where her friends come to share their despair, to vent their hurt and disbelief that she’s lost her life, not to physical disease or unexpected accident, but by her own hand. “I can’t stop thinking that I could have done something,” says one commenter, “why did you do this?” writes another; “I want you back so bad,” says a third.
But she can’t come back, she’s made the forever decision that takes the lives of too many teens and young adults; suicide is a leading cause of death among people aged 15 to 24. As with adults who die by suicide, depression, often undiagnosed, is a principal cause.
Vulnerabilities in adolescents make focus on prevention among young people particularly important says JoEllen Tarallo-Falk, Executive Director of the Center for Health and Learning in Brattleboro, and Director of the Vermont Youth Suicide Prevention Project (VYSPP). “Developmental impulsiveness and lack of life-long perspective on problems and problem solving can predispose adolescents to [be at] risk for suicide,” she says. The work of the VYSPP over the last three years has culminated in a Youth Suicide Prevention Platform for Vermont, which Tarallo-Falk expects will be officially unveiled in early February. “There are a number of strategies we promote,” she says; they include boosting awareness of suicide as a treatable public health problem, contributing to solutions by providing training and resources, and working to develop assets in kids that make them resilient.
The mental illness that afflicts 90 percent of teens and young adults who die by suicide may manifest in persistent changes in sleep and appetite patterns, lack of energy, inability to concentrate, anxiety, loss of interest, severe mood swings, and excessive feelings of guilt or hopelessness.
“Suicide tends to be the nexus for a variety of intersecting mental health concerns,” says Tarallo-Falk, including depression and substance misuse, combined with real or perceived losses and access to the means to kill one’s self.
Some medical researchers believe that immaturity of the adolescent brain may also be a factor. Ronald Dahl, Professor of Psychiatry and Pediatrics at the University of Pittsburgh Medical Center, for example, notes in a widely circulated 2004 presentation that although strength, endurance, and mental capacity grow by leaps and bounds during the teen years, “overall morbidity and mortality rates increase 200% over the same interval of time…it is the high rates of accidents, suicide, homicide, depression, alcohol and substance abuse, violence, reckless behaviors…that are killing many youth in our society.” The areas of the brain that are the last to fully mature, he says, are those that help manage emotions and that sync behaviors with long-term goals; teens, then, are more vulnerable to emotional influence and impulsiveness, and less bounded by regard for risks and consequences.
“Most people who are suicidal report that [suicidal] feelings will pass,” Tarallo-Falk says, “impulsively acting on those feelings is where we lose somebody.”
Every year in Vermont, 8 to15 deaths of kids younger than 25 are reported as suicides. The characters in the narratives of these fledgling lives needlessly lost are varied but all are compelling: a Randolph high school senior known for his smarts, lively banter, and love of theater; a West Rutland girl, just venturing out on her own, struggling with drug use and abusive boyfriends; a young father studying finance and accounting at the University of Vermont; a Castleton State student whose obituary ran in the newspaper that not long before had reported his accomplishments on the lacrosse field; a tender-hearted and sensitive Burlington-area 13 year old who was emotionally battered by bullying.
Many young Vermonters think about suicide and say they attempt it. According to results reported by the Vermont Department of Health for the 2011 Youth Risk Behavior Survey, a wide-ranging questionnaire voluntarily completed by over 20,000 students in 66 Vermont schools, the percentage of kids planning or attempting suicide has dropped since 1993. But still, nearly 20 percent of high schoolers say they felt sad or hopeless almost every day for at least 2 weeks, 8 percent made a suicide plan, and 4 percent attempted suicide. Pressing suicidal thoughts were even more prevalent among middle schoolers; 11 percent of 6th through 8th graders say they made a plan, and 5 percent say they attempted suicide. Percentages reported for Woodstock Central Supervisory Union middle and high schoolers were one to two points higher across all measures, although the Vermont Department of Health cautions against comparison of local and statewide data.
The 2003 death by suicide of Garrett Lee Smith left his parents, Sharon and former Oregon Senator Gordon Smith, stunned, and agonizing over the trail of signs and signals that their son had left in the years leading up to his death. The Smiths channeled their sorrow into an effort to de-stigmatize mental illness and prevent youth suicide. In 2004, the United States Congress passed the Garrett Lee Smith Memorial Act, and in 2008 Vermont became a beneficiary of one of its grant programs. The Center for Health and Learning, which develops and administers a number of programs around mental, emotional, social, and physical health of children, was designated a lead agency for the funding, and directed development of the VYSPP.
“The first priority is to promote awareness that suicide is a public health problem and to develop support for prevention in Vermont,” says Tarallo-Falk, and, she adds, to encourage people to get the mental health, substance abuse, and suicide prevention services that they need.
A primary tactic of the VYSPP has been to create “gatekeepers,” adults who are prepared to respond to signs that some one may be suicidal.
For the VYSPP, the Center for Health and Learning has trained 322 educators representing 33 of the 63 Supervisory Unions in Vermont. The interdisciplinary teams returned to their schools after training to develop protocols for responding to suicidality, to establish relationships with local mental health agencies, and to in turn train parents and other adults in their school communities. Another 200 professionals in the state have been trained as well, including substance abuse professionals, juvenile justice emergency responders, and primary care givers. “We have created a cadre of 33 trainers, and we are hoping to raise funding to continue the work,” says Tarallo-Falk; the program specifically funded by the Garrett Lee Smith Grant officially concludes in February.
The Center for Health and Learning also created two websites for the VYSPP, one to help depressed teens and their concerned friends and families, and another site for gatekeepers. At www.umatterucangethelp.com, kids can find stories of teens who suffered from depression and were helped by treatment, practical advice for dealing with depression, assessment quizzes, and lists of community resources. Gatekeepers can learn about ways to help at www.umatterucanhelp.com. “The message is that anyone can experience mental health problems,” says Tarallo-Falk, “asking for help is a sign of courage and not a sign of weakness.”
Faculty and staff have their ears to the ground at the Woodstock Union Middle and High School, and in the Windsor Central Supervisory Union’s six elementary schools, says Daphne Tuthill, the schools’ Director of Instructional Support Services. “We wrap around folks as much as we can, especially those that are most vulnerable,” she says, “if we hear that a child has said to any one that they intend on hurting themselves, we contact parents, we do an assessment, and be sure that the student is safe.” The schools do have staff trained to make assessments of kids who may be contemplating suicide, and that assessment process doesn’t end, she adds, until “we have covered all of the bases” to ensure student safety. That includes determining if the student has a plan, learning what means they may have access to and eliminating that access, soliciting family support, and connecting the student to health care providers who can help.
Tuthill and Tarallo-Falk agree that developing assets and coping skills in kids that make them resilient is important element of suicide prevention.
The Ottauquechee Community Partnership (OCP) is a Woodstock-based non-profit devoted, in part, to fostering a healthy and positive environment for area youth. While OCP does not create programs specifically targeted at suicide prevention, Executive Director Jackie Fischer says that the group works to help nearby communities arm their children with important competencies. Kids that are engaged in learning, for example, that know how to resist negative peer pressure and resolve conflicts nonviolently, that are involved in activities and programs, are more likely to thrive and less likely to exhibit risky behaviors. “We can’t know the challenges that kids are facing in their families or with their peer groups,” says Fischer, “but we are about building strengths so that kids have what they need to overcome challenges.” Part of the idea is that strong kids hopefully have the courage and connections to ask for help for themselves when they need it, and for their friends or acquaintances if they see warning signs.
For community members interested in working with youths, OCP runs various programs; there are buddy programs in three local elementary schools, for instance, and a mentoring program that begins in the Woodstock Union Middle School. Adults are matched up with kids and spend an hour to an hour and a half with them weekly during the school year. The pairs may do things like play games or read, and with older kids the adults may teach their mentees to cook or knit, or take them on outings to the library or the skating rink. “Our mentoring programs are one way we help kids build assets,” says Fischer, “and we have many kids who want mentors or buddies.”