Suicide Prevention Can Start in School

When a 16-year-old boy stepped in front of a commuter train last month, he became the fourth teen to commit suicide on those tracks in Palo Alto, California, within six months. The teens, ages 13-17, were all students, or were soon to be students, at the same high school.

Palo Alto is reeling -- and, in response, rushing to step up police patrols and school counseling services to prevent any further incidents. Elsewhere, the devastating deaths are a sobering reminder of the risk of teen suicide and the need for communities and schools to take preventive steps: The Centers for Disease Control and Prevention (CDC) reports that suicide is the third leading cause of death among youth ages 10-24.

Furthermore, 15 percent of high school students in a recent survey said they had seriously considered suicide within the previous year. Teens are also particularly vulnerable to the phenomenon of suicide contagion, where one death seems to initiate others.

Amid the shock and grief over the events in Palo Alto, experts say it's important for concerned adults to know that steps can be taken to reduce the risk of teen suicide and help stop such deaths from spreading. And schools can play an important role.

Suicide doesn't strike at random. "Teachers should be aware that suicide is a multifaceted problem, in that 90 percent of kids who kill themselves have a psychiatric disorder," says Paula Clayton, medical director of the nonprofit American Foundation for Suicide Prevention (AFSP). "Even in suicide clusters, there's usually an underlying condition that's precipitated by a more recent event. The cause isn't just the breakup of a relationship, or a divorce in the home, or an arrest. It really is this underlying disorder, and this is the last straw."

Teenagers and young adults are particularly vulnerable to so-called suicide contagion. Madelyn Gould, professor of psychiatry and public health at Columbia University, has studied 50 such clusters nationwide. She explains that when a suicide occurs, it can reinforce suicidal thoughts among young people in the community who were already at risk. "We're most concerned about having some already-vulnerable person start to identify with the victim and really start to think that suicide is the solution to his or her problems," Gould says.

Educators can make a difference with prevention in two ways: by watching out for students who may be at risk, and -- for an even broader impact -- helping start a suicide-screening program at their school.

"Screening programs are incredibly effective," says Kelly Posner, director of the Columbia University Medical Center's Center for Suicide Risk Assessment, who notes that 45 percent of adults who commit suicide have recently seen their primary-care physician. "We should be asking these questions the way we monitor for blood pressure," she says. "Same thing in schools."

Educators can help reduce the risk of teen suicides by taking these measures:

Be on the Lookout

The AFSP's Paula Clayton explains that typical symptoms of depression include mood changes, such as sadness, boredom, irritability, or anxiety; loss of interest or pleasure in activities they used to enjoy; and eating or sleeping too much or too little.

In school, depression might manifest as students falling behind in class, acting tired or withdrawn, losing their concentration, quitting their usual activities, and spending less time with friends. Also, teens with depression tend to become negative about themselves, and ultimately some of them may talk about being absorbed with thoughts of death or wishing they were dead.

Moodiness is, of course, a quintessential teenage trait, so it can be hard to distinguish between what's normal and what's cause for alarm. "The difference is really that it's a change from their normal behavior, and then it's prolonged," Clayton says. "It's not just a month or two. It goes on. And it affects all aspects of the student."

Teachers can also take note of these risk factors for teen suicide, as listed by the CDC: a history of previous suicide attempts, depression, or other mental illness; a family history of suicide; alcohol or drug abuse; a stressful life event or loss; easy access to lethal methods; exposure to the suicidal behavior of others; and incarceration. Suicide among teens is, for reasons that are not well understood, at least four times as common for boys than girls.

Share Your Concern

Clayton recommends that teachers who are worried about a particular student reach out to a school nurse or counselor, or even directly to parents if the teacher has a close relationship with the child. She suggests following up by asking, "Bill is not quite up to his usual self, and I'm concerned about him. Do you want to come in and talk about it?" It's important to remember, she says, that "it really eventually is up to the parents to get the child into treatment."

Help Your School Start a Screening Program

Posner says research has found that high schools with screening programs can detect double the number of at-risk students as other schools. And, ultimately, screening results in lower suicide rates, she says.

Two commonly used screening programs are TeenScreen Schools and Communities, produced by Columbia University, and SOS Signs of Suicide, produced by the Massachusetts-based nonprofit Screening for Mental Health. TeenScreen provides schools with free mental-health screening questionnaires, instruction on how to use them, and guidelines on how to work with families when a student needs professional care. The SOS kits, at $300 each, include a DVD, a class discussion guide, and student screening tools, and are designed to educate students to recognize and respond to depression in themselves or others.

It's essential that schools that do screening have systems in place to refer students to follow-up care if needed. TeenScreen requires its participating schools to do this.

If a teen suicide occurs, educators can take these steps to discourage others from making the same choice:

Pay Attention to More Than Just the Victim's Inner Circle

Schools that experience such a loss routinely make extra counseling services available to students and staff, which Gould affirms is the right thing to do. She adds, though, that schools should be aware that frequently in clusters it's not the closest friends of the earlier victims who become the later victims, but youths who knew them indirectly or not at all.

Consider Doing Widespread Screening for Depression

"At-risk students won't necessarily self-identify, so if you just wait for students to come to the guidance office you'll be missing people," says Gould. This applies to teachers and other adults in the school community who may need care, as well.

Avoid Oversimplifying the Causes or Glamorizing the Act of Suicide

This requires a careful balancing of the mourners' needs to memorialize their loved one with measures to minimize the likelihood of contagion. Prominent or prolonged memorials may help grieving friends and families cope, but they may also reinforce the suicidal thoughts of other vulnerable teens. Gould suggests that schools proactively establish policies about how student deaths will be treated--for example, shrines on campus might be allowed to remain in place for three days--and treat all deaths, whether by suicide or other causes, the same. Online memorials, such as Facebook pages, deserve similar caution.

Schools should also provide accurate information to students and families about the complex causes of suicide, and consider appointing a single spokesperson to ensure a consistent message. Reducing the cause of a suicide to a single difficult event or relationship could deepen other teens' vulnerability or reinforce people's tendency to blame themselves or others. "Schools need to provide accurate information to families and students so that scapegoating is avoided," Gould says. "They need to give factual information about suicide and risk factors for it."

Distribute Reporting Guidelines to Local Media

Distribute area newspapers, television stations, and other media outlets to the AFSP's guidelines for reporting on suicide. The foundation recommends, among other steps, avoiding portrayals that romanticize the act or the victim, and avoiding detailed descriptions of the method.

Useful Resources

Consult these organizations and other resources for more information and advice about dealing with teenage suicide:

American Foundation for Suicide Prevention

AFSP guidelines for the media on reporting on suicide

More Than Sad: An informational film and resource site, including a lesson plan for the film, designed to foster educational discussion with students about suicide, produced by the American Foundation for Suicide Prevention and the New York State Office of Mental Health. A second video, due to be released shortly, will emphasize ways that school staff can spot warning signs and provide help.

National Suicide Prevention Lifeline: 1-800-273-8255

Screening for Mental Health's SOS Signs of Suicide

Suicide Prevention Resource Center

TeenScreen Schools and Communities

Grace Rubenstein is a senior producer at Edutopia.