March 1st, 2012

Initiative prompted by rash of suicides

Youth suicide prevention is at the forefront of efforts in two New England states. Connecticut experienced a rash of suicides last fall while a Rhode Island study showed an increase in events among children under age 15.

In the aftermath of five Conn. suicides, psychologists and social workers from state and local agencies joined school officials, students and parents for a public forum.

Michael J. Schultz, Ed.D, licensed psychologist, family therapist with the Connecticut Department of Children and Families and co-director of its Academy of Workforce Knowledge and Development, says 350 people attended the December forum in Enfield, where two of the suicides occurred.

The forum used the Positive Youth Development framework and included information on child development, trauma and services that are available to help.

Schultz says the Enfield outreach effort includes prevention and early intervention, parental involvement and student empowerment. “The goal here is to utilize this as a springboard for other communities. We really wanted to reinforce the home-school-community approach right from the get-to” and include students from the outset.

Schultz met with high- and middle-schoolers. “They were so crystal clear about what they needed,” he says. “That’s the stuff that gives you hope.”

Schultz says efforts will include peer supports and peer mediation.

High school students told Schultz they need spaces to have conversations that at times do not include adults. And while they appreciate discussions with adults and authority figures, “they don’t always feel adequately heard and understood and respected,” he says.

“They also believe they can spot the kids who are off track immediately,” and that teachers and adults need to be trained to recognize them. “It’s their belief that some kids are screaming loud and clear by what they wear, what they say, what they write, what they draw – and that many professionals are missing things that are right smack in front of them.”

Bullying was a major topic among younger students, as was the subject of “fitting in” with peers. “Some of it is very normal preadolescent development, but I think the key is they don’t have the space to process it. If they have a place at home to do it, they tend to negotiate that pretty well. The at-risk kids didn’t have people they felt they could go to.”

One of the Connecticut deaths was a 10-year-old, an unusual occurrence according to Schultz. “(At that age), it’s more about trying to solve a problem and alleviate the pain of living, if you will.

“We know the adolescent and young adult brain is not fully formulated until 23 or 24, particularly in the frontal lobe area, which is the part that controls impulsiveness or decision making. It’s hard for them to think beyond the next five minutes. All they know is that they are really hurting.”

Suicide among youth younger than 15 was the subject of a Rhode Island study featuring state-level data that showed an increase in that group over the past three years.

“To see these cases I think has really raised some alarm,” says Jennifer Kawatu, RN, MPH, coordinator of the Rhode Island Child Death Review Team (CDRT), which examined suicide among those under 24 from 2005-2010.

Suicide among children that young was not something that was typically seen in the past, such as a decade ago, Kawatu says.

The report found that suicide is the third leading cause of death among Rhode Islanders 15-24 (in line with the national average). It also reported that more than 75 percent of youth who died by suicide had told someone they were thinking about doing it or had previously attempted suicide. As a result, the CDRT’s primary recommendation is to take all warning signs seriously.

Kawatu says, “I think a lot of times people disregard suicidal statements or suicide attempts as just trying to get attention. They may be trying to get attention, but it’s a true call for attention and if they are ignored, a real suicide may result in the end. I think it’s important for both parents and professionals to take those situations very seriously.”

The CDRT found that mental health problems were the primary risk factor for suicide attempts. Of those who died by suicide, about half were actively receiving mental health services, a fact that surprised Kawatu. “So to me, that’s a really concerning, but important factor. I don’t know what could have been done differently, but I think we need to pay attention to that.”

Kawatu says that services need to be expanded. They are currently concentrated in core cities that have higher public health problems and a more than 15 percent poverty rate among children. “However, suicide is one (problem) that is actually fairly evenly distributed among the population geographically and demographically. So we think it’s important for the services to be equally distributed as well.”

“That being said, inability to access mental health services because of poverty, lack of insurance or related to stigma are obviously significant factors,” she says.

One of the CDRT’s recommendations is to reduce access to lethal means. Kawatu says that more than 60 percent of youth who died by suicide in R.I. died by hanging and it would be impossible to remove all electrical cords, belts, etc. from a child’s home.

Schultz says the problem needs to be addressed as a mental health issue with families, schools, mental health professionals and agencies communicating more effectively while navigating the helping system.

“We have to look at and be mindful of our part as helpers and how it is we are able to collaborate on behalf of families so that there is continuity,” he says.

Since the interventions in Enfield, about a half a dozen referrals to hospitals have taken place, with children coming forward to appropriate adults, thereby activating the system.

“That’s the important piece – not only having the protocol but implementing them. And that begins with awareness,” Schultz adds. “There’s been a lot of fertile ground covered as a result of these tragedies. Enfield is serving as a model for what can happen in other places.”

By Pamela Berard

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