Note: Resources for any person who is feeling depressed, troubled or suicidal are listed at the bottom of this article.
Following the March 3 release of the comprehensive report on local youth suicide, community members are still digesting the 214 pages of information which detail at great length risk factors associated with suicide as well as prevention programs.
The Centers for Disease Control and Prevention, along with the Substance Abuse and Mental Health Services Administration, initiated the investigation and constructed the Epi-Aid report after the California Department of Public Health asked for federal assistance on behalf of Santa Clara County to uncover more information about local youth suicide.
In addition to analyzing the report, The Paly Voice spoke with former CDC director Tom Frieden about the wider issue of youth suicide, beyond just Santa Clara County. Frieden, who resigned in January after serving in his position for eight years, said that local health officials made the right decision to request the CDC’s help.
“I really give credit to the state and local areas for inviting the CDC in so that we can all work together to see the best possible understanding of what is happening and what could be done to reduce the risk [of suicide] going forward,” Frieden said. “The investigation is complex, and it’s really important that when it’s final it is the state and local entities that release the findings and discuss with the communities what may be able to be done.”
The first objective of the investigation, which also served as the basis for the proposed solutions, was to identify trends in suicidal youth, who are defined as people between the ages of 10 and 24.
According to the report, the crude suicide rate for youth in Santa Clara County (5.4 per 100,000) was approximately the same as the crude suicide rate for youth across California (5.3 per 100,000). Palo Alto, however, had the highest rate of youth suicide (14.1 per 100,000) in the county.
“In terms of the issues of suicide generally, we know that suicidal ideation is far too common, particularly among youth,” Frieden said.
The reports mentions a wide variety of risk factors, but certain factors, many of which are now well-known among community members, remain central to suicidal ideation.
“Among youth suicide decedents with known precipitating circumstances and who were residents of Palo Alto and died in Santa Clara County from 2003−2015, twenty-five percent or more had the following reported precipitating circumstances: current mental health problems, current depressed mood, current treatment for mental illness, a history of treatment for mental problems, a history of suicide attempt, had left a suicide note, had disclosed suicide intention, had a recent crisis, and school problems,” the report states.
Suicides in the community most likely did not play a role in others’ suicides, according to the report.
“Based on information contained in the reports, [...] there was no indication that other suicide deaths played a contributory role,” it states.
Problems at school, which were possibly correlated with worsening mental health and personal problems, were identified in 25 percent of youth from Palo Alto who died by suicide. The report also notes physical violence, particularly at home, as a relatively high risk factor for suicidal ideation.
“Risk factors for ever having made a suicide attempt among high school students participating in the 2010 administration of the Developmental Assets Survey at the Palo Alto Unified School District include, but are not limited to: Drug and alcohol use, victim or perpetrator of violence, mental health problems, and delinquent behaviors,” the report reads.
Data from the 2013-2014 California Healthy Kids Survey administered in Santa Clara County show that lesbian, gay and bisexual youth have a significantly higher rate of suicidal ideation. Additionally, students “feeling sad or hopeless almost every day for two weeks or more [in the] past year” were also demonstrated to contemplate suicide at an increased rate, but this description was less associated with actual suicide attempt.
According to a survey administered by Project Safety Net, a local community network that aims to promote student well-being, both students and parents identified academic distress or pressure as the second-highest perceived risk factor for suicide, only after depression and mental health issues. Students, however, were significantly less likely than their parents to support “school-based efforts to reduce unnecessary stress.”
The second and third objectives of the investigation were to determine local media’s adherence to safe reporting guidelines and to analyze the effectiveness of current suicide prevention programs, respectively.
Nine percent of articles published in 2015 included photographs of the suicide method, which is a flagrant breach of safe reporting guidelines. The prevalence of sensational headlines, however, has declined from 40 percent in 2009 to 21 percent in 2015.
“I think it is very important that it be handled very sensitively,” Frieden said, referencing general media coverage of suicides.
According to the report, only 30 percent of all current suicide prevention programs were continuously being evaluated for progress, making it nearly impossible for the CDC to determine their efficacy. Those that did engage in self-evaluation focused on the total number of people reached and other metrics that don’t necessarily demonstrate the quality of impact on the community.
Three specific programs in Santa Clara County were touted by the report as having a positive impact in regards to suicide prevention: Applied Suicide Intervention Skills Training; Sources of Strength, a community-based program with a Paly chapter; and QPR gatekeeper training. All of these were identified in the CDC’s Suicide Prevention Technical Package and the SPRC Programs and Practices database.
The fourth section, entitled “Multiple Prevention Approaches to Address Multiple Risk Factors,” identifies a multifaceted approach to reducing suicide risk factors in youth.
The report notes that “use of multiple programs and strategies as part of a comprehensive and coordinated prevention approach may be more effective than using single, unconnected, programs.”
One of the solutions listed is improving and increasing access to high-quality mental health care, particularly services that allow at-risk individuals to receive treatments that are known to work.
“Suicide prevention efforts in Santa Clara County may need to consider ensuring youth have access to quality mental health services that incorporate evidence-based treatment modalities as part of a comprehensive and coordinated prevention approach,” the report reads.
Nearly one third of the youth who died by suicide in Santa Clara County were seeing a healthcare provider at the time of their deaths. The report emphasizes that educating primary care physicians may help them learn to recognize and treat depression in a more effective manner.
Frieden, too, said that easy access to health care is an important measure to take to reduce the prevalence of suicidal ideation.
“Another area that we, for many years across the country, have tried to increase is health care providers being alert to the risk of suicide,” Frieden said. “It’s been found that many individuals who [die by] suicide have seen a health care provider. This is not specific to Santa Clara County – it’s something that has been known for many years nationally.”
Another solution proposed by the report is to increase students’ connection to school and school-based programs.
“In Santa Clara County, connection to and positive relationships with school and teachers were also identified as protective factors for nonfatal suicidal behavior,” it reads. “Therefore, suicide prevention efforts in Santa Clara County could consider including programs that focus on building youth connection to schools as part of a comprehensive and coordinated prevention approach.”
According to the report, building problem-solving and coping skills at school can help students manage stressful situations without experiencing any anguish. The report cites Sources of Strength as improving connectedness to adults, school engagement and positive coping attitudes.
Other solutions mentioned include increasing connection to family and family-based programs, identifying and supporting at-risk youth, crisis intervention, suicide postvention, prevention of other forms of violence, reducing access to lethal means for youth at-risk, safe messaging and reporting about suicide, strategic planning for suicide prevention and selection and implementation of evidence-based programs. Continuous program evaluation is a crucial part of any of these initiatives, according to the report.
In his letter to the PAUSD community, Supt. Max McGee explained that the district will implement several social-emotional learning plans for students and professional education for teachers and staff members.
Students, parents, teachers and the local public have been searching for answers, and the CDC has now offered its input, which will hopefully bring about positive change in the community.
“Suicide, particularly among young people, is so tragic, and we would all like to understand what can possibly be done to reduce the risk in the future,” Frieden said.
Warning signs of suicide:
- Talking about wanting to die
- Looking for a way to kill oneself
- Talking about feeling hopeless or having no purpose
- Talking about feeling trapped or in unbearable pain
- Talking about being a burden to others
- Increasing the use of alcohol or drugs
- Acting anxious, agitated or recklessly
- Sleeping too little or too much
- Withdrawing or feeling isolated
- Showing rage or talking about seeking revenge
- Displaying extreme mood swings
The more of these signs a person shows, the greater the risk. Warning signs are associated with suicide but may not be what causes a suicide.
If someone you know exhibits warning signs of suicide:
- Do not leave the person alone
- Remove any firearms, alcohol, drugs or sharp objects that could be used in a suicide attempt
- Call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255)
- Take the person to an emergency room or seek help from a medical or mental health professional
Paly psychologists recommend that students searching for help should see the guidance counselor, visit the wellness center or talk with another safe adult on campus. School psychologists and therapists are always available through the Guidance Department or Wellness Center.
