*This story originally appeared in The Budget’s March 8, 2018, Local Edition.
By Stacey Carmany
It’s a topic that can be difficult to talk about, yet it’s one that has been weighing heavy on the hearts and minds of parents and educators across the nation.
Suicide is the second leading cause of death among youths between the ages of 10 and 24, both nationwide and in Ohio, according to the most recent data available from the Centers for Disease Control and Prevention.
Locally, the deaths of at least six current and former students of the Perry Local School District in nearby Stark County within the last six months have fueled a renewed focus on youth mental health and suicide prevention in the hopes of reaching vulnerable students before they take drastic action.
“It really does take a community with any issue related to our youth,” said Natalie Bollon, executive director for the Alcohol, Drug Addiction and Mental Health Services Board of Tuscarawas and Carroll counties. “There are so many of us that come in contact with them, and we really have to implement a collaborative approach, whether it’s a guidance counselor or a student or a pastor or a coach, making sure that you are paying attention to the kids you are working with and not being afraid to ask the question.”
Several public forums have been held in Tuscarawas County recently as a way to foster a community-wide dialogue about suicide and depression among teens and adolescents. “What we’re looking at is to let the community and the educators know what some of the risky behaviors are and what some of the initial warning signs are because the vast majority of students that attempt or complete suicide do exhibit some risk behaviors prior to attempting,” Bollon explained.
School-based programs are also being offered in districts throughout Tuscarawas, Holmes and Wayne counties to teach students how to identify and address classmates who may be at risk.
“As there’s more and more awareness, I think people are really looking at some of the things that impact youths’ mental health,” said Vicky Hartzler, associate director for the Mental Health & Recovery Board of Wayne and Holmes Counties. “I think bullying has been one of the main factors associated with a lot of serious problems in schools. The kids feel picked on and ostracized, and those things can lead to all kinds of problems.”
It’s not unusual for teens to exhibit some unusual behaviors. Some, however, should be cause for concern.
“The thing that you typically want to look for is a change in behavior,” Bollon explained. “You really want to be aware of what your child’s typical baseline behavior and mood is, and whenever they start to shift away from that, I think that’s both the parent and the school’s cue to start to pay a little bit more close attention.”
Undiagnosed and untreated depression is considered the most common condition associated with suicide. Signs of depression in teens and adolescents include withdrawal or isolation, changes in sleep (increased or decreased), irritability, dramatic mood changes, a loss of interest in activities that were previously enjoyed, engaging in destructive behaviors, changes in self-care, and slipping grades.
“With kids, you have a lot of behavioral things to look for,” Hartzler said. “The trouble with a lot of the behavioral signs is you don’t know if the child is possibly using drugs or is depressed. You don’t always know the cause of a problem, so I think with youth it’s just important to get in there and start asking questions, to put down the cell phones and start talking.”
Hartzler noted that it is also not uncommon for people to notice certain behaviors and brush them off thinking the person is just going through a hard spell or is simply stressed out, when, in reality, that person may be in need of medical attention. “Really pay attention because if there is an underlying depression, it needs to be treated as any other medical condition would be treated,” she said.
“I know that parents and school systems are sometimes hesitant to reach out and get them involved in the mental health system, but ultimately if a child is struggling to that extent, that’s really where they need to be,” Bollon said. “It doesn’t mean that it’s going to be long term. It doesn’t mean necessarily that it’s even going to be incredibly intensive, but giving them an opportunity to develop some coping skills and an outlet for whatever it is that’s on their shoulders or on their mind is incredibly important.”
There are also some behaviors that may be present when a young person is at immediate risk for suicide. They include making threats of self-harm or suicide; seeking access to means of suicide including firearms or pills; talking or writing about death or dying by suicide; and giving away or throwing away prized possessions. If any of these behaviors are present, help should be sought immediately.
In addition, certain individuals may be at an increased risk for suicide, according to Bollon. “If kids are having any questions about their gender or sexuality, that’s definitely a high-risk group for suicide attempts,” she said. “Perfectionistic kids often have higher risk of suicide attempts, kids that are depressed or have low self-esteem or hopeless and feel like no one cares about them, that’s another group that tends to be at risk for suicidal behaviors.”
Initiating the conversation
Even in situations where a youth has exhibited clear warning signs, it can be difficult for friends and trusted adults to know how to initiate the conversation. “I think a lot of times individuals are scared to use the word suicide,” Bollon shared. “They worry that if they say suicide they’re going to plant the idea in the youth’s head, and that’s really not the case.”
Instead, addressing the issue by name may actually give voice to what the individual is already feeling, according to Hartzler. “If people really think to ask the question, it’s probably been in that person’s mind or crossed through their mind at different times,” she explained. “Asking the question is sometimes a relief to people because they have the opportunity to talk about what’s really going on. By talking about it, you’re not going to put ideas in their head. You may give them the opportunity to finally be able to talk to someone openly about it and get some help.”
Bollon noted that simply showing concern can be one of the most effective tools for suicide prevention. “Kids do best when they know there is at least one specific person who cares about them,” she said. “That may be a coach. That may be a pastor. That may be a youth leader, but really taking that time to connect with these kids individually and making sure that each of them know that they’re valued and they’re worthwhile.”
She added that conversations should also be focused on the future. “During that stage of adolescence they’re not incredibly future-focused, so they’ re very concerned about what’s happening right now, and what’s happening right now for them oftentimes feels overwhelming, whether it’s bullying or difficulty with a romantic relationship, and many don’t have the capability to really kind of think into the future that it’s not necessarily going to be an issue in two months or three months or a year,” she explained.
Educating students and staff about the warning signs for suicide and how to intervene has been a focus of school-based programs offered in districts throughout the area.
At West Holmes High School, students have gone through a program called the Signs of Suicide, or SOS, also known as Acknowledge- Care-Tell, that teaches them how to recognize signs of depression and suicide risk in their peers and how to take action.
The program is sponsored by the Mental Health & Recovery Board of Wayne and Holmes counties and is facilitated by The Counseling Center. A program that teaches students resiliency skills is also being offered throughout Wayne and Holmes County.
“There’s a lot of working going on in the schools, and we’ve just tried to increase our work with the schools in life skills,” Hartzler explained. “It’s about connecting with people, building your own assets, having things that give your life meaning and purpose and having caring adults in your life to support those. That tends to help kids from going down a bad path. Having those caring adults, too, in their lives can help catch problems before they start.”
Jim Foley, director of Community Education and Prevention for The Counseling Center, shared that area students seem to be keenly aware of what’s happening in the Perry school district due to social media as well as personal connections.
He noted that while it is important to mourn these tragedies, they can also serve as teaching tools for students and school staff. “Suicide prevention programs use information from past suicides not to make us feel sad or guilty but to learn what signs we can notice in the future, what actions we can take, especially for people who are not yet getting any formal mental health support or treatment,” he shared. “With in-depth training and screening, we can find the youth who don’t stand out as obviously at risk, who may be mislabeled as just being out of control, just seeking attention, or just being socially withdrawn.”
The Counseling Center provides several different training programs for school staff in Wayne and Holmes counties including QPR (Question-Persuade-Refer), Youth Mental Health First Aid, and the Ohio Department of Education’s Safety and Violence Prevention Curriculum.
In Tuscarawas County, the ADAMHS Board has formed a new subcommittee that works closely with area school districts and the Tuscarawas Area Counseling Network, to look at issues impacting teen and adolescent mental health.
Lindsey Tidrick, counselor for the Strasburg-Franklin school district and a member of the local counseling network, shared that helping students build resiliency skills has been a growing focus within all of the group’s member schools. “I know at all the schools there have been assemblies and presentations from different speakers on resiliency and bullying and how to deal with those things. We’re trying our best to push it out to our kids, even on everyday things, like starting with kindness.”
She added that youth-to-youth programs have also been instrumental in helping schools address these issues. “They really help us,” she said. “Students have to see students doing these things. We have to teach our kids what to do and do the right thing. Us talking to them, at them, that’s when they roll their eyes and shut down, but if their peers can model it, that’s the big thing.”
In addition, the group has also been focusing on providing ongoing staff training at every school. “This is just a piece and a tool of continuing education,” explained Michelle Grimm, school counselor for Dover High and president of the Tuscarawas Area Counseling Network. “It changes with things that are out there, what to look for, because that kind of stuff changes all the time.”