The incident occurred almost 20 years ago, but psychologist Matthew Wintersteen still remembers the broad outlines.
A 15-year-old girl, becoming increasingly disconnected from her peers and her parents, attempted suicide by taking an overdose of sleeping pills.
Luckily, the pills only sickened her, but when she recovered, she told her parents she’d had food poisoning. And they believed her.
The case was an extreme example of what Wintersteen and other experts on child suicide say is all too common: Educators and parents fail to spot the signs of serious behavioral problems or don’t know how to react when they do spot them.
But schools, local and state behavioral agencies, and nonprofit groups are pouring increasing resources into improving behavioral health IQs in both the classroom and the living room.
For example, Wintersteen is involved in a five-year, federally funded statewide program, the Youth Suicide Prevention Initiative, to raise awareness of the warning signs of suicide or other serious behavioral issues with an emphasis on training teachers, counselors, and school psychologists.
Halfway through the grant, said project director Perri Rosen, about 10,000 individuals have been trained, either directly or through train-the-trainer programs, including more than 3,500 who have received specialized training in assessing and managing suicide risk in youth.
Since 2014, Pennsylvania has required suicide-prevention training for all educational personnel working with grades 6-12. The School District of Philadelphia has met this requirement with a more detailed program than the state mandates, according to Lori Paster, the District’s deputy chief of prevention and intervention.
Number of suicide attempts up
According to the city Health Department, the number of completed suicides among youths ages 10-19 from 2013 to 2016 was eight or fewer. (The number rises sharply from ages 19-25).
In a stretch of little more than a week in May, three students in Philadelphia completed suicide. The students were from three different schools, and the incidents were apparently unrelated.
Mental health professionals also worry about the number of suicide attempts or thoughts of suicide.
According to the Youth Risk Behavior Survey of the federal Centers for Disease Control and Prevention, 17.7 percent of U.S. high school students considered suicide in 2015 and 8.6 percent attempted it.
“We’re seeing an increased number of attempts,” said Tami Benton, chair of the department of child and adolescent psychiatry at Children's Hospital of Philadelphia,
Benton said that although “we’ve done a great job of gatekeeper training” in schools and at the provider level, “the biggest thing now is going to be education at the community level – teaching families how to talk about it and teaching kids how to talk about it.”
Stigma is a “major component ” blocking discussions of suicide, she said.
Melissa Harrison, an Ardmore-based therapist, attributes the increase in suicide attempts to general stress on youth in the 21st century and on the wealth of information about suicide methods now available online.
“The medicine cabinets are at home,” she said. “The guns are at home.”
Harrison and other professionals dealing with the subject say that two misconceptions can stand in the way of heading off a potential suicide.
One misconception is that raising the issue increases the likelihood that the child will do it.
“You don’t usually plant the idea in someone’s head,” Harrison said. "It’s probably there already.”
The other is that children won’t be responsive.
“We try to get them talking about it,” Paster said. “They want people to ask them. It’s a relief.”
Harrison cautions, however, that for a teacher, a counselor, or a parent, there’s a right way to broach the subject and a wrong way.
The right way: “I see that you’re struggling. Are you OK?”
The wrong way: “You’re not thinking of hurting yourself, are you?”
Look for the red flags
Harrison works frequently with Minding Your Mind, an area nonprofit that provides mental health education to youth, parents, teachers, and school administrators.
Its roster of speakers includes people who survived suicide attempts, and their stories have a common theme: missed signals by parents and educators.
“I was feeling so much pain in the moment and I wanted the pain to end,” said Drew Bergman, who attempted suicide at age 16 and again at 18, both times with pills and alcohol. “[As a teenager,] you don’t understand an accident can end your life.
“There were red flags. I could sleep all day. My mother had to literally push me out of bed. I was very withdrawn, sleeping in class.
“One teacher in 8th grade did say, ‘I see you’re hurting.’”
But for the most part, he was either punished when he acted out or ignored when he withdrew. Once, in middle school, when he raised his hand to answer a question, the teacher noticed the marks on his arms from cutting himself and asked about them in front of the whole class.
Jordan Burnham was also riding a behavioral health roller coaster, at times so ebullient in high school that he was called the class clown, at other times sleeping a lot, crying or staring off into space.
When he failed his driver’s license test at 16, he tore into the examiner verbally.
“My parents had never seen that side of me,” he said.
Two years later, he jumped out of his ninth-story bedroom window, luckily landing on one foot so he “only” got a shattered leg and other broken bones.
It was five days before the doctors could tell his parents he would live. He still walks with a limp.
Unlike many troubled youths, both Bergman and Burnham had parents who knew enough to seek professional help for their sons.
But there is a cautionary tale there: Getting a child to a mental health professional isn’t enough if they don’t develop a rapport.
“Therapy is like dating,” said Bergman, who recently graduated from Temple University.
Burnham was seeing a therapist before his suicide attempt, but it wasn’t working.
“I liked her, but I never really opened up to her,” he said. “I was always trying to outsmart her.”
Bergman eventually found a school psychologist with whom he worked well.
“I still keep in touch with him,” he said.
- The American Federation for Suicide Prevention video guide. The organization has also produced a video, “It’s Real: College Students and Mental Health,” suited to students headed off to college.
- The federal Substance Abuse and Mental Health Services Administration has produced “More than Sad,” a guide for high schools. There is also a video.
- A PowerPoint presentation by Matthew Wintersteen, PhD.
- The Pennsylvania Youth Suicide Prevention Initiative website.
- The Minding Your Mind website has many resources.
The Notebook's ongoing coverage of behavioral health issues is made possible by a grant from the Van Ameringen Foundation.