Franklin James Cook

Archive for the ‘Prevention’ Category

Community, Prevention Experts Influence “Dr. Phil” Episode

In Media, Opinion, Prevention on March 14, 2010 at 12:39 pm

Three gears working together

By Franklin Cook, SPNAC Editor

I consider Friday’s episode of the Dr. Phil Show — titled “Teens Under Pressure” — a case study of sorts, for it shows that a constructive dialogue is occurring among suicide prevention experts, communities, and the media. The process that shaped the show’s content could be an indication that community-focused suicide prevention is gaining traction in America.

Here is what happened:

Enter the media. A series of suicide fatalities strikes a high school on the West Coast, and a flurry of media coverage follows. Then the double suicide of two high school girls in the East makes the news in a big way, locally and nationally. As one might expect, the Dr. Phil Show plans a television program on the topic of suicide.

Enter the community. When the show’s senior producer contacts the West Coast town to invite people to participate in the program, city officials respond enthusiastically — not about participating but about the possible causal link between media coverage of suicide and suicide contagion.

In a follow-up e-mail to Senior Producer Astra Austin, [a city official] representing “Project Safety Net,” said there are two primary concerns about the planned Dr. Phil program.

The first is that it could contribute to “suicide contagion” following the deaths of four Gunn students since last May, and the second is that the program could “perpetuate the myth” that stress and suicide are tightly connected.

“[This] is a community at high-risk for more suicides due to suicide contagion,” [he] said in the e-mail. “Our most vulnerable teens (those perhaps with previous attempts or who are under medical care) need our protection right now — and will for some time.”

“Please understand our reluctance to participate in the show should not suggest a reluctance to confront or deal with this issue. On the contrary, the … community is working together, tirelessly, publicly, and carefully on this issue.”

Enter the suicide prevention experts. The community’s communication with the TV producer amounts to a mini-workshop on suicide contagion, packed with a well-chosen array of top-quality, up-to-date information and resources, all based on the research and expertise of organizations such as the National Suicide Prevention Lifeline, the Suicide Prevention Resource Center, the American Foundation for Suicide Prevention, and the American Association of Suicidology.

The outcome: The content of Friday’s Dr. Phil Show clearly demonstrates that the producer and the others involved in creating the episode heard the community and tried to follow the guidelines provided by the suicide prevention experts. I have some concerns about several elements of the show (such as how people grieving from the fatalities are addressed), and the jury is certainly still out on the effects of national media coverage such as this on contagion. Those issues notwithstanding, I believe it is extremely important to affirm that this instance of the media’s coverage of suicide represents a rare collaboration among people working to cover an important news story, people in the field of suicide prevention, and people in a community that has been directly affected (I might say traumatized) by recent suicides.

[The abridged URL for this post is http://tinyurl.com/DrPhilEpisode .]

[Editor’s note: In a SPNAC post last year, “Iraq Vet and Teen Say ‘Thank You’ to Lifeline via Avatars,” it was mentioned that “Dr. Phil shared a suicide prevention message through his avatar on the Lifeline Gallery.]

Other related SPNAC posts:

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Please Stop Saying, “Suicide is a permanent solution …”

In Opinion, Prevention on March 5, 2010 at 10:11 am

PeopleTalking

By Franklin Cook, SPNAC Editor

I have worked in suicide prevention and suicide grief support for a little more than a decade, and for the past year and a half (since the SPNAC blog was launched), I’ve scanned hundreds of articles on this tragic subject. In the course of my encounters with what is said and written in communities across the country and on the Internet, I have been subjected about a thousand times to the declaration “suicide is a permanent solution to a temporary problem,” and I cannot hear it one more time without crying out: Please stop saying that!

I know that it must seem like a clever and even a helpful thing to say (or else why would people have kept saying it, right up to the point where it has become nothing less than a cliche but with the power, I’m afraid, of an axiom). The declaration seems clever, I suppose, because it has the pleasant sing-song rhythm of an advertising jingle, like “I am stuck on Band-Aid, ’cause a Band-Aid’s stuck on me.” And it seems helpful because, of course, it is true: Indeed, suicide is a permanent solution.

But here’s why I argue that we should stop saying it:

The statement violates the age-old principle that what we communicate ought to be designed specifically with a focus on the audience for whom the particular communication is intended. “Suicide is a permanent solution to a temporary problem” might strike someone who is not suicidal as a clever statement, and it might be a helpful thing to hear from the point of view of someone who already believes (or is likely to be convinced) that his or her problem is temporary. But the audience for this anti-suicide ditty is, of course, people who are suicidal.

As Edwin Shneidman points out in his Ten Commonalities of Suicide, “The common purpose of suicide is to seek a solution.” So emphasizing to a suicidal person that suicide is a permananet solution is as likely to be unhelpful — or even harmful or dangerous — as it is to be helpful.

The problem a suicidal person is trying to solve, according to Shneidman, is how to escape from psychache, which Shneidman defines as “intolerable emotion, unbearable pain, unacceptable anguish … [that] cannot be abated by means that were previously successful” (emphasis added). In other words, from the point of view of someone who is earnestly considering killing himself or herself, the pain from which suicide would provide escape is not temporary.

Even though the perception that the pain is permanent is not accurate, the strategy of trying to convince a suicidal person that his or her pain is temporary is as likely to be counter-productive as it is to be productive.

Read more here …

Read the rest of this entry »

Let’s Think Carefully about Cyber-Bullying and Suicide

In Prevention on February 28, 2010 at 4:18 pm

Kids with Computers Cellphone

By Franklin Cook, SPNAC Editor

The topic of cyber-bulling and suicide deserves thoughtful consideration, and I would like to contribute to the dialogue by pointing to a few resources for the general reader that I have found to be informative:

I offer the above list of resources in part because I am hesitant about posting very much direct news coverage of cyber-bullying — especially of particular cases that are reported in the media — even as there have been numerous news reports connecting suicide fatalities to cyberbullying over the past several years. SPNAC’s coverage of the issue began when a connection between Megan Meier’s suicide and her online harrassment by an adult became international news. At that time, I took a decidedly reserved approach, which resulted in only a few posts (and I think they contain a number of hyperlinks pointing to very good resources on basic information about cyber-bullying that add to the list above).

My initial posts on the topic focused on the court’s conclusions in the Meiers case,

I also hoped to provide some helpful information about cyberbullying in

covered the story of a suicide survivor turned advocate in

attempted to be ironic with a headline based on an “expert’s” quote in

[The abridged URL for this post is http://tinyurl.com/ThinkCarefully .]

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Attachment-Based Therapy Promising for Suicidal Youth

In Prevention, Research on February 24, 2010 at 7:30 pm

According to a news release from the Children’s Hospital of Philadelphia, a study has shown that “adolescents with suicidal thoughts and elevated depression had stronger and faster reduction of symptoms when treated with family therapy than with standard treatment.”

In this study, Attachment-based Family Therapy (ABFT), found that patients with severe suicidal thinking were at least four times more likely to have no suicide thinking at the end of the treatment or three months after treatment, than patients treated in the community. Patients in ABFT also showed a more rapid decrease in depression symptoms and were retained in treatment longer than in community care … This is the first treatment study for teen suicidal ideation to show robust and statistically significant improvement over treatment as usual.

“Family conflict, chaos, and strife can contribute to youth suicide, while at the same time family love, trust, and communication can buffer against it,” [says Dr. Guy Diamond of the hospital’s Center for Family Intervention Science, who directed the study]. “This therapy aims to resolve family conflicts and promote family strengths so that the appropriate bond of attachment can protect youth from self harm.”

The research report appears in the Journal of the American Academy of Child and Adolescent Psychiatry.

Dr. Diamond is delivering a workshop for clinicians in Attachment-based Family Therapy at Children’s Hospital of Philadelphia on April 9-10.

[The abridged URL for this post is http://tinyurl.com/AttachmentTherapy .]

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One Man’s Death Offers Insight into Humanity and Suicide

In Grief, Intervention, Opinion, Prevention on February 19, 2010 at 12:38 pm
Powell and Market Feb 16 2010 Man who jumped

For information about this photo, please see the note below.

By Franklin Cook, SPNAC Editor

The circumstances surrounding a suicide earlier this week in San Francisco — a man jumped to his death from a building on a busy street corner as a large crowd watched — are so disturbing that I am reluctant to write about it, but I hope to extract something helpful out of the situation.

Let me begin by saying that my own description, calling it “a sucide earlier this week” and “the situation” obscures the most centrally important, viscerally real fact about it, which is that a living, breathing human being died — that a life as unique and special as your life or my life are to us right now was irrevocably extinguished. In the blink of an eye, an actual person was tranformed from an “is” into a “was,” into a man who now can be referred to only in the past tense.

But, for those closest to him, their love for him is not in the past tense.

Here is an audio recording of a news interview I did with Don Grant of KOTA Radio in January 2008 after a teenage boy died by suicide in my hometown in a scene that was very public. In the interview, I say,

When something makes front page news … when the public is very aware of a suicide death, it turns a private matter into a public matter. So I think the first thing I would say to the community is, please remember that this is a very private matter … In many ways, it is a death like any other death, and we don’t want to bring attention to a family’s private suffering … The first thing I would like the community to understand is that this suicide affected a very precious human being … He has a family and friends and loved ones who deserve our respect and our compassion and our understanding and our support. We really need to … understand that, in our hearts, the most important people in this moment are those who have lost their dear loved one. That young man just a few days ago was a very vibrant human being: We should not make judgments about him. He had the same things to be happy over or to be sad over that we have. Suicide sometimes strikes a family, and we should be very understanding of that.

Another thing about last week’s tragedy in San Francisco that merits comment is the crowd’s reaction to — or perhaps I should say participation in — the suicide. Some news coverage (and lots of social network communication) depicted people who urged the man to jump or who laughed about his death. Besides the numerous seemingly obvious and perhaps futile comments that one might make (that such behavior is barbaric, that the media-entertainment machinery has so desensitized us that we are numb to each other’s pain, etc.), I would like to assert this: It might have gone differently, had those near at hand at the time he died acted differently.

This is not merely wishful thinking on my part nor simply my desire to blame someone for something that is terribly upsetting to me. Rather, I am claiming that a very straightforward, common-sense, practical behavior might have saved a man’s life.

What if one inspired, compassionate person in the crowd had yelled — not at the man threatening to jump but at the rest of the crowd — “Chant with me! Please don’t jump. Please don’t jump. Please don’t jump”? I can imagine something like that happening: “Chant with me! Everyone chant with me! Please don’t jump. Please don’t jump.” I can imagine a few dozen people taking up the chant in unison, “Please don’t jump! Please don’t jump! Please don’t jump!” Then a few hundred people joining in, “Please don’t jump! Please don’t jump! Please don’t jump!”

Can’t you, too, imagine that happening, ? If you were there, wouldn’t you have joined in the chanting? “Please don’t jump!”

There is no way to know whether that would have prevented the man from jumping, but, as the photographer says in the quote below, “he stood [on the ledge] for 50 minutes or so,” and, according to other news coverage, “witnesses reported seeing the man start to jump twice and then stop himself at the last second, before he finally made the jump.” So there were unquestionably real moments when his ambivalence between wanting to die and wanting to live might have allowed him to step back from the abyss.

The noisy scene at Powell and Market on Tuesday suggests that ideas such as these — that people facing a suicide crisis ought to be compassionately cared for as unique human beings and that there are effective ways we can intervene to help save a life during a suicide crisis — are so fundamental that perhaps we’ve taken them for granted.

[Editor’s note: There is an inherent contradiction in my words “this is a very private matter” and in my decision to publish the photo that accompanies this post. In addition, publishing the photo is arguably an infraction of the suicide prevention field’s media guidelines, which advise against sensationalizing suicide. My decision to publish the photograph was not made lightly nor without considering those matters, but the point that the man who died was “a living, breathing human being” possessing “a life as unique and special as your life or my life are to us right now” is brought home more powerfully than it could be in any other way by including the picture with the story. The photographer who posted the photo online said of the man pictured that he wanted “to show him alive [while] he is standing there … He stood for 50 minutes or so, and I watched him look around as if he was waiting for some positive message for help … So by remembering this image, next time you see someone … thinking about taking their own life, then please talk to them. Let them know you are [there] for them and ask them what do they need. Show them love even if it is a stranger.” FJC]

[The abridged URL for this post is http://bit.ly/onemansdeath .]

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Man and His Basset Hound Cycling To Boost Awareness

In Mental Illness, Prevention, Take Action on February 13, 2010 at 12:18 pm
Bassett in bike sidecar

Antigone is ready for the next stretch of the bicycle trek from Chicago to San Francisco. (Marci Stenberg, Merced Sun-Star)

In “Man and Dog Peddling a Message: Against Suicide and for Basset Hound Rescue,” Merced Sun-Star reporter Carol Reiter writes about Marshall Lee’s and his dog Antigone’s cross-country journey to promote sucide prevention (and Bassett Hound rescue, as well).

The pair will cross the Golden Gate Bridge in San Francisco early this week to conclude a 3,500-plus mile journey that began in Chicago last October. In the video accompanying the story, Marshall Lee describes the insidiousness of depression and suicide:

Depression eats at you nibble by nibble … It doesn’t … just attack full on. [At first] it had been an occasional thought, “Maybe you should kill yourself.” Then … when unemployments was running out, I was losing my apartment, and I had no place to go, and didn’t know waht to do, that’s when the depression really hit hard, and that’s when the suicidal thoughts came every day …

However, according to the Sun-Star report,

Worries about what would happen to his dog after his death stopped Lee numerous times from carrying through with his suicide plans.

“This cute, sweet dog gave me the ability to say no to suicide,” Lee said.

Lee is asking people to take part in the annual American Foundation for Suicide Prevention Out of the Darkness Overnight Walk, which is in Boston this year on the night of June 26-27. According to AFSP,

The Out of the Darkness Overnight is an 18-mile journey through the night, from dusk until dawn. It’s a unique opportunity to bring the issues of depression and suicide into the light as we walk together to turn heartbreak into hope for tomorrow.

Walker registration is open and general donations to the walk are being accepted.

For updates to this story, see “Antigone Goes West: A Basset Blog.”

[The abridged URL for this post is http://tinyurl.com/ManHoundCycling .]

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Please Share 2-Minute Video “Suicide Affects Everyone”

In Prevention, Take Action on February 11, 2010 at 5:27 pm

The Carson J. Spencer Foundation has produced a two-minute video that offers great advice to college students about suicide prevention. And as is suggested by its title, “Suicide Affects Everyone,” the video’s content is, indeed, for everyone. In the video, Dr. Sally Spencer-Thomas, the foundation’s executive director, says

I believe that letting people know that it’s OK to ask for help is all they need sometimes. They just need that permission to say, “You know what, you’re right. What do I do now?”

Please share the URL for the video with others: http://www.youtube.com/watch?v=r7IK711hF9c

Preventing Suicide by Train Gets Attention of Research

In Prevention, Research on February 10, 2010 at 7:31 am
Dad at Train Tracks

Steve Vale, whose daughter killed herself in 2008 on these tracks in Mansfield, Mass., watches a train speed by. (John Tlumacki, Boston Globe)

In “Striving To Prevent Suicide By Train,” Boston Globe reporter Noah Bierman introduces an ongoing research study about suicide using trains as a means of death.

The Federal Railroad Administration has funded an effort, the first of its kind, to tally train suicides as part of a study into whether and how more of them could be prevented. The study, now in its fourth year and set for release next year, looks more closely at fences and other barriers, which are often low and rickety, if they exist at all, along the nation’s rail beds.

Preliminary findings from the study suggest that there are about 300 to 500 suicides per year in the United States involving a train. One of the questions under consideration is whether better barriers limiting people’s access to train tracks would prevent such suicides. This approach to prevention, called “means restriction,” is one of the proven ways to reduce suicide.

“When you reduce access to a highly lethal method, overall, suicide rates go down,” said Matthew Miller, a Harvard professor and specialist in suicide prevention.

For example, the presence of a gun in the home multiplies the risk that people will kill themselves by a factor of as much as 10, with the highest risk found in homes where children and teenagers have access to loaded, unlocked guns. And instances of bridge suicide drop substantially when engineers build architectural barricades to prevent jumps.

With 215,000 miles of train track in the United States and in the absence of studies assessing the effectiveness of track barriers in preventing suicide, “some in the industry worry that finding a solution means adding more cost and responsibility,” according to Dr. Alan Berman, executive director of the American Association of Suicidology, who is leading the team that is conducting the federal rail suicide study.

Putting up barricades all over the country would not be feasible, he said, but the [team] may suggest testing barriers in targeted areas where prevention is most likely to be successful.

In addition to documenting [train-related] suicides for the first time, Berman’s team is in the midst of conducting 60 psychological autopsies of train suicide victims in an effort to learn about their lives and motivation, to gain insight about how their actions might have been prevented.

The Boston Globe report is framed by the story of 21-year-old Elizabeth Mary Vale, a college student who died by suicide on train tracks in Mansfield, Mass., in September 2008.

[Steve] Vale said his daughter’s suicide note, and attempts she made that day to reach her therapist, indicated she was wavering. Vale has no proof a better barrier would have deterred her.

“We’re not saying it definitely could have,” he said, “but we believe she would not have.”

Related SPNAC posts:

[The abridged URL for this post is http://tinyurl.com/TrainResearch .]

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Primary Care Depression Screening Would Save Lives

In Mental Illness, Opinion, Prevention on February 8, 2010 at 2:46 pm

By Franklin Cook, SPNAC Editor

In a Huffington Post item today, titled “Let’s Not Get Too Depressed about Depression,” Dr. Lloyd Sederer, a psychiatrist and public health advocate, argues for a mandate that would do as much to prevent suicide as any other single action might accomplish:

One hundred percent of primary care practices .. should be screening for depression and using standardized treatment guidelines.

Dr. Sederer has a fairly straightforward plan to accomplish the nationwide screening he recommends.

Mental health has been losing in the competition for fair time and proper management without a numerical measure of a disease. How about starting with its poster child disease — depression — to remedy that?

The good news is that there is a simple, nine-item questionnaire called the PHQ-9 that someone can fill out in the waiting room, before seeing the doctor or nurse, that provides a highly reliable number that tells the doctor the likelihood (almost 90 percent sensitive) that you have a depression.

Of course, screening every visitor to a doctor’s office and then further assessing and effectively treating those who have depressive illness is a vast undertaking that would not be simple nor easy nor without cost. [Editor’s note: Please see Dr. DeQuincy Lezine’s comprehensive and insightful comment on this point.]

But we know that about 33,000 people a year die by suicide in the United States and that about half of them have a mood disorder (which implicates some type of depression in 16,000 suicides annually). So if depression is mental health’s “poster child disease” and it plays a role in 16,000 deaths every year, might not universal screening for depression in primary care be, as Dr. Sederer argues, a good starting place for prevention?

There are several models already available to move such an initiative forward. Here are two examples:

(1) The Three Component Model developed by the Macarthur Initiative on Depression and Primary Care is “a systematic approach” involving the “primary care clinician and practice, care management, and collaborating mental health specialist.”

The three components include elements shown to improve depression outcomes in recent randomized controlled trials. Telephone support for the depressed patient from a care manager is one central element as is periodic quantitative feedback about the patient’s response to treatment from the care manager to the clinician. The feedback is provided through depression severity scores based on PHQ-9. Another element is closer relationships between the primary care clinician and mental health specialists …

(2) The Suicide Prevention Toolkit for Rural Primary Care is an Internet-based resource containing “information and tools to implement state-of-the-art suicide prevention practices and overcome the significant hurdles this life-saving work faces in primary care practices.”

The Toolkit offers the support necessary to establish the primary care provider as one member of a team, fully equipped to reduce suicide risk among their patients. For instance, the tools will help you engage your patients and those around them in managing their own suicide risk. You’ll find tools for developing partnerships with mental health providers — regardless of how far away they may be — and a guide to developing telemental health services, a promising solution for many rural areas. There are also posters for display in your office, schools, and churches, and wallet cards listing warning signs for suicide and the number of the national crisis line.

[The abridged URL for this post is http://tinyurl.com/DepressionScreening .]

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Alaska Army Post Battles Stigma to Prevent Suicide

In Prevention, Stigma on February 7, 2010 at 4:43 pm

By Franklin Cook, SPNAC Editor

In a post last year titled “Culture of Stigma Is a Key Cause of Military, Veteran Suicides,” I wrote that the most important question for suicide prevention advocates is “What is military (and civilian) leadership doing … to decisively lessen the stigma against help-seeking that is killing so many of those whose sacrifices make our freedom possible?”

Today, in “Combat Deaths — At Home after the War,” Anchorage Daily News reporter Richard Mauer takes a look at two current developments at Fort Richardson, Alaska, designed to counter the military’s “culture of stigma.”

First, shortly after assuming command of the U.S. Army in Alaska last fall, Maj. Gen. William Troy learned of a battalion-level decision not to give full honors to a soldier at Ford Richardson who had died by suicide, and Troy made it a policy throughout his command to treat suicide fatalities in the same way other deaths are treated.

“When you do a memorial service in a different way [for a suicide victim], I think that you’re adding to the stigmatization of a soldier who has a behavioral health problem. You don’t mean to, but what you’re doing is, you’re making it look like it’s his fault,” Troy said. “We should be memorializing his service to the nation, his service in combat. He’s a volunteer, a member of a free nation who came and joined our ranks to defend this country, and that’s what we should be memorializing, not passing judgment on the manner of his death.”

Second, soldiers soon to return to Fort Richardson will be the first brigade-size unit (3,000-5,000 soldiers) to test the Army’s Virtual Behavioral Health Pilot Program.

[The program] will screen every … soldier from the commander, Col. Michael Howard, and his sergeant major down to each private. First they’ll describe their experiences in a questionnaire, including any traumatic brain injury they might have suffered, then enter a booth for a private video conference with a mental health professional. The on-line professional can make an immediate referral, including appointment, with a local counselor or therapist, Troy said.

A U.S. Army news release says the objectives of the Virtual Behavioral Health Pilot Program are …

… to provide uniform contact, via face-to-face or the VBHP, with all redeploying Soldiers, in order to identify care requirements early, and help promote a cultural change of Soldiers’ views of behavioral health.

The support of Army leadership in suicide prevention initiatives is evidenced in a Jan. 8 memo issued by Gen. Peter Chiarelli, the Army’s Vice Chief of Staff — who was responding to the report of eight suicide fatalaties in the first eight days of the new year — by asking the Army’s NCOs and other frontline supervisors …

… to troop the line, walk through the motor-pool, stop by the barracks, eat a meal in the dining facility, and visit the guard post at midnight. Look each and every Soldier in the eye. Convey the message that each one is valued by our Army, their families and friends, and our Nation. Remind Soldiers that their Army remains committed to help, support, and assist them to meet hardships head-on, no matter the struggle, stressor, or challenge.

Here are a few SPNAC posts in the past year related to suicide in the military:

[The abridged URL for this post is http://tinyurl.com/AlaskaPost .]

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New Therapy for Suicidal Teenagers Shows Promise

In Prevention, Research on February 5, 2010 at 10:07 pm

In a pilot study, a therapy called Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) showed that “the rate of suicidal events among participants who chose the new therapy was lower than rates typically found in surveys of suicidal teenagers” according to a Jan. 31 news release from Columbia University Medical Center. The news release suggests that CBT-SP merits more rigorous research.

Because of the pilot study’s design (the participants chose their own treatment among three choices: talk therapy, antidepressants, or both), the therapy’s effectiveness is still uncertain, and a randomized, controlled clinical trial is needed.

“Our pilot study was really just step one,” [Barbara Stanley, a Columbia clinical psychologist] says, “but it showed us that research with these kids is feasible, not futile.”

The therapy could be especially important because it is designed for use with teens who have made a nonfatal suicide attempt, which is one of the highest-risk groups for suicide. It is also an approach that can go hand-in-hand with medical treatment for depression, and there is evidence that medicine in combination with “talk therapy” is an effective approach to treating suicidal patients.

“The brains of depressed people who attempt suicide are different from those that do not,” Dr. Stanley says. “Our point of view is that while they need treatment for depression, they also need therapy tailored to help with their suicidal thoughts and behaviors.”

Because most suicidal teenagers are depressed, researchers believed that successful treatment of depression would also eliminate suicidal thoughts. But recent studies — including analyses of brain chemistry by Columbia neuroscientist J. John Mann — suggest there is something different about being suicidal.

CBT-SP addresses teenagers’ suicide attempts very directly, giving them a chance to talk frankly about what led to the attempt so the therapist and the youth can develop a customized strategy that “heads off” as early as possible the kinds of reactions in the teen’s life that might lead to suicidal behavior.

“From the moment they come through the door, we talk about the attempt. We put that time period under a microscope to understand all the thoughts, feelings, and behaviors that led up to it,” [says Stanley]. “Then we identify what skills they lack that could prevent them from attempting suicide again.”

With CBT-SP, the therapist not only helps them understand their feelings and behaviors, but also teaches them specific skills they can use to enhance their capabilities to cope.

The report on the study of CBT-SP are published in the October 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

[The abridged URL for this post is http://tinyurl.com/TeenTherapy .]

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KEY QUOTE — Yeates Conwell, Feb. 1, 2010

In Key Quote, Prevention, Research on February 3, 2010 at 9:05 am
YeatesConwell-Photo_Mug

Yeates Conwell

In “Genetic Variants in Depressed People Raise Suicide Risk,” by HealthDay reporter Amanda Gardner, Yeates Conwell, co-director of the Center for the Study and Prevention of Suicide at the University of Rochester Medical Center in New York, gives some important context for biomedical research on suicide:

“Suicide is a pretty intransigent problem. It’s a very difficult, complex behavior that, despite many years of study, we have to acknowledge that suicide rates haven’t changed a great deal,” said Dr. Yeates Conwell … “We have a long way to go to understand the mechanisms of suicide, so this kind of work is very hopeful, and findings like this that identify some significant associations between genetic patterns and a lifetime history of suicidal behavior are certainly intriguing and potentially important, [but] they have a long way to go to translate to suicide preventive interventions.

That said, Conwell added, the best way to look at suicide is in the interactions between genes and environment, and the variability in suicidality explained by genetic profiles is relatively small.

[Editor’s note: I’ve highlighted elements of Dr. Conwell’s quote to emphasize an idea that lies at the heart of the suicide prevention field’s overall mission, which is developing an interdisciplinary approach to the problem (i.e. “to look at suicide” with a focus on “the interactions between genes and the environment”). In my opinion, this is a critical challenge that has gone substantially unanswered by the field and which, therefore, deserves much more serious attention. FJC]

[The abridged URL for this post is http://tinyurl.com/YeatesConwell020110 .]

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News Report of 9-Year-Old’s Suicide Deserves Mention

In Media, Prevention on January 27, 2010 at 4:31 pm

By Franklin Cook, SPNAC Editor

We live in a world where the suicide of a nine-year-old in a public elementary school, as occurred in Texas last week, is going to attract media attention. So — without getting into what I believe is the media’s responsibility to cover stories about suicide taking into account resources such as “Preventing Suicide: A Resource for Media Professionals” and “Reporting on Suicide: Recommendations for the Media” — I thought it might be useful to comment on a noteworthy story by reporter Alex Branch of the Fort Worth Star-Telegram (although it does “violate” the guidelines in several ways) with a focus on what I think it “gets right” in its coverage:

(1) The story does not normalize suicide in young children:

Experts say that of all age groups, suicides are rarest in children younger than 10 in the United States. Typically, five to 10 suicides nationwide are reported in any given year, according to the American Association of Suicidology in Washington, D.C.

The National Center for Injury Prevention and Control reported 33 suicides among 5- to 9-year-olds from 1999 to 2006. Two were reported in Texas.

“They are infrequent,” said Dr. Alex Crosby, medical epidemiologist for the Centers for Disease Control and Prevention in Atlanta. “There is such a small number that there’s little research into that age group.”

This is in contrast with a great deal of media coverage about suicide, which often begins with alarming statements and statistics about the prevalence of suicide. In fact, even prevention organizations often emphasize dire statistics in their promotional materials (for instance, statements such as “every 18 minutes in the U.S. someone dies by suicide” are nearly ubiquitous in press releases from the prevention industry).

What is meant by “normalizing” a behavior is presenting data in a way that makes it seem as if the behavior is more frequent or more common that it really is (in the case of suicide, even though it happens too often and is an alarming phenomenon, it is a relatively rare event overall).

The challenge, of course, is finding a way to say what the problem is (“32,000 people a year die by suicide in the United States”) while at the same time pointing out that suicide is not at all normal (“people who feel suicidal are in crisis and need help, and people who get help can be prevented from dying by suicide”).

(2) The story avoids attributing the suicide to a simple cause.

“I’ve been asked about bullying,” [a police spokesman] said. “Rumors have popped up. But, as of this point, I don’t have any confirmation of that.”

Bullying, loss of a loved one, and divorce are factors that have been blamed for other cases of child suicide.

In most cases, the children had displayed fairly significant troubles in the past, said Dr. Lanny Berman, executive director of the [American Association of Suicidology].

The idea of “fairly significant troubles” and the inclusion of a number of possible precipitating factors counters the tendency of media reports to point to a single, easily identifiable, proximal cause for a person killing himself or herself. Oversimplifying suicide in that way distorts the reality that suicide is complex and multi-causal.

And I must say how exemplary it seems to me for a media outlet to be OK about simply not knowing what caused something. In this case, nobody knows what caused the little boy to kill himself, and the newspaper didn’t fill in that painful void with whatever blather some “talking head” had to say about it.

(3) The story makes a hypothetical link between this particular suicide and depression but at the same time avoids jumping to a conclusion or categorizing all suicides as being caused by depression.

A misperception is that young children do not experience depression. About 5 percent of children and adolescents suffer from it, according to the American Academy of Child and Adolescent Psychiatry …

Symptoms are often mistaken for adolescent moodiness, Berman said. Unlike in older people, depression in children is usually expressed in actions, rather than feelings …

It is important to remember, however, that in 40 percent of suicides, the victims do not exhibit symptoms of depression, he said.

Including the caveat about 40 percent of suicides not being associated with depression avoids emphasizing mental illness itself as “a single, easily identifiable, proximal cause” of suicide. In my opinion, treating mental illness in that way creates similar problems that oversimplifying suicide in other ways creates. The proliferation, for example, of the idea that 90 percent of people who die by suicide have a diagnosable mental illness fails to account for the complexity of suicidal behavior no less than other narrowly circumscribed interpretations do.

[The abridged URL for this post is http://tinyurl.com/Report9YearOld .]

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Palo Alto Volunteers Act Boldly against Teen Suicides

In Intervention, Prevention on December 2, 2009 at 10:54 am
101202_PaloAlto-TrainTracks

Caroline Kent, 18, places a flower on a fence near a train crossing where four teens have died of suicide. (Michael Macor, San Francisco Chronicle)

By Franklin Cook, SPNAC Editor

Winston Churchill said, “It is better to do something than to do nothing while waiting to do everything”: With that in mind, I would like to salute a group of community members who are standing watch in Palo Alto, Calif.

Following the suicides of four students from a high school in Palo Alto in less than six months at the same train crossing, residents of the city have formed a volunteer group to patrol the crossing and prevent anyone form dying there.

There is no study showing that what they’re doing will prevent suicide (and I suspect there never will be such a study because this is an isolated incident and there are too many variables involved). For all we know, the added publicity they’re stirring up may be harmful in some way (but I doubt that could be substantiated by research, either).

And we certainly don’t know if they’re going to be successful at stopping this particular cluster of suicides that is tragically occurring at Henry Gunn High School.

Here is what we do know: Four children from the community these volunteers call home died by suicide one right after the other using the same means in the same place, and people said, “That’s not going to happen again here if there’s something I can do to stop it.” And then they did something to stop it.

According to a recent story on NPR’s “Morning Edition,” “Twice each hour, the same routine takes place at a busy railroad crossing that runs through a residential Palo Alto neighborhood.”

First the warning bell sounds, as the crossing gates lower to block access to the tracks. Twenty feet away, parents huddled along a chain-link fence freeze, midsentence, and look down the tracks toward the approaching headlights. They watch as the massive silver commuter train bears down and then hurtles through the crossing. And then, just like that, the train is gone. The gates go up again, faces relax, and the adults resume their quiet conversations.

“We’re out here to show the community and the kids that we care about them and that we want the misuse of the tracks to stop,” said Caroline Camhy. The mother of two small children, Camhy started the Track Watch days after the last suicide occurred at this spot a month ago. As school and city officials agonized and conferred, she and other volunteers felt compelled to act.

“We want the deaths to stop, and we want people to know that if they just open their hearts and look around them, they’ll find people who care,” said Camhy. She added, “We’re not the only ones.”

A few weeks ago in my post about blue lights at train stations as a preventative measure against suicide, I was critical of officials doing “something (whether or not it might be effective) because they had to do something,” and that might seem to contradict what I’m applauding in the case of the Track Watchers. But here’s the difference: We know that removing access to lethal means is generally a very effective intervention to keep people safe who are having thoughts of suicide, but we really know nothing about the effect of blue lights on people who are at imminent risk of killing themselves.

Even so, I worry about how Track Watch might be dramatizing the rash of suicides, about whether the volunteers are properly trained and if they are able to take action that is safe and effective should they encounter a determined suicidal person. There is much more that needs to happen than a group of volunteers standing guard at a railroad crossing.

But for a community to commit itself to stop suicide — to literally put themselves between suicidal people and danger — that boldness and determination deserves praise and support. And it suggests that such a commitment is a good starting place for a community to decide “to do everything” it can do to stop suicide, not just students’ deaths at one train crossing but suicide by people of all ages throughout the community now and in the future.

[Editor’s note: The Los Angeles Times story linked to above describes another response to the Palo Alto deaths that bears mentioning, for it focuses on building resiliency by promoting a sense of hopefulness among students at the high school. For more information, please see the “Henry M. Gunn Gives Me Hope” blog.]

[The abridged URL for this post is http://tinyurl.com/PaloAltoSuicides .]

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In Wake of Fort Hood, Focus Is on Mental-Health Readiness

In Mental Illness, Prevention on November 8, 2009 at 10:12 am

In “At Walter Reed, a Palpable Strain on Mental-Health System,” Washington Post reporters Anne Hull and Dana Priest use the deadly shooting rampage last week by an army psychiatrist at Fort Hood, Texas, as a backdrop to starkly criticize what could be called the military’s lack of mental-health readiness.

More than two years after the nation’s political and military leaders pledged to improve mental-health care, their promises have fallen short at military hospitals around the country, according to mental-health professionals, Army officials, and wounded soldiers and their families … It isn’t only Walter Reed that is under fresh scrutiny [after the shootings]: Evidence of an undermanned, overworked health-care system stretches all the way to the Pentagon, where all of the top health-policy positions remain unfilled, leaving a void on an issue long fraught with inefficiencies and entrenched bureaucracies.

The report notes that the top civilian position in the Department of Defense focused on healthcare is vacant (Assistant Secretary of Defense for Health Affairs), along with “three other top positions — the principal deputy, the deputy for clinical programs and policy, and the chief financial officer post.”

The vacancies occur as the Army in particular struggles with a soaring suicide rate. In 2009 so far, 117 active-duty Army soldiers were reported to have committed suicide, with 81 of those cases confirmed — up from 103 suicides a year earlier.

Quoted in the report is PFC Sophia Taylor, who is receiving treatment at Walter Reed while the Army prepares to give her a dishonorable discharge, which she plans to oppose.

“The amputees get the great treatment,” Taylor said. “Purple Hearts, money for losing their limbs. I have a lot of respect for them. But I lost my mind, and I couldn’t even get a simple ‘thank you for your service.'”

Related SPNAC post: “Culture of Stigma Is a Key Cause of Military, Veteran Suicides” at http://tinyurl.com/StigmaMilitary .

[The abridged URL for this post is http://tinyurl.com/MentalHealthReadiness .]

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Study Gives 1st Picture of Suicide Attempts in U.S.

In Prevention, Research on September 17, 2009 at 6:49 am

A news release today from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) “provides important insights into the nature and scope of suicidal thoughts and behaviors.”

Nearly 8.3 million adults (age 18 and older) in the U.S. (3.7 percent) had serious thoughts of committing suicide in the past year according to the first national scientific survey of its size on this public health problem. The study … shows that 2.3 million adult Americans made a suicide plan in the past year and that 1.1 million adults–0.5 percent of all adult Americans–had actually attempted suicide in the past year.

The study also uncovered a strong relationship between substance abuse disorders and having thoughts of suicide or making a suicide attempt.

People experiencing substance abuse disorders within the past year were more than three times as likely to have seriously considered committing suicide as those who had not experienced a substance abuse disorder (11.0 percent versus 3.0 percent). Those with past year substance abuse disorders were also 4 times more likely to have planned a suicide than those without substance abuse disorders (3.4 percent versus 0.8 percent), and nearly seven times more likely to have attempted suicide (2.0 percent versus 0.3 percent).

Dr. Eric Broderick, SAMHSA Acting Administrator, framed the study results as a call to action for establishing suicide prevention as a national priority:

“While there are places that people in crisis can turn to for help like the National Suicide Prevention Lifeline 1-800-273-TALK (8255), the magnitude of the public health crisis revealed by this study should motivate us as a nation to do everything possible to reach out and help the millions who are at risk–preferably well before they are in immediate danger.”

The study, titled “Suicidal Thoughts and Behaviors among Adults,” uses data from the 2008 National Survey on Drug Use and Health, and the full report is available online from SAMHSA.

[The abridged URL for this post is http://tinyurl.com/AttemptsInUS .]

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Prison Program Teaches Self-Care for Mental Health

In Mental Illness, Prevention on September 9, 2009 at 9:40 am

In “Inmates Learn How To Better Manage Their Mental Illness,” Gannett News reporter Cara Matthews covers the Wellness Self-Management program at New York’s Fishkill Correctional Facility.

“Traditionally mental-health treatment was … that I’m the doctor, you take this medication, you’ll get better,” said Howard Holanchock, assistant mental-health commissioner for the state Department of Correctional Services. “But Wellness Self-Management puts it on the patient, to help the patient develop their kind of individual, kind of personalized goals and relapse-prevention plans.”

The report states that “about 15 percent of the approximately 59,000 state prisoners, some 8,000 people, are being treated for mental illness.” One of those 8,000 is Scott Collins, who has been in the Wellness Self-Management program for five months.

“It’s helped me get out of my shell a lot. I usually isolate,” Collins said as he sat in a circle with seven other inmates and three staff members in a basement classroom at the medium-security prison. “Being here has helped me a lot.”

The program is small (it can serve up to 160 inmates), but it is being evaluated for how prisoners who complete it “fare in terms of disciplinary actions in prison and relapse, recidivism and hospitalization after they are released.”

[The abridged URL for this post is http://tinyurl.com/PrisonSelfCare .]

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Ban of “60 Minutes” Stirs Debate on Media-Suicide Link

In Media, Prevention on August 16, 2009 at 9:28 am

LATEST UPDATE: In an Aug. 24 article in the Sydney Morning Herald, Kellee Nolan reports that the Nine Network stopped pressing its objections to the ban of the “60 Minutes” segment.

The Supreme Court of Victoria … heard the Nine Network had agreed never to broadcast the segment, which was about four students from the same Geelong high school who committed suicide in a six-month period this year. The court heard Nine had agreed not to broadcast “on ’60 Minutes’ or any other program … the segment ‘Searching for Answers,’ or any part of it.”

Beyondblue chairman Jeff Kennett, who had initiated the original injunction preventing the show from being broadcast, said

“We just don’t ever want to see programs that provide some solace, that may provide some acceptability to ending a life, particularly for those who at the time of receiving that information, may be at risk.”

Nine Network stood by its story, but issued a statement that said, “t was pretty clear there was not going to be a consensus relating to this story in the short term, so we felt it was best not to further contest the matter.”

ORIGINAL STORY:
Two articles from The Age update the story about a court injunction against the Australian broadcast by TV news magazine 60 Minutes, of a program about teen suicide at a high school in Geelong.

One article announces that “the broadcaster [Channel Nine] had reached agreement with the State Government not to air the program or any part of it until the matter returned to court on August 21.”

[Channel] Nine sought the adjournment so that the Government and anti-depression organisation beyondblue could consider the proposed segment.

In the other article, reporter Michael Bachelard explains that Beyond Blue chairman Jeff “Kennett began his crusade against the publication of stories about suicide long before he took 60 Minutes to the Supreme Court last week to prevent it from airing a report on a cluster of teen deaths at a Geelong high school.”

Kennett’s objection are grounded in the theory that there is a relationship between media coverage about suicide and suicide contagion.

When covering suicides, Australia’s media are governed by a voluntary code of practice, the first question of which is whether the story should run at all. The answer is most often “No.”

Mr Kennett’s action in the Geelong case was informed by clear advice from adolescent psychologist Michael Carr-Gregg, and he was swiftly joined by the State Government in enforcing an injunction on Channel Nine.

The confrontation between the producers of the 60 Minutes segment, titled “Searching for Answers,” and the parties who have taken court action to halt its broadcast, both Beyond Blue and the Victorian Education Department has highlighted the debate over media coverage of suicide.

60 Minutes declined to comment for this article, citing the injunction. But in an earlier comment, a spokesman said that the program had the support of some of the families involved, and that it constituted “careful and appropriate treatment,” which “offers hope to young people in very difficult circumstances.”

Fairfax radio’s Derryn Hinch said this week that the program should have gone to air because, “talking about it, getting kids to watch and to listen, is much better than banning a TV show and making it all sound mysterious and illicit and maybe — to a gullible teenage mind — something rebellious and enticing.”

That approach finds some support in the British media code. Their guidelines, like Australia’s, encourage sensitivity and warn against sensational treatment, but they add that “censorship or misinformation about suicide is unhelpful,” and say that “media professionals should not seek to hide the facts.”

Kennett says his opposition to airing the program follows Carr-Gregg’s about suicide contagion and the media. Carr-Gregg had been interviewed previously in an article in The Sunday Age:

“I do not mind there being factual reporting of an incident. [But when] there are then programs … that increase the risk of there being repeat episodes, it is those programs that I call into question.”

A particular concern was that 60 Minutes was saying that a 17-year-old boy, “who obviously featured in the program,” would be available online to answer viewers’ questions. “That is not an expert … you just can’t do that. On a subject like that, it’s manifestly not something you can do,” Dr Carr-Gregg said.

[The abridged URL for this post is http://tinyurl.com/60MinutesBan .]
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Teen Suicide Show Pulled over Contagion Fear, Injunction

In Media, Prevention on August 9, 2009 at 8:50 pm

A blockbuster television news program, CBS’s 60 Minutes, has been compelled by an organization battling depressive illness, Beyond Blue, to pull a segment that was supposed to have aired Sunday night in Australia. The segment covered the suicide of four teens at the same high school in Geelong, Australia in the past six months, and the organization’s objection to it on concerns about the show contributing to suicide contagion.

According to a story in The Australian,

Beyond Blue chairman Jeff Kennett won an eleventh-hour injunction in the Victorian Supreme Court to block the current affairs program “60 Minutes” from airing a segment on teen suicide at a Geelong high school.

In his affidavit … Mr. Kennett said he was concerned the potential for another suicide at the Geelong high school — where four teenagers have taken their own lives in the past six months — was very high …

In a statement released by 60 Minutes this morning [Monday], the program’s executive producer Hamish Thomson said: “We are extremely disappointed that we were not able to broadcast the story, but we of course fully understand suicide is a deeply sensitive and difficult issue.”

Mr. Thomson said 60 Minutes continued to believe the story should be told.

“60 Minutes has the support of the families involved and has consulted with mental health experts in producing the story,” he said. “We believe our careful and appropriate treatment handles the issue of suicide sensitively, and offers hope to young people in very difficult circumstances.”

The matter is listed to be heard again on Wednesday morning when 60 Minutes will apply to have the injunction lifted.

[The abridged URL for this post is http://tinyurl.com/ShowPulled .]

Related SPNAC post: “Ban of ’60 Minutes’ Stirs Debate on Media-Suicide Link” at http://tinyurl.com/60MinutesBan

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Readers Respond to Story of National Guardsman’s Suicide

In Intervention, Prevention on August 9, 2009 at 11:34 am
NYT-SoldierGraphic

(New York Times graphic)

The New York Times story that SPNAC summarizes in “Suicides in Guard Unit Emblematic of Army’s Dilemma” generated a number of letters to the editor that the Times published today.

In one letter, Kenneth Bacon, who was chief spokesman for the Pentagon under President Bill Clinton, writes that the solution to military suicide doesn’t require “new scientific discoveries.”

We’re talking about combining proven responses to alcoholism, depression and post-traumatic stress syndrome with the need for individual and family therapy. Failure to address these issues today is nothing short of criminal.

In another letter, a Houston man who served as a chaplain in Vietnam writes

It causes the deepest trauma to see comrades torn to pieces and to hear the screams of the dying — screams that I have heard in my dreams for these past 40 years. Sometimes the screams were so loud that I woke up in sweat and in tears.

Suicide sometimes seems like the only relief — a thought I have had a thousand times. Even today I often cry myself to sleep. And I was a Catholic priest!

Douglas Jacobs, president and chief executive of Screening for Mental Health/Military Pathways, writes

“One of the greatest challenges in addressing the problem of suicide in the military is stigma. Service members are trained to be physically and mentally tough, and as a result seeking help is often seen as a sign of weakness. But it takes courage to ask for help.”

And John Draper, Director of the National Suicide Prevention Lifeline, tells readers that the federally funded crisis line for veterans is being used by 10,000 callers per month.

Veterans, family members and concerned friends should know that help is only a toll-free phone call away … It is free, confidential and available 24/7. Our veterans deserve our care. This hot line is one important service that helps to support them through readjustment challenges after service to our country.

Veterans can call the Lifeline at 800-273-TALK (8255), and press “1” to be routed to the Veterans Suicide Prevention Hotline.

[The abridged URL for this post is  http://tinyurl.com/GuardSuicide .]

Related SPNAC post: “Culture of Stigma Is a Key Cause of Military, Veteran Suicides” at http://tinyurl.com/StigmaMilitary

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