We’re Working On It…

By Jonathan Singer, Ph.D., LCSW

Photo by Jonathan Simcoe; unsplash.com

In the late 1990s I lived in Austin, Texas. I worked for the Child and Adolescent Psychiatric Emergency (CAPE) Team. Our job was to provide crisis assessment, intervention, and short-term stabilization therapy for youth in suicidal, homicidal or psychotic crises. Under the big Texas sky and never-ending heat we would travel to schools, emergency shelters, homeless shelters, psychiatric hospitals, juvenile detention facilities, and private homes to see kids in crisis.

Our number one “customer” was schools. We would get phone calls all day from counselors, administrators, and parents referred by counselors and administrators about youth with varying levels of suicide risk. School staff are terrified not only of the emotional toll of death at an early age, but that one suicide will lead to another and another and another like ripples in a lake or dominoes in row. Suicidologists call the spreading of suicide risk “contagion,” and it is a phenomena that occurs almost exclusively among youth. In part because of fear of contagion, when a youth is suicidal in school everyone goes on high alert. In the worst case scenarios youth are temporarily expelled from school “until a mental health professional can write a letter stating that the child is not at risk.” This “cover your ass” response by administrators can exacerbate the crisis when the school functions as a safe haven for youth. In the best case scenarios concerned staff work with community mental health, crisis hotlines, hospitals, parents, and other community members to figure out why this kid wants to kill himself and how these multiple systems can “wrap around” the youth and his family.

“Crisis hotline workers were my best friends during those three weeks.”

There was one phone call that I will never forget. The school counselor said an 8th grader was making statements about wanting to kill herself. I drove to the school, checked in at the front desk, and walked into the counselor’s office. The young woman I thought was the counselor turned out to be a very physically mature, suicidal, 8th grader. During our conversation she let me know that she and her friends had a suicide pact. What started out as a routine suicide assessment escalated into one of the most stressful periods of my professional life. For three weeks I was terrified that one of these kids would die and that the rest would kill themselves in quick succession. I worked with the school counselor, parents, crisis hotline, and the other kids in the pact to figure out what might knock down the first domino, and how we could keep the others from falling. Crisis hotline workers were my best friends during those three weeks. They were the back-up, the overnight, and the consultants that kept everyone focused on their job. The crisis started to resolve after the school district agreed to break up the group by transferring one of the students, and the 8th grader who looked 25 but didn’t think she’d live to see 14 got mad at one of her friends and stopped talking about killing herself. On Friday, after the crisis was over, I went home and curled up in a fetal position. Monday I went back to work.

Photo by Jamie Taylor; unsplash.com

In 2015, I coauthored a book with Terri Erbacher and Scott Poland, Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention. In the book I go into detail about this suicide pact and my subsequent vicarious trauma reaction. If I were to travel back in time to the late 1990s I would take a copy of a tool we created for the book — the Suicide Risk Monitoring Form. The monitoring tool is for folks who work with youth already identified as suicidal. Before leaving on that Friday I would give the school counselor the Monitoring form and say, “Use this form every day with the 8th grader. It will take her 3 minutes to fill out and will help you identify changes in her suicide risk. It tracks ideation, intent, plan, and factors that in the 21st century we think are pretty important like burdensomeness, belonging, hopelessness, and sadness. You can graph the results and visually identify changes over time.” I would also tell her that in the 21st century, youth would no longer use T9 on cell phones. Instead they would send thousands of photos a day to each other using mini internet devices with the legacy name “phone.” There would be suicide prevention applications for these phones, and students would be able to access crisis support 24/7/365 via texting and chatting. There would be school-based curricula like Dialectical Behavior Therapy Skills, and interventions for suicidal youth and their families like Attachment-Based Family Therapy. True, there would continue to be pro-suicide internet chat rooms, but there would also be a very committed and prolific group of suicide prevention evangelists on social media called #SPSM (I would then have to explain that someone changed the name of the “pound sign” to “hashtag”). The school counselor from 1998 would look at me, amazed at all of the advances and say, “Wow. That must be saving so many lives.” I would take a deep breath and say,

“Sadly, more kids are dying by suicide today than in 1998; it is now the second leading cause of death among youth. But trust me, we’re working on it. Really hard.”

Jonathan B. Singer, Ph.D., LCSW is an associate professor of social work at Loyola University Chicago. He is the founder and host of the award winning Social Work Podcast. He is the author of 50+ publications, including the 2015 book Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention.

This blog post was originally written by Dr. Singer for the Lifeline and published on August 30, 2016. It is re-posted here from the Network Resource Center blog. If you’re involved with a crisis center and interested in joining the Lifeline, please email lifelineinfo@mhaofnyc.org.

If you or someone you know is struggling with depression or thoughts of suicide, reach out. The Lifeline is available 24/7 at 1–800–273-TALK (8255).