Over the past decade, youth suicide rates in Kentucky have increased significantly. According to data from REACH Evaluation, the rate of suicide among Kentuckians ages 20-24 increased 18 percent from 2008 to 2018. The rate of suicide among those between ages 15 and 19 increased 36 percent from 2012 to 2018, and the rate of suicide among youth between ages 10 and 14 has more than tripled since 2007. This growing public health crisis has prompted action among parents, educators, health care workers, policy makers, and young people themselves.
As part of its Inside Youth Mental Health initiative, in July KET held a gathering of leading experts in suicide prevention and other concerned citizens that addressed this important topic. Hosted by Renee Shaw, Preventing Youth Suicide: A KET Forum explores the alarming rise in youth suicide, examining its root causes and highlighting the most effective strategies for prevention.
KET’s forum featured a four-person panel of experts: Dr. Julie Cerel, PhD., a suicidologist and professor at the University of Kentucky College of Social Work and past president of the American Association of Suicidology; Patti Clark, MBA,
CPS, suicide prevention coordinator for the Kentucky Department of Behavioral Health; Lori Price, a psychologist and coordinator of student and family support services at Pulaski Co. Schools; and Stephanie Sikes-Jones, state level youth coordinator for TAYLRD (Transition Aged Youth Launching Realized Dreams).
Several members of the studio audience also spoke during the hour-long program. Persons who are struggling with mental health challenges and are having suicidal thoughts are urged to call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or message the Suicide Crisis Text Line at 741 741.
Here are five takeaways from the forum:
1. There is a gender disparity with regards to suicide completions and suicide attempts, and certain groups of young people are also at a higher risk.
According to Patti Clark, adolescent males complete suicides at a higher rate than do females, but young females attempt suicide more often than do males. The higher rate of completion among young males derives from their tendency to use firearms as a means to attempt suicide.
“What we know is that the most lethal means to attempt suicide is a firearm,” Julie Cerel says. “More often than not, when someone uses a firearm in an attempt to take their life, they’ll end up dead. Other means (such as hanging or drug overdose) are less likely to be lethal.”
According to data from the American Journal of Public Health, guns are used in only 6 percent of all suicide attempts, but are used in 54 percent of fatal suicide attempts. Cerel cautions that although suicide completion rates for adolescent and young adult females are still lower than for males, they are rising in recent years, due in part because more young girls are using firearms.
LGBTQ teens are at a higher risk for attempting suicide, Clark adds, especially transgender youth. And young people at an age of transition – for example, those entering sixth grade in middle school or 12th graders leaving high school and entering college or the adult world – are more likely to attempt and complete suicide.
And Cerel points out that suicide rates are higher among young people living in rural areas as opposed to urban youth. “In urban areas, we have more mental health services available for people,” she explains, “and we also have more people around us if we’re really struggling, sometimes people can reach out. In rural areas, people are more isolated and it’s harder to get to sources of support.”
Substance use also puts young people at higher risk for developing suicidal thoughts (known as suicide ideation) and for attempting suicide, Clark says. This risk increases if a person is using more than one substance at the same time. Another risk factor is having a family member or friend die by suicide. Clark explains that this “contagion effect” can ripple throughout a community if the person who died was a high-profile individual.
“When we have a report of a suicide that comes in from a school, we try to make sure that we are providing resources to that community and that school,” she says, “and we’re helping to guide those guidance counselors to recognize kids who may be connected to that student (who died), especially sibling groups, even if they’re not in the same school.”
2. The social pressures affecting young people today are far more complex and pervasive than in years past, but lack of a family support structure remains a major risk factor in harming mental health.
The advent of the internet and resulting rapid innovation in technology since the mid-1990s means that anyone 20 years old or younger has never known a social life that wasn’t centered on digital media consumed thorough mobile devices. The daily social pressures affecting them are far different than the ones teenagers from earlier eras had to deal with, says Stephanie Sikes-Jones of TAYLRD.
“A lot of young people, we’re just facing a different level of stress,” she says. “I think we’re really forced to grow up sooner. We also have access to social media, and on a global perspective we’re comparing ourselves more to everybody, and we’re getting images and messages from a bunch of different places, so it’s really hard to control what’s being input into our minds.”
“Kids are under intense pressure today to perform, whether that be in academics or in athletics” says Lori Price of Pulaski Co. Schools. “Students are under pressure related to bullying, and bullying seems to be at a high level because of social media. But a concern that we see in the school system is generally the breakdown of the family unit… And that breakdown in the family could be because of addiction, or mental illness in the home.”
According to Patti Clark, almost 30 percent of middle- and high school kids in Kentucky schools have reported being bullied, either in person or on the Internet/through social media. She says data from 2014 indicate that students who report being bullied have four times the risk of suicidal ideation and suicide attempts.
3. While many young people who attempt suicide are struggling with long-term mental health issues, others – and in particular, young teens – may be acting in response to an immediate crisis. Those cases require a different approach to intervene.
Audience member Dr. Hatim Omar, MD, FAAP, is the chief of the adolescent medicine division at University of Kentucky Health Care and is the founder and chairman of the Stop Youth Suicide Campaign. He says that for years, most youth suicide attempts were thought to occur during the peak of depressive episodes that in turn were caused by worsening mental health that developed over time. But he says that the 10-year tripling of suicide rates in the 10-14 age group cannot be fully explained by a spike in mental health problems.
Data from the Centers for Disease Control indicate that more than half of the people who die by suicide do not have a diagnosed mental health condition, and Omar points out that among youth ages 10-24, roughly 27 percent of suicides are “same-day suicides,” meaning that the person completes the act on the same day he or she first considers it.
“These young people have no history of mental health,” he explains. “Something just happens – a fight with a parent, or as with a student I saw yesterday, a straight-‘A’ student, had everything going for her, her best friend told her that she didn’t like her anymore. And she tried to kill herself the same night.”
It is difficult to identify and help these young people, who don’t have a clinical history of mental health problems, but without warning suddenly consider suicide. Omar says doing so requires adults – be they parents, teachers, or any concerned person – to create a robust support system that both removes the means of suicide from a young person’s environment and also engages the adolescent to share their thoughts and feelings. By doing so, adults can offer a calming perspective and bring a sense of levity to a crisis situation, Omar explains.
“The difference between a 15-year-old and an adult is that a 15-year-old doesn’t possess abstract thinking,” he says. “They don’t know what tomorrow is. So when something happens, they think that it’s the end of the world, that it’s never going to get better. So, it’s not unusual for them to take that step very quickly, without premeditation, and if they are unfortunate and have access to means – if there’s a firearm in the home, for example – they are dead before anyone detects anything.”
4. Words matter when discussing suicide, and especially when interacting with a young person who may be having suicidal thoughts.
Cerel strongly advises people to carefully consider their language when talking about suicide, both in general and when conversing with people affected by it. She says using the word “committed” implies that the act was a crime or sin, and advises people to always use the phrase “died by suicide” rather than “committed suicide.” Referring to a suicide as “successful” is also harmful to persons who have lost a loved one through the act. The goal is to eliminate the social stigma surrounding suicide, Cerel says, which exists especially in rural communities and communities of color.
When family members and/or friends lose a loved one to suicide, it’s important for counselors to offer support but also let them know that there may never be an answer as to “why” the person chose that path, Cerel adds. She notes that many of the warning signs of growing depression and suicidal thoughts overlap with other conditions, and says that only reliable warning sign from a person who is having suicidal thoughts is verbally expressing those thoughts, or having previously attempted suicide
Audience member Dr. Melinda Moore, PhD., is a psychology professor at Eastern Kentucky University who dedicated her career to mental health after her husband died by suicide at a young age. She urges concerned family members or friends to get behavioral health training so they can learn the best methods of initiating conversation and reach out to any individual they suspect is having suicidal thoughts.
“It makes us comfortable to think that there are warning signs, but actually I think the most important thing we can be equipped to do is to ask that question, ‘Are you having thoughts of suicide?,” she says. “If you notice somebody not being themselves and ask, ‘Are you having thoughts of suicide?,’ and then not leaving them alone, and then having resources such as the national talk number, or taking them to the emergency room, or my favorite is to take them to a mental health professional who actually provides what is called suicide-focused treatment.”
Moore explains that approaching an individual and asking if he or she is thinking about suicide is not as difficult as it seems at first – if the person offering help is trained. She espouses three empirically supported training methods: cognitive behavioral therapy, dialectical behavioral therapy, and what is called the collaborative assessment and management of suicidality. Moore trains her clinical psychology doctoral students in this third method.
“In my classroom, not only do students learn theory, they actually learn through role play how to ask those questions, how to do a proper assessment, and then how to treat those individuals,” she says.
5. Lowering youth suicide rates in Kentucky is everyone’s responsibility.
Lori Price from Pulaski Co. Schools says that she has seen a sharp increase in the number of students who have reached out for help with mental health problems in recent years. That has required teachers and staff in her district to build up their resources and take a more proactive approach in dealing with students. They have developed programs with support from students that reduce stigma around mental health, and also offer one-to-one counseling. All Pulaski Co. staff members are trained in the Youth Mental Health First Aid public education program, and teachers have been trained in trauma-informed care practices.
“Every year we highlight with our staff how to develop an appropriate relationship,” she says. “How to start to notice that a child is beginning to have a behavioral health issue. How to intervene and have a healthy conversation with them. And how to link them to services.”
Price adds that Pulaski Co. Schools also brings in families and the community at large through its multi-level outreach, and her staff has a goal this year to begin training middle and high school students in a counseling method called QPR (Question-Persuade-Refer) in order to bolster peer-to-peer referral and support. “We want them to know how to have a conversation with a youth – their friend – and how to get them help,” she says.
Sikes-Jones works with transition-aged youth (16 to 24) with TAYLRD. Sikes-Jones attempted suicide at age 14 and uses her own personal story to connect with at-risk youth. She says cooperation between the state Department of Behavioral Health and TAYLRD is growing as they work to empower youth to help themselves and one another.
“Peer support is actually a certified, trained position,” she says. “If you are a 18 to 35-year-old with lived experience, in a behavioral health setting or any other sort of state service, you can get certified and go through training to provide and give that lived experience, to be a peer and provide that support on the ‘it can get better’ side of things.”
Sikes-Jones also says that social media, which is often a contributor to mental health problems among youth, can also be used to form support networks that help them overcome those problems. And TAYLRD has helped youth person-to-person with its Drop-In Centers, which resemble rec rooms but are staffed with persons who have lived experience in behavioral health and are trained to offer support and guidance.
Cerel concludes by observing that recently, she’s seen a shift in how leaders in society are addressing suicide, which is a positive development. More people are willing to talk openly about suicide and mental health challenges, and are taking the initiative to reach out to persons in need of treatment. Reducing the suicide rates among Kentucky youth will require this community- and statewide movement to continue growing and forming new partnerships.
“I think it’s important for people to understand that if you’re having thoughts of suicide, you’re not alone,” she says. “If you’ve lost a loved one to suicide, you’re not alone. We’re starting to talk now about these experiences of suicide, and it’s important for us to all realize that these happen pretty frequently, and we need to keep talking about them to keep people alive.”
Following the forum, KET conducted a question-and-answer session with panelists and audience members:
KET further explored suicide prevention in its 2018 six-part series You Are Not Alone. Three excerpts from the series aired during the forum: a discussion among Kentucky teens about their experiences with suicide and mental health issues; a visit to Butler High School in Louisville to learn about its peer-to-peer Sources of Strength program; and a discussion with a mother and daughter in Louisville who are honoring the memory of a lost family member through a nonprofit devoted to identifying mental health problems in young kids.
The entire series is available for online viewing via KET’s webpage at PBS LearningMedia. The LearningMedia site also includes discussion guides suitable for classroom use.