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Winning When We Do Not Want to Play: Combating Teen Suicide

Addressing teen suicide as it relates to depression, anxiety, and rising costs of education

Downtown Noblesville tdp 2017

Did something happen to one of your boys’ friends? I’m seeing all kinds of stuff on Twitter about someone who died and wanted to make sure everything is OK”

This is a text I received after one of my sons’ classmates died. I had not been on Twitter yet that day, or if I had been I had not seen all of the condolences being given to their classmate.

The boy was 19-20. I’m not sure which, but it doesn’t matter. A life lost too young.

Currently, Indiana leads the country in teens considering suicide attempts, known as suicidal ideation. Teens attempting suicide is on the rise to such an extent that I’m worried that youth in Indiana are becoming a little bit desensitized to it. According to the Indiana chapter of National Children’s Alliance https://incacs.org/indiana-10th-nationally-suicide-1st-suicidal-thoughts-among-teens/

“Indiana has spent nearly 15 years in the top ten of national lists of teen and youth suicide rates. As of 2016, Indiana ranks tenth in youth suicide rates and first in suicide ideation or the number of young people who report thinking about suicide and developing a plan to do so. The ideation rate was last reported at 19%, nearly double the national average.”

Youth who attempt suicide usually suffer from depression or anxiety. I attend several local committee meetings a month for my work in a non-profit. Mental health issues are a frequent topic of discussion. People are determining the root causes, as well as the effects of, increased rates of anxiety and depression, particularly in our youth.

As a parent of college age students, I recognize that one of the stressors I experience is the very high cost of higher education. I know that as my high achieving students got closer to their high school graduation date, I became more and more aware of how their scholastic achievements would directly affect the cost of their education.

I tried not to put too much pressure on them, but that is easier said than done when thousands of dollars are at stake. When parents are feeling stress, children pick up on that and can internalize it. I can’t help but wonder what the extreme increase in cost has done to increase the anxiety that current high school students experience in their later years of high school.

We are a two income family. We have two children who happen to be the same age, and we know that our lives as parents of college students will last approximately four years. My husband and I both have full time employment, and both have post graduate degrees.

We value education, and have children who have been successful in their education thus far. I can only imagine the stress families experience who have a lower income, more children, and who place less value on education. If I did not value education as much, I would resent the expense of it in a way I can only imagine.

As a therapist, I have worked with youth who have not had school success. I have worked with youth who have a lot of unrecognized or at least unrealized potential. Many youth with whom I have worked have experienced trauma, which affects their ability to learn and perform well at school. Some of those youth are genetically predisposed to anxiety, depression or both.

If a student is sleeping all day and not going to class, a parent or other trusted adult may not realize that for some period of time. They may reach the end of their semester having attended only a handful of classes, and having spent much of their time isolated. In today’s environment with the use of technology, students can be more isolated. They have their phones, or the internet, to communicate, so they don’t necessarily need to communicate with the people who are physically close to them. Untreated depression becomes more difficult to recognize when youth are in their later teen years.

Teenagers sleep a lot. It is part of their developmental makeup. It is normal for a teen to want to sleep about 10 hours a day, and to be grouchy when their schedule does not allow for that. Most teens have schedules that do not allow for the sleep that their developmental age would like for them to get. Most teens in high school begin school very early in the day. School start times for secondary schools are generally earlier than the elementary times, which is in direct contrast to the natural biorhythms of the ages of children attending these grades.

One of the hallmark signs of depression is sleep disruption. Many who are depressed sleep too much, although some sleep too little. Many experiencing depression report a feeling of tiredness that is not helped by sleep. Too much sleep also makes a person more tired. It’s really about inertia there. The more you sleep, the more you want to sleep.

The Diagnostic and Statistical Manual Version 5 (DSM 5) cites one of the signs of depression as:

“Insomnia (inability to get to sleep or difficulty staying asleep) or hypersomnia (sleeping too much) nearly every day”

In addition:

“Fatigue, tiredness, or loss of energy nearly every day (e.g., even the smallest tasks, like dressing or washing, seem difficult to do and take longer than usual.)”

Anxiety is another area of concern for teens. The first line in the DSM 5 identifies Generalized Anxiety Disorder as:

“Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).”

When I think back to my later high school years, I don’t remember worrying about school performance. I remember experiencing school success, wanting to succeed, and knowing I wanted to attend Indiana University, which I did.

I knew that I wanted to go to graduate school immediately upon graduating from college, which I also did.

I tend to hire staff who have recently graduated from college. I hire for an entry level position, and have had success working with young adults beginning their careers.

I have spoken with many about their student loans, which total much more than they make in 1-2 year’s time. Their stories of financial debt related to their college experiences astound me. Many of my staff have social work or human services degrees. It is not uncommon for me to hire staff who attended a private university for their education. .

Higher rates of depression, anxiety, and increased costs for college are some of the things I think about when I am thinking about the rate of suicidality in teens. According to an article published by Mental Health America http://www.mentalhealthamerica.net/conditions/depression-teens

“Sometimes teens feel so depressed that they consider ending their lives. Each year, almost 5,000 young people, ages 15 to 24, kill themselves. The rate of suicide for this age group has nearly tripled since 1960, making it the third leading cause of death in adolescents and the second leading cause of death among college-age youth.

Studies show that suicide attempts among young people may be based on long-standing problems triggered by a specific event. Suicidal adolescents may view a temporary situation as a permanent condition. Feelings of anger and resentment combined with exaggerated guilt can lead to impulsive, self-destructive acts.”

In addition,

“Unrealistic academic, social, or family expectations can create a strong sense of rejection and can lead to deep disappointment. When things go wrong at school or at home, teens often overreact. Many young people feel that life is not fair or that things “never go their way.” They feel “stressed out” and confused.”

Someone close to me had a suicidal episode a little over a year ago.

As a therapist, I know how to handle suicidal ideation. Explore, is there a plan. That helps me understand if they really mean it. What is their plan? If it is one that will cause imminent death, act quickly.

Are they giving items away? That is a sign someone does not think they will be here going forward.

None of this in any way prepared me to deal with a suicidal teen on a personal level. I feel lucky that the teen was able to receive help and was open to counseling, and most importantly is alive today. I feel lucky that the teen is not related to me. I also am very proud of them for reaching out for help when they needed it, even if it was in a way that terrified me.

I have an annoying habit of stopping anyone who makes a joke about killing him or herself. I interrupt them, and say that suicide jokes are not funny. I say that someday, someone is really going to mean it, and because of all of the suicide jokes people make, you may not know that they really mean it this time.

It is rote for me. I feel confident I repeat it ad nauseam. I can remember saying it as I ate dinner with my growing boys as they became teens.

When I was a 16 year old, my friend and classmate’s father shot himself. He died instantly, as far as I know. Not long after that, a classmate of mine whom I barely knew also killed himself.

I graduated with a class of 150. I am pretty sure that there was a third suicide at that time but I do not remember the details of it.

I’ll let you do the math to think about the rate of suicide and how that affected our community in 1986.

As someone who has worked with a lot of teens, many of whom were depressed, I can feel lucky that I have never lost a client to suicide. I have insisted to a parent that she take her daughter to a doctor and receive medication, or I would not continue to see her due to my concerns about suicidality, which was also a difficult conversation to have.

Many therapists do not have the same experience. The fact that I have spent the majority of the last twenty years supervising staff who provide case management has really helped my odds, I am sure.

Related to the increased rate of suicide and suicidality, Indiana also has a shortage of mental health therapists. I encourage my entry level staff to return to school and receive a master’s degree in social work or counseling.

There is a national shortage of mental health counselors. According to an article on healthline.com, https://www.healthline.com/health-news/shortage-of-therapists-disrupting-mental-health-care-111215#1

“In fact, more than half of all U.S. counties have no mental health professionals, the Washington Post reports. That’s despite the fact that 20 percent of children and 18.5 percent of adults have, or have had at some point, a seriously debilitating mental disorder, according to the National Institute of Mental Health (NIMH).

The article goes on to state:

“The rising cost of education is a barrier for many who are attracted to this profession. Money continues to be a factor throughout one’s career,” said Robinson, a licensed clinical professional counselor herself. “Mental health professionals often engage in years of unpaid clinical internships and residencies in pursuit of independent licensure.”

Many staff whom I supervise do not pursue post graduate degrees. The rate of pay for someone who has a master’s degree in a human service field is very similar to the pay someone receives for bachelor’s level work. As mentioned above, the prohibitive cost of education has to come into play when an individual is determining their educational path.

At the agency where I work, we talk a lot about needing a higher level degree to be eligible for promotion.

This is helping my entry level staff see the benefit of having a graduate degree. I currently have a staff member pursuing her Master’s in Social Work, as well as a recent staff pursuing hers from the same institution.

We are instituting an internship program at the agency where I work to formalize our processes so that more interns can receive quality training.

Indiana has recently changed some requirements for those wishing to receive their License in Mental Health Counseling (LMHC), that will change the internship requirements to put Indiana more in line with licensure requirements for other states. Other states require a lower level test to become a licensed counselor (NCC), while Indiana only recognize the more clinical counselor licensure (NCMHC). Indiana also requires a more intensive internship than local states, as well as face-to face supervision. There is some talk about altering the requirements of face-to-face supervision vs. supervision through electronics, such as through Skype. These changes are intended to help more people be able to become Licensed Mental Health Counselors in Indiana.

So, just to summarize so far.

One concern I have as related to teen suicide rate is the increased rates of depression and anxiety in teens. I have proposed a couple of theories about why some teens may be more at risk for suicide as it relates to higher education.

Also, there is a shortage of mental health counselors, both nationally and statewide. This is coming at a time when the need for mental health counselors is on the rise. There are decision makers working to address this issue, specifically in Indiana that I know of, to encourage universities to offer more master’s level programs, to increase the rates of reciprocity in terms of accepting licenses for mental health counseling from other states, and as it relates to the agency I work for, increasing the ability for current students to experience quality internships.

I would be remiss if I did not include substance use and abuse as it relates to the issue of suicidality and teen suicide.

I previously wrote an article on the Opioid crisis and I encourage anyone reading this article to read that as it relates to the current crisis we are in both statewide and nationally. Teens are using substances, specifically illegal or non-prescribed, differently now than they did even 10 years ago.

I am familiar with Indiana’s Lifeline Law. The law states that a teen will not be charged with a crime for calling the authorities when they are worried about the health of someone with whom they are with who has consumed alcohol.

Teens who are dying from alcohol poisoning are ingesting alcohol at a faster rate than their body can process the alcohol. Many youth are drinking ‘hard alcohol’, but beer and wine can certainly cause alcohol poisoning as well.

I became familiar with the law when a Carmel High School graduate was at a party just prior to leaving for college. His friends did not call 911, and he could not be resuscitated and he died. His parents became champions of the Life Line Law with the program Make Good Decisions, which in 2012 was a part of Promising Future of Central Indiana, where I worked at the time.

I have asked teens I know if they are familiar with the law, and what to do if they are with another person who needs medical attention. The campaign has been very successful and I can attest that my own children and their friends are familiar with the law.

How does this relate to teen suicide?

I think about how alcohol is a depressant. Alcohol is easy for teens, whether they are in high school or college, to get. I think about other illegal of non-prescribed drugs and how they can affect the psyche.

Then I think about the increase in depression and anxiety in our teens. And how a teen who might usually, with a sober mind, recognize that feelings of sadness are temporary and will go away, who may not have the ability to have that recognition under the influence of drugs or alcohol.

I think about the number of teens who have been prescribed anti-depressants. I wonder how increased rates of depression, anxiety, increased diagnoses of attention deficit disorders, and increased substance use are interwoven and related.

I spoke with a local pediatrician last year about my experience with the teen who experienced suicidal ideation. She then talked about her own concerns, specifically that teens are attempting suicide with the very medications that she is prescribing them to treat their depression.

She has a certificate in psychiatry, and is a voice for mental health in my community.

I think about how I would like to summarize this article and use it to move forward in reducing those statistics where Indiana is listed at the top for suicidal ideation.

I want to communicate with teens how important they are. How they are our future. I think about how a teen who feels too deeply recognizes global issues in a way many teens did not 20-30 years ago.

What I really want, though, is to reduce teen suicide. I want to work together to address the systemic issues that have led to the issues described above, and to put systems in place to help youth and families to help teens see the potential in themselves that we see in them.  

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