When silence can be fatal

The unthinkable happened in Clark County, Wash., at the start of the 2000-01 school year: A 16-year-old boy committed suicide. Few in this rural region near the Oregon border dared even speak about it publicly.

Over the course of the school year, however, the deaths eerily kept coming. Five more students took their own lives in what experts term a teen suicide cluster. As panic set in, pressure mounted for a solution, but every option seemed to risk doing more harm than good.

"The ongoing concern all along has been whether to say anything at all," says Karyl Ramsey, then coordinator of the county's suicide prevention campaign. "The fear was that talking about it might exacerbate the problem."

After convening a task force and weighing the risks, Clark County officials gambled that new public-service announcements and school programs addressing suicide might create a safer youth climate.

But across the nation, the same questions remain: What, if anything, can prevent youth suicide? Does education on the topic lead depressed students to get help? Or do discussions instead run the risk of pushing some students closer to attempting suicide?

Finding answers has become an urgent matter for public-health officials who focus on youth. Nearly 5,000 people between ages 15 and 24 take their own lives in the United States each year. Only motor vehicle accidents and homicides account for more deaths in this age group.

Although youth suicide rates have been dropping since 1994, researchers remain concerned as today's teen rates continue to be three times as high as those of the 1950s. This year, states are unfurling new initiatives to catch warning signs and raise public awareness of the problem.

Yet because experts generally say they aren't sure what's causing rates to drop, prevention efforts keep emerging in all shapes and sizes, with intense debates never far behind.

Example: the TeenScreen program from Columbia University in New York. In it, high school students in 95 communities don headphones, answer questions about their thoughts and feelings, and wait to see if evaluators encourage a meeting with a counselor.

The theory is simple: Screening for risk factors might save lives, while education about suicide might backfire.

"It's difficult to do direct education with youth that is safe and effective," says Laurie Flynn, director of the Carmel Hill Center at Columbia. "Just talking to kids about 'Don't do something' isn't terribly effective, since adolescents aren't especially responsive to adult admonition. Just having an assembly on suicide carries with it a possibility of stirring up those few young people who are very depressed and at risk. We just don't know enough yet about how to do [suicide education] well."

But officials for the state of Wisconsin strongly disagree. For them, edu- cation is a must. Since the mid-1980s, state law has required that every Wisconsin public school student receive instruction in suicide prevention.

"These kids are just suffering in silence," said Nic Dibble, a consultant to Wisconsin's department of public instruction. "We can't guarantee there won't be a student who reacts negatively [to suicide-prevention classes]. But on balance, we'd be doing more harm by not doing anything."

The roots of youth suicide remain mysterious. But social alienation in large schools and unrooted families, coupled with more substance abuse at younger ages, and easier access to guns have all been cited as factors in rising teen suicide rates in recent decades, says Lucy Davidson, director of education and prevention practice at the American Foundation for Suicide Prevention in New York.

Warning signs, such as loss of interest in activities and muffled cries for help, are almost always present in teen suicides, say experts. The challenge with youth is to identify those most at risk and get them promptly into treatment. But the question is: What type of treatment?

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