TEEN SUICIDE. Grass-roots efforts a key to effective prevention

The disturbing number of teen-age suicides that continues to snare headlines across the United States has begun to spur a vigorous and widespread search not only for probable causes but also for possible means of suicide prevention. Faced with an adolescent suicide rate triple what it was 30 years ago -- an estimated 5,000 teen-agers kill themselves every year, according to National Institute of Mental Health statistics -- parents, teachers, mental health professionals, and legislators across the country are now responding to a trend that is as confusing as it is alarming.

Although provisional data from the National Center for Health Statistics indicate a slight decline in the 1983 suicide rate for individuals in the 15 to 24 age bracket, suicide is still ``selectively affecting adolescents in the Western industrialized nations,'' says Dr. Pamela Cantor, a clinical psychologist and president-elect of the American Association of Suicidology (AAS). She adds that ``awareness programs in both the home and in high schools can be a tremendous help in combating this crisis.''

On a nationwide level several preventive steps have recently been taken. Four states -- California, Louisiana, Florida, and New Jersey -- have passed legislation requiring public schools to include suicide prevention instruction within curriculums. The National Institute of Mental Health has funded 18 new research grants on suicide, four of which are targeted specifically at adolescent deaths. Additionally, the National Center for Disease Control in Atlanta has established a new branch to determine the reasons for the rise in violent deaths among America's youth. While at least one state council has called for the establishment of a federal commission on youth suicide prevention, other federal legislators are advocating a national conference on teen suicide to be held this June.

However, many observers say that it is the increase in the number of grass-roots efforts, both secular and religious, and the establishment of suicide crisis centers and model school programs within local communities that have the potential to be most effective.

``The numbers of communities wanting to do something is booming,'' says Julie Perlman, executive officer of AAS. ``We're getting requests all over the country from people who want to set up [prevention programs] in their schools and communities. This is certainly the way to go.''

``There is a school of thought in the helping professions that the trained and sympathetic lay person is often better able to deal with a crisis situation than the mental health professional,'' says Stanley Becker, a minister and director of Contact, a Boston arm of an international Christian outreach program. ``On that theory, churches might believe they have the resources to be helpful.''

Currently 550 suicide crisis centers, ranging from volunteer-staffed hot lines to specialized departments of county mental health clinics and religious outreach programs, now operate across the country.

The impetus behind such efforts clearly has been the proliferation of the so-called ``cluster effect'' or copy-cat suicides -- those well-publicized deaths of several teen-agers in often well-to-do communities in such states as Texas, New York, and Massachusetts. While dozens of theories have been proffered as to why suicide has become increasingly prevalent among America's youth -- suggestions range from chemical imbalances to the breakdown of the family unit to fears about nuclear war -- little research has been completed on either the probable causes of suicide or the effectiveness of preventive programs.

``We're still lacking the overall definitive research on the issue,'' says Judie Smith, director of Community Affairs at the Dallas Suicide Crisis Center, one of the nation's oldest outreach centers. ``It's an iceberg issue,'' said a spokesman of the New York State Council on Youth Suicide Prevention recently. ``Nobody really knows the extent of the problem, and very little is being done on a coordinated level.''

Nevertheless, the problem is ``clearly on our doorstep,'' says Bill Curneen, deputy commissioner of mental health for Putnam County, N.Y. After studying a suicide prevention program in neighboring New Jersey, Putnam County officials formulated their own model program -- including parent-effectiveness and teacher-sensitivity training -- that has been replicated in five New York City high schools and eight junior highs.

``We're trying to teach students . . . that suicidal feelings will pass and that they will be happy to be alive again no matter how they feel now,'' says Dr. Michael Peck, director of the Los Angeles Suicide Prevention Center and author of California's suicide prevention curriculum. Dr. Peck cites adverse changes within the family structure and the rise of teen-age alcohol and drug use as aggravating the problem of adolescent suicide and as likely targets in prevention programs.

But other observers point to an erosion of religious faith and emphasize the role churches can play in crisis situations. Some religious leaders say it is the conservative, biblically oriented faiths -- rather than those churches involved in social-service programs -- that are proving most effective in combating the problem. ``Most help centers are quite secular in their approaches,'' says Mr. Becker of Contact. ``They emphasize getting in touch with your feelings or say that you can be what you want to be. But that tends to be a trap. There are some things you just can't do by yourself.''

Observers agree that the most immediately effective programs are those that are aggressive in their outreach. ``The hot line is fine for someone who is ambivalent enough [about committing suicide] to call. But our real role is to mobilize the support system,'' says Ms. Smith of the Dallas crisis center. ``We've developed school curriculum additions, communications skills workshops for parents and students, as well as establishing `care teams' within the schools.''

As for the long-term success of such hands-on preventive efforts, experts admit that little definitive proof exists. AAS is currently at work on establishing effectiveness criteria with the National Center for Disease Control. However, most observers agree that, unlike drug and sex education courses that garner mixed reactions from parents and students, suicide prevention instruction has been well received by students, parents, and faculty alike. ``It's the part of health class that students welcome,'' says Dr. Peck.

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