Dale and Darlene Emme always carry with them the knowledge that if they'd arrived at home seven minutes earlier one day in September 1994, they might have saved their teenage son.
At 11:45 he wrote a suicide note and then shot himself in the front seat of his cherished, 1968 Mustang. At 11:52, the Emmes drove into the garage and found him.
Within days of the tragedy, they began to look for ways to save other teens. "We have dedicated the rest of our lives to preventing this kind of thing from happening," says Mr. Emme, who with his wife has established the Yellow Ribbon Program from their home in Westminster, Colo. They have distributed more than 100,000 cards that carry a suicide prevention message (www.yellowribbon.org).
The Emmes are part of an emerging grass-roots movement determined to remove the cloak of shame that has contributed to the rise in youth suicide - the third leading cause of death among young Americans. According to most experts, it's preventable.
Fueled by the grief and determination of families of suicide victims, small, local support groups have begun to organize nationally, holding candlelight vigils from town halls to the steps of the White House. They've blanketed Congress with letters and schools with information on the causes of suicide and ways to prevent it.
In the process, they're also helping to generate new funding sources for suicide prevention and research.
This nascent effort is also spurred by sobering statistics.
Since the 1950s, the youth suicide rate has quietly quadrupled, according to the Centers for Disease Control and Prevention (CDC) in Atlanta. Within that bulge is a more disturbing trend: The victims are getting younger. Between 1980 and 1994, the suicide rate for 10 to 14 year olds jumped 120 percent.
"It's gone from a fairly minor rate to one that's just a notch below the adult suicide rate," says David Clark, director of the Center for Suicide Research and Prevention at the Rush Presbyterian/St. Luke's Medical Center in Chicago.
While research into youth suicide is limited, Dr. Clark and other experts say that it is triggered by a variety of factors, including clinical depression, substance abuse, a pattern of antisocial behavior, traumatic family disruptions, stress from school, and peer pressure.
But the presence of two other elements - drugs and guns - also appears to significantly push up the suicide rate among US youths. "Access to lethal means - firearms and prescription drugs, plays a role," says Alex Crosby, an epidemiologist at the CDC's Division of Violence Prevention.
And if kids consume alcohol, research shows, they are "much more likely to use a gun to kill themselves," says David Brent, chief of child psychiatry at the Western Psychiatric Institute and Clinic in Pittsburgh.
A recent CDC report found that while the US youth suicide rate is double the international rate, if firearm-related suicides are removed, they're almost equal. "Firearm related suicide is 11 times higher in the US than for 25 comparable countries," says CDC epidemiologist Etienne Krug, who wrote the study.
Short of gun control, which many consider a politically unlikely solution, experts and grass-roots activists have taken a two-pronged approach to prevention: targeting at-risk youth and changing the way society views suicide.
Jerry Weyrauch and his wife have taken it upon themselves to organize hundreds of independent grass-roots support groups that have sprung up around the country.
The Weyrauchs lost their daughter to suicide 10 years ago. And like most suicide survivors, they carried their grief and shame privately for many years. But their burden slowly turned into an urgent need to help others.
Pen and people power
Last year, Mr. Weyrauch founded the Suicide Advocacy Prevention Network (SPAN), from the couple's home in Marietta, Ga. Besides coordinating grass-roots suicide prevention efforts, he has begun petition drives in Congress and state legislatures to declare suicide a national problem and to urge the development of a proven, effective prevention program.
"The one thing that got us started on this was MADD [Mothers Against Drunk Driving]," says Weyrauch. "If we can harness that kind of pen power and people power, we can begin to raise awareness and remove the stigma associated with suicide."
Parents often blame themselves for their child's suicide. They don't want to discuss it publicly. "We just go home and lick our wounds," he says. "But by making it OK for people to talk about it, we can change that and help prevent other suicides."
Last year, SPAN helped organize suicide-prevention awareness days in 12 communities from Bismark, N.D., to Baton Rouge, La. On May 10, it delivered more than 6,000 letters to members of Congress urging that suicide be officially recognized as a national problem. And this May 10, they're hoping to deliver more than 32,000 letters - one for each life lost to suicide each year in the United States.
It was a similar desire to put youth suicide on the national agenda that led the Ronald McDonald House Charities to start funding youth-suicide prevention research and programs three years ago.
"It just seemed to be an issue that was not being paid attention to; like substance abuse 20 years ago, it was being swept under the rug," says Ken Barun, president of Ronald McDonald House Charities.
The charity funded a three-year, $3.2 million prevention program and study at the University of Illinois at Chicago.
It was Ronald McDonald House's first grant in the area of youth suicide, and researchers across the country welcomed it. "This is not an easy area to raise money in," says Alan Berman of the American Foundation for Suicidology in Washington. "Our research is still in its infancy, and we desperately need support to find out what works in prevention."
Dr. Berman says there are still very few corporations willing to have their names associated with suicide. "This is still stigmatic and taboo," he says.
Like many prevention programs, the Chicago effort targeted schools where most at-risk youth can be found. In 1995, a CDC survey of high-schoolers found 25 percent had thought about suicide in the last year; 18 percent of those had formulated a plan; and 9 percent had attempted to take their own life.
The Chicago program used a fairly new strategy called the "gatekeeper" approach. Suicide-prevention experts went into the hundreds of schools in the Chicago area and taught teachers, guidance counselors, hall monitors, and lunch-room attendants the signs of suicidal behavior and how to cope with it.
"That appeared to have the most impact," says Mr. Barun, "but we also found that there was nothing really comprehensive, hands-on that the teachers could use that would give them all of the information they needed."
So the researchers designed a suicide prevention CD-ROM. This February, in the first national effort of its kind, the Ronald McDonald House sent out more than 30,000 copies to junior and senior high schools across the country.
Spotting the signs
"There are clear signs when a child becomes suicidal. If people are trained to spot them, they can prevent it," says Scot Simpson, head of the Washington State Youth Suicide Prevention Committee.
Parents and teachers are advised to be alert when children show a preoccupation with death and dying, withdraw from friends, lose interest in hobbies or school, or make a will.
Mr. Simpson and his wife founded the committee after their teenage son committed suicide in 1992. Mainly through their efforts, Washington is now the only state with an official, statewide suicide-prevention strategy and a million-dollar budget to pay for it, according Simpson.
As in many districts, it took a crisis in Patterson, N.J., to ensure that each school was equipped to deal with the threat of suicide. "We had a 15-year-old sophomore who shot himself last year," says Eileen Shafer, supervisor of substance awareness, physical education, and health for the Patterson school district.
Within each of its 36 schools, the Patterson district has now set up mini crisis teams that include each school's principal, nurse, guidance counselor, school psychologist, and the substance-abuse counselor. Whenever a child talks about suicide or displays suicidal behavior, at least two of the team members are called in to make an assessment.
"People who need to spot and refer a child at risk need intensive training," says Karen Dunne Maxim, coordinator of Bridges, a prevention program developed at the University of Medicine and Dentistry of New Jersey in New Brunswick.
Ms. Maxim and Ms. Shafer say it's critical to address any talk of suicide immediately and the Bridges program gives the staff the most updated and in-depth information on how to deal with such talk.
Experts say educators and parents should understand that a young person often does not have enough life experience to tell the difference between small problems and serious ones. A triviality to an adult is often perceived as unbearably painful to a child. "Give them time, praise, encouragement, consideration, and the same respect you would grant another adult," says information distributed by the Yellow Ribbon Program.
The Bridges training program underscores such advice. "I found the actual hands-on practice the most helpful; the way they demonstrated the skills needed to draw out the child," says Joanette Weiss, a guidance counselor at Patterson's East Side High School.
Maxim says all school systems, like Patterson, need to have a suicide-prevention strategy in place, complete with procedures that include involving a parent and outside mental-health agencies, if warranted.
While New Jersey is ahead of the curve nationally - by making funding for Bridges available - not every school in the state has a program in place. Like most other places in the country, prevention programs are a district-by-district decision.
While many academics applaud those prevention efforts currently under way, many question their effectiveness.
"I think there's been a mismatch between resources and where the need is," says Pittsburgh's Dr. Brent. "Crop-dusting, where you give a little bit to everyone, may not be the best use of resources."
Brent believes the future of prevention lies with new, more targeted approaches.
In New York, Columbia University's David Shaffer has set up experimental screening programs where adolescents are asked in a brief questionnaire whether they've ever had suicidal thoughts or signs of depression.
"What we find is that kids will tell you about themselves if you ask them. They love forms, they love to fill in questionnaires," says Dr. Shaffer. "You don't have to rely on their neighbor to tell you there's a problem."
Shaffer says such screens could be done in schools, doctors' offices, at a yearly meeting with a guidance counselor. Then the information could be used to target treatment more effectively.
In Chicago, Dr. Clark is taking that approach a step further. With a new grant from the Ronald McDonald House Charities, he's set up a program to ensure that children already identified as "at risk" for suicide get support from their families and appropriate counselors. A team will follow a family for six months to ensure that the parents stay involved with their child and the experts working to help him or her.
Clark and other experts are still sorting out the most effective methods to prevent teen suicide. But those working at the grass-roots level are convinced that the growing national attention to youth suicide has already begun to save lives.
"Kids are constantly coming up to us to thank us," says Emme of the Yellow Ribbon Program.