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Can social media play a role in youth suicide prevention?

Benefits outweigh potential risk factors in using new media to address suicide, researcher says

An internationally known suicide prevention researcher visited the Stanford University School of Medicine on Monday to share her work on how social media can be used to prevent suicide, offering insight into alternative avenues for addressing teen mental health concerns.

Jo Robinson, head of suicide prevention research at Orygen Youth Health in Melbourne, Australia, spearheaded two recent studies on transforming social media – a world often "demonized" as a potential contributor to suicide contagion – into a therapeutic tool to provide services and connect and empower teens. Both studies were launched in response to teen suicide clusters in Melbourne, she said.

"Social media gets demonized quite a lot when it comes to suicide," Robinson said Monday, speaking to a small audience in a classroom at Stanford's Li Ka Shing Center for Learning and Knowledge. In the wake of suicides, online memorial pages, photos and comments often spring up and can glorify the incident in a way that is thought to contribute to a contagion.

"One of the things that's kind of informed the work that we're doing is that we thought, 'Well, yes, that's all potentially true and we have to be concerned about that but actually, social media is not going anywhere and young people actually prefer using social media than seeing professionals like me,'" Robinson said. "So how can we actually engage in a positive and constructive way with social media to work with young people and provide a service to them?"

Robinson described how Internet-based treatment has become an increasingly popular way to deliver health programs across the board, including cognitive behavioral therapy (CBT), a method considered one of the most effective ways to treat adolescents with depression, anxiety or suicidal ideation.

Robinson stressed that any online program shouldn't replace face-to-face treatment, but can be a beneficial "adjunct" treatment for teenagers in particular.

Other signs of this shift toward using new media as a suicide-prevention strategy include text-only suicide hotlines, robust social media prevention and anti-stigma campaigns at both the local and national level and a new feature on Facebook that allows users to report suicidal posts or content, which automatically sends a message to the poster indicating a friend is concerned about them and provides access to resources to get help.

Robinson also gave an example of a group of Melbourne teens who, disappointed in local professionals' response to several teen deaths by suicide on a rail line, created a youth suicide prevention group on Facebook that had more than 20,000 members within days of its launch, she said. The group became so large so quickly that mental health professionals were enlisted to monitor the page, with about 1,000 referrals to outside services made in just three months, according to The Australian.

Similarly, though on a smaller scale, a Palo Alto High School graduate created this year a support group on Facebook hoping to connect more alumni with current Paly and Gunn High students "with the intention of elevating dialogue about mental health during this epidemic of teen suicides," the group's description reads. With currently more than 2,700 members, the page has becoming an online gathering place of sorts, with users regularly posting resources, news articles, invitations to local events or related projects and more.

Robinson's first study, conducted in 2011 and 2012 with a group of 21 high school students, investigated the impact of Internet intervention on suicidal ideation. The result was "Reframe-IT," an eight-week online intervention program for students experiencing suicidal thoughts, meant to be completed with the help of a school counselor on campus.

Participants would log on to the website each week, watch and analyze videos of other young people dealing with difficult situations (ranging from an abusive parent to failing a driver's license test), complete several activities and then record their own video testimonial on their smartphones. (Robinson described the smartphone as a "therapeutic tool" that allowed the students to track their feelings wherever they were.)

The website is monitored by a therapist who can provide personalized feedback on the activities, help the participants through each modules of therapy (one per week) and provide crisis intervention if needed.

Though the results of the pilot program were encouraging – there was a significant reduction in suicide ideation, depression and hopelessness in the participants – "no one wants to sit in front of a static website anymore," Robinson said.

The pace of this kind of research can also fail to keep up with the ever-changing world of technology, she said, often rendering the very platform that one is studying null by the time research is complete.

So Robinson moved to studying social media, finding it a more flexible, organic – and effective – way of supporting at-risk teens and reaching them where they are. She and other researchers recently launched a 12-week pilot project, dubbed "Safe Conversations," with a small group of students affected by a recent student death by suicide.

The 11 students – who also came from a vocational school for students who have been kicked out of or "disengaged" with their traditional high school, Robinson said – worked with Robinson and other Orygen researchers to design intervention strategies to roll out on Facebook for the rest of the school. The group collected data, learned about suicide and mental health and worked with a local social media company with a background in health to develop their ideas.

One intervention was the creation of messages to be distributed online and in person with positive messages like "You are perfect exactly as you are with all your flaws; there's no need to change a thing except for the way you see them." Another was a video showing a young man, standing sad and alone at a beach, writing a negative message in the sand before a wave washes it away and a friend joins him to write a more positive message.

Robinson called the results "encouraging" but noted that this was, again, a small uncontrolled study and with a very specific population of students. All six participants who responded to an evaluation agreed or strongly agreed that participating in the project helped them to develop new skills, in particular technical skills; five of six reported it was motivating, enjoyable and worthwhile; and four of the six said it helped them feel better able to talk about suicide safely online. All six are also returning next semester to serve as peer leaders with a new cohort of students who will create their own social-media based intervention strategies.

"It was all about capitalizing on the idea that young people want to hear from other young people," Robinson said.

Shashank Joshi, a Stanford Medicine child and adolescent psychologist who serves as a mental health consultant for the Palo Alto Unified School District, was in the audience at the Monday morning talk. He told Robinson that he has seen local schools similarly struggle with reaching kids where they are and breaking down the perception that adults won't be able to help them, so they don't seek help.

He offered the example of Palo Alto's Sources of Strength, a peer leadership/mentoring program which he said depends on first finding teachers who students view as trusted adults to serve as advisors and then the administration buying in enough to provide these teachers with the release time necessary to sustain the program. The schools that offer teachers an hour of release time once a week to work on the program have been the most successful, Joshi said.

The school district's "Comprehensive Suicide Prevention Toolkit for Schools," a 150-plus page document developed in response to the teen suicide cluster in Palo Alto in 2009 and 2010, does suggest social media be used proactively to not only communicate with students and families but also to provide support and intervention if necessary.

"Although schools may initially consider social media to be outside of its traditional jurisdiction, they can in fact collaborate with students and utilize these tools to disseminate important and accurate information to the school community, identify students who may be in need of additional support or further intervention, share resources for grief support and mental health care, and promote safe messages that emphasize suicide prevention and minimize the risk of suicide contagion," the toolkit reads.

Comments

4 people like this
Posted by Sarah1000
a resident of Los Altos
on Jun 29, 2015 at 7:18 pm

Hopefully, Santa Clara County aka Silicon Valley can follow Melbourne's example in developing social media suicide prevention tools. With new residents due to arrive at Stanford/LPCH, now would seem to be the ideal time to begin its own study on the impact of internet intervention while providing some of the adolescent mental health services so desperately needed in our community.


30 people like this
Posted by Factual
a resident of Professorville
on Jun 29, 2015 at 7:44 pm

The fact is that for a teen's self esteem, social media does more harm than good. Kids that age cannot help destroying someone, usually a girl, emotionally-- usually in an anonymous or semi-anonymous way. They will say things they would never ever dare to say face-to-face.


5 people like this
Posted by Peter Carpenter
a resident of Atherton
on Jun 29, 2015 at 7:58 pm

Peter Carpenter is a registered user.

"They will say things they would never ever dare to say face-to-face."

Ironically this was posted anonymously. Where are the adult role models?


17 people like this
Posted by Marc Vincenti
a resident of Gunn High School
on Jun 29, 2015 at 10:35 pm

Dear Palo Alto Onliners,

Anything and everything might help, but I wouldn't place too many of our eggs in this basket.

We all form our feelings about ourselves, and our very identities, through the looks in others' eyes, the tones of their voices, the way they angle toward us as they sit, or how loud they slam the door, where they choose to sit, how long they hold our hands.

It's in our fiber as human beings that we assess others' love by whether they actually want to be with us, in our presence, or whether they abandon us. In conversations, we unconsciously but very richly read thousands of messages from others that we can scarcely even name: the slow welling of an idea in anothers' eyes; the eagle gaze of rapt attention; the downturn of digust in the corner of a mouth; the wrinkles of thought that move just under the skin.

I have the strange impression that it's getting harder and harder for us human beings to tolerate each others' actual presence; it's easier to have fantasy versions of others, tucked in our minds and in the distances. The difficult truth is, we're always obscurely irritated by other people in some way or other within minutes of their walking into the same room we're in, and the hard and productive work of life is to reflect on these intolerant feelings, and see others with more understanding eyes.

It's an impoverished, poor form of attachement that we give our kids if all we can pass onto them with is a small buzzing box in their hands, or a keyboard for their fingers--both hooked up to strangers at the other end, some of them kind, many not, but most faceless or anonymous.

It's sad enough that our emergency counselors swoop in and out of Gunn and Paly with scarecely any time to really get to know an individual kid; it's sad enough we're hiring our two new high-school therapists in haste, without even getting to know the candidates (hurried before panels of eight) as people.

For a better direction toward safety and salvation for our kids, please see the six practical proposals for school reform advocated by Save the 2,008, the local grassroots effort to make our high schools places that parents look forward to having their children attend.

Please visit: www.savethe2008.com. Join up by signing our Open Letter!

Sincerely,
Marc Vincenti
Co-Founder, S2K8


3 people like this
Posted by Sarah1000
a resident of Los Altos
on Jun 30, 2015 at 7:21 am

Marc- As a parent and non "Native" to technology, I totally agree with you. The only social media I use is Instagram and I just started a couple of months ago to post suicide prevention info. I would much rather interact with most people face-to-face. However, the kids and young adults of today have grown up in an environment filled with technology. Cell phones, computers etc are appendages that they use to communicate. I think it's important not to judge what we don't know. Let's be curious instead and find out how we can use technology to help our kids.


9 people like this
Posted by Community
a resident of Another Palo Alto neighborhood
on Jun 30, 2015 at 4:30 pm

Interesting. PTAC at the bidding of the district office shut down all parental soul-searching via social media this year, and told us the experts hired by the district said all discussion needed to be squashed or we risked making things worse.

This is in stark contrast to what happens typically after every tragedy, even 9/11, when grassroots spontaneously form, those are the forces that usually change and fix things. But they also tend to be powerful, and the district can't have parents getting together and becoming powerful. Hence, once again, manipulating us for their interests against the interests of our kids.

And then the opportunity is lost. This is why it's important to identify and cull people whose professional backsides and bloated salaries take priority over children's wellbeing. School districts should be populated by people who are at least as much driven to always do what's best for kids. We shouldn't have to wait for tragedies to be spurred to act, but now that they've happened, this article makes starkly clear how wrong it was that the above potential benefits were stymied.


11 people like this
Posted by Community
a resident of Another Palo Alto neighborhood
on Jul 7, 2015 at 11:39 pm

[Portion removed.]

Comparing notes with my child, we are both still carrying around the tremendous stress of the last school year. Some of the behavior of school personnel has left both of us feeling a tremendous loss of trust and disconnection. The school year was hard enough, but usually things get better in the summer. But this summer it isn't getting better but I don't know what to do about it. It feels worse in some ways than some very serious personal trauma from the past.

I don't know what to do for my child to help restore a sense of safety and trust in adults. Given the way there was always this other layer of stuff going on behind our backs and we never could count on them to be honest or upfront with us, and given the things we were subjected to, I am too discouraged even to try to find counseling (even if I thought it might help). I have lost a lot of trust in people's intentions myself. Not that we can really afford counseling anyway.

Elementary school was lovely. I so wish we had never considered middle school here. What a nightmare. We all felt an incredible load off when we decided to leave the district. But the wounds of this year are not healing. I have worked a lot on forgiveness, but it's not enough. This may sound strange, but I just want to be myself again.


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