Suicide 'psychological autopsies' planned

Study could lead to better teen-suicide prevention and mental-health programs, physician says

"Psychological autopsies" of Palo Alto students who died by suicide will be conducted to "try to understand the youth suicides that have occurred here," according to community members involved in responding to a "cluster" of suicides last year.

Whether an autopsy is performed will be up to each of the families of the teenagers who have died. Autopsy results will be shared first with families, and later -- at families' discretion -- with the community at large.

The process involves interviews with family, friends, teachers and others who were in contact with the suicide victim with the goal of learning about what prompted them to die by suicide.

"We're hoping to create a narrative account of as many of these events as possible," Shashank V. Joshi, assistant professor of psychiatry at Stanford University, said.

Initial conversations have been held with several of the families, who indicated they are likely to participate, he said.

Physicians want to "present the aggregate information first to the families affected and then to the community at large. ... Any and all potential information to be shared will first be approved for disclosure by the deceased victims' parents," Joshi said.

Joshi told the Palo Alto City Council July 19 that he hoped the autopsies could lead to improved measures to address teen mental health.

The council was discussing a 68-page report issued by Project Safety Net, a community coalition created in response to five student suicides that occurred at the Caltrain tracks between May 2009 and January 2010.

Three of the teens were students at Gunn High School, one was about to enter Gunn as a freshman and another was a 2008 graduate. After the third suicide last Aug. 21, suicide researchers began to describe the events as a "suicide cluster," a phenomenon that could involve contagion.

Intense parent and community concern led to formation of Project Safety Net, which involves school, police, medical and city officials and a wide array of nonprofit organizations and religious congregations.

The psychological autopsies are one project on a lengthy to-do list suggested by the group. The list includes improved counseling and data-gathering, suicide-prevention training for teachers and city youth workers, guidelines for media coverage, physical supervision of the Caltrain tracks and broad community adoption of a youth-wellness strategy known as the "41 Developmental Assets" of the nonprofit Project Cornerstone.

Autopsy interviews will be conducted by Erica Weitz, a Psychiatry Department research assistant trained by the American Association of Suicidology. The study is subject to clearance by the Institutional Review Board at Stanford, which monitors ethical concerns surrounding behavioral research on human subjects. The clearance was pending as of mid-July.

Suicide researchers Madelyn Gould of Columbia University, David Clark of the Medical College of Wisconsin and Alan Berman of the American Association of Suicidology helped develop a plan for the autopsy study.

Joshi, a Palo Alto resident and parent, is on the executive committee of Project Safety Net and is active in a separate medical coalition that sprang up in response to the suicides, known as HEARD (Health Care Alliance for Response to Adolescent Depression).

HEARD's goal is to foster collaboration among primary-care, mental-health and education workers to address depression among teens.

"We hope to shed light on the risk factors for teen suicide in our community and in other communities, and help us develop better suicide-prevention and wellness approaches," Joshi said.

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Like this comment
Posted by John
a resident of another community
on Jul 30, 2010 at 10:53 am

> "We're hoping to create a narrative account of as many of
> these events as possible," Shashank V. Joshi, assistant
> professor of psychiatry at Stanford University, said.

> The process involves interviews with family, friends,
> teachers and others who were in contact with the suicide
> victim with the goal of learning about what prompted them to die
> by suicide.

Why hasn't this sort of thing been done by the police? Seems that an agency in San Mateo County is responsible for investigating accidents along CalTrain right-of-way. Why haven't they done this already? Why does Stanford need to be involved in this?

Like this comment
Posted by midtown mom
a resident of Midtown
on Jul 30, 2010 at 10:55 am

Ironic - to have an article about suicide autopsies, and cluster prevention, and then to publicize it ...

Sounds more like a curiosity factor than a real concern about the families who are still in recovery from what has happened.

Like this comment
Posted by concerned
a resident of Stanford
on Jul 30, 2010 at 11:07 am

We may never know what drove these tormented souls to take their own young lives. It's "too much, too little, to late" to go digging for answers. Let them (and their families) maintain their dignity in peace. As for the rest of the student body, your teachers and parents who push for perfection.....get a grip! Life is to be celebrated, not rated. Status, finalcial or social; straight A students who try to please their parents, because it is expected.
God bless these three souls. May they now have the acceptanace they sought.

Like this comment
Posted by jb
a resident of Leland Manor/Garland Drive
on Jul 30, 2010 at 11:31 am

We are not asking questions about what the teens do to each other. Not all teens, but some. Teens join the teen tribe and some take one another's opinions and advice much more seriously than that of their parents. Their peers are their sources for a lot of questions about growing up. Their parents are sources of resources, good camps, tutoring, athletics, music, and dance lessons.

Raising children to be more empathetic and less clique-y and clanny would be a good approach for subsequent waves of children. But children do what they see in their homes, and wealthy entrepreneurs did not get that way by giving everyone a break and dispensing the milk of human kindness. This is a dangerous town for some kids, in spite of the excellent school system.

Like this comment
Posted by curious
a resident of Gunn High School
on Jul 30, 2010 at 11:41 am

Are there any Gunn or Terman parents working on Project Safety Net? I should hope so if these groups are to maximize relevance, but I have not heard of any participation.

Like this comment
Posted by Marvin Lee
a resident of Community Center
on Jul 30, 2010 at 11:45 am

Autopsy? Who decided to use that unfortunate choice of words?

Like this comment
Posted by Misha
a resident of Midtown
on Jul 30, 2010 at 12:22 pm

Dear John, Midtown Mom ~

Please know that the authorities responsible for the Caltrains right of way have conducted investigations but their purpose and ability is limited. Conducting the study through Stanford provides many advantages, including expertise in psychiatry, study formalities and accountability, confidentiality and data protections. We should be grateful for the efforts by Dr Joshi and Stanford, who are contributing their services.

Please also know that participation in this study is entirely voluntary by the families who are generously participating in order that information is obtained that can be used to inform suicide prevention efforts, to help save precious lives and spare families similar grief and tragedy.

Finally, parents from Gunn and other schools are involved in Project Safety Net (see the list contained in the report).

Like this comment
Posted by STS
a resident of Gunn High School
on Jul 30, 2010 at 1:09 pm

They should also ask current students and 2010 graduates (especially) what changes at Gunn were made last year that they really liked.

Like this comment
Posted by Mary
a resident of Gunn High School
on Jul 30, 2010 at 1:39 pm

Excellent idea! What took them so long to do it? Maybe the dead will not have died in vain. We who survived these tragedies salute you.
Good luck!

Like this comment
Posted by Another parent
a resident of South of Midtown
on Jul 30, 2010 at 2:29 pm

Although I appreciate this information, please stop reintroducing this idea in such a public way. It has been proven that the more publicity this gets the more likely it is that it will continue. Please be more subtle and tasteful in reporting this.

Like this comment
Posted by DDee
a resident of Crescent Park
on Jul 30, 2010 at 3:37 pm

I'd be curious to know when the community elders and wise researchers will think to look beyond the high school to the broader culture in which it is located. Therein lies the root of the problem.

Every person I have met who comes in from outside to work in Palo Alto has shared some version of the same complaint with me, "Palo Alto and Palo Altans are weirdly dysfunctional." A haven of yuppiedom on steroids.

This dysfunctionality is seen by these others from outside in many lights, but they seem to agree on a few basics: Too obsessed with upward mobility and success; very judgmental, harsh and hard with any that they perceive to "not measure up socially or economically"; almost without exception project an aura of "entitlement" that is backed up by some pretty rude, self-centered and clueless to their surroundings or the needs of others - type behaviors. What is more, so many of the financial and mobile attributes are not the fruit of an objective superiority over all others in the market place, but a mix of privilege in education and access, family connections, the network one belongs to, etc. Not that this is bad, but Palo Altans seem to be incapable of self-reflection and sufficient honesty to understand that, “there, but by the grace of God, go I,” when they see or deal with someone NOT of their stripe.

Not long ago, a UC Berkeley study identified these as the traits of America's economically advantaged students when compared to the more socially-oriented, generous, mindful and caring attitudes and behaviors of the poorer students, which – and talk about the subjective lens of the observer - the study classified as being traits of people whose economic class makes them dependent upon others for survival. Well, most of the folk in the real world, and virtually all of the elders I discussed this study with boiled the difference down to one factor: the rich are spoiled, self-centered brats whose mammas obviously left some important messages out of their upbringing.

I am not saying that the Palo Alto high school students are obtusely self-centered and socially maladjusted, but they are living under the pressures and expectations of a community that is. They belong to an age group in which self- doubt is at a high in every generation, therefore coming to the age of passage into adulthood at a time in our history when their guarantees of falling on their feet already a good ways up the career or educational ladder seems much more iffy, plus the added burden of this community ethos can apparently become too overwhelming.

Treat and protect the children by all means, but do some long overdue self-reflection and kenosis as a community at the same time. (That should be easy, you have a church on every corner and a bunch of very well paid and accommodated clergy to count on.)

Like this comment
Posted by unreal!
a resident of Fairmeadow
on Jul 30, 2010 at 3:39 pm

[Post removed by Palo Alto Online staff.]

Like this comment
Posted by Another parent
a resident of South of Midtown
on Jul 30, 2010 at 4:29 pm

Ddee, who are these people you're talking about? Have you any data to back up your claims? As a Palo Altan who knows many wonderful local parents, teens, etc. I can't imagine where you found these people. Certainly there are some bad apples, but you'll find that anywhere. We were certainly overwhelmed by the dot com era and other big changes, which did bring in a lot of driven people, but that does not justify rash judgments of the entire population. Many folks have been working hard on these issues for a long time.

Like this comment
Posted by Sharon
a resident of Midtown
on Jul 30, 2010 at 6:06 pm

Probably better to call them lessons learned or after action reviews AAR as they do in the Marines-- still it is reassuring that we have qualified MDs involved under the supervision of a Stanford IRB---from now on --probably the less said publicly the better until the final report is released.

Like this comment
Posted by Pele
a resident of College Terrace
on Jul 30, 2010 at 10:12 pm

I agree with Ddee. You only need spend a few hours on this board to figure out the weird place that Palo Alto is.

Like this comment
Posted by Zelsa
a resident of Crescent Park
on Jul 31, 2010 at 9:07 am

@ Another parent: "Ddee, who are these people you're talking about?"

All of us except Ddee, presumably.

Like this comment
Posted by Hmmm
a resident of East Palo Alto
on Jul 31, 2010 at 8:41 pm

Much of what Ddee has written has been found true by many. Just questioning Ddee about it, as if what s/he wrote isn't possibly true, is indicative of the problems in PA. It's a harsh town, & one that isn't honest about its harsher problems which result in tragedy. This was true when I lived there & it's still true among much of its social strata.

Like this comment
Posted by Jerome
a resident of Downtown North
on Jul 31, 2010 at 10:42 pm

Why is the Weekly (and the Daily News) so obsessed with these suicides that they need to write up every minor development, and then rehash the past? I'm not saying these deaths shouldn't be reported, but the constant, unceasing coverage serves little purpose. There may be a link between excessive news coverage and more suicides. Yes, we have a free press, but with freedom should come responsibility.

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Posted by Another parent
a resident of South of Midtown
on Aug 1, 2010 at 11:47 am

Dear Hmm, Then I'm sure you won't mind if I make rash judgments about everyone who lives in your town. I repeat, there are many hard working, generous, caring, non judgmental, generous people living in Palo Alto. If you come here and don't find them, perhaps you're looking in the wrong places. Or perhaps you only attract others like you.

Like this comment
Posted by anonymous
a resident of Duveneck/St. Francis
on Aug 1, 2010 at 2:43 pm

"The process involves interviews with family, friends, teachers and others who were in contact with the suicide victim with the goal of learning what prompted them to die by suicide."
Don't you think it may be difficult for some to speak openly and honestly about another person in this regard???
Some people may not really know what was going on with the person, yet they may state something; others may feel pressure to report a certain way. It's like self-reporting -- I am not a medical person, but I believe that people do not always report honestly about themselves (and others) -- for reasons of fear, guilt or they may be plain wrong about something as sensititive and personal as THIS particular case.

Like this comment
Posted by Love the People of Palo Alto
a resident of Midtown
on Aug 1, 2010 at 2:51 pm

Thank you Another Parent. Well put.

Like this comment
Posted by Student
a resident of Palo Verde
on Aug 2, 2010 at 2:02 am

I think this is a bad idea. Suicide clusters are partially caused by bringing attention to what has gone on.. I was good friends with one of the victims and to have to possibly go through what has already happened and what many have worked hard to get through tough times... To bring this all back to many would just bring the attention back to where it was not wanted. Although I can see where they are coming from with this "autopsy" doesnt it bring back the point of not trying to spread more and more information about it? Isnt there a reason that after the last suicide Gunn did not follow the same plans as the previous ones, and we were not told to talk about it in our classes but to almost go on with our regular lives... This sounds like people asking questions that dont need to be answered except to certain people like family and such...

Like this comment
Posted by JDM-klutch
a resident of Adobe-Meadow
on Aug 2, 2010 at 3:38 am

To student,

The needs of the many outweigh the needs of one. This analysis will be used to save people, so please, do not oppose it.

Like this comment
Posted by dxm
a resident of Stanford
on Aug 2, 2010 at 7:33 am

Thanks JDM-klutch for clarifying the philosophy of the People's Republic of Palo Alto and marginalizing the teenager who spoke up! Very succinct.

Like this comment
Posted by Linda
a resident of Old Palo Alto
on Aug 2, 2010 at 7:47 am

Why wait so long? When Dr. Phil tried to visit/bring more light to this issue many in PA became up set. Now you want to reopen the sores for families and friends of the lost students and possibly publish the findings...... what award are you after.

If this was to be done it should have been done in private and never reopened like this especially so close to the start of school.

I agree with the student, but again, the so well educated of PA don't care about the small person only them selves. Have respect for these kids and their families.

Like this comment
Posted by Concerned Mom
a resident of College Terrace
on Aug 2, 2010 at 10:07 am

Last summer I was honored to be able to ask a question of an internationally recognized "holy man". I asked about Palo Alto's teen suicides, and was told they were because of the chemicals in the food and water the teens had ingested. I am hopeful the autopsy might shed light for us all.

Like this comment
Posted by Oh, please
a resident of Another Palo Alto neighborhood
on Aug 2, 2010 at 10:58 am

Concerned Mom,

Now that's a creative answer! I'm not buying it, however.

We already know that one had schizophrenia, thanks to the honesty of the mom.

The other autopsies will find nothing - it's just lip service. PAUSD should focus on de-stressing the load for students instead, such as final exams before Winter Break and no homework during break so the kids can actually have relaxing time off.

Like this comment
Posted by JDM-Klutch
a resident of Adobe-Meadow
on Aug 2, 2010 at 2:40 pm

I am not the one saying that, the experts are. They are experts for a reason. People should move past sentimental reasons and just investigate what happened with these historically troubled students.

Like this comment
Posted by another mom
a resident of Community Center
on Aug 3, 2010 at 12:03 pm

My question is why were all the suicide kids white? (Ok one was half white.) I am a white mother of two Paly students. Also, I was thinking of the Gunn campus configuration versus Paly's. Gunn has few windows. I taught at a school with no windows and it was depressing. Paly has a more open feel and a shopping center kids can cut to if feeling blue. Two things to think about.

Like this comment
Posted by Jose
a resident of Palo Alto Hills
on Aug 5, 2010 at 7:58 am

I have relatives (with teens) who reside in this area and orginially from the State of New Mexico. A point of reference for discussion purposes, whenever a teen suicide becomes a knowned in our communities, regardless of the geographical or location, demographics, race, ethnic, social/economics, physical characteristics or other factors that identify a complete teen suicide/death, it is a painful and traumatic event in all survivor's lifespan. It adversely impacts every one who has a heart and compassion vein in thier human being system. What has happened in your community has already occurred in many communities across the State of New Mexico as well as the nation. Certainly, it is a sad outcome because a young life has been taken away, but the reality is - we have to come to grips about dealing with all teen suicide issues hitting every community in the nation. The 'psychological autopsies" planned for your community is not a new technique or method used to track and prevent teens suicides. Yet, it is a good resource to use in your neighborhoods for prevention and awareness for the youth to listen and learn about what happens in the real world. This is not an MTV advertisment or promotion effort to teach our teens to kill themselves either! What needs to happen in your community is to keep an open mind about what has already happened and learn from it, then, tackle the problem with positive solutions and outcomes, period! You have no time to spend arguing about "saving-face" or who has a better plan than others. Just get it done and stop playing games with each other's kids lives in your neighborhoods. The primary goal and objective is to stop all teen suicides and save our kids from killing themselves, period! Are you listening?

Like this comment
Posted by Rick
a resident of another community
on Aug 13, 2010 at 10:16 pm

I am a therapist from the Seattle area. For the past 23 years I have worked with over 16,000 suicidal inpatients in one-to-one and group psychotherapy over a several day period. After being in dialogue with that many suicidal individuals over that long period of time, we started to see a "pattern" or what is called a "through-line" in a theatrical play. In the world of mathematics it is called an "algorithm" - something that EACH individual case had in common. (It was not merely "depression" -- not everyone with depression is suicidal.) In reading the article and the subsequent comments, it became sadly apparent that many of the remarks are addressing suicide at what may be called the "symptom" level, but not at the "causal" level. Suicide itself IS a "symptom". The question then remains -- symptom of what? It has been said that "one can't find 'the answer' without first asking 'the question'. In other words until the problem is identified and named, it can not be "solved".

Sorry, but further commenting on this topic has been closed.

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