In the days after Palo Alto's most recent student suicide, local mental health experts, school administrators and parents who have lost children to suicide urged other parents to support their children by talking openly with them about suicide and mental health.
"The fact that all of you are here today -- I ask and plead for everybody to go back and have these discussions so we can normalize our dialogue around mental health issues as well as we do around physical health issues," parent Kathleen Blanchard told hundreds who gathered in Gunn High School's Spangenberg Theater the evening of Wednesday, Nov. 5.
Blanchard, whose son JP, a Gunn junior, died by suicide on the train tracks in 2009, was not alone in her plea. She spoke as part of a panel that evening along with Dr. Meg Durbin, a pediatric and internal medicine doctor at Palo Alto Medical Foundation; Sami Hartley, a school mental health coordinator for Lucile Packard Children's Hospital; and Dr. Shashank Joshi, a Stanford University adolescent psychiatrist who has led much of the suicide-prevention work in Palo Alto since the student suicides in 2009 and 2010.
Talking about these issues, the panelists said, is not risky but rather healthy and helpful, particularly when the conversation is empathetic and informative.
"Students may ask things like, 'If I ask my friend about suicide and they're not really thinking about it, wouldn't I put that idea in their head?'" Joshi said. "We can field the question, validate the concern and then give them the science, which shows that particularly for someone you're worried about, asking the question about suicide is one of the most supportive things you can do to help that person feel understood."
Sami Hartley told parents that suicide prevention and education is included in Living Skills, a required course she teaches at Gunn and Palo Alto high schools. The class focuses on topics like personal health, social-emotional well-being and interpersonal relationships. Students role-play how to have a conversation with a friend they're concerned about.
"We discuss mental health as a biological issue, as something that rests in the brain just like diabetes rests in the pancreas," Hartley said. "That's something that changes their perspective entirely."
This push to normalize the community conversation about suicide and mental health comes at a time when all involved -- schools, teachers, students, families, community organizations, local media -- are striving to walk the fine line between providing the space and time to have such critical conversations and placing unhealthy attention on a sensitive issue.
The speakers' advice was followed by a cacophony of parent pleas for the schools to minimize student stress and intense academic pressure. Parents called for reduced homework load and a limit on the number of Advanced Placement (AP) classes students can take. They urged the district to fully implement its little-known homework policy and school principals to instill a culture geared toward true learning rather than grades.
But what Palo Alto needs, the panelists urged, is an understanding that suicide and mental health are complex. Some questions may have no answers, they said. But creating an environment in which people ask those difficult questions will lead to the kind of community that is supportive and caring, where kids feel comfortable and even empowered to open up about their problems.
Palo Alto High School's monthly PTSA meeting last Thursday was given over to two of the school's psychologists, a school-climate faculty member, a Paly mental health therapist and principal Kim Diorio, who talked to 20 parents about the school's response to the most recent suicide and ways to support their children.
Jonathan Frecceri, a mental health therapist who came to the district this year after working for several years at grief-counseling nonprofit Kara, spoke about the "three-legged stool" that is suicide prevention -- a model he said he first heard from Joshi several years ago.
"Prevention is about promoting awareness of mental health; it's about intervening when we have people who are at risk; and it's about post-vention," Frecceri said. "We need every leg of the stool in order to do an effective job with suicide prevention.
"That involves promoting wellness and health in general; it involves building developmental assets in our kids; but it also, I think, involves days like today where we've had these tragedies and we're coming together. How do we have an environment where we can talk to kids and where kids feel safe enough to be able to talk about these issues and just to normalize that this is really scary?"
He, along with speakers at the Gunn meeting, emphasized that parents and others should avoid characterizing suicide as an irresponsible act.
"They're going to remember that you are a very calm, caring, supportive presence as opposed to, 'This is a bad thing; this is irresponsible.' They're going to hear that, maybe, as judgment, so they're going to feel like they can't bring this up," Frecceri said.
"We're not asking anyone here to be a therapist, a psychiatrist, to diagnose anybody. It's just about having that space and that environment with your child for them to be able to bring it up if it comes up."
Blanchard said that sometimes students -- especially those feeling impacted by any degree of anxiety, depression or mental illness, whether moderate or severe -- are unable or unwilling to ask for help. It is critical to educate all students to be vigilant, understanding friends who likely will hear or know things that parents will not, she said.
"We need to help our kids be more aware and have the courage to speak up and say something if they see something. We have to be open to the possibility that something we're seeing is not necessarily a sign of suicide, but it certainly can be a sign that the child is not feeling well, that there is stress ... and something needs to be understood better and therefore can be treated," Blanchard said.
Signs and symptoms of suicide and mental illness should be made generally known, like the warning signs for stroke that are on posters, she said.
"I also want to say that sometimes the child is unable to ask for their own help because they are like a drowning person. They're drowning in their own despair and sorrow," she said. "What they're dependent on is the people around them to notice what's going on and to reach out and to bring help to them."
Places to reach out for help are plenty and have been provided in recent weeks at both campuses. Guidance counselors, the schools' Crisis Response Teams, Adolescent Counseling Services (ACS) and Kara staff have been providing extra support for students and staff, particularly at Gunn. (One Paly parent asked last Thursday if she can tell her child to talk to someone at the schools' on-campus ACS offices -- without a referral or appointment -- if the child wants to talk to someone confidentially who is outside the family. The answer: Yes, parents can do that.)
At both parent meetings, pamphlets and brochures were provided with multiple suicide hotlines, lists of local mental health resources, tips on warning signs or risk factors, ways to support children coping with loss. (See list of resources here).
Durbin, of the Palo Alto Medical Foundation, urged the parents to think of their children's primary care doctors as another source for mental health support.
"I have heard several (people) say that it didn't occur to them that when they have a concern about their child or another family member has a concern ... that one of the places they can go is their regular doctor, as if the regular doctor only gives shots or does sports physicals," Durbin said. "We hope that all of you will recognize that your doctor and your child's regular doctor cares about emotional health, cares about any mental health issues going on, and the doctor can be the first place for you to come."
Hartley told parents that a particular form of crisis response and suicide prevention training, known as Question, Persuade and Refer (or QPR), is available to anyone interested. QPR is a conversational tool that teaches three steps to take when concerned that someone is thinking about suicide: ask the person if they have had suicidal thoughts or feelings; persuade him or her to get help; and then refer them to the places where they can get that help. (QPR is also taught to students in the Living Skills course, and all Gunn staff received the training last fall.) Santa Clara County offers a free, one-hour training session online.
There will also be a mental health education event for Gunn and Paly parents held the evening of Dec. 4 at school district headquarters, 25 Churchill Ave. Hartley said anyone interested in attending should complete the online QPR training before so the event can focus on answering questions and developing and practicing skills instead of introducing the topic from the very beginning, Hartley said. A letter will be sent out to Gunn and Paly parents with a finalized time and more information.
Hartley and others also stressed that it's OK for parents to express their own concern or worry to their children.
"A lot of parents really feel like they need to be strong, ... they need to be able to weather everything and give a positive example of success to their children. They feel uncomfortable showing emotion that isn't positive. I will tell you that that gives a false sense of what emotional experiences are like," Hartley said. "It's OK to be sad. It's OK to be upset or stressed or worried about something with your kids. It's an opportunity for them to see that these are things that normal people experience all the time. It's an opportunity to teach by doing."
Though it may seem facile, she and others said that simple things, like asking children to take a walk with you, can be effective. Exercise, healthy eating and taking care of yourself are all proven mood boosters, Joshi said, and are "all the things that if Meg Durbin were your doctor, she'd be asking you to do."
Vic Ojakian -- a former Palo Alto mayor who has worked on suicide prevention locally and nationally since his son, a Paly graduate, died by suicide in 2004 -- reminded the audience last Wednesday that it will not be one person, one school board, one policy or one effort that will bring positive change to a complex, deep-seated issue.
"One of the things I've learned in all this work is it's not a single individual. It's not two individuals," he said. "It's all of us together that actually changes what's happening."