In the wake of recent suicides on the Caltrain tracks, teen depression and school-related stress are under new scrutiny, as parents and students alike are taking a hard look at what can be done to turn things around.
The Mental Health Association of San Francisco hosted a round-table discussion in downtown Mountain View on youth-suicide prevention on April 1. The panel included three students from the Palo Alto Unified School District, which lost three high school students and one alum since October. A Mountain View teen's suicide in September caused the accidental death of the boy's father from exposure to a toxic blend of chemicals.
"It's really a tragic amount of death by suicide," said Eduardo Vega, executive director of the Mental Health Association of San Francisco.
Vega, who admitted to struggling with depression in his teens, told the audience of more than 40 parents and teens that there are ways to help students who are dealing with depression and thoughts of suicide.
"Nobody needs to die in isolation and despair," Vega said.
Vega advocated bringing a program called "Fire Within" to Palo Alto schools, which uses peer-support and entrepreneurship as tools to take on teen suicide. The goal of the program is to get high school students talking more openly about mental health and pinpoint the root causes of depression and teen suicide.
Fire Within was started by the Carson J. Spencer Foundation and is currently running as a pilot program at Mission High School in San Francisco.
Sally Spencer-Thomas said she started the foundation after her brother died by suicide 10 years ago while struggling with bipolar disorder and that she resolved to find a solution and get "upstream from the crisis of suicide."
Mental health programs, like Fire Within, are important for students struggling through depression, according to Nicole Plata, the youth initiative coordinator for the Mental Health Association of San Francisco, particularly for students who have been in and out of foster care or the criminal justice system. The problem is finding a program that actually works, Plata said, indicating that what Palo Alto schools have seen 11 current and former students die in the past several years.
"There's no reason, in the Bay Area, that people should be taking their lives," Plata said.
The key, she said, is to use peer counseling and get students to talk to each other and engage on an emotional level. She said the Fire Within program can get students certified to find fellow classmates at "high risk" and get them to the support services they need.
Plata said she suffered from Post Traumatic Stress Disorder (PTSD) in college and was able to cope through peer counseling offered through her church.
The Palo Alto students on the panel said talking to fellow students about depression and seeking emotional support from one another could be a helpful tool in dealing with the high stress environment and staving off thoughts of suicide, but so far peer academic pressure is having the opposite effect.
Milla Dzakovic, a Gunn High School student, said there's constant pressure to compete with classmates and strive for perfection and that students are always talking about grades and focusing on academic performance.
Dzakovic said the students at Gunn kicked off a campaign called "We're all in this together" to show support for each other, but that the movement feels shallow and not truthful to the climate at the school; that students are not "in it together."
"Personally, I don't feel connected to the school," she said.
Also on the panel was Carolyn Walworth, a Palo Alto High School student who wrote an opinion piece for the Palo Alto Weekly urging school and district administrators to take the issue of excessive stress seriously.
Walworth agreed that the pressure is coming from other students, and the workload they are expected to carry each school year eclipses opportunities to do non-academic activities because there's just not enough time in the day.
"We're not given that opportunity to do that; it's impossible," she said.
Turning ideas into action
If peer-counseling is an answer to coping with stress and depression, then some local parents are on track.
Trudy Palmer, a Palo Alto parent, has been working with school districts in both Mountain View and Palo Alto to focus attention on mental health services, including a program where students can talk to one another about their problems and have help readily available if they need it.
Palmer is in the very early stages of planning a peer-counseling program for teens at Los Altos High School and is enlisting the help of the Community Health Awareness Council (CHAC) in Mountain View.
Monique Kane, executive director of CHAC, said the organization is working with Palmer to brainstorm ideas for the program, which she said can be useful for getting help to students who would have otherwise fallen through the cracks.
"You pick up on kids that might never have been seen. Students who are sometimes really depressed," Kane said.
The idea is really more of a brainstorm at this point, Kane said, but it could look like an ongoing group program hosted in the school library, with a therapist present to mediate the group and carefully handle serious discussions on depression and suicidal thoughts.
For now, students struggling with school-related stress have been turning to the ASPIRE program at El Camino Hospital, an acronym for After-School Program Interventions and Resiliency Education.
ASPIRE is an intensive eight-week program in which students meet for several hours four days a week after school and go through "dialectical" behavior therapy to how to manage stress and control their emotions throughout the day, according to Michael Fitzgerald, executive director of Behavioral Health Services at El Camino Hospital.
The program started in 2010 in response to a spike in local teen suicides and has since built up a waiting list, Fitzgerald said.
"This includes kids from Palo Alto with severe suicide risk, so we feel like this program has made a big difference," he said.
The reasons for coming to ASPIRE vary widely, from a student whose biggest stress is a B grade to teens so overwhelmed with anxiety they can't even make it to school.
Enrollment in ASPIRE dives down in the summer, which makes it difficult to maintain the program at a larger capacity during the school year. But that might change as demand is increasing overall, Fitzgerald said, and recent months have seen a big increase in the number of students trying to get in.
Waiting lists are unfortunately par for the course in Santa Clara County, where adolescent mental health services are either minimal or nonexistent at hospitals. Fitzgerald said there are no hospitals in the county with an inpatient adolescent psychiatric unit, meaning if teens at risk of suicide need to be hospitalized, they are sent out of the county to either Fremont or San Mateo. Palmer said this is done with an ambulance at the family's expense.
El Camino Hospital's new behavioral health building is still years away from construction, but it could provide much-needed mental health services to teens in the area, Fitzgerald said. Early designs of the building include walls that can be altered to change how many psychiatric units are in the building, which could fit the fluctuating nature of mental health needs among teens throughout the year.
A worsening problem
Mental health providers in the Bay Area seem to agree that teen depression is getting worse.
Kane said students in the area have gotten "more severely depressed and anxious" in the last few years, and there's been an overwhelming demand for CHAC's mental health therapy services, particularly at the schools where CHAC provides one-on-one therapy to students.
Fitzgerald said the root cause for depression could change from kid to kid and that it's better to concentrate on co-factors -- things that may have contributed and added to stress and anxiety of students who ultimately died by suicde. He said only getting five or six hours of sleep a night probably doesn't cause a suicide, but lack of rest, increased stress, bullying and overuse of technology can all "go into that kid's decision."
Just as multiple factors contribute to teen depression, Fitzgerald said the problem is going to need to be addressed by multiple agencies, including schools, hospitals and families.
"We're going to work together with regional partners," Fitzgerald said. "Nobody is going to go at this alone. We really have to work together as a whole community."