For many who work to prevent youth suicides and boost mental health in Palo Alto, the preliminary findings from the Centers for Disease Control and Prevention's ongoing investigation into local deaths by suicide affirm work that is already underway to better support youth in crisis. At least one staunch suicide-prevention advocate, however, is arguing that the report drew from too little data and makes recommendations too general for an issue that demands a high level of insight and understanding.
The Santa Clara County Public Health Department released this week a much-anticipated 32-page preliminary report with mostly countywide data on youth deaths by suicide, drawn from existing data sources.
The report's initial recommendations around suicide prevention -- to provide further education and training to those who work with young people; to target resources and outreach to populations that are at higher risk of dying by suicide, such as young men and LGBTQ youth; to decrease stigma around seeking help and increase access to quality support services -- affirm much of the work that is underway in Palo Alto, said mental-health experts, school-district leadership and other community members.
"I think it always helps to have data to back up the things you find important," Palo Alto Board of Education President Heidi Emberling told the Weekly. "You can read this data as things we knew, or you can read it as more rallying cries to support the things we're doing and the things that we're fighting for."
Education, awareness and access are all central to the CDC's early recommendations. Given the fact that the team of researchers found that many youth who died by suicide in Santa Clara County had experienced some sort of recent crisis, the report suggests that those who live, work and are in close contact with young people should be "familiar with signs of distress so they are able to recognize and intervene with a youth in crisis."
Superintendent Max McGee found this recommendation in line with what he's been urging.
"One of the messages I've been communicating early on, since the first death by suicide last year, was the importance of vigilance on everyone's part -- parents looking out for their kids, students looking out for one another," he said. "I was glad that that was highlighted."
McGee said the district has purchased a new online suicide-prevention training tool called Kognito, which simulates real-life situations between teachers, students, health professionals and others and might become required training for all district staff. The district currently requires teachers to complete Question Persuade Refer (QPR) training when they're first hired, with re-training every two to three years. The training offers an approach to confronting someone about possible suicidal thoughts, spelled out in the acronym: You first ask someone if he or she is considering suicide, persuade him or her to get help and then refer the person to resources.
The report points to relationships between students and teachers or other adults and school connectedness as "protective factors" against suicidal ideation.
"Enhancing relationships between youth and a teacher or another adult could provide opportunities to identify at-risk youth and provide ways for youth to seek help prior to and during a crisis," the report states. "Activities to enhance the relationship between youth and a teacher or other adult should be implemented in tandem with educational programs focused on recognizing warning signs for suicide and how to respond to a suicidal individual."
The report also indicated that many students who reported in a survey that they had seriously considered suicide had also missed school in the previous month. McGee said the district is in the midst of scrutinizing its attendance policy and practices around checking in on students who miss school.
School board member Ken Dauber lauded the report's statement that many different, complex factors contribute to youth suicide and thus require a multifaceted response at every level -- individual, school, community, county.
"It underlines ... the need to be making progress on many different fronts, from improving access of students to mental health resources to looking at opportunities to increase sleep, to building more connections between teachers and students," he said.
"We all need to identify the leverage points within the areas that we're responsible for and commit to making progress on them," he added. "We shouldn't let the fact that there's a broad range of issues here dissuade us from getting to work on the ones that we have control over."
Chloe Sorensen, a rising Gunn High School senior and one of two students on a community coordinating committee for the CDC investigation, said many student and school initiatives have been launched to address the very issues laid out in the report, from putting anonymous counseling referral boxes on both Gunn and Palo Alto High's campuses to organizing student and staff activities to running a student-newspaper series highlighting stories of emotional resiliency and recovery. The district is also creating wellness centers at both high schools and hiring new "wellness outreach workers" who will lead and coordinate wellness efforts.
"I think we have made a lot of progress and I don't think we should doubt that progress," she said. "We know these are the issues and we're doing everything we can to work on them."
However Palo Alto resident and former Mayor Vic Ojakian, who lost his college-aged son to suicide in 2004 and has spent the last decade-plus pushing for mental-health reform at both the local and state levels, criticized the decision to release broad-strokes findings and recommendations before the research team's investigation is even completed.
"In some ways it feels like its a gloss-over, thrown together here and there," he said.
Ojakian also questioned some of the report's data and "limited" sources. Because the CDC researchers only looked at youth who died in Santa Clara County, a number of deaths of local youth occurring out of the area were not considered, Ojakian said. He also suspected that the rates of youth died by suicide who had a recent crisis, had an existing mental-health condition or received psychological treatment were underreported given the researchers drew this information from coroner's reports, which might not necessarily include the above information if it's not available.
He also criticized the report's recommendations as too broad and even unproductive.
"We need to have them relate back to tangible things that we can do because the goal isn't to pat ourselves on the back that we collected some data. The goal is to save lives," Ojakian said.
Others are using the report to make their own connections. To Stanford Medicine child and adolescent psychiatrist Steven Adelsheim, director of the university's new Center for Youth Mental Health and Wellbeing, the report offers guidance for efforts he's leading to increase early access to mental-health services for young people. He is spearheading a plan to open at least two stand alone youth mental-health centers in Santa Clara County with the goal of making it comfortable -- even cool -- to seek help, whether it's for a breakup, problems at school or something more serious.
Specific findings from the report, such as the fact that young men in Santa Clara County are at higher risk for suicide and are less likely have received treatment, will help to tailor the new mental-health centers to meet local needs, Adelsheim said.
Mary Gloner, the new executive director for Project Safety Net, a collaborative of more than 40 community organizations who work with youth, similarly said the report will help inform the group's focus and priorities.
Many who read the report were heartened to see that Santa Clara County's youth suicide rate is not out of the norm but rather close to and in some cases even below local, state and national rates. The report also analyzed 2013-14 survey data that shows Palo Alto Unified high school students reported lower rates of suicidal ideation and serious mental distress than young people in three other Santa Clara County school districts.
The comparisons "put a stake in the heart of the notion that there is something about Palo Alto, that there's something in our drinking water," Ojakian said.
Dauber, however, said these comparisons should not be reason for the community to rest on its laurels.
"The least productive thing we could do with this report is use it as evidence that we don't have to do more than we're already doing," he said.
Any person who is feeling depressed, troubled or suicidal is urged to call 1-800-784-2433 to speak with a crisis counselor. People in Santa Clara County can also call 1-855-278-4204.
People can also reach trained Crisis Text Line counselors by texting "HELLO" to 741741.
Links below provide more resources where one can receive help: