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Palo Alto community, school leaders react to CDC recommendations

Agreement, criticism greet youth-suicides report

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.

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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:

Resources: How to help those in crisis

Guest opinion: How to help those in crisis

Q&A about mental health: Local experts offer their advice, guidance

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Follow the Palo Alto Weekly/Palo Alto Online on Twitter @PaloAltoWeekly and Facebook for breaking news, local events, photos, videos and more.

Comments

26 people like this
Posted by Lousy Work
a resident of Midtown
on Jul 15, 2016 at 8:24 am

Lousy Work is a registered user.

The CDC's report looks more like an brief overview than an in-depth research report! Very shallow, revealing nothing anyone didn't already know, obviously this report was completed in haste! No interviews with parents and friends of victims; it is easy to see that this was a very haphazard report written by researchers who either lazy, didn't believe in their project, incompetent, or all three.

Complete waste of time and money to come to no real conclusion at all!


5 people like this
Posted by Palo Alto Parent
a resident of Barron Park
on Jul 15, 2016 at 12:30 pm

This "online suicide-prevention training too;" purchase is concerning if not alarming...The only way to learn and teach children is to do so in human life situations. This kind of automated platforms using apps, tools perpetuates the virtual world. I feel like we are being duped once again by the hand that feeds us. Just like the text-book industry has done in the past. Here is reality I am concerned with:
"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."


7 people like this
Posted by Parent
a resident of Palo Alto High School
on Jul 15, 2016 at 1:28 pm

This is how I see it.

Our teenagers are under stress, I get that. It is nothing new for teenagers to have stresses. What is new is that nowadays suicide is talked about so much that it now seems like a way out. Now don't get me wrong. I think a lot of teenagers probably look at their problems and yes suicide does cross their mind. It has to. It is talked about all the time. It is put there by every article and every assembly and every teacher diplomatically talking about stress in school. However, just because it crosses their minds it doesn't mean they are considering suicide. Let me say that again, they are not considering suicide as an action they want to take, but it is there as an option which is there but they don't want to take. Every teenager who says they have contemplated it is actually a teenager who has rejected that option. Every teenager who says that they have thought about it, is really saying yes I thought about it but I didn't want to take that step so I am still here struggling with the stresses and hoping to find a way out that doesn't involve that step. I reckon the majority of those who consider it are not really contemplating ending their lives, but are screaming for help.

I was a teenager once. I had stresses. I didn't know anybody who had committed suicide and I didn't have any assemblies, but it did cross my mind every time I thought I couldn't go on. I had a couple of plans. But, I always rejected that idea because of two things. It was something I really didn't want to do. I wanted a life. I knew that if I could just stick it out my life would probably get better. I knew that suicide wasn't just a solution but a life sentence. The other reason I rejected it was because I had some adults in my life - not family and not school related - who cared about me. I had things in my life each week that made life bearable. I knew that I could count the days until the weekend when I could stop feeling so stressed about my problems and spend a few hours being accepted and by not being challenged about academics or family issues. I knew I could for a few hours a couple of times a week just forget my problems.

These two reasons kept me sane. These two reasons kept me alive. These two reasons helped me to get through my teenage years. These two reasons are what I remember most about how I got through my stresses.

I am shocked when I read reports like this but I am not surprised that teenagers look on suicide as an option. Look at it this way, all those people are now people who rejected that option. We should be helping them to keep it this way, not bombarding them with labels of mental illness, but look on those who have survived suicidal thoughts.

I don't for a minute think of myself as someone who was depressed, or had a mental illness. I do think of myself as someone who went through those teenage years with very little self worth, very little understanding and plenty of stress.

I would much prefer to see today's teenagers being able to value themselves and their lives as being worth while. I would prefer to see them valuing their successes rather than chasing for what may or may not seem to them to be unattainable. I would prefer to see them with some hours a couple of times a week to be carefree and happy with something enjoyable to do that doesn't involve challenge or college readiness. I would prefer that they are valued for who they are and the kind of people they want to become rather than what the society around them wants to perceive them to be in the future.

From reading this report I see Palo Alto teenagers to be fairly typical of teenagers today. Of course they think about suicide. It is hard for them not to think about suicide. They know directly or indirectly someone who has committed suicide. It can't escape their notice that suicide is forever and suicide causes problems to those who love and know those who have taken their lives. What we must do, I think, is to let them see beyond their stresses and make them see the good in their own lives and the benefits they have. We must help them to see that their stresses are only temporary and with the help of others and with openness and honesty, they can find a something in their lives that will help them to deal with the stresses they think of as unsurmountable.


9 people like this
Posted by District Teacher
a resident of Midtown
on Jul 15, 2016 at 1:37 pm

I did the QPR training about five (six?) years ago and I am sorry to say that, from that training, I feel ill-prepared. It took about 15-20 minutes and I remember thinking, 'Really? *This* is the training?!' It felt like someone in an office somewhere checked off a box in order to say the training is complete. Needless to say, there is work that needs to be done...


13 people like this
Posted by Marc Vincenti
a resident of Gunn High School
on Jul 15, 2016 at 3:07 pm

Marc Vincenti is a registered user.

Friday afternoon, July 15

It's sad, and upsetting, and depressing, when a group of strangers comes to your town to “study” a rash of deaths, gather statistics with an eye toward advising you on your crisis--and then in the opening sentence of their report to you omits one of your departed teenagers as if she hadn't existed.

But so it is in the body of the CDC's preliminary report, which for some reason omits 18-year-old Sarah Riojas, who had attended both Gunn and Paly, and who, as duly reported by the “Weekly,” died in January of 2011--the sixth fatality in our first suicide cluster.

The CDC report mentions just five.

Ms. Riojas died. Her family wept; the church was packed. It happened. Next to me in the pew an elderly Hispanic woman, sad-eyed, leaned close and whispered, "Teenagers…" She shook her head. "They take everything like it’s the ending of the world."

Surely Sarah’s family and friends would not want her forgotten.

What else has the CDC missed? Practically everything that is real and human and important. Their team has no shared history with this town, visited for only two weeks, obtained reams of data--and talked at length, in depth, and confidentially with practically no one.

They did not investigate the lives and deaths of our ten (now eleven) departed children, nor talk in detail with their friends or families, teachers or tutors or coaches--although the proponents of the study shy away from mentioning this limitation.

In all likelihood the CDC's team has not been called upon to offer a single Kleenex to a single distraught human being--as our community’s dedicated therapists and teachers and parents and teenagers and police officers have had to do for years, listening despite their own sadness.

What else is not on the CDC’s radar?

Our high schools, not in their personnel, not in the devoted staff who work there, but in their regimens and conditions include what the CDC might well add to their litany of "risk factors": overcrowded classes; the emotional inroads into the school-day of social media access and preoccupation; homework and AP workloads un-moderated by sensible school-home communication; relentless grade-reporting required by the District; and sky-high rates of cheating countenanced by the District.

Certainly it's plausible that kids who experience all of the above--in combination every school-day for four of the most intense years of human development--are at some amount of higher risk for taking their own lives.

Maybe in time for its final report, due out this fall, the CDC can expand their care and attention--to every single one of our departed teenagers and to the daily school conditions endured by every single one of the living.

Sincerely,

Marc Vincenti
Gunn English Dept. (1995-2010)
Campaign Coordinator
Save the 2,008 (savethe2008.com)


7 people like this
Posted by Gunn parent
a resident of Gunn High School
on Jul 15, 2016 at 5:02 pm

Does the cdc report take into account the number of kids who have been hospitalized for suicidal ideation? It seems like those numbers are pretty high and quite relevant as well.


Like this comment
Posted by amen
a resident of Fairmeadow
on Jul 15, 2016 at 8:10 pm

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.


4 people like this
Posted by anne
a resident of Another Palo Alto neighborhood
on Jul 17, 2016 at 8:11 am

The greatest factor of the ones the CDC identified (causing mental distress and suicidal thinking in the 30 days prior, see end of report) was physical illness including breathing problems that led to missed work/school. Physical illness.

Not only is this concerning in terms of how well our district deals with sick students - in my observation, not well - it highlights one of the biggest as yet completely unaddressed but fixable factors. There are proven and well researched ways to reduce illnesses in students and staff, that our district does not yet do.

PAUSD, compared to the other districts, had the largest percentage of kids who checked physical illness as a factor, including breathing problems. Which reminds me, according to the data collected by the National Council on Teacher Quality, the average number of days absent for our teachers makes them "frequently absent". This is a big red warning flag that the physical environment needs consideration, too. The CDC did not seem to have an environmental scientist on the team who could bridge the gap in understanding between mind, body, and environment, and who understands the environmental science.

There are well-researched, proven ways to reduce physical illnesses going around school and absenteeism related to illness. It's not rocket science, there is a huge consensus in environmental science. The EPA publishes a toolkit for schools, that is used by about half the schools in the country, proven to tangibly reduce illnesses and absenteeism among students and teachers, and improve student performance. Our district administration has resisted adopting such best practices, saying that it's "too much paperwork". Studies show that when district administrators are not on board, the adoption of plans is not enough, they aren't usually implemented to good effect. The district needs the support and call from the community to do this. Parent volunteers can make a big difference, too.

Now that we know for sure that physical illness is a major factor, surely we can pull together to accomplish something already specified in the facilities bond (but not done) that is proven to reduce that factor?

Although the EPA's toolkit us designed to help even if districts don't have funds, since the district facilities bond specifications called for improving the environment in just that way, but nothing really was done, if we need funding, it can come from the facilities bond. In many ways, addressing these factors is easier and more straightforward than many of the mental health measures (which needed doing, too, don't get me wrong).

When are we going to start treating our kids like whole people whose minds AND bodies are connected? Our teachers would likely benefit, too.


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