Editor's note: Resources for any person who is feeling depressed, troubled or suicidal are listed at the bottom of this article.
For a community that has done much soul searching in the wake of two youth suicide clusters over the last eight years, the findings of a Centers for Disease Control and Prevention report on the subject released Friday are sobering, but not surprising.
The value of the report, experts and community leaders said in interviews with the Weekly, is to provide an endorsement of efforts already underway, a roadmap for work going forward and a reminder of the importance of work yet to be done to prevent youth suicide in Palo Alto and Santa Clara County.
"This report does not identify a silver bullet that is somehow unique to this community or this school district," said school board Vice President Ken Dauber. "What I think it does do is to remind us that this problem is not in the past and that we need to continue to make this issue a top priority, even as the most recent cluster fades from our memory.
“We can't let that urgency slip away,” he said.
At various levels of the community, leaders and experts said the report will be used to inform critical suicide-prevention and mental-health efforts.
For the Palo Alto school district, it affirms work already in place or planned while also pointing to gaps to be addressed. Among the existing efforts: programs that connect cohorts of students with teacher-mentors for all four years of high school, social-emotional education at all schools, the opening of wellness centers on campus, student efforts to reduce the stigma around mental health, and evidence-based programs like Sources of Strength, which trains students to become peer leaders on mental health.
But more, district leaders said, can be done, including ensuring improved access to mental health services on campuses, better evaluation of existing programs to determine their effectiveness, and awareness of the common precipitating factors for suicide, among others.
Terry Godfrey, president of the school board, said she will be looking for specifics in the report to help guide the district's work to address these gaps, such as how to reverse the trend of young men being less likely to receive treatment for mental health problems and resources for evaluating the effectiveness of programs.
Dauber said he will continue to push for action on areas that impact student well-being that the school district has control over, like implementing its homework policy, reducing project and test stacking, and looking for "innovative" ways to increase access to quality school-based mental-health services. (He said he's in conversations with Stanford University providers and the district about having practitioners on campus, paid for by students’ insurance.)
Godfrey said she's also eager to see the results of the latest Developmental Assets survey in Palo Alto, referenced in the CDC report, which was last conducted in 2010. The new survey results are due out later this month, she said.
The school board is tentatively scheduled to discuss the CDC report as part of a larger student-wellness discussion in mid-April, Godfrey said.
Gunn High School senior Chloe Sorensen, who has spearheaded mental health efforts at the school and served on a community coordinating committee for the CDC investigation, said she hopes the report will encourage continued conversation around teen mental health.
Despite progress made — for example, Gunn's new wellness center is increasing awareness about available support services, she said — stigma and access hinder some teenagers from seeking and receiving help.
"A lot of kids still don't feel comfortable accessing these resources even if they are accessible," she said. "There's a lot to be said for having more conversations about mental health."
Vic Ojakian, a former Palo Alto mayor who became a staunch suicide-prevention advocate after his college-aged son died by suicide in 2004, criticized a preliminary report released by the CDC last July as too broad and even counterproductive. But on Friday he said he was pleased to see a more extensive, useful final report.
The report addressed the phenomena of suicide contagion (the CDC said that there is "limited scientific evidence supporting the hypothesis that suicidal behavior is contagious" and given that, the term should be used with caution) and clusters and included information about hospitalization rates, among other data points, he noted.
Now is a time to redouble evaluation efforts, Ojakian said, to carefully examine what's working and what isn't at both the county and local level. The report recommends continuous evaluation to better understand if programs and policies are actually changing behavior and reducing youth deaths by suicide.
Local health care providers said they were heartened to see gaps and at-risk populations they are already working to address given visibility in the report.
The CDC found, for example, that deaths by suicide were more common among 20-to-24-year-olds in Santa Clara County. Michael Fitzgerald, director of mental health and addiction services for El Camino Hospital in Mountain View, said its intensive outpatient program for this age group is in high demand and providing critical support to an age group that, unlike high schoolers, can have weaker ties to family and peers.
Similarly, the Stanford Center for Youth Mental Health and Wellbeing is working with agencies across the county to open two youth mental-health centers that would serve 12-to-25-year-olds in need of support for everything from a bad relationship breakup to severe mental illness. Common precipitating factors among deaths by suicide in Santa Clara County included relationship problems with an intimate partner and school-related behavioral issues as well as diagnosed mental illness and release from a hospital or rehabilitation facility.
"One of the things ... that's important is the capacity to have crisis intervention support for people to have places to go in easily, even after something like a breakup ... to be able to easily walk in and get some support without it necessarily being perceived as a full-blown mental health related issue," said Steven Adelsheim, director of the Stanford Center for Youth Mental Health and Wellbeing.
The new youth centers will also help move Santa Clara County toward an integrated care model, Adelsheim said, with direct connections to primary care physicians who are ideally, as the CDC recommended, better trained to recognize early warning signs of mental distress.
The CDC report comes at a time when youth well-being collaborative Project Safety Net, formed in response to the first Palo Alto suicide cluster in 2009, is preparing to reboot itself with new leadership and a new structure. Mary Gloner, Project Safety Net's executive director, said the report's findings will inform the organization's priorities.
The report is also an opportunity for Project Safety Net to "encourage advocacy of more research" into the issues it identified, she said.
Project Safety Net plans to make available to local organizations and researchers the full data from a survey the collaborative conducted last year to provide fresh data to the Centers for Disease Control and Prevention, Gloner said. The results will also be presented in part at a forum on the CDC study on Wednesday, March 22, in Palo Alto.
At the county level, the Suicide Prevention Oversight Committee will use the report to refine its strategic plan, which addresses suicide broadly in Santa Clara County, according to Sara Cody, health officer for the Santa Clara County Public Health Department.
"It's a very well-referenced report — (there are) 175 different references and many link to recently published best practices or a single resource that will contain evidence and suggestions," Cody said. "What might be most helpful is that it's all in one place. It's like a reference document."
For some community advocates, the report's very existence is a signal of progress on a subject often stigmatized and silenced. In 2009, when Kathleen Blanchard's teenage son died by suicide in Palo Alto, she said there was a reluctance to even broach the topics of suicide and mental health.
"Now we invite the federal government in to bring expertise ... and we're open to that external, expert view as opposed to 'We know better and we can do it ourselves,'" she said Friday.
Another shift she is seeing: "The fact that we are not going to be afraid of the data."
"The data has its limits, but we will not be afraid to seek it and understand it and see where else we need data," Blanchard said.
Leaders, advocates and experts urged the community to appreciate the CDC report for what it is -- a description of a complex public-health issue with no single solution -- and as a call to action for the progress that remains to be made.
"I want people to understand that regardless of who writes what, we need to increase our level of awareness about suicide prevention and what is available," Ojakian said. "I hope the CDC report sensitizes people more. They shouldn't take the report as an end-all be-all, but the message, the takeaway for you if you're just an everyday person or a suicide preventionist like me is: We can do more."
Any person who is feeling depressed, troubled or suicidal can call 1-800-784-2433 to speak with a crisis counselor. People in Santa Clara County can call 1-855-278-4204. Spanish speakers can call 1-888-628-9454.
People can reach trained counselors at Crisis Text Line by texting 741741.
Links below provide more resources where one can receive help: