Published in February 2019 TulsaPeople Magazine
(http://www.tulsapeople.com/Tulsa-People/February-2019/Why-is-adolescent-suicide-on-the-rise-in-Oklahoma/)
Oklahoma adolescent suicide rates are outpacing increases nationally. Local agencies and professionals lend their expertise to this tough issue that doesn’t discriminate.
Adolescent suicide is growing at an alarming rate in Oklahoma.
Suicides among ages 10-24 in the state have increased 41 percent since 2006, compared to a 33 percent increase in the youth suicide rate nationally for the same time period, Oklahoma’s 2017 Youth Risk Behavior Survey indicates.
It is the eighth leading cause of death in the state, and the second leading cause for ages 15-34, reports the American Foundation for Suicide Prevention.
According to the Tulsa Mental Health Plan, within Tulsa Public Schools, a suicide note is received from a student virtually every day.
Thoughts of suicide affect every aspect of a teenager’s life, from their social interactions to their ability to perform in the classroom.
It’s a difficult topic to discuss, but more common than the general public realizes. However, when communication and education are utilized, mental health professionals say suicidal thoughts are treatable, and suicide is preventable.
Oklahoma suicide facts and figures
Contributing factors to suicide
Mental illness, depression and other conditions that can lead to suicide are caused by a combination of factors, but the constant connectivity to smart phone platforms often is blamed.
M.J. Clausen, director of Oklahoma City operations for the Mental Health Association of Oklahoma says cyber bullying and a teen’s fear of missing out can contribute to teen suicide rates. “It is 24/7 and unrelenting,” she says. “The growth of social media is something that has significantly changed during the past 8-10 years.”
Access to today’s social media platforms is overwhelming and can create a superficial world where teens frequently compare themselves to others. “It doesn’t allow kids a break,” says Dr. Sara Coffey, assistant clinical professor of psychiatry and behavioral sciences at the Oklahoma State University College of Osteopathic Medicine. “With anonymous apps, kids can post something derogatory or hurtful to another student without holding themselves accountable.”
On the other hand, Coffey says it’s important to remember social media with parental oversight can be beneficial in helping teens connect with peers in a positive way. “We want to make sure that it’s healthy and adaptable to kids rather than harming.”
Inside the walls of a classroom, Ebony Johnson, Ed. D., executive director of student and family support services at Tulsa Public Schools, says students vulnerable to suicide sometimes are heightened by an interaction with another student or an adult or an internal conflict that no one else can detect.
“When it comes to trauma, we attribute a lot of what the student is going through to something they’ve experienced in their life,” she says. “Whether they’ve witnessed certain things as children or young adults, the behaviors caused by that trauma are exhibited at school.”
These Adverse Childhood Experiences, known as ACEs, are mentioned in a 2018 report on the state of Tulsa’s mental health, prepared by the Urban Institute and funded by the Anne and Henry Zarrow Foundation.
Titled “Prevention, Treatment, Recovery: Toward a 10-Year Plan for Improving Mental Health and Wellness in Tulsa,” the document discusses how “ACE rates among Oklahoma’s children are among the worst in the nation.”
According to the Urban Institute, one in six Oklahoma children has had multiple ACEs such as “witnessing domestic violence, substance misuse or mental illnesses within a household; having an incarcerated family member; being affected by household separation or divorce; and experiencing various types of abuse or neglect, by the time they are 19.”
Johnson and her colleagues at TPS contributed to the Tulsa Mental Health Plan and are optimistic about the laser focus the City of Tulsa and the state of Oklahoma are placing on mental health awareness. “We’re finding that working collectively is where we’re seeing the most benefit,” she says.
As a result of the plan’s findings, the Zarrow Foundation has committed to working with TPS to better understand how to go forward. It’s called Healthy Minds: Enhance Children’s Mental Health System Project.
Though inadequate treatment often is due to low funding, Clausen says Oklahoma’s landscape also factors into a high suicide rate. Consistently, for all ages, Tulsa and Oklahoma counties stay below the state suicide rate, according to data from the Oklahoma Department of Mental Health and Substance Abuse. In 2017, Tulsa County had a rate of 18.1 suicides per 10,000, and Oklahoma County had a rate of 15.5. The state average for 2017 was 19.2.
“Although we (the state of Oklahoma) have a nationally recognized telemedicine program, we are spread out, so people are isolated in rural and non-metro areas,” she says. “It’s difficult for people to get the treatment they need.”
Mental illness that leads to a suicide attempt does not discriminate. According to Clausen, Oklahoma’s suicide rate has increased by 37 percent since 1999, affecting residents from every walk of life. Children and teens in both public and private school environments are equally susceptible to these health challenges.
“It doesn’t matter what background you come from. It happens to all races and classes of people,” says Robin LeBlanc, president of the Oklahoma chapter of the American Foundation for Suicide Prevention. “Depression and mental health is not selective. It happens to whomever, whenever, however, and it’s nothing to be ashamed of.”
PDF: Tulsa’s 10-Year Mental Health Plan
Seeing the signs saves lives
Recognizing a child or teen in distress is critical to getting them the help they need as quickly as possible.
In a school setting, students dealing with deep-seated mental health issues or trauma exhibit behavior much different from those who are anxious or agitated from stress associated with a typical day, such as homework.
Johnson says one indicator is when students struggle with adult-student relationships. “They have a hard time with trust, or it’s the opposite and they seek out relationships with adults that can become co-dependent,” she says.
Other signals to watch for include a child appearing uncomfortable in a group or lacking the ability to transition to the next activity, especially for those in early childhood development classrooms. “They may become attached to one thing and have a tough time when there’s a substitute teacher because of attachment and abandonment issues,” Johnson says.
Students who pace around or walk aimlessly in an agitated or distressed state should raise concern as well as children and teens who are not sociable.
Those who are extremely emotional or who display more aggressive behavior than a typical student also might be experiencing emotional distress.
“Some students can be pretty pessimistic and not see a lot of hope, depending on their background,” Johnson says. “Other students have had unfortunate sexual encounters, so sometimes they may act out and try to exert that behavior on others.”
Youth affected by a disruptive life at home, previous ACEs or mental illness sometimes react more on impulse because they lack the ability to manage their metacognition, the ongoing thoughts we have with ourselves that help us gain insight into how we learn and create successful ways to overcome things we perceive as a challenge.
Amanda Bradley is senior director for Community Outreach Psychiatric Emergency Services (COPES), a program of Tulsa’s Family and Children’s Services. She says children exhibiting mood swings or getting too much or too little sleep are indicators of mental health issues that can coincide with a teen’s rash decision-making behavior. “It’s important to recognize impulsivity because they don’t have the ability to regulate those emotions yet,” she says.
Asking the tough question
As a licensed mental health professional, Bradley oversees COPES, a 24/7 free mobile crisis program serving Oklahomans in psychiatric crisis.
She routinely dispatches with a COPES unit and has experience communicating with teens in distress. “The first thing to do is recognize how brave they are to be reaching out for help and (to explain) that you want to be there to help them,” Bradley says.
Many families are unaware of the struggles their children or adolescents face, so it is crucial to assure them that help is available to initiate and navigate those difficult conversations.
Once a COPES team determines the risk of the individual in crisis, decisions are made to deploy immediately to the location or call emergency services — whatever is needed to stabilize the situation as quickly as possible.
In October 2018, Bradley says 221 children in crisis sought the assistance of COPES. Approximately 40 percent of the calls COPES receives are suicidal. “We have the ability to have conversations not only with the individual in crisis but also another member of the family,” she says.
When children and young adults express signs of emotional distress not typical of behavior for their age, a teacher, coach, counselor, parent or friend must ask the tough question: Are you having suicidal thoughts?
“With adolescents, it’s so important to take every threat or statement or warning sign seriously,” Clausen says. “It is very difficult even as a mental health professional, but we always just want to ask it straight out and allow the person time to say yes or no. Then, you go from there (in terms of getting that individual the help they need).”
Bradley at COPES says it is critical to pose the question in a way that is accepting of what the teenager is feeling so that they trust you to share their thoughts.
“You don’t want to overreact or underreact to the information they’re giving you,” she says. “Be open to just listening and thinking about their feelings and what actions they’ve taken.”
Besides COPES, many other hotlines are available to call or text for immediate action and resources. Dialing 9-1-1 also is an option, along with taking the person in crisis to an emergency room. On school grounds, Johnson says every school leader at TPS is given protocols and safety plans for students who run from the classroom or off school grounds when they’ve experienced a traumatic issue. The district also offers de-escalation strategies and training, prioritizing the safety of not only the student in distress, but the other students in the classroom.
“At the district level, teachers can request a behavior interventionist if they are concerned about a student’s extreme behavior,” she says. “We reach out back to the teacher with immediate support.” TPS administrators can become aware of a student in distress through a number of sources: a teacher, classmate, parent or the student themself.
What schools do to keep kids safe
Upper elementary and high school students having suicidal ideations or experiencing other emotions such as panic attacks can meet with one of the TPS licensed social workers on-site. School counselors and leaders are trained on how to handle the situation and provide resources, including calling COPES.
In a large school district like TPS, Johnson says administrators understand the importance of additional resources to: 1) determine how to directly support students in crisis situations through a tracking system, 2) support teachers and staff members working directly with students and 3) make sure the family of a student in crisis is involved every step of the way and referred to mental health agencies and other wraparound support services.
The district currently is consulting with mental health professionals and specialists across all age ranges for trauma-informed practices. TPS also is exploring training programs that support the mental wellbeing of teachers. Johnson says a teacher care line has been established at TPS for novice instructors who seek support for professional learning, support for troubling classroom behavior and mental health referrals for the teacher themself.
TPS also is working with CASEL — Collaborative for Academic, Social and Emotional Learning — thanks to a Wallace Foundation grant, to develop social and emotional learning opportunities.
Once urgent needs are met and a child or teen is no longer in immediate danger, treatment or therapy are viable options to help him or her improve their mental health long term.
Coffey says medication certainly plays a role, but therapy is the first and foremost recommendation.
“Studies show therapy combined with medication, more specifically for adolescents, can be helpful,” she says. “It’s really important there’s a therapeutic component in treating kids’ depression and suicidal tendencies.” Mental health professionals are available, but not every school site has dedicated, embedded mental health staff. The district works with several outside mental health agencies to address student needs.
Training and prevention: What you can do to help
In addition to the hotlines and response teams called in emergencies, the general public is encouraged to take advantage of free training programs available statewide that help people talk to their friends, relatives, coworkers and others in times of crisis.
The Mental Health Association of Oklahoma offers suicide prevention training, free of charge, focused on three actions: Question, Persuade and Refer.
“QPR is similar to CPR in terms of training people in the community,” Clausen says. “It’s about educating people to ask the question directly while busting the myths surrounding suicide.”
Training also involves understanding how to be mindful and respectful of others when talking about suicide or reporting suicide to the media. A separate training for media professionals is available.
“It can be tempting when we lose celebrities to death by suicide to sensationalize it a little and cover details around the method used, but that’s been shown to increase the risk of more deaths by suicide,” Clausen says. The phenomenon is called suicide contagion, and is usually higher among adolescents than adults.
Other key components of suicide prevention in teens include monitoring their behavior on social media and the internet as well as the elimination of accessible lethal means such as firearms and medications — both prescription and over-the-counter.
“If a family member has a concern of depression or suicide, guns should be away from the child, out of the home and locked up,” says OSU’s Coffey.
Ongoing research offers long-term insights
Local health organizations are dedicated to reducing Oklahoma’s adolescent suicide rate, but much more work lies ahead. Addressing suicide on a unified national or international level will highlight the need for further research and resources.
The Laureate Institute for Brain Research currently is conducting multiple studies related to anxiety and depression in local residents, currently enrolling ages 13-15 and 18-55. A 10-year study is already underway for ages 10-12.
LIBR’s mission is to discover causes of and cures for mood, anxiety and other neuropsychiatric disorders, so there will always be new studies focusing on anxiety and depression. The studies adapt and evolve as more is learned to help narrow down either pathophysiology of the disorders or work toward treatments and cures. LIBR is currently enrolling subjects that are experiencing any anxiety and/or depressive symptoms (medicated or unmedicated, formal diagnosis or not) as well as subjects with no history of psychiatric symptoms.
“While each individual study has its own specific aims and goals, the general goal of all of our work is to bring to bear a multidisciplinary research program aimed at illuminating the pathophysiology of neuropsychiatric disorders,” says Florence Breslin, adolescent manager of clinical assessment and testing at LIBR. “(We work) to develop novel therapeutics, cures and preventions to improve the well-being of persons who suffer from or are at risk for neuropsychiatric illness and to foster collaboration among scientists, clinicians and institutions engaged in research that enhances wellness and alleviates suffering from mental illness.”
Mental health professionals agree that with education and treatment, suicide is preventable. The stigma it carries is slowly disappearing as people learn to talk about the topic. The idea that mentioning suicide to someone will cause suicidal thoughts is a myth. Coffey says people must recognize that mental illness is not attributable to a moral failing or bad parenting.
“We know that mental illness is really a brain disease just like asthma is a lung disease,” she says. “If you see something, say something. If we’re not talking about it, then we’re not able to address it in a way that is going to be most therapeutic.”
Dispatching help with COPES
Community Outreach Psychiatric Emergency Services (COPES) is a free, confidential crisis line and mobile crisis service available 24/7 to children and adults in suicidal crisis and emotional distress. Calls made to the National Suicide Prevention Lifeline as well as the Youth Crisis Mobile Response Line from a 918 area code ring to COPES.
Senior Program Director Amanda Bradley says at least three individuals are answering the phones at all times, dispatching calls to mobile teams in the field. “On any given day, we typically have somewhere between three to four mobile teams responding all over Tulsa County,” she says.
COPES has the unique ability to quickly triage calls and determine how best to stabilize a situation in the least restrictive environment possible. “We truly walk with them on their darkest day to help them see there is hope,” Bradley says.
COPES reports it receives the highest number of kid-related calls for those age 13. Bradley says COPES has a high success rate of helping children and their families avoid a trip to the hospital and identify long-term treatment.
In one instance, COPES received a call from a counselor at Newman Middle School in Skiatook. The student, Chyann DeClue, was talking to a girl in India through an app, and the Indian girl said she was getting ready to end her life by taking medications.
COPES began advising DeClue on what to say to the girl. At the same time, COPES made calls to India (35 in total) to find local responders. They even spoke with the U.S. Embassy in India to reach the right people who spoke the girl’s Chin dialect.
As a result of efforts in Oklahoma, the girl in India did not attempt suicide. She was able to discuss the situation with her family and still communicates with DeClue to this day.
Suicide Prevention Resources
Emergency:
National Suicide Prevention Lifeline
1-800-273-TALK (8255)
Community Outreach Psychiatric Emergency Services (COPES)
fcsok.org/services/crisis-services
918-744-4800
Crisis Text Line
Text: 741741
Call 9-1-1
(can ask for a CIT officer – Crisis Intervention Team)
Additional Resources:
Suicide Prevention Resource Center
American Association of Suicidology
American Foundation for Suicide Prevention
Mental Health Association of Oklahoma
(offers QPR trainings)
Oklahoma Chapter of the American Foundation for Suicide Prevention
afsp.org/chapter/afsp-oklahoma
Laureate Institute for Brain Research
laureateinstitute.org/ongoing-studies.html
Open Arms Youth Project,
a youth center that supports the LGBT community
openarmstulsa.com, 918-838-7104
Dennis R. Neill Equality Center, Tulsa
The Trevor Project,
many programs, including a 24/7 helpline for LGBT youth in crisis
thetrevorproject.org, 866-488-7386
