What should we do when our children start killing themselves?
What do we say? What do we do?
Parents, the public, friends, media and mental health professionals have to wrestle with that question after the cluster of suicides and suicide attempts by teenagers in Woodstock.
It was simple to answer the question only 10 years ago.
What to do?
Shut up. Don’t talk about it.
Weighted under the shame society put on mental illness, families kept the suicides of loved ones a secret.
Worried by the mistaken belief that asking a teenager if they were suicidal would plant the idea, even health care advocates kept quiet.
Based on commonly-held beliefs about doing the right thing, some newspapers rarely wrote about suicides.
Based on the aim of driving circulation up, some newspapers wrote too much.
Turns out that neither approach by the media was doing anyone much good, mental health and suicide-prevention experts say.
Being quiet about suicide increased the stigma about mental illness that discouraged people from getting help and offering help.
Talking about it the wrong way glorified and simplified the act to the point it became a more attractive response for some people than the hard work of seeking help.
Over the past decade, the experts have laboured to change how we — public, family, friends, media — react to suicide.
The mantras now are: Talk more, but not too much, and not in the wrong ways.
That’s being repeated in the wake of the Woodstock suicides, especially because adolescents are involved.
“Teenagers are vulnerable to suicide contagion. They are becoming increasingly vulnerable because of social media,” said Dr. Sandra Fisman, chair of child and adolescent psychiatry at the Schulich School of Medicine and Dentistry at Western University.
“If you don’t manage the discussion about suicide, there is a risk of contagion.”
Contagion is real, she says.
A 2013 Canadian study, published in the Canadian Medical Association Journal, that examined data on more than 22,000 teenagers found evidence that the suicide of a classmate led to young people thinking more about suicide or attempting suicide themselves.
By age 16 or 17, 20 per cent of the teenagers knew someone who had taken his or her own life and 24 per cent had a schoolmate die of suicide.
The contagion effect hit younger teens especially hard, with 12- and 13-year-olds who had a schoolmate die of suicide five times more likely to think about killing themselves.
The dilemma facing media, and by extension everyone else, is how to talk about teen suicide without adding to the contagious effect.
Advocacy organizations, such as the Canadian Association for Suicide Prevention, have created guidelines for media to ward off glorifying or simplifying suicide.
The basics are simple: Don’t suggest one reason for a suicide, such as a break-up; don’t suggest there can be no explanation because the person had everything going for him; don’t romanticize the act by saying the person found peace or is with a loved one now.
These are fairly easy for media to follow. Some of the other guidelines are more problematic.
Don’t publish photos of the people who died. Don’t use suicide in a headline. Don’t put the story on the front page, or at least above the fold. Don’t write stories that make the suicide sound exciting or the person admirable
Those guidelines run counter to decades of tradition and journalists’ deeply-held belief that the dead are honoured through photographs and stories of their lives told by those who loved them. There is a bleak joke in journalism that every hard-core violent criminal who is killed was just about, according to family, to turn their life around. Media give voice to the grieving, and do not judge the perception of those grieving.
Mainstream media and suicide experts will continue to work out how to best report. The problem comes with social media.
“Social media is such a mixed blessing. Social media is such a wild frontier,” Fisman says.
No one can control the messages – either those that help or those that harm – teenagers give each other on social media.
“The management of social media has to take place in the home,” Fisman says.
It’s an old rule already, but a good one, she says: Know what your children, teenagers included, are doing and saying online. Talk to them about what happens in social media, she says.
The media and many others will move on from the Woodstock suicide story, but the community cannot.
The 2013 Canadian study on suicide contagion, by Dr. Ian Colman, Canada Research Chair in mental health epidemiology at the University of Ottawa, and Sonja Swanson from the Harvard School of Public Health in Boston, found that teenagers exposed to suicide are at risk of harming themselves long after the attention has faded.
“Schools and communities should be aware of an increased risk for at least two years following a suicide event,” they concluded.
Fisman looks at the response to the Woodstock suicides and doesn’t like what she sees.
It’s fine to say media should do this, parents should do that, teachers must learn this and mental health services must get better, she says.
What’s missing, though, is an organized response by everyone and every agency, Fisman says.
“We need to create that infrastructure, from the school right through to the hospital system. We need to be talking together,” she says.
“If you start doing this in isolation you don’t create a system where people talk to each other about prevention, resilience-building and early intervention. There is no one piece that is going to be the solution.”
Student wants versus reality:
Hundreds of Woodstock high school students walked out of class this week, saying more is needed to support young people in distress. How their wants stack up against what’s there and what’s realistic.
Want: Crisis beds at Woodstock Hospital, so young people don’t have to be sent to the nearest big city.
Now: No longer-term, in-patient services for teens at local hospital. Young people in crisis go to nearby London Health Sciences Centre’s mental health unit.
How realistic: With a massive network of advanced and specialized health care at London hospitals, little more than 30 minutes from Woodstock, it’s unlikely money would be available to duplicate those services for local teens.
Want: Mental health professionals in schools, available daily
Now: The Thames Valley District school board, with three public high schools in Woodstock, says full- time social workers already tend to high schools, and there is “extra support in the schools right now.”
How realistic: The public school board insists it’s covered; many of the kids disagree.
Want: Youth centre, a dedicated place to help kids de-stress and a safe place to discuss mental health.
Now: The Fusion Youth Centre in nearby Ingersoll is a shining example, but a quarter of its members — who pay just $5 a year — are from outside Ingersoll, including several dozen from Woodstock.
How realistic: Woodstock Coun. Shawn Shapton said the city is looking at the possibility of a youth centre — Ingersoll heavily subsidizes the Fusion Youth Centre — but for now, teens should seek out activities already in place.
“In the city we do offer a lot of facilities . . . We may not have everything under one roof, but we have a lot of options to offer our young people,” Shapton said, citing athletic programs and free outdoor fun.
Other agencies, such as the YMCA, are tailoring time for teens to use their facilities with friends.
Want: Resources accessible by cell phone
Now: Mind Your Mind, a London-based non-profit that works with youth to develop mental health resources, is working with support services in Oxford County to customize an app — available for Android and Apple, and called Be Safe — for local teens.
“Youth were co-creators on that project, and what they came up with was a tool that would help them find relevant resources in a crisis, and make a decision about what’s the best thing for them to do,” said Melissa Taylor-Gates, program manager of Mind Your Mind.
The Be Safe app is free to download, and includes tools to help teens plan for times of crisis — including where to go and who will take care of other tasks like watching pets while they’re out of commission — plus helpful tips and tricks like a “get help script” that can offer suggestions for what to say first when calling a help line.
How realistic: As soon as Mind Your Mind updates the resources to reflect Oxford County realities, the localized app will be live.
Want: Mental health courses in the school curriculum, including about suicide prevention.
Now: Ontario’s new health and physical education curriculum — the one that generated controversy over its sex education components — includes age-appropriate mental health information for all students, a spokesperson for Education Minister Liz Sandals said.
Here’s how that curriculum shakes down:
- Primary pupils learn how to talk about their emotions, the impact of staying active on mental wellness, and how important it is to develop positive relationships with kids and adults.
- Junior and senior elementary kids learn about coping with stress, how to reach out for help and
- High schoolers: Not much specific education for them. Teens learn about “warning signs and symptoms that could be related to mental health concerns,” Sandals’ spokesperson said in an emailed statement.
How realistic: Teachers have some flexibility, but changes to the school curriculum don’t come easily. And there’s no sign of a dedicated course to cover mental health and wellness, including delivering suicide-prevention curriculum to all students.
— Megan Stacey, Woodstock Sentinel-Review