Community Conversations to Inform Youth Suicide Prevention

As our youth suicide rate continues to be double the national average, more and more parents are starting to talk about it and ask questions. What can we do? How can we support our kids? What’s the solution?

The Attorney General’s office recently shared a study of 4 Colorado Counties. This document “Community Conversations to Inform Youth Suicide Prevention” has some good information to digest.

Below is the link to the full study, with some sections copied below (including recommendations) that we thought you’d like to read right away.

https://coag.gov/sites/default/files/final_youth_suicide_in_colorado_report_10.01.18.pdf?utm_campaign=COAGSproutSocialCampaign&utm_content=1546551468&utm_medium=social&utm_source=facebook,instagram,twitter

Pressure and anxiety about failing

The risk factor described the most consistently (more pronounced in El Paso, Mesa and La Plata counties) is pressure, mainly related to academic performance, but also in extracurricular activities. This included feeling that expectations placed on youth were unrealistic and youth were not given the tools to manage the pressure in a healthy way. Youth express that they are also managing information overload via the internet and social media, and other stressors such as school shootings, relationships and sex, divorce and substance use. Youth and adults across the four counties, but particularly in El Paso, Mesa and La Plata, expressed a belief that the time and opportunity for youth to learn or practice selfcare is lacking. Both youth and adults expressed that youth have no time to decompress and no break for their brains, especially with the current bell-to-bell instruction in most schools and the pace of extra-curricular activities.

Social media and cyberbullying

Another common theme around risk factors was the use of social media. Youth are described as always being connected to their phones, plugged into social media accounts or texting. Adults expressed concern that youth use of social media is limiting their face-to-face interactions with others, while also leading to exponentially more opportunities to be impacted by the emotional lives of their peers, making managing the spread of harmful information impossible. Youth expressed feelings of anxiety about the image that must be maintained on social media, and that mistakes they make feel magnified on social media. Of additional concern with social media and technology overall is cyberbullying. Youth and adults note that youth who are experiencing bullying at school cannot escape the harassment, as it continues after school hours on social media or via text messages. Finally, several participants said that the internet and social media give youth easy access to information, both positive and negative, about the world around them. Participants expressed that this can be both empowering and beneficial, but also exposes youth to content that is adult in nature or violent/disturbing, and youth lack the skills and support to consume such information in a healthy way. 

Lack of prosocial activities

Youth and adult focus groups across all four counties described a need to fund, increase and improve the social recreational activities provided to youth, and build awareness that prosocial activities can be protective against suicidal behavior in youth. Yet where these resources exist, there often are issues of access due to transportation or affordability. Again, by comparison a focus group participant in Larimer County stated that recreation centers were easy to access and made affordable to most youth.

Lack of connection to a caring adult

Youth participants across the four counties described a deep desire to have authentic relationships with adults. When it comes to discussing difficult topics, youth across all communities shared that they do not often experience these interactions as authentic or helpful. Youth are concerned that adults will “freak out” or overreact and not listen. They expressed a wish that adults could just be with them in their pain without jumping to assessments or solutions, but rather just trying to understand. Along this same vein, youth groups across each county expressed frustration that adults, most often parents, tend to minimize their problems and pain. Youth feel disheartened when adults tell them to “raise their voice” or speak up about issues that concern them, but then shut them down when they do raise their voice. When youth have established relationships with trusted adults, they reported they will go to those adults for support. However, building that trust requires time and a willingness and capacity to talk with youth about difficult subjects. The comparison community of Larimer County contrasted starkly with the focus counties related to this issue. Focus group participants described an established culture and set of practices around building strong youth-adult connections in the Poudre School District.

Judgment and lack of acceptance in the community

Many focus group participants expressed feelings that their community is not accepting of differences or is judgmental of those who do not fit with the dominant community norms. Youth explained that some people are afraid to be who they are, and that they are growing up in a culture of harsher judgment, belittling and a lack of acceptance, let alone tolerance. Of concern is the lack of community acceptance of youth who identify as LGBTQ+. Youth and adults described increased bullying of LGBTQ+ youth by both peers and adults within schools, a lack of response by schools and other youth-serving institutions, and routine, systemic isolation of these young people. Youth and adults also expressed finding hypocrisy where they feel values espoused by majority political and religious groups in some communities are not put into practice. In contrast, the focus groups in the comparison communities of Douglas and Larimer Counties did not express a sense of judgement or lack of acceptance as notable in their communities.  

Substance use, mental disorders and trauma history and availability of behavioral health care

Across all counties and groups, youth and caregiver substance use and abuse, as well as depression and anxiety, were commonly discussed risk factors contributing to suicidal behavior in youth. These behavioral health issues were described as generational in scope, yet because of stigma and challenges in accessing behavioral health care, they often go underdiagnosed and undertreated. It is difficult to access behavioral health resources – both in and outside of the school setting – and many focus group participants expressed frustration that while resources are available when there is an immediate crisis, they are more limited when youth seek help to prevent a crisis or when they have an ongoing need after a crisis.  Participants described a shortage of providers, long wait times and high staff turnover in community mental health centers. Some participants said there is greater availability of services for children and youth covered by Medicaid, but fewer options for those with private or no insurance. Acute Treatment Units or inpatient facilities are located a significant distance away. There was also some frustration with community mental health centers, such as a lack of communication between schools and providers, a lack of understanding about how the system works and what families should expect, and a perceived or real lack of follow up or aftercare plans. 

Adult suicide

Adult focus group participants in all four counties expressed that adult suicides are just as prevalent as youth suicides, but do not receive the same level of response or resources. Traditionally, youth suicide prevention and adult suicide prevention have been addressed somewhat separately. Focus group participants suggested that perhaps there hasn’t been enough attention placed on how adult suicides in the community are impacting youth, especially the risk that adult suicides are normalizing and modeling suicidal behavior

Factors that increase protection against youth suicide

Focus group participants described existing protective factors such as case management to help navigate support systems, trained school staff, community-based programs for youth to access and programs like Sources of Strength, an evidenced-based youth suicide prevention program. They also noted protective factors around access to prosocial activities such as sports, band and after-school activities in general. Participants in Pueblo, El Paso and La Plata counties reported that these activities are available, but there is a need for increasing access to them through things like registration fee assistance and/or transportation. They noted that groups not tied to academic achievement are also needed, as well as activities for youth who do not participate in sports or other school activities. Participants in Mesa County described limited availability to these types of activities which increase connectedness to more peers and caring, positive adults. Additionally, the natural environment surrounding the four focus counties was named as a protective factor, but with the caveat that access to things like hiking, camping, skiing and other outdoor activities can be expensive and hard to access. 

 

Training on how to help

The one theme that was the most consistent across all the focus groups in the four counties and comparison communities is whom youth turn to for help when they themselves are struggling – first and foremost, their peers. Yet in communities where the pressure to be successful is highest, youth participants said they go to no one for help. However, increasingly, when youth are worried about a suicidal friend, they do seek help from adults.

Youth are using Safe2Tell, which allows them to alert authorities when they believe someone may need help, but they said they are not likely to use a 1-800 help line and would be hesitant to utilize a text line (although this was a preferred resource over calling a help line) for their own needs.

Youth stated in many ways that they want to talk about these issues with someone they know and trust, although they would rarely turn to parents for help because they are worried parents will overreact, underreact or be disappointed if their child is depressed or needs help. Many of the parents said they feel unprepared to help their children if they are feeling suicidal or come to them for help with a friend who is suicidal. Youth also communicated that they do not feel equipped to help their friends, yet they want to help.

Both adult and youth participants feel that youth should be trained in suicide intervention. All group participants expressed concern with any suicide prevention classes or curriculum that are done only once, or over short segments with no sustained effort. Many youth noted frustration that some prevention activities seem to be mostly about adults looking like they are doing something to address the issue, but feel they are not really doing anything. They referred to this as putting a band aid on the problem and said they both want and need more than just band aids.

Youth want to learn how to ask about suicide, how to respond to someone in the moment and how to grieve and recover when there has been a loss. Additionally, youth and parents want to understand what will happen when they do seek help for suicidal thoughts – how to navigate the behavioral health system and what to expect.

By comparison, focus group participants in Larimer County noted that Poudre Valley School District trained every staff member in its schools and all incoming high school freshmen in suicide intervention using the Question, Persuade and Refer (QPR) curriculum. QPR is implemented as part of and in addition to a culture that supports ongoing relationship building and engagement between youth and adults.

Recommendations

The following recommendations are the result of HMA’s analysis of all data collected under this project, particularly the information gathered from community members through key informant interviews and focus groups. These recommendations are intended to be the start of a conversation about what state and local partners can do to address youth suicide in Colorado, and to increase alignment between and among programs at both levels. 

  1. Prioritize relationship building between adults and youth.
  2. Create a culture of support for youth in crisis/post-crisis.
    • Train parents, youth, community youth leaders and school staff to identify and respond to suicidal youth.
    • Prioritize support of teachers and counselors in the aftermath of a suicide death or attempt.
    • Establish and communicate clear policies and/or procedures for supporting students returning to school after seeking care for suicidal ideation or other mental health concerns.
        • Proactively develop and refine school protocols and policies to align with best practices
    • Create cross-agency coordination protocols to support youth in crisis.
  3. Implement programs or strategies that build resilience and coping skills.
    • Provide self-care lessons or activities for youth.
    • Teach youth interpersonal interaction skills and ways to better navigate a social media environment
  4. Increase access to prosocial activities and supportive environments
  5. Increase funding, length of funding periods, and flexibility of funds targeted to the primary prevention of youth suicide.
    • Support youth led initiatives.
  6. Leverage current public awareness campaigns to destigmatize getting help for mental health needs, including suicidal ideation.
    • Implement a social norms campaign communicating that suicide is not a normal response to problems or feelings of depression/anxiety.
    • Use social media to promote helping resources and messages of support and self-care.
    • Model open dialogue about suicide and mental health.
  7. Create coalitions of providers and foster relationships between providers and youthserving organizations.
    • Establish a practice to inform youth and parents/caregivers about next steps for youth referred for help about their suicidality.
  8. Train media professionals on how to cover suicide safely.