About PAUSD
Adult School
Board of Education
Committees
Complaint Policies
Educational Partners
Employment
Fees
Measure A
Palo Alto Drug and Alcohol Community Collaborative (PADACC)
Superintendent
Volunteer!
Youth Community Service
Home > Community > Superintendent's Message
Superintendent's Message

September 2, 2009

 





The following is excerpted from “Night Falls Fast” by Kay Redfield Jamison. The ellipses and quotations are shown as they appear in the book.

  1. For the moment, we know that some groups of individuals are much more likely to kill themselves than others: those who have previously made serious attempts; those who suffer from depression, manic-depression, alcoholism, schizophrenia, or personality disorders; patients who have recently been released from psychiatric hospitals; young men in jails or prisons, especially those who are mentally ill, isolated, or living in overcrowded spaces; police officers; gamblers; the unemployed;
  2. Schools, communities, and national governments have tried, in very different ways, to deal with the problem of suicide prevention in these high-risk groups, as well as in more general populations.  Results have been mixed.  Most school-based suicide awareness programs, though clearly well intentioned, have not been effective and, in some instances, have been inaccurate, misleading, and even damaging.  Some investigators report an improvement in children’s knowledge and beliefs about suicide and others cite a decrease in suicidal behavior.  Studies commissioned by the governments of Australia, Canada, and the United States have, however, questioned the utility of currently used programs designed to increase awareness about suicide and its prevention.  The Australian review, for example, concluded that the data “do not support the promotion of curriculum based suicide prevention programs, and certainly do not support the mandating of such programs in our secondary schools.”  Canadians, likewise, found “insufficient evidence to support curriculum-based suicide prevention programs for adolescents,” and a comprehensive American survey of youth suicide prevention programs found “no justification” to mandate such programs.
  3. An extensive and withering analysis of school-based programs, published a few years ago in The American Psychologist, focused on several specific criticisms:  Many curriculum-based programs are not clearly founded on current empirical knowledge of the risk factors of adolescent suicide.  By deemphasizing or denying the fact that most adolescents who commit suicide are mentally ill, these programs misrepresent the facts.  In their attempt to destigmatize suicide in this way they may be, in fact, normalizing the behavior and reducing potentially protective taboos . . . The incidence of adolescent suicide is sometimes exaggerated in suicide prevention programs because one of the programs’ goals is to increase awareness and concern about the problem . . . The danger of exaggeration is that students may perceive suicide as a more common, and therefore more acceptable, act . . . Magnifying the incidence of the problem is one indication that the developers of curriculum-based programs have not heeded the substantial literature on the imitation or contagion effect in adolescent suicide.  Another is the common use of print or visual media to present case histories of adolescents who have attempted or committed suicide.  The purpose is to teach students how to identify friends who may be at risk for suicidal behavior.  However, the method may have a paradoxical effect in that students may closely identify with the problems portrayed by the case examples and may come to see suicide as the logical solution to their own problems . . . Finally, at the most practical level, suicide prevention programs may never reach their target populations, adolescents most at risk for suicide.  Incarcerated and runaway youths, as well as dropouts, have extremely high rates of suicide.
  4. Other researchers and clinicians have criticized school-based programs for the diffuseness of the audience they aim to reach (all students, rather than those at highest risk), as well as the inaccuracy of the information given about suicide.  An in-depth study of 115 school-based suicide prevention programs for adolescents discovered that most of them were only two hours or less in duration and the majority of the programs focused almost exclusively on a “stress model” of suicide; that is a model that assumes suicide is a response to extreme stress and that in essence, given sufficient stress, suicide could happen to anyone.  Only 4 percent of the programs they reviewed presented the perspective that suicide is usually a consequence of mental illness.  Disturbingly, the reviewers also discovered that “students who indicated having made a prior suicide attempt (approximately 11% of the sample) reacted in a generally more negative fashion to suicide prevention curricula.  A greater proportion found the program less interesting or helpful, and were troubled by the program . . . [A] greater proportion of prior attempters who attended a program than attempters who didn’t attend said they would not want to reveal suicidal preoccupations to others, stated they did not believe that they could be helped by a mental health professional, and that suicide was a reasonable solution to problems.”
  5. The results of such programs, although discouraging, point out some of the difficulties that need to be resolved.  It is clear that the medical dictum of “First, do no harm” needs to be at the heart of any thinking about school programs designed to prevent suicide.  It is important, as well, that school administrations avoid romanticizing suicide and that they place the primary emphasis of their educational and screening efforts on recognition and treatment of mental illness and substance abuse.
  6. David Shaffer and his colleagues at Columbia University in New York have developed a promising program that systematically screens high school students for known predictors of suicide.  (There are no lectures given about suicide, and no responsibility is placed on teachers or students to “act like mental health professionals.”)  If, when a student fills out a brief self-report questionnaire, the responses indicated that he or she may be at risk, he or she then completes a computerized diagnostic interview.  The computer generates a diagnostic impression that is given to the clinician, who, in the third and final stage of the process, personally interviews the student.  On the basis of this interview, the clinician determines whether the student should be referred for treatment.  A case manager gets in touch with the parents if treatment is necessary and helps to facilitate follow-up care.

    The Columbia program has been very effective in locating students at risk for suicide and getting them into treatment.  (Of the students who were identified through the screening process as suffering from major depression, only a third were in treatment.  Of those who had actually attempted suicide, only half were receiving treatment.)  The screening system is now being used by more than seventy groups worldwide, including schools in South Africa and Australia, as well as in the United States.
  7. Community-based suicide prevention programs, such as the Samaritans in Britain and the Suicide Prevention Centers in America, have not had a demonstrable effect on suicide rates.  An early study suggested a possible lowering of the suicide rate in communities that maintained Suicide Prevention Centers, but virtually every study since has found little or no impact.  This lack of effect is counterintuitive in many ways, but not entirely surprising:  Suicide Prevention Centers and crisis hotlines, although very helpful to many people, tend not to be used by the most severely depressed or suicidal individuals.  Additionally, many suicides are impulsive, which generally precludes contacting anyone.  An analysis of the types of patients and callers to Suicide Prevention Centers suggests that the majority are in need of help but are not suicidal.
  8. Suicide prevention is not just a clinical problem.  Society must deal with the potentially infectious repercussions of suicide, especially among the young, and must somehow try to keep a single tragedy from progressing to deaths of others.  The contagious quality of suicide, or the tendency for suicides to occur in clusters, has been observed for centuries and is at least partially responsible for some of the ancient sanctions against the act of suicide.  Epidemics of suicide occurred among soldiers and citizens during Greek and Roman times, for instance as well as among worshipers of Odin in Viking society.  Occasionally, decisive action on the part of a leader prevented further catastrophe.
  9. There has been no shortages of suicide clusters in recent years: they have occurred in psychiatric hospitals and clinics; in suburban America—Plan, Texas; Leominster, Massachusetts; Clear Lake, Texas; Mankato, Minnesota; Bucks County, Pennsylvania; Fairfax County, Virginia; South Boston; New Jersey; South Dakota—and on college campuses (there were, for example, six suicides within three months at Michigan State University).  There have been suicide outbreaks in Alaskan Eskimo villages, on Canadian Indian reservations, in Japan, in England, and in virtually every country that keeps records of such death patterns.  Suicide clustering is primarily, but by no means entirely, a phenomenon of the young.  Its mechanisms are diverse and contested.  Imitation plays an important plays an important role, of course, but presumably a suicide disinhibits or triggers suicidal behavior only in an already vulnerable individual (in a study of two clusters of suicides in Texas, for example, one in which eight adolescents enrolled in the same school district committed suicide within a fifteen-month period and another in which six adolescents killed themselves within a two-to-three month period, those who committed suicide were more likely than control subjects to have had a history of suicide attempts, threats, and self-destructive behavior).  Implausibility also weighs in.  Adolescents often imagine that the attention or retaliation denied to them in life may come their way through death or that suicide is made more acceptable by its having been carried out by others more famous or accomplished.

Sincerely,
Kevin

Kevin Skelly, Ph.D.
Superintendent
 

Superintendent's Messages