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A Silent Epidemic
Killing myself seemed like the best option. When I still felt sad though
―everything in my life was going right‖ (Breel). When I exposed the deep crimson of my
bruised heart on my wrists (butter knife, bad night) – and then on my face – for the world
to see, and nobody noticed. Killing myself seemed like the best option. Frozen. Stuck on
a ledge looking down at train tracks, somewhere mixed up in death and indifference. At
thirteen, I was suicidal. But I was lucky. Somehow while I waded through school day
after day, an angel had the courage to speak up on my behalf, make public a condition, an
illness, of which I was previously wholly unaware. In 2010, when I was thirteen, 38,364
Americans took their own lives (CDC). Suicide is currently the 11
th
leading cause of
death in the United States, placing it above homicide, ranked 15
th
(―Suicide Facts‖).
Among Americans aged 15-24, suicide is the third leading cause of death (―Suicide
Facts‖). Andrew Solomon, a renowned writer on politics, culture, and psychology, has
described depression, suicide’s strongest risk factor, as ―the secret we share.‖ Suicide is
powerfully destructive and ubiquitous – and also powerfully preventable. In order to
decrease the incidence of teenage suicide, high schools must take action to better
recognize, treat, and prevent the development of depression and suicidal thoughts in their
students.
Suicide prevention in teenagers must begin by effectively pinpointing students
most at risk for suicide: those who exhibit telltale signs of mental illness. The Long
Island Crisis Center – a local organization that offers crisis intervention, counseling,
information, referral, and other supportive services primarily through a 24/7 telephone
hotline and live, online counseling – published a notice entitled ―What to Do If You
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Know Someone Who is Suicidal.‖ Even from its title, this notice fails to address various
characteristics of the mentally ill, thus rendering it ineffective, especially in the context of
adolescents. A study conducted by Owens et al. determined that prior to suicide, many
severely depressed individuals encounter ―difficulties in communicating distress‖: they
don’t ―give out clear distress signals,‖ and instead demonstrate ―emotional illiteracy‖ (3).
Furthermore, the study identified ―excessive quietness‖ and ―emotional detachment‖ as
key signs of suicidal ideation (3). These observations emphasize that suicidal teenagers
are usually too psychologically inept to make public their internal struggles. Though the
Long Island Crisis Center leaflet proposes that friends of suicidal people ―take every
threat of suicide seriously‖ and ―ask directly‖ about depression and suicide, following
that advice is ineffectual especially for teens unlikely to reveal emotional instability to
their peers or teachers. To circumvent the faulty communication often associated with
depression, high schools should pursue a more rigorous approach. TeenScreen, a mental
health screening program developed at Columbia University, is the nation’s most widely
used mental health screening program for teenagers, ―with more than 450 active
screening sites in 43 states‖ (Conte et al. 200). TeenScreen’s success can be partially
attributed to its flexibility – the program offers three different screening questionnaires to
meet the needs of various types of institutions (Conte et al. 201). Moreover, TeenScreen
does not support mandatory screenings or screenings lacking parental consent and thus
does not coerce students reluctant to be screened. According to David Shaffer, M.D., the
head researcher behind TeenScreen, this policy encourages students to ―develop
psychological self-awareness‖ and demonstrate their emotions ―truthfully and
effectively.‖ In 2005, 122,000 students were offered screening through TeenScreen, and
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approximately 55,000 students actually participated. Though this figure represents less
than half of the total number of students exposed to TeenScreen, those demonstrating
mental illness (about half) were referred to psychologists and psychiatrists for treatment
(Conte et al. 202).
In order to prevent student suicides, high schools must do more than merely
identify at-risk students; faculty and administration must work together to provide
effective, accessible treatment options. One such option is a crisis hotline: designed and
widely used since the 1970s, telephone-based crisis hotlines have provided time-tested,
immediate emergency telephone counseling since the mid-1970s (National Suicide
Prevention Lifeline). This service may be effectively applied to high schools – especially
with the recent advent of text messaging-based hotlines that cater better to teenagers’
technologically driven lives. Even when a ―teenager is in public,‖ he/she can seek
counseling quickly and discreetly (Kaufman). A student or teacher-run text hotline could
allow teens in distress to seek emotional support while maintaining ―crucial privacy,‖
giving them the power to express pain even if they ―feel threatened by someone near
them‖. Furthermore, students anxious about revealing their identities to peers or faculty
through their voices on the phone can find refuge in the increased ―anonymity‖ provided
by text messaging (Kaufman). In high school classrooms, teachers can take a more
involved approach toward dealing with potentially suicidal students. After they have
successfully identified students at risk through classroom and one-on-one discussion
(Conte et al. 185), they can choose to employ a variety of neglectful tactics including
―avoidance‖ of the topic, ―overreaction,‖ and inappropriate ―encouragement of further
disclosure‖ (Conte et al. 187). A study conducted by Jason R. Randall, PhD in the
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republic of Benin observed that in high schools where suicide threats were openly
discussed among students and teachers, teen suicide rates were reduced 26.2% compared
to the national average (Randall). Well-prepared, responsible teachers must have the
insight to recognize a student in danger. But even more, they must have the courage to
bring the issue to the attention of school psychologists, social workers, and administrators
so the student can receive help. Schools should have extensive emotional health services
for student use, but when this is ―not an option due to funding,‖ high schools must be
ready and able to ―refer at-risk students to mental health professionals‖ outside of the
school system (Conte et al. 188).
Though much can be done to prevent teenage suicide as the problem develops,
primary intervention at the high school level is often too little too late. Action must be
taken with younger students to expose them to the reality of depression and equip them
with tools to maintain good psychological health throughout their high school years. As
children develop into adolescents, their brains learn to solve cognitive problems quickly
and effectively by strengthening highly used white matter tracks (neuron pathways
carrying signals) in the brain (Dwivedi). An emerging hypothesis about suicide
pathogenesis described by Dr. Yogesh Dwivedi at the University of Illinois College of
Medicine states that the development of depression and suicidal thoughts involves
―altered plasticity of neuronal pathways.‖ Dwivedi proposes that depression and suicide
result from the brain’s ―inability‖ ―to make appropriate adaptive responses‖ to
environmental stimuli – especially crises – by altering its white matter tracks to make
new connections and cope with new circumstances. (Dwivedi). This state is exacerbated
by the immaturity of the teenage brain: the prefrontal cortex (the brain’s decision-making
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center) is not fully myelinated (insulated for fast signal transmission) until age 25
(Dwivedi). Combined, these factors provide a picture of an adolescent brain unable to
reason through depression and seek help when necessary. Early intervention can help.
Early familial risk factors including substance abuse, physical or verbal abuse, and
divorce have been identified (Randall). These should be utilized to pinpoint at-risk
students early on. According to a study in the New England Journal of Medicine
conducted by Richard A. Friedman, PhD, ―half of all serious adult psychiatric illnesses
start by 14 years of age.‖ Since students enter high school at 14, action needs to taken
earlier to prevent suicides in high school. Friedman suggests implementing ―mental
health screenings‖ in middle or even elementary schools in order to catch problems early.
Moreover, the aforementioned classroom discussions about suicide should be applied to
middle and elementary schools as well – and then followed up with strong, courageous
teachers willing to speak out about the at-risk students they encounter (Conte et al. 185).
High schools must take action to end the ―silent epidemic‖ that is teenage suicide
(Friedman). Students need networks of teachers, administrators, and mental health
professionals to provide support during times of emotional adversity. With the help of
early screening, exposure, and classroom discussion, high school students can also learn
to find hope from within, allowing their understanding of the sensitive topic of suicide to
embolden them to seek professional intervention. High schools – and middle and
elementary schools – need to implement policies that tackle teenage suicide head-on. And
fast. Teenage suicide rates are on the rise, fueled by the influence of technological
communications (Randall). If we are to make significant headway with this global
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―epidemic‖ in the years to come, there must be a change in global mindset. Together, we
can breed the endurance and acceptance to end teenage suicide. Answer the call to action.





















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Works Cited
Breel, Kevin. "Confessions of a Depressed Comic." TED. N.p., Sept. 2013. Web.
26 Feb. 2014.

Conte, Christopher, et al. Suicide. Ed. Paul Connors. Detroit: Thomson Gale, 2007. Print.
Current Controversies.

Friedman, Richard A. "Screening Teenagers Can Help Prevent Teen Suicide."Suicide.
Ed. Jacqueline Langwith. Detroit: Greenhaven Press, 2008. Opposing Viewpoints.
Rpt. from "Uncovering an Epidemic—Screening for Mental Illness in
Teens." New England Journal of Medicine 355 (2006): 2717-2719. Opposing
Viewpoints in Context. Web. 13 Feb. 2014.

Kaufman, Leslie. "In Texting Era, Crisis Hotlines Put Help at Youths' Fingertips." The
New York Times 4 Feb. 2014, U.S.: n. pag. nytimes.com. Web. 10 Feb. 2014.

National Suicide Prevention Lifeline. SAMHSA, n.d. Web. 12 Mar. 2014.

Owens, Christabel, et al. ―Recognising and responding to suicidal crisis within
family and social networks: qualitative study.‖ British Medical Journal 10.1
(2011): 1-9. Pubmed. Web. 25 Feb. 2014.

Randall, Jason R., et al. "Suicidal Behaviour and Related Risk Factors among School-
Aged Youth in the Republic of Benin." PLOSone 9.2 (2014): n. pag. Pubmed.
Web. 11 Feb. 2014.

Solomon, Andrew. "Depression, the Secret We Share." TED. N.p., Dec. 2013. Web.
26 Feb. 2014.

What to Do If You Know Someone Who Is Suicidal. N.p.: Long Island Crisis Center,
2013. Print.

"Suicide Facts." SAVE: Suicide Awareness Voices of Education. SAVE:
Suicide Awareness Voices of Education, n.d. Web. 26 Feb. 2014.

"Suicide Prevention." CDC. CDC, 9 Jan. 2014. Web. 26 Feb. 2014.