If it takes a village to raise a child, it also takes a village to save one.
Two new laws aimed at destigmatizing mental health and preventing youth suicides will take effect in schools this year, but experts say laying a better path for young people requires a "community approach."
In Oregon, suicide is the second leading cause of death among young people age 12 to 24.
Data from a 2017 Oregon Healthy Teens survey shows that roughly 18% of high school juniors and nearly 17% of eighth graders reported they had seriously considered suicide in the past 12 months. For LGBTQ youth, the prevalence is even higher.
In 2019, the parents of a teen who took her own life, backed by advocates from Basic Rights Oregon, lobbied state lawmakers to do something about that.
The call to action came in the wake of high school student Adi Staub's death. Staub, who came out as transgender during her sophomore year, died in 2017. Her parents noted she often was misgendered, sometimes intentionally, and despite expressions of self-destructive thoughts, the gravity of her suicidal ideation went unnoticed by her peers and teachers at school.
In response, Staub's parents fought for schools to adopt more robust protocols for recognizing suicidal behavior. The result was Senate Bill 52, known as Adi's Act.
Adi's Act requires Oregon schools to develop "a comprehensive district plan on student suicide prevention for students in kindergarten through grade 12."
The prevention plans must include methods to address "high risk" groups like homeless students or those experiencing trauma, students of color, those with disabilities, mental illness or substance abuse problems, and lesbian, gay, bisexual, transgender (also known as LGBTQ) youth.
"The tragedy of a completed suicide may be compounded by suicide contagion, wherein the rate of others' suicidal behavior increases in the aftermath of a suicide, or by clusters, wherein the rate of completed suicides within a time, place or community increases," an April 19 letter to the Legislature from the Oregon School Psychologists Association states. "Adi's Act offers a concrete path to address these problems, and school psychologists act as key players in the development and implementation of effective, research-based suicide intervention plans."
Student health centers, which often are staffed by counties or partner agencies, play a large role in delivering primary care and mental health counseling to students.
Suicide Prevention Lifeline: 800-273-TALK or text HELLO to 741741. Chat online here
Tracy Garell is the senior manager for direct clinical services with Multnomah County's mental health division. Garell is all too familiar with the statistics among young populations she serves.
"We know about one in five children or youth experiences a mental health disorder or concern during their childhood and adolescence," Garell said. "When you look at suicide rates, we don't have great data because we don't really know if all of the deaths by suicide are actually being categorized as such. And we know that people don't always share that they're having thoughts of suicide because of stigma."
It's those statistics that led youth counselors to start conducting suicide screening on every student who comes in for mental health services. Garell said counselors have a three-pronged approach to addressing the issue: Suicide prevention, intervention and what they call "post-vention," to address grief after the suicide of a friend or loved one. In Portland, schools also use their own form of screening tools, when they suspect a student may be struggling or at-risk.
But the solutions shouldn't rest entirely on the shoulders of schoolteachers or counselors, Garell said.
"I really see it as being the whole community needs to come together," she said. "I think it's really important, particularly at the high school and middle school years ... and for parents and family to know what to look for."
What can I do?
Warning signs and behaviors associated with suicidal ideation are fairly vast. The National Institute of Mental Health lists behaviors such as:Talking about wanting to die, or wanting to kill one's self. Talking about feeling empty, hopeless or having no reason to live. Making statements about being a burden to others or feeling unbearable pain. Extreme mood swings. Saying goodbye to friends and loved ones, making a will, or giving away important possessions. Making plans or looking for ways to kill themselves, such as searching for lethal methods, stocking pills or buying a gun.
The institute offers five action steps for helping others in emotional pain:
1. Ask, "Are you thinking about killing yourself?"
2. Keep them safe by reducing access to lethal items or places.
3. Be there. Listen carefully and acknowledge their feelings.
4. Help them connect by offering a suicide prevention number or resource.
5. Stay connected by following up and staying in touch after a crisis.
Statewide, the rules around implementation of Adi's Act will rely on directives from the Oregon Department of Education.
Each school district soon will be expected to create and adopt a suicide prevention plan in order to be compliant with state laws around Division 22 Standards for Public Elementary and Secondary Schools.
The state is trying to help with that, by providing districts with model policy and "exemplar plans" through regional education service district partners, says Jeremy Wells, education specialist for ODE.
Those plans are being developed with heavy input from the Oregon Health Authority, Alliance to Prevent Suicide and Basic Rights Oregon.
"These are not ODE-approved plans," Wells cautions. "What these are, are exemplar plans that meet the essence of the law, that were written for school districts with their partners. The hope is that we have a good sample of small, medium and large school districts that submit exemplar plans to the Oregon Department of Education."
Mental health days
As Adi's Act was making its way through the Legislature, so, too, was a bill to expand the definition of sick days for Oregon students, allowing them to claim mental health days off from school if needed. After lobbying from teens, House Bill 2191 was signed into law in June.
Former Sandy High School student Derek Evans was one of the teens who pushed for HB 2191.
Evans told a Pamplin Media Group reporter that, as a student, he often struggled to balance school, homework, school athletics and extracurricular activities.
"I had a lot on my plate, and it ended up being a lot more than I could handle," Evans said. "Some days my mom would call me out with a cold when I could've taken a mental health day. Every time I went back I felt better and more focused."
While some questioned whether allowing students to miss more school is the right solution to addressing adolescent mental health issues, others have praised the move.
"For students who are experiencing mental or health issues, we think it's going to be helpful," said Ken Struckmeier, executive administrator for middle schools in the Beaverton School District.
Struckmeier said before the new law, schools had a varied approach to student absences.
"The goofiness we had with the previous policy is it was variable from school to school whether the staff had interacted with the family, and whether the staff would construe a mental health day as being important enough to (count) as an excused absence," Struckmeier said.
"That actually is really counterproductive, and so it is much better to be crystal clear on the front end about expectations so that we can have a dialogue."
If parents are honest about the reason for the absence when they call a school, there's a better chance the student can be connected with counseling services or support, he said.
"I think the vast majority of our kids want to be here every day," Struckmeier said. "The data suggests this is not going to open Pandora's box in terms of attendance, but for kids in mental health crisis this could be a thing that saves lives."
Current student services
While school districts wait for guidance from ODE on Adi's Act, at least one district has responded by bolstering its mental health team.
Amy Ruona of Portland Public Schools said a new, full-time staff member recently was hired, who will be able to help PPS sharpen its focus on suicide prevention and reaching students who historically have been at higher risk for suicide.
"We already have suicide prevention curricula available to schools. Our work now is to make sure it is culturally responsive and accessible to all students," Ruona said, referring to the need to consider the diverse backgrounds of all students and include knowledge of their experiences and belief systems.
PPS also is looking to expand access to mental health services for its students. By the end of the school year, Ruona estimates the Portland district will have some form of on-site mental health service at least one day a week in about 70% of its schools-tripling what it had five years ago.
"Adi was one of our students," Ruona added. "We feel very passionately about this work. We want to continue to build upon what's already in place. I want to make sure we're getting more staff trained. We all need to come at this. It's not just a school counselor (responsibility). This is a community challenge."
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