DOCUMENT RESUME

ED 265 485 CG 018 809

TITLE Federal Role in Addressing the Tragedy of Youth

Suicide. Hearing before the Subcommittee on- Juvenile

Justice of the Committee on the Judiciary. United

States Senate, Ninety-Ninth Congress, First Session

on Adequacy of Current Federal Research and

Prevention Efforts and the Role of the Office of

Juvenile Justice and Delinquency Prevention in Youth

Suicides.

INSTITUTION Congress of the U.S., Washington, D.C. Senate

Committee on the Judiciary.

REPORT NO Senate-Rrg -99 -250

PUB DATE 30 Apr 85

NOTE 106p.

PUB TYPE Legal/Legislative/Regulatory Materials (090)

EDRS PRICE MF01/PC05 Plus Postage.

DESCRIPTORS *Adolescents; Conflict Resolution; *Government Role;

Hearings; High Risk Persons; Human Services;

Intervention; *Prevention; *Suicide; Youth

Programs

IDENTIFIERS *Congress 99th

ABSTRACT

This document provides witnesses' testimonies and

prepared statements from a Congressional hearing on the roles of the

federal government and of the Juvenile Justice and Delinquency

Prevention Office in preventing youth suicides. Opening statements

are included from four Senate committee members and statements are

given by the Assistant Secretary for Human Development Services of

the Department of Health and Human Services, and by the Deputy

Director for Special Projects and the Chief of the Suicide Research

Unit from the National Institute of Mental Health. Testimony is also

included from the president of the American As3ociation of

Suicidology, the cochairperson of the National Committee for Youth

Suicide Prevention, and the director of the Youth Suicide and Crisis

Prevention Center of San Mateo County, California. The incidence of

youth suicides, its possible causes, and ways of identifying possible

victims are discussed. Suggestions are made for recognizing suicidal

youth and for reaching out to prevent suicide on individual,

community, and national levels. Current research efforts are detailed

and allocation of additional funding for research is urged.

Legislation declaring June 1985 as Youth Suicide Prevention Month is

included. The seriousness of the problem and the need for national

attention to and programs for the problem are emphasized throughout

this document. (ABB)

***********************************************************************

* Reproductions supplied by EDRS are the best that can be made *

* from the original document. * ***********************************************************************
S. HMI 99-250

FEDERAL ROLE IN ADDRESSING THE

TRAGEDY OF YOUTH SUICIDE

LC%

CO

4- HEARING in BEFORE THE .0 SUBCOMMITTEE ON JUVENILE JUSTICE cV

cz

14.1 COMMITTEE ON THIi1 JUDICIARY

UNITED STATES SENATE

OF THE

NINETY-NINTH CONGRESS

FIRST SESSION

ON

ADEQUACY OF CURRENT PEDERAL RESEARCH AND PREVENTION EFFORTS AND THE ROLE OF THE OFFICE OF JUVENILE JUSTICE AND

DELINQUENCY PREVENTION IN YOUTH SUICIDES

APRIL 30, 1985

Serial No. J-99-21

Printed for the use of the Committee on the Judiciary

lib

a U.B. DEPARTMENT OF EDUCATION

NATIONAL INSTITUTE OF EDUCATION OD EDUCATIONAL RESOURCES ItCORMATION

CENTER IERICI OD i['This doct nent has been reproduced as v--t received iom the person or organization Q originating it

i: Minor changes have been made to improve

CD reproduction quality C.)

Points of view or opinions stated in this document do not necessarily represent official NIE

position or policy

U.S. GOVERNMENT PRINTING OFFICE

50-321 0 WASHINGTON : 1985

2 BEST COPY AVAILABLE
COMMITTEE ON THE JUDICIARY

STROM THURMOND,

CHARLES McC. MATHIAS, JR., Maryland

PAUL LAXALT, Nevada

ORRIN G. HATCH, Utah

ALAN K. SIMPSON, Wyoming

JOHN P. EAST, North Carolina

CHARLES E. GRASSLEY, Iowa

JEREMIAH DENTON, Alabama

ARLEN SPECTER, Pennsylvania

MITCH McCONNELL, Kentucky

South Carolina, Chairman

JOSEPH R BIDEN, Jz., Delawar_

EDWARD M. KENNEDY, Massachusetts

ROBERT C. BYRD, Weet Virginia

HOWARD M. METZENBAUM, Ohio

DENNIS DeCONCINI, Arizona

PATRICK J. LEAHY, Vermont

HOWELL; HEFLIN, Alabama

PAUL SIMON, Illinois

DENTON W. SHED, Chief Counsel and Staff Director

DIANA L. WATERMAN General Counsel

DEDORH G. BERNSTEIN, Chief Clerk

MARE H. Grryarzni, Minority Chief Counsel

SUBCOMMITTEE ON JUVENILE JUSTICE

ARLEN SPECTER, Pennsylvania, Chairman

JEREMIAH DENTON, Alabama PAUL SIMON, Illinois

CHARLES McC. MATHIAS, JL, Maryland HOWARD M. METZENBAUM, Ohio

MITCH McCONNELL, Kentucky

NEAT. S. MANNE, Counsel and Staff Director

LAURIE Wzsmzv Minority Chief Counsel

. r. li Y'-q)0
CONTENTS

OPENING STATEMENTS

Page Denton, Hon. Jeremiah, a U.S. Senator from the State of Alabama 1 Simon, Hon. Paul, a U.S. Senator from the State of Illino's 7 Specter, Hon. Arlen, a U.S. Senator from the State of ?ennsylvania, chair- man, Subcommittee on Juvenile Justice 7

McConnell, Hon. Mitch, a U.S. Senator from the State of Kentucky 8

CHRONOLOGICAL LIST OF WITNESSES

Hardy, Hon. Dorcas R., Assistant Secretary for Human Development Services, Department of Health and Human Services; and Larry B. Silver, M.D., Deputy Director for Special Projects, National Institute of Mental Health, accompanied by Dr. Susan Blumenthal, Chief, Suicide Research Unit, National Institute of Mental Health

Cantor, Dr. Pamela, president, American Association of Suicidology, Chestnut

Hill, MA; Heidi Bilodeau, Boston, MA; and Charolotte P. Ross, cochairper- son, National Committee for Youth Suicide Prevention, director, Youth

Suicide and Crisis Prevention Center of San Mateo County, CA

9

52

ALPHABETICAL LISTING AND MATERIALS SUBMITTED

Bilodeau, Heidi: Testimony 68 Cantor, Dr. Pamela:

Testimony . 52 Prepared statement 55 Hand Gun Safety Guidelines, from the Police Executive Research Forum 58 Denton, Hon. Jeremiah:

Letter from Mrs. Glenn B. Handley 3 Text of S.J. Res. 53 5 Hardy, Hon. Dorcas R.:

Testimony 9 Prepared statement 12 Ross, Charolotte P.: Testimony 69 Silver, Dr. Larry B.:

Testimony 20 Prepared statement 22

Facts About: Teen Suicide, from the American Psychiatric Association 34 Budget for NIMH research on youth suicide 51

APPENDIX

Statement of Dr. Constance E. Clayton, superintendent of schools, School District of Philadelphia 75 Letter from Senator Denton, to Senator Specter 79 Proclamation issued by Governor George Wallace designating June 1985 as "Youth Suicide Prevention Month" 80 State bill H. 284"Alabama Youth Educational Guidance and Suicide Pre- vention Act 81 Letter to Senator Specter, from Glae D. Dickert 92

Excerpts from a State Plan for the Prevention of Youth Suicide in Florida 95

III)
FEDERAL ROLE IN ADDRESSING THE TRAGEDY

OF YOUTH SUICIDE

TUESDAY, APRIL 30, 1985

U.S. SENATE,

SUBCOMMITTEE ON JUVENILE JUSTICE,

COMMITTEE ON THE JUDICIARY,

Washington, DC.

The subcommittee met at 10:05 a.m., in room 226, Dirksen

Senate Office Building, Hon. Jeremiah Denton presiding.

Present: Senators Specter, Simon, McConnell, and Metzenbaum. Staff present: Neal S. Manne, chief counsel; Michael Russell,

counsel; Tracy McGee, chief clerk; Vic Maddox, office of Senator McConnell; Rick Holcomb, office of Senator Denton; Laurie Westley, office of Senator Simon; Steve Ross, office of Senator Metz- enba am.

OPENING STATEMENT OF HON. JEREMIAH DENTON, A U.S.

SENATOR FROM THE STATE OF ALABAMA

Senator DENTON. This hearing will come to order.

Good morning, ladies and gentlemen.

Senator Specter, the distinguished chairman of tne Subcommittee on Juvenile Justice, has been delayed unavoidably this morning. He has asked, therefore, that I call the hearing to order in his absence.

I will make some brief opening remarks and then recognize other members, and I want to welcome at this time Mr. Simon, the distinguished Senator from Illinois. I will recognize other members of

the subcommittee for their opening statements as those members arrive.

I would like to commend Senator Specter for his leadership in

calling attention to the nationwide tragedy of youth suicide. Today's hearing, as well as the hearings conducted during the 98th Congress, forcibly addresses the phenomenon of children taking

their own lives.

American children, adolescents, and young adults are killing

themselves in ever-increasing numbers. The rate of suicide has in- creased more than threefold in the last 20 years and is still continuing to rise. In my own home State of Alabama, the rate of sui- cide has increased 122 percent during the same time period. This year alone, more than 5,000 young Americans can be expected to

take their own lives.

(1)

5
2

Suicide now trails only accidents and homicides as the leading

cause of death for people between the ages of 15 and 24. Even

younger children experience problems which lead them to commit suicide. According to a report prepared by the National Center for Health Statistics, during a 13-year period ending in 1978, there were almost 2,000 documented cases of suicide among children

under the age of 14.

In Alabama, according to information provided by the Alabama Department of Public Health, bureau of vital statistics, 256 chil- dren took their own lives during a 10-year period ending in 1983. Preliminary figures from the bureau estimate that 27 young Ala bamians committed suicide in 1984. One of those tragic deaths in- volved a young student at the University of Alabama, Nix Handley, who shot himself on June 23, 1984. In a letter to me, dated March 20, 1985, Nix's parents detailed the agony which they suffered as a result of their son's death.

Without objection, I will place a copy of the letter in the hearing

record at the conclusion of my statement. The statistics to which I have alluded unfortunately represent only the tip of the iceberg. Some experts estimate that the actual number of suicides among young people is at least four times great- er than is reported. Recent studies indicate that more than 2 million high school students attempted suicide last year.

Youth suicide is a phenomenon that is so perplexing, contradicto- ry, frightening and troubling that our Nation avoids addressing it. As individuals and as a nation, we refuse to believe that young

people emerging from childhood can feel the degree of sadness, hopelessness and despair that leads to suicide.

Inaction and walls of silence serve only as barriers to solving the problem. As a caring Nation concerning about the future of our young people, we must try to help. The children we have already

lost to suicide include some of the best and brightest of their gen- eration and the erstwhile hope for our future. Youth suicide is a problem of nationwide scope and can only be solved through the

combined efforts of individuals, families, communities, organizations and Government to educate our society about what can be

done.

We have not identified the precise cause of youth suicide but in

raising seven children, helping raise eight grandchildren, and by meeting with children in discussion groups and teams, I have come

to realize that some of the major causes are self-evident. The subcommittee conducted a hearing last week in which juvenile arsonists were asked why they had reached a point of despair which motivated them to commit arson, and in the two cases that were heard before the subcommittee, both were angry at the fact that

their parents had recently divorced.

In other hearings I have attended, I have heard testimony on the

tremendous trauma associated with divorce, trauma in the minds

and hearts of the kids. My own parents split up. I am not blaming

either one of them for any great trauma that I experienced. Yet, today we do have a family breakup rate in the United States which

is unprecedented, and which I think is not coincidently linked to

the problem of youthful suicide.

6
3

I hope that by calling attention to the problem of youth suicide, we will be motivated to find those partial solutions and help in the

tragedy.

Thank you.

[The letter and a copy of Senate Joint Resolution 53 follow:]

Luverne, AL, March 20, 1985.

Hon. JEREMIAH DErrrox, Jr.,

U.S. Senator, Hart Senate. Office Building, Washington, DC.

DEAR Smyrna DENTori: I received a copy of your letter today in interest of the

increasing rate of suicide among our youth. I want to thank you for introducing S.J. Res. 53, a Joint Resolution to designate the month of June, 1985, as "Youth Suicide

Prevention Month". My husband, Glenn, and I are so interested in anything that can be done in making everyone aware of this overwhelming tragic problem. On June 23, 1984 (only 9 months ago), our youngest son, Nix, age 22, shot himself

in the head in his apartment at the University of Alabama. Never regaining con- sciousness, he died 3 clays later on rune 26th. He was a fine loving son, a promising

amiable young man, and a senior in Geology who was to have received his degree

this past December. All of the clues or symptoms that we are told are usually

present have failed to appear in Nix's situtation. We have yet to discover a reason or come across an explanation for his actions. Our small town of Luverne was shocked at Nix's suicide as he was the last person anyone would have thought

would make such a choice. Many have said they could see their own child doing this before Nix.

Suicide is such a devastating blow to an entire family. Outsiders do not want to

talk about it, either because of the subject itself, or for the fear of the hurt they may cause you. It is difficult for one to see that more hurt comes from the silence , which is saying in essence to me that "my child never existed". Suicide isso real to those involved, yet so unbelievable.

Glenn and I have always felt that being a father and a mother was the richest

blessing ever bestowed upon us. Our lives have centered around our two sons. There

has always been an abundance of love in our home coupled with respect and appre- ciation for each family member. We had talked to Nix the night before and he

sounded so good to us and we detected no problem. His many friends at the Univer- sity, some who were with him right up until the time he chose to end his lib, were not aware of his intentions.

I say all this to point out that suicide can happen at any time to any our Ciildren, often when we least expect it, and it does happen to those who seemingly have no

reason. Nix was always a very thoughtful child and he left us a note saying he did not know why he was committing suicide and asking us not to worry about him. Had we not had this note, we would not have believed, under any circumstance, that Nix had willfully made a decision to end his life. This was not the way that Nix would have chosen to settle a problem, yet it happened. Glenn is a retired county agent. I am still working as the Director of the Cren- shaw County Department of Pensions r..nd Security. Glenn worked 31 years with 4- H Club youth in the schools. As a social worker, I hove worked for the past 36 years with children and youth with all kinds of problemsand yet, wu as parents did not recognize the despair in one who was very close to us and one who was one of our

most precious possessions. Suicide hurts so deeply that it is indescribable. Our approach has been to face this "head on". We have tried to be brave for each other, for our oldest son, Boyd, and for my parents. Some days it is most difficult, and then, other days we seem to cope fairly well. We went right back to church, to

work and to our daily routines. I have recd every article that I have been able to

find and some books to try to understand a subject I knew little about. As a family, we discuss our feelings and try to give support to each other and to our son, Boyd. I plan to attend a workshop in Mobile on Thursday, April 19th, offered by The Psy- chological Associates on 'Depression and Suicide Among The Young". I realize we are still searching but maybe in some way we can eventually find answers that will not only help us but others.

I understand that a Suicide Crisis Center has been opened in Tuscaloosa since

there have been so many suicides recently. People must be made aware of how often this is happening and to whom. It is too late for us, but if Glenn and I can in anyway help others, we would be only too glad to do so. To help save our children and to spare other parents and
4

families from going through this traumatic experience would be worth any effort

one could put forth.

I want to thank you again for your interest and efforts.

Sincerely,

Mrs. GLENN B. HANDTZY.
99TH CONGRESS

Se J. RES. 53 1ST SESSION

IN THE HOUSE OF REPRESENTATIVES

APRIL 1, 1985

Referred to the Committee on Post Office and Civil Service

JOINT RESOLUTION

To authorize and request the President to designate the month

of June 1985 as "Youth Suicide Prevention Month".

Whereas the youth of society represent the hope for the future;

Whereas the rate of youth suicide has increased more than

threefold in the last two decades;

Whereas over five thousand young Americans took their lives

last year, many mere attempted suicide, and countless families were affected;

Whereas youth suicide is a phenomenon which must be addressed by a concerned society; and

9
6

2

Whereas youth suicide is a national problem which can only be

solved through the combined efforts of individuals, families,

communities, organizations, and government to educate society: Now, therefore, be it 1 Resolved by the Senate and House of Representatives

2 of the United Stales of America in Congress assembled,

3 That the month of June 1985 is designated as "Youth Sui4 cide Prevention Month" and the President is authorized and

5 requested to issue a proclamation calling upon the Governors

6 of the several States, the chief officials of local governments,

7 and the people of the United States to observe such month

8 with appropriate programs and activities.

Passed the Senate March 28 (legislative day, February

18), 1985.

Attest: JO-ANNE L. COE,

Secretary.

10
7

Senator DENTON. I will ask Senator Simon if he cares to make an

opening statement.

OPENING STATEMENT OF HON. PAUL SIMON, A U.S. SENATOR

FROM THE STATE OF ILLINOIS

Senator SIMON. I thank you, Mr. Chairman.

I think you have covered some of the basics questions here. Sui- cide is the second ranking cause of death among Americans between the ages of 15 and 24. The rate of teen suicides has almost tripled in the last 20 years while the rate of adult suicide has remained constant.

I have many more questions than I have answers, I confess. It is a bit startling to note that the suicides among young women are

again fairly constant. Among young men there has been a fairly

substantial increase.

The National Institute of Mental Health is engaged in a study. We will be hearing from a witness this morning on that. I note

that both Florida and California have suicide prevention programs.

It will be interesting to see what they are able to do in a constructive way there.

The most basic answer is simply to surround people, whether

they are teen-agers or in their eighties, with love. That is the obvi- ous. How we reach people who yearn for a little attention, that we pay attention to them as a society and as individuals. I do not expect Government to come up with all the'answers primarily. It is

going to have to be a collective effort among homes and schools and

churches and synagogues and others, but I think Government may

be able to provide some leadership as to where we go and how we meet this problem. And I look forward to this hearing providing at least some focus on this problem. I hope we can be very helpful here.

Senator DENTON. Thank you, Senator Simon. I agree with all the excellent points you made.

Senator Specter will want to receive the testimony of each and

every one of the distingushed group of witnesses. I will, therefore, recess the subcommittee until Senator Specter arrives.

[Short recess.]

OPENING STATEMENT OF HON. ARLEN SPECTER, A U.S. SENATOR

FROM THE STATE OF PENNSYLVANIA, CHAIRMAN, SUBCOMMITTEE ON JUVENILE JUSTICE

Senator SPECTER [presiding]. The subcommittee will come to

order.

I regret the delay in my appearance here today. After this hearing had been scheduled, the House of Representatives Subcommittee scheduled a hearing, dealing with the subject of Conrail, and

considering the vital impact of that subject on Pennsylvania, it was necessary that I be there at 9:30 this morning. I thank my colleagues, Senator Denton and Senator Simon, for proceeding with

their opening statements. Again I express my regrets to those of you who have been kept waiting, but I think that most of you know

that the operations here in the Congress are like a giant juggling

. 11
8

act with so many separate committee hearings in progress all the

time.

This is the second in a series of hearings on juvenile suicide. We had the first hearing last October 3, 1984, on this subject of great national importance and great personal importance as we find the

suicide rate increasing materially among juveniles. One of every

five suicides involves young people in the age group of 15 to 24. The suicide rate has increased some 138 percent for this group of young people from 1960 through 1980, and it is the third leading

cause of death, over 5,000 per year, or some 13 a day. Just really

an astounding rate.

The National Conference on Youth Suicides is planning a meeting for mid June, and I want to congratulate and compliment my

colleague, Senator Denton, for his leadership there in conjunction with ACTION. This holds the potential of being a very worthwhile meeting to analyze the causes and to see if we can deal with the problem in a meaningful way with national leadership. The questions which we will be concerned with today, as we were at the October hearing, are the adequacy of current Federal research and

prevention efforts, whether the Office of Juvenile Justice and Delinquency Prevention might undertake some additional initiatives on this program and the consideration of legislation for two States,

Florida and California, have introduced some innovative ideas.

Philadelphia, my hometown, has a unique hotline which is being put into operation and which really should be doing much, much more about this great national tragedy where, for some perplexing

reason, so many young people seek to take their lives really before

they have had a chance to establish thezmelvris or get their feet on

the ground to really know where their lives are headed, and sud- denly they are ended. So we consider this a matter of great importance and the subcommittee will be pursuing the issue with the meeting in June and beyond this hearing. I am pleased now to call on my distinguished colleague from

Kentucky who arrived in Washington very late in the middle of

the night from Chicago from a :Lind rising activity with me, but not a fund raising activity for either Senator McConnell or myself. Senator MeCorani.. I hope you did not have to get up for a 7:30 meeting like I did.

Senator SPECTER. Mine was earlier.

Senator McONNELL. In the interest of time, I would ask unanimous consent that an opening statement I prepared appear in the

recora at this point.

Senator SPECTER. Without objection, so ordered. Senator McCoNNELL. I want to commend the chairman once

again for his leadership in convening these bearings, and I think it appropriate we go right ahead with the witnesses.

ghe prepared statement of Senator McConnell follows:]

PREPARED STATEMENT OF HON. MITCH MCCoNNELL A U.S. SENATOR FROM THE STATE

OF Kavrocxv

Mr. Chairman, I commend you for holding this hearing designed to help deal with

the problem of youth suicide perhaps one of the most disturbing phenomena of

those that this Subcommittee has been called upon to examine. More alarming even than the fact of suicide among our nation's young people is

the steady rate of increase with which suicide occurs in our adolescent and some12
9

times even pre-adolescent population. In 1950 the suicide rate for the 15-24 year old

age group was 4.9 per 100,000 persons. By 1983 that rate was 11.7 per 100,000, a nearly three-fold increase.

While much has been done in the past few years to develop new approaches to the problem, much remains to be done. Indeed, the statistics indicating that the rate of

teenage suicide has been steadily increasing suggest that even new, more effective approaches need to be developed if the problem is to be solved. Perhaps as important as any aspect of the search for the solution is the need to counter the attitudi- nal problems that lie at the core of the problem. The social pressures exerted on adolescents, combined with the adolscenes often

powerful feeling of isolation, as well as the sense of shame with which we often ap- proach the subject of suicide, made the solution elusive. Perhaps as much as anything else, we need to work on finding ways to promote the kind of atmosphere for our young people in which suicide will not be considered and option. A first step may be increasing awareness of the problem in the adult population, by stripping

away the silence in which we so often shroud it. I am hopeful that this hearing will be a step in the right direction, and that as a

result of it we will have greater insight into the problem. Ultimately, our aim is to

find out how the federal government can assist the state and local agencies that must deal with youth suicide first hand, and if these hearings can help foster a new

attitude of communication, understanding and respect between young people and

adults, we may reach that goal. I look forward to the testimony of the witnesses, and commend you once again. Thank you, Mr. Chairman.

Senator SPECTER. I would now like to call on our first panel con- sisting of Hon. Dorcas R. Hardy, Assistant Secretary for Human

Development Services, Department of Health and Human Services, and Dr. Larry Silver, Deputy Director, accompanied by Dr. Susan Blumenthal, Chief of Suicide Research Unit, National Institute of

Mental Health in Rockville, MD.

We welcome you and look forward to your testimony, and would

like to begin with Secretary Hardy.

STATEMENTS OF PANEL INCLUDING HON. DORCAS R. HARDY, ASSISTANT SECRETARY FOR HUMAN DEVELOPMENT SERVICES,

DEPARTMENT OF HEALTH AND HUMAN SERVICES; AND LARRY

B. SILVER, M.D., DEPUTY DIRECTOR FOR SPECIAL PROJECTS,

NATIONAL INSTITUTE OF MENTAL HEALTH, ACCOMPANIED BY

DR. SUSAN BLUMENTHAL, CHIEF, SUICIDE RESEARCH UNIT,

NATIONAL INSTITUTE OF MENTAL HEALTH

Ms. HARDY. Thank you, Mr. Chairman. I am pleased to have the opportunity to appear before you today

to discuss the problem of youth suicide and to share information with you on what we are doing in the Office of Human Develop- ment Services to combat youth suicide. Within my office, the Administration on Children, Youth and Families, the agency responsible for administering the national runaway and homeless youth program, has taken the lead to mobilize resources to respond to this problem among our youth. We have discussed, and you have alluded to statistics that ad- dress the problem of youth suicides throughout the country, and my colleagues at the National Institute of Mental Health will also

be addressing that. But I should comment that NIMH has recently

reported that every 90 minutes an American teen-ager commits

suicide. The American Psychiatric Association has also reported

that although the incidence of suicide among young people ages 15

to 24 has recently reached a plateau, it has risen dramatically over

the past 30 years, by as much as 300 percent, and specifically the
10

rate climbed from over 4.1 per 100,000 in the 1950's to 12.5 per 100,000 in 1980. Nevertheless, research tells us these deaths are

only the tip of the iceberg and that youth suicides tend to be tm- derrecorded because of the social, legal, religious and economic

stigma that accompanies self-destructive acts. Families who cannot bear the increased burden of society's negative response, along with intense personal pain caused by the loss of a child, may un- derstandably want to attribute the death to a more "acceptable"

cause.

Such behavior is an attempt to deal with the enormous stress placed on the family when a suicide occurs. Now, no segment of the youth population is free from this tragedy. It occurs to youth in

rural areas and in urban areas. It occurs to rich youth and to poor youth. It occurs among wh"3 youth and minority youth at nearly

equal rates. . Only between the sexes do we see significant differences in suici- dal acts. Young women account for 90 percent of suicide attempts,

while boys account for 70 percent of the "successful" suicides. So who is at risk and how are we to recognize youngsters who

are in imminent danger of becoming victims of this tragedy? And, most important, how can we prevent it?

Although it is difficult to pinpoint the exact causes, it is possible

to identify indicators that often mark the potential suicide victim. And as part of an interagency agreement with my office, the Ad- ministration on Children, Youth and Family and ACTION are de- veloping several brochures which are targeted to potential volunteers, to youth, to adults, and especially school personnel, that de- scribe the danger signs and the need to take these signals very seriously.

Among the danger signs that are listed for consideration by par- ents, teachers, and others are direct suicide threats, statements revealing a desire to die, previous suicide attempts, perhaps sudden

changes in behavior like withdrawal or apathy, moodiness, depres- sion, and making final arrangements such as giving away personal

possessions. The brochures also outline steps that parents and teachers and

friends who notice these symptoms can take to help, because assist- ance is available. They need to discuss these symptoms openly and

frankly. They need to show interest and support. They need to get

professional help. They need to communicate. Now, from what we already know about this tragedy, it is clear

there is no one single answer or program that will solve the problem, and it is also clear to me that this is not a Federal problem, or a State problem, or a public versus a private problem. It is a problem for all of us and a problem that calls for the involvement of all

segments of our society. I am pleased to report that there are constructive efforts under- way nationwide to confront this problem. There is a leadership role

that the Federal Government is playing in raising public aware- ness, information dissemination, research and demonstrations of

the kind of services that might help, and generally working in

partnership with all of our governments and private organizations

to expand community involvement in addressing the problem.

14
11

We are actively engaged in finding ways of reaching out to

youngsters at risk through existing service networks. From the more than 265 runaway and homeless youth shelters which my

agency supports, we have learned that the probable risk factors as- sociated with suicidal youth are notably more prevalent among

runaway and homeless youth than among , Judi in general. High

incidence of family problems, low self-esteem, physical and sexual

abuse and neglect are all reported among this population.

Recognizing that our nationwide network of shelters gives us a way to reach youth at risk of suicide, in August 1984, we announced the availability of funding for projects to identify or develop effective techniques for intervention and for providing emergency services to seriously depressed and suicidal youth who use shelter facilities. We want to respond to shelters' concerns about recog- nizing suicidal clients, and we hope to encourage them to work

jointly with community mental health agencies to develop guidelines and procedures that can be used when a client does need

help.

We have just completed the final stages of the competitive

review process, and this week we will be announcing the funding of seven projects totaling over $600,000. Within the next year, all runaway shelters will receive special assistance and guidance on how

to screen for and intervene with potentially suicidal youth in our

runaway shelters.

The second major effort which you addressed earlier is the first

National Conference on Youth Suicide, to be held later this year in Washington. Its objectives are to increase national awareness of

the problem of youth suicides, and to encourage expanded, commu- nity-based strategies for addressing the problem.

Mental health professionals are a vital part of this a -nmunity

network, and the conference will call upon the best of their ranks

to explain the problem and inform the Nation of the latest re- search and treatment advances. We also will be including young- sters and parents who have been directly touched by suicide in

their lives.

I would like to emphasize our commitment to expanding community-based responses to these problems because we believe that the

first line of prevention- -

Senator SPECTER. Dr. Hardy, your entire statement will be made a part of the record, so to the extent you could summarize, we would appreciate it.

Ms. HARDY. Thank you, Senator.

I think the community response is very important, and we know

that the kinds of awareness and the kinds of actions that we intend

to have throughout the government will be successful, we believe, in having a very significant impact on the prevention of this tragedy.

Thank you, Senator.

[The prepared statement of Ms. Hardy follows:]
12

PREPARED STATEMENT OF DORCAS R. HARDY

Mr. Chairman, and Members of the Committee, I am pleased to

have the opportunity to appear before you today to discuss

the alarming problem of youth suicide and to share

information with you on what we are doing in the Office of

Human Development Services (OHDS) to combat it. Within my

office, the Administration on Children, Youth and Families

(ACYF), the agency responsible for administering the

national runaway and homeless youth program, has taken the

lead to mobilize resources to respond to this problem among

our youth.

THE PROBLEM

I would like to begin by outlining briefly the dimensions of

the problem of youth suicide in our country. The

statistics, although they differ slightly from study to

study, are frightening.

My colleagues at the National Institute of Mental Health

(NIMH) recently reported that every 90 minutes an American

teenager commits suicide.

The American Psychiatric Association reports that although

the incidence of suicide among young people age 15 to 24 has

recently reached a plateau, it has risen dramatically over

the past 30 years - by three hundred percent. Specifically,

the rate climbed from 4.1 per 100,000 in the 1950's to 12.5

per 100,000 in 1980. The suicide rate for teenagers rose 41

percent between 1970 and 1978.

16
13

However, researchers tell us that these deaths are only the

tip of the iceberg. Youth suicides tend to be underrecorded because of the social, legal, religious, and

economic stigma that accompanies self-destructive acts.

Families who cannot bear the increased ourden of society's

negative response, along with the intense personal pain

caused by the loss of a child, may understandably want to

attribute the death to a more "acceptable" cause.

Such behavior is an attempt to deal with the enormous stress

placed on the family when a suicide occurs. Not only must

grief and loss be handled, but loved ones must also cope

with a sense of guilt for the suicide. Researchers have

suggested that many drug overdoses, fatal car accidents,

and other self-destructive behaviors, such as eating

disorders and alcohol abuse are, in fact, teen suicides

masquerading under other names.

No segment of the youth population is free from this

tragedy. It occurs to youth in rural areas and in urban

areas; it occurs to rich youth and to poor youth. It occurs

among white youth and minority youth at nearly equal rates.

Only between the sexes do we see significant differences in

suicidal acts. Young women account for 90 percent of

suic:oc attempts, while boys account for 70 percent of the

"successful" suicides.

Who is at risk? How are we to recognize youngsters who are

50-321 0 - 85 - 2

17
14

in imminent danger of becoming victims of this tragedy?

Most important, how can we prevent it?

RECOGNIZING YOUNGSTERS AT RISK

Although it is difficult to pinpoint exact causes, it is

possible to identify indicators that often mark the

potential suicide victim. As part of an interagency

agreement with my office, ACYF and ACTION are developing

several brochures targeted to potential volunteers, youth,

adults, and school personnel, describing the danger signs

and the need to take these signals seriously. Among the

danger signs listed for the consideration of parents and

teachers are:

o Direct suicide threats

o Statements revealing a desire to die

o Previous suicide attempts

o Sudden changes in behavior (withdrawal, apathy,

moodiness)

o Depression (crying, sleeplessness, lost of

appetite, hopelessness)

o Making final arrangements (such as giving away

personal possessions.)

The brochure also outlines steps the parents, teachers and

friends who notice these symptoms can take to help:

o Discuss it openly and frankly

o Show interest and support

o Get professional help.
15

WHAT CAN WE DO?

From what we already know about this tragedy, it is clear

that there is no single answer or program that will solve

the problem. It's also clear that this is not a Federal

problem, or a State problem, or a public versus private

problem. It is a problem for all of us, and a problem that

calls for the involvement of all segments of our society.

I am pleased to be able to report that there are

constructive efforts underway nationwide to confront this

problem. There is a leadership role the Federal government

can play and is playing in raising public awareness,

information dissemination, research and demonstration of the

kinds of services that might help, and generally working in

partnership with State and local governments and private

organizations to expand community involvement in addressing

the problem.

We are actively engaged in finding ways of reaching out to

youngsters at risk through existing service networks. From

the 265 runaway and homeless youth shelters my agency

supports, we have learned that the probable risk factors

associated with suicidal youth are notably more prevalent

among runaway and homeless youth than among youth in

general. High incidence of family problems, low

self-esteem, physical and sexual abuse and neglect are all

reported among this population.

19
16

The prevalence of these factors has led researchers to

identify those youth seeking shelter services as having a

greater potential of suicidal risk than adolescents in

general. A 1984 report on "Runaway and Homeless Youth in

New York City" (Drs. David Shaffer and Carol Caton in

January 1984, Report to the Ittleson Foundation) found that

"no fewer than 33 percent of the girls and about 15 percent

of the boys had previously attempted suicide." Another 33

percent of both girls and boys admitted previously

contemplating or threatening suicide.

Recognizing that our nationwide network of shelters gives us

a way to reach youth at risk of suicide, in August 1984, we

announced the availability of funding for projects to

identify or develop effective techniques for intervention

and for providing emergency services to seriously depressed

and suicidal youth who use shelter facilities, and that

would further distribute information gained among the

network of shelters. We want to respond to shelters'

concerns about recognizing suicidal clients and we hope to

encourage them to work jointly with community mental health

agencies to develop guidelines and procedures that can be

used when a client needs help.

We have just completed the fin 1 stages of the competitive

review process on the applications responding to this

announcement. This week we will be announcing the funding

of seven projects, totalling over $600,000. Within the next

year, all runaway shelters will receive special assistance

20
17

and guidance on how to screen for and intervene with

potentially suicidal youth in runaway shelters.

The second major effort that OHDS is spearheading is the

first National Conference on Youth Suicide, to be held later

this year in Washington, D.C. Its objectives are:

o To increase national awareness of the problem of

youth suicides; and

o To encourage expanded, community-based strategies

for addressing the problem.

Mental health professionals are a vital part of this

community network, and the conference will call upon the

best of their ranks to explain the problem and inform the

nation of the latest research and treatment advances. We

will also include youngsters and parents whc5e lives have

been directly touched by a suicide, and who have insights on what might be done in the family and in the community to

prevent further senseless waste of young lives.

Let me emphasize our commitment to expanding community-based

responses to this problem. We believe that the first line

of prevention, identification, and intervention must come from parents and local institutions with which youngsters

come into everyday contact -- schools, churches, volunteer

and youth service groups, recreational clubs, PTAs, and so

on. Last fall the Comirittee heard testimony on how local school

systems can help prevent the problem of teen suicide. In
MEW.

18

addition to the runaway shelters and mental health centers,

there are other community based initiatives underway. I was

pleased to learn recently that Parents Anonymous, a

self-help network with over 1500 local chapters committed to

reducing child abuse, has created a rapidly increasing

number of self-help groups for teenagers, through which

youngsters can reach out to troubled youth for help and

support from their peers, under the guidance of a

professional. We have encouraged and provided financial

support for this Parents Anonymous activity. We are pleased

with the enthusiastic community response they have helped to

generate.

But these and other services supported by public and rivate

agencies cannot be called into play until and unless someone

realizes that help is needed. Awareness that the teenager

who seems to have all the adolescent problems conquered may

be sending out subtle signals for help is part of the

solution. We expect the national conference to be only one

part of a coordinated campaign for raising public awareness

and providing information to help.

The brochures and educational materials I mentior d earlier

are another component. Builaing the awareness of teachers,

parents, and peers is the first and most valuable step, and

to reach each group effectively specialized materials are

being developed. The joining of forces by ACTiON and the

Department of Health and Human Services will ensure broad

and successful dissemination of the materials.

22
19

In addition, jointly with ACTION we are producing public

service announcements and special efforts to use the ability

of the mass media to reach great numbers of parents and

youth.

In summary, I have described the scope of the particularly

tragic problem of teen suicide. At the same time I have

indicated that there is reason for hope. Recognition of the

problem has stirred a strong response from major agencies of

the Federal government acting together, from State

governments such as California, and from existing community

agencies such as runawi.y shelters, Parents Anonymous

chapters, school systems and mental health centers. Efforts

are being directed at dealing with the problem in the

community where the impact is needed. I have every

expectation that in the coming years tI:ese efforts will

succeed and the tragedy of teen suicides will be reduced.

I would like to thank this Committee for making 'chi. ;sue one of its priorities and for inviting us to testify.

23
20

Senator SPECTER. Thank you very much.

I would like now to turn to Dr. Silver, Deputy Director of NIMH

since 1981, previously a professor of psychiatry, professor of pediatrics, and chief of child psychiatry at Rutgers Medical School.

We welcome you, Dr. Silver, and we look foward to hearing your

testimony.

STATEMENT OF DR. LARRY B. SILVER

Dr. SILVER. With your permission, I would like to submit my

formal statement for the record and.summarize it at this time.

Senator SPECTER. That will be fine. All statements will be made a

part of the record in full and to the extent they can be summarized, leaving the maximum time for questions and answers, the

subcommittee would appreciate it.

Dr. Sn.vxs. Mr. Chairman and members of the Subcommittee on

Juvenile Justice, it is a pleasure to be here today to testify for the Public Health Service. I would like to commend you and your sub- committee on being concerned about this serious problem and on

holding this hearing.

I am Dr. Larry B. Silver, Deputy Director for Special Projects of

the National Institute of Mental Health. I would like to introduce

Dr. Susan Blumenthal, head of the Suicide Research Unit at the

National Institute of Mental Health.

In my testimony I would like to summarize the research we at NIMH are doing as well as talk about the other activities we are working on with other agencies. I will not review the scope of the problem since this has already been discussed. The Public Health Service is concerned about many aspects of

teen suicide. One concern is risk factors. If v e can recognize these

factors that put a teen at risk for suicide, we can move in and do

something about it. What are these psychological, biological and/nr social or cultural risk factors?

One area of concern is psychiatric risk factors. While not all young people who attempt or commit suicide have an underlying

psychiatric disorder, depression and chemical dependence are im- portant risk factors. We know that people who have conduct disor- ders, that is, difficulty handling their behavior in a manner that is

functional and acceptable in society, and who are also impulsive

and aggressive, are at risk. Our research is directed toward learning more about these factors and developing models of intervention.

We are concerned about psychosocial risk factors such as those mentioned earlier by Senator Denton. Individuals who have exper- enced losses are much more likely to attempt suicide. This might be the loss of a loved person, multiple geographical moves and

sttesses within their lives, chronic illness, being a victim of child

abuse, being a runaway, having an unwanted .pregnancy or experi- encing a humiliati,,n in front of family or friends. We also know

that individuals who are more isolated or who show antbocial behavior are more at risk so we want to study this. Recently we have learned of certain populations of suicide attempters or successful suiciders who appear to have biological risk

factors. If th- research turns out to be true, there might someday

24
21

be biologic measurements to better identify some individuals who have a history of aggressive behavior and who might be at high

risk for atteLlpting suicide.

A family history of suicide increases the risk of suicide eightfold; and, therefore, there is also research going on relating to genetic

and familial risk factors. Perhaps the most publicized phenomenon

is the suicide cluster phenomenon. When a suicide occurs it is pos- sible that it will spread within that population; others a.e likely to

attempt suicide. We do not fully understand this phenomenon. The

Centers for Disease Control and the NIMH are studying the vari- ous factors involved in this clustering phenomenon. In terms of future research, the National Institute of Mental

Health and the Public Health Service need to focus research on

high risk populations and on preventive interventions. There is a

need to do more epidemiologic studies to better understand who attempts suicide versus who completes suicide. What the differences are relating to demographics, psychological profiles, family issues, social issues. We want to look further into psychiatric disorders

that are likely to make one prone to suicide, and w'.iat we might do

to intervene and treat these individuals. We are interested in further pursuing the psychosocial risk factors. What goes on in the

family or the individual's life that might be of importance in pre- dicting a risk for suicide. What goes on in the broader society, their school environment, their peer groups that might help predict a person at risk.

Once we can recognize these issues, we might move in and do

something about it. And we want to continue our work in terms of biological risk factors.

The National Institute of Mental Health and the Alcohol, Drug Abuse, and Mental Health Administration have been working very

closely with ACTION, on an initiative that is funded by the Office of Human Development Services to develop programs related to

teen suicide. We have worked with them in developing brochures and in planning a conference scheduled for June 1985.

We have also worked closely with the Centers for Disease Control, collaborating on epidemiological studies to better understand

the problem, and with the National Center for Health Statistics.

We have also been working very closely with the American Asso- ciation of Suicidology, the American Psychiatric Association, the

American Psychological Association, and other professional organi- zations.

In conclusion, we feel that improvement can be achieved only

through careful scientific inquiry and evaluation. Psychiatric, psychological, biological, genetic, and other factors that might contrib- ute to suicide must be studied. While we work to increase our

knowledge, we must also continue to work closely with professionals and other individuals who are concerned about this problem. I thank you for this opportunity to testify today on behalf of the Public Health Service, and look forward to answering any questions you might have.

[The prepared statement of Dr. Silver follows:]

25

--

.4
22

PREPARED STATEMENT OF DR. LARRY B. SILVER

Mr. Chairmen and Members of the Subcommittee on Juvenile

Justice, it is an honor to be invited here today to testify on

behalf of the Public health Service and specifically the

Alcohol, Drug Abuse and Mental health Administration on the

subject of teenage suicide. 1 am pleased that the Subcommittee

is concerned about this major public health problem in our

country and would like to commend your leadership role in

examining this area of national concert.

1 am Dr. Larry B. Silver, Deputy Director for Special

Projects of the National institute of Mental Health (NIMH), one

of the three Institutes of the. Alcohol, Drug Abuse, and Mental

Health Adminisl.ration. With me today is Dr. Susan Blumenthal,

head of the Suicide Research Unit at the National Institute of

Mental Health. The Suicide Research Unit coordinates NIMh's

program in suicide research, funds and conducts research

projects, organizes conferences and workshops, collaborates with

other Federal agencies, prepares scientific presentations about

suicide tor professional groups and to the public and

disseminates information about suicide to the public and health

care professionals.

In my testimony, 1 will address our current ADAMHA

efforts in research, education, and prevention. As you know,

service activities in this area are funded from the Department's

Office of human Development Services.

'ihe professionals of ADAMhA share a deep concern with the

tragic loss of life through teenage suicide and the emotional

toll it takes on the survivors. A better understanding of this

problem leading to better recognition of at-risk individuals,

better prevention programs, and improved clinical interventions

is essential. SCOPE OF THE PROBLLM: Over the past 30 years, the United States suicide rate for

people 15 to 24 years of age has increased dramatically from 4.1

26
23

per 100,000 in the mid-1950's to 12.5 per 100,000 in 1980. As a

consequence, suicide moved from tne fifth leading cause of death

in this age group in 1960 to the third leading cause in 1982.

Research data also indicate that suicide is the second leading

cause of death among college students. Between 1970 and 1978,

39,011 United States residents 15 to 24 years of age committed

suicide. During this same period, the suicide rate for this age

group increased 41 percent while the rate for the rest of the

population remained stable. However, the incidence of suicide

among young people aged 15-24 has leveled off recently.

This increase in reported suicides for young people is

due primarily to an increasing number of suicides among young

white males; rates for males increased by 47.4 percent compared

with an 11.9 percent for females so that by 1978, the ratio of

suicides committed by males to those by females was greater than

4 to 1. Young people who attempt suicide and those who complete

suicide represent different groups characterized by different

:isk factors. For example, young women attempt suicide 4 to 8

times more frequently than males. Recent data also make evident

the seriousness of the suicide problem in inner-city Black

males. the problem is widespread and touches every segment of

society.

Adoles..c.s are not only more likely to attempt suicide,

they are also more likely to use lethal methods in those

attempts. From 1970 to 1978, th_ proportion of suicides

committed by firearms or explosives increased for both males and

females, while the proportion of both males and females

committing suicide by poisoning declined. These changes were

more marked among young women, who have traditionally committed

suicide by poisoning.

Suicidal behavior in younger children is an unrecognized

problem. A recent study has shown that 13 percent of the 6 to

12-year-olds randomly selected from Westchester County

elementary and junior high schools had suicidal thoughts, and 3

27

7
24

percent had made suicide attempts that had not previously come to anyone else's attention.

The Centers for Disease Control (CDC) has recently

established a Violence Epidemiology Branch to carry out research

to reauce the incidence of suicide related morbidity and

mortality. CDC's objective is to characterize those susceptible

individuals so that appropriate interventions can be designed,

implemented, and evaluated.

CDL has established a working group for the purpose of

exploring the best approach to develop and implement uniform

reporting criteria. calculations of suicide incidence based on

death certificates probably underestimate the true incidence for

all ages. One important factor contributing to this

underestimate is tne lack of uniiorm criteria for use by medical

examiners and coroners in the classification of suicide deaths.

This is particularly true of death by suicide of children and

adolescents. CURRENT RESEARCH EFFORTS: The NIMH's primary mission in the area of youth suicide

is research. Currently funded research focuses on the

biological factors associated with violent behavior/suicide,

epidemiological studies, including detailed retrospective

analysis of completed and attempted suicides compared with a control group of adolescents.

Risk Factor Research. There are many reasons why young

people commit suicide. The factors involved are complex, highly

interrelated, and only partially understood. Its causes are

psychological, biological, and sociocultural.

o Psychiatric Risk Factors - -While not all young people

who attempt or commit suicide have an underlying

psychiatric disorder, depression and chemical

dependence are important risk factors for suicide.

Young people who have disorders involving their

conduct tsuch as truency, stealing, confrontations

28
with the law, and running away from home) and are

more impulsive and aggressive are at increased risk

for suicide. One of our most important prevention

strategies is the early detection and treatment of

mental disorders and chemical dependence.

o isychosocial Risk Factors--These include loss of a

loved person, multiple moves and stresses as the

young person has developed, chronic illness, being

the victim of child abuse, being a runaway, having an

unwanted pregnancy, and having experienced a recent

humiliation in front of family or friends.

Personality characteristics of adolescents who

complete suicide have included antisocial behavior

and/or a history of aggressive and impulsive

behavior, isolated, depressed youngsters and

perfectionistic young people who experience injuries

to their self-esteem.

o Biological Risk Factors--Recent biochemical

investigations of suicidal behavior have shown

reduced levels of serotonin, a key chemical messenger

in the bruin, associated with increased aggression in

violent suicide attempts and completions which may

increase the risk of completed suicides twenty-fold.

Research on biological factors may hold promise for

increased prediction of suicide, new

psychopharmacologic treatment interventions and

ultimately prevention of suicide.

o Genetic and Familial Risk Factors--A family history

of suicide increases the risk of suicide eight-fold.

Explanations for this include the psychological

phenomenon of ioentification with a family member who

has committed suicide, genetic factors for suicide,

and the genetic transmissiwl of psychiatric disorders.

o Suicide Clusters--Another characteristics of the
26

current suicide problem merits serious concern.

"Suicide clusters" are occurring at an increasing

rate among adolescents. The term, "suicide cluster,"

refers to the phenomenon of one suicide appearing to

trigger several other suicides in a group, such as a

school or community. Very little is known about this

apparent contagion effect of suicide among

adolescents. Suicide clusters have recently occurred

in Plano, Texas, in Westchester County, New York, in

Minnesota, and in Clear Lake and Houston, Texas.

NIMH funded studies are underway at Columbia

University to investigate the mechanism of suicide

clusters. Analysis of these data should be completed

by December, 1985. increased understanding of these

factors should lead to prevention strategies.

In addition, the Centers for Disease Control (CDC)

assisted the Texas State health Department in investigating

apparent clusters of teen suicides in Plano and Clear Lake,

Texas, in order to identify the degree to which youth suicides

may be influenced by other deaths or suicides. In December

1984, CDC delivered to the Texas Department of Health and the

city of Plano a preliminary report analyzing demographic and

situational data for a cluster of eight suicides. CDC was successful in establishing effective working relationship with

school and community leaders in both Plano and Clear Lake.

These will serve as models for future research efforts in the

area of teen suicides.

CDC plans to complete the analysis of teen suicide

clusters in Plano and Clear Lake by October 1985. CDC also

plans to work with the Texas Research institute of Mental

Sciences to refine the questionnaire used in the CDC

epidemiologic investigations and to make it available to

communities and States in which additional clusters of teenage

suicides are identified.

3.0
27

FUTURE RESEARCH DIRECTIONS

The variation in suicide-death rates in different age,

sex, and ethnic population groups suggests the existence of

high-risk and protective factors. More research is needed

before we can infer the nature of these factors. Since only a

few studies have been focused exclusively on children and

adolescents, much more research is needed to form the basis for

rational treatment and prevention.

Areas in whicn further research is needed:

o Epidemiologic--Including the colleltion of better

statistics on adolescent suicide with associated

demographic and psychosocial factors.

o Psychiatric--What is the prevalence of clinical

diagnosis among adolescents who attempt and commit

suicide, in particular, the proportion of affective

disorder, psychotic or conduct disorders. In addition the prevalence of the association of alcohol

and drug abuse and dependence associated with suicide

needs to be determined.

o Psychosocial-- Are there precipitating events among

individuals sho suicide or attempts suicide, such as

physical illness, familial disruption or other

factors. physical illness, familial disruption and

other factors needs to be determined.

o Genetic/Familial--What is the extent to which genetic

or family history of suicide contributes to suicidal

behavior in adolescents.

o Biological--What are the biological risk factors and

possible biological markers for suicide in

adolescents.

o Preventive Interventions - What is the effects of

high school suicide prevention education programs on

young people. The development of evaluation

components for these programs is essential.

31
28

Determination of what educational methods, services,

and treatment strategies are effective in preventing

adolescent suicide is needed.

ADAM-LA'S RESPONSE TO THE NATION'S SUICIDE PROBLEM The N1MH's primary mission in the area of teenage suicide

is research. The NIMH established a Suicide Research Unit (SRU)

to develop a knowledge base and to etiyulate and support

research related to suicide. Through its research support, NIMh

hopes to reduce the suicide rate in high-risk populations

through improved diagnosis and treatment of psychiatric

disorders. In addition to its research activities, the SRU

collects and disseminates information about suicide to the

public, professionals, and the media and coordinates

suicide-related activities within the N1MH. Among the suicide

related activities carried out by the Suicide Research Unit in

collaboration with other NIMH programs include:

Research:

o NIMH Extramural Research Program The NIMH currently

sponsors nine research projects on suicide in its

extramural program at a total cost of ;829,273. A

new solicitation for research projects on Suicide is

planned for FY 1986. In addition there are 18 other

NIMH grants dealing with some aspect of suicide. The

total amount of funding related to suicide research

is $1,000,000.

o NIMH Intramural Research program Intramural research

at the NIMH includes studies on possible biological

markers for suicide, the relationship of biochemical

factors, aggression and suicide, familial factors in

suicide, alcohol abuse and suicide, and research on

affective disorders.

o National Institute onDrug Abuse, National Institute

on Alcohol Abuse and Alcoholism. The use of alcohol

and drug abuse may reflect an underlying emotional

32

---
29

problem or may oy it's use add to the stress or

influence the judgment of the individual. Thus,

substance abuse is a risk factor for suicide.

Research etforts related to these issues are in

progress. Prevention - The NIMH is approaching the prevention of

suicide in a ',umber of ways:

o Project Depression A major prevention strategy is

the early detection and treatment of affective

disorders. Since the presence of an affective

disorder such as depression is a common precursor of

suicide, the NIMH is developing a major public and

professional education campaign on depression. The

goal of this program is to increase the recognition,

early detection, diagnosis, and treatment of

depression. This initiative is expected to help

decrease the suicide rate and the number of attempted

suicides in this country.

o Early detection - Currently the most effective

strategy for prevention of suicide is the early

detection and appropriate treatment of depression,

substance abuse, and other psychiatric disorders. In order to foster earlier detection and more effective

treatment, more comprehensive education is needed for

individuals at high suicidal risk, their families and

loved ones, primary care physicians, and other health

care providers and mental health specialists. The

ADAMHA is planning activities to improve primary

care physician awareness of alcohol and drug abuse,

chemical dependency, and mental health disorders.

One outcome which should result from this is a

decrease in suicide attempts and completions.

o Preventive interventions - NIMH is planning

evaluation research to test the type and effects of

33

50-321 0 - 85 - 3
30

specialized high school suicide education programs

an.4 curricula on young people. The preventive

effectiveness of suicide hotlines and crisis centers

has yet to be systematically proven. Yet, this lack

of evidence should not be interpreted to mean that

hotlines and centers are ineffective. It is unclear

that people who contact suicide hotlines are those

individuals at highest risk for completing suicide.

Therefore, a review of this suicide prevention

literature has been commissioned to assess current

knowledge about the effectiveness of suicide

education programs, hotlines, and suicide crisis

centers. Based on this review, recommendations for

evaluation of educational and service programs and

prevention strategies will be developed. Further

NIMh-sponsored research is planned to clarify what

populations utilize these services, what services are

offered, and to evaluate the effectiveness of

interventions offered.

Education - Closely related to our prevention activities

are the information and educational efforts:

o Publications and information Dissemination A series

of publications and informational materials on

suicide for the public and scientific community are

being prepared. These include a new suicide

monograph for the general public, a videodisc on the

assessment of adolescent suicidal behavior for

medical students and resident trainees, and a

monograph on black suicide. The NIMH continues to

work actively with the media to promote public

education about suicide and responds to numerous

public and professional inquiries on suicide.

o Conferences and Workshops The suicide research

unit is planning a series of workshops aa.:

34
31

conferences that will bri4g together researchers,

clinicians and education experts to present research

findings to develop future directions for research

snd prevention activities.

o N1MH sponsored a workshop on "Prevention Research:

Suicide and Affective Disorders Among Adolescents and

Young Adults," IA December 1982.

o N1MH will co-sponsor with the New York Academy of

Sciences a 3 day Conference on "The Psychobiology of

Suicidal Behavior" to be held September 18-20, 1985.

Research on psychosocial, behavioral and biological

risk factors for suicide will be presented and future

lines of research will be discussed.

o Workshops--Workshops on the Contagion Effect in

Adolescent Suicide, Prevention of Suicide, and the

Effectiveness of Treatment Strategies for Suicidal

Adolescents are planned in FY 1985 and FY 1986.

Collaboration with Other Federal Agencies and Outside

Croups

o ACTION - The Department has entered into an

interagency agreement with ACTION to address the

issues of youth suicide. A number of activities

are in progress: (1) informational pamphlets for

teenagers, parents and high school teachers on the

prevention of adolepcent suicide; (2) a two day

Conference on Adolescent Suicide to be held June

19-20, 1985; and (3) public service announcements

for television on the prevention of youth suicide.

o Within DRHS - Tha NI?Ili collaborates with other

Federal agencies (including the Centers for

Disease Control (CDC) and National Center for

Health Statistics) to improve surveillance

mechanisms and the data base for suicide

information in this country. The latest published

35
compilation of national suicide statistics for all

ages was in 1984. For youths, no detailed

compilation of suicide statistics at the State,

regional, and national level nas ever been

published. As a conw.quence, we lack the

statistical basis for cleaning the scope and

characteristics of suicide as a public health

problem. The CDC-NIMH Adolescent Suicide Project

has analyzed trends in youth suicide from

1970-1980. This CDC -NIMI collaborative agreement

will result in a two-part Suicide Surveillance

Report on national suicide statistics for the

years 1970-1980. Part 1 is primarily a report of

suicide incidence by age, race, sex, and geographic

area. Part II is a more detailed report focusing on

youth suicide (ages 15-24). This two-part Suicide

Surveillance Report will provide background data for

monitoring and reducing the youth suicide rate.

o Collaboration with Professional Organizations The

NIMH is working with the American Association of

Suicidology, the American Psychiatric Association,

the American Psychological Association and other

professional organizations to increase professional

and public awareness about youth suicide.

NMI BUDGET FM SUICIDE- RELATED PROGRAMS AND ACTIVITIES

1984 Actual 1985 Estimate 1986 Estimate

Research $1,000,000 $1,200,000 $1,400,000

Program Support

(i.e., Video Disc, CDC-NIMH

Collaboration, Other) 200,000 150,000 250,000

$1,200,000 $1050,000 $1,650,000

CONCLUSIONS: Improvement can be achieved only through careful scientific

inquiry and evaluation. New research on psychiatric,

36
33

psychosocial, biological, and genetic risk factors for suicide, as

well as basic and applied research on affective disorders, is

required.

We must strengthen our knowledge about psychiatric,

psychosocial, biological, and genetic risk factors for suicide.

At present the research evidence points to early detection and

effective treatment of depression, alcoholism, drug abuse, and

other psychiatric disorders as the best chance to reduce the

suicide rate in young people.

The Department will continue its PHS leadership role by

providing information learned from research and by working with

the leadership of ACTION, the tuitional Committee for Youth Suicide

Prevention, the American Association of Suicidology, the Drug and

Alcohol Abuse Treatment Program and other programs or

organizations concerned about this problem. In addition, ADAHHA

professionals will continue to actively participate at national

meetings and special conferences, trying to increase thn awareness

of health and mental health professionals, education

professionals, and the public about current suicide research,

prevention strategies and interventioo,:.

Thank you for the opportunity to testily today on the

subject of suicide on behalf of the Public Health Service. 1 would be happy and eager to provide the Subcommittee with any

further information you should require.

37
American

Psychiatric

Association

1400 K Sum. N W. Washington. D C 20005

34

Facts About:

TEEN SUICIDE

The teerr are years of turmoil for just about everyone. You're learning new social roles, developing new relationships, getting used to the charges in your bodies, math(

decisions about your future. And when you're looking for answers to problems, it seems

like no one has them. That can make a person feel pretty much alone.

So when a particularly hard challenge comes along facing friends after what feels like

a public humiliation, doing poorly on a school exam, watching parents divorce or separate

you probably begin to feel depressed and to wonder if life is worth living. It might

sound like a platitude, but the truth is that only by having enough "life esperienee. will

you realise thee eon and dose sumo such of the inst.

You might need some extra support to hold on. If you're depressed, talk It over with

someone a close friend, a school counselor, your minister or rabbi, or a mental health

professional.

Depression is a very common illness, even among teenagers. Your health and grades can

be hurt. Worse, people with depression have a high risk for suicido. Half of these who

suffer one episode of serious depression will have another one. But with adequate

treatment, 110-96 percent of all depressed people begin to get better within about a

utonth.

WHAT TO LOOK FOR: Everyone has normal mood swings in which he or she occasionally

feels down in the dumps, sad or unhappy. But when that depressed mood lingers for more

than two weeks, serious depression could be setting hs. That's dangerous, because

15 percent of people who suffer severe depression kill themselves.

If two or mare of the statements below describe you or a friend, you probably

should find help by talking to a mental health professional or other trusted adult

such as a parent or a school counselor about how you feel.

I am sleeping much later than I used to; rm not sleeping well and wake up

early in the morning; a rm beginning to take a lot of naps.

My appetite has changed, and I've noticeably lost or gained weight.

I feel restless.

I have withdrawn from friends and family.

I can't concentrate very well.

38
35

I've lost interest or pleasure in usual activities that I once enjoyed.

I feel hopeless or guilty.

I've had sudden mood or behavior changes: I used to be quiet and now I am

hyperactive; or once I was an outgoing youth and now I'm withdrawn.

I have thoughts that life isn't worth living.

Young people who have attempted suicide in the pas: or who talk about suicide are

at greater risk for future attempts. Listen for hints like, "I'd be better off dead" or "I won't be a problem for you much longer" or "Nothing matters; it's no use."

Adolescents who madder suicide gesserally feel alone, hopeless, and rejected. They are more vulnerable to having these feelings if they have been abused, feel they have been recently humiliated in front of family or friends, have parents with alcohol or drug problems, or have a family life with parental discord, disruptions, separation or divorce. However, a teenager may be depressed and/or suicidal without any of these.

Many teens who abuse alcohol or drugs are likely to consider, attempt or sneered at suicide. The Fifth Special Report to the U.S. Congress on Alcohol and Health

(1983) found that as many as 80 percent of people who attempt suicide have been drinking at the time. And alcohol is a depressant.

Teenagers who r.ze plannirg to commit suicide might "clean homes' by giving away

favorite possessions, cleaning their rooms, or Urowing things away. They may also become suddenly cheerful after a period of depression, because they think they

have "found the solution" by deciding to end their lives.

One of the most dangerous limn of a tam's life is when be or she hes suffered a

loss or humiliation of some kin& loss of self-esteem by doing poorly on a test, the

breakup with a boyfriend or girlfriend, or the trauma of parents' divorce.

NEW FINDINGS: Every day, psychiatric research is finding new clues to the causes of

depr,..ssion and suicide. Among them:

Depression and the risk for suicide might have biological es well as psychological causes. Studies Have found that some people who are depressed have altered levels

of certain brain chemicals. Other studies have shown that aggressive and impulsive

people who make violent suicide attempts have reduced amounts of seratonin, a key brain chemical.

A family history of suicide is a significant risk factor in a young person. The family

link might be because young people often identify with those closest to them and

are likely to repeat their actions. However, there may be a genetic link as well,

because biological relatives of a suicidal person are six times more likely to

attempt or succeed in suicide than are adoptive relatives.

39
36

SOME NUMBERS: Increased awareness of the problem may have helped slow the rate of

teen suicide in recent years. Still, the numbers show that teen suicide remains a very

serious problem, and many think the actual number of suicides is two to three times

higher than the statistics would indicate.

Suicide is the third leatEng ewe of death amen teamsters. Among college

students, suicide is the second leading came of death. Studies show that about 12

of every 100,000 people between 15 and 24 committed suicide in 1983. Experts

estimate that each year 5,500 teenagers commit suicide.

The incidence of sieside maw people aged 15 to 24 has leveled off recently. Even

so, it has risen dramatically over the past 30 years. The rate went from 4.1 per

100,000 in the 1950s to 12.5 per 100,000 in 1980. Between 1970 and 1978, the

suicide rate for those aged 15 to 24 rose 41 percent while the rate for the rest of

the population remained stable.

White males have had the highest berms* in suicide, which rose 50 'percent

between 1970 and 1978. The increase for white females increased 12 percent.

Recent studies show suicide among young blacks.also is a major problem.

The ratio of male to female suicides is four to one. However, young women

attempt suicide four to eight times more frequently.

Report; of suicide "dusters; in which one micide appears to trigger several others

within a group such ea a school or cosasumity, have increased.

WHAT CAN YOU DO: Most people who are depressed or who are thinking about suicide

don't or won't talk about how they are feeling. They feel worthless. They have no hope.

They deny their emotions or think that talking about their emotions wilt be a "burden" on

others because no one cares. Or they are afraid others will make fun of them.

That's understandable, because when someone mentions suicide, others may treat it as a

joke or deny it. Those reactions only make, the problem worse. So, if n Mend or relative

brings tg the subject, take it seriously and take some time to talk about it.

Remsure that person that he or she does have someone to turn to. Parents, friends,

school counselors, physicians, teachers, or a brother or sister are probably all to'

willing to listen. It's just hard to let them know we want to talk about something as

serious as our emotions.

Don't lecture or point out all the reasons a person Am to live. Instead, listen and

reassure the individual that depression and suicidal tendencies can be treated.

Depressive disorders respond readily to treatments such as psychotherapy or

appropriate medication. Antidepressants can act within two to three weeks and often are used in addition to psychotherapy. Nearly 90 percent of all people

suffering depression respond to these treatments.

You can find help by contacting year local chepter of the American Psychiatric

Aswiatian, which can suggest a psychiatrist who can ht.lp you. Psychiatrists are

physicians who have special training in emotional and mental health. Other sources

40

,, .,:
37

include your local mental health association, your family physician, a county

medical society, a local hospital's department of psychiatry, a mood disorders program that is affiliated with a university or medical school, or a family

service/social agency.

SOME ADDMONAL KRADDIG:

Anderson, Luleen S. Sodas Cane Early This Week. Cambridge, Massachusetts: Schenkman, 1982.

Cain, Albert C., ed. Survivors of Suicide. Springfield, Illinois: Charles C. Thomas,

1972.

Elkind, David. The Hurried Childs Growing Up Too Fast Too Sow*. Reading, Massachusetts: Addison-Wesley, 1981.

Hyde, Margaret 0. and Forsythe, Elizabeth H. Suicide: The Hidden Epidemic. New York:

Franklin Watts, 1978.

Klagsbrun, Francine. Too Yong to Die: Youth and Suicide. New York: Pocket Books,

1984.

Mack, John E. and Hic lder, Holly. Vivienne: The Life and Suicide of an Adolescent

Girl. New Yak: NAL, 1012.

Madison, Arnold. Suicide and Young People. Boston: Clarion/Houghton Mifflin, 1981.

McCoy, Kathleen. Copi% with Teemege Deoressiotn A Parent's Guide. New YIrk: NAL,

1982.

National Institute of Mental Health. Adolescence and Depression, DHHS Pub. No. (ADM)

84-1337, Rockville, MD 20857: the Institute, 1984. (Free single copy).

National institute of Mental Health. What Ire Know, DHHS Pub. No. (ADM)

84-1318, Rockville, MD 20857: the Ins tute, 1984, (Free Single Copy)

*Good for parents.

March 1985

Provided by

The American Psychiatric Association

Division of Public Affairs

1400 K Street, N.W.

Washington, D.C. 20005

41
38

Senator SPECTER. Dr. Blumenthal, we welcome you here and we

look forward to anything you might care to supplement what Dr. Silver has testified to.

Dr. BLumErrniAL. Thank you, Senator. I will be very happy to

answer any questions you might have.

Senator SPECTER. Dr. Silver, you have outlined a great many factors, some in technical terms, some not. In lay direct simple lan- guage to the extent you can, what is our best judgment as to the

cause of teenage 'suicide?

Dr. SILVER. Perhaps I could start to answer and then ask Dr. Blu- menthal to add.

We do not know the full answers yet. We have some ideas. We have some clues, but we do not have the answers.

Senator SPECTER. When you say you do not have the full an- swers, you have outlined a prodigious list of studies to be re- searched.

What research has been accomplished up to the present time? Dr. SILVER. We do know that approximately 60 percent of the youth who successfully suicide have suggested evidence or definite

evidence of a mental disorder, perhaps depression or

Senator Smarm. Before you go on with the factors which lead to

suicide, to what extent has the Federal Government or anyone

really addressed this problem up to the moment?

How well have we done at looking at this important problem? Dr. SILVER. The National Institute of Mental Health is funding

research on the specific issue of teen suicide.

Senator SPECTER. For how long have you so funded it? Dr. SavER. The first grants began in the early sixties and the past year Senator MErzErisAum. Will you tell us something by the year 2020?

Senator SPECTER. Just a minute, Senator Metzenbaum. Let us

proceed in order if we may.

Are adequate resources, in your judgment, being directed to the problem?

Dr. SILVER. I believe so.

Senator SPECTER. What is the resource allocation in a general way, Dr. Silver?

Dr. SILVER. The National Institute of Mental Health at the

moment is funding about $1 million a year in research relating to

the psychological, psychosocial, and biologic factors leading to teen

suicide. We are also currently funding with the Centers for Disease Control epidemiological research, and research on the cluster phe- nomenon. And we are also working closely with the Office of Human Development Services.

Senator SPECTER. Before going on to what resources might be allocated for the future in tei ms of where we might be heading, what are the causes of teenage suicide !Is best we understand them at

the moment based on the research to sate?

Dr. SILVER. As I started to discuss earlier, researchers have studies suicides by meeting with family, friends, school personnel, and others to try to retrospectively sort out what happened. We find

that up to 60% of individuals have had evidence of clinical depres42

ta.

v-v".
tis

39

sion, or have had evidence of a behavior or conduct disorder with

impulsivity.

Senator Smarm These are behavior disorders with impulsivity? Dr. Sn.vsit. These are individuals who have emotional problems

that are acted out in terms of behavior, such as getting into diffi- culty in school, delinquency, Taming away, and who also show evi- dence of difficulty in controling their aggressive behavior. We find

that a percentage of these individuals have already been seeing mental health or health professionals. We are thus trying to sensitize mental health professionals and other health professionals to

recognize and treat depression as well as other psychiatric disor- ders.

Senator SPECTER. What tips would you have for parents? What are the guideposts to look to that might be an indication of a sui- cide potential?

Dr. Sn.vxa. Clearly, evidence of depression or of other types of control problems should be taken seriously. However, there are in- dividuals who attempt or complete suicide where there is no evi- dence of a mental disorder. For these cases we are trying to find

out what are the factors involved or what clues should be looked

for.

The family history is of concern. There is a relationship between

a family history of suicide and trying suicide. Senator SPECTER. Dr. Silver, is that likely to be a genetic problem, a heredity problem or a suggestive problem? There has been

some thought that when you talk about teenage suicides, you might be promoting the likelihood of a suicide, or where it exists in

the family, it plants the idea as opposed to being something heredi-

. SILVER. You are raising all the questions we are concerned with. Is it something inherited through your genes? Is it the experi- ence that you had, or a role model? We also are concerned abut

the impact of the media. I started earlier by mentioning what we do know. There are other areas we do not know and where we need more research.

One area is to gain a better understanding about individuals Who

show no evidence of mental disorder and still attempt or complete

suicide. We are trying to understand what other factors could be pickad up ahead of time. This information is in the brochures that will be put out by ACTION. The goal is to sensitize parents, friends, and school systems. Senator Smarm Secretary Hardy, if funcling were no objective, what would you like to see done in our national attack on the problem of suicide?

Ms. HARDY. I would like to see us have a significant public

awareness campaign and a significant amount of work at the local

level with a lot of community organizations in terms of awareness by parents, awareness by friends and how to better deal with

young people w!la have problems. We have some very s models out 41-gere. We have Parents Anonymous, whic has the

teen component, and those teens are helping other tee P.: who have a potential of suicide. I think that has been very s ,1. There

are a lot of things like that at the local level through the schools, and State legislation, such as that in California, that are out there

4 3
40

that we think are good models and should be done in other parts of

the country.

Senator SPECTER. Dr. Blumenthal, you are in charge of research

at the National Institute. A two-part question.

Do you think adequate resources have been directed to this problem, and what would you like to see done for the future?

Dr. BLUMENTHAL. Well, I think suicide is a tragic human problem and it is the end point for many human problems. So I think when you ask what are the causes, I think there are many and

that we need to continue to conduct research. I think that we have

very recently developed some useful information about psychoso- cial factors, about psychiatric factors, and about biological factors

involved in suicide. I think we need to do more studies that really will tell us more definitely about these factors. We also need to

detect mental illnesses earlier in our young people and to prevent

illnesses that may be associated with suicide. I think that perhaps the media has given us a kind of false im- pression that suicide comes out of the air, and while for some

number of people it may seem that there are no underlying causes

apparent. But there may be tremendous stresses on-going and a youngster may feel that life is not worth living any more. I think

there are many subgroups of youngsters who may decide to and

their lives. There are youngsters who are very perfectionistic and

families that very much need them to remain that way. There are youngsters who are, as Dr. Silwr told us, because of impulsivity

and aggressive behavior, more apt to get in trouble with the law, who run away, who get in trouble in school, and who are tremendous risks because they make people in their environment angry with them and yet these people do not recognize the signs of de- pression. There are many depressed youths. In your State, for example, Senator, there are a number of centers at the Western Psychiatric Institute and the clinic at the Uni- versity of Pennsylvania where research on depression in adoles- cence is going on that will add to our understanding of these risk

factors. I really think that as we destigmatize mental illness in our country, and increase the public awareness that young people are

suffering when their sleep gets distuibed, when appetite is disturbed, when they do not concentrate, when they lose pleasure in

activities like school and sports that have usually given them enor- mous pleasure. We need to recognize the signs telling us when they

get depressed and they may feel life no longer is worth living. If we can intervene earlier, and if we can translate our research into

clinical practice and work with the communities and work with

parents and volunteers who are interested in this problem,. then I

think we will have a much increased ability to prevent suicide in

this country.

Senator SPEC7'ER. Doctor, my question, the final one here, are we devoting adequate resources, Dr. Blumenthal, to this problem? Dr. BLUMENTHAL. I think that Dr. Silver would need to answer

that question.

Senator SPECTER. Well, I would be glad to have him answer it after you do. You are on the front line.

Dr. BLUMENTHAL. Well, I think that we are. I think that there

are always other projects that can be done.

-44
41

Senator SPECTER. Senator Simon.

Senator Sox. Thank you, Mr. Chairman. How does our suicide rate among teen-agers compare to other countries, Germany, Japan, Sweden?

Dr. BLUMENTHAL. We are somewhere in the middle. Countries

like Czechoslovakia, Bulgaria have higher suicide rates. We also

know that we are the only country where guns are the most promi- nent method of suicide.

Senator Salm. What are some countries that have lower suicide

rates?

Dr. BLUMENTHAL. England, for example, is really Senator Sum. Are there any patterns? We are talking about 15

to 24 as a conglomerate group, but are 15-year olds more likely, 16- year -olds? Do we see a higher suicide rate among blacks than

among whites?

There must be some patterns emerging in all of this;

Dr. BLUMENTHAL. We have some trends. I think others have addressed themselves to the fact that the national suicide rate has

tripled ;n the past 30 years. The rate' has stabilized at a relatively high rat- n. youth 15 to 24 years of age over the past 2 or 3 years. The bulk of suicides occurs in the 20- to 24-year-old age group, but the 15- to 19-year olds are also at risk. The rate in the 15- to 19- year -old group has risen and continues to rise somewhat, but we

are seeing an alarming increase in youngsters aged 10 to 14. One caveat, we must remember that many suicides are not reported because of the stigma attached, and because coroners do not report it as such because of the difficulties that parents and physi- cians have in calling it a suicide attempt or a suicide. We know

that more young boys complete suicide at a ratio of four to one, and we know that young women attempt suicide four times as fre- quently as boys. There may be very different risk factors for sui- cide than those present in these two groups. In other words, the

completers and attempters may be different and there may be different risk factoid. We really need to develop ways of identifying

those young people at highest risk to be able to prevent suicides. That is what our work is aimed at at the National Institute of

Mental Health when we fund research ot centers such as those in

Pennsylvania and in other parts of the country. We are really

trying to be able to develop psychological tools, clinical tools, and biological markers for suicidal behavior. We also want to work with families because we corsider that critical. You may be able to

treat a youngster, you may LOC able to identify what the underlying problems are. But if you do not involve the family, and if the

family is not sensitive, if the public is not sensitive to this tragic human problem and to the hurt and pain of the youngster, then

the youngsters are going to go back into an environment where

they may reexperience the problems that they are having. Senator Salm. Again on the subject of patterns can you spell out any ethnic or geographical pattern? In other words, in Illinois do you have patterns similar to Pennsylvania or Ohio. Is there anything that differentiates this problem at all?

Dr. BLUMENTHAL. Again, underscoring the fact that suicide com- pleters and attempters may be different groups, with girls attempting four times more frequently, the West has a higher rate of sui45
42

cide than does the Sun Belt. It is postulated that increased mobility

in the society, the fact that perhaps there are not the kinds of

family ties in people who have moved West, that this may be a risk

factor, but that is something we need further research on. Finally, in terms of method, guns are the method that most young people use. An alarming trend has been that since 1970 more young women are using guns as the primary method of killing themselves. Before that, they had been using medication. When people used medications or poisons they are less likely to succeed

in completing saicide than when they use a very lethal thing like a handgun or a rifle.

Senator SIMON. Another question that any one of you may wish

to address.

I was in the Chicago area where on the radio they say if you are

considering suicide, call a certain number. Are these programs effective? Can you tell?

Dr. BLUMENTHAL. We believe that suicide hotlines and prevention centers are important links for people who are distressed. These people will be able to call a number if they do not know

where else to call, and that this would be a kind of lifeline. I think

it is very important that suicide hotlines work with mental health professionals in getting that kind of input because when you are dealing with a potential suicide, you are dealing with an emergen- cy in the sense that a person might die. I believe that the research

that has been done evaluating suicide hotlines has not been definitive. It is not clear that suicide hotlines prevent suicide, but they may be helping people in distress. I think we need more research on this and we hope to sponsor some research in this area.

What we do know is that in the literature on adults, at least 60

to 80 percent of the people who kill themselves have a serious level of depression. When we have major mood clinics that treat depres- sion, that detect it early and treat it well, we kiiow that the. rates of suicide have been lowered. For example, at Columbia, the Uni- versity of Tennessee and UCLA, 9,000 patients were followed for 9 years and they found only five suicides where they would have ex- pected 55. So I am suggesting that there are many strategies to

prevent suicide and we need to use as many as we can and we need

to mobilize as many people as we can in the community,. in the medical profession, among parents and all of you who have interest in this area. There are many strategies to do that. From the research findings, we believe that one of the major pre- vention strategies is the early detection and treatment of depres- sion and other behavioral disorders, and to also get the message to

children that it is all right to fail sometimes, that they need not be

so perfect. We believe that with this kind of sensitivity to the kinds of stresses and pain that young people have, and the kinds of emotional problems they may suffer, we will help to decrease the sui- cide rate in this country.

Senator SIMON. Thank yOu. Thank you, Mr Chairman.

Senator SPECTER. Senator McConnell.

Senator McCoNNELL. Senator Simon asked if there are any geo- graphical statistics in terms of suicide, and is it more likely to

46
"le

43

occur in one area of the country than the other. I think you indi- cated there were not.

Dr. Buntiorrnm.. No, Senator. It is higher in the West and

higher in the Sun Belt.

Senator MCCONNELL.. In terms of the life style of the children, is

there more of a tendency for it to happen in cities as opposed to

rural areas?

Dr. Sum. To explain the state of our art at this point, it is very

difficult to get accurate data because the coroners, the medical ex- aminers do not necessarily report all suicides or report them as sui- cides. By working with the Centers for Disease Control, we are

trying to come up with a better definition. We are working with

coroners and medical examiners to see if they would be more coop- erative in terms of what they report, so we really only have the tip

of the iceberg in terms of the data available. We did a study of all reported cases recently, the Centers for Dis- ease Control and National Institute of Mental Health and showed

some of the trends that Dr. Blumenthal mentioned in terms of

where it is located, raised a lot of good questions such as the ones you are asking, and they are now going back and reanalyzing these data to see if we can come up with more information. Senator Mc Comm.. The reason I asked is my State is a largely

rural and small town State, and I have been fairly active in a vari- ety of different children field's over the years. I do not recall this

subject coming up anywhere except in Louisville, which is our larg- est city. That is the reason for my curiosity. Dr. &Lyn. The data reported would suggest more urban than

rural, but we do not have all the data yet.

Dr. BLUMENTHAL. One of the odd things we have noted is that there was an outbreak in a rural community in Minnesota among youth last year. We also note that among farmers there has been

an increase so it may be that wherever there is one of the important risk factors such as a humiliating life event which may precipitate a suicide or precipitate a depression in young people or adults as well. We have seen that pattern in over 90 percent of the cases. An event such as an anticipated confrontation with a parent about

truancy or failing at school, or not getting into the college of your choice or having

Senator McCoN-NELL. One major feeling that precipitates the act? Dr. BurainrniAL. There seems to be something associated with

the actual suicide completion. If you go back and do a psychological autopsy, go back and talk to the parents and talk to the friends, talk to the brothers and sisters and the high school teachers and

you look at the medical records, and you try to put it all together, you find that everyone has a different opinion of what happened with the child and that you are able to reconstruct what was going

on in their lives.

From these studies we found that for most of these kids, although there was that precipitating humiliating event, there was also something else that was going on in their life, that they had problems, they were disturbed, depressed or impulsively angry kids. Not all of them. Another group were very perfectionistic youngsters who really feel compelled to succeed and feel tremen- dous pressures to do well.

47

4

is
44

Senator Mc CosNxu.. Is that more often the case than a child frequently experiencing setbacks?

Dr. BLUMENTHAL. The current research suggests that those youngsters may be more in the minority, but Senator Mc- Comm& Which?

Dr. BLUMENTHAL The perfectionists.

Senator McCONNELL. Are less likely to commit suicide?

Dr. BLUMENTHAL. We do not have all the information, but what we do know is that there is a group of youngsters who are more perfectionistic. There seems to be less of themin other words, the perfectionists make up less of the number of the completed sui- cides.

Senator McCoNNELL. The perfectionists make up fewer of the

completed suicides than those who suffer more of a series of humiliating setbacks?

Dr. BLUMENTHAL. I am sorry. I must be confusing you. In 90 percent of the completed suicides, there is some humiliating life event that precipitates the suicide, such as a breakup in a

relationship, a confrontation for truancy or something that really was a blow to that young person's self-esteem.

Senator McCosNELL. I understand.

Is that likely to be the straight A student?

Dr. BLUMENTHAL. Those are the minority of the youth suicides. Senator McCoranzu. That is what I thought you said. My other questions have to do with the rest of the family, other siblings.

Any indication that there is a likelihood that another sibling would do the same thing or is that usually the end of it for a

family?

Dr. BLUMENTHAL. We cannot talk about suicide without talking

about the survivors, the people who are so hurt by the abrupt loss of someone they have loved, and the guilt that 'they may feel and

the horror they may be experiencing about this tragedy. We know when a young person kills themselves in a family it may disrupt

the whole family, and other youngsters in the family may be at risk because of, I think, the tremendous confusion which is created.

We also have information that indicates the risks ',here there is

a family history of suicide. For example, if a father or mother or an uncle committed suicide, that a young person is at eight times greater risk of killing themselves than normal, and we do not know

why. Dr. Silver addressed this. It may be through the phenomenon of identification that the young person has grown up in a family

situation thinking about suicide as a possibility. Senator McCornism Do you have any statistics on siblings com- mitting suicide?

Dr. BLUMENTHAL. We do not. But we know they are at risk. Senator McCoNNELL. Secretary Hardy and I were talking before

the hearing about the likelihood of divorce occurring after a suicide, and I wonder if any of you have any statistics on that? Dr. BLUMENTHAL. Again we do not have good statistics, but I believe that as in any other tragedy, for example, where you have the children or the parents of youngsters who die of cancer or leukemia, you see a lot of family stress. We hope during these times that with the care of family and friends, with community agencies in48
45

tervening, with the help of mental health professionals, that fami- lies can become closer and try to understand this loss. I think it does put stress on families, and this is a question we really need to address, the question of what happens to survivors and how can we help.

Senator McCoranaz. We do not have statistics in either of those areas?

Dr. BLUMFaTTHAL; No, unfortunately.

Senator McCoNNia.L. Thank you, Mr. Chairman. Senator Smarm Senator Metzenbaum.

Senator MirrzENBAubt. Dr. Blumenthal, is there usually a threat in advance where the child tells his friends or her friends or the parents that I think I will take my own life? Is that common or is that a rarity?

Dr. BLUMENTHAL. We believe that often a youngster gives a warning sign. They say something like I wish I were dead or,:you will be better off without me. There have often been some. signs, but families and friends often cover this up because they do not want to hear it and do not really listen. I think one of the things that we want to educate the public and mental health care profes- sionals about is to really hear when a young person or an adult is feeling this kind of distress. Also there have been other warning signs. Often a youngster is not sleeping well. They have lost their appetite. They are fatigued

or they may become very agitated. They lose interest in things that usually give them pleasure. They withdraw from friends and family. There are sudden behavior changes, an outbursts, and feeling an inappropriate sense of guilt or self-reproach such as

saying I am not good enough, I am disappointing you. So these things may be patterns, but I think because families do not know what to do, the public does not know where to turn, and because we still have a stigma about reaching out for help in this country, that these problems build up. I h. k that families again do not hear, and that is what all of us who are here would like to communicate, tbat health care professionals, mental health care specialists, the public and community agencies really need to join together to increase awareness about what these warnings signs are. We just need to hear them, recognize them and intervene. It is important to communicate information to health and mental health clinicians and to the public on teen suicide. The NIMH is nt. N preparing an updated monograph for the general public, a videodisc on the assessment of teen suicidal behavior for medical students and resident trainees, and a monograph on black suicide.

NIMH sponsored a workshop on preventive intervention resear .11 in December 1982 and will hold a series of knowledge transfer

research planning workshops over the coming year. A 3-day confer- ence on suicide will be held in September cosponsored by NIMH

and the New York Academy. of Sciences. A conference for the gen- eral public and for professionals is planned fol mid-June 1985, sponsored by the DHHS [OHDS] and implemented by ACTION. Senator METZENBAUM. My understanding is that those signals are there. Now Dr. Silver has talked about all of the studies that

have been made and are going to be made. You have just said we

50-321 0 - 85 - 4 .49
46

should be alerting the families and others, friends, as to these warning signals. What is of greatest concern to me is the results of all the studies

that have been made since 1960 and merely to learn that more boys are successful than young girls does notand more young women make the effort but are nist that successful, that there are

more done in the West or in the South, and I have a feeling that we may be spending literally millions, I-do not know how many

tens of hundreds of 'millions we are spending in the three Govern- ment agencies represented here, or maybe there are two, and I am

a little frustrated.

You say we want to alert. Why do we not? Why do we not? Dr. BunsnrrnAL. Let me comment a little on research.

In the sixties there was some money that was put into establishing suicide prevention centers and suicide hotlines and doing early

research in this area There really was not very much research

done after that early research. In 1981 NIME established a Suicide

research unit. Since the establishment of that unit, we have been

stimulating new research in the area of suicide and it is a very dif- ferent kind of research from the earlier research. It is research

that addresses very carefully issues of methodology because many

of the early studies were very flawed. Senator ,urs. What?

Dr. BLUMENTHAL. Many early studies were flawed in terms of the

fact that suicide is a very difficult problem to study, and that it happens fairly infrequently, although we are telking about it hap- pening at a very high rate. But it is a hard subject to follow and it is hard to withhold an intervention, to withhold the treatment

from someone who may be suicidal.,But there is now a new generation of research since 1932 that is really starting to look at psychological factors and biological factors and is comparing those two

control groups to people who do not have any problems so that we

can scientifically compare various control (groups. Everyone says how do you distinguish between a youngster who

is going through everyday adolescent tur-toil and one who may be

suicidal, but we have not had studies iii, the past that have ad- dressed that issue. We do not currently have that knowledge but we hope that in the next few years we will have answers to this problem. Dr. SILVER. I would like to give another example, Senator, where

tht research is just evolving. Suicide, as we know, is a lethal disorder and, therefore, you

cannot interview the person who committed suicide. You can try to

learn from family, fiends and others. If you go in and interview

the family within the first 72 hours or a week, you are likely to get one set of responses. They are hurt, numb, there is no evidence he was other than a perfectly normal kid who suddenly committed

suicide. You come back and see them in 6 months or 12 months or

in some of the followup studies at 2 years, and you get new infor- mation each time. As the pain has leoened, they are better able` to

talk. In some cases, they will give you more facts: In other cases, with the passage of time and the need for to deal with the

pain, they give you less information. So the problem we have is it

is not like treatmg someone with an illness while they have the ill-

.50

A
47

ness. The illness causes death so our research can only try to retro- spectively understand, and the informants are not always able to give you all the information, and especially when we get to teen suicide which is perhaps even a more painful loss for parents, even though it is always painful.

Senator MicrzxNBAtim. Let me ask either do:tor, are there kinds of clinical studies which are made with young people generally, with large groups of young people trying to probe their thought processes, whether they have considered suicide as an alternative

while they are living? Because I get the feeling that we are coming up with statistical data but, having said that, it does not seem to get us very far.

I noticed that Dr. Hardy indicates that every 90 minutes there is another teen-age suicide in this country. Did I read that correctly, that every 90 minutes another young person takes his or her life in this country?

Ms. HARDY. That is our understanding, yes, Senator. Dr. Srx.virs. Senator, I think our research is multiple. It is not just the one you are mentioning. We are trying to understand what causes suicide in people who completed it. There are also studies going on to study normal populations of children, of adolescents, of young adults, and in terms of how many

of you have thought about suicide, how many of you considered it, how many of you actually t, ied it but did not tell anyone, and

those data are just coming in.

We are also trying to do something before we have all the facts, and that is the preventive efforts you will have more about later this morning and other efforts to try and educate the public to make them more sensitive so they can respond, and also trying to work with the hotlines, with the crisis intervention centers to make them as maximally efficient as possible to prevent problems. Senator METZENBAUM. How often do you have or does somebody have group sessions with young people, rap sessions, encounter groups where young people are told, or you try to get into their heads as to what they are thinking, not that that group is the challenge or the problem, but the fact is that maybe you can get some insights into it.

I still get the feeling, Dr. Silver and Dr. Blumenthal, that this is in your mind something that thinking about or looking at is a matter of we are going to find some further research. And what concerns me is the need forcertainly I am realistic enough to know you cannot press a button and solve a problem of this kind. Yet I am also concerned how much of the money is used for clinical studies and how much of it is used for laboratory studies and how much of it is used for statistical analysis, and how much money is spent in this area now by the government?

Dr. SILVER. The National Institute of Mental Health is spending approximately $1 million a year on the kinds of research we are

talking about. However, at the same time, we are working very closely with ACTION, the group that is funded by the Office of Human Development Services, to develop what you are talking about.

Senator METZENBAUM. How much are they spending?

51
48

Ms. HARDY. Senator, we have, as I indicated earlier, a variety of programs that touch upon this. We have the runaway youth shelter program, and we see that many of our teens who run away also

have a variety of other problems which can lead to suicide, so there are places like Huckleberry House in Columbus that are being

funded to do these kinds of community-based programs you are

talking about. We also, as Dr. Silver indicated, are working with ACTION, and

they are reaching out through their volunteer networks throughout

the country. We anticipate a conference at the end of the summer. Senator MErzerniAum. What kind of interreaction do you have with the suicide crisis centers that exist in the country? The Feder- al Government funds those or funds portions of those, do they not? Dr. Su ve& No, sir, any funding for service delivery is done under the block grant with the States, and perhaps when Charlotte Ross testifies later, she can tell you more about how these centers are funded. Some are by States, some by non-government groups. There are various models that are funding them. Our role is to be available to them or to help them, we hope, in the near future, to

set up further studies with them.

Ms. HARDY. Senator, in addition, some of our dollars on the services side in terms of runaway youth money are linking with many of these teen suicide prevention centers at the local level, such as

the one in Columbus, OH.

There are others around the country that we have just funded. In fact, this week $600,000 was funded to link our runaway youth

shelters with the suicide prevention centers for teens at that local

level.

Senator MgrzimAtrm. I am concerned, Dr. Silver and Dr. Blu- menthal, th it $1 million to provide research in this area is like a good tip at the Stork Club in the way we operate around Washington. It is such an insignificant amount that I just am shocked at its paucity.

Dr. SILVER. This is money targeted for teen youth suicide. We are doing a lot of research around depression which will have a spinoff on this subject. There is research going on into biological factors, especially where we find an elevated Seratonin level with many

successful or attempting suicidal individuals who have egg ive

behavior. There is a lot of other research going on. The milliondollars is only that which is targeted for the psychosocial, epidemiologic and other types of research we have talked about.

Senator METZENBAUM. Does any of that involve group research?

In other words, encounter groups, talking with young people, meeting with them, trying to get them to explain why their colleagues and their friends think about committin? suicide?

Dr. &Lyn. I cannot think of any specific ones on that. Dr. Burnie/4mm.. No; there are not. I think though that this is an activity that goes on at the local level in schools and so forth. I

think what our hope would be is to work with some of these groups, with the suicide hotlines and crisis centers, and to encour- age more of a collaboration through the American Association of Suicidology, between mental health professionals and these hotlines. Remember, the hotlines are pretty much manned by volunteers. If you think about the fact that suicide is a life-threatening

52
49

problem, how many people who are untrained could really provide a helping hand, could tell someone where to go for help in that kind of crisis. I think that you really need to be able to turn to a

lot of other sources for help and families need to learn to do that.

Senator MEIZENBAUM. Dr. Blumenthal, if you were asked, not necessarily before a Senate committee, how much money do you

think we ought to have available to provide further studies and do that which has to be done in this area, would you answer a million

dollars or would you answer some different figure? Dr. Silver, you may answer. Dr. Smvsat. If I may preface my answer by the fact that suicide is a national problem, not necessarily a National Institute of Mental Health problem. We have to talk about what needs to be

Senator MgrzmuAum. Whose problem is it if not the National

Institute's? Tell me who else should do the funding?

Dr. SILVER. I think a lot of other entities are involved, the Office of Human Development Services is involved. ACTION is involved. A lot of public and private sectors are helping to fund activities. Senator METZENBAUM. Doctor, you are bouncing around with me.

Tell me how much money you think the Federal Government ought to fund? They are not doing direct research in this area. Tell

me how much money you think the Federal Government ought to put in this when every 90 minutes there is another youth suicide?

Dr. SILVER. I think you have to balance it off. At the moment we

are talking about a very serious problem with 5,000 people a year. We could be talking about cancer, we could be talking about heart disease, and I think given the economic realities of the country at the moment that we are putting in an adequate amount of funds to

try and solve this problem, trying to expand it by working with other components of the Government and outside of the Government.

Senator METZENBAA3M. I am embarrassed for you for that answer, doctor. I think it is a terrible answer. I think if you had a real com- mitment to do something about this, you would agree that $1 mil- lion is a totally inadequate amount of money to be putting into this area. And to tell me about the economic realitiesthere could be

5,000 kids a year we lose, and you are telling me that $1 million is enough to put into research?

I remember when I was co-chairman of the National Citizens Committee for the Conquest of Cancer. We put $1 billion into

cancer and I do not find any problem about that at all. Here we

are losing 5,000 kids. There we lost about 350,000 or 400,000 Americans a year.

Dr. SILVER. Senator, you are picking on one thing, the amount of money being spent on youth suicide. Remember again the millions of dollars we are spending to study basic psychiatric disorders like

depression that contribute to it, biological factors research that is

going on, the research that is going on in the Alcohol and Drug In- stitute, the relation of substance abuse to suicide, the work that is

being done in the Centers for Disease Control, the other studies

that are being done. You are picking one topic which is specifically

targeted to study the psychological and social issues related to teen suicide.

53
50

Senator MgrzENBAtat. Indeed I am. All the rest of it has to do with special emphasis Your direction is ostensibly in the field of

child suicide.

And I want to say, Mr. Chairman, that I am not exactly sure when this will come before us for authorization, but when it does, I

would certainly move that we substantially increase the funding in

this area. I just cannot believe that $1 million for child suicide investigation is enough, and I hope you would join with me.

Senator SPacrax. Thank you, Senator Metzenbaum. I start off as I did on the questions of what are the resources, where are we heading, what is adequate? What I would ask you to

do, Dr. Silver, Dr. Blumenthal, and Secretary Hardy, between now

and the time that there is a markup in the Appropriations Com- mittee, which I think is probably going to deal with it must directly, with the Subcommittee on Health and Human Services where I

also sit, I would like to see you come to grips with some of the practical answers as to how your research would interact with the

crisis prevention centers. There has been a certain amount of frustration by everybody on the panel this morning, and that is the purpose of a legislative hearing, to have our ideas tested against what you are doing on the research and/or in the executive

branch. But Senator McConnell is concerned about the absence of

statistics and Senator Simon is looking for some patterns, and I am

looking for some hard indicators. And the testimony you have given is as scientifically accurate as you can provide, but it seems

to me that the problem has gone on so long and there has been so much research that we have come to a point where you ought to

say what does our research tell us as we can best generalize, and how can we use our research to date with the crisis intervention

centers, what can we do to advise parents about the danger sig- nals? Perhaps it boils down to saying on a public announcement

teenagers, if you feel depressed, or if you feel like you are going to

take your own life, for God's sake, tell somebody, and then to the parents or the teachers, if somebody has brought you a danger signal or has told you something, let us get somebody into the picture who can provide psychiatric help. But the pace is less than a

snail's pace

I think Senator Metzenbaum is co,Tect about that. I think that is

the sense as to where we are going. At this juncture I would like to put into the record a letter from

the superintendent of schools of Philadelphia about the TALK - LINE' which has been put into operation there, and that suggests

the time has come for some of the practical approaches and the generalizations as best we can deal with it. The scientific research

is indispensable, and I applaud the work you are doing, and I know

that it is difficult to pick a figure out of the air. And I suppose, Dr. Silver, you would nut turn down $1 billion if David Stockman would authorize it. But we understand the constraints that you op- erate under, but you would like to pursue it in the future. I agree with Senator Metzenbaum that we ought to follow this

more closely in this subcommittee. Senator Mgrzarrimum. Dr. Silver, in David Stockman's world, anything up to $50 million is not even an item in the budget, so

'See appendix page 78.

54

-41
51

you can get up to another $48 million and you will never even come to his attention.

Dr. &NEL Senator, the material that you want, translating what we already know into something that is practical and useful, is exactly what ACTION will be doing under the funding frcm the Office of Human Development Services. These are the pamphlets

that will be coming.

Senator Smarm That defines what ACTION is doing, but I am

interested in what NIMH is doing.

Ms. HARDY. That is the research, Senator, and I think what you have been talking to us about is ACTION, those activities and the

kinds of things that come out of the research and how best we can

use our research, and I think we have given a lot of gcod examples and can provide you with a lot more that really show what we are doing at the community level. And it is not just us. It is a lot of

people.

Senator SPECTER. ACTION has dealt with Dr. Silver and Dr. Blu- menthal. Maybe they have gotten more specifics than what we have, but what I am urging, and we have got to move on to the next panel because time is flying, is to see to the extent it is possi- ble that you relate your very good research work with some of the practical aspects of it.

Dr. Blumenthal, you have one last comment?

Dr. BLUMENTHAL. While research goes on, we have many activities that try to translate the results of that research into clinical practice. We work with communities, with the media, we publish

information, and we work with our scientists to disseminate information about depression and about youth suicide. I think that

there are a number of activities underway and certainly many more that we would like to do and could be doing, but I think this

Senator SPECTER. Tell us about those. Tell us about the ones you would like to do and what you think it would cost us to do it.

Dr. BLUMENTHAL. I think there are a large number of research

questions to be answered.

Senator SPECTER. I do not mean for you to tell us now, but tell us between the time we are going to deal with it on appropriations. We thank you very much.

[Subsequently, Dr. Silver furnished the following information:}

As you have asked, I would like to suggest my best judgment regarding an ex- panded budget for NIMH research on youth suicide. I have broken down the needs into three areas. The total is $2 million. (This amount includes the $1 million cur- rently targeted for teen suicide research.)

RESEARCH -$1.8 MILLION

To expan3 current research on psychosocial, biological, risk factor research; To develop research focusing on teen suicide;

To develop longitudinal studies of suicide attempters;

To expand preventive intervention research (evaluation of hotlines, crisis centers); To evaluate effectiveness of educational programs; and To develop new intervention strategies.

KNOWLEDGE TRANSFER -$O.1 MILLION

To hold research planning and clinical intervention workshops/conferences; and

To develop literature on current knowledge/state of the art for lay public, policy makers, health/mental health professionals.

55 ri
52

INTERAGENCY/ORGANIZATIONAL ACTIVITIES -$O.1 MILLION

To expand collaborative research with CDC; and

To develop collaborative activities with American Association of Suicidology and

other organizations.

Senator SPEcrint. We would like to move on to the next panel of

Dr. Pamela Cantor, president of the American Association of Suicidology, Chestnut Hill, MA; Heidi Bilodeau, Boston, MA; and Charlotte P. Ross, cochairperson of the National Committee for Youth Suicide Prevention and director of the Youth Suicide and Crisis

Prevention Center of San Mateo County, CA.

Welcome and, Dr. Cantor, we would like to begin with you. If you would summarize, all statements will be made a part of

the record, and to the extent you can summarize, leaving the maxi- mum time for questions and answers, we would appreciate it.

STATEMENTS OF PANEL CONSISTING OF DR. PAMELA CANTOR,

PRESIDENT, AMERICAN ASSOCIATION OF SUICIDOLOGY,

CHESTNUT HILL, MA; HEIDI BILODEAU, BOSTON, MA; AND

CHARLOTTE P. ROSS, COCHAIRPERSON, NATIONAL COMMITTEE

FOR YOUTH SUICIDE PREVENTION, DIRECTOR, YOUTH SUICIDE

AND CRISIS PREVENTION CENTER OF SAN MATEO COUNTY, CA

Dr. CANTOR. Thank you, Senator Specter. It is a pleasure to be here. If I might I would like to take a moment before turning to my prepared remarks, to answer two ex- cellent questions that were asked before. A question was asked "Where does the United States stand in

terms of our statistics on youth suicide?" There are World Health Organization statistics to show that Switzerland is the highest rated in terms of youth suicide followed by Austria, Canada, and

the United States. We are fourth. In Switzerland, it is 29 young- sters out of every 100,000 who commit suicide. In the United States, is approximately 12.3 out of every 100,000. The lowest rate

is in countries such as Israel and Egypt, which have a rate of approximately .03 percent per 100,000.

The second question concerned the geographic distribution of ad- olescent suicide. The increase in adolescent suicide has been pri- marily a Western phenomenon. We have tremendously high rates

in States, such as Nevada-27 per 100,000and low rates in the, Eastern Seaboard States such as New York, New Jersey, Massa- chusetts and Connecticut. It seems that suicide is largely a problem

of isolation and it is largely a rural rather than an urban phe- nomenon. It is possible that this is related to the fact there are

fewer social services and more isolation in these Western States.

I am Pamela Cantor, president of the American Association of Suicidology. The association is a national organization of approxi- mately 1,000 members representing psychiatrists, sociologists, psy- chologists and others. It was organized in 1967 to study the causes and prevention of suicide. It has been mentioned that 5,200 adolescents kill themselves

every year. It has not been mentioned that approximately 500,000

adolescents attempt suicide every year. This means that one adoles- cent commits suicide every 90 minutes in the United States. Per56
53

haps even more startling is the statistic that one adolescent attem is suicide every minute in the United States. This is a national health problem of epidemic proportions that is

selectively affecting our youth. In the last 20 years, the mortality rate for every age group in the United States has improved except for the group of young people, ages 15 through 24. The mortality rates for this age group have in- creased. The two types of death which are largebr responsible for

this increase are suicide and homicide. Both of these have doubled in the past 20 years, and both reflect social factors more than any

other cause of death.

What can we do, as you have so astutely asked, to reduce these

alarming statistics?

I have been asked to make specific: recommendations for inter- vention which would have an immediate impact. Clearly we need

research. We need research into biological and affective disorders, and epidemiological research. But we cannot wait for another 20

years for these answers.

I have been asked to make two specific recommendations to you based on my 16 years of research, treatment and public education

in the field. One recommendation is to conduct school programs in

suicide prevention for students and teachers, and community edu- cation for parents. Educational intervention is difficult to evaluate because of the absence of data However, over a period of years, it appears that education would have a great potential for decreasing

self-inflicted mortality. I use the analogy of sanitation and its effect on infectious diseases. More lives have been saved by preventive

sanitation measures than by antibiotics. Based upon studies of the effect of public education in the areas of child abuse, discrimination and drunk driving, it is estimated that self-inflicted mortality

for children and adolescents could be reduced by about 20 percent

through public education.

The second recommendation, and perhaps the most important strategy in the fight to stop teen-age suicide, is the limitation of

the availability of lethal agents.

The increase in suicide among young people can be accounted for almost entirely by firearms. Guns now account for more suicides

than all other methods combined. Sixty-five percent of all teen sui- cides are committed with firearms. An environmental reduction strategy would call for the decreased availability of handguns

to children and adolescents. Some 25 million households have

handguns and one-half of these keep their handguns loaded. Adolescents are impulsive, and having a loaded handgun in the house

is an invitation to disaster.

Mandatory safety training programs and public education in the dangers of handguns in the home would not resolve the underlying problems of self-esteem and depression which drive our young

people to suicide, yet it would result in fewer deaths. Here I use

the analogy of mandatory seatbelta. Seatbelts do not make people better drivers, but they do improve the chances of surviving a collision.

The estimates we have are that 65 percent of teen suicides are

caused by guns. Epidemiological studies estimate that 70 percent of

those victims would not have obtained handguns if there were

57

ti

r.
safety gun regulations, and some 50 percent of these individuals would choose other means, and thus we estimate reduction in firearm accessibility could save the lives of approximately 20 percent

of our youngsters. One example involving the cooperation of police and parents towards education with regard to handgun safety has

been developed by the Handgun Information Center.

Senator SPEcrxx. Dr. Cantor, your entire statement will be made a part of the record. If you can summarize, we would appreciate it. Dr. Ciarron. What we have learned with this is when highly

lethal methods of suicide are made less available, there is evidence

to show that teens do not switch to other means. When the English

converted their highly lethal coke gas as a means of home heating

to nonlethal natural gas, the suicide rate dropped 33 percent. This

low rate has not come up again despite economic unrest in England.

Poisoning, usually with prescription medicine, is the second most commmon method of lethal suicide, accounting for 11.3 percent of all suicides. The availability of lethal drugs could be limited by re- stricting the number of tablets permitted or each prescription. This kind of registration on sedative and hypnotic drugs is thought

to be largely responsible for the decline in suicide rate in Australia

in the 1960's and 1970's. In addition, the tricyclic antidepressants could be sold with an emetic or antidote. If the teen overdosed and

changed his mind, or was found, an antidote could be given and a

life could be saved.

The cost of suicide in terms of mortality, the effects on lives and

the cost of health care are great. Numerous factors are associated with the problem of suicide, and each suggests a specific set of

interventions. The majority of risks for teenagers, however, center on two areas: the cultural pervasiveness of violence and negative

social factors such as emotional neglect and stress. The interventions which would appear to have the greatest impact on youth sui- cides are the limitation of the availability of firearms and medication together with public education programs.

[The prepared statement of Dr. Cantor follows:]

58
55

PREPARED STATEMENT OF DR. PAMELA CANTOR

MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE. I AM DR. PAMELA

CANTOR. PRESIDENT OF THE AMERICAN ASSOCIATION OF SUICIDOLOGY.

THE AMERICAN ASSOCIATION OF SUICIDOLOGY (AAS) IS A NATIONAL

ORGANIZATION OF APPROXIMATELY /000 MEMBERS REPRESENTING

PSYCHIATRISTS. SOCIOLOGISTS. PSYCHOLOGISTS AND OTHERS. WHICH WAS

ORGANIZED IN /967 TO STUDY THE CAUSES AND PREVENTION OF SUICIDE.

THE AAS TRAINS PERSONNEL IN SUICIDE PREVENTION AND INTERVENTION.

CERTIFIES SUICIDE PREVENTION CLINICS ACROSS THE COUNTRY. AND

DISSEMINATES INFORMATION ON SUICIDE PREVENTION THROUGH ITS QUARTERLY

JOURNAL. EACH YEAR. 5.200 ADOLESCENTS COMMIT SUICIDE IN THE U.S. AND 500,000

ATTEMPT SUICIDE. THIS MEANS THAT ONE ADOLESCENT ATTEMPTS SUICIDE

EVERY MINUTE. AND ONE ADOLESCENT TAKES HIS OWN LIFE EVERY NINETY

MINUTES. THIS IS A NATIONAL HEALTH PROBLEM OF EPIDEMIC PROPORTIONS

WHICH IS SELECTIVELY AFFECTING OUR YOUTH. OVER THE PAST 20 YEARS. THE MORTALITY RATE FOR EVERY AGE GROUP IN THE U.S.'HAS IMPROVED EX;PT THE GROUP OF AMERICANS AGED /5 TO 24.

THE TWO TYPES OF DEATH WHICH ARE LARGELY RESPONSIBLE FOR THIS INCREASE ARE SUICIDE AND HOMICIDE. BOTH OF THESE HAVE DOUBLED IN

THE PAST 20 YEARS AND BOTH REFLECT SOCIAL FACTORS MORE THAN ANY

OTHER CAUSE OF DEATH. WHAT CAN BE DONE TO REDUCE THESE ALARMING STATISTICS?

ONE POSSIBILITY IS TO CONDUCT SCHOOL PROGRAMS IN SUICIDE PREVENTION

FOR STUDENTS AND TEACHERS. AND COMMUNITY EDUCATION FOR PARENTS.

EDUCATIONAL INTERVENTION IS DIFFICULT TO EVALUATE BECAUSE OF THE

ABSENCE OF DATA. HOWEVER. OVER A PERIOD OF YEARS. EDUCATION WOULD

APPEAR TO HAVE A GREAT POTENTIAL FOR DECREASING SELF-INFLICTED

MORTALITY. I USE THE ANALOGY OF SANITATION AND ITS EFFECTS ON

INFECTIOUS DISEASES: MORE LIVES HAVE BEEN SAVED BY PREVENTIVE
1,.

56 ..,.

SANITATION THAN BY ANTIBIOTICS. BASED ON STUDIES OF THE EFFECT OF

PUBLIC EDUCATION IN THE AREAS OF CHILD ABUSE. DISCRIMINATION. AND

DRUNK DRIVING. SELF-INFLICTED MORTALITY FOR CHILDREN AND ADOLESCENTS

COULD BE REDUCED BY ABOUT 20% THROUGH PUBLIC EDUCATION.

THE MOST IMPORTANT STRATEGY IN THE FIGHT TO STOP TEENAGE SUICIDE IS

THE LIMITATION OF THE AVAILABILTY OF LETHAL AGENTS. THE INCREASE IN SUICIDE AMONG YOUNG PEOPLE CAN BE ACCOUNTED FOR ALMOST ENTIRELY BY

FIREARMS. GUNS NOW ACCOUNT FOR MORE SUICIDES THAN ALL OTHER METHODS COMBINED:

65% OF ALL TEEN SUICIDES ARE COMMITTED WITH FIREARMS. AN ENVIRONMENTAL RISK REDUCTION STRATEGY WOULD CALL FOR THE DECREASED

AVAILABILITY OF HANDGUNS. SOME 25 MILLION HOUSEHOLDS HAVE HANDGUNS

AND ONE-HALF OF THESE KEEP THEIR HANDGUNS LOADED. ADOLESCENTS ARE IMPULSIVE; HAVING A LOADED HANDGUN IN THE HOUSE IS AN INVITATION TO

DISASTER. MANDATORY SAFETY TRAINING AND PUBLIC EDUCATION ON THE LANGERS OF

HANDGUNS IV THE HOME WOULD NOT RESOLVE THE UNDERLYING PROBLEMS OF

SELF-ESTEEM AND DEPRESSION WHICH DRIVES OUR YOUNG PEOPLE TO SUICIDE.

YET IT WOULD RESULT IN FEWER DEATHS. HERE I USE THE ANALOGY OF

MANDATORY SEATBELTS: SEATBELTS DO NOT MAKE PEOPLE BETTER DRIVERS.

BUT THEY DO IMPROVE THE CHANCES OF SURVIVING A COLLISION.

CURRENTLY. 65% OF TEEN SUICIDES ARE CAUSED BY GUNS: EPIDEMIOLOGICAL

STUDIES ESTIMATE 70% OF THOSE VICTIMS COULD NOT OBTAIN HANDGUNS IF

THERE HAD BEEN HANDGUN REGULATIONS: AND SOME 50% OF THESE INDIVIDUALS MIGHT USE ANOTHER METHOD. THUS WE ESTIMATE REDUCTION IN

FIREARM ACCESSIBILITY WOULD SAVE THE LIVES OF APPROXIMATELY 20%

OF OUR YOUNGSTERS. ONE PROGRAM INVOLVING THE COOPERATION OF THE

POLICE AND PARENTS TO REDUCE FIREARM ACCESSIBILITY. HAS BEEN

DEVELOPED BY THE HANDGUN INFORMATION CENTER. THIS PROGRAM IS DESIGNED TO EMPHASIZE COMMON-SENSE SUGGESTIONS REGARDING THE

STORAGE. MAINTENANCE AND HANDLIIG OF HANDGUNS AND COULD REDUCE THE

NUMBERS OF HANDGUN ACCIDENTS AN) SUICIDES EACH YEAR. ATTACHED TO

THIS TESTIMONY IS A COPY OF ` HANDGUN SAFETY GUIDELINES." A BROCHURE DEVELOPED BY THE CENTER FOR THIS PURPOSE. 60
57

WHEN HIGHLY LETHAL METHODS OF SUICIDE ARE LESS AVAILABLE. THERE IS

EVIDENCE TO SHOW THAT TEENS DO NOT NECESSARILY SWITCH TO OTHER

MEANS. WHEN THE ENGLISH CONVERTED THEIR HOME HEATING GAS FROM

DEADLY COKE GAS TO LOW-LETHALITY NATURAL GAS. THE SUICIDE RATE

DROPPED 33%. THIS LOW RATE HAS REMAINED CONSTANT DESPITE THE BLEAK

ECONOMIC PICTURE IN ENGLAND. WHICH WOULD ORDINARILY BE EXPECTED TO

LEAD TO AN INCREASE IN THE SUICIDE RATE.

POISONING. USUALI.Y WITH PRESCRIPTION MEDICINE. IS THE SECOND MOST COMMON METHOD OF SUICIDE. ACCOUNTING FOR //.3% OF ALL SUICIDES. THE AVAILABILITY OF LETHAL DRUGS COULD BE LIMITED BY RESTRICTING THE

NUMBER OF TABLETS PERMITTED FOR EACH PRESCRIPTION. THIS KIND OF LEGISLATIVE RESTRICTION ON HYPNOTIC AND SEDATIVE DRUGS IS THOUGHT TO BE LARGELY RESPONSIBLE FOR THE DECLINE IN SUICIDE RATES IN AUSTRALIA

IN THE 1960s AND 70S. IN ADDITION. THE TRICYCLIC ANT.-DEPRESSANTS

COULD BE SOLD WITH AN EMETIC OR ANTIDOTE. IF A TEEN CP, RDOSED AND CHANGED HIS MIND. OR WAS FOUND. AN ANTIDOTE COULD BE GI N AND A

LIFE COULD BE SAVED. THE PROJECTION IS THAT THIS WOULD SAVE

APPROXIMATELY 3% OF TEENAGE SUICIDES PER YEAR. THE COST OF SUICIDE IN TERMS OF MORTALITY. THE EFFECTS ON LIVES AND

THE COST OF HEALTH CARE ARE GREAT. NUMEROUS FACTORS ARE ASSOCIATED

WITH THE PROBLEM OF SUICIDE. EACH SUGGESTS A SPECIFIC SET OF

INTERVENTIONS. THE MAJORITY OF RISKS FOR TEENAGERS. HOWEVER. CENTER

ON TWO AREAS: THE CULTURAL PERVASIVENESS OF VIOLENCE. AND NEGATIVE

SOCIAL FACTORS SUCH AS EMOTIONAL NEGLECT AND STRESS. THE INTF'-

VENTIONS WHICH WOULD APPEAR TO NAVE THE GREATEST IMPACT ON YOUTH

SUICIDE ARE THE LIMITATION OF THE AVAILABILITY OF FIREARMS AND MEDICATIONS TOGETHER WITH PUBLIC EDUCATION PROGRAMS.

I WOULD NOW LIKE TO INTROCDUCE HEIDI. A YOUNG WOMAN WHO FIRST

ATTEMPTED SUICIDE AT AGE /5 BY TAKING AN OVERDOSE OF PILLS. SHE WANTED TO DIE. AND WOULD HAVE USED A HANDGUN WERE IT AVAILABLE. FORTUNATEL1. SHE USED A METHOD THAT ALLOWED ROOM FOR RESCUE.

61
" `-',,,ft

, - - 

- t

I

s
59

LET'S

KEEP

HANDGUNS

'OUT OF

THE

WRONG

HANDS

63

';
ilOu M S1REET. N W

SUITE 9/0 WASHINGTON DC ARID

60

POUCE EXECUTIVE RESEARCH FORUM

GARY P HAYES

EXECUTIVT DIRECTOR

Dear Friend:

As police officers, we live each day with handguns.

Before we were issued our handguns we were carefully

trained and made to understand the serious respon

sibility of handgun ownership and the dangers of our

handguns falling into the wrong hands.

A handgun is a magnet for children, who too often mistake it for a toy The result each year is hundreds of

needless deaths and injuries.

Due in part to their accessibility, more than 100,000

handguns are stolen every year from law-abiding citizens. These handguns are often used to commit further

crimes by the burglar or resold on the black market.

Few realize that handguns in the wrong hands kill as

many Americans each year as do drunk drivers. As police, we are doing all we can to curb drunk driving. Like

wise, a handgun should be taken away from someone

who is under age, mentally disturbed or under the influ

ence of alcohol or drugs.

Many handgun tragedies could be prevented if additional safety precautions were taken by handgun owners.

If you are considering purchasing a handgun or already

own one, we strongly recommend you take the time to

read carefully the information contained in this brochure

It may save the life of someone you love.

Sincerely,

Lt. Anthony Chkma

Chicago Police Department

Lt. Mika McCarnpbell

Arlington County (Vs.)

Police Depart/slant

64

Lt. Jack Harris

111C11011 Ponca Department

Sgt. Robert klcDonnall

Baltimore County

Palle.* Department
61

Q

B -.1IL

K

E

A Front Sight

B Top Strap

C Cylinder Bolt Notch

D Rear Sight

E Hammer

F Cylinder Release

G Bacicstrap

H Barrel

1 Ejector Rod

J Cylinder

K Trigger Guard

L Trigger

M Frame

N iLock or Grip

0 The Cylinder

P Cylinder

Q Ejector

8 _AD

161111C. !FF- E N

J A Barrel and Barrel Bushing

B Front Sir ht

C Slide

D Rear Sight

E Hammer

F Safety Catch

G Tang

H Grip Safety

I Stock or Grip

J Main Spring Housing

K Frame

L Slide Stop

M Trigger Guard

N Trigger

0 Magazine Catch

P Magazine

65

ly

I
The decision to own a handgun assumes you are prepared to undertake full-time responsibility for your

weapon's safety and security. You must protect yourself

and your family members against misuse of the handgun by anyone who is either incompetent or unqualified

to handle the weapon. In particular, you must secure

your handgun from theft and misuse by children.

If you have a handgun, you must also personally assume

full-time responsibility for its safe handling and use, making sure you know how it works and how to maintain it.

You must also be aware of the circumstances in which

.iou may legally use a handgun for sell-defense.

If you have a handgun you should understand that it is a

lethal weapon, capable of inflicting death and disabling

injury on living targets. If not treated with utmost caution

and safety, it can accidentally discharge and result in

tragic consequences for you and your family. Studies

show that accidental handgun deaths in the home occur

most often while playing with the gun, examining or demonstrating the gun and cleaning or repairing the gun.

In the pages that follow, we describe step-by-step precautions that you can take to protect you and your family

members from being accidentally killed or maimed by

your handgun. It is your responsibility to put these safety

rules into practice.

Before we begin, you should know the parts of your

pistol or revolver, as illustrated on the preceding page.

Storage

As a handgun owner, safe and secure storage is one of

the most important responsibilities that you assume.

Only you and your spouse should be aware of where

your weapon is permanently stored. It should not be

within sight or reach of children, or accessible to burglars. Specifically we recommend that you:

Store your handgun unloadod and uncocked in a

secuiely locked container.

Store your handgun and

its ammunition in separate locations.

Do not store your handgun among your valuables, such as jewelry or

silver.

Do not store your handgun in a bedside table or

under your mattress or

pillow.

Child-proof your revolver

by placing a padlock

around the top strap of

the weapon or by securing a trigger lock.

66
Child-proof your semi-automatic handgun by removing the magazine,

disassembling the frame

from the slide and magazine or securing a trigger

lock.

Always carry with you on

your key chain the keys

that open both the locked

container that stores your

handgun and its padlock

or trigger lock.

If you qo on vacation,

consider additional safeMaintenance

63

keeping measures for

your handgun while you

are away.

Be certain to check with

your police department

about the laws governing

transportation of handguns outside the home.

Store ammunition in a

locked container, away

from heat or moisture.

Never throw out ammunition in the trash.

Another important responsibility you undertake, sf you

choose to own a handgun, is to clean and maintain your

weapon on a monthly basis. Proper functioning and safety

of a handgun can be impaired by rust, dirt or improper

maintenance procedures. As with any high quality piece of precision equipment, your handgun must be cared for

according to the manufacturer's directions. In addition, we recommend that you.

Always check twice prior

to cleaning your handgun

to make sure it is

unloaded.

Clean your handgun after

each use according to

the manufacturer's directions and with the proper

equipment

Clean your handgun

alone and in a safe

place.

Check your handgun

every month for proper

functioning, either by dry

firing in a safe location or

target shooting at a pistol

range.

Store your handgun in a

location that protects it

from excessive temperature changes or moisture.

Wrap your handgun in a

silicone cloth or moisturebarrier paper. Never wrap

it in a newspaper, sock or

leather holster these

attract moisture.

Do not make repairs on,

or modifications to, your

handgun. These should

only be made by the

manufacturer or a

qualified gunsmith. Note

that any modification to

your handgun may be potentially dangerous and

may void your warranty.

67
64

rig

If you own a handgun you have a responsibility to receive proper training on how to use and maintain your

weapon. Certified and reputable handgun safety courses

and instructors are often sponsored by state and local

gun clubs.

Any safety course snould present relevant information

as well as ample opportunities for you to practice firing

and cleaning your handgun. Specifically, the course

should:

Provide information describing the parts and

workings of the handgun,

how to load and unload it,

and the location and operation of its safety

features.

Teach specific procedures for proper care,

cle- ling and maintenance of the handgun.

Describe safety rules for

handgun home storage

and use, while transporting the weapon, and

while on the range.

Specify the legal require

ments and moral consid

erations related to

handgun ownership, use,

possession, sale and

transfer.

Handling and Use

Teach the principles of

marksmanship: trigger

control, grip and sight

alignment and sight

picture.

Provide opportunities for

you to fire a minimum of

400 rounds of ammunition at the pistol range.

Require you to pass a

written test demonstrating

your comprehension of

course material.

Require you to pass a

performance test demon

strating your ability to

hanr41e, use and dean

,ndgun properly.

If you own a handgun, you must be absolutely certain

that it is unloaded whenever you or a family member

handles it. Further, it should never be displayed at a

social gathering or made a topic of conversation. It

should never appear accompanying the use of drugs or

alcohol. We recommend that the following safety rules

be strictly enforced:

Always treat every handgun as if it were loaded.

Give your handgun to

someone only if you verify

that it is unloaded and

the cylinder or action is

open. Take a handgun

from someone only after

you verify that it is unloaded and the cylinder

or action is open.

68
65

Check and see that a

handgun is unloaded immediately after you pick

up the weapon.

Check that the barrel is

clear before you load or

fire your handgun.

Load your handgun only if

and when you intend to

fire it.

Legal Requirements

Assume your handgun's

safety devices will fail.

When handling or cleaning your handgun, never

leave it unattended it

should be in your view

and under your supervision at all times.

Laws regulating handguns are often complex and vary

greatly among the states. If you are a handgun owner, it

is your responsibility to learn about all relevant aspects

of federal, state and local firearms laws. Specifically you

should know:

Legal requirements

pertaining to handgun

purchase, transfer,

possession, licensing

and registration.

Legal requirements regulating carrying and transporting a handgun.

Legal requirements defining the appropriate use of

deadly force by citizens.

In some states, for instance, deadly force can

only be used after all

other defensive remedies

have been tried and the

armed citizen believes he

is in imminent danger of

the use of deadly force

against him.

Civil penalties for death or

injuries even if you were

justified in firing your

handgun.

Civil penalties for deaths

and injuries if someone

other than yourself

abuses your handgun

If you are unable to answer

these questions, you may

want to reconsider your decision to own a handgun; and

also enroll in a handgun

safety training course.

t.0 69
66

Handgun Ownerk Checklist

What are the legal requirements for the purchase, possession,

registration and transfer

of a handgun in your

community?

What is your handgun

serial number? Where is it recorded?

Under what circumstances can you legally

use a handgun in the protection of your life or the

life of another?

What kind of handgun

training have you received? What c:I;1 you

learn about handgun

safety, use and

maintenance?

Were you required to

pass a written test at the

conclusion of the course?

Were you required to

demonstrate safe handgun handling and cleaning techniques?

What have you done to

"child-proof" your

handgun?
67

How and where is your

handgun stored?

Is it secured by a lock?

Where Is the key?

Who else knows about where it is stored?

Is it unloaded'

Where is the ammunition?

When did you last change

or replace your ammunition?

When was your handgun

last inspected and

cleaned?

It you own a revolver,

identify its cylinder, trigger

guard and hammer.

If you own a semi-automatic pistol, identify its

slide, safety catch and

magazine catch.

Name the safety features

on your handgun

Explain how they

function

71
68

This brochure is published

by The Handgun Information

Center ("The Center") as a

service to the public. It was

developed and written

under a grant to the Police

Executive Research'Forum

("PERF"). The Center and

PERF disclaim any and all liability arising from publication or distribution of this

brochure. Due to the

danger of handguns,

The Center and PERF

advise extreme caution in

their safekeeping and use.

© 1984, The Handgun

information Center

1400 K Street, N.W.

Suite 500

Washington, D.C. 20005

Senator SPECTER. Thank you, Dr. Cantor. We would like now to hear from Heidi Bilodeau, and we very much appreciate your being with us. We understand that you will

be providing testimony about an attempted suicide yourself, and we understand the difficulty of your coming forward to provide this

testimony. And we thank you for being here.

You may now proceed.

STATEMENT OF HEIDI BILODEAU

Ms. BILODEAU. I appreciate being asked.

Senator SPECTER. Could you r .ill the microphone very close so we

can hear everything you say. Even a little more. Ms. BILODEAU. I appreciate being asked here today to speak. When asked what brought me to actively seek suicide to end my

emotional pain, I would have to mention the two major sources of

my despair. One was the conflict of adolescence, and having been

brought up with strong morals and ethics, I felt unequipped to

handle the waves of people who did not think similarly. And I berated myself for my naivete. The other source was the death of a

friend at age 14 whom I had had a disagreement with earlier that week, and thus the combination of loss and guilt became overwhelming. When these emotions continued, they became self-hatred. The

self-destructiveness began then with razor blades. I stayed in my

room most of the time 'writing dirge, which is depressive poetry,

72
69

and planning that day when I would take those pills and never

again feel the pain of war in my soul.

At age 15, I took my first overdose. I had accidentally OD'd once

before. It kept me se,.±..nscious for 2 days, but I was unsuccessful.

So, after another slash of the wrists, I was sent to a State hospital for children. Then, 6 months later, I was sent to where I referred to

as the "warehouse," a State mental institution where, at the age of 16, I would be supposedly helped by the understaffed mental health

system and utilized role models such as the 40-year-old roan who paced up and down the halls, a woman with slashed tracks the

length of both arms, and other refugees of the outside world.

After a year, I signed myself out, but it took much longer to get the internal stuff right., to feel good about what I had to offer as a

person. There were three drug overdose attempts made by me. I

took increasing amounts each time, but God had plans for me, which I am discovering each and every day as a Christian.

The rage which consumed my entire being could have easily di- rected me toward a deadly weapon but, fortunately, my parents possessed no guns. It is difficult to explain to someone who has

never felt that depletion of life force how a person can want to do mercy killing on themselves. I believe it to be instinctual when you

hurt. Your automatic response demands you cease the pain. Suicide is just that.

Dr. Pam Cantor often uses the light at the end of the tunnel. She knows from her working experience that the pain is temporary. The dark tunnel in one's mind does, indeed, have a light, which she

sees. But as a suicide person, I did not. Those years of darkness ended for me and have allowed me the opportunity to utilize the pain in a positive way. So many others never waited out that little

while longer to see the other side.

So, in closing, I must reiterate that if there had been a gun avail- able, I would now be a statistic.

Thank you.

Senator SPECTER. Thank you very much, Ms. Bilodeau. Ms. Ross, thank you for joining us and we look forward to your testimony.

STATEMENT OF CHARLOTTE P. ROSS

Ms. Ross. Thank you, and I just want to comment that when the

testimony is through, I, too, will look forward to answering some of

the questions that were raised to the previor Nanel, as I think

both Dr. Cantor and I can add some informatioi

I was asked to comment on some of the legislative activities that are going on regarding youth suicide. I would like to point out that our laws are created for the purpose of protecting and preserving what we hold to be most sacred. Most often they are created as a

response to a current and obvious need; you all have presented statistics that show you are well aware of the magnitude of the problem and the need to act.

The need for action is both current and urgent. I appreciate also your interest in and concern for the problem, and I appreciate the

time you have made available to me today to share with you the possibilities I and many others see for responsible local legislation

73
70

which can encourage and facilitate appropriate efforts for prevention of youth suicide.

I would like to comment briefly first on the relationship of legislation to suicide, where it has been, where it is, and where I see it going in the future. The concept of legislation to prevent suicide is not new. For many years, as you are probably aware, it was felt that suicide

could be controlled by punishing the act. Suicide, therefore, was de- dared a crime and subject to punishment by law. But the effect of

those laws was not the prevention of suicide. Instead, they added to

the burden already felt by those experiencing suicidal feelings. Sui- cidal persons were forced into greater secrecy and isolation, and ad- ditional barriers were placed between them and what they most needed, the help of caring others. In addition, suicide attempts or deaths were often disguised as accidents by survivors who feared legal repercussions as well as so- cietal stigma.

Perhaps the impact of this stigma can be illustrated by a brief example of the origin and nature of these laws. American criminal penalties for suicide derived from the common law of England. At one time, English common law punished the crime of suicide by re- . quiring burial of the remains of the deceased at a crossroads with a

stake impaling the body, a stone placed over the face, and the am- putation of the hand that committed the self-murder In addition, the King confiscated the suicide victim's property. Forfeiture of property reflected the King's view of suicide as contrary to his interests in preserving the lives of hiE subjects. I think you should note it was not until 1961 that the English Parliament abolished the crime of suicide by statute, realizing that such penalties served more to punish and stigmatize the surviving families of suicides rather than as a deterrent.

In our country in recent years, most of these punitive laws have been removed. To commit suicide is no longer a crime in any of the 50 States, although it was at one time in all, and only 2 States, Oklahoma and Texas, still consider it a crime to attempt suicide. However, although these laws have been removed, their legacy re- mains with us, and it is this we must also combat.

Today, a new and far more humane approach is evolving, paving

the way for the new kinds of legislation affecting not only the victims and survivors of suicidal death, but also who have felt the despair and hopelessness of suicidal depression. In 1983, senate bill 947, the Youth Suicide Prevention School

Program, was introduced in California. This legislation i was the

first in the country designed to prevent youth suicide and to extend help to potential suicide victims. Although it addresses only one

aspect of the problem, the prevention of youth suicide through edu- cation and training in the schools, it was viewed as 8 h important be ning step.

e legislation was drawn from the experience of t J local pro- grams. Although evaluation of the effectiveness of these programs has been limitedschool suicide prevention programs have not been included among the areas selected by most researchers for study and evaluationthe model developed was shown to be sig- nificantly effective in increasing the identification of high-risk stu74
71

dents and in effecting referrals to treatment. Thus, it was selected

as appropriate and responsive to the demand of citizens for action

to turn around the rising tide of young deaths and offer assistance to those who were at risk.

As you also are aware, the California legislation was followed by

similar action in other States. Florida passed senate bill 529, man- dating the development of a comprehensive program of youth sui- cide prevention in the schools. New Jersey has a bill that is

through the senate, and a number of other States are in the various stages of developing local legislation that is responsive to their needs.

I would like to take a moment to add my appreciation to you for Senate Joint Resolution 53. It will do more than call attention to a

month of youth suicide recognition. It increases public awareness and action.

As to what can be done now, it is my belief that this Nation can

indeed turn back the tide of youth suicide. Obviously, I believe it will take not just the efforts of legislators or of educators, parents, researchers, or mental health professionals. It will take all of us

working together and responding to a wide range of needs. States, such as California, are now developing such an approach. Components include supplementing the educational programs for youth with those designed to increase general public awareness. This includes developing a statewide clearinghouse for information and data.

Second, specialized programs for relevaiit groups, which includes supplementary training to be available to mental health profession- als to increase their expertise in dealing with suicidal youth and

survivors. And, last, but clearly not least, special attention is being given to the juvenile justice system. Juvenile detention facilities

and runaway shelters serve youth who have suffered a variety.of losses, who often have inadequate support systems and, therefore, are particularly at risk. Suicide prevention in any institutional setting is a humanitarian effort, but it is also a self-protection meas- ure. A suicide or attempted suicide within such a facility, besides being a tragic event, has definite legal ramifications. An increasing

number of wrongful death suits initiated by concerned third parties has been experienced by juvenile detention facilities throughout the country. There exists a pressing need for special training for

facility staff regarding the identification, assessment and manage- ment of suicidal youth and for the review and possible revision of protocols.

Senator SPECTER. Ms. Ross, your full statement will be made a part of the record. So, to the extent you could summarize, we would appreciate it.

Ms. Ross. Let me just conclude it then with one final comment.

One of the widespread myths about those who are suicidal was reflected in a popular newspaper column recently. For some

reason, the writer seemed to imply some of us can cope with life

and some cannot. Those who cannot will commit suicide, and there

is not much we can do about it. But suicide is not a loser's way out, nor are suicidal feelings indicative of a person who will never make

it. Through this current suicide epidemic, we are not only losing
72

far too many of our young, we are often losing those who have the most to bring to our society. I would like to close today with a note written by a young man who wanted to give up on life. He expressed feelings felt by many young people and also in a way many of the comments made by Heidi.

As he pondered suicide, this is what he wrote:

I am now the most miserable man living. If what I feel were equally distributed to

the whole human family, there would not be one cheerful face on Earth. Whether I shall ever be better, I cannot tell. I awfully forebode I shall not. To remain as I am

is quite impossible. I must die to be better, it appears to me. I can write no more.

To the benefit of our entire Nation, this young man reached out for help and he found it. His name was Abraham Lincoln. Thank you very much.

Senator SPECTER. Thank you very much, Ms. Ross. Ms. Bilodeau, would you pull the microphone closer? Having made the attempts at suicide yourself, as you have de- scribed them, if you were to give advice to some teenagers, and you

were a teenager when you tried to suicide, give advice to somebody who felt like taking their own life, what advice would you give to

that person?

Ms. BILODEAU. To make the effort not to isolate one's self because

there are resources in hotlines, in community centers, in crisis centers that are there for the asking. But, one, people have to be

aware of those resources. But on a very small level, if you just tell one person, and even if that person who is suicidal asks for you not to tell anyone, do it because you are saving their life, and that ex- ceeds their personal wishes because once they get to see the other side of it, it is so much easier.

Senator SPECTER. So your advice to someone who is thinking

about suicide would be--

MS. BILODEAU. Just reach out to one person. Senator SPECTER [continuing]. Read, out to one person, and whom would you suggest that person be? A parent, a teacher, a

friend?

Ms. BILODEAU. Whomever it is easier for you. I had a friend who

is a teacher who was there for me, and she was invaluable. So

whomever the suicidal person is comfortable with and trusts, that

is the person.

Senator SPECTER. So the suicidal person should reach out to a

friend and that friend then should get help for that suicidal person?

BILODEAU. As someone else said, the uses of hotlines, they

are very important, but it is only a beginning step. You have to

follow through with professional people like Pam.

Senator SPECTER. Based upon your own experience, if the suicidal person is not going to reach out for help, what shotild a parent look

for to try to figure out when a child might be inclined to suicide?

Ms. BILODEAU. I believe other people have mentioned some of the

signs: the withdrawals. It is hard for adolescents because you are going to have erratic moods and that is just part of the adjustment process. I would probably say though the withdrawing is the thing

that was indicative in my case. I cannot say of everyone. Maybe extreme anger. Just extremes in a major way.

76
° 73

Senator Smarm. What would you say that the government should be doing by way of funding or resources to try to deal with

this problem of suicide among teenagers?

Ms. BILODEAU. Well, I believe in commonsense methods myself and in local like community resources. The gentleman, Mr. Metz- enbatun, who was sitting there, getting it to a person-to-person

level and the government through other agencies can help provide

funds for community centers, and also work with the State to pro- vide more direct resources because if they are there, they will be utilized.

Senator SPECTER. Dr. Cantor, let me ask you that question. If you were to make a recommendation to this Subcommittee as to what

we should be doing to bring more resources to bear on this problem, what would you say?

Dr. CANTOR. I believe I have answered that in my brief com- ments in my statement. I think there is a threo-pronged approach

that is necessary to make an immediate impact. One is to increase

education available through the media and through schools to par- ents, teachers, the community and children. And the second is to reduce the availability of lethal means, and that those two factors will have a greater impact on reducing the suicide rate among adolescents than else that we have done in the past number of years. Senator SPECTER. How would you respond to that question, Ms. Ross? What would you say if you were to direct our attention to

the most narrow area possible? What is the most important? Ms. Ross. I think you have got an excellent example that was given to you before, and I would like to see much more of that.

Really, the cooperative effort between HHS, ACTION, and the pri- vate sector in bringing together the resources of this country, in mobilizing them all toward youth suicide p1:)vention in very prag- matic ways, in working collaboratively is, indeed, impressive. And I think it will become more impressive. I think further actions along this line so that we use all our resources to their maximum will give us the range of help we need. I

would like to see much more done.

Senator SPECTER. Thank you all very much. We very much ap- preciate your being here.

The Subcommittee will be pursuing the matter further. The hearing is concluded.

[Whereupon, at 12:15 p.m., the subcommittee adjourned, to recon- vene at the call of the Chair.]

71
75

APPENDIX

STATEMENT

OF DR. CONSTANCE E. CLAYTON

SUPERINTENDENT OF SCHOOLS

SCHOOL DISTRICT OF PHIIADELPHIA

Mr. Chairman and Members of the Subcommittee:

Thank you for this opportunity to share with you infkamation related

to the institution of TAIRIZNE, a citywide, crisis hotline fiar children.

In Philadelphia, as in other areas across our nation, we have been

deeply concerned by the ever-increasing numbers of adolescent suicides.

We are keenly aware that:

- -The suicide rate among adolescents has tripled since 195J.

- -Suicide is the second leading cause of death for young

people.

- -For every completed adolescent suicide, there are at least

fifty to one hundred attempts.

--The suicide of a teenager is devastating for family,

friends, school and community.

Figures released for Philadelphia show that over a four year period,

from 1981-1984. approximately two hundred suicides were completed by

individuals between the ages of ten and twenty-four, reflecting 25

percent of all suicides during that period.

During the summer of 1984, an elementary school student in subdistrict six of the School District of Philadelphia committed suicide,

and reports of suicidal attempts and gestures were heard among children of all ages.

Official School District reports have cited attempted suicides, such

as: "on 2-25-85, took forty to fifty unknown pills at

home. Later, in s,(1-71.atadtp that she was feeling ill and was

taken to a local hospital for treatment. Her family believes she will

try again." is thirteen years old.

"on 2-28-85, took eight unknown pills at school

this morning in a suicide attempt. A suicide note was found by a

teacher, and the student was hospitalized." 's note states, in part, "I'm fifteen, I live in , Philadelphia, I'm a very

troubled person who never talks about his problems... It's all over, I

took eight pills of same unknown source and I pray it ends now."

More recently, in mid-March, 1985, a student threatened suicide in a

letter written to the Superintendent cf Schools, Dr. Constance E.

Clayton: "... If you don't help me, I'll commit suicide in one of your

schools."

Fortunately, for the three young people cited in the preceding

paragraphs, intensive treatment, therapy and family counselling have been

undertaken. However, we recognize that many more troubled youngsters

need our help.

78
76

Although there is no definitive explanation of the causes of teenage

suicide, researchers have identified several categories of risk factors:

family conflicts and a chaotic family environment/ pressures to succeed/

increased availability of drugs and alcohol/ depression; the sudden death

or loss of a loved one/ lack of structure in one's life/ disintegration of traditional support systems/ isolation in an increasingly mobile

society/ and others.

These risk factors can be found throughout the general population.

Teenage suicides occur among all social classes, economic groups, races

and religions. Although oommunicatioccan be a first step in helping

such troubled young people, tragically, discernible warning signs of

distress often go unheeded. Through =ELME, we in Philadelphia hope to

provide to students the opportunity for that first step, communication,

and the subsequent, necessary intervention and follow-up.

The tragic suicide of an elementary school child during the summer

of 1984 provided the impetus for TALELINE. A concerned school principal

in subdistrict six contacted Interoommunity A: Alan, Inc. (INTEMAC) to ascertain whether assistance could be obtained for those families who are reluctant to seek mental health services or tnauselves or their children

in the more traditic.al ways. INTERAC is a human service agency in

Northwest Philadelphia, which has provided an ever-increasing range of

mental health, mental retardation, aging, and substance abuse services

since its incorporation in 1969. Although its primary responsibility is

to the 70,000 people who reside withia its catchment area, INIERFC has a well-defined system of access to ememency and crisis intervention

services throughout the City.

For many years, INIERPAC has been working with school personnel in

subdistrict six to address the emotional needs of children and families. This collaboration has taken the form of consultation, referral, and

follow -up and has resulted in a mutually supportive relationship between

the two when problems arise.

Representatives of the subdistrict six office and INTERAC began to

meet and plan for a volunteer hotline which would be available and

responsive to these children and families. With the school providing

volunteer recruitment, publicity and education about the availability of

this service, INIERAC would provide the training of volunteers and

professional clinical support needed for implementation. This

partnership between IlffERAC and the echools, providing telephone access

to caring, listening, support and referral, would relieve children and

families of the previously identified barriers to seeking help.

Within Philadelphia and the Delaware Valley other citywide hotline

services are available though none specifically address the needs and

concerns of children. In contacting each of these providers, including

CONTACT, TEL-E4IELP, VICAR and CAPE, all indicated a perceived need for a

hotline service targeted toward children. The rate of utilization of

these hotlines, without breakdowns by age of caller, ranged from 19,000

to 67,193 calls per year. A hotline for children, initiated January 15,

1985 in Syracuse, New York, experienced a utilization rate of 225 calls

during its first two weeks of operation. Calls to a Philadelphia

citywide hotline are anticipated to at least triple this figure.

The concerns and needs of callers are expected to range from minor

upset to life threatening, keeping in mind, that for children, even the

minor upset can take on crisis proportions. From the si year old

frightened by noises in an empty house to the sixteen year old

considering downing a bottle of pills after a breakup with her boyfriend,

the hotline can serve as a lifeline, a way for each child to be heard,

supported and given needed care. In a similar way, parents are expected

to use the hotline to cope with overwhelming situations which may be

frightening for them to discuss with authority figures.

79
The Stott Paper Company, with its pledge of more than $20,000.00 to

help fund TALILENE, agreed to take a leadership role in attracting

additional corporate support for continued funding of this critical

endeavor. Through the initiative, interest and support of Scott Paper, we hope to maintain TAIMITNE for the youth of Philadelphia in the months

and years ahead. As a result of the discussions between INTERAC and School District

officials in subdistrict six, a meeting was scheduled with the

Superintendent of Schools, who agreed with the concept and who encouraged

the implementation of a youth hotline which would be made available to

all youth in the City of Philadelphia.

In addition to the cooperation of INTERAC and the Stott Paper

COmpany, we have been most fortunate for the cooperative efforts of the PhiladelphiaArthdiocese, the Philadelphia Police Department,

Philadelphia City Mental Health Agencies, members of the Media, parents

and members of the Philadelphia community.

TALEINE volunteers receive thrity-five hours of training by INTERAC

staff, and during its hours of operation, volunteers are supervised by

professional, clinical staff. Although our primary rationale for the

establishment of 77S2OLERE focuses on suicide, we recognize that callers

may wish to discuss other areas which are problematic. Consequently, the

training program for volunteers covers a wide array of tepics, including:

orientation; initial screening of vtlunteers; Skill and information

training; interviewing; listening; problem solving; decision making;

relationship building; discipline; drugs/alcohol; depression/mOcide:

sexuality.

It should be noted that the screening process fur volunteers is most

carefully and intensively conducted to assure that the quality of care

and service provided to young people in need is of the highest caliber.

A network has been established to provide referral services through

local ommunity mental health agencies, school principals and counselors

and the Philadelphia Police Department, as deemed necessary, depending

upon the nature of specific calls received.

During its first week of operation, April 15 to 19, 1985, fifty-five calls were received by =MUNE, from youth between the ages of six to twenty-four. Of these, three calls were potential suicides. In each

situation, appropriate intervention has been taken to diffuse the

callers' anxieties, and follow -up measures have been implemented to

prov:de ongoing counselling through school and mental health agencies.

As the dissemination of information reganiing TALKLINE reaches a

wider audience, we anticipate a significant increase in the number of

calls. In fact, on Thursday, April 25, 1985, a distributim of flyers

to school students announcing the availability of TAMUDRE resulted an

more than 120 calls between the hours of 2:00 and 9:00 p.m.

Wa are most appreciative of mothers of the Philadelphia community

for their interest and support in this endeavor. We are particularly

indebted to Intercom:mill? Action, Inc. for its cooperation in

developing the proposal for =RUNE and the responsibility MIMIC has

undertaken in the training of volunteers and operation of TALELENE, and

to the Scott Paper Company for its centributions, assistance in planning,

financial support, and for its initiative in encouraging corporate

support for TALKLINE.

Although we represent diverse entities, our singular goal is the

preservation of the healthy minds and belies of our young people now, and

for future generations to save a single life would be more than enough.

80
78

References Cited:

1. Adolescent Suicide: A Review

Sheldon P. Wayman,

2. "Dealing with the Crisis of Suicide"

Calvin J. Frederick and Louise Lagul

Public Affairs Pamphlet No. 406A

New York, New York

3. Intercommunity Action, Inc.

TALKLINE Fact Sheet; Proposal Abstract

4. "Surviving: Handbook on Teenage Suicide Prevention" ABC Theater Presentation

February, 1985

SCHOOL DISTRICT OF PHILADELPHIA/INTERAC

TALEL1NE Fact Sheet

During the summer of 1984, an elementary school student of the

Philadelphia public schools committed suicide. This tragic event

precipitated a series of meetings between personnel of the School

District of Philadelphia and members of Intercamunity Action, Inc. a

human service agency in Northwest Philadelphia. As a result of these

meetings, a proposal was developed to initiate a citywide, child targeted

suicide hotline. In addition to the cooperative efforts of the School

District and INTERAC, the Scott Paper Company agreed to provide a startup

grai.t of more than $20,000.00 and other resources for the hotline, and

ha,: taken a leadership role in encouraging other corporate sponsors of

the hotline. On April 15, 1985, TALRISNE, the citywide suicide prevention hotline

for adolescents in Philadelphia, was initiated. According to INTESAC,

which operates the hotline, in the first week of operation, three

potential suicide calls were received. In each case, the situation was

diffused and follow up measures have been taken. These three cases are

convincing proof that our efforts have not been in vain, for if we save

the life of one child, wo have succeeded.

_ _ _
79

` wind gkatts gem

tmodnumno.Moommm

Orr AM roe Myron... MD. AWN IL MK J.. CrIL PW41...00 lenrobre rir Irlrearr 11.1.1 Wm G *WM MAN

IMANILSSMOrlv/VO, AMPIMMOG

a1Mlma.010111111.0000. ANNuMONYORMA

1141INSPKTRPA. MMMUIMMWKOMONWILMOMPOMMM

NMAUMAYMMOOMMOMMO. moromonottormlorarm wftworelmr..WrraoromMa

CONINTTIN ON TN[ JUDICIARY WASHINGTON. De. 20510 mosoartil lorriiMMUY. C00 MON orccolos. mg.

'MRS J. Uhler Yr WAXMINONT

00111. *GPM MA

suseporrrn oft muter,. No TIMCOSII alerrOrr NM.. ALA. CraurolA ow^ IRAN MWMRA UAW Yr ADM IAR.RG priwoar) r orTarrIWAL Arr ~to ow Moen MN PM Immo

30 April 1985

Honorable Arlen Specter

Chairman

Subcommittee on Juvenile Justice

327 Hart Senate Office Building

Washington, D.C. 25010

Dear Arlen: I commend you for conducting a very insightful hearing

on the tragedy of youth suicide. Today's witnesses forcefully

detailed the scope of the national problem of young Americans

killing themselves.

As a follow-up to the testimony on the legislative

initatives presented by Charlotte D. Ross, I thought that it

might be useful to place in the record examples of state

legislation and initatives. Accordingly, I would ask that copies of this latter; a bill entitled the "Alabama Youth

Emotional Guidance and Suicide Prevention Act," which is

now pending in the Alabama State Legislature and a proclamation issued by Governor George Wallace designating June

1985 as "Youth Suicide Prevention Month" be placed in the

appendix to the hearing record.

Thank you for your assistance in this matter.

JD:h) 5 Enclosure

.remi Denton United States Senator

82
80

STATE OF ALABAMA

PROCLAMATION

BY THE GOVERNOR

WHEREAS, the youth oi tociety kepte.sent the hope PA

thc iuturte; and

WHEREAS, the /tate oi youth 6uicide ha, incitea.sed mote

than thkeeiotd in the ta6t two decadee; and

WHEREAS, over Give thoueand young Ameticane took thein

tive6 ta6t germ, many mime attempted euicide, and countte88

6attie6 werte aiiected; and

WHEREAS, youth euicide i6 a phenomenon which muet be

addiceeeed by a concertned 6ociety; and

WHEREAS, youth 6uicide a a nationat pnobtem which can

only be eotved thicough the combined e66oxt6 oi irdividuate,

iamitiee, communitiee, omanizatione, and govetnment to educate

hociety:

NOW, THERFORE, I, Geortge C. Wattace, Goveknok oi the

State oi Atabama, do hekeby pkocZaim June, 1965, a6

YOUTH SUICIDE. PREVENTION MONTH

in Atabama.

83

GIVEN UNDER MY HAND, and the

Giceat Seat oi the Goveknoee

Mice at the State Capitot

in the CA:ty oi Montgomerty on

thi6 the 28th day oi Match,

1985 GEO§ C. WALLACC

GOVERNOR

A
81

1 LRS85-129:1/23/85 '' ) d

, Js) .0..P

d

0'3 , 0,0 i

2

/ (ii' 0 ?)/

3 H. 284 Dy White ev e (6), Dadius, Zoghby, Davis, Biddle, Bowling, Box

R1 jPP:',Rice, Gastpn, Grouby, Ha mart, Adams and Doers

Health loW . 4 RFD

2/5/85 1 0 \ \

\ \,Ntilr!

5 .., k:. - t 6

7

8 SYNOPSIS: This bill establishes the 'Alabama Youth SmOtioaa.

9 Guidance and Suicide Prevention Actr. The

10 department of education and the rehabilitation and

11 crippled children's service of said department and

12 the department of mental health shall administer

13 the provisions of this act. It provides for the

14 cooperation of the departments of education, mental

15 health, pensions and security, youth services, and

16 law enforcement agencies in the identification,

17 intervention and prevention of youth suicide as

18 well as public awareness and education. It 19 provides for local participation by local community

20 agencies, local tax forces and local school boards

21 of education in order to provide a student services

22 program, including guidance And psychological

23 services. I: Lakes certain training required for

24 holders of teachers' certificates and requires

25 curriculum changes.

26

27 A,BILL

28 TO BE ENTITLED

29 AN ACT

30

31 To establish the *Alabama Youth Educational

32 Guidance and Suicide Prevention Act," to prescribe that the

33 department of education, the rehabilitation and crippled

34 children's service of said department, and the departmtn. of
82

1 mental health shall administer the provisions of this act; to

2 prescribe that the said departments, various Law enforcement

3 agencies, Local community agencies, department of youth

4 services, the department of mental health and local task

5 forces and Local school boards of education shall cooperate

6 in providing a student services program and in the

7 identification. intervention and,prevention of youth suicide.

8 including guidance and psychological services; to provide for

9 certain training for holders of all cl f teachers'

10

1112

1314

15

16

1718

19 20

2122

23

2425

26

27

28

29

30

31

323334

certificates whether provisional or otherwise; to provide for

public awareness education; and to provide further for a

student curriculm to include related training or courses in

emotional guidance and suicide prevention.

BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:

Section L. This act may be cited as the 'Alabama

Youth Emotional Guidance and Suicide Prevention Act.'

Section 2. The incidence of teenage suicide has

escalated rapidly over the past LO years. rhe rate of suicide among teenagers has increased122 percent during the

past 20 years. and suicide has been the third Leading cause

of death of persons age 15 through 24 during the past LO

years. The impact of the incidence of teenage suicide has

caused the legislature to determine that the prevention of

suicide by youths is a priority of this state. The

legislature makes the following findings and &go/a:rations:

(1) A statewide program to promote thm positive

emotional guidance of youths, and to prevent suicide by youths

is essential to address the continuing problem of youth

suicide in this state.

(2) The emotional problems of youth often are

compounded by other problems such as drug abuse, alcohol

abuse, and school and family problems.

(3) A suicide prevention program for Alabama youth,

can beet be accomplished by coordinating the educational

At RV,

85
1. 83

1 programs at the state and local levels with the communi

2 suicide prevention and crises center agencies. It is the

3 intent of the legislature that cooperation amo:3 these groups

4 shall be a major component in its effort to achieve the

5 successful prevention of youth suicide.

6 (4) Crises intervention and suicide prevention for

7 the purposes of this act shall center Oft*

8 (a) Better detection by students, teachers, and

9 family members of the signs of emotional distress in a youth

10 that might result in suicide.

11 (b) Defined responsibility for school counselors.

12 (c) Timely referral of potential suicide victims to

13 community professionals as needed.

14 (d) Cooperation between school and nonschool

15 professionals.

16 Section 3. (a) The department of education and the

1718

19 20

2122

23

2425

26

27

2829

30

31

3233

34

rehabilitation and crippled children's service shill develop

a state plan for the prevention of youth suicide and shall

submit the plan to the speaker of the house representatives,

the president of the senate, and the governor no later than

the first day of the next regular session of the legislature

1986. The department of education shall participate and

fully cooperate in the development of the state plan at both

the state and local 'Levels. Furthermore, appropriate local

agencies and organizations shall be provided an opportunity

to participate in the development of the state plan at the

local level. Appropriate local groups and organizations

shall include, but not be Welted to, community mental health

centers, the school boards of the local school districts, the

advocacy committees, private or public organizations or

programs, including parent teacher associations, with

recognized expertise in working with children who are

emotionally distressed and with expertise in working with the

families of such children, lay enforcement agencies, and the
84

1 circuit courts. The state plan to be provided to the

2 legislature and the governor shall include, as a minimum, the

3 information requireo of the various groups in subparagraph

4 (b).

5 lb) The development of the comprehensive state plan

6 shall be accomplished in the following manner:

7 ll) The department of education, the rehabilitation

8 and crippled children's service and the department of mental

9 health shall establish an interprogram task force comprised

10 of representatives from each and from the department of youth

11 services, the state health deportment, 'the department of

12 pensions and security and the department of public safety.

13 The interprogram task force shall be responsible fort

14 a. Developing a plan of action for better

15 coordination and integration of the goals, activities, and

16 funding pertaining to the state plan for the prevention of

17 youth suicide to be developed by the department of education

18 and rehabilitation and crippled children's service and mental

19 health department to maximize staff and resources at the

20 state level. The plan of action shall be included in the

21 state plan.

22 b. Providing a basic format to be used hr the

23 service districts of the departments in the preparation of

24 local plans of action to provide for uniformity in the

25 service distric 'lens and to provide for greater ease in

26 compiling information for the state plan.

27 c. Providing the service districts with technical

28 assistance in the development of local plans of'action, if

29 requested.

30 d. ExarAning the local plans to determine if all

31 the requirements of the local plans have,been met and, if 32 they have not, informing the service districts of the

33 de:iciencies and requesting the additional information

34 needed.
e: 85

1 e. Prmparing the state plan for submission to the

2 legislature and the governor. Such preparation snail include

3 the collecting of information obtained from the local plans,

4 the cooperative plans with the department of education. and

5 the plan of action for coordination and integration of

6 activities of the department of health, department of mental

7 health, and rehabilitation and crippled children's service

8 into one comprehensive plan. The state comprehensive plm,n

9 shall include a section reflecting general conditions and

10 needs, an analysis of variations based on population or

11 geographic identified problems, and recommendations

12 for change. In essence, the plan shall provide an analyils

13 and summary of each element of the local plans to provide a 14 statewide perspective. The plan shall also include each

15 separate local plan of action.

16 f. Worl.ins with the specified state agencies in

17 fulfilling the requirements of this paragraph.

18 Section 4. The department of health, the

19 department of mental health, the rehabilitation and crippled

20 children's service and the department of education shall work

21 together to develop ways to inform and instruc-4 appropriate

27 district school personnel in all school districts in the

23 detection of conditions which indicate youth suicidal

24 tendencies and in the proper actions that should be taken when

25 there is reason to suspect that a student is contemplating

26 suicide. The plan for accomalishing this end shall be

27 included i,n the state plan.

28 Section 5. The department of public safety, the

29 department of mentrl health, the department of health, the

30 rehabilitation and crippled chilOren's service shall work

31 together to develop ways to inform and instruct appropriate

32 local law enforcement personnel in the detection of youth

33 suicidal tendencies, and in the proper action that should be

34 taken to prevent suicide.
86

1 Section 6. Within existing appropriations, the

2 department of health, rehabilitation and crippled children's

3 service shall work with other appropriate public and private

4 agencies to emphasize efforts to educate the general public

5 about the problem of youth suicide and ways to detect the

6 yarning signs that indicate a youth is planning to commit

7 suicide, and in the proper action that should be taken to

8 prevent a suicide. The plan for accomplishing this end shall

be included in the state plan.

Section 7. The department of education, the

rehabilitation and crippled children's service, the

department of health and the department of mental health,

shall work together on the. enhancement or adaptation of

curriculum materials to assist instructional personnel in

providing instruction through a multidisciplinary approach on

the identification, intervention, and prevention of youth

suicide. The curriculum materials shall be geared toward a

program of instruction at the 9-12 grade level. Strategies

for requiring all school districts to utilize the curriculum

9 1011

12

13

1415

15

171819

20 ars to be included in he comprehensive state plan for the

21 prevention of youth suicide.

22 Section 8. The department of education shall

23 develop audio-visual and other training materials relating to

2425

26

272829

30

31

32

3334

suicide prevention and positive emotional guidance and shall

distribute such materials to each school district for

required in-service training for all teachers and

administrat,,rs.

Section 9. Each Service district of the department

of health, the department of mental health, and the

rehabilitation and crippled children's service shall develop

a plan for its specific geographic area. The plan developed

at the district level shall be submitted to the interprogram

task force for use in preparing the state plan. The service

district local plan of action shall be prepared with the

/.1. :';"

89
12

3

4

5

6

7b910

11 12

13

1415

16

87

involvement and assistance of the local agencies and

organisations listed in paragraph (a) and representatives

from those departmental district offices participating in the

prevention of youth suicide. To accomplish this, the

district administrator in each service district shall e stablish a task force on the prevention of youth suicide.

The district administrator shall appoint the members of the task force in accordance with the membership requirements of

this section. In addition, the district administrator shall

e nsure that each subdistrict is represented on the task force; and, if the district does not have subdistricts, the

district administrator shall ensure that both urban and rAral areas are represented on the task force. The task force shall develop a written statement clearly identifying' its

operating procedures, purpose, overall responsibilities, and

method of meeting responsibilities within the provisions of

17 this act. The district plan of action to be prepared by the

18 task force shall include, but shall not be limited to:

19 a. Documentation of the magnitude of the problems

20 of youth suicide in its geographical area.

21 b. A description of programs currently serving

22 Suicidal or emotionally upset youth and their families and of

23 programs for the prevention of youth suicide. including

24 information on their impact, cost-effectiveness, and sources

25 of funding.

26 c. A continuum of programs and services necessary

27 for a comprehensive approach to the prevention of youth

28 suicide as well as a brief description of suzh programs and

29 services.

30 d. A description, documentation, and priority

31 ranking of local needs related to youth suicide prevention

32 based upon the continuum of programs and services.

33 e. A plan for steps to be taken in meeting

34 identified needs, including the rapid coordination and

90
88

1 integration of services, the avoidance of unnecessary

2 duplication and cost.

3 f. A plan for alternative funding strategies for

4 meeting needs through the reallocation of existing resources,

3 utilization of volunteers, contracting with local

6 universities for services, and local government or private

7 agency funding.

0 g. A description of barriers to the accomplishment

9 of a comprehensive approach to the prevention of youth

10 suicide.

11 h. Recommendations for changes that can be

12 accomplished only at the state program level or by

13 legislative action. The district local plan of action shall

14 be submitted to the interprograa task force by October 1,

15 1985.

16 Section 10. It is the intent of the legislature

17 that each school district develop a plan for providing

18 student services to all students in the public school system,

19 including area vocational- technical centers. Each school in

20 a district shall submit a written student services plan to

21 the superintendent and the school board annually. This

22 school plan shall be jointly developed by the princirzl,

23 staff members and school advisory committee. These plans

24 shall be designed to ensure effective use of available

25 resources and avoid unnecessary duplication: It is the

26 intent of the legislature thkt student services coordinators

27 be given time to fuliull their responsibilities under this

28 section.

29 Section 11. A "student services program' is

30 defined as a coordinated effort which shall include, but not

31 be limited to:

32 (a) Guidance services, which shall include, but not

33 be limited to, the availability of individual and group

34 counseling to all students, orientation programs for new

/J.

91
89

1 students at each level of education and for transferring

2 students, consultation with parents, faculty, and

3 out-of-school agencies concerning student problems and needs,

4 utilization of student records and files, supervision of

standardized testing and interpretation of results, the

6 following up of early school dropouts and graduates, a

7 school-initiated system of parental involvement, an organised

8 system of informational resources on which to base

9 educational and vocational decision making, and educational

and job placement.

fb) Psychological services, which shall include,

but not be limited to, evaluation of students with )earning

or adjustment problems, evaluation of students in

exceptional-child education programs, consultation and

counseling with parents. students, and school personnel, a

1011

1213

14

15

16 system for the early identification of learning potential and

17 factc"s which affect the child's educational pmformance, a 18 system of liaison and referrals, with resources available

19 outside of the school, and written policies which assure

20 ethical procedures in psychological activities.

21 (c) Visiting teacher and school social work

22 services, which shall include, but not be limited to, 23 providing casework to assist In the prevention and

24 remediation of problems of attendance, behavior, adjustment,

25 and learning and serving as liaison between the home and

26 school by making home visits and referring students and

27 parents to appropriate school and community agencies for

28 assistance.

29 (d) Occupational and placement services, which

30 shall include, but not be limited to, the dissemination of

31 career education information, placement services, and

32 follow-up studies. Such follow-up studies may be conducted

33 on a statistically valid random-sampling basis where

34 appropriate and shall be stratified to reflect the

92
90

1 appropriate vocational programs of students graduating from

2 or leaving the public school system. The occupational and

3 placement specialist shall serve as liaison between employers

4 and the' school. It shall be the responsibility of district

5 placement personnel to make written recommendations to the

6 superintendent for consideration by the district school board

7 concerning areas of curriculum deficiency having an adverse

8 effect on the employability of job candidates or progress in

9 subsequent educational experiences. Further, district

10 administrative personnel shall report to the school board

11 concerning adjustments in program outcomes, curricula, and

12 delivery of instruction as they are made with the use of

13 placement and follow-up information.

14 (e) The distribution of a suicide prevention public

15 awareness program teveloped for distribution by the

16 interprogram task force established by the departments of

17 health, education, rehabilitation and crippled children's

18 service and mental health.

19 Section 12. Within two years after the effective

20 date of this act and thereafter, each person who holds a

21 certificate issued by the superintendent of education,

22 provisional or otherwise, shall be required to demonstrate,

23 on a comprehensive written examination, or through such other

24 proce4ures as may be designated by the state board of

25 education, mastery of the ability to recognize signs of

26 severe emotional distress in students and techniques of

27 crisis intervention with emphasis on suicide prevention and

28 positive emotional guidance or development. The provisions

29 of this section shall be construed in pari materia with Title

30 16, Chapter 23, Code of Alabama 1975, as amended, and other

31 provisions of ltif related to teacher training and

32 certification.

33 Section 13. The department of education shall

34 include in the curriculum, for all students in either the

93
91

1 ninth or tenth grade, credit for life management skills to

2 include positive emotional development. The amount of credit

3 shall be as assigned by the board. The provisions of this

4 section shall be construed in pari materia with other

S provisions of la'. and lawful rules and regulations relating

6 to student curricula for public schools, except where there

7 is a direct conflict herewith.

8 Section 14. The provisions of this act are

9 severable. If any part of the act is declared invalid or

10 unconstitutional, such declaration shall not affect the part

11 which remains.

12 Section 15. The provisions of this act shall be

13 construed in pari materia with all laws or parts of laws

14 relating to education teachers, students, drug abuse, or

15 suicide prevention; provided, however, that those Jaws or

16 parts of laws which are in conflict herewith are hereby

17 repealed.

18 Section 16. This act shall become effective

19 immediately upon its passage and approval by the Governor, or

20 upon its otherwise becoming a law.

4
92

Senator Arlen Specter, Chairman

Subcommittee on Juvenile Jistice

Committee on the Judiciary

Hart-Senate Office Bldg., Rm. 331

Second and C Streets, N.E. Vashington, D.C. 20510

Dear Senator Specter:

411 Plantation Road Perry, Florida 32347

May 6. 1985

I would like to submit the following testimony and the attached Chapter (4),

"Parental Perspectives", from the State Plan: A Comprehensive Approach for the

Prevention of Youth Suicide in Florida, to be included w.th the testimony presented

last week at your hearings on teen suicide. Some of my special concerns have to do

with the way teen suicide is being handled (and at times, sensationalized) through

th" media. In particular, I am concerned about the advisability of focusing a whole

month's attention on youth suicide. I have worked for a year now on the Florida Task

Force for Suicide Prevention with Health and Rehab. Services and D.O.E. personnel.

I was a school teacher at the time of my son's death in 1982, at age sixteen. Since his death, I have devoted my time to research and prevention. I have also formed a

network of parents who are survivors of suicide, and we have combined our efforts

to help educate others and to offer assistance to other survivors. We have felt that,

not only have we learned a great deal in the process, bet that we have been able to

help educate others by sharing our own experiences.

I would like to share with you a bit about our son who died. He was a fine

young man; bright, he was in the top one/third of his class. He was a Volunteen in

the local hospital, and shortly before his death, he was working in the school Guidance

Office helping other young people with career counseling. The guidance counselor in

that office: was quoted as saying (to a reporter) that you never saw Doug "withou^

a smile and a friendly greeting for everyone". That was just as true at home, and he

brought much joy into our home those 16 years that he lived. Sadly, I did not hear

about the devastating problems that happened to him at school until he was wad,

though we communicated,and I knew something was wrong. He carefully mask4d his problem

for two weeks, hoping, I guess, that things would improve.

His loss van mainly due to serious problems which impacted on him in his school

environment due to violations by teachers of the Code of Ethics, plus very poor Judgement on the part of the teachers. One caused an embarrassing incident to get entirely

out-of-hand which caused Doug to lose face in front of his peers. He had always had

good self-esteem. This, I have learned, can be quickly shattered in teens. In his depression over his problem, he heard another teacher, who I later learned dwelled

uncommonly long on morbidity in the classroom, tell hie class how they coLld "kill

yourself, if you wanted to die 'painlessly." by drowning yourself. Students shared this with me after his death in their own shock and pain. They also shared

that they were tested on other morbid material, such as what drugs or poisons are

used for "murder" or "suicide",and I now have the tests. The next night, after the

lecture in which drowning was made to sound like a viable option, my son tied weights

to his ankles and jumped into the deep end of our pool. Though the autopsy showed

that he tried to get out, he was not able to, and his death was not "painless", as he

choked to death. This teacher is no longer in the system, and "probable cause" was

found to remove the one who caused the embarrassing incident at school.

When we received counseling along with our daughters, now ages 13 and 16, in

order to be able to deal with the tragedy, I was urged by the Psychologist to take

whit happened to Doug to the Florida Senate in the hope that it would call attention

to terrible problems in the school system and hblp others to avoid future tragedies.

The psychologist was as shocked as we were that so many negative things could so impact

on a young person in the school environment in a short period of time. I asked the Fl. senate to find ways to enforce the Code of Ethics for Education, so that incompetent

or sick teachers could be removed. I t'so asked that parents be notified whenever

a teacher plans to deviate from his norm.1 course If study and offer an unannounced

course. (Parents now have some measure of protection,now that the Hatch Amenehaest has been enforced, however this doesn't cover all aresaias all are not

I had, by the time I went to the Senate, talked with other parents whose

children had school-related problems. and I also asked that research be begun to

study the effect of constant negativity in the school environment on the minds of our

youth. I wrote about some of these problems that otLers have experienced in the

State Plan that is attached. Many are described in the book, CHILD ABUSE IN THE

95
93

CLASSROOM, which I enclosed. Through my research over the past 21/2 years, / was aware of many of the problems before I read this book, and I related some of these

to the Senators in 1983. This year. the State of Florida began fingerprinting teachers who applied for

positions in Florida. (see article enclosed which describes the number of teachers

who had not reported criminal records of child molesting. etc.). Though this is some

deterrent, it does nothing to check on teachers already in the nlassroom, and it does

nothing to assure that the Code of Ethics will be enforced. Very often serious offenses

are covered up to insure the image of the education aystem. This is very sad, but true.

Following my testimony. the Legislature did pasa a bill for youth suicide

prevention for Florida to be implemented in schools and in society. Naturally. I vas

very concerned about how the prevention programs would be implemented in the schools.

and I felt atrongly that whatever was offered to student' must be kept very simple

and brief and positive. I felt that it is important to let them know how to recognize

when they or a friaod need help and where to find that help --from parenta or other

resources ouch as clinics or clergy. I felt much more training waa necessary for

teachere and administrators to underatand how to treat bereaved students returning after

losses (this I learned from first-hand experience). I feel wrongly that befriending

programs that I learned about through talking with people Ln Plano could be very

helpful for new or isolated students. As a teacher who understood the horrible

drug problems so rampant in most schools even in early grades now. 1 realized that

"suicide prevention" could taki many forms.4One of these: "substance abuse prevention;--

and a realization that the problem exists) Though it was not a problem In my eon's

case, I feel that drug problems probably lead to many teen suicides ur are a part of

the problem in many cases. I felt very strongly that we muz,t improve the school

environment and provide healthy teachers and couraesoif we were to truly have the

"positive emotional development" and "self-esteem" that is a desired end. If the environment IL not positive and healthy with teachers who are good role models. I

knew that the products of these environments, the student', mould not feel good

about themselves or about their society. It was with all :hie in mind that I Joined

the Fl. Task Force for Prevention when I was invited. I feel that I have learned much

from theL: input and I certainly hope that they have learned from my sharing. One

thing that I have stressed is that it is Just as important what one does NOT do for

prevention, as what one DOES do, as this is a most sensitive issue and the students

are very suggestible aLd impressionable. As Dr. David Shaffer has said. "Anytime you

talk about teen suicide in the youthful community. you're walking on very thin ice."

I am pleased that we were able to coss up with a Plan for prevention for Pl.

that hss been praised by Samuel KlagahrurirOn a visit as the beet state comprehensive

plan that he hss seen. I should ache that this plan required such coordination,

research and effort over many months for All involved, but that it was accomplished

y-tth very little funding, as people who were already employed by MRS and the DOE were

involved along with some experts in the field of Suicidology. fly work and Dottie's

was voluntary.:

We have been most concerned by the role of the media in influencing the lives

of our youth and we feel, as many agFession researchers dr, that it is a strong

factor which contributes to youth suicide. We have also been concerned by the media

coverage of the issue of teen suicide, particularly those sensationalized accounts

graphically depicting teen suicide in the midst of what the CDC in Atlanta has deemed

a "contagion" of teen suicide, and we worry about the effect on the cluster suicides.

Many of us have seen, firsthand. the effects of suggestion on our own children in

trig3ering suicide. We have elso been Appalled by the portrayals stereotyping parents

of children who commit suicide as rich ..ollywood types who are insensitive to the needs

of their children. This is not only misleading to the public, but damaging to the

survivors and their surviving children. I have not yet met a survivor that fits the

mold depicted. I would like to say that of the ondr I tiave grown to know and love.

they are among the most ch.dted and caring people that I have ever met. They are also

the ones who care the most that these horrible tragedies be reduced and that the

true problems that are impectin^ on our youth be improved or changed where this is

possible. We feel that, while some of the prob.ess that children experience at home.

such as losses through divorce or death or loss of friends through moves cannot be

greatly diminished, we can teach parents how to better cope with children going through

these changes. Most of all, we would like something to be done about the problem

*NOTE: Dr. Klagsbrun is thc d3rector of Four Winds Hospital

in New York and has worked with suicidal youth for

over 20 years.

9

BEST COPY AVAILABLE

6
94

areas THAT CAN BE CHANGED: Schools, the media, and problems like drug abuse that affects

our children in society. Prol=ms in these areas can be recognized and parents can

be made aware of the damage that is being done. After all, we cannot really be

serious about prevention if we close our eyes to the daily onslaught of violence that

children are exposed to on TV, even through MTV. We cmnnot ignore the possible damages

done to the gifted children who become deeply involved in DM in schools or in their

public libraries as this "game" asks children to role-play violent roles such as murder,

rape and torture. How in the world did this ever get into our schools anyway. There

are a multitude of questions that we must seek answers to. There are hundreds of

things that we can do that will be"suicide prevention" other than just dwelling

on the topic of "suicide"in the classroom or through the media.

We feel very strongly that the classroom must 1221 be regarded as a place for clinical therapy. Sen. Samuel I. Hayakawa has stated that, "An educational

heresy has flourished, a heresy that rejects the idea of education as the acquisition

of knowledge and skills...the heresy of which I speak regards the fundamental task

in education as therapy." As academics have been supplanted by non-academics, some

of which have proved more harmful than helpful, the illiteracy rate has grown along

with the despondency and despair in our youth. We must once again provide a healthy

climate for learning and return to academics. This will help to reduce much of the

stress and pressure felt by many who feel so inadequate in high school and in lower

grades too. Tbis return to excellence must be carefully phhsed-in so as not to create

more stress, and the emphasis must be on quality--not quantity, as has often been the

case.While I feel :Alt more press coverage on teen suicide will probably be more

harmful than helpful, I feel that dialogue and sharing among responsible adults

and young people is very helpful, as we can all offer insight to each other out

of our own experiences. While I would not advise a month focusing on teen suicide

in the media, I feel that a meeting of the minds could be helpful, and I would like

to join with others who share the common goal of lowering the rate e teen suicide.

I feel that positive programs are a real possibility, but I do feel strongly that

these are best done on a State and local level, as each area understands best the

needs of the people in each area of this country. Intervention methods are not a mystery ano should be available to all. The hard part is doing something about

the CAUSES. It will require of all of us to examine areas in the lives of our

youth that many have never been concerned about before. Many of the problem areas

are areas that we, as adults, have become 4esensitized to such as media violence,

and many are areas that many people simply assume are still as they were when they

themselves were children,such as the schools. This just .an't so, and awareness is

the order of the day. Our children would not be self-destructing if they could

withstand all that they are being exposed to, and the first step is to acknowledge

that, and then to do what we can about it. I think we can gain some insight from

reading the testimony of Julie Smith who testified before your Committee in October,

1984. She testified that she first learned about suicide from watching it on TV on

a number of occasions. These are experiences that children were not exposed to

25 years ago when the suicide rate was 300% less than it is today.

I thank you for your interest in helping our youth and for hearing the

testimony of those of us who endeavor to do what we can to prevent future deaths.

May God grant us 311 the courage and wisdom to know the best way to approach this

very sensitive issue, as well as the openess and willingness to s rare our feelings

on the issue, even with those whose understanding is not the same as our own. May

our youth eventually benefit from this sharing, and may we all learn from each

other.

/gd

Enc.

3.18AJIAVA Yci(YJ 123ki 97

Very incerely,

44, .0. 6:64e41--

D. Dickert
95

EXCERPT FROM A STATE PLAN

FOR

. THE PREVENTION OF

YOUTH SUICIDE IN FLORIDA

CHAPTER y

PARENTAL PERSPECTIVES

In its discussions, the Task Force recognized that survivors

of suicide, who often suffer hurtful repercussions from society's misconceptions, can offer a unique, personal perspective on some of the problems of youth suicide. This chapter presents the

testimony of two parent advocate Task Force members, concerning

the problem of youth suicide and possible solutions. It is

written from the vantage point of their experiences and research.

Gale Dickert and Dottie Katz, parents, submit the following

recommendations based on our own experiences as survivors of suicide, work in the field of education, and based also on the

growing concerns of parents we have talked with over the past two

years.It is our hope that Florida can be a leader in recognizing

that "suicide prevention programs" cannot, alone, stem the

accelerating tide of adolescent suicide. We must provide safe,

healthy, positive environments in schools and in society for our

youth and squarely face what some of the contributing factors are

that could be changed, if recognized. If we provide "prevention

services" without these needed changes, then we will be forced to

watch the epidemic grow. It is not the children who are unwell,

but the system.

In our haste to provide drug programs for oyr youth, we

taught them how to use drugs, in many cases, in school. We must

listen to people like Dr. David Shaffer of Columbia University

who tells us that anytime "we talk about suicide in the youthful community, we are walking on thin ice." We must, therefore, keep

the training the students simple, concise and brief. We suggest we c..1 the word "crisis" intervention and prevention in

describing to them where to seek help. May we also suggest here

that the primary people to encourage students to seek help from

be parents. For too long the schools have assumed to take over

the roles of parents and these are some of the deepest concerns

we have heard from parents. Parents must be notified when their

children are having problems, are truant or are Zailing. This could save lives. If this isn't done; lives may be lost.

We recommend strongly that the curriculum that is to be

developed along with manuals, brochures, etc. be in compliance

with Florida Statutes, keeping in mind, in particular, the

Protection of Pupil Rights Amendment, section 439 of the General

Education Provisions Act (Hatch Amendment). Inspection should be

made by parents or guardians of instructional materials, manuals,

tapes, ortany materials used in connection with prevention of

suicide or the positive emotional development section of the Life

Management Skills Course and other sections of this course. Thi:, 98
96

law states that no student shall be required, as part of any

applicable program, to submit to psychiatric examination,

testing, or treatment, or psychological examination, testing r treatment,,in which the primary purpose s to reveal nformation

concerning the following:

(1) Political affiliations; . (2) Mental and psychological problems potentially

embarrassing to the student or his family;

(3) Sex behavior and attitudes;

(4) Inegal, anti-social, self-incriminating and demeaning

behavior;

(5) UrtcryappraisalsofOttividualswithwhe

respon ents ave close am ly relat onships;

(6) Legally recognised privileged and analogus relationships

such as those of lawyer, physicians, and ministers; or

(7) Income (other than that required by law to determine

eligibility for participating in a program or for

receiving financial assistance under such program).

Section (a) in its entirety states: "All instructional

material, including teacher's manuals, films, tapes, or other

supplementary instructional material which will be used in

connection with any researcn or experimentation program or

project shall be available for inspection by the parents or

guardians of the children engaged in such program or project.

For the purpose of this section "research or experimentation

program or project" means any program or project in any

applicable program designed to explore or develop new or unproven

teaching methods or techniques." (This certainly applies to

suicide prevention programs or the new Life Management Skills

Course, and counseling programs devised to be used in conjunction

with prevention programs.)

We recommend that the Life Management Skills Course not be

expanded to a full year until it has been reviewed by parents and

other concerned individuals.

In'compliance with this law, we feel that testing such as

"You and Death Survey" and any other tests devised to detect

suicidal tendencies are unlawful. There have been suicides

reported in connection with such questioning (one recent one

reported in the Miami Herald Newspaper in October). If one life

is lost due to such testing, we feel that it negates the whole

reason for doing it in the first place. The same is, of course,

true of testing in "death and dying" courses and life management

courses that probe into the personal beliefs, attitudes, and

personal problems If students. We believe that there are not now

(and will not be for years) adequately trained personnel or

trained teachers to deal with the disturbances stirred up by such

questioning. Hundreds of parents, teachers and some counselors

testified last rarch in many states before the U.S. Department of

Educationtin protest to these invasions of privacy and breaking

of the law. They are deeply concerned, as we are, about the

anti-family values which they feel are being instilled into their

children through values clarification courses, questionaires, and

teaching in experimental government funded programs. We join

with other parents in voicing our concerns and stating our

beliefs that these are not preventive measures but could very

well be contributing factors to suicide in youth. We are

convinced that the process of decision-making, using values

clarification techniques, undermines the authority of the parents

and the home and causes students to become alienated, confused,

rebellious to all authority and could lead them to become immoral

(or amoral),

We feel that young people need structure, reinforcement of

what is taught it the hcme, love and caring, traditional

99
foundations of family and beliefs systems and a curriculum which

reflects what parents want their children to be taught in school.

We feel that teaching in its striving to be "neutral" in values

and attitudes toward home and country and religion, tears at the

very fabric of our American way of life and produces alienated,

rootless, despondent, and fearful students. The burdening of

students with the social issues which are most controversial

today, such as abortion, nuclear war, and social conflicts that

we ourselves find difficult to deal with, is prevalent in today's

classrooms. This is done by schools which view their role as

social change agents. We feel this, too' adds to pressures and

is a contributing factor leading to hopelessness, despair, fear,

and feelings of despair about the future --- and suicide in the

young. Failure to adequately teach the basic skills of reading,

writing and arithmetic in the early grades can lead to feelings

of despair, futility and hopelessness in the teenage years. This

can increase the feelings of stress and pressure in high school.

It seems to us that more emphasis has been placed on changing the

child's attitudes, feelings and values than on teaching the basic

skills which would prepare him for life.

Two factors create more stress in both adults and young

people than any others. They are LOSS (any kind, but

particularly loss by death) and CHANGE. Loss can include loss of

friends by moving or disagreements or romantic breakups for young

people. It can be the death or divorce of a parent. A devastating kind of loss can be loss of face -- of self-esteem

through being embarrassed, hurt by peers, teachers or parents, or

through failing to make grades they expected of themselves. Loss can Also stem from the loss of faith and trust one suffers when

taught conflicting beliefs or values from those one learned to

cherish in the home.

CHANGE has become a very important clement in schools as they

strive to promote social change swiftly and subtly through

teaching the young new ideas about family roles, family systems,

politics, sex, values, etc. When this directly conflicts with

what is taught in the home, it creates confusion and STRESS and

undue burdens children and youth cannot deal with. Often the

conflicts created through such teaching causes strife and

conflict in the home as the child tells the parents they no

longer have control. He controls his own destiny, values and

beliefs regarding family and country, sex, drugs, etc. More and

more the schools have refused to communicate with parents and to

hear their objections and suggestions. Parents have become wary

and afraid to approach the schools for fear of being embarrassed,

turned away or rejected. senate Bill 529 calls for comrinication

between parents and schools. It is our recommendation that ALL

PREVENTION MATERIALS DEVELOPED FOR USE WITH STUDENTS BE PRINTED

IN THE SAME FORM TO BE SENT OUT TO ALL PARENTS FOR THEM TO KEEP.

WE REQUEST THAT FUNDING BE MADE AVAILABLE FOR THIS INFORMATION TO

RE GIVEN TO EACH AND EVERY PARENT.

We further request that all parents must sign a form which

describes each aspect of suicide prevention' programs or life

management skills programs to parents nefore their child is

allowed to participate in such programs. This will help to begin

the communication called for in the bill and will prevent

unnecessary shock parents may experience who are not aware of

what their children are being offered.

WE RECOMMEND THAT ALL TEACHERS WHO VIOLATE THE CODE OF ETHICS

OF THE EDUCATION PROFESSION IN FLORIDAAND THE PRINCIPLES OF

PROFESSIONAL CONDUCT FOR THE EDUCATION PROFESSION IN FLORIDA BE

REMOVED FROM THE CLASSROOM, as we believe that child abuse in the

1 0
98

classroom is a contributing factor to the hopelessness,

depression and suicide of our youth in Florida. It has been

pointed out that many criminals come to Florida to seek

employment and, though the fingerprinting legislation has been

passed, it will not insure that all teachers now employed will be

safe teachers for our childrvn. We feel that one large

contributing factor leading to depression is the killing of selfesteem through embarrassment, harassment or neglect found in

Florida's classroom(s), perpetrated not by those excellent

teachers in the system, but by the unethical few who give the

whole teaching profession a bad name. We tell you from

experience that at times these teachers are not being removed

when there is clear evidence that direct violations have

occurred. Therefore, we urge the State Board of Education and

the Education Commission to re-evaluate the goals and purposes of

Professional Practices Services and the Education Standards

Commission and that stricter guidelines be developed to insure

that violators of the Code of Ethics, who endanger the health,

safety, and emotional Kell-being of students, can be promptly

removed from Florida classrooms. If we cannot do this---and

strengthen the Code of Ethics against loopholes---it will greatly

hinder efforts to prevent youth suicide in Florida. It must be

recognized that the public school system has great influence over

the lives of our youth. . WE RECOMMEND THAT THE FOLLOWING NEGATIVE ELEMENTS BE REMOVED

FROM FLORIDA CLASSROOMS AS THESE HAVE PROVED, BY THE TESTIMONY OF

COUNTLESS PARENTS, TO BE CONTRIBUTING FACTORS TO DESPAIR,

DEPRESSION OR SUICIDE IN OUR YOUTH.

1. In recent textbook evaluations, we found that some

companies have published books which are not predominantly

negative, violent or anti-authority as many of the texts

published in the 1960's and 1970's were. Therefore, we recommend

that funds be made available (any' evaluators - parents

preferably) to examine texts that are excellent, will uphold

parental values, be universally acceptable academically, and

which will add to the child's own belief system, his love of

parents and country and self and others. Many of the old

textbooks which now fill our schools offer little positive to the

child.

2. We recommend that the use of private and_personal

journals in the classroom which are examined in any way by

teachers be abolished. This tool has led to atrocities being

committed by teachers and students alike. Journals can be used

by both students and teachers as a gossip tool and cln invade the

privacy of the student and his family. Too often, information is

put in these which should go to a person who could help.

Teachers are reluctant to get involved and this attitude, we

fear, may not change. For this reason and many others, this

practice, which most parents are not aware of, must be stopped.

Many parents who are aware of this practice are incensed that

this is allowed and encouraged.

3. We recommend that violent role-playing activities suco

as Dungeons and Dragons, that are often used in the classroom,

particularly with our most gifted and sensitive students, be

removed from Florida classrooms. It is our opinion that such

games promote an interest in the occult and desensitize our youth

to violent activity, since the games suggest playing violent

roles. We base our opinion on incidences of youth suicide which

were reportedly related to the youths' involvement in Dungeons

and Dragons, and on statements of experts such as Dr. Arnold

Goldstein, Ph.D., Director of The Center for Aggression Research,

University of Syracuse. Recently, Dr. Goldstein stated: "I 1p1
99

think it is a bad idea to play a fantasy role-playing game such

as Dungeons and Dragons. For many, such play causes subtle

changes, which increase both a desensitization toward violence

and a tendency to commit aggressive behavior. Dr. Radeck.,

Teaching Psychiatrist at the University of Illinois, released Dr.

Goldstein's statement. Dr. Radecki, Chairman of The National

Coalition on Television Violence stated that schools should teach

children that violent entertainment, in general, such as violent

movies, music or fantasy role-playing games is harmful and

teaches anti-social behavior. The Surgeon General has reportedly

warned us about the harmful effects of TV violence. Dr. Radecki

further stated that he would estimate that between 25 to 50

percent of the murders committed in this country are directly

related to violent entertainment.

We recommend that other violent role-playing be removed from

the school setting such as those used in gifted programs that

encourage students to role-play death, suicide, lying on a

tombstone and imagining what it is like to be dead. Or roleplaying violent acts, such as imagining that one is a bullet

killing someone, which has been done in some schools for gifted

programs in lower grades. Can you imagine disturbed children

doing this -- and many, many children are disturbed in school

today. Some are disturbed because of what they are required to

do. Many parents have children come home from school in tears or

in despair from what they have been exposed to.

It has become a common practice in the State of Florida and

in other states for children to be required to write their own

obituary. This is required also here in some schools in Leon

County as a counselor mentioned in a suicide prevention workshop

recently. In the book, Child Abuse in the Classroom, a parent

gave the following testimony about a typical death and dying

sequence in Colorado.

"We had an English course in the 7th grade junior high

school title was Death Education. In the manual, 73 out of

80 stories had to do with death, dying, killing, murder, suicide,

and what you want written on your tombstone. One of the girls, a

9th grader, blew her brains out after having written a note on

her front door that said what she wanted on her tombstone. Her young boyfriend, also in 9th grade, found her in that condition."

A young Haitian boy in Miami, who was being teased at school

about being Haitian had to fill out the sentence If I had a

gut, I would . He wrote in the blank,If I had a

gun, I would shoot myself? This was in values clarifications

course in school. He went home that day, in early October 1984,

and shot himself to death. (From Miami Herald).

These two examples point out how strongly influenced these

children are by suggestion and how they will impulsively act out

violent suggestion when depressed. My own son's case is another

grim reminder that, not only do children express their depression

in a different manner from adults, but that they also do not

react tb suggestions and questions and what they read in

literature as adultr do. Viewing movies .where suicide is

sensationalized, for example, may actually enhance its appeal to

children.

IT IS OUR RECOMMENDATION THAT SCHOOL CURRICULA BE EXAMINED SC

THAT THOSE ELEMENTS WHICH TEND TO UNDERMINE ALL PREVENTION

PROGRAMS CAN BE REMOVED. This year there were new state texts,

approved for the learning-disabled and for slow readers for

grades 7-12, that offered what we believe to be incredibly

terrible role models for the child, such as Cheech and Chong,

1;.U2
100

rock groups like Cheap Trick, Pink Floyd and the Wall (who sing

suicidal songs), Ted Nugent and others. This was a whole series

of "Superstars" for the students to study for "reading

comprehension" and to develop "vocabulary skills". There were

also half-page pictures of these counter-culture influences so

they could readily emulate them in their own behavior.)

We feel it is important that these points and realities be

brought to the attention of the task force and to other parents

as well, because it is ironic that we have teachers and

counselors actively seeking information on how to prevent drug

abuse and suicide (and other problems like teen pregnancy) and

all the while they are offering materials that teach terrible

role models, literature that we believe is anti-parent and antiteacher end anti-life and that encourages drug consumption and

suicidal behavior. Sex education courses have been taught that

we feel are merely titillating and erotic to young students and

offer abortion as an easy out. Teachers then may wonder why the

poor girl got pregnant and is standing there feeling suicidal.

CLEARLY, we must make our own selves aware. We must first

change ourselves and our schools. We must make ourselves aware

that our children can't take all that we are exposing them to.

Many are self-destructing. It is not their fault. It is ours.

They can't change this society if we can't. If we burden them

with all the problems of the world that we couldn't solve

ourselves, they might jus, opt to decide not to grow up in this

world that we make sound so grim. They might just decide they

would be better off dead. Shouldn't out first examination begin

with ourselves, cur schools, and what we are offering them?

Can't much of it be changed if we know it is damaging to their

tender psyches?

WILL WE just seek to learn the signs and symptoms of suicidal

depression and hope to catch them before the fatal bullet, or

will we listen to countless parents who are crying out for changes in the media, in our schools and in society. We can't

change it all, but we do at least have some control over what is offered in school, and we can speak out and make our voices heard

about the media and society as the PTA is doing.

COULDN'T WE BE THE FIRST IN THE U.S., NOT ONLY TO HAVE A COMPREHENSIVE SUICIDE PREVENTION PLAN, BUT also to show that we

really have the interest of our youth at heart by being willing

to make real changes _n ourselves, out views, our schools and our

society. We can, if we realise that we are all reponsible for

the lives of these children. If we don't make the necessary

changes, they will continue to die needless, tragic deaths.

..- - -

Despite the emphasis in classrooms on "Death and Dying", when

a child experiences an actual loss and needs concerned teachers

who understand what he's going through -- this is in most cases

NOT AVAILABLE in school. These children return to school

traumatized, unable to concentrate and extremely depressed.

Special help and caring for children who've suffered losses (and

who could be at risk of suicide) is one of the most needed

assistances at school. This includes all loss related problems:

- death of loved ones

- loss of face through failed grades

- loss of a strong romantic tie

- loss of self concept or social status

- loss through divorce

These children don't need TESTING, programming, etc. They

need a listening ear, -raring teachers who don't demand perfection

13
101

and who are patient, and a teacher who lets them go through their

own grief process without undue demands-TTBM school. It's UTTremely important to let parents know when these students ate

absent or making poor grades -- indications of problems. Special

allowances in grading and expectations for studies must be made

and those students can be expected to be late or ablVTIr shortly

after loss. Teachers must be trafned so that abuses of bereaved

students can be stopped.

In addition to changes that can be made in the school setting

to provide a more healthy, positive environment, the concerned

public needs to be made aware of the following societal factors

which,in our opinion contribute to youth suicide:

THE MEDIA: This includes MTV, TV violence and

porncgraphy. Teens see countless numbers of murders,

rapes, mutilations, etc., on TVso that, by the time they

are teenagers, they have become desensitized to violent

acts. TV distorts the idea of death. It also makes

teenagers feel that life situations should be solved in 39

minute segments as on the average TV show. It distorts

reality. Shows such as The Day After create fearful

feelings and terror in children, make them lose hope in

tomorrow. For countless suicides, the final trigger has

been after viewing a TV show or movie depicting suicide or

violent behavior. I counted four I read about in

newspapers after the graphic depiction of a hanging of a

fine young man in An Officer and a Gentleman. This was

over the course of one year. Britain is now taking action

and protecting their youth from over-exposure to this kind

of violent behavior.

'ADVERTISING: Encourages the disappearance of childhood;

is anti-parent. Teens are encouraged by sports heroes to

drink and smoke and have early sex, stressing very poor

values and choices. Advertising has a tremendous

influence over our youth.

CULTURE is largely ANTI-CHILD and ANTI-PARENT. It encourages children to grow up quickly and rush at breakneck speed through life. INFORMATION is never-ending and

absorbed quickly, but communication is not encouraged.

Current interest in the OCCULT, cults and fantasy roleplaying games (and their acceptance in schools in the last

decade) we feel are a very negative feature in the lives

of.millions of our youth, and promote a very unhealthy

interest in death, violence and the dark, negative side of

life. It is unconscionable that this is promoted or even

allowed in our school systems. There were two suicides

police attributed to CAD in Lafayette, Colorado, this

fall. Who knows how many suicides related to these

practices go unreported as such? How many juvenile

delinquents are we locking up who are involved actively in

these pursuits? Police in some areas now routinely ask

young offenders if they are involved in the games.

ANTI-LIFE attitudes which have grown more pervasive over

the past 20 years as the suicide rate has soared.

Abortion has become merely a convenience and birth control

method. Euthanasia is seeking a place in our society for

the elderly and the ill. Pop - culture. philosophers urge us

to forego our guilt and abandon morals. Advocates of

suicide like Hemlock are making their voices heard, and

new manuals for suicide how-to are now on the market in

some places.

J!14
102

ROCK MUSIC urges through its lyrics for listeners to kill

themselves (Pink Floyd and the Wall -- "Goodbye Cruel

World") and school chorus groups have sung "Suicide is

Painless", the theme song of MASH. School children read

in their reading books and learn vocabulary while studying

about Pink Floyd and the Wall's group, thus reinforcing

the idea that this group's ideas have credibility in

today's world to these innocent children.

FEAR OF NUCLEAR WAR stemming from what children have heard

from the media, parents, or classes using scare tactics in

school, is in the back of the mind of every child. In a survey which asked students how they thought they would

die, over 90% answered, "in a nuclear war." The very

thought that such a survey would be done in school is

friyhtening. The classes on war in school deserve much

rethinking. We feel they are a terrible idea.

DRUG AND ALCOHOL ABUSE vhocki.u5 CideMmA ik most Schodr

Dr. Shaffer is Chief of Child Psychiatry at Columbia

University Psychiatric Unit and conducting a four-year study of

adolescent suicide:

Based on his studies of younger

children, he thinks that "previously

good" teenagers may kill themselves

'on impulse' after an episode of

trouble ". ..My belief, though not yet

confirmed, is that suicide is a

catching, contagious behavior. Local

epidemics may account for a

significant number of adolescent

suicides," says Shaffer, "And I think

the more attention...you give a suicide

within the youthful community, the

more you are on thin ice."

from Boston Globe article 1984

Dr. Mark Rosenberg of the Center for Disease Control in

Atlanta and who is doing the other major study of teen suicide in

this country made .his remark on the Phil Donahue Show this year,

in a conversation about causes of teen suicide:

It seems this (teen suicide) has

something in common with other

infectious diseases. One is that

like TB of yore, we end up blaming

the victim and parents when it may

have nothing to do with that. The

second thing it has in common with

these infectious diseases is that

when there is one death in the

community or in a high school, it may

put other people in that community at

risk.

Iris Bolton, Director of The Link Counseling Center in

Atlanta, specialized in the area of suicidology at Emory

University after the death of her son at age 20. She now lectures

on the subject of teen suicide and has written a book on the

subject. She testified in the hearings in Florida last winter on

teen suicide. She has said:

1U5
103

`People who kill themselves tend to be high achievers, perfectionists and sensitive people with a lew tolerance

for injustice. They also have an

inability to communicate their hurts

and have low self-esteem."

We hope these remarks help to dispel myths and

misunderstandings....and also will help to prevent labeling certain children or families as suicidal. We think that would be extremely damaging. As you can see, it can be anyone or anyone's child. hf -:ertainly cannot hope to save them all. All we can do is learn preventive techniques and ways to intervene, always remembering that the first ones to notify for intervention should

be the PARENTS with few exceptions.

Suggested reading: Child Abuse in the Classroom, testimony

before the U.S. DOE.

The Disappearance of Childhood, Neil Postman

The Coming Parent Revolution, J. Westin

0

1 6