Suicide prevention program focuses on teens

It may still be a taboo subject in society, but for freshmen at Medway High school, there's no avoiding frank talk about suicide.

In early December, each of the roughly 240 students spent one of their double-period classes watching a video about depression and suicide presented by a counselor. After completing a self-screening survey, they could check off a box if they wanted to talk with someone about themselves or a friend. They left class with handouts reminding them to "ACT": "Acknowledge" if a friend has a problem; "Care" by letting him or her know you want to help; and "Tell" a trusted adult.

That's the key message of the Signs of Suicide (SOS) prevention program. Since 2000-01, more than 3,500 schools throughout the United States have used its materials and training kits to teach students how to recognize and respond to depression and suicidal thoughts.

"People are always telling me that the program has saved lives in their schools," says Sharon Pigeon, manager of SOS at Screening for Mental Health Inc., a nonprofit in Wellesley, Mass.

Ms. Pigeon's own niece, 14 years old at the time, confided in her that a friend had attempted suicide and planned to "do it right" the next weekend. Using materials from SOS, Pigeon persuaded her niece that they should call the school counselor. "Later, the girl said to [my niece and other friends], 'I don't know which one of you told on me, but I'm glad you did because you saved my life,' " Pigeon says.

Her anecdotes are backed up by independent research. SOS is the only school-based curriculum shown to reduce self-reported suicide attempts in randomized controlled studies.

While suicide by young people is rare, it's the third leading cause of death among 15- to 24-year-olds, according to the National Center for Injury Prevention and Control. Knowing the ripple effects that even one teen suicide can have in a community, educators are eager to equip students with tools like SOS.

Research reports in 2004 and 2007 found that suicide attempts were 40 percent less for students in the SOS high school program than for the control group. The results were similar across racial and socioeconomic groups. Because of such studies, SOS is listed on the National Registry of Effective Programs maintained by the US government's Substance Abuse and Mental Health Services Administration. Middle schools have started using an age-appropriate version of SOS recently as well.

The Massachusetts Department of Mental Health increased its funding for youth suicide prevention to $75,000 in 2007, up from $20,000 the year before. Most of the money is used to purchase SOS kits for hundreds of schools, and to train school staff. Educators are urged to build ties with community mental health providers to make sure help is at hand once students start identifying peers as depressed or potentially suicidal.

Teachers frequently use the ACT acronym (Acknowledge, Care, Tell) to encourage students "not only to identify young people who may be suicidal, but also for such things as bullying and dating violence," says Alan Holmlund, director of the state's suicide prevention program.

Sadie, a Medway senior who heard the SOS presentation as a sophomore, says that "in high school, especially in a small town like this,... once you break someone's trust you don't know where you're going to end up yourself." But SOS gives students a different perspective, she says. "You really see how dangerous it is not to speak out.... When it comes down to either losing a friend because they're not talking to you anymore or losing a friend because they lost their life, you know, I think this makes people come out and say, 'This person needs help.' "

Medway counselor Meredith Poulten sends a letter to parents each year explaining the SOS program and the basic self-screening survey that students are asked to take. After seeing the presentation, students privately answer a few questions about their mental outlook, ranging from "Do you have less energy than you normally do?" to "Do you think seriously about killing yourself?" Then a scoring guide tells them whether they should consider evaluation or counseling.

Each year Mrs. Poulten gets some calls from parents with questions, and a few decide they don't want their children to participate. Usually less than 1 percent of students say they want to talk with a counselor after the screening. But Poulten finds about a dozen whose surveys prompt her to "check to make sure they're OK," she says. "Sometimes they're just having a bad day. If we do really find a problem, then we contact the parents."

Poulten runs a drop-in center where students can come to talk, hang out, or even do research for a class. While she encourages them to talk over issues with parents, she keeps everything confidential unless students are at risk of harming themselves or others. She also oversees peer counselors, who assist with the SOS program and have their own room where students can come talk about anything on their minds.

Perhaps the most effective component of SOS at Medway is an additional video created by a peer counselor who has since graduated. Looking straight into the camera, occasionally flipping wavy blond hair out of his eyes, he tells what led to his own suicide attempts in high school.

Depression and suicidal thoughts are "kind of like a black hole.... It gradually gets bigger and bigger and sucks you in until everything is just a negative thought," he says to the somber freshmen watching him on a screen. He describes the night when he got into a fight not only with his best friend but with his parents, too. He stormed into his room after telling his family, "I'm sorry for making your life so difficult ... and hopefully you can find someone to take my place and be a lot better than I've been."

Nobody checked on him, as he hoped they would. "That night I cut myself worse than I'd ever cut myself before, hoping that I wouldn't wake up in the morning. I thank God every day that I woke up, now," he says. He tried to hang himself that summer, but the following school year Poulten's message started to click and he realized "that people needed me around, and I had things to do and accomplish."

His plea to each freshman at Medway (where a girl succeeded in her suicide attempt while he was a student there): "Look at your friends, notice what's going on.... This isn't a joke."

After the videos, the class is quiet. Poulten invites questions and discussion, but she doesn't push when there's no verbal response. Many students nod when asked if they would feel comfortable talking to an adult about a friend exhibiting the signs they've just learned about. A few say the Medway student's video was easier to relate to than the SOS video, in which actors play out scenes and the right and wrong way to react to a friend exhibiting various warning signs.

Their English teacher, Laura Morris, wonders if the message really sank in for these honors students. "I saw them kind of smirking and laughing.... I was wondering, how can kids get over that sense of 'Oh, that's silly, that's for the kids who are messed up'?"

Most students do take the message seriously, Poulten and the peer counselors say. It's difficult to know if the absence of suicide at Medway in the past few years has been because of SOS. But Poulten has seen an increase in students referring their friends to her.

"We hope that this has a long-lasting effect. At least it's in the back of their mind ... that there's help and if the subject [of suicide] comes up, and what they can do about it," she says.