Maine searches for causes of high teen suicide rate

Maine teenagers are killing themselves at a higher rate than teens in any other state in New England.

The numbers for 15- to 19-year-olds ending their lives are particularly alarming.

From 1999 to 2001, Maine's rate for that age group was 72 percent higher than New England's. It was nearly 49 percent higher than the national rate for those ages, according to Maine statistics.

"It's very concerning," says Cheryl DiCara, coordinator of the Maine Youth Suicide Prevention Program. "Having one of the highest suicide rates in New England is not something we want to be top in."

Rates have not dropped despite creation of the statewide suicide prevention program seven years ago to raise awareness through education.

Now there is interest in launching a screening program at Maine schools to evaluate students for mental illness. Staffers at some schools also are being trained as gatekeepers, to recognize symptoms of serious depression in students.

Meanwhile, experts search for answers to Maine's high rates for youth suicides. There are several theories:

n Maine is a rural state where access to education and services may be a challenge in some towns.

Typically, rural states such as Maine have more suicides. Like Maine, suicide rates for ages 15 to 24 in Vermont and New Hampshire are double that of Massachusetts, a more urban state.

"The highest states with suicides tend to be rural like Idaho, Wyoming, Montana," says Dr. Alex Crosby, medical epidemiologist for the Centers for Disease Control in Atlanta. "Maine's 'rural-ness' may play a role in its high suicide rate."

n The lack of services combined with the social stigma that surrounds suicide may also contribute to the problem.

Carol Carothers, director of the Maine chapter of the National Alliance for the Mentally Ill, believes that stigma may prevent both teenagers and adults from getting mental health treatment.

"There's still an enormous reluctance about kids being depressed and talking openly about suicide," Carothers says. "Kids aren't supposed to get depressed, are they?"

n In Maine and the rest of the United States, about 40 percent of residents own guns. Access to weapons could be an issue that needs more attention, says Alan Berman, director of the American Association of Suicidology.

"Are there readily available means of suicide weapons that can be restricted?" Berman asked. "That might be something the state needs to do more education on, gun safety."

After accidents, suicide is the second-leading cause of death for Maine youths ages 15 to 24, and in most of those deaths firearms were used. From 1998 to 2003, there were 130 suicides of Maine people ages 10 to 24.

Hoping to lower Maine's teen suicide rate, former Gov. Angus King created a task force in 1995. One of the group's top recommendations was to initiate the Maine Youth Suicide Prevention Program in 1997.

Its goals are to prevent suicides through education and increased awareness about depression and other mental illnesses. But there has been little change.

"Despite our efforts, the teen suicide deaths haven't decreased," DiCara says. "But experts told us when we started this that it would take 10 years to really impact a suicide rate."

Loren Coleman, a Maine author who has researched and written books on suicide, believes isolation and poverty are significant factors in the state's high number of suicides.

"You've got people living on the edge of poverty, who are stressed about how to get food, heat their homes," Coleman says. "They may have to drive 50 miles to see a psychiatrist or counselor. Some people feel like there are no services for them, and that helplessness, that desperation can lead to suicide."

Besides increasing services in small towns, Maine should examine other possibilities to determine why young people kill themselves in greater numbers than in neighboring states, Berman says.

"Is there anything unique about Maine's social services, public health strategy, treatment of mental health disorders?" Berman asks. "Does Maine have sufficient public awareness about the kinds of risk factors related to suicide and specifically may be related to its communities?"

Public education is one of the most important tools in reducing Maine's suicide rate, DiCara says. "What we can do is try to get everyone more aware. Everybody needs to know that suicide is a problem in our state for young people," she says. "And everybody needs to learn a little about it. What the warning signs are and what to do."

Carothers, of the National Alliance for the Mentally Ill, agrees that the state must do a better job of identifying kids at risk. Her agency is seeking a federal grant to implement a program called TeenScreen in Maine schools.

Developed by Columbia University, it evaluates schoolchildren for mental illnesses and suicide risks. Using a questionnaire that takes about 10 minutes to complete, it asks students about depression, suicidal thoughts, anxiety, health problems and substance abuse.

Students who need help are referred to professionals for treatment. The goal is to offer a mental-health checkup for every student in school.

"The theory is that we screen kids for all kinds of things, lead paint, other health problems, so why don't we screen them for suicide, the second-leading cause of death in our state?" Carothers says. "And if you screen kids early and catch kids who need assistance, maybe you can prevent them from getting sicker, ending up in jail or trying to kill themselves."

The Maine Youth Suicide Prevention Program is also trying to educate school staff and students on the warning signs of depression and suicide.

Called gatekeeper training, the program began in the spring of 2003. So far, 12 Maine schools have taken part. The entire school staff - teachers, janitors, kitchen help, administrators - are taught to recognize signs in a child who may need help.

Once a child is identified as having depression or suicidal thoughts, he or she is referred for treatment. The schools are also provided with the names and numbers of agencies that can help.

"What we're doing is making sure the school communities know how to recognize signs, know what to do to help these kids and then make sure they know where to find them help," DiCara says.

DiCara would like to expand the program, but finding funding is difficult. Her agency's annual budget is $300,000, the bulk of which is federal money.

"We'd love to put more programs in schools, but funding is always a problem," DiCara says.

Mountain Valley High School in Rumford is among the dozen schools in the gatekeeper program.

Mary Dunlap, a nurse who works at the school's health center, believes the program has made a difference.

"In the past, students who might have been at risk were going unnoticed," Dunlap says. "Now the school staff feels more empowered to do something after they've been trained, and we're seeing a lot more kids get referred for help because of it."

So far this year, Rumford's staff has identified six students as being depressed or at risk for suicide, Dunlap says.

"There's not a cookbook approach on how to handle these kids, and not all of them may have depression symptoms," she says.

"If we give ourselves permission to talk about it as professionals, parents and students, it's only going to help prevent it from happening. No one wants to lose a child," Dunlap says.

Even with the increased awareness, she says, there is no guarantee it will prevent suicide. A Rumford student killed himself last spring.

"It had a huge impact on the school, but we found that because of our training that we were better equipped to handle the issues and concerns that arose after the student's death," Dunlap says.

The suicide happened on a Friday and the high school stayed open for the weekend, offering counseling to students, parents and teachers.

Along with training staff to recognize children in trouble, high schools like Rumford are teaching students the warning signs of depression and suicide.

"We try to be real honest with these kids and tell them they could be saving someone's life," says Ryan Casey, health education teacher at Mountain Valley High. "And because of what they learn in these classes, we're seeing more kids refer kids for help."

The students are taught to seek an adult at the school if they're concerned about a friend or classmate.

The Maine Youth Suicide Prevention Program is also reaching out to kids statewide. This month, youths learned about depression and suicide at a teen conference in Augusta.

Students from a theater group at Lincoln Academy, in Newcastle, performed two skits about teenagers who were depressed or suicidal.

In the middle of the short plays, the actors asked the young people in the audience what warning signs the characters showed.

"It was pretty intense," says Morgan Shattuck, one of the actors. "A girl in the audience had actually tried to kill herself."

Now that he is aware of depression and suicide warning signs, Shattuck says he is more apt to reach out to a friend in trouble.

"I'm feeling a little more sensitive about this now," says Shattuck, who is 16. "If I saw a friend and thought they needed help, I'd probably go tell either a parent or a guidance counselor."

Shattuck's classmate, Caroline Bixby, also acted in the skits about suicide. Preparing for the plays also gave Bixby new insight.

"It's kind of scary to think of kids killing themselves when they have their whole life ahead of them," says Bixby, 16. "I really felt good about doing something to get more people to think about this."

Bixby was surprised when she learned at the teen conference that Maine's youth suicide rate was the highest in New England and higher than the national average.

"If we all talk and learn about this more, it can make a difference," Bixby says. "I might feel kind of strange asking a friend if they're suicidal, but it could change their life if they got help."

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