At least five suicides have occurred in the last six months among teens in South Florida high schools, and emergency room doctors say the number of attempts is up dramatically, too. So when two young people associated with Marjory Stoneman Douglas in Parkland took their lives just six days apart, they exposed an already devastating and larger mental health issue.
No one can definitively say why, but teen depression, anxiety and suicide are increasing at an alarming rate. The struggle with mental health has permeated every income level, race and ZIP code in South Florida. In its path, friends, parents and teachers grapple with the pain left behind when teens feel so helpless they take their own lives.
“If it can happen to us, it can happen to anybody,” said Debbie Schopp of Weston, mother of Dylan Schopp, who took his life four years ago at age 20. “Suicide does not discriminate. It is not about color or money … that doesn’t matter. It’s about mental health, mental illness.”
While suicide in Florida has become the third highest killer of teens and college students, behind unintentional injury and homicide, experts say the real numbers are greater than those recorded.
“We do not know real numbers because many times the death is not determined as suicide, but rather deemed an accident,” said Jackie Rosen, executive director of the Florida Institute for Suicide Prevention.
Still, the numbers from government records are startling:
— Nationally, the suicide rate for teens between 10 and 17 was up 70 percent between 2007 and 2017.
— In Florida, the suicide rate for teens between 12 and 17 jumped 77 percent in the same time period.
— Broward County schools has recorded 16 suicides of current students in the last four school years.
— Each year in the United States, almost 5,000 young people, ages 15 to 24, kill themselves.
Last week, the issue drew heightened attention when two survivors of the Parkland shooting were found dead six days apart in apparent suicides that are being attributed at least in part to post-traumatic stress disorder. School officials in Broward County swung into gear to reach out to other students who may be in crisis, setting up a town hall and opening a counseling center staffed with mental health clinicians. In an automated call, Broward County Public Schools Superintendent Robert Runcie asked parents to use spring break to talk to their children and recognize signs of personal crisis that could lead to suicide.
With the Parkland students, post-traumatic stress disorder may have factored into the suicides, but Rosen said typically there are a series of issues that lead up to suicide rather than a single trigger.
“It’s never one thing,” she said. “There is a build-up, and then their glass gets filled to the top and you add one more drop.”
Psychiatrists are swamped
At Joe DiMaggio Children’s Hospital in Hollywood, Dr. David Rube often treats teenagers in the emergency room with severe depression, some who have even tried to harm themselves.
“If they haven’t done anything yet, they are feeling like they want to,” said Rube, a specialist in child and adolescent psychiatry. Rube said the DiMaggio ER is getting between 90 to 110 visits per month from teens experiencing a mental health crisis, not including those who transfer to the hospital from other facilities after suicide attempts. “We have seen a significant trend upward for the past two to three years.”
For parents, differentiating between normal teenage moodiness and more serious depression can be a challenge. Experts suggest parents, doctors and therapists use six questions known as The Columbia Protocol to recognize warning signs. With mental health, detecting signs is the first step. The ultimate goal is to make the right diagnosis, decide the right treatment, and work on triggers, Rube said.
Occasionally, teens will come to the hospital for an injury, and The Columbia Protocol questions will reveal they are suicidal.
“That’s why we now screen for suicide even if they come in for medical problems,” he said.
Behind the numbers
Could the crazy amount of stress on teens be to blame? Is academic pressure creating too much anxiety? Are today’s teens ill-prepared to handle relationships and break-ups?
Christopher Ferguson, professor of psychology at Stetson University in DeLand, said the increase in teen depression and suicide could be attributed to multiple factors — although it’s likely a combination of factors. Everything from spotty mental health screening, to the huge amount of societal competition, to a genetic predisposition to mental illness could explain the increase in mental illnesses. And then there are child experts who believe smartphones that have led to fewer real conversations and a high use of social media are the main contributing factor with anxiety and depression.
To understand teen suicide better, particularly in the context of Parkland, Ferguson draws a correlation between feelings of shame and suicide — not just survivors’ guilt but also feeling bad about what they did or didn’t do.
“With people who feel bad about their actions in any type of event, suicide [to them] is about restoring their honor,” he said.
How schools cope
As teen mental health becomes an increasing concern, South Florida’s school districts are struggling to keep up. In most high schools, the already overworked guidance counselor handles most daily teen problems, except in crisis situations when grief counselors are brought in.
Broward County Superintendent Runcie has said the mental health support in Broward is “not sufficient.”
At the time of the Parkland shooting, there was roughly one school psychologist for every 2,000 students in Florida, according to the Florida Association of School Psychologists; the National Association of School Psychologists recommends four times as many.
After the shooting, an army of mental health therapists descended on Parkland to help students and their families work through the torrent of emotions they were facing. Shortly after the shooting, state lawmakers gave more than $69 million in mental health to school districts. They money was doled out to districts and charter schools based on their number of students. It represented a significant increase after years of underfunded mental health programs in schools.
Broward County Schools spent its $4.7 million portion to add 60 mental health personnel, including nurses, family therapists, counselors and social workers, according to Tracy Clark, director of marketing and communications with Broward County Public Schools.
While all of Florida’s school districts haven’t detailed yet how they spent the money, the originally submitted plans largely outlined the hundreds of staff they hoped to hire. Only a few school districts explicitly detailed specific prevention programs targeted at lowering rising suicide rates.
Among the experts offering advice is Dr. David Schonfeld, a pediatrician and director of the National Center for School Crisis and Bereavement at the University of Southern California’s School of Social Work. He said he has visited Parkland monthly since the shootings and has been impressed with the school district’s dedication to the community’s mental health care.
He said in the first months after the shootings, there were many therapy volunteers who didn’t have sufficient trauma experience and were rotating through their shifts without trying to develop long-term relationships with students.
“I pointed out the children were talking to multiple people and had to start over every time they came in,” Schonfeld said.
He said students now can see a single therapist consistently and the therapists have made commitments to work with students through the end of the year.
He said the fact that there were no suicides in the year immediately after the massacre shows some of the interventions worked.
“Even when there are parents who love their children, and teachers who are prepared, you can still have suicide,” he said. “It’s understandable to question what’s happened and why. But there’s been a large openness to think through how to do this in the best way possible.”
Some teens are seeking help
Outside of schools, some teens are seeking help. In the last year, more than 3,000 teenagers called the local 2-1-1 hotline (dial #211). In addition, the hotline reported an 85 percent increase in calls in 2018 related to suicide from just three years prior.
“When they are going through so much pain they want to end their lives; what we can do is give them hope,” said Frank Isaza, chief operations officer with 2-1-1 Broward. Isaza said his team has access to more than 4,000 resources for callers.
When teens call and are suicidal, the priority is to create a safety plan, and if necessary, send a mobile unit to their home or call 911 if the suicide is in progress, he said. With more stressors than prior generations, Isaza said, teens typically lack the coping skills. Unfortunately, they also tend to hide their need for help.
“Youth don’t typically have good help-seeking behavior,” he said.
Schopp, whose son Dylan took his life four years ago, believes there are many reasons why teens are dying from suicide.
“Teens and college students just don’t know how to cope when things go wrong,” she said. “We are missing the signs because we are all looking down on our phones and not at the person. If you look at someone who is in pain, you can see it in their eyes.”
Schopp notes that often, it’s the popular teen who takes his or her life, feeling pressured by expectations and hiding true pain from friends and family.
“Social media makes it harder because everything is in your face and it becomes a competition,” she said. “Even though your teen is telling you everything is great, it might not be.”
Social media’s role
Social media has played a complex role in the rise of teen depression and suicide. While it has opened the door to cyber-bullying and exclusion, it also has become a place where teens share despondent feelings — sometimes leading to prevention, sometimes not.
Anthony Wolkin-Grudin, a 20-year old who had attended J.P. Taravella High School in Coral Springs, took his life in April 2018. His Facebook page contains posts from 11 months earlier in which he says “I can’t keep living like this, it’s breaking my heart day by day” as well as one that says “Please, Save me.” His best friend, Allan Varela, said he saw the posts and had long conversations to try to lift Anthony’s spirits and encourage him to seek help. “Friends can motivate you, but in the end you have to seek out the professional help you need … depression is a sickness,” Varela said.
He says he and Anthony’s family re-live the last day in their minds, over and over again. “It’s a lot to bear when something like that happens to a loved one.”
For some teens though, social media provides a platform to feel less isolated. There are Facebook pages for suicide attempt survivors and those contemplating suicide such as Please don’t jump and Instagram accounts such as @no2suicide.
The concern though, is whether teens will go beyond social media to have those vital conversations. In the wake of the recent Parkland suicides, parents and community members are vocal about the need to reach out to teens, rather than waiting for them to seek help.
“What has come to light with the suicides is that the therapy they’re offering is not helping,” said Melissa Broccoli, parent of two Marjory Stoneman Douglas students. “There is a surplus of providers at the school that are not being utilized properly. They wait for students and teachers to come to them. They need to go to the kids who are too weak or hopeless to reach out.”
Several mental health support coalitions have sprung up since the shooting, including Parkland Cares and Professionals United for Parkland. Professionals United for Parkland has referred more than 100 clients for free therapy, and in January trained more than 200 local therapists in trauma care, board member Karyn Hoffman said. Hoffman, a therapist, said the coalition plans to redouble its efforts to reach out to more students in the coming months, including opening Instagram and Snapchat social media accounts that are popular among teens.
“This is the one positive part of social media that we didn’t have after 9/11,” Hoffman said. “We can use social media to de-stigmatize mental health issues.”