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In the six years since Patty Green started the Nicky Green F
Bucks County Courier Times - 7/9/2018
In the six years since Patty Green started the Nicky Green Foundation, she's seen youth suicide rise from the third- to the second-leading cause of death among young people across the country.
It's now the 10th leading cause of death overall in the United States, and a new report by the U.S. Centers for Disease Control and Prevention recently showed suicide rates have increased in nearly every state, including Pennsylvania and New Jersey.
Green, a Lumberton, New Jersey, resident knows the statistics all too well. Her son Nicky, the inspiration behind her foundation, died by suicide on June 14, 2012.
"He was a straight-A student, he was an athlete, he had lots of friends, he wasn't withdrawing, he wasn't quiet - there was nothing that we saw," said Green, a licensed clinical social worker and bereavement counselor. "He literally went to his tournament lacrosse team practice and then his little brother found him the next morning."
The new CDC report and recent deaths of celebrity chef Anthony Bourdain and designer Kate Spade have put suicide in the spotlight, but researchers and advocates like Green say there is more that can and needs to be done to understand and prevent it.
"About three years ago, suicide surpassed the number of deaths by car accidents," said Theresa Tobey, executive director of CONTACT of Burlington County, a nonprofit that operates a 24/7 crisis helpline in the county for those struggling with everything from sexual assault to depression to abuse. "It's a national problem but people don't seem to want to talk about it."
Many reasons why
Many factors can contribute to suicide. It's often associated with depression, but people with other mental health conditions also can feel suicidal, as can people who do not have a diagnosis, said Sharon Curran, chief operating officer at Lenape Valley Foundation in Bucks County.
In fact, according to the new CDC report, researchers studied data from 27 states in 2015 and found that more than half of people who died by suicide did not have a known mental health condition.
Relationship problems, life or economic stressors like the loss of a job or home, and other crises were common among the people included in the study. Researchers said the findings indicate the need for a greater focus on such factors and efforts to prevent them, like strengthening economic and housing supports, building coping and relationship skills, and identifying and better supporting people already at risk.
Risk factors include a family history of suicide, substance abuse, intoxication, sleep deprivation, tragedy and loss, according to the National Alliance on Mental Illness, which has chapters in Burlington, Bucks and Montgomery counties. Research by psychologist and professor Thomas Joiner also has focused on feelings of being a burden and not belonging.
There's a common misconception that suicide is selfish, or "a coward's way out," Curran noted.
"Nothing could be more wrong," she said. "It's actually - in their mind - the more noble thing to do, even though that's not accurate, it's distorted."
It doesn't mean people don't have a family or others around them who love them, she added. But they feel disconnected.
For people who experience those feelings and become desensitized to the fear of harm or death, Curran said, the risk is incredibly high.
It can be even higher for young people, said Dr. Avi Gurwitz, director of Holy Redeemer Pediatric UrgiCare Center in Abington. He and other clinicians used to see about one or two teens per week who thought about or attempted to kill themselves, but now it's more like five or six.
The number of children and teens who were hospitalized for suicidal thoughts or attempts doubled from 2008 to 2015, according to a study from the American Academy of Pediatrics. And in Bucks, the number of suicides among people under age 24 in the county has tripled in recent years, from four in 2016 to 12 in 2017, according to Donna Duffy-Bell, administrator of the county's Mental Health and Developmental Programs.
New Jersey legislators are trying to address the "alarming rise" with two new pieces of legislation introduced in the assembly last week. They would require yearly depression screenings for teens in public school grades seven through 12 and create a commission to study the effects of smartphones and social media usage on youth.
"Teens today are navigating a very different world," New Jersey state Assemblyman Herb Conaway, D-Burlington, who introduced the bills, said in a statement. "The stressors that arise around puberty are now intensified by social media, which can be used to bully and make young people who are already susceptible to social pressure feel like they are not measuring up."
Teens in particular are in a stage of development where they're finding themselves and they are highly influenced by negative experiences like bullying, Gurwitz said. And they tend to think whatever situation they're in is the worst one possible because they don't have as much perspective or as many previous negative experiences to look back on, Tobey added.
"With adults, you can look back - we pull from that past coping to help us in the presence," she said. "(For teens), that past is not there. You try to get them to look towards the future."
Their frontal lobes also are not yet fully developed, so they're much more impulsive and likely to react in the spur of the moment, Gurwitz said.
Conaway, who also is a doctor, acknowledged that teens are notoriously moody. "But we have to distinguish between typical teenage angst and actual depression so we can reach these children before it is too late," he said.
Gurwitz said parents should trust their gut.
"It's the same as looking at a growth chart and if they're growing and then they stop growing, we say, ?OK, something's wrong medically,'" Gurwitz said. "If they're an A student and suddenly they're a C student? Something's wrong."
On the edge
In 2017, CONTACT in Burlington received 27,000 calls, of which about 3 percent were directly related to suicide, Tobey said. Many more, however, were "pre-suicidal" calls, she said, from people struggling with depression and unsure about which way to turn. And the calls have been increasing.
"They don't see any options, they don't see a way out," Tobey explained.
Tobey and Curran, of the Lenape Valley Foundation, said people often go back and forth when thinking about killing themselves.
"People who are ambivalent are the ones that reach out, and we try to reach out to the part of them that wants to live," Tobey said.
"I think a lot of people we hear from say, ?I think about suicide all the time but I would never do it because ?' and that ?because' is really important," she added.
It can be anything from not wanting to leave behind their favorite pet to not wanting to leave behind their loved ones, but it's the job of Tobey's volunteers to talk with people about their reasons for living.
Researchers have been studying how long people feel suicidal. An episode may last a long time or just a matter of minutes, but Curran said talking with people and removing means like prescription medications and weapons can help them get through it. The new CDC report found firearms accounted for more than half of all suicides in 2016.
"Sometimes the barriers to it give them long enough to feel differently and change their mind," she said.
Don't assume people "won't because ? " Curran added. "The misconceptions out there about they're too smart, they've got too much going for them, they've got all these friends - those things are not a guarantee. Money, intelligence, jobs don't matter."
"Suicide prevention is everyone's business," Linda Rosenberg, president and CEO of the National Council for Behavioral Health said in a statement earlier this month. "The best thing we can do if we are worried about someone attempting suicide is to tell them we are concerned, ask them if they are thinking about death and get them help from professionals, family members and friends."
Asking will not "put the thought in their head" or increase the risk of suicide, Curran said. But still, people may worry about the reaction they'll get.
"If the person becomes angry, it's better to have them angry and alive," Curran said. "The more we talk about it, then the more OK it is to say that maybe I've had that thought before in my life."
"It never hurts to ask," Gurwitz added.
But what if the answer is yes? Wendy Flanigan said that's a common concern. As a co-chair of the Bucks County Suicide Prevention Task Force, she helps facilitate QPR (Question, Persuade, Refer) suicide prevention training. The task force has trained more than 1,200 people since it began offering QPR in January 2017.
"It's meant for the layperson," Flanigan said. "The idea behind this is someone who is suicidal is more likely to talk to their family or friends or someone they're close to. ... The idea is not to treat the person, it's how to ask the question and then help connect them to the right resources."
There are crisis hotlines like CONTACT, and Tobey said the organization is creating a text-help line for teens who don't want to call.
Many places also have mobile crisis services that will respond to people's homes. Lourdes Medical Center of Burlington County hosts the screening and crisis intervention program for the county with the help of Legacy Treatment Services, and the program also has a mobile crisis intervention team. On July 1, Lenape began providing mobile crisis services for children in Bucks, as well as adults.
People can also go to an emergency room.
More resources are available but the organizations that offer them still face some challenges, such as parity in health care.
"If you have a heart attack, you'll get admitted right away," Gurwitz said. "But if you have a mental health crisis, it's what county do you live in, what insurance do you have, are you an adolescent, male, female, do you have autism, do you have an eating disorder ? all that takes into account before we can send you somewhere."
Tobey said her organization and others like it face discrepancies in financial support for suicide-related services. CONTACT's sexual assault services, however, are fully funded by the state.
"(The funding) comes from grants, contributions and fundraising events that we have had. So it's extremely difficult," she said.
There's still a stigma surrounding suicide as well, Green said. Many people don't want to come forward. But that's part of the reason Green decided to share Nicky's story.
"We are very close as a family and it's important to us - we have a missing piece that we can never get back," she said.
"It's important to me that people remember Nicholas - that they remember Nicky," Green continued. "I don't mind sharing my story about him. We were this family - we were good, and we're broken now and we're never going to be good again, we're just different and I want to make sure that other families don't break."