When Pam Valentine speaks to a room full of high-school students, she sets her alarm to ring every 17 minutes. That’s the frequency at which a young man or woman in the United States dies of suicide, the third highest cause of death for people ages 10-24. As Valentine speaks for an hour, the world loses three more people to suicide.
Valentine’s son, Michael Valentine, a 1999 graduate of Walt Whitman High School, died of suicide in June 2002. Another local student lost to suicide is Brian Malmon, a 1995 Churchill graduate who died as a student at Columbia University in March 2000.
Valentine’s and Malmon’s deaths motivated both students’ families to raise awareness of depression and potential warning signs that a student may have depression or be at risk for suicide. After Michael’s death, Pamela said, “I pledged that as long as I live that I will work with the school on this.”
Pam Valentine spoke to Whitman students in 2003 at the school’s Youth Summit, now a bi-annual event in which students attend workshops on issues like depression and suicide.
Last month, Valentine went to Chicago to march in Out of the Darkness, a march for families of suicide victims. She also remains active in support groups for people who have lost loved ones to suicide. Sadly, Valentine says, the group continues to get new members.
“This is such a high-pressure area,” Pam Valentine said. Many students have parents who are models of success, and in turn want to see their children achieve. “It’s not a bad thing, but balance is critical.”
Young people, especially young men, are often able to hide the symptoms or feelings of depression that they have.
Malmon’s sister Alison Malmon, a ‘99 Churchill graduate then attending the University of Pennsylvania, launched Active Minds on Campus, a mental health awareness organization for college students. Active Minds now has chapters at 22 colleges, and a national headquarters in Washington, D.C.
“Teenagers are maybe not emotionally equipped to handle the ups and downs and the stresses and anxiety of life,” said Randy Bosnic, a psychology teacher at Gaithersburg High School. “It crosses cultural lines and economic lines — anyone is at risk.”
BOSNIC RESEARCHED national suicide prevention programs after a Gaithersburg High School student died by suicide in the 2003-04 school year.
Last March, Bosnic and Gaithersburg student Keaton Lesnik testified before Maryland’s state legislature in support of H.B. 930, supporting legislation introduced by Del. Sheila Hixson (D-20) to fund suicide screening and prevention programs at Maryland schools.
“We need to do more to try to prevent more incidents like this in the future,” Bosnic said. “We’re proactively trying to address the cause.”
H.B. 930 was unanimously approved by Maryland’s legislature, and Gov. Robert Ehrlich signed it into law in May. Maryland’s Department of Education is now required to seek federal funding for these types of programs, and the money is there. The federal Garrett Lee Smith Memorial Act was signed into law in October 2004. It authorizes $82 million for youth suicide prevention programs at college campuses and mental health centers.
With the passage of Maryland’s legislation, Malmon at Active Minds hopes to begin working with high schools as well.
“I think it’s reassuring, because up until this point, we were recognizing this as a problem, but I think we’re finally starting to do something,” said Heidi Coons, development director at Threshold Services, a Silver Spring-based nonprofit devoted to helping people with mental illnesses.
With state education officials required to seek funding for suicide screening and prevention programs, the question now remains as to how they will be implemented on the county level.
COLUMBIA UNIVERSITY’S TeenScreen is the program Bosnic had in mind when he testified for H.B. 930. TeenScreen is a 10-minute questionnaire which focuses on identifying students with mental health problems or at-risk tendencies for suicide that can’t be seen outwardly, said Rob Caruano, TeenScreen’s co-director.
“You could have the quarterback or the prom queen [who are at-risk], people who can outwardly mask their symptoms.”
Caruano stresses that TeenScreen is not an evaluation, and the program does not recommend specific treatment for those determined to be at-risk.
With the county schools’ existing programs and initiatives in identifying depression, Pam Valentine believes TeenScreen is the next logical step.
“TeenScreen is a tool for getting kids checked at a very high level. … We check every other aspect of health for our kids except for their mental health,” Valentine said. “I think it should be mandatory for all kids, and I don’t mean just high school kids.”
As of April 2005, there were 406 active sites with a TeenScreen program. There is a waiting list of 250 communities that want to implement TeenScreen. “We don’t persuade people,” Caruano said. “Resistance isn’t quite the issue for us. … There’s a lot of momentum going on across the nation.”
BUT LOCAL advocates for a screening program expect opposition to the idea.
Mental health disorders and suicide are sensitive subjects that many people are reluctant to discuss. “It makes people uncomfortable — they don’t want to talk about it,” said Bosnic.
Through Active Minds, one of Malmon’s primary goals is to alleviate the stigma attached to discussing mental health disorders through informal group sessions like brown-bag lunches. “Some of it just takes somebody talking about their own experiences,” Malmon said.
Malmon expects opposition to screening programs from some parents who will wonder what to do if something “is wrong with” their child
“I think in general people are afraid to talk about mental health,” Malmon said. “They feel like if they don’t talk about it, it won’t be a problem.”
SCREENING ALONE is unethical, said Mindy Schuman, a school psychologist and project manager for Kids First Alliance, a county student wellness initiative in the Gaithersburg High School cluster. “Unless you have an active infrastructure … you have no business screening,” Schuman said.
Schuman feels that TeenScreen should be implemented only when a full range of therapy and intervention is available to all of the county’s students — including the uninsured and the undocumented. “I think we’re moving in that direction,” Schuman said, but that the county schools and their communities are not there yet. “It’s a very resource-rich county [but] it’s a county where the poor don’t necessarily know how to access these services.”
“I realize that right now we don’t have mechanisms … to implement something on that scale,” Bosnic said. “There’s so much involved — money, insurance issues. It’s a lot to put on someone’s plate.”
But neither Bosnic nor Pam Valentine want to wait until the day that concrete follow-up procedures exist. Each believes that a screening procedure followed by parental notification could help.
“That’s where a parent has to step in,” Pam Valentine said.
“With consent, let [parents] know the ramifications of the whole thing,” Bosnic said. “Without consent, they don’t get screened.”
MONTGOMERY COUNTY Public Schools address the issues of depression and suicide from several fronts.
County-wide, all high schools have guidance counseling departments. Guidance counselors and other school staff who have reason to believe a student is at risk for suicide are required to document what they have seen and use reasonable means to prevent a suicide. “Most schools do a good job through the guidance counselors of trying to help kids,” said Del. Kathleen Dumais (D-15) a cosponsor of HB 930.
Mental health and suicide are also part of the county’s health education curriculum required of 10th-grade students, which describes health as having spiritual and emotional components, as well as physical. The curriculum includes symptoms of depression and suggestions on how a student should respond if a peer shows signs that he or she is contemplating suicide.
Pam Valentine keeps pushing for more. “These kids are only getting it when they’re in health for a very brief period,” she said.
Three county high schools — Walt Whitman, Sherwood and Magruder — now hold Youth Summits, school-wide workshops in which each student hears a speaker discuss depression and its symptoms. At Whitman, the Youth Summit is now a bi-annual event, with the next one scheduled for March 28, 2006.
“I’m impressed that [those schools’] administrations were willing to do that,” Malmon said. Ordinarily, she said, “the Maryland Department of Education and the principals don’t want to touch the subject.”
“I would love to see programs like that spread throughout Maryland,” Malmon continued. “They involved students in the planning. … That’s the way to best reach students.”
Whitman and Thomas Wootton high schools have chapters of Students Against Destructive Decisions (SADD), originally called Students Against Drunk Driving. The organization changed its name and expanded its mission in 1997 to include violence, teen depression and suicide.
Many of those who supported H.B. 930 say that people with depression and/or suicidal thoughts exhibit some warning signs, some which are not intuitive. The very nature of clinical depression often prevents those affected by it from seeking help. Bosnic and Malmon believe that students can also be better educated to see signs of depression in their peers.
“There’s so much education that needs to be done,” Alison Malmon said. “We need students to know what they could be experiencing, or how to see it in their friends.”
Three months after the passage of H.B. 930, it is unclear whether it will ultimately lead to a screening program in county schools. Bosnic hopes and expects that it is just a matter of time. He would like to see a pilot program include TeenScreen as an option for students in the county’s 10th-grade health education curriculum.
“The long-range goal is to have a TeenScreen program in every school,” said Bosnic. “The main goal is a happier life for kids who are depressed unnecessarily. … It’s unnecessary suffering.”
The refrain from Bosnic and other screening program advocates is that many suicides are preceded by warning signs, and educating students about these symptoms, along with a voluntary screening program, could help reduce the number of suicides.
“I would really, really like people to know that suicide is preventable,” Coons said. “We do a lot to help after the fact. What we need to be doing is putting more effort toward prevention.”
EXISTING SCREENING PROGRAMS
* Teen Screen — Sponsored by Columbia University, Teen Screen is an adolescent mental health and suicide screening initiative active in 43 states. The program’s aim is to offer all parents the opportunity for their teenager to receive a voluntary mental health check-up. See www.teenscreen.org
* Signs of Suicide (SOS) — A suicide prevention program for secondary students. The program’s main teaching tool is a video that teaches students how to identify symptoms of depression and suicidality in See www.mentalhealthscreening.org
SUICIDE PREVENTION LEGISLATION
H.B. 930 passed unanimously through Maryland’s House and Senate and was signed into law by Gov. Robert Ehrlich on May 10. Introduced by Del. Sheila Hixson (D-20) with help from Del. Hank Heller (D-19), the bill requires the Maryland State Department of Education to seek federal funds through the Garrett Lee Smith Memorial Act to fund teen suicide prevention programs. It aims to establish mental health screening programs and peer-to-peer mental health awareness programs in Maryland high schools.
The Garrett Smith Act is federal legislation that was signed into law in Oct. 21, 2004 by President George W. Bush. It authorizes $82 million for youth suicide prevention programs at college campuses and mental health centers. The legislation aims to support the development of youth suicide early intervention and prevention strategies as an expansion of mental health services. It was named after the son of Sen. Gordon Smith (R-Ore.), who died by suicide in September 2003.
A college student’s freshman and sophomore years can be exceptionally difficult if he or she has depression, said Pam Valentine, mother of Michael Valentine, a Whitman graduate who died of suicide in 2002.
“I see far too many kids who lost their support group,” Pam Valentine said. “All the people who had someone to talk to … all that support is gone.”
When Michael was at Whitman, Pam Valentine said she knew nearly every one of his friends, and their parents. That changed when Michael went to the University of Maryland.
College can also be a difficult transition for students who excelled in high-school sports or activities. Many students who played varsity sports in high school are unable to make the cut in an intercollegiate program, and the lack of a supervised and inspiring activity can make a college student feel like a “small fish in a large pond.”
This is “a very big void in these kids’ lives,” Pam Valentine said.