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'A Punch to the Gut': Dealing with Suicide in a Pandemic
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California schools closed in mid-March to prevent the spread of coronavirus. In the first full week of April, Chris Evans, the superintendent of a Sacramento-area school district, received a call one evening informing him that two high school students had died by suicide in the past 24 hours. One was from his district, Natomas Unified, the other from a neighboring district.

"When something like this happens, it's a punch to the gut," said Evans. "One of my biggest worries I had with the shelter-in-place order, was the social-emotional effect it's going to have on so many people. In particular, my job is to really worry about students and their parents."

Later that week, 50 miles away in Stockton, Calif., Hillary Harrell, the principal at Bear Creek High School would receive a similar call from her school's resource officer notifying her that one of her students had died by suicide.

The mother of the young woman who took her life told local media she believed that the social isolation imposed by the lockdown contributed to her daughter's tragic decision.

"I honestly don't remember a lot of the specific details [of the phone call], because it was so horrifying to think about," said Harrell. "I am a mother and have worked as an educator for 20 years. This is not the first student I have lost this way. It's just really hard to describe what you feel in these experiences."

These are the phone calls that educators dread to get even in normal times. But now Harrell and Evans were facing the daunting prospect of notifying and supporting their school community with buildings shuttered, staff and students scattered, and families struggling to take on many of the responsibilities of their children's education.

The pandemic has presented distinct challenges to schools in both preventing and responding to student suicides-which are the second leading cause of death among 10- to 19-year-olds in the United States.

And the stress the pandemic is putting on students-in the form of social isolation, family financial instability, or death of loved ones-doesn't disappear when classes are out for the summer.

Indeed, surveys of students conducted by the nonprofit groups Common Sense Media and America's Promise Alliance have found that the pandemic has been hard on teenagers' mental health, and that it's disproportionately affected black, Latino, and Asian youth.

Social isolation is uniquely hard on teenagers, said Rob Coad, a school psychologist and a member of the National Association of School Psychologists' School Safety and Crisis Response Committee.

"One of their main jobs in life is developing social connections," he said. "Their job is to differentiate from their parents and establish relationships with peers, and we're blocking that. They're missing an important developmental moment."

Already a Crisis

While the pandemic is throwing new mental health challenges at students, rising rates of suicide among adolescents, teens, and even children was a major concern even before the coronavirus outbreak began.

Suicide rates among teens have risen dramatically over the past decade, according to the U.S. Centers for Disease Control and Prevention. From 2007-2017, the suicide rate among 15- to 17-year-olds has increased by 76 percent to nearly 12 deaths per 100,000. It nearly tripled for 10- to 14-year-olds to 2.5 deaths per 100,000, following periods of stability and even declining rates in the early 2000s.

Even some children as young as 9 think about killing themselves, according to a recent study by researchers from Washington University in St. Louis.

No one is sure why these numbers have been going up, although the rise of social media and smartphone use-which create new avenues for unhealthy comparisons and for bullies to pick on their victims-is frequently pointed to as a potential culprit.

"We don't have an absolute [explanation] why this is occurring, we just know that suicide is very complex and it's a complex set of behaviors and issues that come together in a perfect storm," said Coad. "That's why when we talk about the risk factors ... it's a challenge for us to put together what of those factors are putting pressure on an individual student."

While experts are concerned the pandemic may drive more young people to harm themselves, it is not clear what the net effect of the pandemic will be on suicide rates among children and teens.

For a student who, say, was being bullied for being gay, as long as their family is supportive, their school getting shut down this spring may have benefited their mental health, said Jonathan Singer, a professor of social work at Loyola University, Chicago, and an expert on youth suicide.

"But imagine another kid, who had a very toxic home environment," said Singer, "whose reasons for living revolved around their friends at school and the fact that their teachers gave them all sorts of positive support, where school was the only safe place. Then you have a kid who is isolated from that and is now at increased risk."

The home lives of many students are also likely to get much rockier. Job loss and eviction brought on by the economic recession, which the U.S. economy entered in February, will only add to students' emotional stress.

Aside from the obvious-that it's harder for school psychologists, counselors, or social workers to check up on students when school is out-the fact that students are interacting with fewer adults overall is a concern to Singer.

One adult might see a red flag that all the others have missed or didn't even have an opportunity to see-say, a coach who notices that a student athlete's game is off.

"In a pandemic, it's only the parents seeing the kid," said Singer. "If you're [a teacher] on a Zoom call with 25 other kids, you're not going to be picking up on these things. Everybody is acting differently now. So, Joey's acting differently today, well, it's a pandemic, what do you expect?"

Pandemic-related school closures have forced schools to lean even more heavily on teachers to spot suicidal behavior in students, said Coad. Therefore, it's crucial that teachers not only know the risk factors and warning signs, but also who to contact in the district to get the student help immediately.

Warning signs in students include giving away possessions, making statements about wanting to kill themselves, and talking about being gone and gauging people's reactions. Those red flags require an immediate response, said Coad.

Risk factors include mood disorders, substance abuse, loss such as a death, exposure to violence or another suicide.

This is a big ask of teachers right now, concedes Coad, so it's imperative, he said, that schools don't leave them without support.

Putting Supports in Place

Schools will very likely continue to rely on remote learning to some degree in the fall semester, either from the get-go as a means to facilitate social distancing in school buildings or sporadically should a local surge in coronavirus cases force buildings to shut down entirely. For that reason, school districts need to adapt their suicide prevention and response plans to include telehealth and other virtual service delivery platforms, according to the National Association of School Psychologists.

Knowing what community resources are available and being in the position to connect students with those resources is also critical, says the organization. Suicide can happen at any time of day or year and schools cannot tackle suicide prevention on their own.

"The extent to which schools are siloed from community supports" is a significant weakness exposed by the mass school shutdowns this spring, said Singer.

Schools should also continue to help students strengthen their social and emotional skills, NASP recommends, especially focusing on building resiliency among high-risk students.

Finally, heading into the summer months, schools should try to make staff accessible to students and families, said Coad, through phone calls, email, and social media.

Schools don't have to rely just on staff, he said. He's enlisted students at his school, Walnut High on the east side of Los Angeles, to do outreach and share information about suicide and how to get help with their classmates.

Fellow students can be a valuable resource for raising awareness about suicide-how to prevent it and where to get help.

Maggie Patrick, who graduated from high school in Fairfax County, Va., this spring, led suicide awareness efforts at her high school.

Patrick thinks schools should train students annually on what suicide warning signs look like and what to do if see they them in a peer.

"I know not everyone is going to listen, but if even just a dozen kids do, that matters," said Patrick.

A friend of Patrick's died from suicide their freshman year of high school. She said the school, which she left the following year, handled her friend's death poorly.

"They basically tried to ignore the entire thing," she said, with one exception: "In memoriam of her, they had a kindness day where everyone had to be nice, but if you have clinically diagnosed depression, being nice is no good, it's not enough. There were so many other things they needed to talk about."

But schools also face a high-stakes balancing act when responding to a student suicide. While experts say it's important for school leaders to address the issue openly with students, they must be careful not to overwhelm students with information that will further traumatize, especially with anxiety levels already high from the pandemic, said Paul Warren, the student support services coordinator for the Lodi Unified School District in California, which includes Bear Creek High.

School leaders must be careful to not inadvertently romanticize suicide. Otherwise, it could spur other vulnerable students to take their lives. For that reason, memorials can be dicey, said Warren.

"As important as a [funeral] is for closure for kids ... when you think about people that are at high risk for suicide and depression that go and they hear messages [about the deceased] like 'they're in a better place, they're at peace, they're happy' and you hear people getting up and talking about how much they love them ... that's very appealing to somebody who is having severe suicidal thoughts," said Warren. "They may be thinking to themselves, 'I want to be at peace.' ... Depending upon the developmental age of students, they sometimes have magical thinking about their mortality. They don't understand the finality."

Staying Connected

For Evans, in Sacramento, the deaths underscored how crucial it was for schools to remain connected to the students through the shelter-in-place order. School psychologists and counselors in Natomas had been reaching out to students since the buildings had shut down.

The district provided parents with tips on how to talk to their kids about suicide and the additional stressors from the pandemic. It launched a dedicated website with social emotional resources for families where parents and students can request a call from the school psychologist. And the district is using a social media monitoring service that alerts school officials should a student search or post something relating to harming themselves.

After the suicide deaths, the district had 50 instances over the course of April where either the monitoring service flagged something, a parent reached out concerned about their child, or a student reached out to a school staff member asking for help.

"I do really believe by us communicating and being open about it ... has probably saved lives," Evans said. "And that was because we chose not to let [the suicides] just go quietly, but to let people know that they are not alone."

For Harrell, the principal in Stockton, the news of her student's death came in a particularly painful year at Bear Creek: The school of 2,200 had already lost two students in separate car accidents.

"There was a lot of sadness and there was anger" among the students, said Harrell, "and frustration that they are constantly losing their peers. They are tired of losing."

With this suicide death, Harrell relied on a routine that she has developed through the loss of other students. She made the family of the student who died by suicide and their immediate circle the first priority.

Next, she ensured that staff, students, and families knew where to go if they needed help.

She was careful that anyone she had to inform about the death was in a place where they were safe and alone, then Harrell shared the facts as quickly and with as few words as possible.

And finally, Harrell took notes.

"Often in that first experience of grief we hear beautiful stories," she said.

Grief comes in waves, she said, and Harrell saves these stories to share with a parent, friend, or teacher for when they may need them-whether it's a month later or two years.

"You never know when a good story may help someone," she said, adding: "High school is all about rites of passage and celebration-a couple of years down the line this young lady's class will be graduating and we will want those stories."

In the past, said Harrell, the Bear Creek school community has relied on being able to come together physically and not being able to do so has deepened the sense of isolation for some.

It's highlighted the need to have procedures and resources in place to help students cope remotely, she said, "because you never know when the world can turn upside down."

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741.

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