The American Psychological Association has labeled teen suicide “a growing health concern.” Can you share some statistics to help put the issue in perspective?
According to the CDC, about 44,000 people across the life-span die by suicide every year in the U.S. That’s one person every 11.9 minutes. Overall, suicide is the 10th leading cause of death. But among 15- to 24-year-olds—the age group I do most of my research with—it’s the second leading cause. From 2011 until 2014, the suicide rate for 15- to 24-year-olds was pretty stable. Then, from 2014 to 2015, there was an increase of almost 1 person per 100,000 [raising the rate from 11.6 to 12.5]. We don’t know yet if that’s a trend upward or just a blip.

What caused that uptick?
I wish we could say, but there’s never an easy answer when it comes to suicide. There are constellations of risk factors, so when we teach individuals what they should be on the lookout for, we list a bunch of things. People might want to say it’s social media, or substance abuse, or economic hardship. But we can’t just say there’s one cause. It’s those constellations of risk factors.

What are some of the risk factors to look for in young people?
The news about suicide often makes it seem like some event—such as being bullied or experiencing a loss—was the cause. Those are situations that may be a triggering event, but usually occur within the context of other risk factors. Those factors include depression, anxiety, substance use, lack of connection to others (or social withdrawal), previous exposure to death by suicide, and prior suicide attempts. What we worry about is if we start to see a bunch of them together, then there’s an increased likelihood that suicide could happen.

But it doesn’t mean it will happen. You have to balance all of the protective factors. For instance, on college campuses students have access to mental health care. That’s a brilliant thing. Students don’t have to pay for each visit, because it’s part of their student services. If they need help, they can get it. We want to promote to everyone that it’s normal and it’s important to seek help. If we could have an epidemic of help-seeking, that would be good.

Tell me about some of the prevention work you’re doing here at Monmouth.
We had a multiyear suicide prevention grant that let us train students, faculty, and staff about how to take care of each other at the level they’re appropriately supposed to. We created on campus what we call a “competent community.” It’s a public health social work model in which everyone has a role in suicide prevention. The idea is, your role isn’t to do everything, it’s one piece of the puzzle in this model, and if everyone does their role, then no one falls through the cracks. That grant ended in 2016. Then, last January, we received a large private donation that was a logical extension of the work we were already doing.

You’re referring to the SRF Suicide Prevention Research and Training Project. What’s happening through that initiative?
In September, we hosted a free conference, Youth Suicide Prevention: Using the Media to Start the Conversation. It was inspired in part by 13 Reasons Why, as well as other stories in the media earlier this year. The conference was open to anyone who interacts with youth, and we had more than 300 parents, grandparents, clergy, coaches, school counselors and social workers, state workers, administrators, case managers, mental health professionals, and substance abuse professionals attend. We asked the participants ahead of time to share with us their questions about suicide, and we focused the day’s proceedings on those questions. Participants learned ways to start the conversation, whether on the national, school-based, or individual level. We hope they will bring this information back to their organizations, schools, and communities.

Because we received so many clinical questions, we’re planning another conference, for early 2018: Continuing the Conversation: Clinical Approach to Youth Suicide Risk Assessment and Management. The details of the day are still being worked out, but we had a lot of interest from professionals to learn more specific clinical information about suicide. We have an incredible mix of academic researchers and clinical professionals here and on our steering committee; working together synergistically will allow us to get the message across that suicide prevention is something we all need to work on together.

You mentioned 13 Reasons Why, the series about a high school girl who dies by suicide. The show received a lot of media coverage, in part because some people felt it glorified suicide. Does a show like that help or hurt your efforts?
It has its pluses and minuses. It brought the issue to light, and everyone reacted to it in a way that is making a conversation happen. What I would have liked to see is the producers putting protections in place—that is, providing information on what people can do if they’re experiencing those thoughts or know someone who is. You didn’t get that in the show. On some episodes, you were warned there was suicidal content, but they didn’t tell you what to do if you were upset—except in a small, stand-alone segment, “Beyond the Reasons,” which was not connected to the individual episodes. The series had a mature-audiences-only rating, but there were 11- and 12-year-olds watching it without any protections, because parents didn’t know it was happening.

Along the same line, there have been stories in the news about the so-called Blue Whale Challenge. Can you explain what that is? Is this a real thing?
I don’t know a lot about that, but it is supposedly an app or online game where you complete challenges that lead to a final challenge in which you hurt yourself or die by suicide. I don’t know if it’s real. I don’t know if kids are doing it. But if kids think it’s real, then it’s a real thing. If there’s a cluster of contagion of, “Oh, this is what everyone’s doing,” then it’s something we need to be addressing.

Looking ahead, what more needs to be done to confront the issue of adolescent suicide?
California recently passed a law that mandates six hours of clinical training in suicide prevention for clinicians before they can get licensed. More states need to do that. That way, when someone has the courage to get treatment, their therapist, their clinician, their doctor knows what to do. It sounds scary, but [many] clinicians are somewhat ill-prepared—unless they’ve sought out additional training on their own, like the people who came to our September conference. We have to make sure therapists know exactly what needs to be done, and that they’re comfortable doing that job—these are what we call downstream measures.

We also need to focus more on upstream prevention. That means working with young people way before suicidal thoughts or behavior become an option. We can start with young children to build resiliency, problem-solving, and coping skills. I just wrote a curriculum, Lifelines Prevention from Hazelden Inc., with my colleague, Judith Springer, Ph.D. Schools can use it to teach 11th and 12th graders emotional preparedness for life after high school. My colleagues also created a 5th and 6th grade version that mimics the same kind of learning. These curricula complement the Lifelines prevention education for 7th to 11th graders. This way, when people hit the bumps in the road in life that we all know they will face, they can weather them better and not think suicide is the solution.

Michelle Scott, Ph.D., is an associate professor in the School of Social Work and is director of Monmouth University’s SRF Suicide Prevention Research and Training Project.