Live or Let Die : Orange County’s Suicide-Prevention Programs Are Teaching Teen-Agers That Telling Secrets and Breaking Promises Can Sometimes Be the Best Way to Save a Friendship

A gangly, doe-eyed youth named Karen sums up her existence as “a lifetime of downers that just went from bad to worse.”

Her parents divorced when she was 7, her dad died of kidney failure when she was 9, and she and her mother have been estranged most of her life. At 14, the Huntington Beach girl started taking antidepressants prescribed by a psychiatrist to counteract feelings of hopelessness.

And when they didn’t work, she found solace in recreational drugs, alcohol or sex. The only thing she regretted at that time, she remembers, was not having tried those things before she was 14.

Her life hit its nadir right before her 17th birthday, when a steady boyfriend told her to “drop dead” and the undertow of despair she’d fought all along sucked her into a spiral of self-destruction. She swallowed 15 of her antidepressants, thinking two things: “When I am ever going to get out of this (depression)” and “I can’t pop these pills fast enough.”

She called her best friend, Carrie, to sort of say goodby. She told Carrie not to worry about her anymore, that she loved her very much, but said nothing about taking pills.

The cryptic message alarmed Carrie, who had learned to recognize suicidal statements through school suicide-prevention instruction. When she got to Karen’s house, her friend was mixing herself a drink and watching MTV. An empty bottle of antidepressants sat on the kitchen counter. Carrie called the paramedics. Karen’s mother came home from the movies to find out her daughter was in the hospital.

Indeed, teen-agers such as Carrie have a clear advantage over adults in identifying suicidal youths. They are often able to save peers’ lives because of critical information friends disclose or desperate telephone calls made before or after an attempt.

Teen-agers are privy to a kind of exclusive tribal peer talk about depression, fears, sexual exploration, parental problems and suicidal feelings, all of which are an inherent part of adolescent development in varying degrees, psychologists say.

But most psychologists say simple awareness of suicidal friends is not enough. They say teen-agers, whose primary interest is being accepted by their friends, must be taught through youth suicide-prevention and peer-counseling programs in schools how to overcome ambivalence, the fear of breaking confidence, fear of peer rejection and of looking like a tattler, all potential impediments to acting on behalf of a suicidal friend.

While suicide-prevention and peer-counseling education exists in most Orange County high schools, some of these programs will likely be undermined by cuts in the state’s education budget this year, cuts that will largely affect support programs in schools.

Huntington Beach Union High District has eliminated three out six psychologists serving six high schools. Placentia-Yorba Linda Unified District sliced their counselors from 26 to nine last year. The county’s 12 other high school districts fear that if further budget cuts are made, youth suicide-prevention programs and the counselors who run them will be eliminated.

In fact, most districts statewide fear that possible additional cuts of $2.3 billion from the $18.4 billion the governor earmarked earlier for kindergarten through community colleges will force schools to eliminate most support programs for the coming year.

That would be disastrous for the suicidal teens whose only support is found in school support programs and friends, say psychologists.

“If a kid has a bunch of pills or a rifle, 20 of their friends know about it and the parents are the last to know,” said clinical psychologist Joseph L. White, a professor of psychology and psychiatry at UC Irvine who has written the book “Troubled Adolescents.”

“All the kids I see in my practice who have tried or considered suicide have talked to friends about it. School programs are important, no matter what we do. There is a kind of absolute trust in teen relationships, almost a tribe-cult kind of relationship where they protect each other, look for peer acceptance and discuss highly personal things like sex and suicide, things they simply won’t discuss with adults.

“By the time a youngster is troubled enough to think of suicide, they have probably had some disappointing experiences with the adult world, given that they are not going to turn to adults. Teens are the first line of defense--the first-aid station.”

Indeed, mental health care professionals say suicide is a clear and present danger to adolescent lives. Teen suicide has quadrupled since 1950, rising from 2.7 per 100,000 teen-agers that year to 11.3 per 100,000 in 1988, according a federal study released in the fall by the Centers for Disease Control in Atlanta.

In Orange County, 15 teen-agers age 15 through 19 took their own lives last year, according to the county Health Care Agency.

About 1 million American teen-agers attempted suicide during a 12-month period, and an estimated 276,000 sustained injuries serious enough to require medical treatment in 1990, the study found. About 9% to 14% of adolescents have told researchers that they have attempted suicide.

The rising rate of teen suicide over the years prompted the implementation of optional peer counseling programs and youth suicide-prevention education in most of the state’s high schools in the mid-1980s. Psychologists who specialize in suicide say the goal of these programs is to enable those teen-agers who have been taken into confidence by suicidal friends to break the silence and save lives.

A minority of psychiatrists object to the programs, claiming they fail to screen potentially suicidal youths for immediate treatment. In addition, some opponents claim that suicide education causes “contagion” by way of power of suggestion, inadvertently prompting more adolescent suicides.

But anecdotal evidence gathered statewide from teachers, counselors and students in 1986 by the Los Angeles County Office of Education showed about 44 successes, where a teen’s intervention appeared to prevent a suicide as a result of youth suicide-prevention pilot programs.

It is not uncommon for teen-agers to think about suicide, say psychologists, but when they begin talking about it in great detail and forming a plan, there is cause for alarm.

Jason and Larry, both 16, listened for weeks as their friend Tom confided in them about his urge to die and about how he planned to do it. The morbid talk continued steadily until the two youths realized their friend was in danger and went to a school counselor.

Huntington Beach High psychologist Ellen Shiro, who called the suicidal youth into her office, said: “When all this happened, Tom was really angry at his friends, who had learned about suicide in health class. I told him it was only because his friends cared so much about him that they risked his being angry at them to come forward.

“They figured out that he was in danger. He was definitely considering killing himself. His father was called in, and it turned out there was a history of suicide in the family.”

After Tom received therapy along with his family, Shiro said, he was able to overcome his suicidal urges and get on with his life.

“He walked into my office a couple of weeks ago and thanked me for saving his life,” she said. “He told me that now that he has his life back, he is really happy and doing really well at college.”

But it isn’t easy for youths to go to an adult about a friend.

JoAnne and Suzanne, both 15, were worried about their friend Renee, but in an initial meeting with a counselor, they were ambivalent about disclosing details.

Two days later, they overcame their reticence and returned with a harrowing tale. Renee, they said, had been standing on a chair in the shower with a noose around her neck attached to the shower head every day for about a month. She was trying to work up the nerve to step off and hang herself.

Their hesitation underlines the ambivalence teens experience about revealing confidential information, a delay that very well could have cost a life.

“These girls who reported it had second-year training in PALS (Peer Assistance Leadership Society),” said Monica Meyer, a psychologist at Ocean View High School in Huntington Beach. “When they came in the second time they said, ‘After what we’ve learned from PALS, we realized she needs help.’ They realized through the training that rather than keep confidentiality they should go to a trained adult. The suicidal girl was talking about not wanting to live anymore. She was hospitalized for a long period of time after that. It was all a total surprise to the parents.”

Some teen-agers who come forward face the wrath of a friend.

“We were both 15 at the time,” said Anna, 17, of Los Angeles, who volunteers as a peer counselor on Teenline, a hot line for troubled adolescents at Cedars-Sinai Medical Center (supervised by psychologists). “And this friend was taking stress medication, and she was taking too much of it and writing me these really weird, scary letters, like ‘life isn’t worth living’ and ‘it’s really, really bad.’ And poetry about the dead bodies of forgotten friends floating in water. I started to get really worried about her, and I told her I didn’t want her to hurt herself. So I told her mother. My friend was really mad at me for a couple of weeks.

“But all of our friends backed me up. I told her mother that same day I decided to do it, because I knew if I didn’t do it then, I wouldn’t do it ever. I was afraid her mom would say ‘What are you saying about my daughter,’ but she didn’t. My friend did say thanks and kind of understood everything later.”

While enduring an angry friend is unpleasant, it hardly compares with the worst-case scenario.

Steve Gelsinger, a psychologist for the Capistrano Unified School District, recounted this recent tragic situation:

“I had a young man who had been in and out of counseling and was talking about hurting himself. His friend didn’t want to talk to anyone about it because he didn’t want to upset his (suicidal) friend. (The suicidal friend) ended up taking an overdose in the afternoon and he never woke up in the morning. The friend enabled this kid to kill himself because he didn’t want to intervene. The kids were about 17. He is kind of depressed about it and is dealing with it in therapy. He has become very, very angry at himself and at the teen who killed himself.”

There are several reasons youths sometimes don’t come forward, said Michael Peck, a Los Angeles psychologist who has studied teen suicide for 30 years and whose suicide-prevention pilot programs for schools have been implemented in many Los Angeles County schools.

“Kids protect each other,” he said. “They may not believe (a friend would really commit suicide); that is not uncommon. No generation worries about mortality. They may take helping a friend upon themselves like saying, ‘Oh, I’ll trick them out of it.’ They really don’t understand the circumstances of (suicide) and that is why the programs are so valuable, they help them to understand what the circumstances are.”

To get teen-agers to “break through” the dilemma of confidentiality versus disclosure, Peck said that youths first must fully understand that their friends are in danger.

“Part of these programs talk about the concept of a loss and that the dilemma is not just an issue of ‘If you don’t fink on your friend, you won’t have a friend tomorrow to keep confidences for,’ but that it is a matter of saving a life. Programs emphasize that.”

Peer-intervention and youth suicide-prevention courses in schools vary in degrees of quality from the highly sophisticated to the more fundamental. Teens are taught to refuse to be sworn to secrecy and to tell suicidal friends that “suicide is a permanent solution to a temporary problem,” such as grades, problems with family, romance or general despair often related to adolescence.

Most programs teach teen-agers to recognize suicidal behavior, listen with non-judgmental responses, ask if they have a suicide plan, suggest trained adults who can help and get a promise (called a “contract”) that they won’t hurt themselves.

One Huntington Beach youth, 17, endured a prolonged depression that alarmed teachers enough to send the senior to the counselor. Shortly thereafter, the youth slit his wrists and went to school in a long-sleeved shirt, trying to hide what he’d done. His two friends forced him to go to the school counselor the morning after the act, something he resisted. He was subsequently hospitalized for the month of March with his parents’ consent.

After his release from the hospital, he summed up his instability at the time of his attempt this way:

“I was pretty stressed. My parents divorced in ’82 and had both remarried. I have been living with my uncle for a long time. It was just a whole bunch of things. My grades came back, and they weren’t great. And it was my birthday, and I had a really crappy birthday. I didn’t go to school for a couple of days, and then I got in a big fight with my uncle, who was bringing up all this stuff from years ago and blaming me for stuff I didn’t do.”

Shuffling his feet back and forth and turning up his wrists to reveal the scars, the teen-ager adds in a barely audible voice: “I just didn’t care anymore. I just started cutting myself. My uncle came in the bathroom while I was doing it and didn’t even notice. I wasn’t thinking anything when I did it. When you’re in high school you just have no options, you have to do what your parents tell you or they won’t support you, whether you agree with them or not. It was like being in a boat with a hole in it.”

Undoubtedly, it is no small act of heroism for youths to step in when a friend is suicidal. They risk receiving a friend’s fury. The reward, of course, is keeping a friend nearly lost and eclipsing the gnawing guilt that goes hand in hand with a friend’s suicide.

Carrie, who saved her best friend’s life, said that at first she thought her friend was overdosing just to get attention from everyone, something psychologists say is a common misconception about suicide attempts that sometimes impedes intervention.

Carrie now believes she did the right thing.

“We had a difficult time after it happened. We went through a whole week in the hospital, and then she went away for a while. I was really mad at her, but I had never been mad at her before. We have gotten past all that now. We worked it out.”

Trends in Orange County Teen Suicides

From 1985-91, 114 teen-agers took their own lives in Orange County. The figures have changed little over the years.

Suicide Comparison

(Yearly Totals)

1985: 20

1986: 17

1987: 14

1988: 16

1989: 15

1990: 17

1991: 15 (Male: 9; Female: 6)

Teens as a Percentage

Teen suicides, as a percent of total suicides:

1985: 7.0%

1986: 6.0%

1987: 4.7%

1988: 6.1%

1989: 5.8%

1990: 5.9%

1991: 5.9%

Suicide by Age

Two-thirds of teens who committed suicide from 1985-91 were 17 to 19 years old.

19 yrs. old: 23.7%

18 yrs. old: 23.7%

17 yrs. old: 21.1%

16 yrs. old: 15.8%

15 yrs. old: 9.6%

14 yrs. old: 6.1%

What to Look For

* Youths from families in which suicide has occurred or those with a history of drug or alcohol abuse are more at risk. Teens frequently commit suicide shortly after a loss of some kind, such as the death of a friend, family member, divorce of parents, romantic or friendship splits. Mental-health professionals have isolated certain behaviors that may indicate suicidal tendencies.

Other signs:

* Noticeable change in eating habits and sleeping, energy loss and neglect of personal appearance.

* Withdrawal from friends, family and loss of interest in regular activities.

* Poor attention span and decline in quality of schoolwork.

* Radical personality changes.

* Drug and alcohol abuse.

* Talking about death, suicide, hopelessness and despair.

* Giving away personal possessions.

* Giving verbal hints with statements such as “you won’t have to worry about me anymore” and “nothing matters” and “I am not needed.”

* Becoming suddenly cheerful after prolonged depression (the final decision has been made, which is in itself a form of relief).

How to Help

Some ways to be helpful to someone who is threatening suicide:

* Be available and show interest and support.

* Ask if he or she is thinking about suicide.

* Be direct and talk openly and freely about suicide.

* Don’t tell the person to feel better, offer platitudes or lecture on the value of life.Allow him to express his feelings, good or bad.

* Don’t ask why; this encourages defensiveness.

* Offer empathy, not sympathy.

* Don’t act shocked; this will put distance between you.

* Don’t be sworn to secrecy.

* Offer hope that alternatives are available, but don’t offer glib reassurances; it only proves you don’t understand.

* Remove means, such as guns or pills. Get help from people or agencies specializing in crisis intervention and suicide prevention.

Whom to Call

* Teenline (1-800-TLC-TEEN) is a hot line answered by teen-agers who have gone through extensive training and are under the supervision of mental health professionals. It is open from 6 p.m. to 10 p.m. nightly and operates out of Cedars-Sinai Medical Center in Los Angeles.

* California Youth Crisis Line, open 24 hours: (800) 843-5200.

* Child Abuse Hotline, open 24 hours: (800) 540-5000.

Source: Orange County Coroner

Researched by Kathleen Kelleher and Janice L. Jones / LOS ANGELES TIMES