5 Questions: Steven Adelsheim on Santa Clara County youth suicide report

Earlier this month, the federal government released a report on risk factors for suicide among youth in Santa Clara County. The report, which was requested by members of the Palo Alto community in response to youth suicides in 2009 and 2014, reviewed the epidemiology of suicidal behaviors in young people living in the county, as well as aspects of the community response.

Steven Adelsheim, MD, clinical professor of psychiatry and behavioral sciences at the School of Medicine and a child and adolescent psychiatrist at Lucile Packard Children’s Hospital Stanford, has been involved in several efforts to improve mental health care for young people in the community. He spoke with science writer Erin Digitale about the new report, which was produced by the Centers for Disease Control and the Substance Abuse and Mental Health Services Administration.

Q: What did the report say about suicide rates and precipitating circumstances behind youth suicides in Santa Clara County?

Adelsheim: The report found that youth suicide rates for residents of Santa Clara County have remained really stable, with no significant difference over time since 2003. When you look across the board at the county’s 10- to 24-year-olds, the annual suicide rate is 5.4 per 100,000 people, which is very similar to the California rate of 5.3 per 100,000. The national suicide rate among this age group is higher than rates for our county and state, at about 8 per 100,000.

Looking at the county’s youth suicides in detail, two-thirds occurred among young people aged 20 to 24, and three-fourths of young people who died by suicide were male. Their ethnicity distribution was close to that of the county as a whole. When the researchers looked at youth who died by suicide, the cities of Palo Alto and Morgan Hill did have higher rates than the county as a whole: 14.1 suicide deaths per 100,000 among Palo Alto residents and 12.7 per 100,000 among Morgan Hill residents.

A key finding of the report was that many people who died by suicide had faced a recent crisis or mental health issue. About a third were currently being treated for mental illness, and 48 percent had current mental health problems, including depression, substance abuse and alcohol dependence. Fifty-two percent had had a recent life crisis, such as a breakup with a boyfriend or girlfriend, problems at school or a significant argument.

Q: To what extent do you think the findings support or refute assumptions people may have made about youth suicides in Santa Clara County?

Adelsheim: Locally, before the report came out, there was a sense that losses of young people in the Palo Alto area were much larger compared to the county as a whole. It’s true that the rate of youth suicides within Palo Alto was found to be higher than for young people elsewhere in the county, and there may be some ongoing stressors among Palo Alto youth, such as academic stress, that the community is working hard to address. But the findings also make clear that no single factor explains suicide-related deaths.

The report reflects well on efforts the Palo Alto community has been making to improve all aspects of mental health among young people. Strong partnerships have been formed between the school district, the city, parents, teens, mental health care providers — including our team at Stanford — and many others. All these partners deserve credit because their efforts are making a difference.

Q: What else did the report reveal?

Adelsheim: When you look broadly at the entire county and note the rate of suicides in males aged 20 to 24, it raises important questions about how young people who are no longer high school age can access mental health services. I think we need to recognize their crises and build better access to early mental health care across the board. We also need to start asking why these young men are less likely to access mental health care and build programs for them to easily get it.

The contrast between youth suicide rates in rural and urban areas of Northern California is also noteworthy. According to the data the CDC examined, Bay Area counties have rates that are very similar to the state rate of around 5 to 6 suicide deaths per 100,000 young people, while rural counties have much higher rates. The top three were Mendocino (16.2 per 100,000), Lake (15.2 per 100,000) and Humboldt (12.5 per 100,000) counties.

One difficulty is that many rural counties generally lack the financial support to provide the same access to evidence-based interventions across large rural areas. A possible solution is building out telehealth and telepsychiatry capacity, which we at Stanford have done in a small way by providing this kind of support to a pediatric practice in Monterey. There may be value in expanding these types of support to more rural counties to expand access to mental health care.

Q: One area of focus for the CDC report was the quality of news reporting about Santa Clara County’s youth suicides. What does the media need to improve?

Adelsheim: Responsible news reporting is an important element of reducing suicide contagion among youth, but the CDC report shows that local and national coverage of youth suicides was fairly uneven in quality. Problems the CDC documented in media reports included use of sensationalistic terms and headlines, as well as photos or language depicting the means by which people had died. Those should be avoided in news coverage of suicides.

Also, there are several things media stories can include to make coverage more responsible, which the report found were sometimes missing. For instance, it helps to talk about suicide as a public health issue that is multifactorial and can have important mental health aspects. It’s useful to talk about hope and tell stories of people who were struggling but then did better. And it’s very important to say that treatment for mental health problems works, to say there are treatment options, and to provide contact information for crisis services and say, “If you’re concerned that you may harm yourself, here is the place to go.” Overall, avoiding sensationalism and showing that help is available are really important.

Q: How have Stanford Children’s Health and Lucile Packard Children’s Hospital Stanford responded to the need for better mental health services for our community’s youth?

Adelsheim: We have formed many productive partnerships. We’re doing a lot of work with schools in Santa Clara and San Mateo counties, where we’ve been providing direct care, prevention efforts, early intervention, and training and support for school staff around suicide prevention. We’re working with groups like Project Safety Net in Palo Alto and the HEARD Alliance to increase the range of support available for young people, as well as providing community education. We’re also working to launch a program for youth with early signs of psychosis to help decrease suicide risk among those in the early stages of serious psychiatric conditions.

In addition, we’ve partnered with Mills-Peninsula Hospital to have Stanford child and adolescent psychiatrist staff several pediatric inpatient mental health beds. Having hospital beds available for youth in crisis is important, but only one piece of the puzzle. We also want to be able to help young people much earlier. To that end, we’ve been developing a local version of the headspace program, based on a successful Australian program of the same name, for providing outpatient counseling and other early-intervention services to youth. Santa Clara County has allocated funding for two staff positions, a youth development specialist and a school employment specialist, and we’re partnering with the county to potentially access additional innovation grant funding to support the development of two county headspace sites.

The headspace model is designed to help youth aged 12 to 25, so it’s a potential access point for young people aged 20 to 24 who might not otherwise get mental health care. Our marketing for headspace will include messages saying that this is a place to go for help recovering from breakups and other difficult life events, rather than overtly branding it as a mental health clinic. We hope this approach will help us draw in a larger swath of young people.

Overall, we are supporting a broad range of community-based services. We want to have capacity that stretches from prevention to early intervention to acute-care services, and we’re really proud to partner with so many community groups to work toward this worthy goal.

Individuals in crisis can receive help from the Santa Clara County Suicide & Crisis Hotline at (855) 278-4204. Help is also available from anywhere in the United States via Crisis Text Line (text HOME to 741741) or the National Suicide Prevention Lifeline at (800) 273-8255. All three services are free, confidential and available 24 hours a day, seven days a week.