The Nassau County Child Fatality Review Team (NCCFRT) is a multidisciplinary team that has functioned as a NYS approved child fatality review team as provided in Social Services Law (SSL) §422-b working under the supervision of the Office of Children and Family Services (OCFS) since December 2008. The team was created to review fatalities of Nassau County residents age 0-17 years who die in Nassau County and whose death is otherwise unexpected or unexplained to better understand the causes of these deaths and to make recommendations based on the team’s findings in order to reduce future child fatalities. The NCCFRT meetings are confidential and closed to the public.
The NCCFRT would like to share information obtained from the case reviews on teen suicide. NCCFRT reviewed eight suicide cases that occurred to Nassau County residents between 2008 and 2011. The victims were between the ages of 12 and 17 years of age, and: 4 victims were male; 4 were female; 5 of the victims had a history of mental illness; 4 victims had a history of mental health treatment; 4 victims had a recent relationship loss or conflict; 2 had academic problems; 3 had a history of drug use; 4 had a positive toxicology for alcohol or drugs at death; 1 had a criminal or juvenile record; and 4 had prior suicide attempts.
The National Institute of Mental Health (NIMH) estimates that about 15% of adolescents in grades 9 to 12 seriously consider suicide in a given year. Nationally suicide is the third leading cause of death in both the 15 to 24 and the 10 to 14 year age groups. According to NIMH, there is reliable scientific evidence that the strongest risk factors for attempted suicide in youth are depression, substance abuse and aggressive or disruptive behaviors. In addition, the Centers for Disease Control (CDC) reports that males are four times more likely to die from suicide than females. Females, however, are more likely to attempt suicide than are males.
Specific risk factors for suicide among adolescents vary with age, gender, cultural and social influences. However, the following are some factors which may be present: a diagnosable mental or substance abuse disorder; impulsive behaviors; recent losses as in parental divorce, relationship difficulties or death; family violence; prior suicide attempt; access to a firearm; family history of suicide, mental or substance disorder.
Some of the national trends noted above were seen locally in Nassau County and some were not. Based on the reviews it seemed that teens themselves did not know what to do when a friend was suicidal. Based on all the above factors, the NCCFRT sent a letter to all 56 school districts. In this outreach, the NCCFRT encouraged districts to seek ways to implement primary and secondary prevention activities. Though the number of proven interventions for suicide prevention is limited, there are some evidence-based interventions that schools can take that may reduce the risk. The school setting has been identified as a critical place to recognize warning signs of suicide and to implement primary and secondary prevention activities. Recommendations to the school included the following:
1) Creating district–wide suicide prevention, intervention and postvention guidelines for dealing with suicidal and potentially suicidal youth which should include educating students on warning signs, increasing awareness on how to get help for self and friends, provide in-service for faculty and increasing parent awareness. Components of the guidelines, adapted from the Oklahoma Suicide Prevention Toolkit, that should be considered include:
- Gatekeeper programs: School and/or community personnel are trained to increase identification of those at risk. Such training could be implemented during staff development days. Examples of such programs include: safeTALK, ASIST, QPR and Kognito At-Risk for High School Educators. Parents can be included as well. Specific materials for parents can be found at: the American Academy of Child and Adolescent Psychiatry web site (fact sheets for families) and the Columbia Teen Screen website.
- Screening Programs: Screening programs are designed to screen young people for suicide risk factors and mental illness indicators. Students at risk are referred for services. Example: Columbia TeenScreen and Signs of Suicide (SOS)
- Crisis Management: Crisis management involves strategies geared towards youth in immediate crisis. Levels of interaction vary. They are designed to find the youth at risk the appropriate services. Examples: Long Island Crisis Center, crisischat.org, National Suicide Prevention Lifeline: 1-800-273-TALK
- Postvention Strategies: Postvention strategies are designed to reduce future suicides and suicide attempts. Examples: Suicide Prevention Resource Center’s ‘After a Suicide: A Toolkit for Schools’; CONNECT Postvention Training and Media guidelines for suicide reporting.
2) Schools were also informed that model protocols from other states are available on the internet. One such example can be found at: www.state.me.us/suicide/about/reportdocs.htm as part of the Maine Youth Suicide Prevention Program website. Resources at this site include an information booklet, a gatekeeper resource book and a prevention, intervention and postvention guide.
3) Other resources suggested included:
- omh.ny.gov (and click on suicide prevention bar on left)
Suicide is one of the most preventable causes of death. Early diagnosis and treatment of risk factors increases the likelihood that an adolescent can lead a productive adult life. But in many instances, these children are not being identified or diagnosed. Oftentimes, this can be attributed to poor help seeking behaviors and attitudes. A major factor contributing to this deficiency in help seeking behavior, on the part of both the referring individual and the distressed child, is a perceived stigma associated with mental illness. “Social marketing campaigns can stimulate cultural changes that de-stigmatize mental health problems, remove barriers to accessing appropriate care and encourage help seeking” (SPRC, 2004). Focusing on increasing awareness of suicide as a serious public health problem and dispelling myths about suicide and suicide prevention results in changes in beliefs and attitudes. There will then come about a decrease in the stigma associated with suicide and life-threatening behaviors.
Julie Weiser, MD, MPH, is Coordinator of the Nassau County Child Fatality Review Team, Nassau County Department of Health. Patricia Fulton, RN, CASAC, is Supervisor, Nassau County Office of Mental Health, Chemical Dependency and Developmental Disabilities Services. Paula Pontrelli, BS in ED, CPP, is Supervisor, Program Systems Management, Nassau County Office of Mental Health, Chemical Dependency & Developmental Disabilities Services.