Halfway through his junior year at Doherty High School, Matthew Bennett gave his guitar away to a friend.
It wasn't the first indicator that the 17-year-old, known for his involvement in school musicals and choir, was struggling. But as with the other signs — including outright telling friends that he was considering suicide — it was misunderstood by those around him.
Within months, on Feb. 10, 2002, Matthew hanged himself.
The year Matthew took his life, 81 other individuals also completed suicide in El Paso County. It was an all-time high.
Just eight years later, according to 2009 statistics released this month by the El Paso County Coroner's Office, the number of local suicides has doubled, accounting for almost 20 percent of all deaths autopsied last year. (See chart on the right.) Among the victims were some well-known members of the local arts community: former UCCS Gallery of Contemporary Art director Gerry Riggs, artist Timber Kirwan and curator Jason Zacharias.
But some of the lesser-discussed victims were children. Seven percent of the suicides completed during 2009 in the county were by those 19 years old or younger. Between 2004 and 2006, 15 local youths completed suicide; between 2007 and 2009, 28 did. And just over the past eight months, the county has experienced the suicides of two 12-year-olds, including one on May 2.
"Unfortunately our son is one of many, many," says Jane Bennett. "Children, little kids, are saying they're contemplating suicide ... That's too scary. It's too scary a thought to be quiet about it."
She and her husband Guy have chosen not to be quiet. Since Matthew's death, the two have committed themselves as volunteers for the Suicide Prevention Partnership of the Pikes Peak Region (SPP). They educate the public — in particular youths, their parents and teachers — about suicide, and Guy, a real-estate agent by training, oversees SPP's Safe Teen school program.
They'd seem to be fighting long odds. For many years, Colorado has ranked above the national average of 8.4 suicides per 100,000 teenagers between the ages of 15 and 19. Currently, the state sits at 13.4 per 100,000. Not one person interviewed for this story knows exactly why — nor do state experts.
According to a report released in 2008 by the Colorado Trust, a grantmaking organization devoted to promoting health care access, "There are no definitive research findings that explain the higher rates of suicide in Western mountain states or in Colorado."
It goes on to say that perhaps a combination of factors contribute, including lower population density and a high rate of migration, which promotes social and geographical isolation; stigma about the use of mental health services; less availability of mental health services; and high rates of gun ownership.
In Colorado Springs, you might think the strong military presence has much to do with the numbers. But Janet Karnes, director of the Suicide Prevention Partnership of the Pikes Peak Region, says that shouldn't be too much of a factor: Suicides of active-duty soldiers are tallied separately by the military. (See "Behind the numbers" on p. 22).
Instead it's all of the above factors, plus other issues believed to be pushing youth suicide numbers across the country: the languishing economy, which affects older teens looking for jobs directly, and younger children indirectly; higher rates of untreated or undiagnosed depression; and the influence of Internet social networking sites that may provide detailed accounts of suicide methods and chat rooms where there is increased peer pressure to go through with it.
Some of the above is beyond our control; we can't stop wars or resurrect the economy. But even so, we can have something to say about whether or not someone commits suicide.
"If their pain could be stopped," Guy says, "most people would want to live."
The screening situation
Matthew Bennett had been diagnosed with depression before he killed himself. And in that, he was like lots of other kids. The U.S. Surgeon General reports that 11 percent of youths in the United States between 10 and 19 suffer from a serious mental illness, such as depression. That's about 4.5 million young people.
Karen Fallahi has seen what she calls "a strong correlation between depression and suicidal behavior" up close for years, as leader of the Depression and Bipolar Support Alliance of Colorado Springs. And she believes it's time that more attention is given to the extent of depression among young people.
DBSA-CS, a volunteer-run local chapter of a national group that focuses on assisting individuals with mood disorders, has been facilitating free youth support groups since the late 1990s. Before joining a group, Fallahi says, the kids previously "have not been able to express or voice what they're going through, because that expression, 'No one knows unless you've walked in my shoes,' holds true, especially with teens."
In three decades as a Colorado Springs pediatrician, John Genrich has only recently become aware of how true that is. He seems a bit pained at the way he used to address mental health issues with the teens who came through his office.
"I would use what's called 'the hunch technique,'" Genrich says. "That's what I named it — where I would say to myself, 'Oh, I know this teenager. I know his parents, they're professionals. I've known them for 15 years.' And I would ask them the routine questions, about school, peers, drugs, alcohol and sex. And I'd get the usual shoulder-shrug non-answer."
Then he attended a conference through Kaiser Permanente on mental health screening in teens, and got to thinking about all the issues he'd probably missed in his 30 years of practice. And now Genrich not only uses mental health screening, he's an evangelist of sorts for it.
As physician adviser to TeenScreen, a family-foundation-funded program through the National Center for Mental Health Checkups at Columbia University, Genrich talks with other doctors about the benefits of formalizing their approach to identifying mental issues. He says about 40 organizations, including the American Academy of Pediatrics, now recommend mental health screening when adolescents come for routine visits.
Though there are several screening tools available to doctors, Genrich says he likes TeenScreen because it's a standardized form for youths ages 11 to 18 with good sensitivity and specificity. It was initially developed at Harvard University, then refined at Columbia.
Laurie Flynn, TeenScreen's executive director, says that when their studies showed that 90 percent of youths who die by suicide have severe depression, Columbia took that and ran with it.
"One of the great things about finding out that it's so closely associated with depression," says Flynn, "is that we can find depression."
Last year, Kaiser Permanente Southern Colorado paired with TeenScreen to pilot the program with 19 physicians. And this month Kaiser has begun expansion of the 37-question screening through its entire network of local providers. A child can fill it out in about five minutes while waiting to see a doctor, and any trained employee can score it. The doctor then can quickly review the form and ask the child directly about concerns that arise.
Thanks to health care reform, Flynn believes screenings will be a standard of care — for youths and adults — adopted in the next two to four years across the country. She says they should become as routine as anything else that happens in a pediatrician's office.
"The likelihood of a 16-year-old having anything wrong with their heart, lungs, reflexes, blood pressure, the likelihood is infinitesimal, almost never," she says. "It's such a healthy time of life. But we wouldn't dream of not checking because that's what good parents, that's what good physicians do."
The chance of a kid having mental or emotional health problems, meanwhile, is much, much greater: "The National Institutes of Health has research to show that more than half of all mental disorders show symptoms by age 14. So if we're not asking about these things, we're not going to find them," Flynn says. "And we're going to miss the window of opportunity to really help these kids."
Lisa Roberts saw her daughter, Julie, as a "very happy girl at home." (Both names have been changed to protect the family's privacy.) Holding an annual school photo as she talks about Julie, Lisa says, "She was just a typical pre-teen. She wasn't a troublemaker. She had a lot of friends. She was just a regular kid."
And then at age 12, Julie killed herself.
"Everything popped up afterwards," Lisa says. "She was very private. We respected that. We trusted her. There was no reason not to, as far as we knew. But I guess we were wrong."
In Julie's case, Lisa blames bullying at her daughter's Colorado Springs middle school for her death. Lisa and her husband found out from Julie's friends and journals she kept that she had been constantly harassed.
Headlines lately have reflected this very situation, when bullying appears to contribute to suicide. Most notably, in March a Massachusetts district attorney indicted nine students on criminal charges stemming from the suicide of 15-year-old Phoebe Prince after she had experienced relentless bullying.
Gus A. Sayer, superintendent of that South Hadley School District, told the Boston Globe, "The real problem now is the texting stuff and the cyber-bullying. Some kids can be very mean towards one another using that medium. ... Apparently the young woman had been subjected to taunting from her classmates, mostly through the Facebook and text messages.''
But in that case, investigators say, Prince also suffered more traditional verbal abuse and physical intimidation at school. And that's the type of bullying that Lisa became aware of her daughter suffering, after the fact.
"She did tell people, but she didn't tell us," Lisa says. "And the people she told were not true friends. Her true friends knew that some stuff was going on, but they didn't have any idea what she was planning. But kids did know. And at least one adult knew. And no one ever told us, or let us know."
So Lisa believes another place change can happen is with school administrators: "Schools need to open their eyes, because it's not going away. And it can happen to any family."
Parents, she says, need to demand that schools start teaching at a younger age about bullying and suicide prevention. In addition, there's a need to "force teachers and staff members to be more active in the school population, especially at the secondary level, 'cause they're not. They can say they are, but they're not. They don't know who those kids are. They have to be more vigilant. They have to watch."
Viewed from afar, local school districts' delivery of suicide education and prevention seems to be all over the board. Most typically, it's left to teachers to include a component in health classes. The Depression and Bipolar Support Alliance's Fallahi says that though a few years ago they "were busy like nobody's business," this year they didn't receive a single call to present. And SPP's Safe Teen program gets called into schools only on an irregular basis.
"We've actually had some school health teachers just say, 'No, it's not worth it,'" Jane Bennett says.
But she also says certain districts have taken the issue quite seriously. Lewis Palmer School District 38 originally piloted the Suicide Prevention Partnership's Safe Teen program two years ago. And in Widefield District 3, high school counselor Kristin Beauman took the initiative to spearhead Safe Teen staff development train-the-trainer classes, which about 40 K-through-12 teachers in the district attended.
Beauman says that local suicide education used to be overseen by the El Paso County Department of Health and Environment — it worked with SPP to develop Safe Teen — but budget cuts over the past few years axed the agency's involvement. She doesn't know of any group aside from SPP that has stepped up to take the department's place, but believes having suicide prevention professionals involved with teacher and student training and follow-up "is a piece that makes it successful."
Lisa recognizes that there have been budget cuts all across education, and that teachers are overwhelmed. But that's why schools need to reach out to local nonprofits that will send trained people into the districts and teach staff, parents and children alike. SPP and DBSA's programs are free to schools and might have helped Julie in some way.
"If one person would've said one thing," Lisa says, choking the words out through tears that come fast and hard, "she would be here."
Guy Bennett understands that at least for now, much of the responsibility will fall to other kids.
"We know that when we ask the question, "If you were thinking about suicide, how many would tell your parents?' in a normal class maybe one or two hands [go up]. 'How many would tell your friends' parents?' Pick up three or four, maybe. 'How many would tell your friends?' Well, that's the bulk of the people.
"But their friends are about as old as they are, so their life experiences aren't necessarily gonna be any more attuned, so they're not gonna necessarily be able to get them all the information that they need.
"Part of the problem is, as parents and teachers, we've all been taught to solve the problem. We can't always solve the problem."
Matt Simek, Matthew Bennett's best friend, agrees.
"Looking back, friends would've been the first persons I would've talked to about something like that. Speaking from first-hand knowledge, I know that if I knew what Guy and Jane have been teaching, Matthew would have been alive."
He says he or Matthew's other friends would have talked with administrators, or called up Guy and Jane and said, "Hey, this is serious."
"It just wasn't something that had ever been brought up before, wasn't part of the general knowledge, that you need to take talk about suicide seriously. It was more of, 'Talk of suicide is generally somebody being emotional and overblown.' So it's generally ignored."
People may think their friend isn't "the type," or has a great family, or an amazing future ahead of them. Or they may think the person's just joking.
"Matthew had kind of, a, uh, reputation for exaggeration," says Simek. The Bennetts and he laugh knowingly. "So that didn't help anything there."
"They looked at everything he had, and said, 'Nah, he's just jerking my chain — he's just wanting attention,'" Guy says. "We tell people if someone's said that to you, and you think all they want is attention, give them the attention. You need to ask them some questions."
The problem is, though, that many people — kids, parents and the general public alike — don't know what to say, or are worried if they approach the topic with a friend or child, it might push them over the edge.
During one of their recent local parent workshops, Guy met a woman who said she had a 9-year-old son who had been talking about wanting to die. The mother immediately left the presentation, went to the boy and asked him about it: "Do you have any idea how you would die? How you would do that?"
He said, "Uh huh," and proceeded to tell her in detail. An asthmatic, he was planning to take all of his medications at once. If that didn't work, he had figured out a way to strangle himself.
Talking about suicide, Karnes emphasizes, does not cause someone to become suicidal. Leaving someone to deal with the pain alone, may.
"We as a society need to begin to get the word suicide out from under the bed and in the closets where people can talk about it," says Guy. "Like most things, if it's left to fester, it just does not go away."
Behind the numbers
El Paso County suicide statistics do include local veterans, but when it comes to active-duty military personnel, they are not part of the local rolls.
According to Janet Karnes, director of the Suicide Prevention Partnership of the Pikes Peak Region, if an individual who completes suicide is active-duty, the military recovers the body, completes the investigation and tallies the numbers. — KA