Suicide remains the second leading cause of death nationally for 10- to 24-year-olds, and local mental health experts want to remind educators, parents and community members what to look for and how to support children who are struggling.
For children aged 10-14, the suicide rate tripled from 2007-2017, according to the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics' most recent data brief. In 2017, 51 suicides by children aged 10-17 were reported in Tennessee.
The rise in suicide deaths comes after a pattern of decline more than a decade ago.
From 2000-2007, suicide rates dropped for children aged 10-14 and remained stable for those aged 10-24, but since 2007 have increased more than 56%, according to the CDC data brief.
Mental health providers, as well as Hamilton County Schools officials, recognize the increase is a cause for concern.
This issue hit home in Chattanooga last week after a 9-year-old fourth grader at Orchard Knob Elementary School took his own life.
Experts caution parents to pay attention to signs that children are struggling
As the local community mourned the child's death, experts weighed in on the role of counselors in schools and how to talk to children about suicide.
They cautioned that if parents notice any significant changes in their child's personality or behavior — including increased fatigue or trouble sleeping, changes in appetite, difficulty concentrating, withdrawing from their friends or a change in peer groups, isolating themselves, persistent complaints about how they feel such as headaches or stomach aches — they should seek expert advice.
Many recommend first visiting a child's primary care physician or pediatrician, especially if these warning signs have persisted for several weeks, but many mental health providers and community mental health centers can take referrals from doctors, schools or even schedule a first appointment with parents themselves to discuss concerns.
And it's never too early to look for signs.
"Individuals who are making suicide attempts and are succeeding and committing suicide are getting younger and younger," said Gayle Lodato, senior director of Greater Chattanooga Services for the Helen Ross McNabb Center.
Environmental factors play a big role in emotional, behavioral issues
The CDC report does not analyze causes for increases in suicides, but some mental health experts acknowledge the effects technology, social media and the digital age have had on children, especially when it comes to bullying or even accessing information about suicide or self-harm.
"It used to be that you had to deal with it during the school day and then you could get away from it," Lodato said. "Now we are constantly connected. Kids feel overwhelmed very quickly, and if they don't have someone to talk to or don't feel comfortable talking to adults or their caregivers, then they are left struggling by themselves with these very big, very real feelings."
Jucinta Rome, a licensed clinical social worker for Erlanger Behavioral Health, has worked with adults and children as young as 3 years old in Chattanooga for more than a decade. She agrees that bullying is often a contributor to potential mental health issues in children, but she doesn't think children are particularly meaner than they have been in the past.
"We have this huge issue now with bullying that has taken on a different dynamic with social media that has really contributed to mental health issues. Technology has created a way for it to be more secretive," Rome said. "The research is also showing that time that young people are spending on social media really tends to isolate them from the normal interactions."
Trauma or adverse childhood experiences, genetics, both physical and sexual abuse, neglect, being separated from their parents or placed into foster care and other environmental factors also equally contribute to emotional and behavioral issues in children.
Genetics and generational trauma can also play a role, Rome said. Research shows trauma and mental health issues can be passed down through generations.
But even if a child has experienced trauma or is at high-risk due to their experiences, Rome said, there is hope.
"The research has shown that even when a child has experienced a traumatic event, if they have solid, nurturing relationships and a support system, they never need to step in a counseling office," she said.
Rome has made it her mission to "emphasize [to] people that relationships are so important with children."
"If our school system would focus on relationships, I think we would see some improvements in the behavioral issues and also the emotional issues that our children are facing," she said.
The role of schools in addressing mental health needs
Hamilton County school board member Tiffanie Robinson, of District 4, spoke at a recent Hamilton County Commission meeting about the need for government officials to come together to work through challenges in the community.
"How did we get to this point that fourth graders feel like they need to take their own life?" Robinson said during the public comment period at the Oct. 23 commission meeting. "We have real problems in this community, there are parts of our community that are sick and we've got to figure out how to heal them."
Superintendent Bryan Johnson has been pushing for additional funding for student supports including school counselors and social workers. As of January 2019, the ratio of counselors to students in the district's elementary schools was 1 to 612 — well above the 1 to 250 that the American School Counselor Association recommends.
Centerstone, a community mental health center, provides many of the school-based counselors in Hamilton County and partners with more than 20 counties across the state.
Access remains a barrier to seeking treatment for adults and families, even after they've overcome the stigma of mental illness or seeking therapy, but placing counselors in the school building can help alleviate those barriers, said Beth Hail, a licensed clinical social worker and regional vice president for Centerstone.
"Whatever is going on with [all age groups] often is impacting their school performance. If they are dealing with something at home, often they might have trouble focusing, aren't doing well on tests, are isolated from other students or they're having trouble with a peer group," she said. "When we are in schools, there are times we are able to adjust our schedules pretty quickly and we might be able to get to them and address it within a few hours."
School staff and teachers are important to identifying mental health needs, and "they have a tough job and a vital one," Hail said.
"They are trained to educate, but they're really the eyes and ears, because they are with kids all day, they see them longer than their parents do. They kind of have to be in tune with something that might not be right with this child, but they have a whole classroom of children," she said. "So that's where they need additional supports."
Rome echoed Hail — she believes schools can have a powerful impact on students.
"That's where kids are on a daily basis and [they] are able to have adults in their lives that generally care about them and generally are concerned about them," she said.
She also recommends schools focus more on recognizing emotional or behavioral concerns and addressing them from a non-judgmental mindset of seeking solutions, than from a punitive one that seeks to discipline what is deemed bad behavior.
"Come with more of a curious mindset," she said. "People just don't know the experiences that children have had in their lives there's most likely something going on."
"You can't educate a child who is struggling emotionally, we just have to be more supportive as a community," Rome said. "These are needs. They really are needs. They are becoming more prominent, and we have to recognize and accept that. It's just something we have to recognize and treat it and support it and prevent it."
Contact Meghan Mangrum at firstname.lastname@example.org or 423-757-6592. Follow her on Twitter @memangrum.
If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK), or the line is available in Spanish at 1-888-628-9454. You can find a list of additional resources at SpeakingOf Suicide.com/resources.
Who can you talk to for help?
— Community mental health agency
— Private therapist
— School counselor or psychologist
— Family physician
— Suicide prevention/crisis intervention center
— Religious/spiritual leader, clergy
Where to go for help:
— National Suicide Prevention LifeLine: 1-800-273-8255
— Hamilton County Crisis Services: 1-800-704-2651 (for adults in crisis)
— Youth Villages East Region: 1-866-791-9224 (for children and adolescents in crisis)
— The Mental Health Cooperative offers behavioral health outpatient care for both children and adults. Call 423-697-5950 to schedule an appointment.
— The Helen Ross McNabb Center is open Monday-Friday and offers a variety of children, youth and adult services. Call 423-266-6751 or the 24/7 crisis hotline 1-800-255-9711, or visit www.Mcnabbcenter.org.
— Centerstone Chattanooga offers counseling, primary and psychiatric care and crisis care. The center is located at 6110 Shallowford Road, Suite B. For initial appointments, call 1-888-291-4357.
— The Children’s Hospital at Erlanger offers Pediatric Behavioral Health services, including medication management and outpatient counseling services for children, adolescents and their families. Call 423-778-2965.