The care and support of our youth is a shared responsibility that involves collaboration among students, schools, families, health and mental health professionals, and faith and community based organizations. These Frequently Asked Questions (FAQ’s) are focused on providing responses to questions about teen deaths by suicide in Palo Alto that often arise, as a way of answering common questions and raising awareness of community-wide efforts to prevent suicide and promote youth well-being. The FAQ’s will be updated as needed in order to remain current and most helpful in addressing community questions. Q: What is known about the risk factors for teens in Palo Alto? A:  Suicide is very complex and doesn’t “just happen” to anyone, but rather tends to be preceded by a number of risk factors. There is usually a gradual progression from suicidal thinking to suicidal behavior to a suicide attempt. Seventy-five percent to 90 percent of completed suicides occur in persons who have had a mental illness or emotional health problem for at least a year. Our youth may inevitably feel some pressure as they figure out for themselves the definition of “success” – who they are, what they want to do, what matters to them, and how to balance their daily lives. However, to better understand and respond to risk factors that may impact our teens, schools surveys are sent out to all elementary, middle and high schools, on a regular basis, to see how youth are doing, identify trends and monitor progress on various initiatives. This year Palo Alto Unified School District (PAUSD) also implemented the California School Climate Survey for staff and California School Parent Survey for parents to help us understand parent and staff perspectives on risk (and resilience) factors. What we do know, is that signs of depression are found in almost all people who die by suicide, along with contributing factors such as sleep disturbance that can interfere with positive thoughts and behaviors. But the specific triggers that may spur an individual to act on negative feelings at a particular moment in time vary for each person. A relationship setback, academics or other performance or impulsive actions can all be contributing factors. In addition, access to lethal means such as living near a rail corridor is another risk factor. Q. What is the community doing to address teen mental health issues since the 2009-2010 suicide cluster? A. The Palo Alto community has a long history of community collaboration in support of youth. We are addressing this complex public health issue by increasing connections, collaboration and communications across groups, especially students. A key element is promoting youth well-being, mental health awareness and stigma reduction, which is critical to preventing suicide. Project Safety Net (PSN) was established in 2009 in response to the first teen suicide cluster and continues to work together in collaboration with students, mental health professionals, schools, city government, nonprofit organizations, parents and others. Also in 2009, the HEARD Alliance (Health Care Alliance for Response to Adolescent Depression) of health care professionals was founded with a major focus on training primary care physicians to more readily screen teens for mental health issues, and know when to refer them to therapists and psychiatrists. The collective efforts have led to the implementation of significant prevention measures including enhanced mental health support, local medical providers offering free and reduced rates for families, school policy changes designed to reduce student stress, and adoption of peer support programs at the high schools. For the past six years, national experts and the academic and scientific experts have worked with the community to incorporate “best practices” to improve student wellbeing and reduce suicide. PAUSD has also implemented numerous programs focused on enhancing protective factors, eliminating early morning academic classes, adding school mental health specialists, establishing student-led support networks, and providing teacher training and parent education. Examples of these programs include Sources of Strength, Break Free from Depression, Youth Empowerment Support (YES), ChallengeSuccess and QPR (Question, Persuade, Refer – Just like CPR, QPR is an emergency response to someone in crisis and can save lives) that provide students with support networks, opportunities to foster conversations about managing stress, and specific tools to assist someone in crisis. Students have organized forums, student peer support programs (“ROCK” Reach Out, Care, Know); a student-produced documentary (“Unmasked”); and a student newspaper series (“Changing the Narrative”) sharing personal stories of strength, hope, health and growth. Measuring success from the many steps taken is really difficult. But, many students have participated in these various programs and efforts. Some of the most tangible new changes in the past year are Gunn High School’s switch to block scheduling, standardizing homework assignments, and increased mentoring by students and teachers. Q: What explains the second cluster in 2014-15? What is being done differently to prevent suicides? A:  Suicide contagions are rare, and an “echo” cluster is even more rare. It must be emphasized that no one can really answer why suicide clusters or echo clusters occur. The reasons why people take their own lives is unique for each individual. Signs of depression are found in almost all cases, along with sleep disturbance that can interfere with positive thoughts and behaviors. But the specific triggers that may spur one to act on negative feelings vary for each person. Communities where suicides have occurred in clusters are more at risk of future suicides, especially when the means of death cannot be eliminated. That is why stress reduction measures, identification of those needing mental health resources and the availability of services is critical. Q: What is the community doing to decrease the stigma around mental health issues? A: Due to the community collaboration, most youth now expect teachers, mentors and health care professionals, and parents to talk with them about stress, mental health, the benefits of seeking help and where to get help. With a diverse population, Palo Alto is also working to talk about mental health issues within different cultures to reduce the stigma about discussing these issues. Adults and teens alike have published articles about the importance of talking honestly about mental health, addressing sleep, depression, life balance and vulnerability on campus. Q: What has been done to restrict access to the rail corridor (means restriction?) A: From a public health perspective, most suicides are preventable. Research has shown that means restrictions is part of a comprehensive suicide prevention strategy. Limiting access to some methods of suicide is gaining support among mental health researchers who believe that suicides can be prevented, if it is more challenging for an impulsive person to harm themselves. To prevent access to highly lethal means of self-harm, specifically the rail corridor, fencing is used throughout the world. The City of Palo Alto is collaborating with Caltrain to help prevent access to the rail corridor by installing upgraded 8’ welded wire fencing with an 18” three-cable anti-climbing winglet on the top. Also, vegetation along the rail corridor has been removed to improve visibility. The City’s TrackWatch program also provides guards at four locations during rail operation. For more information, please go to www.cityofpaloalto.org/rail. Q: Why did the City put up higher fences when somebody could simply access the corridor at the crossings? A: In addition to the upgraded fencing, the City of Palo Alto, in conjunction with Caltrain, is planning to install an innovative Intrusion Detection System of thermal infrared cameras that can detect humans on the tracks up and down the corridor. The cameras will be installed as a pilot at the Meadow crossing for 60 days. An earlier prototype of this system was evaluated in Pittsford, New York by the Department of Transportation in 2004, and it showed promise regarding the prevention of trespassing on the railroad tracks. Five lives were saved during the evaluation period from 2001-2004. Q: The Palo Alto Unified School District has asked the Centers for Disease Control (CDC) to evaluate the suicide cluster in Palo Alto. What does it mean to have the CDC conduct a study? A: For the past six years, the CDC guidelines about suicide prevention have been built into the district’s suicide prevention toolkit. The community collaborative has worked with the national experts advising the CDC on the topic of suicide prevention. Given that the Palo Alto community experienced its second cluster of suicides last school year, it was important that the community seek out greater involvement by the CDC at this time. The CDC responds to public health crises and has expertise in conducting studies on environmental factors that may contribute to serious health problems. The CDC’s involvement is an important intervention within a continuum of support that has been leveraged over the years. It is not anticipated that the CDC’s investigation will solve this public health problem, but instead provide a unique perspective with hopefully new information about youth suicides in the community. The CDC has experience working with other communities who have experienced suicide clusters. Generally, CDC partners with local community resources to collect information. This may be done via interviews, focus groups, review of documents and other data collection strategies. The data is then analyzed and compiled into a comprehensive report. The CDC’s work to study the teen suicide cluster in Fairfax, Virginia can be found here. It is expected the CDC will be on site in Palo Alto in early spring.  Q: What’s the best way to talk for parents to talk to children and teens about suicide? A: It’s important for parents to talk about suicide with their children – but many parents find it challenging and difficult. There are many resources on the PSN and HEARD web sites. The Society for the Prevention of Teen Suicide has an excellent section specifically for parents – on how to talk with your children about suicide, FAQs on mental health services, etc.  http://www.sptsusa.org/parents/. Because Palo Alto has experienced two suicide clusters, it is important that parents also be able to discuss “contagion”. Contagion is a phenomenon that can follow a suicide death in a community whereby vulnerable people (those in despair or already thinking about suicide) are spurred by knowledge of others’ suicides to consider or attempt suicide themselves.  It is important for parents to be aware of this, and to explain why certain types of memorials, public discussions, and media coverage after a death by suicide are recommended and why others are discouraged. The intent is to reduce risk among the vulnerable and offer them support, to dispel myths, and to show compassion for the loved ones of those knew someone who died by suicide. (Action Alliance for Suicide Prevention) Q: Where can somebody go for mental health resources and information? A: Here are a few resource to get you started: