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Quadcast transcript: Preventing teen suicide

June 7, 2019

Sandra Knispel:         You’re now listening to The UR Quadcast, the official podcast of the University of Rochester.


 Sandra Knispel:        According to the CDC, suicide rates have been rising in nearly every US state. In 2016, nearly 45,000 Americans age 10 or older died by suicide. While the rise affects every age group under 75, the strongest increase is the rate for adolescent girls between the ages of 10 and 14. Thank you for joining us for The Quadcast. I’m your host, Sandra Knispel. And with me today to discuss suicide among children and teens, and of course, how to prevent it, are three University of Rochester and University of Rochester Medical Center experts.

First up, we’ve got Cassie Glenn, an assistant professor of psychology and psychiatry, whose research focuses on predicting suicidal and self-injurious behaviors. She’s also a faculty member in the Center for the Study and Prevention of Suicide at URMC.

We’ve also got Kathleen Baynes, an assistant professor of psychiatry and a psychiatrist at UR Medicine, Mental Health and Wellness, who works with children and adolescents who’ve been hospitalized for mental illness, and Michael Scharf, the director of psychiatry graduate medical education and chief of the Division of Child and Adolescent Psychiatry at the University of Rochester Medical Center. Welcome to the three of you.

Michael Scharf:          Thank you.

Cassie Glenn:              Thank you.

Kathleen Baynes:       Thank you.

Sandra Knispel:         Just to be clear, Mike, when we talk about adolescents, what age span are we actually really talking about?

Michael Scharf:          Well, that’s actually an important question, because depending on who’s quoting numbers, they might not be saying the same thing. Generally speaking, when doctor, when public health, and when the CDC talks about adolescents, we talk about ages 15 to 24. And this is based on not only observations about behaviors and development, but also neuroscience, and as the brain develops, and when we see brain changes really slow down and reach a more steady state or adult state.

Sandra Knispel:         Now when we look at suicide rates, there is an increase that’s really drastic during adolescence. And looking at the most recent CDC data—the suicidal thinking of high school students—about 17 percent said that they thought of suicide. More than 13 percent of high school students said they even made a suicide plan, and 7.4 percent even attempted suicide in the past year. Those numbers are scary. Cassie, do you want to take that one?

Cassie Glenn:             Sure. So I think one thing that’s important to note, too, is this is not just a phenomenon that’s observed in the US. So there’s really interesting cross-national research from the World Health Organization that also demonstrates that suicidal thoughts and behaviors are relatively rare during childhood, but we see this increase dramatically during the transition to adolescence. There’s not just one thing that we can point to that’s driving this increase in risk during this period. There’s a whole host of changes that occur during the transition to adolescence, including biological and psychological and social changes, all of which, when we think about the risk factors for this particular group, may be contributing to this increased risk during the adolescent period.

Sandra Knispel:         Now what, though, about the rate for girls between the ages of 10 and 14? That is sort of the largest increase, and do we have any idea what’s happening there? Kathleen?

Kathleen Baynes:       So I guess one of the questions is what’s happening in that age group that makes them look more like adolescents? So it has to, I think, take a close look at what kind of behaviors are happening in that particular age group that might make these younger peers look like their older counterparts.

Michael Scharf:          There are trends that are clearly impacting both the 10 to 14 year old age range as well as older adolescents, including increased use of cell phones and other screens, and it’s complicated to sort out what’s the real mechanisms going on here. So while that correlation is clear, is it related to just the act of looking at screens and increasing the time? A decrease in time spent with traditional human interactions and social interactions? An increase in isolation, if you will? Could there be other effects from the screen use, like impacting sleep? Also, the content. Sometimes there can quite disturbing or even horrific bullying or acts of cruelty that happen through the internet, through social media, or even witnessing things that could be quite traumatic, such as live streaming of a suicide or a suicide attempt.

Sandra Knispel:         As a parent of high school students, when I look at these numbers—that 7 percent attempted suicide last year, but that really more than 13 percent made a suicide plan—what should I know? And maybe we should even back up. Who are the kids, or the teens who are at greatest risk for suicide? Because clearly, that’s not evenly spread.

Kathleen Baynes:       That’s a frightening statistic. I think one of the things that we need to think about first is what are the protective factors against suicide? And one of those factors is of course relationship and connection. So when we think about connection to others, a relationship with your parents, a relationship with a significant teacher, a sort of saving grace figure, who are the kids that don’t have that kind of relationship? And so there, we want to think about what are the vulnerable youth in our groups? Are those kids that are struggling with identity issues that have been isolated by a perceived trauma, that are disconnected from their families due to other conflicts?

So identifying those kids who are most vulnerable among their peers and thinking about how we can strengthen those protective factors would be really important.

Sandra Knispel:         I haven’t heard anything about drug and alcohol abuse yet. How does that play into risk factors for suicide?

Michael Scharf:          Addiction is certainly a risk factor, and active drug use, whether or not it’s been of a duration, or a pattern where someone refers to it or thinks of it as addiction is a risk factor, both because of the impacts that recurrent drug use can have on your life, on your social interactions, on your connectedness with other folks, isolation, but also because of the disinhibition and impulsivity that can happen while you’re intoxicated. So someone who may have recurrent thoughts of despair or hopelessness or life’s not worth living while they’re under the influence of a mind altering substance might be more likely to active impulsively, to do something with those thoughts.

Sandra Knispel:         And is it just the drug use by the adolescent, or is it also the drug use of, say, their parents that might have a direct impact on their risk for suicide? Do we know that?

Cassie Glenn:             Well, we know that family history is going to be—there are a whole host of risk factors. So we know, for instance, that having a parent who’s engaged in suicidal behavior, having a family member who’s died by suicide, that’s a significant risk factor. And for the genetic contribution conferred if a parent has a significant psychiatric illness. So that just sort of genetic contribution, but I think also what you’re bringing up there is the potential negative life events in terms of what children might witness among a parent who may be addicted to a substance, the kind of trauma that they might experience, is also an environmental stressor that could increase their risk for suicide.

Michael Scharf:          Yes, adverse childhood experiences, referred to in public health literature and medical literature as ACEs, are actually known risk factors for multiple things that can happen later, including midlife physical morbidity and mortality, but also conditions like depression, and then ultimately the worst fatal outcome of depression, including suicide. Having a parent or an adult in your home who’s actively abusing substances is one of the identified adverse childhood experiences, and certainly can have a negative impact.

Sandra Knispel:         There are lots of myths out there about suicide, and while there’s always the risk that by bringing them up we might perpetuate those myths, I think it might also be an occasion or a chance for us to maybe—or for you—to maybe put some of these straight. So Kathleen, do you want to tackle that one?

Kathleen Baynes:       I think one of the greatest myths about suicide is that you can induce suicidal thoughts by asking about them. It’s one of the most important concepts that we teach any trainee learning about how to assess and treat suicidality, and something that we need to pass on more and more to families, teachers, and community members. The idea of asking about suicide means that we’re connecting with kids who are struggling with those kind of thoughts. To not ask about those thoughts means that we’re not realizing who may be struggling internally.

Sandra Knispel:         So, to be very clear: a mother suspects, a father suspects that the child might be depressed, and worries that the son is considering suicide. Should therefore the parent say outright to his child, “Are you depressed? Are you feeling suicidal? Do you have suicidal thoughts?” Is that what you’re saying?

Kathleen Baynes:       Absolutely. Any child that’s suffering, a parent is going to want to know what’s going on in your mind, what’s been happening with you? Have you ever had thoughts that make things seem so bad that life isn’t worth living? I think there are ways that we can make this more of a public conversation, so we identify and hopefully treat people who are struggling in that way.

Michael Scharf:          You know, another important potentially negative myth that impacts people is that once someone is suicidal, they’re always suicidal, or a hopelessness for the people trying to help the hopeless and suicidal person. In fact, data and decades of experience show us that most suicide crises are time limited, and they are in fact not due to one single event or predisposing factor, but a combination of risks, and then current stressors. And if you can help people figure out how to get through that crisis and how to organize the next steps in their life around things that are important to them and meaningful to them, they’re not always suicidal. And so help and hope are both possible, and very real.

Kathleen Baynes:       The idea that suicidality is a direct sort of trigger for imagining that someone is struggling with depression is a myth that we should also of dispel. [Instead it’s] the idea that it’s important that suicidality is considered as a signal that we should be more thoughtful about what is happening with this child, and open up the idea that any number of things could be happening: trauma, substance use, peer rejection, social media, bullying, any number of things. And we want to be curious about this, sort of the way that we’d be curious when a child had a fever.

Sandra Knispel:         When you say “curious,” you’re saying—”ask?”

Kathleen Baynes:       Ask.

Michael Scharf:          Mm-hmm.

Cassie Glenn:              I would say another common myth that sometimes people have, is that if someone is talking about being suicidal, that that’s an indication that they’re not likely to act, that if they observe that someone is planning or researching, that that’s just a cry for help, and that could be attention seeking, but they actually aren’t going to be likely to act on that.  And when we think about warning signs and things to be looking for, we’re actually interested in looking, when people move from thinking to actively planning and potentially thinking about engaging on those kinds of thoughts, so we want to know if someone is thinking more specifically not just about suicide broadly, but about a specific method. Are they engaging in research? Are they giving away possessions? Are they doing things that might indicate they’re actually moving down the pathway to engage in suicidal behavior?

Michael Scharf:          The core myth that a suicide crisis inevitably results in death, that someone who’s suicidal is destined to die as a result of suicide, that is absolutely a myth, and not true. And decades of research and experience demonstrate that.

Sandra Knispel:         Cassie, you were talking already about some red flags. You just mentioned if someone says, “I’m suicidal,” and starts researching – you mentioned giving away possessions. Can you talk to us and make a start on red flags that we should all know about, that we should all look for?

Cassie Glenn:              I think we’ve been talking about risk factors, right? So factors that may increase an individual’s likelihood of potentially becoming suicidal or engaging in suicidal behavior. When we talk about warning signs, we’re talking about some of the earliest indicators that somebody might be in a suicidal crisis. And there isn’t just one thing to look for, and that warning sign may look different across different individuals.

I would say broadly speaking, in addition to the things that I noted about actively preparing potentially for engaging in suicidal behavior, are significant changes in the individual’s mood and their affect and their behavior. And so significant differences in sleeping. Isolation. Are you noticing significant mood changes, depression, aggression, agitation? These are the kinds of significant changes to be aware of, relative to an individual’s baseline. Those are really the things that we’re interested in looking at.

Sandra Knispel:         Any other signs we should be looking for, Kathleen?

Kathleen Baynes:       One of the things that also can sometimes relate to suicidal thoughts is when someone’s engaging in behaviors that connect to that idea, like cutting or other self-harming gestures. So I think we’ve learned a lot more about some of the ways in which some of the sadness or anger or depression can sometimes turn inward, or towards the body. And so paying attention to those risk factors as examples of distress.

Michael Scharf:          I think the most important point when we’re thinking about warning signs or red flags is actually not to memorize a specific list of behaviors or statements, but instead, to really think about how you know a person, and if there’s a change, you should be curious to figure out what’s the change about. And so there are certainly specific behaviors that are more indicative of depression, or hopelessness, or thoughts of suicide. But I would like listeners, rather than feel compelled to have to memorize a list of warning signs, to really internalize the message that if people you care about are behaving differently, or talking in a way that seems not like themselves, be curious. Ask. Try to figure out why. And there are resources that can also refresh your memory for some of the warning signs we talked about here. So again, rather than memorize them, remembering the resources might be useful. The American Foundation for Suicide Prevention, for example, has a lot of very useful information that you could look at quickly to refresh your memory about warning signs.

Sandra Knispel:         What are the resources–since you’re talking resources–what are the places that you would want people to go to to say, listen, “Something is off about this person. Therefore, my next step is going to be X.” What should it be?

Michael Scharf:          Well, you can certainly start with your network of providers or helping professionals. So most people have a primary care doctor that they have a relationship with. If it’s an immediate crisis, there are a number of crisis lines. We have a local crisis line. There’s also a national suicide hotline. And you can speak to someone who can help figure out what to do in the moment. And the person who’s struggling with the suicidal thoughts themselves can speak to the person on the hotline to help figure out how to problem solve what to do in the moment.

And certainly a suicide crisis is an emergency. You can also go to an emergency room. And what staff or services will be available at any specific emergency room will vary, but any emergency department will be prepared to have people come in in suicide crisis to help figure out next steps.

Sandra Knispel:         Kathleen, you just raised a point about cutting, and I know, Cassie, that that’s part of your research. You obviously study non-suicidal self-injury. What is the link between people who cut themselves and possibly attempting suicide? Is there a direct link?

Cassie Glenn:              So we do know from growing research, in particular among youth, that engaging in non-suicidal forms of self-injury, so as you noted, non-suicidal skin cutting as one example, that that seems to be quite a robust risk factor for predicting suicide attempts later on in adolescence, even more so than adolescents’ own history of suicide attempts.

So when we’re looking in research at predictors, typically, a behavior that one has engaged in is the most significant predictor of their likelihood of engaging in that behavior again. And so the fact that non-suicidal self-injury predicts suicide attempts above and beyond even a history of suicide attempts is pretty compelling.

Now is there a direct link? In most of what we study, we can’t necessarily say that there is a direct link. We do know that something significantly predicts something else, and we have some hypotheses about why that might be the case. So some of the leading theories about suicide suggest that what may distinguish individuals – so as you noted at the beginning, 17 percent of adolescents in any given year may think about suicide, and about 7 percent may attempt suicide, right? So that’s a smaller number. So there’s a lot of research focused on what might indicate someone is going to attempt suicide, compared to the larger group who will think about suicide. And non-suicidal skin cutting may be—or non-suicidal self-injury more broadly may be one of those risk factors. And the idea is that engaging in those kinds of behaviors over time might increase an individual’s tolerance for pain, it might reduce their fear of death, and that might be a potential mechanism that increases their likelihood of attempting suicide.

Sandra Knispel:         Then let me ask the question of the uninitiated here. As a parent, as somebody looking in from the outside, you said “other self-injurious behavior.” I know about cutting. What else should parents look for, and maybe sort of pay really attention to, to see if their adolescent, their teen, is engaging in any of those self-injurious behaviors that are maybe not obvious?

Cassie Glenn:              So there’s other forms of what we think of as direct non-suicidal self-injury, so cutting is one form, and there may be burning or other kinds of direct injury to the body. But there’s also a whole category of more indirect self-injurious behaviors. So we might think of—we’ve talked about substance use, disordered eating, it could be engaging in exercise to the degree that someone’s engaging in it to hurt themselves. And so these kinds of behaviors that are engaged in perhaps to excess or with the goal of hurting oneself in some way.

Sandra Knispel:         Mike and Kathleen, since you’re both in the trenches, so to speak, you both see patients, what trends have you noticed here locally in Rochester? Are your patients also getting younger? Are you seeing more of that age group, 10 to 14 year old teenagers, girls? And also, when you compare those numbers of the kids that you’re seeing today versus 10 years ago, 20 years ago, are you seeing those same trends that we’re seeing nationally?

Michael Scharf:          We certainly are. So in Monroe County, we have the only inpatient unit for children. And so most of the children/adolescents that present with suicidal crises come to our emergency room. And we’ve seen an almost 50 percent increase in the number of kids presenting every year, between 2015 and 2018, kids presenting to our psychiatric emergency department.

We’ve seen a tremendous increase in the number of teens and children who are seeking mental health care. In the last six weeks, we’ve actually received about 100 calls a week for our outpatient services, seeking mental health care. And I’ll let Kathleen speak to what the patients are like on the unit.

Sandra Knispel:         Well, before you get to that, my question is, are you getting totally overwhelmed? Do you have the resources to deal with that?

Kathleen Baynes:       It does feel like we have our fingers on the pulse of a crisis. On top of having an increased volume of patients, the kind of patients that we’re seeing are more intense. So we’re seeing more comorbid psychiatric issues, so someone experiencing depression and another comorbid issue, like eating disorder or substance use. We’re seeing someone who’s in a crisis around bullying, or loss of a family contact, a death in the family, bereavement, and on top of that, struggling with social anxiety.

So we’re seeing not just more numbers, but also greater intensity of the kinds of presentations that are concerning for us.

Sandra Knispel:         Is that new? Was that not the case say 15 years ago?

Kathleen Baynes:       So I can’t tell if it’s quite new, but in some ways it’s reassuring, in the sense that people are certainly more open about that they’re struggling. And so I think that’s the silver lining around this crisis, which is that as more people are calling for our services, more people are calling for our services. It’s a sign that people are more open and more willing to seek help. And that we want to respond to with open arms.

Michael Scharf:          Yeah, I think to the question of what the patients are like and is there changes over time in the last 15 years. A higher volume has certainly led to, like on our inpatient unit, a greater percentage of the patients being more severely impacted or more ill, if you will. The nature of the specific problems or combination of problems isn’t necessarily new or something we’ve never seen before. It’s really the quantity and the, again, percentage of our time spent with the more ill, more impaired patients, more at risk patients.

Sandra Knispel:         Let’s talk about what you can do for these patients when they come in. What’s the best practice approach to help them? What kind of interventions do you find work really well?

Kathleen Baynes:       First and foremost, we want to be thoughtful about building rapport, in part because having a close and connected relationship with an adolescent helps us be curious and know what’s going on internally. And having that rapport allows us to then be very thorough in terms of thinking diagnostically about who this kid is, what their symptoms are, and guiding our treatment from that point forward. So having a thorough diagnostic evaluation is very important, because it allows us to have a targeted sort of therapeutic response. So form that end, we look at things like biologic illness, different social things that are going on, educational struggles, and thinking about all the ways that we can help and support someone from a whole-person perspective.

Michael Scharf:          And that diagnosis, that approach to figuring out and understanding what is going on, what’s driving the suicide crisis, is really critical for long term health and recovery. Simultaneous with doing that, we also need to address the immediate safety, and that can include environmental things we have to address. And what I mean by that is parents may need to look at things in the home that could be easy to access, potentially lethal. Firearms, for example, that are unsecured, or only partially or inadequately secured, would be the most common, significant thing people think of, as potential lethal means.

So the process of figuring out how to create the safest environment, and in the short term, that might mean being in the hospital, though of all the people that are coming, and I talked about numbers, and how we’ve had so many more youth presenting, the majority do not get admitted to the hospital. The majority go home with safety plans.

And a good safety plan is organized around keeping someone safe in the moment, while we simultaneously figure out what is going on and driving this crisis, to help people get through it and recover.

Sandra Knispel:         So that must be really scary to parents to be sent home with a teenager who said “I’m suicidal,” right? Because then you essentially sit on top of them and make sure they don’t do anything?

Kathleen Baynes:       Well, the idea of a safety plan is that we’ve been thoughtful about what brought someone into a crisis, and thinking through how to manage and negotiate that crisis. And so in some ways, not being in the hospital can be the most protective experience for people in the setting of their loved ones and close ones who better understand what’s going on with that person.

So one of the aspects of a safety plan is sort of taking someone out of that high intense emotional state and using their cognitive skills to sort of think through a strategy that can be more effective in a crisis, rather than a sort of deeply charged sort of emotional perspective. We mentioned non-suicidal self-injury, and we think sometimes about that as a way of coping with this distress, which is not the healthiest way or the safest way. And so one of the strategies around a safety plan is to provide alternatives to that coping strategy that are healthier, more protective, and actually build and capitalize on protective factors.

Sandra Knispel:         Can you give examples? So to you this is perfectly clear, what a safety plan is. Tell me what it is. What’s in it?

Kathleen Baynes:       So a safety plan is about sort of better knowing yourself. So first, some of the things that we’ll think about what are the body signals that tell you that you’re in distress, because knowing that you’re in distress is the first step in order to communicate to somebody else who can help you.

Once you’re able to communicate what you’re struggling with, you want to think through what are healthy alternative strategies. So one of the things that I think has come into our schools and into our communities more and more is the idea of mindfulness. So mindfulness is a coping strategy that helps settle your emotions, settle your mind, be present in the moment, that sort of circumvents the idea of impulsively acting on what may be a temporary crisis point.

So mindfulness strategies can include sort of more deeper connection to nature, taking walks, slowing things down, using specific mindfulness techniques to take that moment of crisis into a sort of more thoughtful, slowed-down perspective.

Michael Scharf:          So a safety plan then would include the warning signs, or how do you know that things are getting to the crisis point, so that you can do something as early as possible, so a list of those signs, and then a list of things you will do to try to prevent reaching the crisis point. And a good safety plan as one of those things includes who you will tell. How will you communicate with someone about it? And then it needs to be someone who knows you might be calling, who can respond. You can’t say, “I’m going to call my biology teacher,” and no one knows if the biology teacher has any idea this person might call them. That wouldn’t be an appropriate contact in a safety plan.

But a parent, another family member, someone who’s part of creating the plan, as a person you contact. Often, also the crisis lines. We mentioned, again, there’s local crisis lines and national crisis lines, could be a contact on a safety plan.

Sandra Knispel:         So the safety plan is really directly geared towards the patient, not so much the parent who may have brought in that adolescent? It’s really you’re talking directly to the patients, say, you need to recognize—we will teach you to recognize your own triggers, and we will teach you what to do instead?

Kathleen Baynes:       That certainly gives the patient or the adolescent the most advocacy and control, right? So this would be a real developmental task of adolescents, to be sort of developing their own agency. And it taps into sort of what are unique traits in adolescents, right? Which is wanting to take more control, wanting to be more autonomous, all the while communicating more openly and directly with the people that they’re most directly connected to, and feel most—have the most trusting relationship with.

Michael Scharf:          And so those people that they have trusting relationship with, while the language of the treatment plan or safety plan is directed toward the youth, those trusted adults, usually parents, would need to be—it’s critical that they’re aware of what the content is, because they’re usually part of the plan. And then they can also support and maybe even provide reminders, “oh, if you’re having this going on, it’s time to do your mindfulness exercise,” to help make it successful.

Kathleen Baynes:       Ideally, these safety plans are actually a therapeutic intervention in and of themselves, because suddenly, there’s more direct, and open, and honest communication between parent and child.

Michael Scharf:          And maybe even an added sense of control, right, that one’s feelings and the sense of hopelessness and inevitability of “I feel miserable right now, I’m never going to get better, life’s not worth living, and the way I feel right now is forever,” part of the process of safety planning can be demonstrating that, no, there are things you can do to make yourself feel better in the moment, and we’re going to try it right now. And again, give everyone an added sense of control and confidence that there is hope, that there are things they can do to feel better in the moment.

Sandra Knispel:         I want to go back a little bit. So you said many patients get sent home with a safety plan. Some obviously require psychiatric hospitalization. And I know that you, Cassie, are doing research on that. You’re currently studying sleep disturbance in teens after psychiatric hospitalization. And I was wondering if you could talk a little bit about that research, what you’re seeing, what you’re finding.

Cassie Glenn:              Sure. So it’s a little early to know about the findings yet, but I can certainly tell you about why we’re interestingin studying what it is that we’re interesting in. So a lot of what we have been talking about today are risk factors that we know of that predict risk for individuals over longer term periods. So we know that certain demographic factors, certain family factors, may predict that groups of adolescents are at risk.

From a research perspective, and there’s a lot of knowledge obviously clinically, but from a research perspective, we know far less about factors that predict risk over short term time periods, such as hours and days, which is really essential for having an empirically informed list of warning signs.

And so what we’re interested in is one of the highest risk periods, which is during the post-hospitalization period. So when individuals, both adolescents and adults, are discharged from the hospital, they’re at the most high risk for suicide attempts, rehospitalization, and suicide death. We don’t have a good sense of why that’s such a high risk period in the basically one to three months after they’re discharged from the hospital. We have a number of hypotheses about why that might be the case. They go from 24/7 care to then going back into their environment, where there may be a whole host of triggers and less monitoring.

One thing that we’re particularly interested in is how sleep disruptions during that particular period may increase risk over short time periods. And so what we are doing is we’re recruiting adolescents who have been hospitalized at the medical center for suicide risk, and we are following them intensely in the month after they’re discharged from the hospital. And so they’re downloading an app on their cell phones, and we’re asking them questions multiple times a day about how they slept, how they’re thinking, and feeling. Questions related to their thoughts about suicide, to more closely examine these kinds of fluctuations over short time periods.

We have about one to two months left of data collection. This has been a pretty intensive study to conduct, and wouldn’t be possible without our collaboration here with the Division of Child and Adolescent Psychiatry, because it really requires clinical partners and parents and families volunteering to participate in this kind of research. It wouldn’t be possible with the adolescents and their families participating.

Sandra Knispel:         Well, when you have the research, we definitely want to hear. I’d like to start with you then, Cassie. What’s giving you hope that we will get a handle on this really pressing public health problem? Are we making inroads?

Cassie Glenn:             Yeah, and I think we’ve noted a few of these things already. We’ve talked about the American Foundation for Suicide Prevention, which is the largest private funder and clinical resource for suicide research and outreach in the US. I think the fact that that foundation exists—they’re funding the study that I just mentioned. I think that gives me hope.

So for a long time, studying self-injury and studying suicide was circumscribed to studying certain kinds of disorders. We weren’t talking about suicide and self-injury as being these trans-diagnostic, severe behavioral indicators. So trans-diagnostic, not just being indicative of depression or borderline personality disorder, but existing across—among a whole host of adolescents who might struggle with psychiatric illness, and recognizing that they may exist among a large population of youth.

And so I think from a research perspective, the fact that there is research funding and support, I think, is really important to tackle some of these questions and issues.

Sandra Knispel:         Kathleen Baynes, what’s giving you hope?

Kathleen Baynes:       From a clinical perspective, I’m so hopeful even just in having this programming, because it tells us that stigma has gone down dramatically, such that we’re talking about this openly in communities, among public health experts, among patients, among students. I think one of the things that’s most hopeful for me is that more and more adolescents themselves are taking control of this issue. They want more wellness. They want mindfulness in their school. And so that for me, the sort of change in stigma around mental health, has been the most hopeful aspect of this crisis.

Sandra Knispel:         Mm-hmm. What’s your silver lining, Michael Scharf?

Michael Scharf:          Well, while we are facing a public health crisis for children’s mental health needs in the broadest sense, not just around suicide, we’re also seeing the public respond. The community here in Rochester, we’ve really seen a transformation, the help seeking behavior, the requests for care, which are overwhelming at times, when we talk about the number of requests that come in, the number of youth presenting to the ED. It also represents people being willing to get help, to talk to family members about it who bring them for help.

We’ve also seen a number of teens who are willing to tell their story publicly, with advocacy organizations, creating advocacy organizations. In the last couple of years, in some ways it’s been the most exciting part of my job, to work with those teenagers as they tell their story, and really have become organized to do some really neat things.

There’s the Stop the Stigma campaign in Rochester, where teens who lost a friend to a death by suicide organized an annual concern that’s all about raising awareness about suicide and mental health issues facing youth. And local philanthropy has also brought its attention to children’s mental health. We’re very fortunate that the Golisano Foundation and Tom Golisano made a $5 million donation, which the university is matching, to build a new child psychiatry building—a pediatric behavioral health and wellness center—which is in the process of being built right now. This will allow us to expand services and really help address this need.

As this project became public, the number of folks from the community coming out to show support, to be interested, to help either through financial contributions, to help with the building, or related programming for interventions, for things that we’re increasingly learning are helpful, powerful, but not paid for by health insurance or traditional health care, mindfulness skills that we’ve talked about. We anticipate in the new building having groups and classes that—where people can come to learn skills. Parent training.

There’s also really neat emerging data about exercise, about music, about reading, and the impact that each of these things can have on mental health and wellness. And being able to really understand that more, and make exercise regimens, understanding and increasing reading routines, utilizing music as part of our holistic approach to patient care, is really exciting and neat. And these are the things that give me hope.

I think, while we are facing a tremendous crisis, we’re also responding to the crisis as a community. And I feel fortunate to be part of it.

Sandra Knispel:         Thank you so much. Thank you, Dr. Michael Scharf, for coming in, Dr. Kathleen Baynes, and Professor Cassie Glenn. Really enjoyed talking to you today. So let’s keep—let’s keep plugging away at this.

To our listeners, please remember, if you or someone you know is thinking about suicide or is experiencing emotional distress, please don’t hesitate to contact the Suicide Prevention Lifeline at, or you can call 1-800-273-TALK. Once again, thank you for listening to The Quadcast. That’s the official podcast for the University of Rochester. I’m your host, Sandra Knispel.



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