FRANKLIN — For Olivia, a 13-year-old eighth grader at Franklin Middle School, recess was a daily dose of cruelty. It was also a test of emotional survival that led to a suicide attempt.

“People kept telling me to go kill myself, and go cut myself,” she said. “A lot of people call me names. I think people these days don’t understand how the words they say hurt each other.”

The bullying started in third grade, she said, for reasons she didn’t understand.  She hoped her tormentors would lose interest. Instead, the frequency and viciousness of their taunts increased over the next four years, provoked by jealousies over boys.  She didn’t tell anyone, she said, until their verbal assaults became overwhelming, requiring the school principal to intervene.

Her boyfriend called 911 before she could succeed in her attempt at suicide.

Olivia is not her real name; her mother requested that a pseudonym be used to protect her privacy.  But her story is not unusual; if anything, it’s become increasingly familiar – even in close-knit communities where children depend on family and friends, and school officials know students by name.

Olivia said she feels stronger and more resilient these days, bolstered by mental health counseling, regular check-ins with her middle school assistant principal, and a support system that includes her parents and oldest friends from elementary school. She’s learned to tap sources of strength that anchor her self-esteem: drawing, playing basketball, journaling and writing three things she likes about herself each night before sleep, and again when she wakes up.

“It’s realizing my self-worth,” she said. “There’s more to me than what people say about me that isn’t true.”

Olivia is one of a spiraling number of teens nationwide – including many in the Lakes Region – who struggle with anxiety and depression, feel helpless or hopeless, or who have considered killing themselves as the only way out of a situation beyond their control – such as past or persistent trauma or abuse.  Experts point to a matrix of problems that plague young people and adults: widespread drug or alcohol abuse, complex mental health issues, increased social isolation, bullying at school and on social media, and trauma stemming from myriad causes.

That trauma can be rooted in the death or chronic illness of a family member, alcoholism at home, domestic violence that children have no ability to stop, and other, less dramatic events that linger as emotional ghosts. Disturbing childhood experiences can play out in interactions with others – sometimes as anger or rage – and forge a fragile, negative sense of self that persists into adulthood.

Today, the youth suicide numbers are alarming; twice as many girls as boys attempt it, but many more boys succeed, state and national statistics show, because they use more lethal means. According to the Centers for Disease Control, more than 6,200 people age 15 to 24 died by suicide in 2017, making it the second-leading cause of death for that age group in the US and in New Hampshire, just behind accidental death.  Someone in the Granite State dies by suicide every 33 hours, data shows, and as many as 90 percent of suicide victims have a diagnosable mental illness.

Across the country teen suicide rates are significantly higher than previous peaks in 1990. Suicide by young people jumped 56 percent between 2007 and 2016, after falling the previous decade, according to the CDC.

“Those numbers continue to climb,” said Ken Norton, director of the New Hampshire Chapter of NAMI, the National Alliance on Mental Illness. “There’s a pretty big rise in depression and anxiety for young people nationwide.”

Contributing factors include fewer face-to-face activities, more time spent online and communicating by cellphone, increased feelings of stress and isolation, and loss of sleep – which has become epidemic with round-the-clock use of technology, and the hours spent on cellphones and social media, experts report.

“Studies show that kids are looking at their phones sometimes 10 times during the night,” Norton said. 

Research has shown that Facebook can spike anxiety and depression because it displays versions of people who look and sound like they have idyllic lives, which can make others feel inadequate and lonely.

Tara Nelson, head of children’s programs at the Franklin office of Riverbend Community Mental Health, said staff counselors fault social media and cyberbullying for ramping-up social expectations and creating a perceived need to keep up and measure up, stoking students’ levels of anxiety and depression, even in middle school.  The time spent alone and online is robbing kids of opportunities to learn social skills and how to communicate effectively in person, she said. Some children “are not even able to identify their emotions, or regulate their emotions.”

Kayli-Ann Foskey, 13, an eighth-grader at Franklin Middle School who attended a recent community showing of the documentary “Suicide: The Ripple Effect” at Smitty’s Cinema in Tilton, sees loneliness and despair in fellow students. “There are people who cut themselves, and people who just roam around and look sort of lost.”

Ashley McDonald, 13, also a Franklin eighth-grader, said she worries about younger children; the middle school serves 370 students in grades four through eight. “I think it’s maybe because they feel alone and overworked. I think it’s an issue that needs to be talked about more.  People makes jokes about suicide – they sort of just make it a joke,” she said. “I worry in general about people and hope no one resorts to this.”

Interviews with several people paint a picture of Franklin as a tight-knit community of about 9,000 residents where people rally to help each other, are dedicated to their schools and sports, but where many struggle financially. Working parents may be overwhelmed or grapple with substance misuse, addiction, or mental illness themselves. Like with many places in New Hampshire, Franklin is on the frontier of the opioid epidemic that has bludgeoned rural areas nationwide, leaving destruction in its wake. 

“Franklin is a vulnerable community," said state Rep. Werner Horn, who represents the city's first and second voting wards. "There’s an increased risk of mental health complications from trauma. Students have seen a dead body, or someone overdose.” Horn also attended the suicide documentary last month, and said he’s concerned about the prospects for local children who’ve experienced trauma. “We need to be catching the crisis before it evolves into something we can’t mitigate.”

In the CDC’s 2017 Youth Risk Behavior Survey of Franklin Middle School students in sixth through eighth grade, roughly 20 percent reported purposefully hurting themselves, including by cutting or burning, without wanting to die; 34 percent said they felt so sad and hopeless almost every day for at least two weeks in a row that they stopped their normal activities; almost 23 percent have seriously thought about killing themselves; just under 18 percent have ever made a plan; and almost 9 percent have tried to kill themselves. Results of the 2019 survey will be released this winter.

'Not a foreign concept'

In the 2017 CDC survey of Franklin High School students, just under 40 percent reported stopping their daily activities because of feeling sad and helpless, nearly double the state average of 20 percent; 8.7 percent said they attempted suicide, compared to 5.9 statewide; and 4.3 percent made a suicide attempt that had to be treated in the emergency room, more than twice the state average of 2 percent.

Suicide “is not a foreign concept to them. Students at much younger ages are expressing that level of distress,” said Barbara Slayton, wellness coordinator for the Franklin School District. “We need to be de-stigmatizing mental illness.” 

“We have to make it more acceptable to talk about emotions and pain,” said Elaine DeMello, director of training and suicide prevention at NAMI-NH.

Messages about suicide behaviors “have to be in a safe way so the message isn’t “you try it, too,'" which is always the concern, Slayton said. “The message should be, 'If you, too, are feeling this way, here’s where you can go for help.'”

While students and school officials in Franklin navigate in the trenches, they’re also on the front lines of change. Suicide and mental health awareness plays out in ways the schools operate, how mental health can be integrated on a daily basis, and through coordinated responses of school staff who communicate by radio and respond as a team to behavior incidents.

Academies

This year Franklin Middle School, under the leadership of Principal Kenneth Darsney, divided into "academies" in separate school wings, “Winni” and “Pemi” with a shared school library, cafeteria and gym.  Each academy keeps the same group of students and teachers together from fourth through sixth grade, then again in seventh and eighth grade, so teachers and students get to know each other. The advantage of that is each new school year requires less adjustment, teachers learn to recognize individual learning styles and emotional needs, and students have a better chance at forging ongoing bonds with teachers and significant adults at school.

Last year, a pilot program called the “Family Wing” served 25 students who were referred by teachers and parents; many students who floundered in a larger setting thrived in the more intimate, less populated environment, Slayton said.  “It’s about building relationships, which is the best protective factor against all of the (suicide) risk factors,” she said.

“Just being present and available, that speaks volumes,” said Cassandra Lucas, the middle school’s full-time guidance counselor. “Being in the lunchroom, and asking, ‘How’s your day? What’s going on? You’re not you today.’ Letting them know you’re seeing changes without pushing them.  Pulling them in when you see behaviors that aren’t normal. Being present physically and emotionally lets them know you’re there because you care.”

After a two-year hiatus, Franklin Middle School reinstated a data-driven mental health program called “Signs of Suicide,” which trains students to recognize signs of depression, mount a defense against bullying, and use helpful ways to deal with stress, such as solving a little problem first, which can build confidence for tackling bigger ones. Suicide awareness posters, with pull-off tabs listing hotline numbers, are on bathroom and hallway walls. In October and November, through a multi-level support approach not unique to Franklin, children are learning self-awareness and distress-tolerance skills in homeroom, writing down their thoughts and feelings at the start of each day, and practicing self-calming through guided meditations that increase mindfulness (their ability to live in the present, without racing, intrusive thoughts). Younger children learn to calm themselves by breathing deeply: Breathe in to smell the flowers, and out to blow out the candles.

“Some kids can be tricked into deep breathing by having exhaling competitions – who can exhale the longest,” Lucas said. “They have no idea it’s helping them calm down.” 

Learning about wellness

Guidance, mental health, and counseling topics now comprise a required class, along with music, art and health. Children learn about mental wellness, conflict resolution, and healthy ways to communicate. 

After a federal grant ended last year, funding dried up for mental health counselors at the elementary, middle and high schools. Franklin and the New Hampshire Charitable Foundation paid for intervention counselors at the middle and high schools, and with money from this year’s state education budget, another is expected to be added at the elementary school. Intervention specialists counsel students whose speech and behavior indicate mental health challenges, including suicide risk. Counselors at local offices of Health First and Riverbend Community Mental Health see students on-site during school hours or after school.

Early vigilance

Vigilance and prevention begin each morning. There are two adults in each of the middle school’s 16 homerooms, including classroom teachers, guidance counselors, and art and music instructors. While homeroom is time for students to greet each and hear school-wide announcements, it’s also an opportunity to delineate and reinforce responsible behavior and prepare each child for the day, sometimes using a chart which lists expectations and tips for student success.  During the 25 pivotal minutes of homeroom, which lasts from 7:30 to 7:55 a.m., staff try to spot children who have come to school struggling or sad. 

“If somebody has a cloud over their head and looks like they’re having a rough start, we send them to speak to someone else. We’re all radio-equipped to be there when someone needs something,” said Darsney, the principal, who stands outside school every morning to greet students on their way in, and again when they leave at the end of the day.

During a recent morning, when “Clear the hallways” sounded on the PA system, he headed to the site of a student behavior incident – which occurred twice during an hour and a half, once while he met with a visitor in a conference room because a student who needed to calm down was spending quiet time in his office.

“Every single staff member here participates in problem solving,” Darsney said. “We have no hierarchy. It’s a collaborative model. All of us are all-hands-on-deck all the time.”

Experts hope the latticework of ongoing contact with dependable grownups creates a support system for children, in addition to the adults they rely on at home, whether they live with their parents, another relative, or a guardian.

In order to reduce suicide risk, it’s crucial to boost a child’s protective assets, research has shown. “Number one, do you have a relationship with at least one caring adult? A relationship with one trusted adult can buffer you from so much,” Slayton said. “It’s more about the quality of the relationship – it could be a baseball coach you see three times a week. It’s someone you can trust or count on.”

Other protective elements include having a belief system or spiritual life, positive social connections, and things you like to do.

Olivia, the eighth-grader, said she was inspired by a recent showing of the film, “Suicide: The Ripple Effect,” co-produced by Kevin Hines, a survivor who jumped off San Francisco’s Golden Gate Bridge at age 19, who now works as a suicide educator, reaching vulnerable people with messages of hope.

“There are people like me that are struggling with it,” Olivia said. “Realizing you’re not alone really helps.”

At home, she proudly displays her art: A charcoal drawing of a large eye, with a dark figure waving in the center.  A full-color picture of a sneaker she wears while playing basketball on a state team of 7th and 8th graders. A magic-marker drawing of a fractured heart with blue angel wings and a halo on one side, and red devil horns and a pointed tail on the other – symbolizing her struggle at school.

It’s about “how good people have to fight bad people every day to become stronger in the end,” she said.

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