TILTON — Faith Gosselin, 16, of Sanbornton, a junior at Winnisquam Regional High School in Tilton, is trained to recognize signs of depression and suicide risk in fellow students. She keeps on the lookout for those who feel invisible, who may be sad because of stress, bullying, exclusion or upsetting events at home – students who need to know someone notices and cares enough to reach out.
Some of those signs include spending more time alone, not seeing friends and ignoring basic hygiene or one’s appearance. Others include not making eye contact, a blank, glum stare, and avoiding interaction at lunch, recess, in classes and in hallways.
And then there are verbal clues, like a student who says their life isn’t worth anything or talks about being a burden.
“Just knowing someone cares, it helps a lot,” said Gosselin, who is working on a year-long history project on suicide prevention. She’s making a program for the school’s Respect Week that will encourage students to engage in daily random acts of kindness, such as talking to someone you’ve never spoken to before, and high-fiving five students in passing. Her schoolwide announcements will also include statistics on teen suicide.
Research shows that human compassion, connection and kindness can make a difference for someone experiencing emotional distress. Studies now show that mental illness and its consequences affect 25 percent of the U.S. population. Of those, 50 percent develop mental illness by age 14, 75 percent by age 24. The fastest growing rate of suicide is in children age 10 to 14, said David Brent, a psychiatrist and researcher at the University of Pittsburgh Medical Center, who has studied adolescent suicide since 1985. Suicide for all ages of young people is climbing, driven primarily by increases in females. Youth suicide rates are increasing faster in rural counties than in urban ones, and faster in young blacks than in whites of the same age groups, according to Jeff Bridge, an epidemiologist at Nationwide Children’s Hospital in Ohio, and a nationally recognized specialist on youth suicide.
Data shows that many school-based prevention programs work – especially those that coach students in mental health awareness, coping skills and peer support. Some programs also decrease risk factors such as depression and substance abuse, and others target family dynamics, training parents to be limit-setters with warmer, more communicative relationships with their children. Around the world, many school-based awareness and intervention programs have been shown to be effective within 12 months in follow-up studies.
Last year, Gosselin and six other sophomores at Winnisquam learned to serve as peer connections through a program called Connect, a suicide prevention initiative developed in New Hampshire 15 years ago. It trains student leaders to spot vulnerable teens and reach out, connecting them with adults who can help set up counseling for depression, trauma, anxiety and other mental health challenges that may be undermining their lives. Participants in Connect say it has made them more aware of mental illness in general, how to spot signs, how to make meaningful connections in brief but natural ways, and more confident broaching the topic with peers.
The training can’t come too soon. The U.S. Centers for Disease Control and Prevention's Youth Behavior Risk Survey in 2017 showed that 26.3 percent of Winnisquam High students purposefully hurt themselves without wanting to die at least once in the last year, compared to 17.1 percent statewide; 34.4 percent said they felt sad or helpless almost every day for at least two weeks in a rows, and it stopped them from doing usual activities, compared to 28% , the state average; 20.3 percent considered trying to kill themselves during the last 12 months, compared to 16 percent statewide; and 7.6 percent attempted suicide at least once in the year, compared to 5.9 percent statewide.
Madison Gilbert, a Connect peer from Sanbornton, recounted a conversation she recently had with a girl who was crying in the hallway at Winnisquam: “'What’s going on? Are you OK? Do you want to talk? I know you don’t know me very well. But I’m here for you if you want to talk.'"
The girl started to open up and smiled, Madison said. "She got on with her day. Just something as simple as that. It’s noticing how people are changing, maybe because of how things are going at home, or with bullying or stress.”
Asking a stranger about their mental health can feel awkward and invasive at any age – especially asking someone whether they might be thinking about hurting or killing themselves, for fear that it might plant that thought. But that question saves lives, said Elaine DeMello, director of training and suicide prevention services at NAMI-NH, the state’s chapter of the National Alliance on Mental Illness.
“Likely if you’re that concerned, chances are they’ve thought about it, too,” she said, and asking shows you care – an important message for anguished people. “If you don’t ask, you’re not going to be able to help them get help. The question is, how many people do we miss ” by not reaching out.
“If it’s someone you don’t know, it’s going up and asking, “Are you OK? A lot of time, we don’t ask it and mean it,”said Samantha Raticik, a guidance counselor at Winnisquam. “We’re not asking them to be specialized students with awareness or responsibility. Training helps them know when to break that trust and come to an adult.”
After a student reports, guidance contacts someone the struggling young person already trusts: a teacher, coach, counselor, or their parents.
The goal of the program, Raticik said,“is to give them background, then work with their peers to get the messaging out.” Surveys show that students respond best to hearing their peers talk about sensitive topics.“Peer-to-peer education is more effective than adults spewing things at you.”
Laurie Belanger, a student assistance counselor, oversees Connect training at Gilford High School, the first Lakes Region district to adopt it roughly 10 years ago. Twelve trained Connect peers now teach lessons on mental health and suicide awareness and prevention to seventh- and ninth-graders in middle and high school wellness classes.
“We tend to see a lot more referrals” after the training, Belanger said. “They’re becoming gatekeepers for themselves and the larger community, their friends, family and neighbors. It’s a relief for kids that someone’s finally talking about it.”
This semester Gilford High is taking the principle of Connect a step further, training student counselors who will have office hours twice a week starting in December, for students who would rather speak to a peer. Student counselors learn active listening skills, how to set boundaries, the limits of confidentiality, and when it’s important to inform a grownup, Belanger said.
According to Mental Health America, which advocates for research and insurance coverage and tracks statistics, 64.1 percent of youths with major depression do not receive any mental health treatment.
And they face no shortage of risk factors: Depression, anxiety, trauma, substance abuse, eating disorders, maladaptive levels of perfectionism that increase feelings of stress and unworthiness, sexual assault and rape, and trauma and domestic violence at home. Those have all been shown to raise the suicide risk in children and teens, according to the National Association of School Psychologists and experts who study suicide.
For teenagers and trained school staff, Connect is changing the rules of engagement by fostering a willingness to seek help – be it for one's self or someone else. With its strategies of ask, listen and report, students can help without having to solve everything themselves. Connect has been adopted in almost every state, and in Canada, Australia and Great Britain. It’s now considered a mental-health best practice, an approach that combines caring and common sense when talk and transparency matter.
Roughly 70 New Hampshire schools received training in 2018; several more will receive it in 2019, De Mello said. After nine years of federal funding brought the program to New Hampshire communities and schools starting in 2009, it’s hard to know how many continue to train successive waves of student-peers, she said. It’s now up to local school districts to raise money through private charitable grants, or pay per-person for online training from NAMI, at a cost of roughly $75 ot $85 a head. Typically, the wealthier school districts continue the program, said Ken Norton, director of NAMI-NH.
“No one can say it reduces suicide,” Norton said. “We wanted to reduce negative attitudes and increase health seeking” as well as awareness – and follow-up surveys have demonstrated that.
“The data shows having these conversations decreases someone’s risk for suicide,” said Kelly Gaspa, behavioral health director for the Partnership for Public Health in Laconia, serving Belknap County, Northfield, Franklin and Hill. “It’s not about diffusing the crisis. It’s about making the connection. Making sure someone’s OK is something everyone can do. We all have a hand in preventing suicide.”