September is Suicide Prevention Month, and a new bill aims to address the mental health crises faced by many California students. Assembly Bill 2246 would mandate that every California school serving grades seven through 12 adopt suicide prevention policies that specifically address high-risk students, including LGBTQ youth, those experiencing homelessness or foster care, those bereaved by suicide and those with mental illnesses or substance use disorders.
Under existing law, the state “encourages” middle through high schools to provide suicide prevention training at least once to each school counselor over the course of their employment. But if passed, the new bill would require local educational agencies, including school districts and charter schools, to develop and adopt a policy on suicide prevention, intervention and post-intervention procedures.
The policy must also address any suicide awareness and prevention training necessary for teachers. Each local education agency would determine how to institute these policies. The bill most recently passed the Assembly floor on August 29 with 65 ayes. The 11 noes came from Republican Party members. Governor Jerry Brown has until September 30 to sign or veto the legislation.
In Oakland, many therapists and counselors are supportive of the legislation, but say that the mental health care needs of students extend even beyond the scope of this bill.
Dr. Thomas Tarshis, founder of Bay Area Children’s Association (BACA), a non-profit mental health clinic for children that has an office in Oakland, said he hopes the bill is signed, but is concerned about access to quality follow-up treatment. “Schools are definitely the right place to do this,” he said, “but it’s potentially just going to crash down when the schools say, ‘Here’s a depressed teenager who needs help,’ and then there’s no one to send that kid to for help.”
“It’s extremely frustrating if you’ve empowered someone to say ‘I’m depressed with suicidal thoughts and I need help’—and then if they can’t get help, it becomes a very hopeless cycle,” he continued. “So that’s a challenge in trying to reform the system.”
AB 2246 was co-sponsored by The Trevor Project, a national nonprofit providing suicide prevention services and crisis intervention for LGBTQ (lesbian, gay, bisexual, transgender and questioning) young people. The Trevor Project presented a model policy that could be adapted for all school districts, which staffers say could relieve potential administrative strains on the districts. The bill also proposes that the state reimburse associated costs to the districts.
“We’re thrilled that it’s made it this far, and we’re incredibly optimistic that it’s going to be signed by the governor,” said David Bond, VP of Programs for the Trevor Project.
He continued, “We teach young children seatbelt safety and pedestrian safety because motor vehicle accidents is the number one cause of death for children. Suicide is the second leading cause of death, yet in most jurisdictions we provide no suicide prevention education whatsoever.”
The 2013-2014 California Healthy Kids survey of Oakland students found that the percentage of students who reported that they experienced sadness or hopelessness in the previous 12 months was 27 percent in seventh grade, 28 percent in ninth grade and 33 percent in 11th grade. That same survey found that nearly one in five ninth- and 11th-graders had contemplated suicide in the previous 12 months.
Elisabeth and Chris, parents from the Bay Area, believe that the issue of suicide prevention is more complicated than the bill suggests. They say their child became suicidal as a high school freshman. (The parents preferred to use only their first names and omit their child’s name and gender for privacy reasons.)
“I think you’ll have some districts develop solid plans based on sound, existing practices and others that go about it in a pretty ham-fisted way that is just about checking the compliance box,” Elisabeth said. Effective intervention, she believes, should address intricacies in communication and cultural context.
For a year, their child was “more and more depressed, tired and irritable over the course of the year,” Elisabeth said. “Grades were dropping.” They heard from the school’s health center about their teen’s frequent visits, and reports of disengaged behavior and sleeping in class.
For a parent with a child struggling with depression, Elisabeth said, “There’s just this fear component. Every day.”
Tarshis said that early suicide prevention and intervention is critical. “We know that in most cases of suicide, there were some warning signs that could have been picked up on, some sort of intervention that could have saved that young adult or teen’s life,” he said.
La Clinica de la Raza, a community health care provider with centers in Alameda, Contra Costa, and Solano counties, provides clinician-supervised services to 14 Oakland and San Leandro schools linked to eight school-based clinics. These clinics provide yearly assessments for all students, and interventions for students who are identified as at risk for suicidality.
La Clinica provides services to all students regardless of their insurance status, which Ruth Campbell, the clinic’s Integrated Behavioral Health Supervisor, said can be a barrier to mental health care.
Campbell said that suicide prevention programs are more effective in intimate classroom settings. “Any kind of classroom presentation is really helpful, because it normalizes it,” she said. It fosters discussion about mental health, Campbell continued, “so it doesn’t happen in a silo for them.”
John Sasaki, spokesperson for the Oakland Unified School District , said that in Oakland, “we have a pretty robust behavioral system in place in schools.” But of the potential bill, he said, “anything we can do to make our environment safer, to make our kids happier and healthier, we’re going to do.”
“We just trained 125 mental health professionals in crisis response two days ago,” he added. “We’re being proactive. That was the motivation. Every year we train a couple dozen supervisors. This year we decided to up it, be proactive, and make sure everyone is prepared.”
Sasaki said that this training was geared towards crisis response, “which is for anything that’s going on in the community and schools. Historically what we’ve dealt with is street-level violence, outside of schools and even in schools. We have to be ready to respond when our community needs us.”
Elisabeth and Chris said that their teen’s situation required more help than the school could give. “Teachers were thoughtful and accommodating, but it was difficult to get more comprehensive services from the school,” Elisabeth said. “[Our teen’s] problems were moving faster than the wheels of bureaucracy, for sure.”
Their pediatrician ultimately recommended that they find a psychiatrist for their child. But the search for care became an extended battle. Their insurance company offered infeasible solutions, Elisabeth said: “They were giving us lists for people in Pacifica. They said, ‘It’s only 50 miles away.’ Like, if you’re a bird, that’s fine.”
It took four months for their search to lead them to BACA, which had just opened its Oakland location. Though they live a good distance from Oakland, they signed up for care. But during those four months, their child went into what Elisabeth calls “pretty severe crisis.” Her teen, Elisabeth said, “was doing some school refusal, and was hospitalized for suicidality and self-harm.”
What Chris and Elisabeth envisioned would be outpatient care at BACA—weekly therapy for about six months—turned into a more rigorous treatment plan. BACA began an Intensive Outpatient Program (IOP), a three-hour session four to five times a week, and referred them to a residential treatment facility. A private insurance company paid for their teen’s first month in the facility, the parents said, but not for the following 14.
They needed a very supportive system for their child after those 15 months, Elisabeth said, so they turned back to that IOP option. “Residential is a really structured environment with wraparound care, and 80 percent of your day is therapy. So to go from that to very little is a big transition,” she said.
While their teen’s condition is much improved, they said the family still needs support. “It’s still a ton of emotional and mental energy just thinking about what it takes to keep our child stable and focused on positive things,” Elisabeth said.
The intensive treatment plan their child received is what Tarshis calls the “gold standard.” But it is not available for all children who are suffering from depression and suicidality, a problem which would persist even with the passage of AB 2246.
“I think there’s always a dearth of long-term counseling options for kids, because the need exceeds the capacity sometimes,” Campbell said. She said that there is access to triage for acute cases of suicidality, but only some schools do have long-term counseling: “There’s a need for more.”
Campbell is nevertheless supportive of the legislation. “Having access to caring adult at school, having access to teachers who know what the warning signs are, parents who are more informed as to what it is and know how to talk about it,” are critical to fostering that prevention, she said.
The following resources are available for anyone who is contemplating suicide:
National Suicide Prevention Lifeline: 1-800-273-8255
National Trevor Project Lifeline: 1-866-488-7386
Alameda County Crisis Line: 1-800-309-2131