Prevention: Los Angeles Reaches Out To Students With Systemwide Approach
For a school employee, Richard Lieberman has an unusual job description: Keep children from killing themselves.
"They call me Suicide Man," the upbeat director of the Suicide Prevention Unit for the Los Angeles Unified School District said recently.
Nothing in his school psychology courses in college quite prepared Mr. Lieberman for the task of buoying the spirits of children in a district with a student population of 700,000, the size of a large city. But, with the help of a district-run mental-health clinic, a city teeming with psychological clinics, and a $14 million annual investment from the district’s budget in mental-health services, the number of suicides in the district dropped from 35 in 1989 to 19 in 1997.
California lawmakers who provided the seed money for the suicide-prevention unit in 1987 credit the Los Angeles school system with helping the state’s overall teenage-suicide rate shrink while the national rate ballooned. Florida’s Miami-Dade County system, with 350,000 students, is believed to be the only other district in the country that has someone on staff whose job specifically is to prevent student suicides. In explaining his district’s success, Mr. Lieberman points to the requirement that every Los Angeles school have a counselor and a crisis team on site. And those people are prepared to handle emotional crises as nimbly as they do such emergencies as earthquakes and mudslides. All schools also have Mr. Lieberman’s phone number and are told not to hesitate to call if they are in over their heads.
As he inches through the Los Angeles traffic, Mr. Lieberman’s beeper and wireless phone buzz and chime in unison. In any given month, Mr. Lieberman and a school counselor—the unit’s two-person staff—field hundreds of calls from district crisis teams, made up of principals, teachers, and counselors at each of the system’s 700 schools.
On one recent day, inquiries covered a smorgasbord of sorrows: A child shows a morbid drawing to a teacher, another slashes her arms, while a third talks about hearing voices "that are making her do things."
When it comes to suicide prevention, Mr. Lieberman recommends that educators remember a few basic principles:
- School staff members should reject the idea that talking about suicide with students will increase the likelihood that they will act on such impulses. Studies have shown that students are less likely to harm themselves if an adult dispels assumptions about a particular predicament the child believes to be dire and irreversible.
- Teachers should be alert to warning signs that a student might be depressed—sudden changes in attitude or sleeping habits, or drops in grades or attendance.
- Counselors who are trained to keep therapy sessions confidential need to remember the importance of reporting a student’s suicidal intentions. And because students sometimes confess their suicidal feelings in class journals, teachers should take home emergency numbers in case they see a a mention of suicidal intentions in homework.
Callers in Crisis
The Los Angeles County crisis hot line is open to students 24 hours a day. During a recent day in the cheery pink office on the city’s fashionable west side, five volunteers spoke with callers in hushed voices.
The reasons for the upbeat decor are obvious. "We have a lot of hangings, overdoses, kids saying they are going to drive off cliffs," said Barbara Hornichter, the coordinator for the hot line, which gets more than 100 calls from suicidal young people each month.
Many teenagers who call say they are worried about a friend but are reluctant to get them help.
"I say to them: You’d rather have an angry friend than a dead friend, right?" Ms. Hornichter said.
Schools play a crucial part in reducing the risk of "copycat" suicides, the experts here say. Six students in Los Angeles schools killed themselves within two weeks of the shootings at Columbine High School in Colorado a year ago. The suicide-prevention unit received 96 calls about suicidal teenagers from 80 schools in the two weeks after the April 20, 1999, incident in which two teenage gunmen killed 13 people before turning their guns on themselves.
After a suicide, especially a widely publicized one, school staff members should be especially attentive to students they suspect might be emboldened to follow suit, Mr. Lieberman said.
Gloria Grenados, a psychiatric social worker at one of the district’s most crime-battered schools, is constantly on alert.
"We get two suicide attempts a month. I’ve even had three in a day," said Ms. Grenados, who is a counselor, confessor, and surrogate mother to many of the 4,900 students at Bell High School.
The district strategically deploys professional social workers such as Ms. Grenados, in addition to the crisis teams, in 200 of the system’s neediest schools. Bell High, which sits in a poor South-Central Los Angeles neighborhood, used to be notorious for suicides, averaging two a year in the early 1990s. Since Ms. Grenados arrived in 1993, not one Bell student has committed suicide, despite a flood of threats.
One recent afternoon, Ms. Grenados turns on the laptop computer in her office to display her current caseload. With each fresh screen, a collection of student woes appears: a 15-year-old boy on anti-psychotic drugs who attempted suicide at school by tying a cord from his sweatpants around his neck; a 14-year-old girl who has a 2-year-old child she detests and neglects; a teenage girl whose mother died of brain cancer, and who then contracted a sexually transmitted disease from her father, who had raped her. "This is heavy-duty stuff," Ms. Grenados said. "So many of these kids have lost parents to death, substance abuse. … They are so glad that someone is willing to listen to the pain they have harbored for so long."
Ms. Grenados requires that her "hard cases"—students who have expressed suicidal thoughts —check in to her office daily. If they cut class, or are even an hour late, she calls parents or the police. If parents fail to take a clearly suicidal teenager to get psychiatric care, the district often reports them to the county’s department of children and family services.
"If a kid has a broken leg, and parents say he doesn’t need treatment, that’s neglect," said Marlene Wong, the district’s director of mental health. "Mental illness is just as real as epilepsy or diabetes."
"Parents have abdicated responsibility," added Ms. Grenados. "The school has to pick up the ball."
Ms. Grenados said she’s grateful that once she has identified suicidal or depressed students, she has several places to send them for ongoing help. Besides referring them to a psychiatric ward, she can sign them up for psychological counseling at a public or private clinic.
But Ms. Grenados also has an option none of her counterparts in other school districts have: a professionally staffed mental-health facility operated exclusively for district children.
The nation’s only child psychiatric clinic run by a school system is housed in a bungalow classroom shaded by eucalyptus trees in Los Angeles’ San Fernando Valley. In a warren of cozy offices, 11 psychologists, psychiatrists, and social workers counsel district students five days a week.
Students pay nothing for the service, though the district collects reimbursements for students eligible for Medicaid.
With the added help of 50 interns—graduate students in psychology from the University of California, Los Angeles, and the University of Southern California—the clinic resembles a university health center. It serves 70 patients a day for problems ranging from post-traumatic-stress disorder to difficulties with managing anger.
The clinic operates in large part because of a cost-sharing arrangement in which Los Angeles County agreed to provide half the clinic’s $1.2 million annual budget. The remainder of the revenue to run the facility comes from reimbursements from Medicaid; half the clinic’s patients are eligible for the federally subsidized health plan for the poor.
But whether homeless or a millionaire’s child, any student gets served, said Gil Palacio, one of the clinic’s coordinators. "We take anyone regardless of money," he said.
Despite the district’s investment in reducing student suicides, Ms. Wong, the mental-health coordinator, said more must be done to help children in the earliest grades. The seeds of suicide germinate young; psychologists, she said, are able to detect whether children are at risk emotionally as early as preschool.
"When it’s a very bumpy road," she said, "we can bring children back to learning quicker if we start early."
Vol. 19, Issue 32, Pages 24-25