Increasing mental health services, dismantling prejudice top priorities in Salem-Keizer

Editor’s note: September is National Suicide Awareness Month and this story is part of Breaking the Silence, a joint effort by news organizations across Oregon and Lines for Life to change the way we talk about the public health crisis of death by suicide. All of the stories and videos can be found at breakingthesilenceor.com.

Salem and Keizer community members have become far too familiar with the crushing news of student death by suicide.

Several teen suicides have been reported since 2016 alone, with some coming in waves of what experts call "clusters" — one after the other in a short period of time.  

Salem-Keizer Public Schools officials are taking multiple steps in the new year to prioritize the health and safety of the district's nearly 42,000 students.

One of the most noticeable changes is the printed list of crisis and tip lines on the back of every student ID card, including the National Suicide Prevention Lifeline in Spanish.

While this is tangible and allows for immediate assistance, district officials are implementing other solutions as well. 

Actions by the district include: 

• Offering multiple public forums for families and community members to express concerns and ask questions of mental health experts;
• Adding new positions for mental health counselors and behavioral specialists in schools and at the district level;
• Partnering with county and health care agencies to provide more child psychiatrists, counselors and social workers regularly in schools;
• Revising the forms used to assess students in crisis, and hiring someone specifically to coordinate those assessments;
• Starting to train all district staff, including bus drivers, in "Question. Persuade. Refer." — known more commonly as QPR — a program that teaches how to identify someone in crisis, how to start conversations about suicide and how to connect them with resources and supports;
• And beginning to plan how the district will use their estimated $35 million next year from the passing of the Student Success Act by the Oregon Legislature, with a significant portion expected to go toward student mental health.

"Suicide prevention is everybody's business," said Ishawn Ealy, a school social worker in Salem-Keizer. "It's not one entity's responsibility.

"We all can do our due diligence to provide support, be a source of hope and resources in the time of need for an individual."

But like every other school district in Oregon and across the United States, Salem-Keizer is faced with a seemingly ever-present barrier — the negative connotation around mental illness.

The decades-old issue can stop people from getting help, quiet those grieving and convince people in crisis there is 'something wrong with them.'

"If you were physically ill, you'd go to your doctor. People get annual checkups to be preventative," said Melissa Miller, a counselor at McNary High School in Keizer.  "And yet, if you talk with someone about seeing a mental health provider, there's mixed feelings.

"Some people are open ... and know it would help, and others, that word comes out again — 'weak.' "

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Movements and events like the Out of the Darkness walk by the American Foundation for Suicide Prevention, and social media hashtags like #BreakTheStigma and #ItsOkayNotToBeOkay, are encouraging people to talk more openly about mental health and seek help when needed.

Part of Salem-Keizer's efforts in the coming years will not only be to increase access and training, but make these conversations so normal, students and staff utilize the resources without second thought. 

Students in crisis

Just two years ago, McNary counselor Miller lost one of the students on her caseload to suicide. 

Miller knew he had a history of suicidal thoughts, noting he had multiple supports in place. He was close with his family; they were involved in helping him. As his counselor, Miller formed a close relationship with him, which she knew would make a significant difference.

But sometimes, "things just happen."

"It was just gut-wrenching, to be honest," Miller said. "There is nothing that can prepare you for what that's going to be like."

Suicide is the second-leading cause of death in Oregon among youth ages 10-24. And according to the Oregon Health Authority, the state's youth suicide rate is higher than the national average and has been rising since 2011.

"Some, the supports were there. Others, there were just no signs," Miller said. "Some there were signs, supports could have been in place, but sometimes people are really resistant."

When a suicide happens, Miller said the question everyone asks is "Why."

When Miller lost the student she'd been working with, her immediate reaction was to go back through all her work and see if she could have done more, asking, "How could I have done things differently?"

"Until you go through it, you don't really know what it's going to be like," she said. "(Others) might not get that answer ... they might have to work through that and get to a place where they can be at peace with that.

"It is OK to talk about it and reach out for help," she said. "That's what we're here for."

Teen suicide: Resources and signs to look for

School counselors like Miller are often responsible for day-to-day scheduling and academic, career planning, but depending on the time of year, Miller said her main focus may be navigating a student's desire to hurt themselves.

Last year, she said, there was a two-week period where they did 20 suicide risk assessments in two weeks.

"It felt like it was hitting one after the other," Miller said.

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Talking about suicide

Students are frequently referred to counselors like Miller by teachers or peers, or by reporting themselves.

Miller said often students come to talk about something else entirely and she'll begin to see small red flags, prompting her to ask more open-ended questions.

" 'You talked about ... not feeling the greatest lately. Tell more about what you mean by that?' " Miller gave as an example. "They might go into a little bit more and you just kind of slowly open up that little package with them."

Through conversations with students, and further questions with parents or guardians, counselors like Miller assess how far the student may be in a plan to harm themselves, how accessible something like a weapon or medication may be and how the school and its partners can intervene and support.

Often, this means directly asking the student if they are thinking of killing themselves. 

"If they're not really thinking about it, what I've found is my kids will tell me, 'No, I'm just feeling sad,' " Miller said. "And if they are, that's the only way I'm going to know. Just to ask."

This can be an especially scary question to ask without being taught how.

Part of the district's work this school year — which includes training of all Salem-Keizer staff in QPR — aims to arm educators with the tools and practice needed to have those conversations. 

The crisis lines on the back of students IDs also give students quick access to help if they aren't ready to talk to someone in person. 

"It's a huge step in the right direction to eliminate that stigma, because it says we as a district are making this just a normal thing," Miller said. "(Mental health) is not a big secret anymore. It isn't something you shouldn't talk about."

Peers: You are safe, you are welcome

Julian Holman, a sophomore at South Salem High School, spends much of his time helping friends dealing with mental health problems, something he said affects most people he knows.

But he also advocates on district and state-wide levels for more mental health and suicide prevention efforts for students.

He especially focuses on policies and practices helping students who are lesbian, gay, bisexual, transgender or queer, knowing teens in the LGB community are almost five times as likely to attempt suicide compared to heterosexual youth, according to The Trevor Project, and nearly half of trans youth have reported suicide attempts. 

In his time at South, Holman's watched counselors speak at school-wide assemblies about mental health and outreach, "really trying to empower (students) to be able to take care of themselves and their friends around them."

He's seen counselors come into health classes to talk about depression and suicide, specifically, if nothing else but to make sure students know the counselors are an available resource to them. 

And he's seen how South Salem students responded when news struck last year of multiple suicides in the Sprague community.

"There was a lot of mourning … from the whole community," he said, "acknowledging this is real and this has affected so many people, and if we don't do anything, will affect more."

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Holman said people can sometimes be hesitant to help others if they don't know how to do so professionally or "properly," or if they "don't know the root cause," but he argues that shouldn't stop us.

"(What's important is) being there for people, being accepting of people, opening up, making sure others are OK, being aware that others may not be in the same great space you are ... knowing help is real, help exists," he said.

"It's just incredibly important to form connections with other people because those connections really could support someone when they feel like they can't support themselves."

Contact reporter Natalie Pate at npate@StatesmanJournal.com, 503-399-6745 or follow Natalie on Twitter @Nataliempate or Facebook at www.Facebook.com/nataliepatejournalist.

How to get help

The Lines for Life Suicide Lifeline offers free, confidential and anonymous help. Its highly trained staff and volunteers provide immediate assistance, compassionate support and resource referrals.

Call 800-273-8255 (24 hours a day, 7 days a week, 365 days a year) of text 273TALK to 839863 (8 a.m.-11 p.m. PST daily).

The Oregon Youth Line is 877-969-8491 or text "teen2teen" to 839863.

Warning signs

While this is not an all-inclusive list, the American Foundation for Suicide Prevention separates warning signs into three categories — talk, behavior and mood.

A person may be at risk if they talk about:

• Killing themselves
• Feeling hopeless
• Having no reason to live
• Being a burden to others
• Feeling trapped
• Unbearable pain

Behaviors that may signal risk, especially if related to a painful event, loss or change:

• Increased use of alcohol or drugs
• Looking for a way to end their lives, such as searching online for methods
• Withdrawing from activities
• Isolating from family and friends
• Sleeping too much or too little
• Visiting or calling people to say goodbye
• Giving away prized possessions
• Aggression
• Fatigue

People who are considering suicide often display one or more of the following:

• Depression
• Anxiety
• Loss of interest
• Irritability
• Humiliation/Shame
• Agitation/Anger
• Relief/Sudden Improvement