Spotting Trouble: The Debate Over Teen Suicide Risks

The 13-year-old was a middle school student. He lived in Washington Heights. He wrote in his journal that he wanted to die by putting a plastic bag over his head. School-based health counselors contacted his guardian and referred him to an emergency room. He’s in counseling now, and alive. Score one for the city’s mental health network.

But because of funding constraints, it’s unclear that a student at a different school in the city would have had the same access to this level of help. And despite the growing consensus that teenage suicide is a public health problem, there is emotional debate over how best to combat it.

The federal Centers for Disease Control and Prevention estimates that suicide is the third leading cause of death for individuals between the ages of 10 and 24 nationwide. The number of 15-to-24-year-olds who committed suicide across the five boroughs declined from 52 in 2007 to 43 in 2008, according to New York City’s Office of Vital Statistics. But the Department of Health and Mental Hygiene’s 2008 youth risk behavior survey found that depression—the recurring precursor to suicide—was a “serious” area of concern.

After steadily rising for six years through 2005, the number of adolescents and teenagers who reported in the survey that they attempted suicide in the past year fell to 8 percent in 2007, but that number remains higher than it was nearly a decade ago.

Using its suicide prevention MySpace page, the Department of Health and Mental Hygiene (DOHMH) plans to launch a pilot program this fall in which counselors are made available after school via the website. And after the city’s youth risk behavior survey and figures from the CDC showed a higher tendency for attempted suicides among female Latino adolescents and teens, the New York State legislature allocated $1 million to the state Office of Mental Health to support a public awareness campaign focused on Latina teens. In April, an initiative dubbed Life Is Precious opened in Brooklyn after securing $167,000 in funding from Congresswoman Nydia Velázquez. The program, which is focused on Latina girls aged 12 to 17, uses a nonclinical approach to suicide prevention through the use of art therapy. But while outside efforts are important, the city’s school system is a likely place for teens with troubles to display warning signs that they might hurt themselves. One question is whether the capacity to provide help is there.

Inside New York City’s sprawling network of 1,600 public schools, about 250 of them—including about 100 high schools—have on-site health centers. The school-based health centers—or SBHCs—are staffed with medical professionals and social workers who tackle everything from toothaches to mental health needs in underserved neighborhoods. A broad network of community service providers— like the Park Slope Center for Mental Health in Brooklyn and the Children’s Aid Society in Manhattan —independently run the centers and are tasked with handling any number of mental-health-related concerns.

On-site health clinics first began to appear in a limited number of public schools across the country in the early 1970s. Similar to those in most jurisdictions nationwide, New York’s SBHCs are free of charge for enrolled students. Most SBHCs across the country are paid for by state government revenue. In New York, funding them is only partly done through Medicaid and third-party insurance companies. Individual grants and donations also help cover costs.

Unlike outpatient clinics, the city’s SBHCs aren’t presently eligible to receive Medicaid reimbursement payments for mental health services. And while a new plan was slated for adoption last March, it has since been delayed after the federal agency that distributes Medicaid expressed concerns about the manner in which New York State calculates its inpatient services.