They were siblings, children, grandchildren and, in some cases, parents.
Their ages range from 13 to 24.
They came from all corners of Allegheny County and a few outliers.
They are the young people who passed through the Allegheny County Medical Examiner’s office between Jan. 1, 2011, and July 11, 2016, because they took their own lives.
Of the 17 suicides among young people so far this year, three were Black males and one was a Black female. Their ages ranged from 19 to 24.
They leave behind 108 versions of the question: Why?
Mental health experts, school officials and parents are scrambling to find answers. The search is made more urgent in light of five suicides in five years by young people in the communities that make up the Pine-Richland School District in northern Allegheny County. Two of those suicides happened in a three-week period this spring. A third teen suicide happened about a week later in neighboring Hampton Township.
Need help? Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
In May — while community meetings were being held to discuss the Pine-Richland suicides — Democratic state Rep. Dan Miller of Mt. Lebanon introduced a bill that would call for mental health screenings for all students by age 14 in an effort to identify and to treat mental illness and to prevent teen suicide.
Also in May, the Jewish Healthcare Foundation* kicked off a $500,000 effort in part to decrease adolescent suicide by improving access to the mental health system for troubled adolescents. The initiative may include developing an app through which young people can find answers to behavioral health questions, use screening tools to assess their own behavioral health and connect to services.
About half of mental health disorders start to show symptoms in adolescence. Changes in mood, attitude and appetite can be harbingers of a serious condition. But the symptoms don’t always alarm guardians because they can be perceived as normal teenage angst. And sometimes, even when problems escalate, there’s a resistance to seeking mental health services because of the stigma attached to it.
The suicide rate among all age groups in the United States has increased 24 percent from 1999 to 2014.
When it’s already too late, people tend to look for quick answers regarding suicide, particularly when it comes to youth, said Dr. Lisa Pan, an attending physician at UPMC’s Services for Teens at Risk Center [STAR].
If the suicides happen in a wealthy area, they blame the pressures of wealth. If in a poor area, they blame the hopelessness of poverty. But, Pan said, there are youth who face the same stressors who don’t attempt suicide.
Pan is involved in research that shows there could be structural and functional differences in the brains of adolescents who attempt suicide.
“With all of the research we’ve done, we haven’t reduced the rate of suicide. So that tells me there is something more we need to know so that we can intervene for the right people in the right way,” Pan said.
Could screenings close the treatment gap?
Mental health experts say that, though a young person’s environment may provide stressors, in 90 percent of suicides there is an underlying mental health condition, such as depression, that may or may not have been diagnosed.
Suicide is the third leading cause of death among youth ages 10 to 24 in the United States, according to the CDC.
Miller said his bill is aimed at identifying mental health issues in youth at a time when symptoms first start to appear.
Statistics show that 50 percent of chronic mental health problems start by age 14, and 75 percent by age 24, said Julianne Washington, advocacy director for the National Alliance on Mental Illness [NAMI] of Southwestern Pennsylvania.
NAMI’s statistics also show an average gap of eight to 10 years between the onset of symptoms and treatment.
“I believe less than 20 percent of children who are experiencing symptoms are actually getting treatment,” Washington said. “Our hope is that we catch these kids early … that hopefully they will be better able to handle the symptoms of whatever they are experiencing.”
Statistics show that 50 percent of chronic mental health problems start by age 14, and 75 percent by age 24.
Pan said she supports early mental health screening, as does NAMI and the Centers for Disease Control and Prevention [CDC], but she added they must be connected to available resources for immediate referral.
Miller said his legislation is “a needed corollary” to Act 71, state legislation that went into effect last school year requiring all school districts to enact suicide prevention policies. He said under the Affordable Care Act, all health insurance policies would have to cover the cost of the screenings. Parents could opt out of the screening.
Miller said he knows of no states with such a requirement, but that some schools around the country do it voluntarily.
By making mental health screenings as routine as dental and eye checks required of students, mental health would be treated similarly to physical health. Miller said he hopes that will take away the stigma attached to mental health issues.
Patrick and Jacqueline Kimmel of Mt. Lebanon — who lost their 22-year-old son, Jacob, to suicide on Dec. 24, 2010, on his second attempt — are ardent supporters of Miller’s bill.
Jacob, they said, struggled since elementary school with what had been identified as learning disabilities. He was bullied in middle school and isolated in high school. He had few interests other than playing video games and working as a waiter for nine months at the Hofbrauhaus in the South Side of Pittsburgh.
He wasn’t diagnosed with depression until after his first suicide attempt at age 20 while attending the Indiana University of Pennsylvania, where he was a business major. In hindsight, the Kimmels believe Jacob likely suffered from depression from a young age and an earlier screening may have provided a diagnosis and successful treatment plan.
“The would-have, could-have, should-have things that you go through afterward. Always questioning what you could have done differently. That’s what you have afterward,” Patrick Kimmel said.
Timothy and Julie Krebs, of Arnoldin Westmoreland County, lost their daughter Destinee to suicide on Feb. 4, 2015.
Destinee was diagnosed with mental health conditions, including anxiety, depressive disorder and anorexia, in the 2013-14 school year when she was in eighth grade. It was one year after moving with her family from Butler and starting as a student in the New Kensington-Arnold School District. At her new school, her parents said she was bullied and harassed.
Though she was receiving therapy and medication and spent a week in Southwood Psychiatric Hospital, Destinee chose to end her life when she was in ninth grade. The suicide happened one day after she testified in court against another student accused of assaulting her.
“I knew there were problems, but I had no idea she would take her life,” Julie Krebs said. “No parent should have to go through this.”
In May, the Krebs filed a federal lawsuit against the school district and several administrators, alleging the district did not take appropriate action to stop the bullying. The district maintains it acted appropriately.
The third leading cause of death
Suicide is the third leading cause of death among youth ages 10 to 24 in the United States, according to the CDC.
Suicide among U.S. teens and young adults has nearly tripled since the 1940s, according to the CDC, which estimates that 4,600 young people take their lives annually. In addition, about 157,000 youth ages 10 to 24 are treated in emergency rooms for “self-inflicted” injuries each year.
Youth suicide in Allegheny County
In 2013, the most recent year data was available for Pennsylvania, 221 people ages 10 to 24 were reported to have died by suicide, according to the Department of Health. Twenty-four of those deaths were evaluated by the Allegheny County Medical Examiner.
The suicide rate among all age groups in the United States is on the rise; it has risen 24 percent from 1999 to 2014, according to an April report by the CDC.
Males are far more likely to die by suicide than females. Nationally, and in Pennsylvania, about 80 percent of the suicides of 10 to 24 year olds are male. Girls, however, are more likely to report attempting suicide, according to the CDC.
When an unusually high number of suicides occur in a particular area over a certain amount of time, it can be considered a “cluster.” In those instances, mental health experts intervene and study the situation to prevent contagion or copycat suicides.
One national case garnering attention is in Palo Alto, Calif., where the CDC is investigating two suicide clusters among young people in 2009 and 2015. The first was a nine-month span when six teens took their own lives. The more recent cluster involved four teens.
An intervention in Pine-Richland
The Pine-Richland area suicides have been determined to not statistically constitute a cluster by Dr. David Brent, director of the STAR Center. But it should be a call to action for the community, said Dr. Karen Hacker, director of the Allegheny County Health Department.
“The message is the community has to look at itself… (and) ask what could be going on in our environment that could be causing this to happen,” said Hacker, who studied a suicide cluster in Massachusetts before taking her position in Pittsburgh.
“There’s plenty of evidence to suggest that people who consider suicide, if you intervene, those feelings will go away,” Hacker said.
In May, about 100 people attended a meeting of the Pine-Richland school board, where the district announced it had added student assistance teams to its kindergarten through third-grade buildings. Now, the teams are available to grades K-12. The district also renewed its risk assessment protocol to determine the threat or intent of danger when a student or staff member expresses suicidal thoughts.
As a result, 52 mental health risk assessments were performed on students spanning all grade levels from August 2015 to May 2016.
High school students have been trained on how to become “responsible reporters” if their friends give warnings that they may harm themselves, and the district has brought to the high school mental health services for those who request them.
Prevention and assistance plans in higher education
Similar efforts are made at local universities, including the University of Pittsburgh and Carnegie Mellon University — both of which have lost students to suicides in recent years.
According to the medical examiner’s statistics since 2011, there were 10 suicides among those 24 or younger in Oakland in the past five years. Eight were college students.
Pitt and CMU said they offer counseling and other services to students in need and that they make programs known to students as early as freshman orientation and as frequently as possible throughout their education.
“The mental health and well-being of all of our students is an extremely high priority,” said Ed Michaels, director of Pitt’s University Counseling Center.
Both campuses offer spaces for students who are feeling overwhelmed.
At Pitt, it’s the “Stress Free Zone” at the William Pitt Union, which offers opportunities for meditation, relaxation and exercises to cope with stress.
At CMU, it’s the “Mindfulness Room” located on the ground floor of the West Wing and open 24 hours a day during the fall and spring semesters. The university describes it as a place “to simply rest, breathe and relax with no agenda.” It holds plants, a waterfall, yoga mats, meditation pillows and comfortable seating. There are also inspirational whiteboards where students write messages of positivity and hope for each other.
Talking about it at school and at home
Under state law, the 2015-16 school year was the first during which school districts were required to adopt a suicide prevention policy and provide training to its staff and students.
Before that requirement, there was a reluctance among schools to let experts speak about suicide prevention.
“It’s still a myth that if you talk about it, you will give people the idea to do it. We had a lot of resistance there because, as a society, we are afraid to talk about it,” said Jennifer Sikora, chairperson for the Western Pennsylvania Chapter of the American Foundation for Suicide Prevention.
Sikora’s organization is helping to provide training for school staff and students under Act 71.
“It’s still a myth that if you talk about it, you will give people the idea to do it. We had a lot of resistance there because, as a society, we are afraid to talk about it.”
Outreach Teen and Family Services, a Mt. Lebanon-based nonprofit counseling agency, experienced the same aversion to its Teen Screen Program, which offers voluntary mental health screenings at schools.
But the Mt. Lebanon School District and Seton La-Salle High School opened their doors to the program several years ago. In Mt. Lebanon, students in grades 7-12, with parental permission, are offered the Teen Screen service, said district spokeswoman Cissy Bowman. The program is part of the district’s mental health curriculum, which includes health classes, anti-bullying programs and programs that link freshmen with upper class mentors to create a welcoming environment.
Emily Heim, community outreach and program manager for Outreach Teen and Family Services, said about 160 of the roughly 1,000 eligible students participate in the screening annually. About 18 percent of those screened are referred to mental health services.
Bowman said the district sees the program as an asset, even if a majority of the families are not using it.
“The fear of rolling up your sleeves and trying to address prevention means you have to have some ability to assess, refer and look at what are the core causes,” Bowman said. “Why would you be afraid of that?”
Pan said communication between parents and their kids is important in preventing suicide. Mental health screens can help to open up the dialogue.
“It’s important to ask, ‘Have you had thoughts that you don’t want to live?’” she said.
If they have or there are any lingering concerns, Pan suggests not to hesitate in making an appointment with a mental health professional.
*The Jewish Healthcare Foundation contributed funds to PublicSource in Spring 2015 to support coverage of health issues.
Jeffrey Benzing, Eric Holmberg, Iain Oldman, Courtney Linder, Christopher Reed, Niederberger and Stockton contributed research to this story. Holmberg also helped with the data.
Web design and graphics by Natasha Khan, Edited by Halle Stockton