Hamilton County sees 7th youth suicide this year

Hamilton County is experiencing an extended outbreak of youth suicide, alarming experts who urge parents to break the silence with their children. Or Netflix will do it for them.

Since 1999, suicide in Hamilton County residents 18 and younger has averaged about five a year. But three significant spikes have arisen inside the past decade: 16 in 2009, 11 in 2011, 13 in 2016. Officials are especially troubled because in the first four months of this year, there have been six youth suicides. A seventh came Saturday night. The county for the first time could tally teen suicides in double digits in consecutive years.

The year’s first victim, in January, was an 8-year-old boy who hung himself. In the arid words of his autopsy report, he used "a black patterned neck tie resembling that worn by a little boy."

The boy's mother has said she believes her child was bullied at Carson Elementary School in West Price Hill. But Cincinnati Public Schools has reported that Carson had zero bullying reports in the four months before the boy's death.

'A lot of contagion' in Cincinnati

“Hamilton County, regardless of what year, has always been a high-risk county for suicide,” said Helen Anne Sweeney, research manager of the Ohio Department of Mental Health and Addiction Services. “The rates are highest in Cincinnati than in other large metropolitan areas in the state, and even for what we consider high-risk areas of Appalachia. There’s a lot of contagion in Cincinnati for some reason.”

Suicide is the second-leading cause of death for people under age 18, after accidents. No one knows why the numbers in Hamilton County are rising now. There's no similar spike in the surrounding suburban counties or in the counties for Columbus or Cleveland.

Suicide resists easy diagnosis or explanation, often because self-destruction can be an impulsive act. Doctors, public health officials and academics who study and treat suicide list the eternal risk factors in all humans, such as depression and other mental-health illnesses, poverty, isolation, a loss of hope.

"Most people think suicide is about death," said Dr. John Ackerman, with the Center for Suicide Prevention and Research at Nationwide Children’s Hospital in Columbus. "It’s usually about escaping pain."

Then comes the 21st century’s contribution of social media. The instant, sometimes explosive relay of memes – which are simply ideas that get passed around – gives bullies power to inflict trauma and provides desperate people access to fatal information.

How to weigh in the Netflix factor

The culture at large also stirs itself into the mix. In March, the streaming service Netflix unveiled a 13-episode series called “13 Reasons Why,” which focuses on the suicide notes that a teenage girl leaves behind. This week, after a rash of calls to suicide hotlines, Netflix said it would place warnings on the program because experts were concerned that watching the series could be risky behavior for some children.

Of the seven Hamilton County youth suicides this year, five were under 18, two over 18. Three were girls, at least two of whom used handguns, and all four boys died from hanging. Psychiatrist Leah Casuto, who treats adolescents at Lindner Center for Hope in Mason, said she is concerned by data showing an overall rise in youth suicide by hanging.

"How does an 8-year-old know how to hang himself? He shouldn't," she said. "They probably saw it on the internet. That's what scares me."

Dania Barazi is a real estate agent, but her passion is a nonprofit she founded five years ago called SEAS the Day – the acronym stands for “stay educated about suicide.” She speaks at schools across the Cincinnati region. This year alone, she says, she had talked with more than 5,000 students about suicide.

“They feel that they’re not being heard, and they’re not being taken seriously by their adults, by their parents, by their friends,” Barazi said. “They think it’s never going to get better, that they’re going to be stuck in high school forever, they’re going to be stuck with their peers who are unkind to them. I tell them to find a trusted adult and talk to them. And to adults I would say, tell them how to get through it.”

'The line starts getting long'

In the past 10 years, services in Hamilton County to help children in mental-health distress have expanded, although the experts say what is available isn’t enough. Dr. Michael Sorter, director of the division of child and adolescent psychiatry at Cincinnati Children’s Hospital Medical Center, said the mental-health workforce needs to grow dramatically to handle the demand.

“We’re doing some, but not to the depth we need in regard to mental health," he said. "Whether what we have is new cases or the stigma lessening, it’s hard to tell. When you begin offering care, the line starts getting long pretty quickly because there is a need.”

Among the resources available is a course called Youth Mental Health First Aid, available in the Cincinnati region through the Mental Health America of Northern Kentucky and Southwest Ohio. Bill Shamblin is the chief instructor, and he said adults and even peers who notice their children or friends are troubled should say something.

“The No. 1 thing to understand is, first, there are always signs. You can see it," Shamblin said. "Second, you can talk about it. Talking about it helps. And third, once a youth has gotten through that crisis period, more than likely, they are never going to feel suicidal again.”

Unlike Hamilton County, suburban counties say they have not seen an increase in youth suicide this year. In Ohio, the Butler County coroner reported one death in February from a December attempt and one suicide in March. Warren County says it has had no youth suicides. In Kentucky, the Campbell County coroner reported no youth suicides this year so far, and Boone County has had one. Kenton County data wasn't available.

Franklin County, where Columbus is the seat, had seven suicides of people 19 and under; in the first two months of 2017, the county has had three youth suicides. In Cleveland's Cuyahoga County, three young people 17 and under died as suicides in 2016, but none so far this year.

Despite a wealth of anecdotal evidence, there’s little clinical confirmation of a firm link between suicide and bullying, social media or dramatic programs such as “13 Reasons Why.” But Sorter and others do worry about “contagion,” when news of one suicide, a meme jet-fueled by the internet, could beget another because a suicidal person may conclude that self-harm is an option to end pain.

“Maybe our task is to use social media more for the good,” Sorter said. “What’s important is not to be afraid to ask, to inquire, to discuss this with your son or daughter or niece or nephew or loved one. Mental health treatment really does work. And the resilience of our young people is so remarkable to see.”

Warning signs of suicide

People who are wrestling with thoughts of suicide give off indicators. Here are a few things to watch for, and if you see them, ask if help is needed immediately.

• Talking to others or posting on social media about suicide, about wanting to die or about feeling hopeless or trapped or a burden to others. 
• Looking for ways to die by suicide -- gathering medication, sharp objects, firearms, or looking online for methods.
• Expressing unbearable emotional pain.
• Visiting or calling people to "say good-bye."
• Giving away prized possessions.
• Suddenly becoming calm or cheerful after a long period of depression.

Resources for youth and adolescent mental health care

• Talbert House's 24-hour hotline line: 513-281-CARE (2273). 
• Talbert House's 24-hour text line: Send the phrase 4hope to 839863
• The state of Ohio has a 24-hour text line: Send the phrase 4hope to 741741
• Mental Health Association of Northern Kentucky and Southwest Ohio: 859-431-1077
• Mental Health Access Point mobile crisis line: 513-558-8888. 
• Mindpeace, at Cincinnati Children's Hospital Medical Center, 513-803-0844.
• SEAS the Day, dania@seasthedayfoundation.org, 513-212-6631
• Mental Health Recovery Services of Warren & Clinton Counties: 1-877-695-6333.