Local Schools Lack Screening

By DONNA KOEHN dkoehn@tampatrib.com

Published: Mar 12, 2006

TAMPA - One year before Dan Casseday lost his teenage son to suicide, five years before Tony Dungy lost his, Terry Smith's 21-year-old daughter died by her own hand.

The Flagler County high school where Smith teaches and from which his popular, athletic daughter graduated, already had lost two students to suicide the year before.

Sad and shaken students - along with their sad and shaken parents, teachers, superintendent and school board members - decided they must do something fast to strip the taboo from this horror.

They declared an annual suicide prevention week, marked by yellow ribbons on T-shirts, somber assemblies and open discussions about feelings. Students, teachers, janitors and cafeteria workers were trained to spot young people who might be in trouble, to know what to say and how to help them.

A screening system, implemented a year ago, provided another layer of protection.

"There's such a common misconception that if you talk about suicide, it will happen," Smith said. "If this had been around when my daughter was a student here, it might have saved her."

Certainly, some teens experiencing the sturm und drang of adolescence continued to feel depressed at Flagler Palm Coast High School, and some no doubt thought about suicide during the next five years. But no one died from it.

Both Joey Casseday, 16 at his death in 2002, and James Dungy, 18 when he died in December, had attended Gaither High School in Hillsborough County. It is a school touched by suicide too many times over the years.

So a pilot program was proposed to screen Gaither students for suicidal thoughts.

David Shern, dean of the Louis de la Parte Florida Mental Health Institute at the University of South Florida, secured a federal grant to finance TeenScreen, a survey developed four years ago by Columbia University. Gaither's principal was on board; a local counseling center agreed to treat students who might need help.

But before the program could begin, Hillsborough County school administrators backed away from it.

They fretted that too many children without insurance would need help the county couldn't afford to provide, and that genuine depression is too difficult to discern from the normal angst of adolescence.

"We bent over backward," Shern said. "We felt we had answered all of their concerns."

The Scientology Influence

All over the country, school districts great and small have implemented suicide prevention programs and screenings. But not here.

Administrators, school board members, psychiatrists and parents of children who have died by suicide agree that bringing prevention instruction into the schools is a touchy issue. The area's conservative bent is one reason, they say. Some parents are more comfortable letting churches help with their children's problems and moral issues. Fearing stigma, others are queasy about giving schools another opportunity to affix indelible labels.

Privately, however, many concur that unease over the Church of Scientology, a vehement critic of psychiatry, looms large in local discussions.

After failing to get the pilot program at Gaither, Shern tried last year to introduce it in Pinellas County, home to the Scientologists' self-described spiritual mecca in Clearwater. The school board quickly received more than 700 negative e-mails, as well as Freedom of Information requests for all correspondence on the issue. Church representatives met with Pinellas schools Superintendent Clayton Wilcox.

The church denied having a campaign to dissuade the board.

Scientologist Ken Kramer, a public records expert and crusader against psychiatry, said he found out about the Pinellas pilot program and got some of his friends to write board members. Not all of them are Scientologists, he said.

Kramer volunteers for the Citizens Commission on Human Rights, founded by the Church of Scientology in 1969 to expose abuses in psychiatry. In December, that group opened a museum in California called Psychiatry: An Industry of Death. High-profile Scientologists such as actors Tom Cruise and Kirstie Alley speak openly of their disdain for the specialty.

Kramer's recent research led to an admission by the state Department of Health that it had failed to report for prosecution numerous cases of sexual abuse by therapists.

Kramer thinks all teen suicides are directly linked to psychotropic drugs such as Prozac and Paxil. He is studying five years' worth of autopsy and toxicology reports from suicides of Floridians age 18 and younger in hopes of proving his theory.

His research comes as a study, published Monday in the Archives of General Psychiatry, found that 4 percent of children taking the drugs thought about or attempted suicide, compared with 2 percent of those taking a placebo. In October, the Food and Drug Administration required that makers of antidepressants warn about the risks of suicidal thoughts and actions in children taking the drugs in prescribing information.

Kramer views Shern and other TeenScreen supporters as fronts for drug companies seeking to generate consumers for their products.

"They're not the hangmen," he said. "They're the gallows-builders. They lead them [children] to the psych drugs."

Scant Prevention Education

TeenScreen says it does not receive money from drug companies for its screening programs, although it acknowledges that a testing site in Tennessee received $7,500 for computers from Eli Lilly, maker of the antidepressant Prozac, six years ago.

About 122,000 students in 42 states completed one of three online or paper-and-pencil TeenScreen surveys last year. About 30 percent of the answers sent up red flags that one-on-one discussions with counselors were needed. About half those will be recommended for evaluation, a decision that's left to parents.

Parental permission is normally required for testing at TeenScreen sites.

After the negative feedback, the Pinellas County school board decided against allowing the TeenScreen testing. That vexed board member Linda Lerner.

"I was disappointed we didn't have a full discussion," said Lerner, who says she has been on antidepressants for about 20 years. "There were some legitimate concerns that could have been addressed."

TeenScreen would have augmented the one day of suicide prevention education Pinellas high school students receive in mandatory health classes. The students come away with a business card listing resources to call for help.

That's more than Hillsborough County students get.

Gwen Luney, assistant superintendent and the district's point person in its discussions with Shern about TeenScreen, said suicide prevention education is handled in classes taught by the Mendez Foundation, a nonprofit group.

But Regina Birrenkott, director of the foundation, said Mendez offers a drug and violence prevention program that doesn't address suicide.

"Drug education is our primary focus," she said. "We're definitely not suicide prevention. We teach life skills."

If a student were to talk about suicide, the Mendez instructor would refer the child to a school counselor, she said.

Other TeenScreen Concerns

Shern expressed frustration at his thwarted efforts to launch TeenScreen, which he believes to be a good way to identify seriously troubled adolescents. He acknowledged that it might be a lost cause here.

"I don't think it is an accident or a coincidence that Pinellas is home to one of the headquarters of Scientology and that that's why we've been subjected to this concerted opposition here," he said.

"We're not forcing anybody to do anything. That's why this is so maddening. It's pre-empting a choice that parents should be allowed to make. There's such an arrogance about it."

Smith, the teacher in Flagler County, said Scientologists tried to block his efforts there.

"Scientologists came after me personally," he said. "They got my personnel files and my e-mails."

But others also are uneasy about psychiatric screening.

David Cohen, a social work professor and researcher at Florida International University in Miami, expressed disdain for Scientology and thinks its antipsychiatry stance is an attempt to attract people to its own counseling methods.

Nevertheless, he finds himself sharing concerns about the lack of studies proving TeenScreen's worth and the possibility that well-adjusted children could be funneled into the mental health system unnecessarily.

"Who wants a young person to die?" he asked. "But without proof that it benefits young people, who benefits is the army of mental health professionals and their ability to augment the pool of mental health consumers."

Kramer said support for his antipsychiatry cause has come from the far right and the far left, and others in between. "We've got people like [conservative] Phyllis Schlafly as well as Bush-haters."

President Bush's New Freedom Commission on Mental Health in 2003 issued a report supporting screening and cited TeenScreen as a model program for youth.

In 2005, calling suicide a "complex social phenomenon," Gov. Jeb Bush called for a reduction in Florida's suicide rate by one-third by the end of 2010. His task force recommends screening teenagers.

Many Teens In Despair

Seemingly, if any part of Florida would serve as a model for suicide prevention efforts, it would be the Tampa Bay area. The University of South Florida is a center of research and development on the topic.

A suicide prevention guide for schools developed at the university is used in districts throughout the nation and overseas. Available online free, or as a booklet or CD for $9, the "Youth Suicide Prevention School-Based Guide" helps determine which prevention techniques would be most effective and advises how to put those in place.

Pasco County has it; USF knows of no other local districts that do.

Another USF researcher has a $237,500 federal grant for a suicide prevention program to be implemented in four high schools - not in Tampa, but in Albuquerque, N.M.

Among Hillsborough teens, suicide is the fourth-leading cause of death after accidents, natural causes and homicide. It is third, after accidents and natural causes, in Pinellas. But the number of young people who die by suicide is small and has declined slightly over the past few years. In 2004, the most recent year for which statistics are available, three people age 19 or younger killed themselves in Hillsborough, five in Pinellas.

However, Hillsborough schools' statistics suggest many students are in psychological pain.

Last year, approximately 5,000 Hillsborough middle and high school students anonymously completed the Youth Risk Behavior Surveillance Survey developed by the Centers for Disease Control and Prevention. It is administered in selected districts nationwide.

To the question, "In the last 12 months, have you ever felt so sad or hopeless every day for two weeks or more that it stopped you from doing your usual activities?" about one in three high school students said yes.

Almost one in five students said he or she had seriously considered suicide in the past 12 months, and almost all of them had made a plan to carry it out.

One in 10 students made a suicide attempt one or more times in the past year. Of those, about 4 percent had an injury or overdose that required medical treatment.

The Hillsborough County school district doesn't keep a record of how many students die by suicide. However, crisis teams were invited to campuses 12 times in the past five years to help students cope with the suicide of a classmate. That wouldn't include students who died during vacations or weren't well-enough known at school to upset classmates, said Tracy Schatzberg, supervisor of psychological services.

Lyn Casseday knew her son Joey was troubled, but she had no idea of the depth of his despair. She was the one who discovered his body hanging in the bathroom four years ago March 9.

"When I found him, I thought he was just playing mind games with me," she said. "If he had been screened, it might have been caught."

This year Schatzberg formed a small group of community suicide crisis workers, school personnel and suicide prevention advocates to start a discussion. The group has met twice.

Dan Casseday, who asked to join the group, hopes it will give parents a voice, something missing so far in Hillsborough and Pinellas counties.

"If 10 staircases collapsed, killing kids in Hillsborough County schools, do we take the time to sit around and study this?" he asked. "Or do we do something fast to stop this from happening again?"