KOJO NNAMDIWelcome back. A report from the Centers for Disease Control and Prevention says that suicide is the second leading cause of death for children between the ages of 10 and 19. It identifies a number of other disturbing trends too. Just in the past decade it became more common for children to die of suicide than homicide. And experts say the increasing suicide rates among 10 to 14 years old are cause for serious concern. It's a complicated issue, but we're going to talk about it today.

KOJO NNAMDIListener discretion is advised and if you are someone you love needs help you can call the National Suicide Prevention Lifeline at 800-273-8355. We'll provide other resources on our website kojoshow.org. Joining me for this conversation in studio is Ethan Mereish. He's an Assistant Professor of Health Studies at American University. Ethan Mereish, thank you for joining us.

ETHAN MEREISHThank you for having me.

NNAMDII should tell you that WAMU is licensed to American University. And joining us by phone from Seattle, Washington is Dr. Cora Breuner, Professor at Seattle Children's Hospital and the University of Washington and a member of the American Academy of Pediatrics. Cora Breuner, thank you for joining us.

CORA COLLETTE BREUNERI'm extremely grateful. Thanks for the invitation.

NNAMDICora Breuner, looking at this report are you as a health care professional surprised by this information?

BREUNERWell, this is a wonderful question, Kojo, and thanks for asking. I am not surprised, but I am saddened and worried, because I do feel, in my office, clinically, I see more and more youth that are feeling despondent and hopeless.

NNAMDIDoes it surprise you that the children we're talking about are so young? We don't typically think of suicide as an issue that 10 year olds deal with.

BREUNERThat's the piece that is just so extremely saddening and worrisome and it makes you feel like you want to do something about it right now. Obviously every single person, who dies by suicide is another empty chair, another life not lived without promise or hope. And yet you think of a 10 or 11 or a 12 year old, that's fifth, sixth graders. That's elementary school and that's where you start to realize -- wait, what is happening? What is going on? What can we do differently to provide these children another place to go when they feel so helpless and hopeless?

NNAMDIEthan Mereish, your research looks specifically at mental health and communities of color and LGBTQ communities, what's your response to this data?

MEREISHMy response in terms of this data I think it's important in highlighting this important issue in terms of death by suicide among young adolescents, but it misses an important nuance to this data, which is understanding disparities, differences between groups. So for my research I find that suicide rates are higher among LGBTQ adolescents, among people of color, among adolescents of color. So this report doesn't really get at those information, and this is especially problematic especially if we're thinking about D.C. where communities of color especially, again, racial minority adolescents have much higher rates of attempting suicide compared to white adolescents, similarly for LGBTQ adolescents, they are three times more likely to attempt suicide compared to heterosexual or cisgender adolescents here in D.C.

NNAMDIWhat would you want non-academics to keep in mind when they hear this information?

MEREISHThey need to keep in mind that these are people's lives and we need to really do a lot to help address a situation and in so many different levels. So, you know, I think I would answer that question depending who I'm talking to. If it's parents, they need to be really taking a lot of steps if they have an LGBTQ child and affirming and loving their kid to help reduce issues really to suicide or mental health. Or if I'm talking to a teacher or even a pediatrician, how are we screening, how are we asking, even talking about suicide as well as decreasing stigma around seeking mental health services as well as reducing stigma around homophobia, transphobia, or other issues that we know are significant predictors of suicide for LGBTQ youth or racism or other types of oppression for youth of color.

NNAMDIJust how much of a disparity are we talking about here in the District of Columbia between children and teens and communities of color and LBGTQ communities and whites?

MEREISHSure. So I'm going to answer that question using data that were prepared by the D.C. office of the State Superintendent of Education.

NNAMDIOkay.

MEREISHAnd this is the 2017 district of Columbia Youth Risk Behavior survey. So from their published report what we see is in general adolescents, middle schoolers and high schoolers or specifically high schoolers are two times the national average of attempting suicide. And then if we zoom in on those statistics, why is D.C. having higher rates of suicides attempts for youth than the national average -- in understanding what groups are particularly at greater risk we see that for black, Hispanic, Latino or multiracial adolescents. Their rates are two times that of white adolescents.

MEREISHSummarily we see for LGB, so sexual minority, lesbian, gay, bisexual adolescents, they are three times more likely to think, attempt suicide compared to heterosexual adolescents. And then similarly for transgender adolescents in high school or middle school, they're three times the rate of cisgender or non-transgender adolescents. So this is, you know, pretty prevalent differences between these groups and we need to -- and they're happening right here in D.C.

NNAMDICora Breuner, what does mental illness look like in children and young teens? Are the warning signs different for adolescents than they might be for adults?

BREUNERWell, I'm so grateful you ask this question. Yes. I think one of the things that we struggle with when we think of someone, who's depressed as we think of someone that is just sad and crying all the time, which is true for many. But for others it can be manifested with irritability or anger or moodiness or spending a lot of time in the room where someone might think, oh, that's just great they're just rebooting themselves and they should be okay. Or many people feel like it's just teenager moodiness or something that they'll just grow out of. And I think that is the piece that is confusing for a lot of not only pediatricians, but also family members, teachers, etcetera. I think that the piece about education is so extremely important that it doesn't manifest in the way that we think it does and that we should keep our eyes and ears open.

MEREISHAnd I feel that one of the things that's really interesting especially with what Ethan said earlier is that we have shown in Seattle that if we do provide more wraparound services in our LGBT community that the rates of thoughts of self-harm, suicidal ideation or even dying by suicide decrease. So the data shows that if we can provide a loving family and a supportive community and school and healthcare system actually the rates decrease especially in the minority community and in the Native American community as well.

NNAMDIKrista asks on Tweeter, what are the warning signs? What should caregivers, teachers, tutors, coaches, etcetera do if they are worried about a child's mental health? Cora Breuner.

BREUNERWell, another great question. I think that one of the things that we used to say was, leave them alone and don't ask about it, because if we ask and they say they have thoughts of self-harm or committing suicide that we don't have the resources to deal with it, because our mental health system is overburdened. And that's not the way to do this. It's actually to ask those questions and to provide resources that are immediately available. We, at the University of Washington and Seattle Children have next day services available. So if the child or the parent brings the child into the Emergency Room, because they fear that their child has thoughts of self-harm or wants to die by suicide that they have a safety plan made and that they have a next day appointment to see a mental health provider.

NNAMDILet's go to Alisha on the eastern shore in Maryland. Alisha, you're on the air. Go ahead, please.

ALISHAYes. Hi. I'm apparently going to have to move to Seattle now, because that sounds amazing. I live in Maryland and that's not the case with next day services. My nine year old son last winter tried to kill himself by jumping out of a window and thank God he was okay, but it was five weeks of waiting for him to get a placement. Five weeks of him not being able to be in school. Five weeks of me not being able to work. Five weeks of my other child kind of back-burnered to the needs of the one child, who was just a flaming angry ball of sadness that needed help.

NNAMDIThank you very much for sharing that story with us. Ethan Mereish, while college students and adults can usually seek their own mental healthcare, kids like Alisha's son and young teens usually can't. What does that mean for the adults in their life as far as identifying the signs of mental illness?

MEREISHI think there are different ways we could potentially intervene and help in those situations, because you're right. A child oftentimes struggles in asking for help, because they may not know that they need help. So I think there are different strategies we could take. For example, we can increase our screenings of suicide in schools or for visits at a pediatrician office or an Emergency Room.

MEREISHSo if a child just goes for their regular checkup with the pediatrician or annually in their school if they go through a screening process just asking them if they're having those thoughts or if they actually have attempted suicide then we could red flag that child and try to think about wraparound services as the other guest was mentioning to try to help them, and involve then the parent, the family and other support services like their friends or teachers. Given that trying to intervene with a child is important is important for us to intervene in the whole system. So not just like the family of thinking about the school, the community as well as any other context that the child might live in or be a part of.

NNAMDILet's hear about what might be going on in Montgomery County. Here's Regina Morales in Rockville. Regina, you're on the air. Go ahead, please.

REGINAThank you, Kojo. In Montgomery County we have been very concerned about this issue of youth suicide prevention and have been working in the area of youth suicide prevention in the past, especially in the past three or four years, because we're discovering and finding that there's been an increase of school referrals to the Crisis Center for youth suicidal behavior, and an increase in the number of emergency room visits for self-injury.

REGINASo all these things were brought to our attention a few years ago, and, as a collaborative between Montgomery County Health and Human Services and some local non-profit agencies such as Every Mind and Montgomery County Public Schools, we developed the Be The One campaign, betheone.org. And that is -- it started off as a website, which was revamped by a high school senior in 2018 to make sure that we were speaking to young people in their voice and that our message was something that they could hear. So with this website it became eventually an ongoing educational campaign and prevention campaign where we want adults and youth to know what they can do if they are concerned about someone in their life.

NNAMDIThank you very much for sharing that with us, Regina Morales. But, of course, Ethan Mereish, Montgomery County is a fairly wealthy community overall. If a child is in a poor neighborhood or doesn't go to a school with a counselor that child might not have as many people watching for red flags, right?

MEREISHYou're absolutely right. And that's, I think, a huge contributor to why we think about these disparities is lack of access to mental health services, lack of resources available to those children or families. So I think, because of the structural factors is oftentimes why we find these disparities and I think it speaks to the greater need of why we need to provide more equitable approaches to try to intervene with these disparities especially when it comes to suicide.

NNAMDICora Breuner, you take a slightly different approach. Do you feel like it's on parents to recognize the signs of distress in their kids?

BREUNERWell, there's so many different people that we need to enroll to help with this, Kojo. It's parents, of course. It's teachers. It's peers. It's social media. I think that we haven't talked about one of the elephants in the room right now, which is social media's part in this as well as access to means to take your life to die by suicide. So there's a lot of ways to approach this so that we aren't chasing the solution one step at a time, but more equitably throughout the entire system.

NNAMDII'm glad you mentioned social media, because a lot of people have suggested the increase in suicide deaths over the past decade could be attributed to social media and especially to isolation. Do you think that's fair?

BREUNERI think that if you really look at the data -- I spent some time preparing for this interview yesterday and looked at the 2002 to 2017 data as well. And to see the rise in suicide across all age groups and gender and it's up everywhere and minorities, etcetera. And if you overlap that with when social media became more prevalently involved in our lives it was definitely after 2007 that we had Facebook and Snapchat and Tweeter and Instagram, Tic Tac. I mean, they just all have gone up in terms of their usage. And you layer onto that our suicide rates, I can't -- obviously I'm not a researcher like Ethan so I can't exactly say there's causality between the two. But I feel that if you look at it temporally there has to be some connection between the two.

NNAMDIHere's Ethan.

BREUNERYeah. I'm sorry. Go ahead.

MEREISHYeah. I think social media does play a role. In my own research I've recently found that bullying specifically related -- race based bullying or homophobic bullying online not just in person actually contributes to suicidality for black adolescents, who are also sexual minority who are also lesbian, gay, bisexual. So social media, I definitely agree, plays a role. And then within that there are oftentimes bullying that happens anonymously of other youth that even contributes to this problem.

NNAMDIHere now is Ed, in Towson. Ed, you're on the air. Go ahead, please.

EDAll right. Thank you very much. I think briefly my son, you know, he's in high school right now. And he's high function autistic. I got custody of him when he was in the eighth grade. He moved states. He came out of a divorce, you know, and he's on the spectrum. And I think the reason that he got to the point where he actually was on network for being voted homecoming king because -- and they didn't vote for him, because he was autistic. They actually genuinely voted for him. And the thing that made that unique was we have worked -- and this goes back to parents. I have worked with him on what to expect in a high school, because I've been teaching for a lot of years. And I think that's part of it.

EDYou have to validate the things that go on in that building. The teachers aren't going to be -- they cannot help you. They have a lot to deal with. So if the kid has any kind of mentor that is going to be the important part. We role played. We did a lot of things to get him prepared to navigate the waters. And he deals with all of it. He deals with the bullying. And he has navigated the waters where the people that were bullying him respected him enough to vote for him for homecoming king legitimately so.

NNAMDIWow.

EDIt starts at home. It has to start at home if you're going to be successful. You have to. Your kids has to have a foundation.

NNAMDIEd, thank you very much for sharing that story with us. I interrupt you only because we only have about a couple of minutes left. Cora Breuner, you have also had personal experience with young people, who have taken their own lives. And I'm told you'll say that happened not because of a personal failure on a single person's part, but a systemic failure. Can you tell us what you mean by that?

BREUNERYes. That occurred two years ago. One of my son's very good friends from high school died by suicide, and sorry I might tear up, but we went to his funeral, my son and I. And I'm good friends with his mother as well. And it was very difficult to be a member of the healthcare community and also a friend to the mom, who found her son. And also be a mom to know that my son lost his friend and he's never going to see him again. And there was so many layers of both sadness and frustration on my part at being unable to bring him back. And I vowed that I would spend the rest of my medical life really trying to make sure that we created a system that saved the world from one more loss, of one more potential beautiful person that felt so bad that they couldn't live anymore.

NNAMDIEthan Mereish, final question. What would you say needs to be improved about how we approach mental health for children and especially children of color or the children in the LGBTQ spectrum?

MEREISHI would say we have a broken system right now in terms of our mental health system and we need to invest in more funding to help address this issue to increase mental health services, increase clinicians who can work in schools and work outside of schools and communities to help prevent this issue. But in addition to that I think we can add as many clinicians as we can, but we also need to train them well and train them to be more culturally aware and sensitive to youth of colors' issues or unique concerns, as well as, to LGBTQ youths' unique issues and concerns, so cultural sensitivity is also a big important factor of being able to intervene in this issue among clinicians.

NNAMDIEthan Mereish is an Assistant Professor of Health Studies at American University. Thank you for joining us.

MEREISHThank you for having me.

NNAMDIDr. Cora Breuner is a Professor at Seattle Children's Hospital and the University of Washington and a member of the American Academy of Pediatrics. Cora Breuner, thank you for joining us.

BREUNERI'm honored. Thank you, Kojo.

NNAMDIWe're going to take a short break, when we come back a look at local volunteer emergency services. I'm Kojo Nnamdi.