Stigma Viewed as Major Villain in Effort to Curtail Teen Suicide

By Dana Perrigan

The moment Kevin Hines leapt off the Golden Gate Bridge he knew he had made a terrible mistake.

Plummeting toward almost certain death, unable to breath because of the speed of his descent, he suddenly realized that he didn't really want to die. He wanted to live.

The previous evening, the San Francisco teen had lain awake all night. Convinced that he was worthless and a burden to his family, he had decided the best thing to do was kill himself. He had been thinking about doing it for some time, but now he felt ready. He had written several letters. He had formed a plan.

The next morning, a cool overcast day in late September, his adopted father, Patrick Hines, dropped Kevin off at San Francisco City College. After attending one of his classes, Kevin rode a couple of Muni buses to the Golden Gate Bridge - the launching pad for more than 1,000 suicides.

As his final meal, he ate some Starburst candy. He then strolled north along the pedestrian walkway and stopped. This was the place.

"I stood there for about 40 minutes," recalled Hines. "Part of me didn't want to do it. I said to myself, 'If someone comes up to me and asks me if they can help, I won't do it.'"

Instead, a tourist asked him to take a picture of her and her boyfriend. Hines took the camera, centered the couple in the viewfinder and snapped a photo. He returned the camera. Then he put his hands on the railing and catapulted over the side.

"When I hit free fall I thought, 'Holy crap, I'm a dead man,'" Hines said.

It didn't turn out that way. Summoned by bridge personnel, the Coast Guard picked up the still-conscious Hines floating in the water. He was taken to a hospital, where he spent several weeks recovering from his wounds: two shattered vertebrae.

Now, four years after the incident, Hines, who has returned to his classes at City College, suffers no ill effects from his plunge off the bridge. He can walk. He can run. But the attempt and his survival - which his father calls miraculous - did change a few things.

"It changed my attitude toward suicide," said Hines. "It changed my attitude toward life in general. Life is too precious to kill yourself over things you can't control. Everybody has a cross to bear."

For teenagers, according to mental health care workers, that cross can sometimes seem especially hard to shoulder. In general, they lack the perspective of an adult, have little control over their lives and have a tendency to engage in catastrophic thinking. They are also impulsive, emotional and prone to blaming themselves for things that are not their fault. They also live under incredible pressure to conform to their peers and to meet the expectations of their families.

The holidays, unfortunately, often create even more stress on families and troubled teens.

Every day in the United States, five teens commit suicide. Two hundred try and fail. In 2001, the Centers for Disease Control tallied 1,817 teen suicides; 74,844 attempts were made. That same year in California, 174 teens resorted to suicide and 3,795 attempted it. During the past 10 years, an average of four teens a year commit suicide in San Francisco - a city that has, for mostly economic reasons, an abnormally low number (16 percent) of families with children under the age of 17.

In October, a survey taken in California by Research!America for the Iris Alliance Fund, a Bay Area mental health foundation whose goal is to make youth suicide prevention a greater priority, found that four in 10 Americans have known a teenager who has either committed suicide or made an attempt. Thirty-eight percent have been asked for help from someone who was thinking about suicide.

"This is groundbreaking information," said the fund's founder, Mary Hayaski. "The fact that 42 percent of Americans have been touched by the tragedy of teen suicide makes it even more clear that suicide and depression are not matters that should be swept under the rug. They are public health issues that we have to address before more lives are lost."

The survey also revealed that the majority of respondents (57 percent) considered suicide - the third leading cause of death among teenagers - a major public problem. The stigma surrounding mental health problems was listed as the biggest barrier preventing depressed teens from seeking help.

"We are culturally programmed not to hear the word," said Eve Meyer, executive director of San Francisco Suicide Prevention. "From the first to the tenth centuries they buried you at the crossroads with a stake through your heart if you killed yourself. Your family lost its possessions."

Stigma of Mental Health Problems

Despite mounting scientific evidence that depression may often be chemical in nature and, like heart disease, can be genetically inherited, the stigma that surrounds mental health problems remains formidable: A National Mental Health Association survey reveals that 71 percent of Americans believe mental health problems are caused by emotional weakness. Forty-three percent believe they are, in some way, the fault of the person experiencing the problem.

Despite the fact that Kevin Hines had been diagnosed as bi-polar long before his suicide attempt, he still felt that he was somehow to blame for his condition.

"He was cycling downward and he was overcome by grief and by feelings that he was a worthless person and a burden," said Patrick Hines, a San Francisco banker. "He went to the Golden Gate Bridge and dove off with the presumption that his problems would be over."  

Mental health workers say the prevailing attitude toward mental health problems partially explains why only seven percent of health spending in the United States goes toward mental health services. It also explains, they say, why more than two-thirds of those with mental health problems go without treatment.

"Emotional pain is not something you can wish away," Meyer said. "Nobody says, 'Take that stupid cast off your leg and let's go dancing.' But that's what people say about emotional pain."

Ethnic and Cultural Stigmas

The task of dealing with depression and other mental health issues that may lead to suicide is often made more complex because of cultural stigmas. Hayaski, whose family emigrated from Korea to Southern California in 1980, refers to a "culture of silence" among Asian Americans concerning mental health issues. When her elder sister, Bo Yoon, killed herself at the age of 17, the family never talked about it. Her clothes, as well as all photographs of her, were destroyed.

"In my culture we don't really talk about those things," said Hayaski. "We weren't allowed to talk about it or keep any of her possessions. Later, I realized that we needed to erase that stigma."

Hayaski, who founded the Iris Alliance Fund in memory of her sister, says that task is especially difficult in a culture that "considers silence a strength." Asian American families often place great expectations on their children to succeed. When that pressure becomes difficult to bear, seeking professional help is generally not considered an option.

The stigma surrounding mental health problems affects teens belonging to other cultures and ethnic groups as well. A recent study of teen suicide in the U.S. revealed that African American teens had the highest rate of suicide. Paradoxically, adult African American males have the lowest rate of suicide among all ethnic groups.

A disproportionate number of Latino teens - almost always male - commit suicide each year. According to figures from the state's Department of Health Services in 2002, 172 youths, aged 13 through 20, killed themselves in California: Fifty-five were Latino and 20 were Asian American. Of the 3,744 recorded attempts, which indicate that the teen was hospitalized because of injuries, 1,090 were made by Latinos; 255 by Asian Americans and 244 by African Americans.

That same year, two teens committed suicide in San Francisco: one was Latino, the other Asian American. There were 52 recorded attempts.

"When you look at the numbers (for San Francisco) they seem rather low," said Meyer, "but the real carnage is in the attempts. The ratio of attempts to death is 200-to-one." Meyer also points out that many teens engaged in high-risk behavior - unprotected sex, drug use and reckless driving - are committing suicide "without a chosen moment of death."

"Suicide, in general," says Meyer, "is an attempt by people to rid themselves of intolerable pain. The pain can be physical or emotional and that pain is often exacerbated by feelings of being helpless, hopeless and being isolated."

The effort to lower the rate of teen suicide, regardless of ethnicity, is further complicated by the nature of adolescence. Teens, Meyer points out, often are not aware they are depressed. And they don't always exhibit the same symptoms adults do.

"They don't retreat, isolate," says Meyer. "They're in everybody's face. They're angry. They're not thought of as people who are depressed - they're thought of as troublemakers."

If the pain lasts long enough and they don't get help to deal with it, they may sink into despair and, finally, entertain thoughts of killing themselves.

And because they are teens, says Meyer, "they take a shorter amount of time to think it over and to act."

Signs of Suicidal Behavior

Part of the solution, say health care workers, is to raise the awareness of those who are around teens - parents, teachers and peers - to detect signs of trouble. These include:

1. Any mention of death at all;

2. Giving away belongings;

3. Writing a will;

4. Loss of interest in things that were once meaningful;

5. Statements about not having a future;

6. Joking about suicide.

It can often be especially difficult for parents, says Meyer, to recognize the signs and to admit that their child is suffering. They want so much for their children to be happy and are also aware of the social stigma placed on emotional pain and suicide.

Dr. Silvina Irwin, a psychologist with the Department of Psychiatry at San Francisco General Hospital, works with teens suffering from emotional problems related to abuse and other trauma. She notes several risk factors that may predispose a teen to depression or suicide, including a family history of depression or suicide; substance abuse (many teens commit suicide or make an attempt under the influence of drugs); social problems (difficulty making friends, being isolated, not having social support); exposure to trauma; and a previous attempt to commit suicide.

"Research has shown that successful suicides are preceded by a number of unsuccessful attempts," said Irwin. "Boys are generally more successful and the methods they choose more violent."

As coordinator of Suicide Prevention's Youth Risk Reduction Program, Kristina Orlova, regularly makes presentations to students and staff at middle and high schools in the San Francisco Unified School District. Among other things, she teaches students to be alert for signs in their peers of depression or suicidal thinking and how to help.

"When teens have problems," said Orlova, "they generally go to their peers before going to adults."

One of the first things Orlova tells students who think someone they know may be in trouble is to not be afraid to talk to them. Asking them directly if they are thinking about depression and suicide, she says, indicates that it is OK to talk about it. Teens trying to help someone can also call Suicide Prevention's 24-hour crisis line at (415) 781-0500 for advice and assistance.

"It's a gift," said Meyer, "if someone isn't afraid to ask: 'Are you OK? Are you in a lot of pain?'"

"I say, 'Are you going to help out? Are you going to step in or are you going to do nothing about it?'" Orlova said.

Community and School District Resources

Fortunately, she said, there are a lot of resources in San Francisco, both public and private, to help troubled teens. The SFUSD lists 90 counselors in its middle and high schools. In addition to the city's Child and Adolescent Services at San Francisco General Hospital, there are clinics and teen centers located in many neighborhoods that serve low-income families.

Operated by Community Mental Health Services, they include the Chinatown Child Development Center, Mission Family Center, Castro-Mission Health Center, Balboa Teen Health Center, Huckleberry Youth Services, Southeast Family & Child Therapy Center, Larkin Street Youth Clinic and Family Mosaic Project.         

Those interested in volunteering at any one of them should call SF Mental Health Access at (415) 255-3737.

Health care workers hail the recent passage of state Proposition 63, which imposes a surtax on those making more than $1 million a year to fund mental health services. Hayaski believes San Francisco will receive as much as $50 million to boost local mental health services.

"This has to be one of the more important achievements of our time," said Hayaski. "For the first time in history, we will have funds for mental health. Hopefully, this will motivate other states to do the same."

Kevin Hines, who now speaks to teens and adults about his experience, hopes he can motivate them to seek help when they need it.

"Anyone can be depressed. You're not alone. Don't try and fight it yourself," he advises. "It's not the end of the world."

Dana Perrigan is a freelance writer who composed this story for the San Francisco Neighborhood Newspaper Association.