Fears for teenagers who counsel suicidal peers

Suicide prevention programmes in schools remain contentious, as debate rages over whether they reduce the risk or could enhance it. Oskar Alley reports.

Student Amanda Myocevich had come home from Rosehill College, Auckland, with a gift for her father. The 16-year-old had volunteered to work as a Yellow Ribbon ambassador, a schools-based peer support programme that encourages troubled teenagers to talk to schoolmates about their problems.

Her father Keith Myocevich recalls: “She just came home one day and showed me a cap with a yellow ribbon on it and said: 'Do you want it dad?”

“I didn't realise she was an ambassador till . . . afterwards.”

In October 2002 Amanda was found dead. The coroner ruled her death was self-inflicted. Myocevich remains at a loss to explain his daughter's actions. He refuses to believe Amanda was bullied at the Auckland college and her friends confirmed that view.

“We'll never know why Amanda did it,” he says after a long pause.

“As far as I knew, and her sister knew, she was a happy girl. Myself I thought it was exams coming up and it was too much for her. That's what I think it was anyway.”

“God, she was applying for doing makeup artistry in films, sending away for brochures . . . I don't know.”

“My (other) daughter said: 'Dad we'll never know.' What I'm trying to do is remember the good times.”

Debate continues over whether suicide prevention should be included in schools, and whether teens helping teens is an ideal situation.

Myocevich is aware of the debate. He believes Amanda was too young and “not the right sort of person to be an ambassador”.

Critics say teenagers should not be expected to become “ambassadors”, to take responsibility for their troubled peers. They believe too much talk of suicide risks “normalising” or even promoting it, and that adult teachers, counsellors and mental health professionals should do the work. Advocates stress suicidal teens need help and support and are more likely to turn to someone their own age, or that their friends have a better chance of spotting signs of depression, a common factor in suicide attempts.

Yellow Ribbon is the highest-profile suicide prevention programme in New Zealand, used in more than 170 schools. The organisation is the educational arm of the Youth Suicide Awareness Trust, established in 1998 and co-founded by Peter Quinn, whose son Paul, 18, took his life in 1997 after a car he was driving crashed, killing a female friend.

Last month his younger son Michael, 15, was found dead. Teenage mourners at his funeral wore homemade yellow ribbons and draped his rugby jersey across his casket. The school Paul attended uses the Yellow Ribbon programme and some students act as ambassadors to help fellow students. Ambassadors volunteer or are selected by their schoolmates or the guidance counsellor.

The organisation co-ordinates peer support programmes in schools, with student ambassadors available to listen to fellow students' concerns. Its slogan is: “It's OK to ask for help.” The ambassadors are trained to work under the supervision of a guidance counsellor and to refer students to the appropriate professional for help. Their work is also monitored and evaluated monthly by the organisation's regional co-ordinators. Yellow Ribbon was first used in a pilot scheme at Auckland's Macleans College in October 1999. Principal Byron Bentley said last week he had no hesitation introducing the scheme and it remained valuable.

“We're talking about a programme that encourages young people to know they have help when they need it,” he says.

“I can't think of what could be more important than that.”

“Given this country's youth suicide rate we should be supportive of anything that aims to help teenagers with their anxieties and lets them know they're not alone.”

But Canterbury Suicide Project principal investigator Dr Annette Beautrais points to a significant volume of research that warns against peer support programmes.

“There isn't evidence that talking about it prevents it,” she says.

“There is some evidence that talking about it normalises it and makes it more readily available to young people as an option for when they have problems.” Beautrais, one of the country's leading suicide researchers, is also concerned that the sort of teens who volunteer to help their peers could themselves be most at risk of suicide.

Claims that medical authorities do not know what causes suicide are incorrect and “freak out” parents, fuelling anxiety created by the widely held impression that the rate of teen suicides is higher than it is, says Beautrais.

“I have never seen a case where a suicide has come out of the blue,” she says.

International studies, and Beautrais' own work, have identified“"remarkable commonality” in risk factors, including the fact that 90% of cases have at least one mental disorder, typically depression. In a study last year based on data from 1265 young people, Beautrais examined factors that influenced their vulnerability to a suicide or attempted suicide. While depression was the strongest risk factor she also identified social, family and individual issues that encouraged suicidal behaviours when depressed. These included the possibility of previous sexual or physical abuse, family living standards, parental anger or alcohol problems, low self-esteem and truancy or poor exam performance.

Beautrais says it has yet to be proved “beyond doubt” that there is an association between peer support programmes and suicides “and that's the argument its supporters will always make”.

Yellow Ribbon began by concentrating on suicide prevention in schools, based on its American namesake. But criticism of the original programme has seen the organisation modify its direction to encouraging students to seek help with their problems. A study by Auckland University's injury prevention centre last year contained strong warnings about peer-based support services in schools, with “concerning data” suggesting they could do more harm than good. It studied Yellow Ribbon, but also other groups dedicated to positive mental health initiatives for youths such as Project K and Project Hope.

“Evidence suggests there may be mixed effects of the suicide prevention programmes on some students,” the study said.

“Caution is required in relation to the safety and efficacy of peer support programmes.

“Emerging evidence suggests that they may increase the vulnerability of troubled young people.”

The study was also concerned with the “huge responsibility” and stress facing teenagers who try to help their “disturbed” peers.

Youth suicide researchers stress the age bracket covers those aged 15 to 24, and it is among the older members of that group (those aged 20 to 24) that suicide rates are highest. Figures from Youth Suicide Prevention New Zealand show overall, 75% of suicides occur over the age of 25. In 2001 people aged 20 to 24 had the highest suicide rates of any group (25.3 deaths per 100,000 population) followed by adults aged 25 to 29 (21.7%) and 30 to 34 (21.2%). Beautrais says although it is imperative to continue investigating school student deaths, they have received disproportionate media attention and the problem is perceived as being much worse than it is.

The Auckland University study's authors — Dr Sara Bennett, associate professor Carolyn Coggan and Dr Marilyn Brewin — recommended clear guidelines for school-based programmes. They said such programmes should not raise awareness of suicide, not encourage young people to take a high degree of responsibility for their peers, and should have strong relationships with trained counselling services and mental health professionals.

Yellow Ribbon chief executive Keith Pittman acknowledges the study's findings, but stresses his organisation is working closer than ever with relevant government departments.

“We've reacted to what the research says and there were concerns from the government that we've addressed” he says.

“We're very keen to all work together, it's not about patch protection, it's about making a difference.”

Although Fight for Life celebrity boxing contests have boosted Yellow Ribbon's profile and funds, other fundraising avenues are being developed.

“We've followed the government advice and removed the direct references to suicide and this year we're looking at consolidating the good work we've done, and moving forward,” Pittman says.

The organisation's financial set-up has been checked and approved by auditors and two health professionals have given a best practice tick to the schools-based programme. Youth Development Ministry national suicide prevention co-ordinator Sue van Daatselaar van Daatselaar confirms the ministry is working closely with Yellow Ribbon to ensure the programme supports schools to refer young people and their families to the right kind of professional help when problems are evident. More work is also being done to target school leavers who are harder to track when they enter tertiary institutions and workplaces.

“There is a line trending downwards when you look at the rate of youth suicides. It's a good sign we're on the right track but the work doesn't stop now.”

But opinion is sharply divided over the merits of using teens to help teens.

Hamilton-based clinical psychologist Narelle Dawson is a passionate supporter: “One of the reasons I think Yellow Ribbon is doing a wonderful job is that they have the best message ('It's OK to ask for help') that I've ever heard go out to anyone”" she says.

“Young people when they have a problem invariably go to peers rather than the school counsellor or to adults. Anyone who's got children knows that when they become teenagers they talk to each other.”

Dawson is completing her government-funded PhD thesis on a project which includes “psychological autopsies” on six youth suicide cases, contrasting social factors with youths who did not commit suicide.

Most research is geared towards why young people consider suicide, therefore Dawson feels it is important to study why others did not. She has little time for criticism that organisations like Yellow Ribbon risk normalising suicide with a reliance on role models and fundraisers such as Fight for Life.

“When we look at inappropriate sensationalism we need to look at what's done at some of the funerals. I went to one for a girl's suicide where the whole school attended and the priest told them she was now in Oparadise' and watching down from above.

“I was absolutely appalled.”

Oskar Alley
5 July 2004,2106,2961451a11,00.html

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