Paragraph 13 reads: "Jrry Clark took medication faithfully and saw a doctor for adjustments. Until the last six weeks of his life, he saw two counselors regularly and had gone to the hospital and then to the Capital District Psychiatric Center twice for evaluation. His parents begged the doctors to admit him to Four Winds Saratoga, a mental health treatment facility, but after interviewing Jerry, they said he didn't need to go."
Despite best efforts, tragedy happens
By Jennifer Gish Staff Writer
Published: 05:00 a.m., Monday, September 20, 2010
The Clarks are left with just questions now.
Seventeen-year-old Jerry Clark was a standout wrestler with state title hopes and a popular kid at Voorheesville's high school, but he also battled severe depression and on April 27, he took his own life.
There's an added pain of losing someone to suicide, an endless string of what-ifs. As the Clarks see a new school year begin, one that should have included their son, they're left, now four months after he died, still wondering what more could have been done.
And every day they ask questions.
When it comes to mental health, so much is still unknown.
We know the statistics: More than 32,000 people die by suicide each year in the United States, and more than 90 percent of the people who kill themselves are suffering from one or more psychiatric disorders, including major depression (especially combined with alcohol and/or drug abuse), bipolar depression, schizophrenia, post traumatic stress disorder, eating or personality disorders.
It's estimated that one in five teenagers has seriously contemplated suicide. And suicide is the third largest cause of death among those ages 15 to 24.
So the mental health community is left asking a lot of questions, too. What's the best way to reach teens who have mental health problems and may be at risk of suicide? How can they get communities to start talking about the issue before a death like Clark's occurs, making it as comfortable for adults and kids to talk about suicide prevention as they are talking about smoking prevention?
And how do they save more lives?
What often gets lost in the public eye is that mental illness is a disease, not unlike cancer. And sometimes, even when someone with a mental health problem such as depression is undergoing treatment, it can end in death.
"There are some times where every support was in place and every person asked the question (but the person) truly was saying, 'I'll be fine. I'll be fine. I'll be fine,' " says Melanie Puorto, director of suicide prevention initiative for the state Office of Mental Health. "Suicide, while extremely preventable, we can't — because we're human — always predict with 100 percent accuracy."
Jerry Clark took medication faithfully and saw a doctor for adjustments. Until the last six weeks of his life, he saw two counselors regularly and had gone to the hospital and then to the Capital District Psychiatric Center twice for evaluation. His parents begged the doctors to admit him to Four Winds Saratoga, a mental health treatment facility, but after interviewing Jerry, they said he didn't need to go.
He had been hostile to his parents when he arrived at the center, and during his last visit in January arrived with fresh cut marks on his arm. But by the time morning arrived and he was re-evaluated, he'd calmed down.
He'd talked with his close friend, 17-year-old Pat Concordia, about hating to sleep overnight at the hospital waiting for re-evaluation and how he didn't want to be stuck somewhere in a room forced to just sit around and think.
Teens are often resistant to inpatient treatment because of the stigma associated with it, says Lisa Riley, board president of the Capital Region American Foundation for Suicide Prevention. A teenager imagines being locked up in a room alone with too much time to think, rather than a place where they can get well. And sometimes, they don't want their friends to know they were in treatment.
"That's another reason to rethink the mental health system," says Jill Ordonez, director of United Way 2-1-1 and Contact Lifeline, programs of Family and Children's Service of the Capital Region. The program operates a call center for information and referrals for human services as well as crisis calls from those who may be having thoughts of suicide.
"There needs to be many different layers … to offer (teens) to be able to text or e-mail or chat, call a hot line, (get) peer support, whatever it (is)."
Jerry had a smooth ability to work situations to his advantage. When he'd get in trouble in elementary school and was sent to the principal's office, it wouldn't be long before he was helping the secretaries file papers.
Generally, when mental health workers screen patients in crisis situations, they look to see if they're in touch with reality, and they'll ask them if they want to harm themselves and be looking to see if they're calm, cool and collected.
Jerry would tell the evaluator he didn't overdose on pills and then tell his parents he did when the evaluator left the room
. He knew how to answer the questions, which is why screenings can be so difficult.
"It's not cut-and-dry. It's not like cancer (where you can see) it's a cancer cell," Ordonez says. "(Depression) is a disease that affects the way we interact with people and our relationships and our relationship with ourselves in the end. It's hard to really pin down."
As Jerry's parents ask questions, they wonder why the people screening Jerry wouldn't listen to what they were saying about his state of mind.
But a 17-year-old has the right to speak for himself, says Puorto speaking generally and not specifically about this case. "We train clinicians all the time on how to work with this because one of the complaints often of teens or young adults, 'Gee, my parents are dictating what I need' … Sometimes if you don't use their input, (they're) more resistant to treatment."
After trips to the hospital with Jerry twice last winter, circumstances got worse for him. In February, a school suspension effectively ended his wrestling season. By March, the counselors were telling the Clarks they had to get even tougher, taking away his iPod and cellphone. He pushed back. He dropped out of school and started working odd jobs. He moved out of his mother's home and into his girlfriend's house.
"He said the medicine was helping him, and, if we just left him alone and eased up, he'd be fine," Wendy Clark says.
During those last six weeks, Jerry still talked to his family through Facebook and sporadic phone calls. He attended special family gatherings, like birthdays and Easter dinner, and showed up at his mother's home once a week where she'd dole out his medicine. She never gave it to him all at once, afraid he might overdose.
The Clarks knew he'd used marijuana to try to ease the pressure in his head — drug use isn't uncommon among those with severe depression — but begged him to stop because it would interfere with his medication.
He talked about his options for the future, whether he'd re-enroll at Voorheesville to repeat his junior year, go to summer school to make up the classes he needed to graduate on time or get his GED. He wanted to go to college eventually to study psychology. He wanted to be state champion in wrestling.
The decision to complete suicide is often a swift one, Ordonez says, sometimes leaving as little as five minutes between the thought and action.
And the trouble with adolescents is the part of the brain that causes impulsivity is proportionately larger than in adults. An adolescent can also be tricky to medicate with antidepressants because of the growing body and hormonal shifts.
Suicide prevention is still an emerging research area. In 1999, the World Health Organization launched a worldwide initiative for the prevention of suicide, deeming it a public health crisis.
The American Foundation for Suicide Prevention has thrown millions of dollars at research, hoping to answer some of the questions that remain with suicides. Most of them are preventable, using resources like community support, counseling, intervention and medication.
But the World Health Organization estimates that nearly 1 million people globally still die each year by suicide, and so the search for answers continues, as scientists look at everything from physical differences in the brain among those with diagnosed mental illness and suicidal thoughts to what kind of common factors there are among teens who die by suicide.
And programs such as United Way 2-1-1 and Contact Lifeline are working to figure out better ways to reach the teen population. Teens aren't typically as comfortable reaching out through hot lines, and so the center has launched an online-based chat website — http://www.crisischat.org — where those who may be having suicidal thoughts can talk to a trained volunteer or staff member. The chat will be staffed from noon to 6 p.m. Monday through Friday, with the hope of expanding hours soon.
Research is also pointing to how kids can help other kids through peer-based programs where kids are trained to listen to and support struggling students.
But that's all part of breaking down stereotypes and the silence that surround suicides.
Teen suicide isn't about having a hard time at school, a bad breakup or family troubles, it has deeper roots and the questions must continue to be asked.
"People say everything happens for a reason," Concordia, Jerry's close friend, says. "What reason is this?"
Jennifer Gish can be reached at 454-5089 or by e-mail at email@example.com.
There is help
The National Suicide Prevention Lifeline — (800) 273-TALK (8255) — is available 24 hours a day for anyone experiencing emotional distress. The line is also there for people who have a loved one who is struggling.
Those in need of any type of human services, including mental health and crisis support, can also dial 2-1-1, a non-emergency human services hot line.
Lost a loved one to suicide? There are support groups in the area. Contact the American Foundation for Suicide Prevention's Capital Region chapter for information at 899-0021. http://www.afsp.org/capitalregionny for more information.
Interested in being trained to staff a hotline or chatline? Call 2-1-1 (just like you'd dial 9-1-1), and there's an automated option for those who are interested in volunteering.
Suicide warning signs
•Threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself. •Looking for ways to kill oneself by seeking access to firearms, available pills or other means. •Talking or writing about death, dying or suicide when these actions are out of the ordinary for the person. •Feeling hopeless. •Feeling rage or uncontrolled anger or seeking revenge. •Acting reckless or engaging in risky activities — seemingly without thinking. •Feeling trapped — like there's no way out. •Increasing alcohol or drug use. •Withdrawing from friends, family and society. •Feeling anxious or agitated, being unable to sleep, or sleeping all the time. •Experiencing dramatic mood changes. •Seeing no reason for living or having no sense of purpose in life.
Source: American Foundation for Suicide Prevention