Suicide is the third leading cause of death among young people in the US, and although the rate of teen suicide has declined over the last decade, the impact of even one youth suicide is tragic, with far reaching impacts on a community (Gould, et al 1990). One County in Nebraska, which experienced a series of youth suicides, compared these events to a rock being thrown into a pond, with ripple effects in the schools and community at large (Sarpy County, 2010). Even more troubling is the risk of suicide contagion, a phenomenon defined by the Centers for Disease Control and Prevention (CDC) as a process by which exposure to the suicide or suicidal behavior of one or more persons influences others to commit or attempt suicide. The Palo Alto community, with tremendous sadness and compassion, has experienced this phenomenon over the past year.

While tragic, these events are not unique to our community. Suicide clusters occur in other communities around the United States, and estimates are that 100-200 teens die in suicide clusters each year. Teens, in particular, are the most susceptible to suicide contagion, and about 1-5% of all teen suicides are part of a cluster (Gould et, al. 1990; Hacker, 2008). Media coverage, especially front page stories, of a youth suicide, the particulars of the headline, details of the method used, simplistic explanations of the cause of the suicide, or use of the teen’s photo, can be key contributors to contagion (Sarpy County, 2010).

The public health approach to suicide clusters includes intervention, postvention (the strategies utilized to investigate events and educate students and adults in the community for the year following the events), and prevention strategies. CDC guidelines strongly underline the need for a coordinated community-wide response, and community coalitions can “exponentially expand the reach of any effort” (Hacker, et al, 2008). In California, access to statewide suicide data has been made available through a site called kidsdata.org, and this information has assisted communities including Palo Alto in making informed decisions about intervention strategies. Other important recommendations emphasize the following:

• Access to lethal means must be restricted immediately
• Public and media response must minimize sensationalism, avoid unintended glorification of the act or the means, and also include mental health and other community support resources. Every opportunity should be taken to remind the public of the crucial link to mental health conditions such as mood disorders and substance abuse, and that 60-80% of deaths by suicide occur in people who have had such disorders for at least 1 year.
• Immediate evaluation and counseling of close friends, siblings and important adults in the teen’s life should be made available.
• An understanding that no single agency can stop a suicide cluster alone, and that the postvention journey must emphasize prevention.

In response to the five teen suicides the community has experienced between May 2009 and January 2010, the City of Palo Alto and Palo Alto Unified School District (PAUSD), along with many community partners, have taken an active role in developing short and long term plans to address this crisis. This report will describe the process that the Palo Alto community has used to investigate, intervene, and hopefully, to prevent the spread of further suicide contagion. It also delineates specific resiliency and mental health promotion strategies that have taken place, many of which have come from the City/Schools Community Task Force (Project Safety Net), and some of which have come from teens in the community.

Background

Palo Alto is a city of over 60,000 people in the northern part of Santa Clara County in California in an area known as Silicon Valley, and is home to many technology companies and Stanford University. While the demographics are very diverse, there is a deep sense of community and shared values. Many students will talk about having known their friends since they were in preschool programs together. There are several private and parochial schools in the community but the majority of students attend the Palo Alto Unified School District, a Public School District of over 11,000 students known for its academic excellence. The School District has enjoyed long standing partnerships with many local community organizations.

This tight-knit community was shaken in May 2009 when a student at Gunn High School died of suicide at a railroad crossing in the community. Immediately, school officials and community members were encouraged to hold meetings to address this tragedy. Several parent workshops were scheduled in the next few weeks and local community agencies provided support to students, teachers and parents. Less than one month from the first death, and just one night before a community forum on mental health strategies for teens, a second Gunn High School student died at the same railroad crossing. Once again, the community and School District were encouraged by parents and other caring community members to take action. Parent and student meetings continued and community agencies and local mental health professionals increased their efforts to respond to the community needs and concerns.

With the official end of school in June 2009, School District staff met to develop a plan for the next year. From the time of the first suicide, the School District felt that it was important to not just develop short term plans but to put changes in place that could be institutionalized. At the same time, Palo Alto Medical Foundation (PAMF) and Lucile Packard Children’s Hospital (LPCH) staff invited many other health care professionals and City and district officials to meet to develop support plans through their organizations. The faith community and the City of Palo Alto were forming similar groups. Many community members reached out at this time with offers of support, ideas, experts to call, and soothing words. A great deal of information was gathered and read, ideas were shared, experts were consulted, community workshops were held and the School District developed and later shared their specific plan of activities for the 2009-2010 school year. The mental health community developed plans for additional community support, and the City and faith community put together similar plans. In talking with local and national experts, all efforts were focused on interventions that were discrete and planned, but which did not unintentionally romanticize the act of suicide or the means of death. The potential for suicide contagion was very real, and though everyone kept that in mind, no one could completely grasp the fact that additional students might die from suicide in the community.

Two days before school was to start in August 2009, a student about to enter Gunn High School died at the same crossing as the other two students. Once again, the community responded with a sense of disbelief and acknowledgement that these deaths constituted a suicide cluster. Grief groups continued to support students and families; community meetings were held; and more information was gathered regarding possible solutions and strategies. Many community members shared their knowledge, their ideas and their concerns with the school and community officials. Suicide prevention experts and other school districts that had experienced similar tragedies reached out to the Palo Alto community in support. School District staff and City officials spoke with countless groups and individuals as they put all of the ideas in the context of the plan for Palo Alto, that is described in this report. There are few words to describe the despair in the community when a fourth Gunn High School student and then a fifth student (a 2008 Gunn H.S. graduate) died at or near the same railroad crossing; one in October 2009 and the other in January 2010. All prevention efforts were increased, with particular concern directed at not intensifying the cluster crisis.