The study notes: “It turns out that one of the worst things for kids is to be physically and emotionally separated from the adults in their lives.”

It might sound simple, but according to Jim Mason, President of a parenting center in Cincinnati, Ohio, it’s not something all parents are aware of. Beech Acres works to strengthen communication between parents and children from their very earliest years, often once behavior problems have started, but before serious mental illness, violence or self-harm has occurred.

“By engaging parents with their child early on and by intentionally building a relationship one step at a time…we help to create an environment where a child feels safer, more able to express himself and have a means, a place to deal with the pains of childhood,” says Mason.

During play sessions, counselors at Beech Acres coach parents on how to encourage and reinforce good behavior, discourage bad behavior and let their children know they are there for them. These counselors sit out of the view of both parent and child. They watch from behind a one-way mirror and speak to the parent through a hidden earpiece – literally giving them words to say to navigate different moments with their children. Mason calls this “intentional parenting” because the idea is to show parents how to be as self-conscious about the words they choose, and the quality of their interactions, as they are in other areas of their lives.

Elizabeth Flowers regularly visits Beech Acres with her son, Joseph. Flowers says Joseph has problems with impulsivity and that the sessions have helped her and her husband communicate with him when he acts up.

“We can get through the day now,” she says.

It is all intended to establish a bond that can be drawn upon later in life. Not all depression or anxiety in our teenagers can be headed off in this way; But Mason believes this connection sustains kids as they go through their often difficult teenage years.

“The building blocks of a relationship between a child and the parent are the key elements to help…a child to be able to cope with the myriad pressures,” Mason says. “Kids get many, many different messages. So the parent’s job has to be how do I help that child discover his/her core, nurture that core…and teach the skills that they will need to be successful adults.”

For more information on Beech Acres Parenting Center, log onto their Web site.

Hamilton High

Remember when the No Child Left Behind Act became law? President Bush signed it in a ceremony at Hamilton High school – which that day stood for schools everywhere in the mission to bolster academic standards across the country. Well, 5 years later Hamilton High stood for what’s happening in many of the nation’s schools in another, far more disturbing way: there were four student suicides there within months of one another. When i first spoke with the principal he was agonizing over the question of why it had happened and what they had missed. All four teenagers had died by hanging.  No Child Left Behind as principal Dennis Malone would tell us later, may have required schools to increase test scores or attendance, but there wasn’t one indicator to show that a school had increased its attention to students with emotional problems.

So Hamilton High took it upon themselves to do a better job in this area – and in our documentary Cry for Help you will see what they put together and you can judge for yourselves how they do. For teachers and counselors and administrators it’s all extra time and extra work, but they all told us it had to be done. School is where all the kids are – for most of their days, anyway.  And in today’s world, where both parents often work, the folks running the schools are best positioned to reach the teenagers at risk who come through their doors everyday.

See what you think of what they call Character Day:  Hamilton High actually suspended classes for a day to spend time with students studying their emotional well being.  And there’s a crisis team – which is put to the test.  There are many different initiatives being launched across the country now – often in the wake of tragedy – to get at the problem of adolescent mental illness and feelings of suicide.  Hamilton High’s is just one of them.  What you will see represents a start.  With 28 teenagers taking their own lives every week in this country, it’s a start along a path from which schools are finding they can’t turn away.

That’s the theory behind STEPS – Screening, Treatment, and Education to Promote Strength – a first-of-its-kind virtual mental health initiative for teens and their parents.

Created by New York University’s Christopher P. Lucas, an Associate Professor of Child and Adolescent Psychiatry, STEPS aims to reduce risk of suicide and school violence through online education, self-help and screening. The voluntary, school-based program features a Web site for both teens and parents accessible at school or at home. On each site, visitors can find scientific information, chat around the clock with online clinicians and with each other, and participate in a confidential suicide questionnaire.
Since its launch last fall in two New York high schools, STEPS is already showing signs of success – with membership numbers nearly doubling. Lucas says he hopes the program will attract at-risk teens not only with its wealth of information, but also with its edgy style and interactive features.

“STEPS is really the result of seeing what works and what does not work in the suicide prevention field and really trying to leverage the power of technology and the way that teenagers relate to each other,” says Lucas.

While STEPS is currently being studied in only five schools in New York State, Lucas and his colleagues hope  to introduce STEPS to at least a dozen high schools by the end of this year.  They believe that successful intervention with teens who are at risk can be achieved by improving the mental health of an entire student population.

“The goal at the end of this is to get people to seek help,” Lucas says.

Behind the acts of violence and rage of both the Virginia Tech and Columbine shootings is a larger issue of mental illness in teens that is rarely addressed. For instance:

• The rate of teenage suicide has tripled over the last 60 years –28 teenagers a week now die by suicide.¹
• Depression and anxiety in adolescents often go unrecognized or untreated for years, and the results can be fatal – over 90 percent of adolescents who die by suicide have a diagnosable mental illness at the time of their death. ²

While school shootings are rare, signs of mental illness in the perpetrators of these crimes are not. School shooters often have a history of suicide attempts, suicidal thoughts or depression³ – which makes identifying those conditions through mental health screening critically important.

Cry for Help takes an intimate look at the efforts of two high schools to identify adolescents at risk. Hamilton High School in Ohio and Clarkstown North High School in New York have both been affected by teen suicide and have launched powerful new programs to prevent future tragedies.

Following the unrelated suicides of four students that shook the Hamilton community, school officials are taking a direct approach with “Character Day” – a raw, emotional, and honest program designed to motivate students to open up and ask for help. In Clarkstown, school officials are taking advantage of the time their students spend on the Internet by creating an online community – one where teens can anonymously air their problems and seek support from their peers and professionals.

Cry for Help also examines the often difficult transition from high school to college through a first-person account of a young woman who has battled mental illness. Stacy Hollingsworth, a straight-A student and gifted musician, was by all appearances a well-adjusted and accomplished young person. When Stacy phoned home from a campus psychiatric hospital during her freshman year at college, it was then that her parents realized things were not as perfect as they seemed. She had been hiding depression, suicidal thoughts, and feelings of paralyzing hopelessness for years. Stacy and her parents chronicle the painstaking journey to put her life back together, and how she founded her college’s first on-campus chapter of the National Alliance for the Mentally Ill.

Additionally, Cry for Help looks at the efforts by some parents to tackle behavior and communication issues during their children’s earliest years – before depression, violence, anger or suicidal impulses take over.

Interviewees include Dr. Chris Lucas, professor of Child & Adolescent Psychiatry at New York University; Dr. Frank Robertz, co-founder of Institute for Violence Prevention and Applied Criminology in Berlin, Germany; and Dr. Nolan Zane, Director of the Asian American Center on Disparities Research.

THIRTEEN’s Cry for Help is funded by the Estate of Marya Sielska; Members of THIRTEEN; the Irene Ritter Foundation; Judy Collins; the Leon Lowenstein Foundation; Donna and Phil Satow; the Marion E. Kenworthy-Sarah H. Swift Foundation.

Cry for Help is a production of THIRTEEN for WNET.ORG. Mary Murphy is producer and Scott Davis is senior producer. Edie Magnus is reporter and executive producer. Neal Shapiro and Stephen Segaller are executives-in-charge.

¹ Campus Mental Service, Recommendations for Change. Vastag et al, 2001.

² Nejm 2006. Study from Velez et al, American Academy of Child and Adolescent Psychiatry 1988.

³ Secret Service Threat Assessment Study for the U.S. Justice Dept.

Stacy Hollingsworth

In many ways, Stacy Hollingsworth was an exceptional teenager – an energetic young woman with talent in academics, sports, music and acting. Always smiling, she appeared – on the outside – to have it all.

But on the inside, Stacy was suffering in ways that no one – not her parents, friends or teachers – ever knew.

“It was the kind of pain where I literally wanted to curl up into a ball and fade away, or scream at the top of my lungs,” she recalls. “It felt like being a prisoner of war – your own war.”

For six years – despite her success in academics, sports and acting – Stacy silently battled depression. At its worst, the illness paralyzed her with feelings of hopelessness, and caused her to spend hours crying in her bedroom.

It began around the age of 14, when Stacy (now 25) remembers losing interest in the activities she once loved, and having trouble getting out of bed in the morning.

“It was like being tortured by your own brain,” she says.

The summer before her freshman year of high school, Stacy says she started to contemplate taking her own life.

“It wasn’t ‘I want to die.’ It was, ‘I can’t take this anymore,’ ” she says. “It was so excruciating to deal with the symptoms of the depression and the pain, there was this feeling that I can’t do this anymore – I don’t know how long I can last.”

When asked why she didn’t share her suffering with anyone, Stacy says it was mostly the stigma.
“I’d seen the way people with mental health issues were treated, and I didn’t want that to be me,” she says, adding that she was also afraid her illness might affect her acceptance to college, or her plans to go to medical school.

And why not share her struggle with her parents? “I didn’t want to burden them,” says Stacy, an only child.
Her mother, Sharon Hollingsworth, says she never noticed any warning signs of Stacy’s illness beneath her smiles and successes – an experience she uses to caution other parents of teens.

“I think parents think they know everything about their children, and I think in a lot of cases they do,” she says. “But I think there’s also a disconnect between children and parents…dealing with something like depression. I think that there are still things kids are hiding in almost every case.”

Even with her depression, Stacy managed to finish high school in the top of her class, and was accepted to Rutgers University in her home state of New Jersey. But once she got to college, Stacy’s depression, and suicidal impulses, worsened.

One night, after counting out enough prescription medication to commit suicide, she sought help at the campus psychiatric hospital.

“I needed to do something to save my life,” she says. “I had to do something, or I was going to die.”
That hospital stay marked a turning point for Stacy. With the support of her parents, she temporarily withdrew from Rutgers, sought help from a therapist, and eventually found a medication to effectively manage her depression. Stacy also found comfort, and encouragement, in an online community of people suffering with mental illness.

Last spring, Stacy graduated from Rutgers and landed a job with the National Alliance of Mental Illness in New Jersey, an organization dedicated to improving the lives of people who have been affected by mental health issues through advocacy, resources and education. She also founded NAMI-Rutgers, which works solely on campus.

“I think after having gone through my own life-changing experience with mental illness, I feel like I really have a second chance at life,” says Stacy. “It’s amazing to be alive and I want to take however much time I have left to put it to good use.”

For Stacy’s work, Mental Health America presented her with one of six outstanding young advocate awards in 2007 for her efforts to raise awareness of mental health issues among America’s youth, and addressing the issue of stigma.

When asked if she has any words for teens experiencing depression or thoughts of suicide, she says: “First, realize you are not alone – that is so important…Also, come to terms with it and accept yourself. Then, you have to say ‘who do I feel comfortable going to?’ And if there’s not…find someone who can play a role in your recovery.”

Stacy adds: “For the longest time, I never thought I’d be one of the ones who would get better. When I finally did, it surprised me, and it gave me hope…hope is possible.”

For more on Stacy’s story, see her video for MTV’s Half of Us campaign online.

For more on the National Alliance on Mental Illness, log onto NAMI’s Web site.

Edie Magnus, Executive Producer

Dr. Chris Lucas, head of child psychiatry at New York University’s School of Medicine, says it best:

“People only seem to pay attention when there is a major event and when a large number of kids die suddenly together. Whereas kids are dying all the time through gun violence or…though suicide, and there is not much attention paid to that.”

This is precisely how we began to pay attention to all the unheeded cries for help:  it was just after the massacre at Virginia Tech, where so many young people had died suddenly, that we began researching teenage mental illness and rage. Soon, the bigger story came into focus:  All over America, kids were dying by their own hands in far greater numbers than those killed by an enraged school shooter.  Experts we spoke to characterized this as two sides of the same coin: violence turned inward, or unleashed upon others.  Both are the end result of a terrible path that too many kids are on – and one that few of the adults in their lives recognize or understand.

In the nearly two years since we started looking into adolescent mental health, we’ve interviewed scores of experts on depression, anxiety, anger and teen suicide. We entered chat rooms and left postings on a number of Web sites devoted to these topics – and are grateful to the many young people who reached out to tell us their stories. Of the many statistics included in Cry for Help, there is one that stands out: that young people experiencing mental illness like depression and anxiety can go for many years (estimates range from 6 to 23 – which obviously puts them well into adulthood) before they are diagnosed and treated. That’s a lot of silent pain and suffering going under the radar.

Increasingly, schools across the country are feeling compelled to get a handle on the mental health of students. In Cry for Help, we were afforded extraordinary access to two high schools trying two different approaches – which we followed in real time throughout a school year. One of these schools was Hamilton High in Ohio, which had lost four teens to suicide in less than a year’s time.

To us, it seemed the school was using the “It Takes a Village” approach to help students in the wake of the suicides, and to encourage them to open up about their own issues. Teachers, administrators and counselors at HHS volunteered to take part in a series of initiatives that were direct and personal — to find students in emotional pain, to assure them they were not alone, and to offer time and resources to get them additional help if necessary.

The other school we profile is Clarkstown North High School in New York, which launched an equally ambitious effort to reach young people where so many of them now “live” — online. The program allows teens and their parents to seek out information anonymously through a special mental health and suicide prevention Web site.  The theory here is that rather than trying to find the few kids most at risk (which the program’s creator, a New York psychiatrist, Dr. Lucas, likens to finding a needle in a haystack) the goal should be to improve the mental health of the entire student population. In other words, the rising tide lifts all boats.

A young woman named Stacy Hollingsworth gave us invaluable insights into what it feels like to be severely depressed and hide it from the outside world.  Her parents were like so many others:  they thought they knew their child.  The lessons they learned and Stacy’s own account of her journey to the brink of suicide and back are important for anyone who is — or plans to be — raising a child.

There is so much that we in the adult world don’t know about what our kids are saying and feeling.  Cry for Help gives us a chance to listen, and opens a window into their world.  Their stories, and the disturbing statistics on teen suicide, are a clarion call for all of us to start paying more attention every day.

- Edie Magnus, Executive Producer

An injured occupant is carried out of Norris Hall at Virginia Tech in Blacksburg, Va., Monday, April 16, 2007. A gunman opened fire in a dorm and classroom at Virginia Tech, killing 21 people before he was killed, police said. (AP Photo/The Roanoke Times, Alan Kim)

It was the deadliest shooting incident by a single gunman in U.S. history.

On April 16, 2007, a senior at Virginia Tech University opened fire on the Virginia campus, killing 32 people before taking his own life.

The tragedy not only shook the nation; it also called into question the availability, and efficacy, of mental health services for minorities. Although the shooter, Korean student Seung-Hui Cho, had been referred to psychological counseling for symptoms of mental illness, he did not get sufficient help. And although his example is extreme, experts use it to highlight what they see as a common problem: insufficient mental health care for immigrants.

“He (Cho) was referred to care and he went, but he never followed up,” says Nola Zane, Director of the Asian American Center on Disparities Research at the University of California Davis, a government-funded initiative launched in the months after the massacre at VA Tech. “This is not uncommon. Only about 28 percent of Asian Americans with mental illness seek help, because they are ashamed, afraid, and also concerned about how, if people find out they have mental illness, it would reflect on their family.”

A 2005 study by the Asian American Psychological Association showed that when Asian Americans do come for counseling, they show higher levels of psychological distress compared to other groups, in most cases because they have delayed seeking treatment for so long. And relative to other minority groups, Asian Americans spend the least time in treatment.

The problem is not confined to the Asian-American community. Studies have shown that several minority groups are much less likely to receive needed mental health services than whites, and that when treatment is sought, it’s often poor quality.

Some of the more troubling findings by the government’s Office of Minority Mental Health include:

• The suicide rate among African American adolescents, once uncommon, has increased sharply.
• Suicide attempts for Hispanic girls, grades 9-12, were 60 percent higher than for White girls in the same age group, in 2005.
• While the overall death rate from suicide for American Indian/Alaska Natives is comparable to the White population, adolescent American Indian/Alaska Natives have death rates two to five times the rate for Whites in the same age groups. And in 2005, suicide was the second leading cause of death for American Indian/Alaska Natives between the ages of 10 and 34.
• Almost half of all Asian-Americans and Pacific Islanders with mental health problems will confront language barriers when seeking care

“We have no idea whether, even if someone reaches out to an immigrant with mental health issues, whether the care will be appropriate for them,” Zane says. “A lot of immigrant families don’t feel comfortable turning to counseling services because there might not be someone there who will understood them and some of the unique cultural issues they face.”

According to a recent report in the Journal of the American Medical Association, immigrant children are at heightened risk when it comes to mental health treatment. Why? For some it’s the psychological trauma of getting to America. For others it’s the struggle to assimilate, and feelings of discrimination – whether real or not – because of ethnic minority status. The study also found parents of immigrant children often have to move around a lot for work – leaving them little time to help their kids adjust to schools or their community. Combine those things with the ordinary challenges of adolescence and it’s a recipe for trouble: the study found these kids at increased risk for depression, anxiety, and substance abuse.

Resources:

• Office of Minority Health
• National Organization for People of Color Against Suicide

An unidentified woman looks at 15 crosses posted on a hill above Columbine High School in Littleton, Colo. Wednesday, April 28, 1999 in remembrance of the 15 people who died during a shooting rampage at the school. (AP Photo/Eric Gay)

According to a federal study, the odds that an American student will die in high school from violence are one in a million – or even less.

While major episodes of school violence are rare, the survey concluded that signs of mental illness in the adolescents who carry out these crimes are not. It found that most school shooters have a history of suicide attempts, suicidal thoughts, depression or anxiety.

In addition, experts say, the majority of these killings are pre-meditated. They are also carried out by kids who harbor severe, specific fantasies of violence.

What causes kids to act out a violent fantasy? According to the experts, two major factors include mental illness, and social isolation.

“You have so-called normal violent fantasies, which are not intended to be realized because there is too much at stake,” says Dr. Frank Robertz, co-founder of the Institute for Violence Prevention and Applied Criminology in Berlin. “If a kid has good social bonds, good attachment to other people, and a good involvement in society– all that stuff that prevents them from realizing such a deed.  But if you do not have these bonds – these protective factors – you are more likely to do a grave deed.”

Students embrace after a memorial service on the third anniversary of the Columbine High School massacre in Littleton, Colo., on Saturday, April 20, 2002. Friends and family released balloons in memory of the 13 victims. (AP Photo/Ed Andrieski)

Dr. Robertz studies the kids behind the school shootings so familiar to us now we reference them in shorthand: Columbine, Paducah, Pearl, Jonesboro, Northern Illinois University, Virginia Tech. Overseas, too – in Finland, and in Robertz’s native Germany. In March of this year, a teenager in Winnenden, Germany, went on a shooting spree that began at his former school and ended with 16 dead. The gunman, age 17, shot himself after a confrontation with the police.

“These school shootings destroy the community – not only the people who are left dead after the incident, not only the victims, but also their relatives,” says Robertz. “Also the people who are at school who saw this event, also officials who are responsible for the health of their kids at school.”

Robertz focuses on the fantasies of these shooters, which he says are often aired publicly before the killings are carried out. From private diaries, to home videos, Web pages and school papers – the perpetrators of school shootings have almost always put the word out about their grievances and their plans well in advance of carrying them out.

“I think they want to get in touch with us,” Robertz says. “They send us signals along the way.”

SOME EXAMPLES:

A Northern Illinois University police officer, center, helps a victim after a shooting on the campus in DeKalb, Ill., in this Feb. 14, 2008, photo. In an interview with the Associated Press, NIU Police Chief Donald Grady said the shootings resulting in the deaths of five students, was the ugliest test of his career. It was a test that would draw on three decades of military and police work. (AP Photo/Northern Star, Jim Killam, File)

Before killing 32 people at Virginia Tech – the single deadliest incident by a lone gunman in U.S. history – Seung-Hui wrote: “Kill yourselves, or you will never know how the dorky kid that you publicly humiliated and spat on will come behind you and slash your throats. Kill yourselves or you will never know the hour the little kid will come in with hundreds of ammunition on his back to shoot you down.”

Before he killed two students and wounded 22 others in Springfield, Oregon, 15-year-old Kip Kinkel wrote this on a Spanish worksheet:

“I will hunt you down and put a hole in your head. With explosives…RIP. You must DIE.”

And Columbine killers Eric Harris and Dylan Klebold made a home movie for school about wanting to kill their classmates, in addition to a “to do” list – including the purchase of bombs and guns – leading up to the massacre.

By studying these warning signs, Robertz and his co-workers have developed strategies they say can help identify students at risk for acts of violence, before it’s too late.

“In my opinion every one occurrence [of school violence] which has happened would have been preventable,” he says.

Robertz, who has interviewed school shooters, adds that his most surprising finding is how often these kids cry for help.

“All of the school shooters actually said– if someone would have approached me with how I’m feeling, what goes on in my mind, I would have told them,” he says. “So if teachers actually approach kids, they have a very high chance that they will talk about what’s going on in their minds, and will talk about their violent fantasies.”

**For more facts on school violence, visit the National Youth Violence Prevention Resource Center online. The Center, founded in 1999 in response to the massacre at Columbine High School, offers information and statistics on youth violence and prevention, and intervention strategies for the general public.

Nolan Zane: In many East Asian cultures the notion of distress – like feeling bad or feeling depressed –is not, it’s not discounted, but it’s not seen as a major reason for complaining. There is a Buddhist saying: “life is suffering” that sort of encapsulates that perspective – psychological distress, in some cultures, is seen as a legitimate reason to complain and seek help. Whereas in other cultures, it’s sort of accepted as a part of life.  So if a person sort of has that orientation in their family, then one – they may not express much to their family members about the depression or anxiety they may be feeling and two, they may be very reluctant to talk about these even darker thoughts of killing themselves or doing away with themselves because again, they may not feel safe, or feel it would be responded to in a very favorable or accepting manner….

Nolan Zane: Many Asian families, particularly immigrant families,  the focus is on work, doing well in school preparing yourself for a career, so when people have mental health problems they don’t see how counseling and psychotherapy services is going to help them with their work, with their school. So the challenge for the therapist is to show the client or the family in the first few sessions look, this will help you do better in school, or on the job. A lot of times that connection is not made.