Funding provided by the Delta Dental of Iowa Foundation.

♪♪ Mary Neubauer: Sergei died in 2017 just before he would have turned 19.

So today he would be about 23.

And, you know, the experts have told us that that transition from childhood to adulthood is a really critical time for so many people in terms of their mental health, their mental development, and just whether or not they'll be, they'll be able to make it through those years.

And obviously for Sergei, he didn't.

♪♪ Brian Carico: The Friday night before his completion, we have him video on our phones from doing a dance during halftime of the varsity game.

You know, he was dancing -- the interlude.

Yeah.

And you know, we, it was just so cool that you see across there and look at your son, you know, dancing and having fun with his friends and this and that.

And that was at nine o'clock on a Friday night and somewhere between nine o'clock on a Friday night and eight o'clock on a Saturday morning something went different and the impulsivity of teens and his feeling of self-worth somewhere along the lines collided and the outcome was death by suicide.

♪♪ ♪♪ Jennifer Ulie-Wells: We know in the nation, suicide is the second leading cause of death for young people.

In the state of Iowa, it has been the second leading cause of death for as long as I've been here.

We're above average across the nation.

Peggy Huppert: Young adolescent males, and they still are the prime demographic for suicide.

But what is, I think really disturbing to a lot of people including clinicians is seeing the younger and younger age of children as young as 10 taking their own lives.

Kelly Garcia: Those demographics are changing.

We're seeing an uptick in all of the precursors for suicidal ideation and prevalence in our state, binge drinking, rates of depression and access to crisis mental health services.

And all of those indicators are having a steep trajectory in our state.

Brian Carico: He'd be 26.

And he was one of the most lovable kids ever, was truly a polite generous kid.

I remember when he was young and we were at the mall and he said something to hello, sir, or something like that.

And the gentleman came over to us and said, you know how wonderful it is that your kid can talk to us and be that polite at that age.

And that's how he was.

He could talk to anybody.

He loved everybody.

And so he was very athletic.

He really enjoyed being a part of a group.

Dawn Carico: He wanted to make other people feel special.

And he actually wrote about that in a poem.

You know, it was just wanting to let people know that he cares and that they take him seriously about that.

And I think that was really kind of who he was.

And we had a, it was a substitute teacher actually that he had in middle school that wrote, she called it the cadence of Cam.

Brian Carico: Yep, the cadence of Cam.

Dawn Carico: And she wrote this poem about Cameron and she just really nailed it, because it was just like his smile would just be there all the time.

And he was there to encourage people and we heard even more stories after he passed away about all the different little things that he did.

Mary Neubauer: He was just an outgoing kid.

He just drew others to him.

He was really caring about his friends too.

At his funeral and visitation, we were just shocked by young person after young person we'd never even met who told us, you know, Sergei looked out for us, Sergei would check in with us if he thought we were having a bad day.

It was awe inspiring to see the difference that he made in his young life.

He could draw anything.

He could just sit down and whatever was in front of him, he could draw it.

And he would look at my pathetic stick figures and wonder -- (laughs) -- wonder what had happened there.

And he was very athletic.

Just could pick up any sport within just a couple times of playing it.

Larry Loss: When he came here, he could count to 10 and he could say, I didn't do it.

And in four months he was conversationally fluent in English and that's just a real tribute to how intelligent he was.

He was just a really dynamic person and he made friends easily.

But he was always on the lookout for someone who maybe was struggling in some manner.

Jennifer Ulie-Wells: The 2021 Iowa Youth Survey came out.

25% of our 11th graders have seriously contemplated suicide in the last year.

That is ticking up when we talk about the trajectory of mental health.

We are seeing an increase of young people that are having, at least reporting to have suicidal thoughts.

So when you talk about 25%, if you have a school of a thousand kids, that means 250 of your students in the last year have thought about taking their lives, statistically.

Do you, are you able to point out those 250 kids?

No.

So that means that you need to be building strong systems where young people can self-select, their families can self-select, into getting help.

We also want to increase levels of prevention so that kids are building relationships, they have connectedness, they feel engaged, they have purpose in life.

And then when they do need help, that they're able to access that.

Peggy Huppert: Oftentimes they'll talk about physical symptoms.

I have a headache all the time.

They just want to sleep.

They just want to watch TV, just something very mindless because it's a distraction, it's a diversion from what they are really worried about and they've developed anxiety or they're feeling depressed about.

And those are all things to be watchful for and to take seriously.

It's very rare that someone tries to take their own life or successfully takes their own life and there were literally, there was no sign.

Brian Carico: He was always a kid that was sensitive, and you know, some of that.

I know he said right before basketball season that year, I don't want to play basketball.

And we're like, you love basketball.

Yeah, you're gonna play, you know.

And that's where we didn't hear some of that.

And oh, his sleep patterns also, his sleep patterns were just way off, You know, he could stay up all night and then go, you know, and then he'd sleep all day or, you know, and for us, typical teenagers, you know, what is typical teenage sleep patterns?

Dawn Carico: Mm-hmm.

Cameron was seeing a counselor at that time and for whatever reason he didn't feel like he could put it all out there.

And I assume it's part of the stigma, you know, feelings of low self-worth and shame made it hard for him to want to share.

Mary Neubauer: He would become very withdrawn.

And that's hard as a parent to, to figure out because, you know, is it just a teenager, you know, pulling away and being more private as teenagers do, or is there, is there something more going on there?

For him, his depression also would be tied to him just spending hours and hours on his phone which obviously is not good for any of our brain health in that regard.

And then he had started to have just full blown panic attacks where he couldn't breathe, you know, would be just crying and hysterical and we couldn't figure out what was going on.

That was, that was really frightening for us as his parents, because I had never seen someone go through that before.

So there were some signs that were completely obvious and then there were other signs that were hard to figure out.

Larry Loss: But I think an important part to keep in mind is he was really good at masking and we could only see what he wanted us to be able to see.

And I think that's an important message for other parents or people with family members who may be struggling is that the person struggling can be very, very good at masking what's really going on.

Our brains are not fully developed until about the age of 25.

That's when the prefrontal cortex completely develops and that's where decision-making skills and delayed gratification, all that comes from there.

And which is why we know a lot of teenagers particularly do a lot of impulsive things without maybe thinking them through or understanding the long-term consequences.

♪♪ Jennifer Ulie-Wells: We all have good days and bad days, but we don't walk around with signs saying, you know what, I'm feeling really depressed today, I'm having dark thoughts, I'm having suicidal thoughts because we're so scared of how others are going to react.

So with the young people that we're working with, we really are trying to teach the brain science.

We're trying to help them learn to identify feelings.

That's another issue where sometimes when you experience feelings, it just comes off as very overwhelming.

How do you then start to identify well, instead of just overwhelmed, are you disappointed?

Are you hurt?

Are you scared?

Are you lost?

So the first step is then when you identify those feelings, it then helps us be more prepared to regulate those feelings because you're more apt to regulate something that you know and you're able to track and understand is happening.

We also work with students to learn to express feelings then.

So that communication piece is really hard.

Sometimes it's really hard to even just say, you know, I'm feeling upset, I'm feeling frustrated.

And especially if you don't track those feelings, you don't know to express them.

And then we build some practice opportunities so that it becomes more automatic so that not just when you're going through a stressful situation, you have them, but you can use them on a day-to-day basis to reduce the level of stress that you're experiencing.

I might not know you -- But I still care about you.

So if you've been thinking about suicide -- Talk to a friend.

Kelly Garcia: We have a key office that is really focused on suicide prevention that's understanding what threads exist in the state that we might need to pay attention to.

But then we have a variety of different programs that are really armed at supporting families and individuals who find themselves in crisis.

There is no one single approach to these issues, right?

You have to look at a human, a human comes in one door, maybe asking for one type of help, but often needs a variety of services to really heal trauma or to really support that individual or a broader family system.

And so we very much want to be focused on family systems, right?

It's atypical to find that one person is solely in crisis, right?

The family has to heal, especially if we're talking about children.

And so our agency is really thinking about that holistic approach for individuals, how to meet the needs of an individual and of a family.

Peggy Huppert: NAMI is the largest and oldest grassroots organization in the United States, addressing issues around mental health.

And our aim is to educate advocate and support people who are dealing with challenges around mental illness.

Brian Carico: We were asking schools if they wanted to be, you know, trained in youth mental health first aid because one of the things that, you know, when I was the principal at Johnston, I felt that we did a pretty good job of making people aware of mental health and you know, working with kids that struggle and this and that.

And I realized that our staff, as good as we were at it, still missed some things me included with Cameron.

And so I thought to myself that if we where we thought we were doing pretty good missed some things, I could only imagine what other schools that weren't even trying yet for mental health could use.

And so we started doing that youth mental health first aid training and our goal was to train a hundred teachers a year for the next 10 years.

Brian Carico: You're supposed to be aware of what are the signs of, and then give reassurance, listen, and then also be able to help kids find the protective factors within their family or within the community and then also to advocate for themselves and for more education for learning about what's going on with themselves.

So the whole process is basically that you're going to assess the risk and in the youth mental health first aid they talk about the big A and then they talk about the little a.

The little a are the things and the signs and the symptoms that are building and that we start to see, withdrawal of kids, dropping grades, those different things.

And then the big A is the assessing whether or not there's a suicidal ideation.

And then we also spend a lot of time learning how to listen.

And that's one of the things that I think a lot of us as adults, a lot of us as educators think we know how to listen.

But we often don't take the time to hear the words and put them together with what the kids are showing.

If you ask them if they're suicidal and they're not, you're not going to hurt them.

And then if they are, it opens that door for them to be able to have that conversation and to really dig into that relationship or that listening to that student to find out more, to make sure we get them to the right place.

Peggy Huppert: You have to be able to talk about it and talk it through because if the person is willing to be vulnerable enough to share that that's what's happening with them, then we as their loved ones have to be prepared to help them.

No matter what that is, it's listening, it's referring them to professional, it's whatever that is.

Larry Loss: He had a very tumultuous childhood.

He was in and out of orphanages a couple of times.

He had lived with some various family members who obviously hadn't been able to give him the appropriate care that he needed.

Mary Neubauer: And we knew obviously that your life was not sunshine and roses if you ended up in a Russian orphanage.

And so, as Larry said, Sergei was able to speak English really quickly.

And so as soon as he was conversational in English, we started family counseling with him because we knew there were things that he was going to need to deal with in his life.

And he did well for several years, but then as those late teenage years progressed his mental health just really took a nose dive.

He ended up being diagnosed with severe depression, anxiety, PTSD, and survivor's guilt from his years in Russia.

And so some people have said, well, his issues are Russian issues or Eastern European issues.

And I would say to them, and I say to anyone, no, don't do that.

There are children here who are experiencing the same kinds of trauma and abuse that Sergei experienced, and that is going to lead them to have trouble in their later years as well.

Jennifer Ulie-Wells: I've been in education for over two decades and I've been doing advocacy for over a decade.

And one of the things that continues to frustrate me the most is that you do not need to have any expertise to be a decision-maker in this state or any other state.

So I may have no expertise whatsoever in mental health, but I'm making decisions based on what I think mental health is.

So when I'm up at the Capitol and I'm talking to legislators and they say to me, Jen, mental health is not really a thing, it's just bad parenting, it's very, very frustrating because that's not accurate.

It's not evidence based, it's not science based.

And it totally dismisses an entire experience that we know millions of people are going through.

And when you have that mentality that means that you're also not being an advocate for the constituents that you represent, which is why in the state of Iowa, we have a children's mental health system built out of toothpicks.

So when you look at a mental health system that is built out of toothpicks and then you have a catastrophe like COVID that comes blowing through, of course your system's going to blow down.

So it's not surprising that during COVID we saw an exacerbation of mental health issues.

In the nation we actually saw a decrease of about 5% of the suicide rate.

In Iowa it has increased.

It's because we're lacking a comprehensive, fully funded mental health system that's driven by experts in the state.

Mary Neubauer: We just have such a lack of providers, especially providers who have the specialization of working with children.

And so, you know, really from the top to the bottom, we need more.

And I don't think there is one magic solution to the situation.

That's why we've been looking at, you know, loan forgiveness for providers, trying to establish more psychiatric residencies at the University of Iowa, tiered reimbursement for hospitals so that they receive more money to care for those who are most seriously ill. ♪♪ Peggy Huppert: When I hear from the people who have attempted suicide and survived it, how they describe it is such overwhelming pain and a belief that the world, including the people closest to them, will be better off without them, that the only solution is to end their life.

So when I hear people say, oh, how selfish they are, it was the cowardly thing to do, I get kind of angry, honestly, because to be in the shoes of that person and to know and understand the depths of despair and anguish that they are in to do this, no one can imagine it unless they've lived it.

Jennifer Ulie-Wells: We have a whole contingency of families that are dealing with kids that have mental health issues, but they're petrified to tell others.

There's a big difference in my child who is being hospitalized for maybe an asthma attack and then you see your friends and your family doing meal trains.

How can I support you?

Let's bring the balloons over and the gifts.

If your child is hospitalized for a psychiatric disorder, it's very isolating.

You don't get the meal trains.

You don't see people saying, hey, how can I help you?

Instead, what we see are a lot of judgment.

That's because of the stigma.

Brian Carico: My father also completed suicide.

And I remember the obituary was died by self-inflicted gunshot wound.

And at that time, you know, 23 years ago, I was horrified.

I didn't want anybody to know that my father died by suicide.

I didn't want them to know that he suffered from depression.

You know, just not something that a strong 54 year old male does, you know.

And then with Cameron's suicide, we were very open about it.

And so that process for us was to realize that when we don't talk about it and we don't try to help kids is what increases the stigma.

When we don't reach out to help, we tell that student that they should be ashamed of what they're feeling.

And so, you know, it is very important as a school and as a society to really help with that stigma.

Mary Neubauer: And I compare it to, you know, if you have a broken arm, the doctor says, here's the specialist you need to go see.

If you have heart disease, the doctor says, here's the specialist you need to go see.

Sergei was seriously ill, struggling for his life.

We knew that.

And we would turn to the psychiatrists and the staff at the hospital, and we would say, where can he go to get the help that he would need?

And they would say, we don't know.

And they would say, we know that there are programs out there, but you will have to find it.

And as his parents, that was devastating, frightening.

I don't even know all of the descriptors to put on it.

♪♪ Peggy Huppert: A suicide is devastating for anyone who experiences it, but it is particularly devastating to the parent of a child because there's so much guilt attached to that.

I could have done something else.

I should have done something else.

It's devastating.

Brian Carico: The piece that, you know, by being the principal of the school and by being a part of the community I took on myself personally a lot of guilt, a lot of questioning myself.

My son died and yet I'm supposed to take care of these kids.

Why would parents even want to know anything about what I didn't know because that feeling of a lot of questioning of yourself is normal, is a part of the grieving process.

And we didn't know how to respond to people.

So we kind of stepped back because a lot of our identity was we're Cameron's parents, a lot of the people that we were friends with and did things with was because we were Cameron's parents.

And so we kind of pulled back away from that a little bit.

And I think that the piece that I would say is make sure you continue to live for you.

It's a hard piece, but there are other things.

We talk a lot about what we wanted to do for our daughter then and that's a whole ball of wax.

You question your parenting skills a lot and then you try to raise another teenager and everything you're looking at you're questioning.

So I think what I would tell other parents is seek the help, seek the support because it's out there.

And don't be afraid to say that I need it.

Dawn Carico: I echo what Brian says.

I mean, your confidence takes a big hit and you still 10 years later, we have a lot of people coming.

We have a lot of people and I don't want anybody to stop, but people will come and ask questions too.

And you don't know the answers, but we do know a little bit to help people take a next step.

Jennifer Ulie-Wells: A lot of times when we're doing this work, it's very frustrating.

So whether you're a parent that you're not, your family isn't being served, or you're a young person and you're not being served, or you're an educator and you're not being served and all these needs aren't being met, we oftentimes want to find blame and we want to point to each other because we're so desperate for who's causing this.

We have to recognize that it's a systems issue.

People are doing the best that they can with what they have, but oftentimes they haven't been trained, they haven't been prepared and even when they're desperately trying to find resources, the resources don't exist.

So our systems have to do better.

Our decision makers have to do better.

They have to start educating themselves.

They have to start looking at the evidence.

They have to start talking to the experts.

And they have to be doing the best that they can.

Otherwise they're standing by and ruining lives.

And that just can't be acceptable anymore.

We can't keep losing kids.

We can't keep seeing people die by the hands of suicide when all of this is preventable.

Mary Neubauer: So many times I hear families say, what did I miss?

Why didn't I see it?

Why couldn't I have done better?

It's like, you didn't see it because they didn't want you to see it.

And you were not going to be able to save that person.

That person had to find their way through their pain and through, you know, their illness themselves.

And that's the hardest part for, I know for me.

And I believe for you as well.

It's like we did move heaven and Earth to try to help Sergei, but it just wasn't enough.

And that's the hardest part.

But there are other families in that same situation.

I mean, someone is sick with cancer and you would do anything to save them, right?

But in some situations it just isn't enough.

Larry Loss: Well, and I think it's important that they understand that if their loved one happens to take their own life, it doesn't mean that they did anything wrong.

Mary Neubauer: It still hits you after all this time.

It's hard.

Larry Loss: It is.

Because you can second guess yourself.

Could we have done this?

Could we have done that?

♪♪ You just can't beat yourself up about it.

♪♪ Brian Carico: Be the person that is willing to reach out, you know, to show kindness and to show some acceptance and to show -- the number one protective factor for our kids is one caring adult outside of the family whether that's at school, whether that's at church, whether that's a coach, whether that's a mentor.

Be that person.

Be the person that steps up and says, you know, I'd really like to help.

Mary Neubauer: I would say for anyone who is in that amount of pain, I don't know that I understand, but I see your struggle.

And I am so, so sorry that you're, that you're having that struggle.

I would also tell them that it gets better, that it can get better and that you can find your way through it.

And there are people who will help you, who are around you who will help you.

And I also would say -- sorry this is hard.

I also would say, the world needs you.

I look at, as I said, I still remember all the young people who came up to us at Sergei's visitation and funeral and even years and years later who have told us what an impact he had on their lives.

And I think about the difference that he could have continued to make if he could have found his way through.

And so the world needs you.

And if you can just reach out for help, help will be there.

♪♪ If you are thinking about suicide or if you or someone you know is in emotional crisis call or text 988 anytime for confidential free crisis support.

Funding provided by the Delta Dental of Iowa Foundation.