Leah and Scot Simpson lost their son to suicide in 1992.
Trevor Simpson, 16, was a promising and seemingly well-adjusted teenager at Edmonds Woodway High School: popular, charismatic, an honors student and star member of the varsity football team. But one night in January, he left home in the Chevy Nova he bought with the savings from his paper route and never came back. The next day, the Simpsons would find out their son had killed himself.
"We couldn’t believe it," Leah said. "We kept asking ourselves, how did this happen? What did we miss?"
It’s a question too frequently asked by loved ones left behind when someone takes his own life. And when hindsight kicks in, so does rampant self blame. Off-kilter comments, misinterpreted as benign morbidity at the time, seem like obvious warning signs in retrospect. Like when Trevor told one friend just days before his death that "he wanted people to wear purple to his funeral."
But Trevor’s parents, classmates and teachers weren’t taught how to look for and properly address the signs of suicide.
It was a taboo subject that nobody wanted to talk about – much less address head-on. Gathering together after his death, Trevor’s community realized they shouldn’t be asking themselves what they missed, but why they missed it.
"We weren’t educated," she said. "Trevor might still be here if we were."
Driven to fix the gaping hole in suicide-specific community education, the Simpsons spearheaded the creation of the Youth Suicide Prevention Program (YSPP), then funded by the Washington State Department of Health. The program continued as an independent nonprofit in 1999 and has since burgeoned into the state’s leading suicide prevention organization.
YSPP aims to raise suicide awareness, improve parent/teacher education and implement peer-to-peer "Question, Persuade and Refer" training curriculums in secondary schools across the state. The Northshore School District does not currently use YSPP curricula, but Woodinville High School hopes to introduce it this school year.
According to the YSPP website, an average of two youth die by suicide every week in Washington state, while an average of 17 young people per week are hospitalized overnight for non-fatal attempts. That’s excluding any emergency room admissions, which remain unquantifiable under Washington state law. It is the third-leading cause of death in young people ages 10-24, and the second-leading cause in college students in particular, according to YSPP.
Scot and Leah Simpson use an interesting metaphor to explain this disturbing trend. "Suicide is like a slot machine," Scot said. "When you have all ‘7s,’ there’s a suicide or an attempt."
Scot said different psychological, biological, sociological and existential risk factors must all be present at once for someone to attempt suicide – a perfect storm that, like numbers lining up on a slot machine, is pretty uncommon. But he said young people face the added risk of hormone-fueled emotional instability during what is often a "socially traumatizing" point in their lives. Combine this with common mental health disorders, like Trevor’s possible attention deficit hyperactivity disorder (which is linked to low serotonin levels), and the results can be devastating.
"For some kids, one or two of these slots are always filled," he said.
Today, Scot serves on the board of directors of Forefront, a new nonprofit based at the University of Washington. While YSPP works directly with schools and students on a case-by-case basis, Forefront aims to bolster prevention training and education through big-picture legislative action.
Retired YSPP executive director Sue Eastgard and University of Washington Social Work Professor Jennifer Stuber started Forefront to carry out the policies of the Matt Adler Suicide, Treatment and Management Act of 2012. This groundbreaking piece of legislation was coauthored by Stuber and named for her late husband, who killed himself two years ago.
Stuber, who believes early detection and treatment would have saved her husband’s life, was inspired to take action after learning that many health-care professionals in Washington state are never trained in suicide assessment and treatment.
Eastgard said there were no classes on suicide intervention when she was a student at the University of Washington School of Social Work.
"The field has really neglected this as a core competency," she said.
The Matt Adler Act, the first law of its kind in the nation, requires all mental health professionals and social workers to now receive six hours of suicide-specific training every six years in order to retain their licenses.
According to Eastgard, Forefront members are currently organizing to make sure all 26,000 health-care professionals impacted by the new law have access to the training they need.
Forefront is also brainstorming the development plan for a second law it helped pass in June, following the success of the Matt Adler Act. It will require all Washington state public schools to adopt a comprehensive crisis-response plan for the prevention, intervention and "postvention" of suicidal emergencies by the 2014-2015 school year.
"Most schools do have a general crisis plan, but those only cover what to do if there’s an earthquake, or a bomb threat, or a shooter on the school grounds," Eastgard said. "Of course, this happens much more often."
The new law will force all public schools to create concrete procedures for dealing with the reality of teen suicide and depression. Leah Simpson said many schools would otherwise refuse to address the issue of suicide at all, too afraid of "stirring stuff up" and admitting there is a problem.
"It’s a taboo many people don’t even want to talk about," she said.
It will also ensure schools that already voluntarily participate in suicide prevention programs - like the YSPP program Woodinville High School plans to adopt - continue meeting minimum standards, even with future teacher and administration turnaround.
The law will further mandate that all public school counselors, nurses and new school teachers (certified after August 2014) undergo a training program on how to competently recognize and respond to suicidal behavior in students.
Eastgard said schools will ideally craft comprehensive plans that focus on educating all "gatekeepers" – including parents, teachers, counselors and peers.
"If your English teacher is worried you might take your own life, he or she will know what to do," she said. "If there’s a child cutting themselves in the bathroom, the school will know what to do. If a child dies by suicide, there is a procedure about how to handle that."
As Forefront works to carry out these macro-level changes, a recent grant facilitated the organization’s launch of "Husky Help + Hope," a campus-wide outreach program geared specifically toward college students at the University of Washington.
"The UW provides counseling and other services to students in need, but, until now we have not had the resources to implement a large scale prevention and education program like that promised by Husky Help & Hope," said Ellen Taylor, UW Counseling Center director, in a press release.
The three-year HHH plan includes improving resource accessibility, partnering with student groups for mental health promotion, and creating mandatory suicide-assessment training programs for graduate students about to enter the fields of health care and social work.
"Education is the key word," Scot said.
(MELANIE ENG is a student in the University of Washington Department of Communication News Laboratory.)