A two-year study focusing on the relationship between social environments and youth suicide could provide a “partial roadmap” for schools and communities looking to improve the promotion of mental health, according to its lead researcher. The Littleton Public Schools (LPS) district was part of the national study.

The findings of the Social Worlds and Youth Wellbeing Study are detailed in a 66-page report, published in October, that caps two years of research at four LPS high schools.

Leading the study is Dr. Anna Mueller, a professor of sociology at Indiana University. Mueller said schools are at the forefront of suicide prevention but need bolstered safety nets and resources to ensure students' well-being. 

“Schools really are taking on a world of burdens that kids are facing,” Mueller said. “We're having schools do more and more to support our children … with less and less resources.”

Through 192 interviews with students, staff, parents and mental health providers as well as more than 2,000 surveys of parents, guardians and staff, Mueller and her team identified mental health pain points for students and the gaps in schools' safety nets. 

The study comes after years of tragedy for LPS. A 2013 shooting at Arapahoe High School left student Claire Davis and her killer dead. At the same high school, several students have since died by suicide, including two that were back-to-back in 2018. It's left the district eager to engage more in mental health promotion. 

“I think those tragedies and challenging experiences had really primed the district to take mental health more seriously, perhaps ahead of many districts across the United States,” Mueller said.

But LPS, and its community, still have room to improve, said Mueller, who added that while much of the study's findings relate to aspects of LPS, the solutions it presents are universal. 

“All districts need this research,” she said. “Because there's this tremendous gap in our understanding of how to prevent suicide, and even prevent other types of tragedies, like school shootings.”

The study comes as teen suicides continue to climb in Colorado and across the country. According a report from the Centers for Disease Control and Prevention (CDC), rates of suicide for those aged 10 to 24 increased nearly 60% between 2007 and 2018. The COVID-19 pandemic has exacerbated the crisis, with hospital visits for mental health-related emergencies among those aged 10 to 17 up 31% in 2020 compared to the year before, according to the CDC.

Colorado has seen a similar trend. In 2020 there were 213 suicides among those aged 10 to 24, a record high since 2004, according to the Colorado Department of Public Health and Environment.

Making mental health a 'priority of schooling'

Mueller's study found that one of the main drivers of teenage mental health problems was feeling pressure to meet expectations as students. This mostly came from parents, students said, who hold their children to high standards given the LPS district's reputation for academic success. 

But this push for straight As and high test scores can create an unhealthy strain on students' well-being, the study found, and can leave a teenager's mental, social and emotional health pushed to the wayside. 

“If we want to support children's mental health, we need to make that a priority of schooling,” Mueller said. 

LPS students described “piles of homework, no free time and expectations to juggle multiple AP or IB classes,” according to the study. 

One student interviewed said his high school is known for having a “toxic” culture but he chose to attend it over others for its apparent academic rigor in hopes it would pay off with acceptance to a good college. 

The study also found that many students who knew people who died by suicide also dealt with drug addiction, something the study said “is often used as a mechanism to relieve the pressure teens face in and out of school.”

“Definitely drugs, drugs, drugs play a huge part (in my friends' suicides),” one student told researchers. “And no one wants to acknowledge that … almost every death has had to do with drug use.”

Nate Thompson, director of Social, Emotional & Behavior Services at LPS, said the study has shown that drug abuse needs to be a bigger part of the mental health conversation for teens. 

“Substance abuse is a big part of this mental health crisis, and you don't hear that very often,” he said. “Part of that is because it's not easy for any parent who has a kid who struggles with a mental health crisis and also addiction to say that. But kids are saying 'hey, we've got to talk about this.'”

To combat this, the study calls for schools to facilitate cultures where youths feel they can talk to adults about their issues, something that Lena Heilmann, suicide prevention strategies manager at The Colorado Department of Public Health and Environment (CDPHE), said was crucial for saving lives. 

“The research is clear that young people who feel connected really are less likely to feel suicidal, attempt suicide and die by suicide,” Heilmann said. “And the role of trusted adults is key in youth suicide prevention.”

According to the study, a school should promote mental, social and emotional development as much as it does academics. Researchers observed that, in schools that promoted all aspects of growth, students were more willing to tell staff about serious suicidal thoughts and were able to ask for help. Alternatively, at schools that focused more on academic development, researchers observed a more limited view from staff who questioned why certain students were struggling, framing issues around a lack of motivation rather than the root causes for a students' mental health struggles.

The study also points to the need for schools to make all students feel a sense of belonging. Typically, schools will celebrate their highest achievers such as valedictorians and student-athletes. While well-intentioned, spotlighting just these students can lead to unintentional feelings of isolation from other students who feel they do not fit the mold of their school, according to the study. 

One high school student told researchers, “If you're not an athlete ... then (the administration) makes it pretty clear that (it) does not care as much.” This can lead to a school culture in which students feel less supported by staff and, in turn, may be more reluctant to talk about suicide and seek mental help, the study said. 

Another student, whom researchers gave the pseudonym of “Timothy,” dealt directly with an exclusionary culture at his school, which led to bullying, according to the study. Timothy said he became depressed but did not feel comfortable talking to school staff. But after his parents forced him to tell the school what was happening, he began to develop a supportive relationship with several administrators and now feels he can go to them whenever he needs help. 

“This matches our broader observations at this school that staff really care about student well-being, though they do not always have sufficient tools to provide support,” the study said.

Families play a pivotal role in prevention 

A teenager's parents or guardians can have a major effect on how equipped a school is to identify and respond to students with mental-health struggles, the study found. But while the majority of LPS families felt that schools had some responsibility for suicide prevention, few said they would actually ask school staff for help. 

Of the more than 1,200 parents and guardians surveyed, 78% strongly agree that schools should play a role in preventing suicide but only 29% said they would turn to school staff with concerns about a child's mental health. 

Additionally, 97% agreed that schools should intervene when a student is in a mental health crisis and 83% felt it was very important for schools to include mental health in their curriculum. Yet when it came to disclosing a child's suicidal crisis to the school, parents and guardians who have faced that situation were nearly split, with 48% saying they did not tell the school.

For Mueller, this finding is the “crux of the problem” when it comes to the lack of support schools have.

“Families, and maybe even broader communities, haven't quite figured out what it means for a school to take on at least partial responsibility for suicide prevention,” Mueller said. “And so, we end up with these tensions … when it comes to 'would I ask for help from a school?' we're a little less certain.” 

By not telling school staff about a child's mental-health issues, the safety nets around suicide prevention can be severely weakened, said Mueller, whose study quotes one staff member who told researchers, “Parents need to be a part of the solution if anything is going to change for the better.”

The reasons for families' hesitations vary. Most parents and guardians surveyed, over 90%, said they worried to some degree about their child's mental health but said they were more likely to turn to therapists, other family members and even friends for help rather than school staff. For families who sought help for their child, about 67% said they faced barriers. The main reason was a child's resistance to help followed by lack of access to treatment, lack of knowledge about how to get help and an inability to afford treatment. 

Thompson said the district has ways of helping with some of those barriers. This includes on-site therapists for middle and high schoolers as well as a network of more than 200 mental-health care providers that the district can connect families to. The district's mental-health foundation will also pay for services for families in need. 

It's why dialogue between families and staff is all too important, Thompson said. 

“The vast majority of people know that schools are good places to get help, they may just not know exactly what schools can offer,” Thompson said. “Schools didn't do all this stuff when we were growing up … schools do have resources, a lot of resources, and can connect you to even more.” 

Schools can't do it alone

While Mueller's study pinpoints schools as an essential pillar for suicide prevention, the work cannot fall on staff alone, it said. 

Along with families, other aspects of teenagers' social communities, such as mental-health care providers, pediatricians and faith-based organizations, must step up to do their part in providing safe spaces for young people to express their struggles and needs, Mueller said. This, in turn, will alleviate some of the pressure on school staff, who Mueller said are already stretched too thin. 

“I spent a lot of hours sitting in the waiting rooms of school counseling offices … they are so outrageously overworked,” she said. “It breaks my heart a little bit that we're asking these people to just go above and beyond and work such long hours.”

Heilmann, the CDPHE suicide prevention manager, echoed this sentiment. 

“Suicide prevention is everyone's business, we all have a role to play,” she said. “For young people, schools are one key organization. But families are important, youth-serving organizations are important, health-care settings are important. So, we really want everyone to be involved in supporting youth suicide prevention because we all have to be.”

Another source of pain for schools is state funding, which remains low particularly in states like Colorado. Mueller's study recommends increases in school-based therapists and social workers, as well as across-the-board mental health and suicide prevention training for all staff. But that comes with a cost. 

“I do think that the funding issue is a really serious part of the challenges that limit our ability to effectively support students' well-being in schools and thus prevent suicide,” Mueller said. “So, I would really strongly urge politicians to think about that.” 

Still, the reality remains that schools, according to the study, are one of the best-positioned places in a young person's community for identifying their mental health needs and providing support. 

“Kids spend the majority of their waking hours in the school building,” Mueller said.