Nearly 4,000 teen-agers and young adults committed suicide in the U.S. in 1999, at a rate almost triple what it was 50 years ago. It's the third-leading cause of death among young people aged 15-24, behind unintentional injury and homicide.
Dr. Doug Gray, a child and adolescent psychiatrist at the University of Utah, has an idea for lowering that number -- put good suicide prevention programs in juvenile detention and corrections centers.
From August 1996 to June 1999, Gray and his colleagues tracked 151 teens who committed suicide in Utah. He found that nearly two-thirds had previous contact with the juvenile justice system.
"And most of them had multiple contacts," Gray said.
His conclusion: once teens get arrested, or otherwise get pulled into juvenile justice, their chances of some day committing suicide increase five-fold. "And the more often you have involvement with the juvenile justice system, the greater risk you have for suicide."
But his findings also suggest that the local detention center, with its literally captive audience, may be a good place to reach teens most at risk for suicide.
"When we've thought about suicide prevention, we've always thought about schools, and that's not bad," Gray observed. "But a lot of these kids are not in school."
Teen suicide is, almost by definition, a mental health issue. Dr. David Brent, the University of Pittsburgh's internationally recognized expert on teen suicides, found in a five-year study that nine of 10 teens and young adults who committed suicide had a definite or probable psychiatric disorder. A high number had serious mood disorders such as depression, yet only 5 to 20 percent were getting psychiatric treatment at the time of their deaths.
As Gray's research shows, many teens who commit suicide have something else in common -- at least one brush with the law, usually for minor offenses.
"These aren't gang members. It turns out that most of these kids have multiple minor offenses, usually for things like marijuana or truancy -- those kinds of things, as opposed to assault and battery, or felony burglary. They're just not functioning well, and they are not going to get better because no one's treating them," Gray said.
Gray plans to launch a study to see if involving a psychiatrist more and using intensive family counseling will make it less likely that emotionally ill teens will get into trouble with the law again.
"We want to see if this group who gets rapid access to psychiatric help does better than the group that just has the services that are available to everyone in the community. We want to show we can improve these kids' mental health, we want to reduce recidivism and we want to see if it saves money."
The final answer, he said, may be to develop a mental health system within juvenile justice, "not the typical system where you have an appointment every three weeks, but where you work with families and provide parenting classes."
It's not that justice officials are callous toward teens, he said.
"The juvenile justice system wants to help them. They just don't have the resources."
